Lesotho - Demographic and Health Survey - 2005

Publication date: 2005

Lesotho Demographic and Health Survey 2004 Millennium Development Goal Indicators, Lesotho 2004 Goal Indicator Value 1. Eradicate extreme poverty and hunger Prevalence of underweight children under five years of age Male: 18.9% Female: 20.8% Total: 19.8% 2. Achieve universal primary education Net enrolment ratio in primary education1 Male: 81.4% Female: 87.7% Total: 84.5% Proportion of pupils starting grade 1 who reach grade 51 Male: 33.9% Female: 51.1% Total: 42.6% Literacy rate of 15-24-year olds2 Male: 75.2% Female: 91.9% Total: 87.2% 3. Promote gender equality and empower women Ratio of girls to boys in primary and secondary education Primary education: 0.97 Secondary education: 1.32 Ratio of literate women to men, 15-24 years old 1.22 Share of women in wage employment in the non-agricultural sector3 27.0% 4. Reduce child mortality Under-five mortality rate (per 1,000 live births) 113 per 1,000 Infant mortality rate (per 1,000 live births) 91 per 1,000 Proportion of 1-year-old children immunised against measles Male: 85.5% Female: 84.3% Total: 84.9% 5. Improve maternal health Maternal Mortality Ratio (per 100,000 live births) 762 per 100,000 Proportion of births attended by skilled health personnel 55.4% 6. Combat HIV/AIDS, malaria, and other diseases Condom use rate of the contraceptive prevalence rate (any modern method, currently married women 15-49) 14.5% Condom use at last high-risk sex (population age 15-24)4 Male: 47.6% Female: 50.1% Percentage of population age 15-24 years with comprehensive correct knowledge of HIV/AIDS5 Male: 18.4% Female: 25.8% Contraceptive prevalence rate (any modern method, currently married women 15-49) 35.2% Ratio of school attendance of orphans to school attendance of non-orphans age 10-14 years 1.0 7. Ensure environmental sustainability Proportion of population using solid fuels6 Urban: 9.9% Rural: 80.2% Total: 67.8% Proportion of population with sustainable access to an improved water source, urban and rural7 Urban: 90.1% Rural: 57.3% Total: 50.9% Proportion of population with access to improved sanitation, urban and rural8 Urban: 92.3% Rural: 48.0% Total: 55.8% 1 Excludes children with parental status missing 2 Refers to respondents who attended secondary school or higher and women who can read a whole sentence 3 Wage employment includes respondents who receive wages in cash or in cash and kind. 4 High risk refers to sexual intercourse with a partner who neither was a spouse nor who lived with the respondent; time frame is 12 months preceding the survey. 5 A person is considered to have a comprehensive knowledge about AIDS when they say that use of condoms for every sexual intercourse and having just one uninfected and faithful partner can reduce the chance of getting the AIDS virus, that a healthy-looking person can have the AIDS virus, and when they reject the two most common local misconceptions. The most common misconceptions in Lesotho are that AIDS can be transmitted through mosquito bites and that a person can become infected with the AIDS virus by sharing food or utensils with someone who is infected. 6 Charcoal, firewood, straw, dung, or crop waste 7 Improved water sources are: household connection (piped), public standpipe, borehole, protected dug well, protected spring, or rainwater collection. 8 Improved sanitation technologies are: connection to a public sewer, connection to septic system, pour-flush latrine, simple pit latrine, or ventilated improved pit latrine. Lesotho Demographic and Health Survey 2004 Ministry of Health and Social Welfare Maseru, Lesotho Bureau of Statistics Maseru, Lesotho ORC Macro Calverton, Maryland, USA November 2005 The 2004 Lesotho Demographic and Health Survey (2004 LDHS) is part of the worldwide MEASURE DHS project which is funded by Government of Lesotho, Development Cooperation Ireland (DCI), World Bank, UNICEF, DFID, WHO, and USAID’s Regional HIV/AIDS Program (USAID/RHAP). Additional information about the 2004 LDHS may be obtained from the Ministry of Health and Social Welfare, address. P.O. Box 514, Maseru 100, Lesotho, Southern Africa, Telephone +266-22317707 or +266-22324561, Fax +266-22311014 and the Bureau of Statistics, address P.O. Box 455, Maseru, Lesotho, Southern Africa, Telephone +266-22323852, Fax +266- 22310177. The authors’ views expressed in this publication do not necessarily reflect the views of the Government of Lesotho or the donor agencies. Additional information about the DHS project may be obtained from ORC Macro, 11785 Beltsville Drive, Calverton, MD 20705 USA; Telephone: 301-572-0200, Fax: 301-572-0999, E-mail: reports@orcmacro.com, Internet: http://www.measuredhs.com. Recommended citation: Ministry of Health and Social Welfare (MOHSW) [Lesotho], Bureau of Statistics (BOS) [Lesotho], and ORC Macro. 2005. Lesotho Demographic and Health Survey 2004. Calverton, Maryland: MOH, BOS, and ORC Macro. Contents | iii CONTENTS TABLES AND FIGURES . ix FOREWORD . xvii SUMMARY OF FINDINGS . xix MAP OF LESOTHO . xxiv CHAPTER 1 INTRODUCTION Mahlape Ramoseme 1.1 Geography, History, and Economy.1 1.1.1 Geography .1 1.1.2 History .1 1.1.3 Economy.1 1.2 Population .1 1.3 Objectives of the Survey .2 1.4 Organisation of the Survey .3 1.5 Sample Design .3 1.6 Questionnaires.3 1.7 Haemoglobin And HIV Testing.4 1.7.1 Haemoglobin Testing .5 1.7.2 HIV Testing .5 1.8 Training and Fieldwork .6 1.9 Data Processing.6 1.10 Response Rates .7 CHAPTER 2 HOUSEHOLD POPULATION AND HOUSING CHARACTERISTICS John Nkonyana 2.1 Household Population by Age and Sex.9 2.2 Household Composition .11 2.3 Educational Attainment of Household Members.11 2.4 Housing Characteristics .17 2.5 Household Durable Goods .19 2.6 Residency Status .20 CHAPTER 3 CHARACTERISTICS OF SURVEY RESPONDENTS 3.1 Background Characteristics of Respondents.23 3.2 Educational Attainment and Literacy .23 3.3 Access to Mass Media .29 3.4 Employment .31 3.4.1 Employment Status.31 iv │ Contents 3.4.2 Occupation.34 3.4.3 Type of Employer, Form of Earnings, and Continuity of Employment.36 3.4.4 Control Over Earnings and Women’s Contribution to Household Expenditures .37 3.5 Women’s Empowerment .40 3.5.1 Women’s Participation in Decisionmaking .40 3.5.2 Women’s Attitudes Towards Wife Beating.43 3.5.3 Attitudes Towards Refusing Sex with Husband.46 CHAPTER 4 FERTILITY LEVELS, TRENDS, AND DIFFERENTIALS 4.1 Introduction.51 4.2 Current Fertility.51 4.3 Fertility by Background Characteristics .52 4.4 Fertility Trends .53 4.5 Children Ever Born and Children Surviving.54 4.6 Birth Intervals.55 4.7 Age at First Birth.57 4.8 Teenage Fertility.58 CHAPTER 5 FAMILY PLANNING 5.1 Knowledge of Contraceptive Methods.61 5.2 Ever Use of Contraception .65 5.3 Current Use of Contraceptive Methods .67 5.4 Trends in Contraceptive Use .68 5.5 Differentials in Contraceptive Use by Background Characteristics.69 5.6 Current Use of Contraceptives by Women’s Status.71 5.7 Timing of First Use of Contraception .72 5.8 Knowledge of the Fertile Period .73 5.9 Source of Contraception .73 5.10 Informed Choice.74 5.11 Future Use of Contraception .76 5.12 Reasons for Not Intending to Use .76 5.13 Preferred Method for Future Use .77 5.14 Exposure to Family Planning Messages .78 5.15 Contact of Nonusers with Family Planning Providers .80 5.16 Discussion of Family Planning .81 5.17 Attitudes of Respondents Towards Family Planning .82 CHAPTER 6 OTHER PROXIMATE DETERMINANTS OF FERTILITY 6.1 Introduction.87 6.2 Marital Status .87 6.3 Polygyny .88 6.4 Age at First Marriage .89 6.5 Age at First Sexual Intercourse.91 Contents | v 6.6 Recent Sexual Activity .93 6.7 Postpartum Amenorrhoea, Abstinence, and Insusceptibility.96 6.8 Termination of Exposure to Pregnancy .98 CHAPTER 7 FERTILITY PREFERENCES 7.1 Desire for More Children .99 7.2 Need for Family Planning Services. 102 7.3 Ideal Family Size . 107 7.4 Wanted and Unwanted Fertility . 109 7.5 Ideal Family Size and Unmet Need by Women’s Status. 111 CHAPTER 8 INFANT AND CHILD MORTALITY 8.1 Levels and Trends in Infant and Child Mortality. 114 8.2 Socioeconomic Differentials in Infant and Child Mortality . 115 8.3 Demographic Differentials in Infant and Child Mortality. 117 8.4 Differentials in Infant and Child Mortality by Women’s Status . 118 8.5 High-Risk Fertility Behaviour . 119 CHAPTER 9 MATERNAL AND CHILD HEALTH Mahlape Ramoseme 9.1 Antenatal Care . 123 9.2 Delivery Care. 128 9.3 Birth Registration. 133 9.4 Postnatal Care. 135 9.5 Reproductive Health Care and Women’s Status . 136 9.6 Vaccination of Children. 137 9.7 Acute Respiratory Infection and Fever . 141 9.8 Diarrhoeal Disease. 143 9.9 Child Health Indicators and Women’s Status. 148 9.10 Women’s Perceptions of Problems in Obtaining Health Care . 149 9.11 Health Card/Bukana. 151 9.12 Smoking and Alcohol Use . 152 CHAPTER 10 NUTRITION Mahlape Ramoseme 10.1 Breastfeeding and Supplementation . 157 10.1.1 Initiation of Breastfeeding . 157 10.1.2 Infant and Young Child Feeding . 159 10.1.3 Complementary Feeding. 162 10.1.4 Frequency of Foods Consumed by Children. 163 10.2 Micronutrients . 164 10.2.1 Iodisation of Household Salt . 164 10.2.2 Vitamin A Intake among Children . 165 vi │ Contents 10.2.3 Vitamin A Intake among Women . 167 10.2.4 Prevalence of Anaemia in Children . 168 10.2.5 Prevalence of Anaemia in Women . 170 10.2.6 Prevalence of Anaemia in Children by Anaemia Status of Mother. 170 10.3 Nutritional Status of Children Under Five . 172 10.3.1 Stunting . 173 10.3.2 Wasting . 175 10.3.3 Underweight. 175 10.4 Nutritional Status of Women. 176 CHAPTER 11 HIV/AIDS-RELATED KNOWLEDGE, ATTITUDES, AND BEHAVIOUR John Nkonyana 11.1 Introduction. 179 11.2 Knowledge of AIDS and HIV Transmission . 180 11.2.1 Awareness of AIDS. 180 11.2.2 Knowledge of Ways to Reduce AIDS Transmission . 182 11.2.3 Rejection of Misconceptions about AIDS Transmission. 184 11.2.4 Knowledge of Mother-to-Child Transmission. 187 11.3 Stigma Towards HIV-Infected People . 189 11.4 Attitudes Towards Negotiating Safer Sex. 192 11.5 Adult Support for Education about Condom Use. 194 11.6 Multiple Sexual Partnerships . 195 11.7 Paid Sex and Condom Use. 198 11.8 Testing for HIV and Knowledge of Source of Test . 200 11.9 Self-Reporting of Sexually Transmitted Infections. 206 11.10 Male Circumcision . 208 11.11 Prevalence of Injections . 210 11.12 HIV/AIDS-Related Knowledge and Behaviour among Youth . 212 11.12.1 Knowledge of HIV Transmission and Source for Condoms . 212 11.12.2 Age at First Sex among Youth . 214 11.12.3 Higher-Risk Sex among Youth . 219 11.13 Orphanhood and Children’s Living Arrangements . 225 CHAPTER 12 HIV PREVALENCE AND ASSOCIATED FACTORS 12.1 Coverage of HIV Testing. 230 12.2 HIV Prevalence . 233 12.2.1 HIV Prevalence by Socioeconomic Characteristics . 233 12.2.2 HIV Prevalence by Other Sociodemographic Characteristics . 236 12.2.3 HIV Prevalence by Sexual Behaviour. 237 12.2.4 HIV Prevalence by Other Characteristics Related to HIV Risk . 239 12.2.5 HIV Prevalence and Male Circumcision . 240 12.2.6 HIV Prevalence and Youth . 242 12.2.7 HIV Prevalence among Cohabiting Couples . 244 12.2.8 Nutrition Status, Anaemia Level, and HIV Status . 245 12.2.9 HIV Prevalence and Fertility. 246 Contents | vii 12.2.10 HIV Prevalence and Child Mortality . 246 12.3 Distribution of the HIV Burden in Lesotho . 247 CHAPTER 13 TUBERCULOSIS Dr. Davis Rumisha 13.1 Background on Tuberculosis . 249 13.2 Respondents’ Knowledge of Tuberculosis . 249 13.3 Self-Reported Diagnosis, Symptoms, and Treatment. 254 13.4 Willingness to Work with Someone Who Has Previously been Treated for Tuberculosis. 260 CHAPTER 14 ADULT AND MATERNAL MORTALITY 14.1 Data. 263 14.2 Estimates of Adult Mortality. 264 14.3 Estimates of Maternal Mortality . 266 CHAPTER 15 FATHER’S PARTICIPATION IN FAMILY HEALTH CARE 15.1 Advice or Care during Antenatal, Delivery, and Postnatal Periods. 267 15.2 Contact with Health Care Providers . 268 15.3 Knowledge of Pregnancy Complications. 270 15.4 Knowledge of ORS Packets and Feeding Practices During Diarrhoea. 270 REFERENCES .273 APPENDIX A SAMPLE IMPLEMENTATION . 275 APPENDIX B ESTIMATES OF SAMPLING ERRORS. 281 APPENDIX C DATA QUALITY TABLES . 293 APPENDIX D PERSONS INVOLVED IN THE 2004 LESOTHO DEMOGRAPHIC AND HEALTH SURVEY. 299 APPENDIX E QUESTIONNAIRES . 303 Tables and Figures | ix TABLES AND FIGURES Page CHAPTER 1 INTRODUCTION Table 1.1 Basic demographic indicators. 2 Table 1.2 Results of the household and individual interviews. 7 CHAPTER 2 HOUSEHOLD POPULATION AND HOUSING CHARACTERISTICS Table 2.1 Household population by age, sex, and residence. 10 Table 2.2 Household composition. 11 Table 2.3.1 Educational attainment of household population: women. 12 Table 2.3.2 Educational attainment of household population: men . 13 Table 2.4 School attendance . 14 Table 2.5 School attendance ratios . 16 Table 2.6 Grade repetition and dropout rates. 17 Table 2.7 Household characteristics . 18 Table 2.8 Household durable goods . 20 Table 2.9 Residency status. 21 Figure 2.1 Population pyramid . 10 Figure 2.2 Percentage of males and females currently attending school, by age . 14 CHAPTER 3 CHARACTERISTICS OF SURVEY RESPONDENTS Table 3.1 Background characteristics of respondents . 24 Table 3.2.1 Educational attainment by background characteristics: women . 25 Table 3.2.2 Educational attainment by background characteristics: men. 26 Table 3.3.1 Literacy: women. 27 Table 3.3.2 Literacy: men. 28 Table 3.4.1 Exposure to mass media: women. 29 Table 3.4.2 Exposure to mass media: men. 30 Table 3.5.1 Employment status: women . 32 Table 3.5.2 Employment status: men. 33 Table 3.6.1 Occupation: women. 34 Table 3.6.2 Occupation: men . 35 Table 3.7.1 Type of employment: women. 36 Table 3.7.2 Type of employment: men. 37 Table 3.8.1 Decision on use of earnings and contribution of earnings to household expenditures: women . 38 Table 3.8.2 Decision on use of earnings and contribution of earnings to household expenditures: men. 39 Table 3.9 Women's control over earnings . 40 Table 3.10 Women’s participation in decisionmaking. 41 x | Tables and Figures Table 3.11 Women's participation in decisionmaking by background characteristics. 42 Table 3.12.1 Attitude towards wife beating: women. 44 Table 3.12.2 Attitude towards wife beating: men . 45 Table 3.13.1 Attitude towards refusing sex with husband: women. 47 Table 3.13.2 Attitude towards refusing sex with husband: men. 48 Table 3.14 Reprimanding for refusing sex with husband . 50 Figure 3.1 Access to mass media . 31 CHAPTER 4 FERTILITY LEVELS, TRENDS, AND DIFFERENTIALS Table 4.1 Current fertility . 51 Table 4.2 Fertility by background characteristics . 52 Table 4.3 Trends in fertility. 53 Table 4.4 Trends in age-specific fertility rates. 54 Table 4.5 Children ever born and living. 55 Table 4.6 Birth intervals. 56 Table 4.7 Age at first birth . 57 Table 4.8 Median age at first birth by background characteristics. 58 Table 4.9 Teenage pregnancy and motherhood. 59 Figure 4.1 Total fertility rate by background characteristics . 53 Figure 4.2 Total fertility rates, Lesotho 1976-2004. 54 CHAPTER 5 FAMILY PLANNING Table 5.1.1 Knowledge of contraceptive methods: women. 62 Table 5.1.2 Knowledge of contraceptive methods: men . 63 Table 5.2 Knowledge of contraceptive methods by background characteristics . 64 Table 5.3.1 Ever use of contraception: women. 65 Table 5.3.2 Ever use of contraception: men. 66 Table 5.4 Current use of contraception: women. 67 Table 5.5 Trends in current contraceptive use . 68 Table 5.6 Current use of contraception by background characteristics: currently married women . 70 Table 5.7 Current use of contraception by women's status. 72 Table 5.8 Number of children at first use of contraception . 73 Table 5.9 Knowledge of the fertile period. 73 Table 5.10 Source of contraception. 74 Table 5.11 Informed choice . 75 Table 5.12 Future use of contraception . 76 Table 5.13 Reason for not intending to use contraception . 77 Table 5.14 Preferred method of contraception for future use. 78 Table 5.15 Exposure to family planning messages . 79 Table 5.16 Contact of nonusers with family planning providers . 80 Table 5.17 Discussion of family planning with husband . 81 Table 5.18 Discussion of family planning: currently married men . 82 Table 5.19 Attitudes towards family planning: currently married women . 83 Table 5.20 Attitudes towards family planning: all men. 84 Tables and Figures | xi Table 5.21 Men's attitude about contraception. 85 Table 5.22 Men's attitudes towards condoms. 86 Figure 5.1 Current use of family planning among currently married women age 15-49, selected countries in East Africa and Southern Africa. 69 Figure 5.2 Current use of any contraceptive method among currently married women age 15-49, by background characteristics. 71 Figure 5.3 Percent distribution of currently married women currently using contra- ception by person responsible for the decision to use family planning . 71 CHAPTER 6 OTHER PROXIMATE DETERMINANTS OF FERTILITY Table 6.1 Current marital status . 87 Table 6.2 Polygyny: Currently married men. 88 Table 6.3.1 Age at first marriage: women . 89 Table 6.3.2 Age at first marriage: men . 90 Table 6.4 Median age at first marriage. 91 Table 6.5 Age at first sexual intercourse . 92 Table 6.6 Median age at first intercourse . 93 Table 6.7.1 Recent sexual activity: women. 94 Table 6.7.2 Recent sexual activity: men. 95 Table 6.8 Postpartum amenorrhoea, abstinence, and insusceptibility. 96 Table 6.9 Median duration of postpartum insusceptibility by background characteristics . 97 Table 6.10 Menopause. 98 Figure 6.1 Percentage of currently married men who have more than one wife . 89 CHAPTER 7 FERTILITY PREFERENCES Table 7.1 Fertility preferences by number of living children . 99 Table 7.2 Desire to limit childbearing . 101 Table 7.3 Need for family planning among currently married women. 103 Table 7.4.1 Need for family planning among all women. 105 Table 7.4.2 Need for family planning among women who are not currently married . 106 Table 7.5 Ideal number of children . 107 Table 7.6 Mean ideal number of children by background characteristics . 108 Table 7.7 Fertility planning status. 109 Table 7.8 Wanted fertility rates. 110 Table 7.9 Ideal number of children and unmet need by women's status . 111 Figure 7.1 Fertility preferences of currently married women age 15-49. 100 CHAPTER 8 INFANT AND CHILD MORTALITY Table 8.1 Early childhood mortality rates . 114 Table 8.2 Early childhood mortality rates by socioeconomic characteristics. 116 Table 8.3 Early childhood mortality rates by demographic characteristics. 117 Table 8.4 Early childhood mortality rates by women's status . 119 Table 8.5 High-risk fertility behaviour . 121 xii | Tables and Figures Figure 8.1 Trends in infant, child, and under-five mortality, 2001 LDS and 2004 LDHS . 115 Figure 8.2 Under-five mortality by background characteristics . 116 Figure 8.3 Under-five mortality by socioeconomic characteristics . 118 CHAPTER 9 MATERNAL AND CHILD HEALTH Table 9.1 Antenatal care. 124 Table 9.2 Number of antenatal care visits and timing of first visit . 125 Table 9.3 Components of antenatal care . 126 Table 9.4 Tetanus toxoid injections . 128 Table 9.5 Place of delivery . 129 Table 9.6 Assistance during delivery . 131 Table 9.7 Delivery characteristics . 133 Table 9.8 Birth registration . 134 Table 9.9 Postnatal care by background characteristics . 136 Table 9.10 Reproductive health care by women's status . 137 Table 9.11 Vaccinations by source of information. 138 Table 9.12 Vaccinations by background characteristics . 140 Table 9.13 Vaccinations in first year of life. 141 Table 9.14 Prevalence and treatment of symptoms of ARI and fever. 142 Table 9.15 Disposal of children's stools. 144 Table 9.16 Prevalence of diarrhoea . 145 Table 9.17 Knowledge of ORS packets . 146 Table 9.18 Diarrhoea treatment . 147 Table 9.19 Feeding practices during diarrhoea . 148 Table 9.20 Children's health care by women's status. 149 Table 9.21 Problems in accessing health care . 150 Table 9.22 Health card/Bukana . 151 Table 9.23.1 Use of smoking tobacco: women . 152 Table 9.23.2 Use of smoking tobacco: men. 153 Table 9.24 Use of alcohol. 154 Figure 9.1 Antenatal care, tetanus vaccinations, place of delivery, and delivery assistance. 130 Figure 9.2 Percentage of children age 12-23 months with specific vaccinations, according to health cards or mother’s reports. 139 CHAPTER 10 NUTRITION Table 10.1 Initial breastfeeding. 158 Table 10.2 Breastfeeding status by age . 159 Table 10.3 Median duration and frequency of breastfeeding . 161 Table 10.4 Foods consumed by children in the day or night preceding the interview. 162 Table 10.5 Frequency of foods consumed by children in the day or night preceding the interview. 163 Table 10.6 Iodisation of household salt. 165 Table 10.7 Micronutrient intake among children . 166 Table 10.8 Micronutrient intake among mothers . 168 Tables and Figures | xiii Table 10.9 Prevalence of anaemia in children . 169 Table 10.10 Prevalence of anaemia in women . 171 Table 10.11 Prevalence of anaemia in children by anaemia status of mother. 172 Table 10.12 Nutritional status of children . 174 Table 10.13 Nutritional status of women by background characteristics. 177 Figure 10.1 Breastfeeding practices by age . 160 CHAPTER 11 HIV/AIDS-RELATED KNOWLEDGE, ATTITUDES, AND BEHAVIOUR Table 11.1 Knowledge of AIDS. 181 Table 11.2 Knowledge of HIV prevention methods. 183 Table 11.3.1 Misconceptions and comprehensive knowledge about AIDS: women . 185 Table 11.3.2 Misconceptions and comprehensive knowledge about AIDS: men. 186 Table 11.4 Knowledge of prevention of mother-to-child transmission of HIV. 188 Table 11.5.1 Accepting attitudes towards those living with HIV: women . 190 Table 11.5.2 Accepting attitudes towards those living with HIV: men . 191 Table 11.6 Attitudes towards negotiating safer sex . 193 Table 11.7 Adult support for education about condom use to prevent AIDS. 194 Table 11.8.1 Multiple sexual partners and higher-risk sexual intercourse in the past 12 months: women . 196 Table 11.8.2 Multiple sexual partners and higher-risk sexual intercourse in the past 12 months: men . 197 Table 11.9 Payment for sexual intercourse: men . 199 Table 11.10.1 Coverage of prior HIV testing: women . 201 Table 11.10.2 Coverage of prior HIV testing: men. 202 Table 11.11.1 Knowledge of and source for HIV testing: women. 204 Table 11.11.2 Knowledge of and source for HIV testing: men . 205 Table 11.12 Pregnant women who received information and counselling about HIV/AIDS. 206 Table 11.13 Self-reporting of sexually transmitted infections (STI) and STI symptoms. 207 Table 11.14 Male circumcision. 209 Table 11.15 Prevalence of injections . 211 Table 11.16 Comprehensive knowledge about AIDS and of a source of condoms among youth . 213 Table 11.17 Age at first sex among young women and men . 215 Table 11.18 Condom use at first sexual intercourse among youth. 216 Table 11.19 Premarital sexual intercourse and condom use during premarital sexual intercourse among youth . 218 Table 11.20.1 Higher-risk sexual intercourse among youth and condom use at last higher-risk intercourse in the past 12 months: women . 220 Table 11.20.2 Higher-risk sexual intercourse among youth and condom use at last higher-risk intercourse in the past 12 months: men . 221 Table 11.21 Age-mixing . 222 Table 11.22 Drunkenness during sexual intercourse among youth. 223 Table 11.23 Recent HIV tests among youth . 224 Table 11.24 Orphanhood and children's living arrangements. 226 xiv | Tables and Figures Figure 11.1 Reasons for HIV testing among women and men age 15-49 who have ever been tested . 203 Figure 11.2 Percentage of women and men reporting an STI or symptoms of an STI in the past 12 months who sought care, by source of advice or treatment . 208 CHAPTER 12 HIV PREVALENCE AND ASSOCIATED FACTORS Table 12.1 Coverage of HIV testing by sex, residence, and district . 230 Table 12.2 Coverage of HIV testing by background characteristics . 232 Table 12.3 HIV prevalence by age. 233 Table 12.4 HIV prevalence by socioeconomic characteristics. 235 Table 12.5 HIV prevalence by selected sociodemographic characteristics . 236 Table 12.6 HIV prevalence by sexual behaviour . 238 Table 12.7 HIV prevalence by other characteristics. 239 Table 12.8 HIV prevalence by prior HIV testing. 240 Table 12.9 HIV prevalence by circumcision: men. 241 Table 12.10 HIV prevalence among young people . 243 Table 12.11 HIV prevalence among couples. 244 Table 12.12 Nutritional status of women by HIV status. 245 Table 12.13 Prevalence of anaemia in women by HIV status . 245 Table 12.14 Fertility and HIV status . 246 Table 12.15 Early childhood mortality rates by mother's current HIV status. 246 Figure 12.1 HIV prevalence by age. 233 CHAPTER 13 TUBERCULOSIS Table 13.1 Knowledge of tuberculosis . 250 Table 13.2 Knowledge of specific symptoms of tuberculosis . 251 Table 13.3 Knowledge of the cause of tuberculosis. 251 Table 13.4.1 Knowledge of TB causes and transmission modes by background characteristics: women . 252 Table 13.4.2 Knowledge of TB causes and transmission modes by background characteristics: men . 253 Table 13.5.1 Experience of symptoms of tuberculosis: women . 255 Table 13.5.2 Experience of symptoms of tuberculosis: men. 256 Table 13.6.1 Reasons for not seeking treatment for symptoms of tuberculosis: women. 258 Table 13.6.2 Reasons for not seeking treatment for symptoms of tuberculosis: men. 259 Table 13.7 Diagnosis of tuberculosis . 260 Table 13.8 Positive attitudes towards those with TB. 261 Figure 13.1 Percentage of women and men who had symptoms of tuberculosis since age 15 . 257 CHAPTER 14 ADULT AND MATERNAL MORTALITY Table 14.1 Data on siblings . 264 Table 14.2 Adult mortality rates. 265 Table 14.3 Maternal mortality . 266 Tables and Figures | xv CHAPTER 15 FATHER’S PARTICIPATION IN FAMILY HEALTH CARE Table 15.1 Advice or care received by mother during pregnancy and delivery, and after delivery. 268 Table 15.2 Main reason for not receiving advice or care during pregnancy and delivery, and after delivery. 269 Table 15.3 Father’s contact with a health care provider about wife’s health and pregnancy. 270 Table 15.4 Knowledge of pregnancy complications . 271 Table 15.5 Knowledge of ORS packets and feeding practices during diarrhoea. 272 APPENDIX A SAMPLE IMPLEMENTATION Table A.1 Sample implementation: women . 275 Table A.2 Sample implementation: men. 276 Table A.3 Coverage of HIV testing among interviewed women by sociodemographic characteristics . 277 Table A.4 Coverage of HIV testing among interviewed men by sociodemographic characteristics . 278 Table A.5 Coverage of HIV testing among women who ever had sex by risk status variables . 279 Table A.6 Coverage of HIV testing among men who ever had sex by risk status variables . 280 APPENDIX B ESTIMATES OF SAMPLING ERRORS Table B.1 List of selected variables for sampling errors . 284 Table B.2 Sampling errors for national sample . 285 Table B.3 Sampling errors for urban sample. 286 Table B.4 Sampling errors for rural sample. 287 Table B.5 Sampling errors for Lowlands sample . 288 Table B.6 Sampling errors for Foothills sample . 289 Table B.7 Sampling errors for Mountains sample. 290 Table B.8 Sampling errors for Senqu River Valley sample . 291 APPENDIX C DATA QUALITY TABLES Table C.1 Household age distribution . 293 Table C.2 Age distribution of eligible and interviewed women . 294 Table C.3 Completeness of reporting . 295 Table C.4 Births by calendar years . 296 Table C.5 Reporting of age at death in days . 297 Table C.6 Reporting of age at death in months. 298 Foreword | xvii FOREWORD The 2004 Lesotho Demographic and Health Survey (LDHS) was commissioned by the Ministry of Health and Social Welfare to provide countrywide population-based information on maternal and child mortality, nutrition, fertility levels, family planning, sexually transmitted infections (STIs), HIV/AIDS and tuberculosis (TB). The findings from the survey will provide data to benchmark progress on the on- going Health Sector Reforms and at the same time complement information needs for defining global tar- gets such as the Millennium Development Goals (MDGs) and the United Nations General Assembly Spe- cial Summit on HIV/AIDS (UNGASS). The mainstay of the survey was a structured interview with a nationally representative sample of residents of more than 9,000 households on their health status, knowledge, attitudes, and behaviour. Se- lected biomarkers including anaemia and HIV testing as well as a number of anthropometric indices were also measured. The main findings of the survey included relatively high coverage for basic childhood immunisa- tions, increasing contraceptive prevalence, relatively low fertility levels and high levels of ANC atten- dance. An important aspect of the survey was the large amount of information obtained on HIV/AIDS, STIs, and TB knowledge and behaviour. The survey findings indicated high levels of infant mortality and maternal mortality and high prevalence of HIV. The Ministry of Health and Social Welfare (MOHSW) wishes to applaud the technical partner- ship between the Lesotho Bureau of Statistics (BOS) and the MOHSW during the implementation of the survey. The arrangement highlighted synergies between the two sister institutions that should be strength- ened. Among others, the joint implementation of the survey by the MOHSW and BOS ensured maximum utilisation of the resources and skills in field surveys and bio-surveys of both these institutions. The success of this survey would not have been possible without the additional financial support received from Development Cooperation of Ireland (DCI), The World Bank and United Nations Chil- dren’s Fund (UNICEF). Other supporting partners were the United Kingdom Department for International Development (DFID), the World Health Organisation (WHO) and the United States Agency for Interna- tional Development (USAID). Our sincere appreciation also goes to the District Secretaries and the various local structures, par- ticularly the Chiefs in the areas that were selected for the survey, who contributed to the success of the survey in many ways. The Ministry appreciates the dedication shown by the field coordinators, supervisors, editors, in- terviewers, laboratory staff, and data operators. Special thanks and recognition goes to the respondents who graciously gave their time to provide the information needed and undertook various tests, some of which were invasive. They can rest assured that the information provided has added value to knowledge in Lesotho and it will be treated with the highest level of confidence. xviii | Foreword The MOHSW also wishes to express its appreciation for the professional guidance received from ORC Macro, from preparation to completion of the survey. The staff from the MOHSW and BOS who worked closely with ORC Macro, for almost two years, benefited from their integrity and work ethics. They were able to pick up some best practices that will be of use in future surveys. Mrs. M. Makhakhe 2004 Lesotho Demographic and Health Survey Director Director, Health Planning and Statistics Ministry of Health and Social Welfare Summary of Findings | xvii SUMMARY OF FINDINGS The 2004 Lesotho Demographic and Health Survey (2004 LDHS) is a nationally representa- tive survey of 7,095 women age 15-49 and 2,797 men age 15-59 from 8,592 households covering 405 sample points (enumeration areas) through- out Lesotho. This survey is the first national-level population and health survey conducted as part of the global Demographic and Health Surveys (DHS) programme and is designed to provide data to monitor the population and health situation in Lesotho. The survey utilised a two-stage sample based on the 1996 Population Census and was designed to produce separate estimates for key indicators for each of the ten districts in Lesotho. Data collection took place over a three-month pe- riod, from late September 2004 to mid-January 2005. The survey obtained detailed information on fertility levels, marriage, sexual activity, fertility preferences, awareness and use of family planning methods, breastfeeding practices, nutritional status of women and young children, childhood mortal- ity, maternal and child health, awareness and be- haviour regarding HIV/AIDS, other sexually transmitted infections (STIs), and tuberculosis. In addition, the 2004 LDHS carried out anaemia test- ing in children and adults and HIV testing in adults. The 2004 LDHS was implemented by the Lesotho Ministry of Health and Social Welfare (MOHSW) in collaboration with the Lesotho Bu- reau of Statistics (BOS). Technical assistance was provided by ORC Macro through the MEASURE DHS programme. Financial support for the survey was provided by the Government of Lesotho and a number of donor agencies namely, Development Cooperation of Ireland (DCI), the World Bank, the United Nations Children’s Fund (UNICEF), the British Department for International Devel- opment (DFID), the World Health Organisation (WHO, and the United States Agency for Interna- tional Development (USAID). FERTILITY Fertility Levels and Trends. Lesotho has a wealth of demographic data. Changes in fertility lev- els over time can be tracked by examining fertility estimates from various surveys and censuses, span- ning the last three decades. Comparing data from the 2004 LDHS with that of previous censuses and sur- veys indicates that the total fertility rate (TFR) de- clined significantly over the last three decades of the 20th century, going from a high of 5.4 children per woman in the mid-1970s and 5.3 in the mid-1980s to 4.1 in the mid-1990s, 4.2 children in 2001, and 3.5 children per woman in 2004. With a current TFR of 3.5, Lesotho’s fertility rate is one of the lowest in sub- Saharan Africa. Fertility Differentials. Differentials by back- ground characteristics are marked. Rural women have more than twice as many children (4.1 children per woman) as urban women (1.9 children per woman). The total fertility rate is highest in the Mountains zone (4.9 children per woman) and lowest in the Lowlands (2.9 children per woman). As expected, a woman’s education is strongly associated with fertility. For ex- ample, the TFR decreases from 4.2 children for women with some primary education to 2.8 children for women with at least some secondary education. Fertility is also very closely related to household eco- nomic status. Women who live in households in the lowest wealth quintile have high fertility (5.2 chil- dren) while those in households in the highest wealth quintile have low fertility (2.0 children). Unplanned Fertility. Despite a steady rise in the level of contraceptive use over the last fifteen years, the 2004 LDHS data indicate that unplanned pregnan- cies are common in Lesotho. Overall, 38 percent of births in Lesotho are unwanted, while 12 percent are mistimed (wanted later). Fertility Preferences. There is considerable de- sireon the part of currently married women in Lesotho to control the timing and number of births. More than xviii | Summary of Findings half of married women (54 percent) either do not want a/nother child or are sterilised. Nationally, 43 percent of married women want to have an- other child—26 percent want a child later and 17 percent want a child soon (within two years). The 2004 LDHS results show that the mean ideal fam- ily size among women in Lesotho is 3.5 children. FAMILY PLANNING Knowledge of Contraception. Knowledge of family planning is nearly universal, with 97 percent of all women age 15-49 and 96 percent of all men age 15-59 knowing at least one modern method of family planning. Among women, the most widely known methods of family planning are the male condom (94 percent), injectables (86 percent), the pill (85 percent), and the female con- dom (72 percent). Sixty-two of women have heard of the IUCD, while 52 percent have heard of fe- male sterilisation. Use of Contraception. The contraceptive prevalence rate among married women is 37 per- cent. More than one-third of currently married women use a modern method (35 percent), while 2 percent use a traditional method. Injection, the pill, and the male condom are the most commonly used contraceptive methods, and are currently used by 15, 11, and 5 percent of currently married women, respectively. Trends in Contraceptive Use. Current use of contraception by married women decreased between the 2001 Lesotho Demographic Survey (41 percent) and the 2004 LDHS survey (37 per- cent). However, it is difficult to interpret this trend because the two surveys differed considerably in their approach to data collection regarding contra- ceptive knowledge and use, as well as sample size. Differentials in Contraceptive Use. Cur- rently married women in urban areas are more likely to use contraception (50 percent) than those in rural areas (34 percent). Considering ecological zones, married women in the Lowlands (46 per- cent) are more than twice as likely to be using contraception as women in the Mountains (22 percent). Current contraceptive use also varies markedly by district; it is highest among married women in Mafeteng (49 percent) and lowest in Mokhotlong (15 percent). With the exception of Mafeteng, for all residential categories, injectables are generally the most widely used method, followed by the pill. Contraceptive use increases with level of edu- cation, from 9 percent among currently married women with no education to 49 percent among cur- rently married women who have at least some secon- dary education. Source of Modern Methods. In Lesotho, public (government) facilities provide contraceptive methods to 57 percent of users, while 12 percent are supplied through CHAL, 19 percent through the pri- vate medical sector, and 10 percent through other pri- vate sources (e.g., shops). Most users obtain methods at fixed sites; less than 2 percent say they got their method through community-based distribution or a community health worker. The most common source of contraceptive methods in Lesotho is government health centres, which supply just over one-fourth of all users of mod- ern methods. Government hospitals supply about one- fifth of users. Somewhat surprisingly, government sources supply a larger proportion of users of pills and injections than users of long-term methods like the IUCD. Public sector providers are the most common source for male condoms followed by other sources such as shops, friends, or relatives (42, 26, and 11 per- cent, respectively). Unmet Need for Family Planning. Almost one- third of married women in Lesotho have an unmet need for family planning. Unmet need for limiting births (20 percent) is higher than unmet need for spac- ing births (11 percent). Only 55 percent of the demand for family planning is currently being met, implying that the needs of about one in two women in Lesotho are not being met. MATERNAL HEALTH Antenatal Care. A relatively high percentage of women, 90 percent, receive antenatal care from a medical professional, either from doctors (7 percent) or nurses or midwives (83 percent). One percent of women receive antenatal care from traditional birth attendants, while 9 percent do not receive any antena- tal care. The 2004 LDHS data indicate an improve- ment since the 2000 End of Decade Multiple Cluster Survey (EMICS), which reported 53 percent coverage for antenatal care from a health professional. Summary of Findings | xix Sixty percent of women received at least two doses of tetanus toxoid for their most recent birth in the five years preceding the survey, 19 percent received one tetanus toxoid injection and 18 per- cent received none. Delivery Care. Nationally, more than half of births in the five years preceding the survey (52 percent) were delivered in health facilities: 38 percent in public health facilities, 2 percent in pri- vate health facilities, and 13 in CHAL facilities. Forty-five percent of births occurred at home. The data also show that medically trained providers assisted with 55 percent of deliveries, TBAs as- sisted with 13 percent of deliveries, and relatives or friends attended 30 percent of deliveries. Postnatal Care. About one in four women (23 percent) who had a live birth in the five years preceding the survey received postnatal care within two days of delivery, 3 percent received postnatal care 3-6 days after delivery, and 2 per- cent received postnatal care 7-41 days after deliv- ery. About three-fourths of women who had a live birth in the five years preceding the survey did not receive any postnatal care. CHILD HEALTH Childhood Mortality. Data from the 2004 LDHS show an upward trend in the early child- hood mortality rates over time. Data for the most recent five-year period suggests that one of every nine children dies before reaching age five― under-five mortality is 113 deaths per 1,000 live births. About eight in ten of these deaths occur in the first year of life―infant mortality is 91 deaths per 1,000 live births and child mortality is 24 deaths per 1,000 children age one. Neonatal and postneonatal mortality each accounted for 46 deaths per 1,000 live births in the most recent five-year period. The pattern shows that deaths occurring during the neonatal and postneonatal periods account for 81 percent of all deaths under the age of five years. Childhood Vaccination Coverage. Nation- ally, 68 percent of children age 12-23 months are fully immunised, while 2 percent have received no vaccinations. Ninety-five percent of children have received BCG and the first dose of polio vaccine, while 94 percent have received the first dose of DPT. While coverage for the first dose of DPT and polio is high, the proportion of children receiving the recommended third dose of DPT and polio is lower (83 percent and 80 percent, respectively), as is the proportion receiving a measles vaccination (85 per- cent). Hepatitis B1, B2, and B3 have recently been added to the Lesotho immunisation schedule for chil- dren. Overall, 31 percent of children age 12-23 months received Hepatitis B1 vaccine, 22 percent re- ceived Hepatitis B2, and 14 percent received Hepatitis B3. Child Illness and Treatment. Among children under five years of age, 19 percent were reported to have had symptoms of acute respiratory illness in the two weeks preceding the survey and 26 percent were reported to have had fever during the same period. Of these, 54 percent were taken to a health facility or provider for treatment. Fourteen percent of children under five years had diarrhoea in the two weeks pre- ceding the survey. Thirty-one percent of children with diarrhoea were taken to a health provider. Forty-one percent of children with diarrhoea were given a solu- tion made from oral rehydration salts (ORS), 55 per- cent received recommended home fluids (RHF) and 32 percent were given increased fluids. Overall, eight in ten children received ORS, RHF, or increased fluids. NUTRITION Breastfeeding Practices. The data indicate that the majority (95 percent) of children in Lesotho are breastfed for some period of time. Sixty-three percent of infants were put to the breast within one hour of birth, and 85 percent started breastfeeding within the first day. The 2004 LDHS data indicate that supple- mentary feeding of children begins early. Among newborns less than two months of age, 27 percent are receiving supplementary foods or liquids other than water. The median duration of breastfeeding in Leso- tho is 21 months. The median duration of exclusive breastfeeding is at less than one month. One in three children under six months in Leso- tho is given a feeding bottle with a nipple. Iodisation of household salt. Ninety-three per- cent of the households interviewed in the 2004 LDHS had their salt tested for iodine, while 5 percent had no salt available in the household. Only 2 percent of households are consuming salt that is not iodised, xx | Summary of Findings 7 percent of households are consuming inade- quately iodised salt (<15 ppm) and 91 percent are consuming adequately iodised salt (15+ ppm). Intake of Vitamin A. Ensuring that children between six months and 59 months receive enough vitamin A may be the single most effec- tive child survival intervention. Deficiencies in this micronutrient can cause blindness and can increase the severity of infections such as measles and diarrhoea. Fifty-five percent of children age 6-59 months are reported to have received a vita- min A supplement in the 6 months preceding the survey. Forty-nine percent of children under age three who live with their mothers consume fruits and vegetables rich in vitamin A. Seventeen percent of mothers with a birth in the past five years reported receiving a vitamin A dose postpartum. Four percent of interviewed women reported night blindness during preg- nancy. When this figure was adjusted for blind- ness not attributed to vitamin A deficiency during pregnancy, the data showed that only 1 percent of women experienced night blindness during their last pregnancy. Prevalence of Anaemia. Iron-deficiency anaemia is a major threat to maternal health and child health. Overall, about half of children age 6- 59 months in Lesotho (49 percent) have some level of anaemia, including 22 percent of children who are mildly anaemic, 25 percent who are mod- erately anaemic, and 1 percent who are severely anaemic. The prevalence of anaemia is less pro- nounced among women than among children. Twenty-seven percent of women age 15-49 are anaemic, with 19 percent mildly anaemic, 8 per- cent moderately anaemic, and about 1 percent se- verely anaemic. Nutritional Status of Children. According to the 2004 LDHS, 38 percent of children under five are stunted and 15 percent are severely stunted. Four percent of children under five are wasted and 1 percent are severely wasted. Weight- for-age results show that 20 percent of children under five are underweight, with 4 percent se- verely underweight. Children whose biological mothers were not in the household are more likely to be malnourished than children whose mothers were interviewed. The proportion of children under five who are stunted has decreased from 45 percent in 2000 to 38 percent in 2004. The proportion underweight in- creased slightly from 18 percent in 2000 to 20 percent in 2004. Nutritional Status of Women. The mean height of women in Lesotho is 157 centimetres, which is above the critical height of 145 centimetres. Only 2 percent are below 145 centimetres. Six percent of women were found to be chronically malnourished (BMI less than 18.5), while 42 percent are overweight or obese. Awareness of AIDS. Almost all (94 percent) women and men (93 percent) have heard of AIDS, indicating that awareness of AIDS in Lesotho is uni- versal. Almost eight in ten women (78 percent) and seven in ten men age 15-49 (70 percent) know that condom use is an important method of AIDS- prevention. Eighty-two percent of women and 76 per- cent of men said that the chances of getting the AIDS virus (HIV) can be reduced by limiting sex to one faithful uninfected partner. Knowledge of both of these ways of avoiding HIV transmission is high, with 71 percent of women and 60 percent of men citing both as ways of reducing the risk of contracting HIV/AIDS. Three-fourths of women (78 percent) and men (75 percent) know that abstaining from sex re- duces the chances of getting AIDS. Knowledge that a healthy-looking person can have the AIDS virus is widespread. Three-fourths of women (75 percent) and about seven in ten men (69 percent) are aware that a healthy-looking person can have the AIDS virus. The two most common mis- conceptions about the transmission of the AIDS virus are that HIV can be transmitted by mosquito bites and that a person can become infected with the AIDS virus by sharing food or utensils with someone who is in- fected with HIV/AIDS. Forty-four percent of women and 43 percent of men know that HIV cannot be transmited by mosquito bites, while 58 percent of women and 49 percent of men know that a person cannot become infected with the AIDS virus by shar- ing food or utensils with someone who has AIDS. A person is considered to have a comprehensive knowledge about AIDS when they report that 1) using Summary of Findings | xxi a condom every time sexual intercourse occurs and having just one uninfected and faithful partner can reduce the chances of contracting HIV/AIDS, 2) a healthy-looking person can have the AIDS virus, and 3) that they reject the two most com- mon local misconceptions about how HIV/AIDS is transmitted. In Lesotho, only 24 percent of women and 19 percent of men age 15-49 have comprehensive knowledge of HIV/AIDS trans- mission and prevention methods. HIV-Related Behavioural Indicators. One of the strategies for reducing the risk of contract- ing a sexually transmitted infection (STI) is for young persons to delay the age at which they be- come sexually active. Fifteen percent of young women and 27 percent of young men have had sex by age 15. Forty-seven percent of women and 52 percent of men reported they had first sexual intercourse by age 18. Sexual intercourse with a non-marital or non- cohabiting partner is associated with an increased risk of contracting sexually transmitted infections. Thirty-six percent of women and 63 percent of men age 15-49 reported engaging in higher-risk sexual behaviour in the 12 months preceding the survey. Even more disturbing is the fact that four in ten (42 percent) women age 15-24 and half of men in the same age cohort reported engaging in higher-risk sexual behaviour during the past year. Sexual intercourse with more than one part- ner is associated with a high risk of exposure to sexually transmitted infections. Eleven percent of women and 30 percent of men age 15-49 reported having sexual intercourse with more than one partner in the 12 months preceding the survey. Promoting the use of condoms is an impor- tant strategy in the fight against HIV/AIDS trans- mission. Overall, 42 percent of women and 49 percent of men age 15-49 used a condom dur- ing the time they had higher-risk sex. HIV Prevalence. HIV tests were conducted for 81 percent of the 3,758 eligible women and 68 percent of the 3,305 eligible men. Results from the 2004 LDHS indicate that 24 percent of adults in Leso- tho are HIV positive. HIV prevalence in women age 15-49 is 26 percent, while for men age 15-59, it is 19 percent. This female-to-male ratio is found in most population-based studies in Africa and implies that young women are particularly vulnerable to HIV in- fection compared with young men. For both sexes, rates of infection rise with age, peaking at 43 percent among women in their late 30s and 41 percent among men age 30-34. HIV prevalence is substantially higher among women than men under age 30 while, at ages 40-49, the pattern reverses and prevalence among men exceeds that among women. Patterns of HIV Prevalence. Urban residents are more likely to be HIV positive than rural residents (29 and 22 percent, respectively), with the urban-rural differential for women being higher than that for men. Among the four ecological zones, Lowlands has the highest rates of infection for both females and males (28 and 20 percent, respectively). Looking at the dis- tricts, Leribe has the highest infection rate for both women and men, while Thaba-Tseka and Mokhotlong have the lowest rate for women, and Mokhotlong and Qacha’s Nek have the lowest rate for men. Differences in infection levels across educa- tion categories are not large, although having attended school is related to somewhat lower infection levels among both women and men. One-third of employed women and one-fourth of employed men are HIV positive, compared with 23 percent of unemployed women and 16 percent of unemployed men. The rela- tionship between HIV status and economic level (wealth quintile) is not uniform; however, the lowest HIV rates are found among women and men in the lowest wealth quintile. Results from the 2004 LDHS indicate that for 66 percent of cohabiting couples, both partners are HIV negative, while in 20 percent of couples, both partners are HIV positive. In 13 percent of couples, there is discordance in HIV-positive status, i.e., one partner is infected and the other is not. xxiv | Map of Lesotho Introduction | 1 INTRODUCTION 1 Mahlape Ramoseme 1.1 GEOGRAPHY, HISTORY, AND ECONOMY 1.1.1 Geography Lesotho is a small mountain Kingdom situated in the southern part of Africa and is completely surrounded by the Republic of South Africa. The country is divided into 10 administrative districts, which differ in terms of size, topography, climate and stage of development. It has a total area of about 30,355 square kilometres of which slightly more than 10 percent of the land is arable. Lesotho can be distinguished by high altitude terrain, which is why it is sometimes referred to as the “Mountain Kingdom” or the “Kingdom in the Sky” and often called “The Roof of Africa.” The country has been subdivided into two residential areas, urban and rural and further divided into four ecological zones, the Lowlands, Foothills, Mountains and Senqu River Valley. In Lesotho, there are four seasons in a year; summer from December to February, with January being the warmest month; autumn from March to May; winter from June to August; and spring from September to November. In winter, temperatures can drop to below zero centigrade and snowfall is not unexpected especially in the mountains. Spring is Lesotho’s rainy season. 1.1.2 History Lesotho gained its independence on 4th October 1966 after being a British colony for almost 100 years (1868-1966). The three largest religious organizations are the Roman Catholic Church, the Lesotho Evangelical Church, and the Anglican Church. Lesotho has two official languages, Sesotho and English. 1.1.3 Economy Lesotho is primarily a country of subsistence farming. Most Basotho (the name for people living in Lesotho) grow food for their own consumption. Maize, wheat, and sorghum are commonly harvested as well as peas, beans, and potatoes. Traditionally, cattle are prized as a sign of family wealth; they are also used in agricultural work such as ploughing. Lesotho’s gross domestic product (GDP) is 8.832 billion Maluti with an annual growth rate of 3.1 percent. Manufacturing contributes 20.3 percent of the GDP, while agriculture contributes 17.1 percent. (BOS, 2005). Water is one of the most important resources in Lesotho. It is the source of the 30-year, multi- million-dollar Lesotho Highlands Water Project (LHWP), which was initiated in 1986. The LHWP is designed to capture, store, and transfer water from the Orange River system to South Africa’s Free State province and the greater Johannesburg area, which have among the largest concentrations of population, industry, and agriculture in South Africa. 1.2 POPULATION Currently, the population of Lesotho is estimated at 2.2 million (BOS, 2003). Table 1.1 shows that the population of Lesotho increased from 1.6 million in 1986 to 1.9 million in 1996. The annual population growth rate was 1.5 percent per annum during the 1986-1996 period (BOS, 1996). 2 | Introduction According to the 1996 population census, the crude birth rate (CBR) for Lesotho was 30 births per 1,000 compared with 37 per 1,000 in the 1986 population census. As shown in Table 1.1, the total fertility rate (TFR) in Lesotho declined by more than one child between 1986 and 1996. The crude death rate increased from 11.6 deaths to 12.8 deaths per 1,000 over the same period. The infant mortality rate (IMR) has been declining steadily. It was estimated at 113 deaths per 1,000 live births in 1976 (BOS, 1976) and it fell to 85 deaths per 1,000 in 1986 and 74 deaths per 1,000 in 1996 (BOS, 1996). Data from consecutive population censuses show that the population of Lesotho is predominantly rural. However, the proportion living in urban areas has increased from 12 percent in 1986 to 17 percent in 1996. Similarly, life expectancy at birth has increased from 55 years in 1986 to 59 years in 1996. Table 1.1 Basic demographic indicators Selected demographic indicators for Lesotho, 1976, 1986, and 1996 Indicator 1976 1986 1996 Population (millions) 1.2 1.6 1.9 Intercensal growth rate (percent) 2.3 2.6 1.5 Density (pop./km2) 40 53 61 Percent urban 11 12 17 Crude birth rate 38-40 37 30.0 Crude death rate 16-18 11.6 12.8 Total fertility rate 5.4 5.3 4.1 Infant mortality rate (per 1,000 births) 113 85 74 Life expectancy (years) 51 55 59 Male 49.3 49.3 58.6 Female 52.7 56.7 60.2 Source: BOS, 1976; BOS, 1986; BOS, 1996 (census reports) 1.3 OBJECTIVES OF THE SURVEY The Ministry of Health and Social Welfare (MOHSW) initiated the 2004 Lesotho Demographic and Health Survey (LDHS) to collect population-based data to inform the Health Sector Reform Programme (2000-2009). The 2004 LDHS will assist in monitoring and evaluating the performance of the Health Sector Reform Programme since 2000 by providing data to be compared with data from the first baseline survey, which was conducted when the reform programme began. The LDHS survey will also provide crucial information to help define the targets for Phase II of the Health Sector Reform Programme (2005-2008). Additionally, the 2004 LDHS results will serve as the main source of key demographic indicators in Lesotho until the 2006 population census results are available. The LDHS was conducted using a representative sample of women and men of reproductive age. The specific objectives were to: • Provide data at national and district levels that allow the determination of demographic indicators, particularly fertility and childhood mortality rates; • Measure changes in fertility and contraceptive use and at the same time analyse the factors that affect these changes, such as marriage patterns, desire for children, availability of contraception, breastfeeding patterns, and important social and economic factors; Introduction | 3 • Examine the basic indicators of maternal and child health in Lesotho, including nutritional status, use of antenatal and maternity services, treatment of recent episodes of childhood illness, and immunisation coverage for children; • Describe the patterns of knowledge and behaviour related to the transmission of HIV/AIDS, other sexually transmitted infections, and tuberculosis; • Estimate adult and maternal mortality ratios at the national level; • Estimate the prevalence of anaemia among children, women and men, and the prevalence of HIV among women and men at the national and district levels. 1.4 ORGANISATION OF THE SURVEY The 2004 LDHS was implemented by MOHSW in collaboration with the Bureau of Statistics (BOS). Technical assistance was provided through the MEASURE DHS programme. Financial support for the survey was provided by the Government of Lesotho and a number of donor agencies namely, Development Cooperation of Ireland (DCI), the World Bank, the United Nations Children’s Fund (UNICEF), the British Department for International Development (DFID), the World Health Organisation (WHO) and USAID. 1.5 SAMPLE DESIGN The sample for the 2004 LDHS covered the household population. A representative probability sample of more than 9,000 households was selected for the 2004 LDHS sample. This sample was constructed to allow for separate estimates for key indicators in each of the ten districts in Lesotho, as well as for urban and rural areas separately. The survey utilized a two-stage sample design. In the first stage, 405 clusters (109 in the urban and 296 in the rural areas) were selected from a list of enumeration areas from the 1996 Population Census frame. In the second stage, a complete listing of households was carried out in each selected cluster. Households were then systematically selected for participation in the survey. All women age 15-49 who were either permanent household residents in the 2004 LDHS sample or visitors present in the household on the night before the survey were eligible to be interviewed. In addition, in every second household selected for the survey, all men age 15-59 years were eligible to be interviewed if they were either permanent residents or visitors present in the household on the night before the survey. In the households selected for the men’s survey, height and weight measurements were taken for eligible women and children under five years of age. Additionally, eligible women, men, and children under age five were tested in the field for anaemia, and eligible women and men were asked for an additional blood sample for anonymous testing for HIV. 1.6 QUESTIONNAIRES Three questionnaires were used for the 2004 LDHS: the Household Questionnaire, the Women’s Questionnaire, and the Men’s Questionnaire. To reflect relevant issues in population and health in Lesotho, the questionnaires were adapted during a series of technical meetings with various stakeholders from government ministries and agencies, nongovernmental organizations and international donors. The final draft of the questionnaire was discussed at a large meeting of the LDHS Technical Committee organized by the MOHSW and BOS. The adapted questionnaires were translated from English into Sesotho and pretested during June 2004. 4 | Introduction The Household Questionnaire was used to list all of the usual members and visitors in the selected households. The main purpose of the Household Questionnaire was to identify women and men who were eligible for the individual interview. Some basic information was also collected on the characteristics of each person listed, including age, sex, education, residence and emigration status, and relationship to the head of the household. For children under 18, survival status of the parents was determined. The Household Questionnaire also collected information on characteristics of the household’s dwelling unit, such as the source of water, type of toilet facilities, materials used for the floor of the house, ownership of various durable goods, and access to health facilities. For households selected for the male survey subsample, the questionnaire was used to record height, weight, and haemoglobin measurements of women, men and children, and the respondents’ decision about whether to volunteer to give blood samples for HIV. The Women’s Questionnaire was used to collect information from all women age 15-49. The women were asked questions on the following topics: • Background characteristics (education, residential history, media exposure, etc.) • Birth history and childhood mortality • Knowledge and use of family planning methods • Fertility preferences • Antenatal and delivery care • Breastfeeding and infant feeding practices • Vaccinations and childhood illnesses • Marriage and sexual activity • Woman’s work and husband’s background characteristics • Awareness and behaviour regarding AIDS, other sexually transmitted infections (STIs), and tuberculosis (TB) • Maternal mortality The Men’s Questionnaire was administered to all men age 15-59 living in every other household in the 2004-05 LDHS sample. The Men’s Questionnaire collected much of the same information found in the Women’s Questionnaire, but was shorter because it did not contain a detailed reproductive history or questions on maternal and child health, nutrition, and maternal mortality. Geographic coordinates were collected for each EA in the 2004 LDHS. 1.7 HAEMOGLOBIN AND HIV TESTING In all households selected for the male survey, children under five years of age, women age 15-49 and men age 15-59 were tested for anaemia. In addition, all eligible women and men were tested for HIV. Anaemia and HIV testing were carried out only if consent was given by the respondent or, in the case of a minor (under age 18), by the parent or guardian. The protocol for haemoglobin and HIV testing was approved by the Lesotho Ministry of Health and Social Welfare Ethics Committee in Maseru and the ORC Macro Institutional Review Board in Calverton, Maryland, USA. All interviewers were trained on how to take anthropometric measurements, how to administer the anaemia and HIV informed consent forms, and blood collection procedures. Introduction | 5 1.7.1 Haemoglobin Testing Anaemia is a major problem in Lesotho, especially among young children and pregnant women. Determining anaemia levels among women and their children was an important component of the 2004 LDHS because little was known about the prevalence of anaemia in the general population. Anaemia levels were determined by measuring the level of haemoglobin in the blood, a decreased concentration of which characterizes anaemia. For haemoglobin measurement, capillary blood was taken from the finger using sterile, single-use lancets that allowed a relatively painless puncture. The concentration of haemoglobin in the blood was measured in the field using the HemoCue system, a portable photometer. Data collection personnel were specially trained for this procedure. Prior to participating in the study, respondents were informed of their right to not participate in the anaemia testing and were asked for their permission to collect a blood droplet from them and the eligible children. Levels of anaemia were classified as severe, moderate, or mild according to criteria developed by the World Health Organisation (DeMaeyer et al., 1989). Respondents were informed of their anaemia status. Additionally, an informational brochure on anaemia was printed and distributed to respondents eligible for anaemia testing. 1.7.2 HIV Testing In the households selected for the men’s survey, all eligible women and men were asked to voluntarily provide some drops of blood for HIV testing. The protocol for the blood specimen collection and analysis was based on the anonymous linked protocol developed by DHS and approved by ORC Macro’s Institutional Review Board. The protocol allowed for the merging of the HIV results to the sociodemographic data collected in the individual questionnaires, provided that the information that could potentially identify an individual was destroyed before linking is effected. This required that identification codes be deleted from the data file and that the back page of the Household Questionnaire that contained the bar code labels and names of respondents be destroyed prior to merging the HIV results with the individual data file. As part of the procedure to obtain informed consent for blood taking for HIV testing, the interviewer described the testing procedures, the confidentiality of the data, including the fact that test results could not be linked or made available to the subject, and gave information on where to go for voluntary counselling and testing (VCT) services to establish their HIV status. For never-married respondents age 15-17, consent was first obtained from the parent or guardian and then from the respondent him/herself. For respondents who consented, the interviewer collected 3 to 5 blood spots on a filter paper card from a finger prick using a single-use, spring-loaded, sterile lancet. Each filter paper was given a bar code label, with a duplicate label was attached to the Household Questionnaire on the line showing consent for that respondent. A third copy of the same bar code label was affixed to a Blood Transmittal Form to track the blood samples from the field to the BOS and then to the laboratory. Filter papers were dried overnight in a plastic drying box, after which the interviewer packed them in individual Ziploc bags with desiccants and a humidity indicator card and placed them in a larger Ziploc bag for that particular EA. Blood samples were periodically collected in the field along with the completed questionnaires and transported to BOS headquarters in Maseru. There they were logged in, after which they were taken to the Lesotho Blood Transfusion Services for HIV testing. At the Lesotho Blood Transfusion Services all samples were tested using the first test, an ELISA, Vironostika HIV Uniform II Plus O. A negative result was considered negative. All positives were tested with a second ELISA test, originally Genscreen HIV1/2, and later with a more accurate test, Enzygnost. Positive samples on the second test were considered positive. If the results from the two tests were 6 | Introduction discordant, the samples were retested again with both tests. If on the repeat of both tests, the results were negative, the samples were rendered negative; if results were positive, the samples were rendered positive. However, in the rare event of discordant results on the repeat of both tests, a third test, Abbott Determine was used as the tie breaker. The same steps were also followed for 10 percent of the samples testing negative on the first test. Additional internal quality control measures included testing a number of panels in each plate. This was done to check the accuracy of the laboratory technicians. About 5 percent of randomly selected samples were sent for retesting to the National Institute for Communicable Diseases (NICD) in South Africa as part of the external quality control. 1.8 TRAINING AND FIELDWORK Eighty-two people (about half women and half men) were recruited by the MOHSW and BOS to serve as supervisors, field editors, male and female interviewers, and reserves. They all participated in the main interviewer training, which began on 16 August 2004 in Roma and lasted for a period of about four weeks. The trainees came from the BOS and the MOHSW from both the central and district levels. Most of the participants from the BOS had had prior experience as interviewers in other surveys, while most of the participants from the MOHSW had had experience with blood collection and HIV/AIDS testing and counselling. The training was conducted mainly in English and included lectures, presentations, practical demonstrations, and practice interviewing in small groups. The training included two days of field practice with households living close to the training site. The participants also received training relating to height and weight measurements, haemoglobin testing, and blood collection for HIV. The trainers were officers of BOS and MOHSW as well as staff from ORC Macro. In addition to the main trainers, guest lecturers gave presentations in plenary sessions on specialized topics, such as family planning, nutrition, maternal and child health, and HIV/AIDS. Towards the end of the training course, some interviewers were selected as supervisors and field editors. This group was further trained on how to supervise fieldwork and editing of the questionnaires in the field, as well as how to read global positioning system (GPS) coordinates. Data collection began on 28 September 2004. The 12 data collection teams were made up of one supervisor, one field editor, three female interviewers and one male interviewer (with the exception of two teams that had two female interviewers and two male interviewers). Fieldwork was completed on 18 January 2005. Fieldwork supervision was coordinated at MOHSW and BOS headquarters; three teams of Regional Coordinators consisting of one representative from MOHSW and one from BOS for each team periodically visited the field teams to review their work and to monitor data quality. Additionally, close contact between MOHSW and BOS headquarters and the field teams was maintained through mobile phones. 1.9 DATA PROCESSING The processing of the 2004 LDHS results began shortly after the fieldwork commenced. Completed questionnaires were returned periodically from the field to BOS headquarters, where they were entered and edited by data processing personnel who were specially trained for this task. The data processing personnel included two supervisors, two questionnaire administrators/office editors—who ensured that the expected number of questionnaires from each cluster was received—16 data entry operators, and two secondary editors. The concurrent processing of the data was an advantage because BOS was able to advise field teams of problems detected during the data entry. In particular, tables were generated to check various data quality parameters. As a result, specific feedback was given to the teams to improve performance. The data entry and editing phase of the survey was completed in May 2005. Introduction | 7 1.10 RESPONSE RATES Table 1.2 shows household and individual response rates for the 2004 LDHS. Response rates are important because high non-response may affect the reliability of the results. A total of 9,903 households were selected for the sample, of which 9,025 were found to be occupied during data collection. Of the 9,025 existing households, 8,592 were successfully interviewed, yielding a household response rate of 95 percent. Table 1.2 Results of the household and individual interviews Number of households, number of interviews, and response rates, according to residence, Lesotho 2004 Residence Result Urban Rural Total Household interviews Households selected 2,743 7,160 9,903 Households occupied 2,498 6,527 9,025 Households interviewed 2,235 6,357 8,592 Household response rate 89.5 97.4 95.2 Interviews with women Number of eligible women 2,030 5,492 7,522 Number of eligible women interviewed 1,945 5,150 7,095 Eligible woman response rate 95.8 93.8 94.3 Household interviews for men Households selected 1,348 3,515 4,863 Households occupied 1,237 3,189 4,426 Households interviewed 1,092 3,093 4,185 Household response rate 88.3 97.0 94.6 Interviews with men Number of eligible men 791 2,514 3,305 Number of eligible men interviewed 694 2,103 2,797 Eligible man response rate 87.7 83.7 84.6 In these households, 7,522 women were identified as eligible for the individual interview. Interviews were completed with 94 percent of these women. Of the 3,305 eligible men identified, 85 percent were successfully interviewed. The response rate for urban women and men is somewhat higher than for rural respondents (96 percent compared with 94 percent for women and 88 percent compared with 84 percent for men). The principal reason for non-response among eligible women and men was the failure to find individuals at home despite repeated visits to the household. The lower response rate for men reflects the more frequent and longer absences of men from the household, principally because of employment and life style. Response rates for the HIV testing component were lower than those for the interviews. Details of the HIV testing response rates are discussed in Chapter 12. Household Population and Housing Characteristics | 9 HOUSEHOLD POPULATION AND HOUSING CHARACTERISTICS 2 John Nkonyana This chapter presents information on the social, economic, and demographic characteristics of the household population, focusing mainly on such background characteristics as age, sex, educational attendance and attainment, place of residence, and socioeconomic conditions of households. The information provided is intended to facilitate interpretation of the key demographic, socioeconomic, and health indices. It is further intended to assist in the assessment of the representativeness of the survey. One of the background characteristics used throughout this report is an index of socioeconomic status. The economic index used here was recently developed and tested in a large number of countries in relation to inequities in household income, use of health services, and health outcomes (Rutstein et al., 2000). It is an indicator of the level of wealth that is consistent with expenditure and income measures (Rutstein, 1999). The economic index was constructed using household asset data with principal components analysis. The asset information was collected through the Household Questionnaire of the 2004 LDHS and covers information on household ownership of a number of consumer items ranging from a television to a bicycle or car, as well as dwelling characteristics, such as source of drinking water, sanitation facilities, and type of material used for flooring. Each asset was assigned a weight (factor score) generated through principal components analysis, and the resulting asset scores were standardized in relation to a normal distribution with a mean of zero and standard deviation of one (Gwatkin et al., 2000). Each household was then assigned a score for each asset, and the scores were summed for each household; individuals were ranked according to the total score of the household in which they resided. The sample was then divided into quintiles from one (lowest) to five (highest). A single asset index was developed for the whole sample; separate indices were not prepared for the urban and rural populations. 2.1 HOUSEHOLD POPULATION BY AGE AND SEX The 2004 LDHS Household Questionnaire solicited information on key demographic and socioeconomic characteristics; parental survivorship and residence for people age 17 years and under; educational attendance and attainment; and housing characteristics. A household was defined as a person or group of people, related or unrelated to each other, who live together in the same dwelling unit and share a common source of food. Table 2.1 presents the distribution of the 2004 LDHS household population by five-year age groups, according to sex and urban-rural residence. The household population constitutes 32,747 persons, of which 47 percent are males and 53 percent are females. There are more persons in the younger age groups than in the older groups for both sexes. Figure 2.1 shows the age-sex structure of the Lesotho population. The household population age- structure is wide based, as depicted by the population pyramid. Lesotho’s population is still young. This implies that the share of the Lesotho population under age 15 is 41 percent, and the older age groups (65 years and above) make up just 7 percent of the total household population. The recent decline in fertility is also apparent in the narrowing at the base of the pyramid. The jutting out of the bars for women age 50-54 and for men age 60-64 is most likely a result of deliberate age displacement by interviewers to place respondents outside of the age range of eligibility for the interview, thus reducing the interviewer’s workload. 10 | Household Population and Housing Characteristics 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 residence, Lesotho 2004 Urban Rural Total Age Male Female Total Male Female Total Male Female Total <5 9.3 8.5 8.9 13.8 12.0 12.8 13.0 11.3 12.1 5-9 12.2 9.7 10.8 14.9 13.1 14.0 14.5 12.5 13.4 10-14 13.3 12.3 12.8 16.4 14.8 15.6 15.9 14.4 15.1 15-19 12.6 9.9 11.1 13.3 10.5 11.9 13.2 10.4 11.7 20-24 10.2 11.6 11.0 9.6 8.2 8.8 9.7 8.8 9.2 25-29 10.4 11.0 10.7 5.7 5.2 5.5 6.5 6.3 6.4 30-34 7.9 6.9 7.4 4.3 4.4 4.3 4.9 4.9 4.9 35-39 5.5 5.8 5.7 3.2 4.1 3.7 3.6 4.4 4.0 40-44 4.6 4.9 4.7 2.6 4.3 3.5 3.0 4.4 3.7 45-49 3.6 4.1 3.9 2.6 3.4 3.0 2.8 3.5 3.2 50-54 3.0 6.0 4.6 2.5 4.0 3.3 2.6 4.4 3.5 55-59 1.7 2.9 2.4 2.1 3.4 2.8 2.1 3.3 2.7 60-64 2.6 1.7 2.1 2.9 3.3 3.1 2.9 3.0 2.9 65-69 1.3 1.7 1.5 2.0 2.4 2.2 1.9 2.2 2.1 70-74 0.8 1.6 1.2 2.2 3.0 2.6 1.9 2.7 2.3 75-79 0.7 0.5 0.6 0.9 1.5 1.2 0.8 1.3 1.1 80 + 0.4 1.0 0.8 0.9 2.3 1.6 0.8 2.0 1.5 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number 2,628 3,226 5,854 12,867 14,026 26,893 15,495 17,252 32,747 Figure 2.1 Population Pyramid 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 0-4 0246810121416 0 2 4 6 8 10 12 14 16 LDHS 2004 Age Male Percent Female Household Population and Housing Characteristics | 11 2.2 HOUSEHOLD COMPOSITION Table 2.2 shows the distribution of households by sex of the head of household and by household size, according to rural-urban residence. According to the 2004 LDHS, women head 37 percent of households in Lesotho, an increase from 29 percent as shown in the 1996 population census (BOS, 1996). There are modest differences in female-headed households between urban and rural areas (41 and 36 percent, respectively). This may be somewhat attributed to rural to urban migration exacerbated by the proliferation of textile industries in the cities whose employees are predominantly women. Table 2.2 Household composition Percent distribution of households by sex of head of household and by household size, according to residence, Lesotho 2004 Residence Characteristic Urban Rural Total Sex of head of household Male 59.5 63.7 62.7 Female 40.5 36.3 37.3 Total 100.0 100.0 100.0 Number of usual members 1 29.4 11.9 16.0 2 19.4 14.2 15.4 3 18.3 15.6 16.3 4 14.3 17.9 17.0 5 9.1 14.3 13.1 6 4.3 11.1 9.5 7 2.7 6.2 5.3 8 0.9 4.1 3.3 9+ 1.4 4.6 3.8 Total 100.0 100.0 100.0 Number of households 2,043 6,549 8,592 Mean size 2.9 4.2 3.9 Note: Table is based on de jure members, i.e., usual residents. Table 2.2 further shows that the mean size of a Lesotho household is 3.9 persons, 1.1 person lower than the mean household size of 5 found in the 1996 population census (BOS, 1996 IIIB: 4). As expected, urban households have, on average, much smaller household sizes (2.9 persons) than rural households (4.2 persons). In the 2004 LDHS, the mean household size in both rural and urban areas is lower than in the 1996 population census (3.9 persons for urban areas and 5.2 persons for rural areas). 2.3 EDUCATIONAL ATTAINMENT OF HOUSEHOLD MEMBERS Tables 2.3.1 and 2.3.2 show the percent distribution of the de facto female and male household population age six years and over by highest level of education attended, according to background characteristics. Eight percent of females and 19 percent of males have no education at all, while seven in ten women and six in ten men have attended or completed primary education only. Among both males and females, about 5 percent have completed secondary or higher education. The proportion of the household population age six years and above who have attended school is significantly higher for females than males in all age groups. The median number of years of schooling is higher in females (4.8 years) than males (2.8 years). 12 | Household Population and Housing Characteristics Table 2.3.1 shows that the proportion of women with no education is higher among older women, suggesting some improvement in education over the years. Urban women are more likely to be educated than rural women. For example, 4 percent of urban females have no education, compared with 9 percent of rural females. The proportion of urban females with some secondary education or higher (42 percent) is more than twice as high as that of rural females (16 percent). Table 2.3.1 Educational attainment of household population: women Percent distribution of the de facto female household population age six and over by highest level of education attended or completed, according to background characteristics, Lesotho 2004 Background characteristic No education Some primary Completed primary1 Some secondary Completed secondary2 More than secondary Don't know/ missing Total Number Median number of years Age 6-9 18.9 80.7 0.0 0.0 0.0 0.0 0.4 100.0 1,797 0.2 10-14 1.0 88.9 6.5 3.4 0.0 0.0 0.1 100.0 2,480 3.4 15-19 1.0 38.8 22.6 35.4 1.7 0.4 0.1 100.0 1,793 6.4 20-24 1.7 23.4 28.1 33.4 10.7 2.5 0.2 100.0 1,517 6.9 25-29 2.3 22.7 28.1 31.7 11.0 4.2 0.0 100.0 1,085 6.9 30-34 2.7 23.3 31.2 31.3 8.6 2.9 0.1 100.0 844 6.8 35-39 3.6 22.5 31.2 33.1 7.1 2.1 0.4 100.0 757 6.7 40-44 4.9 39.3 26.2 20.2 5.8 3.0 0.5 100.0 760 6.2 45-49 5.5 49.8 25.8 11.6 3.3 3.7 0.3 100.0 607 5.6 50-54 11.9 61.7 12.3 9.8 2.0 2.2 0.1 100.0 757 4.4 55-59 7.9 74.6 9.3 4.8 0.9 2.4 0.1 100.0 569 3.6 60-64 16.2 73.3 5.0 2.0 0.9 1.6 1.0 100.0 513 3.1 65+ 24.2 69.2 3.7 1.8 0.3 0.4 0.3 100.0 1,440 2.3 Residence Urban 3.9 36.3 17.2 27.4 10.0 5.0 0.3 100.0 2,913 6.6 Rural 8.5 59.3 15.6 13.7 2.0 0.6 0.2 100.0 12,034 4.3 Ecological zone Lowlands 5.5 49.4 16.7 20.8 5.1 2.2 0.3 100.0 8,579 5.5 Foothills 7.6 62.8 15.7 11.5 1.4 0.9 0.1 100.0 1,798 4.1 Mountains 12.3 62.4 14.6 8.9 1.2 0.4 0.2 100.0 3,573 3.6 Senqu River Valley 8.6 59.4 14.8 13.9 2.5 0.8 0.1 100.0 997 4.3 District Butha-Buthe 5.5 54.6 17.3 17.5 2.9 2.2 0.1 100.0 905 5.1 Leribe 5.6 54.5 17.2 18.3 3.5 0.8 0.1 100.0 2,196 5.1 Berea 5.6 59.4 18.2 13.1 2.5 0.8 0.4 100.0 1,696 4.8 Maseru 6.5 44.2 16.7 22.0 6.9 3.3 0.4 100.0 3,757 5.9 Mafeteng 5.7 57.3 14.6 19.0 2.4 0.9 0.1 100.0 1,555 4.6 Mohale's Hoek 9.1 58.6 14.2 14.4 2.6 1.0 0.1 100.0 1,455 4.2 Quthing 11.5 59.2 13.9 12.2 2.1 0.6 0.5 100.0 1,027 4.0 Qacha's Nek 11.0 64.0 11.7 11.1 1.6 0.6 0.0 100.0 532 3.8 Mokhotlong 12.0 62.1 14.5 9.4 1.2 0.8 0.0 100.0 772 3.6 Thaba-Tseka 12.7 63.2 15.1 7.2 1.4 0.2 0.3 100.0 1,052 3.5 Wealth quintile Lowest 15.7 69.2 10.6 4.1 0.3 0.0 0.1 100.0 2,816 2.7 Second 9.3 64.4 16.3 8.7 0.8 0.0 0.4 100.0 2,857 3.7 Middle 6.9 59.4 16.3 15.2 1.5 0.4 0.3 100.0 2,979 4.7 Fourth 3.7 50.2 19.6 21.7 3.8 0.7 0.2 100.0 2,993 5.6 Highest 3.4 34.3 16.4 29.8 10.3 5.7 0.1 100.0 3,302 6.7 Total 7.6 54.8 15.9 16.4 3.6 1.5 0.2 100.0 14,947 4.8 Note: Total includes 25 women with missing information on age who are not shown separately. 1 Completed 7 grade at the primary level 2 Completed 12 grade at the secondary level Household Population and Housing Characteristics | 13 Women who live in the Mountains zone are more disadvantaged educationally than other women. Among all districts, the highest proportion of women who never went to school is in Thaba-Tseka (13 percent) and Mokhotlong (12 percent) and the lowest in Butha-Buthe, Leribe, Berea, and Mafeteng (6 percent each). It is worth noting that the proportion of female household members who have never attended school decreases with higher wealth status. Sixteen percent of women in the lowest wealth quintile have no education compared with only 3 percent in the highest quintile. Table 2.3.2 shows that 22 percent of males in rural areas have no education compared with 8 percent in urban areas. There is a marked urban-rural differential in secondary and higher education: 18 percent of males in urban areas have completed secondary or higher education, compared with only 3 percent in rural areas. Table 2.3.2 Educational attainment of household population: men Percent distribution of the de facto male household population age six and over by highest level of education attended or completed, according to background characteristics, Lesotho 2004 Background characteristic No education Some primary Completed primary1 Some secondary Completed secondary2 More than secondary Don't know/ missing Total Number Median number of years Age 6-9 21.9 77.0 0.0 0.6 0.0 0.0 0.5 100.0 1,848 0.0 10-14 6.2 89.8 2.6 1.4 0.0 0.0 0.1 100.0 2,461 2.5 15-19 8.3 57.1 10.2 23.3 0.9 0.2 0.1 100.0 2,045 5.0 20-24 13.4 36.5 15.2 22.5 8.4 3.8 0.2 100.0 1,497 6.0 25-29 16.7 32.2 16.1 19.8 10.3 4.4 0.6 100.0 1,009 6.1 30-34 22.3 35.3 15.2 15.2 8.9 3.0 0.0 100.0 756 4.9 35-39 20.0 35.8 14.8 16.3 8.9 4.1 0.0 100.0 560 5.0 40-44 27.5 39.8 10.4 13.0 5.6 3.7 0.0 100.0 459 3.6 45-49 31.7 39.1 8.4 10.1 4.7 6.0 0.0 100.0 427 2.8 50-54 36.5 43.9 5.0 8.0 4.0 2.6 0.0 100.0 401 1.7 55-59 39.1 47.1 4.7 3.2 3.6 2.3 0.0 100.0 318 1.3 60-64 42.0 45.6 4.7 3.7 2.0 1.9 0.1 100.0 443 1.1 65+ 48.5 42.9 2.9 3.6 0.8 1.1 0.2 100.0 844 0.1 Residence Urban 7.7 41.0 10.1 23.4 11.1 6.5 0.3 100.0 2,334 6.1 Rural 21.7 59.7 7.3 8.5 1.8 0.7 0.2 100.0 10,751 2.3 Ecological zone Lowlands 11.9 56.4 9.3 14.6 5.0 2.5 0.3 100.0 7,582 3.8 Foothills 22.8 60.9 6.5 7.8 1.3 0.5 0.1 100.0 1,608 2.1 Mountains 35.1 53.4 4.5 4.8 1.2 0.8 0.2 100.0 3,103 0.7 Senqu River Valley 19.6 59.4 9.0 9.0 2.3 0.7 0.0 100.0 791 2.6 District Butha-Buthe 13.5 61.5 8.5 11.9 3.2 1.3 0.1 100.0 824 3.4 Leribe 15.1 59.0 8.6 12.0 3.5 1.6 0.2 100.0 1,834 3.2 Berea 14.8 64.7 7.7 9.2 2.6 0.7 0.4 100.0 1,583 2.9 Maseru 14.1 48.7 9.5 16.8 6.7 3.9 0.3 100.0 3,326 4.3 Mafeteng 15.3 63.1 8.3 10.7 1.9 0.5 0.2 100.0 1,379 2.7 Mohale's Hoek 24.9 55.2 6.5 9.1 2.6 1.5 0.1 100.0 1,257 2.0 Quthing 26.1 57.2 6.7 7.9 1.9 0.3 0.0 100.0 822 1.9 Qacha's Nek 25.8 61.5 4.9 5.6 1.8 0.4 0.0 100.0 471 1.7 Mokhotlong 36.1 49.8 5.4 6.1 1.4 1.1 0.1 100.0 707 0.5 Thaba-Tseka 34.8 53.4 5.1 4.6 0.7 1.2 0.4 100.0 883 0.6 Wealth quintile Lowest 39.0 54.1 4.2 2.0 0.3 0.1 0.3 100.0 2,634 0.4 Second 25.0 63.0 6.1 5.1 0.8 0.0 0.1 100.0 2,513 1.7 Middle 15.3 62.3 10.1 9.7 1.7 0.5 0.4 100.0 2,663 3.0 Fourth 10.4 58.5 10.2 15.6 4.0 1.0 0.2 100.0 2,635 3.9 Highest 6.7 44.3 8.4 22.9 10.4 7.1 0.2 100.0 2,640 5.9 Total 19.2 56.4 7.8 11.1 3.5 1.8 0.2 100.0 13,085 2.8 Note: Total includes 17 men with missing information on age who are not shown separately. 1 Completed 7 grade at the primary level 2 Completed 12 grade at the secondary level 14 | Household Population and Housing Characteristics Across districts, the pattern among the male population is similar to that exhibited by the females. The variation in education among the male population according to wealth quintile is also similar to that among the female population. Wealthy males are less likely to have no education, with 7 percent of males in the highest wealth quintile having no education compared with 39 percent in the lowest. Table 2.4 shows the percentage of the household population age 6-24 years who are currently attending school, by age, sex, and residence. Eighty-one percent of people age 6-17 years are in school, with urban attendance higher than rural attendance (86 and 81 percent, respectively) and female attendance higher than male attendance (85 and 78 percent, respectively). However, at age group 18-21, attendance levels drop dramatically, and they are noticeably higher in urban than in rural areas (42 and 27 percent, respectively) and higher for males than females (34 and 25 percent, respectively). Table 2.4 School attendance Percentage of the de jure household population age 6-24 years currently attending school, by age, sex, and residence, Lesotho 2004 Male Female Total Age Urban Rural Total Urban Rural Total Urban Rural Total 6-12 83.2 81.0 81.3 89.1 87.4 87.6 86.3 84.1 84.5 13-17 85.4 71.2 73.3 84.2 79.8 80.6 84.8 75.2 76.7 6-17 84.2 76.9 77.9 87.0 84.4 84.9 85.7 80.5 81.3 18-21 53.0 29.9 33.7 32.9 23.2 25.2 41.9 26.7 29.5 22-24 20.5 8.9 11.1 12.5 3.9 6.1 15.9 6.5 8.6 Figure 2.2 shows that attendance rates for both males and females are 81 and 88 percent, respectively, at age group 6-12 years. Both boys and girls tend to drop out of school, so that at age group 13-17 years, 73 percent of boys and 81 percent of girls are attending school. After age 13-17 years, girls drop out of school more rapidly than boys. Among youth age 22-24 years, 11 percent of males and 6 percent of females attend school. The largest drop in attendance for both sexes occurs at age 18-21 years (34 percent for males and 25 percent for females). Figure 2.2 Percentage of Males and Females Currently Attending School, by Age LDHS 2004 , , , , # # # # 6-12 13-17 18-21 22-24 Age in years 0 20 40 60 80 100 Male Female# , Percent Household Population and Housing Characteristics | 15 Table 2.5 presents net attendance ratios (NARs) and gross attendance ratios (GARs) for the de jure household population by level of schooling and sex, according to background characteristics. The NAR for primary school measures the proportion of children of primary school age who are attending primary school, while the GAR represents the total number of primary school students age 5-24 as a percentage of children of primary school age. In the Lesotho context, the levels refer to 6 to 12 years for primary and 13 to 17 years for secondary. The GAR is usually higher than the NAR because the GAR includes participation of those who may be older or younger than the official age range for that level. Students who are over age for a given level of school may have started school late, may have repeated one or more grades in school, or may have dropped out of school and later returned. The NAR indicates that 85 percent of children of primary school age are attending primary school. There is a gender gap among the children who are attending primary school; the NAR is 88 percent for girls and 81 percent for boys. NARs for primary school do not differ by urban-rural residence. Among districts, NARs are highest in Butha-Buthe (92 percent) and lowest in Mokhotlong (79 percent). The GAR indicates that there are children in primary school who are not of primary school age, with ratios of 130 for males and 126 for females. This is probably a result of the introduction of free primary education about six years ago. As expected, both the NAR and GAR are lower at the secondary school level. The NAR indicates that only 21 percent of the secondary school age population are attending secondary school. Net secondary school attendance is higher for females (NAR of 27) than for males (NAR of 16). The GAR shows that there are many secondary school students who are not of secondary school age. School attendance ratios at the secondary level are lower in rural than in urban areas. For instance, the NAR at the secondary school level in rural areas is 17 percent compared with 42 percent in urban areas. Similarly, the GAR at secondary school is 29 percent in rural areas compared with 73 percent in urban areas. There is a strong relationship between household economic status and school attendance that can be seen at both the primary and secondary levels and among males and females. The NAR increases from 75 percent among students from poorer households (lowest wealth quintile) in primary school to 88 percent among students from richer households (highest wealth quintile). Similarly, the GAR rises dramatically from 6 percent among secondary school attendees in the lowest wealth quintile to 77 percent among those in the highest wealth quintile. The Gender Parity Index (GPI) represents the ratio of the GAR for females to the GAR for males. It is presented at both the primary and secondary levels and offers a summary measure of gender differences in school attendance rates. A GPI less than 1 indicates that a smaller proportion of females than males attend school. In Lesotho, the GPI is slightly less than 1 (0.97) for primary school attendance, indicating that the gender gap is relatively small, while for secondary school attendance it is greater than 1 (1.32), indicating that females are advantaged at this educational level. There are no marked differences in GPI by place of residence. 16 | Household Population and Housing Characteristics Table 2.5 School attendance ratios Net attendance ratios (NAR), gross attendance ratios (GAR), and gender parity index (GPI) for the de jure household population age 6-24 by level of schooling and sex, according to background characteristics, Lesotho 2004 Net attendance ratio1 Gross attendance ratio2 Background characteristic Male Female Total Male Female Total Gender Parity Index3 PRIMARY SCHOOL Residence Urban 81.6 88.0 85.0 124.1 117.2 120.4 0.94 Rural 81.4 87.6 84.5 131.0 127.3 129.2 0.97 Ecological zone Lowlands 85.9 88.5 87.2 137.9 122.3 130.2 0.89 Foothills 81.6 88.3 85.0 136.7 129.6 133.1 0.95 Mountains 71.8 85.1 78.3 109.6 128.4 118.8 1.17 Senqu River Valley 85.2 90.0 87.7 138.9 134.2 136.5 0.97 District Butha-Buthe 91.7 92.8 92.2 149.2 125.8 137.4 0.84 Leribe 86.5 91.5 89.1 137.1 126.7 131.7 0.92 Berea 87.2 89.6 88.3 140.1 130.1 135.5 0.93 Maseru 81.8 83.8 82.8 129.5 115.7 122.5 0.89 Mafeteng 83.2 89.6 86.5 147.9 124.3 135.6 0.84 Mohale's Hoek 74.6 84.6 79.6 119.6 127.3 123.5 1.06 Quthing 79.7 87.5 83.5 120.8 132.4 126.4 1.10 Qacha's Nek 75.4 88.0 81.2 120.8 134.0 126.9 1.11 Mokhotlong 72.9 86.9 79.4 103.1 131.4 116.2 1.27 Thaba-Tseka 73.1 87.1 80.0 115.4 132.6 123.9 1.15 Wealth quintile Lowest 66.9 83.8 75.1 104.0 126.7 115.0 1.22 Second 79.2 87.2 83.1 126.1 131.6 128.8 1.04 Middle 87.4 87.6 87.5 145.3 128.2 136.9 0.88 Fourth 87.7 92.5 90.1 143.1 128.0 135.6 0.89 Highest 88.3 87.7 88.0 135.2 113.7 123.9 0.84 Total 81.4 87.7 84.6 130.1 125.7 127.9 0.97 SECONDARY SCHOOL Residence Urban 36.9 46.9 42.1 72.0 73.5 72.8 1.02 Rural 11.9 22.2 16.6 24.6 34.7 29.3 1.41 Ecological zone Lowlands 21.2 34.8 27.5 40.7 53.0 46.4 1.30 Foothills 10.4 17.0 13.4 26.9 32.1 29.3 1.19 Mountains 5.7 12.4 8.8 12.5 20.0 16.0 1.60 Senqu River Valley 13.3 26.5 20.0 30.1 41.5 35.9 1.38 District Butha-Buthe 16.2 36.2 25.2 41.2 62.8 50.9 1.53 Leribe 16.0 29.1 22.3 32.2 45.2 38.5 1.40 Berea 12.9 27.8 19.9 30.9 39.3 34.8 1.27 Maseru 24.1 35.5 29.4 45.0 55.5 49.9 1.23 Mafeteng 13.0 22.4 16.9 24.3 37.1 29.6 1.53 Mohale's Hoek 19.4 23.6 21.5 34.1 36.0 35.0 1.06 Quthing 12.0 26.4 19.4 28.4 41.4 35.1 1.46 Qacha's Nek 4.5 12.9 8.4 12.2 22.8 17.2 1.86 Mokhotlong 7.0 14.7 10.6 14.7 22.3 18.3 1.51 Thaba-Tseka 4.6 7.7 6.0 11.5 12.8 12.1 1.12 Wealth quintile Lowest 1.1 4.9 2.8 4.9 7.1 5.9 1.47 Second 4.9 12.6 8.6 12.5 17.6 15.0 1.41 Middle 13.3 24.9 18.6 24.3 39.0 31.0 1.61 Fourth 18.1 31.7 24.4 42.4 51.3 46.5 1.21 Highest 38.0 53.6 45.6 69.2 84.8 76.8 1.23 Total 15.6 26.6 20.7 31.6 41.7 36.3 1.32 1 The NAR for primary school is the percentage of the primary-school-age (6-12 years) population that is attending primary school. The NAR for secondary school is the percentage of the secondary-school-age (13-17 years) population that is attending secondary school. By definition, the NAR cannot exceed 100 percent. 2 The GAR for primary school is the total number of primary school students, expressed as a percentage of the official primary-school-age population. The GAR for secondary school is the total number of secondary school students, expressed as a percentage of the official secondary-school-age population. If there are significant numbers of overage and underage students at a given level of schooling, the GAR can exceed 100 percent. 3 The Gender Parity Index for primary school is the ratio of the primary school GAR for females to the GAR for males. The Gender Parity Index for secondary school is the ratio of the secondary school GAR for females to the GAR for males. Household Population and Housing Characteristics | 17 Table 2.6 shows repetition and dropout rates for the de jure household population age 5-24 by school grade, according to background characteristics. Repetition and dropout rates describe the flow of students through the school sys- tem. The repetition rate for the primary education ranges from 6 percent for the sixth grade to 23 percent for the first grade. The repetition rates are higher at every grade for males and rural residents when compared with females and urban resi- dents. There is no clear pattern of repe- tition rates when looking at other back- ground characteristics. The dropout rate increases with grade, from 2 percent of students in first grade to 18 percent of those in seventh grade. Dropout rates are higher among male than female students, with the exception of the seventh grade, when this pattern is reversed. Dropout rates are more pronounced in rural than urban areas and among those in the Mountains zone. 2.4 HOUSING CHARACTERISTICS Given that there is a strong rela- tionship between household economic con- ditions and exposure to diseases, informa- tion on housing characteristics, such as access to electricity, source of drinking water, sanitary facilities, and flooring and roofing materials, is key to explaining the interrelationships between the social and economic conditions of the household and likely exposure to and prevalence of dis- eases. Table 2.7 shows the percent distri- bution of households by housing charac- teristics, according to residence. The table shows that only 7 per- cent of Lesotho households have elec- tricity. There is a large discrepancy be- tween urban and rural areas in the pro- portion of households that have electricity: 26 percent of urban households have electricity compared with less than 1 per- cent of rural households. Table 2.6 Grade repetition and dropout rates Repetition and dropout rates for the de jure household population age 5-24 years by school grade, according to background characteristics, Lesotho 2004 School grade Background characteristic 1 2 3 4 5 6 7 REPETITION RATE 1 Sex Male 24.6 15.3 10.9 11.4 12.6 6.6 11.7 Female 21.4 9.0 8.3 7.4 11.8 5.9 10.6 Residence Urban 16.7 9.3 8.0 5.1 8.2 4.3 2.8 Rural 23.9 12.8 9.9 10.0 13.1 6.7 13.8 Ecological zone Lowlands 20.2 12.6 10.0 9.4 11.3 6.7 9.6 Foothills 20.9 8.1 13.1 12.2 17.2 6.3 18.1 Mountains 29.0 14.0 8.9 6.9 11.9 5.9 12.3 Senqu River Valley 19.9 13.1 2.4 10.9 12.2 3.1 12.0 District Butha-Buthe 14.1 15.2 12.8 10.9 16.6 7.1 6.6 Leribe 19.0 13.6 11.1 13.8 15.2 10.5 10.6 Berea 26.3 12.3 14.8 11.1 7.7 6.3 29.9 Maseru 17.8 9.8 10.9 8.4 12.0 5.0 6.2 Mafeteng 25.7 13.6 6.9 6.8 16.0 6.8 10.1 Mohale's Hoek 25.5 6.8 4.7 4.1 6.1 2.9 3.7 Quthing 19.5 12.7 2.0 10.9 12.5 4.1 11.2 Qacha's Nek 23.4 13.3 8.9 14.0 19.8 5.5 2.4 Mokhotlong 38.3 15.3 10.3 7.6 0.4 6.2 10.7 Thaba-Tseka 25.2 18.5 8.1 5.1 15.8 7.4 13.5 Wealth quintile Lowest 26.0 9.9 8.0 7.6 13.6 2.5 15.6 Second 28.9 13.8 8.8 13.8 8.1 5.5 15.7 Middle 25.0 10.4 12.1 8.7 15.2 9.8 13.2 Fourth 16.8 15.9 10.7 9.7 13.1 4.3 11.4 Highest 15.0 12.1 8.2 5.8 10.2 6.2 6.5 Total 23.1 12.4 9.7 9.3 12.2 6.2 11.1 DROPOUT RATE2 Sex Male 2.1 2.2 2.5 3.6 3.1 4.7 14.5 Female 0.7 0.6 1.2 2.5 2.9 3.3 19.8 Residence Urban 1.0 0.1 0.0 0.1 0.9 0.5 8.4 Rural 1.5 1.7 2.2 3.5 3.5 4.7 20.6 Ecological zone Lowlands 0.4 0.0 0.8 2.3 0.9 1.8 14.4 Foothills 1.3 1.6 1.9 3.3 3.4 5.0 21.6 Mountains 3.1 4.4 4.4 5.0 8.8 7.7 32.8 Senqu River Valley 1.5 2.2 2.1 2.2 3.0 9.1 13.3 District Butha-Buthe 1.2 0.0 0.0 1.3 0.4 4.6 14.4 Leribe 0.8 0.0 0.0 1.0 1.8 4.5 12.1 Berea 0.0 0.0 1.7 3.3 1.4 2.6 14.8 Maseru 0.3 0.8 2.0 3.0 0.8 2.0 13.0 Mafeteng 0.8 0.3 0.8 4.3 4.4 1.6 32.4 Mohale's Hoek 4.7 4.6 5.5 9.2 5.9 2.3 24.6 Quthing 1.2 0.9 1.9 0.0 5.3 10.1 10.5 Qacha's Nek 4.6 4.4 2.3 6.9 1.5 19.3 32.9 Mokhotlong 0.6 4.4 6.2 1.2 14.0 8.7 44.4 Thaba-Tseka 3.1 4.2 2.5 2.0 4.8 2.2 18.9 Wealth quintile Lowest 2.2 2.5 3.9 2.5 7.5 10.5 28.9 Second 3.0 2.5 1.6 5.3 4.9 6.1 26.1 Middle 0.7 1.7 2.7 4.6 3.9 5.6 25.3 Fourth 0.5 0.1 0.6 1.4 1.0 2.7 20.8 Highest 0.0 0.2 0.0 1.2 0.3 0.1 3.6 Total 1.5 1.5 1.9 3.0 3.0 3.9 17.5 1 The repetition rate is the percentage of students in a given grade in the previous school year who are repeating that grade in the current school year. 2 The dropout rate is the percentage of students in a given grade in the previous school year who are not attending school. 18 | Household Population and Housing Characteristics Table 2.7 Household characteristics Percent distribution of households by household characteristics, according to residence, Lesotho 2004 Residence Household characteristic Urban Rural Total Electricity Yes 26.2 0.8 6.8 No 73.6 99.0 93.0 Missing 0.1 0.2 0.2 Total 100.0 100.0 100.0 Source of drinking water Piped into dwelling 11.9 0.6 3.3 Piped into yard/plot 39.5 1.5 10.5 Piped into someone else's yard/plot 17.0 1.0 4.8 Public tap 22.0 50.0 43.3 Open well in dwelling/yard/plot 0.0 0.2 0.2 Open public well 3.4 21.7 17.3 Protected well in dwelling/yard/plot 0.7 1.3 1.2 Protected well in someone else's yard/plot 1.3 1.2 1.2 Protected public well 2.9 13.2 10.7 Spring 0.8 6.9 5.4 River, stream 0.0 2.2 1.7 Dam 0.0 0.1 0.1 Tanker truck 0.2 0.1 0.1 Other/missing 0.2 0.1 0.2 Total 100.0 100.0 100.0 Time to water source Percentage <15 minutes 75.5 37.0 46.1 Median time to source 0.0 19.4 14.5 Sanitation facility Flush toilet 7.7 0.2 2.0 Traditional pit toilet 44.4 29.7 33.2 Ventilated improved pit latrine 40.7 15.7 21.6 No facility, bush, field 7.1 54.4 43.2 Other/missing 0.1 0.1 0.1 Total 100.0 100.0 100.0 Type of cooking fuel Electricity 7.0 0.2 1.8 LPG, natural gas 58.2 10.7 22.0 Charcoal 0.0 0.2 0.1 Firewood, straw 6.6 71.0 55.7 Dung 0.5 7.4 5.7 Paraffin 27.4 9.2 13.5 Crop waste 0.1 1.1 0.9 Other/missing 0.1 0.1 0.1 Total 100.0 100.0 100.0 Flooring material Mud/earth/dung 6.6 51.1 40.5 Wood planks 0.4 0.1 0.2 Parquet, polished wood 0.1 0.0 0.0 Brick tiles 0.5 0.2 0.3 Tiles 16.8 5.9 8.5 Cement 43.1 14.4 21.2 Carpet 13.0 9.9 10.6 Vinyl, linoleum 19.3 18.2 18.4 Other/missing 0.2 0.1 0.1 Total 100.0 100.0 100.0 Number of households 2,043 6,549 8,592 Household Population and Housing Characteristics | 19 The availability of and accessibility to potable water may, to a large extent, minimise the prevalence of potentially fatal water-borne diseases among household members. The source of drinking water is an important determinant of potentially fatal diarrhoeal diseases, such as typhoid, cholera, and dysentery. In Lesotho, more than four in ten households (43 percent) get their drinking water from a public tap. Seventeen percent of the households draw their drinking water from open public wells, while 11 percent each use protected public well or piped water located in their yard or plot. Less than 5 percent of households use other types of water supply sources. Forty-six percent of the households are within 15 minutes of their water source, with a median time to water source of about 15 minutes. In urban areas, the main source is piped water in the yard or plot (40 percent), followed by public tap (22 percent). In rural areas, half of the household get their drinking water from a public tap, and more than one in five (22 percent) from an open public well. The availability of toilet facilities in households ensures a more efficient and hygienic method of human waste disposal. Fifty-seven percent of the households in Lesotho have access to some type of sanitary facility. Three in ten households in Lesotho have traditional pit toilets, while about one in five (22 percent) have ventilated improved pit latrines. Only 2 percent of the households have flush toilets. Traditional pit toilets are more common in urban (44 percent) areas than rural areas (30 percent). As expected, flush toilets are more widely used in urban (8 percent) than in rural areas (less than 1 percent). The most common source of cooking fuel in Lesotho is firewood or straw (56 percent), followed by LPG or natural gas (22 percent). In urban households, the two most commonly used sources are LPG or natural gas (58 percent) and paraffin (27 percent). In rural areas, seven in ten households use firewood or straw for cooking, and one in ten use LPG or natural gas (11 percent) or paraffin (9 percent). The type of flooring material used in dwellings is a proxy indicator of the socioeconomic status of the household as well as its likely exposure to disease-causing agents. The predominant flooring materials used by Lesotho households are mud, earth, or dung with a share of 41 percent. Cement is the next most common flooring material, with a share of 21 percent. Forty-three percent of urban households use cement for flooring their houses, and 51 percent of rural households use mud, earth, or dung. 2.5 HOUSEHOLD DURABLE GOODS Table 2.8 shows the percentage of households possessing various durable goods by urban-rural residence. This indicator provides a rough measure of the socioeconomic status of households. Of the 11 selected durable household goods, sofa or mattress, radio, and horse or donkey or mule were most frequently available. Seventy-nine percent of households in Lesotho own a sofa and mattress, 54 percent own a radio, and 29 percent own a horse or donkey or mule. There is noticeable urban-rural variation in the proportion of households owning durable goods. Ninety-two percent of households in urban areas have a sofa or mattress, compared with 75 percent of rural households. Similarly, 79 percent of urban households have a radio, compared with 47 percent of rural households. Four percent of urban households and 14 percent of rural households have none of the selected durable goods. 20 | Household Population and Housing Characteristics Table 2.8 Household durable goods Percentage of households possessing various durable consumer goods, by residence, Lesotho 2004 Residence Durable consumer goods Urban Rural Total Energy battery/generator/solar 27.5 15.4 18.3 Radio 78.7 46.5 54.1 Television 32.9 6.9 13.1 Telephone 44.0 9.6 17.8 Refrigerator 28.8 7.5 12.5 Sofa/mattress 91.9 74.8 78.8 Bicycle 4.6 2.6 3.0 Motorcycle/scooter 0.4 0.1 0.2 Car/truck 10.5 2.6 4.5 Horse/donkey/mule 2.5 37.1 28.9 Scotch cart 1.3 12.3 9.7 None of the above 3.5 13.8 11.3 Number of households 2,043 6,549 8,592 2.6 RESIDENCY STATUS Table 2.9 shows the residency status of the household population in Lesotho. One in ten men (10 percent) and women (11 percent) live elsewhere in Lesotho. There are no significant variations in the proportion of the population who lives elsewhere in Lesotho by various background characteristics, except for education. The proportion of population living elsewhere in Lesotho generally increases with education attainment. Seven percent of men and 3 percent of women live in the Republic of South Africa (RSA). Again, the differentials by background characteristics are not pronounced, except for education and wealth index. The proportion of household population who live in RSA increases with increasing education and wealth index quintile. The patterns are more clear for men than for women because of the larger proportion of men who live in RSA. The 2004 LDHS results show that 5 percent of the household population live outside of Lesotho, either in RSA or in another country (calculation based on Table 2.9). Household Population and Housing Characteristics | 21 Table 2.9 Residency status Percentage of household population by residency status, according to background characteristics, Lesotho 2004 Male Female Percentage usually living: Percentage usually living: Background characteristic In the house- hold Else- where in Lesotho In RSA In a country other than RSA Total Number In the house- hold Else- where in Lesotho In RSA In a country other than RSA Total Number Age 0-9 94.3 5.3 0.4 0.1 100.0 4,551 93.2 6.1 0.5 0.1 100.0 4,459 10-19 89.2 9.7 1.0 0.1 100.0 5,250 86.4 12.2 1.2 0.2 100.0 5,035 20-29 72.7 17.3 9.4 0.5 100.0 3,565 75.9 19.6 4.1 0.4 100.0 3,481 30-39 67.6 13.2 18.3 0.8 100.0 1,972 81.0 13.1 5.7 0.1 100.0 2,004 40-49 59.9 9.4 28.1 2.5 100.0 1,498 84.6 8.7 5.9 0.7 100.0 1,662 50-59 71.0 8.7 19.8 0.5 100.0 1,043 90.4 4.9 4.6 0.1 100.0 1,511 60+ 92.9 4.1 2.6 0.3 100.0 1,414 95.6 3.1 1.1 0.2 100.0 2,089 Residence Urban 83.0 10.2 6.4 0.4 100.0 3,186 87.7 9.8 2.3 0.2 100.0 3,778 Rural 82.0 9.9 7.6 0.5 100.0 16,132 86.4 10.6 2.7 0.2 100.0 16,493 Ecological zone Lowlands 82.2 9.5 7.8 0.6 100.0 10,878 86.2 10.8 2.7 0.2 100.0 11,418 Foothills 83.3 9.6 6.9 0.2 100.0 2,392 87.9 9.9 2.0 0.1 100.0 2,479 Mountains 81.8 11.6 6.3 0.2 100.0 4,815 87.6 9.9 2.2 0.1 100.0 5,014 Senqu River Valley 80.8 8.4 9.8 1.1 100.0 1,233 84.8 10.4 4.3 0.6 100.0 1,361 District Butha-Buthe 78.9 8.6 11.8 0.7 100.0 1,269 83.7 10.0 5.8 0.4 100.0 1,271 Leribe 85.0 7.2 7.3 0.4 100.0 2,583 90.3 7.7 1.8 0.2 100.0 2,836 Berea 86.0 6.6 6.5 0.8 100.0 2,203 90.3 7.5 2.0 0.2 100.0 2,210 Maseru 84.0 11.1 4.6 0.3 100.0 4,629 87.5 11.0 1.2 0.2 100.0 4,970 Mafeteng 77.7 11.0 10.8 0.4 100.0 2,180 81.5 14.7 3.7 0.1 100.0 2,216 Mohale's Hoek 79.0 12.1 8.3 0.7 100.0 1,935 83.3 13.0 3.4 0.1 100.0 2,022 Quthing 81.1 7.8 9.9 1.2 100.0 1,272 85.9 9.2 4.1 0.8 100.0 1,418 Qacha's Nek 76.0 11.2 12.4 0.4 100.0 781 81.8 10.6 7.3 0.3 100.0 783 Mokhotlong 83.9 10.9 5.2 0.0 100.0 1,089 87.1 10.4 2.4 0.0 100.0 1,101 Thaba-Tseka 81.8 13.6 4.4 0.1 100.0 1,377 89.6 9.8 0.5 0.0 100.0 1,446 Education No education 86.1 8.5 5.0 0.4 100.0 5,811 92.4 6.5 0.9 0.1 100.0 3,763 Primary, incomplete 84.9 7.8 6.9 0.4 100.0 8,960 91.0 6.8 2.0 0.1 100.0 9,240 Primary, complete 70.1 15.0 13.9 1.0 100.0 1,534 81.3 14.4 4.0 0.2 100.0 2,989 Secondary+ 72.6 16.4 10.2 0.7 100.0 2,982 76.5 18.8 4.2 0.5 100.0 4,247 Wealth quintile Lowest 84.7 11.1 3.9 0.2 100.0 3,868 87.4 10.1 2.2 0.1 100.0 3,921 Second 84.6 9.4 5.6 0.3 100.0 3,774 87.6 9.6 2.6 0.2 100.0 3,971 Middle 82.7 9.7 7.0 0.6 100.0 3,897 86.6 10.0 3.2 0.1 100.0 3,970 Fourth 80.2 8.7 10.5 0.5 100.0 3,951 86.1 10.9 2.7 0.2 100.0 4,086 Highest 78.5 10.8 10.0 0.7 100.0 3,828 85.7 11.5 2.3 0.4 100.0 4,324 Total1 82.1 9.9 7.4 0.5 100.0 19,318 86.7 10.5 2.6 0.2 100.0 20,272 RSA = Republic of South Africa 1 Total includes 30 cases missing information on age and 15 cases missing information on the residency status. Characteristics of Survey Respondents | 23 CHARACTERISTICS OF SURVEY RESPONDENTS 3 3.1 BACKGROUND CHARACTERISTICS OF RESPONDENTS Information on the basic characteristics of women and men interviewed in the survey is essential for the interpretation of findings subsequently presented in the report. Background characteristics of the 7,095 women and 2,797 men interviewed in the 2004 LDHS are presented in Table 3.1. For both sexes, the proportion of respondents in each age group declines as age increases, reflecting the comparatively young age structure of the population. Slightly more than half of female respondents are currently married, compared with 42 percent of males. Almost all respondents in current unions declared themselves as living in formal unions with less than 1 percent of females and males saying they were living together in an informal union. Among female respondents, the proportion divorced or separated is 6 percent compared with 4 percent among males. Nine percent of female respondents are widowed compared with 2 percent of males. Never-married females account for one-third of all women, and around half of males have never married. Slightly more than three-quarters of both female and male respondents are rural residents. The Lowlands have the largest proportion of respondents followed by the Mountains zone, and Foothills and Senqu River Valley zones have the smallest proportions. By district, the proportions of respondents range from around 3 percent in Qacha’s Nek to about 26 percent in Maseru. Female respondents are less likely than male respondents to have never attended school (2 and 17 percent, respectively). Among those who attended school, female respondents are more likely than males to have attended secondary school. Comparatively few respondents of either gender have gone to school beyond the secondary level (1 percent of females and 3 percent of males), as shown in Tables 3.2.1 and 3.2.2. Almost half of the survey respondents are Roman Catholic, with one in five belonging to the Lesotho Evangelical Church and another one in five belonging to other Christian denominations (Table 3.1). 3.2 EDUCATIONAL ATTAINMENT AND LITERACY Tables 3.2.1 and 3.2.2 present the distributions of female and male respondents, respectively, by the highest level of education attained according to selected demographic and socioeconomic character- istics. The results reveal that younger persons have reached higher levels of school than older people. The results also show that the female-male differential in educational attainment is evident in every age group although the gap, particularly in the proportion who have ever attended school, is much greater among older than younger respondents. Generally, urban residents have higher educational attainment than rural residents. For example, 58 percent of females in urban areas have attended at least some secondary school, compared with 33 per- cent of rural residents, and the corresponding figures for males are 52 and 21 percent, respectively.1 1 These figures were attained by adding together three education categories: some secondary, completed secondary, and more than secondary.) 24 | Characteristics of Survey Respondents Table 3.1 Background characteristics of respondents Percent distribution of women and men by selected background characteristics, Lesotho 2004 Women Men Background characteristic Weighted percent Weighted Unweighted Weighted percent Weighted Unweighted Age 15-19 24.1 1,710 1,761 26.6 743 752 20-24 20.6 1,463 1,456 18.1 507 508 25-29 14.7 1,044 1,026 13.4 374 367 30-34 11.5 816 807 10.9 305 306 35-39 10.3 728 740 8.3 233 226 40-44 10.4 741 714 5.9 164 163 45-49 8.3 592 591 6.1 170 173 50-54 na na na 5.9 164 165 55-59 na na na 4.9 137 137 Marital status Never married 33.4 2,373 2,358 50.7 1,419 1,403 Married 51.6 3,662 3,668 42.2 1,179 1,191 Living together 0.7 47 58 0.4 12 16 Divorced/separated 5.6 401 382 4.4 124 121 Widowed 8.6 613 629 2.2 60 64 Residence Urban 23.7 1,682 1,945 21.5 603 694 Rural 76.3 5,413 5,150 78.5 2,194 2,103 Ecological zone Lowlands 60.6 4,299 3,118 62.0 1,734 1,248 Foothills 11.1 787 999 11.0 307 392 Mountains 22.2 1,572 2,274 20.9 585 877 Senqu River Valley 6.2 437 704 6.1 171 280 District Butha-Buthe 6.5 458 774 6.5 182 304 Leribe 15.0 1,065 845 14.1 393 297 Berea 10.9 776 685 12.5 350 330 Maseru 26.3 1,868 1,059 26.5 741 405 Mafeteng 10.6 755 709 10.6 297 285 Mohale's Hoek 9.6 684 803 10.1 281 331 Quthing 6.5 461 574 6.0 167 200 Qacha's Nek 3.3 233 497 3.6 99 213 Mokhotlong 5.1 360 605 4.6 130 238 Thaba-Tseka 6.1 435 544 5.6 156 194 Education No education 2.0 145 169 17.1 479 549 Primary, incomplete 30.1 2,136 2,244 42.7 1,194 1,165 Primary, complete 27.3 1,936 1,939 12.2 342 333 Secondary+ 40.6 2,878 2,743 28.0 783 750 Religion Roman Catholic Church 44.9 3,187 3,153 46.5 1,300 1,257 Lesotho Evangelical Church 20.3 1,442 1,378 21.6 605 561 Anglican Church 9.7 691 675 9.1 253 264 Other Christian 24.0 1,704 1,813 16.9 473 525 No religion 0.7 52 60 5.6 158 182 Wealth quintile Lowest 13.9 987 1,160 16.7 466 543 Second 18.2 1,294 1,405 18.4 514 553 Middle 17.7 1,258 1,259 20.2 566 551 Fourth 22.5 1,595 1,455 22.2 621 568 Highest 27.6 1,962 1,816 22.5 630 582 Total 100.0 7,095 7,095 100.0 2,797 2,797 Note: Education categories refer to the highest level of education attended, whether or not that level was completed. na = Not applicable Characteristics of Survey Respondents | 25 Respondents living in the Lowlands are more likely to have a secondary or higher education than respondents from the other zones. Looking at districts, the proportions of respondents with a secondary education are lowest in Thaba-Tseka for both sexes and highest in Mafeteng and Maseru for females and in Maseru for males. As expected, the level of education increases with the wealth index. Among females in the lowest wealth quintile only 12 percent have at least some secondary education, compared with 62 percent of those in the highest quintile. Table 3.2.1 Educational attainment by background characteristics: women Percent distribution of women by highest level of schooling attended or completed, and median number of years of schooling, according to background characteristics, Lesotho 2004 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 women Median years of schooling Age 15-19 0.3 35.8 23.6 37.3 3.0 0.0 100.0 1,710 6.6 20-24 1.2 24.5 28.5 33.9 10.7 1.2 100.0 1,463 6.9 25-29 2.1 25.1 27.3 32.3 11.0 2.4 100.0 1,044 6.8 30-34 2.4 25.1 33.7 29.5 7.8 1.5 100.0 816 6.7 35-39 2.9 25.4 31.7 32.5 6.3 1.3 100.0 728 6.7 40-44 4.4 41.1 27.9 20.7 4.4 1.5 100.0 741 6.2 45-49 4.8 50.7 27.2 12.0 2.3 2.9 100.0 592 5.6 Residence Urban 0.8 17.7 23.8 40.2 14.7 2.8 100.0 1,682 8.1 Rural 2.4 35.6 29.2 27.7 4.2 0.8 100.0 5,413 6.4 Ecological zone Lowlands 1.1 24.5 27.1 36.4 9.2 1.6 100.0 4,299 6.9 Foothills 1.8 39.4 29.9 24.1 3.4 1.4 100.0 787 6.3 Mountains 4.6 45.2 28.9 18.7 2.1 0.5 100.0 1,572 6.0 Senqu River Valley 2.8 34.4 28.1 28.9 5.0 0.8 100.0 437 6.5 District Butha-Buthe 1.7 28.3 29.0 32.3 6.1 2.5 100.0 458 6.7 Leribe 0.8 28.5 29.7 33.9 6.1 1.0 100.0 1,065 6.7 Berea 1.3 33.7 32.6 26.5 4.9 1.0 100.0 776 6.4 Maseru 0.9 22.0 25.9 36.5 12.5 2.2 100.0 1,868 7.1 Mafeteng 1.5 28.5 27.3 37.1 5.0 0.6 100.0 755 6.7 Mohale's Hoek 2.9 37.7 25.0 28.9 4.6 0.8 100.0 684 6.4 Quthing 4.0 41.0 26.4 24.2 3.8 0.7 100.0 461 6.2 Qacha's Nek 5.4 44.9 22.5 23.3 3.2 0.7 100.0 233 6.0 Mokhotlong 6.8 44.0 26.8 18.8 2.5 1.2 100.0 360 6.0 Thaba-Tseka 3.5 45.1 33.4 15.2 2.5 0.3 100.0 435 6.0 Wealth quintile Lowest 6.2 55.7 26.2 11.0 0.9 0.0 100.0 987 5.3 Second 3.7 45.0 32.7 17.2 1.2 0.1 100.0 1,294 6.0 Middle 1.5 33.2 29.8 31.4 3.4 0.7 100.0 1,258 6.5 Fourth 0.7 23.0 31.1 37.9 6.7 0.6 100.0 1,595 6.8 Highest 0.3 15.8 21.7 43.0 15.4 3.7 100.0 1,962 8.2 Total 2.0 31.4 27.9 30.6 6.7 1.3 100.0 7,095 6.6 1 Completed 7 grade at the primary level 2 Completed 12 grade at the secondary level 26 | Characteristics of Survey Respondents Table 3.2.2 Educational attainment by background characteristics: men Percent distribution of men by highest level of schooling attended or completed, and median number of years of schooling, according to background characteristics, Lesotho 2004 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 men Median years of schooling Age 15-19 4.3 55.9 11.8 25.7 2.0 0.3 100.0 743 5.4 20-24 12.9 34.0 18.6 24.4 8.0 2.2 100.0 507 6.2 25-29 18.5 33.3 12.4 20.5 11.2 4.1 100.0 374 5.8 30-34 22.1 38.3 16.1 12.6 8.1 2.8 100.0 305 4.8 35-39 18.4 41.5 13.0 16.4 5.7 5.0 100.0 233 4.5 40-44 23.3 37.6 15.1 15.2 7.0 1.8 100.0 164 3.8 45-49 34.7 33.9 6.8 5.8 7.0 11.8 100.0 170 2.6 50-54 36.7 42.9 4.0 10.5 4.4 1.5 100.0 164 2.0 55-59 32.3 57.2 1.6 2.9 4.1 1.9 100.0 137 1.4 Residence Urban 5.6 26.3 15.8 30.5 14.0 7.7 100.0 603 7.3 Rural 20.3 47.2 11.7 15.5 4.0 1.4 100.0 2,194 4.3 Ecological zone Lowlands 9.6 41.0 14.3 23.3 8.1 3.7 100.0 1,734 5.9 Foothills 19.4 53.1 9.4 14.0 2.9 1.3 100.0 307 3.7 Mountains 37.0 42.2 8.4 8.3 2.9 1.2 100.0 585 2.5 Senqu River Valley 20.9 42.5 15.4 16.7 3.5 0.9 100.0 171 5.0 District Butha-Buthe 12.3 45.1 14.6 21.1 4.6 2.3 100.0 182 5.4 Leribe 13.2 41.5 11.7 18.9 11.8 2.8 100.0 393 5.6 Berea 13.1 52.1 13.0 16.6 4.2 1.0 100.0 350 4.7 Maseru 10.9 34.3 13.5 25.6 9.6 6.1 100.0 741 6.3 Mafeteng 14.2 49.7 14.3 19.8 1.9 0.1 100.0 297 4.4 Mohale's Hoek 23.1 43.5 12.3 15.7 3.7 1.7 100.0 281 4.1 Quthing 28.6 43.7 10.7 12.6 3.8 0.5 100.0 167 3.8 Qacha's Nek 24.2 53.1 6.6 11.9 3.6 0.6 100.0 99 3.6 Mokhotlong 33.7 38.0 9.2 14.7 2.7 1.7 100.0 130 3.4 Thaba-Tseka 35.0 42.5 13.2 5.6 1.0 2.7 100.0 156 2.8 Wealth quintile Lowest 43.2 46.1 6.7 3.1 0.5 0.4 100.0 466 1.2 Second 22.5 56.0 10.2 9.3 2.0 0.0 100.0 514 3.4 Middle 14.6 49.1 15.4 16.1 3.8 1.0 100.0 566 5.0 Fourth 8.4 39.2 18.0 26.2 7.4 0.8 100.0 621 6.1 Highest 4.2 26.9 11.1 33.0 14.5 10.2 100.0 630 8.1 Total 17.1 42.7 12.6 18.7 6.1 2.7 100.0 2,797 5.0 1 Completed 7 grade at the primary level 2 Completed 12 grade at the secondary level The 2004 LDHS interviewers asked respondents to read a simple, short sentence to establish literacy. The sentences were written in Sesotho and English (for those who were interviewed in English). Tables 3.3.1 and 3.3.2 show the percent distributions of female and male respondents, respectively, by level of literacy and the percent literate, according to background characteristics. Characteristics of Survey Respondents | 27 Table 3.3.1 Literacy: women Percent distribution of women by level of schooling attended and by level of literacy, and percent literate, according to background characteristics, Lesotho 2004 No schooling or primary school Background characteristic Secondary school or higher Can read a whole sentence Can read part of a sentence Cannot read at all No card with required language Missing Total Number of women Percent literate1 Age 15-19 40.3 51.0 5.3 2.5 0.0 0.8 100.0 1,710 96.6 20-24 45.8 45.3 4.4 3.9 0.1 0.6 100.0 1,463 95.5 25-29 45.6 45.2 5.3 3.5 0.0 0.4 100.0 1,044 96.1 30-34 38.8 51.1 5.5 4.2 0.1 0.3 100.0 816 95.4 35-39 40.1 50.7 4.5 4.3 0.1 0.3 100.0 728 95.3 40-44 26.6 58.4 6.7 7.9 0.1 0.3 100.0 741 91.7 45-49 17.3 65.3 6.7 10.1 0.0 0.6 100.0 592 89.2 Residence Urban 57.7 38.2 1.9 1.9 0.0 0.3 100.0 1,682 97.8 Rural 32.8 54.9 6.4 5.3 0.1 0.6 100.0 5,413 94.0 Ecological zone Lowlands 47.2 45.8 3.4 3.0 0.0 0.5 100.0 4,299 96.5 Foothills 28.9 58.3 8.0 4.4 0.0 0.4 100.0 787 95.2 Mountains 21.3 59.9 9.4 8.7 0.2 0.5 100.0 1,572 90.7 Senqu River Valley 34.6 55.4 4.2 4.9 0.0 0.8 100.0 437 94.3 District Butha-Buthe 41.0 52.4 2.7 3.6 0.0 0.3 100.0 458 96.1 Leribe 41.0 51.7 4.5 2.3 0.0 0.5 100.0 1,065 97.1 Berea 32.4 57.8 4.1 4.5 0.2 0.9 100.0 776 94.4 Maseru 51.2 39.5 6.0 3.0 0.0 0.3 100.0 1,868 96.7 Mafeteng 42.6 49.3 4.9 3.2 0.0 0.0 100.0 755 96.8 Mohale's Hoek 34.4 56.9 3.4 4.3 0.0 1.0 100.0 684 94.7 Quthing 28.7 57.2 6.0 7.0 0.2 0.9 100.0 461 91.9 Qacha's Nek 27.3 47.3 15.4 8.8 0.7 0.5 100.0 233 90.0 Mokhotlong 22.4 60.9 6.3 9.7 0.0 0.5 100.0 360 89.7 Thaba-Tseka 18.1 64.7 5.9 10.9 0.0 0.5 100.0 435 88.6 Wealth quintile Lowest 11.9 64.4 11.4 11.6 0.2 0.5 100.0 987 87.7 Second 18.5 63.6 9.7 7.9 0.0 0.3 100.0 1,294 91.8 Middle 35.5 55.6 4.4 3.7 0.2 0.5 100.0 1,258 95.5 Fourth 45.2 49.0 2.7 2.2 0.0 0.9 100.0 1,595 96.9 Highest 62.1 34.3 2.1 1.1 0.0 0.3 100.0 1,962 98.5 Total 38.7 50.9 5.3 4.5 0.1 0.5 100.0 7,095 94.9 1 Refers to women who attended secondary school or higher and women who can read a whole sentence or part of a sentence The literacy rate is higher for females (95 percent) than for males (75 percent). This pattern is not unexpected in view of the generally higher educational attainment of females than males. Looking at other differentials, the literacy rate decreases with increasing age, particularly among male respondents. Among female respondents, there are relatively minor differences in literacy rates by residence, with urban females only slightly more likely to be able to read than rural females (98 and 94 percent, respectively). Among male respondents, the residential differential is more pronounced, with the literacy rate for urban males (91 percent) being 20 percentage points higher than the rate for rural males. Literacy rates rise with increasing wealth, with variations being more significant for males than for females. 28 | Characteristics of Survey Respondents Table 3.3.2 Literacy: men Percent distribution of men by level of schooling attended and by level of literacy, and percent literate, according to background characteristics, Lesotho 2004 No schooling or primary school Background characteristic Secondary school or higher Can read a whole sentence Can read part of a sentence Cannot read at all No card with required language Missing Total Number of men Percent literate1 Age 15-19 28.0 48.9 8.9 13.6 0.0 0.6 100.0 743 85.8 20-24 34.6 36.4 6.8 21.0 0.3 1.0 100.0 507 77.7 25-29 35.8 32.5 5.2 26.6 0.0 0.0 100.0 374 73.4 30-34 23.5 36.8 8.1 31.4 0.0 0.2 100.0 305 68.4 35-39 27.1 36.1 11.5 25.4 0.0 0.0 100.0 233 74.6 40-44 24.0 42.5 6.8 26.7 0.0 0.0 100.0 164 73.3 45-49 24.6 30.2 10.3 34.9 0.0 0.0 100.0 170 65.1 50-54 16.4 39.5 7.4 36.3 0.5 0.0 100.0 164 63.3 55-59 8.9 45.0 5.1 41.0 0.0 0.0 100.0 137 59.0 Residence Urban 52.3 34.3 4.4 8.8 0.0 0.2 100.0 603 91.0 Rural 20.9 41.3 8.7 28.6 0.1 0.4 100.0 2,194 70.9 Ecological zone Lowlands 35.1 41.3 7.5 15.6 0.1 0.4 100.0 1,734 83.9 Foothills 18.1 40.9 10.5 30.0 0.0 0.5 100.0 307 69.5 Mountains 12.4 32.4 7.5 47.4 0.1 0.3 100.0 585 52.2 Senqu River Valley 21.1 47.9 7.2 23.8 0.0 0.0 100.0 171 76.2 District Butha-Buthe 28.0 47.8 6.3 17.9 0.0 0.0 100.0 182 82.1 Leribe 33.5 38.5 10.6 16.4 0.0 1.1 100.0 393 82.6 Berea 21.8 47.1 6.7 24.2 0.0 0.1 100.0 350 75.7 Maseru 41.2 32.2 8.4 17.7 0.0 0.4 100.0 741 81.9 Mafeteng 21.7 44.2 8.0 25.3 0.5 0.3 100.0 297 73.9 Mohale's Hoek 21.1 47.3 6.1 25.4 0.0 0.0 100.0 281 74.6 Quthing 17.0 40.9 7.1 34.3 0.0 0.5 100.0 167 65.1 Qacha's Nek 16.1 32.5 15.5 35.2 0.8 0.0 100.0 99 64.1 Mokhotlong 19.1 33.4 3.7 43.1 0.0 0.6 100.0 130 56.3 Thaba-Tseka 9.4 39.8 4.1 46.7 0.0 0.0 100.0 156 53.3 Wealth quintile Lowest 4.0 32.2 9.1 54.5 0.0 0.2 100.0 466 45.3 Second 11.4 45.3 8.5 34.6 0.1 0.2 100.0 514 65.1 Middle 20.9 49.3 9.4 20.2 0.0 0.3 100.0 566 79.5 Fourth 34.4 42.4 8.0 14.5 0.2 0.5 100.0 621 84.8 Highest 57.7 29.8 4.8 6.9 0.0 0.7 100.0 630 92.4 Total 27.6 39.8 7.8 24.3 0.1 0.4 100.0 2,797 75.2 1 Refers to men who attended secondary school or higher and men who can read a whole sentence or part of a sentence Characteristics of Survey Respondents | 29 3.3 ACCESS TO MASS MEDIA Mass media access is essential in increasing people’s knowledge and awareness of what is taking place around them, which may eventually affect their perceptions and behaviour. In the survey, exposure to media was assessed by asking respondents how often they read newspapers, watched television, or listened to a radio. Tables 3.4.1 and 3.4.2 show the percentage of female and male respondents exposed to different types of mass media by various background characteristics such as age, residence, education, and wealth index. This information is important in helping to identify population groups that are more commonly reached by mass media for purposes of assisting health, poverty alleviation, HIV/AIDS, and other development programmes to spread information more efficiently. Table 3.4.1 Exposure to mass media: women Percentage of women who usually read a newspaper at least once a week, watch television at least once a week, and listen to the radio at least once a week, by background characteristics, Lesotho 2004 Background characteristic Reads a newspaper at least once a week Watches television at least once a week Listens to the radio at least once a week All three media No media Number of women Age 15-19 15.3 16.3 52.0 5.6 43.1 1,710 20-24 13.9 12.0 51.2 3.3 45.1 1,463 25-29 13.5 16.0 56.3 5.3 40.0 1,044 30-34 13.6 14.7 62.0 3.4 34.9 816 35-39 13.5 13.4 58.8 3.9 37.4 728 40-44 11.5 13.8 54.4 3.1 43.6 741 45-49 10.0 10.4 49.0 2.8 48.6 592 Residence Urban 22.2 34.6 74.1 10.8 20.2 1,682 Rural 10.8 7.8 48.2 2.1 48.8 5,413 Ecological zone Lowlands 17.3 21.3 66.3 6.1 29.3 4,299 Foothills 9.2 5.4 48.0 1.7 49.9 787 Mountains 6.5 1.8 28.1 0.8 69.4 1,572 Senqu River Valley 9.3 4.2 41.6 1.3 55.1 437 District Butha-Buthe 15.9 8.8 57.0 3.3 38.8 458 Leribe 14.1 16.1 58.1 4.7 38.4 1,065 Berea 18.3 13.4 59.7 4.0 35.0 776 Maseru 17.6 26.1 67.8 7.7 28.0 1,868 Mafeteng 12.7 11.7 59.3 3.6 38.0 755 Mohale's Hoek 8.2 11.3 52.1 2.2 45.0 684 Quthing 8.9 3.1 37.9 1.1 59.1 461 Qacha's Nek 8.1 3.7 33.4 1.2 63.8 233 Mokhotlong 10.4 2.0 31.9 1.2 65.1 360 Thaba-Tseka 3.7 0.9 16.7 0.3 81.0 435 Education No education 0.0 0.1 22.7 0.0 77.3 145 Primary, incomplete 5.0 5.3 36.2 0.7 61.1 2,136 Primary, complete 9.7 8.7 51.7 1.3 44.9 1,936 Secondary+ 23.1 25.1 71.2 8.8 24.2 2,878 Wealth quintile Lowest 4.6 1.0 10.5 0.3 86.2 987 Second 6.9 2.4 31.0 0.2 65.4 1,294 Middle 8.0 4.0 48.7 0.7 49.0 1,258 Fourth 14.0 7.1 67.9 1.7 29.4 1,595 Highest 25.5 40.8 84.4 12.9 10.3 1,962 Total 13.5 14.1 54.3 4.2 42.1 7,095 30 | Characteristics of Survey Respondents Table 3.4.2 Exposure to mass media: men Percentage of men who usually read a newspaper at least once a week, watch television at least once a week, and listen to the radio at least once a week, by background characteristics, Lesotho 2004 Background characteristic Reads a newspaper at least once a week Watches television at least once a week Listens to the radio at least once a week All three media No media Number of men Age 15-19 12.7 20.2 52.2 6.1 43.5 743 20-24 16.3 21.6 58.9 7.9 37.1 507 25-29 20.3 24.2 58.3 9.1 35.5 374 30-34 14.8 21.4 53.0 7.2 42.9 305 35-39 19.3 23.3 61.3 11.9 35.1 233 40-44 22.0 17.9 57.0 10.5 40.2 164 45-49 21.1 23.4 54.4 14.2 44.3 170 50-54 15.0 20.5 54.5 10.2 44.6 164 55-59 15.5 11.9 48.7 3.0 48.0 137 Residence Urban 34.0 46.0 77.7 21.2 16.2 603 Rural 11.7 14.2 49.4 4.7 47.4 2,194 Ecological zone Lowlands 21.2 30.0 66.6 11.7 28.7 1,734 Foothills 11.5 8.4 48.9 2.8 48.4 307 Mountains 7.5 4.9 28.9 2.4 68.7 585 Senqu River Valley 8.4 8.0 45.3 3.2 52.2 171 District Butha-Buthe 16.8 18.4 62.2 7.0 34.3 182 Leribe 20.7 26.5 60.3 12.2 36.8 393 Berea 16.0 24.2 57.2 7.0 37.2 350 Maseru 25.1 32.2 68.8 14.9 27.0 741 Mafeteng 10.7 15.6 52.4 3.6 42.3 297 Mohale's Hoek 9.7 20.0 56.2 4.4 40.1 281 Quthing 9.9 3.9 39.6 1.9 58.0 167 Qacha's Nek 13.0 8.1 35.4 3.2 61.3 99 Mokhotlong 7.8 5.3 35.3 2.9 62.3 130 Thaba-Tseka 5.6 1.9 19.3 1.3 78.5 156 Education No education 0.7 5.4 30.3 0.0 68.7 479 Primary, incomplete 6.4 13.7 47.3 2.3 49.2 1,194 Primary, complete 18.4 20.1 64.7 7.3 32.3 342 Secondary+ 40.7 42.2 79.2 22.8 14.1 783 Wealth quintile Lowest 2.5 3.3 15.7 0.6 82.3 466 Second 7.3 7.8 41.0 1.0 55.3 514 Middle 11.1 12.7 54.5 4.6 41.1 566 Fourth 16.7 20.9 66.4 4.4 28.7 621 Highest 39.1 52.6 86.8 27.0 9.3 630 Total 16.5 21.0 55.5 8.3 40.6 2,797 Radio has the widest audience, with 54 percent of females and and 56 percent of males saying they listen to the radio at least once a week (Figure 3.1). In comparison, 14 percent of females and 21 percent of males, watch television at least once a week and 14 percent of females and 17 percent of males report they read a newspaper or a magazine weekly. Nearly identical percentages of females and males are not exposed to any type of media on a regular basis (42 and 41 percent, respectively). Only 4 percent of women and 8 percent of men are exposed to all three of these media sources weekly. The data show that there are relatively large differences for both sexes in the proportions having access to media by residence. For example, urban residents are much more likely to have been exposed to some form of media than rural residents for both sexes. Considering other residential categories, exposure to media is most common in the Lowlands zone and in Maseru district. The proportion with access to media increases with increasing education level and wealth of respondents. Characteristics of Survey Respondents | 31 3.4 EMPLOYMENT 3.4.1 Employment Status The 2004 LDHS asked respondents whether they were employed at the time of the survey and, if not, whether they were employed in the 12 months preceding the survey. Tables 3.5.1 and 3.5.2 show that 38 percent of women and 32 percent of men are currently employed and that 6 percent of women and 14 percent of men were not working at the time of the survey but had been employed at some point in the 12 months preceding the survey. The proportion of women currently employed increases with age up to age group 25-29 and, for men, it increases up to age group 35-39 before falling somewhat at older ages. Women who are divorced, separated, or widowed are most likely to be employed (51 percent), followed by those who are married (43 percent). In contrast, married men are somewhat more likely to be employed than divorced, separated, or widowed men. Urban residents are more likely to be currently employed than rural residents. Looking at the pattern by district, the percentages currently employed are highest for both sexes in Maseru (48 and 39 percent, respectively). Mokhotlong has the lowest percentage of women currently employed (27 per- cent), and the percentage of currently employed men is lowest in Butha-Buthe and Quthing (22 and 21 percent respectively). The proportion currently employed is higher in men with no education (36 percent) and in women who have attended or completed secondary education or higher (42 percent). The proportion currently employed generally increases as the wealth index increases, with those in the highest wealth quintile much more likely to be currently employed than individuals in the bottom four quintiles. 14 14 54 4 17 21 56 8 Reads a newspaper at least once a week Watches television at least once a week Listens to the radio at least once a week All three media Women Men Figure 3.1 Access to Mass Media LDHS 2004 32 | Characteristics of Survey Respondents Table 3.5.1 Employment status: women Percent distribution of women by employment status, according to background characteristics, Lesotho 2004 Employed in the 12 months preceding the survey Background characteristic Currently employed Not currently employed Not employed in the 12 months preceding the survey Missing/ don't know Total Number of respondents Age 15-19 15.3 3.4 81.3 0.0 100.0 1,710 20-24 33.9 8.1 58.0 0.0 100.0 1,463 25-29 50.0 9.9 40.0 0.0 100.0 1,044 30-34 48.2 5.8 46.0 0.0 100.0 816 35-39 50.8 6.8 42.0 0.3 100.0 728 40-44 49.8 6.2 44.0 0.0 100.0 741 45-49 52.5 5.5 42.0 0.0 100.0 592 Marital status Never married 26.3 5.5 68.2 0.0 100.0 2,373 Married or living together 42.6 6.5 50.8 0.0 100.0 3,709 Divorced/separated/widowed 51.4 8.1 40.4 0.1 100.0 1,014 Number of living children 0 26.4 5.3 68.3 0.0 100.0 2,386 1-2 43.7 7.8 48.6 0.0 100.0 2,563 3-4 47.5 6.3 46.2 0.0 100.0 1,327 5+ 42.1 5.6 52.0 0.3 100.0 820 Residence Urban 55.0 7.4 37.7 0.0 100.0 1,682 Rural 33.2 6.1 60.6 0.0 100.0 5,413 Ecological zone Lowlands 41.4 6.7 51.8 0.0 100.0 4,299 Foothills 32.3 4.5 63.1 0.1 100.0 787 Mountains 34.2 6.6 59.2 0.0 100.0 1,572 Senqu River Valley 34.3 6.1 59.5 0.0 100.0 437 District Butha-Buthe 29.7 4.1 66.1 0.0 100.0 458 Leribe 42.5 4.3 53.1 0.1 100.0 1,065 Berea 34.6 9.8 55.5 0.0 100.0 776 Maseru 47.8 7.3 45.0 0.0 100.0 1,868 Mafeteng 33.2 3.0 63.8 0.0 100.0 755 Mohale's Hoek 33.3 8.5 58.1 0.2 100.0 684 Quthing 31.8 5.5 62.7 0.0 100.0 461 Qacha's Nek 31.8 10.6 57.6 0.0 100.0 233 Mokhotlong 27.3 7.1 65.6 0.0 100.0 360 Thaba-Tseka 40.8 5.2 54.0 0.0 100.0 435 Education No education 34.4 7.5 57.2 0.9 100.0 145 Primary, incomplete 35.3 5.4 59.2 0.0 100.0 2,136 Primary, complete 37.5 7.5 55.0 0.0 100.0 1,936 Secondary+ 41.5 6.4 52.1 0.0 100.0 2,878 Wealth quintile Lowest 31.5 6.7 61.9 0.0 100.0 987 Second 31.5 6.1 62.2 0.1 100.0 1,294 Middle 32.2 7.2 60.5 0.1 100.0 1,258 Fourth 36.3 6.6 57.1 0.0 100.0 1,595 Highest 52.1 5.9 42.1 0.0 100.0 1,962 Total 38.4 6.4 55.1 0.0 100.0 7,095 Characteristics of Survey Respondents | 33 Table 3.5.2 Employment status: men Percent distribution of men by employment status, according to background characteristics, Lesotho 2004 Employed in the 12 months preceding the survey Background characteristic Currently employed Not currently employed Not employed in the 12 months preceding the survey Missing/ don't know Total Number of men Age 15-19 13.5 7.0 77.0 2.6 100.0 743 20-24 30.3 11.9 56.5 1.3 100.0 507 25-29 39.4 23.5 36.5 0.6 100.0 374 30-34 42.4 19.8 33.7 4.2 100.0 305 35-39 52.4 12.4 34.4 0.8 100.0 233 40-44 41.1 17.1 40.0 1.8 100.0 164 45-49 47.9 13.2 37.2 1.7 100.0 170 50-54 32.0 20.4 47.5 0.1 100.0 164 55-59 32.4 15.4 51.4 0.7 100.0 137 Marital status Never married 22.4 10.4 65.0 2.2 100.0 1,419 Married or living together 43.2 17.6 38.0 1.2 100.0 1,191 Divorced/separated/widowed 35.5 20.6 41.9 2.0 100.0 184 Number of living children 0 24.3 11.2 62.5 1.9 100.0 1,561 1-2 44.1 16.3 37.7 1.9 100.0 635 3-4 42.4 20.5 35.3 1.8 100.0 359 5+ 35.4 17.3 46.8 0.4 100.0 242 Residence Urban 44.1 14.1 40.0 1.8 100.0 603 Rural 28.8 14.1 55.3 1.8 100.0 2,194 District Butha-Buthe 22.2 20.0 55.5 2.2 100.0 182 Leribe 35.8 15.3 47.9 1.0 100.0 393 Berea 37.7 13.0 47.5 1.9 100.0 350 Maseru 39.1 12.7 45.4 2.7 100.0 741 Mafeteng 26.9 9.2 63.6 0.2 100.0 297 Mohale's Hoek 25.2 14.8 59.0 1.0 100.0 281 Quthing 20.6 12.1 66.2 1.1 100.0 167 Qacha's Nek 38.2 25.6 35.2 1.0 100.0 99 Mokhotlong 27.0 22.2 49.5 1.4 100.0 130 Thaba-Tseka 23.3 9.4 63.2 4.0 100.0 156 Education No education 35.7 18.5 43.4 2.4 100.0 479 Primary, incomplete 30.4 13.6 54.1 1.9 100.0 1,194 Primary, complete 33.8 12.8 51.0 2.4 100.0 342 Secondary+ 31.8 12.7 54.6 0.9 100.0 783 Wealth quintile Lowest 27.3 19.3 51.9 1.5 100.0 466 Second 26.6 13.2 58.1 2.1 100.0 514 Middle 30.0 16.5 52.2 1.3 100.0 566 Fourth 30.4 14.4 52.9 2.4 100.0 621 Highest 43.7 8.6 46.2 1.4 100.0 630 Total 32.1 14.1 52.0 1.8 100.0 2,797 34 | Characteristics of Survey Respondents 3.4.2 Occupation The distributions of women and men employed in the 12 months preceding the survey by occu- pation are shown in Tables 3.6.1 and 3.6.2. One in three working women and almost four in ten working men are engaged in agricultural occupations. Among both women and men, the next most common occupation is skilled manual labour (27 and 32 percent, respectively). The sales and service sector is the third most common occupation category, engaging 18 percent of women and 12 percent of men. Ten percent of employed women do domestic work, and 7 percent work in professional, technical, or managerial fields. Table 3.6.1 Occupation: women Percent distribution of women employed in the 12 months preceding the survey by occupation, according to background characteristics, Lesotho 2004 Background characteristic Professional/ technical/ managerial Clerical Sales and services Skilled manual Unskilled manual Domestic service Agriculture Total Number of women Age 15-19 1.9 0.6 13.1 9.7 7.1 27.9 39.7 100.0 320 20-24 3.5 3.1 17.8 33.9 2.5 11.2 28.0 100.0 614 25-29 7.0 4.5 15.1 37.7 1.8 9.0 24.9 100.0 626 30-34 8.2 3.4 17.7 29.4 1.6 8.0 31.6 100.0 441 35-39 7.8 2.8 21.6 25.8 5.8 4.2 32.1 100.0 420 40-44 11.8 1.3 21.8 19.1 2.0 4.2 39.7 100.0 415 45-49 7.4 4.9 18.4 19.3 2.6 7.2 40.2 100.0 344 Marital status Never married 5.3 4.5 17.9 31.1 3.6 19.3 18.2 100.0 755 Married or living together 7.1 2.8 16.7 26.0 2.7 5.4 39.2 100.0 1,822 Divorced/separated/widowed 7.5 2.1 21.5 24.8 3.5 10.7 29.9 100.0 603 Number of living children 0 5.3 4.3 16.2 29.7 3.9 18.0 22.5 100.0 757 1-2 7.2 3.2 19.6 32.0 2.1 8.1 27.8 100.0 1,318 3-4 8.3 2.6 16.9 23.0 3.5 6.8 38.8 100.0 714 5+ 5.2 1.2 17.0 12.4 3.8 4.8 55.8 100.0 391 Residence Urban 7.9 6.1 22.4 48.1 2.4 10.3 2.9 100.0 1,048 Rural 6.2 1.6 15.7 16.7 3.4 9.5 47.0 100.0 2,132 Ecological zone Lowlands 6.9 3.8 19.6 35.0 2.2 9.9 22.6 100.0 2,071 Foothills 7.9 1.4 13.4 14.0 5.7 9.8 47.7 100.0 290 Mountains 6.4 1.0 14.9 11.7 4.3 9.5 52.2 100.0 642 Senqu River Valley 4.3 4.5 15.8 11.0 4.3 9.2 50.8 100.0 177 District Butha-Buthe 13.0 2.5 24.2 12.1 4.2 11.9 32.1 100.0 155 Leribe 5.6 1.4 17.8 31.1 2.1 6.9 35.1 100.0 499 Berea 7.6 3.0 14.3 23.4 2.1 12.8 36.8 100.0 345 Maseru 6.8 4.4 21.4 43.8 2.0 8.6 13.0 100.0 1,028 Mafeteng 6.5 3.5 14.9 20.3 5.1 10.0 39.7 100.0 273 Mohale's Hoek 4.2 3.0 18.2 12.3 4.7 12.7 44.9 100.0 285 Quthing 3.8 4.5 14.9 11.5 4.4 7.4 53.4 100.0 172 Qacha's Nek 8.8 1.9 19.3 9.3 2.8 14.1 43.8 100.0 99 Mokhotlong 10.5 1.5 17.0 10.4 4.2 16.3 40.0 100.0 124 Thaba-Tseka 6.0 0.5 7.6 11.4 4.7 7.0 62.7 100.0 200 Education No education 1.6 0.2 13.6 11.0 2.9 9.3 61.4 100.0 61 Primary, incomplete 0.8 0.4 13.7 15.5 4.5 13.8 51.2 100.0 870 Primary, complete 1.3 0.8 16.3 29.6 2.7 14.0 35.5 100.0 871 Secondary+ 14.2 6.3 21.7 33.4 2.4 4.5 17.5 100.0 1,378 Wealth quintile Lowest 3.1 0.2 9.7 10.7 4.2 8.5 63.7 100.0 376 Second 2.9 0.2 13.8 14.1 5.0 10.8 53.2 100.0 487 Middle 4.8 1.7 15.2 20.5 3.6 10.3 43.9 100.0 496 Fourth 6.0 1.9 19.2 31.8 3.4 7.6 30.1 100.0 685 Highest 10.9 6.5 22.7 37.9 1.4 10.8 9.7 100.0 1,136 Total 6.7 3.1 17.9 27.0 3.1 9.7 32.5 100.0 3,180 Characteristics of Survey Respondents | 35 Table 3.6.2 Occupation: men Percent distribution of men employed in the 12 months preceding the survey by occupation, according to background characteristics, Lesotho 2004 Background characteristic Professional/ technical/ managerial Clerical Sales and services Skilled manual Unskilled manual Domestic service Agriculture Total Number of men Age 15-19 3.4 1.4 4.7 3.1 13.1 0.1 74.3 100.0 152 20-24 4.6 1.8 8.2 18.6 13.5 1.6 51.6 100.0 214 25-29 5.6 5.8 15.8 36.4 7.9 0.1 28.5 100.0 235 30-34 4.6 6.0 14.7 44.6 6.4 0.1 23.7 100.0 189 35-39 11.2 5.0 17.3 42.2 3.3 0.6 20.3 100.0 151 40-44 6.2 2.4 21.5 37.3 0.0 0.0 32.6 100.0 95 45-49 19.2 0.7 3.7 40.9 9.0 0.0 26.5 100.0 104 50-54 8.0 1.4 12.1 36.5 3.2 0.9 38.0 100.0 86 55-59 2.3 1.4 9.0 33.2 1.0 0.0 53.2 100.0 66 Marital status Never married 4.7 3.3 8.7 17.4 11.2 1.0 53.6 100.0 465 Married or living together 8.5 2.8 15.5 39.9 5.6 0.0 27.5 100.0 724 Divorced/separated/widowed 3.9 7.5 3.3 38.0 4.2 0.7 42.3 100.0 103 Number of living children 0 4.8 3.2 9.2 20.7 11.5 0.9 49.8 100.0 555 1-2 7.1 5.6 18.2 43.4 3.6 0.0 22.1 100.0 383 3-4 13.2 2.1 11.1 36.6 7.1 0.4 29.6 100.0 226 5+ 2.9 0.0 8.3 35.5 2.7 0.0 50.5 100.0 128 Residence Urban 13.2 7.1 26.1 40.8 6.1 0.1 6.7 100.0 351 Rural 4.4 2.0 6.9 28.3 8.1 0.6 49.8 100.0 942 Ecological zone Lowlands 8.5 4.2 15.0 36.6 8.5 0.4 26.7 100.0 795 Foothills 3.9 2.4 4.0 23.9 6.4 0.7 58.8 100.0 147 Mountains 4.6 1.1 8.4 21.6 4.6 0.4 59.3 100.0 289 Senqu River Valley 1.8 5.6 11.5 33.3 12.3 0.0 35.6 100.0 61 District Butha-Buthe 5.7 1.8 12.8 42.4 4.8 0.0 32.5 100.0 77 Leribe 10.6 2.5 12.9 35.5 5.6 0.5 32.4 100.0 201 Berea 2.9 3.9 7.1 22.2 8.7 0.8 54.3 100.0 177 Maseru 11.2 4.8 18.0 31.6 7.0 0.5 26.9 100.0 385 Mafeteng 0.2 2.0 8.7 33.2 8.6 0.0 47.2 100.0 107 Mohale's Hoek 3.5 5.2 3.0 46.7 12.0 0.0 29.6 100.0 112 Quthing 2.5 5.1 13.5 22.7 16.0 0.0 40.3 100.0 54 Qacha's Nek 1.9 1.0 10.6 22.1 5.0 1.5 58.0 100.0 63 Mokhotlong 5.1 0.4 9.5 25.8 5.0 0.2 53.9 100.0 64 Thaba-Tseka 7.8 0.6 11.3 26.4 4.4 0.3 49.3 100.0 51 Education No education 1.0 0.4 5.0 26.9 5.8 0.4 60.6 100.0 260 Primary, incomplete 2.3 0.7 8.8 30.7 7.2 0.2 50.2 100.0 525 Primary, complete 2.1 8.2 11.3 43.3 6.5 0.9 27.6 100.0 159 Secondary+ 20.1 7.4 22.7 31.3 9.8 0.6 8.0 100.0 349 Wealth quintile Lowest 1.1 0.1 4.7 24.2 6.2 0.0 63.7 100.0 217 Second 4.1 1.2 8.4 25.7 8.3 0.5 51.8 100.0 205 Middle 3.7 3.1 3.4 30.2 7.6 1.7 50.2 100.0 263 Fourth 4.9 4.7 10.6 41.5 10.5 0.1 27.8 100.0 278 Highest 16.3 6.0 27.4 33.1 5.4 0.0 11.8 100.0 330 Total 6.8 3.4 12.1 31.7 7.5 0.4 38.1 100.0 1,293 36 | Characteristics of Survey Respondents Differences by background characteristics show that rural women (47 percent) and men (50 per- cent) are more likely to be employed in agricultural jobs than urban women (3 percent) and men (7 per- cent). In turn, urban residents are more likely than rural residents to be engaged in skilled manual or sales and service occupations. Among women, domestic service is particularly high among never-married (19 percent) and younger respondents age 15-19 (28 percent). 3.4.3 Type of Employer, Form of Earnings, and Continuity of Employment Table 3.7.1 presents the percent distribution of employed women, by type of earnings and em- ployment characteristics, according to type of employment (agricultural or nonagricultural). The data show that slightly more than 60 percent of employed women receive cash for their work, and almost one in three is unpaid. Women are more likely to be paid in kind or not paid at all if they are employed in agricultural activities. Less than half of working women are employed by a nonfamily member, and 38 percent are self-employed. Women are more likely to be self-employed if they are doing agricultural work than if they are engaged in nonagricultural work. Women are also more prone to seasonal work if they are employed in agricultural activities (90 percent) than if they are in non- agricultural occupations (16 percent) and, conversely, continuity of employment is more assured for women who are engaged in nonagricultural work, 74 percent of whom are engaged throughout the year. Table 3.7.1 Type of employment: women Percent distribution of 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), Lesotho 2004 Employment characteristic Agricultural work Nonagricultural work Total Type of earnings Cash only 6.4 85.7 59.9 Cash and in-kind 1.3 3.5 2.8 In-kind only 9.1 2.4 4.6 Not paid 83.2 7.9 32.4 Total 100.0 100.0 100.0 Type of employer Employed by family member 31.5 4.7 13.4 Employed by nonfamily member 13.7 65.0 48.4 Self-employed 54.8 29.9 38.0 Total 100.0 100.0 100.0 Continuity of employment All year 7.6 73.6 52.2 Seasonal 89.5 15.7 39.6 Occasional 2.8 10.3 7.8 Total 100.0 100.0 100.0 Number of respondents 1,032 2,147 3,180 Note: Total includes 15 women with missing information on type of employment who are not shown separately. For the male respondents, questions on the type of employment were somewhat more limited than those for women. For example, men were not asked about the type of employer and the continuity or seasonality of their employment. Table 3.7.2 provides information on the type of earnings and employment patterns for men. Results show that 67 percent of men earn cash for the work they do, and 23 percent are not paid for their work. Characteristics of Survey Respondents | 37 Table 3.7.2 Type of employment: men Percent distribution of men employed in the 12 months preceding the survey by type of earnings, according to type of employment (agricultural or nonagricultural), Lesotho 2004 Type of earnings Agricultural work Nonagricultural work Total Cash only 24.8 88.9 64.5 Cash and in-kind 2.8 2.4 2.6 In-kind only 18.3 1.5 7.9 Not paid 54.1 4.5 23.4 Total 100.0 100.0 100.0 Number of men 492 800 1,293 Note: Total includes 4 men with missing information on type of employment who are not shown separately. 3.4.4 Control Over Earnings and Women’s Contribution to Household Expenditures Women and men who were working and receiving cash earnings were asked who makes the decisions on how their earnings are used. They were also asked what proportion of household expendi- tures is met by their earnings. Table 3.8.1 shows that 70 percent of working women say they decide by themselves how their earnings are used, and an additional 22 percent make the decision jointly with someone else. Table 3.8.2 shows that working men are somewhat less likely than working women to say they alone decide on their own how earnings will be used (57 percent) and somewhat more likely to make these decisions jointly with someone else (28 percent). Only 9 percent of women and 14 percent of men report that the decision on how to use their earnings is made entirely by someone else. Tables 3.8.1 and 3.8.2 also look at how the degree of control over a respondent’s earnings varies by background characteristics. The results generally show that, regardless of background characteristics, the majority of respondents make the decisions on how their cash earnings are used themselves. Married women and men, compared with their unmarried counterparts, are somewhat more likely to involve another person in making the decision. Women and men are more likely to report that someone else makes the decisions about their earnings if they are under age 20 (20 and 35 percent, respectively). The proportions of both women and men in the lowest wealth quintile who report that decisions about the use of their earnings are made by someone are also comparatively high (20 and 23 percent, respectively). Regarding the proportion of household expenditures met by their earnings, 4 percent of working women reported that their earnings supported all household expenditure, and 36 percent reported that their earmings constitute more than half of household expenditures. Younger women and women who are married or living together with their partner are more likely to provide all of the financial support for their households. Seven percent of working men report that their earnings cover all household expenditures. 38 | Characteristics of Survey Respondents Table 3.8.1 Decision on use of earnings and contribution of earnings to household expenditures: women Percent distribution of women employed in the 12 months preceding the survey receiving cash earnings by person who decides how earnings are to be used and by proportion of household expenditures met by earnings, according to background characteristics, Lesotho 2004 Person who decides how earnings are used Proportion of household expenditures met by earnings Background characteristic Self only Jointly1 Someone else only2 Missing Total Almost none/ none Less than half Half or more All Missing Total Number of women Age 15-19 67.3 11.9 20.3 0.5 100.0 8.5 52.6 32.3 6.6 0.0 100.0 160 20-24 68.0 18.7 12.8 0.5 100.0 8.4 48.7 39.6 3.3 0.0 100.0 405 25-29 68.4 23.3 8.3 0.0 100.0 10.8 51.6 34.6 2.6 0.3 100.0 442 30-34 69.0 26.3 4.8 0.0 100.0 10.7 46.4 39.4 3.6 0.0 100.0 286 35-39 70.8 23.6 5.1 0.5 100.0 8.5 51.0 36.8 2.9 0.9 100.0 266 40-44 74.4 19.8 5.8 0.0 100.0 10.9 50.7 34.0 4.5 0.0 100.0 246 45-49 69.9 23.7 6.4 0.0 100.0 9.0 60.1 27.4 3.5 0.0 100.0 187 Marital status Never married 83.8 4.7 11.0 0.6 100.0 8.8 55.0 32.7 3.5 0.0 100.0 569 Married or living together 52.0 38.4 9.5 0.1 100.0 9.8 47.4 38.7 3.8 0.2 100.0 1,025 Divorced/separated/ widowed 94.1 2.3 3.7 0.0 100.0 10.4 54.2 32.1 3.0 0.4 100.0 401 Number of living children 0 75.2 11.4 12.9 0.5 100.0 6.9 52.9 36.0 3.9 0.3 100.0 532 1-2 68.3 24.9 6.8 0.0 100.0 10.6 50.3 35.8 3.1 0.2 100.0 900 3-4 66.3 25.4 8.3 0.0 100.0 10.0 48.8 37.0 4.2 0.0 100.0 406 5+ 65.7 26.6 7.2 0.5 100.0 12.6 53.4 30.2 3.3 0.5 100.0 157 Residence Urban 72.9 21.7 5.1 0.3 100.0 9.5 52.7 34.0 3.8 0.0 100.0 968 Rural 66.3 21.4 12.2 0.1 100.0 9.8 49.2 37.3 3.3 0.4 100.0 1,026 District Butha-Buthe 66.6 22.1 11.4 0.0 100.0 27.1 42.4 29.3 1.2 0.0 100.0 102 Leribe 75.4 17.3 7.4 0.0 100.0 7.3 36.9 51.8 4.0 0.0 100.0 292 Berea 69.9 14.8 15.1 0.2 100.0 5.8 53.1 37.2 3.8 0.0 100.0 202 Maseru 70.0 22.6 7.2 0.3 100.0 10.7 53.8 31.4 4.1 0.0 100.0 861 Mafeteng 60.8 35.1 3.6 0.5 100.0 3.5 58.8 32.0 3.7 2.0 100.0 145 Mohale's Hoek 66.9 22.9 10.1 0.0 100.0 5.5 56.6 34.4 3.5 0.0 100.0 139 Quthing 71.0 21.8 7.2 0.0 100.0 17.9 55.4 21.4 5.4 0.0 100.0 66 Qacha's Nek 75.2 14.8 10.0 0.0 100.0 8.7 50.0 40.1 1.2 0.0 100.0 54 Mokhotlong 69.2 18.6 10.9 1.3 100.0 7.8 52.9 37.5 0.5 1.3 100.0 61 Thaba-Tseka 60.9 20.9 18.2 0.0 100.0 8.3 47.7 43.8 0.2 0.0 100.0 73 Education No education (81.8) (12.7) (5.5) (0.0) (100.0) (15.9) (51.6) (32.5) (0.0) (0.0) (100.0) 19 Primary, incomplete 71.4 16.0 12.4 0.2 100.0 11.7 56.9 27.0 4.0 0.4 100.0 385 Primary, complete 69.5 20.7 9.8 0.0 100.0 9.4 51.2 36.5 2.9 0.0 100.0 532 Secondary+ 68.7 24.1 6.9 0.3 100.0 8.9 48.6 38.4 3.8 0.2 100.0 1,059 Wealth quintile Lowest 63.4 16.9 19.6 0.0 100.0 8.2 53.4 38.2 0.2 0.0 100.0 127 Second 71.1 17.8 10.7 0.4 100.0 15.0 49.0 32.1 3.4 0.4 100.0 210 Middle 63.7 22.2 14.2 0.0 100.0 8.9 50.8 37.1 2.7 0.6 100.0 256 Fourth 68.5 20.9 10.1 0.5 100.0 11.9 49.6 36.7 1.9 0.0 100.0 438 Highest 72.0 23.0 4.9 0.1 100.0 7.9 51.7 35.2 5.0 0.2 100.0 964 Total 69.5 21.5 8.8 0.2 100.0 9.7 50.9 35.7 3.6 0.2 100.0 1,995 Note: Figures in parentheses are based on 25-49 unweighted cases. 1 With husband or someone else 2 Includes husband Characteristics of Survey Respondents | 39 Table 3.8.2 Decision on use of earnings and contribution of earnings to household expenditures: men Percent distribution of men employed in the 12 months preceding the survey receiving cash earnings by person who decides how earnings are to be used and by proportion of household expenditures met by earnings, according to background characteristics, Lesotho 2004 Person who decides how earnings are used Proportion of household expenditures met by earnings Background characteristic Self only Jointly1 Someone else only2 Missing Total Almost none/ none Less than half Half or more All Missing Total Number of men Age 15-19 40.1 21.4 35.4 3.1 100.0 11.9 55.1 29.8 0.0 3.1 100.0 47 20-24 64.1 14.2 21.7 0.0 100.0 15.8 52.8 27.6 3.8 0.0 100.0 129 25-29 64.1 24.3 11.6 0.0 100.0 6.9 54.6 35.8 2.7 0.0 100.0 181 30-34 53.6 33.3 13.1 0.0 100.0 9.7 45.9 41.9 2.5 0.0 100.0 154 35-39 53.2 37.9 8.9 0.0 100.0 13.1 36.5 40.8 9.6 0.0 100.0 131 40-44 52.3 34.3 13.4 0.0 100.0 11.3 35.4 36.4 16.9 0.0 100.0 67 45-49 55.3 33.3 11.4 0.0 100.0 6.2 33.4 45.6 14.9 0.0 100.0 73 50-54 60.0 25.3 14.7 0.0 100.0 5.9 38.4 43.0 12.7 0.0 100.0 57 55-59 (53.9) (40.4) (5.8) (0.0) (100.0) (9.0) (26.7) (61.0) (3.2) (0.0) (100.0) 28 Marital status Never married 71.7 9.5 18.2 0.6 100.0 14.6 52.7 29.8 2.3 0.6 100.0 258 Married or living together 46.0 41.1 13.0 0.0 100.0 7.6 40.9 42.4 9.1 0.0 100.0 537 Divorced/separated/ widowed 87.2 1.7 11.1 0.0 100.0 13.8 46.0 37.5 2.6 0.0 100.0 71 Number of living children 0 69.4 13.4 16.8 0.4 100.0 13.5 51.9 31.4 2.7 0.4 100.0 326 1-2 52.3 35.4 12.3 0.0 100.0 5.6 45.7 40.7 8.1 0.0 100.0 312 3-4 45.5 41.1 13.3 0.0 100.0 14.3 31.0 45.1 9.6 0.0 100.0 161 5+ 46.5 38.7 14.8 0.0 100.0 5.9 39.4 44.0 10.7 0.0 100.0 67 Residence Urban 64.1 28.5 7.5 0.0 100.0 8.4 43.5 40.3 7.9 0.0 100.0 323 Rural 52.9 28.4 18.5 0.3 100.0 11.3 45.6 37.0 5.7 0.3 100.0 544 District Butha-Buthe 66.1 21.1 12.8 0.0 100.0 19.0 30.4 47.1 3.5 0.0 100.0 51 Leribe 60.4 26.0 13.7 0.0 100.0 7.1 41.2 44.6 7.1 0.0 100.0 129 Berea 60.7 18.9 18.9 1.5 100.0 6.0 51.1 37.0 4.4 1.5 100.0 94 Maseru 61.6 26.6 11.8 0.0 100.0 11.4 43.7 36.7 8.2 0.0 100.0 291 Mafeteng 42.3 50.4 7.3 0.0 100.0 0.4 56.6 35.4 7.6 0.0 100.0 63 Mohale's Hoek 49.0 36.8 14.1 0.0 100.0 8.0 44.6 40.7 6.6 0.0 100.0 94 Quthing 51.0 33.0 16.0 0.0 100.0 25.0 48.0 24.0 3.0 0.0 100.0 46 Qacha's Nek 56.2 16.3 27.5 0.0 100.0 6.5 50.7 36.2 6.7 0.0 100.0 30 Mokhotlong 42.8 39.4 17.8 0.0 100.0 8.2 50.9 33.5 7.4 0.0 100.0 37 Thaba-Tseka 54.9 18.3 26.8 0.0 100.0 22.4 33.9 42.8 0.9 0.0 100.0 31 Education No education 48.4 30.6 21.0 0.0 100.0 19.3 45.3 31.0 4.4 0.0 100.0 133 Primary, incomplete 56.7 26.7 16.2 0.5 100.0 6.6 46.4 41.0 5.6 0.5 100.0 312 Primary, complete 65.2 15.6 19.2 0.0 100.0 7.4 55.8 30.2 6.6 0.0 100.0 121 Secondary+ 58.0 34.4 7.7 0.0 100.0 11.1 38.6 41.9 8.4 0.0 100.0 300 Wealth quintile Lowest 55.9 21.0 23.1 0.0 100.0 10.7 52.9 30.4 6.0 0.0 100.0 98 Second 50.0 31.8 18.2 0.0 100.0 15.4 38.8 43.3 2.5 0.0 100.0 119 Middle 61.8 21.4 16.8 0.0 100.0 13.7 50.8 30.8 4.7 0.0 100.0 146 Fourth 61.3 28.6 9.4 0.7 100.0 9.4 47.7 39.6 2.7 0.7 100.0 210 Highest 54.9 32.9 12.3 0.0 100.0 6.8 39.5 41.6 12.0 0.0 100.0 294 Total 57.0 28.4 14.4 0.2 100.0 10.2 44.8 38.3 6.5 0.2 100.0 866 Note: Figures in parentheses are based on 25-49 unweighted cases. 1 With husband or someone else 2 Includes wife 40 | Characteristics of Survey Respondents Table 3.9 shows information on how decisions on use of women’s earnings are related to the pro- portional contribution of these earnings to the household expenditures, according to marital status. The analysis indicates that independence in decisionmaking is slightly inversely related to the proportion of women’s contribution to the household expenses. For instance, 62 percent of currently married women whose contribution to household expenditures is minimal decide for themselves how their earnings are used. Only 55 percent of women who support all of their household’s expenses decide for themselves how their earnings are used, and 34 percent share the decision with their husband and 11 percent say that their husband alone makes decisions. Almost all unmarried women (between 87 and 92 percent) make their own decisions regarding their earnings, regardless of their contribution to the household expendi- tures. Table 3.9 Women's control over earnings Percent distribution of women who received cash earnings for work in the past 12 months by person who decides how earnings are used, according to current marital status, and the proportion of household expenditures met by earnings, Lesotho 2004 Currently married or living together Not married1 Contribution to household expenditures Self only Jointly with husband Jointly with someone else Husband only Someone else only Missing Total Number of women Self only Jointly with someone else Someone else only Missing Total Number of women Almost none/ none 61.8 33.3 4.1 0.8 0.0 0.0 100.0 101 90.9 0.9 7.5 0.8 100.0 92 Less than half 52.2 35.3 2.0 9.7 0.8 0.0 100.0 486 88.2 3.0 8.4 0.5 100.0 530 Half or more 49.4 37.8 2.4 10.2 0.2 0.0 100.0 397 87.0 6.0 6.9 0.0 100.0 315 All (55.0) (33.9) (0.0) (11.1) (0.0) (0.0) (100.0) 39 (92.0) (0.0) (8.0) (0.0) (100.0) 32 Total 52.0 36.1 2.3 9.1 0.4 0.1 100.0 1,025 88.0 3.7 7.9 0.3 100.0 969 Note: Figures in parentheses are based on 25-49 unweighted cases. 1 Never married, divorced, separated, or widowed women 3.5 WOMEN’S EMPOWERMENT In addition to information on women’s education, employment status, and control over earnings, the 2004 LDHS collected information from both women and men on other measures of women’s autonomy and status. Questions were asked about women’s roles in making household decisions, on acceptance of wife beating, and on opinions about when a wife should be able to deny sex to her husband. Such information provides insight into women’s control over their environment and their attitudes towards gender roles, both of which are relevant to understanding women’s demographic and health behaviour. 3.5.1 Women’s Participation in Decisionmaking To assess women’s decisionmaking autonomy, the 2004 LDHS sought information on women’s participation in five different types of household decisions: on the respondents’ own health care; on making large household purchases; on making household purchase for daily needs; on visits to family or relatives; and on what food should be cooked each day. Table 3.10 shows the percent distribution of women according to who in the household usually has the final say on each aspect. A woman is considered to have autonomy in a decision if she either makes the decision herself or participates jointly with someone else in the decisions. Among currently married women, the degree of sole decisionmaking ranges from a high of 81 percent in decisions about what food to cook daily to a low 14 percent in decisions about large household purchases. Although 50 percent of married women make decisions on their own health care by Characteristics of Survey Respondents | 41 themselves or jointly, 44 percent of women say that their husband alone makes these decisions. Decisions about visits to relatives or friends are generally made by the woman herself or jointly (61 percent). Unmarried women are generally less autonomous than married women. The proportions of un- married women reporting that decisions are made by someone else ranges from 46 percent in the case of what food to cook to 59 percent in the case of large household purchases. These patterns are not sur- prising because the majority of the unmarried are younger women who still live with their guardians or parents. Table 3.10 Women's participation in decisionmaking Percent distribution of women by person who has the final say in making specific decisions, according to current marital status and type of decision, Lesotho 2004 Currently married or living together Not married1 Decision Self only Jointly with hus- band Jointly with some- one else Hus- band only Some- one else only Decision not made/ not applic- able Total Number of respond- ents Self only Jointly with some- one else Some- one else only Decision not made/ not applic- able Total Number of respond- ents Own health care 37.0 12.3 0.8 43.8 6.0 0.1 100.0 3,709 38.8 7.9 52.7 0.5 100.0 3,386 Large household purchases 14.1 29.0 1.4 48.0 7.2 0.3 100.0 3,709 30.3 5.4 59.0 5.1 100.0 3,386 Daily household purchases 67.4 10.1 0.9 14.9 6.3 0.2 100.0 3,709 35.1 5.0 55.7 4.0 100.0 3,386 Visits to family or relatives 24.3 35.1 1.9 31.1 5.6 1.8 100.0 3,709 34.0 7.4 54.2 4.2 100.0 3,386 What food to cook each day 80.5 7.6 0.8 5.6 4.5 0.8 100.0 3,709 44.7 4.7 45.5 4.8 100.0 3,386 1 Never married, divorced, separated, or widowed women Table 3.11 shows that although 30 percent of women have a say in all five areas of decisionmaking, another 23 percent have no say at all in any of the specified areas. Women who are under age 20, have never married, and have no children are least likely to participate in all decisions. Older women, urban residents, and those living in Mafeteng are among the most likely to be involved in all decisions. Cash employment also is related to increased decisionmaking power. More than half (53 per- cent) of women who are employed for cash participate in making all decisions, compared with 31 percent who are employed but do not earn cash and 21 percent of unemployed women. 42 | Characteristics of Survey Respondents Table 3.11 Women's participation in decisionmaking by background characteristics Percentage of women who say that they alone or jointly have the final say in specific decisions, by background characteristics, Lesotho 2004 Alone or jointly have final say in: Background characteristic Own health care Making large purchases Making daily purchases Visits to family or relatives What food to cook each day All specified decisions None of the specified decisions Number of women Age 15-19 22.1 11.5 18.3 17.1 30.1 8.1 59.3 1,710 20-24 40.8 30.3 50.6 41.5 63.9 19.3 25.9 1,463 25-29 58.1 50.8 74.6 64.0 84.4 35.8 9.3 1,044 30-34 63.3 54.8 83.4 72.2 89.7 41.5 6.6 816 35-39 66.4 62.0 85.3 73.4 92.5 50.1 4.7 728 40-44 65.8 60.3 86.8 74.0 93.7 49.4 3.6 741 45-49 62.7 58.0 83.2 74.0 91.4 46.8 3.2 592 Marital status Never married 31.6 17.8 22.3 23.9 33.7 15.8 54.0 2,373 Married or living together 50.1 44.5 78.5 61.3 88.9 27.5 6.6 3,709 Divorced/separated/widowed 82.0 77.7 82.1 82.5 86.2 73.5 9.8 1,014 Number of living children 0 30.7 18.8 27.1 25.4 38.5 15.2 51.0 2,386 1-2 54.9 47.6 71.0 61.2 81.3 33.6 12.3 2,563 3-4 62.9 57.3 85.6 71.8 92.9 44.9 3.9 1,327 5+ 57.0 52.5 81.8 67.3 90.1 39.5 5.1 820 Residence Urban 59.3 52.5 66.0 61.2 72.3 43.7 21.6 1,682 Rural 45.2 36.5 58.4 48.9 69.4 26.0 23.3 5,413 Ecological zone Lowlands 51.2 42.1 61.7 54.9 72.0 32.5 21.4 4,299 Foothills 40.2 38.9 60.0 49.1 71.2 26.2 24.7 787 Mountains 44.2 34.7 57.6 43.2 66.3 24.6 25.5 1,572 Senqu River Valley 53.0 45.2 55.7 57.7 62.7 34.4 24.5 437 District Butha-Buthe 46.3 45.3 67.4 49.8 78.0 31.5 19.1 458 Leribe 46.1 33.7 63.0 52.7 73.8 22.4 18.1 1,065 Berea 36.4 31.2 55.5 44.7 64.4 21.8 29.8 776 Maseru 51.3 47.5 62.6 55.4 70.5 36.4 24.5 1,868 Mafeteng 65.8 49.3 67.6 67.3 81.4 41.7 11.1 755 Mohale's Hoek 42.7 34.8 52.0 46.4 67.7 25.9 25.8 684 Quthing 59.3 48.8 58.2 62.2 61.2 36.8 21.4 461 Qacha's Nek 44.0 35.2 58.7 46.0 63.7 28.1 32.0 233 Mokhotlong 46.0 33.5 54.6 37.6 60.4 22.8 28.5 360 Thaba-Tseka 38.5 29.1 51.5 35.2 65.6 22.8 27.3 435 Education No education 53.3 47.8 69.9 60.0 81.1 37.9 12.2 145 Primary, incomplete 41.7 37.0 59.1 48.6 69.1 25.9 24.4 2,136 Primary, complete 50.9 40.7 63.6 53.5 73.6 30.9 19.7 1,936 Secondary+ 51.7 42.0 58.3 52.8 67.9 32.5 24.5 2,878 Employment Not employed 39.5 30.4 49.3 42.5 61.8 21.4 30.9 4,366 Employed for cash 73.0 64.4 81.4 73.6 86.1 53.2 7.5 1,633 Employed not for cash 47.6 44.0 72.4 56.7 79.6 31.2 13.5 1,081 Wealth quintile Lowest 43.9 37.4 58.2 45.3 69.6 26.8 23.7 987 Second 41.9 35.6 58.0 46.4 69.1 23.8 23.0 1,294 Middle 42.7 33.5 55.5 46.8 68.3 23.4 25.1 1,258 Fourth 50.9 42.2 62.5 56.4 71.6 31.5 21.4 1,595 Highest 56.9 47.7 63.9 58.2 70.8 39.4 22.2 1,962 Total 48.5 40.3 60.2 51.8 70.1 30.2 22.9 7,095 Note: Total includes 15 women with missing information on employment status. Characteristics of Survey Respondents | 43 3.5.2 Women’s Attitudes Towards Wife Beating Violence against women is an area that is increasingly being recognised as affecting women’s health and autonomy. Violence against women has serious consequences for their mental and physical well-being, including their reproductive and sexual health (World Health Organisation, 1999). If violence against women is tolerated and accepted in a society, its eradication is made more difficult. To gauge the acceptability of domestic violence, women and men interviewed in the 2004 LDHS were asked whether they thought a husband would be justified in hitting or beating his wife in each of the following five situa- tions: if she burns the food, if she argues with him, if she goes out without telling him, if she neglects the children, and if she refuses to have sexual relations with him. Tables 3.12.1 and 3.12.2 show that many women and men, respectively, find wife beating to be justified in certain circumstances. Nearly 48 percent of women and 51 percent of men agree that at least one of these factors is sufficient justification for wife-beating. The most widely accepted reasons for wife-beating are neglecting the children (37 percent of women and 38 percent of men) and arguing with the husband (36 percent of women and 39 percent of men). Twenty-four percent of women and 30 percent of men think that going out without informing the husband is a justifiable reason for beating. About one-fifth of women and men feel that denying sex to the husband is a justification for wife beating. Even smaller proportions believe that burning the food is a justifiable reason to hit or beat the wife. The tables also show attitudes towards wife beating by background characteristics. Acceptance of wife beating for at least one of the specified reasons is higher among women and men who are under age 25 than among older individuals. Considering residence, the proportions are higher among women and men who live in rural areas, the Mountains zone, or Qacha’s Nek, Mokhotlong, and Thaba-Tseka districts than among those living in other areas. Acceptance of wife beating declines as the level of education increases. Similarly, acceptance of wife beating by women and men declines markedly as wealth increases. 44 | Characteristics of Survey Respondents Table 3.12.1 Attitude towards wife beating: women Percentage of women who agree that a husband is justified in hitting or beating his wife for specific reasons, by background characteristics, Lesotho 2004 Husband is justified in hitting or beating his wife if she: Background characteristic Burns the food Argues with him Goes out without telling him Neglects the children Refuses to have sex with him Agrees with at least one specified reason Number of women Age 15-19 14.7 43.4 29.0 43.0 20.1 56.1 1,710 20-24 11.7 38.7 22.9 39.2 18.4 50.2 1,463 25-29 11.2 32.2 22.1 31.3 18.9 43.2 1,044 30-34 11.8 33.2 23.1 35.4 19.7 44.2 816 35-39 11.3 29.4 21.3 32.2 19.2 41.9 728 40-44 11.7 32.3 21.3 33.1 22.4 45.4 741 45-49 15.7 33.9 27.7 38.3 24.7 47.8 592 Marital status Never married 12.3 36.5 23.0 37.9 15.5 48.8 2,373 Married or living together 12.8 36.7 25.5 37.0 22.8 48.9 3,709 Divorced/separated/widowed 12.7 33.6 23.5 35.6 20.8 45.2 1,014 Number of living children 0 12.4 37.7 24.5 38.9 17.5 50.3 2,386 1-2 11.7 36.2 23.2 35.4 19.4 47.3 2,563 3-4 12.0 31.1 22.2 35.0 20.7 44.2 1,327 5+ 17.1 40.1 30.8 40.3 28.5 52.7 820 Residence Urban 6.4 21.4 12.9 27.3 9.7 34.1 1,682 Rural 14.6 40.8 27.9 40.1 23.3 52.8 5,413 Ecological zone Lowlands 9.7 31.7 19.3 33.4 14.9 43.5 4,299 Foothills 13.7 41.0 28.1 40.2 24.2 53.6 787 Mountains 20.5 47.7 37.1 46.6 32.9 61.0 1,572 Senqu River Valley 11.2 30.2 21.8 33.0 16.9 41.1 437 District Butha-Buthe 13.2 35.9 25.5 38.2 21.0 48.0 458 Leribe 9.8 32.3 20.2 32.6 17.0 44.5 1,065 Berea 10.7 43.1 29.8 43.4 23.7 54.4 776 Maseru 9.3 29.4 17.6 32.9 14.7 43.8 1,868 Mafeteng 10.2 31.9 17.8 28.6 14.0 40.4 755 Mohale's Hoek 17.3 41.7 28.5 41.3 22.6 52.3 684 Quthing 9.6 27.5 18.7 31.1 16.2 37.4 461 Qacha's Nek 17.4 47.6 42.0 50.1 26.6 64.4 233 Mokhotlong 21.3 51.9 43.0 51.2 38.4 64.5 360 Thaba-Tseka 27.0 51.8 38.7 49.4 35.1 64.0 435 Education No education 24.2 45.7 43.2 48.5 39.7 64.5 145 Primary, incomplete 18.6 49.1 35.5 47.2 29.8 60.4 2,136 Primary, complete 12.9 37.9 26.2 38.4 21.7 49.3 1,936 Secondary+ 7.4 25.0 13.9 28.1 10.8 38.0 2,878 Employment Not employed 13.3 39.6 26.4 40.0 21.5 51.7 4,366 Employed for cash 9.0 24.5 17.1 28.1 13.2 37.3 1,633 Employed not for cash 15.5 40.5 27.2 38.8 24.6 51.7 1,081 Number of decisions in which woman has final say1 0 14.5 42.5 29.1 43.0 19.3 55.2 1,623 1-2 14.5 42.2 27.8 42.0 23.7 54.5 1,558 3-4 13.2 37.9 24.4 36.9 22.0 49.7 1,772 5 9.4 25.7 18.2 29.1 16.4 37.6 2,142 Wealth quintile Lowest 23.1 51.9 39.6 50.6 34.8 64.0 987 Second 16.1 46.3 33.4 43.9 28.1 58.8 1,294 Middle 13.6 40.0 25.5 38.7 19.7 51.3 1,258 Fourth 9.5 33.0 19.8 35.3 16.4 45.6 1,595 Highest 7.0 21.8 13.7 26.1 10.6 33.9 1,962 Total 12.6 36.2 24.4 37.1 20.1 48.3 7,095 Note: Total includes 15 women with missing information on employment status. 1 Either by herself or jointly with others Characteristics of Survey Respondents | 45 Table 3.12.2 Attitude towards wife beating: men Percentage of men who agree that a husband is justified in hitting or beating his wife for specific reasons, by background characteristics, Lesotho 2004 Husband is justified in hitting or beating his wife if she: Background characteristic Burns the food Argues with him Goes out without telling him Neglects the children Refuses to have sex with him Agrees with at least one specified reason Number of men Age 15-19 17.6 46.1 33.0 45.8 19.4 60.1 743 20-24 13.7 42.8 30.3 40.3 18.0 54.2 507 25-29 9.5 38.0 22.6 32.4 19.1 46.7 374 30-34 9.9 35.0 29.3 35.6 15.1 46.6 305 35-39 11.3 30.5 31.7 33.2 22.0 43.5 233 40-44 12.7 38.0 28.4 34.8 26.8 50.5 164 45-49 9.4 38.3 33.0 37.5 21.8 52.2 170 50-54 11.6 31.4 30.5 31.7 27.7 45.9 164 55-59 8.6 26.2 22.2 28.9 13.6 37.6 137 Marital status Never married 15.8 42.0 29.5 40.1 18.5 54.8 1,419 Married or living together 9.6 35.1 29.6 35.1 19.8 47.0 1,191 Divorced/separated/widowed 11.9 43.8 31.6 41.3 27.8 53.8 184 Number of living children 0 15.2 42.0 29.8 40.2 19.0 54.8 1,561 1-2 8.2 34.8 27.1 34.1 16.9 43.9 635 3-4 11.4 35.4 32.1 36.4 26.8 50.9 359 5+ 12.5 37.3 31.8 36.6 20.1 49.2 242 Residence Urban 6.4 23.7 20.0 25.0 12.6 34.2 603 Rural 14.7 43.3 32.3 41.6 21.5 56.1 2,194 Ecological zone Lowlands 11.9 37.2 27.3 34.9 16.2 47.0 1,734 Foothills 14.2 43.6 31.8 40.9 20.8 58.2 307 Mountains 16.5 45.7 35.8 45.9 30.3 61.9 585 Senqu River Valley 8.6 28.5 29.2 37.8 15.5 47.2 171 District Butha-Buthe 9.0 34.5 24.3 33.0 16.0 46.1 182 Leribe 11.3 39.9 32.1 38.1 20.3 51.1 393 Berea 10.9 45.5 34.9 45.0 14.9 57.0 350 Maseru 9.5 33.7 23.5 29.8 15.5 45.4 741 Mafeteng 15.6 38.3 25.3 34.3 21.5 48.4 297 Mohale's Hoek 22.5 43.9 34.4 45.1 22.4 54.8 281 Quthing 5.8 26.1 27.5 37.6 14.3 44.5 167 Qacha's Nek 14.3 46.5 35.5 50.3 34.4 66.6 99 Mokhotlong 15.4 48.3 39.0 49.0 30.6 58.8 130 Thaba-Tseka 24.3 48.4 37.9 45.0 30.6 65.1 156 Education No education 15.8 44.1 33.1 44.3 25.4 57.4 479 Primary, incomplete 15.5 47.1 36.4 46.0 26.5 60.8 1,194 Primary, complete 15.2 41.1 31.0 36.0 14.7 51.7 342 Secondary+ 6.1 23.0 16.9 23.0 7.7 33.2 783 Employment Not employed 13.5 41.8 31.2 39.3 19.2 53.7 1,895 Employed for cash 10.1 29.5 23.3 30.0 15.6 40.6 587 Employed not for cash 14.6 41.7 32.9 45.9 30.3 58.1 311 Number of decisions in which woman has final say1 0 17.2 46.0 36.6 48.5 29.3 58.8 137 1-2 19.0 54.0 40.3 53.0 29.7 68.5 686 3-4 11.9 40.0 29.1 37.3 18.6 51.1 1,123 5-6 8.6 24.8 20.7 25.2 11.3 36.8 851 Wealth quintile Lowest 17.6 46.9 37.8 48.1 30.2 62.3 466 Second 19.3 48.6 35.6 45.8 25.7 61.7 514 Middle 10.2 40.3 32.5 39.5 19.0 54.3 566 Fourth 11.6 37.6 25.0 34.6 16.6 46.9 621 Highest 7.9 26.1 21.0 26.3 10.3 36.7 630 Total 12.9 39.1 29.7 38.0 19.6 51.4 2,797 Note: Total includes 2 men with missing information on marital status and 4 men with missing information on employment status. 1 Either by herself or jointly with others 46 | Characteristics of Survey Respondents 3.5.3 Attitudes Towards Refusing Sex with Husband The extent of control women have over matters such as when and with whom they have sex has important implications for demographic and health outcomes, such as transmission of HIV and other sexually transmitted infections. To measure beliefs about sexual empowerment of women, the 2004 LDHS asked all respondents whether they think a wife is justified in refusing to have sex with her husband in the following circumstances: when she knows that her husband has a sexually transmitted disease, when she knows that her husband has sex with other women, when she has recently given birth, and when she is tired or not in the mood. Tables 3.13.1 and 3.13.2 show the responses of women and men, respectively. Sixty-one percent of women and 41 percent of men agree that all of the above reasons are acceptable justifications for a woman to refuse to have sexual relations with her husband, and 7 percent of women and 11 percent of men consider none of the reasons acceptable. For women and men, the most acceptable reason for a wife to refuse having sex is if the wife has recently given birth (85 and 81 percent, respectively), and the least acceptable reason is the wife being tired or not in the mood (73 and 59 percent, respectively). Women and men age 15-19, those with no children, those who have never married, those living in the Mountains zone, especially Qacha’s Nek district, and those with the least autonomy in making household decisions are the most likely to agree with none of the reasons for refusing sex. Characteristics of Survey Respondents | 47 Table 3.13.1 Attitude towards refusing sex with husband: women Percentage of women who believe that a wife is justified in refusing to have sex with her husband for specific reasons, by background characteristics, Lesotho 2004 Wife is justified in refusing sex with husband if she: Background characteristic Knows husband has a sexually transmitted disease Knows husband has sex with other women Has recently given birth Is tired or not in the mood Agrees with all of the specified reasons Agrees with none of the specified reasons Number of women Age 15-19 75.6 75.1 78.7 64.9 54.3 13.5 1,710 20-24 82.5 80.2 88.2 77.8 63.4 4.7 1,463 25-29 84.1 83.6 88.5 73.7 61.1 3.9 1,044 30-34 86.4 81.4 87.6 75.1 64.5 4.5 816 35-39 85.6 83.6 86.0 75.6 63.2 3.8 728 40-44 83.6 79.7 86.3 75.0 61.2 5.8 741 45-49 81.4 77.5 84.0 71.0 60.0 8.5 592 Marital status Never married 80.2 79.1 81.2 70.0 59.2 10.5 2,373 Married or living together 82.1 80.0 87.2 73.5 60.4 5.3 3,709 Divorced/separated/widowed 85.0 79.7 86.5 76.0 63.7 5.2 1,014 Number of living children 0 77.9 77.4 80.3 68.1 56.2 11.1 2,386 1-2 84.2 81.5 88.8 76.1 63.9 4.4 2,563 3-4 85.3 82.0 86.9 74.6 61.9 4.6 1,327 5+ 80.5 76.9 84.6 72.4 59.8 7.3 820 Residence Urban 88.2 87.4 88.6 78.1 67.6 3.6 1,682 Rural 79.9 77.3 84.0 71.0 58.2 8.1 5,413 Ecological zone Lowlands 85.7 83.8 87.1 74.9 64.0 5.2 4,299 Foothills 81.6 75.7 85.8 70.3 56.8 6.3 787 Mountains 70.0 69.2 78.2 66.0 49.6 12.4 1,572 Senqu River Valley 87.3 84.4 88.6 79.9 71.0 6.9 437 District Butha-Buthe 82.2 78.6 83.8 70.5 58.5 7.3 458 Leribe 81.9 79.7 82.4 71.6 62.0 8.8 1,065 Berea 84.5 82.4 86.8 72.2 61.6 5.2 776 Maseru 85.6 82.9 86.4 73.7 61.8 4.8 1,868 Mafeteng 83.8 79.9 90.2 73.4 60.4 4.4 755 Mohale's Hoek 83.9 81.0 90.1 77.5 65.2 5.8 684 Quthing 84.3 84.9 86.5 78.9 70.6 8.8 461 Qacha's Nek 60.7 62.5 61.2 61.8 39.2 19.5 233 Mokhotlong 68.9 67.9 81.2 63.5 51.2 14.2 360 Thaba-Tseka 73.7 73.1 82.1 72.5 52.0 7.5 435 Education No education 64.6 60.2 76.2 64.3 42.8 15.6 145 Primary, incomplete 74.3 72.5 80.7 66.3 52.5 11.2 2,136 Primary, complete 82.4 79.2 85.1 72.9 60.1 5.9 1,936 Secondary+ 88.0 86.2 88.8 77.8 67.5 4.2 2,878 Employment Not employed 79.9 77.8 84.4 71.7 59.5 8.4 4,366 Employed for cash 88.2 86.1 86.8 76.2 65.3 3.9 1,633 Employed not for cash 80.2 77.3 85.5 71.5 56.9 6.2 1,081 Number of decisions in which woman has final say1 0 77.4 76.0 80.9 68.7 57.5 11.3 1,623 1-2 78.4 77.3 83.8 70.1 55.7 8.3 1,558 3-4 81.9 79.4 86.3 73.2 59.2 5.3 1,772 5 87.7 84.4 88.2 77.2 67.3 4.3 2,142 Number of reasons wife beating is justified 0 85.0 83.3 86.6 78.4 68.5 6.9 3,665 1-2 79.7 76.7 82.6 68.5 53.0 6.8 1,685 3-4 79.3 76.2 85.2 64.5 50.9 7.0 1,276 5-6 72.1 71.2 82.2 65.4 50.6 8.9 469 Wealth quintile Lowest 71.8 67.4 78.9 65.7 49.7 12.5 987 Second 78.6 76.0 83.9 69.7 55.9 8.2 1,294 Middle 80.2 79.2 84.4 71.3 59.7 7.7 1,258 Fourth 84.8 81.8 87.0 74.3 62.7 6.0 1,595 Highest 87.8 86.9 87.9 77.8 67.5 3.9 1,962 Total 81.9 79.7 85.1 72.7 60.5 7.0 7,095 Note: Total includes 15 women with missing information on employment status. 1 Either by herself or jointly with others 48 | Characteristics of Survey Respondents Table 3.13.2 Attitude towards refusing sex with husband: men Percentage of men who believe that a wife is justified in refusing to have sex with her husband for specific reasons, by background characteristics, Lesotho 2004 Wife is justified in refusing sex with husband if she: Background characteristic Knows husband has a sexually transmitted disease Knows husband has sex with other women Has recently given birth Is tired or not in the mood Agrees with all of the specified reasons Agrees with none of the specified reasons Number of men Age 15-19 65.5 58.5 72.3 52.8 37.6 18.8 743 20-24 70.6 63.8 84.5 58.2 39.8 8.5 507 25-29 74.7 64.0 84.1 63.1 43.4 7.9 374 30-34 71.2 62.6 83.7 65.6 42.4 7.4 305 35-39 73.0 67.7 85.2 62.2 45.9 7.1 233 40-44 77.5 66.2 83.7 60.3 46.8 8.6 164 45-49 76.1 58.1 83.9 52.5 32.5 10.6 170 50-54 76.9 58.8 80.9 62.4 41.7 5.1 164 55-59 78.2 72.0 84.9 60.7 53.4 10.0 137 Marital status Never married 68.1 60.6 76.7 56.1 39.1 14.5 1,419 Married or living together 75.4 65.3 85.4 61.6 43.8 7.3 1,191 Divorced/separated/widowed 73.1 58.4 84.0 59.9 40.4 7.1 184 Number of living children 0 68.5 60.7 77.6 55.6 39.1 13.7 1,561 1-2 75.7 65.4 87.5 67.4 46.0 5.8 635 3-4 73.7 65.7 83.5 58.7 42.5 9.4 359 5+ 77.4 62.1 81.2 56.3 40.7 8.5 242 Residence Urban 73.6 67.9 83.3 61.6 48.1 9.2 603 Rural 71.0 61.1 80.2 57.9 39.3 11.4 2,194 Ecological zone Lowlands 71.4 63.8 81.8 60.4 42.7 10.1 1,734 Foothills 67.3 58.8 77.3 52.9 36.0 14.8 307 Mountains 70.3 57.0 76.8 52.8 35.0 13.2 585 Senqu River Valley 85.0 75.5 92.4 72.1 57.4 4.3 171 District Butha-Buthe 68.1 60.3 80.3 56.3 37.5 12.1 182 Leribe 70.8 65.2 76.2 57.6 43.4 13.7 393 Berea 74.4 64.9 79.5 60.0 39.2 8.7 350 Maseru 72.3 63.5 81.3 57.9 42.5 10.5 741 Mafeteng 56.2 49.5 80.6 52.9 29.3 16.1 297 Mohale's Hoek 80.2 64.8 88.1 67.6 50.2 5.9 281 Quthing 88.2 78.9 90.4 69.0 59.1 5.2 167 Qacha's Nek 57.4 49.5 67.2 52.2 24.6 19.8 99 Mokhotlong 72.6 61.7 83.3 57.3 44.8 11.3 130 Thaba-Tseka 71.6 61.0 78.9 55.0 33.8 8.7 156 Education No education 68.4 52.5 77.8 53.4 33.3 12.8 479 Primary, incomplete 67.7 61.6 76.2 52.5 37.3 13.7 1,194 Primary, complete 80.9 68.5 86.3 60.8 46.0 6.4 342 Secondary+ 75.2 67.5 87.6 70.6 50.0 7.6 783 Employment Not employed 71.8 62.7 80.3 59.1 40.9 10.8 1,895 Employed for cash 75.6 69.1 86.3 64.4 48.9 7.8 587 Employed not for cash 62.2 49.0 74.5 45.4 28.5 17.1 311 Number of decisions in which woman has final say1 0 57.7 50.4 65.6 41.9 29.1 22.1 137 1-2 71.0 57.9 78.3 55.3 33.5 9.6 686 3-4 73.6 63.5 82.4 58.4 42.9 10.7 1,123 5-6 71.6 67.0 83.5 64.6 47.3 10.5 851 Number of reasons wife beating is justified 0 73.2 65.0 81.3 64.2 48.6 12.6 1,360 1-2 69.8 60.8 78.9 57.3 36.3 10.5 663 3-4 71.2 60.0 81.5 53.3 33.7 7.7 621 5-6 65.9 58.6 83.6 37.7 27.6 11.2 153 Wealth quintile Lowest 71.6 58.3 76.3 53.3 35.4 12.4 466 Second 69.0 58.2 80.0 54.5 36.5 12.5 514 Middle 72.3 64.5 82.0 60.0 43.2 11.7 566 Fourth 71.6 61.5 78.5 58.2 40.6 10.8 621 Highest 72.9 68.5 86.4 65.6 48.2 8.0 630 Total 71.6 62.5 80.9 58.7 41.2 10.9 2,797 Note: Total includes 2 men with missing information on marital status and 4 men with missing information on employment status. 1 Either by herself or jointly with others Characteristics of Survey Respondents | 49 Male respondents in the 2004 LDHS were further asked whether they thought that a husband had the right to take specific actions if his wife refused to have sex with him. The specified actions were to get angry and reprimand her, to refuse to give her money or other means of financial support, to use force and have sex with her even if she does not want to, and to have sex with another woman. Table 3.14 presents the results. Data show that 56 percent of men think that the husband has the right to get angry and reprimand his wife if she refuses to have sex with him. Eighteen percent of men think that a husband has the right to refuse giving money or other means of financial support to his wife if she refuses to have sex, and an equal proportion think that a husband has the right to have sex with another woman if wife refuse to have sex with him. Twelve percent of men believe that a husband has the right to use force to have sex with his wife if she refuses to have sex with him. 50 | Characteristics of Survey Respondents Table 3.14 Reprimanding for refusing sex with husband Percentage of men who believe that if a woman refuses to have sex with her husband when he wants to, he has the right to reprimand her, by background characteristics, Lesotho 2004 Percent that think if a woman refuses sex with husband, the husband has the right to: Background characteristic Get angry and reprimand her Refuse to give her money or other means of financial support Use force and have sex with her even is she doesn't want to Have sex with another woman Number of men Age 15-19 51.0 17.6 12.3 13.7 743 20-24 58.2 18.1 11.0 19.1 507 25-29 56.0 12.4 9.6 20.0 374 30-34 58.2 15.1 12.0 18.7 305 35-39 61.0 18.3 13.1 16.2 233 40-44 52.5 18.5 13.4 22.8 164 45-49 65.3 23.1 18.6 21.0 170 50-54 66.3 24.3 16.0 18.8 164 55-59 49.8 16.4 11.6 14.3 137 Marital status Never married 53.1 15.8 10.9 16.8 1,419 Married or living together 59.3 19.1 13.9 16.8 1,191 Divorced/separated/ widowed 61.8 20.3 14.3 28.9 184 Number of living children 0 54.2 16.5 12.0 17.0 1,561 1-2 56.9 15.6 9.6 17.3 635 3-4 62.0 20.4 14.9 20.9 359 5+ 61.0 24.6 18.1 16.9 242 Residence Urban 48.5 13.5 10.1 16.6 603 Rural 58.6 18.6 13.0 17.8 2,194 Ecological zone Lowlands 53.7 16.2 10.2 16.0 1,734 Foothills 61.8 18.7 12.1 20.0 307 Mountains 61.7 23.6 20.5 21.8 585 Senqu River Valley 56.2 7.7 7.2 14.6 171 District Butha-Buthe 53.3 9.2 9.9 12.7 182 Leribe 57.7 21.0 12.5 15.2 393 Berea 66.6 22.1 13.2 16.9 350 Maseru 52.2 15.5 9.8 18.0 741 Mafeteng 44.2 12.8 9.7 20.9 297 Mohale's Hoek 61.8 18.8 12.2 16.5 281 Quthing 49.7 7.1 7.4 11.3 167 Qacha's Nek 58.1 28.3 23.0 25.2 99 Mokhotlong 61.8 25.8 24.1 25.4 130 Thaba-Tseka 68.8 21.5 19.4 19.3 156 Education No education 58.0 22.9 18.7 23.0 479 Primary, incomplete 57.8 18.7 14.7 19.6 1,194 Primary, complete 57.5 16.7 9.8 13.0 342 Secondary+ 52.8 12.7 6.1 13.1 783 Employment Not employed 55.8 16.4 11.8 16.3 1,895 Employed for cash 58.1 19.1 10.6 16.6 587 Employed not for cash 56.5 21.5 19.5 27.2 311 Number of decisions in which woman has final say1 0 55.0 24.9 19.6 23.5 137 1-2 63.4 25.4 16.0 21.9 686 3-4 58.0 16.0 13.3 17.0 1,123 5-6 48.8 12.0 7.0 13.8 851 Number of reasons wife beating is justified 0 43.8 9.3 5.8 9.8 1,360 1-2 59.8 18.1 12.0 20.5 663 3-4 74.8 31.1 21.0 28.2 621 5-6 78.6 32.4 37.6 30.4 153 Wealth quintile Lowest 61.5 21.6 20.2 22.5 466 Second 61.3 20.8 16.8 23.2 514 Middle 56.8 15.5 10.7 15.2 566 Fourth 51.3 15.4 7.6 14.8 621 Highest 53.3 15.6 9.3 14.2 630 Total 56.4 17.5 12.4 17.6 2,797 Note: Total includes 2 men with missing information on marital status and 4 men with missing information on employment status. 1 Either by herself or jointly with others Fertility Levels, Trends, and Differentials | 51 FERTILITY LEVELS, TRENDS, AND DIFFERENTIALS 4 4.1 INTRODUCTION Fertility is one of the three principal components of population dynamics, the others being mortality and migration (United Nations, 1973). This chapter presents an analysis of the fertility data collected in the 2004 LDHS. It includes a discussion on levels, trends, and differentials in fertility by selected background characteristics; data on lifetime fertility (children ever born and living); and a scrutiny of age at first birth and birth intervals. This discussion is followed by a brief discussion on adolescent fertility, which has become critical to the issue of fertility transition, particularly in the wake of a new policy on adolescent reproductive health. The fertility data were collected by asking all women of reproductive age (15-49 years) to provide complete birth histories of all children they had given birth to, those who were currently living with them, those who were living away, and those who had died. The following information was also collected for each live birth: name, sex, date of birth, survival status, current age (if alive), and age at death (if dead). It is important to mention at the outset that the birth history approach has some limitations that might distort fertility levels and patterns. For instance, women may include relatives’ children as their own or omit children who died young, while older women may forget grown children who have left home (United Nations, 1983). There is also an implicit assumption that the fertility of surviving women is similar to that of women who have died. Accordingly, the results should be viewed with these caveats in mind. 4.2 CURRENT FERTILITY Measures of current fertility are presented in Table 4.1 for the three-year period preceding the survey, corresponding to the period from late 2001 to late 2004. Several measures of current fertility are shown. Age-specific fertility rates (ASFRs) are calculated by dividing the number of births to women in a specific age group by the number of woman-years lived during a given period.1 The total fertility rate (TFR) is a common measure of current fertility and is defined as the average number of children a woman would have if she went through her entire reproductive period (15-49 years) reproducing at the prevailing ASFR. The general fertility rate (GFR) represents the annual number of births per 1,000 women age 15-44, and the crude birth rate (CBR) represents the annual number of births per 1,000 population. The CBR is estimated using the birth history data in conjunction with the population data collected in the household schedule. 1 Numerators for the age-specific fertility rates are calculated by summing all births that occurred during the 1 to 36 months preceding the survey, classified by the age of the mother at the time of birth in 5-year age groups. The de- nominators are the number of woman-years lived in each specific 5-year age group during the 1 to 36 months pre- ceding the survey. Table 4.1 Current fertility Age-specific and cumulative fertility rates, the general fertility rate, and the crude birth rate for the three years preceding the survey, by urban-rural residence, Lesotho 2004 Residence Age group Urban Rural Total 15-19 45 103 91 20-24 98 206 177 25-29 92 190 160 30-34 66 142 122 35-39 51 118 101 40-44 33 50 46 45-49 0 11 9 TFR 1.9 4.1 3.5 GFR 69 138 121 CBR 19.3 26.7 25.3 Note: Rates for age group 45-49 may be slightly biased because of 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 52 | Fertility Levels, Trends, and Differentials Table 4.1 shows a TFR of 3.5 children per woman for the three-year period preceding the survey (late-2001 to late-2004). Fertility is considerably higher in the rural areas (4.1 children per woman) than urban areas (1.9 children per woman). Considering the age pattern, fertility peaks at age 20-24, remains relatively high at age 25-29, and then drops off, falling sharply after age 39. Although the age pattern is generally similar with peak fertility occurring at age 20-24 for both urban and rural women, rural rates are higher than urban rates at every age. 4.3 FERTILITY BY BACKGROUND CHARACTERISTICS Differences in current fertility (as assessed by the total fertility rate and the percentage currently pregnant) by urban-rural residence, district, educational attainment, and wealth quintile are shown in Table 4.2. The percentage currently pregnant is likely to be an underestimate because women in the early stages of pregnancy may not be aware that they are pregnant, or are unsure, and some may choose not to report that they are pregnant. Current fertility is lowest in the Lowlands zone and highest in the Mountains zone (Figure 4.1). By district, the TFR ranges from a low of 2.5 births in Maseru to a high of 5.1 births per woman in Thaba- Tseka. Butha-Buthe and Mafeteng have the lowest proportions of women reporting they are pregnant (about 4 percent), while Mokhotlong (9 percent) and Thaba-Tseka (8 percent) have the highest proportions. As expected, a woman’s education is strongly associated with fertility. For example, the TFR de- creases from 4.2 births for women with primary incomplete education to 2.8 births for women with at least some secondary education. Fertility is also closely associated with wealth whereby the lowest quintile displays higher fertility (5.2 births) and the highest quintile shows the lowest fertility (2.0 births). Table 4.2 also presents a crude assessment of trends in fertility in the various subgroups by comparing current fertility with a measure of completed fertility, the mean number of children ever born (CEB) to women age 40-49. The mean number of children ever born takes into account the lifetime fertility of older women who are nearing the end of their reproductive period and, thus, represents com- pleted fertility of women who began their child- bearing during the three decades preceding the sur- vey. If fertility is stable over time in a population, the TFR and the mean CEB for women 40-49 are expected to be similar. When fertility levels have been falling, the TFR will be substantially lower than the mean CEB among women age 40-49. Table 4.2 Fertility by background characteristics Total fertility rate for the three years preceding the survey, percentage of women 15-49 currently pregnant, and mean number of children ever born to women age 40-49 years, by background characteristics, Lesotho 2004 Background characteristic Total fertility rate Percentage currently pregnant1 Mean number of children ever born to women age 40-49 Residence Urban 1.9 3.9 3.5 Rural 4.1 6.7 5.0 Ecological zone Lowlands 2.9 4.8 4.4 Foothills 4.3 7.1 5.1 Mountains 4.9 8.7 5.2 Senqu River Valley 4.0 6.4 5.1 District Butha-Buthe 3.4 3.7 4.8 Leribe 3.6 6.0 5.1 Berea 3.9 6.4 5.2 Maseru 2.5 6.3 4.0 Mafeteng 3.3 4.1 4.5 Mohale's Hoek 4.0 5.1 4.9 Quthing 4.1 7.1 5.1 Qacha's Nek 4.4 6.4 4.7 Mokhotlong 4.6 8.8 4.8 Thaba-Tseka 5.1 8.2 5.4 Education No education * * * Primary, incomplete 4.2 6.4 5.1 Primary, complete 3.9 6.7 4.9 Secondary+ 2.8 5.2 3.7 Wealth quintile Lowest 5.2 9.6 5.6 Second 4.5 8.0 5.2 Middle 3.8 5.8 5.1 Fourth 3.4 4.4 4.7 Highest 2.0 4.4 3.7 Total 3.5 6.1 4.7 Note: An asterisk indicates that a figure is based on fewer than 250 woman-years of exposure and has been suppressed. 1 Women age 15-49 years Fertility Levels, Trends, and Differentials | 53 Current fertility generally falls substantially below lifetime fertility of women 40-49, except for the small number of respondents with no education. The comparison suggests that fertility has fallen by more than one birth during the past few decades. The implied fertility decline is largest among urban women, women living in the Lowlands zone, and women living in Leribe and Maseru districts (Table 4.2). 1.9 4.1 2.9 4.3 4.9 4.0 3.4 3.6 3.9 2.5 3.3 4.0 4.1 4.4 4.6 5.1 4.2 3.9 2.8 RESIDENCE Urban Rural ECOLOGICAL ZONE Lowlands Foothills Mountains Senqu River Valley DISTRICT Butha-Buthe Leribe Berea Maseru Mafeteng Mohale's Hoek Quthing Qacha's Nek Mokhotlong Thaba-Tseka EDUCATION No education Primary, incomplete Primary, complete Secondary+ 0.0 2.0 4.0 6.0 Figure 4.1 Total Fertility Rate by Background Characteristics LDHS 2004 Births per woman * Note: An asterisk indicates that a figure is based on fewer than 250 woman-years of exposure and has been suppressed. 4.4 FERTILITY TRENDS Lesotho is endowed with a wealth of demographic data. Accordingly, changes in fertility levels over time can be tracked by examining fertility estimates from various surveys and censuses, spanning the last three decades. Table 4.3 and Figure 4.2 indicate that the TFR declined significantly during the last three decades of the 20th century, changing from a high of 5.4 children per woman in the mid-1970s and 5.3 in the mid-1980s to 4.1 in the mid-1990s, 4.2 in 2001, and 3.5 children in 2004. Table 4.3 Trends in fertility Age-specific fertility rates (per 1,000 women) and total fertility rates, 1976, 1986, and 1996 Population and Housing Censuses, 2001 LDS, and 2004 LDHS Age group 1976 Census 1986 Census 1996 Census 2001 LDS 2004 LDHS 15-19 65 70 37 81 91 20-24 239 246 145 196 177 25-29 259 256 153 204 160 30-34 222 223 131 122 122 35-39 165 178 106 148 101 40-44 96 95 66 60 46 45-49 39 30 27 28 9 TFR 5.4 5.3 4.1 4.2 3.5 Sources: BOS 1976, BOS 1986, BOS 1996, BOS 2001, MOHSW, BOS, and ORC Macro, 2005 54 | Fertility Levels, Trends, and Differentials Furthermore, data on other fertility correlates collected in the 2004 LDHS are internally con- sistent with this trend. Fertility changes can be examined by looking at the trend in age-specific fertility rates for successive five-year periods before the survey, using the birth histories obtained from 2004 LDHS respondents. The age-specific fertility rates shown in Table 4.4 were gener- ated from the birth history data collected in the 2004 LDHS. The numerators of the rates are classified by five-year seg- ments of time preceding the survey and the mother’s age at the time of birth. Because women 50 years and over were not interviewed in the survey, the rates for older age groups become progressively more truncated for periods more distant from the survey date. For example, rates cannot be calculated for women age 45-49 for the period 5-9 years and more preceding the survey, because women in that age group would have been 50 years or older at the time of the survey. The results in Table 4.4 confirm that fertility has fallen substantially among all age groups, with the most rapid relative decline among women in their 30s. 4.5 CHILDREN EVER BORN AND CHILDREN SURVIVING Table 4.5 shows the distribution of all women and currently married women age 15-49 by number of children ever born and mean number of children ever born and living. More than four-fifths of women age 15-19 (85 percent) have never given birth. However, this proportion declines rapidly to less than 6 percent for women age 30 and above, indicating that childbearing among women is nearly universal. On average, women attain a parity of 5.2 children by the end of their childbearing years, with 4.4 of these children surviving. Table 4.4 Trends in age-specific fertility rates Age-specific fertility rates for five-year periods preceding the survey, by mother's age at the time of the birth, Lesotho 2004 Number of years preceding survey Mother's age at birth 0-4 5-9 10-14 15-19 15-19 98 95 110 112 20-24 211 223 252 265 25-29 184 195 232 237 30-34 145 174 179 (216) 35-39 116 126 (172) - 40-44 57 (68) - - 45-49 (12) - - - Note: Age-specific fertility rates are per 1,000 women. Estimates in brackets are truncated. 5.4 5.3 4.1 4.2 3.5 1976 Census 1986 Census 1996 Census 2001 LDS 2004 LDHS 0 1 2 3 4 5 6 Figure 4.2 Total Fertility Rates, Lesotho 1976-2004 Births per woman Fertility Levels, Trends, and Differentials | 55 The same pattern is replicated for currently married women, except that only 46 percent of married women age 15-19 have not borne a child. As with all women, this proportion declines, although more rapidly, to 7 percent or less for currently married women age 25 and above compared with 16 percent or less of all women age 25 and above. On average, currently married women age 45-49 have borne 5.5 children, with less than one child having died. Table 4.5 Children ever born and living Percent distribution of all women and currently married women by number of children ever born, and mean number of children ever born and mean number of living children, according to age group, Lesotho 2004 Number of children ever born Age 0 1 2 3 4 5 6 7 8 9 10+ Total Number of women Mean number of children ever born Mean number of living children ALL WOMEN 15-19 84.7 14.5 0.8 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 100.0 1,710 0.16 0.15 20-24 37.2 40.1 18.6 3.6 0.4 0.1 0.0 0.0 0.0 0.0 0.0 100.0 1,463 0.90 0.82 25-29 15.7 28.2 29.2 18.6 6.3 1.8 0.2 0.0 0.0 0.0 0.0 100.0 1,044 1.78 1.59 30-34 5.8 16.1 24.3 23.2 17.0 8.7 3.7 1.1 0.2 0.0 0.0 100.0 816 2.77 2.49 35-39 3.3 9.5 15.3 25.8 14.9 15.9 10.2 3.2 0.9 0.9 0.1 100.0 728 3.57 3.27 40-44 3.4 5.8 11.5 16.4 17.6 15.7 11.3 10.4 5.1 2.1 0.7 100.0 741 4.35 3.90 45-49 1.3 3.5 9.5 12.3 14.8 15.2 15.9 9.5 10.2 4.0 3.8 100.0 592 5.15 4.40 Total 31.9 19.6 14.7 11.6 7.6 5.8 4.0 2.3 1.5 0.6 0.4 100.0 7,095 2.06 1.84 CURRENTLY MARRIED WOMEN 15-19 45.8 50.3 3.8 0.0 0.1 0.0 0.0 0.0 0.0 0.0 0.0 100.0 293 0.58 0.53 20-24 12.6 53.3 27.5 5.7 0.6 0.1 0.0 0.0 0.0 0.0 0.0 100.0 779 1.29 1.17 25-29 7.0 25.6 34.8 22.4 7.7 2.2 0.2 0.0 0.0 0.0 0.0 100.0 700 2.06 1.84 30-34 2.9 13.4 24.5 24.5 19.8 9.0 4.1 1.5 0.3 0.0 0.0 100.0 593 2.98 2.72 35-39 1.8 6.5 15.0 27.6 13.6 18.0 11.0 4.4 0.7 1.3 0.2 100.0 484 3.80 3.50 40-44 1.5 4.7 8.6 17.2 17.3 17.3 11.9 13.2 4.7 2.5 1.2 100.0 478 4.66 4.25 45-49 0.2 2.4 8.7 12.5 14.4 13.5 16.7 9.2 12.8 4.6 5.0 100.0 383 5.45 4.67 Total 8.5 23.8 20.5 16.4 10.2 7.9 5.4 3.5 2.1 1.0 0.7 100.0 3,709 2.84 2.55 4.6 BIRTH INTERVALS Examination of birth intervals is important in providing insights into birth spacing patterns and, subsequently, maternal and child health. Studies have shown that children born less than 24 months after a previous sibling risk poorer health and also threaten maternal health. Table 4.6 provides a glimpse into the birth intervals of children born to women of reproductive age during the five years preceding the survey across selected subgroups. The median birth interval is 42 months, meaning that half of all non-first births take place at least 42 months after a preceding birth. The shortest birth interval is observed among children whose preceding sibling died (28 months), while the longest is among children born to urban mothers (57 months), women living in Maseru (48 months), women with at least some secondary education (47 months), those in the highest wealth quintile (56 months), and women age 40-49 (52 months). Eleven percent of children are born less than 24 months after a previous birth, an interval perceived to be “too short.” The wealth quintile indicates higher proportions of short birth intervals in the lowest quintile (14 percent) and low representation in the highest quintile (6 percent). 56 | Fertility Levels, Trends, and Differentials Table 4.6 Birth intervals Percent distribution of non-first births in the five years preceding the survey by number of months since preceding birth, according to background characteristics, Lesotho 2004 Months since preceding birth Background characteristic 7-17 18-23 24-35 36-47 48+ Total Number of non-first births Median number of months since preceding birth Age 20-29 6.0 8.6 32.0 27.4 26.1 100.0 1,032 37.0 30-39 2.9 3.7 20.4 20.9 52.1 100.0 914 49.6 40-49 4.4 3.6 16.1 20.9 55.0 100.0 365 52.3 Birth order 2-3 4.4 6.5 25.2 24.1 39.7 100.0 1,322 41.7 4-6 4.4 4.9 24.2 23.1 43.5 100.0 769 43.3 7+ 5.4 7.5 26.2 23.2 37.7 100.0 233 41.9 Sex of preceding birth Male 4.9 5.5 26.2 21.8 41.7 100.0 1,161 42.7 Female 4.1 6.6 23.8 25.6 39.9 100.0 1,163 42.0 Survival of preceding birth Living 2.6 5.1 24.5 24.5 43.3 100.0 2,094 44.0 Dead 21.5 15.1 29.7 16.0 17.6 100.0 230 27.7 Residence Urban 4.2 2.1 13.4 20.2 60.2 100.0 276 57.4 Rural 4.6 6.6 26.6 24.2 38.1 100.0 2,047 41.1 Ecological zone Lowlands 3.8 4.7 18.2 23.2 50.1 100.0 1,081 48.1 Foothills 3.7 8.1 30.4 21.9 35.8 100.0 320 38.7 Mountains 5.8 6.6 31.8 24.8 31.0 100.0 776 38.0 Senqu River Valley 4.2 8.3 27.6 25.4 34.6 100.0 147 39.3 District Butha-Buthe 2.5 5.5 32.5 17.7 41.9 100.0 122 41.1 Leribe 3.7 6.7 26.1 22.3 41.2 100.0 365 42.3 Berea 4.5 6.6 20.8 29.1 39.0 100.0 260 42.4 Maseru 3.7 4.8 21.2 20.5 49.9 100.0 446 48.0 Mafeteng 5.0 6.1 15.1 27.0 46.8 100.0 236 45.7 Mohale's Hoek 5.5 3.8 23.7 24.4 42.6 100.0 229 44.5 Quthing 5.4 7.2 28.6 24.6 34.2 100.0 155 39.7 Qacha's Nek 3.5 7.2 38.1 19.4 31.8 100.0 115 36.6 Mokhotlong 4.9 8.2 30.3 28.9 27.8 100.0 173 37.0 Thaba-Tseka 6.8 6.4 30.2 22.5 34.1 100.0 222 39.1 Education No education 7.3 4.5 23.4 27.3 37.5 100.0 81 40.2 Primary, incomplete 5.8 7.1 28.3 24.0 34.8 100.0 821 39.0 Primary, complete 3.7 7.2 24.3 23.2 41.5 100.0 739 42.5 Secondary+ 3.5 3.8 21.9 23.3 47.5 100.0 683 46.8 Wealth quintile Lowest 7.0 6.7 34.8 23.7 27.7 100.0 526 36.4 Second 4.5 7.2 29.4 26.8 32.1 100.0 588 39.3 Middle 3.5 7.3 25.9 22.6 40.7 100.0 404 42.6 Fourth 3.4 5.4 15.3 23.9 52.0 100.0 416 49.4 Highest 3.4 2.8 14.3 19.9 59.6 100.0 389 56.1 Total 4.5 6.1 25.0 23.7 40.8 100.0 2,324 42.4 Note: First-order births are excluded. The interval for multiple births is the number of months since the preceding pregnancy that ended in a live birth. Number of non-first births to mothers age 15-19 is less than 25; therefore, the figures have been suppressed. Fertility Levels, Trends, and Differentials | 57 4.7 AGE AT FIRST BIRTH The onset of childbearing has a direct bearing on fertility. Early initiation of childbearing length- ens the reproductive period and subsequently increases fertility. Table 4.7 shows median age at first birth as well as the percentage of women who gave birth by a given exact age, by five-year age groups of women. The youngest cohort of women for whom median age at first birth can be calculated is 25-29 years (the medians for age groups 15-19 and 20-24 cannot be determined, as less than half of the women had a birth before reaching the lowest age of the age group). Table 4.7 Age at first birth Among all women, percentage who gave birth by exact age, and median age at first birth, by current age, Lesotho 2004 Percentage who gave birth by exact age Current age 15 18 20 22 25 Percentage who have never given birth Number of women Median age at first birth 15-19 0.2 na na na na 84.7 1,710 a 20-24 0.9 15.3 39.3 na na 37.2 1,463 a 25-29 1.5 14.7 41.1 64.0 79.4 15.7 1,044 20.7 30-34 0.5 16.9 43.8 68.4 83.1 5.8 816 20.4 35-39 2.1 16.5 41.7 68.2 84.3 3.3 728 20.6 40-44 1.6 17.0 43.7 67.4 83.9 3.4 741 20.4 45-49 2.3 16.0 48.1 74.5 88.9 1.3 592 20.1 na = Not applicable a = Omitted because less than 50 percent of women had a birth before reaching the beginning of the age group Among women in the 25-29 age group, the median age at first birth is 20.7 years. Although the pattern is not uniform, age at first birth has shown some slight increase over the years, being later for younger women as compared with older women. However, caution should be exercised in interpreting these slight changes, as they are likely to be statistically insignificant. Further insights into the onset of childbearing can be discerned by examining the percentage of women who had a first birth by the given exact ages for various age groups of women. For example, the proportion of women having their first birth by age 18 is slightly lower for younger women compared with older ones. This observation is consistent with a slightly rising age at first birth. Table 4.8 shows the median age at first birth among women age 25-49 by current age, according to selected background characteristics. A significantly higher median age at first birth is observed in urban areas compared with rural areas for all age groups. Among ecological zones, a higher median is recorded in the Lowlands (20.7 years) for women age 25-49. Considering the district patterns, Maseru has the highest median age at birth (21.1 years). The onset of childbearing is significantly related to education of women. According to Table 4.8, women with secondary education or more begin their childbearing two years later than women with no education. 58 | Fertility Levels, Trends, and Differentials Table 4.8 Median age at first birth by background characteristics Median age at first birth among women age 25-49 years, by current age and background characteristics, Lesotho 2004 Current age Background characteristic 25-29 30-34 35-39 40-44 45-49 Women age 25-49 Residence Urban 22.1 21.2 21.7 21.6 21.2 21.6 Rural 20.3 20.2 20.3 20.2 20.0 20.2 Ecological zone Lowlands 20.9 20.6 20.8 20.6 20.3 20.7 Foothills 19.7 20.5 20.8 20.1 20.2 20.2 Mountains 20.3 20.1 20.0 20.2 19.9 20.1 Senqu River Valley 21.5 19.9 20.7 20.0 19.7 20.4 District Butha-Buthe 21.0 20.7 21.1 20.3 19.9 20.5 Leribe 19.9 20.3 20.2 20.6 19.9 20.1 Berea 20.5 20.4 20.3 20.0 20.5 20.3 Maseru 21.2 20.8 21.0 21.2 21.1 21.1 Mafeteng 21.0 20.5 21.2 20.4 19.5 20.5 Mohale's Hoek 20.6 19.8 20.5 19.4 20.2 20.1 Quthing 21.0 19.7 20.3 19.7 19.7 20.1 Qacha's Nek 21.0 20.5 19.7 20.2 20.5 20.4 Mokhotlong 20.6 20.5 20.0 20.6 19.6 20.3 Thaba-Tseka 20.4 20.4 20.5 20.2 19.9 20.3 Education No education * * * * * * Primary, incomplete 19.8 19.7 19.5 19.9 19.6 19.7 Primary, complete 19.9 20.2 20.4 20.1 20.2 20.1 Secondary+ 21.7 21.1 21.6 21.9 22.5 21.7 Wealth quintile Lowest 19.7 20.2 19.6 19.9 20.0 19.9 Second 19.9 20.0 20.2 20.3 19.6 20.0 Middle 20.3 20.0 20.3 19.9 20.3 20.2 Fourth 21.3 20.1 20.8 20.5 20.0 20.6 Highest 21.7 21.3 21.2 20.9 21.1 21.3 Total 20.7 20.4 20.6 20.4 20.1 20.5 Note: An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. 4.8 TEENAGE FERTILITY It is important to examine the fertility of adolescents for various reasons. First, children born to very young mothers are normally predisposed to higher risks of illness and death. Second, adolescent mothers are more likely to experience complications during pregnancy and are less likely to be prepared to deal with them, which often leads to maternal deaths. Finally, early entry into parenthood denies teenagers the opportunity to pursue a basic education or further academic goals. Lack of education is detrimental to career prospects and often results in lower status in society. Table 4.9 shows the percentage of women age 15-19 who were mothers or were pregnant with their first child at the time of the 2004 LDHS. The results indicate that one in five women in the 15-19 age group have had at least one birth (15 percent) or are pregnant with their first child (5 percent). Fertility Levels, Trends, and Differentials | 59 Table 4.9 Teenage pregnancy and motherhood Percentage of women age 15-19 who are mothers or pregnant with their first child, by background characteristics, Lesotho 2004 Percentage who are: Background characteristic Mothers Pregnant with first child Percentage who have begun childbearing Number of women Age 15 0.8 1.1 1.9 293 16 4.5 1.7 6.2 386 17 9.0 5.3 14.3 326 18 24.3 8.3 32.6 358 19 36.1 7.6 43.7 347 Residence Urban 7.2 2.6 9.8 314 Rural 17.1 5.4 22.5 1,396 Ecological zone Lowlands 13.6 4.0 17.6 990 Foothills 13.7 8.0 21.7 199 Mountains 18.6 5.3 24.0 395 Senqu River Valley 20.4 5.4 25.8 125 District Butha-Buthe 10.7 5.3 15.9 125 Leribe 13.0 4.1 17.1 240 Berea 11.8 6.0 17.8 200 Maseru 14.4 5.8 20.3 382 Mafeteng 16.9 3.9 20.8 180 Mohale's Hoek 16.7 3.8 20.6 194 Quthing 22.0 5.7 27.7 144 Qacha's Nek 13.2 4.8 18.0 55 Mokhotlong 17.9 2.9 20.7 84 Thaba-Tseka 19.9 4.9 24.8 107 Education No education * * * 5 Primary, incomplete 16.0 4.4 20.4 601 Primary, complete 20.5 5.8 26.3 400 Secondary+ 11.4 4.8 16.2 704 Wealth quintile Lowest 20.1 7.5 27.6 234 Second 20.9 6.3 27.2 328 Middle 17.6 5.8 23.4 361 Fourth 14.4 2.8 17.2 365 Highest 7.0 3.2 10.3 422 Total 15.3 4.9 20.2 1,710 Note: An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. Table 4.9 also shows that the proportion of teenagers who have begun childbearing increases from 2 percent at age 15 to 44 percent at age 19. Rural teenagers are much more likely than urban teenagers to have begun childbearing. Teenage fertility is markedly higher than the national level in the Mountains and Senqu River Valley zones and in Quthing and Thaba-Tseka districts. Teenagers who attended secondary school are less likely than those with less education to have initiated childbearing. Increasing wealth quintile is associated with lower teenage childbearing. Family Planning | 61 FAMILY PLANNING 5 This chapter presents results from the 2004 LDHS regarding various aspects of contraceptive knowledge, attitudes, and behaviour. Although the focus is on women, some results on men are also presented because men play an important role in the realisation of reproduction goals. To get an indication of interspousal communication and agreement in knowledge and attitudes of couples regarding family planning, the study compared the responses of men, where possible, with the responses of their wives in the same household. 5.1 KNOWLEDGE OF CONTRACEPTIVE METHODS Individuals who have adequate information about the available methods of contraception are better able to make choices about planning their families. Thus, one major objective of the 2004 LDHS was to obtain information regarding the level of knowledge of family planning methods among reproductive age women and men. Information on knowledge of contraception was collected during the survey by asking the respondents to name ways or methods by which a couple could delay or avoid pregnancy. If the respondent failed to mention a particular method spontaneously, the interviewer described the method and asked whether the respondent recognised it. In this manner, information was collected about 12 modern methods: female sterilisation, male sterilisation, the pill, intrauterine contraceptive device (IUCD), injectables, implants, male condoms, female condoms, diaphragm, foam/ jelly, lactational amenorrhoea (LAM), emergency contraception, and two traditional methods (periodic abstinence [rhythm] and withdrawal). Provision was also made in the questionnaire to record any other methods named spontaneously by the respondent. Tables 5.1.1 and 5.1.2 show the knowledge of contraceptive methods among all women age 15-49 and men age 15-59, as well as by marital status. Knowledge of family planning is nearly universal, with 97 percent of all women age 15-49 and 96 percent of men age 15-59 knowing at least one method of family planning. Modern methods are more widely known than traditional methods. For example, 97 percent of women have heard of at least one modern method, and only 51 percent know of a traditional method. Among all women, the male condom is the most widely known method of family planning, with 94 per- cent of all women saying they had heard of the method. Although it is less widely known, a majority of women (72 percent) have also heard about the female condom. Other widely recognised modern methods include the pill (85 percent) and injectables (86 percent). Substantial proportions of women also have heard about the IUCD (62 percent) and female sterilisation (52 percent). One in six women are aware of male sterilisation. Other modern methods including implants, LAM, diaphragm, foam/jelly, and emer- gency contraception are not widely known, with less than 12 percent of women reporting knowledge of any of these methods. Withdrawal is the most widely known traditional method, with more than four in ten women knowing about withdrawal. 62 | Family Planning Table 5.1.1 Knowledge of contraceptive methods: women Percentage of all women, of currently married women, of sexually active unmarried women, of sexually inactive unmarried women, and of women with no sexual experience who know any contraceptive method, by specific method, Lesotho 2004 Unmarried women who ever had sex Method All women Currently married women Sexually active1 Not sexually active2 Unmarried women who never had sex Any method 97.2 98.3 99.7 98.3 91.2 Any modern method 97.1 98.1 99.5 98.3 91.2 Female sterilisation 51.7 57.6 62.7 54.5 24.5 Male sterilisation 16.3 16.7 24.5 17.4 10.1 Pill 85.2 91.7 92.3 88.4 56.9 IUCD 61.6 69.3 73.1 64.5 28.5 Injectables 86.4 92.9 94.6 90.5 56.8 Implants 8.7 10.2 14.2 7.2 3.8 Male condom 94.3 94.9 96.8 95.7 89.1 Female condom 72.2 72.9 81.9 77.1 59.1 Diaphragm 9.5 11.1 11.4 9.0 4.4 Foam/jelly 9.8 11.7 13.6 9.1 3.5 Lactational amenorrhoea method (LAM) 11.8 14.5 15.5 11.4 2.7 Emergency contraception 8.7 9.2 15.3 8.2 5.5 Any traditional method 50.7 60.4 65.7 50.7 14.3 Rhythm or periodic abstinence 14.7 15.8 21.5 16.3 6.4 Withdrawal 41.6 51.2 56.4 40.1 7.8 Local traditional method 22.4 26.7 29.4 22.7 5.8 Mean number of methods known 6.2 6.7 7.3 6.3 3.7 Number of women 7,095 3,709 441 1,770 1,178 1 Had sexual intercourse in the one month preceding the survey 2 Did not have sexual intercourse in the one month preceding the survey As assessed by the mean number of methods recognised, contraceptive knowledge is highest among sexually active unmarried women (7.3 methods) followed by currently married women (6.7 meth- ods). Unmarried women who have never had sexual intercourse are the least likely to know about contraceptive methods; nevertheless, they have heard of an average of 3.7 methods. Although knowledge of the male condom is high among all groups of women, it is highest among sexually active unmarried women (97 percent). The gap in knowledge between women who are married and those who are unmarried and sexually active is especially notable for long-term and permanent methods (i.e., male sterilisation, IUCD). Contraceptive knowledge is slightly lower among all men (4.4 methods) and currently married men (5.3 methods) than among all women (6.2 methods) and currently married women (6.7 methods). Even among those who are unmarried, men are somewhat less likely to know about contraceptive methods. Men are more likely than women to know about male condoms, male sterilisation, and withdrawal, and women are more likely to know about such female-oriented methods as the pill, IUCD, injectables, and implants. Family Planning | 63 Table 5.1.2 Knowledge of contraceptive methods: men Percentage of all men, of currently married men, of sexually active unmarried men, of sexually inactive unmarried men, and of men with no sexual experience who know any contraceptive method, by specific method, Lesotho 2004 Unmarried men who ever had sex Method All men Currently married men Sexually active1 Not sexually active2 Unmarried men who never had sex Any method 96.0 98.2 99.3 97.8 85.5 Any modern method 95.7 97.7 99.1 97.8 85.5 Female sterilisation 37.0 49.0 44.4 31.3 11.2 Male sterilisation 19.5 24.9 23.8 16.2 8.1 Pill 59.5 72.6 65.1 57.6 26.9 IUCD 32.4 40.6 35.8 30.8 12.8 Injectables 60.4 75.9 67.1 55.6 25.8 Implants 4.2 5.4 4.7 4.0 1.2 Male condom 94.6 96.0 98.7 97.2 84.5 Female condom 57.6 59.7 66.4 61.0 40.9 Diaphragm 5.0 6.1 6.1 3.9 2.9 Foam/jelly 5.8 7.9 5.3 5.3 1.7 Lactational amenorrhoea method (LAM) 7.0 11.2 6.0 5.0 1.1 Emergency contraception 6.9 7.8 8.7 7.5 2.7 Any traditional method 44.5 62.5 48.6 38.0 8.2 Rhythm or periodic abstinence 11.0 12.9 12.2 12.3 3.5 Withdrawal 42.2 61.0 45.7 34.0 6.9 Mean number of methods known 4.4 5.3 4.9 4.2 2.3 Number of men 2,797 1,191 384 716 506 1 Had sexual intercourse in the one month preceding the survey 2 Did not have sexual intercourse in the one month preceding the survey 64 | Family Planning Table 5.2 shows knowledge of contraceptive methods by background characteristics. The results indicate that there are no significant variations in knowledge of contraception by background character- istics. Table 5.2 Knowledge of contraceptive methods by background characteristics Percentage of currently married women and currently married men who know at least one contraceptive method and who know at least one modern method by background characteristics, Lesotho 2004 Women Men Background characteristic Knows any method Knows any modern method Number of women Knows any method Knows any modern method Number of men Age 15-19 95.2 95.2 293 * * 3 20-24 97.6 97.6 779 98.4 97.8 102 25-29 99.3 99.0 700 99.4 98.6 200 30-34 99.4 99.4 593 98.7 98.7 212 35-39 98.3 98.3 484 100.0 99.5 178 40-44 98.5 98.3 478 99.1 99.1 124 45-49 98.3 97.3 383 95.0 94.0 132 50-54 na na na 97.2 96.6 127 55-59 na na na 97.0 96.1 113 Residence Urban 99.6 99.6 738 99.5 99.5 293 Rural 98.0 97.8 2,970 97.8 97.1 898 Ecological zone Lowlands 99.3 99.3 2,132 99.4 99.2 692 Foothills 98.1 98.1 456 97.2 96.3 132 Mountains 95.9 95.1 929 95.6 94.6 300 Senqu River Valley 99.7 99.7 191 100.0 99.1 67 District Butha-Buthe 98.9 98.8 250 97.4 97.2 76 Leribe 98.8 98.8 579 99.1 99.1 179 Berea 99.6 99.6 419 97.3 97.3 140 Maseru 98.3 97.9 903 98.7 98.1 326 Mafeteng 98.4 98.4 414 100.0 98.4 84 Mohale's Hoek 99.4 99.4 349 99.0 98.5 125 Quthing 97.8 97.8 215 98.7 97.4 70 Qacha’s Nek 95.0 95.0 119 96.3 96.3 42 Mokhotlong 96.4 96.4 203 94.9 94.9 75 Thaba-Tseka 96.3 95.1 257 97.1 95.7 73 Education No education 98.1 96.9 86 94.8 94.0 304 Primary, incomplete 96.3 96.1 1,154 99.1 98.3 480 Primary, complete 99.1 98.9 1,150 100.0 100.0 128 Secondary+ 99.4 99.3 1,319 99.7 99.7 279 Wealth quintile Lowest 94.5 93.8 574 94.5 92.9 197 Second 98.0 97.7 709 98.4 97.5 246 Middle 98.8 98.8 648 98.7 98.3 212 Fourth 99.0 98.9 854 99.6 99.6 243 Highest 99.9 99.9 923 99.1 99.1 294 Total 98.3 98.1 3,709 98.2 97.7 1,191 Note: An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. na = Not applicable Family Planning | 65 5.2 EVER USE OF CONTRACEPTION All women and men interviewed in the 2004 LDHS who said that they had heard of a method of family planning were asked whether they had ever used that method. Tables 5.3.1 and 5.3.2 show the percentage of all respondents, currently married respondents, and sexually active unmarried respondents who have ever used specific methods of family planning, by age.1 Table 5.3.1 shows that 76 percent of currently married women have used a contraceptive method at some time, 70 percent have used a modern method, and 31 percent have used a traditional method. The methods most commonly used by married women are injectables (45 percent), pill (39 percent), male condom (36 percent), and withdrawal (27 percent). Ever use of other methods does not exceed 10 percent. Table 5.3.1 Ever use of contraception: women Percentage of all women, of currently married women, and of sexually active unmarried women who have ever used any contraceptive method, by specific method and age, Lesotho 2004 Modern method Traditional method Age Any method Any modern method Female sterili- sation Male sterili- sation Pill IUCD Inject- ables Im- plants Male con- dom Female con- dom Dia- phragm Foam/ jelly LAM Emer- gency contra- ception Any tradi- tional method Periodic absti- nence With- drawal Local tradi- tional method Number of women ALL WOMEN 15-19 22.2 21.4 0.0 0.0 2.3 0.3 3.9 0.0 17.9 0.7 0.0 0.0 0.1 0.1 2.9 0.8 2.1 0.3 1,710 20-24 62.3 59.2 0.6 0.2 18.9 0.9 24.5 0.1 41.8 1.7 0.1 0.1 2.4 0.3 14.4 2.7 11.5 1.7 1,463 25-29 82.7 77.8 0.7 0.0 40.3 3.7 51.2 0.1 50.2 2.3 0.3 0.5 4.0 0.9 26.7 4.5 21.8 3.5 1,044 30-34 87.5 83.0 2.3 0.1 48.8 11.7 58.1 0.3 46.5 2.9 0.0 0.7 5.7 0.8 37.9 5.0 32.4 6.3 816 35-39 83.7 78.7 4.5 0.0 48.8 13.2 56.1 0.2 36.3 3.2 0.0 1.9 5.5 0.1 32.4 3.9 28.6 5.7 728 40-44 76.7 68.5 6.4 0.2 41.4 15.2 44.3 0.0 28.2 1.8 0.0 2.1 4.7 0.4 39.5 6.5 32.4 9.4 741 45-49 72.3 60.7 5.5 0.0 33.1 15.7 38.6 0.3 18.2 0.5 0.1 2.4 5.1 0.0 37.4 3.9 32.7 6.9 592 Total 63.1 58.7 2.1 0.1 28.1 6.4 33.8 0.1 33.8 1.8 0.1 0.8 3.3 0.4 22.5 3.4 18.9 3.8 7,095 CURRENTLY MARRIED WOMEN 15-19 39.4 37.3 0.0 0.0 9.0 1.1 11.8 0.0 24.0 1.2 0.0 0.0 0.1 0.1 6.7 0.9 5.8 0.7 293 20-24 66.9 62.1 0.5 0.0 26.7 1.0 32.6 0.1 37.7 1.2 0.0 0.2 3.9 0.6 18.5 2.6 15.8 2.1 779 25-29 84.6 78.7 0.8 0.0 43.1 3.5 55.7 0.0 46.4 1.6 0.3 0.1 4.7 0.7 30.6 4.9 26.0 3.6 700 30-34 88.9 84.2 2.3 0.1 52.0 11.8 60.2 0.4 45.7 2.6 0.0 0.9 6.1 0.7 41.0 3.6 36.3 7.1 593 35-39 84.0 79.1 4.3 0.0 50.3 14.2 56.4 0.0 35.3 3.1 0.0 1.4 6.1 0.2 34.9 4.1 30.2 6.6 484 40-44 78.9 70.7 7.0 0.2 43.7 14.4 45.7 0.0 29.0 1.0 0.0 2.5 4.5 0.3 40.7 5.6 34.7 8.5 478 45-49 74.0 59.8 6.3 0.0 35.0 15.5 39.5 0.5 18.2 0.8 0.1 2.6 4.4 0.0 41.7 4.5 37.2 8.1 383 Total 76.1 69.9 2.7 0.1 38.6 8.1 45.3 0.1 36.1 1.7 0.1 1.0 4.5 0.4 30.8 3.8 26.7 5.1 3,709 SEXUALLY ACTIVE UNMARRIED WOMEN1 15-19 75.5 70.0 0.0 0.0 2.7 1.4 4.2 0.0 67.0 6.4 0.0 0.0 0.0 1.4 16.7 2.6 15.2 3.1 57 20-24 93.8 91.3 3.0 3.6 24.8 2.4 31.1 0.0 77.0 4.2 0.0 0.0 1.3 0.0 28.0 12.2 15.2 7.0 74 25-29 90.4 87.1 0.0 0.0 40.4 8.5 46.1 0.0 70.2 6.2 1.0 2.3 3.3 2.3 34.4 8.4 20.5 7.7 94 30-34 95.1 94.8 3.8 0.0 58.2 10.1 57.7 0.0 73.7 2.4 0.0 0.8 3.8 0.0 47.3 9.3 38.3 9.7 57 35-39 84.7 84.7 8.7 0.0 47.9 22.7 52.0 1.8 60.3 9.0 0.0 3.7 1.5 0.0 22.2 0.7 20.5 2.5 59 40-44 80.9 73.0 9.1 0.0 48.8 14.1 50.5 0.0 33.4 0.2 0.0 0.0 4.0 0.0 52.0 7.5 45.9 18.2 63 45-49 (76.3) (76.3) (2.8) (0.0) (31.3) (26.8) (50.0) (0.0) (36.0) (0.0) (1.1) (2.2) (8.0) (0.0) (31.2) (0.0) (25.2) (8.2) 37 Total 86.3 83.3 3.7 0.6 36.6 11.0 41.4 0.2 61.9 4.4 0.3 1.3 2.8 0.7 33.3 6.5 25.2 8.1 441 Note: Numbers in parentheses are based on 25-49 cases. LAM = Lactational amenorrhoea method 1 Women who had sexual intercourse in the month preceding the survey 1 In the 2004 LDHS, men were only asked about ever use of male-oriented methods, so the data are not comparable. 66 | Family Planning Ever use of any method is highest among sexually active unmarried women (86 percent). Notably, 62 percent of sexually active unmarried women have used the male condom. A considerable proportion of sexually active unmarried women have used traditional methods at some time (33.3 percent) compared with currently married women (30.8 percent). The difference is more pronounced in the age category 15-19 years (10 percentage points). Table 5.3.2 shows that 31 percent of currently married men have used a contraceptive method at some time, 25 percent have used a modern method, and 13 percent have used a traditional method. The method most commonly used by married men is the male condom, with 25 percent of men having used one. Like women, ever use of any method is highest among sexually active unmarried men, 38 percent of whom have used a method at some time. Thirty-five percent of sexually active unmarried men have used the male condom. Table 5.3.2 Ever use of contraception: men Percentage of all men, of currently married men, and of sexually active unmarried men who have ever used any contraceptive method, by specific method and age, Lesotho 2004 Modern method Traditional method Age Any method Any modern method Male sterili- sation Male condom Female condom Any traditional method Periodic absti- nence With- drawal Number of men ALL MEN 15-19 20.3 20.2 0.2 20.0 0.8 1.7 0.5 1.3 963 20-24 35.2 32.2 0.5 32.0 0.8 8.6 2.7 6.4 880 25-29 35.2 32.0 0.4 31.8 1.0 13.2 3.6 11.4 723 30-34 33.1 28.5 0.0 28.5 1.2 15.2 1.4 14.5 561 35-39 35.3 28.9 0.5 28.6 0.5 17.7 1.0 16.9 443 40-44 32.0 24.1 0.0 24.1 0.5 17.2 3.0 16.9 296 45-49 28.9 21.0 1.5 21.0 1.6 18.8 3.3 17.8 310 50-54 31.7 18.4 1.2 17.2 1.0 23.2 1.6 22.6 291 55-59 22.6 11.7 1.4 10.3 0.0 16.4 0.0 16.4 190 Total 30.5 26.0 0.5 25.7 0.9 12.0 2.0 11.0 4,656 CURRENTLY MARRIED MEN 15-19 18.3 17.9 0.0 17.9 0.3 1.2 0.1 1.1 423 20-24 34.5 30.7 0.4 30.2 1.0 8.5 2.5 6.4 457 25-29 34.9 31.5 0.7 31.1 1.2 14.2 3.7 12.4 460 30-34 33.5 27.9 0.0 27.9 1.4 17.1 1.6 16.5 383 35-39 34.7 27.1 0.5 26.8 0.6 17.5 1.8 16.2 261 40-44 33.3 24.7 0.0 24.7 0.4 18.0 2.3 18.0 195 45-49 28.3 18.0 2.8 18.0 1.5 17.1 2.1 17.1 169 50-54 30.8 15.6 0.0 15.6 1.2 23.4 0.6 22.8 152 55-59 23.2 6.9 1.0 5.9 0.0 18.2 0.0 18.2 94 Total 30.7 25.0 0.5 24.7 0.9 13.0 1.9 12.0 2,593 SEXUALLY ACTIVE UNMARRIED MEN1 15-19 38.0 37.3 1.1 36.5 1.5 5.2 1.3 3.9 187 20-24 37.7 37.0 0.0 37.0 2.9 9.7 2.7 8.0 230 25-29 39.1 37.4 0.0 37.4 1.6 10.3 2.5 9.9 138 30-34 37.2 31.1 0.0 31.1 1.3 13.3 2.0 13.3 73 35-39 (36.5) (36.5) (4.5) (36.5) (0.0) (2.0) (0.0) (2.0) 36 40-44 (35.4) (32.3) (0.0) (32.3) (2.6) (7.7) (0.0) (7.7) 30 45-49 35.4 25.4 0.0 25.4 0.0 21.8 0.0 21.8 21 50-54 37.8 12.8 0.0 12.8 0.0 25.0 0.0 25.0 16 55-59 27.9 20.8 0.0 20.8 0.0 25.3 0.0 25.3 6 Total 37.7 35.4 0.5 35.2 1.8 9.4 1.9 8.4 735 Note: Numbers in parentheses are based on 25-49 cases. 1 Men who had sexual intercourse in the month preceding the survey Family Planning | 67 5.3 CURRENT USE OF CONTRACEPTIVE METHODS The percentage of currently married women age 15-49 that are using any method of family planning is known as the contraceptive prevalence rate (CPR). As shown in Table 5.4, the CPR for Lesotho in 2004 is 37 percent. More than one-third of currently married women use modern methods (35 percent), and 2 percent use a traditional method. As expected, current contraceptive use is higher among sexually active unmarried women than among married women, with 48 percent of sexually active unmarried women reporting they are using contraception. Injectables, the pill, and the male condom are the most commonly used contraceptive methods. They are currently used by 15, 11, and 5 percent of married women, respectively. Among sexually active unmarried women, male condoms (20 percent) are the most commonly used method followed by the injectables (12 percent). Table 5.4 Current use of contraception: women Percent distribution of all women, of currently married women, and of sexually active unmarried women by contraceptive method currently used, according to age, Lesotho 2004 Modern method Traditional method Age Any method Any modern method Female sterili- sation Pill IUCD Inject- ables Male con- dom Female con- dom Any tradi- tional method With- drawal Local tradi- tional method Not currently using Total Number of women ALL WOMEN 15-19 8.9 8.9 0.0 0.9 0.0 2.6 5.3 0.1 0.0 0.0 0.0 91.1 100.0 1,710 20-24 29.5 28.5 0.6 5.6 0.3 12.0 9.7 0.0 1.0 0.6 0.5 70.5 100.0 1,463 25-29 42.2 40.1 0.7 13.2 1.6 17.8 6.6 0.0 2.0 1.1 0.9 57.8 100.0 1,044 30-34 46.4 44.5 2.3 14.5 3.6 17.8 6.3 0.0 2.0 0.4 1.6 53.6 100.0 816 35-39 38.5 37.1 4.5 9.2 2.7 14.9 5.8 0.0 1.5 0.7 0.8 61.5 100.0 728 40-44 32.6 29.4 6.4 7.9 3.0 8.3 3.7 0.1 3.2 0.2 2.8 67.4 100.0 741 45-49 22.3 20.5 5.5 3.5 2.8 5.1 3.6 0.0 1.8 1.0 0.7 77.7 100.0 592 Total 29.0 27.6 2.1 7.0 1.5 10.6 6.3 0.0 1.4 0.5 0.9 71.0 100.0 7,095 CURRENTLY MARRIED WOMEN 15-19 14.7 14.7 0.0 4.6 0.2 7.7 2.3 0.0 0.0 0.0 0.0 85.3 100.0 293 20-24 34.1 32.5 0.5 8.5 0.5 16.5 6.3 0.0 1.5 1.1 0.5 65.9 100.0 779 25-29 42.7 40.2 0.8 14.6 1.3 19.3 4.2 0.0 2.5 1.5 0.9 57.3 100.0 700 30-34 49.5 47.2 2.3 17.7 3.7 18.0 5.5 0.0 2.3 0.5 1.8 50.5 100.0 593 35-39 42.5 40.5 4.3 10.3 3.2 17.4 5.3 0.0 2.0 0.8 1.2 57.5 100.0 484 40-44 37.1 33.7 7.0 9.7 3.3 9.6 4.1 0.0 3.4 0.3 2.8 62.9 100.0 478 45-49 26.1 23.5 6.3 5.1 2.6 5.4 4.2 0.0 2.5 1.6 0.9 73.9 100.0 383 Total 37.3 35.2 2.7 10.9 2.1 14.7 4.8 0.0 2.1 0.9 1.2 62.7 100.0 3,709 SEXUALLY ACTIVE UNMARRIED WOMEN1 15-19 37.8 37.8 0.0 1.4 0.0 3.5 31.3 1.7 0.0 0.0 0.0 62.2 100.0 57 20-24 52.6 51.6 3.0 3.4 1.3 16.1 27.9 0.0 1.1 0.0 1.1 47.4 100.0 74 25-29 63.3 60.1 0.0 18.2 6.3 13.8 21.8 0.0 3.2 0.0 3.2 36.7 100.0 94 30-34 56.9 56.9 3.8 10.8 0.8 21.8 19.7 0.0 0.0 0.0 0.0 43.1 100.0 57 35-39 50.0 49.8 8.7 9.4 0.7 12.4 18.5 0.0 0.3 0.0 0.3 50.0 100.0 59 40-44 34.7 29.3 9.1 4.7 1.2 6.7 7.6 0.0 5.4 0.0 5.4 65.3 100.0 63 45-49 (21.9) (19.7) (2.8) (2.9) (11.6) (0.0) (2.3) (0.0) (2.2) (0.0) (2.2) (78.1) 100.0 37 Total 48.0 46.2 3.7 8.2 2.9 11.5 19.7 0.2 1.8 0.0 1.8 52.0 100.0 441 Note: Total includes 1 user of the diaphragm, 2 users of LAM, and 1 user of rhythm or periodic abstinence that are not shown in the table. If more than one method is used, only the most effective method is considered in this tabulation. Numbers in parentheses are based on 25-49 unweighted cases. LAM = Lactational amenorrhoea method 1 Women who have had sexual intercourse in the month preceding the survey 68 | Family Planning Use of any contraceptive method increases with age, from 15 percent among married women age 15-19, to a peak of 50 percent at age 30-34, and then declines to 26 percent at age 45-49. Use of the pill and injectables is most common among women in the prime childbearing years (age 20-39). As expected, use of female sterilisation increases with age. The LDHS results indicate that the majority of women (66 percent) who report use of female sterilisation were in their 30s when they adopted the method. 5.4 TRENDS IN CONTRACEPTIVE USE Table 5.5 shows that the contraceptive prevalence rate for currently married women 15-49 from the 2004 LDHS (37 percent) is slightly lower than the rate estimated in the 2001 LDS for the same age group (41 percent). It is difficult to interpret this trend because the two surveys differed considerably in their approach to data collection related to contraceptive knowledge and use, as well as in the sample size. However, the comparison does support a conclusion that there has been relatively little change in contraceptive use between the two surveys. Table 5.5 Trends in current contraceptive use Percent distribution of currently married women by contraceptive method currently used, Lesotho 2001 and 2004 Contraceptive method LDS 20011 LDHS 2004 Any method 40.6 37.3 Any modern method 36.1 35.2 Pill 11.5 10.9 IUCD 2.9 2.1 Injectables 14.7 14.7 Female sterilisation 0.3 2.7 Implant 0.1 0.0 Male condom 6.5 4.8 Diaphragm/foam/jelly 0.1 0.0 Any traditional method 4.5 2.1 Rhythm or periodic abstinence (calendar) 0.5 0.5 Withdrawal 0.4 0.9 Natural family planning 3.5 na Local traditional method na 1.2 Total 100.0 100.0 Number of respondents 9,459 3,709 na = Not applicable 1Includes 8 married women age 12-14 When compared with other countries in East and Southern Africa where DHS surveys have been conducted, Lesotho’s level of contraceptive use is exceeded only by Zimbabwe and South Africa (Figure 5.1). Family Planning | 69 56 54 39 39 34 25 23 13 8 8 South Africa 1998 Zimbabwe 1999 LESOTHO 2004 Kenya 2003 Zambia 2001-2002 Tanzania 1999 Uganda 2000-2001 Rwanda 2000 Ethiopia 2000 Eritrea 2000 0 10 20 30 40 50 60 70 Modern methods Traditional methods Figure 5.1 Current Use of Family Planning among Currently Married Women Age 15-49, Selected Countries in East Africa and Southern Africa 5.5 DIFFERENTIALS IN CONTRACEPTIVE USE BY BACKGROUND CHARACTERISTICS As shown in Table 5.6, there are marked differences in the CPR by background characteristics in Lesotho. For example, the number of children a woman has is strongly related to the likelihood she is using contraception. The proportion of married women using modern methods reaches a peak at 3-4 children (43 percent) and then drops to 29 percent for those with five or more children. Table 5.6 and Figure 5.2 show that currently married women in urban areas are more likely to use contraceptives (50 percent) than those in rural areas (34 percent). Considering ecological zones, married women in the Lowlands (46 percent) are more than twice as likely to use contraception as women in the Mountains (22 percent). Current contraceptive use also varies markedly by district; it is highest among married women in Mafeteng (49 percent) and lowest in Mokhotlong (15 percent). With the exception of Mafeteng, within all residential categories, injectables are typically the most widely used method followed by the pill. Contraceptive use increases with increasing level of education, from 9 percent among currently married women with no education to nearly half (49 percent) among currently married women with at least some secondary education. 70 | Family Planning Table 5.6 Current use of contraception by background characteristics: currently married women Percent distribution of currently married women by contraceptive method currently used, according to background characteristics, Lesotho 2004 Modern method Traditional method Background characteristic Any method Any modern method Female sterili- sation Pill IUCD Inject- ables Male con- dom Any tradi- tional method With- drawal Local traditional method Not currently using Total Number of women Residence Urban 49.9 48.7 2.7 13.3 4.4 17.9 10.0 1.2 0.1 1.1 50.1 100.0 738 Rural 34.2 31.8 2.7 10.3 1.5 13.8 3.5 2.3 1.1 1.2 65.8 100.0 2,970 Ecological zone Lowlands 45.7 44.0 2.7 14.0 2.9 18.0 6.3 1.7 0.5 1.1 54.3 100.0 2,132 Foothills 31.6 28.6 4.2 7.3 1.7 12.1 3.2 3.0 0.5 2.6 68.4 100.0 456 Mountains 21.5 19.1 1.8 6.1 0.5 8.3 2.4 2.5 1.8 0.6 78.5 100.0 929 Senqu River Valley 33.9 31.0 4.0 7.3 1.4 14.8 3.5 2.9 2.1 0.8 66.1 100.0 191 District Butha-Buthe 45.4 43.7 5.6 11.1 3.4 18.6 5.0 1.7 0.5 1.2 54.6 100.0 250 Leribe 42.5 39.4 2.5 11.5 3.3 16.2 5.9 3.0 1.0 2.0 57.5 100.0 579 Berea 34.2 32.1 3.4 8.4 3.2 12.3 4.8 2.0 0.8 1.3 65.8 100.0 419 Maseru 40.2 37.7 2.4 12.1 1.8 14.1 7.2 2.4 0.7 1.8 59.8 100.0 903 Mafeteng 49.4 48.5 2.6 20.5 1.5 19.6 4.3 0.9 0.1 0.8 50.6 100.0 414 Mohale's Hoek 39.5 37.0 2.3 10.6 2.5 19.1 2.6 2.5 1.4 0.6 60.5 100.0 349 Quthing 29.0 26.5 3.1 5.6 1.6 12.5 3.7 2.5 2.0 0.4 71.0 100.0 215 Qacha’s Nek 23.2 21.8 2.3 6.4 0.2 10.7 2.1 1.4 0.7 0.7 76.8 100.0 119 Mokhotlong 15.4 14.3 1.5 2.9 0.1 6.9 2.9 1.2 1.2 0.0 84.6 100.0 203 Thaba-Tseka 21.1 19.4 2.3 6.4 0.5 8.6 1.6 1.7 1.7 0.0 78.9 100.0 257 Education No education 9.3 6.6 1.2 1.6 0.7 1.3 1.9 2.7 1.0 1.7 90.7 100.0 86 Primary, incomplete 26.8 23.5 2.0 6.6 1.0 11.4 2.5 3.3 1.5 1.7 73.2 100.0 1,154 Primary, complete 36.3 34.8 3.0 11.6 1.5 15.3 3.3 1.5 0.7 0.8 63.7 100.0 1,150 Secondary+ 49.2 47.5 3.2 14.5 3.6 17.8 8.4 1.7 0.6 1.1 50.8 100.0 1,319 Number of living children 0 6.6 6.6 0.0 1.7 0.0 3.8 1.1 0.0 0.0 0.0 93.4 100.0 386 1-2 41.0 39.4 0.6 13.7 1.6 17.4 5.9 1.7 0.9 0.8 59.0 100.0 1,740 3-4 45.9 42.8 5.5 11.9 3.9 16.1 5.5 3.1 1.0 1.9 54.1 100.0 969 5+ 32.4 29.2 6.0 6.9 1.8 11.4 3.0 3.3 1.4 1.9 67.6 100.0 613 Wealth quintile Lowest 17.6 15.4 1.1 4.5 0.5 7.2 2.1 2.2 1.7 0.5 82.4 100.0 574 Second 26.2 23.7 1.8 7.4 0.8 11.7 1.9 2.5 1.2 1.3 73.8 100.0 709 Middle 37.6 34.5 2.9 10.0 1.4 15.6 4.7 3.0 1.2 1.6 62.4 100.0 648 Fourth 41.0 39.1 3.2 12.9 2.1 16.5 4.5 1.9 0.9 1.0 59.0 100.0 854 Highest 54.5 53.2 4.0 16.1 4.5 19.2 9.2 1.3 0.0 1.3 45.5 100.0 923 Total 37.3 35.2 2.7 10.9 2.1 14.7 4.8 2.1 0.9 1.2 62.7 100.0 3,709 Note: If more than one method is used, only the most effective method is considered in this tabulation. Total includes 1 user of the diaphragm, 2 users of lactational amenorrhoea method (LAM), and 1 user of rhythm or periodic abstinence that are not shown in the table. Family Planning | 71 49.9 34.2 45.7 31.6 21.5 33.9 45.4 42.5 34.2 40.2 49.4 39.5 29.0 23.2 15.4 21.1 9.3 26.8 36.3 49.2 RESIDENCE Urban Rural ECOLOGICAL ZONE Lowlands Foothills Mountains Senqu River Valley DISTRICT Butha-Buthe Leribe Berea Maseru Mafeteng Mohale's Hoek Quthing Qacha's Nek Mokhotlong Thaba-Tseka EDUCATION No education Primary, incomplete Primary, complete Secondary+ Figure 5.2 Current Use of Any Contraceptive Method among Currently Married Women Age 15-49, by Background Characteristics LDHS 2004 5.6 CURRENT USE OF CONTRACEPTIVES BY WOMEN’S STATUS Most married women who are currently using contraceptives in Lesotho indicate that they participated in the decision to use family planning methods. Figure 5.3 shows that more than three-fourths of married current users say that they participated jointly with their spouse in the decision to use family planning (78 percent), 15 percent made the decision to use a method mainly on their own, and a minority (5 percent) said that their husband was mainly responsible for the decision to use a family planning method. 15.0 4.8 77.9 0.4 1.8 Mainly respondent Mainly husband/ partner Joint decision Other Missing 0.0 20.0 40.0 60.0 80.0 100.0 Figure 5.3 Percent Distribution of Currently Married Women Currently Using Contraception by Person Responsible for the Decision to Use Family Planning LDHS 2004 Percent 72 | Family Planning The results in Table 5.7 suggest that the likelihood that a couple will use family planning is related to a woman’s status in the household. For example, current use of contraception increases steadily with the number of decisions in which a married woman has a final say, from 21 percent among women with no say in any decision to 46 percent among women who participate in five decisions. The relationship between current use and the other two women’s status indicators shown in Table 5.7 is somewhat less marked. However, women who agree with three to four reasons for refusing to have sex with a husband are more likely to be using contraception than women who agree with only one to two reasons. Women who do not believe that there is any reason to justify wife beating are more likely to be currently using a modern contraceptive method than those who feel that wife beating is justified in some circumstances. Table 5.7 Current use of contraception by women's status Percent distribution of currently married women by contraceptive method currently used, according to selected indicators of women's status, Lesotho 2004 Modern method Traditional method Women's status indicators Any method Any modern method Female sterili- sation Pill IUCD Inject- ables Male con- dom Any tradi- tional method With- drawal Local tradi- tional method Not currently using Total Number of women Number of decisions in which woman has final say1 0 20.5 19.8 0.2 6.8 0.0 10.2 2.5 0.7 0.3 0.4 79.5 100.0 244 1-2 28.2 25.7 2.3 5.5 1.1 13.2 3.5 2.6 1.0 1.6 71.8 100.0 888 3-4 39.3 36.8 3.1 12.6 2.7 14.6 3.8 2.5 1.0 1.4 60.7 100.0 1,555 5 46.2 44.6 3.2 13.8 2.4 17.0 8.1 1.5 0.8 0.6 53.8 100.0 1,022 Number of reasons to refuse sex with husband 0 37.1 33.7 2.9 10.6 0.0 14.5 5.7 3.3 2.7 0.6 62.9 100.0 196 1-2 33.3 30.9 1.6 12.4 1.4 11.3 4.2 2.3 0.9 1.4 66.7 100.0 596 3-4 38.1 36.2 3.0 10.5 2.4 15.3 4.9 2.0 0.8 1.2 61.9 100.0 2,916 Number of reasons wife- beating is justified 0 42.1 40.5 3.4 11.2 2.6 16.7 6.6 1.6 0.5 1.0 57.9 100.0 1,894 1-2 33.3 31.1 2.0 11.5 1.7 12.4 3.5 2.2 1.2 1.0 66.7 100.0 859 3-4 30.5 27.7 2.5 8.1 1.8 13.1 1.9 2.8 1.4 1.5 69.5 100.0 696 5+ 33.9 30.3 0.9 13.7 0.1 11.7 3.9 3.6 1.5 2.1 66.1 100.0 259 Total 37.3 35.2 2.7 10.9 2.1 14.7 4.8 2.1 0.9 1.2 62.7 100.0 3,709 Note: If more than one method is used, only the most effective method is considered in this tabulation. Total includes 1 user of the diaphragm, 2 users of lactational amenorrhoea method (LAM), and 1 user of rhythm or periodic abstinence that are not shown in the table. 1 Either by herself or jointly with others 5.7 TIMING OF FIRST USE OF CONTRACEPTION Table 5.8 shows the distribution of women who have ever used contraception by age and number of living children at first use of contraception. The results indicate that women in Lesotho are adopting family planning methods at lower parities (i.e., when they have fewer children). Among younger women (age 20-24), 41 percent first used contraception before having any children and 50 percent used contraception by parity 1. Among older women (age 45-49), only 2 percent used contraception before having any children and 31 percent used contraception by parity 1. Family Planning | 73 Table 5.8 Number of children at first use of contraception Percent distribution of women who have ever used contraception by number of living children at the time of first use of contraception, according to age, Lesotho 2004 Number of living children at time of first use of contraception Age 0 1 2 3 4+ Missing Total Number of women 15-19 75.6 22.3 0.2 0.0 0.0 2.0 100.0 380 20-24 41.3 49.9 7.1 0.7 0.3 0.8 100.0 911 25-29 18.1 58.1 17.3 4.7 1.3 0.5 100.0 864 30-34 7.9 53.4 25.1 9.0 4.6 0.1 100.0 715 35-39 4.1 42.3 28.1 14.7 10.4 0.5 100.0 610 40-44 3.5 29.2 28.4 18.1 20.5 0.2 100.0 569 45-49 1.9 30.9 18.7 18.6 28.9 1.0 100.0 428 Total 20.7 44.2 18.0 8.6 7.8 0.6 100.0 4,476 5.8 KNOWLEDGE OF THE FERTILE PERIOD An elementary knowledge of reproductive physiology provides a useful background for successful practice of coitus-related methods, such as the calendar method, the Billings method, and other methods collectively called “periodic abstinence.” The successful use of such methods depends in part on an understanding of when, during the ovulatory cycle, a woman is most likely to conceive. Women and men were asked, “From one menstrual period to the next, are there certain days when a woman is more likely to get pregnant if she has sexual relations?” If the answer was “yes,” they were further asked whether that time was just before the woman’s period begins, during her period, right after her period has ended, or halfway between two periods. Table 5.9 shows that comparatively few women and men (16 and 11 percent, respectively) understand that a woman is most likely to conceive halfway between her menstrual periods. About 30 percent of women and 21 percent of men wrongly believe that the fertile period is right before or after a woman’s period has ended. More than half of women say they do not know when the fertile period falls (38 percent) or believe that there is no specific fertile time (13 percent). Men are even more likely than women to say that they do not know when a woman is most likely to conceive (52 percent) or to report that there is no specific fertile period (14 percent). 5.9 SOURCE OF CONTRACEPTION Information on where women obtain their contraceptives is useful for family planning programme managers and implementers for logistic planning. In the 2004 LDHS, women who reported using a modern contraceptive method at the time of the survey were asked where they obtained the method the last time they acquired it. Because some women may not exactly know in which category the source they use falls (e.g., government hospital, mission health centre), interviewers were instructed to note the full name of the source or facility. Supervisors and field editors were instructed to verify that the name and source type were consistent, asking informants in the clusters for the names of local family planning outlets, if necessary. Table 5.9 Knowledge of the fertile period Percent distribution of women by knowledge of the fertile period during the ovulatory cycle, according to current use/non use of Rhythm or periodic abstinence, Lesotho 2004 Perceived fertile period Nonusers of rhythm or periodic abstinence All women All men Just before her period begins 10.3 10.3 7.7 During her period 2.3 2.3 2.2 Right after her period has ended 19.4 19.4 13.1 Halfway between two periods 16.2 16.1 10.8 Other 0.3 0.3 0.1 No specific time 13.3 13.3 14.2 Don't know 38.3 38.3 51.8 Missing 0.0 0.0 0.1 Total 100.0 100.0 100.0 Number of respondents 7,094 7,095 2,797 74 | Family Planning Table 5.10 shows that public (government) facilities provide contraceptives to 57 percent of users, while 12 percent are supplied through CHAL, 19 percent through the private medical sector, and 10 percent through other private sources (e.g., shops). Most users obtain methods at fixed sites; less than 2 percent say they got their method through community-based distribution or a community health worker. Table 5.10 Source of contraception Percent distribution of current users of modern contraceptive methods by most recent source of method, according to specific method, Lesotho 2004 Source Pill IUCD Inject- ables Male condom Female condom Dia- phragm Total Public sector 62.5 50.7 62.2 41.9 51.2 0.0 56.6 Government hospital 19.4 28.7 19.6 20.8 0.0 0.0 20.4 Government health centre 31.3 14.4 33.8 15.1 51.2 0.0 27.3 Family planning clinic 11.6 7.6 8.8 5.9 0.0 0.0 8.8 Other public * * * * * * 0.1 CHAL 11.2 17.6 14.0 7.1 0.0 0.0 11.7 CHAL hospital (2.2) (9.2) (2.2) (2.3) (0.0) (0.0) 2.7 CHAL health centre 9.0 8.4 11.8 4.8 0.0 0.0 9.1 Private medical sector 21.4 31.7 19.2 10.6 48.8 100.0 18.5 Private hospital or clinic 6.3 12.6 8.5 2.2 0.0 100.0 6.6 Pharmacy * * * * * * 1.6 Private doctor (1.1) (12.5) (1.9) (0.0) (0.0) (0.0) 1.9 Private hospital in South Africa 8.0 6.1 7.0 1.4 48.8 0.0 5.9 Other private medical * * * * * * 0.7 Community-based services * * * * * * CBD * * * * * * 0.2 Community health worker * * * * * * 1.0 Support groups * * * * * * 0.7 Other source 1.5 0.0 0.5 38.0 0.0 0.0 10.0 Shop 0.4 0.0 0.0 25.6 0.0 0.0 6.4 Peer educators * * * * * * 0.8 Friends or relatives (0.4) (0.0) (0.0) (10.6) (0.0) (0.0) 2.7 Other (2.9) (0.0) (3.7) (2.0) (0.0) (0.0) 2.8 Missing 0.5 0.0 0.4 0.4 0.0 0.0 0.4 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number of women 499 109 752 444 2 0 1,807 Note: Table excludes lactational amenorrhoea method (LAM). An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. Numbers in parentheses are based on 25-49 unweighted cases. The most common source of contraceptive methods in Lesotho is government health centres, which supply more than one-fourth of users of modern methods. Government hospitals supply about one- fifth of users. Somewhat surprisingly, government sources supply a larger proportion of users of pills and injectables than users of long-term methods like the IUCD. Public sector providers are the most common source for the male condom, followed by other sources such as shops, and friends or relatives (42, 26, and 11 percent, respectively). 5.10 INFORMED CHOICE Current users of modern methods who are well informed about the side effects and problems associated with methods and know of a range of method options are better placed to make an informed choice about the method they would like to use. Current users of various modern contraceptive methods were asked whether at the time they were adopting the particular method, they were informed about side effects or problems that they might have with the method. Table 5.11 shows the percentage of current users of modern methods who were either informed about side effects or problems of the method used, informed of other methods they could use, and informed that sterilisation is a permanent method. These percentages are broken down by method type, initial source, and various background characteristics. Family Planning | 75 Table 5.11 Informed choice Among current users of modern contraceptive methods who adopted the current method in the five years preceding the survey, percentage who were ever informed about the side effects of the method used, percentage who were informed what to do if side effects were experienced, percentage who were informed of other methods that could be used for contraception, and percentage of women who were sterilised in the five years preceding the survey who were informed that they would not be able to have any more children, by specific method, initial source of method, and background characteristics, Lesotho 2004 Method/source/ background characteristic Ever informed about side effects or problems of method used1 Informed what to do if experienced side effects Informed of other methods that could be used2 Informed that sterilisa- tion is permanent3 Method Female sterilisation 0.0 0.0 0.0 74.5 Pill 33.6 29.2 50.5 na IUCD 45.7 43.0 66.9 na Injectables 36.1 30.5 44.8 na Initial source of method4 Public sector 33.9 28.8 46.4 76.8 Government hospital 33.7 31.2 43.4 81.4 Government health centre 33.0 25.5 47.5 80.6 Family planning clinic 36.8 34.1 48.5 30.7 Other public * 100.0 100.0 * CHAL 43.1 39.2 56.4 76.8 CHAL hospital 46.0 43.5 66.0 100.0 CHAL health centre 42.3 38.1 53.8 72.4 Private medical sector 40.7 35.3 53.5 45.8 Private hospital or clinic 36.5 29.9 42.9 22.8 Pharmacy 56.4 44.3 62.0 100.0 Private doctor 33.1 23.9 76.1 100.0 Private hospital in South Africa 50.1 47.8 62.6 33.5 Other private medical 20.9 13.2 23.1 * Community-based services * * * * CBD * * * * Community health worker * * * * Support groups * * * * Other source * * * * Shop * * * * Peer educators * * * * Friends relatives * * * * Other * * * * Residence Urban 41.7 35.0 51.2 78.7 Rural 33.7 29.5 47.6 72.7 Ecological zone Lowlands 36.7 32.0 48.5 71.5 Foothills 31.6 25.1 45.9 71.7 Mountains 34.8 28.9 46.9 94.7 Senqu River Valley 36.5 33.4 60.8 66.2 District Butha-Buthe 44.9 40.4 52.1 59.6 Leribe 36.4 27.9 49.8 64.9 Berea 30.4 25.5 46.7 83.1 Maseru 36.2 29.4 47.7 73.7 Mafeteng 36.7 35.4 44.2 66.3 Mohale's Hoek 38.5 37.2 52.3 93.6 Quthing 32.2 30.1 60.2 63.4 Qacha’s Nek 26.5 21.6 31.0 92.1 Mokhotlong 24.6 23.3 68.3 97.3 Thaba-Tseka 34.6 25.7 44.6 97.9 Education No education 0.0 0.0 9.6 100.0 Primary, incomplete 24.4 18.7 40.5 77.8 Primary, complete 36.9 31.7 50.0 69.1 Secondary+ 41.2 36.8 51.9 75.7 Wealth quintile Lowest 28.3 23.8 42.2 75.0 Second 27.3 23.1 39.1 66.4 Middle 40.0 35.6 53.3 75.8 Fourth 35.0 28.9 43.8 61.2 Highest 39.8 35.0 54.8 84.2 Total 36.0 31.0 48.6 74.5 Note: An asterisk indicates that a number is based on fewer than 25 unweighted cases and has been suppressed. na = Not applicable 1 Among users of female sterilisation, pill, IUCD, injectables, and implants 2 Among users of female sterilisation, pill, IUCD, injectables, implants, female condom, diaphragm, foam or jelly, and lactational amenorrhoea method (LAM) 3 Sterilised women who were told that they would not be able to have any more children 4 Source at start of current episode of use 76 | Family Planning Table 5.11 shows that less than half of users of modern contraceptive methods were informed of other methods available (49 percent) and only around one-third (36 percent) were informed about the side effects or health problems of the method they were provided. The results indicate that the IUCD users are more likely than other users to be informed both about other methods (67 percent) and about side effects or problems (46 percent). Among female sterilisation users, three in four were advised that the method was permanent. With regard to the source of supply, users who obtained their methods from CHAL or private medical providers were slightly more likely to be informed about other methods that could be used and about the side effects associated with the method they adopted than users who obtained their method from a government provider. People living in urban areas are more informed about the side effects or problems associated with the methods used than people living in rural areas. 5.11 FUTURE USE OF CONTRACEPTION An important indicator of the changing demand for family planning is the extent to which non- users of contraception plan to use family planning in the future. Women who were not currently using a method of contraception were asked about their intention to use family planning in the future. The results are presented in Table 5.12. Table 5.12 Future use of contraception Percent distribution of currently married women who are not using a contraceptive method by intention to use in the future, according to number of living children, Lesotho 2004 Number of living children1 Intention 0 1 2 3 4+ Total Intends to use 57.3 66.5 64.0 61.8 45.8 58.5 Unsure 8.6 6.4 4.1 2.1 5.1 5.2 Does not intend to use 34.1 26.5 31.2 35.4 48.3 35.7 Missing 0.0 0.6 0.7 0.7 0.8 0.6 Total 100.0 100.0 100.0 100.0 100.0 100.0 Number of women 242 632 455 337 659 2,325 1 Includes current pregnancy Fifty-nine percent of currently married nonusers say that they intend to use family planning in the future, 36 percent do not intend to use, and 5 percent are unsure. Those who do not intend to use contraception in the future are concentrated among those with three children (35 percent) and those with four or more children (48 percent). 5.12 REASONS FOR NOT INTENDING TO USE Table 5.13 presents the main reasons for not using contraception as reported by currently married nonusers who do not intend to use a contraceptive method in future. More than one-third of the women in this group (38 percent) cited fertility-related reasons for not using—mainly low risk of pregnancy or the desire for as many children as possible. A similar proportion (37 percent) expressed method-related concerns, largely health issues or fear of side effects. Nearly one-fifth of the women reported they themselves (14 percent) or their husband/partner (5 percent) were opposed to the use of contraception. Family Planning | 77 Table 5.13 Reason for not intending to use contraception Percent distribution of currently married women who are not using a contraceptive method and who do not intend to use in the future by main reason for not intending to use, according to age, Lesotho 2004 Age Reason 15-29 30-49 Total Fertility-related reasons 25.9 42.7 37.8 Infrequent sex/no sex 2.4 4.7 4.0 Menopausal/had hysterectomy 0.0 15.0 10.6 Subfecund/infecund 2.1 10.3 7.9 Wants as many children as possible 21.4 12.7 15.2 Opposition to use 27.4 17.7 20.5 Respondent opposed 18.5 12.5 14.3 Husband/partner opposed 8.9 4.0 5.4 Others opposed 0.0 0.2 0.1 Religious prohibition 0.0 1.0 0.7 Lack of knowledge 2.8 1.2 1.6 Knows no method 2.6 0.9 1.4 Knows no source 0.1 0.3 0.2 Method-related reasons 38.4 35.7 36.5 Health concerns 8.2 7.9 8.0 Fear of side effects 22.7 23.2 23.1 Lack of access/too far 0.1 0.1 0.1 Costs too much 1.7 0.6 0.9 Inconvenient to use 2.6 1.4 1.7 Interfere with body's normal processes 3.0 2.5 2.6 Other 2.3 2.7 2.5 Don’t know 2.5 0.0 0.8 Missing 0.8 0.0 0.2 Total 100.0 100.0 100.0 Number of women 243 587 830 The reasons given for not using contraceptives vary with the woman’s age. Among women under age 30, method-related reasons (38 percent) are cited most often followed by opposition to use (27 per- cent). Among nonusers 30 years and above, fertility-related reasons (43 percent) are predominant followed by method-related reasons (36 percent). 5.13 PREFERRED METHOD FOR FUTURE USE Demand for specific methods can be assessed by asking nonusers which method they intend to use in the future. Table 5.14 presents information on method preferences for married women who are not currently using contraception but say they intend to use in the future. The largest percentage of prospective users reported injectables as their preferred method (53 percent), with 25 percent citing pills, and 6 percent favouring the male condom. Method preference among women under 30 and those over 30 years is similar, except that older women are more likely than younger women to prefer female sterilisation and the IUCD. 78 | Family Planning Table 5.14 Preferred method of contraception for future use Percent distribution of currently married women who are not using a contraceptive method but who intend to use in the future by preferred method, according to age, Lesotho 2004 Age Method 15-29 30-49 Total Female sterilization 1.3 5.5 2.9 Male sterilization 0.0 0.5 0.2 Pill 28.0 21.0 25.4 IUCD 2.3 6.2 3.8 Injectables 55.9 48.8 53.2 Implants 0.9 2.1 1.4 Condom 6.0 6.0 6.0 Female condom 0.2 1.7 0.7 Withdrawal 0.4 0.8 0.6 Unsure 3.6 4.9 4.1 Total 98.6 97.6 98.2 Number of women 844 516 1,360 5.14 EXPOSURE TO FAMILY PLANNING MESSAGES Information on the level of public exposure to a particular type of media allows policymakers to identify the most effective media for various target groups in the population. To assess the media dissemination of family planning information, the 2004 LDHS asked all female and male respondents whether they had heard about family planning on the radio or television, or read about family planning in a newspaper or magazine in the few months preceding the interview. Table 5.15 shows that one in three women and a similar percentage of men were exposed to a family planning message through broadcast or print media. Radio was the primary source of family planning information, with one in three women and men who had received any family planning information saying they had heard a radio message. Information about family planning broadcast on television reached more than 9 percent of women and 10 percent of men. Men were more likely to have read about family planning in a newspaper or magazine than women (14 and 11 percent, respectively). There is a sharp contrast in exposure to family planning messages between urban and rural areas. Twenty percent of urban women and men are exposed to messages through television, compared with 6 percent of the women and 8 percent of the men in rural areas. Exposure to family planning messages through the radio varies markedly by ecological zone, from 18 percent of women and 25 percent of men in the Mountains zone to nearly 40 percent of both women and men in the Lowlands. Among women and men, exposure to family planning messages through the three sources of media is highest in Maseru, and lowest in Quthing, where only 15 and 18 percent, respectively, have recently been exposed to family planning messages. The percentages of both women and men who have seen or heard a family planning message rises with the level of education. As expected, the effect of education is greatest with respect to the proportions reading about family planning in a newspaper or magazine, both women and men with a secondary or higher education are more than five times as likely as those with no education to have seen a message in a newspaper or magazine. Family Planning | 79 Table 5.15 Exposure to family planning messages Percentage of women who heard or saw a family planning message on the radio or television, or in a newspaper/magazine in the past few months, according to background characteristics, Lesotho 2004 Women Men Background characteristic Radio Television Newspaper/ magazine None of these three media sources Number of women Radio Television Newspaper/ magazine None of these three media sources Number of men Age 15-19 20.4 8.0 9.9 77.4 1,710 19.3 7.7 9.5 77.8 743 20-24 30.3 8.6 11.6 68.2 1,463 27.2 7.3 12.8 70.2 507 25-29 35.5 10.6 12.3 62.3 1,044 39.3 12.3 17.8 58.7 374 30-34 39.3 10.0 13.5 59.2 816 39.0 9.2 12.8 59.7 305 35-39 39.1 10.3 10.9 59.3 728 42.2 13.4 19.0 56.6 233 40-44 37.6 9.4 8.5 61.3 741 48.5 9.8 13.7 48.6 164 45-49 37.3 10.2 12.6 62.2 592 48.4 23.1 20.4 49.2 170 50-54 na na na na na 46.1 15.5 17.4 53.9 164 55-59 na na na na na 47.1 8.4 15.6 52.9 137 Residence Urban 49.9 19.9 19.8 47.3 1,682 48.7 19.7 23.9 48.3 603 Rural 26.4 6.0 8.6 72.3 5,413 29.8 7.9 11.3 68.4 2,194 Ecological zone Lowlands 39.5 12.7 14.7 58.3 4,299 38.9 13.6 17.2 58.6 1,734 Foothills 27.0 6.9 8.2 72.2 787 29.8 9.0 14.1 68.3 307 Mountains 18.1 3.0 5.2 81.0 1,572 24.5 3.9 7.0 74.4 585 Senqu River Valley 16.2 2.6 4.4 82.3 437 22.5 3.4 5.7 76.3 171 District Butha-Buthe 33.9 6.5 12.5 63.5 458 43.7 16.6 23.0 52.6 182 Leribe 29.7 3.8 6.9 68.8 1,065 34.9 6.3 9.5 62.9 393 Berea 30.0 8.6 8.8 69.4 776 28.1 9.0 10.2 71.1 353 Maseru 47.2 21.4 21.1 50.7 1,868 43.9 18.5 23.6 53.4 740 Mafeteng 31.5 7.5 10.0 66.0 755 20.2 8.8 9.1 77.8 296 Mohale's Hoek 27.9 4.1 7.7 70.1 684 38.4 7.1 12.1 59.2 281 Quthing 13.2 1.9 4.4 85.5 461 16.8 2.2 3.8 82.1 167 Qacha’s Nek 19.2 5.9 7.0 80.3 233 16.9 5.5 7.3 81.3 102 Mokhotlong 22.1 2.1 4.0 76.4 360 38.3 4.0 11.2 60.5 128 Thaba-Tseka 15.6 2.4 5.3 83.6 435 28.7 5.2 8.9 69.8 156 Education No education 14.7 4.6 3.1 85.3 145 22.4 4.4 4.8 76.8 479 Primary, incomplete 22.4 5.4 6.2 77.0 2,136 27.4 7.0 7.8 71.3 1,194 Primary, complete 29.7 6.3 7.6 69.3 1,960 32.2 8.1 12.0 65.9 352 Secondary+ 41.6 14.5 17.8 55.4 2,854 51.7 20.6 30.3 44.1 773 Wealth quintile Lowest 11.2 3.0 4.4 88.2 987 17.4 2.6 3.4 82.1 371 Second 19.2 4.1 5.5 80.2 1,294 28.8 5.2 9.4 70.5 544 Middle 26.1 4.4 6.7 72.7 1,258 33.0 7.3 12.8 64.2 564 Fourth 38.6 7.5 12.3 59.5 1,595 34.7 9.6 13.8 62.6 625 Highest 49.2 20.6 20.4 47.7 1,962 46.7 22.1 24.7 50.5 692 Total 32.0 9.3 11.2 66.4 7,095 33.9 10.4 14.0 64.0 2,797 na = Not applicable 80 | Family Planning 5.15 CONTACT OF NONUSERS WITH FAMILY PLANNING PROVIDERS In the 2004 LDHS, women who were not using any family planning method were asked whether they had been visited by a fieldworker who talked with them about family planning in the 12 months preceding the survey. This information is especially useful for determining whether nonusers of family planning are being reached by family planning programmes throughout Lesotho. Table 5.16 shows that just 10 percent of nonusers had discussed family planning at a health facility (6 percent) or been contacted by a fieldworker about family planning (4 percent) in the 12 months before the survey. Table 5.16 Contact of nonusers with family planning providers Percentage of women who are not using contraception who were visited by a fieldworker who discussed family planning, who visited a health facility and discussed family planning, and who visited a health facility but did not discuss family planning, in the 12 months preceding the survey, by background characteristics, Lesotho 2004 Background characteristic Women visited by fieldworker who discussed family planning Women visited health facility and discussed family planning Women visited health facility but did not discuss family planning Did not discuss family planning with field- worker or at a health facility Number of women Age 15-19 2.3 1.9 14.8 95.8 1,558 20-24 3.7 5.2 24.8 92.1 1,031 25-29 3.3 10.2 22.3 87.6 604 30-34 5.2 12.9 21.0 83.8 437 35-39 6.2 9.5 26.1 86.5 448 40-44 4.8 4.4 24.4 91.9 500 45-49 3.9 6.5 20.5 91.1 460 Residence Urban 5.6 4.1 17.8 90.7 1,023 Rural 3.2 6.3 21.5 91.5 4,014 Ecological zone Lowlands 4.0 5.9 20.8 91.0 2,827 Foothills 3.3 5.4 16.7 92.2 606 Mountains 3.6 5.8 21.8 91.8 1,285 Senqu River Valley 2.3 7.0 24.2 91.7 320 District Butha-Buthe 3.8 3.6 15.0 93.3 315 Leribe 2.2 7.4 21.5 90.9 745 Berea 4.7 6.0 17.5 90.1 579 Maseru 5.2 4.3 16.6 91.5 1,249 Mafeteng 2.7 7.6 29.5 90.7 473 Mohale's Hoek 3.6 7.0 27.0 90.7 474 Quthing 1.3 6.4 21.6 93.0 350 Qacha’s Nek 2.9 6.0 11.8 92.1 176 Mokhotlong 3.9 3.7 30.9 93.3 316 Thaba-Tseka 3.6 7.7 19.4 90.4 360 Education No education 4.0 4.4 14.8 92.2 132 Primary, incomplete 2.7 5.2 18.5 93.0 1,702 Primary, complete 3.0 5.3 21.5 92.5 1,387 Secondary+ 5.1 7.1 22.8 89.0 1,816 Wealth quintile Lowest 2.4 6.1 18.4 92.4 838 Second 4.2 5.6 19.1 91.1 1,031 Middle 2.6 6.1 21.9 92.7 925 Fourth 4.2 6.5 22.3 90.4 1,080 Highest 4.5 5.3 21.7 90.8 1,163 Total 3.7 5.9 20.8 91.4 5,037 Family Planning | 81 5.16 DISCUSSION OF FAMILY PLANNING The use of family planning is facilitated when individuals discuss the issue with others and air their views. To assess the extent to which family planning is discussed, the 2004 LDHS asked women and men about any conversations they may have had about family planning with friends or relatives in the three months preceding the survey. Table 5.17 shows that the majority of women who know about contraception talked about family planning with their husband (partner) in the 12 months preceding the survey, 31 percent discussed it 1 or 2 times, and 39 percent discussed the issue 3 or more times. Conversations about family planning with other relatives or with friends or neighbours are also relatively common. Thirty percent of married women report discussing family planning with a relative (other than the husband) or a friend or neighbour in the three months preceding the survey. Table 5.17 Discussion of family planning with husband Percent distribution of currently married women who know a contraceptive method by the number of times they discussed family planning with their husband in the past year, according to Age, Lesotho 2004 Number of times family planning discussed with husband in the past 12 months Age Never One or two Three or more Missing Total Percentage discussed family planning with friends, neighbours or relatives in the past 3 months Number of women 15-19 45.8 32.1 22.2 0.0 100.0 19.4 278 20-24 26.0 31.7 41.0 1.4 100.0 28.6 761 25-29 19.3 35.3 44.5 0.9 100.0 36.1 695 30-34 25.0 28.8 45.2 1.0 100.0 36.4 589 35-39 25.4 30.9 42.6 1.0 100.0 31.8 476 40-44 34.8 30.6 34.5 0.2 100.0 26.6 470 45-49 50.6 25.6 23.6 0.2 100.0 23.3 376 Total 29.7 31.1 38.5 0.8 100.0 30.2 3,646 Men are less likely to report discussing family planning. Table 5.18 shows that only one-fifth of married men who know about contraception have talked about family planning with any friend, neighbour or relative in the past three months. 82 | Family Planning Table 5.18 Discussion of family planning: currently married men Among currently married men who know a contraceptive method, percentage who discussed family planning with friends, neighbours, or relatives in the 3 months preceding the survey according to the person with whom discussions were held and the percentage who discussed family planning with a health worker or health professional, according to age, Lesotho 2004 Discussion with friends, neighbours or relatives Age Any friend, neighbour, or relative Wife / partner Other male relative1 Other female relative2 Other relative/ unrelated individual Percentage discussed family planning with health worker or health professional Number of men 15-19 * * * * * * 2 20-24 17.2 1.7 0.0 1.9 13.6 2.5 101 25-29 21.9 7.9 1.6 2.4 10.0 3.8 199 30-34 22.1 8.6 1.5 2.1 9.9 5.3 210 35-39 21.0 7.1 1.8 1.0 11.1 3.9 178 40-44 26.7 5.3 2.3 0.6 18.5 5.4 123 45-49 19.0 4.3 0.8 0.7 13.2 6.8 125 50-54 14.1 4.5 0.8 0.0 8.8 9.1 123 55-59 11.7 1.9 2.8 0.0 7.0 3.8 109 Total 19.8 5.8 1.5 1.2 11.3 5.0 1,170 Note: An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. 1 Includes father, father-in-law, son, and brother 2 Includes mother, mother-in-law, daughter, and sister 5.17 ATTITUDES OF RESPONDENTS TOWARDS FAMILY PLANNING Use of effective contraceptive methods is facilitated when couples have a positive attitude towards family planning. Widespread disapproval of contraception use can act as a barrier to the adoption of family planning methods. Attitudinal data were collected by asking women whether they approved of couples using family planning and what they perceived as their husband’s attitude towards family planning. Men were also asked whether they approved of family planning. The results presented in Table 5.19 are confined to currently married women and exclude those who have never heard of a contraceptive method. Eighty percent of these women approve of family planning. The small number of women who never attended school are the least likely to approve of family planning use. Other groups in which approval levels are comparatively low include women age 45-59, women living in the Mountains zone, and women living in Qacha’s Nek, Thaba-Tseka, and Mokhotlong districts. Family Planning | 83 Table 5.19 Attitudes towards family planning: currently married women Percent distribution of currently married women who know of a method of family planning,, by approval of family planning and their perception of their husband's attitude towards family planning, according to background characteristics, Lesotho 2004 Respondent approves of family planning Respondent disapproves of family planning Background characteristic Husband approves Husband disapproves Husband's attitude unknown/ missing Husband approves Husband disapproves Husband's attitude unknown/ missing Total Number of respondents Age 15-19 47.5 11.9 14.7 0.4 16.1 6.0 96.6 278 20-24 54.7 15.7 9.3 3.1 12.1 3.4 98.3 761 25-29 62.7 18.0 6.4 1.8 5.9 3.5 98.4 695 30-34 62.7 15.6 8.4 2.3 6.8 2.7 98.5 589 35-39 56.1 17.2 8.8 4.6 8.6 1.9 97.3 476 40-44 49.4 16.8 8.4 2.8 14.7 6.9 99.1 470 45-49 38.0 18.2 12.4 4.2 19.7 6.4 99.0 376 Residence Urban 68.1 11.3 9.1 2.9 4.9 3.1 99.3 735 Rural 51.4 17.7 9.2 2.8 12.6 4.3 98.0 2,910 Ecological zone Lowlands 64.1 13.7 9.0 2.6 6.3 3.1 98.8 2,117 Foothills 46.5 22.3 8.7 4.3 13.4 2.0 97.2 447 Mountains 37.0 20.0 8.6 3.1 21.1 7.5 97.3 891 Senqu River Valley 52.9 16.4 14.4 0.1 11.4 3.6 98.9 191 District Butha-Buthe 56.6 18.1 5.7 3.5 12.2 2.0 98.1 247 Leribe 59.9 18.1 6.9 3.0 8.3 2.6 98.8 572 Berea 52.4 19.5 10.7 3.2 10.0 2.6 98.4 418 Maseru 63.2 13.5 8.9 3.0 6.6 3.0 98.3 887 Mafeteng 66.0 10.1 11.3 1.5 6.3 4.0 99.3 407 Mohale's Hoek 47.2 16.5 11.3 4.0 14.0 5.1 98.0 347 Quthing 46.5 16.7 15.1 1.1 10.2 6.8 96.5 210 Qacha’s Nek 41.7 19.7 4.8 4.1 21.8 4.1 96.3 113 Mokhotlong 30.5 20.5 6.4 1.1 30.2 7.6 96.3 196 Thaba-Tseka 38.7 21.5 9.1 2.5 17.8 9.4 99.1 248 Education No education 18.3 24.4 6.8 2.7 34.3 11.0 97.5 84 Primary, incomplete 40.0 20.2 10.3 3.7 16.5 6.9 97.6 1,111 Primary, complete 54.6 16.7 10.1 2.8 10.6 3.2 98.1 1,139 Secondary+ 69.7 12.5 7.6 2.0 5.2 2.0 99.0 1,311 Wealth quintile Lowest 33.2 21.0 8.8 4.1 21.7 8.0 96.8 543 Second 43.9 22.8 8.5 2.2 14.8 5.2 97.5 695 Middle 52.0 17.4 10.4 3.4 11.6 3.8 98.6 640 Fourth 59.6 13.5 10.9 3.4 8.0 3.5 98.9 846 Highest 73.1 11.0 7.4 1.5 4.3 1.7 98.9 922 Total 54.7 16.4 9.2 2.8 11.0 4.1 98.3 3,646 Table 5.20 shows the distribution of all men knowing about contraception by their attitude towards family planning use. More than one-third of men indicated that they disapprove of a couple using family planning methods, about half mentioned that they would approve, and 14 percent are unsure about their attitude. As was the case with married women, the approval level is lowest among men who never attended school, with only 32 percent men in this group expressing a positive attitude towards family planning use. Other groups in which the percentage approving of family planning falls below 40 percent include men age 50-59 and men living Mohale’s Hoek and Thaba-Tseka districts. 84 | Family Planning Table 5.20 Attitudes towards family planning: all men Percent distribution of men who know a family planning method by their attitude towards couples' family planning use, according to background characteristics, Lesotho 2004 Background characteristic Respondent approves of family planning Respondent disapproves of family planning Respondent unsure Total Number of men Age 15-19 41.0 36.3 22.7 100.0 676 20-24 48.1 36.3 15.6 100.0 498 25-29 57.7 33.3 9.0 100.0 371 30-34 58.4 34.0 7.6 100.0 297 35-39 58.1 35.6 5.8 100.0 232 40-44 58.5 35.1 6.4 100.0 162 45-49 52.0 35.4 12.6 100.0 162 50-54 35.4 53.7 11.0 100.0 157 55-59 32.9 54.5 12.6 100.0 131 Marital status Never married 45.0 35.9 19.1 100.0 1,337 Married or living together 53.9 37.7 8.4 100.0 1,170 Divorced/separated/ widowed 46.4 47.1 6.4 100.0 173 Missing 100.0 0.0 0.0 100.0 4 Residence Urban 69.2 20.6 10.2 100.0 600 Rural 43.2 42.2 14.6 100.0 2,084 Ecological zone Lowlands 51.5 35.4 13.1 100.0 1,693 Foothills 47.2 42.5 10.3 100.0 285 Mountains 40.1 43.6 16.1 100.0 536 Senqu River Valley 56.1 28.1 15.9 100.0 169 District Butha-Buthe 57.0 34.8 8.2 100.0 176 Leribe 48.8 37.4 13.8 100.0 376 Berea 41.5 49.4 9.1 100.0 333 Maseru 58.8 30.0 11.1 100.0 721 Mafeteng 44.6 38.3 17.2 100.0 282 Mohale's Hoek 39.6 34.6 25.7 100.0 275 Quthing 50.0 34.7 15.3 100.0 165 Qacha’s Nek 45.0 37.5 17.5 100.0 96 Mokhotlong 46.2 44.0 9.8 100.0 117 Thaba-Tseka 38.6 50.3 10.4 100.0 145 Education No education 32.2 53.0 14.6 100.0 436 Primary, incomplete 42.4 41.7 15.9 100.0 1,130 Primary, complete 50.3 38.6 11.1 100.0 347 Secondary+ 67.7 21.6 10.7 100.0 771 Wealth quintile Lowest 36.1 49.2 14.7 100.0 338 Second 41.6 44.8 13.4 100.0 521 Middle 46.4 37.7 15.9 100.0 536 Fourth 46.6 40.2 13.2 100.0 606 Highest 65.3 23.0 11.7 100.0 682 Total 49.0 37.4 13.6 100.0 2,684 In addition to questions about general approval of family planning, men were asked whether they agreed or disagreed with four statements about family planning use: 1) contraception is women’s business and a man should not have to worry about it; 2) women who use contraception may become promiscuous; 3) a woman is the one who gets pregnant so she should use contraception; and 4) women who use contraception may have a problem becoming pregnant. The results of these questions are shown in Table 5.21. Family Planning | 85 Table 5.21 Men's attitude about contraception Among men who know a family planning method, percentage who agree with various statements about contraceptive use, by background characteristics, Lesotho 2004 Percentage who agree that: Background characteristic Contraception is women's business Women who use contraception may become promiscuous A woman is the one who becomes pregnant so she should use contraception Women who use contraception may have a problem becoming pregnant Number of men Age 15-19 39.5 52.1 56.4 50.6 676 20-24 53.2 71.6 64.4 69.4 498 25-29 45.6 73.0 60.1 67.2 371 30-34 49.7 68.9 63.8 72.8 297 35-39 55.0 69.9 70.6 69.1 232 40-44 56.3 72.2 71.7 74.0 162 45-49 44.3 71.0 60.9 64.1 162 50-54 50.9 73.2 62.4 72.7 157 55-59 48.6 76.9 63.8 72.9 131 Marital status Never married 45.3 59.5 59.9 58.2 1,337 Married or living together 49.7 73.7 64.1 71.7 1,170 Divorced/separated/ widowed 54.6 78.0 70.1 73.0 173 Residence Urban 40.6 62.2 58.4 61.0 600 Rural 49.8 68.1 63.5 66.2 2,084 Ecological zone Lowlands 46.5 67.2 62.3 66.3 1,693 Foothills 47.7 66.6 59.1 64.8 285 Mountains 50.0 66.2 62.6 61.8 536 Senqu River Valley 52.8 64.8 67.6 62.6 169 District Butha-Buthe 40.5 63.1 57.3 64.1 176 Leribe 46.1 66.9 58.0 68.4 376 Berea 49.0 75.3 67.7 72.9 333 Maseru 43.7 65.5 61.6 66.8 721 Mafeteng 51.5 68.6 62.0 60.3 282 Mohale's Hoek 51.0 63.0 63.9 57.1 275 Quthing 52.8 68.3 69.2 65.8 165 Qacha’s Nek 41.4 44.5 50.0 43.5 96 Mokhotlong 55.9 77.1 66.1 68.8 117 Thaba-Tseka 56.9 66.0 66.6 64.6 145 Education No education 53.1 70.8 65.0 69.6 436 Primary, incomplete 49.9 66.3 63.0 66.0 1,130 Primary, complete 52.3 71.9 66.2 66.1 347 Secondary+ 39.6 62.9 58.1 60.4 771 Wealth quintile Lowest 54.7 70.3 65.8 65.3 338 Second 52.7 67.8 63.5 65.7 521 Middle 48.8 68.2 63.1 67.8 536 Fourth 46.3 66.4 61.1 66.7 606 Highest 41.0 63.5 60.3 60.8 682 Total 47.8 66.8 62.4 65.0 2,684 The data show that nearly half of men knowing about contraception believe that it is women’s business only (48 percent) and 62 percent agree that the woman is the one who gets pregnant so she should be the one to use a method. Nearly two-thirds of men say that women who use family planning may become promiscuous, and a similar percentage believe that women who use contraception may experience problems becoming pregnant. 86 | Family Planning In the 2004 LDHS, men were also asked whether they agreed or disagreed with nine statements about condom use. The responses are shown in Table 5.22. Seven in ten men agree that condoms protect against sexually transmitted infections and an equal proportion believe that the condom is the best way to prevent unwanted pregnancy. Forty-five percent of men believe that condoms diminish sexual pleasure, and 37 percent believe that condoms are inconvenient to use. Nearly one in three men believe that buying condoms is embarrassing. A similar percentage agree that people who use condoms are not faithful because they might have the AIDS virus or other sexually transmitted infections, and a similar number believe that a woman has no right to tell a man to use condoms. Twenty-seven percent of men believe that condoms contain the AIDS virus. Furthermore, one in ten believes that condoms can be reused. Table 5.22 Men's attitudes towards condoms Percentage of men age 15-59 who agree with particular statements about condoms, by background characteristics, Lesotho 2004 Percentage who agree that: Background characteristic Condoms diminish sexual pleasure Condoms are very inconvenient to use Condoms can be reused Condoms protect against STIs Buying condoms is embarrassing A woman has no right to tell man to use a condom Condoms contain the AIDS virus A condom is best way to prevent unwanted pregnancy People who use condoms are not faithful Number of men Current age 15-19 28.8 23.8 14.1 64.7 31.6 24.6 20.5 64.2 27.7 743 20-24 50.6 41.7 12.5 76.6 35.1 32.4 25.2 77.8 35.6 507 25-29 54.5 43.6 11.4 74.9 28.7 31.9 31.6 77.2 32.4 374 30-34 52.4 40.6 9.1 71.9 29.9 33.2 25.3 76.9 34.0 305 35-39 54.4 46.8 12.0 74.1 34.8 34.9 29.8 77.2 29.3 233 40-44 57.8 47.8 9.4 70.8 39.1 36.6 25.5 72.1 44.9 164 45-49 40.2 37.1 3.9 62.1 31.1 25.7 28.3 60.3 37.9 170 50-54 46.4 41.6 6.9 58.7 46.2 33.8 36.6 55.7 42.6 164 55-59 38.6 37.1 4.0 52.5 40.7 43.6 34.8 56.7 35.4 137 Marital status Never married 38.8 30.3 13.2 69.7 31.5 27.4 21.8 70.6 30.8 1,422 Ever had sex 50.3 38.3 13.9 80.1 34.1 30.4 24.4 81.8 34.9 916 Never had sex 17.9 15.8 11.9 50.9 26.9 22.0 17.1 50.3 23.5 506 Married/living together 50.3 44.1 8.9 69.4 35.9 35.2 30.8 70.2 35.9 1,191 Divorced/separated/ widowed 55.8 48.6 6.4 61.1 35.1 32.3 35.7 67.9 37.6 184 Residence Urban 48.3 34.1 10.6 79.1 25.7 21.4 22.0 77.6 25.4 603 Rural 43.9 38.3 11.0 66.2 35.8 33.7 27.8 68.2 35.7 2,194 Ecological zone Lowlands 46.5 38.6 11.8 74.3 33.4 30.2 26.1 74.9 33.7 1,734 Foothills 46.1 40.5 8.7 59.9 36.2 34.6 29.0 60.0 32.8 307 Mountains 40.9 34.5 10.7 57.1 34.8 33.4 28.9 59.0 34.2 585 Senqu River Valley 39.1 28.8 5.9 72.7 27.7 24.8 18.4 79.4 29.5 171 District Butha-Buthe 44.9 39.8 6.0 69.0 39.7 34.7 30.0 68.1 37.6 182 Leribe 43.4 34.3 8.6 64.3 36.5 28.7 25.5 64.0 33.6 393 Berea 43.8 40.6 9.7 67.3 31.9 29.2 29.0 69.3 28.4 353 Maseru 48.8 39.1 17.0 75.3 31.3 29.8 27.2 73.9 30.8 740 Mafeteng 43.2 37.5 3.0 71.5 36.3 35.5 24.5 77.8 42.1 296 Mohale's Hoek 48.6 41.1 13.1 74.8 30.2 32.7 23.7 76.7 34.1 281 Quthing 37.9 30.2 3.8 68.7 27.5 21.7 18.1 77.5 31.6 167 Qacha's Nek 27.1 15.1 13.6 53.1 23.9 23.7 15.9 51.9 27.7 102 Mokhotlong 33.2 22.4 8.1 52.5 37.8 28.3 24.0 53.1 27.2 128 Thaba-Tseka 56.3 54.1 15.6 64.1 45.5 47.8 43.3 65.4 45.5 156 Education No education 39.5 39.3 9.5 50.7 37.4 36.6 32.1 53.2 36.0 479 Primary, incomplete 48.2 43.0 10.5 65.5 39.0 37.0 30.4 68.0 39.2 1,194 Primary, complete 49.8 36.5 15.1 77.0 30.4 28.1 23.0 75.0 28.4 352 Secondary+ 40.6 27.9 10.6 82.2 24.5 19.7 18.8 82.0 25.3 773 Wealth quintile Lowest 47.2 40.9 10.4 55.5 39.0 38.5 28.9 62.1 34.3 371 Second 44.8 37.2 11.2 64.9 36.3 37.7 33.4 67.4 43.3 544 Middle 47.9 40.9 10.4 69.9 35.4 30.1 28.7 66.5 34.6 564 Fourth 41.9 34.9 12.3 69.6 32.5 31.7 23.6 73.4 32.2 625 Highest 43.6 34.9 10.1 78.3 28.3 21.9 20.7 76.9 25.5 692 Total 44.8 37.4 10.9 69.0 33.6 31.0 26.5 70.2 33.4 2,797 Other Proximate Determinants of Fertility | 87 OTHER PROXIMATE DETERMINANTS OF FERTILITY 6 6.1 INTRODUCTION Research on fertility demonstrates that fertility levels in most populations can be explained by five key proximate determinants that define the risk of becoming pregnant. These are marriage, sexual intercourse, postpartum amenorrhoea and abstinence from sexual relations, onset of menopause, and contraceptive use. This chapter addresses all of these determinants except contraception (see Chapter 5). Marriage is a principal indicator of women’s exposure to risk of pregnancy. Early age at marriage in a population is usually associated with a longer period of exposure to the risk of pregnancy and higher fertility levels. The early initiation of childbearing associated with early marriage may also adversely affect women and children’s health. The durations of postpartum amenorrhoea and postpartum abstinence affect the length of time a woman is insusceptible to pregnancy and thus, determine the interval between births. The onset of menopause marks the end of a woman’s reproductive life cycle. These factors taken together determine the duration of a woman’s reproductive life and the pace of childbearing, making them important in understanding fertility levels and differences. 6.2 MARITAL STATUS The distribution of women and men by marital status at the time of survey is presented in Table 6.1. The categories “married” and “living together” when combined are referred to as “currently married,” and those who are divorced, separated, and widowed are referred to as “formerly married.” The currently married and the formerly married combined gives the proportion “ever married.” Table 6.1 Current marital status Percent distribution of women and men by current marital status, according to age, Lesotho 2004 Marital status Age Never married Married Living together Divorced Separated Widowed Total Number of women/men WOMEN 15-19 82.0 16.8 0.3 0.0 0.5 0.3 100.0 1,710 20-24 40.2 52.9 0.4 0.6 4.2 1.8 100.0 1,463 25-29 18.5 66.4 0.7 0.6 7.3 6.6 100.0 1,044 30-34 9.2 71.6 1.0 1.5 7.6 9.1 100.0 816 35-39 7.4 65.9 0.5 1.3 7.3 17.5 100.0 728 40-44 5.7 62.8 1.6 1.6 6.2 22.0 100.0 741 45-49 3.1 63.7 0.9 0.6 6.9 24.8 100.0 592 Total 33.4 51.6 0.7 0.7 4.9 8.6 100.0 7,095 MEN 15-19 99.6 0.4 0.0 0.0 0.0 0.0 100.0 743 20-24 78.2 20.2 0.0 0.0 1.3 0.3 100.0 507 25-29 42.1 53.3 0.2 0.0 2.8 1.6 100.0 374 30-34 23.8 69.2 0.5 0.6 4.7 1.2 100.0 305 35-39 10.3 75.5 0.9 1.2 7.8 3.8 100.0 233 40-44 8.4 75.4 0.1 0.6 11.2 4.3 100.0 164 45-49 2.8 77.2 0.5 1.7 9.6 6.9 100.0 170 50-54 5.6 75.6 1.6 0.0 12.0 5.2 100.0 164 55-59 0.3 79.6 2.7 0.0 7.9 9.6 100.0 137 Total 50.7 42.2 0.4 0.3 4.1 2.2 100.0 2,797 88 | Other Proximate Determinants of Fertility One-third of women of childbearing age have never been married; more than half are either married or living together with a man; 9 percent are widowed; and the remaining 6 percent are separated or divorced. Considering the age patterns, the low proportion (3 percent) of women age 45-49 that have never been married indicates that marriage is still nearly universal in Lesotho. Nearly half of the men interviewed have never been married, 43 percent are currently mar- ried or living together, 2 percent are widowed, and only 4 percent are separated or divorced. Compared with women, a greater proportion of men have never been married (17 percentage points more), while a smaller proportion are widowed (6 per- centage points less). 6.3 POLYGYNY The extent of polygyny in Lesotho was measured by asking currently married men the question, “Do you have one wife or more than one wife?” If more than one, he was asked, “How many wives do you have?” Table 6.2 shows the distri- bution of the men by the number of wives, according to background characteristics. The data show that 5 percent of men report having more than one wife. Polygyny is notably higher among men living in Thaba-Tseka. Men with no education are more likely to be in polygy- nous unions (7 percent). Table 6.2 Polygyny: Currently married men Percent distribution of currently married men by number of wives, according to background characteristics, Lesotho 2004 Number of wives Background characteristic 1 2+ Total Number of men Age 15-19 * * * 3 20-24 96.5 3.5 100.0 102 25-29 97.7 2.3 100.0 200 30-34 94.2 5.8 100.0 212 35-39 96.4 3.6 100.0 178 40-44 95.3 4.7 100.0 124 45-49 89.8 10.2 100.0 132 50-54 93.6 6.4 100.0 127 55-59 95.2 4.8 100.0 113 Residence Urban 97.1 2.9 100.0 293 Rural 94.3 5.7 100.0 898 Ecological zone Lowlands 95.8 4.2 100.0 692 Foothills 96.5 3.5 100.0 132 Mountains 91.8 8.2 100.0 300 Senqu River Valley 98.0 2.0 100.0 67 District Butha-Buthe 97.4 2.6 100.0 76 Leribe 95.3 4.7 100.0 179 Berea 94.1 5.9 100.0 140 Maseru 98.8 1.2 100.0 326 Mafeteng 91.5 8.5 100.0 84 Mohale's Hoek 94.3 5.7 100.0 125 Quthing 97.4 2.6 100.0 70 Qacha’s Nek 97.1 2.9 100.0 42 Mokhotlong 96.0 4.0 100.0 75 Thaba-Tseka 76.8 23.2 100.0 73 Education No education 92.6 7.4 100.0 304 Primary, incomplete 94.1 5.9 100.0 480 Primary, complete 95.6 4.4 100.0 128 Secondary+ 98.8 1.2 100.0 279 Wealth quintile Lowest 94.1 5.9 100.0 197 Second 94.7 5.3 100.0 246 Middle 93.3 6.7 100.0 212 Fourth 94.8 5.2 100.0 243 Highest 97.2 2.8 100.0 294 Total 95.0 5.0 100.0 1,191 Note: An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. Other Proximate Determinants of Fertility | 89 5.0 2.9 5.7 4.2 3.5 8.2 2.0 2.6 4.7 5.9 1.2 8.5 5.7 2.6 2.9 4.0 23.2 7.4 5.9 4.4 1.2 LESOTHO RESIDENCE Urban Rural ECOLOGICAL ZONE Lowlands Foothills Mountains Senqu River Valley DISTRICT Butha-Buthe Leribe Berea Maseru Mafeteng Mohale's Hoek Quthing Qacha's Nek Mokhotlong Thaba-Tseka EDUCATION No education Primary, incomplete Primary, complete Secondary+ Figure 6.1 Percentage of Currently Married Men Who Have More Than One Wife LDHS 2004 6.4 AGE AT FIRST MARRIAGE Age at first marriage has a major effect on childbearing because women who marry early have, on average, a longer period of exposure to pregnancy, often leading to a higher number of children ever born. Tables 6.3.1 and 6.3.2 show the percentage of women and men who have married by specific ages, according to current age group. Table 6.3.1 shows that 56 percent of all women 20-49 were married before age 20. Few women married at a very early age (before age 15): 5 percent among all women and 2 percent among women age 20-24. Table 6.3.1 Age at first marriage: women Percentage of women who were first married by specific exact ages and median age at first marriage, according to current age, Lesotho 2004 Percentage first married by exact age: Current age 15 18 20 22 25 Percentage never married Number Median age at first marriage 15-19 1.4 na na na na 82.0 1,710 a 20-24 2.3 22.7 44.0 na na 40.2 1,463 a 25-29 3.9 25.7 49.6 66.0 77.4 18.5 1,044 20.0 30-34 2.7 35.3 58.0 72.2 80.9 9.2 816 19.3 35-39 6.4 33.0 58.5 76.0 84.8 7.4 728 19.3 40-44 7.6 42.3 67.9 79.2 86.6 5.7 741 18.6 45-49 7.6 44.3 72.8 85.4 92.6 3.1 592 18.3 20-49 4.5 31.7 55.6 69.3 77.1 18.0 5,385 19.5 25-49 5.3 35.0 60.0 74.6 83.5 9.8 3,922 19.1 na = Not applicable a = Omitted because less than 50 percent of the women married for the first time before reaching the beginning of the age group 90 | Other Proximate Determinants of Fertility The table also shows the median age at first marriage, that is, the age by which half of women have married. Overall, among women age 20-49, the median age at first marriage is 19.5 years. The data show an increase in age at first marriage from 18.3 years among women age 45-49 to 20.0 years among women age 25-29. Table 6.3.2 indicates that men are much older on average than women when they marry for the first time. Only 8 percent of men 25-59 marry before age 20, and less than half married before age 25. Although the pattern is less consistent for men than women, the median age at first marriage for men appears to have increased over time, from 24.5 years among men 50-59 to 25.9 years among men 30-34. Table 6.3.2 Age at first marriage: men Percentage of men who were first married by specific exact ages and median age at first marriage, according to current age, Lesotho 2004 Percentage first married by exact age: Current age 18 20 22 25 Percentage never married Number Median age at first marriage 15-19 na na na na 99.6 743 a 20-24 1.8 8.9 na na 78.2 507 a 25-29 1.2 7.5 19.3 45.4 42.1 374 a 30-34 1.9 5.3 17.9 40.8 23.8 305 25.9 35-39 3.8 12.4 26.9 51.1 10.3 233 24.9 40-44 1.2 7.8 22.2 45.5 8.4 164 25.4 45-49 0.8 9.0 29.0 54.0 2.8 170 24.0 50-54 2.5 9.1 28.7 55.4 5.6 164 24.5 55-59 3.7 6.1 21.1 58.1 0.3 137 24.5 25-59 2.0 8.0 22.7 48.7 18.2 1,547 a 30-59 2.3 8.2 23.8 49.8 10.6 1,172 25.0 na = Not applicable a = Omitted because less than 50 percent of the men married for the first time before reaching the beginning of the age group Table 6.4 present socioeconomic differentials in the median age at first marriage for women age 20-49 and 25-49 and for men 30-59. Urban women tend to marry two years later than their rural counterparts, and the difference is larger among the younger age cohorts. A woman’s education level is also related to the likelihood that she will delay marriage. Among all women age 25-29, for example, the median age at marriage is about 3 years higher among women with at least some secondary education compared with women whose primary education is incomplete. The median age at first marriage for men also varies with residence and education status. Rural men and men with little or no education are especially likely to enter into marriage early. Men age 30-59 are more likely to marry earlier in the Mountains (age 24) as compared with their Lowlands counterparts (age 26). Other Proximate Determinants of Fertility | 91 Table 6.4 Median age at first marriage Median age at first marriage among women age 20-49 and among men 30-59, by current age (women) and background characteristics, Lesotho 2004 Current age Background characteristic 25-29 30-34 35-39 40-44 45-49 Women age 20-49 Women age 25-49 Men age 30-59 Residence Urban 22.5 20.9 20.7 20.5 18.9 a 20.9 25.8 Rural 19.3 18.8 18.8 18.2 18.2 19.0 18.7 24.7 Ecological zone Lowlands 20.6 19.5 19.8 18.9 18.5 20.0 19.5 25.5 Foothills 18.9 18.9 19.1 17.8 18.3 18.8 18.6 24.1 Mountains 18.9 18.8 18.4 18.0 17.9 18.6 18.5 23.7 Senqu River Valley 20.8 19.5 18.7 18.7 18.1 19.6 19.0 25.2 District Butha-Buthe 19.8 19.9 18.6 17.7 17.7 19.1 18.6 23.7 Leribe 19.0 18.8 19.5 18.6 18.4 19.3 18.9 24.6 Berea 19.9 18.8 19.6 18.2 17.9 19.4 19.0 25.3 Maseru 21.1 20.4 20.1 19.9 18.9 a 20.2 25.8 Mafeteng 20.4 19.2 19.6 18.4 18.1 19.3 19.1 25.7 Mohale's Hoek 19.8 18.7 18.8 17.7 18.3 18.9 18.6 24.4 Quthing 20.0 18.8 18.7 18.7 17.9 19.1 18.8 25.1 Qacha’s Nek 20.0 18.5 17.9 17.8 (18.8) 18.9 18.6 25.2 Mokhotlong 19.2 18.9 18.4 18.3 (17.7) 18.8 18.6 22.9 Thaba-Tseka 19.7 19.4 (18.8) 17.9 (17.3) 19.0 19.0 23.7 Education No education * (18.3) * (18.1) (17.5) 18.2 18.2 24.1 Primary, incomplete 18.7 17.9 17.6 17.5 17.7 18.1 17.9 24.5 Primary, complete 18.9 18.9 18.9 18.4 18.4 18.9 18.7 25.9 Secondary+ 21.5 20.4 20.5 20.1 21.4 a 20.8 26.0 Wealth quintile Lowest 18.6 18.6 17.6 17.8 18.0 18.3 18.1 23.4 Second 18.8 19.2 18.7 18.1 17.6 18.6 18.4 24.5 Middle 19.8 18.6 19.4 18.0 18.3 19.3 18.8 25.1 Fourth 20.7 19.1 19.4 18.7 18.4 19.9 19.3 25.4 Highest 21.5 20.2 20.0 19.8 19.5 a 20.3 25.6 Total 20.0 19.3 19.3 18.6 18.3 19.5 19.1 25.0 Note: An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. Figures in parentheses are based on 25-49 unweighted cases. a = Omitted because less than 50 percent of the women married for the first time before reaching the beginning of the age group 6.5 AGE AT FIRST SEXUAL INTERCOURSE Although age at marriage is often used as a proxy measure for the beginning of exposure to the risk of pregnancy, some women engage in sexual activity before marriage. The 2004 LDHS gathered information on the timing of the first sexual intercourse for both men and women. The percentage of women and men who had had sexual intercourse by exact ages is given in Table 6.5. 92 | Other Proximate Determinants of Fertility Table 6.5 Age at first sexual intercourse Percentage of women and men who had first sexual intercourse by specific exact ages and median age at first intercourse, according to current age, Lesotho 2004 Percentage who had first sexual intercourse by exact age: Current age 15 18 20 22 25 Percentage who never had intercourse Number of women/ men Median age at first intercourse WOMEN 15-19 6.9 na na na na 57.1 1,710 a 20-24 5.6 37.9 67.7 na na 11.3 1,463 18.7 25-29 5.2 37.2 65.8 81.0 89.1 2.4 1,044 18.7 30-34 3.9 39.2 64.6 77.7 86.0 0.6 816 18.8 35-39 5.9 36.9 62.8 78.4 85.5 0.3 728 18.9 40-44 7.8 42.1 71.1 82.6 89.0 0.6 741 18.4 45-49 7.6 42.5 70.1 82.4 86.0 0.2 592 18.4 20-49 5.8 38.9 66.9 80.6 86.3 3.7 5,385 18.7 25-49 5.9 39.3 66.6 80.3 87.3 0.9 3,922 18.6 MEN 15-19 17.6 na na na na 54.4 743 a 20-24 6.5 48.9 71.9 na na 13.9 507 18.1 25-29 5.1 38.3 65.9 80.7 91.1 3.7 374 18.6 30-34 4.8 28.9 56.2 72.9 85.3 3.6 305 19.3 35-39 3.5 24.8 48.7 71.2 83.0 1.5 233 20.1 40-44 1.8 19.7 39.8 63.3 80.3 1.1 164 20.5 45-49 3.1 13.1 39.1 58.2 73.2 0.0 170 20.8 50-54 0.6 9.1 28.6 50.1 76.9 0.6 164 22.0 55-59 0.0 6.7 22.9 45.6 78.1 0.0 137 22.4 25-59 3.3 23.8 47.9 67.1 83.0 2.0 1,547 20.1 30-59 2.7 19.1 42.2 62.7 80.4 1.5 1,172 20.5 na = Not applicable a = Omitted because less than 50 percent of the women had intercourse for the first time before reaching the beginning of the age group Relatively few women in Lesotho have had sex by age 15, but half reported having initiated sexual activity before they reached age 19. The median age at which women reported that they had first sexual intercourse has increased over time, from 18.4 years among women age 45-49 to 18.7 years among women age 20-24. The data for male respondents show a later age at first sex for most age groups, compared with female respondents. The data also imply that age at first sex among men has been declining over time, from 22 years for men in their 50s to around 18 years for men in their 20s. Other Proximate Determinants of Fertility | 93 Table 6.6 shows the median age at first sex by background characteristics for women age 20-49 and men age 25-59 years. The greatest differentials are observed by educational level. For example, women with at least some secondary education begin sexual activity two years later than those with primary education incomplete. Table 6.6 Median age at first intercourse Median age at first sexual intercourse among women age 20-49 and men age 25-59, by current age (women) and background characteristics, Lesotho 2004 Current age Background characteristic 20-24 25-29 30-34 35-39 40-44 45-49 Women age 20-49 Women age 25-49 Men age 25-59 Men age 30-59 Residence Urban 19.2 19.0 19.1 19.8 19.1 19.0 19.2 19.2 19.6 20.0 Rural 18.6 18.6 18.7 18.6 18.2 18.2 18.5 18.5 20.3 20.6 Ecological zone Lowlands 19.0 18.9 19.0 19.3 18.6 18.5 18.9 18.8 20.0 20.4 Foothills 18.4 18.2 18.8 18.8 17.7 18.1 18.3 18.3 20.1 20.6 Mountains 18.6 18.4 18.5 18.3 18.1 18.2 18.4 18.3 20.5 20.6 Senqu River Valley 17.8 18.1 18.4 18.5 18.3 17.8 18.1 18.2 19.8 20.1 District Butha-Buthe 19.1 19.3 19.6 18.7 17.9 17.8 18.7 18.6 20.5 20.9 Leribe 19.1 18.5 18.8 19.1 18.3 18.2 18.7 18.5 20.5 20.7 Berea 18.6 19.2 18.8 18.9 18.1 18.3 18.7 18.7 20.1 20.6 Maseru 19.0 18.8 19.2 19.3 18.9 19.0 19.0 19.0 19.7 20.1 Mafeteng 18.6 19.0 18.0 19.3 18.5 18.3 18.7 18.7 20.1 20.7 Mohale's Hoek 18.1 17.9 17.9 18.5 17.4 17.8 17.9 17.8 19.3 20.2 Quthing 17.7 17.9 17.5 18.6 17.0 17.8 17.9 18.0 20.0 20.2 Qacha’s Nek 18.4 18.6 18.2 17.6 18.1 (18.6) 18.2 18.2 20.3 20.4 Mokhotlong 18.8 18.7 19.0 18.6 18.4 (18.3) 18.7 18.7 20.4 20.6 Thaba-Tseka 19.0 18.6 19.5 (18.7) 18.4 (18.2) 18.8 18.7 20.9 21.5 Education No education (16.9) * (16.9) * (17.5) (18.0) 17.6 17.7 20.6 20.8 Primary, incomplete 17.7 17.6 17.9 17.5 17.5 18.0 17.7 17.7 20.1 20.5 Primary, complete 18.5 18.6 18.6 18.8 18.3 18.4 18.5 18.6 20.2 20.4 Secondary+ 19.4 19.2 19.5 19.8 19.7 20.8 19.5 19.6 19.4 20.0 Wealth quintile Lowest 18.0 17.7 18.3 17.6 18.2 17.9 18.0 17.9 20.2 20.5 Second 18.3 18.4 19.2 18.6 18.1 17.9 18.3 18.3 20.3 20.7 Middle 18.8 18.7 18.2 19.0 17.7 18.2 18.5 18.4 20.1 20.5 Fourth 18.9 18.6 18.8 18.9 18.6 18.5 18.8 18.7 20.5 20.8 Highest 19.4 19.3 19.2 19.4 18.9 19.5 19.3 19.2 19.6 20.1 Total 18.7 18.7 18.8 18.9 18.4 18.4 18.7 18.6 20.1 20.5 Note: An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. Figures in parentheses are based on 25-49 unweighted cases. 6.6 RECENT SEXUAL ACTIVITY In the absence of contraception, the chance of becoming pregnant is related to the frequency of sexual intercourse. Thus, the information on sexual activity can be used to refine measures of exposure to pregnancy. Women and men were asked how long ago their last sexual activity occurred. The responses to this question allow for an assessment of recent sexual activity (in the four weeks preceding the survey). Tables 6.7.1 and 6.7.2 show the distribution of women and men, respectively, according to the timing of last sexual activity, by background characteristics. 94 | Other Proximate Determinants of Fertility Table 6.7.1 Recent sexual activity: women Percent distribution of women by timing of last sexual intercourse, according to background characteristics, Lesotho 2004 Timing of last sexual intercourse Background characteristic Within the past 4 weeks Within 1 year1 One or more years Missing Never had sexual intercourse Total Number of women Current age 15-19 11.3 21.6 7.2 2.8 57.1 100.0 1,710 20-24 33.8 37.3 11.5 6.1 11.3 100.0 1,463 25-29 49.2 35.1 8.1 5.2 2.4 100.0 1,044 30-34 54.6 30.3 9.4 5.2 0.6 100.0 816 35-39 49.5 33.6 11.2 5.3 0.3 100.0 728 40-44 48.4 32.6 14.5 3.9 0.6 100.0 741 45-49 49.0 26.6 21.9 2.4 0.2 100.0 592 Marital status Never married 8.4 26.3 13.4 2.4 49.5 100.0 2,373 Married or living together 59.7 30.9 4.1 5.2 0.1 100.0 3,709 Divorced/separated/widowed 23.8 39.9 29.8 6.4 0.0 100.0 1,014 Marital duration2 Married only once 0-4 years 52.7 34.7 4.6 7.8 0.2 100.0 1,005 5-9 years 62.1 28.0 2.8 7.1 0.0 100.0 709 10-14 years 60.8 31.7 4.8 2.7 0.0 100.0 524 15-19 years 64.3 25.9 3.4 6.4 0.0 100.0 469 20-24 years 59.9 31.8 5.5 2.7 0.0 100.0 381 25+ years 65.2 29.3 4.0 1.5 0.0 100.0 516 Married more than once 58.7 36.5 3.4 1.4 0.0 100.0 105 Residence Urban 40.1 29.0 11.9 2.1 16.9 100.0 1,682 Rural 36.6 31.2 10.6 5.2 16.5 100.0 5,413 Ecological zone Lowlands 37.9 30.6 11.5 3.3 16.8 100.0 4,299 Foothills 36.8 29.3 9.3 6.4 18.2 100.0 787 Mountains 37.8 29.5 10.2 6.5 16.0 100.0 1,572 Senqu River Valley 33.1 37.9 10.6 4.5 13.8 100.0 437 District Butha-Buthe 39.5 24.8 9.8 4.8 21.2 100.0 458 Leribe 39.7 30.4 8.7 3.4 17.8 100.0 1,065 Berea 37.0 27.7 11.4 4.7 19.1 100.0 776 Maseru 39.2 30.6 11.0 3.5 15.6 100.0 1,868 Mafeteng 37.6 31.4 11.4 4.6 15.0 100.0 755 Mohale's Hoek 35.2 31.9 13.1 4.2 15.6 100.0 684 Quthing 31.9 39.9 10.9 4.2 13.0 100.0 461 Qacha’s Nek 33.8 34.2 12.0 7.0 13.0 100.0 233 Mokhotlong 39.3 27.5 10.0 4.7 18.5 100.0 360 Thaba-Tseka 32.6 30.2 11.7 8.4 17.1 100.0 435 Education No education 46.2 31.7 12.0 7.3 2.9 100.0 145 Primary, incomplete 37.2 28.7 11.7 5.2 17.3 100.0 2,136 Primary, complete 38.1 33.0 10.6 5.2 13.1 100.0 1,960 Secondary+ 36.7 30.5 10.4 3.2 19.2 100.0 2,854 Current contraceptive method Female sterilisation 58.2 23.8 16.0 2.1 0.0 100.0 148 Pill 64.1 29.8 4.0 2.1 0.0 100.0 499 IUCD 63.7 31.0 4.4 1.0 0.0 100.0 109 Condom 50.1 42.4 5.4 2.1 0.0 100.0 444 Rhythm or periodic abstinence * * * * * * 1 Other method 55.1 33.8 7.2 3.9 0.0 100.0 855 No method 29.5 29.4 12.7 5.1 23.4 100.0 5,037 Wealth quintile Lowest 36.5 30.1 11.9 7.7 13.8 100.0 987 Second 35.6 32.8 11.4 6.0 14.3 100.0 1,294 Middle 35.0 31.4 10.7 4.4 18.4 100.0 1,258 Fourth 37.8 31.7 9.7 3.8 17.0 100.0 1,595 Highest 40.4 28.2 11.0 2.3 18.0 100.0 1,962 Total 37.4 30.6 10.9 4.4 16.6 100.0 7,095 Note: An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. 1 Excludes women who had sexual intercourse within the last 4 weeks 2 Excludes women who are not currently married Other Proximate Determinants of Fertility | 95 Table 6.7.2 Recent sexual activity: men Percent distribution of men by timing of last sexual intercourse, according to background characteristics, Lesotho 2004 Timing of last sexual intercourse Background characteristic Within the past 4 weeks Within 1 year1 One or more years Missing Never had sexual intercourse Total Number of men Current age 15-19 14.5 22.9 8.2 0.0 54.4 100.0 743 20-24 33.6 38.5 13.9 0.0 13.9 100.0 507 25-29 53.8 32.0 10.1 0.4 3.7 100.0 374 30-34 66.4 22.4 7.5 0.2 3.6 100.0 305 35-39 60.5 29.3 8.3 0.5 1.5 100.0 233 40-44 67.9 23.0 8.0 0.0 1.1 100.0 164 45-49 63.0 21.3 15.6 0.0 0.0 100.0 170 50-54 65.9 19.0 14.4 0.0 0.6 100.0 164 55-59 58.2 30.0 11.8 0.0 0.0 100.0 137 Marital status Never married 22.3 29.6 12.2 0.2 35.7 100.0 1,419 Married or living together 70.9 23.4 5.7 0.0 0.0 100.0 1,191 Divorced/separated/widowed 36.1 36.5 27.5 0.0 0.0 100.0 184 Marital duration2 Married only once 0-4 years 63.5 29.8 6.6 0.0 0.0 100.0 276 5-9 years 74.3 23.6 2.1 0.0 0.0 100.0 234 10-14 years 68.9 27.4 3.7 0.0 0.0 100.0 151 15-19 years 69.2 23.6 7.2 0.0 0.0 100.0 146 20-24 years 70.0 18.0 11.9 0.0 0.0 100.0 97 25+ years 74.7 19.1 6.2 0.0 0.0 100.0 221 Married more than once 83.5 12.3 4.3 0.0 0.0 100.0 70 Residence Urban 52.7 25.6 6.9 0.0 14.7 100.0 603 Rural 41.5 28.0 11.4 0.1 19.0 100.0 2,194 Ecological zone Lowlands 44.4 25.6 10.7 0.1 19.2 100.0 1,734 Foothills 41.5 29.4 10.6 0.0 18.5 100.0 307 Mountains 42.7 29.9 10.3 0.2 16.9 100.0 585 Senqu River Valley 47.9 34.8 7.1 0.4 9.8 100.0 171 District Butha-Buthe 39.1 31.6 11.0 0.0 18.2 100.0 182 Leribe 46.5 23.6 10.6 0.0 19.3 100.0 393 Berea 37.6 26.3 14.7 0.0 21.5 100.0 353 Maseru 48.1 27.6 8.9 0.0 15.4 100.0 740 Mafeteng 37.7 24.2 10.4 0.5 27.2 100.0 296 Mohale's Hoek 48.9 27.8 8.5 0.2 14.7 100.0 281 Quthing 49.4 35.4 6.6 0.0 8.5 100.0 167 Qacha’s Nek 42.5 35.3 8.5 0.0 13.6 100.0 102 Mokhotlong 43.7 27.7 9.5 0.0 19.1 100.0 128 Thaba-Tseka 35.6 26.0 16.6 0.7 21.2 100.0 156 Education No education 50.2 29.0 12.1 0.5 8.2 100.0 479 Primary, incomplete 42.6 24.4 9.7 0.0 23.4 100.0 1,194 Primary, complete 42.8 31.1 10.2 0.2 15.7 100.0 352 Secondary+ 42.7 29.6 10.6 0.0 17.1 100.0 773 Wealth quintile Lowest 42.8 30.6 13.1 0.0 13.6 100.0 371 Second 44.0 30.1 9.8 0.3 15.8 100.0 544 Middle 40.4 31.0 9.3 0.0 19.2 100.0 564 Fourth 40.9 24.0 13.6 0.0 21.5 100.0 625 Highest 50.1 24.0 7.5 0.2 18.3 100.0 692 Total 43.9 27.5 10.4 0.1 18.1 100.0 2,797 Note: Total includes 2 men with missing information on marital status. 1 Excludes men who had sexual intercourse within the last 4 weeks 2 Excludes men who are not currently married 96 | Other Proximate Determinants of Fertility Seventeen percent of women age 15-49 and 18 percent of men age 15-59 have never had sexual intercourse. Eleven and 10 percent of women and men, respectively, report that their last sexual encounter occurred more than one year before the survey. About a third of the female respondents (37 percent) and 44 percent of male respondents had a recent sexual encounter (i.e., within 4 weeks preceding the interview). Recent sexual activity is less common among the youngest age group, 15-19: 57 percent of women and 54 percent of men in this age group have never had sex. Recent sexual activity is more common among those who are currently married, with 60 percent of women 15-49 and 71 percent of men having had sex in the four weeks before the survey. Male-female differences are greatest for those who have never married and those formerly married. Among those who have never married, for example, the proportion of males who report a recent sexual encounter is nearly three times that of women (22 and 8 percent, respectively). The proportions reporting recent sexual activity do not differ greatly across most of the other characteristics shown in Table 6.7.1. However, women who report using no contraceptive method are less likely to have had a recent sexual encounter. 6.7 POSTPARTUM AMENORRHOEA, ABSTINENCE, AND INSUSCEPTIBILITY Postpartum amenorrhoea is defined as the period between childbirth and the return of ovula- tion, generally approximated by the resumption of menstruation following childbirth. This period is largely determined by the duration and intensity of breastfeeding. The risk of conception in this period is very low. The duration of postpartum amenor- rhoea and the period of sexual abstinence fol- lowing birth jointly determine the length of the insusceptibility period. Thus, women are consid- ered insusceptible if they are abstaining from sex following childbirth or are amenorrhoeic. Women who gave birth three years pre- ceding the survey were asked about the duration of their periods of amenorrhoea and sexual abstinence following each birth. The results are presented in Table 6.8. All women are insusceptible to pregnancy within the first two months following childbirth. At 6 to 7 months after birth, nearly 60 percent of all women are still amenorrhoeic and abstaining. After about one year, the proportion amenorrhoeic drops steadily, and after 24 to 25 months following childbirth, less than 10 percent are amenorrhoeic. The proportion abstaining also drops steadily after about one year, but the decline is less rapid than observed for the proportion amenorrhoeic. For example, at 18 to 19 months following childbirth, 29 percent are still abstaining compared with 19 percent who are still amenorrhoeic. Table 6.8 Postpartum amenorrhoea, abstinence, and insuscepti- bility Percentage of births in the three years preceding the survey for which mothers are postpartum amenorrhoeic, abstaining, and insusceptible, by number of months since birth, and median and mean durations, Lesotho 2004 Percentage of births for which the mother is: Months since birth Amenorrhoeic Abstaining Insusceptible Number of births < 2 89.8 97.5 100.0 113 2-3 72.9 88.2 94.8 155 4-5 73.8 77.4 92.5 138 6-7 58.5 58.1 75.2 117 8-9 45.1 59.8 71.7 117 10-11 43.8 53.0 70.4 140 12-13 33.4 46.0 66.3 142 14-15 28.4 37.7 52.1 152 16-17 17.7 30.0 38.2 124 18-19 19.1 28.5 40.3 115 20-21 7.8 28.6 35.2 106 22-23 11.7 17.4 22.9 92 24-25 7.6 17.6 19.4 117 26-27 3.7 19.5 21.6 134 28-29 6.4 12.4 17.3 122 30-31 5.5 3.5 7.4 92 32-33 4.7 9.7 13.6 104 34-35 0.2 9.6 9.8 120 Total 31.1 40.5 49.5 2,201 Median 8.3 11.2 15.2 na Mean 10.9 14.2 17.2 na Note: Estimates are based on status at the time of the survey. na = Not applicable Other Proximate Determinants of Fertility | 97 Thus, the principal determinant of the length of the period of insusceptibility in Lesotho is postpartum abstinence. The median duration of abstinence is 11.2 months; of amenorrhea, 8.3 months; and insusceptibility, 15.2 months. Table 6.9 shows the median durations of postpartum amenorrhoea, abstinence, and insusceptibility by background characteristics of the respondents. Older women (age 30 and over) have a slightly longer median period of insusceptibility, mainly because of the longer duration of postpartum amenorrhoea. Variations in the length of postpartum insusceptibility across other background character- istics are not large. Table 6.9 Median duration of postpartum insusceptibility by background characteristics Median number of months of postpartum amenorrhoea, postpartum abstinence, and postpartum insusceptibility following births in the three years preceding the survey, by background characteristics, Lesotho 2004 Background characteristic Postpartum amenorrhoea Postpartum abstinence Postpartum insusceptibility Number of births Mother’s age 15-29 7.8 11.6 14.8 1,480 30-49 12.2 10.2 15.7 722 Residence Urban 12.5 7.7 15.0 307 Rural 8.2 11.8 15.2 1,894 Ecological zone Lowlands 7.1 11.1 15.3 1,092 Foothills 7.4 9.9 14.0 287 Mountains 9.5 11.4 15.5 673 Senqu River Valley 11.4 12.4 13.7 148 District Butha-Buthe 8.5 10.4 13.6 130 Leribe 6.2 6.5 14.0 342 Berea 8.5 13.9 17.5 252 Maseru 7.9 10.5 14.6 439 Mafeteng 7.0 7.2 15.2 218 Mohale's Hoek 10.6 13.4 15.4 224 Quthing 10.9 10.0 13.9 162 Qacha’s Nek 7.7 10.6 11.0 87 Mokhotlong 9.1 11.2 17.3 154 Thaba-Tseka 10.7 15.8 16.3 194 Education No education 10.2 8.3 11.0 54 Primary, incomplete 9.2 13.2 17.1 673 Primary, complete 9.8 10.3 15.0 694 Secondary+ 6.4 10.8 15.0 780 Wealth quintile Lowest 10.6 13.6 15.8 451 Second 9.0 11.1 16.6 517 Middle 8.4 10.1 14.9 398 Fourth 7.2 12.6 15.3 469 Highest 5.9 6.0 7.6 366 Total 8.3 11.2 15.2 2,201 Note: Medians are based on current status. 98 | Other Proximate Determinants of Fertility 6.8 TERMINATION OF EXPOSURE TO PREGNANCY While the onset of infecundity is difficult to determine for an individual woman, there are ways of estimating it for a given population. One indicator of infecundity is the onset of menopause. Menopausal women are defined by the 2004 LDHS as women who are neither pregnant nor postpartum amenorrhoeic, but who have not had a menstrual period in the six months before the survey. The prevalence of menopause increases with age, typically from around age 30. Table 6.10 presents the indicator for women age 30-49, which ranges from 5 percent for women age 30-34 to 46 percent for women age 48-49. Table 6.10 Menopause Percentage of women age 30-49 who are menopausal, by age, Lesotho 2004 Age Percentage menopausal1 Number of women 30-34 4.5 816 35-39 5.4 728 40-41 4.5 323 42-43 11.2 259 44-45 12.9 288 46-47 23.3 259 48-49 45.9 203 Total 10.8 2,878 1 Percentage of all women who are not pregnant and not postpartum amenor- rhoeic whose last menstrual period occurred six or more months preceding the survey Fertility Preferences | 99 FERTILITY PREFERENCES 7 The need for contraception is assessed by whether or not respondents want another child, their preferred interval between children, and the number of children they consider ideal. Therefore, in the 2004 LDHS, women and men were asked a series of questions to ascertain fertility preferences. These data are used in this chapter to quantify fertility preferences and, in combination with data on contra- ceptive use, to permit estimation of unmet need for family planning, both to space and limit births. 7.1 DESIRE FOR MORE CHILDREN To obtain information on the desire for more children at the time of the survey, women and men in the 2004 LDHS sample were asked, “Would you like to have (a/another) child or would you prefer not to have any (more) children?” Respondents who mentioned that they would like to have more children were asked, “How long would you like to wait from now before the birth of (a/another) child?” Responses to these questions are presented in Table 7.1 by the number of living children for both married women and men. Table 7.1 Fertility preferences by number of living children Percent distribution of currently married women and currently married men by desire for children, according to number of living children, Lesotho 2004 Number of living children1 Desire for children 0 1 2 3 4 5 6+ Total WOMEN Have another soon2 83.0 22.3 15.5 6.3 3.0 6.3 2.9 17.4 Have another later3 8.4 50.5 31.0 19.7 8.0 7.2 2.7 25.8 Have another, undecided when 2.2 0.6 0.7 0.7 0.4 0.1 0.2 0.6 Undecided 0.2 1.5 0.9 0.4 1.6 1.0 0.2 0.9 Want no more 5.8 23.9 50.0 67.7 79.1 76.9 86.3 51.4 Sterilised4 0.0 0.4 0.9 4.6 6.4 6.0 5.7 2.7 Declared infecund 0.5 0.8 0.6 0.5 1.3 2.5 1.5 0.9 Missing 0.0 0.0 0.4 0.2 0.2 0.0 0.4 0.2 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number of women 267 980 822 619 393 282 346 3,709 MEN Have another soon2 65.1 23.2 21.7 19.5 11.6 9.8 6.5 22.2 Have another later3 27.6 51.3 32.2 17.8 14.5 14.3 5.0 27.4 Have another, undecided when 2.0 1.4 1.2 0.4 3.4 1.0 0.6 1.3 Undecided 1.8 4.0 2.2 1.7 3.6 0.0 1.3 2.4 Want no more 3.1 18.9 42.7 57.6 66.8 73.9 85.4 45.8 Declared infecund 0.0 0.0 0.0 2.6 0.0 0.0 1.2 0.6 Missing 0.4 1.1 0.0 0.3 0.0 0.9 0.0 0.4 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number of men 116 267 267 191 120 81 148 1,191 1 Includes current pregnancy 2 Wants next birth within 2 years 3 Wants to delay next birth for 2 or more years 4 Includes both female and male sterilisation 100 | Fertility Preferences Figure 7.1 Fertility Preferences of Currently Married Women Age 15-49 LDHS 2004 Want another soon (within 2 years) 17% Sterilised 3% Declared infecund 1% Want no more 51% Want another later (2 or more years) 26% Undecided 1% Want another, undecided when 1% More than half of married women (54 percent) either do not want a/nother child or are sterilised. Almost all of the remaining women want another child, with only 1 percent indicating that they are undecided about whether to have a child (Figure 7.1). Among the women wanting a child, the majority— 26 percent of all women—want to wait at least two years before having a child. Fertility preferences among married men show a similar pattern, although the percentage of men who do not want any more children is lower (46 percent) than among women (51 percent), and the proportion who would like to have another child is higher (51 percent for men compared with 44 percent for women). Surprisingly, 6 percent of childless women and 3 percent of men do not want to have any children. About one-fourth of women and one-fifth of men with one living child say they do not want more children. The proportions desiring to limit childbearing continue to increase with family size, peaking among women and men with six or more children at 86 and 85 percent, respectively. The desire to limit childbearing is shown by background characteristic in Table 7.2. The variation across residential categories shows that married women living in rural areas are almost as likely as urban women to prefer to limit childbearing, though they prefer to do so at higher family sizes than urban women. Variations in the desire for more children by ecological zone and district are also comparatively small for women. The proportions wanting no more children are near or exceed the national average in all zones except Mountains (47 percent) and in all districts except Qacha’s Nek (45 percent), Mokhotlong (44 percent), and Thaba-Tseka (46 percent). There is more residential variation observed in the desire to limit childbearing among men than among women. The proportion wanting no more children is lower among urban men (42 percent) than among rural men (47 percent). The proportion also varies more markedly by ecological zone and district among men than women. Fertility Preferences | 101 Table 7.2 Desire to limit childbearing Percentage of currently married women and men who want no more children, by number of living children (women) and background characteristics, Lesotho 2004 Number of living children1 Background characteristic 0 1 2 3 4 5 6+ All women All men Residence Urban 7.7 28.1 62.4 91.0 90.3 84.2 98.6 54.5 41.9 Rural 5.0 23.0 47.4 67.4 84.8 82.8 91.6 54.0 47.0 Ecological zone Lowlands 6.6 27.2 52.9 79.4 89.0 82.8 96.2 56.3 49.3 Foothills 3.4 25.9 50.0 59.0 91.2 96.1 95.7 56.2 43.2 Mountains 6.3 15.7 44.2 59.4 74.9 76.0 82.4 47.1 36.7 Senqu River Valley 0.0 24.8 61.4 72.4 86.7 87.8 100.0 59.7 55.7 District Butha-Buthe 8.5 21.0 45.2 69.5 90.8 93.5 100.0 54.0 57.1 Leribe 5.2 21.7 55.2 67.8 76.1 88.6 98.4 53.7 56.2 Berea 0.0 22.9 37.0 81.6 84.5 81.8 96.0 55.0 39.4 Maseru 8.9 30.7 61.0 76.9 94.6 89.0 89.8 57.9 41.0 Mafeteng 5.9 30.0 54.2 80.5 89.6 76.9 94.6 57.8 51.5 Mohale's Hoek 3.3 25.0 50.5 62.8 89.8 83.9 90.7 54.6 51.2 Quthing 7.4 24.9 60.9 69.5 74.8 83.1 91.7 55.2 46.4 Qacha's Nek 2.3 15.4 35.5 68.0 67.3 80.8 80.0 44.6 44.9 Mokhotlong 0.9 12.8 37.5 58.5 68.9 81.0 76.4 43.8 35.0 Thaba-Tseka 6.7 11.0 37.6 65.1 78.6 55.8 89.3 45.5 37.2 Education No education 0.0 6.6 58.9 51.3 78.9 60.4 78.0 49.4 40.4 Primary, incomplete 9.9 23.6 39.9 65.7 78.2 79.9 89.6 54.4 53.9 Primary, complete 3.4 21.8 50.4 71.2 87.5 89.1 95.9 55.1 32.8 Secondary+ 3.9 27.0 58.8 79.5 91.6 84.3 97.3 53.4 43.6 Wealth quintile Lowest 3.4 16.9 45.4 53.7 76.5 81.5 82.4 47.2 37.2 Second 4.5 22.6 47.5 72.3 75.7 73.3 91.5 53.3 46.5 Middle 8.0 21.7 52.8 64.2 89.5 86.3 92.9 53.8 46.5 Fourth 6.7 27.6 42.8 76.0 90.9 84.4 99.8 53.7 43.4 Highest 5.7 27.9 60.5 82.4 90.4 88.0 93.3 59.7 52.3 Total 5.8 24.3 50.9 72.3 85.5 82.9 92.1 54.1 45.8 Note: Women who have been sterilised are considered to want no more children. 1 Includes current pregnancy The desire to limit childbearing generally increases with education for women but does not show a clear pattern for men. The differences in the desire to limit childbearing by education are more pronounced among men than among women. For example, the proportion of men who want no more children varies markedly from 33 percent among those who have completed primary education to 54 per- cent among men who have attended but not completed primary education. A significant difference is observed between women and men who completed primary education (55 percent for women compared with 33 percent for men). The desire to limit childbearing generally increases with increasing wealth index, from 47 percent among women in the lowest wealth quintile to 60 percent among those in the highest quintile. 102 | Fertility Preferences 7.2 NEED FOR FAMILY PLANNING SERVICES Women who are currently married and who say that either they do not want any more children or that they want to wait two or more years before having another child, but are not using contraception, are considered to have an unmet need for family planning. Women who are using family planning methods are said to have a met need for family planning. Women with unmet need and met need constitute the total demand for family planning. Table 7.3 presents information for currently married women on unmet need, met need, and total demand for family planning, according to whether the need is for spacing or limiting births. Almost one-third of currently married women in Lesotho have an unmet need for family planning, 11 percent for spacing and 20 percent for limiting childbearing. Taking into account the 37 per- cent of currently married women using contraceptives, the total demand for family planning comprises two-thirds of married women in Lesotho. Thus, if all women who want to space or limit childbearing were to use family planning methods, the contraceptive prevalence rate in Lesotho could increase from the current level of 37 percent (Chapter 5) to about 68 percent. The data in this table, however, show that only 55 percent of this total demand among married women is satisfied. Unmet need for spacing declines with age from a peak of 24 percent at age 15-19 to a low of 1 percent at age 45-49, while unmet need for limiting increases with age except for women age 45-49. Unmet need for family planning is higher in rural (34 percent) than urban (20 percent) areas. By ecological zone, it ranges from a low of 25 percent in the Lowlands to a high of 41 percent in the Mountains. Mafeteng district (22 percent) has the lowest level of unmet need and Mokhotlong, the highest level (45 percent). The proportion in need of family planning declines with educational level. Both total demand for family planning and the proportion of total demand that is satisfied are also associated with demographic and socioeconomic indicators. Demand generally increases with age, reaching a peak of 76 percent in the 30-39 age group. It exceeds 70 percent in the Lowlands and Senqu River Valley zones, Leribe, Butha-Buthe, and Mafeteng districts, and among women with secondary education and the highest wealth quintile. The proportion of the total demand that is satisfied is lowest for women age 15-19 (30 percent), women in Mokhotlong (26 percent), and among the small number of women with no education (16 percent). Fertility Preferences | 103 Table 7.3 Need for family planning among currently married women Percentage of currently married women with unmet need for family planning, with met need for family planning, and the total demand for family planning, by background characteristics, Lesotho 2004 Unmet need for family planning1 Met need for family planning (currently using)2 Total demand for family planning3 Background characteristic For spacing For limiting Total For spacing For limiting Total For spacing For limiting Total Percentage of demand satisfied Number of women Age 15-19 23.6 11.5 35.1 10.2 4.5 14.7 33.8 16.0 49.8 29.6 293 20-24 20.3 10.9 31.1 21.0 13.1 34.1 41.3 23.9 65.2 52.2 779 25-29 11.8 17.5 29.3 21.0 21.7 42.7 32.8 39.2 71.9 59.3 700 30-34 9.0 17.6 26.6 19.2 30.3 49.5 28.2 47.9 76.1 65.1 593 35-39 5.6 28.0 33.6 8.1 34.4 42.5 13.7 62.4 76.1 55.9 484 40-44 3.0 32.6 35.5 3.5 33.6 37.1 6.5 66.2 72.7 51.1 478 45-49 0.5 27.5 28.0 0.8 25.3 26.1 1.2 52.8 54.1 48.2 383 Residence Urban 5.2 14.3 19.6 17.1 32.8 49.9 22.4 47.2 69.5 71.9 738 Rural 12.4 21.4 33.8 13.0 21.1 34.2 25.4 42.6 67.9 50.3 2,970 Ecological zone Lowlands 7.6 17.7 25.3 17.0 28.7 45.7 24.6 46.4 71.0 64.4 2,132 Foothills 11.8 22.4 34.2 11.0 20.6 31.6 22.8 43.0 65.8 48.0 456 Mountains 17.9 23.1 41.0 9.0 12.6 21.5 26.8 35.7 62.5 34.4 929 Senqu River Valley 12.2 25.0 37.2 9.2 24.7 33.9 21.4 49.7 71.1 47.7 191 District Butha-Buthe 9.2 15.5 24.8 18.5 26.9 45.4 27.7 42.4 70.1 64.7 250 Leribe 11.3 19.7 31.0 18.5 24.0 42.5 29.8 43.7 73.5 57.8 579 Berea 13.3 20.6 33.9 12.6 21.6 34.2 25.8 42.3 68.1 50.2 419 Maseru 6.3 20.6 27.0 13.4 26.8 40.2 19.7 47.4 67.1 59.9 903 Mafeteng 6.6 15.1 21.7 17.3 32.1 49.4 24.0 47.1 71.1 69.4 414 Mohale's Hoek 9.4 19.5 28.9 15.2 24.3 39.5 24.6 43.8 68.4 57.7 349 Quthing 12.7 26.2 38.9 7.8 21.2 29.0 20.4 47.4 67.8 42.7 215 Qacha's Nek 18.6 19.3 37.8 6.3 17.0 23.2 24.8 36.2 61.0 38.0 119 Mokhotlong 22.0 23.1 45.1 6.7 8.7 15.4 28.7 31.8 60.5 25.5 203 Thaba-Tseka 19.4 22.9 42.4 9.1 12.0 21.1 28.5 34.9 63.5 33.2 257 Education No education 17.8 29.5 47.3 3.3 6.0 9.3 21.1 35.5 56.6 16.4 86 Primary, incomplete 12.8 23.3 36.1 9.6 17.2 26.8 22.4 40.5 63.0 42.6 1,154 Primary, complete 11.4 20.1 31.5 13.0 23.3 36.3 24.4 43.4 67.8 53.5 1,150 Secondary+ 8.4 16.4 24.8 18.9 30.3 49.2 27.4 46.6 74.0 66.5 1,319 Wealth quintile Lowest 18.7 24.7 43.4 7.5 10.1 17.6 26.2 34.8 61.0 28.8 574 Second 15.5 24.1 39.5 10.1 16.1 26.2 25.5 40.2 65.7 39.9 709 Middle 9.6 20.8 30.4 16.7 20.9 37.6 26.2 41.7 68.0 55.3 648 Fourth 10.3 18.0 28.2 14.5 26.4 41.0 24.8 44.4 69.2 59.2 854 Highest 4.2 15.3 19.4 18.0 36.5 54.5 22.2 51.7 73.9 73.7 923 Total 10.9 20.0 30.9 13.8 23.5 37.3 24.8 43.5 68.2 54.7 3,709 1 Unmet need for spacing includes pregnant women whose pregnancy was mistimed, amenorrhoeic women who are not using family planning and whose last birth was mistimed, and fecund women who are neither pregnant nor amenorrhoeic and who are not using any method of family planning and say they want to wait two or more years for their next birth. Also included in unmet need for spacing are fecund women who are not using any method of family planning and say they are unsure whether they want another child or who want another child but are unsure when to have the birth unless they say it would not be a problem if they discovered they were pregnant in the next few weeks. Unmet need for limiting refers to pregnant women whose pregnancy was unwanted, amenorrhoeic women whose last child was unwanted, and fecund women who are neither pregnant nor amenorrhoeic and who are not using any method of family planning and who want no more children. Excluded from the unmet need category are pregnant and amenorrhoeic women who became pregnant while using a method (these women are in need of a better method of contraception). 2 Using for spacing is defined as women who are using some method of family planning and say they want to have another child or are undecided whether to have another. Using for limiting is defined as women who are using and who want no more children. Note that the specific methods used are not taken into account here. 3 Nonusers who are pregnant or amenorrhoeic and women whose pregnancy was the result of a contraceptive failure are not included in the category of unmet need, but are included in total demand for contraception (since they would have been using had their method not failed). 104 | Fertility Preferences Tables 7.4.1 and 7.4.2 present information for all women and women who are not currently married on unmet need, met need, and total demand for family planning, according to whether the need is for spacing or limiting births. Eighteen percent of all women in Lesotho have an unmet need for family planning, 6 percent for spacing and 12 percent for limiting childbearing. The data also show 47 percent of all women in Lesotho have a demand for family planning. However, only 61 percent of this total demand is satisfied. The unmet need for spacing declines with age from a peak of 12 percent at age 20-24 to a low of less than 1 percent at age 45-49, while unmet need for limiting generally increases with age. Unmet need for family planning is higher in rural (21 percent) than urban (10 percent) areas. By ecological zone, it ranges from a low of 15 percent in the Lowlands to a high of 26 percent in the Mountains. Mafeteng district (14 percent) has the lowest level of unmet need and Mokhotlong the highest level (29 percent). Unmet need for family planning decreases with increasing educational attainment and wealth index. Both the total demand for family planning and the proportion of the total demand that is satisfied also are associated with demographic and socioeconomic indicators. Demand generally increases with age, reaching a peak of 68 percent in the 30-34 age group. Demand for family planning does not vary significantly by ecological zone and district. However, it is correlated with education and wealth status: demand increases with education and increasing wealth. Among women who are not currently married, 4 percent have an unmet need for family planning, 82 percent have a met need for family planning, and the total demand for family planning is 24 percent. Variations by background characteristics show patterns that are similar to those for all women. Fertility Preferences | 105 Table 7.4.1 Need for family planning among all women Percentage of all women with unmet need for family planning, with met need for family planning, and the total demand for family planning, by background characteristics, Lesotho 2004 Unmet need for family planning1 Met need for family planning (currently using)2 Total demand for family planning3 Background characteristic For spacing For limiting Total For spacing For limiting Total For spacing For limiting Total Percentage of demand satisfied Number of women Age 15-19 5.3 2.5 7.8 6.4 2.5 8.9 11.7 5.0 16.7 53.3 1,710 20-24 11.5 6.6 18.1 17.5 12.1 29.5 29.0 18.7 47.6 62.0 1,463 25-29 8.4 12.9 21.3 19.6 22.6 42.2 28.0 35.5 63.5 66.4 1,044 30-34 7.0 14.4 21.4 16.5 29.9 46.4 23.5 44.4 67.9 68.4 816 35-39 4.0 21.0 25.0 7.0 31.5 38.5 11.0 52.5 63.5 60.7 728 40-44 2.1 24.3 26.5 2.6 30.0 32.6 4.7 54.3 59.1 55.2 741 45-49 0.3 20.1 20.4 0.5 21.8 22.3 0.8 41.9 42.7 52.2 592 Residence Urban 2.7 7.4 10.1 15.6 23.6 39.2 18.3 31.0 49.3 79.5 1,682 Rural 7.5 13.3 20.8 9.5 16.3 25.8 17.0 29.6 46.6 55.4 5,413 Ecological zone Lowlands 4.4 10.2 14.6 12.9 21.3 34.2 17.4 31.5 48.8 70.1 4,299 Foothills 7.2 14.6 21.8 7.6 15.4 23.0 14.8 29.9 44.8 51.3 787 Mountains 11.3 14.9 26.2 7.3 11.0 18.3 18.6 25.9 44.5 41.1 1,572 Senqu River Valley 5.9 13.3 19.2 10.7 16.0 26.8 16.7 29.3 46.0 58.3 437 District Butha-Buthe 5.9 9.4 15.3 11.8 19.4 31.1 17.7 28.7 46.4 67.0 458 Leribe 7.0 11.7 18.6 12.8 17.3 30.1 19.8 28.9 48.7 61.8 1,065 Berea 7.5 12.2 19.7 9.4 16.0 25.4 16.8 28.2 45.1 56.3 776 Maseru 3.5 11.8 15.3 12.1 21.0 33.1 15.6 32.8 48.4 68.5 1,868 Mafeteng 4.2 10.2 14.4 12.9 24.5 37.4 17.1 34.6 51.8 72.2 755 Mohale's Hoek 6.0 11.0 17.0 11.4 19.2 30.6 17.4 30.2 47.6 64.3 684 Quthing 6.7 14.2 21.0 9.7 14.5 24.2 16.4 28.7 45.2 53.6 461 Qacha's Nek 10.0 10.7 20.7 9.3 15.0 24.4 19.3 25.8 45.1 54.1 233 Mokhotlong 13.5 15.1 28.6 4.4 7.7 12.1 17.9 22.8 40.7 29.7 360 Thaba-Tseka 11.7 14.9 26.6 7.0 10.4 17.4 18.7 25.3 43.9 39.5 435 Education No education 12.0 21.7 33.7 3.6 5.7 9.3 15.6 27.4 42.9 21.6 145 Primary, incomplete 7.8 14.1 21.9 6.9 13.4 20.3 14.7 27.5 42.2 48.1 2,136 Primary, complete 7.1 13.4 20.4 9.8 19.5 29.2 16.8 32.8 49.7 58.9 1,960 Secondary+ 4.5 8.7 13.2 15.2 21.2 36.4 19.7 29.9 49.6 73.3 2,854 Wealth quintile Lowest 11.3 16.7 28.1 5.9 9.2 15.0 17.2 25.9 43.1 34.9 987 Second 9.4 14.6 24.0 7.2 13.1 20.4 16.6 27.7 44.4 45.9 1,294 Middle 6.1 12.3 18.4 10.8 15.6 26.4 16.9 27.9 44.8 59.0 1,258 Fourth 5.9 10.9 16.8 11.8 20.5 32.3 17.7 31.3 49.1 65.7 1,595 Highest 2.3 8.3 10.6 15.4 25.3 40.7 17.8 33.6 51.3 79.4 1,962 Total 6.3 11.9 18.2 11.0 18.0 29.0 17.3 29.9 47.3 61.4 7,095 1 Unmet need for spacing includes pregnant women whose pregnancy was mistimed, amenorrhoeic women who are not using family planning and whose last birth was mistimed, and fecund women who are neither pregnant nor amenorrhoeic and who are not using any method of family planning and say they want to wait two or more years for their next birth. Also included in unmet need for spacing are fecund women who are not using any method of family planning and say they are unsure whether they want another child or who want another child but are unsure when to have the birth unless they say it would not be a problem if they discovered they were pregnant in the next few weeks. Unmet need for limiting refers to pregnant women whose pregnancy was unwanted, amenorrhoeic women whose last child was unwanted, and fecund women who are neither pregnant nor amenorrhoeic and who are not using any method of family planning and who want no more children. Excluded from the unmet need category are pregnant and amenorrhoeic women who became pregnant while using a method (these women are in need of a better method of contraception). Also excluded from the unmet need category for the all women panel are unmarried women who did not have sexual intercourse in the four weeks preceding the survey. 2 Using for spacing is defined as women who are using some method of family planning and say they want to have another child or are undecided whether to have another. Using for limiting is defined as women who are using and who want no more children. Note that the specific methods used are not taken into account here. 3 Nonusers who are pregnant or amenorrhoeic and women whose pregnancy was the result of a contraceptive failure are not included in the category of unmet need, but are included in total demand for contraception (since they would have been using had their method not failed). 106 | Fertility Preferences Table 7.4.2 Need for family planning among women who are not currently married Percentage of women who are not currently married with unmet need for family planning, with met need for family planning, and the total demand for family planning, by background characteristics, Lesotho 2004 Unmet need for family planning1 Met need for family planning (currently using)2 Total demand for family planning3 Background characteristic For spacing For limiting Total For spacing For limiting Total For spacing For limiting Total Percentage of demand satisfied Number of women Age 15-19 1.6 0.6 2.2 5.6 2.1 7.7 7.2 2.7 9.9 78.0 1,417 20-24 1.5 1.7 3.2 13.5 10.9 24.4 15.0 12.6 27.6 88.2 684 25-29 1.4 3.7 5.1 16.8 24.4 41.1 18.2 28.1 46.2 88.9 344 30-34 1.9 6.0 7.9 9.4 29.0 38.3 11.3 35.0 46.2 82.9 224 35-39 0.7 7.1 7.9 4.9 25.7 30.6 5.7 32.8 38.5 79.6 244 40-44 0.6 9.4 10.0 1.0 23.5 24.5 1.6 32.8 34.4 71.0 264 45-49 0.0 6.6 6.6 0.0 15.4 15.4 0.0 22.0 22.0 70.0 209 Residence Urban 0.7 2.0 2.7 14.4 16.4 30.8 15.1 18.3 33.4 92.1 944 Rural 1.6 3.4 5.0 5.3 10.4 15.7 6.9 13.9 20.7 75.8 2,442 Ecological zone Lowlands 1.3 2.8 4.1 9.0 14.0 23.0 10.2 16.8 27.1 85.0 2,167 Foothills 0.9 3.8 4.7 2.9 8.2 11.1 3.8 12.0 15.8 70.0 331 Mountains 1.7 3.1 4.9 5.0 8.6 13.6 6.8 11.8 18.5 73.7 643 Senqu River Valley 1.0 4.0 5.1 11.9 9.3 21.2 13.0 13.3 26.3 80.6 245 District Butha-Buthe 1.9 2.0 4.0 3.7 10.3 14.0 5.6 12.4 18.0 77.9 208 Leribe 1.8 2.1 3.8 6.1 9.2 15.3 7.9 11.3 19.2 79.9 486 Berea 0.7 2.3 3.0 5.6 9.5 15.1 6.3 11.8 18.1 83.4 357 Maseru 0.8 3.5 4.3 11.0 15.6 26.5 11.8 19.1 30.9 86.0 965 Mafeteng 1.3 4.2 5.5 7.5 15.2 22.7 8.8 19.4 28.2 80.6 340 Mohale's Hoek 2.4 2.1 4.5 7.5 13.9 21.4 9.9 16.0 25.9 82.6 335 Quthing 1.6 3.8 5.4 11.3 8.7 20.0 12.9 12.5 25.4 78.8 246 Qacha's Nek 1.0 1.9 2.8 12.5 13.0 25.6 13.5 14.9 28.4 90.0 114 Mokhotlong 2.3 4.8 7.1 1.4 6.3 7.7 3.8 11.1 14.9 52.0 156 Thaba-Tseka 0.6 3.2 3.8 3.9 8.2 12.0 4.5 11.3 15.8 76.1 178 Education No education 3.4 10.4 13.8 4.1 5.1 9.2 7.5 15.6 23.0 39.9 59 Primary, incomplete 1.9 3.3 5.2 3.7 9.0 12.6 5.6 12.3 17.9 70.7 982 Primary, complete 0.9 3.8 4.7 5.2 14.0 19.2 6.1 17.8 24.0 80.3 810 Secondary+ 1.1 2.1 3.3 12.0 13.4 25.4 13.1 15.5 28.6 88.6 1,534 Wealth quintile Lowest 1.0 5.7 6.7 3.6 7.9 11.5 4.6 13.5 18.2 63.2 412 Second 2.1 3.1 5.2 3.8 9.5 13.3 5.8 12.6 18.4 72.0 585 Middle 2.3 3.3 5.6 4.6 10.0 14.6 7.0 13.3 20.3 72.2 610 Fourth 0.9 2.7 3.6 8.7 13.5 22.2 9.6 16.2 25.8 86.0 741 Highest 0.7 2.0 2.8 13.1 15.4 28.5 13.8 17.4 31.2 91.2 1,038 Total 1.3 3.0 4.4 7.8 12.1 19.9 9.2 15.1 24.3 82.0 3,386 1 Unmet need for spacing includes pregnant women whose pregnancy was mistimed, amenorrhoeic women who are not using family planning and whose last birth was mistimed, and fecund women who are neither pregnant nor amenorrhoeic and who are not using any method of family planning and say they want to wait two or more years for their next birth. Also included in unmet need for spacing are fecund women who are not using any method of family planning and say they are unsure whether they want another child or who want another child but are unsure when to have the birth unless they say it would not be a problem if they discovered they were pregnant in the next few weeks. Unmet need for limiting refers to pregnant women whose pregnancy was unwanted, amenorrhoeic women whose last child was unwanted, and fecund women who are neither pregnant nor amenorrhoeic and who are not using any method of family planning and who want no more children. Excluded from the unmet need category are pregnant and amenorrhoeic women who became pregnant while using a method (these women are in need of a better method of contraception). Also excluded from the unmet need category for the all women panel are unmarried women who did not have sexual intercourse in the four weeks preceding the survey. 2 Using for spacing is defined as women who are using some method of family planning and say they want to have another child or are undecided whether to have another. Using for limiting is defined as women who are using and who want no more children. Note that the specific methods used are not taken into account here. 3 Nonusers who are pregnant or amenorrhoeic and women whose pregnancy was the result of a contraceptive failure are not included in the category of unmet need, but are included in total demand for contraception (since they would have been using had their method not failed). Fertility Preferences | 107 7.3 IDEAL FAMILY SIZE Women and men who were interviewed in the 2004 LDHS were asked two questions for determining ideal family size. Respondents who did not have any living children were asked, “If you could choose exactly the number of children to have in your lifetime, how many would that be?” For respondents who had living children, the question was rephrased as follows, “If you could go back to the time you did not have any children and could choose exactly the number of children to have in your lifetime, how many would that be?” The results are presented in Table 7.5 for both women and men. Table 7.5 Ideal number of children Percent distribution of all women and all men by ideal number of children, and mean ideal number of children for all women and all men and for currently married women and currently married men, according to number of living children, Lesotho 2004 Number of living children1 Desire for children 0 1 2 3 4 5 6+ Total WOMEN 0 7.1 1.4 0.8 0.5 2.1 1.5 2.4 3.1 1 10.8 13.3 5.5 4.3 2.9 1.8 1.5 8.0 2 48.3 36.8 29.1 22.3 24.3 19.7 11.0 33.9 3 20.3 25.9 19.9 18.6 11.6 15.6 15.6 20.0 4 9.1 15.5 33.5 35.4 34.0 31.2 36.1 22.3 5 2.9 3.4 5.3 8.9 7.0 11.4 8.0 5.2 6+ 1.4 3.4 5.5 9.7 17.6 18.0 24.4 7.1 Non-numeric responses 0.2 0.3 0.4 0.2 0.6 0.8 1.1 0.4 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number of respondents 2,210 1,526 1,147 842 532 392 447 7,095 Mean ideal number children for:2 All women 2.3 2.7 3.2 3.5 3.8 4.1 4.3 3.0 Number 2,206 1,521 1,142 840 529 389 442 7,069 Currently married women 3.1 2.9 3.4 3.6 3.8 4.2 4.3 3.5 Number 267 980 820 617 392 282 344 3,701 MEN 0 3.1 0.0 0.8 0.0 0.0 1.7 0.0 1.9 1 4.6 8.1 1.4 2.1 0.0 1.9 1.7 3.9 2 33.3 31.2 25.2 12.5 13.3 11.0 5.3 27.3 3 24.2 25.4 16.4 20.0 6.5 9.1 12.1 21.1 4 19.8 16.3 35.9 33.8 31.4 7.2 19.7 22.5 5 10.0 9.2 12.0 11.7 15.2 17.4 12.6 10.9 6+ 4.7 9.0 6.9 18.3 32.5 49.4 46.0 11.6 Non-numeric responses 0.4 0.7 1.6 1.5 0.9 2.3 2.6 0.8 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number of respondents 1,561 321 313 213 146 86 156 2,797 Mean ideal number children for:2 All men 3.1 3.3 3.7 4.2 5.0 5.4 5.9 3.6 Number 1,556 319 308 210 144 84 152 2,773 Currently married men 3.3 3.3 3.5 4.2 4.8 5.3 5.9 4.1 Number 116 266 263 189 120 79 144 1,178 1 Includes current pregnancy 2 Means are calculated excluding those giving non-numeric responses 108 | Fertility Preferences Almost all women and men gave a numeric response: and less than 1 percent of women and men failed to give a numeric response. Among women, the mean ideal family size is 3.0 children. The average ideal family size as reported by men (3.6 children) is higher than for women. The ideal number of children increases with the number of living children. Women with six or more living children have an ideal family size of 4.3, compared with 2.3 for those with no children. Among men, ideal family size ranges from 3.1 for those without a child to 5.9 for men with six or more living children. This pattern could be attributed to either those with smaller family sizes tending to achieve these desired small families or to “adjustments” of ideal number of children as the actual number increased (rationalisation). However, despite the likelihood of rationalisation, considerable proportions of women and men report ideal family sizes that are smaller than their actual family sizes. For example, around three-quarters of women and half of men with six or more living children report ideal family sizes of less than six children. Table 7.6 presents data on the mean ideal number of children for all women and men, by age (for women) and background characteristics. The ideal family size for women increases with age, from 2.3 children for women age 15-19 to 4.2 children for women age 45-49. Among both men and women, ideal family size is higher in rural areas than urban areas. It is highest in the Mountains zone among both women and men and in Thaba-Tseka district for women and Mokhotlong district for men. Ideal family size decreases with increasing level of education for both women and men. For example, for women it ranges from 4.2 children among those with no education to 2.6 children among women with secondary or higher education. The mean ideal number of children also decreases with an increase in the wealth index for both men and women. Table 7.6 Mean ideal number of children by background characteristics Mean ideal number of children for all women, by age (women) and background characteristics, Lesotho 2004 Age Background characteristic 15-19 20-24 25-29 30-34 35-39 40-44 45-49 All women All men Residence Urban 2.0 2.2 2.3 2.7 2.7 3.5 3.7 2.5 2.9 Rural 2.3 2.8 3.1 3.4 3.8 4.1 4.4 3.2 3.8 Ecological zone Lowlands 2.2 2.4 2.6 3.0 3.3 3.9 4.0 2.9 3.3 Foothills 2.5 3.0 3.3 3.3 3.6 3.7 4.4 3.2 3.9 Mountains 2.4 3.1 3.3 3.8 4.0 4.6 4.9 3.4 4.2 Senqu River Valley 2.1 2.5 2.8 3.1 3.4 3.6 4.0 2.8 3.7 District Butha-Buthe 2.3 2.7 2.7 3.1 3.7 4.1 3.9 3.0 3.6 Leribe 2.5 2.8 3.1 3.2 3.6 4.0 4.8 3.2 3.7 Berea 2.5 2.7 2.7 3.5 3.4 4.2 4.0 3.1 3.7 Maseru 2.2 2.4 2.5 2.9 3.1 3.5 4.0 2.8 3.2 Mafeteng 2.1 2.5 2.9 3.0 3.4 4.0 4.1 2.9 3.4 Mohale's Hoek 2.1 2.6 3.1 3.2 3.7 4.1 4.1 3.0 3.6 Quthing 2.2 2.4 3.0 3.4 3.3 3.7 4.3 2.9 3.8 Qacha's Nek 2.6 3.0 3.3 3.8 3.8 4.5 4.8 3.4 3.8 Mokhotlong 2.3 3.2 3.1 3.8 4.3 4.5 4.1 3.4 4.3 Thaba-Tseka 2.4 3.3 3.3 3.6 4.1 4.7 5.2 3.5 4.1 Education No education 2.4 3.3 3.9 4.1 4.5 4.6 4.8 4.2 4.8 Primary, incomplete 2.3 3.0 3.4 3.7 3.8 4.3 4.6 3.4 3.7 Primary, complete 2.4 2.9 3.0 3.3 3.6 4.0 3.9 3.1 3.1 Secondary+ 2.2 2.4 2.4 2.8 3.2 3.5 3.5 2.6 2.9 Wealth quintile Lowest 2.5 3.2 3.5 3.7 4.3 4.5 4.9 3.5 4.5 Second 2.3 3.0 3.2 3.5 4.0 4.1 4.7 3.3 3.9 Middle 2.3 2.6 2.9 3.2 3.4 4.3 4.5 3.0 3.6 Fourth 2.3 2.6 2.7 3.3 3.4 4.2 4.1 3.0 3.3 Highest 2.1 2.2 2.4 2.8 3.1 3.3 3.5 2.6 3.0 Total 2.3 2.7 2.8 3.2 3.5 4.0 4.2 3.0 3.6 Fertility Preferences | 109 7.4 WANTED AND UNWANTED FERTILITY Interviewers asked women a series of questions regarding children born in the five years preceding the survey date and any current pregnancy to determine whether each birth/pregnancy was wanted then, wanted later, or unwanted. These questions provide a powerful indicator of the degree to which couples successfully control fertility. The data can also be used to gauge the effect of the preven- tion of unwanted births on fertility rates. Table 7.7 shows the percent distribution of births in the five years preceding the survey by whether the birth was wanted by the mother then, wanted later, or not wanted at all. The data indicate that 38 percent of births in Lesotho are unwanted and 12 percent are mistimed (wanted later). The percentage of births considered to have been unwanted is highest for births of order four and above (51 percent). Similarly, a larger proportion of births to older women are reported as unwanted compared with births to young women. Notably, 41 percent of births to women under age 20 are unwanted. Table 7.7 Fertility planning status Percent distribution of births in the five years preceding the survey (including current pregnancies), by fertility planning status, according to birth order and mother's age at birth, Lesotho 2004 Planning status of birth Birth order and mother's age at birth Wanted then Wanted later Wanted no more Missing Total Number of births Birth order 1 58.8 6.6 34.2 0.4 100.0 1,392 2 53.6 16.7 28.8 0.9 100.0 913 3 47.3 14.9 37.1 0.6 100.0 589 4+ 35.5 12.1 51.1 1.4 100.0 1,106 Age at birth <20 50.1 8.4 41.0 0.6 100.0 815 20-24 54.2 13.9 31.0 0.8 100.0 1,217 25-29 53.4 12.5 33.3 0.7 100.0 807 30-34 46.7 12.5 40.2 0.5 100.0 550 35-39 38.6 9.6 50.9 0.9 100.0 406 40-44 30.2 10.0 56.7 3.1 100.0 186 45-49 * * * * * 21 Total 49.5 11.6 38.1 0.8 100.0 4,001 Note: An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. Table 7.8 presents wanted fertility rates. These rates are calculated in the same manner as the total fertility rate, but unwanted births are excluded from the numerator. For this purpose, unwanted births are defined as those that exceed the number considered ideal by the respondent. Women who did not report a numeric ideal family size were assumed to want all of their births. These rates represent the level of fertility that would have prevailed in the three years preceding the survey if all unwanted births had been prevented. A comparison of the total wanted fertility rate and the actual total fertility rate suggests the potential demographic effects of the elimination of unwanted births. The total wanted fertility rate for Lesotho is 2.5. This rate is one child less than the actual fertility rate (3.5). Considering the variation by socioeconomic characteristics, the gap between the wanted and actual fertility rate is greatest for the Foothills and Senqu River Valley zones and Thaba-Tseka district. The gap is also considerable among women in the two lowest wealth quintiles. 110 | Fertility Preferences Table 7.8 Wanted fertility rates Total wanted fertility rates and total fertility rates for the three years preceding the survey, by background characteristics, Lesotho 2004 Background characteristic Total wanted fertility rate Total fertility rate Residence Urban 1.4 1.9 Rural 2.9 4.1 Ecological zone Lowlands 2.0 2.9 Foothills 2.9 4.3 Mountains 3.6 4.9 Senqu River Valley 2.6 4.0 District Butha-Buthe 2.4 3.4 Leribe 2.5 3.6 Berea 2.7 3.9 Maseru 1.8 2.5 Mafeteng 2.3 3.3 Mohale's Hoek 2.9 4.0 Quthing 2.8 4.1 Qacha's Nek 3.5 4.4 Mokhotlong 3.4 4.6 Thaba-Tseka 3.7 5.1 Education No education * * Primary, incomplete 2.9 4.2 Primary, complete 2.8 3.9 Secondary+ 2.0 2.8 Wealth quintile Lowest 3.7 5.2 Second 3.0 4.5 Middle 2.4 3.8 Fourth 2.6 3.4 Highest 1.5 2.0 Total 2.5 3.5 Note: Rates are calculated based on births to women age 15-49 in the period 1-36 months preceding the survey. The total fertility rates are the same as those presented in Table 4.2. An asterisk indicates that a figure is based on fewer than 250 woman-years of exposure and has been suppressed. Fertility Preferences | 111 7.5 IDEAL FAMILY SIZE AND UNMET NEED BY WOMEN’S STATUS The ability of women to make household decisions has important implications on their fertility preferences and the practise of family planning. Table 7.9 shows the ideal family size and unmet need for family planning by selected indicators of women’s status. The table shows that generally, ideal family size and unmet need are related to a woman’s status. For example, mean ideal family size generally declines with both the number of decisions in which the respondent has a final say and the number of reasons with which the respondent agrees that a wife can refuse sex with her husband. Also, women who think that wife beating is not justified for any reason have a mean ideal family size of 3.3, compared with 3.8 for women who gave 5 or 6 reasons why beating a wife is justified. Unmet need is typically higher for women who score lowest on the status indicators. More than one-third of women who participate in none or only 1-2 household decisions are in need of family planning compared with about one-fourth of women who participate in 5 decisions. Table 7.9 Ideal number of children and unmet need by women's status Mean ideal number of children and unmet need for spacing and limiting, by women's status indicators, Lesotho 2004 Unmet need for family planning2 Women's status indicator Mean ideal number of children Number For spacing For limiting Total Number of women Number of decisions in which woman has final say3 0 3.4 244 17.5 17.5 35.0 244 1-2 3.7 886 13.8 24.0 37.8 888 3-4 3.5 1,553 11.5 19.3 30.8 1,555 5 3.2 1,019 6.1 18.2 24.2 1,022 Number of reasons to refuse sex with husband 0 3.8 196 6.3 21.3 27.6 196 1-2 3.7 596 13.3 20.1 33.4 596 3-4 3.4 2,908 10.8 19.9 30.6 2,916 Number of reasons wife beating is justified 0 3.3 1,890 8.6 19.7 28.4 1,894 1-2 3.5 858 13.4 20.8 34.2 859 3-4 3.6 694 12.6 19.6 32.2 696 5-6 3.8 259 14.8 20.6 35.4 259 Total 3.5 3,701 10.9 20.0 30.9 3,709 1 Totals are calculated excluding the women giving non-numeric responses 2 See Table 7.3 for definition of unmet need for family planning 3 Either by herself or jointly with others Infant and Child Mortality | 113 INFANT AND CHILD MORTALITY 8 This chapter presents information on levels, trends, and differentials in neonatal, postneonatal, in- fant, and child mortality. The information is critical for assessment of population and health policies and programmes. Estimates of infant and child mortality are required as an input into population projections, particularly if the level of adult mortality is known from another source or can be inferred with reasonable confidence. Information on mortality of children also serves the needs of health ministries by identifying sectors of the population that are at high risk. Infant and child mortality rates are also regarded as indices reflecting the degree of poverty and deprivation of a population. The primary causes of childhood mortality change as children grow older, from factors related mostly to biological conditions to factors related mostly to their environment. After the neonatal period, postneonatal and child mortality are attributed mainly to childhood diseases and accidents. In this chapter, age-specific mortality rates are defined as follows: Neonatal mortality: the probability of dying within the first month of life Postneonatal mortality: the difference between infant and neonatal mortality Infant mortality: the probability of dying before the first birthday Child mortality: the probability of dying between the first and fifth birthdays Under-five mortality: the probability of dying before the fifth birthday. All rates are expressed per 1,000 live births, except for child mortality, which is expressed per 1,000 children surviving to 12 months of age. The data for mortality estimates were collected in the birth history section of the Women’s Ques- tionnaire. The section begins with questions about the aggregate childbearing experience of respondents (i.e., the number of sons and daughters who live with the respondent, those who live elsewhere, and the number who have died). For each of the births, more detailed information was collected on the sex, the month and year of birth, survivorship status, and current age if the child was alive, or age at death if the child had died. The quality of mortality estimates calculated from retrospective birth histories depends upon the completeness with which births and deaths are reported and recorded. Potentially the most serious data quality problem is the selective omission from the birth histories of births who did not survive, which can lead to underestimation of mortality rates. Other potential problems include displacement of birth dates, which may cause a distortion of mortality trends, and misreporting of the age at death, which may distort the age pattern of mortality. When selective omission of childhood deaths occurs, it is usually most severe for deaths in early infancy. If early neonatal deaths are selectively underreported, the result is an unusu- ally low ratio of deaths occurring within seven days to all neonatal deaths, and an unusually low ratio of neonatal to infant deaths. Underreporting of early infant deaths is most commonly observed for births that occurred long before the survey, hence it is useful to examine the ratios over time. An examination of the ratios (see Appendix Tables C.5 and C.6) shows that no significant num- ber of early infant deaths was omitted in the 2004 LDHS. The proportion of neonatal deaths occurring in the first week of life is 84 percent. The proportions of early neonatal deaths have remained stable over the 20 years preceding the survey (between 77 and 86 percent). The proportions of infant deaths that occur during the first month of life are also roughly constant over the 20 years preceding the survey (varying between 52 and 58 percent). This inspection of the mortality data reveals no evidence of selective 114 | Infant and Child Mortality underreporting or misreporting of age at death that would significantly compromise the quality of the LDHS rates of childhood mortality. 8.1 LEVELS AND TRENDS IN INFANT AND CHILD MORTALITY Table 8.1 shows the variation in neonatal, postneonatal, infant, child, and under-five mortality rates for three successive five-year periods preceding the survey. The use of rates for five-year periods conceals any year-to-year fluctuations in early childhood mortality. For the most recent five-year period preceding the survey, infant mortality is 91 deaths per 1,000 live births, and under-five mortality is 113 deaths per 1,000 live births. This means that about one in every nine children born in Lesotho dies before attaining his or her fifth birthday. The pattern shows that deaths occurring during the neonatal period and the postneonatal period each account for 41 percent of all deaths under the age of five years. Table 8.1 Early childhood mortality rates Neonatal, postneonatal, infant, child, and under-five mortality rates for five- year periods preceding the survey, Lesotho 2004 Years preceding the survey Neonatal mortality (NN) Postneonatal mortality (PNN)1 Infant mortality (1q0) Child mortality (4q1) Under-five mortality (5q0) 0-4 46 46 91 24 113 5-9 44 31 75 16 90 10-14 40 32 72 15 86 1 Computed as the difference between the infant and neonatal mortality rates Table 8.1 shows an upward trend in the early childhood mortality rates over time. For example, the infant mortality rate increased from 75 deaths per 1,000 live births in the 5-9 year period preceding the survey (approximately 1995-1999) to 91 deaths per 1,000 live births during the 2000-2004 period. Under-five mortality has increased from 90 to 113 deaths per 1,000 live births over the same time period. The increase may be a result of several factors, including 1) the effect of the AIDS epidemic in Lesotho, and 2) the tendency of mothers to underreport child deaths, particularly those that happened several years ago. The under-five mortality rate estimated by the 2001 Lesotho Demographic Survey (LDS) is 113 deaths per 1,000 live births, virtually identical to the estimate of the 2004 LDHS (Figure 8.1). The 2001 LDS estimated an infant mortality rate of 81 deaths per 1,000 live births, lower than the 2004 LDHS estimate of 91 deaths per 1,000 live births. The child mortality estimate in the 2001 LDS was 35 deaths per 1,000 births, higher than the 2004 LDHS estimate of 24 deaths per 1,000 live births. Note that the 2001 LDS estimated childhood mortality rates for the two- to eight-year period preceding the survey. The apparent shift in the 2001-2004 period as demonstrated by the two surveys—the increase in infant mortality and the decrease in child mortality—probably signifies the effect of HIV and AIDS and may indicate that a significant number of children affected by HIV do not survive the first year of life. Infant and Child Mortality | 115 81 91 35 24 113 113 2001 LDS 2004 LDHS 0 10 20 30 40 50 60 70 80 90 100 110 120 130 D ea th s pe r 1 ,0 00 Infant mortality Child mortality Under-five mortality Figure 8.1 Trends in Infant, Child, and Under-five Mortality, 2001 LDS and 2004 LDHS In interpreting the mortality data, it is useful to keep in mind that sampling errors are quite large. For example, the 95 percent confidence intervals for the under-five mortality estimate of 113 deaths per 1,000 live births are 101 and 125 per 1,000 live births (Appendix B), indicating that, given the sample size of the 2004 LDHS, the true value may be 12 points higher or lower than the estimated rate of 113 per 1,000. 8.2 SOCIOECONOMIC DIFFERENTIALS IN INFANT AND CHILD MORTALITY Mortality differentials by place of residence, ecological zone, district, educational level of the mother, and wealth index are presented in Table 8.2 and Figure 8.2. For a sufficient number of births to study mortality differentials across population subgroups, period-specific rates are presented for the ten- year period preceding the survey (late 1994 to late 2004). Differentials by place of residence show that the under-five mortality rate is 18 percent higher in rural areas than in urban areas (105 and 87 deaths per 1,000 live births, respectively). The rates by ecological zones and districts display considerable differentials. Except for postneonatal mortality, all childhood mortality indicators are highest in the Mountains and lowest in the Lowlands. Among districts, Thaba-Tseka and Mohale’s Hoek have the highest level of under-five mortality, and Mafeteng and Maseru have the lowest. Infant mortality is highest in Thaba-Tseka (119 deaths per 1,000 live births), followed by Mohale’s Hoek (101 per 1,000 live births), and it is lowest in Mafeteng (57 per 1,000 live births). This implies that a child born in Thaba-Tseka is about twice as likely as a child born in Mafeteng to die before celebrating his or her first birthday. The same pattern is also observed in under-five mortality rates, with the highest rate in Thaba-Tseka (138 deaths per 1,000 live births) and the lowest in Mafeteng (71 deaths per 1,000 live births). Rates by district should be interpreted cautiously because of the high level of sampling errors (see Appendix B). 116 | Infant and Child Mortality Table 8.2 Early childhood mortality rates by socioeconomic characteristics Neonatal, postneonatal, infant, child, and under-five mortality rates for the 10-year period preceding the survey, by background characteristic, Lesotho 2004 Background characteristic Neonatal mortality (NN) Postneonatal mortality (PNN)1 Infant mortality (1q0) Child mortality (4q1) Under-five mortality (5q0) Residence Urban 23 42 64 24 87 Rural 49 38 87 19 105 Ecological zone Lowlands 39 37 76 19 94 Foothills 43 39 82 21 101 Mountains 56 40 97 22 117 Senqu River Valley 39 44 83 20 101 District Butha-Buthe 39 35 74 28 100 Leribe 49 44 93 27 118 Berea 48 35 84 12 95 Maseru 28 40 68 14 81 Mafeteng 33 24 57 15 71 Mohale's Hoek 66 35 101 28 126 Quthing 52 35 87 25 110 Qacha's Nek 65 31 96 21 115 Mokhotlong 36 39 75 21 95 Thaba-Tseka 57 62 119 22 138 Mother’s education No education * * * * * Primary, incomplete 53 45 98 22 118 Primary, complete 42 35 77 24 100 Secondary+ 34 36 70 13 82 Wealth quintile Lowest 51 37 88 28 114 Second 40 50 89 18 106 Middle 63 30 93 14 106 Fourth 47 30 77 28 102 Highest 25 45 70 13 82 Note: An asterisk indicates that a figure is based on fewer than 250 children and has been suppressed. 1 Computed as the difference between the infant and neonatal mortality rates 87 105 94 101 117 101 100 118 95 81 71 126 110 115 95 138 161 118 100 82 RESIDENCE Urban Rural ECOLOGICAL ZONE Lowlands Foothills Mountains Senqu River Valley DISTRICT Butha-Buthe Leribe Berea Maseru Mafeteng Mohale's Hoek Quthing Qacha's Nek Mokhotlong Thaba-Tseka EDUCATION No education Primary, incomplete Primary, complete Secondary+ Figure 8.2 Under-five Mortality by Background Characteristics LDHS 2004 Deaths per 1,000 live births Infant and Child Mortality | 117 As observed in most studies, the mother’s level of education is strongly linked to child survival. Higher levels of educational attainment are generally associated with lower mortality rates, presumably because education exposes mothers to information about better nutrition, use of contraceptives to space births, and knowledge about child immunisation, childhood illness, and treatment. According to Table 8.2, childhood mortality rates for children born to mothers with primary education incomplete are higher than for children born to mothers with higher education, except for child mortality. For example, the infant mortality rates range from 70 deaths per 1,000 live births for children born to mothers with secondary education to 98 deaths per 1,000 live births for children of mothers with primary education incomplete. The corresponding figures for under-five mortality rates are 82 for mothers with secondary education and 118 for mothers with primary education incomplete. 8.3 DEMOGRAPHIC DIFFERENTIALS IN INFANT AND CHILD MORTALITY Childhood mortality rates by sex of child, age of mother at birth, birth order, previous birth inter- val, and birth size are presented in Table 8.3. Differences in the mortality of male and female children at birth are found in nearly all populations. The results show that female mortality is lower than that of males at all ages up to five years. Table 8.3 Early childhood mortality rates by demographic characteristics Neonatal, postneonatal, infant, child, and under-five mortality rates for the 10-year period preceding the survey, by demographic characteristics, Lesotho 2004 Demographic characteristic Neonatal mortality (NN) Postneonatal mortality (PNN)1 Infant mortality (1q0) Child mortality (4q1) Under-five mortality (5q0) Child's sex Male 48 41 89 22 109 Female 41 37 78 19 95 Mother's age at birth <20 45 31 76 21 96 20-29 41 40 81 22 101 30-39 48 35 83 17 99 40-49 66 82 148 10 157 Birth order 1 37 40 77 20 95 2-3 43 37 81 25 104 4-6 46 31 77 16 91 7+ 84 63 147 13 158 Previous birth interval2 <2 years 106 44 150 39 183 2 years 47 29 77 19 94 3 years 33 35 68 19 86 4+ years 39 43 82 15 96 Birth size3 Small/very small 94 72 166 na na Average or larger 31 40 71 na na 1 Computed as the difference between the infant and neonatal mortality rates 2 Excludes first-order births 3 Rates for the five-year period before the survey na = Not applicable 118 | Infant and Child Mortality Children of the youngest and oldest women usually experience the highest risk of death. Table 8.3 shows no clear pattern in the relationship between mother’s age at birth and childhood mortality for younger mothers. However, childhood mortality rates are considerably higher among children born to women in their 40s at the time of birth, except for child mortality. Most research studies have established that first births and higher order births generally face high risk of mortality. Data from the 2004 LDHS do not clearly confirm this pattern for first births. However, with the exception of child mortality, births of order seven and above experience significantly higher levels of childhood mortality. The length of birth interval has a significant effect on a child’s chances of survival, with short birth intervals reducing the chances of survival. As the birth interval gets longer, mortality risk is substantially reduced. Children born less than two years after a prior sibling are at greater risk of dying than children born after intervals of two or more years. For example, the infant mortality rate is 150 deaths per 1,000 live births for children born after an interval of less than two years, compared with a rate of 68 deaths per 1,000 live births for birth intervals of three years. Size of the child at birth also has a bearing on childhood mortality. For example, the infant mortality rate is 166 deaths per 1,000 live births for children whose birth size is small or very small, compared with a rate of 71 deaths per 1,000 live births for children with average or larger birth size. The size at birth of the child appears to have a stronger effect on neonatal mortality than on postneonatal mortality. 113 109 95 96 101 99 157 183 94 86 96 LESOTHO SEX OF CHILD Male Female AGE OF MOTHER <20 20-29 30-39 40-49 PREVIOUS BIRTH INTERVAL <2 years 2 years 3 years 4+ years Figure 8.3 Under-five Mortality by Socioeconomic Characteristics LDHS 2004 Deaths per 1,000 live births 8.4 DIFFERENTIALS IN INFANT AND CHILD MORTALITY BY WOMEN’S STATUS An essential aspect of empowerment of women is the ability to access information, make decisions, and act effectively in their own interest, or the interest of those who depend on them. It follows that if women, as the primary caretakers of children, are appropriately empowered, the health and survival chances of their children would be enhanced. In fact, mother’s empowerment can be used as an individual-level variable that can affect child survival through a set of proximate determinants developed by Mosley and Chen (1984) in their framework on child survival. Table 8.4 shows information on the effect of women’s status as measured by three specific indicators: participation in household decision- Infant and Child Mortality | 119 making, attitude towards the ability of a wife to refuse to have sex with her husband, and attitude towards wife beating. The data show no consistent pattern in mortality rates by the number of household decisions in which a woman has a final say or by the number of reasons to justify a wife’s refusal to have sex with her husband. The rates of childhood mortality are generally lower among children whose mothers do not mention any reasons justifying wife beating. For example, the under-five mortality rate is 85 deaths per 1,000 live births among children whose mothers believe there are no reasons to justify wife beating, compared with 121 deaths per 1,000 live births for children whose mothers cite 3 to 4 reasons. Table 8.4 Early childhood mortality rates by women's status Neonatal, postneonatal, infant, child, and under-five mortality rates for the 10-year period preceding the survey, by women's status indicators, Lesotho 2004 Women's status indicators Neonatal mortality (NN) Postneonatal mortality (PNN)1 Infant mortality (1q0) Child mortality (4q1) Under-five mortality (5q0) Number of decisions in which woman has final say2 0 39 31 70 26 94 1-2 48 33 81 17 97 3-4 50 35 86 19 103 5 38 47 85 21 105 Number of reasons to refuse sex with husband 0 55 41 96 12 107 1-2 53 45 98 18 114 3-4 42 37 80 21 99 Number of reasons wife beating is justified 0 36 32 68 18 85 1-2 49 51 100 21 118 3-4 56 42 99 24 121 5+ 56 34 90 21 109 1 Computed as the difference between the infant and neonatal mortality rates 2 Either by herself or jointly with others 8.5 HIGH-RISK FERTILITY BEHAVIOUR Numerous studies have found a strong relationship between children’s chances of dying and cer- tain fertility behaviours. Typically, the probability of dying in early childhood is much greater if children are born to mothers who are too young or too old, if they are born after a short birth interval, or if they are born to mothers with high parity. Very young mothers may experience difficult pregnancies and deliver- ies because of their physical immaturity. Older women may also experience age-related problems during pregnancy and delivery. For purposes of this analysis, a mother is classified as “too young” if she is less than 18 years of age and “too old” if she is over 34 years of age at the time of delivery; a “short birth in- terval” is defined as a birth occurring within 24 months of a previous birth; and a “high-order” birth is one occurring after three or more previous births (i.e., birth order four or higher). First-order births may be at increased risk of dying, relative to births of other orders; however, this distinction is not included in the risk categories in the table because it is not considered avoidable fertility behaviour. For the short birth interval category, only children with a preceding interval of less than 24 months are included. Short succeeding birth intervals are not included, even though they can influence the survivorship of a child, because of the problem of reverse causal effect (i.e., a short succeeding birth interval can be the result of the death of a child rather than being the cause of the death of a child). 120 | Infant and Child Mortality Table 8.5 presents the distribution of children born in the five years preceding the survey by the above-mentioned categories of increased risk of mortality. The first column shows the risk categories. The second column shows the percentage of children falling into various risk categories. The third column shows the risk ratio of mortality for children by comparing the proportion dead among children in each high-risk category with the proportion dead among children not in any high-risk category (i.e., those whose mothers were age 18-34 at delivery, who were born 24 or more months after the previous birth, or who are of birth order two or three). Column four shows the percentage of currently married women by category of risk if they were to conceive a child at the time of the survey. Four in ten children in Lesotho (41 percent) fall into a high-risk category that is avoidable, with 26 percent in a single high-risk category and 15 percent in a multiple high-risk category. Three in ten children (31 percent) do not fall into any high-risk category. The risk ratio indicates that high risks are especially associated with birth intervals of less than 24 months and births to mothers older than 34 years. Risk ratios are higher for children in a multiple high-risk category (1.36) than for children in a single high-risk category (1.12). Among single high-risk categories, 4 percent of births in Lesotho occur after a short birth interval. These children are twice as likely to die in early childhood as children who are not in any high-risk category. The last column in Table 8.5 was obtained by simulating the distribution of currently married women by the risk category in which a birth would fall if a woman were to conceive at the time of the survey. Although many women are protected from conception because of use of family planning methods, postpartum insusceptibility, and prolonged abstinence, for simplicity only those who have been sterilised are included in the “not in any high-risk category.” Sixty-four percent of currently married women have the potential for having a high-risk birth, with 28 percent falling into a single high-risk category and 36 percent into a multiple high-risk category. Infant and Child Mortality | 121 Table 8.5 High-risk fertility behaviour Percent distribution of children born in the five years preceding the survey by category of elevated risk of mortality and the risk ratio, and percent distribution of currently married women by category of risk if they were to conceive a child at the time of the survey, Lesotho 2004 Births in the 5 years preceding the survey Risk category Percentage of births Risk ratio Percentage of currently married women1 Not in any high-risk category 31.1 1.00 28.9a Unavoidable risk category First-order births between ages 18 and 34 years 27.7 1.11 7.4 Single high-risk category Mother’s age <18 6.9 1.05 0.7 Mother’s age >34 2.1 1.53 6.5 Birth interval <24 months 3.9 2.11 11.2 Birth order >3 13.0 0.78 9.6 Subtotal 25.9 1.12 28.0 Multiple high-risk category Age <18 and birth interval <24 months2 0.1 * 0.3 Age >34 and birth interval <24 months 0.1 * 0.3 Age >34 and birth order >3 12.2 1.23 26.9 Age >34 and birth interval <24 months & birth order >3 1.0 1.27 2.7 Birth interval <24 months and birth order >3 1.8 1.87 5.4 Subtotal 15.3 1.36 35.7 In any avoidable high-risk category 41.1 1.21 63.6 Total 100.0 na 100.0 Number of births 3,572 na 3,709 Note: Risk ratio is the ratio of the proportion dead among births in a specific high-risk category to the proportion dead among births not in any high-risk category. An asterisk indicates that a figure is based on fewer than 250 births and has been suppressed. na = Not applicable 1 Women are assigned to risk categories according to the status they would have at the birth of a child if they were to conceive at the time of the survey: current age less than 17 years and 3 months or older than 34 years and 2 months, latest birth less than 15 months ago, or latest birth being of order 3 or higher 2 Includes the category age <18 and birth order >3 a Includes sterilised women Maternal and Child Health | 123 MATERNAL AND CHILD HEALTH 9 Mahlape Ramoseme This chapter presents findings from key areas in maternal and child health, namely antenatal, postnatal and delivery care, childhood vaccination and common childhood illnesses and their treatment. It is the priority of the Ministry of Health and Social Welfare in Lesotho to provide medical care and counselling services to women during pregnancy and delivery that affect health and survival of both the mother and the newborn. The 2004 LDHS results provide an evaluation of the utilisation of these health services, as well as information useful in assessing the need for service expansion. The information can be used to identify women whose babies are at risk because of non-use of maternal health services. The find- ings are also valuable to policymakers and programme implementers in strengthening implementation of programmes and activities to improve maternal and child care services. The results in the following sec- tions are based on data collected from mothers about live births that occurred in the five years preceding the survey. 9.1 ANTENATAL CARE Antenatal Care Coverage Table 9.1 shows the percent distribution of women who had a live birth in the five years preceding the survey by the type of antenatal care (ANC) provider for the most recent birth. The women were asked to report on all providers they may have seen for ANC. However, if more than one person was seen for care, only the provider with the highest qualification is shown in the table. The data indicate that 90 percent of women in Lesotho receive antenatal care from a health professional, either from a doctor (7 percent) or a nurse, midwife, or nursing assistant1 (83 percent). One percent of the women receive antenatal care from traditional birth attendants, while 9 percent do not receive any antenatal care. The 2004 LDHS data indicate an improvement in this indicator since the 2000 End of Decade Multiple Cluster Survey (EMICS), which reported antenatal care coverage by a health professional of 53 percent. It must be noted that in the 2000 EMICS the questions on antenatal care were asked only of women who had a birth in the year before the survey. Looking at specific providers, there has been an increase in the proportion of women who received ANC from a doctor (6 percent in the 2000 EMICS and 7 percent in 2004 LDHS) and those who received ANC from a nurse, midwife, or nursing assistant (47 percent in 2000 EMICS and 83 percent in 2004 LDHS). Examination of differentials in antenatal care in Table 9.1 shows that the mother’s age at birth and the child’s birth order are not strongly correlated to use of antenatal care. However, higher parity women are more likely than lower parity women to see no one for antenatal care. Rural women are less likely than their urban counterparts to get antenatal care from a doctor and more likely to get no ANC at all. 1 In 2004 LDHS, the answer category “nurse” includes both a “registered nurse” and a “nursing assistant” because most women would not know the difference between a registered nurse and a nursing assistant. Therefore, in this report the proportion of women who received ANC by skilled personnel includes those who have seen a nursing assistant, which may result in an overestimate of this indicator. 124 | Maternal and Child Health Antenatal care coverage is associated with women’s level of education. Women with higher education are much more likely to have received care from a doctor than those with no education (11 and versus 2 percent, respectively), while the proportion of women who get no antenatal care declines steadily as education increases. Table 9.1 Antenatal care Percent distribution of women who had a live birth in the five years preceding the survey by antenatal care (ANC) provider during pregnancy for the most recent birth, according to background characteristics, Lesotho 2004 Background characteristic Doctor Nurse/ midwife/ nursing assistant Traditional birth attendant/ other No one Missing Total Number of women Age at birth <20 5.8 85.9 0.8 7.5 0.0 100.0 546 20-34 7.7 83.4 0.4 8.1 0.3 100.0 1,832 35-49 6.5 79.4 0.9 12.7 0.6 100.0 480 Birth order 1 7.3 86.9 0.7 5.2 0.0 100.0 963 2-3 7.8 83.5 0.2 8.0 0.4 100.0 1,080 4-5 7.0 79.5 0.7 12.8 0.0 100.0 485 6+ 4.9 76.9 1.0 16.0 1.3 100.0 331 Residence Urban 9.7 86.7 0.1 3.3 0.2 100.0 448 Rural 6.7 82.6 0.6 9.8 0.3 100.0 2,411 Ecological zone Lowlands 10.4 81.1 0.5 7.5 0.5 100.0 1,508 Foothills 5.7 80.2 0.1 13.6 0.3 100.0 351 Mountains 2.6 86.9 0.7 9.8 0.1 100.0 810 Senqu River Valley 3.4 90.1 0.5 6.0 0.0 100.0 190 District Butha-Buthe 8.3 79.7 0.3 11.7 0.0 100.0 162 Leribe 4.0 86.7 0.2 8.9 0.2 100.0 446 Berea 3.5 86.2 0.0 9.3 1.0 100.0 332 Maseru 14.1 76.8 0.5 8.4 0.2 100.0 594 Mafeteng 10.2 77.3 0.9 10.7 0.9 100.0 313 Mohale's Hoek 9.0 81.4 1.4 8.1 0.0 100.0 275 Quthing 0.9 91.0 0.5 7.6 0.0 100.0 203 Qacha’s Nek 5.6 91.6 1.0 1.9 0.0 100.0 109 Mokhotlong 3.3 87.3 0.4 8.5 0.4 100.0 183 Thaba-Tseka 2.9 87.3 0.4 9.4 0.0 100.0 240 Education No education 2.3 73.2 4.9 19.6 0.0 100.0 68 Primary, incomplete 4.8 82.1 0.8 11.6 0.7 100.0 877 Primary, complete 5.4 85.6 0.1 9.0 0.0 100.0 890 Secondary+ 11.0 82.9 0.4 5.5 0.2 100.0 1,024 Wealth quintile Lowest 4.1 82.5 0.4 12.8 0.2 100.0 541 Second 4.3 82.3 0.4 12.3 0.7 100.0 645 Middle 7.9 83.3 0.5 8.1 0.3 100.0 510 Fourth 8.7 83.2 1.2 6.9 0.0 100.0 621 Highest 11.2 85.0 0.0 3.5 0.3 100.0 542 Total 7.2 83.2 0.5 8.8 0.3 100.0 2,859 Note: If more than one source of ANC was mentioned, only the provider with the highest qualifications is considered in this tabulation. Maternal and Child Health | 125 Number and Timing of Antenatal Care Visits Health providers recommend that the first antenatal visit should occur within the first trimester of pregnancy and continue on a monthly basis through the 28th week of pregnancy and fortnightly up to the 36th week or until birth. This implies that 12-13 visits should be made during the entire preg- nancy. Antenatal care can be more effective in preventing adverse pregnancy outcomes when it is sought early in pregnancy and continues through to delivery. Table 9.2 provides information on the number of antenatal care visits and the timing of the first visit. Early detection of problems in pregnancy leads to more timely referrals in cases of women in higher-risk categories or complications. Table 9.2 shows that in Lesotho, seven in ten women (70 per- cent) make four or more antenatal visits. Twenty- seven percent of mothers make no visits or make fewer than 4 visits, far below the recommended number of 12. Eighty-four percent of urban women make 4 or more antenatal care visits, compared with 67 percent of rural women. Moreover, few women do not receive antenatal care early in the pregnancy. Only 30 percent of women obtain antenatal care in the first trimester of pregnancy and 68 percent receive antenatal care before the sixth month of pregnancy. The median number of months of pregnancy at first ANC visit is 5. Results show that there is need in Lesotho to promote early antenatal care attendance to ensure appropriate maternal care and prevent pregnancy, delivery, and postnatal complications. Components of Antenatal Care Pregnancy complications are the primary causes of maternal and child morbidity and mortality. Consequently, informing women about the danger signs associated with pregnancy and the actions they should take in case complications arise are important elements of antenatal care services. In the 2004 LDHS, women who had a live birth in the five years before the survey were asked about antenatal care services, including whether they were told about the signs of pregnancy complications, whether they were weighed, whether their height and blood pressure were measured, whether urine and blood samples were taken, and whether they were given any information or counselled about HIV/AIDS.2 Table 9.3 shows that among women who had a birth in the five years preceding the survey, 45 percent received antenatal care for the most recent birth reported that they had been informed about pregnancy complications. Urban women are more likely (53 percent) to have been told about pregnancy complications than rural (43 percent). The likelihood of a woman being told about pregnancy 2 They were also asked whether they took iron supplements (see Chapter 10). Table 9.2 Number of antenatal care visits and timing of first visit Percent distribution of women who had a live birth in the five years preceding the survey by number of antenatal care (ANC) visits for the most recent birth, and by the timing of the first visit according to residence, Lesotho 2004 Residence Number and timing of ANC visits Urban Rural Total Number of ANC visits None 3.3 9.8 8.8 1 0.8 1.7 1.6 2-3 9.0 17.7 16.4 4+ 83.5 67.0 69.6 Don't know/missing 3.4 3.7 3.7 Total 100.0 100.0 100.0 Number of months pregnant at time of first ANC visit No antenatal care 3.3 9.8 8.8 <4 40.2 28.4 30.3 4-5 39.0 37.4 37.6 6-7 16.0 20.7 20.0 8+ 1.2 3.0 2.7 Don't know/missing 0.4 0.7 0.6 Total 100.0 100.0 100.0 Median months pregnant at first visit (for those with ANC) 4.4 4.9 4.8 Number of women 448 2,411 2,859 126 | Maternal and Child Health complications declines as parity increases. Women in the higher wealth index quintiles are more likely to be informed about pregnancy complications than those in the lower quintiles. For example, 56 percent of the women in the highest quintile reported that they were informed about the pregnancy complications, while only 32 percent of the women in the lowest quintile reported that they were informed about pregnancy complications. Among ecological zones, the proportion of women who were informed of the signs and symptoms of pregnancy complications ranges from 40 percent in the Mountains to 53 percent in Senqu River Valley. Among districts, the lowest proportion of women who were informed about the signs and symptoms of pregnancy complications is found in Thaba-Tseka (30 percent) and the highest is in Quthing (56 percent). Table 9.3 Components of antenatal care Percentage of women with a live birth in the five years preceding the survey who received antenatal care for the most recent birth, by content of antenatal care, and percentage of women with a live birth in the five years preceding the survey who received iron tablets or syrup for the most recent birth, according to background characteristics, Lesotho 2004 Among women who received antenatal care Background characteristic Informed of signs of pregnancy compli- cations Informed of where to go in case of compli- cations Weight measured Height measured Blood pressure measured Urine sample taken Blood sample taken Received information or counselling about HIV/ AIDS Number of women Received iron tablets or syrup Number of women Age at birth <20 36.5 33.0 95.3 45.3 90.7 63.4 78.3 45.3 507 36.2 547 20-34 44.6 41.8 95.8 43.4 92.6 68.9 81.4 55.3 1,675 38.7 1,832 35-49 54.1 51.8 95.5 48.9 94.4 76.7 81.8 70.0 416 36.3 480 Birth order 1 40.0 37.1 96.1 46.6 92.0 67.7 80.6 50.7 913 39.2 963 2-3 44.2 41.3 95.8 43.5 93.2 70.5 81.6 55.1 989 38.2 1,080 4-5 50.2 47.6 94.4 37.4 91.4 66.2 78.8 61.9 423 37.2 485 6+ 52.2 49.1 95.9 53.4 93.9 72.9 82.3 65.1 274 33.8 331 Residence Urban 53.1 51.7 96.8 47.4 94.4 87.7 92.4 69.5 433 42.6 448 Rural 42.8 39.7 95.5 44.1 92.2 65.4 78.5 52.9 2,166 37.0 2,411 Ecological zone Lowlands 45.9 43.3 96.4 44.0 95.0 79.0 87.1 58.4 1,388 40.0 1,508 Foothills 44.8 41.3 96.4 46.2 94.2 61.3 82.3 53.9 302 44.6 351 Mountains 39.6 36.4 93.2 45.9 88.7 54.6 70.4 49.6 730 33.4 810 Senqu River Valley 53.3 51.6 98.7 41.7 86.7 64.7 72.2 62.6 179 26.9 190 District Butha-Buthe 51.9 45.8 98.8 45.4 95.6 74.7 88.9 52.4 143 45.8 162 Leribe 50.0 47.2 95.0 42.6 96.3 64.1 78.5 61.0 406 49.6 446 Berea 35.8 33.5 97.1 41.3 93.2 62.0 79.9 48.4 298 47.3 332 Maseru 42.0 39.3 94.6 49.6 93.4 80.7 88.7 65.3 543 41.3 594 Mafeteng 48.6 46.8 96.7 38.8 95.6 87.7 88.3 52.9 277 30.3 313 Mohale's Hoek 48.7 44.2 94.6 44.5 89.9 66.0 75.9 49.2 253 23.1 275 Quthing 56.4 54.6 98.6 41.5 82.2 59.0 66.0 60.5 187 24.7 203 Qacha's Nek 53.0 46.4 96.2 56.8 88.2 61.8 75.1 62.4 107 43.5 109 Mokhotlong 35.3 34.9 94.7 41.9 96.6 67.5 85.1 35.4 167 19.5 183 Thaba-Tseka 30.4 28.2 93.6 46.5 87.8 48.7 70.2 53.3 217 38.0 240 Education No education 47.0 42.4 86.6 36.9 88.6 53.2 68.9 44.1 55 25.9 68 Primary, incomplete 39.6 36.6 94.3 42.5 90.8 60.7 74.6 48.5 769 33.5 877 Primary, complete 46.8 43.6 95.5 47.1 93.0 68.1 82.2 56.6 810 37.8 890 Secondary+ 46.5 44.1 97.4 44.8 93.8 77.5 85.4 61.4 965 42.4 1,024 Wealth quintile Lowest 32.4 30.0 92.2 40.4 87.3 48.8 68.4 44.1 470 36.0 541 Second 43.7 40.7 95.5 46.2 90.0 63.7 76.6 51.4 561 31.9 645 Middle 42.5 39.0 95.9 43.7 93.4 65.3 82.0 56.3 467 36.6 510 Fourth 46.9 44.9 97.9 46.3 97.1 80.0 86.2 59.8 579 40.8 621 Highest 55.6 52.1 96.3 45.8 94.3 84.4 89.6 65.7 521 44.5 542 Total 44.5 41.7 95.7 44.6 92.6 69.1 80.8 55.7 2,599 37.8 2,859 Maternal and Child Health | 127 With regard to antenatal tests and examinations, 96 percent of pregnant women said they were weighed, 46 percent had their heights measured, and 93 percent had their blood pressure measured. Seven in ten women had a urine sample taken and more than eight in ten (81 percent) had a blood sample taken. More than half of the women (56 percent) received information or counselling about HIV/AIDS during their antenatal care. Thirty-eight percent of the pregnant women were given iron supplements at some point during pregnancy. Tetanus Toxoid Immunisation Tetanus toxoid (TT) injections are given during pregnancy for the prevention of neonatal tetanus, historically one of the principal causes of death among infants in many developing countries. To achieve protection for herself and her newborn baby, typically, a pregnant woman will receive at least two doses of tetanus toxoid. On the other hand, if a woman has been fully vaccinated during a previous pregnancy, she may only require one dose during her current pregnancy to achieve such protection. Five doses are considered adequate to provide lifetime protection. To estimate the extent of tetanus toxoid coverage during pregnancy, the 2004 LDHS collected data on the number of injections women received during pregnancy for the most recent birth in the five years preceding the survey. These results are presented in Table 9.4. The data may underestimate the actual extent of protection against tetanus, because women who had received prior vaccinations may not have received additional injections, as they were considered unnecessary. The data indicate that 60 percent of mothers received two or more doses of tetanus toxoid during pregnancy, and 19 percent received one dose. Eighteen percent of mothers did not receive any tetanus injection. Lower parity births and those occurring in urban areas are somewhat more likely to have been protected by tetanus vaccination than higher parity and rural births. Similarly, births to wealthier and more educated women are more likely to be protected than those to poorer and less educated women. Coverage with two doses or more of tetanus toxoid ranges from a low of 51 percent among women in Mokhotlong to 68 percent among those in Mafeteng. The table also shows that Butha-Buthe has the highest proportion of women who did not receive any TT injections (26 percent), while Qacha’s Nek has the lowest proportion (13 percent). 128 | Maternal and Child Health Table 9.4 Tetanus toxoid injections Percent distribution of women who had a live birth in the five years preceding the survey by number of tetanus toxoid injections received during pregnancy for the most recent birth, according to background characteristics, Lesotho 2004 Background characteristic None One injection Two or more injections Don't know/ missing Total Number of women Age at birth <20 15.8 19.8 62.4 2.0 100.0 546 20-34 16.2 19.2 60.9 3.8 100.0 1,832 35-49 26.4 17.2 52.7 3.7 100.0 480 Birth order 1 11.6 18.8 67.7 1.9 100.0 963 2-3 17.8 20.5 57.0 4.6 100.0 1,080 4-5 22.9 17.7 56.8 2.6 100.0 485 6+ 28.6 16.3 50.0 5.1 100.0 331 Residence Urban 12.3 16.8 65.1 5.8 100.0 448 Rural 18.9 19.4 58.8 3.0 100.0 2,411 Ecological zone Lowlands 15.1 16.4 64.0 4.5 100.0 1,508 Foothills 26.5 16.1 54.7 2.7 100.0 351 Mountains 19.7 24.6 54.2 1.5 100.0 810 Senqu River Valley 15.7 20.8 59.5 4.0 100.0 190 District Butha-Buthe 25.7 16.3 56.9 1.0 100.0 162 Leribe 19.5 18.3 57.8 4.3 100.0 446 Berea 20.2 16.1 59.3 4.4 100.0 332 Maseru 16.5 17.4 62.0 4.2 100.0 594 Mafeteng 14.6 14.1 68.0 3.3 100.0 313 Mohale's Hoek 13.7 19.8 62.2 4.3 100.0 275 Quthing 17.8 20.2 59.5 2.5 100.0 203 Qacha’s Nek 12.7 26.2 58.5 2.6 100.0 109 Mokhotlong 18.5 28.0 50.9 2.6 100.0 183 Thaba-Tseka 20.3 24.0 54.8 0.9 100.0 240 Education No education 32.3 17.0 49.1 1.5 100.0 68 Primary, incomplete 23.1 20.8 52.8 3.3 100.0 877 Primary, complete 17.1 18.4 61.2 3.2 100.0 890 Secondary+ 13.0 17.9 65.3 3.8 100.0 1,024 Wealth quintile Lowest 22.8 23.8 51.3 2.1 100.0 541 Second 21.0 19.0 56.7 3.2 100.0 645 Middle 20.7 18.4 58.2 2.7 100.0 510 Fourth 14.7 17.2 64.8 3.3 100.0 621 Highest 10.0 16.6 67.7 5.8 100.0 542 Total 17.8 19.0 59.8 3.4 100.0 2,859 9.2 DELIVERY CARE Place of Delivery The objective of providing safe delivery services is to protect the life and health of the mother as well as her child. An important component of programmes aimed at reducing the health risk to mothers and children is to increase the proportion of deliveries under the supervision of a health professional. Proper medical attention under hygienic conditions during delivery can reduce the risk of complications and infections that may cause death or serious illness either to the mother, or to the baby or both. In the 2004 LDHS, women were asked where they delivered their children born in the five years preceding the survey (Table 9.5 and Figure 9.1). Maternal and Child Health | 129 Table 9.5 Place of delivery Percent distribution of live births in the five years preceding the survey by place of delivery, according to background characteristics, Lesotho 2004 Health facility Background characteristic Public sector Private sector CHAL Home Other Missing Total Number of births Mother's age at birth <20 42.7 2.2 11.5 42.0 0.7 0.8 100.0 724 20-34 38.3 1.5 12.9 45.2 1.3 0.8 100.0 2,293 35-49 31.0 1.5 13.5 50.7 1.0 2.2 100.0 555 Birth order 1 49.1 1.8 14.2 33.3 1.1 0.6 100.0 1,238 2-3 36.1 1.7 12.2 47.2 1.8 1.0 100.0 1,332 4-5 29.8 1.9 12.9 54.7 0.3 0.5 100.0 596 6+ 22.9 0.8 9.6 63.4 0.2 3.0 100.0 405 Residence Urban 65.5 2.8 15.0 13.4 3.1 0.3 100.0 503 Rural 33.6 1.5 12.3 50.7 0.8 1.1 100.0 3,069 Ecological zone Lowlands 46.4 1.7 13.6 35.3 1.7 1.3 100.0 1,771 Foothills 24.4 1.9 16.5 55.7 0.7 0.9 100.0 456 Mountains 27.1 0.9 11.5 59.4 0.5 0.6 100.0 1,105 Senqu River Valley 53.1 4.3 4.7 36.1 1.0 0.8 100.0 239 District Butha-Buthe 33.9 3.9 16.5 44.3 0.6 0.8 100.0 201 Leribe 34.3 2.1 19.0 41.0 2.3 1.3 100.0 552 Berea 30.0 1.7 18.4 46.5 0.7 2.6 100.0 404 Maseru 44.7 1.3 14.6 37.5 1.5 0.5 100.0 715 Mafeteng 43.5 1.3 8.8 44.0 1.2 1.2 100.0 375 Mohale's Hoek 46.2 2.2 5.4 45.0 0.2 0.9 100.0 345 Quthing 48.7 3.2 2.2 45.2 0.7 0.0 100.0 255 Qacha's Nek 43.5 2.1 6.5 45.7 2.2 0.0 100.0 156 Mokhotlong 37.8 0.0 1.4 59.9 0.3 0.6 100.0 254 Thaba-Tseka 15.9 0.1 21.1 61.3 0.3 1.3 100.0 316 Mother's education No education 15.5 1.8 1.8 78.7 0.0 2.2 100.0 94 Primary, incomplete 28.0 1.5 8.0 60.3 0.7 1.6 100.0 1,156 Primary, complete 37.9 1.3 12.0 47.3 1.0 0.5 100.0 1,128 Secondary+ 49.8 2.2 18.8 26.6 1.8 0.8 100.0 1,193 Antenatal care visits1 None 9.5 1.1 1.1 86.5 1.0 0.9 100.0 251 1-3 33.3 1.1 8.1 56.1 1.3 0.0 100.0 513 4+ 45.6 1.8 16.0 35.3 1.2 0.0 100.0 1,990 Don't know/missing 39.7 0.7 11.9 37.3 3.7 6.7 100.0 104 Wealth quintile Lowest 23.5 0.5 6.4 68.5 0.5 0.6 100.0 746 Second 28.9 1.1 9.3 59.1 0.3 1.3 100.0 861 Middle 39.7 2.1 12.8 43.2 1.4 0.9 100.0 638 Fourth 45.9 2.8 16.5 32.1 1.6 1.2 100.0 721 Highest 58.0 2.1 20.9 15.9 2.2 0.9 100.0 605 Total 38.0 1.7 12.7 45.4 1.1 1.0 100.0 3,572 1 Includes only the most recent birth in the five years preceding the survey 130 | Maternal and Child Health Figure 9.1 Antenatal Care, Tetanus Vaccinations, Place of Delivery, and Delivery Assistance LDHS 2004 7.2 83.2 0.5 8.8 17.8 19 59.8 52.4 45.4 8.8 46.6 13.1 29.8 0.7 ANTENATAL CARE Doctor Nurse/midwife/nursing assistant Traditional birth attendant/other No one TETANUS VACCINATION None One Two or more PLACE OF DELIVERY Health facility Home DELIVERY ASSISTANCE Doctor Nurse/midwife/nursing assistant Traditional birth attendant Relative/friend/other No one 0 20 40 60 80 100 Percent More than half of births (52 percent) in Lesotho are delivered in a health facility, while 45 percent are delivered at home. Births to older women and births of higher order are more likely to occur at home. Similarly, rural children are more than twice as likely to be born at home as urban children. The proportion of children born at home decreases with increasing educational level and wealth quintile of the mother. For example, 79 percent of children whose mothers have no education are born at home, compared with 27 percent of those whose mothers have some secondary education. Children whose mothers had more antenatal care visits during pregnancy are less likely to deliver at home. The proportion of births delivered at home is the lowest among women who live in Maseru (38 percent) and the highest in Thaba-Tseka (61 percent). Assistance at Delivery The type of assistance a woman receives during birth has important health consequences for both the mother and the child. Women interviewed in the 2004 LDHS were asked who assisted with the delivery of their children born in the five years preceding the survey. Interviewers were able to record multiple responses if more than one person assisted during delivery. However, for the purpose of this tabulation, only the most highly qualified attendant was considered if there was more than one response. Table 9.6 shows that 55 percent of births in Lesotho are delivered under the supervision of a health professional, mainly a nurse, midwife, or nursing assistant.3 Traditional birth attendants (TBAs) play an important role, with 13 percent of deliveries being attended by them. Relatives and friends assist in 30 percent of births. Maternal age and child’s birth order are associated with the type of assistance at delivery. Births to older women and those of a higher order are slightly more likely to occur with no assistance at all than births to younger women and those of lower order. 3 In 2004 LDHS, the answer category “nurse” includes both a “registered nurse” and a “nursing assistant” since most women would not know the difference between a registered nurse and a nursing assistant. Therefore, in this report the proportion of deliveries assisted by skilled personnel includes those who have seen a nursing assistant, which may result in an overestimate of this indicator. Maternal and Child Health | 131 Table 9.6 Assistance during delivery Percent distribution of live births in the five years preceding the survey by person providing assistance during delivery, according to background characteristics, Lesotho 2004 Background characteristic Doctor Nurse/ midwife/ nursing assistant Traditional birth attendant Relative/ friend/ other No one Don't know/ missing Total Number of births Mother's age at birth <20 9.9 48.5 12.1 28.2 0.7 0.7 100.0 724 20-34 8.2 47.4 13.0 30.1 0.4 0.9 100.0 2,293 35-49 9.8 40.4 14.6 31.0 1.8 2.3 100.0 555 Birth order 1 12.1 55.3 10.7 20.9 0.4 0.6 100.0 1,238 2-3 8.4 45.2 13.4 31.4 0.6 1.0 100.0 1,332 4-5 5.6 41.3 12.9 39.2 0.3 0.7 100.0 596 6+ 5.0 32.2 19.5 37.8 2.3 3.3 100.0 405 Residence Urban 17.8 70.0 2.9 7.8 0.9 0.6 100.0 503 Rural 7.3 42.7 14.8 33.4 0.6 1.1 100.0 3,069 Ecological zone Lowlands 12.0 52.8 9.9 23.5 0.5 1.3 100.0 1,771 Foothills 7.2 37.0 17.6 35.9 1.4 0.9 100.0 456 Mountains 5.4 37.1 17.2 38.7 0.7 0.9 100.0 1,105 Senqu River Valley 3.9 62.4 8.7 24.5 0.3 0.3 100.0 239 District Butha-Buthe 7.3 48.9 16.8 26.3 0.0 0.8 100.0 201 Leribe 7.2 51.4 10.3 29.6 0.0 1.6 100.0 552 Berea 4.6 49.3 5.6 36.9 1.0 2.6 100.0 404 Maseru 20.1 43.1 15.9 19.3 1.1 0.5 100.0 715 Mafeteng 8.1 47.6 17.5 25.3 0.4 1.2 100.0 375 Mohale's Hoek 4.0 51.2 9.9 34.1 0.6 0.2 100.0 345 Quthing 3.1 57.0 7.5 32.4 0.0 0.0 100.0 255 Qacha’s Nek 9.3 47.1 26.1 17.5 0.0 0.0 100.0 156 Mokhotlong 2.9 37.5 18.6 39.3 0.3 1.3 100.0 254 Thaba-Tseka 7.3 33.6 10.7 44.4 2.3 1.7 100.0 316 Mother's education No education 1.5 19.3 17.1 56.6 3.4 2.2 100.0 94 Primary, incomplete 4.5 36.9 15.4 40.4 1.1 1.6 100.0 1,156 Primary, complete 6.8 47.3 13.9 31.1 0.3 0.6 100.0 1,128 Secondary+ 15.5 57.4 9.7 16.2 0.4 0.8 100.0 1,193 Wealth quintile Lowest 4.1 29.6 20.9 43.5 0.9 1.0 100.0 746 Second 5.7 36.3 17.2 38.9 0.6 1.4 100.0 861 Middle 8.6 47.9 10.2 31.4 0.9 0.9 100.0 638 Fourth 10.8 58.5 9.8 19.4 0.5 1.0 100.0 721 Highest 16.8 66.4 4.7 10.8 0.4 0.9 100.0 605 Total 8.8 46.6 13.1 29.8 0.7 1.1 100.0 3,572 Note: If the respondent mentioned more than one person attending during delivery, only the most qualified person is considered in this tabulation. As expected, births to women living in urban areas, to those with more education, or in the higher wealth index quintiles are more likely to be assisted by skilled personnel than those of women in other groups. Mokhotlong has the lowest proportion of deliveries assisted by skilled personnel (40 percent) followed by Thaba-Tseka (41 percent), while Maseru has the highest (63 percent). 132 | Maternal and Child Health The 2004 LDHS reported proportion of births assisted by skilled personnel (55 percent) has decreased somewhat since the EMICS 2000, which reported this indicator at 60 percent. Again, note that the 2000 EMICS collected information on births during the 12 months preceding the survey. The defi- nition of skilled personnel is the same in both surveys. Delivery Characteristics The 2004 LDHS obtained information on a number of aspects of deliveries, including the frequency of caesarean sections and low-birth-weight babies. The caesarean section rate is sometimes considered to be a proxy indicator of women’s access to care for complicated deliveries. Table 9.7 shows that only 5 percent of live births in Lesotho are delivered by caesarean section. The proportion of deliveries by caesarean section is slightly higher than average among women age 35-49 (7 percent), first order births (6 percent), births to urban women (8 percent), births in Qacha’s Nek and Lowlands (7 percent each), those to mothers with some secondary education (8 percent), and births to women in the highest wealth index quintile (9 percent). Information was also collected on the baby’s birth weight and size, because low birth weight is associated with higher neonatal morbidity and mortality. To obtain the birth weight data, mothers were asked whether their baby was weighed at birth, and if so, how much the baby weighed. Two and a half kilograms or more is considered normal birth weight and babies weighing less than that are regarded as small or low birth weight. Because most women do not deliver in a health facility, the mothers were also asked whether the baby was very large, larger than average, average, smaller than average, or very small at birth. The data in Table 9.7 shows that one-third (33 percent) of babies are not weighed at birth, presumably in part because of the low percentage of deliveries occurring in health facilities. A large majority of babies (85 percent) are considered by their mothers to be of average or larger weight; 8 per- cent are considered to be smaller than average and 4 percent are considered very small. Socioeconomic differentials in child’s birth weight are not large. However, children whose mothers have no education are more likely to be smaller than average or very small than children whose mothers have at least some education. Similarly, there is a decrease in the proportion of babies considered to be smaller than average or very small as the wealth quintile of the mother increases. On average, 7 percent of weighed children have birth weight less than 2.5 kg, while 56 percent weighed 2.5 kg or more. Births to mothers living in Qacha’s Nek and those with no education have the highest proportion of birth weight less than 2.5 kg (11 percent each) when compared with other groups. Maternal and Child Health | 133 Table 9.7 Delivery characteristics Percentage of live births in the five years preceding the survey delivered by caesarean section, and percent distribution by birth weight and by mother's estimate of baby's size at birth, according to background characteristics, Lesotho 2004 Birth weight Size of child at birth Background characteristic Delivery by C- section Not weighed Less than 2.5 kg 2.5 kg or more Don't know/ missing Total Very small Smaller than average Average or larger Don't know/ missing Total Number of births Mother's age at birth <20 4.3 30.2 6.0 59.4 4.3 100.0 3.6 9.1 84.4 2.8 100.0 724 20-34 5.0 32.6 6.6 56.8 4.1 100.0 4.2 7.6 85.9 2.3 100.0 2,293 35-49 6.6 38.5 6.6 48.2 6.7 100.0 4.7 10.2 80.3 4.8 100.0 555 Birth order 1 5.6 23.9 7.5 64.5 4.1 100.0 3.4 8.4 85.5 2.7 100.0 1,238 2-3 5.2 33.8 5.0 57.4 3.8 100.0 3.8 6.8 87.0 2.3 100.0 1,332 4-5 4.8 41.0 7.3 46.4 5.3 100.0 5.0 10.5 82.1 2.5 100.0 596 6+ 3.7 46.6 6.7 39.5 7.2 100.0 6.2 9.7 78.5 5.5 100.0 405 Residence Urban 8.0 9.3 7.4 78.5 4.9 100.0 3.5 8.6 86.3 1.7 100.0 503 Rural 4.6 36.9 6.3 52.3 4.5 100.0 4.3 8.3 84.5 3.0 100.0 3,069 Ecological zone Lowlands 6.6 24.5 6.4 64.1 5.0 100.0 3.6 6.5 86.6 3.2 100.0 1,771 Foothills 3.3 44.7 5.7 47.0 2.6 100.0 4.2 10.5 80.4 4.8 100.0 456 Mountains 3.8 43.4 6.8 45.6 4.2 100.0 4.9 10.7 82.8 1.6 100.0 1,105 Senqu River Valley 4.0 25.6 7.0 61.1 6.3 100.0 4.5 6.4 87.6 1.5 100.0 239 District Butha-Buthe 4.8 22.3 7.5 67.2 2.9 100.0 1.5 9.3 85.2 3.9 100.0 201 Leribe 5.2 36.4 5.4 54.8 3.4 100.0 4.2 6.5 86.8 2.5 100.0 552 Berea 4.0 39.7 5.4 48.7 6.2 100.0 3.9 6.1 80.5 9.5 100.0 404 Maseru 6.1 25.5 6.8 62.4 5.3 100.0 4.3 10.9 83.6 1.2 100.0 715 Mafeteng 5.5 30.1 7.3 59.9 2.7 100.0 4.0 6.4 86.8 2.8 100.0 375 Mohale's Hoek 5.6 30.4 6.5 58.7 4.4 100.0 4.5 7.4 86.7 1.4 100.0 345 Quthing 5.1 34.8 6.6 52.9 5.7 100.0 4.1 6.3 88.0 1.5 100.0 255 Qacha's Nek 7.0 18.5 10.9 64.6 6.0 100.0 6.5 12.4 80.6 0.5 100.0 156 Mokhotlong 4.6 48.8 5.5 42.9 2.8 100.0 2.4 10.4 84.4 2.8 100.0 254 Thaba-Tseka 2.8 41.5 5.8 47.0 5.7 100.0 5.8 8.9 83.6 1.7 100.0 316 Mother's education No education 2.9 61.6 11.3 19.1 8.0 100.0 7.4 11.6 77.1 3.9 100.0 94 Primary, incomplete 3.1 44.7 5.7 43.4 6.2 100.0 4.1 9.9 82.6 3.4 100.0 1,156 Primary, complete 4.5 32.9 6.6 56.2 4.2 100.0 5.7 7.1 84.4 2.8 100.0 1,128 Secondary+ 7.8 19.5 6.7 70.9 3.0 100.0 2.5 7.6 87.7 2.3 100.0 1,193 Wealth quintile Lowest 2.5 49.4 5.6 40.6 4.4 100.0 5.0 10.6 82.5 1.9 100.0 746 Second 4.0 43.0 6.6 45.4 5.0 100.0 4.8 9.0 82.9 3.3 100.0 861 Middle 5.0 32.1 6.5 58.2 3.3 100.0 4.1 6.5 84.3 5.1 100.0 638 Fourth 5.9 22.4 8.5 64.2 4.8 100.0 3.6 8.8 85.3 2.4 100.0 721 Highest 9.1 12.2 4.9 78.0 4.8 100.0 3.0 5.9 89.7 1.4 100.0 605 Total 5.1 33.0 6.5 56.0 4.5 100.0 4.2 8.3 84.7 2.8 100.0 3,572 9.3 BIRTH REGISTRATION Lesotho is a signatory to the International Convention of the Rights of the Child, which in part states that every child has the right to a name and nationality and the right to protection from being deprived of his or her identity. To assess the extent of birth registration, in the 2004 LDHS, mothers of children born in a health facility in the five years before the survey were asked if the child has been registered. In 2004 LHDS, a birth is considered to be registered if the child has a birth certificate or any other proof that the birth was reported to local authorities for purposes of initiating the registration process. 134 | Maternal and Child Health Table 9.8 shows that 26 percent of the births in Lesotho are registered. First-born children (30 percent), those who live in urban areas (39 percent) and in the Lowlands (30 percent) are more likely to be registered compared with their counterparts. District differentials indicate that the proportion of registered births is highest in Maseru (37 percent) and lowest in Mafeteng (14 percent). Birth registration is positively associated with the level of education and wealth quintile of the mother. Thirty-one percent of births among women with some secondary education are registered compared with 17 percent of births among women with no education. Similarly, births among the poorest women are less likely to be registered (24 percent) than births among the wealthiest women (36 percent). Table 9.8 Birth registration Percentage of births in the five years before the survey for which the birth was registered, by background characteristics, Lesotho 2004 Birth registered Background characteristic Yes No Don't know/ missing Number of births Birth order 1 29.7 67.3 3.0 963 2-3 25.6 71.3 3.1 1,080 4-5 22.7 74.6 2.7 485 6+ 24.1 72.0 3.8 331 Residence Urban 38.5 59.1 2.4 448 Rural 24.1 72.7 3.2 2,411 Ecological zone Lowlands 29.5 66.2 4.3 1,508 Foothills 24.7 73.6 1.7 351 Mountains 23.3 74.9 1.8 810 Senqu River Valley 17.8 81.2 0.9 190 District Butha-Buthe 30.7 68.2 1.2 162 Leribe 23.9 73.2 2.9 446 Berea 28.7 67.7 3.6 332 Maseru 37.3 57.8 4.9 594 Mafeteng 14.4 82.3 3.4 313 Mohale's Hoek 25.8 70.6 3.6 275 Quthing 18.4 79.9 1.6 203 Qacha's Nek 12.6 86.4 1.0 109 Mokhotlong 21.5 76.3 2.2 183 Thaba-Tseka 30.3 68.4 1.3 240 Education No education 17.2 82.2 0.6 68 Primary, incomplete 20.7 76.2 3.1 877 Primary, complete 27.8 69.3 2.8 890 Secondary+ 30.5 66.1 3.4 1,024 Wealth quintile Lowest 24.3 74.7 1.0 541 Second 20.7 75.4 4.0 645 Middle 23.4 72.6 4.0 510 Fourth 27.8 68.8 3.3 621 Highest 36.2 61.0 2.8 542 Total 26.3 70.6 3.1 2,859 Maternal and Child Health | 135 9.4 POSTNATAL CARE Postnatal care is important for mothers for treatment of complications arising from delivery, especially for births that occur at home. For non-institutional births particularly, postnatal care enables detection of complications that may threaten the survival of the mother. The timing of postnatal care is important. To provide the best outcome possible, it should occur within two days of the delivery since this is the critical period when most maternal deaths occur. In the 2004 LDHS, to assess the extent of utilisation of postnatal care, women with births in the last five years were asked whether they received a postnatal check-up from a health professional or a traditional birth attendant. Table 9.9 shows the percent distribution of women with a birth in the five years preceding the survey by timing of postnatal care. The table indicates that 72 percent of women do not receive any postnatal care. Twenty-three percent received postnatal care within 2 days of delivery, 3 percent received care 3-6 days after delivery, and 2 percent received care 7-41 days after delivery. A check-up within two days of delivery is more common among first-order births (29 percent), urban women (50 percent), women living in the Lowlands and Maseru (29 and 32 percent, respectively), women with some secondary education (38 percent), and those in the highest wealth quintile (48 percent). Rural areas (74 percent), Senqu River Valley (81 percent), and Mokhotlong (93 percent) have the highest proportion of women who do not receive any postnatal care. The proportion of women who do not receive a postnatal check-up is inversely related to level of education and wealth index quintile. 136 | Maternal and Child Health Table 9.9 Postnatal care by background characteristics Percent distribution of women with a live birth in the five years preceding the survey by timing of postnatal care, according to background characteristics, Lesotho 2004 Timing of first postnantal check up Background characteristic 0-2 days after delivery 3-6 days after delivery 7-41 days after delivery Don't know/ missing Did not receive postnatal checkup1 Total Number of women Age at birth <20 20.8 4.7 1.4 0.4 72.7 100.0 285 20-34 24.6 2.2 2.5 0.0 70.6 100.0 1,062 35-49 21.3 1.6 1.7 0.0 75.4 100.0 323 Birth order 1 29.3 2.7 2.5 0.3 65.3 100.0 454 2-3 24.8 2.6 2.3 0.0 70.2 100.0 642 4-5 18.9 3.6 1.9 0.0 75.6 100.0 328 6+ 14.3 0.4 1.7 0.0 83.7 100.0 245 Residence Urban 50.0 3.6 0.3 0.0 46.1 100.0 146 Rural 20.8 2.4 2.4 0.1 74.4 100.0 1,523 Ecological zone Lowlands 28.9 3.2 1.8 0.0 66.1 100.0 769 Foothills 23.6 2.9 2.5 0.5 70.5 100.0 250 Mountains 16.6 1.8 2.6 0.0 79.0 100.0 573 Senqu River Valley 16.7 0.0 2.1 0.0 81.2 100.0 77 District Butha-Buthe 28.6 7.3 7.6 0.0 56.6 100.0 96 Leribe 30.5 3.0 1.7 0.0 64.7 100.0 279 Berea 19.5 3.0 2.2 0.0 75.3 100.0 220 Maseru 32.3 2.3 2.0 0.4 63.1 100.0 315 Mafeteng 28.5 1.9 0.0 0.0 69.5 100.0 166 Mohale's Hoek 12.5 1.9 1.1 0.0 84.5 100.0 135 Quthing 14.4 0.9 0.9 0.0 83.9 100.0 92 Qacha’s Nek 14.1 0.0 9.1 0.0 76.8 100.0 57 Mokhotlong 4.0 1.5 1.5 0.0 93.1 100.0 108 Thaba-Tseka 21.2 2.2 2.1 0.0 74.5 100.0 201 Education No education 10.7 0.0 1.5 0.0 87.9 100.0 56 Primary, incomplete 14.0 1.4 1.5 0.0 83.1 100.0 597 Primary, complete 21.7 2.9 3.3 0.0 72.2 100.0 531 Secondary+ 38.1 3.8 1.9 0.2 55.9 100.0 485 Wealth quintile Lowest 10.2 1.3 1.5 0.0 87.0 100.0 398 Second 16.7 2.4 2.2 0.3 78.5 100.0 445 Middle 21.4 2.9 3.2 0.0 72.4 100.0 286 Fourth 33.9 1.9 2.5 0.0 61.7 100.0 323 Highest 47.9 5.5 1.6 0.0 45.0 100.0 217 Total 23.3 2.5 2.2 0.1 71.9 100.0 1,669 1 Includes women who received the first postnatal check-up after 41 days 9.5 REPRODUCTIVE HEALTH CARE AND WOMEN’S STATUS Table 9.10 shows how antenatal care, delivery, and postnatal care coverage differ according to certain measures of women’s status. The table does not show any positive correlation between the number of household decisions in which a woman participates and all three variables. Maternal and Child Health | 137 There is a generally steady decline in all three of the reproductive health indicators as the number of reasons for which women believe wife beating is justified increases. Among women who say wife beating is not justified in any of the situations described, 62 percent of births were attended by medical professionals, compared with 38 percent of births among women who reported that wife beating is justified in all five of the situations described. Table 9.10 Reproductive health care by women's status Percentage of women with a live birth in the five years preceding the survey who received antenatal and postnatal care from a health professional for the most recent birth, and percentage of births in the five years preceding the survey for which mothers received professional delivery care, by women's status indicators, Lesotho 2004 Women's status indicator Percentage of women who received antenatal care from doctor, nurse/midwife/ nursing assistant Percentage of women who received postnatal care within two days of delivery1 Number of women Percentage of mothers who received delivery care from doctor nurse/midwife/ nursing assistant Number of births Number of decisions in which woman has final say2 0 89.7 55.2 333 55.9 394 1-2 90.3 50.2 667 51.0 853 3-4 92.9 56.2 967 57.0 1,220 5 87.9 58.0 892 56.8 1,105 Number of reasons to refuse sex with husband 0 90.2 54.7 130 48.7 161 1-2 88.9 47.9 435 47.5 571 3-4 90.7 56.7 2,293 57.3 2,840 Number of reasons wife beating is justified 0 91.1 58.7 1,407 62.1 1,722 1-2 89.6 57.5 693 56.4 854 3-4 90.9 47.8 533 44.9 698 5 86.9 44.1 227 38.3 298 Total 90.4 55.2 2,859 55.4 3,572 1 Includes mothers who delivered in a health facility 2 Either by herself or jointly with others 9.6 VACCINATION OF CHILDREN To assess the Lesotho Expanded Programme for Immunisation (LEPI), the 2004 LDHS collected information on vaccination coverage for all children who were born in the five years preceding the survey. However, the focus of the data presented here is on children age 12-23 months at the time of the survey because they are the age group that should be fully immunised. The LEPI largely follows the World Health Organisation’s (WHO) guidelines for vaccinating children. These guidelines stipulate that for a child to be considered fully vaccinated, he/she should receive the following vaccinations: one dose of BCG, three doses each of DPT and polio, and one dose of measles. BCG should be given at birth or first clinic contact and protects against tuberculosis. DPT protects against diphtheria, pertussis, and tetanus. DPT and polio require three vaccinations at approximately 6, 10, and 14 weeks of age. Measles should be given at or soon after reaching nine months 138 | Maternal and Child Health of age. The government of Lesotho has adopted the WHO goal to ensure completion of vaccinations by 12 months of age. The target is to fully vaccinate 80 percent of children. Information presented in Table 9.11 was collected in two ways: from vaccination cards (under- five cards) seen by the interviewer, and from mothers’ verbal reports if the card was not available. Health facilities in Lesotho routinely provide cards on which vaccinations and other important health indicators are recorded. If a mother presented such a card to the interviewer, it was used as the source of information by directly transferring dates of vaccination to the questionnaire. Besides collecting vaccination information from cards, there were two ways of collecting information from the mother herself. If a card was presented, but a vaccine was not recorded as having been given, then the mother was asked to recall whether that particular vaccine had been given. In the event that the mother was not able to present a card for a child at all, she was asked to recall whether or not the child had received BCG, DPT and polio (including the number of doses for each), and measles vaccination. Table 9.11 Vaccinations by source of information Percentage of children age 12-23 months who received specific vaccines at any time before the survey, by source of information (vaccination card or mother's report), and percentage vaccinated by 12 months of age, Lesotho 2004 DPT Polio Hepatitis B Source of information BCG 1 2 3 01 1 2 3 Measles All2 No vaccina- tions 1 2 3 Number of children Vaccinated at any time before survey Vaccination card 76.5 76.3 74.9 71.7 62.6 76.1 74.5 72.3 68.9 62.6 0.0 23.0 16.4 10.1 513 Mother's report 19.9 18.3 16.7 11.1 8.8 19.3 15.7 7.4 16.0 5.2 2.3 8.3 5.5 3.5 147 Either source 96.4 94.6 91.6 82.8 71.4 95.4 90.2 79.7 84.9 67.8 2.3 31.4 22.0 13.6 660 Vaccinated by 12 months of age3 95.3 93.9 89.7 80.4 70.7 94.5 88.3 76.7 74.7 65.5 6.0 28.9 20.0 12.5 660 1 Polio 0 is the polio vaccination given at birth. 2 BCG, measles, and three doses each of DPT and polio vaccine (excluding polio vaccine given at birth) 3 For children whose information was based on the mother's report, the proportion of vaccinations given during the first year of life was assumed to be the same as for children with a written record of vaccination. Table 9.11 and Figure 9.2 present information on vaccination coverage, according to the sources of information. The data presented are for children aged 12-23 months, thereby including only those children who have reached the age by which they should be fully vaccinated. Vaccinations are most effective when given at the proper age, so it is recommended that children complete the schedule of immunisations during their first year of life (i.e., by 12 months of age). Sixty-eight percent of children age 12-23 months are fully immunised, while 2 percent received no vaccinations. Sixty-six percent of children age 12-23 months had all the recommended vaccinations by their first birthday. Maternal and Child Health | 139 Figure 9.2 Percentage of Children Age 12-23 Months with Specific Vaccinations, According to Health Cards or Mother’s Reports 96.4 94.6 91.6 82.8 71.4 95.4 90.2 79.7 84.9 67.8 2.3 BCG 1 2 3 0 1 2 3 Measles All None 0 20 40 60 80 100 120 LDHS 2004 DPT Polio Table 9.12 presents vaccination coverage (according to card information and mothers’ reports) among children age 12-23 months by selected background characteristics. At least nine out of ten children receive BCG, DPT 1, DPT 2, polio 1, and Polio 2. However, the proportion of children receiving the third dose of DPT and Polio is lower (83 and 80 percent, respectively), as is the proportion receiving measles (85 percent). Thus, the dropout rate is 12 percent for DPT and 16 percent for polio. This dropout rate represents the proportion of children who receive the first dose of a vaccine but do not go on to get the third dose. Differentials in coverage levels show that the proportion of children fully vaccinated decreases from 76 percent among first births to 58 percent of children of sixth or higher birth order. Vaccination coverage levels are similar among urban and rural children. By ecological zone, the percentage fully vaccinated ranges from 59 percent in Senqu River Valley to 69 percent in the Lowlands, and by district, it ranges from a low of 53 percent in Quthing to 79 percent in Mafeteng. Hepatitis B1, B2, and B3 have recently been added to the Lesotho immunisation schedule for children. Table 9.12 shows that 31 percent of children age 12-23 months received Hepatitis B1 vaccine, 22 percent received Hepatitis B2, and 14 percent received Hepatitis B3. Girls are somewhat less likely than boys to have received any of the Hepatitis B vaccines. As with other vaccines, the proportion of children receiving any of the Hepatitis B vaccines decreases with increasing birth order. Urban children are more likely to receive Hepatitis B vaccines than rural children. Table 9.12 shows that 78 percent of mothers of children age 12-23 months presented a vaccination card. 140 | Maternal and Child Health Table 9.12 Vaccinations by background characteristics Percentage of children age 12-23 months who received specific vaccines at any time before the survey (according to a vaccination card or the mother's report), and percentage with a vaccination card, by background characteristics, Lesotho 2004 DPT Polio Hepatitis B Background characteristic BCG 1 2 3 01 1 2 3 Measles All2 No vaccina- tions 1 2 3 Per- centage with a health card, seen Number of children Sex Male 95.1 94.0 91.9 82.4 70.1 95.3 90.6 79.2 85.5 67.4 2.7 26.3 18.3 10.8 77.1 326 Female 97.8 95.1 91.3 83.2 72.5 95.5 89.8 80.2 84.3 68.2 2.0 36.3 25.5 16.4 78.3 334 Birth order 1 99.0 97.2 94.6 88.4 76.0 96.5 90.8 83.6 91.7 76.0 0.1 35.1 26.2 15.9 80.2 229 2-3 98.7 95.0 92.8 81.6 72.8 98.2 92.6 80.7 84.9 64.7 0.3 34.6 23.5 14.6 76.6 246 4-5 90.8 93.1 90.1 82.9 68.2 92.1 90.3 77.4 80.3 63.9 6.2 26.7 18.6 12.8 79.1 112 6+ 89.6 86.9 79.9 69.0 56.8 87.4 80.1 67.6 70.8 58.4 10.4 16.1 8.7 4.6 71.3 73 Residence Urban 96.4 96.9 95.2 84.4 89.4 99.1 94.9 83.9 91.1 68.0 0.0 37.0 29.0 18.1 78.2 99 Rural 96.4 94.1 90.9 82.5 68.2 94.7 89.4 79.0 83.8 67.8 2.8 30.4 20.7 12.8 77.6 560 Ecological zone Lowlands 96.0 94.9 92.4 83.6 78.5 97.4 93.1 84.6 85.4 69.3 1.9 37.6 27.8 17.4 81.1 348 Foothills 94.4 95.5 92.1 86.2 70.2 93.9 85.8 78.0 83.1 67.0 4.5 28.6 18.5 8.7 82.3 76 Mountains 97.3 93.8 89.7 79.6 56.9 92.0 85.9 71.7 85.3 67.1 2.7 22.5 14.3 10.2 71.1 198 Senqu River Valley 100.0 93.4 92.8 85.4 83.9 98.2 94.5 81.1 82.1 59.4 0.0 26.4 15.9 6.6 71.6 38 District Butha-Buthe 99.4 98.3 93.9 88.2 82.4 98.2 90.5 76.4 89.9 72.5 0.6 36.6 23.1 11.6 78.6 35 Leribe 94.9 96.6 95.1 86.1 77.2 92.8 88.8 81.5 87.2 69.5 2.6 34.1 19.9 13.5 86.6 117 Berea 90.9 92.8 90.9 77.1 60.0 95.2 90.3 75.8 78.8 55.7 4.8 38.7 28.5 13.4 75.2 67 Maseru 96.0 91.3 86.9 77.3 82.2 96.9 91.3 79.7 85.3 62.8 2.4 33.1 27.8 15.7 76.9 135 Mafeteng 97.7 97.7 90.1 87.4 68.4 97.3 89.6 86.2 85.7 78.7 2.3 32.8 25.1 22.8 81.1 65 Mohale's Hoek 98.8 95.5 94.3 86.6 68.9 95.2 89.9 80.4 80.7 68.2 1.2 39.2 23.1 11.8 75.7 68 Quthing 96.2 91.9 90.0 77.8 78.1 95.2 90.1 75.0 72.0 53.1 3.8 20.0 11.6 4.4 69.5 43 Qacha's Nek 96.5 89.6 88.6 74.8 76.4 88.6 81.7 71.3 88.8 70.5 3.5 35.4 18.1 11.2 80.9 24 Mokhotlong 100.0 100.0 99.7 94.4 63.5 100.0 96.5 87.7 92.3 83.2 0.0 9.8 7.7 7.7 86.7 45 Thaba-Tseka 98.3 93.1 89.4 80.7 47.4 93.1 89.6 75.8 89.4 71.8 1.7 23.5 20.0 14.8 61.2 61 Education No education 84.8 84.8 76.7 51.3 60.4 69.1 69.1 51.3 74.2 48.8 15.2 17.7 9.9 0.0 66.9 11 Primary, incomplete 94.4 91.5 85.8 74.1 60.5 93.1 87.5 72.0 80.6 61.4 4.3 25.4 14.6 9.4 70.8 188 Primary, complete 97.3 96.1 94.9 86.9 69.7 96.5 91.4 81.7 89.1 73.0 1.5 27.0 20.6 14.1 76.3 215 Secondary+ 97.8 96.0 93.7 87.2 81.5 97.3 92.0 85.1 85.0 69.0 1.0 40.3 29.3 17.1 84.7 246 Wealth quintile Lowest 93.6 93.4 89.6 80.0 64.0 90.6 86.2 75.8 81.9 66.1 5.2 18.3 11.7 8.8 73.0 130 Second 99.3 93.8 89.8 80.0 60.0 96.4 89.6 75.4 87.6 67.9 0.7 28.3 18.8 9.1 73.8 154 Middle 95.9 94.9 91.7 83.1 65.3 94.5 92.0 81.3 85.3 68.8 3.3 38.3 26.2 15.1 78.4 111 Fourth 95.0 93.8 90.6 81.6 76.7 96.6 90.5 83.6 84.7 67.0 1.9 34.8 24.7 15.3 84.8 136 Highest 97.8 97.1 96.6 90.0 92.1 98.5 93.0 83.5 84.6 69.4 1.1 38.6 29.7 20.9 79.1 128 Total 96.4 94.6 91.6 82.8 71.4 95.4 90.2 79.7 84.9 67.8 2.3 31.4 22.0 13.6 77.7 660 1 Polio 0 is the polio vaccination given at birth. 2 BCG, measles, and three doses each of DPT and polio vaccine (excluding polio vaccine given at birth) In the 2001 EMICS, the proportion of children fully vaccinated before their first birthday was 77 percent, higher than the 2004 LDHS reported coverage of 68 percent. The coverage for individual vaccines has increased since 2000 with the exception of DPT3 (a decrease from 86 percent in 2000 to 83 percent in 2004) and Polio3 (a decrease from 84 to 80 percent for Polio3). Table 9.13 shows the percentage of children age 12-59 months at the time of the survey who received specific vaccines by 12 months of age, and the percentage with a vaccination card, by current age of child. Half of the children received all vaccines by 12 months of age. Children in the 48-59 month age cohort were less likely (40 percent) to have received all their vaccines compared with those in the 12-23 month age cohort (60 percent). This pattern is true for each individual vaccine. Maternal and Child Health | 141 Table 9.13 Vaccinations in first year of life Percentage of children under five years of age at the time of the survey who received specific vaccines by 12 months of age, and percentage with a vaccination card, by current age of child, Lesotho 2004 DPT Polio Hepatitis B Current age of child in months BCG 1 2 3 01 1 2 3 Measles All2 No vaccina- tions 1 2 3 Per- centage with a health card, seen Number of children 12-23 95.3 93.9 89.7 80.4 70.7 94.5 88.3 76.7 74.7 59.7 3.0 28.9 20.0 12.5 77.7 660 24-35 91.6 89.7 84.5 77.4 61.3 88.8 83.4 74.3 69.5 53.2 6.3 6.2 5.6 4.3 70.6 643 36-47 89.1 85.2 79.1 67.6 62.9 85.4 77.2 63.5 60.7 44.2 9.3 7.3 7.6 4.5 64.7 615 48-59 87.1 83.4 78.4 66.9 62.0 84.9 77.9 61.5 58.8 40.3 11.4 5.0 4.0 3.7 61.9 578 Total 91.0 88.4 83.3 73.5 64.4 88.7 82.1 69.4 66.8 49.9 7.2 13.7 9.8 6.4 69.0 2,495 Note: Information was obtained from the vaccination card or if there was no written record, from the mother. For children whose information was based on the mother's report, the proportion of vaccinations given during the first year of life was assumed to be the same as for children with a written record of vaccinations. 1 Polio 0 is the polio vaccination given at birth. 2 BCG, measles and three doses each of DPT and polio vaccine (excluding polio vaccine given at birth) 9.7 ACUTE RESPIRATORY INFECTION AND FEVER Medical records show that pneumonia is among the top ten causes of hospital admissions and among the top five causes of infant and under five mortality in Lesotho. The Lesotho Government introduced the Integrated Management of Childhood Illness (IMCI) in 1998, the orientation workshop took place in 2001 and immediately after the workshop some health personnel were selected to attend training in different African countries. The implementation, however, began in 2003 in six districts (Mokhotlong, Butha-Buthe, Maseru, Mafeteng, Quthing, and Berea) comprising of eight Health Service Areas (Mokhotlong, Seboche, Maluti, Queen Elizabeth II, Mafeteng, St. Joseph, Quthing, and Scott). There is a plan to expand the implementation to other districts before the end of 2005. The last component of Community IMCI was introduced in 2005 and the strategic plan for IMCI has been drafted. The aim is to train about 500 health workers, but only 16 percent have been trained up to this level. The strategy’s core interventions are integrated management of the four most important causes of death among children under five, namely acute respiratory infection (ARI), diarrhoea, measles, and malnutrition and anaemia. One of the IMCI approaches to combating ARI is to treat cases of ARI early before complications develop. Early diagnosis and treatment with antibiotics can prevent a large proportion of deaths resulting from pneumonia. Emphasis is therefore placed on early recognition of signs of impending severity, both by mothers and primary health care workers, so that help can be sought. It should be noted that prevalence of ARI as measured by the 2004 LDHS is based on mothers’ subjective assessment of the child’s symptoms (i.e., whether the child has been ill with a cough accompanied by short, rapid breathing in the two weeks preceding the survey). These signs are compatible with pneumonia. However, morbidity data collected in surveys are subjective (i.e., mother’s perception of illness) and not validated by medical examination. Table 9.14 shows that 19 percent of children under five were ill with a cough and rapid breathing during the two weeks preceding the survey. The reported prevalence of symptoms suggests that pneu- monia peaks at age 6-11 months. 142 | Maternal and Child Health Looking at residence, proportion of children with ARI symptoms is higher in rural areas (20 per- cent) compared with urban areas (14 percent). District differentials shows that Thaba-Tseka has the largest proportion of children with ARI symptoms (25 percent), and Butha-Buthe has the lowest level (12 percent). ARI prevalence is lower for children whose mothers have some secondary education (14 percent) and higher for children whose mother have no education (27 percent). Table 9.14 Prevalence and treatment of symptoms of ARI and fever Percentage of children under five years who had a cough accompanied by short, rapid breathing (symptoms of ARI) and percentage of children who had fever in the two weeks preceding the survey, and percentage of children with symptoms of ARI and/or fever for whom treatment was sought from a health facility or provider, by background characteristics, Lesotho 2004 Background characteristic Percentage of children with symptoms of ARI Percentage of children with fever Number of children Among children with symptoms of ARI and/or fever, percentage for whom treatment was sought from a health facility/ provider1 Among children with symptoms of ARI and/or fever, percentage for whom treatment was sought from a traditional healer Number of children Age in months <6 14.3 20.6 392 56.5 9.1 93 6-11 29.5 42.2 340 58.7 8.4 156 12-23 23.2 32.0 660 62.2 2.5 235 24-35 19.4 24.7 643 48.5 4.4 185 36-47 14.7 22.7 615 49.5 4.4 154 48-59 13.7 15.5 578 47.2 1.9 118 Sex Male 18.8 25.7 1,651 54.9 4.4 481 Female 18.7 25.4 1,576 53.9 5.1 460 Residence Urban 13.9 19.8 457 56.8 2.8 100 Rural 19.5 26.5 2,770 54.1 5.0 841 Ecological zone Lowlands 16.2 24.6 1,605 56.1 5.0 451 Foothills 21.8 31.8 418 50.8 5.3 144 Mountains 22.0 25.4 988 52.7 4.7 296 Senqu River Valley 16.4 21.2 215 59.2 0.5 50 District Butha-Buthe 11.6 30.7 185 50.3 0.3 59 Leribe 22.2 31.8 490 60.5 6.0 176 Berea 19.8 28.2 365 50.6 2.8 115 Maseru 12.6 18.9 654 43.6 9.3 138 Mafeteng 19.3 23.8 347 57.5 5.5 105 Mohale's Hoek 23.6 32.6 309 60.5 2.5 112 Quthing 14.1 18.4 229 47.7 3.3 48 Qacha's Nek 24.2 25.7 139 48.9 7.3 41 Mokhotlong 19.4 21.4 230 62.8 4.4 55 Thaba-Tseka 24.5 26.7 280 56.3 2.3 93 Education No education 27.2 32.4 79 * * 30 Primary, incomplete 21.9 28.5 1,041 49.7 7.5 335 Primary, complete 20.4 24.8 1,022 58.8 2.0 299 Secondary+ 13.5 22.8 1,086 57.5 4.4 277 Mother's smoking status Smokes cigarettes/ tobacco 24.6 31.8 478 50.4 3.1 168 Does not smoke cigarettes/tobacco 17.7 24.5 2,747 55.3 5.1 773 Wealth quintile Lowest 24.8 28.4 680 43.7 6.7 225 Second 21.1 26.0 779 54.9 7.4 239 Middle 17.8 26.5 570 58.7 2.0 176 Fourth 16.5 24.7 646 60.4 2.3 176 Highest 11.5 21.2 552 58.1 3.3 126 Total 18.7 25.5 3,227 54.4 4.7 941 Note: An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. ARI = Acute Respiratory Infection 1 Excludes pharmacy, shop, and traditional practitioner Maternal and Child Health | 143 Twenty-six percent of children under five were reported to have had fever in the two weeks preceding the survey. Fever is more common among children aged 6-11 months (42 percent) and decreases with age, the lowest prevalence being at age 48-59 months (16 percent). Prevalence of fever does not have a significant difference in males and females. Looking at ecological zone and district, Foothills (32 percent) and Mohale’s Hoek (33 percent) have the highest proportion of children with fever, and Senqu River Valley (21 percent) and Quthing (18 percent) have the lowest. Children of mothers with no education are more likely to have fever (32 percent) than those whose mothers have some secondary education (23 percent). Fifty-four percent of children with symptoms of ARI and/or fever are taken to a health facility or provider for treatment compared with 5 percent who seek treatment from traditional healers. Younger and urban children with ARI symptoms and/or fever are more likely to be taken to a health facility or provider than older children and those from rural areas. Children of mothers with higher education or who live in wealthier households are more likely than other children to be taken to a health facility or provider when they have ARI symptoms and/or fever. 9.8 DIARRHOEAL DISEASE Poor hygiene, which includes poor disposal of faecal matter, contributes to the spread of disease, especially diarrhoea. Table 9.15 shows that the most commonly used method of disposal of young children’s stools is using washable diapers (25 percent). Other methods of disposal include throwing stools in the toilet/latrine (20 percent). A closer look at the table shows marked differentials by district in the disposal of faecal matter. In Mokhotlong and Thaba-Tseka only 6 percent of mothers throw their child’s faecal matter into a latrine, and 69 and 53 percent, respectively, throw the faecal matter outside the dwelling or outside the yard. Use of diapers is highest in Quthing (36 percent) and lowest in Thaba-Tseka (13 percent). Uneducated women are less likely to use toilets or latrines for disposal of faecal matter, compared with more educated women (11 and 39 percent, respectively). As expected, mothers who have no toilet facilities in their household are much less likely to dispose of their children’s stools in toilets. 144 | Maternal and Child Health Table 9.15 Disposal of children's stools Percent distribution of mothers whose youngest child under five years is living with her by way in which child's faecal matter is disposed of, according to background characteristics and type of toilet facilities in household, Lesotho 2004 Stools contained Stools uncontained Use diapers Background characteristic Child always uses toilet/ latrine Thrown into toilet/ latrine Buried in yard Thrown outside dwelling Thrown outside yard Rinsed away Not disposed of Dispos- able Wash- able Other Missing Total Number of mothers Residence Urban 16.6 40.2 4.8 2.0 2.3 0.8 0.5 0.5 31.2 0.0 1.0 100.0 347 Rural 6.8 17.1 10.6 10.7 18.7 4.7 5.1 1.0 24.4 0.1 0.7 100.0 2,159 Ecological zone Lowlands 12.4 31.3 9.1 3.7 8.4 3.2 2.7 0.8 27.6 0.2 0.7 100.0 1,289 Foothills 4.1 15.9 10.7 12.8 17.9 5.5 8.1 0.6 24.1 0.0 0.3 100.0 323 Mountains 3.7 5.2 8.8 19.1 28.5 5.4 6.5 1.1 20.6 0.1 1.0 100.0 724 Senqu River Valley 3.1 10.0 17.9 6.7 23.5 3.4 2.2 2.2 30.4 0.0 0.5 100.0 170 District Butha-Buthe 11.7 29.9 10.7 3.5 8.4 2.4 1.2 0.8 31.4 0.0 0.0 100.0 145 Leribe 8.7 25.7 2.1 5.7 7.4 2.7 18.1 0.5 28.6 0.0 0.5 100.0 383 Berea 6.1 34.6 10.3 6.4 7.6 9.4 0.6 1.1 22.9 0.0 1.1 100.0 303 Maseru 11.3 21.0 13.0 9.6 11.0 2.7 0.2 0.9 29.3 0.4 0.6 100.0 489 Mafeteng 13.5 26.8 13.3 3.5 12.4 4.1 0.5 0.1 25.2 0.0 0.5 100.0 286 Mohale's Hoek 5.6 16.7 10.3 12.1 25.3 2.4 3.5 0.3 23.2 0.0 0.6 100.0 238 Quthing 2.7 7.6 19.4 4.6 25.1 3.8 0.0 2.2 33.5 0.0 1.0 100.0 182 Qacha’s Nek 1.5 6.8 8.8 5.4 19.2 2.0 26.6 5.8 24.0 0.0 0.0 100.0 99 Mokhotlong 1.5 5.9 1.3 22.6 46.0 3.7 1.0 0.0 17.7 0.0 0.5 100.0 162 Thaba-Tseka 9.1 6.0 9.2 25.7 27.4 7.3 0.0 1.0 11.8 0.5 2.1 100.0 219 Education No education 6.5 4.1 12.3 13.8 36.2 1.9 4.5 1.4 19.3 0.0 0.0 100.0 60 Primary, incomplete 4.2 12.0 10.7 13.5 20.7 6.0 6.9 0.9 23.7 0.0 1.4 100.0 778 Primary, complete 8.1 21.8 10.8 9.7 17.3 4.4 2.7 0.8 23.9 0.4 0.2 100.0 795 Secondary+ 11.9 27.5 8.1 5.6 10.6 2.5 3.8 1.0 28.5 0.0 0.6 100.0 873 Toilet facilities None 2.7 4.5 12.8 16.2 27.9 5.3 6.0 1.0 22.6 0.3 0.8 100.0 1,214 Pit latrine 13.9 33.2 6.6 2.4 5.9 3.5 3.2 0.8 29.9 0.0 0.5 100.0 780 Improved latrine 12.3 38.2 8.2 4.8 5.0 2.4 2.7 1.0 24.4 0.0 1.0 100.0 480 Flush toilet * * * * * * * * * * * 100.0 25 Wealth quintile Lowest 2.0 2.0 9.3 21.7 30.1 6.7 6.8 1.2 19.1 0.0 1.0 100.0 501 Second 3.4 7.3 15.0 12.2 24.0 5.6 5.8 0.7 24.4 0.5 1.0 100.0 579 Middle 5.8 23.7 10.8 7.9 16.4 3.2 4.1 1.6 26.0 0.0 0.5 100.0 443 Fourth 12.4 35.3 7.7 3.1 6.3 2.8 3.9 1.2 27.4 0.0 0.0 100.0 537 Highest 18.5 36.3 5.5 1.8 3.6 2.0 0.9 0.1 30.3 0.0 1.1 100.0 446 Total 8.2 20.3 9.8 9.5 16.5 4.1 4.5 0.9 25.3 0.1 0.7 100.0 2,506 Note: An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. Maternal and Child Health | 145 Dehydration caused by severe diarrhoea is a major cause of morbidity and mortality among children in Lesotho. In the 2004 LDHS, women with children under age five were asked if the youngest child had diarrhoea in the two weeks preceding the survey. Table 9.16 presents the prevalence of diarrhoea among children under five. Fourteen percent of children had experienced diarrhoea in the two weeks preceding the survey. Diarrhoea prev- alence increases with age to peak at 6-11 months (28 percent), then falls at older ages. There are only small variations in the prevalence of diarrhoea by sex, residence, and wealth quintile. Mokhotlong has a considerably lower prevalence of diarrhoea (8 percent) than other provinces. Diarrhoea is less common among children whose mothers have some secondary education than those whose mothers have less education. A simple and effective response to a child’s dehydration is prompt increase in intake of appropriate fluids, possibly in the form of solution prepared from oral rehydration salts (ORS). In Lesotho, families are encouraged to rehydrate children with either the commercially packaged ORS, or other fluids prepared at home with locally obtained ingredients: water, salt, and sugar (motsoako) as has been taught by health professionals. They are also advised to prevent malnutrition from diarrhoea by continuing and increasing the feeding of children who have diarrhoea. Dehydration can be treated by the use of ORS, or if dehydration is severe, intravenous fluids. ORS is usually distributed through health facilities and pharmacies, and is also available in local shops, while preparation of recommended home-made fluids is taught in health facilities. To assess the extent of familiarity with ORS, women interviewed in the 2003 LDHS who had a birth in the five years preceding the survey were asked if they had ever heard of a special product called ORS that you can get for the treatment of diarrhoea. The results are shown in Table 9.17. Table 9.16 Prevalence of diarrhoea Percentage of children under five years with diarrhoea in the two weeks preceding the survey, by background characteristics, Lesotho 2004 Background characteristic Diarrhoea in the two weeks preceding the survey Number of children Age in months <6 8.5 392 6-11 27.9 340 12-23 25.4 660 24-35 11.2 643 36-47 5.9 615 48-59 7.5 578 Sex Male 13.8 1,651 Female 14.0 1,576 Residence Urban 8.9 457 Rural 14.7 2,770 Ecological zone Lowlands 13.7 1,605 Foothills 18.2 418 Mountains 12.4 988 Senqu River Valley 13.5 215 District Butha-Buthe 12.9 185 Leribe 16.7 490 Berea 16.1 365 Maseru 12.3 654 Mafeteng 11.2 347 Mohale's Hoek 19.5 309 Quthing 10.0 229 Qacha’s Nek 13.3 139 Mokhotlong 8.4 230 Thaba-Tseka 15.3 280 Mother's education No education 15.5 79 Primary, incomplete 16.6 1,041 Primary, complete 13.3 1,022 Secondary+ 11.7 1,086 Source of drinking water Piped 13.0 1,758 Protected well 12.2 65 Open well 14.2 712 Surface 15.0 277 Other/missing 16.3 416 Wealth quintile Lowest 14.3 680 Second 18.1 779 Middle 14.7 570 Fourth 12.7 646 Highest 7.9 552 Total 13.9 3,227 146 | Maternal and Child Health Table 9.17 Knowledge of ORS packets Percentage of mothers with births in the five years preceding the survey who know about ORS packets for treatment of diarrhoea, by background character- istics, Lesotho 2004 Background characteristic Percentage of mothers who know about ORS packets Number of mothers Age 15-19 82.6 261 20-24 86.3 861 25-29 90.1 640 30-34 91.4 455 35-49 91.4 642 Residence Urban 93.5 448 Rural 87.9 2,411 Ecological zone Lowlands 92.1 1,508 Foothills 88.5 351 Mountains 83.9 810 Senqu River Valley 83.8 190 District Butha-Buthe 93.1 162 Leribe 91.7 446 Berea 82.6 332 Maseru 92.8 594 Mafeteng 95.8 313 Mohale's Hoek 87.0 275 Quthing 80.1 203 Qacha’s Nek 94.6 109 Mokhotlong 86.2 183 Thaba-Tseka 78.4 240 Education No education 80.2 68 Primary, incomplete 83.6 877 Primary, complete 89.1 890 Secondary+ 93.5 1,024 Wealth quintile Lowest 83.8 541 Second 86.4 645 Middle 89.1 510 Fourth 91.6 621 Highest 93.0 542 Total 88.8 2,859 ORS = Oral rehydration salts Nearly nine in ten mothers had heard of ORS packets. Knowledge of ORS increases with age and level of education of the mother. Mothers in urban areas are 6 percent more likely to know about ORS than rural mothers (94 and 88 percent, respectively). Among districts, mothers in Mafeteng (96 percent) are more likely to know about ORS than mothers in other districts, and women in the highest wealth quintile (93 percent) have more knowledge of ORS compared with those in the other quintiles. Maternal and Child Health | 147 Table 9.18 shows data concerning treatment of recent episodes of diarrhoea among children less than five years of age, as reported by the mothers. Results indicate that 31 percent of children with diarrhoea in the two weeks preceding the survey were taken to a health facility for treatment compared with 8 percent taken to traditional healers. Male children are more likely to be taken to a health facility for treatment than female children. Female children are more likely than male children to be taken to a traditional healer in the case of diarrhoea. District variations are hard to determine because of small numbers. Table 9.18 Diarrhoea treatment Percentage of children under five years who had diarrhoea in the two weeks preceding the survey taken for treatment to a health provider, percentage who received oral rehydration therapy (ORT), and percentage given other treatments, according to background characteristics, Lesotho 2004 Oral rehydration therapy (ORT) Other treatments Background characteristic Percentage taken to a health facility/ provider1 Percentage taken to a traditional healer ORS packets RHF Either ORS or RHF In- creased fluids ORS, RHF, or in- creased fluids Pill/ syrup Injec- tion Intra- venous solution Home remedy/ other No treat- ment Number of children Age in months <6 (26.8) (11.9) (14.3) (54.0) (59.6) (14.1) (61.8) (18.5) (0.0) (0.0) (17.2) (23.9) 33 6-11 33.7 8.4 42.2 49.4 71.4 21.9 71.4 26.4 4.9 0.0 15.2 17.5 95 12-23 31.8 8.2 46.8 57.1 79.3 39.2 86.8 16.4 4.0 2.4 22.0 9.7 167 24-35 29.7 5.5 45.4 61.4 80.3 42.6 85.6 15.8 0.0 0.6 19.8 14.4 72 36-47 (31.1) (11.3) (36.0) (50.5) (71.8) (28.6) (73.5) (21.7) (2.7) (0.0) (18.2) (15.3) (37) 48-59 (21.9) (6.8) (42.8) (55.0) (74.1) (26.3) (78.1) (16.0) (0.0) (0.0) (17.6) (21.9) (43) Sex Male 31.3 6.3 42.4 55.8 75.3 26.8 79.6 22.2 4.2 1.1 21.9 13.6 227 Female 29.6 10.2 41.4 54.6 75.1 37.5 79.6 15.6 1.2 0.9 16.2 16.0 220 Residence Urban 39.0 1.1 46.8 62.0 84.9 35.8 90.7 32.2 7.4 1.1 3.9 8.2 41 Rural 29.6 8.9 41.4 54.5 74.2 31.7 78.5 17.6 2.3 1.0 20.6 15.5 406 Ecological zone Lowlands 34.1 8.2 48.6 56.1 80.5 34.5 85.6 24.1 2.1 1.6 17.1 8.2 220 Foothills 23.4 5.0 31.9 63.0 75.2 31.7 77.4 12.0 6.5 0.5 19.8 18.9 76 Mountains 30.6 12.1 39.0 47.0 67.3 29.4 72.0 14.3 2.2 0.0 23.5 22.8 123 Senqu River Valley (21.3) (0.0) (29.4) (62.1) (68.3) (26.2) (71.5) (18.4) (0.0) (1.5) (13.6) (20.2) 29 District Butha-Buthe (35.3) (1.7) (31.6) (70.8) (73.4) (34.6) (79.2) (16.1) (1.8) (0.0) (9.1) (16.8) 24 Leribe 34.5 2.5 51.4 50.6 77.8 34.7 81.3 16.5 5.9 2.5 16.6 18.7 82 Berea (35.2) (8.9) (48.3) (59.7) (85.9) (35.2) (88.7) (25.7) (2.7) (0.0) (19.5) (2.2) 59 Maseru 23.8 15.2 37.5 54.4 73.4 37.1 78.6 20.7 1.5 0.0 26.4 13.5 80 Mafeteng (34.4) 14.8 50.4 67.3 83.8 36.2 87.5 21.7 0.0 3.8 26.1 8.0 39 Mohale's Hoek 29.9 4.1 42.4 54.8 74.6 25.2 80.0 19.1 2.6 0.7 9.9 14.4 60 Quthing * * * * * * * * * * * * 23 Qacha's Nek * * * * * * * * * * * * 19 Mokhotlong * * * * * * * * * * * * 19 Thaba-Tseka (22.8) (2.5) (27.7) (52.6) (70.5) (28.4) (73.0) (15.1) (2.5) (0.0) (20.0) (22.1) 43 Mother's education No education * * * * * * * * * * * * 12 Primary, incomplete 26.8 9.3 37.7 55.2 73.9 28.0 77.8 16.9 2.0 1.2 21.4 14.0 172 Primary, complete 35.0 9.2 49.1 57.2 75.9 31.3 79.9 20.4 2.4 0.0 19.7 15.8 136 Secondary+ 31.2 5.7 39.8 52.1 75.5 39.1 81.4 20.9 3.8 1.8 15.8 14.6 127 Wealth quintile Lowest 27.7 11.4 35.4 53.8 65.9 30.2 69.7 8.0 2.8 0.0 26.5 23.2 97 Second 27.7 9.5 37.1 55.2 78.5 31.0 82.5 16.1 2.8 1.3 22.7 11.5 141 Middle 28.7 8.5 48.1 53.3 70.2 33.9 76.1 18.3 1.2 2.4 10.8 16.7 84 Fourth 42.6 3.8 52.9 53.5 82.4 29.0 87.2 35.9 2.0 0.5 18.5 8.6 82 Highest 26.3 4.8 39.4 65.0 81.2 42.2 84.6 22.0 6.9 0.0 8.1 14.4 44 Total 30.5 8.2 41.9 55.2 75.2 32.1 79.6 19.0 2.7 1.0 19.1 14.8 447 Note: ORT includes solution prepared from oral rehydration salt (ORS) packets, recommended home fluids (RHF), or increased fluids. An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. Figures in parentheses are based on 25-49 unweighted cases. 1 Excludes pharmacy, shop, and traditional practitioner 148 | Maternal and Child Health Forty-two percent of children with diarrhoea are treated with a solution made from ORS packets. Eighty percent of the children with diarrhoea are given ORS, RHF, or more fluids to drink than before the diarrhoea occurred. Nineteen percent of children with diarrhoea are treated with a pill or syrup and an equal proportion are given home-made remedies or herbal medicines. The home-made remedies or herbal remedies are more likely to be given to younger children and children in rural areas. Fifteen percent of children with diarrhoea were given no treatment at all. To gauge knowledge about drinking and eating practices for a child with diarrhoea, mothers with children under five who had had diarrhoea in the two weeks preceding the survey were asked about the drinking and eating patterns of these children, compared with normal practice. Table 9.19 shows that 32 percent of children with diarrhoea are given more to drink than usual, and 36 percent are given the same as usual. It is particularly disconcerting to note that 20 percent of children with diarrhoea are given much less or nothing to drink. Food intake is curtailed even more than fluid intake during an episode of diarrhoea. One in three children with diarrhoea are offered the same amount of food as usual, and only one in ten are given more than usual. Twenty-six percent of children with diarrhoea are given somewhat less food to eat than usual, while 27 percent are given much less or no food at all. These patterns reflect a gap in practical knowledge among some mothers regarding the nutritional require- ments of children during episodes of diarrhoeal illness. This indicates a need for further health education efforts to reduce the number of children becoming dehydrated or malnourished because of diarrhoea. 9.9 CHILD HEALTH INDICATORS AND WOMEN’S STATUS Table 9.20 shows the relationship between indicators of children’s health and women’s status. The results show that vaccina- tion coverage and the proportion of children taken to health providers with fever or symptoms of ARI are negatively related with the number of household decisions in which a woman participates. There is no apparent relationship between the women status and the proportion of children taken to traditional healers when they have fever or symptoms of ARI. There is a negative relationship between the child health measures and the number of circumstances in which the mother feels a woman is justified in refusing to have sex with her husband. Nine percent of women who take their children with diarrhoea to traditional healers believe that wife beating is not justified for any reason, while 7 percent believe that wife beating is justified for 5-6 reasons. However, for women who take their children to the health provider when they have diarrhoea, the reverse is true, 24 percent of them believe that wife beating is not justified for any reason compared with 44 percent who believe that wife beating is justified for 5-6 reasons. Table 9.19 Feeding practices during diarrhoea Percent distribution of children under five years who had diarrhoea in the two weeks preceding the survey by amount of liquids and food offered compared with normal practice, Lesotho 2004 Liquid/food offered Percent Amount of liquids offered Same as usual 35.6 More 32.1 Somewhat less 11.9 Much less 12.7 None 7.0 Don't know/missing 0.7 Total 100.0 Amount of food offered Same as usual 30.2 More 10.1 Somewhat less 25.8 Much less 21.0 None 6.1 Never gave food 5.6 Don't know/missing 1.2 Total 100.0 Number of children 447 Maternal and Child Health | 149 Table 9.20 Children's health care by women's status Percentage of children age 12-23 months who were fully vaccinated, and percentage of children under five years who were ill with a fever, symptoms of ARI and/or diarrhoea, in the two weeks preceding the survey taken to a health provider for treatment, by women's status indicators, Lesotho 2004 Women's status indicator Percentage of children 12-23 months fully vaccinated1 Number of children Percentage of children with fever and/or symptoms of ARI taken to health provider2 Percentage of children with fever and/or symptoms of ARI taken to a traditional healer Number of children Percentage of children with diarrhoea taken to a health provider2 Percentage of children with diarrhoea taken to a traditional healer Number of children Number of decisions in which woman has final say3 0 71.7 81 60.2 5.9 100 31.4 8.5 59 1-2 67.6 153 53.3 8.6 242 34.2 12.8 120 3-4 67.9 222 53.4 1.5 345 32.3 3.8 164 5 66.3 204 54.5 4.9 254 22.8 9.6 104 Number of reasons to refuse sex with husband 0 59.4 23 57.6 1.7 48 31.5 5.0 24 1-2 73.0 111 52.7 5.2 166 36.0 9.0 82 3-4 67.1 526 54.6 4.8 727 29.1 8.2 341 Number of reasons wife beating is justified 0 65.1 312 56.6 4.3 375 23.8 9.1 161 1-2 77.3 161 53.1 3.2 252 27.3 9.1 126 3-4 62.2 146 55.9 6.6 216 37.5 6.4 107 5-6 70.3 41 46.1 6.3 99 44.4 6.9 53 Total 67.8 660 54.4 4.7 941 30.5 8.2 447 1 Those who have received BCG, measles, and three doses each of DPT and polio vaccine (excluding polio vaccine given at birth) 2 Excludes pharmacy, shops, and traditional practitioner 3 Either by herself or jointly with others 9.10 WOMEN’S PERCEPTIONS OF PROBLEMS IN OBTAINING HEALTH CARE The 2004 LDHS included a series of questions aimed at obtaining information on the problems women perceived as barriers to accessing health care for themselves. This information is particularly important in understanding and addressing the barriers women may face in seeking care in general. To obtain this information, all 2004 LDHS respondents were asked whether each of the following factors would pose a big problem in obtaining medical advice or treatment when they are sick: knowing where to go, getting permission to go, getting money needed for treatment, distance to the health facility, having to take transport, not wanting to go alone, and concern that there may not be a female provider. Table 9.21 shows the percentage of women who reported that they have big problems in accessing health care for themselves when they are sick, by type of problem and background characteristics. 150 | Maternal and Child Health Table 9.21 Problems in accessing health care Percentage of women who reported they have a big problem in accessing health care for themselves when they are sick, by type of problem and background characteristics, Lesotho 2004 Problems in accessing health care: Background characteristic Knowing where to go for treatment Getting permission to go for treatment Getting money for treatment Distance to health facility Having to take transport Not wanting to go alone Concern there may not be a female provider Any of the specified problems Number of women Age 15-19 3.7 2.2 32.4 25.8 26.3 14.4 10.1 51.9 1,710 20-29 2.4 2.1 37.3 26.9 28.4 10.5 6.4 53.9 2,507 30-39 2.7 1.7 40.2 26.7 28.4 11.1 6.1 55.0 1,545 40-49 3.6 1.4 50.0 31.6 32.8 12.0 5.7 62.4 1,334 Number of living children 0 3.3 1.9 31.4 24.2 24.3 13.1 8.9 50.2 2,386 1-2 2.8 2.3 38.7 26.6 28.4 10.6 6.6 53.7 2,563 3-4 2.8 1.3 46.2 29.9 31.6 11.0 5.7 60.7 1,327 5+ 3.2 1.9 51.8 36.0 37.9 13.5 5.6 65.9 820 Marital status Never married 3.1 2.0 33.1 22.9 23.2 12.0 8.5 49.8 2,373 Married or living together 2.9 2.2 38.9 29.3 30.7 11.5 6.6 56.1 3,709 Divorced/separated/ widowed 3.4 0.9 54.3 31.3 34.5 12.4 5.6 65.1 1,014 Residence Urban 2.4 1.3 31.7 7.4 10.9 5.1 4.5 40.1 1,682 Rural 3.2 2.1 41.5 33.7 34.3 13.9 7.9 59.9 5,413 Ecological zone Lowlands 2.8 1.6 34.2 20.4 21.7 9.9 6.7 48.9 4,299 Foothills 3.2 2.3 44.8 40.8 37.4 13.6 9.3 63.8 787 Mountains 4.0 2.8 47.5 37.9 40.7 17.1 7.5 65.6 1,572 Senqu River Valley 1.7 0.9 47.9 35.2 39.3 8.7 5.6 64.4 437 District Butha-Buthe 4.2 0.8 26.9 25.6 24.8 6.3 6.6 46.7 458 Leribe 2.8 1.7 29.8 20.0 19.3 9.7 7.3 44.3 1,065 Berea 3.5 3.6 45.4 35.4 36.2 16.6 8.4 65.4 776 Maseru 2.4 1.4 38.5 19.2 20.3 8.8 5.4 51.9 1,868 Mafeteng 1.9 0.9 33.0 24.1 23.6 9.2 5.8 46.9 755 Mohale's Hoek 5.3 3.4 43.3 39.9 46.4 20.6 13.3 64.6 684 Quthing 1.3 0.4 49.7 37.9 37.6 5.9 4.5 62.7 461 Qacha’s Nek 8.2 3.5 53.4 46.0 54.4 16.6 12.4 75.3 233 Mokhotlong 0.8 0.7 48.4 40.3 40.8 18.6 3.9 66.0 360 Thaba-Tseka 3.5 4.0 44.2 23.8 26.3 16.5 7.3 59.2 435 Education No education 5.6 3.5 61.5 50.1 51.3 20.6 9.7 75.4 145 Primary, incomplete 4.1 2.9 48.4 36.4 37.7 16.0 8.5 65.4 2,136 Primary, complete 3.5 2.1 40.7 29.4 30.3 12.2 6.7 58.8 1,960 Secondary+ 1.8 0.9 30.0 18.3 19.8 8.0 6.2 44.2 2,854 Employment Not employed 3.4 2.3 38.8 29.2 28.9 13.0 8.0 55.0 3,915 Working for cash 2.5 1.6 36.2 17.8 20.8 8.0 5.1 49.3 1,995 Not working for cash 2.7 1.3 45.1 38.6 41.6 14.6 7.4 66.1 1,176 Missing 0.0 0.0 36.4 2.1 23.3 2.1 2.1 57.7 10 Wealth quintile Lowest 4.4 3.5 53.7 45.5 49.2 18.5 7.9 71.3 987 Second 3.4 2.4 51.2 39.0 38.8 17.0 8.9 68.7 1,294 Middle 4.3 2.4 41.6 32.4 34.2 14.1 8.6 60.0 1,258 Fourth 2.4 1.4 34.9 23.1 24.1 10.4 7.6 52.8 1,595 Highest 1.8 1.0 25.7 11.2 12.0 4.8 4.2 37.2 1,962 Total 3.0 1.9 39.1 27.5 28.7 11.8 7.1 55.2 7,095 It is clear from the table that women have problems in accessing health care services, with 55 per- cent of all women citing at least one of the specified problems. The majority of women said that difficulty in getting money for treatment was a big problem (39 percent), followed by problems with transport (29 percent) and distance to a health facility (28 percent). Seven percent of women were concerned that there may not be a female health provider, and only 2 percent indicated that getting permission to go for treatment is a big problem. Maternal and Child Health | 151 9.11 HEALTH CARD/BUKANA The 2004 LDHS collected information from eligible women and men on whether they have a health card (locally called Bukana), and if so, whether they have ever used another person’s health card. This information is important in assessing use of health cards by the population as an important tool for tracking their health. Some individuals tend to use another person’s health card when they seek care for certain health issues that might be associated with stigma, such as STIs, tuberculosis, or HIV/AIDS. The findings are presented in Table 9.22. Forty-four percent of men and 43 percent of women have a health card. Rural respondents are more likely than urban respondents to have a health card. Respondents who have been diagnosed with STIs, HIV, or TB have a higher rate of health card/Bukana ownership than those who are not. Table 9.22 Health card/Bukana Percentage of respondents who have a health card/Bukana, and of those, the percentage who have ever used someone else's health card/Bukana, by background characteristics, Lesotho 2004 Male Female Background characteristic Percentage who have a health card/ Bukana Percentage who have ever used someone else's health card/Bukana Number Percentage who have a health card/ Bukana Percentage who have ever used someone else's health card/Bukana Number Age 15-19 42.2 1.3 752 14.8 1.0 1,761 20-24 43.7 1.2 508 59.9 1.9 1,456 25-29 46.0 2.2 367 68.4 3.4 1,026 30-34 47.7 0.7 306 62.8 2.1 807 35-39 43.4 1.8 226 50.8 1.8 740 40-44 35.6 1.2 163 34.3 1.4 714 45-49 42.8 0.6 173 16.1 0.8 591 50-54 47.3 1.8 165 na na na 55-59 43.8 0.7 137 na na na Residence Urban 32.4 0.6 694 32.5 1.7 1,945 Rural 47.4 1.6 2,103 47.1 1.8 5,150 Ecological zone Lowlands 38.7 1.1 1,248 37.4 1.9 3,118 Foothills 46.4 1.0 392 46.4 1.9 999 Mountains 48.6 1.8 877 49.0 1.8 2,274 Senqu River Valley 46.8 1.1 280 44.6 0.7 704 District Butha-Buthe 38.5 0.7 304 39.5 1.9 774 Leribe 52.2 1.3 297 44.7 1.5 845 Berea 45.5 0.6 330 43.8 1.9 685 Maseru 37.5 2.0 405 36.5 2.3 1,059 Mafeteng 42.5 0.7 285 44.3 2.3 709 Mohale's Hoek 42.6 1.5 331 42.7 1.6 803 Quthing 39.5 0.5 200 44.9 0.7 574 Qacha's Nek 51.2 3.3 213 43.1 1.4 497 Mokhotlong 43.7 2.1 238 47.3 1.7 605 Thaba-Tseka 48.5 0.5 194 50.0 1.7 544 Education No education 51.4 1.3 549 49.1 1.8 169 Primary, incomplete 45.9 1.7 1,165 43.9 1.9 2,244 Primary, complete 36.9 1.4 347 48.1 1.8 1,966 Secondary+ 37.6 0.7 736 38.5 1.6 2,716 Presence of STI Has an STI 47.2 1.5 265 55.0 3.7 931 Does not have an STI 43.3 1.3 2,532 41.3 1.5 6,164 HIV status Positive 47.5 1.2 423 46.2 1.5 769 Negative 43.2 1.4 1,819 39.5 1.8 2,051 TB diagnosis Diagnosed with TB 44.4 1.7 117 46.6 1.7 176 Not diagnosed with TB 43.7 1.3 2,680 43.0 1.7 6,919 Wealth quintile Lowest 52.5 2.2 594 51.0 2.3 1,503 Second 49.9 1.8 557 50.0 1.5 1,384 Middle 46.9 1.5 548 44.2 1.3 1,276 Fourth 36.6 0.5 576 36.6 1.7 1,378 Highest 31.4 0.6 522 34.1 1.9 1,554 Total 43.7 1.3 2,797 43.1 1.7 7,095 na = Not applicable 152 | Maternal and Child Health Ownership of a health card/Bukana seems to be inversely related to the level of education of the respondents (i.e., the lower the level of education, the higher the ownership of a health card/Bukana). Ownership of a health card/Bukana decreases with increasing wealth. one percent of men and 2 percent of women report having ever used another person’s health card. 9.12 SMOKING AND ALCOHOL USE To measure the extent of smoking among Basotho adults, women and men interviewed in the 2004 LDHS were asked if they currently smoked cigarettes or used tobacco. Tables 9.23.1 and 9.23.2 show the results. Data show that there is a marked difference in the use of tobacco products between women and men. Fifteen percent of women use tobacco products compared with 42 percent of men. Table 9.23.1 Use of smoking tobacco: women Percentage of women who smoke cigarettes or use tobacco, according to background characteristics and maternity status, Lesotho 2004 Background characteristic Cigarettes Pipe Snuff Other tobacco Does not use tobacco Number of women Age 15-19 0.3 0.0 0.4 0.0 99.3 1,710 20-34 0.1 0.0 9.1 0.1 90.6 3,323 35-49 0.4 0.1 34.4 1.1 64.1 2,062 Residence Urban 0.4 0.0 9.3 0.1 90.2 1,682 Rural 0.2 0.0 15.9 0.5 83.4 5,413 Ecological zone Lowlands 0.3 0.0 11.8 0.4 87.4 4,299 Foothills 0.0 0.1 12.7 0.4 86.9 787 Mountains 0.1 0.0 20.8 0.5 78.6 1,572 Senqu River Valley 0.3 0.0 19.0 0.0 80.7 437 District Butha-Buthe 0.1 0.2 10.4 0.1 89.2 458 Leribe 0.2 0.0 10.9 0.2 88.7 1,065 Berea 0.2 0.0 11.3 0.9 87.6 776 Maseru 0.4 0.0 10.9 0.3 88.4 1,868 Mafeteng 0.4 0.0 15.3 0.1 84.1 755 Mohale's Hoek 0.0 0.2 17.3 0.6 82.0 684 Quthing 0.2 0.0 17.7 0.5 81.6 461 Qacha's Nek 0.1 0.0 30.5 0.4 69.0 233 Mokhotlong 0.3 0.0 22.6 0.2 76.9 360 Thaba-Tseka 0.0 0.0 22.0 0.3 77.5 435 Education No education 0.0 0.0 49.5 1.1 49.4 145 Primary, incomplete 0.2 0.1 22.5 0.7 76.6 2,136 Primary, complete 0.1 0.0 13.9 0.3 85.6 1,960 Secondary+ 0.3 0.0 6.8 0.1 92.7 2,854 Maternity status Pregnant 0.4 0.0 8.1 0.0 91.5 429 Breastfeeding (not pregnant) 0.0 0.1 11.6 0.3 88.0 1,285 Neither 0.3 0.0 15.5 0.4 83.8 5,380 Wealth quintile Lowest 0.0 0.2 24.0 0.7 74.9 987 Second 0.2 0.0 19.4 0.2 80.2 1,294 Middle 0.1 0.0 13.4 0.7 85.7 1,258 Fourth 0.1 0.0 14.1 0.4 85.5 1,595 Highest 0.5 0.0 7.0 0.1 92.5 1,962 Total 0.2 0.0 14.3 0.4 85.0 7,095 For women, the most commonly used type of tobacco product is snuff (14 percent). Eight percent of pregnant women use snuff compared with 16 percent who are neither pregnant nor breastfeeding. The use of snuff decreases with increases in education and wealth quintile. Fifty percent of women with no education use snuff compared with 7 percent of women with at least some secondary education. Women in the lowest wealth quintile are more than three times as likely to use snuff as women in highest wealth quintile (24 and 7 percent, respectively). Women age 35-49 (34 percent) and women living in rural areas Maternal and Child Health | 153 (16 percent) are more likely to use snuff than women age 15-19 (less than 1 percent) urban women (9 per- cent). District level variations show that Qacha’s Nek has the highest proportion of women who use snuff (31 percent), and Butha-Buthe has the lowest (10 percent). Because the number of women who smoke cigarettes is small, Table 9.23.1 does not present data on the number of cigarettes women smoked in the past 24 hours. Table 9.23.2 shows that men age 20-34 are more likely to smoke cigarettes than men age 35-49 (18 and 11 percent, respectively). Men who live in urban areas (25 percent), in Lowlands (17 percent), and Mokhotlong (29 percent) are more likely to smoke cigarettes than their counterparts. Men with lower education and those in the lower wealth quintiles are less likely to smoke cigarettes than men with higher education and those in higher wealth quintiles. However, this trend is reversed for other tobacco products. Table 9.23.2 Use of smoking tobacco: men Percentage of men who smoke cigarettes or tobacco and percent distribution of cigarette smokers by number of cigarettes smoked in preceding 24 hours, according to background characteristics , Lesotho 2004 Number of cigarettes Background characteristic Cigarettes Pipe Snuff Other tobacco Does not use tobacco Total 0 1-2 3-5 6-9 10+ Don't know/ missing Total Number of cigarette smokers Age 15-19 14.0 3.2 1.0 22.6 60.6 771 3.2 31.5 32.5 10.6 22.2 0.0 100.0 108 20-34 17.5 4.2 1.3 24.3 54.6 1,321 5.4 15.9 37.0 16.3 24.8 0.5 100.0 231 35-49 11.4 3.3 0.9 22.9 62.4 705 3.9 26.5 24.7 18.8 24.9 1.1 100.0 80 Residence Urban 25.0 1.6 0.0 9.4 65.6 603 4.3 19.8 28.5 16.0 31.1 0.3 100.0 151 Rural 12.2 4.3 1.4 27.3 56.2 2,194 4.7 23.2 36.2 14.9 20.3 0.6 100.0 268 Ecological zone Lowlands 16.8 3.4 0.8 19.1 61.1 1,734 2.7 22.3 31.8 16.1 26.9 0.2 100.0 291 Foothills 9.9 3.3 2.2 30.5 56.8 307 10.0 15.3 40.9 13.2 20.6 0.0 100.0 30 Mountains 13.2 5.1 1.6 29.8 51.9 585 7.4 20.3 41.6 11.1 17.5 2.2 100.0 77 Senqu River Valley 12.1 2.8 0.5 33.5 53.2 171 (11.8) (33.6) (15.5) (23.2) (15.9) (0.0) 100.0 21 District Butha-Buthe 12.0 10.4 0.9 21.3 56.6 182 (0.0) (26.8) (38.7) (13.8) (18.7) (2.0) 100.0 22 Leribe 14.8 0.5 1.8 24.7 58.7 393 (1.7) (21.1) (30.9) (19.7) (26.7) (0.0) 100.0 58 Berea 10.8 1.4 0.0 30.0 59.7 350 (4.5) (21.2) (35.9) (15.6) (22.8) (0.0) 100.0 38 Maseru 18.9 0.5 0.6 18.9 62.8 741 4.4 22.4 28.0 13.6 31.6 0.0 100.0 140 Mafeteng 13.6 7.9 1.6 16.7 60.9 297 (5.2) (12.6) (40.8) (13.6) (27.7) (0.0) 100.0 40 Mohale's Hoek 15.8 8.7 1.8 22.1 53.8 281 (3.2) (22.3) (41.0) (19.4) (14.1) (0.0) 100.0 44 Quthing 12.6 0.0 0.5 38.2 53.0 167 * * * * * * 100.0 21 Qacha's Nek 10.9 10.4 2.3 21.1 57.3 99 * * * * * * 100.0 11 Mokhotlong 29.4 0.6 1.3 23.3 45.5 130 6.0 25.4 41.3 9.1 16.2 2.0 100.0 38 Thaba-Tseka 3.9 9.6 2.0 30.6 53.2 156 * 19.5 60.9 17.2 2.3 0.0 100.0 6 Education No education 11.6 2.4 1.4 31.7 55.2 166 * * * * * * 100.0 19 Primary, incomplete 10.8 4.6 2.0 26.3 57.7 893 6.6 23.8 28.5 17.3 23.4 0.5 100.0 97 Primary, complete 17.3 4.2 1.5 26.0 52.8 621 7.2 17.0 39.6 12.6 22.8 0.7 100.0 108 Secondary+ 17.9 3.0 0.1 18.7 61.2 973 1.9 22.1 33.5 14.6 27.3 0.5 100.0 174 Wealth quintile Lowest 9.5 5.9 2.4 38.7 44.9 445 9.9 19.2 34.7 11.6 24.7 0.0 100.0 42 Second 11.3 5.9 2.4 35.2 46.3 495 4.2 24.5 40.1 8.2 21.6 1.4 100.0 56 Middle 13.1 4.5 1.5 29.0 53.8 548 1.3 21.3 46.5 17.5 13.5 0.0 100.0 72 Fourth 17.6 2.8 0.0 15.7 66.0 598 5.3 20.4 32.6 20.3 21.4 0.0 100.0 105 Highest 21.4 0.9 0.0 6.4 72.1 605 4.7 19.6 25.4 15.4 33.8 1.0 100.0 130 Total 15.0 3.7 1.1 23.5 58.2 2,797 4.6 22.0 33.5 15.3 24.2 0.5 100.0 419 Note: An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. Figures in parentheses are based on 25-49 unweighted cases. 154 | Maternal and Child Health Thirty-four percent of male cigarette smokers report smoking 3-5 cigarettes per day and 24 per- cent smoke 10 or more cigarettes per day. Alcohol contributes to low birth weight babies and affects brain development during pregnancy, as well as affecting the mother’s health. It is recommended that women should avoid alcohol during pregnancy and breastfeeding. Table 9.24 shows that 70 percent of women interviewed in the 2004 LDHS report that they have ever drunk alcohol, compared with 42 percent of men. In the 3 months preceding the survey, 13 percent of women drank alcohol, compared with 38 percent of men. Older women and men are more likely to drink alcohol in the past few months than younger ones. The proportion of urban women and men who drank alcohol in the last 3 months is higher (16 and 41 percent, respectively) compared with rural women and men (12 and 37 percent, respectively). Table 9.24 Use of alcohol Percentage of women age 15-49 and men age 15-59 who have ever drunk alcohol and who have drunk alcohol in the past 3 months, by background characteristics, Lesotho 2004 Women Men Background characteristic Ever drank alcohol Drank alcohol in past 3 months Number of women Ever drank alcohol Drank alcohol in past 3 months Number of men Age 15-19 84.4 5.4 1,710 66.9 18.8 743 20-24 76.9 10.2 1,463 50.1 31.8 507 25-29 73.8 12.6 1,044 39.9 41.1 374 30-34 72.8 14.5 816 35.1 54.1 305 35-39 68.5 17.3 728 38.5 50.7 233 40-44 61.7 23.6 741 25.9 61.3 164 45-49 54.8 29.3 592 26.4 60.3 170 50-54 na na na 20.4 63.2 164 55-59 na na na 28.9 57.0 137 Residence Urban 64.8 15.5 1,745 37.5 41.4 628 Rural 71.5 12.2 5,710 43.7 36.8 2,340 Ecological zone Lowlands 67.6 12.9 4,514 40.8 38.3 1,830 Foothills 74.5 9.8 839 43.4 34.5 332 Mountains 75.6 13.8 1,644 49.4 36.1 622 Senqu River Valley 63.8 16.0 459 32.5 44.1 183 District Butha-Buthe 81.3 7.6 481 58.9 24.6 193 Leribe 70.2 11.5 1,114 36.1 40.6 417 Berea 70.5 11.1 814 40.3 39.8 371 Maseru 64.8 14.8 1,976 36.1 42.7 787 Mafeteng 72.4 10.6 795 58.4 27.0 307 Mohale's Hoek 66.7 15.4 718 36.1 37.6 304 Quthing 63.0 14.0 490 29.9 43.9 183 Qacha's Nek 71.7 19.1 236 46.4 41.7 101 Mokhotlong 81.1 12.9 371 54.7 33.6 139 Thaba-Tseka 76.6 13.0 460 56.0 33.4 165 Education No education 57.8 34.2 145 41.7 47.3 479 Primary, incomplete 72.3 17.3 2,136 50.0 36.3 1,194 Primary, complete 77.5 10.8 1,960 44.0 38.4 352 Secondary+ 72.3 11.7 2,854 39.5 42.3 773 Wealth quintile Lowest 76.2 18.1 987 44.1 48.2 466 Second 76.3 14.4 1,294 43.0 42.4 514 Middle 75.1 11.2 1,258 47.2 40.7 566 Fourth 73.3 12.3 1,595 50.7 30.7 621 Highest 69.3 13.4 1,962 39.5 41.0 630 Total 69.9 12.9 7,455 42.4 37.8 2,967 na = Not applicable Maternal and Child Health | 155 Men with some secondary education are more likely (42 percent) to have drunk alcohol in the past three months than their women counterparts (12 percent). Similarly, 41 percent of men in the highest wealth quintile have drunk in the past three months compared with women in the highest wealth quintile (13 percent). At the district level, Qacha’s Nek has the highest proportion of women who drank in the past three months (19 percent), and Butha-Buthe has the lowest (8 percent). Among men, the proportion who drank in the past three months is highest in Quthing (44 percent) and Maseru (43 percent) and lowest in Butha-Buthe (25 percent). There is a greater tendency for less educated women to have drunk alcohol in the past three months than more educated women; the difference is not significant in men. Nutrition | 157 NUTRITION 10 Mahlape Ramoseme Nutritional status is the result of complex interactions between food consumption and the overall status of health and care practices. Poor nutritional status is one of the most important health and welfare problems facing Lesotho today and afflicts the most vulnerable groups: women and children. At the indi- vidual level, inadequate or inappropriate feeding patterns lead to malnutrition. Numerous socioeconomic and cultural factors influence the decision on patterns of feeding and nutritional status. The 2004 LDHS used 24-hour recall to determine foods eaten in the past 24 hours, including breastfeeding, complementary feeding, and use of feeding bottles. Heights and weights of all children under five years and women age 15-49 were measured to determine the adult female and child nutritional status. This chapter presents the findings on infant feeding practices and nutritional status of women and children. 10.1 BREASTFEEDING AND SUPPLEMENTATION Feeding practices play a pivotal role in determining optimal development of infants. Poor breast- feeding and infant feeding practices have adverse consequences for the health and nutritional status of children, which in turn has consequences on the mental and physical development of the child. 10.1.1 Initiation of Breastfeeding Breastfeeding is sufficient and beneficial for infant nutrition in the first six months of life. Early initiation of breastfeeding (breastfeeding within one hour) facilitates the newborn’s innate sucking reflex, which helps to stimulate breast milk production and provides all of the nutritional requirements of a young infant (Righard and Alade, 1990). The high concentration of antibodies in colostrum, the first yellowish, highly nutritious milk that is present right after delivery, protects the child from infection before the child’s immune system has matured. Early initiation also encourages the bond between mother and baby and helps to maintain the baby’s body temperature. Breastfeeding also helps the uterus to retract, hence reducing postpartum blood loss of the mother. Prelacteal feeding (giving something other than breast milk in the first three days of life) is generally discouraged because it may inhibit breast- feeding and expose the newborn infant to illness. Table 10.1 indicates that 95 percent of children are breastfed at some point. Sixty-three percent of children are breastfed within one hour of birth and 85 percent within one day after delivery. The proportion of women initiating breastfeeding within one hour of birth is highest in Mokhotlong and Quthing (77 percent) and lowest in Thaba-Tseka (45 percent). Forty-five percent of children are given something before breastfeeding (prelacteal feed). Mothers who were assisted by traditional birth attendant (59 percent) are more likely to practise prelacteal feeding than those assisted by health professionals (39 percent). Prelacteal feeding is most common in Mokhotlong (58 percent) and Quthing (53 percent) and least common in Leribe (37 percent). 158 | Nutrition Table 10.1 Initial breastfeeding Percentage of children born in the five years preceding the survey who were ever breastfed, and among children ever breastfed, percentage who started breastfeeding within one hour and within one day of birth and percentage who received a prelacteal feed, by background characteristics, Lesotho 2004 Children ever breastfed All children Background characteristic Percentage ever breastfed Number of children Percentage who started breastfeeding within 1 hour of birth Percentage who started breastfeeding within 1 day of birth1 Percentage who received a prelacteal feed2 Number of children ever breastfed Sex Male 94.7 1,834 59.7 83.0 46.0 1,736 Female 94.8 1,737 65.4 87.2 44.4 1,648 Residence Urban 92.4 503 64.6 83.4 49.0 465 Rural 95.1 3,069 62.1 85.3 44.6 2,919 Ecological zone Lowlands 94.1 1,771 63.0 84.2 43.4 1,668 Foothills 97.0 456 59.5 85.4 44.3 442 Mountains 94.5 1,105 60.3 85.7 47.8 1,044 Senqu River Valley 96.0 239 74.2 87.5 48.6 230 District Butha-Buthe 95.4 201 67.5 91.3 42.3 191 Leribe 96.5 552 55.6 88.5 36.6 532 Berea 95.0 404 64.2 84.0 42.8 384 Maseru 94.0 715 59.2 79.8 51.1 672 Mafeteng 93.8 375 69.4 86.9 40.6 352 Mohale's Hoek 94.3 345 62.5 85.5 46.3 325 Quthing 95.9 255 76.6 88.8 53.1 244 Qacha’s Nek 93.3 156 63.6 90.0 40.6 145 Mokhotlong 94.9 254 76.6 89.3 58.1 241 Thaba-Tseka 94.1 316 44.8 76.4 41.9 297 Mother's education No education 92.1 94 64.4 85.6 54.3 87 Primary, incomplete 95.4 1,156 63.5 86.1 49.0 1,103 Primary, complete 95.2 1,128 61.1 84.2 45.0 1,073 Secondary+ 94.0 1,193 62.6 84.8 41.0 1,121 Assistance at delivery Health professional3 95.0 1,978 62.1 85.6 39.1 1,879 Traditional birth attendant 95.2 467 62.8 86.3 58.7 445 Other 94.0 1,065 64.9 86.2 52.1 1,002 No one * * * * * 21 Place of delivery Health facility 94.9 1,418 64.6 86.1 39.2 1,345 At home 94.6 1,623 63.7 85.6 54.4 1,535 Other 95.2 495 56.2 85.9 35.6 471 Wealth quintile Lowest 95.7 746 61.1 85.4 49.9 714 Second 95.9 861 62.4 85.4 45.7 826 Middle 95.3 638 59.1 84.2 42.1 608 Fourth 94.9 721 65.1 85.6 44.1 684 Highest 91.2 605 64.8 84.5 43.3 552 Total 94.7 3,572 62.5 85.1 45.2 3,384 Note: Table is based on all births whether the children are living or dead at the time of interview. An asterisk indicates that a figure is based on fewer than 25 cases and has been suppressed. 1 Includes children who started breastfeeding within one hour of birth 2 Children given something other than breast milk during the first three days of life before the mother started breastfeeding regularly 3 Doctor, nurse, midwife, or nursing assistant Nutrition | 159 10.1.2 Infant and Young Child Feeding For optimal growth, it is recommended that infants should be exclusively breastfed for the first six months of life. Exclusive breastfeeding in the early months of life is correlated strongly with increased child survival and reduced risk of morbidity, particularly from diarrhoeal diseases. Table 10.2 shows that exclusive breastfeeding is a common but not universal practice in Lesotho. Fifty-four percent of children less than two months of age are exclusively breastfed. The data in Table 10.2 also show that comple- mentary foods are introduced at a young age in Lesotho. While a little more than half (54 percent) of children are exclusively breastfed at two months of age (as recommended), the remainder are receiving liquids and solid foods prematurely. Conversely, 30 percent of children age 6-7 months are still consuming a liquid diet at an age when solid foods should form an important part of their diet. Table 10.2 Breastfeeding status by age Percent distribution of youngest children under three years living with the mother by breastfeeding status and percentage of children under three years using a bottle with a nipple, according to age in months, Lesotho 2004 Breastfeeding and consuming: Age in months Not breast- feeding Exclusively breastfed Plain water only Water- based liquids/ juice Other milk Comple- mentary foods Total Number of children Percentage using a bottle with a nipple1 Number of children <2 2.0 53.8 18.9 12.1 10.4 2.8 100.0 111 28.9 113 2-3 2.7 41.5 14.6 6.8 17.0 17.3 100.0 145 35.9 147 4-5 4.1 15.2 3.8 12.4 13.7 50.8 100.0 127 34.0 132 6-7 5.5 7.2 0.0 9.2 7.2 70.9 100.0 107 33.5 109 8-9 3.4 5.4 0.0 2.4 1.4 87.3 100.0 102 20.1 106 10-11 9.9 2.3 0.2 3.8 2.4 81.4 100.0 122 19.9 125 12-15 9.8 0.8 0.3 1.4 0.6 87.1 100.0 260 14.5 265 16-19 25.5 2.1 0.0 0.5 2.7 69.2 100.0 207 14.2 217 20-23 40.5 0.0 0.0 0.0 0.5 59.0 100.0 165 10.9 178 24-27 69.1 0.9 0.0 0.0 0.0 30.1 100.0 198 3.5 236 28-31 91.1 2.0 0.0 0.0 0.0 6.8 100.0 160 0.7 201 32-35 89.6 1.1 0.0 0.0 0.0 9.2 100.0 151 1.8 206 <6 3.0 36.4 12.3 10.2 14.0 24.2 100.0 382 33.3 392 6-9 4.5 6.3 0.0 5.9 4.4 78.9 100.0 209 26.9 214 Note: Breastfeeding status refers to a "24-hour" period (yesterday and last night). Children classified as breastfeeding and consuming plain water only consume no supplements. The categories of not breastfeeding, exclusively breastfed, breastfeeding and consuming plain water, water-based liquids/juice, other milk, and complementary foods (solids and semi-solids) are hierarchical and mutually exclusive, and their percentages add to 100 percent. Thus, children who receive breast milk and water-based liquids and who do not receive complementary foods are classified in the water-based liquid category even though they may also get plain water. Any children who get complementary food are classified in that category as long as they are breastfeeding as well. 1 Based on all children under three years 160 | Nutrition Figure 10.1 Breastfeeding Practices by Age <2 2-3 4-5 6-7 8-9 10-11 Age in Months 0 20 40 60 80 100 Exclusively breastfed Breast milk and plain water Breast milk and non-milk liquids Breast milk and other milk Breast milk and complementary foods Not breastfeeding LDHS 2004 Table 10.3 shows that the median duration for any breastfeeding among Basotho children is 21 months. The median duration of exclusive breastfeeding is estimated at less than one month. The median duration of any breastfeeding is slightly higher in rural areas (22 months) compared with urban (17 months). At the ecological zone level, duration of breastfeeding is longest in Mountains and Senqu River Valley (23 months) and shortest in Lowlands (19 months). Analysis by background characteristics of the mother indicates that there is no clear relationship between the level of mother’s education and breastfeeding practices. The socioeconomic status shows that women in the lowest quintile are more likely to breastfeed longer (24 months) than women in the highest quintile (18 months). Frequent breastfeeding of children less than six months of age is a common occurrence in Lesotho. More than nine in ten (94 percent) infants under six months of age were breastfed 6 or more times in the 24 hours preceding the survey. Nutrition | 161 Table 10.3 Median duration and frequency of breastfeeding Median duration of any breastfeeding, exclusive breastfeeding, and predominant breastfeeding among children born in the three years preceding the survey, percentage of breastfeeding children under six months living with the mother who were breastfed six or more times in the 24 hours preceding the survey, and mean number of feeds (day/night), by background characteristics, Lesotho 2004 Breastfeeding children under six months2 Median duration (months) of breastfeeding1 Background characteristic Any breast- feeding Exclusive breast- feeding Predominant breast- feeding3 Number of children Percentage breastfed 6+ times in past 24 hours Mean number of day feeds Mean number of night feeds Number of children Sex Male 20.7 0.9 3.3 1,144 94.5 7.0 5.8 198 Female 21.8 1.0 2.7 1,079 94.2 7.3 5.8 177 Residence Urban 17.1 0.6 2.2 308 90.9 5.7 6.1 47 Rural 22.2 1.0 3.1 1,914 94.9 7.3 5.8 328 Ecological zone Lowlands 19.4 0.7 2.9 1,096 93.6 6.7 5.7 173 Foothills 21.9 0.7 2.0 291 91.6 7.5 6.0 54 Mountains 23.1 1.6 3.3 686 95.6 7.2 5.9 122 Senqu River Valley (23.1) (0.7) (3.6) (149) (99.1) (8.6) (5.5) 27 District Butha-Buthe (20.5) (1.2) (4.1) (131) (96.4) (6.3) (5.3) 26 Leribe (22.9) (2.4) (3.5) (344) (86.7) (7.9) (5.9) 51 Berea (21.5) (0.6) (2.4) (253) (97.9) (6.0) (6.8) 41 Maseru (17.9) (0.7) (2.4) (442) (94.3) (7.2) (5.7) 80 Mafeteng (21.6) (0.6) (2.0) (222) (92.0) (7.0) (5.3) 40 Mohale's Hoek (23.3) (1.5) (2.7) (227) (97.8) (7.1) (5.5) 38 Quthing (22.8) (0.5) (3.2) (163) (97.0) (8.5) (6.3) 27 Qacha’s Nek (21.3) (0.5) (4.5) (89) (93.0) (5.8) (6.3) 16 Mokhotlong (22.4) (1.5) (3.0) (156) (97.0) (5.6) (4.9) 27 Thaba-Tseka (24.3) (1.4) (4.9) (197) (95.6) (8.7) (6.1) 30 Mother's education No education * * * * * * * 9 Primary, incomplete 21.5 0.8 3.2 680 94.6 7.9 6.1 126 Primary, complete 22.6 0.6 2.7 708 94.3 7.1 5.8 122 Secondary+ 19.2 2.0 3.0 781 93.7 6.2 5.4 119 Wealth quintile Lowest 23.9 1.1 2.4 455 96.7 7.8 6.1 83 Second 21.4 1.2 3.7 525 95.3 8.4 6.5 95 Middle 22.5 0.8 4.0 402 91.8 6.5 5.3 76 Fourth 21.2 0.6 3.3 473 94.8 6.2 5.7 70 Highest 17.8 1.8 1.9 367 91.9 5.8 5.0 52 Total 21.3 0.9 3.0 2,222 94.3 7.1 5.8 375 Mean for all children 20.2 3.1 4.7 na na na na na Note: Median and mean durations are based on current status. An asterisk indicates that a figure is based on fewer than 25 cases and has been suppressed. Numbers in parentheses are based on 25-49 unweighted cases. na = Not applicable 1 It is assumed that non-last-born children or last-born child not living with the mother are not currently breastfeeding 2 Excludes children who do not have a valid answer on the number of times breastfed 3 Either exclusively breastfed or received breast milk and plain water, water-based liquids, and/or juice only (excludes other milk) 162 | Nutrition 10.1.3 Complementary Feeding Given that babies need nutritious food in addition to breast milk from the age of six months, it is recommended that children should begin receiving solid foods at this age. To obtain full information on weaning practices, the 2004 LDHS collected data on breastfeeding and nonbreastfeeding children. Table 10.4 presents information on the types of complementary (weaning) foods received by children less than three years of age in the day or night preceding the survey. Ninety-one percent of children 6-9 months are fed complementary foods. Seven percent of children under six months receive commercially produced infant formula. Table 10.4 Foods consumed by children in the day or night preceding the interview Percentage of youngest children under three years of age living with the mother who consumed specific foods in the day or night preceding the interview, by breastfeeding status and age, Lesotho 2004 Age in months Infant formula Other milk/ cheese/ yogurt Other liquids1 Food made from grains Fruits/ vege- tables2 Food made from roots/ tubers Food made from legumes Meat/ fish/ shellfish/ poultry/ eggs Food made with oil/ fat/ butter Fruits and vege- tables rich in vitamin A3 Any solid or semi- solid food Number of children BREASTFEEDING CHILDREN <2 1.9 10.6 16.9 2.9 0.0 0.0 1.1 0.0 0.0 0.0 6.0 109 2-3 6.3 22.5 21.5 13.7 2.9 0.6 0.0 1.5 2.3 2.9 27.2 141 4-5 11.2 27.0 40.6 47.4 14.3 3.7 7.4 4.8 5.2 12.0 67.6 121 6-7 15.1 37.7 53.4 68.1 38.0 5.3 4.9 16.2 12.1 31.0 86.7 101 8-9 17.8 38.3 70.2 81.2 57.6 16.5 8.5 23.5 23.1 49.0 94.4 98 10-11 13.4 44.2 54.0 82.5 70.9 20.5 11.1 23.2 31.7 61.6 91.8 110 12-15 9.7 37.7 62.7 89.6 69.8 12.2 17.6 34.0 27.7 63.4 98.1 234 16-19 16.3 41.5 60.7 87.2 69.9 16.0 17.7 31.0 24.3 61.5 97.9 154 20-23 6.8 43.7 57.0 91.4 69.9 14.2 20.9 28.3 25.3 62.9 100.0 98 24-35 7.2 32.1 51.8 81.4 76.4 14.7 25.2 27.0 27.8 65.6 95.9 91 <6 6.6 20.5 26.4 21.5 5.8 1.4 2.7 2.1 2.6 5.1 34.2 371 6-9 16.4 38.0 61.7 74.6 47.7 10.8 6.7 19.8 17.6 39.9 90.5 199 NONBREASTFEEDING CHILDREN 16-19 20.2 44.7 47.7 70.6 59.7 18.3 9.2 37.6 19.6 52.0 86.5 53 20-23 23.6 53.5 56.4 77.6 81.7 16.1 23.8 45.1 42.7 75.7 94.0 67 24-35 6.8 43.2 50.0 81.8 73.2 16.9 19.6 34.9 33.1 65.3 94.9 417 Note: Breastfeeding status and food consumed refer to a "24-hour" period (yesterday and last night). 1 Does not include plain water 2 Includes fruits and vegetables rich in vitamin A 3 Includes pumpkin, red or yellow yams or squash, carrots, red sweet potatoes, green leafy vegetables, mangoes, papayas, and other locally grown fruits and vegetables that are rich in vitamin A Thirty-four percent of breastfeeding children under six months receive solid or semi-solid foods. The most commonly used complementary foods for breastfeeding children under six months include other liquid other than breast milk (26 percent), food made from grains (22 percent), and milk products (21 per- cent). Foods made from grain are prematurely introduced to children by two to three months (14 percent). By six to seven months, 68 percent are already receiving these foods. Foods made from roots/tubers are introduced gradually from eight to nine months (17 percent). By the age of 10-11 months, 21 percent are receiving root/tuber-based food, and 11 percent get legumes. Consumption of protein-rich foods (meat, fish, poultry, and eggs) generally begins at four to five months (5 percent) and increases to 23 percent by the first year of life. Fruits and vegetables rich in vitamin A are introduced at 2-3 months. However, we have to interpret these results with caution because they are based on mothers’ reporting and they may overreport introduction of fruits and vegetables for children at an early age. The proportion of children consuming vitamin A-rich foods rises to 62 percent by the first year of life. From 6 months of age, food Nutrition | 163 from grains are the most common complementary food followed by fruits and vegetables. From 8 months of age, almost half of the children are fed foods rich in vitamin A. By 16-19 months, 87 percent of nonbreastfeeding children are already consuming solid food, and only 9 percent are receiving food made from legumes. By age 2 years, only 35 percent of children are consuming any animal-based foods. Although nonbreastfed children from 16 to 35 months of age are consuming foods made from grains, and fruits and vegetables at lower rates than breastfed children, 50 percent or less of nonbreastfed children are receiving other milks by the age of 16 months through the second year of life. However, a larger percentage of nonbreastfed children appear to be consuming animal-based foods than breastfed children of the same age. 10.1.4 Frequency of Foods Consumed by Children Table 10.5 presents the mean number of times specific foods were consumed in the day or night preceding the interview by youngest children under three years of age living with the mother, according to breastfeeding status and age. Infants and young children eat small meals and, therefore, frequent meals are necessary to provide them with the required nutrients. The number of meals required is determined on the basis of energy of the foods being fed. Consuming an appropriate variety of food is essential for the child’s nutrition. Table 10.5 shows that on average foods made from grains are given to breastfeeding children twice a day from age 6-9 months, which is the best time for introducing complementary foods. Frequency of consuming various foods does not appear to vary much as children age. Table 10.5 Frequency of foods consumed by children in the day or night preceding the interview Mean number of times specific foods were consumed in the day or night preceding the interview by youngest children under three years of age living with the mother, according to breastfeeding status and age, Lesotho 2004 Solid/semi-solid Liquids Age in months Infant formula Other milk/ cheese/ yogurt Other liquids1 Food made from grains Fruits/ vege- tables2 Food made from roots/ tubers Food made from legumes Meat/ fish/ shellfish/ poultry/ eggs Food made with oil/ fat/ butter Fruits and vegetables rich in vitamin A3 Number of children BREASTFEEDING CHILDREN <2 0.1 0.3 0.5 0.1 0.0 0.0 0.0 0.0 0.0 0.0 109 2-3 0.1 0.6 0.5 0.4 0.1 0.0 0.0 0.0 0.1 0.1 141 4-5 0.3 0.7 0.9 1.2 0.2 0.0 0.1 0.1 0.1 0.2 121 6-7 0.3 0.8 1.3 1.8 0.9 0.1 0.1 0.2 0.2 0.6 101 8-9 0.4 0.8 1.8 2.0 1.1 0.3 0.1 0.3 0.4 0.8 98 10-11 0.3 1.0 1.4 2.4 1.6 0.4 0.1 0.3 0.5 1.3 110 12-15 0.2 1.0 1.7 2.4 1.5 0.2 0.3 0.4 0.5 1.2 234 16-19 0.3 1.0 1.5 2.4 1.8 0.2 0.3 0.5 0.4 1.4 154 20-23 0.1 0.9 1.6 2.7 1.9 0.3 0.3 0.5 0.5 1.5 98 24-35 0.1 0.7 1.5 2.4 1.9 0.2 0.4 0.4 0.5 1.5 91 <6 0.2 0.6 0.6 0.6 0.1 0.0 0.0 0.0 0.1 0.1 371 6-9 0.4 0.8 1.6 1.9 1.0 0.2 0.1 0.2 0.3 0.7 199 NONBREASTFEEDING CHILDREN 16-19 0.4 1.3 1.0 2.0 1.3 0.2 0.1 0.6 0.3 0.8 53 20-23 0.4 1.2 1.6 2.4 2.7 0.3 0.5 0.6 0.8 2.1 67 24-35 0.1 0.9 1.5 2.5 2.1 0.3 0.3 0.5 0.6 1.7 417 Note: Breastfeeding status and food consumed refer to a "24-hour" period (yesterday and last night). 1 Does not include plain water 2 Includes fruits and vegetables rich in vitamin A 3 Includes pumpkin, red or yellow yams or squash, carrots, red sweet potatoes, green leafy vegetables, mangoes, papayas, and other locally grown fruits and vegetables rich in vitamin A 164 | Nutrition On average, nonbreastfeeding children age 16-19 months consume milk products and fruits and vegetables once a day each, and food made from grains twice a day. Foods from grains include flour made from maize or sorghum which is also used to make a fermented or unfermented porridge (motoho or lesheleshele). By age three, this type of food is consumed three times a day. Nonbreastfed children who should consume more dairy products because of the lack of breast milk in their diets are consuming dairy products at the same rate as breastfed children. Diets of nonbreastfed children do not differ much from those of breastfed children. 10.2 MICRONUTRIENTS 10.2.1 Iodisation of Household Salt One of the main interventions of the nutrition programme in Lesotho is to reduce micronutrient deficiencies, including iodine deficiency, vitamin A, and iron deficiency by iodising salt and through supplementation with vitamin A and iron. Disorders induced by dietary iodine deficiency constitute a major global nutrition concern. A lack of sufficient iodine can lead to goitre, hypothyroidism, impaired mental functions, retarded mental and physical development, and lower IQ levels. Iodine deficiency during pregnancy leads to increased rates of abortion, stillbirths, congenital anomalies, cretinism, psychomotor defects, and neonatal mortality. Iodine deficiency can be avoided by using salt that has been fortified with iodine (iodised salt) and by consuming foods rich in iodine such as seafood. Table 10.6 shows the percent distribution of households with salt tested for iodine content by level of iodine in salt (parts per million), percentage of households tested, and percentage of households with no salt, according to background characteristics. It shows that 93 percent of the households interviewed in the 2004 LDHS had their salt tested for iodine, while 5 percent had no salt available in the household. Only 2 percent of households are consuming salt that is not iodised, 7 percent are consuming salt that has inadequate iodine level (<15 ppm), while the majority—91 percent of households—are consuming adequately iodised salt (15+ ppm). The proportion of households with adequately iodised salt in rural areas (88 percent) is lower than in urban areas (98 percent). Most districts have 90 percent or more of the households with adequate level of iodine in salt, except for Qacha’s Nek that has 64 percent of such households. Nutrition | 165 Table 10.6 Iodisation of household salt Percent distribution of households with salt tested for iodine content by level of iodine in salt (parts per million), percentage of households tested, and percentage of households with no salt, according to background characteristics, Lesotho 2004 Iodine content among household tested: Background characteristic None (0 ppm) Inadequate (<15 ppm) Adequate (15+ ppm) Total Number of households Percentage of households tested Percentage of households with no salt Number of households Residence Urban 0.3 1.6 98.1 100.0 1,967 96.3 2.4 2,043 Rural 3.0 8.7 88.3 100.0 5,987 91.4 6.2 6,549 Ecological zone Lowlands 1.3 4.3 94.4 100.0 4,917 94.6 3.7 5,198 Foothills 1.5 15.4 83.1 100.0 885 90.6 7.3 977 Mountains 5.7 10.7 83.6 100.0 1,690 89.0 8.5 1,899 Senqu River Valley 2.8 5.2 92.0 100.0 461 89.1 5.6 518 District Butha-Buthe 1.0 2.3 96.8 100.0 480 92.7 3.6 517 Leribe 0.6 7.7 91.7 100.0 1,157 93.9 4.7 1,233 Berea 3.0 5.2 91.8 100.0 890 94.6 4.4 941 Maseru 1.4 7.7 90.9 100.0 2,238 93.8 4.7 2,385 Mafeteng 1.0 9.0 89.9 100.0 822 93.2 4.2 883 Mohale's Hoek 2.2 6.4 91.4 100.0 758 92.5 4.6 819 Quthing 3.1 4.4 92.5 100.0 465 87.5 6.1 532 Qacha's Nek 12.2 23.9 63.9 100.0 257 87.2 9.9 295 Mokhotlong 6.5 3.7 89.8 100.0 391 90.5 7.8 432 Thaba-Tseka 4.1 3.4 92.5 100.0 495 89.2 9.6 555 Wealth quintile Lowest 4.6 13.6 81.9 100.0 1,488 87.0 10.4 1,711 Second 4.6 9.3 86.1 100.0 1,434 89.6 8.1 1,600 Middle 2.5 7.0 90.5 100.0 1,486 93.0 4.9 1,598 Fourth 0.4 4.8 94.8 100.0 1,665 95.4 1.9 1,745 Highest 0.4 1.9 97.7 100.0 1,881 97.0 1.8 1,938 Total 2.3 7.0 90.7 100.0 7,954 92.6 5.3 8,592 10.2.2 Vitamin A Intake among Children Vitamin A is an essential micronutrient for the immune system and plays an important role in maintaining the epithelial tissue in the body. High levels of vitamin A deficiency (VAD) can cause eye damage leading to blindness and can increase the severity of infections such as measles and diarrhoeal diseases in children. Ensuring that children between 6 and 59 months receive enough vitamin A may be the single most effective child survival intervention. Adequate intake of the vitamin during pregnancy may also reduce maternal deaths. UNICEF and WHO recommend that all countries with an under five mortality rate exceeding 70 per 1,000 live births, or where vitamin A deficiency is a public health problem, should put in place a programme for control of vitamin A deficiency. On the basis of UNICEF/ WHO guidelines, children age 6-11 months should be given one dose of vitamin A (capsule of 100,000 IU) every six months, and children 12 months or older should be given one high dose of vitamin A (capsule of 200,000 IU) every six months (Bureau of Statistics, 2000). Table 10.7 shows the percentage of youngest children under three years who consumed foods rich in vitamin A in the 24 hours preceding the survey, and the percentage of children age 6-59 months who received vitamin A supplements in the six months preceding the survey. Forty-nine percent of children under three years consume foods rich in vitamin A, and 55 percent of children age 6-59 months receive vitamin A supplements. 166 | Nutrition Table 10.7 Micronutrient intake among children Percentage of youngest children under age three living with the mother who consumed fruits and vegetables rich in vitamin A in the 24 hours preceding the survey, and percentage of children age 6-59 months who received vitamin A supplements in the six months preceding the survey, by background characteristics, Lesotho 2004 Background characteristic Consumed fruits and vegetables rich in vitamin A1 Number of children Consumed vitamin A supplements Number of children Age in months <6 4.9 382 * 0 6-9 40.1 209 42.0 214 10-11 62.8 122 60.3 125 12-23 63.0 632 56.3 660 24-35 65.4 508 57.8 643 36-47 na na 55.6 615 48-59 na na 51.6 578 Sex Male 48.5 939 55.0 1,448 Female 49.6 914 54.2 1,387 Birth order 2-3 46.2 661 55.2 967 4-5 47.1 687 55.9 1,038 6+ 51.9 307 52.1 500 Breastfeeding status Breastfeeding 42.2 1,258 55.0 917 Not breastfeeding 63.7 591 54.5 1,894 Residence Urban 47.8 249 58.9 405 Rural 49.2 1,604 53.9 2,431 Ecological zone Lowlands 47.8 923 55.2 1,419 Foothills 52.8 248 47.3 364 Mountains 48.2 556 52.4 865 Senqu River Valley 54.2 126 74.6 187 District Butha-Buthe 48.6 110 64.9 158 Leribe 53.4 289 52.5 434 Berea 43.7 218 40.6 323 Maseru 50.7 360 49.4 571 Mafeteng 42.9 188 69.9 303 Mohale's Hoek 50.8 188 60.3 268 Quthing 51.7 138 73.8 202 Qacha’s Nek 31.5 71 34.1 124 Mokhotlong 47.0 127 66.7 203 Thaba-Tseka 57.2 163 42.0 249 Mother's education No education 45.1 44 44.1 70 Primary, incomplete 50.7 560 50.2 910 Primary, complete 47.7 586 54.7 895 Secondary+ 49.0 663 59.4 960 Mother's age at birth <20 48.8 374 52.7 578 20-24 46.5 578 55.5 839 25-29 45.1 371 54.9 565 30-34 52.7 243 55.5 404 35-49 56.4 286 54.2 449 Wealth quintile Lowest 52.2 381 45.9 597 Second 52.0 437 53.5 681 Middle 48.2 339 58.7 491 Fourth 41.7 394 58.5 570 Highest 51.3 303 58.1 497 Total 49.0 1,853 54.6 2,835 Note: Information on vitamin A supplements is based on mother's recall. An asterisk indicates that a figure is based on fewer than 25 cases and has been suppressed. na = Not applicable 1 Includes pumpkin, red or yellow yams or squash, carrots, red sweet potatoes, green leafy vegetables, mangoes, papayas, and other locally grown fruits and vegetables that are rich in vitamin A Nutrition | 167 The consumption of foods rich in vitamin A and the intake of supplements vary somewhat by background characteristics. Children who are not breastfed are more likely (64 percent) to consume fruits and vegetables rich in vitamin A, compared with their breastfeeding counterparts (42 percent), presum- ably because they are older than breastfeeding children and therefore consume other complementary foods. Urban children are more likely to consume vitamin A supplements (59 percent) compared with their rural counterparts (54 percent). The proportion of children consuming foods rich in vitamin A is highest in Thaba-Tseka (57 percent) and lowest in Qacha’s Nek (32 percent). Consumption of vitamin A supplements is highest in Quthing (74 percent) and lowest in Qacha’s Nek (34 percent) and Thaba-Tseka (42 percent). While it appears that children in Thaba-Tseka are more likely to consume fruits and vege- tables rich in vitamin A and less likely to receive vitamin A supplements, the children in Qacha’s Nek are less likely to consume fruits and vegetables rich in vitamin A or to receive vitamin A supplements. Although mother’s education appears to be positively related to vitamin A supplementation, it does not appear to be similarly related to consumption of foods rich in vitamin A. Children of mothers with no education are less likely to have consumed foods that are high in vitamin A compared with children of mothers with any education. 10.2.3 Vitamin A Intake among Women Table 10.8 presents the percentage of women with a birth in the five years preceding the survey, who received a vitamin A dose in the first two months after birth, and who took iron tablets or syrup dur- ing pregnancy. Few women receive vitamin A supplementation postpartum (17 percent) and this varies with zone of residence, district, and educational attainment. Women in urban areas (20 percent) are more likely to receive vitamin A supplements than those in rural areas (17 percent). At the district level, the percentage of women who reported receiving a postpartum vitamin A dose is highest in Mafeteng (27 per- cent) and lowest in Mokhotlong (7 percent). With regard to educational level, women with no education (14 percent) or those with incomplete primary education (11 percent) are less likely to receive vitamin A doses. The data show that 21 percent of women with some secondary education reported having received a postpartum vitamin A dose. Vita- min A supplementation is strongly associated with economic status, rising from 10 percent among the poorest mothers to 22 percent of the wealthiest. As seen in Table 10.8, the rate of iron supplementation during pregnancy is low. More than half of women (59 percent) did not take iron tablets or syrup during pregnancy. Intake varies considerably by districts. Seventy-nine percent of women in Mokhotlong did not take any iron supplements during pregnancy, compared with 47 percent in Leribe and 48 percent in Berea. Twenty-eight percent of the women took the iron supplements for less than 60 days. 168 | Nutrition Table 10.8 Micronutrient supplementation among mothers Percentage of women with a birth in the five years preceding the survey who received a vitamin A dose in the first two months after delivery, percentage who suffered from night blindness during pregnancy, percentage who took iron tablets or syrup for specific number of days, and percentage who live in households using adequately iodised salt, by background characteristics, Lesotho 2004 Number of days iron tablets/syrup taken during pregnancy Night blindness during pregnancy Background characteristics Received vitamin A dose postpartum1 Reported Adjusted2 None <60 60-89 90+ Don't know/ missing Number of women Age at birth <20 15.9 3.4 0.5 61.7 28.1 0.3 1.8 8.1 546 20-24 17.0 4.0 1.3 58.1 30.0 0.5 1.6 9.8 847 25-29 16.0 3.7 0.9 56.6 29.5 1.1 3.7 9.1 581 30-34 20.3 4.5 1.5 58.4 24.7 1.1 5.3 10.5 405 35-49 16.7 7.0 0.5 60.3 23.5 2.2 4.3 9.8 480 Number of children ever born 1 16.9 2.8 0.5 58.4 29.9 0.5 2.9 8.4 963 2-3 16.9 4.3 1.1 58.7 28.2 0.7 2.9 9.6 1,080 4-5 17.5 5.2 1.6 58.3 24.4 1.9 3.7 11.7 485 6+ 16.9 8.5 1.0 62.1 24.6 1.5 3.2 8.7 331 Residence Urban 19.5 3.9 0.3 54.2 26.5 1.8 6.5 11.0 448 Rural 16.5 4.5 1.1 59.8 27.9 0.8 2.4 9.1 2,411 Ecological zone Lowlands 20.0 4.1 0.9 56.1 27.3 1.3 3.8 11.5 1,508 Foothills 16.0 6.5 1.1 51.2 33.4 0.4 3.9 11.1 351 Mountains 12.1 4.5 1.1 64.8 27.7 0.6 0.9 6.0 810 Senqu River Valley 15.7 2.9 0.9 70.3 20.0 0.8 4.4 4.5 190 District Butha-Buthe 23.4 4.3 1.2 51.7 33.7 1.4 5.8 7.4 162 Leribe 15.6 4.3 0.0 47.2 37.0 0.4 1.8 13.6 446 Berea 17.4 5.4 0.9 47.8 34.5 0.6 1.9 15.2 332 Maseru 18.5 4.1 1.1 55.1 23.1 2.0 7.6 12.3 594 Mafeteng 26.6 4.2 1.6 65.6 24.2 0.4 1.4 8.3 313 Mohale's Hoek 15.1 4.2 1.2 73.2 19.5 1.3 0.3 5.8 275 Quthing 12.1 1.7 0.5 73.8 18.3 0.5 4.4 2.9 203 Qacha’s Nek 17.2 8.6 2.5 53.4 34.1 2.0 2.6 7.9 109 Mokhotlong 7.0 2.6 0.9 78.8 17.6 0.0 0.0 3.7 183 Thaba-Tseka 12.3 6.4 1.3 60.2 34.8 0.4 0.5 4.1 240 Education No education 13.5 5.2 3.3 73.8 22.2 1.2 1.2 1.6 68 Primary, incomplete 11.1 6.0 1.3 63.0 27.5 0.8 1.5 7.3 877 Primary, complete 19.0 4.2 1.2 59.2 27.0 0.7 3.1 10.1 890 Secondary+ 20.5 3.2 0.4 54.2 28.8 1.3 4.5 11.2 1,024 Wealth quintile Lowest 10.2 3.9 1.1 62.3 29.2 0.4 1.4 6.7 541 Second 14.3 6.8 1.3 63.7 25.1 0.8 1.4 9.0 645 Middle 18.8 3.6 1.5 60.0 26.3 1.5 2.7 9.5 510 Fourth 19.7 4.0 0.0 55.4 28.2 1.0 3.2 12.3 621 Highest 22.3 3.3 1.0 52.9 30.0 1.0 6.7 9.3 542 Total 17.0 4.4 1.0 58.9 27.7 0.9 3.0 9.4 2,859 Note: For women with two or more live births in the five-year period, data refer to the most recent birth. 1 In the first two months after delivery 2 Women who reported night blindness but did not report difficulty with vision during the day 10.2.4 Prevalence of Anaemia in Children One of the causes of anaemia is inadequate dietary intake of iron. The Ministry of Health and Social Welfare promotes provision of iron supplements to pregnant women to reduce the incidents of anaemia. Table 10.9 shows the percentage of children age 6-59 months classified as having anaemia, by background characteristics. Forty-nine percent of Basotho children age 6-59 months are reported to have some level of anaemia, including 22 percent of children who are mildly anaemic, 25 percent who are moderately anaemic, and 1 percent who are severely anaemic. Nutrition | 169 Table 10.9 Prevalence of anaemia in children Percentage of children age 6-59 months classified as having anaemia, by background characteristics, Lesotho 2004 Anaemia status Background characteristic Any anaemia Mild (10.0- 10.9 g/dl) Moderate (7.0- 9.9 g/dl) Severe (below 7.0 g/dl) Number of children Age in months 6-9 61.7 23.3 38.2 0.2 104 10-11 67.3 26.9 38.9 1.5 67 12-23 59.3 24.5 32.6 2.2 286 24-35 51.4 24.0 25.1 2.3 347 36-47 42.0 23.9 16.8 1.2 323 48-59 33.9 15.6 18.0 0.3 307 Sex Male 50.5 22.7 27.1 0.7 736 Female 46.7 22.1 22.4 2.1 699 Birth order1 2-3 51.5 24.8 25.9 0.9 336 4-5 49.5 22.6 25.3 1.6 401 6+ 50.1 18.8 29.3 2.0 191 Birth interval in months1 First birth2 51.8 24.6 26.3 0.9 338 <24 51.7 24.8 24.8 2.0 82 24-47 50.2 20.4 27.9 1.9 359 48+ 46.8 23.1 22.4 1.4 277 Residence Urban 48.7 26.8 20.2 1.7 160 Rural 48.6 21.8 25.4 1.4 1,275 Ecological zone Lowlands 49.7 23.4 24.9 1.4 682 Foothills 52.5 22.6 28.4 1.5 197 Mountains 44.5 20.1 23.1 1.4 450 Senqu River Valley 52.1 25.4 25.3 1.4 106 District Butha-Buthe 38.2 14.2 23.3 0.7 85 Leribe 51.7 23.0 27.6 1.1 189 Berea 63.2 30.4 31.6 1.2 197 Maseru 52.8 20.1 29.6 3.0 233 Mafeteng 40.0 20.6 18.6 0.8 178 Mohale's Hoek 46.3 19.9 24.8 1.7 124 Quthing 44.3 23.3 20.4 0.6 123 Qacha's Nek 46.7 20.4 20.8 5.4 68 Mokhotlong 61.9 27.3 34.5 0.0 110 Thaba-Tseka 29.0 19.6 9.3 0.1 129 Mother's education3 No education 32.7 0.0 32.7 0.0 2 Primary, incomplete 46.1 19.7 25.1 1.4 349 Primary, complete 49.4 23.2 24.9 1.3 327 Secondary+ 50.5 22.8 26.3 1.4 487 Mother's age3 15-19 65.1 21.9 42.0 1.1 69 20-24 48.9 23.6 24.1 1.3 352 25-29 53.3 23.8 28.4 1.1 279 30-34 43.6 19.5 22.2 1.9 197 35-49 43.9 19.5 22.9 1.5 269 Children of interviewed mothers 49.9 22.8 25.7 1.4 1,055 Children of non- interviewed mothers Mother in the household 38.8 13.3 24.5 1.0 111 Mother not in the household4 47.3 24.6 21.3 1.5 268 Wealth quintile Lowest 48.3 18.6 28.1 1.5 356 Second 49.0 25.7 21.6 1.6 367 Middle 45.9 21.3 23.3 1.3 276 Fourth 52.8 23.5 27.7 1.7 247 Highest 47.1 23.1 23.4 0.6 188 Total 48.6 22.4 24.8 1.4 1,435 Note: Table is based on children who stayed in the household the night before the interview. Prevalence is adjusted for altitude using formulas in CDC, 1989. g/dl = grams per decilitre 1 Excludes children whose mothers were not interviewed 2 First-born twins, (triplets, etc.) are counted as first births because they do not have a previous birth interval 3 For women who are not interviewed, information is taken from the Household Questionnaire. Excludes children whose mothers are not listed in the household schedules 4 Includes children whose mothers are deceased 170 | Nutrition Prevalence of anaemia among children 6-59 months is highest in Mokhotlong (62 percent) and lowest in Thaba-Tseka (29 percent). Urban and rural areas have the same level of anaemia among children (49 percent). Children whose mothers are age 15-19 years are more anaemic than those of mothers in other age groups. Qacha’s Nek (5 percent) and Maseru (3 percent) have the highest prevalence of severely anaemic children. This shows that there is need to intensify the various components of the anaemia control strategy in these districts. 10.2.5 Prevalence of Anaemia in Women Table 10.10 presents information on the prevalence of anaemia among women age 15-49. Twenty-seven percent of women have some level of anaemia. Prevalence is higher among urban women (38 percent) than rural women (24 percent). Thirty-five percent of HIV-positive women have some degree of anaemia compared with 24 percent of HIV-negative women. Among districts, prevalence of anaemia ranges from a low of 17 percent in Qacha’s Nek to a high of 32 percent in Maseru. Prevalence of anaemia increases with wealth quintile. Nutrition | 171 Table 10.10 Prevalence of anaemia in women Percentage of women age 15-49 with anaemia, by background characteristics, Lesotho 2004 Anaemia status Background characteristic Any anaemia Mild anaemia Moderate anaemia Severe anaemia Number of women Age1 15-19 24.9 19.0 5.2 0.7 655 20-24 26.6 18.7 7.6 0.3 534 25-29 25.4 17.4 6.7 1.3 391 30-34 28.4 17.9 9.2 1.3 327 35-39 33.8 24.2 9.0 0.6 274 40-44 30.5 17.6 10.9 1.9 284 45-49 24.0 16.5 6.2 1.3 239 Children ever born2 None 26.8 19.0 7.3 0.6 823 1 27.1 20.3 6.0 0.8 506 2-3 28.5 17.8 9.3 1.5 747 4-5 27.4 19.8 7.0 0.7 368 6+ 23.8 16.1 6.3 1.4 259 Maternity status2 Pregnant 25.4 13.5 11.9 0.0 172 Breastfeeding 24.6 19.3 4.6 0.7 505 Neither 27.9 19.0 7.8 1.1 2,027 Using IUCD2 Yes (46.0) (18.8) (23.7) (3.4) 36 No 26.9 18.7 7.2 0.9 2,668 Residence Urban 38.2 24.9 12.1 1.2 528 Rural 24.4 17.2 6.3 0.9 2,175 Ecological zone Lowlands 28.6 19.6 8.2 0.7 1,584 Foothills 23.7 17.2 5.5 1.0 293 Mountains 24.2 16.4 6.3 1.4 643 Senqu River Valley 30.3 21.6 7.8 0.9 184 District Butha-Buthe 20.7 14.9 4.9 0.8 177 Leribe 29.9 20.4 9.0 0.5 379 Berea 29.6 22.5 5.9 1.2 331 Maseru 31.6 21.0 9.9 0.7 582 Mafeteng 21.6 14.7 6.2 0.7 337 Mohale's Hoek 26.4 17.4 8.0 1.0 276 Quthing 30.0 18.2 9.0 2.8 193 Qacha's Nek 17.4 13.2 3.2 1.0 107 Mokhotlong 28.7 18.9 8.8 1.1 151 Thaba-Tseka 21.1 17.8 2.6 0.6 171 Education1 No education 26.0 23.8 2.3 0.0 65 Primary, incomplete 24.8 17.9 5.9 1.0 891 Primary, complete 28.4 19.5 8.1 0.9 720 Secondary+ 28.3 18.6 8.7 1.0 1,028 Wealth quintile Lowest 20.8 15.5 4.3 1.0 409 Second 26.2 17.8 7.7 0.7 547 Middle 26.4 17.5 8.4 0.5 494 Fourth 29.6 20.5 7.7 1.3 593 Highest 30.2 20.9 8.3 1.1 660 HIV status Positive 35.3 23.3 10.8 1.2 680 Negative 23.8 16.8 6.2 0.8 1,919 Total 27.1 18.7 7.5 0.9 2,703 Note: Table is based on women who stayed in the household the night before the interview. Prevalence is adjusted for altitude and for smoking status, if known, using formulas in CDC, 1989. Women with <7.0 g/dl of haemoglobin have severe anaemia, women with 7.0-9.9 g/dl have moderate anaemia, and pregnant women with 10.0-10.9 g/dl and nonpregnant women with 10.0-11.9 g/dl have mild anaemia. Numbers in parentheses are based on 25-49 unweighted cases. 1 For women who are not interviewed, information is taken from the Household Questionnaire 2 Excludes women who were not interviewed 172 | Nutrition 10.2.6 Prevalence of Anaemia in Children by Anaemia Status of Mother Table 10.11 shows the percentage of children age 6-59 months classified as anaemic, by the anaemia status of the mother. There is no strong relationship between the anaemia status of the mothers and the anaemia status of children. Table 10.11 Prevalence of anaemia in children by anaemia status of mother Percentage of children age 6-59 months classified as having anaemia, by anaemia status of mother, Lesotho 2004 Anaemia status of child Anaemia status of mother Any anaemia Mild (10.0-10.9 g/dl) Moderate (7.0- 9.9 g/dl) Severe (below 7.0 g/dl) Number of children Any anaemia 55.2 28.5 24.3 2.3 228 Anaemia status Mild anaemia 56.2 29.8 25.9 0.5 168 Moderate anaemia 49.6 28.7 20.8 0.0 49 Severe anaemia * * * * 11 Total 50.8 23.9 25.4 1.6 915 Note: Table is based on children who stayed in the household the night before the interview. Prevalence is adjusted for altitude (and for smoking in the case of mothers with information on smoking status) using formulas in CDC, 1989. Table includes only cases with anaemia measurements for both mothers and children. An asterisk indicates that a figure is based on fewer than 25 cases and has been suppressed. 10.3 NUTRITIONAL STATUS OF CHILDREN UNDER FIVE The growth patterns of healthy and well-fed children are reflected in positive changes in their height and weight. Inadequate food supply, among other factors, often leads to malnutrition, resulting in serious consequences on the physical and mental growth and development of the children. Monitoring of nutrition indicators provides information on the progress made in achieving the Millennium Development Goals,1 as well as targets set in the Health Sector Reforms. In addition to questions about infant and young children’s feeding practices, the 2004 LDHS in- cluded an anthropometric component, in which all children under five years of age were both weighed and measured. Each interviewing team carried a scale and measuring board. The scales were lightweight, bathroom-type scales with a digital screen designed and manufactured under the authority of UNICEF. The measuring boards were specially produced by Shorr Productions for use in survey settings. Children younger than 24 months were measured lying down on the board (recumbent length), and standing height was measured for older children. Evaluation of nutritional status is based on the rationale that in a well-nourished population, there is a statistically predictable distribution of children for any age. In any large population, there is variation in height and weight. This variation approximates a normal distribution. Use of a standard reference population as a point of comparison facilitates the examination of differences in the anthropometric status of subgroups in a population and of changes in nutritional status over time. One of the most commonly used reference populations, and the one used in this report, is the U.S. National Centre for Health Statistics (NCHS) standard, which is recommended for use by the World Health Organisation (WHO). 1 One of the 48 Millennium Development indicators is to reduce by half the proportion of malnourished children by 2015. Nutrition | 173 The use of this reference population is based on the finding that young children of all population groups have similar genetic potential for growth. Three standard indices of physical growth that describe the nutritional status of children are pre- sented: • Height-for-age (stunting) • Weight-for-height (wasting) • Weight-for-age (underweight). Each of the three nutritional indicators is expressed in standard deviations (Z-scores) from the mean of the reference population.2 Deviations of the indicators below -2 standard deviations (SD) indi- cate that the children are moderately affected, while deviations below -3 SD indicate that the children are severely affected. A total of 1,937 (weighted) children under age five were eligible to be weighed and measured. Eight percent of these children were not measured, 6 percent had implausibly high or low values for the height and weight measurements, and 2 percent had incomplete age information. The following analysis focuses on the 1,620 children under five for whom complete and plausible anthro- pometric data were collected. 10.3.1 Stunting Height-for-age is a measure of linear growth. A child who is below -2 SD from the median of the reference population in terms of height-for-age is considered short for his/her age, or stunted, a condition reflecting the cumulative effect of chronic malnutrition. If the child is below -3 SD from the reference median, then the child is considered to be severely stunted. A child between -2 and -3 SD is considered to be moderately stunted. Stunting reflects failure to receive adequate nutrition over a long period of time and may also be caused by recurrent and chronic illness. Height-for-age, therefore, represents a measure of the long-term effects of malnutrition in a population and does not vary appreciably according to the season of data collection. Stunted children are not immediately obvious in a population, a stunted three- year-old child could look like a well-fed two-year-old. Table 10.12 shows the nutritional status of children under five as measured by stunting (height- for-age) indicator by various background characteristics. At the national level, 38 percent of children under five are stunted, and the proportion severely stunted is 15 percent. This represents a significant decline when compared with the 2000 EMICS, which showed a national level of stunting of 45 percent, and a level of severe stunting at 21 percent. Analysis of the indicator by various age groups shows that stunting is highest (46 percent) in children age 12-23 months and lowest (11 percent) in children age 6-9 months. As reflected in the table, children age 12-23 months have the highest proportion of severely stunted children (22 percent) compared with children in other age groups. A higher proportion (39 percent) of male children under five years are stunted compared with female children (37 percent). The survey data show that one-third of children living in urban areas are moderately stunted compared with two-thirds of rural children. At the district level, Thaba-Tseka (52 percent) has the highest proportion of stunted children, and Berea has the lowest (28 percent). The mother’s level of education has an inverse relationship with stunting levels. For example, children of mothers with secondary or higher education have the lowest level of severe stunting (13 per- cent), while children whose mothers have incomplete primary education have the highest level of severe stunting (18 percent). 2 The distribution of the standard reference population has been normalised and hence the mean and median coincide. 174 | Nutrition Table 10.12 Nutritional status of children Percentage of children under five years classified as malnourished according to three anthropometric indices of nutritional status: height-for-age, weight- for-height, and weight-for-age, by background characteristics, Lesotho 2004 Height-for-age Weight-for-height Weight-for-age Background characteristic Percentage below -3 SD Percentage below -2 SD1 Mean Z-score Percentage below -3 SD Percentage below -2 SD1 Mean Z-score Percentage below -3 SD Percentage below -2 SD1 Mean Z-score Number of children Age in months <6 0.0 15.0 (0.4) 1.4 4.5 0.7 0.6 2.3 0.3 149 6-9 4.4 11.2 (0.7) 1.1 6.5 (0.0) 0.3 7.5 (0.6) 96 10-11 9.7 29.2 (1.1) 1.3 5.9 0.0 5.0 13.2 (0.9) 69 12-23 22.2 45.6 (1.9) 2.2 6.2 0.0 5.6 22.4 (1.2) 303 24-35 15.8 40.5 (1.7) 0.5 3.4 (0.2) 4.3 24.4 (1.2) 345 36-47 17.2 42.3 (1.8) 0.6 3.1 (0.0) 2.5 20.1 (1.1) 329 48-59 17.5 45.2 (1.9) 1.4 3.7 (0.2) 4.3 25.3 (1.3) 329 Sex Male 16.8 39.4 (1.7) 1.4 4.4 (0.0) 3.8 18.9 (1.0) 828 Female 13.6 37.0 (1.5) 1.0 4.2 (0.0) 3.4 20.8 (1.0) 793 Birth order 2-3 14.4 36.4 (1.6) 0.8 3.3 0.1 3.2 17.8 (0.9) 417 4-5 13.4 34.6 (1.5) 0.8 2.6 0.1 3.2 17.9 (0.8) 468 6+ 15.6 38.1 (1.5) 3.1 7.1 (0.3) 4.7 23.5 (1.2) 221 Birth interval in months2 First birth3 14.5 36.5 (1.6) 0.8 3.3 0.1 3.2 17.7 (0.9) 419 <24 32.5 54.0 (2.3) 1.0 4.3 (0.1) 10.6 32.2 (1.4) 91 24-47 15.6 39.0 (1.6) 1.6 5.4 (0.1) 3.9 21.7 (1.1) 405 48+ 10.0 29.2 (1.3) 1.6 3.6 0.1 2.6 15.6 (0.8) 335 Size at birth2 Very small (23.2) (61.9) (2.3) (5.2) (9.1) (0.1) (5.2) (27.8) (1.5) 38 Small 23.4 60.1 (2.1) 0.8 5.5 (0.2) 9.1 33.0 (1.5) 108 Average or larger 13.7 33.2 (1.5) 1.2 3.7 0.1 3.2 18.0 (0.9) 1,079 Residence Urban 11.1 30.0 (1.3) 1.1 4.0 0.0 3.8 16.0 (0.8) 214 Rural 15.9 39.5 (1.6) 1.2 4.4 (0.0) 3.6 20.4 (1.0) 1,406 Ecological zone Lowlands 12.0 32.9 (1.4) 0.8 3.7 (0.0) 3.0 14.2 (0.9) 794 Foothills 17.6 38.9 (1.7) 0.7 4.0 (0.0) 3.5 21.0 (1.1) 218 Mountains 18.7 45.0 (1.8) 1.2 4.2 (0.0) 4.1 26.6 (1.2) 488 Senqu River Valley 18.1 44.6 (1.7) 4.1 9.6 (0.0) 6.0 27.4 (1.1) 120 District Butha-Buthe 11.2 30.4 (1.5) 0.4 3.7 0.1 2.1 16.1 (0.8) 108 Leribe 13.4 30.7 (1.2) 2.3 3.7 (0.1) 6.0 17.2 (0.9) 208 Berea 9.5 28.4 (1.4) 0.9 5.7 (0.0) 2.3 14.6 (0.9) 211 Maseru 15.8 41.4 (1.7) 0.4 1.8 0.1 2.1 17.8 (1.0) 290 Mafeteng 12.6 36.0 (1.4) 0.0 3.7 (0.0) 0.8 12.6 (0.9) 200 Mohale's Hoek 15.8 35.0 (1.5) 0.8 3.7 (0.2) 4.7 18.6 (1.1) 149 Quthing 17.6 44.2 (1.7) 4.4 10.1 0.1 5.7 29.4 (1.0) 131 Qacha’s Nek 18.7 45.9 (1.8) 2.4 6.9 (0.1) 6.9 27.0 (1.2) 73 Mokhotlong 22.9 49.2 (2.0) 0.8 4.5 (0.0) 7.6 25.9 (1.2) 106 Thaba-Tseka 21.7 51.9 (2.1) 0.8 3.7 (0.1) 2.5 32.6 (1.3) 145 Mother's education4 No education * * * * * * * * * 4 Primary, incomplete 17.5 41.3 (1.7) 1.6 5.3 (0.1) 5.7 24.8 (1.1) 391 Primary, complete 14.0 37.6 (1.6) 1.0 4.5 (0.1) 2.5 19.6 (1.0) 371 Secondary+ 13.2 34.6 (1.5) 1.0 4.1 0.1 3.6 15.9 (0.8) 594 Mother's age 15-19 11.7 28.4 (1.2) 0.0 3.4 0.3 2.1 9.9 (0.6) 101 20-24 15.4 39.1 (1.6) 0.8 4.6 0.0 4.2 19.7 (1.0) 432 25-29 14.5 37.1 (1.6) 0.5 3.8 0.1 4.3 21.6 (0.9) 302 30-34 12.1 33.8 (1.4) 1.9 4.8 0.0 2.8 17.5 (0.9) 220 35-49 16.7 40.7 (1.7) 2.2 5.6 (0.2) 4.6 21.7 (1.2) 304 Children of interviewed mothers 15.0 36.6 (1.6) 1.3 4.1 0.0 3.8 19.5 (1.0) 1,250 Children of uninterviewed mothers Mother in the household 11.6 45.9 (1.6) 0.0 9.9 (0.2) 5.7 19.3 (1.2) 110 Mother not in the household5 18.2 42.8 (1.6) 1.1 2.9 (0.1) 2.0 21.7 (1.1) 260 Wealth quintile Lowest 17.6 46.9 (1.9) 1.3 4.6 (0.1) 4.7 26.9 (1.3) 364 Second 21.1 45.6 (1.8) 1.3 4.8 (0.1) 4.5 24.1 (1.2) 393 Middle 15.6 35.5 (1.5) 1.2 3.5 0.0 2.5 18.6 (0.9) 329 Fourth 9.6 31.3 (1.3) 0.8 3.7 0.0 3.1 13.6 (0.8) 301 Highest 8.5 25.0 (1.2) 1.2 5.0 0.1 2.5 11.4 (0.7) 234 Total 15.2 38.2 (1.6) 1.2 4.3 (0.0) 3.6 19.8 (1.0) 1,620 Note: Table is based on children who stayed in the household the night before the interview. Each of the indices is expressed in standard deviation units (SD) from the median of the NCHS/CDC/WHO International Reference Population. The percentage of children who are more than three or more than two standard deviations below the median of the International Reference Population (-3 SD and -2 SD) are shown according to background characteristics. Table is based on children with valid dates of birth (month and year) and valid measurement of both height and weight. Numbers in parentheses are based on 25-49 unweighted cases. An asterisk indicates that a figure is based on fewer than 25 cases and has been suppressed. 1 Includes children who are below -3 standard deviations (SD) from the International Reference Population median. 2 Excludes children whose mothers were not interviewed 3 First-born twins (triplets, etc.) are counted as first births because they do not have a previous birth interval. 4 For women who are not interviewed, information is taken from the Household Questionnaire. Excludes children whose mothers are not listed in the household schedule 5 Includes children whose mothers are deceased Nutrition | 175 Forty-one percent of children whose mothers are age 35-49 years are stunted compared with those whose mothers are age 15-19 years (28 percent). Severe stunting is more pronounced in children whose mothers do not live in the household (18 percent) compared with those whose mothers live in the household (12 percent). The proportion of stunting among children decreases with the wealth of the mothers, 47 percent in the lowest quintile compared with 25 percent in the highest quintile. 10.3.2 Wasting Weight-for-height measures body mass in relation to body length and describes current nutritional status. A child who is below -2 SD from the reference median for weight-for-height is considered to be too thin for his/her height, or wasted, a condition reflecting acute malnutrition. Wasting represents the failure to receive adequate nutrition in the period immediately preceding the survey and may be the result of inadequate food intake or recent episodes of illness causing loss of weight and the onset of malnutri- tion. As with stunting, wasting is considered severe if the child is below -3 SD from the reference mean. Severe wasting is closely linked to an elevated risk of mortality. Prevalence of wasting may vary consid- erably by season. Table 10.12 also shows the nutritional status of children under five years as measured by wasting children. Nationally, 4 percent of children are wasted, and the proportion of severely wasted children is 1 percent. Wasting is highest in children age 6-9 months (7 percent) and lowest in children age 24-35 and 36-47 months (3 percent). Children born after a birth interval of 24-47 months are more likely to be wasted (5 percent) than those who are first born (3 percent). In the ecological zones, Senqu River Valley has a high level of wasting (10 percent) compared with the other zones (4 percent). At the district level, the prevalence of wasting is highest in Quthing (10 percent) and lowest in Maseru (2 percent). 10.3.3 Underweight Weight-for-age is a composite index of height-for-age and weight-for-height and, thus, does not distinguish between acute malnutrition (wasting) and chronic malnutrition (stunting). A child can be un- derweight for his age because he is stunted, wasted, or both. Weight-for-age is a useful tool in clinical settings for continuous assessment of nutritional progress and growth. Children whose weight-for-age is below -2 SD from the median of the reference population are classified as underweight. As shown in Table 10.12, 20 percent of children under five are underweight, an increase of 2 percent from 2000 EMICS (18 percent). The proportion of severely underweight children is 4 percent. The proportion of underweight children is highest (25 percent) in the 48-59 months age group and lowest (2 percent) for those less than six months of age. There is not much difference between male children (19 percent) and female children (21 percent). Urban children are less likely to be underweight (16 percent) than rural children (20 percent). At the district level, Thaba-Tseka (33 percent) has the highest proportion of moderate and severely under- weight children, and Mafeteng has the lowest proportion (13 percent). The proportion of underweight children is negatively related with the level of mother’s education. Children whose mothers have some primary education have the highest levels of being underweight (25 percent), while the proportion for children of mothers with some secondary education is lowest (16 percent). Wealth is also negatively correlated with the proportion of children who are underweight. 176 | Nutrition 10.4 NUTRITIONAL STATUS OF WOMEN The 2004 LDHS also collected data on the height and weight of women. The data are used to de- rive two measures of nutritional status: height and body mass index (BMI). A woman’s height can be used to predict the risk of having difficulty in pregnancy, given the relationship between height and pelvic size. The cut-off point at which mothers can be considered at risk because of low stature is normally taken to be between 140 and 150 centimetres (cm). The BMI or Quetelet index is used to measure thinness or obesity. It is defined as weight in kilograms divided by height in metres squared (kg/m2). A cut-off point of 18.5 is used to define thinness or acute undernutrition. A BMI of 25 or above usually indicates over- weight or obesity. Table 10.13 shows nutritional indicators for women by various background characteristics. At the national level, the mean height for women is 157 cm, with only 2 percent of women falling below the 145 centimetre. cut-off. At the district level, the table shows that 4 percent of the women in Mokhotlong are below the cut-off point while only 1 percent is below the cut-off point in Berea, Mafeteng and Mohale’s Hoek. The mean BMI for women age 15-49 is 25. At the national level, 6 percent of women were found to be chronically malnourished (BMI <18.5) and 1 percent were found to be severely thin. A substantial proportion of women (42 percent) had a BMI of 25.0 or higher and are considered overweight or obese. The proportion of overweight or obese women is positively correlated with the woman’s age. Thus, the group age 45-49 has the highest proportion (68 percent) of overweight or obese women, while the group age 15-19 has the lowest (22 percent) proportion of overweight or obese women. The data show that the proportion of women living in urban areas who are overweight or obese (51 per- cent) is higher than that for women in rural areas (40 percent). District comparison shows that Mokhotlong has the lowest proportion of overweight or obese women (29 percent), and Maseru has the highest proportion of overweight or obese women (47 percent). Wealth index has a positive relationship with overweight levels. Women in the highest quintile are more likely to be overweight or obese (56 per- cent) than those in the lowest quintile (28 percent). Nutrition | 177 Table 10.13 Nutritional status of women by background characteristics Among women age 15-49, mean height, percentage under 145 cm, mean body mass index (BMI), and percentage with specific BMI levels, by background characteristics, Lesotho 2004 Height BMI (kg/m2)1 Background characteristic Mean height in centi- metres Percent- age below 145 cm Number of women Mean BMI 18.5- 24.9 (normal) <18.5 (thin) 17.0- 18.4 (mildly thin) 16.0-16.9 (mod- erately thin) <16.0 (severely thin) ≥25.0 (over- weight or obese) 25.0- 29.9 (over- weight) ≥30.0 (obese) Number of women Age 15-19 155.8 3.1 827 22.5 67.8 10.1 6.5 2.5 1.1 22.1 18.9 3.2 772 20-24 157.0 1.9 674 23.6 63.8 7.0 4.8 1.1 1.1 29.2 22.7 6.5 596 25-29 157.8 1.5 496 25.4 50.4 3.0 2.5 0.1 0.4 46.6 31.2 15.4 437 30-34 158.0 1.6 408 26.5 44.1 4.1 2.8 0.7 0.6 51.8 25.4 26.3 371 35-39 157.9 1.7 348 27.2 37.8 2.8 1.8 0.8 0.3 59.4 31.4 28.0 330 40-44 157.3 2.3 360 27.1 40.5 2.8 2.4 0.1 0.3 56.8 28.0 28.8 352 45-49 157.4 2.2 291 27.8 27.8 4.0 2.8 1.1 0.2 68.2 38.4 29.8 287 Residence Urban 157.7 2.6 788 26.1 46.7 2.8 1.9 0.3 0.5 50.5 31.4 19.1 754 Rural 156.9 2.0 2,615 24.7 53.6 6.6 4.5 1.3 0.7 39.8 24.6 15.2 2,391 Ecological zone Lowlands 157.3 1.8 2,077 25.5 48.1 5.4 3.7 1.1 0.6 46.5 27.6 18.9 1,952 Foothills 157.4 2.3 358 24.2 56.3 8.0 5.3 1.7 1.0 35.7 23.2 12.4 328 Mountains 156.4 3.6 750 24.0 62.2 5.5 3.6 1.0 1.0 32.3 22.8 9.4 663 Senqu River Valley 157.2 0.8 218 25.3 48.6 5.1 4.3 0.6 0.1 46.4 28.5 17.9 201 District Butha-Buthe 157.0 1.8 215 25.1 55.7 5.8 3.3 1.3 1.2 38.5 20.9 17.7 203 Leribe 157.5 1.7 490 25.5 49.1 6.0 4.5 0.8 0.7 44.9 24.9 20.0 453 Berea 156.9 1.1 404 24.8 50.9 7.1 6.2 0.7 0.2 42.0 28.4 13.6 366 Maseru 157.3 3.1 864 25.5 48.2 4.9 2.7 1.2 0.9 46.9 30.0 16.9 808 Mafeteng 157.9 1.1 379 25.1 54.1 4.6 3.7 0.9 0.0 41.4 22.3 19.1 358 Mohale's Hoek 156.9 1.2 341 25.0 46.0 8.2 5.5 2.2 0.5 45.9 29.2 16.7 316 Quthing 157.0 2.4 223 25.2 53.1 2.7 2.3 0.5 0.0 44.2 28.3 15.9 199 Qacha's Nek 156.3 2.3 114 24.4 62.3 3.9 2.7 1.0 0.2 33.7 20.8 12.9 106 Mokhotlong 156.6 3.7 173 23.9 65.3 5.3 2.7 1.1 1.5 29.4 20.8 8.6 156 Thaba-Tseka 155.7 3.3 202 23.8 61.7 7.9 5.0 1.2 1.8 30.4 22.3 8.2 179 Education No education 155.5 4.0 71 25.0 42.8 7.3 2.7 3.0 1.7 49.9 37.8 12.1 61 Primary, incomplete 156.4 3.0 1,047 24.1 55.9 8.7 5.7 2.2 0.8 35.4 22.9 12.6 960 Primary, complete 157.1 2.3 885 25.2 53.5 5.1 3.8 0.9 0.5 41.4 24.7 16.7 815 Secondary+ 157.7 1.3 1,402 25.7 48.6 3.8 2.7 0.4 0.6 47.6 29.1 18.6 1,308 Wealth quintile Lowest 156.1 3.1 476 23.5 66.0 6.4 4.2 1.2 1.0 27.6 20.3 7.4 418 Second 156.6 2.5 630 23.7 61.4 6.9 4.9 1.3 0.8 31.7 22.4 9.3 562 Middle 157.2 2.4 604 24.4 55.3 8.8 5.0 2.7 1.1 35.9 21.1 14.8 563 Fourth 157.3 1.7 759 25.4 48.0 5.0 3.3 0.8 0.8 47.0 29.0 18.1 712 Highest 157.7 1.6 934 26.8 40.5 3.1 2.9 0.1 0.1 56.3 32.5 23.9 889 HIV status Positive 157.1 2.6 763 24.7 53.6 5.5 3.6 1.4 0.5 40.8 27.4 13.4 706 Negative 156.9 2.3 2,175 25.0 53.7 5.9 4.1 1.1 0.7 40.5 24.3 16.1 1,986 Total 157.1 2.1 3,404 25.1 52.0 5.7 3.9 1.1 0.7 42.3 26.2 16.1 3,144 1 Excludes pregnant women and women with a birth in the preceding 2 months HIV/AIDS-Related Knowledge, Attitudes, and Behaviour | 179 HIV/AIDS-RELATED KNOWLEDGE, ATTITUDES, AND BEHAVIOUR 11 John Nkonyana 11.1 INTRODUCTION Acquired immunodeficiency syndrome (AIDS) is caused by a human immunodeficiency virus (HIV) that weakens the immune system, making the body susceptible to and unable to recover from other opportunistic diseases that lead to death through these secondary infections. This is a serious public health and socioeconomic problem in many countries around the world. The most affected countries are found in sub-Saharan Africa, especially those located in the eastern, central, and southern parts of the continent. HIV/AIDS remains a major concern in Lesotho because of relatively high prevalence rates reported among adult populations and significantly higher rates among younger ages. The prevalence rate of HIV is lower in rural areas, where about 80 percent of the total population lives, than urban areas. About 85 percent of all AIDS cases occur among people in the most economically productive age group, age 20-45 (Ministry of Health, 2003). The deaths of these individuals constitute a serious economic and social tragedy in the lives of surviving family, friends, and employers. The principal mode of transmission of HIV is through heterosexual contact. Although the probability of transmitting HIV in a single act of intercourse may be low, a number of factors increase the risk. These factors include the viral load of the infected partner, and the presence in either partner of sexually transmitted infections (STIs), such as syphilis, chancroid, or herpes, which cause genital ulcers or trauma during sexual contact. A significant number of adults in Lesotho suffer from STIs and some have multiple sexual partners, which increases their vulnerability and exposure to HIV. Consequently, most new HIV infections are because of heterosexual contact. This is followed in importance by perinatal transmission, whereby the mother passes the HIV virus to the child during pregnancy, at the time of birth, or through breastfeeding. Those born to HIV- infected mothers who do not acquire the virus are at risk of becoming orphans when one or both of their parents die from AIDS-related diseases. Programs designed to slow the spread of HIV need to focus on reducing transmission through sexual contact. Transmission risk also exists among men who have sex with other men, through blood transfusions, and use of unsterilised needles and skin piercing instruments. The future direction of this pandemic depends on the level of knowledge of how the virus is spread and changes in sexual behaviour. The information obtained from the 2004 LDHS provides a unique opportunity to assess the level of knowledge and practices regarding transmission of the AIDS virus and other STIs. The main objective of this chapter is to determine the level of relevant knowledge, perceptions, attitudes, and behaviours at the national and district levels and for socioeconomic subgroups of the population. The results are useful for AIDS control programmes to target those individuals and groups of individuals most in need of information and those who are at risk of contracting the disease. 180 | HIV/AIDS-Related Knowledge, Attitudes, and Behaviour The 2004 LDHS included a series of questions related to HIV/AIDS and STIs in both the woman’s and man’s questionnaires. Both female and male respondents were asked if they have ever heard of AIDS, what a person could do to avoid getting AIDS, if they are aware of mother-to-child transmission, and if they ever talked to their spouse about ways of preventing AIDS. Other questions concerned stigma or discrimination towards people with HIV/AIDS, attitudes towards teaching children about condom use; chances of getting HIV/AIDS, testing for HIV/AIDS, knowledge of other STIs, and infection with STIs. The data obtained from the 2004 LDHS provide a good opportunity to assess levels and trends in some of these efforts. The principal objective of this chapter is to establish the level of HIV/AIDS knowledge, perceptions, and behaviours at the national level and within geographic and socioeconomic subgroups of the population. This chapter presents findings about current levels of HIV/AIDS knowledge, attitudes, and related behaviours for the general population and for youth separately, as they are the main target of many HIV prevention efforts. On the basis of the findings presented in this chapter, AIDS control programmes can target particular groups of individuals most in need of information and services and most vulnerable to the risk of HIV infection. 11.2 KNOWLEDGE OF AIDS AND HIV TRANSMISSION 11.2.1 Awareness of AIDS Table 11.1 shows the percentage of women age 15-49 and men age 15-59 who have heard of AIDS by background characteristics. Table 11.1 and subsequent tables in this chapter that refer to women 15-49 and men 15-59 also include a row with total figures for men 15-49. Table 11.1 shows that the level of knowledge of AIDS is almost universal, with 94 percent of women and 93 percent of men indicating that they have heard about AIDS. The results also show that there are almost no differences in level of knowledge by age and marital status, but there is some difference in urban and rural residence for both men and women. The level of AIDS knowledge varies somewhat by district. It ranges from 81 percent of women and 78 percent of men in Thaba-Tseka to 98 percent for both women and men in Butha-Buthe. Knowledge of AIDS increases with level of education and wealth quintile. HIV/AIDS-Related Knowledge, Attitudes, and Behaviour | 181 Table 11.1 Knowledge of AIDS. Percentage of women age 15-49 and men age 15-59 who have heard of AIDS by background characteristics, Lesotho 2004 Women Men Background characteristics Has heard of AIDS Number of women Has heard of AIDS Number of men Age 15-24 92.3 3,173 92.5 1,250 15-19 92.1 1,710 92.5 743 20-24 92.5 1,463 92.5 507 25-29 94.4 1,044 93.8 374 30-39 94.9 1,545 93.3 538 40-49 94.5 1,334 94.9 334 50-59 na na 92.4 301 Marital status Never married 94.8 2,373 92.0 1,422 Ever had sex 96.7 1,197 94.4 916 Never had sex 92.9 1,175 87.7 506 Married/living together 92.7 3,709 94.4 1,191 Divorced/separated/widowed 93.8 1,014 92.9 184 Residence Urban 99.5 1,682 99.5 603 Rural 91.7 5,413 91.3 2,194 Ecological zone Lowlands 97.5 4,299 96.3 1,734 Foothills 89.5 787 89.6 307 Mountains 84.4 1,572 84.6 585 Senqu River Valley 95.8 437 95.9 171 District Butha-Buthe 97.9 458 97.7 182 Leribe 96.6 1,065 95.2 393 Berea 96.2 776 92.4 350 Maseru 96.2 1,868 95.7 741 Mafeteng 92.2 755 90.3 297 Mohale's Hoek 89.5 684 93.5 281 Quthing 90.5 461 94.5 167 Qacha's Nek 90.4 233 87.2 99 Mokhotlong 91.9 360 93.0 130 Thaba-Tseka 80.9 435 78.2 156 Education No education 80.1 145 82.4 479 Primary, incomplete 90.9 4,207 93.0 1,546 Primary, complete 98.4 2,651 99.8 696 Secondary+ 100.0 92 100.0 77 Wealth quintile Lowest 81.5 987 83.5 466 Second 88.5 1,294 89.7 514 Middle 94.7 1,258 94.4 566 Fourth 97.3 1,595 96.5 621 Highest 99.2 1,962 98.3 630 Total men 15-59 na na 93.1 2,797 Total 15-49 93.6 7,095 93.2 2,496 na = Not applicable 182 | HIV/AIDS-Related Knowledge, Attitudes, and Behaviour 11.2.2 Knowledge of Ways to Reduce AIDS Transmission Abstaining from sex, being faithful to one uninfected partner, and using condoms are important ways to avoid the spread of HIV/AIDS. To ascertain the depth of knowledge about modes of HIV/AIDS transmission, respondents were asked general questions as to whether there is anything a person can do to avoid getting AIDS or the virus that causes AIDS, and if so, what can be done. They were also prompted with specific questions about whether it is possible to reduce the chance of getting AIDS by having just one faithful sexual partner, using a condom at every sexual encounter, and not having sex at all. Table 11.2 shows the percentage of women and men by their answers to these questions, according to background characteristics. The results show that knowledge of HIV prevention methods is widespread, although there are differences between women and men. Almost eight in ten women (78 percent) and seven in ten men age 15-49 (70 percent) know that use of condoms can reduce the risk of contracting HIV during sexual intercourse. Eighty-two percent of women and 76 percent of men indicate that the chances of getting AIDS can be reduced by limiting sex to one faithful uninfected partner. Knowledge of both these two ways of avoiding HIV transmission is also high, with 71 percent of women and 60 percent of men citing both as ways of reducing the risk of getting HIV. As expected, the proportion of both women and men who know that abstaining from sex reduces the chances of getting HIV is high—78 percent among women and 75 percent among men. Knowledge of HIV prevention methods among women and men age 15-19 is lower for all methods compared with respondents in other age groups. Likewise, knowledge of important ways to reduce the risk of getting AIDS is generally lower among those who have never had sex than among those who are married or living with someone, those who are divorced, separated or widowed, or never-married respondents who have had sex. Urban dwellers are more knowledgeable of any of the methods for HIV prevention than their rural counterparts. The level of awareness by district shows that women and men in Butha-Buthe and Leribe districts are the most informed about HIV/AIDS prevention methods while those living in Thaba- Tseka show the lowest levels of knowledge. The level of education attainment is strongly related to respondents’ knowledge of ways to prevent contracting HIV. Women and men who have no education have considerably lower levels of knowledge of HIV/AIDS prevention than those with some education. The data also show that the poorest respondents, irrespective of sex, are the most disadvantaged in terms of knowledge about methods of HIV prevention. HIV/AIDS-Related Knowledge, Attitudes, and Behaviour | 183 Table 11.2 Knowledge of HIV prevention methods Percentage of women age 15-49 and men age 15-59 who, in response to a prompted question, say that people can reduce the risk of getting the AIDS virus by using condoms every time they have sexual intercourse, by having sex with just one partner who is not infected and who has no other partners, and by abstaining from sexual intercourse, by background characteristics, Lesotho 2004 Women Men Percentage who say HIV can be prevented by: Percentage who say HIV can be prevented by: Background characteristics Using condoms1 Limiting sex to one uninfected partner2 Using condoms1 and limiting sex to one uninfected partner2 Abstaining from sexual intercourse Number of women Using condoms1 Limiting sex to one uninfected partner2 Using condoms1 and limiting sex to one uninfected partner2 Abstaining from sexual intercourse Number of men Age 15-24 74.7 78.9 66.7 76.4 3,173 70.6 71.9 58.7 74.0 1,250 15-19 73.1 77.0 64.0 74.8 1,710 69.7 68.7 55.7 75.4 743 20-24 76.4 81.1 69.8 78.3 1,463 71.8 76.7 63.2 72.0 507 25-29 81.3 84.1 74.3 78.7 1,044 68.4 80.3 62.6 79.3 374 30-39 81.3 85.9 76.4 79.0 1,545 70.5 79.6 63.1 76.7 538 40-49 77.1 85.3 71.7 79.9 1,334 65.9 77.9 58.5 73.3 334 50-59 na na na na na 58.5 71.4 52.4 72.8 301 Marital status Never married 76.8 81.0 68.5 79.3 2,373 69.9 71.8 58.3 74.0 1,422 Ever had sex 82.2 85.4 74.4 82.9 1,197 74.4 77.6 64.5 75.7 916 Never had sex 71.3 76.5 62.4 75.6 1,175 61.8 61.3 47.1 70.9 506 Married/living together 78.0 82.5 71.9 76.6 3,709 67.1 79.6 61.4 76.9 1,191 Divorced/separated/ widowed 77.6 85.2 72.8 79.8 1,014 65.2 72.7 54.9 71.0 184 Residence Urban 85.5 90.1 79.5 88.3 1,682 79.1 86.4 74.0 84.7 603 Rural 75.1 80.0 68.2 74.7 5,413 65.5 72.1 55.4 72.4 2,194 Ecological zone Lowlands 82.3 86.7 75.3 82.5 4,299 74.3 79.3 65.0 80.4 1,734 Foothills 73.4 80.5 68.2 73.2 787 61.6 71.5 52.1 67.3 307 Mountains 65.3 70.8 58.5 67.0 1,572 52.7 63.5 43.9 63.0 585 Senqu River Valley 82.1 85.7 76.3 81.2 437 74.6 80.2 68.9 76.0 171 District Butha-Buthe 82.2 90.0 77.8 84.8 458 73.2 87.1 67.6 81.3 182 Leribe 85.3 89.7 80.8 82.6 1,065 73.8 84.0 68.5 80.3 393 Berea 79.8 85.1 72.0 84.0 776 69.9 71.7 58.5 73.9 350 Maseru 78.7 87.4 73.7 78.6 1,868 71.5 80.3 64.8 74.4 741 Mafeteng 74.6 72.4 61.3 74.7 755 68.5 58.2 47.1 76.4 297 Mohale's Hoek 75.5 75.9 67.7 73.6 684 66.2 74.2 56.2 77.4 281 Quthing 75.5 80.6 70.6 77.2 461 70.6 80.5 66.5 75.0 167 Qacha's Nek 70.8 74.5 63.1 67.5 233 56.4 63.9 50.6 57.0 99 Mokhotlong 73.0 80.6 68.9 76.5 360 56.4 77.8 53.4 74.2 130 Thaba-Tseka 62.5 65.6 52.6 66.1 435 50.5 56.5 35.4 65.7 156 Education No education 51.0 62.2 45.6 59.4 145 45.3 58.7 37.9 60.0 479 Primary, incomplete 73.3 78.6 66.2 74.5 4,207 65.9 73.3 55.1 73.9 1,546 Primary, complete 85.2 89.0 79.1 84.1 2,651 88.1 89.0 81.2 86.7 696 Secondary+ 94.1 95.8 89.9 88.2 92 84.0 91.0 81.5 85.7 77 Wealth quintile Lowest 61.8 66.2 53.6 63.3 987 50.7 63.3 43.2 63.3 466 Second 69.5 76.1 62.6 72.2 1,294 62.8 68.6 50.6 66.3 514 Middle 79.4 83.1 72.5 77.7 1,258 67.1 74.3 58.0 76.4 566 Fourth 82.0 87.7 76.4 80.8 1,595 75.0 80.4 65.6 81.0 621 Highest 85.8 89.9 79.5 87.0 1,962 80.8 85.1 73.7 83.7 630 Total men 15-59 na na na na na 68.4 75.2 59.4 75.0 2,797 Total 15-49 77.5 82.4 70.9 78.0 7,095 69.6 75.6 60.2 75.3 2,496 na = Not applicable 1 Every time they have sexual intercourse 2 Who has no other partners 184 | HIV/AIDS-Related Knowledge, Attitudes, and Behaviour 11.2.3 Rejection of Misconceptions about AIDS Transmission In addition to knowing about effective ways to avoid contracting HIV/AIDS, it is also useful to be able to identify incorrect ways of avoiding the virus to eliminate common misconceptions. Common misconceptions about AIDS include beliefs that the AIDS virus can be transmitted by supernatural means, by mosquito bites, by sharing food or utensils with someone who is infected, or by kissing someone, and the belief that people who are healthy-looking cannot have the AIDS virus. In the 2004 LDHS, respondents were asked about all these misconceptions. Tables 11.3.1 and 11.3.2 indicate that a large majority of Basotho do not know that the AIDS virus cannot be transmitted by mosquito bites; only 44 percent of women and 43 percent of men age 15-49 know that AIDS cannot be transmitted by mosquito bites. Furthermore, only 58 percent of women and 49 percent of men know that a person cannot become infected with the AIDS virus by sharing food or utensils with someone who has AIDS. Knowledge that a healthy-looking person can have the AIDS virus is widespread. Three-fourths of women (75 percent) and almost seven in ten men (69 percent) are aware that a healthy-looking person can have the AIDS virus. Looking at the proportion of respondents who reject the two most common misconceptions in Lesotho—that AIDS can be transmitted by mosquito bites and that a person can become infected with the AIDS virus by sharing food or utensils with someone who is infected—and who believe that a healthy-looking person can have the AIDS virus, only 30 percent of women and 24 percent of men age 15-49 have correct knowledge and awareness on all these issues together. A person is considered to have a comprehensive knowledge about AIDS when they say that use of condoms for every sexual intercourse and having just one uninfected and faithful partner can reduce the chance of getting the AIDS virus, that a healthy-looking person can have the AIDS virus, and when they reject the two most common local misconceptions. In Lesotho, only 24 percent of women and 19 percent of men age 15 to 49 have comprehensive knowledge of HIV/AIDS transmission and pre- vention methods. The analysis shows considerable differentials in the levels of rejection of the most common misconceptions and the comprehensive knowledge regarding AIDS transmission. The proportion of women and men who reject the most common misconceptions, who know that a healthy-looking person can have the AIDS virus, or who have comprehensive knowledge about AIDS generally decreases slightly with age. For all indicators, the proportion of respondents with correct knowledge about AIDS is higher in urban than rural areas. Among districts, the proportion of women with a comprehensive knowledge about AIDS ranges from 11 percent on Mokhotlong to 33 percent in Maseru, while for men it ranges from 6 percent in Mokhotlong to 26 percent in Maseru. Education and wealth are directly correlated with the level of correct knowledge and awareness about AIDS-related issues. For both men and women, the level of correct knowledge and awareness about AIDS increases with educational level and wealth index. The level of knowledge and awareness about AIDS is higher among women than men. HIV/AIDS-Related Knowledge, Attitudes, and Behaviour | 185 Table 11.3.1 Misconceptions and comprehensive knowledge about AIDS: women Percentage of women age 15-49 who say that a healthy-looking person can have the AIDS virus and who, in response to prompted questions, correctly reject local misconceptions about AIDS transmission or prevention, and the percentage with comprehensive knowledge about AIDS by background characteristics, Lesotho 2004 Percentage of women who say that: Background characteristics A healthy- looking person can have the AIDS virus AIDS cannot be transmitted by mosquito bites AIDS cannot be transmitted by super- natural means A person cannot become infected by sharing food or utensils with a person who has AIDS AIDS cannot be transmitted by kissing someone Percentage who say a healthy-looking person can have the AIDS virus and who reject the two most common misconceptions1 Percentage with compre- hensive knowledge about AIDS2 Number of women Age 15-24 70.6 49.2 81.5 61.9 63.3 32.1 25.8 3,173 15-19 66.2 52.1 80.7 63.3 64.0 33.1 25.6 1,710 20-24 75.7 45.7 82.3 60.2 62.5 31.0 26.0 1,463 25-29 81.4 40.7 82.4 60.5 60.0 29.8 24.1 1,044 30-39 80.9 39.6 78.5 56.5 57.2 28.7 24.7 1,545 40-49 75.5 36.6 74.4 48.4 47.6 24.4 21.1 1,334 Marital status Never married 74.5 54.4 84.6 68.6 70.4 38.9 31.5 2,373 Ever had sex 82.4 51.9 87.5 71.1 72.0 39.9 34.4 1,197 Never had sex 66.5 56.9 81.7 66.0 68.7 37.8 28.5 1,175 Married/living together 75.9 38.3 77.3 52.7 53.0 25.3 21.1 3,709 Divorced/separated/ widowed 75.2 36.9 76.3 52.3 51.2 23.6 20.2 1,014 Residence Urban 91.2 54.5 88.5 76.5 75.0 45.1 37.8 1,682 Rural 70.4 40.1 76.9 52.2 53.5 24.8 20.3 5,413 Ecological zone Lowlands 83.9 45.9 84.8 65.4 67.2 33.5 27.6 4,299 Foothills 70.7 43.8 74.6 51.9 51.7 28.7 24.0 787 Mountains 53.5 36.0 67.4 39.2 38.2 18.0 14.5 1,572 Senqu River Valley 78.0 45.5 81.9 62.8 59.5 34.2 29.5 437 District Butha-Buthe 76.7 47.6 83.4 62.2 60.9 31.5 26.3 458 Leribe 82.9 45.6 84.8 66.5 67.8 32.8 29.3 1,065 Berea 75.2 39.3 79.1 55.4 59.9 23.8 19.3 776 Maseru 84.7 51.3 84.3 69.5 68.3 40.6 33.2 1,868 Mafeteng 77.3 35.0 80.3 53.3 57.6 23.0 16.1 755 Mohale's Hoek 71.1 39.1 72.3 47.7 48.9 24.0 20.2 684 Quthing 74.2 41.4 73.9 56.5 52.5 31.8 27.7 461 Qacha's Nek 54.2 39.7 70.3 45.1 50.1 17.2 15.1 233 Mokhotlong 48.4 35.2 76.0 32.6 34.8 12.9 11.2 360 Thaba-Tseka 53.2 40.9 68.1 41.6 36.9 21.5 15.6 435 Education No education 45.3 25.0 53.8 25.9 18.4 9.1 5.1 145 Primary, incomplete 67.0 36.5 73.8 47.4 47.1 20.6 17.0 4,207 Primary, complete 89.4 54.4 89.8 75.3 78.0 43.5 35.8 2,651 Secondary+ 99.5 77.7 93.4 92.5 88.7 71.9 70.2 92 Wealth quintile Lowest 50.3 33.2 60.6 33.5 30.9 14.3 11.0 987 Second 61.9 36.0 71.7 44.2 43.1 18.8 15.2 1,294 Middle 74.6 41.0 81.0 57.4 60.3 25.4 21.2 1,258 Fourth 84.0 44.0 84.4 62.5 64.3 32.4 27.0 1,595 Highest 90.1 54.8 89.6 76.0 76.9 44.7 37.3 1,962 Total 15-49 75.3 43.5 79.6 58.0 58.6 29.6 24.4 7,095 1 Two most common misconceptions in Lesotho are: 1) AIDS can be transmitted by mosquito bites, and 2) a person can become infected by sharing food or utensils with a person who has AIDS 2 Respondents with comprehensive knowledge say that use of condom for every sexual intercourse and having just one uninfected and faithful partner can reduce the chance of getting the AIDS virus, say that a healthy-looking person can have the AIDS virus, and reject the two most common misconceptions 186 | HIV/AIDS-Related Knowledge, Attitudes, and Behaviour Table 11.3.2 Misconceptions and comprehensive knowledge about AIDS: men Percentage of men age 15-59 who say that a healthy-looking person can have the AIDS virus and who, in response to a prompted questions, correctly reject local misconceptions about AIDS transmission or prevention, and the percentage with a comprehensive knowledge about AIDS by background characteristics, Lesotho 2004 Percentage of men who say that: Background characteristics A healthy- looking person can have the AIDS virus AIDS cannot be transmitted by mosquito bites AIDS cannot be transmitted by super- natural means A person cannot become infected by sharing food or utensils with a person who has AIDS AIDS cannot be transmitted by kissing someone Percentage who say that a healthy-looking person can have the AIDS virus and who reject the two most common misconceptions1 Percentage with compre- hensive knowledge about AIDS2 Number of men Age 15-24 64.3 46.3 75.6 50.0 53.3 24.6 18.4 1,250 15-19 58.6 48.9 75.1 49.9 53.8 24.6 18.0 743 20-24 72.6 42.5 76.4 50.1 52.5 24.7 18.8 507 25-29 77.7 44.5 77.0 51.2 53.0 28.6 24.0 374 30-39 73.1 37.8 75.9 48.4 47.8 23.7 18.9 538 40-49 72.8 34.8 70.6 41.6 48.8 19.4 16.3 334 50-59 69.1 28.7 65.4 30.5 33.3 12.4 6.4 301 Marital status Never married 65.4 46.4 75.0 49.4 54.5 25.7 19.4 1,422 Ever had sex 72.7 45.2 79.7 50.7 56.7 25.5 20.4 916 Never had sex 52.1 48.6 66.4 47.0 50.5 26.2 17.7 506 Married/living together 74.5 35.5 74.4 44.4 45.3 20.2 16.2 1,191 Divorced/separated/ widowed 66.0 37.2 66.2 41.4 38.5 21.1 14.1 184 Residence Urban 87.5 51.6 83.3 69.1 72.1 40.3 34.1 603 Rural 64.3 38.3 71.7 40.6 43.3 18.3 13.2 2,194 Ecological zone Lowlands 77.2 43.6 79.3 52.7 57.6 27.7 21.2 1,734 Foothills 64.1 36.0 68.7 42.5 42.3 16.8 14.1 307 Mountains 46.9 37.9 60.5 30.0 30.0 12.5 8.8 585 Senqu River Valley 75.5 37.6 78.5 51.4 47.7 22.7 19.1 171 District Butha-Buthe 72.8 43.8 75.9 54.0 53.6 22.2 19.5 182 Leribe 77.2 42.2 79.8 51.2 61.7 25.7 20.9 393 Berea 68.4 36.3 76.2 41.3 48.5 19.0 14.3 350 Maseru 79.4 48.2 80.3 57.4 59.8 33.8 26.4 741 Mafeteng 64.6 34.7 67.7 42.2 40.8 16.5 10.6 297 Mohale's Hoek 70.6 38.9 69.7 40.8 39.8 19.4 13.2 281 Quthing 69.2 38.7 72.8 48.6 45.6 20.6 19.0 167 Qacha's Nek 40.0 38.0 62.1 34.1 41.9 13.0 11.5 99 Mokhotlong 46.8 32.3 66.0 25.3 27.4 10.2 6.2 130 Thaba-Tseka 44.0 41.8 60.6 32.0 28.7 14.4 7.8 156 Education No education 49.4 29.2 54.9 23.6 23.8 8.0 5.0 479 Primary, incomplete 64.3 37.1 72.9 39.9 43.1 15.9 10.8 1,546 Primary, complete 91.0 54.1 88.6 73.9 77.2 44.8 38.1 696 Secondary+ 97.0 80.7 89.7 83.2 87.8 65.0 51.1 77 Wealth quintile Lowest 46.2 33.6 58.5 26.8 27.9 8.6 5.3 466 Second 61.0 35.9 66.5 32.7 31.9 14.3 9.6 514 Middle 71.5 38.5 76.6 42.1 46.0 19.9 14.7 566 Fourth 74.5 44.1 77.6 56.1 61.0 28.2 22.9 621 Highest 86.1 50.6 86.4 67.9 71.7 38.6 31.0 630 Total men 15-59 69.3 41.2 74.2 46.8 49.5 23.1 17.7 2,797 Total men 15-49 69.3 42.7 75.2 48.7 51.5 24.3 19.1 2,496 1 Two most common local misconceptions: (1) AIDS can be transmitted by mosquito bites, and 2) a person can become infected by sharing food or utensils with a person who has AIDS 2 Respondents with comprehensive knowledge say that use of condom for every sexual intercourse and having just one uninfected and faithful partner can reduce the chance of getting the AIDS virus, say that a healthy-looking person can have the AIDS virus, and reject the two most common misconceptions HIV/AIDS-Related Knowledge, Attitudes, and Behaviour | 187 11.2.4 Knowledge of Mother-to-Child Transmission Current strategies on HIV/AIDS in Lesotho are geared towards improving the health of the HIV- infected mother and reducing the transmission to their children during pregnancy, labour, delivery, and post-delivery through breastfeeding, as outlined in the National AIDS Strategic Plan 2000-2004 and the National Prevention of Mother-to-Child Transmission Strategic Plan (Government of Lesotho, 2000). Increasing the level of general knowledge of transmission of the virus from mother to child and of reducing the risk of transmission by use of antiretroviral drugs is critical to achieving this goal. All women and men interviewed in the 2004 LDHS were asked if the virus that causes AIDS can be transmitted from a mother to a child. If the answer was affirmative, they were further asked whether the virus could be transmitted during pregnancy, delivery, or breastfeeding. They were also asked if a mother who is infected with the AIDS virus can reduce the risk of giving the virus to the baby by taking certain drugs during pregnancy. The results of these questions are shown in Table 11.4. Almost three-quarters of women (74 percent) and two-thirds of men (67 percent) know that HIV can be transmitted by breastfeeding. Half of women (50 percent) and four in ten men (39 percent) know that the risk of mother-to-child transmission can be reduced by the mother taking certain drugs during pregnancy. Only 42 percent of women and 32 percent of men know that HIV can be transmitted through breastfeeding and that the risk can be reduced with drugs. The knowledge of transmission through breastfeeding and knowledge of antiretroviral drugs is lowest for the youngest age group for both men and women, as well as for respondents who have never had sex. It is also lower for rural women and men and substantially lower among respondents living in Qacha’s Nek, Mokhotlong, and Thaba-Tseka than those living in other districts. Basotho with no education and those who have not completed primary education are less likely to know about the transmission of HIV through breastfeeding and about antiretroviral drugs during pregnancy than those with higher education. The data also show that wealth is positively associated with knowledge of mother- to-child transmission of HIV. This association is stronger among women than men. Pregnant women are no more likely to know about mother-to-child transmission than those who are not pregnant. 188 | HIV/AIDS-Related Knowledge, Attitudes, and Behaviour Table 11.4 Knowledge of prevention of mother-to-child transmission of HIV. Percentage of women age 15-49 and men age 15-59 who know that HIV can be transmitted from mother to child by breastfeeding and that risk of mother-to-child transmission (MTCT) of HIV can be reduced by mother taking special drugs during pregnancy, by background characteristics, Lesotho 2004 Women Men Percentage who know that: Percentage who know that: Background characteristics HIV can be trans- mitted by breast- feeding Risk of MTCT can be reduced by mother taking special drugs during pregnancy HIV can be transmitted by breastfeeding and risk of MTCT can be reduced by mother taking special drugs during pregnancy Number of women HIV can be trans- mitted by breast- feeding Risk of MTCT can be reduced by mother taking special drugs during pregnancy HIV can be transmitted by breastfeeding and risk of MTCT can be reduced by mother taking special drugs during pregnancy Number of men Age 15-24 69.5 45.1 36.7 3,173 65.4 36.5 30.0 1,250 15-19 67.8 39.9 32.5 1,710 62.5 32.3 26.3 743 20-24 71.5 51.1 41.5 1,463 69.6 42.7 35.6 507 25-29 78.4 55.3 47.2 1,044 65.1 41.2 32.1 374 30-39 76.9 55.5 45.8 1,545 70.4 39.7 32.6 538 40-49 79.8 50.9 44.9 1,334 70.1 43.4 36.3 334 50-59 na na na na 64.3 37.5 30.9 301 Marital status Never married 69.5 46.7 37.2 2,373 63.6 37.8 30.2 1,422 Ever had sex 75.1 53.6 43.3 1,197 69.4 44.2 35.5 916 Never had sex 63.8 39.7 30.9 1,175 53.1 26.1 20.6 506 Married/living together 76.5 51.5 43.7 3,709 69.5 39.6 32.7 1,191 Divorced/separated/ widowed 77.8 52.0 45.4 1,014 73.1 39.4 36.3 184 Pregnancy status Pregnant 73.2 49.9 42.6 429 na na na na Not pregnant 74.4 50.0 41.7 6,666 na na na na Residence Urban 78.7 64.9 54.0 1,682 65.3 48.1 37.0 603 Rural 73.0 45.3 38.0 5,413 67.2 36.1 30.2 2,194 Ecological zone Lowlands 77.5 56.7 46.7 4,299 68.9 44.9 36.3 1,734 Foothills 68.8 47.1 39.0 787 62.5 34.4 27.0 307 Mountains 66.4 32.1 27.9 1,572 60.5 22.2 19.0 585 Senqu River Valley 81.9 52.6 47.7 437 74.0 40.1 36.5 171 District Butha-Buthe 73.6 53.4 42.8 458 70.8 38.9 30.9 182 Leribe 73.0 58.0 47.3 1,065 63.1 55.2 40.7 393 Berea 79.7 50.3 44.2 776 70.5 43.5 40.5 350 Maseru 76.6 57.4 48.1 1,868 67.3 42.8 33.8 741 Mafeteng 75.2 46.0 36.9 755 65.8 28.2 23.5 297 Mohale's Hoek 71.6 45.6 37.0 684 68.1 31.4 25.8 281 Quthing 78.5 52.1 48.6 461 73.4 40.4 38.2 167 Qacha's Nek 69.5 34.7 27.0 233 58.3 25.8 21.3 99 Mokhotlong 67.4 26.8 22.9 360 56.9 19.6 14.8 130 Thaba-Tseka 65.8 32.7 27.7 435 66.2 21.8 19.0 156 Education No education 62.6 25.4 22.2 145 57.3 21.5 18.5 479 Primary, incomplete 72.8 43.8 37.7 4,207 65.8 33.2 28.1 1,546 Primary, complete 77.4 59.8 48.4 2,651 75.3 58.1 46.3 696 Secondary+ 76.8 84.6 65.0 92 68.0 79.2 52.4 77 Wealth quintile Lowest 66.1 30.5 26.8 987 57.5 22.2 18.1 466 Second 71.8 38.7 34.0 1,294 66.9 32.4 28.3 514 Middle 74.7 48.9 41.7 1,258 69.8 40.5 33.6 566 Fourth 77.4 54.0 44.5 1,595 69.0 41.0 34.0 621 Highest 77.4 64.5 52.2 1,962 68.5 52.0 40.3 630 Total men 15-59 na na na na 66.8 38.7 31.6 2,797 Total 15-49 74.3 49.9 41.8 7,095 67.1 38.8 31.7 2,496 na = Not applicable HIV/AIDS-Related Knowledge, Attitudes, and Behaviour | 189 11.3 STIGMA TOWARDS HIV-INFECTED PEOPLE Beliefs about HIV/AIDS show the extent of stigma or discrimination towards people with HIV/AIDS. In the 2004 LDHS, questions were posed to respondents to measure their attitudes towards HIV-infected people, their willingness to buy vegetables from an infected vegetable seller, and their willingness to let others know the HIV status of family members and to take care of relatives who have the AIDS virus in their own households. They were also asked whether HIV-positive female and male teachers should be allowed to continue teaching. Tables 11.5.1 and 11.5.2 show the percentage of women and men who have heard about AIDS and who express positive attitudes towards people with HIV, by background characteristics. The large majority of women and men age 15-49 (87 and 79 percent, respectively) express their willingness to care for a relative sick with the virus that causes AIDS in their own household, while far fewer (48 percent of women and 47 percent of men) say they would be willing to buy fresh vegetables from a vendor who has the AIDS virus. The results further indicate that only 55 percent of women and 48 percent of men believe that a female or male teacher who has the AIDS virus should be allowed to continue teaching in school. Sixty-four percent of women and 66 percent of men say that if a member of their family got infected with the virus that causes AIDS, they would not want it to remain a secret. The percentage expressing acceptance on all the five measures is quite low at 24 percent among women and 20 percent among men age 15-49. Urban women and men (37 and 27 percent, respectively) are more likely than their rural counterparts (20 and 17 percent, respectively) to express acceptance on all five measures towards people infected with HIV/AIDS. Accepting attitudes towards HIV-infected people among both women and men are more common in Maseru and among men in Leribe, and least common in Mokhotlong and Qacha’s Nek districts. Among both women and men, education and wealth are strongly associated with positive attitudes towards those who are HIV-positive. The proportion of women and men who accept all five measures increases steadily with education and wealth quintile. 190 | HIV/AIDS-Related Knowledge, Attitudes, and Behaviour Table 11.5.1 Accepting attitudes towards those living with HIV: women Among women age 15-49 who have heard of HIV/AIDS, percentage expressing specific accepting attitudes towards people with HIV, by background characteristics, Lesotho 2004 Percentage of women who: Background characteristics Are willing to care for a family member with the AIDS virus in the respondent’s home Would buy fresh vegetables from shopkeeper who has the AIDS virus Say that a female teacher with the AIDS virus and is not sick should be allowed to continue teaching Say that a male teacher with the AIDS virus and is not sick should be allowed to continue teaching Would not want to keep secret that a family member got infected with the AIDS virus Percentage expressing acceptance on all five measures Number of women who have heard of HIV/AIDS Age 15-24 85.4 51.6 55.5 55.4 69.7 28.2 2,928 15-19 84.4 51.5 54.1 53.7 71.6 28.8 1,575 20-24 86.5 51.8 57.3 57.3 67.5 27.6 1,353 25-29 87.1 49.1 59.5 59.3 62.9 23.7 985 30-39 90.5 45.8 57.5 57.0 57.7 21.1 1,465 40-49 88.3 41.3 49.5 49.3 57.3 17.9 1,261 Marital status Never married 87.2 55.7 61.4 61.1 69.8 31.7 2,250 Ever had sex 88.9 59.0 65.0 64.7 68.4 32.4 1,158 Never had sex 85.4 52.2 57.5 57.2 71.2 30.9 1,092 Married/living together 87.5 44.2 52.9 52.9 60.3 20.1 3,438 Divorced/separated/ widowed 87.0 43.6 50.3 49.7 61.6 19.9 951 Residence Urban 89.9 62.8 75.7 75.3 67.3 37.0 1,674 Rural 86.4 43.0 48.6 48.4 62.4 19.6 4,965 Ecological zone Lowlands 87.8 52.5 64.1 63.8 66.2 28.5 4,190 Foothills 85.5 40.5 44.2 44.2 66.9 17.9 705 Mountains 84.5 37.6 35.0 34.9 54.7 13.4 1,327 Senqu River Valley 94.1 49.1 51.6 51.3 61.0 22.8 418 District Butha-Buthe 90.2 47.5 50.7 50.6 69.2 25.6 448 Leribe 90.5 48.6 56.4 56.3 67.0 24.0 1,029 Berea 89.3 42.6 54.5 53.6 62.4 20.9 747 Maseru 87.9 58.4 68.3 68.1 65.6 32.6 1,797 Mafeteng 79.8 47.1 58.4 58.4 62.4 21.9 695 Mohale's Hoek 83.7 37.9 49.0 48.8 69.9 20.5 612 Quthing 94.0 47.7 50.7 50.5 59.3 22.0 417 Qacha's Nek 86.4 40.1 37.0 37.1 43.6 11.4 211 Mokhotlong 82.2 33.2 30.3 30.6 57.5 13.2 331 Thaba-Tseka 85.8 43.4 40.2 39.5 54.7 15.7 352 Education No education 79.4 17.8 26.4 26.4 59.3 5.5 117 Primary, incomplete 85.7 37.9 43.6 43.4 61.6 16.2 3,823 Primary, complete 89.9 62.9 72.7 72.5 67.2 35.7 2,607 Secondary+ 89.8 83.6 92.5 91.7 57.3 39.6 92 Wealth quintile Lowest 80.4 30.6 28.9 28.8 59.6 11.1 805 Second 85.9 35.5 34.9 34.8 60.0 12.6 1,145 Middle 88.9 45.9 52.6 52.3 63.2 22.2 1,192 Fourth 88.0 47.1 59.4 59.2 63.5 23.5 1,552 Highest 89.5 64.5 77.0 76.7 67.9 37.6 1,946 Total 15-49 87.3 48.0 55.4 55.2 63.7 24.0 6,640 HIV/AIDS-Related Knowledge, Attitudes, and Behaviour | 191 Table 11.5.2 Accepting attitudes towards those living with HIV: men Among men age 15-59 who have heard of HIV/AIDS, percentage expressing specific accepting attitudes towards people with HIV, by background characteristics, Lesotho 2004 Percentage of men who: Background characteristics Are willing to care for a family member with the AIDS virus in the respondent’s home Would buy fresh vegetables from shopkeeper who has the AIDS virus Say that a female teacher with the AIDS virus and is not sick should be allowed to continue teaching Say that a male teacher with the AIDS virus and is not sick should be allowed to continue teaching Would not want to keep secret that a family member got infected the AIDS virus Percentage expressing acceptance on all five measures Number of men who have heard of HIV/AIDS Age 15-24 76.3 44.1 44.9 44.5 69.3 19.6 1,156 15-19 72.9 41.5 42.9 43.6 69.6 18.2 687 20-24 81.4 47.8 47.9 46.0 69.0 21.6 469 25-29 81.2 51.7 54.0 53.9 64.2 22.9 351 30-39 83.1 50.4 49.6 50.4 61.7 20.6 501 40-49 82.1 46.5 46.9 46.9 59.7 18.2 317 50-59 85.3 25.0 33.3 33.5 62.4 10.2 278 Marital status Never married 77.4 46.7 47.6 47.3 68.8 20.7 1,309 Ever had sex 79.9 51.5 49.8 49.1 69.6 23.1 865 Never had sex 72.5 37.4 43.3 43.6 67.2 15.9 444 Married/living together 83.4 43.5 45.7 46.0 61.4 18.0 1,124 Divorced/separated/ widowed 77.3 35.4 37.0 37.0 63.8 13.4 171 Residence Urban 84.7 64.3 72.3 72.4 51.4 27.3 600 Rural 78.6 38.7 38.2 38.1 69.4 16.6 2,003 Ecological zone Lowlands 80.3 49.8 53.9 53.9 66.3 22.2 1,669 Foothills 83.1 38.8 36.0 35.7 67.1 16.1 275 Mountains 75.1 31.2 27.9 28.1 59.9 10.9 495 Senqu River Valley 86.0 41.2 37.5 37.9 68.1 16.7 164 District Butha-Buthe 85.8 39.4 43.3 43.4 73.8 20.2 178 Leribe 84.1 49.8 50.6 50.6 70.0 24.6 374 Berea 83.3 42.6 43.9 43.5 70.9 17.2 324 Maseru 79.1 56.7 59.7 59.7 56.8 22.6 709 Mafeteng 69.7 37.0 42.4 43.4 73.8 17.5 268 Mohale's Hoek 79.8 33.0 35.5 34.7 71.9 14.4 263 Quthing 84.9 42.5 39.3 39.3 63.1 17.2 157 Qacha's Nek 71.8 37.1 33.8 34.0 51.0 12.1 87 Mokhotlong 75.9 30.7 26.1 25.4 61.5 8.9 121 Thaba-Tseka 81.6 34.6 30.2 31.1 55.8 14.8 122 Education No education 72.2 21.8 22.3 22.4 65.4 5.1 394 Primary, incomplete 78.2 36.1 35.3 35.1 66.7 13.6 1,438 Primary, complete 86.7 70.9 76.9 77.2 63.3 35.2 694 Secondary+ 91.8 82.4 89.9 89.9 56.9 45.9 77 Wealth quintile Lowest 75.0 23.9 23.1 22.9 64.0 6.3 389 Second 75.3 31.8 32.2 32.0 70.0 10.7 461 Middle 82.2 42.8 41.4 42.0 71.6 19.2 534 Fourth 82.4 50.6 52.3 52.0 63.8 23.2 599 Highest 82.3 62.9 68.7 68.8 58.5 29.0 620 Total men 15-59 80.0 44.6 46.0 46.0 65.3 19.0 2,603 Total men 15-49 79.3 46.9 47.6 47.5 65.6 20.1 2,325 192 | HIV/AIDS-Related Knowledge, Attitudes, and Behaviour 11.4 ATTITUDES TOWARDS NEGOTIATING SAFER SEX Knowledge about HIV transmission and ways to prevent it are useless if people feel powerless to negotiate safer sex practices with their partners. To gauge attitudes towards safer sex, respondents in the 2004 LHDS were asked if they think a woman is justified in refusing to have sex with her husband if she knows he has an STI. They were also asked if they think that a woman in the same circumstances is justified in asking her husband to use a condom. The results of these questions are shown in Table 11.6. Eighty-two percent of women and 71 percent men age 15 to 49 feel that a woman is justified in refusing to have sex with her husband if she knows he has an STI, while 91 percent of women and 82 per- cent of men believe that a woman is justified in asking her husband to use a condom if he has an STI. A great majority of respondents—95 percent of women and 92 percent of men—agree with one or both statements. There are differences in these attitudes by background characteristics. Respondents from urban areas are more agreeable to both statements than those living in rural areas. For women, the proportion who believe that a wife is justified in either refusing sexual relations with her husband or in asking that they use a condom if he has an STI ranges from 85 percent in Qacha’s Nek and Mokhotlong to 98 percent in Maseru and Berea, while for men it ranges from 73 percent in Qacha’s Nek to 94 percent in Maseru, Quthing, Mohale’s Hoek, and Berea. As expected, the proportion of respondents who agree with either statement increases with educational attainment and wealth index. HIV/AIDS-Related Knowledge, Attitudes, and Behaviour | 193 Table 11.6 Attitudes towards negotiating safer sex Percentage of women age 15-49 and men age 15-59 who believe that, if a husband has a sexually transmitted infection, his wife is justified in either refusing to have sexual relations with him or asking that they use a condom, by background characteristics, Lesotho 2004 Women Men Woman is justified in: Woman is justified in: Background characteristics Refusing to have sexual relations Asking that they use a condom Either refusing sexual relations or asking to use a condom Number of women Refusing to have sexual relations Asking that they use a condom Either refusing sexual relations or asking to use a condom Number of men Age 15-24 78.8 87.7 92.5 3,173 67.6 79.4 89.0 1,250 15-19 75.6 83.3 89.5 1,710 65.5 76.4 87.7 743 20-24 82.5 92.9 96.1 1,463 70.6 83.9 90.8 507 25-29 84.1 94.9 97.8 1,044 74.7 83.7 94.6 374 30-39 86.0 93.6 97.4 1,545 71.9 86.9 93.9 538 40-49 82.6 91.0 96.1 1,334 76.8 80.2 93.7 334 50-59 na na na na 77.5 67.7 88.1 301 Marital status Never married 80.2 87.4 92.1 2,373 68.2 80.1 89.7 1,422 Ever had sex 87.3 94.7 97.8 1,197 74.4 85.1 93.7 916 Never had sex 72.8 79.9 86.2 1,175 56.9 71.1 82.6 506 Married/living together 82.1 92.3 96.5 3,709 75.4 81.2 93.1 1,191 Divorced/separated/ widowed 85.0 92.6 96.7 1,014 73.1 76.1 89.1 184 Residence Urban 88.2 96.2 98.3 1,682 73.6 87.1 93.6 603 Rural 79.9 89.0 94.0 5,413 71.0 78.4 90.5 2,194 Ecological zone Lowlands 85.7 93.4 97.6 4,299 71.4 83.3 92.9 1,734 Foothills 81.6 90.4 95.3 787 67.3 80.4 91.0 307 Mountains 70.0 82.9 88.0 1,572 70.3 69.1 84.8 585 Senqu River Valley 87.3 92.1 95.3 437 85.0 87.2 95.3 171 District Butha-Buthe 82.2 88.3 95.5 458 68.1 78.9 89.2 182 Leribe 81.9 90.6 94.9 1,065 70.8 85.4 91.7 393 Berea 84.5 90.4 97.5 776 74.4 80.0 93.5 350 Maseru 85.6 95.2 97.5 1,868 72.3 83.0 94.0 741 Mafeteng 83.8 92.0 96.5 755 56.2 81.2 89.0 297 Mohale's Hoek 83.9 92.0 95.8 684 80.2 85.3 93.5 281 Quthing 84.3 89.8 92.8 461 88.2 82.4 93.7 167 Qacha's Nek 60.7 80.1 84.5 233 57.4 55.0 73.1 99 Mokhotlong 68.9 77.4 84.7 360 72.6 64.3 82.8 130 Thaba-Tseka 73.7 87.5 92.8 435 71.6 73.2 88.4 156 Education No education 64.6 74.4 83.2 145 68.4 66.3 85.8 479 Primary, incomplete 78.7 87.9 93.4 4,207 70.7 79.5 90.5 1,546 Primary, complete 87.4 95.8 98.3 2,651 74.4 89.9 95.3 696 Secondary+ 93.1 97.5 97.5 92 82.3 95.5 100.0 77 Wealth quintile Lowest 71.8 80.5 87.3 987 71.6 70.0 86.4 466 Second 78.6 86.7 93.1 1,294 69.0 74.0 88.0 514 Middle 80.2 90.6 95.2 1,258 72.3 80.8 91.4 566 Fourth 84.8 93.9 97.3 1,595 71.6 86.5 94.1 621 Highest 87.8 95.8 98.3 1,962 72.9 86.4 94.1 630 Total men 15-59 na na na na 71.6 80.3 91.1 2,797 Total 15-49 81.9 90.7 95.0 7,095 70.8 81.8 91.5 2,496 na = Not applicable 194 | HIV/AIDS-Related Knowledge, Attitudes, and Behaviour 11.5 ADULT SUPPORT FOR EDUCATION ABOUT CONDOM USE In the 2004 LDHS, respondents were asked whether they think that children age 12-14 should be taught about using condoms to avoid AIDS. The data on adults (age 18-49) are shown in Table 11.7. The data show that roughly 62 percent of women and 54 percent of men agree that children age 12-14 should be taught about using a condom to avoid AIDS. While there are no significant age variations, respondents below the age of 30 appear to be more supportive of condom education of children age 12-14. Table 11.7 Adult support for education about condom use to prevent AIDS Percentage of women and men 18-49 who agree that children 12-14 years should be taught about using a condom to avoid AIDS, by background characteristics, Lesotho 2004 Background characteristics Percentage of women Number of women Percentage of men Number of men Age 18-19 66.2 705 55.3 274 20-24 66.2 1,463 55.3 507 25-29 68.1 1,044 62.5 374 30-39 60.4 1,545 51.8 538 40-49 52.2 1,334 46.6 334 Marital status Never married 69.4 1,444 54.7 944 Ever had sex 72.1 1,001 56.4 749 Never had sex 63.2 442 48.1 195 Married/living together 59.5 3,637 54.2 952 Divorced/separated/ widowed 60.2 1,010 51.9 132 Residence Urban 64.6 1,490 62.8 477 Rural 61.1 4,600 51.7 1,550 Ecological zone Lowlands 64.6 3,719 58.6 1,262 Foothills 60.6 673 47.7 223 Mountains 51.8 1,338 43.1 426 Senqu River Valley 74.8 360 60.3 116 District Butha-Buthe 69.6 387 57.4 127 Leribe 67.1 922 65.8 265 Berea 65.6 667 59.7 263 Maseru 57.5 1,647 51.2 581 Mafeteng 63.8 639 53.1 200 Mohale's Hoek 66.2 566 55.2 198 Quthing 68.3 385 59.0 112 Qacha's Nek 58.7 200 52.4 70 Mokhotlong 46.8 309 37.3 97 Thaba-Tseka 52.9 369 38.2 114 Education No education 46.7 144 39.4 357 Primary, incomplete 58.2 3,557 51.0 1,037 Primary, complete 68.4 2,296 68.1 562 Secondary+ 70.5 92 66.9 72 Wealth quintile Lowest 50.9 843 39.5 349 Second 58.4 1,092 50.7 365 Middle 64.5 1,054 57.3 394 Fourth 65.7 1,378 60.2 455 Highest 65.0 1,722 59.9 464 Total 62.0 6,090 54.3 2,027 HIV/AIDS-Related Knowledge, Attitudes, and Behaviour | 195 Respondents living in urban areas (65 percent of women and 63 percent of men) are more likely to agree with teaching children about condom use to avoid HIV/AIDS than those living in rural areas (61 percent of women and 52 percent of men). Looking at districts, the proportion of women who agree that children age 12-14 be taught about condoms is highest in Butha-Buthe (70 percent) and lowest in Mokhotlong (47 percent), while among men is highest in Leribe (66 percent) and lowest in Mokhotlong (37 percent). The proportion of both men and women who agree that children age 12-14 should be taught about condoms as a way to prevent AIDS increases significantly with education. For example, for women it ranges from 47 percent of those with no education to 71 percent among those with secondary or higher education. Wealth index is also positively associated with this indicator for both sexes. The proportion of men age 18-49 who agree that children age 12-14 should be taught about condom use increases from 40 percent among those in the lowest wealth quintile to 60 percent among men in the highest quintile. 11.6 MULTIPLE SEXUAL PARTNERSHIPS Given that the most important mechanism of HIV transmission is sexual intercourse, information on sexual behaviour is important in designing and monitoring intervention programmes to control the spread of the epidemic. In the context of HIV/AIDS/STI prevention, limiting the number sexual partners and having protected sex are crucial to the fight against the epidemic. The 2004 LDHS included questions on the respondent’s lifetime sexual partners and the ones a respondent had in the 12 months preceding the survey. Male respondents were also asked whether they had paid for sex in the past 12 months. Information on use of condoms at last sexual encounter with each of these partner types was collected as well. Tables 11.8.1 and 11.8.2 show the proportion of women age 15-49 and men age 15-59 who had sexual intercourse with two or more partners in the preceding 12 months and the proportion who had higher-risk sexual intercourse (with someone other than a spouse or a cohabiting partner) by background characteristics. Respondents who engaged in higher-risk sex in the past 12 months were also asked whether they used a condom at the last such encounter. the mean number of lifetime sexual partners is calculated for both men and women. The data show that among those who had sex in the previous 12 months, 11 percent of women age 15-49 and 29 percent of men age 15-59 report having had two or more sexual partners in the 12 months preceding the survey. A larger proportion—36 percent of women and 60 percent of men— report having had higher-risk sexual intercourse in the past 12 months (i.e., sexual intercourse with someone other than their spouse or cohabiting partner). Among respondents who had higher-risk sex in the past 12 months, less than half (42 percent of women and 46 percent of men) report having used a condom at their last encounter. 196 | HIV/AIDS-Related Knowledge, Attitudes, and Behaviour Table 11.8.1 Multiple sexual partners and higher-risk sexual intercourse in the past 12 months: women Among women age 15-49 who had sexual intercourse in the past 12 months, the percentage who had intercourse with more than one partner and the percentage who had higher-risk sexual intercourse1 in the past 12 months, and among those having higher-risk intercourse in the past 12 months, the percentage reporting that a condom was used at last higher-risk intercourse, and the mean number of sexual partners during her lifetime for women who ever had sexual intercourse, by background characteristics, Lesotho 2004 Women who had sexual intercourse in the past 12 months Women who had higher- risk intercourse1 in the past 12 months Women who ever had sexual intercourse Background characteristics Percentage who had 2+ partners in the past 12 months Percentage who had higher-risk intercourse1 in the past 12 months Number of women Percentage who reported using a condom at last higher-risk intercourse1 Number of women Mean number of sexual partners in lifetime Number of women Age 15-24 8.8 41.9 1,621 53.0 680 1.0 2,032 15-19 8.5 53.8 571 50.8 307 1.0 734 20-24 9.0 35.5 1,049 54.9 372 1.1 1,298 25-29 11.3 33.2 910 50.6 302 1.2 1,019 30-39 12.6 31.7 1,332 34.6 422 1.2 1,538 40-49 12.3 33.0 1,069 21.8 353 1.1 1,328 Marital status Never married 11.6 96.6 804 57.5 777 1.0 1,197 Married/living together 10.2 12.3 3,464 34.4 426 1.2 3,707 Divorced/separated/ widowed 14.8 83.6 663 25.9 554 1.1 1,013 Residence Urban 9.9 43.9 1,172 64.0 514 1.2 1,397 Rural 11.4 33.1 3,759 32.8 1,243 1.1 4,520 Ecological zone Lowlands 9.7 35.8 2,973 50.0 1,065 1.1 3,577 Foothills 10.4 27.9 540 29.6 151 1.1 644 Mountains 14.9 35.3 1,103 26.2 390 1.2 1,320 Senqu River Valley 11.5 47.9 315 37.5 151 1.2 376 District Butha-Buthe 9.3 29.6 304 43.1 90 1.1 361 Leribe 11.1 30.5 742 41.8 226 1.2 876 Berea 9.8 26.6 518 36.4 138 1.1 628 Maseru 10.3 41.1 1,337 55.9 550 1.1 1,576 Mafeteng 10.3 31.9 531 40.7 169 1.1 641 Mohale's Hoek 10.4 36.5 468 31.3 171 1.1 577 Quthing 11.4 46.8 333 36.4 156 1.2 401 Qacha's Nek 15.3 45.9 170 34.1 78 1.1 203 Mokhotlong 15.0 37.0 238 19.7 88 1.2 293 Thaba-Tseka 14.8 31.1 291 24.8 90 1.2 361 Education No education 17.1 41.1 119 9.3 49 1.3 141 Primary, incomplete 11.6 34.0 2,960 31.0 1,007 1.1 3,569 Primary, complete 9.7 37.6 1,774 59.5 667 1.1 2,121 Secondary+ 12.6 44.2 78 68.6 34 1.4 87 Wealth quintile Lowest 14.1 34.3 683 20.2 234 1.2 851 Second 13.5 36.3 907 21.0 329 1.1 1,109 Middle 9.7 33.8 853 36.1 288 1.1 1,026 Fourth 9.8 33.4 1,127 47.4 377 1.1 1,323 Highest 9.8 38.9 1,362 63.9 529 1.1 1,608 Total 11.0 35.6 4,932 41.9 1,757 1.1 5,917 1 Sexual intercourse with a partner who neither was a spouse nor who lived with the respondent HIV/AIDS-Related Knowledge, Attitudes, and Behaviour | 197 Table 11.8.2 Multiple sexual partners and higher-risk sexual intercourse in the past 12 months: men Among men age 15-59 who had sexual intercourse in the past 12 months, the percentage who had intercourse with more than one partner and the percentage who had higher-risk sexual intercourse1 in the past 12 months, and among those having higher-risk intercourse in the past 12 months, the percentage reporting that a condom was used at last higher-risk intercourse, and the mean number of sexual partners during his lifetime for men who ever had sexual intercourse, by background characteristics, Lesotho 2004 Men who had sexual intercourse in the past 12 months Men who had higher- risk intercourse1 in the past 12 months Men who ever had sexual intercourse Background characteristics Percentage who had 2+ partners in the past 12 months Percentage who had higher-risk intercourse1 in the past 12 months Number of men Percentage who reported using a condom at last higher-risk intercourse1 Number of men Mean number of sexual partners in lifetime Number of men Age 15-24 35.5 89.3 643 52.8 574 4.4 775 15-19 31.3 97.1 278 51.2 270 3.4 339 20-24 38.8 83.4 365 54.2 304 5.2 436 25-29 32.3 56.0 321 56.7 180 5.8 360 30-39 29.1 47.6 479 44.9 228 8.4 523 40-49 19.0 38.8 292 22.1 114 9.0 332 50-59 16.6 36.4 260 8.9 95 7.7 300 Marital status Never married 37.5 97.9 739 54.1 724 5.2 916 Married/living together 23.2 30.3 1,123 34.4 340 7.5 1,191 Divorced/separated/ widowed 24.8 94.9 133 26.0 127 8.7 184 Residence Urban 35.6 58.5 472 70.1 276 10.1 514 Rural 26.4 60.0 1,524 38.0 914 5.6 1,777 Ecological zone Lowlands 28.2 58.9 1,212 52.9 714 7.0 1,401 Foothills 24.5 59.8 218 33.7 130 6.4 250 Mountains 29.3 57.6 425 29.5 245 5.6 486 Senqu River Valley 35.8 72.0 141 46.5 102 7.7 154 District Butha-Buthe 19.1 58.1 128 48.9 74 5.5 149 Leribe 30.4 57.1 276 48.4 157 6.2 317 Berea 23.5 50.7 225 41.6 114 6.3 277 Maseru 32.9 60.9 560 57.0 341 8.1 626 Mafeteng 22.7 65.3 183 33.6 120 6.1 215 Mohale's Hoek 30.7 63.3 215 37.8 136 5.6 240 Quthing 30.8 69.9 141 41.2 99 8.2 152 Qacha's Nek 24.0 67.3 78 53.7 53 3.6 86 Mokhotlong 29.2 47.7 92 31.1 44 4.7 105 Thaba-Tseka 29.3 53.6 96 23.3 52 7.4 123 Education No education 23.7 46.8 379 16.0 177 7.0 439 Primary, incomplete 29.4 61.4 1,060 38.5 650 6.1 1,212 Primary, complete 30.6 66.6 487 71.2 325 6.4 567 Secondary+ 29.1 54.2 70 81.8 38 15.5 73 Wealth quintile Lowest 29.2 57.2 329 18.2 188 6.3 399 Second 26.7 61.1 381 32.2 233 5.8 436 Middle 28.3 62.7 393 42.8 246 5.8 451 Fourth 28.2 59.1 415 54.3 245 6.2 489 Highest 30.2 58.1 478 69.7 278 8.8 516 Total men 15-59 28.6 59.6 1,996 45.5 1,190 6.6 2,291 Total men 15-49 30.4 63.1 1,736 48.6 1,096 6.5 1,991 1 Sexual intercourse with a partner who neither was a spouse nor who lived with the respondent 198 | HIV/AIDS-Related Knowledge, Attitudes, and Behaviour By definition, the majority of sexually active women and men who have never married engage in higher-risk sex—97 percent of women and 98 percent of men—compared with only 12 percent of currently married women and 30 percent of currently married men. Condom use during higher-risk sex is more pronounced among women and men who have never married (58 percent for women and 54 percent for men) than those currently married (34 percent for women and men) or divorced, widowed, or separated (26 percent for women and men). Sexual behaviours differ by residence. Urban women are slightly less likely than rural women to have had two or more partners in the preceding year (10 and 11 percent, respectively). However, urban women are significantly more likely to report having had a higher- risk sexual intercourse in the past 12 months than rural women (44 and 33 percent, respectively) or to have used a condom the last time they had such encounter (64 percent among urban women and 33 percent among rural women). The pattern is somewhat different for men. Urban men are more likely than their rural counterparts to have had two or more partners in the past 12 months (36 and 26 percent, respectively) but slightly less likely to report a higher-risk sexual intercourse during the same period (59 and 60 percent, respectively). Similarly to women, urban men are much more likely to have used a condom the last time they had higher-risk sex than rural men (70 and 38 percent, respectively). For both men and women, the association of education and wealth index with the number of partners and occurrence of higher-risk sexual encounters is not uniform. On the other hand, these two background characteristics are strongly associated with use of condoms in the last high-risk sexual encounter. The more educated and well-off respondents are much more likely to report condom use at their last higher-risk sexual intercourse than those who are less educated or worse-off. Only 9 percent of women and 16 percent of men with no education have used a condom at such encounter compared with 69 percent of women and 82 percent of men with secondary or higher education. For women, condom use at last higher-risk sexual encounter ranges from 20 percent in the lowest wealth index quintile to 64 percent among women in the highest, while for men it ranges from 18 percent among men in the lowest wealth index quintile to 70 percent among those in the highest. Mean number of lifetime sexual partners is 1.1 for women and 6.6 for men. For men, the mean number of lifetime sexual partners increases steadily with age. Urban men have almost twice as many lifetime sexual partners as rural men (10.1 and 5.6 partners, respectively). 11.7 PAID SEX AND CONDOM USE A special category of higher-risk sex is sex for which compensation is paid. In the 2004 LDHS, men were asked if they had ever paid for sex and, if so, when the most recent encounter took place and if they used condoms at that most recent sex. Women were asked if they had been given or had received money, gifts, or favours in return for sex in the 12 months preceding the survey. Results shown in Table 11.9 indicate that less than 2 percent of men age 15-59 have paid for sexual intercourse in the 12 months before the survey. Fifty-eight percent of men who paid for sexual intercourse in the past year used condoms at the most recent paid sex (data not shown because of the small number of cases). There are no significant variations by age in the percentage of men having paid sex in the 12 months preceding the survey. The proportion of men having paid for sex in the past year is higher among urban men (3 percent) than rural men (1 percent). Education and wealth index are not clearly associated with the proportion of men who paid for sex in the past 12 months. HIV/AIDS-Related Knowledge, Attitudes, and Behaviour | 199 Table 11.9 Payment for sexual intercourse: men Percentage of men age 15-59 who reported payment for sexual intercourse in the past 12 months, by background characteristics, Lesotho 2004 Background characteristics Percentage who paid for sexual intercourse in the past 12 months1 Number of men Age 15-24 1.0 1,250 15-19 0.4 743 20-24 1.9 507 25-29 1.8 374 30-39 3.0 538 40-49 1.7 334 50-59 0.8 301 Marital status Never married 1.4 1,419 Married or living together 1.7 1,194 Divorced/separated/ widowed 2.3 184 Residence Urban 3.4 603 Rural 1.1 2,194 Ecological zone Lowlands 1.9 1,734 Foothills 1.3 307 Mountains 1.3 585 Senqu River Valley 0.0 171 District Butha-Buthe 0.3 182 Leribe 0.5 393 Berea 1.9 350 Maseru 2.8 741 Mafeteng 2.0 297 Mohale's Hoek 0.6 281 Quthing 0.0 167 Qacha's Nek 1.0 99 Mokhotlong 1.8 130 Thaba-Tseka 2.1 156 Education No education 1.7 479 Primary, incomplete 1.3 1,546 Primary, complete 2.2 696 Secondary+ 0.0 77 Wealth quintile Lowest 2.4 466 Second 0.7 514 Middle 1.3 566 Fourth 1.2 621 Highest 2.2 630 Total men 15-59 1.6 2,797 Total men 15-49 1.7 2,496 1 Includes men who reported having a prostitute as one of their last three sexual partners in the past 12 months 200 | HIV/AIDS-Related Knowledge, Attitudes, and Behaviour 11.8 TESTING FOR HIV AND KNOWLEDGE OF SOURCE OF TEST Voluntary counselling and testing (VCT) is now acknowledged as an effective strategy for HIV prevention. HIV testing through VCT or in clinical settings is essential for access to AIDS care. Knowl- edge of HIV status helps HIV-negative individuals make specific decisions to reduce risk and increase safer sex practices so they can remain disease-free. For those who are HIV-infected, knowledge of their status allows them to better protect their sexual partners, to access treatment for HIV disease, and to plan for their future. The 2004 LDHS respondents were asked whether they have ever been tested for the AIDS virus. Those who had been tested were asked when they were last tested, whether they had asked for the test themselves or were required to take it, and whether they received their results. Those who had not been tested were asked if they would like to be tested or not. Tables 11.10.1 and 11.10.2 show that 15 percent of women and 11 percent of men age 15-49 have been tested for HIV. Since the 2000 EMICS, the proportion of women tested for HIV has increased from 12 percent in 2000 to the current proportion of 15 percent, while for men it has decreased from 17 percent to the current proportion of 11 percent (BOS, 2000). Twelve percent of all women in the 2004 LDHS received their HIV test results, representing 83 percent of women who have ever been tested. Among men, 9 percent of all men age 15-49 have received the test results, representing 87 percent of men who have ever been tested. Furthermore, 6 percent of women and 5 percent of men received the HIV test results in the past 12 months. Across all age groups, women are more likely than men to have ever been tested for HIV and to have received the test results. The largest proportion of those who have ever been tested is concentrated between age 25 and 39. For both men and women, those living in urban areas and in the Lowlands are more likely than other sub-groups to have ever been tested for HIV and to have received the test results, and to have received results in the past 12 months. The proportion of respondents who have been tested and have received the test results increases steadily with education level and wealth quintile. A significant proportion of respondents—almost half of women and men (49 percent each) have never been tested for HIV and would like to be tested. This indicates an unmet need for HIV testing in Lesotho. The proportion of respondents never tested for HIV who would like to be tested is higher among rural residents than among their urban counterparts. HIV/AIDS-Related Knowledge, Attitudes, and Behaviour | 201 Table 11.10.1 Coverage of prior HIV testing: women Percent distribution of women by whether tested for HIV and by whether received the results of the test, and the percentage of women who received their test results the last time they were tested for HIV in the past 12 months, according to background characteristics, Lesotho 2004 Percentage never tested who: Percentage ever tested who: Background characteristics Received test results Did not receive test results Would like to be tested Would not like to be tested/ unsure/ do not know Never heard of AIDS Total Percentage tested and who received results in past 12 months Number of women Age 15-24 8.6 2.4 52.1 29.2 7.7 100.0 4.9 3,173 15-19 4.3 1.4 58.0 28.4 7.9 100.0 2.6 1,710 20-24 13.6 3.7 45.1 30.1 7.5 100.0 7.7 1,463 25-29 17.2 3.3 42.3 31.6 5.6 100.0 9.3 1,044 30-39 16.0 2.4 47.3 29.2 5.1 100.0 7.6 1,545 40-49 11.3 2.4 50.0 30.8 5.5 100.0 5.9 1,334 Marital status Never married 7.8 1.1 54.1 31.9 5.2 100.0 4.3 2,373 Ever had sex 12.4 2.2 47.7 34.5 3.3 100.0 6.8 1,197 Never had sex 3.1 0.1 60.6 29.2 7.1 100.0 1.7 1,175 Married/living together 13.6 3.3 46.3 29.5 7.3 100.0 7.3 3,709 Divorced/separated/ widowed 16.1 2.8 48.5 26.5 6.2 100.0 7.7 1,014 Residence Urban 16.6 1.7 43.4 37.9 0.5 100.0 8.6 1,682 Rural 10.6 2.8 51.0 27.3 8.3 100.0 5.6 5,413 Ecological zone Lowlands 13.9 1.6 47.7 34.3 2.5 100.0 7.1 4,299 Foothills 11.1 3.6 50.1 24.7 10.5 100.0 6.2 787 Mountains 7.8 4.0 50.5 22.0 15.6 100.0 4.4 1,572 Senqu River Valley 10.6 4.1 57.2 23.9 4.2 100.0 5.5 437 District Butha-Buthe 14.8 2.8 53.1 27.2 2.1 100.0 7.8 458 Leribe 12.5 3.0 52.4 28.8 3.4 100.0 5.5 1,065 Berea 13.5 1.8 49.6 31.2 3.8 100.0 8.4 776 Maseru 14.2 1.7 44.1 36.2 3.8 100.0 7.3 1,868 Mafeteng 11.8 1.8 46.0 32.5 7.8 100.0 7.2 755 Mohale's Hoek 9.8 1.6 52.8 25.3 10.5 100.0 4.2 684 Quthing 8.8 5.8 54.1 21.9 9.5 100.0 4.6 461 Qacha's Nek 10.5 3.4 52.0 24.5 9.6 100.0 5.9 233 Mokhotlong 6.4 3.5 55.3 26.8 8.1 100.0 4.6 360 Thaba-Tseka 8.4 4.0 46.5 22.0 19.1 100.0 4.4 435 Education No education 4.7 3.7 48.5 23.2 19.9 100.0 2.3 145 Primary, incomplete 10.1 2.7 51.3 26.8 9.1 100.0 5.2 4,207 Primary, complete 14.8 2.3 46.5 34.8 1.6 100.0 7.8 2,651 Secondary+ 28.9 1.1 32.7 37.3 0.0 100.0 22.6 92 Wealth quintile Lowest 6.6 3.3 50.1 21.6 18.5 100.0 3.9 987 Second 9.8 3.7 55.8 19.1 11.5 100.0 4.8 1,294 Middle 11.7 2.0 51.5 29.5 5.3 100.0 6.2 1,258 Fourth 13.0 1.8 46.2 36.3 2.7 100.0 7.2 1,595 Highest 15.5 2.3 45.3 36.1 0.8 100.0 8.0 1,962 Total 12.0 2.5 49.2 29.9 6.4 100.0 6.3 7,095 202 | HIV/AIDS-Related Knowledge, Attitudes, and Behaviour Table 11.10.2 Coverage of prior HIV testing: men Percent distribution of men age 15-59 by whether tested for HIV and by whether received the results of the test, and the percentage of men who received their test results the last time they were tested for HIV in the past 12 months, according to background characteristics, Lesotho 2004 Percentage never tested who: Percentage ever tested who: Background characteristics Received test results Did not receive test results Would like to be tested Would not like to be tested/ unsure/ do not know Never heard of AIDS Total Percentage tested and who received results in past 12 months Number of men Age 15-24 3.4 0.7 54.5 33.9 7.5 100.0 2.2 1,250 15-19 1.3 0.6 56.0 34.5 7.5 100.0 1.1 743 20-24 6.4 0.9 52.2 33.1 7.5 100.0 3.8 507 25-29 13.3 2.9 45.9 31.6 6.2 100.0 7.5 374 30-39 16.2 1.4 44.0 31.6 6.7 100.0 7.7 538 40-49 14.1 2.4 41.1 37.3 5.1 100.0 6.9 334 50-59 6.5 4.8 45.2 35.9 7.6 100.0 3.5 301 Marital status Never married 4.6 1.1 51.3 35.0 8.0 100.0 3.2 1,422 Ever had sex 6.4 1.3 52.9 33.7 5.6 100.0 4.3 916 Never had sex 1.2 0.7 48.5 37.3 12.3 100.0 1.2 506 Married/living together 14.2 2.7 44.9 32.7 5.6 100.0 6.6 1,191 Divorced/separated/ widowed 6.3 1.6 53.7 31.3 7.1 100.0 3.9 184 Residence Urban 13.2 1.5 42.2 42.6 0.5 100.0 6.7 603 Rural 7.6 1.9 50.5 31.3 8.7 100.0 4.1 2,194 Ecological zone Lowlands 10.3 1.6 46.8 37.5 3.7 100.0 5.4 1,734 Foothills 6.6 2.0 51.2 29.8 10.4 100.0 4.0 307 Mountains 5.7 2.2 48.7 28.0 15.4 100.0 3.2 585 Senqu River Valley 7.5 1.8 64.1 22.5 4.1 100.0 3.9 171 District Butha-Buthe 7.9 2.1 59.7 28.0 2.3 100.0 5.0 182 Leribe 12.8 3.0 48.7 30.7 4.8 100.0 5.4 393 Berea 9.5 0.9 48.2 33.7 7.6 100.0 6.3 350 Maseru 10.5 1.6 41.8 41.9 4.3 100.0 5.7 741 Mafeteng 5.0 1.7 43.6 40.0 9.7 100.0 3.0 297 Mohale's Hoek 7.0 2.2 55.4 29.0 6.5 100.0 1.9 281 Quthing 7.4 1.4 64.3 21.4 5.5 100.0 4.1 167 Qacha's Nek 9.8 1.1 48.4 27.9 12.8 100.0 5.1 99 Mokhotlong 5.5 3.2 51.4 33.0 7.0 100.0 2.7 130 Thaba-Tseka 4.0 0.8 49.4 24.0 21.8 100.0 3.8 156 Education No education 5.8 2.5 42.7 31.4 17.6 100.0 2.6 479 Primary, incomplete 6.7 1.7 52.3 32.2 7.0 100.0 3.6 1,546 Primary, complete 12.9 1.5 47.9 37.5 0.2 100.0 7.2 696 Secondary+ 31.1 1.8 21.8 45.3 0.0 100.0 16.0 77 Wealth quintile Lowest 4.4 1.8 47.3 29.9 16.5 100.0 3.1 466 Second 6.3 0.9 54.9 27.5 10.3 100.0 3.6 514 Middle 8.1 2.1 50.7 33.5 5.6 100.0 3.8 566 Fourth 12.0 1.7 50.2 32.6 3.5 100.0 5.8 621 Highest 11.5 2.3 41.5 43.1 1.7 100.0 6.4 630 Total men 15-59 8.8 1.8 48.7 33.8 6.9 100.0 4.7 2,797 Total men 15-49 9.1 1.4 49.2 33.5 6.8 100.0 4.8 2,496 HIV/AIDS-Related Knowledge, Attitudes, and Behaviour | 203 Figure 11.1 shows that among respondents who were tested for HIV, 45 percent of women and 56 percent of men age 15-49 asked for the test themselves, 21 percent of both women and men were offered the HIV test, and 33 percent of women and 22 percent of men were required to have it. 45 21 33 56 21 22 Asked for test Offered test Test required 0 10 20 30 40 50 60 Women Men Figure 11.1 Reasons for HIV Testing among Women and Men Age 15-49 Who Have Ever Been Tested LDHS 2004 Respondents who had never been tested for HIV were asked whether they knew of a place to get an HIV test. Results are shown in Tables 11.11.1 and 11.11.2. The majority of respondents—51 percent of women and 38 percent of men age 15-49—mentioned a public health facility for HIV testing, while 11 percent of women and 7 percent of men mentioned CHAL. Thirty-six percent of women and 54 percent of men reported not knowing a place to get an HIV test, the proportion being higher in rural areas than in urban areas. 204 | HIV/AIDS-Related Knowledge, Attitudes, and Behaviour Table 11.11.1 Knowledge of and source for HIV testing: women Percentage of women never tested for HIV and among those, percent distribution by main place known to get an AIDS test, by background characteristics, Lesotho 2004 Place mentioned for HIV testing: Background characteristics Per- centage never tested Number of women Public Private CHAL Other Missing Don't know a place Total Number of women who have never been tested Age 15-24 81.2 3,173 45.3 0.8 9.4 0.4 0.1 43.9 100.0 2,577 15-19 86.4 1,710 40.8 0.7 8.9 0.4 0.1 49.1 100.0 1,478 20-24 75.1 1,463 51.5 1.1 10.1 0.3 0.1 36.9 100.0 1,099 25-29 73.9 1,044 58.4 2.2 9.1 0.8 0.0 29.5 100.0 771 30-39 76.4 1,545 60.2 1.7 11.7 0.1 0.4 26.0 100.0 1,181 40-49 80.8 1,334 51.1 1.7 13.2 0.7 0.0 33.5 100.0 1,078 Marital status Never married 85.9 2,373 47.8 1.1 7.9 0.4 0.1 42.7 100.0 2,039 Ever had sex 82.2 1,197 57.1 1.7 7.7 0.2 0.0 33.3 100.0 984 Never had sex 89.7 1,175 39.2 0.6 8.0 0.6 0.1 51.5 100.0 1,055 Married/living together 75.7 3,709 53.4 1.6 12.4 0.4 0.2 31.9 100.0 2,809 Divorced/separated/ widowed 74.9 1,014 53.3 0.9 10.8 0.7 0.0 34.2 100.0 760 Residence Urban 81.3 1,682 69.5 1.9 3.4 1.1 0.0 24.1 100.0 1,367 Rural 78.3 5,413 45.5 1.2 12.8 0.2 0.2 40.0 100.0 4,240 Ecological zone Lowlands 82.0 4,299 57.3 1.9 7.8 0.6 0.1 32.1 100.0 3,525 Foothills 74.9 787 29.3 1.1 24.6 0.0 0.0 45.0 100.0 589 Mountains 72.5 1,572 40.4 0.0 12.8 0.1 0.3 46.5 100.0 1,140 Senqu River Valley 80.8 437 64.5 0.4 7.0 0.0 0.0 28.1 100.0 353 District Butha-Buthe 80.3 458 55.6 0.8 18.8 0.1 0.0 24.7 100.0 367 Leribe 81.1 1,065 47.5 0.7 14.7 0.3 0.2 36.6 100.0 864 Berea 80.9 776 40.5 2.6 17.5 0.0 0.0 39.5 100.0 628 Maseru 80.3 1,868 53.5 3.2 7.0 1.3 0.1 34.8 100.0 1,500 Mafeteng 78.6 755 58.6 0.3 7.2 0.0 0.0 33.9 100.0 593 Mohale's Hoek 78.1 684 55.4 0.0 1.6 0.0 0.0 43.0 100.0 534 Quthing 75.7 461 69.3 0.4 5.0 0.0 0.0 25.2 100.0 349 Qacha's Nek 76.5 233 51.0 0.0 6.9 0.0 0.0 42.2 100.0 178 Mokhotlong 82.1 360 59.3 0.0 0.0 0.0 0.0 40.7 100.0 295 Thaba-Tseka 68.5 435 19.2 0.0 33.5 0.5 1.1 45.7 100.0 298 Education No education 71.8 145 47.8 0.0 1.3 0.0 0.0 51.0 100.0 104 Primary, incomplete 78.1 4,207 44.3 1.0 11.6 0.3 0.1 42.7 100.0 3,284 Primary, complete 81.3 2,651 61.7 1.5 9.4 0.7 0.2 26.5 100.0 2,154 Secondary+ 70.1 92 70.8 14.8 11.3 0.0 0.0 3.2 100.0 65 Wealth quintile Lowest 71.6 987 37.0 0.5 10.2 0.1 0.4 51.7 100.0 706 Second 74.9 1,294 42.7 0.7 13.3 0.0 0.0 43.3 100.0 969 Middle 81.1 1,258 46.2 1.1 13.0 0.0 0.2 39.6 100.0 1,020 Fourth 82.5 1,595 53.6 1.3 10.1 0.6 0.2 34.2 100.0 1,316 Highest 81.4 1,962 64.5 2.4 7.9 0.9 0.0 24.3 100.0 1,597 Total 79.0 7,095 51.4 1.4 10.6 0.4 0.1 36.1 100.0 5,607 HIV/AIDS-Related Knowledge, Attitudes, and Behaviour | 205 Table 11.11.2 Knowledge of and source for HIV test: men Percentage of men age 15-59 never tested for HIV and among those, percent distribution by main place known to get an AIDS test, by background characteristics, Lesotho 2004 Place mentioned for HIV testing: Background characteristics Per- centage never tested Number of men Public Private CHAL Other Missing Don't know a place Total Number of men who have never been tested Age 15-24 88.4 1,250 33.5 0.5 5.6 0.4 0.1 59.9 100.0 1,105 15-19 90.5 743 31.0 0.6 4.2 0.4 0.0 63.9 100.0 673 20-24 85.3 507 37.4 0.4 7.8 0.5 0.2 53.6 100.0 432 25-29 77.5 374 45.0 0.1 8.2 0.0 0.6 46.1 100.0 290 30-39 75.6 538 42.8 0.8 9.5 0.8 0.0 46.0 100.0 407 40-49 78.3 334 39.0 0.9 5.9 1.5 0.6 52.1 100.0 261 50-59 81.1 301 40.7 0.8 7.1 0.0 0.0 51.3 100.0 244 Marital status Never married 86.3 1,422 35.1 0.5 5.9 0.4 0.2 57.9 100.0 1,228 Ever had sex 86.7 916 39.2 0.6 7.3 0.3 0.4 52.3 100.0 794 Never had sex 85.8 506 27.7 0.3 3.4 0.6 0.0 68.0 100.0 434 Married/living together 77.5 1,191 42.2 0.6 8.0 0.3 0.0 48.8 100.0 923 Divorced/separated/ widowed 85.0 184 35.1 1.6 6.7 2.5 0.9 53.2 100.0 156 Residence Urban 84.8 603 63.0 1.2 0.5 1.5 0.0 33.9 100.0 511 Rural 81.9 2,194 30.9 0.5 8.6 0.3 0.2 59.6 100.0 1,797 Ecological zone Lowlands 84.3 1,734 41.7 0.9 5.0 0.7 0.1 51.4 100.0 1,462 Foothills 81.0 307 20.1 0.2 19.1 0.4 0.0 60.3 100.0 249 Mountains 76.7 585 29.1 0.0 6.6 0.0 0.5 63.8 100.0 449 Senqu River Valley 86.6 171 57.8 0.0 4.8 0.0 0.0 37.4 100.0 148 District Butha-Buthe 87.7 182 43.3 0.1 15.9 1.1 0.5 39.1 100.0 160 Leribe 79.5 393 32.6 0.3 9.1 0.0 0.0 58.0 100.0 312 Berea 82.0 350 28.9 1.5 8.3 0.5 0.5 60.3 100.0 287 Maseru 83.7 741 43.1 1.1 5.8 1.2 0.0 48.8 100.0 620 Mafeteng 83.5 297 34.6 0.0 5.3 0.0 0.0 60.1 100.0 248 Mohale's Hoek 84.4 281 38.4 0.7 1.3 0.6 0.0 59.0 100.0 237 Quthing 85.7 167 60.9 0.0 3.2 0.0 0.0 35.9 100.0 143 Qacha's Nek 76.4 99 31.3 0.0 4.6 0.0 0.0 64.1 100.0 76 Mokhotlong 84.3 130 42.6 0.0 0.0 0.0 0.0 57.4 100.0 110 Thaba-Tseka 73.4 156 17.7 0.0 17.0 0.0 1.8 63.5 100.0 115 Education No education 74.1 479 23.6 0.1 5.0 0.4 0.0 71.0 100.0 354 Primary, incomplete 84.6 1,546 31.0 0.6 6.5 0.2 0.2 61.6 100.0 1,307 Primary, complete 85.4 696 59.5 1.1 8.1 1.1 0.4 29.9 100.0 594 Secondary+ 67.2 77 66.8 0.0 12.6 1.9 0.0 18.7 100.0 52 Wealth quintile Lowest 77.2 466 24.6 0.4 8.0 0.4 0.0 66.6 100.0 360 Second 82.5 514 28.3 0.5 6.7 0.0 0.7 63.9 100.0 424 Middle 84.2 566 32.0 0.1 8.7 0.4 0.3 58.4 100.0 476 Fourth 82.8 621 39.4 0.8 6.8 0.0 0.0 53.0 100.0 514 Highest 84.6 630 58.7 1.1 4.4 1.6 0.0 34.2 100.0 533 Total men 15-59 82.5 2,797 38.0 0.6 6.8 0.5 0.2 53.9 100.0 2,308 Total men 15-49 82.7 2,496 37.6 0.6 6.8 0.6 0.2 54.2 100.0 2,064 206 | HIV/AIDS-Related Knowledge, Attitudes, and Behaviour Table 11.12 presents data on HIV/AIDS infor- mation and counselling during antenatal care among pregnant women who gave birth in the two years preceding the survey. Fifty-eight percent of pregnant women who gave birth in the past two years received information and counselling about HIV/AIDS during antenatal care for their most recent birth. Pregnant women may be at an advantage to the rest of the population. They can receive information and counsel- ling when they visit antenatal clinics for routine preg- nancy care. The percentage of women who received in- formation or counselling during an antenatal care visit rises steadily with age, education attainment, and wealth index quintile, and is significantly higher in urban than rural areas (80 and 55 percent, respectively). The highest proportion of pregnant women who received information and counselling about HIV/AIDS is among those who live in the Lowlands (66 percent) and Qacha’s Nek (70 percent), and the lowest is among those who live the Mountains (47 percent) and Mokhotlong (39 percent). 11.9 SELF-REPORTING OF SEXUALLY TRANSMITTED INFECTIONS Information about the incidence of sexually transmitted infections (STIs) is not only useful as a marker of unprotected sexual intercourse but also as a co-factor for HIV transmission. The 2004 LDHS elicited information from both female and male respondents about their knowledge of infections other than HIV that can be transmitted sexually. Respondents who had ever had sex were also asked if they had had a sexually transmitted disease in the previous 12 months or if they had had either of two symptoms associated with STIs (a bad-smelling, unusual discharge from the vagina/penis or a genital sore or ulcer). As shown in Table 11.13, only 3 percent of women and men age 15-49 who have ever had sex reported having had an STI in the 12 months before the survey. Twelve percent of women and 7 percent of men reported having had an abnormal genital discharge, while 6 percent of women and 7 percent men reported having had a genital sore or ulcer in the 12 months before the survey. Fifteen percent of women and 12 percent of men reported having an STI, an abnormal discharge, or a genital sore. Table 11.12 Pregnant women received information and counselling about HIV/AIDS Among women who gave birth in the two years preceding the survey, percentage who received information and were counselled about HIV/AIDS during antenatal care for their most recent birth, by background characteristics, Lesotho 2004 Background characteristics Percentage who received information and counselling about HIV/AIDS during antenatal care1 Number of women who gave birth in the past 2 years2 Age 15-24 54.6 738 15-19 54.4 224 20-24 54.7 514 25-29 58.3 296 30-39 63.6 367 40-49 66.9 97 Marital status Never married 58.1 207 Married/living together 60.2 1,117 Divorced/separated/ widowed 46.5 174 Residence Urban 79.9 209 Rural 54.9 1,290 Ecological zone Lowlands 65.5 767 Foothills 52.9 183 Mountains 47.1 450 Senqu River Valley 63.4 98 District Butha-Buthe 65.3 82 Leribe 60.5 252 Berea 55.6 166 Maseru 64.9 291 Mafeteng 62.5 155 Mohale's Hoek 55.9 153 Quthing 58.9 113 Qacha's Nek 69.5 55 Mokhotlong 38.6 100 Thaba-Tseka 46.7 131 Education No education (46.1) 32 Primary, incomplete 52.0 956 Primary, complete 70.4 500 Secondary+ * 10 Wealth quintile Lowest 40.6 304 Second 52.7 350 Middle 57.9 280 Fourth 63.6 316 Highest 81.8 248 Total 58.3 1,498 Note: Figures in parentheses are based on 25-49 unweighted cases. An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. 1 In this context, "counselled" means that someone talked with the respondent about all three of the following topics: 1) babies getting the AIDS virus from their mother, 2) preventing the virus, and 3) getting tested for the virus. 2 Denominator for percentages includes women who did not receive antenatal care for their last birth in the past two years HIV/AIDS-Related Knowledge, Attitudes, and Behaviour | 207 Table 11.13 Self-reporting of sexually-transmitted infections (STI) and STI symptoms Among women age 15-49 and men age 15-59 who ever had sexual intercourse, the percentage reporting having had an STI and/or symptoms of an STI in the past 12 months, by background characteristics, Lesotho 2004 Percentage of women who report having had in the past 12 months: Percentage of men who reported having in the past 12 months: Background characteristics STI Abnormal genital discharge Genital sore or ulcer STI, genital discharge, sore or ulcer Number of women who ever had sexual intercourse STI Abnormal genital discharge Genital sore or ulcer STI, genital discharge, sore or ulcer Number of men who ever had sexual intercourse Age 15-19 1.2 10.8 3.7 12.3 734 1.4 9.7 6.5 14.7 339 20-24 2.5 13.4 7.2 16.2 1,298 1.7 8.7 8.9 14.5 436 25-29 4.2 11.4 7.2 16.4 1,019 5.1 7.8 6.0 12.3 360 30-39 4.3 13.2 5.6 16.0 1,538 4.6 7.8 7.9 11.5 523 40-49 3.1 10.9 5.0 13.0 1,328 2.5 4.2 3.0 6.7 332 50-59 na na na na na 0.8 3.7 6.0 8.3 300 Marital status Never married 2.3 9.2 5.6 12.3 1,197 2.2 7.5 6.9 12.4 913 Married or living together 3.6 12.9 5.7 15.6 3,707 3.1 6.2 6.4 10.4 1,194 Divorced/separated/ widowed 3.0 12.8 6.9 16.1 1,013 4.2 11.9 6.3 14.9 184 Residence Urban 2.8 8.7 5.2 12.4 1,397 2.2 4.7 3.7 7.0 514 Rural 3.4 13.2 6.1 15.8 4,520 3.0 7.9 7.5 12.9 1,777 Ecological zone Lowlands 3.0 10.7 5.4 13.5 3,577 2.2 6.5 6.8 11.3 1,401 Foothills 3.0 11.9 5.0 15.0 644 4.0 8.1 5.1 11.9 250 Mountains 4.0 16.2 8.1 19.4 1,320 3.8 8.9 6.7 12.3 486 Senqu River Valley 3.1 11.3 4.2 14.2 376 3.9 6.5 6.9 10.7 154 District Butha-Buthe 3.6 12.2 3.3 14.4 361 1.1 4.2 2.2 5.3 149 Leribe 2.2 9.9 5.0 11.6 876 1.8 4.9 4.3 7.5 317 Berea 1.7 9.2 5.4 11.3 628 0.7 6.8 4.9 9.0 277 Maseru 3.2 11.3 7.0 15.4 1,576 4.5 6.2 9.4 13.1 626 Mafeteng 5.2 11.7 3.8 13.4 641 4.6 13.1 7.8 19.5 215 Mohale's Hoek 3.2 14.6 4.8 17.8 577 2.2 11.1 7.5 15.9 240 Quthing 2.3 11.1 4.7 13.5 401 3.9 5.1 6.0 9.0 152 Qacha's Nek 3.8 9.6 3.9 12.8 203 3.0 9.3 6.4 11.7 86 Mokhotlong 8.6 23.9 12.7 27.1 293 2.6 8.9 4.0 8.9 105 Thaba-Tseka 1.0 16.1 8.4 19.5 361 1.1 4.0 7.2 10.2 123 Education No education 1.9 14.2 6.6 16.3 141 3.1 7.1 6.9 11.9 439 Primary, incomplete 2.6 12.6 6.3 15.2 3,569 2.5 8.6 7.0 12.9 1,212 Primary, complete 4.3 11.4 5.2 14.8 2,121 3.2 5.2 6.1 9.0 567 Secondary+ 6.1 8.1 4.9 8.7 87 3.4 1.0 2.8 7.2 73 Circumcision status Circumcised na na na na na 3.4 8.3 6.8 12.4 1,232 Uncircumcised na na na na na 2.2 5.9 6.5 10.6 1,056 Wealth quintile Lowest 2.7 13.5 7.0 15.8 851 2.9 8.4 5.8 12.3 399 Second 2.0 14.6 7.3 17.5 1,109 3.1 9.6 7.8 14.9 436 Middle 3.7 13.5 5.9 15.7 1,026 3.7 8.4 9.5 14.0 451 Fourth 3.6 12.0 6.0 15.5 1,323 1.4 4.5 5.6 8.1 489 Highest 3.8 8.9 4.2 12.0 1,608 3.3 5.6 4.7 9.3 516 Total men 15-59 na na na na na 2.8 7.2 6.6 11.5 2,291 Total 15-49 3.2 12.1 5.9 15.0 5,917 3.2 7.7 6.7 12.0 1,991 Note: Total excludes three women who have ever been married but have never had sexual intercourse. na = Not applicable 208 | HIV/AIDS-Related Knowledge, Attitudes, and Behaviour Differentials by background characteristics in the proportion who report having an STI or a symptom of an STI are not significant. Figure 11.2 shows the proportion of women and men who reported having an STI or symptoms of an STI in the past 12 months who sought specific types of care. Sixty-nine percent of women and 64 per- cent of men sought some sort of advice or treatment for their symptoms. More women than men (64 and 50 percent, respectively) sought treatment from a health facility or health professional. Three percent of women and 9 percent of men sought treatment from a traditional healer, and an insignificant percentage of each sex sought advice or medicine from a shop or pharmacy. 64 3 1 1 69 31 50 9 1 3 64 36 Clinic/hospital/ health professional Traditional healer Advice or medicine from shop/pharmacy Advice from friends/relatives Advice or treatment from any source No advice or treatment 0 20 40 60 80 Women Men Figure 11.2 Percentage of Women and Men Reporting an STI or Symptoms of an STI in the Past 12 Months Who Sought Care, by Source of Advice or Treatment LDHS 2004 11.10 MALE CIRCUMCISION Circumcision is practiced in many communities in Lesotho and often serves as a rite of passage to adulthood. Some studies have shown an association between lack of male circumcision and increased transmission of STIs, including HIV. To investigate this relationship, men interviewed in the 2004 LDHS were asked if they were circumcised. Table 11.14 shows that 48 percent of men age 15-59 in Lesotho are circumcised. The highest proportions of circumcised men age 30-59 (nearly 60 percent), while the lowest proportion is for men age 15-19 (21 percent). This could indicate a decline in the practice, although it is also possible that some young men may not have yet gone through the circumcision process. Men living in rural areas are more likely to be circumcised than those living in urban areas. The highest proportion of circumcision is found among men who live in Quthing (69 percent) and Mokhotlong (66 percent), while the lowest is found among men in Maseru (34 percent) and Leribe (37 percent). People with no religion are more likely to be circumcised than those who are adherents to a recognized religion. There is a distinct decline in male circumcision with increasing education and wealth quintile. HIV/AIDS-Related Knowledge, Attitudes, and Behaviour | 209 Table 11.14 Male circumcision Percentage of men age 15-59 who have been circum- cised by background characteristics, Lesotho 2004 Background characteristics Percentage of men who are circumcised Number of men Age 15-19 21.0 743 20-24 54.2 507 25-29 57.5 374 30-39 59.7 538 40-49 59.0 334 50-59 59.1 301 Marital status Never married 34.5 1,419 Married or living together 62.0 1,194 Divorced/separated/ widowed 60.7 184 Residence Urban 32.4 603 Rural 52.2 2,194 Ecological zone Lowlands 39.5 1,734 Foothills 59.1 307 Mountains 63.0 585 Senqu River Valley 62.5 171 District Butha-Buthe 60.9 182 Leribe 36.7 393 Berea 49.5 350 Maseru 33.7 741 Mafeteng 51.0 297 Mohale's Hoek 56.5 281 Quthing 68.9 167 Qacha's Nek 56.5 99 Mokhotlong 66.2 130 Thaba-Tseka 61.1 156 Education No education 78.3 479 Primary, incomplete 50.6 1,546 Primary, complete 23.6 696 Secondary+ 25.8 77 Religion Roman Catholic Church 44.1 1,300 Lesotho Evangelical Church 46.7 605 Anglican Church 49.3 253 Other Christian 53.6 473 No religion 64.1 158 Wealth quintile Lowest 69.6 466 Second 57.3 514 Middle 48.8 566 Fourth 41.5 621 Highest 30.0 630 Total men 15-59 48.0 2,797 Total men 15-49 46.6 2,496 210 | HIV/AIDS-Related Knowledge, Attitudes, and Behaviour 11.11 PREVALENCE OF INJECTIONS Injection overuse contributes to the transmission of blood-borne pathogens because it amplifies the risk of unsafe practices, a result of the fact that reuse of injection equipment in health care settings is a potential vector of HIV/AIDS. Thus, the proportion of injections given with reused syringes and needles is an important indicator to assist in prevention and control of HIV/AIDS. Respondents in the 2004 LDHS were asked if they had any injections given by a health worker in the three months preceding the survey and whether their last injection was given with a syringe and needle from a new, unopened package. It should be noted that medical injections can be self-administered (e.g., insulin for diabetes) and these injections were not included in the data. Table 11.15 shows the results of these questions. Eight percent of women and 5 percent of men age 15-49 received an injection in the past 3 months. Women age 20-39 are more likely than men in the same age groups to have received injections in the past 3 months, probably because of injections given at ANC settings or for family planning. The pattern is reversed for the older age group 40-49. The average number for both women and men is 0.1 injections, with no significant variations by background characteristics. Ninety-six percent of women and 80 percent of men age 15-49 who received an injection from a health worker in the past 3 months were administered the last injection safely (i.e., from a syringe and needle taken from an unopened package). The differentials by background characteristics are not pro- nounced. HIV/AIDS-Related Knowledge, Attitudes, and Behaviour | 211 Table 11.15 Prevalence of injections Percentage of women age 15-49 and men age 15-59 who received at least one injection from a health worker in the past 12 months, the average number of medical injections per person and, among those who received an injection, the percentage whose health worker took the syringe and needle from a new and unopened package for the last injection, by background characteristics, Lesotho 2004 Women Men Background characteristics Percent- age who received an injection from a health worker in the past 3 months Average number of medical injections per year Number of women Last injection, syringe, and needle taken from newly opened package Number of women receiving injections from a health worker in the past 3 months Percent– age who received an injection from a health worker in the past 3 months Average number of medical injections per year Number of women Last injection, syringe, and needle taken from newly opened package Number of women receiving injections from a health worker in the past 3 months Age 15-19 2.2 0.0 1,710 (98.9) 37 3.0 0.0 743 * 22 20-24 10.7 0.2 1,463 95.4 156 4.6 0.1 507 (66.9) 24 25-29 11.9 0.2 1,044 97.4 124 5.5 0.1 374 (71.3) 21 30-39 11.2 0.2 1,545 98.1 173 6.5 0.1 538 (88.9) 35 40-49 3.7 0.0 1,334 (89.1) 49 9.0 0.1 334 (76.6) 30 50-59 na na na na na 10.9 0.2 301 (89.6) 33 Residence Urban 6.7 0.1 1,682 93.8 112 5.3 0.1 603 (88.5) 32 Rural 7.9 0.1 5,413 97.1 427 6.0 0.1 2,194 79.9 132 Ecological zone Lowlands 8.2 0.1 4,299 95.9 353 6.0 0.1 1,734 86.2 105 Foothills 7.4 0.1 787 100.0 58 7.6 0.1 307 67.9 23 Mountains 6.1 0.1 1,572 95.0 95 4.6 0.1 585 (72.6) 27 Senqu River Valley 7.4 0.1 437 100.0 32 5.2 0.1 171 * 9 District Butha-Buthe 6.7 0.1 458 96.9 31 6.8 0.1 182 * 12 Leribe 8.1 0.1 1,065 95.3 87 5.2 0.1 393 * 21 Berea 9.0 0.1 776 95.4 70 5.9 0.1 350 * 21 Maseru 7.0 0.1 1,868 95.0 131 6.6 0.1 741 (84.7) 49 Mafeteng 8.3 0.1 755 100.0 63 5.0 0.1 297 * 15 Mohale's Hoek 9.9 0.1 684 100.0 67 8.4 0.1 281 (81.7) 24 Quthing 6.3 0.2 461 (100.0) 29 1.4 0.0 167 * 2 Qacha's Nek 10.8 0.2 233 85.0 25 10.6 0.1 99 * 11 Mokhotlong 4.1 0.1 360 * 15 1.8 0.1 130 * 2 Thaba-Tseka 5.1 0.1 435 (100.0) 22 4.8 0.1 156 * 8 Education No education 4.8 0.1 145 * 7 6.5 0.1 479 (74.6) 31 Primary, incomplete 7.5 0.1 4,207 97.4 314 6.5 0.1 1,546 78.6 100 Primary, complete 8.0 0.1 2,651 95.9 212 4.2 0.1 696 (96.9) 29 Secondary+ 6.6 0.1 92 * 6 4.8 0.0 77 * 4 Wealth quintile Lowest 6.4 0.1 987 96.1 63 3.8 0.1 466 * 18 Second 8.0 0.2 1,294 94.4 104 5.5 0.1 514 (71.1) 28 Middle 7.5 0.1 1,258 97.4 94 7.2 0.1 566 (82.9) 41 Fourth 7.9 0.1 1,595 94.9 126 4.7 0.1 621 (82.7) 29 Highest 7.7 0.1 1,962 98.6 152 7.6 0.1 630 (91.6) 48 Total men 15-59 na na na na na 5.9 0.1 2,797 81.6 164 Total 15-49 7.6 0.1 7,095 96.4 539 5.2 0.1 2,496 79.5 131 Note: Includes injections given by a doctor, nurse, midwife, nursing assistant, pharmacist, dentist, or other health worker. Figures in parentheses are based on 25-49 unweighted cases. An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. na = Not applicable 212 | HIV/AIDS-Related Knowledge, Attitudes, and Behaviour 11.12 HIV/AIDS-RELATED KNOWLEDGE AND BEHAVIOUR AMONG YOUTH This section addresses knowledge of HIV/AIDS issues and related sexual behaviour among youths age 15-24 who are of particular interest for HIV/AIDS programmes. The period between initiation of sexual activity and marriage is often a time of sexual experimentation, but it may also involve risky behaviours. Comprehensive knowledge of HIV/AIDS transmission and prevention and knowledge of sources of condoms among youth is analysed in this section. Issues such as abstinence, age at sexual debut, age differences between partners, and condom use are also covered. 11.12.1 Knowledge of HIV Transmission and Source for Condoms Knowledge of the means of transmission of HIV is crucial in enabling people to avoid HIV, especially for young people, who are often at greater risk because they may have shorter relationships with more partners or engage in other risky behaviours. Young respondents in the 2004 LDHS were asked the same set of questions as older respondents about whether condom use and limiting number of partners to one uninfected partner can help protect against getting the AIDS virus, and whether a healthy-looking person can have the AIDS virus. The data in Table 11.16 show the level of comprehensive knowledge among young people, namely, the proportion who, in response to a prompted question, agree that people can reduce their chances of getting the AIDS virus by having sex with only one uninfected, faithful partner and by using condoms consistently; who know that a healthy-looking person can have the AIDS virus; and who know that HIV cannot be transmitted by mosquito bites or by sharing food or utensils with a person who has AIDS. Only 26 percent of young women and 18 percent of young men know all of these facts about HIV/AIDS. Interestingly, level of comprehensive knowledge does not increase with age. However, it increases with increasing education, wealth status, and is much higher among urban youths than rural youths. Young women and men who are in a marital, cohabiting relationship and women who are divorced, separated, or widowed are least likely to have comprehensive knowledge about HIV/AIDS than never-married youths. Interestingly, there is no substantial difference in level of comprehensive knowledge between those who have and have not had sex. The lowest level of knowledge is among youth living in the Mountains: 16 percent among women and 9 percent among men. Respondents in such districts as Mafeteng, Mokhotlong, Thaba-Tseka and among men, Qacha’s Nek know the least about HIV/AIDS transmission and prevention. Because of the important role that the condom plays in combating the transmission of HIV, respondents were asked if they know where condoms could be obtained. Note that only responses about “formal” sources were tabulated (i.e., friends and family, and other similar sources were not included). As shown in Table 11.16, general knowledge of condom sources is at the same level among young men and women (63 percent for women and 66 percent for men). Consistent with trends in other indicators, the knowledge is higher among more educated, urban youths and those in highest wealth quintiles. Knowledge of sources of condoms is highest in Senqu River Valley (76 percent for both women and men) compared with other ecological zones, and in Maseru (70 percent for women and 76 percent for men) and Quthing (70 percent for women and 79 percent for men) compared with other districts. HIV/AIDS-Related Knowledge, Attitudes, and Behaviour | 213 Table 11.16 Comprehensive knowledge about AIDS and of a source of condoms among youth Percentage of young women and young men age 15-24 with comprehensive knowledge about AIDS and percentage with knowledge of a source of condoms, by background characteristics, Lesotho 2004 Women 15-24 Men 15-24 Background characteristics Percentage with comprehensive knowledge of AIDS1 Percentage who know a condom source2 Number of women Percentage with comprehensive knowledge of AIDS1 Percentage who know a condom source2 Number of men Age 15-19 25.6 52.1 1,710 18.0 59.1 743 15-17 24.4 46.6 1,005 13.3 51.8 469 18-19 27.4 59.9 705 26.1 71.5 274 20-24 26.0 76.0 1,463 18.8 75.3 507 20-22 25.3 73.6 935 18.4 75.2 320 23-24 27.2 80.2 528 19.5 75.7 187 Marital status Never married 30.5 59.7 1,990 19.0 64.8 1,137 Ever had sex 33.1 76.2 851 20.0 78.2 662 Never had sex 28.6 47.4 1,139 17.6 46.1 475 Married/living together 18.4 67.9 1,072 12.9 74.7 106 Divorced/separated/ widowed 12.6 77.0 111 * * 8 Residence Urban 41.8 77.3 671 39.2 86.6 215 Rural 21.5 59.3 2,502 14.0 61.3 1,035 Ecological zone Lowlands 29.2 67.1 1,865 21.2 69.9 773 Foothills 23.3 51.1 378 16.7 62.0 142 Mountains 16.2 55.2 723 8.7 51.6 258 Senqu River Valley 33.0 75.8 207 25.4 76.4 78 District Butha-Buthe 25.5 65.5 221 19.5 71.6 78 Leribe 29.0 63.9 485 15.4 64.4 153 Berea 18.2 50.6 351 18.4 63.1 164 Maseru 36.2 70.1 783 27.1 76.1 311 Mafeteng 17.8 64.9 327 13.2 56.1 165 Mohale's Hoek 22.9 58.4 315 14.7 61.7 135 Quthing 32.5 69.5 221 25.0 78.8 73 Qacha's Nek 20.0 63.7 108 8.0 49.5 48 Mokhotlong 8.5 61.1 165 8.4 57.7 54 Thaba-Tseka 18.2 51.4 197 11.8 55.1 69 Education No education (3.7) (44.1) 22 2.8 44.8 97 Primary, incomplete 15.2 51.4 1,792 10.2 58.8 769 Primary, complete 39.8 78.5 1,342 38.9 84.1 370 Secondary+ * * 17 * * 13 Wealth quintile Lowest 13.1 48.7 472 5.3 52.1 168 Second 14.3 55.4 589 10.9 58.3 221 Middle 23.2 61.6 623 12.1 57.2 277 Fourth 31.6 66.3 725 27.8 72.1 295 Highest 39.1 76.1 764 28.1 80.8 289 Total 15-24 25.8 63.1 3,173 18.4 65.7 1,250 Note: Figures in parentheses are based on 25-49 unweighted cases. An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. 1 Respondents with a comprehensive knowledge say that use of condom for every sexual intercourse and having just one uninfected and faithful partner can reduce the chance of getting the AIDS virus, say that a healthy-looking person can have the AIDS virus, and say that AIDS cannot be transmitted by mosquito bites, and a person cannot become infected by sharing food or utensils with a person who has AIDS 2 For the purposes of this table, the following are not considered as knowing a source for condoms: friends, family members, and home 214 | HIV/AIDS-Related Knowledge, Attitudes, and Behaviour 11.12.2 Age at First Sex among Youth The analysis in this section deals with age at first sex, premarital and other higher-risk sex, and condom use among young women and men. Table 11.17 shows the proportion of women and men age 15-24 who had sex by age 15 and 18, by background characteristics. Fifteen percent of young women and almost twice as many young men (27 percent) in Lesotho had sex by age 15. The proportion of young women who had sex before ages 15 and 18 is much lower among those who have never been married than among women who have ever been married. However, 27 percent of never-married men and 25 percent of currently married or cohabiting women had their first sex by age 15. Level of education, wealth quintile, and residence are strongly related to age at first sex, especially for women. While more than one-third of women age 15-24 with no education had sex by age 15, the proportion declines significantly to only 1 in 10 women among those who have completed primary education. A larger proportion of women in rural areas report their sexual debut at age 15 and 18 compared with women in urban areas. For men, the relationship between education, wealth quintile, residence, and age at sexual debut is not as strong. Interestingly, knowledge of a condom source is not correlated with the age at first sex, except for women reporting their first sex at the age of 18. Women who know of a source for condoms are more likely than those who do not know of a source to have had their sexual debut by age 18 (52 and 39 per- cent, respectively). Men with knowledge of where to obtain a condom are also significantly more likely to have had an early sexual debut (by age 15 or 18). Both young men and young women are more likely to have had an early sexual debut in Senqu River Valley and Quthing, compared with other ecological zones and districts. HIV/AIDS-Related Knowledge, Attitudes, and Behaviour | 215 Table 11.17 Age at first sex among young women and men Percentage of young women and men age 15-24 who have had sex by exact age 15 and 18, by age, Lesotho 2004 Women Men Background characteristics 15 18 Number of women 15-24 15 18 Number of men 15-24 Age 15-19 16.3 na 1,710 29.7 na 743 15-17 16.3 na 1,005 28.1 na 469 18-19 16.3 60.7 705 32.4 63.7 274 20-24 13.1 54.3 1,463 24.0 63.2 507 20-22 13.5 56.7 935 24.4 65.8 320 23-24 12.6 50.1 528 23.5 58.7 187 Marital status Never married 10.6 31.6 1,990 27.4 50.6 1,137 Married or living together 21.2 72.3 1,072 24.7 68.3 106 Divorced/separated/ widowed 28.0 78.4 111 * * 8 Residence Urban 9.6 39.8 671 27.8 52.7 215 Rural 16.2 48.9 2,502 27.3 52.2 1,035 Ecological zone Lowlands 13.2 44.4 1,865 25.6 50.7 773 Foothills 16.8 47.8 378 28.7 52.7 142 Mountains 16.1 48.9 723 28.1 50.0 258 Senqu River Valley 21.6 61.5 207 40.5 74.9 78 District Butha-Buthe 9.4 43.2 221 17.5 49.2 78 Leribe 11.1 41.8 485 21.7 45.2 153 Berea 12.6 44.7 351 23.6 49.2 164 Maseru 14.4 44.2 783 32.0 53.9 311 Mafeteng 18.5 48.5 327 24.2 48.8 165 Mohale's Hoek 18.8 54.2 315 32.1 60.9 135 Quthing 24.8 66.1 221 39.4 72.5 73 Qacha's Nek 17.8 55.3 108 39.1 66.8 48 Mokhotlong 10.6 41.9 165 19.0 41.3 54 Thaba-Tseka 14.2 42.7 197 23.5 40.0 69 Education No education 35.5 72.2 22 28.4 51.6 97 Primary, incomplete 18.6 51.5 1,792 29.2 49.9 769 Primary, complete 9.7 40.5 1,342 23.3 57.2 370 Secondary+ * * 17 * * 13 Knows a condom source1 Yes 14.8 51.5 2,025 31.7 62.7 848 No 15.0 38.9 1,146 18.1 30.1 401 Wealth quintile Lowest 21.6 55.3 472 31.1 51.6 168 Second 18.7 54.6 589 30.6 53.7 221 Middle 15.7 47.8 623 27.4 54.2 277 Fourth 11.2 45.3 725 22.4 48.9 295 Highest 10.4 36.8 764 27.8 53.2 289 Total 15-24 14.8 47.0 3,173 27.4 52.3 1,250 Note: Figures in parentheses are based on 25-49 unweighted cases. An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. na = Not available 1 For the purposes of this table, the following are not considered as knowing a source for condoms: friends, family members, and home To assess the extent of condom use from the beginning of sexual exposure, respondents age 15-24 were asked whether they had used a condom the first time they had sex. Table 11.18 presents the percentage of youths age 15-24 who used a condom during first sex by background characteristics. Only a fourth of young women and men used a condom during their first sexual encounter. Younger women and men age 15-19 are more likely than those age 20-24 to report condom use at first sex (29 and 27 percent, respectively, compared with 22 percent). Never-married women and men are 4 times more likely to have used a condom the first time they ever have sex as those who are currently married or cohabiting. 216 | HIV/AIDS-Related Knowledge, Attitudes, and Behaviour Predictably, young women and men with higher levels of education, those living in households that are in the highest wealth quintile, and those who live in urban areas report higher condom use at first sexual intercourse than their counterparts in other sub-groups. Twenty-nine percent of women and men with knowledge of a condom source used a condom at first sex among young women and men who were unaware of a source for condoms, while only 12 and 5 percent, respectively, reported condom use. Table 11.18 Condom use at first sexual intercourse among youth Percentage of young women and young men age 15-24 who used a condom the first time they had sexual intercourse, by background characteristics, Lesotho 2004 Women Men Background characteristics Percentage who used a condom at first sexual intercourse Number who have ever had sexual intercourse Percentage who used a condom at first sexual intercourse Number who have ever had sexual intercourse Age 15-19 28.7 734 26.9 339 15-17 28.9 272 20.5 159 18-19 28.6 462 32.5 180 20-24 22.2 1,298 22.4 436 20-22 24.7 813 27.1 267 23-24 18.1 485 15.0 170 Marital status Never married 42.1 851 27.3 662 Married or living together 11.6 1,070 7.8 106 Divorced/separated/ widowed 14.9 111 * 8 Residence Urban 37.9 403 34.7 132 Rural 21.2 1,629 22.2 643 Ecological zone Lowlands 31.1 1,168 28.1 463 Foothills 16.3 241 22.8 88 Mountains 11.6 475 16.5 163 Senqu River Valley 27.8 148 19.4 62 District Butha-Buthe 26.9 128 36.1 47 Leribe 24.7 303 33.6 85 Berea 29.9 207 30.5 95 Maseru 29.7 505 23.0 200 Mafeteng 23.2 216 22.6 91 Mohale's Hoek 23.6 209 15.3 96 Quthing 23.1 162 21.5 59 Qacha's Nek 15.9 78 22.0 35 Mokhotlong 9.3 100 16.6 29 Thaba-Tseka 15.6 125 (20.6) 38 Education No education 6.1 20 5.6 70 Primary, incomplete 16.2 1,169 18.6 449 Primary, complete 35.5 828 38.4 247 Secondary+ 90.5 * 68.2 * Knows a condom source1 Yes 29.4 1,476 29.1 625 No 11.8 554 4.7 150 Wealth quintile Lowest 6.8 339 7.7 109 Second 16.0 409 17.0 146 Middle 23.6 398 19.2 169 Fourth 29.7 461 29.3 171 Highest 42.3 425 40.7 179 Total 15-24 24.5 2,032 24.4 775 Note: Figures in parentheses are based on 25-49 unweighted cases. An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. 1 For the purposes of this table, the following are not considered as knowing a source for condoms: friends, family members, and home HIV/AIDS-Related Knowledge, Attitudes, and Behaviour | 217 The period between age at first sex and age at marriage is often a time of sexual experimentation. Unfortunately, in the era of HIV/AIDS, it can also be a risky time. Table 11.19 shows the percentage of never-married women and men age 15-24 who have not yet engaged in sex, as well as the percentage who had sex in the 12 months preceding the survey and the percentage who used condoms during their most recent sex. Almost six in ten (57 percent) never-married young women reported that they had never had sex, compared with more than four in ten (42 percent) young men. While the proportion of unmarried youth who have never had sex drops rapidly between age groups 15-19 and 20-24, sizeable proportions of women and men age 20-24 have not yet had sex (28 percent of never-married women and 18 percent of never-married men). It appears that never-married youth in the lowest wealth quintile have slightly higher rates of abstinence than those in higher wealth quintiles, especially among women. Just under half of women who know a source for condoms have never had sex compared with three-fourths of women who do not know of a source for condoms. For men, 29 percent of those who know a source for condoms have never had sex compared with 67 percent of men who do not know of a formal source where to get condoms. Looking at districts, abstinence rates among young unmarried women are the lowest in Quthing (40 percent for women and 21 percent for men) and the highest in Thaba-Tseka (75 percent for women and 54 percent for men) and Mokhotlong (71 percent for women and 58 percent for men). Table 11.19 also shows the percentage of never-married young women and men who had sex in the 12 months preceding the survey, as well as the percentage who used a condom the last time they had sex. A significant proportion of never-married respondents age 15-24 had sex in the past 12 months (28 percent of women and 48 percent of men). About half of never-married respondents reported using a condom during last sexual intercourse (56 percent of women and 50 percent of men). While urban women are more likely to have had sex in the preceding 12 months than rural women (35 and 26 percent, respectively), the difference is not as pronounced among men (50 and 47 percent, respectively). A sig- nificantly larger proportion of women age 20-24 (65 percent) than those age 15-19 (47 percent) reported condom use at last sex, whereas close to half of the men in both age groups used a condom at last sex. 218 | HIV/AIDS-Related Knowledge, Attitudes, and Behaviour Table 11.19 Premarital sexual intercourse and condom use during premarital sexual intercourse among youth Among never-married women and men age 15-24, the percentage who have never had sexual intercourse, the percentage who have had sexual intercourse in the past 12 months, and among those who have had premarital sexual intercourse in the past 12 months, the percentage who used a condom at the last sexual intercourse, by background characteristics, Lesotho 2004 Women Men Have had sexual intercourse in the past 12 months Have had sexual intercourse in the past 12 months Background characteristics Percentage who have never had sexual intercourse Percentage who have had sexual intercourse in the past 12 months Number of never- married women 15-24 Percentage who used a condom at last sexual intercourse Number of women Percentage who have never had sexual intercourse Percentage who have had sexual intercourse in the past 12 months Number of never- married men 15-24 Percentage who used a condom at last sexual intercourse Number of men Age 15-19 69.4 20.7 1,402 46.8 291 54.6 37.1 740 48.6 275 15-17 78.9 15.6 929 41.1 145 66.1 26.0 469 41.7 122 18-19 50.8 30.8 473 52.5 146 34.7 56.3 271 54.1 153 20-24 28.1 46.1 588 65.2 271 17.8 67.6 397 52.0 268 20-22 30.0 45.0 405 64.4 182 19.2 65.9 278 54.8 183 23-24 23.7 48.6 182 66.8 89 14.6 71.3 119 45.9 85 Residence Urban 52.6 34.9 505 68.0 176 41.0 49.9 202 75.3 101 Rural 58.8 26.0 1,484 50.0 385 41.9 47.3 934 44.5 442 Ecological zone Lowlands 54.5 30.6 1,274 61.6 390 42.7 46.3 726 57.5 336 Foothills 68.4 18.2 201 37.1 37 43.3 43.5 125 39.4 54 Mountains 67.4 19.4 368 39.9 71 44.5 45.7 213 31.3 97 Senqu River Valley 40.0 43.1 147 47.7 63 21.6 75.0 73 50.6 55 District Butha-Buthe 66.0 23.2 141 59.1 33 43.0 47.6 73 (53.9) 35 Leribe 61.4 25.4 297 57.4 76 47.1 43.6 144 65.2 63 Berea 63.2 20.3 228 (53.7) 46 45.7 37.4 151 52.5 56 Maseru 52.9 34.5 522 68.7 180 39.9 49.7 279 57.1 139 Mafeteng 56.0 29.6 197 50.3 58 47.1 41.7 156 38.7 65 Mohale's Hoek 51.9 29.5 205 36.6 61 32.0 60.0 123 45.6 74 Quthing 39.5 41.4 150 44.4 62 20.5 77.4 67 40.7 52 Qacha's Nek 47.9 33.5 63 59.5 21 30.1 59.0 44 64.3 26 Mokhotlong 71.3 14.5 91 * 13 57.6 32.5 43 (46.4) 14 Thaba-Tseka 74.9 12.3 96 * 12 53.8 34.5 58 (23.2) 20 Education No education * * 6 * 3 37.6 47.1 73 (13.5) 34 Primary, incomplete 61.1 25.7 1,016 41.2 261 45.5 45.2 704 38.8 318 Primary, complete 54.0 30.0 951 67.6 286 35.7 52.3 347 74.8 181 Secondary+ * * 16 * 12 * * 13 * 9 Knows a condom source1 Yes 45.5 37.4 1,201 64.0 449 29.4 58.1 759 58.9 441 No 75.0 14.3 789 22.3 113 66.8 27.0 376 12.9 102 Wealth quintile Lowest 64.4 21.8 206 43.1 45 42.3 42.5 138 27.2 59 Second 56.7 27.1 319 25.5 86 38.1 56.4 196 33.3 111 Middle 58.4 26.5 385 49.3 102 42.1 46.3 257 42.1 119 Fourth 56.8 29.5 464 60.3 137 45.4 42.2 273 56.4 115 Highest 54.6 31.1 616 72.3 191 40.2 51.1 272 75.4 139 Total 15-24 57.2 28.2 1,990 55.7 562 41.8 47.7 1,137 50.3 543 Note: Figures in parentheses are based on 25-49 unweighted cases. An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. 1 For the purposes of this table, the following are not considered as knowing a source for condoms: friends, family members and home. HIV/AIDS-Related Knowledge, Attitudes, and Behaviour | 219 11.12.3 Higher-Risk Sex among Youth In many countries, the most common means of HIV/AIDS transmission is through unprotected sex with an infected person. To prevent HIV/AIDS virus transmission, it is important that young people practice safe sex through the most advocated “ABC” methods (abstinence, being faithful to one uninfected partner, and condom use). Tables 11.20.1 and 11.20.2 show the percentage of young people who engage in higher-risk sex, defined as sex with a non-marital, non-cohabiting partner in the 12-month period preceding the survey, and the extent to which they use condoms in higher-risk sexual encounters. Among sexually active youths age 15-24 years, the percentage of women and men who have engaged in higher-risk sex activity in the past 12 months is 42 and 89 percent, respectively. Half of respondents who had higher-risk intercourse in the past 12 months reported condom use at last sexual encounter (50 percent for women and 48 percent for men). There are significant differences in the level of higher-risk sex and condom use by various background characteristics, mostly for women. By definition, all sexually active women and men who have never married engage in higher-risk sex. Those who have never married are more likely to use condoms during higher-risk sexual activity than ever-married women and men. Almost six in ten women and men who know of a condom source used a condom in their last higher-risk sexual encounter, compared with one in five women (21 percent) and more than one in ten men (12 percent) who do not know where to obtain a condom. Differences in the extent of higher-risk sex among youth by ecological zones are significant. For women, these differences range from 25 percent in Foothills to 60 percent in Senqu River Valley, while for men it ranges from 83 percent in the Mountains to 96 percent in Senqu River Valley. Among those having higher-risk sex, women and men in the Mountains are least likely to report condom use. Women in the highest wealth quintiles and in urban areas are almost twice as likely as other women to engage in higher-risk sexual behaviour, while for men the gap is not as pronounced. It is striking to observe that engagement in higher-risk sex increases significantly with respondent’s educational attainment. For women, this ranges from 28 percent of uneducated women to 47 percent of those who have completed primary education, while for men it increases from 76 percent of uneducated men to 89 percent of those who have completed primary education. 220 | HIV/AIDS-Related Knowledge, Attitudes, and Behaviour Table 11.20.1 Higher-risk sexual intercourse among youth and condom use at last higher-risk intercourse in the past 12 months: women Among young women age 15-24 who had sexual intercourse in the past 12 months, the percentage who had higher-risk sexual intercourse in the past 12 months, and among those having higher-risk intercourse in the past 12 months, the percentage reporting that a condom was used at last higher-risk intercourse, by background characteristics, Lesotho 2004 Women 15-24 who had sexual intercourse in the past 12 months Women 15-24 who had higher-risk intercourse in the past 12 months Background characteristics Percentage who had higher-risk intercourse in the past 12 months Number of women Percentage who reported using a condom at last higher-risk intercourse Number of women Age 15-19 53.8 571 48.3 307 15-17 68.2 218 43.3 149 18-19 44.9 353 52.9 159 20-24 35.5 1,049 51.6 372 20-22 36.0 649 52.4 234 23-24 34.5 400 50.2 138 Marital status Never married 96.9 562 55.9 544 Married or living together 7.8 977 32.5 76 Divorced/separated/ widowed 71.9 83 19.6 59 Residence Urban 57.6 328 65.8 189 Rural 37.9 1,293 44.0 491 Ecological zone Lowlands 47.6 923 58.1 440 Foothills 24.8 197 32.9 49 Mountains 31.4 383 30.4 120 Senqu River Valley 60.2 118 45.8 71 District Butha-Buthe 38.4 105 56.3 40 Leribe 35.3 241 53.0 85 Berea 33.4 164 48.2 55 Maseru 51.3 417 63.3 214 Mafeteng 40.5 172 44.5 70 Mohale's Hoek 43.1 161 35.2 69 Quthing 55.8 124 43.2 69 Qacha's Nek 44.2 61 49.4 27 Mokhotlong 30.6 75 (15.8) 23 Thaba-Tseka 26.8 101 (31.1) 27 Education No education (28.4) 18 * 5 Primary, incomplete 37.9 947 36.6 360 Primary, complete 47.2 643 65.0 303 Secondary+ * 13 * 12 Knows a condom source1 Yes 45.6 1,187 57.5 542 No 31.8 433 20.8 138 Wealth quintile Lowest 27.6 273 29.1 76 Second 37.4 333 27.8 125 Middle 39.5 315 46.1 125 Fourth 41.6 376 55.6 156 Highest 61.4 324 70.3 199 Total 15-24 41.9 1,621 50.1 680 Note: “Higher-risk intercourse” refers to sexual intercourse with a partner who neither was a spouse nor who lived with the respondent. Figures in parentheses are based on 25-49 unweighted cases. An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. 1 For the purposes of this table, the following are not considered as knowing a source for condoms: friends, family members, and home HIV/AIDS-Related Knowledge, Attitudes, and Behaviour | 221 Table 11.20.2 Higher-risk sexual intercourse among youth and condom use at last higher-risk intercourse in the past 12 months: men Among young men age 15-24 who had sexual intercourse in the past 12 months, the percentage who had higher-risk sexual intercourse in the past 12 months, and among those having higher-risk intercourse in the past 12 months, the percentage reporting that a condom was used at last higher-risk intercourse, by background characteristics, Lesotho 2004 Men 15-24 who had sexual intercourse in the past 12 months Men 15-24 who had higher- risk intercourse in the past 12 months Background characteristics Percentage who had higher-risk intercourse in the past 12 months Number of men Percentage who reported using a condom at last higher-risk intercourse Number of men Age 15-19 97.1 278 48.4 270 15-17 100.0 122 43.4 122 18-19 94.8 156 52.6 148 20-24 83.3 366 46.8 304 20-22 86.8 223 51.1 194 23-24 77.7 143 39.3 111 Marital status Never married 98.2 543 50.3 533 Married or living together 35.7 93 (14.0) 33 Divorced/separated/ widowed * 8 * 8 Residence Urban 96.7 111 71.4 107 Rural 87.7 533 42.1 467 Ecological zone Lowlands 90.5 378 56.1 342 Foothills 87.8 70 32.7 61 Mountains 83.4 136 28.5 114 Senqu River Valley 95.7 60 50.5 57 District Butha-Buthe 92.8 39 51.4 36 Leribe 90.4 72 64.8 65 Berea 76.9 68 46.0 52 Maseru 92.0 165 52.7 152 Mafeteng 94.4 74 38.5 70 Mohale's Hoek 89.8 85 43.9 77 Quthing 90.6 58 41.8 53 Qacha's Nek 90.1 30 54.2 27 Mokhotlong (75.3) 25 (29.9) 19 Thaba-Tseka (88.0) 27 (23.4) 24 Education No education 75.8 58 12.5 44 Primary, incomplete 91.0 376 36.8 342 Primary, complete 89.3 201 74.0 179 Secondary+ * 9 * 9 Knows a condom source1 Yes 89.8 521 55.6 468 No 86.8 123 12.3 107 Wealth quintile Lowest 78.8 85 25.5 67 Second 86.8 133 32.8 116 Middle 93.4 137 40.5 128 Fourth 88.9 137 52.9 121 Highest 93.7 152 71.8 142 Total 15-24 89.2 644 47.6 574 Note: “Higher-risk intercourse” refers to sexual intercourse with a partner who neither was a spouse nor who lived with the respondent. Figures in parentheses are based on 25-49 unweighted cases. An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. 1 For the purposes of this table, the following are not considered as knowing a source for condoms: friends, family members, and home 222 | HIV/AIDS-Related Knowledge, Attitudes, and Behaviour In many societies, young women have sexual relationships with men who are considerably older than they are. This practice can contribute to the wider spread of HIV and other STIs, because if a younger, uninfected partner has sex with an older, infected partner, this can introduce the virus into a younger, uninfected cohort. To investigate this practice, the 2004 LDHS asked women age 15-19 who had sex in the 12 months preceding the survey with a non-marital, non-cohabiting partner whether the man was younger, about the same age, or older than they. If older, the women were asked if they thought he was less than 10 years older or 10 or more years older. The results in Table 11.21 show that only 7 percent of women age 15 to 19 have had higher-risk sex with a man 10 years or more older than themselves in the past 12 months. Similar to other indicators, there is a strong relationship between wealth index and urban-rural resi- dence and the likelihood of engaging in age-mixing in sexual partnerships: women in lower wealth quintiles and in rural areas are more likely than others to engage in this type of sexual partnerships. Differences by background characteristics are small, especially because of the small number of cases. Sexual intercourse, while one or both partners are under the influence of alcohol, is more likely than other- wise to be unplanned, and couples are therefore less likely to use condoms. In the 2004 LDHS, respondents who had sex during the preceding 12 months were asked if they or their partner drank alcohol the last time they had sex. Table 11.22 shows the prevalence of sexual intercourse while drinking. While the overall prevalence of sex under the influence of alcohol is relatively low, 7 percent of women and 5 percent of men reported such occurrences. Young women and men age 15-19 were less likely to report drunk- enness during sexual intercourse (5 percent of women and 3 percent of men) compared with those age 20-24 (8 per- cent of women and 7 percent of men). Table 11.21 Age-mixing Among women age 15-19 who have had higher-risk sexual intercourse in the past 12 months, percentage who had higher-risk sex with a man who was 10 or more years older than themselves, by background characteristics, Lesotho 2004 Background characteristics Percentage who had higher-risk intercourse with a man 10+ years older Number of women 15-19 who had higher- risk intercourse in the past 12 months Age 15-17 7.5 153 18-19 7.0 169 Marital status Never married 5.6 295 Ever married (24.5) 28 Residence Urban 3.5 64 Rural 8.2 258 Ecological zone Lowlands 4.3 197 Foothills (5.1) 27 Mountains 16.5 55 Senqu River Valley 10.1 44 District Butha-Buthe (12.4) 23 Leribe (20.1) 38 Berea (1.7) 26 Maseru (1.1) 77 Mafeteng (0.0) 35 Mohale's Hoek (2.7) 45 Quthing * 48 Qacha's Nek (7.5) 13 Mokhotlong * 6 Thaba-Tseka * 11 Education No education * 1 Primary, incomplete 7.9 197 Primary, complete 6.1 125 Knows a condom source1 Yes 7.0 222 No 7.7 100 Wealth quintile Lowest (12.9) 37 Second 9.2 70 Middle 13.9 69 Fourth 2.9 70 Highest 0.8 77 Total 15-19 7.2 323 Note: “Higher-risk intercourse” refers to sexual intercourse with a partner who neither was a spouse nor who lived with the respondent. Figures in parentheses are based on 25-49 unweighted cases. An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. 1 For the purposes of this table, the following are not considered as knowing a source for condoms: friends, family members and home. HIV/AIDS-Related Knowledge, Attitudes, and Behaviour | 223 Table 11.22 Drunkenness during sexual intercourse among youth Percentage of young women and young men age 15-24 who had sexual intercourse in the past 12 months while drinking, by background characteristics, Lesotho 2004 Women 15-24 Men 15-24 Background characteristics Percentage who had sexual intercourse in the past 12 months when drunk Number of women who had sexual intercourse in past 12 months Percentage who had sexual intercourse in the past 12 months when drunk Number of men who had sexual intercourse in past 12 months Age 15-19 5.1 571 2.6 278 15-17 4.5 218 2.8 122 18-19 5.5 353 2.3 156 20-24 7.6 1,049 6.9 366 20-22 6.8 649 5.4 223 23-24 8.9 400 9.3 143 Marital status Never married 7.7 562 4.5 543 Married or living together 5.4 977 7.4 93 Divorced/separated/ widowed 16.9 83 * 8 Residence Urban 7.3 328 9.3 111 Rural 6.6 1,293 4.1 533 Ecological zone Lowlands 8.2 923 5.4 378 Foothills 2.9 197 4.7 70 Mountains 4.8 383 3.2 136 Senqu River Valley 8.5 118 7.4 60 District Butha-Buthe 6.0 105 3.0 39 Leribe 8.9 241 5.3 72 Berea 9.2 164 4.6 68 Maseru 6.9 417 6.2 165 Mafeteng 6.8 172 5.9 74 Mohale's Hoek 6.2 161 2.3 85 Quthing 5.1 124 4.7 58 Qacha's Nek 6.7 61 2.1 30 Mokhotlong 4.4 75 (3.7) 25 Thaba-Tseka 2.5 101 (12.0) 27 Education No education (9.8) 18 4.3 58 Primary, incomplete 6.5 947 4.4 376 Primary, complete 7.2 643 6.6 201 Secondary+ * 13 * 9 Knows a condom source1 Yes 7.3 1,187 5.6 521 No 5.2 433 2.7 123 Wealth quintile Lowest 6.3 273 4.0 85 Second 6.1 333 3.0 133 Middle 7.8 315 4.8 137 Fourth 6.2 376 4.5 137 Highest 7.4 323 8.1 152 Total 15-24 6.8 1,620 5.0 644 Note: Figures in parentheses are based on 25-49 unweighted cases. An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. 1 For the purposes of this table, the following are not considered as knowing a source for condoms: friends, family members, and home 224 | HIV/AIDS-Related Knowledge, Attitudes, and Behaviour Young people may feel that there are barriers to accessing and using many services and facilities, particularly for sensitive concerns relating to sexual health, including STIs, such as HIV/AIDS. Data in Table 11.23 assesses the degree of reach of HIV testing services among sexually active young people and their awareness of their HIV status. Fewer sexually active men (3 percent) than women (7 percent) reported having an HIV test with test results in the 12 months preceding the survey. Relationship between HIV testing and background characteristics is less straightforward than for other indicators, especially for young women. Twice as many young sexually active women (9 percent) and men (4 percent) age 20-24 reported having an HIV test compared with those age 15-19 (4 and 2 percent, respectively). Table 11.23 Recent HIV tests among youth Among young women and young men age 15-24 who have had sexual intercourse in the past 12 months, the percentage who have had an HIV test in the past 12 months and received the results of the test, by background characteristics, Lesotho 2004 Women 15-24 who have had sexual intercourse in past 12 months Men 15-24 who have had sex had sexual intercourse in past 12 months Background characteristics Percentage who have been tested and received results in the past 12 months Number of women Percentage who have been tested and received results in the past 12 months Number of men Age 15-19 4.2 571 1.6 278 15-17 2.1 218 1.6 122 18-19 5.4 353 1.6 156 20-24 8.9 1,049 4.4 366 20-22 10.0 649 3.7 223 23-24 7.0 400 5.5 143 Residence Urban 8.9 328 4.4 111 Rural 6.8 1,293 3.0 533 Ecological zone Lowlands 8.4 923 3.6 378 Foothills 4.9 197 2.7 70 Mountains 5.7 383 2.4 136 Senqu River Valley 6.5 118 3.3 60 District Butha-Buthe 10.0 105 5.7 39 Leribe 5.6 241 5.3 72 Berea 9.5 164 4.2 68 Maseru 7.0 417 3.5 165 Mafeteng 10.3 172 0.3 74 Mohale's Hoek 6.3 161 2.1 85 Quthing 4.4 124 2.4 58 Qacha's Nek 5.6 61 5.9 30 Mokhotlong 6.8 75 (3.1) 25 Thaba-Tseka 6.3 101 (0.0) 27 Education No education (4.5) 18 0.0 58 Primary, incomplete 6.1 947 2.9 376 Primary, complete 8.6 643 4.8 201 Secondary+ * 13 * 9 Knows a condom source1 Yes 8.8 1,187 3.9 521 No 2.9 433 0.3 123 Wealth quintile Lowest 3.9 273 2.3 85 Second 9.3 333 4.1 133 Middle 9.5 315 1.8 137 Fourth 7.3 376 7.1 137 Highest 5.6 324 0.6 152 Total 15-24 7.2 1,621 3.2 644 Note: Figures in parentheses are based on 25-49 unweighted cases. An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. 1 For the purposes of this table, the following are not considered as knowing a source for condoms: friends, family members, and home HIV/AIDS-Related Knowledge, Attitudes, and Behaviour | 225 11.13 ORPHANHOOD AND CHILDREN’S LIVING ARRANGEMENTS Lesotho has observed an upsurge in the number of orphans resulting from the increase in deaths occasioned from HIV/AIDS-related infections. The 2004 LDHS sought information on orphanhood and fostering. Table 11.24 shows the percent distribution of de jure children under age 18, by children’s living arrangements and survival status of parents, according to background characteristics. Less than half (47 percent) of children under age 18 live with both their parents, while 24 percent live with their mothers but not their fathers, 4 percent live with their fathers but not their mothers, and 26 percent do not live with either of their parents (i.e., they are considered to be “fostered”). There is not much variation observed by district and wealth. Data on orphaned children (i.e., children under 18 who have lost either one or both of their natural parents) show that 18 percent have lost their fathers only, 4 percent have lost their mothers, and 4 percent have lost both of their biological parents. Altogether, 2 percent of children under 18 have lost one or both parents (i.e., they are considered orphans). There is some variation in orphanhood by district, the highest being Qacha’s Nek (31 percent) and the lowest being Butha-Buthe (20 percent). 226 | HIV/AIDS-Related Knowledge, Attitudes, and Behaviour Table 11.24 Orphanhood and children's living arrangements Percent distribution of de jure children under age 18 by survival status of parents and children's living arrangements, by background characteristics, Lesotho 2004 Background characteristics Both parents dead Mother dead Father dead Both parents alive Missing informa- tion on father/ mother Total Mother, father, or both dead Not living with either parent Living with mother Living with father Living with both parents Total Number of children Age 0-1 0.3 0.6 8.9 86.8 3.5 100.0 9.9 5.8 36.9 0.8 56.5 100.0 1,521 2-4 1.3 1.7 13.4 79.7 4.0 100.0 16.7 22.0 25.6 2.2 50.2 100.0 2,485 5-9 3.7 3.5 18.4 70.7 3.7 100.0 26.1 27.3 21.2 3.7 47.8 100.0 4,441 10-14 7.4 5.3 22.0 61.4 4.0 100.0 35.2 32.4 20.9 5.2 41.4 100.0 5,037 0-14 4.2 3.5 17.7 70.7 3.8 100.0 25.9 25.8 23.7 3.7 46.8 100.0 13,483 Sex Male 4.6 3.5 17.6 70.4 4.0 100.0 26.1 26.1 23.8 3.6 46.6 100.0 6,805 Female 3.9 3.5 17.9 71.0 3.7 100.0 25.7 25.6 23.6 3.7 47.1 100.0 6,678 Residence Urban 3.9 3.5 17.8 68.6 6.2 100.0 25.8 24.1 27.8 4.6 43.5 100.0 1,936 Rural 4.3 3.5 17.7 71.0 3.4 100.0 25.9 26.1 23.0 3.5 47.4 100.0 11,547 Ecological zone Lowlands 4.5 3.4 17.3 70.5 4.3 100.0 25.8 25.1 24.7 3.9 46.4 100.0 7,103 Foothills 3.4 3.9 16.7 73.5 2.5 100.0 24.2 24.7 21.4 4.3 49.6 100.0 1,772 Mountains 3.8 3.4 18.6 70.5 3.6 100.0 26.2 27.5 21.9 2.9 47.7 100.0 3,706 Senqu River Valley 5.7 3.6 19.6 67.4 3.7 100.0 29.1 26.7 28.0 3.8 41.5 100.0 901 District Butha-Buthe 2.7 3.5 13.2 77.1 3.5 100.0 19.6 25.2 21.2 3.3 50.2 100.0 783 Leribe 3.5 3.5 15.8 74.5 2.8 100.0 23.4 21.2 23.5 3.9 51.4 100.0 1,979 Berea 3.4 2.7 17.0 73.7 3.2 100.0 23.6 25.1 21.9 3.7 49.4 100.0 1,595 Maseru 4.5 3.0 17.6 69.2 5.7 100.0 25.6 26.9 25.0 3.9 44.3 100.0 2,970 Mafeteng 6.0 5.1 19.0 67.8 2.1 100.0 30.4 24.8 24.2 4.6 46.4 100.0 1,411 Mohale's Hoek 5.3 3.8 18.8 67.2 4.9 100.0 28.3 25.7 25.5 3.3 45.5 100.0 1,304 Quthing 5.2 4.0 19.9 69.4 1.5 100.0 29.3 28.4 26.3 4.2 41.0 100.0 964 Qacha’s Nek 5.5 3.5 20.9 61.5 8.6 100.0 30.9 31.9 24.3 3.2 40.7 100.0 570 Mokhotlong 2.7 3.6 16.9 73.4 3.4 100.0 23.5 27.3 19.5 2.3 51.0 100.0 827 Thaba-Tseka 3.4 3.2 20.1 70.4 2.8 100.0 26.8 27.5 22.6 3.0 46.9 100.0 1,081 Wealth quintile Lowest 5.7 3.9 19.6 67.5 3.3 100.0 29.7 31.4 22.7 3.8 42.1 100.0 2,933 Second 4.3 3.5 18.8 70.3 3.1 100.0 26.8 24.7 26.0 3.0 46.3 100.0 2,840 Middle 4.5 3.0 18.9 68.5 5.1 100.0 26.9 29.7 24.8 3.6 41.9 100.0 2,637 Fourth 3.6 4.2 16.5 71.1 4.5 100.0 24.6 22.9 22.8 4.8 49.5 100.0 2,663 Highest 2.8 2.7 14.4 76.9 3.2 100.0 20.7 19.3 22.0 3.1 55.5 100.0 2,411 Number of children 4.2 3.5 17.7 70.7 3.8 100.0 25.9 25.8 23.7 3.7 46.8 100.0 13,483 Orphans are usually considered to be disadvantaged compared with children whose parents are living. To assess whether orphans are educationally disadvantaged, an indicator was devised that com- pares the proportion of children age 10-14 who are attending school among those whose parents are both dead to those whose parents are both alive and who are living with one of them. Table 12.25 indicates that 94 percent of children whose parents are both alive and who are living with one or both parents are in school compared with 89 percent of children who have lost both parents (“double orphaned”). The ratio of school attendance among orphaned to non-orphaned children is 1. This implies that there is no appreciable difference in school attendance between orphans and children living with both parents. Interpretation of this index by background characteristics is hampered by small numbers of orphans in many categories. HIV/AIDS-Related Knowledge, Attitudes, and Behaviour | 227 Table 11.25 Schooling of children 10-14 by orphanhood and living arrangements Percentage of de jure children age 10-14 who are currently attending school, by orphanhood, living arrangements, and background characteristics, and the ratio of orphans to non-orphans who are in school by background characteristics, Lesotho 2004 Both parents alive Living with at least one parent Not living with either parent Mother dead Father dead Both parents dead Mother, father or both dead Background characteristics Percent- age attending school Number Percent- age attending school Number Percent- age attending school Number Percent- age attending school Number Percent- age attending school Number Percent- age attending school Number Ratio of orphaned to non- orphaned children in school1 Sex Male 91.1 1,221 78.4 317 87.8 138 82.9 537 84.2 202 83.1 877 0.9 Female 96.4 1,242 94.4 310 94.8 129 95.3 569 95.1 171 94.3 869 1.0 Residence Urban 98.0 363 94.3 84 88.4 40 94.1 167 97.9 56 92.6 263 1.0 Rural 93.0 2,100 85.1 543 91.7 227 88.4 939 87.7 317 88.0 1,483 0.9 Ecological zone Lowlands 96.1 1,421 91.7 303 93.4 129 94.2 589 92.5 213 92.7 931 1.0 Foothills 93.6 339 85.0 82 95.4 44 84.2 124 91.8 35 86.8 203 1.0 Mountains 87.8 556 76.7 194 87.4 76 81.8 321 77.8 88 81.5 485 0.9 Senqu River Valley 93.8 147 93.4 48 80.1 17 91.3 72 95.2 37 89.5 126 1.0 District Butha-Buthe 96.6 155 98.1 40 100.0 16 90.4 54 91.4 13 92.4 83 0.9 Leribe 95.5 426 91.0 58 98.1 41 94.3 149 90.9 42 93.9 232 1.0 Berea 95.0 316 92.7 77 91.0 17 94.0 126 98.9 40 93.5 184 1.0 Maseru 95.1 582 87.7 150 88.4 53 90.5 237 91.4 87 89.3 376 1.0 Mafeteng 96.5 240 90.0 50 94.5 35 91.0 126 87.7 56 90.7 218 0.9 Mohale's Hoek 89.1 226 81.3 67 86.6 33 85.5 119 88.9 43 84.4 194 1.0 Quthing 91.3 151 87.5 55 84.8 19 85.0 76 92.9 35 85.7 130 1.0 Qacha’s Nek 92.8 79 78.3 31 82.0 11 82.7 67 72.5 20 80.6 98 0.8 Mokhotlong 85.4 119 72.5 43 95.1 16 81.7 63 86.5 12 84.7 91 1.0 Thaba-Tseka 90.5 169 77.6 57 87.9 26 86.7 87 76.3 27 83.4 140 0.8 Wealth quintile Lowest 82.5 420 80.0 178 83.9 68 84.5 257 82.7 100 82.9 425 1.0 Second 92.8 420 77.8 112 93.5 53 85.9 243 87.6 78 86.2 375 0.9 Middle 94.4 485 92.1 141 100.0 44 90.4 225 89.8 75 91.1 345 1.0 Fourth 97.3 546 94.2 99 88.2 64 95.3 213 95.7 68 93.7 345 1.0 Highest 98.7 591 91.3 98 95.9 37 92.2 168 94.9 51 92.0 256 1.0 Number of children 93.8 2,463 86.3 627 91.2 267 89.3 1,106 89.2 373 88.7 1,746 1.0 1 "Ratio of orphans to non-orphans who are in school," a ratio of columns (9) and (1). HIV Prevalence and Associated Factors | 229 HIV PREVALENCE AND ASSOCIATED FACTORS 12 This chapter presents information on HIV testing coverage among eligible survey respondents, the prevalence of HIV among those tested, and the factors associated with HIV infection in the population. The HIV prevalence data provide important information to plan the national response to the AIDS epidemic. The understanding of the distribution of HIV in the population and the analysis of social, biological, and behavioural factors associated with HIV infection offer new insights into the HIV epidemic in Lesotho that will guide more precisely targeted messages and interventions. In Lesotho, as in most of sub-Saharan Africa with generalized HIV/AIDS epidemics, national HIV prevalence estimates have been derived primarily from sentinel surveillance among pregnant women. HIV Sentinel Surveillance was first established in 1991 at five sites throughout Lesotho. At these sites, blood taken for routine investigations among pregnant women who were presenting for their first visit and among patients with sexually transmitted diseases was anonymously tested for HIV. To reflect recent advances in surveillance methodologies in countries with generalized epidemics, the 2003 HIV Sentinel Survey focused exclusively on pregnant women. The findings from that 2003 survey were the basis for calculating the 2003 national adult prevalence rate of 29 percent. The latest HIV Sentinel survey was conducted over a period of twelve weeks from March to June 2005 at ten sites encompassing the original sites used in previous survey rounds, providing a more representative sample of regions, including urban and rural populations. While the rate of HIV infection in pregnant women has been shown to be a reasonable proxy for the level in the combined male and female adult population in a number of settings (WHO and UNAIDS, 2000), there are several well recognised limitations in estimating the HIV rate in the general adult population from data derived exclusively from pregnant women attending selected antenatal clinics. The ANC data do not capture any information on HIV prevalence in non-pregnant women, nor in women who either do not attend a clinic for pregnancy care or receive antenatal care at facilities not represented in the surveillance system. Pregnant women are also more at risk for HIV infection than women who may be avoiding both HIV and pregnancy through the use of condoms or women who are less sexually active and are therefore less likely to become pregnant or expose themselves to HIV. There also may be biases in the ANC surveillance data because HIV infection reduces fertility and because knowledge of HIV status may influence fertility choices. Therefore, women of reproductive age who are infertile secondary to HIV cannot be incorporated in the sentinel surveys. Another contributing factor to the selection bias and non- representation of reproductive women in sentinel surveys is the established association between HIV infection and first trimester abortions. The increased rate of first trimester abortions among women at health care facilities in Lesotho is plausibly linked to increased sexually transmitted infections and HIV, which is instrumental to non-participation of the affected women in the HIV sentinel surveys. The rates among pregnant women are not a good proxy for male HIV rates. Although the information from the ANC surveillance system has been very useful for monitoring trends in HIV levels in Lesotho, the inclusion of HIV testing in the 2004 LDHS offers the opportunity to better understand the magnitude and patterns in the infection level in the general reproductive age population that may not be assessed by routine HIV seroprevalence surveys in Lesotho. The 2004 LDHS results are in turn expected to improve the calibration of the biennial sentinel surveillance data, so that trends in HIV infection can be more accurately measured in the intervals between general population surveys. 230 | HIV Prevalence and Associated Factors 12.1 COVERAGE OF HIV TESTING Table 12.1 presents the coverage rates for HIV testing by the reason for not being tested, according to gender and residence. HIV tests were conducted for 81 percent of the eligible women and 68 percent of the eligible men. For both sexes combined, coverage was 75 percent. Table 12.1 Coverage of HIV testing by sex, residence, and district Percent distribution of women age 15-49 and men age 15-59 eligible for HIV testing by testing status, according to residence and district (unweighted), Lesotho 2004 District Residence Sex/Testing status Urban Rural Butha- Buthe Leribe Berea Maseru Mafeteng Mohale's Hoek Quthing Qacha's Nek Mokhotlong Thaba- Tseka Total WOMEN 15-49 Tested 73.3 83.4 80.3 81.1 80.5 65.0 85.2 82.2 89.7 87.1 84.7 85.0 80.7 Refused 21.7 8.4 12.6 12.3 8.2 24.4 7.8 11.3 3.5 7.0 11.1 11.7 12.0 Absent for testing 1.8 2.7 1.5 2.1 2.1 3.8 3.6 2.8 2.6 1.2 2.0 1.5 2.4 Interviewed in survey 0.2 0.3 0.2 0.0 0.0 1.0 0.0 0.0 0.0 0.4 0.0 0.4 0.2 Not interviewed 1.6 2.4 1.2 2.1 2.1 2.7 3.6 2.8 2.6 0.8 2.0 1.1 2.2 Other/missing 3.3 5.5 5.7 4.5 9.2 6.9 3.4 3.7 4.2 4.7 2.3 1.9 4.9 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number 1,011 2,747 406 424 390 583 384 432 310 256 307 266 3,758 MEN 15-59 Tested 60.7 70.2 68.3 65.2 72.0 50.5 75.0 65.4 71.1 82.7 72.1 74.3 68.0 Refused 27.1 13.2 16.7 19.0 10.1 27.8 12.7 21.1 7.0 11.9 15.6 12.8 16.6 Absent for testing 5.1 7.6 5.6 8.0 5.7 7.2 6.9 7.8 11.7 2.2 6.7 7.5 7.0 Interviewed in survey 0.4 0.3 0.3 0.3 0.0 0.8 0.0 0.3 0.8 0.0 0.7 0.0 0.3 Not interviewed 4.7 7.2 5.3 7.8 5.7 6.4 6.9 7.5 10.9 2.2 5.9 7.5 6.6 Other/missing 7.2 8.9 9.4 7.8 12.2 14.5 5.4 5.8 10.2 3.1 5.6 5.3 8.5 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number 791 2,514 360 348 386 503 332 399 256 226 269 226 3,305 TOTAL Tested 67.8 77.1 74.7 74.0 76.3 58.3 80.4 74.1 81.3 85.1 78.8 80.1 74.7 Refused 24.0 10.7 14.5 15.3 9.1 26.0 10.1 16.0 5.1 9.3 13.2 12.2 14.1 Absent for testing 3.2 5.0 3.4 4.8 3.9 5.3 5.2 5.2 6.7 1.7 4.2 4.3 4.6 Interviewed in survey 0.3 0.3 0.3 0.1 0.0 0.9 0.0 0.1 0.4 0.2 0.3 0.2 0.3 Not interviewed 2.9 4.7 3.1 4.7 3.9 4.4 5.2 5.1 6.4 1.5 3.8 4.1 4.3 Other/missing 5.0 7.1 7.4 6.0 10.7 10.4 4.3 4.7 6.9 3.9 3.8 3.5 6.6 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number 1,802 5,261 766 772 776 1,086 716 831 566 482 576 492 7,063 Based on the reason for nonresponse, individuals who were not tested were divided into the following four categories: • Those who refused testing when asked for informed consent (14 percent, overall) • Those who were interviewed in the survey, but who were not at home at the time testing was conducted in the household (less than 1 percent) • Those who were not at home for the testing and were never interviewed (4 percent), and HIV Prevalence and Associated Factors | 231 • Those who were missing test results for some other reason (e.g., a technical problem pre- vented taking blood) (5 percent). Refusal is the most important reason for non-response on the HIV testing component among both women (12 percent) and men (17 percent). Absence accounts for more than one-fifth of the male non-response and just over 12 percent of the female non-response. Table 12.1 shows that rural residents are more likely to be tested than their urban counterparts (77 percent and 68 percent, respectively). There also were strong differences in HIV testing coverage rates by district. Among both sexes, Qacha’s Nek had the highest rate of testing (85 percent), followed by Quthing (81 percent), and Thaba-Tseka and Mafeteng (80 percent each). Response rates exceeded 70 percent in all other districts except Maseru (58 percent). Refusal is the primary reason for nonresponse in all districts except Quthing, where the primary reason for nonresponse is absence of respondents. Table 12.2 shows coverage rates for HIV testing by age group, gender, ecological zone, education, and wealth. If HIV status influenced participation in the testing, coverage would be expected to decline with age because HIV levels increase sharply with age before levelling off or declining at the older ages. For both men and women, the variation in the coverage rate for testing exhibits no clear pattern. The lowest coverage is seen among women 40-44 (76 percent) and among men the same age (61 percent), while the highest is among women 30-34 (85 percent) and among men 50-54(68 percent). Among both men and women, those with an incomplete primary education are the most likely to have been tested, while men and women with at least some secondary education were least likely to be tested. Similarly, those in the highest quintile of the wealth index were the least likely to be tested and have the highest levels of refusal (20 percent for women and 27 percent for men). To further explore whether nonresponse might have an effect on the HIV seroprevalence results, an analysis was undertaken of the relationships between participation in the HIV testing and a number of other characteristics related to HIV risk. The descriptive tables that were examined in that analysis are included in Appendix A (Tables A.3-A.6). The variation in response rates with these measures is again reassuring. as coverage rates are frequently but not uniformly higher among those groups considered to be at higher risk for HIV. For example, response rates are slightly higher among those who have had sex than among those who have not. Among both women and men, response rates are highest among those who are divorced or separated. Among women, coverage for HIV testing is slightly higher among those who reported having not had any sex in the 12 months preceding the survey than among those who had sex whether higher risk or not. Women who had no sexual partners in the 12 months preceding the survey have higher response rates than those who had multiple partners. The response rate for HIV testing is higher among women who did not use a condom at last higher-risk sexual encounter than those who did. Among men, the coverage rate for HIV testing is higher among uncircumcised than circumcised men. Different from women, men who had three or more regular or higher-risk sexual partners in the past 12 months have higher response rates than those with one, two, or no partners. Similarly to women, the response rate for HIV testing is higher among men who did not use a condom at last higher-risk sexual encounter than those who did. 232 | HIV Prevalence and Associated Factors Table 12.2 Coverage of HIV testing by background characteristics Percent distribution of women age 15-49 and men age 15-59 eligible for HIV testing by testing status, according to selected background characteristics (unweighted), Lesotho 2004 Testing status Tested Refused Absent for testing Other/missing Background characteristic Inter- viewed Not inter- viewed Inter- viewed Not inter- viewed Inter- viewed Not inter- viewed Inter- viewed Not inter- viewed Total Number WOMEN Age 15-19 80.4 0.3 9.1 1.7 0.1 3.0 3.2 2.3 100.0 947 20-24 82.3 0.4 9.4 0.5 0.3 2.1 2.5 2.4 100.0 752 25-29 76.8 0.2 13.2 1.8 0.2 3.8 2.0 2.0 100.0 551 30-34 85.4 0.2 9.3 0.9 0.2 0.7 2.1 1.2 100.0 432 35-39 80.1 0.8 13.3 1.1 0.0 1.1 1.6 2.1 100.0 376 40-44 76.2 0.3 13.6 0.8 0.5 2.4 3.9 2.4 100.0 382 45-49 80.5 0.0 9.7 1.9 0.6 0.6 5.0 1.6 100.0 318 Ecological zone Lowlands 77.7 0.2 13.7 1.1 0.2 2.3 2.8 2.0 100.0 1,673 Foothills 78.0 0.2 9.4 2.3 0.2 3.4 3.0 3.6 100.0 533 Mountains 83.1 0.4 8.5 1.3 0.3 1.9 3.0 1.5 100.0 1,169 Senqu River Valley 86.7 0.8 6.3 0.5 0.3 1.3 2.1 2.1 100.0 383 Education No education 78.5 0.9 4.7 2.8 0.0 1.9 0.9 10.3 100.0 107 Primary, incomplete 84.3 0.5 5.7 1.3 0.2 2.4 3.2 2.4 100.0 1,203 Primary, complete 82.8 0.1 9.7 0.9 0.2 1.4 3.2 1.6 100.0 989 Secondary+ 75.6 0.3 16.0 1.3 0.3 2.6 2.4 1.5 100.0 1,459 Wealth quintile Lowest 91.4 0.0 5.0 0.0 0.2 0.0 3.4 0.0 100.0 582 Second 90.3 0.0 6.1 0.0 0.1 0.0 3.5 0.0 100.0 710 Middle 88.5 0.0 9.5 0.0 0.0 0.0 1.9 0.0 100.0 619 Fourth 83.9 0.0 12.5 0.0 0.7 0.0 2.9 0.0 100.0 728 Highest 76.5 0.0 20.1 0.0 0.2 0.0 3.1 0.0 100.0 899 Total 80.4 0.3 10.7 1.3 0.2 2.2 2.8 2.1 100.0 3,758 MEN Age 15-19 70.3 0.3 10.9 3.6 0.2 6.6 3.3 4.7 100.0 888 20-24 66.6 0.3 11.6 4.1 0.8 7.3 3.9 5.4 100.0 613 25-29 64.8 0.5 14.4 2.7 0.0 9.7 3.6 4.3 100.0 443 30-34 69.5 0.3 14.0 2.2 0.3 6.4 2.0 5.3 100.0 357 35-39 66.4 0.0 16.0 3.7 0.4 7.1 1.5 4.9 100.0 268 40-44 61.4 1.5 17.8 3.6 0.5 6.1 3.0 6.1 100.0 197 45-49 64.8 0.0 19.2 3.1 0.5 2.6 5.2 4.7 100.0 193 50-54 71.7 0.5 11.0 2.1 0.0 5.2 3.7 5.8 100.0 191 55-59 68.4 0.0 13.5 2.6 0.0 1.9 6.5 7.1 100.0 155 Ecological zone Lowlands 64.7 0.5 15.9 2.7 0.3 6.9 3.9 5.0 100.0 1,470 Foothills 61.6 0.2 15.1 5.6 0.0 5.6 4.3 7.6 100.0 484 Mountains 71.7 0.3 11.0 2.8 0.4 6.7 2.5 4.4 100.0 1,023 Senqu River Valley 76.5 0.3 5.8 3.7 0.6 6.4 2.4 4.3 100.0 328 Education No education 66.6 0.4 10.7 4.3 0.0 7.3 3.3 7.4 100.0 700 Primary, incomplete 71.9 0.4 9.9 3.0 0.4 5.5 3.9 5.0 100.0 1,360 Primary, complete 66.9 0.2 13.6 3.2 0.2 9.1 3.0 3.7 100.0 405 Secondary+ 61.8 0.4 20.7 2.9 0.6 6.7 3.0 4.0 100.0 840 Wealth quintile Lowest 86.6 0.0 9.6 0.0 0.4 0.0 3.5 0.0 100.0 543 Second 85.4 0.0 11.2 0.0 0.2 0.0 3.3 0.0 100.0 553 Middle 81.9 0.0 13.6 0.0 0.5 0.0 4.0 0.0 100.0 551 Fourth 78.0 0.0 16.4 0.0 0.5 0.0 5.1 0.0 100.0 568 Highest 68.4 0.0 27.0 0.0 0.3 0.0 4.3 0.0 100.0 582 Total 67.6 0.4 13.3 3.3 0.3 6.6 3.4 5.1 100.0 3,305 Note: This table provides data only at the household level. HIV Prevalence and Associated Factors | 233 12.2 HIV PREVALENCE 12.2.1 HIV Prevalence by Socioeconomic Characteristics Results from the 2004 LDHS indicate that 24 percent of adults age 15-49 in Lesotho are infected with HIV (Table 12.3). HIV prevalence in women age 15-49 is 26 percent, while for men 15-59, it is 19 percent. Figure 12.1 shows that, for both sexes, rates of infection rise with age, peaking at 43 percent among women in their late 30s and 41 percent among men age 30-34. HIV prevalence is substantially higher among women than men under age 30, while, at ages 40-49, the pattern reverses and prevalence among men exceeds the level among women. Table 12.3 HIV prevalence by age Percentage HIV positive among women 15-49 and men age 15-59 who were tested, by age, Lesotho 2004 Women Men Total Age Percentage HIV positive Number Percentage HIV positive Number Percentage HIV positive Number 15-19 7.9 729 2.3 615 5.3 1,343 20-24 24.5 613 11.4 411 19.2 1,025 25-29 39.2 446 24.3 300 33.2 746 30-34 40.3 380 41.3 254 40.7 635 35-39 43.3 317 38.7 186 41.6 503 40-44 28.5 300 33.9 127 30.1 427 45-49 16.8 245 27.8 119 20.4 364 50-54 na na 16.2 139 16.2 139 55-59 na na 16.6 104 16.6 104 Total age 15-49 26.4 3,031 19.3 2,012 23.5 5,043 Total age 15-59 na na 18.9 2,255 23.2 5,286 Note: “HIV positive” refers to HIV-1 only. na = Not applicable Figure 12.1 HIV Prevalence by Age Group and Sex LDHS 2004 * * * * * * * ( ( ( ( ( ( ( 15-19 20-24 25-29 30-34 35-39 40-44 45-49 0 10 20 30 40 50 Percent Women Men( * 234 | HIV Prevalence and Associated Factors To evaluate the effects of non-response bias, HIV prevalence rates among non-tested women and men were predicted based on multivariate statistical models derived from information for those who were tested (Mishra et al., 2005). For purposes of this analysis, the nontested groups were divided according to whether they were interviewed in the 2004 LDHS or not. Predictions for the “noninterviewed, nontested” group were based on a limited set of demographic and socioeconomic variables (only from the household questionnaire), while predictions for the “interviewed, nontested” group used additional sociodemo- graphic and behavioural characteristics for which information was obtained in the individual interviews.1 The results of this analysis show that the predicted HIV prevalence rates among nontested women (26.9 percent) and men (20.3 percent) derived from this analysis are only slightly higher than the preva- lence rates observed among tested women (26.4 percent) and men (18.9 percent). Thus, adjusting the observed prevalence rates to take into account the predicted rates among non-tested women and men makes little difference in the rates. The adjusted HIV prevalence rates for all eligible women and men are 26.2 percent and 19.1 percent, respectively, which are well within the error margins of the observed prevalence rates based on tested respondents. Because few HIV-infected children survive into their teenage years, infected youth represent more recent cases of HIV infection and serve as an important indicator for detecting trends in both prevalence and incidence. Youth are also not likely to have a long-standing history of engaging in behaviour associated with risk of HIV infection. Therefore, the HIV status among youth is a proxy for newly infected individuals. Prevalence among women age 15-24 in the LDHS is 15 percent, compared with 6 percent among men, for an overall prevalence in youth of 11 percent (See Table 12.10). Table 12.4 presents the variation in HIV rates for women and men age 15-49 with a number of socioeconomic characteristics. Prevalence in urban women is 33 percent compared with 24 percent for rural women, for a 1.4 urban-rural relative risk of HIV infection. The urban-rural differential is somewhat less marked among men: 22 percent of urban men are infected compared with 19 percent of rural men. Differences across the other residential categories are generally not large. Among the four zones, Lowlands has the highest rates of infection for both females and males (28 and 20 percent, respectively). Looking at the districts, Leribe has the highest infection rate among both women and men, while Thaba- Tseka, Mokhotlong, and Mohale’s Hoek have the lowest for women, and Butha-Buthe and Mokhotlong have the lowest for men. Differences in infection levels are not large across educational categories, although having attended school is related to somewhat lower infection levels among both women and men. One-third of employed women and one-fourth of employed men are HIV infected, compared with 23 percent of unem- ployed women and 16 percent of unemployed men. The variation between HIV status and wealth is not uniform. The lowest HIV rates for women are found among those in the lowest wealth quintile, while for men the reverse is true. The variation in HIV levels by religious denomination is not large. For example, among women who profess a religious affiliation, the rate varies from 25 percent for Roman Catholics to 28 percent among Anglicans, while for men it ranges from 17 percent among other Christians to 21 percent among Anglicans. Seventeen percent of men who indicated they have no religion affiliation are HIV positive. 1 Variables for predicting prevalence in the “not-interviewed, not-tested” group included age, education, wealth index, residence, and geographic region. Additional variables for predicting prevalence in the “interviewed, not- tested” group included marital union, childbirth in last five years (women only), work status, media exposure, religion, circumcision (men only), STI or STI symptoms in last 12 months, alcohol use, cigarette smoking/tobacco use, age at first sex, number of sex partners in last 12 months, condom use at last sex in last 12 months, paid for sex (for men), higher-risk sex in last 12 months, willingness to care for a family member with AIDS, number of times slept away in last 12 months (men only), away for more than one month in last 12 months (men only), and participation in household decisionmaking (women only). HIV Prevalence and Associated Factors | 235 Table 12.4 HIV prevalence by socioeconomic characteristics Percentage HIV positive among women and men age 15-49 who were tested, by background characteristics, Lesotho 2004 Women Men Total Background characteristic Percentage HIV positive Number Percentage HIV positive Number Percentage HIV positive Number Residence Urban 33.0 735 22.0 407 29.1 1,142 Rural 24.3 2,295 18.6 1,606 21.9 3,901 Ecological zone Lowlands 28.0 1,843 20.4 1,235 25.0 3,078 Foothills 24.2 333 16.9 231 21.2 565 Mountains 23.3 663 17.7 427 21.1 1,090 Senqu River Valley 25.1 192 17.6 119 22.2 311 District Butha-Buthe 25.3 195 12.4 128 20.2 323 Leribe 30.6 433 28.3 270 29.7 704 Berea 25.2 356 22.3 269 24.0 625 Maseru 29.9 796 18.8 522 25.5 1,318 Mafeteng 25.8 324 15.6 222 21.6 546 Mohale's Hoek 20.9 298 20.4 204 20.7 502 Quthing 25.7 198 18.9 115 23.2 312 Qacha’s Nek 25.2 99 13.9 69 20.6 168 Mokhotlong 20.6 153 13.0 97 17.7 250 Thaba-Tseka 20.5 179 14.5 116 18.2 295 Education No education 30.4 70 26.8 312 27.4 382 Primary, incomplete 26.0 941 16.7 879 21.5 1,820 Primary, complete 27.1 793 18.3 280 24.8 1,073 Secondary+ 26.0 1,226 19.5 542 24.0 1,768 Respondent currently working Currently working 32.8 1,148 25.6 615 30.3 1,763 Not currently working 22.5 1,868 16.3 1,383 19.9 3,251 Wealth quintile Lowest 19.6 430 18.3 336 19.0 767 Second 27.9 565 16.8 380 23.4 945 Middle 25.5 543 23.7 425 24.7 967 Fourth 27.3 648 21.6 444 25.0 1,093 Highest 28.9 832 14.8 415 24.2 1,247 Religion Roman Catholic Church 25.1 1,321 20.4 926 23.2 2,247 Lesotho Evangelical Church 27.4 645 18.3 449 23.7 1,094 Anglican Church 28.4 292 20.8 170 25.6 463 Other Christian 26.6 724 16.8 336 23.5 1,060 No religion * 25 16.7 114 19.2 139 Total 26.4 3,031 19.3 2,012 23.5 5,043 Note: ”HIV positive“ refers to HIV-1 only. Total includes 29 cases missing data on whether currently working. An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. 236 | HIV Prevalence and Associated Factors 12.2.2 HIV Prevalence by Other Sociodemographic Characteristics HIV prevalence is closely related to marital status among both women and men age 15-49 (Table 12.5). As expected, rates are high among both widows (47 percent) and widowers (38 percent). Levels are also high among those who are divorced or separated (56 percent for women and 36 percent for men). Among currently married women, the rate is 27 percent, somewhat lower than the level among currently married men of 33 percent. Table 12.5 HIV prevalence by selected sociodemographic characteristics Percentage HIV positive among women and men age 15-49 who were tested, by sociodemographic characteristics, Lesotho 2004 Women Men Total Sociodemographic characteristic Percentage HIV positive Number Percentage HIV positive Number Percentage HIV positive Number Marital status Currently married/in union 26.9 1,604 32.9 743 28.8 2,346 Widowed 47.3 254 (38.3) 25 46.5 279 Divorced/separated 55.9 181 36.1 83 49.7 264 Never in union 14.9 979 8.7 1,145 11.5 2,125 Ever had sex 24.2 503 11.4 746 16.6 1,249 Never had sex 5.0 477 3.7 400 4.4 876 Type of unions In polygynous union na na (32.8) 36 na na Not in polygynous union na na 32.9 707 na na Not currently in union na na 11.3 1,270 na na Pregnancy status Pregnant 23.0 201 na na na na Not pregnant/not sure 26.7 2,817 na na na na Times away from home in past 12 months None na na 18.0 1,136 na na 1-2 na na 19.8 313 na na 3-4 na na 21.1 208 na na 5+ na na 20.7 299 na na Away for more than 1 month Away for more than 1 month na na 21.0 409 na na Away for less than 1 month na na 19.2 413 na na Never away na na 18.0 1,136 na na Total 26.4 3,031 19.3 2,012 23.5 5,043 Note: ”HIV positive“ refers to HIV-1 only. Totals include 29 women and men missing data on marital status and 55 men missing data on whether away from home for more than one month. Figures in parentheses are based on 25-49 unweighted cases. na = Not applicable HIV rates are lowest for respondents who have never been in union. Among women who are sexually active but have never been in a marital union, prevalence is 24 percent, almost as high as the level found among married women and roughly double the level among males (11 percent) who report they have not yet married but have been sexually active. Four percent of individuals who say they have never had sex are HIV positive. These findings are likely a result of a number of factors, including reluctance to report sexual activity and nonsexual trans- mission of AIDS. HIV Prevalence and Associated Factors | 237 Information on the type of marital union is available only for men. The results indicate that the HIV rate for the small number of men reporting a polygynous union is virtually identical to the rate for men in a monogamous union (33 percent each). HIV prevalence among women who are currently pregnant is 23 percent, slightly lower than the rate among women who are not pregnant or are unsure of their pregnancy status (27 percent). The rate among pregnant women provides a useful benchmark to compare with rates in pregnant women tested during sentinel surveillance. The survey results show that HIV rates vary slightly with two measures of mobility for men. The HIV prevalence rate increases with the length of stay away from home and the frequency of the times away from home. 12.2.3 HIV Prevalence by Sexual Behaviour Table 12.6 examines the prevalence of HIV infection by sexual behaviour indicators among respondents who have ever had sexual intercourse. In reviewing these results, it is important to remember that responses about sexual risk behaviours may be subject to reporting bias. Also, a number of the indicators relate to sexual behaviour in the 12 months preceding the survey, so these indicators may not adequately reflect lifetime sexual risk. For women and especially men, Table 12.6 shows that early sexual debut (younger than age 15) is associated with lower HIV prevalence. HIV prevalence rates generally rise with the age at sexual debut. This pattern is somewhat unexpected in view of the assumption that early sexual debut would be associated with a longer average period of sexual activity and thus, greater exposure to the transmission of the HIV virus. It may reflect the fact that individuals initiating sex at very young ages are concentrated in groups with lower HIV prevalence (e.g., they live in rural areas or are age 40 and older). The 2004 LDHS respondents were considered to have had a higher-risk sexual encounter if they had had intercourse with a nonmarital, noncohabiting partner. Women who reported they had a higher- risk sexual encounter in the preceding 12 months are somewhat more likely to be HIV infected compared with those who were sexually active but did not have a higher-risk partner (38 and 27 percent, respectively. The opposite was true for men (22 and 28 percent, respectively). Among women, HIV prevalence tends to increase with the number of sexual partners in the last 12 months. For both men and women, there is no clear pattern between HIV prevalence and number of higher-risk partners. Data for men show that HIV prevalence increases with increasing number of lifetime sexual partners. This information is not available for women. Among men, those who paid for sex more than 12 months preceding the survey have higher HIV prevalence (45 percent) than either those who have never paid for sex (22 percent), or those who paid for sex in the past 12 months (29 percent). 238 | HIV Prevalence and Associated Factors Table 12.6 HIV prevalence by sexual behaviour Percentage HIV positive among women and men age 15-49 who ever had sex and were tested for HIV, by sexual behaviour, Lesotho 2004 Women Men Total Sexual behaviour characteristic Percentage HIV positive Number Percentage HIV positive Number Percentage HIV positive Number Age at first sex < 15 25.4 189 8.1 180 17.0 369 15-17 29.6 980 18.7 562 25.6 1,542 18-19 30.8 689 30.5 350 30.7 1,039 20+ 33.2 478 27.5 500 30.2 978 Missing 31.1 216 44.2 21 32.3 237 Higher-risk sexual intercourse in past 12 months Had higher-risk sexual intercourse 37.6 783 22.1 921 29.2 1,704 Had sexual intercourse, not higher risk 27.4 1,347 28.3 488 27.6 1,836 No sexual intercourse in past 12 months 26.7 421 15.2 203 23.0 625 Number of sexual partners in past 12 months 0 27.3 409 14.0 190 23.1 599 1 30.0 1,899 23.8 948 28.0 2,848 2 38.9 217 25.6 338 30.8 555 3+ * 14 22.9 119 26.0 132 Number of higher-risk sexual partners1 in past 12 months 0 27.4 1,756 24.3 678 26.5 2,434 1 37.7 705 23.0 613 30.9 1,318 2 32.1 71 19.5 201 22.8 272 3+ * 6 22.3 105 24.9 111 Condom use Ever used condom 34.2 1,085 22.7 903 29.0 1,989 Never used condom 27.6 1,466 23.6 709 26.3 2,175 Condom use at last sexual intercourse in past 12 months Used condom 36.6 403 7.3 141 29.0 543 Did not use condom 29.9 1,724 * 5 29.8 1,729 Condom use at last higher-risk sexual intercourse in past 12 months Used condom 39.0 321 17.7 442 26.7 763 Did not use condom 36.6 462 26.1 479 31.3 941 Number of lifetime partners 1 na na 13.5 319 na na 2-3 na na 19.7 420 na na 4-5 na na 25.6 325 na na 6-10 na na 25.7 289 na na 11-15 na na 31.2 65 na na 16-20 na na (36.3) 60 na na 21+ na na 34.4 67 na na Paid for sexual intercourse2 In past 12 months na na (29.2) 31 na na More than 12 months ago na na 44.8 73 na na Never na na 21.8 1,497 na na Condom use at last paid sex Used condom na na (40.4) 53 na na Did not use condom na na 39.8 52 na na Total 15-49 30.4 2,551 23.1 1,613 27.6 4,164 Note: “HIV positive” refers to HIV-1 only. “Higher-risk sexual intercourse” refers to sexual intercourse with a partner who was not a spouse and who did not live with the respondent. Total includes cases with missing information. An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. Figures in parentheses are based on 25-49 unweighted cases. 1 Partner who was not a spouse, who did not live with the respondent, and who was one of the last three sexual partners in the past 12 months. 2 Includes men who reported having a prostitute as one of their last three sexual partners in the past 12 months. na = Not applicable HIV Prevalence and Associated Factors | 239 Information was obtained in the 2004 LDHS on ever use of condoms and on the use of condoms during the last sexual encounter in the 12 month period preceding the survey. Condoms are an effective way of preventing the transmission of HIV and other STIs. Although this would suggest that HIV rates should be lower among condom users, there are a number of factors that may influence the direction of the relationship. For example, condom use rates may be higher among individuals who are infected because they are seeking to protect an uninfected partner. Also, reported condom use is assumed to be “correct condom use” when in fact it may be incorrect use, and as a result not a protective mechanism against HIV infection. Thus, it is not surprising that the associations between condom use and infection levels are not uniform in Table 12.6. Any condom use and condom use at the most recent sexual encounter are associated with higher levels of HIV infection among women and lower rates among men. There is no association between condom use at the last higher risk sexual encounter and the HIV rate for women, while for men the HIV rate is lower among those who used a condom in the most recent higher- risk encounter than among men who did not use a condom. Condom use is not associated with HIV infection rates among the small number of men who report they paid their partner the last time they had sex. 12.2.4 HIV Prevalence by Other Characteristics Related to HIV Risk Table 12.7 presents the variation in HIV prevalence with a number of other characteristics related to HIV risk among men and women who have ever had sex. As expected, women and men with a history of an STI or STI symptoms have higher rates of HIV infection than those with none. HIV prevalence is higher among both women and men who report ever drinking alcohol than among those who never drank alcohol. Among women who ever drank, HIV prevalence is higher (43 percent) among those who said they had not drunk in the past three months than among those who had had an alcoholic drink recently (34 percent). Among men who ever drank, the pattern is reversed with men who recently drank (27 per- cent) having a slightly higher prevalence than those who did not drink alcohol (23 percent) in the past three months. Both women and men who have been tested for HIV in the past are more likely to be HIV infected than those who have never been tested. Among women who have ever had sex, the level of HIV infection is 39 percent among those who have ever been tested for HIV in the past, compared with 30 per- cent among those who have never been tested. Among men, 36 percent of those previously tested are HIV positive, compared with 22 percent of those who have never been tested. Table 12.7 HIV prevalence by other characteristics Percentage HIV positive among women and men age 15-49 who ever had sex and were tested, by selected characteristics, Lesotho 2004 Women Men Total Characteristic Percentage HIV positive Number Percentage HIV positive Number Percentage HIV positive Number Sexually transmitted infection in past 12 months Had STI or STI symptoms 43.9 416 30.4 216 39.3 631 No STI, no symptoms 27.9 2,099 22.0 1,369 25.6 3,468 Use of alcohol Drank alcohol In past 3 months 33.9 425 26.8 727 29.4 1,152 Ever, not in past 3 months 42.5 332 23.0 246 34.2 578 Never drank alcohol 27.3 1,765 18.7 624 25.1 2,389 HIV testing status Ever tested 38.7 420 36.0 186 37.9 606 Never tested 29.6 1,963 21.6 1,337 26.3 3,300 Total 30.4 2,551 23.1 1,613 27.6 4,164 Note: ”HIV positive” refers to HIV-1 only. Totals include 64 cases missing information on presence of an STI or STI symptoms, 44 cases missing information on use of alcohol, and 258 cases missing information on HIV testing status. 240 | HIV Prevalence and Associated Factors Although the individual’s HIV status is associated with prior HIV testing, the above results indicate that many individuals who are HIV positive have not been tested. Table 12.8 shows that nearly four out of five of those infected with HIV (79 percent of infected women and 78 percent of infected men) do not know their HIV status, either because they were never tested or because they were tested and did not receive their results. For women, 17 percent of those who are HIV infected have been tested and know their results for their last test, compared with 10 percent of those who are HIV negative. For men, there is a similar pattern: 16 percent of those who are HIV infected know their results for their last test, compared with 7 percent of those who are HIV negative. Table 12.8 HIV prevalence by prior HIV testing Percent distribution of women and men age 15-49 who were tested, by HIV testing status before the survey, Lesotho 2004 Women Men Total HIV testing status HIV positive HIV negative HIV positive HIV negative HIV positive HIV negative Ever tested and know results of last test 16.8 9.8 16.2 6.5 16.6 8.4 Ever tested, does not know results 3.6 2.3 1.4 0.9 2.9 1.7 Never tested 75.3 80.4 76.6 85.6 75.7 82.6 Missing 4.4 7.5 5.7 7.0 4.8 7.3 Total 100.0 100.0 100.0 100.0 100.0 100.0 Number 799 2,231 387 1,625 1,187 3,856 Note: “HIV positive” refers to HIV-1 only. 12.2.5 HIV Prevalence and Male Circumcision Lack of circumcision is considered a risk factor for HIV infection for men, in part because of physiological differences that increase the susceptibility to HIV infection among uncircumcised men. The 2004 LDHS obtained information on male circumcision status (see Chapter 10), and Table 12.9 examines the relationship between HIV prevalence and male circumcision status. The relationship between male circumcision and HIV levels in Lesotho does not conform to the expected pattern of higher rates among uncircumcised men than circumcised men. The HIV rate is in fact substantially higher among circumcised men (23 percent) than among men who are not circumcised (15 percent). Moreover, the pattern of higher infection rates among circumcised men compared with uncircumcised men is virtually uniform across the various subgroups for which results are shown in the table. This finding could be explained by the Lesotho custom to conduct male circumcision later in life, when the individuals have already been exposed to the risk of HIV infection. (Additional analysis is necessary to better understand the unexpected pattern in Table 12.9.) HIV Prevalence and Associated Factors | 241 Table 12.9 HIV prevalence by circumcision: men Among men age 15-59 who were tested for HIV, percentage HIV positive among circumcised and uncircumcised men, according to background characteristics, Lesotho 2004 Circumcised men Uncircumcised men Background characteristic Percentage HIV positive Number Percentage HIV positive Number Age 15-19 2.5 129 2.3 482 20-24 13.9 219 8.7 189 25-29 24.7 183 24.2 115 30-34 34.4 161 52.8 93 35-39 39.9 113 36.9 73 40-44 33.2 66 (31.2) 55 45-49 26.8 79 (30.8) 39 50-54 26.0 71 6.2 67 55-59 10.4 65 (27.0) 38 Residence Urban 28.6 162 17.3 279 Rural 21.8 925 14.5 872 Ecological zone Lowlands 25.4 548 16.2 819 Foothills 23.0 155 7.8 100 Mountains 18.9 299 14.9 178 Senqu River Valley 19.2 84 14.4 54 District Butha-Buthe 18.5 88 5.3 58 Leribe 34.0 119 22.6 198 Berea 27.4 142 16.9 148 Maseru 22.9 205 14.8 360 Mafeteng 19.7 122 13.2 120 Mohale's Hoek 25.6 129 13.4 98 Quthing 18.8 89 15.3 45 Qacha’s Nek 19.2 44 12.2 34 Mokhotlong 14.0 75 7.2 34 Thaba-Tseka 17.3 74 11.1 54 Education No education 26.0 311 27.5 85 Primary, incomplete 20.4 515 11.9 474 Primary, complete 25.0 118 13.7 174 Secondary+ 22.8 143 17.0 417 Wealth quintile Lowest 20.0 269 13.3 113 Second 18.9 247 13.7 183 Middle 28.2 225 18.6 246 Fourth 28.4 199 17.3 291 Highest 18.7 146 12.2 317 Religion Roman Catholic Church 22.7 476 17.7 570 Lesotho Evangelical Church 24.4 229 12.3 250 Anglican Church 23.7 91 17.4 107 Other Christian 22.7 211 9.7 176 No religion 17.8 71 (16.7) 46 Total 22.8 1,087 15.2 1,151 Note: “HIV positive” refers to HIV-1 only. Figures in parentheses are based on 25-49 unweighted cases. 242 | HIV Prevalence and Associated Factors 12.2.6 HIV Prevalence and Youth Generally, cases of HIV infection among youths age 15-24 represent more recent infections and serve as an important indirect measure for assessing trends in incidence. Table 12.10 shows HIV prevalence among youth according to several socioeconomic and risk behaviour indicators. One in nine persons age 15-24 in Lesotho is HIV positive. HIV prevalence among young women is 15 percent while among young men it is 6 percent. The higher prevalence among women compared with men the same age may be because some younger women are in sexual relationships with older men, who are likely to be infected with HIV because of a longer period of exposure. The HIV rate rises rapidly with age among both females and males because the proportion of youth who have initiated sexual activity, and thus become exposed to the possible transmission of the HIV virus, has increased. Among young women, urban residence is related to higher infection rates than rural residence. Among young men, however, the urban and rural HIV rates are virtually identical, and clearly lower than those for women. Looking at zonal differences in HIV prevalence rates, among young women, prevalence ranges from 13 percent in Mountains to 17 percent in Lowlands, while for young men it ranges from 5 percent in Lowlands to 9 percent in Senqu River Valley. Youth who have ever been in a marital union are more likely to be HIV positive than other youth. HIV rates do not differ significantly according to whether or not the youth has engaged in higher-risk sex (i.e., sex with a nonmarital, noncohabiting partner) in the past 12 months. HIV prevalence generally rises with the total number of sexual partners the young person has had and the number of higher-risk partners. Ever use of condoms and condom use during the first sexual encounter are associated with higher HIV prevalence, while condom use at the last sexual encounter during the 12 months preceding the survey is related to lower HIV levels. HIV Prevalence and Associated Factors | 243 Table 12.10 HIV prevalence among young people Percentage HIV positive among women and men age 15-24 who were tested for HIV, by selected characteristics, Lesotho 2004 Women Men Total Background characteristic Percentage HIV positive Number Percentage HIV positive Number Percentage HIV positive Number Age 15-17 6.1 446 0.7 388 3.6 835 18-19 10.7 282 5.1 227 8.2 509 20-22 22.9 421 7.9 259 17.2 680 23-24 27.9 192 17.4 153 23.3 345 Residence Urban 21.4 273 4.7 160 15.2 433 Rural 13.9 1,069 6.2 866 10.5 1,935 Ecological zone Lowlands 17.0 791 4.6 626 11.5 1,417 Foothills 13.8 154 8.1 124 11.3 278 Mountains 12.9 302 7.7 213 10.8 515 Senqu River Valley 13.5 95 9.3 63 11.8 158 District Butha-Buthe 14.8 90 3.5 68 10.0 158 Leribe 21.5 183 7.1 120 15.8 303 Berea 12.1 166 6.9 136 9.7 301 Maseru 18.4 325 6.4 249 13.2 574 Mafeteng 14.8 148 2.6 140 8.9 288 Mohale's Hoek 13.2 138 7.1 113 10.5 251 Quthing 13.8 100 10.5 59 12.6 159 Qacha’s Nek 17.1 46 4.1 37 11.4 83 Mokhotlong 6.0 69 5.2 45 5.7 114 Thaba-Tseka 11.4 76 5.3 61 8.7 137 Marital status Currently married/in union 19.1 446 19.8 77 19.2 523 Widowed * 7 * 1 * 9 Divorced/separated (66.7) 46 * 4 (64.3) 50 Ever had sex 17.2 373 6.1 559 10.5 932 Never had sex 4.7 463 2.8 380 3.9 843 Higher-risk sexual intercourse in last 12 months Had higher-risk sex 24.3 307 8.3 488 14.5 795 Had sex, not higher risk 20.4 387 9.7 51 19.2 439 No sex in past 12 months 8.3 648 3.2 486 6.1 1,134 Number of partners in last 12 months3 0 8.3 645 3.3 482 6.1 1,127 1 20.7 640 7.7 338 16.2 978 2 41.7 49 9.1 140 17.4 189 3+ * 1 11.5 60 11.5 61 Number of higher-risk sexual partners in last 12 months1 0 12.9 1,032 3.9 533 9.8 1,565 1 22.9 278 7.0 307 14.6 586 2 42.2 24 10.6 123 15.7 146 3+ * 0 10.5 57 10.5 57 Any condom use2 Used condom 23.9 409 8.0 385 16.2 794 Never used condom 11.7 933 4.7 641 8.9 1,574 Condom use at past sex in past 12 months1 Used condom at last sex 19.5 175 7.3 141 14.1 315 No condom use at last sex 23.0 515 17.9 5 23.0 520 Condom used at first sexual intercourse1 Used condom at first sex intercourse 17.8 229 7.3 141 13.8 370 No condom use at last sexual intercourse 15.0 1,113 5.8 885 10.9 1,998 Total 15.4 1,342 6.0 1,026 11.3 2,368 Note: “HIV positive” refers to HIV-1 only. “Higher-risk sexual intercourse” refers to sexual intercourse with a partner who was not a spouse and who did not live with the respondent. Totals include 12 cases with missing information on marital status, 13 cases missing data on number of partners in past 12 months, and 13 cases missing data in number of higher-risk sexual partners in past 12 months. An asterisk indicates that a figure is based on 25-49 unweighted cases and has been suppressed. Figures in parentheses are based on 25-49 unweighted cases. 1 Respondents who had sex in the past 12 months 2 Respondents who have ever had sex 244 | HIV Prevalence and Associated Factors 12.2.7 HIV Prevalence among Cohabiting Couples Nearly 600 couples were tested for HIV in the 2004 LDHS. Results shown in Table 12.11 indicate that, for 66 percent of cohabiting couples, both partners are HIV negative, while in 20 percent of couples, both partners are HIV positive. Thirteen percent of couples are discordant, that is, one partner is infected and the other not. This means that of couples in which at least one partner is HIV positive, 40 percent are discordant. The variation in the level of couple HIV infection by background character- istics generally conforms to the patterns observed with respect to the variation in individual sero- prevalence rates (e.g., the infection rate is higher among urban than rural couples). Table 12.11 HIV prevalence among couples Among cohabiting couples both of whom were tested, percent distribution by results of HIV testing, according to background characteristics, Lesotho 2004 Background characteristic Both HIV positive Man positive, woman negative Woman positive, man negative Both HIV negative Total Number Woman's age 15-19 (9.3) (15.1) (0.5) (75.2) 100.0 41 20-29 23.3 9.5 6.5 60.8 100.0 254 30-39 24.2 6.6 4.2 65.0 100.0 168 40-49 11.5 8.9 2.3 77.3 100.0 117 Man's age 15-19 * * * * 100.0 3 20-29 13.9 11.0 5.6 69.5 100.0 154 30-39 26.8 8.7 5.1 59.4 100.0 216 40-49 23.0 9.6 3.4 63.9 100.0 120 50-59 11.6 4.3 2.9 81.2 100.0 88 Residence Urban 34.9 5.6 3.6 55.9 100.0 117 Rural 16.4 9.8 4.8 69.0 100.0 463 Ecological zone Lowlands 24.5 6.7 4.5 64.3 100.0 322 Foothills 13.2 12.8 2.3 71.8 100.0 67 Mountains 15.7 12.5 3.8 68.0 100.0 160 Senqu River Valley 13.4 5.2 13.4 68.0 100.0 31 District Butha-Buthe 11.6 4.7 5.4 78.3 100.0 33 Leribe 26.5 13.4 6.3 53.8 100.0 83 Berea 18.8 4.7 2.4 74.1 100.0 76 Maseru 26.8 7.3 5.0 61.0 100.0 143 Mafeteng (20.7) (5.4) (1.3) (72.6) 100.0 46 Mohale's Hoek 20.7 13.7 2.9 62.7 100.0 64 Quthing (11.5) (7.7) (10.4) (70.5) 100.0 32 Qacha's Nek 14.8 6.8 9.7 68.7 100.0 23 Mokhotlong 7.7 13.8 5.2 73.3 100.0 41 Thaba-Tseka (14.4) (10.8) (0.4) (74.4) 100.0 39 Woman’s education No education * * * * 100.0 20 Primary, incomplete 17.6 9.8 4.7 67.9 100.0 203 Primary, complete 17.7 10.6 3.0 68.7 100.0 181 Secondary+ 24.1 6.4 5.4 64.1 100.0 177 Man's education No education 10.6 17.2 4.9 67.4 100.0 96 Primary, incomplete 18.0 9.1 2.9 70.0 100.0 231 Primary, complete 11.7 6.9 10.5 70.9 100.0 67 Secondary+ 28.8 6.3 4.4 60.5 100.0 90 Wealth quintile Lowest 12.0 11.0 4.4 72.6 100.0 121 Second 16.0 8.2 7.9 67.9 100.0 130 Middle 17.2 15.7 3.7 63.4 100.0 102 Fourth 27.2 6.6 1.0 65.2 100.0 118 Highest 29.3 3.7 5.3 61.7 100.0 109 Total 20.2 8.9 4.5 66.4 100.0 580 Note: “HIV positive” refers to HIV-1 only. An asterisk indicates that a figure is based on 25-49 unweighted cases and has been suppressed. Figures in parentheses are based on 25-49 unweighted cases. HIV Prevalence and Associated Factors | 245 Discordance is more common among couples in which the woman or man is age 20-29, rural couples, couples in which the woman lives in Senqu River Valley and the man lives in Mokhotlong, and couples in which the man has a low level of education. 12.2.8 Nutrition Status, Anaemia Level, and HIV Status As described in Chapter 10, anthropometric measures and anaemia levels were collected for women in the 2004 LDHS. Table 12.12 considers the relationship between the body mass index (BMI) derived from the weight data and a woman’s HIV status. The results show only a minor difference in the mean BMI between HIV-positive and HIV-negative women. The percentages of HIV-positive and HIV- negative women falling into specific BMI levels are virtually identical, except for a slightly greater tendency for HIV-positive women to fall into the overweight category and a slightly lower tendency to fall into the obese category compared with HIV-negative women. Table 12.12 Nutritional status of women by HIV status Among women age 15-49, the mean body mass index (BMI) and percentage with specific BMI levels, by the woman’s HIV status, Lesotho 2004 BMI (kg/m2)1 Woman’s HIV status Mean BMI 18.5- 24.9 (normal) <18.5 (thin) 17.0- 18.4 (mildly thin) 16.0- 16.9 (moderately thin) <16.0 (severely thin) ≥25.0 (over- weight or obese) 25.0- 29.9 (over- weight) ≥30.0 (obese) Number of women HIV positive 24.7 53.6 5.5 3.6 1.4 0.5 40.8 27.4 13.4 706 HIV negative 25.0 53.7 5.9 4.1 1.1 0.7 40.5 24.3 16.1 1,986 Total 25.1 52.0 5.7 3.9 1.1 0.7 42.3 26.2 16.1 3,144 Note: “HIV positive” refers to HIV-1 only. 1 Excludes pregnant women and women with a birth in the past 2 months Table 12.13 presents women’s anaemia level according to their HIV status. Women infected with the HIV virus are more likely to be anaemic than women who are not infected (33 and 22 percent, respectively). The degree of anaemia varies somewhat with the woman’s HIV status: 11 percent of HIV- positive women are moderately or severely anaemic compared with 6 percent of HIV-negative women. Although the type or cause of anaemia was not investigated in the 2004 LDHS, this relationship between any anaemia and HIV status is consistent with that between anaemia resulting from chronic disease and HIV status. Table 12.13 Prevalence of anaemia in women by HIV status Percentage of women age 15-49 with anaemia, by HIV status, Lesotho 2004 Anaemia status1 Woman’s HIV status Any anaemia Mild anaemia Moderate anaemia Severe anaemia Number of women HIV positive 32.6 21.9 9.4 1.2 680 HIV negative 21.8 15.6 5.4 0.8 1,919 Total 24.8 17.4 6.5 0.9 2,703 Note: Table is based on women who stayed in the household the night before the interview. Anaemia prevalence is adjusted for altitude and for smoking status, if known, using CDC formulas (CDC, 1989). Women with <7.0 g/dl of haemoglobin have severe anaemia, women with 7.0-9.9 g/dl have moderate anaemia, and pregnant women with 10.0-10.9 g/dl and nonpregnant women with 10.0-11.9 g/dl have mild anaemia. “HIV positive” refers to HIV-1 only. 1 For women who are not interviewed, information is taken from the Household Questionnaire 246 | HIV Prevalence and Associated Factors 12.2.9 HIV Prevalence and Fertility HIV infection is assumed to have an inhibiting effect on a woman’s fertility. Table 12.14 shows age-specific fertility rates and the total fertility rate according to the women’s HIV status. The total fertility rate among HIV-negative women is 3.9 births per woman, 26 percent higher than the rate of 3.1 births among HIV-positive women. Looking at urban-rural residence, rural HIV-positive women have a markedly lower TFR than rural HIV-negative women (3.5 compared with 4.5 births). On the other hand, HIV-positive women living in urban areas have a somewhat higher TFR than urban HIV-negative women (2.2 compared with 2.0 births). Considering the age-specific patterns, fertility is higher among HIV- negative women in all but the youngest and oldest age groups. Table 12.14 Fertility and HIV status Age-specific fertility rates and the total fertility rate (TFR), by urban-rural residence and HIV status, Lesotho 2004 HIV status HIV positive HIV negative Total Age group Urban Rural Total Urban Rural Total Urban Rural Total 15-19 99 101 100 43 112 99 52 111 99 20-24 117 147 137 105 232 202 109 209 182 25-29 123 169 152 96 210 179 109 195 168 30-34 26 126 95 32 157 125 29 145 113 35-39 55 79 72 61 124 108 59 107 94 40-44 22 35 32 59 57 57 50 51 51 45-49 0 36 29 0 15 12 0 18 15 TFR1 2.2 3.5 3.1 2.0 4.5 3.9 2.0 4.2 3.6 Note: “HIV positive” refers to HIV-1 only. Rates for age group 45-49 may be slightly biased because of truncation. 1 TFR: Total fertility rate for ages 15-49, expressed per woman 12.2.10 HIV Prevalence and Child Mortality Table 12.15 shows early childhood mortality rates by mother’s HIV status. Except for neonatal mortality, children of mothers who are HIV positive have higher early childhood mortality rates com- pared with children born to mothers who are HIV negative. For example, child mortality is more than twice as high for children who are born to urban mothers who are HIV positive as children born to urban mothers who are HIV negative. Also, postneonatal mortality for children of rural HIV-positive women is almost twice as high (57 per 1,000) as children of rural women who are HIV negative (29 per 1,000). Table 12.15 Early childhood mortality rates by mother's current HIV status Neonatal, postneonatal, infant, child, and under-five mortality rates for the 10-year period preceding the survey, by urban-rural residence and mother’s current HIV status, Lesotho 2004 Background characteristic Neonatal mortality (NN) Postneonatal mortality (PNN)1 Infant mortality (1q0) Child mortality (4q 1) Under-five mortality (5q0) Urban 23 37 60 34 92 HIV-positive mother 21 41 62 49 108 HIV-negative mother 25 34 59 23 80 Rural 51 36 88 20 106 HIV-positive mother 40 57 97 27 121 HIV-negative mother 55 29 84 18 100 Note: “HIV positive” refers to HIV-1 only. 1 Computed as the difference between the infant and neonatal mortality rates HIV Prevalence and Associated Factors | 247 12.3 DISTRIBUTION OF THE HIV BURDEN IN LESOTHO An accurate estimation of HIV prevalence is necessary to assess the scope of the AIDS epidemic in Lesotho and to track trends over time. Sentinel surveillance data from ANC clinics and from individuals seeking medical treatment for STIs and other established HIV-associated conditions such as tuberculosis, have been the principal source of information on HIV prevalence in Lesotho. With the inclusion of HIV testing in the 2004 LDHS, Lesotho has joined several other countries in sub-Saharan Africa in expanding the tools employed in monitoring the scope of the AIDS epidemic to include a nationally representative population-based survey. Ideally, the seroprevalence data from the LDHS survey will be examined and used to create a more accurate set of assumptions to use in estimating prevalence rates from future sentinel surveillance data. Indeed, UNAIDS and WHO suggest that popula- tion-based surveys “should definitely be used to calibrate the results of routine surveillance systems” (WHO and UNAIDS, 2000). The availability of population-based seroprevalence data from the 2004 LDHS enhances the body of information available on the HIV/AIDS epidemic in Lesotho. Tuberculosis | 249 TUBERCULOSIS 13 Dr. Davis Rumisha This chapter examines awareness factors that influence seeking treatment for tuberculosis and stigma as well as the prevalence of tuberculosis (TB) in Lesotho. The 2004 LDHS asked the same set of questions about TB to both female and male respondents. Hence, comparisons between women and men are possible. There are four sections in this chapter. Section 13.1 addresses the status of TB in Lesotho and worldwide, and discusses the medical aspects of the disease. Section 13.2 examines the level of awareness of women and men of TB itself, its signs and symptoms, cause, mode of transmission, and treatment. Section 13.3 deals with self-reported diagnosis, symptoms, and treatment, and Section 13.4 focuses on stigma issues. 13.1 BACKGROUND ON TUBERCULOSIS Tuberculosis is one of the ten leading causes of morbidity and mortality in Lesotho, and is a major health problem. TB is primarily caused by bacteria (Mycobacterium tuberculosis). The majority of cases are pulmonary, but in about 20 percent of cases, the bacteria disseminate to other areas of the body and are classified as extrapulmonary TB (Shafer et al., 1996) nonpulmonary TB. Transmission is mainly airborne, through the inhalation of bacteria-carrying droplets produced by individuals with active pulmonary TB. Among people directly exposed to TB, only about 30 percent will actually become infected. In the general population, only about 5 percent of infected persons will develop active primary TB within two years. This activation rate is much higher for both the very young and very old, and for persons with a suppressed immune system (because of HIV infection or other causes). The activation rate is about 40 percent for persons with HIV, thus making TB diagnosis and treatment an important part of health care for HIV-infected individuals. In Lesotho, a TB suspect is any person with a history of cough for two or more weeks. Other symptoms of active primary TB include persistent cough, chest pain, coughing up blood or sputum, fatigue, weight loss, loss of appetite, chills, fever, and nighttime sweating. In persons who are infected but do not show symptoms of TB, the immune system is able to destroy or “wall off” the TB bacteria. These enclosed bacteria can remain dormant for many years and be reactivated. Risk factors for reactivation include old age, immunosuppression, diabetes, kidney insuf- ficiency, and malnutrition. The reactivation rate is about 5 percent in the general population. Worldwide, two-thirds of untreated smear positive cases will die within five to eight years, the majority within the first two years (Stybo, 1999). The case fatality rate for untreated smear positive TB is about 10 to 15 per- cent (Rieder, 1999). Case fatality rate for smear-positive TB patients can exceed 10 percent if adherence is low, in cases of HIV co-infection, or in areas with high anti TB drugs resistance (WHO, 2002). 13.2 RESPONDENTS’ KNOWLEDGE OF TUBERCULOSIS Table 13.1 presents the level of women’s and men’s awareness of TB and the fact that it can be cured, according to age, marital status, residence, ecological zone, district, education, and wealth quintile. The majority of the women and men surveyed (93 percent of women and 89 percent of men) have heard of TB. The proportion of respondents who believe that TB can be cured is somewhat lower: 78 percent for women and 67 percent for men. 250 | Tuberculosis Table 13.1 Knowledge of tuberculosis Percentage of women and men who have heard of tuberculosis and who believe that tuberculosis can be cured, by background characteristics, Lesotho 2004 Women Men Background characteristic Has heard of TB Believes TB can be cured Number of women Has heard of TB Believes TB can be cured Number of men Age 15-19 90.4 65.4 1,710 86.0 57.0 743 20-24 92.3 77.1 1,463 92.1 63.4 507 25-29 94.3 83.2 1,044 91.6 70.4 374 30-34 93.5 81.6 816 89.9 72.9 305 35-39 94.3 88.2 728 90.4 75.3 233 40-44 95.2 84.5 741 84.4 71.3 164 45-49 95.2 85.7 592 91.1 74.0 170 50-54 na na na 83.6 68.3 164 55-59 na na na 87.2 76.4 137 Marital status Never married 93.4 74.6 2,373 87.9 62.4 1,419 Married or living together 92.6 80.1 3,709 89.8 71.1 1,191 Divorced/separated/ widowed 93.7 80.8 1,014 88.5 70.8 184 Residence Urban 97.6 92.1 1,682 93.2 83.8 603 Rural 91.6 74.1 5,413 87.6 62.0 2,194 Ecological zone Lowlands 96.0 86.8 4,299 90.4 74.9 1,734 Foothills 90.2 70.4 787 85.5 60.5 307 Mountains 86.0 59.0 1,572 84.8 44.8 585 Senqu River Valley 93.8 78.6 437 92.4 69.4 171 District Butha-Buthe 95.7 76.1 458 89.6 64.9 182 Leribe 94.6 80.6 1,065 91.5 75.1 393 Berea 96.3 81.1 776 89.8 65.0 350 Maseru 94.9 87.1 1,868 90.9 76.2 741 Mafeteng 91.1 81.8 755 84.0 65.4 297 Mohale's Hoek 90.1 76.2 684 85.7 63.1 281 Quthing 94.0 75.5 461 93.1 65.1 167 Qacha’s Nek 85.1 64.1 233 80.4 50.5 99 Mokhotlong 92.0 50.0 360 93.9 42.8 130 Thaba-Tseka 84.5 63.9 435 80.0 47.1 156 Education No education 80.9 53.7 145 84.0 49.7 479 Primary, incomplete 87.9 64.6 2,136 85.6 59.2 1,194 Primary, complete 93.8 80.5 1,960 92.8 78.3 352 Secondary+ 97.0 88.5 2,854 94.9 83.5 773 Wealth quintile Lowest 85.0 55.4 987 83.2 42.1 466 Second 89.1 67.1 1,294 87.2 58.5 514 Middle 92.4 78.5 1,258 88.3 67.1 566 Fourth 95.8 86.3 1,595 90.5 75.6 621 Highest 97.9 90.8 1,962 93.0 82.5 630 Total 93.0 78.3 7,095 88.8 66.7 2,797 na = Not applicable Tuberculosis | 251 The level of awareness of TB does not vary much by age or marital status. Looking at residence, rural women (92 percent) and men (88 percent) have a lower level of knowledge about TB than their urban counterparts (98 percent for women and 93 percent for men). TB knowledge does not vary significantly by ecological zone or district. However, the level of knowledge increases with education and wealth quintile for both sexes. Those with no education are least likely to have heard of TB (81 percent among women and 84 percent among men), and those with some secondary or higher education are the most likely (97 percent for women and 95 percent for men). Similarly, the poorest respondents are least likely to have heard of TB (85 percent among women and 83 percent among men), and those in the highest wealth quintile are the most likely (98 percent for women and 93 percent for men). The percentages believing that TB can be cured increase with age for both women and men. Looking at marital status, respondents who were never married have the lowest level of awareness that TB can be cured compared with other groups (75 percent for women and 62 percent for men). The Mountains zone has the lowest level of respondents who believe TB can be cured (59 percent for women and 45 percent for men), while the Lowlands have the highest (87 percent for women and 75 percent for men). The proportion of respondents who believe that TB can be cured ranges from 50 percent of women and 43 percent of men in Mokhotlong to 87 percent of women and 76 percent of men in Maseru. Again, the level of awareness about the fact that TB can be cured rises sig- nificantly with the level of education and wealth quintile. For example, it ranges from 54 percent among women with no education to 89 percent among those with at least some secondary education, and from 50 percent among men with no education to 84 percent among those with at least some secondary education. The signs and symptoms of TB most commonly reported by women and men (Table 13.2) are coughing for several weeks (51 percent for women and 45 percent for men), weight loss (44 percent for women and 39 percent for men), coughing (28 percent for women and 25 percent for men), night sweating (25 percent for women and 14 percent for men), and loss of appetite (20 percent for women and 13 percent for men). It is worrisome that 16 percent of women and 23 percent of men do not know any of the TB-related symptoms. Table 13.3 shows that the reported top- ranking causes of TB are dust or pollution (35 per- cent among women and 50 percent among men), smoking (21 percent among women and 30 percent among men), and exposure to cold temperatures (15 percent among women and 12 percent among men). It must be noted that the microbes, germs, or bacteria—the real cause of TB—are only cited by 7 percent each of women and men. It is also prob- lematic that 41 percent of women and 29 percent of men do not cite any cause for tuberculosis. Table 13.2 Knowledge of specific symptoms of tuberculosis Among women and men who have heard of tuberculosis, percentage who cite specific symptoms of TB, Lesotho 2004 Symptom of TB Women Men Total Coughing 28.0 24.5 27.1 Coughing with sputum 10.0 9.9 10.0 Coughing for several weeks 51.2 45.3 49.6 Fever 4.5 3.1 4.1 Blood in sputum 11.0 9.8 10.6 Loss of appetite 19.8 13.1 18.0 Night sweating 24.5 13.5 21.5 Pain in chest or back 12.5 10.9 12.1 Tiredness/fatigue 8.2 8.0 8.1 Weight loss 43.8 39.1 42.5 Other 4.1 3.6 4.0 Does not know 16.0 22.9 17.9 No symptoms 0.0 0.2 0.1 Number of respondents 6,601 2,484 9,084 Table 13.3 Knowledge of the cause of tuberculosis Among women and men who have heard of tuberculosis, percentage who cite specific causes of TB, Lesotho 2004 Cause of TB Women Men Total Microbes/germs/bacteria 6.5 6.6 6.6 Inherited 3.1 2.5 3.0 Lifestyle 1.8 1.6 1.7 Smoking 21.1 29.5 23.4 Alcohol drinking 12.5 12.1 12.4 Exposure to cold temperatures 14.7 12.1 14.0 Dust/pollution 34.7 49.8 38.8 Other 1.7 1.2 1.6 Does not know 41.4 29.3 38.1 Number of respondents 6,601 2,484 9,084 252 | Tuberculosis Tables 13.4 1 and 13.4.2 show the percentage of women and men who have heard of TB and who cite specific causes for the infection by background characteristics. Special attention in this analysis is paid to the differentials in the knowledge that TB is caused by microbes, germs, or bacteria. It is clear that both urban women (12 percent) and men (15 percent) are more aware than rural women (5 percent) and men (4 percent) that TB is caused by microorganisms. Among districts, Butha-Buthe and Maseru have the highest proportion of women (12 and 9 percent, respectively) and men (11 percent for each district) who know that TB is caused by microbes, germs, or bacteria. Mokhotlong and Thaba-Tseka (2 percent each) Table 13.4.1 Knowledge of TB causes and transmission modes by background characteristics: women Among women who have heard of tuberculosis, percentage who cite specific causes of TB, by background characteristics, Lesotho 2004 Causes Background characteristic Microbes/ germs/ bacteria Inherited Lifestyle Smoking Alcohol drinking Exposure to cold tempera- tures Dust/ pollution Other Don’t know Total Age 15-19 5.6 1.8 1.7 22.7 12.0 13.0 29.5 1.1 43.9 1,546 20-24 5.5 1.3 2.3 22.7 11.6 13.8 35.5 1.1 42.2 1,351 25-29 7.9 4.0 1.5 22.9 14.8 13.5 39.1 0.7 40.1 984 30-34 7.7 3.6 1.5 19.5 13.5 15.4 35.7 1.9 40.3 763 35-39 7.3 5.2 1.5 21.6 12.6 17.6 39.9 3.0 37.5 687 40-44 5.9 4.7 2.1 17.7 13.0 15.8 32.6 2.7 41.6 705 45-49 7.5 4.4 1.9 15.7 10.0 17.8 34.3 3.2 40.8 564 Marital status Never married 8.2 2.9 2.1 24.6 13.0 14.7 33.1 0.9 40.6 2,217 Married or living together 5.6 3.2 1.7 19.4 12.0 13.8 35.6 1.8 42.7 3,435 Divorced/separated/ widowed 6.2 3.2 1.4 19.2 13.0 17.9 35.0 3.3 38.7 950 Residence Urban 12.4 6.4 2.8 23.7 15.2 19.0 42.6 1.4 32.4 1,642 Rural 4.6 2.0 1.5 20.2 11.6 13.3 32.1 1.8 44.4 4,959 Ecological zone Lowlands 7.7 4.1 2.1 21.4 13.5 16.9 36.1 1.9 39.3 4,129 Foothills 5.2 3.1 1.6 19.5 9.8 13.8 31.8 1.3 45.3 710 Mountains 3.6 0.6 0.8 19.8 9.8 7.6 33.0 1.7 45.7 1,352 Senqu River Valley 7.3 1.2 2.9 25.2 16.2 17.5 31.2 0.6 41.4 410 District Butha-Buthe 12.0 3.9 3.1 20.2 9.3 9.1 39.9 0.9 35.4 438 Leribe 7.7 3.7 2.1 18.0 8.9 10.4 40.8 1.3 42.3 1,008 Berea 4.1 4.5 2.4 19.3 11.4 10.7 27.0 1.1 52.4 748 Maseru 9.3 4.4 1.4 24.9 16.2 23.3 39.8 2.0 32.8 1,773 Mafeteng 4.2 3.0 1.5 20.3 15.4 17.3 29.7 2.4 42.2 688 Mohale's Hoek 4.1 1.7 2.5 16.1 8.5 12.9 27.0 2.2 48.0 616 Quthing 7.5 1.3 2.3 24.5 16.3 17.0 31.5 0.2 43.5 433 Qacha’s Nek 2.6 0.8 0.2 20.2 10.6 7.9 17.3 1.5 54.3 198 Mokhotlong 2.3 0.4 0.8 26.7 11.4 5.2 37.3 0.2 43.6 331 Thaba-Tseka 2.2 0.0 0.6 17.4 9.4 7.6 35.5 4.7 40.8 368 Education No education 1.5 1.4 0.0 14.8 12.9 7.9 21.5 1.9 56.3 118 Primary, incomplete 2.8 1.4 1.0 16.8 10.3 11.6 28.7 2.4 49.7 1,877 Primary, complete 3.4 2.7 2.0 20.9 12.4 13.8 34.1 1.2 44.6 1,839 Secondary+ 11.4 4.6 2.3 24.4 14.1 17.7 39.7 1.5 33.0 2,767 Wealth quintile Lowest 2.0 0.2 1.3 18.9 9.4 7.4 30.1 2.0 50.8 839 Second 2.5 1.2 0.7 18.6 10.7 11.1 31.0 1.0 47.1 1,153 Middle 4.4 2.7 1.7 20.8 11.9 12.3 31.7 1.7 44.2 1,162 Fourth 6.2 2.7 2.6 20.6 12.3 17.9 34.1 1.8 41.3 1,528 Highest 12.6 6.1 2.2 24.2 15.5 19.0 41.2 1.9 32.2 1,920 Total 6.5 3.1 1.8 21.1 12.5 14.7 34.7 1.7 41.4 6,601 Tuberculosis | 253 have the lowest proportion of women who know cite bacteria as the cause of TB, while Mafeteng and Mohale’s Hoek (1 percent each) have the lowest proportion of men. Women and men with lower levels of education are less aware that TB is caused by bacteria than women and men with at least some secondary education. For example, for women the level of awareness ranges from 2 percent among the uneducated women to 11 percent among those with secondary or higher education. For both women and men, the level of knowledge of the correct cause of TB also increases with wealth quintile. For example, it ranges from 2 percent among men in the lowest quintile to 14 percent among those in the highest. Table 13.4.2 Knowledge of TB causes and transmission modes by background characteristics: men Among men who have heard of tuberculosis, percentage who cite specific causes of TB, by background characteristics, Lesotho 2004 Causes Background characteristic Microbes/ germs/ bacteria Inherited Lifestyle Smoking Alcohol drinking Exposure to cold tempera- tures Dust/ pollution Other Don’t know Total Age 15-19 6.5 1.7 0.6 29.3 10.8 11.5 38.8 0.5 37.1 640 20-24 3.5 3.0 1.8 32.4 14.9 13.6 45.7 1.7 30.9 467 25-29 9.6 2.5 1.5 35.5 14.1 10.0 46.3 1.2 30.2 343 30-34 3.1 2.7 0.4 29.5 14.2 15.5 56.4 1.3 27.5 274 35-39 8.7 2.1 0.6 30.3 9.8 9.8 62.1 0.5 22.0 210 40-44 5.2 2.9 3.9 25.0 12.4 8.9 56.6 2.7 24.2 138 45-49 13.9 5.3 5.1 22.2 10.6 16.7 54.9 0.9 23.7 155 50-54 5.4 3.2 1.9 19.2 6.4 9.6 62.7 1.8 20.8 137 55-59 8.8 0.8 2.2 26.2 10.0 11.9 67.6 1.3 18.0 119 Marital status Never married 6.1 2.9 0.8 30.7 13.0 12.5 43.1 1.0 33.3 1,248 Married or living together 7.8 2.2 2.3 27.9 11.3 11.4 56.0 1.3 25.3 1,070 Divorced/separated/ widowed 2.7 2.3 2.2 30.6 11.3 13.3 59.5 0.8 24.3 163 Residence Urban 14.6 3.8 2.0 38.1 19.4 18.9 47.1 1.1 20.5 562 Rural 4.3 2.2 1.4 26.9 10.0 10.1 50.5 1.2 31.9 1,922 Ecological zone Lowlands 7.5 3.3 1.9 29.1 13.5 14.1 49.6 1.3 27.8 1,567 Foothills 6.3 1.4 1.4 25.2 7.2 7.6 53.0 0.9 32.5 263 Mountains 3.6 0.8 0.4 31.1 8.1 6.4 49.1 1.2 31.7 496 Senqu River Valley 7.6 2.1 2.3 35.5 18.8 17.2 47.7 0.5 30.8 158 District Butha-Buthe 10.7 3.3 1.3 28.2 5.8 6.3 64.3 0.5 20.4 163 Leribe 8.9 3.4 2.8 22.9 9.2 9.8 59.6 1.2 25.8 360 Berea 3.2 3.4 2.1 22.9 10.4 9.1 40.2 1.6 42.9 314 Maseru 11.0 2.4 0.7 35.1 16.0 18.5 50.9 1.3 20.2 674 Mafeteng 1.4 0.8 2.9 29.3 13.7 10.9 44.0 1.8 33.7 250 Mohale's Hoek 1.2 4.3 0.9 24.4 11.1 9.9 40.5 1.2 41.3 241 Quthing 7.4 2.9 3.5 38.9 21.5 20.1 50.1 0.0 30.1 155 Qacha’s Nek 5.9 0.5 0.0 25.2 12.9 7.9 33.6 0.5 39.6 80 Mokhotlong 3.7 0.7 0.1 38.5 6.0 5.2 55.8 0.0 27.5 122 Thaba-Tseka 2.6 0.0 0.0 28.4 4.5 5.5 53.8 1.8 28.1 125 Education No education 4.4 1.7 1.6 22.2 6.4 6.0 49.5 2.5 34.5 402 Primary, incomplete 2.4 1.8 1.4 26.9 11.4 10.7 46.8 0.6 35.2 1,022 Primary, complete 4.3 3.0 0.5 31.9 16.1 14.6 47.6 0.9 29.4 327 Secondary+ 14.7 3.8 2.2 35.9 14.6 16.2 55.1 1.4 18.1 733 Wealth quintile Lowest 1.7 1.9 1.1 25.8 7.9 6.4 46.8 1.4 37.6 388 Second 1.6 1.9 2.1 27.3 8.1 8.1 50.0 0.7 33.4 449 Middle 4.7 2.3 1.4 27.7 12.0 11.0 48.0 1.4 32.0 499 Fourth 7.6 1.7 0.7 25.5 13.6 14.5 50.6 1.3 28.8 562 Highest 14.4 4.4 2.5 38.8 16.7 17.5 52.2 1.0 18.9 586 Total 6.6 2.5 1.6 29.5 12.1 12.1 49.8 1.2 29.3 2,484 254 | Tuberculosis 13.3 SELF-REPORTED DIAGNOSIS, SYMPTOMS, AND TREATMENT In the 2004 LDHS, respondents were asked if they ever had any of the TB-related symptoms since age 15. Those who reported such symptoms were further asked whether they had seen a health provider for care and treatment and whether they were told they had TB by a health provider the first time they went for a consultation. The results are shown in this section. Tables 13.5.1 and 13.5.2 and Figure 13.1 show the percentage of respondents who had symptoms of TB since age 15. Seventeen percent of women report having had chest or back pain, 15 percent report having had night sweating, and 14 percent report having had cough for more than two weeks since age 15. Among men, 19 percent report having night sweating, 17 percent report having had chest or back pain, and an equal proportion report having had a cough for two or more weeks. Fifteen percent of men report having had fever for two or more weeks. For both women and men, the experience of TB symptoms is inversely associated with education and the wealth quintile. Furthermore, respondents who sought treat- ment 2 to 11 months after the onset of symptoms generally represent the group with the highest propor- tion of such symptoms. Not all respondents with these symptoms are necessarily infected with TB because many other conditions result in similar symptoms. Tuberculosis | 255 Table 13.5.1 Experience of symptoms of tuberculosis: women Percentage of women who have had symptoms of tuberculosis since age 15, by background characteristics, Lesotho 2004 Background characteristic Cough for 2 weeks or more Fever for 2 weeks or more Chest or back pain Blood in sputum Night sweating Number of women Age 15-19 11.4 6.7 11.6 1.9 11.1 1,710 20-24 12.9 10.4 17.3 3.1 13.0 1,463 25-29 13.1 11.1 16.7 3.6 17.4 1,044 30-34 16.3 13.3 21.8 6.3 14.9 816 35-39 14.9 13.7 18.8 5.4 15.9 728 40-44 16.3 14.3 22.3 7.1 20.0 741 45-49 16.0 16.1 21.8 5.3 20.2 592 Marital status Never married 11.2 6.7 12.9 2.5 10.9 2,373 Married or living together 13.5 12.1 18.3 4.0 15.7 3,709 Divorced/separated/ widowed 20.9 18.0 24.8 8.0 22.3 1,014 Residence Urban 11.0 9.3 13.8 3.3 13.5 1,682 Rural 14.6 11.7 18.5 4.3 15.5 5,413 Ecological zone Lowlands 12.9 10.6 16.9 3.6 15.2 4,299 Foothills 13.8 12.0 19.3 4.4 13.8 787 Mountains 16.2 12.6 17.9 5.5 15.6 1,572 Senqu River Valley 13.8 10.0 17.3 4.0 13.2 437 District Butha-Buthe 9.6 6.7 12.3 3.8 7.4 458 Leribe 11.8 8.9 16.9 4.2 10.9 1,065 Berea 14.7 11.1 15.1 5.3 13.0 776 Maseru 13.7 12.0 20.7 3.3 19.6 1,868 Mafeteng 11.5 8.6 14.7 2.5 11.6 755 Mohale's Hoek 19.5 17.6 21.3 5.0 23.0 684 Quthing 14.1 9.5 15.6 3.6 12.6 461 Qacha’s Nek 18.5 15.1 18.3 4.8 16.4 233 Mokhotlong 10.2 4.4 6.6 2.3 3.4 360 Thaba-Tseka 16.6 17.5 22.5 8.5 22.2 435 Education No education 24.1 18.0 27.7 11.5 23.5 145 Primary, incomplete 17.5 15.3 21.3 6.2 20.2 2,136 Primary, complete 13.4 11.7 18.9 3.4 15.6 1,960 Secondary+ 10.7 7.4 12.9 2.6 10.3 2,854 How soon after symptoms was treatment sought 0-7 days 52.1 43.6 68.8 16.4 54.5 708 2-4 weeks 74.8 59.1 71.9 19.9 61.3 311 2-11 months 69.6 63.1 88.4 33.8 74.0 59 1 or more years 5.6 4.4 7.8 1.5 7.4 6,017 Wealth quintile Lowest 18.5 15.6 22.9 5.8 19.7 987 Second 16.8 13.9 20.6 5.5 17.0 1,294 Middle 15.2 12.1 18.5 4.3 15.8 1,258 Fourth 12.4 9.2 15.7 2.6 13.9 1,595 Highest 9.6 8.2 13.2 3.4 11.7 1,962 Total 13.8 11.2 17.4 4.1 15.0 7,095 256 | Tuberculosis Table 13.5.2 Experience of symptoms of tuberculosis: men Percentage of men who have had symptoms of tuberculosis since age 15, by background characteristics, Lesotho 2004 Background characteristic Cough for 2 weeks or more Fever for 2 weeks or more Chest or back pain Blood in sputum Night sweating Number of men Age 15-19 12.4 10.1 11.5 2.8 13.3 743 20-24 14.3 8.6 14.3 4.0 14.9 507 25-29 16.4 14.3 15.6 3.2 19.2 374 30-34 19.6 20.0 18.9 7.9 24.5 305 35-39 13.7 14.0 17.1 6.8 20.7 233 40-44 17.7 20.6 30.0 7.2 26.9 164 45-49 21.1 19.3 22.9 9.0 19.1 170 50-54 27.2 27.8 30.3 16.8 35.2 164 55-59 30.1 26.5 25.3 13.2 22.9 137 Marital status Never married 13.7 10.8 12.3 3.8 15.6 1,419 Married or living together 19.0 18.6 21.6 8.2 21.7 1,191 Divorced/separated/ widowed 25.7 21.3 28.6 7.7 29.8 184 Residence Urban 14.8 12.1 14.4 4.3 17.6 603 Rural 17.3 15.6 18.2 6.4 19.5 2,194 Ecological zone Lowlands 15.8 14.5 16.0 5.2 19.3 1,734 Foothills 19.5 15.9 19.1 8.1 17.9 307 Mountains 18.2 16.1 20.3 7.1 20.7 585 Senqu River Valley 16.3 11.9 18.0 5.5 14.1 171 District Butha-Buthe 11.7 10.5 12.9 6.8 10.7 182 Leribe 14.3 13.9 14.7 6.8 14.8 393 Berea 17.1 17.5 14.4 4.7 16.1 350 Maseru 18.0 15.5 19.1 5.4 24.9 741 Mafeteng 14.2 8.2 12.3 5.5 12.3 297 Mohale's Hoek 20.8 19.9 27.3 6.4 27.7 281 Quthing 16.5 12.4 17.9 4.9 14.6 167 Qacha's Nek 23.1 19.6 22.4 9.8 20.4 99 Mokhotlong 11.6 4.4 5.6 4.2 5.1 130 Thaba-Tseka 20.2 24.7 25.8 7.9 32.6 156 Education No education 21.9 20.8 22.6 9.9 22.9 479 Primary, incomplete 20.1 17.0 19.1 6.8 21.1 1,194 Primary, complete 14.3 13.8 16.3 5.1 17.6 352 Secondary+ 9.6 8.2 11.9 2.5 14.5 773 How soon after symptoms was treatment sought 0-7 days 63.7 57.1 71.8 22.8 69.8 264 2-4 weeks 81.3 71.2 78.8 36.0 72.7 106 2-11 months (89.2) (66.2) (94.5) (61.8) (75.4) 29 1 or more years 7.9 7.1 7.8 2.1 10.5 2,399 Wealth quintile Lowest 23.9 20.2 24.6 10.5 23.4 466 Second 19.0 18.3 19.5 6.6 21.4 514 Middle 15.5 14.3 18.7 6.8 20.0 566 Fourth 16.1 12.9 15.2 4.0 16.9 621 Highest 11.4 10.4 11.3 3.1 15.4 630 Total 16.8 14.8 17.4 5.9 19.1 2,797 Note: Figures in parentheses are based on 25-49 unweighted cases. Tuberculosis | 257 14 11 17 4 15 17 15 17 6 19 Cough for 2 weeks or more Fever for 2 weeks or more Chest or back pain Blood in sputum Night sweating 0 5 10 15 20 25 Women Men Figure 13.1 Percentage of Women and Men Who Had Symptoms of Tuberculosis Since Age 15 LDHS 2004 Tables 13.6.1 and 13.6.2 show that 61 percent of women and 55 percent of men who have had a symptom of TB since age 15 sought consultation or treatment for the symptom(s). The percentage seeking consultation or treatment for both sexes is lowest for those who have never been married and it increases with age, education, and wealth quintile. Urban residents are more likely to seek consultation or treatment (69 percent of women and 63 percent of men) than their rural counterparts (59 percent of women and 53 percent of men). Among women, Mohale’s Hoek shows the highest percentage (71 percent) seeking treatment and Mokhotlong (38 percent) the lowest. Among men, Butha-Buthe has the highest proportion (68 percent), while Mokhotlong has the lowest (35 percent). Women and men who are either currently working or who have worked sometime in the past year are more likely than those who have not worked in more than 12 months to seek consultation or treatment. Among women and men, the most commonly reported reason for not seeking care or treatment for TB symptoms is that symptoms were harmless (17 percent for women and 27 percent for men) and cost (18 percent of women and 13 percent of men). 258 | Tuberculosis Table 13.6.1 Reasons for not seeking treatment for symptoms of tuberculosis: women Percentage of women who have had symptoms of tuberculosis since age 15, by whether they sought treatment for the symptoms and by reason for not seeking treatment, according to background characteristics, Lesotho 2004 Reason for not seeking consultation/treatment Background characteristic Percentage who sought consultation or treatment Symptoms harmless Cost Distance Embarrassed Self medi- cation Don’t know/ other Total Number of women Age 15-19 50.1 24.4 22.5 0.0 0.6 0.2 2.2 100.0 347 20-24 58.5 19.2 16.9 2.2 0.1 0.1 2.4 100.0 357 25-29 63.0 18.8 13.1 0.3 0.0 0.6 3.6 100.0 267 30-34 66.3 16.6 13.4 0.7 1.9 0.0 1.2 100.0 231 35-39 76.0 7.8 14.7 0.9 0.0 0.0 0.6 100.0 187 40-44 63.0 13.4 20.4 0.9 0.6 0.0 1.7 100.0 228 45-49 60.6 13.7 21.1 1.7 0.0 0.4 2.5 100.0 180 Marital status Never married 56.5 24.3 16.9 0.2 0.4 0.0 1.1 100.0 496 Married or living together 62.3 15.5 17.6 1.5 0.2 0.3 2.5 100.0 958 Divorced/separated/ widowed 64.6 12.2 18.5 0.5 1.3 0.3 2.3 100.0 344 Residence Urban 68.8 20.7 6.6 0.5 1.4 0.3 1.2 100.0 354 Rural 59.3 16.5 20.3 1.1 0.2 0.2 2.3 100.0 1,443 Ecological zone Lowlands 64.0 16.1 16.0 0.5 0.8 0.1 2.2 100.0 1,047 Foothills 55.6 19.6 21.3 1.2 0.0 0.4 1.8 100.0 209 Mountains 58.2 15.1 21.6 2.3 0.0 0.4 2.5 100.0 427 Senqu River Valley 56.2 32.8 10.3 0.0 0.0 0.0 0.8 100.0 114 District Butha-Buthe 65.5 20.0 12.4 0.0 0.6 0.3 1.3 100.0 76 Leribe 65.7 16.3 16.2 0.4 0.0 0.7 0.7 100.0 250 Berea 60.3 10.5 22.0 1.0 0.0 0.0 6.2 100.0 168 Maseru 57.4 22.3 15.6 0.9 1.2 0.0 2.2 100.0 553 Mafeteng 66.4 9.9 17.6 0.9 0.9 0.0 3.1 100.0 158 Mohale's Hoek 70.8 8.9 17.9 1.1 0.0 0.4 1.0 100.0 223 Quthing 55.7 34.1 9.5 0.7 0.0 0.0 0.0 100.0 116 Qacha’s Nek 63.2 17.9 13.3 2.6 0.0 0.0 3.0 100.0 64 Mokhotlong 37.6 20.1 40.3 0.0 0.0 1.9 0.0 100.0 42 Thaba-Tseka 55.8 13.3 26.6 2.2 0.0 0.0 2.2 100.0 146 Education No education 57.3 11.8 24.6 3.8 0.0 2.5 0.0 100.0 49 Primary, incomplete 55.5 16.3 24.0 1.2 0.0 0.3 2.7 100.0 667 Primary, complete 63.0 14.8 17.5 0.6 0.5 0.1 3.1 100.0 497 Secondary+ 66.4 21.1 9.8 0.7 1.0 0.0 0.8 100.0 584 Employment status Currently working 65.5 15.8 16.0 0.6 0.2 0.1 1.8 100.0 722 Currently not working but worked in past 12 months 69.0 14.4 10.0 1.2 1.3 0.5 2.7 100.0 164 Haven't worked in more than 12 months 56.3 19.1 20.2 1.2 0.5 0.2 2.2 100.0 911 Wealth quintile Lowest 54.8 14.1 25.2 3.0 0.0 0.7 2.2 100.0 325 Second 55.3 17.7 25.0 0.0 0.0 0.1 1.9 100.0 372 Middle 60.9 15.7 17.2 1.0 0.8 0.0 4.4 100.0 327 Fourth 66.2 16.9 14.5 0.6 0.0 0.0 1.4 100.0 382 Highest 67.2 21.6 7.6 0.4 1.5 0.2 1.0 100.0 392 Total 61.1 17.3 17.6 0.9 0.5 0.2 2.1 100.0 1,798 Tuberculosis | 259 Table 13.6.2 Reasons for not seeking treatment for symptoms of tuberculosis: men Percentage of men who have had symptoms of tuberculosis since age 15, by whether they sought treatment for the symptoms and by reason for not seeking treatment, according to background characteristics, Lesotho 2004 Reason for not seeking consultation/treatment Background characteristic Percentage who sought consultation or treatment Symptoms harmless Cost Distance Embarrassed Don’t know/ other Total Number of men Age 15-19 31.5 46.7 14.9 0.0 1.5 5.3 100.0 153 20-24 48.3 35.4 9.8 3.7 0.0 2.8 100.0 116 25-29 61.5 22.7 9.4 0.9 0.0 5.4 100.0 89 30-34 62.3 27.5 4.6 0.2 0.0 3.8 100.0 91 35-39 74.0 11.4 12.8 0.0 0.0 1.8 100.0 55 40-44 67.3 16.4 16.3 0.0 0.0 0.0 100.0 56 45-49 60.6 19.7 13.2 0.0 0.0 4.0 100.0 55 50-54 61.9 14.1 20.7 0.0 0.0 3.4 100.0 64 55-59 (69.9) (8.0) (16.4) (0.0) (0.0) (5.7) 100.0 49 Marital status Never married 40.0 40.5 12.8 1.0 0.7 4.4 100.0 312 Married or living together 67.0 17.4 11.4 0.6 0.0 3.1 100.0 346 Divorced/separated/ widowed 62.9 15.0 17.4 0.0 0.0 4.7 100.0 69 Residence Urban 63.2 25.9 7.8 0.0 0.0 3.1 100.0 136 Rural 53.2 27.3 13.7 0.9 0.4 4.0 100.0 592 Ecological zone Lowlands 56.1 27.0 11.8 0.3 0.0 4.0 100.0 428 Foothills 57.7 22.7 10.6 0.0 1.4 7.6 100.0 90 Mountains 50.0 28.5 16.4 2.2 0.6 2.2 100.0 169 Senqu River Valley 59.8 31.0 8.7 0.5 0.0 0.0 100.0 41 District Butha-Buthe 67.9 16.3 7.1 0.0 0.0 8.6 100.0 30 Leribe 58.8 18.2 15.5 0.0 0.0 7.4 100.0 86 Berea 56.1 24.7 12.6 0.0 0.0 6.6 100.0 82 Maseru 54.9 30.9 8.2 0.4 0.6 5.0 100.0 216 Mafeteng 48.4 25.9 19.2 2.1 0.0 0.0 100.0 64 Mohale's Hoek 64.0 24.2 11.1 0.0 0.0 0.7 100.0 104 Quthing (52.3) (32.6) (15.1) (0.0) (0.0) (0.0) 100.0 39 Qacha’s Nek (56.2) (30.5) (11.8) (0.8) (0.0) (0.7) 100.0 28 Mokhotlong (34.6) (39.3) (17.4) (4.4) (0.0) (4.4) 100.0 17 Thaba-Tseka 42.1 31.7 19.1 3.4 1.7 1.7 100.0 62 Education No education 53.9 19.7 19.4 2.1 0.0 4.9 100.0 150 Primary, incomplete 55.4 25.9 13.5 0.6 0.6 3.2 100.0 351 Primary, complete 60.9 26.1 9.5 0.0 0.0 3.5 100.0 86 Secondary+ 52.1 38.4 5.0 0.0 0.0 4.3 100.0 142 Employment status Currently working 62.7 24.2 9.6 0.8 0.0 2.1 100.0 245 Currently not working but worked in past 12 months 59.1 17.2 19.3 0.2 0.0 4.3 100.0 112 Haven't worked in more than 12 months 49.7 30.7 12.6 0.9 0.6 5.0 100.0 357 Wealth quintile Lowest 48.9 27.5 17.4 2.3 0.7 3.2 100.0 160 Second 59.2 20.7 13.5 1.0 0.0 5.6 100.0 143 Middle 51.9 27.8 13.7 0.1 0.0 5.6 100.0 155 Fourth 59.4 26.7 12.0 0.0 0.0 1.9 100.0 150 Highest 57.3 33.5 4.4 0.0 1.0 2.6 100.0 121 Total 55.1 27.1 12.6 0.7 0.3 3.8 100.0 728 Note: Figures in parentheses are based on 25-49 unweighted cases. 260 | Tuberculosis Table 13.7 shows that 9 percent of women and 17 percent of men re- ported that they had been told by a doctor or a health provider that they had TB. Urban respondents are significantly more likely to be diagnosed with TB (14 percent for women and 24 percent for men) than rural respondents (8 percent for women and 15 percent for men). Women and men who are currently unemployed but worked in the past 12 months are more likely to be diagnosed with TB than those who are currently working or have not worked in more than 12 months. HIV-positive respond- ents report much higher rates of TB (18 percent of women and 27 percent of men) compared with HIV-negative respondents (10 percent of women and 15 percent of men). Differentials by other background characteristics are not pronounced. 13.4 WILLINGNESS TO WORK WITH SOMEONE WHO HAS PREVIOUSLY BEEN TREATED FOR TUBERCULOSIS Eighty-five percent of women and 79 percent of men who have heard of TB say they are willing to work with someone who has previously been treat- ed for TB (Table 13.8). While no strong differentials exist by marital status, sub- stantial differences are evident by age, residence, district, education, and wealth quintile. Older respondents are more likely than younger respondents to be willing to work with someone who has had TB. Urban women and men are more likely to be willing to do so than their rural counterparts. Mokhotlong has the lowest level of acceptance among women and men (64 percent each), while Maseru has the highest (90 percent among women and 88 percent among men). The higher the respondent’s level of education and wealth quintile, the greater the percentage willing to work with a treated TB patient. Table 13.7 Diagnosis of tuberculosis Among women and men who have had any of the specific symptoms of TB since age 15, percentage who were diagnosed with TB in their first consultation with a health provider, by background characteristics, Lesotho 2004 Women Men Background characteristic Percentage diagnosed with TB in the first consultation Number with TB- specific symptoms Percentage diagnosed with TB in the first consultation Number with TB- specific symptoms Age 15-19 3.3 347 2.6 153 20-24 6.6 357 3.6 116 25-29 10.7 267 21.5 89 30-34 9.8 231 20.4 91 35-39 20.9 187 24.5 55 40-44 10.9 228 30.9 56 45-49 10.3 180 19.4 55 50-54 na na 34.4 64 55-59 na na (27.3) 49 Marital status Never married 6.7 496 8.5 312 Married or living together 8.1 958 24.7 346 Divorced/separated/ widowed 16.9 344 15.4 69 Residence Urban 14.3 354 23.8 136 Rural 8.2 1,443 15.2 592 Ecological zone Lowlands 9.9 1,047 19.2 428 Foothills 6.4 209 17.7 90 Mountains 9.3 427 10.1 169 Senqu River Valley 10.5 114 18.6 41 District Butha-Buthe 10.5 76 29.1 30 Leribe 8.1 250 12.9 86 Berea 10.9 168 22.4 82 Maseru 9.1 553 18.7 216 Mafeteng 9.7 158 17.3 64 Mohale's Hoek 10.3 223 13.4 104 Quthing 10.0 116 (15.1) 39 Qacha’s Nek 15.2 64 (24.7) 28 Mokhotlong 7.2 42 (10.3) 17 Thaba-Tseka 6.2 146 7.5 62 HIV test results Positive 17.5 153 27.0 129 Negative 9.8 306 14.8 292 Not tested 9.2 481 11.6 385 Education No education 18.7 49 17.4 150 Primary, incomplete 7.9 667 16.8 351 Primary, complete 10.0 497 14.7 86 Secondary+ 9.8 584 17.7 142 Employment status Currently working 9.4 722 18.1 245 Currently not working but worked in the past 12 months 12.6 164 25.7 112 Haven't worked in more than 12 months 8.8 911 13.9 357 Wealth quintile Lowest 6.6 325 14.6 160 Second 11.3 372 13.7 143 Middle 9.5 327 18.0 155 Fourth 7.4 382 21.1 150 Highest 11.8 392 16.7 121 Total 9.4 1,798 16.9 728 Note: Figures in parentheses are based on 25-49 unweighted cases. na = Not applicable Tuberculosis | 261 Table 13.8 Positive attitudes towards those with TB Percentage of women and men who have heard of tuberculosis who are willing to work with someone who has previously been treated for tuberculosis, according to background characteristics, Lesotho 2004 Women Men Background characteristic Percentage Number Percentage Number Age 15-19 76.7 1,546 70.2 640 20-24 83.9 1,351 76.9 467 25-29 87.8 984 82.0 343 30-34 89.9 763 84.0 274 35-39 90.4 687 89.2 210 40-44 87.6 705 88.9 138 45-49 88.7 564 82.5 155 50-54 na na 74.2 137 55-59 na na 89.2 119 Marital status Never married 83.0 2,217 75.6 1,248 Married or living together 85.7 3,435 83.1 1,070 Divorced/separated/ widowed 86.7 950 80.7 163 Residence Urban 94.0 1,642 92.5 562 Rural 82.0 4,959 75.3 1,922 Ecological zone Lowlands 90.2 4,129 85.1 1,567 Foothills 78.0 710 74.2 263 Mountains 72.3 1,352 62.9 496 Senqu River Valley 86.0 410 80.2 158 District Butha-Buthe 82.4 438 74.0 163 Leribe 89.0 1,008 83.2 360 Berea 87.5 748 83.3 314 Maseru 90.4 1,773 87.7 674 Mafeteng 86.3 688 72.5 250 Mohale's Hoek 80.5 616 74.0 241 Quthing 83.4 433 77.3 155 Qacha’s Nek 74.8 198 65.1 80 Mokhotlong 64.4 331 63.6 122 Thaba-Tseka 76.5 368 67.8 125 Education No education 63.7 118 64.0 402 Primary, incomplete 72.2 1,877 73.6 1,022 Primary, complete 86.5 1,839 87.9 327 Secondary+ 93.5 2,767 91.4 733 Wealth quintile Lowest 66.4 839 60.6 388. Second 76.4 1,153 72.1 449 Middle 87.8 1,162 80.3 499 Fourth 89.2 1,528 83.0 562 Highest 93.1 1,920 92.2 586 Total 85.0 6,601 79.2 2,484 na = Not applicable Adult and Maternal Mortality | 263 ADULT AND MATERNAL MORTALITY 14 This chapter presents information on overall adult mortality and maternal mortality in Lesotho. Mortality levels and trends provide a good measure of the health status of the population and are an indicator for national development. Studies have shown that improvement in economic performance is related to decline in mortality. The study of adult mortality in Lesotho is more complicated than research on child mortality for a number of reasons. First, while early childhood mortality can be estimated through the birth history approach, there is no equivalent in adult mortality measurement. Second, death rates are much lower at adult ages than at childhood, so estimates for particular age groups can be distorted by sampling errors. Third, there is usually limited information available about the characteristics of those who have died. While the same can be said about data on childhood mortality, it is reasonable to expect the characteristics of parents to influence directly their children’s chances of survival. 14.1 DATA To estimate adult mortality, the 2004 LDHS included a sibling survival history in the Woman’s Questionnaire. A series of questions were asked about all of the respondent’s brothers and sisters and their survival status. These data allow direct estimation of overall adult mortality (by age and sex) and maternal mortality. Survival of siblings (i.e., biological brothers and sisters) is a useful method for collecting infor- mation on adult mortality. Each female respondent was asked to record a list of all children born to her biological mother, including all siblings who were still alive and those who had died. For brothers and sisters who were alive, only the age at the last birthday was asked. For those who had died, the number of years since death and age at death were asked. For sisters who had died at age 12 years or older, three additional questions were asked to determine whether the death was maternity-related: “Was [NAME OF SISTER] pregnant when she died?” and, if negative, “Did she die during childbirth?” and, if negative, “Did she die within two months after the end of a pregnancy or childbirth?” Adult and maternal mortality estimation requires accurate reporting of the number of siblings the respondent ever had, the number who died, and the number of sisters who have died of maternal-related causes (for maternal mortality). Although there is no definitive procedure for establishing the complete- ness of retrospective data on sibling survivorship, Table 14.1 presents several indicators that can be used to measure the quality of sibling survivorship data. The data do not show any obvious defects that would indicate poor data quality or significant underreporting. A total of 33,724 siblings was recorded in the maternal mortality section of the 2004 LDHS questionnaires. The sex ratio of the enumerated siblings (the ratio of brothers to sisters) is 1.04. The survival status for only 39 (less than 1 percent) of the siblings was not reported. For the surviving siblings, current age was not reported for only 186 (1 percent). Among deceased siblings, both 264 | Adult and Maternal Mortality the age at death and years since death were missing for 2 percent. Rather than exclude the siblings with missing data from further analysis, information on the birth order of siblings in conjunction with other information was used to impute the missing data.1 The sibling survivorship data, including cases with imputed values, have been used in the direct estimation of adult and maternal mortality. Table 14.1 Data on siblings Number of siblings reported by survey respondents and completeness of the reported data on age, age at death (AD), and years since death (YSD), Lesotho 2004 Females Males Total Sibling status and completeness of reporting Number Percentage Number Percentage Number Percentage All siblings 16,567 100.0 17,157 100.0 33,724 100.0 Surviving 13,594 82.1 13,470 78.5 27,064 80.3 Deceased 2,956 17.8 3,664 21.4 6,620 19.6 Missing information 17 0.1 22 0.1 39 0.1 Surviving siblings 13,594 100.0 13,470 100.0 27,064 100.0 Age reported 13,504 99.3 13,375 99.3 26,879 99.3 Age missing 90 0.7 96 0.7 186 0.7 Deceased siblings 2,956 100.0 3,664 100.0 6,620 100.0 AD and YSD reported 2,797 94.6 3,483 95.0 6,280 94.9 Missing only AD 57 1.9 83 2.3 140 2.1 Missing only YSD 43 1.4 35 0.9 78 1.2 Missing both 59 2.0 64 1.7 123 1.9 14.2 ESTIMATES OF ADULT MORTALITY One way to assess the quality of data used to estimate maternal mortality is to evaluate the plausibility and stability of overall adult mortality. It is reasoned that if rates of overall adult mortality are implausible, rates based on a subset of deaths—maternal mortality in particular—are likely to have serious problems. Also, levels and trends in overall adult mortality have important implications in their own right for health and social programmes in Lesotho, especially with regard to the potential effect of the AIDS epidemic. The direct estimation of adult mortality uses the reported ages at death and years since death of respondents’ brothers and sisters. Because of the differentials in exposure to the risk of dying, age- and sex-specific death rates are presented in Table 14.2. The rates are shown for the ten-year period preceding the survey for both sexes and for females and males separately. Because the number of deaths on which the 2004 LDHS rates are based is not large (a total of 971 female deaths and 1,147 male deaths), the estimated age-specific rates are subject to considerable sampling variation. To remove the effect of truncation bias—the upper boundary for eligibility for women interviewed in the 2004 LDHS is 49 years—the overall rates were standardised by the age distribution of the survey respondents. 1 The imputation procedure is based on the assumption that the reported birth order of siblings in the history is cor- rect. The first step is to calculate birth dates. For each living sibling with a reported age and each dead sibling with complete information on both age at death and years since death, the birth date was calculated. For a sibling missing these data, a birth date was imputed within the range defined by the birth dates of the bracketing siblings. In the case of living siblings, an age at the time of the survey was then calculated from the imputed birth date. In the case of dead siblings, if either the age at death or years since death was reported, that information was combined with the birth date to produce the missing information. If both pieces of information were missing, the distribution of the ages at death for siblings for whom the years since death was unreported, but age at death was reported, was used as a basis for imputing the age at death. Adult and Maternal Mortality | 265 Adult mortality for both sexes is 11 deaths per 1,000 years of exposure. The age-specific rates rise from 3 per 1,000 for the age group 15-19 to 22 per 1,000 for adults age 40-44 before dropping off to 20 per 1,000 for adults in the 45-49 age group. The small decline in the latter age group is somewhat unexpected because adult mortality levels typically rise steadily with age in the absence of war or other events that may disproportionately affect age cohorts. The decline may reflect errors in the reporting of sibling ages at death. However, it may also reflect the effect of the timing and age pattern of the AIDS epidemic in Lesotho. Looking at the differences in mortality by sex, the rate for men age 15-49 is nearly 25 percent higher than the rate for females in the same age group (12.3 per 1,000 and 9.9 per 1,000, respectively). The rates for both men and women rise with age and peak at age 40-44. The subsequent decline in mortality at age 45-49 is sharper for men than for women. Looking more closely at mortality age patterns, the rates for the 15-19 cohort are similar for men and women, while the female rate exceeds the male rate in cohorts 20-24 and 25-29. Male mortality exceeds female mortality in age groups 30-39, 40-44, and 45-49. Table 14.2 Adult mortality rates Age-specific mortality rates for women and men age 15- 49 based on the survivorship of sisters and brothers of survey respondents for the ten-year period preceding the survey, Lesotho 2004 Age Deaths Exposure Mortality rates WOMEN 15-19 64 21,058 3.05 20-24 125 2,118 5.88 25-29 207 18,061 11.45 30-34 198 14,369 13.81 35-39 174 11,331 15.40 40-44 131 7,677 17.07 45-49 71 4,623 15.27 15-49 971 98,419 9.86a MEN 15-19 66 21,107 3.14 20-24 100 20,620 4.87 25-29 179 18,053 9.89 30-34 247 14,525 17.03 35-39 236 10,857 21.77 40-44 207 7,453 27.77 45-49 112 4,579 24.35 15-49 1,147 97,195 12.34a TOTAL 15-19 131 42,166 3.20 20-24 226 41,919 5.38 25-29 385 36,115 10.67 30-34 446 28,894 15.43 35-39 411 22,188 18.52 40-44 338 15,131 22.34 45-49 182 9,202 19.79 15-49 2,118 195,614 11.09a a Age standardised 266 | Adult and Maternal Mortality 14.3 ESTIMATES OF MATERNAL MORTALITY Maternal deaths are defined as any death that occurred during pregnancy, childbirth, or within two months after the birth or termination of a pregnancy.2 Estimates of maternal mortality are therefore based solely on the timing of the death in relationship with pregnancy. Two survey methods are generally used to estimate maternal mortality in developing countries: the indirect sisterhood method (Graham et al., 1989) and a direct variant of the sisterhood method (Rutenberg and Sullivan, 1991). In this report, the direct estimation procedure is applied. Age-specific mortality rates are calculated by dividing the number of maternal deaths by woman-years of exposure. Again, to address the effect of truncation bias (the upper boundary for eligibility for women interviewed in the 2004 LDHS is 49 years), the overall rate for women age 15-49 is standardised by the age distribution of the survey respondents. Table 14.3 presents direct estimates of maternal mortality for the ten-year period preceding the survey. The data indicate that the rate of mortality associated with pregnancy and childbearing is 0.90 maternal deaths per 1,000 woman-years of exposure. The estimated age-specific mortality rates show a generally plausible pattern, being higher at the peak childbearing ages of the twenties and thirties than at younger ages. Maternal deaths represent 9 percent of all deaths among women age 15-49 (92/971) in Lesotho. Somewhat surprisingly, maternal mortality is highest among women age 40-44. Because fertility levels are typically lower in this age group, exposure to the risk of dying from maternal causes would be expected to be lower. The results suggest that there may either have been errors in the reporting of women’s ages, or possibly, errors in the timing of when the deaths occurred. Table 14.3 Maternal mortality Maternal mortality rates for the ten-year period preceding the survey, based on the survivorship of sisters of survey respondents, Lesotho 2004 Age Maternal deaths Exposure (years) Mortality rates (1,000) 15-19 6 21,058 0.30 20-24 12 21,300 0.59 25-29 22 18,061 1.20 30-34 16 14,369 1.09 35-39 18 11,331 1.63 40-44 16 7,677 2.14 45-49 1 4,623 0.13 Total 15-49 92 98,419 0.90a General fertility rate 0.118a Maternal mortality ratiob - - 762 a Age standardised b Per 100,000 births: calculated as maternal mortality rate divided by the general fertility rate The maternal mortality rate can be converted to a maternal mortality ratio and expressed per 100,000 live births by dividing the rate by the general fertility rate of 0.118, which is the age-adjusted general fertility rate prevailing during the same time period. With this procedure, the maternal mortality ratio during the ten-year period before the survey is estimated as 762 maternal deaths per 100,000 live births. This figure should be viewed with caution, because the number of female deaths occurring during pregnancy, at delivery, or within two months of delivery is small (92). As a result, the maternal mortality estimates are subject to larger sampling errors than the adult mortality estimates: the 95 percent confidence intervals indicate that the maternal mortality ratio varies from 561 to 964 (see Appendix Table B.2). 2 This time-dependent definition includes all deaths that occurred during pregnancy and two months after preg- nancy, even if the death was a result of nonmaternal causes. However, this definition is generally considered to be unlikely to result in overreporting of maternal deaths because most deaths to women during the two-month period are a result of maternal causes, and maternal deaths are more likely to be underreported than overreported. Father’s Participation in Family Health Care | 267 FATHER’S PARTICIPATION IN FAMILY HEALTH CARE 15 One of the policies to improve the health of women and children is to involve men in the health care of their wives and children. Men should be involved in making decisions and taking actions regarding family planning, antenatal care, preparation for de- livery, and children’s immunisation and nu- trition. This section presents information on men’s involvement in ensuring safe mother- hood for their wives and proper health care for their children. 15.1 ADVICE OR CARE DURING ANTENATAL, DELIVERY, AND POSTNATAL PERIODS In the 2004 LDHS, currently married men who have had at least one child since January 2000 were asked several questions regarding the pregnancy care of the mother of the last-born child and the health care of the child. Table 15.1 shows the percentage of last births in the five years preceding the survey for which mothers received advice or care from a health provider during the pregnancy, delivery, or during the six-week period after delivery. For 92 percent of births in the five years preceding the survey, men report that the child’s mother received advice or care during pregnancy, 69 percent received care during delivery, and 83 percent received care in the six weeks after delivery. The propor- tion of fathers reporting care for their wives during pregnancy, delivery, or six weeks after delivery varies somewhat by men’s age but there are no clear patterns. As expected, fathers residing in urban areas and those who are better-educated are more likely to report that the mother of the last-born child received advice or care during pregnancy, during delivery, or during the six-week period after delivery. Table 15.1 Advice or care received by mother during pregnancy and delivery, and after delivery Percentage of last births in the five years preceding the survey for which mothers received advice or care from a health care provider (based on father’s report), by type of advice or care and father’s background characteristics, Lesotho 2004 Mother received advice or care Background characteristic During pregnancy During delivery During the six weeks after delivery Number of fathers Age 15-19 * * * 1 20-24 92.8 65.4 71.9 81 25-29 92.5 72.3 79.9 159 30-34 95.1 66.3 84.6 150 35-39 90.8 73.3 88.5 95 40-44 88.1 57.1 84.2 59 45-49 (95.3) (81.2) (90.4) 49 50-54 (85.4) (67.1) (82.6) 33 55-59 * * * 5 Residence Urban 96.4 90.6 89.5 127 Rural 91.3 63.3 81.0 505 Ecological zone Lowlands 91.7 73.0 83.9 334 Foothills 88.7 61.3 91.1 75 Mountains 94.4 60.8 76.1 190 Senqu River Valley 95.4 89.7 89.1 33 District Butha-Buthe 87.0 71.7 85.6 40 Leribe 90.7 67.5 79.8 85 Berea 90.6 66.4 82.6 91 Maseru 94.0 70.1 87.7 145 Mafeteng (88.9) (70.1) (86.1) 49 Mohale's Hoek 91.0 64.1 75.8 61 Quthing (92.2) (81.8) (84.4) 35 Qacha’s Nek 98.2 79.5 70.4 23 Mokhotlong 96.6 68.7 87.3 49 Thaba-Tseka 95.9 60.9 76.2 54 Education No education 91.9 62.2 77.1 150 Primary, incomplete 89.5 61.9 84.4 257 Primary, complete 96.2 75.3 85.1 72 Secondary+ 95.7 83.9 84.2 153 Wealth quintile Lowest 90.9 59.5 80.3 138 Second 88.9 55.3 76.0 141 Middle 91.1 62.6 76.3 114 Fourth 95.3 84.4 88.7 120 Highest 96.4 85.9 93.3 120 Total 92.4 68.8 82.7 632 Note: Figures in parentheses are based on 25-49 unweighted cases. An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. 268 | Father’s Participation in Family Health Care Table 15.1 also shows that the percentage of last births in the five years preceding the survey for which mothers received advice or care during pregnancy, delivery, and during the six weeks after delivery varies by district. The proportion of mothers who received advice or care during pregnancy ranges from 87 percent in Butha-Buthe to 98 percent in Qacha’s Nek; during delivery it ranges from 61 percent in Thaba-Tseka to 82 percent in Quthing; and during the six weeks after delivery it ranges from 70 percent in Qacha’s Nek and Mohale’s Hoek to 88 percent in Maseru. Male respondents had have had at least one child since January 2000 were also asked about the reason why the mother of the last-born child did not receive advice or care during pregnancy, delivery, or the six weeks after delivery. Table 15.2 shows that the most common reason for not receiving any advice or care during pregnancy was the cost of services (13 percent) followed by lack of knowledge (12 per- cent). The most common reason cited for not receiving any advice or care during delivery was distance or lack of transport (83 percent) followed by high cost (68 percent). A relatively high proportion (63 per- cent) said that advice or care during delivery was not necessary. The main reason given for mothers not to seek advice in the six weeks after delivery was that it was not necessary, or lack of knowledge (35 percent each). The number of births in Table 15.2 are relatively small, therefore making it difficult to make mean- ingful generalizations. Table 15.2 Main reason for not receiving advice or care during pregnancy and delivery, and after delivery Percentage of last births in the five years preceding the survey for which mothers did not receive advice or care from a health care provider (based on father’s report), by the main reason for not seeking advice or care, Lesotho 2004 Mother did not receive advice or care Reason for not receiving advice or care During pregnancy During delivery During the six weeks after delivery Number of births Not necessary (2.4) (62.9) (34.8) 31 Not customary * * * 4 Respondent didn't allow * * * 10 Too costly 13.1 67.6 19.4 88 Too far/no transport 3.8 83.1 13.1 59 Poor service * * * 6 Lack of knowledge (11.5) (53.3) (35.2) 29 Other (4.6) (65.4) (29.9) 31 Total 8.3 69.1 22.6 259 Note: Figures in parentheses are based on 25-49 unweighted cases. An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. 15.2 CONTACT WITH HEALTH CARE PROVIDERS In the 2004 LDHS, men’s involvement in his wife’s pregnancy and care is measured by asking male respondents whether they talked to a health care provider about the pregnancy care or the health of the mother of their last child in the five years preceding the survey. This information is presented in Table 15.3. Findings show that during their wife’s last pregnancy, only 15 percent of fathers talked to a health care provider about the pregnancy care and health of their wife. Fathers in their mid- to-late 30s and mid- to-late 40s and early 50s, urban fathers, and those who are better educated are more likely than other fathers are to talk with a health care provider about their wife’s health and care during pregnancy. Look- ing at ecological zones, the proportion of fathers who discussed with a health care provider about their wife’s health and care during pregnancy ranges from 9 percent of Senqu River valley to 19 percent in the Mountains. Among districts, it ranges from 7 percent in Berea to 22 percent in Butha-Buthe. Father’s Participation in Family Health Care | 269 Table 15.3 Father's contact with a health care provider about wife's health and pregnancy For last births in the five years preceding the survey, the percentage of fathers who spoke with a health care provider about the health of their child’s mother or the pregnancy, by father’s background character- istics, Lesotho 2004 Background characteristic Percentage of fathers who spoke with a health care provider Number of fathers Age 15-19 * 1 20-24 10.6 81 25-29 15.8 159 30-34 14.2 150 35-39 19.2 95 40-44 5.9 59 45-49 (23.2) 49 50-54 19.2 33 55-59 * 5 Residence Urban 16.3 127 Rural 14.6 505 Ecological zone Lowlands 13.7 334 Foothills 12.9 75 Mountains 18.9 190 Senqu River Valley 9.4 33 District Butha-Buthe 21.6 40 Leribe 17.6 85 Berea 7.1 91 Maseru 20.0 145 Mafeteng (8.9) 49 Mohale's Hoek 13.1 61 Quthing (7.8) 35 Qacha’s Nek 20.0 23 Mokhotlong 10.1 49 Thaba-Tseka 19.9 54 Education No education 13.2 150 Primary, incomplete 11.4 257 Primary, complete 17.5 72 Secondary+ 21.4 153 Wealth quintile Lowest 14.9 138 Second 14.9 141 Middle 17.1 114 Fourth 9.9 120 Highest 18.1 120 Total 14.9 632 Note: Figures in parentheses are based on 25-49 unweighted cases. An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. 270 | Father’s Participation in Family Health Care 15.3 KNOWLEDGE OF PREGNANCY COMPLICATIONS For the safety and well-being of mothers and their newborn babies, knowledge of pregnancy complications that may lead to miscarriage or death is important. In the 2004 LDHS, all men age 15-59 were asked whether they know of any complications during pregnancy that could lead to miscarriage or death. Table 15.4 shows that an overwhelming proportion of men, 87 percent, do not know of any pregnancy complications. Six percent of men mentioned swelling of hands and feet, 3 percent mentioned vaginal bleeding, and 2 percent each mentioned abdominal pain and difficult labour for more than 12 hours. Table 15.4 Knowledge of pregnancy complications Percentage of men age 15-59 who know about pregnancy complications that lead to miscarriage or death, by type of complication, Lesotho 2004 Type of complication Percentage of men who know of pregnancy complications Vaginal bleeding 2.7 High fever 0.6 Abdominal pain 2.2 Swelling of hands and feet 6.0 Difficult labour for more than 12 hours 2.0 Convulsions 0.3 Other 1.8 Don't know any signs or symptoms 87.0 Number of men 2,797 15.4 KNOWLEDGE OF ORS PACKETS AND FEEDING PRACTICES DURING DIARRHOEA As mentioned in Chapter 9, diarrhoea is a major public health threat to children under five. In the case of diarrhoea, the child should be given an increased amount of appropriate fluids, possibly in the form of solution prepared from oral rehydration salts (ORS). Parents and caregivers are advised to rehydrate their children with either the commercially packaged ORS, or other fluids prepared at home with water, salt, and sugar (motsoako) as instructed by health professionals. A child who has diarrhoea should also be given more fluids than usual to prevent dehydration. As with women, all eligible male respondents in the 2004 LDHS were asked if they had heard of a special product called ORS that you can get for the treatment of diarrhoea. They were also asked about the amount of fluids that should be given to a child with a diarrhoea episode. The results are shown in Table 15.5. More than six in ten men (65 percent) have heard of ORS packets. Men in their 30s, early 40s, and early 50s are more likely to know about ORS packets than men in other age groups. Men in urban areas are significantly more likely to know about ORS than rural men (78 and 61 percent, respectively). Among districts, men in Maseru are most likely to know about ORS packets (77 percent), while those in Mokhotlong (49 percent) are least likely. Knowledge of ORS increases steadily with level of education, from 60 percent of men with no education to 70 percent of those with at least secondary education. Wealth quintile is positively associated with knowledge of ORS. Forty-seven percent of men in the lowest wealth quintile know about ORS compared with 77 percent of men in the highest quintile. Father’s Participation in Family Health Care | 271 Table 15.5 Knowledge of ORS packets and feeding practices during diarrhoea Percent distribution of men age 15-59 who report specific amounts of liquids that should be given to a child with diarrhoea (compared with normal practice) and percentage who know about ORS packets for treatment of diarrhoea, by background characteristics, Lesotho 2004 Amount of liquids to be given to a child with diarrhoea Background characteristic Less than usual Same as usual More than usual Don’t know/ missing Percentage of men who know of ORS packets Number of men Age 15-19 20.8 27.0 24.2 28.1 54.4 743 20-24 15.0 30.3 27.7 26.9 59.9 507 25-29 10.9 31.6 27.3 30.2 68.4 374 30-34 12.7 25.9 39.6 21.8 71.2 305 35-39 8.9 39.4 33.9 17.8 78.3 233 40-44 11.2 35.5 32.2 21.1 75.4 164 45-49 21.4 24.1 31.2 23.3 68.5 170 50-54 13.2 32.9 21.7 32.2 70.5 164 55-59 9.4 35.1 31.1 24.4 67.6 137 Residence Urban 4.8 32.4 42.2 20.7 77.6 603 Rural 17.8 29.6 25.1 27.4 61.2 2,194 Ecological zone Lowlands 13.9 32.7 32.5 20.9 70.8 1,734 Foothills 17.5 29.1 20.7 32.7 60.1 307 Mountains 18.3 25.8 18.3 37.7 49.3 585 Senqu River Valley 10.3 21.9 42.2 25.6 65.0 171 District Butha-Buthe 14.1 33.5 23.9 28.4 70.3 182 Leribe 12.6 24.2 37.9 25.3 66.6 393 Berea 16.3 28.8 24.0 30.9 55.6 350 Maseru 9.6 33.5 34.4 22.5 77.3 741 Mafeteng 23.6 35.6 22.4 18.4 58.6 297 Mohale's Hoek 16.8 33.3 28.4 21.5 65.9 281 Quthing 8.5 25.0 39.0 27.5 57.7 167 Qacha's Nek 26.2 20.1 15.9 37.8 56.6 99 Mokhotlong 9.9 23.5 13.1 53.5 48.6 130 Thaba-Tseka 29.3 30.5 19.7 20.5 50.4 156 Education No education 17.2 33.0 18.7 31.2 60.1 559 Primary, incomplete 15.4 29.6 29.9 25.2 63.8 1,213 Primary, complete 17.9 28.4 30.3 23.4 65.6 389 Secondary+ 10.6 30.0 34.9 24.5 70.2 636 Wealth quintile Lowest 20.4 28.4 15.0 36.1 46.9 466 Second 17.1 30.6 19.3 33.0 58.2 514 Middle 15.6 31.2 28.8 24.5 64.7 566 Fourth 13.5 31.9 34.3 20.2 71.7 621 Highest 10.3 28.5 41.4 19.8 76.5 630 Total 15.0 30.2 28.8 26.0 64.8 2,797 References | 273 REFERENCES Bureau of Statistics (BOS) [Lesotho]. 1976. Population Census analytical report, 1976, Vol. 4. Maseru, Lesotho: Bureau of Statistics. Bureau of Statistics (BOS) [Lesotho]. 1986. Population Census analytical report, 1986, Vol. 3. Maseru, Lesotho: Bureau of Statistics. Bureau of Statistics (BOS) [Lesotho]. 1996. Population Census analytical report, 1996, Vol. 3A and 3B. Maseru, Lesotho: Bureau of Statistics. Bureau of Statistics (BOS) [Lesotho]. 2000. 2000 End Decade Multiple Indicator Cluster Survey (EMICS). Maseru, Lesotho: Bureau of Statistics. Bureau of Statistics (BOS) [Lesotho]. 2003. Lesotho Demographic Survey, 2003, analytical report, Vol. 1, Maseru, Lesotho: Bureau of Statistics. Bureau of Statistics (BOS) [Lesotho]. 2005. National accounts 1980-2004: Statistical report, No 8. Maseru, Lesotho: Bureau of Statistics. Centers for Disease Control and Prevention (CDC). 1989. CDC criteria for anemia in children and childbearing aged women. Morbidity and Mortality Weekly Report 38: 400-404. DeMaeyer, E. et al. 1989. Preventing and controlling iron deficiency anaemia through primary health care: A guide for health administrators and programme managers. Geneva: World Health Organization. Government of Lesotho. 2000. National AIDS Strategic Plan 2000/2001-2003/2004: A three-year rolling plan for the national response to the HIV/AIDS epidemic in Lesotho. Maseru, Lesotho: Government of Lesotho. Graham, W. et al. 1989. Estimating maternal mortality: The sisterhood method. Studies in Family Planning 20(3):125-135. Gwatkin, D.R., S. Rutstein, K. Johnson, R.P. Pande, and A. Wagstaff. 2000. Socio-economic differences in health, nutrition and poverty. HNP/Poverty Thematic Group of the World Bank. Washington, D.C.: The World Bank. Ministry of Health and Social Welfare (MOHSW) [Lesotho]. 2004. 2003 HIV Sentinel Survey report, 2nd Edition, Maseru, Lesotho: Ministry of Health and Social Welfare. Mishra, V., M. Vaessen, T. Boerma, F. Arnold, A. Way, B. Barrere, et al. 2005. Evaluating HIV estimates from national population-based surveys for bias due to non-response. DHS Analytical Report. Calverton, Maryland: ORC Macro. (draft manuscript). Mosley, W.H. and L.C. Chen. 1984. An analytical framework for the study of child survival in developing countries. Population and Development Review 10 (supplement): 25-45. Rieder, H.L. 1999. Epidemiologic basis for tuberculosis control. Paris: International Union Against Tuberculosis and Lung Disease. 274 | References Rutenberg, N. and J. Sullivan. 1991. Direct and indirect estimates of maternal mortality from the sisterhood method. In Proceedings of the Demographic and Health Surveys World Conference, Vol. 3, 1669-1696. Columbia, Maryland: IRD/Macro International Inc. Rutstein S. 1999. Wealth versus expenditure: Comparison between the DHS wealth index and household expenditures in four departments of Guatemala. Calverton, Maryland, USA: ORC, Macro. Rutstein, S., K. Johnson, and D. Gwatkin. 2000. Poverty, health inequality, and its health and demographic effects. Paper presented at the 2000 Annual Meeting of the Population Association of America, Los Angeles, California. Shafer, R.W. et al. 1996. Tuberculosis in patient infected with HIV: Perspectives of the decade: Clinical Infectious Diseases 22(4):683-704. Styblo, K. 1999. Epidemiology of TB. 2nd edition. Prague: The Royal Netherlands Tuberculosis Association. United Nations. 1973. The determinants and consequences of population trends. Vol. 1. New York: United Nations. United Nations. 1983. Indirect techniques for demographic estimation. Manual X. New York: United Nations. World Health Organisation (WHO). 2002. Global tuberculosis control: Surveillance, planning and financing. WHO/CDS/TB/2002.295:1-227. World Health Organisation (WHO) and Joint United Nations Programme on HIV/AIDS (UNAIDS). 2000. Guidelines for second generation HIV surveillance. Geneva, Switzerland: WHO and UNAIDS. World Health Organisation (WHO). 1999. Violence against women, a priority health issue. WHO/FRH/ WHD/97.8. Geneva: WHO. Appendix A | 275 SAMPLE IMPLEMENTATION Appendix A Table A.1 Sample implementation: women Percent distribution of households and eligible women by results of the household and individual interviews, and household, eligible women and overall response rates, according to urban-rural residence and region, Lesotho 2004 Residence District Result Urban Rural Butha- Buthe Leribe Berea Maseru Mafeteng Mohale's Hoek Quthing Qacha's Nek Mokhotlong Thaba- Tseka Total Selected households Completed (C) 81.5 88.8 88.8 87.7 88.1 81.9 88.8 86.7 88.1 83.4 90.2 88.0 86.8 Household present but no competent respondent at home (HP) 2.1 1.3 1.3 2.4 0.5 1.9 1.3 1.2 1.8 2.5 1.3 0.5 1.5 Postponed (P) 0.0 0.0 0.0 0.1 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Refused (R) 1.4 0.2 0.3 0.9 0.1 1.6 0.3 0.3 0.1 0.4 0.1 0.1 0.5 Dwelling not found (DNF) 6.1 0.9 2.6 1.5 1.5 6.0 1.1 1.7 0.4 2.5 0.3 2.0 2.3 Household absent (HA) 3.5 2.6 0.8 2.4 3.0 2.9 1.2 3.4 6.5 4.0 2.7 2.0 2.8 Dwelling vacant/address not a dwelling (DV) 4.8 5.4 5.4 4.1 5.6 4.4 6.6 6.6 2.5 6.4 4.7 6.7 5.2 Dwelling destroy (DD) 0.2 0.1 0.0 0.2 0.2 0.3 0.0 0.1 0.0 0.0 0.4 0.1 0.2 Other (O) 0.4 0.7 0.7 0.7 0.9 0.9 0.6 0.1 0.5 1.0 0.4 0.4 0.6 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number of sampled households 2,743 7,160 956 1,092 968 1,742 972 1,145 767 734 784 743 9,903 Household response rate (HRR) 89.5 97.4 95.5 94.8 97.6 89.6 97.0 96.5 97.4 94.0 98.2 97.0 95.2 Eligible women Completed (EWC) 95.8 93.8 95.7 95.8 93.8 90.1 92.8 94.7 94.1 96.3 96.2 97.3 94.3 Not at home (EWNH) 2.2 3.1 2.1 2.7 3.0 5.2 3.8 2.2 3.0 1.4 2.2 1.1 2.9 Postponed (EWP) 0.0 0.0 0.0 0.1 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Refused (EWR) 1.1 1.0 1.0 0.3 1.4 1.8 0.8 1.2 0.5 1.0 0.8 0.9 1.0 Partly completed (EWPC) 0.1 0.2 0.2 0.1 0.1 0.5 0.3 0.0 0.2 0.2 0.2 0.0 0.2 Incapacitated (EWI) 0.4 1.4 1.0 0.6 1.2 1.5 1.8 1.4 1.6 1.2 0.3 0.4 1.1 Other (EWO) 0.3 0.5 0.0 0.3 0.4 0.9 0.5 0.5 0.7 0.0 0.3 0.4 0.4 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number of women 2,030 5,492 809 882 730 1,175 764 848 610 516 629 559 7,522 Eligible women response rate (EWRR) 95.8 93.8 95.7 95.8 93.8 90.1 92.8 94.7 94.1 96.3 96.2 97.3 94.3 Overall response rate (ORR) 85.7 91.3 91.4 90.8 91.6 80.7 90.0 91.4 91.7 90.5 94.4 94.4 89.8 1 Using the number of households falling into specific response categories, the household response rate (HRR) is calculated as: 100 * C ________________________ C + HP + P + R + DNF 2 Using the number of eligible women falling into specific response categories, the eligible woman response rate (EWRR) is calculated as: 100 * EWC ___________________________________________________ EWC + EWNH + EWP + EWR + EWPC + EWI + EWO 3 The overall response rate (ORR) is calculated as: ORR = HRR * EWRR/100 276 | Appendix A Table A.2 Sample implementation: men Percent distribution of households and eligible men by results of the household and individual interviews, and household, eligible men and overall re- sponse rates, according to urban-rural residence and region, Lesotho 2004 Residence District Result Urban Rural Butha- Buthe Leribe Berea Maseru Mafeteng Mohale's Hoek Quthing Qacha's Nek Mokhotlong Thaba- Tseka Total Selected households Completed (C) 81.0 88.0 87.5 88.2 88.4 80.8 88.1 87.0 85.9 82.4 88.8 86.9 86.1 Household present but no competent respondent at home (HP) 2.4 1.6 1.9 2.4 0.6 2.2 1.7 1.2 1.9 2.7 2.3 1.1 1.8 Postponed (P) 0.0 0.0 0.0 0.2 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Refused (R) 1.7 0.3 0.4 1.3 0.2 1.8 0.6 0.4 0.3 0.5 0.3 0.0 0.7 Dwelling not found (DNF) 6.6 0.8 2.7 1.7 1.5 6.6 0.6 2.0 0.3 2.7 0.0 1.9 2.4 Household absent (HA) 3.1 2.8 0.6 2.1 2.3 2.8 1.3 3.0 8.0 4.4 3.9 2.2 2.9 Dwelling vacant/address not a dwelling (DV) 4.6 5.5 6.1 3.0 6.1 4.4 6.9 6.0 2.9 6.3 4.2 7.0 5.2 Dwelling destroy (DD) 0.2 0.2 0.0 0.4 0.2 0.6 0.0 0.2 0.0 0.0 0.0 0.3 0.2 Other (O) 0.3 0.8 0.6 0.8 0.6 0.8 0.8 0.2 0.8 0.8 0.5 0.6 0.7 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number of sampled households 1,348 3,515 473 532 476 854 480 563 377 364 385 359 4,863 Household response rate (HRR) 88.3 97.0 94.5 94.0 97.5 88.5 96.8 96.1 97.3 93.2 97.2 96.6 94.6 Eligible men Completed (EMC) 87.7 83.7 84.4 85.3 85.5 80.5 85.8 83.0 78.1 94.2 88.5 85.8 84.6 Not at home (EMNH) 5.9 9.1 7.8 9.8 7.3 8.9 7.5 9.8 13.3 1.8 6.7 8.8 8.3 Postponed (EMP) 0.0 0.1 0.0 0.3 0.3 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.1 Refused (EMR) 3.0 3.4 5.0 1.7 2.8 4.2 3.6 4.5 5.1 0.9 1.9 1.8 3.3 Partly completed (EMPC) 0.4 0.3 0.0 0.0 0.3 1.0 0.3 0.0 0.0 0.4 0.0 0.9 0.3 Incapacitated (EMI) 2.4 2.0 2.2 2.0 2.8 2.2 2.1 1.8 2.7 2.7 0.7 1.8 2.1 Other (EMO) 0.5 1.5 0.6 0.9 1.0 3.2 0.6 1.0 0.8 0.0 2.2 0.9 1.2 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number of men 791 2,514 360 348 386 503 332 399 256 226 269 226 3,305 Eligible men response rate (EMRR) 87.7 83.7 84.4 85.3 85.5 80.5 85.8 83.0 78.1 94.2 88.5 85.8 84.6 Overall response rate (ORR) 77.5 81.1 79.8 80.2 83.3 71.2 83.1 79.7 76.0 87.8 86.0 82.9 80.0 1 Using the number of households falling into specific response categories, the household response rate (HRR) is calculated as: 100 * C ______________________ C + HP + P + R + DNF 2 Using the number of eligible men falling into specific response categories, the eligible man response rate (EMRR) is calculated as: 100 * EMC _________________________________________________ EMC + EMNH + EMP + EMR + EMPC + EMI + EMO 3 The overall response rate (ORR) is calculated as: ORR = HRR * EMRR/100 Appendix A | 277 Table A.3 Coverage of HIV testing among interviewed women by sociodemographic characteristics Percent distribution of interviewed women by testing status, according to sociodemographic characteris- tics (unweighted), Lesotho 2004 HIV testing status Sociodemographic characteristic Tested Refused Absent for testing Other/ missing Total Number Marital status Currently married/in union 86.1 10.6 0.2 3.1 100.0 1,871 Widowed 85.7 11.0 0.6 2.6 100.0 308 Divorced/ separated 86.9 9.4 0.5 3.1 100.0 191 Never in union 83.9 13.0 0.2 2.9 100.0 1,168 Ever had sex 84.8 12.7 0.0 2.5 100.0 592 Never had sex 83.0 13.4 0.3 3.3 100.0 576 Ever had sexual intercourse Yes 85.8 11.0 0.2 2.9 100.0 2,961 No 83.0 13.3 0.3 3.3 100.0 577 Currently pregnant Yes 92.1 5.1 0.0 2.8 100.0 215 Not pregnant/not sure 84.9 11.8 0.3 3.0 100.0 3,323 Religion Roman Catholic Church 83.8 12.0 0.3 3.8 100.0 1,564 Lesotho Evangelical Church 87.1 10.6 0.3 2.0 100.0 688 Anglican Church 85.1 12.1 0.3 2.6 100.0 348 Other Christian 87.2 10.3 0.1 2.5 100.0 895 No religion (78.8) (18.2) (0.0) (3.0) 100.0 33 Total 85.4 11.4 0.3 3.0 100.0 3,538 Note: Figures in parentheses are based on 25-49 unweighted cases. 278 | Appendix A Table A.4 Coverage of HIV testing among interviewed men by sociodemographic characteristics Percent distribution of interviewed men by testing status, according to sociodemographic characteristics (un- weighted), Lesotho 2004 HIV testing status Sociodemographic characteristic Tested Refused Absent for testing Other/ missing Total Number Marital status Currently married/in union 78.1 17.9 0.4 3.6 100.0 1,207 Widowed 73.4 20.3 0.0 6.3 100.0 64 Divorced/ separated 86.8 8.3 0.0 5.0 100.0 121 .Ever had sex 81.2 14.1 0.3 4.4 100.0 909 .Never had sex 80.8 14.6 0.6 4.0 100.0 494 Type of unions In union, polygynous 78.1 18.8 0.0 3.1 100.0 64 In union, not polygynous 78.1 17.8 0.4 3.6 100.0 1,143 Not in union 81.2 14.0 0.4 4.4 100.0 1,590 Ever had sexual intercourse Yes 79.7 15.9 0.3 4.0 100.0 2,303 No 80.8 14.6 0.6 4.0 100.0 494 Circumcision status Circumcised 81.6 14.0 0.4 3.9 100.0 1,433 Not circumcised 78.2 17.3 0.4 4.1 100.0 1,357 Times slept away from home in past 12 months None 80.0 15.0 0.5 4.5 100.0 1,611 1-2 80.2 16.6 0.5 2.8 100.0 434 3-4 75.5 19.8 0.4 4.3 100.0 278 5+ 82.3 14.2 0.0 3.5 100.0 423 Whether away for more than one month in past 12 months Away for more than 1 month 80.3 16.3 0.0 3.4 100.0 558 Away for less than 1 month 78.8 17.1 0.5 3.6 100.0 580 Never away 80.0 15.0 0.5 4.5 100.0 1,611 Religion Roman Catholic Church 78.9 16.6 0.5 4.0 100.0 1,257 Lesotho Evangelical Church 78.8 16.4 0.5 4.3 100.0 561 Anglican Church 80.7 14.4 0.0 4.9 100.0 264 Other Christian 82.5 14.3 0.2 3.0 100.0 525 No religion 81.9 12.1 0.5 5.5 100.0 182 Total 79.9 15.7 0.4 4.0 100.0 2,797 Note: Total includes 2 men with missing information on marital status and 48 men with missing informa- tion on times away from home in the past 12 months. Appendix A | 279 Table A.5 Coverage of HIV testing among women who ever had sex by risk status variables Percent distribution of women who ever had sex by testing status, according to characteristics relating to risk status (unweighted), Lesotho 2004 HIV testing status Background characteristic Tested Refused Absent for testing Other/ missing Total Unweighted number Age at first sex < 15 87.9 8.7 0.0 3.5 100.0 231 15-17 87.6 9.2 0.3 2.8 100.0 1,170 18-19 86.1 10.8 0.3 2.8 100.0 785 20+ 79.8 16.6 0.2 3.4 100.0 565 Higher-risk sex in past 12 months Had higher-risk sex 86.4 10.4 0.4 2.7 100.0 949 Had sex, not higher-risk sex 85.1 11.9 0.2 2.9 100.0 1,552 No sex in past 12 months 87.2 9.3 0.0 3.5 100.0 460 Number of partners in past 12 months 0 87.2 9.5 0.0 3.2 100.0 462 1 85.5 11.3 0.2 2.9 100.0 2,199 2 86.2 10.1 0.7 2.9 100.0 276 3+ 79.2 20.8 0.0 0.0 100.0 24 Number of higher-risk sexual partners in past 12 months 0 85.6 11.3 0.1 3.0 100.0 2,014 1 87.1 9.3 0.5 3.1 100.0 836 2 82.5 16.5 0.0 1.0 100.0 97 3+ 71.4 28.6 0.0 0.0 100.0 14 Any condom use (FP, other) Used condom at any time 83.0 13.8 0.3 2.9 100.0 1,196 Never used condom 87.7 9.1 0.2 2.9 100.0 1,765 Condom use at last sex in past 12 months Used condom at last sex 80.9 16.9 0.2 2.0 100.0 445 No condom at last sex 86.6 10.1 0.3 3.1 100.0 2,053 Condom use at last higher-risk sex in past 12 months Used condom at last higher-risk sex 81.8 15.3 0.3 2.7 100.0 373 No condom at last higher-risk sex 89.4 7.3 0.5 2.8 100.0 576 HIV testing status Ever tested and knows results of last test 83.7 12.8 0.5 2.9 100.0 375 Ever tested, does not results 89.7 8.4 0.0 1.9 100.0 107 Never tested 85.7 11.0 0.2 3.0 100.0 2,257 Total 85.8 11.0 0.2 2.9 100.0 2,961 Note: Total includes 210 women missing information on age at first sex and 222 women with missing infor- mation on whether ever obtained an HIV test. 280 | Appendix A Table A.6 Coverage of HIV testing among men who ever had sex by risk status variables Percent distribution of men who ever had sex by testing status, according to characteristics relating to risk status (unweighted), Lesotho 2004 HIV testing status Background characteristic Tested Refused Absent for testing Other/ missing Total Number Age at first sex < 15 82.0 12.7 0.9 4.4 100.0 228 15-17 81.0 14.4 0.4 4.2 100.0 714 18-19 75.9 19.2 0.4 4.5 100.0 511 20+ 80.4 16.0 0.1 3.6 100.0 840 Higher-risk sex in past 12 months Had higher-risk sex 80.7 14.2 0.3 4.7 100.0 1,223 Had sex, not higher-risk sex 78.2 18.6 0.1 3.1 100.0 803 No sex in past 12 months 79.4 15.9 1.1 3.6 100.0 277 Number of partners in past 12 months 0 79.6 15.7 1.1 3.6 100.0 274 1 79.5 16.2 0.2 4.1 100.0 1,445 2 79.0 16.5 0.2 4.3 100.0 443 3+ 84.1 12.1 0.8 3.0 100.0 132 Number of higher-risk sexual partners in past 12 months 0 78.6 17.8 0.4 3.2 100.0 1,077 1 80.1 14.1 0.4 5.5 100.0 853 2 81.2 15.3 0.4 3.1 100.0 255 3+ 84.5 13.6 0.0 1.8 100.0 110 Paid for sex In past 12 months 72.2 22.2 0.0 5.6 100.0 36 Prior to past 12 months 78.6 18.8 0.0 2.6 100.0 117 Never 79.9 15.6 0.4 4.1 100.0 2,147 Any condom use (FP, other) Used condom at any time 77.4 18.3 0.3 3.9 100.0 1,166 Never used condom 82.0 13.5 0.4 4.1 100.0 1,137 Condom use at last sex in past 12 months Used condom at last sex 75.1 19.7 0.5 4.7 100.0 193 No condom at last sex 100.0 0.0 0.0 0.0 100.0 3 Condom use at last higher-risk sex in past 12 months Used condom 77.4 17.4 0.6 4.6 100.0 545 Never used condom 83.3 11.7 0.1 4.9 100.0 678 Condom use at last paid sexual encounter Used condom at last paid sex 74.6 23.7 0.0 1.7 100.0 59 No condom at last paid sex 78.7 17.0 0.0 4.3 100.0 94 HIV testing status Ever tested and knows results of last test 76.0 22.6 0.0 1.4 100.0 221 Ever tested, does not results 67.3 26.5 0.0 6.1 100.0 49 Never tested 81.1 14.2 0.4 4.3 100.0 1,873 Total 79.7 15.9 0.3 4.0 100.0 2,303 Note: Total includes 10 men missing information on age at first sex, 8 men missing information on number of higher-risk sexual partners in past 12 months, 3 men missing information on whether they paid for sex, and 160 men missing information on whether ever obtained HIV test. Appendix B | 281 ESTIMATES OF SAMPLING ERRORS Appendix B The estimates from a sample survey are affected by two types of errors: (1) nonsampling errors, and (2) sampling errors. Nonsampling errors are the results of mistakes made in implementing data col- lection and data processing, such as failure to locate and interview the correct household, misunderstand- ing of the questions on the part of either the interviewer or the respondent, and data entry errors. Although numerous efforts were made during the implementation of the 2004 Lesotho Demographic and Health Survey (LSDHS) to minimize this type of error, nonsampling errors are impossible to avoid and difficult to evaluate statistically. Sampling errors, on the other hand, can be evaluated statistically. The sample of respondents se- lected in the 2004 LSDHS is only one of many samples that could have been selected from the same population, using the same design and expected size. Each of these samples would yield results that differ somewhat from the results of the actual sample selected. Sampling errors are a measure of the variability between all possible samples. Although the degree of variability is not known exactly, it can be estimated from the survey results. A sampling error is usually measured in terms of the standard error for a particular statistic (mean, percentage, etc.), which is the square root of the variance. The standard error can be used to calcu- late confidence intervals within which the true value for the population can reasonably be assumed to fall. For example, for any given statistic calculated from a sample survey, the value of that statistic will fall within a range of plus or minus two times the standard error of that statistic in 95 percent of all possible samples of identical size and design. If the sample of respondents had been selected as a simple random sample, it would have been possible to use straightforward formulas for calculating sampling errors. However, the 2004 LSDHS sample is the result of a multistage stratified design, and, consequently, it was necessary to use more complex formulae. The computer software used to calculate sampling errors for the 2004 LSDHS is the ISSA Sampling Error Module. This module used the Taylor linearization method of variance estimation for survey estimates that are means or proportions. The Jackknife repeated replication method is used for variance estimation of more complex statistics such as fertility and mortality rates. The Taylor linearization method treats any percentage or average as a ratio estimate, r = y/x, where y represents the total sample value for variable y, and x represents the total number of cases in the group or subgroup under consideration. The variance of r is computed using the formula given below, with the standard error being the square root of the variance: ∑ ∑ = =− ⎥⎥⎦ ⎤ ⎢⎢⎣ ⎡ ⎟⎟⎠ ⎞ ⎜⎜⎝ ⎛ −−== H h h h m i hi h h m z z m m x frvarrSE h 1 2 1 2 1 2 2 1)()( in which hihihi rxyz −= , and hhh rxyz −= 282 | Appendix B where h represents the stratum which varies from 1 to H, mh is the total number of clusters selected in the hth stratum, yhi is the sum of the weighted values of variable y in the ith cluster in the hth stratum, xhi is the sum of the weighted number of cases in the ith cluster in the hth stratum, and f is the overall sampling fraction, which is so small that it is ignored. The Jackknife repeated replication method derives estimates of complex rates from each of sev- eral replications of the parent sample, and calculates standard errors for these estimates using simple for- mulae. Each replication considers all but one clusters in the calculation of the estimates. Pseudo- independent replications are thus created. In the 2004 LSDHS, there were 405 non-empty clusters. Hence, 404 replications were created. The variance of a rate r is calculated as follows: SE r var r k k r r i k i 2 1 21 1 ( ) ( ) ( ) ( )= = − −=∑ in which )()1( ii rkkrr −−= where r is the estimate computed from the full sample of 405 clusters, r(i) is the estimate computed from the reduced sample of 404 clusters (ith cluster excluded), and k is the total number of clusters. In addition to the standard error, ISSA computes the design effect (DEFT) for each estimate, which is defined as the ratio between the standard error using the given sample design and the standard error that would result if a simple random sample had been used. A DEFT value of 1.0 indicates that the sample design is as efficient as a simple random sample, while a value greater than 1.0 indicates the in- crease in the sampling error due to the use of a more complex and less statistically efficient design. ISSA also computes the relative error and confidence limits for the estimates. Sampling errors for the 2004 LSDHS are calculated for selected variables considered to be of primary interest for woman’s survey and for man’s surveys, respectively. The results are presented in this appendix for the country as a whole, for urban and rural areas, and for each of the 4 ecological zones. For each variable, the type of statistic (mean, proportion, or rate) and the base population are given in Table B.1. Tables B.2 through B.8 present the value of the statistic (R), its standard error (SE), the number of unweighted (N) and weighted (WN) cases, the design effect (DEFT), the relative standard error (SE/R), and the 95 percent confidence limits (R±2SE), for each variable. The DEFT is considered undefined when the standard error considering simple random sample is zero (when the estimate is close to 0 or 1). In the case of the total fertility rate, the number of unweighted cases is not relevant, as there is no known un- weighted value for woman-years of exposure to childbearing. The confidence interval (e.g., as calculated for children ever born to women aged 40-49) can be interpreted as follows: the overall average from the national sample is 4.703 and its standard error is 0.074. Therefore, to obtain the 95 percent confidence limits, one adds and subtracts twice the standard error to the sample estimate, i.e., 4.703±2×0.074. There is a high probability (95 percent) that the true average number of children ever born to all women aged 40 to 49 is between 4.556 and 4.850. Sampling errors are analyzed for the national woman sample and for two separate groups of esti- mates: (1) means and proportions, and (2) complex demographic rates. The relative standard errors (SE/R) for the means and proportions range between 0.3 percent and 18.2 percent with an average of 4.0 Appendix B | 283 percent; the highest relative standard errors are for estimates of very low values (e.g., currently using IUCD). If estimates of very low values (less than 10 percent) were removed, then the average drops to 2.7 percent. So in general, the relative standard error for most estimates for the country as a whole is small, except for estimates of very small proportions. The relative standard error for the total fertility rate is small, 3.1 percent. However, for the mortality rates, the averaged relative standard error for the five 5- year period mortality rates is much higher, 8.3 percent. There are differentials in the relative standard error for the estimates of sub-populations. For ex- ample, for the variable want no more children, the relative standard errors as a percent of the estimated mean for the whole country, and for the urban areas are 1.7 percent and 4.3 percent, respectively. For the total sample, the value of the design effect (DEFT), averaged over all variables, is 1.22 which means that, due to multi-stage clustering of the sample, the average standard error is increased by a factor of 1.22 over that in an equivalent simple random sample. 284 | Appendix B Table B.1 List of selected variables for sampling errors, Lesotho 2004 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Variable Estimate Base population –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– WOMEN –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Urban residence Proportion All women 15-49 No education Proportion All women 15-49 With secondary education or higher Proportion All women 15-49 Never married (in union) Proportion All women 15-49 Currently married (in union) Proportion All women 15-49 Had first sex before 18 Proportion All women 20-49 Children ever born Mean All women 15-49 Children ever born to women 40-49 Mean All women 40-49 Children surviving Mean All women 15-49 Knowing any contraceptive method Proportion Currently married women 15-49 Knowing any modern contraceptive method Proportion Currently married women 15-49 Ever used any contraceptive method Proportion Currently married women 15-49 Currently using any method Proportion Currently married women 15-49 Currently using a modern method Proportion Currently married women 15-49 Currently female sterilization Proportion Currently married women 15-49 Currently using pill Proportion Currently married women 15-49 Currently using IUCD Proportion Currently married women 15-49 Currently using condom Proportion Currently married women 15-49 Currently using injectables Proportion Currently married women 15-49 Currently using rhythm or periodic abstinence Proportion Currently married women 15-49 Currently using withdrawal Proportion Currently married women 15-49 Using public sector source Proportion Currently married women 15-49 Want no more children Proportion Currently married women 15-49 Want to delay at least 2 years Proportion Currently married women 15-49 Ideal number of children Mean All women 15-49 Mother received tetanus injection Proportion Births in past 5 years Mother received medical care at birth Proportion Births in past 5 years Child has diarrhoea in the past 2 weeks Proportion Children under 5 Child treated with ORS packets Proportion Children under 5 with diarrhoea in past 2 weeks Consulted medical personnel Proportion Children 12-23 months Child having health card, seen Proportion Children 12-23 months Child received BCG vaccination Proportion Children 12-23 months Child received DPT vaccination (3 doses) Proportion Children 12-23 months Child received polio vaccination (3 doses) Proportion Children 12-23 months Child received measles vaccination Proportion Children 12-23 months Child fully immunized Proportion Children 12-23 months Height-for-age (<-2SD) Proportion Children under 5 who were measured Weight-for-height (<-2SD) Proportion Children under 5 who were measured Weight-for-age (<-2SD) Proportion Children under 5 who were measured Has heard of HIV/AIDS Proportion All women 15-49 Knows condoms reduce HIV/AIDS Proportion All women 15-49 Knows limiting partners reduce HIV/AIDS Proportion All women 15-49 Total fertility rate (past 3 years) Rate All women 15-49 Neonatal mortality rate (past 10 years)1 Rate Number of births in past 5 (10 years) Postneonatal mortality rate (past 10 years)1 Rate Number of births in past 5 (10 years) Infant mortality rate (past 10 years)1 Rate Number of births in past 5 (10 years) Child mortality rate (past 10 years)1 Rate Number of births in past 5 (10 years) Under-five mortality rate (past 10 years)1 Rate Number of births in past 5 (10 years) Maternal mortality rate (past 0-9 years)2 Rate Number of births in past 10 years HIV prevalence Proportion All women 15-49 tested for HIV –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– MEN –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Urban residence Proportion All men 15-59 No education Proportion All men 15-59 With secondary education or higher Proportion All men 15-59 Never married (in union) Proportion All men 15-59 Currently married (in union) Proportion All men 15-59 Had first sex before 18 Proportion All men 25-59 Knowing any contraceptive method Proportion Currently married men 15-59 Knowing any modern contraceptive method Proportion Currently married men 15-59 Want no more children Proportion Currently married men 15-59 Want to delay at least 2 years Proportion Currently married men 15-59 Ideal number of children Mean All men 15-59 Has heard of HIV/AIDS Proportion All men 15-49 Knows condoms reduce HIV/AIDS Proportion All men 15-49 Knows limiting partners reduce HIV/AIDS Proportion All men 15-49 HIV prevalence (15-49) Proportion All men 15-49 tested for HIV HIV prevalence (15-59) Proportion All men 15-59 tested for HIV –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– 1 Five years for national sample and 10 years for regional sample 2 Maternal mortality ratio is reported only for national sample Appendix B | 285 Table B.2 Sampling errors for national sample, Lesotho 2004 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Number of cases Stand- –––––––––––––––– Rela- ard Un- Weight- Design tive Confidence limits Value error weighted ed effect error –––––––––––––––– Variable (R) (SE) (N) (WN) (DEFT) (SE/R) R-2SE R+2SE ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– WOMEN ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Urban residence 0.237 0.009 7095 7095 1.778 0.038 0.219 0.255 No education 0.020 0.002 7095 7095 0.958 0.079 0.017 0.024 With secondary education or higher 0.387 0.009 7095 7095 1.510 0.023 0.369 0.404 Never married (in union) 0.334 0.007 7095 7095 1.252 0.021 0.320 0.348 Currently married (in union) 0.523 0.008 7095 7095 1.326 0.015 0.507 0.538 Had first sex before age 18 0.389 0.008 5334 5385 1.165 0.020 0.374 0.405 Children ever born 2.056 0.027 7095 7095 1.041 0.013 2.001 2.110 Children surviving 1.836 0.024 7095 7095 1.030 0.013 1.787 1.884 Children ever born to women 40-49 4.703 0.074 1305 1334 1.144 0.016 4.556 4.850 Knowing any contraceptive method 0.983 0.003 3726 3709 1.269 0.003 0.978 0.988 Knowing any modern contraceptive method 0.981 0.003 3726 3709 1.207 0.003 0.976 0.987 Ever used any contraceptive method 0.761 0.009 3726 3709 1.266 0.012 0.743 0.779 Currently using any contraceptive method 0.373 0.010 3726 3709 1.294 0.027 0.352 0.394 Currently using a modern method 0.352 0.010 3726 3709 1.341 0.030 0.331 0.373 Currently using pill 0.109 0.006 3726 3709 1.213 0.057 0.096 0.121 Currently using IUCD 0.021 0.002 3726 3709 1.067 0.120 0.016 0.026 Currently using condom 0.048 0.005 3726 3709 1.291 0.094 0.039 0.057 Currently using injectables 0.147 0.008 3726 3709 1.328 0.053 0.131 0.162 Currently using female sterilization 0.027 0.003 3726 3709 1.150 0.113 0.021 0.033 Currently using rhythm or periodic abstinence 0.000 0.000 3726 3709 1.167 1.001 0.000 0.001 Currently using withdrawal 0.009 0.002 3726 3709 1.063 0.182 0.006 0.012 Obtained method from public sector source 0.566 0.015 1748 1807 1.235 0.026 0.536 0.595 Want no more children 0.541 0.009 3726 3709 1.143 0.017 0.523 0.560 Want to delay birth at least 2 years 0.258 0.009 3726 3709 1.281 0.036 0.239 0.276 Ideal number of children 3.015 0.022 7074 7069 1.120 0.007 2.971 3.058 Mothers received tetanus injection for last birth 0.787 0.009 2928 2859 1.178 0.011 0.769 0.806 Mothers received medical care at delivery 0.554 0.011 3697 3572 1.175 0.020 0.532 0.575 Child had diarrhoea in the past 2 weeks 0.139 0.007 3340 3227 1.187 0.053 0.124 0.153 Treated with ORS packets 0.419 0.030 474 447 1.238 0.070 0.360 0.478 Consulted medical personnel 0.215 0.021 474 447 1.043 0.096 0.174 0.256 Child having health card, seen 0.777 0.021 673 660 1.280 0.027 0.736 0.819 Child received BCG vaccination 0.964 0.009 673 660 1.274 0.010 0.946 0.983 Child received DPT vaccination (3 doses) 0.828 0.020 673 660 1.376 0.024 0.787 0.868 Child received polio vaccination (3 doses) 0.797 0.019 673 660 1.213 0.024 0.759 0.835 Child received measles vaccination 0.849 0.015 673 660 1.065 0.017 0.819 0.879 Child fully immunized 0.678 0.023 673 660 1.254 0.034 0.632 0.724 Height-for-age (-2SD) 0.382 0.013 1744 1620 1.059 0.035 0.355 0.409 Weight-for-height (-2SD) 0.043 0.006 1744 1620 1.222 0.146 0.031 0.056 Weight-for-age (-2SD) 0.198 0.011 1744 1620 1.102 0.057 0.176 0.221 Has heard of HIV/AIDS 0.936 0.004 7095 7095 1.384 0.004 0.928 0.944 Knows condoms reduce HIV/AIDS 0.775 0.007 7095 7095 1.394 0.009 0.762 0.789 Knows limiting partners reduce HIV/AIDS 0.824 0.006 7095 7095 1.323 0.007 0.812 0.836 Total fertility rate (past 3 years) 3.539 0.108 na 20080 1.482 0.031 3.322 3.755 Neonatal mortality (past 5 years) 45.588 3.883 3728 3596 1.044 0.085 37.821 53.354 Post-neonatal mortality (past 5 years) 45.508 4.148 3742 3607 1.108 0.091 37.213 53.803 Infant mortality (past 5 years) 91.096 5.620 3742 3607 1.076 0.062 79.856 102.335 Child mortality (past 5 years) 23.996 2.985 3759 3629 1.074 0.124 18.026 29.965 Under-five mortality (past 5 years) 112.905 6.185 3773 3640 1.082 0.055 100.536 125.275 HIV prevalence 0.264 0.010 3032 3031 1.223 0.037 0.244 0.283 Maternal mortality rate (past 0-9 years) 762 101 na na na 0.132 561 964 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– MEN ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Urban residence 0.215 0.012 2797 2797 1.557 0.056 0.191 0.240 No education 0.171 0.008 2797 2797 1.142 0.048 0.155 0.187 With secondary education or higher 0.276 0.015 2797 2797 1.733 0.053 0.247 0.306 Never married (in union) 0.507 0.011 2797 2797 1.196 0.022 0.485 0.530 Currently married (in union) 0.426 0.011 2797 2797 1.129 0.025 0.405 0.447 Had first sex before age 18 0.238 0.012 1537 1547 1.090 0.050 0.214 0.262 Knowing any contraceptive method 0.982 0.004 1207 1191 0.940 0.004 0.975 0.989 Knowing any modern contraceptive method 0.977 0.004 1207 1191 1.027 0.005 0.968 0.986 Want no more children 0.458 0.016 1207 1191 1.095 0.034 0.426 0.489 Want to delay birth at least 2 years 0.274 0.015 1207 1191 1.150 0.054 0.244 0.303 Ideal number of children 3.584 0.045 2772 2773 1.179 0.013 3.494 3.674 Has heard of HIV/AIDS 0.932 0.005 2495 2496 1.065 0.006 0.921 0.942 Knows condoms reduce HIV/AIDS 0.696 0.010 2495 2496 1.103 0.015 0.676 0.716 Knows limiting partners reduce HIV/AIDS 0.756 0.010 2495 2496 1.125 0.013 0.737 0.776 HIV prevalence (15-49) 0.193 0.011 2002 2012 1.269 0.058 0.170 0.215 HIV prevalence (15-59) 0.189 0.011 2246 2255 1.343 0.059 0.167 0.212 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– na = Not applicable 286 | Appendix B Table B.3 Sampling errors for urban sample, Lesotho 2004 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Number of cases Stand- –––––––––––––––– Rela- ard Un- Weight- Design tive Confidence limits Value error weighted ed effect error –––––––––––––––– Variable (R) (SE) (N) (WN) (DEFT) (SE/R) R-2SE R+2SE ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– WOMEN ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Urban residence 1.000 0.000 1945 1682 na 0.000 1.000 1.000 No education 0.008 0.002 1945 1682 1.187 0.292 0.003 0.013 With secondary education or higher 0.577 0.017 1945 1682 1.560 0.030 0.542 0.612 Never married (in union) 0.424 0.015 1945 1682 1.331 0.035 0.394 0.454 Currently married (in union) 0.439 0.016 1945 1682 1.442 0.037 0.406 0.471 Had first sex before age 18 0.295 0.016 1527 1368 1.365 0.054 0.263 0.326 Children ever born 1.431 0.046 1945 1682 1.230 0.032 1.340 1.522 Children surviving 1.302 0.041 1945 1682 1.208 0.032 1.220 1.385 Children ever born to women 40-49 3.534 0.151 319 277 1.425 0.043 3.231 3.836 Knowing any contraceptive method 0.996 0.003 874 738 1.310 0.003 0.990 1.000 Knowing any modern contraceptive method 0.996 0.003 874 738 1.310 0.003 0.990 1.000 Ever used any contraceptive method 0.865 0.016 874 738 1.410 0.019 0.832 0.897 Currently using any contraceptive method 0.499 0.027 874 738 1.571 0.053 0.446 0.553 Currently using a modern method 0.487 0.027 874 738 1.614 0.056 0.433 0.542 Currently using pill 0.133 0.018 874 738 1.551 0.134 0.097 0.168 Currently using IUCD 0.044 0.008 874 738 1.134 0.178 0.029 0.060 Currently using condom 0.100 0.017 874 738 1.641 0.166 0.067 0.134 Currently using injectables 0.179 0.020 874 738 1.544 0.112 0.139 0.219 Currently using female sterilization 0.027 0.007 874 738 1.302 0.262 0.013 0.042 Currently using rhythm or periodic abstinence 0.000 0.000 874 738 na na 0.000 0.000 Currently using withdrawal 0.001 0.001 874 738 0.991 0.876 0.000 0.004 Obtained method from public sector source 0.542 0.026 669 599 1.345 0.048 0.490 0.594 Want no more children 0.545 0.023 874 738 1.380 0.043 0.498 0.591 Want to delay birth at least 2 years 0.213 0.018 874 738 1.294 0.084 0.177 0.249 Ideal number of children 2.536 0.032 1943 1679 1.012 0.012 2.473 2.600 Mothers received tetanus injection for last birth 0.819 0.024 578 448 1.406 0.029 0.771 0.867 Mothers received medical care at delivery 0.878 0.018 670 503 1.232 0.020 0.842 0.913 Child had diarrhoea in the last 2 weeks 0.089 0.016 602 457 1.247 0.177 0.058 0.121 Treated with ORS packets 0.468 0.087 65 41 1.167 0.187 0.293 0.643 Consulted medical personnel 0.365 0.087 65 41 1.214 0.238 0.192 0.539 Child having health card, seen 0.782 0.046 132 99 1.178 0.058 0.690 0.873 Child received BCG vaccination 0.964 0.024 132 99 1.387 0.025 0.916 1.000 Child received DPT vaccination (3 doses) 0.844 0.049 132 99 1.460 0.059 0.745 0.943 Child received polio vaccination (3 doses) 0.839 0.038 132 99 1.112 0.045 0.763 0.915 Child received measles vaccination 0.911 0.032 132 99 1.202 0.035 0.847 0.975 Child fully immunized 0.680 0.063 132 99 1.450 0.093 0.553 0.806 Height-for-age (-2SD) 0.300 0.036 297 214 1.152 0.120 0.228 0.372 Weight-for-height (-2SD) 0.040 0.013 297 214 1.004 0.337 0.013 0.067 Weight-for-age (-2SD) 0.160 0.029 297 214 1.214 0.185 0.101 0.219 Has heard of HIV/AIDS 0.995 0.001 1945 1682 0.822 0.001 0.993 0.998 Knows condoms reduce HIV/AIDS 0.855 0.011 1945 1682 1.328 0.012 0.834 0.876 Knows limiting partners reduce HIV/AIDS 0.901 0.009 1945 1682 1.356 0.010 0.883 0.919 Total fertility rate (past 3 years) 1.922 0.124 na 4753 1.282 0.065 1.673 2.171 Neonatal mortality (past 10 years) 22.747 5.039 1393 1072 1.128 0.222 12.670 32.825 Post-neonatal mortality (past 10 years) 41.594 6.781 1395 1074 1.194 0.163 28.032 55.155 Infant mortality (past 10 years) 64.341 7.915 1395 1074 1.114 0.123 48.510 80.172 Child mortality (past 10 years) 23.797 5.204 1394 1074 1.195 0.219 13.389 34.205 Under-five mortality (past 10 years) 86.607 8.900 1396 1076 1.078 0.103 68.808 104.406 HIV prevalence 0.330 0.023 741 735 1.333 0.070 0.284 0.376 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– MEN ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Urban residence 1.000 0.000 694 603 na 0.000 1.000 1.000 No education 0.056 0.010 694 603 1.115 0.174 0.037 0.076 With secondary education or higher 0.523 0.037 694 603 1.940 0.070 0.449 0.596 Never married (in union) 0.442 0.028 694 603 1.486 0.063 0.386 0.498 Currently married (in union) 0.486 0.027 694 603 1.404 0.055 0.433 0.539 Had first sex before age 18 0.257 0.028 413 388 1.298 0.109 0.201 0.313 Knowing any contraceptive method 0.995 0.004 302 293 0.893 0.004 0.988 1.000 Knowing any modern contraceptive method 0.995 0.004 302 293 0.893 0.004 0.988 1.000 Want no more children 0.419 0.037 302 293 1.308 0.089 0.345 0.494 Want to delay birth at least 2 years 0.238 0.038 302 293 1.549 0.160 0.162 0.314 Ideal number of children 2.917 0.084 693 603 1.368 0.029 2.748 3.085 Has heard of HIV/AIDS 0.995 0.002 627 554 0.708 0.002 0.991 0.999 Knows condoms reduce HIV/AIDS 0.799 0.021 627 554 1.315 0.026 0.757 0.841 Knows limiting partners reduce HIV/AIDS 0.873 0.016 627 554 1.200 0.018 0.842 0.905 HIV prevalence (15-49) 0.220 0.032 432 407 1.582 0.144 0.157 0.283 HIV prevalence (15-59) 0.222 0.033 480 445 1.759 0.151 0.155 0.288 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– na = Not applicable Appendix B | 287 Table B.4 Sampling errors for rural sample, Lesotho 2004 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Number of cases Stand- –––––––––––––––– Rela- ard Un- Weight- Design tive Confidence limits Value error weighted ed effect error –––––––––––––––– Variable (R) (SE) (N) (WN) (DEFT) (SE/R) R-2SE R+2SE –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– WOMEN –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Urban residence 0.000 0.000 5150 5413 na na 0.000 0.000 No education 0.024 0.002 5150 5413 0.921 0.081 0.020 0.028 With secondary education or higher 0.328 0.010 5150 5413 1.469 0.029 0.308 0.347 Never married (in union) 0.307 0.008 5150 5413 1.207 0.025 0.291 0.322 Currently married (in union) 0.549 0.009 5150 5413 1.254 0.016 0.531 0.566 Had first sex before age 18 0.422 0.008 3807 4017 1.057 0.020 0.405 0.438 Children ever born 2.250 0.031 5150 5413 0.970 0.014 2.187 2.312 Children surviving 2.001 0.028 5150 5413 0.973 0.014 1.945 2.057 Children ever born to women 40-49 5.010 0.082 986 1057 1.107 0.016 4.846 5.174 Knowing any contraceptive method 0.980 0.003 2852 2970 1.245 0.003 0.973 0.986 Knowing any modern contraceptive method 0.978 0.003 2852 2970 1.182 0.003 0.971 0.984 Ever used any contraceptive method 0.735 0.010 2852 2970 1.211 0.014 0.715 0.755 Currently using any contraceptive method 0.342 0.011 2852 2970 1.211 0.031 0.320 0.363 Currently using a modern method 0.318 0.011 2852 2970 1.263 0.035 0.296 0.340 Currently using pill 0.103 0.006 2852 2970 1.109 0.061 0.090 0.115 Currently using IUCD 0.015 0.002 2852 2970 1.050 0.160 0.010 0.020 Currently using condom 0.035 0.004 2852 2970 1.092 0.107 0.028 0.043 Currently using injectables 0.138 0.008 2852 2970 1.265 0.059 0.122 0.155 Currently using female sterilization 0.027 0.003 2852 2970 1.112 0.125 0.020 0.034 Currently using rhythm or periodic abstinence 0.000 0.000 2852 2970 1.141 1.002 0.000 0.001 Currently using withdrawal 0.011 0.002 2852 2970 1.041 0.185 0.007 0.015 Obtained method from public sector source 0.577 0.018 1079 1209 1.177 0.031 0.542 0.613 Want no more children 0.540 0.010 2852 2970 1.082 0.019 0.520 0.561 Want to delay birth at least 2 years 0.269 0.010 2852 2970 1.255 0.039 0.248 0.290 Ideal number of children 3.163 0.025 5131 5390 1.079 0.008 3.113 3.214 Mothers received tetanus injection for last birth 0.782 0.010 2350 2411 1.127 0.012 0.762 0.801 Mothers received medical care at delivery 0.501 0.012 3027 3069 1.163 0.024 0.477 0.524 Child had diarrhoea in the past 2 weeks 0.147 0.008 2738 2770 1.155 0.055 0.131 0.163 Treated with ORS packets 0.414 0.031 409 406 1.225 0.076 0.352 0.477 Consulted medical personnel 0.200 0.021 409 406 1.008 0.104 0.158 0.242 Child having health card, seen 0.776 0.023 541 560 1.277 0.030 0.730 0.822 Child received BCG vaccination 0.964 0.010 541 560 1.240 0.010 0.944 0.984 Child received DPT vaccination (3 doses) 0.825 0.022 541 560 1.346 0.027 0.781 0.869 Child received polio vaccination (3 doses) 0.790 0.021 541 560 1.211 0.027 0.747 0.833 Child received measles vaccination 0.838 0.017 541 560 1.039 0.020 0.805 0.871 Child fully immunized 0.678 0.025 541 560 1.206 0.036 0.628 0.727 Height-for-age (-2SD) 0.395 0.015 1447 1406 1.047 0.037 0.366 0.424 Weight-for-height (-2SD) 0.044 0.007 1447 1406 1.237 0.160 0.030 0.058 Weight-for-age (-2SD) 0.204 0.012 1447 1406 1.081 0.060 0.180 0.229 Has heard of HIV/AIDS 0.917 0.005 5150 5413 1.355 0.006 0.907 0.928 Knows condoms reduce HIV/AIDS 0.751 0.008 5150 5413 1.359 0.011 0.734 0.767 Knows limiting partners reduce HIV/AIDS 0.800 0.007 5150 5413 1.318 0.009 0.785 0.815 Total fertility rate (past 3 years) 4.100 0.108 na 15017 1.287 0.026 3.884 4.316 Neonatal mortality (past 10 years) 48.744 3.647 5562 5698 1.071 0.075 41.450 56.037 Post-neonatal mortality (past 10 years) 38.183 3.134 5567 5703 1.108 0.082 31.915 44.451 Infant mortality (past 10 years) 86.926 4.745 5567 5703 1.094 0.055 77.437 96.416 Child mortality (past 10 years) 19.256 2.266 5584 5723 1.086 0.118 14.724 23.789 Under-five mortality (past 10 years) 104.509 5.520 5589 5728 1.158 0.053 93.469 115.548 HIV prevalence 0.243 0.011 2291 2295 1.186 0.044 0.221 0.264 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– MEN –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Urban residence 0.000 0.000 2103 2194 na na 0.000 0.000 No education 0.203 0.010 2103 2194 1.148 0.050 0.183 0.223 With secondary education or higher 0.209 0.015 2103 2194 1.671 0.071 0.179 0.238 Never married (in union) 0.525 0.012 2103 2194 1.128 0.023 0.501 0.550 Currently married (in union) 0.409 0.011 2103 2194 1.055 0.028 0.387 0.432 Had first sex before age 18 0.232 0.013 1124 1159 1.016 0.055 0.206 0.257 Knowing any contraceptive method 0.978 0.005 905 898 0.943 0.005 0.969 0.987 Knowing any modern contraceptive method 0.971 0.006 905 898 1.034 0.006 0.960 0.983 Want no more children 0.470 0.017 905 898 1.008 0.036 0.437 0.504 Want to delay birth at least 2 years 0.285 0.015 905 898 1.014 0.053 0.255 0.316 Ideal number of children 3.769 0.051 2079 2171 1.116 0.013 3.668 3.871 Has heard of HIV/AIDS 0.913 0.007 1868 1942 1.059 0.008 0.900 0.927 Knows condoms reduce HIV/AIDS 0.667 0.012 1868 1942 1.060 0.017 0.644 0.690 Knows limiting partners reduce HIV/AIDS 0.723 0.012 1868 1942 1.111 0.016 0.700 0.746 HIV prevalence (15-49) 0.186 0.011 1570 1606 1.165 0.062 0.163 0.208 HIV prevalence (15-59) 0.181 0.011 1766 1809 1.203 0.061 0.159 0.204 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– na = Not applicable 288 | Appendix B Table B.5 Sampling errors for Lowlands sample, Lesotho 2004 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Number of cases Stand- –––––––––––––––– Rela- ard Un- Weight- Design tive Confidence limits Value error weighted ed effect error –––––––––––––––– Variable (R) (SE) (N) (WN) (DEFT) (SE/R) R-2SE R+2SE ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– WOMEN ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Urban residence 0.363 0.013 3118 4299 1.535 0.036 0.337 0.390 No education 0.011 0.002 3118 4299 0.871 0.148 0.008 0.014 With secondary education or higher 0.472 0.012 3118 4299 1.288 0.024 0.449 0.495 Never married (in union) 0.362 0.010 3118 4299 1.144 0.027 0.343 0.382 Currently married (in union) 0.496 0.011 3118 4299 1.256 0.023 0.473 0.518 Had first sex before age 18 0.352 0.010 2386 3309 1.051 0.029 0.332 0.373 Children ever born 1.884 0.038 3118 4299 1.032 0.020 1.809 1.960 Children surviving 1.695 0.033 3118 4299 1.005 0.020 1.629 1.762 Children ever born to women 40-49 4.433 0.102 585 819 1.133 0.023 4.228 4.638 Knowing any contraceptive method 0.993 0.003 1556 2132 1.342 0.003 0.987 0.999 Knowing any modern contraceptive method 0.993 0.003 1556 2132 1.342 0.003 0.987 0.999 Ever used any contraceptive method 0.832 0.010 1556 2132 1.045 0.012 0.812 0.852 Currently using any contraceptive method 0.457 0.015 1556 2132 1.177 0.033 0.427 0.487 Currently using a modern method 0.440 0.016 1556 2132 1.235 0.035 0.409 0.471 Currently using pill 0.140 0.010 1556 2132 1.100 0.069 0.121 0.160 Currently using IUCD 0.029 0.004 1556 2132 0.935 0.137 0.021 0.037 Currently using condom 0.063 0.007 1556 2132 1.171 0.114 0.049 0.078 Currently using injectables 0.180 0.012 1556 2132 1.218 0.066 0.156 0.203 Currently using female sterilization 0.027 0.004 1556 2132 1.062 0.161 0.018 0.036 Currently using rhythm or periodic abstinence 0.001 0.001 1556 2132 0.996 1.002 0.000 0.002 Currently using withdrawal 0.005 0.002 1556 2132 1.084 0.391 0.001 0.009 Obtained method from public sector source 0.533 0.019 994 1322 1.169 0.035 0.496 0.570 Want no more children 0.563 0.014 1556 2132 1.092 0.024 0.535 0.590 Want to delay birth at least 2 years 0.241 0.014 1556 2132 1.302 0.059 0.213 0.269 Ideal number of children 2.850 0.027 3107 4282 0.952 0.009 2.797 2.903 Mothers received tetanus injection for last birth 0.804 0.014 1097 1508 1.164 0.017 0.776 0.832 Mothers received medical care at delivery 0.648 0.016 1284 1771 1.111 0.025 0.615 0.680 Child had diarrhoea in the past 2 weeks 0.137 0.012 1160 1605 1.206 0.089 0.112 0.161 Treated with ORS packets 0.486 0.051 155 220 1.261 0.104 0.385 0.588 Consulted medical personnel 0.249 0.035 155 220 1.029 0.143 0.178 0.319 Child having health card, seen 0.811 0.029 247 348 1.191 0.036 0.753 0.870 Child received BCG vaccination 0.960 0.015 247 348 1.224 0.016 0.930 0.990 Child received DPT vaccination (3 doses) 0.836 0.034 247 348 1.442 0.040 0.769 0.903 Child received polio vaccination (3 doses) 0.846 0.028 247 348 1.221 0.033 0.790 0.901 Child received measles vaccination 0.854 0.023 247 348 1.022 0.027 0.808 0.899 Child fully immunized 0.693 0.037 247 348 1.264 0.053 0.619 0.766 Height-for-age (-2SD) 0.329 0.021 612 794 1.052 0.065 0.286 0.371 Weight-for-height (-2SD) 0.037 0.010 612 794 1.262 0.268 0.017 0.056 Weight-for-age (-2SD) 0.142 0.015 612 794 1.015 0.106 0.112 0.172 Has heard of HIV/AIDS 0.975 0.003 3118 4299 1.134 0.003 0.968 0.981 Knows condoms reduce HIV/AIDS 0.823 0.009 3118 4299 1.275 0.011 0.806 0.840 Knows limiting partners reduce HIV/AIDS 0.867 0.007 3118 4299 1.231 0.009 0.852 0.882 Total fertility rate (past 3 years) 2.873 0.131 na 12030 1.289 0.046 2.611 3.135 Neonatal mortality (past 10 years) 39.148 4.990 2526 3499 1.208 0.127 29.169 49.128 Post-neonatal mortality (past 10 years) 37.095 3.897 2528 3503 0.974 0.105 29.301 44.889 Infant mortality (past 10 years) 76.243 6.175 2528 3503 1.080 0.081 63.894 88.592 Child mortality (past 10 years) 18.691 3.072 2535 3515 1.079 0.164 12.548 24.835 Under-five mortality (past 10 years) 93.509 7.211 2537 3519 1.135 0.077 79.088 107.931 HIV prevalence 0.280 0.014 1303 1843 1.118 0.050 0.252 0.308 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– MEN ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Urban residence 0.322 0.019 1248 1734 1.420 0.058 0.284 0.359 No education 0.096 0.009 1248 1734 1.090 0.095 0.078 0.114 With secondary education or higher 0.351 0.021 1248 1734 1.569 0.060 0.308 0.393 Never married (in union) 0.531 0.015 1248 1734 1.082 0.029 0.500 0.561 Currently married (in union) 0.399 0.014 1248 1734 0.988 0.034 0.372 0.426 Had first sex before age 18 0.239 0.016 677 961 0.989 0.068 0.207 0.272 Knowing any contraceptive method 0.994 0.003 488 692 0.940 0.003 0.987 1.000 Knowing any modern contraceptive method 0.992 0.004 488 692 0.958 0.004 0.984 1.000 Want no more children 0.493 0.023 488 692 0.999 0.046 0.447 0.538 Want to delay birth at least 2 years 0.240 0.022 488 692 1.119 0.090 0.196 0.283 Ideal number of children 3.307 0.062 1241 1724 1.174 0.019 3.182 3.431 Has heard of HIV/AIDS 0.964 0.005 1116 1553 0.935 0.005 0.954 0.975 Knows condoms reduce HIV/AIDS 0.757 0.013 1116 1553 1.042 0.018 0.730 0.784 Knows limiting partners reduce HIV/AIDS 0.797 0.012 1116 1553 1.019 0.015 0.772 0.821 HIV prevalence (15-49) 0.204 0.016 858 1235 1.176 0.079 0.172 0.236 HIV prevalence (15-59) 0.200 0.016 958 1381 1.259 0.081 0.168 0.233 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– na = Not applicable Appendix B | 289 Table B.6 Sampling errors for Foothills sample, Lesotho 2004 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Number of cases Stand- –––––––––––––––– Rela- ard Un- Weight- Design tive Confidence limits Value error weighted ed effect error –––––––––––––––– Variable (R) (SE) (N) (WN) (DEFT) (SE/R) R-2SE R+2SE ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– WOMEN ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Urban residence 0.000 0.000 999 787 na na 0.000 0.000 No education 0.018 0.004 999 787 1.060 0.251 0.009 0.026 With secondary education or higher 0.289 0.028 999 787 1.942 0.096 0.233 0.345 Never married (in union) 0.284 0.019 999 787 1.316 0.066 0.247 0.322 Currently married (in union) 0.579 0.022 999 787 1.377 0.037 0.536 0.622 Had first sex before age 18 0.458 0.020 737 588 1.066 0.043 0.419 0.497 Children ever born 2.251 0.061 999 787 0.818 0.027 2.129 2.372 Children surviving 2.037 0.063 999 787 0.934 0.031 1.910 2.163 Children ever born to women 40-49 5.055 0.136 180 145 0.769 0.027 4.783 5.326 Knowing any contraceptive method 0.981 0.009 568 456 1.501 0.009 0.964 0.998 Knowing any modern contraceptive method 0.981 0.009 568 456 1.501 0.009 0.964 0.998 Ever used any contraceptive method 0.717 0.026 568 456 1.370 0.036 0.665 0.768 Currently using any contraceptive method 0.316 0.021 568 456 1.073 0.066 0.274 0.358 Currently using a modern method 0.286 0.021 568 456 1.097 0.073 0.244 0.327 Currently using pill 0.073 0.015 568 456 1.347 0.202 0.043 0.102 Currently using IUCD 0.017 0.006 568 456 1.054 0.335 0.006 0.029 Currently using condom 0.032 0.010 568 456 1.311 0.301 0.013 0.052 Currently using injectables 0.121 0.013 568 456 0.967 0.109 0.094 0.147 Currently using female sterilization 0.042 0.011 568 456 1.353 0.270 0.020 0.065 Currently using rhythm or periodic abstinence 0.000 0.000 568 456 na na 0.000 0.000 Currently using withdrawal 0.005 0.003 568 456 1.042 0.624 0.000 0.011 Obtained method from public sector source 0.543 0.038 187 147 1.039 0.070 0.468 0.619 Want no more children 0.562 0.018 568 456 0.869 0.032 0.525 0.598 Want to delay birth at least 2 years 0.250 0.014 568 456 0.772 0.056 0.222 0.278 Ideal number of children 3.189 0.070 996 785 1.358 0.022 3.048 3.329 Mothers received tetanus injection for last birth 0.708 0.027 446 351 1.243 0.038 0.655 0.762 Mothers received medical care at delivery 0.442 0.031 576 456 1.371 0.071 0.379 0.505 Child had diarrhoea in the past 2 weeks 0.182 0.012 530 418 0.718 0.066 0.158 0.206 Treated with ORS packets 0.319 0.038 109 76 0.787 0.119 0.243 0.395 Consulted medical personnel 0.161 0.025 109 76 0.655 0.153 0.112 0.210 Child having health card, seen 0.823 0.038 102 76 0.991 0.047 0.746 0.900 Child received BCG vaccination 0.944 0.027 102 76 1.155 0.029 0.890 0.998 Child received DPT vaccination (3 doses) 0.862 0.031 102 76 0.886 0.036 0.800 0.925 Child received polio vaccination (3 doses) 0.780 0.039 102 76 0.930 0.050 0.702 0.859 Child received measles vaccination 0.831 0.039 102 76 1.010 0.046 0.754 0.908 Child fully immunized 0.670 0.042 102 76 0.872 0.062 0.587 0.754 Height-for-age (-2SD) 0.389 0.033 284 218 1.133 0.085 0.323 0.454 Weight-for-height (-2SD) 0.040 0.013 284 218 1.096 0.311 0.015 0.066 Weight-for-age (-2SD) 0.210 0.028 284 218 1.127 0.132 0.154 0.266 Has heard of HIV/AIDS 0.895 0.017 999 787 1.720 0.019 0.862 0.928 Knows condoms reduce HIV/AIDS 0.734 0.022 999 787 1.573 0.030 0.690 0.778 Knows limiting partners reduce HIV/AIDS 0.805 0.018 999 787 1.420 0.022 0.769 0.841 Total fertility rate (past 3 years) 4.282 0.232 na 2190 1.258 0.054 3.817 4.746 Neonatal mortality (past 10 years) 43.235 7.190 1091 877 1.036 0.166 28.854 57.616 Post-neonatal mortality (past 10 years) 39.052 6.333 1092 878 1.025 0.162 26.386 51.719 Infant mortality (past 10 years) 82.287 11.204 1092 878 1.300 0.136 59.879 104.696 Child mortality (past 10 years) 20.696 5.380 1094 880 1.120 0.260 9.936 31.455 Under-five mortality (past 10 years) 101.280 12.235 1095 880 1.268 0.121 76.809 125.751 HIV prevalence 0.242 0.029 417 333 1.397 0.121 0.183 0.301 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– MEN ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Urban residence 0.000 0.000 392 307 na na 0.000 0.000 No education 0.194 0.020 392 307 0.999 0.103 0.154 0.234 With secondary education or higher 0.181 0.037 392 307 1.896 0.204 0.107 0.255 Never married (in union) 0.503 0.031 392 307 1.208 0.061 0.442 0.564 Currently married (in union) 0.429 0.035 392 307 1.411 0.082 0.359 0.500 Had first sex before age 18 0.230 0.027 210 166 0.928 0.117 0.176 0.284 Knowing any contraceptive method 0.972 0.013 165 132 1.023 0.014 0.946 0.998 Knowing any modern contraceptive method 0.963 0.020 165 132 1.368 0.021 0.923 1.000 Want no more children 0.432 0.041 165 132 1.069 0.096 0.349 0.515 Want to delay birth at least 2 years 0.308 0.036 165 132 0.993 0.116 0.237 0.380 Ideal number of children 3.891 0.108 387 302 1.050 0.028 3.674 4.107 Has heard of HIV/AIDS 0.893 0.015 350 274 0.933 0.017 0.862 0.924 Knows condoms reduce HIV/AIDS 0.620 0.027 350 274 1.029 0.043 0.567 0.674 Knows limiting partners reduce HIV/AIDS 0.715 0.030 350 274 1.245 0.042 0.655 0.775 HIV prevalence (15-49) 0.169 0.025 270 231 1.088 0.147 0.119 0.218 HIV prevalence (15-59) 0.170 0.025 299 256 1.156 0.148 0.119 0.220 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– na = Not applicable 290 | Appendix B Table B.7 Sampling errors for Mountains sample, Lesotho 2004 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Number of cases Stand- –––––––––––––––– Rela- ard Un- Weight- Design tive Confidence limits Value error weighted ed effect error –––––––––––––––– Variable (R) (SE) (N) (WN) (DEFT) (SE/R) R-2SE R+2SE ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– WOMEN ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Urban residence 0.048 0.003 2274 1572 0.759 0.071 0.041 0.055 No education 0.046 0.005 2274 1572 1.169 0.112 0.036 0.056 With secondary education or higher 0.213 0.013 2274 1572 1.553 0.063 0.186 0.240 Never married (in union) 0.261 0.011 2274 1572 1.225 0.043 0.239 0.284 Currently married (in union) 0.591 0.012 2274 1572 1.171 0.020 0.567 0.615 Had first sex before age 18 0.433 0.015 1705 1177 1.280 0.036 0.402 0.464 Children ever born 2.409 0.049 2274 1572 0.967 0.020 2.312 2.506 Children surviving 2.113 0.043 2274 1572 0.950 0.020 2.028 2.199 Children ever born to women 40-49 5.189 0.127 395 281 1.009 0.025 4.935 5.444 Knowing any contraceptive method 0.959 0.007 1295 929 1.277 0.007 0.945 0.973 Knowing any modern contraceptive method 0.951 0.007 1295 929 1.181 0.007 0.937 0.965 Ever used any contraceptive method 0.612 0.020 1295 929 1.484 0.033 0.572 0.652 Currently using any contraceptive method 0.215 0.018 1295 929 1.562 0.083 0.180 0.251 Currently using a modern method 0.191 0.017 1295 929 1.552 0.089 0.157 0.225 Currently using pill 0.061 0.007 1295 929 1.045 0.114 0.047 0.075 Currently using IUCD 0.005 0.002 1295 929 1.243 0.489 0.000 0.010 Currently using condom 0.024 0.005 1295 929 1.113 0.198 0.014 0.033 Currently using injectables 0.083 0.011 1295 929 1.433 0.132 0.061 0.105 Currently using female sterilization 0.018 0.004 1295 929 0.992 0.205 0.010 0.025 Currently using rhythm or periodic abstinence 0.000 0.000 1295 929 na na 0.000 0.000 Currently using withdrawal 0.018 0.004 1295 929 1.143 0.233 0.010 0.027 Obtained method from public sector source 0.734 0.025 394 239 1.139 0.035 0.683 0.785 Want no more children 0.471 0.016 1295 929 1.176 0.035 0.438 0.503 Want to delay birth at least 2 years 0.308 0.015 1295 929 1.135 0.047 0.278 0.337 Ideal number of children 3.429 0.050 2267 1566 1.298 0.014 3.330 3.529 Mothers received tetanus injection for last birth 0.788 0.013 1091 810 1.053 0.016 0.763 0.813 Mothers received medical care at delivery 0.425 0.016 1468 1105 1.145 0.037 0.394 0.457 Child had diarrhoea in the past 2 weeks 0.124 0.012 1317 988 1.297 0.093 0.101 0.147 Treated with ORS packets 0.390 0.050 164 123 1.320 0.129 0.290 0.491 Consulted medical personnel 0.207 0.035 164 123 1.108 0.169 0.137 0.278 Child having health card, seen 0.711 0.041 268 198 1.522 0.057 0.630 0.793 Child received BCG vaccination 0.973 0.011 268 198 1.145 0.011 0.951 0.995 Child received DPT vaccination (3 doses) 0.796 0.029 268 198 1.200 0.036 0.739 0.853 Child received polio vaccination (3 doses) 0.717 0.035 268 198 1.310 0.049 0.646 0.787 Child received measles vaccination 0.853 0.022 268 198 1.032 0.025 0.809 0.896 Child fully immunized 0.671 0.035 268 198 1.245 0.052 0.601 0.741 Height-for-age (-2SD) 0.450 0.020 656 488 0.990 0.044 0.411 0.490 Weight-for-height (-2SD) 0.042 0.009 656 488 1.150 0.225 0.023 0.060 Weight-for-age (-2SD) 0.266 0.024 656 488 1.327 0.088 0.219 0.313 Has heard of HIV/AIDS 0.844 0.010 2274 1572 1.370 0.012 0.823 0.865 Knows condoms reduce HIV/AIDS 0.653 0.012 2274 1572 1.216 0.019 0.629 0.677 Knows limiting partners reduce HIV/AIDS 0.708 0.012 2274 1572 1.251 0.017 0.684 0.732 Total fertility rate (past 3 years) 4.886 0.156 na 4348 1.152 0.032 4.573 5.199 Neonatal mortality (past 10 years) 56.291 5.438 2663 1964 0.983 0.097 45.415 67.167 Post-neonatal mortality (past 10 years) 40.402 5.944 2667 1967 1.460 0.147 28.514 52.290 Infant mortality (past 10 years) 96.693 7.458 2667 1967 1.105 0.077 81.778 111.609 Child mortality (past 10 years) 22.426 3.406 2670 1970 1.118 0.152 15.614 29.238 Under-five mortality (past 10 years) 116.951 8.567 2674 1973 1.181 0.073 99.816 134.085 HIV prevalence 0.233 0.016 977 663 1.164 0.068 0.201 0.264 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– MEN ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Urban residence 0.049 0.004 877 585 0.525 0.078 0.041 0.057 No education 0.370 0.020 877 585 1.237 0.055 0.330 0.411 With secondary education or higher 0.124 0.013 877 585 1.165 0.105 0.098 0.150 Never married (in union) 0.435 0.021 877 585 1.269 0.049 0.393 0.478 Currently married (in union) 0.513 0.020 877 585 1.168 0.038 0.473 0.552 Had first sex before age 18 0.218 0.022 499 327 1.202 0.102 0.173 0.262 Knowing any contraceptive method 0.956 0.010 441 300 1.055 0.011 0.936 0.977 Knowing any modern contraceptive method 0.946 0.012 441 300 1.089 0.012 0.923 0.970 Want no more children 0.367 0.026 441 300 1.135 0.071 0.314 0.419 Want to delay birth at least 2 years 0.339 0.024 441 300 1.069 0.071 0.291 0.387 Ideal number of children 4.230 0.082 868 579 1.053 0.019 4.067 4.394 Has heard of HIV/AIDS 0.847 0.016 782 522 1.218 0.019 0.815 0.878 Knows condoms reduce HIV/AIDS 0.531 0.018 782 522 0.988 0.033 0.495 0.566 Knows limiting partners reduce HIV/AIDS 0.643 0.018 782 522 1.071 0.029 0.607 0.680 HIV prevalence (15-49) 0.177 0.018 653 427 1.211 0.102 0.140 0.213 HIV prevalence (15-59) 0.173 0.017 737 479 1.232 0.099 0.139 0.208 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– na = Not applicable Appendix B | 291 Table B.8 Sampling errors for Senqu River Valley sample, Lesotho 2004 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Number of cases Stand- –––––––––––––––– Rela- ard Un- Weight- Design tive Confidence limits Value error weighted ed effect error –––––––––––––––– Variable (R) (SE) (N) (WN) (DEFT) (SE/R) R-2SE R+2SE ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– WOMEN ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Urban residence 0.101 0.018 704 437 1.546 0.174 0.066 0.136 No education 0.028 0.006 704 437 0.969 0.214 0.016 0.040 With secondary education or higher 0.346 0.028 704 437 1.576 0.082 0.290 0.403 Never married (in union) 0.413 0.026 704 437 1.384 0.062 0.361 0.464 Currently married (in union) 0.439 0.025 704 437 1.347 0.058 0.388 0.489 Had first sex before age 18 0.485 0.021 506 312 0.959 0.044 0.442 0.528 Children ever born 2.119 0.087 704 437 0.985 0.041 1.945 2.292 Children surviving 1.854 0.079 704 437 1.034 0.042 1.697 2.011 Children ever born to women 40-49 5.092 0.275 145 88 1.344 0.054 4.543 5.642 Knowing any contraceptive method 0.997 0.003 307 191 1.003 0.003 0.990 1.000 Knowing any modern contraceptive method 0.997 0.003 307 191 1.003 0.003 0.990 1.000 Ever used any contraceptive method 0.799 0.036 307 191 1.564 0.045 0.727 0.870 Currently using any contraceptive method 0.339 0.024 307 191 0.902 0.072 0.290 0.388 Currently using a modern method 0.310 0.025 307 191 0.955 0.081 0.260 0.361 Currently using pill 0.073 0.013 307 191 0.887 0.180 0.047 0.100 Currently using IUCD 0.014 0.005 307 191 0.734 0.354 0.004 0.024 Currently using condom 0.035 0.013 307 191 1.210 0.362 0.010 0.061 Currently using injectables 0.148 0.030 307 191 1.470 0.201 0.089 0.208 Currently using female sterilization 0.040 0.012 307 191 1.057 0.297 0.016 0.063 Currently using rhythm or periodic abstinence 0.000 0.000 307 191 na na 0.000 0.000 Currently using withdrawal 0.021 0.010 307 191 1.241 0.484 0.001 0.041 Obtained method from public sector source 0.628 0.047 173 100 1.287 0.075 0.534 0.723 Want no more children 0.597 0.022 307 191 0.797 0.037 0.552 0.642 Want to delay birth at least 2 years 0.218 0.025 307 191 1.039 0.112 0.169 0.267 Ideal number of children 2.825 0.074 704 437 1.331 0.026 2.677 2.973 Mothers received tetanus injection for last birth 0.803 0.025 294 190 1.101 0.031 0.752 0.853 Mothers received medical care at delivery 0.663 0.031 369 239 1.200 0.047 0.600 0.726 Child had diarrhoea in the past 2 weeks 0.135 0.017 333 215 0.891 0.125 0.101 0.169 Treated with ORS packets 0.294 0.045 46 29 0.662 0.153 0.204 0.384 Consulted medical personnel 0.134 0.044 46 29 0.867 0.324 0.047 0.221 Child having health card, seen 0.716 0.071 56 38 1.231 0.099 0.574 0.858 Child received BCG vaccination 1.000 0.000 56 38 na 0.000 1.000 1.000 Child received DPT vaccination (3 doses) 0.854 0.049 56 38 1.092 0.058 0.755 0.953 Child received polio vaccination (3 doses) 0.811 0.064 56 38 1.267 0.079 0.683 0.938 Child received measles vaccination 0.821 0.066 56 38 1.350 0.081 0.688 0.953 Child fully immunized 0.594 0.068 56 38 1.076 0.114 0.458 0.729 Height-for-age (-2SD) 0.446 0.039 192 120 1.004 0.087 0.368 0.523 Weight-for-height (-2SD) 0.096 0.033 192 120 1.488 0.340 0.031 0.162 Weight-for-age (-2SD) 0.274 0.033 192 120 1.041 0.121 0.208 0.340 Has heard of HIV/AIDS 0.958 0.018 704 437 2.318 0.018 0.923 0.993 Knows condoms reduce HIV/AIDS 0.821 0.023 704 437 1.559 0.027 0.776 0.867 Knows limiting partners reduce HIV/AIDS 0.857 0.019 704 437 1.474 0.023 0.818 0.896 Total fertility rate (past 3 years) 4.029 0.260 na 1201 1.007 0.065 3.508 4.549 Neonatal mortality (past 10 years) 38.742 9.751 675 430 1.268 0.252 19.240 58.245 Post-neonatal mortality (past 10 years) 43.949 11.017 675 430 1.449 0.251 21.916 65.983 Infant mortality (past 10 years) 82.692 14.257 675 430 1.358 0.172 54.178 111.206 Child mortality (past 10 years) 19.515 7.267 679 432 1.170 0.372 4.980 34.050 Under-five mortality (past 10 years) 100.593 14.194 679 432 1.238 0.141 72.205 128.982 HIV prevalence 0.251 0.024 335 192 1.019 0.096 0.203 0.299 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– MEN ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Urban residence 0.097 0.027 280 171 1.515 0.277 0.043 0.151 No education 0.209 0.037 280 171 1.502 0.175 0.136 0.282 With secondary education or higher 0.211 0.037 280 171 1.507 0.174 0.138 0.285 Never married (in union) 0.521 0.033 280 171 1.107 0.064 0.455 0.587 Currently married (in union) 0.394 0.034 280 171 1.179 0.088 0.325 0.463 Had first sex before age 18 0.311 0.047 151 93 1.251 0.152 0.216 0.405 Knowing any contraceptive method 1.000 0.000 113 67 na 0.000 1.000 1.000 Knowing any modern contraceptive method 0.991 0.009 113 67 1.035 0.009 0.972 1.000 Want no more children 0.557 0.059 113 67 1.261 0.106 0.438 0.675 Want to delay birth at least 2 years 0.264 0.052 113 67 1.244 0.196 0.160 0.367 Ideal number of children 3.655 0.139 276 169 1.297 0.038 3.378 3.932 Has heard of HIV/AIDS 0.957 0.022 247 148 1.702 0.023 0.913 1.000 Knows condoms reduce HIV/AIDS 0.780 0.030 247 148 1.149 0.039 0.719 0.840 Knows limiting partners reduce HIV/AIDS 0.809 0.031 247 148 1.246 0.039 0.747 0.871 HIV prevalence (15-49) 0.176 0.031 221 119 1.205 0.176 0.114 0.238 HIV prevalence (15-59) 0.172 0.023 252 138 0.966 0.134 0.126 0.218 ––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– na = Not applicable Appendix C | 293 DATA QUALITY TABLES Appendix C Table C.1 Household age distribution Single-year age distribution of the de facto household population by sex (weighted), Lesotho 2004 Female Male Female Male Age Number Per- centage Number Per- centage Age Number Per- centage Number Per- centage 0 377 2.2 408 2.6 36 173 1.0 122 0.8 1 376 2.2 369 2.4 37 126 0.7 88 0.6 2 412 2.4 420 2.7 38 145 0.8 116 0.8 3 394 2.3 405 2.6 39 152 0.9 131 0.8 4 394 2.3 414 2.7 40 168 1.0 94 0.6 5 351 2.0 393 2.5 41 156 0.9 78 0.5 6 455 2.6 467 3.0 42 146 0.8 99 0.6 7 487 2.8 450 2.9 43 128 0.7 83 0.5 8 432 2.5 475 3.1 44 161 0.9 105 0.7 9 423 2.5 457 2.9 45 130 0.8 80 0.5 10 445 2.6 496 3.2 46 149 0.9 89 0.6 11 481 2.8 443 2.9 47 113 0.7 87 0.6 12 508 2.9 501 3.2 48 121 0.7 98 0.6 13 522 3.0 518 3.3 49 93 0.5 72 0.5 14 522 3.0 502 3.2 50 155 0.9 90 0.6 15 334 1.9 464 3.0 51 145 0.8 57 0.4 16 388 2.2 466 3.0 52 183 1.1 100 0.6 17 349 2.0 379 2.4 53 120 0.7 63 0.4 18 386 2.2 392 2.5 54 154 0.9 91 0.6 19 337 2.0 344 2.2 55 107 0.6 46 0.3 20 324 1.9 335 2.2 56 146 0.8 84 0.5 21 328 1.9 299 1.9 57 111 0.6 69 0.4 22 315 1.8 319 2.1 58 95 0.6 66 0.4 23 248 1.4 269 1.7 59 110 0.6 53 0.3 24 301 1.7 276 1.8 60 98 0.6 79 0.5 25 262 1.5 222 1.4 61 63 0.4 89 0.6 26 215 1.2 226 1.5 62 128 0.7 113 0.7 27 204 1.2 203 1.3 63 73 0.4 54 0.4 28 193 1.1 167 1.1 64 150 0.9 107 0.7 29 212 1.2 191 1.2 65 87 0.5 62 0.4 30 184 1.1 190 1.2 66 75 0.4 76 0.5 31 159 0.9 151 1.0 67 60 0.3 40 0.3 32 188 1.1 154 1.0 68 98 0.6 55 0.4 33 141 0.8 110 0.7 69 69 0.4 53 0.3 34 172 1.0 152 1.0 70+ 1,052 6.1 556 3.6 35 160 0.9 102 0.7 28 0.2 17 0.1 Don't know/ missing Total 17,252 100.0 15,495 100.0 294 | Appendix C Table C.2 Age distribution of eligible and interviewed women De facto household population of women age 10-54 and men age 10-64, interviewed women age 15-49 and men age 15-59, and percentage of eligible women and men who were interviewed (weighted), by five-year age groups, Lesotho 2004 Interviewed women age 15-49 Age group Household population of women age 10-54 Number Percent Percent of women 10-14 2,480 na na na 15-19 1,793 1,661 24.1 92.6 20-24 1,517 1,428 20.7 94.1 25-29 1,085 1,015 14.7 93.6 30-34 844 802 11.6 95.0 25-39 757 710 10.3 93.8 40-44 760 715 10.4 94.1 45-49 607 567 8.2 93.4 50-54 757 na na na 15-49 7,363 6,898 100.0 93.7 Interviewed men age 15-59 Age group Household population of men age 10-64 Number Percent Percent of men 10-14 1,246 na na na 15-19 877 739 27.0 84.2 20-24 600 495 18.1 82.4 25-29 434 357 13.1 82.2 30-34 354 301 11.0 85.2 25-39 271 227 8.3 83.7 40-44 194 156 5.7 80.6 45-49 195 171 6.2 87.3 50-54 188 162 5.9 86.0 55-59 145 127 4.6 87.2 60-64 244 na na na 15-59 3,259 2,734 100.0 83.9 Note: The de facto population includes all residents and nonresidents who stayed in the household the night before the interview. Weights for both household population of women and interviewed women are household weights. Age is based on the household schedule. na = Not applicable Appendix C | 295 Table C.3 Completeness of reporting Percentage of observations missing information for selected demographic and health questions (weighted), Lesotho 2004 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Percentage with Number missing of Subject Reference group information cases –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– Birth date Births in the 15 years preceding the survey Month only 0.69 9,691 Month and year 0.17 9,691 Age at death Deceased children born in the 15 years preceding the survey 0.66 943 Age/date at first union1 Ever-married women age 15-49 1.09 4,722 Respondent's education All women age 15-49 0.21 7,095 Diarrhoea in last 2 weeks Living children age 0-59 months 4.28 3,227 Anthropometry Living children age 0-59 months (from the Height household questionnaire) 8.28 1,937 Weight 7.76 1,937 Height or weight 8.38 1,937 Anaemia Children Living children agre 0-59 months (from the household questionnaire) 17.09 1,730 Women All women age 15-49 (from the household questionnaire) 26.45 3,672 –––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––––– 1 Both year and age missing 296 | Appendix C Table C.4 Births by calendar years Number of births, percentage with complete birth date, sex ratio at birth, and calendar year ratio by calendar year, according to living, dead, and total children (weighted), Lesotho 2004 Number of births Percentage with complete birth date1 Sex ratio at birth2 Calendar year ratio3 Calendar year Living Dead Total Living Dead Total Living Dead Total Living Dead Total 2004 673 48 721 100.0 95.2 99.7 84.8 63.4 83.2 na na na 2003 669 86 755 99.7 100.0 99.7 109.3 71.3 104.2 101.7 176.8 106.8 2002 644 49 693 100.0 100.0 100.0 96.0 100.4 96.3 100.4 63.5 96.4 2001 614 69 683 99.6 96.7 99.3 89.8 117.9 92.3 100.4 107.7 101.1 2000 579 80 659 100.0 93.8 99.3 96.4 106.6 97.6 99.1 119.7 101.2 1999 556 64 619 99.1 97.2 98.9 95.3 48.9 89.3 92.8 78.6 91.1 1998 619 82 701 99.3 96.8 99.0 112.3 72.7 106.8 108.1 125.5 109.9 1997 589 68 657 99.4 95.4 99.0 106.9 67.0 101.9 97.8 99.3 97.9 1996 586 54 639 99.7 98.2 99.5 91.8 76.8 90.5 104.5 95.1 103.6 2001-2005 2,602 252 2,854 99.8 98.2 99.7 94.8 85.8 93.9 na na na 1996-2000 2,929 347 3,276 99.5 96.1 99.1 100.5 73.6 97.2 na na na 1991-1995 2,650 285 2,935 99.2 94.1 98.7 104.0 83.7 101.8 na na na 1986-1990 2,283 238 2,521 98.8 92.3 98.2 93.6 83.7 92.7 na na na < 1986 2,560 439 2,998 99.0 97.1 98.8 98.5 85.8 96.5 na na na All 13,023 1,561 14,584 99.3 95.8 98.9 98.4 82.3 96.5 na na na na = Not applicable 1 Both year and month of birth given 2 (Bm/Bf)x100, where Bm and Bf are the numbers of male and female births, respectively 3 [2Bx/(Bx-1+Bx+1)]x100, where Bx is the number of births in calendar year x Appendix C | 297 Table C.5 Reporting of age at death in days Distribution of reported deaths under one month of age by age at death in days and the percentage of neonatal deaths reported to occur at ages 0-6 days, for five-year periods of birth preceding the survey (weighted), Lesotho 2004 Number of years preceding the survey Age at death (days) 0-4 5-9 10-14 15-19 Total 0-19 <1 47 49 46 26 169 1 53 39 28 20 140 2 12 10 16 3 40 3 6 13 11 7 37 4 4 0 0 0 4 5 8 4 2 1 15 6 3 2 1 1 7 7 8 6 7 2 23 8 3 0 0 0 3 9 0 1 1 0 2 10 0 1 0 4 6 12 1 0 1 2 4 14 6 5 4 7 22 15 1 1 1 0 3 17 0 0 0 1 1 21 6 4 1 1 11 28 0 0 1 0 1 29 0 1 0 1 2 30 0 0 4 0 4 31+ 0 0 1 0 1 Total 0-30 159 136 123 77 495 Percent early neonatal1 83.8 85.9 83.5 76.7 83.2 1 = 6 days / = 30 days 298 | Appendix C Table C.6 Reporting of age at death in months Distribution of reported deaths under two years of age by age at death in months and the percentage of infant deaths reported to occur at age under one month, for five- year periods of birth preceding the survey, Lesotho 2004 Number of years preceding the survey Age at death (months) 0-4 5-9 10-14 15-19 Total 0-19 <1a 159 136 126 77 498 1 14 20 14 21 68 2 13 17 12 6 48 3 37 14 13 7 71 4 11 6 15 8 39 5 12 4 6 4 26 6 18 9 9 6 41 7 6 9 6 4 26 8 14 7 7 4 32 9 10 6 12 5 32 10 2 4 2 0 7 11 7 3 2 6 18 12 3 1 3 4 10 13 1 0 0 2 4 14 0 2 3 0 5 15 1 0 0 0 1 16 1 0 0 0 1 17 2 0 0 2 5 18 5 1 1 5 12 19 1 0 0 0 1 20 1 0 0 0 1 21 0 0 1 0 1 23 1 1 0 0 1 1 year 8 6 12 9 34 Total 0-11 303 234 222 147 906 Percent neonatal1 52.4 58.3 56.8 52.3 55.0 a Includes deaths under one month reported in days 1 Under one month/under one year Appendix D | 299 PERSONS INVOLVED IN THE 2004 LESOTHO DEMOGRAPHIC AND HEALTH SURVEY Appendix D Administration Majoel Makhakhe Mahlape Ramoseme John Nkonyana Matsotang Tsietsi Survey Director Survey/Field Coordinator Survey/Field Coordinator Field Coordinator Matlokotsi Makoa Malijane Nyabela Thabang Mpeka Field Coordinator Field Coordinator Field Coordinator Technical Team Mrs. ‘Majoel Makhakhe (MOHSW) Dr. Yolisa Mashologu (MOHSW) Dr. Davis Rumisha (MOHSW) Ms. ‘Mamoruti Tiheli (MOHSW) Ms ‘Malijane Nyabela (MOHSW) Mr. Khabiso Ntoampe (MOHSW) Ms ‘Maleqhoa Nyopa (MOHSW) Dr. Phiny Hanson (DCI) Mr. Peter Phori (WHO) Ms Tšoamathe ‘Maseribane (BOS) Dr. Agostino Munyiri (UNICEF) Ms Ntsoaki Mapetla (NUL) Ms ‘Mantsane Tšoloane-Bolepo (NUL) Ms Victoria Diarra (UNDP) Mrs. Nkhala Sefako (LAPCA) Ms Mahlape Ramoseme (MOHSW) Ms ‘Matjotjela Chaphi (MOHSW) Mr. John Nkonyana (MOHSW) Mrs. ‘Mamosa Tlopo (MOHSW) Dr. Maw (MOHSW) Mr. David Mothabeng (MOHSW) Ms Paula Nolan (DCI) Dr. Samuel Sackey (WHO) Mrs. ‘Matsotang Tsietsi (BOS) Mrs. ‘Matlokotsi Makoa (BOS) Dr. ‘Maletela Tuoane (National University of Lesotho - NUL) Mrs. ‘Mapitso Lebuso (NUL) Dr. Nthabiseng Makoa (NUL) Dr. Tetteh Dugbaza (UNFPA) Ms Lipalesa Selokoma (FNCO) Adaptation of the Questionnaire Dr. Phiny Hanson (DCI) Ms Ntsoaki Mapetla (NUL) Mrs. ‘Mapitso Lebuso (BOS) Ms ‘Mamalula Sello (BOS) Dr. Yolisa Mashologu (MOHSW) Ms Selemeng Tšosane (BOS) Ms ‘Mantsane Tšoloane-Bolepo (NUL) Ms Victoria Diarra (UNDP) Mrs. ‘Mamosa Tlopo (MOHSW) Ms ‘Matjotjela Chaphi (MOHSW) Mr. John Nkonyana (MOHSW) Dr. Tetteh Dugbaza (UNFPA) Dr. Davis Rumisha (MOHSW) ‘Maletela Tuoane (NUL) ‘Matsotang Tsietsi (BOS) Ms Tšoamathe ‘Maseribane (BOS) Mrs. ‘Matlokotsi Makoa (BOS) Ms Mahlape Ramoseme (MOHSW) Ms ‘Masentle Malebo (BOS) Dr. Nthabiseng Makoa (NUL) Dr. Masekonyela Sebotsa (FNCO) Ms ‘Malijane Nyabela (MOHSW) Mr. Moseli Khoeli (MOHSW) Ms ‘Masebeo Koto (MOHSW) Dr. Samuel Sackey (WHO) Dr. M. Maw (MOHSW) Questionnaire Translation Mrs. ‘Mamosa Tlopo (MOHSW) Ms ‘Masebeo Koto (MOHSW) Mrs. ‘Matsotang Tsietsi (BOS) Mrs. ‘Mapitso Lebuso (BOS) Mr. Pelesana Moerane (BOS) Mr. Goodman Makojoa (BOS) Mr. Thabang Mpeka (BOS) Ms Selemeng Tšosane (BOS) Ms Mahlape Ramoseme (MOHSW) Mr. John Nkonyana (MOHSW) Ms Tšoamathe ‘Maseribane (BOS) Mrs. Botsoa Hloaele (BOS) Mrs. ‘Matlokotsi Makoa (BOS) Mr. Emisang Tšosane (BOS) Ms ‘Masentle Malebo (BOS) Back-Translation of the Questionnaire and Synchronisation Mrs. Agnes Lephoto (CHAL) Dr. Kelello Lerotholi (Consultant) Questionnaire Pretest Ms Mahlape Ramoseme (MOHSW) Ms ‘Malijane Nyabela (MOHSW) Mrs Florence Mohai (MOHSW) Mrs. ‘Matsotang Tsietsi (BOS) Ms Tšoamathe ‘Maseribane (BOS) Mrs. ‘Mapitso Lebuso (BOS) Ms ‘Mamalula Sello (BOS) Mr. Pelesana Moerane (BOS) Ms Lipalesa Selokoma (FNCO) Mr. John Nkonyana (MOHSW) Mrs. Blandinah Motaung (MOHSW) Ms Khasiane Kabi (MOHSW) Mrs. ‘Matlokotsi Makoa (BOS) Mr. Emisang Tšosane (BOS) Mr. Thabang Mpeka (BOS) Mr. Rampa Motloheloa (BOS) Mr. Tšiu Litšiba (BOS) Ms Molulela Mojakhomo (FNCO) 300 | Appendix D Household Listing Ms Mahlape Ramoseme Mr. Thabang Mpeka Ms ‘Mamotena ‘Maseribane Mr. Joshua Ramotšeoa Ms Nomasondo Monaphathi Mr. Monono Ramangoaele Ms ‘Malebatla Makhaba Ms ‘Mamohale Ntoi Ms ‘Maphoka Kompi Mr. Mokotjo Litšiba Ms ‘Masechaba ‘Makong Ms ‘Mafusi Rafutho Ms ‘Masempe Maqekoane Mr. Motebang Ntokoane Ms Palesa Leshota Ms Francina Masupha Ms ‘Manako Mafoea Mr. Pelesana Moerane Mr. Tšiu Litšiba Mr. Mei Thibeli Mr. Lelimo Manei Mrs. ‘Malydia Teli Mrs. ‘Mamphuthi Phafoli Mr. Tšeliso Nkoefoshe Mr. Malefetsane Makotoko Ms ‘Mamolitsane Thoothe Ms Sandra Mthombeni Mrs. ‘Matsotang Tsietsi Mr. John Nkonyana Mr. Mongali Mohapi Mr. Matete Mahao Mr. David Matsoko Ms Tšenolo Pheko Ms Paballo Mosuoane Ms Morongoenyane Ntšema Ms ‘Mantle Sehlahla Mr. Otlise Tlale Ms ‘Mabohlokoa Lebusa Mr. Moroa Mohloboli Ms ‘Mabalefe Letšela Ms ‘Mamakafane Thai Mr. Justice Phera Ms ‘Mammuso Motsapi Ms ‘Mamonaheng Monyane Ms ‘Masebeo Koto Ms Tlotliso Pali Mr. Rethabile Sethaba-thaba Mr. Mokoena Makenete Ms ‘Meisi Kunene Mr. Ramonono Khati Mr. Koena Matjama Mr. Mokoena Lesenyeho Mr. Tumane Mahloane Ms Teboho Masienyane Team 1 Team member Team rank District Thato Williams Mantoa Mabele Marou Tjotjo Blandinah Motaung Tšeliso Makhele Tiisetso Elias Supervisor (Male) Editor (Female) Male Interviewer Female Interviewer Male Interviewer Male Interviewer Butha-Buthe & Leribe Team 2 Team member Team rank District S. Hlalele Tšoamathe 'Maseribane Tsimane Tsimane Khethisa Kabi Puleng Sello Sello Mahloane Ramalefane Tšehlana Supervisor (Male) Editor (Female) Male Interviewer Male Interviewer Female Interviewer Male Interviewer Female Interviewer Butha-Buthe & Leribe Team 3 Team member Team rank District Moseli Khoeli Mapitso Lebuso Motlalepula Fako Mathabiso Mapiloko Nkhereanye Machake Buasono Klass Supervisor (Male) Editor (Female) Male Interviewer Female Interviewer Male Interviewer Male Interviewer Leribe & Berea Team 4 Team member Team rank District Teboho Motleleng Molulela Mojakhomo Motloang Lemeko Matlotlo Maraka Matete Mahao Tlokotsi Khatlile Supervisor (Male) Editor (Female) Male Interviewer Female Interviewer Male Interviewer Male Interviewer Berea & Maseru Appendix D | 301 Team 5 Team member Team rank District Lesiamo Lenono Masempe Moreki Ntoa Machema Matjotjela Chaphi Bereng Mokoara Bokang Phoka Supervisor (Male) Editor (Female) Male Interviewer Female Interviewer Male Interviewer Male Interviewer Maseru Team 6 Team member Team rank District Makanya Pholoana Mohale Ntlama Joshua Mohapi Malile Mashaile Mamosa Tlopo John Thuso Supervisor (Male) Editor (Male) Male Interviewer Female Interviewer Female Interviewer Male Interviewer Maseru, Mafeteng & Mohale's Hoek Team 7 Team member Team rank District Mojalefa Mosoeu Masentle Malebo Rerang Chabeli Matebello Tsiki Puseletso Maphalla Toka Thejane Supervisor (Male) Editor (Female) Male Interviewer Female Interviewer Female Interviewer Male Interviewer Mohale's Hoek Team 8 Team member Team rank District Lebohang Lephoi Maseatile Mothibeli Phakiso Mohlakeng Mpoeea Sehlomeng Rahaba Mosenene Lebohang Mosuoe Supervisor (Male) Editor (Female) Male Interviewer Female Interviewer Female Interviewer Male Interviewer Mohale's Hoek Team 9 Team member Team rank District Tšeliso Phafoli Motlatsi Malitse Ralikonelo Jockey Teboho Makakole Motloang Behle Manneko Posholi Supervisor (Male) Editor (Male) Male Interviewer Female Interviewer Male Interviewer Female Interviewer Quthing & Mohale's Hoek Team 10 Team member Team rank District Pheello Ramonene Ntswaki Zwane Motšoanakaba Leburu Lieketseng Motjolopane Bokang Makamole Mahase Liphoto Mahlomola Rakauoane Supervisor (Male) Editor (Female) Male Interviewer Female Interviewer Female Interviewer Male Interviewer Male Interviewer Qacha's Nek, Mohale's Hoek & Maseru 302 | Appendix D Team 11 Team member Team rank District Rampa Motloheloa Joalane Putsoa Lehlohonolo Ramphalla Thuso Tlhaole Malefetsane Molapo Lisemelo Zakia Supervisor (Male) Editor (Female) Male Interviewer Female Interviewer Male Interviewer Female Interviewer Thaba-Tseka Team 12 Team member Team rank District Pelesana Moerane Lipalesa Selokoma Masienyane Seeta Ellen Moshesha Seetsa Molapo Khasiane Kabi Supervisor (Male) Editor (Female) Male Interviewer Female Interviewer Male Interviewer Female Interviewer Mokhotlong Data Processing Emisang Tšosane Botsoa Hloaele Goodman Makojoa Selemeng Tšosane Masebeo Koto Joshua Ramotšeoa Matšeliso Tšosane Mokoena Makenete Mokati Sebalo Theko Marie Francina Pitso Data Administrator Supervisor Supervisor Secondary Editor Secondary Editor Office Editor Office Editor Data Clerk Data Clerk Data Clerk Data Clerk Litsietsi Nthunya 'Malydia Teli Lysbeth Mokhele Matšeliso Tšepe 'Meisi Kunene Sandra Mthombeni Moneane Lefa 'Mamphuthi Phafoli Koena Matjama Nthabiseng Shale Mafoso Maqelepo Data Clerk Data Clerk Data Clerk Data Clerk Data Clerk Data Clerk Data Clerk Data Clerk Data Clerk Data Clerk Data Clerk Laboratory Technicians Motsamai Mothabeng 'Maleqhoa Nyopa 'Mamonyane Morebotsane 'Matau Lechaka Supervisor Supervisor Lab Technician Lab Technician Taole Ramaili Refiloe Sekoboto-Tikiso Motlatsi Pelesa Mary Sekautu Lab Technician Lab Technician Lab Technician Lab Technician Social Mobilisation Ms Nthati Lebona (MOHSW) Ms Palesa Mokoena (MOHSW) Mr. Khabiso Ntoampe (MOHSW) Mr. Mojela Matsoso (MOHSW) Mr. Lehlohonolo Makara (MOHSW) Ms ‘Mathato Pule (MOHSW) Mr. Masupha Molapo (MOHSW) Ms Ntšebo Lejaha (MOHSW) Mr. Mohlouoa Makatla (MOHSW) Ms ‘Mamorao Khaebana (MOHSW) Ms Puleng Ramphalla (MOHSW) Mrs. Nkareng Mosala (MOHSW) Mr. Seeta Matšela (MOHSW) Ms ‘Machaka Mahoholi (MOHSW) Mr. Chooko Ntšihlele (MOHSW) Mr. Mojalefa Mapiloko (MOHSW) Mr. Sempe Masupha (MOHSW) Ms Ntšebo Moremoholo (MOHSW) Preliminary Report Ms Mahlape Ramoseme (MOHSW) Dr. Davis Rumisha (MOHSW) Ms ‘Masebeo Koto (MOHSW) Mr. Moseli Khoeli (MOHSW) Ms Ellen Moshesha (MOHSW) Dr. Bosielo Majara (MOHSW) Mrs Blandinah Motaung (MOHSW) Ms ‘Machaka Mahoholi (MOHSW) Dr. Phiny Hanson (DCI) Mrs. ‘Mapitso Lebuso (NUL) Ms ‘Machaka Mahoholi (MOHSW) Mr. John Nkonyana (MOHSW) Dr. Campbell Katito (MOHSW) Mr. Mojalefa Mosoeu (MOHSW) Dr. Limpho Maile (MOHSW) Ms ‘Malijane Nyabela (MOHSW) Ms Khasiane Kabi (MOHSW) Ms Teboho Ramonono (MOHSW) Mrs. Nthabiseng Mohobane (MOHSW) Ms Lipalesa Selokoma (FNCO) Ms ‘Mathabo Liphapang (LPPA) Appendix D | 303 Final Report Reviewers Ms. 'Masebeo Koto Mrs. 'Matlokotsi Makoa Mr. John Nkonyana Ms. Mahlape Ramoseme Chapter Reviewers Chapter 1 Introduction Mr. Thabang Mpeka Dr. Davis Rumisha Chapter 2 Household Population and Characteristics Ms 'Masebeo Koto Mrs. Nthabiseng Mohobane Mr. Masauso Nzima Mrs. 'Matsotang Tsietsi Chapter 3 Characteristics of Survey Respondents Ms. 'Masebeo Koto Mrs. Nthabiseng Mohobane Mr. Masauso Nzima Mrs. 'Matsotang Tsietsi Chapter 4 Fertility Level, Trends and Differentials Mr. Tefo Lepheana Mrs. 'Matlokotsi Makoa Ms Teboho Ramonono Ms Lipalesa Selokoma Chapter 5 Family Planning Mr. Tefo Lepheana Mrs. 'Matlokotsi Makoa Ms Lipalesa Selokoma Chapter 6 Other Priximate Determinants of Fertility Mr. Tefo Lepheana Mrs. 'Matlokotsi Makoa Ms Teboho Ramonono Ms Lipalesa Selokoma Chapter 7 Fertility Preferences Mr. Tefo Lepheana Mrs. 'Matlokotsi Makoa Ms Lipalesa Selokoma Chapter 8 Infant and Child Mortality Dr. Campbell Katito Chapter 9 Maternal and Child Health Dr. Campbell Katito Mrs. Agnes Lephoto Ms Motšelisi Mathe Dr. M. Moteetee Dr. Agostino Munyiri Mr. John Nkonyana Ms 'Mantsane Tšoloane-Bolepo Chapter 10 Nutrition Ms 'Malibuseng Moeketse Ms 'Malijane Nyabela Chapter 11 HIV/AIDS Related Knowledge, Attitude and Behaviour Mrs. Blandinah Motaung Mr. Masauso Nzima Chapter 12 HIV Prevalence and Associated Factors Ms 'Masebeo Koto Dr. Yolisa Mashologu Ms Mahlape Ramoseme Chapter 13 Tuberculosis Mr. M. Nzima Chapter 14 Adult and Maternal Mortality Dr. Campbell Katito Chapter 15 Father's Participation in Family Health Care Ms 'Masebeo Koto Ms Mahlape Ramoseme 304 | Appendix D ORC Macro Staff Ann Way Zhuzhi Moore Alfredo Aliaga Sherrell Goggin Keith Purvis Albert Themme Ruilin Ren Kumbutso Dzekedzeke Chanda Mulenga Sidney Moore Kaye Mitchell Hena Khan John Chang Vice President Country Manager Senior Sampling Expert Data Processing Specialist Data Processing Specialist Data Processing Specialist Sampling Specialist Consultant, Interviewer Training Consultant, Biomarker Specialist Editor Report Production Graphic Design Graphic Design Appendix E | 303 QUESTIONNAIRES Appendix E 21 August, 2004 LESOTHO DEMOGRAPHIC AND HEALTH SURVEY 2004 HOUSEHOLD QUESTIONNAIRE IDENTIFICATION PLACE NAME NAME OF HOUSEHOLD HEAD EA NUMBER . HOUSEHOLD NUMBER . LESOTHO ECOLOGICAL ZONE . (LOWLANDS=1, FOOTHILLS=2, MOUNTAINS=3, SENQU RIVER VALLEY=4) DISTRICT 1 . URBAN/RURAL (URBAN=1, RURAL=2) . HOUSEHOLD SELECTED FOR MALE/HIV/ANEMIA/ANTHROPOMETRY? (YES=1, NO=2) . ňņņŎņņŎņņʼn Ň ųŇųųŇ ųŇ ŊņņŐņņŐņņō Ňų Ň ųŇ ŊņņŐņņō ųųŇ ųŇ ňņņŐņņō ŇųųŇ ųŇ ŊņņŐņņō ŇųųŇ Ōņņō ŇųųŇ Ŋņņŋ INTERVIEWER VISITS 1 2 3 FINAL VISIT DATE INTERVIEWER’S NAME RESULT* ňņņŎņņʼn DAY ŇųųŇųųŇ ŌņņŐņņō MONTH ŇųųŇųųŇ ňņņŎņņŐņņŐņņō YEAR ŇųųŇ ŇųųŇųųŇ ŊņņŏņņŐņņŐņņō NAME ŇųųŇųųŇ ŊņņŐņņō RESULT ŇųųŇ Ŋņņŋ NEXT VISIT: DATE TIME TOTAL NO. OF VISITS ňņņʼn ŇųųŇ Ŋņņŋ TOTAL PERSONS IN HOUSEHOLD ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ TOTAL ELIGIBLE WOMEN ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ TOTAL ELIGIBLE MEN ňņņŎņņʼn Ň Ň Ň Ŋņņŏņņŋ *RESULT CODES: 1 COMPLETED 2 NO HOUSEHOLD MEMBER AT HOME OR NO COMPETENT RESPONDENT AT HOME AT TIME OF VISIT 3 ENTIRE HOUSEHOLD ABSENT FOR EXTENDED PERIOD OF TIME 4 POSTPONED 5 REFUSED 6 DWELLING VACANT OR ADDRESS NOT A DWELLING 7 DWELLING DESTROYED 8 DWELLING NOT FOUND 9 OTHER (SPECIFY) LINE NO. OF RESP. TO HOUSEHOLD QUEST. ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ FIELD EDITOR SUPERVISOR OFFICE EDITOR KEYED BY NAME NAME DATE ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ DATE ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ 1 01=BUTHA-BUTHE; 02=LERIBE; 03=BEREA; 04=MASERU; 05=MAFETENG; 06=MOHALE’S HOEK; 07=QUTHING; 08=QASHA’S NEK; 09=MOKHOTLONG; 10=THABA-TSEKA 305Appendix E | HOUSEHOLD SCHEDULE Now we would like some information about the people who usually live in your household or who are staying with you now. LINE NO. USUAL RESIDENTS AND VISITORS RELATION- SHIP TO HEAD OF HOUSE- HOLD RESIDENCE SEX AGE ELIGIBILITY Please give me the names of the persons who usually live in your household and visitors who stayed here last night, starting with the head of the household. What is the relationship of (NAME) to the head of the household?* Does (NAME) usually live here, or elsewhere in Lesotho, or outside Lesotho?** In which country outside Lesotho does (NAME) usually live?*** How long has (NAME) lived in (COUNTRY)? IF LESS THAN 1 YEAR, RECORD ‘00’. RECORD ‘98’ FOR ‘DON’T KNOW’. Did (NAME) sleep here last night? Is (NAME) male or female? How old is (NAME) in completed years? CIRCLE LINE NUMBER OF ALL WOMEN AGE15-49 WHO ARE USUAL RESI- DENTS (COL. 4) AND/OR SLEPT THERE LAST NIGHT (COL. 7) CIRCLE LINE NUMBER OF ALL CHILD-REN UNDER AGE 6 WHO ARE USUAL RESI- DENTS (COL. 4) AND/OR SLEPT THERE LAST NIGHT (COL. 7) CIRCLE LINE NUMBER OF ALL MEN AGE15-59 WHO ARE USUAL RESI- DENTS (COL. 4) AND/OR SLEPT THERE LAST NIGHT (COL. 7) (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) UR EL OUT IN YEARS YES NO M F IN YEARS 01 ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ 1 2 3 �Ŋņņō GO ŋ TO 7 ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ 1 2 1 2 ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ 01 01 01 02 ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ 1 2 3 �Ŋņņō GO ŋ TO 7 ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ 1 2 1 2 ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ 02 02 02 03 ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ 1 2 3 �Ŋņņō GO ŋ TO 7 ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ 1 2 1 2 ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ 03 03 03 04 ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ 1 2 3 �Ŋņņō GO ŋ TO 7 ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ 1 2 1 2 ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ 04 04 04 05 ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ 1 2 3 �Ŋņņō GO ŋ TO 7 ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ 1 2 1 2 ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ 05 05 05 06 ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ 1 2 3 �Ŋņņō GO ŋ TO 7 ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ 1 2 1 2 ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ 06 06 06 07 ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ 1 2 3 �Ŋņņō GO ŋ TO 7 ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ 1 2 1 2 ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ 07 07 07 08 ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ 1 2 3 �Ŋņņō GO ŋ TO 7 ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ 1 2 1 2 ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ 08 08 08 09 ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ 1 2 3 �Ŋņņō GO ŋ TO 7 ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ 1 2 1 2 ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ 09 09 09 10 ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ 1 2 3 �Ŋņņō GO ŋ TO 7 ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ 1 2 1 2 ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ 10 10 10 * CODES FOR Q.3 RELATIONSHIP TO HEAD OF HOUSEHOLD: 01 = HEAD 02 = SPOUSE 03 = CHILD (SON OR DAUGHTER) 04 = SON-IN-LAW/DAUGHTER-IN-LAW 05 = GRANDCHILD 06 = GREAT GRANDCHILD 07 = PARENT/PARENT-IN-LAW 08 = SIBLING (BROTHER OR SISTER) 09 = OTHER RELATIVE 10 = DOMESTIC EMPLOYEE 11 = HERDBOY 12 = ADOPTED/FOSTER/STEPCHILD 13 = OTHER PERSON NOT RELATED ** CODES FOR Q.4 *** CODES FOR Q. 5 RESIDENTIAL STATUS: COUNTRY OF USUAL RESIDENCE: UR = USUAL RESIDENT 01 = RSA EL = ELSEWHERE IN LESOTHO 02 = SWAZILAND OUT = OUTSIDE LESOTHO 03 = BOTSWANA 04 = NAMIBIA 05 = ZIMBABWE 06 = ZAMBIA 07 = MOZAMBIQUE 08 = ANGOLA 09 = TANZANIA 10 = MALAWI 11 = OTHER AFRICA 12 = UNITED STATES OF AMERICA 13 = ASIA 14 = EUROPE 96 = OTHER 98 = DON’T KNOW 306 | Appendix E LINE NO. PARENTAL SURVIVORSHIP AND RESIDENCE FOR PERSONS LESS THAN 18 YEARS OLD**** EDUCATION IF ALIVE IF ALIVE IF AGE 5 YEARS OR OLDER IF AGE 5-24 YEARS Is (NAME)’s natural mother alive? Does (NAME)’s natural mother live in this house- hold? IF YES: What is her name? RECORD MOTHER’S LINE NUMBER Is (NAME)’s natural father alive? Does (NAME)’s natural father live in this house- hold? IF YES: What is his name? RECORD FATHER’S LINE NUMBER Has (NAME) ever attended school? What is the highest level of school (NAME) has attended?***** What is the highest standard/form/year (NAME) completed at that level?***** Is (NAME) currently attending school? During the current school year, did (NAME) attend school at any time? During the current school year, what level and standard/form/year is (NAME) attending?***** During the previous school year, did (NAME) attend school at any time? During that school year, what level and standard/form/year did (NAME) attend?***** (13) (14) (15) (16) (17) (18) (19) (20) (21) (22) (23) YES NO DK YES NO DK YES NO LEVEL STND/FRM/ YR YES NO YES NO LEVEL STND/FRM/ YR YES NO LEVEL STND/FRM/ YR 01 1 2 8 �����Ŋņņō GO ŋ TO 15 ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ 1 2 8 �����Ŋņņō GO ŋ TO 17 ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ 1 2 NEXT ŋ LINE ňņņʼn ŇųųŇ Ŋņņŋ ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ 1 2 Ŋ� GO TO 21 1 2 GO ŋ TO 22 ňņņʼn ŇųųŇ Ŋņņŋ ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ 1 2 NEXT ŋ LINE ňņņʼn ŇųųŇ Ŋņņŋ ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ 02 1 2 8 �����Ŋņņō GO ŋ TO 15 ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ 1 2 8 �����Ŋņņō GO ŋ TO 17 ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ 1 2 NEXT ŋ LINE ňņņʼn ŇųųŇ Ŋņņŋ ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ 1 2 Ŋ� GO TO 21 1 2 GO ŋ TO 22 ňņņʼn ŇųųŇ Ŋņņŋ ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ 1 2 NEXT ŋ LINE ňņņʼn ŇųųŇ Ŋņņŋ ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ 03 1 2 8 �����Ŋņņō GO ŋ TO 15 ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ 1 2 8 �����Ŋņņō GO ŋ TO 17 ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ 1 2 NEXT ŋ LINE ňņņʼn ŇųųŇ Ŋņņŋ ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ 1 2 Ŋ� GO TO 21 1 2 GO ŋ TO 22 ňņņʼn ŇųųŇ Ŋņņŋ ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ 1 2 NEXT ŋ LINE ňņņʼn ŇųųŇ Ŋņņŋ ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ 04 1 2 8 �����Ŋņņō GO ŋ TO 15 ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ 1 2 8 �����Ŋņņō GO ŋ TO 17 ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ 1 2 NEXT ŋ LINE ňņņʼn ŇųųŇ Ŋņņŋ ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ 1 2 Ŋ� GO TO 21 1 2 GO ŋ TO 22 ňņņʼn ŇųųŇ Ŋņņŋ ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ 1 2 NEXT ŋ LINE ňņņʼn ŇųųŇ Ŋņņŋ ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ 05 1 2 8 �����Ŋņņō GO ŋ TO 15 ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ 1 2 8 �����Ŋņņō GO ŋ TO 17 ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ 1 2 NEXT ŋ LINE ňņņʼn ŇųųŇ Ŋņņŋ ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ 1 2 Ŋ� GO TO 21 1 2 GO ŋ TO 22 ňņņʼn ŇųųŇ Ŋņņŋ ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ 1 2 NEXT ŋ LINE ňņņʼn ŇųųŇ Ŋņņŋ ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ 06 1 2 8 �����Ŋņņō GO ŋ TO 15 ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ 1 2 8 �����Ŋņņō GO ŋ TO 17 ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ 1 2 NEXT ŋ LINE ňņņʼn ŇųųŇ Ŋņņŋ ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ 1 2 Ŋ� GO TO 21 1 2 GO ŋ TO 22 ňņņʼn ŇųųŇ Ŋņņŋ ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ 1 2 NEXT ŋ LINE ňņņʼn ŇųųŇ Ŋņņŋ ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ 07 1 2 8 �����Ŋņņō GO ŋ TO 15 ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ 1 2 8 �����Ŋņņō GO ŋ TO 17 ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ 1 2 NEXT ŋ LINE ňņņʼn ŇųųŇ Ŋņņŋ ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ 1 2 Ŋ� GO TO 21 1 2 GO ŋ TO 22 ňņņʼn ŇųųŇ Ŋņņŋ ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ 1 2 NEXT ŋ LINE ňņņʼn ŇųųŇ Ŋņņŋ ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ 08 1 2 8 �����Ŋņņō GO ŋ TO 15 ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ 1 2 8 �����Ŋņņō GO ŋ TO 17 ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ 1 2 NEXT ŋ LINE ňņņʼn ŇųųŇ Ŋņņŋ ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ 1 2 Ŋ� GO TO 21 1 2 GO ŋ TO 22 ňņņʼn ŇųųŇ Ŋņņŋ ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ 1 2 NEXT ŋ LINE ňņņʼn ŇųųŇ Ŋņņŋ ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ 09 1 2 8 �����Ŋņņō GO ŋ TO 15 ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ 1 2 8 �����Ŋņņō GO ŋ TO 17 ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ 1 2 NEXT ŋ LINE ňņņʼn ŇųųŇ Ŋņņŋ ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ 1 2 Ŋ� GO TO 21 1 2 GO ŋ TO 22 ňņņʼn ŇųųŇ Ŋņņŋ ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ 1 2 NEXT ŋ LINE ňņņʼn ŇųųŇ Ŋņņŋ ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ 10 1 2 8 �����Ŋņņō GO ŋ TO 15 ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ 1 2 8 �����Ŋņņō GO ŋ TO 17 ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ 1 2 NEXT ŋ LINE ňņņʼn ŇųųŇ Ŋņņŋ ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ 1 2 Ŋ� GO TO 21 1 2 GO ŋ TO 22 ňņņʼn ŇųųŇ Ŋņņŋ ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ 1 2 NEXT ŋ LINE ňņņʼn ŇųųŇ Ŋņņŋ ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ **** Q.13 THROUGH Q.16: THESE QUESTIONS REFER TO THE BIOLOGICAL PARENTS OF THE CHILD. IN Q.14 AND Q.16, RECORD ‘00’ IF PARENT NOT LISTED IN HOUSEHOLD SCHEDULE. *****CODES FOR Qs. 18, 21 AND 23: EDUCATION CODES: LEVEL: STANDARD/FORM/YEAR: . 00 = LESS THAN 1 YEAR COMPLETED (FOR Q. 18 ONLY. THIS CODE IS NOT ALLOWED FOR Qs. 21 AND 23) . LEVEL 1 = PRIMARY STANDARD 01-07 = LEVEL 1 (PRIMARY) . LEVEL 2 = VOCATIONAL/TECHNICAL TRAINING AFTER PRIMARY YEAR 01-06 = LEVEL 2 (VOC/TECHN. AFTER PRIMARY) . LEVEL 3 = SECONDARY/HIGH FORM 01-05 = LEVEL 3 (SECONDARY/HIGH) . LEVEL 4 = VOCATIONAL/TECHNICAL TRAINING AFTER SECONDARY YEAR 01-06 = LEVEL 4 (VOC/TECHN. AFTER SECONDARY) LEVEL 5 = COLLEGE YEAR 01-03 = LEVEL 5 (COLLEGE) . LEVEL 6 = GRADUATE/POST GRADUATE YEAR 01-06 = LEVEL 6 (GRADUATE/POST GRADUATE) . 8 = DON’T KNOW 98 = DON‘T KNOW . 307Appendix E | LINE NO. USUAL RESIDENTS AND VISITORS RELATION- SHIP TO HEAD OF HOUSE- HOLD RESIDENCE SEX AGE ELIGIBILITY Please give me the names of the persons who usually live in your household and visitors who stayed here last night, starting with the head of the household. What is the relationship of (NAME) to the head of the household?* Does (NAME) usually live here, or elsewhere in Lesotho, or outside Lesotho?** In which country outside Lesotho does (NAME) usually live?*** How long has (NAME) lived in (COUNTRY)? IF LESS THAN 1 YEAR, RECORD ‘00’. RECORD ‘98’ FOR ‘DON’T KNOW’. Did (NAME) sleep here last night? Is (NAME) male or female? How old is (NAME) in completed years? CIRCLE LINE NUMBER OF ALL WOMEN AGE15-49 WHO ARE USUAL RESI- DENTS (COL. 4) AND/OR SLEPT THERE LAST NIGHT (COL. 7) CIRCLE LINE NUMBER OF ALL CHILD- REN UNDER AGE 6 WHO ARE USUAL RESI- DENTS (COL. 4) AND/OR SLEPT THERE LAST NIGHT (COL. 7) CIRCLE LINE NUMBER OF ALL MEN AGE15-59 WHO ARE USUAL RESI- DENTS (COL. 4) AND/OR SLEPT THERE LAST NIGHT (COL. 7) (1) (2) (3) (4) (5) (6) (7) (8) (9) (10) (11) (12) UR EL OUT IN YEARS YES NO M F IN YEARS 11 ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ 1 2 3 �Ŋņņō GO ŋ TO 7 ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ 1 2 1 2 ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ 11 11 11 12 ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ 1 2 3 �Ŋņņō GO ŋ TO 7 ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ 1 2 1 2 ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ 12 12 12 13 ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ 1 2 3 �Ŋņņō GO ŋ TO 7 ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ 1 2 1 2 ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ 13 13 13 14 ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ 1 2 3 �Ŋņņō GO ŋ TO 7 ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ 1 2 1 2 ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ 14 14 14 15 ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ 1 2 3 �Ŋņņō GO ŋ TO 7 ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ 1 2 1 2 ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ 15 15 15 16 ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ 1 2 3 �Ŋņņō GO ŋ TO 7 ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ 1 2 1 2 ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ 16 16 16 17 ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ 1 2 3 �Ŋņņō GO ŋ TO 7 ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ 1 2 1 2 ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ 17 17 17 18 ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ 1 2 3 �Ŋņņō GO ŋ TO 7 ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ 1 2 1 2 ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ 18 18 18 19 ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ 1 2 3 �Ŋņņō GO ŋ TO 7 ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ 1 2 1 2 ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ 19 19 19 20 ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ 1 2 3 �Ŋņņō GO ŋ TO 7 ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ 1 2 1 2 ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ 20 20 20 * CODES FOR Q.3 RELATIONSHIP TO HEAD OF HOUSEHOLD: 01 = HEAD 02 = SPOUSE 03 = CHILD (SON OR DAUGHTER) 04 = SON-IN-LAW/DAUGHTER-IN-LAW 05 = GRANDCHILD 06 = GREAT GRANDCHILD 07 = PARENT/PARENT-IN-LAW 08 = SIBLING (BROTHER OR SISTER) 09 = OTHER RELATIVE 10 = DOMESTIC EMPLOYEE 11 = HERDBOY 12 = ADOPTED/FOSTER/STEPCHILD 13 = OTHER PERSON NOT RELATED ** CODES FOR Q.4 *** CODES FOR Q. 5 RESIDENTIAL STATUS: COUNTRY OF USUAL RESIDENCE: UR = USUAL RESIDENT 01 = RSA EL = ELSEWHERE IN LESOTHO 02 = SWAZILAND OUT = OUTSIDE LESOTHO 03 = BOTSWANA 04 = NAMIBIA 05 = ZIMBABWE 06 = ZAMBIA 07 = MOZAMBIQUE 08 = ANGOLA 09 = TANZANIA 10 = MALAWI 11 = OTHER AFRICA 12 =UNITED STATES OF AMERICA 13 = ASIA 14 = EUROPE 96 = OTHER 98 = DON’T KNOW 308 | Appendix E LINE NO. PARENTAL SURVIVORSHIP AND RESIDENCE FOR PERSONS LESS THAN 18 YEARS OLD**** EDUCATION IF ALIVE IF ALIVE IF AGE 5 YEARS OR OLDER IF AGE 5-24 YEARS Is (NAME)’s natural mother alive? Does (NAME)’s natural mother live in this house- hold? IF YES: What is her name? RECORD MOTHER’S LINE NUMBER Is (NAME)’s natural father alive? Does (NAME)’s natural father live in this house- hold? IF YES: What is his name? RECORD FATHER’S LINE NUMBER Has (NAME) ever attended school? What is the highest level of school (NAME) has attended?***** What is the highest standard/form/year (NAME) completed at that level?***** Is (NAME) currently attending school? During the current school year, did (NAME) attend school at any time? During the current school year, what level and standard/form/year is (NAME) attending?***** During the previous school year, did (NAME) attend school at any time? During that school year, what level and standard/form/year did (NAME) attend?***** (13) (14) (15) (16) (17) (18) (19) (20) (21) (22) (23) YES NO DK YES NO DK YES NO LEVEL STND/FRM/ YR YES NO YES NO LEVEL STND/FRM/ YR YES NO LEVEL STND/FRM/ YR 11 1 2 8 �����Ŋņņō GO ŋ TO 15 ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ 1 2 8 �����Ŋņņō GO ŋ TO 17 ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ 1 2 NEXT ŋ LINE ňņņʼn ŇųųŇ Ŋņņŋ ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ 1 2 Ŋ� GO TO 21 1 2 GO ŋ TO 22 ňņņʼn ŇųųŇ Ŋņņŋ ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ 1 2 NEXT ŋ LINE ňņņʼn ŇųųŇ Ŋņņŋ ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ 12 1 2 8 �����Ŋņņō GO ŋ TO 15 ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ 1 2 8 �����Ŋņņō GO ŋ TO 17 ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ 1 2 NEXT ŋ LINE ňņņʼn ŇųųŇ Ŋņņŋ ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ 1 2 Ŋ� GO TO 21 1 2 GO ŋ TO 22 ňņņʼn ŇųųŇ Ŋņņŋ ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ 1 2 NEXT ŋ LINE ňņņʼn ŇųųŇ Ŋņņŋ ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ 13 1 2 8 �����Ŋņņō GO ŋ TO 15 ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ 1 2 8 �����Ŋņņō GO ŋ TO 17 ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ 1 2 NEXT ŋ LINE ňņņʼn ŇųųŇ Ŋņņŋ ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ 1 2 Ŋ� GO TO 21 1 2 GO ŋ TO 22 ňņņʼn ŇųųŇ Ŋņņŋ ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ 1 2 NEXT ŋ LINE ňņņʼn ŇųųŇ Ŋņņŋ ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ 14 1 2 8 �����Ŋņņō GO ŋ TO 15 ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ 1 2 8 �����Ŋņņō GO ŋ TO 17 ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ 1 2 NEXT ŋ LINE ňņņʼn ŇųųŇ Ŋņņŋ ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ 1 2 Ŋ� GO TO 21 1 2 GO ŋ TO 22 ňņņʼn ŇųųŇ Ŋņņŋ ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ 1 2 NEXT ŋ LINE ňņņʼn ŇųųŇ Ŋņņŋ ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ 15 1 2 8 �����Ŋņņō GO ŋ TO 15 ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ 1 2 8 �����Ŋņņō GO ŋ TO 17 ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ 1 2 NEXT ŋ LINE ňņņʼn ŇųųŇ Ŋņņŋ ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ 1 2 Ŋ� GO TO 21 1 2 GO ŋ TO 22 ňņņʼn ŇųųŇ Ŋņņŋ ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ 1 2 NEXT ŋ LINE ňņņʼn ŇųųŇ Ŋņņŋ ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ 16 1 2 8 �����Ŋņņō GO ŋ TO 15 ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ 1 2 8 �����Ŋņņō GO ŋ TO 17 ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ 1 2 NEXT ŋ LINE ňņņʼn ŇųųŇ Ŋņņŋ ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ 1 2 Ŋ� GO TO 21 1 2 GO ŋ TO 22 ňņņʼn ŇųųŇ Ŋņņŋ ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ 1 2 NEXT ŋ LINE ňņņʼn ŇųųŇ Ŋņņŋ ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ 17 1 2 8 �����Ŋņņō GO ŋ TO 15 ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ 1 2 8 �����Ŋņņō GO ŋ TO 17 ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ 1 2 NEXT ŋ LINE ňņņʼn ŇųųŇ Ŋņņŋ ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ 1 2 Ŋ� GO TO 21 1 2 GO ŋ TO 22 ňņņʼn ŇųųŇ Ŋņņŋ ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ 1 2 NEXT ŋ LINE ňņņʼn ŇųųŇ Ŋņņŋ ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ 18 1 2 8 �����Ŋņņō GO ŋ TO 15 ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ 1 2 8 �����Ŋņņō GO ŋ TO 17 ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ 1 2 NEXT ŋ LINE ňņņʼn ŇųųŇ Ŋņņŋ ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ 1 2 Ŋ� GO TO 21 1 2 GO ŋ TO 22 ňņņʼn ŇųųŇ Ŋņņŋ ňņņŎņņʼn ŇųųŇųųŇ Ŋņņŏņņŋ 1 2 NE