Sierra Leone - Demographic and Health Survey - 2014

Publication date: 2014

Sierra Leone Demographic and Health Survey 2013 Sierra Leone 2013 D em ographic and H ealth Survey Republic of Sierra Leone Sierra Leone Demographic and Health Survey 2013 Statistics Sierra Leone Freetown, Sierra Leone Ministry of Health and Sanitation Freetown, Sierra Leone ICF International Rockville, Maryland USA July 2014 THE WORLD BANK This report summarises the findings of the 2013 Sierra Leone Demographic and Health Survey (SLDHS), carried out by Statistics Sierra Leone in collaboration with the Ministry of Health and Sanitation of Sierra Leone. The fieldwork took place between June and September, 2013. The survey was funded by the government of Sierra Leone, the UK Department for International Development (DfID), the United Nations Population Fund (UNFPA), the World Bank, the United Nations Development Programme (UNDP), the World Health Organization (WHO), the Food and Agricultural Organization (FAO), the World Food Programme (WFP), the United Nations Children’s Fund (UNICEF), and KfW Development Bank. ICF International provided technical assistance. Additional information about the Sierra Leone DHS survey may be obtained from Statistics Sierra Leone, A.J. Momoh Street, Tower Hill, PMB 595, Freetown, Sierra Leone; Telephone: +23276610004 or +23276869801; Email: statistics@statistics.sl. Information about The DHS Program may also be obtained from ICF International, 530 Gaither Road, Suite 500, Rockville, MD 20850-5971, USA; Telephone: +1-301-407-6500; Fax: +1-301-407-6501; Email: reports@ DHSprogram.com; Internet: www.DHSprogram.com. Suggested citation: Statistics Sierra Leone (SSL) and ICF International. 2014. Sierra Leone Demographic and Health Survey 2013. Freetown, Sierra Leone and Rockville, Maryland, USA: SSL and ICF International. Table of Contents • iii TABLE OF CONTENTS TABLES AND FIGURES . ix FOREWORD . xvii PREFACE . xix ACKNOWLEDGEMENTS . xxi ABBREVIATIONS . xxiii MILLENNIUM DEVELOPMENT GOAL INDICATORS . xxv MAP OF SIERRA LEONE . xxvi 1 INTRODUCTION . 1 1.1 Geography, History, and the Economy . 1 1.1.1 Geography . 1 1.1.2 History . 1 1.1.3 Economy . 2 1.2 Population . 3 1.3 Population and Family Planning Policies and Programmes . 3 1.4 Health Priorities and Programmes . 4 1.5 Strategic Framework to Combat the HIV/AIDS Epidemic . 5 1.6 Objectives of the 2013 SLDHS . 5 1.7 Survey Organisation . 6 1.8 Sample Design . 6 1.9 Questionnaires . 7 1.10 HIV Testing . 8 1.11 Training and Pretest . 9 1.12 Fieldwork . 10 1.13 Data Processing . 10 1.14 Response Rates . 10 2 HOUSING CHARACTERISTICS AND HOUSEHOLD POPULATION . 11 2.1 Household Environment . 11 2.1.1 Drinking Water . 12 2.1.2 Household Sanitation Facilities . 13 2.1.3 Housing Characteristics . 14 2.1.4 Household Possessions . 16 2.2 Wealth Index . 16 2.3 Hand Washing . 17 2.4 Population by Age and Sex . 19 2.5 Household Composition . 20 2.6 Birth Registration . 20 2.7 Children’s Living Arrangements and Orphanhood . 21 2.8 School Attendance by Survivorship of Parents . 22 2.9 Education of the Household Population . 23 2.9.1 Educational Attainment . 23 2.9.2 School Attendance Rates . 25 2.10 Child Labour . 28 2.10.1 Occurrence of Child Labour . 28 2.10.2 Child Labour and School Attendance . 30 3 CHARACTERISTICS OF RESPONDENTS . 33 3.1 Characteristics of Survey Respondents . 33 3.2 Educational Attainment by Background Characteristics . 35 3.3 Literacy . 37 3.4 Access to Mass Media . 39 3.5 Employment . 41 3.6 Occupation . 45 3.7 Type of Employment . 47 iv • Table of Contents 3.8 Health Insurance Coverage . 48 3.9 Smoking . 49 4 MARRIAGE AND SEXUAL ACTIVITY . 53 4.1 Current Marital Status . 53 4.2 Polygyny . 54 4.3 Age at First Marriage . 56 4.4 Age at First Sexual Intercourse . 58 4.5 Recent Sexual Activity . 59 5 FERTILITY . 63 5.1 Current Fertility . 63 5.2 Fertility Differentials . 65 5.3 Fertility Trends . 66 5.4 Children Ever Born and Living . 67 5.5 Birth Intervals . 68 5.6 Postpartum Amenorrhoea, Abstinence, and Insusceptibility . 70 5.7 Menopause . 71 5.8 Age at First Birth . 72 5.9 Teenage Pregnancy and Motherhood . 73 6 FERTILITY PREFERENCES . 75 6.1 Desire for More Children . 75 6.2 Desire to Limit Childbearing by Background Characteristics. 77 6.3 Ideal Number of Children . 79 6.4 Fertility Planning Status . 81 7 FAMILY PLANNING . 83 7.1 Knowledge of Contraceptive Methods . 83 7.2 Current Use of Contraceptive Methods . 84 7.3 Differentials in Contraceptive Use by Background Characteristics . 87 7.4 Source of Contraception . 89 7.5 Informed Choice . 89 7.6 Contraceptive Discontinuation . 90 7.7 Knowledge of the Fertile Period . 91 7.8 Need and Demand for Family Planning . 92 7.9 Future Use of Contraception . 94 7.10 Exposure to Family Planning Messages in the Media. 95 7.11 Contact of Non-users with Family Planning Providers . 96 8 INFANT AND CHILD MORTALITY . 99 8.1 Methodological Considerations . 99 8.2 Assessment of Data Quality . 100 8.3 Levels and Trends of Infant and Child Mortality . 101 8.4 Socioeconomic Differentials in Infant and Child Mortality . 102 8.5 Demographic Differentials in Child Mortality . 103 8.6 Perinatal Mortality . 104 8.7 High-risk Fertility Behaviour . 106 9 REPRODUCTIVE HEALTH . 109 9.1 Antenatal Care . 109 9.2 Number of ANC Visits and Timing of First Visits . 111 9.3 Components of Antenatal Care . 111 9.4 Tetanus Toxoid Injections . 113 9.5 Place of Delivery . 114 9.6 Assistance during Delivery . 115 9.7 Postnatal Care . 117 9.7.1 Postnatal Care for Mother . 117 9.7.2 Postnatal Care for Newborn . 120 9.8 Problems in Accessing Health Care . 123 Table of Contents • v 10 CHILD HEALTH . 125 10.1 Weight and Size at Birth . 125 10.2 Vaccination of Children . 127 10.3 Acute Respiratory Infection . 130 10.4 Fever . 132 10.5 Prevalence of Diarrhoea . 134 10.6 Diarrhoea Treatment . 135 10.7 Feeding Practices . 138 10.8 Knowledge of ORS Packets . 141 10.9 Stool Disposal . 141 11 NUTRITION OF CHILDREN AND ADULTS . 143 11.1 Nutritional Status of Children . 144 11.1.1 Measurement of Nutritional Status among Young Children . 144 11.1.2 Results of Data Collection . 145 11.1.3 Levels of Malnutrition . 145 11.2 Initiation of Breastfeeding . 149 11.3 Breastfeeding Status by Age . 151 11.4 Duration of Breastfeeding . 153 11.5 Types of Complementary Foods . 154 11.6 Infant and Young Child Feeding (IYCF) Practices . 156 11.7 Prevalence of Anaemia in Children . 159 11.8 Micronutrient Intake among Children . 160 11.9 Presence of Iodised Salt in Households . 164 11.10 Nutritional Status of Women and Men . 164 11.11 Prevalence of Anaemia among Women and Men . 168 11.12 Micronutrient Intake among Mothers . 169 12 MALARIA . 173 12.1 Mosquito Nets . 174 12.1.1 Ownership of Mosquito Nets . 175 12.1.2 Access to an Insecticide-Treated Net (ITN) . 176 12.1.3 Use of Mosquito Nets by Persons in the Household . 177 12.1.4 Use of existing ITNs . 179 12.1.5 Use of Mosquito Nets by Children under Age 5 . 179 12.1.6 Use of Mosquito Nets by Pregnant Women . 181 12.2 Indoor Residual Spraying (IRS) . 182 12.3 Intermittent Preventive Treatment of Malaria in Pregnancy . 184 12.4 Prevalence and Prompt Treatment of Children with Fever . 185 12.5 Prevalence of Anaemia in Children . 187 13 ADULT AND MATERNAL MORTALITY . 189 13.1 Data . 190 13.2 Estimates of Adult Mortality . 191 13.3 Estimates of Maternal Mortality . 192 14 HIV/AIDS-RELATED KNOWLEDGE, ATTITUDES, AND BEHAVIOUR . 195 14.1 HIV/AIDS Knowledge of Transmission and Prevention Methods . 196 14.1.1 Awareness of HIV/AIDS . 196 14.1.2 Knowledge of HIV Prevention Methods . 197 14.1.3 Rejection of Misconceptions about HIV/AIDS . 199 14.1.4 Knowledge of Mother-to-Child Transmission of HIV . 202 14.2 Attitudes towards People Living with AIDS . 204 14.3 Attitudes towards Negotiating Safer Sex . 207 14.4 Attitudes towards Condom Education for Youth . 209 14.5 Higher-risk Sex . 210 14.5.1 Multiple Partners and Condom Use . 210 14.5.2 Concurrent Sexual Partners . 213 14.5.3 Transactional Sex . 214 14.6 Coverage of HIV Counselling and Testing . 216 14.6.1 General HIV Testing . 216 vi • Table of Contents 14.6.2 HIV Counselling and Testing during Pregnancy . 218 14.7 Self-reporting of Sexually Transmitted Infections . 220 14.8 Prevalence of Medical Injections . 222 14.9 HIV/AIDS Knowledge and Sexual Behaviour among Youth . 224 14.9.1 HIV/AIDS-related Knowledge among Young Adults . 224 14.9.2 Trends in Age at First Sex . 225 14.9.3 Knowledge of Condom Sources among Young Adults . 225 14.9.4 Abstinence and Premarital Sex . 226 14.9.5 Multiple Sexual Partners . 227 14.9.6 Cross-generational Sexual Partners . 229 14.9.7 Voluntary HIV Counselling and Testing among Young Adults . 230 15 HIV PREVALENCE . 231 15.1 Coverage Rates for HIV Testing . 232 15.2 HIV Prevalence . 234 15.2.1 HIV Prevalence by Age and Sex . 234 15.2.2 Trends in HIV Prevalence . 235 15.2.3 HIV Prevalence by Socioeconomic Characteristics . 236 15.2.4 HIV Prevalence by Demographic Characteristics. 238 15.2.5 HIV Prevalence by Sexual Risk Behaviour . 239 15.3 HIV Prevalence among Youth . 241 15.3.1 HIV Prevalence by Sexual Behaviour among Youth . 242 15.4 HIV Prevalence by Other Characteristics . 243 15.4.1 HIV Prevalence and STIs . 243 15.4.2 Prior HIV Testing . 244 15.5 HIV Prevalence among Cohabiting Couples . 244 16 WOMEN’S EMPOWERMENT AND DEMOGRAPHIC AND HEALTH OUTCOMES . 247 16.1 Employment and Form of Earnings . 247 16.2 Control over Earnings . 248 16.2.1 Control over Wife’s Earnings . 248 16.2.2 Control over Husband’s Earnings . 250 16.3 Women’s Control over Earnings by Magnitude of Earnings . 251 16.4 Ownership of Assets . 253 16.5 Participation in Decision-making . 254 16.6 Attitudes towards Wife Beating . 257 16.7 Women’s Empowerment Indicators . 261 16.8 Current Use of Contraception by Women’s Status . 261 16.9 Ideal Family Size and Unmet Need by Women’s Status . 262 16.10 Women’s Status and Reproductive Health Care . 263 17 DOMESTIC VIOLENCE . 265 17.1 Data Collection . 266 17.1.1 The Use of Valid Measures of Violence . 266 17.1.2 Ethical Considerations . 267 17.1.3 Characteristics of the Sub-Sample of Respondents for the Violence Module . 268 17.2 Experience of Violence by Women and Men . 268 17.3 Experience of Physical Violence and Perpetrators of Physical Violence . 268 17.4 Experience of Sexual Violence and Perpetrators of Sexual Violence . 272 17.5 Experience of Different Types of Violence . 275 17.6 Violence during Pregnancy . 276 17.7 Marital Control . 276 17.8 Spousal/Intimate Partner Violence . 280 17.9 Violence by Spousal Characteristics and Empowerment Indicators . 285 17.10 Frequency of Spousal Violence . 287 17.11 Physical Consequences of Spousal Violence . 290 17.12 Physical Violence by Women and Men Against Their Spouses . 291 17.13 Response to Violence . 295 Table of Contents • vii 18 FEMALE GENITAL CUTTING . 299 18.1 Knowledge and Prevalence of Female Genital Cutting . 299 18.2 Age at Circumcision . 301 18.3 Religious Attitudes towards Practice of FGC . 303 18.4 Attitudes towards Continued Practice of FGC . 304 REFERENCES . 307 APPENDIX A SAMPLE DESIGN . 311 A.1 Objectives of the Survey . 311 A.2 Sampling Frame . 311 A.3 Sample Allocation and Sample Selection . 312 A.4 Selection Probability and Sampling Weight . 313 A.5 Survey Results . 314 APPENDIX B ESTIMATES OF SAMPLING ERRORS . 321 APPENDIX C DATA QUALITY TABLES . 347 APPENDIX D PERSONS INVOLVED IN THE SURVEY . 355 APPENDIX E QUESTIONNAIRES . 361 Tables and Figures • ix TABLES AND FIGURES 1 INTRODUCTION . 1 Table 1.1 Basic demographic indicators . 3 Table 1.2 Results of the household and individual interviews . 10 2 HOUSING CHARACTERISTICS AND HOUSEHOLD POPULATION . 11 Table 2.1 Household drinking water . 12 Table 2.2 Household sanitation facilities . 14 Table 2.3 Household characteristics . 15 Table 2.4 Household possessions . 16 Table 2.5 Wealth quintiles . 17 Table 2.6 Hand washing . 18 Table 2.7 Household population by age, sex, and residence . 19 Table 2.8 Household composition . 20 Table 2.9 Birth registration of children under age 5 . 21 Table 2.10 Children’s living arrangements and orphanhood . 22 Table 2.11 School attendance by survivorship of parents . 23 Table 2.12.1 Educational attainment of the female household population . 24 Table 2.12.2 Educational attainment of the male household population . 25 Table 2.13 School attendance ratios . 26 Table 2.14 Child labour . 29 Table 2.15 Child labour and school attendance . 30 Figure 2.1 Population pyramid . 19 Figure 2.2 Age-specific attendance rates of the de facto population age 5-24 . 28 3 CHARACTERISTICS OF RESPONDENTS . 33 Table 3.1 Background characteristics of respondents . 34 Table 3.2.1 Educational attainment: Women . 36 Table 3.2.2 Educational attainment: Men . 37 Table 3.3.1 Literacy: Women . 38 Table 3.3.2 Literacy: Men . 39 Table 3.4.1 Exposure to mass media: Women . 40 Table 3.4.2 Exposure to mass media: Men . 41 Table 3.5.1 Employment status: Women . 43 Table 3.5.2 Employment status: Men . 44 Table 3.6.1 Occupation: Women . 46 Table 3.6.2 Occupation: Men . 47 Table 3.7 Type of employment . 48 Table 3.8 Health insurance coverage . 49 Table 3.9.1 Use of tobacco: Women . 50 Table 3.9.2 Use of tobacco: Men . 51 Figure 3.1 Women’s employment status in the past 12 months . 42 4 MARRIAGE AND SEXUAL ACTIVITY . 53 Table 4.1 Current marital status . 54 Table 4.2.1 Number of women’s co-wives . 55 Table 4.2.2 Number of men’s wives . 56 x • Tables and Figures Table 4.3 Age at first marriage . 57 Table 4.4 Median age at first marriage by background characteristics . 57 Table 4.5 Age at first sexual intercourse . 59 Table 4.6 Median age at first sexual intercourse by background characteristics . 59 Table 4.7.1 Recent sexual activity: Women . 61 Table 4.7.2 Recent sexual activity: Men . 62 5 FERTILITY . 63 Table 5.1 Current fertility . 64 Table 5.2 Fertility by women’s background characteristics . 65 Table 5.3.1 Trends in age-specific fertility rates . 66 Table 5.3.2 Trends in age-specific and total fertility rates . 66 Table 5.4 Children ever born and living . 67 Table 5.5 Birth intervals . 69 Table 5.6 Postpartum amenorrhoea, abstinence, and insusceptibility . 70 Table 5.7 Median duration of amenorrhoea, postpartum abstinence, and postpartum insusceptibility . 70 Table 5.8 Menopause . 71 Table 5.9 Age at first birth . 72 Table 5.10 Median age at first birth . 72 Table 5.11 Teenage pregnancy and motherhood . 74 Figure 5.1 Age-specific fertility rates, by mother’s age and residence . 64 Figure 5.2 Total Fertility Rate by background characteristics . 66 Figure 5.3 Trends in age-specific fertility rates . 67 6 FERTILITY PREFERENCES . 75 Table 6.1 Fertility preferences by number of living children . 76 Table 6.2.1 Desire to limit childbearing: Women . 78 Table 6.2.2 Desire to limit childbearing: Men . 79 Table 6.3 Ideal number of children by number of living children . 80 Table 6.4 Mean ideal number of children . 81 Table 6.5 Fertility planning status . 82 Table 6.6 Total wanted fertility rates . 82 Figure 6.1 Fertility preferences among currently married women according to number of living children . 77 7 FAMILY PLANNING . 83 Table 7.1 Knowledge of contraceptive methods . 84 Table 7.2 Current use of contraception by age . 86 Table 7.3 Current use of contraception by background characteristics . 88 Table 7.4 Source of modern contraception methods . 89 Table 7.5 Informed choice . 90 Table 7.6 Twelve-month contraceptive discontinuation rates . 90 Table 7.7 Knowledge of fertile period . 91 Table 7.8 Need and demand for family planning among currently married women . 93 Table 7.9 Future use of contraception . 94 Table 7.10 Exposure to family planning messages . 96 Table 7.11 Contact of non-users with family planning providers . 97 Figure 7.1 Trends in contraceptive use among currently married women . 85 Tables and Figures • xi 8 INFANT AND CHILD MORTALITY . 99 Table 8.1 Early childhood mortality rates . 101 Table 8.2 Early childhood mortality rates by socioeconomic characteristics . 103 Table 8.3 Early childhood mortality rates by demographic characteristics . 104 Table 8.4 Perinatal mortality . 105 Table 8.5 High-risk fertility behaviour . 107 Figure 8.1 Infant and under-five mortality rates with confidence intervals for the five years preceding the 2008 SLDHS and the 2013 SLDHS . 102 9 REPRODUCTIVE HEALTH . 109 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 . 113 Table 9.5 Place of delivery . 114 Table 9.6 Assistance during delivery . 116 Table 9.7 Timing of first postnatal check-up . 119 Table 9.8 Type of provider of first postnatal check-up for the mother . 120 Table 9.9 Timing of first postnatal checkup for the newborn . 121 Table 9.10 Type of provider of first postnatal check-up for the newborn . 122 Table 9.11 Problems in accessing health care . 123 Figure 9.1 Trends in antenatal care attendance, health facility delivery, assistance during delivery . 117 Figure 9.2 Mother’s duration of stay in the health facility after giving birth . 118 10 CHILD HEALTH . 125 Table 10.1 Child’s size and weight at birth. 126 Table 10.2 Vaccinations by source of information . 128 Table 10.3 Vaccinations by background characteristics . 129 Table 10.4 Vaccinations in first year of life . 130 Table 10.5 Prevalence and treatment of symptoms of ARI . 131 Table 10.6 Prevalence and treatment of fever . 133 Table 10.7 Prevalence of diarrhoea . 134 Table 10.8 Diarrhoea treatment . 136 Table 10.9 Feeding practices during diarrhoea . 139 Table 10.10 Knowledge of ORS packets or pre-packaged liquids. 141 Table 10.11 Disposal of children’s stools . 142 Figure 10.1 Trends in vaccination coverage during the first year of life among children age 12-23 months . 128 11 NUTRITION OF CHILDREN AND ADULTS . 143 Table 11.1 Nutritional status of children . 146 Table 11.2 Initial breastfeeding . 150 Table 11.3 Breastfeeding status by age . 151 Table 11.4 Median duration of breastfeeding . 153 Table 11.5 Foods and liquids consumed by children in the day or night preceding the interview . 155 Table 11.6 Infant and young child feeding (IYCF) practices . 157 Table 11.7 Prevalence of anaemia in children . 160 Table 11.8 Micronutrient intake among children . 162 xii • Tables and Figures Table 11.9 Presence of iodised salt in household . 164 Table 11.10.1 Nutritional status of women . 166 Table 11.10.2 Nutritional status of men . 167 Table 11.11.1 Prevalence of anaemia in women . 168 Table 11.11.2 Prevalence of anaemia in men . 169 Table 11.12 Micronutrient intake among mothers . 170 Figure 11.1 Nutritional status of children by age . 148 Figure 11.2 Trends in nutritional status of children under 5, 2008 and 2013 . 149 Figure 11.3 Infant feeding practices by age . 152 Figure 11.4 IYCF indicators on breastfeeding status . 153 Figure 11.5 IYCF indicators on minimum acceptable diet . 159 12 MALARIA . 173 Table 12.1 Household possession of mosquito nets . 175 Table 12.2 Access to an insecticide-treated net (ITN) . 176 Table 12.3 Use of mosquito nets by persons in the household . 178 Table 12.4 Use of existing ITNs . 179 Table 12.5 Use of mosquito nets by children . 180 Table 12.6 Use of mosquito nets by pregnant women . 182 Table 12.7 Indoor residual spraying against mosquitoes . 183 Table 12.8 Use of intermittent preventive treatment (IPTp) by women during pregnancy . 184 Table 12.9 Prevalence, diagnosis, and prompt treatment of children with fever . 185 Table 12.10 Source of advice or treatment for children with fever . 186 Table 12.11 Type of antimalarial drugs used . 187 Table 12.12 Haemoglobin <8.0 g/dl in children . 188 Figure 12.1 Percentage of the de facto population with access to an ITN in the household . 177 Figure 12.2 Ownership of, access to, and use of ITNs . 180 13 ADULT AND MATERNAL MORTALITY . 189 Table 13.1 Completeness of information on siblings . 190 Table 13.2 Adult mortality rates . 191 Table 13.3 Adult mortality probabilities . 192 Table 13.4 Maternal mortality . 193 Figure 13.1 Estimates of adult mortality rates . 191 Figure 13.2 Maternal Mortality Ratio (MMR) with confidence intervals for the seven years preceding the 2008 SLDHS and the 2013 SLDHS . 194 14 HIV/AIDS-RELATED KNOWLEDGE, ATTITUDES, AND BEHAVIOUR . 195 Table 14.1 Knowledge of AIDS . 196 Table 14.2 Knowledge of HIV prevention methods . 198 Table 14.3.1 Comprehensive knowledge about AIDS: Women . 200 Table 14.3.2 Comprehensive knowledge about AIDS: Men . 201 Table 14.4 Knowledge of prevention of mother to child transmission of HIV . 203 Table 14.5.1 Accepting attitudes toward those living with HIV/AIDS: Women . 205 Table 14.5.2 Accepting attitudes toward those living with HIV/AIDS: Men . 206 Table 14.6 Attitudes toward negotiating safer sexual relations with husband . 208 Table 14.7 Adult support of education about condom use to prevent AIDS . 209 Table 14.8.1 Multiple sexual partners: Women . 211 Tables and Figures • xiii Table 14.8.2 Multiple sexual partners: Men . 212 Table 14.9 Point prevalence and cumulative prevalence of concurrent sexual partners . 214 Table 14.10 Payment for sexual intercourse and condom use at last paid sexual intercourse . 215 Table 14.11.1 Coverage of prior HIV testing: Women . 216 Table 14.11.2 Coverage of prior HIV testing: Men . 218 Table 14.12 Pregnant women counselled and tested for HIV . 219 Table 14.13 Self-reported prevalence of sexually-transmitted infections (STIs) and STIs symptoms . 221 Table 14.14 Prevalence of medical injections . 223 Table 14.15 Comprehensive knowledge about AIDS and of a source of condoms among youth . 224 Table 14.16 Age at first sexual intercourse among young people . 226 Table 14.17 Premarital sexual intercourse and condom use during premarital sexual intercourse among youth . 227 Table 14.18.1 Multiple sexual partners in the past 12 months among young people: Women . 228 Table 14.18.2 Multiple sexual partners in the past 12 months among young people: Men . 228 Table 14.19 Age-mixing in sexual relationships among women and men age 15-19 . 229 Table 14.20 Recent HIV tests among youth . 230 Figure 14.1 Women’s and men’s knowledge of HIV prevention methods . 199 Figure 14.2 Women and men age 15-49 who sought advice or treatment for STIs . 222 15 HIV PREVALENCE . 231 Table 15.1 Coverage of HIV testing by residence and region . 232 Table 15.2 Coverage of HIV testing by selected background characteristics . 234 Table 15.3 HIV prevalence by age . 235 Table 15.4 Trends in HIV prevalence by age . 236 Table 15.5 HIV prevalence by socioeconomic characteristics . 237 Table 15.6 HIV prevalence by demographic characteristics . 239 Table 15.7 HIV prevalence by sexual behaviour . 240 Table 15.8 HIV prevalence among young people by background characteristics . 242 Table 15.9 HIV prevalence among young people by sexual behaviour . 243 Table 15.10 HIV prevalence by other characteristics . 244 Table 15.11 Prior HIV testing by current HIV status . 244 Table 15.12 HIV prevalence among couples . 245 Figure 15.1 HIV prevalence by sex and age . 235 Figure 15.2 HIV prevalence by sex and age, SLDHS 2008 and 2013 . 236 16 WOMEN’S EMPOWERMENT AND DEMOGRAPHIC AND HEALTH OUTCOMES . 247 Table 16.1 Employment and cash earnings of currently married women and men . 248 Table 16.2.1 Control over women’s cash earnings and relative magnitude of women’s cash earnings . 249 Table 16.2.2 Control over men’s cash earnings . 250 Table 16.3 Women’s control over their own earnings and over those of their husbands . 252 Table 16.4.1 Ownership of assets: Women . 253 Table 16.4.2 Ownership of assets: Men . 254 Table 16.5 Participation in decision-making . 255 Table 16.6.1 Women’s participation in decision-making by background characteristics . 256 Table 16.6.2 Men’s participation in decision-making by background characteristics . 257 xiv • Tables and Figures Table 16.7.1 Attitude towards wife beating: Women . 258 Table 16.7.2 Attitude towards wife beating: Men . 260 Table 16.8 Indicators of women’s empowerment . 261 Table 16.9 Current use of contraception by women’s empowerment . 262 Table 16.10 Ideal number of children and unmet need for family planning by women’s empowerment . 263 Table 16.11 Reproductive health care by women’s empowerment . 263 17 DOMESTIC VIOLENCE . 265 Table 17.1 Experience of physical violence . 269 Table 17.2 Persons committing physical violence . 271 Table 17.3 Experience of sexual violence. 272 Table 17.4 Persons committing sexual violence . 274 Table 17.5 Experience of different forms of violence . 275 Table 17.6 Experience of violence during pregnancy . 276 Table 17.7.1 Marital control exercised by husbands, according to wives . 278 Table 17.7.2 Marital control exercised by wives, according to husbands . 279 Table 17.8.1 Forms of spousal violence: Women . 281 Table 17.8.2 Forms of spousal violence: Men . 282 Table 17.9.1 Spousal violence by background characteristics: Women . 283 Table 17.9.2 Spousal violence by background characteristics: Men . 284 Table 17.10.1 Spousal violence by husband’s characteristics and empowerment indicators . 286 Table 17.10.2 Spousal violence by wife’s characteristics and empowerment indicators . 287 Table 17.11 Physical or sexual violence in the past 12 months by any husband/partner . 288 Table 17.12 Experience of spousal violence by duration of marriage . 290 Table 17.13 Injuries to women due to spousal violence . 291 Table 17.14 Respondent’s violence against their spouse by background characteristics . 292 Table 17.15 Respondent’s violence against their spouse by relationship characteristics . 294 Table 17.16.1 Help seeking to stop violence: Women . 295 Table 17.16.2 Help seeking to stop violence: Men . 297 Table 17.17 Sources for help to stop the violence . 298 18 FEMALE GENITAL CUTTING . 299 Table 18.1 Knowledge of female circumcision . 300 Table 18.2 Prevalence of female circumcision . 301 Table 18.3 Age at circumcision . 302 Table 18.4 Opinions of women and men about whether circumcision is required by religion . 303 Table 18.5 Opinions of women and men about whether the practice of circumcision should continue . 305 APPENDIX A SAMPLE DESIGN . 307 Table A.1 Distribution of residential households by district and type of residence . 311 Table A.2 Population EAs and their average size in number of households by district and by type of residence . 312 Table A.3 Sample allocation of EAs and households by district and by type of residence . 312 Table A.4 Sample implementation: Women . 315 Table A.5 Sample implementation: Men . 316 Table A.6 Coverage of HIV testing by social and demographic characteristics: Women . 317 Table A.7 Coverage of HIV testing by social and demographic characteristics: Men . 318 Tables and Figures • xv Table A.8 Coverage of HIV testing by sexual behaviour characteristics: Women . 319 Table A.9 Coverage of HIV testing by sexual behaviour characteristics: Men . 320 APPENDIX B ESTIMATES OF SAMPLING ERRORS . 321 Table B.1 List of selected variables for sampling errors, Sierra Leone 2013 . 323 Table B.2 Sampling errors: Total sample, Sierra Leone 2013 . 324 Table B.3 Sampling errors: Urban sample, Sierra Leone 2013 . 325 Table B.4 Sampling errors: Rural sample, Sierra Leone 2013 . 326 Table B.5 Sampling errors: Eastern sample, Sierra Leone 2013 . 327 Table B.6 Sampling errors: Northern sample, Sierra Leone 2013 . 328 Table B.7 Sampling errors: Southern sample, Sierra Leone 2013 . 329 Table B.8 Sampling errors: Western sample, Sierra Leone 2013 . 330 Table B.9 Sampling errors: Kailahun sample, Sierra Leone 2013. 331 Table B.10 Sampling errors: Kenema sample, Sierra Leone 2013 . 332 Table B.11 Sampling errors: Kono sample, Sierra Leone 2013 . 333 Table B.12 Sampling errors: Bombali sample, Sierra Leone 2013 . 334 Table B.13 Sampling errors: Kambia sample, Sierra Leone 2013. 335 Table B.14 Sampling errors: Koinadugu sample, Sierra Leone 2013 . 336 Table B.15 Sampling errors: Port Loko sample, Sierra Leone 2013 . 337 Table B.16 Sampling errors: Tonkolili sample, Sierra Leone 2013 . 338 Table B.17 Sampling errors: Bo sample, Sierra Leone 2013 . 339 Table B.18 Sampling errors: Bonthe sample, Sierra Leone 2013 . 340 Table B.19 Sampling errors: Moyamba sample, Sierra Leone 2013 . 341 Table B.20 Sampling errors: Pujehun sample, Sierra Leone 2013 . 342 Table B.21 Sampling errors: Western Rural sample, Sierra Leone 2013 . 343 Table B.22 Sampling errors: Western Urban sample, Sierra Leone 2013 . 344 Table B.23 Sampling errors for adult and maternal mortality rates (last 0-6 years), Sierra Leone 2013 . 345 APPENDIX C DATA QUALITY TABLES . 347 Table C.1 Household age distribution . 347 Table C.2.1 Age distribution of eligible and interviewed women . 348 Table C.2.2 Age distribution of eligible and interviewed men . 348 Table C.3 Completeness of reporting . 349 Table C.4 Births by calendar years . 349 Table C.5 Reporting of age at death in days . 350 Table C.6 Reporting of age at death in months . 350 Table C.7 Nutritional status of children based on the NCHS/CDC/WHO International Reference Population . 351 Table C.8 Completeness of information for dead sisters . 353 Table C.9 Sibship size and sex ratio of siblings . 353 Foreword • xvii FOREWORD ierra Leone is committed to improving its health care system to provide affordable, quality health care. The priorities of the government include combating malaria, improving maternal and child health, reducing teenage pregnancy, scaling up nutrition programs, and improving sanitation and hygiene. To assess progress, measure performance, and map the way forward, the 2013 Demographic and Health Survey (DHS) was conducted. This was the second DHS in Sierra Leone, and its primary objective was to assess indicators on fertility levels and preferences, marriage and sexual activity, family planning methods, breastfeeding practices, nutritional status of women, men, and young children, childhood and maternal mortality, maternal and child health, malaria and use of mosquito nets, domestic violence, and HIV/AIDS and other sexually transmitted infections (STIs). Generally, the results presented in this report indicate improvement in some of the indicators (delivery by skilled birth attendants, child vaccination, and the use of bed nets among women and children). However, the government notes that accelerated progress is needed in other indicators (children under age 5 who are stunted, infant mortality, under-five mortality, and maternal mortality) for which additional actions/efforts are being taken to improve them. The 2013 SLDHS was conducted by Statistics Sierra Leone in collaboration with the Ministry of Health and Sanitation and other stakeholders. The study was funded by the Sierra Leone Government, United Nations Population Fund (UNFPA), United Nations Development Programme, Department for International Development (United Kingdom), World Bank, KfW, United States Agency for International Development, and the World Health Organization. ICF International and the UNFPA Country Support Team provided technical support. The Ministry of Health and Sanitation will collaborate with its health development partners in the implementation of the evidence-based interventions recommended by this report and use the information to improve policy formulation and program design. The Ministry of Health and Sanitation appreciates the efforts of all organizations and individuals who contributed to the success of this project. Ms. Miatta Kargbo Ministry of Health and Sanitation of Sierra Leone FREETOWN S Preface • xix PREFACE tatistics Sierra Leone conducted the 2013 Sierra Leone Demographic and Health Survey (SLDHS) in its capacity as the national agency mandated to collect, analyse, and disseminate official statistics in Sierra Leone. The sample size for the 2013 SLDHS was much higher than for the 2008 SLDHS to allow for estimates from all 14 administrative districts, in addition to the national and regional estimates. A total of 13,006 households were targeted, involving 16,658 female and 7,262 male respondents. The survey provides data on background characteristics of respondents and demographic and key public health indicators, including domestic violence. The target groups in the survey were women age 15 to 49 and men age 15 to 59 from randomly selected households. Information was also collected for children under age 5, including their weight and height. Data collection took place from June to September, 2013, and tabulations were finalized in January 2014. The preliminary report was launched in January 2014. The main report was drafted in April 2014 by a team from Statistics Sierra Leone, the Ministry of Health and Sanitation, the National AIDS Secretariat, Njala University, Fouraby College, representatives from the DHS Technical Committee, the United Nations Population Fund, and the Joint United Nations Programme on HIV/AIDS. The report was compiled and finalized by ICF International. I would like to thank the report writing team and ICF International for their efforts to ensure that the report has been completed on time. Mohammed King Koroma Statistician General Statistics Sierra Leone FREETOWN S Acknowledgements • xxi ACKNOWLEDGEMENTS he success of the 2013 Sierra Leone Demographic and Health Survey (SLDHS) results from the support of many institutions instrumental in the overall implementation. First, on behalf of the Government of Sierra Leone, I wish to thank the United Nations Population Fund, UK Department for International Development, World Bank, United Nations Development Programme, United Nations Children’s Fund, Joint United Nations Programme on HIV/AIDS, World Food Program of the United Nations, Food and Agriculture Organization of the United Nations, World Health Organization, and KfW for the financial and logistical support, without which, the survey would not have been possible. I would like to recognize the support and leadership provided by the senior management of Statistics Sierra Leone and the technical guidance of the resident SLDHS advisor. I would also like to thank the Ministry of Health and Sanitation, especially the staff of the Central Public Health Reference Laboratory in Lakka, Freetown, who conducted HIV analysis of the dried blood samples. The active involvement of officials from the Ministry of Finance and Economic Development is highly appreciated, and I commend ICF International for the technical support provided throughout the survey process. Similar sentiments are extended to the technical and steering committees, whose technical and policy guidance made possible the successful implementation of the entire process. All field staff engaged in data collection, field coordinators and monitors, data processing staff and blood analysis laboratory personnel, worked assiduously and their effort is hereby acknowledged. Finally, my appreciation goes to all household heads, men and women who were selected and responded to all the interviews. Without their participation and support, this project would have been futile. Thank you to everyone. Kaifala Marah (Ph.D) Minister of Finance and Economic Development Treasury Building FREETOWN T Abbreviations • xxiii ABBREVIATIONS A4P Agenda for Prosperity ACT Artemisinin-based combination therapy AD Age at death AIDS Acquired immune deficiency syndrome AL Artmether+lumefantrine ANC Antenatal care APC All Peoples Congress ARI Acute respiratory infection AS+AQ Artesunate+amodiaquine ASFR Age-specific fertility rate BCG Bacille-Calmette-Guerin vaccine against tuberculosis BMI Body mass index BPEH Basic package of essential health CBR Crude birth rate CDC Centers for Disease Control and Prevention CHC Community Health Centres CHP Community Health Posts CPR Contraceptive prevalence rate CSPro Census and survey processing computer package DBS Dried blood spot DfID Department for International Development DHS Demographic and Health Survey DPT Diphtheria, pertussis, and tetanus vaccine EA Enumeration area EIA2 Enzygnost Integral II EIA1 Enzyme immunoassay FAO Food and Agricultural Organisation FGC Female Genital Cutting GAR Gross attendance ratio GDP Gross domestic product GFR General fertility rate GPI Gender parity index Hib Haemophilus influenzae type B HIV Human immunodeficiency virus ICD-10 International Classification of Diseases IDD Iodine deficiency disorder IPTp Intermittent preventive treatment during pregnancy IRS Indoor residual spraying ITN Insecticide-treated net IUD Intrauterine device IYCF Infant and young child feeding xxiv • Abbreviations KfW KfW Development Bank LAM Lactational amenorrhea method LLIN Long-lasting insecticide-treated bed net MCH Maternal and Child Health MCHP Maternal and Child Health Posts MDGs Millennium Development Goals MMR Maternal mortality ratio MOHS Ministry of Health and Sanitation MTCT Mother-to-child transmission NAR Net attendance ratio NGO Nongovernmental organization NMCP National Malaria Control Programme NN Neonatal mortality NPRC National Provisional Ruling Council NSP National Strategic Plan ORS Oral rehydration salts ORT Oral rehydration therapy PLHIV People living with HIV PMTCT Prevention of mother-to-child transmission PNN Postneonatal mortality PRSP Poverty Reduction Strategy Papers PSU Primary sampling unit RDT Rapid diagnostic test RHF Recommended home fluid SHS Second-hand smoke SLDHS Sierra Leone Demographic and Health Survey SLPP Sierra Leone Peoples Party SP Sulphadoxine-pyrimethamine SSL Statistics Sierra Leone STI Sexually transmitted infection SUN Scaling Up Nutrition TFR Total fertility rate UNAIDS Joint United Nations Programme on HIV/AIDS UNFPA United Nations Population Fund UNICEF United Nations Children’s Fund USAID United States Agency for International Development VAD Vitamin A deficiency VCT Voluntary counselling and testing WB World Bank WFP World Food Program WHO World Health Organization YSD Years since death Millennium Development Goal Indicators • xxv MILLENNIUM DEVELOPMENT GOAL INDICATORS Millennium Development Goal Indicators Sierra Leone 2013 Value Total Goal Female Male 1. Eradicate extreme poverty and hunger 1.8 Prevalence of underweight children under five years of age 15.4 17.6 16.4 2. Achieve universal primary education 2.1 Net attendance ratio in primary education1 75.2 70.7 72.9 2.3 Literacy rate of 15-24 year olds2 61.8 76.2a 69.0b 3. Promote gender equality and empower women 3.1a Ratio of girls to boys in primary education3 na na 1.1 3.1b Ratio of girls to boys in secondary education3 na na 0.9 4. Reduce child mortality 4.1 Under-five mortality rate4 164 186 156 4.2 Infant mortality rate4 102 117 92 4.3 Proportion of 1 year-old children immunised against measles 79.0 78.1 78.6 5. Improve maternal health 5.1 Maternal mortality ratio5 na na 1,165 5.2 Percentage of births attended by skilled health personnel6 na na 59.7 5.3 Contraceptive prevalence rate7 16.6 na na 5.4 Adolescent birth rate8 125.1 na na 5.5 Antenatal care coverage 5.5a Antenatal care coverage: at least one visit9 97.1 na na 5.5b Antenatal care coverage: four or more visits10 76.0 na na 5.6 Unmet need for family planning 25.0 na na 6. Combat HIV/AIDS, malaria, and other diseases 6.1 HIV prevalence among the population aged 15-24 years 1.4 0.7 1.1 6.2 Condom use at last high-risk sex11 6.8 17.7 12.3 6.3 Percentage of the population age 15-24 years with comprehensive correct knowledge of HIV/AIDS12 28.8 30.0 29.4 6.4 Ratio of school attendance of orphans to school attendance of non-orphans aged 10-14 years 0.76 0.88 0.81 6.7 Percentage of children under age 5 sleeping under insecticide treated bed nets 48.8 49.3 49.0 6.8 Percentage of children under age 5 with fever who are treated with appropriate antimalarial drugs13 47.2 49.4 48.3 Urban Rural Total 7. Ensure environmental sustainability 7.8 Percentage of population using an improved drinking water source14 88.3 46.5 59.5 7.9 Percentage of population with access to improved sanitation15 21.9 5.4 10.6 na = Not applicable 1 The ratio is based on reported attendance, not enrollment, in primary education among primary school age children (age 6-11). The rate also includes children of primary school age enrolled in secondary education. This is a proxy for MDG indicator 2.1, Net enrollment ratio. 2 Refers to respondents who attended secondary school or higher or who could read a whole sentence or part of a sentence 3 Based on reported net attendance, not gross enrollment, among children age 6-11 for primary and age 12-17 for secondary education 4 Expressed in terms of deaths per 1,000 live births. Mortality by sex refers to a 10-year reference period preceding the survey. Mortality rates for males and females combined refer to the five-year period preceding the survey. 5 Expressed in terms of maternal deaths per 100,000 live births in the seven-year period preceding the survey 6 Among births in the five years preceding the survey 7 Percentage of currently married women age 15-49 using any method of contraception 8 Equivalent to the age-specific fertility rate for women age 15-19 for the three years preceding the survey, expressed in terms of births per 1,000 women age 15-19 9 With a skilled provider 10 With any health care provider 11 Higher-risk sex refers to sexual intercourse with a non-marital, non-cohabitating partner. It is expressed as a percentage of men and women age 15-24 who had higher-risk sex in the past 12 months. 12 Comprehensive knowledge means knowing that consistent use of condoms during sexual intercourse and having just one uninfected faithful partner can reduce the chance of getting the AIDS virus, knowing a healthy-looking person can have the AIDS virus, and rejecting the two most common local misconceptions about transmission or prevention of the AIDS virus. 13 Measured as the percentage of children age 0-59 months who were ill with a fever in the two weeks preceding the interview and received any antimalarial drug a Restricted to men in subsample of households selected for the male interview b The total is calculated as the simple arithmetic mean of the percentages in the columns for male and females. 14 Proportion whose main source of drinking water is a household connection (piped), public standpipe, borehole, protected dug well or spring, or rainwater collection. 15 Improved sanitation technologies are a flush toilet, ventilated improved pit latrine, traditional pit latrine with a slab, or composting toilet. xxvi • Map of Sierra Leone Introduction • 1 INTRODUCTION 1 1.1 GEOGRAPHY, HISTORY, AND THE ECONOMY 1.1.1 Geography ierra Leone is located on the west coast of Africa and covers an area of about 72,000 square kilometres (28,000 square miles). It extends from latitude 7 degrees north to 10 degrees north, and from longitude 10 degrees west to 14 degrees west. The Republic of Guinea borders it on the north and northeast, and the Republic of Liberia borders it on the east and southeast. On the west and southwest, the Atlantic Ocean extends approximately 340 kilometres (211 miles). Administratively, Sierra Leone is divided into four regions. Each region is subdivided into districts, and each district is divided into chiefdoms. Overall, there are 14 districts and 149 chiefdoms. Among the 14 districts, there are five city councils and 14 district councils, including Freetown, the capital, for a total of 19 local councils (SSL, 2006). Sierra Leone has four main physical regions: the Freetown Peninsula’s raised beaches and hills, the Coastal Plains, the Interior Lowlands, and the Interior Plateau. The Freetown Peninsula consists of three roughly parallel ranges of highlands that are narrow but extend about 30 kilometres south of Freetown. The hills and mountains in these highlands rise impressively from 200 to 1,000 metres above the low-lying narrow coastal area. The Interior Lowlands region makes up about half of the country. Most of the area, which is largely swamp, is less than 150 metres above sea level. The Interior Plateau region makes up the eastern half of the country. It is the most extensive physical region and includes the greatest variety of land forms. It is 300 to 450 metres above sea level. The Interior Plateau is dissected by the main rivers flowing westward towards the sea. Rising above the general level of this region are a number of hills and mountains, including the Kambui, Nimini, and Gori hills in the south-eastern region, and the Sula, Kangari, Loma, Tingi, and Wara mountains in the northern region. Climate in Sierra Leone is determined mainly by the seasonal movements of two air masses: the north-easterly Continental Tropical Winds (commonly called North-East Trade Winds) and the south- westerly Maritime Tropical Winds (commonly called South-West Monsoon). The country experiences two main seasons: the dry season, between November and May, and the wet/rainy season, from April/May to November. The present distribution of vegetation in Sierra Leone has been influenced not only by factors of climate and soil but also by man. At present, the following vegetation communities can be distinguished: forest, savannah, grassland, and swamp. The country has eight main river systems: the Great Scarcies, Little Scarcies, Rokel, Jong, Sewa, Wanjei, Moa, and Mano. The rivers typically flow from northeast to southwest, eventually reaching the Atlantic Ocean. 1.1.2 History Sierra Leone’s earliest known contact with Europe was in the 15th century during the Portuguese voyages of exploration. On one such voyage, to discover a sea route to India, the Portuguese reached the Sierra Leone Peninsula. Because the high coastal ranges resembled lions to the explorers, the area was called Sierra Lyoa, meaning Lion Mountains. S 2 • Introduction Contact stimulated trade, with manufactured goods coming from Europe in return for fruit, carvings, and gold from Sierra Leone. However, in the 16th century there was the added dimension of the introduction of the slave trade. In 1562 the earliest known shipment of slaves was taken from the country to the Americas. There was a further strengthening of the European link in 1789 with the founding of settlements for freed slaves. The first group of 411 freed slaves was settled on land bought from King Tom of the Sierra Leone Peninsula. The settlement was under the administration of the Sierra Leone Company, which was founded in 1791 with the aim of re-establishing legitimate trade with the inhabitants. With the abolition of the slave trade and pressure from individuals and organizations in Britain, the British Government took direct responsibility for the new settlement. In 1808 the British Government declared the new settlement to be a Crown Colony. This move was intended to facilitate the enforcement of the Slave Trade Abolition Act. British rule covered only the colony, which was then the Freetown Peninsula and Bonthe Island. The largest part of the country, referred to as the hinterland, was in the hands of traditional rulers. However, in 1896 the rest of the country was declared a protectorate, followed two years later by the Hut Tax War. Today, Sierra Leone is a republic within the British Commonwealth of Nations, having gained independence from Britain on 27 April 1961. It gained the status of republic in April 1971 and adopted a one-party system of government in 1978. In 1991, however, the country reverted to a multiparty state, with two main political parties: the Sierra Leone Peoples Party (SLPP) and the All Peoples Congress (APC). The country then went through a 10-year civil conflict that began in 1991 and ended in 2002. During the period of conflict, there was a military takeover from the then ruling APC Government in April 1992 by the National Provisional Ruling Council (NPRC). The country held democratic elections that ended military rule in 1996 and ushered in a multiparty system of government led by the SLPP. Since then the country has enjoyed multiparty democracy. English is the official language of Sierra Leone, which has about 15 ethnic groups. The major tribes include the Mende, Temne, Limba, and Creole. The main religions are Christianity and Islam. 1.1.3 Economy The Sierra Leonean economy is predominantly agricultural, which has accounted for about half of the real gross domestic product (GDP). However, the share of the GDP attributed to agriculture has been declining, from about 54 percent in 2009 to less than 53 percent in 2010 and 2011, and with a sharper decline from 47 percent in 2012 to 41 percent in 2013, mainly due to the mining activities in the country during this period. Services are next to agriculture as a major percentage of GDP, at about 34 percent. The manufacturing sector, consisting mainly of import–substituting industries, accounts for only 2 percent of GDP. The mining sector accounted for less than 6 percent of GDP between 2001 and 2011 but increased to 12 percent of GDP in 2012 (SSL, 2012), due mainly to the discovery and mining of iron ore in 2011 in the Northern region. Coffee, cocoa, and fish are the major agricultural exports of the country. The performance of the Sierra Leonean economy has been declining since the post-independence era, with its greatest decline during the 10-year civil conflict. Since the end of the conflict in 2002, several measures have been put in place to improve the economy and the quality of life of the people. These include the introduction of five-year development frameworks such as the Poverty Reduction Strategy Papers (PRSP), the Agenda for Change, and the Agenda for prosperity. The implementation of the Agenda for Change saw improvement in the overall economy, with emphasis in energy, infrastructure, agriculture, and social services. The Agenda for Change enabled the economy to grow at an annual average of 6 percent between 2007 and 2012. One of the lessons learned during the implementation of the Agenda for Change was that infrastructural development and social services were effective strategies to create jobs for youth, including Introduction • 3 the Cash for Work Programmes. In 2013 the Government of Sierra Leone launched the Agenda for Prosperity (A4P) to provide continuity by consolidating the gains made under the Agenda for Change. The goal was to transform Sierra Leone into a middle-income country by 2035. 1.2 POPULATION According to the last Population and Housing Census, conducted in 2004, the population of Sierra Leone was 5.0 million (Table 1.1). The country’s projected population for 2014 is 6.2 million. Results of previous censuses indicate an annual population growth rate of 1.8 percent during the 1985–2004 period, which is a decline from the 2.3 percent annual rate reported for the 1974–1985 period. Table 1.1 Basic demographic indicators Selected demographic indicators, Sierra Leone Indicators 1963 Popu- lation and Housing Census 1974 Popu- lation and Housing Census 1985 Popu- lation and Housing Census 2004 Popu- lation and Housing Census Population (millions) 2.2 2.7 3.5 5.0 Intercensal growth rate 1.1 2.0 2.3 1.8 Density (population/km2) 30.3 38 49 69 Percent urban na 27.6 32.2 36.7 na: not applicable Source: Sierra Leone Population and Housing Census, 1963-2004 1.3 POPULATION AND FAMILY PLANNING POLICIES AND PROGRAMMES Sierra Leone is characterised by a youthful population. About 42 percent of the people are under age 15. The country therefore faces the challenge of providing its youth with opportunities for a safe, healthy, and economically productive future. In 2009 the Government of Sierra Leone launched its revised National Population Policy. The revised policy addressed many of the fundamental issues of population, health and sexual and reproductive rights, education, gender equality, equity and empowerment of women, the special needs of persons in especially difficult circumstances such as amputees, war widows, street children and other physically challenged persons and their interrelated development challenges. In more specific terms, the goals of the National Population Policy include the following: (a) To make development planning and policy more comprehensive and effective by the incorporation of the demographic dimension; (b) To achieve a balance between the rate of population growth, available resources, and the social and economic development of the nation; (c) To progress towards a complete demographic transition of a considerably reduced level of low birth and death rates and the resultant low population growth rates through the spread of voluntary family planning and small family norms so as to facilitate the attainment of national economic and social targets; (d) To contribute towards meeting the basic needs of the people and enhancing the quality and utilisation of the nation’s human resources; (e) To promote the health, especially reproductive health of mothers and children, and welfare of all Sierra Leoneans at every stage of the life cycle; 4 • Introduction (f) To further scale up and accelerate programme intervention towards progressively reducing the threat posed by HIV/AIDS and implement an immediate response to other related sexual and infectious diseases, and (g) To guide rural-urban migration, so as to minimise socioeconomic problems and optimise benefits to migrants and non-migrants alike through the achievement of a balanced and integrated rural and urban development. The national policy also outlined several strategies to achieve these goals, which included improvement of the demographic knowledge base on population and development interaction on a regular basis. 1.4 HEALTH PRIORITIES AND PROGRAMMES Sierra Leone reviewed its 1993 National Health Policy in 2002. The current health policy seeks to maintain and improve the health of all Sierra Leoneans, and addresses the following challenges: malaria, sexually transmitted infections (STIs) including HIV/AIDS, TB, reproductive health including maternal and neonatal mortality, childhood diseases, nutrition-related diseases, water-, food-, and sanitation-borne diseases, disability, and mental illness. The Ministry of Health and Sanitation is the major health care provider in Sierra Leone. The Ministry operates all government health facilities in the country. The public delivery system starts from the peripheral health units, which include the Community Health Centres (CHC) at chiefdom headquarter towns and Community Health Posts (CHP) and Maternal and Child Health Posts (MCHP) in other villages within chiefdoms. The next level comprises hospitals at the district headquarter towns. The third level of care is provided in hospitals at the regional headquarter towns. There are two national hospitals – the Connaught Hospital and the Princess Christian Maternal Health Hospital. However, there are several private clinics and hospital spread across the 14 districts of the country. Making adequate health care services universally available requires striking a delicate balance between the health needs of the population and the country’s available resources. It also requires an equitable and efficient allocation of resources. Without proper health care financing strategies, no government can hope to successfully meet the health needs of its citizens. The National Health Sector Strategic Plan (2010–2015) aims to provide the framework that will guide the Ministry of Health and Sanitation and its partners over the next six years in attaining the health- related Millennium Development Goals (MDGs). It reflects the Ministry’s fundamental belief that health is a basic human right. The health goals formulated in the strategic plan underline the need to strengthen the functions of the national health system of Sierra Leone, so as to improve the following: (a) Access to health services (b) Quality of health services (c) Equity in health services (d) Efficiency of service delivery (e) Inclusiveness In line with the government’s Agenda for Change and Health Sector Strategic Plan, the Free Health Care Initiative was introduced in 2010 to provide free health care services for pregnant women, lactating mothers, and children under age 5. The Free Health Care Initiative focuses on an essential package of health care services that will be delivered free of charge at the point of service to ensure a significant improvement in maternal and child health. Introduction • 5 The policies that the government has pursued over the years have had a direct impact on improving the health status of Sierra Leoneans. Nonetheless, much is yet to be done in reducing teenage pregnancies, which have a direct effect on maternal and child health and on infant and maternal mortality. 1.5 STRATEGIC FRAMEWORK TO COMBAT THE HIV/AIDS EPIDEMIC To meet the challenge of the HIV/AIDS epidemic in the country, the Government of Sierra Leone has adopted a multi-sector approach. The National AIDS Council was established in 2002 to provide the overall policy guidance of HIV/AIDS response in Sierra Leone and is chaired by the President of the Republic of Sierra Leone. Within the Office of President, a National AIDS Secretariat was established in 2005 to coordinate the HIV/AIDS programmes. The Government of Sierra Leone launched the first multisectoral National HIV/AIDS Strategic Plan, which was implemented for a five-year period between 2006 and 2010. This plan supported effective programmes to control the spread of HIV/AIDS, to protect the human rights of those with HIV or AIDS, and to provide care for those infected and affected by HIV/AIDS. At this plan’s conclusion in 2010, a new National Strategic Plan (NSP) was developed for 2011–2015. The new NSP has clear and measurable goals, objectives, and priorities that will guide the country’s future programmes and operational plan of the national response to HIV/AIDS. The aim of the 2011–2015 NSP is to achieve zero new HIV infections, zero discrimination, and zero HIV-related deaths by 2015. To achieve this, six impact and outcome level results are to be achieved by 2015: 1. Coordinating structures at national and decentralised levels effectively manage implementation 2. Laws and policies protecting the rights of people living with HIV (PLHIV) and orphans are widely applied 3. Incidence of HIV is reduced by 50 percent 4. Morbidity and mortality amongst the PLHIV are reduced 5. People infected and affected have the same opportunities as the general population 6. Research, monitoring, and evaluation systems are strengthened at all levels 1.6 OBJECTIVES OF THE 2013 SLDHS The 2013 Sierra Leone Demographic and Health Survey (SLDHS) is the second population and health survey that Sierra Leone has conducted. It was designed to provide data to monitor the population and health situation in Sierra Leone and also to be used as a follow-up to the first SLDHS survey, conducted in 2008. The 2013 SLDHS collected information on fertility levels; marriage; sexual activity; fertility preferences; awareness and use of family planning methods; breastfeeding practices; nutritional status of women and young children; childhood and maternal mortality; maternal and child health; and awareness and behaviour regarding HIV/AIDS and other STIs. The 2013 SLDHS is the first survey to collect data on domestic violence. The specific objectives of the 2013 SLDHS were to: • Provide reliable data, at the national, regional, and district levels, on health and demographic indicators in the areas of fertility, mortality, family planning, maternal and child health, 6 • Introduction nutrition, malaria, and HIV/AIDS, which can be used by programme managers and policy makers to evaluate and improve existing programmes or develop new ones; • Measure changes in fertility and contraceptive prevalence; • Examine the basic indicators of maternal and child health in Sierra Leone, including nutritional status, use of antenatal and maternity services, treatment of recent episodes of childhood illness, use of immunisation services, use of mosquito nets and treatment of children and pregnant women for malaria; • Describe the patterns of knowledge, attitudes, and behaviour related to the transmission of HIV/AIDS and other STIs; • Ascertain the extent and pattern of domestic violence and female genital cutting in the country; • Estimate the prevalence of HIV infection at the national, regional and district levels and by urban-rural residence. The 2013 SLDHS provides data to assist policymakers and programme implementers as they monitor and evaluate existing programmes and design new strategies for demographic, social, and health policies in Sierra Leone. The data will be useful in many ways, including the monitoring of the country’s achievement of the MDGs. As in 2008, the 2013 SLDHS survey was designed to cover the entire country. However, unlike the 2008 survey, where disaggregation of data was limited to regional levels, the 2013 SLDHS went further to disaggregate data at the district level. The survey collected information on demographic and health issues from a sample of women of reproductive age 15-49, and also from a sample of men age 15-59 in a subsample of households. 1.7 SURVEY ORGANISATION Statistics Sierra Leone (SSL) implemented the 2013 SLDHS at the request of the Ministry of Health and Sanitation. HIV testing was performed by the National Reference Laboratory at Lakka in Freetown. Financial support for the 2013 SLDHS was provided by the Government of Sierra Leone, the UK Department for International Development (DfID), the World Bank (WB), the United Nations Fund for Population Activities (UNFPA), KfW Development Bank (KfW), the United Nations Children’s Fund (UNICEF), Food and Agricultural Organisation (FAO), World Food Programme (WFP), and World Health Organization (WHO). The implementation of the survey was guided by a National Technical Committee and a National Steering Committee, which provided both technical and policy guidance through the implementation of the survey. As in the previous DHS survey in Sierra Leone, ICF International provided technical support, through the international MEASURE DHS Program. 1.8 SAMPLE DESIGN The 2013 SLDHS sample was designed to produce reliable estimates for important variables for the country as a whole, for urban and rural areas, and for each of Sierra Leone’s four regions and 14 districts. The sample was first stratified to provide adequate representation of urban and rural areas, as well as all regions and districts. Then, the sample was selected in two stages. The first stage involved selecting primary sampling units (PSUs), also called clusters, based on the list of enumeration areas (EAs) created in the 2004 Sierra Leone General Population and Housing Census. The enumeration areas provided the master frame for drawing 435 clusters (277 rural and 158 urban), selected with a probability proportional to their size. The Introduction • 7 sampling frame excluded the population living in collective housing units, such as hotels, hospitals, work camps, prisons, or boarding schools. In the second stage of selection, 30 households were systematically selected from each cluster. All women age 15-49 who were usual household members or who spent the night before the survey in the selected households were eligible for individual interviews. In addition, in a subsample of every second household selected for the survey, all men age 15-59 were selected for interview. In this subsample, all women and men eligible for the individual survey were also eligible for the HIV test. In addition, in this subsample of households, all women and men eligible for the survey and all children age 6-59 months were eligible for the anaemia test. Finally, in the same subsample of households, all women and men eligible for the survey and all children under the age 5 were eligible for anthropometric (height and weight) measurements to determine their nutritional status. 1.9 QUESTIONNAIRES The 2013 SLDHS used three questionnaires, namely, a Household Questionnaire, a Woman’s Questionnaire, and a Man’s Questionnaire. These questionnaires were based on the models developed by the MEASURE DHS Program, but additions and modifications were made to the model questionnaires to adapt them to specific situations and the lexicon of Sierra Leone. The Household Questionnaire was used to list all usual household members, as well as non-members who spent the night preceding the interview in the selected households. Some basic information was collected on the characteristics of each person listed, including age, sex, education, and relationship to the head of household. The Household Questionnaire also included a module on child labour. In addition, several questions were included to determine the physical characteristics of the dwelling, such as source of water, presence of sanitation facilities, and availability of durable goods. The Household Questionnaire was also used to identify people eligible for the individual interview, that is, women age 15-49 and men age 15-59. In addition, the Household Questionnaire was used to register people eligible for anthropometric measurements and the collection of blood samples for anaemia and HIV testing. The Woman’s Questionnaire was used to collect information from all women of reproductive age (15-49). It covered a wide variety of topics, including: • Background characteristics • Birth history • Knowledge, attitudes, and practice of family planning, as well as exposure to family planning messages • Maternal health, including antenatal, delivery, and postnatal care • Immunisation and health of children under age 5 • Breastfeeding and infant feeding practices • Marriage, sexual activity, and husband’s background characteristics • Fertility preferences • Employment and gender roles • Knowledge of AIDS and other STIs • Maternal mortality 8 • Introduction • Female genital cutting • Domestic violence The set of questions on domestic violence sought to obtain information on women’s experience of violence. The questions were administered to one woman per household in the subsample households that were not selected for the men’s survey. In households with more eligible women, special procedures (use of a ‘Kish grid’) were followed to ensure that the woman interviewed about domestic violence was randomly selected. The Man’s Questionnaire was administered to all men age 15-59 living in every second household in the sample; it collected information from the man’s perspective on the following topics: • Background characteristics • Reproduction • Knowledge and attitudes related to family planning and exposure to family planning messages • Marriage and sexual activity • Fertility preferences • Employment and gender roles • Knowledge of HIV/AIDS and other STIs • Miscellaneous health issues, including male circumcision • Domestic violence In every household selected for the Man’s Questionnaire, one man was randomly selected to be administered the set of questions on domestic violence. 1.10 HIV TESTING In the households selected for the Man’s Questionnaire, all eligible women and men who were interviewed were asked to voluntarily provide some drops of blood for HIV testing. Blood specimens were collected in the field and tested in the laboratory. The protocol for blood specimen collection and analysis was based on the anonymous linked protocol developed by the MEASURE DHS Program. It was reviewed and approved by the Sierra Leone National Ethics Committee and the Institutional Review Board of ICF International. The protocol allowed for the linking of the HIV results to the socio-demographic data collected in the individual questionnaires, provided that the information that could potentially identify an individual was destroyed before the linking took place. This required that identification codes be deleted from the data file and that the part of the Household Questionnaire containing the barcode labels and names of respondents be destroyed prior to merging the HIV results with the individual data file. Considerable care was necessary to prepare respondents for the blood sample, and for this reason one health technician was assigned to each of the 24 survey teams. To obtain informed consent for taking blood for HIV testing, the health technician explained the procedures, the confidentiality of the data, and the fact that test results could not be traced back to or made available to the respondent. For those who were interested in knowing their HIV status, the health technician provided information about how they could obtain it through voluntary counselling and testing (VCT) services. If consent was granted, the health technician then collected a dried blood spot (DBS) sample on a filter paper card from a finger prick, using a Introduction • 9 single-use, spring-loaded, sterile lancet. Each DBS sample was given a barcode label, with a duplicate label attached to the Household Questionnaire on the line showing consent for that respondent. The health technician affixed a third copy of the same barcode label to a Blood Sample Transmittal Form in order to track the blood samples from the field to the laboratory. Filter papers were dried overnight in a plastic drying box, after which the health worker packed them in individual Ziploc bags with desiccant and a humidity indicator card and placed them in a larger Ziploc bag with other blood spots for that particular cluster. Blood samples were periodically collected in the field along with the completed questionnaires and transported to SSL headquarters in Freetown for logging in, after which they were taken to the Central Public Health Reference Laboratory at Lakka Hospital in Freetown for HIV testing. At the laboratory, the DBS samples were each assigned a laboratory number and kept frozen until testing started in early December 2013. The HIV testing did not start until the questionnaire data entry was completed, verified, and cleaned, all paper questionnaires were destroyed, and all unique identifiers were removed from the questionnaire data file, except the anonymous barcode number. The HIV testing algorithm called for screening all samples on Vironostika Ag/Ab combination assay, a 4th generation enzyme immunoassay (EIA1). Samples that tested negative were recorded as negative. All samples that tested positive were confirmed on Enzygnost Integral II (EIA2), also a 4th generation assay. Samples that tested positive on both EIA1 and EIA2 were reported as positive; discordant samples were repeated on both EIA1 and EIA2 in parallel. If the samples remained discordant, discordance was resolved by Inno-Lia HIV I/II line immunoassay (Innogenetics) testing. The final result was recorded as positive if the line immunoassay confirmed the result to be positive and negative if the line immunoassay confirmed it to be negative. If the line immunoassay results were indeterminate, the sample was rendered indeterminate. As part of the internal quality control procedure, 10 percent of randomly selected negative samples on EIA1 were retested on EIA2. Upon finishing HIV testing, the HIV test results were entered into a spreadsheet with a barcode as the unique identifier to the result. The barcode linked the HIV test results with the individual interview data. As part of the external quality control procedure, 5 percent of the confirmed negative samples and all confirmed positive samples at the primary lab were selected for re-testing at the Laboratory of Bacteriology and Virology Aristide Le Dantec in Dakar, Senegal. A total of 519 DBS samples (293 HIV negative and 226 HIV positive) were retested for HIV as part of the external quality assurance. Results from the Laboratory of Bacteriology and Virology showed a concordance rate of 98.3% with Central Public Health Reference Laboratory. 1.11 TRAINING AND PRETEST All field personnel were trained for the pretest for four weeks, between April and May 2013, at SSL’s central office in Freetown. After the training, pretest fieldwork was conducted over a one-week period in two urban clusters and two rural clusters. Even though more than 150 men and women received training, only 10 were selected for the pretest exercise. As part of the pretest, health technicians practiced weighing and measuring men, women, and children, as well as collecting and handling blood samples for anaemia and HIV testing. The training course consisted of instructions regarding interviewing techniques and field procedures, a detailed review of items on the questionnaires, instruction and practice in weighing and measuring children and in the collection of blood samples, mock interviews between participants in the classroom, and practice interviews. A two-week refresher training class was conducted between May and June 2013, prior to launching the fieldwork. 10 • Introduction 1.12 FIELDWORK Fieldwork was launched in June 2013 and completed in October 2013. There were a total of 24 field teams, each consisting of one supervisor, one field editor, one health technician, two female interviewers, and one male interviewer. Each team was provided with a vehicle. After a few weeks of fieldwork, the SSL restructured the field personnel and reduced the number of teams from the initial 24 to 18. SSL, through the Publicity Subcommittee, organised and implemented a series of publicity activities, including radio discussions across the country before the beginning of fieldwork. SSL also developed brochures on HIV/AIDS and anaemia, which were given to survey respondents during the fieldwork. 1.13 DATA PROCESSING All questionnaires for 2013 SLDHS were sent to the SSL central office in Freetown, where office editors reviewed them and manually recorded the codes to the few questions without pre-coded answers. The data were processed using CSPro (Census and Survey Processing computer package). Data entry and editing were initiated almost immediately after the beginning of fieldwork. Data processing, consisting of editing, data entry, 100 percent double entry, final editing, and verification, was completed in November 2013. 1.14 RESPONSE RATES Table 1.2 shows response rates for the 2013 SLDHS. A total of 13,006 households were selected for the sample, of which 12,724 were occupied. Of the occupied households, 12,629 were successfully interviewed, yielding a response rate of 99 percent. In the interviewed households, 17,132 eligible women were identified for individual interview; of these, complete interviews were conducted with 16,658 women, yielding a response rate of 97 percent. In the subsample of households selected for the men’s survey, 7,537 eligible men were identified and 7,262 were successfully interviewed, yielding a response rate of 96 percent. Table 1.2 Results of the household and individual interviews Number of households, number of interviews, and response rates, ac- cording to residence (unweighted), Sierra Leone 2013 Residence Total Result Urban Rural Household interviews Households selected 4,739 8,267 13,006 Households occupied 4,623 8,101 12,724 Households interviewed 4,569 8,060 12,629 Household response rate1 98.8 99.5 99.3 Interviews with women age 15-49 Number of eligible women 6,996 10,136 17,132 Number of eligible women interviewed 6,773 9,885 16,658 Eligible women response rate2 96.8 97.5 97.2 Interviews with men age 15-59 Number of eligible men 3,137 4,400 7,537 Number of eligible men interviewed 2,980 4,282 7,262 Eligible men response rate2 95.0 97.3 96.4 1 Households interviewed/households occupied 2 Respondents interviewed/eligible respondents Housing Characteristics and Household Population • 11 HOUSING CHARACTERISTICS AND HOUSEHOLD POPULATION 2 his chapter summarises demographic and socioeconomic characteristics of the population in the households sampled in the 2013 Sierra Leone Demographic and Health Survey (SLDHS). It is helpful to understand that in the 2013 SLDHS a household was defined as a person or a group of persons, related or unrelated, who live together and who share a common source of food. Information was collected from all of the usual residents of each selected household and from visitors who had stayed in the selected household the night before the interview. Those persons who stayed in the selected household the night before the interview (whether usual residents or visitors) represent the de facto population; usual residents alone constitute the de jure population. One focus of this chapter is to describe the environment in which women and children live. This description shows housing facilities (sources of water supply, sanitation facilities, dwelling characteristics and household possessions), household arrangements (headship, size), and general characteristics of the population, such as age-sex structure, literacy, and education. This chapter also presents information on child labour. Moreover, a distinction is made between urban and rural settings where many of these indicators usually differ. Besides providing the background for better understanding of many social and demographic phenomena discussed in the following chapters, the information in this chapter is also useful for assessing the level of economic and social development of the population. 2.1 HOUSEHOLD ENVIRONMENT The physical characteristics of the dwelling in which a household lives are important determinants of the health status of household members, especially children. They can also be used as indicators of the T Key Findings • Three out of five households in Sierra Leone get drinking water from an improved source. • Only 10 percent of households use an improved toilet facility that is not shared with other households. • Fourteen percent of Sierra Leonean households have electricity, with 41 percent of urban households having electricity compared with only 1 percent of rural households. • The most common cooking fuel in Sierra Leone is wood, used by more than three-quarters of households. • The proportion of households with a mobile telephone has increased from 28 percent in 2008 to 55 percent in 2013. • Nearly four out of every five children in Sierra Leone under age 5 have been registered with civil authorities, and about one-third have a birth certificate. • More females than males have not attended school (51 percent versus 41 percent). • Ten percent of children under age 18 in Sierra Leone have one or both parents deceased. • Overall, 37 percent of children age 5-14 in Sierra Leone are involved in child labour (44 percent of children age 5-11 and 16 percent of children age 12-14). 12 • Housing Characteristics and Household Population socioeconomic status of households. Respondents in the 2013 SLDHS were asked a number of questions about their household environment, including questions on the source of drinking water; type of sanitation facility; type of flooring, walls, and roof; and number of rooms in the dwelling. The results are presented here in terms of households and of the de jure population. 2.1.1 Drinking Water Increasing access to improved drinking water is one of the Millennium Development Goals (MDGs) that Sierra Leone along with other nations worldwide has adopted (United Nations General Assembly, 2002). Table 2.1 includes a number of indicators that are useful in monitoring household access to improved drinking water. The source of drinking water is an indicator of whether it is suitable for drinking. Sources that are likely to provide water suitable for drinking are identified as improved sources in Table 2.1. They include a piped source within the dwelling or plot, public tap, tube well or borehole, protected well or spring, and rainwater (WHO and UNICEF, 2010). Lack of ready access to a water source may limit the quantity of suitable drinking water that is available to a household. Moreover, even if the household obtains water from an improved source, water that must be fetched from a source that is not immediately accessible to the household may be contaminated during transport or storage. Another factor in considering the accessibility of water sources is that the burden of going for water often falls disproportionately on female members of the household. Finally, home water treatment can be effective in improving the quality of household drinking water. Table 2.1 Household drinking water Percent distribution of households and de jure population by source of drinking water, time to obtain drinking water, and treatment of drinking water, according to residence, Sierra Leone 2013 Households Population Characteristic Urban Rural Total Urban Rural Total Source of drinking water Improved source 89.0 47.5 60.6 88.3 46.5 59.5 Piped into dwelling 3.2 0.1 1.1 3.0 0.1 1.0 Piped to yard/plot 7.7 0.2 2.6 7.6 0.2 2.5 Public tap/standpipe 34.4 7.9 16.3 33.9 7.6 15.8 Tube well or borehole 7.5 20.6 16.4 8.0 19.8 16.1 Protected well 27.2 16.9 20.2 29.2 17.1 20.9 Protected spring 1.6 1.1 1.3 1.6 1.2 1.3 Rain water 0.3 0.5 0.4 0.3 0.5 0.4 Bottled water 7.1 0.2 2.4 4.8 0.1 1.6 Non-improved source 10.6 52.3 39.1 11.3 53.3 40.2 Unprotected well 5.5 9.9 8.5 6.0 10.0 8.7 Unprotected spring 1.5 17.1 12.2 1.7 17.0 12.2 Tanker truck/cart with drum 0.6 0.1 0.3 0.5 0.1 0.2 Surface water 3.0 25.2 18.2 3.1 26.2 19.0 Other 0.2 0.0 0.1 0.1 0.0 0.1 Missing 0.2 0.2 0.2 0.2 0.2 0.2 Total 100.0 100.0 100.0 100.0 100.0 100.0 Time to obtain drinking water (round trip) Water on premises 20.5 4.3 9.4 21.1 4.5 9.7 Less than 30 minutes 47.9 69.1 62.4 46.7 68.1 61.4 30 minutes or longer 29.7 24.8 26.4 30.4 25.8 27.2 Don’t know/missing 1.9 1.8 1.8 1.8 1.6 1.7 Total 100.0 100.0 100.0 100.0 100.0 100.0 Water treatment prior to drinking1 Boiled 1.9 0.6 1.0 2.0 0.7 1.1 Bleach/chlorine added 17.3 7.8 10.8 19.8 8.4 11.9 Strained through cloth 2.3 0.4 1.0 2.5 0.4 1.0 Ceramic, sand or other filter 0.3 0.2 0.2 0.4 0.2 0.2 Solar disinfection 0.1 0.0 0.1 0.1 0.1 0.1 Other 1.5 1.4 1.4 1.8 1.5 1.6 No treatment 76.3 89.0 85.0 73.8 88.2 83.7 Percentage using an appropriate treatment method2 19.3 8.5 11.9 21.9 9.2 13.1 Number 3,993 8,636 12,629 23,187 51,276 74,463 1 Respondents may report multiple treatment methods so the sum of treatment may exceed 100 percent. 2 Appropriate water treatment methods include boiling, bleaching, filtering, and solar disinfecting. Housing Characteristics and Household Population • 13 Table 2.1 shows that three out of five households in Sierra Leone (61 percent) get drinking water from an improved source. Disparities exist by residence, however, with a higher proportion of urban households (89 percent) having an improved source of drinking water compared with rural households (48 percent). Among the improved sources, protected wells account for the highest proportion (20 percent) of households, but mainly in urban areas (27 percent), while the most common improved category for rural households is a tube well or borehole (21percent). Thirty-nine percent of Sierra Leonean households get their drinking water from a non-improved source, mainly surface water from lakes, streams, and rivers (18 percent) and unprotected springs (12 percent). Although only 11 percent of urban households use non-improved sources for drinking water, the proportion is far higher for rural households (52 percent). Only 9 percent of households reported having water on their premises. Furthermore, disparities in accessing water in the household premises are pronounced between rural and urban areas. Twenty-one percent of urban households have water on their premises, compared with less than 5 percent of rural households. Households without water on their premises were asked how long it takes to fetch water. Sixty-two percent of households are within 30 minutes of the source of their drinking water. Notably, 69 percent of rural households travel less than 30 minutes to obtain drinking water, compared with 48 percent of urban households. About a quarter of households (26 percent) travel 30 minutes or longer to obtain their drinking water (30 percent in urban areas and 25 percent in rural areas). All households also were asked whether they treat their water prior to drinking. An overwhelming majority (85 percent) do not treat their drinking water. Urban households (19 percent) are more likely than rural households (9 percent) to use an appropriate treatment method to ensure that their water is safe for drinking. 2.1.2 Household Sanitation Facilities Ensuring adequate sanitation facilities is an MDG goal that Sierra Leone shares with other countries. A household is classified as having an improved toilet if the toilet is used only by members of one household (i.e., it is not shared) and if the facility used by the household separates the waste from human contact (WHO and UNICEF, 2010). As Table 2.2 shows, only 10 percent of households use an improved toilet facility that is not shared with other households. Urban households are much more likely than rural households to have an improved toilet facility (20 percent and 5 percent, respectively). The most common type of toilet facility in rural areas is an open pit latrine or one without a slab (34 percent of rural households), while in urban areas toilet facilities are mainly shared with other households (33 percent). Overall, 21 percent of households have no toilet facility at all; they are almost exclusively rural, accounting for 28 percent of rural households. 14 • Housing Characteristics and Household Population Table 2.2 Household sanitation facilities Percent distribution of households and de jure population by type of toilet/latrine facilities, according to residence, Sierra Leone 2013 Households Population Type of toilet/latrine facility Urban Rural Total Urban Rural Total Improved, not shared facility Flush/pour flush to piped sewer system 0.6 0.0 0.2 0.6 0.0 0.2 Flush/pour flush to septic tank 7.8 0.1 2.5 7.6 0.1 2.4 Flush/pour flush to pit latrine 1.2 0.1 0.4 1.4 0.0 0.5 Ventilated improved pit (VIP) latrine 3.2 2.2 2.5 3.8 2.4 2.8 Pit latrine with slab 6.6 2.6 3.9 8.4 2.8 4.6 Composting toilet 0.0 0.0 0.0 0.0 0.1 0.0 Total 19.5 5.0 9.6 21.9 5.4 10.6 Shared facility1 Flush/pour flush to piped sewer system 0.2 0.0 0.1 0.1 0.0 0.0 Flush/pour flush to septic tank 2.0 0.0 0.7 1.5 0.0 0.5 Flush/pour flush to pit latrine 1.6 0.1 0.6 1.5 0.1 0.6 Ventilated improved pit (VIP) latrine 19.4 14.4 16.0 17.8 13.8 15.0 Pit latrine with slab 33.0 16.5 21.7 32.8 16.7 21.7 Composting toilet 0.1 0.4 0.3 0.1 0.4 0.3 Total 56.4 31.6 39.4 53.9 31.1 38.2 Non-improved facility Flush/pour flush not to sewer/ septic tank/pit latrine 0.7 0.0 0.2 0.9 0.0 0.3 Pit latrine without slab/open pit 11.6 34.4 27.2 12.1 36.0 28.6 Bucket 0.4 0.0 0.1 0.3 0.0 0.1 Hanging toilet/hanging latrine 3.6 0.7 1.6 3.4 0.7 1.5 No facility/bush/field 6.8 28.1 21.4 6.5 26.4 20.2 Other 0.3 0.1 0.2 0.3 0.1 0.2 Missing 0.7 0.2 0.3 0.8 0.2 0.4 Total 24.2 63.4 51.0 24.2 63.5 51.3 Total 100.0 100.0 100.0 100.0 100.0 100.0 Number 3,993 8,636 12,629 23,187 51,276 74,463 1 Facilities that would be considered improved if they were not shared by two or more households. 2.1.3 Housing Characteristics Table 2.3 presents characteristics of Sierra Leonean households. These characteristics reflect the household’s socioeconomic situation. They also may influence environmental conditions—for example, in the case of the use of biomass fuels, exposure to indoor pollution—that have a direct bearing on the health and welfare of household members. Table 2.3 shows that 14 percent of Sierra Leonean households have electricity, a slight increase from the 12 percent recorded in the 2008 SLDHS. There is a large imbalance between urban and rural areas, with 41 percent of urban households having electricity, compared with 1 percent of rural households. More than half of Sierra Leonean households (57 percent) occupy dwellings with floors made of earth, sand, or dung. The next most common type of flooring material is cement, accounting for 35 percent of households. Most urban households have floors made of cement (67 percent), while rural households mainly have floors made from earth, sand, or dung (76 percent). The number of rooms used for sleeping is an indicator of the extent of crowding in households. Overcrowding increases the risk of contracting diseases like acute respiratory infections, tuberculosis, and skin diseases. Overall, only 27 percent of Sierra Leonean households use only one room for sleeping, while 29 percent use two rooms, and the remainder use three or more rooms for sleeping. Urban households tend to have fewer rooms for sleeping; 36 percent use only one room for sleeping, compared with 22 percent of rural households. Housing Characteristics and Household Population • 15 With regard to cooking arrangements, Sierra Leonean households differ greatly between cooking in the house (4 percent) and cooking in a separate building (39 percent). Fifty-five percent of households do their cooking outdoors. There is little difference in the place of cooking by urban- rural residence—at 56 percent of rural households and 54 percent of urban households. Cooking and heating with solid fuels can lead to high levels of indoor smoke, a complex mix of health-damaging pollutants that could increase the risks of acute respiratory diseases. Solid fuels are defined as coal, charcoal, wood, straw, shrubs, and agricultural crops. In the 2013 SLDHS, households were asked about their primary source of fuel for cooking. Their answers show that 98 percent of households use solid fuel for cooking. The use of solid fuel is nearly universal in households in rural areas (99 percent), compared with 96 percent in urban areas. The most common cooking fuel in Sierra Leone is wood, used by more than three-fourth (78 percent) of households. Although wood is widely used in rural areas (97 percent of households), urban households rely mainly on charcoal (60 percent). The 2013 SLDHS collected information on smoking to assess the percentage of household members who are exposed to second-hand smoke (SHS), which is a risk factor for those who do not smoke. Pregnant women who are exposed to SHS have a higher risk of delivering a low-birth- weight baby (Windham et al., 1999). In addition, children who are exposed to SHS are at a higher risk of respiratory and ear infections and poor lung development (U.S. Department of Health and Human Services, 2006). Table 2.3 provides information on the frequency of smoking in the home, which is used as a proxy for level of SHS exposure. Overall, 38 percent of households in Sierra Leone are exposed daily to SHS, with rural households more frequently exposed daily to SHS than urban households (43 percent versus 26 percent). Table 2.3 Household characteristics Percent distribution of households by housing characteristics, percentage using solid fuel for cooking, and percent distribution by frequency of smoking in the home, according to residence, Sierra Leone 2013 Residence Housing characteristic Urban Rural Total Electricity Yes 41.4 0.7 13.5 No 58.5 99.3 86.4 Missing 0.1 0.0 0.1 Total 100.0 100.0 100.0 Flooring material Earth, sand 15.5 75.8 56.7 Dung 0.7 3.5 2.6 Wood/planks 0.3 0.0 0.1 Palm/bamboo 0.0 0.1 0.1 Parquet or polished wood 0.4 0.2 0.3 Vinyl or asphalt strips 0.2 0.0 0.1 Ceramic tiles 11.6 0.6 4.1 Cement 67.0 19.5 34.5 Carpet 2.4 0.1 0.8 Other 1.7 0.1 0.6 Missing 0.1 0.2 0.2 Total 100.0 100.0 100.0 Rooms used for sleeping One 36.3 21.9 26.5 Two 29.7 29.2 29.4 Three or more 33.0 48.2 43.4 Missing 1.0 0.7 0.8 Total 100.0 100.0 100.0 Place for cooking In the house 5.6 2.9 3.8 In a separate building 36.8 40.3 39.2 Outdoors 53.9 55.6 55.0 No food cooked in household 2.9 0.8 1.5 Other 0.6 0.3 0.4 Missing 0.1 0.1 0.1 Total 100.0 100.0 100.0 Cooking fuel Electricity 0.0 0.0 0.0 LPG/natural gas/biogas 0.3 0.0 0.1 Kerosene 0.2 0.0 0.1 Coal/lignite 0.1 0.0 0.1 Charcoal 59.6 2.2 20.3 Wood 36.4 96.8 77.7 Straw/shrubs/grass 0.2 0.1 0.1 Agricultural crop 0.0 0.0 0.0 Other 0.0 0.0 0.0 No food cooked in household 2.9 0.8 1.5 Missing 0.2 0.1 0.1 Total 100.0 100.0 100.0 Percentage using solid fuel for cooking1 96.3 99.1 98.2 Frequency of smoking in the home Daily 26.3 42.8 37.6 Weekly 1.3 0.7 0.9 Monthly 0.1 0.0 0.1 Less than monthly 0.2 0.2 0.2 Never 71.9 56.1 61.1 Missing 0.1 0.2 0.1 Total 100.0 100.0 100.0 Number 3,993 8,636 12,629 LPG = Liquid petroleum gas 1 Includes coal/lignite, charcoal, wood, straw/shrubs/grass, agricultural crops, and animal dung. 16 • Housing Characteristics and Household Population 2.1.4 HOUSEHOLD POSSESSIONS The availability of durable consumer goods is a useful indicator of a household’s socioeconomic status. Moreover, particular goods have specific benefits. For instance, 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 2.4 shows the availability of selected consumer goods by residence. Ownership of durable goods varies according to residence and the nature of the asset. Of the items asked about in the 2013 SLDHS, radio, television, mobile phone, agricultural land, and farm animals stand out as the assets most commonly owned by households. Fifty-nine percent of Sierra Leonean households own a radio, while 55 percent own a mobile phone and 51 percent own farm animals. Notably, 62 percent of households own agricultural land. Somewhat fewer households own a television set (14 percent), a bicycle (8 percent), a refrigerator (6 percent), or a motorcycle or scooter (6 percent). There is noticeable variation between urban and rural areas in the proportion of households owning specific goods. Most of the electronic goods are considerably more prevalent in urban areas, but farm-oriented possessions are more commonly found in rural areas. For example, 20 percent of urban households own a refrigerator, compared with less than 1 percent of rural households. Similarly, 38 percent of urban households own a television, compared with 2 percent of rural households. Differentials in ownership of mobile phones are also apparent (85 percent for urban households and 41 percent for rural households). Radio possession is prevalent among both urban and rural households (75 percent and 51 percent, respectively). However, ownership of farm animals (cattle, cows, bulls, horses, donkeys, mules, goats, sheep, rabbits, rodents, chickens and other fowls) is more common in rural than urban areas (61 percent and 30 percent, respectively). The percentage of households owning some of the items has increased since the 2008 SLDHS. The most dramatic increase has been in ownership of telephones. The proportion of households with a mobile telephone increased from 28 percent in 2008 to 55 percent in 2013. This increase could be a result of increased availability of affordable phones together with an increase in the number of service providers and the extent of geographical coverage. Ownership of other items increased minimally, while ownership of bicycles decreased from 11 percent in 2008 to 8 percent in 2013. 2.2 WEALTH INDEX The wealth index used in the 2013 SLDHS has also been used in many other DHS surveys as well as other country-level surveys to indicate inequalities in household characteristics, in the use of health and other services, and in health outcomes (Rutstein et al., 2000). It serves as an indicator of wealth that is consistent with expenditure and income measures (Rutstein, 1999). It is based on the survey data about the household’s ownership of consumer goods; dwelling characteristics; type of drinking water source; toilet facilities; and other characteristics that relate to a household’s socioeconomic status. Table 2.4 Household possessions Percentage of households possessing various household effects, means of transportation, agricultural land, and livestock/farm animals by residence, Sierra Leone 2013 Residence Total Possession Urban Rural Household effects Radio 75.1 51.3 58.8 Television 37.9 2.4 13.6 Mobile telephone 84.7 41.1 54.9 Non-mobile telephone 1.0 0.3 0.5 Refrigerator 19.6 0.3 6.4 Means of transport Bicycle 7.1 8.0 7.7 Animal drawn cart 0.2 0.1 0.1 Motorcycle/scooter 8.1 4.4 5.6 Car/truck 5.5 0.2 1.9 Boat with a motor 0.5 0.8 0.7 Ownership of agricultural land 22.9 79.5 61.6 Ownership of farm animals1 29.9 61.2 51.3 Number 3,993 8,636 12,629 1 Cattle, cows, bulls, horses, donkeys, mules, goats, sheep, rabbits, rodents, chickens and other fowls. Housing Characteristics and Household Population • 17 The index was constructed through a principal components analysis. In its current form, which takes better account of urban-rural differences in scores and indicators of wealth, the wealth index is created in three steps. In the first step, a subset of indicators common to urban and rural areas is used to create wealth scores for households in both areas. Categorical variables to be used are transformed into separate dichotomous (0-1) indicators. These indicators and those that are continuous are then examined using a principal components analysis to produce a common factor score for each household. In the second step, separate factor scores are produced for households in urban and rural areas using area-specific indicators. The third step combines the separate area-specific factor scores to produce a nationally applicable combined wealth index by adjusting area-specific scores through a regression on the common factor scores. The resulting combined wealth index has a mean of zero and a standard deviation of one. Once the index is computed, national-level wealth quintiles (from lowest to highest) are obtained by assigning household scores to each de jure household member, ranking each person in the population by his or her score, and then dividing the ranking into five equal categories, each comprising 20 percent of the population. Table 2.5 shows the distribution of the de jure household population into five wealth levels (quintiles) based on the wealth index, by residence. These distributions indicate the degree to which wealth is evenly (or unevenly) distributed by geographic areas of Sierra Leone. Table 2.5 Wealth quintiles Percent distribution of the de jure population by wealth quintiles, and the Gini Coefficient, according to residence and region, Sierra Leone 2013 Wealth quintile Total Number of persons Gini coefficient Residence/region Lowest Second Middle Fourth Highest Residence Urban 2.8 1.6 6.4 28.0 61.2 100.0 23,187 0.26 Rural 27.8 28.3 26.2 16.4 1.4 100.0 51,276 0.34 Region Eastern 24.4 24.6 18.4 19.3 13.3 100.0 17,045 0.28 Northern 18.4 24.6 27.2 23.5 6.2 100.0 29,113 0.22 Southern 31.8 20.5 20.5 19.0 8.2 100.0 16,468 0.27 Western 1.1 1.2 3.8 13.9 80.0 100.0 11,838 0.26 District Kailahun 27.5 30.9 24.0 15.4 2.1 100.0 4,897 0.19 Kenema 24.6 18.2 14.5 20.9 21.8 100.0 7,911 0.31 Kono 20.5 29.4 19.2 20.7 10.2 100.0 4,237 0.28 Bombali 20.7 23.1 21.0 21.4 13.7 100.0 6,171 0.29 Kambia 10.0 27.0 37.4 22.9 2.7 100.0 3,464 0.17 Koinadugu 30.4 27.7 21.8 15.5 4.6 100.0 3,591 0.20 Port Loko 11.6 23.8 32.5 27.3 4.8 100.0 8,822 0.20 Tonkolili 23.0 24.3 23.8 25.0 4.0 100.0 7,065 0.19 Bo 15.9 20.8 22.2 22.8 18.3 100.0 6,270 0.28 Bonthe 45.6 13.4 19.2 19.2 2.6 100.0 3,019 0.30 Moyamba 47.2 20.2 17.7 13.4 1.4 100.0 4,087 0.21 Pujehun 29.9 27.3 22.0 18.3 2.5 100.0 3,092 0.22 Western Area Rural 4.1 5.9 10.7 37.8 41.5 100.0 2,048 0.35 Western Area Urban 0.5 0.3 2.4 8.9 88.0 100.0 9,789 0.23 Total 20.0 20.0 20.0 20.0 20.0 100.0 74,463 0.33 Wealth is concentrated in the urban areas, with 61 percent of the urban population falling in the highest wealth quintile. In contrast, rural areas are poorer, with 28 percent of the population being in the lowest wealth quintile and only 1 percent in the highest quintile. In Western region, which is almost entirely urban, 80 percent of the population is in the highest quintile, while in Southern region 32 percent of its population is in the lowest quintile. Other regions have varying distributions of population in different wealth quintiles. Eastern and Northern regions show a substantial distribution across all the wealth quintiles. The Eastern, Northern, and Southern regions have most of their populations within the first three quintiles. 2.3 HAND WASHING Washing hands with soap and water is the ideal hygienic practice. Research shows the substantial potential that hand washing with water and soap (or a non-soap cleansing agent such as ash or sand) has for reducing the transmission of diarrhoea, respiratory infections, and other illnesses (Ensink and Curtis, 2008; 18 • Housing Characteristics and Household Population Luby et al., 2005). To obtain information on hand washing, SLDHS interviewers asked to see the place where household members most often washed their hands and recorded information on the availability of water and soap and/or other cleansing agents at that place. Table 2.6 shows that a place for hand washing was observed in 22 percent of households— 33 percent urban and 17 percent rural. The main reason that interviewers were not able to observe the place where household members washed their hands was that the place was not in the dwelling (data not shown). Table 2.6 Hand washing Percentage of households in which the place most often used for washing hands was observed, and among households in which the place for hand washing was observed, percent distribution by availability of water, soap and other cleansing agents, Sierra Leone 2013 Percentage of households where place for washing hands was observed Number of households Among households where place for hand washing was observed, percentage with: Number of households with place for hand washing observed Background characteristic Soap and water1 Water and cleansing agent2 other than soap only Water only Soap but no water3 Cleansing agent other than soap only2 No water, no soap, no other cleansing agent Missing Total Residence Urban 33.0 3,993 55.1 0.5 12.6 5.8 0.1 25.2 0.6 100.0 1,318 Rural 16.5 8,636 12.2 2.4 10.6 3.9 0.8 69.7 0.4 100.0 1,423 Region Eastern 21.3 3,041 35.3 2.7 7.6 7.5 0.3 46.6 0.0 100.0 648 Northern 20.3 4,556 9.8 2.1 10.3 2.5 1.1 73.3 0.9 100.0 925 Southern 10.6 2,874 15.4 0.2 16.8 3.2 0.3 63.7 0.3 100.0 305 Western 40.0 2,158 61.7 0.5 14.0 5.9 0.0 17.3 0.6 100.0 863 District Kailahun 2.9 939 (36.5) (0.0) (12.7) (13.5) (0.0) (37.4) (0.0) 100.0 27 Kenema 38.6 1,401 37.3 0.9 8.2 6.2 0.2 47.2 0.0 100.0 540 Kono 11.5 702 21.9 15.2 1.7 14.1 0.9 46.2 0.0 100.0 81 Bombali 32.0 1,022 1.6 0.0 6.4 0.0 0.0 90.5 1.5 100.0 327 Kambia 12.4 487 12.7 1.0 6.2 10.3 0.0 69.8 0.0 100.0 61 Koinadugu 19.2 584 5.3 0.0 2.5 11.4 7.6 73.2 0.0 100.0 112 Port Loko 11.1 1,355 25.8 0.2 27.1 0.6 0.0 43.9 2.4 100.0 150 Tonkolili 24.9 1,109 12.1 6.6 10.0 1.0 0.5 69.8 0.0 100.0 276 Bo 19.2 1,037 18.2 0.0 21.1 4.3 0.3 56.2 0.0 100.0 199 Bonthe 11.2 530 8.3 0.0 4.5 2.1 0.9 84.3 0.0 100.0 59 Moyamba 0.9 723 * * * * * * * 100.0 6 Pujehun 6.8 585 10.1 0.0 16.3 0.0 0.0 71.0 2.6 100.0 40 Western Area Rural 16.7 361 65.6 0.3 25.0 2.4 0.0 6.3 0.3 100.0 60 Western Area Urban 44.7 1,797 61.4 0.5 13.2 6.2 0.0 18.2 0.6 100.0 803 Wealth quintile Lowest 17.6 2,709 7.2 2.7 7.5 3.2 0.5 78.7 0.2 100.0 476 Second 16.6 2,562 12.7 3.4 9.7 5.2 1.5 66.7 0.7 100.0 426 Middle 16.3 2,385 10.7 1.4 14.2 4.2 0.8 68.4 0.4 100.0 389 Fourth 18.7 2,363 29.9 1.2 13.7 5.3 0.1 49.5 0.3 100.0 442 Highest 38.6 2,611 63.2 0.3 12.3 5.5 0.0 17.9 0.8 100.0 1,007 Total 21.7 12,629 32.8 1.5 11.6 4.8 0.5 48.3 0.5 100.0 2,741 Note: Figures in parentheses are based on 25-49 unweighted cases. An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. 1 Soap includes soap or detergent in bar, liquid, powder or paste form. This column includes households with soap and water only as well as those that had soap and water and another cleansing agent. 2 Cleansing agents other than soap include locally available materials such as ash, mud or sand 3 Includes households with soap only as well as those with soap and another cleansing agent Among households where the place for hand washing was observed, 33 percent had soap and water available. In most other households only water was available. Forty-eight percent of households had no water, soap, or other cleaning agent available. Urban households were more likely than rural households to have soap and water available at the usual place for hand washing (55 percent versus 12 percent). In Western Rural district 66 percent of households had soap and water available at the usual place for hand washing, compared with only 2 percent in Bombali district. The likelihood of having soap and water available was highest in Western region (62 percent) and lowest in the Northern region (10 percent). Compared with households in other regions, households in the Western and Southern regions were more likely to have only water available (14 percent Housing Characteristics and Household Population • 19 and 17 percent, respectively). Households in the highest, fourth, and middle wealth quintiles were more likely to have soap and water available than households in the second and lowest wealth quintiles. 2.4 POPULATION BY AGE AND SEX Age and sex are important demographic variables and are the primary basis of demographic classification. Table 2.7 shows the distribution of the de facto household population in the 2013 SLDHS by five-year age groups, according to sex and residence. A total of 73,791 individuals were residing in the sampled households; 38,332 were female (52 percent), and 35,460 were male (48 percent). There are more persons in the younger age groups than in the older age groups for both sexes, with those under age 20 accounting for more than half of the population. Table 2.7 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, Sierra Leone 2013 Urban Rural Male Female Total Age Male Female Total Male Female Total <5 13.7 12.6 13.1 18.5 17.9 18.2 17.0 16.2 16.6 5-9 14.6 13.7 14.1 19.1 16.4 17.7 17.7 15.5 16.6 10-14 13.0 12.8 12.9 14.1 11.0 12.5 13.7 11.6 12.6 15-19 12.4 13.3 12.9 7.9 8.9 8.4 9.3 10.3 9.8 20-24 9.4 10.0 9.7 5.0 6.0 5.5 6.3 7.3 6.8 25-29 7.9 8.7 8.3 5.0 7.3 6.2 5.9 7.7 6.9 30-34 5.4 5.9 5.7 4.6 6.1 5.4 4.9 6.0 5.5 35-39 5.7 6.1 5.9 5.5 6.2 5.9 5.6 6.1 5.9 40-44 4.0 3.3 3.6 4.2 3.6 3.9 4.1 3.5 3.8 45-49 3.9 3.2 3.5 4.0 3.6 3.8 4.0 3.5 3.7 50-54 2.3 3.1 2.7 2.5 3.8 3.2 2.5 3.5 3.0 55-59 2.1 2.0 2.1 2.1 2.5 2.3 2.1 2.3 2.2 60-64 2.1 1.7 1.9 2.7 2.4 2.5 2.5 2.2 2.3 65-69 1.3 1.5 1.4 1.7 1.7 1.7 1.6 1.6 1.6 70-74 1.1 1.0 1.0 1.4 1.2 1.3 1.3 1.1 1.2 75-79 0.5 0.5 0.5 0.9 0.8 0.8 0.8 0.7 0.7 80 + 0.4 0.6 0.5 0.7 0.8 0.8 0.6 0.8 0.7 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number 10,975 12,003 22,978 24,485 26,328 50,813 35,460 38,332 73,791 Figure 2.1 illustrates the age-sex structure of the Sierra Leonean population, in a population pyramid. The share of the population under age 15 is almost 46 percent; people age 15-64 constitute about 50 percent, and those age 65 and older make up 4 percent of the total Sierra Leonean household population. The pyramid has a wide base, indicating that a large proportion of the population is under age 15. Figure 2.1 Population pyramid 10 8 6 4 2 0 2 4 6 8 10 <5 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80 + Percent Age Male Female Sierra Leone, 2013 20 • Housing Characteristics and Household Population 2.5 HOUSEHOLD COMPOSITION Table 2.8 presents information on key aspects of the composition of households, including the sex of the household head and the size of the household. These characteristics are important because they are associated with the welfare of the household. Households headed by women, for example, are typically poorer than households headed by men. In large households economic resources are often more limited than in small ones. Moreover, where the size of the household is large, crowding can lead to health problems. The data for household composition show that, at the national level, women head 28 percent of Sierra Leonean households, a slightly higher proportion than observed in the 2008 SLDHS (22 percent). There are modest differences in female-headed households between urban areas (34 percent) and rural areas (25 percent). The data also show that the mean size of a Sierra Leonean household is 5.9 persons, the same as in the 2008 SLDHS. There is no difference in average household size between rural and urban households (5.9 and 5.8 persons, respectively) 2.6 BIRTH REGISTRATION The registration of births is the inscription of the facts of the birth into an official log kept at the registrar’s office. A birth certificate is issued at the time of registration or later as proof of the registration of the birth. Birth registration is basic to ensuring a child’s legal status and, thus, basic rights and services (UNICEF, 2006; United Nations General Assembly, 2002). Table 2.9 gives 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. Not all children who are registered may have a birth certificate because some certificates may have been lost or never issued. However, all children with a certificate have been registered. Nearly four of every five children in Sierra Leone under age 5 have been registered with civil authorities, and about one-third (34 percent) have a birth certificate. The distribution by age groups and gender shows a nearly equal proportion of birth registration. However, differentials exist according to residence, region, district, and wealth quintile. For example, the births of almost 80 percent of children in urban areas have been registered, compared with 76 percent in rural areas. The Southern region leads in the proportion of children registered (83 percent), followed by Western and Eastern regions (77 percent), with the Northern region having the lowest proportion registered (73 percent). At the district level, Pujehun district recorded the highest proportion of registered births (91 percent), followed by Kailahun and Bonthe Table 2.8 Household composition Percent distribution of households by sex of head of household and by household size; mean size of household, and percentage of households with orphans and foster children under age 18, according to residence, Sierra Leone 2013 Residence Total Characteristic Urban Rural Household headship Male 66.3 74.6 72.0 Female 33.7 25.4 28.0 Total 100.0 100.0 100.0 Number of usual members 0 0.0 0.0 0.0 1 6.3 3.0 4.0 2 6.7 4.9 5.5 3 11.2 9.8 10.3 4 12.9 15.0 14.3 5 16.4 16.6 16.6 6 12.9 15.5 14.6 7 9.5 11.7 11.0 8 7.3 8.2 7.9 9+ 16.8 15.3 15.7 Total 100.0 100.0 100.0 Mean size of households 5.8 5.9 5.9 Percentage of households with orphans and foster children under 18 years of age Foster children1 42.8 35.0 37.5 Double orphans 4.7 3.6 3.9 Single orphans2 18.5 14.8 15.9 Foster and/or orphan children 47.9 39.6 42.2 Number of households 3,993 8,636 12,629 Note: Table is based on de jure household members (i.e., usual residents). 1 Foster children are those under age 18 living in households with neither their mother nor their father present. 2 Includes children with one dead parent and an unknown survival status of the other parent. Housing Characteristics and Household Population • 21 districts (88 percent), while Koinadugu district recorded the lowest proportion (50 percent). The results show that children in higher wealth quintiles are more likely to be registered and to possess a birth certificate than those in lower wealth quintiles. 2.7 CHILDREN’S LIVING ARRANGEMENTS AND ORPHANHOOD Table 2.10 presents detailed information on living arrangements and orphanhood for children under age 18. In Sierra Leone half of the children under age 18 live with both parents, the same as in the 2008 SLDHS. About 14 percent live with their mother only while the father is alive; a slightly higher proportion than observed in the 2008 SLDHS (10 percent). Seven percent live with their father while the mother is alive; a slightly higher proportion (9 percent) was observed in 2008. The percentage of children that live with neither of their natural parents decreased from 26 percent in 2008 to 24 percent in 2013. The table also provides information on the type of orphanhood, that is, the proportion of children who have lost one or both parents. Ten percent of children under age 18 have lost one or both parents, and 2 percent have lost both parents. Girls are more likely than boys not to live with their biological parents (26 and 22 percent, respectively). More children in urban than rural areas (30 and 21 percent, respectively) do not reside with their parents who are still living. The proportion of children not living with their parents is higher in the Western region (29 percent) than in the other regions. In the Western Urban district 29 percent of children are not living with their biological parents. Most children (61 percent) in Koinadugu district live with both biological parents; only 16 percent are not living with a biological parent. Table 2.9 Birth registration of children under age 5 Percentage of de jure children under age 5 whose births are registered with the civil authorities, according to background characteristics, Sierra Leone 2013 Children whose births are registered Number of children Background characteristic Percentage who had a birth certificate Percentage who did not have birth certificate Percentage registered Age <2 34.3 43.0 77.3 4,635 2-4 33.5 42.9 76.4 7,646 Sex Male 32.7 43.4 76.2 6,063 Female 34.8 42.4 77.2 6,218 Residence Urban 44.0 35.6 79.6 3,023 Rural 30.5 45.3 75.8 9,259 Region Eastern 30.4 46.4 76.7 2,896 Northern 32.2 40.7 72.9 5,039 Southern 31.7 51.3 83.0 2,897 Western 50.5 26.8 77.3 1,449 District Kailahun 45.9 41.7 87.6 877 Kenema 28.3 42.1 70.4 1,220 Kono 16.5 58.0 74.6 799 Bombali 36.5 46.4 82.9 893 Kambia 55.7 8.9 64.6 648 Koinadugu 23.9 25.9 49.8 652 Port Loko 33.4 36.7 70.1 1,601 Tonkolili 19.6 66.1 85.7 1,246 Bo 49.4 26.6 75.9 1,083 Bonthe 14.3 74.0 88.3 531 Moyamba 20.6 62.9 83.5 698 Pujehun 28.0 62.6 90.6 585 Western Area Rural 42.0 39.1 81.1 274 Western Area Urban 52.5 24.0 76.5 1,175 Wealth quintile Lowest 26.6 50.8 77.4 2,920 Second 31.3 42.3 73.6 2,689 Middle 31.0 42.6 73.7 2,579 Fourth 34.1 45.9 80.1 2,360 Highest 53.3 27.0 80.3 1,733 Total 33.8 42.9 76.7 12,281 22 • Housing Characteristics and Household Population Table 2.10 Children’s living arrangements and orphanhood Percent distribution of de jure children under age 18 by living arrangements and survival status of parents, the percentage of children not living with a biological parent, and the percentage of children with one or both parents dead, according to background characteristics, Sierra Leone 2013 Living with both parents Living with mother but not with father Living with father but not with mother Not living with either parent Total Percentage not living with a biological parent Percentage with one or both parents dead1 Number of children Background characteristic Father alive Father dead Mother alive Mother dead Both alive Only father alive Only mother alive Both dead Missing information on father/ mother Age 0-4 60.7 20.2 2.2 4.1 0.5 10.1 0.6 0.7 0.5 0.4 100.0 11.9 4.6 12,281 <2 66.5 25.4 2.9 1.7 0.2 2.3 0.3 0.1 0.1 0.5 100.0 2.8 3.6 4,635 2-4 57.2 17.0 1.9 5.5 0.7 14.8 0.7 1.0 0.8 0.3 100.0 17.4 5.2 7,646 5-9 50.5 11.7 3.4 8.1 0.9 20.1 1.2 2.3 1.5 0.4 100.0 25.1 9.3 12,312 10-14 43.3 9.9 5.0 8.2 1.5 23.6 1.3 4.1 2.5 0.6 100.0 31.5 14.4 9,383 15-17 34.9 9.1 6.1 7.9 1.8 25.3 2.4 6.0 4.5 1.8 100.0 38.2 20.9 4,442 Sex Male 51.4 13.8 3.7 7.3 1.1 16.5 1.2 2.7 1.6 0.6 100.0 22.0 10.4 19,379 Female 49.0 13.6 3.8 6.3 0.9 20.2 1.1 2.6 1.9 0.6 100.0 25.9 10.4 19,038 Residence Urban 39.1 17.5 4.9 6.6 0.9 23.0 1.6 3.3 2.4 0.7 100.0 30.3 13.2 11,036 Rural 54.7 12.2 3.3 6.9 1.1 16.5 1.0 2.4 1.5 0.5 100.0 21.3 9.2 27,382 Region Eastern 49.0 14.3 3.5 7.9 0.9 18.7 1.1 2.6 1.3 0.5 100.0 23.8 9.5 8,783 Northern 53.0 12.8 3.7 6.6 1.0 16.9 1.1 2.7 1.7 0.4 100.0 22.4 10.2 15,735 Southern 53.3 11.9 2.9 6.3 1.1 18.9 1.1 2.1 1.6 0.8 100.0 23.8 8.9 8,647 Western 38.8 18.2 5.8 6.4 1.0 20.9 1.5 3.3 3.1 0.9 100.0 28.8 14.8 5,252 District Kailahun 52.4 14.5 4.3 6.8 0.6 16.8 0.6 2.2 1.4 0.4 100.0 21.0 9.2 2,474 Kenema 46.0 14.3 3.0 9.3 0.6 21.0 1.2 2.5 1.4 0.6 100.0 26.1 8.7 3,975 Kono 50.6 14.2 3.5 6.9 1.6 16.9 1.5 3.4 1.1 0.4 100.0 22.9 11.1 2,335 Bombali 54.4 12.2 4.6 5.9 0.7 16.7 0.9 2.8 1.5 0.2 100.0 22.0 10.6 3,292 Kambia 55.1 10.6 2.6 8.0 0.4 19.4 0.7 1.8 1.3 0.2 100.0 23.1 6.7 1,934 Koinadugu 60.7 11.6 3.0 5.9 1.8 11.3 1.5 1.3 2.1 0.7 100.0 16.3 9.8 1,948 Port Loko 53.1 13.5 2.9 5.7 1.0 17.6 1.1 3.2 1.2 0.7 100.0 23.1 9.5 4,771 Tonkolili 46.6 14.3 4.7 8.0 1.2 18.0 1.2 3.2 2.3 0.3 100.0 24.8 12.7 3,789 Bo 54.6 12.9 2.1 5.2 1.1 18.8 1.0 1.9 1.6 0.7 100.0 23.3 7.7 3,391 Bonthe 55.3 9.8 3.6 5.8 0.8 18.8 1.2 2.1 2.0 0.5 100.0 24.1 9.7 1,536 Moyamba 52.6 11.3 3.1 8.7 1.3 17.1 0.9 2.0 2.2 0.8 100.0 22.1 9.4 2,065 Pujehun 49.4 12.2 3.4 6.0 1.2 21.5 1.6 3.0 0.7 1.0 100.0 26.7 9.9 1,654 Western Area Rural 37.7 21.5 4.4 6.5 1.1 22.4 1.3 2.6 1.6 0.9 100.0 27.9 11.1 981 Western Area Urban 39.1 17.5 6.1 6.4 1.0 20.6 1.6 3.4 3.5 0.9 100.0 29.0 15.6 4,272 Wealth quintile Lowest 56.6 12.0 3.7 6.8 0.9 15.4 1.0 1.8 1.3 0.5 100.0 19.5 8.7 7,909 Second 55.0 12.7 3.2 6.8 1.0 15.7 1.0 2.5 1.6 0.4 100.0 20.8 9.4 7,954 Middle 54.1 12.1 3.1 6.7 0.9 17.7 1.0 2.4 1.4 0.5 100.0 22.5 8.8 7,980 Fourth 44.3 15.7 4.4 6.9 1.2 20.0 1.3 3.3 2.1 0.7 100.0 26.8 12.3 7,871 Highest 39.3 16.3 4.4 6.9 1.1 23.8 1.6 3.2 2.5 0.9 100.0 31.1 13.0 6,703 Total <15 52.2 14.3 3.4 6.7 0.9 17.4 1.0 2.2 1.4 0.4 100.0 22.1 9.0 33,975 Total <18 50.2 13.7 3.7 6.8 1.0 18.3 1.2 2.6 1.8 0.6 100.0 23.9 10.4 38,417 Note: Table is based on de jure members (i.e., usual residents). 1 Includes children with father dead, mother dead, both dead and one parent dead but missing information on survival status of the other parent. 2.8 SCHOOL ATTENDANCE BY SURVIVORSHIP OF PARENTS Children who are orphaned may be at a greater risk of not attending school, while those who are in school may drop out because they lack money to pay school fees. The 2013 SLDHS collected information to monitor such situations. Table 2.11 presents data on school attendance of children age 10-14 by parental survival according to background characteristics. The table shows the proportion of children attending school whose parents are both dead and the proportion whose parents are both living and the child is residing with at least one parent. The overall ratio of school attendance of children whose parents are dead to those whose parents are living and the child resides with at least one parent is 0.81. Although the ratio is higher than that observed in the 2008 SLDHS (0.62), the current ratio indicates orphaned children are less likely to have access to Housing Characteristics and Household Population • 23 school than children with at least one living parent. The gap in school attendance between children whose parents are living and children whose parents are dead is wider for girls but has been narrowed from 0.57 in 2008 to 0.76 in 2013. In urban areas children whose parents are living are more likely to be in school than those whose parents are dead (92 percent versus 80 percent); the gap is wider in rural areas than urban areas (0.72 versus 0.87). There are large differentials in the ratio by region; in the Southern and Western regions the ratio is 0.86, compared with 0.61 in the Eastern region. 2.9 EDUCATION OF THE HOUSEHOLD POPULATION Education is a key determinant of an individual’s lifestyle and socioeconomic status. Studies have consistently shown that educational attainment has a strong effect on health behaviours and attitudes. Results from the 2013 SLDHS can be used to look at educational attainment among household members and school attendance ratios among youth. For the tables presented here, the official age for entry into the primary level is six years. The official duration of primary school is six years (i.e., from class 1 to class 6), and the number of years assumed for completion of secondary school is seven years (6 – 3 – 4 – 4 arrangement). 2.9.1 Educational Attainment Tables 2.12.1 and 2.12.2 present data on educational attainment of household members age 6 and older, for each sex. The data show a decrease in the proportion of women and men with no education (51 percent for women and 41 percent for men) compared with the 2008 SLDHS (58 percent for women and 46 percent for men). As expected, men are more likely to have either completed secondary (5 percent) or attained more than secondary (3 percent) than women (2 percent in each case). In most cases the gap between the proportion of men who have no education and the proportion of women who have no education increases with age. For instance, in the 6-9 age group, male children are more likely than female children to have never been to school (33 and 29 percent, respectively), while at age 65 and over 93 percent of women have never been to school, compared with 86 percent of men. Table 2.11 School attendance by survivorship of parents For de jure children age 10-14, the percentage attending school and the ratio of the percentage attending, by parental survival, according to background characteristics, Sierra Leone 2013 Percentage attending school by survivorship of parents Background characteristic Both parents dead Number Both parents alive and living with at least one parent Number Ratio1 Sex Male 70.8 102 80.0 3,084 0.88 Female 61.3 133 81.1 2,681 0.76 Residence Urban 79.9 98 92.3 1,528 0.87 Rural 54.9 136 76.3 4,236 0.72 Region Eastern (48.9) 42 80.4 1,274 0.61 Northern 60.0 81 77.5 2,583 0.77 Southern (67.2) 48 78.5 1,186 0.86 Western 81.8 64 95.1 722 0.86 District Kailahun * 8 83.5 372 0.90 Kenema * 23 78.5 564 0.51 Kono * 11 80.0 338 0.59 Bombali (72.0) 18 90.6 612 0.80 Kambia * 7 66.3 332 0.61 Koinadugu * 8 60.4 333 1.05 Port Loko * 10 81.2 712 0.54 Tonkolili (61.7) 38 75.4 595 0.82 Bo * 26 87.1 459 0.84 Bonthe * 5 68.3 225 0.80 Moyamba * 14 77.0 310 0.78 Pujehun * 3 72.3 192 0.99 Western Area Rural * 6 96.3 149 0.76 Western Area Urban (82.7) 57 94.8 573 0.87 Wealth quintile Lowest (34.4) 25 67.4 1,172 0.51 Second (54.5) 46 75.7 1,227 0.72 Middle (67.5) 31 80.2 1,286 0.84 Fourth 66.9 73 86.9 1,161 0.77 Highest 83.5 61 96.2 918 0.87 Total 65.4 235 80.5 5,765 0.81 Note: Table is based only on children who usually live in the household. Figures in parentheses are based on 25-49 unweighted cases. An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. 1 Ratio of the percentage with both parents deceased to the percentage with both parents alive and living with a parent 24 • Housing Characteristics and Household Population Table 2.12.1 Educational attainment of the female household population Percent distribution of the de facto female household population age 6 and over by highest level of schooling attended or completed and median years completed, according to background characteristics, Sierra Leone 2013 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 6-9 28.7 70.1 0.3 0.2 0.0 0.0 0.8 100.0 4,707 0.3 10-14 16.0 64.3 8.0 11.3 0.1 0.0 0.2 100.0 4,442 3.0 15-19 19.9 13.1 9.1 54.8 2.7 0.2 0.2 100.0 3,933 6.4 20-24 41.0 9.9 5.7 28.5 10.0 4.7 0.3 100.0 2,779 4.7 25-29 64.5 9.1 4.5 12.3 4.6 4.5 0.5 100.0 2,961 0.0 30-34 74.5 9.1 3.1 8.6 1.4 2.8 0.4 100.0 2,309 0.0 35-39 76.5 7.4 3.5 8.1 1.2 2.8 0.4 100.0 2,356 0.0 40-44 78.8 5.2 3.2 9.0 1.4 2.3 0.2 100.0 1,347 0.0 45-49 79.1 4.8 2.9 7.1 1.7 3.9 0.5 100.0 1,333 0.0 50-54 84.6 2.5 3.2 5.6 0.8 2.5 0.7 100.0 1,357 0.0 55-59 88.5 1.9 1.7 4.9 0.7 2.0 0.4 100.0 894 0.0 60-64 92.0 1.1 0.3 3.1 0.7 1.9 0.8 100.0 830 0.0 65+ 92.9 1.4 1.3 2.5 0.5 0.4 0.9 100.0 1,613 0.0 Residence Urban 32.2 24.7 5.5 26.1 5.8 5.0 0.5 100.0 10,146 3.4 Rural 60.2 25.6 3.7 9.5 0.4 0.2 0.5 100.0 20,730 0.0 Region Eastern 54.2 26.6 4.1 12.9 1.3 0.6 0.3 100.0 6,977 0.0 Northern 56.9 24.6 3.8 12.6 1.0 0.8 0.3 100.0 12,020 0.0 Southern 54.3 27.1 4.5 11.5 1.2 0.9 0.6 100.0 6,651 0.0 Western 29.0 23.0 5.7 27.4 7.3 6.9 0.8 100.0 5,227 4.5 District Kailahun 53.5 30.0 4.6 10.7 0.5 0.2 0.6 100.0 2,019 0.0 Kenema 53.5 25.9 3.9 13.7 1.7 1.0 0.2 100.0 3,257 0.0 Kono 56.2 24.1 3.8 13.9 1.4 0.4 0.1 100.0 1,701 0.0 Bombali 48.2 25.2 4.7 18.8 1.6 1.5 0.1 100.0 2,614 0.0 Kambia 64.3 21.9 4.5 8.7 0.3 0.2 0.1 100.0 1,386 0.0 Koinadugu 65.6 23.3 2.4 7.2 0.3 0.2 0.9 100.0 1,484 0.0 Port Loko 56.4 24.8 3.8 12.8 1.1 0.9 0.2 100.0 3,661 0.0 Tonkolili 57.3 25.7 3.4 11.7 0.9 0.5 0.5 100.0 2,875 0.0 Bo 47.0 29.3 4.9 15.0 2.0 1.6 0.3 100.0 2,632 0.0 Bonthe 61.8 21.7 3.5 10.6 0.8 1.1 0.6 100.0 1,195 0.0 Moyamba 58.9 26.1 5.4 8.2 0.6 0.1 0.7 100.0 1,643 0.0 Pujehun 56.4 29.1 3.3 9.3 0.3 0.4 1.2 100.0 1,181 0.0 Western Area Rural 37.7 24.0 6.6 23.0 4.3 3.4 1.0 100.0 877 2.4 Western Area Urban 27.2 22.7 5.5 28.3 7.9 7.6 0.7 100.0 4,350 4.9 Wealth quintile Lowest 66.4 23.1 3.2 6.7 0.2 0.0 0.5 100.0 5,882 0.0 Second 63.2 24.2 3.5 8.6 0.2 0.0 0.4 100.0 5,976 0.0 Middle 57.1 27.5 4.1 10.2 0.4 0.2 0.5 100.0 6,074 0.0 Fourth 46.0 28.3 4.9 18.0 2.0 0.7 0.3 100.0 6,355 0.3 Highest 25.4 23.5 5.8 29.6 7.5 7.5 0.6 100.0 6,587 5.1 Total 51.0 25.3 4.3 15.0 2.1 1.8 0.5 100.0 30,876 0.0 Note: Total includes 14 women with information missing on age. 1 Completed grade 6 at the primary level 2 Completed grade 3 at the senior secondary school level About twice as many women and men in rural areas have no education at all, compared with those in urban areas. Although the Northern and Southern regions have the highest proportions of women and men without education, a significant drop was observed between 2008 and 2013, for both women and men in these regions. As expected, the proportion with no education decreases dramatically as wealth increases. Housing Characteristics and Household Population • 25 Table 2.12.2 Educational attainment of the male household population Percent distribution of the de facto male household population age 6 and over by highest level of schooling attended or completed and median years completed, according to background characteristics, Sierra Leone 2013 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 6-9 33.1 66.0 0.1 0.3 0.0 0.0 0.4 100.0 4,975 0.1 10-14 19.0 60.7 7.6 12.4 0.1 0.0 0.3 100.0 4,875 2.8 15-19 17.9 13.2 6.2 58.4 3.6 0.5 0.2 100.0 3,283 6.9 20-24 24.6 7.7 2.5 43.7 16.4 4.6 0.5 100.0 2,244 8.2 25-29 41.2 6.5 3.3 24.7 15.1 8.6 0.5 100.0 2,105 5.5 30-34 56.6 7.1 3.8 16.0 8.1 7.7 0.7 100.0 1,725 0.0 35-39 59.6 6.9 5.4 17.5 4.4 6.0 0.4 100.0 1,980 0.0 40-44 62.2 7.2 4.1 14.6 4.8 6.8 0.3 100.0 1,463 0.0 45-49 61.9 4.4 4.0 15.3 6.6 7.2 0.6 100.0 1,419 0.0 50-54 67.2 4.4 2.9 11.4 6.2 7.3 0.7 100.0 873 0.0 55-59 64.1 5.5 3.6 12.2 7.4 6.0 1.2 100.0 737 0.0 60-64 79.7 3.3 1.8 8.0 2.1 4.4 0.8 100.0 882 0.0 65+ 86.0 2.1 2.1 5.2 1.0 2.9 0.6 100.0 1,547 0.0 Residence Urban 22.3 23.9 4.1 30.0 11.1 8.1 0.5 100.0 9,126 5.7 Rural 50.5 28.3 3.8 14.2 1.7 1.1 0.4 100.0 18,989 0.0 Region Eastern 45.1 26.6 3.5 18.2 4.0 2.1 0.4 100.0 6,530 0.5 Northern 45.6 28.5 3.8 17.3 2.5 2.0 0.3 100.0 10,749 0.3 Southern 47.6 27.5 4.0 15.1 2.9 2.1 0.7 100.0 6,104 0.0 Western 18.5 22.7 4.5 30.8 13.2 9.8 0.7 100.0 4,732 6.6 District Kailahun 43.0 29.8 4.2 17.2 3.8 1.4 0.7 100.0 1,782 0.7 Kenema 45.9 23.7 3.6 19.1 4.6 2.7 0.3 100.0 3,201 0.5 Kono 46.1 28.7 2.7 17.6 3.1 1.7 0.1 100.0 1,547 0.1 Bombali 38.1 29.3 4.8 21.4 2.9 3.3 0.1 100.0 2,422 1.6 Kambia 52.0 26.2 4.4 14.4 2.0 0.9 0.1 100.0 1,259 0.0 Koinadugu 58.0 24.9 2.5 11.8 1.3 1.0 0.5 100.0 1,308 0.0 Port Loko 43.0 29.2 4.0 18.5 3.1 2.0 0.1 100.0 3,147 0.6 Tonkolili 46.1 29.7 2.9 16.4 2.4 1.9 0.6 100.0 2,613 0.1 Bo 37.7 30.3 4.6 19.5 4.8 2.8 0.2 100.0 2,194 1.3 Bonthe 56.9 21.9 3.8 12.8 1.8 2.4 0.4 100.0 1,166 0.0 Moyamba 49.4 28.0 4.4 13.7 2.1 1.4 1.1 100.0 1,601 0.0 Pujehun 54.8 27.3 2.5 11.2 1.5 1.4 1.3 100.0 1,143 0.0 Western Area Rural 25.1 25.7 7.7 27.7 7.0 5.7 1.1 100.0 811 4.7 Western Area Urban 17.1 22.1 3.8 31.4 14.4 10.6 0.6 100.0 3,921 7.2 Wealth quintile Lowest 60.8 24.6 3.7 9.6 0.7 0.2 0.3 100.0 5,390 0.0 Second 51.7 29.5 3.6 12.9 1.3 0.5 0.5 100.0 5,523 0.0 Middle 46.1 29.9 3.8 16.3 2.2 1.2 0.5 100.0 5,599 0.1 Fourth 36.0 28.3 4.2 23.5 4.7 2.9 0.4 100.0 5,568 2.0 Highest 15.1 22.3 4.2 32.8 13.9 11.2 0.5 100.0 6,034 7.4 Total 41.3 26.9 3.9 19.3 4.8 3.4 0.5 100.0 28,115 1.1 Note: Total includes 7 men with information missing on age. 1 Completed grade 6 at the primary level 2 Completed grade 3 at the senior secondary school level 2.9.2 School Attendance Rates Table 2.13 presents the primary school and secondary school net and gross attendance ratios (NAR and GAR) for the 2012/2013 school year by household residence, regions, districts, and household wealth quintiles. The NAR for primary school is the percentage of the primary-school-age (6-11) population attending primary school. The NAR for secondary school is the percentage of the secondary-school-age (12-18) population attending secondary school. By definition, the NAR cannot exceed 100 percent. The GAR for primary school is the total number of primary school students, of any age, expressed as a percentage of the official primary-school-age population. The GAR for secondary school is the total number of secondary school students, of any age, expressed as a percentage of the official secondary-school-age population. If there are significant numbers of over-age and under-age students at a given level of schooling, the GAR can exceed 100 percent. Youth are considered to be attending school currently if they attended formal academic school at any point during the given school year. 26 • Housing Characteristics and Household Population Table 2.13 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, Sierra Leone 2013 Net attendance ratio1 Gross attendance ratio2 Background characteristic Male Female Total Gender Parity Index3 Male Female Total Gender Parity Index3 PRIMARY SCHOOL Residence Urban 82.6 83.6 83.1 1.01 117.6 123.0 120.3 1.05 Rural 64.2 69.1 66.5 1.08 95.1 100.6 97.7 1.06 Region Eastern 65.0 72.9 68.9 1.12 99.4 106.3 102.8 1.07 Northern 69.1 68.5 68.8 0.99 99.8 98.6 99.2 0.99 Southern 64.8 78.9 71.3 1.22 94.8 117.1 105.1 1.23 Western 84.5 80.2 82.3 0.95 120.6 119.3 119.9 0.99 District Kailahun 71.7 75.1 73.5 1.05 104.6 107.6 106.1 1.03 Kenema 59.0 72.8 65.7 1.24 92.5 103.0 97.6 1.11 Kono 69.1 70.3 69.7 1.02 107.0 111.4 109.1 1.04 Bombali 77.6 77.4 77.5 1.00 109.7 114.5 112.0 1.04 Kambia 55.3 57.3 56.2 1.04 90.4 89.4 90.0 0.99 Koinadugu 61.1 62.0 61.6 1.01 87.8 86.4 87.1 0.98 Port Loko 69.8 67.4 68.6 0.97 98.9 95.4 97.3 0.97 Tonkolili 71.2 71.1 71.2 1.00 102.0 99.8 101.0 0.98 Bo 75.6 81.7 78.6 1.08 106.1 120.4 113.2 1.13 Bonthe 55.8 69.3 61.8 1.24 83.7 105.7 93.5 1.26 Moyamba 59.9 77.0 67.3 1.29 92.7 116.7 103.1 1.26 Pujehun 58.5 82.8 69.2 1.42 85.5 119.5 100.6 1.40 Western Area Rural 80.8 78.4 79.6 0.97 126.1 118.1 122.1 0.94 Western Area Urban 85.4 80.7 82.9 0.94 119.3 119.6 119.4 1.00 Wealth quintile Lowest 54.6 62.7 58.4 1.15 78.9 89.4 83.8 1.13 Second 65.5 65.7 65.6 1.00 97.1 96.1 96.7 0.99 Middle 66.5 73.3 69.7 1.10 100.2 106.6 103.3 1.06 Fourth 75.5 80.6 78.0 1.07 110.7 118.1 114.4 1.07 Highest 88.7 85.5 87.0 0.96 125.1 127.2 126.2 1.02 Total 69.1 73.4 71.2 1.06 101.1 107.2 104.0 1.06 SECONDARY SCHOOL Residence Urban 59.0 57.8 58.4 0.98 105.3 92.4 98.5 0.88 Rural 29.6 28.8 29.2 0.98 51.3 39.3 45.3 0.77 Region Eastern 33.3 36.6 34.9 1.10 61.0 51.7 56.4 0.85 Northern 38.5 36.7 37.6 0.95 67.8 53.8 60.7 0.79 Southern 31.1 30.6 30.8 0.99 54.0 43.0 48.5 0.80 Western 62.2 60.8 61.5 0.98 107.1 99.2 103.0 0.93 District Kailahun 32.2 30.1 31.2 0.94 63.0 44.0 53.4 0.70 Kenema 33.8 38.8 36.0 1.15 62.1 56.2 59.5 0.91 Kono 33.4 38.2 36.1 1.15 56.9 51.3 53.7 0.90 Bombali 51.5 50.8 51.1 0.99 97.2 74.2 84.4 0.76 Kambia 30.3 27.2 28.9 0.90 48.8 37.5 43.6 0.77 Koinadugu 27.8 25.3 26.5 0.91 56.1 36.1 45.6 0.64 Port Loko 42.9 35.0 38.9 0.81 64.3 51.0 57.5 0.79 Tonkolili 30.6 32.7 31.6 1.07 61.2 50.8 56.1 0.83 Bo 43.8 39.1 41.2 0.89 75.5 55.5 64.5 0.74 Bonthe 20.6 22.0 21.3 1.07 43.9 33.0 38.2 0.75 Moyamba 26.5 25.0 25.8 0.94 45.1 31.9 38.9 0.71 Pujehun 24.2 27.2 25.5 1.12 36.4 38.5 37.3 1.06 Western Area Rural 57.3 52.9 55.0 0.92 96.9 78.4 87.5 0.81 Western Area Urban 63.3 62.5 62.9 0.99 109.4 103.4 106.2 0.95 Wealth quintile Lowest 22.3 21.8 22.1 0.98 39.0 28.2 33.6 0.72 Second 25.9 28.0 26.9 1.08 45.9 37.3 41.6 0.81 Middle 33.1 30.2 31.7 0.91 56.7 42.3 49.7 0.75 Fourth 43.7 43.6 43.7 1.00 77.8 66.6 71.9 0.86 Highest 66.3 62.9 64.5 0.95 117.1 100.4 108.2 0.86 Total 40.0 40.0 40.0 1.00 70.4 59.7 64.9 0.85 1 The NAR for primary school is the percentage of the primary-school age (6-11) population attending primary school. The NAR for secondary school is the percentage of the secondary-school age (12-17) population attending secondary school. By definition the NAR cannot exceed 100 percent. 2 The GAR for primary school is the total number of primary school students, expressed as a percentage of the official primary-school-age population. The GAR for secondary school is the total number of secondary school students, expressed as a percentage of the official secondary-school-age population. If there are significant numbers of overage and underage students at a given level of schooling, the GAR can exceed 100 percent. 3 The Gender Parity Index for primary school is the ratio of the primary school NAR (GAR) for females to the NAR (GAR) for males. The Gender Parity Index for secondary school is the ratio of the secondary school NAR (GAR) for females to the NAR (GAR) for males. Housing Characteristics and Household Population • 27 The gender parity index (GPI) assesses sex-related differences in school attendance rates and is calculated by dividing the GAR for the female population by the GAR for the male population. A GPI less than 1 indicates a gender disparity in favour of the male population, i.e., a higher proportion of males than females attends that level of schooling. A GPI greater than 1 indicates a gender disparity in favour of females. A GPI of 1 indicates parity or equality between the rates of participation for the sexes. The data for NAR displayed in Table 2.13 indicates that 71 percent of children of primary school age are attending school—an improvement from 2008, when the NAR was estimated at 62 percent at the primary school level (2008 SLDHS). The NAR for primary school is higher in urban than rural areas (83 percent versus 67 percent). By region, the Western region has the highest NAR at primary level (83 percent). The situation is similar by district, where NAR for primary school is highest in Western Area Urban (83 percent). NAR increases with an increase in wealth quintile, from 58 percent at the lowest wealth quintile to 87 percent at the highest. At the primary school level, the GAR is higher than the NAR (104 percent versus 71 percent), an indication that some children in primary school are not of primary school age. As expected, the NAR and GAR are lower at the secondary school level than at the primary level. However, there has been a considerable improvement in the secondary school NAR; in the 2013 SLDHS the NAR is 12 percentage points higher than the NAR observed in the 2008 SLDHS (40 percent versus 28 percent). Secondary school NAR is generally low across the districts; Western Area Urban has the highest (63 percent), while Bonthe district has the lowest (21 percent). The gap in NAR at the secondary school level between the lowest wealth quintile and the highest wealth quintile is very wide, ranging from 22 percent to 65 percent. The gender parity index shows the ratio of the female to male GARs. In primary school there is parity between the sexes; the index is 1.06. However, the GPI for secondary school drops to 0.85, indicating a bias in favour of males. Comparison with data from the 2008 SLDHS shows that the GPI for primary school has not changed between surveys. For the secondary school level the GPI in 2013 is higher than in 2008 (0.85 versus 0.67). Figure 2.2 shows age-specific attendance rates (ASARs) for the population age 5-24—i.e., the percentage of a given age cohort that attends school, regardless of the level attended (primary, secondary, or higher). From age 5 through age 12, female attendance tends to be higher than male attendance. Attendance peaks at age 11 for both females and females, where the peak attendance rate is 83 percent for girls and 79 percent for boys. Whereas attendance is essentially the same for girls and boys age 13-15, from ages 16 upward the percentage of boys in school exceeds girls at every age. 28 • Housing Characteristics and Household Population Figure 2.2 Age-specific attendance rates of the de facto population age 5-24 2.10 CHILD LABOUR Sierra Leone is a signatory to the Convention on the Rights of the Child (SLG, 2007). To assess the extent to which children in Sierra Leone are working, the 2013 SLDHS included a set of questions on the participation by each child age 5-14 in the household in different types of work. The types of work included working for persons other than members of the household, working in a household business or farm, or selling goods in the street, and doing household chores. The number of hours worked in the seven days preceding the survey was recorded for all children engaged in any type of work. For work that was done for any person not a member of the household, a question was also asked to determine whether the child was paid or not paid for the work. This information was used to calculate the percentage of children age 5-14 engaged in child labour. The definition of child labour includes (a) children age 5-11 who in the seven days preceding the survey worked for someone who is not a member of the household, with or without pay, or engaged in any other family work or did household chores for 28 hours or more, and (b) children age 12-14 who in the seven days preceding the survey worked for someone who is not a member of the household, with or without pay, or engaged in any other family work for 14 hours or more or did household chores for 28 hours or more. This definition helps to identify the type of child work that should be eliminated in order to conform to the UN Convention on the Rights of the Child. As such, the estimate provided here is a minimum of the prevalence of child labour, since some children may be involved in hazardous labour activities for a number of hours that could be less than the numbers specified in the criteria described above. 2.10.1 Occurrence of Child Labour Table 2.14 shows the percentage of de jure children age 5-14 engaged in different types of work in the seven days preceding the interview, by background characteristics. Percentages do not add up to the total for child labour, as children may be involved in more than one type of work. Overall, 37 percent of children age 5-14 in Sierra Leone are involved in child labour—44 percent of children age 5-11 and 16 percent of children age 12-14. Less than 1 percent of children age 5-11 and 2 percent of children age 12-14 are engaged in paid work; 23 percent and 38 percent, respectively, are engaged in unpaid work for someone who is not a member of their household; and 37 percent and 56 percent, respectively, work for a family business. Furthermore, 1 percent of children age 5-11 and 2 percent of children age 12-14 are engaged in household chores for 28 or more hours in a week. 0 10 20 30 40 50 60 70 80 90 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 Percent Age (years) Male Female Sierra Leone, 2013 H ousing C haracteristics and H ousehold P opulation • 29 Table 2.14 Child labour Percentage of de jure children age 5-14 who were engaged in economic activity, in household chores, and in child labour during the seven days preceding the survey, by b Percentage of children age 5-11 involved in: Number of children age 5-11 Percentage of children age 12-14 invo Background characteristic Economic activity Working for family business2 Economic activity3 for at least one hour per week Household chores less than 28 hours per week Household chores for 28 hours or more per week Child labour4 Economic activity Working for family business2 Economic activity3 less than 14 hours per week Economic activity for 14 hours or more per week Hous cho less 28 h per Working outside household1 Working outside household1 Paid work Unpaid work Paid work Unpaid work Sex Male 0.9 23.6 38.2 44.9 67.7 0.8 45.3 8,407 3.0 38.5 58.8 52.5 16.6 8 Female 0.5 22.2 35.7 43.1 70.4 0.9 43.5 7,874 1.3 36.7 53.0 50.3 14.2 8 Residence Urban 0.4 19.5 16.4 27.9 62.4 1.6 29.0 4,448 1.8 27.5 29.1 37.1 8.2 8 Rural 0.8 24.2 44.7 50.1 71.5 0.6 50.2 11,833 2.4 42.6 69.3 58.6 19.0 9 Region Eastern 1.0 29.3 48.0 56.2 73.2 0.6 56.2 3,727 2.1 44.7 67.6 53.5 24.3 9 Northern 0.6 23.1 40.5 46.7 72.9 0.3 46.8 6,740 1.6 40.9 62.1 60.1 11.5 9 Southern 0.7 18.8 36.0 40.1 65.5 1.0 40.4 3,732 3.1 35.3 61.0 50.0 18.9 8 Western 0.5 18.4 7.7 20.6 55.3 3.0 22.7 2,081 2.8 22.0 17.4 27.9 8.9 7 District Kailahun 1.0 33.5 52.1 60.6 73.1 0.0 60.6 1,092 2.8 47.9 78.4 67.8 18.7 8 Kenema 1.4 36.2 45.3 56.2 74.2 0.2 56.2 1,684 1.2 52.4 61.2 53.2 21.1 9 Kono 0.2 12.2 48.3 51.2 71.4 1.9 51.2 952 3.6 22.7 70.4 38.0 38.1 9 Bombali 0.4 34.8 37.9 46.5 75.2 0.3 46.5 1,421 1.1 54.5 61.8 66.5 4.7 9 Kambia 0.6 21.8 28.3 37.2 65.2 0.5 37.4 791 2.6 43.1 50.9 54.9 9.9 7 Koinadugu 2.5 33.5 43.9 55.5 72.4 0.1 55.5 846 5.7 60.1 68.3 70.6 15.7 9 Port Loko 0.1 11.5 40.8 42.2 75.3 0.3 42.6 2,010 0.6 19.3 56.8 45.8 13.8 9 Tonkolili 0.5 22.4 46.2 52.2 71.8 0.3 52.4 1,672 0.5 41.2 71.9 67.6 14.6 9 Bo 0.7 15.0 20.6 26.4 59.1 0.0 26.4 1,518 2.2 31.9 41.5 47.7 6.7 8 Bonthe 0.8 16.3 37.2 40.7 61.1 0.7 41.2 611 1.5 30.0 74.8 73.6 5.6 9 Moyamba 0.9 28.2 55.4 56.7 69.2 3.6 58.0 865 2.6 43.2 70.3 25.8 49.0 8 Pujehun 0.6 17.8 43.9 48.2 78.1 0.2 48.2 738 7.3 37.1 74.7 63.0 16.9 9 Western Area Rural 0.5 20.7 11.3 20.1 56.4 0.8 20.7 404 1.3 29.4 23.1 28.9 16.4 7 Western Area Urban 0.5 17.8 6.8 20.7 55.1 3.6 23.1 1,677 3.1 20.4 16.2 27.6 7.3 7 School attendance Yes 0.7 25.3 38.1 46.9 76.0 1.1 47.4 10,327 1.6 35.6 52.5 49.9 13.6 8 No 0.8 18.9 35.1 39.0 56.9 0.5 39.3 5,935 4.2 45.0 68.6 57.1 21.8 8 Mother’s education No education 0.8 22.6 38.5 45.0 67.7 0.6 45.3 8,328 2.7 39.6 63.8 56.0 16.9 8 Primary 0.5 20.7 30.6 37.8 67.7 0.9 38.1 1,129 1.3 29.6 39.1 37.2 14.7 8 Secondary or higher 0.5 18.0 15.7 25.0 56.7 1.2 25.7 971 1.1 28.2 31.0 37.9 8.5 7 Wealth quintile Lowest 1.1 25.8 50.6 54.4 71.6 0.6 54.6 3,371 2.5 46.0 77.3 56.8 25.7 9 Second 0.6 24.5 45.3 50.6 70.8 0.9 50.8 3,486 2.4 46.6 72.4 61.2 18.8 9 Middle 0.7 24.9 42.6 49.6 70.2 0.7 49.9 3,490 2.6 39.0 68.1 57.8 17.4 9 Fourth 0.6 20.6 31.3 39.2 70.6 0.9 39.9 3,292 1.4 34.9 49.3 50.7 12.7 8 Highest 0.4 17.5 8.2 20.7 59.8 1.3 21.5 2,642 2.1 24.2 19.2 32.9 5.1 8 Total 0.7 22.9 37.0 44.0 69.0 0.9 44.4 16,281 2.2 37.6 56.0 51.5 15.4 8 Note: Total includes 28 children age 5-14 for whom information on school attendance is missing and 13 children 5-14 for whom information on mother’s education is missin 1 Any work, paid or unpaid, for someone who is not a member of the household 2 Includes any work in a family business, on the farm, or selling goods in the street 3 Economic activity is defined as working, paid or unpaid, for someone who is not a member of the household or working in a family business, on the farm, or selling goods 4 Child labour includes (a) children age 5-11 who in the seven days preceding the survey, worked for someone who is not a member of the household, with or without pay chores for 28 or more hours, and (b) children age 12-14 who in the seven days preceding the survey, worked for someone who is not a member of the household, with or w or more hours or did household chores for 28 or more hours 30 • Housing Characteristics and Household Population For all children age 5-14, the percentage engaged in labour is about the same among males (38 percent) and females (37 percent). However, the proportion of children engaged in labour is substantially higher among rural children (43 percent) than urban children (24 percent). By region, the Eastern region has the highest proportion of children age 5-14 engaged in labour (49 percent), while the Western region has the lowest proportion (20 percent). Among districts, it varies from 20 percent of children in the Western Areas to 56 percent in Moyamba district. While the proportion of children in labour does not vary by whether a child attends a school or not, it decreases steadily with mother’s education and household wealth. Twenty- two percent of children whose mothers have at least secondary education are engaged in child labour, compared with 39 percent of children whose mothers have no education. Similarly, this proportion decreases from 48 percent for children in the lowest wealth quintile to 17 percent for children in the highest wealth quintile. 2.10.2 Child Labour and School Attendance One of the negative consequences of child labour is its effect on a child’s schooling. Table 2.15 shows the percentage of children age 5-14 involved in child labour, the percentage of children attending school, and the percentage of children both attending school and also involved in child labour. Among children involved in child labour, 68 percent are attending school. Among children attending school, 38 percent are involved in child labour, a small increase from 31 percent in the 2008 SLDHS. Table 2.15 Child labour and school attendance Percentage of children age 5-14 involved in child labour who are attending school, and percentage of children age 5-14 attending school who are involved in child labour, Sierra Leone 2013 All children age 5-14 Children age 5-14 involved in labour Children age 5-14 attending school Background characteristic Percentage of children involved in child labour Percentage of children attending school Number of children age 5-14 Percentage of child labourers who are attending school Number of children age 5-14 involved in child labour Percentage of children attending school who are involved in child labour Number of children age 5-14 attending school Sex Male 38.2 65.4 11,242 66.1 4,297 38.6 7,351 Female 36.5 68.8 10,452 70.0 3,820 37.2 7,193 Residence Urban 23.7 80.4 6,242 79.9 1,479 23.6 5,020 Rural 43.0 61.6 15,452 65.2 6,638 45.5 9,524 Region Eastern 48.5 65.2 4,929 65.4 2,392 48.7 3,214 Northern 38.0 64.2 9,005 66.8 3,420 39.5 5,778 Southern 35.7 65.3 4,817 68.4 1,721 37.4 3,147 Western 19.8 81.7 2,943 83.7 583 20.3 2,404 District Kailahun 51.6 69.7 1,392 73.1 718 54.1 970 Kenema 46.8 63.6 2,319 61.0 1,084 44.8 1,476 Kono 48.4 63.1 1,218 64.0 590 49.1 768 Bombali 34.9 73.4 1,971 75.0 687 35.6 1,447 Kambia 29.8 53.5 1,090 55.0 325 30.7 583 Koinadugu 46.1 55.0 1,107 60.8 510 51.0 608 Port Loko 35.8 64.4 2,627 65.4 941 36.3 1,692 Tonkolili 43.3 65.5 2,210 69.4 957 45.9 1,448 Bo 22.3 71.8 1,930 80.1 431 24.9 1,386 Bonthe 32.4 54.7 811 61.0 263 36.1 444 Moyamba 56.1 63.9 1,133 66.6 636 58.5 724 Pujehun 41.5 62.8 944 63.5 392 41.9 593 Western Area Rural 20.1 78.3 558 88.4 112 22.7 437 Western Area Urban 19.8 82.5 2,385 82.5 471 19.8 1,967 Age 5-11 44.4 63.4 16,281 67.7 7,233 47.4 10,327 12-14 16.3 77.9 5,413 70.0 884 14.7 4,216 Continued… Housing Characteristics and Household Population • 31 Table 2.15—Continued All children age 5-14 Children age 5-14 involved in labour Children age 5-14 attending school Background characteristic Percentage of children involved in child labour Percentage of children attending school Number of children age 5-14 Percentage of child labourers who are attending school Number of children age 5-14 involved in child labour Percentage of children attending school who are involved in child labour Number of children age 5-14 attending school Mother’s education No education 38.8 64.2 10,859 67.1 4,210 40.5 6,975 Primary 33.1 74.0 1,439 76.7 476 34.3 1,065 Secondary or higher 22.4 83.1 1,247 88.4 280 23.9 1,035 Wealth quintile Lowest 48.6 52.4 4,266 56.8 2,073 52.6 2,237 Second 43.5 60.1 4,530 63.6 1,971 46.0 2,724 Middle 41.9 65.8 4,636 69.8 1,943 44.5 3,051 Fourth 32.9 73.8 4,475 78.1 1,472 34.8 3,302 Highest 17.4 85.3 3,786 87.5 657 17.8 3,229 Total 37.4 67.0 21,694 67.9 8,117 37.9 14,543 Note: Total includes 13 children age 5-14 for whom information on mother’s education is missing. Characteristics of Respondents • 33 CHARACTERISTICS OF RESPONDENTS 3 his chapter describes the demographic and socioeconomic profile of the sample of women and men age 15-49 that were interviewed in the 2013 SLDHS. Percent distributions of various demographic and socioeconomic characteristics are shown for the full sample. The main background characteristics that will be used in subsequent chapters on reproduction and health are age at the time of the survey, marital status, broad education levels, urban/rural residence, region, district, religion, ethnicity, and the wealth quintile to which respondents belong. In addition, the chapter provides information on media exposure, health insurance coverage, employment, and work status. Besides offering a better understanding of many topics discussed in the following chapters, this chapter is useful for assessing the economic and social development of Sierra Leone and its regions. 3.1 CHARACTERISTICS OF SURVEY RESPONDENTS Table 3.1 presents the background characteristics of the women and men interviewed in the 2013 SLDHS. Fifty-seven percent of women and 53 percent of men are under age 30. In general, the proportion of women and men in each age group declines with increasing age, reflecting the comparatively young age structure of the population in Sierra Leone. Sixty-three percent of women and 50 percent of men are married, while 3 percent of women and 4 percent of men are in informal unions with their partners. Male respondents are much more likely than female respondents to have never married (43 percent versus 28 percent). Six percent of female respondents and 3 percent of male respondents are divorced, separated, or widowed. T Key Findings • Sixty-three percent of women and 50 percent of men are married, while 3 percent of women and 4 percent of men are living with a partner in informal unions. • Fifty-six percent of women have no education compared with 40 percent of men. • Nearly 80 percent of respondents are Muslims, and around 20 percent are Christians. • The two largest ethnic groups are the Mende and Temne, each representing around one-third of the population of reproductive age. • The literacy rate for women is 36 percent, and the rate for men is 52 percent. • Fifty-six percent of women and 43 percent of men do not have weekly access to newspapers, television, or a radio. • Sixty-eight percent of women working in agriculture are not paid. • Twenty-seven percent of men age 15-49 use tobacco products. 34 • Characteristics of Respondents Table 3.1 Background characteristics of respondents Percent distribution of women and men age 15-49 by selected background characteristics, Sierra Leone 2013 Women Men Background characteristic Weighted percent Weighted number Unweighted number Weighted percent Weighted number Unweighted number Age 15-19 23.3 3,878 4,051 22.4 1,475 1,526 20-24 16.1 2,683 2,688 15.3 1,007 1,018 25-29 17.1 2,843 2,731 15.5 1,017 996 30-34 13.7 2,287 2,236 12.2 804 769 35-39 13.6 2,260 2,266 14.6 961 930 40-44 8.2 1,362 1,321 10.5 690 695 45-49 8.1 1,344 1,365 9.6 629 643 Religion Christian 21.2 3,527 3,687 19.9 1,312 1,350 Islam 78.2 13,032 12,878 79.6 5,242 5,202 Other 0.2 41 44 0.2 16 13 None 0.1 12 10 0.1 4 4 Missing 0.3 46 39 0.1 7 8 Ethnic group Creole 1.1 191 148 1.4 91 73 Fullah 3.2 530 582 3.8 252 275 Kono 4.5 752 848 3.9 260 303 Limba 6.6 1,104 1,150 5.9 391 404 Loko 2.9 487 415 2.7 178 150 Mandingo 2.3 382 471 2.5 166 200 Mende 33.4 5,558 5,648 32.8 2,158 2,157 Sherbro 2.4 407 430 3.0 198 210 Temne 35.3 5,885 5,424 36.1 2,375 2,222 Koranko 2.9 482 626 2.6 173 216 Other Sierra Leone 4.8 793 818 4.5 299 325 Other Foreign 0.3 52 66 0.4 29 27 Missing 0.2 33 32 0.2 12 15 Marital status Never married 28.4 4,730 4,911 43.3 2,849 2,861 Married 62.6 10,430 10,308 49.6 3,264 3,282 Living together 2.8 473 446 3.8 250 208 Divorced/separated 3.6 605 576 2.9 190 197 Widowed 2.5 420 417 0.4 30 29 Residence Urban 35.6 5,933 6,773 38.1 2,508 2,755 Rural 64.4 10,725 9,885 61.9 4,073 3,822 Region Eastern 21.7 3,614 3,369 21.9 1,442 1,337 Northern 37.8 6,292 6,231 34.9 2,300 2,327 Southern 21.1 3,514 4,354 21.5 1,414 1,742 Western 19.4 3,238 2,704 21.7 1,425 1,171 District Kailahun 5.9 984 952 5.6 371 351 Kenema 9.9 1,651 1,153 10.9 719 517 Kono 5.9 979 1,264 5.4 352 469 Bombali 8.3 1,377 1,288 7.6 499 462 Kambia 4.4 738 1,264 4.1 270 473 Koinadugu 4.3 719 1,100 4.1 268 432 Port Loko 12.0 1,994 1,424 10.3 679 491 Tonkolili 8.8 1,464 1,155 8.9 584 469 Bo 8.4 1,398 1,517 8.1 533 583 Bonthe 4.1 678 981 4.3 283 389 Moyamba 5.1 843 959 5.6 368 427 Pujehun 3.6 595 897 3.5 230 343 Western Area Rural 3.2 528 1,209 3.5 230 503 Western Area Urban 16.3 2,710 1,495 18.2 1,195 668 Education No education 55.8 9,293 9,140 40.3 2,651 2,614 Primary 14.0 2,331 2,278 12.5 825 819 Secondary or higher 30.2 5,034 5,240 47.2 3,106 3,144 Wealth quintile Lowest 18.5 3,089 3,035 18.5 1,218 1,221 Second 18.3 3,046 2,781 17.9 1,175 1,083 Middle 18.8 3,140 2,999 18.2 1,195 1,147 Fourth 20.3 3,388 3,998 18.0 1,183 1,443 Highest 24.0 3,994 3,845 27.5 1,811 1,683 Total 15-49 100.0 16,658 16,658 100.0 6,582 6,577 50-59 na na na na 680 685 Total 15-59 na na na na 7,262 7,262 Note: Education categories refer to the highest level of education attended, whether or not that level was completed. na = Not applicable Characteristics of Respondents • 35 Nearly two-thirds of respondents (64 percent of women and 62 percent of men) live in rural areas. The Northern region has the highest proportion of female respondents (38 percent), while the Western region has the smallest proportion (19 percent). Corresponding figures for men are 35 percent and 22 percent respectively. Table 3.1 shows that 56 percent of women have no education compared with 40 percent of men. Forty-seven percent of men attended at least some secondary school compared with 30 percent of women. Forty-four percent of women and 46 percent of men are in the two highest wealth quintiles, while an equal proportion of both sexes (19 percent each) are in the lowest wealth quintile. The distribution of respondents by religion shows that nearly eight respondents in ten are Muslims, and around 20 percent identify themselves as Christians. Very few Sierra Leoneans responded that they do not have a religious affiliation. The two largest ethnic groups are the Mende and Temne, each representing about one-third of the population of reproductive age. 3.2 EDUCATIONAL ATTAINMENT BY BACKGROUND CHARACTERISTICS Information on educational attainment—the highest level of schooling an individual attended and completed—is fundamental in explaining the extent of Sierra Leoneans’ participation in primary, secondary, and post-secondary education. As a measure of Sierra Leone’s potential for economic growth, educational attainment is also closely linked to health, political participation, and other social development indicators. Sierra Leone launched the Basic Education Programme in 1992 aimed at achieving education for all, thereby increasing school attendance and completion. The results presented in Tables 3.2.1 (women) and 3.2.2 (men) show that, overall, men have a huge advantage in educational attainment, having completed a median of 5.3 years of schooling versus 0.0 years among women. The difference in median years of schooling can be partially explained by the fact that the proportion of respondents with no education is higher among women than men (56 percent versus 40 percent), while a higher proportion of men than women have attained schooling beyond primary school (47 percent versus 30 percent). Women and men age 15-24 have better access to education compared with those age 25-29 or in older age groups. For example, 28 percent of women age 15-24 have no education compared with 65 percent of women age 25-29. Similarly, 18 percent of men age 15-24 have no education compared with 39 percent of men age 25-29 Rural respondents generally have attained less education than urban residents. For example, 68 percent of rural women have no education compared with 33 percent of urban women; and 54 percent of rural men have no education compared with 18 percent of rural men. Of the four regions of Sierra Leone, the Western region has the lowest proportion of women and men with no education (30 percent and 13 percent respectively). In the remaining three regions there are few variations in the proportion of respondents with no education; among women, from 61 percent in Eastern region to 63 percent in the Northern region, and among men, from 44 percent in Eastern region to 51 percent in the Southern region. Access to education increases with women’s wealth. Seventy-five percent of women in the lowest wealth quintile have no education compared with 26 percent of women in the highest wealth quintile. In contrast, 63 percent of women in the highest wealth quintile have attended or completed secondary schooling or higher compared with 11 percent of women in the lowest quintile. Similar patterns are observed among men; 64 percent of men in the lowest wealth quintile have no education compared with 12 percent of men in the highest wealth quintile; 80 percent of men in the highest wealth quintile have attended or completed secondary schooling or higher compared with 22 percent of men in the lowest quintile. 36 • Characteristics of Respondents 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, Sierra Leone 2013 Highest level of schooling Total Median years completed Number of women Background characteristic No education Some primary Completed primary1 Some secondary Completed secondary2 More than secondary Age 15-24 28.1 11.4 7.2 42.9 7.9 2.5 100.0 6.2 6,561 15-19 19.6 12.5 8.3 54.2 5.1 0.3 100.0 6.6 3,878 20-24 40.5 9.9 5.7 26.5 11.9 5.6 100.0 4.9 2,683 25-29 64.6 9.8 4.0 12.2 4.9 4.5 100.0 0.0 2,843 30-34 74.2 9.0 2.9 9.1 1.8 2.9 100.0 0.0 2,287 35-39 77.8 7.1 3.7 7.2 1.4 2.9 100.0 0.0 2,260 40-44 78.8 4.6 3.0 10.0 1.5 2.2 100.0 0.0 1,362 45-49 80.5 4.8 2.2 6.8 1.9 3.7 100.0 0.0 1,344 Residence Urban 33.3 7.3 5.1 34.9 11.5 7.8 100.0 6.6 5,933 Rural 68.2 10.1 4.7 15.7 0.8 0.4 100.0 0.0 10,725 Region Eastern 60.7 10.0 4.7 20.8 2.7 1.1 100.0 0.0 3,614 Northern 63.0 9.1 4.6 19.8 2.3 1.3 100.0 0.0 6,292 Southern 62.1 10.0 5.1 19.2 2.2 1.5 100.0 0.0 3,514 Western 29.5 7.4 5.3 33.6 14.1 10.2 100.0 7.3 3,238 District Kailahun 61.3 11.8 6.9 18.5 1.2 0.2 100.0 0.0 984 Kenema 59.1 9.9 3.7 21.9 3.6 1.9 100.0 0.0 1,651 Kono 62.8 8.2 4.3 21.4 2.7 0.6 100.0 0.0 979 Bombali 54.6 5.5 5.4 28.9 3.4 2.1 100.0 0.0 1,377 Kambia 70.2 11.6 5.0 11.5 1.3 0.4 100.0 0.0 738 Koinadugu 75.4 7.6 3.2 12.5 0.9 0.5 100.0 0.0 719 Port Loko 61.8 11.5 4.1 18.7 2.4 1.5 100.0 0.0 1,994 Tonkolili 62.7 8.7 4.9 20.5 2.1 1.1 100.0 0.0 1,464 Bo 54.2 9.8 4.9 24.7 3.9 2.5 100.0 0.0 1,398 Bonthe 67.9 6.9 5.0 17.2 1.1 1.8 100.0 0.0 678 Moyamba 67.9 10.8 5.3 14.3 1.4 0.2 100.0 0.0 843 Pujehun 65.9 12.6 5.2 15.3 0.7 0.3 100.0 0.0 595 Western Area Rural 40.0 8.5 7.6 31.8 7.6 4.5 100.0 5.2 528 Western Area Urban 27.4 7.1 4.9 33.9 15.4 11.3 100.0 7.7 2,710 Wealth quintile Lowest 74.5 9.7 4.8 10.6 0.4 0.0 100.0 0.0 3,089 Second 71.3 9.9 4.2 14.2 0.4 0.0 100.0 0.0 3,046 Middle 65.8 10.3 4.8 17.7 1.0 0.4 100.0 0.0 3,140 Fourth 51.1 9.8 5.3 27.9 4.4 1.4 100.0 0.0 3,388 Highest 25.6 6.6 5.0 37.4 14.3 11.0 100.0 7.8 3,994 Total 55.8 9.1 4.9 22.6 4.7 3.0 100.0 0.0 16,658 1 Completed grade 6 at the primary level 2 Completed grade 3 at the senior secondary school level Characteristics of Respondents • 37 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, Sierra Leone 2013 Highest level of schooling Total Median years completed Number of men Background characteristic No education Some primary Completed primary1 Some secondary Completed secondary2 More than secondary Age 15-24 18.2 9.4 5.3 52.6 11.6 2.8 100.0 7.6 2,481 15-19 15.9 10.5 6.3 60.0 6.4 0.8 100.0 7.3 1,475 20-24 21.6 7.8 3.7 41.7 19.4 5.8 100.0 8.4 1,007 25-29 39.0 6.6 4.9 25.0 15.1 9.4 100.0 5.8 1,017 30-34 53.1 9.3 4.0 16.2 8.8 8.5 100.0 0.0 804 35-39 60.3 7.2 3.1 18.9 4.0 6.5 100.0 0.0 961 40-44 59.3 7.7 4.1 16.3 3.6 9.0 100.0 0.0 690 45-49 61.3 5.1 3.8 15.2 6.4 8.2 100.0 0.0 629 Residence Urban 18.1 5.1 4.0 41.4 18.0 13.4 100.0 9.0 2,508 Rural 54.0 9.8 4.8 25.6 4.1 1.8 100.0 0.0 4,073 Region Eastern 43.7 9.0 4.6 31.5 7.8 3.3 100.0 4.3 1,442 Northern 48.1 6.9 3.9 30.7 6.1 4.2 100.0 3.0 2,300 Southern 51.3 10.6 5.5 23.3 6.9 2.4 100.0 0.0 1,414 Western 13.2 6.4 4.4 41.3 18.6 16.1 100.0 9.6 1,425 District Kailahun 41.9 10.8 7.2 33.1 4.6 2.5 100.0 4.4 371 Kenema 44.6 7.0 3.8 30.6 9.8 4.1 100.0 4.5 719 Kono 43.7 11.3 3.5 31.8 7.1 2.7 100.0 3.7 352 Bombali 41.6 6.9 3.8 36.3 5.6 5.8 100.0 5.4 499 Kambia 51.8 9.5 3.8 28.2 5.1 1.6 100.0 0.0 270 Koinadugu 58.8 4.6 4.0 27.4 3.1 2.2 100.0 0.0 268 Port Loko 43.6 9.1 5.1 31.0 6.5 4.8 100.0 4.4 679 Tonkolili 52.4 4.2 2.4 28.4 8.0 4.5 100.0 0.0 584 Bo 38.6 11.2 6.0 28.7 12.0 3.6 100.0 5.0 533 Bonthe 59.8 8.5 7.5 19.3 3.6 1.4 100.0 0.0 283 Moyamba 55.3 11.0 5.3 22.8 3.9 1.7 100.0 0.0 368 Pujehun 64.2 11.2 2.5 16.4 4.0 1.7 100.0 0.0 230 Western Area Rural 23.1 10.4 7.6 42.5 11.5 4.9 100.0 7.5 230 Western Area Urban 11.3 5.6 3.7 41.1 20.0 18.3 100.0 10.0 1,195 Wealth quintile Lowest 64.3 8.5 4.8 20.4 1.8 0.2 100.0 0.0 1,218 Second 56.9 9.8 5.1 23.3 4.2 0.8 100.0 0.0 1,175 Middle 49.9 10.9 4.8 27.5 4.9 2.0 100.0 0.0 1,195 Fourth 32.7 7.9 4.8 39.9 9.6 5.1 100.0 6.8 1,183 Highest 12.0 4.8 3.5 41.9 20.6 17.3 100.0 10.0 1,811 Total 15-49 40.3 8.0 4.5 31.6 9.4 6.2 100.0 5.3 6,582 50-59 67.1 6.4 2.8 10.8 5.5 7.3 100.0 0.0 680 Total 15-59 42.8 7.9 4.3 29.6 9.0 6.3 100.0 4.8 7,262 1 Completed grade 6 at the primary level 2 Completed grade 3 at the senior secondary school level 3.3 LITERACY The ability to read is crucial to social and economic opportunities for Sierra Leoneans. In addition, health development programme partners use literacy statistics to determine how best to get messages to women and men in different subgroups. The literacy status of respondents in the 2013 SLDHS was determined by ability of the respondent to read all or part of a simple sentence in English from a card. The literacy test was administered only to respondents who had less than a secondary school education, because those with a secondary education or higher were assumed to be literate. Tables 3.3.1 and 3.3.2 present literacy results for women and men age 15-49. Overall, literacy rates in Sierra Leone are 36 percent for women and for 54 percent men. Literacy rates are higher for younger women and men compared with the older population. For example, literacy rates are 62 percent for women age 15-24, and 15 percent for women age 45-49. Corresponding literacy rates for men are 76 percent for age 15-24 and 34 percent for age 45-49. 38 • Characteristics of Respondents 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, Sierra Leone 2013 Secondary school or higher No schooling or primary school Total Percentage literate1 Number of women Background characteristic Can read a whole sentence Can read part of a sentence Cannot read at all Blind/ visually impaired/ missing Age 15-24 53.2 2.2 6.4 37.9 0.2 100.0 61.8 6,561 15-19 59.6 3.4 7.9 29.0 0.2 100.0 70.9 3,878 20-24 43.9 0.6 4.2 50.9 0.4 100.0 48.7 2,683 25-29 21.6 0.5 3.1 74.5 0.2 100.0 25.3 2,843 30-34 13.8 0.7 3.0 82.2 0.4 100.0 17.5 2,287 35-39 11.5 0.6 2.7 84.7 0.4 100.0 14.8 2,260 40-44 13.7 0.3 2.0 83.8 0.2 100.0 15.9 1,362 45-49 12.5 0.5 1.6 85.2 0.2 100.0 14.5 1,344 Residence Urban 54.2 1.3 3.6 40.5 0.3 100.0 59.2 5,933 Rural 16.9 1.1 4.4 77.3 0.2 100.0 22.5 10,725 Region Eastern 24.6 1.2 4.4 69.5 0.2 100.0 30.2 3,614 Northern 23.4 1.3 3.4 71.6 0.2 100.0 28.1 6,292 Southern 22.8 1.0 5.2 70.6 0.3 100.0 29.1 3,514 Western 57.8 1.3 3.9 36.7 0.3 100.0 63.0 3,238 District Kailahun 20.0 2.6 6.5 70.6 0.4 100.0 29.0 984 Kenema 27.3 0.6 2.9 68.9 0.2 100.0 30.8 1,651 Kono 24.8 0.8 4.9 69.4 0.1 100.0 30.5 979 Bombali 34.5 1.1 3.3 61.2 0.0 100.0 38.8 1,377 Kambia 13.3 0.8 5.7 80.1 0.2 100.0 19.7 738 Koinadugu 13.8 1.6 2.4 81.9 0.2 100.0 17.8 719 Port Loko 22.6 1.5 3.8 71.6 0.5 100.0 27.9 1,994 Tonkolili 23.8 1.3 2.4 72.3 0.3 100.0 27.5 1,464 Bo 31.1 0.8 4.5 63.2 0.4 100.0 36.4 1,398 Bonthe 20.2 1.0 4.1 74.7 0.0 100.0 25.3 678 Moyamba 15.9 1.2 7.3 74.9 0.8 100.0 24.3 843 Pujehun 16.2 1.4 5.2 77.1 0.1 100.0 22.8 595 Western Area Rural 43.9 1.8 4.9 49.1 0.3 100.0 50.6 528 Western Area Urban 60.5 1.2 3.7 34.3 0.2 100.0 65.4 2,710 Wealth quintile Lowest 11.0 1.3 4.5 83.0 0.1 100.0 16.8 3,089 Second 14.6 0.8 4.2 80.1 0.2 100.0 19.7 3,046 Middle 19.1 1.2 4.0 75.4 0.2 100.0 24.3 3,140 Fourth 33.7 1.4 4.5 59.8 0.6 100.0 39.6 3,388 Highest 62.7 1.3 3.6 32.3 0.2 100.0 67.5 3,994 Total 30.2 1.2 4.1 64.2 0.3 100.0 35.5 16,658 1 Refers to women who attended secondary school or higher and women who can read a whole sentence or part of a sentence Women and men in urban areas are more likely than rural residents to be literate. The literacy rate for urban women in Sierra Leone is 59 percent compared with 23 percent in the rural areas. Literacy rates for men in urban and rural areas are 78 percent and 39 percent respectively. Among the four regions, the Western region recorded the highest literacy rates for women and men. Sixty-three percent of women in the Western region are literate compared with 30 percent or less in the other regions. Similarly, 83 percent of men in the Western region are literate compared with 48 percent or less in the other regions. Women and men in the highest quintiles are more likely to be literate than their counterparts in the lowest quintiles. Characteristics of Respondents • 39 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, Sierra Leone 2013 Secondary school or higher No schooling or primary school Total Percentage literate1 Number of men Background characteristic Can read a whole sentence Can read part of a sentence Cannot read at all Blind/ visually impaired/ Missing Age 15-24 67.1 3.0 6.2 23.3 0.4 100.0 76.2 2,481 15-19 67.2 4.4 7.4 20.3 0.7 100.0 79.0 1,475 20-24 66.9 1.0 4.3 27.7 0.1 100.0 72.2 1,007 25-29 49.5 1.2 5.1 44.0 0.2 100.0 55.7 1,017 30-34 33.5 0.6 4.4 61.1 0.3 100.0 38.5 804 35-39 29.4 1.3 3.9 64.9 0.5 100.0 34.6 961 40-44 28.8 1.0 4.0 65.9 0.3 100.0 33.8 690 45-49 29.7 0.3 3.6 65.5 0.9 100.0 33.7 629 Residence Urban 72.8 1.6 3.8 21.5 0.3 100.0 78.2 2,508 Rural 31.4 1.8 5.7 60.6 0.5 100.0 38.9 4,073 Region Eastern 42.7 0.8 4.0 51.8 0.7 100.0 47.5 1,442 Northern 41.1 2.0 4.4 52.2 0.3 100.0 47.5 2,300 Southern 32.5 1.8 7.5 57.7 0.5 100.0 41.8 1,414 Western 76.1 2.0 4.5 17.1 0.3 100.0 82.6 1,425 District Kailahun 40.1 0.2 4.4 54.2 1.0 100.0 44.7 371 Kenema 44.5 0.5 4.5 49.9 0.6 100.0 49.5 719 Kono 41.5 2.3 2.7 52.9 0.5 100.0 46.5 352 Bombali 47.6 0.8 4.2 47.0 0.4 100.0 52.6 499 Kambia 34.9 3.0 5.4 56.4 0.4 100.0 43.2 270 Koinadugu 32.6 0.5 2.2 64.1 0.5 100.0 35.3 268 Port Loko 42.2 3.9 6.4 47.1 0.4 100.0 52.6 679 Tonkolili 41.0 1.1 2.6 55.2 0.1 100.0 44.7 584 Bo 44.3 3.0 8.1 44.0 0.6 100.0 55.4 533 Bonthe 24.2 1.6 8.3 65.9 0.0 100.0 34.1 283 Moyamba 28.4 1.2 9.7 59.9 0.7 100.0 39.3 368 Pujehun 22.1 0.3 1.4 75.9 0.3 100.0 23.8 230 Western Area Rural 59.0 3.5 10.7 26.6 0.2 100.0 73.2 230 Western Area Urban 79.4 1.7 3.3 15.3 0.3 100.0 84.4 1,195 Wealth quintile Lowest 22.4 0.4 5.3 71.2 0.6 100.0 28.2 1,218 Second 28.2 2.3 6.1 62.7 0.7 100.0 36.7 1,175 Middle 34.4 2.5 5.9 56.9 0.3 100.0 42.8 1,195 Fourth 54.6 1.8 5.7 37.5 0.5 100.0 62.0 1,183 Highest 79.7 1.5 3.0 15.5 0.3 100.0 84.3 1,811 Total 15-49 47.2 1.7 5.0 45.7 0.5 100.0 53.9 6,582 50-59 23.6 1.4 3.6 71.1 0.3 100.0 28.6 680 Total 15-59 45.0 1.7 4.9 48.1 0.5 100.0 51.5 7,262 1 Refers to men who attended secondary school or higher and men who can read a whole sentence or part of a sentence 3.4 ACCESS TO MASS MEDIA The 2013 SLDHS collected information on exposure to common print and electronic media. Respondents were asked how often they read a newspaper, listened to the radio, or watched television. This information is important because it indicates the extent to which Sierra Leoneans are regularly exposed to mass media, often used to convey messages on family planning and other health topics. Tables 3.4.1 and 3.4.2 show the percentages of female and male respondents who were exposed to different types of mass media by age, residence, region, district, level of education, and wealth quintile. Seven percent of women and 14 percent of men read newspapers at least once a week, 14 percent of women and 18 percent of men watch television at least once a week, and 40 percent of women and 54 percent of men listen to the radio at least once a week. Overall, only 4 percent of women and 9 percent of men are exposed to all three media at least once per week. More than half of women (56 percent) and more than four of every ten men (43 percent) are not exposed to any of the three types of media on a regular basis. 40 • Characteristics of Respondents There is a slight variation in media access by age. Large disparities exist among women and men in urban and rural areas in accessing any of the three types of media. For example, 14 percent of women in urban areas read a newspaper at least once a week compared with 2 percent in rural areas. Corresponding figures for men in urban and rural areas are 28 percent and 6 percent respectively. Women and men in the Western region access all three types of media more than those in any other region. In the Southern region 70 percent of women and 51 percent of men are without access to any newspaper, television, or radio. Women and men with more education are more likely to access media. The same is true for wealth. For instance, 74 percent of women in the lowest wealth quintile have no weekly exposure to any media source, over twice the proportion found in the highest wealth quintile, at 31 percent. For men, 60 percent in the lowest wealth quintile have no weekly exposure to any media source compared with 23 percent in the highest wealth quintiles. 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, Sierra Leone 2013 Background characteristic Reads a newspaper at least once a week Watches television at least once a week Listens to the radio at least once a week Accesses all three media at least once a week Accesses none of the three media at least once a week Number of women Age 15-19 9.6 17.4 43.5 4.5 51.1 3,878 20-24 9.3 18.8 41.9 4.7 52.2 2,683 25-29 5.5 12.9 37.8 3.5 59.2 2,843 30-34 4.2 10.8 37.3 2.6 59.9 2,287 35-39 3.7 10.4 36.8 2.3 59.8 2,260 40-44 4.3 11.4 38.2 3.2 59.0 1,362 45-49 4.9 8.6 39.9 2.4 57.1 1,344 Residence Urban 13.9 33.1 51.9 8.7 38.7 5,933 Rural 2.4 3.1 33.1 0.6 65.8 10,725 Region Eastern 4.4 6.7 31.9 1.2 64.6 3,614 Northern 4.0 5.9 42.3 1.4 56.5 6,292 Southern 2.3 6.9 28.2 1.3 69.7 3,514 Western 18.3 44.7 56.3 12.6 31.4 3,238 District Kailahun 7.3 12.1 56.2 3.2 39.7 984 Kenema 2.0 6.3 16.3 0.3 79.8 1,651 Kono 5.4 1.9 33.6 0.6 64.0 979 Bombali 5.0 11.2 39.3 3.3 59.3 1,377 Kambia 3.0 10.8 54.7 1.0 43.8 738 Koinadugu 1.6 2.6 6.9 0.5 91.7 719 Port Loko 6.0 5.2 51.8 1.4 47.0 1,994 Tonkolili 1.9 1.1 43.4 0.1 56.0 1,464 Bo 3.6 14.9 30.0 2.9 66.0 1,398 Bonthe 1.7 1.6 28.6 0.3 70.5 678 Moyamba 1.3 1.8 25.7 0.2 73.5 843 Pujehun 1.1 1.3 27.2 0.2 72.3 595 Western Area Rural 15.4 24.6 55.7 10.0 39.4 528 Western Area Urban 18.9 48.6 56.4 13.2 29.9 2,710 Education No education 0.1 5.0 30.5 0.0 68.0 9,293 Primary 1.8 12.0 40.5 0.6 55.3 2,331 Secondary or higher 20.5 31.0 56.6 11.3 34.8 5,034 Wealth quintile Lowest 1.5 1.4 25.2 0.1 73.9 3,089 Second 2.0 3.0 33.5 0.2 65.5 3,046 Middle 2.4 3.0 35.4 0.7 63.4 3,140 Fourth 5.7 8.3 42.2 2.0 55.1 3,388 Highest 17.6 44.8 57.3 12.1 30.6 3,994 Total 6.5 13.8 39.8 3.5 56.2 16,658 Characteristics of Respondents • 41 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, Sierra Leone 2013 Background characteristic Reads a newspaper at least once a week Watches television at least once a week Listens to the radio at least once a week Accesses all three media at least once a week Accesses none of the three media at least once a week Number of men Age 15-19 13.9 20.4 50.8 8.1 44.7 1,475 20-24 21.9 24.0 60.7 12.4 34.7 1,007 25-29 15.6 19.0 54.3 9.7 42.7 1,017 30-34 11.7 14.2 53.2 6.6 45.0 804 35-39 10.7 13.6 51.7 7.1 46.4 961 40-44 10.7 12.5 51.8 7.6 47.0 690 45-49 12.8 13.8 59.8 6.9 37.4 629 Residence Urban 28.3 38.9 67.6 19.9 27.2 2,508 Rural 5.5 4.3 46.0 1.5 52.2 4,073 Region Eastern 11.2 9.6 53.7 4.8 44.3 1,442 Northern 7.8 9.4 49.8 4.1 48.2 2,300 Southern 7.5 6.4 46.9 2.1 50.8 1,414 Western 34.2 49.7 69.2 25.9 24.0 1,425 District Kailahun 5.1 3.3 42.2 0.7 55.7 371 Kenema 13.6 13.0 51.6 7.0 46.4 719 Kono 12.7 9.2 70.1 4.7 28.1 352 Bombali 14.7 24.5 58.2 12.5 40.4 499 Kambia 4.1 4.4 47.5 0.6 50.1 270 Koinadugu 9.6 1.0 20.3 0.7 74.0 268 Port Loko 8.2 8.8 65.1 3.6 33.0 679 Tonkolili 2.3 3.4 39.2 0.6 59.7 584 Bo 10.3 13.1 54.8 4.4 43.0 533 Bonthe 5.7 1.9 27.4 0.7 68.7 283 Moyamba 8.2 3.1 57.1 0.6 40.4 368 Pujehun 2.2 1.5 36.4 0.6 63.6 230 Western Area Rural 23.1 37.6 86.8 19.0 10.9 230 Western Area Urban 36.3 52.1 65.8 27.2 26.5 1,195 Education No education 0.2 5.1 41.2 0.1 58.1 2,651 Primary 3.2 9.8 48.5 1.3 50.4 825 Secondary or higher 29.1 30.2 66.9 17.6 27.5 3,106 Wealth quintile Lowest 2.8 0.9 38.5 0.3 60.3 1,218 Second 3.6 2.8 45.3 0.8 53.8 1,175 Middle 6.0 4.6 48.4 1.5 49.0 1,195 Fourth 13.0 15.0 59.2 5.4 37.7 1,183 Highest 34.9 48.4 71.2 25.7 22.7 1,811 Total 15-49 14.2 17.5 54.2 8.5 42.7 6,582 50-59 11.1 11.4 56.3 5.8 40.5 680 Total 15-59 13.9 17.0 54.4 8.3 42.5 7,262 3.5 EMPLOYMENT Employment is a source of empowerment for women, given that they can exercise control over their own income. It is, however, difficult to measure employment status because some women who work do so on family farms, in family businesses, or in the informal sector, and such work often is not perceived as employment by the women themselves, while the same is true of men employed in these activities. As a result, this type of activity is rarely reported as employment. The 2013 SLDHS asked respondents several questions about their current employment status and continuity of employment in the 12 months preceding the survey. Figure 3.1 and Table 3.5.1 present the proportion of women who were currently employed (i.e., who were working in the seven days preceding the survey), the proportion who were not currently employed but had been employed at some time during the 12 months preceding the survey, and the proportion who had not been employed at any time during the last 12 months. Table 3.5.2 presents similar employment status data for men. 42 • Characteristics of Respondents Figure 3.1 Women’s employment status in the past 12 months Overall, 68 percent of women reported that they were currently employed. An additional 6 percent of women were not currently employed but had worked in the 12 months preceding the survey. Seventy- eight percent of men were currently employed, and an additional 3 percent had worked in the 12 months preceding the survey. The proportion of women and men age 15-19 who were currently employed is lower than among older age groups, a finding that is due partially to the fact that many in the younger age group are students. Women and men who have never married are less likely to be currently employed (42 percent and 55 percent, respectively) compared with other women and men. Women and men with no children are less likely to be currently employed than those who have children. A higher percentage of rural women and men (76 percent and 88 percent respectively) are currently employed compared with urban residents (54 percent and 62 percent respectively). Examining current employment status by region shows that women and men in the Western region have the lowest proportions currently employed (52 percent of women and 62 percent of men). The proportions currently employed do not vary much among the other three regions. Women and men with no education are more likely to be currently employed (80 percent and 95 percent respectively) compared with women and men with primary education (71 percent and 81 percent respectively) or with education beyond the primary level (45 percent and 62 percent respectively). Currently employed 68% Not currently employed, but worked in last 12 months 6% Did not work in last 12 months 26% Sierra Leone, 2013 Characteristics of Respondents • 43 Table 3.5.1 Employment status: Women Percent distribution of women age 15-49 by employment status, according to background characteristics, Sierra Leone 2013 Employed in the 12 months preceding the survey Not employed in the 12 months preceding the survey Missing/ don’t know Total Number of women Background characteristic Currently employed1 Not currently employed Age 15-19 42.5 6.1 51.3 0.1 100.0 3,878 20-24 60.6 6.6 32.7 0.1 100.0 2,683 25-29 74.4 6.5 19.1 0.0 100.0 2,843 30-34 81.8 6.1 11.9 0.3 100.0 2,287 35-39 82.0 6.1 11.8 0.1 100.0 2,260 40-44 80.3 7.0 12.7 0.1 100.0 1,362 45-49 84.2 6.4 9.4 0.0 100.0 1,344 Marital status Never married 41.8 5.4 52.8 0.1 100.0 4,730 Married or living together 78.3 6.8 14.8 0.1 100.0 10,903 Divorced/separated/ widowed 81.2 5.4 13.4 0.0 100.0 1,025 Number of living children 0 43.8 5.5 50.6 0.1 100.0 4,500 1-2 70.4 7.1 22.3 0.1 100.0 5,235 3-4 80.7 6.6 12.6 0.1 100.0 4,159 5+ 84.1 5.9 9.9 0.0 100.0 2,765 Residence Urban 53.6 4.9 41.4 0.1 100.0 5,933 Rural 76.1 7.2 16.7 0.1 100.0 10,725 Region Eastern 71.6 8.1 20.2 0.0 100.0 3,614 Northern 72.9 8.0 19.0 0.1 100.0 6,292 Southern 70.2 4.2 25.5 0.1 100.0 3,514 Western 52.3 3.5 44.1 0.1 100.0 3,238 District Kailahun 70.2 20.4 9.4 0.0 100.0 984 Kenema 73.9 2.8 23.2 0.1 100.0 1,651 Kono 69.3 4.7 25.9 0.0 100.0 979 Bombali 61.6 12.2 26.2 0.0 100.0 1,377 Kambia 66.1 12.5 21.3 0.0 100.0 738 Koinadugu 80.3 1.6 17.8 0.4 100.0 719 Port Loko 73.5 10.9 15.3 0.2 100.0 1,994 Tonkolili 82.6 1.0 16.5 0.0 100.0 1,464 Bo 62.7 2.1 35.2 0.0 100.0 1,398 Bonthe 62.8 3.2 33.7 0.3 100.0 678 Moyamba 79.2 8.3 12.5 0.1 100.0 843 Pujehun 83.5 4.5 11.9 0.0 100.0 595 Western Area Rural 52.4 3.0 44.6 0.0 100.0 528 Western Area Urban 52.3 3.5 44.0 0.1 100.0 2,710 Education No education 79.9 6.8 13.2 0.1 100.0 9,293 Primary 70.5 6.0 23.5 0.1 100.0 2,331 Secondary or higher 45.2 5.6 49.1 0.1 100.0 5,034 Wealth quintile Lowest 78.5 6.7 14.7 0.1 100.0 3,089 Second 76.6 7.3 16.0 0.1 100.0 3,046 Middle 75.0 7.0 17.9 0.1 100.0 3,140 Fourth 66.2 6.8 26.9 0.1 100.0 3,388 Highest 49.6 4.5 45.8 0.1 100.0 3,994 Total 68.1 6.3 25.5 0.1 100.0 16,658 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. The proportion of women currently employed decreases with increasing levels of household wealth. Seventy-nine percent of women in the lowest wealth quintile were currently employed compared with 50 percent in the highest wealth quintile. For men, the proportion currently employed ranges from 60 percent in the highest wealth quintile to 91 percent in the second-lowest wealth quintile. 44 • Characteristics of Respondents Table 3.5.2 Employment status: Men Percent distribution of men age 15-49 by employment status, according to background characteristics, Sierra Leone 2013 Employed in the 12 months preceding the survey Not employed in the 12 months preceding the survey Missing/ don’t know Total Number of men Background characteristic Currently employed1 Not currently employed Age 15-19 45.6 3.5 50.9 0.0 100.0 1,475 20-24 63.7 4.6 31.7 0.0 100.0 1,007 25-29 85.5 3.4 11.2 0.0 100.0 1,017 30-34 93.4 2.3 4.2 0.1 100.0 804 35-39 95.4 2.5 2.1 0.0 100.0 961 40-44 96.4 2.4 1.2 0.0 100.0 690 45-49 96.2 2.1 1.6 0.0 100.0 629 Marital status Never married 54.9 3.8 41.3 0.0 100.0 2,849 Married or living together 95.8 2.5 1.7 0.0 100.0 3,514 Divorced/separated/ widowed 87.4 3.5 8.7 0.4 100.0 219 Number of living children 0 56.7 3.8 39.5 0.0 100.0 2,871 1-2 90.1 3.5 6.4 0.0 100.0 1,546 3-4 97.2 1.4 1.5 0.0 100.0 1,133 5+ 96.7 2.7 0.5 0.0 100.0 1,032 Residence Urban 61.9 3.7 34.3 0.0 100.0 2,508 Rural 87.6 2.7 9.7 0.0 100.0 4,073 Region Eastern 83.5 2.1 14.4 0.0 100.0 1,442 Northern 83.7 3.1 13.2 0.0 100.0 2,300 Southern 78.2 4.3 17.5 0.0 100.0 1,414 Western 62.0 3.0 34.9 0.1 100.0 1,425 District Kailahun 89.6 2.3 8.1 0.0 100.0 371 Kenema 80.5 2.0 17.4 0.0 100.0 719 Kono 83.2 2.2 14.6 0.0 100.0 352 Bombali 73.5 5.4 21.1 0.0 100.0 499 Kambia 92.0 1.0 7.0 0.0 100.0 270 Koinadugu 91.8 1.8 6.3 0.0 100.0 268 Port Loko 88.2 3.9 7.9 0.0 100.0 679 Tonkolili 79.8 1.6 18.6 0.0 100.0 584 Bo 76.3 1.4 22.3 0.0 100.0 533 Bonthe 73.0 9.3 17.8 0.0 100.0 283 Moyamba 77.7 7.0 15.3 0.0 100.0 368 Pujehun 89.7 0.8 9.5 0.0 100.0 230 Western Area Rural 65.9 1.1 33.0 0.0 100.0 230 Western Area Urban 61.3 3.4 35.3 0.1 100.0 1,195 Education No education 94.8 2.5 2.6 0.0 100.0 2,651 Primary 81.4 2.2 16.5 0.0 100.0 825 Secondary or higher 62.3 3.9 33.8 0.0 100.0 3,106 Wealth quintile Lowest 88.6 3.3 8.0 0.0 100.0 1,218 Second 90.5 2.3 7.2 0.0 100.0 1,175 Middle 86.9 2.5 10.7 0.0 100.0 1,195 Fourth 72.0 4.3 23.7 0.0 100.0 1,183 Highest 60.1 3.2 36.7 0.0 100.0 1,811 Total 15-49 77.8 3.1 19.1 0.0 100.0 6,582 50-59 94.0 2.3 3.6 0.1 100.0 680 Total 15-59 79.3 3.0 17.6 0.0 100.0 7,262 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. Characteristics of Respondents • 45 3.6 OCCUPATION The term occupation refers to the job held or the kind of work performed during the reference period. Respondents who were currently employed were asked to state their occupation; Tables 3.6.1 and 3.6.2 present the results for women and men, respectively. These tables show that the agriculture sector employs 52 percent of women and 54 percent of men. Two percent of women and 7 percent of men are employed in professional, technical, and managerial occupations; however, 37 percent of women are engaged in unskilled manual work compared with 27 percent of men. Five percent of women and 3 percent of men work in sales and services occupations. Urban women and men are most often employed in unskilled manual work (68 percent and 47 percent respectively). In rural areas the majority of women (69 percent) and men (73 percent) work in agriculture. By region, the Southern region has the highest percentage of women in agricultural work (64 percent), while the Northern and Southern regions have the highest percentage of men working in agriculture (67 percent each). The Western region has the highest percentage of both women and men in unskilled manual work (69 percent and 49 percent respectively). Occupation also varies with level of education. Ten percent of women and 16 percent of men with at least some secondary education are employed in professional, technical, and managerial occupations. Women and men with no education or only a primary education most commonly work in agriculture. Employed women and men in the lower wealth quintiles are concentrated in agricultural occupations. The most common occupation among women and men in the highest wealth quintile is unskilled manual labor. 46 • Characteristics of 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, Sierra Leone 2013 Background characteristic Professional/ technical/ managerial Clerical Sales and services Skilled manual Unskilled manual Domestic service Agriculture Missing Total Number of women Age 15-19 0.3 0.0 4.0 0.1 35.8 0.9 46.3 12.7 100.0 1,884 20-24 1.5 0.1 6.2 0.0 43.8 0.5 44.9 3.1 100.0 1,804 25-29 3.0 0.7 5.7 0.1 37.4 0.5 50.1 2.5 100.0 2,300 30-34 2.3 0.2 4.6 0.0 37.6 0.2 54.1 1.0 100.0 2,009 35-39 2.3 0.6 3.9 0.0 36.3 0.3 55.8 0.8 100.0 1,992 40-44 2.7 0.2 3.8 0.1 34.5 0.2 57.1 1.3 100.0 1,188 45-49 4.3 0.5 3.4 0.0 32.7 0.3 57.7 1.1 100.0 1,218 Marital status Never married 3.6 0.7 7.1 0.1 44.7 0.8 30.1 13.0 100.0 2,230 Married or living together 1.7 0.2 3.8 0.0 34.8 0.4 57.9 1.2 100.0 9,278 Divorced/separated/ widowed 4.7 0.9 7.2 0.0 43.7 0.2 41.8 1.6 100.0 887 Number of living children 0 3.1 0.6 5.3 0.1 38.6 0.9 39.8 11.7 100.0 2,216 1-2 3.1 0.6 5.8 0.0 41.0 0.4 46.6 2.5 100.0 4,059 3-4 1.8 0.1 4.1 0.0 35.8 0.4 56.7 1.1 100.0 3,631 5+ 0.7 0.0 3.0 0.1 31.8 0.2 63.6 0.7 100.0 2,488 Residence Urban 6.4 1.2 9.5 0.1 67.9 0.7 7.9 6.3 100.0 3,471 Rural 0.6 0.0 2.7 0.0 25.3 0.3 68.8 2.2 100.0 8,925 Region Eastern 1.3 0.1 4.2 0.0 29.9 0.6 59.1 4.8 100.0 2,882 Northern 1.2 0.1 3.3 0.0 34.4 0.3 58.4 2.2 100.0 5,092 Southern 1.4 0.0 3.9 0.1 28.7 0.3 63.9 1.7 100.0 2,614 Western 7.8 2.0 10.1 0.1 69.0 0.8 3.5 6.7 100.0 1,807 District Kailahun 0.4 0.1 2.6 0.0 24.4 2.0 62.5 7.9 100.0 892 Kenema 1.8 0.0 3.8 0.0 37.2 0.0 56.2 1.0 100.0 1,266 Kono 1.5 0.1 6.9 0.0 23.7 0.1 60.0 7.6 100.0 725 Bombali 1.7 0.2 5.2 0.1 25.9 0.2 64.8 2.0 100.0 1,016 Kambia 0.6 0.0 3.5 0.0 28.8 0.9 62.4 3.8 100.0 580 Koinadugu 0.9 0.1 1.4 0.0 17.6 0.0 78.5 1.5 100.0 588 Port Loko 1.0 0.0 1.5 0.0 48.4 0.3 45.8 2.9 100.0 1,684 Tonkolili 1.7 0.0 5.0 0.0 33.2 0.1 59.0 1.1 100.0 1,223 Bo 2.6 0.0 3.6 0.0 33.3 0.0 57.9 2.6 100.0 906 Bonthe 1.2 0.3 9.1 0.3 31.1 0.9 55.9 1.3 100.0 447 Moyamba 0.5 0.0 1.1 0.0 17.3 0.3 79.6 1.1 100.0 737 Pujehun 0.6 0.0 3.9 0.1 34.7 0.3 59.0 1.4 100.0 524 Western Area Rural 2.4 0.3 12.5 0.0 74.9 0.9 7.2 1.8 100.0 293 Western Area Urban 8.8 2.4 9.6 0.1 67.9 0.7 2.7 7.7 100.0 1,514 Education No education 0.1 0.0 3.2 0.0 32.6 0.3 62.8 1.0 100.0 8,058 Primary 0.1 0.0 5.1 0.1 43.6 0.5 47.3 3.3 100.0 1,782 Secondary or higher 10.4 1.7 8.8 0.0 47.4 0.8 19.9 11.0 100.0 2,556 Wealth quintile Lowest 0.2 0.0 1.7 0.0 18.9 0.4 77.2 1.6 100.0 2,631 Second 0.2 0.0 2.6 0.0 22.3 0.3 72.8 1.8 100.0 2,557 Middle 0.5 0.0 2.0 0.0 29.4 0.3 64.9 2.8 100.0 2,573 Fourth 1.5 0.1 7.6 0.1 52.9 0.6 32.7 4.6 100.0 2,475 Highest 9.9 1.8 10.3 0.1 68.7 0.7 1.8 6.7 100.0 2,160 Total 2.2 0.3 4.6 0.0 37.2 0.4 51.7 3.4 100.0 12,396 Characteristics of Respondents • 47 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, Sierra Leone 2013 Background characteristic Professional/ technical/ managerial Clerical Sales and services Skilled manual Unskilled manual Agriculture Missing Total Number of men Age 15-19 1.7 0.0 1.9 1.4 23.5 59.7 11.9 100.0 724 20-24 5.1 0.0 2.2 5.8 30.4 48.4 8.1 100.0 688 25-29 6.7 0.4 3.4 9.8 29.2 47.2 3.2 100.0 904 30-34 7.8 0.4 2.7 6.8 29.0 51.9 1.4 100.0 769 35-39 7.0 0.6 3.2 5.0 26.7 55.6 1.9 100.0 941 40-44 10.4 0.4 1.8 4.1 23.0 58.5 1.8 100.0 681 45-49 10.0 0.9 3.2 3.4 23.7 58.1 0.7 100.0 619 Marital status Never married 5.1 0.4 2.9 5.3 30.2 46.4 9.6 100.0 1,672 Married or living together 7.6 0.4 2.7 5.2 24.5 58.4 1.3 100.0 3,455 Divorced/separated/ widowed 9.5 0.9 1.3 9.3 34.4 39.4 5.1 100.0 200 Number of living children 0 4.7 0.2 3.0 4.7 29.4 49.1 8.9 100.0 1,736 1-2 8.3 0.5 2.9 8.8 29.9 46.8 2.8 100.0 1,447 3-4 8.9 0.5 2.5 4.7 23.3 58.8 1.3 100.0 1,116 5+ 6.4 0.4 2.1 2.5 21.3 66.9 0.5 100.0 1,027 Residence Urban 15.0 1.2 6.6 12.7 47.0 10.9 6.8 100.0 1,647 Rural 3.2 0.1 0.9 2.1 17.6 73.2 2.8 100.0 3,679 Region Eastern 3.6 0.1 1.6 4.5 28.7 55.5 6.0 100.0 1,235 Northern 5.8 0.3 1.3 3.9 19.9 66.7 2.1 100.0 1,996 Southern 4.6 0.2 2.3 4.4 18.9 66.9 2.7 100.0 1,167 Western 16.3 1.3 7.6 11.0 48.5 8.0 7.4 100.0 927 District Kailahun 2.7 0.0 0.0 1.4 24.0 58.7 13.3 100.0 341 Kenema 3.8 0.1 2.6 5.0 33.7 51.6 3.2 100.0 594 Kono 4.3 0.0 1.5 7.3 24.1 59.6 3.2 100.0 301 Bombali 9.1 0.1 2.5 5.2 22.2 59.4 1.6 100.0 394 Kambia 3.2 0.0 1.5 2.7 8.0 82.2 2.5 100.0 251 Koinadugu 5.5 0.4 0.8 4.0 12.7 72.6 4.0 100.0 251 Port Loko 3.7 0.4 1.0 5.1 17.4 69.7 2.6 100.0 625 Tonkolili 7.5 0.5 0.8 2.0 31.3 57.4 0.4 100.0 475 Bo 7.8 0.2 3.3 8.3 19.1 59.2 2.0 100.0 414 Bonthe 2.1 0.4 3.4 2.3 16.3 69.6 5.9 100.0 233 Moyamba 4.1 0.1 0.5 1.5 12.5 79.4 1.8 100.0 312 Pujehun 1.8 0.0 2.0 3.0 30.8 60.4 2.0 100.0 208 Western Area Rural 7.2 0.9 7.6 11.6 52.0 20.3 0.5 100.0 154 Western Area Urban 18.1 1.3 7.6 10.9 47.8 5.5 8.7 100.0 773 Education No education 1.1 0.1 1.1 3.2 24.0 69.5 1.0 100.0 2,582 Primary 0.9 0.0 1.8 5.2 31.0 58.3 2.8 100.0 689 Secondary or higher 16.1 0.9 4.9 8.3 28.6 32.9 8.3 100.0 2,055 Wealth quintile Lowest 1.5 0.0 0.0 1.0 17.1 78.3 2.1 100.0 1,120 Second 2.1 0.0 0.6 1.3 14.6 78.6 2.9 100.0 1,090 Middle 3.8 0.0 1.1 3.5 19.6 68.6 3.3 100.0 1,067 Fourth 7.4 0.4 3.1 8.7 34.5 40.5 5.3 100.0 902 Highest 19.1 1.5 8.4 12.7 47.9 3.6 6.8 100.0 1,146 Total 15-49 6.9 0.4 2.7 5.4 26.7 53.9 4.0 100.0 5,326 50-59 9.6 1.1 3.0 2.4 22.8 59.4 1.7 100.0 655 Total 15-59 7.2 0.5 2.7 5.1 26.2 54.5 3.8 100.0 5,981 3.7 TYPE OF EMPLOYMENT Table 3.7 shows the percent distribution of women employed in the 12 months preceding the survey by type of earnings, type of employer, and continuity of employment, according to type of employment (agricultural or nonagricultural). Eleven percent of women engaged in agricultural work and 52 percent of women engaged in nonagricultural work are paid in cash only. Most other women in these occupational categories are not paid (68 percent for agriculture workers and 37 percent for nonagricultural workers). However, 15 percent of women working in agriculture and 7 percent of women in nonagricultural occupations received cash and in-kind earnings. Sixty-five percent of women engaged in agricultural work 48 • Characteristics of Respondents and 79 percent of women engaged in nonagricultural work are self-employed. Women in agricultural work are more likely than those in nonagricultural work to be employed by a family member (34 percent and 14 percent, respectively). Thirty-seven percent of women working in agriculture are employed all year compared with 75 percent of women engaged in nonagricultural work. Fifty-nine percent of women working in agriculture are seasonally employed compared with 17 percent of those who are nonagricultural workers. Table 3.7 Type of employment Percent distribution of women age 15-49 employed in the 12 months preceding the survey by type of earnings, type of employer, and continuity of employment, according to type of employment (agricultural or nonagricultural), Sierra Leone 2013 Employment characteristic Agricultural work Nonagricultural work Total Type of earnings Cash only 11.4 52.3 30.1 Cash and in-kind 14.9 6.6 10.8 In-kind only 5.5 3.3 4.4 Not paid 67.5 37.2 54.1 Missing 0.7 0.5 0.7 Total 100.0 100.0 100.0 Type of employer Employed by family member 33.6 14.2 24.3 Employed by nonfamily member 0.7 6.3 3.4 Self-employed 65.4 79.0 71.8 Missing 0.3 0.5 0.5 Total 100.0 100.0 100.0 Continuity of employment All year 37.0 74.8 54.4 Seasonal 58.9 17.2 39.4 Occasional 3.8 7.7 5.8 Missing 0.3 0.3 0.4 Total 100.0 100.0 100.0 Number of women employed during the last 12 months 6,413 5,565 12,396 Note: Total includes 418 women with missing information on type of employment. 3.8 HEALTH INSURANCE COVERAGE Medical insurance can provide peace of mind and, most important, can help pay for health care needed to save lives and promote well-being. In the 2013 SLDHS, women and men were asked if they were covered by any health insurance. Results shown in Table 3.8 indicate that only 1 percent of women and 3 percent of men have health insurance. For both women and men, health insurance coverage tends to be the highest in urban areas, in the Western region, among respondents with at least some secondary education, and among respondents in the highest wealth quintile. Characteristics of Respondents • 49 Table 3.8 Health insurance coverage Percentage of women and men age 15-49 with health insurance coverage, according to background characteristics, Sierra Leone 2013 Women Men Background characteristic Percentage covered by health insurance Number of women Percentage covered by health insurance Number of men Residence Urban 2.2 5,933 5.9 2,508 Rural 0.2 10,725 1.1 4,073 Region Eastern 0.5 3,614 3.6 1,442 Northern 0.6 6,292 1.5 2,300 Southern 1.0 3,514 1.2 1,414 Western 2.3 3,238 6.1 1,425 Education No education 0.4 9,293 0.9 2,651 Primary 0.8 2,331 3.8 825 Secondary or higher 2.2 5,034 4.5 3,106 Wealth quintile Lowest 0.2 3,089 0.3 1,218 Second 0.2 3,046 0.8 1,175 Middle 0.4 3,140 1.5 1,195 Fourth 1.0 3,388 2.9 1,183 Highest 2.5 3,994 7.0 1,811 Total 15-49 1.0 16,658 2.9 6,582 50-59 na na 3.9 680 Total 15-59 na na 3.0 7,262 3.9 SMOKING In order to measure the extent of smoking among Sierra Leonean adults, women and men who were interviewed in the 2013 SLDHS were asked if they currently smoked cigarettes or used tobacco. Tables 3.9.1 and 3.9.2 present the percentages of women and men who smoke cigarettes or a pipe or use other tobacco products. Table 3.9.2 also includes information obtained from male cigarette smokers on number of cigarettes smoked in the 24 hours before the interview. The results shown in Table 3.9.1 indicate that less than 9 percent of women said they use tobacco of any kind, and less than 5 percent said they smoke cigarettes, which is a slight decline from the 12 percent and 6 percent recorded in 2008 for overall tobacco use and smoking respectively. Twenty-eight percent of men age 15-49 use tobacco products, with 27 percent saying that they smoke cigarettes, down from 37 percent in the 2008 SLDHS. Men in the highest wealth quintile, those in the urban areas, and those with secondary or higher education are less likely to smoke cigarettes compared with men with less education, rural men, and men in the lower wealth quintiles. Among the regions, men in Northern region have the highest level of cigarette smoking, whereas men in Western region have the lowest level of smoking. Among men age 15-49 who smoke cigarettes, the largest proportion (54 percent) said they smoked 10 or more in the previous 24 hours, followed by those who smoked 3.5 cigarettes (24 percent) and those who smoked 6-9 cigarettes (12 percent). There is little variation among the wealth quintiles in the percentage of men who smoked 10 or more cigarettes in the previous 24 hours; men with secondary or higher education are less likely to smoke 10 or more cigarettes per day compared with men with no education and men with primary education. 50 • Characteristics of Respondents Table 3.9.1 Use of tobacco: Women Percentage of women age 15-49 who smoke cigarettes or a pipe or use other tobacco products, according to background characteristics and maternity status, Sierra Leone 2013 Uses tobacco Does not use tobacco Number of women Background characteristic Cigarettes Pipe Other tobacco Age 15-19 0.5 0.0 0.2 99.1 3,878 20-24 3.1 0.1 1.0 96.1 2,683 25-29 4.3 0.1 2.0 93.7 2,843 30-34 6.5 0.0 4.5 89.5 2,287 35-39 6.6 0.1 6.6 87.5 2,260 40-44 8.4 0.2 10.2 82.0 1,362 45-49 7.7 0.3 13.6 79.2 1,344 Maternity status Pregnant 2.3 0.0 3.6 94.3 1,429 Breastfeeding (not pregnant) 4.0 0.0 3.4 93.0 3,998 Neither 4.9 0.1 4.3 91.1 11,231 Residence Urban 4.0 0.0 1.5 94.5 5,933 Rural 4.7 0.1 5.4 90.3 10,725 Region Eastern 6.9 0.0 7.1 86.8 3,614 Northern 4.6 0.1 1.8 93.7 6,292 Southern 2.5 0.1 7.6 90.0 3,514 Western 3.5 0.0 0.8 95.7 3,238 District Kailahun 10.5 0.1 7.8 82.7 984 Kenema 5.5 0.0 8.9 86.0 1,651 Kono 5.6 0.0 3.5 92.2 979 Bombali 4.0 0.0 1.7 94.6 1,377 Kambia 6.0 0.2 1.5 92.5 738 Koinadugu 3.0 0.1 1.9 95.3 719 Port Loko 3.3 0.0 1.9 95.0 1,994 Tonkolili 6.9 0.5 1.9 91.1 1,464 Bo 2.5 0.0 8.7 88.9 1,398 Bonthe 1.4 0.0 2.7 95.8 678 Moyamba 3.8 0.3 8.4 87.8 843 Pujehun 2.0 0.0 9.4 88.7 595 Western Area Rural 3.1 0.0 1.6 95.5 528 Western Area Urban 3.6 0.0 0.6 95.7 2,710 Education No education 6.0 0.1 6.5 88.0 9,293 Primary 4.3 0.1 2.0 94.0 2,331 Secondary or higher 1.7 0.0 0.3 97.8 5,034 Wealth quintile Lowest 5.1 0.2 6.9 88.2 3,089 Second 5.4 0.2 5.7 89.3 3,046 Middle 4.2 0.0 5.4 90.8 3,140 Fourth 5.1 0.0 2.7 92.5 3,388 Highest 2.8 0.0 0.4 96.7 3,994 Total 4.4 0.1 4.0 91.8 16,658 Characteristics of Respondents • 51 Table 3.9.2 Use of tobacco: Men Percentage of men age 15-49 who smoke cigarettes or a pipe or use other tobacco products and the percent distribution of cigarette smokers by number of cigarettes smoked in preceding 24 hours, according to background characteristics, Sierra Leone 2013 Uses tobacco Does not use tobacco Number of men Percent distribution of men who smoke cigarettes by number of cigarettes smoked in the past 24 hours Total Number of cigarette smokers Background characteristic Cigarettes Pipe Other tobacco 0 1-2 3-5 6-9 10+ Don’t know/ missing Age 15-19 3.8 0.0 0.0 96.1 1,475 0.0 20.0 33.7 6.2 39.6 0.5 100.0 57 20-24 14.3 0.0 0.8 85.3 1,007 0.3 9.6 23.5 10.7 53.1 2.8 100.0 144 25-29 26.1 0.1 1.9 73.3 1,017 0.6 6.4 31.0 11.8 46.6 3.5 100.0 265 30-34 37.7 0.0 1.8 62.2 804 0.5 7.2 26.1 7.0 55.0 4.2 100.0 303 35-39 45.5 0.6 2.4 53.5 961 0.7 5.6 21.9 11.9 56.3 3.7 100.0 437 40-44 39.1 0.3 2.0 59.9 690 0.0 3.5 19.9 14.2 59.3 3.1 100.0 270 45-49 44.2 0.5 1.7 54.7 629 0.6 3.2 21.1 18.1 54.0 3.1 100.0 278 Residence Urban 13.7 0.2 1.1 85.8 2,508 0.1 6.1 24.3 14.2 53.3 1.9 100.0 344 Rural 34.6 0.2 1.6 64.9 4,073 0.6 6.1 24.0 11.6 54.0 3.7 100.0 1,410 Region Eastern 31.8 0.3 2.5 66.9 1,442 0.4 8.8 35.0 12.9 42.2 0.8 100.0 459 Northern 33.0 0.2 0.6 66.8 2,300 0.3 3.7 16.6 11.6 66.8 1.0 100.0 760 Southern 27.8 0.1 1.4 71.9 1,414 0.9 6.4 25.0 11.8 45.2 10.7 100.0 394 Western 9.9 0.2 1.4 89.5 1,425 0.3 9.4 26.0 13.1 46.9 4.2 100.0 141 Distr

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