Samoa - Demographic and Health Survey - 2010

Publication date: 2010

Samoa 2009Demographic and Health Survey Samoa Demographic and Health Survey 2009 Ministry of Health Apia, Samoa Samoa Bureau of Statistics Apia, Samoa ICF Macro Calverton, Maryland, USA June 2010 Disclaimer & Copyright This report summarizes the findings of the 2009 Samoa Demographic and Health Survey (SDHS) carried out by the Ministry of Health in collaboration with the Samoa Bureau of Statistics. ICF Macro provided technical assistance for the survey through a contract with the Ministry of Health. Funding for the SDHS was received from the government of Samoa, the International Development Association (IDA), the Australian Agency for International Development (AusAID) and the New Zealand Agency for International Development (NZAID). Additional information about the survey may be obtained from the Ministry of Health, Private Bag, Apia, Samoa (Telephone: 685-68102; Fax: 685-23483, email: CEO@health.gov.ws). Additional information about the DHS program may be obtained from ICF Macro, 11785 Beltsville Drive, Suite 300, Calverton, MD 20705, U.S.A. (Telephone: 1.301.572.0200; Fax: 1.301.572.0999; e- mail: reports@measuredhs.com). Recommended citation: Ministry of Health [Samoa], Bureau of Statistics [Samoa], and ICF Macro. 2010. Samoa Demographic and Health Survey 2009. Apia, Samoa: Ministry of Health, Samoa. © Copyright Government of Samoa, MOH, 2009 FOREWORD The 2009 Samoa Demographic and Health Survey (SDHS) is a national survey covering all four regions of the country. The survey was designed to collect, analyze, and disseminate information on housing and household characteristics, education, maternal and child health, nutrition, fertility and family planning, gender, and knowledge and behaviour related to HIV/AIDS and sexually transmitted infections (STIs). The 2009 SDHS is the first DHS survey to be undertaken in Samoa both by the health sector and for an improved health system. The planning and implementation of the survey was carried out jointly by the Samoa Bureau of Statistics (SBS) and the Ministry of Health (MOH) with the technical assistance and guidance of ICF Macro. The Ministry of Women, Community and Social Development assisted by facilitating community support for the survey through village mayors. The MOH is grateful to the Samoa Bureau of Statistics for their valuable partnership in conducting the SDHS fieldwork and making arrangements with village communities that were selected for data collection. The MOH is also grateful to the government of Samoa, the World Bank/International Development Association (IDA), the Australian Agency for International Development (AusAID), and the New Zealand Agency for International Development (NZAID) for providing funding for the survey. The MOH is also grateful to the United Nations Children’s Fund (UNICEF) and the United Nations Population Fund (UNFPA) for support during 2009 SDHS final report writing. The MOH further acknowledges the technical assistance by ICF Macro during the preparation and finalization of the survey instruments, training of fieldworkers and data entry operators, creation of the sample design and weighting, and final report writing. As the Minister of Health I extend our appreciation to all who participated directly or indirectly in the SDHS survey: the final report contributors, the field staff, and the other survey personnel whose names appear in Appendix D. I especially appreciate the cooperation of all the survey respondents for making the 2009 SDHS a success. It is my hope that this report will be useful for advocacy and results-oriented decision-making and help to inform service delivery. This report provides only a snapshot of the analysis that can be done with the data that have been collected. It is my sincere hope that researchers will deepen their understanding of the topics covered in the survey by undertaking further research with the survey data set. ________________________________ Gatoloaifaana Amataga Alesana Gidlow Hon. Minister of Health MESSAGE FROM THE DIRECTOR GENERAL OF HEALTH / CEO MOH The role of the Ministry of Health in the Health Sector is changing as a result of major structural reforms initiated in 1998 and culminated in the physical and technical separation of the MOH on 1st July 2006. This evolution of organizational and technical change is currently under implementation. The MOH Act 2006 formalizes the reformed role of the Ministry of Health to provide regulatory oversight of the health sector, including operational budgets and human resources, monitoring of health system performance as well as health promotion and primordial prevention, all of which warrant a high degree of accurate and credible information system. The Samoa 2009 Demographic and Health Survey is a major achievement for the Ministry of Health to realize its mandated monitoring role for health system performance in Samoa. It is also a respond to the increasing demand from development partners to have baseline data and information in place, not only to guide the prioritization of Health Sector Wide Approach Program activities; but also as a measure to any SWAP outcomes and impacts. This DHS provides key data for planning, monitoring and evaluating programs in population health areas such as maternal and child health, family planning, etc and these are crucial in enhancing the monitoring and regulatory role of the Ministry of Health in the health sector. I am privileged to be the Director General of Health and Chief Executive Officer of the Ministry of Health at a time when the first ever Demographic and Health Survey was implemented and successfully completed. The credit therefore goes to all our Government and Non Government Alliances, Development Partners, the Samoan Communities and more specifically the Ministry of Health, Strategic Development and Planning Division staff who capitalized on the professional collaboration of the Samoa Bureau of Statistics as well as Macro International Ltd (Measure DHS USA) to make this a reality. I urge the MOH, all health service providers and health sector partners to make full use of this DHS in order to strengthen the Samoa Health System for better health outcomes and universal coverage. ________________________________ Palanitina Tupuimatagi Toelupe Director General of Health/CEO MOH Contents | vii CONTENTS Page TABLES AND FIGURES . xiii SUMMARY OF FINDINGS . xix MILLENNIUM DEVELOPMENT GOAL INDICATORS .xxv MAP OF SAMOA . xxvi CHAPTER 1 INTRODUCTION 1.1 Geography, History, and Economy.1 1.1.1 Geography .1 1.1.2 History and Governance.1 1.1.3 Economy.2 1.2 Demographic Profile .2 1.3 Samoa Health System .3 1.3.1 Health Care Reforms .3 1.3.2 Maternal and Child Health Care.4 1.4 Sexual Reproductive Health Programme .4 1.4.1 Family Planning.4 1.4.2 HIV/AIDS and STIs .4 1.5 Systems for Collecting Demographic and Health Data.5 1.6 Objectives and Organization of the Survey.5 1.7 Sample Design .6 1.8 Questionnaires.6 1.9 Pretest, Training, and Fieldwork .7 1.9.1 Pretest.7 1.9.2 Training and Fieldwork.7 1.10 Response Rates .8 CHAPTER 2 HOUSEHOLD POPULATION AND HOUSING CHARACTERISTICS 2.1 Household Population by Age and Sex.9 2.2 Household Composition .11 2.2.1 Children’s Living Arrangements and Orphanhood.11 2.2.2 School Attendance by Survivorship of Parents.13 2.3 Educational Attainment of Household Members.13 2.3.1 School Attendance Ratios .15 2.3.2 Grade Repetition and Dropout Rates .17 2.3.3 Age-Specific School Attendance Rates .19 viii │ Contents 2.4 Housing Characteristics .19 2.4.1 Household Drinking Water.20 2.4.2 Household Sanitation Facilities .21 2.4.3 Household Characteristics .22 2.5 Household Possessions.24 2.6 Wealth Quintiles .26 2.7 Birth Registration.27 2.8 Burden of Diseases.28 2.8.1 Household Level: Burden of Diseases .28 2.8.2 Household Members: Burden of diseases .29 CHAPTER 3 CHARACTERISTICS OF SURVEY RESPONDENTS 3.1 Background Characteristics of Respondents.31 3.2 Educational Attainment .33 3.3 Literacy .34 3.4 Access to Mass Media .36 3.5 Employment .38 3.6 Occupation.41 3.7 Type of Employer, Form of Earnings, and Continuity of Employment.43 3.8 Health Insurance Coverage .45 3.9 Knowledge and Attitude Concerning Tuberculosis.45 3.9.1 Misconceptions about the Way Tuberculosis Spreads .48 3.9.2 Exposure to Messages on Tuberculosis.48 3.10 Smoking.52 3.11 Participation in the Physical activity Campaign .54 CHAPTER 4 FERTILITY 4.1 Fertility Levels and Trends .58 4.1.1 Fertility Levels .58 4.1.2 Differentials in Current and Completed Fertility.59 4.1.3 Fertility by Marital Status .60 4.1.4 Trends in Fertility .60 4.2 Children Ever Born and Living.62 4.2.1 Children Ever Born by Marital Status .63 4.3 Birth Intervals.65 4.4 Age at First Birth.66 4.5 Teenage Fertility.67 CHAPTER 5 FAMILY PLANNING 5.1 Knowledge of Contraceptive Methods.69 5.2 Ever Use of Contraception .72 5.3 Current Use of Contraceptive Methods .74 5.4 Differentials in Contraceptive Use by Background Characteristics.75 Contents | ix 5.5 Trends in the Use of Family Planning .76 5.6 Number of Children at First Use of Contraception.76 5.7 Knowledge of Fertile Period .77 5.8 Timing of Sterilization .78 5.9 Source of Contraception .78 5.10 Cost of Contraception .79 5.11 Informed Choice.80 5.12 Future Use of Contraception .81 5.13 Reasons for Not Intending to Use Contraception.81 5.14 Preferred Method of Contraception for Future Use .82 5.15 Exposure to Family Planning Messages .82 5.16 Contact of Non-users with Family Planning Providers .84 5.17 Husband/Partner’s Knowledge about Woman’s Use of Family Planning.85 5.18 Male Attitudes towards Family Planning .86 CHAPTER 6 OTHER PROXIMATE DETERMINANTS OF FERTILITY 6.1 Current Marital Status .89 6.2 Singulate Mean Age at Marriage .90 6.3 Amenorrhoea, Abstinence, and Insusceptibility .91 6.4 Menopause.92 CHAPTER 7 FERTILITY PREFERENCES 7.1 Desire for More Children .93 7.2 Need and Demand for Family Planning.97 7.3 Ideal Family Size .98 7.4 Fertility Planning . 100 CHAPTER 8 INFANT AND CHILD MORTALITY 8.1 Definition, Data Quality, and Methodology. 103 8.2 Levels and Trends in Infant and Child Mortality. 104 8.3 Socioeconomic Differentials in Mortality . 105 8.4 Demographic Characteristics and Child Mortality . 106 8.5 Perinatal Mortality. 106 8.6 High-Risk Fertility Behaviour . 108 CHAPTER 9 MATERNAL HEALTH 9.1 Antenatal Care . 109 9.1.1 Antenatal Care Coverage. 109 9.1.2 Number and Timing of Antenatal Care Visits . 111 9.1.3 Components of Antenatal Care. 111 9.1.4 Tetanus Immunisation . 113 9.2 Delivery Care. 115 9.2.1 Place of Delivery . 115 9.2.2 Assistance at Delivery . 116 9.2.3 Complications of Delivery . 118 x │ Contents 9.3 Postnatal Care. 118 9.3.1 Timing of First Postnatal Check-up . 118 9.3.2 Type of Provider of First Postnatal Check-up . 119 9.4 Problems in Accessing Health Care . 120 CHAPTER 10 CHILD HEALTH 10.1 Child’s Size at Birth . 123 10.2 Vaccination Coverage . 125 10.3 Trends in Vaccination Coverage . 128 10.4 Acute Respiratory Infection . 129 10.5 Fever. 131 10.6 Diarrhoeal Disease. 132 10.6.1 Incidence and Treatment of Diarrhoea. 132 10.6.2 Feeding Practices . 133 10.7 Knowledge of ORS Packets . 134 10.8 Stool Disposal . 135 CHAPTER 11 NUTRITION OF CHILDREN AND ADULTS 11.1 Initiation of Breastfeeding. 137 11.2 Breastfeeding Status by Age. 139 11.3 Duration and Frequency of Breastfeeding . 141 11.4 Types of Complementary Foods . 142 11.5 Infant and Young Child Feeding (IYCF) Practices . 143 11.6 Micronutrient Intake among Children. 146 11.7 Foods Consumed by Mothers. 148 11.8 Micronutrient Intake Among Mothers. 149 11.9 Consumption of Fruits and Vegetables by Women and Men . 151 CHAPTER 12 HIV AIDS-RELATED KNOWLEDGE, ATTITUDES, AND BEHAVIOUR 12.1 Knowledge of AIDS. 156 12.2 Knowledge of HIV Prevention Methods. 157 12.3 Beliefs about AIDS . 159 12.4 Knowledge of Prevention of Mother-to-Child Transmission of HIV . 162 12.5 Stigma Associated with AIDS and Attitudes Related to HIV/AIDS. 163 12.6 Attitudes towards Negotiating Safer Sex. 167 12.7 Coverage of Prior HIV Testing . 168 12.7.1 HIV Testing during Antenatal Care . 170 12.8 Treatment of Individuals with HIV/AIDS. 172 12.9 Prevalence of Medical Injections . 173 12.10 HIV/AIDS-Related Knowledge among Youth . 174 12.11 Exposure to Messages about HIV/AIDS. 176 Contents | xi CHAPTER 13 WOMEN’S EMPOWERMENT AND DEMOGRAPHIC AND HEALTH OUTCOMES 13.1 Employment and Forms of Earnings. 179 13.2 Control over Women’s and Men’s Earnings . 180 13.3 Women’s Participation in Household Decision-making . 184 13.4 Attitudes towards Wife Beating . 188 13.5 Attitudes towards Refusing Sex with Husband . 191 13.6 Women’s Empowerment Indicators . 195 13.7 Current Use of Contraception by Women’s Status. 196 13.8 Ideal Family Size and Unmet Need by Women’s Status. 197 13.9 Reproductive Health Care and Women’s Empowerment Status. 198 REFERENCES . 201 APPENDIX A SAMPLE DESIGN FOR THE 2009 SDHS . 205 APPENDIX B ESTIMATES OF SAMPLING ERRORS.209 APPENDIX C DATA QUALITY TABLES .219 APPENDIX D PERSONS INVOLVED IN THE 2009 SAMOA DEMOGRAPHIC AND HEALTH SURVEY . 223 APPENDIX E QUESTIONNAIRES . 227 Tables and Figures | xiii TABLES AND FIGURES Page CHAPTER 1 INTRODUCTION Table 1.1 Results of the household and individual interviews.8 CHAPTER 2 HOUSEHOLD POPULATION AND HOUSING CHARACTERISTICS Table 2.1 Household population by age, sex, and residence.10 Table 2.2 Household composition.11 Table 2.3 Children's living arrangements and orphanhood.12 Table 2.4.1 Educational attainment of the female household population .14 Table 2.4.2 Educational attainment of the male household population .15 Table 2.5 School attendance ratios .16 Table 2.6 Grade repetition and dropout rates.18 Table 2.7 Household drinking water.20 Table 2.8 Household sanitation facilities.21 Table 2.9 Household characteristics .23 Table 2.10 Household possessions .25 Table 2.11 Wealth quintiles.26 Table 2.12 Birth registration of children under age five .27 Figure 2.1 Population Pyramid .10 Figure 2.2 Age-Specific Attendance Rates of the De Facto Population Age 5 to 24 by Sex.19 Figure 2.3 Percentage of Households with Usual Members Age 25 or Older Ever Diagnosed with Specific Diseases .28 Figure 2.4 Percentage of Households with Usual Members Age 25 or Older Ever Diagnosed with Diabetes or Hypertension, by Wealth.29 Figure 2.5 Percentage of Household Members Age 25 or Older Ever Diagnosed with Specific Diseases .29 Figure 2.6 Percentage of Households with Usual Members Age 25 or Older Ever Diagnosed with Diabetes or Hypertension, by Age .31 CHAPTER 3 CHARACTERISTICS OF SURVEY RESPONDENTS Table 3.1 Background characteristics of respondents .32 Table 3.2.1 Educational attainment: Women.33 Table 3.2.2 Educational attainment: Men .34 Table 3.3.1 Literacy: Women .35 Table 3.3.2 Literacy: Men .36 Table 3.4.1 Exposure to mass media: Women.37 Table 3.4.2 Exposure to mass media: Men .38 Table 3.5.1 Employment status: Women .39 Table 3.5.2 Employment status: Men.40 Table 3.6.1 Occupation: Women.42 Table 3.6.2 Occupation: Men .43 Table 3.7 Type of employment.44 xiv | Tables and Figures Table 3.8.1 Knowledge and attitude concerning tuberculosis: Women .46 Table 3.8.2 Knowledge and attitude concerning tuberculosis: Men .47 Table 3.9 Exposure to messages about TB in printed media and the Internet .49 Table 3.10.1 Exposure to messages about TB: Women.50 Table 3.10.2 Exposure to messages about TB: Men .51 Table 3.11.1 Use of tobacco: Women.53 Table 3.11.2 Use of tobacco: Men .54 Table 3.12 Participation in the Physical Activity Campaign .55 Figure 3.1 Employment Status of Women and Men Age 15-49.41 Figure 3.2 Among Women and Men Age 15-49 Who Have Heard of TB, Knowledge and Misconception About Transmission of TB.48 Figure 3.3 Percentage of Women and Men Exposed to Messages about Tuberculosis.51 CHAPTER 4 FERTILITY Table 4.1 Current fertility .58 Table 4.2 Fertility by background characteristics .59 Table 4.3 Trends in age-specific fertility rates.61 Table 4.4 Children ever born and living.62 Table 4.5 Mean number of children ever born by marital status.63 Table 4.6 Children ever born by marital status.64 Table 4.7 Birth intervals.65 Table 4.8 Age at first birth .66 Table 4.9 Median age at first birth .67 Table 4.10 Teenage pregnancy and motherhood.68 Figure 4.1 Age-Specific Fertility Rates by Urban-Rural Residence.58 Figure 4.2 Age-Specific Fertility Rates by Marital Status.60 Figure 4.3 Trends in Total Fertility Rate by Different Sources .61 Figure 4.4 Percent Distribution of Births in the Past Three Years by Marital Status.64 CHAPTER 5 FAMILY PLANNING Table 5.1 Knowledge of contraceptive methods .70 Table 5.2 Knowledge of contraceptive methods by background characteristics .71 Table 5.3.1 Ever use of contraception: Women .72 Table 5.3.2 Ever use of contraception: Men .73 Table 5.4 Current use of contraception by age .74 Table 5.5 Current use of contraception by background characteristics .75 Table 5.6 Number of children at first use of contraception .77 Table 5.7 Knowledge of fertile period.77 Table 5.8 Source of modern contraception methods .78 Table 5.9 Cost of modern contraceptive methods.79 Table 5.10 Future use of contraception .81 Table 5.11 Reason for not intending to use contraception in the future by age .82 Table 5.12 Preferred method of contraception for future use.82 Table 5.13 Exposure of respondents to family planning messages .83 Table 5.14 Contact of nonusers with family planning providers .84 Table 5.15 Husband/partner's knowledge of women's use of contraception .86 Table 5.16 Male attitudes towards contraceptive use.87 Tables and Figures | xv CHAPTER 6 OTHER PROXIMATE DETERMINANTS OF FERTILITY Table 6.1 Current marital status .89 Table 6.2 Singulate mean age at marriage.90 Table 6.3 Postpartum amenorrhea, abstinence and insusceptibility.92 Table 6.4 Menopause.92 CHAPTER 7 FERTILITY PREFERENCES Table 7.1 Fertility preferences by number of living children .94 Table 7.2.1 Desire to limit childbearing: Women .95 Table 7.2.2 Desire to limit childbearing: Men.96 Table 7.3 Need and demand for family planning among currently married women .98 Table 7.4 Ideal number of children .99 Table 7.5 Mean ideal number of children. 100 Table 7.6 Fertility planning status. 101 Table 7.7 Wanted fertility rates. 102 CHAPTER 8 INFANT AND CHILD MORTALITY Table 8.1 Early childhood mortality rates . 104 Table 8.2 Early childhood mortality rates by socioeconomic characteristics. 105 Table 8.3 Early childhood mortality rates by demographic characteristics. 106 Table 8.4 Perinatal mortality. 107 Table 8.5 High-risk fertility behaviour . 108 CHAPTER 9 MATERNAL HEALTH Table 9.1 Antenatal care. 110 Table 9.2 Number of antenatal care visits and timing of first visit . 111 Table 9.3 Components of antenatal care . 112 Table 9.4 Tetanus toxoid injections . 114 Table 9.5 Place of delivery (including overseas facilities) . 115 Table 9.6 Assistance during delivery . 117 Table 9.7 Timing of first postnatal check-up . 119 Table 9.8 Type of provider of first postnatal check-up . 120 Table 9.9 Problems in accessing health care . 121 CHAPTER 10 CHILD HEALTH Table 10.1 Child's weight and size at birth. 124 Table 10.2 Vaccinations by source of information. 126 Table 10.3 Vaccinations by background characteristics . 128 Table 10.4 Vaccinations in first 18 months of life. 129 Table 10.5 Prevalence of symptoms of ARI . 130 Table 10.6 Prevalence and treatment of fever. 131 Table 10.7 Prevalence of diarrhoea . 132 Table 10.8 Knowledge of ORS packets or pre-packaged liquids. 135 Table 10.9 Disposal of children's stools. 136 Figure 10.1 Vaccination Coverage at Any Time before the Survey among Children 18-29 Months. 126 xvi | Tables and Figures Figure 10.2 Vaccination Coverage in Samoa Compared with Selected Pacific Countries . 127 Figure 10.3 Diarrhoea Treatment among Children Under Five . 133 Figure 10.4 Feeding Practices During Diarrheoa among Children Under Five . 134 CHAPTER 11 NUTRITION OF CHILDREN AND ADULTS Table 11.1 Initial breastfeeding. 138 Table 11.2 Breastfeeding status by age . 140 Table 11.3 Median duration and frequency of breastfeeding . 142 Table 11.4 Foods and liquids consumed by children in the day or night preceding the interview . 143 Table 11.5 Infant and young child feeding (IYCF) practices . 144 Table 11.6 Micronutrient intake among children . 147 Table 11.7 Foods consumed by mothers in the day or night preceding the interview. 149 Table 11.8 Micronutrient intake among mothers . 150 Figure 11.1 Infant Feeding Practices by Age. 141 Figure 11.2 Infant and Young Child Feeding Practices . 145 Figure 11.3 Number of Servings of Fruit Consumed per Week by Women and Men Age 15-49. 152 Figure 11.4 Number of Servings of Vegetables Consumed per Week by Women and Men Age 15-49. 153 Figure 11.5 Number of Combined Servings of Fruits and Vegetables Consumed per Week by Women and Men Age 15-49 . 153 CHAPTER 12 HIV/AIDS-RELATED KNOWLEDGE, ATTITUDES, AND BEHAVIOUR Table 12.1 Knowledge of AIDS. 157 Table 12.2 Knowledge of HIV prevention methods. 158 Table 12.3.1 Comprehensive knowledge about AIDS: Women . 160 Table 12.3.2 Comprehensive knowledge about AIDS: Men. 161 Table 12.4 Knowledge of prevention of mother to child transmission of HIV . 162 Table 12.5.1 Accepting attitudes toward those living with HIV/AIDS: Women . 164 Table 12.5.2 Accepting attitudes toward those living with HIV/AIDS: Men . 165 Table 12.6 Attitudes toward negotiating safer sexual relations with husband . 168 Table 12.7.1 Coverage of prior HIV testing: Women . 169 Table 12.7.2 Coverage of prior HIV testing: Men. 170 Table 12.8 Pregnant women counselled and tested for HIV. 171 Table 12.9 Prevalence of medical injections . 174 Table 12.10 Comprehensive knowledge about AIDS and of a source of condoms among youth . 175 Figure 12.1 Attitudes Towards People Living with HIV/AIDS among Women Age 15-49 Who Have Heard of HIV/AIDS . 166 Figure 12.2 Attitudes Towards People Living with HIV/AIDS among Men Age 15-49 Who Have Heard of HIV/AIDS . 167 Figure 12.3 Treatment of Individuals with HIV/AIDS:Women Age 15-49. 172 Figure 12.4 Treatment of Individuals with HIV/AIDS:Men Age 15-49 . 173 Figure 12.5 Exposure to Messages about HIV/AIDS: Women . 176 Figure 12.6 Exposure to Messages about HIV/AIDS: Men . 177 Tables and Figures | xvii CHAPTER 13 WOMEN’S EMPOWERMENT AND DEMOGRAPHIC AND HEALTH OUTCOMES Table 13.1 Employment and cash earnings of currently married women. 180 Table 13.2.1 Control over women's cash earnings and relative magnitude of women's earnings: Women. 181 Table 13.2.2 Control over men's cash earnings . 183 Table 13.3 Women's control over her own earnings and over those of her husband . 184 Table 13.4.1 Women's participation in decision making . 185 Table 13.4.2 Women's participation in decision making according to men . 185 Table 13.5.1 Women's participation in decision making by background characteristics. 186 Table 13.5.2 Men's attitude toward wives' participation in decision making . 187 Table 13.6.1 Attitude toward wife beating: Women . 189 Table 13.6.2 Attitude toward wife beating: Men. 191 Table 13.7.1 Attitude toward refusing sexual intercourse with husband . 192 Table 13.7.2 Men's attitude toward a husband's rights when his wife refuses to have sexual intercourse. 194 Table 13.8 Indicators of women's empowerment. 196 Table 13.9 Current use of contraception by women's status. 197 Table 13.10 Women's empowerment and ideal number of children and unmet need for family planning . 198 Table 13.11 Reproductive health care by women's empowerment . 199 Figure 13.1 Number of Household Decisions in Which Currently Married Women Participate . 188 APPENDIX A SAMPLE DESIGN FOR THE 2009 SDHS. 205 Table A.1 Sample implementation: Women . 206 Table A.2 Sample implementation: Men. 207 APPENDIX B ESTIMATES OF SAMPLING ERRORS Table B.1 List of selected variables for sampling errors . 211 Table B.2 Sampling errors for national sample . 212 Table B.3 Sampling errors for urban sample. 213 Table B.4 Sampling errors for rural sample. 214 Table B.5 Sampling errors for Apia Urban Area. 215 Table B.6 Sampling errors for North West Upolu sample . 216 Table B.7 Sampling errors for Rest of Upolu sample. 217 Table B.8 Sampling errors for Savaii sample . 218 APPENDIX C DATA QUALITY TABLES Table C.1 Household age distribution . 219 Table C.2.1 Age distribution of eligible and interviewed women . 220 Table C.2.2 Age distribution of eligible and interviewed men. 220 Table C.3 Completeness of reporting . 221 Table C.4 Births by calendar years . 221 Table C.5 Reporting of age at death in days . 222 Table C.6 Reporting of age at death in months. 222 Summary of Findings | xix SUMMARY OF FINDINGS The 2009 Samoa Demographic and Health Survey (2009 SDHS) is a nationally representa- tive sample survey designed to provide informa- tion on population and health issues in Samoa. The survey used a two-stage sample based on the 2006 Population and Housing Census (PHC) to produce separate estimates for key indicators for each of the four geographic regions in Samoa. Each household selected for the SDHS was eligi- ble for interview with the Household Question- naire, and a total of 2,247 households were inter- viewed. In all of the households selected for the survey, all eligible women age 15-49 were inter- viewed with the Women’s Questionnaire. In ad- dition, all eligible men age 15-54 in every other household (half of all households) selected for the survey were interviewed with the Men’s Questionnaire. A total of 3,033 women age 15-49 and 1,689 men age 15-54 were interviewed. Data collection took place from early August to early September 2009. The survey obtained detailed information on fertility, marriage, sexual activity, fertility pref- erences, awareness and use of family planning methods, breastfeeding practices, nutritional status of women and young children, childhood mortality, maternal and child health, awareness and behaviour regarding HIV/AIDS and other sexually transmitted infections (STIs), and knowledge and attitudes toward tuberculosis. The 2009 SDHS was implemented by the Samoa Bureaus of Statistics (SBS) in collabora- tion with the Samoa Ministry of Health (MOH). Technical assistance was provided by ICF Macro through the MEASURE DHS programme. Fund- ing for the survey was provided by the World Bank/International Development Association (IDA), the Australian Agency for International Development (AusAID), and the New Zealand Agency for International Development (NZAID). The United Nations Children’s Fund (UNICEF) and the United Nations Population Fund (UN- FPA) also provided financial support for the re- port writing. Fertility Levels and Trends. The 2009 SDHS findings indicate that a Samoan woman who is at the beginning of her childbearing years will, on average, give birth to 4.6 children by the end of her reproductive period (if fertility levels remain constant at the levels observed in the three-year period preceding the 2009 SDHS). Data from available sources over time show that the TFR in the 1960s and 1970s was very high, around 7 children per woman. According to the 1986 PHC, the TFR dropped to around 5.6 chil- dren per woman, and it further declined to 4.8 children per woman according to the 1991 PHC. The 1999 Samoa DHS reported a TFR of 4.5 children per woman. In the subsequent 2001 and 2006 Population and Housing Censuses, the TFRs were 4.4 and 4.2 children, respectively, indicating that fertility decline has stagnated and that the TFR has remained fairly constant over the past 20 years or so. The results of the 2009 SDHS show a slight increase in TFR from 4.2 children per woman in 2006 to the current level of 4.6 children per woman. This suggests that Samoa is going through a protracted demo- graphic transition in which mortality rates have significantly declined but the decline in fertility has stagnated. Fertility Differentials. Fertility varies by background characteristics. The TFR for rural areas (4.7 births) is higher than the rate for urban areas (4.1 births). The small difference in fertility level between urban and rural areas may be due to better access to reproductive health services for women in urban areas. Among regions, the TFR ranges from 4.1 births per woman in Apia Urban Area to 5.4 births in the Rest of Upolu. Some of these differences may be due to sampling variability, which is quite large because of the small number of respondents in each region. The TFR is highest (5.1 births per woman) among women with secondary educa- tion that is incomplete, compared with 4.1 to 4.3 births among women in the other education categories. It is surprising that the TFR is lowest (4.1 births per woman) among women with primary or less education when compared with women with higher education. There is a negative association between fertility and wealth; women living in the poorest households have the highest fertility (5.9 births per woman), and women in the highest wealth quintile have the lowest fertility (4.0 births per woman). xx | Summary of Findings Unplanned Fertility. Overall, 6 percent of births in Samoa are unwanted, and 9 percent are mistimed (wanted later). The proportion of un- planned births is highest for women age 15-19, amongst whom one in four births was either mis- timed (17 percent) or unwanted altogether (8 per- cent). Also women of age 40-44 experience rela- tively high rates of unplanned births, with 22 per- cent of births mistimed (4 percent) or unwanted (18 percent), indicating a high level of desire to terminate childbearing in this age group. Fertility Preferences. There is considerable desire among currently married Samoans to con- trol the timing and number of births. Fifteen per- cent of currently married women and 28 percent of currently married men would like to wait for two or more years for the next birth, while 52 percent of women and 43 percent of men do not want to have another child. If one were to add to these values the 7 percent of currently married women and the 3 percent of currently married men who are sterilized, about three-fourths of currently married Samoan women (74 percent) and men (73 percent) want to delay or limit their next birth. The similar high proportions of women and men who desire to delay or limit the next birth convey a clear message for population and family planning experts in Samoa. Knowledge of Contraception. Knowledge of any contraceptive method is high in Samoa, with 71 percent of all women and 83 percent of all men knowing at least one method of contra- ception. Among currently married women, 85 percent know at least one method of contracep- tion compared with 71 percent of all women, 84 percent know a modern method compared with 70 percent of all women, and 34 percent know a traditional method compared with 27 percent of all women. Among modern methods, injectables are most commonly known by currently married women (74 percent), followed by the pill (69 percent), female sterilization (39 percent), and the female condom (38 percent). Emergency con- traception is known by 6 percent of currently married women. Implants are the least known modern method (4 percent). Use of Contraception. At the time of the 2009 SDHS, 29 percent of currently married women were using some method of contracep- tion. Modern methods of contraception account for almost all the use, with 27 percent of married women reporting use of a modern method, com- pared with only 2 percent currently using a tradi- tional method. Injectables (used by 14 percent of currently married women), female sterilization (used by 7 percent of currently married women), and pills (used by 6 percent of currently married women) are the most widely used modern meth- ods. Looking at traditional methods, rhythm is used by 1 percent of currently married women, while withdrawal and folk method are used by less than 1 percent each. Trends in Contraceptive Use. Overall con- traceptive use among all women in Samoa has decreased somewhat over the past decade. Current use of any contraceptive among all women age 15-49 has decreased from 25 percent in 1998 (1998 Reproductive Health Knowledge and Services Survey) to 18 percent in 2009 (2009 SDHS), and current use of modern contraceptive methods has decreased from 23 percent in 1998 to 17 percent in 2009. The decrease in current use is observed for all age groups. Differentials in Contraceptive Use. There is almost no difference in current use of contra- ception by urban-rural residence. However, women in rural areas are more likely to use in- jectables (15 percent) than those residing in ur- ban areas (9 percent). Contraceptive prevalence is slightly lower among women residing in Savaii (26 percent) compared with women from other regions (29-30 percent). However, looking at specific methods, the lowest use of injectables is in the Apia Urban Area (9 percent) compared with 14-16 percent among women in other re- gions. The current use of any contraceptive method tends to increase with women’s educa- tion; it is lowest among women with primary or less education (21 percent) and highest among those with vocational or higher than secondary education (30 percent). Use of any method of contraception does not have a clear relationship with wealth status. Source of Modern Methods. In Samoa, the vast majority of users (93 percent) obtain their contraceptive methods from the public sector. Government hospitals are the most common public source (55 percent), followed by family planning clinics (21 percent) and government health centres (17 percent). Very few women (1 percent) use the private medical sector to obtain their contraceptive methods. The two main providers of contraception in the private sector are private medical centres and peer trainers. Summary of Findings | xxi Four percent of women who are using a modern method of contraception get their method from other sources, mostly from overseas (3 percent). Unmet Need for Family Planning. Forty- six percent of currently married Samoan women have an unmet need for family planning. The unmet need for limiting (25 percent) is greater than the unmet need for spacing (20 percent). Overall, about three in ten currently married women are using a method of contraception (9 percent for spacing births and 20 percent for limiting births). The total demand for family planning among women is 74 percent (29 percent for spacing births and 46 percent for limiting births). Only 39 percent of the demand for family planning is currently being met, which implies that the contraceptive needs of about half of cur- rently married women are not being met. MATERNAL HEALTH Antenatal Care. The survey shows that over nine in ten women (93 percent) who had a live birth in the five years preceding the survey re- ceived antenatal care from a health care provider (doctor, nurse, midwife, or nurse aide) during the pregnancy of the most recent birth. This percent- age increases to 96 percent when one includes traditional birth attendants (TBAs) as providers. Coverage is almost uniformly high among moth- ers regardless of their various background char- acteristics. Overall, only 4 percent of pregnant women did not see anyone for prenatal care dur- ing their most recent pregnancy in the past five years. Neonatal tetanus is a leading cause of neo- natal death in developing countries where a high proportion of deliveries occur at home or in places where hygienic conditions may be poor. Tetanus toxoid (TT) vaccinations are given to pregnant women to prevent neonatal tetanus. The survey results show that, for the most recent live birth in the five years preceding the survey, only one in four women in Samoa receive two or more tetanus injections during pregnancy, and only 31 percent of births are protected against neonatal tetanus. Delivery Care. The majority of births in Samoa (81 percent) are delivered in a health fa- cility, and mostly in public sector facilities (79 percent). Only 18 percent of births take place at home. The results also show that that virtually all births (97 percent) in Samoa are delivered with the assistance of a trained health profes- sional (doctor, nurse/midwife, nurse aide, or tra- ditional birth attendant. More specifically, 81 percent of births are delivered with the help of a health care provider, such as a doctor, nurse/ midwife, or nurse aide, while one in six deliver- ies (16 percent) is assisted by a TBA. Very few births (2 percent) are assisted by a relative, a friend, or someone else, and less than 1 percent of all births are delivered without any type of as- sistance at all. Postnatal Care. Postnatal coverage is rela- tively low in Samoa. Data show that four in ten mothers (41 percent) receive postnatal care within the first 4 hours after delivery, about one in six (17 percent) receive postnatal care 4 to 23 hours after delivery, and fewer than one in ten (8 percent) receive care 1 to 2 days after deliv- ery. Overall, 66 percent of mothers in Samoa re- ceive a postnatal check-up within the recom- mended 48 hours after delivery. Three in ten mothers (29 percent) do not receive any postnatal care within 41 days after delivery, which marks almost the end of the 6-week postnatal period. CHILD HEALTH Childhood Mortality. The reported level of under-five mortality in the 2009 SDHS is 15 deaths per 1,000 births during the most recent five-year period before the survey. This implies that at least 1 in every 66 children born in Samoa during the period died before reaching a fifth birthday. The infant mortality rate recorded in the survey for the same period is 9 deaths per 1,000 live births. The 2006 Population and Housing Census recorded an infant mortality rate of 20 per 1,000 live births in the 12 months prior to the census date. This is an indication that the number of re- ported births and deaths in the SDHS was not sufficient to give reliable mortality estimates. The Samoa Bureau of Statistics faced the same problem in the Vital Sample Surveys in 1999 and 2000. Death is generally a painful experience that most mothers prefer not to recall, especially the death of a newborn or young child. The SDHS childhood mortality rates are very likely underestimates and must, therefore, be treated with great care. xxii | Summary of Findings Childhood Vaccination Coverage. Overall, 25 percent of children age 18-29 months in Sa- moa are fully immunized with all basic vaccina- tions at any time before the survey. Only 15 per- cent of children received no vaccinations. Looking at coverage for specific vaccines, 84 percent of children have received the BCG vaccination, 77 percent have received the first DPT dose, and 74 percent have received the first polio dose. While the coverage for the first dose of DPT and polio is relatively high, coverage de- clines for subsequent doses of DPT and polio; only 38 percent of children received the recom- mended three doses of DPT, and 34 percent re- ceived three doses of polio, reflecting dropout rates of 51 percent for DPT and 54 percent for po- lio. Sixty-three percent of children received at least one dose of the measles vaccine, and 70 percent were vaccinated against hepatitis B at birth. Child Illness and Treatment. Among chil- dren under five years of age, 2 percent were reported to have had symptoms of acute respira- tory illness (ARI) in the two weeks preceding the survey. About nine in ten children with symptoms (87 percent) were taken to a health facility or provider for treatment. Over half (54 percent) of children under five years who had ARI symp- toms in the two weeks before the survey were reported by their mothers to have been given antibiotics for the illness. About one in five children under age 5 (19 percent) had a fever in the two weeks preced- ing the survey. More than six in ten children with fever (64 percent) were taken to a health facility or provider for treatment. Over one-third of chil- dren with fever are given antibiotics (38 percent). One in four children with fever in the last two weeks was given panadol or paracetamol for their fever. The Samoa Ministry of Health policy requires that antibiotics be prescribed by trained health personnel after proper diagnosis. Conse- quently, it is not recommended that households stock antibiotics at home. However, the SDHS data show that in 45 percent of the cases when children had a fever and were given an oral anti- biotic (pills or syrup), the antibiotic was already available at the home. Only 5 percent of children in Samoa had diarrhoea in the two weeks before the survey, and virtually none had diarrhoea with blood, a symptom of dysentery. More than two-thirds of the children who were ill with diarrhoea were taken to a health facility or provider (68 percent). Mothers reported that more than nine in ten children with diarrhoea (91 percent) were treated with some form of Oral Rehydration Therapy (ORT) or increased fluids. ORS was given to 68 percent of children, recommended home fluids (RHF) made with salt and sugar were given to 39 percent of children, and coconut juice was given to 42 percent of children. A relatively high pro- portion of children with diarrhoea are treated with home remedies (27 percent). Only 3 percent of children with diarrhoea did not receive any treatment at all. NUTRITION Breastfeeding Practices. The results indi- cate that 92 percent of children born in the past five years have been breastfed at some time. For last-born children who were breastfed, 88 percent started breastfeeding within one hour of birth and 97 percent started breastfeeding within the first 24 hours after delivery. Exclusive breastfeeding is recommended by the World Health Organisa- tion through the age of 6 months, but in Samoa only about half (51 percent) of children under 6 months are exclusively breastfed. Overall, the median duration of breastfeeding in Samoa is 21 months and the median duration of exclusive breastfeeding is 4 months. Infant and Young Child Feeding (IYCF). Infant and young child feeding (IYCF) practices include timely introduction of solid and semi- solid foods beginning at age 6 months, and there- after increasing the amount and variety of foods and the frequency of feeding as the child gets older, while still maintaining frequent breast- feeding. Guidelines have been established with respect to IYCF practices for children age 6-23 months. Overall, only 40 percent of Samoan children age 6-23 months are fed in accordance with IYCF practices. Intake of Vitamin A and Iron among Children and Mothers. Vitamin A is an essen- tial micronutrient for the immune system and plays an important role in maintaining the epithe- lial tissue in the body. Deficiencies in vitamin A can cause blindness and can increase the severity of infections such as measles and diarrhoea among young children. There is currently no rou- tine vitamin A supplementation of children in place in Samoa. SDHS results show that more than nine in ten (92 percent) children age 6-35 Summary of Findings | xxiii months living with their mother consumed foods rich in vitamin A in the 24 hours preceding the survey. Iron is essential for cognitive development. Low iron intake can also contribute to anaemia. Iron requirements are greatest between the ages of 6 and 12 months, when growth is extremely rapid. Data show that more than eight in ten (81 percent) children age 6-35 months living with their mother consumed foods rich in iron. Adequate micronutrient intake by women has important benefits for them and their chil- dren. Breastfeeding children benefit from micro- nutrient supplementation that mothers receive, especially vitamin A. In Samoa, the great major- ity of mothers with young children consume on a daily basis foods that are rich in vitamin A (98 percent). Night blindness is an indicator of vitamin A deficiency that pregnant women are especially prone to experience. Only 5 percent of women with a child born in the past five years reported night blindness during pregnancy for the last birth. When the results were adjusted for blindness not attributed to vitamin A deficiency during pregnancy, only 1 percent of women ex- perienced night blindness during their last preg- nancy. Iron supplementation of women during preg- nancy protects the mother and infant against anaemia. About nine in ten mothers with young children consume on a daily basis foods that are rich in iron (86 percent). Half of women took some form of iron supplementation during the pregnancy of their most recent birth, and among them, 44 percent reported taking supplements for less than 60 days. Only 3 percent of pregnant women take iron supplements for 90 days or more. HIV/AIDS Awareness of HIV/AIDS. Knowledge of HIV/AIDS is quite high in Samoa: 85 percent of women and 87 percent of men have heard of HIV/AIDS. Nevertheless, the 2009 SDHS results indicate that only 4 percent of women and 7 per- cent of men have a comprehensive knowledge of HIV/AIDS prevention and transmission, that is, (1) they know that consistent use of condoms during sexual intercourse and having just one faithful, HIV-negative partner can reduce the chances of getting HIV/AIDS, (2) they know that a healthy-looking person can have HIV (the virus that causes AIDS), and (3) they reject two of the most common local misconceptions about the transmission of AIDS in Samoa—namely, that the AIDS virus can be transmitted through mos- quito bites and that it can be transmitted by the saliva of a person who has HIV or AIDS. General knowledge of HIV transmission during breastfeeding is high: 76 percent of women and 70 percent of men know of the risk of mother-to-child transmission of HIV through breastfeeding. However, only about one in three women (31 percent) and men (34 percent) know that the risk of mother-to-child transmission (MTCT) of HIV can be reduced by the mother taking special drugs during pregnancy. Attitudes towards People Living with HIV/AIDS. It is encouraging to see that 65 per- cent of women and 77 percent of men would be willing to care in their home for a family member sick with AIDS. Furthermore, more than eight in ten women (84 percent) and nine in ten men (90 percent) would not want to keep secret the fact that a family member has an HIV infection. These results indicate that individuals are gener- ally supportive about providing a caring envi- ronment for their family members if they were to become infected with the HIV. On the other hand, only 16 percent of women and 27 percent of men said that they would buy vegetables from a shopkeeper with AIDS. Additionally, only 6 percent of women and 7 percent of men said that a female HIV- positive teacher who is not sick should be al- lowed to continue teaching. Data further show that 82 percent of women and 73 percent of men say that they would not share a meal with a per- son who has HIV. Eighty-five percent of women and 96 percent of men say that all newcomers to Samoa should be required to take a test for HIV. Seventy-three percent of women and 88 percent of men believe that it should be a criminal of- fence to knowingly pass HIV onto someone else. About six in ten women and more than seven in ten men say that they think the names of all per- sons with HIV should be displayed in public places for everyone to see. Finally, about four in ten women and seven in ten men believe that people with HIV or AIDS should be ashamed of themselves, and four in ten women and six in ten men believe that they should be blamed for bringing the diseases to the community. Millennium Development Goal Indicators | xxv MILLENNIUM DEVELOPMENT GOAL INDICATORS Value Goal Indicator Male Female Total 2. Achieve universal primary education 2.1 Net attendance ratio in primary school1 2.2 Percentage of pupils starting grade 1 who reach grade 5 2.3 Literacy rate of population age 15-24 88.0 99.1 97.0 89.1 100.0 99.0 88.5 99.5 98.4 3. Promote gender equality and empower women 3.1 Ratio of girls to boys in primary, secondary, or higher school 3.2 Share of women in wage employment in the non-agricultural sector na na na na 91.0 53.9 4. Reduce child mortality 4.1 Under-five mortality rate (per 1,000 live births) 16 13 15 4.2 Infant mortality rate (per 1,000 live births) 11 8 9 4.3 Percentage of children one year of age immunized against measles3 48.0 58.5 53.6 5. Improve maternal health 5.2 Percentage of births attended by skilled health personnel4 78.6 83.0 80.8 5.3 Contraceptive prevalence rate (any contraceptive method, currently married women age 15-49) na 28.7 28.7 5.4 Adolescent birth rate (per 1,000 women age 15-19) na na 44 5.5 Antenatal care coverage (at least one visit)5 na na 92.7 5.5 Antenatal care coverage (four visits)6 na na 58.4 5.6 Unmet need for family planning (among currently married women age 15-49) na 45.6 45.6 6. Combat HIV/AIDS, malaria and other diseases 6.3 Percentage of population age 15-24 with correct comprehensive knowledge of HIV/AIDS7 5.8 3.0 3.8 Value Urban Rural Total 7. Ensure environmental sustainability 7.8 Percentage of population using improved drinking water sources, urban and rural (de jure population)8 98.6 97.5 97.7 7.9 Percentage of population using improved sanitation facilities, urban and rural (de jure population)9 94.3 94.0 94.1 na = Not applicable 1 2009 SDHS data are based on reported attendance, not enrolment, for children age 5-12 years. 2 Refers to respondents who attended secondary school or higher or who can read a whole sentence in English 3 2009 SDHS data are based on children age 18-29 months. 4 Among all births in the past 5 years. Skilled provider includes doctor, nurse, midwife, and nurse aide. 5 Among last births in the past 5 years. Skilled health personnel include Skilled provider includes doctor, nurse, midwife, and nurse aide. 6 Among last births in the past 5 years. Four or more visits to any provider, whether skilled or unskilled 7 A person is considered to have comprehensive knowledge about HIV/AIDS when s/he knows that consistent use of a condom during sexual intercourse and having just one HIV-negative and faithful partner can reduce the chances of getting HIV, knows that a healthy-looking person can have HIV, and rejects the two most common misconceptions about HIV, i.e., that HIV can be transmitted by mosquito bites and a person can become infected from the saliva of a person who has HIV or AIDS. 8 Proportion whose main source of drinking water is a household connection (piped), public standpipe, tubewell or borehole, protected dug well or spring, or rainwater collection 9 Improved sanitation facilities are a flush toilet, ventilated improved pit (VIP) latrine, traditional pit latrine with a slab, and composting toilet. xxvi | Map of Albania 0 50 10025 Kilometers SAMOA P a c i f i c O c e a n ± Apia Urban Area North West Upolu Rest of Upolu Savaii Introduction | 1 INTRODUCTION 1 1.1 GEOGRAPHY, HISTORY, AND ECONOMY 1.1.1 Geography The Independent State of Samoa consists of two main islands--Upolu and Savaii--as well as the smaller islets of Apolima, Manono, Fanuatapu, Namua, Nuutele, Nuulua, and Nuusafee. Only Upolu, Savaii, Manono, and Apolima are currently inhabited. Samoa is located between latitudes 13 degrees and 15 degrees south and longitudes 171 degrees and 176 degrees west. The two largest islands of Savaii and Upolu are 1,820 square kilometres and 1,114 square kilometres, respectively (Samoa Bureau of Statistics, 2008). The islands of Samoa belong to the Samoan Islands archipelago in the South Pacific Ocean. They feature a rugged mountain range of volcanoes, including Mount Matavanu, which erupted in the 1900s. Mount Silisili is the highest point of Savaii at 1,800 metres. The eastern area is flat and fertile. Twenty kilometres southeast of the port of Salelologa on Savaii is Upolu, the second largest and most populous island. Like Savaii, it has a near impenetrable interior of mountains and ravines, with its highest point being Mount Fito at just over 1,000 metres in elevation. The climate is continuously hot and humid (Field, 1984, 1991). Apia, the capital of Samoa, is situated on the main island of Upolu. Upolu’s population of 137,599 persons represents 76 percent of the total Samoan population of 180,741 persons. The rest of the Samoan population currently resides in Savaii and totals 43,142 persons or 24 percent of the population (Samoa Bureau of Statistics, 2008). The official languages are Samoan and English, and Samoa has a high English literacy rate of 99 percent for women and 95 percent for men (see Chapter 2). Samoa is in the centre of the Pacific region and as such is prone to natural disasters. The country was the site of a devastating tsunami in September 2009 that hit the coastal areas of the southeastern part of the island of Upolu and claimed 147 lives. The tsunami was triggered by an 8.1 magnitude earthquake, which struck the islands minutes before the tsunami occurred (MOH, 2009). 1.1.2 History and Governance The Samoan Islands are believed to have been discovered and settled around 1,000 BC. The Samoans are descendents of Austronesian predecessors from Southeast Asia and Melanesia. The Austronesian migration started in southeastern Asia and moved eastward, reaching the Fiji islands around 1,000 BC. By 200 BC, Samoa was the centre of a flourishing Polynesian community, with trade taking place among Tonga, Fiji, and Samoa. The Samoan language belongs to the Austronesian language family, said to be the world’s largest (Evans, 2010). Samoa was first named the Navigator Islands by French explorer Louis de Bougainville because of its people’s impressive navigating skills (Field, 1984, 1991). As a predominantly Christian society, Samoa has a Congregational Christian church of Samoa, a Roman Catholic church, and a Methodist church, with 34 percent, 20 percent, and 14 percent of the population belonging to these three denominations, respectively (Samoa Bureau of Statistics, 2008). Samoa was ruled by Germany during the late 19th century until 29 August 1914 when New Zealand troops landed in German Samoa and established a period of colonial rule that was to last for almost 50 years (Field, 1984, 1991). Samoa officially became independent on 1 January 1962 after the successful Mau movement, which ended a period of New Zealand administration. The Mau movement (or opinion movement), established in 1908, was a declaration of pacifism and non-violence and a commitment to democracy. Upon gaining its independence, the country was officially known as 2 | Introduction Western Samoa until it was renamed Samoa by a change to the constitution in 1997 (www.parliament.gov.ws). Samoa is a parliamentary democracy. The parliament consists of the head of state and the legislative assembly. There are 49 members in the legislative assembly, and they are chosen through an electoral vote every five years. The next election is to be held in 2011. To be able to run on the ballot, candidates have to be holders of Matai (Chiefly) titles, with the exception of two members who may represent the non-ethnic Samoans. The head of state holds supreme authority and is elected by the members of parliament for a five-year term. The current head of state, Tuiatua Tupua Tamasese Efi, succeeded the late Malietoa Tanumafili II in 2007. The cabinet has the responsibility to provide general direction and control of the executive government of Samoa and reports to the parliament. The prime minister is chosen by the cabinet. Since 1998, the position of the prime minister has been held by Tuilaepa Sailele Malielegaoi. Samoa recently made headlines worldwide by becoming one of the first countries in decades to require its citizens to drive on the left side of the road. This mandated change came into effect on 17 September 2009 (www.parliament.gov.ws). The bold road switch was initially a controversial issue because of concerns that it would increase the road accident rate. The main reason behind the road switch was economic; Samoans have access to cheaper, imported right-hand drive cars from its nearest economically developed neighbours, New Zealand and Australia. 1.1.3 Economy The Samoan economy relies heavily on remittances from overseas, as well as on agriculture, fishery, and tourism industries. With a gross domestic product (GDP) amounting to ST$1,056 million and a GDP per capita of ST$5,842,1 the economy has experienced a gradual decrease in its wealth as a direct impact of the global financial crisis of 2007 (Ministry of Finance, 2009). Samoans residing overseas, mainly in New Zealand, Australia, and the United States, contribute tremendously to the economy by remitting funds to their families in Samoa. Remittances make up about 9 percent of the country’s GDP. Remittances from emigrants to the three countries make up 31 percent, 27 percent, and 21 percent, respectively, of total remittances (Ministry of Finance, 2009). Agriculture represents 6 percent of the GDP, making it the leading industry in terms of overall production, followed by the tourism industry, which represents 4 percent of the GDP. Earnings from tourism were negatively affected in late 2009 after the tsunami caused much damage to almost all of the tourist areas around the southwest side of Upolu Island. 1.2 DEMOGRAPHIC PROFILE There are a number of sources in Samoa that provide diverse demographic information about its population. These include the population and housing censuses, various surveys, and government administrative data. Population censuses collect information related to social, economic, and demographic characteristics of the Samoan population. The most recent Population and Housing Census (PHC) was conducted in 2006. It recorded a total population of 180,741 people, which represents an increase of 3 percent (or 4,031 people) to the population reported in the 2001 PHC of 176,710 people. The 2006 PHC shows a sex distribution of 52 percent male and 48 percent female inhabitants, similar to that of the 1981, 1991, and 2001 censuses (Samoa Bureau of Statistics, 2008). The population density per square kilometre in Samoa has slightly increased from 63 persons per square kilometre in 2001 to 65 persons per square kilometre in 2006. Samoa has a high total sex ratio (the ratio of males to females in a population). The 2006 census reported a total sex ratio of 108 males to 100 females compared with the worldwide ratio of 105 males to 100 females; and the sex ratio at birth was estimated at 107 males to 100 females. The 2006 census reported that almost half of the people belong to dependant age groups (age 0-14 and 65 or older), and the other half belong to the 1 ST$ = Samoan Tala (roughly ST$100 = US$30) Introduction | 3 working age group (age 15-64). The proportion of the population under age 15 years has decreased slightly from 41 percent in 2001 to 39 percent in 2006, and the proportion age 65 years and above has increased slightly from 4 percent to 5 percent over the same period. The life expectancy at birth in Samoa is 72 years for males and 74 years for females (Samoa Bureau of Statistics, 2008). 1.3 SAMOA HEALTH SYSTEM The Samoan health system is made up of a modern public and a modern private health sector as well as a traditional health sector. NGOs, academic institutions, communities, and development partners play various roles within these health sectors. At present, publicly funded health services dominate the Samoan health system. The Ministry of Health (MOH) is responsible for regulatory oversight of the health sector and provides guidance on the policy framework and health priorities of Samoa. The ministry is also responsible for (1) monitoring overall health system performance, (2) disease surveillance, and (3) and basic health promotion and prevention services, including sanitation regulation and services. Major policies and priorities are reflected in the National Health Sector Plan 2008-2018 (MOH, 2008a). National Health Services is the main publicly funded provider of clinical health care services to the population and includes the national referral hospital (TTM Hospital) in Apia, Upolu, and seven district hospitals throughout the country, including the Savaii hospital (MTII Hospital). Outreach services are provided by the Nursing and Integrated Community Health Services. These services include home-based intermediate care for patients who still need nursing and midwifery care when discharged from hospitals. They also include disease prevention and health promotion activities, such as immunizations and maternal and child health services, offered in health centres. The health centres are located within the local communities and villages that own them. District hospitals offer 24-hour services and serve as clinical centres in rural districts. They are staffed and managed by a multi-purpose team of nurses who are responsible for in-patient, outpatient, and outreach services in their respective districts. The district hospitals are supported as necessary by doctors from Upolu TTM Hospital and Savaii MTII Hospital. Other important service providers under the regulatory oversight of the MOH include the National Kidney Foundation of Samoa (NKFS)—a government funded service provider—and a range of health-related NGOs (including the Red Cross), which receive government subsidies to finance a part of their operations. Private practitioners, such as doctors in private clinics, and providers operating in the private MedCen Hospital, are also recognized as important service providers within the health sector. 1.3.1 Health Reforms In the late 1990s, the Samoa Ministry of Health (MOH) undertook a number of health reforms. The reforms focused on the development of national policies and strategic plans, health financing, resource allocation, refurbishment, and institutional strengthening. The newly established National Health Service, which came into effect in July 2006 as a part of health reform, took over the service delivery aspects of health services, except for health promotion and prevention services. The Ministry of Health has taken on a strategic role in regulating and monitoring the health sector. The health reforms resulted in a National Health Service Plan covering urban and rural areas. This national plan has been a result of the strengthened partnerships among various health sectors, including formal and informal private health sectors, community-based organizations, NGOs, the MOH, and other governmental ministries. In February 2007, three district hospitals at Poutasi, Safotu, and Lalomanu were constructed and equipped, and a major refurbishment of the Tupua Tamasese Meaole Hospital was completed. This increased the accessibility of the Samoan citizens to higher-level health care services. 4 | Introduction During the health reforms, the MOH established the Sector Wide Approach program (SWAp) to improve the coordination of international donor funds and activities and to avoid the duplication of efforts. 1.3.2 Maternal and Child Health Care Maternal and child health is a priority for the Samoan Ministry of Health. Antenatal care in Samoa is provided by both public and private health professionals at hospitals, clinics and community health centres. Most deliveries occur at public health facilities, including national and district hospitals; at private hospitals; and, in rural areas, in the community health centres. In Samoa there is a strong culture of childbirth assisted by traditional birth attendants (TBAs) whose role has been acknowledged by the Ministry of Health. The MOH has arranged for provision of registered TBA training in order to ensure TBAs practice safely. Ongoing activities have been implemented in Samoa to promote child health. The Baby Friendly Hospital Initiative (BFHI) inside maternity wards promotes the breastfeeding of newborn babies and the rooming-in. Policies also promote breastfeeding in work places. Other health promotion activities target road safety and injury prevention, rheumatic fever screening, and strengthening the health promoting in schools programme. 1.4 SEXUAL REPRODUCTIVE HEALTH PROGRAMME The Sexual Reproductive Health (SRH) programme is based within the Ministry of Health and plays a coordinating role among the various health sector partners who provide SRH services. The main goals of the SRH programme are to advocate for the development of national policies related to SRH, to help with proper resources for various SRH partners, to establish and monitor professional and service standards, and to provide SRH-related technical advice to the MOH. 1.4.1 Family Planning The main goal of the family planning program and policy is to avoid unwanted pregnancies and to prevent complications due to closely spaced pregnancies. Family planning services is Samoa are provided at both public and private sector. The Ministry of Health monitors the whole range of family planning activities, including the family planning education of the population and the supply of contraceptives throughout the country. Contraceptives are also marketed by the private sector. Family planning services in Samoa include provision of counselling be provided to women by health professionals to help them select and properly use contraceptive methods. For the past decade, women in Samoa have been introduced to various modern contraception methods, including injections, pills, intrauterine device (IUD), sterilization, male and female condoms, and implants. 1.4.2 HIV/AIDS and STIs The close relationship between sexually transmitted infections (STIs) and HIV infection requires that STI control be seen as essential to the prevention and control of HIV infection (MOH, 2008). Communities have received education on STI and HIV prevention methods, treatment options for those infected, and care and support for people living with HIV/AIDS (PLWHA) and their families. A system of STI and HIV infection surveillance and epidemiology and the use of safe blood procedures have also been set up. The STI and HIV/AIDS awareness programs in Samoa also address issues related tithe stigma and misconceptions. As part of its advocacy role in health promotion and prevention, and in implementing STI and HIV-related primary health care, the MOH continues to work in close collaboration with partners from the private and public sectors, international agencies, and NGOs. Introduction | 5 1.5 SYSTEMS FOR COLLECTING DEMOGRAPHIC AND HEALTH DATA The population and household censuses (PHC) are expensive, require many resources, and take a long time to implement. Sample surveys are conducted between surveys to complement the census data and to accommodate information requirements by various organizations and agencies. Because sample surveys are much less expensive and can be implemented more quickly than censuses, they are conducted at more frequent intervals. The 2009 Samoa Demographic and Health Survey (SDHS) is one example of a sample survey of nationally representative households. Another important source of information is administrative data. Vital registration systems (birth and death registration), health services and systems (e.g., childhood immunisation), and education data (school enrolment) are a few examples. The Samoa Bureau of Statistics (SBS) is the responsible governmental agency for maintaining and updating the national registration system and for conducting population censuses and household sample surveys. As part of the national registration system, births, deaths, marriages, and divorces are registered at the local administrative level, and aggregated statistics are forwarded to the SBS central office. As mentioned earlier, the last PHC in Samoa was conducted in 2006, and the next PHC is scheduled for 2011. Collection of health data is primarily the responsibility of the Ministry of Health. Data is provided by the two national referral hospitals, the district hospitals in Upolu and Savaii, and private clinics. The data and information collected from these health information systems are utilized by the MOH to develop evidence-based health policies and plans at the national level. The health information and data are also used to produce reports on various health topics and issues faced by Samoa. 1.6 OBJECTIVES AND ORGANIZATION OF THE SURVEY The 2009 SDHS is a nationally representative sample survey designed to provide information on population and health issues in Samoa. The primary goal of the survey is to develop a single integrated set of demographic and health data pertaining to the population of Samoa. The survey was an initiative of the MOH under its Health Sector Wide Approach program (SWAp). The MOH emphasized the importance of conducting a nationally representative survey such as the SDHS to provide a broad range of data to help assess the health and demographic status of the Samoan population and to assist with monitoring and evaluation of various health and population indicators. Furthermore, the SDHS survey should improve the quality and quantity of the health and population data available to the MOH by other sources. The SDHS was conducted during August and September 2009 by the Samoa Bureau of Statistics (SBS). The SBS worked in close collaboration with the MOH for guidance in areas pertaining to health. ICF Macro provided technical support for the survey through the MEASURE DHS project. Funding for the survey was provided by the World Bank/International Development Association (IDA), the Australian Agency for International Development (AusAID), and the New Zealand Agency for International Development (NZAID). UNICEF and UNFPA also provided financial support for the report writing. The survey collected national and regional level data on fertility and contraceptive use, maternal and child health, adult health, tuberculosis, and HIV/AIDS and other sexually transmitted diseases. The survey obtained detailed information on these issues from women of reproductive age and, on certain topics, from men as well. The survey results are intended to provide the information needed to evaluate existing social programs and to design new strategies for improving the health of Samoans and health services for the people of Samoa. The SDHS also contributes to the growing international database on demographic and health-related variables. 6 | Introduction 1.7 SAMPLE DESIGN The sample for the 2009 SDHS was drawn from the master sample frame that was designed for the 2006 Population and Housing Census. The sample was designed to cover 10 percent of the households in rural areas and 12 percent of households in urban areas. The sample allows for detailed analysis for most indicators at the national level, for urban and rural areas separately, and for each of the four regions of Samoa (Apia Urban Area, North West Upolu, the Rest of Upolu, and Savaii). A representative probability sample of households was selected in two stages. The first stage involved selecting data collection points or clusters from the master sample frame. In the second stage, a complete listing of households was carried out in each selected cluster. Households were then systematically selected from each cluster for participation in the survey. The design did not allow for replacement of clusters or households. A total of 296 primary sampling units or clusters was selected, 104 in urban areas and 192 in rural areas. Because Samoan households do not move frequently, a fresh household listing was not deemed to be necessary. Instead, a listing conducted in November 2006 PHC was used. In the urban areas, 5 households were selected per cluster, whereas in the rural areas, 10 households were selected per cluster. This design resulted in a final sample of 2,247 households. Because of the non-proportional allocation of the sample to the different economic regions, sampling weights will be required in all analysis using the DHS data to ensure the actual representativity of the sample at both the national and regional levels. The sampling weight for each household is the inverse of its overall selection probability with correction for household non-response; the individual weight is the household weight with correction for individual non-response. Sampling weights are further normalized in order to give the total number of unweighted cases equal to the total number of weighted cases at the national level, for both household weights and individual weights. All women age 15-49 who were either permanent residents of the households in the 2009 SDHS sample or visitors present in the household on the night before the survey were eligible to be interviewed. In addition, all men age 15-54 in every other household selected for the survey were eligible to be interviewed if they were either permanent residents or visitors present in the household on the night before the survey. There were a total of 3,033 eligible women and 1,689 eligible men in the survey sample. 1.8 QUESTIONNAIRES Three questionnaires were used in the SDHS: a Household Questionnaire, a Women’s Questionnaire, and a Men’s Questionnaire. The household and individual questionnaires were based on model survey instruments developed in the MEASURE DHS program. The model questionnaires were adapted to meet the current needs of Samoa. Each household selected for the SDHS was eligible for interview with the Household Questionnaire. The Household Questionnaire was used to list all usual members of and visitors to the selected households and to collect information on the socio-economic status of the household. The first part of the Household Questionnaire collected information on the basic demographic data for Samoan households, such as age, sex, educational attainment, and relationship of each household member or visitor to the head of the household. . It was also used to identify the women and men who were eligible for the individual interview (i.e., women age 15-49 and men age 15-54). In the second part of the Household Questionnaire, there were questions on housing characteristics (e.g., the flooring material, the source of water, and the type of toilet facilities), on ownership of a variety of consumer goods, on ownership of land and farm animals, and other questions relating to the socio-economic status of the household. The Women's Questionnaire was used to collect information from all women age 15-49 years and covered the following topics: • Background characteristics (education, residential history, media exposure, etc.) • Birth history Introduction | 7 • Antenatal, delivery, and postnatal care • Knowledge, attitudes, and use of family planning methods • Fertility preferences • Marriage, woman’s work, and husband’s background characteristics • Breastfeeding and infant feeding practices • Vaccinations and childhood illnesses • Childhood mortality • Knowledge of and attitudes toward AIDS and other sexually transmitted diseases • Knowledge of and attitudes toward tuberculosis • Other health issues The Men's Questionnaire, administered to all men age 15-54 years living in every other household, collected information similar to that on the Women's Questionnaire but was shorter because it did not contain questions on reproductive history, maternal and child health, and nutrition. After finalization of the questionnaires in English, they were translated into Samoan. 1.9 PRETEST, TRAINING, AND FIELDWORK 1.9.1 Pretest All three survey questionnaires were pretested. The pretest training was also used as a tool for the training of trainers. The main objectives of the pretest were to provide experience for the trainers, who in turn trained the field staff during the main training, to test the survey instruments and logistics, and to build capacity of the survey team. An ICF Macro consultant visited Apia to conduct the pretest training and to assist with the pretest fieldwork. Pretest training and fieldwork were conducted from 29 June to 10 July 2009 for 27 participants: 15 women and 12 men. Training entailed classroom discussions and practice focusing on the three survey questionnaires: the Household Questionnaire, the Women’s Questionnaire, and the Men’s Questionnaire. Guest speakers from the MOH were invited to make short presentations on family planning, child health, and nutrition programmes being implemented in Samoa. The participants actively discussed the questionnaires and made suggestions for modifications. Based on these suggestions, both English and Samoan versions of the questionnaires were updated for the pretest fieldwork. Participants were divided into 9 teams and participated in one day of field practice in one selected area that was not part of the survey sample. A total of 20 household interviews, 15 women’s interviews, and 12 men’s interviews were completed. Interviews were conducted in both English and Samoan. By the end of the pretest, a few errors in skip patterns and translation had been identified and corrected. 1.9.2 Training and Fieldwork The main training of the survey field personnel was conducted for a period of 15 days from 20 July to 7 August 2009 in Apia. A total of 97 persons from various backgrounds were trained; 9 supervisors, 9 field editors, 54 female interviewers, 18 male interviewers, and 7 office editors. The training of survey field staff consisted of a detailed, question-by-question explanation of the questionnaires, reading of the interviewer’s manual, demonstrations, practice interviewing in small groups and pairs, and tests. Guest speakers were invited to give lectures about family planning and immunisation programmes in Samoa. Each section of the questionnaire was tested. The test results were used to reinforce understanding of key topics among the trainees and to strengthen their interviewing skills. Training included two days of field practice in communities in and around the training site that were not included in the 2009 SDHS sample. Additional training was held for field supervisors and editors. Fieldwork for the main survey lasted from 10 August to 5 September 2009. Senior staff from SBS and MOH coordinated and supervised the fieldwork activities. Field staff were divided into 9 8 | Introduction teams; 2 teams worked in the Apia Urban Area, 3 teams worked in North-West Upolu, 2 teams worked in the Rest of Upolu, and 2 teams worked in the Savaii region. Each team was composed of 1 supervisor, 1 field editor, 6 female interviewers, and 2 male interviewers. Each team was assigned a driver and a vehicle. The processing of the SDHS results began shortly after the fieldwork started. Data editing was first done in the field by field editors and supervisors. Completed and edited questionnaires for each cluster were packed and delivered to the SDHS Centre at Moto’otua where they were entered and edited by data processing personnel. The data processing team was composed of 15 data entry operators, 1 data entry supervisor with 2 assistants, and 7 office editors working in two shifts. Data operators and supervisors went through a one-week training program conducted with the technical assistance of ICF Macro. Data were entered using CSPro, a programme specially developed for use in household based surveys and censuses. All data were entered twice (100 percent verification). The concurrent processing of the data was an advantage because the survey technical staff were able to advise field teams of problems detected during the data entry using tables generated to check various data quality parameters. As a result, specific feedback was given to the teams to improve their performances. The data entry and editing phase of the survey was completed in February 2010. 1.10 RESPONSE RATES Table 1.1 presents household and indi- vidual response rates for the survey. A total of 2,247 households were selected for the sample, of which 2,066 were found occupied at the time of the fieldwork. Of these, 1,947 households were successfully interviewed, yielding a household response rate of 94 percent. In the households interviewed, a total of 3,033 eligible women were identified, of whom 2,657 were interviewed, yielding a response rate of 88 percent. Survey results indicate that 1,689 eli- gible men were identified in the sub-sample of households selected for the male survey and 1,307 were successfully interviewed, yielding a response rate of 77 percent. The household and women’s response rates are slightly lower in urban (92 percent and 86 percent, respectively) than in rural areas (95 percent and 88 percent, respectively), but for men, the response rate is higher in urban (81 percent) than in rural areas (76 percent). The principal reason for non-response among eligible women and men was the failure to find them at home despite repeated visits to the households. The substantially lower response rates for men reflect the more frequent and longer absences of men from the home. Table 1.1 Results of the household and individual interviews Number of households, number of interviews, and response rates, according to residence (unweighted), Samoa 2009 Residence Result Urban Rural Total Household interviews Households selected 486 1,761 2,247 Households occupied 445 1,621 2,066 Households interviewed 409 1,538 1,947 Household response rate1 91.9 94.9 94.2 Interviews with women age 15-49 Number of eligible women 686 2,347 3,033 Number of eligible women interviewed 592 2,065 2,657 Eligible women response rate2 86.3 88.0 87.6 Interviews with men age 15-54 Number of eligible men 339 1,350 1,689 Number of eligible men interviewed 275 1,032 1,307 Eligible men response rate2 81.1 76.4 77.4 1 Households interviewed/households occupied 2 Respondents interviewed/eligible respondents Household Population and Housing Characteristics | 9 HOUSEHOLD POPULATION AND HOUSING CHARACTERISTICS 2 This chapter summarizes the demographic and socio-economic characteristics of the household population in the 2009 SDHS, including age, sex, place of residence, educational status, and housing characteristics. Information collected on the characteristics of the households and the respondents who live within them is important to understanding and interpreting the findings of the survey. This information also provides some indication of how representative of the general population the survey results will be. The main focus of the chapter is to describe the environment in which men, women, and children live. General characteristics of the population are described, such as the age-sex structure and level of literacy and education. Household arrangements (headship, size) and housing facilities (sources of water supply, sanitation facilities, dwelling characteristics, and household possessions) are addressed. A distinction is made between urban and rural areas because many of these indicators differ depending on the location of the residence. A household is defined as a person or group of related and unrelated persons who live together in the same dwelling unit or in connected premises, who acknowledge one adult member as head of the household, and who have common arrangements for cooking and eating their food. The questionnaire for the SDHS distinguishes between the de jure population (persons who usually live in a selected household) and the de facto population (persons who stayed the night before the interview in the household). According to the survey data, the differences between these populations are small. Tabulations for the household data presented in this chapter are primarily based on the de facto population. Due to the way the sample was designed, the number of cases in some regions may appear small because they are weighted to make the regional distribution nationally representative. Throughout this report, numbers in the tables reflect weighted numbers. To ensure statistical reliability, percentages based on 25 to 49 unweighted cases are shown within parentheses, and percentages based on fewer than 25 unweighted cases are suppressed. 2.1 HOUSEHOLD POPULATION BY AGE AND SEX Age and sex are important variables in analysing demographic trends. Table 2.1 and Figure 2.1 present the distribution of the de facto household population in the 2009 SDHS by five-year age groups, according to sex and urban-rural residence. The population age structure shows a substantially larger proportion of persons in younger age groups than in older age groups for each sex (Figure 2.1). This reflects the young age structure of the population of Samoa and indicates a population with high fertility. This type of population structure imposes a heavy burden on the social and economic assets of a country. Thirty-nine percent of the population are less than 15 years of age, 54 percent are age 15-64, and 6 percent are age 65 or older. Male to female distribution is very similar, except for age group 10-14 which has about 2 percent more adolescent males than adolescent females. There is also a 3 percentage point drop-off between ages 10-14 and 15-19, which is slightly larger for males than females (4 percentage points versus 3 percentage points). Examination of the distribution of the household population by single year of age (Table C.1) shows some evidence that interviewers may have intentionally underestimated respondents’ ages to be younger than the age cut-off of 15 so as to make them ineligible for the individual interview. 10 | Household Population and Housing Characteristics Table 2.1 Household population by age, sex, and residence Percent distribution of the de facto household population by five-year age groups, according to sex and residence, Samoa 2009 Urban Rural Total Age Male Female Total Male Female Total Male Female Total <5 13.3 13.1 13.2 13.0 14.1 13.5 13.0 13.9 13.4 5-9 11.8 12.6 12.2 13.1 12.3 12.7 12.9 12.4 12.6 10-14 14.4 12.7 13.5 14.3 12.1 13.2 14.3 12.2 13.3 15-19 11.5 10.0 10.7 9.9 9.5 9.7 10.2 9.6 9.9 20-24 9.3 9.3 9.3 7.8 7.5 7.7 8.1 7.9 8.0 25-29 6.0 6.4 6.2 6.0 6.4 6.2 6.0 6.4 6.2 30-34 4.3 4.9 4.6 5.8 5.2 5.5 5.5 5.2 5.4 35-39 4.6 4.7 4.6 5.9 6.1 6.0 5.7 5.8 5.7 40-44 5.1 4.6 4.8 5.1 4.4 4.8 5.1 4.5 4.8 45-49 4.1 4.7 4.4 4.2 4.9 4.5 4.2 4.9 4.5 50-54 3.9 5.2 4.6 3.4 4.4 3.9 3.5 4.6 4.0 55-59 3.5 2.6 3.1 3.7 2.9 3.3 3.7 2.8 3.3 60-64 2.6 2.2 2.4 2.1 2.9 2.5 2.2 2.8 2.5 65-69 2.1 2.2 2.1 1.9 1.9 1.9 1.9 2.0 2.0 70-74 1.3 1.3 1.3 1.9 2.1 2.0 1.8 1.9 1.8 75-79 0.8 1.2 1.0 1.0 1.3 1.1 0.9 1.3 1.1 80 + 0.7 1.6 1.1 0.5 1.4 0.9 0.6 1.4 1.0 Don't know/missing 0.7 0.7 0.7 0.4 0.5 0.4 0.5 0.5 0.5 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number 1,284 1,404 2,688 6,029 5,462 11,491 7,313 6,865 14,179 Figure 2.1 Population Pyramid 80+ 75-79 70-74 65-69 60-64 55-59 50-54 45-49 40-44 35-39 30-34 25-29 20-24 15-19 10-14 5-9 0-4 0246810 0 2 4 6 8 10 SDHS 2009 Male Percent Female Age Household Population and Housing Characteristics | 11 2.2 HOUSEHOLD COMPOSITION Table 2.2 shows the percent distribution of households in the 2009 SDHS sample by sex of the head of the household and household size. It also presents the mean household size for urban and rural areas, as well as the per- centage of households with orphans and foster children under age 18. These characteristics of household composition are important because they are often associated with differences in household socioeconomic levels. For example, female-headed households are frequently poorer than households headed by males. In addition, the size and composition of the household affect the allocation of financial and other resources among household members, which in turn influence the overall well-being of these individuals. Household size is also associated with crowding in the dwelling, which can lead to unfavourable health conditions. In Samoa, the mean household size is 7.4 persons and is the same in urban and rural areas. Households in Samoa are predominantly male-headed (78 percent), a common feature in the South Pacific countries. Nevertheless, more than two in ten households (22 percent) are headed by women, with no difference by urban- rural residence. Overall, 32 percent of households have nine or more members, 26 percent of house- holds have five or six members, and 21 percent have seven or eight members. Single-person households are the least common (2 percent), followed by two-person households (3 percent), with no urban-rural difference. Urban households are slightly more likely to have nine or more members than rural households (34 percent versus 32 percent). 2.2.1 Children’s Living Arrangements and Orphanhood Information on households with foster children and orphans was collected in the SDHS. Foster children are defined here as children under age 18 living in households with neither their mother nor their father present; orphans are children with one or both parents dead. Foster children and orphans are of concern because they may be at increased risk of neglect or exploitation when their mothers or fathers are not present to assist them. Table 2.2 shows that 25 percent of households have at least one foster child. The proportion is slightly higher in urban areas (27 percent) than in rural areas (25 percent). Six percent of households have a single orphan, and about 1 percent have double orphans. About three in ten households (29 percent) have either foster or orphan children, with little difference seen between urban and rural areas. Table 2.2 Household composition Percent distribution of households by sex of head of household and by household size; mean size of household, and percentage of households with orphans and foster children under 18 years of age, according to residence, Samoa 2009 Residence Characteristic Urban Rural Total Household headship Male 78.4 78.0 78.1 Female 21.6 22.0 21.9 Total 100.0 100.0 100.0 Number of usual members 1 1.3 1.7 1.6 2 3.2 3.3 3.3 3 6.1 6.4 6.4 4 9.2 9.8 9.7 5 14.9 12.1 12.7 6 13.4 13.3 13.3 7 8.6 12.4 11.6 8 9.2 9.1 9.1 9+ 34.1 31.9 32.3 Total 100.0 100.0 100.0 Mean size of households 7.4 7.4 7.4 Percentage of households with orphans and foster children under 18 years of age Foster children1 26.7 24.7 25.1 Double orphans 0.0 1.1 0.9 Single orphans2 4.3 5.9 5.6 Foster and/or orphan children 29.6 28.8 28.9 Number of households 371 1,576 1,947 Note: Table is based on the de jure household members, i.e., usual residents. 1 Foster children are those under 18 years of age living in households where neither their mother nor their father is a de jure resident. 2 Includes children with one dead parent and an unknown survival status of the other parent. 12 | Household Population and Housing Characteristics Table 2.3 shows the distribution of foster children and children with one or both parents dead, according to background characteristics. The table is based on de jure household members. Of the 6,501 children under age 18 reported in the SDHS, about three-quarters (73 percent) live with both parents, and 9 percent live with their mother only, although their father is alive. Only 2 percent live with their father only, although their mother is alive. Ten percent live with neither of their natural parents, although both parents are alive. Table 2.3 also provides data on the extent of orphanhood, that is, the proportion of children who have lost one or both parents. Less than 1 percent of children under age 18 have both parents dead, and only 3 percent have one or both parents dead. The percentage of children living with both biological parents decreases with increasing age of the child. The percentage of children living with both biological parents is slightly higher among rural households (73 percent) and among households in North West Upolu (74 percent) when compared with other households. Except for the households in the fourth wealth quintile, the proportion of children under age 18 who are living with both parents generally decreases with increasing wealth.1 Among children in the highest wealth quintile, 69 percent are living with both biological parents compared with 78 percent in households in the lowest wealth quintile. Table 2.3 Children's living arrangements and orphanhood Percent distribution of de jure children under 18 years of age by living arrangements and survival status of parents, the percentage of children not living with a biological parent, and the percentage of children with one or both parents dead, according to background characteristics, Samoa 2009 Not living with either parent Living with mother but not father Living with father but not mother Background characteristic Living with both parents Father alive Father dead Mother alive Mother dead Both alive Only father alive Only mother alive Both dead Missing infor- mation on father or mother Total Percent- age not living with a biological parent Percent- age with one or both parents dead1 Number of children Age 0-4 75.0 12.1 1.6 1.9 0.2 6.0 0.1 0.3 0.5 2.4 100.0 6.9 2.6 1,907 <2 75.2 14.9 0.9 0.9 0.0 4.6 0.0 0.6 0.0 2.9 100.0 5.2 1.5 796 2-4 74.8 10.1 2.1 2.6 0.3 7.1 0.2 0.1 0.8 2.0 100.0 8.1 3.5 1,110 5-9 74.3 9.1 1.4 1.8 0.5 10.3 0.1 0.2 0.1 2.2 100.0 10.7 2.4 1,806 10-14 71.1 7.2 2.0 2.3 1.0 12.1 0.3 0.4 0.4 3.1 100.0 13.2 4.2 1,900 15-17 67.0 6.4 3.8 2.7 0.5 13.8 0.4 0.7 0.4 4.3 100.0 15.3 5.8 889 Sex Male 72.1 9.8 2.1 2.4 0.7 9.3 0.2 0.4 0.3 2.8 100.0 10.2 3.8 3,424 Female 73.1 8.3 1.8 1.8 0.4 10.9 0.2 0.3 0.4 2.9 100.0 11.7 3.1 3,077 Residence Urban 70.5 12.1 1.8 2.2 0.2 11.6 0.1 0.1 0.0 1.4 100.0 11.9 2.2 1,227 Rural 73.0 8.4 2.0 2.1 0.6 9.7 0.2 0.4 0.4 3.1 100.0 10.7 3.7 5,274 Region Apia Urban Area 70.5 12.1 1.8 2.2 0.2 11.6 0.1 0.1 0.0 1.4 100.0 11.9 2.2 1,227 North West Upolu 73.8 7.7 2.9 2.3 0.3 9.5 0.2 0.2 0.5 2.7 100.0 10.4 4.1 2,103 Rest of Upolu 72.6 8.3 2.0 2.2 1.3 9.1 0.1 0.6 0.7 3.0 100.0 10.5 4.7 1,572 Savaii 72.5 9.3 0.9 1.7 0.4 10.5 0.3 0.5 0.0 3.9 100.0 11.3 2.1 1,600 Wealth quintile Lowest 77.9 7.8 1.3 2.0 0.8 7.7 0.0 0.1 0.1 2.3 100.0 8.0 2.4 1,449 Second 70.2 10.9 2.8 1.9 0.3 10.4 0.1 0.3 0.6 2.5 100.0 11.4 4.1 1,331 Middle 70.3 10.5 1.2 2.6 0.5 9.5 0.4 0.8 0.4 3.8 100.0 11.0 3.3 1,310 Fourth 74.9 6.6 2.2 2.1 0.4 10.2 0.4 0.4 0.0 2.8 100.0 11.0 3.4 1,248 Highest 68.7 9.5 2.5 2.0 0.7 12.9 0.1 0.2 0.6 2.7 100.0 13.8 4.2 1,163 Total <15 73.4 9.5 1.7 2.0 0.6 9.4 0.1 0.3 0.3 2.6 100.0 10.2 3.1 5,613 Total <18 72.6 9.1 2.0 2.1 0.5 10.0 0.2 0.4 0.3 2.8 100.0 10.9 3.4 6,501 Note: Table is based on de jure household members, i.e., usual residents. 1 Includes children with father dead, mother dead, both dead, and one parent dead but missing information on survival status of the other parent. 1 See Section 2.6 for a description of how the wealth index was calculated. Household Population and Housing Characteristics | 13 2.2.2 School Attendance by Survivorship of Parents Children who are orphaned or who live in a house with a chronically ill adult may be at a greater risk of dropping out of school because of lack of money to pay school fees, the need to stay at home to care for the sick relative, or the need to sell goods to survive. The 2009 SDHS included information to monitor such situations, and including information on school attendance of children age 10-14 by parental survival. The overall ratio of school attendance of children whose parents are dead to those whose parents are alive (and at least one of them residing with the child) is not presented due to the low number of cases of children age 10-14 attending school whose parents are both dead (7 cases). As mentioned previously, the vast majority of children (97 percent) either have both parents alive or live with at least one parent. 2.3 EDUCATIONAL ATTAINMENT OF HOUSEHOLD MEMBERS Education is important because it helps individuals make informed decisions that affect their health and well-being. At present, an increasing number of qualified teachers graduate from universities overseas and also from the National University of Samoa, which has enabled the government to improve the level of education, especially in the rural areas. The current system of formal education in Samoa is based on three tiers: eight years of primary education (years 1 through 8), followed by five years of secondary education (years 9 to 13), and then tertiary education. In addition to a university education, which is considered tertiary, many institutions offer vocational, technical, and professional training that could be considered tertiary. Tables 2.4.1 and 2.4.2 show the percent distribution of the de facto female and male household populations, respectively, age five years and over, by highest level of education attended or completed, according to background characteristics. The majority of Samoans have gone to school. The proportion of the population with no education is low: 4 percent for females and 5 percent for males. The percentage is much higher in the age group 5-9 years (because some young children may not yet have attended school) and those age 65 years and older. Compared with results from the 2006 Population and Housing Census (Samoa Bureau of Statistics, 2008), the proportion with no education has increased slightly from 2006 to 2009, from 2 percent to 4 percent for females, and from 3 percent to 5 percent for males. A higher percentage of males than females have attended or completed primary education (40 percent compared with 34 percent). On the other hand, females are somewhat more likely than males to be educated at the secondary or higher levels of education. Half of women and 45 percent of men have attended or completed secondary school, and one in ten women (10 percent) and men (9 percent) have more than secondary (tertiary) education. For both males and females, the percentage who have completed or attended primary school is somewhat higher among rural residents. The opposite is true for higher levels of education, with the urban-rural difference being more pronounced. Thirty-two percent of females and 28 percent of males in urban areas have completed secondary or higher education, compared with 19 percent and 16 percent, respectively, in rural areas. There are variations across regions, and the variation patterns are similar for males and females. Individuals residing in Apia Urban Area are much more likely than those residing in other regions to have more than a secondary education. Eighteen percent of women and 15 percent of men living in the Apia Urban Area have tertiary education compared with 9 percent or less in each of the other regions. Wealth status also has a strong positive relationship with the percentage who have completed secondary education or who have tertiary education. For example, 23 percent of women and 20 percent of men in the highest wealth quintile have at least some university education, compared with 2 percent of women and 3 percent of men in the lowest quintile who do not. 14 | Household Population and Housing Characteristics The median number of years of schooling is 9.7 years for women and 8.5 years for men. The median is higher among the populations living in urban areas and in the Apia Urban Area (11 percent of women and 10 percent of men), and it is positively associated with wealth status. Respondents from the wealthiest household have about 3 more years of schooling than those from the poorest household. Table 2.4.1 Educational attainment of the female household population Percent distribution of the de facto female household populations age 5 and over by highest level of schooling attended or completed and median years completed, according to background characteristics, Samoa 2009 Background characteristic No education Some primary Completed primary1 Some secondary Completed secondary2 More than secondary Don't know/ missing Total Number Median years completed Age 5-9 18.6 79.0 0.0 0.1 0.0 0.0 2.3 100.0 849 0.9 10-14 1.4 71.0 7.7 18.9 0.3 0.0 0.8 100.0 836 5.8 15-19 0.6 2.7 3.3 78.2 8.9 5.9 0.4 100.0 662 10.3 20-24 0.7 0.8 1.0 36.7 29.4 31.2 0.3 100.0 543 12.3 25-29 1.9 1.8 1.7 47.1 27.5 19.0 1.0 100.0 442 11.9 30-34 0.6 2.0 4.1 51.9 22.8 16.1 2.5 100.0 356 11.6 35-39 1.1 1.7 4.6 53.9 24.0 12.6 2.1 100.0 397 11.5 40-44 1.0 2.1 5.5 63.4 17.3 9.9 0.7 100.0 306 11.2 45-49 0.3 6.6 6.0 60.4 14.5 11.3 1.0 100.0 335 11.0 50-54 1.0 12.9 11.7 46.2 14.8 10.8 2.5 100.0 313 10.5 55-59 1.4 21.9 16.8 40.5 11.7 6.4 1.4 100.0 194 9.2 60-64 2.4 22.4 26.4 30.0 8.6 8.9 1.2 100.0 191 7.9 65+ 8.8 30.0 23.8 18.2 5.4 7.4 6.4 100.0 455 7.3 Residence Urban 2.6 25.5 4.7 33.4 14.0 17.6 2.1 100.0 1,220 10.5 Rural 4.6 27.4 7.3 39.2 11.9 7.5 2.1 100.0 4,693 9.5 Region Apia Urban Area 2.6 25.5 4.7 33.4 14.0 17.6 2.1 100.0 1,220 10.5 North West Upolu 5.3 24.9 7.4 39.3 13.8 8.0 1.3 100.0 1,900 9.7 Rest of Upolu 4.2 27.8 6.9 40.2 9.7 8.5 2.7 100.0 1,370 9.6 Savaii 3.9 30.5 7.4 38.2 11.6 5.8 2.5 100.0 1,423 9.2 Wealth quintile Lowest 6.1 31.8 7.9 41.9 7.9 2.4 1.9 100.0 1,101 8.4 Second 4.0 31.1 6.7 40.9 9.5 5.1 2.7 100.0 1,188 9.1 Middle 4.8 27.1 6.8 41.8 12.5 5.8 1.2 100.0 1,204 9.6 Fourth 3.5 24.3 7.6 37.1 14.9 10.2 2.5 100.0 1,179 10.1 Highest 2.5 21.5 4.9 29.0 16.6 23.3 2.1 100.0 1,241 11.2 Total 4.2 27.1 6.7 38.0 12.4 9.6 2.1 100.0 5,913 9.7 Note: Total includes 36 weighted cases with missing information on age 1 Completed 8 grade at the primary level 2 Completed 5 grade at the secondary level Household Population and Housing Characteristics | 15 Table 2.4.2 Educational attainment of the male household population Percent distribution of the de facto male household populations age 5 and over by highest level of schooling attended or completed and median grade completed, according to background characteristics, Samoa 2009 Background characteristic No education Some primary Completed primary1 Some secondary Completed secondary2 More than secondary Don't know/ missing Total Number Median years completed Age 5-9 20.5 76.3 0.0 0.6 0.0 0.0 2.6 100.0 940 0.8 10-14 1.0 78.9 5.5 14.0 0.1 0.0 0.6 100.0 1,048 5.6 15-19 1.1 5.2 7.3 73.9 5.0 6.8 0.7 100.0 742 10.0 20-24 1.2 3.4 5.5 48.9 22.1 17.8 0.9 100.0 592 11.6 25-29 1.9 2.6 8.0 45.6 20.0 19.9 2.0 100.0 440 11.6 30-34 2.7 4.3 8.5 47.6 20.6 13.6 2.6 100.0 404 11.3 35-39 1.5 4.9 10.3 47.6 18.5 13.9 3.3 100.0 416 11.3 40-44 2.7 7.8 10.3 47.5 14.9 13.6 3.2 100.0 370 10.9 45-49 2.6 13.0 10.0 53.8 9.1 9.8 1.6 100.0 306 10.5 50-54 3.0 17.7 13.0 44.6 10.8 8.5 2.5 100.0 254 10.0 55-59 3.9 22.1 19.9 30.2 9.9 10.8 3.2 100.0 270 8.6 60-64 2.6 26.3 22.7 27.3 6.9 9.5 4.5 100.0 161 7.8 65+ 9.8 33.3 17.9 21.2 4.2 8.5 4.9 100.0 381 7.3 Residence Urban 3.0 27.6 4.5 35.7 12.1 15.4 1.7 100.0 1,113 10.0 Rural 5.5 32.2 8.9 35.2 8.5 7.0 2.6 100.0 5,247 8.1 Region Apia Urban Area 3.0 27.6 4.5 35.7 12.1 15.4 1.7 100.0 1,113 10.0 North West Upolu 6.3 30.5 9.2 35.4 9.3 7.8 1.5 100.0 2,037 8.4 Rest of Upolu 4.7 32.8 9.6 34.3 7.4 7.7 3.6 100.0 1,574 7.9 Savaii 5.4 33.8 7.9 35.9 8.7 5.3 3.0 100.0 1,636 8.0 Wealth quintile Lowest 6.7 37.0 9.7 36.5 5.4 2.5 2.2 100.0 1,305 7.4 Second 5.2 33.1 8.7 37.4 7.9 5.1 2.5 100.0 1,270 8.0 Middle 4.4 30.1 9.3 38.9 8.2 7.0 2.1 100.0 1,246 8.6 Fourth 5.0 30.2 7.8 34.9 11.1 7.8 3.2 100.0 1,279 8.8 Highest 4.1 26.4 5.2 28.7 13.3 20.2 2.2 100.0 1,260 10.4 Total 5.1 31.4 8.1 35.3 9.2 8.5 2.4 100.0 6,360 8.5 Note: Total includes 33 weighted cases with missing information on age 1 Completed 8 grade at the primary level 2 Completed 5 grade at the secondary level 2.3.1 School Attendance Ratios The Samoa DHS collected information on school attendance for the population age 5-24 that allows the calculation of net attendance ratios (NARs) and gross attendance ratios (GARs). The NAR for primary school is the percentage of the primary-school-age (5-12 years) population that is attending primary school. The NAR for secondary school is the measure of the secondary-school-age (13-18 years) population that is attending secondary school. By definition, the NAR cannot exceed 100 percent. The GAR however, measures participation at each level of schooling among persons age 5-24. The GAR is almost always higher than the NAR for the same level because the GAR includes participation by those who may be older, may have started school later, may have repeated one or more grades in school, may have dropped out of school (and later returned), or may be younger than the official age range for that level. Table 2.5 presents data on the NAR and GAR for the de facto household population by level of schooling and sex, according to place of residence, region, and wealth quintile. Eighty-nine percent of children age 5-12 who should be attending primary school are currently doing so. At the same time, the GAR at the primary school level is 102 percent. 16 | Household Population and Housing Characteristics The results show a nearly similar NAR for females (89 percent) and for males (88 percent) at the primary school level indicating that there is no gender gap in primary school attendance for the primary school-age population who should be attending school at a given level. The GAR at primary level is higher for males than females (104 percent versus 99 percent), indicating relatively higher overage or underage attendance among males than females. Table 2.5 School attendance ratios Net attendance ratios (NAR) and gross attendance ratios (GAR) for the de facto household population by sex and level of schooling; and the gender parity index (GPI), according to background characteristics, Samoa 2009 Net attendance ratio1 Gross attendance ratio2 Background characteristic Male Female Total Gender Parity Index (GPI)3 Male Female Total Gender Parity Index (GPI)3 PRIMARY SCHOOL Residence Urban 87.4 90.0 88.8 1.03 98.8 99.2 99.0 1.00 Rural 88.1 88.8 88.4 1.01 104.9 99.4 102.4 0.95 Region Apia Urban Area 87.4 90.0 88.8 1.03 98.8 99.2 99.0 1.00 North West Upolu 88.5 86.3 87.5 0.97 104.3 96.9 101.0 0.93 Rest of Upolu 88.6 88.5 88.5 1.00 105.6 100.5 103.3 0.95 Savaii 87.0 92.2 89.4 1.06 105.0 101.4 103.4 0.97 Wealth quintile Lowest 83.9 87.0 85.3 1.04 104.9 97.9 101.7 0.93 Second 88.2 88.2 88.2 1.00 104.1 99.8 102.0 0.96 Middle 89.2 91.9 90.5 1.03 105.9 102.9 104.4 0.97 Fourth 88.4 88.4 88.4 1.00 102.7 96.8 100.1 0.94 Highest 91.2 90.3 90.8 0.99 101.7 99.6 100.8 0.98 Total 88.0 89.1 88.5 1.01 103.9 99.4 101.8 0.96 SECONDARY SCHOOL Residence Urban 58.2 70.2 64.0 1.21 63.5 72.3 67.8 1.14 Rural 48.9 69.3 58.1 1.42 54.6 73.5 63.1 1.34 Region Apia Urban Area 58.2 70.2 64.0 1.21 63.5 72.3 67.8 1.14 North West Upolu 50.6 71.0 60.2 1.40 55.6 74.0 64.3 1.33 Rest of Upolu 46.7 62.0 53.1 1.33 51.9 69.9 59.4 1.35 Savaii 48.7 73.0 59.7 1.50 56.1 75.6 65.0 1.35 Wealth quintile Lowest 40.4 62.7 49.7 1.55 48.7 70.1 57.6 1.44 Second 47.7 67.3 56.9 1.41 53.8 69.9 61.4 1.30 Middle 52.3 68.8 60.3 1.32 58.1 72.1 64.8 1.24 Fourth 56.3 73.8 64.4 1.31 62.0 76.6 68.7 1.24 Highest 59.5 75.5 66.9 1.27 61.0 78.2 69.0 1.28 Total 50.6 69.5 59.3 1.37 56.3 73.2 64.1 1.30 1 The NAR for primary school is the percentage of the primary-school age (5-12 years) population that is attending primary school. The NAR for secondary school is the percentage of the secondary-school age (13- 18 years) population that is attending secondary school. By definition the NAR cannot exceed 100 percent. 2 The GAR for primary school is the total number of primary school students, expressed as a percentage of the official primary-school-age population. The GAR for secondary school is the total number of secondary school students, expressed as a percentage of the official secondary-school-age population. If there are significant numbers of overage and underage students at a given level of schooling, the GAR can exceed 100.0. 3 The Gender Parity Index for primary school is the ratio of the primary school NAR (GAR) for females to the NAR (GAR) for males. The Gender Parity Index for secondary school is the ratio of the secondary school NAR (GAR) for females to the NAR (GAR) for males. Household Population and Housing Characteristics | 17 There are no major variations in the primary school NAR and GAR by the selected background characteristics. Table 2.5 shows that both the NAR and GAR are much lower at the secondary school level: 59 percent of students age 13-18 who should be attending secondary school are in school (NAR), and the GAR for secondary school is 64 percent. The secondary school NAR is substantially higher for females (70 percent) than for males (51 percent), indicating a much wider gender gap in favour of females in the secondary school attendance. The GAR at the secondary school level is also higher for females than males (73 percent versus 56 percent), indicating higher overage or underage attendance among females than males. The NAR and the GAR for secondary education are lower in rural than in urban areas. For example, the secondary school GAR is 63 percent in rural areas compared with 68 percent in urban areas. Regional differences also exist, with the NAR and GAR for the secondary school being notably lower in the Rest of Upolu region (62 percent and 59 percent, respectively) when compared with all other regions. There is a strong relationship between household economic status and school attendance, which is most expressed for secondary school education. For example, the primary school NAR increases from 85 percent among children from the poorest households to 91 percent among those from the richest households. Similarly, the secondary school NAR increases from 50 percent among children in the lowest wealth quintile to 67 percent among those in the highest wealth quintile. The Gender Parity Index (GPI) represents the ratio of the NAR (or GAR) for females to the NAR (or GAR) for males. It is presented in Table 2.5 at both the primary and secondary levels and offers a summary measure of gender differences in school attendance rates. A GPI of less than 1 indicates that a smaller proportion of females than males attend school. In Samoa, the GPI for NAR is 1.01 for primary school attendance and 1.37 for secondary school attendance, indicating that girls are ahead of boys in both levels of education. There are no differences in the GPI for NAR for primary school attendance by urban-rural residence; however, the GPI for GAR for primary school attendance indicates slightly lower attendance by rural students (0.95) compared with those from urban areas (1.00). Generally, the overall GPI indicates slightly higher school attendance by females at both the primary and secondary levels, with the exception of the GPI of the GAR at the primary school level, indicating a slightly higher overage or underage attendance among males than among females. 2.3.2 Grade Repetition and Dropout Rates Table 2.6 presents school repetition and dropout rates for the de facto household population age 5-24 who attended primary school in the previous school year, by school grade and background characteristics. Repetition and dropout rates describe the flow of pupils through the educational system in Samoa. Repetition rates indicate the percentage of pupils who attended a particular class during the previous school year who are repeating that grade in the current school year, that is, those who were in a particular grade in the 2007/2008 academic year who attended the same grade during the 2008/2009 academic year. Dropout rates show the percentage of pupils who attended class during the 2007/2008 academic year but who did not attend school the following year. Repetition and dropout rates approach zero when pupils nearly always progress to the next grade at the end of the school year. They often vary across grades, indicating points in the school system where pupils are not regularly promoted to the next grade, or where they decide to drop out of school. 18 | Household Population and Housing Characteristics Table 2.6 Grade repetition and dropout rates Repetition and dropout rates for the de facto household population age 5-24 who attended primary school in the previous school year, by school grade, according to background characteristics, Samoa 2009 School grade Background characteristic 1 2 3 4 5 6 7 8 REPETITION RATE1 Sex Male 8.7 0.0 0.0 1.1 0.0 0.0 1.9 1.7 Female 7.2 0.6 0.9 0.0 0.4 0.8 2.1 0.5 Residence Urban 6.7 0.0 0.0 0.0 0.0 0.0 3.9 0.9 Rural 8.3 0.3 0.5 0.7 0.3 0.4 1.5 1.2 Region Apia Urban Area 6.7 0.0 0.0 0.0 0.0 0.0 3.9 0.9 North West Upolu 4.8 0.0 1.2 0.9 0.0 0.0 3.3 1.4 Rest of Upolu 9.1 1.3 0.0 1.3 0.9 0.0 0.0 1.1 Savaii 12.2 0.0 0.0 0.0 0.0 1.3 1.3 1.1 Wealth quintile Lowest 7.2 0.0 1.8 0.0 0.0 0.0 1.3 1.8 Second 5.7 0.0 0.0 0.0 1.2 1.4 0.0 0.0 Middle 7.6 1.6 0.0 3.0 0.0 0.0 1.2 1.8 Fourth 10.4 0.0 0.0 0.0 0.0 0.0 2.5 (2.0) Highest 9.8 0.0 0.0 0.0 0.0 0.0 5.3 0.0 Total 8.0 0.3 0.4 0.6 0.2 0.3 1.9 1.1 DROPOUT RATE2 Sex Male 0.3 0.0 0.5 0.0 0.0 0.9 1.3 5.2 Female 0.0 0.0 0.0 0.0 0.0 0.4 0.0 1.4 Residence Urban 0.0 0.0 0.0 0.0 0.0 0.9 0.0 5.5 Rural 0.2 0.0 0.3 0.0 0.0 0.6 0.9 2.9 Region Apia Urban Area 0.0 0.0 0.0 0.0 0.0 0.9 0.0 5.5 North West Upolu 0.0 0.0 0.9 0.0 0.0 1.6 0.0 2.0 Rest of Upolu 0.6 0.0 0.0 0.0 0.0 0.0 1.9 5.0 Savaii 0.0 0.0 0.0 0.0 0.0 0.0 0.9 2.3 Wealth quintile Lowest 0.0 0.0 0.0 0.0 0.0 1.0 2.3 4.2 Second 0.0 0.0 1.2 0.0 0.0 2.0 1.3 3.2 Middle 0.0 0.0 0.0 0.0 0.0 0.0 0.0 6.5 Fourth 0.0 0.0 0.0 0.0 0.0 0.0 0.0 (0.0) Highest 1.2 0.0 0.0 0.0 0.0 0.0 0.0 1.8 Total 0.2 0.0 0.3 0.0 0.0 0.7 0.8 3.4 Note: Numbers in parentheses are based on 25-49 unweighted cases. 1 The repetition rate is the percentage of students in a given grade in the previous school year who are repeating that grade in the current school year. 2 The dropout rate is the percentage of students in a given grade in the previous school year who are not attending school in the current school year. In Samoa, virtually all primary school students in grades 1 through 8 are promoted each year. Repeaters are most common among pupils in grade 1 and, to a lesser extent, in grade 7 (8 percent and 2 percent, respectively). These proportions are especially high among first grade repeaters in the Savaii and Rest of Upolu regions (12 and 9 percent, respectively), and among those from the two highest wealth quintiles (10 percent each). Nearly all primary school students stay in school. The dropout rate is less than 1 percent for all grades, except for grade 8 where it is 3 percent. The survey results show that male students (5 percent), urban residents (6 percent), those living in the Apia Urban Household Population and Housing Characteristics | 19 Area (6 percent) and the Rest of Upolu (5 percent), and individuals in the middle wealth quintile (7 percent) are more likely to drop out in grade 8 than other students. 2.3.3 Age-Specific School Attendance Rates Figure 2.2 shows the age-specific attendance rates (ASAR) for the de facto household population age 5-24 by sex. The ASAR shows participation in schooling at any level, from primary through higher education. The closer the ASAR is to 100, the higher is the participation of a given age population at that level. More than four in ten children age 5 are attending school, 47 percent male and 42 percent female. It should be noted that children age 5 at the time the household was interviewed may still be in pre-school and have not yet entered primary education. School attendance for males rises markedly up to age 10 and remains high up to age 13 and then gradually declines, whereas for females it rises at age 7, peaking at age 13 before gradually declining after age 14. There are no marked differences in the proportion of males and females attending school up to age 13, after which there are substantially higher proportions of females than males attending school, except for ages 22 and 24. 2.4 HOUSING CHARACTERISTICS There is a strong association between the socioeconomic condition of households and the vulnerability of its members, especially children, to common diseases. The amenities and assets available to households are important in determining the general socioeconomic status of the population. The 2009 SDHS included questions on the household’s access to electricity, source of drinking water, type of sanitation facilities, flooring materials, and ownership of durable goods. Figure 2.2 Age-Specific Attendance Rates of the De Facto Population Age 5 to 24 by Sex 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 Age 0 20 40 60 80 100 Percent Female Male SDHS 2009 20 | Household Population and Housing Characteristics 2.4.1 Household Drinking Water The availability of and accessibility to improved drinking water may, to a large extent, minimise the prevalence of water-borne diseases among household members, especially young children. The source of drinking water is important because potentially fatal diseases, such as diarrhoeal diseases, guinea worm, typhoid, schistosomiasis, trachoma, and dysentery, are common in Samoa. Table 2.7 shows the percent distribution of main sources of drinking water, time to collect drinking water, person who usually collects drinking water, and treatment of water prior to drinking, all according to residence. Table 2.7 Household drinking water Percent distribution of households and de jure population by source, time to collect, person who usually collects drinking water; and percentage of households and the de jure population by treatment of drinking water, according to residence, Samoa 2009 Households Population Characteristic Urban Rural Total Urban Rural Total Source of drinking water Improved source 86.5 94.8 93.2 89.0 95.3 94.1 Piped water into dwelling/ yard/ plot 84.4 80.6 81.4 86.6 81.4 82.4 Public tap/ standpipe 0.4 1.3 1.2 0.5 1.3 1.2 Tube well or borehole 0.0 0.2 0.2 0.0 0.3 0.3 Protected dug well 0.6 2.3 1.9 0.8 2.4 2.1 Protected spring 0.5 1.5 1.3 0.6 1.7 1.4 Rainwater 0.7 8.9 7.3 0.5 8.2 6.8 Non-improved source 0.6 0.7 0.7 0.7 0.7 0.7 Surface water 0.6 0.7 0.7 0.7 0.7 0.7 Bottled water, improved source for cooking/washing1 11.8 2.6 4.4 9.7 2.2 3.6 Bottled water, non-improved source for cooking/washing1 0.3 0.1 0.1 0.2 0.1 0.1 Other sources/missing 0.8 1.8 1.6 0.5 1.8 1.5 Total 100.0 100.0 100.0 100.0 100.0 100.0 Percentage using any improved source of drinking water 98.3 97.5 97.6 98.6 97.5 97.7 Time to obtain drinking water (round trip) Water on premises 98.6 96.3 96.8 98.4 96.2 96.6 Less than 30 minutes 0.6 2.6 2.2 0.5 2.7 2.3 30 minutes or longer 0.8 0.7 0.7 1.1 0.7 0.8 Don't know/ missing 0.0 0.4 0.3 0.0 0.4 0.3 Total 100.0 100.0 100.0 100.0 100.0 100.0 Person who usually collects drinking water Adult female 15+ 0.0 0.7 0.6 0.0 0.7 0.6 Adult male 15+ 1.4 1.9 1.8 1.6 2.0 1.9 Female child under age 15 0.0 0.1 0.1 0.0 0.1 0.1 Male child under age 15 0.0 0.5 0.4 0.0 0.5 0.4 Other 0.0 0.3 0.3 0.0 0.3 0.2 Water on premises 98.6 96.3 96.8 98.4 96.2 96.6 Missing 0.0 0.1 0.1 0.0 0.2 0.2 Total 100.0 100.0 100.0 100.0 100.0 100.0 Water treatment prior to drinking2 Boiled 30.1 48.4 44.9 32.5 49.8 46.5 Bleach/chlorine 4.0 0.3 1.0 4.3 0.3 1.0 Strained through cloth 1.8 14.2 11.9 1.9 14.9 12.4 Ceramic, sand or other filter 1.3 3.1 2.8 1.5 2.9 2.6 Other 1.0 1.9 1.7 0.7 1.9 1.7 No treatment 61.2 46.3 49.1 59.2 45.5 48.1 Percentage using an appropriate treatment method3 32.4 53.0 49.1 34.5 53.8 50.1 Number 371 1,576 1,947 2,726 11,645 14,371 1 Because the quality of bottled water is not known, households using bottled water for drinking are classified as using an improved or non-improved source according to their water source for cooking and washing. 2 Respondents may report multiple treatment methods, so the sum of treatment may exceed 100 percent. 3 Appropriate water treatment methods include boiling, bleaching, straining, filtering, and solar disinfecting. Household Population and Housing Characteristics | 21 Overall, 98 percent of households obtain drinking water from an improved source. Eighty-one percent of households have access to piped water in their dwelling, yard, or plot, and just 1 percent access drinking water from a public tap. Seven percent of households use rainwater for drinking, 2 percent get their drinking water from a protected dug well, and 1 percent from a protected spring. Less than 1 percent of households use non-improved sources of drinking water, and about 4 percent use bottled water. Surprisingly, there is no difference between urban and rural households in access to improved sources of drinking water (98 percent each). Table 2.7 provides information on persons who usually collect the drinking water. Almost all households in Samoa (97 percent) have water on their premises (99 percent in urban and 96 percent in rural areas). Therefore, less than 1 percent of households spend more than 30 minutes to collect water. Drinking water is collected more frequently by male adults (2 percent) than by other household members (less than 1 percent). Regarding treatment of water, about half of the households (49 percent) do not treat their water prior to drinking. Of households that do treat their drinking water, the most common treatment methods are boiling (45 percent) or straining through cloth (12 percent). 2.4.2 Household Sanitation Facilities Poor sanitation coupled with unsafe water sources increases the risk of waterborne diseases and illnesses due to poor hygiene. An improved toilet facility is considered the most efficient and hygienic method of human waste disposal. Table 2.8 shows the proportion of households and of the de jure population having access to hygienic sanitation facilities. Hygienic status is determined on the basis of type of facility used and whether or not it is a shared facility. A household’s toilet/latrine facility is classified as hygienic if it is used only by household members (i.e., not shared) and if the type of facility effectively separates human waste from human contact. The types of facilities that are most likely to accomplish this are flush or pour flush into a piped sewer system/septic tank/pit latrine; ventilated, improved pit (VIP) latrine; pit latrine with a slab; and composting toilet. A household’s sanitation facility is classified as unhygienic if it is shared with other households or if it does not effectively separate human waste from human contact. Overall, 94 percent of households in Samoa use improved sanitation facilities that are not shared with another household. Nine in ten (91 percent) households use a flush toilet connected to a septic tank or to a pit latrine, and 3 percent use a pit latrine with a slab. Flush toilets are slightly more widespread in urban than in rural areas (94 percent versus 90 percent). Overall, 6 percent of households use a non-improved toilet. Table 2.8 Household sanitation facilities Percent distribution of households and de jure population by type of toilet/latrine facilities, according to residence, Samoa 2009 Households Population Type of toilet/latrine facility Urban Rural Total Urban Rural Total Improved, not shared facility 95.1 93.7 94.0 94.3 94.0 94.1 Flush/pour flush to septic tank 90.6 83.5 84.9 89.5 84.3 85.3 Flush/pour flush to a pit latrine 2.9 6.8 6.1 3.3 6.4 5.9 Ventilated improved pit (VIP) latrine 0.9 1.6 1.4 0.9 1.6 1.5 Pit latrine with a slab 0.7 1.8 1.6 0.6 1.6 1.4 Non-improved facility 4.9 6.3 6.0 5.7 6.0 5.9 Any facility shared with other households 3.3 3.5 3.4 3.8 3.4 3.5 Flush/ pour flush not to sewer/septic tank/pit latrine 0.0 0.4 0.3 0.0 0.4 0.3 Pit latrine without slab/open pit 0.5 1.1 1.0 0.4 1.1 0.9 No facility/bush/field 0.0 0.1 0.1 0.0 0.1 0.1 Other/missing 1.1 1.2 1.2 1.6 1.1 1.2 Total 100.0 100.0 100.0 100.0 100.0 100.0 Number 371 1,576 1,947 2,726 11,645 14,371 22 | Household Population and Housing Characteristics 2.4.3 Household Characteristics Table 2.9 presents the distribution of households by household characteristics, according to residence. Overall, almost all Samoan households have electricity (100 percent in urban and 97 percent in rural areas). The type of flooring material used in dwellings is a proxy indicator of the socioeconomic status of the household as well as the likelihood of exposure to disease-causing agents. Most households (91 percent) have finished floors (parquet or polished wood, vinyl or asphalt strips, ceramic tiles, cement, carpet), with only 8 percent of households having rudimentary or natural flooring material (gravel, sand, wood planks, coconut midribs). Carpeted floors are the most common type of flooring, used by half of all households (52 percent in rural areas and 46 percent in urban areas). The second most common flooring material is cement, used by 28 percent of all households. Cement flooring is much more common in rural than in urban households (30 percent compared with 17 percent). Overall, 7 percent of households have ceramic tiles, 18 percent in urban areas compared with 5 percent in rural areas. Five percent of all households have floors of wooden planks (6 percent in urban areas and 4 percent in rural areas) or parquet or polished wood floors (10 percent in urban areas and 4 percent in rural areas). The number of rooms used for sleeping indicates the extent of crowding in households. Overcrowding increases the risk of contracting infectious diseases like acute respiratory infections and skin diseases, which particularly affect children. The 2009 SDHS results show that 42 percent of households have three or more rooms for sleeping, 37 percent have only one room, and 21 percent have two rooms. Households in urban areas are markedly more likely than those in rural areas to have three or more rooms for sleeping (62 and 37 percent, respectively). On the other hand, rural households are much more likely to have one room for sleeping (42 percent) compared with urban households (17 percent). Smoke from solid fuels used for cooking, such as charcoal, wood, and other biomass fuels, is a major cause of respiratory infections. The type of fuel used for cooking, the location where food is cooked, and the type of stove used are all related to indoor air quality and the degree to which household members are exposed to risk of respiratory infections and other diseases. Nearly seven in ten households (69 percent) do their cooking in a separate building, 28 percent cook in the house, and 2 percent cook outdoors. The majority of rural households do their cooking in a separate building (77 percent), while the majority of urban households prefer cooking inside of the house (62 percent). Almost two-thirds of the Samoan households (63 percent) use wood for cooking, about one in five (21 percent) use LPG/ natural gas/bio gas, and about one in ten (9 percent) use kerosene. In rural areas, the main cooking fuel is wood (72 percent), followed by LPG/ natural gas/bio gas (16 percent). In urban areas, the most common fuel used for cooking is LPG/ natural gas/bio gas, used by 45 percent of households, followed by wood (28 percent). Reducing the proportion of the population relying on solid fuels is a Millennium Development Goal (MDG). Two-thirds of households (66 percent) use solid fuels for cooking (28 percent in urban areas and 75 percent in rural areas). The majority of these households (95 percent) use an open fire or stove without a chimney or hood, with no major difference between urban and rural areas, and less than 1 percent use a closed stove with chimney. Household Population and Housing Characteristics | 23 Table 2.9 Household characteristics Percent distribution of households and de jure population by housing characteristics and percentage using solid fuel for cooking and among those using solid fuels, percent distribution by type of fire/stove, according to residence, Samoa 2009 Households Population Housing characteristic Urban Rural Total Urban Rural Total Electricity Yes 99.7 97.4 97.9 99.6 97.9 98.2 No 0.3 2.5 2.1 0.4 2.0 1.7 Missing 0.0 0.1 0.1 0.0 0.1 0.1 Total 100.0 100.0 100.0 100.0 100.0 100.0 Flooring material Gravel, sand 0.6 2.1 1.9 0.7 2.1 1.8 Wood planks 5.5 4.4 4.6 4.8 4.1 4.2 Coconut midribs 0.6 1.5 1.3 0.9 1.3 1.2 Parquet or polished wood 10.1 3.5 4.8 11.4 3.2 4.7 Vinyl or asphalt strips 2.1 1.0 1.2 2.1 1.2 1.4 Ceramic tiles 17.9 4.8 7.3 13.7 4.0 5.8 Cement 17.0 30.1 27.6 18.3 31.5 29.0 Carpet 45.8 51.5 50.4 47.8 51.5 50.8 Other/missing 0.5 1.1 1.0 0.2 1.1 1.0 Total 100.0 100.0 100.0 100.0 100.0 100.0 Rooms used for sleeping One 17.1 41.6 36.9 17.7 39.2 35.1 Two 20.7 20.7 20.7 19.1 19.4 19.4 Three or more 62.2 36.9 41.7 63.2 40.5 44.8 Missing 0.0 0.8 0.6 0.0 0.9 0.7 Total 100.0 100.0 100.0 100.0 100.0 100.0 Place for cooking In the house 62.0 19.9 27.9 56.0 16.5 24.0 In a separate building 34.4 77.4 69.2 39.0 81.1 73.1 Outdoors 3.6 1.6 2.0 4.9 1.8 2.4 Other/missing 0.0 1.0 0.9 0.0 0.7 0.6 Total 100.0 100.0 100.0 100.0 100.0 100.0 Cooking fuel Electricity 10.7 2.5 4.1 9.4 1.3 2.9 LPG/ natural gas/ biogas 44.7 15.5 21.0 41.7 13.6 18.9 Kerosene 16.7 6.5 8.5 17.3 6.0 8.2 Wood 27.5 71.5 63.1 31.3 75.8 67.4 Coconut parts 0.3 3.0 2.5 0.3 2.7 2.2 No food cooked in household 0.0 0.8 0.7 0.0 0.5 0.4 Other/missing 0.0 0.2 0.2 0.0 0.1 0.1 Total 100.0 100.0 100.0 100.0 100.0 100.0 Percentage using solid fuel for cooking1 27.8 74.5 65.6 31.6 78.5 69.6 Number of households/ population 371 1,576 1,947 2,726 11,645 14,371 Type of fire/stove among households using solid fuels1 Closed stove with chimney 0.5 0.3 0.4 0.6 0.3 0.3 Open fire/ stove with chimney 7.1 3.4 3.7 5.0 3.2 3.4 Open fire/ stove with hood 1.1 0.2 0.3 1.3 0.3 0.3 Open fire/ stove without chimney or hood 91.3 95.4 95.0 93.1 95.7 95.5 Other/missing 0.0 0.7 0.6 0.0 0.6 0.4 Total 100.0 100.0 100.0 100.0 100.0 100.0 Number of households/ population using solid fuel 103 1,175 1,278 861 9,139 10,000 LPG = Liquid petroleum gas 1 Includes wood and coconut parts 24 | Household Population and Housing Characteristics 2.5 HOUSEHOLD POSSESSIONS The availability of durable goods is a proximate measure of household socioeconomic status. Moreover, particular goods have specific benefits. For example, having access to a radio or a television exposes household members to innovative ideas; a refrigerator prolongs the wholesomeness of foods; and a means of transport allows greater access to many services away from the local area. Table 2.10 provides information on household ownership of durable goods (radios, televisions, telephones, and refrigerators) and modes of transportation (bicycles, motorcycles, and automobiles). The SDHS results indicate that urban households are more likely than rural households to own durable goods. Looking at electronic appliances, 93 percent of households have a mobile telephone, 85 percent have a television or a radio, 51 percent have a refrigerator, and 31 percent have a deep freezer. Furthermore, 44 percent of households have a gas stove, 37 percent have a kerosene stove, and 32 percent have a microwave oven. More than one-third of households (35 percent) have a sewing machine or an electric fan. About one in five households has a non-mobile phone (23 percent) or a rice cooker (22 percent), while around one in ten has a washing machine (14 percent), a desktop or a laptop computer (12 percent), or a blender (10 percent). Televisions, refrigerators, washing machines, and computers are much more common in urban areas than in rural areas. Around nine in ten households have a bed, table, chair, sofa, or food safe, and about half have a cupboard or clock/wall clock. Generally, possession of household fittings is somewhat more common in urban than in rural areas. More than one in five households (27 percent) have fishing gear, about three times as many rural as urban households (31 percent versus 11 percent). About one-third (34 percent) of households in Samoa has a car or truck, or a bicycle (32 percent). Fifteen percent of all households have a canoe. Cars or trucks are more common in urban areas than in rural areas (48 percent and 31 percent, respectively). On the other hand, rural households are more likely than urban households to own a bicycle or a canoe. About nine in ten (88 percent) Samoan households own their residential house, while about three in ten (28 percent) own another house. Seventy-one percent of Samoa households own agricultural land; the proportion is understandably higher in rural than in urban areas (78 percent and 43 percent, respectively). Three- quarters of households own livestock (83 percent in rural and 45 percent in urban areas). Household Population and Housing Characteristics | 25 Table 2.10 Household possessions Percentage of households and de jure population possessing various household effects, means of transportation, houses, types of land, and livestock/farm animals by residence, Samoa 2009 Households Population Possession Urban Rural Total Urban Rural Total Household effects Electronic appliances: Radio 84.6 84.7 84.7 83.9 85.9 85.5 Television 93.3 82.7 84.7 93.6 84.6 86.3 Mobile telephone 98.5 93.3 94.3 98.7 94.1 95.0 Non-mobile telephone 37.4 19.8 23.1 36.0 19.7 22.8 Refrigerator 67.5 47.2 51.0 65.1 47.5 50.8 Deep freezer 32.2 30.4 30.7 33.1 31.5 31.8 Gas stove 59.8 40.5 44.2 58.3 40.4 43.8 Kerosene stove 44.1 35.2 36.9 45.9 35.4 37.4 Microwave oven 44.3 29.4 32.2 40.6 28.8 31.1 Electric jug or kettle 83.3 71.5 73.8 81.6 72.6 74.3 Rice cooker 36.8 18.2 21.7 32.7 17.2 20.1 Blender 19.8 7.9 10.1 17.7 7.4 9.3 Sewing machine 39.1 33.6 34.6 40.2 34.8 35.8 CD or cassette player 70.6 62.5 64.0 71.7 64.4 65.8 Video or DVD player 72.3 64.5 66.0 73.0 65.8 67.2 Electric water pump 13.5 3.2 5.2 12.3 3.4 5.1 Washing machine 30.1 9.6 13.5 26.1 8.4 11.8 Desktop or laptop computer 27.8 8.6 12.2 25.0 7.6 10.9 Electric fan 52.9 31.3 35.4 50.4 30.6 34.3 Air conditioner 4.0 2.4 2.7 3.2 2.4 2.5 Household Fittings: Bed 94.0 90.3 91.0 93.3 91.4 91.8 Table 95.8 92.4 93.0 95.0 92.9 93.3 Chair 97.3 91.8 92.8 96.8 92.6 93.4 Sofa 88.9 87.9 88.1 89.4 88.6 88.7 Food safe 85.6 85.1 85.2 84.8 86.2 86.0 Cupboard 65.8 48.9 52.1 63.7 50.0 52.6 Clock or wall clock 66.2 43.1 47.5 66.6 43.7 48.1 Other items: Generator 1.2 1.1 1.2 1.1 1.0 1.0 Solar power 1.2 0.2 0.4 0.8 0.1 0.3 Fishing gear 11.3 31.1 27.3 12.6 33.8 29.7 Means of transport Bicycle 25.1 33.4 31.8 25.9 35.6 33.7 Motorcycle/ scooter 3.6 1.9 2.2 3.4 1.7 2.0 Car/ truck 47.9 31.1 34.3 45.5 31.0 33.7 Hand cart 4.9 4.5 4.6 5.9 4.7 5.0 Boat 1.9 2.1 2.1 1.7 2.6 2.5 Outboard motor 2.4 1.9 2.0 1.9 2.4 2.3 Canoe 3.7 17.0 14.5 4.5 19.7 16.8 Ownership of a house House of residence 86.7 87.6 87.5 87.1 88.5 88.3 Another house 31.3 27.7 28.4 29.6 26.7 27.2 Ownership of land Residential 66.4 55.3 57.4 64.3 55.8 57.4 Agricultural 42.7 77.9 71.2 44.9 78.9 72.4 Commercial 10.5 8.3 8.8 8.3 7.8 7.9 Ownership of farm animals Ownership of livestock1 44.7 82.7 75.4 50.5 85.7 79.0 Ownership of cats and dogs 73.3 77.6 76.8 75.7 80.8 79.8 Number 371 1,576 1,947 2,726 11,645 14,371 1 Pigs, horses, ducks, chickens 26 | Household Population and Housing Characteristics 2.6 WEALTH QUINTILES The wealth index was developed and tested in a number of countries as a tool for assessing inequities in household income and relating those inequities to use of health services and health outcomes (Rutstein et al., 2000). The wealth index is constructed by assigning a weight or factor score to each household asset through principal components analysis. These scores are summed by house- hold, and individuals are ranked according to the total score of the household in which they reside. The sample is then divided into population quintiles—five groups with an equal number of individuals in each group. At the national level, approximately 20 percent of the population is in each wealth quintile. Wealth quintiles provide a consistent measure of combined indicators of household income and expenditures. The wealth quintile, as constructed, uses information on household ownership of consumer items, ranging from a television to a bicycle or car, as well as on dwelling characteristics, such as source of drinking water, sanitation facilities, and type of flooring material. Each asset was assigned a weight (factor score) generated through principal components analysis, and the resulting asset scores were standardised in relation to a normal distribution with a mean of zero and standard deviation of one. Each household was then assigned a score for each asset, and the scores were summed for each household; individuals were ranked according to the total score of the household in which they resided. The sample was then divided into quintiles from one (lowest) to five (highest). A single asset index was developed for the whole sample; separate indices were not prepared for the urban and rural populations. Table 2.11 shows the distribution of the population across the five wealth quintiles by urban-rural residence and region. These distributions indicate the degree to which wealth is evenly (or unevenly) distributed by geographic areas. The findings indicate that wealth in Samoa is concentrated in urban areas. Among the population in urban areas, 41 percent are in the highest wealth quintile, and 11 to 18 percent are in each of the other four quintiles. In rural areas, the opposite is true; a lower percentage of the population is in the highest wealth quintile (15 percent) compared with the other four wealth quintiles (20 to 22 percent). Marked differentials in the wealth distribution are also observed among regions. For example, more than four in ten residents (41 percent) in the Apia urban area are in the highest wealth quintile compared with 11 percent in the lowest wealth quintile. In contrast, in the Savaii region, 28 percent of the population falls in the lowest two wealth quintiles compared with 8 percent in the highest wealth quintile. Table 2.11 Wealth quintiles Percent distribution of the jure population by wealth quintiles according to residence and region, Samoa 2009 Wealth quintile Residence/region Lowest Second Middle Fourth Highest Total Number of population Residence Urban 10.9 12.9 18.1 16.7 41.4 100.0 2,726 Rural 22.2 21.6 20.4 20.8 15.0 100.0 11,645 Region Apia Urban Area 10.9 12.9 18.1 16.7 41.4 100.0 2,726 North West Upolu 17.5 21.4 18.3 21.7 21.0 100.0 4,601 Rest of Upolu 22.9 18.3 23.5 21.5 13.8 100.0 3,509 Savaii 27.5 25.2 20.0 19.0 8.2 100.0 3,535 Total 20.0 20.0 20.0 20.1 20.0 100.0 14,371 Household Population and Housing Characteristics | 27 2.7 BIRTH REGISTRATION The Convention on the Child’s Right (UN General Assembly, 1989) states that every child has the right to a name and a nationality and the right to protection from being deprived of his or her identity. Parents are required to give their children a name and to register the child because the child has a right to know who his or her parents are and to have a nationality through registration in accordance with national laws and relevant international instruments. Table 2.12 shows the percentage of children under age 5 whose births were officially registered and the percentage with a birth certificate at the time of the survey. The births of 48 percent of children under age 5 in Samoa have been registered: 44 percent have birth certificates, and 4 percent do not. The reason that not all children reported as registered had a birth certificate may be because some certificates have been lost or were never issued at the time of birth. However, all children with a certificate had been registered. Table 2.12 Birth registration of children under age five Percentage of de jure children under five years of age whose births are registered with the civil authorities, according to background characteristics, Samoa 2009 Percentage of children whose births are registered Background characteristic Had a birth certificate Did not have a birth certificate Total registered Number of children Age <2 29.6 5.0 34.6 796 2-4 54.7 2.4 57.1 1,110 Sex Male 44.8 3.3 48.1 958 Female 43.7 3.7 47.4 949 Residence Urban 61.4 0.7 62.1 356 Rural 40.3 4.1 44.4 1,551 Region Apia Urban Area 61.4 0.7 62.1 356 North West Upolu 44.4 1.1 45.5 610 Rest of Upolu 32.8 8.2 41.0 494 Savaii 43.0 3.8 46.8 447 Wealth quintile Lowest 27.3 3.2 30.5 403 Second 44.9 1.9 46.8 391 Middle 41.3 3.3 44.7 372 Fourth 49.3 6.1 55.4 375 Highest 59.8 3.0 62.8 367 Total 44.2 3.5 47.7 1,907 Children age 2-4 years (57 percent) are markedly more likely to have their births registered than those younger than 2 years (35 percent), possibly reflecting the fact that Samoan children are allowed to enter school starting at age 5 and a birth certificate is commonly required for enrolment. There is no substantial variation in birth registration by sex of child. There are, however, marked differences by urban-rural residence. Although 62 percent of children under age 5 years in urban areas have their births registered, only 44 percent of their rural counterparts have been registered. The distribution of children whose births are registered varies by region. Children in the Apia Urban Area region are more likely to be registered (62 percent) than children in all other regions (41 to 47 percent), with the Rest of Upolu region having the lowest level of birth registration (41 percent). Births to households in the highest wealth quintile (63 percent) are much more likely to be registered than those in the lowest wealth quintile (31 percent). 28 | Household Population and Housing Characteristics 2.8 BURDEN OF DISEASES In an effort to assess the burden of diseases in Samoa, all respondents to the Household Questionnaire in the 2009 SDHS were asked whether the respondent or any other household member has ever been diagnosed by a medical doctor with a list of non-communicable diseases and infectious diseases, whether the respondent or any other household member has had certain infectious diseases in the previous 12 months, and how many of the household members have had each of the specific diseases ever or in the last 12 months. 2.8.1 Household Level: Burden of Diseases Approximately one in five households reported having at least one household member age 25 or older ever diagnosed with a non-communicable disease, including hypertension or diabetes (19 and 18 percent, respectively). Cardiovascular and rheumatic heart diseases were ever diagnosed among members age 25 or older in 2 and 3 percent of households, respectively (Figure 2.3). The age range for measuring the burden of non-communicable diseases is 25 or more years because these diseases mostly affect adults. The proportion of households with members ever diagnosed with diabetes or hypertension increases steadily with an increase in wealth (Figure 2.4). For example, only 9 percent of households in the lowest wealth quintile have a member age 25 or older diagnosed with diabetes compared with 29 percent of households in the highest wealth quintile. Similarly, 12 percent of the poorest households reported having at least one member age 25 or older ever diagnosed with hypertension compared with 25 percent of those in the wealthiest households. Diabetes is less common in the Savaii region (14 percent) than in other regions (17 to 21 percent), and hypertension is less common in the North West Upolu (15 percent) compared with other regions (20 to 22 percent). Rheumatic heart disease is somewhat higher in the Apia urban area region (6 percent) than elsewhere. Diabetes, hypertension, cardiovascular disease, or rheumatic heart disease have been diagnosed in an average of 1 individual age 25 or older per household (data not shown). 18 19 2 3 Diabetes Hypertension Cardiovascular diseases Rheumatic heart disease 0 5 10 15 20 25 Percent Figure 2.3 Percentage of Households with Usual Members Age 25 or Older Ever Diagnosed with Specific Diseases SDHS 2009 Household Population and Housing Characteristics | 29 The proportion of households with usual members of any age having been diagnosed with an infectious disease, including dengue fever, measles, typhoid, meningococcal disease, rubella, and leprosy, over the last 12 months is quite small. Overall, 2 percent of households reported having at least one member who was diagnosed with dengue fever, 2 percent with measles, 1 percent each with typhoid fever, meningococcal disease, and filiriasis, and less than 1 percent combined with rubella and leprosy. A somewhat higher proportion of urban households have members who have been diagnosed recently with dengue fever (6 percent) and measles (3 percent) compared with rural households (2 percent and 1 percent, respectively). In the 12 months before the survey, an average of 2 household members of any age per household have been diagnosed with measles, while an average of 1 household member has been diagnosed with any of the other infections (data not shown). 2.8.2 Household Members: Burden of Diseases Seven percent of the household members age 25 or older have been ever diagnosed with hypertension, 6 percent with diabetes, and 1 percent each with cardiovascular or rheumatic heart diseases (Figure 2.5). 18 9 10 16 24 29 19 12 14 22 24 25 Samoa Lowest Second Middle Fourth Highest 0 5 10 15 20 25 30 Percent Diabetes Hypertension Figure 2.4 Percentage of Households with Usual Members Age 25 or Older Ever Diagnosed with Diabetes or Hypertension, by Wealth SDHS 2009 WEALTH QUINTILE 6 7 1 1 Diabetes Hypertension Cardiovascular diseases Rheumatic heart disease 0 2 4 6 8 10 Percent Figure 2.5 Percentage of Household Members Age 25 or Older Ever Diagnosed with Specific Diseases SDHS 2009 30 | Household Population and Housing Characteristics Figure 2.6 shows that the percentages of household members ever diagnosed with diabetes or hypertension increase with age and are especially high among older residents who are age 60 or more. For example, only 1 percent or less of usual household members age 30-34 were reported as having ever been diagnosed with hypertension or diabetes, while one in ten of household members age 55-59 and about one in five of those age 60-64 were reported as having ever been diagnosed with these diseases. The percentage of household members age 25 or older who have ever been diagnosed with diabetes and hypertension also increases with an increase in wealth (data not shown). The percentage of household members of any age being diagnosed in the last 12 months by a medical doctor with any of the specified infections (dengue fever, measles, typhoid, meningococcal disease, rubella, and leprosy) is less than 1 percent for each of the infections. The prevalence of diabetes and hypertension among the population age 25-64 reported in the 2002 Samoa STEPS Survey (MOH, 2002) (22 percent for diabetes and 21 percent for hypertension) cannot be directly compared with the 2009 SDHS prevalence. The direct comparison of the results between the two surveys is hampered by a number of factors, such as the differences in sampling methodology, age ranges of the survey population, and wording of the questions asked to measure the prevalence of diabetes and hypertension in the two surveys. In the 2002 Samoa STEPS survey, individuals age 25-64 were directly asked whether they had ever been diagnosed with diabetes or hypertension, and whether the reported disease had been validated by a specific diagnostic test. In the 2009 SDHS, data on diabetes and hypertension were collected in the Household Questionnaire, where the respondent was asked whether he/she or any other member of the household had ever been diagnosed by a medical doctor with a list of 11 specified diseases, including diabetes and hypertension. There is a risk of recall bias in the 2009 SDHS results because the Household Questionnaire respondent may not have been fully aware of all diseases affecting other members in the household. 6 0 0 1 2 5 9 10 20 17 7 0 1 2 2 3 7 10 18 23 Samoa 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65+ 0 5 10 15 20 25 Percent Diabetes Hypertension Figure 2.6 Percentage of Households with Usual Members Age 25 or Older Ever Diagnosed with Diabetes or Hypertension, by Age SDHS 2009 AGE Characteristics of Survey Respondents | 31 CHARACTERISTICS OF SURVEY RESPONDENTS 3 This chapter provides a descriptive summary of the demographic and socioeconomic profile of respondents who participated in the 2009 SDHS. Basic information on women and men of reproductive age is crucial for the interpretation of findings on reproduction, health, and women’s status. Moreover, the distribution of respondents according to their demographic and socioeconomic characteristics indicates how representative they are of the general population. The main background characteristics that are described here in detail—age at the time of the survey, marital status, residence, education, and wealth quintile—will re-appear in subsequent chapters on reproduction and health. This chapter on characteristics of respondents also includes information on their level of literacy, exposure to the mass media, employment and earnings, health insurance coverage, knowledge and attitudes concerning tuberculosis, use of tobacco, and participation in physical activity campaigns. 3.1 BACKGROUND CHARACTERISTICS OF RESPONDENTS Table 3.1 shows the distribution of women age 15-49 and men age 15-49 by selected background characteristics, including age, religion, ethnicity, marital status, urban-rural residence, region, education, and wealth status. More than half of both women and men (53 percent each) are under age 30. The proportions in each age group decline with increasing age, reflecting the comparatively young age structure of the Samoan population. The majority of respondents (96 percent of women and 95 percent of men) are Christians of different denominations. About one-third of both women and men belong to the Congregational Christian Church of Samoa (EFKS/Taiti), while about one-fifth are Roman Catholic, and between 12 and 15 percent each, are either Methodist or members of the Latter Day Saints (LDS) Church. Almost all respondents are members of the Samoan ethnic group. The results of the 2009 SDHS indicate that 59 percent of women are married or in a union (living in an informal arrangement with a partner) compared with 47 percent of the men. Because men marry later in life than women, more than half of the men interviewed in the survey (51 percent) have never married, compared with 37 percent of women. On the other hand, women are more than twice as likely as men to be widowed or divorced/separated (5 and 2 percent, respectively) The survey shows that about eight in ten women (79 percent) and men (83 percent) live in rural areas. The highest percentage of women and men (34 percent of women and 36 percent of men) live in North West Upolu, and the lowest percentage (21 percent of women and 17 percent of men)live in the Apia Urban Area. The distribution in the other two regions does not vary much (23 to 24 percent). The majority of respondents (60 percent of women and 55 percent of men) have attended some secondary school but have not completed it. Women tend to be more educated than men. Women are less likely than men to have no education or only a primary education (5 percent and 13 percent, respectively) and more likely to have completed secondary school or higher (35 percent and 32 percent, respectively). Smaller percentages of both women and men comprise the two lower wealth quintiles (17 to 19 percent), and higher percentages of both are fairly evenly distributed among the three higher wealth quintiles (20 to 23 percent). 32 | Characteristics of Survey Respondents Table 3.1 Background characteristics of respondents Percent distribution of women and men age 15-49 by selected background characteristics, Samoa 2009 Women Men Background characteristic Weighted percentage Weighted number Unweighted number Weighted percentage Weighted number Unweighted number Age 15-19 21.1 560 558 22.1 269 276 20-24 17.8 474 470 17.1 209 204 25-29 14.1 375 377 13.8 168 164 30-34 11.6 308 313 13.2 161 167 35-39 13.5 358 359 12.5 153 153 40-44 10.7 284 289 12.1 147 145 45-49 11.2 299 291 9.2 112 109 Religion EFKS/Taiti1 33.6 893 899 33.1 404 411 Methodist 13.6 361 368 14.7 179 176 Roman Catholic 17.3 460 459 20.3 247 247 Latter Day Saints (LDS) 14.4 383 385 11.7 143 149 Seventh Days Adventists (SDA) 4.7 126 121 4.9 60 57 Assembly of God 10.2 272 267 8.7 106 99 Worship Centre 1.3 35 34 1.1 13 15 Jehovah's Witness 0.9 24 25 0.8 10 11 Other 3.7 98 92 4.3 53 49 Refused to answer 0.2 4 4 0.1 1 1 Don't know 0.0 1 1 0.0 0 0 Missing 0.1 2 2 0.3 4 3 Ethnicity Samoan 98.3 2,613 2,610 99.2 1,210 1,207 Part-Samoan 1.1 30 31 0.5 6 7 Other 0.3 9 10 0.3 4 4 Don't know 0.0 1 1 0.0 0 0 Missing 0.2 5 5 0.0 0 0 Marital status Never married 36.6 971 967 50.8 619 622 Married 42.5 1,129 1,128 39.2 479 474 Living together 16.0 425 426 7.7 94 94 Divorced/ separated 4.0 107 112 2.1 26 26 Widowed 0.9 24 24 0.2 2 2 Residence Urban 20.6 548 592 17.3 211 254 Rural 79.4 2,109 2,065 82.7 1,009 964 Region Apia Urban Area 20.6 548 592 17.3 211 254 North West Upolu 34.1 907 897 36.0 439 441 Rest of Upolu 22.5 597 566 22.8 279 263 Savaii 22.8 605 602 23.9 291 260 Education Primary/old mission/ no education 5.0 132 132 13.0 158 157 Secondary incomplete 60.1 1,598 1,588 54.9 670 672 Secondary complete 19.5 519 524 15.3 187 187 Vocational/ higher 15.4 408 413 16.8 206 202 Wealth quintile Lowest 17.8 472 482 17.1 209 204 Second 19.4 516 524 18.5 226 232 Middle 21.0 557 548 22.5 274 271 Fourth 20.9 555 540 21.7 264 248 Highest 21.0 558 563 20.3 248 263 Total 15-49 100.0 2,657 2,657 100.0 1,220 1,218 50-54 na na na na 87 89 Total 15-54 na na na na 1,307 1,307 Note: Education categories refer to the highest level of education attended, whether or not that level was completed. na = Not applicable 1 EFKS/Taiti = Ekalesia Faapotopotoga Kerisiano Samoa = Congregational Christian Church Characteristics of Survey Respondents | 33 3.2 EDUCATIONAL ATTAINMENT Education provides people with the knowledge and skills that lead to a better quality of life. Level of education has been found to be closely associated with the health of women and children, as well as with the reproductive health behaviours of women and men. Tables 3.2.1 and 3.2.2 show the distribution of women and men by highest level of schooling attended or completed, and the median number of years of schooling, according to background characteristics. The results reflect the fact that education has been almost universal in Samoa for some time. Overall, a negligible percentage of all respondents age 15-49 (less than 1 percent) have never attended school, and the majority (95 percent of women and 87 percent of men) have attended or completed at least a secondary or higher education. The median number of years of schooling for women age 15-49 is 11.5 years and for men age 15-49 is 11.2 years. Table 3.2.1 Educational attainment: Women Percent distribution of women age 15-49 by highest level of schooling attended or completed, and median years completed, according to background characteristics, Samoa 2009 Highest level of schooling Background characteristic No education Some primary Completed primary1 Some secondary Completed secondary2 More than secondary Total Median years completed Number of women Age 15-24 0.5 0.8 1.7 60.0 19.0 18.0 100.0 11.5 1,033 15-19 0.9 0.7 2.3 77.6 10.8 7.7 100.0 10.8 560 20-24 0.2 0.9 0.9 39.3 28.7 30.2 100.0 12.3 474 25-29 1.0 0.6 1.2 50.7 26.5 20.0 100.0 11.9 375 30-34 0.0 1.7 2.9 58.8 21.9 14.7 100.0 11.6 308 35-39 0.2 1.0 4.5 61.5 20.6 12.2 100.0 11.4 358 40-44 0.0 2.6 4.8 65.6 17.1 9.9 100.0 11.2 284 45-49 0.0 6.2 5.7 66.8 11.3 9.9 100.0 10.9 299 Residence Urban 0.0 1.2 2.2 49.2 22.2 25.2 100.0 11.9 548 Rural 0.5 1.8 3.1 63.0 18.8 12.8 100.0 11.4 2,109 Region Apia Urban Area 0.0 1.2 2.2 49.2 22.2 25.2 100.0 11.9 548 North West Upolu 0.6 2.0 3.5 59.0 21.8 13.1 100.0 11.4 907 Rest of Upolu 0.6 0.7 2.3 69.3 13.5 13.6 100.0 11.3 597 Savaii 0.3 2.6 3.3 62.7 19.6 11.6 100.0 11.3 605 Wealth quintile Lowest 0.8 3.4 4.3 74.7 12.6 4.2 100.0 11.0 472 Second 0.6 2.6 3.0 68.3 16.3 9.2 100.0 11.2 516 Middle 0.4 1.2 3.4 64.2 20.4 10.4 100.0 11.4 557 Fourth 0.0 1.0 3.2 56.3 22.8 16.7 100.0 11.6 555 Highest 0.3 0.6 0.8 40.0 24.2 34.1 100.0 12.3 558 Total 0.4 1.7 2.9 60.1 19.5 15.4 100.0 11.5 2,657 1 Completed grade 8 at the primary level 2 Completed grade 5 at the secondary level Data show that the variation of patterns in educational attainment by background characteristics is similar for women and men. The differences across subgroups in educational attainment are more pronounced at the level of secondary education or higher. For example, 25 percent of urban women and 21 percent of urban men have some higher-level education, compared with 13 and 16 percent, respectively, of rural women and men. Residents in the Apia Urban Area region seem to have an educational advantage over the rest of the country: 25 percent of women and 21 percent of men in the Apia Urban Area region have a higher than secondary education, compared with 12 percent of women and 13 percent of men in the Savaii region. Attainment of a higher than secondary education closely relates to wealth status: 34 percent of women and 30 percent of men in the highest wealth quintile have attended or completed more than a secondary education, compared with 4 percent of women and 9 percent of men in the lowest quintile. Men living in the wealthiest households have, on average, almost two additional years of schooling compared with men in the poorest households (12.2 and 10.5 years, respectively). However, for women the overall difference between the median numbers of years of schooling is smaller: 11.0 years among women in the lowest wealth quintile compared with 12.3 years among those in the highest quintile. 34 | Characteristics of Survey Respondents Table 3.2.2 Educational attainment: Men Percent distribution of men age 15-49 by highest level of schooling attended or completed, and median years completed, according to background characteristics, Samoa 2009 Highest level of schooling Background characteristic No education Some primary Completed primary1 Some secondary Completed secondary2 More than secondary Total Median years completed Number of men Age 15-24 0.3 4.7 4.9 59.1 13.9 17.0 100.0 11.1 478 15-19 0.6 5.1 5.3 69.9 6.7 12.4 100.0 10.5 269 20-24 0.0 4.3 4.4 45.1 23.3 23.0 100.0 11.8 209 25-29 0.8 1.5 7.1 47.6 19.8 23.3 100.0 11.7 168 30-34 1.1 3.1 7.8 50.3 21.2 16.5 100.0 11.5 161 35-39 0.6 5.7 9.9 50.8 16.7 16.2 100.0 11.1 153 40-44 1.2 5.4 13.3 54.6 13.0 12.5 100.0 10.9 147 45-49 0.0 8.1 11.0 60.4 7.0 13.5 100.0 10.7 112 Residence Urban 1.1 2.8 2.6 54.4 18.2 20.9 100.0 11.5 211 Rural 0.5 5.0 8.9 55.0 14.7 16.0 100.0 11.1 1,009 Region Apia Urban Area 1.1 2.8 2.6 54.4 18.2 20.9 100.0 11.5 211 North West Upolu 0.4 4.3 8.7 58.3 12.9 15.5 100.0 10.9 439 Rest of Upolu 0.3 6.5 9.0 50.0 14.5 19.7 100.0 11.3 279 Savaii 0.8 4.5 9.2 54.8 17.6 13.2 100.0 11.2 291 Wealth quintile Lowest 0.4 9.0 10.9 59.8 11.0 8.9 100.0 10.5 209 Second 1.0 6.7 11.3 58.3 11.2 11.4 100.0 10.7 226 Middle 0.3 3.8 6.8 63.7 12.2 13.2 100.0 11.1 274 Fourth 0.0 3.5 7.1 55.0 15.5 18.8 100.0 11.2 264 Highest 1.3 1.0 3.8 37.7 25.8 30.4 100.0 12.2 248 Total 15-49 0.6 4.6 7.8 54.9 15.3 16.8 100.0 11.2 1,220 50-54 0.0 14.6 17.8 52.4 9.5 5.7 100.0 9.6 87 Total 15-54 0.6 5.2 8.5 54.7 14.9 16.1 100.0 11.1 1,307 1 Completed grade 8 at the primary level 2 Completed grade 5 at the secondary level 3.3 LITERACY The ability to read and write are important assets that allow each individual to progress throughout life. It is a key factor that assists people, especially those involved in decision making, policy and development planning, and the assessment and creation of future programmes based on these data. Having a clear idea population able to read and write are distributed within the general population will greatly help policy makers and programme providers build a solid foundation for future initiatives and projects, such as providing health services and family planning, knowing what kind of messages they can provide so that people understand and able to interpret them. During the 2009 SDHS, the respondents were given both simple English and Samoan sentences to read. Only, men and women who had never attended secondary school were asked. The literacy rate for Samoa was measured by whether the respondent could read the whole sentence, part of the sentence or not at all. Those with visual impaired or blindness were not asked. Tables 3.3.1 and 3.3.2 show the percent distribution of women and men age 15-49 respectively, by level of literacy and percent of literacy, according to background characteristics. Characteristics of Survey Respondents | 35 Virtually all Samoan women and the vast majority of men are literate (99 and 95 percent, respectively). There are no major differences across subgroups of women in the proportions who are literate. There are some variations among men. The levels of literacy are somewhat lower among older men, men living in the rural areas, men living in the Savaii region (92 percent), and men from the lowest wealth quintile (91 percent each). Table 3.3.1 Literacy: Women Percent distribution of women age 15-49 by level of schooling attended and level of literacy, and percentage literate, according to background characteristics, Samoa 2009 No schooling or primary school Background characteristic Secondary school or higher Can read a whole sentence Can read part of a sentence Cannot read at all Blind/ visually impaired Missing Total Percentage literate1 Number Age 15-19 96.1 1.8 0.8 0.4 0.0 0.8 100.0 98.8 560 20-24 98.1 0.7 0.5 0.8 0.0 0.0 100.0 99.2 474 25-29 97.2 0.0 1.3 1.1 0.0 0.4 100.0 98.5 375 30-34 95.5 2.5 1.1 0.9 0.0 0.0 100.0 99.1 308 35-39 94.3 2.9 2.1 0.4 0.0 0.4 100.0 99.2 358 40-44 92.6 3.2 1.5 2.3 0.0 0.5 100.0 97.3 284 45-49 88.1 4.9 4.1 1.7 1.0 0.3 100.0 97.0 299 Residence Urban 96.7 1.8 0.8 0.5 0.0 0.2 100.0 99.2 548 Rural 94.6 2.2 1.6 1.1 0.1 0.4 100.0 98.4 2,109 Region Apia Urban Area 96.7 1.8 0.8 0.5 0.0 0.2 100.0 99.2 548 North West Upolu 93.9 2.6 1.6 1.3 0.2 0.4 100.0 98.1 907 Rest of Upolu 96.4 1.3 1.4 0.4 0.0 0.5 100.0 99.1 597 Savaii 93.8 2.3 1.9 1.4 0.2 0.3 100.0 98.1 605 Wealth quintile Lowest 91.6 2.5 3.5 2.3 0.0 0.1 100.0 97.6 472 Second 93.8 2.0 2.0 1.4 0.6 0.3 100.0 97.7 516 Middle 95.0 2.5 1.2 0.7 0.0 0.6 100.0 98.7 557 Fourth 95.8 2.8 0.8 0.2 0.0 0.4 100.0 99.4 555 Highest 98.3 0.7 0.1 0.6 0.0 0.3 100.0 99.2 558 Total 95.0 2.1 1.5 1.0 0.1 0.4 100.0 98.6 2,657 1 Refers to women who attended secondary school or higher and women who can read a whole sentence or part of a sentence in English 36 | Characteristics of Survey Respondents Table 3.3.2 Literacy: Men Percent distribution of men age 15-49 by level of schooling attended and level of literacy, and percentage literate, according to background characteristics, Samoa 2009 No schooling or primary school Background characteristic Secondary school or higher Can read a whole sentence Can read part of a sentence Cannot read at all Missing Total Percentage literate1 Number Age 15-19 89.0 2.1 4.9 3.5 0.6 100.0 96.0 269 20-24 91.3 2.1 4.8 1.8 0.0 100.0 98.2 209 25-29 90.6 3.1 2.2 2.7 1.4 100.0 95.9 168 30-34 88.0 1.7 3.0 6.7 0.5 100.0 92.8 161 35-39 83.7 6.3 4.2 5.8 0.0 100.0 94.2 153 40-44 80.1 7.8 7.0 5.0 0.0 100.0 95.0 147 45-49 80.9 5.0 5.5 8.6 0.0 100.0 91.4 112 Residence Urban 93.5 3.1 2.8 0.2 0.3 100.0 99.5 211 Rural 85.7 3.8 4.8 5.3 0.4 100.0 94.3 1,009 Region Apia Urban Area 93.5 3.1 2.8 0.2 0.3 100.0 99.5 211 North West Upolu 86.7 4.6 4.8 3.7 0.2 100.0 96.1 439 Rest of Upolu 84.2 4.1 5.6 5.5 0.7 100.0 93.8 279 Savaii 85.6 2.2 4.1 7.6 0.5 100.0 91.9 291 Wealth quintile Lowest 79.7 3.7 7.7 7.8 1.1 100.0 91.1 209 Second 81.0 6.4 7.6 5.0 0.0 100.0 95.0 226 Middle 89.1 2.9 3.1 4.9 0.0 100.0 95.1 274 Fourth 89.4 3.4 3.5 3.4 0.3 100.0 96.2 264 Highest 93.9 2.3 1.4 1.8 0.6 100.0 97.6 248 Total 15-49 87.0 3.7 4.5 4.5 0.4 100.0 95.2 1,220 50-54 67.6 9.2 12.7 10.5 0.0 100.0 89.5 87 Total 15-54 85.7 4.0 5.0 4.9 0.4 100.0 94.8 1,307 1 Refers to men who attended secondary school or higher and men who can read a whole sentence or part of a sentence in English 3.4 ACCESS TO MASS MEDIA The mass media, such as newspapers, television, and radio just to name a few, play an important role in the everyday life of Samoan people. Various types of media are commonly used by governmental and non-governmental organisations (NGOs) to disseminate public messages about important issues of concern in the country. The availability and easy access to various types of media by the public has greatly improved the understanding and awareness of the population on various issues affecting the country. Access to information is essential to increase people’s knowledge and awareness of the events that take place around them. In the 2009 SDHS, information was collected on respondents’ exposure to print and broadcast media, both of which are effective in reaching the population with important health messages, including those on reproductive health and HIV/AIDS. In the survey, exposure to media was assessed by asking how often a respondent reads a newspaper, watches television, or listens to the radio. Tables 3.4.1 and 3.4.2 show that exposure of women and men to print and broadcast media in Samoa is high. Overall, men are somewhat more likely than women to watch television or listen to the radio at least once a week. Eighty-four percent of women age 15-49 and 89 percent of men age 15-49 watch television weekly, and 83 percent of women and 92 percent of men listen to the radio weekly. Women, on the other hand, are somewhat more likely than men to read a newspaper at least once a week (47 versus 44 percent, respectively). About four in ten women (38 Characteristics of Survey Respondents | 37 percent) and men (40 percent) age 15-49 are exposed to all three media at least once a week. Only 4 percent of women and 2 percent of men have no access to any of the specified media. Media exposure is higher among younger women than among older women. For example, 45 percent of women age 20-24 have been exposed to all three media at least once a week compared with 31 percent of women age 45-49. However, among men, exposure is lower among those in their late thirties and early forties (33 to 34 percent), as well as among teenagers (35 percent) when compared with other age groups (41 to 49 percent). Men and women in urban areas (54 percent and 46 percent, respectively) are more likely to be exposed to all three media on a weekly basis than those in rural areas (34 and 39 percent, respectively). Exposure to all three media at least once a week ranges from 30 percent for women living in the Rest of Upolu to 54 percent of women living in Apia Urban Area. For men, it ranges from 24 percent among men in Savaii to 50 percent among men in North West Upolu. The proportion of respondents exposed to all three media increases with the level of education and with the wealth quintile. For example, more than four times as many men with higher than secondary education (65 percent) as men with primary or less education (15 percent) are exposed to all three media at least once a week. Similarly, about three times as many men in the highest wealth quintile (58 percent) as men in the lowest wealth quintile (23 percent) are exposed to all three media on a weekly basis. The same patterns are observed among women. Table 3.4.1 Exposure to mass media: Women Percentage of women age 15-49 who are exposed to specific media on a weekly basis, by background characteristics, Samoa 2009 Background characteristic Reads a newspaper at least once a week Watches television at least once a week Listens to radio at least once a week All three media at least once a week No media at least once a week Number of women Age 15-19 49.4 86.7 85.3 39.9 2.9 560 20-24 56.0 89.8 82.6 45.1 2.1 474 25-29 49.0 83.7 84.0 40.5 4.9 375 30-34 43.7 85.1 83.7 35.8 3.6 308 35-39 44.2 80.3 84.2 35.9 3.9 358 40-44 39.7 75.1 79.1 31.5 9.5 284 45-49 39.6 80.9 81.7 31.3 3.8 299 Residence Urban 63.5 91.9 82.4 53.8 1.9 548 Rural 42.8 81.8 83.5 34.0 4.6 2,109 Region Apia Urban Area 63.5 91.9 82.4 53.8 1.9 548 North West Upolu 49.1 82.0 82.6 37.8 4.2 907 Rest of Upolu 37.3 79.5 83.6 29.5 4.9 597 Savaii 38.7 83.8 84.6 32.6 5.0 605 Education Primary or less 23.7 75.4 78.3 18.5 7.4 132 Secondary incomplete 41.8 83.3 83.8 34.1 4.3 1,598 Secondary complete 51.0 85.1 85.1 41.5 3.2 519 Vocational/higher 70.0 87.3 80.2 55.4 3.2 408 Wealth quintile Lowest 36.6 68.9 78.6 25.4 9.1 472 Second 39.1 85.1 83.2 30.7 3.3 516 Middle 45.1 87.4 83.6 37.6 3.1 557 Fourth 49.7 87.1 85.7 41.5 2.5 555 Highest 62.3 88.7 84.4 52.6 3.0 558 Total 47.0 83.9 83.2 38.1 4.1 2,657 38 | Characteristics of Survey Respondents Table 3.4.2 Exposure to mass media: Men Percentage of men age 15-49 who are exposed to specific media on a weekly basis, by background characteristics, Samoa 2009 Background characteristic Reads a newspaper at least once a week Watches television at least once a week Listens to radio at least once a week All three media at least once a week No media at least once a week Number of men Age 15-19 38.3 87.8 91.3 35.3 2.7 269 20-24 43.6 95.7 94.9 41.4 0.9 209 25-29 50.9 94.7 96.9 49.2 0.0 168 30-34 46.3 88.2 90.4 43.1 4.0 161 35-39 41.0 81.5 91.1 33.8 2.0 153 40-44 41.0 85.6 90.1 33.4 1.7 147 45-49 54.9 85.6 87.9 45.6 1.6 112 Residence Urban 50.7 91.7 86.7 46.0 3.3 211 Rural 42.8 88.3 93.2 38.5 1.6 1,009 Region Apia Urban Area 50.7 91.7 86.7 46.0 3.3 211 North West Upolu 53.0 90.0 92.9 50.3 2.1 439 Rest of Upolu 44.4 86.3 91.7 35.3 1.8 279 Savaii 25.9 87.6 95.3 23.9 0.7 291 Education Primary or less 16.9 78.2 87.2 15.2 6.8 158 Secondary incomplete 39.1 89.2 92.3 34.7 1.6 670 Secondary complete 55.4 91.3 95.2 50.9 0.9 187 Vocational/higher 71.6 93.9 92.4 65.3 0.0 206 Wealth quintile Lowest 30.4 71.1 88.4 22.8 5.8 209 Second 39.5 90.5 92.2 36.0 1.5 226 Middle 38.1 92.5 93.7 34.2 0.4 274 Fourth 48.3 93.5 92.9 44.9 0.9 264 Highest 62.4 93.6 92.5 58.4 1.6 248 Total 15-49 44.2 88.9 92.1 39.8 1.9 1,220 50-54 46.8 79.1 82.8 33.7 6.7 87 Total 15-54 44.4 88.2 91.5 39.4 2.2 1,307 3.5 EMPLOYMENT In the 2009 SDHS, respondents were asked about their employment status at the time of the survey and, if they were not currently employed, about any work they may have done in the 12 months prior to the survey.1 All employed respondents were asked additional questions about their occupation; whether they were paid in cash, in kind, or not at all; and for whom they worked. 1 The measurement of women’s employment can be especially difficult because some of the activities that women do, especially work on family farms, for family businesses, or in the informal sector, are often not perceived by women themselves as employment and hence are not reported as such. To avoid underestimating women’s employment, therefore, the questions relating to employment in the Women’s Questionnaire encouraged women to report such activities. First, women were asked, “Aside from your own housework, have you done any work in the last seven days?” Women who answered “No” to this question were then asked, “As you know, some women take up jobs for which they are paid in cash or kind. Others sell things, have a small business, or work on the family farm or in the family business. In the last seven days, have you done any of these things or any other work?” Characteristics of Survey Respondents | 39 Tables 3.5.1 and 3.5.2 show the percent distribution of female and male respondents by employment status according to background characteristics. Men are more likely to be employed than women. A substantially higher proportion of men (42 percent) than women (20 percent) reported being currently employed. Another 10 percent of men and 9 percent of women had worked in the 12 months preceding the survey although not at the time of the survey (Figure 3.1). Furthermore, 71 percent of women were not currently employed or employed in the 12 months preceding the survey compared with 48 percent of men, Table 3.5.1 Employment status: Women Percent distribution of women age 15-49 by employment status, according to background characteristics, Samoa 2009 Employed in the 12 months preceding the survey Background characteristic Currently employed1 Not currently employed Not employed in the 12 months preceding the survey Total Number of women Age 15-19 4.9 2.7 92.4 100.0 560 20-24 25.8 14.0 60.1 100.0 474 25-29 26.3 13.0 60.7 100.0 375 30-34 20.5 11.4 68.1 100.0 308 35-39 18.3 15.0 66.4 100.0 358 40-44 25.3 6.1 68.6 100.0 284 45-49 27.1 4.3 68.6 100.0 299 Marital status Never married 17.3 7.1 75.6 100.0 971 Married/living together 21.3 10.6 68.0 100.0 1,554 Divorced/separated/widowed 23.2 11.4 65.4 100.0 132 Number of living children 0 17.1 7.3 75.6 100.0 967 1-2 23.5 12.5 63.9 100.0 662 3-4 23.6 10.3 66.0 100.0 545 5+ 16.6 8.2 75.2 100.0 483 Residence Urban 32.0 8.6 59.4 100.0 548 Rural 16.8 9.6 73.5 100.0 2,109 Region Apia Urban Area 32.0 8.6 59.4 100.0 548 North West Upolu 18.0 9.7 72.3 100.0 907 Rest of Upolu 13.2 9.9 76.7 100.0 597 Savaii 18.6 9.1 72.3 100.0 605 Education Primary or less 15.3 4.1 80.6 100.0 132 Secondary incomplete 13.6 8.3 78.1 100.0 1,598 Secondary complete 22.8 13.5 63.8 100.0 519 Vocational/higher 42.8 10.2 47.0 100.0 408 Wealth quintile Lowest 11.7 9.0 79.2 100.0 472 Second 15.2 10.2 74.6 100.0 516 Middle 18.6 8.6 72.8 100.0 557 Fourth 22.8 9.0 68.1 100.0 555 Highest 29.8 10.1 60.1 100.0 558 Total 19.9 9.4 70.6 100.0 2,657 1 "Currently employed" is defined as having done work in the past seven days. Includes persons who did not work in the past seven days but who are regularly employed and were absent from work for leave, illness, vacation, or any other such reason. 40 | Characteristics of Survey Respondents Table 3.5.2 Employment status: Men Percent distribution of men age 15-49 by employment status, according to background characteristics, Samoa 2009 Employed in the 12 months preceding the survey Background characteristic Currently employed1 Not currently employed Not employed in the 12 months preceding the survey Missing Total Number of men Age 15-19 10.3 4.4 85.3 0.0 100.0 269 20-24 43.0 11.7 45.2 0.0 100.0 209 25-29 56.3 11.8 31.5 0.4 100.0 168 30-34 53.6 13.3 33.2 0.0 100.0 161 35-39 59.2 10.0 30.9 0.0 100.0 153 40-44 44.4 11.7 43.9 0.0 100.0 147 45-49 55.6 9.4 35.0 0.0 100.0 112 Marital status Never married 28.8 8.2 63.1 0.0 100.0 619 Married/living together 55.8 12.2 31.9 0.1 100.0 573 Divorced/separated/widowed (69.0) (0.0) (31.0) (0.0) 100.0 28 Number of living children 0 31.3 8.1 60.6 0.0 100.0 682 1-2 56.2 14.7 28.7 0.4 100.0 214 3-4 57.7 10.5 31.7 0.0 100.0 189 5+ 54.6 10.4 35.0 0.0 100.0 136 Residence Urban 39.6 12.6 47.8 0.0 100.0 211 Rural 43.0 9.3 47.7 0.1 100.0 1,009 Region Apia Urban Area 39.6 12.6 47.8 0.0 100.0 211 North West Upolu 43.0 5.1 51.9 0.0 100.0 439 Rest of Upolu 47.5 13.9 38.6 0.0 100.0 279 Savaii 38.6 11.3 49.9 0.3 100.0 291 Education Primary or less 37.1 6.9 56.1 0.0 100.0 158 Secondary incomplete 38.9 9.4 51.7 0.0 100.0 670 Secondary complete 46.3 10.7 43.1 0.0 100.0 187 Vocational/higher 54.1 13.1 32.4 0.4 100.0 206 Wealth quintile Lowest 38.5 11.0 50.5 0.0 100.0 209 Second 41.9 9.3 48.8 0.0 100.0 226 Middle 39.9 9.7 50.2 0.3 100.0 274 Fourth 42.1 9.2 48.7 0.0 100.0 264 Highest 49.1 10.5 40.4 0.0 100.0 248 Total 15-49 42.4 9.9 47.7 0.1 100.0 1,220 50-54 47.6 11.3 40.2 0.9 100.0 87 Total 15-54 42.7 10.0 47.2 0.1 100.0 1,307 Note: Figures in parentheses are based on 25-49 unweighted cases. 1 "Currently employed" is defined as having done work in the past seven days. Includes persons who did not work in the past seven days but who are regularly employed and were absent from work for leave, illness, vacation, or any other such reason. Looking at the differentials by background characteristics, employment is lower among younger respondents age 15-19, as well as among women age 30-39 and men age 20-24 and 40-44. Women and men who are currently or formerly married are more likely than their never-married counterparts to be currently employed. Women with no living children and those with five or more children are less likely to be currently employed compared with women with one or two children. Men with no children are less likely to be currently employed than men who have one or more living children. Characteristics of Survey Respondents | 41 Women in urban areas (32 percent) are much more likely to be currently employed than their rural counterparts (17 percent); among men there is not much difference by urban-rural residence with rural men only slightly more likely to be currently employed than urban men (43 percent versus 40 percent). Employment among women is highest in the Apia Urban Area (32 percent) and lowest in the Rest of Upolu region (13 percent). Among men, those living in the Rest of Upolu region are most likely to be employed at the time of the survey (48 percent), and men in Savaii are least likely to be currently employed (39 percent). The likelihood that a woman or a man is currently employed increases with education level. For example, 43 percent of women with vocational or higher than secondary education are currently employed compared with 15 percent of women with primary or less education. Current employment also increases with wealth. Among women, it ranges from 12 percent of those in the lowest wealth quintile to 30 percent among women in the highest wealth quintile. Among men, the current employment rate also increases with wealth status, although the relationship is less uniform than that observed for women. 3.6 OCCUPATION Information on a woman’s occupation not only allows an evaluation of the woman’s source of income but also has implications for her empowerment. To obtain information on occupation in the survey, respondents who indicated that they were currently working or had been employed in the 12- month period prior to the survey were asked about the kind of work they did. Their responses were recorded verbatim and served as the basis for the coding of occupation that occurred in the central office. Table 3.6.1 shows the percent distribution of women employed in the 12 months preceding the survey by occupation, according to background characteristics. More than half (55 percent) of employed women are in sales and services; about one in four (23 percent) is employed in professional, technical, or managerial positions; and one in seven (14 percent) works in clerical positions. Only 4 percent of women work in agriculture. Figure 3.1 Employment Status of Women and Men Age 15-49 SDHS 2009 Currently employed 20% Not employed in past 12 months 71% Not currently employed 9% Not currently employed 10% Not employed in past 12 months 48% Currently employed 42% 42 | Characteristics of Survey Respondents Table 3.6.1 Occupation: Women Percent distribution of women age 15-49 employed in the 12 months preceding the survey by occupation, according to background characteristics, Samoa 2009 Background characteristic Professional/ technical/ managerial Clerical Sales and services Skilled manual Unskilled manual Agriculture Missing Total Number of women Age 15-19 (1.4) (22.2) (71.8) (2.0) (0.0) (0.0) (2.6) 100.0 43 20-24 22.0 20.2 52.2 1.9 0.6 2.3 0.8 100.0 189 25-29 22.6 15.7 56.0 0.0 1.3 2.2 2.2 100.0 147 30-34 25.5 10.3 54.0 0.9 1.2 4.8 3.4 100.0 98 35-39 23.6 12.3 55.1 3.5 0.0 3.5 1.9 100.0 119 40-44 25.9 5.7 55.6 4.4 0.0 3.3 5.1 100.0 89 45-49 26.9 8.7 48.7 1.0 1.4 12.1 1.0 100.0 94 Marital status Never married 24.2 21.4 50.0 1.1 0.0 1.3 2.0 100.0 237 Married/living together 22.8 10.7 55.8 2.2 1.1 5.0 2.5 100.0 496 Divorced/separated/widowed (14.2) (10.9) (66.3) (2.0) (0.0) (6.6) (0.0) 100.0 46 Number of living children 0 20.8 20.3 53.6 0.9 0.5 1.8 2.1 100.0 236 1-2 21.7 12.6 57.6 2.3 0.5 3.6 1.7 100.0 239 3-4 31.4 9.1 49.3 2.5 0.5 4.9 2.4 100.0 185 5+ 15.1 11.6 58.9 1.9 2.1 7.6 2.9 100.0 120 Residence Urban 23.0 17.4 55.9 0.0 0.0 3.2 0.4 100.0 222 Rural 22.6 12.6 54.1 2.6 1.0 4.3 2.9 100.0 557 Region Apia Urban Area 23.0 17.4 55.9 0.0 0.0 3.2 0.4 100.0 222 North West Upolu 20.0 15.5 53.6 4.7 1.0 2.6 2.6 100.0 251 Rest of Upolu 23.1 11.9 53.9 2.0 2.2 3.2 3.6 100.0 138 Savaii 26.0 8.8 55.0 0.0 0.0 7.5 2.7 100.0 168 Education Primary or less * * * * * * * 100.0 26 Secondary incomplete 8.0 7.2 70.3 3.6 1.6 5.9 3.4 100.0 349 Secondary complete 13.7 17.5 64.0 1.0 0.0 1.6 2.3 100.0 188 Vocational/higher 56.8 22.2 19.2 0.0 0.0 1.3 0.5 100.0 216 Wealth quintile Lowest 7.2 6.3 74.8 3.1 1.2 7.3 0.0 100.0 98 Second 15.7 10.0 63.0 2.2 1.9 6.5 0.8 100.0 131 Middle 18.4 11.8 60.3 1.5 0.8 6.5 0.7 100.0 152 Fourth 26.8 14.3 50.0 3.6 0.0 1.3 4.0 100.0 176 Highest 33.4 20.8 40.6 0.0 0.4 1.4 3.5 100.0 222 Total 22.7 13.9 54.6 1.9 0.7 4.0 2.2 100.0 779 Note: Figures in parentheses are based on 25-49 unweighted cases. An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. There is no difference by urban-rural residence (23 percent each) among women who hold professional, technical, or managerial jobs and only minor differences exist by region. However, there are substantial differences by education and wealth. For example, over half of women with vocational or higher than secondary education hold professional, technical, or managerial jobs compared with 8 percent of women who have attended and 14 percent of women who have completed secondary education. Additionally, one-third of women living in households in the highest wealth quintile have professional, technical, or managerial jobs compared with 7 percent of women in the lowest quintile. The proportion of women working in sales and services is markedly higher among women who have attended or completed secondary school (70 and 64 percent, respectively) than among women with vocational or higher education (19 percent). The percentage of women working in sales and services decreases steadily with wealth from 75 percent of women in the lowest wealth quintile to 41 percent of women in the highest wealth quintile. Characteristics of Survey Respondents | 43 Table 3.6.2 shows that among employed men age 15-49, 51 percent are employed in sales and services, 24 percent work in agriculture, 15 percent hold professional, technical, or managerial positions, 7 percent work as skilled manual labourers, and only 3 percent are employed in clerical positions. The variations across subgroups in the occupational profile among employed men are generally similar to those observed among women. Table 3.6.2 Occupation: Men Percent distribution of men age 15-49 employed in the 12 months preceding the survey by occupation, according to background characteristics, Samoa 2009 Background characteristic Professional/ technical/ managerial Clerical Sales and services Skilled manual Unskilled manual Agriculture Missing Total Number of men Age 15-19 (2.9) (2.8) (59.8) (2.6) (0.0) (31.9) (0.0) 100.0 39 20-24 14.7 5.1 45.7 6.6 0.7 27.2 0.0 100.0 114 25-29 17.1 3.2 53.5 5.6 0.0 19.9 0.7 100.0 115 30-34 9.8 0.0 53.0 12.7 0.8 22.9 0.9 100.0 108 35-39 18.8 4.1 51.3 5.4 0.9 19.4 0.0 100.0 106 40-44 14.8 6.9 51.4 6.9 0.0 20.0 0.0 100.0 83 45-49 18.4 1.6 42.4 4.5 0.0 32.6 0.5 100.0 73 Marital status Never married 11.8 3.9 50.8 5.8 0.3 26.9 0.4 100.0 229 Married/living together 15.6 3.0 51.1 7.7 0.5 21.7 0.3 100.0 390 Divorced/separated/widowed * * * * * * * 100.0 19 Number of living children 0 13.5 3.7 49.0 6.1 0.3 27.0 0.3 100.0 269 1-2 17.4 2.0 53.4 8.1 0.6 18.1 0.5 100.0 152 3-4 17.4 6.9 50.8 6.1 0.0 18.4 0.3 100.0 129 5+ 9.7 0.0 49.6 7.6 1.1 32.0 0.0 100.0 88 Residence Urban 24.8 6.4 49.8 7.3 0.0 10.6 1.2 100.0 110 Rural 12.6 2.8 50.7 6.7 0.5 26.6 0.2 100.0 527 Region Apia Urban Area 24.8 6.4 49.8 7.3 0.0 10.6 1.2 100.0 110 North West Upolu 16.2 4.3 62.2 5.6 0.0 11.7 0.0 100.0 211 Rest of Upolu 10.9 1.2 36.6 7.9 1.5 41.3 0.5 100.0 171 Savaii 9.2 2.5 50.4 6.9 0.0 31.0 0.0 100.0 145 Education Primary or less 4.1 1.4 44.0 3.8 1.1 45.5 0.0 100.0 70 Secondary incomplete 4.6 2.2 53.3 9.9 0.6 29.4 0.0 100.0 324 Secondary complete 11.1 6.1 61.6 6.5 0.0 13.4 1.2 100.0 106 Vocational/higher 46.4 5.1 38.7 1.3 0.0 7.9 0.6 100.0 138 Wealth quintile Lowest 6.0 0.9 51.0 8.7 0.0 33.4 0.0 100.0 103 Second 7.8 3.0 56.8 8.0 0.8 23.6 0.0 100.0 115 Middle 7.2 4.4 52.3 6.9 0.6 28.0 0.6 100.0 136 Fourth 12.6 3.2 58.3 6.5 0.0 19.4 0.0 100.0 136 Highest 35.0 4.8 36.4 4.8 0.6 17.5 0.9 100.0 148 Total 15-49 14.7 3.4 50.5 6.8 0.4 23.8 0.3 100.0 638 50-54 17.1 0.0 40.2 4.2 0.0 38.5 0.0 100.0 51 Total 15-54 14.9 3.2 49.7 6.6 0.4 24.9 0.3 100.0 689 Note: Figures in parentheses are based on 25-49 unweighted cases. An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. 3.7 TYPE OF EMPLOYER, FORM OF EARNINGS, AND CONTINUITY OF EMPLOYMENT Women and men who were employed in the 12 months preceding the survey were asked about the type of earnings they received, that is, whether they were paid in cash, in kind, or not at all. They were also asked about whether they were employed by a relative or a nonrelative or if they were self-employed. Additionally, women and men were asked whether they worked continuously throughout the year or seasonally. Table 3.7 shows the percent distribution of women and men age 15-49 employed in the 12 months preceding the survey by the type of earnings and employer, and continuity of employment, according to type of employment (agricultural or non-agricultural). 44 | Characteristics of Survey Respondents Overall, 87 percent of employed women earn cash only, 3 percent are paid in cash and in kind, and 10 percent receive either in-kind payment or no payment at all. Although more men are currently employed than women, they are slightly less likely than women to be paid in cash only (75 percent versus 87 percent). Men are twice as likely as women to receive no payment at all or in kind only (20 percent versus 10 percent). This is possibly because overall more men than women are self- employed, particularly men working in the agricultural sector. Nearly half (46 percent) of women and two-thirds of men (65 percent) who work in agriculture do not receive payment, and 41 percent of women and 21 percent of men are paid in cash only. In contrast, 90 percent of women and 92 percent of men who work in nonagricultural jobs are paid in cash only. Table 3.7 shows that over half of women (51 percent) and more than four in ten men (44 percent) who have been employed in the preceding 12 months are employed by a nonfamily member, 11 percent of women and 8 percent of men are employed by a family member, and 37 percent of women and 47 percent of men are self-employed. The proportion self-employed among women working in agricultural jobs is 74 percent, compared with 36 percent of those employed in nonagricultural jobs. The corresponding proportions for men are 86 and 35 percent, respectively. Table 3.7 Type of employment Percent distribution of women and men age 15-49 employed in the 12 months preceding the survey by type of earnings, type of employer and continuity of employment, according to type of employment (agricultural or nonagricultural), Samoa 2009 Women Men Employment characteristic Agricultural work Nonagricultural work Total Agricultural work Nonagricultural work Total Type of earnings Cash only (40.8) 89.8 86.7 20.6 91.9 74.9 Cash and in-kind (13.3) 2.0 2.5 10.1 3.5 5.1 In-kind only (0.0) 0.3 0.3 4.2 1.2 1.9 Not paid (45.9) 7.5 9.3 65.1 3.3 18.0 Missing (0.0) 0.4 1.2 0.0 0.0 0.0 Total 100.0 100.0 100.0 100.0 100.0 100.0 Type of employer Employed by family member (18.8) 10.1 10.5 3.5 9.7 8.2 Employed by nonfamily member (6.9) 54.1 51.3 10.5 55.0 44.4 Self-employed (74.4) 35.8 37.3 86.0 35.3 47.4 Missing (0.0) 0.0 0.8 0.0 0.0 0.0 Total 100.0 100.0 100.0 100.0 100.0 100.0 Continuity of employment All year (59.2) 81.9 79.9 74.1 76.8 76.2 Seasonal (31.2) 15.6 16.5 23.2 21.4 21.7 Occasional (9.7) 2.2 2.4 1.8 1.8 1.8 Missing (0.0) 0.3 1.1 0.8 0.0 0.2 Total 100.0 100.0 100.0 100.0 100.0 100.0 Number of women employed during the past 12 months 31 731 779 152 484 638 Note: Total includes women with missing information on type of employment who are not shown separately. Figures in parentheses are based on 25-49 unweighted cases. Characteristics of Survey Respondents | 45 With regard to continuity of employment, the data show that about eight in ten employed respondents (80 percent of women and 76 percent men) work all year. As expected, most women who work in nonagricultural jobs typically work all year (82 percent) compared with women who work in agriculture (59 percent). The difference observed for men is substantially smaller; the majority of men typically work all year regardless of type of employment (74 percent of men work in agricultural jobs and 77 percent of men work in nonagricultural jobs). This is not surprising considering that the climate in Samoa is mostly tropical, with no winter. There are only two distinct seasons: a dry season from May to October and a wet season from November to April. Due to its close proximity to the Equator, there are no large seasonal differences in temperature, which allows agricultural activities to occur continuously throughout the year. 3.8 HEALTH INSURANCE COVERAGE In Samoa, health care is heavily subsidized by the government in all the areas of health services. The main goal of the government is to make health care accessible and affordable for all Samoan people. Sixty-six percent of total health expenditures in Samoa are sourced from public funds, while 9 percent are financed from out-of-pocket household funds as part of the user-fee system that has been put in place. Donor funding covers 21 percent of health care expenditures in Samoa. It is clear from these figures that the Samoan health system is mostly funded by public and donor funds, in an effort to limit the population’s out-of-pocket support for health care (MOH, 2008a) The only form of health insurance that exists in the public sector is the Senior Citizens Benefit Scheme initiated in 1990 for citizens age 65 and older. It is coordinated by the Samoa National Provident Fund. The benefit package includes free health care services for the senior population in any of the public facilities, free inpatient and diagnostic services, and a free supply of medication and drugs from the public pharmacies. The Samoan and the New Zealand government also provide funding for the Overseas Treatment Scheme, facilitated by the National Health Service, which represents 9 percent of all health care funding. Under the Overseas Treatment Scheme, the Samoan government and the New Zealand Agency for International Development (NZAID) cover the fee for hospital treatment overseas for patients who need to go abroad, and the patients are responsible only for the airfare (MOH, 2008a). All women and men who were interviewed in the 2009 SDHS were asked if they hold a membership in any health insurance scheme such as social security, employer-based insurance, or privately purchased commercial insurance. The vast majority of women and men age 15-49 (97 percent each) say that they are not covered by any type of health insurance scheme. Less than 1 percent of respondents are covered by social security, and about 1 percent are covered by insurance through their employer or by privately purchased commercial insurance (data not shown). 3.9 KNOWLEDGE AND ATTITUDE CONCERNING TUBERCULOSIS Tuberculosis (TB) is primarily caused by a bacterium called Mycobacterium tuberculosis.2 The disease usually affects the lungs, although other organs are involved in up to one-third of cases. If properly treated, tuberculosis caused by drug-susceptible strains is curable in virtually all cases. If untreated, more than half the cases may be fatal within five years. Transmission is usually airborne through the spread of droplets produced when patients with infectious pulmonary tuberculosis cough. Tuberculosis is a major global health problem and is currently responsible for the deaths of about two million people each year. 2 Bovine tuberculosis was eliminated with the introduction of pasteurization. In Samoa, any commercially available animal milk is pasteurized, and milk products available for human consumption are made from pasteurized milk. 46 | Characteristics of Survey Respondents TB is a minor public health problem in Samoa. The 2009 SDHS collected information on the respondent’s knowledge and attitudes concerning TB. Tables 3.8.1 and 3.8.2 show the percentage of women and men who have heard of TB, and among those who have heard of TB, the percentage who know that TB is spread through the air by coughing, the percentage who believe that TB can be cured, and the percentage who would want a family member’s TB to be kept secret. Table 3.8.1 Knowledge and attitude concerning tuberculosis: Women Percentage of women age 15-49 who have heard of tuberculosis (TB), and among women who have heard of TB, the percentage who know that TB is spread through the air by coughing, the percentage who believe that TB can be cured, and the percentage who would want to keep secret that a family member has TB, by background characteristics, Samoa 2009 Among women who have heard of TB Among all women Background characteristic Percentage who have heard of TB Number of women Percentage who report that TB is spread through the air by coughing Percentage who believe that TB can be cured Percentage who would want a family member's TB kept secret Number of women Age 15-19 64.4 560 71.2 67.4 13.9 360 20-24 74.4 474 74.1 72.0 13.2 352 25-29 78.6 375 81.1 78.9 9.7 295 30-34 83.9 308 80.4 81.4 7.5 259 35-39 74.7 358 75.3 78.9 13.7 267 40-44 86.5 284 80.8 82.7 11.6 246 45-49 81.6 299 83.0 86.5 7.8 244 Residence Urban 79.2 548 80.8 81.4 14.8 434 Rural 75.3 2,109 76.6 76.2 10.3 1,588 Region Apia Urban Area 79.2 548 80.8 81.4 14.8 434 North West Upolu 74.8 907 76.6 73.6 11.7 678 Rest of Upolu 74.1 597 82.9 78.9 10.8 443 Savaii 77.2 605 70.5 77.5 8.0 467 Education Primary or less 57.3 132 73.6 67.9 6.0 76 Secondary incomplete 72.8 1,598 76.8 75.3 12.8 1,163 Secondary complete 81.9 519 79.6 80.5 9.9 425 Vocational/higher 87.9 408 78.0 82.1 9.4 359 Wealth quintile Lowest 68.7 472 76.0 74.8 12.9 324 Second 73.8 516 76.1 79.0 10.6 380 Middle 73.0 557 74.8 76.3 10.3 407 Fourth 80.0 555 78.4 75.3 12.1 444 Highest 83.8 558 81.0 80.6 11.0 468 Total 76.1 2,657 77.5 77.3 11.3 2,023 More than three-quarters of women (76 percent) and men (78 percent) in Samoa have heard of TB. Younger respondents age 15-49 are less likely to have heard of TB, and the level of knowledge tends to increase with age. There are no major variations by urban-rural residence or region, although women in rural areas are slightly less likely to have heard of TB than those in urban areas (75 percent compared with 79 percent). Respondents with less education and those in households in the lowest wealth quintile are less likely to know about TB. For example, 57 percent of women with primary or less education have heard of TB compared with 88 percent of women with vocational or higher than secondary education. Similarly, knowledge of TB increases from 69 percent of women in the lowest wealth quintile to 84 percent of those in the highest wealth quintile. Among women and men who have heard of TB, a relatively high proportion know that TB is spread through the air by coughing (78 percent of women and 70 percent of men). About 8 in 10 respondents believe that TB can be cured (77 percent women and 85 percent men). The knowledge that TB can be cured is generally lower among the youngest respondents, those with less education, and those in the lower wealth quintiles. Characteristics of Survey Respondents | 47 There is very little stigma attached to TB. For example, only 11 percent of women and 8 percent of men said that if a family member had TB, they would want it to remain a secret. There are no major variations by background characteristics except for urban-rural residence. Urban women and men (15 percent each) are more likely than rural women (10 percent) and men (6 percent) to want to keep secret that a family member has TB. Compared with estimates from recent Demographic and Health Surveys conducted in South Pacific countries, the percentage of women and men in Samoa who know that TB spreads through the air by coughing (78 percent of women and 70 percent of men) is higher than that observed in Tuvalu where 61 percent of women and 56 percent of men in 2007 knew (TCSD, SPC, and Macro International , 2009). The prevalence observed in Samoa is lower, however, than in the Solomon Islands where 82 percent of women and 86 percent of men in 2006-07 (SISO, SPC and Macro International Inc. 2009) knew this fact and also lower than in the Marshall Islands where 82 percent of women and men each in 2007 knew the way that TB spread (EPPSO, SPC and Macro International Inc. 2008). Prevalence in Samoa is similar to that in Nauru for men (31 percent, but not for women (74 percent) (Nauru Bureau of Statistics, SPC, and Macro International Inc. 2009). Table 3.8.2 Knowledge and attitude concerning tuberculosis: Men Percentage of men age 15-49 who have heard of tuberculosis (TB), and among men who have heard of TB, the percentage who know that TB is spread through the air by coughing, the percentage who believe that TB can be cured, and the percentage who would want to keep secret that a family member has TB, by background characteristics, Samoa 2009 Among men who have heard of TB Among all men Background characteristic Percentage who have heard of TB Number of men Percentage who report that TB is spread through the air by coughing Percentage who believe that TB can be cured Percentage who would want a family member's TB kept secret Number of men Age 15-19 55.0 269 66.0 79.1 8.0 148 20-24 75.4 209 70.6 86.3 5.7 157 25-29 84.8 168 69.0 81.2 15.9 143 30-34 84.5 161 68.6 88.7 4.1 136 35-39 88.2 153 70.5 85.5 6.7 135 40-44 87.9 147 69.2 81.7 3.4 129 45-49 87.4 112 78.2 91.3 8.5 98 Residence Urban 76.7 211 85.4 83.0 14.7 162 Rural 77.8 1,009 66.7 84.8 6.0 785 Region Apia Urban Area 76.7 211 85.4 83.0 14.7 162 North West Upolu 78.5 439 65.4 86.3 4.8 345 Rest of Upolu 74.4 279 78.8 90.0 7.2 207 Savaii 80.0 291 58.0 78.0 6.8 233 Education Primary or less 67.5 158 62.4 77.8 1.8 107 Secondary incomplete 74.9 670 69.6 83.0 6.6 501 Secondary complete 84.6 187 72.7 87.9 13.6 158 Vocational/higher 88.0 206 73.0 89.7 8.0 181 Wealth quintile Lowest 73.3 209 64.0 80.1 3.8 153 Second 79.2 226 64.9 83.0 7.7 179 Middle 76.7 274 75.0 85.0 9.1 210 Fourth 78.9 264 69.4 84.2 6.1 208 Highest 79.4 248 74.2 89.2 9.9 197 Total 15-49 77.6 1,220 69.9 84.5 7.5 947 50-54 81.2 87 76.0 86.0 5.2 70 Total 15-54 77.8 1,307 70.4 84.6 7.3 1,017 48 | Characteristics of Survey Respondents 3.9.1 Misconceptions about the Way Tuberculosis Spreads Although the majority of women and men are able to correctly identify that TB is spread through the air by coughing, misconceptions about TB transmission are widespread in the adult population. Figure 3.2 shows the percentages of women and men who have heard about TB and how TB is spread. As commented earlier (see Tables 3.8.1 and 3.8.2), overall, 78 percent of women and 70 percent of men correctly know that the illness is spread through air when coughing or sneezing. Figure 3.2 shows that the two most common misconceptions, reported by about four in ten respondents, are that TB spreads through sharing utensils (40 percent of men and 39 percent of women) and through sharing food (40 percent of women and 38 percent of men). About one in five women and men who have heard of TB believe that it can be contracted through saliva, while 13 percent of women and 16 percent of men think that TB can be contracted through smoking. Furthermore, although 6 percent of women and 12 percent of men believe that TB can be contracted through sexual contact, less than 10 percent (9 percent of women

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