Lesotho Demographic and Health Survey 2014

Publication date: 2016

Lesotho 2014Demographic andHealth Survey Lesotho 2014 D em ographic and H ealth Survey BOPHELO MINISTRY OF HEALTH Lesotho Demographic and Health Survey 2014 Ministry of Health Maseru, Lesotho The DHS Program ICF International Rockville, Maryland, USA May 2016 World Bank The 2014 Lesotho Demographic and Health Survey (2014 LDHS) was implemented by the Lesotho Ministry of Health from 22 September to 7 December 2014. The funding for the LDHS was provided by the government of Lesotho, the United States Agency for International Development (USAID), the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), the United Nations Population Fund (UNFPA), the United Nations Children’s Fund (UNICEF), the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund), the World Bank, and the World Health Organization (WHO). ICF International provided technical assistance through The DHS Program, a USAID-funded project providing support and technical assistance in the implementation of population and health surveys in countries worldwide. Additional information about the 2014 LDHS may be obtained from the Ministry of Health, P.O. Box 514, Maseru, Lesotho; Telephone: +266-22-314404; Internet: http://www.gov.ls/health/. Information about The DHS Program may be obtained from ICF International, 530 Gaither Road, Suite 500, Rockville, MD 20850, USA; Telephone: +1-301-407-6500; Fax: +1-301-407-6501; E-mail: info@DHSprogram.com; Internet: www.DHSprogram.com. Cover photo of Maletsuyane Falls near Semonkong, Lesotho, is provided courtesy of Joanna Lowell, ICF International. Suggested citation: Ministry of Health [Lesotho] and ICF International. 2016. Lesotho Demographic and Health Survey 2014. Maseru, Lesotho: Ministry of Health and ICF International. Contents • iii CONTENTS TABLES AND FIGURES . vii FOREWORD . xv READING AND UNDERSTANDING TABLES FROM THE 2014 LDHS . xvii ADDITIONAL DHS PROGRAM RESOURCES . xxv ACRONYMS AND ABBREVIATIONS . xxvii MILLENNIUM DEVELOPMENT GOAL INDICATORS . xxix MAP OF LESOTHO . xxx 1 INTRODUCTION AND SURVEY METHODOLOGY . 1 1.1 Survey Objectives . 1 1.2 Sample Design . 1 1.3 Questionnaires . 2 1.4 Blood Pressure Measurement, Anthropometry, Anaemia Testing, and HIV Testing . 3 1.5 Pretest . 4 1.6 Training of Field Staff . 4 1.7 Fieldwork . 5 1.8 Data Processing . 5 1.9 Response Rates . 5 2 HOUSING CHARACTERISTICS AND HOUSEHOLD POPULATION . 7 2.1 Drinking Water Sources and Treatment . 7 2.2 Sanitation . 8 2.3 Exposure to Smoke inside the Home . 9 2.4 Household Wealth . 10 2.5 Hand Washing . 10 2.6 Household Population and Composition . 11 2.7 Birth Registration . 12 2.8 Children’s Living Arrangements and Parental Survival . 12 2.9 Education . 13 2.9.1 Educational Attainment . 13 2.9.2 School Attendance . 13 2.10 Distance to a Health Facility . 14 3 CHARACTERISTICS OF RESPONDENTS . 31 3.1 Basic Characteristics of Survey Respondents . 31 3.2 Education and Literacy . 32 3.3 Mass Media Exposure . 33 3.4 Employment . 34 3.5 Occupation . 34 3.6 Health Insurance Coverage . 35 3.7 Tobacco Use . 35 3.8 Time Away from Home . 36 4 MARRIAGE AND SEXUAL ACTIVITY . 57 4.1 Marital Status . 57 4.2 Polygyny . 58 4.3 Age at First Marriage . 59 4.4 Age at First Sexual Intercourse . 59 4.5 Recent Sexual Activity . 60 iv • Contents 5 FERTILITY . 71 5.1 Current Fertility . 71 5.2 Children Ever Born and Living . 72 5.3 Birth Intervals . 73 5.4 Insusceptibility to Pregnancy . 73 5.5 Age at First Birth . 74 5.6 Teenage Childbearing . 75 6 FERTILITY PREFERENCES . 85 6.1 Desire for Another Child . 85 6.2 Ideal Family Size . 86 6.3 Fertility Planning Status . 87 6.4 Wanted Fertility Rates . 88 7 FAMILY PLANNING . 97 7.1 Contraceptive Knowledge and Use . 98 7.2 Source of Modern Contraceptive Methods . 99 7.3 Informed Choice . 100 7.4 Discontinuation of Contraceptives . 100 7.5 Demand for Family Planning . 101 7.6 Contact of Nonusers with Family Planning Providers . 103 8 INFANT AND CHILD MORTALITY . 115 8.1 Infant and Child Mortality . 116 8.2 Biodemographic Risk Factors . 117 8.3 Perinatal Mortality . 117 9 MATERNAL HEALTH CARE . 123 9.1 Antenatal Care Coverage and Content . 124 9.1.1 Skilled Providers . 124 9.1.2 Timing and Number of ANC Visits . 124 9.2 Components of ANC Visits . 125 9.3 Protection against Neonatal Tetanus . 125 9.4 Delivery Services . 126 9.4.1 Institutional Deliveries . 126 9.4.2 Skilled Assistance during Delivery . 127 9.4.3 Delivery by Caesarean . 128 9.5 Postnatal Care . 128 9.5.1 Postnatal Health Check for Mothers . 128 9.5.2 Postnatal Health Checks for Newborns . 129 9.6 Problems in Accessing Health Care . 130 10 CHILD HEALTH . 143 10.1 Birth Weight . 143 10.2 Vaccination of Children . 144 10.3 Symptoms of Acute Respiratory Infection . 145 10.4 Fever . 146 10.5 Diarrhoeal Disease . 146 10.5.1 Prevalence of Diarrhoea . 146 10.5.2 Treatment of Diarrhoea . 147 10.5.3 Feeding Practices . 147 10.5.4 Knowledge of ORS Packets . 148 10.5.5 Men’s Knowledge of Feeding Practices during Diarrhoea . 148 10.6 Disposal of Children’s Stools. 149 11 NUTRITION OF CHILDREN AND ADULTS . 163 11.1 Nutritional Status of Children . 163 11.1.1 Measurement of Nutritional Status among Young Children . 163 11.1.2 Data Collection . 165 Contents • v 11.1.3 Levels of Child Malnutrition . 165 11.2 Infant and Young Child Feeding Practices . 166 11.2.1 Breastfeeding . 166 11.2.2 Exclusive Breastfeeding . 167 11.2.3 Median Duration of Breastfeeding . 167 11.2.4 Complementary Feeding . 168 11.2.5 Minimum Acceptable Diet . 169 11.3 Anaemia Prevalence in Children . 171 11.4 Micronutrient Intake and Supplementation among Children . 172 11.5 Presence of Iodised Salt in Households . 172 11.6 Adults’ Nutritional Status . 172 11.6.1 Nutritional Status of Women . 172 11.6.2 Nutritional Status of Men . 173 11.7 Anaemia Prevalence in Adults . 174 11.8 Micronutrient Intake among Mothers . 174 12 HIV/AIDS-RELATED KNOWLEDGE, ATTITUDES, AND BEHAVIOUR . 191 12.1 HIV/AIDS Knowledge, Transmission, and Prevention Methods. 192 12.2 Knowledge about Mother-to-Child Transmission . 193 12.3 HIV/AIDS Attitudes . 194 12.3.1 Attitudes towards People Living with HIV/AIDS . 194 12.3.2 Attitudes towards Negotiating Safer Sexual Relations with Husbands . 195 12.3.3 Attitudes towards Condom Education for Young People . 195 12.4 Multiple Sexual Partners . 195 12.5 Paid Sex . 196 12.6 Coverage of HIV Testing Services. 197 12.6.1 Awareness of HIV Testing Services and Experience with HIV Testing . 197 12.6.2 HIV Testing of Pregnant Women . 198 12.6.3 Reasons for Not Getting Tested for HIV . 199 12.7 Male Circumcision . 199 12.8 Self-reporting of Sexually Transmitted Infections . 200 12.9 Injections . 201 12.10 HIV/AIDS-Related Knowledge and Behaviour among Young People . 201 12.10.1 Knowledge . 201 12.10.2 First Sex . 201 12.10.3 Premarital Sex . 202 12.10.4 Multiple Sexual Partners . 202 12.10.5 Age-mixing in Sexual Relationships . 202 12.10.6 Coverage of HIV Testing Services . 203 13 HIV PREVALENCE . 235 13.1 Coverage Rates for HIV Testing . 235 13.2 HIV Prevalence . 236 13.2.1 HIV Prevalence by Age and Sex . 236 13.2.2 HIV Prevalence by Sexual Risk Behaviour . 239 13.2.3 HIV Prevalence among Young People . 239 13.2.4 HIV Prevalence by Other Characteristics Related to HIV Risk . 240 13.2.5 HIV Prevalence among Couples . 240 13.3 HIV Incidence . 240 14 WOMEN’S EMPOWERMENT . 255 14.1 Married Women’s and Men’s Employment . 255 14.2 Control over Women’s Earnings . 256 14.3 Control over Men’s Earnings . 257 14.4 Women’s and Men’s Ownership of Assets . 258 vi • Contents 14.5 Women’s Participation in Decision Making . 258 14.6 Attitudes towards Wife Beating . 259 15 ADULT AND MATERNAL MORTALITY . 277 15.1 Data . 277 15.2 Direct Estimates of Adult Mortality . 278 15.3 Trends in Adult Mortality . 279 15.4 Direct Estimates of Maternal Mortality . 280 16 TUBERCULOSIS . 285 16.1 Respondents’ Knowledge of Tuberculosis . 285 16.1.1 Awareness of Tuberculosis and Knowledge that Tuberculosis Can Be Cured . 285 16.1.2 Knowledge of Symptoms Associated with Tuberculosis . 286 16.1.3 Knowledge of the Cause of Tuberculosis and Its Mode of Transmission . 286 16.2 Self-Reported Symptoms, Diagnosis, and Treatment . 287 16.2.1 Self-reported Tuberculosis Symptoms . 287 16.2.2 Treatment Seeking for Tuberculosis Symptoms . 287 16.2.3 Tuberculosis Diagnosis and Treatment . 288 16.3 Attitudes towards Those Treated for Tuberculosis . 288 17 NONCOMMUNICABLE DISEASES . 301 17.1 Knowledge of Breast Cancer . 301 17.2 Breast Self-examination and Clinical Exam . 302 17.3 Knowledge of and Experience with Cervical Cancer Exam . 302 17.4 Knowledge and History of Diabetes . 303 17.5 History of High Blood Pressure . 303 17.6 Blood Pressure Status . 304 REFERENCES . 319 APPENDIX A SAMPLE DESIGN . 321 A.1 Introduction . 321 A.2 Sample Frame . 321 A.3 Sample Design and Implementation . 322 A.4 Sample Probabilities and Sampling Weights . 324 APPENDIX B ESTIMATES OF SAMPLING ERRORS . 333 APPENDIX C HIV TESTING METHODOLOGY . 373 APPENDIX D DATA QUALITY TABLES . 377 APPENDIX E PERSONS INVOLVED IN THE 2014 LESOTHO DEMOGRAPHIC AND HEALTH SURVEY . 383 APPENDIX F QUESTIONNAIRES . 387 Tables and Figures • vii TABLES AND FIGURES 1 INTRODUCTION AND SURVEY METHODOLOGY . 1 Table 1.1 Results of the household and individual interviews . 6 2 HOUSING CHARACTERISTICS AND HOUSEHOLD POPULATION . 7 Figure 2.1 Household drinking water by residence . 8 Figure 2.2 Household toilet facilities by residence . 9 Figure 2.3 Household wealth by residence . 10 Figure 2.4 Population pyramid . 11 Figure 2.5 Birth registration by district . 12 Figure 2.6 Orphanhood by age . 12 Figure 2.7 Secondary school attendance by wealth quintile . 14 Table 2.1 Household drinking water . 16 Table 2.2 Household sanitation facilities . 17 Table 2.3 Household characteristics . 18 Table 2.4 Wealth quintiles . 19 Table 2.5 Household possessions . 19 Table 2.6 Hand washing . 20 Table 2.7 Household population by age, sex, and residence . 20 Table 2.8 Household composition . 21 Table 2.9 Residency status . 22 Table 2.10 Birth registration of children under age 5 . 23 Table 2.11 Children’s living arrangements and orphanhood . 24 Table 2.12 School attendance by survivorship of parents . 25 Table 2.13.1 Educational attainment of the female household population . 26 Table 2.13.2 Educational attainment of the male household population . 27 Table 2.14 School attendance ratios . 28 Table 2.15 Method of travel and travel time to nearest health facility . 29 Table 2.16 Travel time to health facility by walking. 29 3 CHARACTERISTICS OF RESPONDENTS . 31 Figure 3.1 Education of survey respondents . 32 Figure 3.2 Exposure to mass media . 33 Figure 3.3 Employment by education . 34 Figure 3.4 Occupation . 35 Figure 3.5 Use of tobacco . 36 Table 3.1 Background characteristics of respondents . 38 Table 3.2.1 Educational attainment: Women . 39 Table 3.2.2 Educational attainment: Men . 40 Table 3.3.1 Literacy: Women . 41 Table 3.3.2 Literacy: Men . 42 Table 3.4.1 Exposure to mass media: Women . 43 Table 3.4.2 Exposure to mass media: Men . 44 Table 3.5.1 Employment status: Women . 45 Table 3.5.2 Employment status: Men . 46 Table 3.6 Type of employment: Women . 47 viii • Tables and Figures Table 3.7.1 Occupation: Women . 48 Table 3.7.2 Occupation: Men . 49 Table 3.8.1 Health insurance coverage: Women . 50 Table 3.8.2 Health insurance coverage: Men . 51 Table 3.9.1 Use of tobacco: Women . 52 Table 3.9.2 Use of tobacco: Men . 53 Table 3.10.1 Time away from home: Women . 54 Table 3.10.2 Time away from home: Men . 55 4 MARRIAGE AND SEXUAL ACTIVITY . 57 Figure 4.1 Marital status . 58 Figure 4.2 Median age at first sexual intercourse and first marriage among women and men . 60 Table 4.1 Current marital status . 62 Table 4.2.1 Number of women’s co-wives . 63 Table 4.2.2 Number of men’s wives . 64 Table 4.3 Age at first marriage . 65 Table 4.4 Median age at first marriage by background characteristics . 66 Table 4.5 Age at first sexual intercourse . 67 Table 4.6 Median age at first sexual intercourse by background characteristics . 68 Table 4.7.1 Recent sexual activity: Women . 69 Table 4.7.2 Recent sexual activity: Men . 70 5 FERTILITY . 71 Figure 5.1 Trends in total fertility rate (TFR) by residence . 72 Figure 5.2 Total fertility rate by district . 72 Figure 5.3 Total fertility rate by wealth quintile . 72 Figure 5.4 Birth interval distribution . 73 Figure 5.5 Age at first birth by education . 75 Figure 5.6 Teenage childbearing by district . 75 Table 5.1 Current fertility . 77 Table 5.2 Fertility by background characteristics. 77 Table 5.3.1 Trends in age-specific fertility rates . 78 Table 5.3.2 Trends in age-specific and total fertility rates . 78 Table 5.4 Children ever born and living . 78 Table 5.5 Birth intervals . 79 Table 5.6 Postpartum amenorrhoea, abstinence, and insusceptibility . 80 Table 5.7 Median duration of amenorrhoea, postpartum abstinence, and postpartum insusceptibility . 80 Table 5.8 Menopause . 81 Table 5.9 Age at first birth . 81 Table 5.10 Median age at first birth . 82 Table 5.11 Teenage pregnancy and motherhood . 83 6 FERTILITY PREFERENCES . 85 Figure 6.1 Trends in desire to limit childbearing . 86 Figure 6.2 Ideal family size . 86 Figure 6.3 Ideal family size by number of living children . 87 Figure 6.4 Fertility planning status . 87 Figure 6.5 Trends in wanted and actual fertility . 88 Tables and Figures • ix Table 6.1 Fertility preferences by number of living children . 90 Table 6.2 Desire to limit childbearing . 91 Table 6.3 Ideal number of children by number of living children . 92 Table 6.4 Mean ideal number of children . 93 Table 6.5 Fertility planning status . 94 Table 6.6 Wanted fertility rates . 95 7 FAMILY PLANNING . 97 Figure 7.1 Contraceptive use . 98 Figure 7.2 Trends in contraceptive use . 98 Figure 7.3 Modern contraceptive use by district . 99 Figure 7.4 Modern contraceptive use by education . 99 Figure 7.5 Source of modern contraceptive methods . 100 Figure 7.6 Demand for family planning . 101 Figure 7.7 Trends in total demand for family planning . 102 Figure 7.8 Unmet need by district . 102 Table 7.1 Knowledge of contraceptive methods . 104 Table 7.2 Current use of contraception by age . 105 Table 7.3.1 Trends in the current use of contraception . 105 Table 7.3.2 Current use of contraception by background characteristics . 106 Table 7.4 Source of modern contraceptive methods . 107 Table 7.5 Informed choice . 108 Table 7.6 Twelve-month contraceptive discontinuation rates . 109 Table 7.7 Reasons for discontinuation . 109 Table 7.8 Knowledge of fertile period . 109 Table 7.9.1 Need and demand for family planning among currently married women . 110 Table 7.9.2 Need and demand for family planning for all women and for women who are not currently married . 111 Table 7.10 Future use of contraception . 112 Table 7.11 Exposure to family planning messages . 113 Table 7.12 Contact of nonusers with family planning providers . 114 8 INFANT AND CHILD MORTALITY . 115 Figure 8.1 Trends in early childhood mortality . 116 Figure 8.2 Under-5 mortality by mother’s education . 117 Figure 8.3 Perinatal mortality by district . 117 Table 8.1 Early childhood mortality rates . 119 Table 8.2 Early childhood mortality rates by socioeconomic characteristics . 119 Table 8.3 Early childhood mortality rates by demographic characteristics . 120 Table 8.4 Perinatal mortality . 121 Table 8.5 High-risk fertility behaviour . 122 9 MATERNAL HEALTH CARE . 123 Figure 9.1 Antenatal care coverage trends . 124 Figure 9.2 Trends in place of delivery . 126 Figure 9.3 Institutional deliveries by district . 126 Figure 9.4 Institutional deliveries by mother’s education . 126 Figure 9.5 Delivery assistance . 127 Figure 9.6 Delivery assistance by wealth quintile . 127 Figure 9.7 Postnatal care by place of delivery . 129 x • Tables and Figures Table 9.1 Antenatal care . 131 Table 9.2 Number of antenatal care visits and timing of first visit. 132 Table 9.3 Components of antenatal care . 133 Table 9.4 Tetanus toxoid injections . 134 Table 9.5 Place of delivery . 135 Table 9.6 Assistance during delivery . 136 Table 9.7 Timing of first postnatal check for the mother . 137 Table 9.8 Type of provider of first postnatal check for the mother . 138 Table 9.9 Timing of first postnatal check for the newborn . 139 Table 9.10 Type of provider of first postnatal check for the newborn . 140 Table 9.11 Problems in accessing health care . 141 10 CHILD HEALTH . 143 Figure 10.1 Childhood vaccinations . 144 Figure 10.2 Trends in childhood vaccinations . 145 Figure 10.3 Vaccination coverage by district . 145 Figure 10.4 Diarrhoea prevalence by age . 146 Figure 10.5 Treatment of diarrhoea . 147 Figure 10.6 Feeding practices during diarrhoea . 148 Figure 10.7 Prevalence and treatment of childhood illnesses . 148 Table 10.1 Child’s size and weight at birth . 150 Table 10.2 Vaccinations by source of information . 151 Table 10.3 Vaccinations by background characteristics . 152 Table 10.4 Vaccinations in first year of life . 153 Table 10.5 Prevalence and treatment of symptoms of ARI . 154 Table 10.6 Prevalence and treatment of fever . 155 Table 10.7 Prevalence of diarrhoea . 156 Table 10.8 Diarrhoea treatment . 157 Table 10.9 Feeding practices during diarrhoea . 158 Table 10.10 Knowledge of ORS packets . 159 Table 10.11 Men’s knowledge of feeding practices during diarrhoea. 160 Table 10.12 Disposal of children’s stools . 161 11 NUTRITION OF CHILDREN AND ADULTS . 163 Figure 11.1 Children’s nutritional status . 165 Figure 11.2 Trends in children’s nutritional status . 165 Figure 11.3 Stunting in children by district . 166 Figure 11.4 Breastfeeding practices by age . 167 Figure 11.5 IYCF breastfeeding indicators . 168 Figure 11.6 IYCF indicators on minimum acceptable diet . 170 Figure 11.7 Trends in childhood anaemia. 171 Figure 11.8 Anaemia in children by district . 171 Figure 11.9 Trends in women’s nutritional status . 173 Figure 11.10 Prevalence of anaemia in adults . 174 Table 11.1 Nutritional status of children . 176 Table 11.2 Initial breastfeeding . 178 Table 11.3 Breastfeeding status by age . 179 Table 11.4 Median duration of breastfeeding . 180 Table 11.5 Foods and liquids consumed by children in the day or night preceding the interview . 181 Table 11.6 Infant and young child feeding (IYCF) practices . 182 Tables and Figures • xi Table 11.7 Prevalence of anaemia in children . 183 Table 11.8 Micronutrient intake among children . 184 Table 11.9 Presence of iodised salt in household . 185 Table 11.10.1 Nutritional status of women . 186 Table 11.10.2 Nutritional status of men . 187 Table 11.11.1 Prevalence of anaemia in women . 188 Table 11.11.2 Prevalence of anaemia in men . 189 Table 11.12 Micronutrient intake among mothers . 190 12 HIV/AIDS-RELATED KNOWLEDGE, ATTITUDES, AND BEHAVIOUR . 191 Figure 12.1 Trends in HIV Knowledge . 192 Figure 12.2 Comprehensive knowledge of HIV by education . 193 Figure 12.3 Trends in knowledge of maternal-to-child transmission of HIV . 194 Figure 12.4 Multiple sexual partners and condom use . 196 Figure 12.5 Trends in HIV testing . 198 Figure 12.6 Recent HIV testing by wealth quintile . 198 Figure 12.7 STI advice or treatment seeking-behaviour . 200 Figure 12.8 Age at first sex among young people . 201 Figure 12.9 Premarital sex and condom use among young people . 202 Table 12.1 Knowledge of AIDS . 205 Table 12.2 Knowledge of HIV prevention methods . 206 Table 12.3.1 Comprehensive knowledge about HIV/AIDS: Women . 207 Table 12.3.2 Comprehensive knowledge about HIV/AIDS: Men . 208 Table 12.4 Knowledge of prevention of mother-to-child transmission of HIV. 209 Table 12.5.1 Accepting attitudes towards those living with HIV/AIDS: Women . 210 Table 12.5.2 Accepting attitudes towards those living with HIV/AIDS: Men . 211 Table 12.6 Attitudes towards negotiating safer sexual relations with husband . 212 Table 12.7 Adult support of education about condom use to prevent AIDS . 213 Table 12.8.1 Multiple sexual partners: Women . 214 Table 12.8.2 Multiple sexual partners: Men . 215 Table 12.9 Point prevalence and cumulative prevalence of concurrent sexual partners . 216 Table 12.10 Payment for sexual intercourse and condom use at last paid sexual intercourse . 217 Table 12.11.1 Coverage of prior HIV testing: Women . 218 Table 12.11.2 Coverage of prior HIV testing: Men . 219 Table 12.12 Pregnant women counselled and tested for HIV . 220 Table 12.13.1 Opinions on why some individuals choose not to undergo voluntary HIV testing and counselling: Women . 221 Table 12.13.2 Opinions on why some individuals choose not to undergo voluntary HIV testing and counselling: Men . 222 Table 12.14.1 Main reason why respondent has not been tested for HIV: Women . 223 Table 12.14.2 Main reason why respondent has not been tested for HIV: Men . 224 Table 12.15 Male circumcision . 225 Table 12.16 Self-reported prevalence of sexually-transmitted infections (STIs) and STIs symptoms . 226 Table 12.17 Prevalence of medical injections . 227 Table 12.18 Comprehensive knowledge about AIDS and of a source of condoms among young people . 228 Table 12.19 Age at first sexual intercourse among young people . 229 Table 12.20 Premarital sexual intercourse and condom use during premarital sexual intercourse among young people . 230 xii • Tables and Figures Table 12.21.1 Multiple sexual partners in the past 12 months among young people: Women . 231 Table 12.21.2 Multiple sexual partners in the past 12 months among young people: Men. 232 Table 12.22 Age-mixing in sexual relationships among women and men age 15-19 . 233 Table 12.23 Recent HIV tests among young people . 234 13 HIV PREVALENCE . 235 Figure 13.1 HIV prevalence by residence and sex . 237 Figure 13.2 Trends in HIV prevalence . 237 Figure 13.3 HIV prevalence by age . 237 Figure 13.4 HIV prevalence by district . 238 Figure 13.5 HIV prevalence by number of lifetime partners . 239 Figure 13.6 HIV incidence by sex . 241 Table 13.1 Coverage of HIV testing by residence, ecological zone, and district . 242 Table 13.2 Coverage of HIV testing by selected background characteristics . 243 Table 13.3 HIV prevalence by age . 244 Table 13.4 HIV prevalence by socioeconomic characteristics . 245 Table 13.5 HIV prevalence by demographic characteristics . 246 Table 13.6 HIV prevalence by male circumcision . 247 Table 13.7 HIV prevalence by sexual behaviour . 248 Table 13.8 HIV prevalence among young people by background characteristics . 249 Table 13.9 HIV prevalence among young people by sexual behaviour . 250 Table 13.10 HIV prevalence by other characteristics . 251 Table 13.11 Prior HIV testing by current HIV status . 252 Table 13.12 HIV prevalence among couples. 253 14 WOMEN’S EMPOWERMENT . 255 Figure 14.1 Women’s and men’s employment by age. 256 Figure 14.2 Control over women’s earnings. 257 Figure 14.3 Ownership of assets . 258 Figure 14.4 Women’s participation in decision making . 259 Figure 14.5 Attitudes towards wife beating . 260 Table 14.1 Employment and cash earnings of currently married women and men . 262 Table 14.2.1 Control over women’s cash earnings and relative magnitude of women’s cash earnings . 263 Table 14.2.2 Control over men’s cash earnings . 264 Table 14.3 Women’s control over their own earnings and over those of their husbands . 265 Table 14.4.1 Ownership of assets: Women . 266 Table 14.4.2 Ownership of assets: Men . 267 Table 14.5 Participation in decision making . 268 Table 14.6.1 Women’s participation in decision making by background characteristics . 269 Table 14.6.2 Men’s participation in decision making by background characteristics . 270 Table 14.7.1 Attitude towards wife beating: Women . 271 Table 14.7.2 Attitude towards wife beating: Men . 272 Table 14.8 Indicators of women’s empowerment . 273 Table 14.9 Current use of contraception by women’s empowerment . 273 Table 14.10 Ideal number of children and unmet need for family planning by women’s empowerment . 274 Table 14.11 Reproductive health care by women’s empowerment . 274 Table 14.12 Early childhood mortality rates by indicators of women’s empowerment . 275 Tables and Figures • xiii 15 ADULT AND MATERNAL MORTALITY . 277 Figure 15.1 Adult mortality rates among women and men age 15-49 . 279 Figure 15.2 Trends in maternal mortality ratios with confidence intervals . 281 Table 15.1 Completeness of information on siblings . 282 Table 15.2 Adult mortality rates . 282 Table 15.3 Adult mortality probabilities . 283 Table 15.4 Maternal mortality . 283 16 TUBERCULOSIS . 285 Figure 16.1 Tuberculosis knowledge by education . 286 Figure 16.2 Knowledge of the cause of tuberculosis . 286 Figure 16.3 Experience of tuberculosis symptoms . 287 Figure 16.4 Tuberculosis treatment length . 288 Table 16.1 Knowledge of tuberculosis . 290 Table 16.2 Knowledge of specific symptoms of tuberculosis . 291 Table 16.3.1 Knowledge of the cause of tuberculosis: Women . 292 Table 16.3.2 Knowledge of the cause of tuberculosis: Men . 293 Table 16.4 Knowledge of the mode of tuberculosis transmission . 294 Table 16.5.1 Experience of symptoms of tuberculosis: Women . 294 Table 16.5.2 Experience of symptoms of tuberculosis: Men . 295 Table 16.6.1 Treatment seeking for symptoms of tuberculosis: Women . 296 Table 16.6.2 Treatment seeking for symptoms of tuberculosis: Men . 297 Table 16.7 Diagnosis of tuberculosis . 298 Table 16.8 Received medicine for tuberculosis . 299 Table 16.9 Positive attitudes towards those with tuberculosis . 300 17 NONCOMMUNICABLE DISEASES . 301 Figure 17.1 Knowledge of breast cancer by education . 301 Figure 17.2 Knowledge of and experience with Pap smear by education . 303 Figure 17.3 Hypertension and Body Mass Index (BMI) . 304 Table 17.1.1 Knowledge of breast cancer: Women . 306 Table 17.1.2 Knowledge of breast cancer: Men . 307 Table 17.2 Breast self-exam and clinical exam . 308 Table 17.3 Knowledge of, and experience with, the Pap smear exam . 309 Table 17.4 Knowledge of diabetes . 310 Table 17.5 Knowledge of specific symptoms of diabetes . 311 Table 17.6 History of diabetes . 311 Table 17.7 History of high blood pressure and actions taken to lower blood pressure . 312 Table 17.8 Coverage of blood pressure measurement among women and men . 313 Table 17.9.1 Blood pressure status: Women . 314 Table 17.9.2 Blood pressure status: Men . 315 Table 17.10.1 Blood pressure status by health status measures: Women . 316 Table 17.10.2 Blood pressure status by health status measures: Men . 317 APPENDIX A SAMPLE DESIGN . 321 Table A.1 Household distribution . 322 Table A.2 Enumeration areas and households . 322 Table A.3 Sample allocation of clusters and households . 323 Table A.4 Sample allocation of completed interviews with women and men . 323 Table A.5 Sample implementation: Women . 326 xiv • Tables and Figures Table A.6 Sample implementation: Men . 327 Table A.7 Coverage of HIV testing by social and demographic characteristics: Women . 328 Table A.8 Coverage of HIV testing by social and demographic characteristics: Men . 329 Table A.9 Coverage of HIV testing by sexual behaviour characteristics: Women . 330 Table A.10 Coverage of HIV testing by sexual behaviour characteristics: Men . 331 APPENDIX B ESTIMATES OF SAMPLING ERRORS . 333 Table B.1 List of selected variables for sampling errors, Lesotho 2014 . 335 Table B.2 Sampling errors for national sample, Lesotho 2014 . 337 Table B.3 Sampling errors for urban sample, Lesotho 2014 . 339 Table B.4 Sampling errors for rural sample, Lesotho 2014 . 341 Table B.5 Sampling errors for Lowlands sample, Lesotho 2014 . 343 Table B.6 Sampling errors for Foothills sample, Lesotho 2014 . 345 Table B.7 Sampling errors for Mountains sample, Lesotho 2014 . 347 Table B.8 Sampling errors for Senqu River Valley sample, Lesotho 2014 . 349 Table B.9 Sampling errors for Butha-Buthe sample, Lesotho 2014 . 351 Table B.10 Sampling errors for Leribe sample, Lesotho 2014 . 353 Table B.11 Sampling errors for Berea sample, Lesotho 2014 . 355 Table B.12 Sampling errors for Maseru sample, Lesotho 2014 . 357 Table B.13 Sampling errors for Mafeteng sample, Lesotho 2014 . 359 Table B.14 Sampling errors for Mohale’s Hoek sample, Lesotho 2014 . 361 Table B.15 Sampling errors for Quthing sample, Lesotho 2014 . 363 Table B.16 Sampling errors for Qacha’s Nek sample, Lesotho 2014 . 365 Table B.17 Sampling errors for Mokhotlong sample, Lesotho 2014 . 367 Table B.18 Sampling errors for Thaba-Tseka sample, Lesotho 2014 . 369 Table B.19 Sampling errors for adult and maternal mortality rates, Lesotho 2014 . 371 APPENDIX C HIV TESTING METHODOLOGY . 373 Figure C.1 Stage 1 HIV testing algorithm . 373 Figure C.2 Stage 2 Algorithm for HIV incidence testing and serological confirmation . 374 Table C.1 Sensitivity calculations for potential impact of missing viral load results on HIV incidence estimates, Lesotho 2014 . 375 APPENDIX D DATA QUALITY TABLES . 377 Table D.1 Household age distribution . 377 Table D.2.1 Age distribution of eligible and interviewed women . 378 Table D.2.2 Age distribution of eligible and interviewed men . 378 Table D.3 Completeness of reporting . 379 Table D.4 Births by calendar years . 379 Table D.5 Reporting of age at death in days . 380 Table D.6 Reporting of age at death in months . 380 Table D.7 Sibship size and sex ratio of siblings . 381 Foreword • xv FOREWORD he 2014 Lesotho Demographic and Health Survey (LDHS) was implemented by the Ministry of Health (MOH). The 2014 LDHS was the third DHS survey to be conducted in Lesotho in collaboration with the worldwide Demographic and Health Surveys Program. It provides updated estimates of basic demographic and health indicators, including fertility rates and preferences, maternal and child mortality rates, maternal and child health indicators, knowledge and attitudes of women and men about HIV/AIDS and other sexually transmitted diseases, patterns of recent behaviour regarding the use of condoms and other contraceptive methods, and the incidence and prevalence of HIV infection. The MOH wishes to acknowledge the efforts of a number of organisations and individuals who contributed substantially to the success of the survey. First, we would like to acknowledge the financial assistance from the government of Lesotho, the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund), the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), the United Nations Population Fund (UNFPA), the United Nations Children’s Fund (UNICEF), the United States Agency for International Development (USAID), the World Health Organization (WHO), and the World Bank. We thank the Bureau of Statistics (BOS) for providing the sample frame, GIS shapefiles corresponding to the LDHS sample points, and the training of enumerators on conducting the household listing. We would like to thank ICF International for technical backstopping throughout the survey. The survey also could not have been carried out successfully without the dedication of the staff of the MOH who planned, participated in, and oversaw the entire LDHS. Finally, we are grateful to the survey respondents who generously gave their time to provide the information that forms the basis of this and future reports. Mr. T.J. Lebakae Principal Secretary Ministry of Health T Reading and Understanding Tables from the 2014 LDHS • xvii READING AND UNDERSTANDING TABLES FROM THE 2014 LDHS xviii • Reading and Understanding Tables from the 2014 LDHS Example 1: Exposure to Mass Media A Question Asked of All Survey Respondents Table 3.4.1 Exposure to mass media: Women Percentage of women age 15-49 who are exposed to specific media on a weekly basis, by background characteristics, Lesotho 2014 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 Accesses all three media at least once a week Accesses none of the three media at least once a week Number of women Age 15-19 18.9 27.7 54.7 7.2 34.5 1,440 20-24 18.2 27.8 58.2 7.4 32.5 1,325 25-29 15.9 28.8 64.3 7.2 30.2 1,094 30-34 15.3 32.3 63.8 7.8 28.4 957 35-39 14.5 34.5 64.1 9.1 29.6 744 40-44 11.6 28.1 59.9 5.7 33.4 562 45-49 10.9 28.2 61.6 5.9 32.9 499 Residence Urban 25.5 53.7 73.4 14.2 13.8 2,419 Rural 10.6 15.4 52.8 3.3 42.1 4,202 Ecological zone Lowlands 21.4 40.8 70.7 10.6 19.6 4,184 Foothills 8.1 7.9 49.0 0.7 45.7 688 Mountains 5.9 9.2 36.6 1.6 58.9 1,288 Senqu River Valley 7.6 14.5 49.6 3.1 44.9 461 District Butha-Buthe 10.4 21.6 38.6 3.5 51.9 385 Leribe 12.3 26.4 62.9 4.4 30.1 1,064 Berea 18.9 36.5 69.5 8.3 21.6 892 Maseru 24.5 42.9 70.1 12.5 19.2 1,864 Mafeteng 18.7 31.3 70.6 9.7 22.7 576 Mohale’s Hoek 12.2 21.8 59.6 5.6 35.2 519 Quthing 8.8 17.2 55.3 3.3 40.0 315 Qacha’s Nek 11.0 20.8 35.5 4.1 52.5 204 Mokhotlong 4.4 7.2 37.2 1.0 59.7 349 Thaba-Tseka 6.5 9.2 34.9 2.3 61.1 452 Education No education 1.2 14.4 36.8 0.0 61.8 68 Primary incomplete 4.0 12.0 41.2 1.2 53.8 1,178 Primary complete 5.3 18.5 53.8 1.6 41.6 1,375 Secondary 19.8 34.0 67.6 8.3 23.6 3,418 More than secondary 45.6 64.7 74.6 28.5 8.2 581 Wealth quintile Lowest 3.0 1.7 24.8 0.4 73.5 960 Second 6.4 4.1 44.5 0.9 52.0 1,033 Middle 11.4 8.4 59.2 1.1 35.8 1,244 Fourth 17.6 27.3 73.6 5.3 18.6 1,605 Highest 30.5 75.6 77.5 20.9 6.5 1,778 Total 16.0 29.4 60.3 7.3 31.7 6,621 1 3 2 4 5 Reading and Understanding Tables from the 2014 LDHS • xix Step 1: Read the title and subtitle. They tell you the topic and the specific population group being described. In this case, the table is about women age 15-49 and their exposure to different types of media. All eligible female respondents age 15-49 were asked these questions. Step 2: Scan the column headings—highlighted in green in Example 1. They describe how the information is categorized. In this table, the first three columns of data show different types of media that women access at least once a week. The fourth column shows women who access all three media, while the fifth column is women who do not access any of the three types of media at least once a week. The last column lists the number of women interviewed in the survey. Step 3: Scan the row headings—the first vertical column highlighted in blue in Example 1. These show the different ways the data are divided into categories based on population characteristics. In this case, the table presents women’s exposure to media by age, urban-rural residence, ecological zone, district, educational level, and wealth quintile. Most of the tables in the LDHS report will be divided into these same categories. Step 4: Look at the row at the bottom of the table highlighted in red. These percentages represent the totals of all women age 15-49 and their access to different types of media. In this case, 16.0% of women age 15-49 read a newspaper at least once a week, 29.4% watch television weekly, and 60.3% listen to the radio weekly. Step 5: To find out what percentage of women with more than secondary education access all three media weekly, draw two imaginary lines, as shown on the table. This shows that 28.5% of women age 15-49 with more than secondary education access all three types of media weekly. Practice: Use the table in Example 1 to answer the following questions: a) What percentage of women in Lesotho do not access any of the three media at least once a week? b) What age group of women are most likely to watch television weekly? c) Compare women in urban areas to women in rural areas—which group is more likely to listen to the radio weekly? Answers: a) 31.7% b) Women age 35-39: 34.5% of women in this age group watch television weekly c) Women in urban areas, 73.4% listen to the radio weekly, compared to 52.8% of women in rural areas xx • Reading and Understanding Tables from the 2014 LDHS Example 2: Prevalence of Anaemia in Men Comparing and Understanding Patterns Table 11.11.2 Prevalence of anaemia in men Percentage of men age 15-49 with anaemia, by background characteristics, Lesotho 2014 Anaemia status by haemoglobin level Background characteristic Any anaemia <13.0 g/dl Number of men Age 15-19 16.6 672 20-29 9.8 918 30-39 14.2 566 40-49 20.1 364 Smoking status Smokes cigarettes/tobacco 13.5 1,052 Does not smoke 14.5 1,467 Residence Urban 14.8 862 Rural 13.7 1,658 Ecological zone Lowlands 13.2 1,614 Foothills 19.7 239 Mountains 15.9 503 Senqu River Valley 9.3 164 District Butha-Buthe 21.9 140 Leribe 12.0 365 Berea 9.7 360 Maseru 15.1 764 Mafeteng 11.6 229 Mohale’s Hoek 17.0 194 Quthing 6.1 99 Qacha’s Nek 19.9 73 Mokhotlong 20.2 137 Thaba-Tseka 14.1 159 Education No education 18.4 201 Primary incomplete 17.3 844 Primary complete 14.9 294 Secondary 11.1 985 More than secondary 9.8 197 Wealth quintile Lowest 18.8 359 Second 16.1 457 Middle 13.1 511 Fourth 13.9 591 Highest 10.8 601 Total 15-49 14.1 2,520 50-59 23.0 266 Total 15-59 14.9 2,786 Note: Prevalence is adjusted for altitude and for smoking status, if known, using formulas in CDC, 1998. 1 3 2 4 5 Reading and Understanding Tables from the 2014 LDHS • xxi Step 1: Read the title and subtitle. In this case, the table presents anaemia among men age 15-49. Step 2: Identify the information presented in the table— highlighted in green in the table to the right. In this table there is only one indicator—anaemia. Step 3: Look at the row headings to identify the background characteristics. In this table, anaemia is presented by age, smoking status, urban-rural residence, ecological zone, district, education level, and wealth quintile. Step 4: Look at the rows at the bottom of the table to determine the total proportion of men with anaemia. This shows that 14.1% of men age 15-49 in Lesotho are anaemic. Step 5: However, the 2014 LDHS interviewed men age 15-59. Find the row for men age 50-59: what proportion of these men are anaemic? It’s 23.0%. The final row above the footnotes shows that 14.9% of men age 15-59 are anaemic. It is important to note that all of the background characteristics in this table are shown only for men age 15-49. For example, 14.5% of men age 15-49 who do not smoke are anaemic. Practice: By looking at patterns by background characteristics, we can see which groups are more in need of interventions to address anaemia. Resources are often limited; looking for patterns can help programme planners and policy makers determine how to most effectively use resources. To gain a better understanding of differences in the prevalence of anaemia, use the table in Example 2 to consider the following questions: 1. Is anaemia more common in urban or rural areas? 2. What are the lowest and the highest percentages (range) of anaemia by ecological zone? 3. What are the lowest and the highest percentages (range) of anaemia by district? 4. How does the prevalence of anaemia vary by age? 5. Is there a clear pattern of anaemia by education level? 6. Is there a clear pattern of anaemia by wealth quintile? Answers: 1. Anaemia is slightly less common in rural areas (13.7%) than in urban areas (14.8%). However, the difference between these two groups is small. 2. Anaemia is lowest in the Senqu River Valley (9.3%) and highest in Foothills (19.7%). 3. Just 6.1% of men age 15-49 in Quthing are anaemic, compared to a high of 21.9% in Butha-Buthe. 4. Anaemia is highest among men age 50-59 (23.0%), while anaemia is lowest among men age 20-29 (9.8%). 5. Anaemia decreases as level of education increases; 18.4% of men with no education are anaemic, compared to 9.8% of men with more than secondary education. 6. There is a pattern in anaemia by wealth quintile. Anaemia generally decreases as household wealth increases; 18.8% of men age 15- 49 living in households in the lowest wealth quintile are anaemic, compared to 10.8% of men living in households in the highest wealth quintile. xxii • Reading and Understanding Tables from the 2014 LDHS Example 3: Prevalence and Treatment of Symptoms of ARI A Question Asked of a Subgroup of Survey Respondents Table 10.5 Prevalence and treatment of symptoms of ARI Among children under age five, the percentage who had symptoms of acute respiratory infection (ARI) in the two weeks preceding the survey and among children with symptoms of ARI, the percentage for whom advice or treatment was sought from a health facility or provider and the percentage who received antibiotics as treatment, according to background characteristics, Lesotho 2014 Among children under age five: Among children under age five with symptoms of ARI: Percentage for whom advice or treatment was sought from a health facility or provider2 Percentage who received antibiotics Number of children Background characteristic Percentage with symptoms of ARI1 Number of children Age in months <6 2.7 328 * * 9 6-11 4.2 342 * * 14 12-23 5.8 655 (68.8) (23.7) 38 24-35 5.1 572 (57.3) (15.8) 29 36-47 5.2 501 (76.3) (9.8) 26 48-59 3.7 498 * * 18 Sex Male 4.6 1,432 60.5 10.3 65 Female 4.7 1,464 65.7 20.8 69 Cooking fuel Electricity or gas 4.2 952 (71.9) (8.0) 40 Paraffin 5.6 134 * * 8 Coal/lignite * 4 * * 0 Wood/straw3 5.0 1,567 61.8 20.6 78 Animal dung 3.8 238 * * 9 Residence Urban 3.7 841 * * 31 Rural 5.0 2,055 63.0 19.9 103 Ecological zone Lowlands 4.4 1,617 64.4 9.5 72 Foothills 8.1 348 (55.1) (35.9) 28 Mountains 3.8 703 (74.3) (10.8) 27 Senqu River Valley 3.4 228 * * 8 Mother’s education No education (10.7) 26 * * 3 Primary incomplete 7.0 580 (45.9) (12.5) 41 Primary complete 4.0 748 (77.8) (8.5) 30 Secondary 3.9 1,324 (70.1) (22.9) 52 More than secondary 4.1 217 * * 9 Wealth quintile Lowest 4.7 623 (59.9) (15.4) 29 Second 5.2 583 (66.5) (17.8) 31 Middle 4.3 571 (63.4) (18.4) 25 Fourth 5.0 577 * * 29 Highest 4.0 542 * * 21 Total 4.7 2,896 63.1 15.7 135 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 Symptoms of ARI consist of cough accompanied by short, rapid breathing that was chest-related and/or by difficult breathing that was chest-related. 2 Excludes pharmacy, shop, and traditional practitioner 3 Includes grass, shrubs, crop residues 1 3 b 2 a 3 4 Reading and Understanding Tables from the 2014 LDHS • xxiii Step 1: Read the title and subtitle. In this case, the table is about two separate groups of children: all children under age 5 (a) and children under age 5 who had symptoms of acute respiratory infection (ARI) in the two weeks before the survey (b). Step 2: Identify the two panels. First, identify the columns that refer to all children under age 5 (a), and then isolate the columns that refer only to those children under age 5 who had symptoms of ARI in the two weeks before the survey (b). Step 3: Look at the first panel. What percentage of children under age 5 had symptoms of ARI in the two weeks before the survey? It’s 4.7%. Now look at the second panel. How many children under age 5 are there who had symptoms of ARI in the two weeks before the survey? It’s 135 children or 4.7% of the 2,896 children under age 5 (with rounding). The second panel is a subset of the first panel. Step 4: Only 4.7% of children under age 5 who had symptoms of ARI in the two weeks before the survey. Once these children are further divided into the background characteristic categories, there may be too few cases for the percentages to be reliable. • What percentage of children age 36-47 months who had symptoms of ARI in the two weeks before the survey received antibiotics? 9.8%. This percentage is in parentheses because there are between 25 and 49 children (unweighted) in this category. Readers should use this number with caution—it may not be reliable. (For more information on weighted and unweighted numbers, see Example 4.) • What percentage of children age 6-11 months who had symptoms of ARI in the two weeks before the survey received antibiotics? There is no number in this cell—only an asterisk. This is because fewer than 25 children age 6-11 months (unweighted) had symptoms of ARI in the two weeks before the survey. Results for this group are not reported. The subgroup is too small, and therefore the data are not reliable. Note: When parentheses or asterisks are used in a table, the explanation will be noted under the table. If there are no parentheses or asterisks in a table, you can proceed with confidence that enough cases were included in all categories that the data are reliable. xxiv • Reading and Understanding Tables from the 2014 LDHS Example 4: Understanding Sampling Weights in LDHS Tables A sample is a group of people who have been selected for a survey. In LDHS surveys, the sample is designed to represent the national population of age 15-49. In addition to national data, most countries want to collect and report data on smaller geographical or administrative areas. However, doing so requires a minimum sample size per area. For the 2014 LDHS, the survey sample is representative of the country as a whole, for urban and rural areas, for four ecological zones, and for each of Lesotho’s 10 districts. To generate statistics that are representative of the country as a whole and the 10 districts, the number of women surveyed in each district should contribute to the size of the total (national) sample in proportion to the size of the district. However, if some districts have small populations, then a sample allocated in proportion to each district’s population may not include sufficient women from each district for analysis. To solve this problem, districts with small populations are oversampled. For example, let’s say that you have enough money to interview 6,621 women and want to produce results that are representative of Lesotho as a whole and its districts (as in Table 3.1). However, the total population of Lesotho is not evenly distributed among the districts: some districts, such as Leribe, are heavily populated while others, such as Qacha’s Nek are not. Thus, Qacha’s Nek must be oversampled. A sampling statistician determines how many women should be interviewed in each district in order to get reliable statistics. The blue column (1) in the table above shows the actual number of women interviewed in each district. Within the districts, the number of women interviewed ranges from 556 in Quthing to 930 in Maseru. The number of interviews is sufficient to get reliable results in each district. With this distribution of interviews, some districts are overrepresented and some districts are underrepresented. For example, the population in the Qacha’s Nek district is about 3% of the population in Lesotho, while Leribe is about 16% of the population in Lesotho. But as the blue column shows, the number of women interviewed in Qacha’s Nek accounts for about 8% of the total sample of women interviewed (558/6,621) and the number of women interviewed in Leribe accounts for 12% of the total sample of women interviewed (785/6,621). This unweighted distribution of Basotho women does not accurately represent the population. In order to get statistics that are representative of Lesotho, the distribution of the women in the sample needs to be weighted (or mathematically adjusted) such that it resembles the true distribution in the country. Women from a small district, like Qacha’s Nek, should only contribute a small amount to the national total. Women from a large district, like Leribe should contribute much more. Therefore, DHS statisticians mathematically calculate a “weight” which is used to adjust the number of women from each district so that each district’s contribution to the total is proportional to the actual population of the district. The numbers in the purple column (2) represent the “weighted” values. The weighted values can be smaller or larger than the unweighted values at the district level. The total national sample size of 6,621women has not changed after weighting, but the distribution of the women in the districts has been changed to represent their contribution to the total population size. How do statisticians weight each category? They take into account the probability that a woman was selected in the sample. If you were to compare the red column (3) to the actual population distribution of Lesotho, you would see that women in each district are contributing to the total sample with the same weight that they contribute to the population of Lesotho. The weighted number of women in the survey now accurately represents the proportion of women who live in Qacha’s Nek and the proportion of women who live in Leribe. With sampling and weighting, it is possible to interview enough women to provide reliable statistics at the national and district levels. In general, only the weighted numbers are shown in each of the LDHS tables, so don’t be surprised if these numbers seem low in some cases: they may actually represent a larger number of women interviewed. Table 3.1 Background characteristics of respondents Percent distribution of women age 15-49 by selected background characteristics, Lesotho 2014 Women Background characteristic Weighted percent Weighted number Unweighted number District Butha-Buthe 5.8 385 593 Leribe 16.1 1,064 785 Berea 13.5 892 760 Maseru 28.2 1,864 930 Mafeteng 8.7 576 624 Mohale’s Hoek 7.8 519 621 Quthing 4.8 315 556 Qacha’s Nek 3.1 204 558 Mokhotlong 5.3 349 605 Thaba-Tseka 6.8 452 589 Total 15-49 100.0 6,621 6,621 3 2 1 Additional DHS Program Resources • xxv ADDITIONAL DHS PROGRAM RESOURCES The DHS Program Website – Download free DHS reports, standard documentation, key indicator data, and training tools, and view announcements. DHSprogram.com STATcompiler – Build custom tables, graphs, and maps with data from 90 countries and thousands of indicators. Statcompiler.com DHS Program Mobile App – Access key DHS indicators for 90 countries on your mobile device (Apple, Android, or Windows). Search DHS Program in your iTunes or Google Play store DHS Program User Forum – Post questions about DHS data, and search our archive of FAQs. userforum.DHSprogram.com Tutorial Videos – Watch interviews with experts and learn DHS basics, such as sampling and weighting, downloading datasets, and How to Read DHS Tables. www.youtube.com/DHSProgram Datasets – Download DHS datasets for analysis. DHSprogram.com/Data Spatial Data Repository – Download geographically linked health and demographic data for mapping in a geographic information system (GIS). spatialdata.DHSprogram.com Social Media – Follow The DHS Program and join the conversation. Stay up to date through: Facebook www.facebook.com/DHSprogram Twitter www.twitter.com/ DHSprogram Pinterest www.pinterest.com/ DHSprogram LinkedIn www.linkedin.com/ company/dhs-program YouTube www.youtube.com/DHSprogram Blog Blog.DHSprogram.com Acronyms and Abbreviations • xxvii ACRONYMS AND ABBREVIATIONS AIDS acquired immunodeficiency syndrome ANC antenatal care ARI acute respiratory infection ART antiretroviral therapy BMI body mass index BOS Bureau of Statistics CAPI computer-assisted personal interviewing CBD community-based distributor CBR crude birth rate CDC Centers for Diseases Control and Prevention CHAL Christian Health Association of Lesotho CPR contraceptive prevalence rate DBS dried blood spots DEFT design effect DHS Demographic and Health Surveys EA enumeration area ELISA enzyme-linked immunosorbent assay EPI Expanded Programme on Immunization FNCO Food and Nutrition Coordinating Office FRR False Recent Rate GAR gross attendance ratio GFR general fertility rate GIS geographic information system GPI gender parity index HIV human immunodeficiency virus HTS HIV Testing and Counselling Services ICD International Classification of Diseases IFSS internet file streaming system IMPAC integrated management of pregnancy and childbirth IUCD intrauterine contraceptive device IYCF infant and young child feeding LDHS Lesotho Demographic and Health Survey LPG liquid petroleum gas MAD minimum acceptable diet MDG Millennium Development Goal MOH Ministry of Health MMR maternal mortality ratio MTCT mother-to-child transmission MUAC mid-upper-arm circumference xxviii • Acronyms and Abbreviations NAR net attendance ratio NCD noncommunicable disease NCHS National Center for Health Statistics NICD National Institute for Communicable Diseases NRL National Reference Laboratory ORS oral rehydration salts ORT oral rehydration therapy PDA personal digital assistant PEPFAR U.S. President’s Emergency Plan for AIDS Relief PHC Population and Housing Census PMTCT prevention of mother-to-child transmission PY person-years RHF recommended homemade fluids RSA Republic of South Africa SD standard deviation SE standard error STI sexually transmitted infection TB tuberculosis TFR total fertility rate UNFPA United Nations Population Fund UNICEF United Nations Children’s Fund USAID United States Agency for International Development VAD vitamin A deficiency VIP ventilated improved pit VMMC voluntary male medical circumcision WHO World Health Organization Millennium Development Goal Indicators • xxix MILLENNIUM DEVELOPMENT GOAL INDICATORS Millennium Development Goal Indicators Lesotho 2014 Sex Total Indicator Female Male 1. Eradicate extreme poverty and hunger 1.8 Prevalence of underweight children under age 5 8.3 12.5 10.3 2. Achieve universal primary education 2.1 Net attendance ratio in primary education1 97.5 93.0 95.3 2.3 Literacy rate of 15- to 24-year-olds2 98.6 90.6a 94.6b 3. Promote gender equality and empower women 3.1 Ratio of girls to boys in primary, secondary, and tertiary education 3.1a Ratio of girls to boys in primary education3 na na 1.0 3.1b Ratio of girls to boys in secondary education3 na na 1.5 3.1c Ratio of girls to boys in tertiary education3 na na 1.0 4. Reduce child mortality 4.1 Under-5 mortality rate4 82 102 85 4.2 Infant mortality rate4 60 78 59 4.3 Proportion of 1-year-old children immunised against measles 92.8 87.6 90.1 5. Improve maternal health 5.1 Maternal mortality ratio5 na na 1024 5.2 Percentage of births attended by skilled health personnel6 na na 77.9 5.3 Contraceptive prevalence rate7 60.2 na na 5.4 Adolescent birth rate8 94.3 na na 5.5 Antenatal care coverage 5.5a Antenatal care coverage: at least one visit9 95.2 na na 5.5b Antenatal care coverage: four or more visits10 74.4 na na 5.6 Unmet need for family planning 18.4 na na 6. Combat HIV/AIDS, malaria, and other diseases 6.1 HIV prevalence among the population age 15-24 13.1 6.0 9.6 6.2 Condom use at last high-risk sex11 81.9 78.7a 80.3b 6.3 Percentage of the population age 15-24 with comprehensive correct knowledge of HIV/AIDS12 37.6 30.9a 34.3b 6.4 Ratio of school attendance of orphans to school attendance of non-orphans age 10-14 0.95 0.90 0.92 Urban Rural Total 7. Ensure environmental sustainability 7.8 Percentage of population using an improved drinking water source13 96.3 76.9 82.2 7.9 Percentage of population with access to improved sanitation14 49.0 51.6 50.9 na = Not applicable 1 The ratio is based on reported attendance, not enrolment, in primary education among primary school age children (age 6-12). The rate also includes children of primary school age enrolled in secondary education. This is a proxy for MDG indicator 2.1, net enrolment ratio. 2 Refers to respondents who attended secondary school or higher or who could read a whole sentence or part of a sentence 3 Based on reported net attendance, not gross enrolment, among 6- to 12-year-olds for primary, 13- to 17-year-olds for secondary, and 18- to 24-year- olds for tertiary education 4 Expressed in terms of deaths per 1,000 live births. Mortality by sex refers to a 10-year reference period preceding the survey. Mortality rates for males and females combined refer to the 5-year period preceding the survey. 5 Expressed in terms of maternal deaths per 100,000 live births in the 7-year period preceding the survey 6 Among births in the 5 years preceding the survey 7 Percentage of currently married women age 15-49 using any method of contraception 8 Equivalent to the age-specific fertility rate for women age 15-19 for the 3-year period preceding the survey, expressed in terms of births per 1,000 women age 15-19 9 With a skilled provider 10 With any health care provider 11 Higher-risk sex refers to sexual intercourse with a non-marital, non-cohabitating partner. Expressed as a percentage of men and women age 15-24 who had higher-risk sex in the past 12 months. 12 Comprehensive knowledge means knowing that consistent use of a condom during sexual intercourse and having just one uninfected faithful partner can reduce the chance of getting HIV, knowing a healthy-looking person can have HIV, and rejecting the two most common local misconceptions about transmission or prevention of HIV. 13 Percentage of de jure population whose main source of drinking water is a household connection (piped), public tap or standpipe, tube well or borehole, protected dug well or spring, rainwater collection, or bottled water 14 Percentage of de jure population whose household has a flush toilet, ventilated improved pit latrine, ordinary pit latrine/pit latrine with a slab, or composting toilet and does not share this facility with other households a Restricted to men in the subsample of households selected for the male interview b The total is calculated as the simple arithmetic mean of the percentages in the columns for male and females. xxx • Map of Lesotho Introduction and Survey Methodology • 1 INTRODUCTION AND SURVEY METHODOLOGY 1 he 2014 Lesotho Demographic and Health Survey (LDHS) was implemented by the Lesotho Ministry of Health (MOH). Data collection took place from 22 September to 7 December 2014. ICF International provided technical assistance through The DHS Program, which is funded by the United States Agency for International Development (USAID) and offers financial support and technical assistance for population and health surveys in countries worldwide. Other agencies and organisations that facilitated the successful implementation of the survey through technical or financial support were the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), the Global Fund to Fight AIDS, Tuberculosis and Malaria (Global Fund), the United Nations Children’s Fund (UNICEF), the United Nations Population Fund (UNFPA), the World Bank, the World Health Organization (WHO), the Christian Health Association of Lesotho (CHAL), the National University of Lesotho, the Bureau of Statistics (BOS) of the Ministry of Development Planning, and the Food and Nutrition Coordinating Office (FNCO) of the Prime Minister’s Office. 1.1 SURVEY OBJECTIVES The primary objective of the 2014 LDHS project is to provide up-to-date estimates of basic demographic and health indicators. Specifically, the LDHS collected information on fertility levels, marriage, sexual activity, fertility preferences, awareness and use of family planning methods, breastfeeding practices, nutrition, childhood and maternal mortality, maternal and child health, awareness and behaviour regarding HIV/AIDS and other sexually transmitted infections (STIs), and other health issues such as smoking, knowledge of breast cancer, and male circumcision. In addition, the 2014 LDHS provides estimates of anaemia prevalence among children age 6-59 months and adults, and gives estimates of hypertension, HIV prevalence and HIV incidence among adults. The 2014 LDHS is a follow-up to the 2004 and 2009 LDHS surveys. The information collected through the LDHS is intended to assist policy makers and programme managers in evaluating and designing programmes and strategies for improving the health of the country’s population. 1.2 SAMPLE DESIGN The sampling frame used for the 2014 LDHS is an updated frame from the 2006 Lesotho Population and Housing Census (PHC) provided by the Lesotho Bureau of Statistics (BOS). The sampling frame excluded nomadic and institutional populations such as persons in hotels, barracks, and prisons. The 2014 LDHS followed a two-stage sample design and was intended to allow estimates of key indicators at the national level as well as in urban and rural areas, four ecological zones,1 and each of Lesotho’s 10 districts.2 The first stage involved selecting sample points (clusters) consisting of enumeration areas (EAs) delineated for the 2006 PHC. A total of 400 clusters were selected, 118 in urban areas and 282 in rural areas.3 The second stage involved systematic sampling of households. A household listing operation was undertaken in all of the selected EAs in July 2014, and households to be included in the survey were randomly selected from these lists. About 25 households were selected from each sample point, for a total sample size of 9,942 1 Lowlands, Foothills, Mountains, and Senqu River Valley. 2 Butha-Buthe, Leribe, Berea, Maseru, Mafeteng, Mohale’s Hoek, Quthing, Qacha’s Nek, Mokhotlong, and Thaba-Tseka. 3 One rural EA was inadvertently dropped from the sample. After the fieldwork was completed, it was determined that the EA had not been visited. T 2 • Introduction and Survey Methodology households. Because of the approximately equal sample sizes in each district, the sample is not self-weighting at the national level, and weighting factors have been added to the data file so that the results will be proportional at the national level. All women age 15-49 who were either permanent residents of the selected households or visitors who stayed in the household the night before the survey were eligible to be interviewed. In half of the households, all men age 15-59 who were either permanent residents of the selected households or visitors who stayed in the household the night before the survey were eligible to be interviewed. In the subsample of households selected for the male survey, blood pressure measurements and anaemia testing were performed among eligible women and men who consented to being tested. With the parent’s or guardian’s consent, children age 6-59 months were also tested for anaemia. In the same subsample of households, blood specimens were collected for laboratory testing of HIV from eligible women and men who consented; height and weight were measured for eligible women, men, and children age 0-59 months; and mid-upper-arm circumference (MUAC) measurements were collected for children age 6-59 months. 1.3 QUESTIONNAIRES Three questionnaires were used for the 2014 LDHS: the Household Questionnaire, the Woman’s Questionnaire, and the Man’s Questionnaire. These questionnaires, based on The DHS Program’s standard Demographic and Health Survey questionnaires, were adapted to reflect the population and health issues relevant to Lesotho. Input was solicited from various stakeholders representing government ministries and agencies, nongovernmental organisations, and international donors. After the preparation of the definitive questionnaires in English, the questionnaires were translated into Sesotho. The Household Questionnaire was used to list all members of and visitors to selected households. Basic demographic information was collected on the characteristics of each person listed, including his or her age, sex, marital status, education, and relationship to the head of the household. For children under age 18, the parents’ survival status was determined. The data on age and sex of household members, obtained in the Household Questionnaire, were used to identify women and men eligible for individual interviews. The Household Questionnaire also collected information on characteristics of the household’s dwelling unit, such as source of water, type of toilet facilities, materials used for the floor of the dwelling unit, and ownership of various durable goods. The Woman’s Questionnaire was used to collect information from all eligible women age 15-49. These women were asked questions on the following topics:  Background characteristics (age, education, media exposure, and so on)  Birth history and child mortality  Knowledge and use of family planning methods  Fertility preferences  Antenatal, delivery, and postnatal care  Breastfeeding and infant feeding practices  Vaccinations and childhood illnesses  Marriage and sexual activity  Women’s work and husbands’ background characteristics Introduction and Survey Methodology • 3  Knowledge, awareness, and behaviour regarding HIV/AIDS and other sexually transmitted infections (STIs)  Adult mortality, including maternal mortality  Knowledge, attitudes, and behaviour related to other health issues (for example, tuberculosis, diabetes, breast and cervical cancer) The Man’s Questionnaire was administered to all men age 15-59 in the subsample of households selected for the male survey. The Man’s Questionnaire collected much of the same information as the Woman’s Questionnaire but was shorter because it did not contain questions to elicit a detailed reproductive history or questions on maternal and child health. In this survey, instead of using paper questionnaires, interviewers used personal digital assistants (PDAs) to record responses during interviews, and team supervisors managed the data using tablet computers. The PDAs and tablets were equipped with Bluetooth technology to enable remote electronic transfer of files (e.g., transfer of assignment sheets from team supervisors to interviewers and transfer of completed questionnaires from interviewers to supervisors). The computer-assisted personal interviewing (CAPI) data collection system employed in the 2014 LDHS was developed by The DHS Program using the mobile version of CSPro. The CSPro software was developed jointly by the U.S. Census Bureau, The DHS Program, and Serpro S. A. 1.4 BLOOD PRESSURE MEASUREMENT, ANTHROPOMETRY, ANAEMIA TESTING, AND HIV TESTING In the half of the households selected for the male survey, the 2014 LDHS incorporated several “biomarkers”: blood pressure measurement, anthropometry, anaemia testing, and HIV testing. In contrast with the data collection procedure for the household and individual interviews, data related to all biomarkers except blood pressure were initially recorded on a paper form (the Biomarker Data Collection Form) and subsequently entered into the team supervisor’s tablet computer. The survey protocol, including biomarker collection, was reviewed and approved by the Lesotho Ministry of Health Research and Ethics Committee and the Institutional Review Board of ICF International. Blood pressure. During the individual interview, three blood pressure measurements were taken from consenting women age 15-49 and men age 15-59 using Omron M3W blood pressure monitors. Measurements were taken at intervals of 10 minutes or more. The average of the second and third measurements was used to classify the respondent with respect to hypertension, according to internationally recommended categories (WHO 1999; NIH 1997). The results, as well as information about the symptoms of high blood pressure and ways in which it can be prevented, were provided to the respondent via the Blood Pressure Findings Report Form and Brochure. Anthropometry. Height and weight measurements were recorded for children age 0-59 months, women age 15-49, and men age 15-59. In addition, mid-upper-arm circumference (MUAC) was recorded for children age 6-59 months. Anaemia testing. Blood specimens for anaemia testing were collected from women age 15-49 and men age 15-59 who voluntarily consented to be tested and from all children age 6-59 months for whom consent was obtained from their parents or the adult responsible for the children. Blood samples were drawn from a drop of blood taken from a finger prick (or a heel prick in the case of children age 6-11 months) and collected in a microcuvette. Haemoglobin analysis was carried out on-site using a battery-operated portable HemoCue analyser. Results were provided verbally and in writing. Parents/guardians of children with a haemoglobin level under 7 g/dl were instructed to take the child to a health facility for follow-up care. Likewise, non- 4 • Introduction and Survey Methodology pregnant women, pregnant women, and men were referred for follow-up care if their haemoglobin levels were below 7 g/dl, 9 g/dl, and 9 g/dl, respectively. All households in which anthropometry and/or anaemia testing was conducted were given a brochure explaining the causes and prevention of anaemia. HIV testing. Interviewers collected blood specimens via finger-prick for laboratory testing for HIV from women age 15-49 and men age 15-59 who consented to be tested. The protocol for blood specimen collection and analysis was based on the anonymous linked protocol developed by The DHS Program. This protocol allows for merging of HIV test results with the sociodemographic data collected in the individual questionnaires after removal of all information that could potentially identify an individual. Interviewers explained the procedure, the confidentiality of the data, and the fact that the test results would not be made available to the respondent. If a respondent consented to HIV testing, five blood spots from the finger prick were collected on a filter paper card to which a barcode label unique to the respondent was affixed. A duplicate label was attached to the Biomarker Data Collection Form. A third copy of the same barcode was affixed to the Dried Blood Spot Transmittal Sheet to track the blood samples from the field to the laboratory. Respondents were asked whether they would consent to having the laboratory store their blood sample for future unspecified testing. If respondents did not consent to additional testing using their sample, it was indicated on the Biomarker Data Collection Form that they refused additional tests using their specimen, and the words “no additional testing” were written on the filter paper card. Each respondent, whether providing consent or not, was given an informational brochure on HIV and a list of nearby sites providing HIV testing and counselling services (HTS). Blood samples were dried overnight and packaged for storage the following morning. Samples were periodically collected from the field and transported to the National Reference Laboratory (NRL) in Maseru. Upon arrival at the NRL, each blood sample was logged into the CSPro HIV Test Tracking System database, given a laboratory number, and stored at -20˚C until tested. The HIV testing protocol stipulated that blood could be tested only after questionnaire data collection had been completed, data had been verified and cleaned, and all unique identifiers other than the anonymous barcode number had been removed from the data file. Testing was performed to estimate HIV prevalence and HIV incidence. The details of the testing algorithm are shown in Appendix C. 1.5 PRETEST Ten women and five men participated in a training to pretest the LDHS survey protocol over a three-week period in June 2014. The majority of participants had worked in various LDHS survey activities previously, including the 2009 LDHS. Participants were employed by the MOH, the BOS, or the Lesotho Planned Parenthood Association. Ten days of classroom instruction were provided. Trainers were from The DHS Program. Pretest field practice took place over four days in both rural and urban locations. Following field practice, a debriefing session was held with the pretest field staff, and modifications to the questionnaires were made based on lessons drawn from the exercise. 1.6 TRAINING OF FIELD STAFF The MOH recruited and trained 100 people for the main fieldwork to serve as supervisors, interviewers, secondary editors, and reserve interviewers. The field staff main training took place over four weeks (6-29 August 2014) at the Khotsong Lodge in Thaba-Bosiu, Lesotho. The training course consisted of instruction regarding interviewing techniques and field procedures, a detailed review of questionnaire content, instruction on how to administer the paper and electronic questionnaires, instruction in weighing and measuring children Introduction and Survey Methodology • 5 and adults, mock interviews between participants in the classroom, practice biomarker collection between participants, and practice interviews with real respondents in areas outside the 2014 sample points. In addition, participants completed limited field practice in blood pressure measurement, anthropometry, anaemia testing, and blood collection for HIV testing.4 Participants were evaluated through homework, in-class exercises, quizzes, and observations made during field practice. Ultimately, 75 participants were selected to serve as interviewers and 15 as team supervisors. The latter received additional training in data quality control procedures, fieldwork coordination, and use of special programmes for the tablet computers. A major challenge was faced by all who attended the main training. During the second week of the training, an interviewer candidate, Ms. Mathebane Ramataboee, was brutally murdered along with a friend. The killings were unrelated to the LDHS. Ms. Ramataboee was a public health nurse working with the EPI Programme at the MOH, and had served as an interviewer in the 2009 LDHS and in the 2014 LDHS pretest. As a well-liked and respected member of the community, her loss was felt keenly by main training participants. 1.7 FIELDWORK Data collection was carried out by 15 field teams, each consisting of one team supervisor, two or three female interviewers, two or three male interviewers, and one driver. All interviewers on each team also served as biomarker technicians. Electronic data files containing interview results were transferred from each interviewer’s PDA to the team supervisor’s tablet each day. Six senior staff members from the MOH coordinated and supervised fieldwork activities. Electronic data files were transferred to the central office every few days via the secured Internet File Streaming System (IFSS). Participants in fieldwork monitoring also included two survey technical specialists from The DHS Program. Data collection took place over a 2.5-month period, from 22 September 2014 through 7 December 2014. The substantial gap between the end of the main training and the start of fieldwork was due to concerns about team safety following political disturbances on 30 August 2014. Immediately prior to the launch, the MOH conducted a two-day refresher training course for interviewers and supervisors at MOH headquarters. 1.8 DATA PROCESSING All electronic data files for the 2014 LDHS were transferred via IFSS to the MOH central office in Maseru, where they were stored on a password-protected computer. The data processing operation included secondary editing, which involved resolution of computer-identified inconsistencies and coding of open-ended questions. The data were processed by one person who took part in the main fieldwork training. Data editing was accomplished using CSPro software. Secondary editing and data processing were initiated in October 2014 and completed in February 2015. 1.9 RESPONSE RATES Table 1.1 shows response rates for the 2014 LDHS. A total of 9,942 households were selected for the sample, of which 9,543 were occupied. Of the occupied households, 9,402 were successfully interviewed, yielding a response rate of 99%. This compares favourably to the 2009 LDHS response rate (98%). 4 Equipment shortages due to procurement issues necessitated that field practice teams share height boards, HemoCue analysers, and blood pressure monitors. 6 • Introduction and Survey Methodology In the interviewed households, 6,818 eligible women were identified for individual interviews; interviews were completed with 6,621 women, yielding a response rate of 97%. In the subsample of households selected for the male survey, 3,133 eligible men were identified and 2,931 were successfully interviewed, yielding a response rate of 94%. The lower response rate for men was likely due to their more frequent and longer absences from the household. The response rates for both women and men were slightly lower in the 2014 LDHS than in the 2009 LDHS (in which response rates were 98% for women and 95% for men). Strikingly, however, the numbers of eligible women and men identified in households in the 2014 LDHS were substantially lower than in the 2009 LDHS. Whereas there was an average of 0.83 eligible women and 0.72 eligible men per household in the 2009 LDHS, the corresponding averages in 2014 were 0.73 and 0.67 (data not shown). The reason for the difference in the average number of eligible women and men between the 2009 and 2014 LDHS surveys is unknown. Possibilities range from a demographic shift in the population of Lesotho to data quality issues such as age displacement or omission of household members (or a combination of both). Table 1.1 Results of the household and individual interviews Number of households, number of interviews, and response rates, according to residence (unweighted), Lesotho 2014 Residence Total Result Urban Rural Household interviews Households selected 2,934 7,008 9,942 Households occupied 2,843 6,700 9,543 Households interviewed 2,798 6,604 9,402 Household response rate1 98.4 98.6 98.5 Interviews with women age 15-49 Number of eligible women 2,282 4,536 6,818 Number of eligible women interviewed 2,202 4,419 6,621 Eligible women response rate2 96.5 97.4 97.1 Interviews with men age 15-59 Number of eligible men 960 2,173 3,133 Number of eligible men interviewed 903 2,028 2,931 Eligible men response rate2 94.1 93.3 93.6 1 Households interviewed/households occupied 2 Respondents interviewed/eligible respondents Housing Characteristics and Household Population • 7 HOUSING CHARACTERISTICS AND HOUSEHOLD POPULATION 2 Key Findings  Drinking water: Only 77% of rural households have access to an improved source of drinking water, compared with 97% of urban households.  Sanitation: Although the proportion of rural households without a toilet facility is dropping, 38% of households still have none.  Household population and composition: The population of Lesotho is young, with 39% of the population under age 15.  Birth registration: The proportion of children under age 5 whose births are registered with the government has declined slightly since 2009 (from 45% in 2009 to 43% in 2014).  Orphans: Among children under age 18, more than one- quarter are orphans (one or both parents are dead) and over one-third do not live with either parent.  School attendance: The net attendance ratio falls from 94% in primary school to 42% in secondary school. Girls and boys are about equally likely to attend primary school, but girls are much more likely than boys to attend secondary school. nformation on the socioeconomic characteristics of the household population in the LDHS provides context to interpret demographic and health indicators and can furnish an approximate indication of the representativeness of the survey. In addition, this information sheds light on the living conditions of the population. This chapter presents information on source of drinking water, sanitation, exposure to smoke inside the home, wealth, hand washing, household population composition, educational attainment, school attendance, birth registration, and family living arrangements. 2.1 DRINKING WATER SOURCES AND TREATMENT Improved sources of drinking water Include piped water, public taps, standpipes, tube wells, boreholes, protected dug wells and springs, rainwater, and bottled water Sample: Households I 8 • Housing Characteristics and Household Population In Lesotho, almost all urban households (97%), but only 77% of rural households, have access to an improved source of drinking water (Table 2.1). Improved sources protect against outside contamination so that water is more likely to be safe to drink. Urban and rural households rely on different sources of drinking water. Most urban households (70%) have piped water in their dwelling or yard (Figure 2.1). In contrast, rural households mainly rely on public taps (56%), followed by unimproved sources (23%). Only 5% of rural households have piped water on their premises; 37% travel 30 minutes or longer round trip to fetch drinking water (Table 2.1). Clean water is a basic need for human life. Most households (87%) report that they do no treat their water prior to drinking (Table 2.1). One in ten households boils their drinking water, making it the most commonly used water treatment. Despite the fact that a higher proportion of households in rural areas obtains water from unimproved sources compared with urban areas, water treatment is more common in urban areas. Twenty-one percent of households in the urban areas boil their drinking water compared with 7% in the rural areas. Trends: The proportion of households obtaining water from improved sources increased from 79% in 2009 to 84% in 2014. Gains were concentrated in urban households; the proportion of urban households with access to improved drinking water sources increased from 91% to 97%, while the proportion of rural households with access to improved drinking water sources shifted from 74% in 2009 to 77% in 2014. 2.2 SANITATION Improved toilet facilities Include any non-shared toilet of the following types: flush/pour flush toilets to piped sewer systems, septic tanks, and pit latrines; ventilated improved pit (VIP) latrines; and pit latrines with slabs Sample: Households Nearly 5 in 10 households in Lesotho usually use improved toilet facilities, which are defined as non-shared facilities that prevent people from coming into contact with human waste and thus reduce the transmission of cholera, typhoid, and other diseases. Shared toilet facilities of an otherwise acceptable type are especially common in urban areas (Figure 2.2). Twenty-seven percent of households do not use any toilet facility. Figure 2.1 Household drinking water by residence 70 5 26 24 56 46 1 8 6 2 9 7 3 23 16 Urban Rural All Unimproved source Protected well or spring Tubewell or borehole Public tap/standpipe Piped water into dwelling/yard/plot Percent distribution of households by source of drinking water Housing Characteristics and Household Population • 9 The most commonly used improved toilet facility in both urban and rural areas is a pit latrine with slab (referred to in Lesotho as an ordinary pit latrine) (Table 2.2). The proportion of households with an improved toilet facility is higher in rural areas than in the urban areas. Thirty-nine percent of rural households have unimproved toilet facilities or no toilet facilities at all, which increases the risk of disease transmission. Only 6% of households in urban areas lack toilet facilities or have an unimproved facility. Trends: The proportion of urban households with improved toilet facilities has increased since 2009, rising from 26% to 41%. In rural households, the proportion has more than doubled (rising from 22% to 50%). During this same period, the proportion of rural households without any toilet facilities dropped from 45% to 38%. 2.3 EXPOSURE TO SMOKE INSIDE THE HOME Exposure to smoke inside the home, either from cooking with solid fuels or from smoking tobacco, has potentially harmful health effects. Fifty-seven percent of households in Lesotho use some type of solid fuel for cooking, virtually all of it wood (Table 2.3), a figure unchanged since 2009 (58%). Exposure to cooking smoke is greater when cooking takes place inside the house rather than in a separate building or outdoors. In Lesotho, cooking is done inside the house in slightly more than a half of households (53%), a figure identical to 2009. Additionally, in 16% of households someone smokes inside the house daily. Other Housing Characteristics The survey also collected data on access to electricity, flooring materials, and the number of rooms used for sleeping. Sixty-two percent of urban households and 12% of rural households have access to electricity. Nationally, the proportion of households with access to electricity has increased four-fold over the last decade: 7% of households had access to electricity in 2004, 17% in 2009, and 28% in 2014. At 33% each, cement and earth/mud/dung are the most common flooring materials used in Lesotho. By residence, however, differences in flooring material exist. The most common flooring material in rural areas is earth/mud/dung (46%); the most common flooring material in urban areas is cement (50%). Table 2.3 provides complete information on housing characteristics. Figure 2.2 Household toilet facilities by residence 41 50 47 53 11 25 1 1 1 5 38 27 Urban Rural All No facility/bush/field Unimproved facility Shared facility Improved facility Percent distribution of households by type of toilet facilities 10 • Housing Characteristics and Household Population 2.4 HOUSEHOLD WEALTH Wealth index Households are given scores based on the number and kinds of consumer goods they own, ranging from a television to a bicycle or car, plus housing characteristics such as source of drinking water, toilet facilities, and flooring materials. These scores are derived using principal component analysis. National wealth quintiles are compiled by assigning the household score to each usual (de jure) household member, ranking each person in the household population by their score, and then dividing the distribution into five equal categories, each with 20% of the population. Sample: Households In Lesotho, the wealthiest households are concentrated in urban areas. Eighty-five percent of the urban population belongs to the two highest wealth quintiles. More than half (54%) of the rural population falls in the two lowest wealth quintiles (Figure 2.3).Two districts in the Mountains ecological zone of Lesotho have extreme concentrations of poverty; the majority of the population in Mokhotlong and in Thaba-Tseka is in the lowest wealth quintile (53% and 55%, respectively) (Table 2.4). Household Durable Goods The survey also collected information on household effects, means of transportation, agricultural land, and farm animals. Urban households are more likely than rural households are to own a radio (72% versus 51%), television (53% versus 16%), or mobile telephone (96% versus 78%). In contrast, rural households are more likely than urban households are to own agricultural land (61% versus 17%) or farm animals (64% versus 28%). For complete information on household durable goods, see Table 2.5. 2.5 HAND WASHING To obtain hand-washing information, interviewers asked to see the place where members of the household most often wash their hands. Soap and water—the ideal hand washing agent—was seen in 46% of the hand- washing locations that were observed; another 34% had water only (Table 2.6). No water, soap, or other cleaning agent was observed in 18% of handwashing locations. The representativeness of these data is unclear because a place for hand washing was observed in only a small percentage of households (5%). The most common reason interviewers were unable to observe the place where household members usually wash their hands was because there was no designated place for hand washing. Figure 2.3 Household wealth by residence 28 3 26 12 23 31 16 54 7 Urban Rural Percent distribution of de jure population by wealth quintiles Wealthiest Fourth Middle Second Poorest Housing Characteristics and Household Population • 11 2.6 HOUSEHOLD POPULATION AND COMPOSITION Household A person or group of related or unrelated persons who live together in the same dwelling unit(s), who acknowledge one adult male or female as the head of the household, who share the same housekeeping arrangements, and who are considered a single unit. De facto population All persons who stayed in the selected households the night before the interview (whether usual residents or visitors) De jure population All persons who are usual residents of the selected households, whether or not they stayed in the household the night before the interview A total of 31,406 individuals stayed overnight in 9,402 sample households in the 2014 LDHS. Fifty-three percent of them (16,727) were female, and 47% (14,679) were male (Table 2.7). The population pyramid in Figure 2.4 shows their distribution by 5-year age groups and sex. The broad base of the pyramid shows that Lesotho’s population is young, which is typical of developing countries with low life expectancy. The proportion of children under age 15 was 39% in 2014, while the proportion of individuals age 65 and older was 8% (Table 2.7). On average, households in Lesotho comprise 3.3 persons (Table 2.8). Urban households are smaller than rural households (2.8 persons versus 3.6 persons). Women head 36% of all households. The 2014 LDHS also captured information on residency status. In Lesotho, many individuals reside away from their home communities and/or apart from their families for extended periods to pursue work or educational opportunities. Such persons were listed in the household schedule section of the Household Questionnaire, but were not classified as usual residents of their family’s household; instead, they were classified as residing elsewhere, either in Lesotho, in South Africa, or in some other country. As shown in Table 2.9, among males listed in the household schedule, 77% live in the household, 14% live elsewhere in Lesotho, and 9% live in South Africa. Among females listed in the household schedule, 82% live in the household, 14% live elsewhere in Lesotho, and 5% live in South Africa. Figure 2.4 Population pyramid 10 6 2 2 6 10 <5 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80+ Age Percent distribution of the household population Male Female 261210 12 • Housing Characteristics and Household Population Trends: The population pyramid is comparable to 2009, when children under age 15 made up 40% of the population and individuals age 65 and older made up 7%. Average household size has decreased since 2009, from 3.6 to 3.3 persons, while the proportion of female-headed households has remained unchanged since 2009. The residency status of individuals listed in the household schedule of the Household Questionnaire is comparable to 2009. 2.7 BIRTH REGISTRATION Registered birth Child has a birth certificate or his/her birth has been registered with the civil authority. Sample: De jure children under age 5 The births of 43% of children under age 5 had been registered with the civil authority at the time of the survey. These births included 18% of children under age 5 with a birth certificate (Table 2.10). Boys and girls are equally likely to be registered. The registration of births varies widely across districts, with children most likely to be registered in Berea and Maseru (Figure 2.5). The percentage of registered children increases with the household’s wealth quintile, from 34% in the lowest wealth quintile to 63% in the highest wealth quintile (Table 2.10). Trends: Registration of children’s births has changed little between 2009 (45%) and 2014 (43%). 2.8 CHILDREN’S LIVING ARRANGEMENTS AND PARENTAL SURVIVAL Orphan A child with one or both parents dead Sample: Children under age 18 Twenty-seven percent of Lesotho children under age 18 are orphans, meaning that one or both of their parents are dead (Table 2.11). The proportion of orphaned children increases rapidly with age, rising from 6% of children under age 2 to 48% of children age 15-17 (Figure 2.6). Orphanhood varies little by residence or district. Only 22% of children under age 18 live with both of their parents; 35% do not live with a biological parent. For information on school attendance by survivorship of parents, see Table 2.12. Figure 2.5 Birth registration by district Percentage of children under age 5 whose births are registered Figure 2.6 Orphanhood by age 6 13 21 37 48 27 <2 2-4 5-9 10-14 15-17 0-17 Percentage of children under age 18 with one or both parents dead, by age of child Age in years Housing Characteristics and Household Population • 13 Trends: Since the 2009 LDHS, the proportion of children under age 18 who are orphaned has changed little (28% versus 27%). 2.9 EDUCATION 2.9.1 Educational Attainment Median educational attainment Number of years of schooling completed by half of the population Sample: De facto household population age 6 and older Overall, 86% of males age 6 and over in Lesotho have ever attended school, compared with 95% of females (Tables 2.13.1 and 2.13.2).The proportions of women and men who have completed secondary school or gone beyond secondary school are identical (10%). Median educational attainment is slightly higher for females (5.7 years) than for males (4.0 years). Trends: Educational attainment at the household level continues to increase. In 2004, 8% of women and 19% of men in surveyed households had no education at all compared with 5% of women and 15% of men in 2009, and 5% of women and 13% of men in 2014. Secondary education has increased from 5% of women and 5% of men completing secondary school in 2004 to 8% of women and 7% of men in 2009, and 10% of women and 10% of men in 2014. Patterns by background characteristics  Urban residents are much more likely to have completed secondary school than rural residents. Among women in urban households, 22% have completed secondary school or beyond compared with 5% of women in rural households. A similar pattern holds for men; 25% of urban men completed secondary school compared with 4% of rural men.  Educational attainment varies by district. Fewer than 1 in 10 women in Quthing, Qacha’s Nek, Mokhotlong, and Thaba-Tseka has no education. Twenty-seven percent of men in Thaba-Tseka have no education.  Educational attainment increases with household wealth among women and men. Thirty percent of women in the wealthiest households have completed secondary school or beyond compared with less than 1% of women in the poorest households. 2.9.2 School Attendance Net attendance ratio (NAR) Percentage of the school-age population that attends primary or secondary school Sample: Children age 6-12 for primary school NAR and children age 13-17 for secondary school NAR Gross attendance ratio (GAR) The total number of primary and secondary school students expressed as a percentage of the official primary and secondary school-age population Sample: Children age 6-12 for primary school GAR and children age 13-17 for secondary school GAR 14 • Housing Characteristics and Household Population Ninety-five percent of girls age 6-12 attend primary school compared with 92% of boys (Table 2.14). The net attendance ratio drops in secondary school: only 51% of girls and 35% of boys age 13-17 attend secondary school. Patterns by background characteristics  Urban children age 13-17 are more likely than their rural counterparts are to attend secondary school (65% versus 34%).  Girls are more likely than boys are to attend secondary school in all the districts of Lesotho. Attendance ranges from a low of 11% in Thaba-Tseka to a high of 46% in Maseru for boys and from a low of 32% in Thaba-Tseka to 60% in both Berea and Leribe for girls.  Girls and boys in the highest wealth quintile are 3 and 10 times more likely to attend secondary school, respectively, than those in the lowest wealth quintile (Figure 2.7). Other Measures of School Attendance The survey also collected data on two other indicators. The gross attendance ratio (GAR), which measures participation at each level of schooling among all those age 5-24, is 122% at the primary school level and 61% at the secondary school level. These figures indicate that children outside the official school age population for that level are attending primary school, and not all who should be attending secondary school are doing so. The gender parity index (GPI), which is the ratio of female to male attendance rates, is close to 1 at primary school level and exceeds 1 at secondary school level. This confirms that there is relatively little difference in overall school attendance by boys and girls at the primary level, but by secondary school, female school attendance is much greater than male attendance. For complete information on these indicators, see Table 2.14. 2.10 DISTANCE TO A HEALTH FACILITY In the 2014 LDHS, interviewers asked about the means of transport used by households to get to the nearest health facility, and the time required getting to the facility. Overall, in 72% of households members walk to the nearest health facility; in 22% of households they travel by car, truck, bus, or taxi, and in 6% they use a combination of walking and bus or taxi (Table 2.15). Among households in which members travel to the nearest health facility by walking, 27% require more than 120 minutes of travel time (Table 2.16). Figure 2.7 Secondary school attendance by wealth quintile 24 40 47 63 74 51 7 20 34 45 69 35 Lowest Second Middle Fourth Highest Total Girls Boys WealthiestPoorest Net attendance ratio for secondary school among children age 13-17 Housing Characteristics and Household Population • 15 LIST OF TABLES For detailed information on household population and housing characteristics, see the following tables:  Table 2.1 Household drinking water  Table 2.2 Household sanitation facilities  Table 2.3 Household characteristics  Table 2.4 Wealth quintiles  Table 2.5 Household possessions  Table 2.6 Hand washing  Table 2.7 Household population by age, sex, and residence  Table 2.8 Household composition  Table 2.9 Residency status  Table 2.10 Birth registration of children under age 5  Table 2.11 Children’s living arrangements and orphanhood  Table 2.12 School attendance by survivorship of parents  Table 2.13.1 Educational attainment of the female household population  Table 2.13.2 Educational attainment of the male household population  Table 2.14 School attendance ratios  Table 2.15 Method of travel and travel time to nearest health facility  Table 2.16 Travel time to health facility by walking 16 • Housing Characteristics and Household Population Table 2.1 Household drinking water Percent distribution of households and de jure population by source of drinking water, time to obtain drinking water, and treatment of drinking water, according to residence, Lesotho 2014 Households Population Characteristic Urban Rural Total Urban Rural Total Source of drinking water Improved source 96.9 77.2 83.6 96.3 76.9 82.2 Piped into dwelling/yard/plot 69.5 4.8 25.6 67.5 4.7 21.9 Public tap/standpipe 24.3 55.7 45.6 25.5 55.5 47.3 Tube well/borehole 1.3 7.8 5.7 1.8 7.5 6.0 Protected well 0.6 3.2 2.3 0.5 3.3 2.5 Protected spring 1.1 5.7 4.2 1.0 5.8 4.5 Rain water 0.0 0.1 0.1 0.0 0.0 0.0 Bottled water 0.1 0.0 0.0 0.1 0.0 0.0 Unimproved source 3.1 22.8 16.4 3.7 23.1 17.8 Unprotected well 1.4 9.8 7.1 1.6 9.7 7.5 Unprotected spring 1.6 11.4 8.2 1.9 11.9 9.1 Tanker truck/car with small tank 0.0 0.5 0.4 0.0 0.5 0.4 Surface water 0.1 1.0 0.7 0.1 1.1 0.8 Total 100.0 100.0 100.0 100.0 100.0 100.0 Time to obtain drinking water (round trip) Water on premises 71.0 6.1 26.9 68.9 6.1 23.3 Less than 30 minutes 23.9 55.9 45.6 24.9 54.9 46.7 30 minutes or longer 5.0 36.6 26.4 6.0 37.5 28.9 Don’t know 0.2 1.4 1.0 0.2 1.5 1.1 Total 100.0 100.0 100.0 100.0 100.0 100.0 Water treatment prior to drinking1 Boiled 21.2 6.7 11.4 21.3 6.7 10.7 Bleach/chlorine added 0.2 0.2 0.2 0.2 0.2 0.2 Strained through cloth 0.5 1.3 1.0 0.5 1.4 1.1 Ceramic, sand or other filter 0.7 0.1 0.3 0.7 0.0 0.2 Other 0.1 0.4 0.3 0.2 0.4 0.3 No treatment 77.7 91.8 87.3 77.7 91.8 87.9 Percentage using an appropriate treatment method2 22.0 7.0 11.8 22.1 6.9 11.0 Number 3,020 6,382 9,402 8,566 22,694 31,260 1 Respondents may report multiple treatment methods, so the sum of treatment may exceed 100%. 2 Appropriate treatment methods include boiling, bleaching, filtering, and solar disinfecting. Housing Characteristics and Household Population • 17 Table 2.2 Household sanitation facilities Percent distribution of households and de jure population by type of toilet/latrine facilities, according to residence, Lesotho 2014 Households Population Type of toilet/latrine facility Urban Rural Total Urban Rural Total Improved 41.1 50.0 47.1 49.0 51.6 50.9 Flush/pour flush to piped sewer system 4.0 0.0 1.3 3.8 0.0 1.0 Flush/pour flush to septic tank 2.7 0.1 1.0 3.0 0.2 0.9 Flush/pour flush to pit latrine 0.0 0.0 0.0 0.0 0.0 0.0 Ventilated improved pit (VIP) latrine 6.1 15.3 12.3 7.2 16.4 13.9 Ordinary pit latrine/pit latrine with slab 28.2 34.5 32.5 35.1 35.0 35.0 Shared facility1 53.2 10.9 24.5 45.4 9.4 19.2 Flush/pour flush to piped sewer system 0.4 0.0 0.1 0.3 0.0 0.1 Flush/pour flush to septic tank 0.3 0.0 0.1 0.3 0.0 0.1 Ventilated improved pit (VIP) latrine 6.8 1.4 3.1 5.9 1.1 2.4 Ordinary pit latrine/pit latrine with slab 45.7 9.5 21.1 39.0 8.2 16.6 Unimproved facility 5.8 39.1 28.4 5.6 39.1 29.9 Flush/pour flush not to sewer/septic tank/pit latrine 0.4 0.0 0.1 0.4 0.0 0.1 Pit latrine without slab/open pit 0.7 1.4 1.2 0.6 1.4 1.2 No facility/bush/field 4.7 37.7 27.1 4.6 37.6 28.6 Total 100.0 100.0 100.0 100.0 100.0 100.0 Number 3,020 6,382 9,402 8,566 22,694 31,260 Note: Total includes 1 household using a flush/pour flush toilet to pit latrine and 1 household using a composting toilet, neither of which is shared. 1 Facilities that would be considered improved if they were not shared by 2 or more households 18 • Housing Characteristics and Household Population Table 2.3 Household characteristics Percent distribution of households by housing characteristics, percentage using solid fuel for cooking, and percent distribution by frequency of smoking in the home, according to residence, Lesotho 2014 Residence Total Housing characteristic Urban Rural Electricity Yes 61.5 11.8 27.8 No 38.5 88.2 72.2 Total 100.0 100.0 100.0 Flooring material Earth/mud/dung 5.6 46.3 33.2 Wood planks 0.5 0.1 0.2 Parquet or polished wood 0.1 0.0 0.0 Vinyl tile/vinyl carpet 20.7 15.2 16.9 Ceramic tiles 13.9 7.3 9.4 Cement 50.4 24.1 32.5 Carpet 8.8 7.0 7.6 Other 0.0 0.1 0.0 Total 100.0 100.0 100.0 Rooms used for sleeping1 One 59.4 39.5 45.9 Two 24.9 41.2 36.0 Three or more 15.0 19.3 17.9 Total 100.0 100.0 100.0 Place for cooking In the house 90.7 34.5 52.6 In a separate building 1.6 10.5 7.6 Outdoors 7.5 54.8 39.6 No food cooked in household 0.2 0.2 0.2 Total 100.0 100.0 100.0 Cooking fuel Electricity 27.4 3.1 10.9 LPG/biogas 50.9 13.2 25.3 Paraffin 12.4 4.0 6.7 Coal 0.0 0.1 0.1 Wood 7.7 65.5 47.0 Straw/shrubs/grass 0.1 2.4 1.7 Agricultural crop 0.1 0.6 0.4 Animal dung 1.0 10.8 7.7 Other 0.1 0.0 0.0 No food cooked in household 0.2 0.2 0.2 Total 100.0 100.0 100.0 Percentage using solid fuel for cooking2 9.0 79.5 56.8 Frequency of smoking in the home Daily 9.5 19.5 16.3 Weekly 2.7 4.7 4.1 Monthly 1.7 2.9 2.5 Less than monthly 1.9 3.3 2.8 Never 84.3 69.5 74.3 Total 100.0 100.0 100.0 Number 3,020 6,382 9,402 LPG = Liquid petroleum gas 1 Total includes 24 households for which respondents indicated that no rooms were used for sleeping. 2 Solid fuel includes coal, wood, straw/shrubs/grass, agricultural crops, and animal dung. Housing Characteristics and Household Population • 19 Table 2.4 Wealth quintiles Percent distribution of the de jure population by wealth quintiles, and the Gini coefficient, according to residence and region, Lesotho 2014 Wealth quintile Total Number of persons Gini coefficient Residence/zone/district Lowest Second Middle Fourth Highest Residence Urban 0.2 3.0 12.4 30.7 53.8 100.0 8,566 0.16 Rural 27.5 26.4 22.9 15.9 7.3 100.0 22,694 0.34 Ecological zone Lowlands 4.8 13.7 21.9 27.5 32.1 100.0 17,606 0.25 Foothills 26.4 29.9 25.3 14.0 4.5 100.0 3,585 0.33 Mountains 47.8 27.3 13.9 7.3 3.7 100.0 7,352 0.41 Senqu River Valley 35.5 27.6 17.2 13.5 6.2 100.0 2,717 0.40 District Butha-Buthe 24.1 26.8 23.7 15.4 10.1 100.0 1,974 0.40 Leribe 8.6 19.8 25.5 28.8 17.2 100.0 4,764 0.28 Berea 11.8 17.2 24.5 17.8 28.7 100.0 3,836 0.33 Maseru 6.4 14.6 15.2 27.3 36.5 100.0 7,590 0.27 Mafeteng 9.5 18.1 25.6 24.9 21.9 100.0 2,808 0.30 Mohale’s Hoek 32.7 22.8 18.9 14.8 10.8 100.0 2,951 0.39 Quthing 22.7 25.3 26.6 15.6 9.7 100.0 1,776 0.35 Qacha’s Nek 34.5 27.2 17.0 12.6 8.7 100.0 1,088 0.43 Mokhotlong 52.8 26.7 9.8 6.2 4.6 100.0 1,961 0.46 Thaba-Tseka 55.2 21.8 14.1 5.9 3.0 100.0 2,513 0.44 Total 20.0 20.0 20.0 20.0 20.0 100.0 31,260 0.36 Table 2.5 Household possessions Percentage of households possessing various household effects, means of transportation, agricultural land, and livestock/farm animals by residence, Lesotho 2014 Residence Total Possession Urban Rural Household effects Radio 72.1 50.8 57.6 Television 52.9 15.8 27.7 Mobile telephone 95.5 78.1 83.7 Non-mobile telephone 7.2 1.1 3.1 Refrigerator 43.3 11.9 22.0 Battery/generator 4.8 13.9 11.0 Solar panel 4.9 21.7 16.3 Computer 17.7 2.6 7.5 Bed/mattress 98.7 94.3 95.7 Internet access 37.4 9.2 18.3 Means of transport Bicycle 3.7 1.6 2.3 Animal drawn cart/scotch cart 1.9 13.1 9.5 Motorcycle/scooter 0.4 0.1 0.2 Car/truck 19.2 6.0 10.2 Ownership of agricultural land 17.0 60.5 46.5 Ownership of farm animals1 27.8 64.0 52.4 Number 3,020 6,382 9,402 1 Cattle, milk cows, bulls, horses, donkeys, mules, goats, sheep, chickens, pigs, or rabbits 20 • Housing Characteristics and Household Population Table 2.6 Hand washing Percentage of households in which the place most often used for washing hands was observed, and among households in which the place for hand washing was observed, percent distribution by availability of water, soap, and other cleansing agents, Lesotho 2014 Percentage of households where place for washing hands was observed Number of households Among households where place for hand washing was observed, percentage with: Number of households with place for hand washing observed Background characteristic Soap and water1 Water only Soap but no water2 No water, no soap, no other cleansing agent Total Residence Urban 11.6 3,020 54.1 34.4 1.2 10.2 100.0 349 Rural 2.4 6,382 28.0 32.5 4.4 35.1 100.0 151 Ecological zone Lowlands 7.0 5,670 52.2 32.8 1.8 13.2 100.0 397 Foothills 2.3 983 * * * * 100.0 23 Mountains 2.2 1,978 23.0 30.9 6.4 39.6 100.0 44 Senqu River Valley 4.7 771 31.0 25.6 0.0 43.3 100.0 36 Wealth quintile Lowest 1.3 1,795 (23.4) (15.4) (6.9) (54.2) 100.0 23 Second 1.6 1,761 (1.8) (22.3) (3.9) (72.0) 100.0 29 Middle 2.5 1,857 (17.1) (37.8) (6.0) (39.1) 100.0 47 Fourth 3.9 2,001 17.4 65.8 1.9 14.9 100.0 77 Highest 16.3 1,987 62.9 28.0 1.2 7.9 100.0 324 Total 5.3 9,402 46.2 33.8 2.2 17.7 100.0 500 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 Soap includes soap or detergent in bar, liquid, powder, or paste form. This column includes households with soap and water only as well as those that had soap and water and another cleansing agent. 2 This column includes households with soap only as well as those with soap and another cleansing agent. Table 2.7 Household population by age, sex, and residence Percent distribution of the de facto household population by 5-year age groups, according to sex and residence, Lesotho 2014 Urban Rural Total Age Male Female Total Male Female Total Male Female Total <5 12.0 9.2 10.5 13.3 12.5 12.9 13.0 11.6 12.2 5-9 11.0 10.6 10.8 15.3 14.2 14.7 14.2 13.2 13.6 10-14 10.8 10.4 10.6 15.9 13.8 14.8 14.5 12.9 13.6 15-19 11.0 10.2 10.6 11.5 8.6 10.0 11.4 9.1 10.1 20-24 10.4 10.5 10.4 8.2 7.7 7.9 8.8 8.5 8.6 25-29 10.2 9.5 9.8 6.1 5.9 6.0 7.2 6.9 7.1 30-34 8.2 9.5 8.9 5.1 4.7 4.9 5.9 6.0 6.0 35-39 7.0 6.6 6.8 3.6 3.9 3.8 4.5 4.7 4.6 40-44 4.5 4.3 4.3 3.5 3.3 3.4 3.7 3.6 3.6 45-49 3.2 3.4 3.3 2.6 3.0 2.8 2.8 3.1 2.9 50-54 2.7 5.2 4.1 2.5 4.5 3.6 2.6 4.7 3.7 55-59 2.3 2.6 2.5 2.5 3.7 3.1 2.4 3.4 2.9 60-64 2.7 2.7 2.7 3.0 3.5 3.3 2.9 3.3 3.1 65-69 1.8 1.8 1.8 2.3 2.7 2.5 2.2 2.4 2.3 70-74 1.0 1.3 1.2 1.9 2.7 2.3 1.7 2.3 2.0 75-79 0.7 0.9 0.8 1.2 2.2 1.7 1.1 1.9 1.5 80 + 0.4 1.2 0.9 1.4 3.1 2.3 1.2 2.5 1.9 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number 3,829 4,741 8,571 10,849 11,986 22,835 14,679 16,727 31,406 Housing Characteristics and Household Population • 21 Table 2.8 Household composition Percent distribution of households by sex of head of household and by household size; mean size of household, and percentage of households with orphans and foster children under age 18 years, according to residence, Lesotho 2014 Residence Total Characteristic Urban Rural Household headship Male 65.2 64.2 64.5 Female 34.8 35.8 35.5 Total 100.0 100.0 100.0 Number of usual members 0 0.5 0.6 0.6 1 27.1 17.4 20.5 2 22.0 17.2 18.8 3 19.1 18.8 18.9 4 15.6 17.1 16.6 5 8.2 12.5 11.1 6 3.8 7.4 6.3 7 2.0 4.3 3.5 8 0.7 2.0 1.6 9+ 0.9 2.5 2.0 Total 100.0 100.0 100.0 Mean size of households 2.8 3.6 3.3 Percentage of households with orphans and foster children under 18 years of age Foster children1 22.0 39.5 33.9 Double orphans 4.2 7.7 6.6 Single orphans2 14.2 21.6 19.2 Foster and/or orphan children 27.4 44.2 38.8 Number of households 3,020 6,382 9,402 Note: Table is based on de jure household members, i.e., usual residents. 1 Foster children are those under age 18 living in households with neither their mother nor their father present. 2 The category of single orphans includes children with one dead parent and an unknown survival status of the other parent. 22 • Housing Characteristics and Household Population Table 2.9 Residency status Percent distribution of males and females listed in the household schedule of the Household Questionnaire by whether they live in the household, elsewhere in Lesotho, in the Republic of South Africa, or in another country, according to background characteristics, Lesotho 2014 Male Female Background characteristic In the household Else- where in Lesotho In RSA In other country Total Number In the household Else- where in Lesotho In RSA In other country Total Number Age 0-9 89.9 8.8 1.2 0.0 100.0 4,369 90.6 8.3 1.0 0.1 100.0 4,494 10-19 83.7 14.7 1.6 0.0 100.0 4,571 81.0 17.9 1.0 0.1 100.0 4,492 20-29 66.6 20.4 12.9 0.1 100.0 3,633 69.8 23.2 6.9 0.1 100.0 3,519 30-39 63.1 17.2 19.7 0.0 100.0 2,466 72.7 14.7 12.5 0.1 100.0 2,403 40-49 62.3 14.2 23.3 0.2 100.0 1,541 73.6 11.9 14.5 0.0 100.0 1,518 50-59 67.2 9.8 23.0 0.0 100.0 1,100 87.1 6.2 6.7 0.0 100.0 1,561 60+ 90.6 5.1 4.3 0.0 100.0 1,488 93.4 5.1 1.4 0.0 100.0 2,242 Residence Urban 81.0 11.8 7.1 0.1 100.0 4,768 85.1 11.3 3.4 0.2 100.0 5,526 Rural 75.8 14.3 9.9 0.0 100.0 14,400 80.1 14.4 5.4 0.0 100.0 14,703 Ecological zone Lowlands 78.6 12.3 9.0 0.0 100.0 10,396 82.8 12.2 4.9 0.1 100.0 11,396 Foothills 74.1 15.5 10.4 0.0 100.0 2,356 78.5 16.4 5.1 0.0 100.0 2,342 Mountains 78.2 15.4 6.3 0.0 100.0 4,600 82.2 14.3 3.5 0.0 100.0 4,568 Senqu River Valley 69.2 15.1 15.6 0.1 100.0 1,817 75.9 16.1 8.0 0.1 100.0 1,923 District Butha-Buthe 79.0 11.4 9.6 0.0 100.0 1,211 84.9 9.5 5.5 0.0 100.0 1,198 Leribe 74.2 14.4 11.4 0.0 100.0 2,977 78.7 15.5 5.8 0.0 100.0 3,246 Berea 79.2 13.5 7.3 0.0 100.0 2,354 81.1 13.9 5.0 0.1 100.0 2,431 Maseru 82.2 11.7 6.0 0.1 100.0 4,290 85.7 11.0 3.0 0.2 100.0 4,742 Mafeteng 77.2 11.9 10.9 0.0 100.0 1,734 82.6 11.8 5.6 0.0 100.0 1,780 Mohale’s Hoek 68.8 16.9 14.3 0.0 100.0 2,011 74.7 18.6 6.7 0.0 100.0 2,097 Quthing 68.9 14.2 16.8 0.1 100.0 1,170 75.3 14.4 10.2 0.1 100.0 1,287 Qacha’s Nek 77.1 12.8 10.1 0.0 100.0 658 85.4 9.6 5.0 0.0 100.0 680 Mokhotlong 79.6 14.3 6.0 0.0 100.0 1,230 81.6 14.9 3.5 0.0 100.0 1,203 Thaba-Tseka 78.7 17.3 3.9 0.0 100.0 1,533 83.4 15.0 1.6 0.0 100.0 1,567 Education1 No education 79.6 11.9 8.5 0.0 100.0 2,469 88.5 8.7 2.6 0.2 100.0 1,142 Some primary 81.0 10.9 8.2 0.0 100.0 8,096 89.7 7.4 2.8 0.0 100.0 7,552 Completed primary 66.3 14.7 19.0 0.0 100.0 1,377 75.8 14.5 9.7 0.0 100.0 2,565 Some secondary 68.6 19.8 11.6 0.0 100.0 3,140 73.3 20.3 6.4 0.0 100.0 4,624 Completed secondary 69.4 18.1 12.2 0.3 100.0 900 71.1 21.4 7.4 0.0 100.0 996 More than secondary 70.3 23.5 5.8 0.4 100.0 845 66.7 28.5 4.2 0.7 100.0 1,033 Don’t know 58.5 11.8 29.7 0.0 100.0 217 45.6 25.3 29.1 0.0 100.0 202 Wealth quintile Lowest 78.7 14.4 6.8 0.0 100.0 3,793 83.7 12.7 3.5 0.0 100.0 3,908 Second 76.5 14.6 8.9 0.0 100.0 3,964 80.3 13.9 5.8 0.0 100.0 3,993 Middle 76.3 13.6 10.1 0.0 100.0 3,885 79.8 13.7 6.5 0.0 100.0 4,123 Fourth 76.1 12.9 11.0 0.0 100.0 3,874 81.5 13.0 5.5 0.0 100.0 4,050 Highest 77.8 13.0 9.1 0.2 100.0 3,652 82.2 14.4 3.2 0.3 100.0 4,154 Total 77.1 13.7 9.2 0.0 100.0 19,168 81.5 13.6 4.9 0.1 100.0 20,229 1 Excludes household population less than age 5 Housing Characteristics and Household Population • 23 Table 2.10 Birth registration of children under age 5 Percentage of de jure children under age 5 whose births are registered with the civil authorities, according to background characteristics, Lesotho 2014 Children whose births are registered Number of children Background characteristic Percentage who had a birth certificate Percentage who did not have a birth certificate Percentage registered Age <2 14.0 25.3 39.3 1,380 2-4 20.6 25.1 45.7 2,338 Sex Male 18.0 24.3 42.4 1,846 Female 18.3 26.0 44.3 1,873 Residence Urban 24.8 29.1 53.9 870 Rural 16.1 24.0 40.1 2,848 Ecological zone Lowlands 20.1 28.0 48.1 1,972 Foothills 19.6 24.8 44.4 471 Mountains 13.4 23.6 37.0 944 Senqu River Valley 18.1 13.5 31.6 332 District Butha-Buthe 17.7 16.1 33.8 254 Leribe 18.7 28.8 47.5 575 Berea 16.8 34.8 51.6 439 Maseru 19.9 30.7 50.5 861 Mafeteng 25.1 19.2 44.4 322 Mohale’s Hoek 10.9 19.2 30.1 342 Quthing 18.9 13.8 32.7 219 Qacha’s Nek 21.4 9.4 30.8 118 Mokhotlong 13.2 30.1 43.3 249 Thaba-Tseka 17.6 20.6 38.1 340 Wealth quintile Lowest 9.5 24.7 34.2 866 Second 14.3 22.6 36.8 801 Middle 17.8 24.6 42.3 772 Fourth 20.8 26.2 47.0 693 Highest 33.6 29.3 62.8 587 Total 18.1 25.2 43.3 3,718 24 • Housing Characteristics and Household Population Table 2.11 Children’s living arrangements and orphanhood Percent distribution of de jure children under age 18 by living arrangements and survival status of parents, the percentage of children not living with a biological parent, and the percentage of children with one or both parents dead, according to background characteristics, Lesotho 2014 Living with both parents Living with mother but not with father Living with father but not with mother Not living with either parent Missing information on father/ mother Total Percent- age not living with a biologi- cal parent Percent- age with one or both parents dead1 Number of children Background characteristic Father alive Father dead Mother alive Mother dead Both alive Only father alive Only mother alive Both dead Age 0-4 28.7 34.9 4.7 3.3 0.2 17.5 0.9 3.4 0.7 5.8 100.0 22.5 10.2 3,718 <2 34.6 46.4 4.3 1.6 0.0 7.7 0.3 0.8 0.3 4.0 100.0 9.1 5.7 1,380 2-4 25.2 28.1 5.0 4.3 0.3 23.3 1.2 4.9 1.0 6.9 100.0 30.3 12.8 2,338 5-9 22.4 22.5 6.1 5.1 0.9 22.5 2.2 7.2 3.5 7.6 100.0 35.4 20.7 4,283 10-14 18.7 18.1 9.3 5.1 1.8 16.2 4.1 11.2 8.7 6.8 100.0 40.3 36.6 4,313 15-17 15.9 13.4 11.3 3.8 3.4 15.3 5.1 13.0 13.5 5.2 100.0 46.9 48.0 1,925 Sex Male 22.1 22.7 7.1 4.9 1.3 18.1 3.0 8.3 6.1 6.5 100.0 35.5 26.7 7,100 Female 22.0 23.6 7.7 4.1 1.3 18.5 2.7 8.1 5.3 6.7 100.0 34.6 26.2 7,140 Residence Urban 29.0 23.6 8.3 3.5 1.5 14.3 2.1 6.5 5.0 6.1 100.0 28.0 24.4 3,233 Rural 20.0 23.0 7.1 4.8 1.3 19.5 3.1 8.7 5.9 6.7 100.0 37.1 27.0 11,006 Ecological zone Lowlands 22.4 24.1 7.3 4.4 1.5 17.8 2.8 7.8 5.1 6.8 100.0 33.5 25.5 7,359 Foothills 18.8 26.1 8.6 3.4 0.9 18.7 3.1 8.7 6.2 5.5 100.0 36.7 28.2 1,762 Mountains 25.4 20.1 7.3 5.2 1.4 18.3 2.8 8.4 6.1 5.0 100.0 35.6 26.9 3,789 Senqu River Valley 14.7 22.4 6.7 4.5 0.5 20.4 2.8 9.3 7.2 11.5 100.0 39.7 28.1 1,330 District Butha-Buthe 20.2 25.5 8.3 4.3 0.8 21.2 2.4 7.5 6.0 3.9 100.0 37.1 25.5 949 Leribe 20.5 22.5 8.2 4.3 1.8 18.3 3.9 7.3 5.4 7.9 100.0 34.8 27.9 2,180 Berea 22.7 21.8 7.1 5.0 1.7 20.0 3.4 9.3 3.8 5.2 100.0 36.5 26.0 1,650 Maseru 26.8 25.0 8.3 4.4 1.7 14.5 2.2 6.3 5.0 5.7 100.0 28.0 24.5 3,068 Mafeteng 13.8 24.2 8.0 4.6 0.8 21.6 2.7 11.9 6.0 6.4 100.0 42.2 30.2 1,270 Mohale’s Hoek 17.2 24.9 5.8 3.7 1.2 17.4 3.1 9.0 7.5 10.2 100.0 37.0 27.9 1,383 Quthing 14.0 23.8 5.4 3.2 0.8 21.9 2.3 9.5 6.8 12.4 100.0 40.4 26.2 868 Qacha’s Nek 17.6 22.3 6.0 4.1 0.5 21.3 4.1 10.6 8.1 5.4 100.0 44.1 30.9 546 Mokhotlong 26.8 19.1 6.8 4.8 1.3 19.7 3.1 8.4 5.9 4.2 100.0 37.1 26.3 1,038 Thaba-Tseka 30.3 20.2 7.0 6.0 1.0 16.2 1.8 6.8 6.0 4.6 100.0 30.9 23.2 1,287 Wealth quintile Lowest 24.1 19.2 9.1 5.3 1.3 17.4 2.6 8.3 6.0 6.7 100.0 34.4 28.3 3,280 Second 19.7 20.8 6.7 5.5 1.2 20.2 2.8 9.6 6.4 7.0 100.0 39.1 27.9 3,130 Middle 17.7 23.3 8.6 3.9 0.8 19.5 3.0 9.5 6.4 7.5 100.0 38.3 29.5 2,931 Fourth 19.4 29.4 7.0 3.7 1.7 17.4 3.4 7.5 4.6 5.9 100.0 33.0 24.9 2,634 Highest 30.9 24.7 5.0 3.7 1.7 16.5 2.4 5.1 4.6 5.4 100.0 28.7 19.7 2,264 Total <15 23.0 24.7 6.8 4.6 1.0 18.8 2.5 7.4 4.5 6.8 100.0 33.2 23.1 12,314 Total <18 22.0 23.2 7.4 4.5 1.3 18.3 2.8 8.2 5.7 6.6 100.0 35.1 26.5 14,239 Note: Table is based on de jure members, i.e., usual residents. 1 Includes children with father dead, mother dead, both dead, and one parent dead but missing information on survival status of the other parent Housing Characteristics and Household Population • 25 Table 2.12 School attendance by survivorship of parents For de jure children age 10-14, the percentage attending school by parental survival and the ratio of the percentage attending, by parental survival, according to background characteristics, Lesotho 2014 Percentage attending school by survivorship of parents Ratio1 Background characteristic Both parents deceased Number Both parents alive and living with at least one parent Number Sex Male 84.2 192 94.4 903 0.89 Female 94.3 184 98.7 904 0.95 Residence Urban 92.4 71 98.4 441 0.94 Rural 88.4 305 95.9 1,366 0.92 Ecological zone Lowlands 92.1 162 99.1 970 0.93 Foothills 90.6 57 96.2 203 0.94 Mountains 82.9 109 91.3 492 0.91 Senqu River Valley 91.5 48 97.7 141 0.94 District Butha-Buthe (91.6) 25 95.3 120 (0.96) Leribe (90.9) 56 98.9 280 (0.92) Berea * 23 100.0 188 * Maseru (88.1) 71 97.8 439 (0.90) Mafeteng (94.5) 30 98.1 124 (0.96) Mohale’s Hoek 87.4 51 94.2 191 0.93 Quthing (93.0) 27 94.4 88 (0.99) Qacha’s Nek 97.9 24 99.5 72 0.98 Mokhotlong 77.1 30 91.2 125 0.85 Thaba-Tseka 83.9 40 92.0 178 0.91 Wealth quintile Lowest 86.0 99 91.4 390 0.94 Second 82.5 91 95.5 343 0.86 Middle 87.5 82 98.6 357 0.89 Fourth 98.8 63 98.9 351 1.00 Highest (100.0) 41 98.8 366 (1.01) Total 89.1 376 96.5 1,807 0.92 Notes: Table is based only on children who usually live in the household. 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 Ratio of the percentage with both parents deceased to the percentage with both parents alive and living with a parent 26 • Housing Characteristics and Household Population Table 2.13.1 Educational attainment of the female household population Percent distribution of the de facto female household population age 6 and over by highest level of schooling attended or completed and median years completed, according to background characteristics, Lesotho 2014 Background characteristic No education Some primary Completed primary1 Some secondary Completed secondary2 More than secondary Don’t know Total Number Median years completed Age 6-9 11.9 88.1 0.0 0.0 0.0 0.0 0.0 100.0 1,807 0.5 10-14 0.3 86.1 2.5 11.2 0.0 0.0 0.0 100.0 2,154 4.1 15-19 0.6 17.6 11.3 66.5 3.3 0.5 0.1 100.0 1,516 6.7 20-24 0.4 11.7 16.6 45.1 16.3 9.5 0.3 100.0 1,415 7.8 25-29 1.1 18.7 19.4 32.1 14.1 13.9 0.6 100.0 1,159 7.2 30-34 2.3 19.3 25.5 33.1 8.3 10.8 0.8 100.0 1,009 6.8 35-39 2.3 20.4 25.9 28.7 9.9 10.5 2.2 100.0 787 6.8 40-44 2.3 21.2 31.1 30.2 6.5 8.6 0.2 100.0 597 6.7 45-49 2.7 28.0 29.0 27.1 5.6 6.5 1.1 100.0 518 6.5 50-54 4.1 40.6 24.5 18.1 3.7 7.5 1.4 100.0 790 6.1 55-59 5.8 52.4 19.6 11.9 2.5 5.7 2.1 100.0 567 5.3 60-64 6.5 60.0 16.1 9.9 1.7 4.4 1.3 100.0 550 4.5 65+ 14.8 70.9 7.8 2.8 0.5 1.8 1.4 100.0 1,529 3.0 Residence Urban 2.6 30.0 11.7 33.1 9.8 11.7 1.1 100.0 4,219 6.7 Rural 5.3 53.9 14.7 20.2 3.2 2.2 0.5 100.0 10,178 5.1 Ecological zone Lowlands 2.7 39.1 13.4 29.3 7.0 7.6 0.8 100.0 8,324 6.2 Foothills 4.1 58.1 15.7 18.4 2.1 1.0 0.6 100.0 1,614 5.1 Mountains 8.0 58.5 14.4 15.3 2.2 1.4 0.2 100.0 3,206 4.5 Senqu River Valley 7.7 54.5 13.2 17.7 3.5 2.3 1.1 100.0 1,254 4.8 District Butha-Buthe 4.8 47.8 14.0 24.6 4.6 3.4 0.7 100.0 875 5.6 Leribe 3.9 41.9 15.8 29.7 4.1 4.2 0.3 100.0 2,236 6.0 Berea 2.4 41.0 15.1 25.6 6.6 8.5 0.8 100.0 1,755 6.2 Maseru 2.6 39.8 13.1 27.6 7.6 8.2 1.0 100.0 3,569 6.2 Mafeteng 3.2 48.8 12.8 24.7 5.6 4.7 0.2 100.0 1,287 5.6 Mohale’s Hoek 4.6 56.5 12.9 18.9 3.3 2.6 1.2 100.0 1,392 4.9 Quthing 7.9 54.8 10.4 19.2 4.0 2.6 1.1 100.0 833 4.9 Qacha’s Nek 8.3 53.7 12.9 18.5 4.2 2.3 0.0 100.0 505 4.9 Mokhotlong 7.9 58.2 12.6 17.2 2.3 1.4 0.3 100.0 848 4.5 Thaba-Tseka 9.2 56.7 16.7 14.0 2.0 1.4 0.0 100.0 1,096 4.6 Wealth quintile Lowest 9.6 66.2 14.2 9.0 0.5 0.0 0.5 100.0 2,763 3.7 Second 5.5 60.9 15.6 15.9 1.5 0.3 0.3 100.0 2,757 4.6 Middle 3.5 49.1 15.5 26.3 3.4 1.5 0.6 100.0 2,798 5.6 Fourth 2.7 35.8 14.5 34.8 6.8 4.4 0.9 100.0 2,935 6.3 Highest 1.7 26.0 9.9 31.9 12.3 17.3 0.9 100.0 3,143 7.4 Total 4.5 46.9 13.9 23.9 5.1 5.0 0.7 100.0 14,397 5.7 1 Completed 7th grade at the primary level 2 Completed 5th grade at the secondary level Housing Characteristics and Household Population • 27 Table 2.13.2 Educational attainment of the male household population Percent distribution of the de facto male household population age 6 and over by highest level of schooling attended or completed and median years completed, according to background characteristics, Lesotho 2014 Background characteristic No education Some primary Completed primary1 Some secondary Completed secondary2 More than secondary Don’t know Total Number Median years completed Age 6-9 15.0 84.9 0.0 0.1 0.0 0.0 0.0 100.0 1,713 0.3 10-14 2.4 91.3 1.2 4.9 0.0 0.0 0.3 100.0 2,133 3.2 15-19 3.7 38.8 9.3 46.0 0.9 0.7 0.7 100.0 1,670 6.0 20-24 4.8 28.2 10.7 33.7 12.0 9.4 1.3 100.0 1,288 6.7 25-29 6.9 29.8 13.4 23.5 13.3 11.8 1.3 100.0 1,059 6.6 30-34 13.7 31.6 14.4 17.2 11.2 10.8 1.1 100.0 869 6.2 35-39 18.8 33.1 9.1 18.9 10.6 8.8 0.7 100.0 664 5.6 40-44 17.1 36.3 13.9 14.9 6.9 9.1 1.7 100.0 549 5.2 45-49 18.8 36.5 11.0 15.5 9.1 7.3 1.9 100.0 408 5.1 50-54 26.6 35.7 13.4 12.4 4.5 5.1 2.2 100.0 376 3.1 55-59 25.4 39.1 8.1 14.3 3.7 6.2 3.2 100.0 360 3.5 60-64 31.5 43.7 7.1 6.6 5.4 4.6 1.1 100.0 429 1.9 65+ 41.3 44.3 3.1 4.2 1.2 3.4 2.4 100.0 893 0.6 Residence Urban 5.3 35.7 7.2 25.7 11.6 13.1 1.2 100.0 3,285 6.4 Rural 15.8 57.6 7.3 14.2 2.6 1.6 0.9 100.0 9,125 3.1 Ecological zone Lowlands 7.2 45.4 8.3 23.4 7.1 7.4 1.1 100.0 6,919 5.5 Foothills 14.2 63.9 7.5 10.3 2.4 1.0 0.7 100.0 1,452 3.1 Mountains 23.9 58.7 5.4 8.1 2.0 1.0 1.0 100.0 2,976 2.0 Senqu River Valley 18.8 57.8 5.7 12.0 2.8 2.0 0.9 100.0 1,063 2.4 District Butha-Buthe 13.2 57.2 6.4 16.7 3.4 2.5 0.6 100.0 780 3.8 Leribe 8.7 51.2 8.8 22.7 4.7 3.1 0.8 100.0 1,869 4.8 Berea 8.3 47.3 9.8 20.2 6.3 7.1 1.1 100.0 1,592 5.2 Maseru 8.2 43.8 7.6 21.7 7.7 9.4 1.6 100.0 2,951 5.5 Mafeteng 11.0 55.1 7.5 17.6 4.7 3.6 0.5 100.0 1,131 4.1 Mohale’s Hoek 19.5 57.7 4.3 11.0 3.9 2.1 1.5 100.0 1,182 2.4 Quthing 17.0 57.4 5.0 14.5 3.0 1.9 1.2 100.0 679 2.8 Qacha’s Nek 16.3 56.1 6.6 14.4 3.5 2.8 0.3 100.0 441 3.3 Mokhotlong 20.8 60.8 5.8 8.3 2.5 1.1 0.7 100.0 794 2.1 Thaba-Tseka 27.1 56.0 6.7 6.9 1.8 1.4 0.1 100.0 991 1.8 Wealth quintile Lowest 27.2 63.1 4.6 4.1 0.5 0.1 0.4 100.0 2,420 1.5 Second 15.5 63.2 7.8 10.6 1.7 0.3 1.0 100.0 2,522 2.9 Middle 11.3 56.0 9.6 17.9 3.3 0.9 1.0 100.0 2,488 4.1 Fourth 7.9 46.6 7.6 27.1 6.3 3.0 1.6 100.0 2,486 5.3 Highest 3.6 30.4 6.8 26.3 13.0 19.0 1.0 100.0 2,493 7.1 Total 13.0 51.8 7.3 17.2 5.0 4.7 1.0 100.0 12,409 4.0 1 Completed 7th grade at the primary level 2 Completed 5th grade at the secondary level 28 • Housing Characteristics and Household Population Table 2.14 School attendance ratios Net attendance ratios (NAR) and gross attendance ratios (GAR) for the de facto household population by sex and level of schooling; and the Gender Parity Index (GPI), according to background characteristics, Lesotho 2014 Net attendance ratio1 Gross attendance ratio2 Background characteristic Male Female Total Gender Parity Index3 Male Female Total Gender Parity Index3 PRIMARY SCHOOL Residence Urban 95.5 92.5 93.9 0.97 121.7 114.0 117.6 0.94 Rural 91.1 95.9 93.5 1.05 125.1 120.1 122.6 0.96 Ecological zone Lowlands 94.9 94.1 94.4 0.99 128.3 113.1 120.2 0.88 Foothills 94.8 95.1 94.9 1.00 130.6 119.9 125.3 0.92 Mountains 87.0 97.2 91.9 1.12 115.2 128.4 121.6 1.11 Senqu River Valley 90.0 95.0 92.4 1.06 124.9 121.1 123.0 0.97 District Butha-Buthe 89.5 94.4 92.0 1.06 130.0 113.9 121.8 0.88 Leribe 94.9 93.1 93.9 0.98 127.6 109.8 118.4 0.86 Berea 96.8 95.3 96.1 0.98 136.2 115.1 125.9 0.85 Maseru 94.3 94.6 94.5 1.00 123.7 118.8 121.0 0.96 Mafeteng 95.0 95.1 95.1 1.00 125.7 118.0 121.8 0.94 Mohale’s Hoek 87.5 97.1 92.2 1.11 115.5 120.8 118.1 1.05 Quthing 92.1 95.8 94.0 1.04 129.1 128.4 128.7 0.99 Qacha’s Nek 94.1 95.3 94.7 1.01 125.9 123.5 124.8 0.98 Mokhotlong 86.7 96.3 91.3 1.11 115.1 134.4 124.3 1.17 Thaba-Tseka 84.4 96.2 90.4 1.14 115.8 118.8 117.3 1.03 Wealth quintile Lowest 86.9 96.1 91.5 1.11 116.9 123.2 120.0 1.05 Second 91.4 96.3 93.9 1.05 129.9 121.3 125.5 0.93 Middle 94.4 97.0 95.7 1.03 129.4 120.4 124.8 0.93 Fourth 96.4 94.1 95.2 0.98 130.8 114.3 122.2 0.87 Highest 93.4 90.8 92.0 0.97 114.6 111.5 113.0 0.97 Total 92.0 95.1 93.6 1.03 124.4 118.7 121.5 0.95 SECONDARY SCHOOL Residence Urban 62.0 67.9 65.2 1.10 93.3 99.7 96.7 1.07 Rural 26.1 43.9 34.3 1.68 39.8 58.5 48.4 1.47 Ecological zone Lowlands 49.1 63.1 55.9 1.28 73.5 88.8 80.9 1.21 Foothills 17.7 35.6 25.8 2.02 27.1 44.2 34.8 1.63 Mountains 13.4 34.0 23.3 2.54 22.1 44.9 33.0 2.03 Senqu River Valley 22.8 35.3 28.6 1.55 35.3 51.4 42.8 1.45 District Butha-Buthe 36.9 52.5 44.3 1.42 53.9 79.7 66.0 1.48 Leribe 44.4 60.0 51.8 1.35 61.5 84.7 72.5 1.38 Berea 37.7 60.4 48.6 1.60 63.4 80.9 71.8 1.28 Maseru 46.3 55.4 50.7 1.20 72.5 78.7 75.5 1.09 Mafeteng 38.4 56.5 47.5 1.47 54.3 72.7 63.6 1.34 Mohale’s Hoek 25.0 39.6 31.7 1.59 36.4 52.8 43.9 1.45 Quthing 28.9 40.8 34.9 1.41 45.5 62.3 53.9 1.37 Qacha’s Nek 27.3 48.8 37.6 1.79 43.8 67.0 54.9 1.53 Mokhotlong 11.9 32.9 22.2 2.78 20.3 43.7 31.8 2.15 Thaba-Tseka 11.0 32.3 20.4 2.94 16.9 40.6 27.3 2.41 Wealth quintile Lowest 6.6 23.7 14.5 3.58 12.1 28.1 19.5 2.32 Second 20.1 39.9 29.0 1.99 31.9 49.5 39.8 1.55 Middle 33.7 46.7 39.9 1.39 48.5 64.0 55.9 1.32 Fourth 45.1 62.7 53.4 1.39 67.3 89.8 77.9 1.34 Highest 69.4 74.4 72.1 1.07 106.0 109.4 107.8 1.03 Total 34.6 50.9 42.4 1.47 52.4 70.5 61.1 1.34 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%. 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% 3 The Gender Parity Index for primary school is the ratio of the primary school NAR (GAR) for females to the NAR (GAR) for males. The Gender Parity Index for secondary school is the ratio of the secondary school NAR (GAR) for females to the NAR (GAR) for males. Housing Characteristics and Household Population • 29 Table 2.15 Method of travel and travel time to nearest health facility Percent distribution of households by transportation method to nearest health facility, and time required to get to nearest health facility by usual means of transportation, according to residence, Lesotho 2014 Residence Total Characteristic Urban Rural Transportation method to nearest health facility Car/truck/bus/taxi 24.4 20.2 21.5 Motorcycle/scooter 0.1 0.1 0.1 Horse/donkey/mule 0.0 1.2 0.8 Walking 71.7 71.9 71.9 Combination walking and bus/taxi 3.3 6.5 5.5 Household doesn’t use nearest health facility 0.3 0.1 0.1 Don’t know nearest health facility 0.2 0.1 0.1 Total1 100.0 100.0 100.0 Time to get to nearest health facility by usual means of transportation <20 minutes 35.9 8.1 17.0 20-40 minutes 39.6 17.7 24.7 41-60 minutes 14.2 16.9 16.0 61-120 minutes 6.3 26.0 19.7 >120 minutes 3.5 30.9 22.1 Don’t know 0.5 0.5 0.5 Total 100.0 100.0 100.0 Number 3,020 6,382 9,402 1 Total includes 1 household using a bicycle and 2 households using other methods of transportation. Table 2.16 Travel time to health facility by walking Among households that travel to the nearest health facility by walking, the percent distribution of the time required to walk to the nearest health facility, according to residence, Lesotho 2014 Residence Total Characteristic Urban Rural Time to get to nearest health facility by walking <20 minutes 28.4 5.5 12.8 20-40 minutes 43.0 11.4 21.6 41-60 minutes 17.2 16.1 16.5 61-120 minutes 8.1 28.1 21.7 >120 minutes 3.2 38.6 27.3 Don’t know 0.0 0.2 0.1 Total 100.0 100.0 100.0 Number 2,167 4,591 6,758 Characteristics of Respondents • 31 CHARACTERISTICS OF RESPONDENTS 3 Key Findings  Education: Among respondents age 15-49, 60% of women and 47% of men in Lesotho have attended some secondary school. However, only 19% of women and 16% of men have completed secondary school or beyond.  Literacy: More women than men can read; 97% of women and 85% of men age 15-49 are literate.  Exposure to mass media: About one-third of women and men have no regular exposure to any mass media.  Employment: Thirty-eight percent of women and 59% of men age 15-49 are currently employed.  Health insurance: Health insurance coverage is extremely low (only 2% have any kind of health insurance).  Tobacco use: Forty-two percent of men and 8% of women age 15-49 use tobacco products. his chapter presents information on the demographic and socioeconomic characteristics of the survey respondents such as age, education, place of residence, marital status, employment, and wealth status. This information is useful for understanding the factors that affect use of reproductive health services, contraceptive use, and other health behaviours. 3.1 BASIC CHARACTERISTICS OF SURVEY RESPONDENTS A total of 6,621 women age 15-49 and 2,931 men age 15-59 were interviewed in the 2014 LDHS. There are more women and men in younger than in older age groups (Table 3.1). Forty-two percent of women and 47% of men are in the 15-24 age group, and 31% of women and 28% of men are in the 25-34 age group. Among respondents age 15-49, women are more likely to be married (54% versus 36%) or widowed (7% versus 2%) than men. Differences were not observed in the proportion of women and men who were living together (1% each) or who were divorced or separated (5% each). Most respondents identify as Christians, but women more so than men (98% versus 92%). Thirty-nine percent of women and 41% of men are Roman Catholic. Men are more likely than women to report that they have no religion (6% versus 1%). Women and men are geographically distributed in a similar pattern. About two-thirds of women and men live in rural areas. A majority of respondents live in the Lowlands (63% of women and 64% of men). Maseru has the highest percentage of respondents in any district and Qacha’s Nek the fewest: 28% of women and 30% of men live in Maseru district while only 3% of all respondents live in Qacha’s Nek. T 32 • Characteristics of Respondents 3.2 EDUCATION AND LITERACY Some secondary education Respondents who had some secondary education, completed secondary school, or attended higher levels of education are included in this measure. Sample: Women and men age 15-49 Literacy Respondents who had not attended school or who had attended only primary school were asked to read all or part of a sentence. Respondents who attended secondary school or had higher education were assumed to be literate. Sample: Women and men age 15-49 Education levels, especially among women, are high in Lesotho (Tables 3.2.1 and 3.2.2). Sixty percent of women and 47% of men age 15-49 have at least some secondary education (Figure 3.1), and 97% of women and 85% of men are literate (Tables 3.3.1 and 3.3.2). One percent of women and 8% of men have no education. Advanced education is relatively rare; only 9% of women and 8% of men have more than secondary education. Trends: Since 2009, the median number of years of schooling completed has changed little. For women, it was 7.0 years in 2009 compared with 6.9 years in 2014; for men, it was 6.2 years in both 2009 and 2014. Literacy rates among women are also unchanged since 2009 (97%); for men, literacy rates have increased from 81% to 85%. Patterns by background characteristics  Younger respondents have more education. Women age 15-19 are nearly twice as likely as women age 45-49 to have attended at least some secondary school (72% versus 39%), and the pattern is similar for men (53% versus 33%) (Tables 3.2.1 and 3.2.2).  Men living in rural areas are more likely not to have any education than their female counterparts (11% versus 1%).  Educational attainment varies widely by district. Sixty-seven percent of women and 58% of men in Maseru have at least some secondary education. In contrast, only 39% of women and 19% of men in Thaba-Tseka have at least some secondary education.  Women and men in the highest wealth quintile are more likely than those in any other wealth quintile to have completed secondary education; 42% of women and men in the highest wealth quintile completed secondary school compared with 2% of women and 1% of men in the lowest wealth quintile. The literacy rate increases with wealth, rising from 92% of women in the lowest quintile to 99% in the highest quintile, Figure 3.1 Education of survey respondents 1 8 18 33 21 12 42 31 10 8 9 8 Women Men Percent distribution of women and men age 15-49 by highest level of schooling attended or completed More than secondary Completed secondary Some secondary Primary complete Primary incomplete No education Characteristics of Respondents • 33 and from 61% of men in the lowest wealth quintile to 96% in the highest wealth quintile (Tables 3.3.1 and 3.3.2).  The literacy rate among women changes little across districts. Among men, Leribe has the highest literacy rate (91%) and Thaba-Tseka has the lowest (63%). 3.3 MASS MEDIA EXPOSURE Exposure to mass media Respondents were asked how often they read a newspaper, listened to the radio, or watched television. Those who responded at least once a week are considered to be regularly exposed to that form of media. Sample: Women and men age 15-49 Mass media often convey messages on family planning, HIV/AIDS awareness, and other health topics. Men and women age 15-49 are about equally likely to be regularly exposed to any and all forms of media, including newspapers, television, and radio (Figure 3.2). Radio is the most common form of media exposure for both women and men across all sub- groups. About one-third of women and men are not regularly exposed to any form of media. Trends: The proportion of people who are not regularly exposed to any mass media has increased slightly since 2009, from 29% to 32% among women and from 33% to 36% among men. Patterns by background characteristics  Rural women are three times more likely than their urban counterparts to have no regular exposure to any form of mass media (42% versus 14%) (Table 3.4.1). The same pattern holds true for men (48% versus 14%) (Table 3.4.2).  Residents of Berea, Mafeteng, and Maseru are more likely to read newspapers, watch television, and listen to the radio than people in other districts. Women and men in Thaba-Tseka are most likely to report no regular exposure to any of the three media (61% and 68%, respectively).  Highly educated women and men have much greater exposure to mass media. Only 8% of women and 8% of men with more than a secondary education lack regular exposure to any media, compared with 62% of women and 73% of men with no education. Figure 3.2 Exposure to mass media 16 29 60 7 32 16 28 56 8 36 Reads newspaper Watches television Listens to radio All three media None of these media Percentage of women and men age 15-49 who are exposed to media on a weekly basis Women Men 34 • Characteristics of Respondents 3.4 EMPLOYMENT Currently employed Respondents who were employed in the seven days before the survey Sample: Women and men age 15-49 Men age 15-49 are more likely to be employed than women age 15-49. Fifty-nine percent of men are currently employed, compared with 38% of women (Tables 3.5.1 and 3.5.2). An additional 11% of men and 9% of women reported working in the past 12 months even though they were not currently employed. Most of the women who worked in the past year:  Did nonagricultural work (83%)  Worked year-round (61%)  Were employed by a nonfamily member (61%)  Were paid entirely in cash (83%) (Table 3.6) Trends: Since 2009, current employment levels have remained stable or slightly declined. Among women, 39% were currently employed in 2009 compared with 38% in 2014; among men, the percentage currently employed has fallen from 62% to 59%. Patterns by background characteristics  Women are more likely to work if they are divorced, separated, or widowed than if they are married, but the reverse is true for men. Never-married women and men are least likely to be employed (Table 3.5.1 and Table 3.5.2).  Women and men in the Lowlands (46% and 64%, respectively) are more likely to be currently employed compared with their counterparts in other ecological zones.  Women with more than secondary education are twice as likely as women with no education and incomplete primary education to be currently employed. Among men, the level of education does not correlate clearly with employment status (Figure 3.3). 3.5 OCCUPATION Occupation Categorised as professional/technical/managerial, clerical, sales and services, skilled manual, unskilled manual, domestic service, agriculture, and other Sample: Women and men age 15-49 who were currently employed or had worked in the 12 months before the survey Figure 3.3 Employment by education 32 31 39 36 6157 58 65 54 76 No education Primary incomplete Primary complete Secondary More than secondary Percentage of women and men age 15-49 who are currently employed Women Men Characteristics of Respondents • 35 Women age 15-49 are most often employed in sales and services (28%), followed by unskilled manual labour (16%) (Table 3.7.1 and Figure 3.4). Men age 15-49 are most commonly employed in agriculture (34%) and skilled manual labour (21%) (Table 3.7.2 and Figure 3.4). Trends: Since 2009, there has been a rise in women and men who work in sales and services and unskilled manual labour, and a decline in those who work in agriculture. Patterns by background characteristics  Agriculture is the leading occupation in rural areas for men (49%), but not women (16%). Sales and services is the leading occupation for women in both urban and rural areas (28% for each).  Women with more than secondary education are twice as likely to work in the professional, technical, and managerial occupations as their male counterparts (52% and 24%, respectively). Men with no education, incomplete primary education, or complete primary education most often work in agriculture. Women with incomplete primary education most commonly work in sales and services or domestic service (26% each), whereas women with complete primary education most commonly work in sales and services (23%), unskilled manual labour (21%), or domestic service (20%).  The proportion of women in professional, technical, and managerial occupations increases with wealth quintile. The women in the highest quintile are eight times more likely to be in a professional, technical, or managerial occupation than women in the lowest quintile. 3.6 HEALTH INSURANCE COVERAGE Ninety-eight percent of both women and men age 15-49 in Lesotho do not have health insurance (Tables 3.8.1 and 3.8.2). Women and men living in urban areas, those with higher levels of education, and those from the wealthiest households are most likely to have health insurance. Trends: The proportion of women who have no health insurance has increased from 91% in 2009 to 98% in 2014. Similarly, the proportion of men without health insurance has increased from 92% in 2009 to 98% in 2014. 3.7 TOBACCO USE Ninety-two percent of women and 58% of men age 15-49 reported that they do not use any tobacco product (Tables 3.9.1 and 3.9.2). Among women who use tobacco products, the vast majority use snuff; among men who use tobacco products, nearly all smoke cigarettes (Figure 3.5). Among men who smoke cigarettes, one in six men (16%) reported smoking 10 or more cigarettes in the 24 hours prior to the interview. Figure 3.4 Occupation 34 1 12 21 18 3 5 10 14 16 11 28 5 10 Agriculture Domestic service Unskilled manual Skilled manual Sales and services Clerical Professional/ technical/ managerial Percentage of women and men age 15-49 by occupation Women Men 36 • Characteristics of Respondents Trends: Tobacco use among men has increased since 2009, from 35% to 42%. During this period, tobacco use among women has remained stable (9% in 2009 versus 8% in 2014). Patterns by background characteristics  Cigarette smoking rises sharply with age among men, from a low of 19% for those age 15-19 to a high of 53% for those age 25-29. After age 30, tobacco use is relatively stable (Table 3.9.2).  Tobacco use varies by residence. Forty-three percent of men in rural areas smoke cigarettes versus 38% in urban areas.  Tobacco use declines markedly by education level; only 34% of men with no education do not use tobacco compared with 76% of men with more than secondary education. Likewise, 73% of women with no education do not use tobacco compared with 99% with more than secondary education.  The use of snuff by women increases dramatically with age, from a low of less than 1% among women 15-19 to a high of 25% among women 45-49. Snuff use among women inversely correlates with education and wealth. 3.8 TIME AWAY FROM HOME Women and men answered a series of questions about whether they had spent time away from home in the past 12 months and the past 5 years. Fifty-one percent of women and 53% of men age 15-49 reported that they had been away for one night or more in the 12 months preceding the survey, and 15% of women and 18% of men had been away for more than one month in the past 12 months. One in five women (21%) and 29% of men have been away for three or more months in the past 5 years (Tables 3.10.1 and 3.10.2). Among these respondents, on average, women made 2.9 trips of 3 months or more in the past 5 years, and men made 2.2 trips. Among respondents age 15-49 who were away for 3 or more months in the past 5 years, about one in three went to South Africa the most recent time they were away (data not shown). The reason for the last visit of 3 or more months varied by sex: 41% of women were away for reasons related to family or marriage, 34% were away for work, and 17% were away for school or university; 62% of men were away for work, 12% for family or marriage, and 11% for school or university (data not shown). Figure 3.5 Use of tobacco 0.3 0 8 8 41 6 1 42 Cigarettes Pipe Snuff Any Percentage of women and men age 15-49 who use specific types of tobacco Women Men Characteristics of Respondents • 37 LIST OF TABLES For detailed information on the characteristics of survey respondents, see the following tables:  Table 3.1 Background characteristics of respondents  Table 3.2.1 Educational attainment: Women  Table 3.2.2 Educational attainment: Men  Table 3.3.1 Literacy: Women  Table 3.3.2 Literacy: Men  Table 3.4.1 Exposure to mass media: Women  Table 3.4.2 Exposure to mass media: Men  Table 3.5.1 Employment status: Women  Table 3.5.2 Employment status: Men  Table 3.6 Type of employment: Women  Table 3.7.1 Occupation: Women  Table 3.7.2 Occupation: Men  Table 3.8.1 Health insurance coverage: Women  Table 3.8.2 Health insurance coverage: Men  Table 3.9.1 Use of tobacco: Women  Table 3.9.2 Use of tobacco: Men  Table 3.10.1 Time away from home: Women  Table 3.10.2 Time away from home: Men 38 • Characteristics of Respondents Table 3.1 Background characteristics of respondents Percent distribution of women and men age 15-49 by selected background characteristics, Lesotho 2014 Women Men Background characteristic Weighted percent Weighted number Unweighted number Weighted percent Weighted number Unweighted number Age 15-19 21.7 1,440 1,542 26.0 691 690 20-24 20.0 1,325 1,300 21.1 561 534 25-29 16.5 1,094 1,072 15.4 410 394 30-34 14.5 957 907 12.6 334 345 35-39 11.2 744 728 10.4 276 275 40-44 8.5 562 582 8.3 221 222 45-49 7.5 499 490 6.3 168 166 Religion Roman Catholic 38.6 2,558 2,514 40.9 1,088 1,018 Lesotho Evangelical 17.1 1,133 1,133 17.9 476 472 Anglican 7.2 477 453 7.8 207 202 Pentecostal 24.9 1,646 1,682 18.8 499 507 Other Christian 10.1 668 691 6.8 180 196 Other non-Christian 1.4 90 83 1.6 42 36 No religion 0.7 49 65 6.3 168 195 Marital status Never married 33.1 2,190 2,201 56.4 1,501 1,464 Married 53.6 3,549 3,556 36.0 959 971 Living together 1.0 63 53 0.9 25 22 Divorced/separated 5.4 358 340 4.9 132 122 Widowed 7.0 461 471 1.7 45 47 Residence Urban 36.5 2,419 2,202 34.6 920 821 Rural 63.5 4,202 4,419 65.4 1,741 1,805 Ecological zone Lowlands 63.2 4,184 3,290 64.3 1,711 1,348 Foothills 10.4 688 670 9.5 252 258 Mountains 19.5 1,288 1,897 19.7 523 734 Senqu River Valley 7.0 461 764 6.5 174 286 District Butha-Buthe 5.8 385 593 5.4 143 222 Leribe 16.1 1,064 785 14.7 390 283 Berea 13.5 892 760 14.3 379 326 Maseru 28.2 1,864 930 30.4 809 427 Mafeteng 8.7 576 624 9.1 242 268 Mohale’s Hoek 7.8 519 621 7.6 202 241 Quthing 4.8 315 556 3.9 105 187 Qacha’s Nek 3.1 204 558 2.8 74 201 Mokhotlong 5.3 349 605 5.4 144 241 Thaba-Tseka 6.8 452 589 6.5 172 230 Education No education 1.0 68 81 8.0 213 237 Primary incomplete 17.8 1,178 1,282 32.9 875 911 Primary complete 20.8 1,375 1,383 11.9 316 317 Secondary 51.6 3,418 3,354 39.2 1,043 972 More than secondary 8.8 581 521 8.0 214 189 Wealth quintile Lowest 14.5 960 1,183 14.1 376 468 Second 15.6 1,033 1,138 18.0 479 501 Middle 18.8 1,244 1,307 20.1 536 542 Fourth 24.2 1,605 1,453 23.2 616 550 Highest 26.9 1,778 1,540 24.6 654 565 Total 15-49 100.0 6,621 6,621 100.0 2,660 2,626 50-59 na na na na 271 305 Total 15-59 na na na na 2,931 2,931 Note: Education categories refer to the highest level of education attended, whether or not that level was completed. na = Not applicable Characteristics of Respondents • 39 Table 3.2.1 Educational attainment: Women Percent distribution of women age 15-49 by highest level of schooling attended or completed, and median years completed, according to background characteristics, Lesotho 2014 Highest level of schooling Total Median years completed Number of women Background characteristic No education Some primary Completed primary1 Some secondary Completed secondary2 More than secondary Age 15-24 0.1 13.4 14.3 56.0 10.9 5.2 100.0 7.2 2,765 15-19 0.0 15.7 12.3 66.2 5.1 0.7 100.0 6.8 1,440 20-24 0.2 10.9 16.5 44.9 17.3 10.1 100.0 7.8 1,325 25-29 0.8 18.9 20.4 31.6 13.4 14.9 100.0 7.2 1,094 30-34 2.1 19.7 24.8 34.0 6.9 12.5 100.0 6.9 957 35-39 2.1 20.5 26.0 30.9 10.6 9.8 100.0 6.8 744 40-44 1.2 21.3 30.9 31.6 5.9 9.1 100.0 6.7 562 45-49 2.7 28.3 30.2 28.2 4.4 6.2 100.0 6.5 499 Residence Urban 0.7 9.0 14.5 44.9 14.6 16.3 100.0 8.0 2,419 Rural 1.2 22.9 24.4 40.0 7.1 4.4 100.0 6.7 4,202 Ecological zone Lowlands 0.5 11.9 17.4 45.6 12.2 12.3 100.0 7.5 4,184 Foothills 0.8 28.8 27.3 36.5 4.2 2.3 100.0 6.5 688 Mountains 2.6 28.5 27.8 33.5 5.4 2.2 100.0 6.4 1,288 Senqu River Valley 1.4 24.8 22.3 38.4 8.3 4.8 100.0 6.6 461 District Butha-Buthe 1.6 21.6 19.3 40.9 10.1 6.5 100.0 6.9 385 Leribe 0.8 10.7 22.5 51.0 7.5 7.4 100.0 7.0 1,064 Berea 0.3 13.2 20.9 41.8 11.0 12.8 100.0 7.2 892 Maseru 0.7 15.1 16.8 41.4 12.7 13.3 100.0 7.4 1,864 Mafeteng 0.1 17.2 20.2 43.7 11.2 7.5 100.0 7.0 576 Mohale’s Hoek 1.6 22.3 23.6 39.8 7.6 5.1 100.0 6.7 519 Quthing 1.6 26.8 16.2 40.3 10.0 5.1 100.0 6.7 315 Qacha’s Nek 2.4 22.6 23.8 37.1 9.4 4.7 100.0 6.7 204 Mokhotlong 2.5 29.2 26.0 33.8 5.9 2.6 100.0 6.4 349 Thaba-Tseka 2.0 29.7 29.3 32.0 4.5 2.4 100.0 6.4 452 Wealth quintile Lowest 3.2 39.3 32.1 23.6 1.7 0.0 100.0 6.1 960 Second 1.2 29.3 29.9 35.1 3.9 0.6 100.0 6.4 1,033 Middle 0.7 17.1 22.5 49.9 7.2 2.6 100.0 6.8 1,244 Fourth 0.3 11.2 17.3 52.6 11.4 7.2 100.0 7.3 1,605 Highest 0.6 6.0 11.3 40.1 18.0 23.9 100.0 8.9 1,778 Total 1.0 17.8 20.8 41.8 9.8 8.8 100.0 6.9 6,621 1 Completed 7th grade at the primary level 2 Completed 5th grade at the secondary level 40 • Characteristics of Respondents Table 3.2.2 Educational attainment: Men Percent distribution of men age 15-49 by highest level of schooling attended or completed, and median years completed, according to background characteristics, Lesotho 2014 Highest level of schooling Total Median years completed Number of men Background characteristic No education Some primary Completed primary1 Some secondary Completed secondary2 More than secondary Age 15-24 2.3 32.3 9.8 43.9 6.3 5.4 100.0 6.3 1,252 15-19 0.7 36.9 9.6 50.6 1.5 0.8 100.0 6.1 691 20-24 4.3 26.7 9.9 35.7 12.3 11.1 100.0 6.8 561 25-29 5.8 32.5 15.1 23.0 12.8 10.8 100.0 6.5 410 30-34 13.5 30.5 17.8 16.4 9.6 12.1 100.0 6.2 334 35-39 17.3 34.0 7.7 23.2 7.2 10.7 100.0 5.7 276 40-44 19.9 35.5 11.7 17.9 6.7 8.3 100.0 5.1 221 45-49 14.2 37.6 15.0 19.6 5.7 7.8 100.0 5.7 168 Residence Urban 2.4 18.8 9.3 37.6 13.8 18.1 100.0 7.7 920 Rural 10.9 40.3 13.2 28.1 4.7 2.7 100.0 5.6 1,741 Ecological zone Lowlands 2.9 26.2 12.2 37.9 9.6 11.3 100.0 6.7 1,711 Foothills 13.2 46.8 13.1 21.6 4.2 1.0 100.0 5.2 252 Mountains 21.8 45.7 10.1 16.6 4.1 1.7 100.0 4.1 523 Senqu River Valley 9.2 40.2 12.1 26.3 6.9 5.3 100.0 5.8 174 District Butha-Buthe 8.5 37.0 12.2 33.4 4.5 4.5 100.0 6.1 143 Leribe 5.5 27.9 14.2 42.0 6.1 4.3 100.0 6.3 390 Berea 5.6 26.5 14.7 33.7 10.3 9.3 100.0 6.6 379 Maseru 3.7 29.7 8.8 33.9 9.8 14.1 100.0 6.7 809 Mafeteng 6.6 36.1 16.4 27.5 6.7 6.7 100.0 6.1 242 Mohale’s Hoek 12.4 38.3 9.9 27.8 8.4 3.2 100.0 5.6 202 Quthing 12.1 35.9 7.3 31.4 7.2 6.1 100.0 5.9 105 Qacha’s Nek 7.7 32.6 14.3 31.2 7.8 6.3 100.0 6.2 74 Mokhotlong 16.4 48.5 13.2 13.9 5.4 2.6 100.0 4.1 144 Thaba-Tseka 26.0 44.3 11.0 13.1 3.4 2.1 100.0 3.8 172 Wealth quintile Lowest 26.7 50.9 11.2 10.0 1.2 0.0 100.0 3.2 376 Second 11.3 50.1 12.7 22.8 3.2 0.0 100.0 5.0 479 Middle 5.3 37.7 16.6 33.0 5.9 1.5 100.0 6.0 536 Fourth 3.7 25.6 11.9 44.8 8.2 5.9 100.0 6.7 616 Highest 1.1 12.9 7.8 36.0 16.3 25.9 100.0 8.7 654 Total 15-49 8.0 32.9 11.9 31.4 7.8 8.0 100.0 6.2 2,660 50-59 26.7 39.0 10.2 15.6 3.8 4.7 100.0 3.2 271 Total 15-59 9.7 33.5 11.7 29.9 7.4 7.7 100.0 6.1 2,931 1 Completed 7th grade at the primary level 2 Completed 5th grade at the secondary level Characteristics of Respondents • 41 Table 3.3.1 Literacy: Women Percent distribution of women age 15-49 by level of schooling attended and level of literacy, and percentage literate, according to background characteristics, Lesotho 2014 Secondary school or higher No schooling or primary school Total Percent- age literate1 Number of women Background characteristic Can read a whole sentence Can read part of a sentence Cannot read at all No card with required language Blind/visually impaired Age 15-24 72.2 22.4 4.0 1.3 0.1 0.0 100.0 98.6 2,765 15-19 72.0 23.1 3.7 1.0 0.1 0.0 100.0 98.9 1,440 20-24 72.3 21.6 4.3 1.6 0.1 0.0 100.0 98.3 1,325 25-29 59.9 31.1 6.6 1.9 0.3 0.2 100.0 97.6 1,094 30-34 53.4 33.0 8.2 5.4 0.1 0.0 100.0 94.5 957 35-39 51.3 38.1 6.0 4.5 0.0 0.0 100.0 95.5 744 40-44 46.6 41.0 8.6 3.7 0.0 0.0 100.0 96.3 562 45-49 38.8 44.5 11.6 4.2 0.5 0.4 100.0 94.9 499 Residence Urban 75.8 17.7 4.4 1.7 0.4 0.1 100.0 97.9 2,419 Rural 51.5 37.7 7.3 3.4 0.0 0.0 100.0 96.5 4,202 Ecological zone Lowlands 70.2 23.0 4.7 1.8 0.2 0.1 100.0 97.9 4,184 Foothills 43.1 43.9 9.2 3.9 0.0 0.0 100.0 96.1 688 Mountains 41.1 44.6 9.1 5.1 0.0 0.1 100.0 94.8 1,288 Senqu River Valley 51.5 37.2 7.8 3.5 0.0 0.0 100.0 96.5 461 District Butha-Buthe 57.5 29.2 10.1 3.2 0.0 0.0 100.0 96.8 385 Leribe 65.9 27.4 3.6 2.3 0.6 0.3 100.0 96.9 1,064 Berea 65.6 27.5 4.9 1.9 0.0 0.0 100.0 98.1 892 Maseru 67.4 23.8 6.7 2.1 0.0 0.0 100.0 97.9 1,864 Mafeteng 62.4 31.3 3.6 2.1 0.5 0.1 100.0 97.3 576 Mohale’s Hoek 52.5 37.2 6.8 3.5 0.0 0.0 100.0 96.5 519 Quthing 55.4 34.3 6.4 3.7 0.2 0.0 100.0 96.1 315 Qacha’s Nek 51.2 37.8 6.3 4.7 0.0 0.0 100.0 95.3 204 Mokhotlong 42.3 42.9 9.8 5.0 0.0 0.0 100.0 95.0 349 Thaba-Tseka 39.0 46.6 9.5 4.8 0.0 0.2 100.0 95.0 452 Wealth quintile Lowest 25.3 53.7 13.0 7.8 0.1 0.0 100.0 92.1 960 Second 39.7 45.8 10.2 4.3 0.0 0.0 100.0 95.7 1,033 Middle 59.7 32.6 5.1 2.4 0.2 0.0 100.0 97.4 1,244 Fourth 71.3 23.1 4.1 1.2 0.1 0.2 100.0 98.5 1,605 Highest 82.1 13.8 3.0 0.8 0.3 0.0 100.0 98.9 1,778 Total 60.4 30.4 6.2 2.8 0.1 0.1 100.0 97.0 6,621 1 Refers to women who attended secondary school or higher and women who can read a whole sentence or part of a sentence 42 • Characteristics of Respondents Table 3.3.2 Literacy: Men Percent distribution of men age 15-49 by level of schooling attended and level of literacy, and percentage literate, according to background characteristics, Lesotho 2014 Secondary school or higher No schooling or primary school Total Percent- age literate1 Number of men Background characteristic Can read a whole sentence Can read part of a sentence Cannot read at all No card with required language Blind/visually impaired Age 15-24 55.7 25.6 9.4 9.4 0.0 0.0 100.0 90.6 1,252 15-19 52.8 29.4 9.8 8.0 0.0 0.0 100.0 92.0 691 20-24 59.1 20.9 8.8 11.1 0.0 0.0 100.0 88.9 561 25-29 46.5 27.5 13.2 12.8 0.0 0.0 100.0 87.2 410 30-34 38.1 30.6 11.9 18.7 0.7 0.0 100.0 80.6 334 35-39 41.1 23.8 9.9 25.3 0.0 0.0 100.0 74.7 276 40-44 32.9 25.1 9.0 32.0 0.0 0.9 100.0 67.1 221 45-49 33.2 29.0 16.2 21.0 0.0 0.6 100.0 78.4 168 Residence Urban 69.5 18.8 3.8 7.4 0.2 0.2 100.0 92.1 920 Rural 35.5 30.6 14.4 19.5 0.0 0.1 100.0 80.4 1,741 Ecological zone Lowlands 58.7 24.2 8.3 8.5 0.1 0.2 100.0 91.1 1,711 Foothills 26.9 39.3 13.5 20.3 0.0 0.0 100.0 79.7 252 Mountains 22.4 27.7 15.7 34.2 0.0 0.0 100.0 65.8 523 Senqu River Valley 38.6 27.3 15.9 18.2 0.0 0.0 100.0 81.8 174 District Butha-Buthe 42.3 27.5 16.9 13.3 0.0 0.0 100.0 86.7 143 Leribe 52.4 27.1 11.8 8.6 0.0 0.0 100.0 91.4 390 Berea 53.2 27.9 8.4 10.2 0.0 0.3 100.0 89.5 379 Maseru 57.8 21.4 7.6 12.7 0.3 0.3 100.0 86.8 809 Mafeteng 40.8 34.6 11.4 13.2 0.0 0.0 100.0 86.8 242 Mohale’s Hoek 39.4 24.0 15.2 21.3 0.0 0.0 100.0 78.7 202 Quthing 44.7 22.0 13.4 19.9 0.0 0.0 100.0 80.1 105 Qacha’s Nek 45.4 33.0 9.4 12.3 0.0 0.0 100.0 87.7 74 Mokhotlong 21.9 30.6 15.6 31.9 0.0 0.0 100.0 68.1 144 Thaba-Tseka 18.6 32.9 11.8 36.7 0.0 0.0 100.0 63.3 172 Wealth quintile Lowest 11.2 31.0 18.4 39.4 0.0 0.0 100.0 60.6 376 Second 25.9 34.6 16.8 22.5 0.0 0.2 100.0 77.3 479 Middle 40.4 35.3 12.4 11.9 0.0 0.0 100.0 88.1 536 Fourth 58.9 22.4 7.7 10.7 0.0 0.3 100.0 88.9 616 Highest 78.2 14.7 3.3 3.5 0.3 0.0 100.0 96.2 654 Total 15-49 47.2 26.5 10.7 15.3 0.1 0.1 100.0 84.5 2,660 50-59 24.1 31.1 13.1 30.5 0.0 1.1 100.0 68.4 271 Total 15-59 45.1 26.9 10.9 16.7 0.1 0.2 100.0 83.0 2,931 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 Respondents • 43 Table 3.4.1 Exposure to mass media: Women Percentage of women age 15-49 who are exposed to specific media on a weekly basis, by background characteristics, Lesotho 2014 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 Accesses all three media at least once a week Accesses none of the three media at least once a week Number of women Age 15-19 18.9 27.7 54.7 7.2 34.5 1,440 20-24 18.2 27.8 58.2 7.4 32.5 1,325 25-29 15.9 28.8 64.3 7.2 30.2 1,094 30-34 15.3 32.3 63.8 7.8 28.4 957 35-39 14.5 34.5 64.1 9.1 29.6 744 40-44 11.6 28.1 59.9 5.7 33.4 562 45-49 10.9 28.2 61.6 5.9 32.9 499 Residence Urban 25.5 53.7 73.4 14.2 13.8 2,419 Rural 10.6 15.4 52.8 3.3 42.1 4,202 Ecological zone Lowlands 21.4 40.8 70.7 10.6 19.6 4,184 Foothills 8.1 7.9 49.0 0.7 45.7 688 Mountains 5.9 9.2 36.6 1.6 58.9 1,288 Senqu River Valley 7.6 14.5 49.6 3.1 44.9 461 District Butha-Buthe 10.4 21.6 38.6 3.5 51.9 385 Leribe 12.3 26.4 62.9 4.4 30.1 1,064 Berea 18.9 36.5 69.5 8.3 21.6 892 Maseru 24.5 42.9 70.1 12.5 19.2 1,864 Mafeteng 18.7 31.3 70.6 9.7 22.7 576 Mohale’s Hoek 12.2 21.8 59.6 5.6 35.2 519 Quthing 8.8 17.2 55.3 3.3 40.0 315 Qacha’s Nek 11.0 20.8 35.5 4.1 52.5 204 Mokhotlong 4.4 7.2 37.2 1.0 59.7 349 Thaba-Tseka 6.5 9.2 34.9 2.3 61.1 452 Education No education 1.2 14.4 36.8 0.0 61.8 68 Primary incomplete 4.0 12.0 41.2 1.2 53.8 1,178 Primary complete 5.3 18.5 53.8 1.6 41.6 1,375 Secondary 19.8 34.0 67.6 8.3 23.6 3,418 More than secondary 45.6 64.7 74.6 28.5 8.2 581 Wealth quintile Lowest 3.0 1.7 24.8 0.4 73.5 960 Second 6.4 4.1 44.5 0.9 52.0 1,033 Middle 11.4 8.4 59.2 1.1 35.8 1,244 Fourth 17.6 27.3 73.6 5.3 18.6 1,605 Highest 30.5 75.6 77.5 20.9 6.5 1,778 Total 16.0 29.4 60.3 7.3 31.7 6,621 44 • Characteristics of Respondents Table 3.4.2 Exposure to mass media: Men Percentage of men age 15-49 who are exposed to specific media on a weekly basis, by background characteristics, Lesotho 2014 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 Accesses all three media at least once a week Accesses none of the three media at least once a week Number of men Age 15-19 12.9 26.1 46.7 3.8 39.7 691 20-24 17.2 30.0 58.4 8.8 34.5 561 25-29 18.3 27.6 59.4 6.2 33.9 410 30-34 17.6 28.8 62.8 11.5 32.9 334 35-39 14.0 23.8 57.8 8.1 37.4 276 40-44 15.6 30.1 54.2 9.4 38.3 221 45-49 20.3 27.1 60.3 9.4 32.6 168 Residence Urban 28.2 53.5 72.6 15.4 13.9 920 Rural 9.6 14.0 46.9 3.3 47.7 1,741 Ecological zone Lowlands 21.5 36.9 65.8 10.3 24.1 1,711 Foothills 5.5 10.3 43.5 1.9 51.7 252 Mountains 5.9 10.5 32.8 2.6 62.8 523 Senqu River Valley 8.4 13.0 43.8 2.5 50.3 174 District Butha-Buthe 12.2 19.1 36.0 4.9 52.9 143 Leribe 15.1 28.1 59.0 5.2 30.9 390 Berea 17.0 33.0 64.3 10.6 28.4 379 Maseru 22.3 37.7 65.4 9.7 24.3 809 Mafeteng 18.2 28.8 61.9 11.0 32.2 242 Mohale’s Hoek 14.7 18.3 51.6 6.2 41.8 202 Quthing 9.3 15.2 42.3 2.3 47.9 105 Qacha’s Nek 11.2 24.7 43.8 4.9 47.1 74 Mokhotlong 4.6 8.1 32.3 1.9 65.2 144 Thaba-Tseka 4.1 9.3 30.2 2.6 67.8 172 Education No education 0.6 2.7 26.1 0.6 73.2 213 Primary incomplete 3.0 12.8 43.4 0.5 52.2 875 Primary complete 11.0 24.3 61.5 2.2 32.7 316 Secondary 23.8 39.2 66.6 10.9 21.6 1,043 More than secondary 54.3 62.1 74.8 33.6 8.4 214 Wealth quintile Lowest 0.6 3.2 21.1 0.1 77.6 376 Second 6.2 5.2 44.6 1.9 52.6 479 Middle 11.4 13.6 55.1 1.5 38.6 536 Fourth 16.1 30.3 66.4 4.4 22.3 616 Highest 35.9 67.0 74.4 23.5 10.8 654 Total 15-49 16.0 27.6 55.8 7.5 36.0 2,660 50-59 10.2 23.5 58.9 5.1 38.1 271 Total 15-59 15.5 27.3 56.1 7.2 36.2 2,931 Characteristics of Respondents • 45 Table 3.5.1 Employment status: Women Percent distribution of women age 15-49 by employment status, according to background characteristics, Lesotho 2014 Employed in the 12 months preceding the survey Not employed in the 12 months preceding the survey Total Number of women Background characteristic Currently employed1 Not currently employed Age 15-19 10.4 5.3 84.3 100.0 1,440 20-24 27.9 11.6 60.5 100.0 1,325 25-29 42.9 10.7 46.4 100.0 1,094 30-34 57.2 8.9 34.0 100.0 957 35-39 55.4 7.7 36.9 100.0 744 40-44 54.9 7.9 37.1 100.0 562 45-49 48.8 7.6 43.6 100.0 499 Marital status Never married 26.1 7.2 66.7 100.0 2,190 Married or living together 40.5 9.0 50.5 100.0 3,612 Divorced/separated/widowed 57.1 10.7 32.2 100.0 819 Number of living children 0 23.3 7.9 68.7 100.0 2,152 1-2 45.8 8.3 45.9 100.0 2,897 3-4 45.1 10.5 44.4 100.0 1,169 5+ 35.6 9.3 55.1 100.0 403 Residence Urban 54.2 7.5 38.3 100.0 2,419 Rural 28.3 9.3 62.4 100.0 4,202 Ecological zone Lowlands 45.6 9.0 45.4 100.0 4,184 Foothills 24.6 11.2 64.2 100.0 688 Mountains 23.4 6.2 70.4 100.0 1,288 Senqu River Valley 27.0 8.2 64.8 100.0 461 District Butha-Buthe 24.4 5.4 70.2 100.0 385 Leribe 41.4 11.0 47.7 100.0 1,064 Berea 40.5 10.6 48.9 100.0 892 Maseru 50.8 8.8 40.4 100.0 1,864 Mafeteng 31.9 7.2 60.9 100.0 576 Mohale’s Hoek 28.4 8.9 62.6 100.0 519 Quthing 27.0 9.0 63.9 100.0 315 Qacha’s Nek 23.9 7.1 69.0 100.0 204 Mokhotlong 23.9 5.9 70.2 100.0 349 Thaba-Tseka 24.3 5.4 70.2 100.0 452 Education No education 31.9 6.0 62.2 100.0 68 Primary incomplete 30.5 9.6 59.9 100.0 1,178 Primary complete 38.5 9.3 52.2 100.0 1,375 Secondary 36.1 8.5 55.4 100.0 3,418 More than secondary 61.4 6.2 32.3 100.0 581 Wealth quintile Lowest 17.1 8.1 74.8 100.0 960 Second 26.1 9.6 64.3 100.0 1,033 Middle 31.7 11.3 57.0 100.0 1,244 Fourth 42.6 9.5 47.9 100.0 1,605 Highest 55.6 5.8 38.7 100.0 1,778 Total 37.8 8.6 53.6 100.0 6,621 1 Currently employed is defined as having done work in the past 7 days. Included are persons who did not work in the past 7 days but who are regularly employed and were absent from work for leave, illness, vacation, or any other such reason. 46 • Characteristics of Respondents Table 3.5.2 Employment status: Men Percent distribution of men age 15-49 by employment status, according to background characteristics, Lesotho 2014 Employed in the 12 months preceding the survey Not employed in the 12 months preceding the survey Total Number of men Background characteristic Currently employed1 Not currently employed Age 15-19 35.2 10.0 54.8 100.0 691 20-24 56.2 9.8 34.0 100.0 561 25-29 67.0 14.9 18.1 100.0 410 30-34 73.2 9.0 17.7 100.0 334 35-39 76.0 9.7 14.3 100.0 276 40-44 72.6 11.7 15.7 100.0 221 45-49 68.0 12.3 19.7 100.0 168 Marital status Never married 49.3 9.8 40.9 100.0 1,501 Married or living together 71.7 11.5 16.8 100.0 983 Divorced/separated/widowed 66.0 16.1 17.9 100.0 176 Number of living children 0 50.5 10.5 39.0 100.0 1,607 1-2 72.7 10.6 16.8 100.0 686 3-4 70.8 13.1 16.1 100.0 279 5+ 60.8 12.0 27.2 100.0 87 Residence Urban 69.6 9.9 20.4 100.0 920 Rural 52.9 11.3 35.8 100.0 1,741 Ecological zone Lowlands 64.0 11.4 24.7 100.0 1,711 Foothills 50.7 11.6 37.8 100.0 252 Mountains 49.1 8.9 41.9 100.0 523 Senqu River Valley 47.5 10.3 42.2 100.0 174 District Butha-Buthe 56.7 7.2 36.1 100.0 143 Leribe 62.2 12.9 24.8 100.0 390 Berea 63.1 8.8 28.1 100.0 379 Maseru 63.0 12.9 24.0 100.0 809 Mafeteng 63.3 6.6 30.1 100.0 242 Mohale’s Hoek 50.2 13.3 36.5 100.0 202 Quthing 48.3 11.9 39.7 100.0 105 Qacha’s Nek 45.7 13.0 41.3 100.0 74 Mokhotlong 44.2 7.2 48.6 100.0 144 Thaba-Tseka 50.0 8.3 41.8 100.0 172 Education No education 57.2 11.4 31.4 100.0 213 Primary incomplete 57.9 10.4 31.6 100.0 875 Primary complete 64.5 13.6 21.9 100.0 316 Secondary 54.4 11.3 34.3 100.0 1,043 More than secondary 75.8 5.4 18.8 100.0 214 Wealth quintile Lowest 45.8 9.4 44.8 100.0 376 Second 52.4 12.4 35.2 100.0 479 Middle 55.3 12.9 31.8 100.0 536 Fourth 66.1 10.5 23.5 100.0 616 Highest 66.6 9.2 24.2 100.0 654 Total 15-49 58.7 10.8 30.5 100.0 2,660 50-59 62.5 7.5 29.9 100.0 271 Total 15-59 59.1 10.5 30.4 100.0 2,931 1 Currently employed is defined as having done work in the past 7 days. Included are persons who did not work in the past 7 days but who are regularly employed and were absent from work for leave, illness, vacation, or any other such reason. Characteristics of Respondents • 47 Table 3.6 Type of employment: Women Percent distribution of women age 15-49 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 2014 Employment characteristic Agricultural work Nonagricultural work Total Type of earnings Cash only 33.6 90.0 82.9 Cash and in-kind 3.8 1.9 2.2 In-kind only 7.7 1.2 2.2 Not paid 54.9 6.8 12.7 Total 100.0 100.0 100.0 Type of employer Employed by family member 22.9 4.8 6.4 Employed by nonfamily member 30.5 65.2 61.1 Self-employed 46.6 30.0 32.5 Total 100.0 100.0 100.0 Continuity of employment All year 14.9 67.0 61.2 Seasonal 67.7 14.3 20.2 Occasional 17.4 18.7 18.6 Total 100.0 100.0 100.0 Number of women employed during the last 12 months 302 2,549 3,073 Note: Total includes women with missing information on type of employment who are not shown separately. 48 • Characteristics of Respondents Table 3.7.1 Occupation: Women Percent distribution of women age 15-49 employed in the 12 months preceding the survey by occupation, according to background characteristics, Lesotho 2014 Background characteristic Professional/ technical/ managerial Clerical Sales and services Skilled manual Unskilled manual Domestic service Agriculture Missing Total Number of women Age 15-19 3.1 1.4 30.2 4.3 4.9 27.6 15.2 13.3 100.0 226 20-24 4.7 4.4 32.7 4.6 17.1 20.3 10.0 6.2 100.0 524 25-29 12.4 5.9 26.0 11.5 18.4 11.5 7.0 7.2 100.0 586 30-34 13.7 3.5 24.9 15.0 17.9 11.4 8.7 4.9 100.0 632 35-39 10.1 5.7 29.9 13.3 16.3 9.3 8.3 7.1 100.0 470 40-44 13.0 6.2 22.4 10.4 16.2 10.1 12.4 9.2 100.0 353 45-49 10.8 2.3 26.4 10.3 13.7 16.4 12.9 7.1 100.0 282 Marital status Never married 8.6 4.3 29.1 8.8 14.4 18.6 7.2 9.2 100.0 730 Married or living together 11.3 4.5 27.2 11.2 16.3 10.5 11.5 7.4 100.0 1,788 Divorced/separated/widowed 8.9 4.7 26.1 10.6 17.5 20.1 8.0 4.1 100.0 555 Number of living children 0 10.2 3.9 29.9 7.3 13.3 17.3 8.6 9.6 100.0 673 1-2 12.2 5.3 25.2 12.7 17.6 12.7 8.0 6.2 100.0 1,569 3-4 7.0 4.2 30.4 8.7 15.7 13.2 14.7 6.1 100.0 650 5+ 5.1 1.5 27.0 10.7 14.4 17.8 12.6 10.9 100.0 181 Residence Urban 13.1 6.2 27.5 13.2 18.2 11.8 3.4 6.7 100.0 1,493 Rural 7.5 2.9 27.5 8.0 14.1 16.4 15.9 7.7 100.0 1,580 Ecological zone Lowlands 10.8 4.7 28.0 11.0 18.6 12.9 7.5 6.5 100.0 2,283 Foothills 4.4 3.5 28.5 6.6 8.1 25.4 15.8 7.7 100.0 246 Mountains 11.2 3.8 24.7 12.0 8.4 13.9 17.3 8.6 100.0 381 Senqu River Valley 8.4 5.7 24.0 7.2 10.5 15.6 15.8 12.7 100.0 162 District Butha-Buthe 12.1 4.3 28.0 7.7 2.6 18.9 16.7 9.6 100.0 115 Leribe 8.7 2.8 25.7 9.2 21.3 15.9 10.0 6.4 100.0 556 Berea 12.1 4.9 28.1 10.3 13.8 19.0 5.3 6.4 100.0 456 Maseru 9.5 5.0 25.9 13.1 20.3 11.0 7.5 7.7 100.0 1,112 Mafeteng 9.4 5.3 40.7 6.7 10.3 11.6 12.3 3.6 100.0 225 Mohale’s Hoek 9.5 2.2 29.6 9.0 14.5 15.5 9.7 10.1 100.0 194 Quthing 10.1 4.3 28.0 8.7 6.6 18.1 16.3 7.9 100.0 114 Qacha’s Nek 15.2 3.3 27.6 8.4 7.0 12.4 18.1 7.9 100.0 63 Mokhotlong 11.4 4.9 23.4 11.9 9.9 15.9 14.3 8.3 100.0 104 Thaba-Tseka 13.2 8.7 22.3 8.6 8.1 10.5 21.0 7.5 100.0 135 Education No education (0.0) (0.0) (12.8) (23.3) (20.6) (21.8) (18.6) (2.9) 100.0 26 Primary incomplete 0.8 1.0 26.1 11.1 13.3 26.2 16.2 5.3 100.0 473 Primary complete 2.3 1.7 23.2 10.9 20.8 19.8 13.0 8.3 100.0 658 Secondary 6.0 5.0 32.5 12.0 17.9 11.3 8.6 6.6 100.0 1,524 More than secondary 51.7 11.9 17.5 2.8 3.9 0.9 0.9 10.2 100.0 394 Wealth quintile Lowest 2.3 1.7 20.8 12.8 14.8 15.9 18.1 13.6 100.0 242 Second 3.8 1.5 24.4 6.4 13.8 23.2 19.6 7.4 100.0 369 Middle 4.8 2.0 30.6 7.4 17.2 19.0 13.4 5.6 100.0 535 Fourth 8.2 4.5 28.1 12.5 21.1 9.7 9.4 6.3 100.0 837 Highest 18.3 7.5 27.9 11.5 12.7 11.7 3.2 7.2 100.0 1,091 Total 10.2 4.5 27.5 10.5 16.1 14.1 9.8 7.2 100.0 3,073 Note: Figures in parentheses are based on 25-49 unweighted cases. Characteristics of Respondents • 49 Table 3.7.2 Occupation: Men Percent distribution of men age 15-49 employed in the 12 months preceding the survey by occupation, according to background characteristics, Lesotho 2014 Background characteristic Professional/ technical/ managerial Clerical Sales and services Skilled manual Unskilled manual Domestic service Agriculture Missing Total Number of men Age 15-19 1.1 2.7 9.8 9.9 4.0 1.0 63.8 7.6 100.0 313 20-24 2.6 3.5 15.7 19.8 12.5 1.0 38.1 6.8 100.0 370 25-29 6.7 3.4 20.0 22.0 18.1 0.4 24.3 5.1 100.0 335 30-34 6.4 2.2 25.1 24.6 8.6 2.6 23.4 7.1 100.0 275 35-39 7.6 1.6 23.6 23.7 12.4 0.0 25.9 5.1 100.0 236 40-44 8.9 0.6 22.8 20.7 13.0 0.0 19.8 14.2 100.0 186 45-49 6.0 5.0 8.4 29.9 13.0 1.9 29.0 6.8 100.0 135 Marital status Never married 3.0 3.2 13.8 15.5 9.6 1.6 46.1 7.2 100.0 887 Married or living together 7.2 2.7 22.2 25.9 13.1 0.5 20.9 7.6 100.0 818 Divorced/separated/widowed 6.7 0.0 21.5 22.0 15.0 0.0 29.9 4.8 100.0 145 Number of living children 0 3.4 2.9 13.7 16.6 10.5 1.5 44.0 7.4 100.0 981 1-2 6.7 3.0 25.9 26.1 12.4 0.5 21.4 4.1 100.0 571 3-4 10.4 1.5 19.6 24.9 14.4 0.3 18.8 10.2 100.0 234 5+ 0.0 2.1 10.5 16.6 10.2 0.0 39.8 20.7 100.0 63 Residence Urban 8.0 4.4 29.9 23.3 13.5 1.4 10.3 9.2 100.0 732 Rural 3.3 1.6 10.3 18.8 10.3 0.7 49.0 5.9 100.0 1,118 Ecological zone Lowlands 5.3 2.9 21.7 23.4 13.0 1.1 24.5 8.1 100.0 1,289 Foothills 0.0 1.7 15.1 15.7 6.9 1.7 54.8 4.1 100.0 157 Mountains 7.3 1.5 6.8 12.0 7.6 0.0 59.4 5.4 100.0 304 Senqu River Valley 4.5 5.6 10.8 17.7 12.7 1.5 41.1 6.1 100.0 100 District Butha-Buthe 5.8 0.9 18.3 18.2 5.1 0.8 45.6 5.3 100.0 91 Leribe 3.6 2.4 21.5 19.8 5.9 0.4 39.6 6.8 100.0 293 Berea 4.9 2.8 15.5 22.8 9.5 1.7 33.7 9.2 100.0 273 Maseru 6.0 3.2 22.0 25.1 16.7 1.5 17.2 8.3 100.0 615 Mafeteng 2.0 1.8 21.3 18.6 10.9 0.4 40.6 4.4 100.0 169 Mohale’s Hoek 6.3 1.5 11.3 11.7 12.0 0.4 49.2 7.6 100.0 128 Quthing 4.1 5.3 12.5 15.1 6.5 2.3 45.5 8.7 100.0 63 Qacha’s Nek 8.8 3.7 10.6 25.1 10.5 0.0 33.6 7.7 100.0 44 Mokhotlong 5.9 0.7 7.5 13.8 12.0 0.0 54.9 5.2 100.0 74 Thaba-Tseka 7.7 4.6 8.5 12.9 12.0 0.0 52.1 2.2 100.0 100 Education No education 3.1 0.0 10.3 20.5 7.2 1.0 53.4 4.4 100.0 146 Primary incomplete 1.5 1.4 11.2 19.1 12.6 0.4 48.8 5.1 100.0 598 Primary complete 0.9 1.8 18.0 20.9 14.5 1.7 37.8 4.5 100.0 247 Secondary 5.5 4.0 24.1 21.6 12.2 1.1 22.4 9.1 100.0 685 More than secondary 24.3 6.0 24.9 21.6 5.0 1.5 3.8 13.0 100.0 173 Wealth quintile Lowest 0.3 0.9 5.5 12.8 11.6 0.0 66.0 3.1 100.0 208 Second 2.6 1.2 9.5 19.7 8.2 0.5 52.0 6.3 100.0 310 Middle 2.6 2.7 15.0 20.4 13.3 1.7 36.2 8.0 100.0 365 Fourth 3.3 3.8 21.7 24.1 13.5 0.2 24.0 9.3 100.0 472 Highest 12.4 3.4 27.5 21.2 10.6 1.9 16.1 7.0 100.0 496 Total 15-49 5.2 2.7 18.1 20.6 11.6 1.0 33.7 7.2 100.0 1,850 50-59 5.5 0.9 19.4 19.2 11.1 1.8 32.0 10.1 100.0 190 Total 15-59 5.2 2.5 18.2 20.5 11.5 1.1 33.5 7.5 100.0 2,040 50 • Characteristics of Respondents Table 3.8.1 Health insurance coverage: Women Percentage of women age 15-49 with specific types of health insurance coverage, according to background characteristics, Lesotho 2014 Background characteristic Employer-based insurance Mutual health organisation/ community-based insurance Privately purchased commercial insurance Other None Number of women Age 15-19 0.2 0.2 0.1 0.1 99.4 1,440 20-24 0.2 0.3 0.8 0.3 98.5 1,325 25-29 1.3 0.3 0.8 0.3 97.9 1,094 30-34 1.2 1.3 0.5 0.0 97.2 957 35-39 2.1 0.4 0.5 1.0 95.9 744 40-44 1.6 0.8 0.5 0.5 96.6 562 45-49 1.5 0.0 1.0 1.0 97.3 499 Residence Urban 1.8 1.0 1.1 0.6 95.8 2,419 Rural 0.5 0.1 0.3 0.2 99.1 4,202 Ecological zone Lowlands 1.4 0.7 0.8 0.4 96.9 4,184 Foothills 0.2 0.0 0.1 0.4 99.4 688 Mountains 0.0 0.0 0.1 0.1 99.8 1,288 Senqu River Valley 0.3 0.0 0.2 0.5 99.0 461 District Butha-Buthe 0.5 0.1 0.2 0.2 99.1 385 Leribe 0.4 0.1 0.3 0.3 98.9 1,064 Berea 1.2 0.9 1.3 1.0 95.9 892 Maseru 1.9 1.0 0.8 0.3 96.3 1,864 Mafeteng 0.8 0.2 0.5 0.4 98.6 576 Mohale’s Hoek 0.6 0.0 0.0 0.1 99.3 519 Quthing 0.0 0.0 0.3 0.3 99.4 315 Qacha’s Nek 0.4 0.0 0.2 0.9 98.4 204 Mokhotlong 0.0 0.0 0.2 0.0 99.8 349 Thaba-Tseka 0.1 0.0 0.1 0.0 99.7 452 Education No education 0.0 0.0 0.0 0.0 100.0 68 Primary incomplete 0.0 0.0 0.0 0.1 99.9 1,178 Primary complete 0.6 0.4 0.1 0.1 98.9 1,375 Secondary 0.5 0.3 0.5 0.4 98.4 3,418 More than secondary 6.3 2.6 3.3 1.5 88.1 581 Wealth quintile Lowest 0.0 0.0 0.0 0.0 100.0 960 Second 0.3 0.0 0.1 0.2 99.5 1,033 Middle 0.2 0.1 0.1 0.3 99.4 1,244 Fourth 0.6 0.1 0.3 0.4 98.6 1,605 Highest 2.6 1.4 1.8 0.7 94.0 1,778 Total 0.9 0.4 0.6 0.4 97.9 6,621 Characteristics of Respondents • 51 Table 3.8.2 Health insurance coverage: Men Percentage of men age 15-49 with specific types of health insurance coverage, according to background characteristics, Lesotho 2014 Background characteristic Employer based insurance Mutual health organisation/ community-based insurance Privately purchased commercial insurance Other None Number of men Age 15-19 0.0 0.1 0.0 0.1 99.8 691 20-24 0.5 0.0 1.3 0.2 98.1 561 25-29 0.4 0.3 0.4 0.4 98.5 410 30-34 1.9 0.0 0.0 1.2 96.9 334 35-39 2.3 0.5 0.7 0.0 96.6 276 40-44 2.5 0.0 0.2 0.1 97.2 221 45-49 3.9 0.4 0.0 0.0 95.7 168 Residence Urban 2.3 0.5 0.8 0.5 95.9 920 Rural 0.5 0.0 0.2 0.1 99.2 1,741 Ecological zone Lowlands 1.5 0.2 0.6 0.4 97.3 1,711 Foothills 0.9 0.0 0.0 0.3 98.8 252 Mountains 0.1 0.0 0.2 0.0 99.6 523 Senqu River Valley 0.1 0.0 0.0 0.1 99.7 174 District Butha-Buthe 0.5 0.0 0.3 0.0 99.1 143 Leribe 1.1 0.3 0.0 0.4 98.2 390 Berea 1.7 0.2 0.5 0.5 97.2 379 Maseru 1.5 0.2 0.8 0.4 97.2 809 Mafeteng 2.3 0.4 0.4 0.4 96.6 242 Mohale’s Hoek 0.0 0.0 0.0 0.0 100.0 202 Quthing 0.2 0.0 0.5 0.2 99.1 105 Qacha’s Nek 0.0 0.0 0.2 0.3 99.4 74 Mokhotlong 0.4 0.0 0.0 0.0 99.6 144 Thaba-Tseka 0.1 0.0 0.3 0.0 99.6 172 Education No education 0.0 0.0 0.0 0.0 100.0 213 Primary incomplete 0.4 0.0 0.0 0.1 99.5 875 Primary complete 1.3 0.0 0.0 0.9 97.7 316 Secondary 1.2 0.0 0.4 0.0 98.4 1,043 More than secondary 4.3 2.0 3.3 1.5 89.0 214 Wealth quintile Lowest 0.0 0.0 0.0 0.0 100.0 376 Second 0.0 0.0 0.0 0.2 99.8 479 Middle 0.3 0.0 0.3 0.0 99.4 536 Fourth 0.8 0.2 0.1 0.0 98.9 616 Highest 3.6 0.4 1.3 1.0 93.7 654 Total 15-49 1.1 0.2 0.4 0.3 98.0 2,660 50-59 1.3 0.0 0.0 1.2 97.5 271 Total 15-59 1.1 0.1 0.4 0.4 98.0 2,931 52 • Characteristics of Respondents Table 3.9.1 Use of tobacco: Women Percentage of women age 15-49 who smoke cigarettes or a pipe or use other tobacco products, according to background characteristics and maternity status, Lesotho 2014 Uses tobacco Does not use tobacco Number of women Background characteristic Cigarettes Pipe Snuff Other tobacco Age 15-19 0.2 0.0 0.2 0.0 99.7 1,440 20-24 0.6 0.0 1.5 0.1 97.9 1,325 25-29 0.3 0.1 4.7 0.0 95.0 1,094 30-34 0.1 0.0 8.6 0.3 91.1 957 35-39 0.1 0.1 11.2 0.1 88.6 744 40-44 0.2 0.2 23.1 0.1 76.5 562 45-49 0.0 0.0 25.1 0.1 74.8 499 Maternity status Pregnant 0.0 0.0 4.7 0.1 95.3 284 Breastfeeding (not pregnant) 0.1 0.1 5.5 0.2 94.0 951 Neither 0.3 0.0 8.0 0.1 91.7 5,387 Residence Urban 0.6 0.1 4.4 0.0 95.0 2,419 Rural 0.1 0.0 9.2 0.1 90.6 4,202 Ecological zone Lowlands 0.3 0.0 5.4 0.0 94.3 4,184 Foothills 0.1 0.1 10.2 0.3 89.4 688 Mountains 0.1 0.1 11.8 0.2 88.0 1,288 Senqu River Valley 0.0 0.0 10.2 0.3 89.5 461 District Butha-Buthe 0.0 0.0 4.8 0.0 95.2 385 Leribe 0.2 0.0 5.6 0.0 94.1 1,064 Berea 0.4 0.1 6.9 0.0 92.8 892 Maseru 0.4 0.1 5.8 0.1 93.6 1,864 Mafeteng 0.2 0.0 7.7 0.0 92.1 576 Mohale’s Hoek 0.0 0.0 9.3 0.1 90.6 519 Quthing 0.0 0.3 6.2 0.2 93.3 315 Qacha’s Nek 0.3 0.0 18.5 0.4 81.0 204 Mokhotlong 0.0 0.0 12.7 0.0 87.3 349 Thaba-Tseka 0.2 0.0 11.6 0.4 88.2 452 Education No education 0.0 1.3 25.8 0.0 72.9 68 Primary incomplete 0.0 0.0 18.2 0.2 81.7 1,178 Primary complete 0.1 0.0 10.4 0.2 89.4 1,375 Secondary 0.4 0.0 3.4 0.0 96.2 3,418 More than secondary 0.6 0.4 0.3 0.0 99.0 581 Wealth quintile Lowest 0.0 0.0 14.9 0.3 84.9 960 Second 0.2 0.0 10.3 0.2 89.3 1,033 Middle 0.1 0.1 8.2 0.0 91.6 1,244 Fourth 0.3 0.0 5.7 0.0 94.0 1,605 Highest 0.4 0.1 3.0 0.0 96.6 1,778 Total 0.3 0.0 7.5 0.1 92.2 6,621 Characteristics of Respondents • 53 Table 3.9.2 Use of tobacco: Men Percentage of men age 15-49 who smoke cigarettes or a pipe or use other tobacco products and the percent distribution of cigarette smokers by number of cigarettes smoked in preceding 24 hours, according to background characteristics, Lesotho 2014 Uses tobacco Does not use tobacco Number of men Percent distribution of men who smoke cigarettes by number of cigarettes smoked in the past 24 hours Total Number of cigarette smokers Background characteristic Cigarettes Pipe Snuff Other tobacco 0 1-2 3-5 6-9 10+ Age 15-19 18.6 3.3 0.0 2.8 81.4 691 7.7 33.3 45.0 10.0 4.0 100.0 129 20-24 44.8 4.7 0.0 8.4 54.9 561 4.6 21.3 44.4 14.7 14.9 100.0 251 25-29 53.1 7.5 0.4 8.6 46.3 410 8.4 26.7 34.8 15.6 14.5 100.0 217 30-34 50.3 9.6 0.4 7.8 48.5 334 7.5 11.3 34.9 20.4 25.8 100.0 168 35-39 51.3 11.2 0.6 10.8 47.8 276 5.7 14.4 38.0 20.7 21.2 100.0 141 40-44 48.4 6.1 2.3 9.0 49.8 221 11.5 17.4 40.5 12.3 18.3 100.0 107 45-49 47.9 3.7 2.7 13.1 49.5 168 13.7 14.6 43.2 13.5 15.0 100.0 81 Residence Urban 37.9 5.4 0.3 5.6 61.7 920 5.9 18.7 36.2 17.6 21.6 100.0 348 Rural 42.9 6.5 0.7 8.5 56.3 1,741 8.5 21.3 41.5 14.8 13.9 100.0 746 Ecological zone Lowlands 40.6 5.7 0.4 6.1 58.8 1,711 4.8 19.1 39.7 16.5 19.9 100.0 696 Foothills 44.3 5.6 0.0 14.6 55.7 252 16.8 24.4 32.6 17.5 8.7 100.0 112 Mountains 41.3 7.9 0.8 5.6 57.6 523 7.7 24.3 43.1 13.3 11.5 100.0 216 Senqu River Valley 40.8 5.7 1.5 16.2 57.3 174 21.1 16.3 41.5 11.8 9.3 100.0 71 District Butha-Buthe 45.8 6.2 0.3 11.1 53.4 143 18.1 26.8 34.5 9.6 11.0 100.0 65 Leribe 42.6 7.0 0.7 9.7 57.0 390 7.2 24.0 37.2 15.0 16.6 100.0 166 Berea 43.1 8.3 0.0 10.5 56.3 379 4.3 24.6 40.0 16.2 14.8 100.0 164 Maseru 40.4 3.6 0.2 2.9 59.6 809 4.5 14.1 41.3 20.5 19.6 100.0 327 Mafeteng 40.8 8.1 1.0 4.2 57.4 242 1.0 24.8 42.4 9.3 22.5 100.0 98 Mohale’s Hoek 38.4 5.7 1.2 19.9 60.1 202 23.2 14.1 35.6 6.5 20.7 100.0 78 Quthing 36.6 7.1 0.0 8.4 63.4 105 5.0 23.3 46.1 13.4 12.3 100.0 38 Qacha’s Nek 38.5 13.2 2.1 6.8 57.6 74 4.0 24.3 39.1 19.4 13.2 100.0 29 Mokhotlong 39.7 1.6 0.5 2.7 59.7 144 9.2 25.0 30.5 21.3 14.1 100.0 57 Thaba-Tseka 41.5 8.7 1.3 8.2 56.6 172 15.3 20.4 49.0 13.4 2.0 100.0 71 Education No education 63.3 14.9 1.1 11.8 34.3 213 9.4 18.3 44.1 14.3 13.8 100.0 135 Primary incomplete 49.6 8.2 0.8 8.4 49.4 875 10.3 20.5 36.6 15.4 17.2 100.0 434 Primary complete 41.6 5.1 0.5 9.2 57.9 316 7.4 19.2 39.0 19.6 14.7 100.0 131 Secondary 33.0 3.4 0.3 5.9 66.8 1,043 4.7 20.6 43.5 14.4 16.7 100.0 344 More than secondary 23.3 3.4 0.0 4.9 76.1 214 (0.9) (28.4) (32.4) (19.8) (18.6) 100.0 50 Wealth quintile Lowest 44.0 8.0 1.4 9.7 53.7 376 15.6 20.2 42.2 14.6 7.4 100.0 166 Second 46.8 7.2 0.2 8.5 52.5 479 6.0 22.6 39.8 14.2 17.3 100.0 224 Middle 45.9 6.4 0.7 8.9 53.7 536 7.6 20.2 40.5 18.8 12.8 100.0 246 Fourth 40.8 5.4 0.6 6.6 58.7 616 4.9 18.7 39.1 13.9 23.5 100.0 251 Highest 31.7 4.7 0.1 5.2 68.0 654 6.5 21.0 37.9 16.6 18.1 100.0 207 Total 15-49 41.1 6.1 0.5 7.5 58.2 2,660 7.7 20.5 39.8 15.7 16.4 100.0 1,094 50-59 43.4 6.4 2.6 6.9 53.7 271 9.1 19.8 39.1 11.6 20.5 100.0 117 Total 15-59 41.3 6.1 0.7 7.4 57.7 2,931 7.8 20.4 39.7 15.3 16.8 100.0 1,212 Note: Figures in parentheses are based on 25-49 unweighted cases. 54 • Characteristics of Respondents Table 3.10.1 Time away from home: Women In the past 12 months, the percentage of women age 15-49 who have been away from home for 1 or more nights, the percentage who have been away for more than 1 month at a time, and the percentage who have not been away at all; in the past 5 years, the percentage of women who have been away for 3 or more months at a time, and among women who have been away for 3 or more months at a time in the past 5 years, the mean number of times they have been away for 3 or more months, Lesotho 2014 In the past 12 months, percentage of women who have been away for: In the past 5 years, percentage of women who have been away for 3 or more months Number of women Among women who have been away for 3 or more months in the past 5 years, the mean number of times they have been away for 3 or more months Number of women Background characteristic One or more nights More than 1 month Not away Number of women Age 15-19 42.5 16.0 57.5 1,440 16.3 1,440 3.2 235 20-24 49.4 21.5 50.6 1,325 29.5 1,325 3.4 391 25-29 53.8 16.2 46.2 1,094 28.0 1,094 2.7 306 30-34 55.7 13.3 44.3 957 18.9 957 2.6 181 35-39 53.7 9.8 46.3 744 15.5 744 2.5 115 40-44 56.9 9.5 43.1 562 14.5 562 2.7 82 45-49 52.0 10.8 48.0 499 15.4 499 2.3 77 Residence Urban 55.0 12.7 45.0 2,419 19.4 2,419 3.1 469 Rural 48.5 16.5 51.5 4,202 21.8 4,202 2.8 918 Ecological zone Lowlands 56.0 14.6 44.0 4,184 20.5 4,184 2.7 856 Foothills 52.2 19.5 47.8 688 23.6 688 3.0 162 Mountains 35.2 14.1 64.8 1,288 20.2 1,288 3.6 260 Senqu River Valley 46.2 16.4 53.8 461 23.6 461 3.0 109 District Butha-Buthe 39.7 12.3 60.3 385 16.2 385 3.2 62 Leribe 61.9 18.4 38.1 1,064 22.2 1,064 3.0 237 Berea 59.9 15.1 40.1 892 22.1 892 2.4 197 Maseru 54.4 13.8 45.6 1,864 20.0 1,864 2.9 372 Mafeteng 49.3 15.4 50.7 576 21.0 576 1.9 121 Mohale’s Hoek 45.8 16.3 54.2 519 26.6 519 3.4 138 Quthing 39.4 14.4 60.6 315 22.2 315 2.5 70 Qacha’s Nek 52.8 20.3 47.2 204 25.4 204 2.4 52 Mokhotlong 35.7 14.6 64.3 349 20.3 349 5.0 71 Thaba-Tseka 29.0 11.6 71.0 452 14.9 452 3.8 68 Education No education 27.9 7.0 72.1 68 14.0 68 * 10 Primary incomplete 39.9 11.2 60.1 1,178 19.2 1,178 2.6 227 Primary complete 48.8 15.0 51.2 1,375 20.5 1,375 2.4 282 Secondary 52.5 15.7 47.5 3,418 21.2 3,418 3.1 725 More than secondary 71.0 20.9 29.0 581 24.7 581 3.7 144 Wealth quintile Lowest 34.7 12.4 65.3 960 21.1 960 2.7 203 Second 45.7 17.9 54.3 1,033 21.7 1,033 3.0 224 Middle 48.1 15.6 51.9 1,244 22.6 1,244 2.5 281 Fourth 56.8 16.9 43.2 1,605 22.6 1,605 3.2 363 Highest 59.2 13.0 40.8 1,778 17.7 1,778 3.1 316 Total 15-49 50.9 15.1 49.1 6,621 20.9 6,621 2.9 1,387 Note: An asterisk indicates that a figure is based on fewer than 25 cases and has been suppressed. Characteristics of Respondents • 55 Table 3.10.2 Time away from home: Men In the past 12 months, the percentage of men age 15-49 who have been away from home for 1 or more nights, the percentage who have been away for more than 1 month at a time, and the percentage who have not been away at all; in the past 5 years, the percentage of men who have been away for 3 or more months at a time, and among men who have been away for 3 or more months at a time in the past 5 years, the mean number of times they have been away for 3 or more months, Lesotho 2014 In the past 12 months, percentage of men who have been away for: In the past 5 years, percentage of men who have been away for 3 or more months Number of men Among men who have been away for 3 or more months in the past 5 years, the mean number of times they have been away for 3 or more months Number of men Background characteristic One or more nights More than 1 month Not away Number of men Age 15-19 47.4 14.5 52.6 691 18.7 691 1.9 130 20-24 54.0 22.6 46.0 561 35.4 561 2.3 198 25-29 58.1 24.3 41.9 410 40.2 410 2.1 165 30-34 60.6 20.0 39.4 334 33.5 334 1.9 112 35-39 50.6 12.7 49.4 276 25.1 276 2.6 69 40-44 46.9 15.7 53.1 221 22.2 221 2.2 49 45-49 48.6 11.3 51.4 168 22.6 168 (2.3) 38 Residence Urban 55.2 14.6 44.8 920 25.0 920 2.0 230 Rural 51.0 20.0 49.0 1,741 30.5 1,741 2.2 532 Ecological zone Lowlands 55.2 16.5 44.8 1,711 27.5 1,711 2.0 470 Foothills 50.9 19.1 49.1 252 31.8 252 1.6 80 Mountains 45.8 23.4 54.2 523 30.6 523 2.8 160 Senqu River Valley 48.2 16.8 51.8 174 29.3 174 2.5 51 District Butha-Buthe 46.2 14.4 53.8 143 25.9 143 2.7 37 Leribe 58.0 20.8 42.0 390 27.6 390 2.6 108 Berea 53.7 14.5 46.3 379 27.3 379 1.4 104 Maseru 56.9 18.4 43.1 809 29.2 809 1.8 236 Mafeteng 48.6 17.3 51.4 242 28.7 242 1.7 69 Mohale’s Hoek 45.1 18.4 54.9 202 30.9 202 2.9 62 Quthing 53.3 17.7 46.7 105 25.6 105 (2.2) 27 Qacha’s Nek 59.8 17.5 40.2 74 35.1 74 2.3 26 Mokhotlong 48.2 24.2 51.8 144 29.2 144 3.6 42 Thaba-Tseka 35.9 18.1 64.1 172 28.8 172 2.9 50 Education No education 45.2 17.1 54.8 213 27.2 213 2.6 58 Primary incomplete 44.1 17.0 55.9 875 29.8 875 2.1 261 Primary complete 51.2 17.4 48.8 316 32.8 316 1.8 103 Secondary 56.6 18.5 43.4 1,043 26.1 1,043 2.3 273 More than secondary 75.8 23.3 24.2 214 31.1 214 2.4 66 Wealth quintile Lowest 45.3 19.2 54.7 376 29.4 376 2.5 111 Second 43.2 17.9 56.8 479 30.9 479 2.2 148 Middle 54.1 20.9 45.9 536 30.7 536 1.9 165 Fourth 56.2 17.8 43.8 616 26.1 616 2.2 161 Highest 58.5 15.7 41.5 654 27.1 654 2.1 177 Total 15-49 52.5 18.1 47.5 2,660 28.6 2,660 2.2 761 50-59 43.3 11.4 56.7 271 17.1 271 1.9 46 Total 15-59 51.6 17.5 48.4 2,931 27.6 2,931 2.2 808 Note: Figures in parentheses are based on 25-49 unweighted cases. Marriage and Sexual Activity • 57 MARRIAGE AND SEXUAL ACTIVITY 4 Key Findings  Age at first marriage: Marriage is almost universal in Lesotho, but women marry more than 5 years earlier than men, on average. The median age at first marriage is 20.3 years for women age 25-49 and 25.9 years for men age 30-49.  Polygyny: Two percent of married women reported that their husband has more than one (multiple) wives.  Sexual initiation: The median age at first sexual intercourse is 1.8 years earlier than the median age at first marriage for women and 6.4 years earlier for men, indicating that both women and men engage in sex before marriage.  Postponing marriage but not sex: Women and men in Lesotho are waiting longer to get married, but not to initiate sex. Since 2004, the median age at first sexual intercourse has changed little among women (18.7 years in 2004 versus 18.5 years in 2014), while for men, it has dropped from 19.0 years to 18.1. During the same period, the median age at first marriage for women has increased from 19.1 years to 20.3 years and for men from 25.0 years to 25.9 years.  Widowhood: More than 20% of women in their 40s are widowed arriage and sexual activity help determine the extent to which women are exposed to the risk of pregnancy. Thus, they are important determinants of fertility levels. However, the timing and circumstances of marriage and sexual activity also have profound consequences for women’s and men’s lives. This chapter presents information on marital status, polygyny, age at first marriage, and age at first sexual intercourse for both women and men. 4.1 MARITAL STATUS Currently married Women and men who report being married or living together with a partner as though married at the time of the survey Sample: Women and men age 15-49 M 58 • Marriage and Sexual Activity Marriage is nearly universal in Lesotho. By age 45-49, only 6% of women and men have never been married (Table 4.1). Fifty-five percent of women and 37% of men age 15-49 are currently married or living together with a partner as though married (Figure 4.1). Women are more likely than men to be widowed (7% versus 2%) while the proportion of women and men who are divorced or separated is identical (5%). More than one in five women age 40-49 are widowed. Figure 4.1 Marital status Percent distribution of women and men age 15-49 by current marital status Trends: Since 2004, the proportion of women married or living together has increased slightly, from 52% to 55%, while the proportion of widowed women has declined from 9% to 7%. The proportion of men married or living together has not changed substantially, increasing from 38% in 2004 to 39% in 2009 and falling to 37% in 2014. Over this same time period, the proportion of men who were widowed has remained constant at 2%. 4.2 POLYGYNY Polygyny Women who report that their husband or partner has other wives are considered to be in a polygynous marriage. Sample: Currently married women age 15-49 Two percent of women reported that their husband or partner has other wives (Table 4.2.1). While most married women (93%) reported that their husband has no other wives, 5% said they did not know. Men were about as likely as women to report multiple wives (Table 4.2.2). Trends: The percentage of men who reported that they had multiple wives decreased from 5% in 2004 to 3% in 2014. Patterns by background characteristics  Older women are slightly more likely than younger women to have co-wives. About 4% of women age 40- 44 and age 45-49 report their husbands have multiple wives. (Table 4.2.1).  Women are most likely to report co-wives in Mohale’s Hoek (4%) and least likely to do so in Butha-Buthe (0.2%). In contrast, men living in Butha-Buthe, Leribe, Maseru, and Qacha’s Nek were most likely to report having multiple wives (4% each) while those living in Quthing and Thaba-Tseka were least likely (0% each). Never married 33% Married or living together 55% Divorced or separated 5% Widowed 7% Women Never married 56% Married or living together 37% Divorced or separated 5% Widowed 2% Men Marriage and Sexual Activity • 59  In general, less educated women are more likely to have co-wives. Five percent of women with primary incomplete education report that their husband has multiple wives compared with 1% of women with more than secondary education. 4.3 AGE AT FIRST MARRIAGE Median age at first marriage Age by which half of respondents have been married. Sample: Women age 25-49 and men age 30-59 Women tend to marry considerably earlier than men in Lesotho. The median age at first marriage is 20.3 years among women age 25-49 and 25.9 years among men age 30-59 (Table 4.3). While one in four women (25%) marry before their eighteenth birthday, only 4% of men marry that young. Trends: The median age at first marriage for women age 25-49 has increased slowly but steadily over time, from 19.1 years in 2004 to 20.3 years in 2014. Over the same time period, the proportion of women who were married before age 18 declined from 35% to 25%. For men age 30-59, the median age at first marriage increased from 25.0 in 2004 to 25.9 in 2014. Patterns by background characteristics  Urban women marry later than rural women. For women age 25-49, the median age at first marriage is 2.5 years older among urban than among rural women (22.1 years versus 19.6 years) (Table 4.4).  The median age at first marriage for women ranges from 19.3 years in Mokhotlong to 21.0 years in Maseru.  Educated women marry much later. There is almost a 7-year difference in the median age at first marriage between women with the least and most education (18.1 years versus 24.9 years).  Women in wealthy households marry later. The median age at first marriage is over 3 years older in the highest wealth quintile than in the lowest quintile (22.4 years versus 19.0 years). 4.4 AGE AT FIRST SEXUAL INTERCOURSE Median age at first sexual intercourse Age by which half of respondents have had sexual intercourse. Sample: Women and men age 20-49 The median age at first intercourse for women age 20-49 in Lesotho is 18.5 years (Table 4.5). Six percent of women age 20-49 have first sex before age 15, and 42% before age 18. By age 20, 72% of women have had sexual intercourse. On average, men in Lesotho have their first sexual intercourse at younger ages than women. The median age at first intercourse for men age 20-49 is 18.1 years. Twelve percent of men age 20-49 first have sex before age 15 and 49% do so before age 18. By age 20, 70% of men have experienced sexual intercourse. Age at first marriage is widely considered a proxy indicator for the age at which women begin to be exposed to the risks inherent in sexual activity. A comparison of the median age at first intercourse with the median age at first marriage can be used as a measure of whether respondents engage in sex before marriage. The median age 60 • Marriage and Sexual Activity at first intercourse for women age 25-49 in Lesotho is almost 2 years younger than the median age at first marriage of women age 25-49 (18.5 years versus 20.3 years), indicating that many women engage in sex before marriage (Figure 4.2). Thus, women in Lesotho may be exposed to the risk of pregnancy and begin childbearing at an even earlier age than indicated by the median age at first marriage. The median age at first intercourse for men age 25-49 is 18.6 years, which is nearly identical to the median age at first intercourse for women age 25-49 (18.5 years). By contrast, the median age at first marriage for men age 30- 49 is 25.9 years. Thus, on average, men in Lesotho are initiating sexual intercourse many years prior to marriage. Trends: Since 2004, the median age at first sexual intercourse has changed little among women age 20-49 (18.7 years versus 18.5 years) while for men age 20-49, it has dropped from 19.0 years to 18.1 years. The proportion of women age 20-49 engaging in sex before age 18 has increased slightly, from 39% to 42%; the proportion of men age 20-49 engaging in sex before age 18 has shot up, from 34% to 49%. Patterns by background characteristics  Rural and urban women age 20-49 start having sex around the same age. The median age at first sex is 0.4 years younger among rural than among urban women (18.3 years versus 18.7 years) (Table 4.6).  The median age at first sexual intercourse for women age 20-49 ranges from 17.5 years in Quthing to 18.7 years in Butha-Buthe and Berea.  More educated women wait longer before having sex. Among women age 25-49, there is a nearly 3-year difference in the median age at first sex between women with the most and least education (20.3 years versus 17.5 years).  Age at first sexual intercourse increases steadily with household wealth. The median age at first sex in the lowest quintile is 1.2 years younger than in the highest wealth quintile. 4.5 RECENT SEXUAL ACTIVITY The survey also collected data on recent sexual activity. Forty-one percent of women and 48% of men age 15-49 reported having sexual intercourse during the four weeks before the survey. More than one in ten women and men (14% and 13%, respectively) have never had sexual intercourse. For more information on recent sexual activity, see Tables 4.7.1 and 4.7.2. Figure 4.2 Median age at first sexual intercourse and first marriage among women and men 18.5 20.318.6 25.9* Median age at first sex Median age at first marriage Median age in years Women age 25-49 Men age 25-49 *Men age 30-59 Marriage and Sexual Activity • 61 LIST OF TABLES For more information on marriage and sexual activity, see the following tables:  Table 4.1 Current marital status  Table 4.2.1 Number of women’s co-wives  Table 4.2.2 Number of men’s wives  Table 4.3 Age at first marriage  Table 4.4 Median age at first marriage by background characteristics  Table 4.5 Age at first sexual intercourse  Table 4.6 Median age at first sexual intercourse by background characteristics  Table 4.7.1 Recent sexual activity: Women  Table 4.7.2 Recent sexual activity: Men 62 • Marriage and Sexual Activity Table 4.1 Current marital status Percent distribution of women and men age 15-49 by current marital status, according to age, Lesotho 2014 Marital status Total Percentage of respondents currently in union Number of respondents Age Never married Married Living together Divorced Separated Widowed WOMEN 15-19 81.6 17.7 0.0 0.0 0.5 0.1 100.0 17.7 1,440 20-24 41.1 51.8 1.1 1.3 3.7 1.1 100.0 52.9 1,325 25-29 21.3 68.3 0.9 1.3 4.8 3.4 100.0 69.2 1,094 30-34 13.0 67.4 2.5 2.3 6.6 8.3 100.0 69.9 957 35-39 7.0 72.3 0.9 2.3 5.8 11.8 100.0 73.2 744 40-44 5.9 66.3 0.7 2.7 3.5 20.9 100.0 67.0 562 45-49 5.6 61.0 1.0 2.2 5.4 24.8 100.0 62.0 499 Total 33.1 53.6 1.0 1.5 3.9 7.0 100.0 54.6 6,621 MEN 15-19 99.0 1.0 0.0 0.0 0.0 0.0 100.0 1.0 691 20-24 83.3 15.3 0.1 0.2 0.8 0.2 100.0 15.5 561 25-29 42.7 49.3 1.3 1.6 4.6 0.4 100.0 50.6 410 30-34 27.7 59.8 1.8 0.9 7.9 1.9 100.0 61.5 334 35-39 20.3 61.4 2.0 4.4 9.3 2.6 100.0 63.4 276 40-44 7.5 75.5 2.4 1.6 6.2 6.8 100.0 77.9 221 45-49 5.8 76.1 1.0 2.3 7.1 7.6 100.0 77.2 168 Total 15-49 56.4 36.0 0.9 1.2 3.8 1.7 100.0 37.0 2,660 50-59 3.5 67.1 2.3 1.5 6.8 18.8 100.0 69.4 271 Total 15-59 51.5 38.9 1.0 1.2 4.1 3.3 100.0 40.0 2,931 Marriage and Sexual Activity • 63 Table 4.2.1 Number of women’s co-wives Percent distribution of currently married women age 15-49 by number of co-wives, according to background characteristics, Lesotho 2014 Number of co-wives Total Number of women Background characteristic 0 1 2+ Don’t know Age 15-19 94.3 1.0 0.0 4.7 100.0 255 20-24 94.7 1.2 0.1 4.0 100.0 701 25-29 94.0 1.3 0.4 4.3 100.0 757 30-34 93.0 2.8 0.3 3.9 100.0 669 35-39 93.1 0.9 0.7 5.3 100.0 544 40-44 89.0 3.4 0.8 6.8 100.0 377 45-49 93.1 3.5 0.2 3.2 100.0 310 Residence Urban 94.4 1.6 0.1 3.9 100.0 1,150 Rural 92.7 2.0 0.5 4.8 100.0 2,463 Ecological zone Lowlands 93.7 2.1 0.3 3.9 100.0 2,134 Foothills 91.2 2.8 0.2 5.7 100.0 427 Mountains 92.8 0.8 0.6 5.7 100.0 797 Senqu River Valley 93.5 2.3 0.3 3.9 100.0 254 District Butha-Buthe 96.0 0.2 0.0 3.8 100.0 211 Leribe 91.3 2.5 0.1 6.1 100.0 577 Berea 95.4 0.9 0.4 3.3 100.0 461 Maseru 93.6 2.5 0.5 3.5 100.0 968 Mafeteng 92.5 2.3 0.0 5.3 100.0 312 Mohale’s Hoek 91.6 3.5 0.5 4.4 100.0 297 Quthing 92.4 0.4 0.0 7.3 100.0 158 Qacha’s Nek 90.3 0.4 0.0 9.3 100.0 114 Mokhotlong 90.8 0.8 0.3 8.1 100.0 205 Thaba-Tseka 95.9 1.7 1.4 1.0 100.0 308 Education No education 90.2 1.2 2.1 6.5 100.0 47 Primary incomplete 91.2 4.1 0.7 4.0 100.0 695 Primary complete 93.3 1.1 0.4 5.2 100.0 909 Secondary 93.8 1.7 0.2 4.3 100.0 1,665 More than secondary 94.8 0.5 0.2 4.5 100.0 297 Wealth quintile Lowest 94.3 1.3 0.5 4.0 100.0 592 Second 92.9 2.2 0.4 4.5 100.0 602 Middle 92.5 2.9 0.5 4.1 100.0 676 Fourth 93.8 1.7 0.3 4.2 100.0 844 Highest 92.7 1.5 0.3 5.5 100.0 898 Total 93.2 1.9 0.4 4.5 100.0 3,612 64 • Marriage and Sexual Activity Table 4.2.2 Number of men’s wives Percent distribution of currently married men age 15-49 by number of wives, according to background characteristics, Lesotho 2014 Number of wives Total Number of men Background characteristic 1 2+ Age 15-19 * * 100.0 7 20-24 100.0 0.0 100.0 87 25-29 98.4 1.6 100.0 207 30-34 99.4 0.6 100.0 206 35-39 96.1 3.9 100.0 175 40-44 93.6 6.4 100.0 172 45-49 97.6 2.4 100.0 130 Residence Urban 96.9 3.1 100.0 349 Rural 97.7 2.3 100.0 634 Ecological zone Lowlands 97.3 2.7 100.0 593 Foothills 95.3 4.7 100.0 100 Mountains 98.3 1.7 100.0 229 Senqu River Valley 98.9 1.1 100.0 61 District Butha-Buthe 96.0 4.0 100.0 57 Leribe 96.2 3.8 100.0 130 Berea 97.9 2.1 100.0 142 Maseru 96.3 3.7 100.0 291 Mafeteng 99.5 0.5 100.0 87 Mohale’s Hoek 98.1 1.9 100.0 68 Quthing 100.0 0.0 100.0 28 Qacha’s Nek 96.3 3.7 100.0 26 Mokhotlong 97.5 2.5 100.0 64 Thaba-Tseka 100.0 0.0 100.0 91 Education No education 98.1 1.9 100.0 114 Primary incomplete 97.6 2.4 100.0 337 Primary complete 97.5 2.5 100.0 146 Secondary 96.1 3.9 100.0 292 More than secondary 100.0 0.0 100.0 94 Wealth quintile Lowest 98.2 1.8 100.0 164 Second 96.4 3.6 100.0 171 Middle 97.3 2.7 100.0 196 Fourth 98.0 2.0 100.0 206 Highest 97.2 2.8 100.0 246 Total 15-49 97.4 2.6 100.0 983 50-59 98.2 1.8 100.0 188 Total 15-59 97.5 2.5 100.0 1,171 Note: An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. Marriage and Sexual Activity • 65 Table 4.3 Age at first marriage Percentage of women and men age 15-49 who were first married by specific exact ages and median age at first marriage, according to current age, Lesotho 2014 Percentage first married by exact age: Percentage never married Number of respondents Median age at first marriage Current age 15 18 20 22 25 WOMEN 15-19 1.3 na na na na 81.6 1,440 a 20-24 1.0 17.3 38.8 na na 41.1 1,325 a 25-29 2.6 19.8 40.3 56.6 71.8 21.3 1,094 21.0 30-34 4.5 21.6 43.5 56.3 71.1 13.0 957 20.9 35-39 1.9 24.1 49.3 63.2 76.2 7.0 744 20.1 40-44 4.6 33.3 53.0 71.4 81.5 5.9 562 19.7 45-49 4.3 35.6 61.0 76.5 86.4 5.6 499 19.2 20-49 2.8 23.1 45.2 na na 19.6 5,181 a 25-49 3.4 25.1 47.4 62.5 75.8 12.2 3,856 20.3 MEN 15-19 0.0 na na na na 99.0 691 a 20-24 0.0 1.2 5.7 na na 83.3 561 a 25-29 0.0 1.6 7.8 17.8 39.3 42.7 410 a 30-34 0.0 3.4 9.6 15.9 35.3 27.7 334 27.7 35-39 0.0 1.6 7.4 20.7 37.4 20.3 276 27.8 40-44 0.0 5.6 12.0 21.8 46.7 7.5 221 25.6 45-49 0.0 3.9 11.9 30.4 53.4 5.8 168 24.6 20-49 0.0 2.4 8.3 na na 41.5 1,969 a 25-49 0.0 2.9 9.3 20.1 40.8 24.8 1,408 a 20-59 0.0 2.6 8.5 na na 36.9 2,240 a 25-59 0.0 3.0 9.5 21.4 43.2 21.4 1,679 a 30-59 0.0 3.5 10.0 22.5 44.5 14.5 1,270 25.9 Note: The age at first marriage is defined as the age at which the respondent began living with her/his first spouse/partner. na = Not applicable due to censoring a = Omitted because less than 50% of the women or men began living with their spouse or partner for the first time before reaching the beginning of the age group. 66 • Marriage and Sexual Activity Table 4.4 Median age at first marriage by background characteristics Median age at first marriage among women age 20-49 and age 25-49, and median age at first marriage among men age 30-59, according to background characteristics, Lesotho 2014 Women age Men age Background characteristic 20-49 25-49 30-59 Residence Urban a 22.1 27.4 Rural 19.8 19.6 25.3 Ecological zone Lowlands a 21.0 26.7 Foothills 19.3 19.1 25.5 Mountains 19.4 19.3 24.9 Senqu River Valley a 20.1 24.3 District Butha-Buthe 20.0 19.9 25.8 Leribe a 20.4 24.9 Berea a 20.7 26.1 Maseru a 21.0 26.6 Mafeteng a 20.4 28.5 Mohale’s Hoek 19.9 19.7 25.7 Quthing a 20.3 25.4 Qacha’s Nek 19.9 19.9 25.6 Mokhotlong 19.5 19.3 25.5 Thaba-Tseka 19.4 19.4 24.6 Education No education 18.4 18.1 24.8 Primary incomplete 18.4 18.4 25.3 Primary complete 19.4 19.4 25.1 Secondary a 21.0 26.7 More than secondary a 24.9 28.9 Wealth quintile Lowest 19.1 19.0 25.3 Second 19.6 19.6 25.2 Middle 20.0 19.6 26.3 Fourth a 20.5 26.1 Highest a 22.4 26.5 Total a 20.3 25.9 Note: The age at first marriage is defined as the age at which the respondent began living with her/his first spouse/partner. a = Omitted because less than 50% of the respondents began living with their spouse/partners for the first time before reaching the beginning of the age group. Marriage and Sexual Activity • 67 Table 4.5 Age at first sexual intercourse Percentage of women and men age 15-49 who had first sexual intercourse by specific exact ages, percentage who never had sexual intercourse, and median age at first sexual intercourse, according to current age, Lesotho 2014 Percentage who had first sexual intercourse by exact age: Percentage who never had intercourse Number Median age at first intercourse Current age 15 18 20 22 25 WOMEN 15-19 6.0 na na na na 54.1 1,440 a 20-24 4.6 41.9 77.0 na na 6.8 1,325 18.4 25-29 6.4 41.2 71.6 88.0 95.2 1.6 1,094 18.5 30-34 7.3 42.4 66.1 83.4 91.8 0.6 957 18.5 35-39 6.1 42.5 69.4 85.8 95.2 0.4 744 18.5 40-44 4.5 41.8 69.2 85.1 92.2 0.0 562 18.5 45-49 8.1 45.6 72.4 86.7 94.4 0.0 499 18.3 20-49 6.0 42.3 71.5 na na 2.2 5,181 18.5 25-49 6.5 42.4 69.6 85.9 93.8 0.7 3,856 18.5 15-24 5.3 na na na na 31.4 2,765 a MEN 15-19 24.6 na na na na 40.4 691 a 20-24 20.9 63.6 85.7 na na 8.2 561 17.1 25-29 11.6 53.1 75.8 88.3 92.7 2.4 410 17.7 30-34 10.4 44.3 62.7 80.6 88.4 1.4 334 18.5 35-39 9.3 42.2 60.3 79.7 89.9 0.6 276 18.7 40-44 6.7 29.2 48.9 73.0 84.8 0.4 221 20.1 45-49 2.3 33.6 55.4 74.7 86.6 1.6 168 19.4 20-49 12.4 48.7 69.5 na na 3.3 1,969 18.1 25-49 9.0 42.8 63.0 80.8 89.2 1.4 1,408 18.6 15-24 23.0 na na na na 26.0 1,252 a 20-59 11.1 45.4 65.8 na na 3.1 2,240 18.4 25-59 7.8 39.3 59.1 77.2 87.3 1.3 1,679 18.9 30-59 6.6 34.8 53.7 73.7 85.6 1.0 1,270 19.5 na = Not applicable due to censoring a = Omitted because less than 50% of the respondents had sexual intercourse for the first time before reaching the beginning of the age group. 68 • Marriage and Sexual Activity Table 4.6 Median age at first sexual intercourse by background characteristics Median age at first sexual intercourse among women age 20-49 and age 25-49, and median age at first sexual intercourse among men age 20-59, age 25-59, and age 25-59, according to background characteristics, Lesotho 2014 Women age Men age Background characteristic 20-49 25-49 20-59 25-59 30-59 Residence Urban 18.7 18.8 18.0 18.5 19.0 Rural 18.3 18.3 18.6 19.2 19.8 Ecological zone Lowlands 18.6 18.6 18.2 18.8 19.4 Foothills 18.2 18.1 18.4 18.9 19.2 Mountains 18.3 18.3 18.9 19.4 20.0 Senqu River Valley 18.0 18.2 17.9 18.9 19.6 District Butha-Buthe 18.7 18.7 20.2 20.6 20.9 Leribe 18.5 18.5 18.3 18.9 19.0 Berea 18.7 18.7 18.6 19.0 19.6 Maseru 18.5 18.5 17.7 18.2 18.8 Mafeteng 18.5 18.6 18.5 19.0 19.7 Mohale’s Hoek 18.2 18.1 18.5 19.3 20.3 Quthing 17.5 17.8 17.8 18.4 19.2 Qacha’s Nek 18.4 18.6 17.8 18.2 18.6 Mokhotlong 18.5 18.6 18.7 20.1 20.2 Thaba-Tseka 18.4 18.4 19.7 20.0 20.3 Education No education 17.7 17.5 20.1 20.1 20.3 Primary incomplete 17.1 17.2 18.7 19.4 19.8 Primary complete 18.1 18.3 18.5 18.8 19.5 Secondary 18.8 18.9 17.8 18.4 18.8 More than secondary a 20.3 17.7 18.1 18.4 Wealth quintile Lowest 17.8 17.8 19.2 19.7 20.1 Second 18.0 18.1 18.6 19.3 20.0 Middle 18.3 18.3 18.4 18.9 19.4 Fourth 18.6 18.6 18.3 18.9 19.5 Highest 19.0 19.0 17.8 18.3 19.0 Total 18.5 18.5 18.4 18.9 19.5 a = Omitted because less than 50% of the respondents had intercourse for the first time before reaching the beginning of the age group. Marriage and Sexual Activity • 69 Table 4.7.1 Recent sexual activity: Women Percent distribution of women age 15-49 by timing of last sexual intercourse, according to background characteristics, Lesotho 2014 Timing of last sexual intercourse Never had sexual intercourse Total Number of women Background characteristic Within the past 4 weeks Within 1 year1 One or more years Missing Age 15-19 12.9 24.6 8.1 0.2 54.1 100.0 1,440 20-24 37.0 44.5 11.1 0.6 6.8 100.0 1,325 25-29 50.8 38.4 8.8 0.4 1.6 100.0 1,094 30-34 51.6 36.0 10.7 1.0 0.6 100.0 957 35-39 59.6 30.9 7.2 1.8 0.4 100.0 744 40-44 48.5 33.3 16.6 1.6 0.0 100.0 562 45-49 49.1 32.0 17.8 1.1 0.0 100.0 499 Marital status Never married 11.6 32.1 15.1 0.4 40.9 100.0 2,190 Married or living together 62.2 33.5 3.6 0.7 0.0 100.0 3,612 Divorced/separated/widowed 22.6 45.7 29.2 2.4 0.0 100.0 819 Marital duration2 0-4 years 56.3 38.7 4.2 0.8 0.0 100.0 1,086 5-9 years 62.9 33.1 3.6 0.4 0.0 100.0 778 10-14 years 63.4 33.3 2.3 1.1 0.0 100.0 514 15-19 years 64.1 31.9 3.2 0.8 0.0 100.0 454 20-24 years 63.8 31.3 3.3 1.5 0.0 100.0 321 25+ years 69.1 26.0 5.0 0.0 0.0 100.0 346 Married more than once 76.5 22.6 0.9 0.0 0.0 100.0 114 Residence Urban 43.2 32.0 10.1 1.0 13.8 100.0 2,419 Rural 39.1 36.0 10.8 0.7 13.3 100.0 4,202 Ecological zone Lowlands 41.6 34.2 10.0 0.8 13.5 100.0 4,184 Foothills 37.8 38.6 10.7 1.2 11.7 100.0 688 Mountains 40.4 31.9 11.4 0.5 15.7 100.0 1,288 Senqu River Valley 35.7 39.1 13.0 1.6 10.6 100.0 461 District Butha-Buthe 35.9 36.2 13.2 1.4 13.3 100.0 385 Leribe 39.3 37.5 10.5 0.3 12.3 100.0 1,064 Berea 42.0 33.3 10.7 0.7 13.2 100.0 892 Maseru 45.1 31.8 8.9 1.0 13.2 100.0 1,864 Mafeteng 35.8 37.1 10.6 0.7 15.7 100.0 576 Mohale’s Hoek 35.1 39.5 12.4 1.5 11.4 100.0 519 Quthing 34.3 36.8 14.1 1.0 13.8 100.0 315 Qacha’s Nek 35.8 37.1 14.0 0.0 13.0 100.0 204 Mokhotlong 38.4 33.0 9.5 0.1 19.0 100.0 349 Thaba-Tseka 46.5 29.1 9.4 1.1 13.9 100.0 452 Education No education 45.7 32.7 17.1 3.4 1.1 100.0 68 Primary incomplete 42.0 33.1 10.6 0.6 13.7 100.0 1,178 Primary complete 43.5 36.8 11.6 1.2 6.9 100.0 1,375 Secondary 36.9 34.4 10.2 0.7 17.9 100.0 3,418 More than secondary 51.8 33.3 9.3 1.0 4.6 100.0 581 Wealth quintile Lowest 38.0 34.9 12.0 1.2 13.9 100.0 960 Second 40.1 35.4 10.6 0.8 13.0 100.0 1,033 Middle 36.9 37.4 11.7 0.3 13.6 100.0 1,244 Fourth 40.8 36.2 9.5 0.3 13.2 100.0 1,605 Highest 44.7 30.3 9.9 1.3 13.8 100.0 1,778 Total 40.6 34.5 10.6 0.8 13.5 100.0 6,621 1 Excludes women who had sexual intercourse within the last 4 weeks 2 Excludes women who are not currently married 70 • Marriage and Sexual Activity Table 4.7.2 Recent sexual activity: Men Percent distribution of men age 15-49 by timing of last sexual intercourse, according to background characteristics, Lesotho 2014 Timing of last sexual intercourse Never had sexual intercourse Total Number of men Background characteristic Within the past 4 weeks Within 1 year1 One or more years Missing Age 15-19 16.7 31.2 11.1 0.6 40.4 100.0 691 20-24 40.8 36.5 12.2 2.3 8.2 100.0 561 25-29 63.1 29.6 3.7 1.2 2.4 100.0 410 30-34 66.4 24.3 4.8 3.2 1.4 100.0 334 35-39 67.3 19.1 11.5 1.5 0.6 100.0 276 40-44 65.8 24.4 8.9 0.6 0.4 100.0 221 45-49 67.1 17.5 12.2 1.6 1.6 100.0 168 Marital status Never married 28.0 34.9 12.4 1.8 23.0 100.0 1,501 Married or living together 78.5 17.7 2.6 1.2 0.0 100.0 983 Divorced/separated/widowed 43.1 34.7 21.0 1.2 0.0 100.0 176 Marital duration2 0-4 years 79.5 16.9 2.0 1.6 0.0 100.0 286 5-9 years 80.9 15.3 2.7 1.2 0.0 100.0 197 10-14 years 77.4 21.1 1.1 0.4 0.0 100.0 130 15-19 years 82.1 15.8 1.3 0.9 0.0 100.0 112 20-24 years 74.5 20.5 4.1 0.9 0.0 100.0 86 25+ years (64.8) (18.1) (12.9) (4.2) (0.0) 100.0 43 Married more than once 77.7 19.6 1.6 1.1 0.0 100.0 129 Residence Urban 52.8 25.7 8.1 1.9 11.5 100.0 920 Rural 44.9 30.0 9.9 1.4 13.7 100.0 1,741 Ecological zone Lowlands 48.0 27.8 9.6 1.9 12.8 100.0 1,711 Foothills 45.9 28.1 10.7 0.5 14.7 100.0 252 Mountains 47.9 29.9 8.3 0.9 12.9 100.0 523 Senqu River Valley 46.2 32.1 7.8 1.3 12.7 100.0 174 District Butha-Buthe 43.6 27.0 8.8 1.4 19.2 100.0 143 Leribe 46.4 30.2 11.8 0.6 11.0 100.0 390 Berea 47.9 27.1 10.2 0.4 14.4 100.0 379 Maseru 50.5 28.2 8.0 2.9 10.4 100.0 809 Mafeteng 44.3 29.0 10.4 1.0 15.3 100.0 242 Mohale’s Hoek 44.2 29.6 8.3 0.8 17.1 100.0 202 Quthing 47.3 26.3 10.8 3.0 12.7 100.0 105 Qacha’s Nek 48.9 33.5 9.3 0.2 8.2 100.0 74 Mokhotlong 48.1 24.1 11.4 1.7 14.7 100.0 144 Thaba-Tseka 48.1 31.7 5.5 0.8 13.9 100.0 172 Education No education 52.5 30.1 10.9 0.7 5.9 100.0 213 Primary incomplete 45.6 30.0 9.7 1.9 12.8 100.0 875 Primary complete 54.1 24.7 11.8 0.8 8.6 100.0 316 Secondary 43.1 28.9 8.9 1.4 17.7 100.0 1,043 More than secondary 64.1 24.7 4.6 2.7 3.9 100.0 214 Wealth quintile Lowest 46.3 29.5 8.9 1.1 14.2 100.0 376 Second 43.0 28.3 10.9 1.6 16.2 100.0 479 Middle 43.8 31.3 9.7 1.9 13.3 100.0 536 Fourth 48.7 29.0 9.6 1.3 11.3 100.0 616 Highest 54.0 25.4 7.8 1.6 11.2 100.0 654 Total 15-49 47.7 28.5 9.3 1.5 13.0 100.0 2,660 50-59 56.8 27.3 11.8 3.2 0.9 100.0 271 Total 15-59 48.5 28.4 9.5 1.7 11.9 100.0 2,931 Note: Figures in parentheses are based on 25-49 unweighted cases. 1 Excludes men who had sexual intercourse within the last 4 weeks 2 Excludes men who are not currently married Fertility • 71 FERTILITY 5 Key Findings  Total fertility rate: The current total fertility rate in Lesotho is 3.3 children, which is identical to the rate in 2009 and slightly lower than the rate in 2004 (3.5 children).  Patterns of fertility: Fertility levels are markedly lower among urban women, highly educated women, and women in wealthy households compared with other women.  Birth intervals: Birth intervals continue to increase in Lesotho. The median birth interval has grown from 42.4 months in 2004 to 45.8 months in 2014.  Age at first birth: The median age at first birth rose from 20.5 years in 2004 to 20.9 years in 2009, where it remains today. he number of children that a woman bears depends on many factors, including the age she begins childbearing, how long she waits between births, and her fecundity. Postponing first births and extending the interval between births have played a role in reducing fertility levels in many countries. These factors also have positive health consequences. In contrast, short birth intervals (of less than 24 months) can lead to harmful outcomes for both newborns and their mothers, such as preterm birth, low birth weight, and death. Childbearing at a very young age is associated with an increased risk of complications during pregnancy and childbirth and higher rates of neonatal mortality. This chapter describes the current level of fertility in Lesotho and some of its proximate determinants. It presents information on the total fertility rate, birth intervals, insusceptibility to pregnancy (due to postpartum amenorrhoea, postpartum abstinence, or menopause), age at first birth, and teenage childbearing. 5.1 CURRENT FERTILITY Total fertility rate The average number of children a woman would have by the end of her childbearing years if she bore children at the current age-specific fertility rates. Age-specific fertility rates are calculated for the 3 years before the survey, based on detailed birth histories provided by women. Sample: Women age 15-49 T 72 • Fertility The total fertility rate (TFR) in Lesotho is 3.3 children per woman (Table 5.1). Childbearing peaks at age 20-24 (181 births per 1,000 women), and drops steadily thereafter. Rural women have 1.6 more children, on average, than urban women (TFR of 3.9 versus 2.3 children). Trends: The TFR declined by 0.2 children between the 2004 and 2009 LDHS surveys, from 3.5 to 3.3 children per woman (Figure 5.1). Since 2009, the TFR has remained stable at 3.3 children per woman. Since 2004, the TFR for rural women has declined from 4.1 to 3.9 children, while the TFR for urban woman has increased from 1.9 to 2.3 children. Patterns by background characteristics  The total fertility rate ranges from a low of 2.6 children in Maseru to a high of 4.4 children in Mokhotlong (Figure 5.2).  The number of children a woman bears generally decreases as her education level increases. Women with some primary education or completed primary education have, on average, 1.6 more children than women with more than secondary education (Table 5.2).  Women in the lowest wealth quintile have more than twice as many children, on average, as women in the highest quintile (5.0 versus 2.1 children) (Figure 5.3). More information on trends in age-specific fertility rates for this survey is found in Table 5.3.1, and more information on trends in age-specific and total fertility rates across LDHS surveys is found in Table 5.3.2. 5.2 CHILDREN EVER BORN AND LIVING The survey also collected data on the number of children ever born to women age 15-49 and those still living. Of the 4.1 average children ever born to women age 45-49, 3.6 survived to the time of the survey. For complete information on children ever born and living, by mother’s age, see Table 5.4. Figure 5.1 Trends in total fertility rate (TFR) by residence Figure 5.2 Total fertility rate by district TFR for the 3 years before the survey Figure 5.3 Total fertility rate by wealth quintile 3.33.33.5 2.32.11.9 3.94.04.1 201420092004 TFR for the 3 years before each survey Rural Total Urban 5.0 3.9 3.8 2.7 2.1 3.3 Lowest Second Middle Fourth Highest Total TFR for the 3 years before the survey Poorest Richest Fertility • 73 5.3 BIRTH INTERVALS Median birth interval Number of months since the preceding birth by which half of children are born Sample: Non-first births in the 5 years before the survey The median birth interval in Lesotho is 45.8 months. Eleven percent of all children in Lesotho are born within 24 months of a previous birth (Table 5.5 and Figure 5.4). Short birth intervals place newborns and their mothers at increased health risk. Trends: Birth intervals have increased modestly over the last decade in Lesotho, with the median interval growing by about 3 months between 2004 and 2014 (from 42.4 to 45.8 months). The proportion of children born too soon—after an interval of less than 24 months—has fluctuated between 11% and 12% over the last decade. Patterns by background characteristics  Births to older women have longer birth intervals than births to younger women. The median birth interval is nearly 2 years longer among women age 40-49 than women age 20-29 (59.6 months versus 37.4 months).  The median birth interval in urban areas is 5 months longer than in rural areas (49.0 months versus 44.2 months).  The median birth interval ranges from 38.6 months in Mokhotlong to 49.0 months in Leribe.  Birth intervals are longer by about 11 months for births to women with the more than secondary education compared with births to women with incomplete primary education (52.6 months versus 41.3 months).  Births to women in wealthier households have longer birth intervals. The median birth interval in the highest wealth quintile is 17 months longer than in the lowest quintile (56.2 months versus 38.8 months). 5.4 INSUSCEPTIBILITY TO PREGNANCY Median duration of postpartum amenorrhoea Number of months after childbirth by which time half of women have begun menstruating Sample: Women who gave birth in the 3 years before the survey Median duration of postpartum insusceptibility Number of months after childbirth by which time half of women are no longer protected against pregnancy either by postpartum amenorrhoea or abstinence from sex Sample: Women who gave birth in the 3 years before the survey Figure 5.4 Birth interval distribution 7-23 months 11% 24-35 months 24% 36-47 months 19% 48-59 months 14% 60+ months 32% Percent distribution of non-first births in the 5 years before the survey by number of months since preceding birth 74 • Fertility Almost all women are insusceptible to pregnancy during the first 2 months after a birth, and continued postpartum amenorrhoea and abstinence from sexual intercourse may protect them from pregnancy for longer periods. In Lesotho, for births in the 3 years preceding the survey, the median duration of postpartum amenorrhoea is 6.7 months, and women abstain from sexual intercourse for a median of 7.2 months after giving birth. Women are insusceptible to pregnancy after childbirth (either because they are amenorrhoeic or because they are still abstaining from sex after birth) for a median of 11.2 months (Table 5.6). Trends: From 2004 to 2014, the median duration of postpartum amenorrhoea has slowly declined, from 8.3 months in 2004 to 7.4 months in 2009 and 6.7 months in 2014. The duration of postpartum abstinence fell from 11.2 months in 2004 to 7.2 months in 2009, where it remained in 2014. Postpartum insusceptibility to pregnancy decreased from 15.1 months in 2004 to 11.5 months in 2009; since then it has fallen slightly to 11.2 months. Patterns by background characteristics  Older women have a longer duration of postpartum amenorrhoea: 7.6 months among women age 30-49 versus 5.9 months among women age 15-29. Conversely, younger women have a longer duration of postpartum abstinence than older women (7.6 versus 6.1 months) (Table 5.7).  Rural women remain amenorrhoeic longer than urban women (7.9 versus 4.5 months). Similarly, rural women are sexually abstinent for a longer duration postpartum than urban women (7.9 versus 5.4 months).  The duration of postpartum amenorrhoea decreases as wealth increases, falling from 9.0 months in the lowest quintile to 5.1 months in the fourth quintile. The duration of postpartum abstinence also generally decreases with increasing wealth, falling from 9.0 months in the lowest quintile to 4.7 months in the highest quintile. Menopause Women are considered to have reached menopause if they are neither pregnant nor postpartum amenorrhoeic and have not had a menstrual period in the 6 months before the survey, or if they report being menopausal. Sample: Women age 30-49 Once women reach menopause, they are no longer able to become pregnant. Overall, 12% of women age 30-49 are menopausal. This proportion increases with age, rising from 5% among women age 30-34 to 54% among women age 48-49 (Table 5.8). 5.5 AGE AT FIRST BIRTH Median age at first birth Age by which half of women have had their first child. Sample: Women age 25-49 The median age at first birth in Lesotho is 20.9 years among women age 25-49 (Table 5.9). The median age at first birth in Lesotho has increased by about 5 months since 2004, when it was 20.5 years. Patterns by background characteristics  Women in urban areas begin childbearing more than a year later, on average, than rural women (21.8 versus 20.6 years) (Table 5.10). Fertility • 75  Highly educated women have their first child later than other women. Women with more than secondary education begin childbearing almost 5 years later than women with no education (24.8 versus 20.1 years) (Figure 5.5).  Women in the lowest wealth quintile have their first birth 2 years earlier, on average, than women in the highest quintile (20.3 versus 22.4 years). 5.6 TEENAGE CHILDBEARING Teenage childbearing Percentage of women age 15-19 who have given birth or are pregnant with their first child Sample: Women age 15-19 In Lesotho, 19% of women age 15-19 have begun childbearing: 15% have given birth, and an additional 4% are pregnant with their first child (Table 5.11). Trends: Teenage childbearing has held steady over the last decade. The proportion of teenagers who have a child or who are pregnant was 20% in 2004 and 2009 compared with 19% in 2014. Patterns by background characteristics  Teenagers in rural areas are more likely to begin childbearing than their urban peers: 23% of rural teenagers have had a live birth or are pregnant, compared with 12% of urban teenagers.  Some districts have much higher rates of teenage childbearing than others. The percentage of teenagers who have had a child or are pregnant ranges from a low of 14% in Maseru to a high of 25% in Butha-Buthe (Figure 5.6).  Teenage childbearing is less common among young women in the wealthiest households. Teenagers in the lowest wealth quintile are about five times as likely to have started childbearing by age 19 as those in the highest quintile (28% versus 6%). Figure 5.5 Age at first birth by education Figure 5.6 Teenage childbearing by district Percentage of women age 15-19 who have begun childbearing 20.1 19.5 20.5 21.5 24.8 20.9 No education Primary incomplete Primary complete Secondary More than secondary Total Median age at first birth among women age 25-49 76 • Fertility LIST OF TABLES For more information on fertility levels and some of the determinants of fertility, see the following tables:  Table 5.1 Current fertility  Table 5.2 Fertility by background characteristics  Table 5.3.1 Trends in age-specific fertility rates  Table 5.3.2 Trends in age-specific and total fertility rates  Table 5.4 Children ever born and living  Table 5.5 Birth intervals  Table 5.6 Postpartum amenorrhoea, abstinence, and insusceptibility  Table 5.7 Median duration of amenorrhoea, postpartum abstinence, and postpartum insusceptibility  Table 5.8 Menopause  Table 5.9 Age at first birth  Table 5.10 Median age at first birth  Table 5.11 Teenage pregnancy and motherhood Fertility • 77 Table 5.1 Current fertility Age-specific and total fertility rates, the general fertility rate, and the crude birth rate for the 3 years preceding the survey, by residence, Lesotho 2014 Residence Total Age group Urban Rural 15-19 58 112 94 20-24 127 211 181 25-29 113 159 140 30-34 90 129 112 35-39 39 92 72 40-44 21 64 49 45-49 3 4 4 TFR(15-49) 2.3 3.9 3.3 GFR 85 137 118 CBR 23.3 24.7 24.3 Notes: Age-specific fertility rates are per 1,000 women. Rates for age group 45-49 may be slightly biased due to truncation. Rates are for the period 1-36 months prior to interview. TFR = Total fertility rate expressed per woman GFR = General fertility rate expressed per 1,000 women age 15-44 CBR = Crude birth rate, expressed per 1,000 population Table 5.2 Fertility by background characteristics Total fertility rate for the 3 years preceding the survey, percentage of women age 15-49 currently pregnant, and mean number of children ever born to women age 40-49, by background characteristics, Lesotho 2014 Background characteristic Total fertility rate Percentage of women age 15-49 currently pregnant Mean number of children ever born to women age 40-49 Residence Urban 2.3 3.6 2.9 Rural 3.9 4.7 4.2 Ecological zone Lowlands 2.8 4.1 3.4 Foothills 4.2 5.2 4.6 Mountains 4.3 4.5 4.6 Senqu River Valley 3.7 3.6 4.2 District Butha-Buthe 3.7 4.7 3.9 Leribe 3.5 3.6 3.7 Berea 3.1 3.5 3.7 Maseru 2.6 4.4 3.5 Mafeteng 2.8 6.1 3.5 Mohale’s Hoek 3.8 3.8 3.7 Quthing 3.9 3.3 4.1 Qacha’s Nek 2.9 5.0 3.8 Mokhotlong 4.4 5.2 4.9 Thaba-Tseka 4.0 4.3 4.6 Education No education (1.9) 6.9 (3.8) Primary incomplete 4.0 5.0 4.9 Primary complete 4.0 4.5 3.9 Secondary 2.9 4.0 3.3 More than secondary 2.4 3.5 2.2 Wealth quintile Lowest 5.0 5.1 4.9 Second 3.9 4.8 4.4 Middle 3.8 5.2 4.0 Fourth 2.7 4.3 3.7 Highest 2.1 2.9 2.8 Total 3.3 4.3 3.8 Notes: Total fertility rates are for the period 1-36 months prior to interview. In column 1, figures in parentheses correspond to 125-249 unweighted person- years of exposure. In column 3, figures in parentheses are based on 25-49 unweighted cases. 78 • Fertility Table 5.3.1 Trends in age-specific fertility rates Age-specific fertility rates for 5-year periods preceding the survey, by mother’s age at the time of the birth, Lesotho 2014 Number of years preceding survey Mother’s age at birth 0-4 5-9 10-14 15-19 15-19 88 86 78 83 20-24 170 181 178 200 25-29 135 154 164 184 30-34 111 124 146 [140] 35-39 73 90 [106] 40-44 39 [59] 45-49 [3] Note: Age-specific fertility rates are per 1,000 women. Estimates in brackets are truncated. Rates exclude the month of interview. Table 5.3.2 Trends in age-specific and total fertility rates Age-specific and total fertility rates (TFR) for the 3-year period preceding several surveys Mother’s age at birth 2004 LDHS 2009 LDHS 2014 LDHS 15-19 92 96 94 20-24 177 171 181 25-29 160 155 140 30-34 122 117 112 35-39 102 74 72 40-44 46 40 49 45-49 9 7 4 TFR 15-49 3.5 3.3 3.3 Note: Age-specific fertility rates are per 1,000 women. Table 5.4 Children ever born and living Percent distribution of all women and currently married women age 15-49 by number of children ever born, mean number of children ever born and mean number of living children, according to age group, Lesotho 2014 Number of children ever born Total Number of women Mean number of children ever born Mean number of living children Age 0 1 2 3 4 5 6 7 8 9 10+ ALL WOMEN 15-19 85.0 14.1 0.9 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 100.0 1,440 0.16 0.15 20-24 38.7 41.3 16.9 2.8 0.2 0.0 0.0 0.0 0.0 0.0 0.0 100.0 1,325 0.85 0.80 25-29 15.6 29.9 32.9 16.3 4.2 1.0 0.0 0.1 0.0 0.0 0.0 100.0 1,094 1.67 1.51 30-34 9.2 20.8 30.3 23.0 9.4 4.8 2.1 0.3 0.1 0.0 0.0 100.0 957 2.27 2.05 35-39 5.4 10.6 28.0 23.6 15.4 10.5 3.6 1.9 0.6 0.3 0.0 100.0 744 2.95 2.66 40-44 4.1 10.0 20.0 21.9 17.6 8.4 9.1 3.8 2.9 1.3 0.9 100.0 562 3.54 3.19 45-49 4.1 6.7 14.4 17.1 19.8 15.0 8.5 6.4 4.1 1.5 2.6 100.0 499 4.09 3.58 Total 31.4 21.8 19.3 12.4 6.8 3.9 2.1 1.1 0.6 0.3 0.3 100.0 6,621 1.75 1.58 CURRENTLY MARRIED WOMEN 15-19 44.6 50.8 4.4 0.2 0.0 0.0 0.0 0.0 0.0 0.0 0.0 100.0 255 0.60 0.55 20-24 13.9 56.2 25.0 4.6 0.3 0.0 0.1 0.0 0.0 0.0 0.0 100.0 701 1.22 1.15 25-29 4.3 30.5 38.7 19.8 5.3 1.3 0.0 0.2 0.0 0.0 0.0 100.0 757 1.96 1.76 30-34 4.0 17.2 32.0 27.2 11.1 5.4 2.7 0.2 0.1 0.0 0.0 100.0 669 2.53 2.29 35-39 3.3 9.1 27.9 24.2 18.3 11.3 3.0 2.0 0.7 0.3 0.0 100.0 544 3.07 2.81 40-44 2.0 7.0 17.8 23.6 19.8 9.2 10.3 5.1 2.9 1.7 0.6 100.0 377 3.81 3.44 45-49 2.8 5.4 13.8 12.5 17.8 17.8 11.6 8.5 4.5 1.5 3.9 100.0 310 4.49 3.93 Total 8.4 26.6 26.4 17.3 9.6 5.4 3.0 1.6 0.8 0.4 0.4 100.0 3,612 2.40 2.17 Fertility • 79 Table 5.5 Birth intervals Percent distribution of non-first births in the 5 years preceding the survey by number of months since preceding birth, and median number of months since preceding birth, according to background characteristics, Lesotho 2014 Months since preceding birth Total Number of non-first births Median number of months since preceding birth Background characteristic 7-17 18-23 24-35 36-47 48-59 60+ Age 15-19 * * * * * * 100.0 11 * 20-29 5.2 11.0 30.1 20.4 15.1 18.2 100.0 890 37.4 30-39 2.1 3.9 17.5 17.1 13.8 45.6 100.0 796 55.3 40-49 1.4 0.7 20.5 15.7 12.0 49.7 100.0 198 59.6 Sex of preceding birth Male 4.0 7.3 24.8 17.9 13.9 32.1 100.0 921 45.4 Female 3.5 6.4 22.9 19.1 14.4 33.7 100.0 974 47.1 Survival of preceding birth Living 2.2 6.1 23.6 19.5 14.8 33.8 100.0 1,698 47.3 Dead 16.6 13.4 25.7 10.1 8.8 25.5 100.0 196 34.0 Birth order 2-3 3.9 7.5 22.6 17.8 14.3 33.9 100.0 1,322 47.0 4-6 3.0 5.7 24.8 19.6 14.3 32.5 100.0 482 46.5 7+ 4.4 4.1 35.7 23.9 11.7 20.1 100.0 90 37.2 Residence Urban 3.2 5.4 20.7 19.4 12.2 39.1 100.0 534 49.0 Rural 3.9 7.4 25.0 18.2 14.9 30.5 100.0 1,360 44.2 Ecological zone Lowlands 4.1 5.8 20.9 17.2 12.9 39.2 100.0 1,002 50.1 Foothills 2.4 6.4 25.0 18.8 15.1 32.3 100.0 241 45.0 Mountains 3.9 8.8 29.5 18.7 16.5 22.6 100.0 496 39.3 Senqu River Valley 2.8 8.2 22.7 26.4 13.4 26.5 100.0 155 42.9 District Butha-Buthe 1.0 6.7 27.2 18.9 17.3 28.8 100.0 113 45.5 Leribe 3.5 4.8 20.3 20.6 14.5 36.2 100.0 305 49.0 Berea 5.3 10.8 21.2 15.3 11.1 36.4 100.0 213 44.5 Maseru 3.5 5.0 23.1 16.8 15.0 36.6 100.0 485 48.8 Mafeteng 3.8 7.2 22.4 18.3 10.7 37.6 100.0 141 46.8 Mohale’s Hoek 2.9 8.2 20.7 19.2 11.9 37.1 100.0 166 45.3 Quthing 6.4 9.3 25.6 17.8 17.6 23.3 100.0 101 40.7 Qacha’s Nek 6.6 5.7 28.2 21.3 12.9 25.3 100.0 55 41.2 Mokhotlong 5.4 8.2 28.3 20.2 14.0 23.9 100.0 135 38.6 Thaba-Tseka 1.9 7.2 30.7 21.1 16.4 22.7 100.0 182 41.4 Education No education (2.3) (6.3) (28.3) (31.8) (8.6) (22.6) 100.0 24 (37.4) Primary incomplete 4.0 8.9 26.6 18.5 14.3 27.8 100.0 510 41.3 Primary complete 2.6 5.7 28.1 20.1 14.0 29.5 100.0 561 43.6 Secondary 4.3 7.3 19.8 16.1 14.6 38.0 100.0 686 50.4 More than secondary 5.6 1.1 13.6 22.6 13.0 44.1 100.0 113 52.6 Wealth quintile Lowest 2.7 6.4 33.3 22.6 15.6 19.4 100.0 448 38.8 Second 3.8 9.0 27.8 20.7 15.1 23.6 100.0 411 40.0 Middle 4.2 7.8 23.0 13.4 12.5 39.0 100.0 360 49.5 Fourth 5.0 6.9 15.2 17.7 10.8 44.4 100.0 343 54.2 Highest 3.2 3.9 15.7 16.9 16.3 44.1 100.0 333 56.2 Total 3.7 6.9 23.8 18.5 14.2 32.9 100.0 1,894 45.8 Notes: 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. 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. 80 • Fertility Table 5.6 Postpartum amenorrhoea, abstinence, and insusceptibility Percentage of births in the 3 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 2014 Percentage of births for which the mother is: Number of births Months since birth Amenorrhoeic Abstaining Insusceptible1 < 2 82.8 94.6 98.3 87 2-3 63.3 81.6 91.2 137 4-5 65.9 66.6 86.1 108 6-7 49.9 58.2 75.8 113 8-9 37.6 37.8 56.4 104 10-11 36.3 32.7 55.2 145 12-13 22.5 27.9 42.2 117 14-15 31.0 20.9 43.8 150 16-17 15.5 18.8 28.7 97 18-19 8.3 12.2 19.7 97 20-21 15.4 12.1 25.4 104 22-23 6.1 13.7 18.5 120 24-25 2.3 5.4 7.1 104 26-27 6.3 11.0 17.3 99 28-29 3.0 7.4 8.2 109 30-31 1.4 9.4 10.7 112 32-33 5.3 7.5 12.8 107 34-35 2.0 4.5 6.6 77 Total 26.1 29.6 40.4 1,987 Median 6.7 7.2 11.2 na Mean 9.4 10.7 14.3 na Note: Estimates are based on status at the time of the survey. na = Not applicable 1 Includes births for which mothers are either still amenorrhoeic or still abstaining (or both) following birth Table 5.7 Median duration of amenorrhoea, postpartum abstinence, and postpartum insusceptibility 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 2014 Background characteristic Postpartum amenorrhoea Postpartum abstinence Postpartum insusceptibility1 Mother’s age 15-29 5.9 7.6 10.9 30-49 7.6 6.1 12.6 Residence Urban 4.5 5.4 8.2 Rural 7.9 7.9 12.5 Ecological zone Lowlands 5.5 6.3 9.6 Foothills (8.2) 9.1 (16.3) Mountains 8.0 7.7 13.8 Senqu River Valley 6.9 (8.9) (15.3) Education No education * * * Primary incomplete 8.6 8.2 15.0 Primary complete 7.6 7.9 11.7 Secondary 5.5 6.8 11.5 More than secondary (4.2) * (6.3) Wealth quintile Lowest 9.0 9.0 17.6 Second 8.0 8.0 12.6 Middle 5.3 7.2 12.1 Fourth 5.1 7.3 9.2 Highest 5.2 4.7 7.3 Total 6.7 7.2 11.2 Notes: Medians are based on the status at the time of the survey (current status). 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 Includes births for which mothers are either still amenorrhoeic or still abstaining (or both) following birth Fertility • 81 Table 5.8 Menopause Percentage of women age 30-49 who are menopausal, by age, Lesotho 2014 Age Percentage menopausal1 Number of women 30-34 5.1 957 35-39 6.0 744 40-41 4.8 222 42-43 12.3 225 44-45 17.1 205 46-47 32.1 214 48-49 53.6 196 Total 12.3 2,762 1 Percentage of all women who are not pregnant and not postpartum amenorrhoeic whose last menstrual period occurred 6 or more months preceding the survey Table 5.9 Age at first birth Percentage of women age 15-49 who gave birth by exact ages, percentage who have never given birth, and median age at first birth, according to current age, Lesotho 2014 Percentage who gave birth by exact age Percentage who have never given birth Number of women Median age at first birth Current age 15 18 20 22 25 15-19 0.3 na na na na 85.0 1,440 a 20-24 0.2 13.9 37.3 na na 38.7 1,325 a 25-29 0.5 12.2 37.1 58.5 77.6 15.6 1,094 21.0 30-34 1.0 14.9 37.5 58.1 75.2 9.2 957 21.1 35-39 0.3 13.4 37.2 60.9 79.6 5.4 744 21.0 40-44 0.9 14.6 39.4 62.3 80.6 4.1 562 20.8 45-49 1.8 15.9 43.3 67.9 84.8 4.1 499 20.6 20-49 0.6 13.9 38.1 na na 16.5 5,181 a 25-49 0.8 13.9 38.3 60.6 78.7 8.9 3,856 20.9 na = Not applicable due to censoring a = Omitted because less than 50 percent of women had a birth before reaching the beginning of the age group 82 • Fertility Table 5.10 Median age at first birth Median age at first birth among women age 25-49 years, according to background characteristics, Lesotho 2014 Background Women age characteristic 25-49 Residence Urban 21.8 Rural 20.6 Ecological zone Lowlands 21.4 Foothills 20.1 Mountains 20.6 Senqu River Valley 20.5 District Butha-Buthe 20.9 Leribe 20.9 Berea 21.3 Maseru 21.2 Mafeteng 21.0 Mohale’s Hoek 20.5 Quthing 20.5 Qacha’s Nek 21.1 Mokhotlong 20.5 Thaba-Tseka 20.7 Education No education 20.1 Primary incomplete 19.5 Primary complete 20.5 Secondary 21.5 More than secondary 24.8 Wealth quintile Lowest 20.3 Second 20.4 Middle 20.5 Fourth 20.8 Highest 22.4 Total 20.9 Fertility • 83 Table 5.11 Teenage pregnancy and motherhood Percentage of women age 15-19 who have had a live birth or who are pregnant with their first child, and percentage who have begun childbearing, by background characteristics, Lesotho 2014 Percentage of women age 15-19 who: Percentage who have begun childbearing Number of women Background characteristic Have had a live birth Are pregnant with first child Age 15 1.4 1.6 3.0 295 16 5.7 2.2 8.0 333 17 11.7 4.2 15.9 246 18 24.2 7.2 31.4 285 19 34.0 5.6 39.6 280 Residence Urban 10.0 1.7 11.7 449 Rural 17.3 5.1 22.5 991 Ecological zone Lowlands 12.2 3.3 15.6 854 Foothills 20.4 8.0 28.3 161 Mountains 18.6 4.1 22.7 321 Senqu River Valley 19.0 4.0 23.0 104 District Butha-Buthe 21.5 3.2 24.7 82 Leribe 16.0 3.5 19.5 244 Berea 17.1 5.6 22.7 201 Maseru 11.6 2.6 14.2 329 Mafeteng 8.9 5.8 14.7 148 Mohale’s Hoek 18.2 4.2 22.4 108 Quthing 18.7 2.7 21.5 84 Qacha’s Nek 9.9 5.8 15.8 54 Mokhotlong 18.4 5.6 24.0 99 Thaba-Tseka 16.5 4.1 20.6 92 Education No education nc nc nc 0 Primary incomplete 11.9 5.2 17.1 226 Primary complete 25.7 7.7 33.4 177 Secondary 14.0 3.2 17.3 1,026 More than secondary * * * 11 Wealth quintile Lowest 23.8 4.5 28.3 226 Second 14.5 6.7 21.3 248 Middle 19.4 5.7 25.1 315 Fourth 14.7 3.1 17.8 349 Highest 4.8 1.1 5.8 301 Total 15.0 4.1 19.1 1,440 Note: As asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. nc = No cases Fertility Preferences • 85 FERTILITY PREFERENCES 6 Key Findings  Desire for another child: Fifteen percent of currently married women age 15-49 want to have another child soon, but a higher percentage, 24%, want to wait at least 2 years.  Limiting childbearing: Women are more likely than men to want no more children, no matter how many children they already have. Overall, 58% of women and 40% of men do not want another child. Almost two-thirds of women with two living children (64%) and 85% of women with three living children do not want any more children.  Ideal family size: Over the last decade, the ideal family size has dropped slightly for both women and men. Women currently want 2.6 children, on average, while men want 3.0 children.  Unwanted births: Of all births in the past 5 years and current pregnancies, 49% were wanted at the time of conception, 30% were mistimed, and 22% were unwanted. nformation on fertility preferences can help family planning programme planners assess the desire for children, the extent of mistimed and unwanted pregnancies, and the demand for contraception to space or limit births. This information may suggest the direction that fertility patterns will take in the future. This chapter presents information on whether and when married women and men want more children, ideal family size, whether the last birth was wanted at that time, and the theoretical fertility rate if all unwanted births were prevented. 6.1 DESIRE FOR ANOTHER CHILD Desire for another child Women and men were asked whether they wanted more children and, if so, how long they would prefer to wait before the next child. Women and men who are sterilised are assumed not to want any more children. Sample: Currently married women and men age 15-49 Fifteen percent of currently married women age 15-49 want to have another child soon. Most other currently married women have a need for family planning, either because they want to wait at least 2 years before having another child (24%) or because they want no more children at all (56%) (Table 6.1). Twenty percent of currently married men age 15-49 want to have another child soon, 34% want to wait at least 2 years before having another child, and 40% want no more children. I 86 • Fertility Preferences Trends: The proportion of currently married women who want no more children (including women who are sterilised) increased from 54% in 2004 to 59% in 2009 before declining slightly to 58% in 2014. Currently- married men have followed a similar trend, although the overall proportion of men who want no more children is much lower than that of women (Figure 6.1). Patterns by background characteristics  The more children a woman already has, the less likely she is to want another child. Three-quarters (76%) of currently married women with no children want to have a child within the next 2 years, compared with one in five (19%) women with one child and one in 10 (10%) women with two children (Table 6.1).  Men are generally more likely than women to want to have another child, no matter how many children they already have. For example, 11% of married men with four children want another child soon, compared with 2% of married women with four children.  The proportion of currently married women (58%) and men (40%) who want no more children does not differ by urban-rural residence (Table 6.2). 6.2 IDEAL FAMILY SIZE Ideal family size Respondents with no children were asked, “If you could choose exactly the number of children to have in your whole life, how many would that be?” Respondents who had children were asked: “If you could go back to the time when you did not have any children and could choose exactly the number of children to have in your whole life, how many would that be?” Sample: Women and men age 15-49 If women could choose their family size, they would choose to have 2.6 children, on average, while men would choose to have 3.0 children (Table 6.3). Ideal family size is slightly higher among women and men who are currently married (Figure 6.2). Trends: From 2004 to 2014, the ideal family size in Lesotho fell from 3.0 to 2.6 children for women and from 3.4 to 3.0 children for men. Figure 6.1 Trends in desire to limit childbearing Figure 6.2 Ideal family size 404138 585954 201420092004 Percentage of currently married women and men age 15-49 who want no more children Men Women 2.6 2.93.0 3.4 All Currently married Mean ideal number of children among women and men age 15-49 Women Men Fertility Preferences • 87 Patterns by background characteristics  The more children respondents already have, the more children they consider ideal. For example, women who have one child consider 2.4 children to be ideal, on average. In contrast, women who have six or more children consider 3.8 children to be ideal (Figure 6.3).  Family size norms vary across districts. Women in Berea and Maseru want smaller families of 2.5 children, while women in Thaba-Tseka want 3.1 children.  Older women want larger families. Ideal family size increases from 2.1 children among women age 15-19 to 3.6 children among women age 45-49 (Table 6.4).  Women in wealthy households want slightly smaller families. The ideal number of children is 2.9 among women in the lowest wealth quintile compared with 2.5 children among women in the highest quintile. 6.3 FERTILITY PLANNING STATUS Planning status of birth Women reported whether their most recent birth was wanted at the time (planned birth), at a later time (mistimed birth), or not at all (unwanted birth). Sample: Current pregnancies and births in the 5 years before the survey to women age 15-49 According to mothers’ reports, only about half of births were wanted at the time of conception (49%), and 30% were mistimed, that is, wanted at a later date. Twenty-two percent of births were not wanted at all (Figure 6.4). Trends: Since 2004, the proportion of births wanted at the time of conception has remained relatively constant at about half of all births (48%-50%). The proportion of births that were mistimed more than doubled between 2004 and 2009 (from 12% to 31%), and has not changed in 2014 (30%). The proportion of unwanted births decreased from 4 in 10 in 2004 (38%) to 1 in 5 in 2009 (21%) and has remained the same in 2014 (22%). Figure 6.3 Ideal family size by number of living children Note: Figures in parentheses are based on 25-49 unweighted cases. Figure 6.4 Fertility planning status 2.2 2.4 2.8 3.2 3.3 3.4 3.8 2.8 2.9 3.2 3.6 4.1 (4.9) (4.8) 0 1 2 3 4 5 6+ Number of living children Mean ideal number of children Women Men Wanted then 49% Mistimed 30% Unwanted 22% Percent distribution of births to women age 15-49 in the five years before the survey (including current pregnancies) by planning status of births 88 • Fertility Preferences Patterns by background characteristics  The more children a woman has, the more likely it is that her last birth was unwanted. Ten percent of first births were unwanted, compared with 29% of third births and 51% of fourth or higher order births (Table 6.5).  The proportion of births that were mistimed decreases with the mother’s age, ranging from 42% of births to women less than age 20 to 9% of births to women age 40-44. 6.4 WANTED FERTILITY RATES Wanted fertility rate The number of children the average woman would have over the course of her lifetime if she bore children at current age-specific fertility rates, excluding unwanted births. A birth is considered wanted if the number of living children at the time of conception is lower than the ideal number of children currently reported by the respondent. Sample: Births to women age 15-49 during the 3 years before the survey The wanted fertility rate reflects the level of fertility that would result if all unwanted births were prevented. The wanted fertility rate in Lesotho is 2.3 children, compared with the actual total fertility rate of 3.3 children (Table 6.6). In other words, women in Lesotho are currently having one child more than they want, on average. Trends: The total wanted fertility rate in Lesotho has declined slightly from 2.5 children in 2004 to 2.3 children in 2014 (Figure 6.5). However, the gap between wanted and actual fertility has remained relatively constant over time. Patterns by background characteristics The total wanted fertility rate is consistently lower than the actual total fertility rate, but the size of the gap varies by women’s background characteristics.  The gap between wanted and actual fertility is twice as large in rural areas (3.9-2.7=1.2) as in urban areas (2.3-1.7=0.6) (Table 6.6).  Women in Mokhotlong have the largest gap between actual and wanted fertility (1.7 children). The gap is smallest in Qacha’s Nek (0.6 children).  Women with more than secondary education have the smallest gap (0.4 children) between wanted and actual fertility compared with women in all other educational categories.  The gap between wanted and actual fertility steadily narrows with wealth, falling from 1.9 children in the lowest wealth quintile to 0.4 in the highest wealth quintile. Figure 6.5 Trends in wanted and actual fertility 2.5 2.4 2.3 1.0 0.9 1.0 2004 2009 2014 3.3 3.3 Total wanted fertility Difference TFR 3.5 Wanted and actual number of children per woman Fertility Preferences • 89 LIST OF TABLES For more information on fertility preferences, see the following tables:  Table 6.1 Fertility preferences by number of living children  Table 6.2 Desire to limit childbearing  Table 6.3 Ideal number of children by number of living children  Table 6.4 Mean ideal number of children  Table 6.5 Fertility planning status  Table 6.6 Wanted fertility rates 90 • Fertility Preferences Table 6.1 Fertility preferences by number of living children Percent distribution of currently married women and currently married men age 15-49 by desire for children, according to number of living children, Lesotho 2014 Number of living children Total 15-49 Total 15-59 Desire for children 0 1 2 3 4 5 6+ WOMEN1 Have another soon2 76.0 18.7 9.7 5.3 1.8 1.3 3.5 14.9 na Have another later3 10.3 49.8 22.6 8.1 3.4 1.1 1.0 24.1 na Have another, undecided when 1.2 1.2 1.1 0.6 0.0 0.0 0.0 0.9 na Undecided 1.0 1.0 1.9 0.7 0.9 0.4 0.8 1.2 na Want no more 4.8 28.4 62.7 82.1 87.9 91.5 86.2 56.0 na Sterilised4 0.0 0.1 1.4 2.5 4.1 4.0 7.7 1.7 na Declared infecund 6.8 0.8 0.6 0.7 1.8 1.8 0.8 1.2 na Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 na Number of women 245 1,102 1,033 585 331 164 152 3,612 na MEN5 Have another soon2 68.8 22.7 17.1 10.4 10.6 (10.2) (2.6) 20.3 18.6 Have another later3 22.4 57.2 33.1 18.8 17.9 (7.0) (5.6) 34.1 29.2 Have another, undecided when 0.9 1.9 2.8 2.7 4.6 (0.0) (0.0) 2.3 2.1 Undecided 2.9 2.8 4.4 2.5 0.5 (0.0) (0.0) 2.8 2.6 Want no more 2.0 14.3 41.7 65.6 65.4 (82.9) (91.8) 39.7 45.9 Sterilised4 0.0 0.5 0.0 0.0 1.1 (0.0) (0.0) 0.2 0.8 Declared infecund 3.0 0.5 0.3 0.0 0.0 (0.0) (0.0) 0.5 0.8 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number of men 76 319 252 181 72 37 45 983 1,171 Notes: Total includes 1 man for whom information on the desire for children is missing. Figures in parentheses are based on 25-49 unweighted cases. na = Not applicable 1 The number of living children includes the 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 5 The number of living children includes one additional child if respondent’s wife is pregnant (or if any wife is pregnant for men with more than one current wife). Fertility Preferences • 91 Table 6.2 Desire to limit childbearing Percentage of currently married women age 15-49 who want no more children, by number of living children, and percentage of currently married men age 15-49 who want no more children, according to background characteristics, Lesotho 2014 Number of living children1 Total women Total men Background characteristic 0 1 2 3 4 5 6+ Residence Urban 5.3 30.8 69.8 92.1 92.5 (97.9) * 57.7 39.5 Rural 4.5 27.3 60.6 81.5 91.9 95.0 92.9 57.8 40.2 Ecological zone Lowlands 6.0 29.6 67.7 88.8 96.1 95.0 (91.6) 58.0 40.3 Foothills (8.0) 36.7 57.7 83.5 (84.5) * (100.0) 61.7 41.4 Mountains 0.8 24.7 55.1 77.3 86.6 93.3 92.6 55.7 39.0 Senqu River Valley * 16.7 62.8 74.1 95.5 * * 55.6 37.8 District Butha-Buthe (8.2) 22.3 64.3 86.4 * * * 56.1 43.9 Leribe (0.0) 27.3 57.6 88.9 (88.4) * * 55.8 41.0 Berea (20.3) 35.5 72.6 85.5 (89.8) * * 64.2 50.0 Maseru (5.0) 33.8 65.2 90.9 94.2 * * 59.5 40.6 Mafeteng (0.0) 31.4 73.9 (83.2) (100.0) * * 56.8 27.4 Mohale’s Hoek * 21.0 65.0 77.1 * * * 54.1 34.8 Quthing * 14.9 58.5 (71.0) (94.7) * * 53.6 33.8 Qacha’s Nek * 31.8 61.6 83.7 (100.0) * * 60.6 35.8 Mokhotlong (0.0) 25.6 50.2 (71.7) (92.4) * (97.6) 56.5 37.6 Thaba-Tseka (0.6) 19.0 57.0 78.2 (84.5) (87.4) (86.3) 53.8 38.7 Education No education * * * * * * * 72.0 45.7 Primary incomplete (9.6) 33.9 59.9 75.4 89.0 93.9 89.8 65.7 39.1 Primary complete (4.3) 23.8 59.5 87.0 88.4 97.5 100.0 61.9 33.9 Secondary 4.4 29.1 67.0 87.3 97.8 (95.6) (89.9) 52.8 39.2 More than secondary * 28.3 69.0 (94.8) * * * 52.3 47.9 Wealth quintile Lowest (3.3) 23.7 58.0 77.8 87.1 95.2 91.5 57.4 39.6 Second (0.0) 24.8 59.1 77.3 90.7 * (98.3) 56.1 35.3 Middle (0.0) 32.0 64.8 89.2 93.6 (92.0) (92.8) 60.1 40.9 Fourth 7.3 30.9 62.6 84.6 94.0 (93.3) (92.0) 57.1 33.4 Highest 8.1 28.6 70.2 91.8 94.2 * * 58.0 48.2 Total 15-49 4.8 28.5 64.1 84.6 92.0 95.5 93.9 57.8 40.0 50-59 na na na na na na na na 81.6 Total 15-59 na na na na na na na na 46.6 Notes: Women who have been sterilised are considered to want no more children. 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 1 The number of living children includes the current pregnancy. 92 • Fertility Preferences Table 6.3 Ideal number of children by number of living children Percent distribution of women and men 15-49 by ideal number of children, and mean ideal number of children for all respondents and for currently married respondents, according to the number of living children, Lesotho 2014 Number of living children Total Ideal number of children 0 1 2 3 4 5 6+ WOMEN1 0 7.5 3.3 3.4 1.1 1.9 3.4 4.6 4.3 1 9.2 12.3 9.8 4.9 3.1 4.7 1.7 8.8 2 53.9 43.7 31.3 30.9 31.6 20.6 19.6 40.6 3 21.1 25.5 26.6 19.9 15.5 24.2 11.2 22.6 4 6.1 12.0 22.6 30.3 33.5 27.3 38.6 17.2 5 1.7 2.1 4.0 6.3 5.6 7.9 6.5 3.4 6+ 0.5 1.1 1.8 6.6 8.8 10.8 16.1 2.9 Non-numeric responses 0.0 0.0 0.4 0.0 0.0 1.2 1.8 0.2 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number of women 2,022 1,644 1,357 767 423 212 197 6,621 Mean ideal number of children for:2 All women 2.2 2.4 2.8 3.2 3.3 3.4 3.8 2.6 Number of women 2,021 1,643 1,351 767 423 209 194 6,608 Currently married women 2.7 2.5 2.8 3.2 3.3 3.5 3.9 2.9 Number of currently married women 245 1,102 1,027 585 331 161 148 3,600 MEN3 0 2.9 1.8 3.4 0.7 2.9 (0.0) (0.0) 2.5 1 5.2 5.0 2.2 3.6 0.4 (5.1) (0.0) 4.4 2 40.9 36.2 28.3 18.4 19.8 (13.9) (15.5) 35.5 3 28.0 31.1 26.9 27.7 11.1 (4.8) (14.0) 27.2 4 13.9 17.0 22.3 23.7 32.4 (32.7) (19.2) 17.0 5 6.4 5.3 11.0 12.5 14.5 (10.9) (18.9) 7.8 6+ 2.2 3.2 5.1 10.5 18.3 (30.2) (28.6) 4.7 Non-numeric responses 0.5 0.4 0.7 2.9 0.6 (2.4) (3.7) 0.7 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number of men 1,563 423 305 197 84 38 51 2,660 Mean ideal number of children for men 15-49:2 All men 2.8 2.9 3.2 3.6 4.1 (4.9) (4.8) 3.0 Number of men 1,556 421 303 191 84 37 49 2,640 Currently married men 3.2 2.9 3.3 3.6 4.0 (4.9) (4.8) 3.4 Number of currently married men 76 318 250 176 72 36 43 971 Mean ideal number of children for men 15-59:2 All men 2.8 2.9 3.3 3.8 4.2 4.9 5.4 3.2 Number of men 1,572 443 351 230 121 80 105 2,901 Currently married men 3.4 2.9 3.3 3.8 4.1 5.0 5.5 3.6 Number of currently married men 79 327 281 209 99 69 89 1,153 Note: Figures in parentheses are based on 25-49 unweighted cases. 1 The number of living children includes current pregnancy for women. 2 Means are calculated excluding respondents who gave non-numeric responses. 3 The number of living children includes one additional child if respondent’s wife is pregnant (or if any wife is pregnant for men with more than one current wife). Fertility Preferences • 93 Table 6.4 Mean ideal number of children Mean ideal number of children for all women and men age 15-49 by background characteristics, Lesotho 2014 Background characteristic Mean Number of women1 Mean Number of men1 Age 15-19 2.1 1,439 2.6 690 20-24 2.3 1,325 2.8 559 25-29 2.6 1,091 3.0 409 30-34 2.7 956 3.1 331 35-39 3.0 740 3.2 272 40-44 3.3 562 3.9 215 45-49 3.6 494 3.8 165 Residence Urban 2.4 2,415 2.7 914 Rural 2.8 4,193 3.2 1,727 Ecological zone Lowlands 2.5 4,176 2.8 1,703 Foothills 2.8 687 3.0 248 Mountains 2.9 1,284 3.5 517 Senqu River Valley 2.7 461 3.3 172 District Butha-Buthe 2.7 385 3.2 142 Leribe 2.7 1,059 3.1 390 Berea 2.5 892 2.8 379 Maseru 2.5 1,863 2.8 806 Mafeteng 2.6 574 2.8 236 Mohale’s Hoek 2.6 519 3.1 200 Quthing 2.6 315 3.3 104 Qacha’s Nek 2.8 204 3.4 74 Mokhotlong 2.8 348 3.4 141 Thaba-Tseka 3.1 449 3.7 168 Education No education 3.2 68 4.0 207 Primary incomplete 2.9 1,173 3.3 868 Primary complete 3.0 1,373 3.1 314 Secondary 2.4 3,413 2.7 1,039 More than secondary 2.5 581 2.8 214 Wealth quintile Lowest 2.9 956 3.7 372 Second 2.7 1,033 3.2 476 Middle 2.6 1,244 3.0 532 Fourth 2.6 1,599 2.7 611 Highest 2.5 1,776 2.7 650 Total 2.6 6,608 3.0 2,640 1 Number of respondents who gave a numeric response 94 • Fertility Preferences Table 6.5 Fertility planning status Percent distribution of births to women age 15-49 in the five years preceding the survey (including current pregnancies), by planning status of the birth, according to birth order and mother’s age at birth, Lesotho 2014 Planning status of birth Total Number of births Birth order and mother’s age at birth Wanted then Wanted later Wanted no more Birth order 1 57.4 32.5 10.1 100.0 1,337 2 52.3 33.9 13.8 100.0 904 3 44.5 26.3 29.1 100.0 538 4+ 26.9 21.8 51.3 100.0 617 Mother’s age at birth <20 44.0 42.2 13.8 100.0 674 20-24 52.3 34.0 13.7 100.0 1,099 25-29 51.8 29.2 18.9 100.0 720 30-34 49.6 18.2 32.2 100.0 536 35-39 35.9 16.4 47.7 100.0 247 40-44 39.6 8.7 51.7 100.0 115 45-49 * * * 100.0 4 Total 48.5 29.9 21.6 100.0 3,395 Note: Total includes 1 woman for whom information on the fertility planning status is missing. An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. Fertility Preferences • 95 Table 6.6 Wanted fertility rates Total wanted fertility rates and total fertility rates for the 3 years preceding the survey, by background characteristics, Lesotho 2014 Background characteristic Total wanted fertility rates Total fertility rate Residence Urban 1.7 2.3 Rural 2.7 3.9 Ecological zone Lowlands 2.1 2.8 Foothills 2.7 4.2 Mountains 2.9 4.3 Senqu River Valley 2.6 3.7 District Butha-Buthe 2.6 3.7 Leribe 2.6 3.5 Berea 2.3 3.1 Maseru 1.9 2.6 Mafeteng 2.1 2.8 Mohale’s Hoek 2.7 3.8 Quthing 2.8 3.9 Qacha’s Nek 2.3 2.9 Mokhotlong 2.7 4.4 Thaba-Tseka 3.0 4.0 Education No education (1.3) (1.9) Primary incomplete 2.5 4.0 Primary complete 3.0 4.0 Secondary 2.2 2.9 More than secondary 2.0 2.4 Wealth quintile Lowest 3.1 5.0 Second 2.7 3.9 Middle 2.8 3.8 Fourth 2.0 2.7 Highest 1.7 2.1 Total 2.3 3.3 Notes: 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 5.2. Figures in parentheses correspond to 125-249 unweighted person-years of exposure. Family Planning • 97 FAMILY PLANNING 7 Key Findings  Modern contraceptive use: Modern contraceptive use by currently married women has steadily increased over the last decade, growing from 35% in 2004 to 46% in 2009 and 60% in 2014. Injectables are the most popular contraceptive, used by 24% of currently married women.  Sources of modern methods: Nearly two-thirds (63%) of modern contraceptive users obtain their contraceptives from public-sector facilities.  Contraceptive discontinuation: One out of every five times (22%) that women began using a contraceptive method in the 5 years before the survey, they discontinued the method in less than 12 months. The leading reasons for method discontinuation are method- related health concerns and side effects (24%), a desire to become pregnant (16%), and method failure (13%).  Percentage of demand for family planning satisfied: Demand for family planning satisfied by use of modern methods among currently married women is 76%.  Unmet need for family planning: Unmet need for family planning among currently married women has declined from 31% in 2004, to 23% in 2009, and to 18% in 2014. ouples can use contraceptive methods to limit or space the number of children they have. This chapter presents information on the use and sources of contraceptive methods, informed choice of methods, and rates and reasons for discontinuing contraceptives. It also examines the potential demand for family planning and how much contact nonusers have with family planning providers. In Lesotho, family planning is part of the Sexual and Reproductive Health Programme of the Ministry of Health (MOH) and is an important part of the National Strategic Development Plan (MDP 2012). C 98 • Family Planning 7.1 CONTRACEPTIVE KNOWLEDGE AND USE Knowledge of contraceptive methods is almost universal in Lesotho, with 99% of women age 15-49 and 98% of men age 15-49 knowing at least one method of contraception. For more information on contraceptive knowledge by method, see Table 7.1. Contraceptive prevalence rate Percentage who use any contraceptive method Sample: Currently married women age 15-49 The contraceptive prevalence rate (CPR) is 60% in Lesotho, and nearly all currently married women age 15-49 who use contraception use a modern method (60%) (Table 7.2). Modern contraceptive use among currently married women is highest (70%) among women age 35-39. Among sexually active, unmarried women age 15-49, 72% use a modern method. Modern methods Include male and female sterilisation, injectables, intrauterine contraceptive devices (IUCDs), contraceptive pills, implants, female and male condoms, the Standard Days Method, and emergency contraception Among currently married women, the most commonly used methods are injectables (24%), male condoms (17%), and pills (14%) (Figure 7.1). By contrast, among sexually active unmarried women, male condoms are by far the most commonly used method (45%) followed by injectables (14%) and pills (8%). Trends: From 2004 to 2014, modern contraceptive use by currently married women has steadily increased, from 35% in 2004 to 60% in 2014 (Figure 7.2). The greatest gains were in the use of injectables, which increased from 15% in 2004 to 24% in 2014, and male condoms, which increased from 5% in 2004 to 17% in 2014 (Table 7.3.1). Use of traditional methods declined from 2% in 2004 to 0.4% in 2014. Figure 7.1 Contraceptive use Figure 7.2 Trends in contraceptive use 60 60 24 17 14 1 1 2 <1 Any method Any modern method Injectables Male condom Pill Implants IUCD Female sterilisation Traditional method Percentage of currently married women age 15-49 currently using a contraceptive method 60 46 35 <112 201420092004 Percentage of currently married women currently using a contraceptive method Traditional methods Any modern method Family Planning • 99 Patterns by background characteristics  Urban married women are more likely to use modern contraceptives than rural married women (65% versus 57%). Rural married women are more likely to use injectables than women in urban areas (25% versus 21%) (Table 7.3.2).  There is a notable difference in contraceptive use across districts. Among married women, modern contraceptive use ranges from a low of 48% in Mokhotlong to a high of 64% in Berea and Quthing (Figure 7.3).  Modern contraceptive use increases substantially with education. Sixty-seven percent of married women with more than secondary education use a modern method compared with 38% of married women with no education (Figure 7.4).  Modern contraceptive use increases with household wealth from 50% among the lowest quintile to 66% among the highest quintile, but the differences by wealth are less than those observed by education (Table 7.3.2). 7.2 SOURCE OF MODERN CONTRACEPTIVE METHODS Source of modern contraceptives Place where the modern method currently being used was obtained the last time it was acquired Sample: Women age 15-49 currently using a modern contraceptive method Nearly two-thirds (63%) of all modern contraceptive users obtain their methods from the public sector, 16% from the private medical sector, and 17% from other sources (Figure 7.5). A small proportion of users obtain their method from a facility outside of Lesotho (2%). However, the importance of each source varies, depending on the method. Figure 7.3 Modern contraceptive use by district Percentage of currently married women age 15-49 currently using a modern contraceptive method Figure 7.4 Modern contraceptive use by education 38 52 58 63 67 No education Primary imcomplete Primary complete Secondary More than secondary Percentage of currently married women age 15-49 currently using a modern contraceptive method 100 • Family Planning  Injectables, implants, and pills: Eight in 10 women obtain injectables (81%) and implants (81%) from the public sector, especially government health centres and hospitals. Six in 10 women obtain pills (62%) from the public sector (Table 7.4).  Male condoms: The predominant sources for male condoms are government health centres (31%), shops (30%), and friends or relatives (12%).  Female sterilisation: The public sector, most often government or Christian Health Association of Lesotho (CHAL) hospitals (49% and 41%, respectively), were the most common sources for female sterilisation. 7.3 INFORMED CHOICE Informed choice Informed choice consists of women being informed at the time they started the current episode of method use about side effects of the method, what to do if they experience side effects, and other methods they could use. Sample: Women age 15-49 who are currently using selected modern contraceptive methods and who started the last episode of use within the 5 years before the survey Less than half of all women using modern contraceptives were informed about side effects or other problems with the method they used (46%) and what to do if they experienced side effects (36%). A higher proportion of women (69%) were informed of other methods they could use (Table 7.5). 7.4 DISCONTINUATION OF CONTRACEPTIVES Contraceptive discontinuation rate Percentage of contraceptive use episodes discontinued within 12 months Sample: Women age 15-49 who started an episode of contraceptive use within the 5 years before the survey One out of every five times (22%) that women began using a contraceptive method in the 5 years before the survey, they discontinued the method in less than 12 months. In fewer than 1 out of 10 episodes (9%), women switched to another method. Discontinuation rates are higher for pills (27%) than for either injectables (21%) or male condoms (20%) (Table 7.6). Overall, the most common reason for discontinuing a method in less than 12 months is method-related health concerns or side effects (24%), followed by desire to become pregnant (17%), method failure (13%), and Figure 7.5 Source of modern contraceptive methods Public sector, 63% Private medical sector, 16% Facility outside Lesotho, 2% Other source, 17% Percent distribution of current users of modern methods by most recent source of method Family Planning • 101 infrequent sex (12%) (Table 7.7). Women are far more likely to cite method-related health concerns and side effects as a reason for discontinuing injectables (47%) than pills (22%) or male condoms (4%). Knowledge of the Fertile Period The survey also collected information on women and men’s knowledge of the fertile period. Only 26% of women and 17% of men know that a woman is most likely to conceive halfway between two periods. For complete information on knowledge of the fertile period, see Table 7.8. 7.5 DEMAND FOR FAMILY PLANNING Unmet need for family planning Proportion of women who (1) are not pregnant and not postpartum amenorrhoeic and are considered fecund and want to postpone their next birth for 2 or more years or stop childbearing altogether but are not using a contraceptive method, or (2) have a mistimed or unwanted current pregnancy, or (3) are postpartum amenorrhoeic and their last birth in the last 2 years was mistimed or unwanted. Sample: Currently married women age 15-49 Demand for family planning: Unmet need for family planning + current contraceptive use (any method) Proportion of demand satisfied: Current contraceptive use (any method) Unmet need + current contraceptive use (any method) Proportion of demand satisfied by modern methods: Current contraceptive use (any modern method) Unmet need + current contraceptive use (any method) Total demand for family planning is high. Seventy- nine percent of currently married women age 15-49 in Lesotho have a demand for family planning; 31% want to space births, and 48% want to limit births. Sixty percent of currently married women are already using a contraceptive method either to space or to limit births, so their need is met. However, 18% of currently married women have an unmet need for family planning: they want to space or limit births but are not currently using contraception (Table 7.9.1, Figure 7.6). If all of these women adopted a method, the contraceptive prevalence rate would increase from 60% to 79%. Figure 7.6 Demand for family planning Unmet need for spacing 9% Unmet need for limiting 10% Met need for spacing 23% Met need for limiting 38% No need for family planning 21% Percent distribution of currently married women age 15-49 by need for family planning 102 • Family Planning Trends: The total demand for family planning among currently married women age 15-49 in Lesotho has increased over time, rising from 68% in 2004, to 70% in 2009, and finally to 79% in 2014 (Figure 7.7). However, contraceptive use had also increased over time. As a result, unmet need for family planning among married women has dropped from 31% in 2004 to 23% in 2009 and to 18% in 2014. Patterns by background characteristics  Unmet need for family planning among currently married women ranges from a low of 16% in Quthing and Maseru to a high of 25% in Mokhotlong (Figure 7.8).  Unmet need for family planning is lowest among currently married women with more than secondary education (13%) and highest among those with no education (32%).  One in four (25%) currently married women in the lowest wealth quintile has an unmet need for family planning compared with one in seven (14%) in the highest wealth quintile. For additional information on need and demand for family planning among all women and among women who are not currently married, see Table 7.9.2. Future Use of Contraception The survey also collected information on nonusers’ intent to use contraception in the future. Sixty-seven percent of currently married women age 15-49 who are not currently using contraception intend to use family planning at some future time. For more information on future use of contraception, see Table 7.10. Exposure to Family Planning Messages in the Media Table 7.11 offers information on exposure to family planning messages in the media among women and men age 15-49. Women reported hearing or seeing a family planning message in the past few months on the radio (23%), on television (14%), in newspapers or magazines (12%), and on billboards, pamphlets, or posters (24%). The proportion of women who were exposed to family planning messages exceeded that for men for each type of media. Figure 7.7 Trends in total demand for family planning Figure 7.8 Unmet need by district Percentage of currently married women age 15-49 by unmet need for family planning 0 10 20 30 40 50 60 70 80 90 100 2004 2009 2014 Percentage of currently married women age 15-49 with unmet need, met need, and total demand for family planning Unmet need Met need, traditional methods Met need, modern methods 68 70 79 Total demand Family Planning • 103 7.6 CONTACT OF NONUSERS WITH FAMILY PLANNING PROVIDERS Contact of nonusers with family planning providers Respondent discussed family planning in the 12 months before the survey with a fieldworker or during a visit to a health facility. Sample: Women age 15-49 who are not currently using any contraceptive methods The vast majority (82%) of women age 15-49 who are not using a contraceptive method said they had not discussed family planning with a fieldworker or health facility staff member in the 12 months before the survey (Table 7.12). Four percent reported discussing family planning with a fieldworker and 16% with a provider at a health facility. Notably, 40% of nonusers had visited a health facility in the past 12 months but did not discuss family planning during that visit. Patterns by background characteristics  Women age 25-44 (21-28%) are more likely to have discussed family planning during a health facility visit than younger women (4-17%) or older women (19%).  Women are most likely to have discussed family planning while visiting a health facility in Mohale’s Hoek (23%) and least likely to have done so in Butha-Buthe (10%).  Women with no education are the most likely of any women to have discussed family planning while visiting a health facility (31%). LIST OF TABLES For detailed information on family planning, see the following tables:  Table 7.1 Knowledge of contraceptive methods  Table 7.2 Current use of contraception by age  Table 7.3.1 Trends in the current use of contraception  Table 7.3.2 Current use of contraception by background characteristics  Table 7.4 Source of modern contraceptive methods  Table 7.5 Informed choice  Table 7.6 Twelve-month contraceptive discontinuation rates  Table 7.7 Reasons for discontinuation  Table 7.8 Knowledge of fertile period  Table 7.9.1 Need and demand for family planning among currently married women  Table 7.9.2 Need and demand for family planning for all women and for women who are not currently married  Table 7.10 Future use of contraception  Table 7.11 Exposure to family planning messages  Table 7.12 Contact of nonusers with family planning providers 104 • Family Planning Table 7.1 Knowledge of contraceptive methods Percentage of all respondents, currently married respondents, and sexually active unmarried respondents age 15-49 who know any contraceptive method, by specific method, Lesotho 2014 Women Men Method All women Currently married women Sexually active unmarried women1 All men Currently married men Sexually active unmarried men1 Any method 98.5 99.5 99.7 97.9 99.1 98.7 Any modern method 98.5 99.5 99.7 97.8 99.0 98.7 Female sterilisation 68.2 73.9 75.4 56.3 71.9 57.2 Male sterilisation 17.1 16.4 23.2 20.0 21.5 25.3 Pill 91.2 96.7 94.1 72.8 89.3 72.8 IUCD 70.9 76.7 77.5 37.5 46.0 38.2 Injectables 92.2 96.9 93.5 75.5 92.3 77.2 Implants 65.7 77.8 70.4 24.7 36.3 23.3 Male condom 97.7 98.7 99.1 97.3 98.2 98.7 Female condom 91.4 94.0 95.9 82.8 87.7 86.6 Emergency contraception 35.1 32.5 51.7 28.9 29.2 36.3 Other modern 0.3 0.2 1.0 0.0 0.0 0.0 Any traditional method 76.7 83.5 86.1 75.9 88.1 84.1 Rhythm 39.9 41.2 49.0 33.8 39.0 39.7 Withdrawal 71.6 79.0 83.6 73.4 86.7 81.6 Other 4.9 5.9 3.5 5.2 7.2 5.6 Mean number of methods known by respondents 15-49 7.5 7.9 8.2 6.1 7.1 6.4 Number of respondents 6,621 3,612 450 2,660 983 502 Mean number of methods known by respondents 15-59 na na na 6.1 7.0 6.4 Number of respondents na na na 2,931 1,171 517 na = Not applicable 1 Had last sexual intercourse within 30 days preceding the survey Family Planning • 105 Table 7.2 Current use of contraception by age Percent distribution of all women, currently married women, and sexually active unmarried women age 15-49 by contraceptive method currently used, according to age, Lesotho 2014 Any method Any modern method Modern method Any tradi- tional method Traditional method Not currently using Total Number of women Age Female sterili- sation Male sterili- sation Pill IUCD Inject- ables Implants Male condom Female condom Rhythm With- drawal ALL WOMEN 15-19 20.1 19.7 0.0 0.0 0.7 0.0 4.8 0.3 13.8 0.1 0.4 0.0 0.3 79.9 100.0 1,440 20-24 52.9 52.5 0.0 0.0 8.8 0.3 19.7 1.5 22.1 0.0 0.5 0.1 0.4 47.1 100.0 1,325 25-29 61.4 61.2 0.2 0.0 14.0 0.2 26.2 1.4 19.3 0.0 0.1 0.0 0.1 38.6 100.0 1,094 30-34 62.6 62.4 0.8 0.0 14.5 1.7 23.3 2.2 19.6 0.3 0.2 0.2 0.0 37.4 100.0 957 35-39 66.5 65.8 2.6 0.3 12.6 2.1 21.2 2.3 24.3 0.3 0.7 0.4 0.3 33.5 100.0 744 40-44 54.2 54.0 3.6 0.0 10.7 2.9 14.8 0.5 20.7 0.8 0.2 0.1 0.1 45.8 100.0 562 45-49 35.2 34.7 4.8 0.0 6.0 1.9 7.0 0.2 14.1 0.8 0.4 0.4 0.0 64.8 100.0 499 Total 48.9 48.5 1.1 0.0 9.1 1.0 16.9 1.2 19.0 0.2 0.4 0.1 0.2 51.1 100.0 6,621 CURRENTLY MARRIED WOMEN 15-19 35.3 35.3 0.0 0.0 3.3 0.0 17.4 1.5 12.8 0.3 0.0 0.0 0.0 64.7 100.0 255 20-24 57.8 57.4 0.0 0.0 13.6 0.2 29.6 1.6 12.4 0.0 0.4 0.0 0.4 42.2 100.0 701 25-29 65.4 65.3 0.4 0.0 17.8 0.2 30.1 1.7 15.2 0.0 0.1 0.0 0.1 34.6 100.0 757 30-34 67.1 66.8 1.1 0.0 18.3 1.4 26.4 1.9 17.5 0.1 0.3 0.3 0.0 32.9 100.0 669 35-39 71.0 70.1 3.2 0.5 14.7 2.8 23.2 1.1 24.5 0.1 1.0 0.6 0.4 29.0 100.0 544 40-44 59.5 59.3 4.3 0.0 13.5 3.5 16.0 0.3 21.0 0.8 0.1 0.1 0.0 40.5 100.0 377 45-49 39.9 39.4 5.3 0.0 7.6 2.4 8.4 0.3 15.2 0.2 0.4 0.4 0.0 60.1 100.0 310 Total 60.2 59.8 1.7 0.1 14.2 1.3 24.0 1.4 16.9 0.2 0.4 0.2 0.2 39.8 100.0 3,612 SEXUALLY ACTIVE UNMARRIED WOMEN1 15-19 72.8 69.3 0.0 0.0 0.0 0.0 2.3 0.0 67.1 0.0 3.4 0.0 3.4 27.2 100.0 63 20-24 70.2 67.2 0.0 0.0 6.9 0.0 8.4 6.5 45.4 0.0 3.0 1.2 1.8 29.8 100.0 119 25-29 82.1 82.1 0.0 0.0 5.8 0.0 31.6 2.2 42.5 0.0 0.0 0.0 0.0 17.9 100.0 74 30-34 80.1 80.1 0.0 0.0 6.8 0.6 21.6 2.0 49.1 0.0 0.0 0.0 0.0 19.9 100.0 72 35-39 81.3 81.3 0.0 0.0 14.7 0.0 13.7 10.7 39.2 2.9 0.0 0.0 0.0 18.7 100.0 50 40-44 (63.7) (63.7) (0.0) (0.0) (13.0) (0.0) (13.1) (0.0) (34.0) (3.6) (0.0) (0.0) (0.0) (36.3) 100.0 46 45-49 (47.9) (47.9) (5.9) (0.0) (18.6) (6.9) (0.0) (0.0) (16.6) (0.0) (0.0) (0.0) (0.0) (52.1) 100.0 26 Total 73.4 72.1 0.3 0.0 7.9 0.5 14.0 3.6 45.0 0.7 1.3 0.3 1.0 26.6 100.0 450 Notes: If more than one method is used, only the most effective method is considered in this tabulation. Figures in parentheses are based on 25-49 unweighted cases. 1 Women who have had sexual intercourse within 30 days preceding the survey Table 7.3.1 Trends in the current use of contraception Percent distribution of currently married women age 15-49 by contraceptive method currently used, Lesotho 2004-2014 Method 2004 LDHS 2009 LDHS 2014 LDHS Any method 37.3 47.0 60.2 Any modern method 35.2 45.6 59.8 Female sterilisation 2.7 2.4 1.7 Male sterilisation 0.0 0.0 0.1 Pill 10.9 12.5 14.2 IUCD 2.1 1.9 1.3 Injectables 14.7 19.3 24.0 Implants 0.0 0.1 1.4 Male condom 4.8 9.4 16.9 Female condom 0.0 0.1 0.2 Other modern method 0.1 0.0 0.0 Any traditional method 2.1 1.4 0.4 Rhythm/periodic abstinence 0.0 0.1 0.2 Withdrawal 0.9 0.7 0.2 Folk method/other 1.2 0.6 0.0 Not currently using 62.7 53.0 39.8 Total 100.0 100.0 100.0 Number of women 3709 4049 3612 106 • Family Planning Table 7.3.2 Current use of contraception by background characteristics Percent distribution of currently married women age 15-49 by contraceptive method currently used, according to background characteristics, Lesotho 2014 Any method Any modern method Modern method Any tradi- tional method Traditional method Not currently using Total Number of women Age Female sterili- sation Male sterili- sation Pill IUCD Inject- ables Implants Male condom Female condom Rhythm With- drawal Number of living children 0 17.0 17.0 0.0 0.0 2.5 0.0 2.7 0.0 11.6 0.2 0.0 0.0 0.0 83.0 100.0 355 1-2 65.1 64.6 0.7 0.1 17.0 0.9 27.1 1.5 17.4 0.1 0.4 0.3 0.2 34.9 100.0 2,043 3-4 70.3 70.2 3.1 0.0 14.9 3.1 27.8 1.7 19.4 0.1 0.1 0.1 0.1 29.7 100.0 902 5+ 47.5 46.6 5.8 0.0 8.0 1.1 17.3 1.2 12.6 0.7 0.9 0.2 0.7 52.5 100.0 312 Residence Urban 65.5 65.2 1.3 0.2 17.2 2.0 21.3 1.4 21.7 0.1 0.3 0.3 0.0 34.5 100.0 1,150 Rural 57.7 57.3 1.8 0.0 12.9 1.0 25.3 1.3 14.7 0.2 0.4 0.1 0.2 42.3 100.0 2,463 Ecological zone Lowlands 63.8 63.4 2.0 0.1 15.3 1.8 22.7 1.4 20.0 0.1 0.4 0.3 0.1 36.2 100.0 2,134 Foothills 55.4 55.4 1.3 0.0 13.9 1.2 26.5 0.5 11.6 0.4 0.0 0.0 0.0 44.6 100.0 427 Mountains 53.1 52.6 1.3 0.0 10.8 0.3 25.6 1.6 12.8 0.3 0.4 0.1 0.3 46.9 100.0 797 Senqu River Valley 59.4 59.2 0.8 0.0 16.9 0.7 26.2 2.0 12.6 0.0 0.2 0.0 0.2 40.6 100.0 254 District Butha-Buthe 56.5 56.2 0.9 0.0 14.3 3.1 27.2 0.9 9.4 0.4 0.3 0.3 0.0 43.5 100.0 211 Leribe 64.2 63.4 3.7 0.0 12.4 2.4 24.2 2.0 18.6 0.2 0.8 0.5 0.3 35.8 100.0 577 Berea 63.9 63.9 2.4 0.0 12.4 1.8 23.7 1.5 21.8 0.2 0.0 0.0 0.0 36.1 100.0 461 Maseru 62.5 62.3 1.3 0.3 14.0 1.3 22.7 1.2 21.3 0.2 0.3 0.3 0.0 37.5 100.0 968 Mafeteng 58.6 58.2 0.6 0.0 23.4 0.3 20.5 0.0 13.3 0.0 0.4 0.0 0.4 41.4 100.0 312 Mohale’s Hoek 53.4 53.4 0.4 0.0 16.7 0.7 23.9 1.3 10.0 0.4 0.0 0.0 0.0 46.6 100.0 297 Quthing 64.0 63.6 0.7 0.0 19.7 1.1 26.1 0.2 15.9 0.0 0.4 0.0 0.4 36.0 100.0 158 Qacha’s Nek 56.5 56.1 3.1 0.0 8.3 1.2 26.8 2.3 14.4 0.0 0.4 0.0 0.4 43.5 100.0 114 Mokhotlong 49.2 48.4 1.4 0.0 11.6 0.0 22.6 2.4 10.4 0.0 0.9 0.3 0.6 50.8 100.0 205 Thaba-Tseka 56.7 56.4 1.0 0.0 10.6 0.3 29.0 1.8 13.6 0.0 0.3 0.0 0.3 43.3 100.0 308 Education No education 38.1 38.1 0.0 0.0 9.1 0.0 10.6 2.6 15.8 0.0 0.0 0.0 0.0 61.9 100.0 47 Primary incomplete 52.9 52.3 1.3 0.0 10.7 0.5 24.0 2.3 13.3 0.1 0.6 0.0 0.6 47.1 100.0 695 Primary complete 58.1 58.0 1.8 0.0 14.2 0.9 24.3 0.8 15.9 0.1 0.1 0.1 0.0 41.9 100.0 909 Secondary 63.4 63.3 1.5 0.0 14.4 1.7 25.3 1.3 18.8 0.3 0.1 0.1 0.0 36.6 100.0 1,665 More than secondary 68.7 66.8 3.3 0.9 22.4 2.5 18.3 1.4 18.1 0.0 2.0 1.4 0.5 31.3 100.0 297 Wealth quintile Lowest 50.3 49.9 0.7 0.0 10.2 0.1 26.3 1.3 11.1 0.1 0.5 0.1 0.4 49.7 100.0 592 Second 56.6 56.3 0.5 0.0 13.0 0.1 29.1 1.4 11.8 0.3 0.3 0.0 0.3 43.4 100.0 602 Middle 62.3 62.3 1.2 0.0 14.1 1.1 25.8 1.0 18.9 0.2 0.1 0.0 0.1 37.7 100.0 676 Fourth 61.4 60.8 3.4 0.0 13.7 2.0 22.9 1.9 16.9 0.2 0.6 0.4 0.2 38.6 100.0 844 Highest 66.2 65.9 1.8 0.3 18.4 2.5 19.0 1.2 22.7 0.1 0.3 0.3 0.0 33.8 100.0 898 Total 60.2 59.8 1.7 0.1 14.2 1.3 24.0 1.4 16.9 0.2 0.4 0.2 0.2 39.8 100.0 3,612 Note: If more than one method is used, only the most effective method is considered in this tabulation. Family Planning • 107 Table 7.4 Source of modern contraceptive methods Percent distribution of users of modern contraceptive methods age 15-49 by most recent source of method, according to method, Lesotho 2014 Source Female sterilisation Pill IUCD Injectables Implants Male condom Total Public sector 90.8 61.8 43.3 80.9 80.6 46.7 63.2 Govt. hospital 49.1 14.2 13.1 16.4 21.5 8.4 13.6 Govt. health centre 1.0 39.0 22.1 51.0 49.0 31.4 39.3 Govt. health post 0.0 1.9 1.8 1.1 0.7 0.4 0.9 Family planning clinic 0.0 2.8 1.3 1.4 0.9 0.9 1.4 CHAL Hospital 40.7 1.3 1.7 4.5 3.2 1.4 3.4 CHAL Health centre 0.0 1.6 3.3 5.0 3.0 1.6 2.9 CHAL Health post 0.0 0.3 0.0 0.3 0.0 0.0 0.2 Village health worker/CBD 0.0 0.6 0.0 0.8 2.2 2.3 1.4 Other public sector 0.0 0.0 0.0 0.3 0.0 0.3 0.2 Private medical sector 2.9 34.4 52.6 15.2 16.8 5.8 15.6 Private hospital/clinic 0.4 5.2 8.2 5.8 3.2 1.7 3.9 Pharmacy 0.0 14.9 0.0 1.3 0.0 2.9 4.4 Private doctor 2.4 6.8 6.7 4.0 1.2 0.2 3.0 Lesotho Planned Parenthood (LPPA) 0.0 7.4 37.7 3.9 12.3 0.8 4.1 Red Cross health centre 0.0 0.0 0.0 0.2 0.0 0.1 0.2 Other private medical sector 0.0 0.0 0.0 0.0 0.0 0.1 0.0 Facility outside Lesotho 6.3 0.2 4.1 2.0 2.6 0.9 1.5 Other source 0.0 2.7 0.0 0.4 0.0 42.3 17.3 Peer educators 0.0 0.3 0.0 0.0 0.0 0.7 0.4 Support groups 0.0 0.3 0.0 0.0 0.0 0.4 0.2 Shop 0.0 1.1 0.0 0.3 0.0 29.5 11.9 Friends/relatives 0.0 1.0 0.0 0.1 0.0 11.6 4.8 Other 0.0 0.9 0.0 1.5 0.0 4.0 2.3 Missing 0.0 0.0 0.0 0.0 0.0 0.4 0.2 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number of women 73 602 63 1,117 81 1,258 3,213 Note: Total includes 3 users of male sterilisation and 16 users of female condom who are too few in number to be shown separately. CBD = Community-based distributor 108 • Family Planning Table 7.5 Informed choice Among current users of modern methods age 15-49 who started the last episode of use within the 5 years preceding the survey, the percentage who were informed about possible side effects or problems of that method, the percentage who were informed about what to do if they experienced side effects, and the percentage who were informed about other methods they could use, by method and initial source, Lesotho 2014 Among women who started last episode of modern contraceptive method within 5 years preceding the survey: Method/source Percentage who were informed about side effects or problems of method used Percentage who were informed about what to do if experienced side effects Percentage who were informed by a health or family planning worker of other methods that could be used Number of women Method Female sterilisation (38.1) (16.2) (62.8) 28 Pill 43.1 33.2 67.9 476 IUCD (72.9) (66.4) (90.9) 32 Injectables 44.8 36.0 68.3 931 Implants 60.6 56.0 81.6 78 Initial source of method1 Public sector 45.3 36.2 70.6 1,196 Govt. hospital 51.1 42.5 77.5 269 Govt. health centre 42.3 34.3 67.8 727 Govt. health post * * * 15 Family planning clinic * * * 24 CHAL Hospital 38.2 21.7 72.8 63 CHAL Health centre 63.0 50.5 78.4 76 CHAL Health post * * * 7 Village health worker/CBD * * * 13 Other public sector * * * 2 Private medical sector 48.2 38.4 65.4 313 Private hospital/clinic 49.8 35.9 57.2 83 Pharmacy 36.1 16.6 61.0 61 Private doctor 33.7 29.6 51.3 76 Lesotho Planned Parenthood (LPPA) 66.6 61.7 87.3 90 Red Cross health centre * * * 1 Other private medical sector * * * 2 Facility outside Lesotho (40.6) (35.5) (62.8) 24 Other private sector * * * 13 Peer educators * * * 2 Support groups * * * 1 Shop * * * 10 Total 45.5 36.4 69.2 1,546 Notes: Table includes users of only the methods listed individually. Users who got their method from friends/relatives or other sources that could not be characterised are excluded from this table. Figures in parentheses are based on 25-49 unweighted cases. An asterisk indicates that a figure is based on 25 unweighted cases and has been suppressed. CBD = Community-based distributor 1 Source at start of current episode of use Family Planning • 109 Table 7.6 Twelve-month contraceptive discontinuation rates Among women age 15-49 who started an episode of contraceptive use within the 5 years preceding the survey, the percentage of episodes discontinued within 12 months, by reason for discontinuation and specific method, Lesotho, 2014 Method Method failure Desire to become pregnant Other fertility related reasons1 Side effects/health concerns Wanted more effective method Other method related reasons2 Other reasons Any reason3 Switched to another method4 Number of episodes of use5 Pill 2.9 3.4 2.4 8.4 1.3 5.5 3.3 27.2 10.1 854 Injectables 0.6 2.3 0.8 11.3 0.5 2.7 2.6 20.7 8.6 1,570 Male condom 3.3 3.0 3.4 0.7 3.5 1.5 4.8 20.2 7.4 1,652 All methods6 2.3 2.7 2.2 6.1 2.0 2.8 3.6 21.6 8.5 4,313 Note: Figures are based on life table calculations using information on episodes of use that began 3-62 months preceding the survey. 1 Includes infrequent sex/husband away, difficult to get pregnant/menopausal, and marital dissolution/separation 2 Includes lack of access/too far, costs too much, and inconvenient to use 3 Reasons for discontinuation are mutually exclusive and add to the total given in this column. 4 The episodes of use included in this column are a subset of the discontinued episodes included in the discontinuation rate. A woman is considered to have switched to another method if she used a different method in the month following discontinuation or if she gave “wanted a more effective method” as the reason for discontinuation and started another method within 2 months of discontinuation. 5 Number of episodes of use includes both episodes of use that were discontinued during the period of observation and episodes of use that were not discontinued during the period of observation. 6 IUCD, implants, female condom, rhythm method and withdrawal are included in the discontinuation rate for all methods, but are not listed separately. Table 7.7 Reasons for discontinuation Percent distribution of discontinuations of contraceptive methods in the 5 years preceding the survey by main reason stated for discontinuation, according to specific method, Lesotho 2014 Reason Pill IUCD Injectables Male condom Withdrawal Other1 All methods Became pregnant while using 14.4 (1.1) 4.3 19.7 33.5 (27.7) 13.1 Wanted to become pregnant 17.7 (7.0) 18.1 15.6 1.0 (2.1) 16.5 Husband/partner disapproved 4.2 (1.8) 1.4 8.8 1.9 (9.5) 5.0 Wanted a more effective method 6.4 (1.4) 2.1 13.6 26.6 (0.0) 7.9 Health concerns/side effects 22.4 (46.0) 47.0 3.8 4.8 (8.6) 23.9 Lack of access/too far 6.2 (7.6) 6.8 2.5 0.0 (0.0) 4.8 Cost too much 1.4 (0.0) 1.9 0.0 0.0 (3.6) 1.0 Inconvenient to use 6.7 (0.9) 2.1 3.4 6.1 (0.0) 3.6 Up to God/fatalistic 0.0 (0.0) 0.3 0.1 0.0 (0.0) 0.2 Difficult to get pregnant/menopausal 1.5 (0.0) 0.6 0.1 0.7 (0.0) 0.6 Infrequent sex/husband away 8.7 (12.4) 5.8 18.5 12.9 (0.0) 11.5 Marital dissolution/separation 0.4 (0.0) 0.8 0.9 8.4 (0.0) 0.9 Other 7.1 (20.3) 5.5 7.6 4.1 (44.8) 7.2 Don’t know 2.9 (1.4) 3.1 5.4 0.0 (3.8) 3.9 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number of discontinuations 652 36 1,102 1,169 54 27 3,065 Note: Figures in parentheses are based on 25-49 unweighted cases 1 Male sterilisation, implants, female condom, rhythm method, and withdrawal are included in the discontinuation rate for other methods. Table 7.8 Knowledge of fertile period Percent distribution of women and men age 15-49 by knowledge of the fertile period during the ovulatory cycle, according to current use of the rhythm method, Lesotho 2014 Perceived fertile period All women All men Just before her menstrual period begins 14.9 11.0 During her menstrual period 2.9 5.1 Right after her menstrual period has ended 22.3 15.6 Halfway between two menstrual periods 25.8 17.2 Other 0.4 0.2 No specific time 9.2 12.6 Don’t know 24.4 38.2 Total 100.0 100.0 Number 6,621 2,660 110 • Family Planning Table 7.9.1 Need and demand for family planning among currently married women Percentage of currently married women age 15-49 with unmet need for family planning, percentage with met need for family planning, the total demand for family planning, and the percentage of the demand for contraception that is satisfied, by background characteristics, Lesotho 2014 Unmet need for family planning Met need for family planning (currently using) Total demand for family planning1 Percentage of demand satisfied2 Percentage of demand satisfied by modern methods3 Number of women Background characteristic For spacing For limiting Total For spacing For limiting Total For spacing For limiting Total Age 15-19 24.5 4.4 28.9 23.1 12.1 35.3 47.6 16.5 64.2 55.0 55.0 255 20-24 15.6 5.9 21.5 35.7 22.0 57.8 51.3 27.9 79.2 72.9 72.4 701 25-29 9.3 8.1 17.4 31.0 34.5 65.4 40.2 42.6 82.8 79.0 78.8 757 30-34 6.1 10.2 16.3 25.8 41.2 67.1 32.0 51.4 83.4 80.4 80.1 669 35-39 3.2 11.9 15.1 14.8 56.3 71.0 18.0 68.2 86.2 82.5 81.3 544 40-44 1.1 18.7 19.8 3.4 56.1 59.5 4.5 74.8 79.3 75.0 74.8 377 45-49 1.1 13.1 14.1 1.1 38.8 39.9 2.1 51.8 54.0 73.9 73.1 310 Residence Urban 5.7 7.9 13.7 24.7 40.8 65.5 30.4 48.7 79.1 82.7 82.4 1,150 Rural 9.9 10.8 20.7 21.5 36.2 57.7 31.3 47.0 78.3 73.6 73.1 2,463 Ecological zone Lowlands 7.0 9.1 16.1 24.6 39.2 63.8 31.7 48.3 79.9 79.9 79.3 2,134 Foothills 11.6 12.2 23.8 18.0 37.4 55.4 29.6 49.5 79.2 70.0 70.0 427 Mountains 11.0 11.2 22.2 19.9 33.1 53.1 30.9 44.4 75.3 70.5 69.9 797 Senqu River Valley 8.3 8.9 17.2 20.3 39.1 59.4 28.6 48.0 76.6 77.6 77.3 254 District Butha-Buthe 8.6 12.3 20.9 24.4 32.1 56.5 33.0 44.4 77.4 73.0 72.7 211 Leribe 7.3 9.4 16.7 26.4 37.8 64.2 33.8 47.2 81.0 79.3 78.4 577 Berea 7.8 9.4 17.2 21.0 42.9 63.9 28.8 52.3 81.1 78.7 78.7 461 Maseru 7.4 9.0 16.4 22.0 40.6 62.5 29.4 49.6 78.9 79.2 78.9 968 Mafeteng 9.3 11.5 20.8 23.3 35.3 58.6 32.6 46.8 79.4 73.8 73.3 312 Mohale’s Hoek 10.5 11.8 22.4 21.2 32.1 53.4 31.8 43.9 75.7 70.5 70.5 297 Quthing 7.0 9.1 16.1 25.5 38.5 64.0 32.5 47.6 80.1 79.9 79.4 158 Qacha’s Nek 6.8 11.6 18.4 16.9 39.6 56.5 23.8 51.2 75.0 75.4 74.9 114 Mokhotlong 13.6 11.9 25.4 19.4 29.8 49.2 32.9 41.7 74.6 65.9 64.8 205 Thaba-Tseka 10.8 7.7 18.5 20.8 35.9 56.7 31.6 43.6 75.2 75.4 75.0 308 Education No education 5.2 26.7 31.8 3.6 34.5 38.1 8.8 61.2 69.9 54.5 54.5 47 Primary incomplete 6.6 13.4 20.0 16.0 36.9 52.9 22.6 50.3 72.9 72.5 71.7 695 Primary complete 10.9 12.6 23.5 17.8 40.3 58.1 28.7 52.9 81.5 71.2 71.2 909 Secondary 8.2 7.5 15.7 26.8 36.6 63.4 35.1 44.0 79.1 80.2 80.0 1,665 More than secondary 8.0 4.5 12.5 31.0 37.7 68.7 39.0 42.2 81.2 84.6 82.2 297 Wealth quintile Lowest 12.9 11.6 24.5 19.2 31.1 50.3 32.2 42.7 74.8 67.3 66.6 592 Second 10.2 12.9 23.1 22.8 33.7 56.6 33.0 46.7 79.7 71.0 70.6 602 Middle 8.3 8.9 17.3 21.2 41.1 62.3 29.5 50.0 79.6 78.3 78.2 676 Fourth 7.9 9.1 17.0 23.3 38.1 61.4 31.2 47.2 78.4 78.3 77.5 844 Highest 5.3 8.3 13.5 24.7 41.5 66.2 29.9 49.8 79.7 83.0 82.7 898 Total 8.5 9.9 18.4 22.5 37.6 60.2 31.0 47.5 78.6 76.5 76.1 3,612 Note: Numbers in this table correspond to the revised definition of unmet need described in Bradley et al., 2012. 1 Total demand is the sum of unmet need and met need. 2 Percentage of demand satisfied is met need divided by total demand. 3 Modern methods include female sterilisation, male sterilisation, pill, IUCD, injectables, implants, male condom, and female condom. Family Planning • 111 Table 7.9.2 Need and demand for family planning for all women and for women who are not currently married Percentage of all women and women not currently married age 15-49 with unmet need for family planning, percentage with met need for family planning, total demand for family planning, and percentage of the demand for contraception that is satisfied, by background characteristics, Lesotho 2014 Unmet need for family planning Met need for family planning (currently using) Total demand for family planning1 Percentage of demand satisfied2 Percentage of demand satisfied by modern methods3 Number of women Background characteristic For spacing For limiting Total For spacing For limiting Total For spacing For limiting Total ALL WOMEN Age 15-19 6.1 1.4 7.5 14.9 5.2 20.1 21.0 6.6 27.6 72.8 71.5 1,440 20-24 10.4 4.8 15.2 34.4 18.5 52.9 44.9 23.3 68.1 77.7 77.0 1,325 25-29 7.4 7.1 14.5 30.0 31.4 61.4 37.4 38.5 75.8 80.9 80.7 1,094 30-34 5.1 8.9 13.9 22.9 39.7 62.6 27.9 48.6 76.5 81.8 81.6 957 35-39 3.0 10.0 13.0 12.2 54.3 66.5 15.2 64.3 79.5 83.7 82.8 744 40-44 0.9 14.6 15.5 3.7 50.5 54.2 4.6 65.1 69.7 77.8 77.5 562 45-49 0.9 9.6 10.5 0.8 34.4 35.2 1.7 44.0 45.7 77.0 76.1 499 Residence Urban 4.0 5.3 9.3 23.0 28.4 51.3 27.0 33.7 60.6 84.7 84.1 2,419 Rural 6.9 7.7 14.6 18.5 28.9 47.5 25.5 36.6 62.0 76.5 75.9 4,202 Ecological zone Lowlands 5.0 6.0 11.0 22.1 28.8 50.9 27.1 34.7 61.9 82.2 81.6 4,184 Foothills 7.8 9.2 17.1 15.7 30.1 45.7 23.5 39.3 62.8 72.8 72.6 688 Mountains 7.6 8.2 15.9 16.6 26.6 43.2 24.3 34.8 59.1 73.1 72.6 1,288 Senqu River Valley 5.5 6.4 12.0 19.0 32.5 51.5 24.5 38.9 63.4 81.1 80.7 461 District Butha-Buthe 5.1 9.4 14.6 17.8 26.1 43.9 22.9 35.5 58.5 75.1 74.6 385 Leribe 5.0 6.2 11.2 23.5 28.5 52.0 28.5 34.6 63.1 82.3 81.4 1,064 Berea 4.6 5.9 10.6 21.0 31.3 52.2 25.6 37.2 62.8 83.2 82.4 892 Maseru 5.6 6.4 12.0 20.6 29.2 49.8 26.2 35.6 61.9 80.5 80.1 1,864 Mafeteng 6.4 7.2 13.5 19.6 26.9 46.5 26.0 34.1 60.1 77.5 76.9 576 Mohale’s Hoek 7.5 7.9 15.5 18.4 28.4 46.8 26.0 36.3 62.3 75.2 75.2 519 Quthing 4.4 6.0 10.4 22.5 29.8 52.3 26.9 35.9 62.7 83.4 82.7 315 Qacha’s Nek 4.9 7.3 12.2 19.3 29.6 48.9 24.2 36.9 61.1 80.1 79.7 204 Mokhotlong 8.7 8.4 17.1 15.2 22.6 37.8 23.9 31.0 54.8 68.9 67.7 349 Thaba-Tseka 8.6 6.5 15.0 15.8 31.0 46.8 24.4 37.4 61.8 75.7 75.3 452 Education No education 3.5 18.8 22.4 3.2 28.5 31.7 6.8 47.3 54.1 58.6 58.6 68 Primary incomplete 5.1 10.4 15.5 12.1 32.4 44.5 17.2 42.8 60.0 74.2 73.5 1,178 Primary complete 7.4 10.0 17.4 15.4 36.0 51.3 22.8 46.0 68.7 74.7 74.6 1,375 Secondary 5.6 4.7 10.3 22.7 25.3 47.9 28.2 30.0 58.2 82.3 81.9 3,418 More than secondary 5.8 2.6 8.4 34.9 24.7 59.6 40.7 27.3 68.0 87.6 85.2 581 Wealth quintile Lowest 9.1 8.6 17.6 15.2 26.8 42.0 24.3 35.4 59.7 70.4 69.8 960 Second 6.9 10.2 17.0 17.8 29.5 47.3 24.6 39.7 64.3 73.5 73.2 1,033 Middle 5.5 6.5 12.0 18.0 32.4 50.4 23.4 39.0 62.4 80.8 80.4 1,244 Fourth 5.4 6.2 11.6 22.1 28.8 50.9 27.5 35.0 62.5 81.4 80.9 1,605 Highest 4.2 4.6 8.8 23.9 26.7 50.6 28.1 31.3 59.4 85.2 84.3 1,778 Total 5.9 6.8 12.6 20.1 28.7 48.9 26.0 35.5 61.5 79.4 78.9 6,621 SEXUALLY ACTIVE UNMARRIED WOMEN4 Age 15-19 24.2 2.5 26.7 61.1 11.7 72.8 85.3 14.2 99.5 73.2 69.7 63 20-24 15.6 10.4 26.0 50.1 20.1 70.2 65.6 30.6 96.2 73.0 69.9 119 25-29 5.8 4.8 10.6 47.7 34.4 82.1 53.6 39.2 92.7 88.6 88.6 74 30-34 2.5 13.1 15.6 29.6 50.5 80.1 32.1 63.5 95.6 83.7 83.7 72 35-39 0.0 11.1 11.1 5.9 75.4 81.3 5.9 86.4 92.3 88.0 88.0 50 40-44 (0.0) (21.3) (21.3) (6.9) (56.8) (63.7) (6.9) (78.1) (85.0) (74.9) (74.9) 46 45-49 (4.9) (29.3) (34.2) (0.0) (47.9) (47.9) (4.9) (77.2) (82.1) (58.4) (58.4) 26 Residence Urban 8.6 11.1 19.7 42.7 33.3 76.0 51.3 44.4 95.7 79.4 77.6 235 Rural 9.8 11.0 20.8 28.3 42.3 70.5 38.1 53.3 91.3 77.2 76.3 215 Ecological zone Lowlands 9.4 9.8 19.2 40.5 34.5 75.0 49.9 44.3 94.2 79.7 77.9 338 Foothills (3.2) (22.6) (25.8) (25.5) (41.8) (67.2) (28.7) (64.4) (93.1) (72.3) (72.3) 26 Mountains 9.5 15.5 25.0 17.3 45.9 63.2 26.8 61.4 88.2 71.6 71.6 57 Senqu River Valley (11.7) (6.9) (18.5) (26.3) (53.2) (79.5) (37.9) (60.1) (98.0) (81.1) (81.1) 29 Education No education * * * * * * * * * * * 4 Primary incomplete 9.0 18.5 27.5 14.9 51.4 66.3 23.9 69.9 93.8 70.7 70.7 80 Primary complete 1.7 17.6 19.3 22.6 49.6 72.2 24.4 67.2 91.5 78.9 78.9 63 Secondary 11.2 9.5 20.8 38.2 36.3 74.5 49.4 45.8 95.3 78.2 77.2 229 More than secondary 9.7 2.4 12.2 64.0 16.4 80.4 73.7 18.9 92.5 86.9 81.6 74 (Continued…) 112 • Family Planning Table 7.9.2—Continued Unmet need for family planning Met need for family planning (currently using) Total demand for family planning1 Percentage of demand satisfied2 Percentage of demand satisfied by modern methods3 Number of women Background characteristic For spacing For limiting Total For spacing For limiting Total For spacing For limiting Total SEXUALLY ACTIVE UNMARRIED WOMEN4 Wealth quintile Lowest 14.5 11.7 26.3 12.5 48.0 60.5 27.0 59.7 86.8 69.7 69.7 44 Second 6.9 22.8 29.7 22.7 44.5 67.3 29.6 67.4 97.0 69.4 69.4 59 Middle 6.0 15.7 21.7 29.5 43.9 73.4 35.5 59.6 95.1 77.2 76.6 70 Fourth 3.0 13.1 16.2 32.6 46.3 78.9 35.6 59.4 95.1 83.0 83.0 121 Highest 14.7 2.8 17.4 52.6 22.4 75.0 67.3 25.2 92.4 81.1 77.4 156 Total 9.2 11.1 20.2 35.8 37.6 73.4 45.0 48.6 93.6 78.4 77.0 450 Notes: Numbers in this table correspond to the revised definition of unmet need described in Bradley et al., 2012. Figures in parentheses are based on 25-49 unweighted cases. An asterisk indicates that a figure is based on 25 unweighted cases and has been suppressed. 1 Total demand is the sum of unmet need and met need. 2 Percentage of demand satisfied is met need divided by total demand. 3 Modern methods include female sterilisation, male sterilisation, pill, IUCD, injectables, implants, male condom, and female condom. 4 Women who have had sexual intercourse within 30 days preceding the survey Table 7.10 Future use of contraception Percent distribution of currently married women age 15-49 who are not using a contraceptive method by intention to use in the future, according to number of living children, Lesotho 2014 Number of living children1 Total Intention to use in the future 0 1 2 3 4+ Intends to use 58.1 76.5 72.4 74.0 48.2 67.2 Unsure 3.8 2.6 3.2 1.2 3.0 2.8 Does not intend to use 38.1 20.9 24.3 24.8 48.8 29.9 Total 100.0 100.0 100.0 100.0 100.0 100.0 Number of women 185 468 337 162 287 1,439 1 Includes current pregnancy Family Planning • 113 Table 7.11 Exposure to family planning messages Percentages of women and men age 15-49 who heard or saw a family planning message on radio, on television, in a newspaper or magazine, or on a billboard, poster, or pamphlet in the past few months, according to background characteristics, Lesotho 2014 Women Men Background characteristic Radio Television Newspaper/ magazine None of these three media sources1 Billboards, posters, or pamphlets Number of women Radio Television Newspaper/ magazine None of these three media sources1 Billboards, posters, or pamphlets Number of men Age 15-19 13.3 8.1 11.4 77.4 17.5 1,440 11.5 5.4 6.2 82.5 12.9 691 20-24 20.8 14.3 12.5 67.3 25.2 1,325 21.0 10.9 11.4 71.0 21.9 561 25-29 23.0 14.7 10.7 66.8 24.3 1,094 26.7 13.0 10.1 67.8 26.9 410 30-34 26.5 15.7 11.0 63.1 26.8 957 22.8 13.3 11.9 68.0 18.7 334 35-39 29.6 20.2 12.3 60.6 29.6 744 22.0 14.1 10.6 66.8 25.1 276 40-44 30.3 18.0 10.8 60.3 27.1 562 27.1 13.5 6.4 65.9 18.4 221 45-49 31.7 12.8 11.1 61.6 24.3 499 34.4 18.2 13.5 57.2 20.0 168 Residence Urban 26.7 25.9 17.0 55.5 32.7 2,419 26.3 22.8 15.7 59.8 31.9 920 Rural 20.8 7.3 8.3 73.7 19.3 4,202 18.4 4.9 6.3 77.5 13.5 1,741 Ecological zone Lowlands 27.6 20.2 15.4 58.6 31.5 4,184 25.9 15.7 12.8 63.8 27.2 1,711 Foothills 17.3 4.1 7.4 77.1 20.1 688 15.6 2.6 3.8 80.8 11.6 252 Mountains 12.7 3.0 3.0 85.3 7.7 1,288 10.3 2.7 3.8 88.0 4.4 523 Senqu River Valley 17.7 4.6 5.6 77.9 9.9 461 14.6 3.7 3.3 82.3 6.6 174 District Butha-Buthe 14.6 8.8 8.0 76.4 21.2 385 15.6 6.7 4.8 79.0 12.4 143 Leribe 25.6 12.7 12.0 63.6 30.2 1,064 27.4 11.2 10.4 64.8 24.9 390 Berea 27.8 19.8 16.8 58.2 32.4 892 25.5 14.4 12.1 66.3 23.0 379 Maseru 26.0 20.6 13.0 61.3 26.1 1,864 23.6 15.8 11.8 66.4 24.4 809 Mafeteng 29.3 17.2 19.4 57.0 38.4 576 22.1 11.9 12.2 67.2 32.7 242 Mohale’s Hoek 20.8 8.8 7.8 73.3 15.8 519 14.2 4.8 7.7 81.3 8.4 202 Quthing 19.7 6.1 7.3 75.4 11.9 315 15.5 5.3 6.0 77.9 8.7 105 Qacha’s Nek 14.6 8.4 7.0 80.9 13.4 204 14.3 7.2 7.7 80.7 12.6 74 Mokhotlong 12.2 3.1 3.1 85.5 8.4 349 12.4 3.7 2.9 86.4 5.2 144 Thaba-Tseka 10.7 2.1 1.8 87.6 5.6 452 10.3 2.4 2.2 88.5 3.7 172 Education No education 9.2 6.8 0.0 89.4 5.5 68 12.1 2.0 0.6 87.9 3.8 213 Primary incomplete 17.6 5.1 2.5 79.4 10.2 1,178 14.7 3.9 2.3 82.6 6.0 875 Primary complete 19.8 8.9 4.8 75.7 16.1 1,375 23.3 6.8 7.6 71.8 17.1 316 Secondary 25.0 15.5 14.2 63.1 27.2 3,418 24.5 14.3 12.5 64.7 29.0 1,043 More than secondary 30.8 37.1 30.6 42.3 56.0 581 36.4 40.2 36.8 41.3 52.3 214 Wealth quintile Lowest 9.9 0.5 1.6 89.1 5.7 960 7.0 0.4 1.6 91.5 4.1 376 Second 16.1 1.7 2.9 81.9 12.2 1,033 15.6 1.1 3.4 82.9 8.7 479 Middle 21.4 3.0 8.7 73.6 19.5 1,244 20.7 3.2 5.0 76.4 13.6 536 Fourth 26.9 11.7 14.2 63.0 28.7 1,605 25.9 10.1 11.0 66.1 27.1 616 Highest 31.5 38.4 21.3 45.7 40.4 1,778 29.0 32.0 20.9 52.4 35.5 654 Total 15-49 23.0 14.1 11.5 67.0 24.2 6,621 21.1 11.1 9.5 71.4 19.9 2,660 50-59 na na na na na 0 30.5 16.1 11.0 61.8 15.4 271 Total 15-59 na na na na na 0 22.0 11.6 9.7 70.5 19.4 2,931 na = Not applicable 1 Percentage of respondents who have neither seen nor heard a message on radio, on television, or in a newspaper or magazine 114 • Family Planning Table 7.12 Contact of nonusers with family planning providers Among women age 15-49 who are not using contraception, the percentage who during the past 12 months were visited by a fieldworker who discussed family planning, the percentage who visited a health facility and discussed family planning, the percentage who visited a health facility but did not discuss family planning, and the percentage who did not discuss family planning either with a fieldworker or at a health facility, by background characteristics, Lesotho 2014 Percentage of women who were visited by fieldworker who discussed family planning Percentage of women who visited a health facility in the past 12 months and who: Percentage of women who did not discuss family planning either with fieldworker or at a health facility Number of women Background characteristic Discussed family planning Did not discuss family planning Age 15-19 2.2 4.4 33.5 93.7 1,150 20-24 3.5 17.4 44.4 80.7 624 25-29 5.3 25.8 43.0 71.6 423 30-34 4.6 20.7 51.1 77.4 358 35-39 6.0 22.0 38.0 74.1 249 40-44 7.8 27.6 33.0 69.0 258 45-49 5.5 18.8 46.1 78.2 324 Residence Urban 3.4 13.7 42.0 84.0 1,177 Rural 4.4 16.7 39.0 80.9 2,208 Ecological zone Lowlands 4.0 15.2 41.2 82.4 2,056 Foothills 4.8 14.8 39.9 82.9 373 Mountains 3.5 15.8 36.3 82.2 731 Senqu River Valley 5.5 20.9 41.2 76.5 224 District Butha-Buthe 5.6 9.8 28.9 87.0 216 Leribe 5.4 17.4 38.8 79.8 511 Berea 4.1 14.3 38.5 84.0 426 Maseru 3.3 14.9 46.3 82.1 935 Mafeteng 3.2 16.0 42.1 83.3 308 Mohale’s Hoek 4.3 23.2 41.2 75.2 276 Quthing 5.0 13.5 33.4 83.3 150 Qacha’s Nek 3.0 18.1 43.3 81.0 104 Mokhotlong 2.9 16.2 35.5 82.0 217 Thaba-Tseka 4.5 13.1 33.8 84.0 241 Education No education 4.4 30.9 22.8 67.5 46 Primary incomplete 4.9 16.7 36.0 80.1 654 Primary complete 4.2 20.7 40.5 77.7 669 Secondary 3.2 12.7 41.1 85.3 1,780 More than secondary 8.3 17.5 45.2 77.9 235 Wealth quintile Lowest 3.6 17.6 36.7 81.0 556 Second 4.2 18.4 38.4 79.5 545 Middle 4.0 16.0 39.2 81.5 617 Fourth 3.5 15.9 41.6 82.7 789 Highest 4.9 12.2 42.3 84.0 878 Total 4.1 15.6 40.0 82.0 3,385 Infant and Child Mortality • 115 INFANT AND CHILD MORTALITY 8 Key Findings  Current levels: For the 5-year period preceding the survey, the under-5 mortality rate is 85 deaths per 1,000 live births, and the infant mortality rate is 59 deaths per 1,000 live births. This means that one in 12 children in Lesotho dies before his or her fifth birthday, and about two-thirds of these deaths occur during infancy.  Trends: Under-5 mortality has decreased since 2004. In 2004, the number of deaths per thousand births was 113; this number increased to 117 in 2009 and declined to 85 in 2014. Infant mortality also fell, from 91 deaths in 2004 and 2009 to 59 deaths per 1,000 live births in 2014.  District differences: Large differences in perinatal mortality are seen among the districts. The perinatal mortality rate ranges from a low of 23 deaths per 1,000 pregnancies in Qacha’s Nek to a high of 81 deaths per 1,000 pregnancies in Mohale’s Hoek. nformation on infant and child mortality is relevant to a demographic assessment of the population, and is an important indicator of the country’s socioeconomic development and quality of life. It can also help identify children who may be at higher risk of death and lead to strategies to reduce this risk, such as promoting birth spacing. This chapter presents information on levels, trends, and differentials in perinatal, neonatal, infant, and under-5 mortality rates. It also examines biodemographic factors and fertility behaviours that increase mortality risks for infants and children. The information is collected as part of a retrospective birth history, in which female respondents list all of the children they have borne, along with each child’s date of birth, survivorship status, and current age or age at death. The quality of mortality estimates calculated from birth histories depends on the mother’s ability to recall all of the children she has given birth to, as well as their birth dates and ages at death. Potential data quality problems include:  The selective omission from the birth histories of those births that did not survive, which can result in underestimation of childhood mortality.  The displacement of birth dates, which may distort mortality trends. This can occur if an interviewer knowingly records a birth as occurring in a different year than the one in which it occurred. This may happen if an interviewer is trying to cut down on his or her overall work load, because live births occurring during the 5 years before the interview are the subject of a lengthy set of additional questions. I 116 • Infant and Child Mortality  The quality of reporting of age at death. Misreporting the child’s age at death may distort the age pattern of mortality, especially if the net effect of the age misreporting is to transfer deaths from one age bracket to another.  Any method of measuring childhood mortality that relies on the mothers’ reports (e.g., birth histories) assumes that female adult mortality is not high, or if it is high, that there is little or no correlation between the mortality risks of the mothers and those of their children. In countries like Lesotho that have high rates of female adult mortality, primarily due to the HIV epidemic (see Chapter 13), these assumptions may not hold, and the resulting childhood mortality rates will be understated to some degree. Selected indicators of the quality of the mortality data on which the estimates of mortality in this chapter are based are presented in Appendix D, Tables D.4-D.6. 8.1 INFANT AND CHILD MORTALITY Neonatal, infant, and under-5 mortality rates Neonatal, infant, and under-5 mortality are direct estimates of the risk of dying within 1 month, 1 year, and 5 years after birth, respectively. They are reported as the number of deaths per 1,000 live births. Sample: Live births to women age 15-49 In the five-year period before the 2014 LDHS, the neonatal mortality rate was 34 deaths per 1,000 births. In Lesotho, this means that 1 of every 29 children dies in the first month of life. The infant mortality rate is higher, with 59 deaths occurring per 1,000 live births; in other words, 1 of every 17 children dies before celebrating a first birthday. The under-5 mortality rate of 85 deaths per 1,000 live births translates to 1 of every 12 children dying before their fifth birthday (Table 8.1). About two-thirds of all deaths in the first 5 years of life occur during infancy. About 40% of all deaths occur during the first month of life. Trends: Under-5 mortality increased slightly from 2004 to 2009 and then declined in 2014 (Figure 8.1). Infant mortality was 91 deaths per 1,000 live births in 2004 and 2009, before dropping to 59 deaths per 1,000 live births in 2014. Neonatal mortality changed little between 2004 and 2009 and declined in 2014. All three measures of mortality were higher in 2009 than in 2014. Patterns by background characteristics Mortality estimates by background characteristics are calculated for the 10-year period before the survey to ensure that there are sufficient cases to produce statistically reliable estimates (Table 8.2).  Under-5 mortality is higher in urban areas than in rural areas (95 deaths per 1,000 live births versus 90 deaths per 1,000 live births).  Neonatal mortality ranges from a low of 23 deaths per 1,000 in Quthing to a high of 50 deaths per 1,000 live births in Mafeteng. Figure 8.1 Trends in early childhood mortality 85 117113 59 9191 34 4746 201420092004 Deaths per 1,000 live births in the 5-year period before the survey Under-5 mortality Infant mortality Neonatal mortality Infant and Child Mortality • 117  Under-5 mortality declines with the level of education of the mother (Figure 8.2).  Under-5 mortality generally increases with household wealth, from 77 deaths per 1,000 in the lowest wealth quintile to 120 deaths per 1,000 in the fourth wealth quintile, and declines to its lowest point in the highest quintile (70 deaths per 1,000). 8.2 BIODEMOGRAPHIC RISK FACTORS Researchers have identified multiple risk factors for infant and child mortality based on the characteristics of the mother and child and the circumstances of the birth. Table 8.3 illustrates the relationship between these risk factors and neonatal, infant, and under-5 mortality.  Boys are more likely to die in childhood than girls. The gender gap is most pronounced in the postneonatal period (between 1 month and12 months).  Infant mortality rises from 59 deaths per 1,000 live births to 79 deaths per 1,000 live births as birth order increases. 8.3 PERINATAL MORTALITY Perinatal mortality rate Perinatal deaths comprise stillbirths (pregnancy loss that occurs after 7 months of gestation) and early neonatal deaths (deaths of live births within the first 7 days of life). The perinatal mortality rate is calculated as the number of perinatal deaths per 1,000 pregnancies of 7 or more months’ duration. Sample: Number of pregnancies of 7 or more months’ duration to women age 15-49 in the five years before the survey. The causes of stillbirths and early neonatal deaths are closely linked, and it can be difficult to tell whether a death is one or the other. Because the perinatal mortality rate encompasses both stillbirths and early neonatal deaths, it offers a better measure of the level of mortality around delivery. During the 5 years before the survey, the perinatal mortality rate in Lesotho was 50 deaths per 1,000 pregnancies (Table 8.4). Patterns by background characteristics  Perinatal mortality rates are highest among the oldest mothers. Figure 8.2 Under-5 mortality by mother’s education Figure 8.3 Perinatal mortality by district Deaths per 1,000 pregnancies of 7 or more months’ duration in the 5-year period before the survey 112 95 82 (58) Primary incomplete Primary complete Secondary More than secondary Deaths per 1,000 live births for the 10-year period before the survey Note: Figures in parentheses are based on 250-499 unweighted person- years of exposure to the risk of death. 118 • Infant and Child Mortality  Differences by district are large. Perinatal mortality ranges from a low of 23 deaths per 1,000 pregnancies in Qacha’s Nek to a high of 81 deaths per 1,000 pregnancies in Mohale’s Hoek (Figure 8.3). For additional information on high-risk fertility behaviour, see Table 8.5. LIST OF TABLES For detailed information on infant and child mortality, see the following tables:  Table 8.1 Early childhood mortality rates  Table 8.2 Early childhood mortality rates by socioeconomic characteristics  Table 8.3 Early childhood mortality rates by demographic characteristics  Table 8.4 Perinatal mortality  Table 8.5 High-risk fertility behaviour Infant and Child Mortality • 119 Table 8.1 Early childhood mortality rates Neonatal, postneonatal, infant, child, and under-5 mortality rates for 5-year periods preceding the survey, Lesotho 2014 Years preceding the survey Neonatal mortality (NN) Postneonatal mortality (PNN)1 Infant mortality (1q0) Child mortality (4q1) Under-5 mortality (5q0) 0-4 34 26 59 27 85 5-9 33 46 79 22 99 10-14 39 43 82 24 104 1 Computed as the difference between the infant and neonatal mortality rates Table 8.2 Early childhood mortality rates by socioeconomic characteristics Neonatal, postneonatal, infant, child, and under-5 mortality rates for the 10-year period preceding the survey, by background characteristics, Lesotho 2014 Background characteristic Neonatal mortality (NN) Postneonatal mortality (PNN)1 Infant mortality (1q0) Child mortality (4q1) Under-5 mortality (5q0) Residence Urban 22 49 70 27 95 Rural 38 30 68 24 90 Ecological zone Lowlands 31 40 70 29 97 Foothills 39 24 63 18 80 Mountains 36 31 67 18 83 Senqu River Valley 37 38 75 27 100 District Butha-Buthe 28 (21) (49) (11) (59) Leribe 32 52 84 24 106 Berea 33 16 49 (29) (76) Maseru 31 38 69 28 95 Mafeteng 50 (32) (81) (26) (106) Mohale’s Hoek 44 36 80 (34) (111) Quthing 23 (48) (71) (32) (101) Qacha’s Nek 35 (47) (82) (25) (105) Mokhotlong 33 44 77 15 91 Thaba-Tseka 28 21 49 14 62 Mother’s education No education * * * * * Primary incomplete 44 44 88 26 112 Primary complete 28 38 67 31 95 Secondary 32 30 63 21 82 More than secondary (23) (18) (41) (17) (58) Wealth quintile Lowest 33 30 63 15 77 Second 40 23 63 26 87 Middle 30 44 74 34 105 Fourth 42 51 93 29 120 Highest 22 29 51 20 70 Note: Figures in parentheses are based on 250-499 unweighted person-years of exposure to the risk of death. An asterisk indicates that a rate is based on fewer than 250 person-years of exposure to the risk of death and has been suppressed. 1 Computed as the difference between the infant and neonatal mortality rates 120 • Infant and Child Mortality Table 8.3 Early childhood mortality rates by demographic characteristics Neonatal, postneonatal, infant, child, and under-5 mortality rates for the 10-year period preceding the survey, by demographic characteristics, Lesotho 2014 Demographic characteristic Neonatal mortality (NN) Postneonatal mortality (PNN)1 Infant mortality (1q0) Child mortality (4q1) Under-5 mortality (5q0) Child’s sex Male 35 43 78 27 102 Female 32 28 60 23 82 Mother’s age at birth <20 48 24 72 15 86 20-29 30 36 66 28 92 30-39 26 45 71 26 95 40-49 * * * * * Birth order 1 35 24 59 26 83 2-3 32 37 69 27 94 4-6 33 45 79 15 93 7+ * * * * * Previous birth interval2 <2 years (79) (35) (114) (13) (126) 2 years 22 51 73 26 97 3 years 25 55 80 29 107 4+ years 29 33 62 24 85 Birth size3 Small/very small (76) (42) (119) na na Average or larger 24 24 48 na na Notes: Figures in parentheses are based on 250-499 unweighted person-years of exposure to the risk of death. An asterisk indicates that a rate is based on fewer than 250 person-years of exposure to the risk of death and has been suppressed. Total includes 32 children for whom information on birth size could not be recalled by the respondent or was missing. na = Not available 1 Computed as the difference between the infant and neonatal mortality rates 2 Excludes first-order births 3 Rates for the 5-year period before the survey Infant and Child Mortality • 121 Table 8.4 Perinatal mortality Number of stillbirths and early neonatal deaths, and the perinatal mortality rate for the 5-year period preceding the survey, by background characteristics, Lesotho 2014 Background characteristic Number of stillbirths1 Number of early neonatal deaths2 Perinatal mortality rate3 Number of pregnancies of 7+ months duration Mother’s age at birth <20 12 22 54 628 20-29 38 39 45 1,703 30-39 18 19 51 739 40-49 6 3 82 114 Previous pregnancy interval in months4 First pregnancy 36 30 57 1,171 <15 0 4 43 96 15-26 6 12 56 333 27-38 8 9 34 500 39+ 23 28 48 1,085 Residence Urban 28 14 45 928 Rural 46 70 51 2,257 Ecological zone Lowlands 51 38 50 1,783 Foothills 7 17 61 387 Mountains 13 22 46 765 Senqu River Valley 3 8 42 249 District Butha-Buthe 1 6 38 198 Leribe 9 13 45 503 Berea 8 6 35 388 Maseru 29 16 55 814 Mafeteng 8 12 79 262 Mohale’s Hoek 11 12 81 283 Quthing 1 3 24 174 Qacha’s Nek 0 2 23 88 Mokhotlong 2 6 40 205 Thaba-Tseka 5 7 44 271 Mother’s education No education (0) (2) (68) 28 Primary incomplete 14 24 58 652 Primary complete 23 11 42 829 Secondary 32 45 53 1,447 More than secondary 5 2 29 229 Wealth quintile Lowest 12 18 44 676 Second 17 19 55 640 Middle 15 17 50 636 Fourth 12 23 54 641 Highest 19 8 46 591 Total 74 84 50 3,184 Note: Figures in parentheses are based on 25-49 unweighted cases. 1 Stillbirths are foetal deaths in pregnancies lasting 7 or more months. 2 Early neonatal deaths are deaths at age 0-6 days among live-born children. 3 The sum of the number of stillbirths and early neonatal deaths divided by the number of pregnancies of 7 or more months’ duration, expressed per 1,000. 4 Categories correspond to birth intervals of <24 months, 24-35 months, 36-47 months, and 48+ months. 122 • Infant and Child Mortality Table 8.5 High-risk fertility behaviour Percent distribution of children born in the 5 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 2014 Births in the 5 years preceding the survey Percentage of currently married women1 Risk category Percentage of births Risk ratio Not in any high risk category 34.9 1.00 30.6a Unavoidable risk category First order births between ages 18 and 34 years 31.8 0.83 6.7 Single high-risk category Mother’s age <18 7.1 0.78 0.7 Mother’s age >34 3.0 1.15 11.7 Birth interval <24 months 4.6 1.64 12.6 Birth order >3 9.4 1.24 8.9 Subtotal 24.1 1.17 33.9 Multiple high-risk category Age <18 and birth interval <24 months2 0.2 * 0.2 Age >34 and birth interval <24 months 0.0 * 0.5 Age >34 and birth order >3 7.5 1.03 22.3 Age >34 and birth interval <24 months and birth order >3 0.4 * 2.0 Birth interval <24 months and birth order >3 1.2 (1.94) 3.9 Subtotal 9.3 1.13 28.8 In any avoidable high-risk category 33.3 1.16 62.7 Total 100.0 na 100.0 Number of births/women 3,112 na 3,612 Notes: 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. Ratios in parentheses are based on 25-49 unweighted cases. An asterisk indicates that a ratio is based on fewer than 25 unweighted cases 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 Health Care • 123 MATERNAL HEALTH CARE 9 Key Findings  Antenatal care coverage: Ninety-five percent of women who gave birth in the 5 years before the survey received antenatal care from a skilled provider for their most recent birth. However, only 41% had their first antenatal visit during the first trimester, and only 74% had the recommended four or more visits. All indicators have improved since the 2004 and 2009 surveys.  Components of antenatal care: Pregnant women are more likely to have their blood pressure measured (99%) and a blood sample taken (97%) than to provide a urine sample (83%) during antenatal care.  Protection against neonatal tetanus: Nearly three in four births (74%) are protected against neonatal tetanus, but the proportion varies somewhat among districts, from 67% in Quthing to 79% in both Butha-Buthe and Qacha’s Nek.  Delivery: Institutional deliveries in Lesotho have increased from 52% in 2004 to 59% in 2009 and to 77% in 2014. Home deliveries are more common in rural areas and among less educated and poorer women.  Postnatal checks: Only 62% of women and 18% of newborns receive the recommended postnatal health check within 2 days of delivery. ealth care services during pregnancy and childbirth and after delivery are important for the survival and wellbeing of both the mother and the infant. Maternal and newborn health, as highlighted in the National Strategic Development Plan (MDP 2012) and the Health Sector Strategic Plan (MOH 2013), are a priority for the government of Lesotho. Antenatal care (ANC) can reduce health risks for mothers and their babies by monitoring pregnancies and screening for complications. Delivery at a health facility, with skilled medical attention and hygienic conditions, reduces the risk of complications and infections during labour and delivery. Timely postnatal care can treat complications arising from delivery and teach the mother how to care for herself and her infant. As highlighted in the 2010 Maternal Death Review Report, a majority of documented maternal deaths in Lesotho occurred during the postpartum period (MOH 2014a). Utilisation of ANC, delivery, and postnatal care services can contribute to policies and programmes to improve maternal and child health care. The first part of this chapter presents information on ANC providers, the number and timing of ANC visits, and various components of care. The second focuses on childbirth and presents information on the place of delivery, assistance during delivery, and caesarean deliveries. The third section focuses on postnatal care and H 124 • Maternal Health Care presents information on postnatal health checks for mothers and newborns. The conclusion examines the barriers that women may face when seeking care during pregnancy, delivery, and the postnatal period. 9.1 ANTENATAL CARE COVERAGE AND CONTENT 9.1.1 Skilled Providers Antenatal care (ANC) from a skilled provider Pregnancy care received from skilled providers, i.e., doctors and nurses/midwives. Sample: Women age 15-49 who had a live birth in the 5 years before the survey Ninety-five percent of women age 15-49 received ANC from a skilled provider during the pregnancy of their most recent birth (Table 9.1). Trends: The proportion of women age 15-49 in Lesotho who received ANC from a skilled provider has risen from 90% in 2004 to 95% in 2014 (Figure 9.1). Patterns by background characteristics  Higher-order births are less likely to receive ANC (Table 9.1). Only 86% of women giving birth to their sixth or later child received ANC from a skilled provider, compared with 98% of women giving birth to their first child.  ANC coverage from a skilled provider is slightly higher in urban areas than rural areas (98% and 94%, respectively). Urban women are twice as likely as rural women to receive ANC from a doctor (23% versus 11%).  District differences in ANC coverage are small, ranging from 92% in Quthing and Thaba-Tseka to 98% in Leribe and Qacha’s Nek. Women in Qacha’s Nek (27%) are more likely than women in other districts to receive ANC from a doctor.  Women in the highest wealth quintile are four times more likely to receive ANC from a doctor than those in the poorest quintile (28% versus 7%). 9.1.2 Timing and Number of ANC Visits Seventy-four percent of women had at least four ANC visits during their last pregnancy (Table 9.2, Figure 9.1), as recommended by WHO. Five percent of women had no ANC visits. Only 41% of women had their first ANC visit during the first trimester, as recommended by Lesotho’s guidelines for integrated management of pregnancy and childbirth (IMPAC) (Table 9.2, Figure 9.1). Another 34% first received ANC during the fourth or fifth month of pregnancy, but 3% delayed until the eighth month. Figure 9.1 Antenatal care coverage trends 90 70 30 92 70 33 95 74 41 Received any ANC from a skilled provider Had 4+ ANC visits Had ANC in first trimester (<4 months) Percentage of women age 15-49 who had a live birth in the 5 years before the survey (for the most recent birth) 2004 2009 2014 Maternal Health Care • 125 Trends: The proportion of women that received the recommended four or more ANC visits has increased since 2004 from 70% to 74% (Figure 9.1), while the proportion of women receiving no antenatal care has decreased from 9% to 5%. The median number of months pregnant at the first ANC visit has decreased slightly, from 4.8 months in 2004 to 4.3 months in 2014. 9.2 COMPONENTS OF ANC VISITS Pregnant women are more likely to have their blood pressure measured (99%) and a blood sample taken (97%) than to have a urine sample taken as part of routine ANC (83%) (Table 9.3). Trends: From 2004 to 2014, there has been an increase for each of three ANC components. The proportion of pregnant women who had their blood pressure measured increased from 93% in 2004 to 96% in 2009 and to 99% in 2014. Blood samples were taken from 81% of pregnant women in 2004 compared with 92% in 2009 and 97% in 2014. Urine sample collection also rose, from 69% in 2004 to 70% in 2009 and to 83% in 2014. Other Components of ANC The 2014 LDHS also collected data on other components of care important to maternal and newborn health outcomes. Sixty-three percent of women received information on signs of pregnancy complications, and 75% took iron tablets. For complete information on these components of ANC, see Table 9.3. 9.3 PROTECTION AGAINST NEONATAL TETANUS Protection against neonatal tetanus The number of tetanus toxoid injections needed to protect a baby from neonatal tetanus depends on the mother’s vaccinations. A birth is protected against neonatal tetanus if the mother has received any of the following:  Two tetanus toxoid injections during that pregnancy  Two or more injections, the last one within 3 years of the birth  Three or more injections, the last one within 5 years of the birth  Four or more injections, the last one within 10 years of the birth  Five or more injections at any time prior to the birth Sample: Last live births in the 5 years before the survey to women age 15-49 Depending on whether and when a pregnant woman has been vaccinated against tetanus before the most recent pregnancy, she may need as many as two tetanus toxoid injections during her pregnancy to protect her baby against neonatal tetanus. Seventy-four percent of women’s last births were protected against neonatal tetanus (Table 9.4). Trends: The proportion of births protected against neonatal tetanus increased from 60% in 2004 to 76% in 2009, and then declined slightly to 74% in 2014. Patterns by background characteristics  Births are least likely to be protected against neonatal tetanus in Quthing (67%), and most likely to be protected in Butha-Buthe (79%).  Protection against neonatal tetanus increases with wealth quintile. 126 • Maternal Health Care 9.4 DELIVERY SERVICES 9.4.1 Institutional Deliveries Institutional deliveries Deliveries that take place in a health facility Sample: All live births in the 5 years before the survey Seventy-seven percent of live births in the 5 years before the survey took place in a health facility, while 23% were delivered at home. Most institutional deliveries took place at public sector health facilities (70%) (Table 9.5). Trends: Institutional deliveries in Lesotho are increasing: the proportion of births in health facilities rose from 52% in 2004 to 59% in 2009 and 77% in 2014. Over the same period, home deliveries decreased from 45% to 23% (Figure 9.2). Patterns by background characteristics  Higher-order births are much more likely to be home deliveries. Only 49% of sixth or higher-order births occurred at a health facility, compared with 85% of first births.  Antenatal care increases the likelihood of an institutional delivery. If mothers have at least one ANC visit, births are more than three times as likely to take place in a facility.  By districts institutional deliveries are least common in Mokhotlong (61%) and most common in Leribe 84%) (Figure 9.3).  Institutional deliveries are most common among mothers with more than secondary school (96%) (Figure 9.4), and among women in households in the highest wealth quintile (93%). Figure 9.3 Institutional deliveries by district Figure 9.4 Institutional deliveries by mother’s education Percentage of live births in the 5 years preceding the survey that were delivered at a health facility Figures in parentheses are based on 25-49 unweighted cases. Figure 9.2 Trends in place of delivery 52 59 77 45 40 23 2004 2009 2014 Percentage of live births in the 5 years before the survey Delivered in health facility Delivered at home (52) 57 71 86 96 77 No education Primary incomplete Primary complete Secondary More than secondary Total Percentage of live births in the 5 years preceding the survey that were delivered at a health facility Maternal Health Care • 127 9.4.2 Skilled Assistance during Delivery Skilled assistance during delivery Births delivered with the assistance of doctors and nurse/midwives. Sample: All live births in the 5 years before the survey In Lesotho, 8 in 10 deliveries (78%) are assisted by a skilled provider, for the most part, a nurse/midwife (61%). Unskilled persons, such as traditional healers, village health workers, and relatives/friends, assist in 21%; 1% of births receive no assistance (Figure 9.5). Skilled providers assist at nearly 100% of deliveries in health facilities, but only 7% of deliveries that take place elsewhere (Table 9.6). Trends: Skilled assistance at delivery has increased in Lesotho over the last decade; 55% of deliveries had skilled assistance in 2004 compared with 62% in 2009 and 78% in 2014. Patterns by background characteristics  Skilled assistance declines sharply with birth order: 87% of first births have skilled assistance, compared with 50% of sixth or higher-order births (Table 9.6).  Urban deliveries are more likely than rural deliveries to have received skilled assistance (90% versus 73%).  There are moderate differences among districts in delivery assistance. Deliveries in Mokhotlong are least likely to be assisted by a skilled provider (63%) and most likely to be assisted by a relative or friend (27%). In contrast, skilled providers assist 85% of deliveries in Leribe while a relative or friend assists in 12%. Deliveries in Thaba-Tseka (8%), Mokhotlong (9%), and Butha- Buthe (14%) are less likely to be assisted by a doctor than in other districts (17-21%).  The more education a woman has, the more likely it is that a skilled provider will assist at delivery. Ninety-seven percent of births to women with more than secondary education were delivered by a skilled provider compared with 59% of births to women with an incomplete primary school education.  The wealthier the household, the more likely it is that deliveries are assisted by a skilled provider (Figure 9.6). Compared with deliveries in the lowest wealth quintile, deliveries in the highest quintile are three times as likely to be assisted by a doctor (23% versus 8%). Figure 9.5 Delivery assistance Figure 9.6 Delivery assistance by wealth quintile Nurse/midwife 61% Doctor 17% Relative/ friend 16% Village health worker 5% No one 1% Percent distribution of births in the 5 years before the survey 60 67 81 90 94 78 Lowest Second Third Fourth Highest Total Percentage of live births in the 5 years before the survey assisted by a skilled provider WealthiestPoorest 128 • Maternal Health Care 9.4.3 Delivery by Caesarean Access to caesarean sections can reduce maternal and neonatal mortality and complications such as obstetric fistula. However, use of caesarean section without a medical need can put women at risk of short- and long- term health problems. WHO advises that caesarean sections should only be done when medically necessary, and does not recommend a target rate for countries to achieve at the population level. Research conducted by WHO has found that increases in countries’ caesarean section rates up to 10% are associated with a decline in maternal and neonatal mortality. However, increases in caesarean section rates beyond 10% are not associated with reductions in maternal and newborn mortality rates (WHO 2015a). Recent routine data in Lesotho reveal that caesarean section rates vary among hospitals, and the procedure is more common in private than in public facilities (MOH 2015a). In the 2014 LDHS, caesarean deliveries made up 10% of all births in the 5 years before the survey (Table 9.6). Trends: Five percent of births occurred via caesarean section in 2004 compared with 7% in 2009 and 10% in 2014. Patterns by background characteristics  Caesarean deliveries are more common among first births (14%) than higher-order births (5% to 8%) (Table 9.6).  The caesarean delivery rate is higher in urban than rural areas (12% versus 9%).  Among districts, Mokhotlong has the lowest caesarean rate (4% versus 6-13% elsewhere).  Highly educated women are more likely to undergo caesarean deliveries. The caesarean rate for deliveries to women with more than secondary education is 17%, compared with less than 8% for deliveries to women with less than secondary education.  The caesarean rate is about three times higher in the highest wealth quintile than in the lowest three quintiles (15% versus 6%). 9.5 POSTNATAL CARE 9.5.1 Postnatal Health Check for Mothers Safe motherhood programmes recommend that women receive a postnatal health check within 2 days after delivery. In Lesotho, 71% of mothers received a postnatal check, but only 62% had a check in the first two days (Table 9.7). One in four mothers (26%) did not have any postnatal health check. Trends: The proportion of mothers who received a postnatal check in the first 2 days after delivery has increased dramatically, from 39% in 2004 to 49% in 2009 to 62% in 2014. Patterns by background characteristics  Women who delivered in a health facility were much more likely to receive a postnatal health check within 2 days of delivery than those who delivered elsewhere (74% versus 11%) (Figure 9.7).  There are marked differences in postnatal care for mothers by district. Mothers are most likely to have a timely postnatal health check in Leribe (72%) and least likely in Mokhotlong (41%) (Table 9.7). Maternal Health Care • 129  Mothers with more than a secondary education (83%) are more likely than women with less education to have a timely postnatal health check (47% to 68%).  Women from the wealthiest households (80%) are almost two times as likely to receive timely postnatal care as women from the poorest households (46%). Type of Provider Twelve percent of women received a postnatal health check in the first 2 days after delivery from a doctor, 49% from a nurse/midwife, and <1% from a village health worker (Table 9.8). 9.5.2 Postnatal Health Checks for Newborns Postnatal care services for newborns should start as soon as possible after birth because many neonatal deaths occur within the first 48 hours of life. The vast majority of newborns in Lesotho (77%) do not receive any postnatal health check. Only 18% of newborns receive a check within 2 days after birth, and another 3% receive a check 3-6 days after birth (Table 9.9). Patterns by background characteristics  Newborns delivered in a health facility were much more likely to receive a postnatal health check within 2 days of birth than those delivered elsewhere (20% versus 13%). Still, the difference in the proportion of women who receive a timely postnatal check after delivery and the proportion of newborns who receive a timely postnatal check is striking, even when the delivery took place in a health facility (Figure 9.7).  The percentage of newborns who receive a postnatal health check within 2 days ranges from a low of 7% in Mokhotlong to as high of 36% in Quthing.  There is no clear correlation between a mother’s education and the likelihood of a timely postnatal health check for newborns. Similarly, differences by household wealth are small and follow no consistent pattern. Type of Provider Only 4% of newborns received a postnatal check within 2 days after birth from a doctor, 14% from a nurse/midwife, and <1% from a village health worker (Table 9.10). Figure 9.7 Postnatal care by place of delivery 74 20 11 13 62 18 Women Newborns Percentage of last births in the 2 years before the survey for which women and newborns received a postnatal check within 2 days after birth Health facility Elsewhere Total 130 • Maternal Health Care 9.6 PROBLEMS IN ACCESSING HEALTH CARE Problems in accessing health care Women were asked whether each of the following factors is be a big problem in seeking medical advice or treatment for themselves when they are sick:  getting permission to go to the doctor  getting money for advice or treatment  distance to a health facility  not wanting to go alone Sample: Women age 15-49 Four in ten women (42%) in Lesotho reported at least one of the problems asked about in accessing health care for themselves. This proportion ranges from 36% in Maseru to 56% in Thaba-Tseka (Table 9.11). The most commonly reported problems are getting money to pay for treatment (27%) and distance to the health facility (26%). Fewer women say that not wanting to go alone (9%) or needing permission to go for treatment (4%) are big problems in seeking medical advice or treatment. LIST OF TABLES For detailed information on maternal health care, see the following tables:  Table 9.1 Antenatal care  Table 9.2 Number of antenatal care visits and timing of first visit  Table 9.3 Components of antenatal care  Table 9.4 Tetanus toxoid injections  Table 9.5 Place of delivery  Table 9.6 Assistance during delivery  Table 9.7 Timing of first postnatal check for the mother  Table 9.8 Type of provider of first postnatal check for the mother  Table 9.9 Timing of first postnatal check for the newborn  Table 9.10 Type of provider of first postnatal check for the newborn  Table 9.11 Problems in accessing health care Maternal Health Care • 131 Table 9.1 Antenatal care Percent distribution of women age 15-49 who had a live birth in the 5 years preceding the survey by antenatal care (ANC) provider during pregnancy for the most recent birth; the percentage receiving antenatal care from a skilled provider for the most recent birth; and the percentage with an ANC visit received outside of Lesotho for the most recent birth, according to background characteristics, Lesotho 2014 Antenatal care provider No ANC Total Percentage receiving antenatal care from a skilled provider1 Percentage with an ANC visit received outside Lesotho Number of women Background characteristic Doctor Nurse/ midwife Village health worker Mother’s age at birth <20 11.5 85.6 0.3 2.6 100.0 97.1 4.5 467 20-34 14.9 80.4 0.2 4.5 100.0 95.3 2.9 1,805 35-49 17.7 73.9 0.0 8.5 100.0 91.5 3.9 303 Birth order 1 16.3 81.4 0.2 2.0 100.0 97.8 4.2 977 2-3 14.5 80.7 0.2 4.6 100.0 95.2 3.2 1,126 4-5 12.7 78.7 0.3 8.4 100.0 91.3 1.8 321 6+ 8.4 77.9 0.4 13.4 100.0 86.3 2.5 150 Residence Urban 22.5 75.0 0.0 2.5 100.0 97.5 3.6 749 Rural 11.4 82.8 0.3 5.5 100.0 94.2 3.2 1,825 Ecological zone Lowlands 18.3 77.8 0.1 3.8 100.0 96.2 3.0 1,459 Foothills 14.5 76.6 1.0 7.9 100.0 91.1 2.6 316 Mountains 6.7 88.3 0.3 4.7 100.0 95.0 3.0 598 Senqu River Valley 11.3 83.3 0.0 5.4 100.0 94.6 7.7 202 District Butha-Buthe 3.6 88.9 0.0 7.5 100.0 92.5 1.9 167 Leribe 12.5 85.0 0.0 2.5 100.0 97.5 2.9 423 Berea 18.3 76.9 0.4 4.3 100.0 95.3 2.0 322 Maseru 20.9 74.6 0.1 4.3 100.0 95.5 2.7 636 Mafeteng 24.5 69.1 0.9 5.5 100.0 93.6 4.2 213 Mohale’s Hoek 12.7 83.8 0.0 3.4 100.0 96.6 3.2 234 Quthing 7.0 85.0 0.0 8.0 100.0 92.0 13.3 136 Qacha’s Nek 26.8 70.7 0.0 2.5 100.0 97.5 9.8 70 Mokhotlong 4.4 92.0 0.3 3.3 100.0 96.4 2.2 161 Thaba-Tseka 3.7 88.0 0.5 7.9 100.0 91.6 0.7 212 Education No education (0.0) (83.8) (0.0) (16.2) 100.0 (83.8) (0.0) 23 Primary incomplete 9.3 81.8 0.1 8.7 100.0 91.2 3.8 491 Primary complete 11.2 83.3 0.5 5.0 100.0 94.5 2.5 644 Secondary 16.6 80.2 0.2 3.1 100.0 96.8 3.8 1,222 More than secondary 28.2 70.5 0.0 1.3 100.0 98.7 2.7 195 Wealth quintile Lowest 6.7 85.6 0.7 7.0 100.0 92.3 1.6 512 Second 10.2 82.3 0.2 7.3 100.0 92.5 3.1 504 Middle 12.4 82.0 0.0 5.6 100.0 94.4 3.5 522 Fourth 15.7 82.4 0.2 1.7 100.0 98.2 5.3 540 Highest 28.3 70.0 0.0 1.7 100.0 98.3 3.1 498 Total 14.6 80.6 0.2 4.6 100.0 95.2 3.3 2,575 Notes: If more than one source of ANC was mentioned, only the provider with the highest qualifications was considered in this tabulation. Figures in parentheses are based on 25-49 unweighted cases. 1 Skilled provider includes doctor and nurse/midwife. 132 • Maternal Health Care Table 9.2 Number of antenatal care visits and timing of first visit Percent distribution of women age 15-49 who had a live birth in the 5 years preceding the survey, by number of antenatal care (ANC) visits for the most recent live birth, and by the timing of the first visit, and among women with ANC, median months pregnant at first visit, according to residence, Lesotho 2014 Residence Total Number and timing of ANC visits Urban Rural Number of ANC visits None 2.5 5.5 4.6 1 0.8 1.9 1.6 2-3 15.6 20.0 18.7 4+ 80.1 72.1 74.4 Don’t know 0.9 0.5 0.6 Total 100.0 100.0 100.0 Number of months pregnant at time of first ANC visit No antenatal care 2.5 5.5 4.6 <4 50.5 37.3 41.2 4-5 29.4 36.5 34.4 6-7 14.0 18.0 16.8 8+ 3.4 2.5 2.7 Don’t know 0.1 0.3 0.2 Total 100.0 100.0 100.0 Number of women 749 1,825 2,575 Median months pregnant at first visit (for those with ANC) 3.9 4.5 4.3 Number of women with ANC 730 1,726 2,456 Maternal Health Care • 133 Table 9.3 Components of antenatal care Among women age 15-49 with a live birth in the 5 years preceding the survey, the percentage who took iron tablets during the pregnancy of the most recent birth, and among women receiving antenatal care (ANC) for the most recent live birth in the 5 years preceding the survey, the percentage receiving specific antenatal services, according to background characteristics, Lesotho 2014 Among women with a live birth in the past 5 years, the percentage who during the pregnancy of their last birth: Among women who received antenatal care for their most recent birth in the past 5 years, the percentage with selected services Background characteristic Took iron tablets Number of women with a live birth in the past 5 years Informed of signs of pregnancy complications Blood pressure measured Urine sample taken Blood sample taken Number of women with ANC for their most recent birth Mother’s age at birth <20 76.6 467 61.7 98.5 78.6 95.5 455 20-34 76.3 1,805 63.8 99.0 83.4 97.0 1,724 35-49 67.6 303 63.3 98.1 84.5 97.0 277 Birth order 1 78.1 977 65.2 99.1 84.8 97.0 957 2-3 76.1 1,126 63.9 98.8 81.6 96.6 1,074 4-5 68.4 321 59.9 98.3 80.2 97.2 294 6+ 67.2 150 53.1 97.7 80.2 95.3 130 Residence Urban 81.8 749 73.3 99.0 87.9 97.7 730 Rural 72.7 1,825 59.1 98.7 80.4 96.4 1,726 Ecological zone Lowlands 78.9 1,459 70.4 99.3 87.9 97.1 1,404 Foothills 64.4 316 55.7 98.7 71.3 96.3 291 Mountains 74.4 598 53.4 97.9 77.1 96.2 570 Senqu River Valley 70.1 202 52.7 97.6 77.8 96.6 191 District Butha-Buthe 83.9 167 75.6 99.7 86.6 98.2 154 Leribe 75.3 423 56.4 99.6 82.7 95.8 413 Berea 77.4 322 69.7 99.2 83.1 96.6 308 Maseru 74.1 636 72.0 99.4 84.4 97.6 609 Mafeteng 78.6 213 66.1 98.6 89.7 96.4 201 Mohale’s Hoek 72.1 234 56.8 97.2 78.0 96.5 226 Quthing 69.8 136 53.4 98.6 75.3 95.3 126 Qacha’s Nek 70.3 70 53.7 95.8 84.8 97.5 69 Mokhotlong 79.1 161 50.5 98.0 69.3 95.8 156 Thaba-Tseka 72.3 212 56.4 97.9 85.7 97.2 195 Education No education (63.9) 23 (61.7) (97.0) (72.5) (97.0) 19 Primary incomplete 68.6 491 54.8 98.1 77.0 96.8 448 Primary complete 72.4 644 57.1 98.4 77.2 97.3 612 Secondary 77.6 1,222 66.1 99.1 85.8 96.2 1,184 More than secondary 89.7 195 86.4 100.0 94.5 98.3 192 Wealth quintile Lowest 71.6 512 54.4 97.7 75.8 96.8 476 Second 70.4 504 51.4 98.5 75.4 96.4 467 Middle 72.8 522 63.9 98.8 82.8 95.7 493 Fourth 77.2 540 69.0 99.1 87.5 97.1 531 Highest 84.8 498 76.9 99.8 90.7 97.7 489 Total 75.4 2,575 63.4 98.8 82.6 96.8 2,456 Note: Figures in parentheses are based on 25-49 unweighted cases. 134 • Maternal Health Care Table 9.4 Tetanus toxoid injections Among mothers age 15-49 with a live birth in the 5 years preceding the survey, the percentage receiving two or more tetanus toxoid injections during the pregnancy for the last live birth and the percentage whose last live birth was protected against neonatal tetanus, according to background characteristics, Lesotho 2014 Background characteristic Percentage receiving two or more injections during last pregnancy Percentage whose last birth was protected against neonatal tetanus1 Number of mothers Mother’s age at birth <20 64.0 66.9 467 20-34 58.8 75.9 1,805 35-49 45.7 76.9 303 Birth order 1 65.6 67.7 977 2-3 56.5 79.4 1,126 4-5 50.8 79.3 321 6+ 39.0 69.3 150 Residence Urban 64.0 79.1 749 Rural 55.9 72.4 1,825 Ecological zone Lowlands 61.0 76.8 1,459 Foothills 51.6 68.1 316 Mountains 54.0 71.5 598 Senqu River Valley 61.0 74.7 202 District Butha-Buthe 61.2 78.7 167 Leribe 58.0 74.4 423 Berea 53.0 72.6 322 Maseru 60.5 75.4 636 Mafeteng 61.7 76.8 213 Mohale’s Hoek 62.6 74.8 234 Quthing 53.3 66.9 136 Qacha’s Nek 56.9 79.4 70 Mokhotlong 58.1 68.9 161 Thaba-Tseka 53.0 74.7 212 Education No education (50.9) (61.0) 23 Primary incomplete 47.8 67.5 491 Primary complete 59.0 76.9 644 Secondary 62.4 75.9 1,222 More than secondary 56.7 75.3 195 Wealth quintile Lowest 52.8 69.9 512 Second 55.5 72.6 504 Middle 59.9 75.6 522 Fourth 62.5 75.7 540 Highest 60.3 78.0 498 Total 58.2 74.4 2,575 Note: Figures in parentheses are based on 25-49 unweighted cases. 1 Includes mothers with two injections during the pregnancy of her last birth, or two or more injections (the last within 3 years of the last live birth), or three or more injections (the last within 5 years of the last birth), or four or more injections (the last within 10 years of the last live birth), or five or more injections at any time prior to the last birth Maternal Health Care • 135 Table 9.5 Place of delivery Percent distribution of live births in the5 years preceding the survey by place of delivery, percentage delivered in a health facility, and percentage delivered in a health facility outside of Lesotho, according to background characteristics, Lesotho 2014 Health facility Home Other Total Percentage delivered in a health facility Number of births Background characteristic Public sector Private sector Outside Lesotho Mother’s age at birth <20 73.6 1.7 5.3 18.5 1.0 100.0 80.6 616 20-34 69.8 3.5 3.3 22.9 0.3 100.0 76.7 2,158 35-49 61.6 2.4 3.7 31.9 0.3 100.0 67.8 338 Birth order 1 77.3 3.5 4.6 13.9 0.7 100.0 85.4 1,217 2-3 69.1 3.0 3.7 23.8 0.3 100.0 75.8 1,322 4-5 58.3 2.6 3.0 35.7 0.4 100.0 63.9 391 6+ 47.1 1.0 0.5 51.0 0.5 100.0 48.5 181 Antenatal care visits1 None 25.1 0.0 0.4 72.7 1.8 100.0 25.5 119 1-3 66.3 1.0 2.9 28.8 1.0 100.0 70.2 523 4+ 75.4 4.2 4.3 15.8 0.2 100.0 83.9 1,917 Residence Urban 79.5 4.4 5.0 10.9 0.2 100.0 88.9 900 Rural 65.7 2.5 3.2 28.0 0.6 100.0 71.4 2,211 Ecological zone Lowlands 77.0 3.9 4.0 14.6 0.4 100.0 85.0 1,733 Foothills 55.6 2.7 1.1 40.2 0.5 100.0 59.4 380 Mountains 61.3 1.6 3.5 32.8 0.8 100.0 66.4 752 Senqu River Valley 65.3 1.5 7.0 25.9 0.3 100.0 73.8 247 District Butha-Buthe 68.8 0.5 3.6 27.0 0.0 100.0 72.8 197 Leribe 77.6 1.5 4.7 15.5 0.8 100.0 83.7 494 Berea 69.4 5.6 3.0 21.7 0.3 100.0 78.0 381 Maseru 73.3 5.6 2.2 18.8 0.1 100.0 81.0 786 Mafeteng 68.6 2.6 4.1 24.0 0.8 100.0 75.3 253 Mohale’s Hoek 71.2 0.7 2.1 26.0 0.0 100.0 74.0 273 Quthing 58.2 0.6 13.0 27.3 0.8 100.0 71.9 173 Qacha’s Nek 62.9 0.0 16.0 20.8 0.2 100.0 78.9 87 Mokhotlong 58.3 0.4 2.2 39.1 0.1 100.0 60.8 203 Thaba-Tseka 63.5 3.9 0.6 30.3 1.8 100.0 68.0 266 Mother’s education No education (48.6) (0.0) (3.1) (48.2) (0.0) 100.0 (51.8) 28 Primary incomplete 53.0 1.1 2.6 42.6 0.4 100.0 56.7 639 Primary complete 65.9 2.0 3.0 28.8 0.2 100.0 70.9 806 Secondary 78.4 3.2 4.3 13.4 0.6 100.0 86.0 1,415 More than secondary 78.6 10.9 6.2 3.7 0.6 100.0 95.7 224 Wealth quintile Lowest 53.2 1.4 2.3 42.5 0.5 100.0 56.9 665 Second 61.8 1.0 3.0 34.1 0.0 100.0 65.9 624 Middle 75.4 1.4 3.4 18.8 1.0 100.0 80.2 621 Fourth 79.3 4.1 5.7 10.1 0.8 100.0 89.1 630 Highest 80.7 7.7 4.6 7.1 0.0 100.0 92.9 572 Total 69.7 3.0 3.8 23.0 0.5 100.0 76.5 3,112 Notes: Figures in parentheses are based on 25-49 unweighted cases. Total includes 1 birth for whom information on place of delivery was missing. 1 Includes only the most recent birth in the 5 years preceding the survey 136 • Maternal Health Care Table 9.6 Assistance during delivery Percent distribution of live births in the 5 years preceding the survey by person providing assistance during delivery, percentage of birth assisted by a skilled provider and percentage delivered by caesarean-section, according to background characteristics, Lesotho 2014 Person providing assistance during delivery Percentage delivered by a skilled provider1 Percentage delivered by C-section Number of births Background characteristic Doctor Nurse/ midwife Village health worker Traditional healer Relative/ friend No one Total Mother’s age at birth <20 17.5 65.0 4.2 0.6 12.7 0.0 100.0 82.5 10.3 616 20-34 16.7 61.4 4.8 0.3 15.6 1.0 100.0 78.1 9.0 2,158 35-49 19.3 49.1 7.0 0.0 22.7 1.9 100.0 68.4 12.9 338 Birth order 1 20.9 66.0 3.6 0.6 8.6 0.2 100.0 86.9 13.9 1,217 2-3 15.9 61.5 5.0 0.2 16.9 0.5 100.0 77.3 7.6 1,322 4-5 12.5 52.1 8.2 0.1 22.7 3.8 100.0 64.6 4.8 391 6+ 10.9 39.3 6.4 0.0 41.3 2.1 100.0 50.2 7.1 181 Antenatal care visits2 None 8.5 18.5 10.0 0.0 55.0 8.1 100.0 26.9 5.5 119 1-3 12.4 59.0 5.5 0.9 21.3 0.4 100.0 71.5 6.6 523 4+ 20.6 64.7 4.3 0.1 9.8 0.5 100.0 85.3 11.6 1,917 Don’t know * * * * * * 100.0 * * 17 Place of delivery Health facility 22.3 77.4 0.0 0.0 0.0 0.2 100.0 99.7 12.7 2,380 Elsewhere 0.2 6.7 20.9 1.4 67.3 3.0 100.0 7.0 0.0 731 Residence Urban 21.6 68.1 2.1 0.5 6.7 0.8 100.0 89.7 12.1 900 Rural 15.3 57.8 6.1 0.2 19.5 0.9 100.0 73.1 8.7 2,211 Ecological zone Lowlands 21.2 64.9 3.1 0.4 9.5 0.9 100.0 86.1 11.8 1,733 Foothills 12.4 48.3 8.2 0.3 28.5 2.2 100.0 60.7 6.4 380 Mountains 9.7 59.1 7.0 0.2 23.4 0.3 100.0 68.8 6.8 752 Senqu River Valley 18.8 56.0 6.2 0.0 18.0 0.5 100.0 74.9 8.5 247 District Butha-Buthe 13.5 63.8 8.0 0.2 13.1 1.2 100.0 77.3 9.0 197 Leribe 18.9 66.2 1.8 0.0 11.7 1.4 100.0 85.0 11.7 494 Berea 20.5 59.1 3.2 0.5 16.5 0.3 100.0 79.5 12.5 381 Maseru 20.1 61.9 3.4 0.4 12.7 1.1 100.0 82.0 10.6 786 Mafeteng 19.5 55.5 8.2 0.4 14.8 1.6 100.0 75.1 9.2 253 Mohale’s Hoek 16.7 58.0 7.1 0.8 17.2 0.2 100.0 74.7 6.2 273 Quthing 16.7 56.1 2.2 0.0 23.6 0.9 100.0 72.8 9.2 173 Qacha’s Nek 17.7 61.6 3.8 0.4 15.7 0.8 100.0 79.3 10.9 87 Mokhotlong 8.7 54.1 9.0 0.3 27.3 0.4 100.0 62.8 3.8 203 Thaba-Tseka 7.7 63.3 9.1 0.4 19.5 0.0 100.0 71.0 8.2 266 Mother’s education No education (4.1) (44.5) (6.1) (0.0) (40.2) (5.0) 100.0 (48.6) (3.9) 28 Primary incomplete 10.7 48.7 7.6 0.1 30.9 1.6 100.0 59.4 7.0 639 Primary complete 14.7 57.3 7.1 0.5 19.2 1.0 100.0 72.0 7.7 806 Secondary 20.4 66.7 2.8 0.4 9.0 0.5 100.0 87.1 11.0 1,415 More than secondary 25.0 72.2 2.4 0.0 0.3 0.1 100.0 97.2 17.1 224 Wealth quintile Lowest 8.2 51.9 8.8 0.3 29.5 1.0 100.0 60.1 5.5 665 Second 13.1 54.1 8.0 0.3 23.2 1.0 100.0 67.2 5.0 624 Middle 19.9 60.9 3.0 0.5 14.3 1.3 100.0 80.8 11.3 621 Fourth 22.1 67.8 2.5 0.0 6.9 0.6 100.0 89.9 12.7 630 Highest 23.4 70.5 1.8 0.5 3.3 0.4 100.0 94.0 14.5 572 Total 17.1 60.8 4.9 0.3 15.8 0.9 100.0 77.9 9.7 3,112 Notes: If the respondent mentioned more than one person attending during delivery, only the most qualified person is considered in this tabulation. 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. Total includes 2 births for which information on assistance during delivery is missing, and 1 birth for which information on place of delivery is missing. 1 Skilled provider includes doctor and nurse/midwife 2 Includes only the most recent birth in the 5 years preceding the survey. Maternal Health Care • 137 Table 9.7 Timing of first postnatal check for the mother Among women age 15-49 giving birth in the 2 years preceding the survey, the percent distribution of the mother’s first postnatal check for the last live birth by time after delivery, and the percentage of women with a live birth in the 2 years preceding the survey who received a postnatal check in the first two days after giving birth, according to background characteristics, Lesotho 2014 Time after delivery of mother’s first postnatal check No postnatal check1 Total Percentage of women with a postnatal check in the first 2 days after birth2 Number of women Background characteristic Less than 4 hours 4-23 hours 1-2 days 3-6 days 7-41 days Don’t know Mother’s age at birth <20 26.9 20.0 16.2 1.7 6.3 4.2 24.9 100.0 63.0 279 20-34 23.5 20.7 17.6 1.5 8.0 3.0 25.6 100.0 61.9 945 35-49 23.1 22.7 15.0 1.8 6.5 1.2 29.7 100.0 60.8 145 Birth order 1 26.5 20.1 19.0 1.6 7.6 4.6 20.7 100.0 65.5 592 2-3 24.7 20.8 16.9 1.7 7.7 2.4 25.8 100.0 62.4 571 4-5 13.1 25.6 15.8 2.1 7.1 1.0 35.4 100.0 54.5 131 6+ 21.2 17.8 4.6 0.0 5.9 0.0 50.5 100.0 43.6 75 Place of delivery Health facility 28.9 24.9 20.3 1.4 6.8 3.8 13.8 100.0 74.1 1,104 Elsewhere 4.3 3.6 3.5 2.4 10.2 0.0 76.0 100.0 11.4 265 Residence Urban 27.6 23.4 18.7 2.0 8.3 4.9 15.1 100.0 69.7 357 Rural 22.9 19.9 16.5 1.5 7.2 2.4 29.7 100.0 59.2 1,012 Ecological zone Lowlands 26.8 21.6 20.9 2.1 7.7 3.8 17.0 100.0 69.3 745 Foothills 18.8 19.9 14.4 1.4 7.7 3.8 33.9 100.0 53.1 172 Mountains 20.9 19.9 11.4 0.9 6.0 1.2 39.6 100.0 52.2 343 Senqu River Valley 24.4 19.2 12.6 0.8 10.0 2.7 30.1 100.0 56.3 109 District Butha-Buthe 24.0 19.2 20.2 2.5 9.6 5.5 19.1 100.0 63.4 94 Leribe 20.1 28.8 23.4 2.4 6.3 3.8 15.3 100.0 72.2 212 Berea 23.6 18.5 20.5 1.5 9.3 3.8 22.8 100.0 62.6 176 Maseru 29.8 21.1 12.7 0.9 7.4 2.8 25.3 100.0 63.6 334 Mafeteng 20.3 18.7 27.2 3.8 7.5 3.1 19.5 100.0 66.1 100 Mohale’s Hoek 26.0 15.5 19.9 1.8 2.8 4.8 29.1 100.0 61.4 137 Quthing 16.8 23.8 14.2 1.7 8.5 0.6 34.4 100.0 54.9 80 Qacha’s Nek 24.0 22.7 19.4 0.0 3.9 0.0 29.9 100.0 66.2 34 Mokhotlong 19.0 18.3 3.6 0.3 11.7 1.9 45.2 100.0 40.9 91 Thaba-Tseka 26.7 17.2 9.5 0.9 7.9 0.9 36.9 100.0 53.4 111 Education No education * * * * * * * 100.0 * 6 Primary incomplete 17.3 19.6 10.5 0.8 6.0 4.5 41.4 100.0 47.3 254 Primary complete 21.8 19.7 13.8 1.7 6.2 2.4 34.4 100.0 55.2 337 Secondary 26.8 20.4 21.1 1.9 9.0 2.8 18.0 100.0 68.2 690 More than secondary 33.1 31.4 17.9 1.4 4.8 3.9 7.5 100.0 82.5 82 Wealth quintile Lowest 19.7 12.4 13.5 0.4 7.1 1.8 45.0 100.0 45.6 310 Second 19.3 21.2 12.9 1.8 10.0 3.0 31.7 100.0 53.5 271 Middle 24.4 23.1 20.6 2.5 5.0 3.3 21.1 100.0 68.1 293 Fourth 27.9 22.2 18.1 2.1 8.9 4.2 16.6 100.0 68.2 282 Highest 31.5 27.3 21.2 1.2 6.2 3.2 9.4 100.0 79.9 213 Total 24.2 20.8 17.0 1.6 7.5 3.1 25.9 100.0 62.0 1,369 Note: An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. 1 Includes women who received a check after 41 days 2 Postnatal check from a doctor, nurse/midwife, or village health worker 138 • Maternal Health Care Table 9.8 Type of provider of first postnatal check for the mother Among women age 15-49 giving birth in the 2 years preceding the survey, the percent distribution by type of provider of the mother’s first postnatal health check in the 2 days after the last live birth, according to background characteristics, Lesotho 2014 Type of health provider of mother’s first postnatal check No postnatal check in the first 2 days after birth Total Number of women Background characteristic Doctor Nurse/midwife Village health worker Mother’s age at birth <20 12.6 50.1 0.3 37.0 100.0 279 20-34 11.1 50.1 0.7 38.1 100.0 945 35-49 18.7 42.1 0.0 39.2 100.0 145 Birth order 1 13.2 51.7 0.6 34.5 100.0 592 2-3 12.0 50.2 0.3 37.6 100.0 571 4-5 11.0 42.3 1.1 45.5 100.0 131 6+ 8.6 34.6 0.5 56.4 100.0 75 Place of delivery Health facility 15.0 59.2 0.0 25.9 100.0 1,104 Elsewhere 0.9 7.9 2.6 88.6 100.0 265 Residence Urban 14.1 55.6 0.0 30.3 100.0 357 Rural 11.6 47.0 0.7 40.8 100.0 1,012 Ecological zone Lowlands 15.0 54.2 0.2 30.7 100.0 745 Foothills 6.8 45.0 1.4 46.9 100.0 172 Mountains 7.7 43.8 0.6 47.8 100.0 343 Senqu River Valley 16.4 39.1 0.8 43.7 100.0 109 District Butha-Buthe 12.9 48.8 1.7 36.6 100.0 94 Leribe 10.1 61.4 0.7 27.8 100.0 212 Berea 9.8 52.8 0.0 37.4 100.0 176 Maseru 17.3 46.3 0.0 36.4 100.0 334 Mafeteng 13.7 52.4 0.0 33.9 100.0 100 Mohale’s Hoek 10.1 50.1 1.3 38.6 100.0 137 Quthing 16.0 38.9 0.0 45.1 100.0 80 Qacha’s Nek 15.4 50.7 0.0 33.8 100.0 34 Mokhotlong 6.0 34.5 0.4 59.1 100.0 91 Thaba-Tseka 7.3 44.6 1.6 46.6 100.0 111 Education No education * * * * 100.0 6 Primary incomplete 7.8 39.2 0.3 52.7 100.0 254 Primary complete 10.1 44.8 0.3 44.8 100.0 337 Secondary 14.6 52.9 0.7 31.8 100.0 690 More than secondary 15.7 66.8 0.0 17.5 100.0 82 Wealth quintile Lowest 6.3 38.6 0.6 54.4 100.0 310 Second 10.2 41.7 1.5 46.5 100.0 271 Middle 14.2 53.9 0.0 31.9 100.0 293 Fourth 15.1 52.8 0.3 31.8 100.0 282 Highest 16.9 63.0 0.0 20.1 100.0 213 Total 12.2 49.2 0.5 38.0 100.0 1,369 Note: An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. Maternal Health Care • 139 Table 9.9 Timing of first postnatal check for the newborn Percent distribution of last births in the 2 years preceding the survey by time after birth of first postnatal check, and the percentage of births with a postnatal check in the first 2 days after birth, according to background characteristics, Lesotho 2014 Time after birth of newborn’s first postnatal check No postnatal check1 Total Percentage of births with a postnatal check in the first 2 days after birth2 Number of births Background characteristic Less than 1 hour 1-3 hours 4-23 hours 1-2 days 3-6 days Don’t know Mother’s age at birth <20 1.4 6.6 5.7 5.0 3.2 2.3 75.8 100.0 18.7 279 20-34 1.5 6.8 4.6 5.4 2.7 1.5 77.6 100.0 18.3 945 35-49 2.4 2.9 3.9 8.7 3.5 0.2 78.4 100.0 17.8 145 Birth order 1 0.9 7.8 5.4 5.7 3.1 2.7 74.4 100.0 19.8 592 2-3 2.2 6.3 4.4 5.6 2.6 0.7 78.0 100.0 18.7 571 4-5 2.9 1.6 3.3 8.0 3.1 0.2 80.9 100.0 15.7 131 6+ 0.0 2.7 4.4 1.8 2.7 0.0 88.5 100.0 8.9 75 Place of delivery Health facility 1.9 7.3 5.2 5.4 2.2 1.8 76.2 100.0 19.8 1,104 Elsewhere 0.2 2.3 3.1 6.9 5.6 0.0 81.9 100.0 12.5 265 Residence Urban 2.5 7.3 3.3 4.9 3.4 2.7 75.9 100.0 18.0 357 Rural 1.3 6.0 5.3 6.0 2.7 1.1 77.8 100.0 18.5 1,012 Ecological zone Lowlands 1.1 6.8 4.2 6.0 3.2 1.7 76.9 100.0 18.1 745 Foothills 0.5 2.3 1.9 5.5 3.8 0.0 86.0 100.0 10.2 172 Mountains 3.2 5.0 6.1 4.4 1.9 1.3 78.1 100.0 18.7 343 Senqu River Valley 1.8 13.3 8.7 7.8 1.9 2.9 63.6 100.0 31.6 109 District Butha-Buthe 1.6 2.9 4.5 5.5 3.3 0.9 81.3 100.0 14.5 94 Leribe 0.0 5.4 3.1 7.6 2.6 1.7 79.6 100.0 16.1 212 Berea 1.2 10.5 3.3 5.7 1.8 1.3 76.1 100.0 20.8 176 Maseru 2.2 5.3 3.5 1.4 2.8 1.6 83.4 100.0 12.2 334 Mafeteng 0.8 7.5 3.0 12.8 6.7 0.0 69.3 100.0 24.1 100 Mohale’s Hoek 1.4 6.4 6.7 8.6 2.8 2.1 72.1 100.0 23.0 137 Quthing 4.8 6.6 12.7 11.4 2.0 0.3 62.3 100.0 35.5 80 Qacha’s Nek 3.4 8.0 8.6 10.0 3.6 1.9 64.5 100.0 30.0 34 Mokhotlong 1.7 3.7 0.4 1.1 2.9 0.9 89.2 100.0 7.0 91 Thaba-Tseka 1.4 8.0 10.1 3.6 1.7 3.4 71.9 100.0 23.1 111 Mother’s education No education * * * * * * * 100.0 * 6 Primary incomplete 2.3 6.0 4.7 8.9 2.9 1.4 73.8 100.0 21.9 254 Primary complete 0.8 4.4 5.0 3.7 2.7 1.4 82.0 100.0 13.8 337 Secondary 1.5 7.5 5.0 5.8 2.7 1.6 75.9 100.0 19.7 690 More than secondary 4.0 6.2 2.1 3.6 5.1 0.8 78.3 100.0 15.8 82 Wealth quintile Lowest 0.1 5.1 4.7 5.8 3.7 1.3 79.3 100.0 15.7 310 Second 2.0 6.2 4.1 5.8 2.4 1.0 78.6 100.0 18.1 271 Middle 1.2 7.3 6.0 5.2 2.8 0.4 77.1 100.0 19.7 293 Fourth 2.9 6.0 3.0 7.3 2.1 3.9 74.9 100.0 19.1 282 Highest 2.0 7.4 6.4 4.0 3.2 0.8 76.3 100.0 19.7 213 Total 1.6 6.3 4.8 5.7 2.9 1.5 77.3 100.0 18.4 1,369 Note: An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. 1 Includes newborns who received a check after the first week 2 Postnatal check from a doctor, nurse/midwife, or village health worker 140 • Maternal Health Care Table 9.10 Type of provider of first postnatal check for the newborn Percent distribution of last births in the 2 years preceding the survey by type of provider of the newborn’s first postnatal health check during the 2 days after the last live birth, according to background characteristics, Lesotho 2014 Type of health provider of newborn’s first postnatal check No postnatal check in the first 2 days after birth Total Number of births Background characteristic Doctor Nurse/midwife Village health worker Mother’s age at birth <20 4.0 14.5 0.3 81.3 100.0 279 20-34 3.8 14.1 0.4 81.7 100.0 945 35-49 7.7 10.1 0.0 82.2 100.0 145 Birth order 1 5.0 14.7 0.1 80.2 100.0 592 2-3 3.4 14.7 0.6 81.3 100.0 571 4-5 5.2 10.5 0.0 84.3 100.0 131 6+ 2.8 5.6 0.5 91.1 100.0 75 Place of delivery Health facility 4.9 14.8 0.0 80.2 100.0 1,104 Elsewhere 1.3 9.5 1.7 87.5 100.0 265 Residence Urban 6.2 11.8 0.0 82.0 100.0 357 Rural 3.5 14.5 0.4 81.5 100.0 1,012 Ecological zone Lowlands 6.0 11.9 0.3 81.9 100.0 745 Foothills 0.7 9.5 0.0 89.8 100.0 172 Mountains 1.5 16.5 0.7 81.3 100.0 343 Senqu River Valley 6.5 25.1 0.0 68.4 100.0 109 District Butha-Buthe 1.5 12.2 0.8 85.5 100.0 94 Leribe 3.6 11.6 1.0 83.9 100.0 212 Berea 5.5 14.4 0.8 79.2 100.0 176 Maseru 6.2 6.0 0.0 87.8 100.0 334 Mafeteng 5.4 18.7 0.0 75.9 100.0 100 Mohale’s Hoek 1.3 21.7 0.0 77.0 100.0 137 Quthing 8.0 27.5 0.0 64.5 100.0 80 Qacha’s Nek 6.1 23.9 0.0 70.0 100.0 34 Mokhotlong 1.1 5.4 0.4 93.0 100.0 91 Thaba-Tseka 1.5 21.5 0.0 76.9 100.0 111 Mother’s education No education * * * * 100.0 6 Primary incomplete 3.2 17.9 0.8 78.1 100.0 254 Primary complete 2.1 11.2 0.5 86.2 100.0 337 Secondary 5.4 14.2 0.1 80.3 100.0 690 More than secondary 6.6 9.3 0.0 84.2 100.0 82 Wealth quintile Lowest 1.5 13.1 1.1 84.3 100.0 310 Second 3.5 14.1 0.4 81.9 100.0 271 Middle 4.9 14.8 0.0 80.3 100.0 293 Fourth 4.6 14.5 0.0 80.9 100.0 282 Highest 7.6 12.1 0.0 80.3 100.0 213 Total 4.2 13.8 0.3 81.6 100.0 1,369 Note: An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. Maternal Health Care • 141 Table 9.11 Problems in accessing health care Percentage of women age 15-49 who reported that they have serious problems in accessing health care for themselves when they are sick, by type of problem, according to background characteristics, Lesotho 2014 Problems in accessing health care Background characteristic Getting permission to go for treatment Getting money for treatment Distance to health facility Not wanting to go alone At least one problem accessing health care Number of women Age 15-19 4.3 25.3 24.9 13.1 42.3 1,440 20-34 4.1 26.7 26.1 8.9 41.4 3,376 35-49 2.1 29.9 25.0 5.9 42.1 1,805 Number of living children 0 3.8 23.9 21.3 11.9 39.0 2,152 1-2 3.9 26.3 24.7 7.2 40.0 2,897 3-4 2.5 31.2 29.8 7.6 45.1 1,169 5+ 3.7 41.7 41.9 10.1 59.4 403 Marital status Never married 4.0 25.8 20.9 11.3 39.5 2,190 Married or living together 3.6 26.8 28.2 8.1 42.2 3,612 Divorced/separated/widowed 2.8 33.6 26.1 6.6 45.7 819 Employed last 12 months Not employed 3.4 28.4 29.9 10.6 45.4 3,548 Employed for cash 3.5 25.5 18.3 6.5 35.6 2,615 Employed not for cash 5.7 29.3 33.3 10.6 48.8 458 Residence Urban 3.5 21.2 10.9 6.6 28.5 2,419 Rural 3.7 30.8 34.0 10.3 49.4 4,202 Ecological zone Lowlands 3.3 26.2 18.4 7.6 36.8 4,184 Foothills 5.9 35.3 41.1 12.8 55.8 688 Mountains 3.4 25.9 36.2 10.5 46.6 1,288 Senqu River Valley 3.3 28.8 37.6 11.6 52.4 461 District Butha-Buthe 3.4 26.7 27.3 7.1 42.4 385 Leribe 4.5 30.7 24.4 9.4 44.2 1,064 Berea 3.9 28.6 24.3 8.1 42.1 892 Maseru 4.0 26.2 19.2 7.5 36.2 1,864 Mafeteng 2.4 24.4 24.9 11.6 40.0 576 Mohale’s Hoek 1.7 23.3 29.0 8.3 42.8 519 Quthing 6.5 25.3 28.0 9.9 41.1 315 Qacha’s Nek 3.1 26.4 23.3 11.9 42.5 204 Mokhotlong 1.5 26.3 34.3 10.8 45.8 349 Thaba-Tseka 3.0 32.6 44.8 11.5 56.0 452 Education No education 4.6 45.4 49.8 21.5 68.7 68 Primary incomplete 4.8 35.8 38.0 12.7 54.7 1,178 Primary complete 3.6 33.5 34.8 9.0 49.6 1,375 Secondary 3.7 24.3 19.8 8.0 37.3 3,418 More than secondary 0.8 11.3 9.2 5.8 19.9 581 Wealth quintile Lowest 5.0 36.7 48.4 14.2 61.4 960 Second 4.9 33.3 39.2 10.4 53.5 1,033 Middle 2.7 34.2 29.4 7.9 48.3 1,244 Fourth 3.0 23.2 16.5 8.6 35.7 1,605 Highest 3.3 17.6 10.8 6.3 25.3 1,778 Total 3.6 27.3 25.5 9.0 41.8 6,621 Child Health • 143 CHILD HEALTH 10 Key Findings  Vaccination: Sixty-eight percent of children age 12-23 months had received all basic vaccinations at the time of the survey, up from 62% in 2009, but equivalent to the coverage observed in the 2004 LDHS.  Symptoms of acute respiratory infection (ARI): Five percent of children under age 5 had symptoms of an ARI in the 2 weeks before the survey. Sixty-three percent of these children were taken to a health facility or provider for advice or treatment.  Fever: Fifteen percent of children under age 5 had a fever in the 2 weeks before the survey, and 61% of these children were taken to a health facility or provider for advice or treatment.  Diarrhoea: Twelve percent of children under age 5 had diarrhoea in the 2 weeks before the survey, and 75% received oral rehydration therapy (ORT). Eighteen percent of the children with diarrhoea went untreated. nformation on child health and survival can help policymakers and programme managers assess the efficacy of current strategies, formulate appropriate interventions to prevent deaths from childhood illnesses, and improve the health of children in Lesotho. This chapter presents information on birth weight and vaccination status for young children. It also looks at the prevalence of, and treatment practices for, three common childhood illnesses: symptoms of acute respiratory infection (ARI), fever, and diarrhoea. Because appropriate sanitary practices can help prevent and reduce the severity of diarrhoeal disease, information is also provided on the disposal of children’s faecal matter. 10.1 BIRTH WEIGHT Low birth weight Percentage of births with a reported birth weight < 2.5 kilograms regardless of gestational age Sample: Live births in the 5 years before the survey that have a reported birth weight, either from a written record or mother’s report Birth weight is an important indicator when assessing a child’s health in terms of early exposure to childhood morbidity and mortality. Children who weigh less than 2.5 kilograms at birth, or are reported to be very small or smaller than average, are considered to have a higher-than-average risk of early childhood death. In the 2014 LDHS, birth weight was recorded based on either a written record or the mother’s report. The mother’s estimate of the infant’s size at birth was also obtained because birth weight is unknown for many infants. I 144 • Child Health Written records or mother’s reports of birth weight were available for 83% of live births in the 5 years before the survey. Ten percent of these infants had a low birth weight of less than 2.5 kg (Table 10.1). Birth weights were available for only 59% of highest order births, 66% of births in Mokhotlong, and 68% of births in the lowest wealth quintile, and thus are under-represented; therefore, the pattern of birth weights by background characteristics may be biased and should be interpreted with caution. Table 10.1 also includes information on a mother’s estimate of her infant’s size at birth. Although the mother’s estimate of size is subjective, it can be a useful proxy for the child’s weight. Four percent of births are reported as very small, 10% as smaller than average, and 85% as average or larger than average. 10.2 VACCINATION OF CHILDREN All basic vaccinations coverage 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). To have received all basic vaccinations, a child must receive at least:  one dose of BCG vaccine, which protects against tuberculosis  three doses of DPT, which protects against diphtheria, pertussis (whooping cough), and tetanus  three doses of polio vaccine  one dose of measles vaccine Sample: Living children age 12-23 months Sixty-eight percent of children age 12-23 months received all basic vaccinations at any time before the survey (Table 10.2). Coverage was highest for the first dose of DPT1 (98%), and the two vaccines that require just one dose: BCG and measles (98% and 90%, respectively) (Figure 10.1). Eighty- five percent of children received the third dose of DPT and 76% of children received the third dose of polio vaccine. The difference between the percentages of children receiving the first and third doses is 13 percentage points for DPT and 20 percentage points for polio. One percent of children age 12-23 months had not received any vaccinations by the time of the survey. Table 10.2 also shows vaccination coverage for each vaccination which was given by the time the child reached age 12 months, which gives some idea about the percentage of children receiving vaccines on time. Overall, 60% of children have received the recommended vaccinations by age 12 months. 1 Children typically received DPT as part of DPT-HepB-Hib or DTap-IPV-Hib depending on whether they followed the immunisation schedule of Lesotho or the Republic of South Africa. Figure 10.1 Childhood vaccinations 98 98 95 85 96 89 76 90 68 1 BCG 1 2 3 1 2 3 All None Percentage of children age 12-23 months vaccinated at any time before the survey Measles basicPolioDPT/Pentavalent Child Health • 145 Trends: The proportion of children 12-23 months in Lesotho who have received all basic vaccinations has dropped from 68% in 2004 to 62% in 2009, before rebounding to 68% in 2014 (Figure 10.2). Over this same period, the proportion of children who have received no vaccinations has remained low, fluctuating between 1% and 3%. Patterns by background characteristics  Girls are as likely as boys to have received all basic vaccinations (68%) (Table 10.3).  Differences in vaccination coverage by residence are small with one exception: 92% of children in urban areas received Polio 0 compared with 83% in rural areas.  Vaccination coverage varies across districts (Figure 10.3). The proportion of children who received all basic vaccinations ranges from a low of 48% in Mokhotlong to a high of 80% in Mafeteng. Vaccination card ownership and availability Vaccination cards are a critical tool in ensuring a child receives all recommended vaccinations on schedule. The proportion of children who ever had a vaccination card or booklet was nearly 100% (Table 10.3). Not all mothers were able to produce their child’s vaccination card at the time of the interview; only 77% of vaccination cards were seen. For 4% of children, a vaccination card from South Africa was shown to the interviewer. For additional information on vaccinations in the first year of life, see Table 10.4. 10.3 SYMPTOMS OF ACUTE RESPIRATORY INFECTION Mothers reported that 5% of children under age 5 had symptoms of ARI in the 2 weeks before the survey. The prevalence of ARI peaks at 6% among children age 12-23 months (Table 10.5). Treatment of ARI symptoms Children with ARI symptoms for whom advice or treatment was sought from a health facility or provider. ARI symptoms consist of cough accompanied by (1) short, rapid breathing that is chest-related, and/or (2) difficult breathing that is chest-related. Sample: Children under age 5 with symptoms of ARI in the 2 weeks before the survey Figure 10.2 Trends in childhood vaccinations Figure 10.3 Vaccination coverage by district Percentage of children age 12-23 months who received all basic vaccinations at any time before the survey 68 62 68 2 3 1 2004 2009 2014 Percentage of children age 12-23 months who received all basic vaccinations at any time before the survey No vaccinations All basic vaccinations 146 • Child Health Almost two-thirds (63%) of children with ARI symptoms were taken to a health facility or provider for advice or treatment (Table 10.5). Sixteen percent of children with symptoms received antibiotics. 10.4 FEVER Fever is a symptom of numerous illnesses including pneumonia, common cold, and influenza. Mothers reported that 15% of children under age 5 were ill with fever in the 2 weeks before the survey. Prevalence of fever peaks at 19% among children age 6-23 months (Table 10.6). Treatment of fever Children with fever for whom advice or treatment was sought from a health facility or provider Sample: Children under age 5 with fever in the 2 weeks before the survey Sixty-one percent of children with fever were taken to a health facility or provider for advice or treatment and 24% received an antibiotic (Table 10.6). Trends: Help-seeking for fever has increased since 2004, when 56% of children with fever were taken to a health facility or provider for advice or treatment compared with 61% in 2014. 10.5 DIARRHOEAL DISEASE 10.5.1 Prevalence of Diarrhoea Mothers reported that 12% of children under age 5 had a diarrhoeal episode in the 2 weeks before the survey and that 1% had blood in the stool (Table 10.7). The prevalence of diarrhoea rises rapidly (from 6% to 22%) after age 6 months, when children are typically introduced to complementary foods. Prevalence remains high at age 12-23 months, about the time when children start to walk and are at increased risk of contamination from the environment. The introduction of other liquids and foods at the time of weaning can also facilitate the spread of disease-causing microbes (Figure 10.4). Patterns by background characteristics  Urban children are slightly less likely to have diarrhoea than rural children (10% versus 13%).  The prevalence of diarrhoea is slightly higher for children living in households with unimproved toilets than for children living in households with improved, not-shared toilets (13% and 11%, respectively). Similarly, the prevalence of diarrhoea is slightly higher for children in households in which the source of drinking water is unimproved compared with those in households with an improved source of drinking water (14% versus 11%). Figure 10.4 Diarrhoea prevalence by age 6 22 22 9 6 5 12 <6 6-11 12-23 24-35 36-47 48-59 Total Percentage of children under age 5 who had diarrhoea in the 2 weeks preceding the survey Age in months Child Health • 147 10.5.2 Treatment of Diarrhoea Fifty-one percent of children with diarrhoea were taken to a health facility or provider for advice or treatment (Table 10.8). Oral rehydration therapy Children with diarrhoea are given a fluid made from a special packet of oral rehydration salts (ORS) or government-recommended homemade fluids (RHF). Sample: Children under age 5 with diarrhoea in the 2 weeks before the survey Oral rehydration therapy (ORT) is a simple and effective way to reduce dehydration caused by diarrhoea. Most children with diarrhoea (75%) receive some form of ORT, either ORS packets (53%) or recommended home fluids (RHF) (52%) or both (Figure 10.5). Almost four in five children receive either ORT or increased fluids. While 16% of children receive antibiotics, less than 1% are given zinc supplements, which can reduce the duration and severity of diarrhoea. Eighteen percent of children with diarrhoea do not receive any treatment. Trends: The proportion of children with diarrhoea who were taken to a health facility or provider increased from 31% in 2004 to 53% in 2009, before dropping slightly to 51% in 2014. Over this same time period, the proportion of children with diarrhoea who received fluids from ORS packets rose from 42% in 2004, to 51% in 2009, and to 53% in 2014, while the proportion who received RHF decreased slightly, from 55% in both 2004 and 2009, to 52% today. The percentage of children who receive no treatment also increased slightly, from 15% in 2004 to 18% in 2009, where it remains today. Patterns by background characteristics  Rural children with diarrhoea are more likely than urban children to be taken to a health facility or provider (54% versus 42%). However, a greater proportion of rural than urban children with diarrhoea go untreated (21% versus 11%).  Children are more likely to be taken to a health facility or provider if their mothers are in the lowest quintile, compared with other wealth quintiles. 10.5.3 Feeding Practices Appropriate feeding practices Children with diarrhoea are given more liquids than usual, and as much food or more than usual. Sample: Children under age 5 with diarrhoea in the 2 weeks before the survey Figure 10.5 Treatment of diarrhoea 18 23 16 79 22 75 52 53 51 No treatment Home remedy/other Antibiotics ORT or increased fluids Increased fluids ORS or RHF Recommended Home Fluids Fluid from ORS packet Taken to a health provider Percentage of children under age 5 with diarrhoea in the 2 weeks before the survey 148 • Child Health To reduce dehydration and minimise the effects of diarrhoea on nutritional status, mothers are encouraged to continue normal feeding of children with diarrhoea and to increase the amount of fluids given. Twenty-two percent of children under 5 with diarrhoea in the 2 weeks before the survey were given more liquids than usual, as recommended. More than 50% received the same amount of liquids as usual. Of greater concern, mothers gave less or no fluid to 27% of sick children (Figure 10.6). With regard to food intake during a diarrhoea episode, 52% of children with diarrhoea are fed according to the recommended practice of giving either more food or the same amount of food as usual. Forty-three percent of children are given less food than usual, while 2% received no food during diarrhoea. For additional information on feeding practices during diarrhoea, see Table 10.9. 10.5.4 Knowledge of ORS Packets About nine in ten women (89%) in Lesotho know of ORS packets for the treatment of diarrhoea (Table 10.10). Knowledge of ORS packets is highest in urban areas (93%) and among women with more than secondary education (98%) and those in the wealthiest households (96%). Treatment of Childhood Illness In summary, during the 2 weeks before the survey, fever was the most common illness reported among children under age 5. But it is children with ARI symptoms who are most often taken for advice or treatment (63%) (Figure 10.7). Professional advice is sought less often when children have fever (61%) or diarrhoea (51%). 10.5.5 Men’s Knowledge of Feeding Practices during Diarrhoea Men age 15-49 whose youngest, living child was born in the last 2 years were asked about feeding practices during diarrhoea. Thirty-seven percent of men correctly stated that a child with diarrhoea should receive more to drink than usual (Table 10.11). Twenty-one percent indicated that a child with diarrhoea should receive about the same amount of liquids as usual, 12% stated they should be given less than usual to drink, and 30% did not know how much they should be given to drink. Figure 10.6 Feeding practices during diarrhoea Figure 10.7 Prevalence and treatment of childhood illnesses 4 22 48 51 43 26 2 1 3Food given Liquids given Percentage of children under age 5 with diarrhoea in the 2 weeks before the survey More Same Less None Never gave (compared to usual) (compared to usual) 5 15 12 63 61 51 ARI Fever Diarrhoea ARI Fever Diarrhoea Percentage of children under age 5 with symptoms in the 2 weeks before the survey Among those with illness, percentage from whom advice or treatment was sought from a health facility or provider Child Health • 149 10.6 DISPOSAL OF CHILDREN’S STOOLS Safe disposal of children’s stools The child’s last stools were put or rinsed into a toilet or latrine, or buried, or the child used a toilet or latrine. Sample: Youngest child under age 5 living with the mother Proper disposal of children’s faeces is important to prevent the spread of disease. Sixty-two percent of children under age 5 had their last stool disposed of safely (Table 10.12). Patterns by background characteristics  Children’s stools are more likely to be disposed of safely in households with an improved, non- shared toilet and shared toilet (79% for both) than in households with an unimproved toilet facility (25%).  Safe disposal of children’s stools increases with wealth. Only 24% of children in the lowest wealth quintile had their stools safely disposed of, compared with 86% of children in the highest wealth quintile.  There are large differences in the disposal of children’s stools by district. The proportion of children whose last stool was safely disposed of ranges from a low of 17% in Mokhotlong to a high of 79% in Maseru. LIST OF TABLES For detailed information on low birth weight, vaccinations, childhood illness, and disposal of children’s stools, see the following tables:  Table 10.1 Child’s size and weight at birth  Table 10.2 Vaccinations by source of information  Table 10.3 Vaccinations by background characteristics  Table 10.4 Vaccinations in first year of life  Table 10.5 Prevalence and treatment of symptoms of ARI  Table 10.6 Prevalence and treatment of fever  Table 10.7 Prevalence of diarrhoea  Table 10.8 Diarrhoea treatment  Table 10.9 Feeding practices during diarrhoea  Table 10.10 Knowledge of ORS packets  Table 10.11 Men’s knowledge of feeding practices during diarrhoea  Table 10.12 Disposal of children’s stools 150 • Child Health Table 10.1 Child’s size and weight at birth Percent distribution of live births in the 5 years preceding the survey by mother’s estimate of baby’s size at birth, percentage of live births in the5 years preceding the survey that have a reported birth weight, and among live births in the 5 years preceding the survey with a reported birth weight, percentage less than 2.5 kg, according to background characteristics, Lesotho 2014 Percent distribution of all live births by size of child at birth Percentage of all births that have a reported birth weight1 Number of births Births with a reported birth weight1 Background characteristic Very small Smaller than average Average or larger Don’t know/ missing Total Percentage less than 2.5 kg Number of births Mother’s age at birth <20 5.0 10.4 83.6 1.0 100.0 85.0 616 13.8 524 20-34 3.6 9.9 85.4 1.0 100.0 84.1 2,158 9.7 1,814 35-49 4.0 11.3 83.4 1.3 100.0 76.3 338 8.6 258 Birth order 1 3.7 11.2 84.0 1.2 100.0 89.8 1,217 11.7 1,094 2-3 3.9 9.6 85.6 0.9 100.0 82.9 1,322 9.3 1,097 4-5 4.4 7.9 86.5 1.3 100.0 76.1 391 7.8 298 6+ 5.1 12.1 81.9 0.9 100.0 59.2 181 16.1 107 Mother’s smoking status Smokes cigarettes/ tobacco * * * * 100.0 * 6 * 6 Does not smoke 3.9 10.2 84.8 1.1 100.0 83.4 3,106 10.4 2,589 Residence Urban 3.1 8.1 87.9 0.9 100.0 92.4 900 10.8 832 Rural 4.3 11.0 83.6 1.1 100.0 79.7 2,211 10.2 1,763 Ecological zone Lowlands 3.4 9.9 85.6 1.1 100.0 89.5 1,733 9.9 1,551 Foothills 5.2 10.3 83.0 1.6 100.0 73.3 380 11.6 279 Mountains 4.9 11.3 83.2 0.6 100.0 74.7 752 11.4 562 Senqu River Valley 3.4 8.1 87.4 1.2 100.0 82.4 247 10.0 203 District Butha-Buthe 1.9 9.7 87.9 0.5 100.0 90.9 197 9.5 179 Leribe 3.3 12.7 82.4 1.6 100.0 87.8 494 7.6 433 Berea 5.0 9.4 85.5 0.0 100.0 81.4 381 8.3 310 Maseru 3.5 8.0 87.5 1.0 100.0 85.0 786 10.0 668 Mafeteng 1.3 11.7 85.7 1.4 100.0 88.4 253 13.0 224 Mohale’s Hoek 3.7 9.5 84.3 2.5 100.0 81.5 273 11.2 222 Quthing 5.8 7.2 86.9 0.1 100.0 80.1 173 13.7 138 Qacha’s Nek 2.7 8.9 87.1 1.3 100.0 94.5 87 7.9 83 Mokhotlong 11.1 11.7 76.2 1.0 100.0 66.2 203 15.0 134 Thaba-Tseka 2.8 13.5 82.8 0.9 100.0 76.5 266 13.7 204 Mother’s education No education (9.2) (9.3) (81.5) (0.0) 100.0 (54.3) 28 * 15 Primary incomplete 4.3 11.0 83.1 1.6 100.0 69.3 639 15.2 443 Primary complete 4.1 12.3 83.1 0.4 100.0 78.4 806 9.9 632 Secondary 4.0 9.1 85.7 1.1 100.0 90.8 1,415 9.7 1,285 More than secondary 1.2 6.5 90.9 1.4 100.0 98.5 224 5.6 221 Wealth quintile Lowest 5.4 10.5 82.6 1.5 100.0 67.8 665 15.2 451 Second 3.4 12.6 82.6 1.4 100.0 75.8 624 8.3 473 Middle 4.4 12.4 82.5 0.6 100.0 86.7 621 11.6 539 Fourth 3.3 7.9 87.4 1.4 100.0 92.9 630 8.6 585 Highest 3.0 7.0 89.7 0.3 100.0 95.7 572 9.2 547 Total 3.9 10.2 84.8 1.1 100.0 83.4 3,112 10.4 2,595 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 Based on either a written record or the mother’s recall Child Health • 151 Table 10.2 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 age 12 months, Lesotho 2014. BCG DPT1 Polio2 Measles All basic vaccina- tions3 No vaccina- tions Number of children Source of information 1 2 3 0 1 2 3 Vaccinated at any time before survey Vaccination card 76.2 77.1 76.4 73.2 69.0 75.7 74.7 71.2 71.2 65.3 0.0 505 Mother’s report 21.8 21.1 18.6 12.2 16.4 20.3 13.8 4.5 18.9 3.1 1.0 150 Either source 98.0 98.3 95.0 85.4 85.3 96.0 88.5 75.7 90.1 68.3 1.0 655 Vaccinated by 12 months of age4 97.6 98.3 95.0 83.9 84.3 96.0 88.4 74.9 79.6 60.1 1.1 655 1 Children received DPT as part of DPT-HepB-Hib or DTaP-IPV-Hib depending on whether they followed the immunisation schedule of Lesotho or the Republic of South Africa. 2 Polio 0 is the polio vaccination given at birth. 3 BCG, measles, and three doses each of DPT and polio vaccine (excluding polio vaccine given at birth) 4 For children whose information is based on the mother’s report, the proportion of vaccinations given during the first year of life is assumed to be the same as for children with a written record of vaccination. 152 • Child Health Table 10.3 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, percentage with a vaccination card seen, and percentage with a vaccination card from the Republic of South Africa seen, by background characteristics, Lesotho 2014 BCG DPT1 Polio2 Measles All basic vaccina- tions3 No vaccina- tions Percent- age ever with a vaccination card Percent- age with a vaccination card seen Percent- age with a vaccination card from RSA seen Number of children Background characteristic 1 2 3 0 1 2 3 Sex Male 98.9 99.4 96.7 86.3 85.4 96.2 88.1 76.9 87.6 68.3 0.4 99.9 78.4 3.8 339 Female 97.0 97.0 93.2 84.4 85.2 95.8 88.8 74.3 92.8 68.3 1.6 99.6 75.8 3.5 316 Birth order 1 99.2 98.3 94.5 83.4 85.8 95.2 86.5 74.9 94.3 70.2 0.8 99.9 75.3 4.3 283 2-3 96.7 98.1 95.5 88.0 85.1 96.4 88.7 75.7 88.3 67.0 1.2 99.5 77.6 2.5 259 4-5 96.7 97.8 93.5 82.6 86.3 95.7 92.8 79.0 82.3 65.0 1.4 100.0 81.0 5.1 76 6+ (100.0) (100.0) (98.7) (87.5) (81.7) (100.0) (93.0) (74.4) (87.5) (69.1) (0.0) (100.0) (79.7) (3.8) 37 Residence Urban 98.6 99.3 96.3 82.4 91.7 96.3 87.2 75.8 92.8 70.1 0.7 100.0 72.6 3.4 180 Rural 97.8 97.9 94.5 86.5 82.9 95.9 88.9 75.6 89.1 67.6 1.1 99.6 78.8 3.7 475 Ecological zone Lowlands 98.1 98.5 94.9 85.6 87.4 97.0 89.5 79.0 91.9 71.3 0.7 99.6 77.0 3.3 370 Foothills 97.5 98.9 98.9 89.1 85.6 95.0 85.0 69.2 93.6 65.8 1.1 100.0 78.4 3.4 66 Mountains 97.4 97.0 93.7 81.9 83.8 95.8 89.3 71.6 83.4 62.5 1.8 99.8 75.6 4.6 172 Senqu River Valley 100.0 100.0 95.3 91.2 74.4 90.3 81.9 73.3 96.2 69.4 0.0 100.0 81.8 3.3 46 District Butha-Buthe 97.9 97.9 97.9 86.7 86.8 96.8 93.0 70.6 95.7 70.6 2.1 100.0 72.0 1.4 36 Leribe 98.9 100.0 98.2 90.6 88.2 95.5 90.4 77.1 92.0 69.3 0.0 100.0 76.2 4.3 109 Berea 98.5 95.3 92.2 87.7 85.3 98.5 91.0 80.1 91.8 74.4 1.5 98.5 77.8 3.6 89 Maseru 97.3 100.0 92.6 78.0 87.1 97.6 84.1 75.5 90.9 66.1 0.0 100.0 76.3 2.2 157 Mafeteng 97.6 97.6 97.6 91.8 93.1 97.6 96.1 86.1 91.6 79.5 2.4 100.0 82.5 7.1 51 Mohale’s Hoek 100.0 99.1 98.0 92.3 78.5 88.2 83.3 72.9 92.7 64.9 0.0 100.0 81.8 1.4 64 Quthing 98.7 97.5 92.2 81.5 81.3 96.9 83.5 65.6 86.8 60.1 0.0 100.0 77.0 14.2 36 Qacha’s Nek 97.3 97.3 96.0 88.9 82.0 93.5 90.9 77.1 90.9 74.1 2.7 100.0 76.1 6.8 20 Mokhotlong 95.9 94.5 91.9 67.5 67.4 93.1 84.7 60.3 76.4 47.5 4.1 98.9 69.0 2.8 38 Thaba-Tseka 96.6 98.0 96.0 90.7 90.6 98.0 94.2 79.7 84.8 72.3 2.0 100.0 79.2 0.0 55 Mother’s education No education * * * * * * * * * * * * * * 3 Primary incomplete 96.2 97.6 94.6 83.9 78.3 96.1 86.2 70.3 87.3 61.8 1.3 98.7 77.1 3.2 141 Primary complete 97.1 98.7 96.2 86.2 87.2 97.8 92.1 79.5 87.2 70.4 1.3 100.0 82.3 4.4 142 Secondary 99.2 98.5 95.4 86.0 87.2 96.4 89.0 77.0 92.4 70.0 0.5 100.0 75.5 3.5 332 More than secondary (98.3) (98.3) (89.7) (84.6) (95.0) (89.7) (83.0) (75.2) (94.0) (75.2) (1.7) (100.0) (73.3) (4.8) 36 Wealth quintile Lowest 97.0 97.2 95.0 83.7 75.7 95.6 86.8 67.9 87.6 59.7 1.8 99.7 73.8 2.2 155 Second 96.6 96.8 94.3 80.9 86.7 95.3 87.4 72.2 85.3 62.7 1.6 98.9 78.5 6.3 121 Middle 98.0 98.9 96.1 93.5 88.0 98.0 94.1 85.7 97.1 81.5 0.0 100.0 84.5 2.9 129 Fourth 99.1 99.1 93.6 88.0 90.8 96.5 87.9 79.0 91.0 70.4 0.9 100.0 77.1 5.2 140 Highest 99.5 99.5 96.5 79.7 87.2 94.4 86.0 74.4 89.7 68.4 0.5 100.0 71.7 1.6 109 Total 98.0 98.3 95.0 85.4 85.3 96.0 88.5 75.7 90.1 68.3 1.0 99.7 77.1 3.6 655 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. RSA = Republic of South Africa. 1 Children received DPT as part of DPT-HepB-Hib or DTaP-IPV-Hib depending on whether they followed the immunisation schedule of Lesotho or the Republic of South Africa. 2 Polio 0 is the polio vaccination given at birth. 3 BCG, measles, and three doses each of DPT and polio vaccine (excluding polio vaccine given at birth) Child Health • 153 Table 10.4 Vaccinations in first year of life Percentage of children age 12-59 months at the time of the survey who received specific vaccines by age 12 months, percentage with a vaccination card, percentage with a vaccination card seen, and percentage with a vaccination card from the Republic of South Africa seen, by current age of child, Lesotho 2014 BCG DPT1 Polio2 Measles All basic vaccina- tions3 No vaccina- tions Percent- age ever with a vaccina- tion card Percent- age with a vaccina- tion card seen Percent- age with a vaccina- tion card from RSA seen Number of children Age in months 1 2 3 0 1 2 3 12-23 97.6 98.3 95.0 83.9 84.3 96.0 88.4 74.9 79.6 60.1 1.1 99.7 77.1 3.6 655 24-35 95.8 96.9 92.3 85.5 79.2 95.4 87.9 72.0 75.4 55.8 1.9 99.8 70.4 3.1 572 36-47 94.3 96.1 90.8 82.7 76.9 94.1 84.9 70.1 81.7 56.5 2.9 99.3 64.6 2.1 501 48-59 93.4 94.0 88.1 75.2 73.7 92.3 84.1 59.6 69.7 44.8 4.5 99.8 60.9 2.4 498 Total 95.5 96.5 91.9 82.2 78.9 94.6 86.6 69.7 77.1 54.8 2.4 99.7 68.9 2.9 2,226 Note: Information was obtained from the vaccination card or if there was no written record, from the mother. For children whose information is based on the mother’s report, the proportion of vaccinations given during the first year of life is assumed to be the same as for children with a written record of vaccinations. RSA = Republic of South Africa 1 Children received DPT as part of DPT-HepB-Hib or DTaP-IPV-Hib depending on whether they received they followed the immunisation schedule of Lesotho or the Republic of South Africa. 2 Polio 0 is the polio vaccination given at birth. 3 BCG, measles, and three doses each of DPT/pentavalent and polio vaccine (excluding polio vaccine given at birth) 154 • Child Health Table 10.5 Prevalence and treatment of symptoms of ARI Among children under age 5, the percentage who had symptoms of acute respiratory infection (ARI) in the 2 weeks preceding the survey and among children with symptoms of ARI, the percentage for whom advice or treatment was sought from a health facility or provider and the percentage who received antibiotics as treatment, according to background characteristics, Lesotho 2014 Among children under age 5: Among children under age 5 with symptoms of ARI: Percentage for whom advice or treatment was sought from a health facility or provider2 Percentage who received antibiotics Number of children Background characteristic Percentage with symptoms of ARI1 Number of children Age in months <6 2.7 328 * * 9 6-11 4.2 342 * * 14 12-23 5.8 655 (68.8) (23.7) 38 24-35 5.1 572 (57.3) (15.8) 29 36-47 5.2 501 (76.3) (9.8) 26 48-59 3.7 498 * * 18 Sex Male 4.6 1,432 60.5 10.3 65 Female 4.7 1,464 65.7 20.8 69 Cooking fuel Electricity or gas 4.2 952 (71.9) (8.0) 40 Paraffin 5.6 134 * * 8 Coal/lignite * 4 * * 0 Wood/straw3 5.0 1,567 61.8 20.6 78 Animal dung 3.8 238 * * 9 Residence Urban 3.7 841 * * 31 Rural 5.0 2,055 63.0 19.9 103 Ecological zone Lowlands 4.4 1,617 64.4 9.5 72 Foothills 8.1 348 (55.1) (35.9) 28 Mountains 3.8 703 (74.3) (10.8) 27 Senqu River Valley 3.4 228 * * 8 Mother’s education No education (10.7) 26 * * 3 Primary incomplete 7.0 580 (45.9) (12.5) 41 Primary complete 4.0 748 (77.8) (8.5) 30 Secondary 3.9 1,324 (70.1) (22.9) 52 More than secondary 4.1 217 * * 9 Wealth quintile Lowest 4.7 623 (59.9) (15.4) 29 Second 5.2 583 (66.5) (17.8) 31 Middle 4.3 571 (63.4) (18.4) 25 Fourth 5.0 577 * * 29 Highest 4.0 542 * * 21 Total 4.7 2,896 63.1 15.7 135 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 Symptoms of ARI consist of cough accompanied by short, rapid breathing that was chest-related and/or by difficult breathing that was chest-related. 2 Excludes pharmacy, shop, and traditional practitioner 3 Includes grass, shrubs, and crop residues Child Health • 155 Table 10.6 Prevalence and treatment of fever Among children under age 5, the percentage who had a fever in the 2 weeks preceding the survey; and among children with fever, the percentage for whom advice or treatment was sought from a health facility or provider and the percentage who received antibiotics as treatment, by background characteristics, Lesotho 2014 Among children under age 5: Among children under age 5 with fever: Percentage for whom advice or treatment was sought from a health facility or provider1 Percentage who took antibiotic drugs Number of children Background characteristic Percentage with fever Number of children Age in months <6 9.7 328 (63.5) (4.6) 32 6-11 19.2 342 70.6 26.4 66 12-23 18.8 655 66.3 28.3 123 24-35 14.8 572 52.2 33.0 85 36-47 13.9 501 55.5 8.8 70 48-59 12.2 498 56.9 26.8 61 Sex Male 14.0 1,432 58.8 19.0 201 Female 16.0 1,464 62.9 28.0 235 Residence Urban 13.8 841 60.1 24.3 116 Rural 15.5 2,055 61.3 23.7 319 Ecological zone Lowlands 15.7 1,617 60.3 25.3 254 Foothills 19.3 348 59.4 28.2 67 Mountains 12.7 703 64.2 20.9 90 Senqu River Valley 10.9 228 (61.1) (8.0) 25 Mother’s education No education (16.0) 26 * * 4 Primary incomplete 16.8 580 55.6 15.7 97 Primary complete 14.7 748 67.1 25.3 110 Secondary 15.3 1,324 60.2 28.2 202 More than secondary 10.2 217 * * 22 Wealth quintile Lowest 14.0 623 61.5 17.5 87 Second 14.9 583 59.2 21.6 87 Middle 16.5 571 57.1 21.4 94 Fourth 18.2 577 70.1 23.9 105 Highest 11.5 542 (53.2) (39.4) 63 Total 15.0 2,896 61.0 23.9 436 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 Excludes pharmacy, shop, and traditional practitioner 156 • Child Health Table 10.7 Prevalence of diarrhoea Percentage of children under age 5 who had diarrhoea in the two weeks preceding the survey, by background characteristics, Lesotho 2014 Diarrhoea in the 2 weeks preceding the survey Number of children Background characteristic All diarrhoea Diarrhoea with blood Age in months <6 6.0 0.0 328 6-11 22.3 1.0 342 12-23 22.0 2.7 655 24-35 8.8 0.6 572 36-47 5.7 1.3 501 48-59 4.5 0.4 498 Sex Male 12.1 1.3 1,432 Female 11.5 1.0 1,464 Source of drinking water1 Improved 11.4 0.9 2,369 Unimproved 13.8 2.1 527 Toilet facility2 Improved 11.3 0.7 1,309 Shared3 10.9 0.5 666 Unimproved 13.2 2.3 922 Residence Urban 10.0 0.6 841 Rural 12.5 1.3 2,055 Ecological zone Lowlands 12.3 0.7 1,617 Foothills 13.2 2.0 348 Mountains 10.8 1.5 703 Senqu River Valley 8.9 1.6 228 Mother’s education No education (8.1) (0.0) 26 Primary incomplete 15.1 2.3 580 Primary complete 11.8 1.1 748 Secondary 11.7 0.8 1,324 More than secondary 4.2 0.0 217 Wealth quintile Lowest 12.9 2.4 623 Second 13.4 1.1 583 Middle 12.3 1.3 571 Fourth 11.0 0.0 577 Highest 9.1 0.8 542 Total 11.8 1.1 2,896 Note: Figures in parentheses are based on 25-49 unweighted cases. 1 See Table 2.1 for definition of categories. 2 See Table 2.2 for definition of categories. 3 Facilities that would be considered improved if they were not shared by two or more households Ta bl e 10 .8 D ia rr ho ea tr ea tm en t A m on g ch ild re n un de r ag e 5 w ho h ad d ia rr ho ea in t he 2 w ee ks p re ce di ng t he s ur ve y, t he p er ce nt ag e fo r w ho m a dv ic e or t re at m en t w as s ou gh t fro m a h ea lth f ac ili ty o r pr ov id er , th e pe rc en ta ge g iv en o ra l re hy dr at io n th er ap y (O R T) , t he p er ce nt ag e gi ve n in cr ea se d flu id s, th e pe rc en ta ge g iv en O R T or in cr ea se d flu id s, a nd th e pe rc en ta ge g iv en o th er tr ea tm en ts , b y ba ck gr ou nd c ha ra ct er is tic s, L es ot ho 2 01 4 P er ce nt ag e of c hi ld re n w ith di ar rh oe a fo r w ho m a dv ic e or tr ea tm en t w as s ou gh t fro m a h ea lth fa ci lit y or pr ov id er 1 O ra l r eh yd ra tio n th er ap y (O R T) In cr ea se d flu id s O R T or in cr ea se d flu id s O th er tr ea tm en ts M is si ng N o tre at m en t N um be r o f ch ild re n w ith di ar rh oe a B ac kg ro un d ch ar ac te ris tic Fl ui d fro m O R S pa ck et s R ec om - m en de d ho m e flu id s (R H F) E ith er O R S or R H F A nt ib io tic dr ug s A nt i- m ot ili ty dr ug s Zi nc su pp le - m en ts H om e re m ed y/ ot he r Ag e in m on th s <6 * * * * * * * * * * * * 20 6- 11 53 .7 53 .3 55 .4 75 .8 16 .9 78 .3 14 .3 0. 0 0. 8 18 .4 0. 0 21 .7 76 12 -2 3 56 .6 58 .9 53 .9 82 .0 22 .3 84 .5 19 .2 0. 0 1. 2 22 .6 0. 0 13 .9 14 4 24 -3 5 39 .8 48 .0 46 .8 61 .3 23 .4 70 .1 19 .3 1. 4 0. 0 27 .5 2. 7 20 .3 51 36 -4 7 (5 0. 8) (6 8. 6) (4 2. 7) (7 4. 6) (3 0. 9) (9 1. 4) (1 6. 9) (0 .0 ) (0 .0 ) (2 6. 3) (0 .0 ) (8 .6 ) 29 48 -5 9 * * * * * * * * * * * * 22 Se x M al e 51 .8 50 .6 51 .4 74 .2 18 .9 77 .6 14 .9 0. 7 0. 0 27 .0 0. 8 19 .3 17 4 Fe m al e 50 .0 56 .3 52 .3 75 .1 24 .4 81 .1 17 .8 0. 0 1. 4 18 .8 0. 0 17 .0 16 8 Ty pe o f d ia rr ho ea N on -b lo od y 47 .7 51 .2 50 .3 73 .8 21 .5 78 .2 15 .4 0. 2 0. 2 21 .8 0. 0 19 .6 30 7 B lo od y (8 0. 2) (7 6. 3) (7 0. 1) (8 7. 0) (2 3. 2) (9 2. 3) (2 6. 1) (2 .2 ) (5 .1 ) (3 5. 3) (0 .0 ) (6 .4 ) 33 D on ’t kn ow * * * * * * * * * * * * 2 R es id en ce U rb an 42 .3 52 .6 59 .2 79 .6 28 .8 85 .6 12 .6 0. 0 0. 0 25 .4 1. 6 11 .2 84 R ur al 53 .7 53 .6 49 .4 73 .0 19 .3 77 .2 17 .5 0. 5 0. 9 22 .2 0. 0 20 .5 25 7 Ec ol og ic al z on e Lo w la nd s 45 .0 47 .1 54 .2 74 .1 22 .2 78 .9 15 .2 0. 0 0. 6 25 .5 0. 7 17 .7 20 0 Fo ot hi lls (5 6. 4) (6 2. 2) (5 1. 4) (7 3. 7) (2 3. 8) (7 7. 0) (1 8. 5) (0 .0 ) (1 .4 ) (1 0. 5) (0 .0 ) (2 3. 0) 46 M ou nt ai ns 62 .2 67 .3 49 .4 79 .1 19 .6 83 .8 18 .3 1. 7 0. 5 24 .0 0. 0 15 .0 76 S en qu R iv er V al le y (5 4. 3) (4 3. 5) (3 9. 2) (6 5. 0) (1 9. 5) (7 1. 3) (1 4. 4) (0 .0 ) (0 .0 ) (2 1. 7) (0 .0 ) (2 3. 4) 20 M o th e r’ s e d u c a ti o n N o ed uc at io n * * * * * * * * * * * * 2 P rim ar y in co m pl et e 54 .3 52 .1 53 .0 71 .5 20 .9 80 .2 19 .1 0. 6 0. 0 17 .8 0. 0 19 .8 88 P rim ar y co m pl et e 57 .0 54 .3 52 .7 73 .6 15 .7 73 .6 20 .9 0. 8 0. 4 17 .7 0. 0 23 .5 88 S ec on da ry 47 .2 53 .7 50 .2 76 .9 25 .1 82 .3 12 .3 0. 0 0. 8 28 .0 0. 9 15 .0 15 5 M or e th an s ec on da ry * * * * * * * * * * * * 9 W ea lth q ui nt ile Lo w es t 58 .9 60 .9 52 .3 76 .3 16 .6 80 .2 15 .2 1. 6 0. 5 20 .5 0. 0 19 .0 80 S ec on d 51 .9 55 .4 41 .0 71 .3 19 .5 76 .6 14 .4 0. 0 0. 0 24 .5 0. 0 19 .3 78 M id dl e 43 .1 54 .1 54 .4 75 .9 14 .8 76 .9 10 .0 0. 0 1. 8 23 .8 0. 0 22 .4 70 Fo ur th 45 .2 47 .2 69 .0 83 .4 24 .0 85 .8 16 .2 0. 0 0. 0 29 .0 2. 1 9. 8 63 H ig he st (5 4. 6) (4 4. 8) (4 3. 0) (6 4. 0) (3 9. 9) (7 7. 4) (3 0. 2) (0 .0 ) (1 .3 ) (1 5. 5) (0 .0 ) (1 9. 8) 49 To ta l 50 .9 53 .4 51 .9 74 .6 21 .7 79 .3 16 .3 0. 4 0. 7 23 .0 0. 4 18 .2 34 2 N ot es : O R T in cl ud es fl ui d pr ep ar ed fr om o ra l r eh yd ra tio n sa lt (O R S ) pa ck et s an d re co m m en de d ho m e flu id s (R H F) . F ig ur es in p ar en th es es a re b as ed o n 25 -4 9 un w ei gh te d ca se s. A n as te ris k in di ca te s th at a fig ur e is b as ed o n fe w er th an 2 5 un w ei gh te d ca se s an d ha s be en s up pr es se d. 1 E xc lu de s ph ar m ac y, s ho p an d tra di tio na l p ra ct iti on er Child Health • 157 Ta bl e 10 .9 F ee di ng p ra ct ic es d ur in g di ar rh oe a P er ce nt d is tri bu tio n of c hi ld re n un de r ag e 5 w ho h ad d ia rr ho ea in th e 2 w ee ks p re ce di ng th e su rv ey b y am ou nt o f l iq ui ds a nd f oo d of fe re d co m pa re d w ith n or m al p ra ct ic e, th e pe rc en ta ge o f c hi ld re n gi ve n in cr ea se d flu id s an d co nt in ue d fe ed in g du rin g th e di ar rh oe a ep is od e, a nd th e pe rc en ta ge o f c hi ld re n w ho c on tin ue d fe ed in g an d w er e gi ve n O R T an d/ or in cr ea se d flu id s du rin g th e ep is od e of d ia rr ho ea , b y ba ck gr ou nd c ha ra ct er is tic s, L es ot ho 2 01 4 A m ou nt o f l iq ui ds g iv en A m ou nt o f f oo d gi ve n P er ce nt ag e gi ve n in cr ea se d flu id s an d co nt in ue d fe ed in g1 P er ce nt ag e w ho co nt in ue d fe ed in g an d w er e gi ve n O R T an d/ or in cr ea se d flu id s1 N um be r o f ch ild re n w ith di ar rh oe a B ac kg ro un d ch ar ac te ris tic M or e S am e as us ua l S om e- w ha t le ss M uc h le ss N on e D on ’t kn ow To ta l M or e S am e as us ua l S om e- w ha t le ss M uc h le ss N on e N ev er ga ve fo od D on ’t kn ow To ta l Ag e in m on th s <6 * * * * * * 10 0. 0 * * * * * * * 10 0. 0 * * 20 6- 11 16 .9 55 .6 14 .3 12 .2 0. 9 0. 0 10 0. 0 5. 3 50 .4 20 .4 14 .6 0. 9 8. 0 0. 4 10 0. 0 13 .6 59 .6 76 12 -2 3 22 .3 54 .9 10 .1 12 .8 0. 0 0. 0 10 0. 0 5. 8 51 .4 26 .5 14 .7 1. 3 0. 4 0. 0 10 0. 0 20 .3 69 .5 14 4 24 -3 5 23 .4 33 .7 20 .7 17 .9 4. 3 0. 0 10 0. 0 1. 6 38 .7 32 .5 26 .8 0. 4 0. 0 0. 0 10 0. 0 19 .8 53 .5 51 36 -4 7 (3 0. 9) (3 6. 5) (1 5. 6) (8 .5 ) (0 .0 ) (8 .6 ) 10 0. 0 (2 .0 ) (4 5. 1) (2 2. 1) (2 2. 2) (4 .9 ) (0 .0 ) (3 .7 ) 10 0. 0 (1 1. 9) (6 0. 6) 29 48 -5 9 * * * * * * 10 0. 0 * * * * * * * 10 0. 0 * * 22 Se x M al e 18 .9 52 .5 16 .2 10 .4 1. 8 0. 0 10 0. 0 6. 3 43 .1 30 .1 16 .4 0. 8 3. 2 0. 0 10 0. 0 14 .1 61 .1 17 4 Fe m al e 24 .4 48 .6 9. 4 15 .0 1. 0 1. 5 10 0. 0 2. 1 53 .5 19 .4 19 .0 2. 2 3. 0 0. 8 10 0. 0 19 .2 61 .7 16 8 Ty pe o f d ia rr ho ea N on -b lo od y 21 .5 53 .1 11 .4 12 .3 1. 3 0. 5 10 0. 0 4. 2 50 .5 23 .6 17 .1 1. 2 3. 3 0. 1 10 0. 0 16 .4 61 .9 30 7 B lo od y (2 3. 2) (2 9. 4) (2 3. 4) (1 7. 7) (3 .1 ) (3 .2 ) 10 0. 0 (4 .9 ) (2 7. 4) (3 3. 7) (2 4. 6) (4 .5 ) (1 .7 ) (3 .2 ) 10 0. 0 (1 7. 0) (5 8. 2) 33 D on ’t kn ow * * * * * * 10 0. 0 * * * * * * * 10 0. 0 * * 2 R es id en ce U rb an 28 .8 44 .5 15 .5 9. 8 1. 4 0. 0 10 0. 0 5. 0 54 .1 24 .9 10 .4 1. 4 3. 8 0. 4 10 0. 0 24 .4 72 .0 84 R ur al 19 .3 52 .6 12 .0 13 .7 1. 4 1. 0 10 0. 0 4. 0 46 .3 24 .8 20 .1 1. 6 2. 9 0. 4 10 0. 0 14 .0 57 .9 25 7 Ec ol og ic al z on e Lo w la nd s 22 .2 54 .3 12 .8 9. 7 0. 6 0. 5 10 0. 0 3. 5 53 .3 24 .9 13 .2 1. 4 3. 2 0. 5 10 0. 0 16 .8 66 .3 20 0 Fo ot hi lls (2 3. 8) (3 1. 7) (1 5. 3) (1 9. 6) (6 .6 ) (3 .1 ) 10 0. 0 (3 .3 ) (3 6. 8) (3 0. 2) (2 6. 7) (3 .1 ) (0 .0 ) (0 .0 ) 10 0. 0 (1 5. 4) (5 1. 9) 46 M ou nt ai ns 19 .6 51 .3 11 .8 17 .3 0. 0 0. 0 10 0. 0 4. 6 43 .6 19 .2 27 .3 0. 2 4. 8 0. 4 10 0. 0 16 .3 54 .1 76 S en qu R iv er V al le y (1 9. 5) (5 4. 8) (1 2. 5) (9 .8 ) (3 .4 ) (0 .0 ) 10 0. 0 (1 2. 2) (4 1. 9) (3 3. 3) (5 .4 ) (4 .5 ) (2 .8 ) (0 .0 ) 10 0. 0 (1 8. 5) (6 2. 1) 20 M o th e r’ s e d u c a ti o n N o ed uc at io n * * * * * * 10 0. 0 * * * * * * * 10 0. 0 * * 2 P rim ar y in co m pl et e 20 .9 49 .7 7. 5 21 .9 0. 0 0. 0 10 0. 0 2. 1 46 .2 14 .9 28 .1 1. 8 6. 5 0. 4 10 0. 0 13 .6 49 .7 88 P rim ar y co m pl et e 15 .7 53 .3 15 .3 10 .7 2. 3 2. 8 10 0. 0 3. 2 44 .5 33 .2 14 .1 1. 6 2. 2 1. 2 10 0. 0 15 .7 55 .1 88 S ec on da ry 25 .1 49 .9 13 .6 9. 6 1. 9 0. 0 10 0. 0 6. 4 51 .2 25 .7 14 .1 0. 7 1. 9 0. 0 10 0. 0 19 .2 71 .7 15 5 M or e th an s ec on da ry * * * * * * 10 0. 0 * * * * * * * 10 0. 0 * * 9 W ea lth q ui nt ile Lo w es t 16 .6 49 .9 12 .4 21 .1 0. 0 0. 0 10 0. 0 3. 4 38 .1 24 .5 28 .0 0. 3 5. 7 0. 0 10 0. 0 15 .4 50 .7 80 S ec on d 19 .5 45 .1 13 .5 16 .7 3. 5 1. 8 10 0. 0 5. 5 36 .7 30 .5 17 .6 4. 3 5. 5 0. 0 10 0. 0 13 .8 58 .7 78 M id dl e 14 .8 57 .7 14 .8 9. 8 1. 4 1. 5 10 0. 0 2. 0 55 .9 24 .1 15 .4 0. 0 0. 7 2. 0 10 0. 0 10 .4 63 .6 70 Fo ur th 24 .0 59 .1 10 .6 4. 5 1. 8 0. 0 10 0. 0 9. 5 59 .1 17 .9 10 .7 0. 9 1. 9 0. 0 10 0. 0 16 .9 74 .2 63 H ig he st (3 9. 9) (3 9. 6) (1 3. 0) (7 .5 ) (0 .0 ) (0 .0 ) 10 0. 0 (0 .0 ) (5 8. 2) (2 6. 3) (1 3. 3) (2 .2 ) (0 .0 ) (0 .0 ) 10 0. 0 (3 1. 3) (6 3. 5) 49 To ta l 21 .7 50 .6 12 .9 12 .7 1. 4 0. 7 10 0. 0 4. 2 48 .2 24 .8 17 .7 1. 5 3. 1 0. 4 10 0. 0 16 .6 61 .4 34 2 N ot es : I t i s re co m m en de d th at c hi ld re n sh ou ld b e gi ve n m or e liq ui ds to d rin k du rin g di ar rh oe a, a nd fo od s ho ul d no t be r ed uc ed . Fi gu re s in p ar en th es es a re b as ed o n 25 -4 9 un w ei gh te d ca se s. A n as te ris k in di ca te s th at a fi gu re is b as ed o n fe w er th an 2 5 un w ei gh te d ca se s an d ha s be en s up pr es se d. 1 C on tin ue d fe ed in g pr ac tic es in cl ud e ch ild re n w ho w er e gi ve n m or e, s am e as u su al , o r s om ew ha t l es s fo od d ur in g th e di ar rh oe a ep is od e. 158 • Child Health Child Health • 159 Table 10.10 Knowledge of ORS packets Percentage of women age 15-49 with a live birth in the 5 years preceding the survey who know about ORS packets for treatment of diarrhoea by background characteristics, Lesotho 2014 Background characteristic Percentage of women who know about ORS packets Number of women Age 15-19 81.7 216 20-24 86.7 762 25-34 90.5 1,129 35-49 91.9 467 Residence Urban 93.0 749 Rural 87.2 1,825 Ecological zone Lowlands 92.5 1,459 Foothills 83.3 316 Mountains 83.3 598 Senqu River Valley 88.1 202 District Butha-Buthe 87.7 167 Leribe 91.8 423 Berea 91.6 322 Maseru 90.8 636 Mafeteng 88.0 213 Mohale’s Hoek 86.0 234 Quthing 83.6 136 Qacha’s Nek 79.1 70 Mokhotlong 84.1 161 Thaba-Tseka 88.6 212 Education No education (85.8) 23 Primary incomplete 83.7 491 Primary complete 86.9 644 Secondary 90.7 1,222 More than secondary 97.7 195 Wealth quintile Lowest 83.3 512 Second 83.9 504 Middle 88.4 522 Fourth 93.1 540 Highest 95.7 498 Total 88.9 2,575 Note: Figures in parentheses are based on 25-49 unweighted cases. ORS = Oral rehydration salts 160 • Child Health Table 10.11 Men’s knowledge of feeding practices during diarrhoea Percent distribution of men age 15-49 whose youngest child was born in the last 2 years, who report specific amounts of liquids that should be given to a child with diarrhoea (compared with normal practice), by background characteristics, Lesotho 2014 Amount of liquids to be given to a child with diarrhoea: Total Number of men Background characteristic Less than usual1 About the same More Don't know Age 15-19 * * * * 100.0 8 20-24 14.6 27.4 31.7 26.3 100.0 64 25-29 9.3 17.5 41.1 32.2 100.0 122 30-34 6.8 23.2 35.7 34.3 100.0 101 35-39 18.2 13.3 42.8 25.8 100.0 54 40-44 (25.4) (19.5) (30.7) (24.4) 100.0 36 45-49 * * * * 100.0 14 Marital status Never married * * * * 100.0 20 Ever married 12.3 20.3 38.3 29.1 100.0 380 Residence Urban 10.1 21.5 43.7 24.7 100.0 133 Rural 12.8 20.2 34.3 32.7 100.0 267 Ecological zone Lowlands 11.4 20.7 40.7 27.2 100.0 223 Foothills 10.4 19.9 35.2 34.5 100.0 53 Mountains 12.7 21.0 35.5 30.8 100.0 105 Senqu River Valley (18.4) (19.5) (15.4) (46.7) 100.0 18 Education No education 25.5 26.7 12.7 35.1 100.0 40 Primary incomplete 13.3 18.3 35.2 33.1 100.0 156 Primary complete 9.2 33.5 30.9 26.4 100.0 52 Secondary 9.9 15.2 50.8 24.1 100.0 113 More than secondary (1.5) (22.4) (42.1) (34.0) 100.0 38 Wealth quintile Lowest 19.0 21.2 33.9 25.9 100.0 83 Second 15.9 19.1 19.3 45.8 100.0 73 Middle 11.7 17.8 38.0 32.5 100.0 80 Fourth 8.0 19.0 47.6 25.4 100.0 84 Highest 5.3 26.0 46.6 22.1 100.0 79 Total 15-49 11.9 20.6 37.4 30.0 100.0 400 50-59 * * * * 100.0 14 Total 15-59 11.9 20.7 37.3 30.1 100.0 414 Note: Figures in parentheses are based on unweighted 25-49 cases. An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. 1 Includes respondents who said Nothing to drink Child Health • 161 Table 10.12 Disposal of children’s stools Percent distribution of youngest children under age 5 living with the mother by the manner of disposal of the child’s last faecal matter, and percentage of children whose stools are disposed of safely, according to background characteristics, Lesotho 2014 Manner of disposal of children’s stools Total Percentage of children whose stools are disposed of safely1 Number of children Background characteristic Child used toilet or latrine Put/rinsed into toilet or latrine Buried Put/rinsed into drain or ditch Thrown into garbage Left in the open Other Age in months <6 2.3 48.6 7.2 13.8 14.6 9.5 4.0 100.0 58.1 315 6-11 7.0 51.5 5.1 8.2 12.7 13.9 1.6 100.0 63.6 332 12-23 4.5 50.0 5.2 5.0 14.3 21.1 0.0 100.0 59.6 602 24-35 17.5 42.2 3.8 2.5 6.2 27.5 0.3 100.0 63.4 442 36-47 28.9 31.1 4.1 2.0 6.1 27.4 0.0 100.0 64.1 307 48-59 44.2 16.3 3.1 1.6 4.0 30.2 0.6 100.0 63.7 252 Toilet facility2 Improved 19.2 56.6 3.0 3.2 5.6 11.6 0.7 100.0 78.8 1,066 Shared3 19.9 56.8 1.9 6.9 8.3 5.7 0.6 100.0 78.5 471 Non-improved or shared 5.1 10.8 9.5 7.9 18.5 46.7 1.5 100.0 25.4 713 Residence Urban 24.0 56.7 2.6 4.6 8.4 3.0 0.6 100.0 83.3 599 Rural 11.6 36.9 5.6 5.7 11.0 28.2 1.1 100.0 54.0 1,651 Ecological zone Lowlands 21.1 55.4 2.3 5.2 7.2 8.1 0.6 100.0 78.8 1,235 Foothills 13.8 35.6 10.9 6.2 8.7 24.3 0.4 100.0 60.3 293 Mountains 3.4 21.4 5.7 5.0 18.3 44.3 1.9 100.0 30.5 539 Senqu River Valley 8.7 24.0 8.9 6.8 9.6 40.5 1.4 100.0 41.7 182 District Butha-Buthe 17.2 43.7 13.4 2.9 4.9 17.9 0.0 100.0 74.3 152 Leribe 21.5 44.9 2.1 8.3 7.6 14.8 0.4 100.0 68.6 362 Berea 12.5 52.7 4.1 4.6 15.5 9.7 1.0 100.0 69.2 266 Maseru 22.0 54.6 2.3 5.2 7.5 8.4 0.0 100.0 78.9 549 Mafeteng 19.5 52.5 2.8 4.6 3.8 15.1 1.7 100.0 74.8 183 Mohale’s Hoek 6.3 31.0 12.8 3.0 10.7 34.5 1.8 100.0 50.1 212 Quthing 11.1 33.3 5.3 9.3 5.1 35.7 0.2 100.0 49.7 121 Qacha’s Nek 9.0 28.1 9.7 1.2 11.2 40.4 0.4 100.0 46.8 64 Mokhotlong 2.2 14.0 1.0 5.2 29.7 45.1 2.8 100.0 17.2 151 Thaba-Tseka 2.8 19.9 5.4 6.4 13.7 49.2 2.7 100.0 28.1 190 Mother’s education No education (3.9) (15.6) (0.7) (0.0) (23.5) (56.2) (0.0) 100.0 (20.3) 22 Primary incomplete 9.1 30.4 5.6 4.2 13.1 36.1 1.5 100.0 45.1 436 Primary complete 14.1 34.2 7.1 6.2 10.6 26.7 1.1 100.0 55.4 577 Secondary 16.6 50.0 3.5 6.0 8.2 15.0 0.6 100.0 70.1 1,053 More than secondary 23.2 54.5 3.7 2.8 13.2 1.5 1.1 100.0 81.5 162 Wealth quintile Lowest 3.2 12.7 8.1 6.9 17.8 49.3 2.0 100.0 24.0 479 Second 11.2 31.6 6.6 6.4 11.2 32.3 0.8 100.0 49.4 459 Middle 13.7 54.3 3.8 6.7 6.9 13.8 0.8 100.0 71.9 473 Fourth 20.7 59.2 2.9 3.5 7.3 6.2 0.3 100.0 82.7 442 Highest 28.2 56.3 2.0 3.1 7.6 1.9 0.7 100.0 86.4 397 Total 14.9 42.1 4.8 5.4 10.3 21.5 0.9 100.0 61.8 2,250 Note: Figures in parentheses are based on 25-49 unweighted cases. 1 Children’s stools are considered to be disposed of safely if the child used a toilet or latrine, if the faecal matter was put/rinsed into a toilet or latrine, or if it was buried. 2 See Table 2.2 for definition of categories. 3 Facilities that would be considered improved if they were not shared by two or more households Nutrition of Children and Adults • 163 NUTRITION OF CHILDREN AND ADULTS 11 Key Findings  Nutritional status of children: One-third (33%) of children under age 5 are stunted (short for their age); 3% are wasted (thin for their height); 10% are underweight (thin for their age) and 7% are overweight (heavy for their height).  Breastfeeding: Almost all children (95%) are breastfed at some point in their life. Two-thirds of infants under 6 months are exclusively breastfed.  Minimum acceptable diet: Feeding practices of only 11% of children age 6-23 months meet the minimum acceptable dietary standards.  Anaemia: More than half of children age 6-59 months are anaemic; 27% of women and 14% of men age 15-49 also are anaemic.  Obesity: Forty-five percent of women age 15-49 are overweight or obese; 20% are obese. Twelve percent of men age 15-49 are overweight or obese; 7% are obese.  Salt iodisation: More than nine in ten households used iodised salt for cooking. his chapter focuses on the nutritional status of children and adults. It describes the nutritional status of children under age 5, and infant and young child feeding practices, including breastfeeding and feeding with solid/semisolid foods. Also covered are the diversity of foods fed and the frequency of feeding as well as micronutrient status, supplementation, and fortification. Relevant aspects of the nutritional status of women and men age 15-49 are addressed. 11.1 NUTRITIONAL STATUS OF CHILDREN The anthropometric data on height and weight collected in the 2014 LDHS permit the measurement and evaluation of the nutritional status of young children in Lesotho. This evaluation allows identification of subgroups of the child population that are at increased risk of faltered growth, disease, impaired mental development, and death. 11.1.1 Measurement of Nutritional Status among Young Children The 2014 LDHS measured the height and weight of children under age 5 in all sampled households, regardless of whether their mother was interviewed in the survey. Weight measurements were obtained using SECA mother-infant scales with a digital screen. Height measurements were carried out using a Shorr Productions T 164 • Nutrition of Children and Adults measuring board. Children younger than 24 months were measured lying down on the board (recumbent length), and standing heights were measured for older children. Children’s height/length, weight, and age data were used to calculate three indices: height-for-age, weight-for- height, and weight-for-age. Each of these indices provides different information about growth and body composition for assessing nutritional status. As indicated in the box below, stunting, or low height-for-age, is a sign of chronic undernutrition that reflects failure to receive adequate nutrition over a long period. Stunting can also be affected by recurrent and chronic illness. Wasting, or low weight-for-height, is a measure of acute undernutrition and represents the failure to receive adequate nutrition in the period immediately before the survey. Wasting may result from inadequate food intake or from a recent episode of illness causing weight loss. The opposite of wasting is overweight (high weight-for-height), a measure of overnutrition. Weight-for- age is a composite index of weight-for-height and height-for-age. Thus, it includes both acute (wasting) and chronic (stunting) undernutrition and is an indicator of overall undernutrition. Stunting, or height-for-age Height-for-age is a measure of linear growth retardation and cumulative growth deficits. Children whose height-for-age Z-score is below minus two standard deviations (-2 SD) from the median of the reference population are considered short for their age (stunted), or chronically undernourished. Children who are below minus three standard deviations (-3 SD) are considered severely stunted. Sample: Children under age 5 Wasting, or weight-for-height The weight-for-height index measures body mass in relation to body height or length and describes current nutritional status. Children whose Z-score is below minus two standard deviations (-2 SD) from the median of the reference population are considered thin (wasted), or acutely undernourished. Children whose weight-for-height Z-score is below minus three standard deviations (-3 SD) from the median of the reference population are considered severely wasted. Sample: Children under age 5 Underweight, or weight-for-age Weight-for-age is a composite index of height-for-age and weight-for-height. It takes into account both acute and chronic undernutrition. Children whose weight-for-age Z-score is below minus two standard deviations (-2 SD) from the median of the reference population are classified as underweight. Children whose weight-for-age Z-score is below minus three standard deviations (-3 SD) from the median are considered severely underweight. Sample: Children under age 5 Overweight in children Children whose weight-for-height Z-score is more than 2 standard deviations (+2 SD) above the median of the reference population are considered overweight. Sample: Children under age 5 The means of the z-scores for height-for-age, weight-for-height, and weight-for-age are also calculated as summary statistics representing the nutritional status of children in a population. These mean scores describe the nutritional status of the entire population of children without the use of a cutoff point. A mean Z-score of Nutrition of Children and Adults • 165 less than 0 (i.e., a negative mean value for stunting, wasting, or underweight) suggests the downward shift in the entire sample population’s nutritional status relative to the reference population. The farther away the mean z-scores are from 0, the higher would be the prevalence of undernutrition. 11.1.2 Data Collection Height and weight measurements were obtained for 1,981 children under age 5 who were present in the LDHS sample households at the time of the survey. The following analysis is based on the 95% for whom complete and credible anthropometric and age data were collected. 11.1.3 Levels of Child Malnutrition According to the 2014 LDHS, 33% of children under age 5 are stunted or too short for their age. This is a sign of chronic undernutrition. Three percent of children under age 5 are wasted (too thin for their height), a sign of acute undernutrition, and, 7% of children under age 5 are overweight, a sign of overnutrition. In addition, 10% are underweight, or too thin for their age (Table 11.1, Figure 11.1). Trends: The prevalence of stunting, wasting, and underweight has decreased steadily between 2004 and 2014 (Figure 11.2). In contrast, the prevalence of overweight has held steady over the last decade. Figure 11.1 Children’s nutritional status Figure 11.2 Trends in children’s nutritional status Patterns by background characteristics  The occurrence of stunting initially increases with a child’s age, with prevalence peaking in the age range of 24-35 months (43%). Nineteen percent of children age 24-35 months are severely stunted. 22 9 7 11 2 Stunting Wasting Underweight Overweight Percentage of children under age 5 classified as malnourished Moderate Severe 3 10 33 44 39 33 5 4 3 16 13 107 7 7 2004 2009 2014 Percentage of children under age 5 classified as malnourished Stunting Underweight Overweight Wasting 166 • Nutrition of Children and Adults  Undernutrition levels vary by district (Figure 11.3). Mokhotlong has the highest prevalence of stunting and underweight (48% and 16%, respectively) while Berea, Qacha’s Nek, Mokhotlong, and Thaba-Tseka have the highest prevalence of wasting (4% each).  The prevalence of overweight children varies by district: Mohale’s Hoek and Qacha’s Nek have the highest prevalence of overweight children (10% in both) and Berea the lowest (4%).  The prevalence of stunting, wasting, and underweight are all correlated with household wealth. All three nutritional status indicators are highest among children in the lowest wealth quintile and lowest among children in the highest wealth quintile. 11.2 INFANT AND YOUNG CHILD FEEDING PRACTICES Appropriate infant and young child feeding (IYCF) practices include exclusive breastfeeding in the first 6 months of life, continued breastfeeding through age 2, introduction of solid and semisolid foods at age 6 months, and gradual increases in the amount of food given and frequency of feeding as the child gets older. It is also important for young children to receive a diverse diet, i.e., eating foods from different food groups to take care of the growing micronutrient needs (WHO 2008). 11.2.1 Breastfeeding Initiation of Breastfeeding Early initiation of breastfeeding is important for both the mother and the child. The first breast milk contains colostrum, which is highly nutritious and has antibodies that protect the newborn from diseases. Early initiation of breastfeeding also encourages bonding between the mother and her newborn facilitating the production of regular breast milk. Thus, it is recommended that children be put to the breast immediately or within 1 hour after birth and that prelacteal feeding (i.e., feeding newborns anything other than breast milk before breast milk is regularly given) be discouraged. The Ministry of Health encourages women to deliver in health facilities and promotes rooming-in of all new infants in maternity hospitals and breastfeeding within the first hour of birth to foster bonding and protect children from harsh external environments. Early breastfeeding Initiation of breastfeeding within 1 hour of birth Sample: Last born children who were born in the 2 years before the survey Table 11.2 shows that 95% of last-born children who were born in the 2 years before the survey were breastfed at some point in their life. Differences by background characteristics generally were not large, Figure 11.3 Stunting in children by district Percentage of children under age 5 who are stunted Nutrition of Children and Adults • 167 although infants whose mothers had more than secondary education were least likely to have ever been breastfead (88%). Two-thirds (65%) of infants were breastfed within 1 hour of birth, and 86% began breastfeeding within 1 day of birth. Early breastfeeding practices by background characteristics:  The likelihood of an infant breastfeeding within 1 hour of birth varied markedly by district, ranging from a low of 59% in Leribe to a high of 79% in Thaba-Tseka.  The proportion of infants who breastfed within 1 hour of birth was higher among those in the lowest wealth quintile (74%) than among those in higher wealth quintiles (61% to 64%). The practice of giving prelacteal feeds limits the frequency of suckling by the infant and exposes the baby to the risk of infection. Overall, 13% of infants received a prelacteal feed. 11.2.2 Exclusive Breastfeeding Breast milk contains all of the nutrients needed by children in the first 6 months of life and is an uncontaminated nutritional source. It is recommended that children be exclusively breastfed in the first 6 months of their life; that is, they are given nothing but breast milk. Complementing breast milk before age 6 months is unnecessary and is discouraged because the likelihood of contamination and resulting risk of diarrhoeal disease are high. Early initiation of complementary feeding also reduces breast milk output because the production and release of breast milk is modulated by the frequency and intensity of suckling. Table 11.3 and Figure 11.4 show breastfeeding practices by child’s age. Sixty-seven percent of infants under age 6 months are exclusively breastfed. Exclusive breastfeeding declines with age: only 44% of infants age 4-5 months are exclusively breastfed compared with 82% of infants age 0-1 month and 76% of infants age 2-3 months. Contrary to the recommendation that children under 6 months be exclusively breastfed, many infants consume other liquids, such as plain water (4%), and 10% consume complementary foods in addition to breast milk. Trends: Exclusive breastfeeding among children under 6 months has increased over the last decade, from only 36% in 2004 to 54% in 2009 and to 67% in 2014. 11.2.3 Median Duration of Breastfeeding The median duration of breastfeeding in Lesotho is 17.2 months; that is, half of children are breastfed until age 17.2 months (Table 11.4). The median duration of exclusive breastfeeding is almost four months, and the median duration of predominant breastfeeding (i.e., the period in which an infant receives only water or other nonmilk liquids in addition to breast milk) is four and a half months. Figure 11.4 Breastfeeding practices by age 0 10 20 30 40 50 60 70 80 90 100 <2 2-3 4-5 6-7 8-9 10-11 12-13 14-15 16-17 18-19 20-21 22-23 Percent distribution of children under age 2 Breastfeeding and complementary foods Not breastfeeding Exclusive breastfeeding Breastfeeding and water only Breastfeeding and other liquids Age in months 168 • Nutrition of Children and Adults Trends: Median durations of exclusive and predominant breastfeeding have been increasing since 2004. Exclusive breastfeeding rose from 0.9 months in 2004 to 2.5 months in 2009, and to 3.9 months in 2014. Predominant breastfeeding was 3.0 months in 2004, 4.6 months in 2009, and 4.5 months in 2014. Patterns by background characteristics  Children are breastfed 6 months longer on average in rural areas than in urban areas.  Median durations of any breastfeeding are shorter for children in the highest wealth quintile (11.7 months) than for children in the other quintiles. A summary of IYCF breastfeeding indicators is shown in Figure 11.5. 11.2.4 Complementary Feeding After the first 6 months, breast milk is no longer enough to meet the nutritional needs of the infant; therefore, complementary foods should be added to the diet of the child. The transition from exclusive breastfeeding to family foods is referred as complementary feeding. This is the most critical period for children as during this transition children are most vulnerable to becoming undernourished. Complementary feeding should be timely, i.e., all infants should start receiving foods in addition to breast milk from 6 months onwards. Among the youngest children living with their mother, 83% age 6-8 months are receiving complementary foods (data not shown). In the 2014 LDHS, women who had at least one child living with them who was born in 2012 or later were asked questions about the types of liquids and foods the child had consumed during the day or night before the interview. Mothers who had more than one child born in 2012 or a later year were asked questions about the youngest child living with them. Figure 11.5 IYCF breastfeeding indicators Percentage of children * Predominant breastfeeding includes exclusive breastfeeding, breastfeeding plus plain water, and breastfeeding plus non-milk liquids/juice ** Age appropriate breastfeeding = Children age 0-5 months who are exclusively breastfed + children age 6-23 months who receive breast milk and complementary foods 23 62 30 71 76 44 67 Bottle feeding (0-23 months) Age-appropriate breastfeeding** (0-23 months) Continued breastfeeding at 2 years Continued breastfeeding at 1 year Predominant breastfeeding* (0-5 months) Exclusive breastfeeding at 4-5 months of age Exclusive breastfeeding under 6 months of age Nutrition of Children and Adults • 169 Appropriate complementary feeding should include feeding children a variety of foods to ensure that requirements for nutrients are met. Fruits and vegetables rich in vitamin A should be consumed daily. Eating a range of fruits and vegetables, in addition to those rich in vitamin A, is also important. Studies have shown that plant-based complementary foods by themselves are insufficient to meet the needs for certain micronutrients. Therefore, it has been recommended that meat, poultry, fish, or eggs should be part of the daily diet as well or eaten as often as possible (WHO 1998). Table 11.5 indicates that the type of foods and liquids received by children during the day and night before the survey depend on the child’s age and breastfeeding status. Overall, food made from grains is by far the most commonly consumed item, followed by fruits and vegetables rich in vitamin A. Patterns by background characteristics  Forty-seven percent of nonbreastfeeding children age 6-23 months consumed fruits and vegetables rich in vitamin A, compared with 37% of breastfeeding children in the same age group.  One-third (35%) of nonbreastfeeding children and 17% of breastfeeding children age 6-23 months consumed meat, fish, or poultry.  One in three (35%) nonbreastfeeding children age 6-23 months consumed eggs compared with one in four (24%) breastfeeding children.  Twenty-four percent of nonbreastfeeding children age 6-23 months consumed foods made from legumes and nuts, and 13% consumed cheese, yogurt, and other milk products; among breastfeeding children in the same age group, 17% consumed foods made from legumes and nuts, and 10% consumed cheese, yogurt, and other milk products. 11.2.5 Minimum Acceptable Diet Infant and young children should be fed a minimum acceptable diet (MAD) to ensure appropriate growth and development. Without adequate diversity and meal frequency, infants and young children are vulnerable to undernutrition, especially stunting and micronutrient deficiencies, and to increased morbidity and mortality. The WHO minimum acceptable diet recommendation, which is a combination of dietary diversity and minimum meal frequency, is different for breastfed and nonbreastfed children. The definition of the composite indicator of a minimum acceptable diet for all children 6-23 months is indicated in the box below. Dietary diversity is a proxy for adequate micronutrient-density of foods. Minimum dietary diversity means feeding the child food from at least four food groups. The cut-off of four food groups is associated with better- quality diets for both breastfed and nonbreastfed children. Consumption of food from at least four food groups means that the child has a high likelihood of consuming at least one animal source of food and at least one fruit or vegetable in addition to a staple food (grains, roots, or tubers) (WHO 2008). The four food groups should come from a list of seven food groups: grains, roots, and tubers; legumes and nuts; dairy products (milk yogurt, cheese); flesh foods (meat, fish, poultry, and liver/organ meat); eggs; vitamin A-rich fruits and vegetables; and other fruits and vegetables. The minimum meal frequency is a proxy for a child’s energy requirements. For infants and young children the indicator is based on how much energy the child needs and, if the child is breastfed, the amount of energy needs not met by breast milk. Breastfed children are considered to be consuming minimum meal frequency if they receive solid, semi-solid, or soft foods at least twice a day for infants 6-8 months and at least three times a 170 • Nutrition of Children and Adults day for children 9-23 months. Nonbreastfed children ages 6-23 months are considered to be fed with a minimum meal frequency if they receive solid, semi-solid, or soft foods at least four times a day. Minimum acceptable diet Proportion of children age 6–23 months who receive a minimum acceptable diet (apart from breast milk). This composite indicator is calculated from the following two fractions: Breastfed children age 6–23 months who had at least the minimum dietary diversity and the minimum meal frequency during the previous day Breastfed children age 6–23 months and Nonbreastfed children age 6–23 months who received at least two milk feedings and had at least the minimum dietary diversity (not including milk feeds) and the minimum meal frequency during the previous day Nonbreastfed children age 6–23 months The 2014 LDHS indicates that 77% of Lesotho children age 6-23 received breast milk, breast milk substitutes, or milk or milk products (2+ times) during the day or night before the interview (Table 11.6). Twenty-three percent of children had an adequately diverse diet—that is, they had been given foods from the appropriate number of food groups—and 61% had been fed the minimum number of times appropriate for their age. The feeding practices of only 11% of children age 6-23 months meet the minimum standards with respect to all three IYCF feeding practices. The IYCF indicators for minimum acceptable diet by breastfeeding status among children age 6-23 months are summarised in Figure 11.6. Patterns by background characteristics  Breastfed children are much less likely than nonbreastfed children to receive the minimum number of food groups (17% and 34%, respectively).  Children in urban areas (18%) are twice as likely as those in rural areas (9%) to be fed according to the recommended IYCF guidelines.  There are marked differences in children’s feeding practices by district; 18% of children in Maseru are fed according to the three IYCF practices, compared with none in Qacha’s Nek, 1% in Mokhotlong, and 2% in Mohale’s Hoek. However, these results should be interpreted with caution because of the small number of children reported on in the different districts. Figure 11.6 IYCF indicators on minimum acceptable diet 17 60 11 34 62 13 23 61 11 Minimum dietary diversity Minimum meal frequency Minimum acceptable diet Percentage of children age 6-23 months Breastfed Nonbreastfed All children 6-23 months Nutrition of Children and Adults • 171 11.3 ANAEMIA PREVALENCE IN CHILDREN Anaemia prevalence Any anaemia is defined as a blood haemoglobin level below 11.0 g/dl in children. In the DHS, severe anaemia is defined as <7.0 g/dl; moderate anaemia is defined as 7.0-9.9 g/dl. Sample: Children 6-59 months Anaemia is a condition that is marked by low levels of haemoglobin in the blood. Iron is a key component of haemoglobin, and iron deficiency is estimated to be responsible for half of all anaemia globally. Other causes of anaemia include malaria, hookworm and other helminths, other nutritional deficiencies, chronic infections, and genetic conditions. Anaemia is a serious concern for children because it can impair cognitive development, stunt growth, and increase morbidity from infectious diseases. Haemoglobin testing was carried out among children age 6-59 months. Haemoglobin levels were successfully measured for 96% of the children eligible for testing. The methodology used to measure haemoglobin levels is described in the first chapter of this report. Overall, 51% of children suffered from some degree of anaemia (haemoglobin levels below 11.0 g/dl). About half of these cases were classified as mild anaemia, while 25% of children had moderate anaemia, and 1% were severely anaemic (Table 11.7). Trends: Prevalence of anaemia in children changed little between 2004 and 2009 (from 48% to 47%), and has increased between 2009 and 2014 (from 47% to 51%) (Figure 11.7). Patterns by background characteristics  Anaemia is more prevalent among children under age 24 months than among older children, with a peak prevalence of 65% observed among children 9-11 months.  Anaemia prevalence varies by district, from a low of 41% in Berea to a high of 59% in Butha-Buthe and Mokhotlong (Figure 11.8). Figure 11.7 Trends in childhood anaemia Figure 11.8 Anaemia in children by district Percentage of children age 6-59 months with any anaemia 21 25 25 26 21 25 2 1 1 2004 2009 2014 Percentage of children age 6-59 months Moderate Mild Severe 47 51 48 172 • Nutrition of Children and Adults 11.4 MICRONUTRIENT INTAKE AND SUPPLEMENTATION AMONG CHILDREN Micronutrient deficiency is a major contributor to childhood morbidity and mortality. Micronutrients are available in foods and can also be provided through direct supplementation. Breastfeeding children benefit from supplements given to the mother. The information collected on food consumption among the youngest children under age 2 is useful in assessing the extent to which children are consuming food groups rich in two key micronutrients—vitamin A and iron— in their daily diet. Iron deficiency is one of the primary causes of anaemia, which has serious health consequences for both women and children. Vitamin A is an essential micronutrient for the immune system and plays an important role in maintaining the epithelial tissue in the body. Severe vitamin A deficiency (VAD) can cause eye damage and is the leading cause of childhood blindness. VAD also increases the severity of infections such as measles and diarrhoeal disease in children and slows recovery from illness. VAD is common in dry environments where fresh fruits and vegetables are not readily available. The 2014 LDHS also included questions designed to ascertain whether young children had received vitamin A supplements or deworming medication in the 6 months before the survey. Vitamin A supplementation is an important intervention in preventing VAD among young children. Sixty-one percent of children age 6-23 months ate foods rich in vitamin A in the day or night preceding the interview, and 41 percent consumed iron-rich foods (Table 11.8). As expected, intake of both vitamin A-rich and iron-rich foods increases as children are weaned. Nonbreastfeeding children are more likely than breastfeeding children to consume foods rich in vitamin A (70% versus 55%) and iron (52% versus 34%). In the 6 months before the survey, six in ten children (61%) age 6-59 months received a vitamin A supplement and one in five (22%) received deworming medication. 11.5 PRESENCE OF IODISED SALT IN HOUSEHOLDS Iodine is an essential micronutrient, and iodised salt prevents goitre or other thyroid-related health problems among children and adults. In line with food and drug regulations, household salt should be fortified with iodine to at least 15 parts per million (ppm). In Lesotho, salt is iodised with the additive potassium iodate. The 2014 LDHS tested for the presence of potassium iodate in household salt. Overall, salt was tested in 70% of households, and salt was not tested in 24% of the households due to lack of test kits in the first weeks of survey field work (Table 11.9). Among households in which salt was tested, 93% had iodised salt. It should be noted that household salt was tested for the presence or absence of iodine only; the iodine content in the salt was not measured. 11.6 ADULTS’ NUTRITIONAL STATUS 11.6.1 Nutritional Status of Women The 2014 LDHS collected anthropometric data on height and weight for 97% of the women age 15-49 interviewed in the survey who were in the subsample eligible for biomarkers. These data were used to calculate several measures of nutritional status, specifically maternal height and body mass index (BMI). Information on BMI is presented in Table 11.10.1. Nutrition of Children and Adults • 173 Body mass index (BMI) BMI is calculated by dividing weight in kilograms by height in metres squared (kg/m2). A BMI of less than 18.5 indicates that the respondents are too thin for their height (that is, that they have a chronic energy deficiency). At the other end of the BMI scale, women and men are considered overweight if their BMI falls between 25.0 and 29.9 and are obese if their BMI is greater than or equal to 30.0. Sample: Women age 15-49 who are not pregnant and who have not had a birth in the 2 months before the survey and men age 15-49 Forty-five percent of women in Lesotho are overweight or obese. Four percent are thin, and 51% of women have a BMI in the normal range. Trends: The percentage of women who are thin (indicative of undernutrition) has declined in the last 5 years by 2 percentage points. In contrast, the proportion of women who are overweight or obese (indicative of overnutrition) has increased by 3 percentage points since 2009 (Figure 11.9). Patterns by background characteristics  Women most likely to be thin (BMI below 18.5) are those in the 15-19 age group (9%), those living in Berea, Mafeteng, and Thaba-Tseka districts (6% each), those with primary incomplete education (6%), and those in the lowest wealth quintile (6%).  Fifty percent of urban women are overweight or obese, compared with 42% of rural women.  Overweight/obesity increases with wealth, rising from 25% of women in the lowest wealth quintile to 55% in the highest wealth quintile. 11.6.2 Nutritional Status of Men The LDHS also collected anthropometric data on height and weight for men. Overall, this information was collected for 98% of the men interviewed in the survey. Seventy-four percent of men age 15-49 have a BMI in the normal range, while 14% are thin and 12% are overweight or obese (Table 11.10.2). Patterns by background characteristics  The proportion of men who are thin (BMI below 18.5) is highest among those age 15-19 (27%).  Men from Mokhotlong (18%) and Mafeteng (18%) are more likely to be thin than men from other districts (12% to 17%).  The prevalence of overweight or obesity is higher among urban (18%) than rural (8%) men and highest among men with more than secondary education (36%). Figure 11.9 Trends in women’s nutritional status 6 6 4 42 42 45 2004 2009 2014 Percentage of women age 15-49 Underweight Overweight/obese 174 • Nutrition of Children and Adults 11.7 ANAEMIA PREVALENCE IN ADULTS Anaemia prevalence Any anaemia is defined as a blood haemoglobin level below 11.0 g/dl in pregnant women; below 12.0 g/dl in nonpregnant women; and below 13.0 g/dl for men. The cutoffs are adjusted for altitude for enumeration areas above 1,000 metres and for cigarette smoking for women and men. Sample: Women 15-49 and men 15-49 Anaemia among women and men was measured using similar procedures as for children age 6-59 months except that capillary blood was collected exclusively from a finger prick. Haemoglobin levels were successfully measured for 96% of women and 96% of men interviewed and eligible for biomarkers. Anaemia results are adjusted for pregnancy status, altitude, and smoking status. Over one-quarter (27%) of women in Lesotho are anaemic (Table 11.11.1). Twenty percent of women are classified as mildly anaemic, 7% are moderately anaemic, and 1% are severely anaemic (Figure 11.10). Fourteen percent of men age 15-49 are anaemic (Table 11.11.2). Trends: Between the 2004 and 2009 LDHS, the prevalence of any anaemia in women dropped from 33% to 26%; however, between the 2009 and 2014 LDHS, the prevalence of any anaemia among women has changed little (26% and 27%, respectively). Among men, the prevalence of any anaemia increased slightly from 12% in 2009 to 14% in 2014. Patterns by background characteristics  Anaemia levels among adults vary by district. Anaemia prevalence is highest among women living in Maseru (34%) and men living in Butha-Buthe (22%), and lowest among women living in Thaba-Tseka (17%) and among men living in Quthing (6%).  In comparison with young children (51%) and women (27%), the prevalence of anaemia among men is moderate (14%). 11.8 MICRONUTRIENT INTAKE AMONG MOTHERS The LDHS included questions to ascertain whether mothers had received iron supplements during pregnancy. Pregnant women should take iron supplements, eat iron-rich foods, and avoid parasites and malaria to prevent anaemia. Two-thirds of women who gave birth in the 5 years before the survey took iron supplements. About half of women took iron supplements for 90 days or more, as recommended. One in five women did not take iron supplements at all (Table 11.12). Figure 11.10 Prevalence of anaemia in adults 20 7 1 Women Men Percentage of women and men age 15-49 Moderate Mild Severe 14 27 Any Nutrition of Children and Adults • 175 LIST OF TABLES For more information on nutrition of children and adults, see the following tables:  Table 11.1 Nutritional status of children  Table 11.2 Initial breastfeeding  Table 11.3 Breastfeeding status by age  Table 11.4 Median duration of breastfeeding  Table 11.5 Foods and liquids consumed by children in the day or night preceding the interview  Table 11.6 Infant and young child feeding (IYCF) practices  Table 11.7 Prevalence of anaemia in children  Table 11.8 Micronutrient intake among children  Table 11.9 Presence of iodised salt in household  Table 11.10.1 Nutritional status of women  Table 11.10.2 Nutritional status of men  Table 11.11.1 Prevalence of anaemia in women  Table 11.11.2 Prevalence of anaemia in men  Table 11.12 Micronutrient intake among mothers 176 • Nutrition of Children and Adults Table 11.1 Nutritional status of children Percentage of children under 5 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 2014 Height-for-age1 Weight-for-height Weight-for-age Number of children Background characteristic Percent- age below -3 SD Percent- age below -2 SD2 Mean Z- score (SD) Percent- age below -3 SD Percent- age below -2 SD2 Percent- age above +2 SD Mean Z- score (SD) Percent- age below -3 SD Percent- age below -2 SD2 Percent- age above +2 SD Mean Z- score (SD) Age in months <6 2.5 13.7 -0.5 0.9 4.8 24.8 0.9 0.2 4.7 1.3 0.1 168 6-8 3.8 22.0 -1.1 1.4 5.1 15.1 0.5 0.9 13.1 4.7 -0.4 67 9-11 4.2 21.6 -0.9 3.2 6.0 8.3 -0.2 4.0 16.1 3.6 -0.7 85 12-17 7.1 27.6 -1.2 1.4 6.1 5.6 0.2 2.1 13.3 0.8 -0.5 194 18-23 9.5 37.5 -1.5 0.3 4.0 7.5 0.3 1.7 8.4 3.2 -0.5 168 24-35 19.2 43.1 -1.8 0.3 2.6 7.1 0.5 1.1 11.3 0.8 -0.7 410 36-47 11.9 40.3 -1.7 0.3 0.8 4.1 0.4 1.3 8.3 0.3 -0.7 394 48-59 10.5 29.5 -1.5 0.0 0.9 2.7 0.2 2.4 11.3 0.0 -0.8 383 Sex Male 13.5 38.8 -1.6 0.6 2.6 7.8 0.4 2.1 12.5 0.7 -0.7 892 Female 8.8 28.1 -1.3 0.6 3.0 7.0 0.4 1.2 8.3 1.3 -0.5 977 Birth interval in months3 First birth4 8.5 30.9 -1.4 0.6 1.9 9.2 0.4 1.7 9.5 1.0 -0.5 526 <24 18.7 46.9 -1.7 0.0 3.2 6.5 0.3 0.1 9.8 0.0 -0.7 91 24-47 14.7 39.0 -1.6 1.1 3.0 5.9 0.2 2.2 13.9 0.8 -0.8 327 48+ 7.4 25.4 -1.2 0.8 4.6 8.6 0.4 1.6 9.9 2.3 -0.4 368 Size at birth3 Very small (29.0) (55.7) (-2.1) (0.0) (7.5) (3.8) (-0.2) (5.5) (29.7) (0.0) (-1.4) 28 Small 17.4 46.1 -1.8 2.0 7.1 7.0 -0.1 2.3 21.3 0.0 -1.1 134 Average or larger 9.2 30.2 -1.4 0.6 2.5 8.3 0.4 1.6 8.9 1.4 -0.5 1,140 Mother’s interview status Interviewed 10.4 32.5 -1.4 0.7 3.0 8.0 0.3 1.7 10.8 1.3 -0.6 1,312 Not interviewed but in household 12.8 29.5 -1.5 0.0 3.4 5.5 0.3 1.7 9.2 0.0 -0.6 151 Not interviewed and not in the household5 12.2 36.9 -1.6 0.3 1.8 6.0 0.5 1.4 9.3 0.8 -0.6 406 Mother’s nutritional status6 Thin (BMI<18.5) (6.8) (52.4) (-1.8) (2.7) (8.6) (3.7) (-0.1) (5.4) (20.9) (0.0) (-1.1) 31 Normal (BMI 18.5-24.9) 13.1 37.2 -1.6 0.9 2.8 4.7 0.2 2.3 13.7 0.9 -0.8 645 Overweight/ obese (BMI ≥ 25) 8.6 26.2 -1.2 0.6 3.5 11.5 0.5 1.1 7.4 1.9 -0.3 545 Residence Urban 7.8 27.3 -1.2 0.3 1.3 6.6 0.4 0.7 8.2 1.1 -0.5 453 Rural 12.0 35.1 -1.5 0.7 3.3 7.6 0.4 1.9 11.0 1.0 -0.6 1,416 Ecological zone Lowlands 8.6 27.2 -1.3 0.2 1.7 7.0 0.4 0.9 8.1 1.1 -0.4 1,008 Foothills 15.4 40.9 -1.7 2.2 4.5 9.4 0.4 4.4 14.9 2.3 -0.7 221 Mountains 13.6 42.0 -1.7 0.4 4.1 6.8 0.2 1.7 13.1 0.6 -0.8 475 Senqu River Valley 12.6 34.4 -1.6 1.3 3.4 8.8 0.3 2.4 9.8 0.8 -0.7 165 District Butha-Buthe 12.3 40.3 -1.5 1.2 1.8 8.8 0.4 1.8 7.5 1.6 -0.6 124 Leribe 10.4 31.3 -1.3 0.0 3.3 7.6 0.4 1.1 8.0 2.0 -0.5 283 Berea 8.3 27.4 -1.3 0.0 3.5 4.3 0.3 1.6 12.7 1.6 -0.5 233 Maseru 10.4 29.9 -1.4 0.5 1.8 7.3 0.4 1.2 8.7 0.4 -0.5 444 Mafeteng 8.6 25.9 -1.3 1.3 2.6 7.7 0.4 1.5 10.8 1.3 -0.5 170 Mohale’s Hoek 14.3 38.1 -1.7 1.7 3.3 10.3 0.3 3.0 11.6 0.6 -0.7 165 Quthing 10.4 34.1 -1.5 0.0 1.2 7.5 0.5 0.3 5.5 0.9 -0.5 109 Qacha’s Nek 10.1 32.5 -1.6 1.7 4.0 10.4 0.3 3.7 12.0 0.5 -0.7 55 Mokhotlong 18.9 47.7 -1.8 0.3 3.6 7.4 0.2 3.3 15.8 0.0 -0.9 124 Thaba-Tseka 10.4 40.0 -1.6 0.4 4.1 6.3 0.1 1.4 14.2 1.1 -0.8 162 Mother’s education7 No education * * * * * * * * * * * 16 Primary incomplete 15.3 40.3 -1.7 1.2 5.1 7.6 0.3 2.5 15.1 1.4 -0.8 295 Primary complete 11.7 35.3 -1.6 0.9 3.8 5.1 0.1 2.9 12.9 0.9 -0.8 379 Secondary 8.0 29.1 -1.3 0.4 2.1 7.7 0.4 0.9 8.7 0.8 -0.5 665 More than secondary 6.6 15.1 -0.8 0.0 0.7 18.2 0.9 0.0 1.1 3.9 0.2 104 (Continued…) Nutrition of Children and Adults • 177 Table 11.1—Continued Height-for-age1 Weight-for-height Weight-for-age Number of children Background characteristic Percent- age below -3 SD Percent- age below -2 SD2 Mean Z- score (SD) Percent- age below -3 SD Percent- age below -2 SD2 Percent- age above +2 SD Mean Z- score (SD) Percent- age below -3 SD Percent- age below -2 SD2 Percent- age above +2 SD Mean Z- score (SD) Wealth quintile Lowest 15.5 45.6 -1.8 1.2 4.8 7.5 0.1 3.6 15.5 0.8 -0.9 392 Second 15.8 38.1 -1.6 0.9 4.0 7.3 0.4 2.6 12.8 1.7 -0.7 428 Middle 9.8 34.8 -1.5 0.3 2.2 7.4 0.4 0.2 9.0 1.2 -0.6 392 Fourth 9.1 28.2 -1.4 0.1 1.3 7.3 0.4 1.2 9.1 0.0 -0.5 368 Highest 2.0 13.4 -0.8 0.0 0.9 7.4 0.5 0.0 2.8 1.7 -0.1 288 Total 11.0 33.2 -1.5 0.6 2.8 7.4 0.4 1.6 10.3 1.1 -0.6 1,869 Notes: Table is based on children who stayed in the household on the night before the interview. Each of the indices is expressed in standard deviation units (SD) from the median of the WHO Child Growth Standards adopted in 2006. The indices in this table are NOT comparable to those based on the previously used NCHS/CDC/WHO reference. The table is based on children with valid dates of birth (month and year) and valid measurement of both height and weight. The total includes 9 cases for which information on size at birth is missing, and 3 cases for which information on mother’s education level is missing. 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 Recumbent length is measured for children under age 2, or in the few cases when the age of the child is unknown and the child is less than 85 cm; standing height is measured for all other children. 2 Includes children who are below -3 standard deviations (SD) from the WHO Child Growth standards population median 3 Excludes children whose mothers were not interviewed 4 First-born twins (triplets, etc.) are counted as first births because they do not have a previous birth interval. 5 Includes children whose mothers are deceased 6 Excludes children whose mothers were not weighed and measured, children whose mothers were not interviewed, and children whose mothers are pregnant or gave birth within the preceding 2 months. Mother’s nutritional status in terms of BMI (body mass index) is presented in Table 11.10.1. 7 For women who are not interviewed, information is taken from the Household Questionnaire. Excludes children whose mothers are not listed in the Household Questionnaire. 178 • Nutrition of Children and Adults Table 11.2 Initial breastfeeding Among last-born children who were born in the 2 years preceding the survey, the percentage who were ever breastfed and the percentages who started breastfeeding within 1 hour and within 1 day of birth; and among last-born children born in the 2 years preceding the survey who were ever breastfed, the percentage who received a prelacteal feed, by background characteristics, Lesotho 2014 Among last-born children born in the past 2 years: Among last-born children born in the past 2 years who were ever breastfed: Background characteristic Percentage ever breastfed Percentage who started breastfeeding within 1 hour of birth Percentage who started breastfeeding within 1 day of birth1 Number of last- born children Percentage who received a prelacteal feed2 Number of last-born children ever breastfed Sex Male 95.9 65.0 87.5 676 13.1 648 Female 95.0 65.5 85.1 693 12.8 659 Assistance at delivery Health professional3 95.2 64.3 86.7 1,122 10.8 1,068 Other 97.3 70.1 85.4 233 20.6 227 No one * * * 12 * 11 Place of delivery Health facility 95.2 64.1 86.8 1,104 10.6 1,051 At home 96.4 71.3 85.4 256 20.8 247 Other * * * 9 * 9 Residence Urban 93.7 63.7 87.2 357 13.3 335 Rural 96.0 65.9 86.0 1,012 12.9 972 Ecological zone Lowlands 94.8 61.6 86.1 745 13.0 706 Foothills 97.5 64.7 84.4 172 15.2 168 Mountains 95.9 73.0 88.5 343 12.1 329 Senqu River Valley 95.1 67.3 84.1 109 11.8 104 District Butha-Buthe 93.6 70.9 85.6 94 10.4 88 Leribe 97.0 58.6 85.7 212 8.8 206 Berea 97.6 65.8 88.6 176 13.0 172 Maseru 92.9 59.6 83.6 334 15.9 310 Mafeteng 95.9 62.9 84.9 100 17.2 96 Mohale’s Hoek 95.2 71.2 85.4 137 10.5 130 Quthing 94.0 62.3 82.8 80 13.9 76 Qacha’s Nek 96.1 68.5 88.7 34 7.2 33 Mokhotlong 96.4 72.9 89.1 91 15.3 87 Thaba-Tseka 98.0 79.4 94.5 111 13.1 109 Mother’s education No education * * * 6 * 6 Primary incomplete 95.5 64.2 86.5 254 15.4 242 Primary complete 96.5 65.8 88.7 337 11.4 325 Secondary 95.7 65.4 85.8 690 11.9 660 More than secondary 88.0 65.0 80.4 82 22.9 73 Wealth quintile Lowest 98.0 73.7 88.3 310 11.5 304 Second 96.2 63.6 87.2 271 11.4 261 Middle 96.9 60.7 85.7 293 16.5 284 Fourth 92.0 64.0 83.2 282 10.4 260 Highest 93.1 63.3 87.2 213 15.7 198 Total 95.4 65.3 86.3 1,369 13.0 1,307 Notes: Table is based on last-born children born in the 2 years preceding the survey regardless of whether the children are living or dead at the time of interview. Total includes 1 child for whom information on assistance at delivery was missing. An asterisk indicates that a figure is based on 25 unweighted cases and has been suppressed. 1 Includes children who started breastfeeding within 1 hour of birth 2 Children given something other than breast milk during the first 3 days of life 3 Doctor or nurse/midwife Nutrition of Children and Adults • 179 Table 11.3 Breastfeeding status by age Percent distribution of youngest children under age 2 who are living with their mother, by breastfeeding status, and the percentage currently breastfeeding; and the percentage of all children under two years using a bottle with a nipple, according to age in months, Lesotho 2014 Not breast- feeding Breastfeeding status Total Percentage currently breast- feeding Number of youngest children under age 2 living with their mother Percentage using a bottle with a nipple Number of all children under age 2 Age in months Exclusively breastfed Breast- feeding and consuming plain water only Breast- feeding and consuming non-milk liquids1 Breast- feeding and consuming other milk Breast- feeding and consuming comple- mentary foods 0-1 1.3 81.8 3.2 10.3 3.4 0.0 100.0 98.7 80 12.1 85 2-3 6.0 76.0 4.2 2.4 9.7 1.7 100.0 94.0 131 18.8 136 4-5 10.9 44.1 2.8 4.9 10.6 26.8 100.0 89.1 105 45.6 107 6-8 9.5 10.2 2.0 0.5 3.7 74.1 100.0 90.5 155 39.0 157 9-11 18.2 1.3 3.3 1.3 0.0 75.9 100.0 81.8 177 27.9 185 12-17 29.0 0.8 1.6 0.4 0.0 68.2 100.0 71.0 325 19.9 343 18-23 67.0 0.3 0.2 0.0 0.2 32.3 100.0 33.0 277 13.9 311 0-3 4.2 78.2 3.8 5.4 7.4 1.1 100.0 95.8 211 16.3 221 0-5 6.4 66.9 3.5 5.2 8.4 9.6 100.0 93.6 315 25.8 328 6-9 13.6 7.9 2.2 1.1 2.9 72.2 100.0 86.4 199 40.3 204 12-15 28.8 1.0 1.9 0.3 0.0 68.0 100.0 71.2 243 22.0 254 12-23 46.5 0.5 1.0 0.2 0.1 51.7 100.0 53.5 602 17.1 655 20-23 70.5 0.0 0.0 0.0 0.0 29.5 100.0 29.5 186 11.7 216 Note: Breastfeeding status refers to a 24-hour period (yesterday and last night). Children who are classified as breastfeeding and consuming plain water only consumed no liquid or solid supplements. The categories of not breastfeeding, exclusively breastfed, breastfeeding and consuming plain water, non-milk liquids, 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 non-milk liquids and who do not receive other milk and who do not receive complementary foods are classified in the non-milk 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 Non-milk liquids include juice, juice drinks, clear broth, or other liquids. 180 • Nutrition of Children and Adults Table 11.4 Median duration of breastfeeding Median duration of any breastfeeding, exclusive breastfeeding, and predominant breastfeeding among children born in the 3 years preceding the survey, by background characteristics, Lesotho 2014 Median duration (months) of breastfeeding among children born in the past 3 years1 Background characteristic Any breast- feeding Exclusive breastfeeding Predominant breast- feeding2 Sex Male 17.4 3.9 4.7 Female 17.0 4.0 4.4 Residence Urban 12.2 * 3.2 Rural 18.4 4.4 4.9 Ecological zone Lowlands 14.8 3.2 3.7 Foothills (19.4) 4.8 5.3 Mountains 21.6 4.7 5.1 Senqu River Valley (18.1) 3.9 5.0 Mother’s education No education * * * Primary incomplete 18.9 3.9 4.4 Primary complete 18.1 4.6 5.2 Secondary 16.9 3.8 4.3 More than secondary * a a Wealth quintile Lowest 21.0 4.3 5.4 Second 19.4 4.4 4.8 Middle 16.4 4.5 4.8 Fourth 14.0 4.1 4.2 Highest 11.7 a * Total 17.2 3.9 4.5 Mean for all children 16.6 4.5 5.4 Notes: Median and mean durations are based on the distributions at the time of the survey of the proportion of births by months since birth. Includes children living and deceased at the time of the survey. 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. a = omitted because less than 50 percent of the children in this group were exclusively or predominantly breastfeeding. 1 It is assumed that non-last-born children and last-born children not currently living with the mother are not currently breastfeeding. 2 Either exclusively breastfed or received breast milk and plain water, and/or non-milk liquids only Nutrition of Children and Adults • 181 Table 11.5 Foods and liquids consumed by children in the day or night preceding the interview Percentage of youngest children under two years of age who are living with the mother by type of foods consumed in the day or night preceding the interview, according to breastfeeding status and age, Lesotho 2014 Liquids Solid or semi-solid foods Any solid or semi- solid food Number of children Age in months Infant formula Other milk1 Other liquids2 Fortified baby foods Food made from grains3 Fruits and vege- tables rich in vitamin A4 Other fruits and vege- tables Food made from roots and tubers Food made from legumes and nuts Meat, fish, poultry Eggs Cheese, yogurt, other milk product BREASTFEEDING CHILDREN 0-1 3.5 0.0 11.9 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 78 2-3 9.6 0.7 3.6 0.0 1.5 0.0 0.0 0.0 0.0 0.0 0.0 0.0 1.8 123 4-5 24.0 11.2 21.7 3.1 21.9 1.3 0.0 1.0 0.0 0.0 0.0 2.8 30.0 93 6-8 15.5 10.3 59.6 12.8 65.3 20.0 16.1 9.5 10.5 3.6 24.3 10.9 81.8 140 9-11 9.7 9.5 67.1 9.0 75.5 30.9 16.9 15.6 19.0 16.7 19.2 6.1 92.8 145 12-17 6.2 18.7 57.2 6.0 83.3 44.3 22.1 14.5 20.4 23.3 28.0 10.8 96.2 231 18-23 5.8 24.9 67.4 2.6 90.2 54.5 7.6 19.9 15.5 22.9 22.7 10.9 97.9 91 6-23 9.1 15.5 61.6 7.8 78.3 37.0 17.3 14.4 17.0 17.1 24.3 9.7 92.3 607 Total 10.2 11.7 45.2 5.6 55.2 25.1 11.6 9.8 11.5 11.5 16.3 6.8 65.5 902 NONBREASTFEEDING CHILDREN 0-11 57.5 28.5 57.5 28.6 64.5 24.9 16.2 22.9 15.0 28.5 26.7 13.0 82.6 67 12-17 26.5 28.4 69.1 12.3 76.3 48.6 30.3 22.2 19.9 23.9 34.7 12.6 89.5 94 18-23 12.3 37.2 62.7 7.8 89.7 49.6 30.1 21.8 25.9 39.0 34.2 13.4 96.9 186 6-23 21.0 34.4 66.0 12.3 84.0 47.3 29.2 23.5 23.5 34.9 34.9 13.2 94.2 327 Total 24.9 33.1 63.4 13.0 81.2 44.5 27.5 22.1 22.2 32.9 32.9 13.1 92.1 347 Note: Breastfeeding status and food consumed refer to a 24-hour period (yesterday and last night). 1 Other milk includes fresh, tinned, and powdered cow or other animal milk. 2 Doesn’t include plain water 3 Includes fortified baby food 4 Includes fruits and vegetables such as pumpkin, carrots, red pepper, squash, yellow or orange sweet potatoes, dark green leafy vegetables, ripe mangoes, apricots, dried peaches or papayas, and other locally grown fruits and vegetables that are rich in vitamin A 182 • Nutrition of Children and Adults Table 11.6 Infant and young child feeding (IYCF) practices Percentage of youngest children age 6-23 months living with their mother who are fed according to three IYCF feeding practices based on breastfeeding status, number of food groups, and times they are fed during the day or night preceding the survey, by background characteristics, Lesotho 2014 Among breastfed children 6-23 months, percentage fed: Number of breast- fed children 6-23 months Among nonbreastfed children 6-23 months, percentage fed: Number of non- breastfed children 6-23 months Among all children 6-23 months, percentage fed: Number of all children 6-23 months Background characteristic 4+ food groups1 Minimum meal fre- quency2 Both 4+ food groups and minimum meal frequency Milk or milk products3 4+ food groups1 Minimum meal fre- quency4 With 3 IYCF practices5 Breast milk, milk, or milk products6 4+ food groups1 Minimum meal fre- quency7 With 3 IYCF practices Age in months 6-8 14.6 64.0 11.9 140 * * * * 15 96.5 15.6 63.9 11.9 155 9-11 14.4 52.1 8.4 145 (44.2) (41.7) (71.0) (12.7) 32 89.8 19.4 55.6 9.2 177 12-17 19.2 60.9 10.8 231 37.8 32.1 61.3 10.9 94 81.9 22.9 61.0 10.8 325 18-23 19.0 63.9 10.7 91 29.6 35.1 61.2 14.1 186 52.8 29.8 62.1 13.0 277 Sex Male 15.0 59.6 10.4 280 33.7 34.1 60.4 13.1 170 75.0 22.2 59.9 11.4 450 Female 18.7 60.3 10.5 327 36.2 34.7 64.2 12.7 157 79.3 23.9 61.6 11.2 484 Residence Urban 28.0 49.6 18.3 108 42.5 41.9 68.1 18.2 130 68.6 35.6 59.7 18.3 239 Rural 14.6 62.2 8.8 498 29.9 29.4 58.4 9.4 197 80.2 18.8 61.1 9.0 695 Ecological zone Lowlands 21.7 53.8 12.8 279 39.1 38.5 65.1 15.6 239 71.9 29.5 59.0 14.1 518 Foothills 19.2 57.6 13.1 81 (27.0) (18.3) (53.8) (6.4) 28 81.2 19.0 56.6 11.3 109 Mountains 11.1 69.4 6.9 196 24.0 22.9 52.4 3.3 40 87.0 13.1 66.5 6.3 237 Senqu River Valley 9.9 60.9 7.5 51 (17.4) (30.9) (60.4) (10.0) 19 77.3 15.6 60.7 8.2 70 District Butha-Buthe 12.3 64.9 10.2 43 (33.9) (19.9) (65.9) (6.4) 21 78.3 14.8 65.2 9.0 64 Leribe 24.5 71.7 15.6 91 (35.7) (27.8) (73.8) (7.0) 48 77.9 25.6 72.4 12.6 138 Berea 18.0 54.4 12.8 68 (25.4) (39.1) (63.0) (7.2) 47 69.6 26.6 57.9 10.5 115 Maseru 23.3 45.2 14.2 123 41.9 40.3 58.2 21.5 106 73.2 31.2 51.2 17.6 228 Mafeteng (24.3) (41.1) (7.2) 40 (48.9) (56.4) (70.3) (27.9) 30 78.3 37.9 53.5 16.0 70 Mohale’s Hoek 2.7 56.9 0.9 69 (25.2) (21.1) (48.3) (4.2) 33 75.9 8.7 54.1 2.0 102 Quthing 21.7 69.4 16.3 38 (26.7) (38.3) (61.0) (13.4) 14 80.1 26.2 67.2 15.5 52 Qacha’s Nek 6.4 51.3 0.0 19 * * * * 5 82.6 7.0 54.2 0.0 25 Mokhotlong 4.3 69.1 1.6 58 * * * * 9 90.0 4.0 66.5 1.4 67 Thaba-Tseka 19.0 80.6 14.3 57 * * * * 15 84.8 21.2 78.1 11.4 72 Mother’s education No education * * * 4 * * * * 1 * * * * 4 Primary incomplete 14.1 65.1 9.6 128 17.8 11.4 40.2 2.2 58 74.5 13.2 57.4 7.3 185 Primary complete 19.5 61.9 13.1 163 24.9 30.1 70.2 13.2 64 78.9 22.5 64.2 13.1 226 Secondary 15.5 56.4 8.6 297 38.9 39.1 63.0 15.5 171 77.6 24.2 58.8 11.1 468 More than secondary * * * 16 (62.8) (58.1) (82.1) (17.8) 34 74.8 53.7 76.1 20.9 50 Wealth quintile Lowest 7.9 65.1 5.5 183 (6.6) (16.9) (32.8) (4.5) 40 83.3 9.5 59.4 5.4 223 Second 15.0 67.2 10.0 126 23.0 15.7 65.6 4.5 51 77.8 15.2 66.7 8.4 177 Middle 15.6 58.1 9.2 138 17.1 24.6 65.6 0.7 67 72.9 18.5 60.6 6.4 205 Fourth 25.5 52.3 18.5 103 45.8 37.6 57.7 14.3 83 75.8 30.9 54.7 16.6 185 Highest 38.6 45.6 16.1 57 58.5 58.2 75.7 30.1 86 75.0 50.4 63.7 24.6 142 Total 17.0 60.0 10.5 607 34.9 34.4 62.3 12.9 327 77.2 23.1 60.8 11.3 934 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 Food groups: a. infant formula, milk other than breast milk, cheese or yogurt or other milk products; b. foods made from grains, roots, and tubers, including porridge and fortified baby food from grains; c. vitamin A-rich fruits and vegetables; d. other fruits and vegetables; e. eggs; f. meat, poultry, fish, and shellfish (and organ meats); g. legumes and nuts 2 For breastfed children, the minimum meal frequency is receiving solid or semi-solid food at least twice a day for infants 6-8 months and at least three times a day for children 9-23 months. 3 Includes two or more feedings of commercial infant formula, fresh, tinned, and powdered animal milk, and yogurt 4 For nonbreastfed children age 6-23 months, the minimum meal frequency is receiving solid or semi-solid food or milk feeds at least four times a day. 5 Nonbreastfed children age 6-23 months are considered to be fed with a minimum standard of three Infant and Young Child Feeding Practices if they receive other milk or milk products at least twice a day, receive the minimum meal frequency, and receive solid or semi-solid foods from at least four food groups, not including the milk or milk products food group. 6 Breastfeeding, or not breastfeeding and receiving two or more feedings of commercial infant formula, fresh, tinned and powdered animal milk, and yogurt 7 Children are fed the minimum recommended number of times per day according to their age and breastfeeding status as described in footnotes 2 and 4. Nutrition of Children and Adults • 183 Table 11.7 Prevalence of anaemia in children Percentage of children age 6-59 months classified as having anaemia, by background characteristics, Lesotho 2014 Anaemia status by haemoglobin level Number of children Background characteristic Any anaemia (<11.0 g/dl) Mild anaemia (10.0-10.9 g/dl) Moderate anaemia (7.0-9.9 g/dl) Severe anaemia (< 7.0 g/dl) Age in months 6-8 58.1 23.2 33.1 1.8 66 9-11 64.6 29.6 33.5 1.4 87 12-17 62.3 23.6 36.3 2.4 201 18-23 58.3 28.9 25.9 3.5 169 24-35 54.3 22.3 31.5 0.4 404 36-47 42.4 25.0 16.9 0.6 398 48-59 42.0 25.1 16.2 0.7 384 Sex Male 52.8 26.2 25.2 1.4 826 Female 48.9 23.4 24.6 0.9 883 Mother’s interview status Interviewed 54.2 25.4 27.2 1.7 1,152 Not interviewed but in household 45.0 28.1 16.9 0.0 144 Not interviewed and not in the household1 43.2 21.8 21.2 0.2 413 Residence Urban 48.3 22.7 25.3 0.3 410 Rural 51.6 25.4 24.7 1.4 1,299 Ecological zone Lowlands 49.1 24.2 24.0 0.9 917 Foothills 47.9 23.2 23.0 1.7 197 Mountains 55.8 25.8 28.1 1.9 447 Senqu River Valley 49.9 27.3 22.6 0.0 149 District Butha-Buthe 59.2 27.0 29.6 2.7 112 Leribe 55.7 30.1 22.6 3.0 262 Berea 40.9 21.0 19.9 0.0 200 Maseru 48.5 23.4 25.0 0.2 402 Mafeteng 44.5 23.2 20.5 0.7 158 Mohale’s Hoek 56.1 22.5 32.0 1.5 158 Quthing 47.4 28.4 18.6 0.4 98 Qacha’s Nek 47.3 21.0 24.9 1.5 52 Mokhotlong 58.5 25.0 32.0 1.5 118 Thaba-Tseka 53.5 25.5 26.9 1.1 149 Mother’s education2 No education * * * * 18 Primary incomplete 48.9 24.5 22.8 1.6 266 Primary complete 50.2 23.9 25.5 0.8 331 Secondary 56.8 27.7 27.3 1.8 593 More than secondary 50.3 24.1 24.5 1.7 86 Wealth quintile Lowest 53.9 26.0 26.7 1.2 371 Second 54.8 25.9 27.4 1.4 387 Middle 50.8 25.3 23.9 1.5 364 Fourth 47.1 18.4 27.8 0.9 332 Highest 45.0 28.8 15.7 0.5 255 Total 50.8 24.8 24.8 1.2 1,709 Notes: Table is based on children who stayed in the household on the night before the interview and who were tested for anaemia. Prevalence of anaemia, based on haemoglobin levels, is adjusted for altitude using formulas in CDC, 1998. Haemoglobin is in grams per decilitre (g/dl). Total includes 3 cases for which information on mother’s education is missing. An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. 1 Includes children whose mothers are deceased 2 For women who are not interviewed, information is taken from the Household Questionnaire. Excludes children whose mothers are not listed in the Household Questionnaire. 184 • Nutrition of Children and Adults Table 11.8 Micronutrient intake among children Among youngest children age 6-23 months who are living with their mother, the percentages who consumed vitamin A-rich and iron-rich foods in the day or night preceding the survey, and among all children 6-59 months, the percentages who were given vitamin A supplements in the 6 months preceding the survey , and who were given deworming medication in the 6 months preceding the survey, and among all children age 6-59 months who live in households that were tested for iodised salt, the percentage who live in households with iodised salt, by background characteristics, Lesotho 2014 Among youngest children age 6-23 months living with the mother: Among all children age 6-59 months: Among children age 6-59 months living in households tested for iodised salt Background characteristic Percentage who consumed foods rich in vitamin A in last 24 hours1 Percentage who consumed foods rich in iron in last 24 hours2 Number of children Percentage given vitamin A supplements in last 6 months Percentage given deworming medication in last 6 months3 Number of children Percentage living in house- holds with iodised salt4 Number of children Age in months 6-8 37.4 25.8 155 56.6 7.2 157 96.1 102 9-11 53.9 37.4 177 80.6 15.8 185 96.7 128 12-17 63.2 42.4 325 75.0 24.2 343 90.8 246 18-23 74.3 48.4 277 79.6 30.0 311 91.3 216 24-35 na na na 60.7 24.8 572 91.3 407 36-47 na na na 47.9 22.8 501 94.5 354 48-59 na na na 49.0 19.4 498 92.5 364 Sex Male 60.0 39.3 450 61.4 21.1 1,266 92.9 889 Female 60.9 41.6 484 61.2 23.3 1,302 92.5 928 Breastfeeding status Breastfeeding 55.2 34.3 607 70.9 19.4 657 91.6 465 Not breastfeeding 70.2 52.0 327 58.0 23.1 1,911 93.1 1,352 Mother’s age 15-19 54.0 38.7 116 63.2 15.4 159 91.4 103 20-29 63.5 43.4 555 61.9 22.3 1,490 93.0 1,052 30-39 54.9 34.4 212 58.1 21.3 741 92.6 524 40-49 65.4 37.3 51 67.6 30.9 178 91.7 138 Residence Urban 69.1 53.1 239 60.2 26.3 766 98.6 488 Rural 57.5 36.1 695 61.8 20.4 1,802 90.6 1,329 Ecological zone Lowlands 62.3 46.7 518 62.2 25.7 1,455 96.0 1,073 Foothills 71.4 46.1 109 64.4 19.9 295 88.0 224 Mountains 52.2 26.6 237 57.7 17.0 622 87.4 438 Senqu River Valley 57.7 32.2 70 61.6 16.0 196 90.7 81 District Butha-Buthe 66.5 35.5 64 66.3 36.5 160 89.2 115 Leribe 65.0 49.6 138 58.5 23.0 402 94.9 322 Berea 61.8 44.6 115 63.0 21.5 315 96.7 277 Maseru 64.4 47.4 228 60.8 22.3 657 94.4 429 Mafeteng 68.2 52.0 70 73.6 31.4 210 93.8 184 Mohale’s Hoek 51.8 26.5 102 60.3 15.9 225 82.3 79 Quthing 64.2 44.0 52 53.3 14.2 138 99.3 65 Qacha’s Nek 39.2 16.8 25 53.6 10.8 75 84.2 52 Mokhotlong 34.4 18.4 67 58.9 19.8 168 91.0 131 Thaba-Tseka 65.4 33.3 72 60.5 19.3 218 85.1 164 Mother’s education No education * * 4 (52.7) (13.9) 24 * 14 Primary incomplete 62.0 31.0 185 57.4 19.1 527 88.8 379 Primary complete 58.5 36.0 226 59.1 20.1 660 91.7 452 Secondary 59.6 44.4 468 63.5 24.3 1,166 95.0 840 More than secondary 70.9 61.5 50 67.0 26.0 190 96.4 132 Wealth quintile Lowest 55.0 20.9 223 59.1 16.7 552 84.3 391 Second 62.5 40.0 177 59.6 22.5 504 91.7 351 Middle 60.4 41.8 205 61.9 24.2 513 93.0 376 Fourth 61.1 50.7 185 63.2 20.1 507 97.1 350 Highest 65.8 56.6 142 62.9 28.1 491 98.5 350 Total 60.5 40.5 934 61.3 22.2 2,568 92.7 1,817 Notes: Information on vitamin A supplements is based on both mother’s recall and the immunisation card (where available). Information on deworming medication is based on the mother’s recall. 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 1 Includes meat (and organ meat), fish, poultry, eggs, pumpkin, pumpkin, carrots, red pepper, squash, yellow or orange sweet potatoes, dark green leafy vegetables, ripe mangoes, apricots, dried peaches, papayas and other fruits and vegetables that are rich in vitamin A 2 Includes meat (including organ meat), fish, poultry and eggs 3 Deworming for intestinal parasites is commonly done for helminths and for schistosomiasis. 4 Excludes children in households in which salt was not tested Nutrition of Children and Adults • 185 Table 11.9 Presence of iodised salt in household Among all households, the percentage with salt tested for iodine content, the percentage with no salt in the household, and the percentage with salt not tested; and among households with salt tested, the percentage with iodised salt, according to background characteristics, Lesotho 2014 Among all households, the percentage: Among households with tested salt: Background characteristic With salt tested With no salt in the household Not tested due to lack of test kit Number of households Percentage with iodised salt Number of households Residence Urban 64.1 3.2 32.6 3,020 97.2 1,938 Rural 72.8 8.0 19.2 6,382 91.1 4,645 Ecological zone Lowlands 71.6 4.9 23.5 5,670 95.8 4,061 Foothills 77.0 8.2 14.8 983 89.4 757 Mountains 73.3 9.9 16.8 1,978 86.9 1,449 Senqu River Valley 40.9 7.2 51.9 771 91.0 315 District Butha-Buthe 74.4 11.2 14.4 582 89.2 433 Leribe 79.4 5.9 14.7 1,471 95.3 1,168 Berea 86.2 4.7 9.1 1,163 96.6 1,002 Maseru 62.8 5.4 31.8 2,400 95.0 1,507 Mafeteng 84.3 5.4 10.3 899 93.9 758 Mohale’s Hoek 34.0 3.9 62.2 888 86.2 302 Quthing 48.9 7.0 44.1 494 97.5 241 Qacha’s Nek 70.2 7.9 21.9 330 86.1 231 Mokhotlong 80.4 10.5 9.1 492 86.9 396 Thaba-Tseka 79.5 11.3 9.2 684 85.3 544 Wealth quintile Lowest 67.7 13.8 18.5 1,795 83.9 1,216 Second 69.4 8.8 21.7 1,761 90.6 1,223 Middle 72.3 5.7 22.0 1,857 93.6 1,343 Fourth 72.5 2.7 24.8 2,001 97.1 1,451 Highest 67.9 2.3 29.8 1,987 97.6 1,350 Total 70.0 6.5 23.5 9,402 92.9 6,583 186 • Nutrition of Children and Adults Table 11.10.1 Nutritional status of women Among women age 15-49, the percentage with height under 145 cm, mean body mass index (BMI), and the percentage with specific BMI levels, by background characteristics, Lesotho 2014 Height Body Mass Index1 Mean Body Mass Index (BMI) Normal Thin Overweight/obese Number of women Background characteristic Percent- age below 145 cm Number of women 18.5-24.9 (total normal) <18.5 (total thin) 17.0-18.4 (mildly thin) <17 (moder- ately and severely thin) ≥25.0 (total over- weight or obese) 25.0-29.9 (over- weight) ≥30.0 (obese) Age 15-19 2.3 739 22.3 72.7 9.0 7.0 2.0 18.3 15.3 2.9 690 20-29 1.3 1,220 25.0 54.2 4.3 3.1 1.2 41.5 25.8 15.7 1,125 30-39 1.2 842 27.3 41.1 2.1 1.4 0.6 56.9 28.2 28.7 796 40-49 0.7 548 28.2 31.9 1.5 1.1 0.3 66.6 31.2 35.4 543 Residence Urban 1.2 1,177 26.1 45.7 4.2 2.7 1.5 50.1 27.6 22.4 1,124 Rural 1.5 2,172 25.2 54.1 4.3 3.5 0.8 41.6 23.6 18.0 2,031 Ecological zone Lowlands 1.3 2,088 26.0 47.5 4.2 3.1 1.0 48.3 26.0 22.3 1,967 Foothills 1.5 334 25.3 51.1 4.9 2.8 2.1 44.0 23.9 20.0 311 Mountains 1.9 675 24.2 60.2 4.3 3.3 1.0 35.5 24.3 11.2 639 Senqu River Valley 0.9 252 25.1 56.4 4.5 3.8 0.7 39.1 20.1 19.0 238 District Butha-Buthe 0.7 202 26.3 51.3 2.4 2.4 0.0 46.3 21.6 24.7 189 Leribe 1.4 524 25.7 49.2 3.1 2.7 0.4 47.7 28.1 19.5 498 Berea 1.2 441 25.8 46.8 5.6 5.1 0.5 47.6 26.1 21.6 418 Maseru 1.2 928 25.8 49.2 4.1 2.1 2.0 46.8 25.1 21.7 868 Mafeteng 1.8 288 26.0 46.6 5.5 3.3 2.2 47.9 25.7 22.2 265 Mohale’s Hoek 2.4 280 25.7 51.2 3.2 3.2 0.0 45.6 25.4 20.2 265 Quthing 1.0 171 25.5 51.8 4.9 4.3 0.6 43.3 23.6 19.7 163 Qacha’s Nek 4.2 99 25.3 51.9 4.7 4.7 0.0 43.4 26.4 17.0 94 Mokhotlong 0.7 178 23.5 68.0 4.6 2.9 1.6 27.4 19.5 7.9 167 Thaba-Tseka 1.1 239 23.9 62.4 5.8 4.4 1.4 31.8 22.3 9.5 229 Education No education (5.3) 37 (25.4) (59.4) (2.7) (2.7) (0.0) (37.9) (18.7) (19.1) 35 Primary incomplete 2.4 592 24.7 56.9 6.3 5.3 1.0 36.8 21.4 15.4 555 Primary complete 1.5 721 25.7 49.4 3.1 2.1 0.9 47.5 27.1 20.4 680 Secondary 1.1 1,727 25.4 51.7 4.4 3.0 1.4 43.9 25.4 18.5 1,632 More than secondary 0.0 273 27.8 37.6 2.9 2.9 0.0 59.5 25.9 33.6 253 Wealth quintile Lowest 1.7 481 23.2 69.0 6.2 5.5 0.7 24.8 18.9 5.9 446 Second 2.1 555 24.6 56.8 5.1 3.4 1.7 38.1 22.4 15.8 521 Middle 2.2 632 25.2 52.1 3.9 3.4 0.5 43.9 28.0 16.0 591 Fourth 0.6 816 26.4 47.2 3.2 2.1 1.2 49.5 24.8 24.7 761 Highest 1.0 866 26.8 40.8 4.0 2.7 1.3 55.2 28.2 27.1 835 Total 1.4 3,349 25.5 51.1 4.3 3.2 1.1 44.6 25.0 19.6 3,155 Notes: The body mass index (BMI) is expressed as the ratio of weight in kilograms to the square of height in metres (kg/m2). Figures in parentheses are based on 25-49 unweighted cases. 1 Excludes pregnant women and women with a birth in the preceding 2 months Nutrition of Children and Adults • 187 Table 11.10.2 Nutritional status of men Among men age 15-49, mean body mass index (BMI), and the percentage with specific BMI levels, by background characteristics, Lesotho 2014 Body Mass Index Mean Body Mass Index (BMI) Normal Thin Overweight/obese Number of men Background characteristic 18.5-24.9 (total normal) <18.5 (total thin) 17.0-18.4 (mildly thin) <17 (moderately and severely thin) ≥25.0 (total over- weight or obese) 25.0-29.9 (over- weight) ≥30.0 (obese) Age 15-19 19.8 70.4 27.4 16.7 10.7 2.1 2.0 0.2 679 20-29 21.4 82.8 9.0 7.1 1.9 8.2 7.0 1.2 944 30-39 22.4 70.4 10.5 9.1 1.4 19.1 13.8 5.3 586 40-49 23.0 64.8 9.1 6.4 2.7 26.1 16.6 9.4 373 Residence Urban 22.1 70.2 11.8 8.3 3.5 18.0 13.0 5.0 895 Rural 21.1 76.2 15.5 10.9 4.6 8.3 6.3 2.0 1,688 Ecological zone Lowlands 21.6 71.8 14.6 10.3 4.3 13.6 10.0 3.6 1,655 Foothills 21.1 76.9 15.2 10.5 4.7 7.9 4.8 3.1 246 Mountains 21.3 80.1 11.4 8.0 3.5 8.4 6.2 2.2 513 Senqu River Valley 21.0 74.6 17.4 12.6 4.8 8.0 7.4 0.6 169 District Butha-Buthe 21.5 76.4 12.8 9.3 3.5 10.7 8.6 2.2 142 Leribe 21.1 75.1 15.7 10.5 5.2 9.2 7.3 1.9 370 Berea 21.8 70.7 14.0 9.3 4.7 15.3 11.2 4.1 371 Maseru 21.8 74.0 11.8 8.3 3.5 14.2 9.8 4.4 787 Mafeteng 20.9 71.8 17.9 13.2 4.7 10.3 7.8 2.5 234 Mohale’s Hoek 21.1 74.0 16.6 12.6 4.0 9.4 8.4 1.0 198 Quthing 21.4 73.3 15.2 10.4 4.7 11.5 10.0 1.6 102 Qacha’s Nek 21.6 72.8 14.6 12.8 1.8 12.6 9.3 3.3 73 Mokhotlong 20.7 76.3 18.3 12.8 5.5 5.4 4.3 1.1 141 Thaba-Tseka 21.4 80.7 11.9 7.3 4.6 7.4 4.2 3.2 166 Education No education 21.6 85.6 5.9 5.3 0.7 8.4 6.3 2.1 203 Primary incomplete 20.9 74.8 17.4 11.1 6.3 7.8 6.1 1.7 861 Primary complete 21.5 72.8 14.3 9.7 4.6 12.9 10.0 2.9 301 Secondary 21.3 75.0 14.7 10.8 3.9 10.2 7.5 2.8 1,008 More than secondary 24.1 57.8 6.6 6.3 0.3 35.6 24.5 11.1 210 Wealth quintile Lowest 20.8 75.5 17.6 12.7 5.0 6.8 5.1 1.7 363 Second 20.8 79.8 15.9 10.9 5.0 4.4 3.6 0.8 471 Middle 20.9 76.6 15.3 9.8 5.5 8.0 6.6 1.5 517 Fourth 21.2 74.8 15.0 10.3 4.7 10.2 8.3 1.9 602 Highest 22.9 66.3 9.4 7.7 1.7 24.3 16.3 8.0 630 Total 15-49 21.4 74.1 14.2 10.0 4.2 11.7 8.6 3.1 2,583 50-59 23.1 63.2 8.8 5.6 3.2 28.0 21.4 6.6 270 Total 15-59 21.6 73.1 13.7 9.6 4.1 13.2 9.8 3.4 2,853 Note: The body mass index (BMI) is expressed as the ratio of weight in kilograms to the square of height in metres (kg/m2). 188 • Nutrition of Children and Adults Table 11.11.1 Prevalence of anaemia in women Percentage of women age 15-49 with anaemia, by background characteristics, Lesotho 2014 Anaemia status by haemoglobin level Any Mild Moderate Severe Number of women Not pregnant <12.0 g/dl 10.0-11.9 g/dl 7.0-9.9 g/dl < 7.0 g/dl Background characteristic Pregnant <11.0 g/dl 10.0-10.9 g/dl 7.0-9.9 g/dl < 7.0 g/dl Age 15-19 24.1 19.0 4.6 0.5 731 20-29 29.0 20.8 7.7 0.5 1,206 30-39 28.6 20.6 6.9 1.1 822 40-49 25.6 19.4 5.8 0.4 538 Number of children ever born 0 26.8 20.1 6.2 0.4 998 1 27.4 18.1 8.6 0.6 743 2-3 29.8 22.1 6.5 1.1 1,041 4-5 21.0 17.9 3.1 0.0 372 6+ 27.6 21.2 6.3 0.0 144 Maternity status Pregnant 35.5 23.6 11.9 0.0 137 Breastfeeding 25.0 19.3 5.3 0.3 485 Neither 27.3 20.1 6.5 0.7 2,676 Using IUCD Yes (34.7) (24.6) (9.1) (1.0) 35 No 27.2 20.1 6.5 0.6 3,263 Residence Urban 31.9 22.7 8.2 1.1 1,142 Rural 24.8 18.7 5.6 0.4 2,156 Ecological zone Lowlands 30.8 23.0 7.1 0.7 2,044 Foothills 21.5 15.9 4.8 0.7 335 Mountains 20.8 14.7 5.5 0.5 672 Senqu River Valley 23.8 16.5 6.7 0.6 247 District Butha-Buthe 29.4 22.7 6.4 0.3 203 Leribe 25.4 18.6 6.2 0.6 519 Berea 22.9 18.6 4.1 0.2 432 Maseru 34.2 25.0 8.2 1.1 901 Mafeteng 27.7 19.7 7.2 0.8 285 Mohale’s Hoek 25.8 18.2 7.2 0.4 278 Quthing 23.6 18.1 5.4 0.0 164 Qacha’s Nek 27.5 21.3 5.3 0.8 99 Mokhotlong 24.4 15.2 8.5 0.6 178 Thaba-Tseka 16.9 12.6 3.5 0.8 238 Education No education (31.2) (31.2) (0.0) (0.0) 37 Primary incomplete 27.5 20.3 7.1 0.1 588 Primary complete 23.9 16.3 6.3 1.3 709 Secondary 28.1 21.0 6.4 0.6 1,702 More than secondary 30.0 22.4 7.4 0.2 262 Wealth quintile Lowest 22.8 16.4 6.0 0.4 481 Second 23.2 18.3 4.3 0.6 553 Middle 27.3 19.9 7.0 0.4 627 Fourth 31.0 23.8 6.6 0.6 797 Highest 28.9 20.0 7.9 0.9 840 Total 27.3 20.1 6.5 0.6 3,297 Notes: Prevalence is adjusted for altitude and for smoking status if known using formulas in CDC, 1998. Figures in parentheses are based on 25-49 unweighted cases. Nutrition of Children and Adults • 189 Table 11.11.2 Prevalence of anaemia in men Percentage of men age 15-49 with anaemia, by background characteristics, Lesotho 2014 Anaemia status by haemoglobin level Background characteristic Any anaemia <13.0 g/dl Number of men Age 15-19 16.7 670 20-29 9.8 918 30-39 14.2 566 40-49 20.1 364 Smoking status Smokes cigarettes/tobacco 13.5 1,052 Does not smoke 14.6 1,465 Residence Urban 14.8 861 Rural 13.7 1,656 Ecological zone Lowlands 13.2 1,613 Foothills 19.9 237 Mountains 15.9 503 Senqu River Valley 9.3 164 District Butha-Buthe 21.9 140 Leribe 12.0 365 Berea 9.7 360 Maseru 15.1 762 Mafeteng 11.7 229 Mohale’s Hoek 17.0 194 Quthing 6.1 99 Qacha’s Nek 19.9 73 Mokhotlong 20.2 137 Thaba-Tseka 14.1 159 Education No education 18.4 201 Primary incomplete 17.3 842 Primary complete 14.9 294 Secondary 11.1 984 More than secondary 9.8 197 Wealth quintile Lowest 18.8 359 Second 16.1 455 Middle 13.1 511 Fourth 13.9 590 Highest 10.8 601 Total 15-49 14.1 2,517 50-59 23.1 266 Total 15-59 15.0 2,783 Note: Prevalence is adjusted for altitude and for smoking status, if known, using formulas in CDC, 1998. 190 • Nutrition of Children and Adults Table 11.12 Micronutrient intake among mothers Among women age 15-49 with a child born in the past 5 years, the percentage who received a vitamin A dose in the first 2 months after the birth of the last child, and the percent distribution by number of days they took iron tablets during the pregnancy of the last child; and among women age 15-49 with a child born in the past 5 years and who live in households that were tested for iodised salt, the percentage who live in households with iodised salt, by background characteristics, Lesotho 2014 Among women with a child born in the past 5 years: Among women with a child born in the last 5 years, who live in households that were tested for iodised salt Percentage who received vitamin A dose postpartum1 Number of days women took iron tablets during pregnancy of last birth Number of women Percentage living in households with iodised salt2 Number of women Background characteristic None <60 60-89 90+ Don’t know Total Age 15-19 66.7 26.6 10.2 6.8 46.5 9.9 100.0 216 93.0 150 20-29 69.8 19.5 10.2 5.6 52.4 12.2 100.0 1,435 93.1 1,007 30-39 65.3 21.1 8.8 4.8 53.8 11.6 100.0 745 92.8 523 40-49 62.5 35.1 10.4 5.6 39.5 9.3 100.0 178 90.9 139 Residence Urban 72.4 15.8 11.1 6.4 54.9 11.9 100.0 749 98.5 479 Rural 65.8 24.1 9.3 5.1 50.0 11.5 100.0 1,825 90.8 1,341 Ecological zone Lowlands 70.5 18.6 10.4 5.7 53.8 11.5 100.0 1,459 95.8 1,079 Foothills 59.6 31.2 9.1 7.1 40.6 12.0 100.0 316 89.4 243 Mountains 67.5 22.6 9.2 3.8 53.8 10.7 100.0 598 87.6 418 Senqu River Valley 61.3 25.7 9.0 6.4 44.3 14.7 100.0 202 91.5 79 District Butha-Buthe 60.7 16.1 8.5 7.4 57.1 11.0 100.0 167 89.1 120 Leribe 69.5 18.0 6.8 5.3 47.9 22.0 100.0 423 95.2 340 Berea 65.4 20.0 14.5 9.6 49.1 6.7 100.0 322 96.8 286 Maseru 72.4 24.3 12.1 4.3 52.6 6.8 100.0 636 94.4 416 Mafeteng 72.5 21.4 7.1 4.6 58.6 8.2 100.0 213 93.6 188 Mohale’s Hoek 63.9 23.9 8.6 3.8 50.8 12.9 100.0 234 82.0 78 Quthing 62.7 25.8 7.7 6.6 47.1 12.8 100.0 136 99.2 59 Qacha’s Nek 68.2 28.0 6.5 5.0 54.6 6.0 100.0 70 84.1 48 Mokhotlong 65.8 18.0 7.9 6.0 50.9 17.2 100.0 161 90.2 125 Thaba-Tseka 63.4 23.6 11.1 3.6 49.4 12.3 100.0 212 86.3 160 Education No education (72.6) (28.5) (4.9) (7.8) (27.1) (31.8) 100.0 23 * 14 Primary incomplete 62.7 27.4 10.4 3.4 48.5 10.3 100.0 491 88.0 350 Primary complete 65.9 24.0 12.0 6.5 46.8 10.8 100.0 644 92.6 441 Secondary 70.5 19.8 8.4 6.2 52.9 12.7 100.0 1,222 94.8 879 More than secondary 68.8 10.3 11.0 2.9 67.5 8.4 100.0 195 96.5 136 Wealth quintile Lowest 61.2 24.9 11.8 3.5 49.0 10.8 100.0 512 84.8 359 Second 64.2 26.4 8.1 6.3 49.0 10.2 100.0 504 92.6 347 Middle 69.2 23.4 7.9 7.9 49.1 11.8 100.0 522 91.6 385 Fourth 71.0 18.8 9.2 4.9 51.6 15.5 100.0 540 96.9 383 Highest 73.0 14.7 12.4 4.8 58.5 9.6 100.0 498 98.3 346 Total 67.7 21.7 9.8 5.5 51.4 11.6 100.0 2,575 92.8 1,820 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 the first two months after delivery of last birth 2 Excludes women in households where salt was not tested HIV/AIDS-related Knowledge, Attitudes, and Behaviour • 191 HIV/AIDS-RELATED KNOWLEDGE, ATTITUDES, AND BEHAVIOUR 12 Key Findings  Knowledge of HIV prevention methods: Thirty-nine percent of women and 31% of men have “comprehensive knowledge” about the modes of HIV transmission and prevention.  Knowledge of prevention of mother-to-child transmission of HIV: Eighty-two percent of women and 74% of men know that HIV can be transmitted by breastfeeding. Among women and men, 87% and 70%, respectively, know that the risk of mother-to-child transmission is reduced by a mother taking special drugs during pregnancy.  Sexual partners: Seven percent of women and 27% of men had two or more sexual partners in the year before the survey. Among these respondents, 54% of women and 65% of men reported that they used a condom during their most recent sexual intercourse.  HIV tests: Ninety-seven percent of women and 92% of men know where to get an HIV test. Eighty-four percent of women and 63% of men have been tested for HIV and have received the results of their last test. Fifty-eight percent of women and 36% of men were tested in the past 12 months and received the results of their last test. esotho is one among many countries in Africa facing the devastating impact of the HIV/AIDS epidemic. As of 2014, an estimated 314,000 adults and children in the country were living with HIV (MOH 2015b). The principal mode of HIV transmission in Lesotho is heterosexual intercourse, which accounts for 97% of all new HIV infections in the country (LNAC 2009). Among other modes of transmission, the most important in Lesotho is vertical transmission, in which the mother passes HIV to her child during pregnancy, childbirth, and breastfeeding. The prevention of mother-to-child transmission of HIV (PMTCT) programme in Lesotho is a priority in the fight against HIV/AIDS in children. The programme seeks to prevent paediatric HIV infection through primary prevention of HIV infection in the childbearing population, prevention of unintended pregnancies, PMTCT through a three-drug (Option B+) regimen, and provision of care and follow-up psychosocial support. The principal objective of this chapter is to provide the prevalence of relevant knowledge, perceptions, and behaviours at the national level and also within geographic and socioeconomic subpopulations. In this way, the STI, HIV, and AIDS programme in Lesotho can target those groups of individuals most in need of information and most at risk of HIV infection. L 192 • HIV/AIDS-related Knowledge, Attitudes, and Behaviour To facilitate comparisons between sexes, findings in this chapter will refer to the 15-49 age group unless otherwise noted. The chapter concludes with a discussion of the findings for young people age 15-24. 12.1 HIV/AIDS KNOWLEDGE, TRANSMISSION, AND PREVENTION METHODS Knowledge of HIV is almost universal in Lesotho—99% of women and 98% of men have heard of AIDS (Table 12.1). Nine in ten respondents (92% of women and 88% of men) know that consistent condom use is a way to prevent HIV transmission. Similarly, 91% of women and 87% of men recognise that the risk of getting HIV can be reduced by limiting sexual intercourse to one uninfected partner (Table 12.2). Eighty-six percent of women and 81% of men know both prevention methods. Trends: Between 2004 and 2014, the proportion of respondents knowing both prevention methods has increased from 71% to 86% for women and from 60% to 81% for men (Figure 12.1). Patterns by background characteristics  Knowledge of prevention methods varies by district, especially for men; for example, 87% of men in both Leribe and Maseru recognise using condoms and limiting sexual intercourse to one uninfected partner as a way to avoid getting HIV, compared with 66% of men in Thaba-Tseka.  HIV knowledge increases with education. Only 69% of women and 61% of men with no education know the two major prevention methods compared with 93% of women and 92% of men with more than secondary education. In its effort to assess HIV/AIDS knowledge, the 2014 LDHS obtained information on several common misconceptions about HIV transmission. Respondents were asked whether they think it is possible for a healthy-looking person to have HIV, for mosquitos to transmit HIV, for HIV to be transmitted by supernatural means, or for HIV to be passed by sharing food with a person who has AIDS. Overall, women and men in Lesotho still have challenges in rejecting some of the common myths about HIV. Although 91% of women and 85% of men agreed that a healthy-looking person can have HIV, only about half of women and men (50% and 46%, respectively) said HIV cannot be transmitted by mosquitoes (Tables 12.3.1 and 12.3.2). Eighty-five percent of women and 73% of men said a person cannot become infected by sharing food with a person who has AIDS. Figure 12.1 Trends in HIV Knowledge Note: Comprehensive knowledge values presented here for 2004 and 2009 differ slightly from those published in the 2004 and 2009 LDHS reports. Those reports incorrectly identified the two most common local misconceptions in the calculation of this indicator. 71 60 26 20 81 72 36 27 86 81 39 31 Women Men Women Men 2004 2009 2014 Percentage of women and men age 15-49 Know that HIV can be prevented by using condoms and limiting sex to one uninfected partner Has comprehensive knowledge of HIV HIV/AIDS-related Knowledge, Attitudes, and Behaviour • 193 Comprehensive knowledge of HIV Knowing that consistent use of condoms during sexual intercourse and having just one uninfected faithful partner can reduce the chances of getting HIV, knowing that a healthy-looking person can have HIV, and rejecting the two most common local misconceptions about transmission or prevention of HIV Sample: Women and men age 15-49 Comprehensive knowledge of HIV is a composite measure and indicates that an individual knows that both consistent condom use and limiting sexual intercourse to one uninfected partner can prevent HIV, and that a healthy-looking person can have HIV, and rejects the two most common local misconceptions about the transmission of HIV, which in Lesotho are that HIV can be transmitted through mosquitoes and that a person can become infected with HIV by sharing food with a person who has AIDS. In Lesotho, only 39% of women and 31% of men have comprehensive knowledge of HIV prevention and transmission (Tables 12.3.1 and 12.3.2). Trends: Between 2004 and 2009, the proportion of women and men with a comprehensive knowledge of HIV/AIDS increased moderately, from 26% to 36% for women and from 20% to 27% for men. However, in the 2009 to 2014 time period, only very slight (3 to 4 percentage point) increases in comprehensive knowledge were observed for both women and men (Figure 12.1). Patterns by background characteristics  Rural women (34%) and men (26%) are less likely to have comprehensive knowledge of HIV than urban women (46%) and men (42%).  Although at the district level, there is variability in comprehensive knowledge of HIV, strikingly, in no district does a majority of respondents have a comprehensive knowledge.  Among both women and men, comprehensive knowledge of HIV rises with education and wealth quintile. The difference by education among men is particularly striking; only 13% of men with no education have comprehensive knowledge of HIV, compared with 72% of men with more than a secondary education (Figure 12.2). 12.2 KNOWLEDGE ABOUT MOTHER-TO-CHILD TRANSMISSION Increasing the level of general knowledge about transmission of HIV from mother to child and reducing the risk of transmission using antiretroviral drugs are critical in reducing mother-to-child transmission (MTCT) of HIV. To assess MTCT knowledge, respondents were asked whether HIV can be transmitted from mother to child through breastfeeding and whether a mother with HIV can reduce the risk of transmission to her baby by taking certain drugs during pregnancy. Figure 12.2 Comprehensive knowledge of HIV by education 22 23 32 41 73 13 18 31 38 72 No education Primary incomplete Primary complete Secondary More than secondary Percentage of women and men age 15-49 Women Men 194 • HIV/AIDS-related Knowledge, Attitudes, and Behaviour Women are more aware than men that HIV can be transmitted through breastfeeding (82% versus 74%) and that the risk of MTCT can be reduced by taking special drugs (87% versus 70%) (Table 12.4). Overall, 77% of women and 58% of men are aware that HIV can be transmitted through breastfeeding and that this risk can be reduced by taking special drugs. Trends: Knowledge of MTCT has increased markedly in Lesotho (Figure 12.3). In particular, knowledge that MTCT can be reduced by a mother taking special drugs during pregnancy has risen among women, from 50% in 2004 to 79% in 2009 and to 87% in 2014, and among men, from 39% in 2004 to 58% in 2009 and to 70% in 2014. Patterns by background characteristics  A majority of respondents in all districts have knowledge of MTCT with the exception of men in Thaba-Tseka district, where only 46% of men know both that HIV can be transmitted through breastfeeding and that this risk can be reduced by taking special drugs.  MTCT knowledge increases with education, especially among men. Only 46% of men with no education know about MTCT compared with 72% of men with more than secondary education. 12.3 HIV/AIDS ATTITUDES 12.3.1 Attitudes towards People Living with HIV/AIDS Widespread stigma and discrimination in a population can adversely affect both people’s willingness to be tested and their adherence to antiretroviral therapy (ART) in ART programmes. Thus, reduction of stigma and discrimination in a population is an important indicator of the success of programmes targeting HIV/AIDS prevention and control. Accepting attitudes about HIV Women and men are asked four questions to assess the level of stigma associated with HIV/AIDS. Respondents that indicate that (1) they are willing to care for a family member with AIDS in their home; (2) they would buy fresh vegetables from a shopkeeper who has HIV; (3) a female teacher who has HIV but is not sick should be allowed to continue teaching, and; (4) they would not want to keep secret that a family member was infected with HIV are considered to have accepting attitudes. Sample: Women and men age 15-49 In the 2014 LDHS, respondents who had heard of AIDS were asked a number of questions to assess the level of stigma associated with HIV/AIDS. The large majority of women and men report accepting attitudes towards HIV-infected relatives, teachers, and shopkeepers (Tables 12.5.1 and 12.5.2). More than 90% of both women and men would be willing to care for a relative with AIDS in their home. Ninety-two percent of women and Figure 12.3 Trends in knowledge of maternal-to- child transmission of HIV 74 67 50 39 81 72 79 58 82 74 87 70 Women Men Women Men 2004 2009 2014 Know that HIV can be transmitted by breastfeeding Know that risk of MTCT can be reduced by mother taking special drugs during pregnancy Percentage of women and men age 15-49 HIV/AIDS-related Knowledge, Attitudes, and Behaviour • 195 81% of men agree that a female teacher with HIV should be allowed to continue teaching. And 88% of women and 80% of men would buy fresh vegetables from a shopkeeper with HIV. But far fewer women and men indicated that they would not want to keep secret that a family member was infected with HIV (56% and 53%, respectively). Overall, 46% of women and 36% of men expressed accepting attitudes with regard to all four situations. Trends: Stigma associated with HIV/AIDS has diminished slightly. In 2009, 42% of women and 33% of men expressed accepting attitudes regarding these same four situations compared with 46% of women and 36% of men in 2014. Patterns by background characteristics  There were marked differences by districts in the proportions of women and men expressing accepting attitudes, with women and men from Butha-Buthe, Berea, and Maseru being most likely to express accepting attitudes on all four indicators.  Women and men from the same district often had different levels of acceptance; for example, in Mokhotlong, 46% of women were accepting on all four indicators compared with only 30% of men.  Accepting attitudes on all four indicators generally increase with education and wealth quintile for both men and women. 12.3.2 Attitudes towards Negotiating Safer Sexual Relations with Husbands Knowledge about HIV transmission and ways to prevent it is of little use if people feel powerless to negotiate safer sex practices with their partners. To assess attitudes towards negotiating safer sexual relations with husbands, women and men were asked whether they thought that a wife is justified in refusing to have sexual intercourse with her husband if she knows he has sex with other women or asking that he use a condom if she knows he has an STI. Table 12.6 shows that 66% of women and 55% of men believe a woman has a right to refuse sexual intercourse with her husband if she knows he has sex with other women, and 92% of women and 90% of men believe that a wife is justified in asking her husband to use a condom if she knows he has an STI. 12.3.3 Attitudes towards Condom Education for Young People Adults age 18-49 were also asked about their support for condom education for children age 12-14; that is, do they agree that children age 12-14 should be taught to use a condom to avoid AIDS (Table 12.7). Seventy-two percent of women and 67% of men agreed. Support for condom education was highest among women and men living in Quthing (81% and 77%, respectively) and among the most educated women and men (84% and 78%, respectively). 12.4 MULTIPLE SEXUAL PARTNERS Given that most HIV infections in Lesotho are contracted through heterosexual intercourse, information on sexual behaviour is important in designing and monitoring intervention programmes to control the spread of the epidemic. The 2014 LDHS included questions on the number of respondents’ sexual partners both during their lifetimes and also over the 12 months before the survey. Men were asked whether they paid for sex during the 12 months before the interview. Information was also collected on women’s and men’s use of condoms during their most recent sexual intercourse with each type of partner. 196 • HIV/AIDS-related Knowledge, Attitudes, and Behaviour Seven percent (7%) of women and 27% of men reported that they had two or more sexual partners in the year before the survey Among these women and men who had 2 or more partners in the preceding year, 54% and 65%, respectively, reported using a condom during their most recent sexual intercourse (Tables 12.8.1 and 12.8.2, and Figure 12.4). On average, women have had 2.7 lifetime sexual partners, while men have had 9.6. Patterns by background characteristics  Among districts, the proportion of men having sex with two or more partners in the past 12 months is highest in Maseru (32%) and lowest in Butha-Buthe (14%).  Among those with more than one sexual partner in the past 12 months, never-married men were much more likely to report condom use during their most recent sexual intercourse than those who are currently married (83% and 45%, respectively).  Among women who had ever had sexual intercourse, those who are divorced, separated, or widowed had more partners on average (3.7 partners) than those who are currently married (2.4 partners) and those who have never married (2.8 partners).  Among women and men, the average number of lifetime sexual partners increases with education. Women and men with more than secondary education have an average of 3.6 and 14.6 lifetime partners, respectively. Point prevalence of concurrent sexual partners Percentage of respondents who had two (or more) sexual partners concurrently (at the same time) exactly 6 months before the survey Cumulative prevalence of concurrent sexual partners Percentage of respondents who had two (or more) sexual partners concurrently at any time during the 12 months before the survey Point prevalence and cumulative prevalence of concurrent sexual partners are indicators designed to measure overlap in sexual partnerships. Among men, point prevalence was 8%, and cumulative prevalence was 19% (Table 12.9). This means that at a specific point in time 6 months before the survey, 8% of men engaged in sexual relationships with two or more partners (point prevalence). The cumulative prevalence indicates that 19% of men had two or more concurrent sexual partners at any time in the 12 months before the survey. Among women, point prevalence was 2% and cumulative prevalence was 5%. 12.5 PAID SEX The act of paying for sex introduces an uneven negotiating ground for safer sexual intercourse. Eleven percent of men reported ever paying for sex; 3% reported paying for sex at least once during the 12 months before the Figure 12.4 Multiple sexual partners and condom use 7 54 27 65 Percent who have had 2+ partners in past 12 months Percent who used a condom during last sex (among those with multiple partners) Percentage of women and men age 15-49 Women Men HIV/AIDS-related Knowledge, Attitudes, and Behaviour • 197 survey. Ninety percent of men who had engaged in paid sex in the past 12 months used a condom the last time they paid for sex (Table 12.10). Trends: Although there have not been major changes in the percentage of men paying for sex, those who did engage in paid sex were more likely to use a condom. Among men who had paid for sex, 64% reported condom use in 2009 compared with 90% in 2014. Patterns by background characteristics  Divorced/separated/widowed men, men age 25-29, and men with more than secondary education are most likely to report having ever paid for sex (18% for each).  By district, the percentage of men who had ever paid for sex ranged from a low of 6% in Butha-Buthe to a high of 13% in Maseru.  Men in the highest wealth quintile are more likely to report ever having paid for sex than men in lower wealth quintiles (15% versus 8% to 10%). 12.6 COVERAGE OF HIV TESTING SERVICES Knowledge of HIV status helps HIV-negative individuals make specific decisions to reduce risk and increase safer sex practices so that they can remain disease free. Among those who are living with HIV, knowledge of their status allows them to take action to protect their sexual partners, to access care, and to receive treatment. 12.6.1 Awareness of HIV Testing Services and Experience with HIV Testing To assess awareness and coverage of HIV testing services, LDHS respondents were asked whether they had ever been tested for HIV. If they said that they had, they were asked whether they had received the results of their last test and where they had been tested. If they had never been tested, they were asked whether they knew a place where they could go to be tested. The majority of respondents (97% of women and 92% of men) knew of a place where they could get an HIV test (Tables 12.11.1 and 12.11.2). Never-married respondents who had never had sex were less likely than others to know a place to get an HIV test, as were men and women age 15-19. Knowledge of a place to get an HIV test generally increased with increasing wealth quintile and was somewhat more common among urban than rural residents, although the difference was more pronounced among men. In general, differences by district were not large. Overall, 84% of women and 63% of men had ever been tested and had received the result of the last test. Nearly six in ten women (58%) and four in ten men (36%) were tested for HIV in the past year and received the results of the test. 198 • HIV/AIDS-related Knowledge, Attitudes, and Behaviour Trends: HIV testing has increased dramatically since 2004, when only 12% of women and 9% of men were ever tested for HIV and received the results of their last test, and 6% of women and 5% of men were tested for HIV in the past 12 months and received results of the last test (Figure 12.5). Patterns by background characteristics  The proportion of women and men who have never been tested is highest among women and men age 15-19 (42% and 52%, respectively), and those who have never had sex (55% of both women and men).  Among women, but not men, there is little difference in recent testing between respondents from urban and rural areas; 47% of urban men were tested in the last 12 months and received the results of their last test compared with 31% of rural men.  Recent HIV testing is relatively high throughout Lesotho ranging from 53% of women in Mafeteng and Quthing to 66% of women in Thaba-Tseka and from 24% of men in Mokhotlong to 43% of men in Maseru.  Among men but not among women, recent HIV testing coverage increases with education and wealth (Figure 12.6). 12.6.2 HIV Testing of Pregnant Women Screening for HIV in pregnant women is a key tool in reducing transmission of HIV from a mother to her child. Table 12.12 shows that 81% of women who gave birth during the 2 years before the survey received HIV counselling during antenatal care. Seventy-nine percent of women reported they had both received counselling about HIV and had been offered, accepted, and received the results of an HIV test during antenatal care, as recommended. This recommended testing protocol was experienced most commonly by women in Leribe (85%) and least commonly by women in Thaba-Tseka (73%). In general, women with lower levels of education and those from the poorest households were least likely to report receiving the full range of HIV counselling and testing services during antenatal care. Figure 12.5 Trends in HIV testing na = not available Note: Data on the percentage of women tested for HIV in the past 12 months are not available for the 2009 LDHS due to a skip error in the questionnaire. Figure 12.6 Recent HIV testing by wealth quintile 12 6 9 5 66 na 37 24 84 58 63 36 Percentage of women and men age 15-49 who have been tested for HIV 2004 2009 2014 Women Ever tested Tested in past 12 months Men Ever tested Tested in past 12 months 59 61 60 59 54 23 34 35 38 46 Lowest Second Middle Fourth Highest Percentage of women and men age 15-49 who were tested for HIV in the 12 months before the survey and received the results Women Men WealthiestPoorest HIV/AIDS-related Knowledge, Attitudes, and Behaviour • 199 12.6.3 Reasons for Not Getting Tested for HIV HIV testing and counselling is a strategy for prevention and control of the HIV epidemic, because new infections are transmitted by people who do not know they are infected. The undiagnosed infection remains a significant factor fuelling the HIV epidemic as shown in Tables 12.11.1 and 12.11.2, 15% of women and 35% of men have never been tested. In the 2014 LDHS, all respondents who had heard of HIV, regardless of whether or not they had ever been tested, were asked why some individuals choose not to undergo HIV testing and counselling. As shown in Tables 12.13.1 and 12.13.2, the leading reasons given all relate to fear: fear of results was cited by 75% of women and 69% of men, fear of stigma and discrimination was cited 32% of women and 25% of men, fear of death was cited by 20% of women and 19% of men, and fear of depression was cited by 18% of women and 20% of men. Respondents who had heard of AIDS but who had never been tested for HIV were asked the main reason they had not been tested. Among both women and men, the most common reasons given for not being tested were that the respondents believed that they were not at risk, fear of results, or some other, unspecified reason (Tables 12.14.1 and 12.14.2). 12.7 MALE CIRCUMCISION Male circumcision has been associated with a lower risk of HIV transmission from women to men (Williams et al., 2006; WHO and UNAIDS, 2007). In Lesotho, male circumcision that occurs as part of a traditional ceremony within an initiation school is a common practice. In 2012, the Lesotho MOH launched a voluntary male medical circumcision (VMMC) programme. The goal of this programme is to rapidly scale up VMMC in order to reach 80% coverage by 2017. This translates into an immediate target of 317,215 men age 15-49 (WHO 2013). To examine the practice of circumcision in Lesotho, men interviewed in the 2014 LDHS were asked separately about whether they had undergone traditional circumcision and medical male circumcision. As shown in Table 12.15, 45% of men reported that they are traditionally circumcised only, 23% reported that they are medically circumcised only, and 5% reported that they are both traditionally and medically circumcised. Overall, 72% of men are either traditionally or medically circumcised. Patterns by background characteristics  The proportion of men who report that they are traditionally circumcised only increases rapidly with age, from 26% among men age 15-19 to 47% among men age 20-24, and plateaus at 52-55% among men age 25 and older. In contrast, younger men are more likely than older men to report that they are medically circumcised: 29% of men age 15-24 report that they are medically circumcised only, as compared with 15% of men age 40-49.  Traditional circumcision only is much more common among men living in rural areas than urban areas (56% and 22%, respectively). Medical male circumcision is much more common in urban areas than rural areas; 41% of men age 15-49 in urban areas report that they are medically circumcised but not traditionally circumcised, compared with 13% in rural areas.  The proportion of men who are traditionally circumcised only is inversely correlated with education and wealth. In contrast, the proportion of men who are medically circumcised rises rapidly with increasing education and wealth: 2% of men in the lowest wealth quintile are medically circumcised only, as compared with 46% in the highest wealth quintile. 200 • HIV/AIDS-related Knowledge, Attitudes, and Behaviour 12.8 SELF-REPORTING OF SEXUALLY TRANSMITTED INFECTIONS Sexually transmitted infections (STIs) and symptoms Respondents who have ever had sex are asked whether they had an STI or symptoms of an STI (a bad-smelling, abnormal discharge from the vagina/penis or a genital sore or ulcer) in the 12 months before the survey. Sample: Women and men age 15-49 In the 2014 LDHS, respondents who had ever had sex were asked whether they had had a sexually transmitted infection or symptoms of an STI in the 12 months before the survey. Women were slightly more likely than men to report having had an STI or having experienced STI symptoms (Table 12.16). Among women, in the 12 months before the survey, 3% reported that they had an STI; 12% had a bad-smelling, abnormal discharge; and 5% had a genital sore or ulcer. Among men, 3% reported that they had an STI and 8% reported a bad- smelling, abnormal discharge, and 5% reported a genital sore or ulcer. Taken together, 15% of women and 12% of men had either had an STI or symptoms of an STI during the 12 months before the survey. Seventy percent of women and 52% of men who had an STI or STI symptoms sought advice or treatment from a clinic, hospital, private doctor, or other health professional (Figure 12.7). Four percent of women and 5% of men sought advice or treatment from a shop or pharmacy, and 5% of women and 13% of men sought advice or treatment from any other source. Twenty-three percent of women and 32% of men did not seek any treatment when they had an STI or STI symptoms. Figure 12.7 STI advice or treatment seeking-behaviour 70 4 5 23 52 5 13 32 Sought advice or treatment from a clinic/hospital/ private doctor/other health professional Sought advice or medicine from a shop/pharmacy Sought advice or treatment from any other source No advice or treatment Percentage of women and men age 15-49 with an STI or STI-Symptoms Women Men HIV/AIDS-related Knowledge, Attitudes, and Behaviour • 201 12.9 INJECTIONS Injection overuse in a health care setting can contribute to the transmission of blood-borne pathogens because it amplifies the effect of unsafe practices such as reuse of injection equipment. LDHS respondents were asked whether they had received any injections from a health worker in the 12 months before the survey and, if so, whether their last injection was administered with a syringe from a new, unopened package. It should be noted that self-administered medical injections (e.g., insulin injections for diabetes) were not included in the calculations. Thirty-four percent (34%) of women and 17% of men reported receiving an injection from a health worker during 12 months before the survey (Table 12.17). Ninety-eight percent of women and 92% of men indicated that for their most recent injection the syringe was taken from a newly opened package. 12.10 HIV/AIDS-RELATED KNOWLEDGE AND BEHAVIOUR AMONG YOUNG PEOPLE This section addresses HIV/AIDS-related knowledge among young people age 15-24 and also assesses the extent to which young people are engaged in behaviours that may place them at risk of contracting HIV. 12.10.1 Knowledge Knowledge of how HIV is transmitted is crucial to enabling people to avoid HIV infection, and this is especially true for young people, who are often at greater risk because they may have shorter relationships with more partners or engage in other risky behaviours. In Lesotho, 38% of young women and 31% of young men have comprehensive knowledge of HIV (defined as knowing that both consistent condom use and limiting sexual intercourse to one uninfected partner are HIV prevention methods, knowing that a healthy-looking person can have HIV, and rejecting the two most common local misconceptions about HIV transmission) (Table 12.18). Among both sexes, the proportion with comprehensive knowledge generally increases with age and educational attainment. Urban young people are more likely than rural young people to have comprehensive knowledge of HIV. Although less than half of young people have comprehensive knowledge of HIV, knowledge of a source for condoms is relatively high. Eighty-five percent of young women and 87% of young men know a place where they can obtain a condom. 12.10.2 First Sex Young people who initiate sex at an early age are typically at higher risk of becoming pregnant or contracting an STI than young people who initiate sex later. Consistent condom use can reduce such risks. In Lesotho, 5% of women and 23% of men age 15-24 reported having sex before age 15 (Table 12.19 and Figure 12.8). Among those age 18-24, 46% of young women and 67% of young men report having had sex by age 18. Figure 12.8 Age at first sex among young people 5 46 23 67 Sex by age 15 Sex by age 18 Women Men Percentage of women and men age 15-24 who had sex by age 15 and precentage of women and men age 18-24 who had sex by age 18 202 • HIV/AIDS-related Knowledge, Attitudes, and Behaviour Trends: The percentage of young women and men age 15-19 who had sex by age 15 has declined slightly since 2009 for both women (from 9% to 6%) and men (from 26% to 25%). Patterns by background characteristics  Rural young women but not rural young men are somewhat more likely than their urban counterparts to have had sex before age 15 or age 18.  Variations by education level are vast among young women but not young men: approximately two-thirds (64%) of women age 18-24 with primary incomplete education had sexual intercourse before the age of 18, compared with 21% of women with more than secondary education. Among men, in contrast, minor differences are observed by education level. 12.10.3 Premarital Sex The 2014 LDHS also collected information on the patterns of sexual activity among never-married young people age 15-24 in Lesotho. Half of never married young women (51%) and 28% of never- married young men age 15 to 24 reported that they have never engaged in sexual intercourse (Table 12.20). Thirty-seven percent of never-married young women reported that they had sexual intercourse in the past 12 months compared with 58% of never- married young men (Figure 12.9). Among never-married young people who had intercourse in the past 12 months, condom use at last sexual intercourse was comparable among young women than young men (82% and 80%, respectively). Condom use at last sexual intercourse is more common among never-married young women and young men in urban areas (85% and 87%, respectively) than among those in rural areas (80% and 77%, respectively). Condom use at last sexual intercourse generally increases with age and education. 12.10.4 Multiple Sexual Partners Five percent of young women and 23% of young men report having multiple sexual partners in the 12 months before the survey (Tables 12.21.1 and 12.21.2). Among young people who had ever been married, only 5% of young women reported having had sexual intercourse with more than one partner in the previous 12 months, compared with 39% of young men. Among young men who had multiple partners in the past 12 months, 78% reported that they used a condom during their most recent sexual intercourse. 12.10.5 Age-mixing in Sexual Relationships In many societies, young women have sexual relationships with men who are considerably older than they are. This practice can contribute to the 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. In Lesotho, 8% of young women age 15-19 had sexual intercourse with a man 10 or more years older than them (Table 12.22). One percent (1%) of young men age 15-19 reported having a partner 10 or more years older. Figure 12.9 Premarital sex and condom use among young people 37 82 58 80 Percent who had sexual intercourse in past 12 months Percent who used a condom at last sex (among those who had sexual intercourse in past 12 months) Percentage of never-married women and men age 15-24 Women Men HIV/AIDS-related Knowledge, Attitudes, and Behaviour • 203 12.10.6 Coverage of HIV Testing Services Seeking an HIV test may be more difficult for young people than adults because many young people lack experience in accessing health services for themselves and because there are often barriers to young people obtaining services. In Lesotho, among women and men who have been sexually active in the last 12 months, 66% of young women and 32% of young men have been tested for HIV in the past 12 months and received the results of the test (Table 12.23). Young people who know a condom source are more likely than those who do not to have had a test and received the results. Urban young men, but not urban young women, are more likely than their rural counterparts to have been tested and received the results. Among both young women and young men, uptake of HIV testing generally increases with age. Trends: Coverage of HIV testing services among young people has improved dramatically over the last 10 years. In the 2004 LDHS, 7% of young women and 3% of young men were tested for HIV and received their results in the 12 months before the survey as compared with 66% of young women and 32% of young men in 2014. LIST OF TABLES For detailed information on HIV/AIDS-related knowledge, attitudes, and behaviour, see the following tables:  Table 12.1 Knowledge of AIDS  Table 12.2 Knowledge of HIV prevention methods  Table 12.3.1 Comprehensive knowledge about HIV/AIDS: Women  Table 12.3.2 Comprehensive knowledge about HIV/AIDS: Men  Table 12.4 Knowledge of prevention of mother-to-child transmission of HIV  Table 12.5.1 Accepting attitudes towards those living with HIV/AIDS: Women  Table 12.5.2 Accepting attitudes towards those living with HIV/AIDS: Men  Table 12.6 Attitudes towards negotiating safer sexual relations with husband  Table 12.7 Adult support of education about condom use to prevent AIDS  Table 12.8.1 Multiple sexual partners: Women  Table 12.8.2 Multiple sexual partners: Men  Table 12.9 Point prevalence and cumulative prevalence of concurrent sexual partners  Table 12.10 Payment for sexual intercourse and condom use at last paid sexual intercourse  Table 12.11.1 Coverage of prior HIV testing: Women  Table 12.11.2 Coverage of prior HIV testing: Men  Table 12.12 Pregnant women counselled and tested for HIV  Table 12.13.1 Opinions on why some individuals choose not to undergo voluntary HIV testing and counselling: Women  Table 12.13.2 Opinions on why some individuals choose not to undergo voluntary HIV testing and counselling: Men  Table 12.14.1 Main reason why respondent has not been tested for HIV: Women  Table 12.14.2 Main reason why respondent has not been tested for HIV: Men  Table 12.15 Male circumcision  Table 12.16 Self-reported prevalence of sexually transmitted infections (STIs) and STI symptoms  Table 12.17 Prevalence of medical injections 204 • HIV/AIDS-related Knowledge, Attitudes, and Behaviour  Table 12.18 Comprehensive knowledge about HIV/AIDS and of a source of condoms among young people  Table 12.19 Age at first sexual intercourse among young people  Table 12.20 Premarital sexual intercourse and condom use during premarital sexual intercourse among young people  Table 12.21.1 Multiple sexual partners in the past 12 months among young people: Women  Table 12.21.2 Multiple sexual partners in the past 12 months among young people: Men  Table 12.22 Age-mixing in sexual relationships among women and men age 15-19  Table 12.23 Recent HIV tests among young people HIV/AIDS-related Knowledge, Attitudes, and Behaviour • 205 Table 12.1 Knowledge of AIDS Percentage of women and men age 15-49 who have heard of AIDS, by background characteristics, Lesotho 2014 Women Men Background characteristic Have heard of AIDS Number of respondents Have heard of AIDS Number of respondents Age 15-24 98.2 2,765 97.2 1,252 15-19 97.8 1,440 97.0 691 20-24 98.7 1,325 97.5 561 25-29 99.5 1,094 99.1 410 30-39 99.5 1,701 98.3 610 40-49 99.6 1,062 98.6 389 Marital status Never married 98.4 2,190 97.4 1,501 Ever had sex 99.2 1,295 98.8 1,156 Never had sex 97.3 895 92.6 345 Married/living together 99.2 3,612 98.5 983 Divorced/separated/widowed 99.4 819 99.7 176 Residence Urban 99.9 2,419 99.4 920 Rural 98.4 4,202 97.2 1,741 Ecological zone Lowlands 99.5 4,184 98.9 1,711 Foothills 98.5 688 96.3 252 Mountains 97.5 1,288 96.1 523 Senqu River Valley 98.3 461 96.5 174 District Butha-Buthe 96.8 385 96.5 143 Leribe 99.5 1,064 99.0 390 Berea 98.4 892 97.6 379 Maseru 99.8 1,864 98.9 809 Mafeteng 99.5 576 98.2 242 Mohale’s Hoek 99.2 519 97.7 202 Quthing 97.4 315 95.7 105 Qacha’s Nek 98.6 204 99.5 74 Mokhotlong 98.0 349 98.6 144 Thaba-Tseka 98.1 452 93.4 172 Education No education 97.7 68 95.3 213 Primary incomplete 97.0 1,178 95.8 875 Primary complete 99.1 1,375 99.0 316 Secondary 99.5 3,418 99.6 1,043 More than secondary 99.8 581 100.0 214 Wealth quintile Lowest 97.1 960 95.2 376 Second 97.5 1,033 96.2 479 Middle 99.5 1,244 98.2 536 Fourth 99.8 1,605 99.2 616 Highest 99.7 1,778 99.5 654 Total 15-49 99.0 6,621 98.0 2,660 50-59 na na 99.1 271 Total 15-59 na na 98.1 2,931 na = Not applicable 206 • HIV/AIDS-related Knowledge, Attitudes, and Behaviour Table 12.2 Knowledge of HIV prevention methods Percentages of women and men age 15-49 who, in response to prompted questions, say that people can reduce the risk of getting HIV by using condoms every time they have sexual intercourse, and by having one sex partner who is not infected and has no other partners, by background characteristics, Lesotho 2014 Women Men Percentage who say HIV can be prevented by: Number of women Percentage who say HIV can be prevented by: Number of men Background characteristic Using condoms1 Limiting sexual intercourse to one uninfected partner2 Using condoms and limiting sexual intercourse to one uninfected partner1,2 Using condoms1 Limiting sexual intercourse to one uninfected partner2 Using condoms and limiting sexual intercourse to one uninfected partner1,2 Age 15-24 88.6 88.5 82.3 2,765 88.9 85.6 81.3 1,252 15-19 86.6 86.2 79.8 1,440 87.3 83.7 79.1 691 20-24 90.8 91.1 85.0 1,325 90.9 87.9 84.0 561 25-29 93.4 92.4 87.8 1,094 89.4 88.3 84.5 410 30-39 94.8 93.1 90.0 1,701 85.6 87.7 78.7 610 40-49 94.8 92.7 89.5 1,062 86.5 86.0 78.8 389 Marital status Never married 88.8 88.8 82.6 2,190 88.0 85.4 80.7 1,501 Ever had sex 92.2 91.1 86.1 1,295 90.1 88.3 83.6 1,156 Never had sex 83.8 85.3 77.6 895 80.8 75.9 71.1 345 Married/living together 93.5 92.4 88.5 3,612 88.0 87.8 81.4 983 Divorced/separated/widowed 94.1 90.7 86.6 819 86.2 89.3 78.9 176 Residence Urban 94.3 93.4 89.1 2,419 93.5 92.4 88.6 920 Rural 90.6 89.6 84.7 4,202 84.9 83.5 76.8 1,741 Ecological zone Lowlands 93.6 92.6 88.3 4,184 91.7 90.1 85.6 1,711 Foothills 91.6 90.3 86.0 688 80.3 78.6 70.2 252 Mountains 87.3 86.9 80.7 1,288 79.9 79.4 71.2 523 Senqu River Valley 91.1 89.3 84.6 461 85.1 84.8 78.2 174 District Butha-Buthe 89.2 82.4 79.0 385 82.4 77.5 71.6 143 Leribe 95.3 93.9 90.4 1,064 90.9 91.9 87.1 390 Berea 92.3 91.9 87.8 892 85.4 89.0 81.8 379 Maseru 94.3 93.6 89.5 1,864 94.2 90.9 87.4 809 Mafeteng 91.2 89.0 83.1 576 86.2 82.5 75.1 242 Mohale’s Hoek 89.0 90.9 83.4 519 84.3 84.1 77.7 202 Quthing 91.4 88.4 85.4 315 86.1 81.5 75.2 105 Qacha’s Nek 91.6 87.3 83.1 204 87.7 85.3 80.7 74 Mokhotlong 86.5 88.8 81.5 349 80.8 80.7 69.9 144 Thaba-Tseka 85.6 87.0 80.2 452 74.6 73.5 66.0 172 Education No education 84.6 72.8 68.8 68 67.9 76.5 60.5 213 Primary incomplete 85.8 85.5 77.9 1,178 81.1 78.6 71.3 875 Primary complete 93.2 90.6 87.0 1,375 92.9 87.9 84.2 316 Secondary 93.1 92.5 88.2 3,418 94.4 93.1 89.7 1,043 More than secondary 96.1 96.5 92.8 581 96.0 95.2 92.4 214 Wealth quintile Lowest 84.6 83.8 77.5 960 75.9 75.4 66.8 376 Second 89.1 87.2 81.2 1,033 84.1 83.5 77.1 479 Middle 94.4 93.1 89.4 1,244 86.6 84.5 77.4 536 Fourth 94.2 93.8 89.6 1,605 91.9 91.6 86.3 616 Highest 94.0 93.2 89.0 1,778 94.7 92.1 89.4 654 Total 15-49 92.0 91.0 86.3 6,621 87.9 86.6 80.9 2,660 50-59 na na na na 82.8 83.5 73.3 271 Total 15-59 na na na na 87.4 86.3 80.2 2,931 na = Not applicable 1 Using condoms every time they have sexual intercourse 2 Partner who has no other partners HIV/AIDS-related Knowledge, Attitudes, and Behaviour • 207 Table 12.3.1 Comprehensive knowledge about HIV/AIDS: Women Percentage of women age 15-49 who say that a healthy-looking person can have HIV and who, in response to prompted questions, correctly reject local misconceptions about transmission or prevention of HIV, the percentage with a comprehensive knowledge about AIDS by background characteristics, and the percentage who incorrectly say that AIDS can be cured, Lesotho 2014 Percentage of respondents who say that: Percentage who say that a healthy looking person can have HIV and who reject the two most common local miscon- ceptions1 Percentage with a compre- hensive knowledge about AIDS2 Percentage who say that AIDS can be cured Number of women Background characteristic A healthy- looking person can have HIV HIV cannot be trans- mitted by mosquito bites HIV cannot be trans- mitted by supernatural means A person cannot become infected by sharing food with a person who has AIDS Age 15-24 87.3 52.8 88.9 85.1 43.0 37.6 12.7 2,765 15-19 83.3 52.3 88.5 83.7 40.7 34.8 12.8 1,440 20-24 91.7 53.2 89.3 86.5 45.4 40.6 12.6 1,325 25-29 93.7 49.4 89.9 87.8 44.7 40.7 8.6 1,094 30-39 93.0 49.5 88.6 85.2 43.7 40.2 13.1 1,701 40-49 92.3 44.5 83.2 81.1 39.9 36.0 15.2 1,062 Marital status Never married 88.0 54.7 89.8 87.1 46.1 40.0 12.0 2,190 Ever had sex 92.2 55.1 91.3 88.7 48.7 42.8 10.8 1,295 Never had sex 82.0 54.1 87.6 84.9 42.3 35.9 13.7 895 Married/living together 91.8 47.1 87.1 83.9 40.8 37.5 12.9 3,612 Divorced/separated/widowed 92.4 50.5 87.6 83.3 43.8 39.2 12.2 819 Residence Urban 95.1 55.8 91.8 90.0 50.0 45.8 9.7 2,419 Rural 88.1 46.7 85.9 81.9 38.9 34.3 14.2 4,202 Ecological zone Lowlands 94.0 51.6 89.4 88.6 45.8 41.5 10.6 4,184 Foothills 86.9 45.7 83.3 81.1 37.8 32.5 16.0 688 Mountains 82.6 48.9 85.9 75.0 38.2 34.0 16.2 1,288 Senqu River Valley 88.2 45.6 88.5 84.3 38.2 33.1 14.3 461 District Butha-Buthe 87.5 51.3 85.2 86.9 45.4 38.0 11.9 385 Leribe 93.5 48.8 87.6 87.6 42.8 39.0 10.9 1,064 Berea 92.4 52.8 87.3 85.9 46.5 41.0 10.1 892 Maseru 94.2 52.3 90.7 87.1 45.4 42.5 10.8 1,864 Mafeteng 90.7 47.4 87.5 88.6 42.4 35.9 14.9 576 Mohale’s Hoek 87.1 41.8 85.2 80.3 35.3 31.3 15.5 519 Quthing 87.2 48.3 85.4 85.0 38.7 35.3 15.4 315 Qacha’s Nek 87.9 52.1 83.1 84.0 44.4 40.8 14.9 204 Mokhotlong 82.7 50.3 91.4 78.0 39.9 36.1 20.2 349 Thaba-Tseka 82.1 49.8 87.8 72.4 38.0 31.8 13.4 452 Education No education 74.3 40.6 73.1 69.3 31.2 21.9 21.1 68 Primary incomplete 79.8 39.0 78.4 69.5 27.7 22.7 20.3 1,178 Primary complete 89.8 43.2 86.0 80.6 36.0 32.3 13.8 1,375 Secondary 93.7 51.5 91.2 90.5 45.6 41.1 10.8 3,418 More than secondary 98.6 80.9 95.9 95.0 76.4 72.5 2.9 581 Wealth quintile Lowest 77.7 43.1 83.4 70.1 30.6 25.7 18.7 960 Second 86.9 45.5 84.6 79.0 36.9 31.4 16.3 1,033 Middle 92.1 47.8 87.2 87.1 40.2 36.4 12.1 1,244 Fourth 94.5 48.3 89.3 89.7 43.5 39.6 11.2 1,605 Highest 95.2 59.6 92.0 90.5 54.5 50.1 8.5 1,778 Total 90.6 50.0 88.1 84.9 42.9 38.5 12.5 6,621 1 Two most common local misconceptions: HIV can be transmitted by mosquito bites and by sharing food with a person who has AIDS 2 Comprehensive knowledge means knowing that consistent use of condoms during sexual intercourse and having just one uninfected faithful partner can reduce the chance of getting HIV, knowing that a healthy-looking person can have HIV, and rejecting the two most common local misconceptions about HIV transmission or prevention. 208 • HIV/AIDS-related Knowledge, Attitudes, and Behaviour Table 12.3.2 Comprehensive knowledge about HIV/AIDS: Men Percentage of men age 15-49 who say that a healthy-looking person can have HIV and who, in response to prompted questions, correctly reject local misconceptions about transmission or prevention of HIV, the percentage with a comprehensive knowledge about AIDS by background characteristics, and the percentage who incorrectly say that AIDS can be cured, Lesotho 2014 Percentage of respondents who say that: Percentage who say that a healthy looking person can have HIV and who reject the two most common local miscon- ceptions1 Percentage with a compre- hensive knowledge about AIDS2 Percentage who say that AIDS can be cured Number of men Background characteristic A healthy- looking person can have HIV HIV cannot be trans- mitted by mosquito bites HIV cannot be transmitted by supernatural means A person cannot become infected by sharing food with a person who has AIDS Age 15-24 80.7 47.0 85.5 75.7 34.5 30.9 15.5 1,252 15-19 75.9 49.5 84.3 75.2 33.9 29.7 14.3 691 20-24 86.7 44.0 87.0 76.4 35.2 32.3 17.0 561 25-29 88.8 49.9 85.3 75.1 42.1 38.0 16.3 410 30-39 88.9 41.8 80.5 72.4 34.5 29.5 16.0 610 40-49 89.6 44.4 80.4 64.8 31.5 28.0 20.6 389 Marital status Never married 81.8 47.4 84.4 75.3 35.7 32.0 15.7 1,501 Ever had sex 84.5 46.7 85.3 75.9 36.1 32.8 16.6 1,156 Never had sex 72.7 50.0 81.0 73.1 34.5 29.2 12.6 345 Married/living together 89.7 44.1 82.4 70.5 35.2 30.7 16.8 983 Divorced/separated/widowed 88.2 42.6 83.7 71.5 30.7 28.0 21.6 176 Residence Urban 94.1 52.7 88.1 83.0 46.4 41.8 14.2 920 Rural 80.4 42.3 81.2 68.1 29.3 25.7 17.7 1,741 Ecological zone Lowlands 90.8 46.1 87.0 78.9 38.3 34.4 14.5 1,711 Foothills 76.8 45.3 75.0 65.0 28.9 25.1 17.9 252 Mountains 70.5 45.3 77.4 58.6 28.6 24.5 21.8 523 Senqu River Valley 85.0 46.5 81.3 73.6 33.4 29.0 17.5 174 District Butha-Buthe 76.3 44.9 79.4 67.5 30.2 25.8 11.6 143 Leribe 90.8 43.6 87.0 80.9 37.5 32.9 14.6 390 Berea 89.6 49.6 84.5 75.8 38.7 35.0 15.5 379 Maseru 91.7 48.7 86.2 77.0 40.2 37.1 15.6 809 Mafeteng 81.3 34.7 79.8 71.2 24.3 20.1 16.5 242 Mohale’s Hoek 73.6 46.1 81.1 69.8 30.0 26.7 22.5 202 Quthing 84.0 43.9 78.0 64.5 33.1 28.8 16.1 105 Qacha’s Nek 86.7 50.0 83.1 70.0 37.4 34.4 16.3 74 Mokhotlong 76.6 50.4 84.2 64.9 35.4 29.4 23.0 144 Thaba-Tseka 64.9 41.6 76.3 58.5 24.7 19.0 18.9 172 Education No education 66.8 35.3 67.7 49.7 15.8 13.0 28.2 213 Primary incomplete 75.7 38.0 75.1 58.0 22.0 17.9 23.9 875 Primary complete 87.6 41.9 85.9 77.0 33.6 30.6 16.9 316 Secondary 93.3 48.7 91.0 85.1 42.4 38.1 9.9 1,043 More than secondary 98.6 81.0 94.7 95.9 76.0 71.5 5.9 214 Wealth quintile Lowest 66.0 40.7 73.7 55.4 20.7 17.6 23.5 376 Second 81.3 41.5 79.4 66.0 29.4 25.3 19.8 479 Middle 85.8 44.0 83.1 73.8 33.6 28.4 18.3 536 Fourth 90.5 44.7 86.5 79.6 38.8 35.7 14.2 616 Highest 93.4 54.8 90.0 82.4 45.7 41.6 10.7 654 Total 15-49 85.1 45.9 83.6 73.3 35.2 31.2 16.5 2,660 50-59 85.5 31.7 75.9 65.3 24.8 20.5 21.1 271 Total 15-59 85.2 44.6 82.9 72.5 34.2 30.3 16.9 2,931 1 Two most common local misconceptions: HIV can be transmitted by mosquito bites and by sharing food with a person who has AIDS 2 Comprehensive knowledge means knowing that consistent use of condoms during sexual intercourse and having just one uninfected faithful partner can reduce the chance of getting HIV, knowing that a healthy-looking person can have HIV, and rejecting the two most common local misconceptions about HIV transmission or prevention. HIV/AIDS-related Knowledge, Attitudes, and Behaviour • 209 Table 12.4 Knowledge of prevention of mother-to-child transmission of HIV Percentages of women and men age 15-49 who know that HIV can be transmitted from mother to child by breastfeeding and that the risk of mother to child transmission (MTCT) of HIV can be reduced by the mother taking special drugs during pregnancy, by background characteristics, Lesotho 2014 Women Men Percentage who know that: Number of women Percentage who know that: Number of men Background characteristic HIV can be transmitted by breastfeeding 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 HIV can be transmitted by breastfeeding 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 Age 15-24 79.7 81.8 71.3 2,765 71.3 65.0 53.2 1,252 15-19 75.0 77.0 65.2 1,440 68.3 63.2 50.0 691 20-24 84.7 87.0 77.9 1,325 75.0 67.2 57.0 561 25-29 86.5 92.6 82.8 1,094 78.4 80.1 66.5 410 30-39 85.7 91.9 82.8 1,701 75.1 71.8 61.6 610 40-49 79.9 88.8 76.3 1,062 73.0 75.5 61.9 389 Marital status Never married 76.3 80.0 67.6 2,190 70.6 66.7 54.1 1,501 Ever had sex 79.6 86.0 72.5 1,295 73.1 68.9 56.2 1,156 Never had sex 71.6 71.1 60.5 895 61.9 59.3 47.1 345 Married/living together 86.0 91.0 81.9 3,612 77.8 76.6 65.3 983 Divorced/separated/widowed 82.4 90.8 80.0 819 75.1 67.4 57.2 176 Currently pregnant Pregnant 87.9 88.3 82.2 284 na na na na Not pregnant or not sure 82.1 87.3 76.7 6,337 na na na na Residence Urban 83.3 89.4 78.8 2,419 75.4 80.8 66.3 920 Rural 81.9 86.1 75.9 4,202 72.5 64.9 54.2 1,741 Ecological zone Lowlands 83.0 89.7 78.6 4,184 74.1 75.9 61.7 1,711 Foothills 80.0 85.3 73.6 688 72.2 60.9 52.4 252 Mountains 80.8 80.9 73.3 1,288 72.3 59.3 52.1 523 Senqu River Valley 84.5 86.4 76.7 461 73.3 63.8 53.5 174 District Butha-Buthe 79.5 83.0 73.3 385 62.3 62.7 51.4 143 Leribe 80.0 88.4 75.0 1,064 67.7 68.1 52.0 390 Berea 82.9 91.2 79.7 892 74.4 76.2 64.7 379 Maseru 84.2 89.6 79.7 1,864 77.6 78.8 65.2 809 Mafeteng 82.8 88.1 77.1 576 76.9 68.7 57.7 242 Mohale’s Hoek 82.0 83.1 74.3 519 73.9 61.3 54.5 202 Quthing 81.5 84.0 73.3 315 78.2 62.8 55.2 105 Qacha’s Nek 82.6 85.8 75.4 204 69.7 64.9 50.9 74 Mokhotlong 84.2 84.3 77.8 349 81.0 64.2 56.7 144 Thaba-Tseka 81.2 80.3 73.3 452 62.2 55.2 45.5 172 Education No education 74.2 74.6 65.0 68 70.5 49.7 45.8 213 Primary incomplete 77.3 81.2 70.5 1,178 71.7 60.1 50.6 875 Primary complete 82.7 88.4 77.8 1,375 75.5 76.4 62.9 316 Secondary 83.2 88.1 77.7 3,418 73.2 78.8 63.4 1,043 More than secondary 88.2 94.4 85.0 581 82.5 83.4 71.8 214 Wealth quintile Lowest 78.0 77.2 69.2 960 68.3 52.6 46.8 376 Second 83.6 88.1 78.4 1,033 75.9 64.8 57.6 479 Middle 83.4 88.8 77.9 1,244 73.4 66.7 54.0 536 Fourth 83.3 89.0 77.9 1,605 75.0 79.0 63.9 616 Highest 82.5 89.8 78.7 1,778 73.6 79.7 64.2 654 Total 15-49 82.4 87.3 76.9 6,621 73.5 70.4 58.4 2,660 50-59 na na na na 74.2 72.8 59.9 271 Total 15-59 na na na na 73.6 70.6 58.6 2,931 na = Not applicable 210 • HIV/AIDS-related Knowledge, Attitudes, and Behaviour Table 12.5.1 Accepting attitudes towards those living with HIV/AIDS: Women Among women age 15-49 who have heard of AIDS, percentage expressing specific accepting attitudes towards people with HIV/AIDS, by background characteristics, Lesotho 2014 Percentage of respondents who: Percentage expressing acceptance attitudes on all four indicators Number of respondents who have heard of AIDS Background characteristic Are willing to care for a family member with AIDS in the respondent’s home Would buy fresh vegetables from shopkeeper who has HIV Say that a female teacher who has HIV but is not sick should be allowed to continue teaching Would not want to keep secret that a family member got infected with HIV Age 15-24 93.4 84.0 89.4 56.2 43.1 2,715 15-19 92.5 80.2 86.2 58.6 43.1 1,408 20-24 94.3 88.2 92.9 53.6 43.0 1,308 25-29 97.4 90.3 94.5 55.4 47.9 1,088 30-39 97.0 92.0 94.2 57.6 50.1 1,692 40-49 96.8 89.8 90.8 54.9 46.6 1,057 Marital status Never married 94.0 84.6 90.3 58.2 46.3 2,155 Ever had sex 95.1 87.4 93.1 59.5 49.3 1,285 Never had sex 92.5 80.4 86.3 56.3 42.0 870 Married/living together 95.9 89.0 92.3 54.9 45.6 3,583 Divorced/separated/widowed 97.9 92.9 92.7 56.5 49.2 814 Residence Urban 96.1 91.5 95.8 55.9 48.9 2,418 Rural 95.2 86.1 89.3 56.4 44.7 4,135 Ecological zone Lowlands 95.9 90.1 94.6 57.4 48.7 4,165 Foothills 94.5 85.7 88.3 57.9 45.7 678 Mountains 94.6 82.7 84.6 51.9 39.2 1,256 Senqu River Valley 96.0 87.5 89.9 54.3 44.3 453 District Butha-Buthe 95.5 90.3 92.5 63.7 53.4 373 Leribe 95.1 89.4 93.6 47.8 39.9 1,058 Berea 95.7 90.7 94.0 56.4 49.3 878 Maseru 96.0 89.5 94.8 60.5 51.1 1,861 Mafeteng 95.1 86.8 89.7 60.4 47.2 574 Mohale’s Hoek 96.7 83.6 87.8 55.6 44.3 515 Quthing 94.3 86.9 89.8 55.9 45.9 307 Qacha’s Nek 95.5 87.0 89.5 38.0 30.7 201 Mokhotlong 96.5 85.6 82.7 61.0 46.1 342 Thaba-Tseka 93.6 81.7 85.5 51.6 37.7 444 Education No education 93.6 70.0 69.5 53.9 39.5 66 Primary incomplete 93.5 77.1 78.5 55.1 37.6 1,143 Primary complete 95.5 87.3 90.8 55.6 44.5 1,362 Secondary 96.1 90.9 95.5 56.9 49.0 3,400 More than secondary 96.5 97.0 99.8 55.9 52.2 581 Wealth quintile Lowest 93.6 78.4 80.0 53.8 37.9 932 Second 95.7 85.9 88.3 55.6 42.6 1,008 Middle 95.3 89.0 92.3 56.5 46.3 1,238 Fourth 96.2 89.5 93.7 56.1 47.9 1,602 Highest 95.9 92.5 97.5 57.7 51.3 1,773 Total 95.5 88.1 91.7 56.2 46.3 6,552 HIV/AIDS-related Knowledge, Attitudes, and Behaviour • 211 Table 12.5.2 Accepting attitudes towards those living with HIV/AIDS: Men Among men age 15-49 who have heard of HIV/AIDS, percentage expressing specific accepting attitudes towards people with HIV/AIDS, by background characteristics, Lesotho 2014 Percentage of respondents who: Percentage expressing acceptance attitudes on all four indicators Number of respondents who have heard of AIDS Background characteristic Are willing to care for a family member with AIDS in the respondent’s home Would buy fresh vegetables from shopkeeper who has HIV Say that a female teacher who has HIV but is not sick should be allowed to continue teaching Would not want to keep secret that a family member got infected with HIV Age 15-24 88.1 76.4 78.6 53.3 32.4 1,217 15-19 85.9 74.1 75.8 52.0 29.2 670 20-24 90.8 79.3 81.9 54.9 36.4 547 25-29 94.0 84.9 83.8 48.8 38.0 406 30-39 91.6 82.5 82.6 55.2 40.1 600 40-49 95.3 79.9 79.6 54.4 35.8 383 Marital status Never married 88.6 78.2 79.9 52.4 33.1 1,462 Ever had sex 89.1 80.0 80.9 51.2 33.4 1,142 Never had sex 86.8 71.7 76.4 56.7 32.1 319 Married/living together 94.5 81.7 81.2 54.2 38.4 969 Divorced/separated/widowed 89.4 80.6 80.6 54.4 39.7 176 Residence Urban 94.0 86.3 92.1 50.9 39.9 914 Rural 89.2 76.1 74.2 54.4 33.2 1,692 Ecological zone Lowlands 92.9 84.1 86.6 52.4 38.7 1,693 Foothills 84.8 71.9 71.9 56.6 31.3 243 Mountains 88.3 68.3 64.5 53.5 27.3 503 Senqu River Valley 86.9 80.5 78.7 54.9 34.9 168 District Butha-Buthe 85.6 80.5 81.0 61.7 40.7 138 Leribe 87.3 84.9 85.1 46.0 33.5 386 Berea 93.4 84.2 86.4 54.9 40.8 370 Maseru 94.6 82.2 87.5 52.5 38.3 800 Mafeteng 89.8 75.2 72.1 57.1 35.5 237 Mohale’s Hoek 86.8 74.6 73.3 61.4 34.7 198 Quthing 88.5 80.0 79.3 47.0 30.1 100 Qacha’s Nek 86.7 77.3 79.8 36.4 23.9 74 Mokhotlong 92.0 68.3 56.8 59.1 29.7 142 Thaba-Tseka 88.3 67.1 63.3 53.4 25.5 161 Education No education 84.9 60.0 54.7 61.4 26.4 203 Primary incomplete 86.7 68.0 65.1 54.7 27.0 838 Primary complete 93.7 84.2 83.9 56.1 41.3 313 Secondary 93.2 88.4 93.3 51.8 41.8 1,039 More than secondary 97.4 95.3 97.3 42.4 39.0 214 Wealth quintile Lowest 87.1 63.8 56.9 56.1 25.1 358 Second 86.4 75.7 74.2 59.6 33.7 460 Middle 90.3 80.9 81.4 52.3 37.1 526 Fourth 92.6 82.3 85.2 53.8 38.2 611 Highest 94.9 87.8 92.6 47.3 38.8 651 Total 15-49 90.9 79.7 80.5 53.2 35.6 2,606 50-59 91.9 78.4 70.5 47.2 29.7 268 Total 15-59 91.0 79.6 79.5 52.6 35.0 2,874 212 • HIV/AIDS-related Knowledge, Attitudes, and Behaviour Table 12.6 Attitudes towards negotiating safer sexual relations with husband Percentage of women and men age 15-49 who believe that a woman is justified in refusing to have sexual intercourse with her husband if she knows that he has sexual intercourse with other women, and percentage who believe that a woman is justified in asking that they use a condom if she knows that her husband has a sexually transmitted infection (STI), by background characteristics, Lesotho 2014 Women Men Woman is justified in: Number of women Woman is justified in: Number of men Background characteristic Refusing to have sexual intercourse with her husband if she knows he has sex with other women Asking that they use a condom if she knows that her husband has an STI Refusing to have sexual intercourse with her husband if she knows he has sex with other women Asking that they use a condom if she knows that her husband has an STI Age 15-24 67.0 89.0 2,765 55.4 89.1 1,252 15-19 68.9 86.2 1,440 57.9 87.2 691 20-24 64.9 92.1 1,325 52.2 91.5 561 25-29 66.5 94.6 1,094 54.5 92.1 410 30-39 65.2 93.3 1,701 50.5 90.2 610 40-49 64.2 94.6 1,062 58.4 89.3 389 Marital status Never married 70.9 89.5 2,190 54.9 88.9 1,501 Ever had sex 73.3 94.6 1,295 54.2 91.2 1,156 Never had sex 67.5 82.2 895 57.5 81.2 345 Married/living together 63.2 93.0 3,612 54.1 90.8 983 Divorced/separated/widowed 65.4 93.4 819 53.7 92.5 176 Residence Urban 70.0 93.8 2,419 61.2 93.4 920 Rural 63.7 90.8 4,202 51.0 88.0 1,741 Ecological zone Lowlands 68.6 93.9 4,184 57.3 92.7 1,711 Foothills 66.9 90.4 688 50.9 88.0 252 Mountains 58.6 86.9 1,288 48.6 82.2 523 Senqu River Valley 61.8 90.1 461 51.0 87.9 174 District Butha-Buthe 60.7 86.7 385 53.3 83.0 143 Leribe 66.3 92.2 1,064 51.3 89.1 390 Berea 73.5 94.7 892 59.4 90.7 379 Maseru 68.2 94.4 1,864 55.5 95.6 809 Mafeteng 65.7 93.6 576 59.3 90.7 242 Mohale’s Hoek 64.2 88.3 519 54.1 84.7 202 Quthing 66.4 93.4 315 58.6 91.8 105 Qacha’s Nek 62.8 90.6 204 46.8 85.5 74 Mokhotlong 62.0 90.1 349 54.3 84.6 144 Thaba-Tseka 52.8 83.2 452 43.3 78.7 172 Education No education 44.1 86.2 68 44.2 76.7 213 Primary incomplete 56.7 87.0 1,178 50.3 86.3 875 Primary complete 61.5 92.7 1,375 54.3 89.1 316 Secondary 68.9 92.7 3,418 57.1 94.4 1,043 More than secondary 81.2 96.2 581 70.2 96.4 214 Wealth quintile Lowest 56.1 85.0 960 49.5 78.1 376 Second 62.0 91.1 1,033 45.7 89.3 479 Middle 66.0 92.2 1,244 50.4 89.0 536 Fourth 66.7 93.1 1,605 58.8 93.4 616 Highest 73.1 94.9 1,778 63.4 94.4 654 Total 15-49 66.0 91.9 6,621 54.6 89.9 2,660 50-59 na na na 58.0 90.3 271 Total 15-59 na na na 54.9 89.9 2,931 na = Not applicable HIV/AIDS-related Knowledge, Attitudes, and Behaviour • 213 Table 12.7 Adult support of education about condom use to prevent AIDS Percentages of women and men age 18-49 who agree that children age 12-14 years should be taught about using a condom to avoid AIDS, by background characteristics, Lesotho 2014 Women Men Background characteristic Percentage who agree Number Percentage who agree Number Age 18-24 72.2 1,891 64.3 837 18-19 71.8 566 66.0 277 20-24 72.4 1,325 63.5 561 25-29 73.3 1,094 71.5 410 30-39 71.5 1,701 66.2 610 40-49 68.8 1,062 67.3 389 Marital status Never married 75.3 1,383 65.1 1,088 Married/living together 69.5 3,549 67.8 982 Divorced/separated/widowed 74.4 815 69.8 176 Residence Urban 74.5 2,157 73.7 813 Rural 69.8 3,590 62.7 1,432 Ecological zone Lowlands 74.7 3,668 70.9 1,454 Foothills 66.4 589 60.8 213 Mountains 63.0 1,089 54.5 428 Senqu River Valley 74.0 401 69.0 150 District Butha-Buthe 59.9 346 51.7 119 Leribe 75.5 917 63.4 313 Berea 76.6 767 68.3 330 Maseru 74.6 1,676 73.2 719 Mafeteng 67.0 473 68.3 194 Mohale’s Hoek 65.5 453 66.0 166 Quthing 80.7 263 76.6 88 Qacha’s Nek 68.0 172 57.8 57 Mokhotlong 72.9 289 62.9 114 Thaba-Tseka 56.9 390 48.8 145 Education No education 52.3 68 55.1 209 Primary incomplete 65.6 999 58.4 702 Primary complete 66.7 1,263 68.7 279 Secondary 73.8 2,837 72.7 842 More than secondary 84.0 580 78.4 214 Wealth quintile Lowest 57.9 815 52.3 313 Second 69.8 873 58.7 404 Middle 72.6 1,055 66.2 439 Fourth 74.9 1,397 74.9 520 Highest 75.9 1,607 73.0 570 Total 18-49 71.6 5,747 66.7 2,246 50-59 na na 60.5 271 Total 18-59 na na 66.0 2,516 na = Not applicable 214 • HIV/AIDS-related Knowledge, Attitudes, and Behaviour Table 12.8.1 Multiple sexual partners: Women Among all women age 15-49, the percentage who had sexual intercourse with more than one sexual partner in the past 12 months; among those having more than one partner in the past 12 months, the percentage reporting that a condom was used at last intercourse; and among those ever having intercourse, the mean number of sexual partners during their lifetime, by background characteristics, Lesotho 2014 All women Among women who had 2+ partners in the past 12 months: Among women who ever had sexual intercourse1: Background characteristic Percentage who had 2+ partners in the past 12 months Number of women Percentage who reported using a condom during last sexual inter- course Number of women Mean number of sexual partners in lifetime Number of women Age 15-24 5.1 2,765 67.2 142 2.1 1,892 15-19 2.9 1,440 (57.9) 41 1.7 660 20-24 7.6 1,325 71.0 100 2.4 1,232 25-29 8.1 1,094 54.5 89 3.0 1,067 30-39 8.6 1,701 43.8 146 3.0 1,655 40-49 5.6 1,062 46.4 59 2.7 1,048 Marital status Never married 5.6 2,190 81.2 122 2.8 1,276 Married/living together 7.1 3,612 39.5 258 2.4 3,577 Divorced/separated/widowed 6.7 819 60.9 55 3.7 808 Residence Urban 6.6 2,419 68.7 160 3.0 2,049 Rural 6.6 4,202 45.3 276 2.5 3,612 Ecological zone Lowlands 6.9 4,184 61.3 290 2.9 3,569 Foothills 6.7 688 (36.9) 46 2.1 605 Mountains 5.2 1,288 37.5 67 2.2 1,079 Senqu River Valley 6.8 461 45.9 32 2.8 409 District Butha-Buthe 3.4 385 * 13 2.0 332 Leribe 7.9 1,064 64.2 84 2.5 914 Berea 6.9 892 67.0 61 3.1 770 Maseru 7.0 1,864 58.4 131 2.9 1,601 Mafeteng 5.0 576 (31.6) 29 2.4 478 Mohale’s Hoek 7.7 519 29.5 40 2.4 454 Quthing 7.3 315 (58.5) 23 3.1 269 Qacha’s Nek 6.2 204 (49.6) 13 2.5 177 Mokhotlong 4.4 349 (37.1) 16 2.3 282 Thaba-Tseka 5.7 452 (34.6) 26 2.2 386 Education No education 5.9 68 * 4 2.4 67 Primary incomplete 7.6 1,178 36.4 90 2.5 1,002 Primary complete 5.5 1,375 45.8 76 2.5 1,275 Secondary 6.1 3,418 60.7 210 2.6 2,783 More than secondary 9.5 581 (69.7) 55 3.6 534 Wealth quintile Lowest 5.5 960 26.6 53 2.4 823 Second 6.1 1,033 47.7 63 2.4 888 Middle 6.3 1,244 54.7 78 2.5 1,068 Fourth 6.5 1,605 54.4 104 2.7 1,380 Highest 7.7 1,778 66.5 137 3.1 1,503 Total 6.6 6,621 53.9 435 2.7 5,662 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 Means are calculated excluding respondents who gave non-numeric responses. HIV/AIDS-related Knowledge, Attitudes, and Behaviour • 215 Table 12.8.2 Multiple sexual partners: Men Among all men age 15-49, the percentage who had sexual intercourse with more than one sexual partner in the past 12 months; among those having more than one partner in the past 12 months, the percentage reporting that a condom was used at last intercourse; and among those having intercourse, the mean number of sexual partners during their lifetime by background characteristics, Lesotho 2014 All men Among men who had 2+ partners in the past 12 months: Among men who ever had sexual intercourse1: Background characteristic Percentage who had 2+ partners in the past 12 months Number of men Percentage who reported using a condom during last sexual inter- course Number of men Mean number of sexual partners in lifetime Number of men Age 15-24 22.7 1,252 78.2 284 6.0 914 15-19 15.3 691 79.7 106 4.0 410 20-24 31.8 561 77.3 178 7.6 504 25-29 38.5 410 72.9 158 12.6 389 30-39 30.7 610 52.7 187 12.4 582 40-49 21.2 389 35.1 82 10.9 364 Marital status Never married 23.5 1,501 82.8 353 7.6 1,135 Married/living together 31.1 983 44.9 306 11.4 952 Divorced/separated/widowed 30.0 176 (66.6) 53 13.3 161 Type of union In polygynous union * 25 * 10 * 25 In non-polygynous union 30.9 958 44.4 296 11.2 927 Not currently in union 24.2 1,677 80.7 406 8.3 1,296 Residence Urban 32.0 920 70.6 295 12.7 786 Rural 23.9 1,741 61.6 417 7.9 1,462 Ecological zone Lowlands 27.8 1,711 69.5 475 10.7 1,441 Foothills 27.5 252 63.3 69 8.5 209 Mountains 23.2 523 51.7 122 6.9 448 Senqu River Valley 26.3 174 60.5 46 8.3 149 District Butha-Buthe 14.2 143 (72.2) 20 5.8 106 Leribe 30.2 390 72.8 118 9.2 339 Berea 23.9 379 61.1 91 9.1 313 Maseru 31.8 809 70.8 258 11.8 711 Mafeteng 22.7 242 56.3 55 10.9 198 Mohale’s Hoek 23.5 202 66.1 47 7.3 160 Quthing 21.9 105 (60.5) 23 7.6 90 Qacha’s Nek 30.0 74 67.2 22 9.5 68 Mokhotlong 29.9 144 40.4 43 8.5 120 Thaba-Tseka 20.0 172 (52.0) 34 6.4 144 Education No education 19.9 213 34.0 42 7.3 192 Primary incomplete 23.2 875 58.6 203 7.4 745 Primary complete 28.4 316 63.4 90 9.7 281 Secondary 28.2 1,043 73.4 294 10.8 833 More than secondary 38.7 214 71.2 83 14.6 198 Wealth quintile Lowest 21.0 376 50.4 79 6.4 311 Second 23.3 479 62.8 111 7.4 392 Middle 24.0 536 58.6 129 8.7 456 Fourth 28.5 616 71.1 176 9.9 529 Highest 33.2 654 71.3 217 13.3 559 Total 15-49 26.7 2,660 65.3 711 9.6 2,248 50-59 11.5 271 (46.5) 31 9.9 249 Total 15-59 25.3 2,931 64.5 743 9.6 2,496 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 Means are calculated excluding respondents who gave non-numeric responses. 216 • HIV/AIDS-related Knowledge, Attitudes, and Behaviour Table 12.9 Point prevalence and cumulative prevalence of concurrent sexual partners Percentage of all women and all men age 15-49 who had concurrent sexual partners 6 months before the survey (point prevalence1), and percentage of all women and all men age 15-49 who had any concurrent sexual partners during the 12 months before the survey (cumulative prevalence2), and among women and men age 15-49 who had multiple sexual partners during the 12 months before the survey, percentage who had concurrent sexual partners, by background characteristics, Lesotho 2014 Among all respondents: Among all respondents who had multiple partners during the 12 months before the survey: Background characteristic Point prevalence of concurrent sexual partners1 Cumulative prevalence of concurrent sexual partners2 Number of respondents Percentage who had concurrent sexual partners2 Number of respondents WOMEN Age 15-24 0.7 2.2 2,765 43.3 142 15-19 0.3 1.1 1,440 (36.7) 41 20-24 1.2 3.5 1,325 46.0 100 25-29 2.4 5.7 1,094 70.5 89 30-39 3.7 7.3 1,701 85.1 146 40-49 2.6 4.9 1,062 87.7 59 Marital status Never married 1.0 2.7 2,190 48.1 122 Married/living together 2.8 6.0 3,612 83.5 258 Divorced/separated/widowed 1.8 3.1 819 46.5 55 Residence Urban 2.0 4.3 2,419 64.3 160 Rural 2.1 4.7 4,202 71.5 276 Total 15-49 2.1 4.5 6,621 68.9 435 MEN Age 15-24 4.9 13.0 1,252 57.4 284 15-19 2.3 6.6 691 43.0 106 20-24 8.0 21.0 561 65.9 178 25-29 11.0 26.8 410 69.5 158 30-39 11.0 23.9 610 78.0 187 40-49 10.2 20.6 389 97.0 82 Marital status Never married 4.6 12.9 1,501 55.1 353 Married/living together 13.5 27.5 983 88.4 306 Divorced/separated/widowed 6.5 19.3 176 (64.3) 53 Type of union In polygynous union * * 25 * 10 In non-polygynous union 13.3 27.6 958 89.4 296 Not currently in union 4.8 13.6 1,677 56.3 406 Residence Urban 9.4 23.0 920 71.8 295 Rural 7.3 16.5 1,741 68.9 417 Total 15-49 8.0 18.7 2,660 70.1 711 50-59 5.8 10.8 271 (93.3) 31 Total 15-59 7.8 18.0 2,931 71.1 743 Notes: Two sexual partners are considered to be concurrent if the date of the most recent sexual intercourse with the earlier partner is after the date of the first sexual intercourse with the later partner. 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 The percentage of respondents who had two (or more) sexual partners that were concurrent at the point in time 6 months before the survey 2 The percentage of respondents who had two (or more) sexual partners that were concurrent anytime during the 12 months preceding the survey HIV/AIDS-related Knowledge, Attitudes, and Behaviour • 217 Table 12.10 Payment for sexual intercourse and condom use at last paid sexual intercourse Percentage of men age 15-49 who ever paid for sexual intercourse and percentage reporting payment for sexual intercourse in the past 12 months, and among them, the percentage reporting that a condom was used the last time they paid for sexual intercourse, by background characteristics, Lesotho 2014 Among all men: Among men who paid for sex in the past 12 months: Background characteristic Percentage who ever paid for sexual intercourse Percentage who paid for sexual intercourse in the past 12 months Number of men Percentage reporting condom use at last paid sexual intercourse Number of men Age 15-24 4.4 1.9 1,252 * 24 15-19 0.9 0.5 691 * 3 20-24 8.7 3.7 561 * 21 25-29 17.9 5.0 410 * 20 30-39 16.5 5.3 610 (96.1) 32 40-49 13.9 1.3 389 * 5 Marital status Never married 7.4 2.4 1,501 (85.0) 36 Married/living together 14.3 3.7 983 (92.1) 36 Divorced/separated/widowed 17.7 5.6 176 * 10 Residence Urban 14.2 4.9 920 (91.5) 45 Rural 8.7 2.1 1,741 (88.1) 37 Ecological zone Lowlands 11.6 3.9 1,711 (92.0) 66 Foothills 8.3 2.3 252 * 6 Mountains 9.1 1.4 523 * 8 Senqu River Valley 9.0 1.4 174 * 2 District Butha-Buthe 6.0 1.2 143 * 2 Leribe 10.9 2.7 390 * 10 Berea 10.0 1.3 379 * 5 Maseru 13.1 5.4 809 * 44 Mafeteng 10.7 3.7 242 * 9 Mohale’s Hoek 10.0 1.0 202 * 2 Quthing 10.6 2.0 105 * 2 Qacha’s Nek 8.2 1.1 74 * 1 Mokhotlong 8.3 2.9 144 * 4 Thaba-Tseka 7.4 1.7 172 * 3 Education No education 10.2 1.2 213 * 3 Primary incomplete 10.7 2.6 875 (73.3) 23 Primary complete 9.2 3.2 316 * 10 Secondary 9.6 3.1 1,043 * 32 More than secondary 18.0 6.4 214 * 14 Wealth quintile Lowest 9.6 2.2 376 * 8 Second 8.5 1.1 479 * 5 Middle 8.4 1.4 536 * 8 Fourth 10.0 3.3 616 * 20 Highest 15.2 6.2 654 * 40 Total 15-49 10.6 3.1 2,660 89.9 82 50-59 17.6 1.9 271 * 5 Total 15-59 11.3 3.0 2,931 89.8 87 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. 218 • HIV/AIDS-related Knowledge, Attitudes, and Behaviour Table 12.11.1 Coverage of prior HIV testing: Women Percentage of women age 15-49 who know where to get an HIV test, percent distribution of women age 15-49 by testing status and by whether they received the results of the last test, the percentage of women ever tested, and the percentage of women age 15-49 who were tested in the past 12 months and received the results of the last test, according to background characteristics, Lesotho 2014 Percentage who know where to get an HIV test Percent distribution of women by testing status and by whether they received the results of the last test Total Percentage ever tested Percentage who have been tested for HIV in the past 12 months and received the results of the last test Number of women Background characteristic Ever tested and received results Ever tested, did not receive results Never tested1 Age 15-24 94.1 71.0 1.5 27.5 100.0 72.5 54.0 2,765 15-19 90.2 56.5 1.5 42.1 100.0 57.9 40.5 1,440 20-24 98.2 86.8 1.5 11.7 100.0 88.3 68.6 1,325 25-29 99.4 95.1 1.4 3.5 100.0 96.5 69.8 1,094 30-39 99.3 93.1 2.2 4.8 100.0 95.2 59.8 1,701 40-49 99.1 89.5 2.6 7.8 100.0 92.2 53.5 1,062 Marital status Never married 93.4 64.0 1.2 34.8 100.0 65.2 43.5 2,190 Ever had sex 97.4 77.7 1.3 20.9 100.0 79.1 54.0 1,295 Never had sex 87.7 44.1 1.1 54.8 100.0 45.2 28.4 895 Married/living together 98.9 93.3 2.0 4.7 100.0 95.3 66.5 3,612 Divorced/separated/widowed 99.2 93.2 2.8 4.0 100.0 96.0 58.9 819 Residence Urban 98.4 83.1 1.6 15.3 100.0 84.7 57.1 2,419 Rural 96.3 83.9 2.0 14.1 100.0 85.9 58.5 4,202 Ecological zone Lowlands 98.1 84.0 1.3 14.7 100.0 85.3 57.1 4,184 Foothills 96.8 82.5 3.4 14.2 100.0 85.8 59.4 688 Mountains 94.8 83.0 2.7 14.3 100.0 85.7 58.9 1,288 Senqu River Valley 95.3 83.9 2.1 13.9 100.0 86.1 61.4 461 District Butha-Buthe 93.1 82.5 1.8 15.8 100.0 84.2 62.0 385 Leribe 98.5 84.6 1.0 14.4 100.0 85.6 58.4 1,064 Berea 97.2 82.7 1.5 15.8 100.0 84.2 55.7 892 Maseru 98.4 84.2 1.9 13.8 100.0 86.2 58.0 1,864 Mafeteng 97.9 83.2 2.6 14.2 100.0 85.8 52.5 576 Mohale’s Hoek 97.1 84.8 2.6 12.6 100.0 87.4 60.8 519 Quthing 93.2 77.9 1.7 20.4 100.0 79.6 52.7 315 Qacha’s Nek 96.8 84.7 2.4 12.9 100.0 87.1 62.6 204 Mokhotlong 94.7 79.6 2.5 17.9 100.0 82.1 54.0 349 Thaba-Tseka 95.6 87.4 1.7 10.9 100.0 89.1 66.3 452 Education No education 97.0 73.3 6.2 20.5 100.0 79.5 37.3 68 Primary incomplete 93.1 81.0 3.2 15.7 100.0 84.3 55.5 1,178 Primary complete 97.7 89.6 1.5 8.8 100.0 91.2 61.9 1,375 Secondary 97.8 81.6 1.5 17.0 100.0 83.0 57.8 3,418 More than secondary 99.8 88.0 1.2 10.8 100.0 89.2 57.3 581 Wealth quintile Lowest 93.8 82.2 3.0 14.8 100.0 85.2 59.4 960 Second 95.7 84.3 2.8 12.9 100.0 87.1 60.7 1,033 Middle 97.2 85.8 1.2 13.0 100.0 87.0 59.6 1,244 Fourth 98.7 83.7 1.2 15.1 100.0 84.9 59.1 1,605 Highest 98.2 82.4 1.7 15.9 100.0 84.1 53.5 1,778 Total 97.1 83.6 1.8 14.5 100.0 85.5 58.0 6,621 1 Includes don’t know/missing HIV/AIDS-related Knowledge, Attitudes, and Behaviour • 219 Table 12.11.2 Coverage of prior HIV testing: Men Percentage of men age 15-49 who know where to get an HIV test, percent distribution of men age 15-49 by testing status and by whether they received the results of the last test, the percentage of men ever tested, and the percentage of men age 15-49 who were tested in the past 12 months and received the results of the last test, according to background characteristics, Lesotho 2014 Percentage who know where to get an HIV test Percent distribution of men by testing status and by whether they received the results of the last test Total Percentage ever tested Percentage who have been tested for HIV in the past 12 months and received the results of the last test Number of men Background characteristic Ever tested and received results Ever tested, did not receive results Never tested1 Age 15-24 87.2 51.2 1.8 47.0 100.0 53.0 28.6 1,252 15-19 84.2 46.1 1.9 52.0 100.0 48.0 24.9 691 20-24 91.0 57.5 1.7 40.8 100.0 59.2 33.1 561 25-29 96.1 71.8 1.9 26.4 100.0 73.6 43.2 410 30-39 95.7 73.8 3.1 23.1 100.0 76.9 43.9 610 40-49 96.1 74.1 3.3 22.6 100.0 77.4 42.6 389 Marital status Never married 87.8 54.0 1.6 44.5 100.0 55.5 29.3 1,501 Ever had sex 90.8 57.1 1.7 41.2 100.0 58.8 31.3 1,156 Never had sex 77.9 43.5 1.1 55.4 100.0 44.6 22.5 345 Married/living together 96.6 75.2 2.7 22.1 100.0 77.9 46.2 983 Divorced/separated/widowed 98.9 70.1 6.9 23.0 100.0 77.0 42.9 176 Residence Urban 96.6 74.5 2.5 23.0 100.0 77.0 46.7 920 Rural 89.3 56.7 2.2 41.0 100.0 59.0 30.9 1,741 Ecological zone Lowlands 94.8 67.7 2.2 30.1 100.0 69.9 39.9 1,711 Foothills 86.5 52.9 2.0 45.1 100.0 54.9 32.0 252 Mountains 85.0 51.5 3.1 45.4 100.0 54.6 27.6 523 Senqu River Valley 90.7 63.8 2.3 34.0 100.0 66.0 34.9 174 District Butha-Buthe 91.6 60.2 2.0 37.8 100.0 62.2 37.4 143 Leribe 93.7 68.2 0.0 31.8 100.0 68.2 36.7 390 Berea 91.6 65.7 1.2 33.0 100.0 67.0 37.1 379 Maseru 94.1 68.7 2.9 28.4 100.0 71.6 43.3 809 Mafeteng 94.2 55.4 3.8 40.9 100.0 59.1 30.4 242 Mohale’s Hoek 87.3 52.3 3.9 43.9 100.0 56.1 29.6 202 Quthing 88.7 55.9 3.5 40.6 100.0 59.4 25.3 105 Qacha’s Nek 94.7 68.8 3.3 27.9 100.0 72.1 36.7 74 Mokhotlong 88.2 54.2 2.5 43.3 100.0 56.7 23.7 144 Thaba-Tseka 83.0 51.2 2.8 46.0 100.0 54.0 34.8 172 Education No education 85.1 53.3 5.6 41.0 100.0 59.0 27.0 213 Primary incomplete 84.7 50.4 3.5 46.1 100.0 53.9 26.8 875 Primary complete 95.2 66.5 1.2 32.2 100.0 67.8 38.4 316 Secondary 96.4 70.1 1.0 28.9 100.0 71.1 41.8 1,043 More than secondary 100.0 83.0 2.6 14.5 100.0 85.5 55.8 214 Wealth quintile Lowest 83.8 49.2 3.5 47.3 100.0 52.7 22.8 376 Second 89.1 59.5 2.1 38.4 100.0 61.6 33.8 479 Middle 90.6 56.2 2.4 41.4 100.0 58.6 34.7 536 Fourth 93.5 67.9 2.3 29.8 100.0 70.2 38.1 616 Highest 97.9 73.9 1.9 24.2 100.0 75.8 46.0 654 Total 15-49 91.8 62.9 2.3 34.8 100.0 65.2 36.4 2,660 50-59 95.9 71.5 6.4 22.1 100.0 77.9 36.0 271 Total 15-59 92.2 63.7 2.7 33.6 100.0 66.4 36.4 2,931 1 Includes don’t know/missing 220 • HIV/AIDS-related Knowledge, Attitudes, and Behaviour Table 12.12 Pregnant women counselled and tested for HIV Among all women age 15-49 who gave birth in the 2 years preceding the survey, the percentage who received counselling on HIV during antenatal care, the percentage who received an HIV test during antenatal care for their most recent birth by whether they received their results and post-test counselling, and the percentage who received an HIV test at the time during ANC or labour for their most recent birth by whether they received their test results, according to background characteristics, Lesotho 2014 Percentage who received counselling on HIV during antenatal care1 Percentage who were tested for HIV during antenatal care and who: Percentage who received counselling on HIV and an HIV test during ANC, and received the results Percentage who had an HIV test during ANC or labour and who:2 Number of women who gave birth in the past 2 years3 Received results and: Did not receive results Background characteristic Received post-test counselling Did not receive post- test counselling Received results Did not receive results Age 15-24 76.5 66.6 24.7 1.9 74.6 92.0 2.0 667 15-19 68.1 59.7 31.6 3.1 66.4 92.1 3.1 187 20-24 79.8 69.3 22.0 1.5 77.8 92.0 1.6 480 25-29 86.7 74.3 22.2 1.2 85.6 96.6 1.2 315 30-39 82.7 66.2 23.1 2.7 79.6 89.3 2.7 321 40-49 86.4 60.8 26.2 6.7 79.0 87.0 6.7 66 Marital status Never married 74.4 70.2 20.1 1.1 73.4 91.1 1.1 190 Married/living together 82.5 69.1 23.8 2.2 80.1 93.2 2.2 1,075 Divorced/separated/widowed 74.5 53.0 31.1 4.1 71.6 84.1 4.1 104 Residence Urban 84.4 70.0 22.7 2.2 81.2 92.8 2.2 357 Rural 79.5 67.3 24.2 2.2 77.6 92.0 2.2 1,012 Ecological zone Lowlands 83.1 70.9 21.6 1.8 80.5 93.0 1.8 745 Foothills 82.0 66.2 24.1 4.1 78.4 91.1 4.1 172 Mountains 75.4 60.0 31.5 1.8 74.1 91.6 1.8 343 Senqu River Valley 80.0 76.3 14.3 2.3 79.6 90.6 2.7 109 District Butha-Buthe 83.3 71.1 18.9 1.4 81.9 90.0 1.4 94 Leribe 87.6 67.3 28.4 0.0 85.2 96.5 0.0 212 Berea 79.3 65.1 25.7 1.7 76.7 92.5 1.7 176 Maseru 82.8 68.4 22.9 4.6 79.1 91.3 4.6 334 Mafeteng 81.5 72.5 16.6 4.6 77.5 89.1 4.6 100 Mohale’s Hoek 76.9 69.7 25.1 1.2 76.1 94.9 1.2 137 Quthing 78.0 70.0 18.0 2.4 78.0 87.9 2.4 80 Qacha’s Nek 76.2 73.3 20.5 2.4 75.0 93.9 3.7 34 Mokhotlong 75.4 69.3 23.9 0.6 74.4 93.5 0.6 91 Thaba-Tseka 74.0 60.1 29.0 0.6 72.9 89.0 0.6 111 Education No education * * * * * * * 6 Primary incomplete 76.2 64.1 20.5 5.2 73.1 84.7 5.2 254 Primary complete 76.3 64.8 27.2 1.9 74.1 92.5 1.9 337 Secondary 84.1 71.4 22.9 1.2 82.3 94.8 1.2 690 More than secondary 86.8 67.3 27.6 2.8 84.0 94.9 2.8 82 Wealth quintile Lowest 72.0 63.0 26.2 2.7 69.8 89.2 2.7 310 Second 75.6 65.2 25.2 2.4 75.1 90.3 2.4 271 Middle 84.4 68.1 22.9 2.0 81.7 91.5 2.0 293 Fourth 87.1 69.2 26.8 1.0 85.3 97.3 1.0 282 Highest 86.7 77.2 15.9 2.8 82.3 93.0 3.0 213 Total 80.8 68.0 23.8 2.2 78.5 92.2 2.2 1,369 Note: An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. 1 In this context, counselling on HIV means that someone talked with the respondent about all three of the following topics: (1) babies getting HIV from their mother, (2) preventing HIV, and (3) getting tested for HIV. 2 Women are asked whether they received an HIV test during labour only if they were not tested for HIV during ANC. 3 Denominator for percentages includes women who did not receive antenatal care for their last birth in the past two years. Ta bl e 12 .1 3. 1 O pi ni on s on w hy s om e in di vi du al s ch oo se n ot to u nd er go v ol un ta ry H IV te st in g an d co un se lli ng : W om en P er ce nt ag e of w om en a ge 1 5- 49 w ho re po rte d sp ec ifi c re as on s w hy s om e in di vi du al s ch oo se n ot to g et te st ed fo r H IV , b y ba ck gr ou nd c ha ra ct er is tic s, L es ot ho 2 01 4 P er ce nt ag e of w om en w ho re po rte d sp ec ifi c re as on s w hy s om e in di vi du al s ch oo se n ot to g et te st ed fo r H IV : B ac kg ro un d ch ar ac te ris tic A lre ad y kn ow s ta tu s N ot a t r is k Fe ar o f re su lts Fe ar o f st ig m a/ di sc rim i- na tio n Fe ar o f de at h Fe ar o f de pr es si on D on ’t kn ow w he re to g et co un se lli ng an d te st in g Fe ar o f ge tti ng in fe ct ed du rin g te st Fe ar o f pa rtn er s’ re ac tio n La ck o f kn ow le dg e/ ig no ra nc e Fa ta lis m / no c ur e To o ex pe ns iv e O th er re as on D on ’t kn ow N um be r o f w om en Ag e 15 -2 4 4. 7 5. 4 75 .2 27 .4 16 .9 15 .5 0. 5 0. 8 3. 6 9. 3 2. 4 0. 2 6. 3 6. 0 2, 76 5 1 5- 19 5. 2 5. 0 73 .1 27 .0 14 .8 14 .0 0. 8 0. 7 2. 6 8. 6 3. 0 0. 4 7. 2 7. 6 1, 44 0 2 0- 24 4. 1 5. 8 77 .4 27 .8 19 .2 17 .2 0. 3 0. 8 4. 7 10 .0 1. 8 0. 0 5. 3 4. 2 1, 32 5 25 -2 9 3. 6 5. 0 75 .5 33 .3 22 .0 18 .4 0. 4 0. 6 5. 9 13 .2 2. 6 0. 0 5. 6 3. 9 1, 09 4 30 -3 9 3. 2 4. 3 74 .5 36 .4 22 .5 20 .1 0. 4 1. 0 5. 6 12 .8 2. 6 0. 0 4. 9 2. 7 1, 70 1 40 -4 9 4. 4 6. 4 72 .2 38 .4 22 .2 19 .3 0. 4 1. 7 4. 8 13 .5 2. 1 0. 5 3. 3 3. 9 1, 06 2 M ar ita l s ta tu s N ev er m ar rie d 4. 7 5. 8 74 .4 28 .9 17 .6 16 .8 0. 7 1. 1 3. 3 10 .4 2. 5 0. 2 6. 4 5. 2 2, 19 0 E ve r h ad s ex 4. 5 6. 7 77 .1 31 .0 18 .0 17 .7 0. 5 1. 3 4. 3 11 .3 2. 0 0. 1 5. 8 3. 5 1, 29 5 N ev er h ad s ex 5. 0 4. 5 70 .4 25 .7 16 .9 15 .5 0. 9 0. 9 1. 8 9. 1 3. 1 0. 3 7. 3 7. 8 89 5 M ar rie d/ liv in g to ge th er 4. 1 4. 9 74 .5 33 .5 20 .9 17 .9 0. 3 0. 7 5. 6 12 .0 2. 5 0. 2 4. 9 4. 4 3, 61 2 D iv or ce d/ se pa ra te d/ w id ow ed 2. 3 5. 2 75 .5 37 .4 22 .5 19 .5 0. 3 1. 5 4. 4 12 .2 2. 2 0. 0 4. 6 2. 6 81 9 R es id en ce U rb an 4. 1 6. 5 77 .3 30 .4 20 .1 19 .6 0. 5 0. 8 3. 7 12 .2 2. 6 0. 3 5. 3 2. 9 2, 41 9 R ur al 4. 1 4. 4 73 .0 33 .6 20 .0 16 .7 0. 4 1. 0 5. 2 11 .1 2. 4 0. 1 5. 4 5. 4 4, 20 2 Ec ol og ic al z on e Lo w la nd s 5. 0 6. 0 76 .4 30 .4 21 .3 18 .9 0. 5 1. 2 3. 9 12 .8 2. 8 0. 2 5. 3 3. 2 4, 18 4 Fo ot hi lls 2. 7 6. 1 73 .0 34 .7 19 .1 17 .4 0. 5 0. 4 3. 4 9. 0 2. 3 0. 1 6. 0 6. 0 68 8 M ou nt ai ns 2. 9 3. 2 70 .0 33 .3 16 .7 12 .9 0. 2 0. 7 6. 4 8. 3 1. 9 0. 2 5. 6 7. 3 1, 28 8 S en qu R iv er V al le y 1. 3 2. 0 72 .8 44 .8 19 .1 21 .0 0. 5 0. 5 8. 7 12 .3 1. 1 0. 0 4. 0 5. 8 46 1 D is tr ic t B ut ha -B ut he 2. 5 2. 6 69 .5 35 .6 21 .1 17 .8 0. 5 1. 3 1. 9 8. 2 2. 2 0. 0 2. 7 6. 2 38 5 Le rib e 4. 9 4. 5 77 .6 31 .9 16 .9 17 .3 0. 6 1. 2 4. 5 10 .9 2. 2 0. 2 6. 1 3. 2 1, 06 4 B er ea 10 .5 7. 4 77 .9 36 .4 26 .8 26 .6 0. 6 0. 9 5. 3 18 .8 4. 3 0. 0 5. 5 3. 3 89 2 M as er u 2. 5 8. 2 74 .2 28 .5 20 .8 14 .6 0. 5 0. 8 3. 4 9. 3 2. 1 0. 4 6. 3 3. 5 1, 86 4 M af et en g 3. 0 3. 6 78 .9 27 .9 19 .6 20 .3 0. 0 1. 4 2. 1 16 .1 3. 1 0. 3 3. 6 4. 0 57 6 M oh al e’ s H oe k 3. 1 3. 0 65 .9 26 .8 11 .2 14 .0 0. 8 1. 3 6. 3 9. 4 1. 9 0. 0 4. 1 7. 7 51 9 Q ut hi ng 1. 6 3. 5 73 .8 48 .2 26 .1 23 .6 0. 3 1. 2 10 .0 15 .5 2. 0 0. 0 3. 7 4. 8 31 5 Q ac ha ’s N ek 4. 3 2. 4 73 .9 46 .9 29 .5 25 .7 0. 1 0. 9 8. 5 7. 1 3. 5 0. 0 7. 9 6. 6 20 4 M ok ho tlo ng 1. 4 1. 9 73 .0 33 .8 10 .1 7. 5 0. 0 0. 0 3. 3 9. 1 1. 6 0. 0 7. 8 6. 1 34 9 Th ab a- Ts ek a 3. 6 1. 8 73 .5 33 .4 19 .8 15 .6 0. 3 0. 5 8. 6 7. 9 1. 0 0. 0 3. 7 6. 7 45 2 Ed uc at io n N o ed uc at io n 0. 4 1. 7 63 .6 33 .7 20 .2 11 .6 0. 0 2. 2 5. 2 3. 6 2. 2 0. 0 9. 1 13 .0 68 P rim ar y in co m pl et e 2. 9 4. 7 69 .4 29 .6 18 .4 14 .7 0. 4 1. 4 3. 7 9. 0 1. 9 0. 0 5. 4 7. 6 1, 17 8 P rim ar y co m pl et e 3. 7 3. 4 73 .8 34 .4 19 .0 15 .1 0. 4 0. 6 5. 2 10 .3 2. 1 0. 2 3. 8 5. 5 1, 37 5 S ec on da ry 4. 7 6. 0 76 .1 32 .3 20 .0 19 .4 0. 5 0. 9 5. 0 11 .9 2. 8 0. 2 5. 8 3. 2 3, 41 8 M or e th an s ec on da ry 4. 2 6. 3 79 .1 34 .0 25 .8 21 .4 0. 4 1. 2 3. 9 18 .2 2. 2 0. 4 5. 9 2. 6 58 1 W ea lth q ui nt ile Lo w es t 2. 9 2. 5 66 .7 34 .6 17 .7 12 .1 0. 3 0. 8 5. 5 7. 7 2. 2 0. 0 6. 1 9. 4 96 0 S ec on d 3. 0 4. 4 72 .0 32 .5 17 .1 15 .2 0. 5 0. 8 5. 2 9. 4 1. 3 0. 1 5. 8 5. 2 1, 03 3 M id dl e 4. 7 4. 5 76 .0 36 .6 20 .2 18 .1 0. 4 1. 2 5. 1 11 .0 3. 1 0. 0 4. 7 5. 3 1, 24 4 Fo ur th 5. 4 6. 0 77 .7 31 .4 18 .9 20 .2 0. 6 1. 1 4. 0 11 .8 2. 4 0. 2 4. 5 2. 5 1, 60 5 H ig he st 3. 8 6. 9 76 .4 29 .3 23 .9 19 .9 0. 4 0. 8 4. 3 14 .9 2. 8 0. 4 5. 9 2. 6 1, 77 8 To ta l 4. 1 5. 2 74 .6 32 .4 20 .0 17 .7 0. 4 1. 0 4. 7 11 .5 2. 4 0. 2 5. 4 4. 5 6, 62 1 HIV/AIDS-related Knowledge, Attitudes, and Behaviour • 221 Ta bl e 12 .1 3. 2 O pi ni on s on w hy s om e in di vi du al s ch oo se n ot to u nd er go v ol un ta ry H IV te st in g an d co un se lli ng : M en P er ce nt ag e of m en a ge 1 5- 49 w ho re po rte d sp ec ifi c re as on s w hy s om e in di vi du al s ch oo se n ot to g et te st ed fo r H IV , b y ba ck gr ou nd c ha ra ct er is tic s, L es ot ho 2 01 4 P er ce nt ag e of m en w ho re po rte d sp ec ifi c re as on s w hy s om e in di vi du al s ch oo se n ot to g et te st ed fo r H IV : B ac kg ro un d ch ar ac te ris tic A lre ad y kn ow s ta tu s N ot a t r is k Fe ar o f re su lts Fe ar o f st ig m a/ di sc rim i- na tio n Fe ar o f de at h Fe ar o f de pr es si on D on ’t kn ow w he re to g et co un se lli ng an d te st in g Fe ar o f ge tti ng in fe ct ed du rin g te st Fe ar o f pa rtn er s’ re ac tio n La ck o f kn ow le dg e/ ig no ra nc e Fa ta lis m / no c ur e To o ex pe ns iv e O th er re as on D on ’t kn ow N um be r o f m en Ag e 15 -2 4 7. 7 6. 3 67 .7 20 .2 16 .3 17 .5 1. 4 0. 9 1. 7 9. 7 1. 8 0. 1 6. 3 7. 5 1, 25 2 1 5- 19 7. 4 4. 5 65 .6 19 .9 12 .9 14 .3 1. 8 1. 1 1. 5 8. 4 1. 8 0. 1 7. 4 8. 6 69 1 2 0- 24 8. 2 8. 6 70 .3 20 .5 20 .5 21 .4 1. 0 0. 8 1. 9 11 .3 1. 8 0. 0 5. 0 6. 1 56 1 25 -2 9 4. 4 8. 1 70 .2 28 .0 19 .9 26 .2 1. 1 1. 8 3. 7 14 .6 3. 3 0. 0 6. 2 5. 1 41 0 30 -3 9 7. 8 5. 4 69 .1 27 .1 20 .9 21 .9 0. 3 1. 8 2. 8 12 .2 4. 4 0. 0 4. 4 4. 8 61 0 40 -4 9 2. 4 6. 8 69 .3 31 .6 22 .5 20 .8 0. 4 2. 3 2. 5 15 .9 3. 2 0. 0 6. 0 4. 9 38 9 M ar ita l s ta tu s N ev er m ar rie d 7. 1 6. 8 68 .0 20 .1 17 .1 18 .3 1. 3 1. 8 1. 4 10 .0 2. 0 0. 0 5. 9 7. 0 1, 50 1 E ve r h ad s ex 6. 7 7. 2 70 .9 20 .9 19 .3 20 .2 0. 9 1. 9 1. 4 10 .5 2. 0 0. 0 5. 4 5. 8 1, 15 6 N ev er h ad s ex 8. 1 5. 4 58 .2 17 .4 9. 7 11 .9 2. 8 1. 6 1. 1 8. 4 2. 0 0. 2 7. 9 11 .0 34 5 M ar rie d/ liv in g to ge th er 5. 4 5. 6 70 .0 30 .1 20 .5 22 .8 0. 4 0. 8 3. 7 14 .4 3. 9 0. 0 5. 5 5. 0 98 3 D iv or ce d/ se pa ra te d/ w id ow ed 6. 7 9. 0 66 .8 33 .1 24 .4 23 .9 0. 4 1. 9 3. 6 14 .4 4. 5 0. 0 6. 5 4. 4 17 6 R es id en ce U rb an 8. 4 7. 4 75 .8 25 .0 22 .4 25 .1 0. 7 1. 4 2. 5 12 .7 3. 4 0. 0 4. 3 3. 2 92 0 R ur al 5. 4 6. 0 64 .8 24 .5 16 .9 17 .8 1. 1 1. 5 2. 3 11 .5 2. 6 0. 0 6. 6 7. 7 1, 74 1 Ec ol og ic al z on e Lo w la nd s 8. 0 7. 2 73 .4 24 .0 21 .0 23 .7 0. 8 1. 5 2. 0 12 .2 2. 7 0. 0 5. 4 3. 3 1, 71 1 Fo ot hi lls 5. 6 5. 9 63 .3 27 .1 16 .8 13 .7 1. 7 1. 2 1. 7 12 .3 3. 7 0. 0 3. 5 9. 7 25 2 M ou nt ai ns 2. 9 4. 4 56 .0 22 .6 12 .0 11 .6 1. 3 1. 4 3. 0 10 .6 2. 1 0. 0 7. 7 13 .0 52 3 S en qu R iv er V al le y 3. 1 6. 3 67 .0 33 .9 20 .8 23 .1 0. 0 1. 9 5. 4 12 .8 4. 7 0. 0 7. 2 7. 3 17 4 D is tr ic t B ut ha -B ut he 8. 9 2. 6 56 .1 31 .8 19 .1 19 .5 1. 2 2. 5 0. 0 8. 0 4. 4 0. 0 0. 8 10 .3 14 3 Le rib e 4. 5 7. 2 71 .9 21 .8 18 .6 21 .6 1. 2 2. 1 1. 5 9. 2 3. 5 0. 0 6. 5 3. 4 39 0 B er ea 12 .3 7. 7 72 .2 33 .1 26 .0 27 .3 0. 8 2. 0 3. 9 19 .7 1. 7 0. 0 3. 9 3. 0 37 9 M as er u 7. 2 7. 4 72 .3 20 .7 20 .2 20 .6 1. 0 1. 1 1. 4 9. 9 2. 4 0. 0 6. 0 4. 0 80 9 M af et en g 4. 7 6. 7 70 .3 24 .3 18 .3 18 .8 0. 0 1. 8 2. 3 16 .2 4. 4 0. 3 5. 1 7. 1 24 2 M oh al e’ s H oe k 4. 3 7. 7 62 .5 15 .3 10 .5 12 .3 1. 2 1. 1 5. 0 10 .0 2. 3 0. 0 6. 3 9. 3 20 2 Q ut hi ng 2. 0 5. 0 67 .5 37 .3 27 .6 29 .8 0. 5 2. 1 4. 8 14 .2 5. 0 0. 0 7. 9 6. 3 10 5 Q ac ha ’s N ek 6. 9 5. 9 67 .2 36 .3 23 .0 27 .3 1. 3 1. 2 5. 5 9. 8 3. 8 0. 0 8. 9 11 .4 74 M ok ho tlo ng 2. 8 3. 4 66 .4 29 .6 6. 9 10 .6 1. 0 0. 5 1. 9 11 .5 1. 1 0. 0 12 .3 9. 9 14 4 Th ab a- Ts ek a 2. 9 2. 9 54 .8 19 .4 9. 8 12 .2 1. 2 0. 4 2. 3 10 .4 2. 8 0. 0 4. 3 14 .8 17 2 Ed uc at io n N o ed uc at io n 4. 3 6. 1 52 .0 19 .9 18 .0 15 .5 1. 2 3. 0 1. 7 5. 9 1. 8 0. 0 7. 6 13 .5 21 3 P rim ar y in co m pl et e 6. 0 6. 2 60 .2 21 .5 15 .5 14 .6 0. 8 1. 5 2. 4 10 .2 2. 3 0. 1 5. 9 10 .1 87 5 P rim ar y co m pl et e 5. 4 4. 4 74 .0 28 .4 19 .8 20 .3 1. 1 2. 0 1. 9 16 .2 3. 0 0. 0 4. 0 5. 5 31 6 S ec on da ry 6. 8 6. 8 76 .5 26 .4 19 .2 24 .3 0. 7 1. 0 2. 5 11 .9 2. 8 0. 0 6. 1 2. 6 1, 04 3 M or e th an s ec on da ry 9. 6 9. 6 73 .3 28 .1 30 .2 29 .4 2. 1 1. 2 2. 8 18 .9 6. 2 0. 0 5. 1 0. 6 21 4 W ea lth q ui nt ile Lo w es t 2. 3 5. 0 54 .3 26 .9 16 .4 10 .5 1. 0 2. 1 2. 3 9. 6 2. 3 0. 0 7. 4 15 .0 37 6 S ec on d 4. 4 7. 4 65 .9 25 .0 14 .9 16 .8 0. 6 2. 2 3. 9 10 .5 3. 1 0. 0 4. 1 6. 7 47 9 M id dl e 7. 2 5. 2 66 .8 24 .9 18 .2 20 .8 1. 2 1. 0 1. 5 12 .3 2. 6 0. 1 6. 4 6. 6 53 6 Fo ur th 6. 8 6. 8 75 .8 22 .2 18 .6 21 .3 1. 0 1. 4 1. 9 12 .0 2. 9 0. 0 6. 5 3. 7 61 6 H ig he st 9. 3 7. 3 73 .7 25 .2 23 .7 27 .2 0. 9 1. 1 2. 4 14 .0 3. 2 0. 0 5. 1 2. 4 65 4 To ta l 1 5- 49 6. 4 6. 5 68 .6 24 .6 18 .8 20 .3 1. 0 1. 5 2. 4 11 .9 2. 8 0. 0 5. 8 6. 1 2, 66 0 50 -5 9 1. 9 5. 8 61 .0 35 .0 23 .7 17 .6 0. 6 2. 3 4. 9 17 .7 4. 2 0. 3 4. 4 6. 2 27 1 To ta l 1 5- 59 6. 0 6. 4 67 .9 25 .6 19 .3 20 .1 0. 9 1. 5 2. 6 12 .5 3. 0 0. 1 5. 7 6. 1 2, 93 1 222 • HIV/AIDS-related Knowledge, Attitudes, and Behaviour Ta bl e 12 .1 4. 1 M ai n re as on w hy re sp on de nt h as n ot b ee n te st ed fo r H IV : W om en P er ce nt d is tri bu tio n of w om en a ge 1 5- 49 w ho h av e he ar d of A ID S a nd h av e ne ve r b ee n te st ed fo r H IV , b y th e m ai n re as on th ey h av e no t b ee n te st ed fo r H IV , a cc or di ng to b ac kg ro un d ch ar ac te ris tic s, L es ot ho 2 01 4 P er ce nt ag e of w om en w ho re po rte d sp ec ifi c re as on s w hy th ey h av e no t b ee n te st ed fo r H IV : To ta l N um be r o f w om en B ac kg ro un d ch ar ac te ris tic A lre ad y kn ow s ta tu s N ot a t r is k Fe ar o f re su lts Fe ar o f st ig m a/ di sc rim i- na tio n Fe ar o f de at h Fe ar o f de pr es si on D on ’t kn ow w he re to g et co un se lli ng an d te st in g Fe ar o f ge tti ng in fe ct ed du rin g te st Fe ar o f pa rtn er s’ re ac tio n La ck o f kn ow le dg e/ ig no ra nc e Fa ta lis m / no c ur e To o ex pe ns iv e O th er re as on D on ’t kn ow Ag e 15 -2 4 1. 3 19 .5 20 .3 1. 2 1. 6 2. 8 3. 4 0. 4 0. 0 10 .1 0. 2 0. 3 22 .1 16 .9 10 0. 0 71 1 1 5- 19 1. 4 19 .5 17 .6 1. 4 1. 2 2. 6 4. 0 0. 4 0. 0 10 .2 0. 3 0. 3 23 .1 17 .9 10 0. 0 57 3 2 0- 24 0. 9 19 .1 31 .4 0. 3 3. 4 3. 7 0. 7 0. 0 0. 0 9. 7 0. 0 0. 0 18 .1 12 .6 10 0. 0 13 8 25 -2 9 (2 .0 ) (2 6. 4) (1 2. 2) (2 .2 ) (1 .7 ) (1 0. 3) (0 .0 ) (0 .0 ) (0 .0 ) (9 .5 ) (0 .0 ) (0 .0 ) (3 1. 5) (4 .3 ) 10 0. 0 32 30 -3 9 3. 2 16 .0 21 .5 0. 8 2. 4 2. 7 0. 0 0. 0 0. 0 11 .8 4. 2 0. 0 21 .5 15 .8 10 0. 0 72 40 -4 9 1. 7 10 .3 33 .0 4. 9 3. 3 3. 1 0. 7 0. 0 0. 0 3. 2 0. 0 0. 0 25 .8 14 .0 10 0. 0 79 M ar ita l s ta tu s N ev er m ar rie d 1. 3 20 .2 20 .5 0. 9 1. 6 3. 3 3. 2 0. 3 0. 0 10 .2 0. 3 0. 3 21 .7 16 .1 10 0. 0 72 7 E ve r h ad s ex 0. 4 17 .3 27 .7 1. 4 2. 8 7. 0 1. 8 0. 0 0. 0 11 .9 0. 2 0. 7 16 .6 12 .3 10 0. 0 26 1 N ev er h ad s ex 1. 8 21 .8 16 .5 0. 7 1. 0 1. 2 4. 1 0. 5 0. 0 9. 2 0. 3 0. 0 24 .6 18 .2 10 0. 0 46 6 M ar rie d/ liv in g to ge th er 3. 1 12 .9 22 .7 3. 5 3. 5 1. 1 0. 2 0. 0 0. 0 6. 9 1. 8 0. 0 28 .7 15 .5 10 0. 0 13 9 D iv or ce d/ se pa r- at ed /w id ow ed (0 .0 ) (6 .5 ) (3 1. 2) (7 .0 ) (0 .0 ) (8 .7 ) (2 .0 ) (0 .0 ) (0 .0 ) (7 .9 ) (0 .0 ) (0 .0 ) (1 8. 4) (1 8. 4) 10 0. 0 28 R es id en ce U rb an 0. 9 19 .2 22 .9 0. 6 1. 9 3. 6 2. 8 0. 1 0. 0 9. 2 0. 9 0. 3 23 .0 14 .7 10 0. 0 36 8 R ur al 2. 0 18 .3 20 .0 2. 1 1. 8 2. 8 2. 7 0. 4 0. 0 9. 9 0. 2 0. 1 22 .6 17 .1 10 0. 0 52 6 Ec ol og ic al z on e Lo w la nd s 1. 5 17 .9 23 .8 1. 5 2. 3 4. 0 2. 4 0. 1 0. 0 9. 1 0. 7 0. 2 21 .0 15 .5 10 0. 0 59 8 Fo ot hi lls 3. 5 19 .8 16 .6 3. 9 2. 0 2. 0 1. 8 0. 0 0. 0 11 .4 0. 0 0. 0 23 .7 15 .3 10 0. 0 87 M ou nt ai ns 1. 2 21 .2 12 .8 0. 7 0. 2 0. 5 4. 3 1. 3 0. 0 10 .6 0. 2 0. 0 29 .9 17 .2 10 0. 0 15 2 S en qu R iv er V al le y 0. 0 17 .8 23 .7 0. 0 1. 1 2. 8 3. 8 0. 0 0. 0 9. 6 0. 0 1. 4 19 .7 20 .1 10 0. 0 57 D is tr ic t B ut ha -B ut he 0. 7 21 .4 14 .4 1. 9 1. 5 1. 7 2. 3 0. 0 0. 0 15 .3 1. 0 0. 0 21 .8 18 .0 10 0. 0 48 Le rib e 2. 3 20 .7 25 .9 4. 2 1. 9 5. 6 0. 3 0. 0 0. 0 11 .9 0. 0 0. 0 16 .7 10 .6 10 0. 0 14 8 B er ea 3. 9 16 .5 24 .5 3. 3 5. 3 0. 7 2. 3 0. 0 0. 0 15 .8 0. 0 0. 9 14 .0 12 .9 10 0. 0 12 7 M as er u 0. 8 21 .0 22 .6 0. 0 1. 6 5. 1 3. 3 0. 8 0. 0 3. 9 1. 0 0. 0 26 .8 13 .2 10 0. 0 25 5 M af et en g 0. 0 10 .3 18 .0 0. 6 1. 1 1. 0 3. 0 0. 6 0. 0 11 .6 1. 5 0. 0 21 .8 30 .5 10 0. 0 79 M oh al e’ s H oe k 1. 8 20 .5 15 .6 0. 9 0. 9 3. 2 1. 3 0. 0 0. 0 5. 9 0. 0 0. 0 22 .6 27 .2 10 0. 0 61 Q ut hi ng 0. 0 21 .4 27 .3 0. 0 1. 1 4. 1 5. 8 0. 0 0. 0 9. 3 0. 0 1. 4 16 .4 13 .2 10 0. 0 56 Q ac ha ’s N ek 3. 7 13 .5 18 .2 1. 1 1. 4 0. 0 7. 4 0. 0 0. 0 3. 3 1. 4 0. 0 37 .1 12 .9 10 0. 0 23 M ok ho tlo ng 0. 0 11 .3 14 .7 0. 0 0. 0 0. 0 4. 8 0. 0 0. 0 15 .0 0. 0 0. 0 37 .0 17 .2 10 0. 0 55 Th ab a- Ts ek a 2. 3 21 .9 10 .2 2. 1 0. 0 0. 0 2. 4 0. 0 0. 0 10 .0 0. 0 0. 0 30 .2 21 .0 10 0. 0 41 Ed uc at io n N o ed uc at io n * * * * * * * * * * * * * * 10 0. 0 12 P rim ar y in co m pl et e 1. 8 14 .6 12 .3 1. 6 0. 5 0. 0 6. 6 0. 0 0. 0 14 .4 0. 2 0. 5 28 .2 19 .4 10 0. 0 15 0 P rim ar y co m pl et e 4. 1 12 .5 21 .9 2. 5 2. 2 3. 1 2. 3 1. 9 0. 0 13 .0 0. 0 0. 0 17 .2 19 .4 10 0. 0 10 8 S ec on da ry 1. 2 21 .3 23 .3 1. 4 2. 4 3. 2 2. 2 0. 1 0. 0 8. 3 0. 3 0. 2 21 .6 14 .6 10 0. 0 56 1 M or e th an se co nd ar y (0 .0 ) (1 5. 7) (1 9. 8) (1 .2 ) (0 .0 ) (1 0. 8) (0 .0 ) (0 .0 ) (0 .0 ) (4 .5 ) (4 .1 ) (0 .0 ) (2 7. 0) (1 7. 0) 10 0. 0 62 W ea lth q ui nt ile Lo w es t 3. 8 16 .8 11 .0 1. 4 0. 3 0. 4 4. 0 0. 0 0. 0 8. 7 0. 0 0. 0 32 .1 21 .5 10 0. 0 11 4 S ec on d 0. 0 14 .7 16 .7 1. 8 2. 1 2. 5 4. 6 0. 0 0. 0 12 .6 0. 0 0. 7 25 .7 18 .5 10 0. 0 10 8 M id dl e 0. 2 18 .3 30 .6 1. 7 0. 0 3. 0 2. 1 0. 0 0. 0 13 .4 0. 2 0. 0 13 .7 16 .8 10 0. 0 15 6 Fo ur th 2. 2 22 .8 15 .8 2. 5 1. 7 4. 6 1. 8 0. 9 0. 0 6. 0 0. 5 0. 5 26 .5 14 .2 10 0. 0 23 9 H ig he st 1. 4 17 .4 26 .5 0. 4 3. 6 3. 3 2. 7 0. 2 0. 0 9. 9 1. 1 0. 0 19 .5 14 .1 10 0. 0 27 7 To ta l 1. 5 18 .6 21 .2 1. 5 1. 9 3. 1 2. 7 0. 3 0. 0 9. 6 0. 5 0. 2 22 .7 16 .1 10 0. 0 89 4 N ot e: F ig ur es in p ar en th es es a re b as ed o n 25 -4 9 un w ei gh te d ca se s. A n as te ris k in di ca te s th at a fi gu re is b as ed o n fe w er th an 2 5 un w ei gh te d ca se s an d ha s be en s up pr es se d. HIV/AIDS-related Knowledge, Attitudes, and Behaviour • 223 T ab le 1 2. 14 .2 M ai n re as on w hy re sp on de nt h as n ot b ee n te st ed fo r H IV : M en P er ce nt d is tri bu tio n of m en a ge 1 5- 49 w ho h av e he ar d of A ID S a nd h av e ne ve r b ee n te st ed fo r H IV , b y th e m ai n re as on th ey h av e no t b ee n te st ed fo r H IV , a cc or di ng to b ac kg ro un d ch ar ac te ris tic s, L es ot ho 2 01 4 P er ce nt ag e of m en w ho re po rte d sp ec ifi c re as on s w hy th ey h av e no t b ee n te st ed fo r H IV : To ta l N um be r o f m en B ac kg ro un d ch ar ac te ris tic A lre ad y kn ow s ta tu s N ot a t r is k Fe ar o f re su lts Fe ar o f st ig m a/ di sc rim i- na tio n Fe ar o f de at h Fe ar o f de pr es si on D on ’t kn ow w he re to g et co un se lli ng an d te st in g Fe ar o f ge tti ng in fe ct ed du rin g te st Fe ar o f pa rtn er s’ re ac tio n La ck o f kn ow le dg e/ ig no ra nc e Fa ta lis m / no c ur e To o ex pe ns iv e O th er re as on D on ’t kn ow Ag e 15 -2 4 2. 2 17 .5 20 .5 1. 1 1. 7 3. 0 7. 4 0. 7 0. 0 8. 8 0. 2 0. 0 24 .6 12 .2 10 0. 0 55 3 1 5- 19 2. 0 17 .0 16 .2 0. 4 2. 6 2. 6 10 .2 0. 7 0. 0 9. 5 0. 4 0. 0 25 .4 13 .1 10 0. 0 33 9 2 0- 24 2. 6 18 .3 27 .4 2. 3 0. 2 3. 8 3. 1 0. 5 0. 0 7. 8 0. 0 0. 0 23 .3 10 .7 10 0. 0 21 5 25 -2 9 0. 0 13 .1 22 .8 2. 5 4. 2 5. 5 1. 7 0. 0 0. 8 3. 2 0. 0 0. 0 32 .8 13 .5 10 0. 0 10 4 30 -3 9 1. 2 18 .1 25 .5 2. 3 0. 0 2. 9 0. 4 1. 1 0. 0 13 .9 0. 8 0. 0 20 .5 13 .4 10 0. 0 13 1 40 -4 9 2. 9 35 .1 11 .1 2. 7 1. 2 1. 2 0. 9 1. 3 0. 9 5. 4 0. 0 0. 9 28 .9 7. 5 10 0. 0 83 M ar ita l s ta tu s N ev er m ar rie d 1. 8 18 .1 22 .0 1. 2 1. 6 3. 2 6. 9 0. 9 0. 0 8. 0 0. 2 0. 0 23 .7 12 .4 10 0. 0 62 8 E ve r h ad s ex 1. 4 16 .1 25 .6 1. 3 2. 0 3. 9 6. 4 1. 2 0. 0 9. 6 0. 3 0. 0 22 .3 9. 8 10 0. 0 46 2 N ev er h ad s ex 2. 9 23 .5 11 .7 0. 8 0. 5 1. 1 8. 5 0. 1 0. 0 3. 5 0. 0 0. 0 27 .6 19 .7 10 0. 0 16 6 M ar rie d/ liv in g to ge th er 2. 3 17 .3 19 .8 2. 3 2. 2 3. 7 0. 0 0. 1 0. 3 10 .5 0. 5 0. 3 30 .5 10 .1 10 0. 0 20 3 D iv or ce d/ se pa ra te d/ w id ow ed (0 .0 ) (3 6. 5) (5 .1 ) (4 .8 ) (0 .0 ) (0 .0 ) (1 .9 ) (0 .0 ) (2 .0 ) (8 .2 ) (0 .0 ) (0 .0 ) (2 5. 1) (1 6. 3) 10 0. 0 40 R es id en ce U rb an 3. 6 20 .7 26 .9 1. 6 2. 5 5. 1 1. 2 0. 6 0. 0 4. 3 0. 0 0. 0 22 .0 11 .4 10 0. 0 20 6 R ur al 1. 3 18 .1 18 .7 1. 6 1. 4 2. 5 6. 3 0. 7 0. 2 9. 9 0. 3 0. 1 26 .4 12 .3 10 0. 0 66 5 Ec ol og ic al z on e Lo w la nd s 2. 7 20 .4 24 .7 1. 8 1. 8 4. 1 2. 5 1. 0 0. 2 5. 9 0. 5 0. 0 21 .8 12 .6 10 0. 0 49 7 Fo ot hi lls 0. 8 17 .4 17 .0 0. 7 3. 6 1. 9 11 .7 0. 7 0. 0 13 .4 0. 0 0. 0 19 .0 13 .6 10 0. 0 10 4 M ou nt ai ns 0. 5 16 .1 12 .9 1. 6 1. 0 1. 3 7. 9 0. 2 0. 3 13 .6 0. 0 0. 3 33 .2 11 .1 10 0. 0 21 7 S en qu R iv er V al le y 1. 6 16 .2 22 .0 0. 7 0. 0 3. 8 4. 6 0. 0 0. 0 4. 2 0. 0 0. 0 38 .8 8. 0 10 0. 0 53 D is tr ic t B ut ha -B ut he 2. 9 22 .8 17 .0 2. 1 1. 6 6. 5 10 .2 0. 8 0. 0 6. 3 0. 0 0. 0 21 .1 8. 7 10 0. 0 49 Le rib e 2. 1 26 .4 20 .0 2. 5 2. 4 2. 0 5. 3 0. 7 0. 0 8. 4 0. 0 0. 0 25 .6 4. 5 10 0. 0 12 0 B er ea 0. 8 18 .1 19 .3 1. 2 1. 7 2. 4 1. 3 3. 9 0. 0 11 .5 0. 9 0. 0 18 .0 20 .9 10 0. 0 11 6 M as er u 3. 2 20 .5 24 .2 2. 6 2. 4 5. 5 4. 5 0. 0 0. 0 4. 6 0. 0 0. 0 21 .6 10 .8 10 0. 0 22 1 M af et en g 2. 4 17 .8 27 .1 0. 8 3. 2 2. 1 2. 5 0. 0 0. 0 6. 4 1. 3 0. 0 22 .5 13 .9 10 0. 0 94 M oh al e’ s H oe k 1. 0 9. 8 23 .6 0. 0 0. 0 0. 6 8. 8 0. 0 0. 9 13 .2 0. 0 0. 0 25 .7 16 .3 10 0. 0 84 Q ut hi ng 0. 0 19 .8 19 .7 0. 0 0. 0 3. 4 6. 8 0. 0 0. 0 3. 0 0. 0 0. 0 40 .8 6. 5 10 0. 0 38 Q ac ha ’s N ek 0. 0 14 .3 23 .7 1. 7 1. 7 1. 1 0. 0 1. 1 0. 0 3. 9 0. 0 0. 0 35 .0 17 .4 10 0. 0 20 M ok ho tlo ng 1. 8 9. 9 15 .0 0. 0 0. 7 1. 9 8. 8 0. 0 0. 0 18 .9 0. 0 0. 0 34 .1 9. 0 10 0. 0 60 Th ab a- Ts ek a 0. 0 18 .7 7. 6 2. 4 0. 0 2. 5 5. 2 0. 2 1. 0 11 .4 0. 0 1. 0 36 .8 13 .3 10 0. 0 68 Ed uc at io n N o ed uc at io n 3. 1 22 .0 12 .7 1. 1 2. 9 0. 9 6. 3 1. 8 0. 9 10 .2 0. 0 0. 0 25 .9 12 .4 10 0. 0 77 P rim ar y in co m pl et e 1. 0 18 .8 17 .0 1. 9 2. 4 2. 7 8. 0 0. 6 0. 2 9. 0 0. 0 0. 2 26 .9 11 .5 10 0. 0 36 7 P rim ar y co m pl et e 1. 3 14 .7 22 .8 0. 6 1. 0 1. 7 3. 6 1. 3 0. 0 11 .1 1. 3 0. 0 31 .5 8. 9 10 0. 0 99 S ec on da ry 1. 9 19 .6 24 .9 1. 5 0. 9 5. 0 2. 2 0. 4 0. 0 7. 8 0. 3 0. 0 21 .6 13 .7 10 0. 0 29 7 M or e th an s ec on da ry * * * * * * * * * * * * * * 10 0. 0 31 W ea lth q ui nt ile Lo w es t 0. 9 16 .3 16 .5 1. 4 2. 5 1. 5 5. 9 2. 0 0. 4 12 .0 0. 0 0. 0 30 .8 9. 7 10 0. 0 16 0 S ec on d 2. 9 19 .4 23 .6 2. 3 2. 2 1. 2 6. 5 0. 2 0. 0 7. 1 0. 6 0. 0 20 .6 13 .4 10 0. 0 16 5 M id dl e 0. 0 18 .5 14 .8 1. 6 0. 2 4. 3 6. 5 1. 1 0. 4 11 .4 0. 0 0. 3 26 .7 14 .2 10 0. 0 21 2 Fo ur th 0. 9 15 .8 27 .5 2. 4 3. 7 2. 9 5. 8 0. 0 0. 0 7. 7 0. 7 0. 0 19 .7 12 .9 10 0. 0 17 9 H ig he st 5. 4 24 .1 22 .0 0. 0 0. 0 5. 6 0. 0 0. 2 0. 0 3. 9 0. 0 0. 0 29 .6 9. 2 10 0. 0 15 5 To ta l 1 5- 49 1. 9 18 .7 20 .7 1. 6 1. 7 3. 1 5. 1 0. 7 0. 2 8. 6 0. 3 0. 1 25 .4 12 .1 10 0. 0 87 1 50 -5 9 2. 4 29 .2 12 .9 2. 5 0. 6 4. 6 1. 4 3. 0 3. 2 7. 1 0. 0 0. 8 24 .4 7. 9 10 0. 0 57 To ta l 1 5- 59 1. 9 19 .4 20 .2 1. 6 1. 6 3. 2 4. 8 0. 8 0. 4 8. 5 0. 2 0. 1 25 .3 11 .8 10 0. 0 92 8 N ot e: F ig ur es in p ar en th es es a re b as ed o n 25 -4 9 un w ei gh te d ca se s. A n as te ris k in di ca te s th at a fi gu re is b as ed o n fe w er th an 2 5 un w ei gh te d ca se s an d ha s be en s up pr es se d. 224 • HIV/AIDS-related Knowledge, Attitudes, and Behaviour HIV/AIDS-related Knowledge, Attitudes, and Behaviour • 225 Table 12.15 Male circumcision Percentage of men age 15-49 who report having been circumcised, by background characteristics, Lesotho 2014 Background characteristic Percentage traditionally or medically circumcised1 Percentage traditionally circumcised only Percentage medically circumcised only Percentage both traditionally and medically circumcised Don’t know Number of men Age 15-24 69.7 35.4 29.0 5.3 0.0 1,252 15-19 58.9 25.7 30.0 3.2 0.0 691 20-24 83.0 47.3 27.8 7.9 0.0 561 25-29 76.5 51.8 18.8 5.9 0.0 410 30-39 75.0 52.0 18.8 3.6 0.7 610 40-49 71.9 54.8 15.1 2.0 0.3 389 Residence Urban 68.4 22.1 41.3 5.0 0.1 920 Rural 74.3 56.4 13.4 4.3 0.2 1,741 Ecological zone Lowlands 70.4 35.4 30.6 4.4 0.1 1,711 Foothills 72.4 59.9 9.0 3.0 0.5 252 Mountains 76.7 62.7 8.1 5.6 0.4 523 Senqu River Valley 77.3 58.0 14.4 4.8 0.0 174 District Butha-Buthe 78.2 61.0 12.6 4.7 0.0 143 Leribe 74.7 46.8 23.7 3.7 0.5 390 Berea 68.9 34.8 29.8 4.3 0.0 379 Maseru 68.3 30.8 32.3 5.2 0.0 809 Mafeteng 72.9 50.2 19.7 3.0 1.0 242 Mohale’s Hoek 73.6 61.5 9.0 2.5 0.6 202 Quthing 73.7 46.5 19.2 8.0 0.0 105 Qacha’s Nek 74.8 54.6 13.2 7.1 0.0 74 Mokhotlong 77.8 62.1 8.7 7.0 0.0 144 Thaba-Tseka 78.8 64.3 11.8 2.7 0.0 172 Education No education 87.6 81.4 0.5 4.2 1.5 213 Primary incomplete 72.6 62.4 5.9 4.3 0.1 875 Primary complete 72.9 53.1 16.0 3.8 0.0 316 Secondary 68.3 27.6 36.4 4.3 0.0 1,043 More than secondary 73.8 5.0 61.1 7.7 0.6 214 Wealth quintile Lowest 76.8 70.1 2.3 4.4 0.0 376 Second 75.3 59.8 10.0 5.0 0.4 479 Middle 71.5 53.1 15.1 3.3 0.2 536 Fourth 70.2 36.5 28.9 4.7 0.0 616 Highest 70.1 19.2 45.5 5.1 0.4 654 Total 15-49 72.3 44.6 23.1 4.5 0.2 2,660 50-59 70.2 55.1 13.8 1.0 1.5 271 Total 15-59 72.1 45.5 22.2 4.2 0.3 2,931 1 Includes men who know that they have been traditionally circumcised but not whether they have been medically circumcised, and men who know that they have been medically circumcised but not whether they have been traditionally circumcised. 226 • HIV/AIDS-related Knowledge, Attitudes, and Behaviour Table 12.16 Self-reported prevalence of sexually-transmitted infections (STIs) and STIs symptoms Among women and men age 15-49 who ever had sexual intercourse, the percentage reporting having an STI and/or symptoms of an STI in the past 12 months, by background characteristics, Lesotho 2014 Percentage of women who reported having in the past 12 months: Percentage of men who reported having in the past 12 months: Background characteristic STI Bad smelling/ abnormal genital discharge Genital sore/ulcer STI/ genital discharge/ sore or ulcer Number of women who ever had sexual intercourse STI Bad smelling/ abnormal discharge from penis Genital sore/ulcer STI/ abnormal discharge from penis/ sore or ulcer Number of men who ever had sexual intercourse Age 15-24 1.7 11.6 3.4 14.2 1,896 1.8 8.7 3.7 11.5 927 15-19 0.7 9.9 4.1 12.4 661 0.0 9.3 2.9 11.4 412 20-24 2.3 12.5 3.1 15.2 1,235 3.2 8.3 4.4 11.5 514 25-29 4.3 13.6 4.9 17.8 1,076 4.0 8.4 6.1 13.3 400 30-39 3.8 11.0 6.2 14.9 1,692 5.3 7.0 6.1 12.5 604 40-49 3.0 11.5 4.3 14.6 1,062 3.7 5.3 5.1 9.7 385 Marital status Never married 2.1 9.8 3.8 12.6 1,295 2.0 8.1 3.5 10.7 1,156 Married/living together 3.5 12.6 5.0 16.4 3,612 4.6 7.2 5.8 12.1 983 Divorced/separated/widowed 2.3 11.2 4.5 13.7 819 5.7 6.9 10.5 16.7 176 Male circumcision Traditionally or medically circumcised1 na na na na na 3.7 7.9 4.6 11.7 1,741 Traditionally circumcised only na na na na na 2.8 7.6 4.9 11.3 1,124 Medically circumcised only na na na na na 4.7 7.4 2.4 10.2 497 Both traditionally and medically circumcised na na na na na 8.4 13.3 10.3 22.1 117 Not circumcised na na na na na 2.4 6.8 6.3 12.0 572 Don’t know na na na na na * * * * 2 Residence Urban 3.7 11.8 5.3 15.6 2,085 5.4 7.1 5.8 12.3 814 Rural 2.7 11.8 4.3 14.9 3,641 2.3 8.0 4.5 11.5 1,501 Ecological zone Lowlands 3.3 11.9 5.5 15.9 3,621 4.5 8.2 5.2 12.7 1,493 Foothills 2.2 11.9 2.5 13.5 608 2.1 6.2 4.5 9.4 215 Mountains 2.9 12.3 2.8 14.5 1,085 1.0 6.9 4.6 10.4 456 Senqu River Valley 2.8 9.4 5.4 13.4 412 1.2 6.5 4.4 9.5 152 District Butha-Buthe 2.7 9.3 3.9 11.6 334 1.2 6.4 2.0 7.5 115 Leribe 1.4 12.0 3.5 14.7 933 3.1 6.4 4.6 10.8 347 Berea 2.4 10.9 4.1 14.4 775 4.4 7.9 3.8 11.7 325 Maseru 4.3 13.4 6.6 17.7 1,618 4.9 9.0 6.4 14.4 725 Mafeteng 4.2 11.1 5.6 15.8 486 4.8 9.4 6.1 14.1 205 Mohale’s Hoek 2.5 8.8 3.6 12.0 460 1.4 6.4 4.0 8.3 168 Quthing 4.1 10.0 3.8 13.2 271 1.2 4.1 4.6 8.4 92 Qacha’s Nek 4.0 15.0 5.9 19.0 177 2.0 10.7 5.9 15.1 68 Mokhotlong 2.5 15.8 2.4 17.1 283 1.0 7.5 3.8 10.2 123 Thaba-Tseka 1.7 9.7 3.3 11.6 390 0.7 4.2 4.4 7.3 148 Education No education 2.3 11.3 11.8 16.5 67 1.6 4.6 3.2 7.1 200 Primary incomplete 2.3 12.4 6.0 16.2 1,016 2.5 9.0 7.7 14.6 763 Primary complete 2.9 12.0 4.3 14.4 1,280 1.8 8.0 3.1 10.8 289 Secondary 2.7 12.0 4.5 15.4 2,808 4.8 7.2 4.0 11.1 858 More than secondary 6.8 9.2 3.3 13.9 555 4.9 6.8 3.4 9.6 205 Wealth quintile Lowest 2.0 11.1 3.2 13.2 826 2.2 7.8 6.0 12.4 323 Second 2.2 11.3 4.2 14.4 899 1.3 9.2 4.4 12.4 401 Middle 3.0 13.3 4.4 16.1 1,075 2.6 6.4 4.0 10.1 465 Fourth 3.1 11.7 6.1 16.5 1,393 3.8 7.9 6.5 12.6 546 Highest 4.1 11.5 4.7 14.9 1,533 5.8 7.2 4.2 11.5 581 Total 15-49 3.0 11.8 4.7 15.2 5,726 3.4 7.6 5.0 11.8 2,315 50-59 na na na na na 1.4 3.0 6.3 8.4 268 Total 15-59 na na na na na 3.2 7.2 5.1 11.4 2,584 Note: An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. na = Not applicable 1 Includes men who know that they have been traditionally circumcised but not whether they have been medically circumcised, and men who know that they have been medically circumcised but not whether they have been traditionally circumcised. HIV/AIDS-related Knowledge, Attitudes, and Behaviour • 227 Table 12.17 Prevalence of medical injections Percentage of women and men age 15-49 who received at least one medical injection in the last 12 months, the average number of medical injections per person in the last 12 months, and among those who received a medical injection, the percentage of last medical injections for which the syringe and needle were taken from a new, unopened package, by background characteristics, Lesotho 2014 Women Men Background characteristic Percentage who received a medical injection in the last 12 months Average number of medical injections per person in the last 12 months Number of respon- dents For last injection, syringe and needle taken from a new, unopened package Number of women receiving medical injections in the last 12 months Percentage who received a medical injection in the last 12 months Average number of medical injections per person in the last 12 months Number of respon- dents For last injection, syringe and needle taken from a new, unopened package Number of men receiving medical injections in the last 12 months Age 15-24 29.5 0.8 2,765 98.4 817 13.4 0.4 1,252 93.4 167 15-19 20.1 0.5 1,440 98.3 289 13.6 0.5 691 91.0 94 20-24 39.8 1.2 1,325 98.5 528 13.1 0.3 561 96.4 73 25-29 44.8 1.1 1,094 98.7 490 22.4 0.4 410 94.9 92 30-39 36.5 1.2 1,701 97.2 621 20.1 0.5 610 93.4 123 40-49 30.0 1.0 1,062 96.5 318 20.7 0.6 389 85.2 80 Marital status Never married 22.9 0.6 2,190 97.4 501 15.0 0.4 1,501 92.8 226 Ever had sex 29.1 0.8 1,295 97.6 376 15.6 0.5 1,156 93.3 181 Never had sex 13.9 0.3 895 96.6 125 13.0 0.3 345 (91.0) 45 Married/living together 41.1 1.2 3,612 98.1 1,485 21.5 0.5 983 91.5 211 Divorced/separated/widowed 31.7 1.1 819 97.2 260 14.8 0.6 176 * 26 Residence Urban 33.6 1.1 2,419 98.3 814 22.9 0.6 920 93.4 211 Rural 34.1 0.9 4,202 97.6 1,432 14.5 0.4 1,741 91.3 252 Ecological zone Lowlands 36.4 1.1 4,184 98.2 1,522 20.5 0.6 1,711 92.0 350 Foothills 35.8 1.0 688 95.9 247 13.5 0.3 252 (94.6) 34 Mountains 24.6 0.7 1,288 97.8 317 10.3 0.3 523 93.0 54 Senqu River Valley 34.8 0.9 461 97.9 161 14.0 0.3 174 (90.8) 24 District Butha-Buthe 29.9 0.8 385 97.9 115 9.9 0.2 143 * 14 Leribe 36.1 0.9 1,064 97.1 383 15.4 0.4 390 (91.1) 60 Berea 36.3 1.1 892 96.9 324 19.8 0.7 379 90.3 75 Maseru 35.9 1.1 1,864 98.4 670 24.7 0.6 809 93.5 200 Mafeteng 35.9 1.4 576 97.5 207 14.5 0.4 242 (94.3) 35 Mohale’s Hoek 36.8 1.0 519 99.2 191 10.6 0.3 202 (89.0) 21 Quthing 29.6 0.8 315 98.6 93 10.0 0.2 105 * 10 Qacha’s Nek 30.9 0.7 204 99.2 63 19.6 1.0 74 (93.8) 15 Mokhotlong 25.1 0.7 349 96.4 88 10.6 0.3 144 (93.2) 15 Thaba-Tseka 24.7 0.6 452 97.7 112 9.8 0.2 172 (85.1) 17 Education No education 19.2 0.4 68 * 13 10.1 0.2 213 * 21 Primary incomplete 32.2 1.0 1,178 97.1 379 15.1 0.5 875 91.2 132 Primary complete 32.8 0.9 1,375 96.1 451 16.9 0.7 316 91.9 53 Secondary 34.5 1.0 3,418 98.6 1,178 20.0 0.5 1,043 93.3 209 More than secondary 38.7 1.1 581 98.7 225 22.0 0.3 214 (99.2) 47 Wealth quintile Lowest 27.6 0.8 960 95.9 265 8.3 0.2 376 (93.3) 31 Second 32.9 1.1 1,033 96.6 340 13.8 0.3 479 95.1 66 Middle 35.4 1.0 1,244 98.5 441 17.2 0.7 536 90.4 92 Fourth 36.4 1.1 1,605 98.6 585 20.2 0.5 616 93.6 125 Highest 34.6 1.0 1,778 98.3 616 22.7 0.5 654 90.8 149 Total 15-49 33.9 1.0 6,621 97.9 2,246 17.4 0.5 2,660 92.3 463 50-59 na na na na na 20.5 0.8 271 93.2 56 Total 15-59 na na na na na 17.7 0.5 2,931 92.4 518 Notes: Medical injections are those given by a doctor, nurse, 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 228 • HIV/AIDS-related Knowledge, Attitudes, and Behaviour Table 12.18 Comprehensive knowledge about AIDS and of a source of condoms among young people 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 2014 Women Men Background characteristic Percentage with comprehensive knowledge of AIDS1 Percentage who know a condom source2 Number of respondents Percentage with comprehensive knowledge of AIDS1 Percentage who know a condom source2 Number of respondents Age 15-19 34.8 77.5 1,440 29.7 84.0 691 15-17 32.8 71.2 874 26.9 79.6 415 18-19 38.1 87.4 566 33.9 90.7 277 20-24 40.6 93.7 1,325 32.3 90.9 561 20-22 39.4 92.4 841 30.5 90.7 361 23-24 42.7 96.0 484 35.8 91.3 200 Marital status Never married 37.9 81.2 1,719 31.5 86.9 1,151 Ever had sex 40.5 90.8 850 31.9 91.0 826 Never had sex 35.3 71.8 869 30.4 76.3 325 Ever married 37.2 92.1 1,046 24.4 89.7 101 Residence Urban 43.8 91.8 922 40.2 93.3 384 Rural 34.5 82.0 1,843 26.8 84.3 868 Education No education * * 3 (8.7) (50.1) 28 Primary incomplete 20.0 65.1 370 17.0 76.5 404 Primary complete 27.9 82.3 396 30.6 84.9 122 Secondary 40.3 89.0 1,852 37.7 94.8 629 More than secondary 74.6 98.3 144 (60.4) (98.1) 68 Total 15-24 37.6 85.3 2,765 30.9 87.1 1,252 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 Comprehensive knowledge means knowing that consistent use of condoms during sexual intercourse and having just one uninfected faithful partner can reduce the chance of getting HIV, knowing that a healthy-looking person can have HIV, and rejecting the two most common local misconceptions about AIDS transmission or prevention of HIV. The components of comprehensive knowledge are presented in Tables 12.2, 12.3.1 and 12.3.2. 2 For this table, the following responses are not considered a source for condoms: friends, family members, and home. HIV/AIDS-related Knowledge, Attitudes, and Behaviour • 229 Table 12.19 Age at first sexual intercourse among young people Percentage of young women and young men age 15-24 who had sexual intercourse before age 15 and percentage of young women and young men age 18-24 who had sexual intercourse before age 18, by background characteristics, Lesotho 2014 Women age 15-24 Women age 18-24 Men age 15-24 Men age 18-24 Background characteristic Percentage who had sexual intercourse before age 15 Number of women Percentage who had sexual intercourse before age 18 Number of women Percentage who had sexual intercourse before age 15 Number of men Percentage who had sexual intercourse before age 18 Number of men Age 15-19 6.0 1,440 na na 24.6 691 na na 15-17 6.8 874 na na 22.8 415 na na 18-19 4.8 566 55.0 566 27.4 277 72.4 277 20-24 4.6 1,325 41.9 1,325 20.9 561 63.6 561 20-22 3.9 841 42.4 841 19.5 361 62.7 361 23-24 6.0 484 41.1 484 23.5 200 65.2 200 Marital status Never married 3.2 1,719 34.1 912 22.8 1,151 65.8 738 Ever married 8.8 1,046 56.7 979 24.7 101 71.8 99 Knows condom source1 Yes 5.3 2,359 46.3 1,737 23.7 1,090 68.0 760 No 5.4 406 39.7 154 18.1 161 51.6 77 Residence Urban 4.7 922 41.8 660 23.3 384 67.8 278 Rural 5.7 1,843 47.9 1,231 22.8 868 65.8 560 Education No education * 3 * 3 (6.6) 28 * 24 Primary incomplete 11.8 370 64.4 191 28.0 404 65.9 232 Primary complete 8.0 396 59.4 284 25.6 122 69.2 86 Secondary 3.8 1,852 42.9 1,271 20.0 629 67.4 428 More than secondary 1.0 144 20.5 143 (22.5) 68 (68.8) 68 Total 5.3 2,765 45.8 1,891 23.0 1,252 66.5 837 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 applicable 1 For this table, the following responses are not considered a source for condoms: friends, family members and home. 230 • HIV/AIDS-related Knowledge, Attitudes, and Behaviour Table 12.20 Premarital sexual intercourse and condom use during premarital sexual intercourse among young people Among never-married women and men age 15-24, the percentage who have never had sexual intercourse, the percentage who had sexual intercourse in the past 12 months, and, among those who had premarital sexual intercourse in the past 12 months, the percentage who used a condom at the last sexual intercourse, by background characteristics, Lesotho 2014 Never-married women age 15-24 Never-married men age 15-24 Percentage who have never had sexual intercourse Percentage who had sexual intercourse in the past 12 months Number of never married respondents Women who had sexual intercourse in the past 12 months Percentage who have never had sexual intercourse Percentage who had sexual intercourse in the past 12 months Number of never married respondents Men who had sexual intercourse in the past 12 months Background characteristic Percentage who used a condom at last sexual intercourse Number of women Percentage who used a condom at last sexual intercourse Number of men Age 15-19 66.3 25.4 1,175 80.1 298 40.8 47.4 684 77.8 324 15-17 76.0 19.1 807 77.8 154 54.7 35.1 413 75.5 145 18-19 45.1 39.1 368 82.6 144 19.5 66.0 271 79.6 179 20-24 16.6 62.8 544 84.4 342 9.9 73.7 467 81.6 344 20-22 19.5 57.1 404 85.1 231 9.8 72.5 318 77.6 230 23-24 8.1 79.1 141 83.0 111 10.1 76.4 149 89.8 114 Knows condom source1 Yes 44.7 41.8 1,396 83.3 584 24.8 61.9 1,000 81.4 619 No 75.9 17.4 323 72.6 56 51.0 32.5 151 (59.6) 49 Residence Urban 48.5 41.7 668 85.2 279 27.1 55.9 359 87.2 201 Rural 51.9 34.3 1,051 80.2 361 28.8 59.0 792 76.6 467 Education No education * * 1 * 1 * * 23 * 12 Primary incomplete 73.0 17.7 218 (74.1) 39 28.6 59.0 363 65.6 214 Primary complete 52.0 33.1 172 78.4 57 23.4 55.9 110 77.0 61 Secondary 48.9 38.7 1,226 82.5 475 30.2 56.2 590 88.5 332 More than secondary 20.2 67.7 102 89.4 69 (12.4) (75.6) 65 (94.7) 49 Total 15-24 50.6 37.2 1,719 82.4 640 28.3 58.1 1,151 79.8 668 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 this table, the following responses are not considered a source for condoms: friends, family members and home. HIV/AIDS-related Knowledge, Attitudes, and Behaviour • 231 Table 12.21.1 Multiple sexual partners in the past 12 months among young people: Women Among all young women age 15-24, the percentage who had sexual intercourse with more than one partner in the past 12 months, and among those having more than one partner in the past 12 months, the percentage reporting that a condom was used at last intercourse, by background characteristics, Lesotho 2014 Women age 15-24 Women age 15-24 who had 2+ partners in the past 12 months Background characteristic Percentage who had 2+ partners in the past 12 months Number of women Percentage who reported using a condom at last intercourse Number of women Age 15-19 2.9 1,440 (57.9) 41 15-17 1.6 874 * 14 18-19 4.9 566 * 27 20-24 7.6 1,325 71.0 100 20-22 6.7 841 67.6 56 23-24 9.1 484 (75.3) 44 Marital status Never married 5.0 1,719 80.7 86 Ever married 5.3 1,046 46.2 55 Knows condom source1 Yes 5.5 2,359 66.1 129 No 3.2 406 * 13 Residence Urban 5.9 922 83.1 54 Rural 4.7 1,843 57.3 87 Education No education * 3 * 1 Primary incomplete 2.8 370 * 10 Primary complete 4.7 396 * 18 Secondary 5.0 1,852 68.2 92 More than secondary 13.7 144 * 20 Total 15-24 5.1 2,765 67.2 142 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 this table, the following responses are not considered a source for condoms: friends, family members and home. 232 • HIV/AIDS-related Knowledge, Attitudes, and Behaviour Table 12.21.2 Multiple sexual partners in the past 12 months among young people: Men Among all young men age 15-24, the percentage who had sexual intercourse with more than one partner in the past 12 months, and among those having more than one partner in the past 12 months, the percentage reporting that a condom was used at last intercourse, by background characteristics, Lesotho 2014 Men age 15-24 Men age 15-24 who had 2+ partners in the past 12 months Background characteristic Percentage who had 2+ partners in the past 12 months Number of men Percentage who reported using a condom at last intercourse Number of men Age 15-19 15.3 691 79.7 106 15-17 9.8 415 (80.2) 41 18-19 23.5 277 79.4 65 20-24 31.8 561 77.3 178 20-22 28.1 361 71.1 102 23-24 38.5 200 85.4 77 Marital status Never married 21.3 1,151 82.7 245 Ever married 38.5 101 (49.8) 39 Knows condom source1 Yes 24.2 1,090 79.8 264 No 12.3 161 * 20 Residence Urban 25.5 384 84.3 98 Rural 21.4 868 74.9 186 Education No education (27.8) 28 * 8 Primary incomplete 20.4 404 70.4 83 Primary complete 22.7 122 (78.4) 28 Secondary 21.9 629 82.5 138 More than secondary (41.0) 68 * 28 Total 15-24 22.7 1,252 78.2 284 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 this table, the following responses are not considered a source for condoms: friends, family members and home. HIV/AIDS-related Knowledge, Attitudes, and Behaviour • 233 Table 12.22 Age-mixing in sexual relationships among women and men age 15-19 Among women and men age 15-19 who had sexual intercourse in the past 12 months, percentage who had sexual intercourse with a partner who was 10 or more years older than themselves, by background characteristics, Lesotho 2014 Women age 15-19 who had sexual intercourse in the past 12 months Men age 15-19 who had sexual intercourse in the past 12 months Background characteristic Percentage who had sexual intercourse with a man 10+ years older Number of women Percentage who had sexual intercourse with a woman 10+ years older Number of men Age 15-17 7.5 218 2.1 147 18-19 8.3 322 0.0 184 Marital status Never married 1.4 298 1.0 324 Ever married 16.0 243 * 7 Knows condom source1 Yes 8.2 466 1.0 305 No 6.3 75 (0.0) 26 Residence Urban 7.7 139 3.2 79 Rural 8.0 402 0.2 253 Education No education nc 0 nc 0 Primary incomplete 10.7 64 2.4 130 Primary complete 10.0 79 (0.0) 26 Secondary 7.2 392 0.0 172 More than secondary * 6 * 3 Total 15-19 7.9 540 0.9 331 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. nc = No cases 1 For this table, the following responses are not considered a source for condoms: friends, family members and home. 234 • HIV/AIDS-related Knowledge, Attitudes, and Behaviour Table 12.23 Recent HIV tests among young people Among young women and young men age 15-24 who have had sexual intercourse in the past 12 months, the percentage who were tested for HIV in the past 12 months and received the results of the last test, by background characteristics, Lesotho 2014 Women age 15-24 who have had sexual intercourse in the past 12 months: Men age 15-24 who have had sexual intercourse in the past 12 months: Background characteristic Percentage who have been tested for HIV in the past 12 months and received the results of the last test Number of women Percentage who have been tested for HIV in the past 12 months and received the results of the last test Number of men Age 15-19 56.9 540 25.5 331 15-17 46.8 218 28.4 147 18-19 63.6 322 23.2 184 20-24 70.8 1,080 36.4 433 20-22 71.2 646 34.3 272 23-24 70.3 434 39.8 161 Marital status Never married 51.0 640 31.0 668 Ever married 76.1 981 36.8 96 Knows condom source1 Yes 68.0 1,494 33.1 707 No 45.0 126 14.0 58 Residence Urban 59.9 525 47.1 225 Rural 69.2 1,095 25.2 539 Education No education * 1 * 16 Primary incomplete 63.6 181 14.8 252 Primary complete 73.2 261 25.8 74 Secondary 66.5 1,068 42.1 371 More than secondary 50.6 109 (54.3) 52 Total 15-24 66.2 1,621 31.7 764 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 this table, the following responses are not considered a source for condoms: friends, family members and home. HIV Prevalence • 235 HIV PREVALENCE 13 Key Findings  HIV prevalence: Twenty-five percent of adults age 15-49 in Lesotho are infected with HIV. In both 2004 and 2009, the HIV prevalence rate for adults was slightly less—23%. The difference among the three surveys is not statistically significant, however.  HIV prevalence by sex: The HIV prevalence rate is 30% among women and 19% among men.  HIV prevalence by district: HIV prevalence among adults age 15-49 varies by district, from 17% in Mokhotlong to 28% in Maseru.  HIV prevalence among couples: Overall, 35% of couples have at least one partner with HIV. In 20% of couples, both partners are HIV positive. Fifteen percent of couples are discordant, that is, one partner is HIV positive and the other is HIV negative.  HIV incidence: HIV incidence among women and men age 15-49 is 1.9 new infections per 100 person-years (PY) of exposure (confidence interval: 1.2-2.6). en years ago, the 2004 LDHS included HIV testing among survey respondents, providing the first direct estimates of HIV prevalence among the general female and male populations in Lesotho. In a follow-up LDHS survey in 2009, HIV prevalence estimates among the general population were repeated. The 2014 LDHS once again included HIV testing among women and men, to track trends in HIV prevalence among the general population, and for the first time, to provide an estimate of HIV incidence. The results of this testing will be used to refine HIV prevalence estimates based on the sentinel surveillance system and to allow better monitoring of the epidemic. The methodology used to conduct HIV testing in the 2014 LDHS is described in detail in Appendix C. This chapter provides information on HIV testing coverage rates among eligible survey respondents and the results of the testing. It also compares HIV prevalence estimates from the 2004, 2009, and 2014 LDHS surveys and discusses levels and differentials in HIV prevalence among those who were tested. Finally, it includes an estimate of HIV incidence among survey respondents. 13.1 COVERAGE RATES FOR HIV TESTING Overall, 92% of LDHS respondents who were eligible for testing were both interviewed and tested (Table 13.1). Testing coverage rates were higher among women than among men (94% and 89%, respectively). Among all respondents eligible for testing, 2% refused to provide blood and 3% were absent at the time of T 236 • HIV Prevalence blood collection. Among women, absenteeism and refusal contributed nearly equally to nonresponse; among men, absenteeism contributed more to nonresponse than refusal (4% and 2%, respectively). HIV testing response rate Percentage of women and men who are tested for HIV as part of the DHS survey Sample: Women and men who are in households selected for HIV testing and are within the eligible age range for HIV testing based on information collected in the household questionnaire. The HIV testing response rate is calculated as follows: Women age 15-49 and men age 15-59 who were interviewed and whose blood sample underwent the complete HIV testing algorithm with a final result of positive, negative, or indeterminate. All women age 15-49 and men age 15-59 in households selected for HIV testing Trends: A comparison of the 2004, 2009, and 2014 LDHS indicates that HIV coverage rates have increased; from 81% in 2004 to 94% in 2009 and 2014 among women age 15-49 and from 68% in 2004 to 88% in 2009 to 89% among men age 15-59. For women age 15-49 and men age 15-59 combined, the HIV testing response rates have increased from 75% in 2004 to 91% in 2009 to 92% in 2014. Patterns by background characteristics  Coverage of HIV testing among all eligible respondents varied from a low of 90% in Berea and Leribe to a high of 94% in Butha-Buthe.  Among both women and men, coverage levels were lowest among those who had no education (81% of women and 81% of men) (Table 13.2).  Women and men in the highest wealth quintile had lower coverage rates (90% and 85%, respectively) than those in the four lowest wealth quintiles (95-96% for women and 88-91% for men). Additional tables describing the relationship between participation in HIV testing and characteristics related to HIV risk are presented in Appendix A (Tables A.7-A.10). Overall, the results in Tables A.7-A.10 do not show a systematic relationship between participation in testing and variables associated with a higher risk of HIV infection. 13.2 HIV PREVALENCE 13.2.1 HIV Prevalence by Age and Sex HIV prevalence Percentage of women and men testing positive for HIV as part of the DHS survey. See testing methodology in Appendix C. Sample: Women and men age 15-49 who are tested for HIV as part of the survey HIV Prevalence • 237 According to the 2014 LDHS, 25% of adults age 15-49 in Lesotho are HIV- positive (Table 13.3 and Figure 13.1). HIV prevalence is higher among women (30%) than men (19%). These findings are in line with other recent estimates. For example, using data from antenatal clinic surveillance and mathematical modelling (Spectrum), the prevalence of HIV in 2013 among ANC clients was estimated to be 26% (MOH 2014b). The 2014 UNAIDS estimate for HIV prevalence among adults age 15-49 was 23% (MOH 2015b). Trends: A comparison of the 2004, 2009, and 2014 LDHS HIV prevalence estimates indicates that HIV prevalence has increased from 23% in 2004 and 2009 to 25% among adults age 15-49. Prevalence among women has increased from 26% in 2004 to 27% in 2009 to 30% in 2014, and prevalence among men has remained stable, shifting from 19% in 2004 to 18% in 2009 to 19% in 2014 (Figure 13.2).1,2 Statistical testing indicates that none of these changes over time is statistically significant, with the exception of the increase among women from 26% in 2004 to 30% in 2014 (p<0.05). Patterns by background characteristics  Among both women and men, HIV prevalence initially increases with age and then declines. For women, HIV prevalence peaks at 46% in the 35-39 age group. For men, HIV prevalence peaks at 44% in the 40-44 age group (Figure 13.3). 1 All trend data and confidence intervals are taken from The DHS Program’s STATcompiler. Due to corrections to the data files, the HIV prevalence presented here may differ slightly from the prevalences that were published in the 2004 and 2009 LDHS final reports. 2 The HIV prevalence testing algorithm used in the 2014 LDHS included a confirmatory test that was not used in either the 2004 or 2009 LDHS. Figure 13.1 HIV prevalence by residence and sex Figure 13.2 Trends in HIV prevalence Figure 13.3 HIV prevalence by age 30 19 36 23 26 16 Women age 15-49 Men age 15-49 Total Urban Rural 23.4 23.0 24.6 26.3 26.7 29.7 19.0 18.0 18.6 0 5 10 15 20 25 30 35 2004 2009 2014 2004 2009 2014 2004 2009 2014 Total age 15-49 Women age 15-49 Men age 15-49 0 5 10 15 20 25 30 35 40 45 50 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-59 Men Women Age in years 238 • HIV Prevalence  HIV prevalence is higher among employed women and men (39% and 23%, respectively) than those who are not employed (21% and 9%, respectively) (Table 13.4).  HIV prevalence among adults age 15-49 varies dramatically by district, ranging from a low of 17% in Mokhotlong to a high of 28% in Maseru (Figure 13.4).  Among men age 15-49, HIV prevalence generally decreases with an increase in level of education, from 30% among those with no education to 10% among those with more than a secondary education. HIV prevalence does not vary consistently with education among women; HIV prevalence is highest among women with complete primary education (37%) (Table 13.4). Patterns by other sociodemographic and health characteristics  HIV prevalence varies by marital status and is highest among those who are widowed (65%). HIV prevalence is also high among women and men who are divorced or separated (49% and 43%, respectively) compared with those who are currently married or living with a partner (31% and 30%, respectively) (Table 13.5).  A sizeable proportion (5%) of respondents who said they had never had sex were HIV positive, indicating that some women and men failed to report sexual activity or that there is some degree of nonsexual transmission of HIV.  Among women who slept away from home five or more times in the past 12 months, 35% are infected with HIV compared with 28% who did not sleep away from home in the past 12 months. Among men, those who slept away from home five or more times in the past 12 months were more likely to have HIV than men who slept away from home less than five times (21% versus 16-18%).  Women who were pregnant at the time of the survey had a lower HIV prevalence than those who were not pregnant or who were unsure of their pregnancy status (25% and 30%, respectively).  Male circumcision has been shown to reduce the risk of HIV infection. Several studies in sub-Saharan Africa, including clinical trials conducted in South Africa, Kenya, and Uganda (Auvert et al. 2005; NIAID 2006) have documented that the protective effect of male circumcision is significant. The 2014 LDHS asked about two different kinds of circumcision: traditional and medical. HIV prevalence among men who reported that they were only medically circumcised (14%) was lower than among those who reported that they had not been circumcised (21%) or had only been traditionally circumcised (21%) (Table 13.5). Additional information on HIV prevalence by male circumcision and by background characteristics is shown in Table 13.6. Figure 13.4 HIV prevalence by district Percentage of women and men age 15-49 HIV Prevalence • 239 13.2.2 HIV Prevalence by Sexual Risk Behaviour HIV prevalence rates by sexual behaviour characteristics among respondents who have ever had sexual intercourse are presented in Table 13.7. In reviewing these results, it is important to remember that responses about sexual risk behaviours may be subject to reporting bias. Also, sexual behaviour in the 12 months preceding the survey may not adequately reflect lifetime sexual risk. Nor is it possible to know the sequence of events (e.g., whether any reported condom use occurred before or after HIV transmission).  Among women who ever had sex, HIV prevalence is highest among women whose first had sex before age 16. Among these women, HIV prevalence was 36% compared with 33% among women who initiated sexual intercourse at age 16 or older. In contrast, among men, HIV prevalence increases with increasing age at first sex. Among men who initiated sexual intercourse before age 16, HIV prevalence is 15% compared with 33% among those who initiated sexual intercourse at age 20 and older.  HIV prevalence was higher among women and men who had concurrent partners in the past 12 months (55% and 27%, respectively) than among those who had two or more partners in the past 12 months that did not overlap, and those with one or no sexual partners in the past 12 months.  Women who used a condom during their most recent sexual intercourse in the 12-month period before the survey were more likely to be HIV positive than those who did not (41% and 26%, respectively). One possible explanation for this pattern is that HIV-positive respondents are more likely to use condoms because they either know or suspect that they are infected with HIV and use condoms to prevent transmission.  Among both women and men, HIV prevalence increases with the increasing number of lifetime partners. For example, 20% of women and 12% of men who had had only one sexual partner in their lifetime are HIV-positive, compared with 70% of women and 29% of men with 10 or more lifetime sexual partners (Figure 13.5). In summary, the results presented in Table 13.7 do not demonstrate a consistent relationship between sexual risk behaviour and HIV prevalence. More detailed analysis is clearly necessary to understand these relationships because they are often confounded by other factors that are associated with both behavioural measures and HIV prevalence such as age, marital status, and residence. 13.2.3 HIV Prevalence among Young People Young people in the 15-24 age range are an important group for monitoring reduction of HIV. Ten percent of respondents age 15-24 (13% of young women and 6% of young men) are HIV positive (Table 13.8). HIV prevalence is higher among young women and men who are married than among their never-married counterparts. The HIV prevalence among young adults who have never had sex (4% among women and 6% among men) may reflect underreporting of sexual activity among young people, survival of children infected through mother-to-child transmission, or other determinants of HIV transmission. Figure 13.5 HIV prevalence by number of lifetime partners 20 33 42 51 70 12 14 16 22 29 1 2 3-4 5-9 10+ 1 2 3-4 5-9 10+ Number of lifetime partners HIV prevalence among women and men age 15-49 who ever had sex Women Men 240 • HIV Prevalence Patterns by background characteristics  Young people in urban areas are somewhat more likely to be infected than those in rural areas (13% versus 8%).  Among young women, HIV prevalence is highest in Maseru (16%) and lowest in Quthing (10%). Among young men, HIV prevalence is highest in Maseru (10%) and lowest in Berea (1%). For additional information on HIV prevalence among young people by sexual behaviour, see Table 13.9. 13.2.4 HIV Prevalence by Other Characteristics Related to HIV Risk The LDHS also looks at HIV prevalence by other characteristics related to HIV risk among women and men age 15-49 who have ever had sex. As expected, women and men with a history of a sexually transmitted infection (STI) or STI symptoms in the past 12 months have higher rates of HIV infection than those with no history or symptoms (33% versus 27%). Individuals who had been tested for HIV previously were twice as likely to be HIV positive as those who had never been tested (31% versus 15%) (Table 13.10). The relationship between prior HIV testing and the actual HIV status of respondents is seen in Table 13.11. The results show that the majority of individuals who are HIV positive have been tested previously and received the result of their last test. Eighty-five percent of people living with HIV have been tested for HIV and received the result of their last test, including 91% of HIV-positive women and 73% of HIV-positive men. This represents a large increase from the 2009 LDHS in which only 71% of HIV-positive women and 52% of HIV-positive men had been previously tested and received the result of their last test. However, 15% of HIV- positive respondents have never been tested or were tested but did not receive the results of their last test, and, therefore, cannot be aware of their status. 13.2.5 HIV Prevalence among Couples Among the women and men tested for HIV in the 2014 LDHS there are 708 cohabiting couples. In 65% of cohabiting couples, both partners tested negative for HIV (Table 13.12). Both partners were HIV positive in 20% of cohabiting couples, while 15% of couples were discordant; that is, one partner is HIV-positive and the other is HIV-negative. In 8% of couples, the male partner has HIV and the woman does not, and in 7% of couples, the woman has HIV and the man does not. 13.3 HIV INCIDENCE HIV incidence HIV incidence is a measure of people newly infected with HIV among individuals who are at risk for becoming infected within a given time frame (UNAIDS/WHO 2015). See testing and calculation methodology in Appendix C. Sample: Women and men age 15-49 who are tested for HIV as part of the survey According to the 2014 LDHS, HIV incidence among women and men age 15-49 in Lesotho is 1.9 new infections per 100 person-years (PY) of exposure (confidence interval: 1.2-2.6). HIV incidence appears to be lower among women (1.7 infections per 100 PY; confidence interval: 0.8-2.6) than men (2.1 infections per 100 HIV Prevalence • 241 PY; confidence interval: 1.1-3.2). However, the difference between women and men is not statistically significant (Figure 13.6). Figure 13.6 HIV incidence by sex LIST OF TABLES For detailed information on HIV prevalence, see the following tables:  Table 13.1 Coverage of HIV testing by residence, ecological zone, and district  Table 13.2 Coverage of HIV testing by selected background characteristics  Table 13.3 HIV prevalence by age  Table 13.4 HIV prevalence by socioeconomic characteristics  Table 13.5 HIV prevalence by demographic characteristics  Table 13.6 HIV prevalence by male circumcision  Table 13.7 HIV prevalence by sexual behaviour  Table 13.8 HIV prevalence among young people by background characteristics  Table 13.9 HIV prevalence among young people by sexual behaviour  Table 13.10 HIV prevalence by other characteristics  Table 13.11 Prior HIV testing by current HIV status  Table 13.12 HIV prevalence among couples 1.9 1.7 2.1 0 1 1 2 2 3 3 4 4 5 5 Total age 15-49 Women age 15-49 Men age 15-49 New infections per 100 person-years of exposure 5 4 3 2 1 0 242 • HIV Prevalence Table 13.1 Coverage of HIV testing by residence, ecological zone, and district Percent distribution of women age 15-49 and men age 15-59 eligible for HIV testing by testing status, according to residence, ecological zone, and district (unweighted), Lesotho 2014 Testing status Number DBS Tested1 Refused to provide blood Absent at the time of blood collection Other/missing2 Total Residence, zone, and district Inter- viewed Not inter- viewed Inter- viewed Not inter- viewed Inter- viewed Not inter- viewed Inter- viewed Not inter- viewed WOMEN 15-49 Residence Urban 92.4 0.4 2.7 0.1 0.3 1.8 0.8 1.6 100.0 1,166 Rural 95.4 0.1 0.9 0.0 0.1 1.1 1.3 1.1 100.0 2,353 Ecological zone Lowlands 93.1 0.3 2.1 0.0 0.2 1.4 1.5 1.4 100.0 1,730 Foothills 93.2 0.0 2.0 0.0 0.0 1.1 2.3 1.4 100.0 352 Mountains 96.4 0.2 0.4 0.0 0.2 1.2 0.4 1.3 100.0 1,018 Senqu River Valley 95.7 0.2 1.2 0.2 0.0 1.2 0.5 1.0 100.0 419 District Butha-Buthe 95.9 0.3 0.6 0.0 0.0 0.0 2.5 0.6 100.0 318 Leribe 92.4 0.0 1.0 0.0 0.2 2.5 2.9 1.0 100.0 408 Berea 91.3 1.0 2.0 0.0 0.2 2.5 1.5 1.5 100.0 402 Maseru 92.7 0.0 3.1 0.0 0.2 1.2 1.0 1.8 100.0 491 Mafeteng 95.3 0.0 2.5 0.0 0.0 0.6 0.0 1.6 100.0 319 Mohale's Hoek 95.6 0.0 1.8 0.0 0.0 0.3 1.2 1.2 100.0 339 Quthing 96.4 0.3 1.3 0.3 0.0 1.0 0.0 0.6 100.0 308 Qacha's Nek 95.1 0.3 0.7 0.0 0.7 1.4 0.0 1.7 100.0 287 Mokhotlong 96.0 0.3 0.3 0.0 0.0 2.1 0.0 1.2 100.0 329 Thaba-Tseka 95.3 0.0 0.6 0.0 0.0 0.9 1.6 1.6 100.0 318 Total 94.4 0.2 1.5 0.0 0.1 1.3 1.1 1.3 100.0 3,519 MEN 15-59 Residence Urban 88.6 0.3 2.9 0.0 0.5 3.1 2.0 2.5 100.0 960 Rural 88.6 0.2 1.7 0.0 0.4 3.6 2.7 2.8 100.0 2,172 Ecological zone Lowlands 88.6 0.2 2.4 0.0 0.4 3.0 2.8 2.6 100.0 1,585 Foothills 85.3 0.3 1.9 0.0 0.3 5.0 3.4 3.8 100.0 320 Mountains 90.0 0.2 1.6 0.1 0.6 3.5 1.5 2.5 100.0 881 Senqu River Valley 88.2 0.3 1.7 0.0 0.6 4.0 2.6 2.6 100.0 346 District Butha-Buthe 91.4 0.4 1.1 0.0 0.0 1.1 3.7 2.2 100.0 267 Leribe 86.8 0.3 1.8 0.0 0.3 3.2 4.1 3.5 100.0 341 Berea 87.6 0.3 2.6 0.0 0.8 5.4 1.5 1.8 100.0 388 Maseru 88.6 0.2 2.8 0.0 0.4 3.7 2.4 1.8 100.0 492 Mafeteng 88.8 0.0 1.9 0.0 0.0 1.6 2.6 5.1 100.0 313 Mohale's Hoek 90.3 0.0 2.2 0.0 0.4 2.5 2.5 2.2 100.0 278 Quthing 86.2 0.4 1.2 0.0 0.8 2.4 3.3 5.7 100.0 246 Qacha's Nek 91.0 0.8 1.2 0.0 0.4 5.3 0.0 1.2 100.0 245 Mokhotlong 88.6 0.0 1.3 0.0 0.3 5.7 1.7 2.3 100.0 299 Thaba-Tseka 87.5 0.0 3.4 0.4 1.1 3.0 2.7 1.9 100.0 263 Total 88.6 0.2 2.0 0.0 0.4 3.5 2.5 2.7 100.0 3,132 TOTAL (WOMEN 15-49 and MEN 15-59) Residence Urban 90.7 0.4 2.8 0.0 0.4 2.4 1.3 2.0 100.0 2,126 Rural 92.1 0.2 1.3 0.0 0.2 2.3 2.0 1.9 100.0 4,525 Ecological zone Lowlands 91.0 0.2 2.2 0.0 0.3 2.2 2.1 2.0 100.0 3,315 Foothills 89.4 0.1 1.9 0.0 0.1 3.0 2.8 2.5 100.0 672 Mountains 93.4 0.2 0.9 0.1 0.4 2.3 0.9 1.8 100.0 1,899 Senqu River Valley 92.3 0.3 1.4 0.1 0.3 2.5 1.4 1.7 100.0 765 District Butha-Buthe 93.8 0.3 0.9 0.0 0.0 0.5 3.1 1.4 100.0 585 Leribe 89.9 0.1 1.3 0.0 0.3 2.8 3.5 2.1 100.0 749 Berea 89.5 0.6 2.3 0.0 0.5 3.9 1.5 1.6 100.0 790 Maseru 90.6 0.1 3.0 0.0 0.3 2.4 1.7 1.8 100.0 983 Mafeteng 92.1 0.0 2.2 0.0 0.0 1.1 1.3 3.3 100.0 632 Mohale's Hoek 93.2 0.0 1.9 0.0 0.2 1.3 1.8 1.6 100.0 617 Quthing 91.9 0.4 1.3 0.2 0.4 1.6 1.4 2.9 100.0 554 Qacha's Nek 93.2 0.6 0.9 0.0 0.6 3.2 0.0 1.5 100.0 532 Mokhotlong 92.5 0.2 0.8 0.0 0.2 3.8 0.8 1.8 100.0 628 Thaba-Tseka 91.7 0.0 1.9 0.2 0.5 1.9 2.1 1.7 100.0 581 Total 91.7 0.2 1.7 0.0 0.3 2.3 1.8 2.0 100.0 6,651 1 Includes all dried blood spots (DBS) tested at the lab and for which there is a result, i.e., positive, negative, or indeterminate. Indeterminate means that the sample went through the entire algorithm, but the final result was inconclusive. 2 Includes (1) other results of blood collection (e.g., technical problem in the field), (2) lost specimens, (3) noncorresponding bar codes, and (4) other lab results such as blood not tested for technical reason, not enough blood to complete the algorithm, etc. HIV Prevalence • 243 Table 13.2 Coverage of HIV testing by selected 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 2014 Testing status Number DBS Tested1 Refused to provide blood Absent at the time of blood collection Other/missing 2 Total Background characteristic Inter- viewed Not inter- viewed Inter- viewed Not inter- viewed Inter- viewed Not inter- viewed Inter- viewed Not inter- viewed WOMEN 15-49 15-19 96.1 0.0 0.7 0.0 0.4 1.5 0.7 0.6 100.0 822 20-24 94.2 0.3 1.2 0.0 0.1 1.5 1.2 1.5 100.0 673 25-29 93.4 0.2 1.7 0.0 0.0 1.9 1.0 1.7 100.0 580 30-34 91.9 0.2 2.0 0.2 0.0 0.4 2.9 2.4 100.0 491 35-39 95.5 0.3 1.6 0.0 0.3 0.5 0.3 1.6 100.0 378 40-44 93.9 0.3 2.2 0.0 0.0 2.2 0.6 0.6 100.0 312 45-49 95.1 0.8 1.9 0.0 0.0 0.8 1.1 0.4 100.0 263 50-54 na na na na na na na na na na 55-59 na na na na na na na na na na Education No education 80.8 0.0 0.0 0.0 0.0 5.8 0.0 13.5 100.0 52 Primary incomplete 95.4 0.0 0.7 0.0 0.0 0.7 0.9 2.2 100.0 668 Primary complete 95.0 0.4 1.3 0.0 0.0 1.2 1.3 0.8 100.0 753 Secondary 95.0 0.2 1.4 0.0 0.3 1.1 1.2 0.8 100.0 1,762 More than secondary 89.7 0.4 4.3 0.4 0.0 3.2 0.7 1.4 100.0 282 Missing 0.0 50.0 0.0 0.0 0.0 50.0 0.0 0.0 100.0 2 Wealth quintile Lowest 95.3 0.2 0.3 0.0 0.2 2.0 0.8 1.3 100.0 612 Second 96.2 0.2 0.5 0.0 0.0 0.6 0.9 1.6 100.0 638 Middle 96.3 0.1 0.7 0.0 0.1 0.7 1.3 0.6 100.0 674 Fourth 95.3 0.0 1.8 0.0 0.3 0.7 0.7 1.3 100.0 762 Highest 89.9 0.6 3.4 0.1 0.1 2.4 1.8 1.7 100.0 833 Total 94.4 0.2 1.5 0.0 0.1 1.3 1.1 1.3 100.0 3,519 MEN 15-59 15-19 91.6 0.1 1.0 0.0 0.1 2.6 2.2 2.3 100.0 726 20-24 90.1 0.2 1.4 0.0 0.7 3.2 2.5 2.0 100.0 563 25-29 87.9 0.2 2.6 0.0 0.5 4.0 2.9 1.9 100.0 420 30-34 84.9 0.0 3.4 0.0 0.3 4.0 3.2 4.2 100.0 377 35-39 87.0 0.0 3.1 0.0 0.7 3.8 2.7 2.7 100.0 293 40-44 86.0 0.0 3.3 0.0 0.4 4.5 2.1 3.7 100.0 242 45-49 83.9 1.1 2.2 0.0 1.1 4.8 2.2 4.8 100.0 186 50-54 88.8 1.1 1.1 0.6 0.0 3.4 2.8 2.2 100.0 179 55-59 93.1 0.0 1.4 0.0 0.7 2.1 0.7 2.1 100.0 145 Education No education 81.1 0.0 1.6 0.0 0.8 6.3 2.9 7.3 100.0 381 Primary incomplete 89.7 0.3 1.9 0.1 0.3 2.7 2.4 2.7 100.0 1,083 Primary complete 89.8 0.0 1.6 0.0 0.3 3.2 2.7 2.4 100.0 372 Secondary 90.2 0.4 2.0 0.0 0.4 3.1 2.6 1.4 100.0 1,076 More than secondary 87.6 0.0 4.6 0.0 1.4 3.7 0.9 1.8 100.0 217 Missing 0.0 0.0 0.0 0.0 0.0 100.0 0.0 0.0 100.0 3 Wealth quintile Lowest 87.5 0.2 1.2 0.2 0.7 4.1 3.5 2.6 100.0 567 Second 89.7 0.0 2.0 0.0 0.2 3.8 2.3 2.0 100.0 604 Middle 89.9 0.2 1.1 0.0 0.3 3.2 2.0 3.4 100.0 654 Fourth 90.8 0.2 1.8 0.0 0.3 2.5 1.9 2.5 100.0 628 Highest 85.3 0.6 4.0 0.0 0.7 3.8 2.7 2.9 100.0 679 Total 88.6 0.2 2.0 0.0 0.4 3.5 2.5 2.7 100.0 3,132 1 Includes all dried blood spots (DBS) tested at the lab and for which there is a result, i.e., positive, negative, or indeterminate. Indeterminate means that the sample went through the entire algorithm, but the final result was inconclusive. 2 Includes (1) other results of blood collection (e.g., technical problem in the field), (2) lost specimens, (3) noncorresponding bar codes, and (4) other lab results such as blood not tested for technical reason, not enough blood to complete the algorithm, etc. 244 • HIV Prevalence Table 13.3 HIV prevalence by age Among the de facto women age 15-49 and men age 15-59 who were interviewed and tested, the percentage HIV positive, by age, Lesotho 2014 Women Men Total Age Percentage HIV positive Number Percentage HIV positive Number Percentage HIV positive Number 15-19 5.4 704 4.8 706 5.1 1,410 20-24 21.5 638 7.5 566 14.9 1,204 25-29 37.5 528 17.9 402 29.1 929 30-34 44.9 454 27.5 319 37.7 773 35-39 45.5 335 41.2 270 43.6 605 40-44 44.6 274 43.5 217 44.1 491 45-49 37.2 242 30.4 166 34.4 408 50-59 na na 28.8 275 na na Total 15-49 29.7 3,175 18.6 2,646 24.6 5,821 Total 15-59 na na 19.6 2,921 na na na = Not applicable HIV Prevalence • 245 Table 13.4 HIV prevalence by socioeconomic characteristics Percentage HIV positive among women and men age 15-49 who were tested, by socioeconomic characteristics, Lesotho 2014 Women Men Total Background characteristic Percentage HIV positive Number Percentage HIV positive Number Percentage HIV positive Number Religion Roman Catholic 29.9 1,266 18.9 1,091 24.8 2,357 Lesotho Evangelical 29.0 537 19.7 473 24.6 1,010 Anglican 29.6 207 22.6 200 26.2 407 Pentecostal 30.6 801 17.3 494 25.5 1,295 Other Christian 29.1 310 14.8 189 23.7 499 Other non-Christian (23.4) 31 (22.3) 37 22.8 68 No religion (17.3) 23 16.1 163 16.2 186 Employment (past 12 months) Not employed 21.4 1,699 9.4 802 17.6 2,501 Employed 39.2 1,476 22.6 1,844 30.0 3,320 Residence Urban 35.6 1,129 23.1 919 30.0 2,048 Rural 26.4 2,046 16.2 1,727 21.8 3,773 Ecological zone Lowlands 31.7 1,986 20.2 1,699 26.4 3,685 Foothills 27.9 311 18.4 246 23.7 557 Mountains 25.6 640 13.9 528 20.3 1,169 Senqu River Valley 26.1 238 17.3 173 22.4 411 District Butha-Buthe 22.0 191 20.2 142 21.2 333 Leribe 31.4 507 17.5 385 25.4 892 Berea 31.7 420 18.4 377 25.4 797 Maseru 33.3 876 22.4 810 28.0 1,686 Mafeteng 29.1 271 20.6 240 25.1 512 Mohale's Hoek 25.6 264 12.9 201 20.1 465 Quthing 26.8 160 11.5 104 20.8 264 Qacha's Nek 27.1 94 12.9 73 20.9 168 Mokhotlong 23.4 167 9.6 143 17.0 309 Thaba-Tseka 27.7 225 20.7 169 24.7 395 Education No education (24.9) 36 29.7 212 29.0 247 Primary incomplete 32.7 559 19.2 870 24.4 1,429 Primary complete 37.1 681 20.4 311 31.9 992 Secondary 26.7 1,643 17.0 1,042 23.0 2,685 More than secondary 23.2 256 10.4 211 17.4 467 Wealth quintile Lowest 24.5 456 19.9 373 22.4 828 Second 25.0 526 15.1 477 20.3 1,003 Middle 29.6 602 17.4 539 23.8 1,140 Fourth 34.9 774 21.6 625 29.0 1,399 Highest 30.7 817 18.6 633 25.4 1,450 Total 15-49 29.7 3,175 18.6 2,646 24.6 5,821 50-59 na na 28.8 275 na na Total 15-59 na na 19.6 2,921 na na Note: Figures in parentheses are based on 25-49 unweighted cases. na = Not applicable 246 • HIV Prevalence Table 13.5 HIV prevalence by demographic characteristics Percentage HIV positive among women and men age 15-49 who were tested, by demographic characteristics, Lesotho 2014 Women Men Total Demographic characteristic Percentage HIV positive Number Percentage HIV positive Number Percentage HIV positive Number Marital status Never married 16.1 1,055 8.7 1,512 11.7 2,566 Ever had sex 23.8 655 9.3 1,165 14.5 1,820 Never had sex 3.6 399 6.7 347 5.0 746 Married/living together 31.0 1,718 29.6 967 30.5 2,686 Divorced or separated 48.6 169 43.3 124 46.3 293 Widowed 67.9 233 (49.3) 43 64.9 276 Type of union In polygynous union (65.1) 38 * 27 62.7 64 In non-polygynous union 29.9 1,613 28.8 940 29.5 2,553 Not currently in union 28.2 1,456 12.3 1,679 19.7 3,136 In union, polygyny status unknown 37.8 68 nc 0 na na Times slept away from home in past 12 months None 27.5 1,583 18.1 1,249 23.3 2,832 1-2 28.9 713 17.6 498 24.2 1,211 3-4 32.9 304 16.3 239 25.6 543 5+ 34.9 574 21.2 659 27.6 1,233 Time away in past 12 months Away for more than 1 month 27.0 462 18.8 483 22.8 944 Away for less than 1 month 33.8 1,130 19.2 913 27.3 2,043 Not away 27.5 1,583 18.1 1,251 23.4 2,834 Time away in past 5 years Away for 3 or more months at a time once 32.9 345 16.9 366 24.7 711 Away for 3 or more months at a time more than once 33.6 314 21.8 383 27.1 697 Not away for 3 or more months at a time 28.7 2,516 18.3 1,897 24.3 4,413 Currently pregnant Pregnant 24.7 131 na na na na Not pregnant or not sure 29.9 3,044 na na na na ANC for last birth in the last 3 years ANC provided by the public sector 26.8 664 na na na na ANC provided by other than the public sector 26.2 226 na na na na No ANC/No birth in last 3 years 30.8 2,285 na na na na Male circumcision Traditionally or medically circumcised1 na na 17.8 1,926 na na Traditionally circumcised only na na 20.8 1,175 na na Medically circumcised only na na 13.5 624 na na Both traditionally and medically circumcised na na 11.0 124 na na Not circumcised na na 20.8 719 na na Don't know na na * 1 na na Total 15-49 29.7 3,175 18.6 2,646 24.6 5,821 50-59 na na 28.8 275 na na Total 15-59 na na 19.6 2,921 na na Notes: Total includes 1 man for whom information on times slept away from home in the past 12 months is missing. 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 nc = No cases 1 Includes men who know that they have been traditionally circumcised but not whether they have been medically circumcised, and men who know that they have been medically circumcised but not whether they have been traditionally circumcised. HIV Prevalence • 247 Table 13.6 HIV prevalence by male circumcision Among men age 15-49 who were tested for HIV, the percentage HIV positive by whether traditionally or medically circumcised, according to background characteristics, Lesotho 2014 Traditionally or medically circumcised1 Traditionally circumcised only Medically circumcised only Both traditionally and medically circumcised Not circumcised Background characteristic Percentage HIV positive Number Percentage HIV positive Number Percentage HIV positive Number Percentage HIV positive Number Percentage HIV positive Number Age 15-19 2.8 416 4.7 177 1.5 217 * 23 7.6 290 20-24 7.0 468 3.8 262 11.3 160 (9.9) 46 10.2 98 25-29 17.5 313 22.1 213 8.5 75 * 26 19.7 89 30-34 28.2 244 25.9 170 37.0 65 * 9 25.6 74 35-39 38.7 199 42.9 135 (27.8) 48 * 12 48.3 71 40-44 39.2 157 40.2 124 (38.4) 27 * 6 (54.7) 60 45-49 28.6 129 29.4 94 (28.2) 33 * 2 (36.7) 37 Religion Roman Catholic 18.6 790 19.7 486 16.4 258 (19.8) 46 19.7 302 Lesotho Evangelical 19.0 363 23.2 211 13.7 124 (10.8) 27 22.0 108 Anglican 13.7 138 11.5 90 (20.9) 41 * 7 42.3 62 Pentecostal 17.4 367 25.4 216 6.1 119 * 28 17.1 127 Other Christian 16.4 127 25.6 67 7.2 50 * 10 11.7 61 Other non-Christian * 26 * 15 * 9 * 1 * 11 No religion 13.8 116 15.1 90 * 21 * 5 (21.5) 47 Residence Urban 20.6 642 32.8 206 15.3 388 (10.4) 48 29.1 276 Rural 16.4 1,284 18.3 969 10.5 236 11.3 76 15.6 443 Ecological zone Lowlands 18.1 1,205 23.3 596 13.2 531 (11.6) 78 25.5 492 Foothills 20.9 180 20.0 147 * 24 * 7 11.9 67 Mountains 15.2 407 16.5 332 7.3 44 (13.1) 29 9.6 122 Senqu River Valley 19.0 134 21.8 100 12.0 25 * 9 11.1 38 District Butha-Buthe 21.6 112 22.4 88 (17.2) 18 * 6 (15.2) 30 Leribe 15.6 286 20.4 175 1.9 93 * 16 23.0 100 Berea 16.2 263 22.2 131 11.3 114 * 17 23.4 115 Maseru 20.3 561 25.4 249 17.6 269 * 43 27.1 248 Mafeteng 21.6 176 21.6 121 23.5 48 * 8 18.2 63 Mohale's Hoek 13.8 149 15.2 124 (9.6) 18 * 5 10.3 52 Quthing 15.1 78 16.5 49 (15.0) 20 * 8 (1.0) 27 Qacha's Nek 12.5 55 15.0 40 (7.4) 10 * 5 (14.0) 18 Mokhotlong 10.1 112 12.2 88 (4.1) 13 * 11 (7.5) 31 Thaba-Tseka 21.8 134 24.8 109 (9.2) 21 * 4 (16.4) 36 Education No education 28.5 185 28.3 171 * 1 * 9 (38.0) 27 Primary incomplete 19.9 631 21.8 541 (8.9) 51 (7.8) 39 17.2 239 Primary complete 18.6 227 17.2 162 (23.5) 52 * 13 25.2 84 Secondary 14.8 725 16.7 290 14.1 388 (9.0) 48 22.1 317 More than secondary 9.3 158 * 11 9.6 131 * 16 (13.7) 52 Wealth quintile Lowest 21.5 286 21.8 260 * 9 * 17 14.4 87 Second 16.3 357 18.7 280 (6.2) 49 * 25 11.6 120 Middle 15.5 386 17.1 289 12.6 80 * 17 22.0 153 Fourth 19.9 447 23.9 226 15.0 190 * 31 26.1 179 Highest 16.6 452 26.8 121 13.8 295 (5.0) 34 23.8 180 Total 15-49 17.8 1,926 20.8 1,175 13.5 624 11.0 124 20.8 719 50-59 27.9 192 29.4 152 (23.8) 36 * 3 30.8 80 Total 15-59 18.7 2,118 21.8 1,328 14.1 659 10.9 127 21.8 799 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 Includes men who know that they have been traditionally circumcised but not whether they have been medically circumcised, and men who know that they have been medically circumcised but not whether they have been traditionally circumcised. 248 • HIV Prevalence Table 13.7 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 characteristics, Lesotho 2014 Women Men Total Sexual behaviour characteristic Percentage HIV positive Number Percentage HIV positive Number Percentage HIV positive Number Age at first sexual intercourse <16 36.4 509 14.6 752 23.4 1,261 16-17 32.7 865 17.9 600 26.7 1,465 18-19 33.0 738 20.6 429 28.5 1,167 20+ 32.7 639 32.7 481 32.7 1,120 Don't know/missing (29.1) 25 (16.9) 37 21.8 62 Multiple sexual partners and partner concurrency in past 12 months 0 34.6 344 16.1 248 26.8 593 1 31.8 2,197 21.1 1,316 27.8 3,513 2+ 46.7 212 20.5 698 26.6 909 Had concurrent partners1 55.2 65 27.4 202 34.2 268 None of the partners were concurrent 42.9 147 17.7 495 23.4 642 Missing (52.1) 23 (22.5) 38 33.6 61 Condom use at last sexual intercourse in past 12 months Used condom 40.5 1,181 20.2 1,243 30.1 2,424 Did not use condom 25.9 1,228 22.1 770 24.4 1,998 No sexual intercourse in last 12 months 35.7 367 16.9 286 27.5 653 Number of lifetime partners 1 19.8 982 11.5 222 18.3 1,203 2 33.3 748 14.1 312 27.7 1,061 3-4 41.9 693 15.9 569 30.2 1,263 5-9 51.0 256 22.2 571 31.1 828 10+ 69.7 71 29.1 573 33.6 644 Don't know (52.4) 25 30.7 52 37.8 77 Paid for sexual intercourse in past 12 months Yes na na 16.8 79 na na Used condom na na 18.0 71 na na Did not use condom na na * 9 na na No/no sexual intercourse in past 12 months na na 20.5 2,220 na na Total 15-49 33.4 2,776 20.4 2,300 27.5 5,075 50-59 na na 29.0 273 na na Total 15-59 na na 21.3 2,572 na na 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 applicable 1 A respondent is considered to have had concurrent partners if he or she had overlapping sexual partnerships with two or more people during the 12 months before the survey. (Respondents with concurrent partners include polygynous men who had overlapping sexual partnerships with two or more wives). HIV Prevalence • 249 Table 13.8 HIV prevalence among young people by background characteristics Percentage HIV positive among women and men age 15-24 who were tested for HIV, by background characteristics, Lesotho 2014 Women Men Total Background characteristic Percentage HIV positive Number Percentage HIV positive Number Percentage HIV positive Number Age 15-19 5.4 704 4.8 706 5.1 1,410 15-17 5.6 424 4.8 423 5.2 848 18-19 5.2 280 4.7 283 5.0 563 20-24 21.5 638 7.5 566 14.9 1,204 20-22 17.1 409 5.7 365 11.7 774 23-24 29.3 230 10.9 201 20.7 431 Marital status Never married 8.9 836 5.5 1,174 6.9 2,010 Ever had sex 13.6 443 5.1 847 8.0 1,290 Never had sex 3.7 392 6.3 327 4.9 720 Married/living together 17.4 460 11.7 92 16.5 552 Divorced/separated/widowed (44.6) 47 * 6 (41.9) 53 Currently pregnant Pregnant 16.9 77 na na na na Not pregnant or not sure 12.9 1,266 na na na na Residence Urban 16.3 443 9.2 402 12.9 845 Rural 11.5 899 4.5 870 8.1 1,769 Ecological zone Lowlands 14.1 843 6.6 830 10.4 1,673 Foothills 13.0 131 3.2 119 8.4 250 Mountains 11.6 271 4.8 237 8.4 507 Senqu River Valley 8.9 98 7.0 87 8.0 184 District Butha-Buthe 11.3 84 4.6 64 8.4 148 Leribe 12.4 208 5.8 194 9.2 402 Berea 11.8 168 1.4 179 6.5 347 Maseru 15.9 373 9.5 391 12.6 764 Mafeteng 14.1 122 6.8 118 10.5 240 Mohale's Hoek 10.7 109 4.1 101 7.5 210 Quthing 9.7 76 4.8 55 7.7 131 Qacha's Nek 11.7 39 3.1 35 7.6 74 Mokhotlong 11.0 81 2.1 71 6.8 152 Thaba-Tseka 14.0 82 7.5 64 11.1 146 Education No education * 1 (10.6) 27 (10.4) 28 Primary incomplete 12.1 186 5.3 404 7.4 590 Primary complete 15.0 188 6.2 122 11.5 310 Secondary 12.5 904 6.3 649 9.9 1,552 More than secondary 18.1 63 (5.2) 70 11.3 134 Wealth quintile Lowest 13.3 204 7.8 147 11.0 351 Second 8.6 236 3.1 225 5.9 462 Middle 12.6 273 3.2 285 7.8 558 Fourth 16.6 329 8.4 324 12.5 653 Highest 13.1 300 7.5 292 10.3 591 Total 15-24 13.1 1,342 6.0 1,272 9.6 2,615 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 applicable 250 • HIV Prevalence Table 13.9 HIV prevalence among young people by sexual behaviour Percentage HIV-positive among women and men age 15-24 who have ever had sex and were tested for HIV, by sexual behaviour, Lesotho 2014 Women Men Total Sexual behaviour characteristic Percentage HIV positive Number Percentage HIV positive Number Percentage HIV positive Number Multiple sexual partners and partner concurrency in past 12 months 0 12.8 136 4.1 147 8.3 282 1 17.5 738 4.5 494 12.3 1,232 2+ 19.1 71 8.4 286 10.6 357 Had concurrent partners1 * 12 7.0 59 8.6 71 None of the partners were concurrent 19.6 60 8.8 226 11.1 286 Condom use at last sexual intercourse in past 12 months Used condom 20.7 476 5.6 600 12.3 1,076 Did not use condom 13.3 333 7.3 180 11.2 513 No sexual intercourse in last 12 months 13.1 141 5.5 165 9.0 306 Total 15-24 17.0 950 5.9 945 11.4 1,895 Notes: Total includes 5 women and 18 men for whom information on multiple sexual partners and partner concurrency in the past 12 months is missing. An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. 1 A respondent is considered to have had concurrent partners if he or she had overlapping sexual partnerships with two or more people during the 12 months before the survey. (Respondents with concurrent partners include polygynous men who had overlapping sexual partnerships with two or more wives). HIV Prevalence • 251 Table 13.10 HIV prevalence by other characteristics Percentage HIV positive among women and men age 15-49 who ever had sex and were tested for HIV, by whether had an STI in the past 12 months and by prior testing for HIV, Lesotho 2014 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 36.1 458 28.5 271 33.3 729 No STI, no symptoms 32.9 2,305 19.3 2,021 26.6 4,326 Don't know * 13 * 8 * 21 Prior HIV testing Ever tested 35.0 2,541 23.4 1,585 30.5 4,126 Received results 34.4 2,483 23.1 1,527 30.1 4,010 Did not received results 59.4 58 31.7 58 45.5 116 Never tested 16.8 235 13.8 714 14.5 949 Total 15-49 33.4 2,776 20.4 2,300 27.5 5,075 Note: An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. 252 • HIV Prevalence Table 13.11 Prior HIV testing by current HIV status Percent distribution of women and men age 15-49 who tested HIV positive and who tested HIV negative by HIV testing status prior to the survey, Lesotho 2014 Women Men Total HIV testing prior to the survey HIV positive HIV negative HIV positive HIV negative HIV positive HIV negative Previously tested Received result of last test 91.1 79.7 73.4 61.2 85.0 70.6 Did not receive result of last test 4.0 1.5 3.8 1.9 3.9 1.7 Not previously tested 4.9 18.8 22.8 36.8 11.0 27.6 Total 100.0 100.0 100.0 100.0 100.0 100.0 Number 942 2,233 493 2,154 1,435 4,386 HIV Prevalence • 253 Table 13.12 HIV prevalence among couples Percent distribution of couples living in the same household, both of whom were tested for HIV, by HIV status, according to background characteristics, Lesotho 2014 Background characteristic Both HIV positive Man HIV positive, woman HIV negative Woman HIV positive, man HIV negative Both HIV negative Total Number Woman's age 15-19 1.2 6.6 1.3 90.9 100.0 52 20-29 18.3 7.5 11.3 63.0 100.0 270 30-39 25.3 7.4 4.7 62.6 100.0 234 40-49 20.7 11.2 4.7 63.4 100.0 151 Man's age 15-19 * * * * 100.0 8 20-29 11.6 4.6 7.8 76.0 100.0 180 30-39 21.3 10.1 8.9 59.7 100.0 252 40-49 29.1 7.1 3.4 60.4 100.0 190 50-59 13.9 13.5 7.9 64.7 100.0 79 Age difference between partners Woman older (10.7) (0.0) (6.0) (83.2) 100.0 26 Same age/man older by 0-4 years 19.6 7.4 5.0 68.0 100.0 355 Man older by 5-9 years 19.7 10.8 9.1 60.5 100.0 242 Man older by 10-14 years 17.6 8.5 11.4 62.5 100.0 65 Man older by 15+ years * * * * 100.0 20 Type of union Non-polygynous 18.8 8.2 6.9 66.1 100.0 686 Polygynous * * * * 100.0 10 In union, polygyny status unknown or missing * * * * 100.0 12 Multiple partners in past 12 months1 Both no 21.3 7.6 4.9 66.2 100.0 484 Man yes, woman no 13.3 9.4 10.8 66.4 100.0 180 Woman yes, man no * * * * 100.0 20 Both yes * * * * 100.0 17 Either missing * * * * 100.0 7 Concurrent sexual partners in past 12 months2 Both no 20.9 7.4 6.3 65.4 100.0 609 Man yes, woman no 13.6 14.0 7.1 65.2 100.0 83 Woman yes, man no * * * * 100.0 11 Both yes * * * * 100.0 4 Residence Urban 27.8 6.4 8.6 57.2 100.0 238 Rural 15.9 9.1 6.1 69.0 100.0 470 Ecological zone Lowlands 21.3 9.6 7.6 61.5 100.0 423 Foothills 21.0 7.4 6.1 65.5 100.0 68 Mountains 16.4 4.2 6.8 72.6 100.0 173 Senqu River Valley 17.3 11.8 2.7 68.2 100.0 43 District Butha-Buthe 12.1 3.3 5.5 79.1 100.0 45 Leribe 11.7 14.6 9.3 64.3 100.0 95 Berea 16.4 10.7 9.9 63.0 100.0 90 Maseru 30.1 6.8 5.6 57.5 100.0 222 Mafeteng 16.2 10.7 4.8 68.3 100.0 54 Mohale's Hoek 15.6 8.8 2.1 73.5 100.0 46 Quthing (15.4) (2.9) (7.6) (74.1) 100.0 23 Qacha's Nek 14.7 2.7 9.6 73.0 100.0 18 Mokhotlong 13.9 5.7 9.7 70.6 100.0 49 Thaba-Tseka 20.3 6.4 7.0 66.3 100.0 67 Woman's education No education * * * * 100.0 13 Primary incomplete 21.1 10.6 8.5 59.8 100.0 148 Primary complete 18.2 10.2 5.5 66.2 100.0 182 Secondary 21.5 6.2 5.4 66.9 100.0 301 More than secondary 15.0 7.8 14.1 63.1 100.0 63 (Continued…) 254 • HIV Prevalence Table 13.12—Continued Background characteristic Both HIV positive Man HIV positive, woman HIV negative Woman HIV positive, man HIV negative Both HIV negative Total Number Man's education No education 20.9 6.5 4.3 68.3 100.0 101 Primary incomplete 18.5 9.6 7.0 64.9 100.0 260 Primary complete 14.8 12.0 9.1 64.1 100.0 92 Secondary 27.1 6.4 4.6 61.9 100.0 194 More than secondary 8.9 4.8 15.4 70.9 100.0 61 Wealth quintile Lowest 15.1 9.5 6.2 69.2 100.0 133 Second 15.7 6.9 5.9 71.5 100.0 133 Middle 15.9 9.9 9.6 64.6 100.0 122 Fourth 28.7 7.1 4.2 59.9 100.0 152 Highest 21.8 7.9 8.8 61.4 100.0 168 Total 19.9 8.2 6.9 65.0 100.0 708 Notes: The table is based on couples for which a valid test result (positive or negative) is available for both partners. 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 A respondent is considered to have had multiple sexual partners in the past 12 months if he or she had sexual intercourse with two or more people during this time period. (Respondents with multiple partners include polygynous men who had sexual intercourse with two or more wives.) 2 A respondent is considered to have had concurrent partners if he or she had overlapping sexual partnerships with two or more people during the 12 months before the survey. (Respondents with concurrent partners include polygynous men who had overlapping sexual partnerships with two or more wives). Women’s Empowerment • 255 WOMEN’S EMPOWERMENT 14 Key Findings  Employment and control over earnings: About half of currently married women are employed compared with 83% of currently married men. One-third of currently married women who receive cash earnings report deciding for themselves how earnings will be used; 62% say they decide on use of earnings with their husband.  Ownership of assets: About one third of women own a house, and 28% own land. In contrast, only one in four men owns a house or land.  Participation in decision making: Sixty-five percent of currently married women make decisions, either alone or jointly, about their own health care, whether to visit their families and relatives, and major household purchases.  Attitude towards wife beating: Thirty-three percent of women and 40% of men believe that a husband is justified in beating his wife in at least one of five specified circumstances. his chapter explores women’s empowerment in terms of employment, earnings, control over earnings, and magnitude of earnings relative to those of their partners. In addition, responses to specific questions are used to define two different indicators of women’s empowerment: women’s participation in household decision making and women’s attitudes towards wife beating. 14.1 MARRIED WOMEN’S AND MEN’S EMPLOYMENT Employment Respondents are considered to be employed if they have done any work other than their housework in the 12 months before the survey. Sample: Currently married women and men age 15-49 Earning cash for employment Respondents are asked if they are paid for their labour in cash or in kind. Only those who receive payment in cash only or in cash and in kind are considered to earn cash for their employment. Sample: Currently married women and men age 15-49 employed in the 12 months before the survey Men are more likely to be employed than women. Half of currently married women age 15-49 reported being employed at any time in the 12 months before the survey compared with 83% of currently married men age 15-49 (Table 14.1). T 256 • Women’s Empowerment Not all women and men receive earnings for the work they do; however, among those who do receive earnings, most but not all receive cash. Among those employed, cash only is the most common form of payment for both women and men; however women are slightly more likely to be paid in cash only for their work compared with men (82% and 78%, respectively). Fourteen percent of women and 15% of men do not receive any form of earnings for their work. Trends: Since 2004, employment among currently married women has remained stable at 49-50%. The proportion of women receiving cash earnings only, increased from 53% in 2004 to 67% in 2009, and to 82% in 2014, while the proportion who did not receive any earnings for their work decreased from 39% in 2004 to 27% in 2009 to 14% in 2014. Among currently married men employment increased from 63% in 2004 to 85% in 2009 before falling slightly to 83% in 2014. The proportion of men receiving cash earnings alone decreased from 75% in 2004 to 60% in 2009, but then increased to 78% in 2014. The proportion that did not receive any earnings for their work increased from 18% in 2004 to 32% in 2009 and decreased to 15% in 2014. Patterns by background characteristics  Employment increases with age among currently married women, peaking in the 30-34 age group (62%), and then declining. Similarly, employment among currently married men rises with age, peaking in the 35- 39 age group (88%), and then declining slightly (Figure 14.1).  The youngest and oldest age groups of currently married, employed women (those age 15-19 and 45-49) are the most likely not to be paid (22% for each) compared with other age groups. This contrasts with men, where the oldest age group (45-49) of currently married, employed men is the least likely to not be paid (11%). 14.2 CONTROL OVER WOMEN’S EARNINGS Control over one’s own cash earnings Respondents are considered to have control over their own earnings if they participate in decisions alone or jointly with their husband about how their own earnings will be used. Sample: Currently married women age 15-49 who received cash earnings for employment during the 12 months before the survey To assess women’s autonomy, currently married women who earned cash for their work in the 12 months before the survey were asked who the main decision maker was with regard to the use of their earnings. Women gain direct access to economic resources when they are paid for work in cash and have autonomy to make decisions about how to spend this earned cash. Figure 14.1 Women’s and men’s employment by age 23 36 48 62 60 58 49 74 83 84 88 84 83 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Percentage of currently married women and men who were employed at any time in the past 12 months Age in years Currently married men Currently married women Women’s Empowerment • 257 One-third (33%)of currently married women who receive cash earnings report deciding for themselves how their earnings are used, while 62% indicated that the decision is made jointly with their husband (Table 14.2.1, Figure 14.2). Only 4% of women report that their husband mainly decides how their earnings are used. In couples where both women and men earned cash, 55% of women reported that they earn less than their husbands and 15% report earning more. Trends: Since 2004, women’s ability to make independent decisions on the use of their earnings has declined (from 52% in 2004 to 37% in 2009 and 33% in 2014). However, during this same time frame, women’s ability to make joint decisions with their husband has increased (from 36% in 2004 to 58% in 2009 and to 62% in 2014). Overall, in the last decade, women’s ability to make decisions either independently or jointly with their husbands on the use of their earnings has increased, from 88% in 2004 to 94% in 2009 to 95% in 2014. Patterns by background characteristics  Women in rural areas (37%) are more likely to make independent decisions on the use of their earnings than women in the urban areas (30%).  Decision-making on the use of their earnings by currently married women differs across districts. The proportion of women whose husbands mainly make decisions on the use of their cash earnings ranges from a low of 1% in Mokhotlong to a high of 11% in Qacha’s Nek.  Women with less education (primary incomplete) are much more likely to independently control their cash earnings (43%) than women with more education (30-33%). Making joint decisions is highest (67%) among women with more than secondary education. 14.3 CONTROL OVER MEN’S EARNINGS Among married men age 15-49 who receive cash earnings, 76% report that they decide jointly with their wives how to spend those earnings (Table 14.2.2). Only 14% of men indicated that they decide alone how to spend their earnings. Married women were also asked who decides how their husband’s earnings are used; 72% reported that this decision was taken jointly, while 11% reported that it was mainly the husband that made the decision. For information on women’s control over their own earnings and over those of their husbands by women’s earnings relative to their husband’s earnings, see Table 14.3. Figure 14.2 Control over women’s earnings Mainly wife 33% Wife and husband jointly 62% Mainly husband 4% Percent distribution of currently married women with cash earnings in the last 12 months 258 • Women’s Empowerment 14.4 WOMEN’S AND MEN’S OWNERSHIP OF ASSETS Ownership of a house or land Respondents who own a house or land, whether alone or jointly with someone else Sample: Women and men age 15-49 Thirty-five percent of women own a house, either alone, jointly with someone, or both alone and jointly; similarly, 28% of women report that they own land, either alone, jointly, or both alone and jointly (Table 14.4.1, Figure 14.3). Joint ownership of these assets is more common among women than is sole ownership: 26% of women own a house jointly with someone, while 21% own land jointly with someone. Strikingly, the proportion of men age 15-49 who own a house (25%) or own land (25%) is smaller than the proportion of women who own either asset (Table 14.4.2). Similar to women, joint ownership of either asset is more common among women than sole ownership. Patterns by background characteristics  House and land ownership, either alone or jointly, increases with age for both women and men. While 2% of women age 15-19 own a house and 5% own land, 86% of women age 45-49 own a house and 50% own land.  Women’s ownership of a house, either alone or jointly, is more common in rural areas than in urban areas. Forty-one percent of rural women own a house compared with 25% of urban women. No difference is seen in women’s ownership of land; 28% of both rural and urban women own land, either alone or jointly. In contrast, rural men are equally likely to own a home, either alone or jointly, as urban men (25% for each), and rural men are less likely to own land, either alone or jointly, than urban men (21% versus 31%). 14.5 WOMEN’S PARTICIPATION IN DECISION MAKING Participation in major household decisions Women are considered to participate in household decisions if they make decisions alone or jointly with their husband in all three of the following areas: (1) the woman’s own health care, (2) major household purchases, and (3) visits to the woman’s family or relatives. Sample: Currently married women age 15-49 Figure 14.3 Ownership of assets 10 6 8 8 13 21 16 26 1 1 1 1 75 72 75 65 Men Women LAND Men Women HOUSE Percent distribution of women and men age 15-49 by house and land ownership Alone Jointly Alone and jointly Do not own a house Own: Women’s Empowerment • 259 The 2014 LDHS sought information from currently married women on their participation in three types of household decisions: the respondent’s own health care; making major household purchases; and visits to family or relatives (Table 14.5). More than seven in 10 women participate in each individual decision. Fewer women (72%) participate in making decisions to visit their family or relatives than in making decisions regarding their own health care (89%) or making major household purchases (89%). Sixty-five percent of women participate in all three decisions, while only 3% participate in none of the three decisions (Table 14.6.1, Figure 14.4). Patterns by background characteristics  Participation in all three decisions, either solely or jointly with their husband, increases with age, rising from 36% of women age 15-19 to a peak of 75% of women age 35-39.  Urban women are more likely to participate in all three decisions, either alone or jointly with their husbands, than rural women (74% and 62%, respectively).  Women’s participation in decision making, either alone or jointly with their husbands, increases substantially with education and wealth; 48% of women with no education participate in all three decisions compared with 83% of women with more than secondary education. Women in the wealthiest households (76%) are more likely to participate in all three decisions than women in the poorest households (53%). The 2014 LDHS also collected information from currently married men on their participation in two types of household decisions: their own health care and making major household purchases. Information on men’s participation in decision making is shown in Table 14.5 and Table 14.6.2. 14.6 ATTITUDES TOWARDS WIFE BEATING Attitudes towards wife beating Respondents are asked if they agree that a husband is justified in hitting or beating his wife under each of the following five circumstances: she burns the food, she argues with him, she goes out without telling him, she neglects the children, and she refuses to have sex with him. If respondents answer ‘yes’ in at least one circumstance, they are considered to have attitudes justifying wife beating. Sample: Women and men age 15-49 Figure 14.4 Women’s participation in decision making 89 89 72 65 3 Woman's own health care Major household purchases Visits to family or relatives Participate in all 3 decisions Participate in none of these decisions Percentage of currently married women age 15-49 participating in select decisions 260 • Women’s Empowerment In Lesotho, one-third of women believe that a husband is justified in beating his wife for at least one of five specified circumstances (Table 14.7.1). The comparable figure among men is 40% (Table 14.7.2, Figure 14.5). Additionally, for each of the specified circumstances that respondents were asked about, men were just as likely as or more likely than women to agree that wife beating was justified. Trends: Tolerance of wife beating appears to have declined over time among women and men. The proportion of women who agree that wife beating is justified in at least one of five specified circumstances has fallen from 48% in 2004 to 37% in 2009, and to 33% in 2014. Among men, the proportion has decreased from 53% in 2004 to 48% in 2009, finally dropping to 40% in 2014. Patterns by background characteristics  Tolerance for wife beating is higher among never-married women than among ever-married women; 37% of women who have never married agree that wife beating is justified in at least one of the five specified circumstances compared with 32% of married women and 28% of divorced, separated, or widowed women.  Wife beating is more acceptable in rural areas than urban areas; 39% of women and 44% of men in rural areas agree that wife beating is justified in at least one of the five specified circumstances compared with 23% of women and 32% of men in urban areas.  Women’s tolerance of wife beating generally decreases with education, and a similar pattern occurs among men. Fifty-two percent of women with incomplete primary education agree with wife beating in at least one of five specified circumstances compared with only 5% of women with more than secondary education. Over half (53%) of men with no education find wife beating acceptable for at least one reason compared with 17% of men with more than secondary education.  For both women and men, tolerance of wife beating decreases steadily with wealth. However, the magnitude of the decrease differs; while about half of women and men in the lowest wealth quintile agree with wife beating in at least one of five specified circumstances, only 5% of women in the highest wealth quintile do. In contrast, 28% of men in the highest wealth quintile agree with wife beating in at least one circumstance. For additional information on indicators of women’s empowerment and variation of selected health indicators by women’s empowerment, see Tables 14.8, 14.9, 14.10, 14.11, and 14.12. Figure 14.5 Attitudes towards wife beating 6 25 11 22 9 33 6 26 16 26 9 40 Burns the food Argues with him Goes out without telling him Neglects the children Refuses sexual intercourse Any of these reasons Percentage of women and men age 15-49 who agree that a husband is justified in beating his wife for specific reasons Women Men Women’s Empowerment • 261 LIST OF TABLES For detailed information on women’s empowerment and demographic and health outcomes, see the following tables:  Table 14.1 Employment and cash earnings of currently married women and men  Table 14.2.1 Control over women’s cash earnings and relative magnitude of women’s cash earnings  Table 14.2.2 Control over men’s cash earnings  Table 14.3 Women’s control over their own earnings and over those of their husbands  Table 14.4.1 Ownership of assets: Women  Table 14.4.2 Ownership of assets: Men  Table 14.5 Participation in decision making  Table 14.6.1 Women’s participation in decision making by background characteristics  Table 14.6.2 Men’s participation in decision making by background characteristics  Table 14.7.1 Attitude towards wife beating: Women  Table 14.7.2 Attitude towards wife beating: Men  Table 14.8 Indicators of women’s empowerment  Table 14.9 Current use of contraception by women’s empowerment  Table 14.10 Ideal number of children and unmet need for family planning by women’s empowerment  Table 14.11 Reproductive health care by women’s empowerment  Table 14.12 Early childhood mortality rates by indicators of women’s empowerment 262 • Women’s Empowerment Table 14.1 Employment and cash earnings of currently married women and men Percentage of currently married women and men age 15-49 who were employed at any time in the past 12 months and percent distribution of currently married women and men employed in the past 12 months by type of earnings, according to age, Lesotho 2014 Among currently married respondents: Percent distribution of currently married respondents employed in the past 12 months, by type of earnings Total Number of respondents Age Percentage employed in past 12 months Number of respondents Cash only Cash and in-kind In-kind only Not paid WOMEN 15-19 23.1 255 75.2 0.0 3.3 21.5 100.0 59 20-24 36.3 701 79.7 1.3 3.7 15.3 100.0 254 25-29 48.1 757 88.5 1.9 1.4 8.2 100.0 364 30-34 61.7 669 82.5 1.8 1.9 13.8 100.0 413 35-39 60.0 544 85.4 3.6 1.5 9.6 100.0 327 40-44 58.2 377 76.8 3.6 1.0 18.6 100.0 219 45-49 49.0 310 75.3 0.9 2.2 21.6 100.0 152 Total 49.5 3,612 82.3 2.2 2.0 13.6 100.0 1,788 MEN 15-19 * 7 * * * * * 3 20-24 74.1 87 68.3 1.1 3.5 27.1 100.0 64 25-29 83.2 207 77.4 3.2 2.8 16.7 100.0 172 30-34 84.2 206 77.4 4.8 2.9 14.9 100.0 173 35-39 87.7 175 81.3 7.2 0.0 11.6 100.0 153 40-44 84.1 172 79.0 4.2 4.0 12.7 100.0 144 45-49 82.7 130 82.9 5.8 0.0 11.3 100.0 107 Total 15-49 83.2 983 78.3 4.6 2.2 14.9 100.0 818 50-59 70.3 188 56.0 5.4 2.6 36.0 100.0 132 Total 15-59 81.1 1,171 75.2 4.7 2.2 17.9 100.0 950 Note: An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. Women’s Empowerment • 263 Table 14.2.1 Control over women’s cash earnings and relative magnitude of women’s cash earnings Percent distribution of currently married women age 15-49 who received cash earnings for employment in the 12 months preceding the survey by person who decides how wife’s cash earnings are used and by whether she earned more or less than her husband, according to background characteristics, Lesotho 2014 Person who decides how the wife’s cash earnings are used: Total Wife’s cash earnings compared with husband’s cash earnings: Total Number of women Background characteristic Mainly wife Wife and husband jointly Mainly husband Other More Less About the same Husband has no earnings Don’t know Age 15-19 (32.4) (49.3) (3.8) (14.5) 100.0 (2.1) (68.5) (3.5) (20.1) (5.9) 100.0 44 20-24 33.4 60.5 4.3 1.8 100.0 10.5 64.6 2.6 17.1 5.2 100.0 206 25-29 29.7 67.1 2.6 0.5 100.0 14.8 59.0 8.9 16.5 0.8 100.0 329 30-34 34.3 61.0 4.6 0.2 100.0 17.6 51.9 11.2 16.0 3.3 100.0 348 35-39 35.3 60.1 4.6 0.0 100.0 14.3 57.9 7.0 20.0 0.8 100.0 290 40-44 32.7 65.1 2.2 0.0 100.0 21.8 40.9 7.6 24.1 5.7 100.0 176 45-49 34.4 62.4 3.2 0.0 100.0 16.5 43.7 8.5 30.5 0.8 100.0 116 Number of living children 0 38.7 51.3 3.1 6.9 100.0 11.4 62.8 2.3 19.1 4.4 100.0 138 1-2 32.6 62.7 4.4 0.3 100.0 15.2 55.7 8.0 18.3 2.9 100.0 882 3-4 31.9 66.3 1.8 0.0 100.0 16.4 53.2 10.0 18.8 1.5 100.0 402 5+ 35.2 58.0 6.8 0.0 100.0 18.0 42.5 5.1 30.5 4.0 100.0 88 Residence Urban 29.7 66.6 3.5 0.2 100.0 18.0 57.0 8.8 13.8 2.5 100.0 756 Rural 36.6 58.0 3.9 1.4 100.0 12.6 52.8 6.9 24.6 3.0 100.0 754 Ecological zone Lowlands 33.3 62.4 3.7 0.7 100.0 16.7 56.5 8.3 15.6 2.9 100.0 1,146 Foothills 39.1 57.0 2.8 1.1 100.0 9.0 48.7 3.6 35.2 3.5 100.0 121 Mountains 29.0 65.5 3.8 1.7 100.0 11.8 48.9 8.3 29.2 1.8 100.0 170 Senqu River Valley 30.5 63.0 5.7 0.8 100.0 12.0 54.0 7.2 25.9 0.9 100.0 73 District Butha-Buthe 25.5 70.4 2.9 1.2 100.0 9.1 52.4 6.2 31.1 1.2 100.0 57 Leribe 42.8 52.7 4.0 0.5 100.0 14.0 57.9 5.6 17.5 5.0 100.0 263 Berea 33.3 61.6 3.4 1.7 100.0 15.0 55.2 10.2 16.8 2.8 100.0 224 Maseru 28.2 68.4 3.3 0.0 100.0 17.0 54.0 8.9 18.1 2.0 100.0 577 Mafeteng 42.9 52.6 2.8 1.6 100.0 22.6 56.4 7.7 11.4 1.9 100.0 108 Mohale’s Hoek 35.8 57.2 5.5 1.5 100.0 9.9 64.8 4.2 17.0 4.0 100.0 89 Quthing 37.0 59.4 2.5 1.1 100.0 10.2 61.4 8.7 17.6 2.0 100.0 49 Qacha’s Nek 34.0 55.4 10.5 0.0 100.0 8.3 55.0 8.0 27.4 1.2 100.0 30 Mokhotlong 22.8 72.1 1.3 3.9 100.0 14.4 41.4 8.2 32.1 3.9 100.0 42 Thaba-Tseka 27.8 64.5 5.8 1.9 100.0 15.8 40.5 5.1 37.5 1.1 100.0 71 Education No education * * * * 100.0 * * * * * 100.0 14 Primary incomplete 42.5 53.4 3.1 1.1 100.0 11.1 50.9 9.7 27.2 1.1 100.0 221 Primary complete 29.6 64.0 5.8 0.6 100.0 10.6 55.2 7.7 23.7 2.9 100.0 314 Secondary 32.9 62.5 3.8 0.9 100.0 15.4 58.7 6.6 16.3 3.0 100.0 758 More than secondary 31.1 67.4 0.9 0.6 100.0 27.0 46.0 10.8 13.1 3.1 100.0 203 Wealth quintile Lowest 39.5 55.6 2.8 2.1 100.0 11.6 40.6 5.8 39.6 2.4 100.0 116 Second 29.5 66.2 3.4 0.8 100.0 11.5 46.3 10.3 29.3 2.7 100.0 157 Middle 36.5 57.7 4.4 1.4 100.0 13.5 57.0 7.2 18.1 4.3 100.0 252 Fourth 31.2 64.7 3.3 0.8 100.0 14.8 59.0 6.9 17.6 1.7 100.0 401 Highest 32.7 63.0 3.9 0.3 100.0 18.3 56.4 8.5 14.1 2.8 100.0 585 Total 33.1 62.3 3.7 0.8 100.0 15.3 54.9 7.9 19.2 2.7 100.0 1,510 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. 264 • Women’s Empowerment Table 14.2.2 Control over men’s cash earnings Percent distributions of currently married men age 15-49 who receive cash earnings and of currently married women age 15-49 whose husbands receive cash earnings, by person who decides how husband’s cash earnings are used, according to background characteristics, Lesotho 2014 Men Women Person who decides how husband’s cash earnings are used: Total Number of men Person who decides how husband’s cash earnings are used: Total Number of women Background characteristic Mainly wife Husband and wife jointly Mainly husband Other Mainly wife Husband and wife jointly Mainly husband Other Age 15-19 * * * * 100.0 1 17.6 65.1 13.0 4.3 100.0 177 20-24 (7.5) (69.8) (22.6) (0.0) 100.0 45 17.6 72.7 9.2 0.5 100.0 571 25-29 7.3 79.0 12.0 1.7 100.0 139 17.9 71.5 10.5 0.1 100.0 631 30-34 9.8 77.4 12.8 0.0 100.0 142 17.9 70.7 11.2 0.2 100.0 561 35-39 15.0 75.3 9.8 0.0 100.0 136 16.0 73.7 10.2 0.1 100.0 450 40-44 8.0 74.9 16.3 0.8 100.0 120 13.9 69.8 16.1 0.2 100.0 300 45-49 6.7 77.7 14.2 1.4 100.0 95 12.3 73.9 13.8 0.0 100.0 231 Number of living children 0 8.8 72.1 19.0 0.0 100.0 78 20.5 68.9 8.6 1.9 100.0 271 1-2 9.2 77.4 12.5 0.9 100.0 377 16.8 71.3 11.5 0.4 100.0 1,686 3-4 8.1 75.0 16.2 0.8 100.0 178 15.0 73.0 11.9 0.0 100.0 730 5+ (18.0) (80.1) (1.8) (0.0) 100.0 45 16.9 71.4 11.5 0.2 100.0 234 Residence Urban 9.0 78.5 12.5 0.0 100.0 322 17.9 72.9 9.1 0.2 100.0 1,005 Rural 9.9 74.5 14.4 1.3 100.0 356 16.1 70.9 12.5 0.6 100.0 1,917 Ecological zone Lowlands 9.2 76.3 13.6 0.9 100.0 504 17.1 72.7 10.1 0.1 100.0 1,796 Foothills (15.1) (66.9) (18.0) (0.0) 100.0 51 14.3 71.3 12.5 2.0 100.0 328 Mountains 9.2 79.5 11.4 0.0 100.0 89 18.8 66.6 14.2 0.4 100.0 598 Senqu River Valley 6.2 82.8 11.0 0.0 100.0 34 10.9 76.9 11.5 0.7 100.0 199 District Butha-Buthe 5.4 69.7 24.9 0.0 100.0 33 16.1 74.7 8.7 0.5 100.0 172 Leribe 17.7 75.7 6.6 0.0 100.0 92 15.8 71.1 13.1 0.0 100.0 488 Berea 8.0 71.2 20.8 0.0 100.0 116 16.6 69.9 12.0 1.4 100.0 389 Maseru 7.8 81.4 10.2 0.6 100.0 252 17.7 73.1 9.1 0.0 100.0 785 Mafeteng 7.3 66.4 22.1 4.2 100.0 55 19.4 68.2 11.5 1.0 100.0 258 Mohale’s Hoek (12.0) (76.1) (9.7) (2.2) 100.0 36 12.8 75.9 11.0 0.4 100.0 251 Quthing (1.7) (90.3) (8.0) (0.0) 100.0 18 15.6 72.6 11.1 0.7 100.0 140 Qacha’s Nek (10.6) (64.1) (25.3) (0.0) 100.0 16 14.3 69.4 15.2 1.1 100.0 84 Mokhotlong (10.8) (80.1) (9.1) (0.0) 100.0 25 10.0 80.2 9.3 0.4 100.0 126 Thaba-Tseka 12.0 77.4 10.6 0.0 100.0 34 21.8 61.8 16.1 0.3 100.0 230 Education No education 10.7 73.7 15.6 0.0 100.0 45 (13.6) (69.8) (16.6) (0.0) 100.0 32 Primary incomplete 15.0 69.2 15.1 0.8 100.0 196 20.5 64.9 14.1 0.6 100.0 514 Primary complete 6.7 76.6 15.5 1.3 100.0 104 16.8 69.6 13.3 0.3 100.0 710 Secondary 7.5 80.8 11.0 0.7 100.0 241 16.7 73.7 9.1 0.6 100.0 1,404 More than secondary 5.6 81.2 13.3 0.0 100.0 91 9.4 78.3 12.2 0.0 100.0 261 Wealth quintile Lowest 9.8 79.1 11.1 0.0 100.0 58 20.5 64.5 14.6 0.5 100.0 403 Second 10.0 75.0 12.2 2.8 100.0 83 13.8 72.9 12.1 1.2 100.0 452 Middle 11.9 67.4 19.7 1.0 100.0 130 17.7 68.5 12.9 0.8 100.0 555 Fourth 8.4 80.4 11.2 0.0 100.0 173 17.2 74.3 8.4 0.2 100.0 721 Highest 8.6 78.2 12.8 0.4 100.0 234 15.2 74.0 10.8 0.0 100.0 791 Total 15-49 9.5 76.4 13.5 0.7 100.0 678 16.7 71.5 11.3 0.4 100.0 2,922 50-59 9.4 74.8 15.8 0.0 100.0 81 na na na na na na Total 15-59 9.5 76.2 13.7 0.6 100.0 759 na na na na na na 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 applicable Women’s Empowerment • 265 Table 14.3 Women’s control over their own earnings and over those of their husbands Percent distribution of currently married women age 15-49 with cash earnings in the last 12 months by person who decides how the wife’s cash earnings are used and percent distribution of currently married women age 15-49 whose husbands have cash earnings by person who decides how the husband’s cash earnings are used, according to the relation between wife’s and husband’s cash earnings, Lesotho 2014 Person who decides how the wife’s cash earnings are used: Total Number of women Person who decides how husband’s cash earnings are used: Total Number of women Women’s earnings relative to husband’s earnings Mainly wife Wife and husband jointly Mainly husband Other Mainly wife Wife and husband jointly Mainly husband Other More than husband 38.6 56.6 4.7 0.0 100.0 232 23.4 63.2 13.4 0.0 100.0 232 Less than husband 35.6 59.8 4.0 0.6 100.0 829 19.2 71.8 8.8 0.1 100.0 829 Same as husband 23.7 75.4 0.9 0.0 100.0 119 12.6 83.5 3.9 0.0 100.0 119 Husband has no cash earnings or did not work 24.6 71.1 3.3 1.0 100.0 290 na na na na na 0 Woman worked but has no cash earnings na na na na na 0 16.9 72.5 10.4 0.2 100.0 226 Woman did not work na na na na na 0 14.6 72.1 12.5 0.8 100.0 1,476 Don’t know (40.3) (45.6) (3.1) (11.0) 100.0 41 (13.2) (51.4) (35.4) (0.0) 100.0 41 Total1 33.1 62.3 3.7 0.8 100.0 1,510 16.7 71.5 11.3 0.4 100.0 2,922 Note: Figures in parentheses are based on 25-49 unweighted cases. na = Not applicable 1 Includes cases where a woman does not know whether she earned more or less than her husband 266 • Women’s Empowerment Table 14.4.1 Ownership of assets: Women Percent distribution of women age 15-49 by ownership of a house and land, according to background characteristics, Lesotho 2014 Percentage who own a house: Percentage who do not own a house Total Percentage who own land: Percentage who do not own land Total Number of women Background characteristic Alone Jointly Alone and jointly Alone Jointly Alone and jointly Age 15-19 0.4 1.8 0.0 97.8 100.0 0.9 4.0 0.1 95.0 100.0 1,440 20-24 1.8 10.7 0.8 86.8 100.0 2.1 13.2 0.8 83.8 100.0 1,325 25-29 3.5 28.9 0.8 66.9 100.0 4.3 24.5 1.0 70.2 100.0 1,094 30-34 8.5 36.5 2.1 52.8 100.0 6.7 29.0 1.4 62.9 100.0 957 35-39 11.8 48.9 2.6 36.7 100.0 8.7 33.2 1.1 57.0 100.0 744 40-44 20.5 49.6 3.2 26.7 100.0 16.2 34.3 3.2 46.4 100.0 562 45-49 30.9 52.3 2.4 14.4 100.0 18.0 30.8 1.4 49.7 100.0 499 Residence Urban 6.2 18.4 0.7 74.7 100.0 6.5 20.4 0.8 72.3 100.0 2,419 Rural 8.5 30.7 1.7 59.1 100.0 5.7 20.9 1.2 72.2 100.0 4,202 Ecological zone Lowlands 6.5 22.6 1.0 69.9 100.0 6.4 21.2 0.8 71.6 100.0 4,184 Foothills 9.5 32.1 2.2 56.2 100.0 6.2 24.2 2.2 67.5 100.0 688 Mountains 9.5 34.3 1.8 54.4 100.0 4.8 19.0 1.4 74.9 100.0 1,288 Senqu River Valley 10.3 27.9 1.4 60.4 100.0 5.9 15.8 0.5 77.8 100.0 461 District Butha-Buthe 8.6 31.6 0.8 59.0 100.0 7.5 30.2 1.4 60.9 100.0 385 Leribe 7.1 30.3 0.7 62.0 100.0 3.2 21.5 0.2 75.1 100.0 1,064 Berea 7.1 22.7 2.2 68.0 100.0 8.0 19.4 1.8 70.8 100.0 892 Maseru 6.5 22.5 1.0 70.1 100.0 7.2 22.7 1.0 69.1 100.0 1,864 Mafeteng 6.6 20.0 1.0 72.4 100.0 6.8 21.4 0.8 71.0 100.0 576 Mohale’s Hoek 9.3 25.4 1.8 63.5 100.0 5.6 16.2 1.1 77.0 100.0 519 Quthing 7.7 25.4 1.1 65.7 100.0 6.3 15.5 0.8 77.4 100.0 315 Qacha’s Nek 10.1 31.6 0.3 58.0 100.0 8.0 18.2 0.2 73.6 100.0 204 Mokhotlong 5.9 26.7 4.9 62.5 100.0 2.9 15.6 3.3 78.3 100.0 349 Thaba-Tseka 13.9 41.1 0.9 44.1 100.0 3.4 18.2 0.5 77.9 100.0 452 Education No education 20.4 40.0 2.5 37.1 100.0 7.7 21.0 0.8 70.5 100.0 68 Primary incomplete 10.9 32.4 2.0 54.7 100.0 7.6 22.2 1.5 68.7 100.0 1,178 Primary complete 12.3 35.8 1.8 50.1 100.0 6.9 22.7 1.3 69.1 100.0 1,375 Secondary 4.7 21.0 0.9 73.5 100.0 4.8 19.0 0.8 75.4 100.0 3,418 More than secondary 5.8 20.3 1.7 72.2 100.0 7.9 23.0 1.1 68.0 100.0 581 Wealth quintile Lowest 12.5 31.9 2.5 53.1 100.0 5.2 16.7 1.9 76.3 100.0 960 Second 8.5 27.5 1.4 62.6 100.0 5.9 19.2 0.7 74.2 100.0 1,033 Middle 7.7 26.9 1.1 64.3 100.0 5.1 19.7 1.2 74.0 100.0 1,244 Fourth 6.0 23.8 1.0 69.2 100.0 5.2 21.2 0.5 73.1 100.0 1,605 Highest 6.0 24.1 1.2 68.7 100.0 7.9 24.0 1.2 66.8 100.0 1,778 Total 7.6 26.2 1.3 64.8 100.0 6.0 20.7 1.1 72.2 100.0 6,621 Women’s Empowerment • 267 Table 14.4.2 Ownership of assets: Men Percent distribution of men age 15-49 by ownership of a house and land, according to background characteristics, Lesotho 2014 Percentage who own a house: Percentage who do not own a house Total Percentage who own land: Percentage who do not own land Total Number of men Background characteristic Alone Jointly Alone and jointly Alone Jointly Alone and jointly Age 15-19 0.9 0.1 0.0 99.0 100.0 2.4 0.7 0.0 96.9 100.0 691 20-24 2.7 2.3 0.5 94.5 100.0 5.4 2.4 0.1 92.1 100.0 561 25-29 9.6 14.0 0.9 75.5 100.0 12.6 13.9 1.5 71.9 100.0 410 30-34 13.8 26.3 2.2 57.7 100.0 12.4 21.4 3.5 62.6 100.0 334 35-39 15.5 30.2 0.5 53.8 100.0 22.9 24.9 0.6 51.6 100.0 276 40-44 15.4 44.2 2.5 37.8 100.0 16.6 37.3 4.3 41.7 100.0 221 45-49 24.0 48.2 5.1 22.6 100.0 14.8 34.8 3.7 46.8 100.0 168 Residence Urban 11.1 13.1 1.2 74.7 100.0 13.7 15.7 1.7 68.9 100.0 920 Rural 7.0 17.3 1.1 74.7 100.0 7.9 12.2 1.1 78.7 100.0 1,741 Ecological zone Lowlands 9.1 13.1 1.0 76.8 100.0 11.5 13.4 1.4 73.7 100.0 1,711 Foothills 5.1 15.9 1.8 77.2 100.0 9.3 15.0 2.6 73.1 100.0 252 Mountains 7.7 24.4 1.2 66.7 100.0 5.8 14.3 1.2 78.7 100.0 523 Senqu River Valley 8.7 16.9 0.8 73.6 100.0 7.5 8.5 0.0 84.0 100.0 174 District Butha-Buthe 7.3 21.2 1.8 69.7 100.0 9.0 22.5 1.1 67.4 100.0 143 Leribe 8.9 19.0 0.4 71.7 100.0 10.4 12.4 1.1 76.2 100.0 390 Berea 7.4 12.7 1.1 78.7 100.0 10.4 11.0 1.7 76.9 100.0 379 Maseru 9.4 14.7 1.2 74.7 100.0 12.2 16.5 1.7 69.6 100.0 809 Mafeteng 6.8 7.0 1.6 84.6 100.0 10.6 11.0 2.3 76.0 100.0 242 Mohale’s Hoek 6.5 13.6 0.6 79.4 100.0 5.5 8.5 0.0 86.0 100.0 202 Quthing 7.9 12.5 0.0 79.6 100.0 8.6 8.8 0.0 82.6 100.0 105 Qacha’s Nek 10.7 16.3 0.8 72.2 100.0 8.4 10.7 0.6 80.3 100.0 74 Mokhotlong 3.4 19.4 3.1 74.1 100.0 5.5 11.8 2.7 80.1 100.0 144 Thaba-Tseka 13.9 30.0 0.9 55.2 100.0 7.7 13.5 0.0 78.7 100.0 172 Education No education 13.7 32.7 3.1 50.5 100.0 7.2 19.4 2.6 70.8 100.0 213 Primary incomplete 8.9 16.4 1.1 73.6 100.0 9.8 12.2 1.7 76.3 100.0 875 Primary complete 7.6 21.6 0.2 70.6 100.0 9.3 14.1 2.0 74.6 100.0 316 Secondary 7.1 9.1 0.9 83.0 100.0 9.7 10.9 0.5 78.8 100.0 1,043 More than secondary 8.8 21.1 1.9 68.1 100.0 15.2 23.4 1.8 59.5 100.0 214 Wealth quintile Lowest 10.8 24.6 1.9 62.7 100.0 8.1 11.9 1.2 78.8 100.0 376 Second 9.9 17.4 0.6 72.1 100.0 10.0 12.4 1.2 76.4 100.0 479 Middle 6.3 14.6 0.7 78.4 100.0 6.7 11.3 1.2 80.8 100.0 536 Fourth 7.4 12.1 0.2 80.2 100.0 9.9 13.3 1.3 75.5 100.0 616 Highest 8.6 14.1 2.2 75.1 100.0 13.7 16.8 1.7 67.8 100.0 654 Total 15-49 8.4 15.8 1.1 74.7 100.0 9.9 13.4 1.3 75.3 100.0 2,660 50-59 33.2 48.8 4.2 13.8 100.0 25.7 35.4 4.8 34.1 100.0 271 Total 15-59 10.7 18.9 1.4 69.0 100.0 11.4 15.4 1.7 71.5 100.0 2,931 268 • Women’s Empowerment Table 14.5 Participation in decision making Percent distribution of currently married women and currently married men age 15-49 by person who usually makes decisions about various issues, Lesotho 2014 Decision Mainly wife Wife and husband jointly Mainly husband Someone else Other Total Number WOMEN Own health care 40.3 49.0 9.0 1.5 0.2 100.0 3,612 Major household purchases 13.7 75.2 9.0 1.3 1.0 100.0 3,612 Visits to her family or relatives 22.5 49.7 24.9 2.5 0.4 100.0 3,612 MEN Own health care 7.9 53.8 35.8 2.2 0.3 100.0 983 Major household purchases 11.7 69.5 16.3 2.2 0.3 100.0 983 Women’s Empowerment • 269 Table 14.6.1 Women’s participation in decision making by background characteristics Percentage of currently married women age 15-49 who usually make specific decisions either by themselves or jointly with their husband, by background characteristics, Lesotho 2014 Specific decisions All three decisions None of the three decisions Number of women Background characteristic Woman’s own health care Making major household purchases Visits to her family or relatives Age 15-19 72.0 72.5 44.1 36.2 12.8 255 20-24 88.8 88.1 68.2 61.9 3.5 701 25-29 91.6 90.8 71.9 65.2 1.9 757 30-34 91.1 91.2 74.8 68.4 1.6 669 35-39 91.7 91.9 80.7 74.6 2.4 544 40-44 92.1 90.0 78.7 70.8 1.3 377 45-49 87.8 87.2 76.9 68.4 3.1 310 Employment (past 12 months) Not employed 87.3 85.4 68.3 61.0 4.5 1,824 Employed for cash 91.4 92.7 77.1 70.7 1.4 1,510 Employed not for cash 91.2 89.8 71.0 64.9 2.1 278 Number of living children 0 82.4 81.8 54.8 47.0 7.6 355 1-2 90.0 90.1 73.5 67.3 2.7 2,043 3-4 90.3 89.9 75.4 68.2 2.0 902 5+ 90.0 85.2 74.5 65.3 3.1 312 Residence Urban 93.1 93.7 79.3 73.5 1.2 1,150 Rural 87.6 86.5 68.9 61.6 3.9 2,463 Ecological zone Lowlands 90.9 91.6 76.0 69.7 1.9 2,134 Foothills 89.0 87.9 71.5 62.4 2.8 427 Mountains 85.7 83.2 62.8 56.0 5.5 797 Senqu River Valley 87.8 84.8 71.0 63.5 4.8 254 District Butha-Buthe 90.7 91.9 76.4 72.0 3.5 211 Leribe 90.0 90.7 76.8 67.4 1.5 577 Berea 87.5 88.9 71.5 63.9 3.0 461 Maseru 92.4 93.4 78.2 73.0 1.5 968 Mafeteng 85.0 86.0 64.4 57.1 5.0 312 Mohale’s Hoek 91.8 84.0 70.9 63.1 3.1 297 Quthing 91.0 89.0 71.6 66.3 3.1 158 Qacha’s Nek 86.3 83.7 61.2 56.3 5.7 114 Mokhotlong 88.6 85.5 63.6 56.9 3.5 205 Thaba-Tseka 83.1 80.5 62.5 54.2 7.0 308 Education No education 79.0 77.9 70.7 47.9 4.9 47 Primary incomplete 84.7 84.3 65.5 58.7 6.0 695 Primary complete 87.4 88.1 69.6 61.8 3.8 909 Secondary 91.5 90.0 73.7 67.5 1.9 1,665 More than secondary 95.2 96.8 87.6 82.7 0.0 297 Wealth quintile Lowest 82.9 82.6 61.8 52.6 6.1 592 Second 88.5 85.8 68.8 62.2 4.3 602 Middle 87.9 87.6 71.6 63.1 2.9 676 Fourth 91.2 91.0 72.5 66.7 1.9 844 Highest 93.4 93.9 81.6 76.3 1.4 898 Total 89.3 88.8 72.2 65.4 3.0 3,612 270 • Women’s Empowerment Table 14.6.2 Men’s participation in decision making by background characteristics Percentage of currently married men age 15-49 who usually make specific decisions either alone or jointly with their wife, by background characteristics, Lesotho 2014 Specific decisions Both decisions Neither of the two decisions Number of men Background characteristic Man’s own health Making major household purchases Age 15-19 * * * * 7 20-24 90.5 75.1 70.7 5.1 87 25-29 87.1 85.9 78.7 5.8 207 30-34 91.7 90.6 83.0 0.7 206 35-39 84.5 84.6 73.5 4.3 175 40-44 91.6 87.9 85.7 6.2 172 45-49 94.3 84.2 82.0 3.5 130 Employment (past 12 months) Not employed 86.9 88.0 79.9 5.0 165 Employed for cash 90.3 85.1 79.0 3.6 678 Employed not for cash 89.6 86.6 82.0 5.7 140 Number of living children 0 88.8 76.2 67.6 2.6 121 1-2 89.1 87.4 80.3 3.8 530 3-4 90.8 87.8 83.1 4.4 252 5+ 90.6 83.5 81.7 7.6 81 Residence Urban 92.8 86.2 81.1 2.1 349 Rural 87.9 85.6 78.7 5.2 634 Ecological zone Lowlands 92.0 84.9 80.1 3.3 593 Foothills 88.0 89.6 83.2 5.5 100 Mountains 85.3 87.1 77.7 5.3 229 Senqu River Valley 85.8 83.5 74.9 5.6 61 District Butha-Buthe 94.8 93.8 92.5 3.9 57 Leribe 82.7 86.1 76.6 7.8 130 Berea 92.0 88.2 81.9 1.8 142 Maseru 94.1 85.9 83.6 3.6 291 Mafeteng 88.3 83.0 74.4 3.2 87 Mohale’s Hoek 77.5 78.3 62.9 7.1 68 Quthing 90.9 72.1 70.1 7.1 28 Qacha’s Nek 88.9 85.9 80.2 5.4 26 Mokhotlong 87.9 87.0 76.9 1.9 64 Thaba-Tseka 89.6 88.2 81.1 3.3 91 Education No education 87.8 86.7 80.0 5.5 114 Primary incomplete 87.6 82.7 77.1 6.8 337 Primary complete 91.5 91.9 85.3 1.9 146 Secondary 91.5 86.7 80.2 2.0 292 More than secondary 90.4 83.7 77.0 3.0 94 Wealth quintile Lowest 88.3 86.4 79.4 4.7 164 Second 85.5 89.0 79.3 4.7 171 Middle 89.2 85.6 78.6 3.8 196 Fourth 91.3 85.3 80.3 3.7 206 Highest 92.2 83.7 79.9 3.9 246 Total 15-49 89.6 85.8 79.6 4.1 983 50-59 90.0 90.3 82.2 1.8 188 Total 15-59 89.7 86.5 80.0 3.8 1,171 Note: An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. Women’s Empowerment • 271 Table 14.7.1 Attitude towards wife beating: Women Percentage of all women age 15-49 who agree that a husband is justified in hitting or beating his wife for specific reasons, by background characteristics, Lesotho 2014 Husband is justified in hitting or beating his wife if she: Percentage who agree with at least one specified reason Number of women Background characteristic Burns the food Argues with him Goes out without telling him Neglects the children Refuses to have sexual intercourse with him Age 15-19 10.7 36.1 15.9 32.9 9.6 48.0 1,440 20-24 6.0 25.6 10.4 21.7 11.0 34.0 1,325 25-29 4.9 22.1 9.0 18.9 8.7 29.7 1,094 30-34 4.4 19.2 8.5 16.4 7.8 25.6 957 35-39 4.5 18.3 8.5 17.5 9.0 25.3 744 40-44 4.2 18.5 8.3 16.7 8.6 26.4 562 45-49 6.3 20.3 10.7 21.4 11.1 31.5 499 Employment (past 12 months) Not employed 7.8 29.1 13.4 25.6 11.8 38.6 3,548 Employed for cash 3.9 17.7 7.0 16.1 6.0 25.1 2,615 Employed not for cash 8.8 28.6 11.5 28.0 10.3 39.2 458 Number of living children 0 7.9 27.0 12.0 25.3 7.6 37.2 2,152 1-2 5.4 22.1 9.3 19.2 9.2 29.8 2,897 3-4 5.1 25.7 11.2 22.3 12.4 34.2 1,169 5+ 7.6 25.4 13.1 23.2 12.0 35.1 403 Marital status Never married 8.3 26.8 11.1 25.1 7.3 37.3 2,190 Married or living together 6.0 24.1 11.1 20.5 10.9 32.1 3,612 Divorced/separated/widowed 2.8 20.6 7.9 20.1 8.7 28.0 819 Residence Urban 3.2 15.8 5.8 15.7 4.8 22.8 2,419 Rural 8.1 29.6 13.5 25.6 12.1 39.4 4,202 Ecological zone Lowlands 4.5 20.5 7.7 18.4 6.7 28.6 4,184 Foothills 8.7 34.9 16.4 26.7 14.0 44.1 688 Mountains 10.0 31.1 16.3 29.5 15.9 41.6 1,288 Senqu River Valley 9.2 27.8 13.8 26.8 8.8 37.0 461 District Butha-Buthe 3.9 22.7 11.4 19.2 9.6 31.3 385 Leribe 5.4 21.1 8.2 19.1 8.9 30.1 1,064 Berea 3.4 20.6 8.8 17.0 7.7 28.3 892 Maseru 5.6 22.2 8.7 20.9 7.7 31.2 1,864 Mafeteng 7.6 32.1 12.8 25.7 8.8 39.8 576 Mohale’s Hoek 7.3 22.3 12.1 19.6 7.9 27.4 519 Quthing 10.7 30.9 12.4 32.6 12.3 44.2 315 Qacha’s Nek 9.6 34.1 14.8 28.1 10.6 44.3 204 Mokhotlong 12.4 33.9 19.8 33.4 18.6 46.4 349 Thaba-Tseka 7.2 28.8 13.5 24.6 13.9 37.2 452 Education No education 9.9 32.6 13.8 29.6 15.0 41.7 68 Primary incomplete 12.4 40.6 22.0 35.7 18.6 52.1 1,178 Primary complete 7.9 29.1 12.9 25.9 13.0 38.4 1,375 Secondary 4.5 20.8 7.5 18.9 6.2 29.4 3,418 More than secondary 0.5 2.6 1.3 2.3 0.5 5.4 581 Wealth quintile Lowest 12.0 38.2 19.8 32.9 17.9 48.0 960 Second 8.8 35.4 16.9 29.7 14.7 46.2 1,033 Middle 6.5 26.6 10.4 25.4 9.3 37.0 1,244 Fourth 5.1 21.7 8.8 19.7 7.8 29.7 1,605 Highest 2.8 12.0 4.2 11.2 3.3 18.5 1,778 Total 6.3 24.6 10.7 22.0 9.4 33.3 6,621 272 • Women’s Empowerment Table 14.7.2 Attitude towards wife beating: Men Percentage of all men age 15-49 who agree that a husband is justified in hitting or beating his wife for specific reasons, by background characteristics, Lesotho 2014 Husband is justified in hitting or beating his wife if she: Percentage who agree with at least one specified reason Number of men Background characteristic Burns the food Argues with him Goes out without telling him Neglects the children Refuses to have sexual intercourse with him Age 15-19 10.1 31.0 15.7 33.6 10.6 48.9 691 20-24 6.6 28.1 15.7 29.4 8.4 42.8 561 25-29 5.3 22.7 16.3 26.2 9.3 38.6 410 30-34 2.2 22.0 12.2 19.6 6.1 32.3 334 35-39 4.5 21.2 15.2 20.9 10.5 33.3 276 40-44 6.2 26.0 20.6 20.1 9.2 33.4 221 45-49 5.1 19.4 14.9 13.7 10.5 26.0 168 Employment (past 12 months) Not employed 8.8 30.8 17.6 29.5 11.7 46.2 810 Employed for cash 4.2 20.8 13.2 20.9 6.0 32.8 1,336 Employed not for cash 8.2 30.9 19.1 34.2 13.8 46.9 514 Number of living children 0 7.7 26.9 15.7 29.5 9.1 43.1 1,607 1-2 3.9 24.7 13.6 20.2 8.1 34.0 686 3-4 4.6 20.4 16.7 21.7 9.5 31.9 279 5+ 8.2 31.7 26.9 25.4 19.3 44.1 87 Marital status Never married 7.2 27.3 15.3 29.6 9.2 43.6 1,501 Married or living together 5.2 24.3 16.9 22.7 9.4 34.4 983 Divorced/separated/widowed 5.8 21.6 11.5 15.8 8.2 33.7 176 Residence Urban 3.6 19.5 10.0 21.5 5.1 31.8 920 Rural 7.8 29.2 18.7 28.6 11.4 43.7 1,741 Ecological zone Lowlands 5.4 22.6 11.2 22.4 6.3 34.8 1,711 Foothills 7.4 30.6 22.6 30.0 10.2 44.5 252 Mountains 8.7 33.0 25.6 36.9 17.3 51.8 523 Senqu River Valley 7.6 28.5 19.5 24.8 12.3 43.1 174 District Butha-Buthe 2.3 28.8 16.1 23.9 11.2 37.5 143 Leribe 4.6 26.3 13.5 25.6 9.2 41.0 390 Berea 6.6 21.6 13.7 22.2 7.6 33.5 379 Maseru 6.5 24.9 12.4 24.5 7.5 37.2 809 Mafeteng 8.9 26.4 16.8 27.5 6.4 39.1 242 Mohale’s Hoek 4.7 26.3 22.3 26.2 8.1 39.1 202 Quthing 6.5 25.9 16.0 27.3 10.3 41.7 105 Qacha’s Nek 5.5 34.7 20.5 29.0 7.9 48.6 74 Mokhotlong 10.9 25.2 26.7 38.2 15.6 48.9 144 Thaba-Tseka 7.8 31.2 18.9 31.4 19.5 51.2 172 Education No education 8.9 38.2 28.8 35.9 19.7 52.5 213 Primary incomplete 9.4 35.3 22.0 34.4 14.3 50.1 875 Primary complete 5.0 25.7 17.9 27.9 9.6 39.9 316 Secondary 4.7 18.6 9.2 19.8 4.2 32.7 1,043 More than secondary 1.7 9.9 4.6 10.4 2.1 17.1 214 Wealth quintile Lowest 8.2 37.0 28.2 37.9 18.0 53.9 376 Second 9.1 30.5 20.5 30.5 13.0 47.1 479 Middle 7.7 28.8 17.1 27.5 10.0 42.5 536 Fourth 3.5 21.0 10.5 23.5 5.5 34.9 616 Highest 4.9 18.1 8.6 17.4 4.3 27.9 654 Total 15-49 6.4 25.8 15.7 26.1 9.2 39.6 2,660 50-59 4.9 20.5 15.3 19.3 9.2 30.9 271 Total 15-59 6.3 25.3 15.6 25.5 9.2 38.8 2,931 Women’s Empowerment • 273 Table 14.8 Indicators of women’s empowerment Percentage of currently married women age 15-49 who participate in all decision making and the percentage who disagree with all of the reasons justifying wife-beating, by value on each of the indicators of women’s empowerment, Lesotho 2014 Empowerment indicator Percentage who participate in all decision making Percentage who disagree with all the reasons justifying wife- beating Number of women Number of decisions in which women participate1 0 na 45.0 110 1-2 na 57.9 1,141 3 na 73.8 2,361 Number of reasons for which wife-beating is justified2 0 71.0 na 2,454 1-2 58.0 na 736 3-4 46.1 na 338 5 41.8 na 85 na = Not applicable 1 See Table 14.6.1 for the list of decisions 2 See Table 14.7.1 for the list of reasons Table 14.9 Current use of contraception by women’s empowerment Percent distribution of currently married women age 15-49 by current contraceptive method, according to selected indicators of women’s status, Lesotho 2014 Any method Modern methods Any traditional method Not currently using Total Number of women Empowerment indicator Any modern method Female sterili- sation Male sterili- sation Temporary modern female methods1 Male condom Number of decisions in which women participate2 0 42.0 42.0 1.4 0.0 27.8 12.8 0.0 58.0 100.0 110 1-2 56.3 56.2 1.5 0.0 39.1 15.6 0.1 43.7 100.0 1,141 3 62.9 62.4 1.8 0.1 42.8 17.7 0.5 37.1 100.0 2,361 Number of reasons for which wife-beating is justified3 0 61.9 61.5 1.7 0.1 41.7 18.0 0.4 38.1 100.0 2,454 1-2 57.9 57.4 1.9 0.0 38.7 16.8 0.4 42.1 100.0 736 3-4 58.1 57.8 1.3 0.0 45.5 11.0 0.3 41.9 100.0 338 5 37.5 37.5 0.0 0.0 29.5 8.0 0.0 62.5 100.0 85 Total 60.2 59.8 1.7 0.1 41.2 16.9 0.4 39.8 100.0 3,612 Note: If more than one method is used, only the most effective method is considered in this tabulation. 1 Pill, IUCD, injectables, implants, and female condom 2 See Table 14.6.1 for the list of decisions. 3 See Table 14.7.1 for the list of reasons. 274 • Women’s Empowerment Table 14.10 Ideal number of children and unmet need for family planning by women’s empowerment Mean ideal number of children for women 15-49 and the percentage of currently married women age 15-49 with an unmet need for family planning, by indicators of women’s empowerment, Lesotho 2014 Mean ideal number of children1 Number of women Percentage of currently married women with an unmet need for family planning2 Number of currently married women Empowerment indicator For spacing For limiting Total Number of decisions in which women participate3 0 3.2 110 19.3 12.8 32.1 110 1-2 3.0 1,139 9.7 10.1 19.8 1,141 3 2.9 2,351 7.5 9.7 17.1 2,361 Number of reasons for which wife-beating is justified4 0 2.6 4,404 7.8 10.3 18.0 2,454 1-2 2.6 1,423 9.6 8.5 18.0 736 3-4 2.7 659 10.2 10.4 20.6 338 5 2.9 122 14.5 9.5 23.9 85 Total 2.6 6,608 8.5 9.9 18.4 3,612 1 Mean excludes respondents who gave non-numeric responses. 2 See Table 7.9.1 for the definition of unmet need for family planning. 3 Restricted to currently married women. See Table 14.6.1 for the list of decisions. 4 See Table 14.7.1 for the list of reasons. Table 14.11 Reproductive health care by women’s empowerment Percentage of women age 15-49 with a live birth in the 5 years preceding the survey who received antenatal care, delivery assistance and postnatal care from health personnel for the most recent birth, by indicators of women’s empowerment, Lesotho 2014 Empowerment indicator Percentage receiving antenatal care from a skilled provider1 Percentage receiving delivery care from a skilled provider1 Percentage of women with a postnatal check in the first 2 days after birth2 Number of women with a child born in the past 5 years Number of decisions in which women participate3 0 97.0 71.3 57.8 63 1-2 96.9 77.8 62.4 639 3 95.9 83.0 64.6 1,306 Number of reasons for which wife-beating is justified4 0 95.0 83.5 65.4 1,677 1-2 94.6 75.4 55.0 570 3-4 96.6 70.0 51.3 281 5 (97.6) (61.5) (48.1) 48 Total 95.2 79.8 61.3 2,575 Note: Figures in parentheses are based on 25-49 unweighted cases. 1 ‘Skilled provider’ includes doctor or nurse/midwife. 2 Includes women who received a postnatal check from a doctor or nurse/midwife or village health worker in the first 2 days after the birth. Includes women who gave birth in a health facility and those who did not give birth in a health facility. 3 Restricted to currently married women. See Table 14.6.1 for the list of decisions. 4 See Table 14.7.1 for the list of reasons. Women’s Empowerment • 275 Table 14.12 Early childhood mortality rates by indicators of women’s empowerment Infant, child, and under-5 mortality rates for the 10-year period preceding the survey, by indicators of women’s empowerment, Lesotho 2014 Empowerment indicator Infant mortality (1q0) Child mortality (4q1) Under-5 mortality (5q0) Number of decisions in which women participate1 0 * * * 1-2 87 27 112 3 62 23 83 Number of reasons for which wife-beating is justified2 0 59 25 83 1-2 85 30 112 3-4 71 18 88 5 * * * Note: An asterisk indicates that a rate is based on fewer than 250 unweighted person-years exposure to the risk of death and has been suppressed. 1 Restricted to currently married women. See Table 14.6.1 for the list of decisions. 2 See Table 14.7.1 for the list of reasons. Adult and Maternal Mortality • 277 ADULT AND MATERNAL MORTALITY 15 Key Findings  Adult mortality: For women and men who have reached age 15, the probability of dying before age 50 is 44% and 48%, respectively.  Maternal mortality ratio: The maternal mortality ratio is 1,024 maternal deaths per 100,000 live births for the 7-year period before the survey. This ratio does not differ significantly from the one reported in the 2009 LDHS.  Lifetime risk of maternal death: Current levels of fertility and mortality indicate that 1 in 32 women will die from pregnancy or childbearing. dult and maternal mortality indicators can be used to assess the health status of a population, especially in developing countries such as Lesotho. Estimation of mortality rates requires complete and accurate data on adult deaths, including maternal deaths. In the 2014 LDHS, data were collected from women on the survival of their sisters and brothers to obtain an estimate of adult mortality. The inclusion of questions to determine whether any of the sisters’ deaths were maternity-related permits estimation of maternal mortality, a key indicator of maternal health and well-being. The term maternal mortality, used in this chapter and in previous LDHS surveys, corresponds to the term pregnancy-related mortality, which is defined in the latest version of the International Classification of Diseases (ICD-10). The ICD-10 definition of a pregnancy-related death is ‘the death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the cause of death’ (WHO 2011). In keeping with this definition, the sibling survival module used in the DHS surveys measures only the timing of death and not the cause of death. The data collected in the LDHS questionnaire refer to deaths within 2 months following a birth rather than 42 days following a birth. This chapter includes results estimated from sibling history data collected in the sibling survival module (commonly referred to as the maternal mortality module) that is part of the Woman’s Questionnaire. In addition to adult mortality rates for 5-year age groups, the chapter includes a summary measure (35q15) that represents the probability of dying between exact ages 15 and 50 – that is, between the 15th and 50th birthdays. To allow assessment of trends in adult mortality probabilities, 35q15 values for the 2009 and 2004 LDHS are included for comparison. 15.1 DATA To obtain a sibling history, each female respondent was first asked to give the total number of her mother’s live births (including the birth of the respondent). The respondent was then asked to provide a list of all of the brothers and sisters born to her mother, starting with the first born. The respondent was next asked whether each sibling was still alive at the survey date. For living siblings, the current age was recorded. For deceased siblings, the age at death and number of years since death were recorded. Interviewers were instructed that, when a respondent could not provide precise information on age at death or years since death, approximate but A 278 • Adult and Maternal Mortality quantitative answers were acceptable. For sisters who died at age 12 or above, three questions were used to determine whether the death was maternity-related: ‘Was [NAME OF SISTER] pregnant when she died?’ and, if not, ‘Did she die during childbirth?’ and, if not, ‘Did she die within two months after the end of a pregnancy or childbirth?’ Table 15.1 shows the number of living and dead siblings reported by the respondents and the completeness of data on current age for living siblings and on age at death and years since death for dead siblings. Overall, the sibling history data collected in the 2014 LDHS are fairly complete:  For 99.9% of deceased siblings, both age at death and years since death (or year of death) were reported.  There are very few siblings for whom survival status was not reported (0.1%). Among surviving siblings, current age was reported for all but 3 of 21,168 siblings. Rather than exclude 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 sex ratio for enumerated siblings (the ratio of brothers to sisters multiplied by 100) is 99 (Appendix Table C.7). This figure is identical to the ratio of 99 in the 2009 LDHS. Since 1986, the sex ratio at birth in Lesotho has ranged between 102 and 105 (BOS 2013), suggesting that brothers were underreported in the 2009 and 2014 LDHS. 15.2 DIRECT ESTIMATES OF ADULT MORTALITY Adult mortality rate The number of adult deaths per 1,000 population age 15-49. Adult mortality rates by 5-year age groups are calculated as follows: the number of deaths to respondent’s siblings in each age group are divided by the number of person- years of exposure to the risk of dying in that age group during a specified period prior to the survey. The number of deaths is the number of siblings (brothers or sisters) reported as having died within the specified period. The person-years of exposure in each age group are calculated for both surviving and dead siblings based on their current age (living siblings) or age at death and years since death (dead siblings). Sample: Siblings (both living and dead) who were age 15-49 in the specified 7-year period preceding the survey by sex and 5-year age groups. One way to assess the quality of the data used to estimate maternal mortality is to evaluate the plausibility and stability of overall adult mortality. It is reasoned that if estimated rates of overall adult mortality are implausible, rates based on a subset of deaths (maternal deaths in particular) are unlikely to be free of serious problems. 1 The imputation procedure was based on the assumption that the reported birth ordering of siblings in the history was correct. The first step was 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. 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 was then calculated from the imputed birth date. In the case of dead siblings, if either age at death or years since death were 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 years since death were not reported but age at death was reported was used as a basis for imputing age at death. Adult and Maternal Mortality • 279 The reported ages at death and years since death of the respondents’ brothers and sisters are used to make direct estimates of adult mortality. Because of the differentials in exposure to the risk of dying, age- and sex-specific death rates are presented in this report. Table 15.2 and Figure 15.1 show age-specific mortality rates among women and men age 15-49 for the 7 years before the 2014 LDHS. To ensure a sufficiently large number of adult deaths to generate a robust estimate, the rates are calculated for the 7-year period before the survey (roughly late-2007 to late-2014). Nevertheless, age- specific mortality rates obtained in this manner are subject to considerable sampling variation. Use of this 7- year period is a compromise between the desire for the most recent data and the need to minimise the level of sampling error.  Overall, adult mortality is slightly higher among men (14.0 deaths per 1,000 population) than among women (12.8 deaths per 1,000 population).  Mortality levels rise rapidly with age. Mortality rates are higher among women than men in the younger age groups (between ages 20 and 34), while the reverse is true in the older age groups (age 35 and older). 15.3 TRENDS IN ADULT MORTALITY Adult mortality, summarised here by the age-adjusted rate for ages 15-49, changed modestly since the 2009 LDHS.2 The rate decreased from 13.7 deaths to 12.8 deaths per 1,000 population among women and from 16.6 deaths to 14.0 deaths per 1,000 population among men. Age-specific assessments of mortality rates indicate a declining trend for women in all age groups except 40-44 and 45-49; for men, there is a declining trend in all age groups except age 15-19, where there is no change. Table 15.3 provides an alternative summary, the probability of dying between exact ages 15 and 50, 35q15. That is, 35q15 is the probability of a 15-year-old woman or man dying before age 50, if experiencing the age- specific death rates in Table 15.2. The 2014 LDHS data show that women and men have similar probabilities: 436 of 1,000 women age 15, and 476 of 1,000 men age 15, would be expected to die before reaching age 50. In the 5 years between the 2009 and 2014 LDHS, the probability of dying between exact ages 15 and 50 decreased from 446 to 436 among women and from 535 to 476 among men. Confidence intervals for the 35q15 estimates are presented in Appendix B.19 and indicate that the change between the surveys is not significant. 2 The 2009 LDHS reported mortality estimates for maternal deaths occurring during the 10-year period preceding the survey. For comparison purposes, these estimates have been recalculated for the 7-year period preceding the 2009 LDHS. Figure 15.1 Adult mortality rates among women and men age 15-49 0 5 10 15 20 25 30 35 40 45 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Deaths per 1,000 population Age in years Women Men 280 • Adult and Maternal Mortality 15.4 DIRECT ESTIMATES OF MATERNAL MORTALITY Maternal mortality rate The number of maternal deaths per 1,000 women age 15-49. Maternal mortality rates by 5-year age groups are calculated by dividing the number of maternal deaths to female siblings of respondents in each age group by the total person-years of exposure of the sisters to the risk of dying in that age group during the 7 years prior to the survey. The number of deaths is the number of sisters reported as having died during pregnancy or delivery, or in the 2 months following the delivery in the specified period by their age group at the time of death. The person-years of exposure in each age group are calculated for both surviving and dead sisters based on their reported current age (living sisters) or age at death and years since death (dead sisters). Sample: Sisters (both living and dead) age 15-49 in the specified period, by sex and 5-year age groups. Maternal mortality ratio The number of maternal deaths per 100,000 live births. The maternal mortality ratio is calculated by dividing the age-standardised maternal mortality rate for women age 15-49 for the specified period by the general fertility rate (GFR) for the same time period. Maternal deaths are a subset of all female deaths; they are defined as any deaths that occur during pregnancy or childbirth, or within 2 months after the birth or termination of a pregnancy. Estimates of maternal mortality are therefore based solely on the timing of the death in relationship to the pregnancy. Two 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; Stanton et al. 1997). In this report, the direct estimation procedure is applied. Age-specific estimates of maternal mortality from reported survivorship of sisters are shown in Table 15.4 for the 7-year period before the 2014 survey.  The maternal mortality rate among women age 15-49 is 1.1 deaths per 1,000 woman-years of exposure.  By 5-year age groups, the maternal mortality rate is highest among women age 35-39 (2.1) and lowest among women age 40-44 (0.2).  The percentage of female deaths that are maternal deaths varies by age and ranges from less than 1% among women age 40-44 to 25% among women age 15-19.  The estimated age-specific mortality rates display a plausible pattern, being generally higher during the peak childbearing ages than in the younger and older age groups. However, the age-specific pattern should be interpreted with caution because of the small number of events: only 67 maternal deaths were reported among women of all ages, representing 9% of female deaths.  The maternal mortality ratio (MMR) has been estimated at 1,024 deaths per 100,000 live births during the 7-year period before the survey. In other words, for every 1,000 live births in Lesotho during the 7 years before the 2014 LDHS, slightly more than 10 women died during pregnancy, during childbirth, or within 2 months of childbirth.  The lifetime risk of maternal death (0.032) indicates that in the 7-year period before the survey, 3% of women died during pregnancy or childbirth, or within 2 months of childbirth. Adult and Maternal Mortality • 281 The estimated maternal mortality ratio in 2014 (1,024) is lower than in the 2009 LDHS (1,243) and higher than in the 2004 LDHS (939). As shown in Table 15.3 and Figure 15.2, the confidence interval surrounding the maternal mortality ratio of 1,024 deaths per 100,000 live births is 731 to 1,318, while the confidence interval for the 2009 ratio of 1,243 deaths per 100,000 live births is 921-1,565, and the confidence interval for the 2004 ratio of 939 deaths per 100,000 live births is 682 to 1,196, showing that the MMR confidence intervals overlap substantially for the 2004, 2009, and 2014 surveys.3 The MMR estimates for 2004, 2009, and 2014 are not significantly different from one another. There is no evidence to conclude that the maternal mortality ratio has changed over the last decade. LIST OF TABLES For detailed information on adult and maternal mortality, see the following tables:  Table 15.1 Completeness of information on siblings  Table 15.2 Adult mortality rates  Table 15.3 Adult mortality probabilities  Table 15.4 Maternal mortality 3 The maternal mortality ratios presented in the 2009 LDHS (1,155 maternal deaths per 100,000 live births with a confidence interval of 874 to 1,435 deaths per 100,000 live births) and in the 2004 LDHS (762 maternal deaths per 100,000 live births with a confidence interval of 561 to 964 deaths per 100,000 live births) were calculated for the 10-year period preceding the survey. For comparison purposes, these estimates have been recalculated for the 7-year period preceding each survey. Figure 15.2 Trends in maternal mortality ratios with confidence intervals 939 1243 1024 0 200 400 600 800 1000 1200 1400 1600 1997-2004 2002-2009 2007-2014 Maternal deaths per 100,000 live births (7 years preceding the 2014 LDHS) (7 years preceding the 2009 LDHS) (7 years preceding the 2004 LDHS) 1196 682 1565 921 1318 731 282 • Adult and Maternal Mortality Table 15.1 Completeness of information on siblings Completeness of data on survival status of all sisters and brothers reported by interviewed women, age of living siblings, and age at death (AD) and years since death (YSD) of dead siblings (unweighted), Lesotho 2014 Sisters Brothers All siblings Number Percent Number Percent Number Percent All siblings 13,515 100.0 13,476 100.0 26,991 100.0 Living 10,784 79.8 10,384 77.1 21,168 78.4 Dead 2,715 20.1 3,080 22.9 5,795 21.5 Survival status unknown 16 0.1 12 0.1 28 0.1 Living siblings 10,784 100.0 10,384 100.0 21,168 100.0 Age reported 10,783 100.0 10,382 100.0 21,165 100.0 Age missing 1 0.0 2 0.0 3 0.0 Dead siblings 2,715 100.0 3,080 100.0 5,795 100.0 AD and YSD reported 2,714 100.0 3,078 99.9 5,792 99.9 Missing only AD nc 0.0 nc 0.0 nc 0.0 Missing only YSD nc 0.0 nc 0.0 nc 0.0 Missing AD and YSD 1 0.0 2 0.1 3 0.1 nc = No cases Table 15.2 Adult mortality rates Direct estimates of female and male mortality rates for the 7 years preceding the survey, by 5-year age groups, Lesotho 2014 Age Deaths Exposure years Mortality rates1 WOMEN 15-19 23 10,201 2.29 20-24 73 13,097 5.57 25-29 137 12,511 10.93 30-34 178 9,957 17.84 35-39 130 6,785 19.12 40-44 111 3,945 28.21 45-49 83 2,732 30.29 15-49 734 59,229 12.82a MEN 15-19 26 9,684 2.64 20-24 68 12,325 5.49 25-29 117 12,100 9.65 30-34 153 9,277 16.51 35-39 163 6,449 25.26 40-44 114 3,907 29.28 45-49 104 2,589 40.00 15-49 744 56,331 13.99a 1 Expressed per 1,000 population a Age-adjusted rate Adult and Maternal Mortality • 283 Table 15.3 Adult mortality probabilities The probability of dying between the ages of 15 and 50 for women and men for the 7 years preceding the survey, Lesotho 2014 Women Men Survey 35q151 35q151 2014 LDHS 436 476 2009 LDHS 446 535 2004 LDHS 394 470 1 The probability of dying between exact ages 15 and 50, expressed per 1,000 persons who reach age 15 Table 15.4 Maternal mortality Direct estimates of maternal mortality rates for the 7 years preceding the survey, by 5-year age groups, Lesotho 2014 Age Percentage of female deaths that are maternal Number of maternal deaths Exposure years Maternal mortality rate1 15-19 25.0 6 10,201 0.57 20-24 14.4 11 13,097 0.80 25-29 15.5 21 12,511 1.70 30-34 6.2 11 9,957 1.11 35-39 10.9 14 6,785 2.09 40-44 0.5 1 3,945 0.15 45-49 4.3 4 2,732 1.31 15-49 9.1 67 59,229 1.07a General fertility rate (GFR)2 105a Maternal mortality ratio (MMR)3 1,024 CI: (731-1,318) Lifetime risk of maternal death4 0.032 2009 LDHS Maternal mortality ratio (MMR)3 1,243 CI: (921-1,565) 2004 LDHS Maternal mortality ratio (MMR)3 939 CI: (682-1,196) CI = Confidence interval 1 Expressed per 1,000 women 2 Expressed per 1,000 woman age 15-49 3 Expressed per 100,000 live births; calculated as the age-adjusted maternal mortality rate times 100 divided by the age-adjusted general fertility rate 4 Calculated as 1-(1-MMR)TFR where TFR represents the total fertility rate for the 7 years preceding the survey a Age-adjusted rate Tuberculosis • 285 TUBERCULOSIS 16 Key Findings  Knowledge of the cause of tuberculosis: Only 13% of women and 12% of men age 15-49 know that tuberculosis is caused by a microbe.  Knowledge of modes of transmission of tuberculosis: Eighty-five percent of women and 75% of men know that tuberculosis can be transmitted through the air by coughing and sneezing.  Treatment-seeking behaviour for tuberculosis: Fifty- nine percent of women and 50% of men sought treatment when experiencing symptoms associated with tuberculosis. uberculosis (TB) is one of the top ten causes of morbidity and mortality in Lesotho. In 2014, the estimated per capita incidence of TB was 852/100,000, ranking Lesotho first globally in terms of TB incidence (WHO 2015b). Co-infection with HIV is common; in 2014, 74% of TB patients tested were HIV positive (MOH 2015). Nevertheless, the TB case notification rate has declined over the last several years, and is now below 50% (WHO 2015b). This chapter examines awareness of the factors that influence treatment-seeking behaviour. The information is organised in three sections: (1) knowledge of TB and its symptoms, cause, and modes of transmission; (2) the self-reported identification of symptoms associated with TB and, among those with symptoms who do not seek treatment, the reasons given for not seeking treatment; and (3) attitudes towards those who have had TB. 16.1 RESPONDENTS’ KNOWLEDGE OF TUBERCULOSIS 16.1.1 Awareness of Tuberculosis and Knowledge that Tuberculosis Can Be Cured Knowledge of tuberculosis among the general population is widespread (Table 16.1). The vast majority of both women and men age 15-49 (97% and 91%, respectively) have heard of TB. Nine in 10 women and 8 in 10 men know that TB can be cured. Patterns by background characteristics  The proportion of respondents who know that TB can be cured varies by district. Among women, knowledge that TB can be cured ranges from a low of 79% in Thaba-Tseka to a high of 93% in Maseru; among men, knowledge that TB can be cured ranges from 71% in Thaba-Tseka to 83% in Berea, Maseru, Mohale’s Hoek, and Qacha’s Nek. T 286 • Tuberculosis  Knowledge that TB can be cured increases with education (Figure 16.1) and generally with wealth. For example, 74% of women and 68% of men with no education know that TB can be cured compared with 97% of women and 90% of men with more than secondary education. 16.1.2 Knowledge of Symptoms Associated with Tuberculosis Survey respondents who had heard of tuberculosis were asked what signs and symptoms would lead them to think that a person had TB. Among respondents age 15- 49, the symptoms of TB most commonly reported were coughing for several weeks (61% of women and 51% of men) followed by weight loss (48% of women and 37% of men), and night sweating (47% of women and 24% of men). Only 9% of women and 10% of men cited blood in the sputum as a symptom of TB (Table 16.2). Notably, nearly 1 in 10 women and 1 in 5 men were unable to name any TB-associated symptoms. 16.1.3 Knowledge of the Cause of Tuberculosis and Its Mode of Transmission Tuberculosis is caused by the bacterium Mycobacterium tuberculosis and is mainly transmitted through the inhalation of M. tuberculosis-containing airborne particles produced by individuals with active pulmonary tuberculosis. Respondents were asked what they thought the cause(s) of tuberculosis are. As shown in Tables 16.3.1 and 16.3.2, only 13% of women and 12% of men age 15-49 correctly stated that microbes are the cause of tuberculosis (Figure 16.2). Instead, the most common answers provided by respondents were dust or pollution (44% of women and 53% of men), smoking (25% of women and 34% of men), and exposure to cold temperatures (16% of women and 14% of men). Almost one in three women (29%) and one in four men (23%) were unable to name any cause of tuberculosis. Figure 16.1 Tuberculosis knowledge by education Figure 16.2 Knowledge of the cause of tuberculosis 74 84 88 92 97 68 74 79 86 90 No education Primary incomplete Primary complete Secondary More than secondary Percentage of women and men age 15-49 who know TB can be cured Women Men 13 1 1 25 10 16 44 4 29 12 1 1 34 10 14 53 4 23 Microbes/ germs/ bacteria Inherited Lifestyle Smoking Alcohol Exposure to cold Dust/ pollution Other Don't know Percentage of women and men age 15-49 who gave specific responses as the cause of TB Women Men Tuberculosis • 287 Patterns by background characteristics  Urban women (18%) and men (19%) are more aware than rural women (10%) and men (8%) that TB is caused by microbes.  Knowledge that TB is caused by microbes increases with education. For example, only 1% of women and 4% of men with no education are aware that TB is caused by microbes compared with 39% of women and 41% of men with more than secondary education.  Knowledge of the cause of TB also increases with wealth. Only 5% of women in the poorest households know that TB is caused by microbes compared with 20% in the wealthiest households. Likewise, only 3% of men in the lowest wealth quintile know the cause of TB compared with 23% in the highest quintile. Although knowledge of the cause of tuberculosis was low among respondents, 85% of women and 75% of men age 15-49 are aware that tuberculosis is spread through the air via coughing or sneezing (Table 16.4). 16.2 SELF-REPORTED SYMPTOMS, DIAGNOSIS, AND TREATMENT 16.2.1 Self-reported Tuberculosis Symptoms To identify respondents who currently suffer from tuberculosis or may have in the past, respondents were asked if they had experienced any of the following symptoms since age 15: a cough for 2 weeks or more, fever for 2 weeks or more, sweating at night, and weight loss. Men were generally more likely than women to report having had symptoms associated with TB (Figure 16.3). Among women age 15-49, 13% reported a cough for 2 weeks or more, 10% reported fever for 2 weeks or more, 12% reported night sweating, and 24% reported weight loss (Table 16.5.1). Among men age 15-49, 17% reported a cough for 2 weeks or more, 12% reported fever for 2 weeks or more, 17% reported night sweating, and 23% reported weight loss (Table 16.5.2). 16.2.2 Treatment Seeking for Tuberculosis Symptoms Respondents who reported a least one symptom associated with tuberculosis were asked whether they had sought a consultation or treatment from any source. Fifty-nine percent of women and 50% of men age 15-49 sought a consultation or treatment (Tables 16.6.1 and 16.6.2). Those respondents who did not seek a consultation or treatment were asked the main reason they did not. By far the most common reason given for women (80%) and men (77%) was that the symptoms they experienced were harmless. Although treatment for tuberculosis is provided free of charge in Lesotho, cost was cited by 5% of women and 6% of men as the main reason for not seeking a consultation or treatment. Patterns by background characteristics  In general, the proportion of women and men who sought a consultation or treatment increased with age. For example, only 41% of women and 36% of men age 15-19 who experienced a symptom associated with tuberculosis sought a consultation or treatment compared with 75% of women and 82% of men age 40-44. Figure 16.3 Experience of tuberculosis symptoms 13 10 12 24 17 12 17 23 Cough for 2 or more weeks Fever for 2 or more weeks Night sweating Weight loss Percentage of women and men age 15-49 with any of four symptoms since age 15 Women Men 288 • Tuberculosis  Rural men are more likely to seek a consultation or treatment than urban men (52% versus 46%). Similar differences by residence are not seen for women. 16.2.3 Tuberculosis Diagnosis and Treatment Respondents who had at least one symptom associated with tuberculosis were asked whether they were told they had TB by a doctor or nurse. Twelve percent of women and 15% of men say that they had been told by a doctor or a nurse that they had TB (Table 16.7). Among those who were told that they had TB, 98% (of both women and men) received medicine (Table 16.8). The duration of standard (short course) TB treatment is 6 months. Among respondents told that they had TB who were provided with medicine, 87% of women and 78% of men reported that they were told to take treatment for 6 months. Seven percent of women and 6% of men were told to take treatment for more than 6 months, and 4% of women and 14% of men were told to take treatment for less than 6 months (Figure 16.4). Figure 16.4 Tuberculosis treatment length Percent distribution of women and men age 15-49 diagnosed with tuberculosis who received medicine for tuberculosis and were told to take it for the specified period of time 16.3 ATTITUDES TOWARDS THOSE TREATED FOR TUBERCULOSIS Respondents who had heard of TB were asked if they would be willing to work with someone who had previously been treated for the disease. Ninety-five percent of women and 92% of men indicated that they would be willing to (Table 16.9). The proportion of respondents with positive attitudes towards those who had received treatment was higher among urban respondents than rural respondents, and generally increased with education and wealth. Less than 6 months 4% 6 months 87% More than 6 months 7% Don't know/Don't remember 2% Women Less than 6 months 14% 6 months 78% More than 6 months 6% Don't know/Don't remember 2% Men Tuberculosis • 289 LIST OF TABLES For detailed information on tuberculosis-related knowledge, attitudes, and behaviours, see the following tables:  Table 16.1 Knowledge of tuberculosis  Table 16.2 Knowledge of specific symptoms of tuberculosis  Table 16.3.1 Knowledge of the cause of tuberculosis: Women  Table 16.3.2 Knowledge of the cause of tuberculosis: Men  Table 16.4 Knowledge of the mode of tuberculosis transmission  Table 16.5.1 Experience of symptoms of tuberculosis: Women  Table 16.5.2 Experience of symptoms of tuberculosis: Men  Table 16.6.1 Treatment seeking for symptoms of tuberculosis: Women  Table 16.6.2 Treatment seeking for symptoms of tuberculosis: Men  Table 16.7 Diagnosis of tuberculosis  Table 16.8 Received medicine for tuberculosis  Table 16.9 Positive attitudes towards those with tuberculosis 290 • Tuberculosis Table 16.1 Knowledge of tuberculosis Percentage of women and men who have heard of tuberculosis (TB), and who believe that TB can be cured, by background characteristics, Lesotho 2014 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 94.1 81.1 1,440 93.1 73.6 691 20-24 96.2 89.0 1,325 95.3 82.8 561 25-29 97.3 91.0 1,094 94.6 87.1 410 30-34 98.0 93.7 957 89.2 80.9 334 35-39 98.7 94.0 744 86.0 80.0 276 40-44 97.5 95.6 562 81.3 78.0 221 45-49 98.1 93.7 499 84.0 79.5 168 Marital status Never married 95.7 86.5 2,190 92.8 77.6 1,501 Married or living together 96.9 90.5 3,612 90.2 84.1 983 Divorced/separated/widowed 98.2 95.0 819 80.6 77.0 176 Residence Urban 98.3 93.6 2,419 93.6 85.7 920 Rural 95.8 87.5 4,202 89.6 76.9 1,741 Ecological zone Lowlands 97.9 91.9 4,184 92.5 83.0 1,711 Foothills 95.8 87.2 688 86.7 73.9 252 Mountains 93.7 84.2 1,288 88.7 73.3 523 Senqu River Valley 95.8 89.3 461 90.2 78.5 174 District Butha-Buthe 93.6 86.6 385 88.3 76.1 143 Leribe 97.1 88.8 1,064 93.7 79.8 390 Berea 95.3 90.2 892 89.0 82.6 379 Maseru 98.7 92.5 1,864 91.9 82.5 809 Mafeteng 98.1 91.4 576 91.4 80.2 242 Mohale’s Hoek 98.3 92.1 519 93.1 82.5 202 Quthing 94.4 89.1 315 88.7 76.3 105 Qacha’s Nek 96.9 88.6 204 92.2 82.6 74 Mokhotlong 96.3 88.9 349 92.3 71.6 144 Thaba-Tseka 91.3 79.4 452 84.2 70.6 172 Education No education 90.5 73.5 68 82.2 67.9 213 Primary incomplete 94.4 83.9 1,178 87.2 73.8 875 Primary complete 95.8 87.6 1,375 89.9 79.2 316 Secondary 97.6 91.7 3,418 95.7 85.7 1,043 More than secondary 98.7 97.2 581 94.4 90.1 214 Wealth quintile Lowest 92.5 81.4 960 84.3 66.2 376 Second 94.8 86.0 1,033 86.9 78.3 479 Middle 96.7 89.2 1,244 91.6 81.1 536 Fourth 98.8 92.9 1,605 94.3 84.5 616 Highest 98.2 94.0 1,778 94.4 83.9 654 Total 15-49 96.7 89.8 6,621 91.0 79.9 2,660 50-59 na na na 84.3 76.2 271 Total 15-59 na na na 90.4 79.6 2,931 na = Not applicable Tuberculosis • 291 Table 16.2 Knowledge of specific symptoms of tuberculosis Among women and men age 15-49 who have heard of tuberculosis, percentage who cite specific symptoms of tuberculosis, Lesotho 2014 Symptom Women Men Total Coughing 22.2 21.5 22.0 Coughing with sputum 8.3 10.1 8.8 Coughing for several weeks 60.5 50.9 57.8 Fever 8.5 4.5 7.4 Blood in sputum 8.8 9.5 9.0 Loss of appetite 28.2 14.3 24.4 Night sweating 47.4 23.6 40.9 Pain in chest or back 7.1 7.1 7.1 Tiredness/fatigue 6.3 5.7 6.1 Weight loss 48.3 37.2 45.2 Other 0.0 14.6 4.0 Does not know 8.8 17.2 11.1 No symptoms 0.2 0.7 0.3 Number of respondents 6,403 2,421 8,824 292 • Tuberculosis Table 16.3.1 Knowledge of the cause of tuberculosis: Women Among women age 15-49 who have heard of tuberculosis, percentage who cite specific causes of tuberculosis, by background characteristics, Lesotho 2014 Causes cited Number of women Background characteristic Microbes/ germs/ bacteria Inherited Lifestyle Smoking Alcohol drinking Exposure to cold temperatures Dust/ pollution Other Don’t know Age 15-19 11.8 0.6 0.8 22.8 7.8 9.8 42.9 4.4 31.4 1,354 20-24 9.9 0.5 0.5 24.7 8.9 16.8 44.1 3.6 29.9 1,275 25-29 12.6 1.0 1.1 28.3 11.1 16.8 43.3 4.8 29.3 1,064 30-34 13.3 1.1 1.0 25.4 10.6 21.6 44.5 4.4 27.8 938 35-39 16.5 0.9 1.0 23.6 9.6 14.8 45.7 5.6 27.3 734 40-44 14.1 1.3 0.7 26.5 10.0 15.9 46.4 3.9 25.9 548 45-49 13.6 1.7 0.6 21.5 9.4 17.0 47.5 4.6 25.1 490 Marital status Never married 13.7 0.8 0.8 24.8 8.8 15.4 44.6 4.8 27.3 2,097 Married or living together 11.7 1.0 0.9 25.1 10.0 15.4 44.1 4.3 29.7 3,502 Divorced/separated/ widowed 13.9 0.9 0.7 23.3 9.1 18.0 45.3 3.7 28.8 804 Residence Urban 17.6 1.2 1.0 27.2 11.4 18.3 44.9 4.7 23.2 2,379 Rural 9.7 0.7 0.7 23.4 8.4 14.2 44.1 4.3 32.1 4,024 Ecological zone Lowlands 15.4 1.2 0.8 25.8 10.8 18.2 48.6 4.6 22.7 4,095 Foothills 8.0 0.4 1.3 22.9 7.4 13.3 37.1 2.8 36.9 659 Mountains 7.3 0.3 0.7 22.5 6.5 9.2 37.2 4.3 41.7 1,207 Senqu River Valley 9.1 0.8 0.6 24.0 8.4 13.9 35.9 6.1 37.9 442 District Butha-Buthe 10.9 0.3 0.9 21.5 5.7 5.9 43.8 1.4 37.6 360 Leribe 14.2 0.6 0.7 25.4 9.3 13.0 51.7 4.4 23.5 1,032 Berea 16.6 1.0 2.0 35.3 10.9 21.1 58.9 5.7 13.5 851 Maseru 13.5 1.2 0.3 22.8 11.6 21.7 41.4 3.9 27.4 1,839 Mafeteng 13.1 1.2 1.0 21.2 8.5 15.2 41.0 4.4 29.6 565 Mohale’s Hoek 10.7 1.1 0.6 20.1 9.5 10.0 30.5 5.2 41.7 510 Quthing 8.7 1.3 0.8 29.7 9.2 15.5 46.1 5.9 28.2 297 Qacha’s Nek 11.9 0.9 0.8 25.4 7.8 9.8 34.3 8.2 34.9 197 Mokhotlong 6.3 0.1 0.6 26.1 6.3 4.6 39.8 3.8 41.6 336 Thaba-Tseka 8.9 0.3 0.8 19.1 6.0 13.3 39.5 3.3 42.2 413 Education No education 0.5 0.0 2.4 13.0 7.7 23.5 39.4 9.7 35.8 61 Primary incomplete 4.7 0.1 0.6 22.7 9.0 15.0 37.5 5.0 38.5 1,113 Primary complete 5.5 0.8 0.7 23.5 8.3 16.9 43.3 3.2 35.0 1,318 Secondary 13.8 1.1 0.7 26.0 10.5 15.7 47.8 4.5 24.9 3,337 More than secondary 38.9 1.4 2.2 25.8 7.7 13.9 41.1 5.3 17.5 574 Wealth quintile Lowest 4.5 0.2 0.7 24.2 7.7 10.2 34.4 5.1 44.0 888 Second 6.5 0.6 0.9 21.6 7.7 13.8 39.5 4.1 36.7 980 Middle 12.0 0.6 0.6 23.7 8.6 16.0 45.3 5.1 29.5 1,203 Fourth 13.2 1.1 0.4 25.8 10.9 15.4 51.1 3.7 24.3 1,586 Highest 20.2 1.5 1.4 26.7 10.8 19.7 45.6 4.4 20.3 1,747 Total 15-49 12.7 0.9 0.8 24.8 9.5 15.7 44.4 4.4 28.8 6,403 Tuberculosis • 293 Table 16.3.2 Knowledge of the cause of tuberculosis: Men Among men age 15-49 who have heard of tuberculosis, percentage who cite specific causes of tuberculosis, by background characteristics, Lesotho 2014 Causes cited Number of men Background characteristic Microbes/ germs/ bacteria Inherited Lifestyle Smoking Alcohol drinking Exposure to cold temperatures Dust/ pollution Other Don’t know Age 15-19 8.8 0.2 0.4 26.6 6.1 10.0 50.3 2.8 29.7 644 20-24 12.0 0.8 2.2 34.6 9.4 14.9 49.7 2.8 23.0 534 25-29 12.3 0.5 2.0 41.5 13.5 14.3 57.1 5.6 18.5 387 30-34 9.7 0.5 1.2 37.5 10.0 19.7 56.0 3.7 19.1 298 35-39 13.4 0.7 0.4 39.8 10.4 16.3 55.5 7.0 18.6 237 40-44 17.8 3.0 0.0 32.6 7.7 17.5 55.9 3.1 15.0 179 45-49 15.0 0.5 2.9 34.2 13.5 14.9 59.3 8.2 21.1 141 Marital status Never married 11.1 0.6 1.3 30.9 7.6 13.3 51.0 3.7 25.5 1,393 Married or living together 12.4 0.8 1.2 38.7 12.6 16.2 57.1 4.2 18.0 887 Divorced/separated/ widowed 12.8 0.5 1.5 39.2 8.1 14.2 54.4 7.0 20.4 142 Residence Urban 19.3 1.0 2.5 38.8 10.7 17.6 52.2 4.6 16.7 861 Rural 7.5 0.5 0.6 31.8 8.8 12.7 54.0 3.8 25.6 1,560 Ecological zone Lowlands 14.2 0.9 1.8 36.8 10.7 16.9 54.9 4.3 18.4 1,582 Foothills 8.7 0.3 0.5 30.6 5.0 12.9 48.4 2.4 28.0 218 Mountains 6.3 0.2 0.2 26.8 7.0 6.8 49.6 3.9 33.4 464 Senqu River Valley 6.2 0.9 0.4 36.2 10.8 13.6 56.8 5.4 23.6 157 District Butha-Buthe 6.6 0.8 0.5 36.3 6.8 4.2 56.7 2.4 26.4 126 Leribe 13.4 0.6 1.2 35.4 6.2 11.7 69.6 4.8 13.7 365 Berea 11.1 1.2 3.5 42.5 13.1 22.0 56.9 5.6 14.4 338 Maseru 15.8 0.8 1.4 35.5 11.2 20.3 48.0 3.2 19.8 744 Mafeteng 8.8 0.7 0.8 26.3 9.2 8.9 48.8 4.0 29.7 221 Mohale’s Hoek 11.8 0.0 0.3 31.4 12.2 8.6 42.2 5.3 33.4 188 Quthing 7.2 1.6 0.6 39.0 11.2 14.5 56.2 4.1 19.4 93 Qacha’s Nek 12.3 0.9 1.1 35.6 10.6 11.8 50.5 6.5 25.5 69 Mokhotlong 3.4 0.3 0.0 26.6 4.7 2.3 48.3 5.2 37.7 133 Thaba-Tseka 6.2 0.0 0.0 23.1 2.3 10.6 54.8 1.6 34.6 145 Education No education 3.6 0.8 0.0 28.4 7.5 13.5 49.3 5.4 26.8 175 Primary incomplete 3.3 0.3 0.5 31.3 7.9 10.2 47.4 4.1 33.2 763 Primary complete 8.3 1.1 1.4 41.0 12.7 14.6 63.1 3.0 18.2 284 Secondary 14.4 0.8 1.6 34.5 9.9 16.6 57.8 3.9 17.1 998 More than secondary 41.4 0.8 3.6 40.0 10.4 19.8 44.2 5.5 10.8 202 Wealth quintile Lowest 2.7 0.2 0.2 30.7 7.6 7.8 50.0 4.9 30.5 317 Second 7.6 0.6 0.8 32.8 7.8 13.9 52.7 3.3 26.6 416 Middle 5.9 0.4 0.6 36.5 10.8 11.2 55.1 3.9 25.4 491 Fourth 12.6 0.7 0.7 35.4 9.5 15.8 56.6 3.2 20.9 581 Highest 22.6 1.2 3.3 34.2 10.5 19.4 51.3 5.3 14.6 617 Total 15-49 11.7 0.7 1.3 34.3 9.5 14.4 53.4 4.1 22.5 2,421 50-59 8.8 2.8 1.0 27.5 10.2 11.5 56.1 8.0 23.4 228 Total 15-59 11.4 0.9 1.3 33.7 9.5 14.2 53.6 4.4 22.5 2,650 294 • Tuberculosis Table 16.4 Knowledge of the mode of tuberculosis transmission Among women and men age 15-49 who have heard of tuberculosis (TB), percentage who cite specific modes of TB transmission, Lesotho 2014 Mode of transmission Women Men Total Through the air when coughing or sneezing 84.7 75.2 82.1 Sharing utensils 8.0 7.4 7.8 Touching a person with TB 1.9 1.8 1.9 Sharing food 1.7 2.4 1.9 Sexual contact 1.1 1.8 1.3 Mosquito bites 0.0 0.1 0.0 Other 4.3 4.7 4.4 Does not know 13.1 20.8 15.2 Number of respondents 6,403 2,421 8,824 Table 16.5.1 Experience of symptoms of tuberculosis: Women Percentage of women age 15-49 who have had symptoms associated with tuberculosis since age 15, by background characteristics, Lesotho 2014 Background characteristic Cough for 2 weeks or more Fever for 2 weeks or more Night sweating Weight loss Number of women Age 15-19 11.5 6.4 9.4 17.0 1,440 20-24 11.4 7.4 8.8 23.0 1,325 25-29 12.3 8.7 11.5 25.9 1,094 30-34 16.1 10.8 13.0 27.4 957 35-39 12.8 10.0 12.2 24.7 744 40-44 16.5 14.7 18.0 27.4 562 45-49 17.7 19.3 21.9 33.3 499 Marital status Never married 13.1 8.1 10.2 19.3 2,190 Married or living together 12.3 9.6 11.8 25.5 3,612 Divorced/separated/widowed 18.6 14.5 18.7 31.1 819 Residence Urban 14.6 10.0 12.9 24.2 2,419 Rural 12.6 9.6 11.7 24.1 4,202 Ecological zone Lowlands 14.8 10.8 13.0 25.0 4,184 Foothills 12.8 7.9 10.7 30.2 688 Mountains 10.2 7.9 10.7 20.0 1,288 Senqu River Valley 9.3 7.5 10.4 19.1 461 District Butha-Buthe 8.1 5.9 6.4 20.5 385 Leribe 13.8 8.9 10.9 24.9 1,064 Berea 13.1 9.3 11.8 23.6 892 Maseru 17.9 12.5 16.1 29.2 1,864 Mafeteng 12.1 11.4 13.0 24.0 576 Mohale’s Hoek 9.7 7.9 9.5 16.8 519 Quthing 8.3 7.1 11.6 20.9 315 Qacha’s Nek 14.9 9.1 9.9 22.8 204 Mokhotlong 13.2 10.1 14.8 30.3 349 Thaba-Tseka 7.1 5.7 5.7 12.2 452 Education No education 16.6 15.2 22.1 30.5 68 Primary incomplete 16.3 14.4 17.3 29.8 1,178 Primary complete 11.8 10.1 12.3 26.8 1,375 Secondary 12.9 8.7 11.1 22.1 3,418 More than secondary 12.9 4.7 6.6 17.4 581 Wealth quintile Lowest 10.4 8.9 11.7 22.2 960 Second 13.5 10.1 12.8 27.2 1,033 Middle 15.2 11.3 12.3 26.4 1,244 Fourth 12.3 10.5 12.4 25.4 1,605 Highest 14.4 8.2 11.8 20.6 1,778 Total 15-49 13.3 9.7 12.1 24.1 6,621 Tuberculosis • 295 Table 16.5.2 Experience of symptoms of tuberculosis: Men Percentage of men age 15-49 who have had symptoms associated with tuberculosis since age 15, by background characteristics, Lesotho 2014 Background characteristic Cough for 2 weeks or more Fever for 2 weeks or more Night sweating Weight loss Number of men Age 15-19 13.8 6.1 10.7 12.1 691 20-24 15.0 10.1 13.6 21.4 561 25-29 14.2 10.2 15.4 26.5 410 30-34 17.6 11.3 19.2 27.7 334 35-39 18.3 18.6 23.8 31.1 276 40-44 26.7 25.1 26.9 34.9 221 45-49 20.6 18.9 25.1 24.2 168 Marital status Never married 15.7 9.5 12.6 18.4 1,501 Married or living together 16.5 13.3 20.5 27.2 983 Divorced/separated/widowed 24.3 24.2 30.0 36.7 176 Residence Urban 16.3 11.4 17.5 22.8 920 Rural 16.7 12.1 16.3 22.9 1,741 Ecological zone Lowlands 17.6 13.0 18.3 24.3 1,711 Foothills 18.4 10.5 14.7 25.0 252 Mountains 13.7 9.7 13.1 19.0 523 Senqu River Valley 12.2 10.0 14.4 17.3 174 District Butha-Buthe 16.3 13.4 14.5 28.0 143 Leribe 18.2 12.4 12.9 20.8 390 Berea 13.9 10.8 15.7 18.8 379 Maseru 20.0 13.9 22.4 28.5 809 Mafeteng 18.2 14.8 21.7 25.1 242 Mohale’s Hoek 11.2 7.8 8.9 14.8 202 Quthing 13.0 7.9 11.8 16.5 105 Qacha’s Nek 13.8 7.1 11.5 13.3 74 Mokhotlong 16.5 9.4 17.2 26.6 144 Thaba-Tseka 10.3 9.7 9.8 17.0 172 Education No education 21.0 18.6 19.5 29.6 213 Primary incomplete 18.0 15.0 20.2 27.1 875 Primary complete 16.0 12.0 19.8 29.2 316 Secondary 15.5 9.2 13.1 18.6 1,043 More than secondary 12.2 5.2 12.7 10.0 214 Wealth quintile Lowest 20.6 12.5 17.1 26.8 376 Second 15.8 15.3 19.7 23.0 479 Middle 16.0 11.4 14.0 21.9 536 Fourth 15.7 11.0 17.2 25.1 616 Highest 16.1 10.2 16.0 19.3 654 Total 15-49 16.6 11.9 16.7 22.9 2,660 50-59 27.1 21.7 29.5 34.6 271 Total 15-59 17.5 12.8 17.9 23.9 2,931 296 • Tuberculosis Table 16.6.1 Treatment seeking for symptoms of tuberculosis: Women Percentage of women age 15-49 who have had symptoms associated with tuberculosis since age 15, by whether they sought treatment for the symptoms and by reason for not seeking treatment, according to background characteristics, Lesotho 2014 Percentage seeking consultation or treatment Number of women Reason for not seeking consultation/treatment Total Number of women who did not seek treatment Background characteristic Symptoms harmless Cost Distance Embarrassed Long queue Other Age 15-19 41.2 358 78.3 5.8 1.0 0.3 0.0 14.6 100.0 210 20-24 50.6 383 81.8 2.8 2.6 0.0 0.9 12.0 100.0 189 25-29 64.6 335 84.5 3.6 3.1 0.0 1.5 7.2 100.0 119 30-34 64.1 326 81.1 1.6 0.4 0.0 2.5 14.4 100.0 117 35-39 61.0 232 83.5 8.4 0.0 1.1 0.0 6.9 100.0 91 40-44 74.5 189 80.8 8.1 2.6 0.0 0.0 8.5 100.0 48 45-49 73.1 202 (66.9) (6.2) (8.7) (0.0) (0.0) (18.3) 100.0 55 Marital status Never married 48.2 606 81.1 5.3 1.2 0.2 0.5 11.7 100.0 314 Married or living together 60.5 1,108 80.7 4.1 2.2 0.2 1.1 11.7 100.0 437 Divorced/separated/ widowed 75.5 311 75.3 5.5 4.9 0.0 0.0 14.3 100.0 76 Employment status Currently working 64.1 846 82.5 3.7 1.6 0.0 1.4 10.8 100.0 304 Currently not working, but worked in past 12 months 60.0 231 80.0 7.2 0.5 0.0 0.0 12.3 100.0 92 Has not worked in more than 12 months 54.4 947 78.9 4.8 2.7 0.4 0.5 12.7 100.0 432 Residence Urban 58.5 784 85.8 0.5 2.3 0.2 1.0 10.1 100.0 326 Rural 59.5 1,240 76.8 7.4 1.9 0.2 0.6 13.1 100.0 502 Ecological zone Lowlands 58.6 1,366 80.7 5.1 2.4 0.1 0.9 10.7 100.0 566 Foothills 58.4 234 81.4 3.7 1.8 0.0 0.0 13.1 100.0 97 Mountains 59.6 318 76.4 4.2 1.4 0.8 0.9 16.3 100.0 128 Senqu River Valley 66.2 106 85.2 1.2 0.5 0.0 0.0 13.2 100.0 36 District Butha-Buthe 57.2 89 83.0 11.6 0.0 0.0 0.0 5.4 100.0 38 Leribe 58.5 344 76.7 1.1 3.6 0.0 2.7 15.9 100.0 143 Berea 64.1 267 84.6 7.9 0.0 0.0 0.0 7.6 100.0 96 Maseru 59.0 709 81.7 3.0 3.3 0.0 0.5 11.5 100.0 290 Mafeteng 52.8 174 81.4 6.3 0.7 0.8 0.0 10.8 100.0 82 Mohale’s Hoek 59.1 107 82.2 12.0 0.0 0.0 0.0 5.9 100.0 44 Quthing 59.0 78 67.7 2.6 0.5 0.0 0.0 29.2 100.0 32 Qacha’s Nek 61.3 60 78.5 2.1 0.0 0.0 2.1 17.3 100.0 23 Mokhotlong 54.5 125 83.2 4.0 0.9 1.8 0.0 10.1 100.0 57 Thaba-Tseka 67.8 73 (68.5) (9.7) (5.4) (0.0) (2.6) (13.8) 100.0 24 Education No education (44.9) 24 * * * * * * 100.0 13 Primary incomplete 59.4 426 66.4 12.5 2.4 0.0 0.4 18.3 100.0 173 Primary complete 66.1 431 78.8 5.8 3.8 0.7 0.0 10.9 100.0 146 Secondary 57.5 991 86.0 2.0 1.7 0.2 1.4 8.7 100.0 422 More than secondary 51.7 153 87.8 0.0 0.0 0.0 0.0 12.2 100.0 74 Wealth quintile Lowest 60.7 255 72.2 8.6 1.0 1.0 0.6 16.6 100.0 100 Second 60.6 336 74.9 9.0 2.5 0.0 0.9 12.7 100.0 132 Middle 60.0 402 74.5 7.9 3.0 0.0 1.9 12.6 100.0 161 Fourth 59.6 507 84.6 1.9 3.9 0.3 0.0 9.3 100.0 205 Highest 56.2 526 87.3 0.6 0.0 0.0 0.6 11.5 100.0 230 Total 15-49 59.1 2,025 80.3 4.7 2.1 0.2 0.8 12.0 100.0 828 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. Tuberculosis • 297 Table 16.6.2 Treatment seeking for symptoms of tuberculosis: Men Percentage of men aged 15-49 who have had symptoms associated with tuberculosis since age 15, by whether they sought treatment for the symptoms and by reason for not seeking treatment, according to background characteristics, Lesotho 2014 Percentage seeking consultation or treatment Number of men Reason for not seeking consultation/treatment Total Number of men who did not seek treatment Background characteristic Symptoms harmless Cost Distance Embarrassed Long queue Other Age 15-19 36.0 164 77.0 6.0 4.3 1.3 0.0 11.4 100.0 105 20-24 37.2 174 83.3 4.1 2.6 1.6 0.0 8.5 100.0 109 25-29 43.4 148 73.1 9.5 2.8 1.2 0.0 13.3 100.0 84 30-34 51.7 119 76.7 0.0 1.3 4.8 0.0 17.2 100.0 58 35-39 53.7 112 (67.1) (14.0) (1.8) (0.0) (0.0) (17.1) 100.0 52 40-44 81.9 99 * * * * * * 100.0 18 45-49 71.8 57 * * * * * * 100.0 16 Marital status Never married 41.9 428 77.7 6.3 2.6 1.9 0.0 11.5 100.0 249 Married or living together 54.6 360 78.0 3.4 3.7 0.5 0.0 14.4 100.0 163 Divorced/separated/ widowed 65.9 85 (60.1) (17.9) (0.0) (4.3) (3.8) (13.8) 100.0 29 Employment status Currently working 47.4 561 75.5 5.6 2.7 1.4 0.4 14.5 100.0 295 Currently not working, but worked in past 12 months 59.1 116 (78.1) (14.9) (3.9) (0.0) (0.0) (3.1) 100.0 47 Has not worked in more than 12 months 49.6 196 79.6 3.0 2.7 2.7 0.0 12.0 100.0 99 Residence Urban 45.8 331 81.5 7.5 0.7 1.3 0.0 9.0 100.0 179 Rural 51.7 542 73.4 5.0 4.3 1.7 0.4 15.3 100.0 262 Ecological zone Lowlands 48.6 613 78.6 7.3 1.9 1.3 0.4 10.7 100.0 315 Foothills 46.3 86 (71.8) (6.6) (2.2) (3.5) (0.0) (15.9) 100.0 46 Mountains 54.5 133 75.5 0.9 6.0 0.0 0.0 17.7 100.0 61 Senqu River Valley 52.1 41 (61.5) (0.0) (9.5) (5.8) (0.0) (23.2) 100.0 20 District Butha-Buthe 44.3 47 (62.4) (5.5) (14.1) (8.0) (0.0) (10.0) 100.0 26 Leribe 60.0 123 (77.7) (0.0) (5.6) (3.5) (0.0) (13.2) 100.0 49 Berea 44.0 116 86.4 4.1 0.0 0.0 0.0 9.5 100.0 65 Maseru 47.2 333 78.0 10.5 0.0 0.7 0.0 10.7 100.0 176 Mafeteng 46.8 86 74.5 2.9 7.0 1.5 2.4 11.7 100.0 46 Mohale’s Hoek 51.5 43 (61.8) (9.3) (13.4) (0.0) (0.0) (15.5) 100.0 21 Quthing (55.2) 24 * * * * * * 100.0 11 Qacha’s Nek (52.4) 18 (71.8) (0.0) (0.0) (2.5) (0.0) (25.7) 100.0 8 Mokhotlong 43.9 49 (84.6) (1.9) (0.0) (0.0) (0.0) (13.5) 100.0 27 Thaba-Tseka (65.2) 35 * * * * * * 100.0 12 Education No education 60.4 78 (74.1) (6.8) (2.3) (2.5) (0.0) (14.2) 100.0 31 Primary incomplete 46.5 318 69.2 9.3 4.0 1.9 0.7 14.9 100.0 170 Primary complete 55.3 123 85.3 1.5 0.0 0.4 0.0 12.8 100.0 55 Secondary 47.2 300 78.8 4.8 3.1 1.7 0.0 11.6 100.0 158 More than secondary (50.0) 53 * * * * * * 100.0 27 Wealth quintile Lowest 54.8 129 67.4 1.4 7.5 2.8 0.0 21.0 100.0 58 Second 53.6 148 73.6 5.7 1.7 2.5 1.6 14.8 100.0 69 Middle 44.8 167 71.2 11.7 4.0 1.6 0.0 11.5 100.0 92 Fourth 53.0 207 78.6 5.8 0.0 2.1 0.0 13.4 100.0 97 Highest 43.8 222 85.2 4.2 2.5 0.0 0.0 8.0 100.0 124 Total 15-49 49.5 873 76.7 6.0 2.8 1.6 0.3 12.7 100.0 441 50-59 72.1 125 (67.4) (7.7) (7.9) (0.0) (0.0) (17.0) 100.0 35 Total 15-59 52.3 998 76.0 6.1 3.2 1.4 0.2 13.0 100.0 476 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. 298 • Tuberculosis Table 16.7 Diagnosis of tuberculosis Among women and men age 15-49 who have had any of the specific symptoms associated with tuberculosis (TB) since age 15, percentage who were told by a doctor or a nurse that they had TB, by background characteristics, Lesotho 2014 Women Men Background characteristic Percentage diagnosed with TB Number with TB-specific symptoms Percentage diagnosed with TB Number with TB-specific symptoms Age 15-19 3.5 358 0.6 164 20-24 5.2 383 3.3 174 25-29 12.2 335 7.0 148 30-34 13.4 326 22.5 119 35-39 15.6 232 23.6 112 40-44 28.9 189 36.9 99 45-49 21.0 202 39.3 57 Marital status Never married 7.3 606 7.0 428 Married or living together 11.1 1,108 20.1 360 Divorced/separated/widowed 26.6 311 31.7 85 Employment status Currently working 14.6 846 12.9 561 Currently not working but worked in past 12 months 9.2 231 21.0 116 Has not worked in more than 12 months 11.2 947 16.6 196 Residence Urban 14.3 784 13.1 331 Rural 11.1 1,240 15.8 542 Ecological zone Lowlands 13.1 1,366 14.9 613 Foothills 6.2 234 16.0 86 Mountains 13.2 318 12.5 133 Senqu River Valley 13.7 106 18.7 41 District Butha-Buthe 10.0 89 15.4 47 Leribe 8.7 344 14.8 123 Berea 14.8 267 14.7 116 Maseru 14.1 709 13.9 333 Mafeteng 9.6 174 18.6 86 Mohale’s Hoek 14.5 107 12.2 43 Quthing 16.1 78 (15.5) 24 Qacha’s Nek 9.3 60 (16.5) 18 Mokhotlong 13.1 125 11.8 49 Thaba-Tseka 7.7 73 (19.1) 35 Education No education * 24 23.1 78 Primary incomplete 12.2 426 15.7 318 Primary complete 15.3 431 17.6 123 Secondary 11.7 991 9.9 300 More than secondary 9.7 153 (18.4) 53 Wealth quintile Lowest 8.1 255 19.9 129 Second 12.8 336 17.7 148 Middle 14.3 402 14.5 167 Fourth 11.4 507 14.5 207 Highest 13.7 526 10.3 222 Total 15-49 12.4 2,025 14.8 873 50-59 na na 28.5 125 Total 15-59 na na 16.5 998 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 applicable Tuberculosis • 299 Table 16.8 Received medicine for tuberculosis Among women and men age 15-49 who were told by a doctor or nurse that they had tuberculosis (TB), percentage who received medicine, by background characteristics, Lesotho 2014 Women Men Background characteristic Percentage diagnosed who received medicine Number told they had TB Percentage diagnosed who received medicine Number told they had TB Age 15-19 * 12 * 1 20-24 * 20 * 6 25-29 (100.0) 41 * 10 30-34 (97.0) 44 * 27 35-39 (98.6) 36 (100.0) 26 40-44 94.1 55 (100.0) 37 45-49 (100.0) 42 * 22 Marital status Never married (97.0) 44 (100.0) 30 Married or living together 98.3 123 97.2 72 Divorced/separated/widowed 98.0 83 (100.0) 27 Employment status Currently working 100.0 123 97.2 72 Currently not working but worked in past 12 months * 21 * 24 Has not worked in more than 12 months 96.5 106 (100.0) 33 Residence Urban 100.0 112 (95.3) 43 Rural 96.4 138 100.0 86 Ecological zone Lowlands 98.6 179 97.8 91 Foothills * 15 * 14 Mountains 94.0 42 * 17 Senqu River Valley (100.0) 15 * 8 Education No education * 2 * 18 Primary incomplete 95.2 52 (100.0) 50 Primary complete 99.3 66 * 22 Secondary 98.2 116 (100.0) 30 More than secondary * 15 * 10 Wealth quintile Lowest (97.6) 21 (100.0) 26 Second (89.5) 43 * 26 Middle 100.0 57 * 24 Fourth (100.0) 58 (100.0) 30 Highest 100.0 72 * 23 Total 15-49 98.0 250 98.4 129 50-59 na na (100.0) 36 Total 15-59 na na 98.8 165 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 applicable 300 • Tuberculosis Table 16.9 Positive attitudes towards those with tuberculosis 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 2014 Women Men Background characteristic Willing to work with someone previously treated for TB Number Willing to work with someone previously treated for TB Number Age 15-19 90.4 1,354 86.0 644 20-24 95.6 1,275 91.7 534 25-29 94.5 1,064 93.9 387 30-34 96.3 938 96.1 298 35-39 97.0 734 96.0 237 40-44 97.5 548 95.6 179 45-49 94.6 490 93.8 141 Marital status Never married 94.0 2,097 89.4 1,393 Married or living together 94.7 3,502 95.3 887 Divorced/separated/widowed 96.2 804 95.5 142 Employment status Currently working 97.1 2,393 93.2 1,439 Currently not working but worked in past 12 months 94.9 552 94.4 251 Has not worked in more than 12 months 92.9 3,457 88.5 732 Residence Urban 97.2 2,379 96.8 861 Rural 93.2 4,024 89.2 1,560 Ecological zone Lowlands 96.2 4,095 94.6 1,582 Foothills 93.0 659 88.1 218 Mountains 90.9 1,207 84.8 464 Senqu River Valley 93.1 442 91.1 157 District Butha-Buthe 93.6 360 89.1 126 Leribe 96.3 1,032 93.6 365 Berea 96.0 851 96.2 338 Maseru 96.4 1,839 95.3 744 Mafeteng 93.9 565 86.2 221 Mohale’s Hoek 92.3 510 91.4 188 Quthing 92.4 297 91.8 93 Qacha’s Nek 93.1 197 92.9 69 Mokhotlong 91.5 336 81.2 133 Thaba-Tseka 89.7 413 81.6 145 Education No education 81.7 61 83.7 175 Primary incomplete 87.2 1,113 84.4 763 Primary complete 94.9 1,318 94.3 284 Secondary 96.6 3,337 97.4 998 More than secondary 98.6 574 97.1 202 Wealth quintile Lowest 88.7 888 81.1 317 Second 91.6 980 90.5 416 Middle 94.7 1,203 92.5 491 Fourth 96.7 1,586 92.3 581 Highest 97.6 1,747 97.6 617 Total 15-49 94.7 6,403 91.9 2,421 50-59 na na 92.5 228 Total 15-59 na na 92.0 2,650 na = Not applicable Noncommunicable Diseases • 301 NONCOMMUNICABLE DISEASES 17 Key Findings  Breast cancer screening: One in 10 women (10%) age 15-49 have had a clinical exam for breast cancer in the past 12 months.  Cervical cancer screening: Eleven percent of women age 15-49 have had a Pap smear, 4% in the past 12 months.  Knowledge of diabetes: Most women (91%) and men (87%) age 15-49 have heard of diabetes, but 4 in 10 women (43%) and 5 in 10 men (53%) do not know any symptoms.  Blood pressure: Nineteen percent of women and 13% of men age 15-49 have hypertension. One in five women and one in seven men with hypertension (5% of all women and 2% of all men age 15-49) have their hypertension controlled with medication. oncommunicable diseases (NCDs) are a significant and growing burden on the health of individuals and populations worldwide. Screening and prevention are key tools in the control of NCDs. This chapter presents information on knowledge of breast cancer, experience with breast self-exams and clinical breast exams, knowledge of cervical cancer and experience with screening for cervical cancer via a Pap smear exam, knowledge and history of diabetes, and history of blood pressure screening and blood pressure status. Lesotho instituted its noncommunicable disease program in 2000. 17.1 KNOWLEDGE OF BREAST CANCER Most women (87%) and men (70%) age 15-49 in Lesotho have heard of breast cancer (Figure 17.1). However, only 16% of women and 17% of men who have heard of breast cancer know that both women and men can develop breast cancer (Tables 17.1.1 and 17.1.2). Patterns by background characteristics  Urban women (95%) and men (84%) are more likely to have heard of breast cancer than rural women (82%) and men (62%). N Figure 17.1 Knowledge of breast cancer by education 74 74 84 91 99 87 51 51 70 83 98 70 No education Primary incomplete Primary complete Secondary More than secondary Total Percentage of women and men age 15-49 who have heard of breast cancer Women Men 302 • Noncommunicable Diseases  There is a range in knowledge by district among both women and men. Thaba-Tseka has the lowest level of knowledge among districts for both women (73%) and men (48%). The highest levels of knowledge are 92% among women in Berea and Maseru and 79% among men in Leribe.  Knowledge of breast cancer increases with both education (Figure 17.1) and wealth among both sexes. 17.2 BREAST SELF-EXAMINATION AND CLINICAL EXAM Slightly fewer than 4 in 10 women age 15-49 (38%) have performed a breast self-exam in the past 12 months, and 1 in 10 women (10%) has had a clinical exam for breast cancer in the past 12 months (Table 17.2). Trends: The prevalence of self-exams has increased over time, from 26% in 2009 to 38% in 2014. Similarly, the prevalence of clinical breast exams has increased from 5% in 2009 to 10% in 2014. Patterns by background characteristics  The youngest women (age 15-19) are the least likely to have conducted a self-exam (30%) or to have had a clinical exam (6%) in the past 12 months.  Urban women are more likely than rural women to report conducting a self-exam (44% versus 34%) but only slightly more likely to report having a clinical exam (11% versus 9%).  The likelihood of having conducted a self-exam or having had a clinical exam generally increases with education and wealth. Fifteen percent of women with more than secondary education have had a clinical exam compared with 6-10% of women with less education. Likewise, 59% of women with more than secondary education have conducted a self-exam compared with 23-40% with less education. Women in the highest wealth quintile are more likely to conduct self-exams (47%) and have clinical exams (12%) than women in lower wealth categories (28-40% and 6-11%). 17.3 KNOWLEDGE OF AND EXPERIENCE WITH CERVICAL CANCER EXAM The Papanicolaou (Pap) smear exam is used to screen for cervical cancer, the leading cause of cancer deaths among women in the developing world. Less than half (47%) of women age 15-49 have heard of the Pap smear exam. Eleven percent have ever had a Pap smear, and 4% have had a Pap smear in the past 12 months (Table 17.3). Trends: While the proportion of women who have heard of the Pap smear exam has increased from 31% in 2009 to 47% in 2014, the proportion of women who have had a Pap smear in the past 12 months has decreased slightly from 6% in 2009 to 4% in 2014. Noncommunicable Diseases • 303 Patterns by background characteristics  Urban women are more likely than rural women to have heard of the Pap smear (58% versus 40%), to have ever had a Pap smear (15% versus 8%), or had a Pap smear in the past 12 months (5% versus 3%).  The likelihood of having heard of the Pap smear, having ever had a Pap smear, or having had a Pap smear in the past 12 months increases with education (Figure 17.2) and wealth. Women with more than secondary education (24%) and women in the highest wealth quintile (19%) are much more likely than women with lower levels of education (2-11%) or women in lower wealth quintiles (3-10%) to have ever had a Pap smear. 17.4 KNOWLEDGE AND HISTORY OF DIABETES Large majorities of women (91%) and men (87%) age 15-49 have heard of diabetes (Table 17.4). However, more than 4 in 10 women (43%) and 5 in 10 men (53%) do not know any symptoms (Table 17.5). Less than 1 percent of women and men have been diagnosed with diabetes by a doctor or a nurse (Table 17.6). Trends: The proportion of women who report having ever been diagnosed with diabetes by a doctor or nurse has changed only slightly since 2009 (2% in 2009 compared with 1% in 2014). 17.5 HISTORY OF HIGH BLOOD PRESSURE Three in 10 women (30%) and nearly 6 in 10 men (59%) age 15-49 report never having had their blood pressure measured. Most of those who have had their blood pressure measured report that the most recent measurement took place less than 6 months before the survey (62% of women and 47% of men). Seventeen percent of women and 11% of men whose blood pressure has ever been measured were told they had high blood pressure by a doctor or nurse, and nearly all women (95%) and men (93%) told they had high blood pressure report taking some action to lower their blood pressure (Table 17.7). The most common actions taken were to take medication they had been prescribed (77% of women and 60% of men), cut down on salt in food consumed (76% of women and 66% of men), and exercising (53% of women and 69% of men). Trends: The proportion of women who have had their blood pressure checked has increased, rising from 53% in 2009 to 70% in 2014. Figure 17.2 Knowledge of and experience with Pap smear by education 27 2 2 32 6 3 42 9 3 48 11 4 82 24 8 Heard of Pap smear Ever had a Pap smear Had Pap smear in past 12 months Percentage of women age 15-49 No education Primary incomplete Primary complete Secondary More than secondary 304 • Noncommunicable Diseases 17.6 BLOOD PRESSURE STATUS The 2014 LDHS asked a subset of women and all men if they would agree to have their blood pressure measured; almost all selected women (96%) and men (95%) age 15-49 consented (Table 17.8). Blood pressure status Systolic (mmHg) Diastolic (mmHg) Optimal <120 AND <80 Normal 120-129 OR 80-84 High normal 130-139 OR 85-89 Level of hypertension Grade 1, mildly elevated 140-159 OR 90-99 Grade 2, moderately elevated 160-179 OR 100-109 Grade 3, severely elevated 180+ OR 110+ Note: Respondents whose blood pressure would fall in two different rows based on their systolic and diastolic levels are classified according to the highest blood pressure row they fall in on either of those two measures. Individuals were classified as hypertensive if their systolic blood pressure was 140 mmHg or higher or if their diastolic blood pressure was 90 mmHg or higher. Elevated blood pressure was classified as mild, moderate, or severe, according to the cutoff points recommended by the World Health Organization and the National Institutes of Health (WHO 1999; NIH 1997). Following internationally recommended guidelines, individuals were also considered hypertensive if they had a normal average blood pressure reading but were taking antihypertensive medication. In Lesotho, 19% of women and 13% of men age 15-49 have hypertension. Five percent of women and 2% of men have normal blood pressure and are taking medication to control blood pressure (Tables 17.9.1 and 17.9.2). Patterns by background characteristics  As expected, the prevalence of hypertension generally increases with age among both women and men.  The prevalence of hypertension is higher in urban areas than in rural areas for both women (23% versus 18%) and men (16% versus 11%).  There is a larger difference in rates of hypertension between those who use tobacco and those who do not among women (29% versus 18%) than among men (14% versus 12%) (Tables 17.10.1 and 17.10.2).  More women (77%) than men (64%) with hypertension had previously been told by a doctor or a nurse that they had high blood pressure.  Rates of hypertension increase with BMI among both women and men (Figure 17.3). Figure 17.3 Hypertension and Body Mass Index (BMI) 6 6 13 11 25 24 34 47 Women Men Percentage of women and men age 15-49 with hypertension by BMI category Thin Normal Overweight Obese Noncommunicable Diseases • 305 LIST OF TABLES For detailed information on noncommunicable diseases, see the following tables:  Table 17.1.1 Knowledge of breast cancer: Women  Table 17.1.2 Knowledge of breast cancer: Men  Table 17.2 Breast self-exam and clinical exam  Table 17.3 Knowledge of, and experience with, the Pap smear exam  Table 17.4 Knowledge of diabetes  Table 17.5 Knowledge of specific symptoms of diabetes  Table 17.6 History of diabetes  Table 17.7 History of high blood pressure and actions taken to lower blood pressure  Table 17.8 Coverage of blood pressure measurement among women and men  Table 17.9.1 Blood pressure status: Women  Table 17.9.2 Blood pressure status: Men  Table 17.10.1 Blood pressure status by health status measures: Women  Table 17.10.2 Blood pressure status by health status measures: Men 306 • Noncommunicable Diseases Table 17.1.1 Knowledge of breast cancer: Women Percentage of women age 15-49 who have heard of breast cancer, and among women who have heard of breast cancer, the percentage who say women only, men only, or both women and men can get breast cancer; by background characteristics, Lesotho 2014 Has heard of breast cancer Number of women Among women who have heard of breast cancer, percentage who Background characteristics Says only women can get breast cancer Says only men can get breast cancer Says both women and men can get breast cancer Total Number of women Age 15-19 77.2 1,440 91.0 0.2 8.8 100.0 1,111 20-24 87.2 1,325 85.7 0.1 14.2 100.0 1,156 25-29 88.4 1,094 81.4 0.0 18.6 100.0 967 30-34 90.2 957 84.6 0.0 15.4 100.0 864 35-39 91.7 744 82.4 0.3 17.3 100.0 682 40-44 91.5 562 79.0 0.2 20.7 100.0 514 45-49 91.3 499 78.0 0.0 22.0 100.0 456 Marital status Never married 82.8 2,190 84.4 0.2 15.4 100.0 1,813 Married or living together 88.6 3,612 84.4 0.1 15.5 100.0 3,199 Divorced/separated/widowed 90.0 819 82.9 0.0 17.1 100.0 736 Residence Urban 94.9 2,419 80.5 0.1 19.3 100.0 2,297 Rural 82.2 4,202 86.7 0.1 13.2 100.0 3,452 Ecological zone Lowlands 93.1 4,184 82.4 0.1 17.5 100.0 3,894 Foothills 78.4 688 89.1 0.0 10.9 100.0 539 Mountains 74.8 1,288 88.5 0.1 11.4 100.0 963 Senqu River Valley 76.3 461 85.7 0.3 14.1 100.0 352 District Butha-Buthe 75.6 385 87.9 0.1 12.0 100.0 291 Leribe 91.2 1,064 87.1 0.1 12.8 100.0 970 Berea 92.1 892 81.3 0.0 18.7 100.0 822 Maseru 92.3 1,864 81.4 0.1 18.4 100.0 1,721 Mafeteng 90.0 576 84.2 0.2 15.6 100.0 518 Mohale’s Hoek 80.1 519 86.9 0.0 13.1 100.0 416 Quthing 78.0 315 81.8 0.4 17.9 100.0 245 Qacha’s Nek 79.0 204 84.4 0.5 15.0 100.0 161 Mokhotlong 78.6 349 86.1 0.0 13.9 100.0 274 Thaba-Tseka 72.8 452 91.5 0.0 8.5 100.0 329 Education No education 74.1 68 91.1 0.0 8.9 100.0 50 Primary incomplete 73.7 1,178 86.4 0.3 13.2 100.0 868 Primary complete 84.0 1,375 88.1 0.2 11.7 100.0 1,155 Secondary 90.7 3,418 85.3 0.0 14.7 100.0 3,099 More than secondary 99.2 581 67.0 0.2 32.8 100.0 577 Wealth quintile Lowest 70.1 960 91.0 0.1 9.0 100.0 673 Second 77.7 1,033 89.5 0.0 10.5 100.0 803 Middle 86.6 1,244 87.1 0.1 12.8 100.0 1,077 Fourth 92.7 1,605 84.4 0.1 15.5 100.0 1,488 Highest 96.0 1,778 77.1 0.2 22.7 100.0 1,707 Total 15-49 86.8 6,621 84.2 0.1 15.7 100.0 5,749 Noncommunicable Diseases • 307 Table 17.1.2 Knowledge of breast cancer: Men Percentage of men age 15-49 who have heard of breast cancer, and among men who have heard of breast cancer, the percentage who say women only, men only, or both women and men can get breast cancer; by background characteristics, Lesotho 2014 Has heard of breast cancer Number of men Among men who have heard of breast cancer, percentage who Background characteristics Say only women can get breast cancer Say only men can get breast cancer Say both women and men can get breast cancer Total Number of men Age 15-19 54.9 691 87.3 0.0 12.7 100.0 380 20-24 68.7 561 85.5 0.1 14.4 100.0 385 25-29 71.6 410 80.7 0.9 18.4 100.0 293 30-34 78.2 334 83.0 0.0 17.0 100.0 261 35-39 79.1 276 82.9 0.0 17.1 100.0 218 40-44 78.1 221 75.3 0.0 24.7 100.0 172 45-49 83.0 168 80.5 1.0 18.5 100.0 140 Marital status Never married 63.4 1,501 85.3 0.0 14.7 100.0 952 Married or living together 76.9 983 81.1 0.6 18.3 100.0 757 Divorced/separated/widowed 80.1 176 78.9 0.0 21.1 100.0 141 Residence Urban 84.0 920 81.5 0.3 18.2 100.0 772 Rural 61.9 1,741 84.3 0.2 15.6 100.0 1,077 Ecological zone Lowlands 79.2 1,711 83.5 0.3 16.2 100.0 1,355 Foothills 58.7 252 81.9 0.0 18.1 100.0 148 Mountains 48.5 523 83.6 0.0 16.4 100.0 254 Senqu River Valley 53.7 174 77.6 0.4 22.0 100.0 93 District Butha-Buthe 55.1 143 80.3 0.0 19.7 100.0 79 Leribe 79.1 390 85.5 0.0 14.5 100.0 308 Berea 75.2 379 84.1 0.5 15.4 100.0 285 Maseru 78.4 809 83.1 0.4 16.5 100.0 634 Mafeteng 68.2 242 80.5 0.0 19.5 100.0 165 Mohale’s Hoek 55.2 202 87.8 0.0 12.2 100.0 112 Quthing 60.7 105 75.7 0.0 24.3 100.0 64 Qacha’s Nek 61.3 74 80.3 0.8 18.9 100.0 46 Mokhotlong 52.0 144 81.2 0.0 18.8 100.0 75 Thaba-Tseka 48.0 172 81.6 0.0 18.4 100.0 82 Education No education 51.3 213 77.4 0.0 22.6 100.0 109 Primary incomplete 51.4 875 81.8 0.0 18.2 100.0 450 Primary complete 70.2 316 85.5 0.0 14.5 100.0 222 Secondary 82.5 1,043 87.2 0.5 12.3 100.0 860 More than secondary 97.9 214 69.7 0.0 30.3 100.0 209 Wealth quintile Lowest 45.7 376 86.9 0.0 13.1 100.0 172 Second 59.6 479 82.0 0.0 18.0 100.0 285 Middle 69.0 536 86.4 0.5 13.1 100.0 370 Fourth 76.1 616 86.4 0.5 13.1 100.0 469 Highest 84.8 654 77.6 0.0 22.4 100.0 555 Total 15-49 69.5 2,660 83.1 0.2 16.6 100.0 1,850 50-59 79.9 271 71.6 1.1 27.3 100.0 216 Total 15-59 70.5 2,931 81.9 0.3 17.8 100.0 2,066 308 • Noncommunicable Diseases Table 17.2 Breast self-exam and clinical exam Percentage of women age 15-49 who performed a breast self-exam in the past 12 months and percentage of women who had a breast cancer clinical exam in the past 12 months, by background characteristics, Lesotho 2014 Background characteristics Percentage of women who performed breast self-exam in the past 12 months Percentage of women who had a breast cancer clinical exam in the past 12 months Number of women Age 15-19 29.9 5.8 1,440 20-24 35.8 10.5 1,325 25-29 42.3 11.5 1,094 30-34 40.3 12.0 957 35-39 42.0 9.7 744 40-44 42.1 10.9 562 45-49 35.6 8.8 499 Marital status Never married 33.7 6.2 2,190 Married or living together 39.7 11.8 3,612 Divorced/separated/widowed 37.5 9.7 819 Residence Urban 43.7 10.7 2,419 Rural 33.9 9.1 4,202 Ecological zone Lowlands 41.9 10.9 4,184 Foothills 28.1 7.4 688 Mountains 30.5 7.6 1,288 Senqu River Valley 30.4 8.1 461 District Butha-Buthe 21.5 9.8 385 Leribe 38.2 9.7 1,064 Berea 40.8 9.3 892 Maseru 43.0 11.1 1,864 Mafeteng 40.2 11.3 576 Mohale’s Hoek 34.2 7.2 519 Quthing 30.0 9.5 315 Qacha’s Nek 37.8 6.6 204 Mokhotlong 33.5 8.4 349 Thaba-Tseka 28.0 7.6 452 Education No education 22.9 6.0 68 Primary incomplete 28.5 7.8 1,178 Primary complete 31.6 9.2 1,375 Secondary 39.6 9.6 3,418 More than secondary 58.8 15.3 581 Wealth quintile Lowest 28.0 6.2 960 Second 27.8 8.4 1,033 Middle 36.2 10.8 1,244 Fourth 40.3 9.7 1,605 Highest 46.6 11.5 1,778 Total 37.5 9.7 6,621 Noncommunicable Diseases • 309 Table 17.3 Knowledge of, and experience with, the Pap smear exam Percentage of women age 15-49 who have heard of the Pap smear, percentage of women who have had a Pap smear, and percentage of women who have had a Pap smear in the past 12 months, by background characteristics, Lesotho 2014 Background characteristics Percentage who have heard of the Pap smear Percentage who have ever had a Pap smear Percentage who have had a Pap smear in the past 12 months Number of women Age 15-19 23.0 3.5 1.9 1,440 20-24 42.1 5.3 2.4 1,325 25-29 51.9 9.8 4.2 1,094 30-34 60.6 14.6 6.8 957 35-39 56.9 15.5 4.1 744 40-44 60.9 20.1 6.4 562 45-49 59.7 20.3 5.4 499 Marital status Never married 36.6 4.6 1.8 2,190 Married or living together 50.6 13.3 5.0 3,612 Divorced/separated/widowed 57.7 14.0 5.5 819 Residence Urban 58.4 14.6 5.3 2,419 Rural 40.2 8.2 3.2 4,202 Ecological zone Lowlands 54.6 13.2 5.0 4,184 Foothills 34.8 5.6 1.7 688 Mountains 30.2 5.0 2.5 1,288 Senqu River Valley 40.5 9.1 2.6 461 District Butha-Buthe 40.3 7.3 3.4 385 Leribe 49.1 10.9 3.2 1,064 Berea 57.0 15.2 6.5 892 Maseru 53.0 13.0 4.8 1,864 Mafeteng 45.4 9.5 4.1 576 Mohale’s Hoek 45.8 8.0 1.6 519 Quthing 36.5 7.2 3.3 315 Qacha’s Nek 36.8 5.7 1.8 204 Mokhotlong 31.9 5.4 3.8 349 Thaba-Tseka 27.9 5.6 2.2 452 Education No education 26.9 2.4 2.4 68 Primary incomplete 31.5 6.0 2.6 1,178 Primary complete 42.0 8.9 3.1 1,375 Secondary 48.4 10.6 4.2 3,418 More than secondary 82.3 24.1 7.9 581 Wealth quintile Lowest 24.9 3.1 1.5 960 Second 36.1 5.9 2.7 1,033 Middle 43.9 9.0 3.4 1,244 Fourth 51.4 9.9 4.0 1,605 Highest 62.9 18.9 6.4 1,778 Total 46.8 10.5 4.0 6,621 310 • Noncommunicable Diseases Table 17.4 Knowledge of diabetes Percentage of women and men age 15-49 who have heard of diabetes, by background characteristics, Lesotho 2014 Women Men Background characteristics Have heard of diabetes Number Have heard of diabetes Number Age 15-19 85.1 1,440 77.9 691 20-24 90.6 1,325 87.8 561 25-29 91.6 1,094 91.8 410 30-34 94.5 957 91.2 334 35-39 94.7 744 88.7 276 40-44 94.2 562 91.6 221 45-49 95.9 499 89.3 168 Marital status Never married 89.2 2,190 83.9 1,501 Married or living together 92.2 3,612 90.1 983 Divorced/separated/widowed 92.8 819 92.9 176 Residence Urban 95.5 2,419 94.4 920 Rural 88.9 4,202 82.8 1,741 Ecological zone Lowlands 94.7 4,184 91.5 1,711 Foothills 88.3 688 81.2 252 Mountains 82.9 1,288 74.7 523 Senqu River Valley 88.4 461 84.7 174 District Butha-Buthe 81.3 385 69.4 143 Leribe 94.5 1,064 89.3 390 Berea 90.5 892 83.6 379 Maseru 96.0 1,864 95.7 809 Mafeteng 94.3 576 89.2 242 Mohale’s Hoek 88.4 519 83.7 202 Quthing 90.6 315 87.1 105 Qacha’s Nek 89.1 204 84.7 74 Mokhotlong 82.7 349 75.9 144 Thaba-Tseka 82.3 452 70.8 172 Education No education 83.9 68 77.7 213 Primary incomplete 84.6 1,178 80.0 875 Primary complete 89.9 1,375 85.6 316 Secondary 93.0 3,418 92.2 1,043 More than secondary 98.7 581 98.8 214 Wealth quintile Lowest 79.9 960 72.9 376 Second 86.3 1,033 83.3 479 Middle 93.0 1,244 85.6 536 Fourth 94.6 1,605 90.7 616 Highest 96.3 1,778 94.6 654 Total 15-49 91.3 6,621 86.8 2,660 50-59 na na 93.8 271 Total 15-59 na na 87.4 2,931 na = Not applicable Noncommunicable Diseases • 311 Table 17.5 Knowledge of specific symptoms of diabetes Among women and men age 15-49, percentage who cite specific symptoms of diabetes, Lesotho 2014 Women Men Symptom of diabetes Frequent urination 14.2 6.7 Feeling very thirsty 17.7 6.7 Feeling very hungry 7.1 4.2 Extreme fatigue 6.3 4.3 Blurry vision 5.5 3.9 Cuts/bruises slow to heal 16.1 11.5 Weight loss 8.1 5.3 Pain/tingling/numbness in hands and feet 3.5 3.0 Other 10.2 9.6 Don’t know 43.3 52.5 Number of respondents 6,621 2,660 Table 17.6 History of diabetes Percent distribution of women and men age 15-49 by history of diabetes, and, among women and men diagnosed with diabetes and receiving medication, the method of taking medicine, Lesotho 2014 Women Men History of diabetes Told had diabetes by a doctor or a nurse 0.9 0.5 Receiving treatment 0.5 0.2 Not receiving treatment 0.3 0.3 Never told had diabetes 99.1 99.5 Total 100.0 100.0 Number of respondents 6,621 2,660 Method of taking medicine Injected (20.0) * Orally (66.7) * Both injected and orally (13.3) * Total 100.0 100.0 Number of respondents diagnosed with diabetes and receiving treatment 36 5 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. 312 • Noncommunicable Diseases Table 17.7 History of high blood pressure and actions taken to lower blood pressure Percent distribution of women and men age 15-49 by whether or not they have ever had their blood pressure measured, and among those who have had their blood pressure measured, when the last check was performed and who performed the check; among women and men age 15-49, the percentage who were ever told by a doctor or nurse that they have high blood pressure and, among those told they had high blood pressure, the percentage taking various actions to lower their blood pressure, Lesotho 2014 History of high blood pressure and actions taken to treat hypertension Women Men History of high blood pressure Percentage never measured 29.9 58.5 Percentage who have ever had blood pressure measured 70.1 41.5 Total 100.0 100.0 Number of respondents 6,621 2,660 When last had blood pressure checked Less than 6 months ago 61.7 46.9 6 - 11 months ago 16.0 17.5 1 - 5 years ago 20.5 31.4 More than 5 years ago 1.8 3.9 Don’t know 0.0 0.4 Total 100.0 100.0 Number of respondents who ever had blood pressure checked 4,645 1,104 Person who last checked blood pressure Doctor/nurse 96.6 94.0 Pharmacist 1.2 0.6 Self 0.2 0.6 Other 1.9 4.3 Don’t know 0.1 0.5 Total 100.0 100.0 Number of respondents who ever had blood pressure checked 4,645 1,104 Ever told had high blood pressure by doctor/nurse Percentage ever told had high blood pressure 17.3 11.4 Percentage told does not have high blood pressure 82.7 88.6 Total 100.0 100.0 Number of respondents who ever had blood pressure checked 4,645 1,104 Actions taken to lower blood pressure Percentage taking some action to lower blood pressure 94.9 93.0 Taking prescribed medication 76.8 60.1 Controlling weight/losing weight 38.5 48.5 Cutting down on salt in diet 76.0 66.1 Exercising 53.4 69.2 Cut down alcohol 19.5 41.0 Stopped smoking 12.9 24.4 Taking traditional medicine/herbs 26.9 38.2 Number of respondents with a history of high blood pressure 806 126 Noncommunicable Diseases • 313 Table 17.8 Coverage of blood pressure measurement among women and men Percentage of eligible women and men age 15-49 who were measured for blood pressure, by background characteristics (unweighted), Lesotho 2014 Women Men Background characteristics Percentage measured for blood pressure Number of women Percentage measured for blood pressure Number of men Age 15-19 97.4 806 95.4 690 20-24 95.2 650 96.4 534 25-29 95.3 558 91.6 394 30-34 96.6 475 94.8 345 35-39 97.3 369 95.6 275 40-44 95.7 302 94.6 222 45-49 96.1 258 94.0 166 Marital status Never married 96.7 1,120 95.6 1,464 Ever married 96.1 2,298 93.8 1,162 Residence Urban 96.6 1,120 95.1 821 Rural 96.1 2,298 94.7 1,805 Ecological zone Lowlands 96.5 1,676 95.3 1,348 Foothills 95.3 343 92.2 258 Mountains 96.9 991 96.0 734 Senqu River Valley 94.9 408 92.0 286 District Butha-Buthe 93.0 315 91.0 222 Leribe 98.7 394 97.2 283 Berea 98.4 382 97.2 326 Maseru 95.2 476 93.0 427 Mafeteng 97.1 312 95.9 268 Mohale’s Hoek 95.5 334 95.0 241 Quthing 91.0 301 89.8 187 Qacha’s Nek 99.3 277 99.5 201 Mokhotlong 98.4 317 96.3 241 Thaba-Tseka 95.8 310 92.6 230 Education No education 97.6 42 94.9 237 Primary incomplete 96.3 648 94.2 911 Primary complete 97.1 735 95.9 317 Secondary 96.1 1,726 95.1 972 More than secondary 94.8 267 94.7 189 Wealth quintile Lowest 96.4 591 92.5 468 Second 97.1 623 98.0 501 Middle 96.8 664 94.1 542 Fourth 95.4 747 94.7 550 Highest 95.8 793 94.7 565 Total 15-49 96.3 3,418 94.8 2,626 50-59 na na 96.1 305 Total 15-59 na na 95.0 2,931 na = Not applicable 314 • Noncommunicable Diseases Table 17.9.1 Blood pressure status: Women Among women age 15-49, prevalence of hypertension, percent distribution of blood pressure values, and percentage having normal blood pressure and taking medication, by background characteristics, Lesotho, 2014 Classification of blood pressure Normal blood pressure and taking medication Number of women Prevalence of hypertension1 Normal Elevated Total Socioeconomic characteristics Optimal <120/<80 mmHg Normal 120-129/ 80-84 mmHg High normal 130-139/ 85-89 mmHg Mildly elevated (Grade 1) 140-159/ 90-99 mmHg Moderately elevated (Grade 2) 160-179/ 100-109 mmHg Severely elevated (Grade 3) 180+/ 110+ mmHg Age 15-19 6.2 65.3 18.4 11.2 4.3 0.6 0.1 100.0 1.3 724 20-24 12.6 57.1 24.5 10.4 7.0 1.0 0.0 100.0 4.6 641 25-29 17.5 53.8 22.9 10.2 10.8 1.8 0.4 100.0 4.8 539 30-34 21.9 42.1 22.6 17.6 13.8 1.6 2.4 100.0 6.6 476 35-39 27.5 38.2 22.6 13.9 17.2 5.5 2.6 100.0 4.8 347 40-44 36.3 38.8 16.3 11.6 20.1 10.5 2.7 100.0 5.7 280 45-49 43.5 20.9 22.9 15.4 22.2 12.0 6.7 100.0 9.3 247 Marital status Never married 11.2 59.1 21.1 11.3 7.5 0.8 0.2 100.0 2.9 1,072 Ever married 23.3 45.3 21.8 13.0 13.3 4.5 2.1 100.0 5.5 2,182 Residence Urban 22.5 49.3 20.4 11.7 13.8 3.6 1.2 100.0 5.1 1,140 Rural 17.6 50.1 22.2 12.9 10.1 3.1 1.6 100.0 4.4 2,114 Ecological zone Lowlands 21.0 50.7 20.4 11.7 12.1 3.6 1.6 100.0 5.4 2,037 Foothills 16.8 45.7 25.9 13.9 9.6 2.9 2.2 100.0 4.4 326 Mountains 15.3 50.2 23.1 13.1 10.9 1.7 1.0 100.0 2.8 654 Senqu River Valley 18.9 47.9 21.5 15.1 9.3 5.3 0.8 100.0 4.3 237 District Butha-Buthe 16.6 43.2 27.1 14.9 12.1 1.5 1.1 100.0 2.9 190 Leribe 16.3 52.2 23.4 10.5 9.1 2.7 2.0 100.0 4.5 531 Berea 20.3 52.6 23.0 6.9 11.1 5.8 0.6 100.0 3.4 435 Maseru 25.0 48.0 19.0 12.7 15.1 3.4 1.9 100.0 6.5 890 Mafeteng 19.0 50.5 17.0 16.9 10.8 2.9 2.0 100.0 5.4 281 Mohale’s Hoek 15.0 52.4 22.0 13.4 9.4 1.7 1.2 100.0 4.0 270 Quthing 21.6 45.9 20.2 14.5 11.8 5.6 2.0 100.0 4.1 152 Qacha’s Nek 16.2 52.8 20.4 11.5 9.3 2.9 3.1 100.0 4.0 99 Mokhotlong 14.6 50.6 24.4 13.3 10.3 1.3 0.1 100.0 3.0 176 Thaba-Tseka 13.6 49.0 24.4 16.5 7.0 3.1 0.0 100.0 3.5 229 Education No education (42.3) (41.2) (26.6) (5.3) (17.1) (9.8) (0.0) 100.0 (15.4) 36 Primary incomplete 16.2 50.3 23.7 12.7 9.2 2.5 1.5 100.0 4.4 562 Primary complete 23.7 46.4 20.1 12.9 13.9 4.0 2.7 100.0 5.8 708 Secondary 17.1 52.3 21.3 12.4 10.0 3.0 1.0 100.0 4.0 1,687 More than secondary 25.4 43.9 22.0 11.8 17.4 3.5 1.4 100.0 4.5 260 Wealth quintile Lowest 15.0 52.3 22.7 11.9 9.6 2.7 0.8 100.0 2.7 466 Second 15.5 45.4 25.7 15.9 9.7 1.8 1.5 100.0 3.9 538 Middle 17.5 51.9 20.8 12.1 9.2 4.1 1.8 100.0 4.2 623 Fourth 21.9 49.9 20.6 11.3 13.9 2.7 1.6 100.0 5.3 785 Highest 23.1 49.8 19.7 11.9 12.7 4.4 1.4 100.0 5.9 841 Total 19.3 49.9 21.6 12.5 11.4 3.3 1.4 100.0 4.7 3,254 Note: Figures in parentheses are based on 25-49 unweighted cases. 1 An individual was classified as having hypertension if he/she had a systolic blood pressure level of 140 mmHg or above or a diastolic blood pressure level of 90 mmHg or above at the time of the survey or was currently taking antihypertensive medication to control his/her blood pressure. The term hypertension as used in this table is not meant to represent a clinical diagnosis of the disease; rather, it provides an indication of the disease burden in the population at the time of the survey. Noncommunicable Diseases • 315 Table 17.9.2 Blood pressure status: Men Among men age 15-49, prevalence of hypertension, percent distribution of blood pressure values, and percentage having normal blood pressure and taking medication, by background characteristics, Lesotho, 2014 Classification of blood pressure Normal blood pressure and taking medication Number of men Prevalence of hypertension1 Normal Elevated Total Background characteristics Optimal <120/ <80 mmHg Normal 120-129/ 80-84 mmHg High normal 130-139/ 85-89 mmHg Mildly elevated (Grade 1) 140-159/ 90-99 mmHg Moderately elevated (Grade 2) 160-179/ 100-109 mmHg Severely elevated (Grade 3) 180+/ 110+ mmHg Age 15-19 4.6 58.8 25.1 11.5 4.3 0.4 0.0 100.0 0.0 658 20-24 12.3 42.1 32.2 13.8 10.3 1.4 0.2 100.0 0.7 538 25-29 10.5 40.0 30.7 18.6 8.7 0.9 1.1 100.0 1.0 375 30-34 16.8 38.5 29.5 18.7 12.1 1.1 0.0 100.0 3.6 310 35-39 19.3 40.4 25.4 16.5 12.8 2.8 2.1 100.0 3.6 261 40-44 24.9 39.4 18.8 21.5 17.0 2.8 0.4 100.0 5.1 206 45-49 18.5 29.5 31.3 22.4 10.0 4.2 2.7 100.0 4.3 159 Marital status Never married 9.6 48.0 29.1 13.7 7.9 1.0 0.2 100.0 0.6 1,437 Ever married 17.0 39.9 26.4 18.9 11.6 2.0 1.2 100.0 3.4 1,071 Residence Urban 16.2 39.9 28.8 16.8 12.1 1.9 0.6 100.0 2.2 851 Rural 11.0 46.9 27.5 15.6 8.2 1.2 0.6 100.0 1.6 1,657 Ecological zone Lowlands 13.7 42.8 27.6 16.9 10.2 1.8 0.7 100.0 1.7 1,612 Foothills 10.3 46.4 30.6 15.1 7.3 0.1 0.5 100.0 2.9 235 Mountains 9.7 48.5 27.3 15.4 7.3 0.8 0.7 100.0 1.7 502 Senqu River Valley 15.6 46.7 29.7 9.3 12.4 1.8 0.0 100.0 1.3 159 District Butha-Buthe 12.0 53.1 22.2 14.8 8.3 1.4 0.3 100.0 2.3 131 Leribe 9.4 45.6 27.5 18.1 5.8 1.8 1.2 100.0 1.8 379 Berea 12.2 42.6 29.6 15.7 8.5 2.1 1.4 100.0 1.6 366 Maseru 15.2 41.6 28.7 16.4 11.9 1.0 0.3 100.0 2.2 746 Mafeteng 13.2 45.8 26.3 16.0 9.4 1.7 0.8 100.0 2.1 230 Mohale’s Hoek 10.6 45.3 28.0 16.1 10.0 0.7 0.0 100.0 0.0 192 Quthing 13.2 43.1 30.6 13.4 9.4 2.5 0.9 100.0 1.3 94 Qacha’s Nek 15.2 48.1 26.9 12.8 9.8 2.4 0.0 100.0 3.0 74 Mokhotlong 11.5 46.6 27.8 16.7 7.9 0.6 0.3 100.0 3.0 139 Thaba-Tseka 12.9 47.8 27.5 12.3 11.0 1.3 0.1 100.0 0.6 157 Education No education 15.5 46.6 26.1 12.0 11.9 0.8 2.5 100.0 2.8 203 Primary incomplete 9.9 47.5 27.8 15.4 7.9 0.9 0.3 100.0 1.1 822 Primary complete 11.5 44.6 27.5 17.9 9.2 0.4 0.5 100.0 1.9 304 Secondary 13.0 44.7 27.8 15.4 9.5 2.0 0.6 100.0 1.5 978 More than secondary 22.4 29.0 31.4 21.7 14.1 3.2 0.6 100.0 5.0 200 Wealth quintile Lowest 11.4 48.4 26.8 14.0 9.2 0.8 0.8 100.0 1.4 349 Second 10.2 45.1 27.7 17.7 7.6 1.1 0.8 100.0 1.4 471 Middle 9.5 49.8 24.6 17.0 7.3 0.5 0.8 100.0 1.6 503 Fourth 12.9 45.0 29.2 14.0 9.3 2.4 0.2 100.0 1.3 578 Highest 18.1 37.1 30.4 16.6 13.2 1.9 0.7 100.0 3.0 608 Total 15-49 12.7 44.5 27.9 16.0 9.5 1.4 0.6 100.0 1.8 2,508 50-59 33.9 27.0 23.1 17.8 22.5 7.9 1.8 100.0 3.6 259 Total 15-59 14.7 42.9 27.5 16.1 10.7 2.0 0.7 100.0 2.0 2,767 1 An individual was classified as having hypertension if he/she had a systolic blood pressure level of 140 mmHg or above or a diastolic blood pressure level of 90 mmHg or above at the time of the survey or was currently taking antihypertensive medication to control his/her blood pressure. The term hypertension as used in this table is not meant to represent clinical diagnosis of the disease; rather, it provides an indication of the disease burden in the population at the time of the survey. 316 • Noncommunicable Diseases Table 17.10.1 Blood pressure status by health status measures: Women Among women age 15-49, prevalence of hypertension, percent distribution of blood pressure values, and percentage having normal blood pressure and taking medication, by health status measures, Lesotho 2014 Classification of blood pressure Normal blood pressure and taking medication Number of women Prevalence of hypertension1 Normal Elevated Total Health status measures Optimal <120/<80 mmHg Normal 120-129/ 80-84 mmHg High normal 130-139/ 85-89 mmHg Mildly elevated (Grade 1) 140-159/ 90-99 mmHg Moderately elevated (Grade 2) 160- 179/ 100-109 mmHg Severely elevated (Grade 3) 180+/ 110+ mmHg Use of tobacco products Uses tobacco products 28.6 46.6 19.2 10.8 13.1 7.4 2.9 100.0 8.2 298 Does not use tobacco products 18.4 50.2 21.8 12.6 11.2 2.9 1.3 100.0 4.3 2,956 History of hypertension Told had high blood pressure by a doctor or a nurse 77.4 18.0 17.0 16.3 25.0 14.6 9.1 100.0 37.7 402 Never told had high blood pressure 11.1 54.4 22.2 11.9 9.5 1.7 0.4 100.0 0.0 2,851 Nutritional status Thin (BMI<18.5) 6.1 78.8 9.0 8.5 2.3 1.4 0.0 100.0 2.4 128 Normal (BMI 18.5-24.9) 12.7 57.4 21.4 11.0 8.1 1.6 0.5 100.0 3.0 1,565 Overweight (BMI 25.0-29.9) 24.7 43.2 23.3 13.9 14.2 4.3 1.1 100.0 6.2 759 Obese (BMI ≥ 30.0 ) 33.8 27.4 22.2 17.7 20.2 7.5 5.0 100.0 6.1 588 Not eligible (pregnant or recent birth) 14.0 63.9 21.2 4.9 7.5 1.7 0.7 100.0 4.7 181 Total 15-49 19.3 49.9 21.6 12.5 11.4 3.3 1.4 100.0 4.7 3,254 Note: Total includes 33 women for whom nutritional status information was out of range. 1 An individual was classified as having hypertension if he/she had a systolic blood pressure level of 140 mmHg or above or a diastolic blood pressure level of 90 mmHg or above at the time of the survey or was currently taking antihypertensive medication to control his/her blood pressure. The term hypertension as used in this table is not meant to represent clinical diagnosis of the disease; rather, it provides an indication of the disease burden in the population at the time of the survey. Noncommunicable Diseases • 317 Table 17.10.2 Blood pressure status by health status measures: Men Among men age 15-49, prevalence of hypertension, percent distribution of blood pressure values, and percentage having normal blood pressure and taking medication, by health status measures, Lesotho 2014 Classification of blood pressure Normal blood pressure and taking medication Number of men Prevalence of hypertension1 Normal Elevated Total Health status measures Optimal <120/ <80 mmHg Normal 120-129/ 80-84 mmHg High normal 130-139/ 85-89 mmHg Mildly elevated (Grade 1) 140-159/ 90-99 mmHg Moderately elevated (Grade 2) 160-179/ 100-109 mmHg Severely elevated (Grade 3) 180+/ 110+ mmHg Use of tobacco products Uses tobacco products 13.8 42.6 28.6 15.9 10.3 1.7 0.9 100.0 1.8 1,047 Does not use tobacco products 12.0 45.9 27.4 16.0 8.9 1.3 0.4 100.0 1.8 1,461 History of hypertension Told had high blood pressure by a doctor or a nurse 64.1 14.6 25.3 32.8 17.9 5.9 3.6 100.0 40.4 112 Never told had high blood pressure 10.3 45.9 28.1 15.2 9.1 1.2 0.5 100.0 0.0 2,395 Nutritional status Thin (BMI<18.5) 5.9 65.0 19.8 9.3 4.9 0.5 0.4 100.0 0.5 354 Normal (BMI 18.5-24.9) 11.4 44.3 29.5 15.8 8.7 1.1 0.5 100.0 1.6 1,821 Overweight (BMI 25.0-29.9) 23.8 22.8 31.6 23.0 17.7 4.2 0.7 100.0 1.9 211 Obese (BMI ≥ 30.0 ) 46.9 14.0 21.2 27.0 29.1 4.4 4.3 100.0 13.4 74 Total 15-49 12.7 44.5 27.9 16.0 9.5 1.4 0.6 100.0 1.8 2,508 50-59 33.9 27.0 23.1 17.8 22.5 7.9 1.8 100.0 3.6 259 Total 15-59 14.7 42.9 27.5 16.1 10.7 2.0 0.7 100.0 2.0 2,767 Note: Total includes 47 men for whom nutritional status information was out of range. 1 An individual was classified as having hypertension if he/she had a systolic blood pressure level of 140 mmHg or above or a diastolic blood pressure level of 90 mmHg or above at the time of the survey or was currently taking antihypertensive medication to control his/her blood pressure. 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World Health Organization (WHO) Multicentre Growth Reference Study Group. 2006. WHO Child Growth Standards: Length/Height-for-Age, Weight-for-Age, Weight-for-Length, Weight-for-Height and Body Mass Index-for-Age: Methods and Development. Geneva: WHO. World Health Organization (WHO) and Joint United Nations Program on HIV/AIDS (UNAIDS). 2007. New Data on Male Circumcision and HIV Prevention: Policy and Programme Implications. Geneva: WHO and UNAIDS. Appendix A • 321 SAMPLE DESIGN Appendix A A.1 INTRODUCTION he 2014 Lesotho Demographic and Health Survey (2014 LDHS) is the third DHS conducted in Lesotho and follows surveys carried out in 2004 and 2009. The 2014 LDHS was designed to provide up-to-date information on key indicators needed to track progress in Lesotho’s population and health programmes. These indicators include fertility and child mortality levels, maternal mortality, fertility preferences and contraceptive use, utilisation of maternal and child health services, women’s and children’s nutrition status and knowledge, and attitudes and behaviours relating to HIV/AIDS and other sexually transmitted diseases. To obtain these data, a nationally representative sample of households was selected. All women age 15-49 who were usual residents of the sampled households or stayed in the households on the night before the interview were eligible for interview in the LDHS. In addition, in a subsample of households (every second household), all men age 15-59 who were usual residents of the households or stayed in the households on the night before the interview were eligible for interview. In the subsample of households selected for the male survey, all women and men who were eligible for the individual survey were asked to consent to provide a blood sample for HIV and anaemia testing. Women and men in this subsample were also weighed and measured and asked to consent to blood pressure measurement. In addition, all children under age 5 in the subsample were weighed; their height/length and mid-upper arm circumference were measured; and with consent from their parents or guardians, all children 6-59 months were tested for anaemia. The survey was designed to provide representative estimates for main demographic and health indicators for the country as a whole, for the urban and rural areas separately, for each of the four ecological zones, and for each of the ten administrative districts. A.2 SAMPLE FRAME The 2014 LDHS sample was selected using a stratified, two-stage cluster design. The frame used for the first stage of the selection of the 2014 LDHS sample was based on an updated version of the 2006 Population and Housing Census (2006 PHC), provided by the Lesotho Bureau of Statistics (BOS). The frame file is a complete list of all census enumeration areas (EAs) within the territory of Lesotho, with identification information, administrative unit, and a measure of size (the number of residential households located in each EA). The updating consisted of combining small census EAs to form EAs of an adequate size, that is, a size of about 100 households per EA. The small size of the EAs and the availability of sketch maps and other materials to delimit their geographic boundaries made the census EA an ideal unit for use as the first stage sampling unit of the LDHS sample. Households were the units for second-stage sampling. Lesotho is administratively divided into 10 districts; each district is subdivided into a number of constituencies, and each constituency into a number of community councils. Table A.1 shows the distribution of households by district and by type of residence as described in the updated 2006 census frame. The size of the districts by total number of households varies greatly, ranging from a low of 3.4% for Qacha’s Nek to a high of 26.6% for Maseru. The urbanisation of the districts also varies greatly, ranging from a low of 6.8% urban households in Thaba-Tseka district to a high of 54.1% urban households in Maseru. Overall, 29.8% of the households in Lesotho are located in urban areas. T 322 • Appendix A Table A.2 presents the distribution of EAs and their average size in number of households in the sample frame by district and residence. In total, there are 4,097 EAs in Lesotho; 1,107 are urban, and 2,990 are rural. The average EA size is 110 households; the average urban EA size is 121 households, and the average rural EA is 106 households. Table A.1 Household distribution Distribution of residential households in the sampling frame by district and by type of residence, the percentage of each district that is urban, and the percentage that each district contributes to the total household number, Lesotho 2014 District Household distribution Percentage of district that is urban Percentage district contributes to the total number of households Urban Rural District Butha-Buthe 5692 20106 25798 22.1 5.7 Leribe 19019 52957 71976 26.4 16.0 Berea 18447 41393 59840 30.8 13.3 Maseru 64838 55067 119905 54.1 26.6 Mafeteng 9068 34772 43840 20.7 9.7 Mohale’s Hoek 6351 32459 38810 16.4 8.6 Quthing 3675 21973 25648 14.3 5.7 Qacha’s Nek 2742 12423 15165 18.1 3.4 Mokhotlong 2437 18871 21308 11.4 4.7 Thaba-Tseka 1908 25981 27889 6.8 6.2 Lesotho 134177 316002 450179 29.8 100.0 Table A.2 Enumeration areas and households Distribution of the enumeration areas (EAs) and households in the sampling frame by district and residence, Lesotho 2014 District Number of EAs Average EA size Urban Rural District Urban Rural District Butha-Buthe 49 184 233 116 109 111 Leribe 161 468 629 118 113 114 Berea 153 363 516 121 114 116 Maseru 518 514 1032 125 107 116 Mafeteng 81 301 382 112 116 115 Mohale’s Hoek 56 343 399 113 95 97 Quthing 28 230 258 131 96 99 Qacha’s Nek 24 129 153 114 96 99 Mokhotlong 22 200 222 111 94 96 Thaba-Tseka 15 258 273 127 101 102 Lesotho 1107 2990 4097 121 106 110 A.3 SAMPLE DESIGN AND IMPLEMENTATION The sample for 2014 LDHS was a stratified sample selected in two stages. Stratification was achieved by separating each district into urban and rural areas; in total, 20 sampling strata were created. Samples were selected independently in each sampling stratum, by a two-stage selection process. In the first stage, 400 EAs were selected with a probability proportional to size and with independent selection in each sampling stratum. The EA size is the number of residential households in the EA during the 2006 PHC. Implicit stratification was achieved at each of the lower administrative unit levels by sorting the sampling frame before the sample selection, according to ecological zone and lower level administrative units, within each of the explicit stratum, and by using a probability proportional to size selection procedure. After the selection of EAs and before the main survey, a household listing operation was carried out in all selected EAs, and the resulting lists of households served as the sampling frame for the selection of households in the second stage. If an EA was too large to be a DHS cluster (>200 households), the EA was divided into smaller segments following specified guidelines, and one of the resulting segments was selected with Appendix A • 323 probability proportional to size. The household listing was conducted only in the selected segment, and the listing of the segment was then used to select the final household sample. So a 2014 LDHS cluster was either an EA or a segment of an EA. In the second stage of selection, a fixed number of 25 households were selected in every urban and rural cluster, by an equal probability systematic sampling. A spreadsheet indicating the selected household numbers for each cluster was prepared. The survey interviewers were asked to interview only the pre-selected households. To prevent bias, replacements and changes of the pre-selected households were not allowed. Table A.3 shows the sample allocation of EAs and households, by district and by type of residence. The sample allocation was a power allocation (with the number of households as a measure of size) with small adjustments that took into account the district population and its urban-rural distribution. A proportional allocation was not applied because of the lack of parity in the district size. Among the 400 clusters selected, 118 clusters were in urban areas and 282 clusters were in rural areas. The total number of households selected in the 2014 LDHS was 10,000; 2,950 were in urban areas and 7,050 in rural areas. Table A.3 Sample allocation of clusters and households Sample allocation of clusters and households by district, according to residence, Lesotho 2014 District Allocation of clusters Allocation of households Urban Rural Total Urban Rural Total Butha-Buthe 10 25 35 250 625 875 Leribe 15 31 46 375 775 1150 Berea 16 28 44 400 700 1100 Maseru 27 24 51 675 600 1275 Mafeteng 11 29 40 275 725 1000 Mohale’s Hoek 9 30 39 225 750 975 Quthing 8 27 35 200 675 875 Qacha’s Nek 10 28 38 250 700 950 Mokhotlong 7 29 36 175 725 900 Thaba-Tseka 5 31 36 125 775 900 Lesotho 118 282 400 2950 7050 10000 Table A.4 below shows the expected number of women’s and men’s interviews by district and by type of residence. The expected survey results were calculated based on the survey results of the 2009 LDHS: the average number of women age 15-49 per household was 0.83; the average number of men age 15-59 per household was 0.72; the household response rate was 94%; the women’s individual response rate was 97.9%; and the men’s individual response rate was 95%. Table A.4 Sample allocation of completed interviews with women and men Sample allocation of expected number of completed interviews with women and men by district, according to residence, Lesotho 2014 District Women 15-49 Men 15-59 Urban Rural Total Urban Rural Total Butha-Buthe 174 459 633 79 212 291 Leribe 304 663 967 118 263 381 Berea 326 604 930 126 237 363 Maseru 543 509 1052 212 204 416 Mafeteng 193 534 727 86 246 332 Mohale’s Hoek 157 552 709 71 254 325 Quthing 139 496 635 63 229 292 Qacha’s Nek 155 458 613 79 237 316 Mokhotlong 125 547 672 55 246 301 Thaba-Tseka 90 587 677 40 263 303 Lesotho 2206 5409 7615 929 2391 3320 324 • Appendix A An examination of response rates for the 2014 LDHS indicates that the survey was successfully implemented. Table A.5 and Table A.6 present the interview response rates in the 2014 LDHS for women and men, respectively, by urban and rural area, ecological zone, and district. Overall, the number of completed interviews is somewhat lower than the expected number for both women and men. The coverage of HIV testing was slightly higher in the 2014 LDHS than in the 2009 survey. Tables A.7-A.10 present response rates for the HIV testing by background characteristics. A.4 SAMPLE PROBABILITIES AND SAMPLING WEIGHTS Due to the nonproportional allocation of the sample across districts and the differential response rates, sampling weights must be used in all analyses of the 2014 LDHS results to ensure that survey results are representative at both the national and domain level. Since the 2014 LDHS sample is a two-stage stratified cluster sample, sampling weights are based on sampling probabilities calculated separately for each sampling stage and for each cluster where: P1hi: first-stage sampling probability of the ith cluster in stratum h P2hi: second-stage sampling probability within the ith cluster (households) The following describes the calculation of these probabilities: Let ah be the number of clusters selected in stratum h, Mhi the number of households according to the sampling frame in the ith cluster, and M hi the total number of households in the stratum. The probability of selecting the ith cluster in stratum h in the 2014 LDHS sample is calculated as follows: M M a hi hih  Let hib be the proportion of households in the selected segment compared with the total number of households in cluster i in stratum h if the cluster is segmented, otherwise 1=hib . Then the probability of selecting cluster i in the sample is: hi hi hih 1hi b M M a = P × Let hiL be the number of households listed in the household listing operation in cluster i in stratum h, and let hig be the number of households selected in the cluster. The second stage’s selection probability for each household in the cluster is calculated as follows: hi hi hi L gP =2 Appendix A • 325 The overall selection probability of each household in cluster i of stratum h in the 2014 LDHS is therefore the product of the two stages’ selection probabilities: hihihi PPP 21 ×= The design weight for each household in cluster i of stratum h is the inverse of its overall selection probability: hihi PW /1= A spreadsheet containing all sampling parameters and selection probabilities was prepared to facilitate the calculation of the design weights. Design weights were adjusted for household nonresponse and individual nonresponse to obtain the sampling weights for households and for women and men, respectively. Nonresponse is adjusted at the sampling stratum level. For the household sampling weight, the household design weight is multiplied by the inverse of the household response rate, by stratum. For the women’s individual sampling weight, the household sampling weight is multiplied by the inverse of the women’s individual response rate, by stratum. For the men’s individual sampling weight, the household sampling weight for the male subsample is multiplied by the inverse of the men’s individual response rate, by stratum. After adjusting for nonresponse, the sampling weights are normalised to get the final standard weights that appear in the data files. The normalisation process is aimed at obtaining a total number of unweighted cases equal to the total number of weighted cases using normalised weights at the national level, for the total number of households, women, and men. Normalisation is done by multiplying the sampling weight by the estimated total sampling fraction obtained from the survey for the household weight, the individual woman’s weight, and the individual man’s weight. The normalised weights are relative weights that are valid for estimating means, proportions, ratios, and rates, but they are not valid for estimating population totals or for pooled data. The sampling weights for HIV testing are calculated in a similar way, but the normalization of the HIV weights is different. The individual HIV testing weights are normalized at the national level for women and men together so that HIV prevalence estimates calculated for women and men together are valid. Ta bl e A. 5 S am pl e im pl em en ta tio n: W om en P er ce nt d is tri bu tio n of h ou se ho ld s an d el ig ib le w om en b y re su lts o f t he h ou se ho ld a nd in di vi du al in te rv ie w s, a nd h ou se ho ld , e lig ib le w om en a nd o ve ra ll w om en re sp on se ra te s, a cc or di ng to u rb an -r ur al re si de nc e, e co lo gi ca l zo ne , a nd d is tri ct (u nw ei gh te d) , L es ot ho 2 01 4 R es id en ce E co lo gi ca l z on e D is tri ct To ta l R es ul t U rb an R ur al Lo w la nd s Fo ot hi lls M ou nt ai ns S en qu R iv er V al le y B ut ha - B ut he Le rib e B er ea M as er u M af et en g M oh al e’ s H oe k Q ut hi ng Q ac ha ’s N ek M ok ho tlo ng Th ab a- Ts ek a Se le ct ed h ou se ho ld s C om pl et ed (C ) 95 .4 94 .2 94 .2 94 .9 94 .4 96 .1 98 .7 92 .7 92 .1 93 .3 94 .0 97 .8 98 .1 92 .3 93 .4 95 .0 94 .6 H ou se ho ld p re se nt b ut n o co m pe te nt re sp on de nt at h om e (H P ) 0. 6 1. 2 0. 8 0. 7 1. 5 1. 0 0. 5 1. 9 0. 6 0. 9 0. 5 0. 4 0. 8 2. 1 1. 2 1. 0 1. 0 P os tp on ed (P ) 0. 0 0. 0 0. 0 0. 0 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 R ef us ed (R ) 0. 4 0. 0 0. 3 0. 0 0. 0 0. 1 0. 1 0. 4 0. 1 0. 4 0. 2 0. 0 0. 0 0. 2 0. 0 0. 0 0. 2 D w el lin g no t f ou nd (D N F) 0. 4 0. 2 0. 4 0. 1 0. 2 0. 0 0. 0 0. 3 0. 2 0. 4 0. 7 0. 0 0. 0 0. 2 0. 2 0. 2 0. 2 H ou se ho ld a bs en t ( H A ) 1. 3 2. 7 2. 0 2. 7 2. 5 2. 1 0. 2 1. 7 3. 5 2. 9 2. 5 1. 1 0. 6 3. 4 3. 9 2. 3 2. 3 D w el lin g va ca nt /a dd re ss no t a d w el lin g (D V ) 1. 3 1. 6 2. 0 1. 4 1. 1 0. 6 0. 3 2. 8 2. 5 1. 8 2. 0 0. 5 0. 3 1. 5 1. 2 1. 0 1. 5 D w el lin g de st ro ye d (D D ) 0. 1 0. 1 0. 0 0. 2 0. 3 0. 1 0. 1 0. 0 0. 1 0. 2 0. 1 0. 0 0. 1 0. 3 0. 1 0. 4 0. 1 O th er (O ) 0. 4 0. 0 0. 3 0. 0 0. 0 0. 0 0. 0 0. 1 1. 0 0. 1 0. 0 0. 1 0. 0 0. 0 0. 0 0. 0 0. 1 To ta l 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 N um be r o f s am pl ed ho us eh ol ds 2, 93 4 7, 00 8 4, 73 1 99 6 2, 95 3 1, 26 2 87 1 1, 14 4 1, 07 2 1, 27 3 99 6 97 1 86 2 95 0 90 3 90 0 9, 94 2 H ou se ho ld re sp on se ra te (H R R )1 98 .4 98 .6 98 .5 99 .2 98 .2 98 .9 99 .4 97 .1 99 .1 98 .2 98 .5 99 .6 99 .2 97 .3 98 .5 98 .7 98 .5 El ig ib le w om en C om pl et ed (E W C ) 96 .5 97 .4 96 .9 97 .4 97 .2 97 .6 98 .3 96 .8 95 .7 96 .2 98 .0 98 .9 97 .4 97 .2 96 .0 97 .7 97 .1 N ot a t h om e (E W N H ) 1. 5 1. 1 1. 3 1. 2 1. 4 0. 9 0. 3 1. 8 2. 3 1. 3 0. 6 0. 3 0. 9 1. 2 2. 2 1. 0 1. 3 P os tp on ed (E W P ) 0. 1 0. 0 0. 0 0. 0 0. 0 0. 1 0. 0 0. 0 0. 1 0. 0 0. 0 0. 0 0. 2 0. 0 0. 0 0. 0 0. 0 R ef us ed (E W R ) 0. 6 0. 2 0. 4 0. 1 0. 3 0. 1 0. 3 0. 4 0. 4 0. 6 0. 0 0. 2 0. 2 0. 5 0. 2 0. 3 0. 3 P ar tly c om pl et ed (E W P C ) 0. 3 0. 0 0. 2 0. 1 0. 0 0. 0 0. 2 0. 0 0. 3 0. 5 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 0. 1 In ca pa ci ta te d (E W I) 0. 6 1. 0 0. 8 1. 0 0. 9 1. 0 0. 7 0. 9 0. 6 1. 0 0. 9 0. 6 0. 7 1. 0 1. 3 1. 0 0. 9 O th er (E W O ) 0. 4 0. 2 0. 4 0. 1 0. 2 0. 3 0. 2 0. 1 0. 6 0. 3 0. 5 0. 0 0. 7 0. 0 0. 3 0. 0 0. 3 To ta l 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 N um be r o f w om en 2, 28 2 4, 53 6 3, 39 6 68 8 1, 95 1 78 3 60 3 81 1 79 4 96 7 63 7 62 8 57 1 57 4 63 0 60 3 6, 81 8 E lig ib le w om en re sp on se ra te (E W R R )2 96 .5 97 .4 96 .9 97 .4 97 .2 97 .6 98 .3 96 .8 95 .7 96 .2 98 .0 98 .9 97 .4 97 .2 96 .0 97 .7 97 .1 O ve ra ll w om en re sp on se ra te (O R R )3 95 .0 96 .0 95 .4 96 .6 95 .5 96 .5 97 .8 94 .0 94 .9 94 .4 96 .5 98 .5 96 .6 94 .6 94 .6 96 .4 95 .7 1 U si ng th e nu m be r o f h ou se ho ld s fa llin g in to s pe ci fic re sp on se c at eg or ie s, th e ho us eh ol d re sp on se ra te (H R R ) i s ca lc ul at ed a s: 10 0 * C __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ _ C + H P + P + R + D N F 2 Th e el ig ib le w om en re sp on se ra te (E W R R ) i s eq ui va le nt to th e pe rc en ta ge o f i nt er vi ew s co m pl et ed (E W C ). 3 Th e ov er al l w om en re sp on se ra te (O W R R ) i s ca lc ul at ed a s: O W R R = H R R * E W R R /1 00 326 • Appendix A Ta bl e A. 6 S am pl e im pl em en ta tio n: M en P er ce nt d is tri bu tio n of h ou se ho ld s an d el ig ib le m en b y re su lts o f t he h ou se ho ld a nd in di vi du al in te rv ie w s, a nd h ou se ho ld , e lig ib le m en a nd o ve ra ll m en re sp on se ra te s, a cc or di ng to u rb an -r ur al re si de nc e, e co lo gi ca l z on e, an d di st ric t ( un w ei gh te d) , L es ot ho 2 01 4 R es id en ce E co lo gi ca l z on e D is tri ct To ta l R es ul t U rb an R ur al Lo w la nd s Fo ot hi lls M ou nt ai ns S en qu R iv er V al le y B ut ha - B ut he Le rib e B er ea M as er u M af et en g M oh al e’ s H oe k Q ut hi ng Q ac ha ’s N ek M ok ho tlo ng Th ab a- Ts ek a Se le ct ed h ou se ho ld s C om pl et ed (C ) 95 .6 93 .6 94 .1 94 .7 93 .9 94 .9 98 .4 91 .9 92 .1 94 .1 93 .6 98 .3 97 .9 90 .7 93 .1 93 .2 94 .2 H ou se ho ld p re se nt b ut n o co m pe te nt re sp on de nt at h om e (H P ) 0. 7 1. 5 0. 9 0. 6 1. 8 1. 6 0. 7 2. 6 0. 4 0. 8 0. 6 0. 2 0. 9 3. 2 1. 3 1. 6 1. 2 P os tp on ed (P ) 0. 0 0. 0 0. 0 0. 0 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 R ef us ed (R ) 0. 5 0. 1 0. 3 0. 0 0. 1 0. 0 0. 2 0. 7 0. 0 0. 5 0. 0 0. 0 0. 0 0. 2 0. 0 0. 0 0. 2 D w el lin g no t f ou nd (D N F) 0. 5 0. 2 0. 4 0. 0 0. 3 0. 0 0. 0 0. 2 0. 4 0. 3 0. 8 0. 0 0. 0 0. 2 0. 2 0. 5 0. 3 H ou se ho ld a bs en t ( H A ) 1. 2 2. 8 1. 9 3. 0 2. 6 2. 7 0. 5 1. 6 3. 5 2. 5 2. 4 0. 8 0. 5 4. 4 3. 6 3. 2 2. 3 D w el lin g va ca nt /a dd re ss no t a d w el lin g (D V ) 1. 2 1. 8 2. 1 1. 6 1. 2 0. 6 0. 2 2. 6 3. 1 1. 9 2. 4 0. 6 0. 5 1. 3 1. 6 1. 1 1. 6 D w el lin g de st ro ye d (D D ) 0. 1 0. 1 0. 0 0. 2 0. 2 0. 2 0. 0 0. 0 0. 0 0. 0 0. 2 0. 0 0. 2 0. 0 0. 2 0. 5 0. 1 O th er (O ) 0. 2 0. 0 0. 2 0. 0 0. 0 0. 0 0. 0 0. 2 0. 6 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 0. 1 To ta l 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 N um be r o f s am pl ed ho us eh ol ds 1, 47 1 3, 50 3 2, 36 9 50 8 1, 46 8 62 9 44 0 57 1 54 2 64 2 49 9 48 2 43 0 47 4 45 0 44 4 4, 97 4 H ou se ho ld re sp on se ra te (H R R )1 98 .3 98 .2 98 .2 99 .4 97 .8 98 .4 99 .1 96 .2 99 .2 98 .4 98 .5 99 .8 99 .1 96 .2 98 .4 97 .9 98 .2 El ig ib le m en C om pl et ed (E M C ) 94 .1 93 .3 94 .1 90 .9 93 .7 93 .1 96 .3 93 .0 92 .5 94 .3 93 .3 95 .3 91 .5 92 .7 92 .0 94 .7 93 .6 N ot a t h om e (E M N H ) 2. 8 3. 5 2. 5 4. 7 3. 7 4. 0 1. 5 2. 3 4. 9 2. 8 1. 6 2. 2 2. 4 6. 1 5. 7 3. 0 3. 3 P os tp on ed (E M P ) 0. 1 0. 0 0. 1 0. 0 0. 0 0. 0 0. 0 0. 6 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 0. 0 0. 1 R ef us ed (E M R ) 1. 6 0. 8 1. 5 0. 6 0. 8 0. 3 1. 1 2. 1 1. 0 0. 8 1. 3 1. 4 0. 4 0. 0 1. 0 1. 1 1. 1 P ar tly c om pl et ed (E M P C ) 0. 1 0. 1 0. 1 0. 3 0. 0 0. 0 0. 0 0. 0 0. 0 0. 4 0. 3 0. 0 0. 0 0. 0 0. 0 0. 0 0. 1 In ca pa ci ta te d (E M I) 0. 6 1. 7 1. 0 2. 8 1. 1 2. 3 0. 7 1. 2 1. 3 0. 8 2. 9 0. 7 3. 7 0. 8 1. 0 1. 1 1. 4 O th er (E M O ) 0. 7 0. 6 0. 6 0. 6 0. 7 0. 3 0. 4 0. 9 0. 3 0. 8 0. 6 0. 4 2. 0 0. 4 0. 3 0. 0 0. 6 To ta l 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 10 0. 0 N um be r o f m en 96 0 2, 17 3 1, 58 5 32 0 88 2 34 6 26 7 34 1 38 8 49 2 31 3 27 8 24 6 24 5 29 9 26 4 3, 13 3 E lig ib le m en re sp on se ra te (E M R R )2 94 .1 93 .3 94 .1 90 .9 93 .7 93 .1 96 .3 93 .0 92 .5 94 .3 93 .3 95 .3 91 .5 92 .7 92 .0 94 .7 93 .6 O ve ra ll m en re sp on se ra te (O R R )3 92 .5 91 .7 92 .5 90 .4 91 .6 91 .5 95 .4 89 .4 91 .8 92 .8 91 .9 95 .1 90 .6 89 .1 90 .5 92 .7 91 .9 1 U si ng th e nu m be r o f h ou se ho ld s fa llin g in to s pe ci fic re sp on se c at eg or ie s, th e ho us eh ol d re sp on se ra te (H R R ) i s ca lc ul at ed a s: 10 0 * C __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ _ C + H P + P + R + D N F 2 Th e el ig ib le m en re sp on se ra te (E M R R ) i s eq ui va le nt to th e pe rc en ta ge o f i nt er vi ew s co m pl et ed (E M C ). 3 Th e ov er al l m en re sp on se ra te (O M R R ) i s ca lc ul at ed a s: O M R R = H R R * E M R R /1 00 Appendix A • 327 328 • Appendix A Table A.7 Coverage of HIV testing by social and demographic characteristics: Women Percent distribution of interviewed women age 15-49 by HIV testing status, according to social and demographic characteristics (unweighted), Lesotho 2014 Testing status Total Number of women Characteristic DBS Tested1 Refused to provide blood Absent at the time of blood collection Other/missing2 Marital status Never married 97.5 1.3 0.2 1.1 100.0 1,120 Ever had sex 97.5 1.3 0.0 1.2 100.0 668 Never had sex 97.6 1.1 0.4 0.9 100.0 452 Married/living together 97.0 1.6 0.2 1.2 100.0 1,866 Divorced or separated 98.3 1.7 0.0 0.0 100.0 173 Widowed 96.1 1.9 0.0 1.9 100.0 259 Type of union In polygynous union 94.6 2.7 0.0 2.7 100.0 37 In non-polygynous union 97.0 1.7 0.2 1.2 100.0 1,739 Not currently in union 97.4 1.4 0.1 1.1 100.0 1,552 In union, polygyny status unknown 98.9 0.0 0.0 1.1 100.0 90 Ever had sexual intercourse Yes 97.1 1.6 0.1 1.2 100.0 2,966 No 97.6 1.1 0.4 0.9 100.0 452 Currently pregnant Pregnant 96.5 2.8 0.0 0.7 100.0 142 Not pregnant or not sure 97.2 1.5 0.2 1.2 100.0 3,276 Times slept away from home in past 12 months None 97.6 1.2 0.2 1.0 100.0 1,777 1-2 96.9 1.6 0.0 1.6 100.0 763 3-4 95.6 1.6 0.3 2.5 100.0 315 5+ 97.0 2.3 0.2 0.5 100.0 563 Time away in past 12 months Away for more than 1 month 97.2 1.8 0.0 1.0 100.0 509 Away for less than 1 month 96.4 1.9 0.2 1.6 100.0 1,132 Not away 97.6 1.2 0.2 1.0 100.0 1,777 Time away in past 5 years Away for 3 or more months at a time once 97.2 1.7 0.0 1.1 100.0 363 Away for 3 or more months at a time more than once 97.7 1.4 0.0 0.9 100.0 345 Not away for 3 or more months at a time 97.1 1.5 0.2 1.2 100.0 2,710 Religion Roman Catholic 97.9 1.1 0.0 0.9 100.0 1,314 Lesotho Evangelical 96.8 2.0 0.5 0.7 100.0 598 Anglican 94.4 3.7 0.0 1.9 100.0 215 Pentecostal 97.0 0.7 0.2 2.1 100.0 869 Other Christian 96.6 2.8 0.0 0.6 100.0 353 Other non-Christian 97.3 2.7 0.0 0.0 100.0 37 No religion 100.0 0.0 0.0 0.0 100.0 32 Total 15-49 97.2 1.5 0.1 1.2 100.0 3,418 1 Includes all dried blood spots (DBS) tested at the lab and for which there is a result, i.e. positive, negative, or indeterminate. Indeterminate means that the sample went through the entire algorithm, but the final result was inconclusive. 2 Includes (1) other results of blood collection (e.g. technical problem in the field), (2) lost specimens, (3) non corresponding bar codes, and (4) other lab results such as blood not tested for technical reason, not enough blood to complete the algorithm, etc. Appendix A • 329 Table A.8 Coverage of HIV testing by social and demographic characteristics: Men Percent distribution of interviewed men 15-59 by HIV testing status, according to social and demographic characteristics (unweighted), Lesotho 2014 Testing status Total Number of men Characteristic DBS Tested1 Refused to provide blood Absent at the time of blood collection Other/missing2 Marital status Never married 95.4 1.6 0.3 2.8 100.0 1,476 Ever had sex 95.6 1.7 0.3 2.5 100.0 1,130 Never had sex 94.8 1.2 0.3 3.8 100.0 346 Married/living together 94.4 2.6 0.6 2.5 100.0 1,208 Divorced or separated 90.5 4.8 1.4 3.4 100.0 147 Widowed 94.9 3.0 1.0 1.0 100.0 99 Type of union In polygynous union 100.0 0.0 0.0 0.0 100.0 29 In non-polygynous union 94.2 2.6 0.6 2.5 100.0 1,179 Not currently in union 94.9 1.9 0.4 2.7 100.0 1,722 Ever had sexual intercourse Yes 94.7 2.3 0.5 2.5 100.0 2,584 No 94.8 1.2 0.3 3.8 100.0 346 Male circumcision Traditionally or medically circumcised 95.1 1.8 0.5 2.6 100.0 2,173 Traditionally circumcised only 94.8 1.9 0.4 2.9 100.0 1,447 Medically circumcised only 95.3 1.7 0.7 2.3 100.0 597 Both traditionally and medically circumcised 96.8 2.4 0.0 0.8 100.0 126 Not circumcised 93.8 3.2 0.5 2.5 100.0 753 Don't know 75.0 0.0 0.0 25.0 100.0 4 Times slept away from home in past 12 months None 94.1 2.1 0.6 3.3 100.0 1,450 1-2 95.8 2.1 0.4 1.7 100.0 521 3-4 93.7 3.0 0.0 3.4 100.0 268 5+ 95.6 2.2 0.6 1.6 100.0 689 Missing 100.0 0.0 0.0 0.0 100.0 2 Time away in past 12 months Away for more than 1 month 95.2 1.8 0.4 2.6 100.0 504 Away for less than 1 month 95.4 2.6 0.4 1.6 100.0 974 Not away 94.1 2.1 0.6 3.3 100.0 1,452 Time away in past 5 years Away for 3 or more months at a time once 95.4 1.6 0.3 2.7 100.0 373 Away for 3 or more months at a time more than once 93.4 2.7 1.1 2.7 100.0 437 Not away for 3 or more months at a time 94.9 2.2 0.4 2.6 100.0 2,120 Religion Roman Catholic 95.4 1.8 0.5 2.2 100.0 1,137 Lesotho Evangelical 93.8 2.8 0.7 2.6 100.0 535 Anglican 93.0 1.8 0.9 4.4 100.0 228 Pentecostal 94.6 2.5 0.2 2.7 100.0 557 Other Christian 98.6 0.9 0.0 0.5 100.0 216 Other non-Christian 87.5 7.5 0.0 5.0 100.0 40 No religion 92.6 2.3 0.5 4.6 100.0 217 Total 15-59 94.7 2.2 0.5 2.6 100.0 2,930 1 Includes all dried blood spots (DBS) tested at the lab and for which there is a result, i.e. positive, negative, or indeterminate. Indeterminate means that the sample went through the entire algorithm, but the final result was inconclusive. 2 Includes (1) other results of blood collection (e.g. technical problem in the field), (2) lost specimens, (3) non corresponding bar codes, and (4) other lab results such as blood not tested for technical reason, not enough blood to complete the algorithm, etc. 330 • Appendix A Table A.9 Coverage of HIV testing by sexual behaviour characteristics: Women Percent distribution of interviewed women age 15-49 who ever had sexual intercourse by HIV test status, according to sexual behaviour characteristics (unweighted), Lesotho 2014 Testing status Total Number of women Sexual behaviour characteristic DBS Tested1 Refused to provide blood Absent at the time of blood collection Other/ missing2 Age at first sexual intercourse <16 97.2 1.6 0.0 1.2 100.0 563 16-17 98.3 0.8 0.1 0.9 100.0 916 18-19 97.2 1.4 0.1 1.3 100.0 791 20+ 95.3 2.9 0.2 1.7 100.0 665 Don't know/missing 96.8 3.2 0.0 0.0 100.0 31 Multiple sexual partners and partner concurrency in past 12 months 0 97.6 1.3 0.0 1.1 100.0 375 1 97.1 1.5 0.1 1.3 100.0 2,329 2+ 98.7 0.9 0.0 0.4 100.0 230 Had concurrent partners3 97.2 1.4 0.0 1.4 100.0 72 None of the partners were concurrent 99.4 0.6 0.0 0.0 100.0 158 Missing 78.1 15.6 3.1 3.1 100.0 32 Condom use at last sexual intercourse in past 12 months Used condom 96.9 1.6 0.1 1.4 100.0 1,191 Did not use condom 97.6 1.3 0.1 1.0 100.0 1,368 No sexual intercourse in last 12 months 96.1 2.5 0.2 1.2 100.0 407 Number of lifetime partners 1 97.3 1.4 0.2 1.2 100.0 1,096 2 97.6 1.5 0.0 0.9 100.0 776 3-4 97.1 1.5 0.1 1.2 100.0 733 5-9 97.6 0.4 0.0 2.0 100.0 254 10+ 98.6 1.4 0.0 0.0 100.0 73 Don't know 73.5 20.6 0.0 5.9 100.0 34 Prior HIV testing Ever tested 97.1 1.6 0.1 1.2 100.0 2,715 Received results 97.1 1.6 0.1 1.2 100.0 2,651 Did not received results 96.9 3.1 0.0 0.0 100.0 64 Never tested 97.2 1.2 0.0 1.6 100.0 251 Total 15-49 97.1 1.6 0.1 1.2 100.0 2,966 1 Includes all dried blood spots (DBS) tested at the lab and for which there is a result, i.e. positive, negative, or indeterminate. Indeterminate means that the sample went through the entire algorithm, but the final result was inconclusive. 2 Includes (1) other results of blood collection (e.g. technical problem in the field), (2) lost specimens, (3) non corresponding bar codes, and (4) other lab results such as blood not tested for technical reason, not enough blood to complete the algorithm, etc. 3 A respondent is considered to have had concurrent partners if he or she had overlapping sexual partnerships with two or more people during the 12 months before the survey. Appendix A • 331 Table A.10 Coverage of HIV testing by sexual behaviour characteristics: Men Percent distribution of interviewed men age 15-59 who ever had sexual intercourse by HIV test status, according to sexual behaviour characteristics (unweighted), Lesotho 2014 Testing status Total Number of men Sexual behaviour characteristic DBS Tested1 Refused to provide blood Absent at the time of blood collection Other/ missing2 Age at first sexual intercourse <16 95.5 1.7 0.4 2.5 100.0 771 16-17 95.8 1.5 0.7 2.0 100.0 596 18-19 94.7 2.9 0.4 2.1 100.0 486 20+ 93.7 2.8 0.6 2.8 100.0 671 Don't know/missing 85.0 8.3 0.0 6.7 100.0 60 Multiple sexual partners and partner concurrency in past 12 months 0 94.5 2.9 0.0 2.6 100.0 274 1 95.1 1.9 0.6 2.5 100.0 1,550 2+ 94.3 2.5 0.6 2.7 100.0 714 Had concurrent partners3 94.3 1.6 0.8 3.2 100.0 247 None of the partners were concurrent 94.2 3.0 0.4 2.4 100.0 467 Missing 89.1 10.9 0.0 0.0 100.0 46 Condom use at last sexual intercourse in past 12 months Used condom 95.0 2.2 0.3 2.4 100.0 1,272 Did not use condom 94.6 1.9 0.9 2.6 100.0 992 No sexual intercourse in last 12 months 93.8 4.1 0.0 2.2 100.0 320 Paid for sexual intercourse in past 12 months Yes 97.0 1.5 0.0 1.5 100.0 67 Used condom 96.6 1.7 0.0 1.7 100.0 58 Did not use condom 100.0 0.0 0.0 0.0 100.0 9 No (No paid sexual intercourse/no sexual intercourse in last 12 months) 94.6 2.3 0.5 2.5 100.0 2,517 Number of lifetime partners 1 93.3 2.2 0.7 3.7 100.0 270 2 96.9 1.5 0.6 0.9 100.0 324 3-4 95.8 1.3 0.5 2.4 100.0 621 5-9 93.8 2.1 0.2 3.9 100.0 665 10+ 95.9 2.3 0.5 1.3 100.0 609 Don't know 82.1 13.7 2.1 2.1 100.0 95 Prior HIV testing Ever tested 95.2 2.0 0.4 2.3 100.0 1,781 Received results 95.3 1.9 0.5 2.3 100.0 1,707 Did not received results 93.2 4.1 0.0 2.7 100.0 74 Never tested 93.5 3.0 0.6 2.9 100.0 803 Total 15-59 94.7 2.3 0.5 2.5 100.0 2,584 1 Includes all dried blood spots (DBS) tested at the lab and for which there is a result, i.e. positive, negative, or indeterminate. Indeterminate means that the sample went through the entire algorithm, but the final result was inconclusive. 2 Includes (1) other results of blood collection (e.g. technical problem in the field), (2) lost specimens, (3) non corresponding bar codes, and (4) other lab results such as blood not tested for technical reason, not enough blood to complete the algorithm, etc. 3 A respondent is considered to have had concurrent partners if he or she had overlapping sexual partnerships with two or more people during the 12 months before the survey. (Respondents with concurrent partners includes polygynous men who had overlapping sexual partnerships with two or more wives). Appendix B • 333 ESTIMATES OF SAMPLING ERRORS Appendix B he estimates from a sample survey are affected by two types of errors: nonsampling errors and sampling errors. Nonsampling errors are the results of mistakes made in implementing data collection and data processing, such as failure to locate and interview the correct household, misunderstanding 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 2014 Lesotho Demographic and Health Survey (2014 LDHS) 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 selected in the 2014 LDHS 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 among all possible samples. Although the degree of variability is not known exactly, it can be estimated from the survey results. 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 calculate 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% 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 2014 LDHS sample is the result of a multi-stage stratified design, and, consequently, it was necessary to use more complex formulas. Sampling errors are computed by SAS programs developed by ICF International. These programs use the Taylor linearisation method to estimate variances for survey estimates that are means, proportions, or ratios. The Jackknife repeated replication method is used for variance estimation of more complex statistics such as fertility and mortality rates. The Taylor linearisation 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 zz m m x frvarrSE h 1 2 1 2 2 2 1 1)()( in which hihihi rxyz −= , and hhh rxyz −= T 334 • 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 several replications of the parent sample, and calculates standard errors for these estimates using simple formulas. Each replication considers all but one cluster in the calculation of the estimates. Pseudo-independent replications are thus created. In the 2014 LDHS there were 399 non-empty clusters. Hence, 399 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 399 clusters, r(i) is the estimate computed from the reduced sample of 398 clusters (ith cluster excluded), and k is the total number of clusters. In addition to the standard error, the design effect (DEFT) for each estimate is also calculated The design effect 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 increase in the sampling error due to the use of a more complex and less statistically efficient design. Relative standard errors and confidence limits for the estimates are also calculated. Sampling errors for the 2014 LDHS are calculated for selected variables considered to be of primary interest. The results are presented in this appendix for the country as a whole, for urban and rural areas, for four ecological zones, and for 10 districts. 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.19 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% confidence limits (R±2SE), for each variable. The sampling errors for mortality rates are presented for the 5-year period preceding the survey for the national sample and for the 10-year period preceding the survey at domain levels. The DEFT is considered undefined when the standard error considering a simple random sample is zero (when the estimate is close to 0 or 1). The confidence interval (e.g., as calculated for children ever born to women age 40-49) can be interpreted as follows: the overall average number of children ever born to women age 40-49 from the national sample is 3.796 and its standard error is 0.091. Therefore, to obtain the 95% confidence limits, one adds and subtracts twice the standard error to the sample estimate, i.e., 3.796±2×0.091. There is a high probability (95%) that the true average number of children ever born to all women age 40 to 49 is between 3.613 and 3.979. For the total sample, the value of the DEFT, averaged over all variables, is 1.29. This means that, due to multi- stage clustering of the sample, the average standard error is increased by a factor of 1.29 over that in an equivalent simple random sample. Appendix B • 335 Table B.1 List of selected variables for sampling errors, Lesotho 2014 Variable Estimate Base population WOMEN Urban residence Proportion All women 15-49 Literacy Proportion All women 15-49 No education Proportion All women 15-49 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 Married before age 20 Proportion All women 20-49 Had sexual intercourse before age 18 Proportion All women 20-49 Currently pregnant Proportion All women 15-49 Children ever born Mean All women 15-49 Children surviving Mean All women 15-49 Children ever born to women age 40-49 Mean All women 40-49 Know any contraceptive method Proportion Currently married women 15-49 Know a modern 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 using pill Proportion Currently married women 15-49 Currently using IUCD Proportion Currently married women 15-49 Currently using male condoms Proportion Currently married women 15-49 Currently using injectables Proportion Currently married women 15-49 Currently using implants Proportion Currently married women 15-49 Currently using female sterilisation Proportion Currently married women 15-49 Used public sector source Proportion Current users of modern method Want no more children Proportion Currently married women 15-49 Want to delay next birth at least 2 years Proportion Currently married women 15-49 Ideal number of children Mean All women 15-49 Mother received antenatal care for last birth Proportion Women with a live birth in last five years Mothers protected against tetanus for last birth Proportion Women with a live birth in last five years Births with skilled attendant at delivery Proportion Births occurring 1-59 months before survey Had diarrhoea in the past 2 weeks Proportion Children under 5 Treated with ORS Proportion Children under 5 with diarrhoea in past 2 weeks Sought medical treatment Proportion Children under 5 with diarrhoea in past 2 weeks Vaccination card seen Proportion Children 12-23 months Received BCG vaccination Proportion Children 12-23 months Received DPT/pentavalent vaccination (3 doses) Proportion Children 12-23 months Received polio vaccination (3 doses) Proportion Children 12-23 months Received measles vaccination Proportion Children 12-23 months Received all basic vaccinations Proportion Children 12-23 months Height-for-age (-2SD) Proportion Children under 5 who are measured Weight-for-height (-2SD) Proportion Children under 5 who are measured Weight-for-age (-2SD) Proportion Children under 5 who are measured Prevalence of anaemia (children 6-59 months) Proportion All children 6-59 months who were tested Prevalence of anaemia (women 15-49) Proportion All women 15-49 who were tested Body Mass Index (BMI) <18.5 Proportion All women 15-49 who were measured Body Mass Index (BMI) ≥25 Proportion All women 15-49 who were measured Had 2+ sexual partners in past 12 months Proportion All women 15-49 Condom use at last sex Proportion Women 15-49 with 2+ partners in past 12 months Abstinence among youth (never had sex) Proportion Never-married women 15-24 Sexually active in past 12 months among never-married youth Proportion Never-married women 15-24 Had an HIV test and received results in past 12 months Proportion All women 15-49 Accepting attitudes towards people with HIV Proportion All women who have heard of HIV/AIDS Total fertility rate (3 years) Rate Women-years of exposure to childbearing Neonatal mortality rate¹ Rate Children exposed to the risk of mortality Post-neonatal mortality rate¹ Rate Children exposed to the risk of mortality Infant mortality rate¹ Rate Children exposed to the risk of mortality Child mortality rate¹ Rate Children exposed to the risk of mortality Under-five mortality rate¹ Rate Children exposed to the risk of mortality HIV prevalence among all women 15-49 Proportion All interviewed women with DBS tested at the lab HIV prevalence among young women 15-24 Proportion All interviewed women 15-24 with DBS tested at the lab (Continued…) 336 • Appendix B Table B.1—Continued Variable Estimate Base population MEN Urban residence Proportion All men 15-49 Literacy Proportion All men 15-49 No education Proportion All men 15-49 Secondary education or higher Proportion All men 15-49 Never married/in union Proportion All men 15-49 Currently married/in union Proportion All men 15-49 Had sexual intercourse before age 18 Proportion All men 20-49 Know any contraceptive method Proportion Currently married men 15-49 Know a modern method Proportion Currently married men 15-49 Want no more children Proportion Currently married men 15-49 Want to delay next birth at least 2 years Proportion Currently married men 15-49 Ideal number of children Mean All men 15-49 Body Mass Index (BMI) <18.5 Proportion All men 15-49 who were measured Body Mass Index (BMI) ≥25 Proportion All men 15-49 who were measured Prevalence of anaemia Proportion All men 15-49 who were tested Had 2+ sexual partners in past 12 months Proportion All men 15-49 Condom use at last sex Proportion Men 15-49 with 2+ partners in past 12 months Abstinence among youth (never had sex) Proportion Never-married men 15-24 Sexually active in past 12 months among never-married youth Proportion Never-married men 15-24 Paid for sexual intercourse in past 12 months Proportion All men 15-49 Had an HIV test and received results in past 12 months Proportion All men 15-49 Accepting attitudes towards people with HIV Proportion All men who have heard of HIV/AIDS HIV prevalence among all men 15-49 Proportion All interviewed men with DBS tested at the lab HIV prevalence among all men 15-59 Proportion All interviewed men 15-59 with DBS tested at the lab HIV prevalence among young men 15-24 Proportion All interviewed men 15-24 with DBS tested at the lab WOMEN AND MEN HIV prevalence all respondents age 15-49 Proportion All interviewed women and men 15-49 with DBS tested at the lab HIV prevalence all respondents age 15-24 Proportion All interviewed women and men 15-24 with DBS tested at the lab 1 The mortality rates are calculated for 5 years before the survey for the national sample, and 10 years before the survey for the zonal and district samples. Appendix B • 337 Table B.2 Sampling errors for national sample, Lesotho 2014 Value (R) Standard error (SE) Number of cases Design effect (DEFT) Relative error (SE/R) Confidence limits Variable Unweighted (N) Weighted (WN) R-2SE R+2SE WOMEN Urban residence 0.365 0.015 6621 6621 2.498 0.040 0.336 0.395 Literacy 0.970 0.002 6621 6621 1.167 0.003 0.965 0.975 No education 0.010 0.001 6621 6621 1.120 0.135 0.007 0.013 Secondary education or higher 0.604 0.011 6621 6621 1.784 0.018 0.583 0.626 Never married/in union 0.331 0.007 6621 6621 1.270 0.022 0.316 0.345 Currently married/in union 0.546 0.009 6621 6621 1.441 0.016 0.528 0.563 Married before age 20 0.452 0.010 5079 5181 1.409 0.022 0.432 0.471 Had sexual intercourse before age 18 0.423 0.010 5079 5181 1.380 0.023 0.404 0.442 Currently pregnant 0.043 0.003 6621 6621 1.166 0.068 0.037 0.049 Children ever born 1.748 0.029 6621 6621 1.276 0.016 1.691 1.805 Children surviving 1.579 0.026 6621 6621 1.276 0.016 1.528 1.631 Children ever born to women age 40-49 3.796 0.091 1072 1062 1.370 0.024 3.613 3.979 Know any contraceptive method 0.995 0.002 3609 3612 1.323 0.002 0.991 0.998 Know a modern method 0.995 0.002 3609 3612 1.323 0.002 0.991 0.998 Currently using any method 0.602 0.011 3609 3612 1.375 0.019 0.579 0.624 Currently using a modern method 0.598 0.011 3609 3612 1.385 0.019 0.575 0.621 Currently using pill 0.142 0.007 3609 3612 1.265 0.052 0.128 0.157 Currently using IUCD 0.013 0.002 3609 3612 1.180 0.169 0.009 0.018 Currently using male condoms 0.169 0.008 3609 3612 1.287 0.048 0.153 0.185 Currently using injectables 0.240 0.009 3609 3612 1.322 0.039 0.222 0.259 Currently using implants 0.014 0.002 3609 3612 1.251 0.177 0.009 0.018 Currently using female sterilisation 0.017 0.003 3609 3612 1.340 0.172 0.011 0.022 Used public sector source 0.632 0.011 3194 3213 1.290 0.017 0.610 0.654 Want no more children 0.578 0.009 3609 3612 1.138 0.016 0.559 0.596 Want to delay next birth at least 2 years 0.241 0.008 3609 3612 1.165 0.034 0.224 0.257 Ideal number of children 2.636 0.021 6608 6608 1.272 0.008 2.594 2.678 Mother received antenatal care for last birth 0.952 0.005 2596 2575 1.178 0.005 0.942 0.962 Mothers protected against tetanus for last birth 0.744 0.012 2596 2575 1.340 0.016 0.721 0.767 Births with skilled attendant at delivery 0.779 0.011 3138 3112 1.373 0.015 0.756 0.802 Had diarrhoea in the past 2 weeks 0.118 0.009 2915 2896 1.409 0.072 0.101 0.135 Treated with ORS 0.534 0.033 328 342 1.189 0.061 0.469 0.599 Sought medical treatment 0.509 0.029 328 342 1.057 0.057 0.451 0.567 Vaccination card seen 0.771 0.020 655 655 1.200 0.026 0.731 0.811 Received BCG vaccination 0.980 0.006 655 655 1.045 0.006 0.968 0.991 Received DPT/pentavalent vaccination (3 doses) 0.854 0.016 655 655 1.172 0.019 0.821 0.886 Received polio vaccination (3 doses) 0.757 0.020 655 655 1.209 0.027 0.716 0.798 Received measles vaccination 0.901 0.013 655 655 1.107 0.014 0.875 0.927 Received all basic vaccinations 0.683 0.022 655 655 1.201 0.032 0.639 0.727 Height-for-age (-2SD) 0.332 0.013 1882 1869 1.162 0.040 0.306 0.359 Weight-for-height (-2SD) 0.028 0.004 1882 1869 1.062 0.147 0.020 0.036 Weight-for-age (-2SD) 0.103 0.009 1882 1869 1.189 0.083 0.086 0.120 Prevalence of anaemia (children 6-59 months) 0.508 0.016 1726 1709 1.283 0.031 0.476 0.540 Prevalence of anaemia (women 15-49) 0.273 0.010 3349 3297 1.287 0.037 0.253 0.293 Body Mass Index (BMI) <18.5 0.043 0.004 3193 3155 1.131 0.095 0.035 0.051 Body Mass Index (BMI) ≥25 0.446 0.011 3193 3155 1.247 0.025 0.424 0.468 Had 2+ sexual partners in past 12 months 0.066 0.004 6621 6621 1.343 0.062 0.058 0.074 Condom use at last sex 0.539 0.032 430 435 1.322 0.059 0.475 0.603 Abstinence among youth (never had sex) 0.506 0.015 1772 1719 1.238 0.029 0.476 0.535 Sexually active in past 12 months among never-married youth 0.372 0.015 1772 1719 1.286 0.040 0.343 0.402 Had an HIV test and received results in past 12 months 0.580 0.009 6621 6621 1.414 0.015 0.563 0.597 Accepting attitudes towards people with HIV 0.463 0.010 6539 6552 1.611 0.021 0.443 0.483 Total fertility rate (3 years) 3.263 0.102 18347 18463 1.291 0.031 3.060 3.466 Neonatal mortality rate (last 0-4 years) 33.529 3.712 3161 3134 1.068 0.111 26.105 40.952 Post-neonatal mortality rate (last 0-4 years) 25.960 3.783 3154 3127 1.312 0.146 18.394 33.526 Infant mortality rate (last 0-4 years) 59.489 5.067 3164 3136 1.139 0.085 49.356 69.622 Child mortality rate (last 0-4 years) 27.438 3.929 2966 2945 1.244 0.143 19.581 35.295 Under-five mortality rate (last 0-4 years) 85.294 6.017 3193 3165 1.143 0.071 73.260 97.328 HIV prevalence among all women 15-49 0.297 0.010 3321 3175 1.319 0.035 0.276 0.318 HIV prevalence among young women 15-24 0.131 0.011 1424 1342 1.265 0.086 0.108 0.153 (Continued…) 338 • Appendix B Table B.2—Continued Value (R) Standard error (SE) Number of cases Design effect (DEFT) Relative error (SE/R) Confidence limits Variable Unweighted (N) Weighted (WN) R-2SE R+2SE MEN Urban residence 0.346 0.016 2626 2660 1.761 0.047 0.313 0.378 Literacy 0.845 0.010 2626 2660 1.456 0.012 0.824 0.865 No education 0.080 0.007 2626 2660 1.322 0.088 0.066 0.094 Secondary education or higher 0.472 0.016 2626 2660 1.648 0.034 0.440 0.505 Never married/in union 0.564 0.013 2626 2660 1.341 0.023 0.538 0.590 Currently married/in union 0.370 0.013 2626 2660 1.335 0.034 0.344 0.395 Had sexual intercourse before age 18 0.487 0.015 1936 1969 1.277 0.030 0.458 0.516 Know any contraceptive method 0.991 0.004 993 983 1.373 0.004 0.983 0.999 Know a modern method 0.990 0.004 993 983 1.385 0.004 0.981 0.999 Want no more children 0.400 0.020 993 983 1.312 0.051 0.359 0.440 Want to delay next birth at least 2 years 0.341 0.019 993 983 1.289 0.057 0.302 0.380 Ideal number of children 3.016 0.035 2605 2640 1.160 0.012 2.946 3.086 Body Mass Index (BMI) <18.5 0.142 0.009 2560 2583 1.364 0.066 0.123 0.161 Body Mass Index (BMI) ≥25 0.117 0.008 2560 2583 1.192 0.065 0.101 0.132 Prevalence of anaemia 0.141 0.009 2505 2517 1.277 0.063 0.123 0.159 Had 2+ sexual partners in past 12 months 0.267 0.013 2626 2660 1.527 0.049 0.241 0.294 Condom use at last sex 0.653 0.020 670 711 1.074 0.030 0.614 0.693 Abstinence among youth (never had sex) 0.283 0.018 1119 1151 1.332 0.064 0.247 0.318 Sexually active in past 12 months among never-married youth 0.581 0.019 1119 1151 1.306 0.033 0.542 0.619 Paid for sexual intercourse in past 12 months 0.031 0.004 2626 2660 1.317 0.144 0.022 0.040 Had an HIV test and received results in past 12 months 0.364 0.012 2626 2660 1.308 0.034 0.339 0.389 Accepting attitudes towards people with HIV 0.356 0.013 2568 2606 1.327 0.035 0.330 0.381 HIV prevalence among all men 15-49 0.186 0.011 2481 2646 1.353 0.057 0.165 0.207 HIV prevalence among all men 15-59 0.196 0.010 2775 2921 1.343 0.052 0.175 0.216 HIV prevalence among young men 15-24 0.060 0.010 1173 1272 1.425 0.165 0.040 0.080 MEN AND WOMEN HIV prevalence among all respondents 15-49 0.246 0.008 5802 5821 1.434 0.033 0.230 0.263 HIV prevalence among all respondents 15-24 0.096 0.008 2597 2615 1.424 0.086 0.080 0.113 1 The mortality rates are calculated for 5 years before the survey for the national sample, and 10 years before the survey for the zonal and district samples. Appendix B • 339 Table B.3 Sampling errors for urban sample, Lesotho 2014 Value (R) Standard error (SE) Number of cases Design effect (DEFT) Relative error (SE/R) Confidence limits Variable Unweighted (N) Weighted (WN) R-2SE R+2SE WOMEN Urban residence 1.000 0.000 2202 2419 na 0.000 1.000 1.000 Literacy 0.979 0.004 2202 2419 1.291 0.004 0.971 0.987 No education 0.007 0.002 2202 2419 1.255 0.316 0.003 0.012 Secondary education or higher 0.758 0.014 2202 2419 1.580 0.019 0.729 0.787 Never married/never in union 0.389 0.011 2202 2419 1.105 0.029 0.366 0.412 Currently married/in union 0.475 0.016 2202 2419 1.461 0.033 0.444 0.506 Married before age 20 0.326 0.015 1726 1970 1.366 0.047 0.295 0.357 Had sexual intercourse before age 18 0.388 0.017 1726 1970 1.421 0.043 0.355 0.421 Currently pregnant 0.036 0.005 2202 2419 1.285 0.141 0.026 0.046 Children ever born 1.392 0.043 2202 2419 1.329 0.031 1.307 1.477 Children surviving 1.253 0.038 2202 2419 1.325 0.030 1.178 1.329 Children ever born to women age 40-49 2.933 0.181 332 344 1.712 0.062 2.570 3.295 Know any contraceptive method 0.994 0.004 1004 1150 1.483 0.004 0.987 1.001 Know a modern method 0.994 0.004 1004 1150 1.483 0.004 0.987 1.001 Currently using any method 0.655 0.024 1004 1150 1.577 0.036 0.607 0.702 Currently using a modern method 0.652 0.024 1004 1150 1.607 0.037 0.604 0.700 Currently using pill 0.172 0.016 1004 1150 1.342 0.093 0.140 0.204 Currently using IUCD 0.020 0.005 1004 1150 1.202 0.265 0.009 0.031 Currently using male condoms 0.217 0.018 1004 1150 1.364 0.082 0.182 0.253 Currently using injectables 0.213 0.018 1004 1150 1.376 0.084 0.177 0.248 Currently using implants 0.014 0.004 1004 1150 1.134 0.297 0.006 0.023 Currently using female sterilisation 0.013 0.004 1004 1150 1.118 0.313 0.005 0.020 Used public sector source 0.501 0.018 1118 1234 1.220 0.036 0.464 0.537 Want no more children 0.577 0.016 1004 1150 1.026 0.028 0.545 0.609 Want to delay next birth at least 2 years 0.203 0.015 1004 1150 1.186 0.074 0.173 0.233 Ideal number of children 2.430 0.026 2198 2415 1.055 0.011 2.378 2.483 Mothers received antenatal care for last birth 0.975 0.008 667 749 1.347 0.008 0.958 0.991 Mothers protected against tetanus for last birth 0.791 0.020 667 749 1.288 0.026 0.750 0.831 Births with skilled attendant at delivery 0.897 0.016 786 900 1.276 0.018 0.865 0.930 Had diarrhoea in the past 2 weeks 0.100 0.017 737 841 1.526 0.167 0.067 0.134 Treated with ORS 0.526 0.059 72 84 1.010 0.112 0.408 0.644 Sought medical treatment for diarrhoea 0.423 0.057 72 84 0.995 0.136 0.308 0.538 Vaccination card seen 0.726 0.043 159 180 1.193 0.059 0.641 0.812 Received BCG vaccination 0.986 0.009 159 180 0.951 0.009 0.968 1.004 Received DPT/pentavalent vaccination (3 doses) 0.824 0.036 159 180 1.205 0.044 0.751 0.896 Received polio vaccination (3 doses) 0.758 0.039 159 180 1.139 0.052 0.679 0.837 Received measles vaccination 0.928 0.023 159 180 1.150 0.025 0.881 0.975 Received all basic vaccinations 0.701 0.041 159 180 1.115 0.058 0.619 0.783 Height-for-age (-2SD) 0.273 0.033 414 453 1.446 0.121 0.206 0.339 Weight-for-height (-2SD) 0.013 0.005 414 453 0.992 0.423 0.002 0.024 Weight-for-age (-2SD) 0.082 0.018 414 453 1.327 0.220 0.046 0.118 Prevalence of anaemia (children 6-59 months) 0.483 0.045 374 410 1.709 0.092 0.393 0.572 Prevalence of anaemia (women 15-49) 0.319 0.020 1087 1142 1.404 0.064 0.279 0.360 Body Mass Index (BMI) < 18.5 0.042 0.008 1059 1124 1.199 0.179 0.027 0.057 Body Mass Index (BMI) ≥ 25 0.501 0.022 1059 1124 1.425 0.045 0.456 0.545 Had 2+ sexual partners in past 12 months 0.066 0.007 2202 2419 1.262 0.101 0.053 0.079 Condom use at last sex 0.687 0.069 149 160 1.792 0.100 0.550 0.825 Abstinence among youth (never had sex) 0.485 0.028 673 668 1.438 0.057 0.430 0.541 Sexually active in past 12 months among never-married youth 0.417 0.026 673 668 1.391 0.063 0.364 0.470 Had an HIV test and received results in past 12 months 0.571 0.017 2202 2419 1.607 0.030 0.537 0.605 Accepting attitudes towards people with HIV 0.489 0.019 2200 2418 1.788 0.039 0.451 0.527 Total fertility rate (3 years) 2.255 0.120 6132 6844 1.311 0.053 2.015 2.495 Neonatal mortality (last 0-9 years) 21.755 4.956 1518 1726 1.304 0.228 11.843 31.667 Post-neonatal mortality (last 0-9 years) 48.555 8.768 1521 1736 1.426 0.181 31.019 66.091 Infant mortality (last 0-9 years) 70.310 10.763 1523 1732 1.528 0.153 48.784 91.836 Child mortality (last 0-9 years) 27.075 6.208 1479 1677 1.342 0.229 14.659 39.491 Under-five mortality (last 0-9 years) 95.482 13.056 1526 1734 1.639 0.137 69.370 121.593 HIV prevalence among all women 15-49 0.356 0.021 1077 1129 1.421 0.058 0.314 0.397 HIV prevalence among young women 15-24 0.163 0.024 441 443 1.338 0.145 0.115 0.210 (Continued…) 340 • Appendix B Table B.3—Continued Value (R) Standard error (SE) Number of cases Design effect (DEFT) Relative error (SE/R) Confidence limits Variable Unweighted (N) Weighted (WN) R-2SE R+2SE MEN Urban residence 1.000 0.000 821 920 na 0.000 1.000 1.000 Literacy 0.921 0.016 821 920 1.743 0.018 0.888 0.954 No education 0.024 0.007 821 920 1.386 0.307 0.009 0.039 Secondary education or higher 0.695 0.026 821 920 1.635 0.038 0.642 0.748 Never married/in union 0.538 0.026 821 920 1.467 0.047 0.487 0.589 Currently married/in union 0.380 0.025 821 920 1.486 0.066 0.329 0.430 Had sexual intercourse before age 18 0.519 0.027 637 733 1.367 0.052 0.465 0.573 Know any contraceptive method 0.988 0.010 313 349 1.576 0.010 0.968 1.007 Know a modern method 0.988 0.010 313 349 1.576 0.010 0.968 1.007 Want no more children 0.395 0.041 313 349 1.483 0.104 0.312 0.477 Want to delay next birth at least 2 years 0.333 0.036 313 349 1.355 0.109 0.260 0.405 Ideal number of children 2.720 0.049 816 914 1.057 0.018 2.622 2.818 Body Mass Index (BMI) <18.5 0.118 0.016 803 895 1.370 0.132 0.087 0.150 Body Mass Index (BMI) ≥25 0.180 0.016 803 895 1.210 0.092 0.147 0.213 Prevalence of anaemia 0.148 0.020 781 861 1.558 0.135 0.108 0.188 Had 2+ sexual partners in past 12 months 0.320 0.030 821 920 1.839 0.094 0.260 0.380 Condom use at last sex 0.706 0.028 242 295 0.961 0.040 0.650 0.762 Abstinence among youth (never had sex) 0.271 0.035 326 359 1.425 0.130 0.200 0.341 Sexually active in past 12 months among never-married youth 0.559 0.041 326 359 1.472 0.073 0.478 0.640 Paid for sexual intercourse in past 12 months 0.049 0.010 821 920 1.382 0.214 0.028 0.069 Had an HIV test and received results in past 12 months 0.467 0.022 821 920 1.234 0.046 0.424 0.510 Accepting attitudes towards people with HIV 0.399 0.022 816 914 1.309 0.056 0.354 0.444 HIV prevalence among all men 15-49 0.231 0.022 773 919 1.434 0.094 0.188 0.275 HIV prevalence among all men 15-59 0.240 0.021 851 989 1.452 0.089 0.198 0.283 HIV prevalence among young men 15-24 0.092 0.022 336 402 1.417 0.244 0.047 0.137 MEN AND WOMEN HIV prevalence among all respondents 15-49 0.300 0.017 1850 2048 1.590 0.057 0.266 0.334 HIV prevalence among all respondents 15-24 0.129 0.019 777 845 1.588 0.148 0.091 0.167 na = Not applicable Appendix B • 341 Table B.4 Sampling errors for rural sample, Lesotho 2014 Value (R) Standard error (SE) Number of cases Design effect (DEFT) Relative error (SE/R) Confidence limits Variable Unweighted (N) Weighted (WN) R-2SE R+2SE WOMEN Urban residence 0.000 0.000 4419 4202 na na 0.000 0.000 Literacy 0.965 0.003 4419 4202 1.106 0.003 0.959 0.971 No education 0.012 0.002 4419 4202 1.069 0.146 0.009 0.016 Secondary education or higher 0.515 0.013 4419 4202 1.784 0.026 0.489 0.542 Never married/never in union 0.297 0.010 4419 4202 1.386 0.032 0.278 0.316 Currently married/in union 0.586 0.011 4419 4202 1.435 0.018 0.565 0.607 Married before age 20 0.529 0.012 3353 3211 1.449 0.024 0.504 0.554 Had sexual intercourse before age 18 0.444 0.012 3353 3211 1.371 0.026 0.421 0.468 Currently pregnant 0.047 0.004 4419 4202 1.111 0.076 0.040 0.054 Children ever born 1.954 0.036 4419 4202 1.239 0.019 1.881 2.026 Children surviving 1.767 0.033 4419 4202 1.235 0.019 1.701 1.832 Children ever born to women age 40-49 4.209 0.102 740 718 1.266 0.024 4.006 4.413 Know any contraceptive method 0.995 0.002 2605 2463 1.204 0.002 0.991 0.998 Know a modern method 0.995 0.002 2605 2463 1.204 0.002 0.991 0.998 Currently using any method 0.577 0.012 2605 2463 1.248 0.021 0.552 0.601 Currently using a modern method 0.573 0.012 2605 2463 1.244 0.021 0.549 0.597 Currently using pill 0.129 0.008 2605 2463 1.173 0.060 0.113 0.144 Currently using IUCD 0.010 0.002 2605 2463 1.121 0.216 0.006 0.015 Currently using male condoms 0.147 0.008 2605 2463 1.193 0.056 0.130 0.163 Currently using injectables 0.253 0.011 2605 2463 1.298 0.044 0.231 0.276 Currently using implants 0.013 0.003 2605 2463 1.307 0.221 0.007 0.019 Currently using female sterilisation 0.018 0.004 2605 2463 1.416 0.202 0.011 0.026 Used public sector source 0.715 0.013 2076 1979 1.334 0.019 0.688 0.741 Want no more children 0.578 0.012 2605 2463 1.190 0.020 0.555 0.601 Want to delay next birth at least 2 years 0.258 0.010 2605 2463 1.141 0.038 0.239 0.278 Ideal number of children 2.755 0.028 4410 4193 1.307 0.010 2.699 2.811 Mothers received antenatal care for last birth 0.942 0.006 1929 1825 1.148 0.006 0.930 0.954 Mothers protected against tetanus for last birth 0.724 0.014 1929 1825 1.362 0.019 0.697 0.752 Births with skilled attendant at delivery 0.731 0.014 2352 2211 1.370 0.019 0.703 0.758 Had diarrhoea in the past 2 weeks 0.125 0.010 2178 2055 1.356 0.078 0.106 0.145 Treated with ORS 0.536 0.039 256 257 1.259 0.072 0.459 0.614 Sought medical treatment for diarrhoea 0.537 0.034 256 257 1.091 0.063 0.470 0.604 Vaccination card seen 0.788 0.022 496 475 1.204 0.028 0.744 0.832 Received BCG vaccination 0.978 0.007 496 475 1.082 0.007 0.963 0.992 Received DPT/pentavalent vaccination (3 doses) 0.865 0.018 496 475 1.152 0.020 0.830 0.900 Received polio vaccination (3 doses) 0.756 0.024 496 475 1.243 0.032 0.708 0.804 Received measles vaccination 0.891 0.015 496 475 1.112 0.017 0.860 0.922 Received all basic vaccinations 0.676 0.026 496 475 1.241 0.039 0.624 0.728 Height-for-age (-2SD) 0.351 0.014 1468 1416 1.058 0.039 0.324 0.379 Weight-for-height (-2SD) 0.033 0.005 1468 1416 1.075 0.156 0.023 0.043 Weight-for-age (-2SD) 0.110 0.010 1468 1416 1.179 0.091 0.090 0.130 Prevalence of anaemia (children 6-59 months) 0.516 0.016 1352 1299 1.122 0.031 0.484 0.547 Prevalence of anaemia (women 15-49) 0.248 0.010 2262 2156 1.105 0.040 0.228 0.268 Body Mass Index (BMI) < 18.5 0.043 0.005 2134 2031 1.086 0.110 0.034 0.053 Body Mass Index (BMI) ≥25 0.416 0.013 2134 2031 1.179 0.030 0.391 0.441 Had 2+ sexual partners in past 12 months 0.066 0.005 4419 4202 1.389 0.079 0.055 0.076 Condom use at last sex 0.453 0.037 281 276 1.232 0.081 0.380 0.526 Abstinence among youth (never had sex) 0.519 0.017 1099 1051 1.104 0.032 0.485 0.552 Sexually active in past 12 months among never-married youth 0.343 0.017 1099 1051 1.219 0.051 0.308 0.378 Had an HIV test and received results in past 12 months 0.585 0.009 4419 4202 1.268 0.016 0.566 0.604 Accepting attitudes towards people with HIV 0.447 0.011 4339 4135 1.439 0.024 0.426 0.469 Total fertility rate (3 years) 3.855 0.118 12214 11619 1.303 0.031 3.620 4.091 Neonatal mortality (last 0-9 years) 38.241 3.590 4491 4204 1.148 0.094 31.061 45.420 Post-neonatal mortality (last 0-9 years) 30.057 2.808 4480 4188 1.020 0.093 24.440 35.673 Infant mortality (last 0-9 years) 68.297 4.440 4498 4209 1.074 0.065 59.416 77.178 Child mortality (last 0-9 years) 23.749 2.742 4284 4008 1.082 0.115 18.265 29.234 Under-five mortality (last 0-9 years) 90.424 5.099 4515 4225 1.094 0.056 80.226 100.623 HIV prevalence among all women 15-49 0.264 0.011 2244 2046 1.174 0.041 0.242 0.286 HIV prevalence among young women 15-24 0.115 0.012 983 899 1.192 0.105 0.091 0.139 (Continued…) 342 • Appendix B Table B.4—Continued Value (R) Standard error (SE) Number of cases Design effect (DEFT) Relative error (SE/R) Confidence limits Variable Unweighted (N) Weighted (WN) R-2SE R+2SE MEN Urban residence 0.000 0.000 1805 1741 na na 0.000 0.000 Literacy 0.804 0.013 1805 1741 1.372 0.016 0.779 0.830 No education 0.109 0.010 1805 1741 1.302 0.087 0.090 0.129 Secondary education or higher 0.355 0.018 1805 1741 1.558 0.049 0.320 0.390 Never married/in union 0.578 0.015 1805 1741 1.258 0.025 0.549 0.607 Currently married/in union 0.364 0.014 1805 1741 1.224 0.038 0.337 0.392 Had sexual intercourse before age 18 0.469 0.016 1299 1236 1.171 0.035 0.436 0.501 Know any contraceptive method 0.993 0.003 680 634 1.001 0.003 0.986 0.999 Know a modern method 0.992 0.004 680 634 1.108 0.004 0.984 0.999 Want no more children 0.402 0.022 680 634 1.173 0.055 0.358 0.447 Want to delay next birth at least 2 years 0.346 0.023 680 634 1.233 0.065 0.301 0.391 Ideal number of children 3.173 0.045 1789 1727 1.178 0.014 3.083 3.262 Body Mass Index (BMI) <18.5 0.155 0.012 1757 1688 1.344 0.075 0.132 0.178 Body Mass Index (BMI) ≥25 0.083 0.008 1757 1688 1.252 0.099 0.067 0.100 Prevalence of anaemia 0.137 0.009 1724 1656 1.045 0.063 0.120 0.155 Had 2+ sexual partners in past 12 months 0.239 0.012 1805 1741 1.202 0.050 0.215 0.264 Condom use at last sex 0.616 0.027 428 417 1.146 0.044 0.562 0.670 Abstinence among youth (never had sex) 0.288 0.021 793 792 1.281 0.072 0.247 0.329 Sexually active in past 12 months among never-married youth 0.590 0.021 793 792 1.210 0.036 0.548 0.633 Paid for sexual intercourse in past 12 months 0.021 0.004 1805 1741 1.104 0.176 0.014 0.029 Had an HIV test and received results in past 12 months 0.309 0.015 1805 1741 1.343 0.047 0.280 0.339 Accepting attitudes towards people with HIV 0.332 0.015 1752 1692 1.333 0.045 0.302 0.362 HIV prevalence among all men 15-49 0.162 0.011 1708 1727 1.284 0.071 0.139 0.185 HIV prevalence among all men 15-59 0.173 0.011 1924 1932 1.264 0.063 0.151 0.195 HIV prevalence among young men 15-24 0.045 0.010 837 870 1.407 0.224 0.025 0.065 MEN AND WOMEN HIV prevalence among all respondents 15-49 0.218 0.008 3952 3773 1.248 0.038 0.201 0.234 HIV prevalence among all respondents 15-24 0.081 0.008 1820 1769 1.241 0.098 0.065 0.097 na = Not applicable Appendix B • 343 Table B.5 Sampling errors for Lowlands sample, Lesotho 2014 Value (R) Standard error (SE) Number of cases Design effect (DEFT) Relative error (SE/R) Confidence limits Variable Unweighted (N) Weighted (WN) R-2SE R+2SE WOMEN Urban residence 0.530 0.019 3290 4184 2.215 0.036 0.492 0.569 Literacy 0.979 0.003 3290 4184 1.106 0.003 0.974 0.985 No education 0.005 0.001 3290 4184 1.123 0.266 0.003 0.008 Secondary education or higher 0.702 0.012 3290 4184 1.509 0.017 0.678 0.726 Never married/never in union 0.363 0.009 3290 4184 1.121 0.026 0.344 0.382 Currently married/in union 0.510 0.011 3290 4184 1.311 0.022 0.487 0.533 Married before age 20 0.382 0.012 2568 3330 1.232 0.031 0.358 0.406 Had sexual intercourse before age 18 0.397 0.013 2568 3330 1.325 0.032 0.372 0.423 Currently pregnant 0.041 0.004 3290 4184 1.146 0.096 0.033 0.049 Children ever born 1.541 0.034 3290 4184 1.210 0.022 1.473 1.609 Children surviving 1.389 0.030 3290 4184 1.209 0.022 1.328 1.450 Children ever born to women age 40-49 3.361 0.111 518 655 1.306 0.033 3.139 3.584 Know any contraceptive method 0.996 0.002 1654 2134 1.385 0.002 0.992 1.000 Know a modern method 0.996 0.002 1654 2134 1.385 0.002 0.992 1.000 Currently using any method 0.638 0.015 1654 2134 1.248 0.023 0.609 0.668 Currently using a modern method 0.634 0.015 1654 2134 1.260 0.024 0.604 0.664 Currently using pill 0.153 0.011 1654 2134 1.221 0.071 0.131 0.174 Currently using IUCD 0.018 0.004 1654 2134 1.084 0.195 0.011 0.025 Currently using male condoms 0.200 0.012 1654 2134 1.193 0.059 0.177 0.224 Currently using injectables 0.227 0.013 1654 2134 1.243 0.056 0.201 0.253 Currently using implants 0.014 0.004 1654 2134 1.261 0.262 0.007 0.021 Currently using female sterilisation 0.020 0.004 1654 2134 1.280 0.222 0.011 0.028 Used public sector source 0.560 0.014 1652 2110 1.163 0.025 0.532 0.589 Want no more children 0.580 0.012 1654 2134 1.011 0.021 0.556 0.605 Want to delay next birth at least 2 years 0.230 0.012 1654 2134 1.114 0.050 0.207 0.253 Ideal number of children 2.516 0.021 3284 4176 1.007 0.008 2.474 2.559 Mothers received antenatal care for last birth 0.962 0.006 1147 1459 1.130 0.007 0.949 0.975 Mothers protected against tetanus for last birth 0.768 0.016 1147 1459 1.265 0.021 0.737 0.800 Births with skilled attendant at delivery 0.861 0.013 1349 1733 1.211 0.015 0.835 0.886 Had diarrhoea in the past 2 weeks 0.123 0.013 1256 1617 1.420 0.108 0.097 0.150 Treated with ORS 0.471 0.045 152 200 1.091 0.095 0.382 0.560 Sought medical treatment for diarrhoea 0.450 0.040 152 200 0.982 0.089 0.370 0.529 Vaccination card seen 0.770 0.030 295 370 1.195 0.039 0.711 0.830 Received BCG vaccination 0.981 0.008 295 370 1.040 0.009 0.964 0.998 Received DPT/pentavalent vaccination (3 doses) 0.856 0.023 295 370 1.114 0.027 0.810 0.902 Received polio vaccination (3 doses) 0.790 0.028 295 370 1.170 0.036 0.733 0.847 Received measles vaccination 0.919 0.018 295 370 1.099 0.019 0.884 0.954 Received all basic vaccinations 0.713 0.029 295 370 1.078 0.041 0.655 0.771 Height-for-age (-2SD) 0.272 0.019 791 1008 1.124 0.070 0.234 0.310 Weight-for-height (-2SD) 0.017 0.005 791 1008 1.040 0.280 0.008 0.027 Weight-for-age (-2SD) 0.081 0.011 791 1008 1.100 0.133 0.059 0.102 Prevalence of anaemia (children 6-59 months) 0.491 0.025 721 917 1.299 0.051 0.441 0.542 Prevalence of anaemia (women 15-49) 0.308 0.013 1627 2044 1.162 0.043 0.281 0.334 Body Mass Index (BMI) < 18.5 0.042 0.006 1555 1967 1.115 0.136 0.030 0.053 Body Mass Index (BMI) ≥ 25 0.483 0.016 1555 1967 1.226 0.032 0.452 0.514 Had 2+ sexual partners in past 12 months 0.069 0.006 3290 4184 1.315 0.084 0.058 0.081 Condom use at last sex 0.613 0.044 224 290 1.339 0.071 0.526 0.701 Abstinence among youth (never had sex) 0.474 0.020 942 1147 1.219 0.042 0.434 0.513 Sexually active in past 12 months among never-married youth 0.416 0.019 942 1147 1.157 0.045 0.378 0.453 Had an HIV test and received results in past 12 months 0.571 0.012 3290 4184 1.410 0.021 0.546 0.595 Accepting attitudes towards people with HIV 0.487 0.013 3272 4165 1.537 0.028 0.460 0.514 Total fertility rate (3 years) 2.770 0.115 9174 11736 1.194 0.042 2.539 3.001 Neonatal mortality (last 0-9 years) 30.671 4.354 2504 3238 1.181 0.142 21.962 39.379 Post-neonatal mortality (last 0-9 years) 39.723 5.429 2506 3245 1.235 0.137 28.865 50.582 Infant mortality (last 0-9 years) 70.394 6.924 2512 3246 1.250 0.098 56.546 84.242 Child mortality (last 0-9 years) 29.104 4.210 2411 3120 1.149 0.145 20.684 37.523 Under-five mortality (last 0-9 years) 97.449 8.276 2522 3258 1.316 0.085 80.897 114.001 HIV prevalence among all women 15-49 0.317 0.015 1611 1986 1.263 0.046 0.288 0.346 HIV prevalence among young women 15-24 0.141 0.015 696 843 1.168 0.110 0.110 0.171 (Continued…) 344 • Appendix B Table B.5—Continued Value (R) Standard error (SE) Number of cases Design effect (DEFT) Relative error (SE/R) Confidence limits Variable Unweighted (N) Weighted (WN) R-2SE R+2SE MEN Urban residence 0.494 0.022 1348 1711 1.594 0.044 0.451 0.538 Literacy 0.911 0.010 1348 1711 1.325 0.011 0.891 0.932 No education 0.029 0.006 1348 1711 1.205 0.190 0.018 0.040 Secondary education or higher 0.587 0.020 1348 1711 1.469 0.034 0.548 0.626 Never married/in union 0.576 0.017 1348 1711 1.268 0.030 0.542 0.610 Currently married/in union 0.346 0.017 1348 1711 1.292 0.048 0.313 0.380 Had sexual intercourse before age 18 0.499 0.019 998 1277 1.202 0.038 0.461 0.537 Know any contraceptive method 0.991 0.006 473 593 1.421 0.006 0.979 1.003 Know a modern method 0.990 0.006 473 593 1.410 0.007 0.977 1.003 Want no more children 0.403 0.029 473 593 1.276 0.071 0.346 0.461 Want to delay next birth at least 2 years 0.335 0.026 473 593 1.200 0.078 0.283 0.387 Ideal number of children 2.832 0.040 1341 1703 1.093 0.014 2.752 2.913 Body Mass Index (BMI) <18.5 0.146 0.012 1308 1655 1.245 0.083 0.122 0.171 Body Mass Index (BMI) ≥25 0.136 0.010 1308 1655 1.057 0.074 0.116 0.156 Prevalence of anaemia 0.132 0.012 1279 1613 1.301 0.094 0.107 0.157 Had 2+ sexual partners in past 12 months 0.278 0.019 1348 1711 1.537 0.068 0.240 0.315 Condom use at last sex 0.695 0.025 334 475 0.982 0.036 0.646 0.745 Abstinence among youth (never had sex) 0.272 0.023 587 751 1.257 0.085 0.225 0.318 Sexually active in past 12 months among never-married youth 0.580 0.025 587 751 1.235 0.043 0.530 0.630 Paid for sexual intercourse in past 12 months 0.039 0.006 1348 1711 1.235 0.168 0.026 0.051 Had an HIV test and received results in past 12 months 0.399 0.016 1348 1711 1.180 0.039 0.368 0.430 Accepting attitudes towards people with HIV 0.387 0.017 1334 1693 1.249 0.043 0.353 0.420 HIV prevalence among all men 15-49 0.202 0.014 1265 1699 1.278 0.071 0.174 0.231 HIV prevalence among all men 15-59 0.212 0.014 1404 1869 1.259 0.065 0.185 0.240 HIV prevalence among young men 15-24 0.066 0.013 611 830 1.329 0.202 0.039 0.093 MEN AND WOMEN HIV prevalence among all respondents 15-49 0.264 0.011 2876 3685 1.371 0.043 0.242 0.287 HIV prevalence among all respondents 15-24 0.104 0.012 1307 1673 1.375 0.112 0.080 0.127 na = Not applicable Appendix B • 345 Table B.6 Sampling errors for Foothills sample, Lesotho 2014 Value (R) Standard error (SE) Number of cases Design effect (DEFT) Relative error (SE/R) Confidence limits Variable Unweighted (N) Weighted (WN) R-2SE R+2SE WOMEN Urban residence 0.000 0.000 670 688 na na 0.000 0.000 Literacy 0.961 0.010 670 688 1.356 0.011 0.941 0.982 No education 0.008 0.003 670 688 0.983 0.430 0.001 0.014 Secondary education or higher 0.431 0.033 670 688 1.734 0.077 0.365 0.498 Never married/in union 0.259 0.020 670 688 1.203 0.079 0.218 0.300 Currently married/in union 0.621 0.024 670 688 1.294 0.039 0.572 0.669 Married before age 20 0.615 0.040 516 527 1.852 0.065 0.536 0.695 Had sexual intercourse before age 18 0.466 0.029 516 527 1.312 0.062 0.408 0.524 Currently pregnant 0.052 0.008 670 688 0.908 0.149 0.037 0.068 Children ever born 2.144 0.079 670 688 0.976 0.037 1.985 2.303 Children surviving 1.964 0.074 670 688 1.007 0.038 1.815 2.113 Children ever born to women age 40-49 4.568 0.264 124 130 1.242 0.058 4.040 5.096 Know any contraceptive method 0.998 0.002 412 427 0.972 0.002 0.993 1.002 Know a modern method 0.998 0.002 412 427 0.972 0.002 0.993 1.002 Ever used any contraceptive method 0.554 0.037 412 427 1.506 0.067 0.480 0.628 Currently using any method 0.554 0.037 412 427 1.506 0.067 0.480 0.628 Currently using a modern method 0.139 0.019 412 427 1.104 0.135 0.101 0.177 Currently using pill 0.012 0.005 412 427 0.980 0.430 0.002 0.023 Currently using IUCD 0.116 0.022 412 427 1.367 0.187 0.073 0.159 Currently using male condoms 0.265 0.024 412 427 1.116 0.092 0.217 0.314 Currently using injectables 0.005 0.005 412 427 1.339 0.957 0.000 0.014 Currently using female sterilisation 0.013 0.008 412 427 1.413 0.608 0.000 0.029 Used public sector source 0.715 0.033 304 314 1.258 0.046 0.650 0.781 Want no more children 0.617 0.023 412 427 0.951 0.037 0.571 0.662 Want to delay nest birth at least 2 years 0.259 0.019 412 427 0.861 0.072 0.221 0.296 Ideal number of children 2.817 0.079 669 687 1.299 0.028 2.658 2.975 Mothers protected against tetanus for last birth 0.911 0.019 303 316 1.188 0.021 0.872 0.949 Births with skilled attendant at delivery 0.681 0.038 303 316 1.424 0.055 0.606 0.757 Had diarrhoea in the past 2 weeks 0.607 0.037 366 380 1.284 0.061 0.534 0.681 Treated with ORS 0.132 0.019 335 348 1.051 0.143 0.094 0.169 Sought medical treatment 0.622 0.078 42 46 1.072 0.125 0.467 0.778 Vaccination card seen 0.564 0.078 42 46 1.052 0.138 0.408 0.720 Received BCG vaccination 0.784 0.053 63 66 1.030 0.067 0.678 0.889 Received DPT/pentavalent vaccination (3 doses) 0.975 0.019 63 66 0.984 0.020 0.936 1.013 Received polio vaccination (3 doses) 0.891 0.041 63 66 1.061 0.046 0.809 0.974 Received measles vaccination 0.692 0.065 63 66 1.125 0.094 0.562 0.821 Received all basic vaccinations 0.936 0.036 63 66 1.173 0.038 0.865 1.008 Height-for-age (-2SD) 0.658 0.066 63 66 1.113 0.100 0.526 0.789 Weight-for-height (-2SD) 0.409 0.032 217 221 1.017 0.079 0.345 0.473 Weight-for-age (-2SD) 0.045 0.016 217 221 1.132 0.348 0.014 0.077 Prevalence of anaemia (children 6-59 months) 0.149 0.039 217 221 1.528 0.262 0.071 0.227 Prevalence of anaemia (women 15-49) 0.215 0.028 341 335 1.209 0.128 0.160 0.270 Body Mass Index (BMI) <18.5 0.215 0.028 341 335 1.209 0.128 0.160 0.270 Body Mass Index (BMI) ≥25 0.049 0.011 316 311 0.899 0.227 0.027 0.072 Had 2+ sexual partners in past 12 months 0.440 0.029 316 311 1.013 0.066 0.382 0.498 Condom use at last sex 0.067 0.009 670 688 0.937 0.135 0.049 0.086 Abstinence among youth (never had sex) 0.369 0.095 45 46 1.293 0.257 0.180 0.559 Sexually active in past 12 months among never-married youth 0.537 0.051 140 145 1.204 0.095 0.435 0.639 Had an HIV test and received results in past 12 months 0.316 0.050 140 145 1.270 0.159 0.216 0.417 Accepting attitudes towards people with HIV 0.594 0.023 670 688 1.193 0.038 0.549 0.640 HIV prevalence all respondents 0.457 0.023 660 678 1.166 0.050 0.412 0.503 Total fertility rate (3 years) 4.194 0.258 1868 1904 0.974 0.061 3.679 4.710 Neonatal mortality (last 0-9 years) 38.704 9.230 700 721 1.125 0.238 20.244 57.163 Post-neonatal mortality (last 0-9 years) 24.070 6.583 694 714 1.080 0.273 10.905 37.235 Infant mortality (last 0-9 years) 62.774 10.929 700 721 1.068 0.174 40.916 84.632 Child mortality (last 0-9 years) 18.251 6.195 655 675 1.047 0.339 5.861 30.641 Under-five mortality (last 0-9 years) 79.879 10.801 701 722 0.996 0.135 58.278 101.480 HIV prevalence among all women 15-49 0.279 0.028 328 311 1.118 0.099 0.224 0.335 HIV prevalence among young women 15-24 0.130 0.038 142 131 1.321 0.288 0.055 0.205 (Continued…) 346 • Appendix B Table B.6—Continued Value (R) Standard error (SE) Number of cases Design effect (DEFT) Relative error (SE/R) Confidence limits Variable Unweighted (N) Weighted (WN) R-2SE R+2SE MEN Urban residence 0.000 0.000 258 252 na na 0.000 0.000 Literacy 0.797 0.033 258 252 1.296 0.041 0.732 0.862 No education 0.132 0.019 258 252 0.882 0.141 0.095 0.170 Secondary education or higher 0.269 0.035 258 252 1.247 0.128 0.200 0.338 Never married/in union 0.566 0.037 258 252 1.198 0.065 0.492 0.640 Currently married/in union 0.399 0.035 258 252 1.131 0.087 0.330 0.468 Had sexual intercourse before age 18 0.493 0.044 195 187 1.218 0.089 0.406 0.581 Know any contraceptive method 1.000 0.000 104 100 na 0.000 1.000 1.000 Know a modern method 1.000 0.000 104 100 na 0.000 1.000 1.000 Want no more children 0.414 0.071 104 100 1.461 0.172 0.271 0.556 Want to delay next birth at least 2 years 0.333 0.048 104 100 1.039 0.145 0.237 0.430 Ideal number of children 3.009 0.128 253 248 1.356 0.042 2.754 3.265 Body Mass Index (BMI) <18.5 0.152 0.035 254 246 1.549 0.232 0.082 0.222 Body Mass Index (BMI) ≥25 0.079 0.021 254 246 1.203 0.259 0.038 0.120 Prevalence of anaemia 0.199 0.027 247 237 1.059 0.137 0.144 0.253 Had 2+ sexual partners in past 12 months 0.275 0.035 258 252 1.257 0.128 0.205 0.345 Condom use at last sex 0.633 0.075 69 69 1.280 0.119 0.483 0.784 Abstinence among youth (never had sex) 0.335 0.070 105 107 1.508 0.209 0.195 0.476 Sexually active in past 12 months among never-married youth 0.556 0.075 105 107 1.520 0.134 0.407 0.705 Paid for sexual intercourse in past 12 months 0.023 0.009 258 252 0.987 0.404 0.004 0.041 Had an HIV test and received results in past 12 months 0.320 0.037 258 252 1.269 0.115 0.246 0.394 Accepting attitudes towards people with HIV 0.313 0.031 249 243 1.062 0.100 0.251 0.376 HIV prevalence among all men 15-49 0.184 0.024 243 246 0.968 0.131 0.136 0.232 HIV prevalence among all men 15-59 0.180 0.023 273 275 0.995 0.129 0.134 0.226 HIV prevalence among young men 15-24 0.032 0.016 114 119 0.972 0.499 0.000 0.065 MEN AND WOMEN HIV prevalence among all respondents 15-49 0.237 0.020 571 557 1.149 0.086 0.196 0.278 HIV prevalence among all respondents 15-24 0.084 0.021 256 250 1.229 0.255 0.041 0.126 na = Not applicable Appendix B • 347 Table B.7 Sampling errors for Mountains sample, Lesotho 2014 Value (R) Standard error (SE) Number of cases Design effect (DEFT) Relative error (SE/R) Confidence limits Variable Unweighted (N) Weighted (WN) R-2SE R+2SE WOMEN Urban residence 0.120 0.013 1897 1288 1.686 0.105 0.094 0.145 Literacy 0.948 0.006 1897 1288 1.185 0.006 0.935 0.960 No education 0.026 0.005 1897 1288 1.246 0.176 0.017 0.035 Secondary education or higher 0.411 0.018 1897 1288 1.601 0.044 0.375 0.447 Never married/in union 0.270 0.016 1897 1288 1.611 0.061 0.237 0.303 Currently married/in union 0.619 0.021 1897 1288 1.843 0.033 0.578 0.660 Married before age 20 0.587 0.014 1403 967 1.101 0.025 0.558 0.615 Had sexual intercourse before age 18 0.459 0.019 1403 967 1.398 0.041 0.422 0.496 Currently pregnant 0.045 0.006 1897 1288 1.220 0.129 0.034 0.057 Children ever born 2.128 0.068 1897 1288 1.379 0.032 1.992 2.264 Children surviving 1.919 0.057 1897 1288 1.297 0.030 1.804 2.034 Children ever born to women age 40-49 4.589 0.222 288 194 1.485 0.048 4.145 5.033 Know any contraceptive method 0.990 0.004 1122 797 1.399 0.004 0.981 0.998 Know a modern method 0.990 0.004 1122 797 1.399 0.004 0.981 0.998 Ever used any contraceptive method 0.531 0.020 1122 797 1.373 0.039 0.490 0.571 Currently using any method 0.526 0.021 1122 797 1.392 0.039 0.485 0.568 Currently using a modern method 0.108 0.010 1122 797 1.119 0.096 0.088 0.129 Currently using pill 0.003 0.001 1122 797 0.918 0.511 0.000 0.006 Currently using IUCD 0.128 0.012 1122 797 1.217 0.095 0.104 0.152 Currently using male condoms 0.256 0.020 1122 797 1.551 0.079 0.215 0.296 Currently using injectables 0.016 0.004 1122 797 1.048 0.248 0.008 0.023 Currently using female sterilisation 0.013 0.004 1122 797 1.194 0.310 0.005 0.021 Used public sector source 0.840 0.016 836 553 1.281 0.019 0.807 0.872 Want no more children 0.557 0.022 1122 797 1.463 0.039 0.514 0.601 Want to delay nest birth at least 2 years 0.255 0.018 1122 797 1.358 0.069 0.219 0.290 Ideal number of children 2.899 0.061 1891 1284 1.730 0.021 2.777 3.020 Mothers protected against tetanus for last birth 0.950 0.009 818 598 1.152 0.009 0.933 0.967 Births with skilled attendant at delivery 0.715 0.021 818 598 1.360 0.029 0.673 0.757 Had diarrhoea in the past 2 weeks 0.688 0.020 1025 752 1.316 0.029 0.648 0.729 Treated with ORS 0.108 0.012 957 703 1.194 0.110 0.085 0.132 Sought medical treatment 0.673 0.046 99 76 1.014 0.069 0.580 0.765 Vaccination card seen 0.622 0.047 99 76 0.998 0.076 0.528 0.716 Received BCG vaccination 0.756 0.035 226 172 1.272 0.046 0.686 0.826 Received DPT/pentavalent vaccination (3 doses) 0.974 0.010 226 172 0.999 0.010 0.954 0.995 Received polio vaccination (3 doses) 0.819 0.034 226 172 1.400 0.042 0.750 0.888 Received measles vaccination 0.716 0.037 226 172 1.293 0.052 0.642 0.791 Received all basic vaccinations 0.834 0.028 226 172 1.185 0.034 0.777 0.890 Height-for-age (-2SD) 0.625 0.047 226 172 1.509 0.075 0.532 0.719 Weight-for-height (-2SD) 0.420 0.024 624 475 1.176 0.057 0.373 0.468 Weight-for-age (-2SD) 0.041 0.009 624 475 1.220 0.227 0.022 0.059 Prevalence of anaemia (children 6-59 months) 0.131 0.015 624 475 1.089 0.112 0.102 0.160 Prevalence of anaemia (women 15-49) 0.208 0.015 983 672 1.142 0.071 0.178 0.237 Body Mass Index (BMI) <18.5 0.208 0.015 983 672 1.142 0.071 0.178 0.237 Body Mass Index (BMI) ≥25 0.043 0.008 939 639 1.142 0.176 0.028 0.058 Had 2+ sexual partners in past 12 months 0.355 0.018 939 639 1.123 0.049 0.320 0.390 Condom use at last sex 0.052 0.007 1897 1288 1.364 0.133 0.038 0.066 Abstinence among youth (never had sex) 0.375 0.063 106 67 1.320 0.167 0.249 0.500 Sexually active in past 12 months among never-married youth 0.642 0.025 500 313 1.146 0.038 0.592 0.691 Had an HIV test and received results in past 12 months 0.225 0.024 500 313 1.273 0.106 0.178 0.273 Accepting attitudes towards people with HIV 0.589 0.014 1897 1288 1.246 0.024 0.561 0.618 HIV prevalence all respondents 0.392 0.015 1855 1256 1.329 0.038 0.361 0.422 Total fertility rate (3 years) 4.250 0.223 5167 3530 1.499 0.053 3.804 4.697 Neonatal mortality (last 0-9 years) 35.767 5.061 2036 1492 1.210 0.141 25.645 45.888 Post-neonatal mortality (last 0-9 years) 30.808 3.965 2030 1486 0.959 0.129 22.877 38.738 Infant mortality (last 0-9 years) 66.574 6.829 2040 1495 1.164 0.103 52.917 80.232 Child mortality (last 0-9 years) 17.708 3.819 1967 1431 1.188 0.216 10.069 25.346 Under-five mortality (last 0-9 years) 83.103 8.300 2046 1497 1.299 0.100 66.504 99.703 HIV prevalence among all women 15-49 0.256 0.017 981 640 1.252 0.068 0.221 0.291 HIV prevalence among young women 15-24 0.116 0.021 419 271 1.335 0.181 0.074 0.158 (Continued…) 348 • Appendix B Table B.7—Continued Value (R) Standard error (SE) Number of cases Design effect (DEFT) Relative error (SE/R) Confidence limits Variable Unweighted (N) Weighted (WN) R-2SE R+2SE MEN Urban residence 0.115 0.012 734 523 1.017 0.104 0.091 0.139 Literacy 0.658 0.022 734 523 1.267 0.034 0.614 0.703 No education 0.218 0.019 734 523 1.234 0.086 0.180 0.255 Secondary education or higher 0.224 0.020 734 523 1.287 0.088 0.185 0.264 Never married/in union 0.510 0.025 734 523 1.362 0.049 0.459 0.560 Currently married/in union 0.437 0.023 734 523 1.280 0.054 0.390 0.484 Had sexual intercourse before age 18 0.416 0.028 531 379 1.315 0.068 0.360 0.472 Know any contraceptive method 0.987 0.008 315 229 1.174 0.008 0.972 1.002 Know a modern method 0.987 0.008 315 229 1.174 0.008 0.972 1.002 Want no more children 0.390 0.030 315 229 1.073 0.076 0.330 0.449 Want to delay next birth at least 2 years 0.368 0.045 315 229 1.632 0.121 0.279 0.458 Ideal number of children 3.515 0.081 727 517 1.161 0.023 3.353 3.677 Body Mass Index (BMI) <18.5 0.114 0.018 719 513 1.545 0.161 0.078 0.151 Body Mass Index (BMI) ≥25 0.084 0.017 719 513 1.599 0.197 0.051 0.118 Prevalence of anaemia 0.159 0.013 708 503 0.977 0.085 0.132 0.186 Had 2+ sexual partners in past 12 months 0.232 0.016 734 523 1.029 0.069 0.200 0.264 Condom use at last sex 0.517 0.045 186 122 1.220 0.087 0.427 0.607 Abstinence among youth (never had sex) 0.314 0.034 304 213 1.290 0.110 0.245 0.383 Sexually active in past 12 months among never-married youth 0.570 0.036 304 213 1.267 0.063 0.498 0.642 Paid for sexual intercourse in past 12 months 0.014 0.004 734 523 1.014 0.309 0.006 0.023 Had an HIV test and received results in past 12 months 0.276 0.026 734 523 1.590 0.095 0.223 0.328 Accepting attitudes towards people with HIV 0.273 0.029 707 503 1.723 0.106 0.216 0.331 HIV prevalence among all men 15-49 0.139 0.021 702 528 1.619 0.152 0.097 0.181 HIV prevalence among all men 15-59 0.153 0.020 793 583 1.587 0.133 0.112 0.194 HIV prevalence among young men 15-24 0.048 0.021 320 237 1.760 0.439 0.006 0.091 MEN AND WOMEN HIV prevalence among all respondents 15-49 0.203 0.013 1683 1169 1.340 0.065 0.177 0.230 HIV prevalence among all respondents 15-24 0.084 0.013 739 507 1.245 0.151 0.059 0.110 Appendix B • 349 Table B.8 Sampling errors for Senqu River Valley sample, Lesotho 2014 Value (R) Standard error (SE) Number of cases Design effect (DEFT) Relative error (SE/R) Confidence limits Variable Unweighted (N) Weighted (WN) R-2SE R+2SE WOMEN Urban residence 0.103 0.014 764 461 1.230 0.132 0.076 0.130 Literacy 0.965 0.007 764 461 1.059 0.007 0.951 0.979 No education 0.014 0.005 764 461 1.108 0.331 0.005 0.024 Secondary education or higher 0.515 0.028 764 461 1.530 0.054 0.459 0.570 Never married/in union 0.316 0.022 764 461 1.311 0.070 0.271 0.360 Currently married/in union 0.552 0.022 764 461 1.206 0.039 0.508 0.595 Married before age 20 0.497 0.024 592 357 1.172 0.049 0.448 0.545 Had sexual intercourse before age 18 0.499 0.024 592 357 1.146 0.047 0.452 0.546 Currently pregnant 0.036 0.006 764 461 0.888 0.166 0.024 0.048 Children ever born 1.978 0.076 764 461 1.115 0.038 1.826 2.131 Children surviving 1.782 0.073 764 461 1.182 0.041 1.635 1.928 Children ever born to women age 40-49 4.161 0.158 142 83 0.958 0.038 3.844 4.477 Know any contraceptive method 0.993 0.004 421 254 1.005 0.004 0.984 1.001 Know a modern method 0.993 0.004 421 254 1.005 0.004 0.984 1.001 Ever used any contraceptive method 0.594 0.028 421 254 1.157 0.047 0.539 0.650 Currently using any method 0.592 0.028 421 254 1.163 0.047 0.536 0.648 Currently using a modern method 0.169 0.024 421 254 1.291 0.140 0.122 0.216 Currently using pill 0.007 0.005 421 254 1.114 0.650 0.000 0.016 Currently using IUCD 0.126 0.019 421 254 1.181 0.152 0.088 0.164 Currently using male condoms 0.262 0.024 421 254 1.100 0.090 0.215 0.309 Currently using injectables 0.020 0.007 421 254 1.046 0.362 0.005 0.034 Currently using female sterilisation 0.008 0.004 421 254 0.890 0.476 0.000 0.016 Used public sector source 0.681 0.034 402 236 1.450 0.050 0.613 0.748 Want no more children 0.556 0.029 421 254 1.191 0.052 0.498 0.614 Want to delay nest birth at least 2 years 0.259 0.023 421 254 1.062 0.088 0.214 0.305 Ideal number of children 2.723 0.060 764 461 1.238 0.022 2.602 2.844 Mothers protected against tetanus for last birth 0.946 0.015 328 202 1.182 0.015 0.917 0.975 Births with skilled attendant at delivery 0.747 0.031 328 202 1.287 0.041 0.686 0.808 Had diarrhoea in the past 2 weeks 0.749 0.036 398 247 1.673 0.048 0.676 0.821 Treated with ORS 0.089 0.020 367 228 1.343 0.224 0.049 0.129 Sought medical treatment 0.435 0.081 35 20 0.947 0.186 0.273 0.598 Vaccination card seen 0.543 0.074 35 20 0.862 0.136 0.395 0.692 Received BCG vaccination 0.818 0.041 71 46 0.890 0.050 0.736 0.901 Received DPT/pentavalent vaccination (3 doses) 1.000 0.000 71 46 na 0.000 1.000 1.000 Received polio vaccination (3 doses) 0.912 0.033 71 46 1.010 0.036 0.847 0.978 Received measles vaccination 0.733 0.059 71 46 1.128 0.080 0.615 0.850 Received all basic vaccinations 0.962 0.027 71 46 1.223 0.028 0.909 1.016 Height-for-age (-2SD) 0.694 0.072 71 46 1.334 0.104 0.550 0.838 Weight-for-height (-2SD) 0.344 0.034 250 165 1.158 0.099 0.276 0.411 Weight-for-age (-2SD) 0.034 0.014 250 165 1.046 0.414 0.006 0.063 Prevalence of anaemia (children 6-59 months) 0.098 0.017 250 165 0.919 0.178 0.063 0.132 Prevalence of anaemia (women 15-49) 0.238 0.027 398 247 1.293 0.114 0.184 0.293 Body Mass Index (BMI) <18.5 0.238 0.027 398 247 1.293 0.114 0.184 0.293 Body Mass Index (BMI) ≥25 0.045 0.010 383 238 0.998 0.232 0.024 0.066 Had 2+ sexual partners in past 12 months 0.391 0.031 383 238 1.279 0.080 0.328 0.454 Condom use at last sex 0.068 0.009 764 461 1.004 0.134 0.050 0.087 Abstinence among youth (never had sex) 0.459 0.068 55 32 1.004 0.149 0.322 0.595 Sexually active in past 12 months among never-married youth 0.414 0.037 190 114 1.027 0.089 0.340 0.487 Had an HIV test and received results in past 12 months 0.410 0.042 190 114 1.174 0.103 0.326 0.494 Accepting attitudes towards people with HIV 0.614 0.023 764 461 1.295 0.037 0.568 0.659 HIV prevalence all respondents 0.443 0.029 752 453 1.573 0.064 0.386 0.500 Total fertility rate (3 years) 3.696 0.256 2138 1293 1.170 0.069 3.184 4.209 Neonatal mortality (last 0-9 years) 36.890 7.765 769 479 1.024 0.210 21.360 52.420 Post-neonatal mortality (last 0-9 years) 38.270 7.150 771 480 1.017 0.187 23.970 52.570 Infant mortality (last 0-9 years) 75.160 9.949 769 479 0.955 0.132 55.261 95.058 Child mortality (last 0-9 years) 27.355 6.343 730 459 0.973 0.232 14.669 40.040 Under-five mortality (last 0-9 years) 100.458 10.639 772 481 0.888 0.106 79.181 121.736 HIV prevalence among all women 15-49 0.261 0.026 401 238 1.168 0.098 0.209 0.312 HIV prevalence among young women 15-24 0.089 0.027 167 98 1.206 0.299 0.036 0.143 (Continued…) 350 • Appendix B Table B.8—Continued Value (R) Standard error (SE) Number of cases Design effect (DEFT) Relative error (SE/R) Confidence limits Variable Unweighted (N) Weighted (WN) R-2SE R+2SE MEN Urban residence 0.080 0.016 286 174 0.974 0.195 0.049 0.112 Literacy 0.818 0.033 286 174 1.435 0.040 0.752 0.883 No education 0.092 0.020 286 174 1.182 0.220 0.051 0.132 Secondary education or higher 0.386 0.041 286 174 1.412 0.106 0.304 0.467 Never married/in union 0.611 0.030 286 174 1.031 0.049 0.552 0.671 Currently married/in union 0.353 0.031 286 174 1.083 0.087 0.292 0.414 Had sexual intercourse before age 18 0.577 0.036 212 125 1.061 0.063 0.504 0.649 Know any contraceptive method 0.988 0.012 101 61 1.109 0.012 0.963 1.012 Know a modern method 0.988 0.012 101 61 1.109 0.012 0.963 1.012 Want no more children 0.378 0.061 101 61 1.247 0.160 0.257 0.500 Want to delay next birth at least 2 years 0.308 0.037 101 61 0.809 0.121 0.233 0.382 Ideal number of children 3.343 0.112 284 172 1.054 0.034 3.118 3.567 Body Mass Index (BMI) <18.5 0.174 0.026 279 169 1.122 0.147 0.123 0.226 Body Mass Index (BMI) ≥25 0.080 0.016 279 169 1.009 0.205 0.047 0.113 Prevalence of anaemia 0.093 0.018 271 164 1.017 0.194 0.057 0.128 Had 2+ sexual partners in past 12 months 0.263 0.027 286 174 1.049 0.104 0.208 0.317 Condom use at last sex 0.605 0.061 81 46 1.106 0.100 0.483 0.726 Abstinence among youth (never had sex) 0.231 0.043 123 80 1.138 0.188 0.144 0.318 Sexually active in past 12 months among never-married youth 0.648 0.043 123 80 1.004 0.067 0.561 0.734 Paid for sexual intercourse in past 12 months 0.014 0.007 286 174 0.987 0.484 0.000 0.028 Had an HIV test and received results in past 12 months 0.349 0.030 286 174 1.054 0.085 0.290 0.409 Accepting attitudes towards people with HIV 0.349 0.028 278 168 0.970 0.080 0.293 0.405 HIV prevalence among all men 15-49 0.173 0.024 271 173 1.036 0.138 0.125 0.220 HIV prevalence among all men 15-59 0.185 0.022 305 194 1.009 0.121 0.140 0.230 HIV prevalence among young men 15-24 0.070 0.024 128 87 1.052 0.341 0.022 0.118 MEN AND WOMEN HIV prevalence among all respondents 15-49 0.224 0.018 672 411 1.128 0.081 0.187 0.260 HIV prevalence among all respondents 15-24 0.080 0.017 295 184 1.070 0.211 0.046 0.114 na = Not applicable Appendix B • 351 Table B.9 Sampling errors for Butha-Buthe sample, Lesotho 2014 Value (R) Standard error (SE) Number of cases Design effect (DEFT) Relative error (SE/R) Confidence limits Variable Unweighted (N) Weighted (WN) R-2SE R+2SE WOMEN Urban residence 0.190 0.021 593 385 1.279 0.109 0.148 0.231 Literacy 0.968 0.006 593 385 0.896 0.007 0.955 0.981 No education 0.016 0.005 593 385 1.044 0.332 0.006 0.027 Secondary education or higher 0.575 0.035 593 385 1.710 0.061 0.505 0.645 Never married/never in union 0.304 0.025 593 385 1.329 0.083 0.254 0.355 Currently married/in union 0.549 0.025 593 385 1.244 0.046 0.498 0.600 Married before age 20 0.505 0.032 466 304 1.363 0.063 0.442 0.568 Had sexual intercourse before age 18 0.393 0.028 466 304 1.215 0.070 0.338 0.448 Currently pregnant 0.047 0.006 593 385 0.730 0.135 0.034 0.060 Children ever born 1.825 0.086 593 385 1.121 0.047 1.653 1.998 Children surviving 1.717 0.082 593 385 1.144 0.048 1.552 1.882 Children ever born to women age 40-49 3.943 0.252 94 63 1.026 0.064 3.438 4.448 Know any contraceptive method 1.000 0.000 324 211 na 0.000 1.000 1.000 Know a modern method 1.000 0.000 324 211 na 0.000 1.000 1.000 Currently using any method 0.565 0.029 324 211 1.038 0.051 0.508 0.622 Currently using a modern method 0.562 0.029 324 211 1.035 0.051 0.505 0.620 Currently using pill 0.143 0.019 324 211 0.969 0.132 0.105 0.180 Currently using IUCD 0.031 0.008 324 211 0.846 0.263 0.015 0.047 Currently using male condoms 0.094 0.014 324 211 0.838 0.145 0.067 0.121 Currently using injectables 0.272 0.031 324 211 1.269 0.116 0.209 0.335 Currently using implants 0.009 0.005 324 211 0.929 0.548 0.000 0.018 Currently using female sterilisation 0.009 0.005 324 211 0.902 0.518 0.000 0.019 Used public sector source 0.717 0.035 263 168 1.271 0.049 0.647 0.788 Want no more children 0.561 0.029 324 211 1.049 0.052 0.503 0.619 Want to delay next birth at least 2 years 0.282 0.024 324 211 0.943 0.084 0.235 0.329 Ideal number of children 2.718 0.081 593 385 1.292 0.030 2.556 2.879 Mothers received antenatal care for last birth 0.925 0.023 250 167 1.387 0.025 0.879 0.971 Mothers protected against tetanus for last birth 0.787 0.024 250 167 0.938 0.031 0.738 0.835 Births with skilled attendant at delivery 0.773 0.030 298 197 1.180 0.039 0.712 0.834 Had diarrhoea in the past 2 weeks 0.092 0.019 277 184 1.075 0.203 0.055 0.129 Vaccination card seen 0.720 0.069 54 36 1.121 0.096 0.582 0.857 Received BCG vaccination 0.979 0.021 54 36 1.069 0.021 0.938 1.021 Received DPT/pentavalent vaccination (3 doses) 0.867 0.052 54 36 1.132 0.060 0.763 0.972 Received polio vaccination (3 doses) 0.706 0.078 54 36 1.259 0.111 0.549 0.862 Received measles vaccination 0.957 0.030 54 36 1.077 0.031 0.898 1.017 Received all basic vaccinations 0.706 0.078 54 36 1.259 0.111 0.549 0.862 Height-for-age (-2SD) 0.403 0.045 184 124 1.233 0.112 0.312 0.493 Weight-for-height (-2SD) 0.018 0.010 184 124 0.985 0.534 0.000 0.038 Weight-for-age (-2SD) 0.075 0.023 184 124 1.241 0.306 0.029 0.120 Prevalence of anaemia (children 6-59 months) 0.592 0.032 167 112 0.869 0.055 0.527 0.657 Prevalence of anaemia (women 15-49) 0.294 0.029 313 203 1.123 0.098 0.236 0.352 Body Mass Index (BMI) < 18.5 0.024 0.008 293 189 0.897 0.333 0.008 0.041 Body Mass Index (BMI) ≥ 25 0.463 0.028 293 189 0.945 0.060 0.408 0.518 Had 2+ sexual partners in past 12 months 0.034 0.008 593 385 1.011 0.222 0.019 0.049 Abstinence among youth (never had sex) 0.529 0.035 152 94 0.871 0.067 0.458 0.599 Sexually active in past 12 months among never-married youth 0.269 0.032 152 94 0.887 0.119 0.205 0.333 Had an HIV test and received results in past 12 months 0.620 0.019 593 385 0.949 0.031 0.582 0.657 Accepting attitudes towards people with HIV 0.534 0.022 579 373 1.047 0.041 0.491 0.578 Total fertility rate (3 years) 3.720 0.286 1688 1098 1.139 0.077 3.149 4.292 Neonatal mortality (last 0-9 years) 27.859 8.088 550 369 1.055 0.290 11.684 44.034 Post-neonatal mortality (last 0-9 years) 21.314 8.190 545 366 1.226 0.384 4.934 37.694 Infant mortality (last 0-9 years) 49.173 10.096 550 369 1.025 0.205 28.980 69.366 Child mortality (last 0-9 years) 10.643 5.759 510 339 1.212 0.541 0.000 22.162 Under-five mortality (last 0-9 years) 59.293 10.808 551 371 1.024 0.182 37.678 80.908 HIV prevalence among all women 15-49 0.220 0.019 305 191 0.813 0.088 0.181 0.258 HIV prevalence among young women 15-24 0.113 0.028 132 84 1.027 0.252 0.056 0.169 (Continued…) 352 • Appendix B Table B.9—Continued Value (R) Standard error (SE) Number of cases Design effect (DEFT) Relative error (SE/R) Confidence limits Variable Unweighted (N) Weighted (WN) R-2SE R+2SE MEN Urban residence 0.185 0.036 222 143 1.361 0.192 0.114 0.257 Literacy 0.867 0.030 222 143 1.305 0.034 0.808 0.927 No education 0.085 0.023 222 143 1.231 0.273 0.039 0.131 Secondary education or higher 0.423 0.047 222 143 1.403 0.110 0.330 0.517 Never married/in union 0.521 0.040 222 143 1.198 0.077 0.440 0.602 Currently married/in union 0.400 0.040 222 143 1.208 0.100 0.321 0.480 Had sexual intercourse before age 18 0.349 0.039 167 106 1.047 0.111 0.271 0.426 Know any contraceptive method 1.000 0.000 90 57 na 0.000 1.000 1.000 Know a modern method 1.000 0.000 90 57 na 0.000 1.000 1.000 Want no more children 0.439 0.065 90 57 1.236 0.149 0.308 0.569 Want to delay next birth at least 2 years 0.349 0.060 90 57 1.177 0.171 0.229 0.468 Ideal number of children 3.170 0.130 219 142 1.061 0.041 2.909 3.431 Body Mass Index (BMI) <18.5 0.128 0.043 221 142 1.908 0.337 0.042 0.215 Body Mass Index (BMI) ≥25 0.107 0.024 221 142 1.146 0.223 0.060 0.155 Prevalence of anaemia 0.219 0.033 217 140 1.168 0.150 0.153 0.285 Had 2+ sexual partners in past 12 months 0.142 0.027 222 143 1.157 0.191 0.088 0.196 Condom use at last sex 0.722 0.082 33 20 1.037 0.114 0.558 0.887 Abstinence among youth (never had sex) 0.476 0.061 84 55 1.114 0.128 0.354 0.599 Sexually active in past 12 months among never-married youth 0.439 0.056 84 55 1.022 0.127 0.327 0.550 Paid for sexual intercourse in past 12 months 0.012 0.007 222 143 1.016 0.627 0.000 0.026 Had an HIV test and received results in past 12 months 0.374 0.042 222 143 1.303 0.113 0.290 0.459 Accepting attitudes towards people with HIV 0.407 0.039 216 138 1.150 0.095 0.329 0.484 HIV prevalence among all men 15-49 0.202 0.036 211 142 1.283 0.176 0.131 0.273 HIV prevalence among all men 15-59 0.207 0.032 244 161 1.214 0.152 0.144 0.271 HIV prevalence among young men 15-24 0.046 0.025 92 64 1.143 0.547 0.000 0.096 MEN AND WOMEN HIV prevalence among all respondents 15-49 0.212 0.019 516 333 1.063 0.090 0.174 0.250 HIV prevalence among all respondents 15-24 0.084 0.023 224 148 1.241 0.275 0.038 0.130 na = Not applicable Appendix B • 353 Table B.10 Sampling errors for Leribe sample, Lesotho 2014 Value (R) Standard error (SE) Number of cases Design effect (DEFT) Relative error (SE/R) Confidence limits Variable Unweighted (N) Weighted (WN) R-2SE R+2SE WOMEN Urban residence 0.329 0.031 785 1064 1.859 0.095 0.266 0.391 Literacy 0.969 0.007 785 1064 1.205 0.008 0.954 0.984 No education 0.008 0.004 785 1064 1.138 0.454 0.001 0.015 Secondary education or higher 0.659 0.022 785 1064 1.323 0.034 0.615 0.704 Never married/never in union 0.333 0.017 785 1064 0.982 0.050 0.300 0.366 Currently married/in union 0.542 0.018 785 1064 1.015 0.033 0.506 0.579 Married before age 20 0.453 0.024 600 819 1.159 0.052 0.405 0.500 Had sexual intercourse before age 18 0.412 0.028 600 819 1.368 0.067 0.357 0.467 Currently pregnant 0.036 0.006 785 1064 0.831 0.153 0.025 0.047 Children ever born 1.747 0.052 785 1064 0.841 0.030 1.642 1.852 Children surviving 1.573 0.053 785 1064 0.942 0.034 1.467 1.678 Children ever born to women age 40-49 3.736 0.182 134 183 1.129 0.049 3.373 4.099 Know any contraceptive method 1.000 0.000 422 577 na 0.000 1.000 1.000 Know a modern method 1.000 0.000 422 577 na 0.000 1.000 1.000 Currently using any method 0.642 0.033 422 577 1.398 0.051 0.577 0.708 Currently using a modern method 0.634 0.032 422 577 1.374 0.051 0.570 0.699 Currently using pill 0.124 0.019 422 577 1.177 0.152 0.086 0.162 Currently using IUCD 0.024 0.007 422 577 0.980 0.308 0.009 0.038 Currently using male condoms 0.186 0.021 422 577 1.114 0.113 0.144 0.229 Currently using injectables 0.242 0.027 422 577 1.285 0.111 0.188 0.296 Currently using implants 0.020 0.007 422 577 0.972 0.334 0.007 0.033 Currently using female sterilisation 0.037 0.009 422 577 1.008 0.251 0.018 0.055 Used public sector source 0.650 0.029 404 547 1.214 0.044 0.592 0.707 Want no more children 0.558 0.025 422 577 1.021 0.044 0.509 0.608 Want to delay next birth at least 2 years 0.271 0.024 422 577 1.117 0.089 0.223 0.319 Ideal number of chi