Nigeria - Demographic and Health Survey - 1992

Publication date: 1992

Nigeria Nigeria Demographic and Health Survey 1990 Federal Office of Statistics ®DHS Demographic and Health Surveys IRD/Macro International, Inc. Nigeria Demographic and Health Survey 1990 Federal Office of Statistics Lagos, Nigeria IRD/IVlacro International Inc. Columbia, Maryland USA April 1992 This report summarises the findings of the 1990 Nigeria Demographic and Health Survey, conducted by the Federal Office of Statistics of Nigeria. lRD/Macro International provided technical assistance. Funding for the project was provldnd by the U.S. Agency for International Development (Contract No. DP-3023-Z-00.8074-00). The Nigeria DHS survey is part of the worldwide Demographic and Health Surveys Programme, which is designed to collect data on fertility, family planning, and maternal and child health. Additional information on the Nigeria DHS survey may be obtained from the Federal Office of Statistics, P.M.B. 12528, 36/38 Broad Street, Lagos Island, Lagos, Nigeria. Additional information about the DHS programme may be obtained by writing to: DHS, IRD/IVlacm International Inc.,8850 StanfordBoulevard, Suite4000,Columbia, MD 21045,U.S.A. (Telephone410-290-2800;Telex 198116; Fax 410-290-2999). CONTENTS Page Tables . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . v Figures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ix Acronyms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xi Foreword . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xiii Summary of Findings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xv Map of Nigeria . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xviii 1 INTRODUCTION 1.1 History, Geography, and Economy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 1.2 Population . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 1.3 Population and Family Planning Policies and Programmes . . . . . . . . . . . . . . . . . . . . . . . . . . 3 1.4 Health Priorities and Programmes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 1.5 Objectives and Organisation of the Survey . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 2 CHARACTERISTICS OF HOUSEHOLDS AND RESPONDENTS 2.1 Characteristics of the Household Population . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 2.2 Housing Characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 2.3 Background Characteristics of Survey Respondents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 3 FERTILITY 3.1 Current Fertility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23 3.2 Children Ever Bom and Living . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29 3.3 Birth Intervals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 3.4 Age at First Birth . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31 3.5 Teenage Pregnancy and Motherhood . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33 4 FERTILITY REGULATION 4.1 Knowledge of Contraception . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37 4.2 Ever Use of Contraception . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40 4.3 Current Use of Contraception . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42 4.4 Number of Children at First Use of Contraception . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45 4.5 Use of Social Marketing Brand Pills . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45 4.6 Knowledge of the Fertile Period . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46 4.7 Sources for Family Planning Methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47 4.8 Intention to Use Family Planning Among Nonusers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49 4.9 Approval of Family Planning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52 $ PROXIMATE DETERMINANTS OF FERTILITY 5.1 Marital Status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57 5.2 Polygyny . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58 5.3 Age at First Marriage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59 5.4 Age at First Sexual Inlercourse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61 5.5 Recent Sexual Activity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63 5.6 Postpartum Amenorrhoea, Abstinence and Insusceptibility . . . . . . . . . . . . . . . . . . . . . . . . . 65 5.7 Termination of Exposure to Pregnancy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66 i i i Page 6 FERTILITY PREFERENCES 6.1 Desire for More Children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69 6.2 Demand for Family Planning Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71 6.3 Ideal and Actual Number of Children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73 6.4 Fertility Planning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75 7 INFANT AND CHILD MORTALITY 7.1 Infant and Child Mortality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78 7.2 High Risk Fertility Behaviour . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83 8 MATERNAL AND CHILD HEALTH 8.1 Antenatal Cam and Delivery Assistance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85 8.2 Vaccinations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 92 8.3 Acute Respiratory Infection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97 8.4 Fever . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99 8.5 Diarrhoea . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100 9 INFANT FEEDING AND CHILDHOOD NUTRITION 9.1 Breastfeeding and Supplementation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 107 9.2 Nutritional Status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 112 10 LOCAL AVAILABILITY OF FAMILY PLANNING AND HEALTH SERVICES 10.10rganisat ion of the Family Planning and Health System . . . . . . . . . . . . . . . . . . . . . . . . . . 117 10.2 Nigeria Service Availability Questionnaire . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 118 10.3 Availability of Family Planning Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 118 10.4 Availability of Maternal and Child Health Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 122 REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 127 APPENDICES Appendix A. Appendix B. Appendix C. Appendix D. Appendix E. Persons Involved in the Nigeria Demographic and Health Survey Survey . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 131 Survey Design . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 135 Estimates of Sampling Errors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 145 Data Quality Tables . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 157 Survey Instruments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 167 iv Table 1.2 Table 2.1 Table 2.2 Table 2.3 Table 2.4 Table 2.5 Table 2.6 Table 2.7 Table 2.8 Table 2.9 Table 2.10 Table 3.1 Table 3.2 Table 3.3 Table 3.4 Table 3.5 Table 3.6 Table 3.7 Table 3.8 Table 3.9 Table 3.10 Table 4.1 Table 4.2 Table 4.3 Table 4.4 Table 4.5 TABLES Page Results of the household and individual interviews . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 Household population by age, residence and sex . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 Population by age from selected sources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 Household composition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 Educational level of the household population . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 School enrollment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 Housing characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 Household durable goods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 Background characteristics of respondents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 Level of education . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 Access to mass media . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 Current fertility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23 Fertility by background characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25 Age-specific fertility rates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26 Fertility by marital duration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28 Children ever born and living . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29 Birth intervals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31 Age at first birth . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32 Median age at first birth . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33 Teenage pregnancy and motherhood . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34 Children born to teenagers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35 Knowledge of contraceptive methods and source for methods . . . . . . . . . . . . . . . . . . . 37 Knowledge of modem contraceptive methods and source for methods . . . . . . . . . . . . . 39 Ever use of contraception . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41 Current use of comraception . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42 Current use of contraception by background characteristics . . . . . . . . . . . . . . . . . . . . . 43 V Page Table 4.6 Table 4.7 Table 4.8 Table 4.9 Table 4.10 Table 4.11 Table 4.12 Table 4.13 Table 4.14 Table 4.15 Table 4.16 Table 5.1 Table 5.2 Table 5.3 Table 5.4 Table 5.5 Table 5.6 Table 5.7 Table 5.8 Table 5.9 Table 5.10 Table 5.11 Table 6.1 Table 6.2 Table 6.3 Table 6.4 Table 6.5 Number of children at first use of contraception . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45 Knowledge of fertile period . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46 Source of supply for modem contraceptive methods . . . . . . . . . . . . . . . . . . . . . . . . . . . 47 Time to source of supply for modem contraceptive methods . . . . . . . . . . . . . . . . . . . . 49 Future use of contraception . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50 Reasons for not using contraception . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51 Preferred method of contraception for future use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52 Family planning messages on radio and television . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53 Acceptability of the use of mass media for family planning messages . . . . . . . . . . . . . 54 Discussion of family planning by couples . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54 Attitudes of couples toward family planning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55 Current marital status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57 Polygyny . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58 Number of co-wives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59 Age at first marriage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60 Median age at first marriage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61 Age at first sexual intercourse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62 Median age at first intercourse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63 Recent sexual activity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64 Postpartum amenorrheoa, abstinence and insusceptibility . . . . . . . . . . . . . . . . . . . . . . . 65 Median duration of postpartum insusceptibility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66 Termination of exposure to the risk of pregnancy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67 Fertility preferences by number of living children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70 Fertility preferences by age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70 Desire to limit (stop) childbearing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71 Need for family planning services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72 Ideal number of children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73 vi Table 6.6 Table 6.7 Table 6.8 Table 7.1 Table 7.2 T~ble 7.3 Table 7A Table 8.1 Table 8.2 Table 8.3 Table 8A Table 8.5 Table 8.6 Table 8.7 Table 8.8 Table 8.9 Table 8.10 Table 8.11 Table 8.12 Table 8.13 Table 8.14 Table 9.1 Table 9.2 Table 9.3 Table 9.4 Table 9.5 Table 9.6 Page Mean ideal number of children by background characteristics . . . . . . . . . . . . . . . . . . . 74 Fertility planning status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75 Wanted fertility rates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 76 Infant and child mortality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78 Infant and child mortality by background characteristics . . . . . . . . . . . . . . . . . . . . . . . 80 Infant and child mortality by demographic characteristics . . . . . . . . . . . . . . . . . . . . . . 82 High risk fertility behaviour . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 84 Antenatal care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 86 Tetanus toxoid vaccination . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 88 Place of delivery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89 Assistance during delivery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 90 Characteristics of delivery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 92 Vaccinations by source of information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93 Vaccinations by background characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95 Vaccinations in the first year of life . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97 Prevalence and treatment of acute respiratory infection . . . . . . . . . . . . . . . . . . . . . . . . 98 Prevalence and treatment of fever . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99 Prevalence of diarrhoea . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 101 Knowledge and use of ORS packets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 102 Treatment of diarrhoea . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103 Feeding practices during diarrhoea . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 105 Initial breastfeeding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 108 Breastfeeding status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109 B reastfeeding and supplementation by age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 110 Median duration and frequency of breastfeeding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111 Nutritional status by demographic characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . 113 Nutritional status by socioeconomic characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . 115 vii Page Table 10.1 Table 10.2 Table 10.3 Table 10.4 Table 10.5 Table 10.6 Table 10.7 Table 10.8 Distance to nearest family planning services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 119 Distance to nearest family planning services for users/nonusers . . . . . . . . . . . . . . . . . 120 distance to nearest family planning services by type of facility . . . . . . . . . . . . . . . . . . 121 Time to nearest family planning services by type of facility . . . . . . . . . . . . . . . . . . . . 122 Distance to nearest maternal and child health services . . . . . . . . . . . . . . . . . . . . . . . . 123 Distance to nearest maternal and child health services for children . . . . . . . . . . . . . . 125 Distance to nearest maternal and child health services by type of facility . . . . . . . . . . 126 Time to nearest maternal and child health services by type of facility . . . . . . . . . . . . 126 Appendix B Table B.I Appendix C Table C.I Table C.2 Table C.3 Table C.4 Table C.5 Table C.6 Table C.7 Table C.8 Appendix D Table D. 1 Table D.2 Table D.3 Table D.4 Table D.5 Table D.6 Results of the household and individual interviews by residence and region . . . . . . . 138 List of selected variables for sampling errors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 149 Sampling errors - Entire sample . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 150 Sampling errors - Urban areas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 151 Sampling errors - Rural areas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 152 Sampling errors - Northeast region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 153 Sampling errors - Northwest region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 154 Sampling errors - Southeast region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 155 Sampling errors - Southwest region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 156 Household age distribution . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 159 Age distribution o f eligible and interviewed women . . . . . . . . . . . . . . . . . . . . . . . . . . 161 Completeness of reporting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 162 Births by calendar year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 163 Reporting of age at death in days . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 164 Reporting of age at death in months . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 165 viii Figure 2.1 Figure 2.2 Figure 3.1 Figure 3.2 Figure 3.3 Figure 4.1 Figure 4.2 Figure 4.3 Figure 6.1 Figure 7.1 Figure 7.2 Figure 7.3 Figure 8.1 Figure 8.2 Figure 8.3 Figure 8.4 Figure 8.5 Figure 9.1 Figure 10.1 FIGURES Page Population pyramid of Nigeria . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 School enrollment by age and place of residence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 Trends in the total fertility rate . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27 Distribution of children's year of birth . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28 Percent of teenagers who have begun childbearing . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35 Trends in contraceptive knowledge . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38 Current use of contraception . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44 Sources of family planning methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48 Fertility preferences among currcntly married women . . . . . . . . . . . . . . . . . . . . . . . . . 69 Trends in infant and under-five mortality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79 Infant mortality by selected characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81 Child mortality by selected characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81 Number of anmatal care visits and stage of pregnancy at first visit . . . . . . . . . . . . . . . . 87 Assistance during delivery by region . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91 Vaccination coverage among children age 12-23 months . . . . . . . . . . . . . . . . . . . . . . . 94 Percemage of children 12-23 months who are fully vaccinated . . . . . . . . . . . . . . . . . . . 96 Percentage of children receiving treatment for diarrhoea by type of treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 104 Percemage of children under 5 years who are chronically undernourished . . . . . . . . . 114 Distribution of currently married rural women by nearest source of family planning/health services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 124 ix ACRONYMS DHS DPA EA FHS FMOH FOS GDP IPPF IRD JSS NDHS NDSS NFS NISER NISH NPC PHC PPFN PRS SAC SSS UNFPA UNHSCP UNICEF USAID WFS WHO Demographic and Health Surveys Department of Population Activities Enumeration Area Family Health Services Federal Ministry of Health Federal Office of Statistics Gross Domestic Product International Planned Parenthood Federation (formerly) Institute for Resource Development Junior Secondary School Nigeria Demographic and Health Survey National Demographic Sample Survey Nigeria Fertility Survey Nigeria Institute for Social and Economic Research National Integrated Survey of Households National Population Commission Primary Health Care Planned Parenthood Federation of Nigeria Planning Research and Statistics Survey Advisory Committee Senior Secondary School United Nations Population Fund United Nations Household Survey Capability Programme United Nations Children Fund United States Agency for International Development World Fertility Survey World Health Organisation xi FOREWORD The Nigeria Demographic and Health Survey (NDHS) is a nationally representative survey which was carded out in all states of the Federal Republic of Nigeria. It was designed to provide information on fertility, family planning and health in Nigeria. The survey was conducted by the Federal Office of Statistics (FOS) of Nigeria, and is part of the worldwide Demographic and Health Surveys Programme coordinated by IRD/Macro International, Inc. The data collection phase of the NDHS was conducted in 1990, just two years following the declaration of the Nigeria National Population Policy (Federal Ministry of Health, 1988). The primary motivation for undertaking the survey was to provide reliable statistics on demographic and health practices, the very issues of concern in the National Population Policy. It is expected that the NDHS will provide information to strengthen the design and implementation of programmes aimed at controlling fertility, promoting family planning and improving the health status of the population. The survey will also provide a cross-sectional view of many demographic and health characteristics of the Nigerian population as of 1990. Since Nigeria gained independence in 1960, there has been a paucity of reliable population and health data at the national level. Vital registration data arc virtually nonexistent and, as of this writing, the most recent census data come from the 1963 Population Census, and those data are of questionable accuracy as well as being totally outdated. Lack of data has resulted from the inherent difficulties of data collection in a country so culturally diverse and in which population data are politically sensitive. Notwithstanding such difficulties, a milestone in the collection of demographic data was reached with the 1981 Nigerian Fertility Survey in which the household survey approach was employed to obtain high-quality data from 9,727 female respondents. It was preceded by the National Demographic Sample Survey (NDSS) in 1980 and followed by the Health Module of the National Integrated Survey of Households (NISH) in 1983 (HANSS). The 1990 NDHS represents another milestone for Nigeria in which rigorous procedures were employed to obtain high- quality data with the survey approach. On this occasion an even more detailed set of information was obtained on demographic and maternal and child health practices for 8,781 female respondents. The substantial achievement of completing the NDHS and publishing this volume is due to the contributions of many individuals. First to be thanked is the then Sole Administrator of FOS who gave his solid support to the exercise. The survey was carried out by the Common Services Department of FOS (in collaboration with other departments of FOS), under the directorship of Mr. O.O. Ajayi. The Survey Coordinator was Mr. O.F. Adedeji, who was assisted by the following core FOS staff: Mr. C.F. Adegbulugbe, Miss V.A. Adeyemi, Mr. R.O. Salawu, Mr. Fred Adeoye, Mrs. R.A. Adade, Mr. J.O. Adedire, Mrs. I. Azeez, Mr. Y.I. Ifalomomi, and Mrs. V.T. Ayo. Mrs. M. Oyediran provided assistance in writing this report. Of course, a major acknowledgement is due to the interviewers and respondents who worked together to record the data, one interview at a time. Each interviewing team was supervised by an FOS staff person and the teams in each region were the responsibility of the FOS state and regional officers. All of these individuals worked to overcome considerable logistical and technical problems, frequently under difficult field conditions. Their contributions are deeply appreciated and most gratefully acknowledged. I must not forget the assistance freely rendered during the training of the interviewers by both the Planned Parenthood Federation of Nigeria (PPFN) and UNICEF (Nigeria). Finally, I wish to acknowledge here the immeasurable contributions of several intemational agencies for providing funding and technical assistance for the survey. The Nigerian Family Health Services Project of the U.S. Agency for International Development initiated the idea of the survey, provided funding and, when the need arose during fieldwork, even provided vehicles and drivers for data collection. Their xiii communication facility support is also gratefully acknowledged. The unstinting support of Project Administrator, Dr. Richard Sturgis, is particularly noted. The Demographic and Health Survey Programme provided technical assistance in many staff visits to Nigeria over the course of the survey. DHS staff and consultants who participated are: Jeremiah Sullivan, Thanh Le, Fred A mold, Christopher Scott, Trevor Croft, Elizabeth Britton, David Cantor, Marilyn Wilkinson, Irwin Shorr, Ties Boerma, and Wamucii Njogu. For production of this report thanks are due Luis Hemando Ochoa, Kaye Mitchell, Sidney Moore, and Robert Wolf. Special acknowledgement is due to Kia I. Reinis who made invaluable contributions during data analysis, report preparation, and was the primary person representing DHS throughout all phases of the survey. O. O. Ajayi Ag. Head, Federal Office of Statistics Lagos, Nigeria xiv SUMMARY OF FINDINGS The 1990 Nigeria Demographic and Health Survey (NDHS) is a nationally representative survey conducted by the Federal Office of Statistics with the aim of gathering reliable information on fertility, family planning, infant and child mortality, maternal care, vaccination status, breastfeeding, and nutrition. Data collection took place two years after implementation of the National Policy on Population and addresses issues raised by that policy. Fieldwork for the NDHS was conducted in two phases: from April to July 1990 in the southern states and from July to October 1990 in the northern states. Interviewers collected information on the reproductive histories of 8,781 women age 15-49 years and on the health of their 8,113 children under the age of five years. According to the NDHS, fertility remains high in Nigeria; at current fertility levels, Nigerian women will have an average of 6 children by the end of their reproductive years. The total fertility rate may actually be higher than 6.0, due to underestimation of births. In a 1981/82 survey, the total fertility rate was estimated to be 5.9 children per woman. One reason for the high level of fertility is that use of contraception is limited. Only 6 percent of married women currently use a contraceptive method (3.5 percent use a modem method, and 2.5 percent use a traditional method). These levels, while low, reflect an increase over the past decade: ten years ago just 1 percent of Nigerian women were using a modem family planning method. Periodic abstinence (rhythm method), the pill, IUD, and injection are the most popular methods among married couples: each is used by about 1 percent of currently married women. Knowledge of contraception remains low, with less than half of all women age 15-49 knowing of any method. Certain groups of women are far more likely to use contraception than others. For example, urban women are four times more likely to be using a contraceptive method (15 percent) than rural women (4 percent). Women in the Southwest, those with more education, and those with five or more children are also more likely to be using contraception. Levels of fertility and contraceptive use are not likely to change until there is a drop in desired family size and until the idea of reproductive choice is more widely accepted. At present, the average ideal family size is essentially the same as the total fertility rate: six children per woman. Thus, the vast majority of births are wanted. The desire for childbearing is strong: half of women with five children say that they want to have another child. Another factor leading to high fertility is the early age at marriage and childbearing in Nigeria. Half of all women are married by age 17 and half have become mothers by age 20. More than a quarter of teenagers (women age 15-19 years) either are pregnant or already have children. National statistics mask dramatic variations in fertility and family planning between urban and rural areas, among different regions of the country, and by women's educational attainment. Women who are from urban areas or live in the South and those who are better educated want and have fewer children than other women and are more likely to know of and use modem contraception. For example, women in the South are likely to marry and begin childbearing several years later than women in the North. In the North, women continue to follow the traditional pattern and marry early, at a median age of 15, while in the South, women are marrying at a median age of 19 or 20. Teenagers in the North have births at twice the rate of those in the South: 20 births per 1130 women age 15-19 in the North compared to 10 XV birdas per 100 women in the South. Nearly half of teens in the North have already begun childbearing, versus 14 percent in South. This results in substantially lower total fertility rates in the South: women in the South have, on average, one child less than women in the North (5.5 versus 6.6). The survey also provides information related to maternal and child health. The data indicate that nearly 1 in 5 children dies before their fifth birthday. Of every 1,000 babies born, 87 die during their first year of life (infant mortality rate). There has been little improvement in infant and child mortality during the past 15 years. Mortality is higher in rural than urban areas and higher in the North than in the South. Undemutrition may be a factor contributing to childhood mortality levels: NDHS data show that 43 percent of the children under five are chronically undemourished. These problems are more severe in rural areas and in the North. Preventive and curative health services have yet to reach many women and children. Mothers receive no antenatal care for one-third of births and over 60 percent of all babies arc born at home. Only one-third of births are assisted by doctors, trained nurses or midwives. A third of the infants are never vaccinated, and only 30 percent are fully immunised against childhood diseases. When they are ill, most young children go untreated. For example, only about one-third of children with diarrhoea were given oral rehydration therapy. Women and children living in rural areas and in the North are much less likely than others to benefit from health services. Almost four times as many births in the North are unassisted as in the South, and only one-third as many children complete their polio and DPT vaccinations. Programmes to educate women about the need for antenatal care, immunisation, and proper treatment for sick children should perhaps be aimed at mothers in these areas, Mothers everywhere need to learn about the proper time to introduce various supplementary foods to breastfeeding babies. Nearly all babies are breastfed, however, almost all breastfeeding infants are given water, formula, or other supplements within the first two months of life, which both jeopardises their nutritional status and increases the risk of infection. xvi NIGERIA NORTHWEST ~#OKO/o • SOKOTO • • NLGER OYO 52 urban EAS and 2 rural EAs in Lagos D U.O~W I ",'A, . - ,, D L • ~m'A BI~NDEL SOUTHWEST ~,/JaRIVERS_ • ~'- • KANO- q el i • • ~0." ~_ ?uo., ; "" .& • t GONGOLA SOUTHEAST BORNO =t NORTHEAST Key • Urban EA • Rural EA State Capital o Natlonal Capital xviii CHAPTER 1 INTRODUCTION 1.1 History, Geography, and Economy History The many ethnolinguistic groups that make up Nigeria existed as separate and autonomous political entities long before being merged into a British Colonial territory. The establishment and expansion of British influence in both the northern and southern parts of Nigeria and the imposition of British rule resulted in the amalgamation of the protectorates of Northern and Southern Nigeria in 1914. The pattern of government established by the British after the amalgamation was of the crown colony type. The affairs of the colonial administration were conducted by Britons until 1942 when a few Nigerians, for the first time, were appointed non-official members of the executive council. Nigeria became an independent nation on October 1, 1960. Three years later, on October 1, 1963, Nigeria became a republic, severing all links with the British crown, yet retaining membership in the Commonwealth. The first government of independent Nigeria was overthrown in a military coup and replaced by the military administration of Major-General Aguiyi-lronsi on January 15, 1966. This was followed by a series of counter-coups. The government of the Eastern Region seceded on May 30, 1967, igniting a 30-month civil war, which ended in victory for the Federal Government on January 12, 1970. On October 1, 1979, the military administration of General Olusegun Obasanjo voluntarily handed over power to an elected civilian government while a new constitution and democratic form of government were adopted. After four years of civil rule, the military again stepped in on December 31, 1983 with Major- General Buhari as the Head of State. The present military administration of President Ibrahim Babangida came to power on August 27, 1985 after overthrowing Major-General Buhari. The Babangida administration has since embarked on a transition programme of handing over power to a democratically elected civilian government in 1992. Islam and Christianity are the two main religions of the country; the third important religion is the indigenous traditional religion. Muslims reside mostly in the North, while Christians reside mostly in the South. Internal migration, especially from rural to urban areas, has been one of the important demographic themes of modern Nigeria. High rates of migration and natural increase produced an urban population which grew from between 3 and 4 million residents in 1950 to nearly 17 million in 1980. By the latter year, over 20 percent of the population lived in urban areas. Geography The Federal Republic of Nigeria is one of the largest countries in Africa. It is situated on the Gulf of Guinea in West Africa. It is bounded by Niger on the North, Cameroon to the East, and Benin on the West. It covers an area of about 923,768 square kilometres with an estimated population of 112,258,100 persons (National Population Commission), making Nigeria by far the most populous country in Africa. The country has three main rivers: the Niger, Benue and Cross rivers. Rainfall varies greatly, and vegetation ranges from tropical rain forest along the coast to savanna/woodland in the North, with mixed vegetation in between. Temperatures are generally high, and increase from South to North, resulting in widely divergent physical features. The temperature at the coast seldom rises above 32°C but humidity can be as high as 95 percent. The country is influenced by two main wind systems: the moist, relatively cool monsoon wind that brings rain from the Southwest, and the hot, dry, Harmattan wind that sweeps across the country from the Northeast between December and February, bringing dust and high temperatures during the day, and low temperatures at night. On May 27, 1967, a decree was issued by the government of Lieutenant-Colonel Gowon dividing the counU7 into 12 states; the number of states was later increased to 19 in April 1976. In 1988, the present government formed two new states from existing states. Then in 1991 it formed nine more states, increasing the total number to 30 plus Abuja, the Federal Capital Territory. There are about 380 ethnic groups in Nigeria; the major groups are Edo, Efik, Fulani, Hausa, Igbo, Kanuri,Tiv, Urhobo, and Yoruba. Most ethnic groups arc concentrated in different parts of the country. The Hausa, Kanuri, and Fulani live primarily in the North, the Yoruba inhabit the Southwest, the Igbo and Efik are found in the Southeast, the Tiv live in the mid-section of the country, and the Edo and Urhobo reside in the Niger River delta. Economy Nigeria has a mixed economy in which petroleum plays a key role. Nigeria is the sixth largest producer of crude oil in the world, and the second largest in Africa. Economic growth soared in the early 1970s as the country enjoyed the high price ofoil on the world market and experienced a massive inflow of foreign exchange. Petroleum accounted for about 90 percent of exports and 80 percent of government revenue. The boom in oil prices sparked considerable rural to urban migration during the 1970s, resulting in a decline in the agricultural sector. From the beginning of the 1980s, however, there was a downturn in the economy because of falling oil prices, declining sales due to competition in the international oil market, energy conservation strategies adopted by oil purchasing countries, and the worldwide economic recession. The Federal government has since formulated policies to promote economic growth. Industrial policies include increased export of manufactured goods to diversify the nation's foreign exchange base, and strengthening the manufacturing sector through exposure to international competition. Some of the objectives of the agricultural policy focus on (i) increasing production and processing of export crops with a view to increasing their foreign exchange earning capacity, (ii) increasing production of agricultural raw materials to meet the growing needs of the expanding industrial sector, (ili) large scale production of commodities which consume a considerable percentage of Nigeria's foreign exchange, but can be produced locally within the country, (iv) increasing urban to rural migration by increasing opportunities for rural employment and improving the quality of life for persons living in rural areas. In 1988 the agricultural sector represented 36 percent of the GDP while petroleum and industrial sectors contributed 20 percent each. 1.2 Population Table 1.1 Demographic indicators Indicator NFS 1981/82 and National Census NDSS 1980 1963 Population (millions) Density (pop./sq.km.) Percent urban Crude birth rate (per 1,000) Crude death rate (per 1,000) Total fertility rate Infant mortality rate (per 1,000) Life expectancy at birth 84.7 55.7 92 60 23 19 46 66 16 27 6.3 -- 85 -- 48 36 Sources: National Population Bureau and WFS, 1984; National Population Bureau and IRD/Westinghouse, 1988; Federal Office of Statistics, 1963 The 1963 National Census reported a total population of 55.7 million. The National Population Commission (NPC), Lagos, projected the 1963 figure forward at a constant growth rate of 2.5 percent per year to arrive at a 1980 estimate of 84.7 million persons, making Nigeria the most populous country in Africa and among the 15 largest countries in the world. NPC estimated the 1988 population to be 112,258,100 persons, and it is likely that the population is increasing by more than 3 percent per year. In 1963, Nigeria was sparsely settled with a density of 60 persons per square kilometre; this figure has since doubled to 122 persons per square kilometre. The distribution of the population is characterised by areas of high density in the Southeast, Southwest, and North-central parts of the country, while other areas are less densely inhabited. While still predominantly rural, the population has become more urbanised, increasing from 19 percent in 1963 to 23 percent urban in 1980. The crude birth rate decreased from 66 per thousand to about 46 per thousand in 1980 and the crude death rate fell from 27 per thousand to 16 per thousand in the same period. Life expectancy at birth rose from about 36 years in 1963 to about 48 years in 1980. The combination of high birth rates and declining death rates means that the Nigerian population will continue growing at a fast pace for decades to come. 3 1.3 Population and Family Planning Policies and Programmes Population issues have been of great concern to the Government of Nigeria throughout the post- independence period. The population of the country, which stood at 30.4 million in 1952, had by 1963 increased to 55.7 million; the 1988 mid-year estimate was 112 million. In light of the high population growth rate, and its adverse effect on national development and on individual welfare, the Government formulated and launched the National Policy on Population (Federal Ministry of Health, 1988). The policy is predicated on the right of couples and individuals to decide fully the number and spacing of their children, and the right to information, education, and the means to exercise such rights. The objectives of the policy are as follows: (i) To improve the living standards and the quality of life of the people of this country; (ii) To promote their health and welfare, especially through preventing premature deaths and illness among the high risk groups; (iii) To achievelower population growth rates, through reduction of birth rates by voluntary fertility regulation methods that are compatible with the attainment of economic and social goals of the nation; (iv) To achieve a more even distribution of population between urban and rural areas. In order to achieve these objectives and to promote national awareness of the adverse effects of rapid population growth, the following strategies are being vigorously pursued: Establishing fertility regulation and management programmes which make services and facilities accessible and affordable to couples and individuals who want to regulate their fertility; Integrating family planning services into the Primary Health Care Programme; Providing necessary and adequate population information and education to young people, couples and individuals to promote responsible parenthood and to enable them to understand the value of moderate-sized families and the importance of spacing of children; Improving rural living conditions through effective implementation of Integrated Rural Development programmes. Nongovernmental agencies such as the United Nations Population Fund (UNFPA) and the International Planned Parenthood Federation (IPPF) through its Nigerian affiliate, the Planned Parenthood Federation of Nigeria (PPFN) operate family planning clinics in all states, supplementing the efforts of the Federal Ministry of Health (FMOH). 1.4 Health Priorities and Programmes The Federal Government's systematic efforts to develop the health sector over the past three decades have resulted in noticeable improvements in the range of available health care facilities and in the services being provided. The 1981 - 1985 Fourth National Development Plan established a govemment commitment to provide adequate and effective primary health care that is promotive, protective, preventive, restorative and rehabilitative to 80 percent of the population by 1985; and to extend the same to the entire population, within the available resources, by the year 2000. This is with the aim of ensuring socially and economically productive lives for all individuals and communities. Particular emphasis is placed on maternal and child health care, which encompasses family planning, immunisation against major infectious diseases, education regarding the prevention and control of health problems, and environmental sanitation to secure a quality of environment adequate for the health and well- being of all Nigerians. Health services in Nigeria are provided by the Federal, state and local governments as well as nongovermnent organisations. Federal, state and local governments are coordinated in a three-tier health care system: (i) primary health care, which is largely the responsibility of local governments, with the support of the State Ministry of Health, (ii) secondary health care, which provides specialised services to patients referred from the primary health care level, and (iii) tertiary health care, which provides highly specialised referral services to the primary and secondary levels of the health care delivery system. 1.5 Objectives and Organisation of the Survey Objectives The Nigeria Demographic and Health Survey (NDHS) is a national sample survey of women of reproductive age designed to collect data on socioeconomic characteristics, marriage patterns, history of child bearing, breastfeeding, use of contraception, immunisation of children, accessibility to health and family planning services, treatment of children during episodes of illness, and the nutritional status of children. The primary objectives of the NDHS are: (i) To collect data for the evaluation of family planning and health programmes; (ii) To assess the demographic situation in Nigeria; and (iii) To support dissemination and utilisation of the results in planning and managing family planning and health programmes. Organisation The Nigeria Demographic and Health Survey is a joint project between the Federal Government of Nigeria, represented by the Federal Office of Statistics (FOS), and the U.S, Agency for International Development (USAID). The survey was funded by USAID and the Nigerian Government; it was carried out by the FOS, with technical support from IRD/Macro International Inc. located in Columbia, Maryland. Funds from USAID were administered by IRD/Macro International, and were used for salaries of temporary staff recruited for the survey, allowances of survey personnel, data processing and anthropometric equipment, printing of questionnaires, publication of reports, vehicle maintenance and fuel. Four vehicles were provided to the project by USAID, three were provided by FOS, and four were loaned from USAID's Family Health Services Project (FHS). A Survey Advisory Committee (SAC) was formed, consisting of representatives from FOS, IRD, NPC, FMOH and representatives from the Department of Primary Health Care (PHC), the Depamnent of Planning Research and Statistics (PRS), the Department of Population Activities (DPA), UNICEF, the World Health Organisation (WHO), FHS, PPFN, and the Nigeria Institute for Social and Economic Research (NISER). The committee met periodically, during important phases of the project (e.g., questionnaire design, the pretest and the main survey). The Sole Administrator of FOS appointed the Director of Common Services (FOS) as the Project Director. The Director had overall responsibility for survey implementation. He was assisted by a project coordinator, two FOS senior staff (project statisticians who were fully involved in the project), as well as other FOS staff who participated on a part-time basis. The execution of the project activities was divided between the project statisticians; one was responsible for sampling and the logistics of data collection, while the other was responsible for questionnaire design and translation, the pretest, training for the main survey, and the reinterview subsample. Questionnaires Three questionnaires were used in the main fieldwork for the NDHS: the household questionnaire, the individual questionnaire, and the service availability questionnaire. The first two questionnaires were adapted from the DHS model B questionnaire, which was designed for use in countries with low contraceptive prevalence. The questionnaires were developed in English, and then translated into six of the major Nigerian languages: Efik, Hausa, Igbo, Kanuri, Tiv, and Yoruba. English versions of the questionnaires are reproduced in Appendix E. All usual members and visitors in the selected households were listed on the household questionnaire. For each person listed, information was collected on age, sex, education, and relationship to the head of household. The household questionnaire was used to identify women eligible for the individual questionnaire. The individual questionnaire was administered to women age 15-49 who spent the night preceding the household interview in the selected household. Information in the following areas was obtained during the individual interview: 1. Background characteristics of the respondent 2. Reproductive behaviour and intentions 3. Knowledge and use of contraception 4. Breastfeeding, health, and vaccination status of children 5. Marriage 6. Fertility preferences 7. Husband's background and woman's work 8. Height and weight of children under five. The service availability questionnaire was implemented in the service availability survey (SAS), a separate activity from the main fieldwork. The SAS was designed to assess the availability (or supply) of health and family planning services. Thus, while the individual questionnaire collected information from female respondents pertaining to the demand for health and family planning services, the service availability (SA) questionnaire collected information pertaining to the supply of these services by canvassing health and family planning facilities. The SA questionnaire was administered at the community level (enumeration area), and information was gathered from two sources: groups of four or five knowledgeable informants in the selected community (assembled by the interviewer), and informants interviewed at facilities visited by the interviewer. The results of the service availability survey are presented in Chapter 10. Sample To produce a nationally representative survey, the NDHS sample was drawn from the national master sample for the 1987/1992 National Integrated Survey of Households (N1SH) programme being implemented by the FOS. The 299 sample clusters correspond to the enumeration areas (EA) of the NISH master sample. A sample of about 10,000 households was designed with twofold oversampling of the urban stratum, yielding 132 urban EAs and 167 rural EAs. Thus, the NDHS sample is a weighted sample, and all tables presented in this report are based on weighted data. A more detailed description of the sample design is presented in Appendix B. To ensure data quality, a reidentification and redemarcation of EAs selected for the NDHS sample was conducted by FOS state offices and supervised by state senior staff and FOS staff from Lagos. Then, a household listing operation was carried out in each of the sampling units and a selection of 34 households per EA was made at the FOS headquarters in Lagos. Fieldwork The NDHS field staffconsisted of 25 teams, each composed of four female interviewers, one female editor, and one male or female supervisor. The interviewers and editors were newly recruited for the survey, while supervisors were experienced FOS staff. Fieldwork was conducted from April to October 1990 (April to July in the southern states, and July to October in the northem states). The persons involved in the survey are listed in Appendix A. A more complete description of the fieldwork is presented in Appendix B. Table 1.2 is a summary of results from the household and the individual interviews. A total of 9,998 households were selected; of these, 8,999 were successfully interviewed. The shortfall is largely due to households being absent; for which a predominant cause seemed to be for purposes of planting crops. In the interviewed households 9,200 eligible women were identified and 8,781 were successfully interviewed. Table 1.2 Results of the household and individual interviews Number of households, number of interviews, and response rates, Nigeria 1990 Result Total Household Interviews Households sampled 9998 Households found 9465 Households interviewed 8999 Individual Interviews Number of eligible women 9200 Number of eligible women interviewed 8781 7 CHAPTER 2 CHARACTERISTICS OF HOUSEHOLDS AND RESPONDENTS Information on the background characteristics of the households interviewed in the survey and the individual survey respondents is essential for the interpretation of survey findings and provides a rough measure of the representativeness of the survey. This chapter presents this information in three sections: characteristics of the household population, housing characteristics, and background characteristics of survey respondents. 2.1 Characteristics of the Household Population The NDHS collected information on all usual residents and visitors who spent the previous night in the household. A household was defined as a person or group of persons living together and sharing a common source of food. Age The age distribution of the household population in the NDHS is shown in Table 2.1 and Figure 2.1 by five-year age groups. The distribution conforms to the pattern characteristic of high fertility populations, Table 2.1 Household population by age, residence and sex Percent distribution of the de facto household population by five-year age group, according to urban-rural residence and sex, Nigeria 1990 Urb~m Rural Total Age group Male Female Total Male Female Total Male Female Total 04 14.6 15.1 14.8 16.9 17.3 17.1 16.4 16.8 16.6 5-9 16.8 16.7 16.7 18.8 17.1 18.0 18.3 17.0 17.7 10-14 13.5 15.7 14.6 13.2 13.4 13.3 13.3 13.9 13.6 15-19 11.0 8.8 9.9 8.8 7.0 7.9 9.4 7.4 8.4 20~4 6.9 8.6 7.8 5.4 7.2 6.3 5.8 7.5 6.7 ~-~ 7.5 8.0 7.7 5.5 7.4 6,5 6.0 7.6 6.8 30-34 6.3 6.2 6.2 5.4 6.4 5.9 5.6 6.3 6.0 35-39 4.9 3.9 4.4 4.2 4.2 4.2 4.4 4.2 4.3 4044 4.5 3.7 4.1 4.0 3.9 4.0 4.1 3.8 4.0 4549 3.0 2.2 2.7 3.4 2.9 3.2 3.3 2.8 3.0 50-54 2.6 4.0 3.3 3.3 4.7 4.0 3.1 4.5 3.8 55-59 1.4 1.9 1.7 2.0 2.8 2.4 1.9 2.6 2.2 60-64 2.2 2.2 2.2 2.8 2.5 2.6 2.6 2.4 2.5 65-69 1.5 0.9 1.2 1.8 1.0 1.4 1.8 1.0 1.4 70-74 1.3 0.9 1.1 1.9 0.9 1.4 1.7 0.9 1.3 75-79 0.5 0.3 0.4 0.7 0.4 0.5 0.7 0.3 0.5 80+ 1.1 0.9 1.0 1.5 0.7 1.1 1.4 0.7 1.1 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number 5,799 5,690 11,489 17,651 17,888 35,539 23,450 23,578 47,028 Figure 2.1 Population Pyramid of Nigeria 80+ 75-79 70-74 65-69 60-64 56-59 50-54 45-49 40-44 35-39 30-34 25-29 20-24 15-19 10-14 5-9 0 -4 20 15 10 5 0 5 10 15 20 Percent NDHS 1990 i.e., a much higher proportion of the population in the younger than in the older age groups. However, the youngest age group (0-4) numbers fewer than the 5-9 year olds; this either results from an undercount of children in the youngest group, or from some 0-4 year olds being reported as age 5-9. Evidence of heaping can also be seen in the female age groups 10-14 and 50-54 years. That heaping does not occur among males in these age groups suggests that some interviewers may have pushed women out of the age range eligible for the individual interview. An assessment of this phenomenon by Rutstein and Bicego (1990), indicates that the effects of misreporting at the upper and lower boundaries (age 15 and 49) are minimal. Table 2.2 compares the population age structure found in the 1990 Nigeria Demographic and Health Survey (NDHS) with that in the 1963 Census (Federal Office of Statistics, 1963), the 1980 National Demographic Sample Survey (NDSS 1980) (National Population Bureau and IRD/Westinghouse, 1988), and the 1981/82 Nigeria Fertility Survey (NFS 1981/82) (National Population Bureau and World Fertility Survey, 1984); dependency ratios are also shown. The age dependency ratio is the ratio of the number of persons age 0 to 14 and 65 and over divided by the number of persons age 15 to 64. It is an indicator of the dependency responsibility of adults in their productive years. 10 Table 2.2 Population by age ~om selected sources Percent distribution of the population by age group, selected sources, Nigeria 1963-1990 Census NDSS NFS NDHS Age group 1963 1980 1981/82 1990 Less thin 15 43.1 47.2 49.5 47.1 15-64 54.9 50.2 48.1 48.5 65+ 2.0 2.8 2,3 4.3 Total I00.0 I00.0 I00.0 I00,0 Median age . . . . 16.3 Dependency ratio 0.82 1.00 1.08 1.06 Sources: 1963 Census (Federal Office of Statistics, 1963); 1980 National Demographic Sample Survey (National Population Bureau and IRD/Westinghonse, 1988); 1981/82 Nigeria Fertility Survey (National Population Bureau and World Fertility Survey, 1984) The dependency ratios in Nigeria are typical of those found in other African countries. With approximately 47 percent of the population under age 15 and 4 percent over age 64, there is one dependent person for each adult in the population. As in many rapidly growing populations, old age dependency is minimal compared to child dependency. Household Composition While the large majority of households in Nigeria are headed by males (86 percent), there are regional differences (see Table 2.3). About 20 percent of housebolds in the South are headed by women, whereas it is unusual in the North for a household to be headed by a woman (5 percent). There are two characteristics worth noting when comparing urban and rural households. First, fern ale headed households are more common in urban areas (18 percent) than in rural areas (13 percent); and second, single person households are more common in urban areas (16 percen0 than in rural areas (9 percent) and households of nine or more persons are more common in rural areas, 17 percent compared to 11 percent in urban areas. As a result, average household size is larger in rural (5.6) than in urban (4.8) areas. 11 Table 2.3 Household composition Percent dista'ibution of households by sex of head of household, household size, kinship structure, and presence of foster children, according to urban-rural residence and region, Nigeria 1990 Characteristic Residence Region Urban Rural Northeast Northwest Southeast Southwest Total Household headship Male 82.0 87.1 94.3 94.9 77.3 81.2 85.7 Female 18.0 12.9 5.7 5.1 22.7 18.8 14.3 Numberofusualmembers 1 16.2 9.2 7.4 6.7 12.9 15.8 11.1 2 12.7 9.6 10.8 10.8 9.3 11.3 10.5 3 12.9 12.7 13.2 18.1 9.6 12.0 12.8 4 12.2 13.2 14.6 13.3 11.9 12.4 12.9 5 11.1 11.9 11.7 11.7 11.6 11.8 11.7 6 10.4 11.3 10.2 9.9 12.5 10.8 11.0 7 8.1 8.8 7.7 8.9 9.0 8.5 8.6 8 5.5 6.5 5.9 5.3 7.4 5.6 6.2 9+ 11.0 16.8 18.6 15.2 15.6 11.7 15.2 Meanslze 4.8 5.6 5.8 5.4 5.5 4.9 5.4 Relationship structure One adult 22.2 13.5 9.7 8.8 19.9 22.0 15.8 Two related adults of opposite sex 34.8 37.1 40.9 46.6 29.8 32.8 36.5 of same sex 5.2 2.0 1.2 0.6 4.2 4.6 2.9 Three or more related adults 34.6 45.5 45.8 43.3 43.5 37.9 42.6 Other 3.3 1.8 2.4 0.7 2.5 2.7 2.2 With loser children 7.1 6.8 6.2 3.8 8.1 8.6 6.9 Note: Table is based on de jure members; i.e., usual residents. Households are largest, on average, in the Northeast (5.8 persons per household), and smallest in the Southwest (4.9 persons per household). The overall average household size is 5.4 persons, Seven percent of households include one or more children under age 15 who have neither their natural mother nor natural father l iving with them. Educat ion In the three decades since independence, the education sector has recorded phenomenal growth in student enrolments and numbers of institutions, and has expanded to reach all parts of the federation. The national education policy has evolved over the years to meet the needs of the country. In 1976, Nigeria adopted a national policy of Universal Primary Education, which gave every child the right to free primary schooling. The emphasis in education shifted from the standard liberal education to the new more practical 12 6-3-3-4 system. Under the new system, primary education is six years, and secondary education is six years rather than five years (three years junior secondary and three years senior secondary). A graduate of secondary school may then choose to further his or her education by attending a university or polytechnic school for a 4-year course leading to a degree or to the Higher National Diploma. At this level, very few courses last more than four years. The goal is for the nation to meet its manpower requirements in various areas of social, economic and political growth, as well as achieving national development and modernization. A nationwide mass literacy programme was launched in June 1990, although it had been in existence at state and locallevels for over 25 years. The National Commission on Nomadic Education was recently established to address the needs of children of migrant cattle herders and fishing peoples in the riverine areas. In the NDHS, information on educational attainment was collected for every member of the household (see Table 2.4). One-half of the population has received no formal education; 43 percent of males and 58 percent of females have never been to school; 32 percent of males and 26 percent of females have attended only primary school; and 14 percent of males and 9 percent of females have attended secondary school. Only 3 percent of males and 1 percent of females have obtained higher education. The proportion of persons with no education is much higher in the rural areas than in urban areas, and this difference is seen for both males and females. Rural residents are twice as likely to have never attended school (58 percent) as urban residents (29 percent). There are major regional differences in the level of education. The Northwest has the highest proportion of persons with no education (73 percent of males and 86 percent of females); in the Southwest, those who have never been to school are in the minority (18 percent of males and 30 percent of females). 13 Table 2.4 Educational level of the household population Percent distribution of the de facto male and female household populations age five and over by highest level of education attended, according to selected background characteristics, Nigeria 1990 Number Median Background Some Completed S¢~ne Completed of number characteristic None primary primary seconda~ secc~dal 7 Higher Missing Total persons of years MALE Age 5-9 51.0 29.7 0.2 0.0 0.0 0.0 lO-14 21.7 49.9 8.9 7.0 0.0 0.0 15-19 20.6 15.4 21.3 24.8 I~0 0,5 20-~ 23.0 5.0 22.4 12.5 ~.9 4.8 25-~ 31.8 3.9 21.7 6.8 23.9 9.0 30-34 41.1 5.5 22.3 3.1 15.4 8.3 35-39 ~.I 5.0 21.5 2.8 13.2 7.5 40-44 53.6 5.6 22.3 2.8 9.3 4.1 45-49 52.7 9.5 18,4 4.1 8.1 4.4 50-54 72.6 7.3 8.5 1.8 5.3 3,1 55-59 72.3 7.7 8.4 3.0 2.0 2.3 ~4M 80.1 5.0 6.8 1,1 2.2 1.5 ~+ 84.4 5.8 4.7 1.0 1,1 0.9 Reslden~ Urban 22.4 21.2 15.1 ii.I 15.7 6.5 RuN 50.2 18.4 11.6 4.5 5.1 1.4 R~lon No,east 65.5 7.8 8.6 1.8 4.0 1,1 No , west 72.8 10.3 6.2 2.9 3.6 1.3 S~th~st 26.8 27.8 18.4 6.2 8.0 2.3 S~thwcst 17.8 26.4 14.1 13.1 14.6 5.7 T~ 43.3 19.1 IZ5 6.1 7.7 2.6 19.1 I~.0 4293 0.7 12.4 I~.0 3,115 3.6 7.5 I~.0 2,194 6.5 4.5 1~,0 1,362 6.9 2.8 I~.0 1,4~ 6.6 4.2 l~,0 1,320 6.1 3.9 I~.0 I~34 4.0 2.4 1~.0 971 0.9 2.7 1~.0 771 0.9 1,4 1~,0 729 0.7 4.2 1~.0 443 0.7 3.2 1~,0 614 0.6 2.1 1~.0 1,320 0.6 8.1 1~.0 4,848 6.1 8.8 1~.0 14,7~ 0.9 I 1.2 i00.0 4,731 0.7 2.9 I00.0 3,997 0.7 10.5 I00.0 6,148 3.6 8.4 I00.0 4,737 6.0 8.6 100.0 19,613 1.2 FEMALE Age 5-9 54.4 27.9 10-14 34.1 41.7 15-19 33.6 11.0 20-7A 42.0 6.6 25-29 54,2 6.3 30-34 71.1 7.5 35-39 70.4 9.4 40-44 78.9 7.8 45-49 84.7 6.5 5O-54 90.9 3.8 55-59 95.8 1.6 60-64 96.3 2.2 65+ 95.2 1.9 Residence Urban 36.3 21.4 Rural 65.2 15.4 Region Northeast 82.0 4.8 Northwest 86.2 6.6 Southeast 43.1 24.6 Southwest 29.7 27.5 Total 58.2 16.9 0.2 0.0 0.0 0.0 7.4 6.6 0.1 0.0 ~.6 20.0 8.2 0.4 18.6 10.6 17.1 2.3 17.2 5.8 11.7 3.2 10.8 2.7 3.1 2.9 11.9 2.3 3.4 1.1 8.0 1.9 1.1 0.8 5,0 1.9 0.7 0.9 3.2 0.4 0.5 0.3 1.1 0,7 0,1 0.2 0.7 0.I 0.I 0.0 1.9 0.1 0.2 0.1 17.4 I~.0 4,010 0,7 I0.I I~.0 3,288 2.9 6.2 l~.0 IJ49 6.2 3.0 I~.0 1,777 6.0 1.6 I~.0 IJ84 0.9 2.0 I~.0 I~91 0.7 1.6 I~.0 982 0.7 1.6 I~.0 905 0.6 0.3 I~.0 654 0.6 0.9 1~.0 1,072 0.5 0,5 100.0 615 0,5 0,5 I~.0 567 0.5 0,6 I~.0 711 0.5 12.1 10.8 9.9 2.5 7.0 I~.0 4~33 3.0 7.5 3.0 2.0 0.4 6.5 I~,0 14,889 0.7 4.0 0.8 0.7 0.0 7.7 I~.0 4,~8 0.6 3.1 1.4 I.I 0.I 1.5 I~.0 4,~1 0.6 12.5 5.5 4.0 0.8 9.4 1~.0 6,476 1.0 12.8 11.6 9.5 2.7 6.3 I~.0 4,437 3.6 8,6 4.9 3.9 0.9 6.7 1~,0 19,622 0.8 14 Table 2.5 presents enrolment rates by age, sex and residence. Fifty-five percent of children age 6-15 years are enrolled in school. As shown in Figure 2.2, enrolment is higher in urban areas (about three-quarters of children are enrolled) than in rural areas (one-half are enrolled); and boys are more likely to be enrolled than girls (59 percent versus 51 percent). Enrolment after age 15 drops significantly; only one-quarter of older teens are still in school and only 11 percent of those in their early twenties are still in school; the urban/rural differences are not as great at these ages, but male/female differences are greater because women are much less likely than men to go on for higher schooling. Table 2.5 School artrolmont Percentage of the de facto household population age 6-24 years enrolled in school, by age group, sex, and urban- rural residence, Nigeria 1990 Age group Male Female Total Urban Rural Total Urban Rural Total Urban Rural Total 6-I0 74,1 49.9 55.4 69.4 43.0 49.4 71.7 46.6 52,5 11-15 75,8 60.9 64.9 70.2 48.0 54.0 73,0 54.6 59,5 6-15 74.8 54.1 59.1 69.7 45.0 51.2 72.3 49.7 55.3 16-20 37.6 32.4 33.9 30,0 16.9 20.5 33.9 24.6 27,2 21-24 18.0 16,6 17.1 10.1 4.1 6.0 13.6 9.4 10.8 80 70 60 50 40 30 20 10 Percent 0-- 6-15 Figure 2.2 School Enrollment by Age and Place of Residence 16-20 21-24 I "Urban mRural i NDHS 1990 15 2.2 Hous ing Character i s t i cs In order to assess the socioeconomic conditions under which respondents live, women were asked to give specific information about their household environment. Table 2.6 presents this information for all households in which women were interviewed. (Although the questions on household characteristics were asked in the individual questionnaire, Table 2.6 has been tabulated to represent households; i.e., households with more than one eligible woman are still counted only once). Table 2.6 Housing characteristics Percent distribution of households with eligible women by housing characteristics, according to urban-rural residence and region, Nigeria 1990 Characteristic Residence Region Urban Rural Northeast Northwest Southeast Southwest Total Electricity 82.4 8.6 Source of drinking water Piped into residence 1.5 Piped into yard Public tap Well with hand pump Well without hand pump 14.8 River, spring, surface water 4.9 Tanker truck/other vendor 8.9 Rainwater 0.3 Other 0.4 Total 100.0 I00.0 Sanitation facility Flush 29.9 2.1 Bucket 1.5 0.3 Pit 60.4 62.2 No facilities 8.1 35.5 Total 100.0 100.0 Flooring Parquetc~olished wood 2.0 0.2 Vinyl/asphalt strips 0.9 0.3 Ceramic tiles 3.3 0.7 Wood planks O.5 0.1 Cement 72.6 46.9 Animal dung 0.5 1.1 Earth/sand 7.1 50.6 Other 12.9 0.1 Total 100.0 100.0 Persons per sleeping room 1-2 43.4 50.2 3~l 35.6 33.6 5-6 14.7 10.3 7 + 6.2 5.6 Missing/Don't know 0.l 0.4 Total 100.0 100.0 Mean persons per room 3.4 3.2 Number of households 1,649 4,844 11.0 13.0 22.4 65.4 27.3 17.3 4.8 5.1 2.7 10.3 5.5 13.8 1.8 3.4 4.1 3.7 8.6 4.8 32.2 8.4 11.3 4.1 17.3 24.5 14.4 7.4 6.8 15.3 4.8 2.4 7.2 7.0 28.1 31.9 49.1 9.5 13.2 ~.7 51.9 30.5 32.1 62.0 27.4 40.0 0.7 1.6 0.5 1.5 8.1 2.8 0.7 1.2 0.1 0.8 0.3 0.6 0.0 0.0 0.0 0.0 0.4 0.1 1~.0 100.0 l~.0 1~.0 100.0 0.5 1.7 7.7 27.7 9.1 0.1 0.1 0.6 1.4 0.6 74.9 66.7 57.8 48.8 61.7 24.5 31.5 33.9 22.1 28.5 lO0.O 100.0 100.0 100.0 100.0 0.2 0.3 0.2 2.0 0.6 0.3 0.3 0.6 0.7 0.5 0.2 0.9 0.9 3.8 1.4 0.4 0.2 0.0 0.4 0.2 32.4 54.5 58.8 66.0 53.4 1.5 0.4 0.5 1.4 0.9 ~.7 43.3 38.9 11.3 39.5 0.3 0.2 0.0 14.3 3.4 l~.O i~ .0 1~,0 100.0 1~.0 54.9 47.0 50.0 41.5 48.5 31.8 38.0 31.2 36.2 34.1 7.8 11.0 11.9 14.8 11.4 4.8 3.5 6.8 7.5 5.7 0.7 0.5 0.1 0.0 0.3 100.0 100.0 100.0 100.0 100.0 3.0 3.1 3.2 3.5 3.2 1,471 1,529 2,025 1,468 6,493 16 Overall, 27 percent of households in Nigeria have electricity. While electricity is available to the majority of eligible women in urban areas (82 percent) it is available to only a small minority in rural areas (9 percent). Two-thirds of households in the Southwest have electricity, compared to 11 percent in the Northeast. Sources used by households to obtain drinking water differ considerably by area of residence. In urban areas, piped water is the primary source of drinking water: 32 percent obtain water from a public tap and another 31 percent have water piped into their residence or yard. In rural areas, water from rivers and springs is the main source of drinking water (52 percent) and another 28 percent obtain water from a well without a hand pump. Modem sanitation facilities are not available to large segments of the population. The use of pit toilets is common in both urban and rural areas (60 and 62 percent respectively); in urban areas, most of the rest of the population use flush toilets (30 percent), and in rural areas, most of the rest of the population have no facilities (36 percen0. The flooring material of dwelling units is usually cement (53 percent) or earth (40 percent). Cement flooring is most common in urban areas (73 percent). Of the remaining urban households, most have carpet or tile flooring (coded in the "other" category). Households in rural areas also have cement flooring (47 percent) but are equally likely to have an earth or sand floor (51 percent). Information was collected on the number of rooms households use for sleeping (as a measure of crowding). There was not much diversity according to residence and region. In about one-third of households three or four persons share a room for sleeping; however, in almost half of the households the average is one or two persons. Household Durable Goods Respondents were asked about ownership of particular household goods (radio and television, to assess access to media; refrigerator, to assess food storage) and modes of transportation (bicycle, motorcycle, car). The results presented in Table 2.7 indicate that 55 percent of households own a radio (80 percent in urban areas, 47 percent in rural areas) and 19 percent own a television (54 percent in urban areas, 7 percent in rural areas). Televisions and refrigerators are mostly restricted to the urban areas due to lack of electricity in rural areas. Many rural households (37 percent) own a bicycle whereas only 17 percent of urban households have a bicycle. Seventeen percent of urban households own an automobile. 17 Table 2.7 Household durable goods Percentage of households with eligible women possessing various durable consumer goods, by urban-rural residence end region, Nigeria 1990 Possession Residence Region Urban Rural Northeast Northwest Southeast Southwest Total Radio 79.6 46.6 39.1 53.1 55.9 71.5 54.9 Television 53.7 7.1 6.3 8.1 16.5 46.0 18.9 Refrigerator 32.9 3.1 4.1 4.6 8.9 26.0 10.7 Bicycle 16.6 36.9 26.4 30.8 46.4 17.7 31.7 Motorcycle 17.5 16.3 10.0 19.0 19.0 17.3 16.6 Auto 16.6 4.4 3.2 4.9 6.7 15.5 7.5 Number of households 1,649 4,844 1,471 1,529 2,025 1,468 6,493 2.3 Background Characteristics of Survey Respondents General Characteristics Women were asked two questions in the individual interview to assess their age: "In what month and year were you born?" and "How old were you at your last birthday?" Interviewers were trained in probing techniques for situations in which respondents did not know their age or date of birth; and as a last resort, interviewers were instructed to record their best estimate of the respendent's age. The five-year age distribution is shown in Table 2.8. The proportion of women age 15-19 ( 18 percent) is slightly smaller than the proportion age 20-24 (19 percent), which is not what would be expected in an expanding population. It is also smaller than the proportion of women age 15-19 in the NFS (21.6 percent). The proportion of women 20-24 was larger in the NDHS than in the NFS (17.6 percent). The data in Table 2.8 indicate that 78 percent of NDHS respondents are currently in a union (either married or living together), 17 percent have never been married, and 4 percent are either widowed, divorced or separated. The percentage of women who are currently married is quite high; the NFS also reported a high percentage of currently married women (80 percent). Marriage patterns are discussed in detail in Chapter 5. 18 Table 2.8 Background characteristics of respondents Percent distribution of women by selected background characteristics, Nigeria 1990 Number of women Background Weighted Un- characteristic percent Weighted weighted Age 15-19 18.4 1,611.6 1,678 20-24 19.1 1,676.2 1,682 25-29 19.0 1,669.3 1,658 30-34 16.1 1,409.5 1,386 35-39 10.9 954.0 948 4044 9.5 836.1 827 45 -49 7.1 624.3 602 Marital status Never married 17.2 1,513.1 1,701 Married 70.9 6,229.8 6,097 Living together 7.4 650.3 599 Widowed 2,4 213.7 201 Divorced 1,1 94.7 85 Separated 0,9 79.4 98 Education No education 57.2 5,019.9 4,540 Some primary 9.0 794.1 742 Completed primary 14.8 1,299.8 1,366 Some secondary 8.7 764.8 918 Completed secondary/higher 10.2 893.9 1,207 Residence Urban 24.9 2,187.2 3.530 Rural 75.1 6,593.8 5,251 Region Northeast 22.8 1,999.5 2,038 Northwest 23.9 2,098.1 1,699 Southeast 31.5 2,768.5 2,324 Southwest 21.8 1,914.9 2,720 Religion Protestantism 33.7 2,963.2 2,942 Catholicism 13.9 1,222.9 1.210 Islam 47.5 4,174.1 4,269 Traditional religion 2.4 207.5 188 No Religion 2.4 213.3 172 All women 100.0 8,781.0 8,781 The majority of respondents have never attended school (57 percent), 15 percent have completed only primary school, and 10 percent have completed secondary school (2 percent of these women have gone for schooling beyond the secondary level). 19 Although urbanization is increasing, the population is still predominantly rural; three-quarters of respondents live in rural areas. The data indicate that 32 percent of respondents live in the Southeast; the Northeast, Northwest and Southwest each account for 21-24 percent of the women interviewed. Most women report themselves to be either Moslem or Christian, and the population is evenly divided between the two, (48 percent Muslim, 48 percent Christian). Those who adhere to traditional religions and those who report no religion each account for 2 percent of the population. Differentials in Education Table 2.9 shows the distribution of the surveyed women by education, according to selected characteristics. Education is inversely related to age; that is, older women are generally less educated than younger women. For example, 85 percent of women age 45-49 have had no formal education, whereas only 34 percent of women age 15-19 have never been to school. Table 2.9 Level of education Percent distribution of women by the highest level of education attended, according to selected background characteristics, Nigeria 1990 Level of education Completed Number Background Some Completed Some secondary/ of characteristic None primary primary secondary Higher Total women Age 15-19 33.8 12.0 20.4 23.1 10.5 100.0 1,612 20-24 42.1 7.9 18.9 11.6 19.5 100.0 1,676 25-29 54.3 6.9 16.9 6.8 15.0 100.0 1,669 30-34 70.0 10.2 11.5 2.5 5.6 100.0 1,410 35-39 72.6 9.6 10.6 2.6 4.7 100.0 954 40-44 78.2 8.8 9.1 2.0 2.0 100.0 836 45-49 84.9 7.2 5.1 1.4 1.4 100.0 624 Residence Urban 31.2 7.3 19.4 16.6 25.5 100.0 2,187 Rural 65.8 9.6 13.3 6.1 5.1 100.0 6,594 Region Northeast 83.7 4.7 7.1 2.4 2.0 100.0 2,000 Northwest 87.8 2.9 5.0 2.1 2.2 100.0 2,098 Southeast 36.2 16.8 23.7 11.2 11.8 100.0 2,769 Southwest 26.1 9.1 20.7 18.9 25.1 100.0 1,915 Total 57.2 9.0 14.8 8.7 10.2 100.0 8,781 Twice as many urban women have received some education as rural women (69 percent versus 34 percent). Only a small proportion of rural women (11 percent) go on for secondary schooling compared to urban residents (42 percent). 20 Table 2.9 provides information on women's level of education by region. The northern regions have a much higher proportion of uneducated women (86 percent) than the southern regions (36 percent in the Southeast, 26 pereent in the Southwest). The proportion of women who have had some secondary education is ten times higher in the Southwest than in either of the Northern regions. Access to Media Women were asked if they usually listen to a radio or watch television at least once a week. This information is important to programme planners seeking to reach women with family planning and health messages through the media. Overall, one-quarter of women watch television weekly and one-half listen 1o the radio weekly (see Table 2.10). Media access is higher among younger women, one-third of whom watch television at least once a week and over one-half listen to the radio once a week, Most media access is among the urban population, although 44 percent of the rural population does listen to the radio. A much higher proportion of educated women, women in urban areas, and women in the Southwest watch television and listen to the radio. Table 2.10 Access to mass media Percentage of women who usually watch television once a week, or listen to radio once a week, by selected background characteristics, Nigeria 1990 Watch Listen to Number Background television radio of characteristic weekly weekly women Age 15-19 33.8 58.0 1,612 20-24 28.5 55.8 1,676 25-29 28.0 55.9 1,669 30-34 19.5 52.3 1,410 35-39 21.5 52.9 954 40-44 20.0 45.4 836 45-49 16.6 40.6 624 Education No education 9.3 39.7 5,020 Some primary 23.6 56.6 794 Completed primary 39.8 69.0 1,300 Some secondary 56.4 73.6 765 Completed secondary/higher 71.3 86.3 894 Residence Urban 67.4 82.1 2,187 Rural 11.7 43.7 6,594 Region Northeast 8.4 35.5 2,000 Northwest 11.5 47.8 2,098 Southeast 25.6 53.8 2,769 Southwest 58.8 77.1 1,915 Total 25.5 53.3 8,781 21 CHAPTER 3 FERTILITY The fertility measures presented in this chapter are based on the reported reproductive histories of women age 15-49 interviewed in the NDHS. Each woman was asked the number of sons and daughters living with her, the number living elsewhere, and the number who had died. She was then asked for a history of all her births, including the month and year each was born, the name, the sex, and if deceased, the age at death, and if alive, the current age and whether he/she was living with the mother. Based on this information, measures of completed fertility (number of children ever born) and current fertility (age-specific rates) are examined. These measures are also analyzed in connection with various background characteristics. 3.1 Current Fertility The current level of fertility is the most important topic in this chapter because of its direct relevance to population policies and programmes. Three-year age-specific fertility rates are presented in Table 3.1. Three-year rates are calculated as a compromise between three criteria: to provide the most current information, to reduce sampling error, and to avoid problems noted in previous surveys of the displacement of births from five years preceding the survey to six years. Table 3.1 Current fertility Age-specific and cumulative fertility rates and the crude birth rate for the three years preceding die survey, by urben-ruxal residence mad region, Nigeria 1990 Age group Residence Region Urban Rural Northeast Northwest Southeast Southwest Total 15-19 0.093 0.166 0.224 0.194 0.106 0.074 0.146 20-24 0.199 0.280 0.280 0.281 0.256 0.210 0.258 25-29 0.255 0.265 0.237 0.274 0.268 0.270 0.263 30-34 0.223 0.219 0.221 0.229 0.220 0.211 0.220 35-39 0.145 0.164 0.140 0.156 0.162 0.176 0.159 4044 0.057 0.100 0.129 0.134 0.053 0.078 0.092 45-49 0.034 0.071 0.075 0.061 0.050 0.073 0.064 TFR 15-49 5.033 6.326 6.532 6.645 5.573 5.461 6.011 TFR 15-44 4.865 5.970 6.155 6.339 5.322 5.095 5.691 GFR 0,172 0.213 0,223 0.229 0.188 0,173 0,203 CBR 34 40 39 46 37 32 39 TFR: GFR: CBR: Note: Total fertility rate expressed per woman General fertility rate (births divided by number of women 15-44), expressed per 1,000 women Crude birth rate, expressed per 1,000 population Rates are for the period 1-36 months preceding the survey. Rates for age group 45-49 may be slightly biased due to truncation. 23 Numerators of the age-specific fertility rates in Table 3.1 are calculated by isolating live births which occurred in the 1-36 months preceding the survey (determined from the date of interview and date of birth of the child), and classifying them by the age (in five-year age groups) of the mother at the time of birth (determined from the date of birth of the mother). The denominators of the rates are the number of woman- years lived in each of the specified five-year age groups during the 1-36 months preceding the survey. There are two regionally distinct patterns of fertility: that of the North and that of the South. During the central childbearing years (25-39), women tend to bear children at about the same rates in the North and the South. It is during the early and late childbearing years that differences are evident. In the teenage years, women in the North have children at twice the rate of women in the South (on average, each year, 1,000 women age 15-19 in the South will give birth to 100 babies, while 1,000 women age 15-19 in the North will give birth to 200 babies). Women in the North achieve their peak fertility in their early twenties, while women in the South reach their highest fertility in their late twenties. In their early 40s, women in the North continue bearing children at twice the rate of women in the South. The sum of the age-specific fertility rates, i.e., the total fertility rate (TFR), is used to summarise the current level of fertility. It can be interpreted as the number of children a woman would have by the end of her childbearing years if she were to pass through those years bearing children at the currently observed rates. If fertility were to remain constant at current levels, a Nigerian woman would give birth to an average of six children. The higher fertility of women in the North results in a total fertility rate which is one child greater than that of women in the South (6.6 versus 5.5). The crude birth rate (CBR) presented in Table 3.1 is the annual number of births in a population per 1,0t30 persons. The CBR can be estimated from the birth history data and the age-sex distribution of the household population. Overall, there were about 39 births per thousand population over the last three years, according to the NDHS. 24 Fertility trends can be analyzed in two ways. One is to compare NDHS data with previous surveys. The last national estimates of total fertility can be calculated from data collected in the 1981/82 Nigeria Fertility Survey (NFS). Table 3.2 compares three-year total fertility rates as estimated by the NDHS and NFS t. The two surveys, nearly a decade apart, yield almost the same total fertility rates (5.9 for the NFS and 6.0 for the NDHS); however, estimates vary greatly for subgroups of the population. Further analysis would be required before concluding whether differences are due to real trends or simply the result of differential data quality. Both surveys do indicate that the fertility of uneducated women is fifty percent higher than the fertility of the most educated women. Table 3.2 Fertility by background characteristics Total fertility rate for the three years preceding the survey end mean number of children ever born to women age 40-49, by selected background characteristics, Nigeria 1990 Background ch~acterlstie NDHS NFS Mean number Mean number of children of children Total ever born Total ever born fertility to women fertility to women rate I age 40-49 rate I age 40-49 Residence Urban 5.03 6.01 5.79 4.81 Rural 6.33 6.61 5.98 5.56 Region Northeast 6.53 5.75 5.95 4.34 Northwest 6.64 6.21 6.38 4.49 Southeast 5.57 6.99 5.72 6,53 Southwest 5.46 6.84 6.25 5.30 Education No education 6.50 6.41 6.14 5.45 Some primary 7.17 7,38 6.81 5,99 Completed primary 5.57 6.54 7.59 5.71 Some secondary 5.07 6.44 3.90 4.31 Completed secondary~igher 4.18 5.82 NA NA Total 6.01 6.49 5.94 5.41 NA = Not applicable IRate for women age 15-49 years 1 The NFS report presented a five-year total fertility rate of 6.34; a three-year rate is presented here for purposes of comparability with the NDHS estimate. (The five-year rate estimated for the NDHS is 6.27). 25 Fertility trends can also be estimated based on NDHS data alone. Table 3.3 shows the age-specific fertility rates for four-year periods preceding the survey. Four-year periods were used instead of the customary five-year periods in order to avoid the effects of displacement of births from five to six years preceding the survey. Table 3.3 Age-specific fertility rates Age-specific fertility rates (per thousand women) for four-year periods preceding the survey, by mother's age at the time of birth, Nigeria 1990 Number of years preceding the survey Mother's age 0-3 4-7 8-11 12-15 16-19 15-19 144 178 166 179 168 20-24 267 297 321 288 250 25-29 274 316 326 309 [286] 30-34 228 261 287 284 [280] 35-39 162 210 [237] [253] 40-44 95 [119] [188] 45-49 [67] [110] -- Note: Age-specific fertility rates are per 1,000 women. Estimates enclosed in brackets are mmcated. The data in Table 3.3 along with similar data from the NFS are plotted in Figure 3.1. Figure 3.1 shows the trends in the total fertility rate based on estimates from the NFS and the NDHS. These are four- year rates, for several periods preceding each survey. There are three points worth noting: i) the NDHS and NFS estimates for 1976 coincide almost exactly, lending confidence to these estimates, ii) given the NDHS estimate for 1980, it appears likely that the NFS estimate for that year is low, and ili) the NDHS estimate repeats the NFS pattern of declining fertility in the four years immediately preceding the survey. 26 Figure 3.1 Trends in the Total Fertility Rate Women 15-34, NFS and NDHS Surveys No. of children 6 5 4 3 i i i i ~ I 1968 1972 1976 1980 1984 1988 1992 Note: The points shown are the mid-points of four-year periods, . . . . NFS - - '~- -NDH8 Is the fertility decline real, or has there been an undercount of births in the years preceding the survey? If there has been no change in fertility over time, the number of births (and woman-years of exposure) would be expected to increase because of the larger cohorts of women moving into the childbearing years (due to the past high fertility). If fertility is fairing, the number of births would be expected to increase over time, but at a slower rate. Figure 3.2 shows the number of births reported in each calendar year. The curve shows a five-year moving average of the numbers. It can be seen from the curve that the number of births in the five years preceding the survey levels offsharply instead of continuing to rise gradually. It appears, therefore, that the number of births in the five years preceding the survey has been underestimated. Both the NFS and the NDHS encountered a pattern of declining births in the years immediately preceding the survey, which lends weight to the diagnosis of underreport'mg. (Although not shown here, the woman- years of exposure increase steadily over time, as expected, indicating that there has been no decline and/or underestimation of the number of women.) So, the question becomes: if births have been underestimated, has there been any fertility decline at all, and if so, how much? The answer to this question requires further investigation, including an analysis of the proximate determinants of fertility, to see whether other behaviours have changed to a degree that would be commensurate with a decline in fertility. 27 Figure 3.2 Distribution of Children's Year of Birth Percent of total births 6 4 2 0 55 60 65 70 75 80 85 90 Year of Birth Births in one year 5 yr. moving average NDH8 1990 Table 3.4 Fertility by marital duration Fertility rates for ever-married women by duration since first marriage in years for four-year periods preceding the survey, Nigeria 1990 Marriage Number of years preceding the survey duration at birth 0-3 4-7 8-11 12-15 16-19 0-4 328 340 326 307 287 5-9 292 340 349 325 292 10-14 259 299 312 299 257 15-19 217 244 250 243 [239] 20-24 141 181 [203] [1861 25-29 72 [87] [95] -- Note: Duratlon-specific fertility rates are per 1,000 women. Estimates enclosed in brackets are truncated Table 3.4 presents fertility rates for ever-married women by duration since first marriage for four-year periods preceding the survey. Fertility early in marriage often remains resilient to change, even when fertility is declining, because fertility decline usually begins at the older ages (when women start to limit the number of blahs), and not by young couples postponing births. However, Table 3.4 shows a recent decline in 28 fertility, even for marriages of short duration. This may be a real decline, or may reflect an undercount of recent births, as noted earlier. 3.2 Ch i ld ren Ever Born and Living The distribution of women by number of children ever born is presented in Table 3.5 for all women and for currently married women. In the NDHS questionnaire, the total number of children ever born was ascertained by a sequence of questions designed to maximize recall. The mean number of children ever born Table 3.5 Children ever born and living Percent disqxibution of all women and of currently married women by number of children ever born (CEB) and mean number ever born m~d living, according to five-year age groups and regions, Nigeria 1990 Number of children ever born (CEB) 0 I 2 3 4 5 6 7 8 9 Number Mean Mean no. of no. of living 10+ Total women CEIl children ALL WOMEN Age 15-19 76.5 17.3 5.0 0.8 0.3 0.0 0.0 0.0 0.0 0.0 0.0 100.0 1,612 0.3 0.3 20-24 32.3 24.7 21,9 11.4 7.9 1.1 0.6 0.2 0.0 0.0 0.0 I00.0 1,676 1.4 1.2 25-29 11.3 12.9 17.8 20.3 15.3 13.1 6.5 1.8 0.6 0.2 0.3 I00.0 1,669 3.0 2.4 30-34 4.1 5.2 9.7 12.6 16.6 16.9 14.4 10.7 6.2 2.8 0.8 100.0 1,410 4.6 3.7 35-39 4.5 2.7 6.7 7.2 14.0 12.5 14.5 13.9 11.3 6.1 6.5 100.0 954 5.5 4.3 40~4 4.6 3.9 4.2 7.7 7.9 9.5 11.3 13.0 14.9 9.4 13.6 100.0 836 6.3 4.8 45-49 4.0 3.9 3.9 6.1 5.9 8.9 9.4 12.4 14.0 10.8 20,6 I00.0 624 6.8 5.1 Reglon Nollheast 18.6 14.9 13.9 12.5 10.4 7.5 6.2 5.0 4.0 3.1 4.0 100.0 2,000 3.3 2.5 No~hwest 16.4 14.6 13.5 12.5 11.2 8.2 6.3 7.7 4.6 1.9 3.1 I00.0 2,098 3.4 2.6 Southeast 29.0 9.2 10.0 8.4 8.4 8.7 7.9 5.7 5.0 3.7 3.9 100,0 2,769 3.3 2.8 Southwest 31.9 10.8 8.6 7.7 9.8 8.6 7.1 4.3 5.5 2.1 3.6 100.0 1,915 3.1 2.5 To~al 24.2 12.1 11.4 10.2 9.8 8.3 7.0 5.7 4.8 2.8 3.6 100.0 8,781 3.3 2.6 CURRENTLY MARRIED WOMEN Age 15-19 41.4 42.1 13.4 2.3 0.8 0.0 0.0 0.0 0.0 0.0 0.0 I00.0 597 0.8 0.7 20-24 15.6 29.6 27,8 14.7 10.1 1.3 0.8 0.2 0.0 0.0 0.0 I00.0 1,279 1.8 1.5 25-29 5.3 12.7 19.0 22.3 16.3 14.2 7.2 2.0 0.7 0.2 0.2 I00,0 1,492 3.2 2.6 30-34 3.5 5.1 9.8 12.4 16.5 16.7 14.6 11.2 6.4 2.9 0.8 I00.0 1,348 4.6 3.8 35-39 3.9 2.5 7.0 7.6 14.0 12.0 14.8 14.1 II.3 6.3 6.5 100.0 892 5.6 4.4 40-44 4.7 4.2 3.9 7.9 7.8 8.7 11.1 13.6 14.7 9.4 14.0 I00.0 731 6.3 4.8 45-49 4.4 3.9 3.7 5.9 6.0 8.7 8.2 13.2 14,2 9.9 21.9 I00.0 543 6.8 5.1 Region Northeast 13.9 15.6 14.8 13.2 11.2 8.0 6.5 5.4 4.2 3.1 4.1 100.0 1,849 3.5 2.7 Northwest II.I 15.6 14.0 13.3 II.9 8.8 6.8 8.3 4.9 2,1 3.4 I00.0 1,944 3.7 2.8 Southeast 6.4 10.7 14.6 12.0 10.9 11.2 10.6 7.9 6.3 4.7 4.9 100.0 1,801 4.4 3.7 Southwest 5.8 13.9 12.0 10.9 14.0 11.9 10.0 6.2 7.7 3.0 4,8 100.0 1,287 4.3 3.5 Total 9.7 14.0 14.0 12.5 11.8 9.8 8.3 7.0 5.6 3.2 4.2 100.0 6,880 3.9 3.1 29 for all women increases rapidly with age, so that by the end of her childbearing years, a woman has given birth to almost seven children. The distribution of women by number of births indicates that alraost one- quarter of teens have already Ix)me a child, and nearly one-third of women age 45 and over have borne nine or more children. The results for younger women who are currently married differ from those for the sample as a whole because of the large number of unmarried women with minimal fertility. Differences at older ages, though minimal, generally reflect the impact of marital dissolution. The parity distribution for older, currently married women also provides a measure of primary infertility. Voluntary childlessness is rare in West Africa, anti married women with no live births are most likely unable to bear children. The NDHS results suggest that about 4 to 5 percent of Nigerian women are unable to bear children. 3.3 Birth Intervals There has been a fair amount of research to indicate that short birth intervals are deleterious to the health of babies. This is particularly true for babies born at intervals of less than 24 months. Table 3.6 shows the percent distribution of births in the five years preceding the survey by the number of months since the previous birth. Over one-quarter of births were born after an interval of less than 24 months. The median birth interval length (30 months) is only six months longer than the minimum considered safe. The unusual aspect of these results is that birth interval length is one of the very few behaviours examined in this report which is invariant to regional and educatlonal characteristics of the mother. Although the table indicates that a high proportion of births to teens were preceded by short intervals, this does not reflect the actual situation of most teen births because the table excludes first births (which are the majority of teen births). 30 Table 3.6 Birth intervals Percent distribution of births in the five yeurs preceding the survey by number of months since previous birth, according to demographic and socioeconomic characteristics, Nigeria 1990 Number of months since previous binh Characteristic 7-17 18-23 24-35 36-47 48+ Median number of Number months since of Total previous birth births Age of mother 15-19 16.8 28.4 38.4 10.4 6.1 100.0 25.2 120 20-29 11.5 19.9 42.0 15.1 11.5 100.0 28.6 3,031 30-39 8.2 16.3 42.0 16.3 17.3 100.0 30.9 2,761 40 + 6.8 12.7 32.0 17.6 30.9 100.0 36.4 813 Birth order 2-3 9.5 18.9 41.6 15.1 14.9 100.0 29.4 2,534 4-6 9.5 17.5 40.0 16.5 16.6 100.0 30.7 2,709 7 + 10.3 16.1 40.5 15.8 17.4 100.0 30.7 1,481 Sex of prior birth Male 9.6 18.1 41.1 15.6 15.8 100.0 29.7 3,332 Female 9.7 17.4 40.4 16.0 16.5 100.0 30.6 3,393 Survival of prior birth Living 8.7 16.9 40.8 16.6 17.1 100.0 30.9 5,808 Dead 15.8 22.6 40.4 10.9 10.2 100.0 26.9 916 Residence Urban 8.8 16.9 42.3 16.5 15.4 100.0 30.4 1,392 Rural 9.9 17.9 40.3 15.6 16.3 I00.0 30,1 5,333 Region Northeast 9.4 17.2 37.4 17.0 19.0 100.0 31.1 1,576 Northwest 9.5 17.5 40.7 16.8 15.5 100.0 30.8 1,847 Southeast 11.7 18,7 43.9 12.9 12.8 100.0 28.6 2,049 Southwest 6.8 17.0 39.6 17.7 18.9 100,0 31.5 1,252 Education No education 9.1 16.9 38.8 16.6 18.6 100.0 31.2 4,445 Some primary 10.3 18.1 45.6 15.8 10.1 100.0 29.0 692 Completed primary 9.4 19.1 44.7 15.2 11.7 100.0 29.1 941 Some se.condm T 14.5 18.7 45.6 9.3 12,0 100.0 27.2 319 Completed secondary/higher 11.9 21.8 40.8 13.2 12.3 100.0 29.2 322 Total 9.6 17.7 40.7 15.8 16.1 100,0 30.2 6,724 Note: First-ordur births arc excluded. The interval for multiple births is the number of months since the preceding pregnancy that ended in a live birth. 3.4 Age at First Birth The age at which childbearing begins has important demographic consequences as well as important consequences for the mother and child. In many countries, postponement of first births, reflecting an increase in the age at marriage, has contributed greatly to overall fertility decline. Table 3.7 presents the distribution of Nigerian women by age at first birth, according to their current age. One-half of women became mothers before the age of 20, of which 10 to 12 percent gave birth before age 15, and 21 to 28 percent gave birth between age 15 and 17. There has been little change in the median age at first birth, although there is some evidence of a decline among younger women. 31 Table 3.7 Age at first biTth Percent disuibufion of women 15-49 by age at first birth, according to current age. Nigeria 1990 Current age Women Median with Age at first birth Number age at no of first births <15 15-17 18-19 20-2l 22-24 25+ Total women birth 15-19 76.5 5.6 14.7 3.1 NA NA NA 100.0 1,612 a 20-24 32.3 12.1 22.8 18.6 10.3 3.9 NA 100.0 1,676 19.7 25-29 11.3 9.6 25.5 18.8 16.0 15.1 3.8 100.0 1,669 19.6 30-34 4.1 12.3 27.6 17.5 14.1 14.2 10.2 100.0 1,409 19.1 35-39 4.5 9.4 23.4 16.3 17.0 12,4 17.1 100.0 954 20.1 40~4 4.6 12.1 22.9 14.1 14.5 14.0 17.8 100.0 836 20.1 45-49 4.0 9.5 21.2 18.0 13.1 13.3 21.0 100.0 624 20.1 NA = Not applicable aLess than 50 percent of the women in the age group x to x+4 have had a birth by age x Table 3.8 summarizes the median age at first birlh for different cohorts and compares the entry age into parenthood for different subgroups of the population. (Medians for cohort 15 - 19 could not be determined because half the women have not yet had a birth.) Findings for older women should be interpreted with caution. For example, the higher medians for older women in the North may reflect omission or misdating of early births, rather than a genuine trend. Overall, the findings point to a possible decline in age at first birth in the North, and an increase in the South. The median age in the Northeast (18.8) is nearly two years below that in the Southwest (20.5). 32 Table 3.8 Median age st first birth Median age at first birth among women age 20-49 years, by current age and selected background characteristics, Nigeria 1990 Current age Background Ages Ages characteristic 20-24 25-29 30-34 35-39 40-44 45-49 20-49 25-49 Residence Urban a 20.8 19.9 20.4 20.8 20.4 a 20.4 Rural 19.1 19.3 18.8 20.0 19.8 20.0 19.3 19.4 Region Northeast 17,5 18.0 17.6 19,9 20.7 22.4 18.3 18,8 Northwest 18.5 19.2 19.4 20.1 20.4 19.4 19.3 19.5 Southeast a 20.0 19.5 19.9 18.6 19.4 19.9 19.6 Southwest a 21.3 19.6 20.4 20.6 20.6 a 20.5 Education No education 17.8 18.2 18.5 20.0 20.2 20.0 18.8 19.1 Some primary 19.0 19.3 18.9 19.1 19.8 19.8 19.3 19.3 Completed primary 19.7 20.2 20.2 20.6 19.6 20.8 a 20.3 Some secondary a 20.6 20.6 22.4 20.4 21.4 a 20.8 Completed secondary/higher a a 23,3 21.3 22.1 23.3 a 24,5 Total 19.7 19.6 19.1 20.1 20.1 20.1 19.7 19.7 Note: The medians for cohort 15-19 could not be determined because half the women have not yet had a birth. aMediarts were not calculated for these cohorts because less than 50 percent of women in the age group x to x+4 have had a birth by age x. 3.5 Teenage Pregnancy and Motherhood One of the targets outlined in the National Policy on Population is: "to reduce pregnancy to mothers below 18 years and above 35 years of age by 50 percent by 1995 and by 90 percent by the year 2000." Table 3.9 shows the percentage of women age 15-19 who are mothers or pregnant with their first child. About 40 percent of teenagers 18 years of age have already begun childbearing (have already given birth, or are pregnant with their first child), and 30 percent of teens 17 years of age. Attempts to reduce early childbearing need to target women in the North, where 48 percent of teens have begun childbearing, compared with 14 percent in the South. 33 Table 3.9 Teenage pregnancy and motherhood Percentage of teenagers 15-19 who are mothers or pregnant with their first child, by selected background characteristics, Nigeria 1990 Percentage who are: Percentage who have Pregnant begun Number Background with f'tr st child- of characteristic Mothers child bearing teenagers Age 15 9.3 3.9 13.1 373 16 14.9 5.9 20.8 322 17 24.7 5.5 30.2 326 18 34.4 5.0 39.3 333 19 39.0 3.8 42.8 259 Residence Urban 14.6 2.8 17.4 462 Rural 27.0 5.6 32.7 1,150 Education No education 43.4 8.6 52.1 545 Some primary 19.2 7.4 26.6 193 Completed primary 18.1 3.1 21.2 329 Some secondary 7.0 1.2 8.2 372 Completed secondary/higher 11.2 1.0 12.2 169 Region Northeast 39.5 10.7 50.2 352 Northwest 40.7 5.6 46.2 308 Southeast 13.9 2.9 16.7 570 Southwest 9.1 1.6 10.8 381 Total 23.5 4.8 28.3 1,612 Figure 3.3 shows the percentage of teenagers who have begun childbearing (have already given birth, or are pregnant with their first child), by region. The differences between regions are great: four times as many women age 17 in the Northeast have begun childbearing as in the Southeast. 34 Figure 3.3 Percentage of Teenagers Who Have Begun Childbearing, by Region Percent 100 80 60 40 20 0 15 I i I 16 17 18 19 Age l --Northeast -~--Northwest --~- Southesst -~ Southwest i NDH8 1990 Whereas most teens who have begun childbearing have given birth only once, a small proportion have given birth twice. Table 3.10 shows the distribution of women age 15-19 by number of children ever born, excluding those who are currently pregnant. Eleven percent of women age 18 have given birth to two children. By giving birth early and presumably with short birth intervals, these women and their children are at a higher risk of dying. The issue of high-risk childbearing is discussed in Chapter 8. Table 3.10 Children bern to teenagers Percent dis~ibution of teenagers 15-19 by number of children ever bern (CEB), Nigeria 1990 Age 0 1 2+ Number of Mean children ever born number Number of of Total CEB teenagers 15 90.8 8.4 0.9 100.0 0.1 373 16 85.1 13.6 1.3 1(30.0 0.2 322 17 75.3 17.7 7.0 100.0 0.3 326 18 65.6 23.8 10.6 100.0 0.5 333 19 61.0 25.8 13.2 1(30.0 0.6 259 Total 76.5 17.3 6.2 100.0 0.3 1,612 35 CHAPTER 4 FERTILITY REGULATION 4.1 Knowledge of Contraception Determining the level of knowledge of contraceptive methods and of services was a major objective of the Nigeria DHS survey, since knowledge of specific methods and of the places where they can be obtained is a precondition for use. Information about knowledge of contraceptive methods was collected by asking the respondent to name ways or methods by which a couple could delay or avoid pregnancy. If the respondent failed to mention a particular method spontaneously, the interviewer described the method and asked if she recognised it. Eight modem methods--the pill, IUD, injection, foaming tablets, barrier methods (diaphragm, foam and jelly), condoms, female sterilisation and male sterilisation--were described, as well as two traditional methods--periodic abstinence (rhythm method) and withdrawal. Any other methods mentioned by the respondent, such as herbs or breastfeeding, were also recorded. For each method recognised, the respondent was asked if she knew where a person could obtain the method. If she reported knowing about the rhythm method, she was asked if she knew where a person could obtain advice on how to use the method. Table 4.1 indicates that less than half (46 percent) of all Nigerian women age 15-49 know of at least one method of family planning. Looked at another way, this means that over half of the women reported that Table 4.1 Knowledge of contraceptive methods and source for methods Percentage of all women and currently married women who know specific contraceptive methods and who know a source (for information or services), by specific methods, Nigeria 1990 Know method Know a source Currently Currently Contraceptive All married All married method women women women women Any method 45.7 43.6 34.0 31.9 Modern method 43,5 41.2 33.2 31.2 Pill 35,1 33.8 25.0 24.1 IUD 20,3 19.8 15.9 15.6 Injection 34.2 33.6 25.2 24.8 Foaming tablets 10.7 9.6 8.1 7.1 Diephragm/foam/jelly 7.9 7.3 6.2 5.7 Condom 24.1 21.6 17.7 15.9 Female stedlisation 20.4 19.4 15.7 14.9 Male sterilis atinn 7.5 6.7 5.6 4.9 Any traditional method 25.7 23.6 10.8 8.9 Rhythm 17.3 14.7 10.8 8.9 Withdrawal 14.2 12.4 HA NA Other traditional methods 10.0 10.3 NA NA Number of women 8,781 6,880 8,781 6,880 37 they did not know any method of family planning. Knowledge of methods was slightly lower among currently married women and higher among never-married women than among all women. However, since it is currently married women who are at greatest risk of pregnancy, this chapter focuses primarily on them. Almost twice as many married women reported knowing a modem method (41 percent) as reported knowing a traditional method (24 percent). The most frequently reported methods are the pill and injection, each known by 34 percent of married women. Following these, the condom, IUD, and female sterllisation are the most commonly known methods (about 20 percent of married women). Other modem methods (foaming tablets, diaphragm, and male sterilisation) are less well known. As for traditional methods, about 15 percent of married women know the rhythm method, i.e, periodic abstinence, while 12 percent know withdrawal. Although the level of contraceptive knowledge in Nigeria is low, there has been improvement over time. In the 1981/82 Nigerian Fertility Survey (NFS), only 34 percent of all women ~ reported that they bad heard of any method (National Population Bureau and World Fertility Survey, 1984, Table 7.2). Thus, in the 10 years between the NFS and the NDHS, the level of contraceptive knowledge increased by 35 percent. There were also large increases in the proportion of women who know specific methods (see Figure 4.1). Not all women who know a family planning method know where they can obtain it. One-quarter of the women who have heard of the two most frequently mentioned methods, the pill and injection, do not know a place where they can obtain the methods. The same is true for condoms. Overall, only one-third of Figure 4.1 Trends in Contraceptive Knowledge Women 15-49, NFS and NDHS Surveys Any method Pill IUD Injection Condom Female aterilisation Male sterilisation Rhythm Withdrawal 10 20 30 40 Percent W NFS 1981-82 =aim NDHS 1990 50 Data from the NFS are tabulated for all women, not just currently married women. 38 currently married women know a place where they can obtain some method of family planning. As with knowledge of the methods themselves, knowledge of places where specific methods can be obtained is slightly higher among women who have never been married than among those who are currently married. Table 4.2 indicates that among married women, knowledge of at least one contraceptive method is somewhat higher among women in their late 20s than among younger or older women. This is also true for knowledge of at least one modem method and knowledge of a place to obtain a modem method. Knowledge of contraceptive methods and their sources differs substantially by urban-rural residence. The proportion of Table 4.2 Knowledge of modem contraceptive methods and source for methods Percentage of currently married women who know at least one modem contraceptive method and who know a source (for information or services), by selected background characteristics, Nigeria 1990 Know a Know Know source for Number Background any a modem modem of characteristic method method 1 method women Age 15-19 31.7 30.5 23.0 597 20-24 45.4 42.1 31.8 1,279 25-29 49.2 47.2 36.1 1,492 30-34 43.5 41.9 30.1 1.348 35-39 44.4 42.1 34.0 892 4044 43.9 41.4 31.3 731 45-49 35.3 30.2 23.9 543 Residence Urban 70.4 68.5 58.9 1,476 Rural 36.3 33.7 23.7 5,404 Region Northeast 24.0 21.9 17.9 1,849 Northwest 30.3 27.7 15.1 1,944 Southeast 56.6 53.9 40.9 1,801 Southwest 73.6 71.4 61.2 1,287 Education No education 29.1 26.7 18.3 4,610 Some primary 63.1 60.2 43.0 594 Completed primary 67.2 64.5 52.6 911 Some secondary 83.8 82.0 66.0 322 Completed secondary/higher 90.8 89.4 81.9 438 Total 43.6 41.2 31.2 6,880 1Includes pill, IUD, injection, vaginal methods (foaming tablets/diaphragm/ foam/jelly), condom, female stefilisation, and male sterilisation. 39 urban married women who know at least one family planning method (70 percent) is twice that of rural women (36 percent). The same relationship holds for knowledge of a modem method; however, knowledge of a source for a modem method shows an even wider differential, with almost 60 percent of urban women knowing a source, compared to only 24 percent of rural women. This means that, not only are rural women less likely than urban women to know specific contraceptive methods, but even among those who do, a smaller percentage know of a source for these methods. Differences in contraceptive knowledge by region are large. The proportion of married women who have heard of at least one family planning method is three times higher in the Southwest (74 percent) than in the Northeast (24 percent). The level of knowledge in the Southeast (57 percent) is also higher than in the Northwest (30 percent). The same pattern holds for knowledge of modem methods and for knowledge of where these methods can be obtained. There are also large differences in contraceptive knowledge by educational attainment. Fewer than 30 percent of women with no education say that they have heard of any method of family planning, compared to two-thirds of those with primary education and over 80 percent of those with some secondary education. Over 90 percent of respondents who completed secondary school have heard of a family planning method. 4.2 Ever Use of Contraception All women interviewed in the NDHS who said that they had heard of a method of family planning were asked if they had ever used it. Only one in seven Nigerian women (15 percent) has ever used a method of family planning and only one in eleven (9 percent) has ever used a modem method (see Table 4.3). A slightly smaller proportion of currently married women (14 percent) have ever used family planning than among all women (15 percent). Ever-use is lowest for those in the youngest and oldest age groups (15-19 and 45-49 years) and is relatively uniform for those in the intermediate age groups. Ever-use of modem methods among currently married women is only slightly higher than ever-use of traditional methods. The most widely used methods are the pill (5 percent of married women) and rhythm method, i.e., periodic abstinence (4 percent). Three percent of married women have ever used withdrawal, and two percent each have ever used condoms, injection, and the IUD. The level of ever use of family planning appears to remain constant over time, with 14 percent of currently married women in both the 1981/82 NFS and the 1990 NDHS saying they had used a family planning method sometime 2 (London, et al., 1985). However, most of the ever-use reported in the earlier survey consisted of prolonged abstinence, which was not specifically asked about in the NDHS and is not considered a family planning method as such. Ever use of modem methods increased among currently married women from 2 percent in 1981/82 to 8 percent in 1990. Data from the NFS cited here are not strictly comparable to those from the NDHS, since they refer to women age 15-44, instead of 15-49; however, the effect of this discrepancy is minimal. 40 Table 4.3 Ever use of contr~eption Percentage of all women and currently married women who have ever used a contraceptive method, by specific methods and age, Nigeria 1990 Age of woman Background All characteristic 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Ages ALL WOMEN Any method 8.3 18.0 18.7 14,1 18.3 15.7 12.7 15.2 Modern method 4.0 10.1 11.3 8.0 12.3 11.5 7,1 9.0 Pill 1.8 5.0 6.5 4,5 7.0 5.9 4.6 4.9 IUD 0.2 0.7 1.3 1.8 3.1 3.8 2,0 1.6 Injection 0.5 1.5 1.6 2,0 3.0 3.9 2,2 1.8 Foaming tablets 0.7 0.6 0.6 0.6 1.1 0.8 0.0 0.6 Diaphragm/foam/jelly 0.2 O. 1 0.3 0.2 0.3 0.1 0.0 0.2 Condom 1.6 4.6 3.8 1,9 1.6 1.0 1.0 2.5 Female sterilisation 0.0 0.0 0.1 0.1 0.4 1.3 0.6 0.2 Male sterilisatinn 0.0 O. 1 0.0 O. 1 0.2 0.0 0.0 0.0 Any traditional method 5,9 12.8 11.7 9.0 8.6 6.5 8,0 9.3 Rhythm 3,9 7.7 7.8 4.5 4,5 3.1 3.4 5.4 Withdrawal 1,8 5.0 5.5 3,3 2.6 2.1 1.9 3.5 Other traditional methods 1,3 2.7 1.8 2.5 2.7 2.4 3.7 2,3 Number of women 1,612 1.676 1,669 1,410 954 836 624 8.781 CURRENTLY MARRIED WOMEN Any method 4.4 13,4 16.0 13.7 17.3 16.2 12.1 14.0 Modern method 2,2 7.3 9.6 7.6 11.3 12.1 7.2 8.4 Pill 1.0 4.1 5.6 4.4 6.1 6.4 4.5 4.8 IUD 0.3 0.7 1.2 1.9 2.6 4.1 2.3 1.7 Injection 0.5 1.5 1.3 1.7 3.1 4.0 2.4 1.9 Foaming tablets 0.1 0.2 0.6 0.5 1.2 1.0 0.0 0.5 Diaphragm/foam/jelly 0.0 0.0 0.2 0.2 0.3 0.1 0.0 0.1 Condom 0.7 2,2 3.3 1.8 1.7 1.0 1.0 2.0 Female stefilisation 0.O 0.0 0.1 0.1 0.4 1.4 0.5 0.3 Male sterilisation 0.0 0.0 0.0 O. 1 0.2 0.0 0.0 0.0 Any traditional method 2.9 9.0 9.6 8.7 8.7 6.6 6.9 8.1 Rhythm 1.0 5.0 6.1 4.3 4.8 3.1 2.3 4.3 Withdrawal 1.1 2.5 4.6 3.1 2.5 2.2 1.3 2.8 Other traditional methods 1.2 2.4 1.7 2.4 2.7 2.3 3.7 2.3 Number of women 597 1,279 1,492 1,348 892 731 543 6,880 41 4,3 Current Use of Contraception Only 6 percent of currently married women in Nigeria are using a contraceptive method (see Table 4.4). Contraceptive use among women who are not married is twice as high, 13 percent (not shown). Since it is customary to analyze contraceptive use among currently married women, this chapter focuses primarily on married women. TaMe 4,4 Current use of contraception Percent distribution of all women and of ctuarently married women by contraceptive me~hod currently used, according to age, Nigeria 1990 Ago of woman Method 15-19 20-24 25-29 30-34 35-39 40-44 45-49 15-44 15-49 ALL WOMEN Any method 5.9 9.5 8.6 6.5 8.4 7.9 4.2 7.8 7.5 Any modern method 1.9 3.8 3.9 3.6 5.3 5.4 3.3 3,8 3.8 Pill 1.0 1.7 1.7 1.1 1.7 1.1 1.3 1.4 1.4 IUD 0.1 0.3 0.9 1.1 1.2 1.7 0.6 0.7 0.7 Injection 0.1 0.7 0.4 0.9 1.5 1.1 0.6 0.7 0.7 Foanfin 8 tablets 0.3 0.1 0.1 0,2 0.2 0.2 0.0 0.2 0.2 Condom 0.4 1.1 0.8 0.2 0.3 0.1 0.1 0.6 0.5 Female sterilisation 0.0 0.0 0.I 0,1 0.4 1.3 0.6 0.2 0.2 Any traditional method 3.9 5.6 4.6 2.8 3.1 2.5 1.0 4.0 3.8 Rhythm 2.9 3.7 3.3 1.5 1.6 1.0 0.3 2.6 2.4 Withdrawal 0.5 1.2 0.9 0.5 0.6 0.8 0.1 0.8 0.7 Other Ixac~tional methods 0.6 0.8 0.4 0.7 1.0 0.7 0.5 0.7 0.7 Not using 94.1 90.5 91.4 93.5 91.6 92.1 95.8 92.2 92.5 Total 100.0 100.0 100.0 100,0 100.0 100.0 100.0 100.0 100.0 Number of women 1,612 1,676 1,669 1,410 954 836 624 8,157 8,781 CURRENTLY MARRIED WOMEN Any method 1.3 5.1 6.0 6.5 8.6 8.4 4.6 6.1 6.0 Any modern method 0.6 2.7 3.1 3.7 5.4 5.8 3.6 3.5 3.5 PHI 0.2 1.4 1.2 1.1 1.8 1.2 1.5 1.2 1.2 IUD 0.0 0.2 0.7 1.1 1.0 1.9 0.7 0.8 0.8 Injection 0.0 0.6 0.3 0.9 1.6 1.0 0.7 0.8 0.7 F, oarmng tablets 0.0 0.1 0.1 0.2 0.2 0.2 0.0 0.1 0.1 Condom 0.4 0.4 0.6 0.2 0.4 O. 1 O. 1 0.4 0.4 Female sterilisation 0.0 0.0 0.1 0.1 0.4 1.4 0.5 0.3 0.3 Any traditional method 0.7 2.4 3.0 2.7 3.2 2.6 1.0 2.6 2.5 Rhythm 0.2 1.6 2.0 1.4 1.7 1.0 0.4 1.4 1.4 Withckawal 0.3 0.4 0.7 0.6 0.6 0.9 0.0 0.6 0.5 Other traditional methods 0.3 0.4 0.4 0.8 0.9 0.7 0.6 0.6 0.6 Not using 98.7 94.9 94.0 93.5 91.4 91.6 95.4 93.9 94.0 Totsl I00.0 I00.0 I00.0 I00.0 I00.0 I00.0 100.0 I00.0 I00.0 Number of women 597 1,279 1,492 1,348 892 731 543 6,338 6,880 Almost as many married women are using traditional methods (3 percent) as are using modem methods (4 percent). The most popular contraceptive method is the rhythm method, i.e, periodic abstinence, followed by the pill, IUD, and injection, each of which is used by about one percent of married women. Contraceptive use is highest among women in their late 30s and early 40s, and lowest among women age 42 15-19. This pattern is most likely due largely to the fact that younger women are just starting their families, while older women are more likely to have completed their families and to want to stop childbearing altogether. For the same reasons, younger women are more likely to use less effective methods such as withdrawal or rhythm, or temporary methods such as the condom, while older women are more likely to use more effective methods such as the pill, IUD, and injection. As with the data on ever use, it appears at f'Lr St glance that the level of current use of family planning has changed little over time, increasing among married women age 15-44 from 5 percent in 1981/82 (London, et al., 1985) to 6 percent in 1990. However, most of current use in the earlier survey was of traditional methods, almost exclusively prolonged abstinence. Looking just at modem methods, current use increased from I percent to 4 percent among married women age 15-44. While overall use of family planning is quite low, the NDHS data show that some women are more likely to bc using contraception than others (sue Table 4.5 and Figure 4.2). Women most likcly to be using Table 4.5 Curr~t use of cor~aception by backp~otmd cheracteristlcs Percent distribution of curre~ttly married women by contraceptive method curronfly used, according to selected background characteristics, Nigeria 1990 Modem raethoda Traditional metho& Not Any Any Periodic usin 8 Number Background Any modern In'~c- Con- bad. ablti- With- any of characteristic method method Pill IUD don dcfn method nence drawal Other method Total women Realdence Urban 14.8 9.6 3.1 2.5 1.8 1.1 5.2 3.5 1.1 0.6 85.2 100.0 1,476 Rural 3.6 1.9 0.7 0.3 0.4 0.1 1.7 0.8 0.4 0.5 96.4 100.0 5,404 Regina Northeast 2.0 1.3 0.5 0.1 0.5 0.0 0.7 0.0 0.2 0.5 98.0 100.0 1,849 Northwest 1.2 0.7 0.4 0.2 0.0 0.0 0.5 0.0 0.0 0.4 98.8 100.0 1,944 Scuthe.tst 8.8 3.9 0.8 0.9 1.1 0.5 5.0 3.5 1.0 0.5 91.2 100.0 1,801 Southwest 15.0 10.5 4.0 2.5 1.6 1.2 4.5 2.3 1.1 1.1 85.0 100.0 1,287 l~du~Uon No education 2.0 1.3 0.5 0.2 0.3 0.0 0.7 0.1 0.1 0.4 98.0 100.0 4,610 Some pxlnu~ 7.8 3.9 1.3 0.6 1.1 0.0 3.9 1.5 1.4 1.0 92.2 100.0 594 Completedlzlmary 10.5 6.4 2.0 1.9 1.4 0.3 4.1 2.8 0.5 0.8 89.5 100.0 911 Some secondary 17.0 9.7 3.2 1.7 2.8 1.1 7.3 4.1 2.1 1.1 83.0 100.0 322 Completed secondary/higher 28.4 16.7 5.5 4.4 1.6 4.2 11.7 9.0 2.2 0.4 71.6 100.0 438 Number of living children None 4.2 1.6 0.9 0.0 0.3 0.3 2.6 2.0 0.3 0.3 95.8 100.0 802 I 3.5 1.7 0.7 0.1 0.1 0.6 1.8 0.9 0.6 0.3 96.5 100.0 1',154 2 4.1 2.6 0.9 0.3 0.6 0.7 1.6 0.8 0.2 0.5 95.9 100.0 1,172 3 5.1 2.8 0.9 0.8 0.5 0.1 2.3 1.3 0.S 0.5 94.9 100.0 1,051 4 7.0 4.5 LI 1.9 0.9 0.3 2.5 1.5 0.5 0.5 93.0 100.0 894 5ormo~e 9.6 6.2 2.2 1.4 1.5 0.2 3.5 1.7 0.8 1.0 90.4 100.0 1,806 Total 6.0 3.5 1.2 0.8 0.7 0.4 2.5 1.4 0.5 0.6 94.0 100.0 6,880 Note: Total men of modem methods and all methods include usen of fcsmlng tablets (0.1 perce~ ~ women) and female sterilization (0.3 perumt of w~nm). 43 Figure 4.2 Current Use of Contraception Currently Married Women 15-49 RESIDENCE Urban Rural REGION Northeast Northwest Southeaet Southwest EDUCATION No educ. Prim. Incomp. Prim. Comp. Sec. Incomp Sec./Higher ~ 4 2 []1 ~ 8 m 2 8 17 28 O 10 20 30 Percent NDHS 1990 contraception are those in urban areas, those inthe Southwest, those withmore education, and those with five or more children. Urban women are four times more likely to be using family planning (15 percent) than rural women (4 percent). Both urban and rural women rely primarily on the rhythm method, followed by the pill. The proportion of married women using any method of contraception varies widely by region, from 1 percent in the Northwest to 15 percent in the Southwest. In the North, the pill and traditional methods (other than rhythm, i.e., periodic abstinence, and withdrawal) are the most frequently used methods; in the Northeast, injection is also used. In the Southeast, the rhythm method is the most popular method, followed by injection, withdrawal, the IUD, and the pill, all of which have about the same level of use. In the Southwest, the pill, IUD, and rhytlun are the most widely used methods. Greater use of family planning among women with formal education--an association documented in countries around the world--also occurs in Nigeria. Contraceptive use increases steadily with increasing level of education, from 2 percent of women with no education to more than one-quarter (28 percent) of those who have completed secondary education. At all educational levels, traditional methods account for around half or just under half of all use, and the rhythm method is the single most widely used method for all but those with no education. As for modem methods, the pill is the most popular method among all educational groups. Use of condoms is limited to those who have secondary schooling. Contraceptive use varies little according to the number of children a woman has, up to four children. As the number of children increases, use of modem methods becomes more important in the overall method mix. 44 4.4 Number of Children at First Use of Contraception In many cultures, family planning is used only when couples have already had as many children as they want. As the concept of planning families gains acceptance, however, couples may begin to use contraception for spacing births as well as for limiting family size. Moreover, unmarried young women may be particularly motivated to use family planning to avoid an unwanted pregnancy. Table 4.6 shows the number of children a woman had when she first used contraception. For older age cohorts, women generally started using family planning only after they had had five or more children. For younger age cohorts, women were more likely to have started using family planning before they had had any children. For example, roughly the same proportion of women age 45-49 and 20-24 have ever used a contraceptive method (13 percent and 14 percent, respectively). However, while over half of the ever users age 45-49 waited until they had had at least four children, half of the ever users age 20-24 started to use a method before they had had any children at all. This reflects a shift towards use of family planning for spacing puq)oses. Table 4.6 Number of children at First use of contraception Percent distribution of ever-married women by number of living children at the time of first use of contraception, according to current age, Nigeria 1990 Number of living children at time Never of first use of contraception Number Current used of age contraception 0 1 2 3 4 5+ Total women 15-19 95.7 2.4 1.8 0.0 0.0 0.0 0.0 100.0 622 20-24 86.3 6.6 3.7 1.9 1.0 0.2 0.0 100.0 1,312 25-29 84.0 4.7 4.0 2.9 2.3 1.1 1.0 100.0 1,537 30-34 86.2 2.3 2.8 2.4 1.5 1.8 2.8 100.0 1,397 35-39 82.3 2.2 1.1 2.6 1.8 2.7 7.0 100.0 943 40-44 84.3 1.5 1.5 1.2 2.6 2.3 6.1 104).0 834 45-49 87.3 0.9 1.2 0.7 2.7 1.2 5.9 100.0 624 Total 85.9 3.4 2.6 1.9 1.7 1.3 2.9 100.0 7,268 4.5 Use of Social Marketing Brand Pills Several years ago, a social marketing programme was launched to distribute oral contraceptives (the pill) through the private sector. The programme operates by providing a large pharmaceutical company with pills for a price that is just above cost. The company then sells them through its roughly 4000 outlets throughout the country. More recently, the programme was expanded to include condoms and foaming tablets, but this change was too recent to be measured in the NDHS. In order to measure the extent to which the programme has reached the general public, all NDHS respondents who reported that they were currently using the pill (121 women) were asked to show the packet of pills they were using, or, if they could not, to tell the interviewer which brand they were using. Overall, only 4 percent of pUl users were using either of the two social marketing brands, Nordiol and Norquest. The 45 proportion was the same in urban and rural areas (4 percent in urban, 5 percent in rural areas). The social marketing project seems to have made the greatest impact in the Southeast, where 10 percent of pill users are using a social marketing brand; in the Southwest, the proportion is only 3 percent. There were too few pill users in the Northeast and Northwest to tabulate brand used. In fact, even in the two southern regions, the numbers of pill users is small, and, consequently, the data on brands used are subject to relatively high sampling errors. It should be noted that both brands are available through outlets other than those of the social marketing project; however, most users of these brands probably obtained them through project outlets. 4.6 Knowledge of the Fertile Period A basic knowledge of reproductive physiology is useful for successful practice of coital-related methods such as withdrawal, the condom, or barrier methods, but it is especially important for users of periodic abstinence or the rhythm method. The successful practice of periodic abstinence depends on an understanding of when during the ovulatory cycle a woman is most likely to conceive. Table 4.7 presents the percent distribution of all respondents and those who have ever used periodic abstinence by reported knowledge of the fertile period in the ovulatory cycle. Table 4.7 Knowledge of fertile period Percent disa'ibution of all women and of women who have ever used periodic abstinence by knowledge of the fertile period during the ovulatory cycle, Nigeria 1990 Ever users Perceived All of periodic fertile period women abstinence During menstrual period 2.3 3.7 Right after period has ended 30.2 34.1 In the middle of the cycle 20.0 42.6 Just before period begins 2.7 3.1 At any time 9.4 8.4 Don't know 35.1 7.9 Total 100.0 100.0 Number 8,781 474 Thirty-five pement of the women interviewed said they did not know when a woman is most likely to conceive and 30 percent said that a woman is most likely to conceive just after her period has ended. Only 20 percent gave the "correct" response: that a woman is most likely to conceive in the middle of her ovulatory cycle. Ever-users of periodic abstinence are more knowledgeable about the ovulatory cycle than women in general. Forty-three percent identified the fertile time as occurring in the middle of the cycle, and only 8 percent said they did not know when it occurred. It should be noted that the precoded response categories for this question are only one way of dividing the cycle into distinct periods. Women may actually have a more accurate understanding of their fertility cycles than is reflected by these categories. However, it appears that almost half of all women and one-fifth of those who have used periodic abstinence do not 46 understand the ovulatory process, since they either reported that they did not know when a woman is most likely to get pregnant or they gave answers such as "during her period" or "at any time." 4.7 Sources for Family Planning Methods All current users of modem methods of family planning were asked to report the source from which they most recently obtained their methods. Because women often do not know exactly which category the source they use falls into (e.g., govemment hospital, private health centre, etc.), interviewers were instructed to write the name of the source. Supervisors and field editors were to verify that the name and the type of source were consistent, asking cluster informants for the names of local family planning sources if necessary. This practice was designed to improve the reporting of data on sources of family planning. Table 4.8 indicates that 37 percent of modem method users last obtained their methods from public (government) sources, while 47 percent relied on private sources, and 4 percent used outlets of the Planned Parenthood Federation of Nigeria. Government hospitals were the single most frequently cited source, 26 percent of users. In fact, one-half of users obtained their methods from hospitals or health cemres, whether public or private. Table 4.8 Source of supply for modern contraceptive methods Percent distribudon of current users of modem contraceptive methods by source of supply or information, according m specific method, Nigeria 1990 most recent DUreX/ Source Pill IUD Injection Condom Total I Total government 29.0 61.0 44.9 (13.4) 36.7 Govc~'nrnent hospital 19.5 41.2 31.9 (7.2) 25.9 Government health centre 8.2 19.8 10.9 (6,2) I0.0 Government doctor 1.3 0.0 2. I (0.0) 0.9 PPFM 2.3 7.8 3.6 (3.6) 4.3 Total prlvate 62.1 20.0 48.5 (54.9) 47.2 Private doctor 1.5 0.7 8.3 (0.2) 2.2 Private hospital/health centre 4.1 18.6 35.6 (4.0) 13.2 Private pharmacy 23.9 0.0 0.0 (14.2) 11,7 Private patient medical office 28.8 0.0 3.0 (30,7) 17.3 Private market 2.0 0.0 0.0 (4.1) 1.3 Private place of work 1.8 0.8 1.6 (1.7) 1.3 Total other sources 5.9 11.1 3.0 (11.7) 8.8 Mission 1.5 10.1 1.6 (0.0) 5.0 Friends#elatives 4.4 1.0 1.3 (11.3) 3.7 Don't know/Missing 0.7 0.0 0.0 (16.4) 2.9 Total 100.0 I00.0 I00.0 I00.0 100.0 Number of users 121 65 61 46 329 IUsers of foaming tablets (0.2 percent) and female stcrilisadon (0.2 percent) are excluded because there are fewer than 25 ceaes for each category. 47 Which source a woman uses depends on many things, one of which is the type of method she has chosen. Most pill users obtain supplies from private sources, one-quarter from pharmacies and one-quarter from patent medicine shops. Conversely, the IUD is obtained largely from govemment facilities, approximately two-fifths from government hospitals and one-fifth from govemment health centres. Injections are obtained about equally from govemment and private sources. Most condoms are purchased from patent medicine shops and pharmacies, and the condom is the method most likely to be obtained from friends or relatives. Overall, government sources supply 30 percent of pill users, 61 percent of IUD users, 45 percent of injection users, and 13 percent of condom users. Private sources supply 62 percent of pill users, 20 percent of IUD users, 49 percent of injection users, and 55 percent of condom users. Figure 4.3 summarises the sources for current users of all modem methods combined. Figure 4.3 Sources of Family Planning Methods Current Users of Modern Methods Other 9 =, Don't Know/ Missing 3% :e 47% Government 37% FN 4% NDHS 1990 Women who are currently using a modem contraceptive method were asked how long it takes to travel from their home to the place where they obtain the method. Nonusers were asked if they knew a place where they could obtain a modem method and, if so, how long it would take to travel there. The results are shown in Table 4.9. Looking f irst at women who are currently using a modem method, 34 percent are within 30 minutes of the place to which they go to get their method, while 30 percent are 30 minutes to one hour from their source. Only 22 percent of users of modem methods are one hour or more from their source of supply. As expected, urban users are generally closer than rural users to their supply sources. 48 Table 4.9 Time to somce of supply for modem contraceptive methods Percent distribution of women who are currently using a modem contraceptive method, of women who are not using a modern method, and of women who know a method, by time to reach a source of supply, according to urban-rural residence, Nigeria 1990 Women who are currently using a modem method Women who are not using a modem method Women who know a contraceptive method Minutes to source Urban Rural Total Urban Rural Total Urban Rural Total 0-14 22.2 9.1 17.1 12.1 2.9 5.0 15.5 6.9 10.2 15-29 17.4 16.8 17.1 11.5 1.8 4.0 14.2 4.8 8.4 30-59 31.1 28.3 30.0 16.5 5.4 7.9 21.2 12.6 15.9 60 or more 17.0 30.6 22.3 9.5 13.7 12.7 12.1 28.0 21.9 Does not know time 11.4 14.4 12.6 3.8 1.6 2.1 4.8 4.1 4.3 Does not know source 1.0 0.8 0.9 45.9 73.7 67.5 20.9 35.0 29.6 Not stated 0.0 0.0 0.0 0.6 0.9 0.8 11.3 8.5 9.6 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Median time to source 30.2 30.8 30.4 30.1 60.4 40.6 30.1 60.2 30.9 Number of women 200 129 329 1,821 6,296 8,117 1,542 2,475 4,017 Among women who are not currently using a modem method, two-thirds (68 percent) do not know a source for a modem contraceptive method. Since this question was asked of all nonusers and includes women who do not know a method, it is not surprising that so many do not know a source. The final panel of Table 4.9 is based on all women who know a method. Since women who were using a traditional method were not asked the questions on distance to a source of family planning, they are categorized as "not stated" in this panel. Even among women who know of at least one family planning method, 30 percent say they do not know of a place to get a modem method, and fewer than 20 percent are within 30 minutes of a source for a modem method. Among those who know a source, in urban areas there is no difference in the median distance (time) to a source between users and nonusers of modem methods; however, in rural areas, women who do not use are on average twice as far away from a source. 4.8 Intention to Use Family Planning Among Nonusers Women who were not using a contraceptive method at the time of the survey were asked if they thought they would do something to keep from getting pregnant at any time in the future. Among currently married nonusers, a large majority (68 percent) said they do not intend to use family planning in the future (see Table 4.10). About one in five nonusers (22 percent) said they did intend to use in the future; just over half of these women said they planned to use a method within the next 12 months. Intention to use family planning is closely related to the number of children a woman has. While only 9 percent of childless nonusers said they intended to use family planning in the future, 26 percent of nonusers with four or more children said they intended to use. Perhaps because contraceptive use is so low in Nigeria, the majority of those who say they intend to use contraception in the future are women who have never used. Those who used in the past but are not currently using make up less than nne-quarter of those who intend to use in future. 49 Table 4.10 Future use of contraception Petr, ent distribution of currently married women who are not using a contraceptive method by past experience with contraception and intention to use in the future, according to number of living children, Nigeria 1990 Past experience with contraception and future intentions Number of living children I 0 1 2 3 4+ Toml Never used contraception Intends to use in next 12 months 1.4 6.2 7.2 7.4 13.1 8.9 Intends to use later 4.9 9.4 7.9 8.3 7.0 7.6 Unsure as to intention 12.9 9.0 9.3 8.2 9.7 9.5 Does not intend to use 76.4 68.1 67.5 67,9 60.1 65.5 Previously used contraception Intends to use in next 12 months 0.6 2.0 2.6 3.9 4.6 3.3 Intends to use later 2.0 2.7 1.9 1.7 1.3 1.8 Unsure as to intention 0.2 0.7 0.9 0.4 0.6 0.6 Does not intend to use 1.6 1.9 2.6 2.2 3.4 2.7 Total 100.0 100.0 100.0 100.0 100.0 100.0 All currently married nonusers Intends to use in next 12 months 2.0 8.1 9.7 11.3 17.7 12.2 Intends to use later 6.9 12.1 9.9 10.0 8.3 9.4 Unsure as to intention 13.1 9.7 10.2 8.6 10.3 10.2 Does not intend to use 78.0 70.1 70.1 70.2 63.6 68.2 Total 100.0 100.0 100.0 100.0 100.0 100.0 Number of women 578 1,127 1,095 1,058 2,606 6,465 lincludes current pregneney Table 4.11 presents the reasons for not using contraception given by women who do not intend to use a method. Of the 68 percent of married nonusers who say they do not intend to use family planning in the future, almost half say they do not intend to use because they want children (47 percent). Other reasons given are "religion" (12 percent), lack of knowledge (12 percent), and "fatalism" (6 percent), which encompasses responses that imply that there is nothing the woman can do about the number of children she will have. Women under age 30 are more likely to say that they do not intend to use because they want children, while those age 30 and over are more likely to cite reasons such as being menopausal or infecund ("difficult to get pregnant"), or lack of knowledge. 50 Table 4.11 Reasons for not using contraception Percent distribution of women who are not using a contraceptive method and who do not intend to use in the future by main reason for not using, according to age, Nigeria 1990 ~e Reason for not using contraception 15-29 30-49 Total Wants ch'ddren 57.7 37.6 47.1 Lack of knowledge 9.3 14.0 11.7 Fatalistic 5,3 6.0 5.7 Costs too much 0.2 0.5 0,4 Side effects 2.2 3.5 2.9 Health concerns 0.7 1.4 1.1 Hard to get methods 0.6 0.4 0.5 Religion 12.1 12.3 12.2 Opposed to family planning 3.4 4.4 3.9 Partner opposes family planning 2.8 2.2 2.5 Others oppose family planning 0.5 0.2 0.4 Infrequent sex 0.4 1.3 0.9 Difficult to get pregnant 1.9 6.3 4.2 Menopausal/hysterectomy 0.0 6.0 3.2 Inconvenient 0.6 1.0 0.8 Other reasons 0.4 0.6 0.5 Don't know 2.1 1.9 2.0 Total 100.0 100.0 100.0 Number of women 2,092 2,315 4,408 Nonusers who said that they d/d intend to use family planning in the future were asked which method they preferred to use (see Table 4.12). Most of these women said they preferred to use either the pill (30 percent) or injection (24 percent), while almost one-quarter (23 percent) were unsure which method they might use. Women who intend to use in the next 12 months are more likely to know which method they prefer to use and strongly favour the pill, while women who intend to use after 12 months are more likely to say they are unsure of which method they might use. 51 Table 4.12 Preferred method of contraception for future use Percent distribution of currently married women who are not using a contraceptive method but who intend to use in the future by preferred method, according to whether they intend to use in the next 12 months or later, Nigeria 1990 Intend to use In next After Preferred method 12 12 of contraception months months Total Pill 34.0 24.2 29.7 IUD 6.2 4.4 5.5 Injection 26.7 21.2 24.3 Foaming tablets 0.3 0.3 0.3 Diaphragm/foam/jelly 1.1 0.8 1.0 Durex/Condom 1.7 2.6 2.0 Female sterilisation 4.2 3.6 3.9 Rhythm 5.2 5.6 5.4 Withdrawal 1.8 2.2 2.0 Other 2.8 3.1 3.0 Unsure/Don't know 16.1 31.9 23.0 Total 100.0 100.0 100.0 Number of women 790 607 1.397 4.9 Approval of Family Planning All respondents in the NDHS were asked if they had heard a message about family planning on radio or television in the month preceding the survey. One in four women said they had heard a message, while three-quarters had not (see Table 4.13). The proportion of women who had heard family planning messages varied widely by background characteristics. One-half of women who live in urban areas or in the Southwest had heard messages, compared to less than 20 percent of women living in rural areas or in regions other than the Southwest. More educated women were also much more likely to have heard a family planning message on radio or television than their less educated counterparts. 52 Table 4.13 Family planning messages on radio and television Percent disuributinn of all women by whether they have heard a family planning message on radio or on television in the month preceding the survey, according to selected background characteristics, Nigeria 1990 Heard family planning message on radio or on television Number Background of characteristic No Yes Total women Residence Urban 50.2 49.8 100.0 2,187 Rural 83.8 16.2 t00.0 6,594 Region Northeast 84.7 15.3 100.0 2,000 Northwest 80.1 19.9 100.0 2,098 Southeast 79.5 20.5 100.0 2,769 Southwest 54.5 45.5 100.0 1,915 Education No education 84.5 15.5 100.0 5,020 Some primary 78.8 21.2 100.0 794 Completed primary 66.8 33.2 100.0 1,300 Some secondary 58.8 41.2 100.0 765 Completed secondasy/higher 48.2 51.8 100.0 894 Total 75.4 24.6 100.0 8,781 Table 4.14 presents results from a question on whether women believe it acceptable or not acceptable to air family planning messages over radio or television. Just over half the women interviewed said that such messages are acceptable to them. 3 The proportion of women who think family planning messages are acceptable varies little according to the age group of the woman; only those age 45 -49 are slightly less likely to find such messages acceptable. However, there are strong differences in the acceptability of family planning messages by background characteristics. Women living in urban areas or in the Southwest, as well as more educated women are much more likely to accept family planning messages on radio or television than other women. Although not shown in Table 4.14, 30 percent said that it was not acceptable and 14 percent had no opinion. 53 Table 4,14 Acceptability of the use of mass media for disseminating family planning messages Pen~entage of women who believe that it is acceptable to have messages about family planning on radio or television, by age and selected background characteristics, Nigeria 1990 Age of woman Background ~:hasacteristie 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Total Residence Urban 74.0 81.4 80.9 75.1 74.6 71.8 63.7 76.4 Rural 49.3 50.5 51.7 47.4 48.8 52.1 43.1 49.4 Region Northeast 37.4 38.4 38.1 35.6 39.2 38.4 24.7 36.7 Northwest 32.6 40.1 42.6 37.6 29.5 37.8 31.0 37.2 Southeast 67.4 71.3 72.6 67.5 61.2 64.2 59.0 67.4 Southwest 76.6 86.0 85.0 78.3 81.2 81.2 72.2 80.8 Education No education 28.9 31.9 39.9 42.9 42.8 47.2 40.9 39.6 Some primary 56.9 69.0 66.3 75.9 78.1 88.8 78.2 70.3 Completed primary 64.7 69.1 76.3 75.9 86.2 84.6 80.9 72.9 Some secondary 75.3 83.5 91.6 84.5 94.0 96.6 100.0 81.6 Completed secondary/higher 85.4 89.4 91.1 93.1 97.9 94.4 73.5 89.8 Total 56.4 59.1 59.1 53.9 54.7 56.2 46.9 56.1 An indication of the acceptability of family planning is the extent to which couples discuss the topic with each other. Table 4.15 indicates that 41 percent of married women who know a contraceptive method had discussed family planning with their husbands in the previous year. Most of these women had discussed Table 4.15 Discussion of family planning by couples Percent distribution of currently married women who know a contraceptive method by the number of times family planning was discussed with husband in the year preceding the survey, according to current age, Nigeria 1990 Age Number of times family planning discussed Number Once or Three Not of Never twice or more ascenained Total women 15-19 69.7 22.4 6.9 0.9 100.0 189 20-24 62.0 26.4 11.4 0.3 100.0 580 25-29 57.9 25.0 16.6 0.5 100.0 735 30-34 55.2 25.2 19.2 0.5 100.0 587 35-39 54.4 23.4 20.9 1.3 100.0 397 40-44 53.0 20.2 23.6 3.2 100.0 32l 45-49 60.7 18.0 19.1 2.2 100.0 191 Total 58.1 24.0 17.0 1.0 100.0 2,999 54 the topic only once or twice with their husbands, but a substantial proportion had discussed family planning more often. Older women---except those age 45-49--are more likely to have discussed family planning with their husbands in the previous year than am younger women. To obtain more direct information about the acceptability of family planning, respondents were asked if they approved or disapproved of couples using a method to avoid pregnancy. Although all women were asked this question, the data presented here is restricted to currently married women and excludes those women who had never heard of a contraceptive method. Currently married women were also asked if they thought that their husbands approved of the use of family planning. It should bc noted that wives' opinions of their husbands' attitudes may bc incorrect, either bccanse they have misconstrued their husbands' truc attitudes, or because of a tendency to report their husbands' attitudes as similar to their own. Table 4.16 presents results from these two questions. Table 4.16 Attitudes of couples toward family plarming Among currently married women who know a conU'aceptive method, the percentage who approve of family plmming, by their perception of their husband's attitude and selected background characteristics, Nigeria 1990 Respondent approves mid: Both Husband's Number Background Respondent partners Husband attitude of characteristic aplxoves approve disapproves is unknown women Age 15-19 57.4 30.4 11.0 16.1 189 20-24 67.8 42.6 11.7 13.3 580 25-29 72.5 45.8 10.7 15.5 735 30-34 74.6 45.4 13.8 14.8 587 35-39 73.5 45.3 15.0 12.5 397 40M4 70.9 36.5 16.5 14.8 321 45-49 69.4 46.2 8.5 12.5 191 Residence Urbea 77.5 51.2 12.8 12.7 1,039 Rural 67.2 38.8 12.4 15.2 1,961 Region Northeast 62.6 39.0 10.9 I 1.8 444 Northwest 54.2 34.5 6.2 13.4 589 Southeast 75.3 43.8 12.4 18.1 1,020 Southwest 80.1 49.6 17.5 12.0 947 Education No education 59.4 32.3 11.7 14.7 1,344 Some primary 71.0 38.4 14.7 16.5 375 Completed primary 77.4 49.6 12.7 14.3 612 Some seonndm7 83.6 51.3 16.3 15.0 269 Completed second~/higher 89.9 68.3 10.7 10.5 398 Total 70.8 43.1 12.6 14.3 2,999 55 Overall, 71 percent of married women who know a contraceptive method approve of family planning. Forty-three percent of women say that their husbands also approve of family planning; only 13 percent say that they approve of family planning and their husbands do not. Approval of family planning by married women shows little variation by age of the woman, except that women age 15-19 are less likely to approve than older women. Married women (as well as their husbands) who live in urban areas, in the Southwest or the Southeast, and those who are better educated, are more likely than other women to approve of the use of family planning. 56 CHAPTER 5 PROXIMATE DETERMINANTS OF FERTILITY This chapter addresses the principal factors, other than contraception, which affect a woman's risk of becoming pregnant: nuptiality and sexual intercourse, postpartum amenorrhoea and abstinence from sexual relations, and secondary infertility. While it is by no means exact, marriage is an indicator of exposure of women to the risk of pregnancy, and is therefore important for the understanding of fertility. Populations in which age at marriage is low also tend to experience early childbearing and high fertility; hence the motivation to examine trends in age at marriage. This chapter also includes more direct measures of the beginning of exposure to pregnancy and the level of exposure: age at first sexual intercourse and the frequency of intercourse. Measures of other proximate determinants of fertility are the durations of postpartum amenorrhoea and postpartum abstinence and the level of secondary infertility. 5.1 Marital Status Current marital status at the time of the survey is shown in Table 5.1. The term "married" refers to legal or formal marriage, while "living together" refers to informal unions. In subsequent tables, these two categories are combined and referred to collectively as "currently married" or "currently in union." Women who are widowed, divorced, and not living together (separated) make up the remainder of the "ever-married" or "ever in union" category. Table 5.1 Current marital status Percent distribution of women by current marital status, according to age, Nigeria 1990 Marital status Number Never Living Not living of Age married Married together Widowed Divorced together Total women 15-19 61.4 34.0 3.0 0.3 0.7 0.6 100.0 1,612 20-24 21.7 70.8 5.5 0.5 0.7 0.8 100.0 1,676 25-29 7.9 81.5 7.9 1.0 0.7 0.9 100.0 1,669 30-34 0.9 84.9 10.8 1.4 1.4 0.7 100.0 1,410 35-39 1.2 83.7 9.8 3.7 0.5 1.1 100.0 954 40-44 0.3 77.7 9.8 7.8 2.8 1.7 100.0 836 45-49 0.1 78.7 8.2 10.3 1.8 0.8 100.0 624 Total 17.2 70.9 7.4 2.4 1.1 0.9 100.0 8,781 57 Most women are currently in a union (78 percent). The NFS, which also defined marriage to include both formal and informal unions, reported a similar figure (80 percent of women were in a union at the time of the survey). Although the great majority of women are in a union, a fair proportion enter their twenties having never been married (22 percent of women age 20-24 years). As expected, the proportion of women who are widowed increases with age, reaching 10 percent among those 45-49 years. Two percent of women are divorced or separated. 5.2 Polygyny Since polygyny is common in Nigeria, married women were asked whether their husbands had other wives, and if so, how many. Overall, 41 percent of currently married women are in a polygynous union. 1 Table 5.2 indicates that polygyny exists in all regions and among all socioeconomic groups, although prevalence varies. Rural women and women in the North are more likely than urban women and women in the South to be in such unions. Nearly one-half of women who have no education are in a polygynous union, compared to 17 percent of those who have completed secondary school. Table 5.2 Polygyny Percentage of currently married women in a polygynous union, by age and selected background characteristics, Nigeria 1990 Age of woman Background All characteristic 15-19 20-24 25-29 30-34 35-39 40-44 45-49 ages Residence Urban 22.6 26,0 27.4 34.5 39.3 51.5 45.6 33.6 Rural 27.8 35.8 38.2 51.1 49.6 45.5 55.1 42.9 Region Northeast 25,8 34.5 46.5 51.1 50.8 52.5 54.3 43.6 Northwest 31,0 44.1 43.8 62,3 57,0 50.4 65.8 49.7 Southeast 24.3 26.0 21.7 34.0 36.1 38,8 37.6 30.4 Southwest 21.4 23.6 28.7 40.0 50,1 45.4 57,1 38.4 Education No education 32.0 42.0 43.8 54.0 53.0 48.8 56.3 47.8 Some primary 27,1 34.8 40.4 32.3 28,4 43.4 26.6 34.1 Completed primary 11.5 26.8 21.7 34.6 33,5 35,1 49,5 27.0 Some secondary 22.5 20.5 31.3 25.8 42.5 49.6 20,5 26.8 Completed secondary/higher 0.6 15.0 11.9 23.7 26.6 33.8 36.3 16.9 Total 27.0 33.7 35.6 47.3 47.3 46.8 53.4 40.9 ~ The NFS also reported a high incidence of polygyny: 43 percent of currently married women reported themselves to be in a polygynous union. 58 It is not uncommon for a woman to have two or more co-wives (see Table 5.3). In fact, in the Southeast, although most women are in a monogamous union (70 percent), more women have two or more co-wives (20 percent) than have one co-wife (10 percent.) The likelihood of having two or more co-wives increases with age, as more time passes in which the husband may acquire a younger wife. Women who are more educated are less likely to have a co-wife; 28 percent of women with no education have one co-wife, compared to 8 percent of those who have completed secondary or higher education. Table 5.3 Number of co-wives Percont distribution of currently married woman by number of co-wives, according to selected background characteristics, Nigeria 1990 Number of co-wives Number Background of characteristic 0 1 2+ Total women Age 15-19 73.0 15.7 11.3 100.0 597 20-24 66.3 22.5 11.1 100.0 1,279 25-29 64.4 21.4 14.1 100.0 1,492 30-34 52.7 28.5 18.8 100.0 1,348 35-39 52.7 22.0 25.3 100.0 892 40-44 53.2 23.1 23.3 100.0 731 45-49 46.6 26.3 27.1 100.0 543 Residence Urban 66.4 20.0 13.4 100.0 1,476 Rural 57.1 24.0 18.9 100.0 5,404 Region Northeast 56.4 26.0 17.6 100.0 1,849 Northwest 50.3 33.3 16.3 100.0 1,944 Southeast 69.6 10.2 20.1 100.0 1,801 Southwest 61.6 21.8 16.6 100.0 1,287 Educatlon No education 52.2 28.0 19.8 100.0 4,610 Some primary 65.9 16.0 18.0 100.0 594 Completed primary 73.0 14.4 12.6 100.0 911 Some secondary 73.2 12.6 14.2 100.0 322 Completed secondary/higher 83.1 7.9 8.4 100.0 438 Total 59.1 23.1 17.7 100.0 6,880 5.3 Age at First Marriage The National Policy on Population states that "Families shall be dissuaded from giving away their daughters in marriage before the age of 18 years." However, the NDHS indicates that half the women in Nigeria have married by age 17 (the median age nationally) and, except for the youngest cohorts, this pattern has remained stable over time (see Table 5.4). 59 Table 5.4 Age at first marriage Percentage of women who were first married by exact age 15, 18, 20, 22, and 25, and median age at first marriage, according to currant age, Nigeria 1990 Percentage of women who were first married by exact age: Current age 15 18 20 22 Percentage Median who had Number age at never of first 25 married women marriage 15-19 20.1 NA NA NA NA 61.4 1612 a 20-24 26.7 51.9 67.6 NA NA 21.7 1676 17.8 25-29 29.8 55.0 68.8 78.6 88.6 7.9 1669 17.2 30-34 29.8 62.5 76.0 85.7 93.7 0.9 1410 16.3 35-39 25.4 56.4 70.1 82.8 90.3 1.2 954 17.3 40-44 29.9 57.6 70.6 85.9 92.7 0.3 836 16.8 45-49 24.0 56.5 71.9 83.5 91.6 0.1 624 17.3 20-49 28.0 56.4 70.6 81.2 88.2 7.3 7169 17.1 25-49 28.4 57.7 71.5 82.8 91.2 2.9 5493 16.9 NA = Not applicable SOmitted because less than 50 percent of the women in the age group x to x+4 were first married by age x Cohort trends in age at marriage can also be described by comparing the cumulative distribution for successive age groups, as shown in Table 5.4. (For each cohort the accumulated percentages stop at the lower age boundary of the cohort to avoid censoring problems. For instance, for the cohort currently aged 20-24, accumulation stops with the percentage married by exact age 20). On a national scale, age at marriage has not changed appreciably over time. Only among the youngest women (15-24) has there been a slight shift from marrying during the mid-teen years to the later teen years. Whereas about 30 percent of women have typically married by age 15, only 20 percent of those currently age 15-19 years have married by age 15. Thus, the median age at marriage has increased by about one-half a year. The national picture masks quite variable marriage behaviour pattems; Table 5.5 gives a more detailed picture of the trends in the median age at marriage. It can be seen that the slight change observed at the national level has been achieved primarily through changes in the behaviour of women in the South. In the Southeast, the median age at marriage has increased by two years between the cohorts of women age 20-29 and 40-49; a similar increase appears to be taking place in the Southwest. There has been no clear change in behaviour among women in the North. Education is closely related to age at first marriage. The median age at first marriage increases steadily with education, from 15.7 among women with no education, to 20 for women with secondary schooling. 60 Table 5.5 Median age at first marriage Median age at first marriage among women age 20-49 years, by current age and selected background characteristics, Nigeria 1990 Current age Women Women Background age age characteristic 20-24 25-29 30-34 35-39 40-44 45-49 20-49 25-49 Residence Urban a 19.9 18.l 18.7 18.9 19.1 19.4 19.0 Rural 16.7 16.3 15.9 16.8 16.4 16.9 16.4 16,3 Region Northeast 14.8 14.9 15.1 15.4 15.3 15.7 15.2 15,2 Northwest 15.7 15.4 15.4 15.2 15.2 15.7 15.4 15.4 Southeast 19.4 19.3 18.2 18.1 17.3 17.4 18.5 18.3 Southwest a 20.5 18.6 19.7 20.1 19.5 a 19.7 Education No education 15.2 15.3 15.6 16.1 16.0 16.8 15.7 15.8 Some primary 17.3 16.7 17.3 18.2 18.9 18.8 17.8 18.0 Completed primary 18.0 18.8 19.1 19.5 19.2 20.1 18.7 19.1 Some secondary 19.8 20.3 19.6 20.5 19.2 20.6 20.0 20.2 Completed secondary/higher a 24.9 22.9 21.1 22.2 23.4 a 23.9 Total 17.8 17.2 16.3 17.3 16.8 17.3 17.1 16.9 Note: Medians are not shown for women 15-19 because less than 50 percent have married by age 15 in all subgroups shown in the table. aOmitted because less than 50 percent of the women in the age group were first married by age 20. 5.4 Age at First Sexual Intercourse While age at first marriage is commonly used as a proxy for exposure to intercourse, the two events do not coincide exactly. Women may engage in sexual relations prior to marriage, especially if they are postponing the age at which they marry. The NDHS asked women to state the age at which they first had sexual intercourse (see Tables 5.6 and 5.7). (Note that the information on age at first sexual intercourse in Tables 5.6 and 5.7 parallels the information on age at first marriage in Tables 5.4 and 5.5.) In many cases sexual activity precedes marriage (see Table 5.6). For example, by age 18, 63 percent of women have had intercourse, whereas only 56 percent have married; by age 20, 80 percent have had intercourse, while 72 percent have married. Overall, the median age at first sexual intercourse is just over 16 years, which is about three-quarters of a year earlier than the median age at marriage. Comparing cohorts, there has been little change over time. 61 Table 5.6 Age at first sexual intercourse Percentage of women who had first sexual intercourse by exact age 15, 18, 20, 22, and 25, and median age at f'trst intercourse, according to current age, Nigeria 1990 Current age 15 18 20 22 Percentage of women who had Percentage Median first intercourse by exact age: who Number age at never had of first 25 intercourse women intercourse 15-19 24.4 NA NA NA NA 45.6 1,612 a 20-24 29.7 63.0 82.5 NA NA 7.5 1,676 16.6 25-29 31.2 62.1 80.4 89.6 96.7 1.5 1,669 16.4 30-34 32.8 67.4 82.6 91.9 97.4 0.4 1,410 15.9 35-39 27.8 63.0 75.3 87.5 93.3 0.2 954 16.5 404-4 31.1 61.1 77.5 89.9 94.2 0.0 836 16.4 45-49 27.6 62.3 78.7 88.3 94.2 0.0 624 16.5 20-49 30.4 63.4 80.2 89.9 94.8 2.2 7,169 16.3 25-49 30.6 63.5 79.4 89.7 95.6 0.6 5,493 16.2 NA = Not applicable aOmitted because less than 50 percent of the women in the age group x to x+4 had had intercourse by age x I f women do not wait for marriage to become sexually active, has the increasing age at marriage in the Southeast and Southwest and among women with increasing education had any effect on reducing exposure to intercourse? Table 5.7 shows that while women in the Southeast and Southwest do indeed initiate sexual activity two to three years later than women in the Northeast and Northwest, they have been doing so for several decades. While age at marriage has been increasing, the age of initiating sexual relations has remained unchanged in the Southeast and Southwest. However, women with more education do tend to marry later (the median age at first marriage for the most educated women is eight years later than that of women with no education); but they do not delay sexual relations to the same degree that they delay marriage (the median among the most educated is 3,5 years later than for the least educated women). An urban-rural comparison shows similar results: while urban women have a median age at marriage three years later than rural women, their median age at first intercourse is only two years later. 62 Table 5.7 Median age at first intercourse Median age at first sexual intercourse among women age 20-49 years, by current age and selected background characteristics, Nigeria 1990 Current age Women Women Background age age characteristic 20-24 25-29 30-34 35-39 40-44 45-49 20-49 25-49 Residence Urban 17.9 17.8 17.4 17.6 17.8 18.3 17.8 17.7 Rural 16.0 15.9 15.7 16.1 16.1 16.0 15.9 15.9 Region Northeast 14.7 15.0 15.0 15.4 15.3 15.5 15.1 15.2 Northwest 15.5 15.3 15.3 15.1 15.3 14.9 15.3 15.2 Southeast 17.8 17.9 17.6 17.4 16.6 17.1 17.6 17.5 Southwest 18.4 18.5 17.9 18.7 18.9 18.4 18.4 18.5 Education No education 15.0 15.2 15.4 15.8 15.9 15.9 15.5 15.6 Some primary 16.6 16.3 16.8 17.8 18.3 18.3 17.1 17.3 Completed primary 17.3 18.2 18.3 18.5 17.9 18.9 18.0 18.2 Some secondary 18.1 18.1 19.1 18.5 17.8 20.1 18.3 18.4 Completed secondary/higher 18.9 19.0 20.0 19.2 18.5 20.0 19.0 19.2 Total 16.6 16.4 15.9 16.5 16.4 16.5 16.3 16.2 Note: Medians were not shown for women 15-19 because less than 50 percent had had intercourse by age 15 in all subgroups shown in the table. 5.5 Recent Sexual Activity In the absence of contraception, the probability of pregnancy is related to the frequency of intercourse. Thus, information on sexual activity can be used to refine measures of exposure to pregnancy. Only l0 percent of women interviewed in the NDHS had never had sexual intercourse. But not all women who have ever had intercourse are currently sexually active. Table 5.8 presents data on sexual activity, by background characteristics; the distributions are shown for women who have ever had intercourse. Women are considered to be sexually active if they had intercourse at least once in the four weeks prior to the survey. Women who arc not sexually active may be abstaining in the period following a birth, ormaybe abstaining forvariousother rcasons. Among women who have had sexualintercourse, 61 percent were sexually active in the month prior to the survey. Women who have never been in a union are just as likely to be sexually active as those who are in a union; however, they are not as likely to be postpartum abstaining (the main reason women in a union may not be sexually active). Approximately one-fifth of women in the South who have ever had sexual intercourse are currently abstaining for reasons other than being postpartum; this number is double that for women in the North. Compared to the Northeast (where three-quarters of women who have had intercourse are currently sexually active), only half of the women in the South are currently sexually active. As expected, women who arc using a method of family planning are more likely to be sexually active than those who are not. 63 Table 5.8 Recent sexual activity Percent distribution of women who have ever had sexual intercourse by sexual activity in the four weeks preceding the survey and the duration of abstinence by whether or not postpartum, according to selected background characteristics, Nigeria 1990 Not sexually active in last 4 weeks Sexually Abstaining Absta/ming active (postpartum) (not postpartum) Number Background in last of characteristic 4 weeks 0-1 years 2+ years 0-1 years 2+ years Missing Total women Age of mother 15-19 66.3 16.7 1.7 13.8 0.8 0.7 100.0 877 20-24 65.8 19.8 1.0 12,4 0.8 0.2 100.0 1,551 25-29 58.7 25.7 3.0 10.9 1.3 0.4 100.0 1,646 30-34 61.1 21.2 4.2 12.1 1.2 0.2 100.0 1,404 35-39 57.7 20.4 4.7 13.7 3.3 0.1 100.0 952 40-44 56.8 10.8 6.4 17.2 8.6 0.2 100.0 836 45-49 52.5 8.1 1.6 22.0 15.9 0.0 100.0 624 Duration of union 0-4 59.3 29.0 1.7 9.0 0.3 0.7 100.0 1,377 5-9 62.8 24.9 2.8 9.1 0.3 0.2 100.0 1,405 10-14 63.0 20.1 4.7 10.9 1.3 0.0 100.0 1,374 15-19 60.5 21.5 3.4 12.0 2.4 0.2 100.0 1,261 20-24 58.7 16.0 5.3 14.9 5.1 0.0 100.0 847 25+ 58.9 5.6 2.7 18.9 13.5 0.3 100.0 1,003 Never in union 58.5 3.1 0.9 33.0 4.0 0.6 100.0 623 Residence Urban 58.0 18.2 2.5 17.6 3.5 0.2 100.0 1,881 Rural 61.4 19.4 3.3 12.4 3.2 0.3 100.0 6,010 Region Northeast 74.6 14.8 1.7 7.5 1.1 0.4 100.0 1,920 Northwest 66.3 20.1 3.1 8.3 2.1 0.2 100.0 1,990 Southeast 52.0 19.9 3.7 18.8 5.5 0.2 100.0 2,349 Southwest 49.4 21.9 4.1 20.0 4.2 0.4 100.0 1,632 Education No education 63.1 18.0 3.8 11.1 3.7 0.2 100.0 4,878 Some primary 52.4 27.0 3.7 13.3 3.4 0.1 100.0 680 Completed primary 55.6 22.4 2.9 16.4 2.5 0.3 100.0 1,093 Some secondary 57.5 20.3 0.4 19.9 2.0 0.0 100.0 487 Completed secondary/higher 60.8 13.7 0.2 22.1 2.3 0.8 100.0 745 Current contraceptive No method 59.0 20.6 3.4 13.3 3.5 0.2 100.0 7,228 Pill 79.6 2.4 0.0 16.4 1.1 0.5 100.0 121 IUD 85.1 0.7 1.6 11.2 1.4 0.0 100.0 65 Injection 84.7 3.8 0.0 11.5 0.0 0.0 100.0 61 Durex]Condom (81.6) (2.6) (0.0) (15.7) (0.0) (0.0) 100.0 46 Other modern (76.3) (4.5) (3.1) (12.7) (3.3) (0.0) 100.0 37 Other 74.1 3.8 0.2 20.4 0.4 1.1 100.0 331 Total 60.6 19.1 3.1 13.6 3.3 0.3 100.0 7,891 64 5.6 Postpartum Amenorrhoea, Abstinence, and Insusceptibility Postpartum protection from conception can be prolonged by breastfeeding, which can lengthen the duration of amenorrhoea (the period following a birth, but prior to the return of menses). Protection can also be prolonged by delaying the resumption of sexual relations. Table 5.9 presents the percentage of births whose mothers are postpartum amenorrboeic and abstaining, as well as the percentage of births whose mothers are defined as still postpartum insusceptible for either reason, by time since the last birth. Table 5.9 Postpartum amenorrhoea) abstinence mad insusceptibility Percentage of births whose mothers are postpartum amanorrhoeic, abstaining and insusceptible, by number of months since birth, and median and mean durations, Nigeria 1990 Number Months Amenor- Imus- of since birth rhoeie Abstaining ceptible births <2 93.7 95.9 98.5 267 2-3 89.2 89.5 95.8 283 4-5 82.8 74.7 93.3 307 6-7 76.8 61.2 85.7 352 8-9 72.6 58.4 84.6 303 10-11 64,0 51.3 74.8 210 12-13 57.4 44.4 73.0 317 14-15 44.6 33.4 58.1 294 16-17 48.9 40.7 59.8 295 18-19 41.0 31.4 52.2 232 20-21 27,0 30.0 45.2 216 22-23 22.6 21.7 32.0 168 24-25 12.1 17.9 26.0 315 26-27 7.9 10.4 14.9 300 28-29 8.6 9.3 13.0 265 30-31 7.4 8.8 13.7 245 32-33 4.2 10.8 12.8 212 34-35 14.2 16.4 20,0 222 Total 45.3 40.9 55.2 4,802 Median 14.6 10.8 19.0 Mean 15.8 14.4 19.3 Prevalence/Incidence Mean 16.1 14.5 19.6 Three-quarters of Nigerian women remain amenorrhoeic for at least six months following a birth; most women abstain from sexual relations during this time. However, about 12 months later (about 18 months al~er birth), fewer than half the women are still amenorrhoeic (41 percent), and fewer than one-third (31 percent) are still abstaining. Overall, 50 percent of women become susceptible to pregnancy within 19 months of giving birth. 65 Table 5.10 shows the median durations of insusceptibility by background characteristics of the mothers. As will be seen in Chapter 8, duration of breastfeeding (which is linked to amenorrhoea) decreases as the education level of the mother increases. As a result, the duration of amenorrhoea for educated women is shorter too. Whereas the median for women with no education is one and a half years, it is less than nine months for women with secondary or more schooling. Women are more similar to each other in their durations of abstaining than their durations of amenorrhoea. The median duration of abstinence is between 10 and 11 months. Table 5.10 Median duration of postpartum insusceptibility by background characteristics Median number of months of postpartum umenorrhoea, postpartum abstinence, and postpartum insusceptibility, by selected background characteristics, Nigeria 1990 Postpartum Number Background Postpartum Postpartum insuscep- of characteristic amenorrhoea abstinence tibility women Age <30 13.8 9.5 17.3 2,856 30+ 16.2 11.5 21.0 1,946 Residence Urban 12.0 11.6 15.1 998 Rural 16.4 10.6 19.9 3,804 Region Northeast 19.5 10.9 21.2 1,214 Northwest 17.1 7.8 19.9 1,311 Southeast 12.0 11.0 15.9 1,395 Southwest 13.2 12.7 17.0 883 Education No education 18.2 10.6 21.0 2,972 Some primary 15.1 12.7 20.0 495 Completed primary 12.1 10.9 15.2 728 Some secondary 7.9 8.5 16.3 279 Completed secondary/higher 8.5 8.3 10.2 323 Total 14.6 10.8 19.0 4,802 Note: Medians ere based on current status. 5.7 Termination of Exposure to Pregnancy Later in life, the risk of pregnancy begins to decline with age, typically beginning around age 30. While the onset of infecundity is difficult to determine for any individual woman, there are ways of estimating it for a population. Table 5.11 presents indicators of decreasing exposure to the risk of pregnancy for women age 30 and above. 66 The first indicator, menopause, includes women who are neither pregnant nor postpartum amenorrhoeic, but have not had a menstrual period in the six months preceding the survey. Forty-one percent of the oldest women interviewed are menopausal. The second indicator of infecundity is obtained from a demonstrated lack of fertility. If a woman was continuously married for the five years preceding the survey, did not use contraception, and did not give birth in that time (nor is currently pregnant), she is considered terminally infertile. By the early forties, about half the women appear to be terminally infertile. The last indicator is long-term abstinence, which is the percentage of currently married women who did not have intercourse in the last three years. This percentage is fairly low, except among the oldest women. Table 5.11 Termination of exposure to the risk of pregnancy Indicators of menopause, terminal infertility and long-term abstinence among currently married women age 30-49, by age, Nigeria 1990 Terminal Long-term Age Menopause I infertility 2 abstinence 3 30-34 2.3 16.1 1.4 35-39 3.1 26.5 2.7 40-41 12.2 49.9 4.8 42-43 11.6 46.9 4.7 44~15 24.5 59.3 6.0 46-47 19.3 67.5 5,1 48-49 40.7 83.1 l 1.9 Women 30-49 10.6 33.7 3.4 1Percentage of non-pregnant, non-amenorrhoeic currently married women whose last menstraal period occurred six or more months preceding the survey or who report that they are menopausal. 2percentage of currently married women in their first onion of five or more years who have never used contraception and who did not have a birth in the five years preceding the survey and who are not pregnant. 3Percentage of currently married women who did not have intercourse in the three years preceding the survey. 67 CHAPTER 6 FERTILITY PREFERENCES In the NDHS several questions were asked to ascertain womens' fertility preferences: their desire to have another child, the length of time they wanted to wait before having that child, and the number of children they considered to be ideal. These data make the quantification of fertility preferences possible, and in combination with information on contraceptive use allows us to estimate the demand for family planning, either to space or to limit births. These questions were asked of nonsterilised, currently married women; and the question to ascertain ideal family size was asked of all women. 6.1 Desire for More Children Women were asked: "Would you like to have mother child or would you prefer not to have any more children?" If they did indeed want another child, they were asked: "How long would you like to wait from now before the birth of another child?" These questions were appropriately phrased if the woman had not yet had any children, and if the woman was pregnant, she was asked about her desire after the baby she was expecting. Figure 6.1 shows the percent distribution of currently married women by their fertiIity preferences and Table 6.1 shows the distribution according to the number of living children. Overall, 64 percent of women want another child, but 33 percent want to wait two or more years before having that child. Fifteen percent do not want any more children at all. Not surprisingly, the desire for more children declines Figure 6.1 Fertility Preferences among Currently Married Women 15-19 Want Ch i ld Wi th in 2 yre 31% Undecided 14% Want No More 15~ Mis_ . . . _. Infecund 4% NDHS1990 69 Table 6.1 Fertility preference by number of living children Percent distribution of currently married women by desire for more children, according to number of living children, Nigeria 1990 Desire for Number of living children l children 0 1 2 3 4 5 6+ Total Have another soon 2 60.4 38.9 37.9 30.1 23.5 21.1 15.2 31.2 Have another later ~ 8.3 45.1 40.1 39.5 35.2 30.5 19.3 32.8 Have another, undecided when 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Undecided 14.5 7.9 11.0 14.0 17.1 17.2 16.0 13.6 Wants no more 1.4 3.2 5.0 8.6 16.7 23.6 43.4 15.1 Sterilised 0.0 0.1 0.1 0.2 0.2 0.4 0.9 0.3 Declared Infeeund 11.8 2.8 3.8 4.1 4.0 4.0 3.6 4.4 Missing 3.5 2.0 2.1 3.4 3.3 3.1 1.5 2.6 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number of women 612 1,168 1,144 1,113 928 735 1,181 6,880 llncludes current pregnancy 2Wants next birth within 2 years ~Wanls to delay next birth for 2 or more years Table 6.2 Fertility preferences by age Percent distribution of currently married women by desire for more children, according to age, Nigeria 1990 Desire for Age of woman children 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Total Have another soon 1 38.3 39.6 32.8 30.0 29.4 23.l 15.7 31.2 Have another later 2 47.7 43.9 42.9 31.7 23.8 12.5 7.1 32.8 Have another, undecided when 0.1 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Undecided I0.3 9.8 12.6 17.6 15.4 17.6 11.0 13.6 Wants no more 1.4 2.7 6.9 14.5 23.4 32.7 45.9 15.1 Sterilised 0.0 0.0 0.1 0.1 0.4 1.4 0.5 0.3 Declared Infecund 0.6 1.2 1.5 2.8 5.3 11.6 17.0 4.4 Missing 1.7 2.7 3.2 3.3 2.3 1.1 2.8 2.6 Total 100.0 100.0 I00.0 100.0 100.0 100.0 I00.0 100.0 Number 597 1.279 1,492 1,348 892 731 543 6,880 lWants next birth within 2 years ZWants to delay next birth for 2 or more years noticeably as the number of living children increases. Thus, 60 percent of women with no living children want to have a child soon (within the next two years), whereas only 15 percent of women with 6 or more living children want a child soon. Conversely, among women with no living children, only one percent declare not wanting any children, and 43 percent of women who have six or more children no longer want any more. This indicates a considerable interest in controlling fertility, and therefore a potential demand for family planning services, among women with many children. In the category of women with six or more children, those who either want to space or to limit their births total more than 60 percent. 70 The percent distribution of currently married women by desire for children, according to age is shown in Table 6.2. The desire to limit bi~as increases rapidly with age; only one percent of women age 15-19 want no more children, while 46 percent of those age 45-49 years want to stop childbearing. The desire to stop childbearing varies greatly by background characteristics of the respondent (see Table 6.3). Overall, the percentage of women who want no more children is twice as high in the Southeast and Southwest (22 and 23 percent) as it is in the Northeast and Northwest (9 and 10 percen0. The percentage of women wanting no more children is positively associated with education. Among women with four children, the desire to stop having children is much more common for women with the highest level of education (37 percent) than for women with no education (15 percent). Table 6.3 Desire to limit (stop) childbearing Percentage of currently married women who want no more children, by number of living children and selected background characteristics, Nigeria 1990 Number of living children 1 Background cheraeteristic 0 1 2 3 4 5 6+ Total Residence Urban 0.0 2.7 5,5 11.4 27.5 32.8 51.8 20,5 Rural 1.8 3.4 4.9 8.1 13,6 21.4 42.1 14.0 Region Northeast 2.3 3.6 4,5 4.3 10.0 17.6 31.5 9.2 Northwest 1.2 2.8 5,8 11.0 11.5 21.0 24.1 10.1 Southeast 0.6 4.2 4.5 10.4 19.3 26.6 52.8 21.8 Southwest 0.0 2.4 5.5 9.6 27.8 29.6 60.1 23.4 Education No education 1.8 3.8 4.1 8.3 14.8 19.9 37.4 13.9 Some primary 0.0 2.9 4.3 3.8 16.0 22.0 55.6 20.6 Completed primary 1.0 0.5 9.6 11.9 19.2 35.9 63.0 20.0 Some secondary 0.0 4.5 1.8 5.5 15.3 45.2 56.3 11.9 Completed secondarflhigher 0.2 3.4 6.3 16.9 37.4 54.9 97.4 17.6 Total 1.4 3.3 5.1 8.8 16.9 24.0 44.3 15.4 Note: Women who have been sterilised are considered to want no more children. llncludes current pregnancy 6.2 Demand for Family Planning Services Women who are currently married, and who declare either that they do not want to have any more children (they want to limit their childbearing) or that they want to wait two or more years before having another child (they want to space their births), but are not currently using contraception, have an unmet need for family planning. 1 Women with unmet need and those currently using contraception constitute the total demand for family planning (see Table 6.4). 1 The calculation of unmet need, being a current status measure, is further refined by excluding women who are currently amenorrheeic (nearly 30 percent of women) and, therefore, not in need of family planning at this point in time. For an exact description of the calculation, see footnote 1, Table 6.4. 71 Fertility desires are high in Nigeria, so the total demand for family planning is relatively low, 27 percent of currently married women. Table 6.4 indicates that the demand for family planning is highest among the most educated women: 47 percent 0f those who have completed secondary school have a demand for family planning. Demand is greater in urban areas (37 percent) than in rural areas (24 percent); but only 40 percent of the demand in urban areas is satisfied. Table 6.4 Need for family' planning services Percentage of currently naarried women with unmet need for family planning, met need for family planning, and the total demand for far~ly planning services, by selected background characteristics, Nigeria 1990 Met need for Unmet need for family planning Total demand for Percentage farrfily planning ~ (currently using) 2 family planning of demand Background For For For For For For satis- characteristic spacing lirr~ting Total spacing lircfiting Total spacing limiting Total fled Age 15-19 15.7 0.3 16.0 1.3 0.0 1.3 17.0 0.3 17.3 7.7 20-24 13,6 1.0 14.6 4.7 0.4 5.1 18.3 1.4 19.7 26.0 25-29 13.2 2.9 16.1 5.3 0.7 6.0 18.5 3.6 22.1 27.3 30 34 12.1 6.0 18.1 3.7 2.8 6.5 15.8 8.8 24.6 26.5 35-39 11,2 12.7 23.9 2.9 5.8 8.7 14.1 18.4 32.6 26.8 40 44 6.1 23.7 29.7 0,8 7.6 8.4 6.9 31.2 38.1 22.0 45-49 4.1 39.3 43.4 0.4 4.2 4,6 4.5 43.4 47.9 9.6 Residence Urban 12.3 9.7 22.0 8.5 6.4 14.9 20.8 16.1 36.9 40.4 Rural 11.3 9.2 20.5 2.0 1.6 3.6 13.3 10.8 24.1 15.0 Re81on Northeast 14.4 6.5 20.9 1.0 1.0 2.0 15.4 7.5 22.9 8.8 Northwest 8.0 6.2 14.2 0.7 0.6 1.2 8.6 6.8 15.4 7.9 Southeast 13.1 13.2 26.3 5,1 3.8 9.0 18.2 17.0 35.3 25.4 Southwest 10.6 12.4 23.0 8.4 6.6 15.0 19.0 19.0 38.0 39.5 Education No education 10.0 9.8 19.8 1.0 1.0 2.0 11.0 10.7 21.8 9.1 Some primary 15.4 10.4 25.7 3.2 4.6 7.8 18.6 14.9 33.5 23.3 Completed prima~ 12.8 9.7 22.5 4.1 6.5 10.6 17.0 16.2 33.1 32.1 Some secondary 21.0 4.4 25.4 12.6 4.4 17.0 33.6 8.8 42.4 40.2 Completed secondary/higher 13.0 4.9 18.0 19.7 9.0 28.7 32.7 13.9 46.7 61.5 Total 11.5 9.3 20.8 3.4 2.7 6.0 14.9 11.9 26.8 22.5 IUnmet need for spacing refers to pregnant women whose pregnancy was mistimed, amenorrhoeic women whose last birth was mistimed, and women who are neither pregnant nor amenorrhoeic and who are not using any method of family planning and who say they want to wait two or more years for their next birth. Unmet need for limiting refers to pregnant women whose pregnancy was unwanted, amenorrhoeic women whose last child was unwanted, and to women who are neither pregnant nor amenorrhoeic and who are not using any method of family planning and who want no more children. Also excluded are menopausal and infecund women, defined in Footnotes 1 and 2 in Table 5.11. 2Using for spacing refers to women who are using some method of family planning and who say they want to wait two or more years for their next child, Using for limiting refers to women who are using and who want no more children. 72 For the great majority of women, the need for family planning is not fulfilled (more than three- quarters of the total demand is unsatisfied). Although the unmet need for spacing and for limiting purposes is very low (12 and 9 percent of currently married women), younger women are more likely to need family planning for spacing purposes (16 percent), and older women for limiting purposes (39 percent). The data show that even the moderate demand for family planning that currently exists in Nigeria remains mostly unfulfilled. Large differences in need for family planning exist between regions. Even the low demand extant in the Northeast (23 percent) and Northwest (15 percent), is not fulfilled (less than 10 percent of demand is satisfied). In the Southeast and Southwest, 35 and 38 percent of demand is satisfied, respectively. The most educated women have the highest proportion of demand satisfied (62 percent). 6.3 Ideal and Actual Number of Children In order to ascertain what women consider to be the ideal number of children, they were asked: "If you could go back to the time you did not have any children and could choose exactly the number of children to have in your whole life, how many would that be?" Table 6.5 indicates that the idea of conscious reproductive choice is largely unknown to a large proportion of women. Sixty-one percent of women gave non-numeric responses. Such a high proportion of non-numerical responses is unusual, even for African countries. 2 In most cases, women indicated that the number of children they would have is "up to God." Table 6.5 Ideal number of chil&en Pereant distribution of all women by ideal number of children and mean ideal number of children for all women and for eurrantiy married women, according to number of living children, Nigeria 1990 Number of living children I Ideal number of children None 1 2 3 4 5 6+ Total 0 0.0 0.1 0.0 0.1 0.0 0.0 0.1 0.0 1 0.3 0.5 0.1 0.0 0.0 0.0 0.0 0.1 2 1.4 0.5 1.1 0.2 0.4 0.6 0.5 0.8 3 3.8 2.9 1.0 1.2 0.5 0.9 0.8 1.9 4 18.6 10.3 11.4 5.6 9.6 3.0 2.9 10.0 5 13.4 6.9 8.8 7.4 8.2 8.9 2.8 8.5 6+ 15.3 14.3 12.9 17.0 19.2 23.7 26.2 17.8 Non-numeric response 47.2 64.6 64.7 68.5 61.9 62.8 66.8 60.8 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number of women 2,083 1,290 1,194 1,166 986 784 1,278 8,781 Mean ideal number 5.0 5.5 5.7 6.1 6.1 7.0 7.2 5.8 Number of women 1101 457 422 367 375 292 425 3438 Mean for women in union 5.5 5.6 5.7 6.1 6.0 7.1 7.2 6.2 Number of women in union 157 381 401 348 345 265 385 2,284 Note: The means exclude women who gave non-numeric responses. 1Includes eu~ent pregnancy 2 For instance, in Liberia, Mali and Morocco, countries which show the highest proportions of non-numeric responses in DHS sma, eys, at most one-quarter of all women gave this type of response. 73 Because the majority of women gave a non-numeric response, the means shown in Table 6.5 should be interpreted with caution. They do not represent the preferences of all women, but only of those that gave a numeric answer (39 percent of women). Given that urban and more educated women are more likely to give numeric answers, it is probable that these means are biased downwards and, as a result, the ideal number of children for all women is underestimated. Table 6.5 shows an association between the ideal number of children and the number of living children. The ideal number is 5 among childless women and 7 among women with 5 or more children. The reason for this is twofold. On the one hand, women may successfully attain their desired family size, and consequently those who want more children have more. On the other hand, women may rationalize and adjust their ideal number of children to the actual number of children they have had. Table 6.6 presents the mean ideal number of children by age and selected background characteristics of the respondents. Typically, urban and more educated women have a smaller ideal family size. Thus, among women with no education the mean ideal number of children is 6.9, and gradually decreases to 4.6 among the highest educated women. In urban areas, the mean ideal number of children is 5, compared to 6.3 in rural areas. The difference between regions is also significant, the ideal family size being about one child larger in the Northem regions than in the Southern regions. Table 6.6 Mean ideal number of children by background characteristics Mean ideal number of children for all women, by age and selected background characteristics, Nigeria 1990 Age of woman Background characteristic 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Total Residence Urban 4.7 4.6 4.9 5~7 5.4 6.2 6.2 5.0 Rural 5.6 5.8 6.2 6.8 6.5 7.3 7.3 6.3 Region Northeast 6.2 6.5 6.8 7.0 6.6 6.7 7.0 6.6 Northwest 5.5 6.5 6.8 7.4 5.6 7.0 10.1 6.7 Southeast 5.3 5.3 5.7 6.3 6.5 7.6 6.8 5.9 Southwest 4.7 4.6 4.6 5.9 5.5 6.2 6.0 5.0 Education No education 6.0 7.1 6.9 7.1 6.5 7.4 7.3 6.9 Some primary 5.9 5.5 5.4 6.5 6.1 7.2 5.8 6.1 Completed primary 5.4 5.5 5.8 6.4 6.0 6.7 6.7 5.8 Some secondary 4.9 4.8 5.5 5.3 4.9 5.8 5.5 5.0 Completed secondary/higher 4.8 4.5 4.6 4.7 5.1 5.0 5.4 4.6 Total 5.3 5.3 5.7 6.5 6.1 7.0 7.0 5.8 74 6.4 Fertility Planning Since the issue of mistimed and unwanted fertility is an important one, the NDHS asked whether each birth in the five years preceding the survey was planned (wanted then), unplanned (wanted later), or not wanted at all (wanted no more). The responses give an indication of the degree to which couples are successfully controlling their fertility. These data are likely to be underestimates because women with unplanned or unwanted births may rationalize such births anti declare them as wanted once they are bom. Table 6.7 shows that 87 percent of births in the last 5 years were wanted at the time they were conceived, while 8 percent were wanted later, and only 2 percent were not wanted at all. Four percent of the fourth or higher order births were not wanted, and 9 percent of births of this order were wanted, but at a later time. The proportion of births that were not wanted increases with mother's age at the time of the birth. Less than one percent of births to the youngest women were not wanted, compared to 14 percent of births to women age 45-49. Table 6.7 Fertility planning status Percent dislxibutinn of births in the five yeecs preceding the survey by fertility planning status, according to birth order and mother's age, Nigeria 1990 Planning status of birth Birth order Wanted Number and mother's Wanted Wanted no of age then later more Missing Total births Birth order 1 84.1 6.2 0.8 8.9 100.0 1,797 2 92.0 6.3 0.5 1.1 100.0 1,480 3 89.8 8.5 0.5 1.1 100.0 1,410 4+ 84.8 9.2 4.0 2.1 100.0 4,669 Age at birth <19 90.3 8.3 0.5 0.8 100.0 1,460 20-24 90.2 8.3 0.9 0.6 100.0 2.508 25-29 90.1 7.6 1.6 0.6 100.0 2,507 30-34 86.4 9.5 2.2 1.8 100,0 1,423 35-39 81.9 8.7 7.7 1.8 100.0 832 40-44 82,8 5.9 10.6 0,7 100.0 335 45-49 78.8 6.3 14.2 0.7 100.0 88 Total 86.6 8.1 2.3 3.1 100.0 9,356 Note: Birth order includes current pregnancy. The potential demographic impact of avoiding unwanted births can be estimated by calculating the wanted fertility rate. The wanted fertility rate is calculated in the same manner as the total fertility rate, but unwanted births arc excluded from the numerator. For this calculation, unwanted births are defined as those which exceed the number considered ideal by the respondent. (Women who did not report an ideal family size were assumed to want all their births.) This rate represents the level of fertility that would have prevailed in the three years preceding the survey if all unwanted births had been prevented. A comparison of the total wanted fertility rate and the actual total fertility rate suggests the potential demographic impact of the elimination of unwanted births. 75 Table 6.8 presents the total wanted fertility rate and the total fertility rate by background characteristics. In the first column, women who did not report an ideal family size are assumed to want all their births. Given the small proportion of unwanted births in Nigeria, the difference between the total wanted fertility rate (column 1) and the actual total fertility rate (column 3) is small. The actual total fertility rate is only three percent higher than the wanted rate (6.0 versus 5.8). This means that even if Nigerian women effectively controlled their childbearing, fertility rates would remain high, either because women still prefer large families, or because they are not familiar with the idea of conscious reproductive choice. However, since a large proportion of women gave nonnumerical responses to the question on ideal family size (nearly 60 percent of respondents said the number of children they would have is "up to God"), it is useful to look at the total wanted fertility rate for women who did specify an ideal family size (column 2). The total wanted fertility rate for women who did specify an ideal family size is 5 children. Table 6.8 Wanted fertility rates Total wanted fertility rates and total fertility rates for the three years preceding the survey, by selected background characteristics, Nigeria 1990 Total Total wanted wanted Total Background fertility fertility fertility characteristic rate rate 1 rate Residence Urban 4.8 4.3 5.0 Rural 6.1 5.5 6.3 Region Northe~t 6.2 6.4 6.5 Northwest 6.6 5.9 6.6 Southeast 5.2 4.8 5.6 Southwest 5.2 4.4 5.5 Education No education 6.3 6.1 6.5 Some primary 6.7 6.6 7.2 Completed primary 5.3 5.0 5.6 Some secondary 4.7 4.5 5.1 Completed secondary/higher 4.0 3.0 4.2 To~ 5.8 5.0 6.0 Note: Rates are based on births to women 15-49 in the period 1-36 months preceding the survey, The total fertility rates are the same as those presented in Table 3.1. ITFR among those women who reported an ideal family size. Excludes women who gave non-numerical responses to question on ideal family size. 76 CHAPTER 7 INFANT AND CHILD MORTALITY A demographic assessment of Nigeria's population would be incomplete without analysis of infant and child mortality rates. Such analysis can form the basis for informed decisions on health, as well as population, policies and programmes. This chapter presents information on levels, trends and differentials in neonatal, postneonatal, infant and child mortality. This information can be used for population projections and as a means of identifying those sectors of the child population that are at high risk. Information about infant and child mortality is also necessary for economic and health planning. Mortality estimates are calculated from information that was collected in the birth history section of the individual questionnaire. The section began with questions about the aggregate childbearing experience of respondents (i.e., the number of sons and daughters who live in the household, who live elsewhere, and who died). These questions were followed by a retrospective birth history in which data were obtained on sex, date of birth, survivorship status, and current age or age at death of each of the respondents' live births. The rates presented here are defined as follows: Neonatal mortality: Postneonatal mortality: Infant mortality: Child mortality: Under-five mortality: the probability of dying within the first month of life; the difference between infant and neonatal mortality; the probability of dying before the first birthday; the probability of dying between the first and fifth birthday; the probability of dying before the fifth birthday. The reliability of the mortality estimates is affected by the completeness of reporting deaths, the degree of differential displacement of birth dates of surviving and dead children, and the extent to which age at death is accurately reported. Heaping of age at death at 12 months in the NDHS was fairly common (see Appendix D, Table D.6). Also, interviewers at times recorded deaths at "1 year," even though instructions required them to record deaths under two years of age in months. An unknown fraction of these deaths may have actually occurred before the first birthday. Thus, the infant mortality rate may be biased downward somewhat and child mortality biased upward; under-five mortality would be unaffected. Yet, earlier simulation studies using DHS data from other countries indicate that while age at death misreporting is troublesome, the type and magnitude of that observed in the NDHS is unlikely to result in biases of more than 5 percent (Sullivan et al., 1990). The rates presented here are thus unadjusted; that is, all deaths reported at 12 months or "1 year" are assigned to the post-infant age period. It is seldom possible to establish, with confidence, mortality levels for a period more than 15 years before a survey? Even in the recent 15-year period considered here, apparent trends in mortality should be interpreted with caution. First, there may exist differences in the completeness of death reporting related to the length of time preceding the survey. Second, the accuracy of reports of age at death and of date of birth may deteriorate with time. Thus, without a detailed evaluation of the quality of birth history data (which is not attempted in this report), conclusions regarding changes in mortality should be considered preliminary. 1 Due to limitations of the data, rates for periods earlier than 15 years preceding the survey do not adequately represent all births. 77 7.1 Infant and Child Mortality In the five years preceding the survey, nearly 1 in 5 children died before their fifth birthday. Neonatal, postneonatal, infant, child and under-five mortality rates are shown in Table 7.1 for five-year periods in the 15 years preceding the survey. Under-five mortality over this period has fallen slowly from 201 deaths to 192 deaths per thousand live births. The small decline is largely attributable to a drop in the neonatal rate from 52 to 42 deaths per thousand live births; mortality between 1 and 59 months of age has shown no improvement over the period. The latter finding may reflect the offsetting effects of improved health services on the one hand, and the deteriorating economic position of the average Nigerian household, on the other. Overall, 87 of every 1,000 children born die before their first birthday, and 115 of every 1,000 children alive at age one year die before their fifth birthday. Table 7.1 Infant and child mortality Infant and child mortality rates by five-year periods preceding the survey. Nigeria 1990 Years preceding survey Neonatal Postneonatal Infant Child Under-five mortality mortality mortality mortality mortality (NN) (PNN) (lqo) (4ql) (sqo) 04 42.1 45.2 87.2 115.2 192.4 5-9 48.7 47.0 95.7 103.3 189.1 10-14 51.9 46.7 98.6 113.5 200.9 A comparison of NDHS and NFS data is given in Figure 7.1. Estimates for the overlapping period centred around 1977 suggests serious underreporting of deaths in the NFS, especially for children age 1-5 years. In sum, child survival has improved very little over the decade of the 1980s in Nigeria; the only encouraging sign is a small decline in mortality during the first month of life. An important finding of the NDHS involves the age pattem of under-five mortality. In most countries of the world, mortality during the first year of life exceeds that during the subsequent four years. However, this is not the case in Nigeria: child mortality (115/1000) is substantially higher than infant mortality (87/1000) in the 5-year period preceding the survey. The higher level of child mortality, relative to infant mortality, is a pattern found in other West African countries such as Mall and Senegal. 78 Figure 7.1 Trends In Infant and Under-five Mortality, NFS and NDHS Surveys Deaths per 1,000 b i r ths 25O 200 150 100 50 0 1962 i i J I i 1967 1972 1977 1982 1987 1991 . Inftnt mort. NFS -~-- Under-five NFS Note: The points shown ere the mid-points of five-year periods. Infant mort. NDH8 Under-five NDH8 79 Table 7.2 Infant and child mortality by background characteristics Infant and child mortality rates for the ten-year period preceding the survey, by selected background characteristics, Nigeria 1990 Neonatal Postneonatal Infant Child Under-five Background mortality mortality mortality mortality mortality characteristic (NN) (PNN) (lqo) (4ql) (sqo) Residence Urban 40,4 35.1 75.4 58.9 129.8 Rural 46,7 49.1 95.8 123.8 207.7 Region Northeast 39.2 48.5 87.7 139.2 214.6 Northwest 57.8 52.0 109,8 151.2 244.4 Southeast 38.6 44.1 82,7 66.5 143.7 Southwest 46.3 38.3 84,6 90.3 167.2 Education No education 48.4 47.5 95,9 126.4 210.1 Some primary 43.4 54.1 97,5 103.7 191.1 Completed primary 38.5 41.2 79,8 63.0 137.7 Some secondary 42.7 50.2 92,9 62.9 149.8 Completed secondary/higher 30.0 18.7 48.6 30.2 77.3 Medical maternity care No antenatal/delivery care 43.2 58.0 101.2 184.7 267,2 Either antenatal or delivery 34.5 37.2 71.7 106.4 170,4 Both antenatal & delivery 46.5 34.5 81.0 68.4 143,8 45.3 46.1 91.4 109.6 191,0 Total Table 7.2 presents neonatal, postoeonatal, infant, child and under-five mortality rates by selected background characteristics for the 10-year period (1981-1990) preceding the survey. A ten-year reference period is used to allow for adequate numbers of events in each population subgroup. Figures 7.2 and 7.3 show infant and child mortality rates by selected characteristics. The pattern of higher child mortality relative to infant mortality is most prominent in the Northeast and Northwest (see Table 7.2). ParticularlystrikingisthecomparisonoftheSoutheastandNortheast. While the two regions have similar levels of infant mortality, child mortality in the Northeast (139/1000) is more than double that in the Southeast (67/1000). The regional variation in the age pattem of under-five mortality may be explained by socioeconomic differentials (a topic which is beyond the scope of this report). It can be seen in Table 7.2 that high child mortality (relative to infant mortality ) is experienced by children born to mothers who are uneducated, who live in nJral areas, and who have limited access to basic health services. It would be expected that neonatal mortality would reflect the quality of care received during the antenatal and delivery period. Surprisingly, women who received the most care (both antenatal and delivery care) gave birth to babies who experienced higher neonatal mortality than babies born to women with less care. It may be that many of these women had complications which required medical attention at birth while uncomplicated pregnancies did not require medically assisted delivery. 80 Figure 7.2 Infant Mortality by Selected Characteristics RESIDENCE Urban Rural REGION Nor theast Nor thwest Southeast Southwest EDUCATION NO educ. Pr lm. Incomp. Prim. Comp, Sec. Incomp. Sec . IH igher Note: Based on deaths preced ing the survey. 7e 96 88 86 96 97 - 8O 49 0 20 In the 10 years 40 60 80 100 120 Deaths per 1,000 births 140 NDHS 1990 Figure 7.3 Child Mortality (1-4 years) by Selected Characteristics RESIDENCE Urban Rural REGION Nor theast Nor thwest Southeast Southwest EDUCATION NO educ. Prlm. Incomp. Prim. Comp. Sec, Incomp. Sec . IN igher Note: Based on deaths preced ing the survey. 69 124 - - 139 161 07 126 104 es 03 30 o 9o 40 0o 9o too 12o 14o Deaths per 1,000 in the 10 years 160 NDHS 90 8] Table 7.3 presents mortality rates for the ten years preceding the survey by selected demographic characterislics. Children born to the youngest and oldest mothers have higher mortality rates than do children born to mothers age 20-39 years; first born and high parity children also have higher neonatal mortality than children of birth orders 2-6. Shorter birth intervals are associated with higher mortality both during and after infancy. Children born less than two years after a previous birth are three times more likely to die during infancy than babies born four or more years after the previous birth. The birth interval effect appears most pronounced during the neonatal period, a pattern which is consistent with an explanation involving maternal depletion, the term used to describe the physical weakness of mothers associated with frequent childbearing. The DHS findings support the importance of child spacing for child survival. Table 7.3 Infant and child mortality by demographic characteristics Infant and child mortality rates for the ten-year period preceding the survey, by selected demographic characteristics, Nigeria 1990 Neonatal Posmoonatal Infant Child Under-five Demographic mortality mortality mortality mortality mortality characteristic (NN) (PNN) (tq0) (4ql) (sq0) Sex of child Male 49.0 44.7 93.7 117,6 200.2 Female 41.6 47.5 89.1 101.5 181,6 Age of mother at birth < 20 61.6 58.9 120.6 122.8 228.5 20-29 36.7 42.3 79.0 107.0 177.5 30-39 48.5 43.0 91.5 101.9 184.0 40-49 (68.5) (57.5) (126.0) (138.6) (247.2) Birth order 1 50.4 41.9 92.4 90.6 174.5 2-3 37.0 44.9 81.9 108.0 181.1 4-6 42.7 49.5 92.2 110.8 192.8 7+ 61.1 46.6 107.7 136.7 229.6 Previous birth Interval < 2 yrs 57.5 60.9 118.4 123.2 227.0 2-3 yrs 29.0 39.9 68.9 112.6 173.7 4 yrs + 16.9 21.8 38.7 54.9 91.5 Slze at blrth I Very small (93.2) (95.0) (188.2) (122.3) (287.4) Smaller than average 63.0 59.0 122.0 (185.5) (284.9) Average 30.4 35.3 65.7 120.6 178.4 Larger than average 21.2 49.4 70.6 (102.6) (166.0) Very large 49.0 37.4 86.4 (111.5) (188.2) Note: Rates based on fewer than 500 eases (exposed persons) are enclosed in ~Rarentheses. ates for the five-yesr period preceding the survey. Children who are very small or smaller than average at birth, as perceived by their mothers, experience higher mortality rates than children perceived to be average, larger than average, or very large. Since low birth weight is known to have a strong effect on early morbidity, it is not surprising that the most pronounced effect occurs during the neonatal period and diminishes with increasing age of the child. 82 7.2 High Risk Fertility Behaviour Infants and children have a greater probability of dying if they are born to mothers who are too young or too old, if they are bern after a short birth interval, or if they are of high parity (see Table 7.4). In this analysis, a mother is classified as "too young" if she is less than 18 years of age, and "too old" if she is over 34 years of age at the time of delivery, A "short birth interval" is defined by a birth occurring less than 24 months after the previous birth, and a child is of "high birth order" if the mother had previously given birth to three or more living children (i.e., if the child is of birth order 4 or higher). Children can be further cross- classified by combinations of these characteristics. First births, although often at increased risk, are not included in this analysis because they are not considered an avoidable risk. Column 1 in Table 7.4 shows the percentage of children born in the five years preceding the survey who are included in specific risk categories (due to mother's age, time elapsed since previous birth, or number of previous births). Two-thirds of children (68 percent) were at elevated risk as a result of the mother's fertility behaviour. Forty-two percent of children were at elevated risk due to one high risk characteristic (i.e., they were in a single risk category); an additional 25 percent had more than one high risk characteristic and were in a multiple risk category. Fourteen percent of births in the five years preceding the survey were to mothers who were over 34 years of age, and 8 percent were to mothers who were less than 18 years of age; one-quarter of the births occurred after an interval of 24 months or less; and half of all children were of birth order 4 or higher. In order to calculate the increase in risk attributable to fertility behaviour, risk ratios were calculated for each of the risk categories (see column 2, Table 7.4). A risk ratio is the ratio of the proportion of children in the category who have died, to the proportion who have died in the not in any risk category (children in the not in any risk category are bom to mothers age 18-34, bom at an interval of 24 months or more after the previous birth, and are parity 3 or less). Children in the multiple risk categories had nearly twice the risk of dying of children in the not in any risk category. Children born to mothers less than 18 years of age (and at no other risk) had a 30 percent greater chance of dying than the children in the reference category. Based on this brief analysis of high risk fertility behaviour, the question can be asked: how many women currently have the potential for having a high risk birth? This may be answered by simulating the distribution of currently married women by the risk category into which a currently conceived birth would fall. In other words, a woman's current age, time elapsed since last birth, and parity are used to determine into which category her next birth would fall, if she were to conceive at the time of the survey. For example, if a woman age 37, who has five children, and had her last birth three years ago were to become pregnant, she would fall into the multiple risk category of being too old (35 or older) and at too high a parity (4 or more children). Women who have the potential for a high risk birth can avoid experiencing the risk by using contraception to avoid the pregnancy (either to space or to limit the pregnancy, depending on which risk category she is in). To determine what proportion of women in the simulation have the potential for a high risk birth, it is assumed that all but sterilised women conceive. Two points emerge from this discussion. First, the percentage of estimated high risk births (in any category) will increase without some fertility control among women who share a high risk profile. This can be seen by comparing the proportion of women who currently have the potential for a high risk birth (79 percent) with the proportion of births in the five years preceding the survey that were classified as high risk (68 percent). Second, this increase in high risk births is linked to increases in the percentage of births in the multiple risk categories, from 25 to 44 percent of births. These findings pose a challenge to polieymakers and programme managers alike--to generate the demand for family planning and to improve the availability of contraceptive methods, so that high risk births can be avoided. 83 Table 7.4 High risk fertility bebevinur Percent dis~'ibution of children born in the five years preceding the survey who are at elevated risk of mortality, and the percent distribution of currently married women at risk of conceiving a child with an elevated risk of mortality, by category of increased risk, Nigeria 1990 Births in last 5 years preceding the survey Percentage of currently Risk Percentage Risk married category of births ratio women a Not In any risk category 32.3 1,00 20.9 b Single risk categories Mother's age < 18 7.0 1.31 2.7 Mother's age • 34 0.8 (0.26) 4.0 Birth interval < 24 7.6 1.07 9.3 Birth order • 3 26.9 1.05 19.0 Subtotal 42.3 1.08 35.0 Multiple risk categories Age <18 & birth interval <24 c 1.4 (3,98) 0.9 Age >34 & birth interval<24 0.1 (2.77) 0.1 Age >34 & birth order>3 10.4 1.47 22.6 Age >34 & birth interval <24 & birth order >3 2.6 1.67 5.9 Birth interval <24 & birth order >3 11.0 2.09 14.6 Subtotal 25.4 1.90 44.1 In any risk category 67.7 1.39 79.1 Total 100.0 NA 100.0 Number 8,118 NA 6,880 NA = Not applicable Note: Risk ratio is the ratio of the proportion dead of births in a specific risk category to the proportion dead of births not in any risk category. Figures in parentheses are ratios based on fewer than 200 cases. aWornen were assigned to risk categories according to the status they would have at the birth of a child, if the child were conceived at the time of the survey: age less than 17 years and 3 months, age older than 34 years and 2 months, latest birth less than 15 months ago, and latest birth of order 3 or ~gher. ncludes sterilised women CIncludes the combined categories Age <18 and birth order >3. 84 CHAPTER 8 MATERNAL AND CHILD HEALTH This chapter presents findings in three areas of importance to matemal and child health: maternal care and characteristics of the neonate, vaccinations, and common childhood illnesses and their treatment. Coupled with information on neonatal and infant mortality rates, this information can be used to identify subgroups of women whose live births are "at risk" because of nonuse of maternal health services, and to provide information to assist in the planning of appropriate improvements in services. Data were obtained for all live births which occurred in the five years preceding the survey. 8.1 Antenatal Care and Delivery Assistance Table 8.1 shows the percent distribution of births in the five years preceding the survey by source of antenatal care received during pregnancy, according to matemal and background characteristics. Interviewers were instructed to record all persons a woman may have seen for care, but in the table, only the provider with the highest qualifications is considered (if more than one person was seen). For over half (57 percent) of all births, mothers received antenatal care from a doctor, trained nurse, or midwife. For one-third (35 percent) of births, mothers received no antenatal care at all. Thus, most Nigerian women either rely on a doctor or nurse for antenatal care or receive no care at all. Women received antenatal care from a traditional birth attendant (TBA) for only 4 percent of births. There are marked differences in the sources of antenatal care for births in urban and rural areas. The concentration of doctors in urban areas probably accounts for the fact that most births to urban women received antenatal care from a doctor (61 percent), while only 30 percent of births to rural women received such care. In fact, 41 percent of rural births received no antenatal care, compared to 11 percent of urban births. There are several reasons why this may be so: rural women may not have access to antenatal care providers, or they may not be aware of the importance of antenatal care, or they may not be able to afford to pay for the care. Births to women in the Southwest are much more likely than births in other regions to receive antenatal care from a doctor: 58 percent compared to 27 to 35 percent in other regions. While the majority of births in the Southwest and Southeast receive antenatal care from a doctor, trained nurse, or midwife (86 and 65 percent), a birth in the Northeast or Northwest is as likely to have received antenatal care as not. Auxiliary midwives, village health workers, and traditional birth attendants provide antenatal care to a greater proportion of births in the Southeast than any other region. There is a strong association between education and receiving antenatal care. Births to women with no education are about as likely to receive some kind of care as not; whereas it is unlikely that a birth to a woman who has had some education will receive no antenatal care. As the mother's level of education increases, so does the likelihood that she will be seen by a doctor during the pregnancy; 28 percent of births to mothers with no education received antenatal care from a doctor compared to 76 percent of women who completed secondary or higher schooling. Antenatal care can be more effective when it is sought early in the pregnancy, and continues through to parturition. Obstetricians generally recommend that antenatal visits be made on a monthly basis to the 28th week (7th month), formightly to the 36th week (Sth month) and then weekly until the 40th week (until birth). Regular visits allow proper monitoring of the mother and child throughout the pregnancy. If the first 85 Tabl© 8.1 Antenatal care Percent disUibution of b i~s in the five years preceding the survey, by source of antenatal care during pregnancy according to selected back83ound characteristics, Nigeria 1990 Trained Tradi- Trained Auxiliary Village traditional tional Number Background nurse/ midwife/ health birth birth of characteristic Doctor Midwife Assistant worker au~dant attendant Other No one Total births MOther's age at birth < 20 30.7 17.5 0.9 1.8 0.9 3.6 1.5 43.2 100.0 1,344 20-34 38.5 20.8 1.3 1.5 0.9 3.7 1.5 31.8 100.0 5,649 35+ 31.8 20.1 1.3 1.7 0.6 3.2 1.6 39.6 100.0 1,119 Birth order 1 39.1 21.0 0.9 1.2 1.1 3.6 1.1 32.0 100.0 1,458 2-3 38.5 19.9 1.0 1.9 0.8 3.4 1.0 33.5 100.0 2,516 4-5 37.5 18.6 1.3 2.0 1.1 3.3 1.5 34.8 100.0 1,992 6+ 30.7 21.4 1.7 1.1 0.6 4.0 2.3 38.2 100.0 2,147 Residence Urban 61.2 23.1 0.5 0.4 0.7 1.3 1.6 11.1 100.0 1,714 Rural 29.6 19.4 1.4 1.9 0.9 4.2 1.5 41.1 100.0 6,399 Region Northeast 26.5 9.9 0.3 1.3 0.2 3.7 3.5 54.7 100.0 1,924 Northwest 31.2 14.0 0.2 0.2 0.7 0.5 0.9 52.4 100.0 2,242 Southeast 35.0 29.5 2.7 3.8 1.7 7.6 0.1 19.6 100.0 2,422 Southwest 58.1 27.4 1.7 0.5 0.7 1.7 2.1 7.7 100.0 1,525 MOther's education No education 27.5 15.9 0.9 1.7 0.7 3.4 2.0 47.9 100.0 5,091 Some primary 35.0 32.4 4.2 1.3 1.3 6.7 1.2 17.9 100.0 824 Completed primary 47.8 28.3 1.0 1.9 1.2 4.0 0.9 15.0 100.0 1,212 Some secondary 60.6 26.4 0.4 1.4 0.9 1.5 0.2 8.6 100.0 459 Completed secondary/higher 76.4 18.2 0.9 0.6 0.6 0.4 0.3 2,6 100.0 521 All births 36.3 20.2 1.2 1.6 0.9 3.6 1.5 34.8 100.0 8,113 Note: Figures are for births in the period 1-59 months preceding the survey. If more than one source of antenatal care wM mentioned, only the most qualified provider is considered. antenatal visit is made at the third month of pregnancy, this schedule translates to a total of 12 to 13 visits during the pregnancy. Information about the visits made by pregnant women is presented in Figure 8.1. In 52 percent of births, mothers made four or more antenatal care visits. This constitutes 81 percent of all births that received care, which suggests that those women who used the antenatal clinics were aware of the importance of regular attendance. However, for alarge proportion of births, mothers obtained fewer than the recommended number of visits; the median number of antenatal care visits was seven. Nurse-midwives, who also give antenatal care, may vary the scheme of attendance for pregnant women and this, along with late initiation of visits, could contribute to the less than optimal frequency of attendance. 86 Only 42 percent of all births received some antenatal care before the 6th month of gestation (see Figure 8.1). However, for births to mothers who made antenatal visits, 67 percent received attention before the sixth month of pregnancy. Figure 8.1 Distribution of Births by Number of Antenatal Care Visits and Stage of Pregnancy at First Visit Received 1 Visit 2% No Visits 35% NO Care 05% 2-3 Visits 1 0 ' ~ Don't Know/ Missing 2% DK/Mlssing 3% 8" mo 2% 4~ Visits 52 '6 mo 42 mo 18% Number of Antenatal Care Visits Stage of Pregnancy at First Visit NDHS 1990 The median duration of gestation at which the first antenatal care visit was made was 5.3 months. This is rather late if mothers are to receive the maximum benefits of antenatal care. The advantage of starting antenatal care within the first three months of pregnancy is that a woman's normal baseline health can be assessed. Knowledge of a woman's baseline health will make early detection of any abnormalities easier; this, in turn, aids health workers in taking appropriate action to care for the mother. Table 8.2 presents tetanus toxoid coverage during pregnancy for all births in the five years preceding the survey. Tetanus toxoid injections are given during pregnancy for the prevention of neonatal tetanus, one of the principal causes of death among infants in many developing countries. For full protection, a pregnant woman should receive two doses of the toxoid. However, if a woman has been vaccinated during a previous pregnancy, she may only require one dose for a current pregnancy. Forty-one percent of births received the protection of two or more doses of tetanus toxoid during gestation; 46 percent were not protected by any tetanus toxoid vaccination. The mothers of births in the Southeast and Southwest were twice as likely to receive two or more doses during gestation (53 and 60 percent) than were mothers in the Northeast and Northwest (24 and 30 percent). The relationship between education of mothers and vaccination status is striking; the proportion of live births in which two or more doses of tetanus toxoid were received increases steadily from 29 percent 87 Table 8.2 Tetanus toxoid vaccination Percent disu'ibution of births in the five years preceding the survey, by number of tetanus toxold injections given to the mother during pregnancy and whether the respondent received an antenatal card, according to selected background characteristics, Nigeria 1990 Number of tetanus toxoid injections Percentage Two given Number Background One doses Don't know/ antenatal of characteristic None dose or more Missing Total card births Mother's age at birth < 20 54.5 11.2 32.2 2.1 100.0 48.6 1,344 20-34 43.4 11.9 43.4 1.3 100.0 60.6 5,649 35+ 52.1 8.9 38.4 0.6 10O.0 53.6 1,119 Birth order 1 43.8 14.0 41.4 0.8 100.0 60.7 1,458 2-3 44.7 12.0 41.6 1.6 100.0 59.1 2,516 4-5 45.7 10.3 42.2 1.7 100.0 57.4 1,992 6+ 50.9 9.8 38.4 0.9 100.0 54.1 2,147 Residence Urban 23.1 12.6 63.2 1.1 100.0 85.1 1,714 Rural 52.7 11.0 34.9 1.4 I00.0 50.3 6,399 Region Northeast 65.2 10.6 24.1 0.2 100.0 35.8 1,924 Northwest 56.7 11.1 29.7 2.6 100.0 44.9 2,242 Southeast 35.8 11.0 52.5 0.7 100.0 67.7 2,422 Southwest 24.7 13.3 60.0 1.9 100.0 88.0 1,525 Mother's education No education 58.0 11.2 29.3 1.5 100.0 44.9 5,091 Some primary 34.6 11.8 53.2 0.4 100.0 69.1 824 Completed primary 29.0 12.0 57.8 1.3 100.0 76.5 1,212 Some secondary 20.0 12.7 66.5 0.8 100.0 85.6 459 Completed secendary/higher 16.0 10.3 72.3 1.4 100.0 96.1 521 All births 46.4 11.4 40.9 1.3 100.0 57.6 8,113 Note: Figures are for births in the period 1-59 months preceding the survey. among women with no education, to 72 percent of births to women who completed secondary education. Educated women may have greater accessibility to modem medical care, or may have a greater understanding of the advantages of vaccinations, or may be more able to utilise the services provided. Fifty-eight percent of births in the last five years preceding the survey we re to mothers who received antenatal cards for their pregnancies. Those who were less likely to have cards were births to women under 20 years of age, births to rural women, births to women from the Northeast and Northwest, and births to women who had no education. 88 Women who had contact with health professionals during pregnancy were much more likely to deliver at a health facility than women who had no such contact (see Table 8.3). Fifty-three percent of births to women who made four or more antenatal care visits were delivered in a health facility, compared to two percent of births to women who made no antenatal care visits. Table 8.3 shows the distribution of births by the place of delivery. The differences between the North and the South are substantial. While delivering births at home is not uncommon in the Southeast and Southwest (38 and 25 percent of bi~as), it is the norm in the Northeast and Northwest where nine of ten children are still delivered at home. The high proportion of births delivered at home in the North has serious consequences for both maternal and child health. Table 8.3 Place of deliver,/ Percent distribution of births in the five years preceding the survey, by place of delivery, according to selected background characteristics, Nigeria 1990 Home of Number Background Health At health Don't know/ of characteristic facility home worker Other Missing Total births Mother's age at birth < 20 23.8 70.1 4.3 0.4 1.4 100.0 1,344 20-34 32.8 59.9 4.5 0.6 2.1 100.0 5,649 35+ 29.8 62.0 4.9 0.5 2.8 100.0 1,119 Birth order 1 34.7 58.3 5.1 0.3 1.5 100.0 1,458 2-3 30.1 63.7 4.1 0,3 1.8 100.0 2,516 4-5 30.7 61.1 4.9 0.8 2.4 100.0 1,992 6+ 29.5 62.9 4.3 0.8 2.5 100.0 2,147 Residence Urbma 58.2 32.8 3.8 0.4 4.8 100.0 1,714 Rural 23.6 69.7 4.7 0.6 1.4 100.0 6,399 Region Northeast 10.4 88.6 0.1 0.3 0.7 100.0 1,924 Northwest 9.7 89.5 0.2 0.2 0.3 100.0 2,242 Southeast 46.3 38.4 11.4 0.9 3.0 100.0 2,422 Southwest 63.6 24.9 5.6 0.9 5.0 100.0 1,525 Mother's education No education 15.8 80.2 2.8 0.4 0.8 100.0 5,091 Some primary 44.7 40.3 10.8 1.3 3.0 100.0 824 Completed primary 48.1 37.7 8.7 0.8 4.7 100.0 1,212 Some secondary 71.2 17.6 4.2 0.8 6.2 100.0 459 Completed secondary/higher 81.7 12.6 3.0 0.2 2.6 100.0 521 Antenatal care visits None 1.6 94.6 2.4 0.3 1.0 100.0 2,805 1-3 visits 25.7 69.1 3.8 0.8 0.7 100.0 963 4 or more visits 52.8 38.1 6.3 0.7 2.2 109.0 4,187 Don't know/Missing 4.6 64.9 2.6 0.0 27.8 100.0 157 All births 30.9 61.9 4.6 0.6 2.1 100.0 8,113 Note: Figures axe for births in the period 1-59 months preceding the smwey. 89 The expected pattern with regard to mother's education can be seen in Table 8.3: the proportion of births delivered in a health facility increases steadily from 16 percent of births to mothers with no education to 82 percent of births to mothers with completed secondary or higher education. Overall, about 60 percent of births in Nigeria are delivered at home, while 30 percent are delivered in health facilities. The type of assistance a woman receives during the birth of her child depends on the place of delivery. Births that are delivered at home are more likely to be delivered without assistance from anyone, whereas, births delivered at a health facility are more likely to be delivered by trained medical personnel (not shown). Table 8.4 Assistance during delivery Percent distribution of births in the five years preceding the survey, by type of assistance during delivery, according to selected background characteristics, Nigeria 1990 Trained Tradl- Trained Auxiliaw Village traditional tic.a/ Number Background nurse/ midwife/ health birth biah Don't know/ of characteristic Doctor Midwife Assistant worker attendant attendant Other No one Missing Total births Mother's age at birth < 20 7.7 16.0 1.1 0.7 3.7 23.0 4.9 42.4 0.7 100.0 1,344 20-34 11.1 21.7 1.2 1.0 3.5 18.9 5.3 37.0 0.4 100.0 5,649 35+ 9.6 19.7 1.9 1.1 3.5 16.6 4.6 41.9 1.1 100.0 1,119 Birth order 1 13.0 21.9 1.1 0.9 4.1 19.8 4.3 34.5 0.3 100.0 1,458 2-3 10.1 19.8 1.4 0.8 3.6 18.7 4.5 40.6 0.4 100.0 2,516 4-5 10.2 20.9 0.8 1.2 3.5 20.4 5.2 37.4 0.5 100,0 1,992 6+ 8.9 20.0 1.6 1.0 3.2 18.4 6,3 40.0 0.7 100.0 2,147 Residence Urban 21.3 38.1 1.2 0.2 2.6 9.6 4.5 21.6 0.8 100.0 1,714 Rural 7.4 15.8 1.3 1.2 3.8 21.8 5.3 43.1 0.4 100.0 6,399 Region Northeast 7.2 3.7 0.1 0.3 2.9 23.4 5.8 56.1 0.7 100.0 1,924 Northwest 5.0 5.0 0.2 0.1 2.2 21.0 2.6 63.5 0.2 100.0 2,242 Southeast 10.5 35.1 1.9 2.5 5.8 21.1 6.7 15.9 0.5 100.0 2,422 Southwest 21.7 41.4 3.3 0.7 2.7 8.3 5.5 15.7 0.8 100.0 1,525 Mother's education No education 6.2 9.4 0.7 1.0 3.4 21.8 5.7 51.4 0.3 100.0 5,091 Some primary 9.7 34.9 2.1 1.2 4.6 18.7 5.7 22.2 0.9 100.0 824 Completed primary 14.2 34.4 2.4 1.1 4.1 17.6 3.8 21.2 1.2 100.0 1,212 Some secondary 21.6 47.4 3.1 0.5 3.4 9.4 4.8 9.3 0.5 100.0 459 Completed secondary/ 32,0 49.9 0.8 0.6 2.4 6.3 2.0 5.7 0.1 100.0 521 higher Antenatal care visits None 0.9 0.9 0.2 0.1 3.5 30.6 6.2 57.6 0,0 100,0 2,805 1-3 visits 12.0 14.1 0.6 0.3 4.9 16.0 5.9 46.3 0.0 100.0 963 4 or more visits 16.5 35.8 2.1 1.7 3.3 11.4 4.4 24.7 0.0 100.0 4,187 Don't know/Missing 2,6 1.1 1.6 0.0 2.1 44.4 1.4 20.4 26.3 100.0 157 Total 10.3 20.5 1.2 1.0 3.6 19.2 5.1 38.6 0.5 100.0 8,113 Nom: Figures are for births in the period 1-59 months preceding the survey. If the respondent mentioned more than one attendant, only the most qualified attendant is considered. 90 Figure 8.2 Assistance During Delivery by Region Other ,~oz rBA 21% TBA 24% Medical Medical erson 13% Other 6 ~rson 14% No one 63% Northwest [~o one 56% Northeast TRA R% TBA 21% Other Other 7% No one 16 Medical No one 16% cal ~rson 70% 56% Southwest Southeast NDHS 1990 Overall, more than half the births in the Northeast and Northwest are delivered without assistance, while only 16 percent of births in the Southeast and Southwest are delivered without assistance (see Table 8.4 and Figure 8.2). Births to rural women, births to women in the Northeast and Northwest, highs to women with no education, and births to women who made no antenatal visits, are more likely to be delivered without any type of assistance. These characteristics identify women who are at greater risk of dying due to complications occurring during pregnancy and delivery. While doctors provided some antenatal care to 36 percent of births (see Table 8.1) they assisted in delivering only I0 percent (see Table 8.4). Trained nurses, midwives, and birth attendants delivered approximately 30 percent of the births in the Northeast and Northwest, and 62 to 52 percent of the births in the Southeast and Southwest. It is possible that many of the women who received antenatal care from doctors could not afford doctors' delivery fees; however, it is standard practice in Nigeria for normal deliveries to 91 be performed by nurse-midwives rather than doctors. If they are available to assist, doctors tend to do so in cases with complications. Only 2.5 percent of births in the last five years preceding the survey were delivered by caesarean section. Less than 2 percent of births were born prematurely (see Table 8.5). For 90 percent of births, the birth weight was unknown, which is to be expected given that two-thirds of births are delivered at home. Only 16 percent of babies born in the five years preceding the survey were reported by the mother to be very small or smaller than average at birth; 30 percent were reported to be larger than average or very large; the remaining half of births were reported to be of average size at birth (see Table 8.5). 8.2 Vaccinations To assist in the evaluation of the Expanded Programme for Immunisation (EPI), the NDHS collected information on vaccination coverage for all children born in the five years preceding the survey, although data presented here are restricted to children who were alive at the time of the survey. The EPI follows the World Health Organisation's (WHO) guidelines for vaccinating children. To be considered fully vaccinated, a child should receive the following vaccinations: BCG, measles, and three doses each of DPT and polio. BCG is for protection against tuberculosis, and DPT is for protection against diphtheria, per- tussis, and tetanus; both DPT and polio require three vaccinations at intervals of several weeks. WHO recommends that children receive the complete schedule of vaccinations by 12 months of age. Information on vaccination coverage was collected in two ways: from vaccination cards shown to the interviewers and from Table 8.5 Characteristics of deliver, Percent distribution of births in the five years preceding the survey by whether the delivery was by caesarean section, whether premature, and by birth weight and the mother's estimate of baby's size at birth, Nigeria 1990 Characteristic Percent Caesarean 2.5 Premature birth 1.5 Birth weight Less than 2.5 kg. 0.7 2.5 kg. or more 8.9 Don't know/missing 90.4 Total 100.0 Size at birth Very small 6.3 Smaller than average 9.9 Average 52.3 Larger than average 13.0 Very large 16.8 Don't know/missing 1.6 Total 100.0 Number of births 8,113 Note: Figures are for births in the period 1-59 months preceding the survey. mothers' reports. The majority of child welfare clinics in Nigeria provide cards on which vaccinations are recorded; when a mother was able to present such a card to the interviewer, this was used as the source of information. The interviewer recorded vaccination dates directly from the card. In addition to collecting vaccination information from cards, there were two ways of collecting the information from the mother herself. If a vaccination card had been presented, but a vaccine had not been recorded on the card as being given, the mother was asked to recall whether that particular vaccine had been given. If there was no card at all for the child, the mother was asked to recall whether the child had received BCG, polio (including the number of doses), or measles vaccinations. DPT coverage is not asked about for children without a written record and is assumed to be the same as mother's report for polio vaccine. (Polio and DPT are usually given at the same time.) 92 Vaccination coverage is presented in Table 8.6 according to the source of the information used to determine coverage, i.e., the vaccination card or mother's report. Data are presented for children age 12-23 months, thereby including only those children who have reached the age by which they should be fully vaccinated. Estimates of coverage arc summarized in Figure 8.3, which presents coverage figures as ascertained from both vaccination cards and mothers' reports. Table 8.6 Vaccinations by source of information Percentage of children 12-23 months who had received specific vaccines at any time before the survey and the percentage vaccinated by 12 months of age, by whether the infornmtion was from a vaccination card or from the mother, Nigeria 1990 Percentage of children who received: DPT Polio Number Source of of information BCG 1 2 3+ 1 2 3+ Measles All 1 None children Vaccinated at any time before the survey Vaccination card 34.2 33.2 25.0 20.0 33.7 25.2 20.1 23.9 18.0 0.0 1,380 Mother's report 26.5 26.0 21.8 13.3 26.0 21.8 13,3 22.1 11.6 36.8 1,380 Either source 60.7 59.2 46.8 33.3 59.7 47.0 33.4 46.0 29.6 36.8 1,380 Vaccinated by 12 months of age Vaccination card 27.2 26.6 19.9 15.3 27.0 20.1 15.3 14.6 II.I 6.5 1,380 Either source 48.3 47.5 37.2 25.4 47.8 37.4 25.4 28.1 18.3 48.6 1,380 Note: The DPT coverage rate for children without a written record is assumed m be the same as that for polio vaccine since mothers were specifically asked whether the child had received polio vaccine. For children whose information was ba.md on the mother's report, the proportion of vaccinations given during the first year of life was assumed to be the same as for children with a written record of vaccination. lChildren who am fully vaccinated (i.e., those who have received BCG, measles and three doses of DPT and polio). According to the information from vaccination cards, 34 percent of children received a BCG vaccination. However, not all children who get vaccinated have cards; 27 percent of children who did not have a card were reported by their mothers to have received the BCG vaccine. This translates to an overall coverage of 61 percent of children vaccinated against tuberculosis. Vaccinations are most effective when given at the proper age; according to the card information, 27 percent of children received the BCG vaccine by 12 months of age. Assuming that the proportion of vaccinations given during the first year of life is the same for children whose mothers report their status as it is for children with cards, it can be estimated that about 48 percent of children received BCG vaccinations by their first birthday. Coverage of the first dose of polio and the first dose of DPT are about the same as for BCG. Over half the children have received the first dose (60 percent), although only 48 percent received it by 12 months of age. Coverage declines after the first dose; not as many children received the second and third doses of polio and DPT as did the first dose. Only 33 percent of children received the third doses of polio and DPT, and only 25 percent did so by 12 months of age. 93 Figure 8.3 Vaccination Coverage Among Children Age 12-23 Months Percent 70 60 50 40 30 20 10 0 6O / I : : I 4;' BCQ 1 2 3 Pol io Note: Based on hea l th card in format ion and mothers ' reports. 46 Meas les A l l None NDHS 1990 Twenty-eight percent of children age 12-23 months were vaccinated against measles before their first birthday; and overall, only 18 percent have had all the recommended vaccinations by their first birthday. As mentioned above, 61 percent of children age 12-23 months have received a BCG vaccination; the next highest coverage level is 60 percent for the first dose of polio vaccine. Thus, whether or not a child has received BCG appears to be indicative of whether the child will ever receive any vaccinations; this pattern holds tree across all background variables, as shown in Table 8.7. More than one-third of children have never been vaccinated; and only 30 percent of children are fully vaccinated. Figure 8.4 shows the percentage of children age 12-23 months who are fully vaccinated (according to card information and mothers' reports) by selected background characteristics of the mother. The highest proportion of children who are fully vaccinated is among mothers with completed secondary or higher education (80 percent); the lowest proportion is among children in the Northeast region (16 percent) and children of mothers who have no education (17 percent). Vaccination status does not differ appreciably by the sex or birth order of the child. However, it does differ markedly by characteristics of the mother. Children with the least protection are those bom to women with no education; these children accounted for 61 percent of all bi~as in the five years preceding the survey, and half of them did not receive a single vaccination. Although protection improves for children of better educar~l mothers, even these children may not complete the schedule of vaccinations. Nearly three-quarters of children with mothers who have some primary education begin the series for DPT and polio, but 15 percent never go on to receive the second dose, and an additional 18 percent never get the third dose. Coverage is especially low in the Northeast and Northwest, where only 1 in 6 children has completed the DPT/polio series. 94 Table 8.7 Vaccinations by background eheaacteristics Percentage of children 12-23 months who had received specific vaccines by the time of the sm'vey (according to the vaccination card or the mother's report) and the percentage with a vaccination card, by selected background characteristics, Nigeria 1990 Percentage of children who received: Percentage DPT Pollo with Number Background a of characteristic BCG 1 2 3+ 1 2 3+ Measles All 1 None card children Sex Male 59.7 57.9 45.9 33.7 58.2 46.1 33.8 45.7 30.8 38.6 30.9 683 Female 61.7 60.5 47.6 32.9 61.1 47.9 32.9 46.4 28.4 35.0 38.5 697 Birth ocder 1 58.4 57.4 46.1 31.1 57.4 46.1 31.4 44.9 26.2 39.9 35.5 265 2-3 62.9 61.0 45.4 36.0 62.1 45.9 36.0 47.6 33.4 35.1 35.9 441 4-5 60.6 58.8 48.8 33.9 59,1 49.0 33.9 48.1 30.4 36.0 33.1 445 6+ 59.3 58.6 46.3 29.6 58.8 46.3 29.6 40.4 24.5 37.8 34.8 230 Residence Urban 81.3 80.8 74.5 58.9 81.6 74.8 59.1 68.8 52.5 16.3 43.9 295 Rural 55.1 53.4 39.2 26.4 53.7 39.5 26.4 39.8 23.3 42.4 32.3 1,086 Region Northeast 41.2 40.8 32.1 17.3 42.6 32.7 17.3 31.6 15.9 54.5 21.2 359 Northwest 52.6 51.7 35.1 18.7 51.7 35.1 18.7 39.7 17.7 45.4 36.5 373 Southeast 73.0 70,2 58.8 50.4 70.2 59.0 50.4 53.9 43.3 25.6 40.9 408 Southwest 81.6 79.8 66.5 51.0 79.8 66.5 51.3 64.0 45.3 15.9 41.8 240 Mother's education No education 46.2 44.8 32,6 19.1 45.3 32.7 19.1 33.8 16.6 51.4 25.7 845 Some primary 75.0 72.0 57.4 39.3 72.2 58.1 39.3 51.5 31.1 19.3 54.2 136 Completed primary 81.2 79.9 62.7 49.0 80.7 63.4 49.0 62.2 43.5 18.1 45.5 198 Some secondary 88.2 86.6 71.0 61.4 86.6 71.0 61.4 67.4 55.1 6.0 46.9 89 Completed secondary/higber 94.8 94.4 93.7 83.4 94.4 93.7 84.1 85.9 80.3 5.2 51.3 111 All children 60.7 59.2 46.8 33.3 59.7 47.0 33.4 46.0 29.6 36.8 34.7 1,380 Note: The DPT coverage rate for children without a written record is assumed to be the same as that for polio vaccine since mothers were specificatty asked whether the child had received polio vaccine. 1Children who ~-c fully vaccinated 0.e., tho6e who have received BCG, measles and three doses of DFF and polio). 95 Figure 8.4 Percentage of Children 12-23 Months Who are Fully Vaccinated TOTAL RESIDENCE Urban Rural REGION Northeast Northwest Southeast Southwest EDUCATION No educ. Prim. Incomp. Prim. Comp. Sec. Incomp. SecgHIgher 63 43 46 44 5s 80 20 40 90 80 100 Percent Note: Based on health card Information and mothers' reports. NDHS 1990 Table 8.8 shows the percentage of children age 12-59 months who had been vaccinated by 12 months of age, by their current age. The table also shows the percentage of children with a vaccination card shown to the interviewer. The coverage estimates are based on both card information and mothers' reports. The percentage of children with vaccination cards decreases with increasing age from 35 percent for children 12-23 months of age to 16 percent for children age 48-59 months. This decline could be due to either a genuine decline in coverage, or to the loss of cards over time. Cards were shown to interviewers by mothers for 26 percent of the children age 12-59 months. Overall, 38 percent of children received the BCG vaccine before their first birthday. Thirty-six percent received the first dose of polio and DPT, and this fell to 21 percent by the third dose. Twenty-one percent of children received the measles vaccination; it seems plausible that the mothers who were regular in their attendance at the child welfare clinics and completed the polio/DPT series for their children were also the same mothers who had their children vaccinated against measles. The table is also meant to illustrate changes in the vaccination programme over time. Coverage has improved in the very recent past (it is highest for the children one year of age). 96 Table 8.8 Vaccinations in the first year of life Percentage of children one to four years of age for whom a vaccination card was shown to the interviewer and the percentage vaccinated for BCG, DPT, polio, mad measles during the first year of life, by current age of the child, Nigeria, 1990 Current age of child in months Vaccine 12-13 24-35 36-47 48-59 All children 12-59 months Vaccination card shown to Interviewer 34.7 29.3 25.3 16.2 26.4 Percent vaccinated at 0- It months a BCG 48.3 36.0 34.9 30.4 37.5 DPT 1 b 47.5 34.2 33.8 27.0 35.7 DPT 2 37.2 28.4 31.0 22.6 29.9 DPT 3 25.4 18.2 22.7 16.6 20.8 Polio 1 47.8 34.1 33.5 27.1 35.7 Polio 2 37.4 28.5 31.1 22.9 30.0 Polio 3 25.4 18.2 22.6 16.5 20.7 Measles 28.1 18.8 21.0 15.8 21.0 All vaccinations c 18.3 11.7 15.1 11.2 14.1 No vaccinations 48.6 61.8 63.1 67.8 60.3 Number of children 1,380 1,320 1,415 1,349 5,463 alnformation was obtained either from a vaccination card or from the mother if there was no written record. For children whose information was based on the mother's report, the proportion of vaccinations given during the first year of life was assumed to be the same as that for children with a written vaccination record. bTbe DPT coverage rate for children without a written record is assumed to be the same as that for polio vaccine, since mothers were specifically asked whether the child had received polio vaccine. CChildren who have received BCG, measles and three doses of DPT and polio vaccines. 8.3 Acute Respiratory Infection Pneumonia is one of the foremost causes of infant mortality in Nigeria. Its prevalence was estimated by asking mothers if their children had experienced coughing, accompanied by short, rapid breathing, in the two weeks preceding the survey. These symptoms are compatible with pneumonia. Early diagnosis and treatment with antibiotics can prevent a large proportion of pneumonia deaths. Table 8.9 shows that 7 percent of children under five years of age were ill with a cough and rapid breathing at some time in the two weeks preceding the survey. Thirty-five percent of these children visited a health facility of some kind, 23 percent received an antibiotic treatment, 23 percent received injections, and 35 percent received cough syrup. 97 Talde &9 Prevalence and treatment of acute ~sp i ra~ infection Percentnge of children unde~ five years who were ill with a cough accompanied by rapid breathing during the two weeks preceding the sulvey, and the percentage of ill cbi]dren who were treated with specific remedies, by selected background charac~risfics, Nigca'ia 1990 Among children with cough and rapid breathing Percentage Percentage Percentage treated with: of children taken to with cough a health Antibiotic None/ Number Background and rapid facility or pill or Cough Home Don't know/ of characteristic breathing provider I syrup Injection syrup remedy Other Missing children Child's age < 6 months 7.0 41.8 3.2 29.5 37.9 10.1 53.1 0.0 751 6-11 months 8.9 27.7 29.8 11.2 36.0 10.7 34.5 0.0 813 12-23 months 9.5 37.0 25.2 25.6 40.3 6.3 35.2 0.0 1,380 24-35 months 5.9 29.7 30.5 24.6 33.3 16.1 31.8 0.0 1,320 36-47 mo~ths 4.8 33.9 23.4 23.5 25.5 12.1 36.9 0.0 1,415 48-59 months 5.3 37.9 20.2 25.8 34.9 13.5 33.6 2.3 1,349 Sex Male 7.3 32.6 23.7 22.9 34.8 13.9 35.0 0.0 3,431 Female 6.2 36.8 22.8 24.0 35.9 7.6 38.3 0.8 3,596 Blrlh order 1 6.7 35.4 17.0 25.6 30,8 17.4 33.1 0.0 1,281 2-3 6.2 35.4 22.3 21.8 33.6 16.1 32.2 0.0 2,226 4-5 7.3 41.4 27.4 23.1 34.6 3.5 47.4 0.0 1,707 6+ 6.9 26.3 24.8 23.9 41.0 8.1 33.0 1.3 1,814 ReMdence Urban 4.2 43.5 35.1 24.3 47.6 4.3 48.5 0.0 1,532 Rural 7.4 33.2 21.4 23.3 33.4 12.0 34.6 0.4 5,496 Region Northeast 10.7 35.5 23,5 25.5 23.6 7.5 31.2 0.9 1,653 Northwest 4.8 35.0 21.2 28.3 42.2 10.9 26.7 0.0 1,862 Southeast 6.3 26.3 20.4 12.9 35.8 16.3 40.6 0.0 2,166 Southwest 5.2 47.8 31.2 32.1 55.0 9.3 54.7 0.0 1,347 Mother's education No education 6.8 29.4 21.3 22.9 28.6 11.3 29.9 0.6 4,330 Some prinuu 7 7.0 27.9 18,5 21.6 33.8 8.8 30.3 0.0 718 Completed pt~mty 6.9 39.1 32.6 18.6 41.8 14.2 53.0 0.0 1,076 Some secondm'y 6.1 60.9 28.7 21.2 60.8 10.9 37.0 0.0 406 Compieted secondary/higher 5.9 64.7 23,9 46.1 67.6 2.2 72.5 0.0 492 All children 6.7 34.6 23.3 23.4 35.3 10.9 36.5 0.4 7,028 Note: Figmes are for children born in the period 1-59 months preceding the survey. tlncludes health post, health centre, hospital, and private doctor. Treatment practices for ill children differ more by background characteristics of the mother than does the prevalence of the illness itself. Children of more educated mothers are twice as likely to be taken to a health facility (60 percent) as children of less educated mothers (30 percent). Children in the Southeast were less likely to be taken to a facility than were children in the Southwest (26 versus 47 percent). There are no large differentials by age, sex, or parity. 98 8.4 Fever One of the major causes of mortality and morbidity among children in Nigeria is malaria. Since the major manifestation of malaria is fever, mothers were asked whether their children had had a fever in the two weeks preceding the survey, and what type of treatment was sought, if any. "The remedy is to treat every child with fever promptly with antimalarial drags before its major and deadly manifestations appear. ''t Table 8,10 Prevalence and treatment of fever Percentage of children under five years who had a fever during the two weeks preceding the survey, and the percentage of children with a fever who were uv, ated with specific remedies, by selected background characteristics, Nigeria 1990 Among children with fever Percentage Percentage Pmcentage treated with: of taken to children a health Antibiotic None/ Number Background with facility or Anti- pill or Home Cough Don't know/ of charactefisfc fever provider x malarial syrup Injection remedy syrup Missing children Child's age < 6 months 25.4 36.7 10.3 13.1 27.5 9.2 39.4 1.0 751 6-11 Months 37.4 34.6 24.6 19.9 19.6 4.8 44.8 0.5 813 12-23 Months 41.4 34.7 23.5 24.5 25.7 4.5 49.5 0.g 1,380 24-35 Months 34.9 27.6 20.3 24.3 21.5 9.2 43.5 1.5 1,320 36-47 Months 30.3 22.3 17.7 17.3 14.3 6.0 44.7 0.6 1,415 48-59 Months 24.9 27.4 24.0 21.9 23.2 12.8 36.4 1.1 1,349 Sex Male 33.5 31.8 23.2 23.4 21.8 8.6 43.8 0.8 3,431 Female 31.8 28.2 18.6 18.9 21.6 6.1 44.2 1.1 3,596 Birth order 1 29.6 27.4 17.9 21.5 18.6 11.9 39.7 0.3 1,281 2-3 30.4 32.5 23.4 22.1 26.8 6.2 39.7 1.3 2,226 4-5 33.9 30.3 20.8 19.0 21.5 5.8 46.3 0.9 1,707 6+ 36.2 28.8 20.0 21.8 18.3 7.3 48.9 0.9 1,814 Residence Urban 22.2 49.3 30.3 28.8 27.2 5.9 61.3 0.4 1,532 Rural 35.5 26.7 19.3 19.8 20.7 7.6 41.0 1.0 5,496 Region Northeast 32.9 33.2 23.6 27.9 14.7 9.4 36.6 1.9 1,653 Northwest 37.5 22.7 14.9 18.2 26.5 8.7 22.3 O.g 1,862 Southeast 36.1 26.5 22.3 15.8 19.0 5.4 61.5 0.3 2,166 Southwest 19.9 53.2 26.8 31.0 31.1 5.9 64.3 1.4 1,347 Mother's education No education 33.6 25.0 16.8 20.3 18.6 9.1 33.9 0.9 4,330 Some primary 37.2 25.6 23.3 21.4 23.9 4.1 57.6 1.1 718 Completed primary 32.4 39.3 30.6 21.7 27.1 6.6 60.2 1.0 1,O76 Some secondary 29.9 52.4 27.8 23.7 30.1 0.8 64.0 0.9 406 Completed secondary/higher 20.2 56.4 31.7 27.9 32.1 1.5 72.0 0.8 492 All children 32.6 30.0 20.9 21.1 21.7 7.4 44.0 0.9 7,028 Note: Figures are for children born in the period 1-59 months preceding the survey. alneludes health post, health centaz, hospital, and private doctor. l Quote from Professor O. Ransome-Kuti, Honourable Minister of Health (Ransome-Kuti et al., 1989). 99 Table 8.10 indicates that one-third of children under five years of age were reported to have had fever but only 21 percent of these received antimalarial treatment. Although there were no significant differences in the prevalence rate for fever, treatment practices did differ by background characteristics of the mother. Children in urban areas were twice as likely to be taken to a health facility for treatment of their fever, as children in rural areas; the same was true for children of the most educated mothers (secondary or higher) compared to children whose mothers had no education. 8.5 Diarrhoea Dehydration brought on by severe diarrhoea is a major cause of morbidity and mortality among Nigerian children; it ranked as the number one cause for hospital admissions at the Massey Street Children's Hospital in Lagos in 1982. One treatment for dehydration is oral rehydration therapy (ORT): a solution prepared from commercially produced packets of oral rehydration salts (ORS); or a homemade solution prepared from sugar, salt and water. The former tends to be expensive, whereas, preparation of the latter is taught in child health clinics. ORT has been taught actively in Nigeria since the 1980s. Table 8.11 shows the prevalence of diarrhoea in children under five years of age. Eighteen percent of children had experienced diarrhoea at some time in the two weeks preceding the survey; 4 percent of children had experienced bloody diarrhoea in the previous two weeks, while 8 percent were still having an episode of diarrhoea at the time of the survey (i.e., within the last 24 hours). Children age 6-23 months were the most likely to have experienced diarrhoea in the two weeks preceding the survey. Children age 12-35 months experienced slightly higher rates of bloody diarrhoea than children in other age groups. Prevalence of diarrhoea was found to be higher in rural areas than in urban areas, and the Northeast and Northwest regions reported prevalence rates about double those in the Southeast and Southwest. 100 Table 8.11 Prevalence of dian'hoea Percentage of children under five years who had di~trrhoea and diarrhoea with blood in the two weeks preceding the survey, and the percentage of children who had diarrhoea in the preceding 24 horn's, by selected background characteristics, Nigeria 1990 Diarrhoea in the All preceding 2 weeks t diarrhoea in the Number Background All Dimrhoea preeodinl~ of characteristic diarrhoea with blood 24 hours" children Child's age < 6 months 11.7 1.3 6.6 751 6-11 Months 26.3 3.2 12.4 813 12-23 Months 29.3 6.9 14.5 1,380 24-35 Months 20.7 5.8 10.2 1,320 36-47 Months 10.4 3.3 3.4 1,415 48-59 Months 9.6 2.5 3.8 1,349 Sex Male 19,4 4.0 10.2 3,431 Female 16.4 4.2 6.5 3,596 Birth order 1 18.5 3.0 8.5 1,281 2-3 18.8 4.5 9.2 2,226 4-5 16.5 4.3 7.4 1,707 6+ 17.6 4.1 8.0 1,814 Residence Urban 11.7 1.7 4.5 1,532 Rural 19.6 4.8 9.4 5,496 Region Northeast 23.9 6.1 13.7 1,653 Northwest 25.7 5.3 11.9 1,862 Southeast 12.2 2.7 4.6 2,166 Southwest 8.7 2.1 2.7 1,347 M~her's education No education 20.1 5.1 10.2 4,330 Some primary 14.4 1.9 4.9 718 Completed primary 17.2 4.0 7.0 1,076 Some secondary 12.7 2.0 3.9 406 Completed secondary/higher 8.9 0.5 3.1 492 All children 17.9 4.1 8.3 7,028 Note: Figures are for children born in the period 1-59 months preceding the survey. llncludes diarrhoea in the past 24 hours 21ncludes diarrhoea with blood 101 Knowledge of ORS packets is quite low, only 14 percent of mothers who had births in the previous five years had ever heard of such packets (see Table 8.12). Use of ORS packets is even lower, only 8 percent of mothers had ever used a packet, which is to be expected since knowledge is low, and packets are commercially sold at prices which are expensive for the average family. Mothers most likely to have used ORS are those living in urban areas, and those who have secondary or higher education. Mothers least likely to have used ORS were those less than 20 years of age. Table 8.12 Knowledge and use of ORS packets Percentage of mothers with births in the five years preceding the survey who know about artd have ever used ORS packets, by selected background characteristics, Nigeria 1990 Know Have ever Number Background about ORS used ORS of characteristic packets packets mothers Age 15-19 15.0 2.4 373 20-24 12.9 7.1 1,080 25-29 16.9 9.9 1,338 30-34 16.0 9.6 1,108 35+ 11.1 4.6 1,169 Residence Urban 21.3 13.2 1,089 Rural 12.5 5.9 3,980 Region Northeast 13.6 6.3 1,232 Northwest 16.7 10.0 1,399 Southeast 14.9 7.3 1,456 Southwest 11.1 5.5 982 Education No education I0.6 5.6 3,209 Some primary 16.0 5.4 492 Completed primary 21.1 10.0 750 Some secondary 18.0 12.3 276 Completed secondary/higher 29.9 19.3 338 All mothers 14.4 7.5 5,069 Note: Figures include mothers who have given ORS for diarrhoea during the preceding two weeks, although they were not asked about knowledge of ORS packets. 102 Table 8.13 and Figure 8.5 show the percentage of children with recent bouts of diarrhoea who were given treatment. One-quarter of all children who had a recent bout of diarrhoea were taken to a health facility or provider. Children in urban areas were much more likely to visit a health facility or provider than were rural children (40 percent versus 23 percent), and children in the Southwest were more than twice as likely to have been taken to a facility as children in the Southeast. Table 8.13 Treatment of diarrhoea Percentage of children under five years who had diarrhoea in the two weeks preceding the stawey who were taken for treatment to a health fauiUty or provider, die percentege who received oral rehydration therapy (OR'I), the percentage who received increased fluids, the percentage who received neither ORT nor increased fluids, and the percentage receiving other treatments, according to selected background characteristics, Nigeria 1990 Percentage Percentage re~ving Percentage Oral lehydratlon Percentage receiving other treatments: taken to therapy (ORT) receiving neither Number of a health in- ORT nor Home children Background facility or ORS Home creased increased Anti- In- remedy, with characteristic provider I packets solution fluids fluids biotics jection Other diarrhoea 2 Child's age < 6 months 24.8 10.3 18.0 14.6 70.0 6.3 3.6 29.5 88 6-11 months 25.5 12.5 21.6 7.6 70.0 16.9 9.0 28.6 214 12-23 months 27.4 10.4 29.8 8.7 61.8 11.7 5.4 28.0 404 24-35 months 21.6 10.0 22.4 12.0 67.9 12.3 3.4 28.4 273 36-47 months 21.7 12.9 15.8 14.8 65.2 12.6 7.7 27.1 148 48-59 months 28.8 16.9 22.0 8.2 71.3 3.8 6.5 24.1 129 Sex Male 23.6 12.0 22.7 9.7 67.8 8.5 3.7 26.7 666 Female 26.8 11.3 24.5 11.0 65,0 15.2 8.3 29.0 590 Birth order 1 25.9 14.6 25.7 6.7 68.8 5.7 7.3 26.7 237 2-3 26.0 11.5 23.0 12.3 65.5 13.5 4.4 23.4 418 4-5 23.9 11.2 24.2 10.8 65.3 12.0 10.3 31.3 282 6+ 24.5 10.0 22.1 9.9 67.1 13.2 2.6 31.3 319 Residence Urban 40.3 25.5 43.2 18.7 42.9 19,9 6.8 37.9 179 Rural 22.6 9.3 20.3 8.9 70.4 10,2 5.6 26.1 1,076 Region Northeast 25.5 13.6 18.7 8.8 70.4 8,8 6.8 25.2 395 Northwest 24.1 10.7 19.3 7.7 72.1 5,9 2.3 17.0 478 Southeast 17.1 8.9 33.3 13.1 57.6 17,5 5.8 39.2 265 Southwest 45.8 15.1 34.9 19.6 50.5 31.1 16.7 54.6 118 Mother's education No education 22.7 8.0 17.0 8.6 73.4 9.6 6.0 26.1 872 Some primary 23.4 11.6 30.4 15.6 60.2 19.6 4.2 25.4 103 Completed primary 37.6 25.3 39.3 12.7 49.2 11.7 6.4 30.7 185 Some secondary 16.4 19.5 41.5 11.6 53.9 14.5 5.4 42.3 52 Completed secondary/higher 35.2 17.4 50.4 20.5 32.9 28.9 4.7 37.7 44 All children 25.1 11.6 23.5 10.3 66.5 11.6 5.8 27.8 1,256 Note: Oral rehydration therapy (ORT) includes solution prepared from ORS salt, water). llncludes health post, health centre, hospital, and private doctor. 2Includes children born in the period 1-59 months preceding the survey. packets, and recommended home solution (sugar, 103 Figure 8.5 Percentage of Children Receiving Treatment for Diarrhoea by Type of Treatment Taken to Health Fac. ~ 25 ORS Packet ~ 12 m ~ Home Solution ~ 24 Increased Fluids ~ 10 Antibiotic/Injection ~ 17 Home Remedy ~ 28 L 0 5 10 15 20 25 30 Percent Note: Based on children age 1-59 months who had dlarrhoe8 in the two weeke preceding the survey. 35 NDHS 1990 Twelve percent of children who recently had diarrhoea were given a solution prepared from ORS packets and 24 percent were given a homemade solution of sugar, salt and water: two-thirds of the children were not given either solution. The use of homemade solutions appears to be rather low; however, their use is taught mainly in the health facilities, and only 25 percent of children with diarrhoea had been taken to a health facility. A higher percentage of children from the urban areas, from the Southeast and Southwest, and who had educated mothers had been given the homemade solution. Increasing fluids during the episode of diarrhoea followed the same pattern. Use of antibiotics and injections was low (12 and 6 percent of cases), which is consistent with the acceptance of ORT as the modem treatment for diarrhoea. Twenty-eight percent of children were given home remedies other than the recommended home solution. Table 8.14 shows that three-quarters of children who had diarrhoea and were still being breastfed had mothers who continued their feeding as they usually did, without increasing the quantity of feeds. Most children also had mothers who did not change the amount of other fluids fed to their children with diarrhoea. However, as many as 31 percent of the children were given less fluid during the bout of diarrhoea. This high proportion of children who had the fluid intake reduced suggests that increased education efforts are needed to stress the importance of increasing fluid intake during a diarrhoeal attack. 104 Table 8.14 Feeding practices during diarrhoea Feeding practices among children under five years who had diarrhoea in the two weeks preceding the survey, Nigeria 1990 Feeding practices Percent Breastfeedlng frequency 1 Same as usual 74.6 Increased 12.3 Reduced 10.7 Stopped 1.3 Don't know/misslng 1.0 Number of children 1,021 Amount of fluids given Same as usual 55.3 More 10.3 Less 31.2 Don't know/missing 0.4 Number of children with diarrhoea 2 1,256 1Applies only to children who are still breast fed. 2Children born hi the period 1-59 months preceding the survey. 105 CHAPTER 9 INFANT FEEDING AND CHILDHOOD NUTRITION This chapter covers two related topics: infant feeding (including breastfeeding practices, introduction of supplementary weaning foods, and use of feeding bottles) and nutritional status (based on height and weight measurement of the respondent's children under the age of five years). 9.1 Breastfeeding and Supplementation Infant feeding has an impact on both the child and the mother. Feeding practices are important determinants of the child's nutritional status, which in turn influences the risk of dying. The mother is affected by breastfeeding through its effects on postpartum infertility, which is related to the length of birth intervals, and thus fertility levels. These effects are influenced by both the duration and intensity of breastfeeding, and by the age at which the child receives supplemental foods and liquids. Practically all Nigerian children (97 percent) are breastfed for some period of time (see Table 9.1 ). Tiff rty-three percent of children were put to the breast within one hour of birth and 50 percent within the first day. The timeliness with which women put their infants to the breast is one of the few behaviours in which women in the Southeast and the Southwest differ markedly. In the Southeast, 47 percent of last born children were put to the breast within the first hour of birth, whereas in the Southwest only 17 percent were put to the breast in the first hour. Breast milk is sterile, and contains all the nutrients needed by children in the first few months of life. In addition, it provides some immunity to disease through the mother's antibodies. That breastfeeding helps in reducing the prevalence of diarrhoea and nutritional deficiencies is undisputed. The percent distribution of living children by breastfeeding status at the time of the survey is shown in Table 9.2. Only 7 percent of children age 10-11 months were not breastfeeding; i.e., the majority of children are breasffed for at least one year. Byage 16-17 months,21 percent of children were no longer being breastfed. Exclusive breastfeeding is rare in Nigeria: only 2 percent of children under 2 months of age are fed only breast milk. Most children are given water in addition to breast milk (57 percent of children under 2 months of age). Supplements (other than water) are introduced early; as many as 38 percent of children age 0-1 month were already being given supplements other than plain water. Fifty-seven percent of children age 2-3 months were receiving supplements. The percentage receiving supplements increases to 72 percent among children age 12-13 months, and thereafter drops as children stop breastfeeding altogether. While most children are breastfed for a full year, 17 percent of those age 12-13 months are reportedly not yet receiving supplements to their diet of breast milk and water. 107 Table 9.1 Initial breasffeeding Percentage of children hem in the five years preceding the survey who were ever breesifed, and the percentage of last-born children who started breasifeeding within one hour of birth and within one day of ~ by selected background characteristics, Nigeria 1990 Among all children: Among laat-hern childran, percentage who started breaatfeeding: Percentage Number Number Background ever of Within 1 hour Within 1 day of characteristic brcastfed children of bkth of birth childrcn Sex Male 96.3 4072 33.1 51.0 2,588 Female 97.1 4127 33.0 48.9 2,588 Residence Urban 96.3 1730 28.9 51.0 1,118 Rural 96.9 6469 34.2 49.6 4,058 Reginn Northeast 96.5 1948 36.1 44.6 1,246 Northwest 96.6 2267 27.7 37.3 1.445 Southeast 97.4 2447 46.8 71.5 1,475 Southwest 96.1 1536 17.0 43.2 1.011 Mother's education No education 96.9 5152 33.9 46.0 3,289 Some primary 96.0 829 31.7 55.8 496 Completed primary 96.1 1224 33.9 58.1 761 Some secondary 96.6 462 25.9 53.7 281 Completed secondary/ higher 97.5 526 30.9 58.2 346 Assistance at delivery Medically trained person 95.6 2542 29.0 55.5 1,570 Auxiliary midwife/ village health worker 96.8 186 38.2 62.3 114 Traditional birth attandant 96.8 1894 34.5 45.8 1,181 Other or none 97.5 3577 34.9 47.7 2,312 Place of delivery Health facility 96.1 2532 28.8 55.5 1,565 At home 97.7 5452 35.3 47.3 3,471 Other 79.6 215 243 53.2 141 All children 96.7 8199 33.1 49.9 5,176 Note: Table is besed on all children born in the five years preceding the sun, ey, whether living or deed at the time of the interview. 108 Table 9.2 Breastfeeding status Percent dislxibution of living children by breasffeeding status, according to child's age in months, Nigeria 1990 Percentage of living children who are: Breasffeeding and: Number Not Exclusively Plain of breast- breast- water Supple- living Age in months feeding fed only ments Total children 0-1 3.1 2.1 56.8 38.0 100.0 260 2-3 0.3 1.0 41.7 57.1 100.0 279 4-5 3.6 0.1 30.9 65.4 100.0 291 6-7 1.7 0.8 30.9 66.6 100.0 338 8-9 3.6 0.5 21.1 74.9 100.0 286 10-11 7.1 0.2 18.9 73.8 100.0 189 12-13 11.6 0.0 16.8 71.7 100.0 300 14-15 15.9 0.7 14.2 69.2 100.0 260 16-17 20.8 0.7 16.5 62.0 100.0 269 18-19 39.2 0.4 8.6 51.8 100.0 214 20-21 50.5 0.0 3.1 46.5 100.0 190 22-23 65.7 0.0 12.1 22.2 100.0 147 24-25 77.2 0.0 2.8 20.0 100.0 257 26-27 88.2 0.0 2.3 9,4 100.0 264 28-29 86.8 0.0 4.5 8.7 100.0 214 30-31 94.6 0.0 1.1 4.3 100.0 205 32-33 79.3 0.0 0.0 20.7 100.0 190 34-35 82.8 0.0 0.5 16.7 100.0 190 Note: Breastfeeding status refers to preceding 24 hours. Children classified as breastfeeding and plain water only receive no supplements. Solid or mushy food is introduced into the diet early (see Table 9.3). Two percent of breastfeeding children were receiving food as early as one month of age. By age 4-5 months, one-third of breastfeeding children had food introduced into their diets; by age 20-21 months, the majority of breastfeeding infants were receiving supplements of solid or mushy food (84 percent). Over one- third (36 percent) of newborns (age 0-1 months) were being given a bottle and teat (nipple) in addition to being breastfed. These findings have important health implications, as neonates are particularly vulnerable to infections. 109 Table 9.3 Bre~tfeeding and supplementation by age Percentage of bre~tfeeding children who are receiving specific types of food supplementation, and the percentage who are using a bottle with a nipple, by age in months, Nigeria 1990 Age in months Percentage of breastfeeding children who are: Receiving supplement Using a bottle Number Infant Other Other Solid/ with a of formula milk liquid mushy nipple children 0-1 18.9 8.0 23.5 1.6 36.0 252 2-3 26.4 13.9 19.3 13.1 30.8 279 4-5 21.0 11.6 26.3 33.7 26.8 280 6-7 18.7 16.0 23.0 47.0 29.8 332 8-9 14.1 15.1 20.1 60.8 15.9 276 10-11 13.5 15.4 27.9 65.5 21.3 176 12-13 12.1 13.9 24.3 68.9 20.1 266 14-15 9.9 10.7 21.9 72.9 10.0 219 16-17 6.6 19.5 13.7 65.1 7.9 213 18-19 3.9 11.9 20.1 72.4 9.7 130 20-21 1.8 10.7 17.5 83.9 2.2 94 22-23 0.0 14.2 17.6 49.5 2.8 50 24-25 2.5 15.5 25.0 68.0 5.2 59 26-27 (4.7) (0.0) (12.1) (80.2) (4.7) 31 28-29 (0.0) (5.6) (6.0) (63.0) (7.7) 28 30-31 * * * * * 11 32-33 (0.0) (0.0) (4.5) (100.0) (0.0) 39 34-35 (3.0) (3.0) (5.6) (97.2) (0.0) 33 Note: Breasffeeding status refers to preceding 24 hours. Percents by type of supplement among breastfeeding children may sum to more than 100 percent, as children may have received more than one type of supplement. The median duration of breastfeeding is 20 months (see Table 9.4). The duration of breastfeeding is longest for children in the Northeast (22 months), children in the Northwest (21 months), and children of mothers with no education (21 months). Children are categorized as fully breasffed if they are receiving only breast milk, or if water is the only addition to their diet of breast milk. The median duration of full breastfeeding is only 1.5 months. The longest median duration of full breastfeeding is for children in the Northeast (5 months). Although a duration of 2.2 months is relatively short, at 2.2 months the median duration of full breastfeeding is longer in rural areas than in urban areas (0.5 months). The duration of full breastfeeding is also longer in the North than in the South, longer for less educated women than for more educated women, and longer for those who had no assistance at delivery than for those who had medical assistance at delivery. Ninety-three percent of children under 6 months of age were breastfed six or more times in the 24 hours preceding the interview. Children whose mothers had completed secondary education were less likely to be breast fed six or more times in the 24 hours preceding the interview (78 percent). An explanation for this may be that some of the mothers have wage jobs and are unable to breastfeed their babies during the day. There were no appreciable regional differences in the frequency of feeds in the preceding 24 hours. 110 Table 9.4 Median duration and frequency of breasffeedlng Median duration of may breasffeedlng and full breasffecding, end the percentage of children under six months of age who were breasffed six or more times in the 24 hours preceding the survey, by selected to backg~und characteristics, Nigeria 1990 Median duration in months Percentage < 6 months Any Full Number breast fed Number Background breast- breast- of 6+ times in of characteristic feeding feeding I children last 24 hours children Sex Male 19.6 1.3 2470 92.9 448 Female 19.3 1.7 2408 93.3 382 Residence Urban 15.3 0.5 1021 91.7 163 Rural 20.4 2.2 3858 93.4 667 Region Northeast 21.5 5.2 1229 92.1 204 Northwest 20.8 2.4 1346 95.9 241 Southeast 17.4 2.0 1408 94.3 235 Southwest 16.1 0.4 895 88.1 150 Mother's education No education 21.3 2.3 3028 94.0 497 Some primary 19.7 2.4 499 96.9 82 Completed primary 16.2 0.8 735 92.5 146 Some secondary 15.6 0.6 283 (96.0) 48 Completed secondary/nigher 13.3 0.5 330 78.3 57 Assistance at delivery Medically trained person 16.1 0.6 1464 92.9 265 Auxiliary midwife/ village health worker 19.0 0.7 107 * 16 Traditional birth attendant 19.8 2.2 1140 92.6 190 Other or none 21.6 3.0 2167 93.6 359 All children 19.5 1.5 4878 93.1 830 Mean 19.7 5.9 4878 NA NA Prey aiencefmeidence mean 20.1 5.6 4878 NA NA NA = Not applicable Note: Medians and means me bssed on current status. 1Either exclusively breastfed or received plain water only in addition to breastfeeding. Medians for exclusive breasffeeding are not shown due to very few children being exclusively breasffed. 111 9.2 Nutr i t ional Status One of the major contributions of the NDHS to the study of child health status is the anthropometric data collected on the children of respondents. These data on children under five years of age allow for calculation of indicators of nutritional status. These indicators are important because children's nutritional status influances their susceptibility to disease and untimely death. Children's nutritional status reflects infant and child feeding practices as well as recurrent and chronic infections. Both the height and weight of children were measured; these data were used to constmct the following indices: • height-for-age • weight-for-height • weight-for-age The validity of these indices is determined by the coverage of the population of children under study. In the NDHS, all children under five years of age whose mothers were present in the sample household the night before the interview were eligible to be included in the anthmpometric data collection. However, not all eligible children are included in the results presented here; the height or weight measurement is missing for 9 percent of eligible children, and one or both of the measurements are grossly improbable in 5 percent of cases. The month and year of birth is not known for 7 percent of cases and two of the indices (height-for- age, and weight-for-age) are influenced by the accuracy of the reporting of the child's age. Hence, height and weight data are shown for only 79 percent of the eligible children. (Although the term "height" is used here, children younger than 24 months were measured lying down on a measuring board (recumbent length), while standing height was measured for older children.) As recommended by the World Health Organisation (WHO), the nutritional status of children in the survey is compared with an international reference population defined by the U.S. National Center for Health Statistics (NCHS) and accepted by the U.S. Centers for Disease Control (CDC). The use of this reference population is based on the finding that well-nourished young children of all population groups (for which data exist) follow very similar growth pattems (see Martorell and Habicht, 1986). The reference population serves as a point of comparison, facilitating the examination of differences in the anthropometric status o f subgroups in a population and of changes in nutritional status over time. In any large population, there is variation in height and weight; this variation approximates a normal distribution. The height-for-age index is an indicator of linear growth retardation. Children whose height-for-age is below minus two standard deviations (-2 SD) from the median of the reference population are considered short for their age, "stunted," and are chronically undernourished. Children who are below minus three standard deviations (-3 SD) from the median of the reference population are considered severely stunted. Stunting reflects the outcome of a failure to receive adequate nutrition over a long period of time, and is also affected by recurrent and chronic illness. Height-for-age, therefore, represents a measure of the long-term effects of undernutrition in a population and does not vary appreciably according to the season of data collection. Stunted children are not immediately obvious in a population; a stunted three-year old child could look like a well-fed two-year old. The weight-for-height index measures body mass in relation to body length, and describes current nutritional status. Children who are below minus two standard deviations (-2 SD) from the median of the reference population are considered thin, "wasted," and are acutely undernourished. Wasting represents the failure to receive adequate nutrition in the period immediately preceding the survey and may be the result of recent episodes of illness, causing loss of weight and the onset of undemutrition. Wasting may also reflect acute food shortage. Children whose weight-for-height is below minus three standard deviations (-3 SD) from the median of the reference population are considered to be severely wasted. 112 Weight-for-age is a composite index of height-for-age and weight-for-height; it takes into account both acute and chronic undemutrition. It is a useful tool in clinical settings for continuous assessment of nutritional progress and growth. Children whose weight-for-age is below minus two standard deviations from the median of the reference population are classified as "underweight." In the reference population only 2.3 percent of children fall below minus two (-2 SD) for each of the three indices. Table 9.5 shows the percentage of children under five years of age classified as undemourisbed according to height-for-age, weight-for-height, and weight-for-age indices, by the child's age group and selected demographic characteristics. Two-fifths of the children (43 percent) are classified as stunted (this includes 22 percent who are severely stunted). These figures are rather high and suggest that feeding practices for children are very poor. Table 9.5 Nutritional status by demographic characteristics Percentage of children under five years who are classified as undernourished according to three anthropometric indices of nutritional status: height-for-age, weight-for-halght, and weight-for-age, by selected demographic characteristics, Nigeria 1990 Demographic characteristic Height-for-age Weight-for-height Weight-for-age Percentage Percentage Percentage Percentage Percentage Percentage Number below below below below below below of -3 SD -2 SD l -3 SD -2 SD l -3 SD - 2 SD 1 children Age Under 6 months 5.9 12.4 0.9 6.3 0.9 7.6 796 6-11 months 9.1 25.3 2.0 11.2 7.7 35.1 588 12-23 months 20.7 44.6 3.6 15.6 15.2 45.3 1,129 24-35 months 30.1 53.3 1.8 8.2 19.2 45.6 1,018 36-47 months 31.3 55.3 1.0 6.8 13.3 37.1 1,099 48-59 months 26.8 52.9 0.9 5.8 10.6 36.0 935 Sex Male 23.4 43.4 1.7 9.8 12.0 35.8 2,735 Female 21.0 42.7 1.8 8.3 11.9 35.7 2,830 Birth order 1 20.0 41.6 1.7 8.9 10.0 35.7 965 2-3 22.3 43.0 1.7 9.8 11.8 34.9 1,750 4-5 22.9 44.1 1.7 7.2 12.2 35.4 1,381 6+ 22.7 43.2 1.9 9.9 13.1 37.0 1.468 Birth Interval < 2 Years 26.6 47.6 1.3 7.6 14.4 36.4 1,138 2-3 Years 22.1 42.7 2.1 9.8 12.2 36.6 2,687 4 or more years 18.5 39.4 1.3 8.5 9.6 31.6 769 All children 22,2 43.1 1.8 9.1 12.0 35.7 5,565 Note: Figures are for children bern in the period 1-59 months preceding the ma'vey. Each index is expressed in terms of the number of standard deviation (SD) units from the median of the NCHS/CDC/WHO intornational reference population. Children are classified as undernourished ff their z-scores are below minus two or minus three standard deviations (-2 SD or -3 SD) from the median of the reference population. IInchides children who are below -3 SD 113 Stunting becomes increasingly common as children get older, twice as many children age 6-11 months are slanted as children under 6 months of age; and then, twice as many more children are stunted by two years of age. Over 50 percent of the children two years and older are stunted. The likelihood of stunting occurring varies little by sex or birth order, however, stunting occurs more frequently among children born alter a short birth interval (less than 24 months), than those born after a long interval (4 years or more) (48 percent versus 39 percent). Figure 9.1 shows the percentage of children under five years of age who are stunted, by selected socioeconomic characteristics of the mother. The weight-for-height index gives information about children's recent nutritional status. Severe wasting represents failure to receive adequate nutrition in the period immediately preceding the survey and may be the result of recent illness, or of seasonal variations in food supply. Nine percent of children are classified as wasted, i.e., below minus two standard deviations (-2 SD) from the median of the reference population; 2 percent are severely wasted (-3 SD). Figure 9.1 Percentage of Children Under Five Years Who Are Chronically Undernourished (Stunted) TOTAL RESIDENCE Urben Rural REGION Northeast Nor thwest Southeast Southwest EDUCATION NO educ, Prim, Incomp. Pr im. Comp. Sec , Incomp. 8s t . /H igher 36 - - ~ 46 62 37 36 48 311 40 3(1 23 t0 20 S0 40 Percent Note: Chron ica l ly undernour i shed ch i ld ren are those who are be low -2 SD f rom the med ian of the In ternat iona l re fe rence popu lat ion for he lght - fo r -&ge . 50 60 NDHS 1990 Weight-for-age provides an index for chronic and acute undemutrition, but does not distinguish between a child who is underweight because of stunting and one who is underweight because of wasting. Overall, 36 percent of children are underweight, and 12 percent are below minus three standard deviations (-3 SD) from the median of the reference population and are therefore classified as severely underweight. The likelihood of being underweight varies little by sex or birth order, but more children with a birth interval of less than two years were underweight. Children under 6 months of age are the least likely to be underweight (8 percent). This is most likely due to the positive effects of breastfeeding; Table 9.2 showed that only 7 percent of children this age were not being breastfed. After 6 months of age, however, the percentage of children who are underweight increases substantially (35 percent of children age 6-11 months), and remains high. 114 Table 9.6 shows the percentage of children under five years of age classified as undernourished (according to the three anthropometric indices) by socioeconomic characteristics; a familiar pattern emerges. Undemutrition is higher among rural children than urban, and higher among children whose mothers have no education. These findings hold for height-for-age, weight-for-height, and weight-for-age. There are also marked regional differences; the highest levels of wasting (over 10 percent) and stunting (over 50 percent) are seen in the Northeast and Northwest. Table 9.6 Nutritional status by socioeconomic characteristics Pemantage of children under five years who are classified as undernourished according to three anthropometric indices of nutritional status: height-for-age, weight-for-height and weight-for-age, by selected socioeconomic ch~acteristics, Nigeria 1990 Socioeconomic characteristic Height-for-age Weight-for-height Weight-for-age Percentage Percentage Percentage Percentage Percentage Percentage Number below below below below below below of -3 SD -2 SD 1 -3 SD -2 SD 1 -3 SD -2 SD 1 children Residence Urban 13.7 35.0 1.5 7.2 6.8 26.3 1,278 Rural 24.7 45.5 1.8 9.6 13.5 38.5 4,287 Reginn Northeast 30.1 51.9 3.2 11.3 18.6 44.6 1,199 Northwest 28.8 50.4 2.7 12.1 14.2 43.8 1.351 Southeast 17.1 36.6 0.6 7.6 9.5 29.6 1,893 Southwest 14.3 35.6 0.9 5.5 6.3 26.9 1,122 Mother's education No education 26.3 48.1 2.2 11.0 14.9 41.2 3,283 Some primary 17.5 38.6 0.9 8.2 9.6 31.4 618 Completed primary 18.9 39.7 1.5 5.8 8.5 29.8 899 Some secondary 15.3 35.9 1.0 5.8 7.0 28.4 347 Completed secondary/higher 9.3 23.1 0.9 4.6 3.9 17.4 415 All children 22.2 43.1 1.8 9.1 12.0 35.7 5,565 Note: Figures are for children born hi the period 1-59 months preceding the survey. Each index is expressed in terms of the number of standard deviation (SD) units from the median of the NCHS/CDC/WHO international reference population. Children are classified as undernourished if their z-scores are below minus two or minus three stand~d deviations (-2 SD or -3 SD) from the median of the reference population. llncindes children who are below -3 SD 115 CHAPTER 10 LOCAL AVAILABILITY OF FAMILY PLANNING AND HEALTH SERVICES Use of family planning and health services is determined by supply as well as demand. The NDHS fielded the Nigeria Service Availability Questionnaire (reproduced in Appendix E) to assess the availability, or supply, of family planning and health services. The questionnaire was applied at the community level (enumeration area). Information was gathered from two sources: 1) groups of four or five knowledgeable informants in the community (assembled by the interviewer) and 2) informants visited in facilities. The information collected in the enumeration area (EA) and in the facilities is assigned to each respondent (individual questionnaire) to obtain population-based estimates. The number of independent data points, however, remains the same as the number of EAs for which the information was collected, 166 for rural areas and 20 for urban areas.~ Due to the small number of actual data points, the service availability estimates are subject to larger sampling errors than are the estimates based on data from individual women in the main survey. Given that service availability differs in rural and urban areas, it is reasonable to examine the two areas separately. However, service availability is far less of a problem in urban 2 than in rural areas, and the small number of sampling points in urban areas leads to extremely large sampling errors. Given that service availability is of much greater concern in rural areas, and that all rural EAs in the NDHS (except one) were canvassed with the service availability questionnaire, this chapter focuses just on the rural EAs in Nigeria. 10.1 Organisation of the Family Planning and Health System Due to the decentralised structure of the Federal government, the delivery of family planning and health services in Nigeria is quite complex. While policies and guidelines are set by the Federal government, policies for service provision are determined at the state level, and actual implementation and provision of care is handled by the local government areas (LGAs). The objective of the national health policy is to "achieve health for all Nigerians based on the national philosophy of social justice and equity" (Ransome-Kuti et al., 1989). The emphasis in health care provision is on the provision of primary health care (PHC), and states are free to determine how to achieve this goal. As a result, there is great diversity in the types and means of service provision across states. The organisation of stationary facilities is structured on a three-tier system. The primary tier, based at the locallevel, generally provides maternal and child health (MCH) care, preventive care and basic curative care. The secondary tier, based at the state level, is largely composed of district hospitals. These hospitals provide curative services, although preventive services are also available. At the federal level is the tertiary tier, which encompasses teaching hospitals. Due to the greater complexity of services available in urban areas, it was decided to limit the number of urban EAs covered in the service availability study to 20. 2 For example, all urban women sampled live less than one mile from a place that offers at least one method of family planning. 117 10.2 Nigeria Service Availability Questionnaire The service availability questionnaire was designed to provide a picture of the service environment available to Nigerian women. There are two types of mechanisms for providing services: outreach programmes and stationary facilities. The former deliver services directly to people in their communities, while the latter function as repositories of services, relying on people to come to them to obtain services. Outreach services are provided by health workers, mobile clinics, and market and retail outlets. The informants assembled for the cluster interview were asked whether their communities are served by such services, and if so, the nature of these services. For example, if a health worker visits the community, the informants were asked whether she provides family planning methods (and more specifically, the pill, condom, and foaming tablets), basic medications, ORS instruction, vitamins, and immunisations. Many types of stationary facilities exist. Community informants were asked to identify the nearest facility of each of the following types: a hospital (representing either the secondary or tertiary level), a health centre (the most complex primary health care facility), a health clinic, maternity centre or maternity home (facilities offering limited primary health care), a family planning clinic, and a pharmacy or patent medicine shop. Facilities said to be within six hours walking distance from the community were eligible to be visited by interviewers. One facility of each type was visited if it met the eligibility requirement. A second facility of each type would be visited if the first one visited did not provide family planning methods. When facilities were visited, detailed information regarding staff, equipment, services, fees, supplies, medications, vaccines, and contraceptives was collected. Attention was focussed on whether facilities had basic supplies, whether they experienced shortages of supplies or medicines, and whether equipment was in working order. Interviewers also verified the existence of equipment and supplies. Despite attempts to explain to local informants the differences between the various types of facilities, there were some instances in which informants identified a facility of one type, and upon visitation, interviewers found it to be another type of facility. This is referred to as misidentification. Interviewers were instructed to handle such situations as follows: if the respondents identify a health centre, and the interviewer learns upon visiting the facility that it is in fact a health clinic, the interviewer should conduct the site visit interview as one for a health clinic. (It is assumed that this facility is closer than any other health clinic that may have been identified in the cluster interview, because interviewers were to order their site visits so as to go to the closest one first). Misidentification of a facility has two results: a) if a health clinic was identified in the cluster interview it is not visited, and b) no health centre is visited (it is not known whether or not there is a health centre because informants and interviewers thought a health centre had been identified during the cluster interview). When a facility of one type (e.g., health centre) is identified, but it is in fact of another type (e.g., health clinic), then the type of facility originally identified (the health centre), may or may not exist. The health centre is therefore classified in the no facility known category in the following tables. 10.3 Availability of Family Planning Services Outreach Programmes While outreach programmes are reported in only a minority of communities, they do exist (see Table 10.1). Ten percent of currently married rural women live in communities served by a health worker who provides family planning services. Health workers provide family planning services to 13 percent of the women in the Southeast and to 15 percent of the women in the Northwest. 118 Table 10.1 Distance to nearest family planning services Percentage of cun~ently married (rural) women age 15-49 who live in communities served by family plmming (FP) outxeaeh services, and the percent distribution of these women by distance to the nearest facility providing family planning services, according to region, Nigeria 1990 FP outreach services and distance to nearest facility providing FP services Northeast Northwest Southeast Southwest Total Outreach services Health worker 1.1 15.3 13.3 8.7 9.8 Mobile clinic 1.1 7.9 1.3 0.0 3.2 Market outlet 0.0 2.4 0.0 4.9 1.3 Miles to nearest stationary facility t Under 1 10.8 5.1 9.4 20.3 9.6 1-4 24.4 18.6 26.1 12.7 21.8 5-9 15.3 18.3 7.0 13.3 13.7 10-14 22.9 32.8 6.6 2.1 19.1 15-29 15.4 4.0 8.4 48.5 13.4 30+ 8.4 3.4 1.0 3.0 4.2 Distmace unknown 1.7 0.0 2.0 0.0 1.1 No facility known 1.0 17.8 39.6 0.0 17.1 Total 100.0 100.0 100.0 100.0 100.0 Number of women 1,622 1,668 1,545 569 5,404 Percent with a family planning campaign within past year 15.3 1.1 29.8 42.3 17.9 Number of EAs 52 36 57 21 166 Note: Regional information may be subject to large sampling errors due to the small number of sampling points. IDistmee was obtained from the community-level service availability survey. Stationary Facil ities Thirty percent of currently married rural women live within 5 miles of a facility that provides family planning (see Table 10.1); however, in the Northwest, only one-quarter live within 5 miles of a facility that provides family planning. As many as 40 percent of women in the Southeast live in communities where the informants were unable to identify a stationary facility which provides family planning services. The opposite is tree in the Southwest, where all the women live in communities with a stationary facility providing family planning services. In format ion Campaigns Informants in the cluster interview were asked whether there had been an information campaign in the community within the past year which included family planning messages that promoted specific family planning methods or the general benefits of contraception. Whether or not there had been a family planning 119 campaign in the preceding year varied greatly by region (see Table 10.1). As many as 42 percent of the women in the Southwest live in communities which had a campaign in the previous year, whereas only one percent of women in the rural Northwest live in communities which recently had a family planning information campaign. Although not presented here, informants were also asked to report what the messages of the family planning or health campaigns were. Availability of Family Planning by User Status Women cannot use family planning methods unless they are available (with the exception of rhythm and withdrawal). How different are the users and nonusers of family planning with regard to access? Do the contraceptive users live in communities with better access? Table 10.2 shows that 37 percent of users of supply methods live within one mile of a facility offering family planning methods, compared to 9 percent of nonusers. In fact, over one-half of nonusers either live 10 or more miles from a facility that offers family planning, or were unable to identify any facility that offers family planning. Yet, few of these nonusers live in communities served by an outreach programme. Thus, lack of availability may be one reason for nonuse. Table 10.2 Distance to nearest family planning services for users/nonusers of family planning Percentage of currently married (rural) women age 15-49 who live in communities served by family planning (FP) outreach services, and the percent distribution of these women by distance to the nearest facility providing family planning services, according to use of family planning and type of method used, Nigeria 1990 Family planning users FP outreach services and distance to Tradi- nearest facility Clinical Supply tional All All providing FP services methods methods methods users Nonusers women Outreach ~rvlces Health worker 19.0 5.3 12.2 10.8 9.7 9.8 Mobile clinic 3.5 0.8 2.7 2.2 3.2 3.2 Market outlet 2.1 2.5 0.0 1.3 1.3 1.3 Miles to nearest stationary facility 1 Under 1 21.2 37.3 28.3 30.4 8.8 9.6 1-4 36.4 14.7 38.6 29.6 21,6 21.g 5-9 13.8 9.2 12.1 11.3 13.8 13.7 10-14 2.1 11.1 3.6 6.1 19.6 19.1 15-29 13.8 15.5 6.0 10.7 13.5 13.4 30+ 0.0 1.1 0.2 0.5 4.3 4.2 Distance unknown 0.0 0.0 2.0 1.0 1. l 1.1 No facility known 12.7 11.1 9.3 10.5 17.4 17.1 Total 100.0 100.0 100.0 100,0 100.0 100.0 Number of women 32 70 93 196 5,209 5,404 Percent with a family planning campaign within past year 37.3 16.3 27.8 25.2 17.6 17.9 IDistance was obtained from the community-level service availability survey. 120 Tables 10.3 and 10,4 show the distributions of women by distance and one-way travel time to the nearest facility providing family planning, (The medians are for those reporting a time or distance). The majority of rural women live in communities in which respondents were able to identify at least one facility providing family planning. Twenty-seven percent of rural women live within one hour of a hospital which provides family planning services; but nearly one-half of rural women live in communities in which respondents were unable to identify a hospital which provides family planning; and as many as three-quarters of women live in communities in which respondents were unable to identify a health clinic or pharmacy which provides family planning. Table 10.3 Distance to nearest family plarmin~ services by type of facility Percent distribution of currently married (rural) women age 1549 by distance to nearest facility providing family planning (FP) services/supplies, according to type of facility, Nigeria 1990 Distance to nearest facility providing Health Health FP All Public Private FP services/supplies Hospital clinic centre Pharmacy clinic types facility facility Miles to nearest stationary facility l Under 1 2.0 3.1 2.6 4.9 0.0 9.6 6.0 5.9 1-4 11.4 8.6 10.2 3.7 0.0 21.8 20.1 6.3 5-9 9.3 3.2 6.3 4.1 0.0 13.7 11.2 5.6 10-14 8.5 3.9 10.2 4.5 1.0 19.1 I6.3 6.0 15-29 15.3 2.5 5.7 3.8 0.2 13.4 7.7 4.8 30+ 6.8 1.3 0.8 0.1 1.4 4.2 1.2 0.1 Distance unknown 0.5 0.0 1.5 0.1 0.0 1.1 1.5 0.1 No facility known 46.2 77.4 62.5 78.8 97.4 17.1 35.9 71.1 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number of women 5,404 5,404 5,404 5,404 5,404 5,404 5,404 5,404 Median distance a 12.0 4.9 9.2 7.4 34.1 8.7 8.4 7.5 1Distance was obtained from the community-level service availability survey. 2Based on women having access to a facility of a specific known type. 121 Table 10.4 Time to nearest family planning services by type of facility Percent distribution of currently married (rural) women age 15-49 by one-way travel time to nearest facility providing family planning (FP) services/supplies, according to type of facility, Nigeria 1990 Time in minutes to facility providing Health Health FP All Public Private FP services/supplies Hospital clinic centre Pharmacy clinic types facility facility One-way travel time I Under 15 1.3 3.3 2.1 3.4 0.0 8.0 4.5 4.4 15-29 3.5 3.3 2.2 2.2 0.0 5.8 5.1 3.1 30-59 22.3 4.6 8.3 7.7 0.0 24.5 22.6 10.3 60-119 9.1 5.5 6.4 3.3 0.2 14.8 11.1 4.8 120+ 17.5 5.9 17.3 4.4 2.4 29.0 19.7 6.2 Time unknown 0.2 0.0 1.1 0.1 0.0 0.7 1.1 0.1 No facility known 46.2 77.4 62.5 78.8 97.4 17.1 35.9 71.1 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number of women 5,404 5,404 5,404 5,404 5,404 5,404 5,404 5,404 Median time 2 55.9 60.0 90.8 40.4 135.8 60.3 55.9 40.7 ITime was obtained from the community-level service availability study. 2Based on women having access to a facility of a specific known type. 10.4 Ava i lab i l i ty o f Materna l and Ch i ld Hea l th Serv ices Table 10.5 indicates that almost all women live in communities where informants were able to identify a facility which provides maternal and child health (MCH) services. Nearly 70 percent of women in the Southeast live within 5 miles of a facility which offers maternal and child health services. In the Northwest, only 38 percent of women live within 5 miles of such a facility; and, just over half of the women in the Southwest and in the Northeast l ive within 5 miles of an MCH facility. While everyone may not be in the immediate vicinity of a health facility, it is clear from comparing Tables 10.1 and 10.5 (see also Figure 10.1) that facilities offering health services are much more available than those offering family planning services. Util ising the existing health system for family planning services may be a viable option for increasing the availability of family planning. 122 Table 10.5 Distance to nearest maternal and child health services Percemage of cta-tently married (rural) women age 15-49 who live in communities served by maternal and child health (MCH) services, mad the percent distribution of these women by distance to the nearest facility providing maternal and child health services, according to region, Nigeria 1990 MCH outreach services and distance to nearest facility providing MCH services Northeast Northwest Southeast Southwest Total Outreach services Health worker 50.6 39.7 66.3 87.5 55.6 Mobile clinic 30.3 32.7 14.3 28.5 26.3 Health post 28.6 25.9 28.6 24.3 27.3 Retail outlet 47.4 47.5 15.6 39.9 37.6 Market outlet 59.3 54.4 28.9 38.6 46.9 Miles to nearest stationary facility t Under 1 20.2 13.1 41.6 38.5 26.0 1-4 36.2 25.2 25.5 13.2 27.3 5-9 11.9 19.4 2.0 20.6 12.3 10-14 20.0 34.1 11.2 4.7 20.2 15-29 7.0 6.9 7.5 23.0 8.8 30+ 3.5 1.4 6.7 0.0 3.4 Distance unknown 1.1 0.0 0.0 0.0 0.3 No facility known 0.0 0.0 5.5 0.0 1.6 Total 100.0 100.0 100.0 100.0 100.0 Number of women 1,622 1,668 1,545 569 5,404 Percent with a health campaign within past year Number of EAs 46.9 51.0 34.2 65.7 46.5 52 36 57 21 166 Note: Regional information may be subject to large sampling errors due to the small numbex of sampling point. tDistance was obtained from the communlty-level service availability study. 123 Figure 10.1 Distribution of Currently Married Rural Women by Nearest Source of Family Planning/Health Services 10+ miles 37% ~ 5-9 miles 14% No Faciliiy Known 17 0-4 miles 31% Family Planning Services 0-4 miles 54% Health Services NDHS 1990 Table 10.6 shows that 55 percent of young children live within 5 miles of a stationary facility which provides MCH services. Whereas the majority of children born to mothers who received both antenatal care and delivery assistancelive within 5 miles of a stationary facility providing MCH (72 percent), about one-half of children whose mothers did not receive full care (i.e., they received neither antenatal care nor delivery assistance, or received only one or the other) also live within 5 miles of a facility. So, it is not the case that all mothers who received neither antenatal care nor delivery assistance live too far from a facility offering MCH services. Table 10.6 also shows that children who received all the recommended vaccinations before the age of one year are about 50 percent more likely than children who did not receive the full schedule of vaccinations to live within 5 miles of a facility offering MCH services. But all children, those fully vaccinated and those not, have fairly equal access to outreach services. 124 Table 10.6 Distance to nearest maternal and child health services for children Percentage of children (rural) age 0-4 years who live in communities served by maternal and child health (MCH) services, and the percent distribution of these children by distance to the nearest facility providing maternal and child health services, according to maternal care and vaccination coverage, Nigeria 1990 Maternal care t Vaccination coverage 2 MCH outreach services and distance to nearest Neither All Some/no facility providing All ANC & ANC or ANC vaccina- vaccina- MCH services children DA DA nor DA tions 3 tions Outreach services Health worker 55.9 66.0 49.1 54.8 58.8 54.9 Mobile clinic 23.7 16.1 12.7 33.6 16.8 24.2 Health post 29.0 32.4 22.0 31.2 34.2 28.5 Retail outlet 33.7 23.3 27.4 42.2 26.8 34.2 Market outlet 43.9 33.7 31.4 55.8 37.4 44.3 Miles to nearest stationary facility 4 Under 1 27.9 49.3 23.9 19.8 42.9 26.3 1-4 27.0 22.8 21.1 32.3 23.4 27.0 5-9 11.0 9.9 6.4 14.2 5.7 11.1 10-14 19.4 9.7 34.0 15.8 16.8 20.1 15-29 8.9 5.4 8.8 10.6 5.6 9.5 30+ 3.7 1.5 1.7 5.9 2.7 3.9 Distance unknown 0.5 0.2 1.2 0.3 1.4 0.4 No facility known 1.6 1.1 2.9 1.1 1.7 1.6 Total 100.0 100.0 100.0 100.0 100.0 100.0 Number of children 6,469 1,533 1,771 3,164 539 4,549 Percent with a health campaign within past year 47.8 58.7 63.4 33.9 55.0 47.8 IANC = An~natal care by doctor, nurse, or trained midwife DA = Delivery assistance by doctor, nurse, trained midwife, or delivered in a health facility. 2Figures are for children age 1-4 years 3Received BCG, measles, and three doses of DPT and polio vaccines before first birthday 4Distance was obtained from the community-level service availability survey Tables 10.7 and 10.8 show the distributions of currently married rural women by distance and one- way travel time to the nearest facility providing MCH services. Almost all women live in communities in which respondents were able to identify at least one facility providing MCH services, and one-half live within 5 miles (or within one hour travel time) of such a facility. 125 Table 10.7 Distance to nearest mammal and child health services by type of facility Percent distribution of cm'renfly married (rural) woman age 15-49 by distance to nearest facility providing maternal and child health (MCH) services, according m type of facility, Nigeria 1990 I~.$larice to I~al'eat facility providing Health Health All Public Private MCH services Hospital clinic centre Pharmacy types facility facility Miles to facility t Undea" 1 3.8 8.2 6.8 20.1 26.0 13.1 21.2 1-4 12.5 16.2 14.3 22.8 27.3 23.2 24.6 5-9 10.0 6.4 10.5 12.8 12.3 14.7 11.4 10-14 10.0 6.4 14.2 16.2 20.2 16.6 17.4 15-29 18.7 4.2 10.0 4.9 8.8 8.1 5.9 30+ 11.4 1.9 2.6 1.2 3.4 0.6 1.2 Distmace unknown 0.5 1.0 1.4 0.1 0.3 0.4 1.0 No such facility known 33.1 55.7 40.2 21.9 1.6 23.3 17.2 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number of women 5,404 5,404 5,404 5,404 5,404 5,404 5,404 Median distance 2 13.2 4.5 9.3 4.0 4.1 6.2 4.0 1Dist.'ace was obtained from the community-level service availability survey. 2Breed on women having access to a facility of a known specific type. Table 10.8 Time to nearest maternal mad child health services by type of facility Percent distribution of currently married (rmal) women age 15-49 by one-way ~'avel time to nearest facility providing mstea-nal mad child health (MCH) services, according to type of facility, Nigeria 1990 Time in minutes to nearest facility Health Health All Public Private providing MCH services Hospital clinic centre Pharmacy types facility facility One-way travel t ime ~ Under 15 2.6 8.0 7.0 18.4 22.6 11.5 19.4 15-29 3.7 8.2 3.7 9.2 12.0 8.3 8.7 30-59 24.8 6.0 11.4 12.4 16.0 18.9 12.2 60-119 11.7 9.8 9.9 12.7 15.4 13.7 14.5 120+ 23.9 11.2 26.0 25.3 31.8 24.3 26.9 Time unknown 0.2 1.0 1.7 0.1 0.6 0.0 1.0 No facility known 33.1 55.7 40.2 21.9 1.6 23.3 17.2 Total 1130.0 100.0 100.0 100.0 100.0 100.0 100.0 Number of women 5,404 5,404 5,404 5,404 5,404 5,404 5,404 Median time 2 60.3 55.9 90.3 50.9 45.4 55.6 60.1 1Time was obtained from the community-level se~ice availability survey. 2Based on women having access to a facility of a specific known type. 126 REFERENCES FederalMinistry of Health [Nigeria]. 1988. NationalPolicyonPopulationforDevelopment, Unity,Progress and Self-Reliance. Lagos, Nigeria: Department of Population Activities. Federal Office of Statistics [Nigeria]. 1963. Population Census of Nigeria, 1963 Combined National Figures. Lagos, Nigeria. London, Kathy A., Jeanne Cushing, Shea O. Rutstein, John Cleland, John E. Anderson, Leo Morris, and Sidney H. Moore. 1985. Fertility and Family Planning Surveys: An Update. Population Reports, Series M, No. 8. Baltimore, Maryland: Johns Hopkins University, Population Information Program. Martorell, R. and J.P. Habicht. 1986. Growth in Early Childhood in Developing Countries. In Human Growth: A Comprehensive Treatise, ed. by Frank Falkner and J.M. Tanner, Vol. 3, 241-262, New York: Plenum Press. National Population Bureau [Nigeria] and World Fertility Survey. 1984. The Nigeria Fertility Survey 1981/82: Principal Report. Vol. 1: Methodology and Findings. Lagos, Nigeria: National Population Bureau. National Population Bureau [Nigeria[ and Institute for Resource Development/Westinghouse [1988]. National Demographic Sample Survey (NDSS) 1980: Nigeria National Report. Columbia, Maryland: IRD/Westinghouse. Ransome-Kuti, O., A.O.O. Sorungbe, K.S. Oyegbite, and A. Bamisalye, eds. [ 1989] Strengthening Primary Health Care at Local Government Level: The Nigerian Experience. Lagos, Nigeria: Academy Press Ltd. Rutstein, Shea Oscar and George T. Bicego. 1990. Assessment of the Quality of Data Used to Ascertain Eligibility and Age in the Demographic and Health Surveys. In An Assessment of DHS-I Data Quality, 3-37. Institute for Resource Development/Macro Systems. DHS Methodological Reports, No.1. Columbia, Maryland. Sullivan, Jeremiah M., George T. Bicego, Shea Oscar Rutstein. 1990. Assessment of the Quality of Data Used for the Direct Estimation of Infant and Child Mortality in the Demographic and Health Surveys. In An Assessment of DHS4 Data Quality, 113-14. Institute for Resource Development//Vlaero Systems. DHS Methodological Reports, No. 1. Columbia, Maryland. 127 APPENDIX A PERSONS INVOLVED IN THE NIGERIA DEMOGRAPHIC AND HEALTH SURVEY APPENDIX A PERSONS INVOLVED IN THE NIGERIA DEMOGRAPHIC AND HEALTH SURVEY Project Director Mr. 0.0. Ajayi Project Statisticians Mr. C.F. Adcgbulugbe Miss. V.A. Adeycmi Mr. R.O. Salawu Resource Persons Mrs. R.A. Adade Mr. J.O. Adcdire Mr. M. Oyediran Mrs. V.T. Ayo Anthropometric Assistants Mr. Y.I. Ifalomomi Mrs. I. Azeez NDHS STAFF Project Coordinator Mr. O.F. Adedeji Data Processing Staff Mr. Fred Adeoye Mr. Alalade Mr. John Agaba Mrs. S. Odcjayi Mr. Fcstus Odion Typists Mr. Michael lbanga Mrs. Elizabeth Obugo Jeremiah Sullivan Kia I. Rcinis Thanh Le Fred Arnold Christopher Scott Trevor Croft IRD/DHS STAFF Elizabeth Britton David Cantor Marilyn Wilkinson Irwin Shorr Tics Bocrma Wamucii Njogu 131 FIELD COORDINATORS Regional Officers A. Idowu O.C. Akinyede, Lagos/Ogun O.A.U. Essien, SE A.Sj. Mayaki, NW W.T. Marcathy, NE State Officers R.O. Oke O.C. Moneke Abifarin J.A. Fasamni S.O. Awoniyi B.O. Amobi O.E. Okon G.I. Ichi A. Onyeaka J. Nwokorokwu J.J. Kojusola Oyo Kwara Ondo Ogun Lagos Anambra Imo Rivers Bendel Cross River Akwa Ibom B.B. Adetimirin G. Oparakwu A.A. Mohammed Samanja F.A. Olaniyan A.T. Odunlami L.L. Gambo I. Audu S.A. Adeosun J.O. Elutade I. Raji FIELD STAFF Southwest Teams Supervisors Interviewers F.A. Adedokun F.O. Adeosun S.A. Adeyemi S.A. Adedeji Olubiyi Balogun M.I. Dada Keshinro Oladele Editors T. Olanlokun O.M. Adu K.R. Rabiu D. Fagbamila O.F. Onasanya A. Oni A. Adebanjo F. Fatoki A. Akinwumi B.T. Olaleye B. Olanrewaju A. Ottun M. Oni M. Olayiwola T. Oni E. Olanibofin T. Okosun M. Ogagbayi B. Folonunsho V. Emechete H. Atoyebi B. Aminu F. Akinwande A. Adelabi J. Oyekunle A. Philips K. Olukoya B. Rufus C. Olawuyi Kano Katsina Kaduna Sokoto Niger Abuja Gongola Bomo Bauchi Benue Plateau 132 Supervisors E.I. Essien E. Imosili V. Onuze N. Nwokedi K.K. Uduma P.N. Bani Editors G. James M. Asibor G. Wilcox R. Osuji R. Ezenwelu E. Ifudu Supervisors P.S. Abaya Baga Jalo Musa Oshonie D.A. Ikagu Editors R. Sampson S. Arthimas T. Daniel Y. Mbawuese B. Dakon Southeast Teams I. Okon C. Ukpong E. Oku A. Bassey R. Ajayi M. Egbujor J. Ogbechie A. Agborubere L. Asawo E. Dienagha U. Nduka Northeast Teams R. Kwarvul H. Pam K. Shem L. Bulus P. Damisa L. Audu A. Babakura A. Sgt. Ali A. Aliyu Interviewers Interviewers A. Oparakwu N. Onyekwu J. Amobi E. Nwosu W. Ochei A. Osondu N. Anyaoha D. Gloria N. Ottah E. Ojide A. Ojobo B. Iveren L. Gundu E. Ochigbo F. Benjamin J. Ezekiel K. Kwande L. Polycarp Supervisors Dahiru Musa M.M. Gom M. Imoisemi T.Y. Dankat E.A. Williams Editors C. Clement P. Jatau F. Adisa G. Samuel A. Kadiri Northwest Teams M. Aliyu S. Odiri L. Ibrahim D. Umenu U. Abdullai A. Yakubu V. Raphael R. Kami P. Kanwai S. Abass Interviewers M. Olagunju C. lnusa H. Fagge B. Zakari Z. Jimoh H. Yahaya B. Muse J. Bawa B. Adamu Z. Peppah 133 APPENDIX B SURVEY DESIGN APPENDIX B SURVEY DESIGN B.1 Sample Design and Implementation The NDHS Sample was drawn from the National Master Sample for the 1987/1992 National Integrated Survey of Households (NISH) programme being implemented by the Federal Office of Statistics (FOS). NISH, as part of the United Nations National Household Survey Capability Programme, is a multi- subject household-based survey system. The NISH master sample was created in 1986 on the basis of the 1973 census enumeration areas (EA). Within each state, EAs were stratified into three sectors (urban, semiurban, and rural), from which an initial selection of approximately 8C0 EAs was made from each state. EAs were selected at this stage with equal probability within sectors. A quick count of households was conducted in each of the selected EAs, and a final selection of over 4,000 EAs was made over the entire country, with probability proportional to size. This constitutes the NISH master sample from which the NDHS EAs were subsampled. Prior to the NDHS selection of EAs, the urban and semiurban sectors of NISH were combined into one category, while the rural retained the NISH classification. A sample of about 10,000 households in 299 EAs was designed with twofold oversampling of the urban stratum, yielding 132 urban EAs and 167 rural EAs. ~ The sample was constructed so as to provide national estimates as well as estimates for the four Ministry of Health regions. The distribution of the states across these regions is shown below. NORTHEAST NORTHWEST SOUTHEAST SOUTHWEST Bauchi Abuja FCT Akwa Ibom Bendel Bored Kaduna Anambra Lagos Gongola Katsina Benue Ogun Kano Kwara Cross River Ondo Plateau Niger Imo Oyo Sokoto Rivers The NDHS conducted its own EA identification and listing operation; a new listing of housing units and households was compiled in each of the selected 299 EAs. For each EA, a list of the names of the head of households was constructed, from which a systematic sample of 34 households was selected to be interviewed. A fixed number of 34 households per EA was taken in order to have better control of the sample size (given the variability in EA size of the NISH sample). Thus, the NDHS sample is a weighted sample, maintaining the twofold over sampling of the urban sector. The sample for Lagos state was drawn from the newly demarcated area frame carried out by the National Population Bureau in 1990. 137 Table B.1 Results of the household and individual interviews by residence and region Percent distribution of households and eligible women in the sample by results of the household and individual interviews, and household, eligible women and overall response rates, according to residence and region, Nigeria 1990 Residence Region Urban Rural Northeast Northwest Southeast Southwest Total Selected households Completed (C) 87.2 92.3 92.2 92.9 90.7 86.7 90.0 Household present but no competent respondent at home (HP) 0.4 0.1 0.0 0.1 0.2 0.5 0.2 Postponed (P) 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Refused (R) 1.6 0.4 0.2 0.4 0.4 2.0 0.9 Dwelling not found (DNF) 0.8 0.4 0.5 0.5 0.4 0.8 0.6 Household absent (HA) 4.1 3.0 2.1 2.3 4.7 4.1 3.5 Dwelling vacant/address not a dwelling (DV) 3.1 2.6 3.8 2.7 1.5 3.3 2.8 Dwelling destroyed (DD) 0.6 0.3 0.3 0.2 0.8 0.4 0.4 Other (O) 2.2 0.9 0.9 1.1 1.3 2.2 1.5 Total percent 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number 4438 5560 2188 1695 2622 3493 9998 Household response rate (HRR) a 96.9 99.0 99.2 99.1 98.9 96.3 98.1 Eligible women Completed (EWC) 94.4 96.2 97.0 97.3 95.7 93.1 95.4 Not at home (EWNH) 3.2 2.0 1.6 1.6 2.0 4.1 2.5 Postponed (EWP) 0.1 0.1 0.0 0.1 0.2 0.2 O. 1 Refused (EWR) 0.7 0.3 0.3 0.2 0.3 0.8 0.5 Partly completed (EWPC) 0.6 0.3 0.2 0.2 0.3 0.9 0.4 Other (EWO) 1.0 1.1 0.8 0.7 1.5 1.0 1.0 Total percent 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number 3741 5459 2102 1747 2428 2923 9200 Eligible woman response rate (EWRR) b Overall response rate (ORR) c 95.3 97.2 97.7 98.0 97.2 94.0 96.5 92.4 96.3 96.9 97.1 96.1 90.6 94.6 aUsing the number of households falling into specific response categories, the household response rate (HRR) is calculated as: C C +HP+P+R+DNF bUsing the number of eligible women falling into specific response categories, the eligible woman response rate (EWRR) is calculated as: EWC EWC + EWNH + EWP + EWR + EWPC CThe overall response rate (ORR) is calculated ~: ORR = HRR * EWRR 138 Table B. 1 summarises the results of the household and individualinterviews by residence and region. The household response rate for the NDHS was 98.1 percent (96.9 percent in urban areas and 99 percent in rural areas). The household response rates varied by region from 96.3 percent in the Southwest to 99.2 in the Northeast. For women eligible for the individual interview, the response rate was 96.5 (95,3 percent in urban areas and 97.2 percent in rural areas). The eligible woman response rate varied by region from 94.0 percent in the Southwest to 98.0 percent in the Northwest. The overall response rate, which is the product of the household response rate and the eligible woman response rate, was 94.6 percent (92.4 percent in urban areas and 96.3 percent in rural areas). The overall response was 96 percent or higher in all the regions except Southwest (90.6 percent). B.2 Fieldwork and Data Analysis Questionnaires The household and individual questionnaires were adapted from the DHS model B questionnaire, which was designed for use in countries with low contraceptive prevalence. The questionnaires were developed in English, and then translated by experienced translators into six of the major Nigerian languages: Efik, Hausa, Igbo, Kanuri, Tiv, and Yoruba. An independent translator translated the questionnaires back into English. Painstaking steps were then taken to reconcile the local language with the original English. English versions of the questionnaires are reproduced in Appendix E. Pretest A pretest exercise was carried out on NDHS with a view to ensuring that the questions were in a logical sequence, that the translations were comprehensible, appropriate and meaningful, and that the preceded answers were adequate. The pretest was conducted in January and February of 1990. Fieldwork was conducted in both urban and rural EAs and in each of the four regions, and all language questionnaires were tested. Training lasted two weeks and was comprised of classroom training on the questionnaires and field practice. Invited for the first two days of the training were the FOS regional and state officers from the seven pretest states namely: Anambra, Benue, Boruo, Cross River, Kano, Lagos, and Oyo. Those involved in the intensive training were: six senior officers from FOS headquarters in Lagos, and three female interviewers and one FOS supervisor from each pretest state. In all, 21 newly recruited interviewers and 7 FOS supervisors participated in the pretest training exercise. DHS staffhandled the training on the questionnaire and supervised the field practice. At the end of training, the field staff went back to their respective states for the pretest fieldwork which lasted two weeks. At the end of the fieldwork, the interviewers and supervisors came back to Lagos for a debriefing exercise and all their experiences during the fieldwork were related. The six senior officers and the DHS staff who supervised the data collection in the states also related their experiences. All these experiences were used to improve the quality of the final version of the questionnaire. Recruitment of Field Staff The first activity before the commencement of the main survey data collection was the recruitment of interviewers and supervisors, which took place in March 1990 in the southern states, and in June 1990 in the northern states. The recruitment exercise in each state was done by NDHS project staff in the Lagos headquarters, with the assistance of FOS regional and state officers. Candidates were selected for maturity, minimum educational qualification of West African School Certificate or the General Certificate o f Education 139 (ordinary level), ability to read and speak one of the major Nigerian languages chosen for NDHS, and willingness to work in the field for several months. In all, 157 female candidates were recruited as interviewers and 30 FOS staff were selected as supervisors, including some who took part in the pretest exercise. At the end of four weeks intensive training, 125 female candidates (100 interviewers and 25 editors) and 25 supervisors were finally selected for the fieldwork. Assessment tests were used in selecting candidates. Training of Field Staff The training of field staff was carried out at four separate centres and in two phases, one in the North and one in the South. The southem training phase took place in Ibadan and Enugu, between March and April 1990. Two teams of two staff persons from FOS and one from DHS conducted the training at the centres. The same trainers conducted the northern phase of the training, which took place at Kaduna and Jos, between June and July 1990. The four FOS staff persons handled both training on the questionnaires and field practice, while DHS staff were available for back-up and technical assistance. Apart from the interviewers and supervisors who attended the 4-week training sessions, the FOS regional and state officers who served as field coordinators in their respective regions and states were also present at each centre for the first two days of the training. Four data processing officers from FOS headquarters in Lagos attended the training in Ibadan for two weeks, to familiarise themselves with the questionnaire and their responsibilities as data entry personnel for the survey. All training participants were provided accommodations in hotels, and the conference halls in these hotels were the venue for training. Each training session lasted four weeks. The first two weeks were devoted to classroom lectures, demonstrations of interviewing techniques, and instruction on how to complete the questionnaires and assignment sheets, using the instruction manuals as guides. By the third week of training, interviewers were grouped by language, with their supervisors, for practice reading the questionnaires and role playing. The fourth week was devoted to practice fieldwork in non-NDHS EAs near the training centre. The interviewers were assigned households to be interviewed in the local language. The completed questionnaires for practice fieldwork were checked by the trainers and supervisors and errors were discussed during the evening sessions before proceeding to the next EA. During training, a series of assessment tests was given to the interviewers and supervisors. These tests were graded and the results were used in selecting interviewers and supervisors; those candidates who had a better grasp of the questionnaire, and were adept at detecting errors in completed questionnaires, were designated as field editors. Two guest lecturers were invited to each training centre. A staff person from the Planned Parenthood Federation of Nigeria (PPFN) lectured on family planning methods and sources where methods can be obtained, and a staff person from Federal/State Ministry of Health, Primary Health Care Unit lectured on child health and immunisation. Anthropometry was taught over a two-week period, altemating training time with work on other sections of the individual questionnaire. In the southern phase, training was conducted by a DHS consultant on anthropometry, who was assisted by two FOS staff. In the northern phase, the two FOS staff conducted the anthropometric training. Arrangements were made with nurseries, day care centres, and hospitals for practice measuring of infants and children. All trainees received anthropometric training. 140 Composition of the Fieldwork Teams At the end of the one-month training course, the fieldworkers were selected from the larger pool of trainees. Over the four training sites, a total of 100 interviewers and 25 field editors were selected. Fieldwork teams were composed of four female interviewers, one female editor, one male or female supervisor, and one driver. In all, a total of 25 teams were engaged for the main survey. Fifteen teams were used in the southern phase of fieldwork (9 in the Southwest and 6 in the Southeast), and 10 teams were used in the nortbem phase (5 in the Northwest and 5 in the Northeast). Main Survey Fieldwork The main survey fieldwork commenced immediately after training. The first week of fieldwork was conducted in the states where training took place, covering both urban and rural EAs; one EA per team. The first week of fieldwork was done in the South in April 1990 and in the North in July 1990. At the end of the first week, a debriefing session was held, during which field staff and trainers related their experiences and problems. There were question and answer sessions and solutions to problems were discussed. The procedures and fieldwork plan and itinerary were discussed before the teams were posted to their respective states for the fieldwork. Fieldwork for the main survey was conducted in the South between April and July and in the North between July and October 1990. Thirty-four households were selected for interview in each EA (selection of households was done in the Lagos office from household listings). Women eligible for the individualinterview were identi fled during the household interview. Team supervisors located the housing units and assigned selected households to the interviewers. Completed household and individual questionnaires were handed over to the field editor, who checked to ensure that all relevant questions were correctly recorded, that the skip instructions were properly followed, and that responses were internally consistent. This field editing was done before the team left the EA so that the interviewer could return to the respondent to resolve any errors. Each questionnaire was field edited prior to being sent to the office in Lagos for data entry. Supervisors made sure that all the selected households and eligible respondents for an EA were interviewed, and that assignment sheets for the interviewers and supervisors were duly completed. All completed records were then tied together for submission to the FOS state office, for submission to Lagos headquarters. Data Processing Data processing staff for the NDHS consisted of four data entry clerks and one supervisor;, all were FOS staff. They were given periodic assistance by the DHS staff. Four IBM microcomputers were installed in the project office, FOS, Federal Secretariat and were used to process the data. All data entry occurred in the project office in Lagos. Before questionnaires were passed for data entry, office editing was conducted. This entailed checking for intemai consistency of responses recorded in the questionnaire, that skip instructions were properly followed, that there were no omissions, and that all entries were legible. This hastened the work of data entry staff. 141 Data entry started in April and was completed in October 1990. Once all the data had been entered, a final edit was conducted by running a computer programme to check for inconsistencies, and corrections were made (when possible) by referencing the original questionnaire. This final edit was completed in December 1990. The preliminary report was published in March 1991. 142 SCHEDULE OF ACTIVITIES FOR THE NIGERIA DEMOGRAPHIC AND HEALTH SURVEY Activity 1. Survey design and questionnaire development 2. EA identification and household listing 3. Preparation of sampling frame 4. Pretest 5. Printing questionnaires 6. Training for main survey 1st Phase (southern states) 2nd Phase (northern states) 7. Fieldwork for main survey 1st Phase (southem states) 2nd Phase (nor.bern states) 8. Data entry of main survey 9. Training for service availability questionnaire 10. Final data edit of main survey 11. Data entry of service availability questionnaire 1 I. Publication of preliminary report 12. Publication of first country report 13. Publication of summary report Month December January February January/February March March/April June/July April-July July-October April-October October December January March April May Year 1989 1990 1990 1990 1990 1990 1990 1990 1990 1990 1990 1990 1991 1991 1992 1992 143 APPENDIX C ESTIMATES OF SAMPLING ERRORS APPENDIX C ESTIMATES OF SAMPLING ERRORS The estimates from a sample survey are affected by two types of errors: (1) nonsampling error, and (2) sampling error. Nonsampling error is the result 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, or data entry errors. Although numerous efforts were made during the implementation of the NDHS 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 women selected in the NDHS 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. The sampling error is a measure of the variability between all possible samples. Although the degree of variability is not known exactly, it can be estimated from the survey results. Sampling error is usually measured in terms of the s tandard 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 percent of all possible samples of identical size and design. If the sample of women had been selected as a simple random sample, it would have been possible to use straightforward formulas for calculating sampling errors. However, the NDHS sample is the result of a two-stage stratified design, and, consequently, it was necessary to use more complex formulas. The computer package CLUSTERS, developed by the International Statistical Institute for the World Fertility Survey, was used to compute the sampling errors with the proper statistical methodology. The CLUSTERS 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: var(r)-- 1- f m~ r~ 2 zh x 2 h-t ~ 2.~z~--- ~=1 rak in which z~-- y~- r .xm,and z h-- Yh-r'x k where h mh Yhl x~ f represents the stratum which varies from I to H, is the total number of EAs selected in the h 'h stratum, th is the sum of the values of variable y in EA i in the h stratum, is the sum of the number of cases (women) in EA i in the h 'h stratum, and is the overall sampling fraction, which is so small that CLUSTERS ignores it. 147 In addition to the standard errors, CLUSTERS computes the design effect (DEFT) for each estimate, which is defined as the ratio between the standard error using the given sample design and the standard error that would result if a simple random sample had been used. A DEFT value of 1.0 indicates that the sample design is as efficient as a simple random sample, while a value greater than 1.0 indicates the increase in the sampling error due to the use of a more complex and less statistically efficient design. CLUSTERS also computes the relative error and confidence limits for the estimates. Sampling errors for the NDHS 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, and for the four health zones: Northeast, Northwest, Southeast, and Southwest. For each variable, the type of statistic (mean or proportion) and the base population are given in Table B. 1. Tables B.2 to B.8 present the value of the statistic (R), its standard error (SE), the number of unweighted (N) and weighted (WN) cases, the design effect (DEFT), the relative standard error (SE/R), and the 95 percent confidence limits (R~SE), for each variable. In general, the relative standard errors of most estimates for the country as a whole are small, except for estimates of very small proportions. There are some differentials in the relative standard error for the estimates of sub-populations such as geographical areas. For example, for the variable EVBORN (children ever born to women aged 15-49), the relative standard error as a percent of the estimated mean for the whole country, for urban areas and for the Southeast zone is 1.5 percent, 2.3 percent, and 2.7 percent, respectively. The confidence interval (e.g., as calculated for EVBORN) can be interpreted as follows: the overall average from the national sample is 3.311 and its standard error is .051. Therefore, to obtain the 95 percent confidence limits, one adds and subtracts twice the standard error to the sample estimate, i.e., 3.311+.102. There is a high probability (95 percent) that the true average number of children ever born to all women aged 15 to 49 is between 3.209 and 3.413. 148 Table C.I List of selected variables for sampling errors, Nigeria, 1990 VARIABLE URBAN SECOND NEVMAR CURMAR MAR20 SEX18 EVBORN EVB4049 SURVIV KMETHOD KSOURCE EVUSE CUSING CUMODERN CUPILL CUIUD CUSTERIL CUPABST NOMORE DELAY IDEAL TETANUS MDCARE DIARR1 DIARR2 ORSTRE MEDTRE HCARD BCG DPT3 POUO3 MEASLES FULLIM ESTIMATE Urban Proportion With secondary education or higher Proportion Never married Proportion Currently married Proportion Married before age 20 Proportion Had first sexual intercourse before 18 Proportion Children ever born Mean Children ever born to women over 40 Mean Children surviving Mean Know any contraceptive method Proportion Know source for any method Proportion Ever used any contraceptive method Proportion Currently using any method Proportion Currently using a modem method Proportion Currently using pill Proportion Currently using IUD Proportion Currently using female sterilisation Proportion Currently using periodic abstinence Proportion Want no more children Proportion Want to delay next birth at least 2 years Proportion Ideal number of children Mean Mothers received tetanus injection Proportion Received medical care at birth Proportion Had diarrhoea in last 24 hours Proportion Had diarrhoea in last 2 weeks Proportion Treated with ORS packets Proportion Consulted a medical facility Proportion Having health card, seen Proportion Received BCG vaccination Proportion Received DPT vaccination (3 doses) Proportion Received polio vaccination (3 doses) Proportion Received measles vaccination Proportion Fully immunised Proportion BASE POPULATION All women All women All women All women Women age 20 and older Women age 20 and older All women All women age 40-49 All women Currently married woman Currently married women Currently married women Currently married women Currently married women Currently married women Currently married women Currently married woman Currently married women Currently married women Currently married women All women Births in last 5 years Births in last 5 years Children under 5 Children under 5 Children under 5 with diarrhoea in last 2 weeks Children under 5 with diarrhoea in last 2 weeks Children 12-23 months Children 12-23 months Children 12-23 months Children 12-23 months Children 12-23 months Children 12-23 months 149 Table C.2 Sampling Errors - Entire Sample, Nigeria 1990 Variable Standard Value error (R) (SE) Number of cases Design Relative Confidence limits Unweighted Weighted effect error (N) (WN) (DEFT) (SE/R) R -2SE R+2SE URBAN SECOND NEVMAR CURMAR MAR20 SEX18 EVBORN EVB4049 SURVIV KMETHOD KSOURCE EVUSE CUSING CUMODERN CUP1LL CUIUD CUSTERIL CUPABST NOMORE DELAY IDEAL TETANUS MDCARE DIARR1 DIARR2 ORSTRE MEDTRE HCARD BCG DFI~ POL103 MEASLES FULLIM .249 .017 .189 .013 .172 .008 .784 .011 .706 .010 .633 .016 3.311 .051 6.488 .145 2.624 .036 .436 .017 .319 .018 .14o .010 .060 .006 .035 .003 .012 .002 .008 .001 .003 .000 .014 .003 .151 .007 .328 .008 5.823 .084 .535 .028 .308 .019 .083 .006 .179 .009 .116 .013 .251 .023 .315 .020 .574 .020 .311 .023 .312 .023 .426 .021 .276 .021 8,781.0 8,781.0 3.750 .069 .214 .284 8,781.0 8,781.0 3.142 .069 .163 .216 8,781.0 8,781.0 2.084 .049 .156 .189 8,781.0 8,781.0 2.403 .013 .762 .805 7,103.0 7,169.4 1.829 .014 .686 .726 7,103.0 7,169.4 2.835 .026 .60I .666 8,781.o 8,781.0 1.570 .015 3.21o 3.412 1,429.0 1,460.4 1.734 .022 6.198 6.778 8,781.0 8,781.o 1.399 .o14 2.552 2.696 6,696.0 6,880.1 2.833 .039 .402 .470 6,696.0 6,880.1 3.207 .057 .283 .356 6,696.0 6,880.1 2.412 .073 .119 .160 6,696.0 6,880.1 2.099 .lOl .048 .073 6,696.0 6,88o.1 1.478 .094 .029 .042 6,696.0 6,880.1 1.225 .134 .009 .016 6,696.0 6,880.1 1.123 .153 .006 .010 6,696.0 6,880.1 .0oo .000 .003 .003 6,696.0 6,880.1 1.886 .197 .008 .019 6,696.0 6,880.1 1.542 .045 .138 .165 6,696.0 6,880.1 1.424 .025 .311 .344 3,752.0 3,438.0 2.1o6 .014 5.655 5.992 7,819.0 8,118.2 3.867 .052 .480 .591 7,819.0 8,118.2 2.902 .063 .269 .347 6,784.0 7,027.6 1.650 .069 .072 .095 6,784.0 7,027.6 1.784 .049 .161 .196 1,117.0 1,255.7 1.288 .108 .091 .142 1,117.0 1,255.7 1.713 .090 .206 .296 1,488.o 1,535.5 1.636 .062 .276 .355 1,488.0 1,535.5 1.56o .035 .534 .614 1,488.0 1,535.5 1.933 .074 .265 .357 1,488.0 1,535.5 1.934 .074 .265 .358 1,488.0 1,535.5 1.661 .050 .384 .469 1,488.0 1,535.5 1.83o .077 .234 .318 150 Table C.3 Sampling Errors - Urban Areas, Nigeria 1990 Number of cases Variable Standard Value error (R) (SE) Design Relative Confidence limits Unweighted Weighted effect error (N) (WN) (DEBT) (SE/R) R-2SE R+2SE URBAN 1.000 .000 3,530.0 2,187.2 .000 .000 1.000 1.000 SECOND .421 .018 3,530.0 2,187.2 2.127 .042 .386 .457 NEVMAR .281 .012 3,530.0 2,187.2 1.579 .043 .257 .305 CURMAR .675 .013 3,530.0 2,187.2 1.646 .019 .649 .701 MAR20 .542 .016 2,793.0 1,725.5 1.648 .029 .510 .573 SEX18 .522 .017 2,793.0 1,725.5 1.821 .033 .487 .556 EVBORN 2.749 .064 3,530.0 2,187.2 1.322 .023 2.622 2.876 EVB4049 6.014 .246 462.0 290.0 1.713 .041 5.522 6.506 SURVIV 2.353 .050 3,530.0 2,187.2 1.222 .021 2.253 2.452 KMETHOD .704 .022 2,368.0 1,475.8 2.313 .031 .660 .747 KSOURCE .598 .023 2,368.0 1,475.8 2.284 .038 .552 .644 EVUSE .316 .016 2,368.0 1,475.8 1.699 .051 .283 .348 CUSING .149 .011 2,368.0 1,475.8 1.548 .076 .126 .172 CUMODERN .096 .007 2,368.0 1,475.8 1.189 .075 .081 .110 CUPILL .031 .004 2,368.0 1,475.8 1.151 .131 .023 .040 CUIUD .025 .003 2,368.0 1,475.8 .912 .116 .019 .031 CUSTERIL .004 .001 2,368.0 1,475.8 .978 .335 .001 .006 CUPABST .035 .006 2,368.0 1,475.8 1.625 .176 .022 .047 NOMORE .201 .011 2,368.0 1,475.8 1.282 .053 .180 .222 DELAY .330 .015 2,368.0 1,475.8 1.534 .045 .301 .360 IDEAL 5.008 .071 1,981.0 1,207.6 1.656 .014 4.866 5.149 TETANUS .769 .015 2,739.0 1,713.8 1.469 .019 .740 .798 MDCARE .593 .021 2,739.0 1,713.8 1.807 .036 .550 .636 DIARR1 .045 .005 2,471.0 1,531.8 1.154 .114 .034 .055 DIARR2 .117 .008 2,471.0 1,531.8 1.221 .071 .101 .134 ORSTRE .255 .041 246.0 179.4 1.522 .161 .173 .337 MEDTRE .403 .041 246.0 179.4 1.349 .101 .322 .485 HCARD .391 .027 523.0 336.6 1.245 .068 .337 .444 BCG .773 .020 523.0 336.6 1.089 .026 .733 .812 DPT3 .541 .030 523.0 336.6 1.368 .055 .481 .601 POLIO3 .544 .030 523.0 336.6 1.380 .056 .483 .604 MEASLES .633 .026 523.0 336.6 1.226 .041 .581 .685 FULLIM .484 .030 523.0 336.6 1.367 .062 .424 .544 151 Table C.4 Sampling Errors - Rural Areas, Nigeria 1990 Variable Standard Value error (R) (SE) Number of cases Design Relative Confidence limits Unweighted Weighted effect error (N) (WN) (DEFT) (SE/R) R-2SE R+2SE URBAN .000 .000 5,251.0 6,593.8 .000 .000 .000 .000 SECOND .112 .012 5,251.0 6,593.8 2.864 .111 .087 .137 NEVMAR .136 .009 5,251.0 6,593.8 1.931 .067 .118 .155 CURMAR .820 .012 5,251.0 6,593.8 2.219 .014 .796 .843 MAR20 .758 .013 4,310.0 5,443.8 1.984 .017 .732 .784 SEXI8 .668 .022 4,310.0 5,443.8 3.113 .034 .624 .713 EVBORN 3.497 .067 5,251.0 6,593.8 1.581 .019 3.364 3.631 EVB4049 6.605 .168 967.0 1,170.5 1.649 .025 6.269 6,942 SURV1V 2.714 .045 5,251.0 6,593.8 1.373 .017 2.623 2.805 KMETHOD .363 .019 4,328.0 5,404.3 2,649 .053 .324 .402 KSOURCE .243 .018 4,328.0 5,404.3 2.793 .075 .207 .279 EVUSE .091 .010 4,328.0 5,404.3 2.207 .106 .072 .111 CUSING .036 .006 4,328.0 5,404.3 2.145 .168 .024 .048 CUMODERN .019 .003 4,328.0 5,404.3 1.434 .157 .013 .025 CUPILL .007 .002 4,328.0 5,404.3 1.226 .221 .004 .010 CUIUD .003 .001 4,328.0 5,404.3 .000 .374 .001 .006 CUSTERIL .003 .000 4,328.0 5,404.3 .000 .000 .003 .003 CUPABST .008 .003 4,328.0 5,404.3 2.143 .368 .002 .014 NOMORE .137 .008 4,328.0 5,404,3 1.521 .058 .121 .153 DELAY .327 .010 4,328.0 5,404.3 1.342 .029 .308 .346 IDEAL 6.265 .117 1,771.0 2,230.4 1.889 .019 6.032 6.499 TETANUS .473 .038 5,080.0 6,404.4 4.173 .080 .397 .548 MDCARE .232 .020 5,080.0 6,404.4 2.592 .087 .192 .272 DIARR1 .094 .008 4,313.0 5,495.8 1.618 .080 .079 .I09 DIARR2 .196 .011 4,313.0 5,495.8 1.661 .054 .175 .217 ORSTRE .093 .013 871.0 1,076.3 1.183 .138 .068 .119 MEDTRE .226 .026 871.0 1,076.3 1.696 .117 .173 .279 HCARD .294 .024 965.0 1,198.9 1.651 .083 .245 .343 BCG .518 .025 965.0 1,198.9 1.540 .049 .468 .568 DPT3 .246 .025 965.0 1,198,9 1.821 .103 .195 ,297 POLIO3 .246 .025 965.0 1,198.9 1.821 .103 .195 .297 MEASLES .368 .026 965.0 1,198.9 1.648 .070 .317 .420 FULLIM .218 .023 965.0 1,198.9 1.744 .107 .171 .265 152 Table C.5 Sampling Errors - Northeast Region, Nigeria 1990 Number of Gases S ta-ndard Design Relative Confidence limits Value error Unweighted Weighted effect error Variable (R) (SE) (N) (WN) (DEFT) (SE/R) R-2SE R+2SE URBAN .127 .019 SECOND .044 .012 NEVMAR .057 .009 CURMAR .925 .010 MAR20 .891 .014 SEX18 .823 .019 EVBORN 3.340 .086 EVB4049 5.751 .285 SURVIV 2.543 .074 KMETHOD .240 .028 KSOURCE .181 .022 EVUSE .057 .011 CUSING .020 .004 CUMODERN .013 .003 CUPILL .005 .002 CUIUD .001 .000 CUSTERIL .002 .001 CUPABST .000 .000 NOMORE .089 .013 DELAY .339 .021 IDEAL 6.634 .237 TETANUS .348 .033 MDCARE .108 .016 DIARR1 .137 .014 DIARR2 .239 .022 ORSTRE .136 .028 MEDTRE .255 .030 HCARD .196 .027 BCG .392 .039 DPT3 .167 .022 POLIO3 .167 .022 MEASLES .293 .029 FULLIM .149 .020 2,038.0 1,999.5 2.636 .153 .088 .166 2,038.0 1,999.5 2,734 .281 .019 .069 2,038.0 1,999.5 1,749 .158 .039 .075 2,038.0 1,999.5 1.627 .010 .905 .944 1,682.0 1,647.1 1,874 .016 .863 .920 1.682.0 1,647.1 2.001 .023 .786 .861 2,038.0 1,999.5 1,318 .026 3.169 3.511 350.0 339.4 1,450 .050 5,181 6,321 2,038.0 1,999.5 1.527 .029 2,395 2,691 1,877.0 1,848.6 2.878 .118 .183 .297 1,877.0 1,848.6 2,438 .120 .137 .224 1,877.0 1,848.6 2.030 .190 .035 .079 1,877.0 1,848.6 1.244 .201 .012 .028 1,877.0 1,848.6 1,041 .205 .008 .019 1,877.0 1,848.6 1,275 .401 .001 .010 1,877.0 1,848.6 .000 .000 .001 .001 1,877.0 1,848.6 1.302 .639 -.001 .005 1,877.0 1.848.6 .000 .000 .000 .000 1,877.0 1,848.6 2,025 .149 .063 .116 1,877.0 1,848.6 1,913 .062 .297 .380 517.0 541.3 1.840 .036 6,160 7.108 1,933.0 1.923.7 2.489 .096 .282 .414 1,933.0 1.923.7 1,789 .148 .076 .141 1,647.0 1,653.2 1.526 .102 .109 .165 1,647.0 1,653.2 1,986 .093 .194 .284 395.0 395.2 1.570 .205 .080 .192 395.0 395.2 1,295 .119 .194 .315 401.0 397.7 1.390 .140 .141 .251 401.0 397.7 1,616 .101 .313 .471 401.0 397.7 1,175 .132 .123 .211 401.0 397.7 1.175 .132 .123 .211 401.0 397.7 1.289 .100 .234 .351 401.0 397.7 1.149 .137 .108 .190 153 Table C.6 Sampling Errors - Northwest Region, Nigeria 1990 Variable Standard Value error (R) (SE) Number of cases Design Relative Confidence limits Unweighted Weighted effect error (N) (WN) (DEFT) (SE/R) R-2SE R+2SE URBAN .157 .036 1,699.0 2,098.1 4.120 .232 .084 .229 SECOND .043 .010 1,699.0 2,098.1 2.131 .245 .022 .063 NEVMAR .060 .010 1,699.0 2,098.1 1.699 .163 .040 .079 CURMAR .926 .008 1,699.0 2,098.1 1.325 .009 .910 .943 MAR20 .829 .041 1,428.0 1,790.3 4.070 .049 .748 .911 SEX18 .742 .074 1,428.0 1,790.3 6.368 .099 .595 .890 EVBORN 3.44I .124 1,699.0 2,098.1 1.814 .036 3.192 3.690 EVB4049 6.207 .391 276.0 340.1 2.016 .063 5.424 6.990 SURVIV 2.579 .062 1,699.0 2,098.1 1.168 .024 2.455 2.703 KMETHOD .303 .030 1,561.0 1,943.6 2.537 .097 .244 .362 KSOURCE .152 .019 1,561.0 1.943.6 2.143 .128 .113 .I91 EVUSE .044 .008 1,561.0 1.943.6 1.603 .190 .027 .060 CUSING .012 .004 1,561.0 1,943.6 1.563 .356 .004 .021 CUMODERN .007 .003 1.561.0 1,943.6 1.225 .362 .002 .013 CUPILL .004 .002 1,561.0 1,943.6 1.094 .418 .001 .008 CUIUD .002 .000 1,561.0 1,943.6 .000 .000 .002 .002 CUSTERIL .000 .000 1,561.0 1,943.6 .000 .000 .000 .000 CUPABST .000 .000 1,561.0 1,943.6 .000 .000 .000 .000 NOMORE .100 .013 1,561.0 1,943.6 1.668 .126 .075 .126 DELAY .322 .011 1,561.0 1,943.6 .946 .035 .300 .344 IDEAL 6.731 .425 323.0 319.5 2.549 .063 5.880 7.581 TETANUS .433 .101 1,870.0 2,241.5 6.542 .233 .231 .636 MDCARE .101 .016 1,870.0 2,241.5 1.726 .155 .070 .132 DIARR1 .119 .017 1,532.0 1,862.2 1.925 .141 .085 .152 DIARR2 .257 .016 1,532.0 1,862.2 1.381 .064 .224 .290 ORSTRE .107 .019 364.0 478.3 1.029 .177 .069 .144 MEDTRE .241 .045 364.0 478.3 1.919 .186 .151 .331 HCARD .327 .041 347.0 416.8 1.590 .126 .245 .409 BCO .484 .036 347.0 416.8 1.290 .073 .413 .555 DPT3 .171 .030 347.0 416.8 1.438 .174 .112 .231 POLIO3 .171 .030 347.0 416.8 1.438 .174 .112 .231 MEASLES .363 .029 347.0 416.8 1.094 .080 .305 .42l FULLIM .162 .029 347.0 416.8 1.436 .180 .104 .221 154 Table C.7 Sampling Errors - Southeast Region, Nigeria 1990 Variable Standard Value error (R) (SE) Num~rofcases Design Relative Confidence limits Unweighted Weighted effect error (N) (WN) (DEFr) (SE/R) R -2SE R+2SE URBAN SECOND NEVMAR CURMAR MAR20 SEX18 EVBORN EVB4049 SURVIV KMETHOD KSOURCE EVUSE CUSING CUMODERN CUPILL CUIUD CUSTERIL CUPABST NOMORE DELAY IDEAL TETANUS MDCARE DIARR1 DIARR2 ORSTRE MEDTRE HCARD BCG DFF3 POLIO3 MEASLES FULLIM .160 .018 .231 .022 .262 .016 .650 .018 .618 .013 .541 .015 3.344 .090 6.993 .215 2.773 .066 .566 .038 .423 .036 .199 .020 .090 .012 .039 .006 .008 .002 .009 .003 .005 .002 .035 .009 .213 .016 .314 .015 5.888 .103 .641 .036 .455 .039 .046 .009 .122 .013 .089 .022 .171 .032 .374 .041 .698 .045 .474 .054 .474 .054 .507 .051 .410 .049 2,324.0 2,768.5 2.354 .112 .125 .196 2,324.0 2.768.5 2.511 .095 .187 .275 2,324.0 2,768.5 1.776 .062 .229 .294 2,324.0 2,768.5 1.855 .028 .614 .687 1,844.0 2,198.6 1.158 .021 .592 .644 1,844.0 2,198.6 1.250 .027 .512 .570 2,324.0 2,768.5 1.375 .027 3.164 3.524 389.0 452.6 1.555 .031 6.562 7.424 2,324.0 2.768.5 1.221 .024 2.641 2.906 1,506.0 1,800.5 2.976 .067 .490 .643 1,506.0 1,800.5 2.803 .084 .351 .494 1,506.0 1,800.5 1.914 .099 .160 .238 1,506.0 1,800.5 1.640 .135 .066 .114 1,506.0 1,800.5 1.141 .146 .027 .050 1.506.0 1,800.5 1.072 .308 .003 .013 1,506.0 1,800.5 1.230 .326 .003 .016 1,506.0 1,800.5 .920 .321 .002 .009 1.506.0 1,800.5 1.943 .265 .016 .053 1,506.0 1,800.5 1.558 .077 .180 .246 1,506.0 1,800.5 1.7.57 .048 .284 .344 1,313.0 1,562.3 1.592 .018 5.681 6.094 1,985.0 2,428.0 2.569 .055 .570 .712 1,985.0 2,428.0 2.726 .086 .377 .533 1,784.0 2,165.6 1.885 .201 .028 .065 1,784.0 2.165.6 1.700 .110 .095 .149 218.0 264.6 1.152 .248 .045 .133 218.0 264.6 1.202 .189 .107 .236 370.0 452.1 1.642 Al l .292 .457 370.0 452.1 1.885 .064 .609 .788 370.0 452.1 2.082 .113 .366 .581 370.0 452.1 2.082 .113 .366 .581 370.0 452.1 1.967 .100 .405 .608 370.0 452.1 1.923 .119 .312 .507 155 Table C.8 Sampling Errors - Southwest Region, Nigeria 1990 V~iable Standard Value error (R) (SE) Number of cases Design Relative Confidence limits Unweighted Weighted effect error (N) (WN) (DEFT) (SE/R) R-2SE R+2SE URBAN .606 .045 2,720.0 1,914.9 4,776 .074 .516 .695 SECOND .441 .019 2,720.0 1,914.9 2,043 .044 .402 .480 NEVMAR .287 .017 2,720.0 1,914.9 2.010 .061 .252 .322 CURMAR .672 .019 2,720.0 1,914.9 2.133 .029 .634 .711 MAR20 .489 .016 2,149.0 1,533.5 1,456 .032 .457 .520 SEX18 .434 .017 2,149.0 1,533.5 1.552 .038 .401 .467 EVBORN 3.091 .124 2,720.0 1,914.9 2.066 .040 2,844 3.338 EVB4049 6.844 .295 414.0 328.3 2.072 .043 6.254 7.434 SURVIV 2.543 .087 2,720.0 1,914.9 1.802 .034 2.368 2,717 KMETHOD .736 .029 1,752.0 1,287.4 2.762 .040 .677 .794 KSOURCE .625 .028 1,752.0 1,287.4 2.390 .044 .570 .681 EVUSE .319 .025 1,752.0 1,287.4 2.234 .078 .270 .369 CUSING .150 .018 1,752.0 1,287.4 2.157 .123 .113 .187 CUMODERN .105 .011 1,752.0 1,287.4 1,534 .107 .082 .127 CUPILL .040 .006 1,752.0 1,287.4 1.264 .148 .028 .052 CUIUD .025 .004 1,752.0 1,287.4 1.082 .160 .017 .034 CUSTERIL ,004 .002 1,752.0 1,287.4 1.317 .468 .000 .009 CUPABST .023 .004 1,752.0 1,287.4 1,029 .159 .016 .031 NOMORE .230 .017 1,752.0 1,287.4 1.732 .076 .195 .265 DELAY .340 .015 1,752.0 1,287.4 1,359 .045 .310 .371 IDEAL 5.007 .078 1,599.0 1,014.9 1.743 .016 4.851 5.162 TETANUS .753 .024 2,031.0 1,524.9 2.142 .032 .704 .801 MDCARE .631 .030 2,031.0 1,524.9 2,266 .047 .572 .690 DIARR1 .027 .006 1,821.0 1,346.7 1.512 .212 .016 .039 DIARR2 .087 .007 1,821.0 1,346.7 1,021 .080 .073 .101 ORSTRE .151 .035 140.0 117.7 1.215 .233 .081 .222 MEIYrRE .458 .078 140.0 117.7 1.880 .171 .301 ,615 HCARD .376 .040 370.0 268.8 1.581 .106 .297 .456 BUG .774 .034 370.0 268.8 1.567 .043 .707 .841 DPT3 .468 .032 370.0 268.8 1.243 .069 .404 .532 POLIO3 .471 .032 370.0 268.8 1.253 .069 .406 .535 MEASLES .586 .051 370.0 268.8 1,983 .086 .485 .688 FULLIM .417 .031 370.0 268.8 1.199 .073 .355 .478 156 APPENDIX D DATA QUALITY TABLES APPENDIX D DATA QUALITY TABLES Table D.I Household age distrbution Single year age distribution of the de facto household population by sex (weighted), Nigeria 1990 Males Females Number Percent Number Pe~cnt 0 840 3.6 821 3.5 I 683 2.9 697 3.0 2 737 3.1 696 3.0 3 807 3.4 881 3.7 4 770 3.3 861 3.7 5 695 3.0 696 3.0 6 1,025 4.4 957 4.1 7 890 3.8 775 3.3 8 984 4.2 864 3.7 9 700 3.0 718 3.0 10 914 3.9 943 4.0 11 456 1.9 451 1.9 12 745 3.2 715 3.0 13 515 2.2 558 2.4 14 485 2.1 622 2.6 15 687 2.9 420 1.8 16 384 1.6 346 1.5 17 350 1.5 349 1.5 18 529 2.3 379 1.6 19 243 1.0 255 1.1 20 587 2.5 754 3.2 21 173 0.7 212 0.9 22 253 1.1 303 1.3 23 175 0.7 280 1.2 24 174 0.7 227 1.0 25 672 2.9 812 3.4 26 165 0.7 243 1.0 27 201 0.9 241 1.0 28 267 1,1 336 1.4 29 105 0.4 152 0.6 30 858 3.7 969 4.1 31 89 0.4 113 0.5 32 231 1.0 186 0.8 33 79 0.3 99 0.4 34 63 0.3 124 0.5 35 653 2.8 561 2.4 36 85 0.4 106 0.4 37 87 0.4 76 0.3 38 134 0.6 154 0.7 39 75 0.3 85 0.4 40 747 3.2 586 2.5 159 Table D.1 ~continued) Single year age distribution of the de facto household population by sex (weighted), Nigeria 1990 Males Females Number Percent Number Percent 41 31 0.1 50 0.2 42 117 0.5 137 0,6 43 49 0.2 66 0.3 44 28 0.1 66 0.3 45 462 2.0 368 1.6 46 50 0.2 53 0.2 47 78 0.3 68 0.3 48 109 0.5 101 0.4 49 72 0.3 64 0.3 50 539 2.3 506 2.1 51 25 0.1 100 0.4 52 91 0.4 221 0.9 53 34 0.1 137 0.6 54 40 0.2 108 0.5 55 209 0.9 349 1.5 56 52 0.2 74 0.3 57 39 0.2 65 0.3 58 93 0.4 101 0.4 59 50 0.2 26 0.1 60 485 2.1 450 1.9 61 23 0.1 13 0.1 62 51 0.2 68 0.3 63 26 0.1 21 0.1 64 30 0.1 15 0.1 65 269 1.1 150 0.6 66 20 0.1 13 0.1 67 41 0.2 22 0.1 68 39 0.2 39 0.2 69 42 0.2 13 0.1 70+ 909 3.9 474 2.0 Don't know, missing 40 0.2 18 0.1 Total 23,450 100.0 23,578 100,0 160 Table D.2 Age distribution of eligible and interviewed women Five year age distribution of the de facto household population of women age 10-54, five year age distribution of interviewed women age 15-49, and percentage of eligible women who were interviewed (weighted), Nigeria 1990 Interviewed women All Percentage women Number Percent interviewed 10-14 3,288 NA NA NA 15-19 1,749 1,612 18.4 92.2 20-24 1,777 1,676 19.1 94.4 25-29 1,784 1,669 19.0 93.6 30-34 1,491 1,410 16.1 94.6 25-39 982 954 10.9 97.2 40-44 905 836 9.5 92.4 45-49 654 624 7.1 95.4 50-54 1,072 NA NA NA 15-49 9,340 8,781 100.0 94.0 Note: The de facto population includes all residents and non- residents who slept in the household the night before the interview. NA = Not applicable 161 Table D.3 Completaness of reporting Percentage of ob~ertations missing information for selected de*nographic and health questions, Nigeria 1990 Percentage of reference group with missing Subject Reference group information Number Birthdate Last 15 years Month only 16.1 22,171 Month and year 0.I 22,171 Age at death Last 15 years 0.6 4,060 Age at first union a Ever-married respondents 0.1 7,268 Respondent's education All respondents 0.1 8,781 Child's size at birth Births in last 1-59 months 0.5 8,113 Anthropometry b Living children age 1-59 months Child's weight 9.4 7,028 Child's height 9.4 7,028 Diarrhoea in last 2 weeks Living children age 1-59 months 1.7 7,028 aBoth year and age missing bchild not measured 162 Table D.4 Births by calendar year Distribution of births by calendar years since birth for living (L), dead (D) and all (T) children, according to repo~ng completeness, sex ratio at birth, and ratio of births by calendar year (weighted), Nigeria 1990 Complete calendar years Imor to sur~ey Percent with Sex ratio Calend& Number of births complete birthdato at birth year ratio L D T L D T L D T L D T 0 1,012.6 63.1 1,075.7 98.3 91.7 97.9 106.8 147.4 108.8 NA NA NA 1 1,589,1 141.0 1,730.1 95.8 86.1 95.0 97.2 107.9 98.0 NA NA NA 2 1,270.0 257.0 1,527.0 93.0 75.9 90.1 99.3 123.3 103.0 83.2 135.8 89.0 3 1,461.9 237.6 1,699.5 89.2 74.6 87.1 93.7 135.5 98.6 112.2 80.7 106.4 4 1,336.0 331.8 1,66%8 85.0 73.2 82.6 83.7 117.3 89.5 101.1 135.7 106.5 5 1,182.1 251.4 1,433.6 87.7 73.6 85.2 101.8 120.4 104.9 80.7 61.9 76.7 6 1,592.1 480.2 2,072.3 84.2 66.5 80.1 103.5 109.7 104.9 131.6 174.6 139.6 7 1,237.7 298.5 1,536.3 82,6 69.3 80.0 108.6 118.0 110.4 81.4 71.3 79.2 8 1.449.2 357.1 1,806.3 83.9 69.2 81.0 110.7 104.1 109.3 129.6 123.4 128.3 9 998.8 280.2 1,279.1 77.4 68.3 75.4 106.1 80.5 99.9 NA NA NA 0-4 6,669.7 1,030.4 7,700.1 92.0 77.1 90.0 95.3 123.1 98,6 NA NA NA 5-9 6.460.1 1,667.6 8,127.6 83.4 69.0 80.5 106.1 105.8 106.0 NA NA NA 10-14 4,718.4 1,300.3 6,018.6 81.5 69.8 79.0 93.3 119.3 98.4 NA NA NA 15-19 2,729.9 927.0 3,656.8 80.2 70.4 77.7 117.5 126.5 119.7 NA NA NA 20+ 2,463.6 1,107.5 3,571.1 79.5 71.2 76.9 133.0 113.1 126.5 NA NA NA All 23,041.6 6,032.7 29,074.3 84.7 71.2 81.9 103.9 115.9 106.2 NA NA NA NA = Not applicable 163 Table D.5 Reporting of age at death in days Distribution of reported deaths under 1 month of age by age at death in days and the poreentage of neonatal deaths reported to occur at ages 0-6 days, for five-year periods of birth preceding the survey, Nigeria 1990 Years preceding survey Age at death (days) 0-4 5-9 10-14 15-19 0-19 0 104.0 63.4 53.6 43.8 264.8 1 42.4 45.9 23.5 18.4 130.2 2 30.4 27.6 35.2 17.4 110.7 3 23.8 39.2 26.4 27.2 116.6 4 28.7 30.4 16.9 16.6 92.6 5 13.6 24.2 14.0 9.0 60.8 6 5.5 8.1 15.6 5.8 35.1 7 21.5 42.1 32.4 26.3 122.3 8 9.6 22.1 13.4 7.0 52.0 9 3.5 13.5 8.2 6.7 32.0 10 0.8 9.4 3.0 3.5 16.7 11 2.0 1.2 1.4 1.1 5.7 12 5.4 13.9 5.3 0.0 24.6 13 1.3 2.2 0.9 2.6 7.0 14 15.8 17.7 19.8 13.9 67.2 15 3.8 9.3 7.0 3.5 23.7 16 0.4 1.2 3.1 0.0 4.6 17 3.4 0.0 0.3 1.4 5.1 18 3.6 0,0 1.3 3.4 8.3 20 9.2 6,9 3.8 2.8 22.7 21 7.8 4.6 8.9 8.3 29.6 22 1.6 0.6 0,3 0.0 2.5 23 0.0 0.5 0,0 0.0 0.5 24 0.0 0.3 2,2 0.0 2.5 25 2.8 0.0 0.6 0.9 4.3 26 1,4 0.5 0.8 0.0 2.7 27 0.0 0.9 0.0 1.5 2.3 28 2.5 2.4 2.5 4.7 12.2 29 1.0 0.0 0.0 0.0 1.0 30 6.5 5.7 13.4 5.8 31.4 Missing 0.5 2.1 1,7 0.0 4.3 Percent early neonatal 70.5 60.6 59.0 59.7 62.8 Total 0-30 352.0 393.7 314.0 231.7 1.291.5 164 Table D.6 Reporting of age at death in months Distribution of reported deaths under 2 years of age by age at death in days and the poreentage of infant deaths reported to occur at ages under one month, for five-year periods of birth preceding the survey, Nigeria 1990 Years preceding survey Age at death (months) 0-4 5-9 10-14 15-19 0-19 <1 month including days 352.6 395.8 315.7 231.7 1,295.8 1 13.9 22.1 26.1 14.0 76.1 2 42.9 61.6 34.4 33.0 171.9 3 25.1 47.2 35.8 30.5 138.6 4 17.5 19.7 22.2 17.8 77.1 5 23.7 31.9 23.6 15.7 94.9 6 57.0 35.3 18.9 21.4 132.6 7 25.0 43.0 23.2 27.3 118.5 8 29.8 40.0 26.3 15.1 111.3 9 30.9 29.5 25.5 11.5 97.4 10 15.3 30.0 19.6 11.5 76.4 11 30.0 15.6 11.0 7.6 64.2 12 74.4 95.4 81.3 59.4 310.5 13 11.6 29.6 10.9 6.1 58.3 14 19.2 31.7 13.8 15.2 79.8 15 15.9 14.7 11.3 5.5 47.3 16 13.1 12.4 8.3 4.9 38.6 17 3.0 9.4 2.9 4.0 19.3 18 20.9 43.2 26.2 19.7 110.0 19 7.3 7.0 8.6 2.1 25.0 20 7.7 2.4 4.6 3.1 17.9 21 2.8 0.7 0.0 1.1 4.5 22 3.1 3.0 0.0 0.0 6.1 23 1.1 0.0 0.0 2.9 3.9 Missing 0.5 0.0 0.0 0.0 0.5 1 Year 27.7 52.7 34.4 29.3 144.1 Percent neonatal 55.2 54.2 58.7 56.2 55.9 Total 0-23 663.7 771.7 582.3 437.2 2,454.9 165 APPENDIX E SURVEY INSTRUMENTS Household Questionnaire Individual Questionnaire Service Availability Questionnaire NIGERIA DEMOGRAPHIC AND HEALTH SURVEY HOUSEHOLD SCHEDULE- -ENGL ISH IDENTIF ICAT ION PLACE NAME NAME OF RESPONDENT CLUSTER NUMBER . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HOUSEHOLD NUMBER . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . STATE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . URBAN/RURAL (urban- l , ru ra l=2) . . . . . . . . . . . . . . . . . . . . . . . . . C ITY /TOWN/RURAL (c i ty=l , town=2, ru ra l (v i l l age)=3) . . . . . INTERVIEWER V IS ITS 1 2 3 F INAL V IS IT DATE INTERVIEWER'S NAME RESULT* NEXT V IS IT : DATE T IME *RESULT CODES: 1 COMPLETED 2 HOUSEHOLD PRESENT BUT NO COMPETENT RESP. 3 HOUSEHOLD ABSENT 4 POSTPONED 5 REFUSED 6 DWELL ING VACANT OR ADDRESS NOT A DWELL ING 7 DWELL ING DESTROYED 8 DWELL ING NOT FOUND 9 OTHER AT HOME DAY MONTH YEAR TOTAL NUMBER ~--] OF V IS ITS TOTAL IN HOUSEHOLD TOTAL EL IG IBLE WOMEN (SPECIFY) F IELD EDITED BY OFF ICE EDITED BY KEYED BY NAME DATE KEYED BY ,, - - ~ L 169 HOUSEHOLD SCHEDULE HOW we would l i ke scxne information about the people who usual ly l ive in your Household or who are staying with you now. ~Lease give me the Uhat is the 3oes ~ames of the persons relat ionship (NAME) tho usual ly Live in of (NAME) to usuaLl ~our household or the head t i re ire staying with you of the here? ~ow, starting with household? :he head of the ~o~seho(d. RELAT]ONSRIPHDuGEHOLD * T O HEAD OF RESIDENCE I SEX AGE I EDUCATION Did Is How Bid Has I Whet is FOR (NAME) ~NAME) is INAHE) the hiGhestJ ALL sleep mate he/she? ever Level and I AGED here or been grade of I LESS last female to school ng =,l THAN night? ? ;choot? he/she ! 25 completed? YRS. :I) m 01 02 03 04 05 06 07 09 10 11 12 13 14 (2) (3) (4) (5) (6) (7) (8) (9} (IOI I I I I I I YES NO IrES NO M F IN YEARS ~ES HO LEVEL GRADE YEG NO I T ] 2 i12 12 FF I . , 2 , I~FT I 12 I = F[~ 2 !12 12 r -N . ,2 . ~ - 12 12 2 2 1 2 2 E Z ] _ _ , ~ 1 2 1 2 2 [ - -~ .12 , A ~ - - 2 [ - -~ 2 1 2 2 ~ . 1 2 ,AFT- - 2 2 12 2 ~ 1 2 , A ~ - - 2 212 2[ -N12 [ ~ I ~ - 1 2 . . . 212 2 r -~.12 .n [ -~ 2 [ -~ 212 2~. , 2 h A - ' 2 I -A i 2 12 2 [ -A . 1~ , I~- 2 i ns :n., nn-, i 2 1 2 2 2 2 I -A 2 12 2 [~12 ,F ]~- ,~ : FOSTERING **~ ~EL IG I - FOR EVERYONE AGED i LESS THAN 15 YRG, CIRCLE I LINE Does Does ! NUMBER ' his/her his/her DF W(~4Ek ! natural natural LIGIBLE mOther father FOR l i ve l ive NDI- I here? here? VIDUAL NTEH - I IF YES: IF YES: VIEW IS What is What is he/she ~her name? his name? s t i l t in school? I RECORD RECORD MOTHER'S FATNER'S i LINE LINE i NL~4BEH HUMBER (11) (12) (13) ~,F-N o2 r ib , I - F ] o' D5 [ - ~ o7 [~ L I - F ] . lo I [ -~ , [ -~ 12 ~ L m 1, [ -A , [ -N 1, * CCOES FOR Q.3 RELATIONSHIP TO HEAD OF HOUSEHOLD: 01: HEAD 07= PARENT-IN°LAW 02= WIFE OR HUSBAND 08= BROTHER OR SISTER 03 =GON OR DAUGHTER 09= OTHER RELATIVE 04= SON OR DAUGHTER'IH'LAW 10 = ADOPTED/FOSTER CHILD 05= GRAHOCHILD 11: HOT RELATED 06: PARENT 9B: DK ** t RECORD IO0' IF PARENT NOT MEMBER OF HOUSEHOLD. *Q COOES FOR Q.9 LEVEL OF EDUCATION: 1, PRIMARY 2: SECONDARY 3: HIGHER B= OK GRADE: CO= LEGS THAN ONE YEAR COMPLETED 98=DK 170 PLease give ma the Jhat is the Does Did Is How Bid Has What is na~s of the ~rsons -e lat ionship (NAME) (NAME) (NAME) is :NAME) the highest ~o usual ly l ive in )f (NAME) to usual l sleep J ~te he/she? ever level a~ J your household or :he head Live here I or been grade of i are staying with you )f the here? Last feraate to schooling** now, starting with ~ouseho~d? night? ? ;chool? he/she the head of the cor~tet~ ~ousehold. J 15 16 18 19 2O 21 22 23 24 25 26 (2) (3) (4) ~ (6) i (7) a (8) I YES NO YES NO IN YEARS 'ES NO LEVEL GRADE YES NO i FF] ,~ ,2 , ~ JFT] . ,~ ,FIF-[- i~ I m - - , I FOSTERING *** ELIGI- BILITY • FOR EVERYONE AGED FOR LESS THAN 15 YRS. CIRCLE ALL LINE AGED Does Does NUMBER LESS his/her his/her )F WOMEN THAN natural natural ILIG]BLE 25 mother father FOR YRS. I Live Live INDI- her~ here~ VIDUAL NTER- IF YES: IF YES: VIE~ Is What is What is he/she her nacre? his name~ J s t i I l in i schootT RECORD RECORD MOTHER'S FATHER'S LINE LINE NUMBER NUMBER (12) (131 , , .~ F -~ lg ~_ .~ ~ , .~ .~] . ~, .V~ ~.~' TICK HERE IF CONTINUATION SHEET USED. E l TOTAL NUMBER OF ELIGIBLE WOMEN EF ~ Just to make sure that I have a complete L ist ing: 1) Are there any other persons such as small ch i ldren or infants that we have not Listed? 2) In addit ion, are there any other people who may not be members of your fatally, such as doe~stic servants, Lodgers or fr iends who usuaLLy rive here? 3) Do you have any guests or temporary v i s i to rs staying here, or anyone etse who stept here [~st night? YES F--] YES YES • ENTER EACH IN TABLE NO [~ • ENTER EACH IN TABLE NO [~ • ENTER EACH ]N TABLE NO [ ] 171 NIGERIA DEMOGRAPHIC AND HEALTH SURVEY INDIV IDUAL QUEST IONNAIRE- -ENGL ISH IDENTIF ICAT ION PLACE NAME NAME OF HOUSEHOLD HEAD CLUSTER NUMBER . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HOUSEHOLD NUMBER . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . STATE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . URBAN/RURAL (urban=l , ru ra l=2) . . . . . . . . . . . . . . . . . . . . . . . . . CITY~TOWN~RURAL (c i ty=l , town=2, rura l (v i l l age)=3) . . . . NAME AND L INE NUMBER OF WOMAN INTERVIEWER V IS ITS 1 2 3 F INAL V IS IT DATE INTERVIEWER'S NAME RESULT* DAY MONTH YEAR I I I NEXT V IS IT : DATE T IME TOTAL NUMBER ~-~ OF V IS ITS 1 COMPLETED 2 NOT AT HOME *RESULT CODES: 3 POSTPONED 4 REFUSED 5 PARTLY COMPLETED 6 OTHER (SPECIFY) LANGUAGE OF QUEST IONNAIRE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . LANGUAGE OF INTERVIEW . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . NAT IVE LANGUAGE OF RESPONDENT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . TRANSLATOR USED . . . . . . . . . . . . . . . . . . . . . . . . YES . . .1 NO. . .2 LANGUAGE CODES: 1 HAUSA 3 IGBO 5 KANURI 7 ENGL ISH 2 YORUBA 4 EF IK 6 T IV 8 OTHER (SPECIFY) NAME DATE [ F IELD EDITED BY 173 SECTION I . RESPONDENT=S BACKGROUND NO. I QUESTIONS AND FILTERS I COOING CATEGORIES SKIP I TO RECORD THE TIME. HOUR. .~o. . ° . . . . . . . . ° . .oo . . . MINUTES . . . . . . . . . . . . . . . . . . . . 102 F i r s t I would l i ke to ask so~e quest ions about you and | your household. For most of the time unt i l you were 12 I years o ld , d id you l i ve in a c i ty , in a town, or in a ru ra l v i l l age? CITY . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 | TO~N . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 I RURAL VILLAGE . . . . . . . . . . . . . . . . . . . 3 I I 103 Now lOng have you been l i v ing cont inuous ly in I TEARS . . . . . . . . . . . . . . . . . . . . . . I I I I (NAME OF CURRENT PLACE OF RESIDENCE)? I I ] i I ALWAYS . . . . . . . . . . . . . . . . . . . . . . . . . 95 VISITOR; . . . . . . . . . . . . . . . . . . . 9~ ' -~ I05 104 Just before you moved here, d id you l i ve in a c i ty , J CITY . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 J in a town, or in a ru ra l v i l l age? J TOWN . . . . . . . . . . . . . . . . . . . . . . . . . . 2 I RURAL VILLAGE . . . . . . . . . . . . . . . . . 3 105 In what month and year were you bern? MONTH . . . . . . . . . . . . . . . . . . . . . . OK MONTH . . . . . . . . . . . . . . . . . . . . . . . 98 YEAR . . . . . . . . . . . . . . . . . . . . . . . ~] DK YEAR . . . . . . . . . . . . . . . . . . . . . . . . 98 106 Ho~ old were you at your las t b i r thday? AGE IN COMPLETED YEARS . . . . . ~ I I COMPARE AND CORRECT 105 AND/OR 106 IF INCONSISTENT. NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 -111 108 I What is the h ighest leve l of school you attended: PRIMARY . . . . . . . . . . . . . . . . . . . . . . . . . 1 I I pr imary, secondary, or h igher? SECONDARY . . . . . . . . . . . . . . . . . . . . . . . 2 I HIGHER . . . . . . . . . . . . . . . . . . . . . . . . . . 3 109 I LJhat is the h ighest (c lass / fo rm/year ) you completed CLASS . . . . . . . . . . . . . . . . . . . . . . I at that Level? I [ I 111 SECONDARY OR HIGHER [ -7 V Can you read and understand a le t te r or newspaper eas i ly , , i th d i f f i cu l ty , or not at a l l ? EASILY . . . . . . . . . . . . . . . . . . . . . . . . . . 1 WITH DIFFICULTY . . . . . ~ . . . . . . . . . . . 2 NOT AT ALL . . . . . . . . . . . . . . . . . . . . . . 3 I t I J o . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2 '1 1 174 NO. QUESTIONS AND FILTERS 114 What i s the source of ~ater your household uses fo r handwashing and dishwashing? SKIP CODING CATEGORZES I TO PIPED INTO RESZDENCE . . . . . . . . . . . 01 PIPED INTO YARD OR PLOT . . . . . . . . 02 /~116 PUBLIC TAP . . . . . . . . . . . . . . . . . . . . . 03 WELL WITH HANDPLm4P . . . . . . . . . . . . . 04 WELL WITHOUT HANDPUMP . . . . . . . . . . 05 RIVER, SPRING, SURFACE WATER.06 TANKER TRUCK, OTHER VENDOR . . . . . 07 RA]Nt~L~TER . . . . . . . . . . . . . . . . . . . . . . 08 OTHER 09 (SPECIFY) ,,s i Ho.,oo,0oe '" '° '° 'h'Pe I . . I I ° 116 Does your household get d r ink ing water YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 "118 from th i s same source? NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 | 117 What is the source of d r ink ing water For members of your household? PIPED ZNTO RESIDENCE . . . . . . . . . . . 01 PIPED INTO YARD OR PLOT . . . . . . . . 02 PUBLIC TAP . . . . . . . . . . . . . . . . . . . . . 03 WELL WITH HANDPUMP . . . . . . . . . . . . . 06 WELL UITHDUT HANDPL~4P . . . . . . . . . . 05 RIVER, SPRING, SURFACE WATEH.O6 TANKER TRUCK, OTHER VENDOR . . . . . 07 RAINWATER . . . . . . . . . . . . . . . . . . . . . . 08 OTHER 09 (SPECIFY) 118 What kind of to i let fac i l i ty does your household have? FLUSH . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 m BUCKET . . . . . . . . . . . . . . . . . . . . . . . . . . 2 I PIT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 OTHER 4 (SPECIFY) NO FACILITIES . . . . . . . . . . . . . . . . . . . 5 119 Does your house have: YES HO m ELect r i c i ty? ELECTRICITY . . . . . . . . . . . . . . . . 1 2 I A rad io? RADIO . . . . . . . . . . . . . . . . . . . . . . I 2 A te lev i s ion? TELEVISION . . . . . . . . . . . . . . . . . I 2 A re f r igerator? REFRIGERATOR . . . . . . . . . . . . . . . 1 2 HC~ many rooms in your household are used fo r steeping? ROOHS . . . . . . . . . . . . . . . . . . . . . F ~ I ] I 120 121 122 VAIN MATERIAL OF THE FLOOR. (RECORD 06SERVATIOM.) Does any member of your household own: A c lock or watch? A donkey, horse, or cameL? A canoe? A b icyc le? A motorcyc le? A car? PARQUET OR POLISHED b~OD . . . . . . . . 1 VINYL OR ASPHALT STRIPS . . . . . . . . . 2 CERAMIC TILES . . . . . . . . . . . . . . . . . . . 3 IWO00 PLANKS . . . . . . . . . . . . . . . . . . . . . 4 CEMENT . . . . . . . . . . . . . . . . . . . . . . . . . . S ANIMAL DUNG . . . . . . . . . . . . . . . . . . . . . 6 EARTH/SAMD . . . . . . . . . . . . . . . . . . . . . . 7 OTHER 8 (SPECIFY) YES NO CLOCK OR WATCH . . . . . . . . . . . . . 1 2 DONKEY/HORSE/CAMEL . . . . . . . . . 1 2 CANOE . . . . . . . . . . . . . . . . . . . . . . 1 2 BICYCLE . . . . . . . . . . . . . . . . . . . . 1 2 MOTORCYCLE . . . . . . . . . . . . . . . . . 1 2 CAN . . . . . . . . . . . . . . . . . . . . . . . . 1 2 1:~3 i What re l ig ion do you belong to? I PROTESTANTISH . . . . . . . . . . . . . . . . . . . 1 CATHOLICISM . . . . . . . . . . . . . . . . . . . . . 2 ISLAM . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 TRADITICeAL RELIGION . . . . . . . . . . . . 4 NO RELIGION . . . . . . . . . . . . . . . . . . . . . 5 OTHER 6 (SPECIFY) 175 S[CTI~H 2. HEPRODUCT)ON NO. QUEST[OHS AHD FILTERS 201 1 uould Like to ask about a l l the chi ldren with uhom God has blessed you. PLease do not feet that I am counting your ch i ldren, but i t is very important To obtain complete information on chi ldbear ing in Nigeria. God w i l t cer ta in ly bless and protect your ch i ldren. Ho~ I wo4Jtd l i ke to ask abo~t a l l the b i r ths you have had dur ing your | i fe . Have you ever given b i r th? CODING CATEGORIES YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 SKIP I TO I p2~ I I I I 202 I DO you have mny sons Or daUQhters you have given b i r th | YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 I I to who are non l i v ing ~i th you? | HO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 ,204 And how Icany daughters l ive uJth you? OAUGHTERS AT HONE . . . . . . . . . . [F NONE ENTER *00 ' , 204 I DO you have any sons or daughters you have given b i r th I YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 I I to who are a l ive but do not Live with You? I NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 .206 205 I Ho~ many sons are a l ive but do not Live with you? SONS ELSE~/HERE . . . . . . . . . . . . . ~1~ I I And how many daughters are a l ive but do not Live with I you? DAUGHTERS ELSEIJHERE . . . . . . . . IF NONE ENTER IO0'. 206 I t does happen that sometimes ch i ldren die. I pray that th is never happens to you. I f i t already has, may i t never happen again to you. i t may be very pa infu l to ta lk about and we are very sorry to br ing beck these bed memories, but i t w i l t help the gover~t to take measures to improve the health of the mothers so that a l l babies born are blessed with Li fe. Have you ever given b i r th to a buy or a g i r l who was burn a l ive I~t Later died? IF NO, PRORE: Any buy or g i r t who cr ied or showed any sign of Life but o~Ly survived a few hours or days? YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 ~208 I I 207 | How many buys have died? I And how many g i r l s have died? IF HONE ENTER 1001. 209 210 AHS~/ERS TO 203, 205, ANO 207, AND ENTER TOTAL. IF NONE ENTER 'OO'. TOTAL . . . . . . . . . . . . . . . . . . . . . . CHECK 208: JuSt to make sure that I have th is r ight : yc~ have had in TOTAL Live b i r ths during your Li fe. Is that correct? TEB v CHECK 208: ORE OR MORE BIRTHS v PR~ AND NO • CORRECT 201"209 AS NECESSARY NO BIRTHS I P 223 I 176 211 Now I would l i ke to ta lk to you abo~t a l l of your b i r ths , whether s t i l l a l i ve or not, s ta r t ing with the f i r s t one you had. (RECORD NAMES OF ALL THE BIRTHS IN 212, RECORD TWINS AND TRIPLETS ON SEPARATE LINES). 212 213 What name was given to your ( f i r s t /next ) baby? RECORD SINGLE OR MULTIPLE BIRTH STATUS (NAME) % (NAME) o3) % 214 Is [NAME) a boy or a g i r l ? 215 In what n~nth and year was (NAME) born? PROBE: What is h i s / her birthday? OR: In what season? (NAME) (NAME) (NAME) (NAME) N (MANE) 216 Is (NAME) s t i l l a l ive? 217 218 IF ALIVE: IF ALIVE: HOW old was Is (NAME) (NAME) at Living with h is /her last you? birthday? RECORD AGE IN COMPLETED YEARS 219 220 IF LESS THAN IF DEAD: 15 YRS. OF AGE: How old was he/she With whom when he/she died? does he/she Live? IF " I YR.", PROBE: How many months IF 15+: GO TO Did was (NAME)? NEXT BIRTH RECORD DAYS IF LESS THAN 1 MONTH MONTHS IF LESS THAN T~O YEARS, OR YEARS. YES.1 NO.2 I v 220 YES.1 NO.2 I v 220 AGE IN YEARS AGE IN YEARS AGE IN YEARS AGE IN YEARS AGE IN YEARS AGE IN YEARS AGE IN YEARS YES . . . . . . . 1 (GO TO NEXT BIRTH)( NO . . . . . . . . 2 YES . . . . . . . I (GO TO NEXT BIRTH)< NO . . . . . . . . 2 YES . . . . . . . 1 (GO TO NEXT BIRTH)< NO . . . . . . . . 2 YES . . . . . . . 1 (GO TO NEXT BIRTH)< NO . . . . . . . . 2 YES . . . . . . . I (GO TO NEXT BIRTH)< NO . . . . . . . . 2 YES . . . . . . . 1 (GO TO NEXT BIRTH)< NO . . . . . . . . 2 YES . . . . . . . 1 (GO TO NEXT BIRTH)< ] NO . . . . . . . . 2 FATHER . . . . . . . . . I OTHER RELATIVE.2 SOMEONE ELSE.3 (GO NEXT BIRTH) FATHER. I OTHER RELATIVE.2 SOMEONE ELSE.3 (GO NEXT BIRTH) FATHER . . . . . . . . . 1 OTHER RELATIVE.2 SOMEONE ELSE.3 (GO NEXT BIRTH) FATHER . . . . . . . . . 1 OTHER RELATIVE.2 SOMEONE ELSE.3 (GO NEXT BIRTH) FATHER . . . . . . . . . I OTHER RELATIVE.2 ;OMEONE ELSE.3 (GO NEXT BIRTH) FATHER . . . . . . . . . OTHER RELATIVE.2 SOMEONE ELSE.3 (GO NEXT BIRTH) FATHER . . . . . . . . . 1 OTHER RELATIVE.2 SOMEONE ELSE.3 (GO NEXT BIRTH) DAYS./ MONTHS.2 YEARS.3 DAYSI I ' ' I MONTHS.2 YEARS.3 DAYS.1 MONTHS.,2 YEARS,.,3 DAYB'II'I MOHFHSI.2 YEARS.,.3 DAYS. I MONTHS.2 YEARS,,.3 DAYS.1 MONTHS.2 YEARS.3 DAYS.1 MONTHS.2 YEARS.3 177 212 ~IBE flagW t~4kS given to your rmxt baby? 213 RECORD SINGLE OR MULTIPLE BIRTH STATUS 214 Is (BANE) • bay or • girL? 215 216 In vhet month Is (NRJ4E) shd year uas s t i l l (NAME) barn? alive? PROBE: Nhst Is h is / her birthday? OR: [n what seBeofl? 217 IF ALIVE: How old wee (NAME) st h ls /her test birthday? RECORD AGE IN COMPLETED YEARS. 218 IF ALIVE: IS (MANE) I lv i r , g u i th you? 219 IF LESS THAN 15 YRS. OF AGE: ~ith whom does he/she live? IF 15+: GO TO NEXT BIRTH 220 IF DEAD: How otd~ls he/she ~en he/she died? IF "1 YR. N, PROBE: How many months old WOS (MAME)? RECORD DAYS IF LESS THAN 1V~TH MONTHS IF LESS THAN TWO YEARS, ON YEARS. ( NAME ) (NAME) ( NAME ) ( NAME ) N (NAME) ( NAME ) (NAME) ,GE,H I?ES . ,] YEARS (GO TO NEXT [ ~ BIRTH)< NO . . . . . . . . Z FATHER . . . . . . . . . 1 OTHER RELATIVE.2 SOMEONE ELSE.] (GO NEXT H]BTH DAYS,.,.( MONTHS.2 YEARS.] AGE IN IYES . . . . . . . 1] YEARS (CO TO NEXT BIRTH)< NO . . . . . . . . 2 FATHER . . . . . . . . . 1 OTHER RELATXVE.2 SOMEONE ELSE.,3 (GO NEXT H%HTH DAYS.1 N~4THE.2 YEARS.] FATHER . . . . . . . . . 1 OTHER RELAT[VE.2 SOMEONE ELSE.3 (GO NEXT BIRTH EUIo --° I E oTo x [ ~ NO . . . . . . . . 2 FATHER . . . . . . . . . 1 OTHER RELATIVE.E SOMEONE ELSE.3 (CO NEXT BIRTH) FATHER . . . . . . . . . 1 OTHER RELAT%VE.2 SOHEONE ELSE.] (GO NEXT BIRTH) NO . . . . . . . . 2 FATHER . . . . . . . . . OTHER RELATIVE.2 SOMEONE ELSE.,.3 (C-O NEXT BIRTH) NI*ESYEA . . . . . . . *O 22 IEAo - -2 . L oA*s2 M BO . . . . . . . . Z I (FOR 15% SOMEONE ELSE.] YEARS.3 I GO TO 221) I (GO TO 221) I CCMPARE 208 W[TH NUMBER OF BIRTHS IN HISTORY ABOVE AND MARK: NUII6ERS NUMBERS ARE ARE SAME ~ DIFFERENT ~ • (PROBE ANO RECONCILE) / - - v I HECK 215 AND ENTER THE NUMBER OF gIRTHS SINCE JANUARY 1985. IF NONE r ENTER O. I v [] 178 140. ~ QUESTIONS ARO FILTERS 27~ J Are you prngnant nov? I KIP I C~IDR CATEODRIE8 I TR l YES . 1 I GO.*° , . , , * , . . , . . . , o . . . . . , , , • . . . .2 "~ ' - 1 UNSURE . . . . . . . . . . . . . . . . . . . . . . . . . . . . ' - - -22 JS ~25 At the t im you becm prq~glldult, d id you went to become THEN . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 J p regn l l t then, d id you ~aht to N i t ~r~tl| LATER . . . . . . . . . . . . . . . . . . . . . . . . . . 2 I l a ter , or d id you not ~nt to becem GOT AT ALL . . . . . . . . . . . . . . . . . . . . . 3 pregnant at eft? 226 Uben did your test I Im~truat period startT DAYS AGO . . . . . . . . . . . . . . . . . 1 WEEKS AGO . . . . . . . . . . . . . . . . 2 HONTHS ~ . . . . . . . . . . . . . . . ] YEARS AGO . . . . . . . . . . . . . . . . & BEFORE LAST BIRTH . . . . . . . . . . . . . 996 NEVER NENSTRUATED . . . . . . . . . . . . . 9g~ IN HENOPAUSE . . . . . . . . . . . . . . . . . . 996 227 Iletueen the f i r s t day of a v~mmn,s period amci the f i r s t day of her next period° ~ l t~ do you th ink she has the 9restest chance of I~ lng prngmmt? PROOf: Which days of a k~ean'a monthly cycle does she have to be careful to avoid becoming pregnant? DURING HER I~RIOD . . . . . . . . . . . . . . . 1 RIGHT AFTER HER PERIOD HAS ELIDED . . . . . . . . . . . . . . . . . . . . . . 2 iN THE NIDOLE OF THE CYCLE . . . . . . 3 JUST BEFORE HER PER]ED REGINS.4 AT ANY TINE . . . . . . . . . . . . . . . . . . . . . § OTHER 6 (SPECIFY) R~ . . . . . . . . . . . . . . . . . , . . . . . . . . . . . .8 6 179 SECTION 3 : CONTRACEPTION 301 NOU I would L ike to ta lk about fami ly p lann ing - the var ious uays o r methods that a coup le can use to de lay o r avo id a pregnancy . ~tch ways or methoe~ have you heard about? CIRCLE CODE 1 IN 302 FOB EACH METHOD MENTIONED SPONTANEOUSLY. THEN PROCEED DOWN THE COLUMN, HEAOING THE NAME AND DESCRIPTION OF EACH METHOD NOT MENTIONED SPONTAHEOUSLT. CIHCLE CODE 2 IF METHOD IS RECOGNIZED, AND CODE 3 IF NOT RECOGNIZED. THEN, FOR EACH METHOD WITH CODE 1 OR 2 CIRCLED IN 302, ASK 303"30(. BEFORE PROCEEDING TO THE NEXT METHOD. 303 Have you ever 304 Do you know where used (METHOD)? a person cou ld go P ILL Women can take a p i t t every day . 02J [LID women can have a tocYp or co i l p laced ins ide them by a doctor o r a nurse . O•J INJECTIONS Momen can have an in jec t ion by a doctor or nurse wh ich s tops them f rom becoming pregnant For severa l months . /*1 FOAMING TABLETS Woelen can p lace a foaming tab le t o r p i t t ins ide them before in tercourse° DIAPHRAGH,FOAM,JELLY Woaen can ptace a spu~e, d iaphragm, je l l y o r cream ins ide them before in tercourse . O• DUREX OR CONDOM Men can use rubber sheath dur ing sexuat in tercourse . O• FEMALE STERILIZATION Woe~ can have an operat ion to avo id hav ing any more ch i ld ren . O• MALE STERILIZAT[OB Men can have an operat ion to avo id hav ing any more ch i ld ren , 91 RHYTHM Couples can avo id hav ing sexua l in tercourse on cer ta in ~ys o f the month ~hen the ~oman i s more l i ke ly to become pregnant . •J WITHDRAWAL Hen can be care fu l and pu l l out be fore c l imax . 11 Have you heard o f any o ther ways or methods that WOmen or men can uBe to avo id pre~ncy? (SPECIFY) 2 (SPECIFY) 3 ~02 Have yOU ever heard o f (METHOB)? READ CESCRIPTZON OF EACH METHOC YES/SPOBT . . . . . . . . . . . . . . . . . . . 1 YES/PROBEO . . . . . . . . . . . . . . . . . . Z NO . . . . . . . . . . . . . . . . . . . . . . . . . . 31 v YES/SPONT . . . . . . . . . . . . . . . . . . . 1 YES/PROBED . . . . . . . . . . . . . . . . . . 2 NO . . . . . . . . . . . . . . . . . . . . . . . . . . 31 v YES/SPOBT . . . . . . . . . . . . . . . . . . . 1 YES/PROBED . . . . . . . . . . . . . . . . . . 2 l V . YES/SPOBT . . . . . . . . . . . . . . . . . . . 1 YES/PROBED . . . . . . . . . . . . . . . . . . 2 NO . . . . . . . . . . . . . . . . . . . . . . . . . . 3~ v YES/SPONT . . . . . . . . . . . . . . . . . . . 1 YES/PROBED . . . . . . . . . . . . . . . . . . 2 NO . . . . . . . . . . . . . . . . . . . . . . . . . . ~1 / v . YES/SPONT . . . . . . . . . . . . . . . . . . . 1 YES/PROBED . . . . . . . . . . . . . . . . . . 2 NO . . . . . . . . . . . . . . . . . . . . . . . . . . V YES/SPONT . . . . . . . . . . . . . . . . . . . 1 YES/PROBEO . . . . . . . . . . . . . . . . . . 2 HO . . . . . . . . . . . . . . . . . . . . . . . . . . 3 V • YES/SPOBT . . . . . . . . . . . . . . . . . . . 1 YES/PRO~BED . . . . . . . . . . . . . . . . . . 2 HO . . . . . . . . . . . . . . . . . . . . . . . . . . ~t v YES/SPOMT . . . . . . . . . . . . . . . . . . . 1 YES/PROBED . . . . . . . . . . . . . . . . . . 2 NO . . . . . . . . . . . . . . . . . . . . . . . . . . v YES/SPONT . . . . . . . . . . . . . . . . . . . 1 YES/PROBED . . . . . . . . . . . . . . . . . . 2 NO . . . . . . . . . . . . . . . . * . . . . . . . . . 31 Y YES/SPONT . . . . . . . . . . . . . . . . . . . 1 NO, . , , , . . . . . . . , . , . . . . . . . . . , .3 (SPECIFY) 305 CHECX 303: NOT A SINGLE "YES u (NEVER USED) [~ v YES . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . 2 tO get (METHOD)? YES . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . 2 YES . . . . . . . . . . . . . . . 1 YES . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . 2 NO . . . . . . . . . . . . . . . . . . . . . . . . . 2 YES . . . . . . . . . . . . . . . 1 YES . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . 2 NO . . . . . . . . . . . . . . . . . . . . . . . . . 2 YES . . . . . . . . . . . . . . . 1 YES . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . 2 NO . . . . . . . . . . . . . . . . . . . . . . . . . 2 YES . . . . . . . . . . . . . . . 1 YES . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . 2 NO . . . . . . . . . . . . . . . . . . . . . . . . . 2 YES . . . . . . . . . . . . . . . I YES . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . 2 NO . . . . . . . . . . . . . . . . . . . . . . . . . 2 Have you ever had an YES . . . . . . . . . . . . . . . . . . . . . . . . 1 operat ion to avo id hav ing any more NO . . . . . . . . . . . . . . . . . . . . . . . . . 2 ch i ld ren? YES . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . 2 YES . . . . . . . . . . . . . . . 1 YES . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . 2 NO . . . . . . . . . . . . . . . . . . . . . . . . . 2 YES . . . . . . . . . . . . . . . 1 Do you kno~ ~here a person can obta in adv ice on hOW to NO . . . . . . . . . . . . . . . . 2 use the rhythm method7 YES . . . . . . . . . . . . . . . . . . . . . . . . t NO . . . . . . . . . . . . . . . . . . . . . . . . . 2 YES . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . 2 YES . . . . . . . . . . . . . . . 1 TEE . . . . . . . . . . . . . . .1 NO. . . . . . . . . . . . . . . .2 TEE. . . . . . . . . . . . . . .1 NO. . . . . . . . , . . . . . . .2 AT LEAST C l~ aTES" [ -7 (MR USI~) ~ S[ |P TO 180 NO I QUESTIONS AND FILTERS I 306 J Nave you ever used anything or t r ied in any way to I detay or avoid gett ing pregnant? SKIP CODING CATEGORIES I TO T. . ~ I NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1~-2- .3za l 3°7 I ~at have You used ° r d°ne7 I I CORRECT 303-305 (ARD 30Z iF NECESSARY) 308 E l 310 Now l woutd t i ke to ask you about the t im .hen you f i r s t did so . th in9 or used a mthed to avoid get t ing pregnant. How many r iv ing ch i ld ren did you have at that t im, i f any? tF NONE ENTER 'OO'. I Are you cur rent ly ~ing something or using mny method I to avoid get t ing pregnant? I NUMBER OF CHILDREN . . . . . . . . . [ ~ I YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 I NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 P328 311 I~n~ch method are you using? PILL . . . . . . . . . . . . . . . . . . . . . . . . . . . O1 | IUO . . . . . . . . . . . . . . . . . . . . . . . . . . . . 02-- 7 INJECTIORS . . . . . . . . . . . . . . . . . . . . . 03 ~319 FOAMING TABLETS . . . . . . . . . . . . . . . . 0/, P317 DIAPHRAGM/FOAM/JELLY . . . . . . . . . . . 05 ~319 OUREX OR CONDON . . . . . . . . . . . . . . . . 06 ~317 FEMALE BTERIL|ZATION . . . . . . . . . . . 07 ~L~LE STERILIZATION . . . . . . . . . . . . . 08 ! ~319 RHYTHM . . . . . . . . . . . . . . . . . . . . . . . . . 09 OTHERWtTHDRAWAL . . . . . . . . . . . . . . . . . . . . . 11 ~10 326 (SPECIFY) I I J YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 J 31Z At the time you f i r s t started using the p i t t , d id you NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 consutt a doctor or a r~rse ? DK . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 i t oo =o l o . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ! 316 Hay t see the package of piLLs you are using no~? (RECORD BANE OF BRAND.) I PACKAGE SEEN . . . . . . . . . . . . . . . . . . . . [~]~316 BRAND NAME PACKAGE NOT SEEN . . . . . . . . . . . . . . . . 2 J 315 Do you know the brand name of the p ik ts you are now using? I BRANDNA.E [~ l OK . . . . . . . . . . . . . . . . . . . : . . . . . . . . . 98 (RECORD NAME OF BRAND.) COST. . °° . . ° . . . . . . . FREE . . . . . . . . . . . . . . . . . . . . . . . . 9996__~319 OK . . . . . . . . . . . . . . . . . . . . . . . . . . 9998 8 181 " I 317 I QUESTIONS AND FILTERS HOW much does one (condol~foamir~ tab le t ) cost you? SKiP I CODING CATEGORIES I TO I . FREE . . . . . . . . . . . . . . . . . . . . . . . . 9996 OK . . . . . . . . . . . . . . . . . . . . . . . . . . 9990 you use in one monthT NUMBER . . . . . . . . . . . . . . . . . . . DK . . . . . . . . . . . . . . . . . . . . . . . . . . . . 90 319 320 CHECK 311 AND MARK BOX: SHE/HE STERILIZED & Where d id the ~ter i I i l a t ion take piece? USING ANOTHER METNOO L~ / I v Here d id you obta in (METHOD) the last time? (NAME OF PLACE) Was th i s p lace operated by the government, a mission, or by a pr ivate organizat ion? HOSPITAL . . . . . . . . . . . . . . . . . . . . . . . . O1 | HEALTH CENTER. MATERNITY CENTER, I FAMILY PLANNING CLINIC, ON HEALTH CLINIC/POST . . . . . . . . . . . . . 02 OOCTON . . . . . . . . . . . . . . . . . . . . . . . . . . 03 ~'321 PLANNED PARENTHOOD FED, CL IN IC . .04 - 1 PRIVATE CLINIC . 05 | PHARMACY . . . . . . . . . . . . . . . . . . . . . . . . 06 ~322 PATENT MEDICINE SHOP . . . . . . . . . . . . 07 MARKET . . . . . . . . . . . . . . . . . . . . . . . . . . 08~ HUSBAND'S PLACE OF WORK . . . . . . . . . 09--- 1 TOUR PLACE OF WORK . . . . . . . . . . . . . . 10 | CHURCH . . . . . . . . . . . . . . . . . . . . . . . . . . 11 FRIENDS/RELATIVES . . . . . . . . . . . . . . . 12 324 OTHER 13 (SPECIFY) DK . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 98--- I GOVERNMENT . . . . . . . . . . . . . . . . . . . . . . 1" -~ MISSION . . . . . . . . . . . . . . . . . . . . . . . . . 2 / PRIVATE ORGANIZATION . . . . . . . . . . . . 3~-"32Z DK. . . . .o . . . . . . . . . . . . . . . . . . . . . o .o0 321 Was the method given at a gover~t fac i l i ty , a miss ion, or at the doctor ,s p r ivate pract ice? GOVERNMENT . . . . . . . . . . . . . . . . . . . . . . I MISSI(~ . . . . . . . . . . . . . . . . . . . . . . . . . E PRIVATE PRACTICE . . . . . . . . . . . . . . . . 3 DK. . . . . . . . . . . . . . . . . . . . . . . . , . . . . .0 32 1 How tOng does i t take to t rave( f r~ your home to th i s piece? I MINUTES . . . . . . . . . . . . . . . . . . 1 ~U~So. . . . . . . . . . . . . . . . . . .~ l OK . . . . . . . . . . . . . . . . . . . . . . . . . . . . 998 323 325 In d~| t month and yemr Ms the s ter i l i za t ion operat ion done? 9 182 NO. I QUESTIONS AND FILTERS I 326 | For ho~ many months have you been using I (CURRENT MET I~) continuously? SKIP I COOING CATEGORIES I TO I . 327 I What is the main reason you are using a method of fami ly planning? I SPACE BIRTHS . . . . . . . . . . . . . . . . . . . . 1~ t STOP CHILDBEARING . . . . . . . . . . . . . . . 2 ECONONIC COSTS . . . . . . . . . . . . . . . . . . 3 339 HEALTH . . . . . . . . . . . . . . . . . . . . . . . . . . 4 OTHER S (SPECIFY) 328 | Do you in tend to use a method to avoid pregnancy | YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 ,330 I at any t ime in the future? I NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 | DK . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ~ ~333 329 I~nat is the main reason you do not intend to use a method? WANTS CHILDREN . . . . . . . . . . . . . . . . . 01 - LACK OF KROI~LEDGE . . . . . . . . . . . . . . 02 FATALISTIC . . . . . . . . . . . . . . . . . . . . . 03 COST TOO MUCH . . . . . . . . . . . . . . . . . . 04 SIDE EFFECTS . . . . . . . . . . . . . . . . . . . 05 HEALTH CONCERNS . . . . . . . . . . . . . . . . 06 HARD TO GET METHODS . . . . . . . . . . . . 07 RELIGION . . . . . . . . . . . . . . . . . . . . . . . OH OPPOSED TO FAMILY PLANNING . . . . . 09 PARTNER OPPOSED TO FP . . . . . . . . . . 10 OTHER PEOPLE OPPOSED TO FP . . . . . 11 IHFRESUENT SEX . . . . . . . . . . . . . . . . . 12 DIFFICULT TO GET PREGNANT . . . . . . 13 MENOPAUSAL/HAD HTSTERECTONY.,.14 INCONVENIENT . . . . . . . . . . . . . . . . . . . 15 MOT MARRIED . . . . . . . . . . . . . . . . . . . . 16 OTHER 17 (SPECIFY) OK . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9~ ~'333 33°1 °°'°° ° " ° " "h" I 'Es . I with in the next 12 months? NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 DK. . . . . ° ,o ,o , . . . . . . . ° , , . . . . . . . . 8 331 When you use a method, which method l~outd you pre fer to use? PILL . . . . . . . . . . . . . . . . . . . . . . . . . . . 01 IUO . . . . . . . . . . . . . . . . . . . . . . . . . . . . 02 INJECTIONS . . . . . . . . . . . . . . . . . . . . . 03 FOAMING TABLETS . . . . . . . . . . . . . . . . 04 DIAPHRAC44/FOAH/JELLY . . . . . . . . . . . OS DUREX OR CONDOR . . . . . . . . . . . . . . . . 06 FEMALE STERILIZATION . . . . . . . . . . . 07 MALE STERILIZATION . . . . . . . . . . . . . 08 RHYTHM . . . . . . . . . . . . . . . . . . . . . . . . . 09~ WITHDRAWAL . . . . . . . . . . . . . . . . . . . . . 10 OTHER 11 (SPECIFY) UNSURE . . . . . . . . . . . . . . . . . . . . . . . . . 98- .~333 332 Where can you get (METHOD MENTIONED IN 331)? (IIAME OF PLACE) HOSPITAL . . . . . . . . . . . . . . . . . . . . . . . . 01--- i HEALTH CENTER, MATERNITY CENTER, ~-~335 FAMILY PLANNING CLINIC. OR | HEALTH CLINIC/POST . . . . . . . . . . . . . 02 POCTOR . . . . . . . . . . . . . . . . . . . . . . . . . . 03 ,,336 PLANNED PARENTHOGO. FED, CLIRIC.O~-- PRIVATE CLINIC . . . . . . . . . . . . . . . . . . 05 pHARMACy . . . . . . . . . . . . . . . . . . . . . . . . 06 PATENT REDICIME SHOP . . . . . . . . . . . . 07 MARKET . . . . . . . . . . . . . . . . . . . . . . . . . . 08 -~337 HUSBAROIS PLACE OF MORK . . . . . . . . . 09 YOUR PLACE OF tA3RK . . . . . . . . . . . . . . 10 CHUACH . . . . . . . . . . . . . . . . . . . . . . . . . . 11 FR 1EMDS/RELAT I VES . . . . . . . . . . . . . . . 12 OTHER 13--- (SPECIFY) DK . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 183 NO. I QUESTIONS ~ FILTERS ,331 o o ~ , . ,L , .L.,ng, ° ' ' "~" . . r . ~ °.,.,. SKIP I CODING CATEGORIES I TO I YES. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 1 4 0 . ,2 | ,339 334 Where ts that? (NAME OF PLACE) HOSPITAL. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 01HEALTHHEALTHFAM i LyCENTER ,CL [ N i C/POST . 0 2 P L A N N i NGMATERN I TYcL ] N i C ' OSCENTER, [ DOCTOR . . . . . . . . . . . . . . . . . . . . . . . . . . 03 PLANNED PARENTHO00 FED. CLINIC.O/*---- PRIVATE CLINIC. . . . . . . . . . . . . . . . . .05 PHARMACY . . . . . . . . . . . . . . . . . . . . . . . . 06 PATENT MEDICINE SHOP . . . . . . . . . . . . 07 MARKET. . . . . . . . . . . . . . . . . . . . . . . . . . 08 HUSBAMDIS PLACE OF ~K)RK . . . . . . . . . 09 YOUR PLACE OF k;ORIC . . . . . . . . . . . . . . 10 CHURCH . . . . . . . . . . . . . . . . . . . . . . . . . . 11 FR ] EHDS/RELAT ] VES . . . . . . . . . . . . . . . 12 OTHER 13- (SPECIFY) DK . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 98 ~336 -~'337 1,339 336 ] a miss ion, [s the doctOror atat aa privategOVernmentoffice?facitity, MISSION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 P R I V A T E D K . . GOVERNMENT'. 3"''''''''''''''''''''1 I ~1 l~ 't "'~ °~ °"''°°It t° ' ' t the" I EASY''''''''''''''OIFFICOLT . . . . . . . . . . . . . . . . . . . . . . . ' ' ' ' ' ' ' ' ' "" 3~1~ Who would you ta lk to i f yo4J wanted to get factua l in format ion about using a contracept ive method? VILLAGE HEALTH WORICEH . . . . . . . . . . 01 HEALTH CLINIC/POST . . . . . . . . . . . . . 02 HEALTH CENTER . . . . . . . . . . . . . . . . . . 03 HOSPITAL . . . . . . . . . . . . . . . . . . . . . . . 04 PR ] VATE DOCTOR . . . . . . . . . . . . . . . . .05 FAMILY PLANNING CLINIC . . . . . . . . . 06 MOTHER . . . . . . . . . . . . . . . . . . . . . . . . ,07 MOTHER" IN'LAW, . . . . . . . . . . . . . . . . .08 FEMALE FRIEND . . . . . . . . . . . . . . . . . . 09 MALE FRIEND, . . . . . . . . . . . . . . . . . . . 10 HUSBAND/PARTNER . . . . . . . . . . . . . . . . 11 OTHER 12 (SPECIFY) 340 Who would you ta lk to i f yo~ wanted to get personal advtce about using • contracept ive method? ¥|LLASE HEALTH IdORNER . . . . . . . . . . 01 HEALTH CLINIC/POST . . . . . . . . . . . . .02 HEALTH CENTER. . . . . . . . . . . . . . . . . .03 IIO~P | TAt. . . . . . . . . . . . . . . . . . . . . . . 04 PRIVATE DOCTOR . . . . . . . . . . . . . . . . . 05 FAHILY PLAIINING CLINIC . . . . . . . . . 06 IqOTNIER . . . . . . . . . . . . . . . . . . . . . . . . . 07 NOTRRR- IN-LN "l . . . . . . . . . . . . . . . . . . 06 FEMALE FRIEND . . . . . . . . . . . . . . . . . . 09 MALE FRIEND . . . . . . . . . . . . . . . . . . . .10 IIUSBAMO/PAR THER . . . . . . . . . . . . . . . . 1 | OTHER 12 (SPECIFY) "'1 ''''''O'"'ng''h'(""hh--E'~"~*''°°rt'"~I""--'"--:t I :::::::::::::::::::::::::::::::: I I--'-'" ':.'°"",. o '''' J= . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ' l 11 184 SECTION ~, PREGNANCY AND BREASTFEEDING 402 403 CHECK 222 : ONE OR MONE LIVE r '~ NO L IVE BIRTHS BIRTHS SINCE JAN.t985 LI--J SINCE JAN. 1985 I I • (SKIP TO 501) + ENTER THE LINE NOI48SR, MANE, AMD SURVIVAL STATUS OF EACH BIRTH SINCE JANUARY 1985 IN THE TABLE. I ASK THE QUESTIONS ABOJT ALL OF THESE BIRTHS. BEGIN WITH THE LAST BIRTH, i ( IF THERE ARE )lORE THAM THBEE BIRTHS, US E ADDIT'IONAL FORMS). Mou I would Like to ask yo~ s~ce more quest ions about the hea l th of ch i ld ren you had in the past f tve years. (We wiLL ta lk about one ch i ld at a t im. ) LINE NUMBER FRON Q. 212 FROM Q. 212 AND 0. 216 At the t ime became pregnant Wi t~NAME) , d id . you ~ant to become pregnant then, d id you went to ~a i t unt i l l a~r or d id you w4mt ~ mot# ch i ld ren at aLL? LAST BIRTH NAME ALIVE 0 DEAD 0 V E V THEH . . . . . . . . . . . . . . . . . . . . . I 1 I (SKIP TO 405)< LATER . . . . . . . . . . . . . . . . . . . . 2 NO ~E . . . . . . . . . . . . . . . . . . 3~ (SKIP TO 405)< / FT~ NEXT'TO'LAST BIRTH NAME ALIVE ~ DEAD 0 V 1 ¥ THEN . . . . . . . . . . . . . . . . . . . . . 1. J (SKIP TO 405)< LATER . . . . . . . . . . . . . . . . . . . . 2 NO MORE . . . . . . . . . . . . . . . . . . ~;7 (SKIP TO 405)< / m N~E__ ~ ISECOND-FRON-LAST 6IRTH ALIVE ~ DEAD v l v I THEN . . . . . . . . . . . . . . . . . . . . . 1] (SKIP TO 405)< LATER . . . . . . . . . . . . . . . . . . . . 2 HO MORE . . . . . . . . . . . . . . . . . . (SKIP TO 405)< • 40/* I How much longer would you Like to have waJ t~ MONTHS . . . . . . . . . . . . 1 I L l YEARS . . . . . . . . . . . . . 2 DK . . . . . . . . . . . . . . . . . . . . . 998 YEARS . . . . . . . . . . . . . 2 YEARS . . . . . . . . . . . . . 2 DK . . . . . . . . . . . . . . . . . . . . . 998 DK . . . . . . . . . . . . . . . . . . . . . 998 405 i/nan you were pregnant w i th (NAME), d id you see anyone for an antenatal check on th i s preBnancy? I F YES, WhOm d id you see? AnyOne else? PRONE FOR THE TYPE OF PERSON AND RECORD ALL PERSONS SEEN. DOCTOR . . . . . . . . . . . . . . . . . . . 1 NURSE/MIDWIFE/COMMUNITY HEALTH OFFICER . . . . . . . . . . 1 AUXILIARY NZDWIFE/C~N. HEALTH ASSISTANT . . . . . . . . 1 VILLAGE HEALTH ~ORKER.1 TRAINED (TRADITIONAL) BIRTH ATTENDANT . . . . . . . . . 1 TRADITIONAL BIRTH ATTENDANT . . . . . . . . . . . . . . . 1 OTHER 1 (SPECIFY) NO ONE . . . . . . . . . . . . . . . . . . . 1 1 (SKIP TO 409)< i DOCTOR . . . . . . . . . . . . . . . . . . . 1 NUR SE/N I DW I FE/CCI4MUN l T Y HEALTH OFFICER . . . . . . . . . . 1 AUXILIARY N[ DNI FE/COH#4Ult. HEALTH ASSi STAHT . . . . . . . . 1 WILLA~ HEALTH ~KER. . , .1 TRAINED (TRADITIONAL) BIRTH ATTENDANT . . . . . . . . . 1 TRADITIONAL BIRTH ATTENDANT . . . . . . . . . . . . . . . I OTHER I (SPECIFY) NO ONE . . . . . . . . . . . . . . . . . . . (SKIP TO 609)< DOCTOR . . . . . . . . . . . . . . . . . . . 1 NURSE/NIDNI FE/CDMk~JN I TY HEALTH OFFICER . . . . . . . . . . 1 AUXILIARY NIDWI FE /C~N. HEALTH ASSISTANT . . . . . . . . 1 VILLAGE HEALTH ~KER. . . .1 TRAINED (TRADITI~AL) BIRTH ATTENDANT . . . . . . . . . 1 TRADITIONAL BIRTH ATTENDANT., . . . . . . . . . . . . . 1 OTHER I (SPECIFY) NO ONE . . . . . . . . . . . . . . . . . . . 1~ / (SKIP TO 409)< 4~ | Were you g iven an YES . . . . . . . . . . . . . . . . . . . . . . 1 YES . . . . . . . . . . . . . . . . . . . . . . 1 YES . . . . . . . . . . . . . . . . . . . . . . 1 I I e~tenata[ card For NO . . . . . . . . . . . . . . . . . . . . . . . 2 NO . . . . . . . . . . . . . . . . . . . . . . . 2 NO . . . . . . . . . . . . . . . . . . . . . . . 2 I th i s p reg~y? DK . . . . . . . . . . . . . . . . . . . . . . . B DK . . . . . . . . . . . . . . . . . . . . . . . 8 OK . . . . . . . . . . . . . . . . . . . . . . . B +H. - - ,+th . preRnaOt ~1 ~ [~1 were you when you f i r s t MONTHS . . . . . . . . . . . . . HONTHS . . . . . . . . . . . . . HOqTHS . . . . . . . . . . . . . saw someone for an antenata l check on th i s pregna~y? DK . . . . . . . . . . . . . . . . . . . . . . 98 DK . . . . . . . . . . . . . . . . . . . . . . 98 OK . . . . . . . . . . . . . . . . . . . . . . 98 408 I+°++- + " I ,ONHEHOEVlS ITS . . . , , , ,ONHEROFVlS ITS . . . , , , R~EEHOFVlS ITS . . . d id you have dur i~ that pregna~¢~ 4o9 I ~en you were pregnant I with (NAME) ~re you g iven YES . . . . . . . . . . . . . . . . . . . . . 1 YES . . . . . . . . . . . . . . . . . . . . . 1 YES . . . . . . . . . . . . . . . . . . . . . 1 an in jec t ion in the ara , , o o + o , , + , + , + .o . . . . . . . . . . . . . . . . . . . . . . . o . . . . . . . . . . . . . . . . . . . . . . + . . . . . . . . . . . . . . . . . . . . . . get t i~ tetanus, that i s , (SKIP TO 411)< ~ (SKIP TO 411)< ~ (SKIP TO 411)< I convuLslorm a f te r b i r th? DK . . . . . . . . . . . . . . . . . . . . . . DK . . . . . . . . . . . . . . . . . . . . . . OK . . . . . . . . . . . . . . . . . . . . . . J ,,o I H--+t'-dI°youS,, ,hi. ,o,.,,~, T,,ES . D T,,E, . [ ] ,,~S . • DK . . . . . . . . . . . . . . . . . . . . . . . 8 DK . . . . . . . . . . . . . . . . . . . . . . . 8 DK . . . . . . . . . . . . . . . . . . . . . . . 8 12 185 411 blbere d id y~u g ive b i r th to (NAME)? LAST SIRTH NAME YU I~ . . . . . . . . . . . . . . . 01 I~ OF RELATIVE ON FRIEND . . . . . . . . . . . . . . 02 OF VILLAGE HEALTH WGRKER . . . . . . . . . . 03 OF TRADITIONAL BIRTH ATTENOADT . . . . . . . . 04* HEALTH CL IN IC / I~T . . . . . . OS HEALTH CENTER . . . . . . . . . . . 06 MATERNITT CENTER . . . . . . . . 07 I~ ITAL . . . . . . . . . . . . . . . . 06 OTHER 09 (SP£CIFT) NEXT-TO-LAST BIRTH kW4E YOUR fiCHE . . . . . . . . . . . . . . . 01 OF BBLATIVE ON FRIEND . . . . . . . . . . . . . . 02 NONE OF VILLAGE VEALTBUONKER . . . . . . . . . . 03 OF TIUOITIONAL BIRTH ATTENDANT . . . . . . . . O& HEALTH CLINIC/POST . . . . . . 05 HEALTH CENTER . . . . . . . . . . . 06 IMTERNITT CENTER . . . . . . . . 07 HOSPITAL . . . . . . . . . . . . . . . . 08 OTHER 09 (SPECIFY) SECONO'FRCI4-LAST SIHTH YU ~ . . . . . . . . . . . . . . . 01 HCIgE OF RELATIVE ON FRIEND . . . . . . . . . . . . . . 02 N(~IE OF VILLAGE HEALTH WORKER . . . . . . . . . . 03 OF TRADITIONAL SIRTH ATTENDANT . . . . . . . . 04 HEALTH CLINIC/POST . . . . . . OS HEALTff OENTER . . . . . . . . . . . 06 NATERNITT CENTER . . . . . . . . 07 HOSPITAL . . . . . . . . . . . . . . . . . ON OTHER 09 (SPECIFY) 412 ~o • i l l • ted w i th the de( |v•ry o f (NAME)? Any~ else? PRONE FOR THE TYPE OF PERSON AND RECORO ALL PI[RI~MS ASSISTING. D~XTON . . . . . . . . . . . . . . . . . . . 1 NURSE/MIDVlFE/CCIqUNITY HEALTH OFFICER . . . . . . . . . . 1 AUXILIARY MIDWIFE/COI~UN. HEALTH ASSISTANT . . . . . . . . 1 VILLAGE HEALTH WOmRER.1 TRAINED (TRADITIONAL) BIHTH ATTENOANT . . . . . . . . . 1 TRADITIONAL BIRTH ATTENOANT . . . . . . . . . . . . . . . 1 OTHER I DO(TON . . . . . . . . . . . . . . . . . . . 1 NURGE/lq I OUI FB/GEI4LM I TT HEALTH OFFICER . . . . . . . . . . 1 AUXILIARY MIDUI FE/COMMUN. HEALTH ASSISTANT . . . . . . . . 1 VILLAGE HEALTH HQRKER.1 TRAINED (TRADITIONAL) gIRTH ATTENDANT . . . . . . . . . 1 TRADITIONAL BIRTH ATTENOANT . . . . . . . . . . . . . . . 1 OTHER (SPECIFY) NO ONE . . . . . . . . . . . . . . . . . . . 1 DOCTON.o°. . . .o . . . . . . . . . . . 1 NURSE/NIDWIFE/COMqMITY HEALTH OFFICER . . . . . . . . . . 1 AUXILIARY MIOWIFE/CCNqUll. HEALTH ASSISTANT . . . . . . . . 1 VILLAGE HEALTH WORKER.1 TRAINED (TRADITIONAL) BIRTH ATTE~ANT . . . . . . . . . 1 TRADITIONAL BIRTH ATTENDANT . . . . . . . . . . . . . . . 1 1 OTHER 1 (SPECIFY) NO ONE . . . . . . . . . . . . . . . . . . . 1 (SPECIFY) NO OME . . . . . . . . . . . . . . . . . . . 1 413 V i i (HAME) born on t ime OG TIME . . . . . . . . . . . . . . . . . . 1 ON TIME . . . . . . . . . . . . . . . . . . 1 ON TIME . . . . . . . . . . . . . . . . . . 1 o r p remature ly? PREMATURELY . . . . . . . . . . . . . . 2 PREMATURELY . . . . . . . . . . . . . . Z PREMATURELY . . . . . . . . . . . . . . 2 OK . . . . . . . . . . . . . . . . . . . . . . . 8 DK . . . . . . . . . . . . . . . . . . . . . . . S DK . . . . . . . . . . . . . . . . . . . . . . . B 414 MAc (NAME) de l ivered YES . . . . . . . . . . . . . . . . . . . . . . 1 YES . . . . . . . . . . . . . . . . . . . . . . 1 YES . . . . . . . . . . . . . . . . . . . . . . 1 by caesorl lb~ sect ion? #0 . . . . . . . . . . . . . . . . . . . . . . . 2 NO . . . . . . . . . . . . . . . . . . . . . . . 2 NO . . . . . . . . . . . . . . . . . . . . . . . 2 415 WIS (HAM) weighed I t b i r thT 416 i NOV much d id (gAME) Weigh? YES . . . . . . . . . . . . . o ,oo , , °o°1 MO** , ,oo , , . ° , . . . . . . . . . . . . .L~2 (SKIP TO 417 )<- - J KILOGRAMS . . . . . . . . ~] . I '~ DK*.o° . . . . . . . . . . . . . . . . . . YES . . . . . . . . . . . . . . . . . . . . . . 1 NO, . . . . . . . . . . . . . . . . . . . . . -2 ] (SKIP TO 417 )< KILOGRAMS . . . . . . . . ~ . [ ] DK . . . . . . . . . . . . . . . . . . . . . . 98 YES . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . 2 (SKIP TO 417 )<~ KILOGRAMS . . . . . . . . ~ , ~ DK . . . . . . . . . . . . . . . . . . . . . . 98 417 UMn O l i~) Yes born , ms he l l~e: very (•P ie , VERY LARGE . . . . . . . . . . . . . . . 1 VERY LARGE . . . . . . . . . . . . . . . 1 VERY LARGE . . . . . . . . . . . . . . . 1 te rser th in mvtrage, LARGER THAN AVERAGE . . . . . . 2 LARGER THAN AVERAGE . . . . . . 2 LARGER THAN AVERAGE . . . . . . 2 • v~rlg41. AVEHAG~ . . . . . . . . . . . . . . . . . . 3 AVEHAG~ . . . . . . . . . . . . . . . . . . 3 AVERAGE . . . . . . . . . . . . . . . . . . 3 mi le r theh ov~r lge , SIMLLEH TflN4 AVERAGE . . . . . 4 ~k~MLLEA THAN AVERAGE . . . . . 4 SMJALLER THAN AVERAGE . . . . . 4 o r very i l l ? VERY SMALL . . . . . . . . . . . . . . . 5 VERY SMALL . . . . . . . . . . . . . . . S VERY SMALL . . . . . . . . . . . . . . . 5 DR . . . . . . . . . . . . . . . . . . . . . . . 8 Pl( . . . . . . . . . . . . . . . . . . . . . . . 8 O[ . . . . . . . . . . . . . . . . . . . . . . . 8 - ' * ' * " F . i TEB ** , , . . . . . . . . . . . . .H .o l : s ince the b i r th o f (NNqE)? NO. . . . . . . . . . . . . . . . * * . .oo~) (SKIP TO S2O)< ] &19 For how ~ months a f te r I " - - [ - - - I ~ r - ~ I th . b , * th . , ( - - ) , , , . THE . . . . . . . . . . . . . - -HS . . . . . . . . . . . . . OTH, . . . . . . . . . . . . . I not h ive • period? I I / 111 I I J DI{ . . . . . . . . . . . . . . . . . . . . . 911 DR . . . . . . . . . . . . . . . . . . . . . 96 OK . . . . . . . . . . . . . . . . . . . . . 98 13 186 420 I f PREGNANT CIRCLE '3 ' , OTHERWISE ASK: Have yOU resumed sexua( reta~i~s since the b i r th of (N/O~E)? LAST BIRTH NAME YES. . . . . . . ° . . . . . . . . ° . . . . . 1 (SKIP TO 422) ( NEXT-TO-LAST BIRTH SECC~D-FRON-LAST BIRTH | NAME NAME I I . . I PREGNANT . . . . . . . . . . . . . . . . . 3 I 42, For I the b i r th of (NAME) d id MONTHS . . . . . . . . . . . . . ~THS . . . . . . . . . . . . . I~THS . . . . . . . . . . . . . you not have sexual re la t ions? OK . . . . . . . . . . . . . . . . . . . . . 98 DK . . . . . . . . . . . . . . . . . . . . . 98 DK . . . . . . . . . . . . . . . . . . . . . 98 I ever YES . . . . . . . . . . . . . . . . . . . . . . 1 YES . . . . . . . . . . . . . . . . . . . . . . 1~ 422 Did you YES . . . . . . . . . . . . . . . . . . . . . . ! 1 (SKIP TO 432)< ] breastfeed (XANEI? (SKIP TO 424)< (SKIP TO 432)< / I NO . . . . . . . . . . . . . . . . . . . . . . . 2 NO . . . . . . . . . . . . . . . . . . . . . . . 2 RO . . . . . . . . . . . . . . . . . . . . . . . 2 | 423 ~*1~y d id you not breast feed (NAME)? MOTHER ILL/~4EAK . . . . . . . . 1. CHILD ILL/~EAK . . . . . . . . . Z CHILD DIED . . . . . . . . . . . . . 3 NIPPLE/BREAST PROBLEM.4 NO MILK . . . . . . . . . . . . . . . . 5 h~)RKING . . . . . . . . . . . . . . . . 6 CHILD REFUSED . . . . . . . . . . 7 OTHER (SPECIFY) (SKIP TO 4]4)< MOTHER ILL/h'~EAK . . . . . . . . 1 CHILD ILL/WEAK . . . . . . . . . CHILD DIED . . . . . . . . . . . . . NIPPLE/BREAST PR~BLEM.4 NO MILK . . . . . . . . . . . . . . . . 5 UORKING . . . . . . . . . . . . . . . . 6 CHILD REFUSED . . . . . . . . . . OTHER (SPECIFY) MOTHER [LL/HIEAK . . . . . . . . 1 CHILD ILL/WEAK . . . . . . . . . 2 CHILD 0lED . . . . . . . . . . . . . 3 • IPPLE/BREAST PROOLEM.4 NO MILK . . . . . . . . . . . . . . . . 5 '.~ORKING . . . . . . . . . . . . . . . . E CHILD REFUSED . . . . . . . . . . 7 OTHER (SPECIFY) (SKIP TO 434)< (SKIP TO 434)< 424 Did you feed (NAME) FED COLOSTRUN . . . . . . . . . . . . 1~ t co[ostrum from the breast (SKIP TO 426 )< I 1 or . i t ~t~ ~o(o~t ,= ~AITED . . . . . . . . . . . . . . . . . . . ~ i had passed? OK. . . i l l ;p . io .£ i ; . ; : . . . . . 625 |~ i ;e you ~ai ted for I co los t r t~ tO bass~ ~hat d id you feed (NAME)? PLAIN UATER . . . . . . . . . . . . . . 1 SUGAR/GLUCOSE UATER . . . . . . 2 BABY FORMULA . . . . . . . . . . . . . 3 fRESH MILK . . . . . . . . . . . . . . . 4 $OTA MILK . . . . . . . . . . . . . . . . 5 01HER 6 (SPECIFY) I 426 427 I Hc.~ Long a f te r b i r th d id you f i r s t put (NAME) to the breast? RECORD )N DAYS IF MORE THAN 24 HOURS IMMEDIATELY . . . . . . . . . . . . 000 HOURS . . . . . . . . . . . . . . 1~ DAYS . . . . . . . . . . . . . . . . 2 I IF DEAD CIRCLE '3 ~, OTHERUISE ASK: Are you s t i | [ breast- feeding (NAME)? YES . . . . . . . . . . . . . . . . . . . . . . 1 ROD. . . . . . . . . . . . . . . . . . . . . . 2 (SKIP TO 432)¢ | OE~ . . . . . . . . . . . . . . . ° . . - - . 3~ ~,i:: i~i,i,i:i,i,!,i~:~:~:,:i~i:i~i,i~i,i:i,i:~:~i:ii:i:~i:~ i i~i~i,i,~:i,i:i~i:~:::~i~i:i~i i~ ~!ii!i !iiiii:i!~ i!:!i~:ii~ii:i ~I~ i! i i!!!!:!~iii!iiiii!iii !i!i~!i! iii••iiiii•i•i••ii•iiiii•iiiiiiii•iiiii!ii!iiiii•iiiii•iiii•iiiiiii••i•i••iii•iiiii•iiiiii•i!iiiiii•iiii ~:~iii~i~ii~ii~!i!~i~i~i~i~i!~i~iiii~i~!!:~i~!~ii~i~i~:~i~i:~ii~i~i~i~!!~!i~i~:~!!~i~i~ii 14 187 J LAST BIRTH NAME ¢2B m BOW many times did you HUMBER OF I breastfeed Last n ight NIGHTTIME I I I between sundown and sunup? FEEDINGS ( IF ANSWER IS NOT NUMERIC, PR(RBE FOR APPROXIMATE NO.) NEXT-TO-LAST BIRTH SECOND-FROI4-LAST BIRTH MANE NAME 429 J How many times did you NUMBER OF I breastfeed yesterday DAYLIGHT dur ing the day l ight hours? FEEDINGS ( IF ANSWER IS NOT NUMERIC, PR~E FOR APPROXIMATE NO.) ¢30 At iny t ime yesterday or Last n ight Was (NAME) g iven any of the foLLowing?: P la in water~ Sugar wmler? Juice? Herbal tea? Baby Formula? Fresh mi lk? Soya mi lk? Any so l id or mushy food, such as mashed ~na~ or mashed grain? CHECK 430 : FO00 OR LIQUID GIVEN YESTERDAY? YES NO PLAIN WATER . . . . . . . . . . . I 2 SUGAR WATER . . . . . . . . . . . I 2 JUICE . . . . . . . . . . . . . . . . . I 2 HERBAL TEA . . . . . . . . . . . . I 2 BABY FORMULA . . . . . . . . . . I 2 FRESH MILK . . . . . . . . . . . . I 2 SOYA MILK . . . . . . . . . . . . . I 2 SOLID/MUSHY FOO(D . . . . . . I 2 YES TO NO TO ALL ONE D~ ; , MORE-- v (SKI; TC (SKIP TO 435 ) 436) 15 188 432 I LAST BIRTH NAME NOgTHS . . . . . . . . . . . . . ~ ' ~ UNTIL DIED . . . . . . . . . . . . . ~1 (SKIP TO 435 )< / NEXT'TO-LAST BIRTH NAME P~NTNS . . . . . . . . . ~ . . .~-~ UNTIL DIED . . . . . . . . . . . . . 95 1 (SKIP TO 435 )< / SECOND-FRON-~ST BIRTH IL~ME HOITHS . . . . . . . . . . . . . ~ l UNTIL DIED . . . . . . . . . . . . . (SKIP TO 435 )< / 433 635 Why did you s top breast feed ing (NAME)? CHEEK 216: CHILD ALIVE? Was (NkHE) ever g iven any water , o r saueth ing e tso to d r iok o r eat (o ther than breastmi iK )? NOTHER ILL/WEAK . . . . . . . . . 01 CHILD ILL/WEAK . . . . . . . . . . 02 CHILD DIED . . . . . . . . . . . . . . 03 NIPPLE/BREAST PROBLEM.04 NO MILK . . . . . . . . . . . . . . . . . D5 WOBXING . . . . . . . . . . . . . . . . . CHILD REFUSED . . . . . . . . . . . O~ WEANING AGE . . . . . . . . . . . . . 08 BECAME PREGNANT . . . . . . . . . 09 OTHER 10 (SPECIFY) ALIVE ~ DEAD (SKIP TO 436) i v YES . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . 2. (SK[P TO 438 )< I~)THER ILL/VEAK . . . . . . . . . 01 MOTHER ILL/MEAX . . . . . . . . . 01 CHILD ILL/WEAK . . . . . . . . . . 02 CHILD ILL/WEAK . . . . . . . . . . (]2 CHILD DiEt) . . . . . . . . . . . . . . 03 CHILD BIED . . . . . . . . . . . . . . B3 NIPPLE/BREAST PROBLEM.04 NiPPLE/BREAST PROBLEN.O4 NO NJLK . . . . . . . . . . . . . . . . . 05 rio MILK . . . . . . . . . . . . . . . . . 05 WORKING . . . . . . . . . . . . . . . . . 06 ~ORKING . . . . . . . . . . . . ~ . . , .~ EHKLO REFUSED . . . . . . . . . . . 07 CHILD REFUSED . . . . . . . . . . . 07 SEAMING AGE . . . . . . . . . . . . . 08 SEAMING AGE . . . . . . . . . . . . . OB BECAME PREGNANT . . . . . . . . . 09 BECAME PREGNANT . . . . . . . . . 09 OTHER 10 OTHER 10 (SPEC]FY) (SPECLFY) (SKIP (SKIP TO k36) TO 43&) I v m YES . . . . . . . . . . . . . . . . . . . . . . 1 YES. . . . . . . . . . . . . . . . . . . . . . 1 | I Mo . . . . . . . . . . . . . . . . . . . . . . . NO . . . . . . . . . . . . . . . . . . . . . . . z~ (SKIP TO 638 )< (SNIP TO 438 )< / I I 436 Now many months o ld was (NAHE) when you star ted ~iving the fo t towing on a regu lar bas i s? : FormuLa or mi lk o ther than breastmi tk , such as soyo mi lk? Water o r o ther L iqu ids? [-]-1 AGE IN MONTHS . . . . . . . l i t NOT GIVEN . . . . . . . . . . . . . . . . 96 ]-I-1 AGE IN I~TNS . . . . . . . L I I NOT GIVEN . . . . . . . . . . . . . . . . 96 I-1-1 AGE LN NONTHS . . . . . . I l l NOT GIVER . . . . . . . . . . . . . . . . 06 I--I-- AGE iN HONTHS . . . . . . . [ [ NOT GIVEN . . . . . . . . . . . . . . . . AGE IN NONTNS . . . . . . . MOT GIVEN . . . . . . . . . . . . . . . . AGE IN NC~TNS . . . . . . MOT GIVEN . . . . . ~ . . . . . . . . . . 9b FF7 AGE IN MONTHS . . . . . . . t J I MOT GIVEN . . . . . . . . . . . . . . . . 06 AGE IN MONTHS . . . . . . . ~ - ~ MOT GIV1EN . . . . . . . . . . . . . . . . 96 AGE IN I'IOMTNS . . . . . . NOT GIVEN . . . . . . . . . . . . . . . . 96 Any so l id o r mushy food , ~uch as mashed bmww~ or mashed gra in? iF DEAD CIRCLE '3 a, 437 OTNERW[ $E ASK: YES . . . . . . . . . . . . . . . . . . . . . . 1 B id (NAME) dr ink anyth ing NO . . . . . . . . . . . . . . . . . . . . . . . 2 f rom a bot t le w i th a n ipp le DEAD . . . . . . . . . . . . . . . . . . . . . ] yes terday or Last n ight? DK . . . . . . . . . . . . . . . . . . . . . . . 8 418 GO BACK TO 40] FOR NEXT BIRTH; OR, iF NO BORE BIRTHS, SKIP TO FIRST COLUMN OF QUESTION 4]9 . 16 189 439 440 ~ECTION 46, IMMUNIZATION AND HEAi)TH I I I I ENTER THE LINE NUMBER m NAME, /~ SUItVIVAL STATUS OF EACH BIRTH SINCE JAIA/ARY 1~5. IN THE TABL4E. ASK THE QUESTIONS ABOUT ALL OF THESE BIRTHS. BEGIN UITH THE LAST BIRTH. ( IF THERE ARE MORE THAN THREE BIRTHS e USE ADDiTiOBAL FORMS). LIME NUMBER FROM g. 212 FROM O. 212 AND O. 216 Do you have a card where (NAME=S) vacc inat ions ere ur i t ten down? IF YES: May I see i t , ptease? I LAST BIRTH NAME ALIVE[~ DEAD [~ v i v YES, SEEN . . . . . . . . . . . . . . . 1 1 (SK p TO 442)< , / YEs, NOT SEEN . . . . . . . . . . . 2 (SKIP TO 444)< 1 NO CARD . . . . . . . . . . . . . . . . . 3 m NEXT'TO-LAST BIRTH NAME ALIV~ [~] DEAD E~ v m v YES, SEEN . . . . . . . . . . . . . . . 1 1 (SKIP TO 442)< / YES, NOT SEEN . . . . . . . . . . . 2 1 (SKIP TO 444)< / NO CARD . . . . . . . . . . . . . . . . . 3 t M SECOND- FROM- LAST BIRTH NAME ALIVE [~ DEAD E~ v i v im l YES, SEEN . . . . . . . . . . . . . . . 1 (SKIP TO 442)< ,~-~ YES, NOT SEEN . . . . . . . . . . . 2 (SKIP TO 444)<-- 1 NO CARD . . . . . . . . . . . . . . ~.3 44, Did, .ver h . .e . *ES . . . . . . . . . . . . . . . . . . . . . '1 TES . TEa . '1 vacc inat ion card fo r (SKIP TO 444)< ] NO (SKIP TO 444)< 2 j (SKIP TO 444)< ] (NAME)? NO . . . . . . . . . . . . . . . . . . . . . . 2 . . . . . . . . . . . . . . . . . . . . . . NO . . . . . . . . . . . . . . . . . . . . . . 2 442 1)COPY VACCINATIOH DATES FOR EACH VACCINE FROM THE CARD. 2)WRITE '44' IN 'DAY ~ COLUMN, IF CARD SHOWS THAT A VACCINATION WAS GIVEN, BUT NO DATE RECORDED. BCG POLIO ' FOLIO 2 FOLIO 3 DPT 1 DPT 2 OPT 3 MEASLES BEG P1 P2 P3 D1 D3 . MEATI DAY NO YR I I n DAY NO I BCC I P, P2 P3 01 D2 oSi TR DAY NO YR I I SCDI P1 I pz I ~ = , • , P3 I ~ m t • , D' I D2 I ~ = , • , 03 I .EA,~ I I I I Has (NAME) received any vacc inat ions that are not recorded On th i s cord? YES . . . . . . . . . o . , ° , .o , . ° ° , (PROBE FOB ~_~ VACCINATIONS, AND NRITE '661 IN THE < CORRESPQNDING DAY COLUMN) NO . . . . . . . . . . . . . * * . * . * .2 ~K*,* . , , . * * . ° . . . . . . . . . 8 YES, , ° . . , , , . . . . . . ° , . , , , ' (PROBE FOB VACCINATIOMS, AND NRITE '06 r IN THE < COBRESPOND IMG DAY COLUI~) NO . . . . . . . . . . . . . . . . . . . . 2 OK. . , . . * . * °*° . . . . . . . . . S YES** . . *** . . , . . . . . . . . . .1 (PROBE FOR VACCINATIONS, ANO WRITE *66* IS THE CORRESPCMOING DAY COLUMN) ~O . . . . . . , o , ° . , , ° . . . . . . 2 DK . . . . . . . . . . . . . . . . , . , .~ (SKIP TO 4gGS) (SKIP TO &46) (SKIP TO 446) I . i . i * ' * . i amy vacc inat ions To NO . . . . . . . . . . . . . . . . . . . . . . 2 NO . . . . . . . . . . . . . . . . . . . . . . 2 NO . . . . . . . . . . . . . . . . . . . . . . 2 prevlmt h im/her from (SKIP TO ;~6)< (SKIP TO 446)< (SKIP TO 446)< Gett ing diseases? OK . . . . . . . . . . . . . . . . . . . . . . OK . . . . . . . . . . . . . . . . . . . . . . DK . . . . . . . . . . . . . . . . . . . . . . 17 190 445 PLease teLL r~ i f (NAME) (hea) rece iv~l any o f the foLLow/n9 vacc inat ions : A BCG vecc inat ion agelr, .st tubercu los i s , that I s , an in jec t ion in the arm or shou lder th l t Le f t a scar? PoL io vacc ine , that i s , d rops in the mouth? IF YES: HOW many t imes? HANE An injection aga ins t meas les? CHECK 216: CHILD ALIVE? LAST BIRTH NEXT-TO-LAST BIRTH NAME YES . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . 2 0~ . . . . . . ° . ° . . . . . . . . . . . . . Yes . . . . . . °° . . . . . . . . . . ° . .1 NO . . . . . . . . . . . . ° . ° . . . . . . . 2 DK . . . . . . . . . . . . . . . ° . . . . . . : . : :H OF . . . . . . . . . . 1 t YES . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . 2 DK . . . . . . . . . . . . . . . . . . . . . . B YES .° . °°** . . . . . . . . . . . . . . 1 ~°° . ° . . . . . . . . . . . . . . . . . . 2 DK . . . . . . . . . . . . . . . . . . . . . . 8 YES . . . . . . . . ° . . ° . ° . . . . . . . 1 HO. . . . . . . . . . . . . . ° . . . . . . . 2 DK . . . . . . . . . . . . . . . . . . . . . . 8 . . . . . . . . . . YES . . . . . . . . . . . . . . . . . . . . ". 1 NO . . . . . . . . . . . . . . . . . . . . . . . 2 DK . . . . . . . . . . . . . . . . . . . . . . B ALIVE [] DEAD ! AL'VE [] (SKIP TO (SKIP TO 448) 4481 mm DEAD I v $ECOND-FRON-~ST BIRTH NAME YES . . . . . . . . . . . . . . . . . . . . . 1 HO . . . . . . . . . . . . . . . , . . . . . .2 OK . . . . . . . . . . . . . . . . . . . . . . 8 YES . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . 2 DK . . . . . . . . . . . . . . . . . . . . . . 8 . YES . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . 2 DK . . . . . . . . . . . . . . . . . . . . . . B ALIVE [] DEAD 1 (SKIP TO 448) vllim 447 GO BACK TO 440 FOR NEXT BZHTH; OR, ]F NO MORE BIRTHS, SKIP TO 482. 448 | Has (NAME) been i t [ w i th YES . . . . . . . . . . . . . . . . . . . . . 1 YES . . . . . . . . . . . . . . . . . . . . . 1 YES . . . . . . . . . . . . . . . . . . . . . 1 m I a fever a t any t ime in NO . . . . . . . . . . . . . . . . . . . . . . 2 NO . . . . . . . . . . . . . . . . . . . . . . 2 NO . . . . . . . . . . . . . . . . . . . . . . 2 I the las t 2 Weeks? DK . . . . . . . . . . . . . . . . . . . . . . B DK . . . . . . . . . . . . . . . . . . . . . . 8 DN . . . . . . . . . . . . . . . . . . . . . . 8 a cough a t any Time in NO . . . . . . . . . . . . . . . . . . . . . . 2 NO . . . . . . . . . . . . . . . . . . . . . . 2 NO . . . . . . . . . . . . . . . . . . . . . . 2 the last 2 week~ (SKIP TO 4521< (SKIP FO 452)< (SKIP TO 452)< OK . . . . . . . . . . . . . . . . . . . . . . OK . . . . . . . . . . . . . . . . . . . . . . DK . . . . . . . . . . . . . . . . . . . . . . cough Last? DAYS DAYS DAYS ( IF LESS THAN 1 DAY, ( I F LESS THAN 1 DAY. ( I F LESS THAN ] DAY, RECORD '00 '1 RECORD '00 ' ) RECORD ~00 ' ) 451 YES . . . . . . . . . ~ . . . . . . . . . . . 1 YES . . . . . . . . . . . . . . . . . . . . . 1 YES . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . 2 NO . . . . . . . . . . . . . . . . . . . . . . 2 NO . . . . . . . . . . . . . . . . . . . . . . 2 DK . . . . . . . . . . . . . . . . . . . . . . 8 DK . . . . . . . . . . . . . . . . . . . . . . B OK . . . . . . . . . . . . . . . . . . . . . . B When (NAME) had the i l l ness w i th a cough, d id he /she breathe 452 I CHECK 448 AND 449: FEVER OR COUGH? 453 | Did you seek adv ice o r I t reatment fo r the fever /cough? "YES" IN E]THER 448 OR 449 OTHER ! (SKiP TO 4621 YES . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . 2] (SKIP TO 462)< "YES N iN EITHER 448 OR 449 OTHER TO 462) YES . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . 2 1 (SKIP TO 462)< / "YES" IN EITHER 448 OR %49 OTHER TO 462) v YES . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . 2] (SKIP TO 4621< 454 ~en you perce ived that (NAME) was i LL , who began t reatment? VILLAGE HEALTH WORKER.Q1 HEALTH CLINIC/POST . . . . . . 02 HEALTH CENTER . . . . . . . . . . . Q] HOSPITAL . . . . . . . . . . . . . . . . 04 PRIVATE DOCTOR . . . . . . . . . . 05 TRADITIONAL/SPIRITUAL HEALER . . . . . . . . . . . . . . . . . 06 VILLAGE CHEMIST AT PATENT MEDICINE SHOP. . .07 PHARMACY . . . . . . . . . . . . . . . . MYSELF/RELATiVES . . . . . . . . 09 OTHER 10 (SPECIFY) VILLAGE HEALTH ~ORKER.01 HEALTH CLiNIC/POST . . . . . . 02 HEALTH CENTER . . . . . . . . . . . 03 HOSPITAL . . . . . . . . . . . . . . . . 04 PRIVATE DOCTOR . . . . . . . . . . 05 TRADIT;OIdAL/SPIRITUAL HEALER . . . . . . . . . . . . . . . . . 06 VILLAGE CHEMIST AT PATENT MEDICINE SHOP. . .07 PHARMACY . . . . . . . . . . . . . . . . 08 MYSELF/RELATIVES . . . . . . . 09 OTHER 10 (SPECIFY) VILLAGE HEALTH WORKER.Ol HEALTH CLINIC/POST . . . . . . 02 HEALTH CENTER . . . . . . . . . . . 03 HOSPITAL . . . . . . . . . . . . . . . . 06 PRIVATE DOCTOe . . . . . . . . . . 05 TRADITIOSAL/SPIRITUAL HEALER . . . . . . . . . . . . . . . . . 06 VILLAGE CHEfllST AT PATENT MEDICIHE SHOP.HOT PHARMACY . . . . . . . . . . . . . . . . 08 MYSELF/RELATIVE~ . . . . . . . 09 OTHER 10 (SPECIFY) 18 191 Was th i s t reatment g iven a t home or away frc*n home? 655 LAST BIRTH NAME AWAY l ION HOME . . . . . . . . . . . 2 NEXT'TO'LAST BIRTH NAME AT HONE/COMPOUND . . . . . . . . . 1 (SKIP TO 458 )< AWAY FROM HONE . . . . . . . . . . . 2 SECOND'FROM'LAST BIRTH I NAME AT . ,11 AWAY FROM HONE . . . . . . . . . . . 2 m &56 457' I NOV much t ime d id i t take to go to th i s place? I HOW much d id i t cost to t rave l to th i s p lace? MINUTES . . . . . . . . . . I I I I EEl HOURS . . . . . . . . . . . . 2 :OST . FT7 NO COST . . . . . . . . . . . i . . 9996 MINUTES . . . . . . . . . . I I I I HOURS . . . . . . . . . . . . 2 COST . NO COST . . . . . . . . . . . i . . ~6 MINUTES . . . . . . . . . . 1 ~ I HOURS . . . . . . . . . . . . 2 Cost . I . NO COST . . . . . . . . . . . . . . 9996 G58 HOW much d id i t cost fo r the t reatment obta ined a t th i s p lace? (RECORD CASH ON CASH EQUIVALENT OF NON-CASH PAYMENTS) 1 NO COST . . . . . . . . . . . . . 999996 NO COST . . . . . . . . . . . . . 999996 CASH.1 ~ . ~ NO COST . . . . . . . . . . . . . 9999'96 659 What was gLve~ to t reat the fever /cough, Lf anyth ing? Anyth ing else? (CIRCLE EACH MENTIONED) NOTHING GiVEN . . . . . . . . . . . . I INJECTION . . . . . . . . . . . . . . . . I ANTIBIOTIC (PILL OR SYRUP) . . . . . . . . . 1 ANTIMALARILL (PILL OR SYRUP) . . . . . . . . . 1 COUGH SYRUP . . . . . . . . . . . . . . 1 OTHER PILL OR SYRUP . . . . . . 1 UNKNDWN PiLL OR SYRUP. .1 HONE REMEDY/ HERBAL MEDICINE . . . . . . . . . 1 OTHER (SPECIFY) NOTHING GIVEN . . . . . . . . . . . . 1 INJECTION . . . . . . . . . . . . . . . . 1 ANTIBIOT[C (P i l l OR SYRUP) . . . . . . . . . 1 ANTZMALARIAL (PILL ON SYRUP) . . . . . . . . . 1 COUGH SYRUP . . . . . . . . . . . . . . 1 OTHER PILL OR SYRUP . . . . . . 1 UNKNO~ PILL OR SYRUP. .1 HONE REMEDY/ HERBAL MEDICINE . . . . . . . . . 1 1 OTHER 1 (SPECIFY) NOTHING GIVEN . . . . . . . . . . . . 1 INJECTION . . . . . . . . . . . . . . . . 1 ANTIBIOTIC (P I l l ON SYRUP) . . . . . . . . . 1 AHTIHALARIAL (PILL OR SYRUP) . . . . . . . . . 1 COUGH SYRUP . . . . . . . . . . . . . . 1 OTHER PILL OH SYRUP . . . . . . 1 UNHNONN P i l l OR SYRUP.1 HONE REMEDY/ HERBAL MEDICINE . . . . . . . . . 1 OTHER I (SPECIFY) 460 I f you purchased drugs er o ther p reparat ions fo r (NARE)ts t reatment , uhere d id you buy thm? VILLAGE HEALTH MORKER.01 HEALTH CLINIC/POST . . . . . . 02 HEALTH CENTER . . . . . . . . . . . 03 HOSPITAL . . . . . . . . . . . . . . . . 04 PRIVATE DOCTOR . . . . . . . . . . 05 TRADITIONAL/SPIRITUAL HEALER . . . . . . . . . . . . . . . . . 06 VILLAGE CHEMIST AT PATENT MEDICINE SHOP.07 PHNRI4ACY . . . . . . . . . . . . . . . . 08 NO DRUGS PURCHASED . . . . . . 09 OTHER 10 (SPECIFY) VILLAGE HEALTH ~KER. . .O l HEALTH CLINIC/POST . . . . . . 02 HEALTH CENTER . . . . . . . . . . . 03 HOSPITAL . . . . . . . . . . . . . . . . 04 PRIVATE DOCTOR . . . . . . . . . . 05 TRADITIONAL/SPiRITUAL HEALER . . . . . . . . . . . . . . . . . 06 VILLAGE CHEMIST AT PATENT MEDICINE SHOP.07 PHARMACY . . . . . . . . . . . . . . . . OB NO DRUGS PURCHASED . . . . . . 09 OTHER 10 (SPECIFY) VILLAGE HEALTH ~KER. . .01 HEALTH CLINIC/POST . . . . . . 02 HEALTH CENTER . . . . . . . . . . . 03 HOSPITAL . . . . . . . . . . . . . . . . 04 PRIVATE DOCTOR . . . . . . . . . . OS TRADIlIONAL/SPIHITUAL HEALER . . . . . . . . . . . . . . . . . 06 VILLAGE CHEMIST AT PATENT MEDICINE SHOP.07 PHARMACY . . . . . . . . . . . . . . . . OS NO DRUGS PURCHASED . . . . . . 09 OTHER 10 (SPECIFY) 461 Sqat was the most impor tant reason why you chose to go to th i s source o f care? LOl~R TRANSPORTATION COSTS . . . . . . . . . . . . . . . . . . . 1 LONER TREATMENT COSTS . . . . . . . . . . . . . . . . . . . 2 SHORTER WAITING TIME AT FACi l iTY . . . . . . . . . . . . . 3 BETTER QUALITY CARE . . . . . . . . . . . . . . . . . . . . 4 GREATER AVAILABILITY OF DRUGS . . . . . . . . . . . . . . . . 5 SHORTER TRAVEL TiME TO S~CE OF CARE . . . . . . . 6 NO ALTERNATIVE SOURCE OF CARE . . . . . . . . . . 7 OTHER 8 (SPECIFY) LOUER TRANSPORTATION COSTS . . . . . . . . . . . . . . . . . . . I LOWER TREATMENT COSTS . . . . . . . . . . . . . . . . . . . 2 SHORTER WAITING TIME AT FACil iTY . . . . . . . . . . . . . 3 BETTER QUALITY CARE . . . . . . . . . . . . . . . . . . . . 4 GREATER AVAILABil iTY OF OSUGS . . . . . . . . . . . . . . . . 5 SNORTER TRAVEL TiME TO$OE,mCE OF CARE . . . . . . . 6 NO ALTERNATIVE SOURCE OF CARE . . . . . . . . . . 7 OTHER 8 (SPECIFY) LObaR TRANSPORTATION COSTS . . . . . . . . . . . . . . . . . . . I LOUER TREATMENT COSTS . . . . . . . . . . . . . . . . . . . 2 SHORTER WAITING TIME AT FACILITY . . . . . . . . . . . . . 3 BETTER UL ITY CARE . . . . . . . . . . . . . . . . . . . . g GREATER AVAiLABILiTY OF DRUGS . . . . . . . . . . . . . . . . S SHOATER TRAVEL TIME TO SOURCE OF CARE . . . . . . . 6 NO ALTERNATIVE SOURCE OF CARE . . . . . . . . . . T OTHER 8 (SPECIFY) 19 192 462 1 I Has (NAME) has diarrhea in the Last tvo reeks? LAST BIRTH NEXT*TO'LAST O[RTH ] SECONO'FIK]M'LAST |IRTH I ILQE llkqE kWnE YES . . . . . . . . . . . . . . . . . . . . . . 1 YES . . . . . . . . . . . . . . . . . . . . . . 1 (SKIP TO 464)< ] l (SKIP TO 44~t)< ] l (SKIP TO ~)< ]1 YES . . . . . . . . . . . : . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . 2 NO . . . . . . . . . . , . . . . . . . . . . . . 2 OK . . . . . . . . . . . . . . . . . . . . . . . 8 I OK . . . . . . . . . . . . . . . . . . . . . . . . 81oK . . . . . . . . . . . . . . . . . . . . . . . 81 "° . . . . . . . . . . . . . . . . . . . . . . . 2 463 l GO BACK TO 4/*0 FOR NEXT BZHYH; OR, IF NO )K3RE GIRTHS, SKIP TO 482. 464 m Has (NAME) has diarrhea I in the Last 24 hours? YES . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . ? DE . . . . . . . . . . . . . . . . . . . . . . . 8 YES . . . . . . . . . . , . . . . . . . . . . . 1 DE . . . . . . . . . * *°°°° . , ° . . . . °8 GO. . . . . . . . . . . . ° . , . . ° °° . * .~ YES . . . . . . . . . . . . . . . . . . . . . . I | NO.°°.o . . . . . . . . . . . . ° °°***~ I 0~°°°°°o° .HH***** . * . ° . °8 465 I Ha tong has the I diarrhea Lasted/did the diarrhea last? DAYS [ ~ (iF LESS THAN I DAY, ENTER IO0*) DAYS M (IF LESS THAN 1 DAY, ENTER IOOI) 0.E (-I-1 I (IF LESS THAN 1 DAY, ENTER =00 m ) 466 | Mas there any blood I in the stools? YES . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . 2 DK . . . . . . . . . . . . . . . . . . . . . . . 8 *" . ' I . ' I HO . . . . . . . . . . . . . . . . . . . . . . . 2 NO . . . . . . . . . . . . . . . . . . . . . . . 2 G[ . . . . . . . . . . . . . . . . . . . . . . . 8 OK . . . . . . . . . . . . . . . . . . . . . . . 8 467 m Iihat do you think may be I the reasc~ (HARE) haS diarrhea? TEETHING . . . . . . . . . . . . . . . . . 1 TEETHING . . . . . . . . . . . . . . . . . 1 OTHERCONTAMINATED FOOD/WATER.23 OTHERCONTAMINATED FOOO/WATER.2 (SPECIFY) I DX . . . . . . . . . . . . . . . . . . . . . . . 8 DE . . . . . . . . . . . . . . . . . . . . . . . 8 TEETHING . . . . . . . . . . . . . . . . . 1 CO'TAM|HATED FOOU/WATER.2 OTHER 3 (SPECIFY) OE . . ** . * . .o . . . . . . . . . . . . . . ,~ m Do you think (NAME'S) HOT DANGEROUS . . . . . . . . . . . . 1 MOT DANGEROUS . . . . . . . . . . . . 1 HOT DANGEROUS . . . . . . . . . . . . 1 | I diarrhea was r~ot dangerous SLIGHTLY DANGEROUS . . . . . . . 2 SLIGHTLY DANGEROUS . . . . . . . 2 SLIGHTLY DANGEROUS . . . . . . . 2 I to h is /her health, or ~as VERY DANGEROUS . . . . . . . . . . . 3 VERY DANGEROUS . . . . . . . . . . . 3 VERY GAHGJEROUS . . . . . . . . . . . 3 i t s l ight ly or very dangerous? OK . . . . . . . . . . . . . . . . . . . . . . . 8 DE . . . . . . . . . . . . . . . . . . . . . . . 8 DK . . . . . . . . . . . . . . . . . . . . . . . 8 20 193 LAST BIRTH I NEXT-TO-LAST BIRTH I SECOND-FROM-LAST BIRTH NAME I NAME J NAME 470 671 CHECK 427: LAST CHILD STILL BREASTFED? Sen (NAME) had d ia r rhea , d id yOU change the f requency o f b reest feed ing? YES NO [~ (SKIP TO 4721 m YES . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . 2 1 (SKIP TO 4~)< I Dur ing the d ia r rhea , d id you i rc rease the nuNber o f ~ o r reduce them, or d id yOU stOP coe lo te te ty? INCREASED . . . . . . . . . . . . . . . . I REDUCED . . . . . . . . . . . . . . . . . . 2 STOPPED COMPLETELY . . . . . . . 3 672 Was he /she g iven the same SAME . . . . . . . . . . . . . . . . . . . . . 1 SAME . . . . . . . . . . . . . . . . . . . . . 1 SAME . . . . . . . . . . . . . . . . . . . . . 1 anmunt to d r ink as be fore ' HORE . . . . . . . . . . . . . . . . . . . . . 2 MORE . . . . . . . . . . . . . . . . . . . . . 2 MORE . . . . . . . . . . . . . . . . . . . . . Z the d ia r rhea , or more, o r LESS . . . . . . . . . . . . . . . . . . . . . 3 LESS . . . . . . . . . . . . . . . . . . . . . 3 LESS . . . . . . . . . . . . . . . . . . . . . 3 tess? DE . . . . . . . . . . . . . . . . . . . . . . . 8 OK . . . . . . . . . . . . . . . . . . . . . . . 8 DK . . . . . . . . . . . . . . . . . . . . . . . 8 (`73 I Was (NAME) g iven YES . . . . . . . . . . . . . . . . . . . . . . 1 YES . . . . . . . . . . . . . . . . . . . . . . 1 YES . . . . . . . . . . . . . . . . . . . . . . 1 I I a f lu id made f rom a NO . . . . . . . . . . . . . . . . . . . . . . . 2 NO . . . . . . . . . . . . . . . . . . . . . . . 2 NO . . . . . . . . . . . . . . . . . . . . . . . 2 I spec ia l packet? DK . . . . . . . . . . . . . . . . . . . . . . . 8 DK . . . . . . . . . . . . . . . . . . . . . . . 8 DK . . . . . . . . . . . . . . . . . . . . . . . 8 (`74 475 (`76 Was (NAME) g iven a recommended home-made f lu id made f rom sugsr , sa t t and water? CHECK (`7"~ AND (`7(`: CHILD GIVEN FLUID FROM PACKET ((`73) AND/OR BECOMMENDFD HOME-MADE FLUID ((`7(`)? For how n~mny days was (NAME) g iven th i s f lu id? YES . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . 2 OK . . . . . . . . . . . . . . . . . . . . . . . 8 YES GIVEN NO FLUID FLU IO[~ (PKT./HOME ) v (SKIP TO (`77) v DAYS . . . . . . . . . . . . . . . . DK . . . . . . . . . . . . . . . . . . . . . . 98 YES . . . . . . . . . . . . . . . . . . . . . . 1 HO. . . , . . . . . . . . . . . . . . . . . . . 2 OK . . . . . . . . . . . . . . . . . . . . . . . B YES GIVEN NO FLUID FLU IO~ (PKT./HOME) (SKIP TO ( `77) v YES . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . 2 DX . . . . . . . . . . . . . . . . . . . . . . . 8 YES GIVEN NO FLUID FLUIDE~ (PKT./HOME) v (SKIP TO (`77) v DAYS . . . . . . . . . . . . . . . . ~ DAYS . . . . . . . . . . . . . . . . T ~ OK . . . . . . . . . . . . . . . . . . . . . . 98 OK . . . . . . . . . . . . . . . . . . . . . . 98 (`77 Was anyth ing g iven fo r the YES . . . . . . . . . . . . . . . . . . . . . . 1 YES . . . . . . . . . . . . . . . . . . . . . . 1 YES . . . . . . . . . . . . . . . . . . . . . . l J d ia r rhea (o ther than th i s NO . . . . . . . . . . . . . . . . . . . . . . . L]2 NO . . . . . . . . . . . . . . . . . . . . . . . 21 HO . . . . . . . . . . . . . . . . . . . . . . . 2 I f lu id )? (SKIP TO 679)< l (SKIP TO 479)< j (SKIP TO 479)< . . . . . . . . . . . . . . . . . . . . . . . 8 J OK . . . . . . . . . . . . . . . . . . . . . . . 8 DK . . . . . . . . . . . . . . . . . . . . . . . DK (`78 What was g iven to t reat the d ia r rhea? Anyth ing e l se? (CIRCLE EACH MENTIONED) INJECTION . . . . . . . . . . . . . . . . 1 ANTIBIOTIC (P ILL OR SYRUP) . . . . . . . . . 1 OTHER PILL OR SYRUP . . . . . . 1 ( I .V . ) ]NTRAVENC(JS . . . . . . . 1 UNKNOWN PILL OR SYRUP. . . .1 HOME REMEDY/ HERBAL MEDICINE . . . . . . . . . 1 OTHER 1 INJECTION . . . . . . . . . . . . . . . . 1 ANTIBIOTIC (P ILL OR SYRUP) . . . . . . . . . 1 OTHER PILL OR SYRUP . . . . . . 1 ( I .V . ) INTRAVENOUS . . . . . . . 1 UNKNOWN P ILL OR SYRUP. . . .1 HOME REMEDY/ HERBAL MEDICINE . . . . . . . . . 1 OTHER 1 (SPECIFY) INJECT$ON . . . . . . . . . . . . . . . . 1 ANTIBIOTIC (P ILL OR SYRUP) . . . . . . . . . 1 OTHER PILL OR SYRUP . . . . . . 1 ( ] .V . ) INTRAVENOUS . . . . . . . 1 UNKNOWN PILL OR SYRUP. . . .1 HOME REHEDY/ HERBAL MEDICINE . . . . . . . . . 1 OTHER 1 (SPECIFY) [SPECIFY) 479 D id you seek adv ice o r YES . . . . . . . . . . . . . . . . . . . . . 1 YES . . . . . . . . . . . . . . . . . . . . . 1 YES . . . . . . . . . . . . . . . . . . . . . 1 m t reatment fo r the I d iar rhea? NO . . . . . . . . . . . . . . . . . . . . . . 21 NO . . . . . . . . . . . . . . . . . . . . . . 21 NO . . . . . . . . . . . . . . . . . . . . . . 2 1 (SKIP TO (`81)< ] (SKIP TO ( ,81)< / (SKIP TO 681 )< I 480 From ~homdid you seek e~lvice o r t reatment? AnyOne e l se? (CIRCLE EACH MENTIONED) VILLAGE HEALTH kCCKER. . . .1 HEALTH CLINIC/POST . . . . . . . | HEALTH CENTER . . . . . . . . . . . . 1 HOSPITAL . . . . . . . . . . . . . . . . . 1 PRIVATE DOCTOR . . . . . . . . . . . 1 TRADITIONAL/SPIRITUAL HEALER . . . . . . . . . . . . . . . . . . 1 VILLAGE CHEMIST AT PATENT MEDICINE SHOP. . . . ( PHARMACY . . . . . . . . . . . . . . . . . 1 OTHER 1 VILLAGE HEALTH WORKER.1 HEALTH CLINIC/POST . . . . . . . 1 HEALTH CENTER . . . . . . . . . . . . 1 HOSPITAL . . . . . . . . . . . . . . . . . 1 PRIVATE DOCTOR . . . . . . . . . . . 1 TRADITIONAL/SPIRITUAL HEALER . . . . . . . . . . . . . . . . . . 1 VILLAGE CHEMIST AT PATENT MEDICINE SHOP. . . .1 PHARMACY . . . . . . . . . . . . . . . . . 1 OTHER 1 (SPECIFY) VILLAGE HEALTH WOAKER.,.1 HEALTH CLINIC/POST . . . . . . . 1 HEALTH CENTER . . . . . . . . . . . . 1 HOSPITAL . . . . . . . . . . . . . . . . . 1 PRIVATE DOCTOR . . . . . . . . . . . 1 TRADiTIONAL/SPIRITUAL HEALER . . . . . . . . . . . . . . . . . . ( V%LLAGE CHEMIST AT PATENT MEDICINE SHOP, . . .1 PHARMACY . . . . . . . . . . . . . . . . . 1 OTHER 1 (SPECIFY) (SPECIFY) 481 GO BACK TO 440 FOR NEXT BIRTH; OR, IF NO MORE BIRTHS, GO TO (`82. I 21 194 NO. QUESTIONS AND FILTERS CODING CATEGORIES 482 m CHECK 4~: I ORS SOLUTION MENTIONED [ [ (ANY YES IN 673) ORS SOLUTION MOT MENTIONED OR 47'3 NOT ASKED SKIP I 483 I Have you ever seen a packeT l i ke th i s before? I YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 I I (SHOW PACKET) m RO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 - - ' .7 484 I Have you ever prepared a so lu t ion w i th one of these | YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 I I packeTs to TreaT d ia r rhea in yourse l f or s~eeone e lse? I I (SHOW PACKET) NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2--'4"486 485 HOW much waTer d id you use TO prepare (LOCAL NAME)? F~ SOFT DRINK BOTTLES . . . . . . . . . 1 I I BEER BOTTLES . . . . . . . . . . . . . . . 2 CUPS . . . . . . . . . . . . . . . . . . . . . . . 3 FOLLOWED PACKAGE INSTRUCTIONS.95 OTHER 96 (SPECIFY) OK . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 98 486 Where can you geT The (LOCAL NAME) packeT? PROBE: Anywhere etse? (CIRCLE ALL PLACES MENTIONED) VILLAGE HEALTH WORKER . . . . . . . . . . . I HEALTH CLINIC/POST . . . . . . . . . . . . . . I HEALTH CENTER . . . . . . . . . . . . . . . . . . . I HOSPITAL . . . . . . . . . . . . . . . . . . . . . . . . I PRIVATE DOCTOR . . . . . . . . . . . . . . . . . . I TRADITIONAL/SPIRITUAL HEALER.I VILLAGE CHEMIST AT PATENT MEDICINE SHOP . . . . . . . . . . . 1 PHARMACY . . . . . . . . . . . . . . . . . . . . . . . . 1 OTHER I (SPECIFY) OK . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I 22 195 NO. 488 GKJESTIONS AND FILTERS CHECK 676: RECOMMENDED HOME-MADE FLUID MENTIONED (ANT YES IN 474) I Have you ever prepared a recommended home-made f lu id mde from sugar , sa l t and water to t reat d ia r rhea in yourse l f or someone e lse? SKIP I RECOMMENDED HONE "MADE FLU IO 9 1 1 N L I m NOT MENTIONED OR 476 NOT ASKED l YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 J NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2--,='501 689 $~no taught you to prepare the home f lu id made from sugar , sa l t and water? VILLAGE HEALTH '=,~ORKER . . . . . . . . . . 01 HEALTH CLINIC/POST . . . . . . . . . . . . . 02 HEALTH CENTER . . . . . . . . . . . . . . . . . . 03 HOSPITAL . . . . . . . . . . . . . . . . . . . . . . . 06 PRIVATE DOCTOR . . . . . . . . . . . . . . . . . 05 TRADITIONAL/SPIRITUAL HEALER.06 VXLLAGE CHEMIST AT PATENT MEDICINE SHOP . . . . . . . . . . 07 PHARMACY . . . . . . . . . . . . . . . . . . . . . . . 08 ]MMUNZZATXON CARD . . . . . . . . . . . . . . 09 OTHER 10 (SPECIFY) DK . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 98 490 How much water d id you use to prepare the home f lu id? SOFT DRINK BOTTLES . . . . . . . . . 1 I J U BEER BOTTLES . . . . . . . . . . . . . . . 2 CUPS . . . . . . . . . . . . . . . . . . . . . . . 3 OTHER 96 (SPECIFY) DK . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 98 491 HOW much sugar d id you use to prepare the hocne f lu id? CUBES . . . . . . . . . . . . . . . . . . . 1 I J l TEASPOONS . . . . . . . . . . . . . . . 2 OTHER 996 (SPECIFY) OK . . . . . . . . . . . . . . . . . . . . . . . . . . . . 998 492 How much sa l t d id you use to prepare the home f lu id? 1 TEASPOON . . . . . . . . . . . . . . . . . . . . . . 1 2 TEASPOONS . . . . . . . . . . . . . . . . . . . . . 2 ] TEASPOONS . . . . . . . . . . . . . . . . . . . . . 3 OTHER 4 (SPECIFY) DK . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 _ oo . v I . I fo r t reat ing d ia r rhea? NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . a OK . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 23 196 SECTION 5. MARRIAGE NO. QUESTIONS ANO FILTERS 501 Have you ever been married or rived with a man? SKIP l COOING CATEGORIES l TO I YES . 1 I NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 ~510 s°21 r ° - - ° r iv i r th n°r r I - - . you rm~ widowed, divorced or no longer l i v ing together? LIVING TOGETHER . . . . . . . . . . . . . . . . . 2 pSO& WIO~D . . . . . . . . . . . . . . . . . . . . . . . . . DIVONCED . . . . . . . . . . . . . . . . . . . . . . . . 507 NO LONGER LiViNG TOGETHER . . . . . . . 5 503 J Does your husband/part~r l ive with you or (~es he l ive J LIVES WITH HER . . . . . . . . . . . . . . . . . . 1 J I etseuhere? | LIVES ELSEWHERE . . . . . . . . . . . . . . . . . 2 I 504 Does your husband/partner have any other wives besides I YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 I yourset f? I I NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ~._~507 505 Ho~ many other wives does he have? I NUNHER . . . . . . . . . . . . . . . . . . . . . ~ I I | OK . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9~ L507 '~1 'r. ~ ,~. ' '~. -~,. . . . ' '~, I '''~ . ~1 50;' Have you been married or rived with a man only Once, I ONCE . . . . . . . . . . . . . . . . . . . . . . . . . . . . , I or more than once? I I MORE THAN ONCE . . . . . . . . . . . . . . . . . . 2 508 I yourNOU o[d were you when you started Living w i t h ( f i r s t ) husbend or partner? ] A°E . . . . . . . . . . . . . . . . . . . . . . . . F ~ I 509 In what month and year did you start l i v ing with him? NONTH . . . . . . . . . . . . . . . . . . . . . . ~ l COMPARE 50B AND 509 WITH 105 AND 106. OK HONTH . . . . . . . . . . . . . . . . . . . . . . . 98 ! NAKE CORRECTIO~dS ]F INCONSISTENT. r~- - -~ ~--P511 i l l j YEAR . . . . . . . . . . . . . . . . . . . . . . . DK YEAR . . . . . . . . . . . . . . . . . . . . . . . . 98 ~°lF - - °~ I '~ . I Have you ever had sexual intercourse? NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 P515 24 197 NO. QUESTIOMS AND FILTERS CODING CATEGORIES 511 Now we need some deta i t s about your sexuml ac t iv i ty in o rder to get a bet ter unders tand ing of cont racept ion and fe r t i t i ty . How er, e r~ t imes d id you have sexual in tercourse in the r ~ fas t four weeks? TIMES . . . . . . . . . . . . . . . . . . . . . . I [ ] i nterco4Jrse? T I MES . . . . . . . . . . . . . . . . . . . . . . 513 When was the test t ime 'you had sexuat in tercoucse? SKIP TO DAYS AGO . . . . . . . . . . . . . . . . . 1 WEEKS AGO . . . . . . . . . . . . . . . . 2 MONTHS AGO . . . . . . . . . . . . . . . 3 YEARS AGO . . . . . . . . . . . . . . . . 4 BEFORE LAST BIRTH . . . . . . . . . . . . . 996 514 I ow o ld were you when you f i r s t had sexuat in tercourse? I PRESENCE OF OTHERS AT THIS POINT. AGE . (N I FIRST TIME MHEN ~RRIED . . . . . . . . 96 YES NO I CHILDREN UNDER 10 . . . . . . . . . . 1 2 HUSBAND . . . . . . . . . . . . . . . . . . . . 1 2 OTHER MALES . . . . . . . . . . . . . . . . 1 2 OTHER FEMALES . . . . . . . . . . . . . . 1 2 25 198 601 I CHECK 311: NEITHER STERILIZED - - V SECTION 6. FERTILITY PREFERENCES SKIP HE OR SHE STERILIZED [-'7 I ~. 606 I E 603 CHECK 501 AND 502: CURRENTLY Now I have some questions about the future, CHECK 223 AND MARK BOX: NOT PREGNANT OR UNSURE V Uoutd you Like to have (a/another) ch i ld or v~utd you prefer not to have any (more) children? PREGNANT~ I V After the ch i ld you are expecting, Mould you Like to have another ch i ld or Mould you prefer not to have any more children? HAVE A (ANOTHER) CHILD . . . . . . . . . / NO MORE . . . . . . . . . . . . . . . . . . . . . . . . 2 SAYS SHE CAN=T GET PREGNANT . . . . 6O9 UNDECIDED OR DK . . . . . . . . . . . . . . . . CHECK 223 AND MARK BOX: NOT PREGNANT OR UNSURE ! t V How long would you l ike to wait from now before the b i r th of (a/another) chikd? PREGNANT How tong uould you l i ke to Mait after the b i r th you are expecting before the b i r th of another child? . . . . . . . . . . . . . . . . . , i YEARS . . . . . . . . . . . . . . . . . . . . 2 [ - -~ I __609 SOON/N~ . . . . . . . . . . . . . . . . . . . . . . . ~4 / SAYS SHE CAN'T GET PREGNANT.995 -~ OTHER 996 I (SPECIFY) DK . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99D 605 CHECK 216: I f NO LIVING CHILDREN, CIRCLE '96 ~, OTHERWISE ASK: Row old would you l ike your youngest ch i ld to be before having another child? J AGE OF YOUNGEST I YEARS . l--r] 7 NO LIVING CHILDREN . . . . . . . . . . . . . . . 96 609 Do you regret that you (your husband) had the operation not to have any (more) children? I YES . . . . . . . . . . . . . . . . . . . . . . . t . . . . . 1 J NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 ~6O8 I 607 J Why do you regret it? I WARTS ANOTHER CHILD . . . . . . . . . . . . . 1 - -~613 OTHER REASON 2 -~ (SPECIFY) J over again, do you thiN( you would make the =~ 613 decision to have a ster i ( izat ion? NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 Z6 199 RO. I QUESTIONS ANO FILTERS m 609 J , o you th ink that your husbend/bar tner approves or I d isapproves of coup les us ing a method to avo id pregnancy? SKIP COOING CATEGORIES I TO i APPROVES . . . . . . . . . . . . . . . . . . . . . . . . 1 I DISAPPROVES . . . . . . . . . . . . . . . . . . . . . 2 I D~ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 I I 610 I How o f ten have you ta lked to your husband/par tner about NEVER . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 I I fami ly p lann ing in the bast year? ONCE OR TWICE . . . . . . . . . . . . . . . . . . . Z I MORE OFTEN . . . . . . . . . . . . . . . . . . . . . . 3 611 I Have you and your husband/par tner ever d iscussed YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 I I the number of ch i ld ren you ~outd L ike to have? I NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 I °° I . I same number of ch i ld ren that you want, NORE CHILDREN . . . . . . . . . . . . . . . . . . . 2 or does he ~ant more FEaR CHILDREN . . . . . . . . . . . . . . . . . . ] or fewer than you uant? DK . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 in tercourse a f te r the b i r th of a baby? YEARS . . . . . . . . . . . . . . . . . . . . 2 OTHER 996 (SPECIFY) shoo, a°,he uo,,, sheh.s cO,e,e,ys, I . . . . . . . . . . . . . . . . . . . . . . . . . . . . breastfee<:l ing before s ta r t ing to have sexual re la t ions aga in , or doesn ' t i t matter? OOESR'T HATTER . . . . . . . . . . . . . . . . . . 2 616 CHECK Z16 AND NARK BOX: NO LIVING CHILDREN ~ HAS LIVING CHILDREN ! / i i v Y I f yOU cou ld choose I f you cou ld go beck to the t ime exact ly the number of you d id not have any ch i ld ren ch i ld ren to have in and Could choose exact ly the your ut lote L i fe , how nud0er o f ch i ld ren to have in many would that be? your t,.,hote | i re , how many would that be? RECORD SINGLE NUMBER OR OTHER ANStlER. MUNBER . . . . . . . . . . . . . . . . . . . . [ ~ UP TO GO0 . . . . . . . . . . . . . . . . . . . . . . 95 OTHER (SPECIFY) 27 200 SECTION 7, NUSBANDI~ ~ACKGROUND AND t~NAN*S WORK SKIP NO. OUESTIONS AND FILTERS CODING CATEGORIES I TO m 701 CHECK 501 : I I ,708 EVER MARRIED [~ NEVER NARRIED, OR LIVED NEVER LIVED [ '~ TOGETHER TOGETHER v ASK QUESTIONS ABOUT CURRENT OR ROST RECENT HUSBAND/PARTNER. I ::::::::::::::::::::::::::::::::::::::: 702 Did your ( lest ) husband/partner ever attend school? 703 I What ~es the highest level of school he ettended: PRINARY . . . . . . . . . . . . . . . . . . . . . . . . 1 I I primary~ secondary, or higher? SECONDARY . . . . . . . . . . . . . . . . . . . . . . . ~ | HIGHER . . . . . . . . . . . . . . . . . . . . . . . . . . 3 I I OK . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8~--, '705 704 I What uas the highest (class, form, year) he campLeted CLASS . . . . . . . . . . . . . . . . . . . . . . ~ I I at that level? I I I I DK . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 98 705 What kind of work does (did) your (Last) husband/partner mainly do? [ I I )708 707 (Does/did) your husband/partner work I~sinLy on his o~m land or family tend, or (does/did) he rent land, or (does/did) he work on someone etse's land? I H]S/FAMILY LAND . . . . . . . . . . . . . . . . . 1 | RENTED LAND . . . . . . . . . . . . . . . . . . . . . 2 I SOMEONE ELSE+S LAND . . . . . . . . . . . . . 3 28 201 NO. I QUESTiONS AND FILTERS I 7O8 As you kno~, many women work - i mean as ide from do ing the i r o~n housework. Some take up jobs fo r which they are pa id Ln cash or k ind . Others se l l th ings , have a amt I bus iness or work on the fmi ly farm or in the fmi ty bus iness . Are you cur rent ly do ing any such work? COOING CATEGORIES YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO.o. . . . . . . . . . . . . . . . . . . . . . . . . . . . ~ SKIP I TO I ~716 I 709 ~/hat i s your occupat ion , that i s , what k ind of work do you do? I EMPLOYEE . 1 I 710 In your work, are you an employee, se l f -employed , or an employer? SELF-EMPLOYED . . . . . . . . . . . . . . . . . . . 2 EMPLOYER . . . . . . . . . . . . . . . . . . . . . . . . 3 711 J Do you earn cash fo r th i s work? YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 I I I NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Z 712 Do you do th i s work at home or a~ay from home? HONE . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 AWAY . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 YES NO [~ I 714 I Whi le you are work ing, do you usua l ly I have (NAME OF YOUNGEST CHILD AT HONE) w i th yOU, soe~etimes have h im/her w i th you, or never have h im/her w i th you? USUALLY . . . . . . . . . . . . . . . . . . . . . . . . . . 1 • SONETINES . . . . . . . . . . . . . . . . . . . . . . . . 2 NEVER . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 I 11"7'61 .716 I 715 t/no usua l ly takes care of (NAME OF YOUNGEST CHILD AT HONE) wh~le you are working? RECORD THE TIME HUSBAND . . . . . . . . . . . . . . . . . . . . . . . . . 01 OLDER CHILD(REX) . . . . . . . . . . . . . . . . 02 OTHER RELATIVES . . . . . . . . . . . . . . . . . 03 NEIGHBORS . . . . . . . . . . . . . . . . . . . . . . . 06 FRIENDS . . . . . . . . . . . . . . . . . . . . . . . . . 05 SERVANTS/HIRED HELP . . . . . . . . . . . . . 06 CHILD IS IN SCHOOL . . . . . . . . . . . . . . OT INSTITUTIONAL EHILDCARE . . . . . . . . . 08 OTHER 09 (SPECIFY) HOUR . . . . . . . . . . . . . . . . . . . . . . ~ MINUTES . . . . . . . . . . . . . . . . . . . ~-~ 202 SECT ION ~, WEIGHT AND LENGTH CHECK 215/216: ONE OR MORE L IV ING CHILDREN BORN S INCE JAM. 1985 NO L IV ING CHILDREN BORN S INCE JAN. 1985 I I "END INTERVIEWER: IN 802-804, RECORD THE L INE NUMBERS, NAMES, AND B IRTH DATES OF ALL L IV ING CHILDREN BORN S INCE JANUARY 1; 1985 START ING WITH THE YOUNGEST CHILD. RECORD WEIGHT AND LENGTH IN 805 AND 806. 802 L INE NO. FROM Q.212 803 NAME FROM Q.212 804 DATE OF B IRTH FROM Q.215 AND ASK FOR DAY 8O5 WEIGHT ( in kg . ) 806 LENGTH ( in cm. ) 807 BCG SCAR ON ARM OR SHOULDER 808 DATE CHILD WEIGHED AND MEASURED 809 RESULT W YOUNGEST L IV ING CHILD (NAME) DAY . . . . . . MONTH . . . . YEAR . . . . . SCAR SEEN . . . . . 1 NO SCAR . . . . . . . 2 DAY . . . . . . I MONTH . . . YEAR . . . . . CH ILD MEASURED. I CHILD S ICK . . . . . 2 CHILD NOT PRESENT . . . . . . . 3 CHILD REFUSED. .4 MOTHER REFUSED.5 OTHER . . . . . . . . . . 6 (SPECIFY} 21 NEXT-TO- ~OUNGEST L IV ING CHILD (NAME) DAY . . . . . . MONTH . . . yEAR . . . . . I-]-1.11 i U [I SCAR SEEN . . . . . 1 NO SCAM . . . . . . . 2 i DAY . . . . . . i MONTH . . . . YEAR . . . . . CH ILD MEASURED. I CH ILD S ICK . . . . . 2 CHILD NOT PRESENT . . . . . . . 3 CHILD REFUSED. .4 MOTHER REFUSED.5 OTHER . . . . . . . . . . 6 (SPECIFY} 31 SECOND-TO- YOUNGEST L IV ING CHILD (NAME) DAY . . . . . . MONTH . . . . YEAR . . . . . [U Ill I I SCAR SEEN . . . . . 1 NO SCAR . . . . . . . 2 DAY . . . . . . MONTH . . . . YEAR . . . . . CH ILD MEASURED. I CH ILD S ICK . . . . . 2 CHILD NOT PRESENT . . . . . . . 3 CHILD REFUSED. .4 MOTHER REFUSED.5 OTHER . . . . . . . . . . 6 (SPECIFY} 810 NAME OF MEASURER: NAME OF ASSISTAMT : 30 203 INTERVIEWER'S OBSERVATIONS (To be filled in after completing interview) Comments about respondent: Comments about specific questions: Any other comments: SUPERVISOR'S OBSERVATIONS Name of Supervisor: Date: EDITOR'S OBSERVATIONS Name of Field Editor: Name of Keyer: Date: Date: 204 NIGERIA SERVICE AVAILABILITY QUESTIONNAIRE IDENT IF ICAT ION STATE. CLUSTER NUMBER CLUSTER V IS IT START DATE. CLUSTER V IS IT END DATA. URBAN/RURAL RES IDENCE: URBAN. RURAL. . . . . . . . . . . . . i . . . . . . . . . . . .2 TYPE OF AREA: C ITY . . . . . . . . . . . . . . . . . . . . . . . 1 TOWN . . . . . . . . . . . . . . . . . . . . . . . 2 RURAL (V ILLAGE) . . . . . . . . . . . . 3 QUEST IONNAIRE NUMBER . . . INTERVIEWER NAME DATA ENTRY CLERK STATE I l L CLUSTER NUMBER I I I I I DAY MONTH DAY MONTH I I 1[ -1 URBAN/RURAL TYPE OF AREA QUEST IONNAIRE NO. [-----q LANGUAGE OF CLUSTER INTERVIEW . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . i HAUSA 3 IGBO 5 KANURI 7 ENGL ISH 2 YORUBA 4 EF IK 6 T IV 8 OTHER (SPECIFY) 205 ICT la l 1A. C~ITY CRNIACTERI IT IC l No. I QUEIT lolls ] COOING CATEGI0t IES I KIPTO RUEST|ORS 100 TO 102 ARE TO IE ANS~RED IY THE IMTERVIE~E UPOII ARRIVAL AT THE CLUSTER. 1~ RE~D THE T I~. 101 TYPE OF AREA ( tn ~ lch EA I I found/neares t To EA) i 102 DENSITY OF RURAL VILLAGE 103 104 10S 106 107 108 109 110 I l l t12 N~U~. .o . . . . , . . . * **b°**° . [~ MINUTES . . . . . . . . . . . . . . ~ . . .~ '~ CITY . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 " " TO~ . . . . . . . . . . o . . . . . . °o . . . . . . . . . 2 RURAL (V ILLAGE) . . . . . . . . . . . . . . . . . 3 COMPACT . . . . . . . . . . . . . . . . . . . . . . . . . 1 SCATTERED . . . . . . . . . . . . . . . . . . . . . . . 2 113 P 109 I THE REMAINING OUESTIONS IN SECTIONS 1 AND 2 ARE TO BE ANSWERED BY KNONLEDGEABLE INFORMANTS FROM THE CLUSTER. Hat I s the name o f the neares t c t ty / to~? Nhst i s the most commonly used fo rm o f t ranspor ta t ion to go to the neares t c i ty / tour? How Long does i t take to reach the neares t c i ty / town us ing the the most comport type o f T ranspor ta t ion? MOTORIZED . . . . . . . . . . . . . . . . . . . . . . 1 CYCLING . . . . . . . . . . . . . . . . . . . . . . . . . 2 ANIMAL . . . . . . . . . . . . . . . . . . . . . . . . . . 3 UALK%NG . . . . . . . . . . . . . . . . . . . . . . . . . 4 BOATING . . . . . . . . . . . . . . . . . . . . . . . . . 5 OTHER . , ,6 HOURS . . . . . . . . . . . . . . . . . . M INUTES . . . . . . . . . . . . . . . . What i s the main access route to th i s community? PAVED ROAD . . . . . . . . . . . . . . . . . . . . . . 1 I UNPAVEO ROAD . . . . . . . . . . . . . . . . . . . . 2 R%VER . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 OTHER (RAILWAY) . . . . . . . . . . . . . . . . . 4 PATH . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 I I I s the main access route usuabte dur ing the ra iny season? YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 i What a re the major economic ac t iv i t ies o f the inhab i tants o f th i s coml~Jnlty? (CIRCLE ALL APPLICABLE) I~hat i s The main source o f d r ink ing water in the community? AGRICULTURAL . . . . . . . . . . . . . . . . . . . . 1 FISHING . . . . . . . . . . . . . . . . . . . . . . . . . 1 TRADING/MARKETING . . . . . . . . . . . . . . . 1 MANUFACTUR%NG . . . . . . . . . . . . . . . . . . . 1 MINING . . . . . . . . . . . . . . . . . . . . . . . . . . 1 OTHER . . .1 PIPED . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 PUBLIC TAP . . . . . . . . . . . . . . . . . . . . . . BOREHOLE . . . . . . . . . . . . . . . . . . . . . . . . 3 WELL . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 RIVER, SaRING~ SURFACE WATER. . . .S I OTHER . . .6 I s there e lec t r i c i ty in th i s co~rm~i ty? I YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 What I s the main w ins o f waste d i sposa l in th i s co~n~Jntty? INCINERATIOM . . . . . . . . . . . . . . . . . . . . 1 BURNING . . . . . . . . . . . . . . . . . . . . . . . . . 2 DUNG HILL . . . . . . . . . . . . . . . . . . . . . . . 3 REFUSE BINS/COLLECTION . . . . . . . . . . 4 OTHEB . . .5 NO METHO0 . . . . . . . . . . . . . . . . . . . . . . . 6 Uf lat type o f to i le t fac i l i t i es a re used by most househo lds in th i s community? FLUSH (WATER CLOSET) . . . . . . . . . . . . 1 BUCKET . . . . . . . . . . . . . . . . . . . . . . . . . . Z PIT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ] UTHER .,,4 XO FACIL IT IES . . . . . . . . . . . . . . . . . . . 5 1-1 206 SBCTION lB . AVAILABILITY OF PONLIC SERVICES SEAREST TO OR IN THE COIAg~ITY INTERVIEWER: NOU I ~OUtd l i ke to ask you about the distances to var io~ schools and serv ices , how yau USUaLly Oo there end how far i t i s from here. INSTRUCTION FOIl IBTERVIEUER: IF THE LOCATION OF THE SEEVICE IS UNKNOWN TO THE INFORKASTS, REC(~O 'gg l ' FOR GUEST]ON 113 AND CONTINUE WITH THE NEXT SERVICE. SERVICES 113 TRAVEL TIME TO GET THERE (HIBUTES) A. EDUCATION 1 Pr l IMry School 2 Secondery School 3 UnJversity/Potytechnicsl/ Technical School B. GENERAL SERVICES 1 Post Of f i ce /Ma i l Service 2 De i ty Barker 3 Weekly Harket 4 Cinema S PubLic Transportat ion IF '998* - - IF '998' IF '998' 116~ 114 HOST CQWAON TRANSPORT (a) [ E I I I I [ I I 115 DISTANCE IN MILES [hl n-1 r-n COOES: CGI~AENTS: (a) Motor i zed . . . .1 Cycl ing . . . . . . 2 An iml . . . . . . . 3 ~atk ing . . . . . . 4 Boating . . . . . . 5 Other . . . . . . . . 6 1-2 (b] 97 • 97+ O0 = Less than l / l ocated in ru ra l c lus ter 98 = Distance unknown 207 SIECTICI4 IC . NEALTN ANO FAMILY PLANNING PilQ~IIAPlS IN TIME CCIqNUNITY mO. 116 116m 116b 116c 116d OUEBTIOilS ~'CX)ING CATEGORIES SlIP TO i Is th is ¢omunlty v is i ted by • health worker (such us • CHEW, YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 family planning worker, comunity heetth l ss l s t ln t , mot|visor)? NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 - ~ 117 Does th i s health worker supply (LIST) and kNhet does i t cost? BASIC MEDICATIONS: e: Basic fledtcatior~s? b: ONT i r~t ruct ion (augsr /sst t )? c: V i tm{ns? d: Immunizations? e: FamiLy PLanning Services? PILL? Cocx~n? Foaming TabLets? How often does the health worker v i s i t th i s commLa~ity? For whom does th i s health worker work? HOW many health workers do you know of who ~ork in thls ares? 1-3 YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 - NO . . . . . . * . . . . . . . . . . * . . . . . . * , ° . * .2 - + + YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 - NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 | J EPAE'ET½F--] . . . . . VITAMINS: YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I - NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 l J "EEAOE+OST.½1 --I"-- IMP~JNIZATINS: YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 -- NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 J SPECIFY WHICH: ~ ~ . - - AVE~ FAMILY PLAMN]N°: YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 - - - -~ 116b YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 -- NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 | J COST OF 1 4 - - MONTH CYCLE. [ ~ . ~ - ~ ] COND~ : YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 - . o . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 m J :OSTOF, . P1P I I ' - - FOAMTNG TABLETS: YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Z l J COST OF PACKET,~.~ I~ " - - ~AHT]TY . . . . . . . . . . . . . ~ NO. OF TIMES ~ PER MONTH.1 I I I YEAR.2 i FEDERAL MOH . . . . . . . . . . . . . . . . . . . . . 1 STATE MOH . . . . . . . . . . . . . . . . . . . . . . . 2 L~AL GOVERNMENT . . . . . . . . . . . . . . . . 3 RRI~TE ORGANIZATION . . . . . . . . . . . . 4 EBURCH/MISSZ~ . . . . . . . . . . . . . . . . . . 5 LOCAL FACIL%TY . . . . . . . . . . . . . . . . . . 6 OTHER . . .7 D~'T KN~ . . . . . . . . . . . . . . . . . . . . . . B NO. OF ~RKERS . . . . . . . . . t I J 208 NO° 117a 117b 117c QUESTIONS Is th i s coranun l ty v i s i ted by s mob i le hea l th c l in i c? Does th i s mob i le hea l th c l in i c s~PpLy (L IST) and uhat does i t cos t? a: Bas ic Med icat ions? b: ORT ins t ruc t ion (sugar /sa t t )? c : V i tamins? d : Immunizat ions? e : Fami ly PLann ing Serv ices? P i l l ? condoJn? Foaming Tab le ts? How o f ten does the mob i le hea l th c l in i c v i s i t th i s comr~ni ty? Who sponsors the mob i le hea l th c l in i c? CODING CATEC-ONIES K IP TO ~BS.o.°°oo.o°.*.°°°.oo.*l MO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 - P 116 BASLC NEDICATIONS: ~ l YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 RO°H.ooo,,.o°,,.°.°,.o°.,,,.2 AVERAGE r.,OST °,, D ~ ' -~ I 4.-.- --I ONT: YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 -- No . ' 1 o VITAMINS: YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 -- . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 1 AVERAOECOST.,.~F--FI'-- o ]HMUN I ZAT ]ONS: YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 -- ,o . ' 1 sPEC"T ~'c': D F--V1 "- AVERAGE COST FAM[LY PLANNING: YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 - - ~ 117b YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 -- No . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ~ l COST OF, D FVT"-- NORTH CYCLE . . . . . CONDOM: YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 -~ NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 | J COST OF 3 . . . . . . ~ [ - l - - ] - - FOAH[HG TABLETS: YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 - NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 | 1 COST OF PACKET° I r - - I - -1 -- OUANTITY= . . . . . . . . . . . . [ ~ i i i NO. OF T[HES I I I PER NONTH.1 L I I YEAR.,,2 FEOERAL MOH . . . . . . . . . . . . . . . . . . . . . 1 STATE HOH . . . . . . . . . . . . . . . . . . . . . . . 2 LGA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 PRLVATE ORGANLZATLON . . . . . . . . . . . . 4 CHURCH/MISSIO~ . . . . . . . . . . . . . . . . . . 5 LOCAL FACILLTY . . . . . . . . . . . . . . . . . . 6 OTHER . , .7 DONIT KNOW . . . . . . . . . . . . . . . . . . . . . . 8 1-4 209 |o. 118 118a 118b 119 120 120a 121 122 122a 123 QU(STIONS , t IS there • heal th poot in th i s ¢ommJntty? YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 DO res |dent l tn th i s co4mJnlty th ink that the health post ta I peace to go when health care is needed? Why rmt? i Is there a t rad i t ionaL heater Ln th i s community? YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 i Is there a t rad i t lo rw l | b i r th attendant ava i lab le to women here YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 who r¢~lutarty assists during del ivery? NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 -- • 121 i Has the Trad i t iona l b i r th attendant had any special t ra ln lng YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 from the Nail or other organizat ion? NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 i Is the area v i s i ted by e tratn~lmfCkeife? YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 B0 . . . . . . . . . . . . . . . . . . . .H . . . . . . . . 2 i i IS there a ~ighboclrhood re ta i l stand (8 staLL or table from YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 which items are sold) in th i s coffmJr~ity? NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 -- • 123 [ Does th i s neighbourhood re ta i l stand seLL (LIST) and what BASIC MEDICATIONS: does i¢ cost? YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 -7 a: Basic MeclicatJo~s? NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 J AVESAOE COST'''I b: ORT packets? c: Vitamins? e: FamiLy PLanning SuppLies? P i l l ? Conpom? Foaming TabLets? in any of the mrketa commonly attended by inhabitants of th i s ccmmuntty~ t l there i morket out let? 1-$ COOING CATEGORIES l SKIP TO / NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 ~- - -~ 119 w YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 - - ~ 119 NO . . . . . . . . . * . . , , o ,o . . , , . ° . * . . . . . 2 NO. . .oo , . . . . . o . , , . . oooo , . . . .oo . .~ ORT: YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 - NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 | J . ,AC , ,TDpT- l . _ . . . . . VITAMINS: YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 - NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 | J AV"AOE COST'''I I,F---T---I "- FAMILY PLANNING: YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 - • 123 YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 -- NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 | J COST OF 1 ~- - MONTH CYCLF., , , I J r ~ ] . YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 - NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 | J oosT o,, . I I . F I - - I ' - - F~MING TABLETS: YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I -- NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 | J °°sT D''AO*ET I I ~ANIITY . . . . . . . . . . . . . ~ ] YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 - • 124 210 No. 123a 124 lZGa I OUESTIOMS Does th i s ~rket out le t eeLL (L IST) Ind ~hat i s the cos t? a: Bas ic Med icat ions? b: ORI packets? c : V i rg ins? e : F~ i iy P lann ing Supp l ies? P i t t ? Condom? Foaming Tab le ts? Have there been any in fo rmat ion campaigns about hea l th or fami ly p lann ing in the col l lmUnity in the Last year? What spec i f i caLLy ~as The message o f ~h is campaign? (CIRCLE ALL APPLICABLE) PROBE: Anyth ing e l se? COOZNG CATEGORIES SKIP TO BASZC MEDICATIONS: YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 - ,--j NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 | _1 AVERAGE DOBT ~ ~- - I " ORT: YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 - NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 [ _] ONE PRDKE, . I I~- - l " VITAMINS: YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 - NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 / J A¥"AGE °OST'"I [ - -n "- FAMILY PLANN [ NGI YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2- J 124 YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 - No . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 | I COST OF 1 I [ I ~- - MONTH CYCLE . . . . I I I CONDOM: YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 - NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ~ 1 / DOS, OF, . . . . . I I~- -~ ' - - FOAMING TABLETS: YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 - NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 | J C°ST OF PADNET'I I . r~ l " - QUART ] TY . . . . . . . . . . . . . i I J YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 - ~ A201 CHILD SPACING . . . . . . . . . . . . . . . . . . . 1 BENEFITS OF BIRTH CONTROL . . . . . . . 1 USE OF FAMILY PLANNING . . . . . . . . . . 1 SPECIFIC METHOD(S) PRGMOTIOH,,,.1 WHERE METHOOS AVAILABLE . . . . . . . . . 1 BENEFITS OF PROLONGED LACTATION,1 FAMILY PLANNING TV PROGRAMS . . . . . 1 FAMILY PLANNING RADIO PROGRAMS,.1 EP] . . . . . : . . . . . . . . . . . . . . . . . . . . . . . 1 ORT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 A%DS . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 DRUG ABUSE . . . . . . . . . . . . . . . . . . . . . . 1 NUTR%TION . . . . . . . . . . . . . . . . . . . . . . . 1 SANITATION . . . . . . . . . . . . . . . . . . . . . . 1 OTHER (SPECIFY) . , ,1 CONGENTS: 1-6 211 SECTION 2. IMTERVIEWER: A. HOSPITALS FACILITY IDENTIFICAT%ON FORM NOW I am going to ask some questions about the fac i l i t i es close to your community that provide he l ( th and fami ly planning services. io . k201 AZ02 N203 A204 A205 A206 A207 A208 A209 QUESTIONS ~hat is the name of the r~arest hospital to th is cocmunity that has services such ms antenatal care and Immunization? t/here is i t located? How far is i t ( In mil~s) from here? (WRITE IN 'OO' IF LESS THAN 1 MILE. IF 1 TO 96 MILES, ~RITE IN DISTANCE AS GLVEN IN CLUSTER. IF 97 MILES OH MORE, WRXTE IN '97% XF DISTANCE IS UNKNOWN, ~RITE IN '98 ' . ) ~/hat iS the most cocnl~n type of transport inhabitants in th is community would use to go to the hospital? How long does i t take in hours arid minutes to get from here to (HOSPITAL NAME) using most common type of transport? CODING CATEGORIES HOSPITAL NAME NONE KNO~/N . . . . . . . . . . . . . . . . . . . . . . . . 98 ADDRESS MILES . . . . . . . . . . . . . . . . . . . . . . MOTORIZED . . . . . . . . . . . . . . . . . . . . . . . . . . T CYCLING . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 ANIMAL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 WALKING . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 BOATING . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 OTHER 6 HOURS . . . . . . . . . . . . . . . . . . . . . . MINUTES . . . . . . . . . . . . . . . . . . . . gKIP TO - - -b B201 - -~" A206 Mow Long in hours and mioutes does i t take to get from here to (HOSPITAL NAME) by walking? HOURS . . . . . . . . . . . . . . . . . . . . . . L I I MINUTES . . . . . . . . . . . . . . . . . . . . r ~ IF MC THAN 6 HOURS--~ A21~ Does th is hospita| provide: YES NO antenatal services? ANTENATAL . . . . . . . . . . . . . . . . . . . I 2 del ivery? DELIVERY . . . . . . . . . . . . . . . . . . . . 1 2 postnata( services? POSTNATAL . . . . . . . . . . . . . . . . . . . 1 2 in~T~izat ion (EPI)? iMMUNIZATION . . . . . . . . . . . . . . . . 1 2 growth monitoring (nut r i t ion)9 NUTRITION . . . . . . . . . . . . . . . . . . . I 2 Generally do peop(e in th is community th ink : YES NO there ere long wait ing times at (HOSPITAL NAME)7 LONG WAITING TIMES . . . . . . . . . . 1 2 the s ta f f are competent? STAFF COMPETENT . . . . . . . . . . . . . 1 2 the services 8t the fac i l i ty are expensive? EXPENSIVE . . . . . . . . . . . . . . . . . . . 1 2 medicines are read i ly avai lable? MEDICINES READILY AVAILABLE.T 2 medicines are fake? MEDICINES ARE FAKE . . . . . . . . . . 1 Z (HOSPITAL NAME) is too far awBy? TOO FAR AWAY . . . . . . . . . . . . . . . . I 2 Does (HOSPITAL NAME) provide famiKy planning services? YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 -~ A216 NO. . . . , . . . . . . . • . . . . . . . . . . . . . . . . . . . . 2 DONtT KNOM . . . . . . . . . . . . . . . . . . . . . . . . . 8 2-1 COMMENTS: 212 ~.10 t212 t213 t214 ~215 ~216 ~217 k218 k219 QUEST IO~S ~at ts the name of the nearest hosp l t l l p rov id ing fmiLy p len~ing serv lce l to th i s ¢onmJnity? Where is i t Located? How far (s i t ( in mi les ) from here? (mITE IN IOO' IF LESS THAN 1 MILE. IF 1 TO 96 MILES, NRITE IN DISTANCE AS GIVEN IN CLUSTER. IF 97 MILES OR MORE, ~RITE IN =97'. IF DISTANCE IS UNKNOWN, URITE IN 19Sl.) What i s the most common type of t ransport to the hosp i ta l? How Long does i t take to get from here to (HOSPITAL NAME) using most common type of t ransport7 HO~ long in hours anti minutes does i t take to Net from here to (HOSPITAL NAME) by walking? Ho~ many hospJta(s in to ta l are there w i th in 6 hours ~aLk? Ooes (HOSPITAL NAME) prov ide fami ly p lann ing services? What i s the name of the nearest hosp i ta l p rov id ing fami ly pLarw~ing services to th i s community? How Long in hours and minutes does i t take to get from here to (HOSPITAL NAME) by walking? COOING CATEGORIES HOSPITAL NAME NONE KNOUN . . . . . . . . . . . . . . . . . . . . . . . . 98 -- -~ ADDRESS MILES . . . . . . . . . . . . . . . . . . . . . . ~ - ~ MOTORIZED . . . . . . . . . . . . . . . . . . . . . . . . . . 1 CYCLING . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 ANIMAL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 WALKING . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 BOATING . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 OTHER 6 HOURS . . . . . . . . . . . . . . . . . . . . . . MINUTES . . . . . . . . . . . . . . . . . . . . HOWRS . . . . . . . . . . . . . . . . . . . . . . N HUTES . . . . . . . . . . . . . . . . . . . . [ - - I [ SKIP TO "~'A216 - - - '~A215 NO. HOSPITALS . . . . . . . . . . . . . . ~- -1 J - - - B201 YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 - -~" B201 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 DON~T KNOW . . . . . . . . . . . . . . . . . . . . . . . . . 8 HOSPITAL NAME NONE KNOWN . . . . . . . . . . . . . . . . . . . . . . . . 98 ---~" B201 HOURS . . . . . . . . . . . . . . . . . . . . . . MINUTES . . . . . . . . . . . . . . . . . . . . ~ ' ~ COMMENTS: 2-2 213 E. Io. 1201 J202 3203 1206 ]ZO5 B206 B207 BED8 SEOQ HEALTH CLINIC/MATERNITY CENTER/MATERNITY HOME (~JESTIONS t/nat Is the name of the nearest c ( (n (c , materni ty center or mtern i ty home to th i s c~ i ty that has services such as antenatat care and immunization? Uhere is I t Located? How far is i t ( in miles) from here7 (WRITE IN '00' IF LESS THAN 1 MILE. IF 1 TO 96 MILES, WRITE IN OISTANCE AS GIVEN IN CLUSTER. IF 497t MILES OR MORE, WRITE IN WRITE IN '97 ' . IF DISTANCE IS UNKNC~N, WRITE IN =98~,) What is the ~st c ~ type of transport inhabitants in th is comnc~ity would use To go to the c t in lc /matern i ty center? HOW long does i t take in hours arx:r minutes To get from here to (CLINIC/MATERNITY CENTER NAME) using most common type of transport? COOING CATEGOO IES CLINIC/HATERNITY CENTER NAME HOME KNC~M . . . . . . . . . . . . . . . . . . . . . . . . 9B - ADDRESS MILES . . . . . . . . . . . . . . . . . . . . . . SKIP TO - * C~1 MOTORIZED . . . . . . . . . . . . . . . . . . . . . . . . . . I CYCLING . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 ANIMAL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 WALKING . . . . . . . . . . . . . . . . . . . . . . . . . . . . & -~ B206 BOATING . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 OTHER 6 HOURS . . . . . . . . . . . . . . . . . . . . . . MINUTES . . . . . . . . . . . . . . . . . . . . HOW long in hours ar~ minutes does i t take to get fro{n here to (CLINID/MATERNtTY CENTER NAME) by watkinq? HOURS . . . . . . . . . . . . . . . . . . . . . . [ I t MINUTES . . . . . . . . . . . . . . . . . . . . ~ IF MORE THAN 6 HOURS-~ N217 Does th i s c l in i c /matern i ty center provide: YES NO antenatal services? ANTENATAL . . . . . . . . . . . . . . . . . . . 1 2 del ivery? DELIVERY . . . . . . . . . . . . . . . . . . . . 1 2 postnatal serv ices? POSTNATAL . . . . . . . . . . . . . . . . . . . 1 2 immunization (EPI)7 IMMUNIZATION . . . . . . . . . . . . . . . . 1 2 growth n~)nitoring (nut r i t ion)? NUTRITION . . . . . . . . . . . . . . . . . . . 1 2 General ly do people in th is conrr~nity th ink : YES NO there are tong wai t ing times at (CLINIC/MATERN]IY CTR)~ LONG WAlliNG TIMES . . . . . . . . . . 1 2 the s ta f f are competent9 STAFF COMPETENT . . . . . . . . . . 2 the services at the fac i l i ty are expensive? EXPENSIVE . . . . . . . . . . . . . . . . . . . 1 2 medicines are read i ly avai lable? MEDICINES READILY AVAILABLE.1 2 medicines are fake7 MEDICINES ARE FAKE . . . . . . . . . . 1 2 (CLINIC/MATERNITY CENTER NAME) is too far away? TOO FAR AUAY . . . . . . . . . . . . . . . . 1 2 ODeS (CLINIC/MATERNITY CENTER NAME) provide fami ly planning YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 -~ 8216 services? NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 DON'T KNOW . . . . . . . . . . . . . . . . . . . . . . . . . 8 23 COMMENTS: 214 do, i210 1211 3212 Z213 3214 3215 3216 3217 3218 3219 QUEST IONS What I s the niqm of the neerest c l in i c or matern i ty ¢ehtqw providing fami ly ptlmnlng services to th i s commmlty? Where is i t located? Row far is i t ( In mile=) from here? (WRITE IN '00 t IF LESS THAW 1 NILE, IF 1 TO 96 MILES, WRITE IN DISTANCE AS GIVEN IN CLUSTER* IF 97 MILES ON MORE, WRITE IN '97~, IF DISTANCE IS UMRNOWMw WRITE IN =981) What is the most c~l .on type of transport to the c l in i c / maternity center? How Long does i t take to get from here to (CLINIC/MATERNITY CENTER NAME) using most colrl~on ty l~ of transport? How Long in hours and minutes does i t take to get from here to (CLIN]C/MATERN]TY CENTER NAME) by walk riB? HOW many c l in i cs , materni ty centers and maternity homes in Total are there w i th in 6 hours walk? (~0 ING CATEGORIES CLINIC/~TEEN|TY ~NTEE NAME NONE KNOWN . . . . . . . . . . . . . . . . . . . . . . . . 911- ADDRESS MILES . . . . . . . . . . . . . . . . . . . . . . MOTORIZED . . . . . . . . . . . . . . . . . . . . . . . . . . ( CYCLING . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 ANIMAL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 WALKING . . . . . . . . . . . . . . . . . . . . . . . . . . . . k - "~ BOATING . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 OTHER 6 HCWJRS . . . . . . . . . . . . . . . . . . . . . . MINUTES . . . . . . . . . . . . . . . . . . . . HOURS . . . . . . . . . . . . . . . . . . . . . . MINUTES . . . . . . . . . . . . . . . . . . . . NO. CL IN ICS/MATERNIT IES . . . . [~ Does (CLINIC/MATERNITY. CENTER NAME) provide family planning YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I - =, services? NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 DON~T KNOW . . . . . . . . . . . . . . . . . . . . . . . . . 8 i What is the name of the nearest c l in i c or maternity center CLINIC/MATERNITY CENTER providing fami ly planning services to th is conznunity? NAME Now Long in hours and minutes does i t take to get from here to (CLINIC/MATERNITY CENTER NAME) by walk rig? S;ClP TO -'--~6216 6215 -" C201 ~" C201 NONE KN~M . . . . . . . . . . . . . . . . . . . . . . . . 98 -~ C201 J HOURS . . . . . . . . . . . . . . . . . . . . . . MINUTES . . . . . . . . . . . . . . . . . . . . COHMENTS: 2-4 215 C. HEALTH CENTER Io . :201 :202 :203 C20& CZ05 C206 C207 C208 C209 QUESTIONS Met Im The nm of the nelrest hearth center to This comtJnlty thee has services such ms ~te~tm| c i te mnd ImsmllmtlonY Where Is i t t¢ceted? HOW fsr is i t ( in mites) from here? (ON ITE IN '00 ' IF LESS THAN 1 MILE. IF 1 TO 96 MILES, WRITE IN DISTANCE AS GIVEN IN CLUSTER. IF 97 MILES OR MORE, WRITE IN '97 j . IF DISTANCE IS UNKNOWN, WRITE IN 1981.) Whet is The most common type of t ransport inhabitants in th is community would use to go to the health center? How tong ®es i t take in hours and minutes to get from here to (HEALTH CENTER NAME) using most common type of transport? Now tong in hours and minutes does i t take To get f r~ here to (HEALTH CENTER NAME) by watkinq? Does th i s hearth center provide: antenatal services? del ivery? postnatal services? in~nunization (EPI)? growth monitoring (nut r i t ion)T Generally do peopte in th is coemJnity th ink : there are tong wai t ing T ins at (HEALTH CENTER NAME)? the s ta f f are competent? the services at the fac i l i ty are expensiveT t~adicines are read i ly avai lable? n~-clicines are fake? (HEALTH CENTER NAME) is too fa r away? Does (HEALTH CENTER NAME) prov ide fami ly p lann ing serv ices? C(XIING CATEGORIES HEALTH CENTER NN4E NONE KNOWN . . . . . . . . . . . . . . . . . . . . . . . . 98 ADDRESS MILES . . . . . . . . . . . . . . . . . . . . . . MOTORIZED . . . . . . . . . . . . . . . . . . . . . . . . . . 1 CYCLING . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 ANIMAL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ] WALKING . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 BOATING . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 OTHER 6 HOURS . . . . . . . . . . . . . . . . . . . . . . MINUTES . . . . . . . . . . . . . . . . . . . . HOURS . . . . . . . . . . . . . . . . . . . . . . MINUTES . . . . . . . . . . . . . . . . . . . . IF MORE THAN 6 HOURS- YES NO ANTENATAL . . . . . . . . . . . . . . . . . . . 1 2 DELIVERY . . . . . . . . . . . . . . . . . . . . 1 2 POSTNATAL . . . . . . . . . . . . . . . . . . . 1 2 IMMUNIZATION . . . . . . . . . . . . . . . . 1 2 NUTRITION . . . . . . . . . . . . . . . . . . . 1 2 NO LONG WAITING TIMES . . . . . . . . . . I 2 STAFF COMPETENT . . . . . . . . . . . . . 1 2 EXPENSIVE . . . . . . . . . . . . . . . . . . . 1 2 MEDICINES READILY AVAILABLE.1 2 SKIP TO --"~" D201 - ~ C206 C217 MED[CIKES ARE FAKE . . . . . . . . . . t 2 TCX~ FAR AWAY . . . . . . . . . . . . . . . . 1 2 q I YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 -~ C216 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 DON'T KNO~ . . . . . . . . . . . . . . . . . . . . . . . . . 8 COf4MENTS: 2-5 216 No. C210 C211: C212 C213 C214 C215 C216 C217 C218 CZ19 QUESTIONS What is the ~ of the ~arest health center providing ramify p ierc ing services to th i s c~munity? Where is it located? Now far is it ( in mites) f r~ here? (WRITE IN 'O0, IF LESS THAN 1 MILE. IF 1 TO 96 MILES, WRITE IN DISTANCE AS GIVEN ]N CLUSTER. IF 97 MILES OR MORE, WRITE IN '97 t . IF DISTANCE IS UNKNOWN, WRITE IN 'gB ~) What is the n~ost common type of transport to the health center? How tong does i t taRe to get frc~'n here to (HEALTH CENTER NAME) using most common type of transport? How tong in hours and minutes does it take to get from here to (HEALTH CENTER NAME) by wa[kinq? how many health centers in to(at are there within 6 hours walk? Does (HEALTH CENTER NAME) provide family planning services? What is the name of the nearest heatth center providing family ptannlng servLces to th l s c~n i ty? NOW long in hours and minutes does it take to get from here to (NEALTN CENTER NAME) by wa~kin~? COMMENTS: 2-6 CQ(}LNG CATEGORIES HEALTH CENTER NAME NONE KNOWN . . . . . . . . . . . . . . . . . . . . . . . . 98 - - " -~ ADDRESS MILES . . . . . . . . . . . . . . . . . . . . . . [~ "-'~'C216 MOTORIZED . . . . . . . . . . . . . . . . . . . . . . . . . . 1 CYCLLNG . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 ANIMAL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 WALKING . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 ----P C215 I BOATING . . . . . . . . . . . . . . . . . . . . . . . . . . . . S i OTHER 6 HOURS . . . . . . . . . . . . . . . . . . . . . . MINUTES . . . . . . . . . . . . . . . . . . . . ~ :, I .ouRg . . . . . . . . . . . . . . . . . . . . . . MINUIES . . . . . . . . . . . . . . . . . . . . i NO. HEALTH CENTERS . . . . . . . . . ~ - -~ D201 L_ l ] YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I -~ D201 NO . 2 OONql KNOW . . . . . . . . . . . . . . . . . . . . . . . . . 8 HEALTH CENTER NAME NONE KNOWN . . . . . . . . . . . . . . . . . . . . . . . . 98 - -~ D201 SKIP TO HOURS . . . . . . . . . . . . . . . . . . . . . . ~- -~ MINUTES . . . . . . . . . . . . . . . . . . . . ~F~ 217 Do ;Io. )201 )202 ~203 ~)Z04 D205 D206 D2OE D216 FAMILY PLANNING CLINIC QUESTIONS What Is the r~me of the nearest f lm i ty p r iming c l in ic to th i s community? Where IS ~t lOCated? Now far is i t ( in mites) f r~ here? (WRITE IN '00' IF LESS THAN 1 MILE, IF 1 TO 96 MILES, WRITE IN DISTANCE AS GIVER IN CLUSTER. IF 97 MILES OR MORE, URITE IN ' 97 ' . iF DISTANCE IS UNKNOWN, ~RITE IN 1981.) What is the most common type of t ransport Inhabitants In This community xoutd use to go to the fami ly ptenntng c l in i c? NOW IOn S does i t take in hours and minutes to get from here to (FAMILY PLANNING CL]N]C NAMEI using most cc~on type to transport~ HOW Long in hours and minutes does i t take to get from here to (FAMILY PLANNING CLINIC MANE) by ~a[kinQ? Generally do people in th i s commanity th ink : there are long wai t ing Times at (FAMILY PLANNING CLINIC)? the staff are competent? the services at the fac i l i ty are expensive? contraceptives are avaflable? contraceptives are fake? (FAMILY PLANNING CLINIC NAME) is too far away? How many fami ly planning c t in ics in tota l are there w i th in 6 hours walk~ CODING CATEGORIES K IP TO FAMILY PLANNING CLINIC NAME NONE KNOWN . . . . . . . . . . . . . . . . . . . . . . . . 9B - . -b E201 ADDRESS MILES . . . . . . . . . . . . . . . . . . . . . . MOTORIZED . . . . . . . . . . . . . . . . . . . . . . . . . . 1 CYCLING . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 ANIMAL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . WALKING . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 - BOATING . . . . . . . . . . . . . . . . . . . . . . . . . . . . S OTHER 6 flOURS . . . . . . . . . . . . . . . . . . . . . . MINUTES . . . . . . . . . . . . . . . . . . . . MINUTES . . . . . . . . . . . . . . . . . . . . ~ ' ~ IF MORE THAN 6 HOURS- YES NO LONG WAITING TINES . . . . . . . . . . 1 Z STAFF COMPETENT . . . . . . . . . . . . . 1 2 EXPENSIVE . . . . . . . . . . . . . . . . . . . 1 2 CONTRACEPTIVES AVAILABLE.1 2 CONTRACEPTZVES FAKE . . . . . . . . . 1 2 TOO FAR AUAY . . . . . . . . . . . . . . . 1 2 NO. F.P. CLINICS . . . . . . . . . . . -.b D206 -~" E201 COHMENTS: 2-7 218 E* PNAJU4ACY/PATENT NEDICINE STG~E/CHENIST ST~E NO. E~01 E202 E203 [ ;~ E205 E206 E208 E20~ DUI[ST IONS Nt~et iS the rume of the neerest pr ivate pharmacy, patent medicine store or ¢hmtst store to th is ¢omeunity? I/here is i t tocstKrt HOW far is i t ( in miles) f r (~ here? (WRITE |H '00' i f LESS THAN ( M%LE. i f 1 TO 96 MILES, WRITE ]R D|STAHCE AS GIVEN |H CLUSTER. ]F 97 MILES DR MORE, WRITE IN q97'. IF DISTANCE )S UHKNOUH, URITE IN 1?81.) Uhat is the most common type of transport inhabitants in th is community would use to go to the phsrNcy/patent medicii~e Store/ chemist? Ho~ i(~9 does i t teke in hours mndmirwtes to get from here to (PHARMACY/PATENT MIEDICINE STORE/CHEMIST) using most ¢oe~n type of trenepert? HOW LonD in hours and minutes does i t take to get from here to (PHARMACY/PATENT MEDIC%ME STORE/CHEMIST NAME) by ~atkinq? COOING CATEGORIES J PHARMACY/PATENT MEDICINE/CHEMIST NAME NONE KNOWN . . . . . . . . . . . . . . . . . . . . . . . . ~ - ADDRESS MILES . . . . . . . . . . . . . . . . . . . . . . ~ i MOTORIZED . 1 CYCLING . . . . . . . . . . . . . . . . . . . . . . . . . . . . Z ANIMAL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 WALKING . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 BOATING . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 OTHER 6 HOI*JR $ . . . . . . . . . . . . . . . . . . . . . MINUTES . . . . . . . . . . . . . . . . . . . . I ~ HOURS . . . . . . . . . . . . . . . . . . . . . . ~ ] MINUTES . . . . . . . . . . . . . . . . . . . . SKIP TO -~ 220 - - * E206 IF MORE THAN 6 H(XJRS- ~ E217 GeneraLly do people in th l s community th ink : YES NO medicines at the pharmacy/store are expensive? EXPEHSZVE . . . . . . . . . . . . . . . . . . . 1 2 medicines are read i ly avaii~bte? MEDIC)NEE READILY AVAZLADLE.1 2 medicines ere fake? MEDICINES ARE FAKE . . . . . . . . . . 1 2 I (PHARMACY/PATENT MEDICINE/CHEMIST NAME) is too far a~ay? T(X3 FAR AUAY . . . . . . . . . . . . . . . . 1 2 i i i Does (PHARMACY/PATENT MEOIC%NE STORE/CHEMIST NAME) carry famiKy YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 -~ E216 ptanni n9 supplies? NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 DON'T KNOW . . . . . . . . . . . . . . . . . . . . . . . . . 8 2"8 COMHENTS: 219 NO. E210 E211 E212 E213 E214 E215 E216 E217 E21E E21~ QUESTIONS ~at t l the ~ of the ne l re l t I~l ; 'mlcy, ~ l t ln t in ld |¢ l~ l "store or chmi l t s to re to th i s co~| ty that him f~( ly ptanning eCR3Ptias? Where i s it iDeated7 HOW far is t t ( in mites) from here? (WRITE IN '00 ' IF LESS THAN 1 MILE. IF 1 TO 96 MILES, WRITE IN DISTANCE AS GIVEN IN CLUSTER. IF 9T MILES OR MORE~ WRITE IN 1971. IF DISTANCE IS UMKNO~H, WRITE IN ~98~.) CODING CATEGORIES PHARMACY/PATENT MEDICINE/CHEMIST NAME NONE KNC&/M . . . . . . . . . . . . . . . . . . . . . . . . 98 ADDRESS MILES . . . . . . . . . . . . . . . . . . . . . . ~ - ~ SKIP TO - -~ E216 What is the most common type of t ransport to the pharmacy/patent MOTORIZED . . . . . . . . . . . . . . . . . . . . . . . . . . 1 medicine store/chemist? CYCLING . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 ANIMAL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ] WALKING . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 - -~ E215 BOATING . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 OTHER 6 Now tong does i t take to get f rc~ here to (PHARMACY/PATENT MEDICINE STORE/CHEMIST) using most common type of transport? HOURS . . . . . . . . . . . . . . . . . . . . . . ~ MINUTES . . . . . . . . . . . . . . . . . . . . HOW long in hours and minutes does i t take to get from here r ~ to (PHARMACY/PATENT MEDICINE STORE/CHEMIST NAME) by walking? HOURS . . . . . . . . . . . . . . . . . . . . . . I I I MINUTES . . . . . . . . . . . . . . . . . . . . 1 1 7 Bow irklny pharmaciesq patent nledtcine stores and chemist stores r ~ in to ta l are there w i th in 6 hours walk? NO. PHARMCIES/CHEMISTS . . . . . ~ [ I _--b 220 i i Does (PHARMACY/PATENT MEDICINE STORE/CHEMIST NAME) provide YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 ~ 220 famity p tann ing suppties? NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 DON"T HNOU . . . . . . . . . . . . . . . . . . . . . . . . . 8 i What iS the name of the nearest pharmacy, patent medicine store PHARMACY/PATENT MEDICIME/CHEMIST or chemist store to th i s cc¢~fflunity that has fami ly p lann ing NAME suppt ies7 NONE KNOUN . . . . . . . . . . . . . . . . . . . . . . . . 98 - -~ 220 Hou tong in hours and minutes does i t take to get from here to (PHARMACY/PATENT MEDICINE STORE/CHEMIST NAME) by watklng? HOLDIng . . . . . . . . . . . . . . . . . . . . . . Lt l MINUTES . . . . . . . . . . . . . . . . . . . . ~ COMMENTS: 2-9 220 CCI4TBACEPTIVE METHOD IOENTIFICATION I0 . GUESTIONS m 220 ~at is the name of the nearest ~21 ~Z3 2Z4 .~25 226 Z27 .~28 .~29 ~30 231 COOING CATEGORIES SKIP TO ' NEAREST PILL PROVIDER NAME NONE NHO~N . . . . . . . . . . . . . . . . . . . . . . . . 98 - - -~ 222 H~JRS . . . . . . . . . . . . . . . . . . . . . . MINUTES . . . . . . . . . . . . . . . . . . . . ~ [ - ~ ' NEAREST CONDOM PROVIDER NAME NONE kNOWN . . . . . . . . . . . . . . . . . . . . . . . . 98 - -~" 224 , HOURS . . . . . . . . . . . . . . . . . . . . . . M]NUIES . . . . . . . . . . . . . . . . . . . . NEAREST INJECTABLE PROVIDER NAME NONE KNOWN . . . . . . . . . . . . . . . . . . . . . . . . 9B -- J" 226 HOURS . . . . . . . . . . . . . . . . . . . . . . I - - [~ MINUTES . . . . . . . . . . . . . . . . . . . . [SLl NEARESt FOAMING IABLEI PROVIDER NAME NONE NNO&tN . . . . . . . . . . . . . . . . . . . . . . . . 9B - -~ 228 HOURS . . . . . . . . . . . . . . . . . . . . . . MINUTES . . . . . . . . . . . . . . . . . . . . ' NEAREST IUCD PROVIDER NAME NONE KNOWN . . . . . . . . . . . . . . . . . . . . . . . . 98 - ~ 230 HOURS . . . . . . . . . . . . . . . . . . . . . . MINUTES . . . . . . . . . . . . . . . . . . . . F ~ NEAREST STERILIZATION PROVIDER NAME NONE KNOWN . . . . . . . . . . . . . . . . . . . . . . . . 98---~" 232 NCIJR S . . . . . . . . . . . . . . . . . . . . . . MINUTES . . . . . . . . . . . . . . . . . . . . ~ l ~ of the nearest fac i l i ty to th is costnunlty where b i r th control p i l l s can be obtained? Row lOnQ in hours and minutes does i t take to get from here to there by watkina? What is the name of the nearest fac i l i ty to th is comr~mty where condocns can be obtained? Row long in hours and minutes does i t take to get from here to there by walking? What iS the name of the nearest fac i l i ty to th is ¢on~Jmty where in jectables (Depoprovera, Nor is terat ) can be obtained? HOW long in hours and minutes does it take to get from here to there by watk~Lnq? What is the name of the nearest fac i l i ty to th is where foaming tablets can be obtained? ~ty How Long in hours and minutes does i t take to get from here to there bY walkit'~l? What iS the n~me of the nearest facility to this con~unlty where IUCDs can be obtained? HOW tong in hours and minutes does i t take to get froza here to there by wa[kin9? What is the name of the nearest fac i l i ty to th is comraunity where contraceptive s ter i l i za t ion (tubal l iga t ion , vasectomy) can be obtained? How tong in hours and minutes does i t take to get fro~ here to there by walkinq? COMMENTS: 2-10 221 232. CLUSTER INFORNANTS RECORD THE TINE, E~D OF CLUSTER INTERVIEW. 1. Z. 3 . 4. , 233. NAME POSITION/TITLE/OCCUPATION TOTAL NUMBER OF INFORNAHTS IN THE CLUSTER . . . . . . ~I[~JR . . . . . . . . . . . . . . . . . . . . NINUTES . . . . . . . . . . . . . . . . . LOG OF FAC[LIT]ES TO BE VISITED DIRECTIONS: LIST BELOW ALL FACIL IT IES THAT WERE CITED AS DEING W]TH]M SIX HOURS WALK FRON THE CLUDTER. FACXLITY TYPE: LOCATION: DATE VISITEO: 2-11 222 SECTION } . Date: HOSPITAL VISIT Hospital Name: IF THE HOSPITAL IS 6 HOURS WALK OR LESS AWAY, IT IS TO BE VISITED. COIAPLETE QUESTIONS 301 TO 303 UPON ARRIVAL AT THE FACILITY BASES ON yQLIR O~N OBSERVATIONS. THEN FIND A KNOWLEDGEABLE SOURCE AT THE FACILITY TO ANSWER THE REMAINING QUESTIONS. IF THIS FACILITY HAS ALREADY BEEN VISITED FOR A DIFFERENT CLUSTER, RECORD CLUSTER NUMBER HERE: 1 1 1 1 301 ;02 103 DO Y(~J THINK THAT THE ESTIMATE OF THE TIME TO THE FACILITY GIVEN IN THE CLUSTER IS REASONABLE? DO YOU THINK THAT THE ESTIMATE OF DISTANCE TO THE FACILITY GIVEN IN THE CLUSTER IS REASONABLE? WHAT IS THE FLOOR MATERIAL? QUESTIONS TO BE ASKED OF STAFF PERSON AT FACILITY: QUESTIONS In what year did th is hospital open? Urwder what author i ty is th i s hospLta[ operated? Io, i04 ~$5 ~06 507 $08 509 REASONABLE . . . . . . . . . . . . . . . . . . . . . . . . 1 OVERESTIMATED . . . . . . . . . . . . . . . . . . . . . 2 UNDERESTIMATED . . . . . . . . . . . . . . . . . . . . 3 REASONABLE . . . . . . . . . . . . . . . . . . . . . . . . I OVERESTIMATED . . . . . . . . . 2 , UNDERESTIMATES . . . . . . . . . . . . . . . . . . . . 3 , PARQUET OR POLISHED W~)(X) . . . . . . . . . . I , TERRAZO . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 , CERAMIC TILES., 3 WOOD PLANKS . . . . . . . . . . . . . . . . . . . . . . . 4 CEMENT .S , EARTH/SAND . . . . . . . . . . . . . . . . . . . . . . . . 6 OFHER . . .7 310 311 How many beds does th is hospita( have? On average, how many outpat ients are seen da i ty at th is fac i l i ty? Do you keep an outpat ient record Log? Is there a standard outpat ient (or registrat ion/generaL) fee at th is fac i l i ty? IF YES, what is i t? Is everyone charged the outpat ient feet What proport ion of pat ients are charged the outpat ient fee? 3-1 COtIMENTS: J CODING CA1EGOR IES YEAR OPENED . rF2 B ~ F OON~T KNOW . . . . . . . . . . . . . . . . . . . . 98 i FEDERAL . . . . . . . . . . . . . . . . . . . . . . . . . . . I STATE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 ' LGA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 CHURCH/MI SSION . . . . . . . . . . . . . . . . . . . . 4 PRIVATE . . . . . . . . . . . . . . . . . . . . . . . . . . . S OTHER .6 DON'T RfiOW . . . . . . . . . . . . . . . . . . . . . . . . 8 i NUMBER OF BEDS . . . . . . . . I I I I I I YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 I [ YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 - -7 ] OUTPATI"T FEE--F--F] " BO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Z - - ~" 312 I I YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 - -~ 312 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 I I PROPORTION CHARGED . . . . . . . . I [ J I I I SKIP TO 223 IO, 112 113 114 115 116 L17 QUESTIONS COOING CATEGORIES SK IP TO NOV m~ny s ta f f of the fo l low ing tYPes does the h~pi ta t h ive? Nuqd)er of doctors NuMber of nurses Nm~er of t ra ined ml~tves Humber of COfftTU~lty Health Ext~s |~ Uorkers (CHE~I) ~at t I the method most f requent ly used for the s ter i l i za t ion of medical lnstrui l!eflta such as needles ~ lyr |r lges? Is the (TYPE OF STERILIZATION EQUIPMENT) ~ork lng r ight now? Has The (TYPE OF STERILIZATION EQUIPMENT) been out of working order at any t f~ in The Last 6 ~nths? Can 1 see your (TYPE OF STERILIZATION EQUIPMENT)? Has th i s fac JL t ty run out of i t s supply of reusable or disposable needles at any t |~e in The Last 6 months? REGULAR STAFF F~ n-1 ELECTRIC STERIL IZER . . . . . . . . . . . . . . . 1 AUTOCLAVE . . . . . . . . . . . . . . . . . . . . . . . . . 2 STEAM STERILIZER., 3 OTHER & BONE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 I ~ 317 YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 - - ~ 317 YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 SEEN . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO1 SEEN . . . . . . . . . . . . . . . . . . . . . . . . . . 2 YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO. . . . . i . . . . . . . . . , . , . . . . . . . . . H .o . P SERVICES AVAILABLE AT THE FACILITY: Ro~ I would l i ke to ask you about maternal and ch i ld hea l th serv ices avaiLabLe at th i s hosp i ta l . ASK Q.318 FOR THE FIRST 1 ] A~tenataL care 2 I De l ivery c i te YES . . . . . . . . . 1 NO . . . . . . . . . . 2-- YES . . . . . . . . . 1 NO . . . . . . . . . . 2-- n Fl-1 ~-~ ~ i i ! ! !i:ilili!:!i!:iii i!ii ! i!!i !i!!!i ii@ili!i~i!iq!iiii!Fililiqiii~!i~!!Fii@ii~i!i!iii~iqi~!i@i ~- -1 ~ ~-~ x 3 I Postnata l care YES . . . . . . . . . 1 ,o . ,_ ~ FT l .n -1 ~ , 4 I ImmUnization (EPI) YES . . . . . . . . . 1 NO . . . . . . . . . . 2 - I I 5 I monitoringChiLd groWthsessions NoYES . . . . . . . . . . . . . . . . . . . 2-1 ~ . (~Tr iT I . . , 6 I Nutr i t ion ( food) YES . . . . . . . . . 1 ~ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . r I I demonstrat ion NO . . . . . . . . . . 2 - ~ ; ::: : ::~: :::: : : : : : : ~ ;::~;:::~:: : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : ~ : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : 7 Oral rehyfJratlon YES . . . . . . . . . . 1 v therapy un | t - . , , , ' M ~-~- I ~- l x CONES: ( I1 • Oon,t kr~u [c] 97 • Everyone pays [~ 98 • Don,t knoe 0 • Whatever someone re t reats serv ice [t)] 8 Fl-1 ~-l z!ii~i!i?~ii!:i!i~iiiiiiiiii!~iiiiii!iiii!!!i:!i:i~i~i~!;i~i!i:~!i!i!!i iiii !!i~iii 3-2 224 EOUII~ENT AVAILABLE AT THE FACILITY: NW | to ld L ike to ask you about i f the fac i t | ty has var ious types o f eq~JIpmont, i f the equ ipment ~orka r ight now and a f te r IHAshaV~ asked y o u | T ' ASK O. 323HbO~EANo THEN at~ the~ll IFOq~LI~t'TNE FACILITY | need to NOT HAVE I t " ASXLT, ASK ABDUT THE Q'322 FOR TH~ NEXT PIECE FIRST PLECEoFOFEQuIPMENT.EQULPMENT" AFTER |F TNEAsKLNG 0.~?-2 FACILITY AND 0 ,323 FO~ ALL PIECES OF EOULPMENT, ASK TO SEE THOSE PLECES OF EOU]PMENT THAT THE FACLLITY HAS AND THAT NEED TO BE SEEN ACCORDING TO 0 .324 . EQUIPMENT Runn ing water 2 ELect r i c i ty 3 Ref r igerator 4 C~S cooker KeroseNe StOVe 6 te |ephor~e/Redi 0 Transmi t te r 7 T~b[e fo r gyn exm (O~/GYN co~¢h ) 8 Ang le poiaecl Lamp 9 Weigh ing sca les fo r ch i ld ren 10 BLood pressure apparatus 11 Gauze /Cot ton wool 12 Ant i sept i cs 13 IUCO inser t ion k i t 522 Do you have (EQUIPMENT)? YES. . . . . . . . . . . . . . . .1 XO. . . . . . . . . . . . . . . . .2 - - I YES. . . . . . . . . . . . . . . .1 NO. . . . . . . . . . . . . . . . . 2 4 YES. . . . . . . . . . . . . .1 NO . . . . . . . . . . . . . . . . .2 - - YES. . . . . . . . . . . . . . . . 1 NO. . . . . . . . . . . . . . . . .2 - - 323 Do~sr |ght nOwT(EOUIPMENT) taork ] 324AN0 RECORD OUTCCI4E ASK TO SEE EOUIPENNT TES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 ~i i~ i !~ i~IN i ! J I *ES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 ~ i ~ ~ N ! i ~ I I YES . . . . . . . . . . . . . . . . . . . . . . . .1 SEEN. . . . . . . . . . . . . . . . . . . . .1 NO. . . . . . . . . . . . . . . . . . . . . . . . . 2 NOT SEEN. . . . . . . . . . . . . . . .2 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 TES" ' ~! ~ i~ i i~ i~ i I • I YES. . . . . . . . . . . . . . . .1 YES. . . . . . . . . . . . . . . . . . . . . . . .1 NO. . . . . . . . . . . . . . . . . 2-~ NO. . . . . . . . . . . . . . . . . . . . . . . . .2 YES. . . . . . . . . . . . . . . .1 NO. . . . . . . . . . . . . . . . .2 - - YES. . . . . . . . . . . . . . . .1 NO. . . . . . . . . . . . . . . . . 2-- q YES. . . . . . . . . . . . . . . .1 NO . . . . . . . . . . . . . . . . .2~ YES. . . . . . . . . . . . . . . .1 NO. . . . . . . . . . . . . . . . .2~ YES. . . . . . . . . . . . . . . .1 NO . . . . . . . . . . . . . . . . ,2--1 YES. . . . . . . . . . . . . . . .1 NO . . . . . . . . . . . . . . . . ,2--lv YES. . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . .2"1 • SEEN. . . . . . . . . . . . . . . . . . . . .1 ,; i~ii ~ ! ~:i~ii~i ~:iii i ii, L~:i ~i ~i i NOT SEEN. . . . . . . . . . . . . . . . .2 ] YES. . . . . . . . . . . . . . . . . . . p . . . .1 SEEN, . . . . . . . . . . . . . . . . . . .1 NO* . . . . . . . . . . . . . . . . . . . . . . . .2 NOT SEEN. . . . . . . . . . . . . . . . .2 i YES. . . . . . . . . . . . . . . . . . . . . . . .1 SEEN. . . . . . . . . . . . . . . . . . . . . 1 NO. . . . . . . . . . . . . . . . . . . . . . . . .2 NOT SEEN . . . . . . . . . . . . . . . . .2 i YES, . . . . . . . . . . . . . . . . . . . . . . .1 SEEN. . . . . . . . . . . . . . . . . . . . . 1 NO. . . . . . . . . . . . . . . . . . . . . . . . .2 NOT SEEN. . . . . . . . . . . . . . . . .2 i b SEEN• . . . . . . . . . . . . . . . . . . . . 1 ~::~ !!: ~!~!! i~ i !: :! ~! !: .~: ;~ii ~:':::!~!i~ !:::: NOT SEER. . . . . . . . . . . . . . . . .2 I ', i.!:~!~:~)!!ii~:~:!~):~ :. ~::i.;:;::: i~.:~* NOT SEEN. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2 SEEN" .1 • ~ SEEN. . . . . . . . . . . . . . . . . . . . . 1 ~ii~i~i!~i~i~!; ~i NoT BEEN. . . . . . . . . . . . . . . . .2 • i SEER. . . . . . . . . . . . . . . . . . . . . 1 14 M ic roscope YES. . . . . . . . . . . . . . .1 YES. . . . . . . . . . . . . . . . . . . . . . . .1 NO . . . . . . . . . . . . . . . . .2~ NO. . . . . . . . . . . . . . . . . . . . . . . . .2 NOT SEEN. . . . . . . . . . . . . . . . .2 • i 1s ~r . t~th . . , . NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2~ *Es ' NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 *SS ' i~ i~! i ;~ i i~ i • t 16 SLood~ * " . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2~ ~i i l 1 2!; i : i~i • I ,7 ALOB ,., . s . . . . . . . . . . . . . . . . . . . . . . . . . . . . . '32~ ~ ~ o )i!:~~ . Io, QUESTIONS COOING CATEGORIES SKLP TO ;25 Do you have mob| re ¢ t Jn |¢ /c~J t reach serv ices in your catchment YES . . . . . . . 1 area? . NO. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2 -~-~ 327 L26 services?In how many d i f fe rent s i tes do you have mob i le ct|n|c/outreach NUMBER OF OUTREACH S]TES . ,~-~ 3-3 225 NEDICATION AVAILABILITY AT THE FACILITY: NOV I .~u ld Like to ask yc~ I#~out mdlcat lont and v lcc lnea ava i lab le at th i s fac i l i ty . I w i l l need to knou for each medicat ion ind vacc ine, i f they i re iva t l ibLe and i f you have run out oF any of them in the Last a ix mootha. I w f i i a lso need to know the coat p l l l lM l t l pay fo r each medicine here i f there i s a charge. F ina l ly , l w i l t need to see each mld lc ine and v lcc f r~ a f te r ~1 h ive d t l cu l led a l l of thl~q. ASK 0.327 FON EACH MEOICATION. IF THE MEOICATIOW IS AVAILARLE, ASK 0.328 AND THEN 0.329 ~IEN APPROPRIATE. IF THE MEDICATION IS NOT AVAILABLE, CONTINUE WITH THE NEXT MEDICATION. 1 I Ant l -mlLar la i syrup I (e .g . chtoroqu l rm) QUANTITY: ¢h l ld t$ treatment YES . . . . . . . . . . . . . . . . . 1 YES . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . 2 - NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 YES . . . . . . . . . . . . . . . . . 1 YES . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . 2-~ NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 ! YES . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . 2-] YES . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . 2-] YES . . . . . . . . . . . . . . . . . 1 9 j Tetar s vaccin 10 I Measles vacc ine 11 [ SCG vacc ine 12 I Men ing i t i s vacc ine QUANTITY: 1 tab le t 3 I Qu in ine No YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 1 ~ - ~ ~- - -~ QUANTITY: cht ld~I treatment 4 I Antibiotic eyrup YES . . . . . . . . . 1 ~- - - [~ ~ - - ] (e .g . pen ic i l l i n ) NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 QUANTITY: ch i ld ' s treatl lteflt 5 I I ron tab le ts YES . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 . I No . . . . . . . . . . . . . . . . . . 27 NO . . . . . . . . . . . . . . . . . . . . . . . . 2 . 6 I OIlS packets YES. 1 YES . . . . . . . . . . . . . . . . . I . I NO . . . . . . . . . . . . . . 2--, NO . . . . . . . . . . . . . . . . . . . . . . . 2 7 DPT vaccLne YES . . . . . . . . . . . . . . . . . 1 YES . .1 : : . NO . . . . . . . . . . . . . . . . . . 2-- NO . . . . . . . . . . . . . . . . 2 . . . . . . . . . . B POLIO vaccfne YES . . . . . . . . . 1 YES . . . . . . . . . . . . 1 . . . . . . . . NO . . . . . . . . . . . . . . . . . . 2 - - NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 YES . . . . . . . . . . . . . . . . . 1 YES . . . . . . . . . . . . . . . . 1 . . . . . . . . . . . . . . . . . . . . . NO . . . . . . . . . . . . . . . . . . 2- .o . . . . . . . . . . . . . . . . . . . . . . . . 2 YES. 1 YES . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . 2 - NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 YES . . . . . . . . . . . . . . . . . 1 YES . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . 2 - NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 iii iiii i ~!i i!!i!!!iii~ i!!i!i~!ii !!~!~ !i~i!i!:~!?!i!~!!ii!~ii~!iiii!!ii No. 33O 331 332 333 334 335 336 QUESTIONS COOING CATEGORIES SKIP TO May I please see the medicines we jus t dlscuss(~l that you say SEEN . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 are ava i lab le here r ight nou? NOT SEEM . . . . . . . . . . . . . . . . . . . . . . . . . . 2 May l please see the vaccines we Just discussed that you say SEEM. 1 are ava i lab le here r ight rmw? NOT SEEN . . . . . . . . . . . . . . . . . . . . . . . . . . 2 Does th i s fac i l i ty p rov l~ fami ly p la~lng services? YES . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 -~ 343 Are any ~k)ctora trall%ud In col~treceptlve I te r l l i l a t ion YES . . . . . . . . . . . . 1 proceo~rea? NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 Are any doctor l tPltn41<:l In ItJO Inser t lm? YES . . . . . . . . . 1 NO. . . . . .+ .** . . . . . . . . . . . . . . . . . . . . . . 2 Are arly rlurses tralng<l In IOO In le r t to f l ? YES . . . . . . . . . . . 1 NO. . . . . . . . . . .+ . . . . . . . . . . . o . . . . . . . . 2 On iver lge , hot+ iNrly r~ pet ie f l t l fo r f i t l y p lann ing I re le lm I~nth ly? NEW PATIENTS I I I I 3-4 226 NQ. 337 QUIESTIOMS ~IBG P~ATEGOIilES SKIP TO On average, how many pat ients rev is i t month(y? r - ~ REVISIT PATIENTS . . . . . . I [ J J [ 1 1 1 COMTRACEPTIVE METHOD AVAILABILITY: Now I would Like to ask ycNJ aLxput which fami ly planning methods are ava i lab le at th i s hosp i ta l . ASK ABOUT THE FIRST METHOD. IF THZS METHOD IS AVAILABLE FROM THE HOSPITAL, HOVE ACROSS THE TABLE. IF THIS METHOD IS HOT AVAILABLE, HOVE OOWN THE TABLE. WHEN ASKING Ae~tJT Q.]40~ ALWAYS ASK ABOUT THE QUANTITY GIVEN WHEN ASKING ABDUT COST IF OME IS GIVEN. FOR FOAMING TABLETS, WHEN RECORDING THE PRICE ALSO RECORD THE NOMBER OF TABLETS IN THE PACKAGE, 338 Is 339 Now many days 340 Now mucl (METHOD) per week is (METHOD) (QUANTITY avai lable? avai lable? [a] (METHOD) c 01 J P i l l QUANTITY: 02 J IUCD ~4JANTITY: IUCD & insert io~ O] j Znjectlon (Depopro- I vera, Nor is terat ) QUANTITY: 1 i n jec t ion o4. I cond~ QUANTITY: D5 I Foaming tablets METHOD YES.1 NO . . . . . 2 1 cycle J YES.1 ! NO . . . . . 2 I YES.,,1 NO . . . . . 2 I YES.1 NO . . . . . 2 3 condoms I $ YES.*1 ]HO . . . I YES.1 NO . . . . . 2 I YES,.1 I I Female sterilization 07 J Other methods p Specify I] II [] II II II I I NO . 2 343,] l COOES: [a] 8 = Don't know NO. 343 Now much does (QUANTITY) of (I cost? 341 Have you run out of (METHCO) in the Last 6 months? YES . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . 2 342 In what year did you f i r s t offer (METHO0)? [b| YES . . . . . . . . . . . . . . I F-F~. I - l - I NO . ~ IQL--~-- ] YES . . . . . . . . . . . . . . 1 I~ - I .1~-1 NO . 2 ,Q~ YES . . . . . . . . . . . . . . 1 ~ . F - ~ NO . 2 ,gF--F~ ~-] .~F] :~°s-::::::::::::::~ '°1 17 YES . . . . . . . . . . . . . . 1 F-~.~-~ No . I I I lb] 98 = Don't know / QUESTIONS COOING CATEGORIES I SKIP TO What is your position or title here? QUESTIONS 344 TO 346 ARE TO BE ANSWERED BY THE INTERVIEWER AFTER THE FACILITY VISIT IS COMPLETE. 344 345 346 DID THE INFORMANT SEEM KNOWLEDGEABLE? YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 WAS THE RESPONDENT HELPFUL? YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 ADDITIONAL COMMENTS: 3-5 227 SECTION 4. Date: CLINIC/MATERNITY HONE VISIT Name: iF THE CLINIC/MATERNITY CENTER/MATERNITY HOME IS 6 HOURS WALK ON LESS AWAY, IT IS TO BE VISITED. COMPLETE GUESTIONS /.01 TO AO3 UPON ARRIVAL AT THE FACILITY EASED ON YOUR OWN OBSERVATIONS. THEN FIND A KNOWLEDGEABLE SOURCE AT THE FACILITY TO ANSWER THE REMAINING O~JESTIO~S, IT THIS FACILITY HAS ALREADY BEEN VISITED FOR A DIFFERENT CLUSTER, RECORD CLUSTER NUMBER HERE: IF THE FACILITY HAD ALREADY BEEN VISITED, A SECOND VISIT IS NOT NEEDED. I I I I 401 DO YOU THINK THAT THE ESTIMATE OF THE TIME TO THE FACILITY REASONABLE . . . . . . . . . . . . . . . . . . . . . . . . 1 GIVER IN THE CLUSTER IS REASONABLE? OVERESTIMATED . . . . . . . . . . . . . . . . . . . . . 2 UNDERESTIMATED . . . . . . . . . . . . . . . . . . . . 3 ~oz DO YOU THINK THAT THE ESTIMATE OF DISTANCE TO THE FACILITY REASONABLE . . . . . . . . . . . . . . . . . . . . . . . . 1 GIVEN IN THE CLUSTER IS REASONABLE? OVERESTIMATED . . . . . . . . . 2 UNDERESTIMATED . . . . . . . . . . . . . . . . . . . . 3 WHAT IS THE FLOOR MATERIAL? PARQUET OR POLISHED I.~000 . . . . . . . . . . I TERRAZO 2 . CERAMIC TILES . . . . . . . . . . . . . . . . . . . . . 3 . ~)00 PLANKS . . . . . . . . . . . . . . . . . . . . . . . 4 CEMENT . . . . . . . . . . . . . . . . . . . . . . . . . . . . S EARTH/SAND . . . . . . . . . . . . . . . . . . . . . . . . 6 OTHER . . ,7 ,03 QUESTIONS TO BE ASKED OF STAFF PERSON AT FACILITY: Io. ,04 ,OS i06 ~07 ~08 ~09 ;10 ;11 DUESTIONS In what year did this clinic/maternlty center/maternity home open? Under what authority is this cllnic/maternity center/maternity home operated? HOW many be(Is does this ctinic/maternlty center/maternity home have? On average, how many outpatients are seen daily at this Fac iL i ty? Do you keep an outpat ient record tog? I s there a standard outpatient (or registration/generaL) fee a t th i s fac i l i ty? IF YES, what i s i t ? IS everyone charged the outpatient fee~ What proportfon of patients are charged the outpatient fee? 4-I COMMENTS: CODING CATEGORIES SKIP TO YEAR OPENED . . . . . . . . . . . 19~F~ ~ DON'T KNOW . . . . . . . . . . . . . . . . . . . . g8 FEDERAL . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 STATE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 LGA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 CHURCH/MISSION . . . . . . . . . . . . . . . . . . . . 4 PRIVATE . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 OTHER .6 DON'T KNOW . . . . . . . . . . . . . . . . . . . . . . . . 8 ____ .a_ NOMBEROF BEDB . F NUMBER OF DALLY OUTOATIENTB . { 21 ] YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I - - OUTOATIENT FEE I 17" ] NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 ~ 412 YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I - -4412 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 PROPORTION CHARGED . . . . . . . . E l i 228 IJo. ~12 ¢13 ~14 ¢15 ¢16 GUESTIONS CODING CATEGODIES SKIP TO BOW many s ta f f o f the fo l low ing types does the cL in ic /matern i ty center /matern i ty home have? Number of doctors Number of nurses Number of Tra ined midwives Number of community Hearth Extens ion Workers (CHEWs) What is the method most f requent ly used fo r The s ter i l i za t ion of medical ins t ruments such as needles and syr inges? IS The (TYPE OF STERILIZATION EQUIPMENT) work ing r ight now? Has the (TYPE OF STERILIZATION EQUIPMENF) been out of work ing order a t any t ime in the Last 6 months? Can I see your (TYPE OF STERILIZATION EQUIPMENT)? Has th i s fac i t i ty run out of i t s supply of reusable o r d isposabte needtes at any t ime in the (as ( 6 months? REGULAR STAFF F-m ELECTRIC STERILIZER . . . . . . . . . . . . . . . 1 AUTOCLAVE . . . . . . . . . . . . . . . . . . . . . . . . . 2 STEAM STERILIZER . . . . . . . . . . . . . . . . . . 3 OTHER 6 NONE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 ~ " 417 L I YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 ! NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 ~-P A17 I YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 / NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 J i SEEN . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NOT SEEN . . . . . . . . . . . . . . . . . . . . . . . . . . 2 YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . SERVICES AVAILABLE AT THE FACILITY: Wow I would Like to ask you about maternal aP~3 ch i ld health serv ices ava i lab le at th i s c t in i c /matern i ty center /matern i ty home. ASK 0.418 FOR THE FIRST SERVICE. IF THiS SERVICE IS AVAILABLE, CONTINUE ACROSS THE TABLE, IF NOT, ASK ABCXJT THE NEXT SERVICE. SERVICE I Antenatal care 2 DeLivery care 418 Is (SER* VICE) ava i lab le? mon i to r ing s~ (nut r i t ion) YES . . . . . . . . . 1 NO . . . . . . . . . . 2- YES . . . . . . . . . 1 NO . . . . . . . . . . 2-- 419 How many days per week i s (SERVICE) ava i lab le? (a ] , (b] I I !i!~!~ii i!i!i?i! ~ i ~i~! i ~ ~i! ii~!~i ~i i I !i i i ii 420 What i s the aver - age fee fo r (SERVICE)? IF FREE, SKIP 0.421. I ] 621 On average, what p ropor t i¢x of pat ients pay fo r (SERVICE)? [c ] , [d] ] Pos tnata l care YES . . . . . . . . . 1 RO . ~] I I V [~.F [~ I--[--I ' 6 Immunizat ion (EPI) YES . . . . . . . . . 1 RO . z~ I I ~- - ] FF--1 r -~- l , v , , l , Ch.O growtB.ss,on. NOYEg . . . . . . . . . . . . . . . . . . . ~ ' YES . . . . . . . . . 1 NO . . . . . . . . . . 2-~ 6 Nut r i t ion ( food) demonstrat ion I ] , Orair.BvOrati~ YES . . . . . . . . . . . . . . . . . . . . . ' ' 1 , , ~- -1 [ ' - -~ V I~ t,er.,~ ,.i,~ ,0 ~ . . ,. 422, ~ I I I I CCOES: [a] O = IJhenever someone requests serv ice (b] 8 = Don ' t ~(now [c] 97 • Everyone pays (d] 98 • DOn't know 4-Z 229 EOUIPMENT AVAILABLE AT THE FACILITY: Nou I would L ike to ask you about i f the fac i l i ty has var |ous types of Iqu lpment , i f the eoNlpment works r ight ~ Mid mf ter ] have asked you about I l t l the equipment, I need to see i t . ABX Q.422 FOR THE FIRST PIECE OF EQUIPRENT. IF THE FACILITY HAS IT. ASK 0.423 AND THEN OR IF THE FACILITY OOEE NOT HAVE IT, ASK ABQUT THE NEXT PIECE OF EQUIPMENT. AFTER ASKING 0.422 AND O.&23 FOR ALL PIECES OF EQUIPMENT. ASK TO BEE THOSE PIECES OF EOU[PNENT THAT THE FAC]L%TY HAS AND THAT NEEO TO BE SEEN ACCORDING TO 0.424, EQUIPMENT I Running water E lec t r i c i ty 3 Sef r igerator 4 Gas cooker 5 Kerosene s tove 6 Tel ephone/R ad io Transmitter 7 Table fo r gyn exam (OB/GYN couch) 8 Angle poised lamp ue igh ing sca les fo r ch i ld ren 10 Blood pressure apparatus 11 Gauze/Cotton wool 12 Ant i sept i cs 13 IUCD inser t ion k i t 14 Microscope ;22 Do you have (EQUIPMENT)? YES . . . . . . . . . . . . . . . . 1 NO. . . . . . . . . . . . . . . . . 27 YES . . . . . . . . . . . . . . . . I NO . . . . . . . . . . . . . . . . . 2~ YES . . . . . . . . . . . . . . . . I NO. . . . . . . . . . . . . . . . .2-- 1 YES; . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . 2 7 YEB . . . . . . . . . . . . . . . .1 NO, . . . . . . . . . . . . . . . .2~ 423 DoesriBht(EOU]PMENT)now? work I 4z4AND ASKBECOROTO SEEouTCoMEEQUIPEMNT I YEB. . . . . . . . . . . . . . . . . . . . . . . . 1 i YES. . . . . . . . . . . . . . . . . . . . . . . .1 BEEN. . . . . . . . . . . . . . . . . . . . . 1 NO. . . . . . . . . . . . . . . . . . . . . . . . .2 NOT BEEN, . . . . . . . . . . . . . . . ,2 NO. . . . . . . . . . . . . . . . . . . . . . . . .2 NO. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Z TEs" .1 ' !: ~" " ~i' i:i:]~ ~/~i~! ! !~ i~ i l YES . . . . . . . . . . . . . . . . 1 YES. . . . . . . . . . . . . . . . . . . . . . . .1 " " : ' "~:~>~ . . . . . NO . . . . . . . . . . . . . . . . . 2 7 NO. . . . . . . . . . . . . . . . . . . . . . . . ,2 . . . . . . . YES . . . . . . . . . . . . . . . . 1 • BEEN. . . . . . . . . . . . . . . . . . . . ,1 NO . . . . . . . . . . . . . . . . . 2 7 NOT BEEN. . . . . . . . . . . . . . . . .:~ SEEN. . . . . . . . . . . . . . . . . . . . . 1 NOT SEEN. . . . . . . . . . . . . . . . .2 SEEN. . . . . . . . . . . . . . . . . . . . . 1 NOT BEEN. . . . . . . . . . . . . . . . .2 BEEN. . . . . . . . . . . . . . . . . . . . .1 NOT SEEN. . . . . . . . . . . . . . . . .2 BEEN. . . . . . . . . . . . . . . . . . . . .1 NOT BEEN. . . . . . . . . . . . . . . . .;~ BEEN. . . . . . . . . . . . . . . . . . . . .1 NOT BEEN. . . . . . . . . . . . . . . . .2 • BEEN. . . . . . . . . . . . . . . . . . . . .1 NOT SEEN. . . . . . . . . . . . . . . . .2 YES . . . . . . . . . . . . . . . . . . . . . . . . 1 ' BEEN, . . . . . . . . . . . . . . . . . . . . 1 NO. . . . . . . . . . . . . . . . . . . . . . . . .2 NOT SEEN. . . . . . . . . . . . . . . . . 2 YEB . . . . . . . . . . . . . . . . 1 YES . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . 27v NO . . . . . . . . . . . . . . . . . . . . . . . . . 2 YES . . . . . . . . . . . . . . . . I YES . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . 27 NO . . . . . . . . . . . . . . . . . . . . . . . . . 2 • i l YES . . . . . . . . . . . . . . . . 1 YES . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . 2-1 NO . . . . . . . . . . . . . . . . . . . . . . . . . 2 YES. . . . . . . . . . . . . . .1 " ' ~ NO . . . . . . . . . . . . . . . . . 2 -7 YES . . . . . . . . . . . . . . . . I • ' • NO . . . . . . . . . . . . . . . . . 2~1, t - i YES . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . 2~1 • i YES . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . ~ i~E] It). ,25 ,E6 QUESTIONS COOING CATEGORIES SNIP TO DO you have mobi le c l ln l c /out reach serv ices in your catchment YES. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I area? . NO. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .Z - , -~427 Inaervices?hOw many d i f fe rent s i tes do you have rn~bile c [ in ic lCUt r~ach NUMBER OF OUTREACH S ITES . .~- - -~ 4-3 CORHENTS: 230 I~DICATION AVAILABILITY AT T~E FACILITY: NOV I v~Jtd Like to ask you about led lcmt l~ lad vaccines avmlLmbte at th ts f sc l l l ty . I wt t l n4ed to know fo r esch Isc l l~at lc~ enci vecclr~l. I f they i re avetL ib te end I f you have Pun out of I~y of them In the las t s ix mo~ths. I ~1|1 a les need to know the cost pat ients pay fo r each mdlc ln4 here I f there Is s chsrge. F ina l ly , I w i l l need to see e~h medicine l id vsccIne a f te r we h ive discussed s t t of tha i , ASK O.+27 FOR |ACB 14EDICATIOM. IF THE 14EDICATIOW IS AVAILABLE, lgd lP O .&~A aMG THeM o &~q) MN+M AP I :q ;#~PBI&T+. | ; TM~ M~IPA? IP , i l l~ Mf lT &V&|L&R[¢ f2 'M IT l l l l J l~ U ITM TMF MFYT k l l~f l l r~ lkT l~M_ 1 , Ant i -mater ia l syrup YES . . . . . . . . . . . . . . . . . I YES . . . . . . . . . . . . . . . . . . . . . . . . . . . ' ~ r - -~- -~ I (e .g . chlorofp~lna) NO . . . . . . . . . . . . . . . . . . 2 - NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 I 1111 QUAMTITY: ch l td*s t reatmmt . I 2 I Fensider YES . . . . . . . . . . . . 1 YES . . . . . . . . . . 1 r - - r - -~ r - - - -T - -~ I NO . . . . . . . . . . . . . . . . . . 2 - NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 I I 1 [11 QUANTITY: 1 tab le t ] I Quinine YES . . . . . . . . . . . . . . . . . , YES. ' I - " -~ I~ '~ I NO . . . . . . . . . . . . . . . . . . 2 - NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 OUAMTITY: chlLd+s t reat i ses 4 ~ Ant ib io t i c syrup YES . . . . . . . . . . . . . . . . . 1 YES . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 ~ r - - - '~-~ (e.g. pen ic iLL in ) 140 . . . . . . . . . . . . . . . . . . 2 - NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 111111 CAMNTITY: ch i ld ' s treatment 5 L I ron tab le ts YES . . . . . . . . . . . . . . . . . 1 YES . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 i : : i l i i~ ::,i I FES . . . . . , . . . . . . . . . . . 1 YES • . . . . . • • • • . • • • . • • • • . . • • • • • • 1 ============================================= : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : NO . . . . . . . . . . . . . . . . . . 2"~ NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 :~:~: . . . . . . . . . . . . . . . . . . . . . . . ~ YES . . . . . . . . . . . . . . . . . 1 YES . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 MO . . . . . . . . . . . . . . . . . . 2 - , NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 YES . . . . . . . . . . . . . . . . . 1 YES . . . . . . . . . . . . . . . . 1 YES . . . . . . . . . . . . . . . . . I YES . . . . . . . . . . . . . . . . . . . . . . I . :: ; : : : : . . . . . . . . . . . . . . . . . . . . . . . . NO. . ° , . . . .+ . . . . . . . . . : ) - - NO . . . . . . . . , . . o°° , . .o , . . . . . . . . . 2 + :: :: : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : YES . . . . . . . . . . . . . . . . . 1 YES . . . . . . . . . . . . 1 ++[+]++++++ +++++++++ ++ ++ ++++++++ +++ ++ + ++ +++ ++++ +++ +++~ +i ++++ +++ NO . . . . . . . . . . . . . . . . . . 2- NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 ++ ++++++++ +++++J+++ + +:++~+ +++++++]!++++]++++++++ +++ .+++i+++~+i++ + +++ ,Es . . . . . . . . . . . . . . . . . , ,Es . . . . . . . . . . . . . . . . . . . . . . . . . . . , +++++++++++ ++ +++++++++++++++++++++++++++++++++ NO . . . . . . . . . . . . . . . . . . 2- NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 ++:+ ++ + +]+ [+ ++++++ !+]]]+[]]]+]+]+[ + . . . . . . . . . . . . . . . . . . . . . . +:++ . . . . . . YES . . . . . . . . . . . . . . . . . 1 YES . . . . . . . . . . . . . . . . 1 ++ :/:+:::++: ~ :: +: +: +:+ +: +:+: ++:+ +++ + + + +;+++++ ++ +i+[+++++ No . . . . . . . . . . . . . . . z+sm No . . . . . . . . . . . . . . . . . . . . . . 2 : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : : 6 I ORS packets 7 I OPT vacc ine 8 I Po l io vacc ine 9 I Tetanus vaccine 10 I Measles vacc ine I1 I BeG vaccine 12 [ HenLng l t l s vacc ine ~i,~ . i+ +: + +i+ %: iii+ ~:,i ,+++~,:, ,:+:~ :,+:,+; $0 I I I2 13 IS 16 QUESTIONS Hay I please see the medicines ~ jus t discussed that you say are ava i lab le here r ight now? Hay I please see the vaccines me jus t discussed that you say are ava i lab le here r ight now? Does th i s fac i l i ty prov ide fun i ty ptann i r~ services? Are any doctors t rmln~l In co~tr l cept ive s ter i l i za t ion procedures? Are any doctors t ra ined tn IUO Inser t ion? Are amy nurses t rmln ld In IUD In le r t lo f l ? On average, h~ mmy neu pat ients fo r fami ly ptenn|ng are esam monthly? COOING CATEGORIES SEEN. 1 NOT SEEM . . . . . . . . . . . . . . . . . . . . . . . . . . 2 SEEN . . . . . . . . . . . . . . . . . . . . . . . 1 HOT SEEN . . . . . . . . . . . . . . . . . . . . . . . . . . 2 YES . . . . . . 1 MO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 - - -~ &43 YES . . . . . . . . . . . . . . . . . . 1 NO. . . . . . ° °° . . . ° . . . . . . . . . . . . . . . . . . . 2 YES . . . . . . . . . . . . . . . . . . . 1 N0°°O. . .OOO. . * .o°o . .HHo.°***HOO2 YES. . . , . . . . . . . . . . . . . . . . . . . . . . . . . . .1 B0. . . . . , , . . . . . . . . . . . . . . . . . . . . . . . . .2 MEU PATIENTS . . . . . . . . . . ~ - - ~ SKIP TO 4-4 231 h. QUESTIONS &37 On average, hou many pot i~ts rev is i t monthly? CCOING CATEGODIES REVISIT PATIENTS. SKIP TO ¢ONTRACEPTI~ METY~ AVAILABILITY: I Mould t l ke to esk you about which fami ty p tann l l~ mtho(~ I rE Iv l | t lb |e I t th i s c t ln ic /maternt ty center /nmtern i ty home. ASK ABOUT Tile FIRST NETHOD. IF THIS METHOD IS AVAILABLE FRCI4 THE CLINIC/MATERNITY CENTER/MATERNITY HONE, MOVE ACROSS THE TABLE. IF THIS 14ETHQD IS NOT AVAILABLE, MOVE DOWN THE TABLE• t/HEN ASKING ABOUT 0.440, ALWAYS ASK ABOUT THE QUANTITY GIVEN WHEN ASKING /4~UT COST IF ORE IS GIVEN. FOR FOAMING TABLETS, VHEN RECGRDIMG THE PRICE ALSO RECORD THE HUMBER OF TABLETS IN THE PACKAGE. METHOD 01 J P i t t UNT ITY : 1 cyc le ~ Itu~ UNTITY : IUCD & inser t lo~ 03 I In JL~t lon (Oepopro- I ver l , i o r la tera t ) QUANTITY: I In jec t |on 04 I COndOm QUANTITY: 3 corm 65 t Foaming tabtets I NORBER . . . . . . . . . . . [ ~ QUANTITY: package 438 Is (METHOD) avai t 8bte? YES. . . 1 NO . . . . . 2 t YES.'.1 NO . . . . . 2 I YES. . . . 1 NO . . . . . 2 I YES., . .1 NO . . . . . 2 1 YES. . . I NO . . . . . Z I s ter i l i za t ion . YES. . .1 06 I Female NO . . . . . 07 J Other methods YES. . .1 ~:,fv' iNo"ai~ COPES: 439 Hovgmny days per week i s (METHOD) avs i tab le? (a) I I &&O How mJch does (QUANTITY) of (METe) Cost? -1-1 ~-1 461 Have you run out of (METHOD) In the las t 6 months? YES . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . 2 462 In Hat year d id you f i r s t o f fe r (METHOD)? (b| 19J--F- ] YES* . . * . . . . . . . . . . 1 1 F -FT~ No . , , , F -~ i - - YES . . . . . . . . . . . . . . 1 I ED.F -~ ,o . , "F -~ YES . . . . . . . . . . . . . . 1 I I - ] -1 I '1 - ] SO . ' l o [~ I F--[-].l-~ :~s.::::::::::::::~ IvF~ i I J [--[--] 1--~ "~--] L i i (a] 8 = Don:t krm~ YES . . . . . . . . . . . . . . 1 I I (bl 98 m Oon~t kr~w No. QUESTIONS 443 t,enat is your pos i t ion or t i t te here? CODING CATEGORIES ] SKIP TO QUESTIORS 444 TO 446 ARE TO BE ANSWERED BY THE INTERVIEWER AFTER THE FACILITY VISIT IS COMPLETE. 444 446 DID THE INFORMANT SEEM KNOWLEDGEABLE? YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . , . . . . . . . . . . . . . . . . . . . . . . . . . . Z WAS THE RESPONDENT HELPFUL? YEq . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 ADDITIONAL COMMENTS: 4-5 232 SECTlO~d ~, Date: HEALTH CENTER VISIT Center Name: IF THE CENTER IS 6 HOURS WALK OR LESS AWAY, IT IS TO BE VISITED• CCIAPLETE QUESTIONS 501 TO 503 UP(~ ARRIVAL AT THE FACILITY BASED ON YOUR C~dN OBSERVATIONS. THEM FIND A KNO~dLEDGEABLE SQUPCE AT THE FACILITY TO ANSVER THE REMAINING QUESTIONS. IF THIS FACILITY HAS ALREADY BEEN VISITED FOR A DIFFERENT CLUSTER, REC(~D CLUSTER NUMBER HERE: IF THE FACILITY HAS ALREADY BEEN VISITED, A SECOND VISIT IS SOT NEEDED. I I I I 501 DO YOU THINK THAT THE ESTIMATE OF THE TIME TO THE FACILITY REASONABLE . . . . . . . . . . . . . . . . . . . . . . . . 1 GIVEN ZN THE CLUSTER IS REASONABLE? OVERESTIMATED . . . . . . . . . . . . . . . . . . . . . 2 502 503 UNDERESTIMATED . . . . . . . . . . . . . . . . . . . . 3 00 YOU THINK THAT THE ESTIMATE OF DISTANCE TO THE FACIL ITY REASONABLE . . . . . . . . . . . . . . . . . . . . . . . . 1 GIVEN IH THE CLUSTER IS REASONABLE? OVERESTIMATED . . . . . . . . . . . . . . . . . . . . . Z UNDERESTIMATED . . . . . . . . . . . . . . . . . . . . ] WHAT ZS THE FLCOR MATERIAL? P~RQUET OR POLISHED ~ . . . . . . . . . . I TERRAZO . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 CERAMIC TILES . . . . . . . . . . . . . . . . . . . . . ] ~300 PLANKS . . . . . . . . . . . . . . . . . . . . . . . 4 CEHENT . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 EARTH/SAND . . . . . . . . . . . . . . . . . . . . . . . . 6 OTHER . . .7 QUESTIONS TO BE ASKED OF STAFF PERSON AT FACILITY: go. 504 505 506 507 508 509 510 511 QUESTIONS In what year did th is health center open? Under what author i ty is th i s health center operated? COO I HG CATEGORIES YEAR OPENED . . . . . . . . . . . 1911 I DON'T KNO~,/ . . . . . . . . . . . . . . . . . . . . 98 FEDERAL . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 STATE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 LGA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 CHURCH/MISSION . . . . . . . . . . . . . . . . . . . . 4 PRIVATE . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 OTHER .6 DOH~T KNOW . . . . . . . . . . . . . . . . . . . . . . . . 8 HOW many beds does th is health center have? : NUMBER OF BEDS . . . . . . . . I I I l NUMBER OF DAILY On average, how many outpat ients are seen da i [y at th i s ,a°,.ty, OUTPAT,ENTS . I I I P l DO you keep an outpat ient record log? YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 i Is there a standard outpatient (or registratior~/genera[) fee YES . I - - at th is fac i t i ty? ~ ~ _J IF YES, what is i t? OUTPATIENT FEE.I I I I I I " - I I I I I I NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 - - ~ 512 Is everyone charged the outpat ient fee? YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 - -~ 512 SO . . . . . . . . . . . . . . + . . .+ . . .o+ . . . . . . . . 2 What proportion of patients are charged the outpatient fee? PROPORTION CHARGED . I I I 5-I COMMENTS: SKiP TO 233 I10. 512 513 514 515 516 517 QUEST IONS COOING CATEGORIES SK IP TO J REGULAR STAFF Hot+ mny s ta f f of the fo l lou lng typas does the health center have? Number of doctors Nun~er of nurses Nun~er of t ra ined midwives Nu~ber of Community Health Extension Workers (CHEWs) What is the ~thod most f requent ly used for the s ter i l i za t ion ELECTRIC STERILIZER . . . . . . . . . . . . . . . 1 of medical instruments such as rH~edtes and syringes? AUTOCLAVE . . . . . . . . . . . . . . . . . . . . . . . . . 2 STEAM STERILIZER . . . . . . . . . . . . . . . . . . ] OTHER 6 MORE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 - -~" 517 i Is the (TYPE OF STERILIZATION EQUIPMENT) working r ight now? YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 - -~ 517 Has the (TYPE OF STERILIZATION EQU%PMERT) been out of working YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 order at any time in the last 6 months? NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 i Can ] see your (TYPE OF STERZLIZATION EQUIPMENT)? SEEN . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NOT SEEM . . . . . . . . . . . . . . . . . . . . . . . . . . 2 i Has th is fac i l i ty ru~ out of i t s su~ty of reusable or disposable YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 needles at any Time in the Last 6 months? NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 SERVICES AVAXLASLE AT THE FACILITY: MOW ] would l i ke to ask yc~J about mJiternat a~ ch i ld health services ava i lab le at th i s health center. ASK Q.518 FOR THE SERVICE 1 Antenatal care 2 Del ivery care 3 Postnatal care 4 Immunizat ion (EPI) 5 Chi ld growth monitoring sessions (nut r i t ion) 6 Rut r l t lm l (food) dc~r~nstratlcK~ 7 Oral rehydrat ion (hera W un i t 518 Is (SER- VICE) avai lable? YES . . . . . . . . . 1 NO . . . . . . . . . . Z-- YES . . . . . . . . . 1 NO . . . . . . . . . . 2- - YES . . . . . . . . . 1 NO . . . . . . . . . . 2-~ YES . . . . . . . . . 1 NO . . . . . . . . . . 2 7 YES . . . . . . . . . 1 NO . . . . . . . . . . 2-~ YES . . . . . . . . . . 1 NO . . . . . . . . . . . 2 522q--J I I COOES: (a] 0 • t4henever someone requests service 519 How many days per week is (SERVICE) avai lable? [a] , [b~ II 520 What is the aver- age fee for (SERVICE)? IF FREE, SKIP 0 .521 . FVTY- 521 On average, ~hat proportio¢ of pat ients pay for (SERVICE]? [c ] , [d) I I I I FT-1 I (c] 97 • Everyone pays I I IJ I [b] 8 = Don't know (d] 98 • DOn'T knotd 5-Z 234 I EQUIPMENT AVAILABLE AT THE FACIL ITY: NOV I uoutd L ike to ask you about i f the fac i l i ty has var ious types o f equ ipment , i f the equipment ~orks r ight nou ~nd I f te r I h ive asked you about aLL the equ ipment , I need to see I t . ASK 0 .522 FOR THE FIRST PIECE OF EQUIPMENT. IF THE FACILITY HAS IT , ASK O. 523 AND THEN OiL IF THE FACILITY DOES NOT HAVE IT , ASK ABOUT THE NEXT PIECE OF EQUIPMENT. AFTER ASKING 0 .522 AND 0 .523 FOR ALL PIECES OF EQUIPMENT, ASK TO SEE THOSE PIECES Of EQUIPMENT THAT THE FACILITY HAS AND THAT NEED TO BE SEEN ACCORDING TO 0.524 . EQUIPMENT JSZE Do you have Running water 2 ELect r i c i ty ] Re f r |gerator Gas cooker Kero |er~ s tove 6 Telept~one/Redlo T ron~mit te r 7 TabLe fo r 9yn exam IOn/GYM coax:h) (EQUIPMENT)? YES . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . 2-1 YES . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . 2 -~ YES . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . 2 -1 YES. . . . . . . . . . . . . . .~ NO . . . . . . . . . . . . . . . . . 2-- I YES . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . 2-~ YES . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . ~-1 YES . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . E~ 8 AngL~ po ised tamp YES . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . 2"7 YES . . . . . . . . . . . . . . . . 1 9 Ue igh ing sca les fo r ch i ld ren 10 Btood pressure apparatus II Gauze/Cot ton WOoL 12 Ant i sept i cs 13 IUCD Inser t ion k i t 523 Does (EQUIPMENT) work r ight no~? YES. . . . . . . . . . . . . . . . . . . . . . . . 1 NO. . . . . . . . . . . . . . . . . . . . . . . . . 2 YES. . . . . . . . . . . . . . . . . . . . . . .1 NO . . . . . . . . . . . . . . . . . . . . . . . . . 2 §24 ASK TO SEE EQUIPEMNT A~D RECORD OUTCOME . i! . !! !!!'~?'"!'!!!!!! : i ! ! ! '1 ~'!! YES . . . . . . . . . . . . . . . . . . . . . . . . 1 SEEN . . . . . . . . . . . . . . . . . . . . . I NO . . . . . . . . . . . . . . . . . . . . . . . . . 2 NOT SEEN . . . . . . . . . . . . . . . . . 2 J YES . . . . . . . . . . . . . . . . . . . . . . . . 1 :: ::::::::::: : : : ~!:!!*:::: :~ililiiiii~ii~iii~iiiiiiiii!iiiiiiiiiiiii~ii~iiiii iiiiii~ili!ii!i~iiiiiiii~iii~iiiiiiiiiiiii NO. . . . . . . , . . . . . . . . , . . . . . . . ,Z . . . . . ] ; i : SEEM . . . . . . . . . . . . . . . . . . . . . 1 NOT SEEN . . . . . . . . . . . . . . . . . 2 YES . . . . . . . . . . . . . . . . . . . . . . . . 1 SEEN . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . 2 NOT SEEN . . . . . . . . . . . . . . . . . E YES . . . . . . . . . . . . . . . . . . . . . . . . 1 SEEN . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . 2-- I NO . . . . . . . . . . . . . . . . . . . . . . . . . 2 NOT SEEN . . . . . . . . . . . . . . . . . E YES . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . 2-1 • t YES . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . 2-1 YES . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . 2-1 • i YES . . . . . . . . . . . , . . , ,1 NO . . . . . . . . . . . . . . . . . 2 525¢~ YES . , . . . . . , . . . . . . . . . . . . . . , .1 NO . . . . . . . . . . . . . . . . . . . . . . . , ,2 ~i~i~!~;~!~;~i~ii~i~;~iii2~;!ii~;~!~i~i~i~i~i!!!~i~!i~;~ii~i!!i~!;~i;i!~i~i~i~i SEEN . . . . . . . . . . . . . . . . . . . . . 1 NOT SEEN . . . . . . . . . . . . . . . . . 2 SEEN . . . . . . . . . . . . . . . . . . . . . 1 NOT SEEN . . . . . . . . . . . . . . . . . 2 SEEN . . . . . . . . . . . . . . . . . . . . . 1 NOT SEEN . . . . . . . . . . . . . . . . . 2 • SEEN . . . . . . . . . . . . . . . . . . . . . 1 i NOT SEEN . . . . . . . . . . . . . . . . . 2 No° 525 526 QUESTIONS Do you have mob i le c l in i c /out reach serv ices in your catchment area? In how many d i f fe rent s i tes do you have mob i le c l in i c /out reach serv ices? COOING CATEGORIES YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2 - NUMBER OF OUTREACH S ITES . . [~ COMMENTS: 5"3 SKIP TO ~" 527 235 flEDICATION AVAILABILITY AT THE FACILITY: lay I ~outd l i ke to elk you a leut meclfcettona and vaccfr~s ava i lab le at th i s fac | t l ty . I u t t t need to k r~ for each mdtcat lon and vaccine, i f they are ava i lab le and i f you have run out of any of Them in the taut s ix months. I v i i | etso need to krmu the cost pet lef l ts pay for each medic|he here i f There is a charge. FIrmtty, ! v i i i need to see each mdlc i r~ ~ vaccir~e a f te r ~ have discussed a i r of them. ASK 0.527 FOR EACH MEDICATION. IF THE MEDICATION IS AVAILABLE, , jAot i - . t . . i . , . y r . Y . . . . . . . . . . . . . . . . . . , *ES . . . . . . . . . . . . . . . . . . . . . . . . . . . , (e .g . chtoroc~Jlne) NO . . . . . . . . . . . . . . . . . . 2- HO . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 IJANTITY: ¢hl td*a t reat l~t .i , I , . .der YES . . . . . . . . . 'hi ' " NO . . . . . . . . . . . . . . . . . . 2 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 QUANTITY: 1 tab let ~ i " 3 [ Ouinlrm YES . . . . . . . . . . . . . . . . . 1 YES . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 ~ r - -~- -~ .__.J NO . . . . . 2- NO . . . . . . . . . 2 I l l l i l UNT|TY: ch i ld ' s Treatment , , Ant ib io t i c sy rup YES . . . . . . . . . . . . . . . . . 1 YES . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 ~ m (e .g , pen ic i l l i n ) NO . . . . . . . . . . . . . . 2--i: NO . . . . . . . . . . . . 2 I I I I l l UIT ITY : ch i ld ' s treatment / ~ Iron tablets YES . . . . . . . . . . . . . . . . . 1 YES . . . . . . . . . 1 : NO . . . . . . . . . . . . . . . . . . 2- NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 6~ ORS pecketm YES . . . . . . . . 1 YES . . . . . . . . 1 iiiiii:iiii~iiiiiii~ i~]iiill iii i!i i ~ii!iii~iiiiliiiiiiiii!i]il NO . . . . . . . . . . . . . . . . . . 2 - No . . . . . . . . . . . . . . . . . . . . . z ili!iiii~i!~:i!iiiiii!iii~ii!~ili~iiiiii~ii!~iiiiiiii!iiii!i!i!iii!i!ii!i ii iiiiiiiil 7~ DPT vaccine YES . . . . . . . . . . . . . . . . . 1 YES . . . . . . . . . . . . . . . . . . . . . 1 ! . . . . . . . . . . . !;~i NO . . . . . . . . . . . . . . . . . . 2-~ NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . z - NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 NO g ,e ta ,~s v .oc ,~ ,Es . . . . . . . . . . . . . . . . . , ,ES . . . . . . . . . . . . . . . . . . . . . . . . . . . , NO . . . . . . . . . . . . . . . . . . 2- NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 No . . . . . . . . . . . . . . . . . . ~ - No . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , ECO.oc loe YES . . . . . . . . . . . . . . . . . , , . . . , ~,~,,~,~,~,~,;~,~,~,~,~,~,,,~,,~,~,~,~,~,,~,~ NO . . . . . . . . . . . . . . . . . . 2- NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 121Men ing i t i svacc ine J NO YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . 530. - ] 2 1 NO YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 1 i•i•i!i!!•••••i•!•i•i}!•i•i•iiiiiiiiii!••iii•i•iii•!•i•••iii!•i•!iiiiii•i•i•i•iiiiii•ii•i I l l i l l l l l l l l l l l I I I I I I I I I NO, QUESTIONS COOING CATEGORIES SKIP TO 530 Nay I please see the medicines we just discussed that you say SEEN . . . . . . . . . . . . . . . . . . 1 are avaiLabLe here r ight ,',¢w? NOT SEEN . . . . . . . . . . . . . . . . . . . . . . . . . . 2 531 Nay I please see the vaccines we just discussed that you say SEEN . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 ere ava i lab le here r ight nou? NOT SEEN . . . . . . . . . . . . . . . . . . . . . . . . . . 2 532 Ooel th i s fac i l i ty provide f~ty pLsfV~ing services? YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 - -~. 543 533 Are any doctors t ra ined In contraceptive s ter i l i za t ion YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 procedures? NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 r 53~ I Are any doctors t ra ined in IUD Insertion? YES . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 535 Are any nurses t ra ined In IUD insert ion? YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Z 536 On average, how many nee pat ients for family planning are seen monthly? NEW PATIENTS . . . . . . . . . . [ i J J 5-4 236 ). 57 QUESTIONS CODING CATEGORIES SKIP TO On average, how many pat ients rev is i t monthly? REVISIT PATIENTS . . . . . . J i l l I I I I I COWTRACEPT]VE 14ETHOO AVAILABILITY: g~ I Mc~Jld Like to ask you akx>ut which fami ly planning methods are avai lab le at th i s health center. ASK ABOUT THE FIRST METHOD. IF THIS METHOO IS AVAILABLE FROM THE HEALTH CENTER, MOVE ACROSS THE TABLE. IF THIS METHOO IS gOT AVAILAgLEt HOVE DOWN THE TABLE. WHEN ASKING ABOUT Q.540, ALVAYS ASK ABOUT THE QUANTITY GIVEN WHEN ASKING ABOUT COST IF ONE 1S GIVEN. FOR FOANIMG TABLETS, WHEN RECORDING THE PRZCE ALSO RECORD THE MOMBER OF TABLETS IN THE PACKAGE. METHOO 01 J Pill QUANTITY: I cycle 02 I IUCD QUANTITY: IUCD & inser t ion 03 J In ject ion (Depc@ro- vera, Nor is terat ) GUANTITY: I in jec t ion 04 J Conclo~ QUANTITY: 3 CO~ o5 I Foaming tablets 06 ] Female s ter i l i za t ion 07 J Other methods Specify 538 Is (METHOO) avai lable? YES.1 NO . . . . . 2 I YES.L NO . . . . . 2 I - - v YES. . . . I NO . . . . . 2 I - - v YES,,,,1 NO . . . . . 2 I YES.1 NO . . . . . 2 I YES,,.1 NO . . . . . 2 I YES. . , , I NO . . . . . 2 543,] COOES: 539 HOW m6ny days per week is (METNOO) avai lable? [a] 540 Hou much dces 541 Have you run OUt S4Z In what ye (OUARTIFYI of of (NETHCO) in the did you f i r s t (NETH00) cost? Last 6 months? (METHOD)? [~ YES . . . . . . . . . . . . . . 1 [ ] ~ F~- I go . 2 YES . . . . . . . . . . . . . . 1 [ ] [ - ~ - ~ No . 2 , ~ i YES . 1 [ ] ~ [ - R H0 . ~ . ~ i YES . . . . . . . . . . . . . . 1 [ ] [ -T I . [ - I I ,o . ~ - l - ] - I i YES . . . . . . . . . . . . . . 1 i i i i [] FT].FT-] i ,oF]-I YES . . . . . . . . . . . . . . I I -~ E i No . ~ - I~- ] I I I [b] 98 = Don't know [ ] I [aI 8 = Don't know year fc~J f i r s t of fer [hi No. QUESTIONS COOING CATEGORIES 543 What is your pos i t ion or t i t le here? QUESTIONS 544 TO 546 ARE TO BE ANSUERED BY THE IRTERVIEi~ER AFTER THE FACILITY VISIT IS CO#4PLETE. i sK,P TO 544 545 546 DID THE INFORMANT SEEN KNOWLEDGEABLE? YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 WAS THE RESPONDENT HELPFUL? YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 RO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 ADDITIONAL CQHMENTS: 5-5 237 IECFION &. DMte: FAMILY PLANNING CLINIC CLinic Mime: IF THE CLINIC [$ 6 HOIJt$ VALK OR LESS AWAY, IT IS TO BE VISITED. COMPLETE QUESTIONS 601 TO 603 UPO~ ARRIVAL AT THE FACILITY EASED ON YOUR QkW ORSERVATIONS. THEN FIND A KNOWLEDGEAHLE SOURCE AT THE FACILITY TO ANSUER THE REMAINING OUEST IONS. IF THiS FACILITY HAS ALREADY SEEN VISITED FOR A DIFFERENT CLUSTER, RECORD CLUSTER NUMBER HERE: IF THE FACILITY NA$ ALREADY BEEN VISITED l A SECOND VISIT IS NOT HEEDED. 601 O0 YOU THINK THAT THE ESTIMATE OF THE TIME TO THE FACIL ITY REASONABLE . . . . . . . . . . . . . . . . . . . . . . . . 1 G|V1EN IN THE CLUSTER IS REASONABLE? OVERESTIMATED . . . . . . . . . . . . . . . . . . . . . :~ 602 603 UNDERESTIMATED . . . . . . . . . . . . . . . . . . . . 3 DO YOU THINK THAT THE ESTIMATE OF DISTANCE TO THE FACILITY REASONABLE. 1 GIVEN IN THE CLUSTER IS REASONABLE? OVERESTIMATED . . . . . . . . . . . . . . . . . . . . . 2 UNDERESTIMATED . . . . . . . . . . . . . . . . . . . . 3 . WHAT IS THE FL(X)~ MATERIAL? PARQUET OR POLISHED ~XX]O 1 TERRAZO . . . . . . . . . . . . . . . . . . . . . . . . . . . Z CERAMIC TILES . . . . . . . . . . . . . . . . . . . . . 3 UOCO PLANKS . . . . . . . . . . . . . . . . . . . . . . . & CEMENT . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 EARTH/SAND . . . . . . . . . . . . . . . . . . . . . . . . 6 OTHER . . .7 QUESTIONS TO SE ASKED OF STAFF PERSON AT FACILITY: NO. 604 605 608 609 610 611 612 613 614 QUESTIONS in whet year did th is c l in i c open? Under what author i ty is th i s clinic operated? Do you keep records on fami ly planning c l ients? Is there • standard outpat ient (or registration~general) fee at th i s FaciLity? IF YES, whet is i t? Is everyone charged the outpat ient fee? Vhat proportLon of petLents are charged the outpat ient Fee? HOW n~ny s ta f f of the fot lo~in9 types does the cLin ic have? Humber of doctors Humber of nurses Humber of Connunity Health Extension Workers (CREWs) Wnat is the method most f requent ly used For the s ter i l i za t ion of medical instruments such as needles end syringes? Is the (TYPE OF STERILIZATXON EQUIPMENT) working r ight now? 6-1 CODING CATEGORIES i YEAR OPENED . . . . . . . . . . . 19~- -T~ DON'T KNOW . . . . . . . . . . . . . . . . . . . . 98 FEDERAL . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 STATE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 LGA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ] CHURCH/MISSION . . . . . . . . . . . . . . . . . . . . 4 PRIVATE . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 OTHER .6 DON~T KNOW . . . . . . . . . . . . . . . . . . . . . . . . 8 i YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 - - OUTPATIENT F E E . , ~ ~ - ~ NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 - -~ 612 YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 - -~" 612 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 PROPORTION CHARGED . . . . . . . . REGULAR STAFF m ELECTRIC STERILIZER . . . . . . . . . . . . . . . 1 AUTOCLAVE . . . . . . . . . . . . . . . . . . . . . . . . . 2 STEAM STERILIZER . . . . . . . . . . . . . . . . . . 3 OTHER 4 HONE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 - -~" 617 YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 - -~ 617 SKIP TO 238 Be. 615 616 617' BI~STIONS C©OING CATE6OSIES SKIP TO IM~ the (TYPE OF STERILIZATION EQUIPMENT) been out of uorktng YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 order at any time in the l i s t 6 months? NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 Call I lee your (TYPE OF STERILIZATION E~,IIPNENT)? SEEN . . . . . . . . . . . . . . . . . . . 1 , NOT SEEN . . . . . . . . . . . . . . . . . . . . . . . . . . 2 . th i s Fac i l i ty run out of i t s eul~Ly of reusable or disposabLe YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 senates et any time in the tesT 6~nths? NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 EOUIPMENT AVAILABLE AT THE FACILITY: Nov I ~utd Like to ask you about I f the fac i l i ty has veriou~ typam of equipment, i f the abutpm~t Works r ight rime Imd~fter I have ask~ you ~-~--2~ e l i the Squlpme~t~ I r~eKI to lee t t . ASK D.622 FOR THE FIRST PIECE Of EQUIPMENT. IF TND FACILITY HAS IT, ASK B.623 AND THEN OR IF THE FACILITY DOES NOT NAVE IT, ASK ABOUT THE NEXT PIECE OF EOUIP~ENT. AFTER ASKING Q.622 AND Q.62] FOR ALL PIECES OF EQUIPMENT, ASK TO SEE THOSE PIECES OF EQUIPMENT THAT THE FACILITY HAS ANO THAT NEED TO BE SEEN ACCORDING TO 9.62A. EQUIF~CENT [622 DO you have 1623 Ooe8 (EQUIPNEHT) ~ork I 624 ASK TO SEE EOUIPENNT i Running water 2 I E lec t r i c i ty I Sis cooker 5 I Kerosene stove 6 I Telephone/RediD Transmitter 7 I Table for gyn exam lOB/GYM couch) 8 I Angle poised ~amp 10 I Stood pressure el=~aratus 12 I Ant isept ics 13 J IUCO inser t ion k i t (EQUIPMENT)? YES . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . 2 -1 YES . . . . . . . . . , . . . . . ,1 NO . . . . . . . . . . . . . . . . . 2-1 YES . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . 2"~ YES . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . 2-~ YES . . . . . . . . . . . . . . . . 1 HO . . . . . . . . . . . . . . . . . 2-~ YES . . . . . . . . . . . . . . . . I NO . . . . . . . . . . . . . . . . . 2-- I YES . . . . . . . . . . . . . . . . I NO . . . . . . . . . . . . . . . . . 2-1 YES . . . . . . . . . . . . . , ° °1 NO . . . . . . . . . . . . . . . . . 2-~ YES . . . . . . . . . . . . . . . .1 HO . . . . . . . . . . . . . . . . . 2-1 YES . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . 2 625,-J I r ight newT I YES . . . . . . . . . . . . . . . . . . . . . . . . 1 HD, . . . . . , , , ° .o . . . . . . . . . . . . .2 AND RECORD OUTCOME YES . . . . . . . . . . . . . . . . . . . . . . . . 1 :?":~'~ ~': l ~ :':'~:~'~:~ ~i . ~ ' : ' YES. . . . . . . . . . . . . . . . . . . . . . . .1 NO. . . . . . . . . . . . . . . . . . . . . . . . .2 YES . . . . . . . . . . . . . . . . . . . . . . . .1 NO . . . . . . . . . . . . . . . . . . . . . . . . .2 YES . . . . . . . . . . . . . . . . . . . . . . . .1 NO . . . . . , . . . . . . . . . . . . . . . . . . .2 .I . . . . . . . . . . . . :~ : : 1 t SEEN . . . . . . . . . . . . . . . . . . . . . 1 NOT SEEN . . . . . . . . . . . . . . . . . 2 YES . . . . . . . . . . . . . . . . . . . . . . . . 1 SEEN . . . . . . . . . . . . . . . . . . . . . 1 HO . . . . . . . . . . . . . . . . . . . . . . . . . 2 NOT SEEN . . . . . . . . . . . . . . . . . 2 m YES . . . . . . . . . . . . . . . . . . . . . . . . 1 SEEN . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . 2 NOT SEEN . . . . . . . . . . . . . . . . . 2 P SEEN . . . . . . . . . . . . . . . . . . . . . 1 NOT SEEN . . . . . . . . . . . . . . . . . 2 SEEN . . . . . . . . . . . . . . . . . . . . . 1 NOT SEEN . . . . . . . . . . . . . . . . . 2 No, 625 626 633 634 635 636 QUESTIONS CODING CATEGORIES SKIP TO Do you have mobile cttnLc/outreach services in your catchl~l~t YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 area? ND . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 -- --~ 633 In ho~ mint d i f fe rent s i tes do you have mobile c t ln lc /outreech services? NUMBER OF GOTREACH SITES. I L l i Are any doctors t ra ined in contraceptive s ter i l i za t ion YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I procedures? NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 Are any doctors tralnecl in IUO insert ion? YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 HO. , , . ,oo , . . . . . . o . , , ,o , . , , , . . . . . ,,:) Are any nurses t ra ined in lUG Insertion? YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . , . . . . . . . . . . . . . . 2 On average, how many new pat ients for fami ly planning are setm monthly? NEU PATIENTS . . . . . . . . . . l l l l 6-2 CONeENTS: 239 ;Io, ~37 GUESTIODS COOING CATEGORIES SKIP TO On average, how many pet i c~ts rev is i t monthly? REVISIT PATIENTS . . . . . . I l J l CONTRACEPTIVE METHOD AVAILABILITY: MOW I ~ould Like to ask you ecbout ~ Ich fami ly p lann ing methods are avaiLabLe st th i s c l in i c• ASK ABOUT THE FIRST HIETNOD. IF THIS METHOD IS AVAILABLE FROM THE CLINIC, HOVE ACROSS THE TABLE. ZE THIS NETHOD IS NOT AVAILABLE, 14Ce4E DOWN ~ TABLE• WHEN ASKING ABOUT 0,640, ALWAYS ASK ABOUT THE (XJANTITY GIVEN WNEH ASKING ABOUT COST IF ONE IS GIVEN. FOR FOAMING TABLETS, HttEN RECOSOIHG THE PRICE ALSO RECOSD THE HUMBER OF TABLETS IN THE PACKAGE. METHOD 01 I P i t t OUAHTITY: 1 cyc le 0' J IUCD OUANTITY: IUCO & inser t ion 03 I In jec t ion (Depopro- I vera, Nor i s te ra t ) QUANT%TY: I in jec t ion I 04 I co~ I OUANTITY: 3 conclo~Ts 05 I Foaming tab le ts I 06 I Fen~le s ter i l i za t ion I O? ] Other methods Speci fy 638 Is 639 HO~ many days (NETNOO) per ~ek ts (METHOD) ava i lab le? I ava i lab le? [a] YES. . . , 1 I I , o . . . . . , , , I I I YES,,, ,1 I I NO . . . . . , , , I I I • i YES. . . 1 I ] . . . . . . , , , I I J • i YES. ,1 [ ] , o . . . . . ~ I I I • q YES. . . 1 .o . . . . . , I I I • i YES.1 I I . o . . . . . , , , I I I • i YES. • .1 I I . o . . . . . , I I COOES: Ca] 8 = Don't know 64o Now much does ~ l f Nave you run out (QUANTITY) of (METHOD) in the (METHOD) COSt? las t 6 ~tha? YES . . . . . . . . . . . . . . I - ~ F - n .o . . . . . . . . . . . . . . . , i - ~ YES . . . . . . . . . . . . . . I ~FF1 ~n-1 I Ib] 98 = DOn't know 642 In ~at year d id yo4J f i r s t o f fe r (NETHOD)? [b] ,,~-] NO . . . . . . . . . . . . . . . 2 19 r - ~ q YES . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . 2 19 [~r - ~ I I YES . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . 2 19 [~] YES . . . . . . . . . . . . . . 1 HO . . . . . . . . . . . . . . . 2 19F- ~ i i YES . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . 2 19F-- ~ NO. QUESTIONS COOING CATEGORIES 6~3 tJhat is your pos i t ion or t i t l e here? QUESTIONS 644 TO 6/.6 ARE TO BE ANSWERED BY THE INTERVIEWER AFTER THE FACILITY VISIT IS COMPLETE, J SKIP TO 644 645 646 010 THE INFORNANT SEEN KNOWLEDGEABLE? YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 WAS THE RESPONDENT HELPFUL? YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 ADDITIONAL COMMENTS: 6-3 240 SEDTIQI ~v Dire: PHARMACY/PATENT MEDICINE STORE/CHEMIST Ha.me: IF TIlE PHARMACY/PATENT MEDICINE STOaE/CHEMIST IS 6 HOURS OR LESS AWAY, i t IS TO BE VISITED. COMPLETE OUESYIORS 2'01 TO ~rO] ARRIVAL AT THE FACILITY BASED OR YOUR OMN OBSERVATIONS, THEN FIND A KMOULEBGE&BLE SOURCE AT THE FACILITY TO AN,SIdER THE REMAINING QUESTIONS. IF THIS FACILITY HAS ALREADY BEEN VISITED FOR A DIFFERENT CLUSTER, RECORD CLUSTER NUMBER HERE: IF THE FACILITY HAS ALREADY BEEN VISITED. A SECOND VISIT IS NOT HEEDED. I l l ] 701 O0 YOU THINK THAT THE EST[NATE OF THE TiME TO THE FACILITY REASONABLE . . . . . . . . . . . . . . . . . . . . . . . . 1 GIVER IN THE CLUSTER IS REASONABLE? OVERESTIMATED . . . . . . . . . . . . . . . . . . . . . B 00 YOU THINK THAT THE ESTIMATE OF DISTANCE TO THE FACILITY GIVER IN THE CLUSTER IS REASONABLE? WHAT iS THE FLOOR MATER]AL? 702 703 QUESTIONS TO BE ASKED OF STAFF PERSON AT FACILITY: No. 704 705 ?06 ?07 QUESTIONS HOW many hours per ~eek i s the pharmacy/patent med ic ine s to re / chemis t open? HOW many days per week i s The pharmacy~patent medic ine s to re / chemis t opent? i s [here a t ra ined ~ermcist ava i tabte? Does the fac i t i ty have the fo l low ing i tems in ~ork ing order? Running water? E tec te ic i ty? Tetephone or rad io t ransmi t te r? Re f r igerator? UNDERESTIMATED . . . . . . . . . . . . . . . . . . . . 3 REASONABLE . . . . . . . . . . . . . . . . . . . . . . . . I OVERESTINATEO . . . . . . . . . . . . . . . . . . . . . 2 UNDERESTIMATED . . . . . . . . . . . . . . . . . . . . 3 PARQUET OR POLISHED ~JO00 . . . . . . . . . . 1 TERRAZO . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 CERAMIC T]LES . . . . . . . . . . . . . . . . . . . . . 3 , WOO0 PLANKS . . . . . . . . . . . . . . . . . . . . . . . 4 , CEMENT . . . . . . . . . . S EARTH/SAND . . . . . . . . . . . . . . . . . . . . . . . . 6 OTHER . . ,7 708 CCX)ING CATEGORIES HOURS PER WEEK . . . . . . . . . . . . DAYS PER WEEK . . . . . . . . . . . . . . . . . I I YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 YES NO RUNNING WATER . . . . . . . . . . . . . 1 2 ELECTRICITY . . . . . . . . . . . . . . . 1 2 TELEPHONE . . . . . . . . . . . . . . . . . 1 2 REFRIGERATOR . . . . . . . . . . . . . . 1 2 In ~hat year d id The phar rnacy /petent med ic ine s to re /chemis t F ~ open? YEAR OPENED . . . . . . . . . . . . . 19 t l I 7-1 COMMENTS: SKIP TO 241 NEDLCATIOM AVAILABILITY AT THE FACILITY: Nou I would Like to ask you about medicines ive i tabta I t th le store. I wi l l need to knou for each medicine i f t t is ava i lab le and i f you hive run OUt of i t at any time in the Lest s ix months. I w i l t aLso'need to f ind out the coat of each medicine for ¢atomers of th i s etore. ASK 0.709 FOM EACH MEDICATION. IF THE MEOICATIOM IS AVAILABLE, ASK 0.710 AND 0.711. IF THE MEDICATION I$ NOT AVAILABLE. CONTINUE WITH THE NEXT MEO]CATION. 709 Is (MEDICATION)IT10 At any time in the test 6 months MEDICATION 1 Ant i -ma lar ia l syrup (e.g. chtoro~ine) QUANTITY: ch i ld ' s treatment 2 Fansidar OUANTITY: 1 tabLet 3 OuinLne OUANTITY: ch i ld ' s treatment 4 AntLbiot lc syrup (e.g. pen ic i l l i n ) QUANTITY: ch i ld ' s treatment 5 Iron tab lets QUANTITY: 1 bot t le 6 ORS packet~ OUANT[TY: 1 packet I HO, l 712 ava i labte nowT I YES . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . 2~ YES . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . 2 7 YES. , , : . . . . . . . . . 1 NO . . . . . . . . . . . . . . 2"7 tm YES . . . . . . . . . . . . . 1 J y0u run out of (HEDICATLON)T YES . . . . . . . . . . . . . . . . . . . . . . . . . . 1 YES . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 YES . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 YES . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO. . , , , . , , , , , . . . , . . . . . . . . . . . . 2 YES . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . 2-] NO . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 YES . . . . . . . . . . . . . 1 YES . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . 2 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 712 ,~ I I 711 On average, how much do ¢ustolllf pay for (OUANTITV) OF (HEOICATIOM)? QUESTIONS Does th is pharmacy/patent medicine store/chemist carry family planning methods? / COOING CATEGORIES |SN IP TO YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 717 CONTRACEPTIVE METHO0 AVAILABILITY Now I would lLke to ask you about which family planning methods are avai lab le at th is pharmacy/patent medicLne store/chemist. ASK ABOUT THE FIRST METHO0. IF THIS METHO0 IS AVAILABLE FROM THE STORE, XOVE ACROSS THE TABLE. %F THIS METHCO IS NOT AVAILABLE, MOVE DOUN THE TABLE. UHEN ASKING ABOUT 0.714. ALWAYS ASK ABOUT THE OUANT]TY GIVEN WHEN ASKING ABOUT COST IF ONE IS GIVEN. FOR FOAMING TABLETS. WHEN RECORDING THE PRICE ALSO RECORD THE NL94BER OF TABLETS IN THE PACKAGE. ET.O0 T ] O1 I P i l l YES . . . . . . . . . . . . . . . . . . . . . . 1 I NO . . . . . . . . . . . . . . . . . . . . . . . 2 OUANTITY: 1 CycLe 1 D] r In jec t ion (Depo- YES . . . . . . . . . . . . . . . . . . . . . . 1 r provera, Nor i s te ra t ) NO . . . . . . . . . . . . . . . . . . . . . . . 2 QUANTITY: 1 v ia l ] D4 I Condom YES . . . . . . . . . . . . . . . . . . . . . . 1 f NO . . . . . . . . . . . . . . . . . . . . . . . 2 QUANTITY: Packet of 3 i • i OS I Foaming tablets YES . . . . . . . . . . . . . . . . . . . . . . 1 I ,2 . . . . . . . . . . . . . . . . . . . . . . I • i 07 I other methods YES . . . . . . . . . . . . . . . . . . . . . . 1 I NO . . . . . . . . . . . . . . . . . . . . . . . 2 Spec i fy I 716,] I ;'-2 (QUANTITY) of (14ETHO0)? COHHENTS: in the Last 6 months? YES . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 YES . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . YES . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . i k ; YES . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 YES . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 242 No. QUESTIONS C~O] HG CATEGORIES 716 What is your pos{t ion or t i t le here? QUESTZONS 717 "0 719 ARE TO BE ANSWEREO l i t THE ]NTERVIE~/ER AFTER THE FACILITY V;SIT IS CONPLETED. 717 718 719 DID THE INFORMANT SEEM KNI~/LEDGEABLE? YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 WAS THE RESPONDENT HELPFUL? YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ADDITIONAL COMMENTS: I SKIP TO 7-3 243 Front Matter Title Page Contact Information Table of Contents List of Tables List of Figures Acronyms Foreword Summary of Findings Map of Nigeria Chapter 01 - Introduction Chapter 02 - Characteristics of Households and Respondents Chapter 03 - Fertility Chapter 04 - Fertility Regulation Chapter 05 - Proximate Determinants of Fertility Chapter 06 - Fertility Preferences Chapter 07 - Infant and Child Mortality Chapter 08 - Maternal and Child Health Chapter 09 - Infant Feeding and Childhood Nutrition Chapter 10 - Local Availability of Family Planning and Health Services References Appendix A - Persons Involved in The Nigeria Demographic and Health Survey Appendix B - Survey Design Appendix C - Estimates of Sampling Errors Appendix D - Data Quality Tables Appendix E - Questionnaires Household Questionnaire Individual Questionnaire Service Availability Questionnaire

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