Tanzania - Demographic and Health Survey - 1993

Publication date: 1993

Tanzania i • " T r • Tanzania Demographic and Health Survey 1991/1992 Sylvester Ngallaba Saidi Hussein Kapiga Ireneus Ruyobya J. Ties Boerma Bureau of Statistics Planning Commission Dares Salaam, Tanzania Macro International Inc. Columbia, Maryland USA June 1993 This report summarises the findings of the 1991/1992 Tanzania Demographic and Health Survey (TDHS) conducted by the Bureau of Statistics, in collaboration with the Ministry of Health. Macro International Inc. provided technical assistance. Core funds for the TDHS were provided by the U.S. Agency for Intemational Development in Washington through the worldwide Demographic and Health Surveys programme. Additional funding was provided by USAIDfl'anzania. The TDHS is part of the worldwide Demographic and Health Surveys (DHS) programme, which is designed to collect data on fertility, family planning, and maternal and child health. Additionalinform ation about the TDHS may be obtained from the Bureau of Statistics, P.O. Box 796, Dares Salaam (Telephone 051-22722/5; Fax 051-36364). Additional information about the DHS programme may be obtained by writing to: DHS, Macro International Inc., 8850 Stanford Boulevard, Suite 4000, Columbia, MD 21045, USA (Telephone 410-290-2800; Fax 410-290-2999). CONTENTS Page TABLES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . vii FIGURES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xiii ACRONYMS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xv PREFACE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xvii MAP OF TANZANIA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xviii CHAPTER 1 1.1 1.2 1.3 1.4 1.5 1.6 INTRODUC~ON Geography, History, and Economy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 Population . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 Population and Family Planning Policies and Programmes . . . . . . . . . . . . . . . . . . . . 2 Health Priorities and Programmes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 Objectives and Organisation of the Survey . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 Fieldwork . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 CHAPTER 2 2.1 2.2 2.3 CHAPTER 3 3.1 3.2 3.3 3.4 3.5 CHAPTER 4 4.1 4.2 4.3 4.4 4.5 4.6 4.7 4.8 CHARACTERISTICS OF HOUSEHOLDS AND RESPONDENTS Characteristics of the Household Population . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 Housing Characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 Background Characteristics of Survey Respondents . . . . . . . . . . . . . . . . . . . . . . . . 17 FERTILITY Current Fertility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 Children Ever Born and Living . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25 Birth Intervals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26 Age at First Birth . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28 Teenage Pregnancy and Motherhood . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29 FERTILITY REGULATION Knowledge of Contraception . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31 Ever Use of Contraception . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34 Current Use of Contraceptives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35 Number of Children at First Use of Contraception . . . . . . . . . . . . . . . . . . . . . . . . . . 38 Knowledge of Fert'de Period . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39 Sources of Family Planning Methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40 Intention to Use Family Planning Among Nonusers . . . . . . . . . . . . . . . . . . . . . . . . 43 Approval of Family Planning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46 iii CHAPTER 5 5.1 5.2 5.3 5.4 5.5 5.6 5.7 CHAPTER 6 6.1 6.2 6.3 6.4 CHAPTER 7 7.1 7.2 CHAPTER 8 8.1 8.2 8.3 8.4 8.5 CHAPTER 9 9.1 9.2 9.3 9.4 CHAPTER 10 10.1 10.2 10.3 10.4 10.5 10.6 Page PROXIMATE DETERMINANTS OF FERTILITY Marital Stutus . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51 Polygamy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52 Age at First Marriage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54 Age at First Intercourse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56 Recent Sexual Activity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56 Postpartum Amenorrhoea, Abstinence, and Insusceptibility . . . . . . . . . . . . . . . . . . 59 Termination of Exposure to Pregnancy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60 FERTILITY PREFERENCES Desire for More Children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63 Demand for Family Planning Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65 Ideal and Actual Number of Children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67 Fertility Planning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69 INFANT AND CHILD MORTALITY Infant and Child Mort,ality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71 High-Risk Fertility Behaviour . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 76 MATERNAL AND CHILD HEALTH Antenatal Care and Delivery Assistance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79 Vaccinations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 86 Acute Respiratory Infection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 92 Fever . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93 Diarrhoea . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 94 INFANT FEEDING AND CHILDHOOD NUTRITION Breastfeeding and Supplementation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99 Birth Weight . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 104 Child Nutritional Status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 106 Mother's Nutritional Status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111 RESULTS OF THE MALE SURVEY Background Characteristics of Male Survey Respondents . . . . . . . . . . . . . . . . . . . 113 Fertility Regulation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 117 Nupfiality and Sexual Intercourse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 130 Fertility Preferences . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 138 Couples . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 142 Desire for More Children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 145 iv CHAPTER 11 11.1 11.2 11.3 11.4 11.5 CHAPTER 12 12.1 12.2 12.3 Page AIDS KNOWLEDGE AND SEXUAL PRACTICES AIDS Awareness and Knowledge . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 147 AIDS Misconceptions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 149 Sources of Information about AIDS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 150 Attitudes about AIDS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 152 Sexual Practices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 154 LOCAL AVAILABILITY OF FAMILY PLANNING AND HEALTH SERVICES Services Availability Questionnaire . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 161 AvailabUity of Family Planning Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 162 Availability of Maternal and Child Health Services . . . . . . . . . . . . . . . . . . . . . . . . 164 REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 171 APPENDIX A APPENDIX B APPENDIX C APPENDIX D APPENDIX E PERSONS INVOLVED IN THE TANZANIA DEMOGRAPIHC AND HEALTH SURVEY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 175 SURVEY DESIGN . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 179 ESTIMATES OF SAMPLING ERRORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 191 DATA QUALITY TABLES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 209 QUESTIONNAIRES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 215 V Table 1.1 Table 1.2 Table 2.1 Table 2.2 Table 2.3 Table 2.4.1 Table 2.4.2 Table 2.5 Table 2.6 Table 2.7 Table 2.8 Table 2.9 Table 2.10 Table 3.1 Table 3.2 Table 3.3 Table 3.4 Table 3.5 Table 3.6 Table 3.7 Table 3.8 Table 3.9 Table 3.10 Table 4.1 Table 4.2 Table 4.3 Table 4.4 Table 4.5 Table 4.6 Table 4.7 Table 4.8 TABLES Page Demographic indicators . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 Result of the household and individual interviews . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5 Household population by age, residence and sex . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 Population by age from selected sources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 Household composition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 Educational level of the female household population . . . . . . . . . . . . . . . . . . . . . . . . . . 11 Educational level of the male household population . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 School enrolment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 Housing characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 Household durable goods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 Background characteristics of respondents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 Level of education . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 Access to mass media . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 Current fertility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 Fertility by background characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23 Age-specific fertility rates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24 Fertility by marital duration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24 Children ever born and living . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25 Birth intervals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27 Age at first birth . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28 Median age at first birth . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29 Teenage pregnancy and motherhood . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 Children born to teenagers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 Knowledge of contraceptive methods and source for methods . . . . . . . . . . . . . . . . . . . . 31 Knowledge of modem contraceptive methods and source for methods . . . . . . . . . . . . . 33 Ever use of contraception . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34 Current use of contraception by age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35 Current use of contraception by background characteristics . . . . . . . . . . . . . . . . . . . . . 36 Number of children at first use of contraception . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39 Knowledge of fertile period . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40 Source of supply for modem contraceptive methods . . . . . . . . . . . . . . . . . . . . . . . . . . . 41 vii Table 4.9 Table 4.10 Table 4.11 Table 4.12 Table 4.13 Table 4.14 Table 4.15 Table 4.16 Table 5.1 Table 5.2 Table 5.3 Table 5.4 Table 5.5 Table 5.6 Table 5.7 Table 5.8 Table 5.9 Table 5.10 Table 5.11 Table 6.1 Table 6.2 Table 6.3 Table 6.4 Table 6.5 Table 6.6 Table 6.7 Table 6.8 Table 7.1 Table 7.2 Table 7.3 Table 7.4 Page Time to source of supply for modem contraceptive methods . . . . . . . . . . . . . . . . . . . . . 42 Future use of contraception . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44 Reasons for not using contraception . . . . . . . . . . . . . . . . . . . . . . . . . ~ . . . . . . . . . . . . . . 45 Preferred method of contraception for future use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45 Family planning messages on radio and television . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46 Acceptability of the use of mass media for disseminating family planning messages . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47 Discussion of family planning by couples . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48 Attitudes of couples toward family planning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49 Current marital status by age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51 Polygyny . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52 Number of co-wives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53 Age at first marriage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54 Median age at first marriage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55 Age at first sexual intercourse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56 Median age at first intercourse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57 Recent sexual activity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58 Postpartum amenorrhoea, abstinence and insusceptibility . . . . . . . . . . . . . . . . . . . . . . . 59 Postpartum amenorrhoea, abstinence and insusceptibility by background characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60 Termination of exposure to the risk of pregnancy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61 Fertility preference by number of living children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63 Fertility preferences by age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64 Desire to limit childbearing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65 Need for family planning services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66 Ideal number of children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67 Mean ideal number of children by background characteristics . . . . . . . . . . . . . . . . . . . . 68 Fertility planning status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69 Wanted fertility rates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70 Infant and child mortality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71 Infant and child mortality by background characteristics . . . . . . . . . . . . . . . . . . . . . . . . 73 Infant and child mortality by demographic characteristics . . . . . . . . . . . . . . . . . . . . . . . 76 High-risk fertility behaviour . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77 viii Table 8.1 Table 8.2 Table 8.3 Table 8.4 "Iable 8.5 Table 8.6 Table 8.7 Table 8.8 Table 8,9 Table 8.10 Table 8,11 Table 8.12 Table 8.13 Table 9.1 Table 9.2 Table 9.3 Table 9A Table 9.5 Table 9.6 Table 9.7 Table 9.8 Table 9.9 Table 9.10 Table 9.11 Table 10.1 Table 10.2 Table 10.3 Table 10.4 Table 10.5 Table 10.6 Table 10.7 Table 10.8 Page Antenatal care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80 Tetanus toxoid vaccination . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 82 Place of delivery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 84 Assistance during delivery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85 Vaccinations by source of information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87 Vaccinations in the first year of life . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89 Vaccinations by background characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91 Prevalence and treatment of acute respiratory infection . . . . . . . . . . . . . . . . . . . . . . . . . 92 Prevalence and treatment of fever . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93 Prevalence of diarrhoea . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 94 Knowledge and use of ORS packets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95 Treatment of diarrhoea . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 96 Feeding practises during diarrhoea . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97 Initial breastfeec ing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100 Breastfeeding status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 101 Breastfeeding and supplementation by age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 102 Median duration and frequency of breastfeeding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103 Feeding pattems for children under 5 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 104 Birth weight data . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 105 Mean birth weight and incidence of low birth weight . . . . . . . . . . . . . . . . . . . . . . . . . 106 Nutritional status by demographic characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . 108 Nutritional status by socioeconomic characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . 109 Anthropometric indicators of maternal nutritional status . . . . . . . . . . . . . . . . . . . . . . . 111 Differentials in matemal anthropometric indicators . . . . . . . . . . . . . . . . . . . . . . . . . . . 112 Background characteristics of respondents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 114 Level of education . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 115 Access to mass media . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 116 Knowledge of contraceptive methods and source for methods . . . . . . . . . . . . . . . . . . . 117 Knowledge of modem contraceptive methods and source for methods . . . . . . . . . . . . 119 Ever use of contraception . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 120 Current use of contraception by age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 121 Current use of contraception by background characteristics . . . . . . . . . . . . . . . . . . . . 123 ix Table 10.9 Table 10.10 Table 10.11 Table 10.12 Table 10.13 Table 10.14 Table 10.15 Table 10.16 Table 10.17 Table 10.18 Table 10.19 Table 10.20 Table 10.22 Table 10.23 Table 10.24 Table 10.25 Table 10.26 Table 10.27 Table 10.28 Table 10.29 Table 10.30 Table 10.31 Table 10.32 Table 10.33 Table 11.1 Table 11.2 Table 11.3 Table 11.4 Table 11.5 Table 11.6 Table 11.7 Table 11.8 Page Source of supply for modem contraceptive methods . . . . . . . . . . . . . . . . . . . . . . . . . . 124 Time to source of supply for modem contraceptive methods . . . . . . . . . . . . . . . . . . . . 125 Future use of contraeeption . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 126 Reasons for not using contraception . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 127 Preferred method of contraception for future use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 127 Family planning messages on radio and television . . . . . . . . . . . . . . . . . . . . . . . . . . . . 128 Acceptability of the use of mass media for disseminating family planning messages . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 129 Attitudes of couples toward family planning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 130 Current marital status by age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 131 Polygyny . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 132 Age at first marriage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 133 Median age at first marriage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 134 Age at first sexual intercourse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 135 Recent sexual activity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 137 Fertility preference by number of living children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 138 Fertility preferences by age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 139 Ideal number of children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 141 Background characteristics of husbands . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 142 Age difference between spouses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 143 Knowledge of methods among married couples . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 143 Attitudes of couples toward family planning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 144 Spouse's perception of other spouse's approval of family planning . . . . . . . . . . . . . . 145 Desire for more children among couples by number of living children . . . . . . . . . . . . 145 Ideal number of children according to spouses . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 146 Knowledge of AIDS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 148 AIDS transmission . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 150 Sources of AIDS information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 151 Government and personal action for AIDS patients . . . . . . . . . . . . . . . . . . . . . . . . . . . 152 Frequency of intercourse in the four weeks preceding the survey . . . . . . . . . . . . . . . . 155 Usual frequency of intercourse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 156 Number of sexual parmers in the four weeks preceding the survey . . . . . . . . . . . . . . . 157 Condom use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 158 X Table 11.9 Table 12.1 Table 12.2 Table 12.3 Table 12.4 Table 12.5 Table 12.6 Table 12.7 Table 12.8 Table 12.9 Table 12.10 Table 12.11 Table B. 1 Table B.2 Table B.3 Table B.4 Table B.5 Table C. 1 Table C.2 Table C.3 Table C.4 Table C.5 Table C.6 Table C.7 Table C.8 Table C.9 Table C.10 Table C.11 Table C. 12 Table C.13 Page Men's perceptions about condoms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 159 Distance to nearest family planning services according to residence . . . . . . . . . . . . . . 162 Distance to nearest family planning services according to type of facility and residence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 163 Time to nearest family planning services according to type of facility and residence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 164 Distance to nearest antenatal care services according to residence . . . . . . . . . . . . . . . 165 Distance to nearest antenatal care services according to type of facility . . . . . . . . . . . 165 Time to nearest antenatal care services according to type of facility . . . . . . . . . . . . . . 166 Time to nearest delivery care services according to type of residence . . . . . . . . . . . . 166 Distance to nearest facility providing delivery care services according to type of facility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 167 Time to nearest facility providing delivery assistance according to type of facility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 167 Distance to nearest immunisation services according to residence . . . . . . . . . . . . . . . . 168 Time to nearest immunisation services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 169 Results of the household and individual interviews by residence and zone . . . . . . . . . 184 Sample implementation for women according to residence and zone . . . . . . . . . . . . . 185 Sample implementation for women according to region . . . . . . . . . . . . . . . . . . . . . . . 186 Sample implementation for men according to residence and zone . . . . . . . . . . . . . . . . 187 Sample implementation for men according to region . . . . . . . . . . . . . . . . . . . . . . . . . . 188 List of selected variables for sampling errors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 193 Sampling errors, entire sample . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 194 Sampling errors, urban . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 195 Sampling errors, rural . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 196 Sampling errors, Mainland . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 197 Sampling errors, Dares Salaam . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 198 Sampling errors, other urban . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 199 Sampling errors, Rural (Mainland) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 200 Sampling errors, Zanzibar . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 201 Sampling errors, Coast . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 202 Sampling errors, North Highlands . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 203 Sampling errors, Lake . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 204 Sampling errors, Central . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 205 xi Table C.14 Table C.15 Table D.1 Table D.2 Table D.3 Table D.4 Table D.5 Table D.6 Page Sampling errors, Southem Highlands . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Sampling errors, South . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 207 Household age distribution . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 209 Age distribution of eligible and interviewed women . . . . . . . . . . . . . . . . . . . . . . . . . . 210 Completeness of reporting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 211 Births by calendar year since birth . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 212 Reporting of age at death in days . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 213 Reporting of age at death in months . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 214 xii FIGURES Figure 2.1 Figure 2.2 Figure 2.3 Figure 3.1 Figure 3.2 Figure 3.3 Figure 4.1 Figure 4.2 Figure 4.3 Figure 6.1 Figure 7.1 Figure 7.2 Hgure7.3 ~gureS.1 Figure8.2 Egure8.3 ~gureS.4 ~gum8.5 ~gure9.1 Figure 9.2 Figure 10.1 Figure 10.2 Figure 10.3 Figure 10.4 Figure 10.5 Figure 10.6 Page Population pyramid of Tanzania . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 Level of education for men and women . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13 School enrolment by age and place of residence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 Age-specific fertility rates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22 Total fertility rate by background characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23 Children ever born to women 15-49 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26 Current use of modem contraceptives . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37 Use of modem contraceptive methods, married women 15-49 . . . . . . . . . . . . . . . . . . . 38 Distribution of current users by source of contraceptive supply . . . . . . . . . . . . . . . . . . . 42 Fertility preferences among currently married women 15-49 . . . . . . . . . . . . . . . . . . . . . 54 Trends in mortality, infants and children under five . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72 Infant mortality in the ten years preceding the survey by selected characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 74 Child mortality (1-4 years) in the ten years preceding the survey by selected characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 74 Number of antenatal care visits and timing of first visit . . . . . . . . . . . . . . . . . . . . . . . . . 81 Vaccination coverage among children age 12-23 months . . . . . . . . . . . . . . . . . . . . . . . 87 Vaccination coverage among children 12-23 months . . . . . . . . . . . . . . . . . . . . . . . . . . . 88 Pementage of children who received DPT1, DPT3, and measles vaccine by 12 months of age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 90 Pementage of children age 1-59 months who received treatment for diarrhoea in the two weeks preceding the survey by type of treatment . . . . . . . . . . . . . . . . . . . . . 97 Nutritional status of children under five years, mean Z-scores by age in months . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 107 Percentage of cliildmn under five years who are underweight by region . . . . . . . . . . . 110 Contraceptive knowledge among currently married men and women . . . . . . . . . . . . . 118 Current use of contraceptives among currently married men and women . . . . . . . . . . 122 Percentage of men and of women who have ever had sexual intercourse by exact age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 136 Fertility preferences among currently married men 15-60 . . . . . . . . . . . . . . . . . . . . . . 139 Percent nf currently married men who want no more children . . . . . . . . . . . . . . . . . . . 140 Mean ideal number of children among all men . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 141 xiii Figure 10.7 Figure 11.1 Figure 11.2 Page Spouses responses on approval of family planning . . . . . . . . . . . . . . . . . . . . . . . . . . . 144 AIDS awareness and knowledge of modes of transmission . . . . . . . . . . . . . . . . . . . . . 149 Sources of information about AIDS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 152 xiv ACRONYMS ARI BCG BMI CBR CCM CDC CDD DHS DPT EA EP1 GDP IEC ISSA IUD MCH~P NACP NCHS NFPP ORS ORT PHC SD TBA TDHS TFR UN UMATI UNFPA UNICEF USAID WHO Acute Respiratory Infections Bacillus Calmette-Guerin (vaccine) Body Mass Index Crude Birth Rate Chama Cha Mapinduzi (political party) Centers for Disease Control Control of Diarrhoeal Diseases Demographic and Health Surveys Diphtheria - Poliomyelitis - Tetanus (vaccine) Enumeration Area Expanded Programme of Immunization Gross Domestic Product Information, Education, and Communication Integrated System for Survey Analysis Intra-Uterine Device Mammal and Child Health/Family Planning National AIDS Control Programme National Center for Health Statistics National Family Planning Programme Oral Rehydration Salts Oral Rehydration Therapy Primary Health Care Standard Deviation Traditional Birth Attendant Tanzania Demographic and Health Survey Total Fertility Rate United Nations Family Planning Association of Tanzania United Nations Population Fund United Nations Children's Fund United States Agency for International Development World Health Organisation XV PREFACE The Tanzania Demographic and Health Survey (TDHS) involved all areas of the country and was a truly representative survey that aimed at collecting data on fertility, mortality, family planning, and health of the Tanzanians. The survey is part of a worldwide undertaking that aims at assessing the changing demographic and health situation in many developing countries. This effort has, for some time, been coordinated and continues to be coordinated by the Demographic and Health Surveys programme of Macro International Inc., of Columbia, Maryland, USA. A decision to join the programme was made sometime in mid-1990; preparations began in July 1990, and the survey was executed between October 1991 and March 1992. The data processing arrangement, particularly the use of the ISSA (Integrated System for Survey Analysis) package, was done simultaneously with the fieldwork, and the tabulations were done a few months after the fieldwork was completed. Tanzania has a long history of census taking which dates as far back as 1910 when the first count was taken. However, the first modem census was not taken until 1948 under the East African Commission; subsequent censuses were undertaken in 1957, 1967, 1978, and 1988. During the period between 1948 and 1988 only one demographic survey was carried out at a national level, in 1973 (the National Demographic Survey). Vital registration, which is a very important source of fertility and mortality information, is more or less nonexistent, though efforts are now being made to expand and improve the system to cover the whole country instead of just a small section of the urban population. Given this background, the Tanzania Demographic and Health Survey represents yet another milestone in an effort to collect high-quality data on the demographic situation, family planning, and health. The successful completion of the TDHS and publication of this volume is due to the contributions of many people. First, I wish to thank the National Family Planning Project staff for their decision to assign the work to the Bureau of Statistics and provide the field interviewers. To the nurses who worked tirelessly throughout the survey period, I acknowledge with gratitude their valuable contributions to the survey. They endured many logistical and technical difficulties while in the field. Likewise, I would also like to extend my sincere appreciation to the Tanzania Food and Nutrition Centre for their valuable assistance in rendering free training services during the training of the interviewers. The great efforts that were made by the Census Office staff in supervising and running the survey are highly commended. At this juncture, I wish to acknowledge here the immeasurable contributions of the following international agencies who participated in one way or another in the operation of the survey. The U.S. Agency for International Development facilitated the work by providing funds for the entire project. The Demographic and Health Surveys division of Macro International Inc. of Columbia, Maryland, initiated the idea of the survey and provided the needed technical as well as material and moral support during the entire period of the survey. Special acknowledgement is due to Ms. Anne Cross for her efforts in convincing the Government of Tanzania to conduct this survey, to Ms. Naomi Rutenberg who acted as the country coordinator, to Ties Boerma who worked tirelessly to put the survey in its present final form, and to all the staff who participated in some way in bringing this work to its successful conclusion. My sincere appreciation is also extended to the UN agencies, UNFPA and UNICEF, which played a very vital role in providing advice, particularly in determining the items to be included in the survey. Last but not least, I wish to convey my sincere thanks to the Party and Government officials at the national, regional, district, ward, and village levels for their vital role in ensuring the smooth and successful completion of the survey fieldwork. The publication of this report is clear evidence of their contributions to the survey. N.K. Mbalilaki GOVERNMENT STATISTICIAN xvii TANZANIA UGANDA RW BL ZAIR IBAR :-As) 5 SAL.AA~ , F_. .~) "IA INDIAN OCEAN MOZAMBIQUE • - - Enumeraf ion Area xviii CHAPTER1 INTRODUCTION 1.1 History, Geography, and Economy Geography The United Republic of Tanzania is the largest country in East Africa, covering 940,000 square kilometers, 60,000 of which is inland water. Tanzania lies south of the Equator and shares borders with eight countries: Kenya and Uganda to the north; Rwanda, Burnndi, Zaire, and Zambia to the west; and Malawi and Mozambique to the South. Tanzania has an abundance of inland water with several large lakes and rivers. Lake Tanganyika runs along the westem border and is Africa's deepest and longest freshwater lake, and the world's second deepest lake. Lake Victoria is the world's second largest lake and drains into the Nile river. The Rufiji is Tanzania's largest river and drains into the Indian Ocean south of Dares Salaam. Of all the rivers in Tanzania, only the Rufiji and the Kagera are navigable by anything larger than a canoe. One of Tanzania's most distinctive geological features is the Great Rift Valley, which was caused by faulting throughout eastern Africa and is associated with volcanic activity in the North-Eastern regions of the country. Two branches of the Rift Valley run through Tanzania. The western branch holds Lakes Tanganyika, Rukwa, and Nyasa; the eastem branch ends in northern Tanzania and includes Lakes Natron, Manyara, and Eyasi. Except for a narrow belt of 900 square kilometres along the coast, most of Tanzania lies above 200 metres in altitude, and much of the country is higher than 1000 metres above sea level. In the north, Mount Kilimanjaro rises to over 5000 metres with the highest peak, Kibo, reaching 5,895 metres. This is the highest point in Africa. Tanzania has a diversity of landscape. The main climatic feature for most of the country is the long dry spell from May to October, followed by a period of rainfall during November/December. The main rainy season along the coast and the areas around Mt. Kilimanjaro is from March to May, with short rains between October and December. In the western part of the country, around lake Victoria, rainfall is well distributed throughout the year, with the peak between March and May. Administratively, Tanzania mainland is divided into 20 regions, and Zanzibar into five. The regions are subdivided into districts. History Tanganyika became an independent nation from British rule on December 9th, 1961. One year later, on December 9th, 1962, it became a republic, severing all links with the British crown except for its membership in the Commonwealth. Zanzibar became independent on January 12th, 1964, after the overthrow of the rule of the Sultanate. On April 26th, 1964, Tanganyika and Zanzibar joined to form the United Republic of Tanzania. Economy Tanzania has a mixed economy in which agriculture plays a key role. Agriculture, which comprises crop, animal husbandry, forestry, fishery, and hunting subsectors, contributes the largest share of any sector to the Gross Domestic Product (GDP). The GDP increased by 3.8 percent in 1991 compared to 3.6 percent in 1990 and 3.3 percent in 1989. Economic growth in the last 5 years follows the implementation of structural adjusmaent policies over the last 7-8 years. The economic growth rate attained in 1991 is higher than the annual population growth rate of 2.8 percent. However, as in the previous years, it is lower than the targeted growth rates of 4.5 and 5.0 percent as envisioned in the Second Economic Recovery Programme and the Second Five-Year Development Plan, respectively. 1.2 Population The 1967 Tanzania census reported a total population of 12.3 million. According to the 1988 census the population had increased to 23.1 million (see Table 1.1). Tanzania is stir sparsely populated, though the population density is high in some parts of the country and has been increasing over time. In 1967, the average population density was 14 persons per square kilometer, by 1988 it had increased to 26 persons per square kilometer. Although the population is still predominantly rural, the proportion of urban residents has been increasing steadily, increasing from 6 percent in 1967 to 18 percent in 1988. Life expectancy rose from 41 years in 1967 to48 years in 1988. The intercensal growth rate between 1978 and 1988 was 2.8 percent, compared to 3.2 percent between 1967 and 1978. Table 1.1 Demographic indicators T Tanz~tia~ 1967~ 1978, and 1988 Census Indicator 1967 1978 1988 Population (milfions) 12.3 17.5 23.1 Density (pop./sq.km) 14 20 26 Percent urban 6.39 13.78 18.33 Crude birth rate 47 49 46 Crude death rate 24.4 19.0 15.0 Total fertility rate 6.6 6.9 6.5 Infant mortality rate (per 1000) 155 137 115 Life expectancy at birth 41 44 48 Source: Bureau of Statistics, 1967; 1978; 1988 1.3 Population and Family Planning Policies and Programmes Population Policy The population of Tanzania has trebled from 7.7 million in 1948 to 23.1 million in 1988. At this rate of growth, it is estimated that by the year 2000 the population will be about 33 million. However, the national economy did not grow significantly in the last decade due to various constraints, and the resources available per head declined by between 7.5-10 percent during 1980-1985 and increased by 1.0 percent per annum between 1985 and 1991. As in other countries in sub-Saharan Africa, rapid population growth has been associated with poor economic performance. The consequences of rapid population growth are felt acutely and visibly in the public budgets for health, education, and related fields of human resource development. It is obvious that expansion of and improvements in the quality of these services is unlikely to happen without first controlling the rapid population growth. It is against this background that Tanzania formulated the 1992 National Population Policy. The major objective of this policy is to reinforce national development by developing available resources in order to improve the quality of life of the people. The main emphasis is regulation of population growth and improvement of the health and welfare of women and children. With specific reference to family planning, the goals of the policy arc to lower the annual population growth rate through a reduction in the numbers of births and an increase in voluntary fertility regulation. Other specific objectives related to population regulation include making family planning services available to all who want them, encouraging every family to space births at least two years apart, and supporting family life education programmes for youth and family planning for men as well as women. Family Planning The Family Planning Association of Tanzania (UMATI) introduced family planning services to Tanzania in 1959. During the early years most services were concentrated in the urban areas. With the expansion of UMATI in the early seventies, services were extended to cover all regions in the country. The government became actively involved in service provision in 1974 following the launching of the integrated Maternal and Child Health (MCH) programme. Although family planning services were provided as part of the integrated programme, contraceptive use continued to be low in the country. In 1984, the government started a National Childspacing Programme with support from the United Nations Population Fund (UNFPA). Evaluation of the National Childspaeing Programme in 1987 indicated only a slight increase in contraceptive prevalence and identified lack of trained service providers and poor logistic support as the major constraints to expansion of services. The findings and recommendations from this evaluation were used to plan a five-year National Family Planning Programme (NFFP). The implementation of this programme began in 1989 with the broad objective of raising the contraceptive acceptance rate from about 7 to 25 percent by 1993. Other specific objectives of the programme arc to: Improve the quality of family planning services through training of service providers, improvement of supervision, and upgrading of the logistic system, Improve accessibility of family planning services by increasing the proportion of health units providing family planning services, Improve general health of mothers and children, and Raise awareness and demand for family planning services. 1.4 Health Priorities and Programmes The government of Tanzania emphasises equity in the distribution of health services and views access to services as a basic human right. In response to the worldwide efforts to attain the social goal of "Health for All" by the year 2000, Tanzania's health strategy focuses on the delivery of primary health care services. In 1991 a new primary health care (PHC) strategy was developed by the Ministry of Health. As the primary objectives, the PHC strategy focuses on strengthening district management capacity, multiseetoral collaboration, and community involvement. At the central, regional, and district level, PHC steering committees have been established. About 60 percent of health services arc provided by the government and the remainder are provided by nongovernmental organisations. Tanzania has an extensive network of health facilities. At the national level there are four major referral hospitals, one of which is the university teaching hospital. Most regions have a regional hospital and there are a total of 152 hospitals in 106 districts. At the divisional level there are about 273 rural health centres and at the ward level there are about 3000 dispensaries. At the village level there are village health posts staffed by two village health workers. It is estimated that there are currently around 5550 village health workers in the country. 1.5 Objectives and Organisation of the Survey The Tanzania Demographic and Health Survey (TDHS) is a national sample survey of women of reproductive ages (15-49) and men aged 15 to 60. The survey was designed to collect data on socio- economic characteristics, marriage patterns, birth history, breastfeeding, use of contraception, immunisation of children, accessibility to health and family planning services, treatment of children during times of illness, and the nutritional status of children and their mothers. The TDHS is part of a worldwide programme that is being funded by the United States Agency for International Development (USAID). The primary objectives of the TDHS were to: Collect data for the evaluation of family planning and health programmes, Determine the contraceptive prevalence rate, which will help in the design of future national family planning programmes, and Assess the demographic situation of the country. The TDHS involved various institutions and individuals. The Bureau of Statistics had the responsibility of running the project and the Ministry of Health provided technical advice and logistical support. Local UNFPA and UNICEF offices provided advisory and logistic support. Financial support was provided by USAID and administered by Macro International. The funds were used to meet expenses related to salaries, allowances for survey personnel, data processing, anthropometric equipment, printing of questionnaires, maintenance of vehicles, fuel, and publication of reports. The Bureau of Statistics provided ten vehicles for the fieldwork and its supervision. The entire work was under the supervision of the survey director who was closely assisted by survey statisticians and the field teams. The supervisors were recruited from both the Bureau of Statistics and the Planning Commission. The Ministry of Health provided male and female nurses who worked as field interviewers. The Census Office prepared the sample frame in conjunction with a sampling expert from Macro International. The questionnaire design and translation (into Kiswahili), the pretest, and the training for the main survey were carried out by the survey statisticians. 1.6 Fieldwork The TDHS field staff consisted of eight teams, each composed of six female interviewers and one male interviewer, a field editor, a supervisor and a driver. Interviewers were recruited from the Ministry of Health and all of them were trained nurses. The fieldwork was conducted during the rainy season (between October 1991 and March 1992). The persons involved in the survey are listed in Appendix A, and a detailed account of the fieldwork is presented in Appendix B. Table 1.2 shows the results of the household and individual interviews. Out of the 9282 households selected for interview, 8561 households could be located and 8327 were actually interviewed. The shortfall between selected and interviewed households was largely due to the fact that many dwellings were either vacant or destroyed or no competent respondents were present at the time of the interview. A total of 9647 eligible women (i.e., women age 15-49 who spent the night before the interview in a sampled household) 4 were identified for interview, and 9238 women were actually interviewed (96 percent response rate). The main reason for non-interview was absence from the home or incapacitation. The TDHS male survey covered men aged between 15 and 60 years who were l iving in selected households (every fourth household of the female survey). The results of the survey show that 2392 eligible men were identified and 2114 men were interviewed (88 percent response rate). Men were generally not interviewed because they were either incapacitated or not at home during the time of the survey. Table 1.2 Results of the household and individual interviews Number of households, number of interviews, end response rates, Tanzania 1991/92 Result Total Household Interviews Households sampled 9282 Households found 8561 Households interviewed 8327 Household response rate 97.3 Individual Interviews Number of eligible women 9647 Number of eligible women interviewed 9238 Eligible women response rate 95.8 Number of eligible men 2392 Number of eligible men inte~iewed 2114 Eligible men response rate 88.3 5 CHAPTER 2 CHARACTERISTICS OF HOUSEHOLDS AND RESPONDENTS Information on the background characteristics of the households interviewed in the survey and the individual survey respondents is essential for the interpretation of survey findings, and provides a rough measure of the representativeness of the survey. This chapter presents this information in three sections: Characteristics of the household population, Housing characteristics, and Background characteristics of survey respondents. 2.1 Characteristics of the Household Population The TDHS collected information on all usual residents and visitors who spent the previous night in the household. A household was def'med as a person or a group of persons l iving together and sharing a common source of food. Age The age distribution of the household population in the TDHS is shown in Table 2.1 and Figure 2.1 by five-year age groups. This distribution conforms to the pattern typical of high-fertility populations, i.e., a much higher proportion of the population is in the younger age groups than in the older age groups. Table 2.1 Household population by age T residence~ and sex Percent distribution of the de facto household population by five-year age group, according to orban,rural residence and sex, Tanzania 1991/92 Age group Urban Rural Total Male Female Total Male Female Total Male Female Total 0-4 17.0 14.6 15.8 5-9 13.4 14.0 13.7 10-14 13.8 12.0 12.9 15-19 12.6 13.0 12.8 20-24 8.1 10.8 9.4 25-29 7.0 9.0 8.0 30-34 5.7 6.5 6.1 35-39 4.1 4.5 4.3 40-44 4.2 2.9 3.6 45~.9 4.1 3.1 3.6 50-54 3.1 3.4 3.3 55-59 2.3 1.7 2.0 60-64 2.3 1.9 2.1 65-69 0.9 1.0 1.0 70-74 0.5 0.7 0.6 75-79 0.3 0.4 0.4 80 + 0.3 0.4 0.4 Missing/Don't know 0.2 0.0 0.1 Total 100.0 100.0 100.0 Number 4732 4717 9449 18.6 17.6 18.1 18.2 16.9 17.6 16.2 15.0 15.6 15.6 14.8 15.2 14.8 13.9 14.3 14.5 13.5 14.0 10.8 9.6 10.2 11.2 10.3 10.8 6.5 8.2 7.4 6.8 8.7 7.8 5.6 7.0 6.3 5.9 7.4 6.7 5.0 5.1 5.1 5.2 5.4 5.3 3.9 4.5 4.2 3.9 4.5 4.2 3.3 3.4 3.3 3.5 3.3 3.4 2.8 3.2 3.0 3.1 3.2 3.1 2.5 3.7 3.1 2.6 3.7 3.2 2.5 2.9 2.7 2.5 2.7 2.6 2.2 2.1 2.2 2.2 2.1 2.1 1.9 1.6 1.7 1.7 1.4 1.6 1.5 0.9 1.2 1.3 0.9 1.1 0.7 0.6 0.6 0.6 0.5 0.6 1.0 0.6 0.8 0.8 0.6 0.7 0.2 0.1 0.l 0.2 0.1 0.1 100.0 100.0 1~.0 1~.0 1~.0 1~.0 16439 17540 33~8 21170 22257 434~ 7 Age 50+ 75-79 70-74 65-69 60-64 55-59 50-54 45-49 40-44 35-39 30-34 25-29 20-24 15-19 10-14 5-9 0-4 10 Figure 2.1 Population Pyramid of Tanzania 9 0 5 10 Percent TDHS 1991/92 Table 2.2 shows that the population age structure found in the TDHS is very similar to that in the 1967, 1978, and 1988 population censuses. Dependency ratios are also shown. The age dependency ratio is the ratio of the number of persons age 0 to 14 and 65 and over divided by the number of persons age 15 to 64. It is an indicator of the dependency responsibility of adults in their productive years. Table 2.2 Population by age from selected sources Percent disu'ibution of the population by age group, selected sources, Tanzania 1991/92 Census TDHS Age group 1967 1978 1988 1991/92 Less than 15 43.9 46.1 45.8 46.8 15-64 50.5 49.7 49.9 49.2 65+ 5.6 4.0 4.2 3.9 Total 100.0 100.0 100.0 100.0 Median age 1.03 - - - 16.4 Dependency ratio 1.00 1.01 0.97 The dependency ratios in Tanzania are typical of those found in other African countries. With Source: Bureau of Statistics, 1967; 1978; 1988 approximately 47 percent of the population below age 15 and approximately 4 percent above 64, there is roughly one dependent person for each adult in the population. However, old age dependency is minimal compared to child dependency. 8 Household Composit ion Table 2.3 presents the percent distribution of households by sex of head of household, size, and relationship structure and indicates whether the household includes fostered children, according to urban/rural residence. According to the TDHS data, the large majority of households in Tanzania are headed by males (81 percent), which is somewhat higher than the 1988 census figure (70 percent; Bureau of Statistics, 1992). Table 2.3 Household composition Percent distribution of households by sex of head of household, household size, relationship structure, and presence of foster children, according to urban-rural residence and region, Tanzania 1991/92 Mainland Dares Other Characteristic Total Salaam urban Rural Zanzibar Total Household headship Male 75.5 82.9 81.5 83.0 77.6 81.4 Female 24.5 17.1 18.5 17.0 22.4 18.6 Number of usual members 1 13.0 7.2 9.0 18.9 9.0 9.0 2 12.9 9.6 10.4 13.1 11.7 10.5 3 14.4 12.2 12.6 12.2 15.1 12.7 4 12.0 14.5 14.0 13.4 12.4 13.9 5 12.2 13.2 13.0 11.9 15.8 13.1 6 7.1 11.9 10.8 9.0 12.5 10.9 7 8.3 10.9 10.0 5.2 8.7 10.0 8 7.5 6.6 6.8 6.4 6.2 6.7 9+ 12.7 13.9 13.4 9.8 8.7 13.2 Mean size 4.9 5.5 5.3 4.4 4.8 5.3 Relationship structure One adult 19.2 12.4 14.3 22.6 18.0 14.5 Two related adults: Of opposite sex 28.6 37.7 35.5 29.3 41.5 35.7 Of same sex 8.3 3.4 4.6 7.5 4.3 4.6 Three or more related adults 39.5 43.8 42.5 36.2 32.7 42.2 Other 4.0 2.6 3.0 4.4 3.5 3.0 Foster children I 23.3 23.2 22.8 16.7 31.5 23.1 Note: Table is based on de jure members, i.e., usual residents. IFoster children are those under age 15 living in households with neither their mother nor their father present. The average household size for the country is 5.3 persons per household. Rural households are generally larger than urban households (5.5 versus 4.4 for Dares Salaam and 4.9 for other urban areas). The proportion of single-person households was relatively higher in Dar es Salaam and other urban areas than in the rural areas. About 23 percent of households include one or more children under age 15 who have neither their natural mother nor father living with them (i.e., foster children). The highest proportion of households with foster children (32 percent) is found in Zanzibar and the lowest (17 percent) in rural areas. Education In the three decades since independence, the education sector has expanded to reach most parts of the country and phenomenal growth has been recorded in both student enrolment and the number of new institutions. In 1970 a nationwide mass literacy program was launched and in 1975 a national policy of Universal Primary Education was adopted which gave every child the right to free primary education. Primary education, which includes seven years of schooling, was made compulsory for all children 7 to 14 years of age in 1978. There are six years of secondary education. Entry into the fifth year of secondary education (Form V) is based on open competitive examination results. In Zanzibar, although education also incorporates two stages, it differs slightly from the mainland system. Primary education is entered at age 6-8 years and takes 8 years to complete. It is followed by two three-year cycles of secondary school. In the TDHS, information on educational attainment was collected for every member of the household. Tables 2.4.1 and 2.4.2 show the percent distribution of the de facto male and female household population age 5 and over, respectively, by highest level of education attended according to age, residence, and region. It appears that 37 percent of males and 48 percent of females have never been to school (see also Figure 2.2). Fifty-eight percent of males and 49 percent of females have attended only primary school, and 4 percent of males and 2 percent of females have attended secondary school. A very small proportion of males and females (less than 1 percent) have received higher education. The levels of education by age show a pronounced increase in levels of education during the past decades. Progress in eradicating illiteracy in Tanzania would probably be even greater if nonformal education programmes (adult literacy programmes) were taken into account. The proportion of both males and females with no education is highest in Zanzibar, followed by rural areas, However, Zanzibar also has the highest proportion of people with completed primary education. At the regional level, Kilimanjaro has the lowest proportion of people with no education and the highest percentage with primary education. 10 Table 2.4.1 Educational level of the female household population Percent distribution of the de facto female household populations age five and over by highest level of education attended, according to selected background characteristics, Tanzania 1991/92 No Some Don't Number Median Background educa- Primary Completed secondary/ know/ of number characteristic tio~ incomplete primary Higher Missing Total persons of years Age 5-9 83.2 16.5 0.0 0.0 0.3 100.0 3300 0.0 10-14 22.3 77.5 0.2 0.0 0.0 100.0 3013 3.2 15-19 14.8 78.9 6.3 0.0 0.0 100.0 2297 7.2 20-24 16.4 75.9 7.6 0.0 0.1 100.0 1939 7.3 25-29 28.1 67.6 3.4 0.6 0.2 100.0 1653 7.1 30-34 43.7 51.3 4.0 0.7 0.3 100.0 1206 3.5 35-39 55.9 41.7 2.1 0.2 0.1 100.0 1012 0.0 40-44 60.4 38.0 1.3 0.2 0.0 100.0 727 0.0 45-49 73.1 26.2 0.2 0.0 0.6 100.0 701 0.0 50-54 82.7 15.9 0.2 0.0 1.2 100.0 818 0.0 55-59 85.7 13.5 0.1 0.0 0.7 100.0 591 0.0 60-64 91.2 8.5 0.0 0.0 0.3 100.0 458 0.0 65+ 91.4 7.7 0.0 0.0 0.9 100.0 760 0.0 Missing/Don't lmow 73,8 0.0 0.0 0,0 26.2 100.0 12 0,0 Residence Mainland 47.9 49.7 2.0 0.1 0.3 100.0 17937 1.4 Dares Salaam 32.2 60.8 6.5 0.2 0.3 100.0 965 5.4 Other urban 35.9 57.8 5.7 0.5 0.2 100.0 3022 4.2 Rural 51.6 47.1 0.9 0.1 0.3 1G0.0 13949 0.0 Z~zibar 53.9 33.0 13.1 0.0 0.0 100.0 550 0.0 Region Dodoma 49.6 49.2 1.1 0.0 0.1 100.0 1271 1.0 Arusha 43.4 48.1 6.0 1.0 1.5 100.0 1090 2.4 Kilimanjaro 26.0 68.2 5.5 0.2 0.0 I00.0 1053 4.8 Tanga 41.2 57.2 1.2 0.0 0.4 100.0 987 2.6 Morogom 50.5 48.2 1.2 0.1 0.0 100.0 942 0.0 Coast 56.9 41.4 1.2 0.2 0.3 100.0 376 0.0 Lindi 55.4 43.4 0.2 0.6 0.4 100.0 515 0.0 Mtwara 60.3 39.5 0.0 0.2 0.0 100.0 725 0.0 Ruvuma 36.3 62.6 0.7 0.2 0.2 100.0 688 3.5 Iringa 52.0 45.9 1.3 0.0 0.8 100.0 1067 0.0 Mbeya 45.8 53.5 0.5 0.0 0.2 100.0 914 1.9 Singida 48.0 49.3 2.5 0.0 0.2 100.0 715 1.5 Tabora 57.3 41.3 1.2 0.0 0.1 100.0 566 0.0 Rukwa 55.8 43.4 0.6 0.0 0.2 100.0 414 0.0 Kigoma 54.1 45.3 0.3 0.0 0.3 100.0 806 0.0 Shinyanga 59.5 39.1 1.3 0.0 0.1 100.0 1494 0.0 Kagera 49.1 47.3 3.3 0.0 0.2 100.0 1284 1.0 Mwanza 49.9 48.5 1.4 0.0 0.2 100.0 1238 1.0 Mara 46.8 52.6 0.4 0.0 0,2 100.0 829 1.7 Total 48.1 49.2 2.4 0.1 0.3 100.0 18487 1.4 11 Table 2.4.2 Educational level of the male household populat ion Percent distribution of the de facto male household populations age five and over by highest level of education attended, according to selected background characteristics, Tanzania 1991/92 No Some Don't Number Median Background educa- Primary Completed secondauc/ know/ of number characteristic tion incomplete primary Higher Missing Total persons of years Age 5-9 87.0 12,8 0.0 0.0 0.2 100.0 3294 0.0 10-14 22.6 77,2 0.2 0.0 0.0 100.0 3077 2.8 15-19 11.1 83.1 5.7 0.0 0.1 100,0 2376 7.1 20-24 9.7 80.7 9.4 0.1 0.1 100.0 1449 7.4 25-29 9.8 83.0 6.8 0.3 0.1 100.0 1258 7,4 30-34 16.9 72.8 9.4 0,3 0.7 100.0 1094 7.3 35-39 27.7 62.6 8.0 1.4 0.3 100.0 827 5.7 40-44 29.3 63,8 6.2 0.5 0.2 100.0 746 4,6 45-49 35.8 57.2 5.4 1,1 0,5 100.0 660 4.2 50-54 41.3 50.9 7.0 0.7 0.2 100.0 556 3.9 55-59 50.7 43.0 4.7 0.1 1.6 100.0 525 0.0 60-64 60.0 37.1 1.5 0.2 1.2 100.0 472 0.0 65+ 71.3 26.9 0.9 0.1 0.8 I00.0 934 0.0 Missing/Don't know 45.7 34.9 1.6 0.0 17.7 100.0 44 0.9 Residence Mainland 37.0 58,8 3.6 0.2 0.3 100.0 16826 3.6 Dares Salaam 21.8 65.4 11.9 0.6 0.2 100,0 1046 7.1 Other urban 29.9 62.6 7,0 0.4 0.2 100.0 2891 4.6 Rural 39.8 57.5 2.2 0.1 0,4 100.0 12889 3.0 Zanzibar 41.2 41.5 17.1 0.3 0.0 100.0 486 2.9 Region Dodoma 42.6 56.3 1.2 0.0 0.0 100.0 1200 2.4 Arusha 43.0 50.5 4.5 0.5 1.5 100.0 1060 2.9 Kilimanjaro 21.1 72.7 5.3 0.5 0.3 100.0 942 5.3 Tanga 30.5 66.3 3.1 0.0 0.0 100.0 872 4.1 Morogoro 35.8 61.1 3.1 0.0 0.0 100.0 872 3.5 Coast 45.2 52.0 2.1 0.1 0.6 100.0 343 2.1 Lindi 47.8 49.5 1.6 0.0 1.0 100.0 469 1.6 Mtwara 39.6 59.8 0.4 0.2 0.0 100.0 728 3.1 Ruvuma 29.0 68.1 2.1 0.7 0.2 100.0 575 4.5 Ifinga 36.2 60.4 2,7 0.0 0.7 100.0 954 3.5 Mbeya 32.2 63.5 4.1 0.0 0.1 100.0 847 4.3 Singida 41.8 54.8 3.2 0.1 0.1 100.0 654 2.6 Tabora 41.6 56.0 2.4 0.0 0.1 100.0 560 2.7 Rukwa 42.1 55.2 2.4 0.1 0.2 100.0 438 2.4 Kigoma 44.0 54.1 1.6 0.3 0,0 100.0 690 2.4 Shinyanga 44.0 52.9 2.2 0.3 0.7 100.0 1442 2.4 Kagera 35.1 57.9 6.7 0.1 0.2 100.0 1211 3.7 Mwanza 39.4 56.8 3.4 0.2 0.3 1OO.0 1204 3.0 Mara 37.6 59.3 2.9 0.1 0.2 100.0 720 3.3 Total 37.1 58.4 4.0 0.2 0.3 100.0 17312 3.6 12 Figure 2.2 Level of Education for Men and Women Percent 80 60 40 20 No Education Pr imary Secondary/Higher TDHS 1991/92 Table 2.5 and Figure 2.3 present the percentage of the de facto household population 6-24 years of age enrolled in schools by age, sex, and residence. Forty-seven percent of children aged 6-15 years are enmled. However, enrolment for children aged 11-15 is comparatively high (71 percent) suggesting that many children start primary education aider age 6 or 7. In the age group 6-15 there is a slight difference in enmlment between rural and urban, with rural accounting for about 46 percent and urban about 52 percent. Enrolment after age 15 drops sharply, with only 18 percent of those 16-20 years old and 2 percent of those in their early 20s still in school. Table 2.5 School er.rolment Percentage of the de facto household population age 6-24 years enrolled in school, by age group, sex, and urban/rural residence, Tanzania 1991/92 Age group Male Female Total Urban Rural Total Urban Rural Total Urban Rural Total 6-10 31.6 22.6 24.4 33.3 26.6 27.9 32.5 24.6 26.2 11-15 74.9 71.6 72.4 71.0 68.6 69.0 73.1 70.1 70.8 6-15 53.6 45.7 47.4 50.8 45.7 46.7 52.3 45.7 47.0 16-20 29.3 23.7 25.1 14.6 10.5 11.6 21.4 17.0 18.1 21-24 8.6 1.8 3.7 3.4 0.7 1.4 5.7 1.2 2.4 13 Percent 8O 7O 60 5O 4O 3O 20 10 0 Figure 2.3 School Enrolment by Age and Place of Residence 6-10 11-15 16-20 21-24 Age In Years TDHS 1991/92 2.2 Housing Characteristics In order to assess the economic and environmental conditions in which the respondents live, women were asked to give specific information about their household environment. Table 2.6 presents the percent distribution of households by housing characteristics according to residence. The source of drinking water and its distance from the household, type of sanitation facilities, and type of flooring materials are important determinants of the health status of household members. Overall, only 7 percent of households in Tanzania have electricity. Dares Salaam has the highest proportion of households with electricity (28 percent). In the rural areas only 1 percent of households have electricity. Sources of drinking water differ considerably by area of residence. The three primary sources of drinking water for the Mainland are public wells, public taps, and rivers or streams. In Dar es Salaam, 70 percent of the households have piped water in their homes and 20 percent obtain water from public taps. In other urban centres, 46 percent of households obtain water from a public tap and about 27 percent have piped water in their houses. Major sources of water in Zanzibar are public wells (34 percent) and public taps (32 percent). In rural areas, only 2 percent of the households have piped water in their houses. The majority get water from a public well (33 percent), rivers or streams (24 percent), public taps (16 percent), and springs (12 percent). 14 Table 2.6 Housing characteristics Percent distribution of households with eligible women by housing characteristics, according to urban/rural residence and region, Tanzania 1991/92 Mainland Dares Other Characteristic Total Salaam urban Rural Zanzibar Total Electricity Yes 6.6 28.2 20.4 1.3 12.7 6.8 No 92.5 71.4 78.3 97.8 86.9 92.3 Missing 0.9 0.4 1.3 0.9 0.4 0.9 Source of drinking water Piped into residence 10.9 69.9 26.9 1.8 22.3 11.3 Public tap 21.8 20.1 45.8 16.1 31.8 22.2 Well in residence 1.2 1.8 1.1 1.1 3.3 1.2 Public well 28.1 5.7 14.7 33.3 33.8 28.3 Spring 9.2 0.2 1.6 11.9 7.4 9.1 River, stream 18.5 0.0 4.4 23.6 1.0 17.9 Pond, lake 3.8 0.0 2.3 4.5 0.0 3.7 Dam 1.8 0.0 0.0 2.4 0.2 1.8 Rainwater 0.2 0.0 0.0 0.3 0.0 0.2 Tanker 0.1 1.3 0.0 0.0 0.0 0.1 Other 3.0 0.0 1.9 3.5 0.1 2.9 Missing 1.4 1.0 1.3 1.4 0.0 1.3 Total 100.0 100.0 100.0 100.0 100.0 100.0 Sanitation facility Own flush toilet 0.9 2.6 3.2 0.2 1.1 0.9 Shared flush toilet 0.4 0.8 1.5 0.1 0.2 0.4 Traditional pit latrine 84.2 92.1 88.8 82.4 41.3 82.8 Improved pit latrine 1.3 1.9 3.4 0.7 1.3 1.3 No facility, bush 12.3 1.8 2.2 15.7 56.2 13.7 Missing/Don't know 0.9 0.8 0.9 0,9 0.0 0.9 Total 100.0 100.0 100.0 100.0 100.0 100.0 Flooring Earth, sand 80.2 24.3 57.0 90.9 69.2 79.8 Wood planks 0.1 0.2 0.0 0.1 0.0 0.1 Parquet, polished wood 0.0 0.2 0.0 0.0 0.0 0.0 Ceramic tiles 0.2 0.9 0.8 0.0 0.0 0.2 Cement 18.2 74.0 41.1 7.6 30.8 18.6 Other 0.1 0,0 0.0 0.2 0.0 0.1 Missing/Don' t know 1.1 0.5 1.2 1.2 0.0 1.1 Total 100.0 100.0 100.0 100.0 100.0 100.0 Persons per sleeping room 1-2 54.0 60.1 61.4 51.6 66.1 54.4 3-4 32.3 30.2 29.3 33.3 25.9 32.1 5-6 8.4 6.2 6.5 9.1 6.3 8.4 7 + 3,1 2.5 0.9 3,7 1.2 3.0 Missing/Don't know 2.1 1.0 1.9 2.3 0.5 2.1 Total 100.0 100.0 100.0 100.0 100.0 100.0 Mean persons per room 2.8 2,5 2.5 2.9 2.5 2.8 Number of households 8057 537 1476 6044 269 8327 15 Modem sanitation facilities are not yet available to large proportions of the population. The use of traditional pit toilets is common in both urban and rural areas, accounting for about 83 percent of all households. An additional 14 percent of the households have no toilet facilities. This pattern is similar in most parts of the country except for Dares Salaam and Zanzibar. In Dar es Salaam, 92 percent of the households use traditional pit toilets and 2 percent have no toilet facilities. In Zanzibar, 41 percent of the households use traditional pit toilets and 56 percent of the households have no toilets. Eighty percent of the households have floors made of earth or sand and only 19 percent are made of cement. These percentages vary greatly. For example, in Dares Salaam only 24 percent of the households have floors made of earth/sand and 74 percent use cement. Earth or sand flooring is used extensively in rural areas (91 percent), other urban centres (57 percent), and Zanzibar (69 percent). Other forms of floor materials, e.g., wood planks, parquet, and polished wood, are rarely used. Information on the number of rooms that a household used for sleeping was collected with the intent of determining the extent of crowding. More than half of the households averaged one to two people per sleeping room and a third had three to four people sharing a sleeping room. There is very little diversity among the different geographical areas. Household Durable Goods Respondents were asked about ownership of particular bousehold goods (e.g., radio and television to assess access to media, refrigerator to assess food storage) and modes of transportation (bicycle, motorcycle, car). The results presented in Table 2.7 indicate that 33 percent of households own a radio, with ownership being highest in Dares Salaam (70 percen0 and lowest in rural areas (25 percen0. Less than 1 percent of households in Tanzania possess a television set. Since the Mainland does not have a television station, the percent of households with a television set is lower than in Zanzibar, where there is a television station. Refrigerators are not very common and are mainly found in urban areas. Table 2.7 Household durable goods Percentage of households with eligible women possessing various durable consumer goods, by urban/rural residence and region, Tanzania 1991/92 Mainland Dares Other Possession Total Sa laam urban Rural Zanzibar Total Radio 32.5 69.6 51.5 24.6 48.9 33.1 Television 0.4 2.0 0.9 0.l 4.7 0.5 Refrigerator 1.1 7.8 1.9 0.3 3.1 1.2 Bicycle 21.2 10.5 23.7 21.5 32.8 21.5 Motorcycle 0.7 1.2 1.2 0.6 1.6 0.8 Private car 1.3 3.7 2.3 0.9 1.5 1.3 Number of households 8057 537 1476 6044 269 8327 16 Bicycles are the most common means of transport owned by households. Twenty- two percent of rural households, 11 percent of households in Dares Salaam, and 33 percent of households in Zanzibar own a bicycle. Only 1 percent of surveyed households owns an automobile, and most of them are located in Dar es Salaam and other urban areas. 2.3 Background Characteristics of Survey Respondents General Characteristics Table 2.8 shows the percent distribu- tion of women by age, marital status, ur- ban/rural residence, region, religion, and level of education. Eligible women were asked two questions to determine their ages, "In what month and year were you born?" and "How old were you at your last birthday?" Inter- viewers were trained in probing techniques for situations in which respondents did not know their age or date of birth, and as a last resort, interviewers were instructed to record their best estimate of the respondent's age. Data on marital status of the women at the time of the survey show that 25 percent had never married, 65 percent were in unions (47 percent in monogamous unions and 18 percent in polygamous unions), and 10 per- cent were divorced, separated, or widowed. The vast majority of women live on the mainland (97 percent), with only 3 per- cent living on Zanzibar. One-quarter of wom- en live in urban areas on the mainland, and al- most three quarters in rural areas. One-third of respondents had never attended school. Forty-two percent had com- pleted primary school and only 5 percent of women had gone beyond the primary educa- tion level. Table 2.8 Background characteristics of respondents Percent distribution of women by selected background characteristics, Tanzania 1991/92 Number of women Background Weighted Un- characteristic percent Weighted weighted Age 15-19 23.6 2183 2229 20-24 20.4 1882 1849 25-29 17.3 1599 1573 30-34 12.6 1165 1121 35-39 10.8 I000 1010 40-44 7.7 715 757 45-49 7.5 695 699 Marital status Never married 24.5 2261 2188 Married, monogamous 47.4 4379 4381 Married, polygamous 18.0 1659 1710 Widowed/Divorced/Sep. 10.2 939 959 Educatlon No education 33.9 3128 3259 Primary incomplete 19.8 1825 1887 Completed primary 41.6 3841 3653 Secondary/Higher 4.8 444 439 Residence Mainland 97.2 8978 8718 Dar es Salaam 6.3 585 505 Other urban 18.3 1686 1178 Rural 72.6 6707 7035 Zanzibar 2.8 260 520 Reglon I Dodoma 7.0 649 341 Arusha 6.2 573 367 Kilimanj art 5.6 516 438 Tanga 5.1 471 383 Morogoro 5.5 512 486 Coast 1.7 159 377 Lindi 2.3 217 347 Mtwara 3.9 363 343 Ruvuma 3.5 320 455 Ifinga 5.1 475 378 Mbeya 4.9 449 304 Singida 3.8 355 409 Tabora 2.9 271 414 Rukwa 2.4 217 496 Kigoma 4.1 375 496 Shinyanga 8.6 793 614 Kagera 6.6 608 384 Mwanza 7.2 666 590 Mara 4.4 403 591 Religion Muslim 30.7 2834 3202 Catholic 30.1 2777 2694 Protestant 25.0 2308 2049 None 13.8 1271 1242 Other religion 0.0 0 1 Missing 0.5 47 50 All woman 100.0 9238 9238 1Excludes Dares Salaam and Zanzibar. 17 The three major religions reported by women were Islam (31 percent), Catholicism (30 percent), and Protestantism (25 percent). Fourteen percent of all women either adhere to traditional religions or have no religion. Differentials in Education Table 2.9 shows the percent distribution of women by highest level of education attained according to age, residence, and region. Education is inversely related to age; older women are generally less educated than younger women. The survey results show that 74 percent of women age 45-49 have had no formal education in contrast to 15 percent of women age 15-19. The percentage of women with no education increases with age while the proportion of women with completed primary or secondary/higher education decreases with age, indicating recent improvements in educational attainments. Urban women fare better than rural women in education. While 38 percent of rural women have never been to school, only 20 percent of women in other urban areas and 19 percent in Dares Salaam have never been to school. Zanzibar has a much higher proportion of women with no education (41 percent) than Mainland (34 percent). Generally, only a small proportion of women continue education beyond the primary level. The situation is worst in rural areas where only 2 percent of women have secondary or higher education. Due to the difference in the secondary education system between the Mainland and Zanzibar, 28 percent of women in Zanzibar have secondary education compared to 4 percent in Mainland. A comparison among regions shows that only 9 percent of the women in Kilimanjaro have no education. On the other hand, about half of the women in Shinyanga have never been to school. The Amsha and Kilimanjaro regions have the highest proportion of women with secondary or higher education (13 and 12 percent, respectively). Mtwam, Kigoma, Mbeya, and Mara have the lowest levels of post-primary education (less than 1 percent have secondary or higher education). Access to Media Women were asked if they usually listen to a radio or watch television at least once a week. This information is important to programme planners seeking to reach women with family planning and health messages through the media. Table 2.10 shows that one quarter of women read newspapers and 46 percent listen to the radio. Only 3 percent watch television. Access to the media is somewhat higher among younger women (under 30 years): half of these women listen to the radio at least once a week and about 30 percent read newspapers. Educated women have more access to the media than those with less education and the proportion of women with access to media is higher in urban than in rural areas. 18 Table 2.9 Leval of education Percent distribution of women by highest level of education attended, according to selected background characteristics, Tanzania 1991/92 Level of education No Pr imary Corn- Number Background educa- incom- pleted Secondary/ of characteristic tion plet~ primary Higher Total women Age 15-19 15.3 23.0 55.3 6.4 100,0 2183 20-24 16.2 12.2 63.4 8.1 100.0 1882 25-29 27.9 15.7 52,4 4.0 100,0 1599 30-34 44.9 20.6 30.0 4.5 100.0 1165 35-39 56.5 24.4 16.9 2.3 100.0 1000 40-44 61,6 28.6 8.2 1.6 100.0 715 45-49 74.2 22.0 3.7 0.1 1{30.0 695 Residence Mainland 33.7 20.0 42.3 4.1 100.0 8978 Dares Salaam 18.7 15.2 56.7 9.5 1{30.0 585 Other urban 20.3 18.4 50.6 10.7 100.0 1686 Rural 38.3 20.8 38.9 2.0 100.0 6707 Zanzibar 41.0 12.9 18.1 28,0 100.0 260 Region Dodoma 35.6 16.5 45.8 2.2 100.0 649 Arusha 31.7 15.3 39.9 13.1 100.0 573 Kilimmaj~o 8.5 19.2 60.9 11.5 100.0 516 Tanga 26.1 18.9 53.5 1.6 100.0 471 Morogoro 35.1 21.6 40.3 3.0 100,0 512 Coast 40.6 19.8 36.8 2.7 10O.0 159 L'mdi 33.9 26.2 38.5 1.4 100.0 217 Mtwara 45,3 21.5 33.0 0.2 100.0 363 Ruvuma 19.9 30.2 48.2 1.7 100.0 320 Iringa 42.3 11.6 43.3 2.9 100.0 475 Mbeya 32.7 16,6 49.8 0.9 100.0 449 Singida 29.0 24.4 40.8 5.8 100.0 355 Tabora 47.0 23,1 27.7 2.1 100.0 271 Rukwa 46.1 22,0 30,8 1.1 100.0 217 Kigoma 38.9 17.5 43.0 0.6 100.0 375 Shinyanga 51.7 17.3 28.8 2.1 100.0 793 Kagera 30.7 24,3 37.7 7.4 100.0 608 Mwanza 36.7 22.9 37.8 2.6 100.0 666 Mara 30.2 28.9 40.3 0.6 100.0 403 Total 33.9 19,8 41.6 4.8 100.0 9238 19 Table 2.10 Access to mass media Percentage of women who usually read a newspaper once a week, watch television once a week, or listen to radio once a week, by selected background characteristics, Tanzania 1991/92 Read Watch Listen to Number Background newspaper television radio of characteristic weekly weekly weekly women Age 15-19 31.1 4.3 50.1 2183 20-24 34.2 4.5 53.3 1882 25-29 26.6 3.1 49.0 1599 30-34 21.1 3.1 46.4 1165 35-39 16.4 2.2 37.6 1000 40-44 12.4 2.7 35.1 715 45-49 8.5 1.6 32.4 695 Education No education 0.5 1.5 25.6 3128 Primary incomplete 22.3 1.7 41.4 1825 Completed primary 40.1 4.1 59.9 3841 Secondary/Higher 76.8 18.7 93.4 444 Residence Mainland 24.6 3.1 45.3 8978 Dares Salaam 71.8 12.0 89.8 585 Other urban 47.3 7.2 71.2 1686 Rural 14.8 1.3 35.0 6707 Zanzibar 37.6 14.6 77.0 260 Region Dodoma 18.6 0.3 34.7 649 Arusha 37.5 5.1 63.8 573 Kilimanj aro 46.1 5.5 72.7 516 Tanga 25.1 1.7 39.4 471 Morogoro 26.1 3.7 42.3 512 Coast 38.6 7.5 65.5 159 Lindi 17.7 3.1 42.2 217 Mtwara 11.2 3.0 26.2 363 Ruvuma 17.3 2.0 43.8 320 Iringa 18.4 3.1 30.8 475 Mbeya 15.8 0.3 45.9 449 Singida 27.8 5.5 43.2 355 Tabora 8.9 0.7 28.7 271 Rukwa 13.9 1.2 31.7 217 Kigoma 15.6 0.8 41.6 375 Shinyanga 12.4 1.3 29.5 793 Kagera 13.7 2.3 35.5 608 Mwanza 19.0 2.4 44.6 666 Maxa 21.8 0.8 47.6 403 Total 24.9 3.4 46.2 9238 20 CHAPTER 3 FERTILITY The fertility measures presented in this chapter are based on the reported birth histories of women between 15 and 49 years old who were interviewed in the TDHS. Every woman was asked the number of sons and daughters who either were living with her, were living elsewhere, or had died. Also, she was asked for a history of her births, including the month and year each child was born; the name and sex; if deceased, the age at death; and if alive, the current age and whether the child was living with the mother. The information obtained from these questions was used to calculate measures of current and completed fertility, i.e., the number of children ever bom. 3.1 Current Fertility The current level of fertility is presented in this chapter because it has a direct relevance to population policies and programmes. Three- year age-specific fertility rates are presented in Table 3.1. The purpose of calculating three-year rates is to reduce errors that emanate from the size of the sample and to avoid problems caused by the displacement of births from five years preceding the survey to six. This latter practise is often done by the interviewer in order to reduce the amount of work that would have to be done. The sum of the age-specific fertility rates is called the total fertility rate (TFR), which can be defined as the number of children a woman would have by the end of her childbearing years if she were to pass through the years bearing children at the currently observed age-specific fertility rates. As shown in Table 3.1, the total fertility rate is 6.3. The crude birth rate, also presented in Table 3.1, stands at 43 per thousand over the three years prior to the survey. This estimate is close to the 46 per 1,000 that was estimated from the 1988 Population Census. Table 3.1 Current fertility Age-specific and cumulative fertility rates and the crude birth rate for the three years preceding the survey, by urban-rural residence and region, Tanzania 1991/92 Age group Urban Rural Total 15-19 131 149 144 20-24 236 297 282 25 -29 229 284 270 30-34 198 242 231 35-39 139 187 177 40-44 75 117 108 45-49 19 42 37 TFR 15-49 5.14 6.59 6.25 TFR 15-44 5.04 6.38 6.06 GFR 179 222 212 CBR 42.1 43.0 42.8 TFR: Total fertility rate expressed per woman GFR: General fertility rate (births divided by number of women 15-44). expressed per 1,000 women CBR: Crude birth rate, expressed per 1,000 population Note: Rates ere for the period 1-36 months preceding the survey. Rates for age group 45-49 may be slightly biased due to truncation. The age-specific fertility rates derived from the TDHS can be compared with data from the 1988 census (Figure 3.1). Except for the two youngest age groups, fertility rates are lower in the TDHS than in the census. The fertility decline appears to he greatest among women aged 25-39. 21 Figure 3,1 Age-Specific Fertility Rates 1988 Census and 1991/92 TDHS Births per 1,000 Women 300 250 200 1507 100 5O i i i i 5-19 20-24 25-29 30-34 35-39 40-44 45-49 Age The total fertility rates by level of education and by place of residence can be summarized in Table 3.2 and Figure 3.2. Due to small sample sizes for some categories, the data should be viewed with caution. Dar es Salaam has considerably lower fertility than other urban and rural areas in Tanzania. In TDHS an attempt was made to compare fertility estimates by region. Due to the small numbers of women, the ability to make regional comparisons was seriously compromised. To avoid this problem, regions were grouped into six "zones," mainly based on geographic and ecologic characteristics. This strategy enhanced the power to make the necessary geographical comparisons by distributing relatively large numbers of women in each zone. However, it should be noted that these zones do not conform to the administrative zones of the United Republic of Tanzania. The classification of regions into the zones is shown below: Coastal zone: Northem Highlands zone: Lake zone: Central zone: Southem Highlands zone: Southern zone: Tanga, Morogoro, Coast, Dares Salaam and Zanzibar Arusha and Kilimanjaro Tabora, Kigoma, Shinyanga, Kagera, Mwanza, and Mara Dodoma and Singida Iringa, Mbeya, and Rukwa Lindi, Mtwara, and Ruvuma Total fertility rotes are lowest in the Southern regions and Coastal zone (5.1 and 5.7 children per woman, respectively). Lake and Central regions have the highest levels of fertility (6.9 and 7.1 children per woman, respectively). Women with secondary education have a total fertility rate of 4.2 children per woman, which is considerably less than all other women. Women who have only completed a primary education have a total fertility of 6.0; women with incomplete primary education and women with no formal education have total fertility rates of 6.4 and 6.5, respectively. 22 Table 3.2 Fertility by background characteristics Total fertility rate for the three years preceding the survey and mean number of children ever born to women age 40- 49, by selected background characteristics, Tanzama 1991/92 Mean number of children Total ever born Background fertility to women characteristic rate- age 40-49 Residence Mainland 6.2 6.9 Dares Salaam 4.0 6.1 Other urban 5.6 6.4 Rural 6.6 7.1 Zanzibar 6.4 6.9 Zone Coastal 5.7 6.8 Northern Highlands 6.0 7.3 Lake 6.9 7.3 Central 7.1 6.2 Southern Highlands 6.3 7.1 South 5.1 6.4 Education No education 6.5 6.9 Primary incomplete 6.4 7.1 Completed primary 6.0 6.5 Secondary/Higher 4.2 4.8 Total 6.3 6.9 IRate for women age 15-49 years by Main land Dar ee Salaam Other Urban Rural Zanz ibar Coastal Northern Highlands Lake Centra l South Highlands South No Education Incomplete Pr imary Completed Pr imary Secondary/Higher Figure 3.2 Total Fertility Rate Background Characteristics 2 4 6 TDHS 1991/92 23 Fertility trends can be analysed in two ways. One way is to compare TDHS data with previous censuses. As has been observed (see Table 1.1), the 1978 and 1988 censuses reveal that fertility declined over time, from 6.9 to 6.5 to 6.3 according to the TDHS. A second way to analyse fertility trends is by using the TDHS data alone. Table 3.3 shows the age- specific fertility rates for four-year periods preceding the survey. Four-year periods were used instead of the usual five-year periods in order to avoid the effects of shifting births from five to six years preceding the survey. According to the table, there has been a gradual decline in fertility during the last 20 years, e.g., the cumulative fertility of women age 15-34 decreased from 5.7 to 4.6 during this period. Table 3.3 Al~e-specifie fertility rates Age-specific fertility rates (per thousand women) for four-year periods preceding the surcey, by mother's age at the free of birth, Tanzania 1991/92 Number of years ineceding the survey Mother's age 0-3 4-7 8-11 12-15 16-19 15-19 139 146 158 185 209 20-24 281 285 289 316 309 25-29 266 269 289 311 297 30-34 226 268 275 269 [320] 35-39 176 185 202 [257] 40-44 110 [115] [176] 45-49 [40] [34] Note: Age-specific fertility rates are per 1,000 women. Estinmtes enclosed in brackets are tsuncated. A similar pattern is observed in Table 3.4 which shows the fertility rates for ever-married women by duration since first marriage. For the same marriage duration, fertility has declined over time. Table 3.4 Fertility by marital duration Fertility rates for ever-married women by duration since fi~t marriage in years, for four-year periods preceding the survey, Tanzama 1991/92 Marriage Number of years pr¢ceding the survey duration at birth 0-3 4-7 8-11 12-15 16-19 0-4 332 339 344 361 354 5-9 284 307 325 328 321 10-14 258 272 284 317 299 15-19 211 232 254 248 [258] 20-24 150 192 193 [212] 25-29 89 107 [171] Note: Duratlon-specific fertility rates are per 1,000 women, Estimates enclosed in brackets are ta'uncated. 24 3.2 Children Ever Born and Living The distribution of all women by number of children ever born is presented in Table 3.5 for all women and currently married women. The mean number of children ever born increases with age; at the end of her reproductive period, the Tanzanlan woman has given birth to about 7 children. About three percent of women 40 years and older are childless. Currently married women at the end of their childbearing years have given birth to an average of seven children (7.2). Among currently married women aged 40-49 only two percent are childless. Data on children ever born from the TDHS and the 1988 Census can be compared in Figure 3.3. Up to about age 40 the two data sets exhibit remarkably similar results, which suggests good data quality in each. Table 3.5 Children ever born and living Percent distribution of all women and of currently married women by number of children ever born (CEB) and mean number ever born and living, according to five-year age groups, Tanzania 1991/92 Number of children ever born (CEB) Number Mean no. Mean no. Age of of of living group 0 1 2 3 4 5 6 7 8 9 10+ Total women CEB children ALL WOMEN Age 15-19 76.8 19.7 3.4 0.1 0.0 0.0 0.0 0.0 0.0 0.0 0.0 100.0 2183 0.27 0.24 20-24 24.3 30.5 28.6 12.1 3.9 0.5 0.0 0.0 0.0 0.0 0.0 100.0 1882 1.42 1.24 15-29 6.4 12.7 21.3 24.7 18.7 11.2 3.6 1.0 0.4 0.1 0.0 100.0 1599 2.92 2.48 30-34 4.3 5.9 8.2 12 .5 16,4 20.9 16.9 10.2 2.6 1.5 0.7 100.0 1165 4.43 3.75 35-39 1.9 4.1 3.2 8.4 8.7 15.5 17.8 14,6 13.2 7.5 5.1 100.0 10O0 5.83 4.80 40-44 2.6 3.7 4.5 3.2 6.0 8.1 12,8 15.6 12.6 11.9 18.9 100.0 715 6.90 5.65 45-49 4.1 3.7 2.5 4.4 7.5 8.5 9.2 13.3 13.8 11.7 21.4 100.0 695 6.94 5.43 Total 25.5 14.8 12,2 9.8 8.1 7.6 6.4 5.2 3.8 2.8 3.7 100.0 9238 3.11 2.58 CURRENTLY MARRIED WOMEN Age 15-19 42.1 48.4 9.0 0.5 0.0 0.0 0.0 0.0 0.0 0.0 0.0 100.0 558 0.68 0.60 20-24 10.9 31.3 35.8 16.2 5.2 0.7 0.1 0.0 0.0 0.0 0.0 100.0 1283 1.76 1.53 15-29 3.5 10 .3 19.3 27.3 20.7 12.8 4.3 1.2 0.5 0.0 0.0 100.0 1274 3.16 2.70 30-34 1.4 4.8 8.1 12 .8 17.1 21.2 17.6 11.2 3.0 1.8 0.9 100.0 935 4.67 3.96 35-39 1.4 4.1 2.7 7.4 7.8 15.4 19.0 15.5 13.6 7.8 5.5 100.0 841 5.98 4.92 40-44 2.3 3.1 3.8 2.0 6.0 8.0 13.0 16.2 13.5 12.2 19.8 100.0 603 7.09 5.82 45-49 2.3 4.5 1,7 4.2 6.1 7.4 10.1 13 .3 14.6 12.6 23.2 100.0 545 7.2A 5.67 Total 7.8 15.3 14.7 12.8 10.4 9.7 8.5 7.0 5.1 3.7 5.0 100.0 6038 4.02 3.34 25 9 7 6 5 4 3 2 1 o; Figure 3.3 Children Ever Born to Women 15-49 1988 Census and 1991/92 TDHS i i i i i 15-19 20-24 25-29 30-34 35-39 40-44 45-49 "Census 1988 ")I~'rDHS 1991/92 ~ l m 3.3 Birth Intervals The timing of births has implications for both fertility and mortality. A woman who has births spaced closely together most likely will complete her childbearing years with more children than one who spaces her births farther apart. Babies who are bom within a short interval are subject to poor health and thus are more exposed to the risks of dying than those who are born after longer birth intervals. Table 3.6 shows the percent distribution of births in the five years before the survey by interval since previous birth by demographic and background characteristics. Half of all births occurred after an interval of 33 months, 18 percent of all births occurred less than 24 months after a previous birth, 63 percent occurred at an interval between 24 and 47 months, and 19 percent of the births occurred at an interval of four years or more. In general, there are only small differences in median birth interval length between subgroups. However, if the previous child is deceased, birth intervals are about 6 months shorter than if the previous child is surviving. Younger women also have shorter birth intervals than older women. 26 Table 3.6 Birth intervals Percent distribution of births in the five years preceding the survey by number of months since previous birth, according to demographic and socioeconomic characteristics, Tanzania 1991/92 Number of months since previous birth Characteristic 7-17 18-23 24-35 36-~7 48+ Total Median number of Number months since of previom birth births Age of mother 15-19 18.3 20.4 49.8 9.2 2.2 100.0 25.4 78 20-29 6.4 14.1 49.1 17.1 13,4 100.0 30.9 3046 30-39 5.1 10.5 40.0 20.6 23.8 100.0 35.0 2430 40 + 3.7 7.5 34.5 25.9 28.4 100.0 38.1 743 Blrlh order 2-3 6.1 13,1 45.8 17.5 17.5 100.0 32.1 2604 4-6 4.7 11.2 44.8 18.8 20.5 100,0 33.6 2295 7 + 6.7 11.2 38.8 23.7 19.6 100.0 34.5 1398 Sex of prior birth Male 5.8 11.5 44.0 19.1 19.6 100.0 33.4 3178 Female 5,6 12.5 43.7 19.7 18.5 100.0 33.1 3119 Survival of prior birth Living 3.3 11.3 45.4 20.7 19.3 100.0 33.9 5339 Dead 19.2 16.2 35.4 11.7 17.5 100.0 28.3 958 Residence Mainland 5.6 11.9 43.9 19.5 19.1 100.0 33.3 6108 Dar es Salaam 5.3 6.5 44.7 22.4 21.1 100.0 34.7 270 Other urban 4.7 12.4 39.8 19,8 23.3 100.0 34,4 934 Rural 5.7 12.1 44.7 19.3 18.2 100.0 33.1 4904 Zanzibar 11.1 15.4 42.1 14.4 17.0 100.0 30.4 189 Zone Coastal 6.2 10.0 41.2 20.9 21.6 100.0 34.6 1238 Northvrn Highlands 6.5 16.5 34.8 15.8 26.4 100.0 33.5 714 Lake 6.8 14.4 48.5 16.2 14.1 100.0 30.7 2317 Central 4.0 9.5 48.4 23.3 14.8 100.0 33.2 723 Southern Highlands 3.8 9.5 40.4 23.3 23.0 100.0 36.1 805 South 3.9 7.1 41.3 22.9 24.8 100.0 36.3 501 Region Dodoma 4.0 7.3 49.9 25.3 13.5 100.0 33.3 500 Arusha 6.0 17.2 33.7 14,7 28.5 100.0 33,8 427 Kilimanjaro 7.3 15.5 36.4 17.5 23.4 100.0 32.9 287 Tanga 5.9 11.8 37.6 18.9 25.8 100.0 34.8 323 Morogoro 5.3 8,7 39.6 24.6 21.8 100.0 35.5 365 Coast 3.7 7.5 48.6 22.8 17.4 100.0 33.6 91 Lindi 5.1 6.8 34.8 27.0 26.2 100.0 37.8 140 Mtwara 3.3 4.4 37.3 20.5 34.6 100.0 38.3 152 Ruvuma 3,5 9.2 48.6 21.9 16.9 100.0 34.5 209 Iringa 2.6 7.0 37.9 27.8 24.7 100.0 37.7 352 Mbeya 4.3 11.7 39.5 20.9 23.6 100.0 35.4 283 Singida 4.1 14.5 45.0 18.9 17.6 100.0 32,8 223 Tabora 4.9 8.6 42.1 26.6 17.8 100,0 34.9 186 Rukwa 5.6 11.0 47.0 18.1 18.4 100.0 33.6 171 Kigoma 6.7 15.0 53.5 14.3 10.4 100.0 30.2 296 Shinyanga 7.3 13.8 49.0 15,5 14.4 100.0 30.5 633 Kagera 8.4 17.1 45.6 15.2 13.6 100.0 30.8 445 Mwanza 6.5 13.3 52.3 15.8 12.1 100.0 29.7 466 Mara 5.0 16.5 44.5 15.4 18.5 100.0 31.3 292 Education No education 5.4 11.5 40.8 21.4 20.9 100.0 34.5 2574 Primary incomplete 5.0 10.5 45.6 19.0 19.9 100.0 33.3 1288 Completed primary 5.9 13.7 47.0 17.4 16.0 100.0 32.0 2277 Secondary/Higher 14.1 8.2 34.7 17.6 25.4 100.0 34.1 158 Total 5.7 12.0 43.9 19.4 19.0 100.0 33.3 6297 Note: First-order births are excluded. The interval for multiple births is the number of months since the preceding pregnancy that ended in a live I~a'th. 27 3.4 Age at FirstBirth The age at which childbearing begins has important demographic consequences and also consequences for the mother and child. A rise in the age at first birth is usually a reflection of the increase of age at first marriage, though the opposite may not be true. In many countries, postponement of first births, reflecting an increase in age at marriage, has contributed greatly to overall fertility decline. Table 3.7 shows the percent distribution of women by age at first birth according to current age of the mother. While 10 percent of older women (45-49) had their first birth before age 15, only 4 percent of the younger women (20- 24) had their first birth before reaching age 15. Among older women (45-49), 60 percent had their first birth before reaching age 20, whereas 57 percent of the young women had their first birth before age 20. The median age at first birth has increased by about one year across cohorts age 40-44 to 20-24. Table 3.7 Age at first birth Percent distribution of women 15-49 by age at first birth, according to current age, Tanzania 1991/92 Current ago Women Median with Age at first birth Number age at no of first births <15 15-17 18-19 20-21 22-24 25+ Total women birth 15-19 76.8 0.9 13.9 8.4 NA NA NA 10~.0 2183 a 20-24 24.3 4.0 24.3 28.5 14.7 4.2 NA 100.0 1882 19,5 25-29 6.4 5.6 26.1 24.7 19.3 12.6 5,4 100.0 1599 19,5 30-34 4.3 9.2 35.6 20.8 14.6 10,4 5.1 100.0 1165 18.5 35-39 1.9 8,0 36.8 22.0 13.6 10,1 7.4 100.0 1000 18.4 40-44 2.6 9.7 34.4 21.2 13,6 11.0 7.5 100.0 715 18.5 45-49 4.1 9.7 31,3 19.1 14,5 10.5 10.9 100.0 695 18.8 NA = Not applicable aLess than 50 percent of the women in the age group x to x+4 have had a birth by age x 28 Table 3.8 presents the median age at first birth by place of residence and education. There is no variation in age at first birth by place of residence, but there is a substantial increase in the age at first birth with increasing levels of education, Table 3.8 Median age at first birth Median age at ftrst birth among women age 20-49 years, by current age and ~elected background characteristics, Tanzania 1991/92 Current age Background Ages Ages characteristic 20-24 25-29 30-34 35-39 40-44 45-49 20-49 25-49 Residence Mainland 19.5 19.5 18.5 18.4 18.5 18.8 19,0 18.8 Dar es Salaam a 20.1 18.8 (17.8) (18.2) (17.4) 19.4 18.7 Other urban 20.0 19,7 17.7 17.7 18.5 18.3 18.9 18,5 Rural 19.3 19.4 18.7 18.7 18.5 19.0 19.0 18.9 Zanzibar 19,7 19.5 18,3 (17.3) (17.8) (18.9) 18.8 18.4 Education No education 18.3 17.9 18.1 18.3 18.4 18.9 18,3 18.3 Primary incomplete 18.4 18.6 17.2 17.9 18.3 18.6 18.1 18.1 Completed primary 19.7 20.2 19.6 19.5 20.0 19.3 19.8 20,0 Secondary/Higher a 23,9 23.1 * * * a 23.4 Total 19.5 19.5 18.5 18.4 18.5 18.8 19.0 18.8 Note: The medians for cohort 15-19 could not be determined because half the women have not yet had a birth. Rates shown in parentheses are b~ed on 25-49 women, whereas an asterisk means the rate is based on fewer than 25 women and has been suppressed. aMediens were not calculated for these cohorts because less than 50 percent of women in the age group x to x+4 have had a birth by age x. 3.5 Teenage Pregnancy and Motherhood The issue of fertility among women aged 15-19 is vital because teenage mothers and their children are at high risk for social and health problems. Children born to young mothers are more prone to illness and higher mortality during childhood than children born to older mothers. Table 3.9 presents the percentage of teenagers aged 15-19 who are mothers or are pregnant with their first child by background characteristics. Overall, 29 percent of teenagers covered by this survey have already begun childbearing (i.e,, they have given birth or had their first pregnancy at the time of the survey). Among those age 15, three percent have begun childbearing and among those age 19, almost 60 percent have a a birth or are pregnant. 29 Table 3.9 Teenage pregnancy and motherhood Percentage of teenagers 15-19 who are mothers or pregnant with their first child by selected background characteristics, Tanzania 1991/92 Percentage who are: Percentage who have Pregnant begun Number Background with first child- of characteristic Mothers child bearing teenagers 0.5 2.7 3.2 392 16 6.0 4.1 10.1 474 17 18.2 9.3 27.6 387 18 33.7 6.5 40.2 457 19 53.3 6.2 59.4 474 Residence Mah-dand 23.2 5.8 29.0 2114 Dares Salaam 15.5 6.2 21.7 162 Other urban 25.7 4.8 30.5 421 Rural 23.3 6.1 29.4 1531 Zanzibar 23.9 2.2 26.1 69 Zone Coastal 24.1 5.2 29.4 480 Northern Highlands 11.8 2.0 13.8 228 Lake 22.4 5.6 28.0 813 Central 26.2 7.7 34.0 235 Southern Highlands 27.3 7.0 34.4 219 South 29.2 7.9 37.1 208 Education No education 29.1 6.4 35.5 333 Primary incomplete 16.4 4.0 20.4 503 Completed primary 26.8 6.7 33.5 1207 Secondary/Higher 3.1 1.5 4.6 139 Total 23.2 5.7 29.0 2183 Although most teenagers who have begun childbearing have given birth only once, a small proportion of them have given birth twice. Table 3.10 shows the percent distribution of teenagers 15-19 by number of children ever born according to single years of age. Twenty percent of teenagers have given birth to one child and 4 percent have had 2 or more children. The mean number of children ever born among teenagers is 0.3. Table 3.10 Children born to teenagers Percent distribution of teenagers 15-19 by number of children ever bern (CEB), Tanzania 1991/92 Age 0 1 2+ Number of Mean children ever born number Number of of Total CEB teenagers 15 99.5 0.5 0.0 100.0 0.00 392 16 94.0 5.8 0.2 100.0 0.06 474 17 81.8 16.0 2.2 100.0 0.20 387 18 66.3 28.1 5.7 100.0 0.40 457 19 46.7 44.4 8.9 100.0 0.62 474 Total 76.8 19.7 3.6 100.0 0.27 2183 30 CHAPTER 4 FERTILITY REGULATION 4.1 Knowledge of Contraception Knowing about contraceptives is an important step needed before one can actually use contraceptives. Information on an individual's contraceptive knowledge was obtained at the interview by asking the respondent to name ways or methods by which a couple could delay or avoid pregnancy. I f the respondent failed to mention a particular method spontaneously, the interviewer mentioned and described the method and asked i f the respondent knew it. The following modem methods were described: pills, IUD, injections, barrier methods (diaphragm, foam, and jelly), condoms, and female and male sterilisation. Three traditional methods were also described--periodic abstinence (rhythm method), mucus method, and withdrawal. For each method recognised, the respondent was asked if she knew where it could be obtained. I f she reported knowing about the rhythm method, she was asked i f she knew where a person could obtain advice on how to use the method. The results are presented in Table 4.1. Table 4.1 Knowledge of contraceptive methods and source for methods Percentage of all women and currently married women who know specific contraceptive methods and who know a source (for information or services), by specific methods, Tanzania 1991/92 Know method Know a source Currently Currently Contraceptive All married All married method women women women women Any method 74.4 80.2 65.5 71.4 Any modern method 72.2 77.6 65.1 71.1 Modern method Pill 68.9 74.6 59.5 65.6 IUD 31.3 35.0 29.1 32.7 Injection 39.6 44.0 36.5 40.7 Diaphragm/foam/jelly 19.5 22.2 17.9 20.4 Condom 51.3 55.0 44.8 48.3 Female sterilisation 49.5 54.6 46.0 50.8 Male sterilisation 10.1 11.3 9.3 10.5 Any traditional method 44.1 48.9 NA NA Periodic abstinence 23.3 24.7 19.1 20.7 Mucus method 9.3 9.8 NA NA Withdrawal 23.9 27.1 NA NA Other 21.2 24.6 NA NA Number of women 9238 6038 9238 6038 NA = Not applicable 31 Of all Tanzanian women aged 15-49 years who were interviewed in the survey, 74 percent knew at least one method of family planning. The level of knowledge was slightly higher (80 percent) among currently married women. A majority of all women interviewed (72 percent) knew at least one modem contraceptive method, while less than half (44 percent) reported knowing at least one traditional method. Currently married women were relatively more likely to know of modem contraceptive methods (78 percent) and traditional methods (49 percent). Since currently married women are regarded to be at highest risk of getting pregnant, the remaining sections of this chapter will focus on them. However, in interpreting the results it is recommended that readers take into consideration that out of 9238 women interviewed, 6038 (65 percent) were currently married. Hence, currently married women constitute two thirds of all women covered by this study. The modem contraceptive methods most frequently reported by currently married women were pills (75 percent), condom (55 percent) and female sterilization (55 percent). Other methods commonly reported were injections (44 percent), IUD (35 percent), and barrier methods (22 percent). Male sterilization was the least known modem method of contraception. As for the traditional methods, 25 percent of married women knew periodic abstinence, while 27 percent knew withdrawal. Only 10 percent of currently married women knew the mucus method. Overall, the level of knowledge of both modem and traditional contraceptive methods was slightly lower among all women when compared to currently married women, suggesting that women not currently married were less likely to be aware of contraceptive methods. Results of several other studies in Tanzania (Kapiga et al., 1993; Ministry of Health, 1992) showed widespread knowledge of modem contraceptive methods, with pills being the best known. The high level of knowledge of the pill may be due to its wide availability in most family planning service delivery points and for the fact that it is the most used method in Tanzania. Data presented in the subsequent sections of this chapter support this observation. The observed high level of knowledge of condoms has been reported in several other studies (NACP, 1992; Ministry of Health, 1992) and has been associated with the ongoing HIV/AIDS campaign in which condom use is promoted as a preventive measure. Only 12 percent of currently married women who knew of pills were not aware of a place where they could obtain this method, and 7 percent of currently married women who knew female sterilization did not know where this procedure was done. As for other modem contraceptive methods, a majority of women were not aware of the place where these methods could be obtained. In general, about 92 percent of currently married women who know a modem method also are aware of where it can be obtained. The association between age, education, and region where respondents were residing at the time of the survey, knowledge of family planning methods, and sources where such methods could be obtained was assessed in Table 4.2. Knowledge of at least one method of contraception among currently married women is low in the extreme age groups (15-19 years and 45-49 years). The level of knowledge increases with age, reaches a peak at 30-34 years, and then decreases to reach the lowest level at 45-49 years. A similar pattern was observed for knowledge of modem contraceptives and a source where the methods could be obtained. Overall, the levelof knowledge of contraceptive methods and of a place where they could be obtained is lower on the Tanzania mainland than in Zanzibar. However, due to the small number of currently married women interviewed in Zanzibar (only 168), comparisons with mainland Tanzania should be regarded cautiously. Within mainland Tanzania, the level of knowledge is lower in rural areas than in urban areas. 32 Table 4.2 Knowledge of modem contraceptive methods and source for methods Percentage of currently married women who know at least one modem contraceptive method and who know a source (for information or services), by selected background characteristics, Tanzania 1991/92 Know a Know Know source for Number Background any a modem modem of characteristic method method ] method women Age 15-19 70.9 68.7 58.4 558 20-24 81.4 79.6 73.0 1283 25-29 84.5 82.6 76.0 1274 30-34 85.5 83.7 77.5 935 35-39 79.7 76.7 72.2 841 40-44 80.1 76.6 70.0 603 45-49 69.2 62.7 56.3 545 Residence Mainland 79.8 77.1 70.5 5870 Dar es Salaam 91.7 91.1 84.9 349 Other urban 94.2 93.8 89.1 966 Rural 75.8 72.5 65.4 4555 Zanzibar 95.9 95.9 92.5 168 Region Dodoma 94.9 93.1 86.5 445 Arusha 70.3 65.4 58.8 350 Kilimmajaro 94.5 94.5 93.4 258 Tanga 71.1 69.9 67.0 306 Morogoro 93.6 93.0 90.1 334 Coast 90.8 89.4 79.7 98 Lindi 94.4 93.8 81.3 155 Mtwara 81.9 78.9 66.3 249 Ruvuma 9.2.2 91.1 80.1 210 Iringa 70.3 68.6 63.7 338 Mbeya 75.9 70.9 70.6 333 Singida 86.6 84.8 82.5 190 Tabora 79.0 76.1 74.1 174 Rukwa 50.5 47.9 45.7 158 Kigoma 73.8 71.2 65.3 245 Shinyanga 60.9 53.3 40.6 578 Kagera 77.2 76.3 71.0 371 Mwanza 78.6 75.3 63.9 444 M~a 87.3 84.0 75.3 285 Education No education 68.7 64.2 56.2 2505 Primary incomplete 85.6 83.5 76.9 1166 Completed primary 89.2 88.3 83.0 2215 Secondary/Higher 98.9 98.9 98.9 152 Total 80.2 77.6 71.1 6038 1Includes pill, 1UD, injection, vaginal methods (foaming tablets/diephragm/ foam/jelly), condom, female stefilisatlon, and male sterilisatlon. 33 Knowledge of contraceptive methods varies widely by region (Table 4.2). More than 90 percent of currently married women in Zanzibar, Ruvuma, Lindi, Dares Salaam, Morogoro, Kilimanjaro, and Dodoma are aware of at least one modem contraceptive method. Knowledge of modem contraceptive methods is low in Rukwa (48 percent), Shinyanga (53 percent), Arusba (65 percent), Iringa (69 percent), and Tanga (70 percent). The level of education of currently married women is positively associated with knowledge of contraceptive methods and a source where they could be obtained. Knowledge of at least one modem contraceptive method was 64 percent among women with no education, 84 percent among women with incomplete primary education, 88 percent among women who had completed primary education, and 99 percent among women with secondary education or higher. However, only 3 percent of currently married women had secondary education or higher. 4.2 Ever Use of Contraception All women interviewed in the survey who reported knowing a method of family planning were asked if they had ever used that method. The results are presented in Table 4.3. About 23 percent of all women have ever used a method of family planning, and 14 percent have ever used a modem contraceptive method. Table 4.3 Ever use of con~aceptlon Percentage of all women and of currently married women who have ever used any contraceptive method, by specific method and age, Tanzania 1991/92 Age Any modern Any meth- method od Modem methods Traditional methods nia- Female Male Peal- In phragm, steal- steri- Any odic With- Number jec- foam, lisa- lisa- ttad. absti- Mucus draw- of pill IUD tiea jelly Condom tion tion method nence method al Other women ALL WOMEN 15-19 6.7 2.9 1,3 0.0 0.0 0.1 1.8 0.0 0.0 5.0 3.3 0.3 1.7 0.5 2183 20-24 25.0 13.9 9.3 0.4 0.2 0.2 6.2 0.3 0.0 15.9 9.0 0.8 7.6 1.9 1882 25-29 28.2 17.2 14.9 0.9 0.8 0.1 3.7 0.4 0.1 16.6 7.1 1.9 9.9 2.2 1599 30-34 32.5 20.6 17.5 1.6 1.6 0.3 4.8 1.1 0.0 20.5 10.4 1.8 11.1 3.4 1165 35-39 30.4 22.9 18.7 3.6 1.4 0.7 3.7 4.6 0.1 14.7 6.2 2.0 7.3 3.7 1000 404-4 27.0 19.9 14.9 3.3 1.7 0.7 2.6 5.0 0.1 15.0 5.1 1.0 7.9 4.4 715 45-49 21.4 13.1 8.0 1.9 2.4 0.3 0.8 4.0 0.2 13.0 3.6 0.4 7.8 4.0 695 Total 22.7 14.1 10.8 1.2 0.9 0.3 3.6 1.5 0.0 13.6 6.5 1.1 7.0 2.4 9238 CURRENTLY MARRIED WOMEN 15-19 10.9 4.1 2.4 0.0 0.0 0.0 2.1 0.0 0.0 7.3 4.0 0.5 3.1 0.8 558 20-24 26.2 15.2 10,6 0.4 0,1 0.2 6.8 0.3 0.0 16.1 7.2 1.0 8.8 2.2 1283 25-29 26.6 15.4 13.2 0.9 0.4 0.2 2,4 0.3 0.1 16.4 5.7 1.9 10.5 2.3 1274 3034 32.3 19,1 16.1 1.7 1.8 0.2 4.6 1.2 0.0 21.4 11.2 1.9 11.4 3.6 935 35-39 28.3 20.9 16.6 3.0 1,3 0.8 3.5 3.9 0.1 14.2 5.7 1.7 7.6 3.4 841 40-44 26.6 19.8 14.9 3.1 1.9 0.6 2.5 4.9 0.1 15.1 4.9 1.2 7.7 4.2 603 45-49 20.9 12.4 7.6 2.1 2.3 0.1 0.3 3.4 0.2 13.5 4.1 0.5 7.9 4.0 545 Total 25.7 15.8 12.3 1.5 1.0 0.3 3.6 1.6 0.1 15.6 6.5 1.4 8.7 2.8 6038 34 Among currently married women, 26 percent reported having used family planning methods, and 16 percent have ever used modem family planning methods. Ever use of traditional family planning methods was reported by 14 percent of all women and 16 percent of currently married women. The most commonly used methods of family planning by currently married women were pills (l 2 percent), withdrawal (9 percent), and periodic abstinence (7 percent). Generally, ever use of modem family planning methods increases with age up to 35-39 years, after which it decreases. 4.3 Current Use of Contraceptives Table 4.4 presents the distribution of women by family planning method currently used according to age. Only 10 percent of currently married women in Tanzania were using family planning methods at the time of interview. This section focuses primarily on married women, since it is customary to analyse contraceptive use among currently married women. Table 4.4 Cun'ent use of contraception by age Percent distribution of all women and of currently married women by contlaceptive method currently used, according to age, age, Tanzania 1991/92 Age Any modem Any meth- method od Modern methods Traditional methods Die- Fcmaal© Male Ptgi- Not phragm, steri- steri- Any eric With cur- Inje~- foam+ Con- lisa- lisa- trsd. absti- Mucus draw- reraly Pill IUD tion jelly dora ti~'l ti~-t method nerve method Id Other usin 8 Total Number ALL WOMEN 15-19 3.4 1.0 0.6 0.0 0.0 0.0 0.4 0.0 0.0 2.4 1.7 0.0 0.5 0.2 3.4 IC0.0 2183 20-24 9.9 5.7 3.6 0.2 0.1 0.0 1.5 0.3 0.0 4,2 2.1 0.1 1.4 0.5 9.9 100.0 1882 25-29 10.7 5.7 4.6 0.3 0.1 0.0 0.3 0.4 0.0 5.0 2.1 0,2 2.0 0.7 10.7 1(30.0 1599 30-34 14.9 10.5 7.0 0.4 0.8 0.0 1.1 1.1 0.0 4.4 1.9 0.0 1.9 0.7 14.9 1(30.0 1165 35-39 14.2 11.1 3.7 1.0 0.5 0.0 1.2 4.6 0.0 3.1 1.0 0.2 1.4 0.5 14.2 leO.0 1000 40-44 10.7 7.6 0.9 0.5 0.9 0.1 0.2 5.0 0.0 3.1 0.7 0.0 1.8 0.6 10.7 100.0 715 45-49 7.2 5.4 0.1 0.4 0.6 0.1 0.1 4.0 0.2 1.8 0.8 0.0 0.5 0.5 7.2 100.0 695 Total 9.5 5.9 3.0 0.3 0.3 0.0 0.7 1.5 0.0 3.6 1.6 0.1 1.3 0.5 9.5 100.0 9238 CURRENTLY MARRIED WOMEN 15-19 5.2 1.7 1.4 0.0 0.0 0.0 0.2 0.0 0.0 3.6 1.7 0.0 1.4 0.5 5.2 100.0 558 20-24 10.0 5.9 4.3 0.2 0.0 0.0 1.1 0.3 0.0 4.1 1.3 0.1 2.0 0.6 10.0 100.0 1283 25-29 9.9 5.2 4.1 0.4 0.2 0.0 0.3 0.3 0.0 4.8 1.4 0.3 2.5 0.6 9.9 100.0 1274 30-34 13.8 9.1 5.5 0.4 1.0 0.0 l.t 1.2 0.0 4.7 1.8 0.0 2.3 0.6 13.8 100.0 935 35-39 13.3 10.5 3.8 1.0 0.4 0.0 1.3 3.9 0.0 2.8 0.8 0.0 1.6 0.4 13.3 100.0 841 40-44 10.9 7.5 0.8 0.6 0.9 0.1 0.2 4.9 0.0 3.4 0.6 0.0 2.1 0.7 10.9 100.0 603 45-49 7.1 4.8 0.1 0.5 0.5 0.1 0.1 3.4 0.2 2.3 1.0 0.0 0.6 0.7 7.1 I00.0 545 Total 10.4 6.6 3.4 0.4 0.4 0.0 0.7 1.6 0.0 3.9 1.3 0.1 1.9 0.6 10.4 100.0 6038 Use of modem methods was higher (7 percent) than that of traditional methods (4 percent). Pills were used by 3 percent of currently married women, which is about half of all women using modem methods. Other methods commonly used were withdrawal (2 percent), female sterilization (2 percent), and periodic abstinence (1 percent). Use of family planning methods was lowest among younger women (15-19 years) and highest among women between 30-39 years of age. The tendency to use family planning methods was higher among older women, probably due to the fact that they are more likely to have completed their 35 families and hence want to stop childbearing. Similar findings were also observed in Nigeria (Federal Office of Statistics, 1992). To determine the factors associated with current use of family planning methods, use of the methods was assessed by various background characteristics of women, such as urban/rural residence, region, education, and number of living children. The results are presented in Table 4.5 and Figure 4.1. Table 4.5 Current use of contraception by back~rotmd characteristics Percent distribution of currently marr ied women by contraceptive method currently used, according to selected background characteristics, Tanzania 1991/92 Background chatactetlstlc Modem methods Traditional mctho& Femdi¢ Male Any Pod- Any All Vagthdi stexl- stefi- trl,d, cdic With Number meth- rood- Injec- meth- Con- lka- llisa- meth- absti- draw- of od era Pill IUD tion ods dc~n don tion. od hence Mucus al Other women Residence Mainland 10.5 6.6 3.4 0.4 0,4 0.0 0.7 1.6 0.0 4.0 1.3 0.1 2.0 0.6 5870 Dares Salaam 15.7 10.9 5.7 0.5 0.6 0.0 1.9 2.2 0.0 4.8 0.6 0.0 3.5 0.6 349 Other urban 18.7 15.1 9.5 1.3 1.3 0.0 1.4 1.6 0.0 3.6 1,6 0.1 1.1 0.8 966 Rural 8.4 4.4 1.9 0.2 0.1 0.0 0.5 1.6 0.0 4.0 1,3 0.1 2.1 0.6 4555 Zanzibar 7.1 6.6 2.9 0.3 1.1 0.0 0,8 1.5 0,0 0.5 0.5 0.0 0.0 0.0 168 Region Dodoma 9.6 8.3 4.5 0.0 1.6 0.0 2.2 0.0 0.0 1.3 0.5 0.0 0.6 0.2 445 Arusha 17.3 12,3 7.6 0,8 0.4 0.0 1.1 2.5 0.0 5.0 0.8 0.6 3,3 0,2 350 Kilimanjaro 33.1 25.3 8,5 4.8 0,4 0.3 3.4 7.9 0.0 7.8 1.8 0,3 5,6 0.0 258 Tanga 15.8 7.5 4.9 0.0 0.7 0.0 0.3 1.6 0.0 8.3 1.8 0.0 6.5 0.0 306 Morogoro 10.6 4.5 3.3 0.0 0.0 0.0 1.0 0.2 0,0 6.1 2.0 0.0 2.4 1.8 334 Coast 13.6 3.3 1.8 0.0 0.0 0.4 1.1 0.0 0.0 10.3 0.8 0.0 6.7 2.8 98 Lindi 11.5 9.7 4.9 0.0 1.0 0.0 0.6 3.2 0.0 1.8 0.0 0.0 0.2 1.6 155 Mtwara 2.3 1.5 0.4 0.0 0.4 0.0 0.0 0.7 0.0 0.8 0.0 0,0 0.0 0.8 249 Ruvuma 7,8 5.1 1.3 0.0 0.0 0.0 0.3 3.5 0.0 2.7 0,0 0.4 1.3 1.1 210 lringa 11.1 9.0 6.7 0,9 0.2 0.0 0.0 0.8 0.3 2.1 1.2 0.0 0.9 0.0 338 Mbeya 12.1 5.4 2.9 0.9 0.0 0.0 0.0 1.6 0.0 6.7 0.8 0.O 5.9 0.0 333 Singida 14.0 10.7 8.4 0.9 0.0 0.0 0.0 1.4 0.0 3.4 1.5 0.0 1.1 0.7 190 Tabora 9.0 4.1 1.0 0.2 0.0 0,0 0.0 2.9 0.0 5.0 1.6 0.4 1.5 1.4 174 Rukwa 5,6 4.4 2.3 0.0 0.0 0.0 0.5 1.7 0.0 1.2 0.9 0.0 0.1 0.1 158 Kigoma 4.9 2.8 1.3 0.0 0.1 0.0 0.9 0.5 0.0 2.1 0.3 0.0 0,5 1,3 245 Shinyanga 4.2 1.2 0.6 0.0 0.0 0.0 0.3 0.3 0.0 3.0 2,4 0.0 0.0 0,6 578 Kagera 8.4 3.9 0.5 0.0 0.3 0.0 0.0 3.2 0.0 4.4 2,8 0,0 1.3 0.3 371 Mwanza 4.0 2.3 1.5 0.0 0.0 0.0 0.0 0.9 0.0 1.6 0.8 0.0 0.3 0.6 444 Mall 7.9 3.0 0.8 0.2 1.1 0,0 0.0 0.9 0.0 4.9 2.9 0.3 1.1 0.6 285 Education No education 3.7 1.8 0.6 0.0 0.2 0.0 0.1 0.8 0,0 1.9 0.7 0,0 0,8 0.4 2505 Primary incomplete 12.9 8.2 2.3 0.6 1.0 0.0 0.7 3.6 0.0 4.7 0,7 0.2 2.9 0.9 11(6 Completed primary 14.6 9.3 6,1 0.4 0.3 0.O 1.2 1.3 0.0 5.3 1.9 0.1 2.7 0.6 2215 Secondary/Higher 42.4 33.1 17.2 6.6 0.3 0,0 3.9 5.2 0.0 9.3 4.9 0.5 3.0 0.9 152 Number of children 0 1.8 0.6 0.1 0.0 0.0 0.0 0.0 0.5 0.0 1.2 1.2 0.0 0.0 0.0 619 1 9.8 6.3 4.5 0.0 0.1 0.0 0.7 1.0 0.0 3.5 1.4 0.3 1.4 0.4 1058 2 11.6 6.0 4.2 0.4 0.0 0.0 1.2 0.3 0.0 5.6 1.6 0.1 2.9 1.0 1001 3 11.3 7.7 4.8 1.2 0.1 0.0 0.6 1.0 0.0 3.6 1.2 0.1 1.9 0.5 835 4÷ 12.0 8,0 2.9 0.5 0.8 0.1 0.7 2.9 0.0 4.0 1.1 0,0 2.2 0.7 2525 Total 10.4 6.6 3.4 0.4 0.4 0.0 0.7 1.6 0.0 3.9 1.3 0A 1.9 0.6 6038 36 Figure 4.1 Current Use of Modern Contraceptives among Currently Married Women 15-49 RESIDENCE/ MalnlanO ~ Dar es Salaam k ¢ ~ Other urbai3 I~¢~ Rural Zanzibar r~ R E G I O N / Ki l imanjaro ~ Arushe ~ Sin(;Ida ~ L1 n d ) I ~ Ir lnga Dodoma Tangs Mbeye • ,~ Ruvums Moroaoro~ R u'kwe ~ Tabors K a g e r s ~ Coast Mare Mwanzs ~ Mtwara ~ Shinyanga ~ ~a~-~,~p -~ : . 10 20 Percent 30 TDHS 1991/92 The proportion of married women using any method of family planning was higher in the Tanzania mainland (11 percent) than in Zanzibar (7 percent). Within the Tanzania mainland, women in rural areas were less likely to use family planning methods than those in urban areas. However, the prevalence of contraceptive use was slightly lower in Dares Salaam (16 percent) than in other urban areas (19 percent). In both urban and rural areas, the pill was the most used method. The prevalence of use of family planning methods varied widely by region. Regions with the highest proportion of married women using modem methods were Kilimanjaro (25 percent), Arusha (12 percent), Dares Salaam (11 percent), and Singida (11 percent). Lowest prevalence of contraceptive use was found in Shinyanga (1 percent), Mtwara (2 percent), Mwanza (2 percent), and Kigoma (3 percent). Overall, pills were the most popular method in most of the regions. Use of traditional methods was relatively high in Coast (10 percent), Tanga (8 percent), Kilimanj aro (8 percent), and Mbeya (7 percent). In general, withdrawal was the most common traditional method used in all regions. The probability of using family planning methods is associated with level of education. As documented in other countries, a monotonic increase in contraceptive use was found to be associated with increasing level of education. The proportion of married women using any family planning method increased from about 4 percent among women with no formal education to 42 percent among those with secondary education or higher. A similar pattern was observed for both modem and traditional methods. Female sterilisation is the most commonly used method among women with no education and those with incomplete primary education, whereas pills are the most used contraceptive method among women with completed primary education and above. The association between level of education and use of contraception was further explored by relating the proportion of women who had completed primary school and above and current use of contraceptives by 37 region; the results are shown in Figure 4.2. These results indicate that there is a strong relationship between contraceptive use and level of education. The level of education explains 63 percent of the variation in use of modem contraceptives between regions. Kilimanjaro region is an outlier, especially because of its high use of modem contraceptives: the level of use is higher than expected on the basis of its level of education. Dares Salaam, despite having a level of contraceptive use higher than most other regions, has a lower level than expected on the basis of its level of education. :30 Percent Figure 4.2 Use of Modern Contraceptive Methods, Married Women 15-49 25 20 15 10 5 0 • Kilimanjaro 10 20 30 40 50 60 70 80 90 Percent Completed Primary Education or Above 100 TDHS 1991/92 Use of any family planning method was found to increase from about 2 percent among women with no living child to 12 percent among those with at least four living children. Increasing prevalence of modem contraceptive use was also found to be associated with increasing number of living children. Use of specific modem and traditional methods varied little according to the number of living children, except for female sterilization and IUD, which were found to be used mainly by women with at least three living children. In general, these findings indicate that women more likely to be using family planning methods are those on mainland Tanzania, particularly those in urban areas other than Dares Salaam, those residing in the Kilimanjaro region, those who have completed secondary education, and those with at least two living children. 4.4 Number of Children at First Use of Contraception Family planning methods may be used by couples for either limiting family size or spacing births. Family size limiters are likely to start using contraceptives only when they have already had as many children as they want, whereas couples wishing to space their births may start contracepting at a much earlier phase before having many births. In many cultures where acceptance of family planning is not widespread, most couples use contraceptives for limiting family size. As the concept of planning families gains acceptance, 38 however, couples may begin to use contraception for spacing births as well as for limiting family size. To explore the possible motivation for use of contraceptives, a question was posed on the number of living children ever-married women had when they first used contraception; the results are presented in Table 4.6. Table 4.6 Number of children at first use of contraception Percent distribution of ever-married women by number of living children at the time of first use of contraception, according to current age, Tanzania 1991/92 Ntmaber of living children at time Never of first use of contraception Number Current used of age contraception 0 1 2 3 4+ Missing Total women 15-19 88.5 6.0 4.7 0.2 0.0 0.0 0.6 100.0 618 20-24 73.6 2.5 17.8 3.7 0.7 0.4 1.3 100.0 1409 25-29 72.3 1.3 12.2 8.3 3.6 1.3 1.0 100.0 1457 30-34 66.9 0.7 10.2 7.1 6.1 7.8 1.3 100.0 1117 35-39 70.7 1.1 6.8 4.7 5.4 10.6 0.7 100.0 976 40-44 73.1 0.8 2.8 3.8 3.7 15.0 0.8 100.0 709 45-49 78.5 0.1 2.6 2.0 3.8 12.0 1.0 100.0 692 Total 73.6 1.7 9.7 4.9 3.4 5.8 1.0 100.0 6977 Overall, only 2 percent of women used contraceptives before they had children. About 37 percent of women who had ever used contraceptives (10 percent of all ever-married women) started using contraceptives when they had one child, suggesting that they were interested in spacing their births. On the other end, about 22 percent of ever users of contraceptives (6 percent of all ever-married women) used contraceptives for the first time when they had at least 4 living children, suggesting that they were interested in limiting family size. When we take into consideration the age of respondents at interview a very interesting pattem can be observed. Among ever users of contraceptives, over half (52 percent) of women below 20 years of age started using contraceptives before they had any living child, while 67 percent of women between 20-24 years started using contraceptives when they had only one child. Among women age 40-49 who reported to have ever used contraceptives, 56 percent had at least 4 living children at the time they started using contraceptives. These results suggests that the major motivation for starting to use contraceptives was prevention of unwanted pregnancies for those below 20 years of age; spacing of births for those between 20-29 years; and limiting family size for those at40 years and above. Thus, they reflect a possible increasing tendency of using family planning methods for prevention of unwanted pregnancies and child spacing rather than of family size limitation. 4.5 Knowledge of the Fertile Period The time between two menstrual bleedings is commonly referred to as a menstrual cycle. Women's ability to conceive tends to vary within the menstrual cycle. Generally, women are said to be "fertile" for a brief period of time at mid-cycle, and relatively "infertile" for the rest of the cycle. Knowledge of this fact is obviously important for successful practice of coital-related methods and periodic abstinence or the rhythm 39 method. To assess this knowledge, women were asked to identify the time within the menstrual cycle when a woman is most likely to conceive. Table 4.7 presents the percent distribution of all women and those who have ever used periodic abstinence by reported knowledge of the fertile period. Of all women interviewed, 42 percent reported that they did not know when a woman is most likely to conceive, and 20 percent said that a woman is most likely to conceive just after her period has ended. Only 13 percent gave the correct response -- that a woman was most likely to conceive in the middle of her menstrual cycle. Ever users of periodic abstinence were more likely to know the time in the cycle when a woman was expected to conceive. Of 598 women who had ever used periodic abstinence, 31 percent correctly identified the mid-cycle as the fertile period, and only 12 percent said they did not know. In general, knowledge of the fertile period was very low, since more than half of all women and those who have ever used periodic abstinence gave wrong answers or reporting that they did not know when a woman was most likely to conceive. Table 4.7 Knowledge of fertile period Percent dgtst~ibution of all women and of women who have ever used periodic abstinence by knowledge of the fertile period during the ovulatory cycle, Tanzania 1991/92 Ever u~ers Perceived All of periodic fertile period women abstinence During menstraal period 0.6 0.6 Right after period has ended 19.5 27.8 In the middle of the cycle 13.0 31.1 Just before period begins 5.7 11.6 Other 0.1 0.3 No particular time 18.2 15.9 Don't know 42.1 12.1 Missing 0.9 0.6 Total 100.0 100.0 Number 9238 598 4.6 Sources for Family Planning Methods All current users of modem contraceptive methods were asked to report the source from which they most recently obtained their methods. Interviewers were instructed to write the name of the source, which was later verified and coded by the supervisors and field editors. The reported sources of contraceptive supplies are summarized in Table 4.8. Public (govemment) facilities were reported by the majority (73 percent) of modem contraceptive users as the source of their most recent contraceptive supplies. Eighteen percent reported obtaining contraceptives from private medical facilities, while only 4 percent obtained their supplies from other private outlets such as shops or friends and relatives. The most common sources of methods were dispensaries for public (government) sector and religious organisation health facilities and private shops for the private sector. 40 Several factors may influence a woman to select a certain facility as a source of contraceptive supplies. One of these factors may be the type of method chosen. Table 4.8 shows the most recent source of supply by the method used by current users of modem contraceptive methods. The majority of users of the pill, IUD, and condom and all users of injectables obtained their supplies from public (govemment) facilities. Among 134 women reporting to have been sterilized, half were performed in public (government) facilities, and one-third were done in a private medical facility. The sources of modem contraceptive methods are summarized in Figure 4.3. Table 4.8 Source of supply for modem contraceptive methods Percent distribution of current users of modem contraceptive methods by most recent source of supply, according to specific methods, Tanzania 1991192 Female In jet- sterill- Source of supply Pill IUD tion Condom sadon Total Public sector 86.3 (74.6) (100.0) 54.3 49.4 72.9 Consultant hospital 0.7 (7.0) (9.2) 2.2 12.3 4.5 Regional hospital 6.6 (21.5) (10.3) 4.3 10.2 8.2 District hospitul 18.8 (7.2) (38.1) 12.0 25.6 19.9 Health centre 21.5 (30.3) (16.3) 10.1 0.0 14.9 Dispensary 37.4 (8.6) (21.5) 24.3 0.0 23.9 Parastatal health facility 1.4 (0.0) (4.7) 0.0 1.4 1.3 Village health post/Worker 0.0 (0.0) (0.0) 1.4 0.0 0.2 Medical private sector 9.2 (25.4) (0.0) 18.0 36.3 17.8 Religious org. facility 6.1 (25.4) (0.0) 6.4 33.4 14.0 Private doctor/Hospital/Clinic 0.9 (0.0) (0.0) 4.0 2.8 1.7 Pharmacy/Medical store 2.0 (0.0) (0.0) 7.5 0.0 2.0 UMATI CBD worker 0.1 (0.0) (0.0) 0.0 0.0 0.1 Other private sector 2.4 (0.0) (0.0) 23.1 0.0 4.1 Shop 0.3 (0.0) (0.0) 21.3 0.0 2.8 Friends, relatives 2.1 (0.0) (0.0) 1.9 0.0 1.3 Other 0.0 (0.0) (0.0) 0.5 0.5 0.2 Don't know 0.0 (0.0) (0.0) 4.1 0.0 0.5 Missing 2.1 (0.0) (0.0) 0.0 13.8 4.5 Total 100.0 100.0 100.0 100.0 100.0 100.0 Number 279 31 29 69 134 545 UMATI = Family Planning Association of Tanzania 41 Figure 4.3 Distribution of Current Users by Source of Contraceptive Supply Mission Facility 14% Pharmacy/Shop Other 5'~ Don't Know/Missing 5% " 1 Centre 15% Dispensary 24% Government Hospital 33% TDHS 1991/92 Other factors that may influence a woman to select a certain source of supplies is the distance from home to the facility. To assess the distance involved, current users of modem contraceptive methods were asked how long it takes to travel from their home to the place where they obtain the method. Nonusers were asked if they knew a place where they could obtain a modem method and, i f so, how long it would take to travel there. The results are shown in Table 4.9. Table 4.9 Time to source of supply for modem contraceptive methods Percent distribution of women who are currently using a modem contraceptive method, of women who are not using a modem method, and of women who know a method, by time to reach a source of supply, according to urban/rural residence, Tanzania 1991/92 Women who are currently using a modem method Women who are not using a modem method Women who know a eontxaceptive method Minutes to source Urban Rural Total Urban Rural Total Urban Rural Total 0-14 16.7 10.4 13.4 10.2 3.8 5.3 12.3 5.4 7.4 15-29 22.5 6.9 14.4 11.4 3.1 5.0 14.4 4.5 7.3 30-59 22.1 14.1 18.0 22.7 8.7 12.0 25.8 12.4 16.3 60 or more 31.2 61.6 47.0 22.3 34.0 31.2 26.3 47.7 41.5 Does not know time 1.4 1.9 1.6 0.5 0.6 0.6 0.6 0.9 0.8 Does not know source 0.7 0.3 0.5 31.8 49.1 45.0 19.0 27.8 25.3 Not stated 5.4 4.8 5.1 1.1 0.7 0.8 1.7 1.2 1.4 Total 100.0 100.0 10O.0 100.0 100.0 100.0 100.0 100.0 100.0 Number of women 262 282 545 2032 6661 8693 1991 4885 6876 42 Among women currently using modem contraceptive methods, 28 percent reported living less than 30 minutes from the source of contraceptives, while 18 percent took 30 minutes to one hour to reach the source of contraceptives. Almost half (47 percent) of current users reported taking one hour or more to reach the source. As expected, women in rural areas were more likely to live farther from their source of contraceptives than their urban counterparts. Among women who are not currently using modem contraceptive methods, 45 percent did not know a source for contraceptive methods. This finding may be due to the fact that all women were asked this question, including those who do not know any method. However, even among those women who knew a family planning method, 25 percent said they did not know a place to get modem methods. 1 This suggests that lack of knowledge of a source of contraceptive supply is not necessarily due to not knowing about family planning methods. Among those who knew a source of contraceptives, the time to a source of contraceptives was similar in users and nonusers in urban and rural areas. For instance, the proportion more than 60 minutes away from the source is highest among rural women who use (62 percent), followed by women who know a method (48 percent) and non-users (34 percent). These findings partly suggest that travel time to the source of contraceptive supply may not be an important determinant of contraceptive use in urban and rural areas. However, the large proportion of non-users who do not know a source complicates the picture: these may be women who live far from a source. In that case, travel time is an important determinant of use. 4.7 Intention to use Family Planning Among Nonusers Currently married women who were not using contraceptive methods at the time of survey were asked if they intended to use family planning methods in future. The results are presented in Table 4.10. Over half of women (56 percent) said they did not intend to use family planning methods in the future, whereas 17 percent were not sure. In general, women with no living children were more likely to report that they do not intend to use family planning methods. Nineteen percent of nonusers said they were intending to use family planning methods within 12 months, 7 percent said they intended to use after 12 months, and about 2 percent indicated their intention to use contraceptives in the future, although they were not sure of the timing. Thus, the majority of women intending to use family planning methods in the future reported that they were planning to do so within the next 12 months. These results are not entirely consistent with the results presented in Table 4.1, where, based on a different question, it was shown that 89 percent of women who know a method know a source. No explanation for this difference can be given. 43 Table 4.10 Future use of contraception Percent dis~butlon of currently married women who a~ not using a contraceptive method by past experience with contraception and intention to use in the future, according to number of living children, Tanzania 1991/92 Past experience with contraception and future intentions Number of living children I 0 1 2 3 4+ Total Never used contraception Intends to use in next 12 months 2.3 10.6 11.5 13.0 14,0 11,9 Intends to use later 5.2 5.6 6.5 3.8 2,9 4.3 Unsure as to liming 0.9 0.8 1.2 1.2 1.0 1.0 Unsure as to intention 17.3 19.7 18.5 12.7 12,3 15.1 Does not intend to use 68.8 51.8 46.6 48.3 48,5 50,5 Missing 0.0 0.3 0.3 0.0 0.3 0,2 Previously used contraception Intends to use in next 12 months 0.6 3.5 8,2 10,1 8.3 7.1 Intends to use later 1.2 2.4 1.8 2.4 2.7 2.3 Unsure as to timing 0.0 0.0 0.3 2.1 0.6 0.6 Unsure as to intention 1.2 2.0 0.7 1.5 1.7 1.5 Does not intend to use 2,4 3.1 4.3 4.8 7.6 5.5 Missing 0.0 0.0 0.0 0.1 0.1 0.1 Total 100.0 100.0 100.0 100,0 100.0 100.0 All currently married nonusers Intends to use in next 12 months 2.9 14.1 19.7 23.2 22.4 19.0 Intends to use later 6.4 8.0 8.3 6.2 5.6 6.6 Unsure as to timin~ 0.9 0.8 1.5 3.2 1.6 1.6 Unsure as to intenlaon 18.4 21.7 19.2 14.1 13.9 16.5 Does not intend to use 71,3 54.9 51.0 53.1 56.2 55.9 Missing 0,0 0,3 0.3 0.2 0.4 0.3 Total 100.0 100.0 100.0 100.0 100.0 100,0 Number of women 461 927 897 796 2327 5409 1Includes cun-ent pregnancy Women who said they do not intend to use family planning methods were asked to give their reasons for nonuse. Out of the 3025 respondents, 36 percent said they do not intend to use family planning methods in the future because they want children (see Table 4.11). Other reasons given were difficulty in conceiving (12 percent), infecundity (post-menopausal/had hysterectomy) (11 percent), lack of knowledge of methods (9 percent), and opposition to family planning (8 percent). Women below 30 years of age were more likely to report that they do not intend to use contraceptives because they want children, whereas those age 30 years or more were more likely to say that they were infecund or menopausal and therefore no longer at risk of getting pregnant. Nonusers who indicated their willingness to use family planning methods in the future were asked to mention the method they preferred to use. A majority of these women (53 percent) said they preferred to use pills (see Table 4.12). Other preferred methods were injections (12 percent), female sterilization (9 percent), and IUD (5 percent). Women who intend to use in the next 12 months have similar method preference as women who intend to use after 12 months. However, women who were not sure of the timing of future use were more likely to prefer the withdrawal method. 44 Table 4.11 Reasons for not using contraception Percent distribution of women who are not using a contraceptive method and who do not intend to use in the future by main reason for not using, according to age, Tanzania 1991/92 Age Reason for not using contraception <30 30+ Total Wants children 52.2 23.9 36.4 Lack of knowledge 10.8 7.6 9.0 Partner opposed 4.1 2.4 3.1 Costs too much 0.0 0.1 0.1 Side effects 3.6 3.1 3.4 Health concerns 0.8 1.9 1.4 Hard to get methods 2.5 1,8 2.1 Religion 0.5 0.6 0.5 FOPpeSod to family planning 7.7 7.6 7.7 atalistic 3.8 6.2 5.2 Other people opposed 0.1 0.2 0.1 Infrequent sex 1.3 2.1 1.8 Difficult to be pregnant 4.7 17.8 12.0 Menopausal, had hysterectomy 0.0 20.2 11.3 Inconvenient 1.1 1.3 1.2 Not married 0.4 0.4 0.4 Other 0.6 0.7 0.7 Don't know 5.5 2.0 3.5 Missing 0.1 0.1 0.1 Total 100.0 100.0 100.0 Number 1331 1694 3025 Table 4.12 Preferred method of eontracoption for future use Percent distribution of currently married women who are not using a contraceptive method but who intend to use in the future by preferred method, according to whether they intend to use in the next 12 months or later, Tanzania 1991/92 Intend to use In next After Unsure Preferred method 12 12 as to of contraception months months timing Total 1 Pill 53.1 54,3 54.5 53.4 IUD 5.6 3,3 0.0 4.7 Injection 13.7 10,2 3.6 12.2 Diaphragm/Foam/Jelly 1.0 2.1 0.0 1.2 Condom 1.5 1,2 0.0 1.4 Female sterilisation 8.9 7,0 9.6 8.5 Male sterilisation 0.2 0,4 0.0 0.3 Periodic absfinenco 3.5 4.0 5.8 3.8 Mucus method 0.2 0.3 0.0 0.2 Withdrawal 1.6 2.0 12.5 2.4 Other 3.4 5.6 6.2 4.1 Missing 7.3 9.4 7.8 8.0 Total 100.0 100.0 100.0 100.0 Number 1026 359 88 1475 1Includes 3 missing cases 45 4.8 Approval of Family Planning Radio and television are the major potential sources of information about family planning. To assess the effectiveness of such messages, all respondents were asked if they had heard a message about family planning on radio or television in the month preceding the survey. A large majority of respondents (76 percent) said they bad not heard any message, whereas only 23 percent reported that they did (see Table 4.13). Women in Zanzibar were more likely to have heard family planning messages on radio and television than their counterparts on the mainland. It should be noted that although the question was asked for both radio and television for the mainland, radio is the only source of information, since no public television system is in place there. This may account for the differences observed between Zanzibar and the Tanzania mainland. Table 4.13 Family pbmning messages on radio and television Percent distribution of all women by whether they have heard a family planning message on radio or on television in the month preceding the suiwey, according to selected background characteristics, Tmazania 1991/92 Heard family planning message on radio or on television Background Radio Television characteristic Neither only only Both Missing Total Number Residence Mainland 77.5 21.5 0.3 0.3 0.4 100.0 8978 Dares Salaam 43.8 53.1 0.9 2.2 0.0 100.0 585 Other urban 62.4 36.8 0.4 0.4 0.0 100.0 1686 Rural 84.2 14.9 0.3 0.2 0.5 100.0 6707 Zanzibar 33.0 55.4 0.4 11.0 0.2 100.0 260 Region Dodoma 84.7 14.5 0.5 0.0 0.3 100.0 649 Arusha 63.9 35.7 0.0 0.3 0.1 100.0 573 Kilimanjaro 73.0 26.5 0.4 0.2 0.0 100.0 516 Tanga 86.2 12.5 0.0 0.4 0.9 100.0 471 Morogoro 76.7 22.6 0.5 0.1 0.1 100.0 512 Coast 65.4 32.9 1.0 0.8 0.0 100.0 159 Lindi 86.3 13.7 0.0 0.0 0.0 100.0 217 Mtwara 93.3 6.7 0.0 0.0 0.0 100.0 363 Ruvuma 91.2 8.6 0.2 0.0 0.0 100.0 320 Iringa 77.9 19.6 0.0 0.3 2.3 100.0 475 Mbeya 79.9 19.4 0.0 0.2 0.4 100.0 449 Singida 80.3 19.2 0.5 0.0 0.0 100.0 355 Tabora 83.8 15.5 0.2 0.2 0.3 100.0 271 Rukwa 78.3 21.1 0.2 0.2 0.2 100.0 217 Kigoma 74.6 25.3 0.0 0.2 0.0 100.0 375 Shinyanga 88.5 10.8 0.0 0.0 0.7 100.0 793 Kagera 78.0 19.0 1.4 0.9 0.7 100.0 608 Mwanza 77.0 22.1 0.5 0.2 0.2 100.0 666 Mara 75.6 24.0 0.0 0.3 0.1 100.0 403 Education No education 86.7 12.2 0.2 0.2 0.6 100.0 3128 Primary incomplete 77.8 21.3 0.1 0.4 0.4 100.0 1825 Completed primary 70.3 28.5 0.4 0.6 0.2 100.0 3841 Secondary/Higher 46.4 46.6 1.7 5.0 0.2 100.0 444 Total 76.2 22.4 0.3 0.6 0.4 100.0 9238 On the Tanzania mainland, radio messages on family planning were more likely to have been heard by women in urban areas than those in rural areas and the proportion varied widely across regions. Over half of respondents in Zanzibar (67 percent) and Dares Salaam (56 percent) have heard family planning messages 46 on radio compared to less than 12 percent of respondents in Mtwara, Ruvuma, and Shinyanga. More educated women were also more likely to have heard a family planning message on radio or television than their less educated counterparts. Women were asked whether they thought it was acceptable or not acceptable for family planning information to be provided on radio or television. Overall, a majority of women interviewed (71 percent) reported that it was acceptable to use radio or television for family planning information (Table 4.14). Table 4.14 Acceptability of the use of mass media for disseminating family planning messages Percentage of women who believe that it is acceptable to have messages about family planning on radio or television, by selected background characteristics, Tanzania 1991/92 Not Background Accept- accept- characteristic able able Missing Total Number A15.19ge 57.9 13.5 28.7 100.0 2183 20-24 79.4 10.2 10.4 100.0 1882 25-29 77.4 11.2 11.3 100.0 1599 30-34 79.7 11.2 9.1 100.0 1165 35-39 68.9 17.7 13.4 100.0 1000 40-44 67.7 16.7 15.7 100.0 715 45-49 60.4 15.4 24.2 100.0 695 Residence Mainland 70.5 12.7 16.8 100.0 8978 Dares Salaam 79.4 15.9 4.7 100.0 585 Other urban 82.1 8.4 9.5 100.0 1686 Rural 66.8 13.4 19.7 100.0 6707 Zanzibar 71.2 24.3 4.6 100.0 260 Region Dodoma 73.7 13.8 12.5 100.0 649 Arusha 77.3 11.1 11.6 100.0 573 Kilimanj axo 84.6 4.6 10.8 100.0 516 Tanga 78.5 6.8 14.7 100.0 471 Morogoro 73.8 13.4 12.9 100.0 512 Coast 61.7 28.2 10.0 100.0 159 Lindi 74.2 14.1 11.7 100.0 217 Mtwara 56.4 13.8 29.8 100.0 363 Ruvuma 69.4 15.6 15.0 100.0 320 Iringa 55.8 15.4 28.8 100.0 475 Mbeya 62.7 7.9 29.4 100.0 449 Singida 69.7 10.8 19.5 100.0 355 Tabora 75.1 9.4 15.5 100.0 271 Rukwa 51.9 11.3 36.8 100.0 217 Kigoma 68.3 15.0 16.7 100.0 375 Shinyanga 66.6 10.2 23.3 100.0 793 Kagera 71.5 15.7 12.8 100.0 608 Mwanza 69.3 13.4 17.2 100.0 666 Mara 70.1 17.9 12.0 100.0 403 Education No education 57.0 19.3 23.6 100.0 3128 Some primary 70.8 11.6 17.6 100.0 1825 Completed primary 79.3 9.3 11.4 100.0 3841 Secondary/Higher 88.5 5.7 5.7 100.0 444 Total 70.5 13.0 16.5 100.0 9238 47 Acceptability of radio and television as a source of information was relatively low among women below 20 years and above 44 years, while the proportion of women reporting these channels to be unacceptable was relatively higher among women above 34 years of age. Women in Zanzibar were twice as likely as their counterparts in Tanzania mainland to say that radio and television were unacceptable media for family planning information. Within the Tanzania mainland, women in Dares Salaam and rural areas were more likely to report that radio and television were unacceptable than women in other urban areas. Acceptability of radio and television for dissemination of family planning messages varied across regions. Less than 10 percent of women in Kilimanjaro, Tanga, Mbeya, and Tabora reported that radio and television were unacceptable for dissemination of family planning messages, compared to more than twenty percent of women in Coast and Zanzibar. More educated women were much more likely to accept family planning messages on radio or television than less educated women. TO assess the acceptability of family planning among married women who know family planning methods, the TDHS included a question about the extent to which couples discuss the topic with each other. Table 4.15 indicates that 56 percent of respondents had not discussed family planning with their husbands during the previous year. Among those who have discussed family planning with their husbands, most had discussed the topic only once or twice. Women below 20 years of age and those above 39 years of age were more likely not to have discussed family planning with their husbands than their counterparts age 20-39 years. Table 4.15 Discussion of family planning by couples Percent distribution of currently married women who know a contraceptive method by the number of times family planning was discussed with husband in the year preceding the survey, eccording to current age, Tanzania 1991/92 Number of times family planning discussed Number Three Once or or more Don't know/ of Age Never twice times Missing Total women 15-19 66.1 26.2 7.3 0.3 100.0 396 20-24 51.1 29.3 19.4 0.2 100.0 1040 25-29 52.9 28.2 18.6 0.3 100.0 1073 30-34 49.0 29.0 21.8 0.2 100.0 788 35-39 58.1 19.9 21.2 0.8 100.0 637 40-44 61.3 22.5 16.1 0.0 100.0 453 45-49 72.9 13.4 13.2 0.5 100.0 358 Total 56.0 25.6 18.1 0.3 100.0 4746 TO obtain more direct information about the acceptability of family planning, respondents were asked if they approved or disapproved of couples using family planning methods. Although all women were asked this question, the data presented here are restricted to currently married women and exclude those women who had never heard of a contraceptive method. Currently married women were also asked if they thought that their husbands approved of the use of family planning. The results are shown in Table 4.16. 48 Table 4.16 Attitudes of couples toward family planning Among curranfly married non-stefilised women who know a contraceptive method, the percentage who approve of family planning, by their perception of their husband's attitude and selected background characteristics, Tanzania 1991/92 Respondent Respondent approves disapproves Unsure Unsure Number Background Both Husband of Husband of Both of characteristic approve disapproves husband approves husband disapprove Missing Total women Age 15-19 35.5 15.2 30.9 0.7 6.4 10.7 0.5 100.0 396 20-24 50.0 11.6 25.7 1.2 4.9 6.2 0.4 100.0 1040 25-29 45.1 19.0 21.2 1.7 6.1 6.8 0.1 100.0 1073 30-34 46.2 18.6 21.7 1.4 5.3 6.6 0.1 100.0 788 35-39 42.2 17.8 21.4 1.4 7.6 8.8 0.8 100.0 637 40~14 37.0 21.0 23.6 1.2 9.5 7.7 0.0 100.0 453 45-49 34.3 16.2 29.9 1.1 9.9 7.8 0.8 100.0 358 Residence Mainland 44.2 16.2 24.5 1.3 6.4 7.0 0.4 10O.0 4587 Dar as Salaam 60.1 13.5 17.2 1.5 1.7 6.0 0.0 100.0 313 Other urban 59.1 18.6 14.3 0.9 2.9 4.1 0.1 100.0 895 Rural 38.8 15.9 27.8 1.4 7.8 7.8 0.4 100.0 3379 Zanzibar 26.1 32.8 11.1 1.7 9.7 18.4 0.3 100.0 159 Region Dodoma 43.5 19.6 23.9 0.0 9.1 3.8 0.2 100.0 422 Arusha 56.8 18.8 11.3 1.8 5.3 6.0 0.0 100.0 237 Killmanjaro 73.5 12.1 13.0 0.0 0.4 1.0 0.0 100.0 223 Tanga 56.4 17.5 22.4 0.0 3.2 0.5 0.0 100.0 213 Morogoro 49.9 18.9 16.6 1.0 4.3 8.4 0.9 100.0 312 Coast 39.6 20.2 15.3 3.3 8.2 12.9 0.5 100.0 89 Lindi 34.7 17.4 21.0 3.5 6.2 16.4 0.8 100.0 141 Mtwara 21.8 9.0 38.8 3.7 12.4 13.3 1.0 100.0 202 Ruvuma 30.5 23.5 24.7 1.3 7.7 12.2 0.2 100.0 187 Iringa 43.3 20.4 14.2 4.4 4.8 11.8 1.1 100.0 233 Mbeya 43.5 16.1 31.2 1.1 4.1 4.0 0.0 100.0 247 Singida 46.3 17.4 29.9 0.5 2.8 3.2 0.0 100.0 162 Tabura 36.8 11.2 39.5 0.4 7.8 4.0 0.3 100.0 132 Rukwa 49.8 10.4 26.0 0.3 6.9 5.2 1.4 100.0 77 Kigoma 54.5 9.8 20.7 1.2 9.6 4.2 0.0 100.0 179 Shinyanga 23.4 10.9 46.5 2.0 10.5 6.6 0.0 100.0 350 Kagera 52.9 8.1 20.8 0.4 8.3 8,6 0.9 I00.0 274 Mwanza 28.1 20.9 33.6 0.2 9.6 7.5 0.0 I00.0 345 Mara 41.4 24.1 16.5 2.0 4.5 10.5 0.9 100.0 246 Education No education 27.4 18.3 29.7 1.6 11.3 11.2 0.4 100.0 1699 Primary incomplete 41,8 21,9 21.1 0,9 5.6 8.1 0,5 I00,0 956 Completed primary 56.1 13.4 21.6 1.3 3.2 4.1 0.2 100.0 1948 Secondary/Higher 76.7 11.1 7.5 0.3 2.0 2.4 0.0 100.0 142 Total 43.6 16.8 24.0 1.3 6.6 7.4 0.3 I00.0 4746 49 Overall, 84 percent of married women who know of a method approve of couples using family planning methods. Half of these women (44 percent) reported that their husbands also approved of family planning. However, about 17 percent of women said that they appmve of family planning but their husbands do not. Seven percent of the respondents said that both they and their husbands disapproved of family planning. Only 1 percent of respondents reported that they disapproved of family planning, but their husbands approved. Women in Zanzibar were more likely than women in the mainland to disapprove of family planning methods, as were their spouses. Husbands of respondents approving family planning methods in Zanzibar were more likely to disapprove family planning than those in other parts of Tanzania. Approval of family planning methods by both respondents and husbands was found to increase with increasing women's education, while disapproval of family planning methods was found to decrease with increasing education. These findings underscore the importance of education in changing women's attitudes towards use of family planning methods. 50 CHAPTER 5 PROXIMATE DETERMINANTS OF FERTILITY This chapter concerns the principal factors other than contraception that affect a woman's risk of becoming pregnant, namely nuptiality and sexual intercourse, postpartum amenorrhoea and abstinence from sexual relations, and secondary infertility. Marriage is the primary indicator of exposure of women to the risk of pregnancy and therefore is important for the understanding of fertility. Populations in which age at marriage is low tend to experience early childbearing and subsequently high fertility. This situation necessitates an examination of trends in age at marriage. This chapter also includes more direct measures of the beginning of exposure to pregnancy and the level of exposure: age at first sexual intercourse and the frequency of intercourse. Measures of other proximate determinants of fertility are the durations of postpartum amenorrhoea and postpartum abstinence and the level of secondary fertility. 5.1 Marital Status The demographic significance of marriage patterns derives from the fact that formal or informal unions am primary indicators of exposure to the risk of pregnancy. Current marital status of eligible women at the time of the survey is shown in Table 5.1. Here, "marriage" refers to civil, religious, or traditional marriage, as well as "living together." Divorced (including separated) and widowed make up the remainder of the "ever married" category. Table 5.1 Current marital status by age Percent distribution of women by current marital status, according to age, Tanzania 1991/92 Marital status Number Never Living of Age married Married together Widowed Divorced Total women 15-19 71.8 21.2 4.3 0.2 2.6 100.0 2180 20-24 25.1 55.9 12.2 0.7 6.0 100.0 1880 25-29 8.9 58.0 21.6 1.8 9.7 t00.0 1597 30-34 4.1 55.7 24.6 4.2 11.4 100.0 1165 35-39 2.4 55.7 28.4 5.0 8.5 100.0 1000 40-44 0.9 53.8 30.5 6.8 8.1 100.0 714 45-49 0.4 49.4 29.0 10.4 10.7 100.0 695 Total 24.5 47.4 18.0 2.9 7.3 100.0 9233 About 65 percent of the eligible women are currently married. This is virtually the same proportion as observed in the 1988 population census (66 percent currently married). As expected, most of the single (never married) women are in the young age groups, that is below 25 years. 51 5.2 Polygyny According to Table 5.2, polygyny is fairly common in Tanzania: slightly more than one in four currently married women said their husbands had other wives (28 percent). Twenty-nine percent of rural currently married women have co-wives compared to 12 percent in Dares Salaam. Polygynous unions exist in all the regions and among women of different education. Mara and Shinyanga regions have the highest percentages of married women in polygynous union, and Kilimanjaro and Dares Salaam the smallest. More than one-third of women with no education are in polygynous unions compared to 14 percent of those with secondary or higher education. Table 5.2 Polygyny Percentage of currently married women in a polygynous union, by age end selected background characteristics, Tanzania 1991/92 Age of women Background All characteristic 15-19 20-24 25-29 30-34 35-39 40-44 45-49 ages Residence Mainland 16.6 18.0 27.2 30.7 33.8 36.1 37.2 27.5 Dares Salaam (0.0) 6.2 13.3 (11.2) (23.3) (23.2) * 12.4 Other urban 6.5 15.6 21.9 28.9 31.0 37.6 35.8 24.1 Rural 20.4 19.6 29.4 32.7 35.1 36.7 38.0 29.4 Zanzibar (19.9) 16.3 25.6 (25.8) (31.9) (36.6) (27.8) 25.2 Region Dodoma * (15.5) (15.4) (13.0) (16.5) * * 18.8 Arusha * 19.4 27.8 (33.3) (33.0) (42.1) * 31.1 Kilimanjaro * (2.1) (10.6) (10.9) (17.0) (29.4) (6.1) 12.2 Tanga * 13.6 (18.1) (42.6) (34.4) (33.2) (48.4) 28.5 Morogoro (4.8) 12.5 21.3 (27.5) 31.9 (27.4) (34.3) 22.5 Coast (12.8) 12.0 23.6 32.1 31.0 * (20.4) 22.3 Lindi (6.6) (15.0) (8.7) (33.8) (49.1) (65.1) (49.6) 33.1 Mtwara (14.5) (15.0) (15.6) (21.2) (42.2) (42.4) (38.5) 26.5 Ruvuma (26.6) 14.5 34.6 (27.4) (35.6) (31.4) (42.0) 29.8 Iringa * 17.7 38.0 37.3 (53.8) (36.4) (34.3) 34.8 Mbeya * 11.8 (26.5) (45.1) (31.1) (45.7) * 26.6 Singida * 16.3 (29.8) (36.0) (42.4) * * 28.2 Tabora (14.2) (22.5) 32.1 (18.1) (35.5) (22.5) (26.9) 25.2 Rukwa (14.6) 15.2 33.8 21.9 (31.7) (28.0) * 23.3 Kigoma (8.9) 11.6 25.0 34.0 (36.4) (69.1) (47.1) 30.2 Shinyanga 22.2 35.9 41.0 44.9 36.7 (36.8) (51.9) 38.0 Kagera (8.7) 19.2 19.0 (12.4) (29.1) (25.0) (26.1) 19.7 Mwanza 12.1 22.0 33.5 42.8 (37.0) (36.4) (45.4) 31.2 Mara 42.2 29.8 52.4 52.9 56.9 (62.2) * 48.9 Education No education 20.0 27.4 36.4 36.3 34.7 40.8 39.8 35.4 Some primary 18.3 22.3 25.7 27.2 33.4 31.7 29.9 27.5 Completed primary 14.8 14.4 23.3 24.3 31.0 24.4 24.1 19.4 Some secondary * (8.0) (4.1) (25.4) * * * 14.2 Total 16.7 17.9 27.1 30.6 33.8 36.2 37.0 27.5 Note: Rates shown in parentheses are based on 25-49 women, whereas an asterisk means the rate is based on fewer than 25 women and has been suppressed. 52 Table 5.3 shows that 73 percent of currently married women have no other co-wives while 16 percent have one co-wife, and 11 percent have two or more co-wives. Mara, Kigoma, and Zanzibar have the highest proportion of currently married women with more than one co-wife. Not only is polygyny more common among less educated women, but the propensity for those in polygynous unions to have more than one co- wife is more common among less educated women. Table 5,3 Number of co-wives Percent distribution of currently married women by number of co-wives, according to selected background characteristics, Tartzania 1991D2 Number of co-wives Number Background of characteristic 0 1 2+ Missing Total women A15_19ge 83.3 11.0 5.5 0.2 100.0 558 20-24 82.1 10.6 6,3 1.0 100.0 1283 25-29 72.9 17.6 9.0 0.5 100.0 1274 30-34 69.4 18.0 11.7 0.9 100,0 935 35-39 66.2 17.2 15.9 0.6 100.0 841 40-44 63.8 19.7 16.2 0.3 100.0 603 45-49 63.0 19.9 16.5 0.5 100.0 545 Residence Mainland 72.5 16.2 10.8 0.6 100.0 5870 Dares Salaam 87.6 7.5 4.9 0.0 100.0 349 Other urban 75.9 15.9 7.3 0,8 100.0 966 Rural 70.6 16.9 11.9 0.6 100.0 4555 Zanzibar 74.8 7.8 16.0 1.4 100.0 168 Region Dodoma 81.2 15.6 3.2 0.0 100.0 445 Arusha 68.9 16.2 14.0 0.9 100.0 350 Kilimanjaro 87.8 9.1 2.8 0.4 100.0 258 Tanga 71.5 15.5 12.2 0.8 100.0 306 Morogoro 77.5 15,4 7.0 0.1 100.0 334 Coast 77.7 13.2 9.2 0.0 100.0 98 Lindi 66.9 23.1 10.0 0.0 100.0 155 Mtwara 73.5 18.4 8.1 0.0 100.0 249 Ruvuma 70.2 18.2 11.6 0,0 100.0 210 Iringa 65.2 17.5 14.1 3,2 100.0 338 Mbe~a 73.4 13.3 11.4 1,8 100.0 333 Singlda 71.8 18.7 9.2 0.3 100.0 190 Tabora 74.8 15.5 8.7 0.9 100.0 174 Rukwa 76.7 12.2 10.5 0.6 100.0 158 Ki~oma 69.8 13.2 16.3 0.6 100.0 245 Shmyanga 62.0 26.7 10.7 0.7 100.0 578 Kagera 80.3 6.9 12.1 0.6 100.0 371 Mwanza 68.8 18.4 12.8 0.0 100.0 444 Mara 51.1 22.2 26.5 0.3 10O.0 285 Education No education 64.6 19.1 15.7 0.6 100.0 2505 Primary incomplete 72.5 16.7 10.3 0.5 100.0 1166 Completed primary 80.6 12.5 6.2 0.7 100.0 2215 Secondary/Higher 85.8 9,0 4.8 0.4 100.0 152 Total 72.5 16.0 10.9 0.6 100.0 6038 53 5.3 Age at FirstMarriage According to the 1971 Marriage Act, the minimum legal age for a woman to get married is 18 years. The TDHS results show that the median age at first marriage is about 18 years (see Table 5.4). Age at marriage appears to be rising from about 17 years among women in their fourties, to 19 years among women in their twenties. Among women age 20-49, 15 percent were married by age 15, almost half by age 18 and two-thirds by age 20. Table 5.4 Age at first marriage Percentage of women who were first married by exact age 15, 18, 20, 22, and 25, and median age at first marriage, according to current age, Tanzania 1991192 Current age 15 18 20 22 Percentage of women who were Percentage Median first married by exact age: who had Number age at never of tin'st 25 married women marriage 15-19 3.7 NA NA NA NA 71.7 2183 a 20-24 7.2 36.6 61.0 NA NA 25.1 1882 19.0 25-29 10.9 39.7 59.1 74.0 85.9 8.9 1599 19.0 30-34 19.2 53.2 69.5 80.2 88.9 4.1 1165 17.7 35-39 19.0 55.0 74.3 83.7 91.3 2.4 1000 17.5 40-44 23.7 58.9 76.2 84.3 92.5 0.9 715 17.2 45-49 27.2 59.4 76.1 86.8 94.3 0.4 695 17.2 20-49 15.4 47.2 66.9 78.1 85.7 9.9 7055 18.3 25-49 18.3 51.0 69.0 80.4 89.7 4.3 5174 17.9 NA = Not applicable aOmitted because less than 50 percent of the women in the age group x to x+4 were first married by age x Table 5.5 shows that Zanzibar has a lower median age at first marriage (16 years) than that observed on the Mainland (18 years). Rural women are married slightly earlier than urban women. Differences by education are more pronounced. Women with secondary or higher education have the highest median age at first marriage (23 years), compared to women with completed primary education (20 years), and incomplete primary education and no education (17 years). 54 Table 5.5 Median age at first marriage Median age at first marriage among women age 20-49 years, by current age and selected background cheraetedstics, Tanzania 1991/92 Current age Women Women Background age age characteristic 20-24 25-29 30-34 35-39 40.44 45-49 20-49 25-49 Residence Mainland 19.1 19.0 17.7 17.6 17.2 17.2 18.3 18.0 Der es Salaam 19.6 19.5 17.6 17.8 16.8 15.8 18.9 18.3 Other urban a 20.2 17.4 18.0 17.5 18.2 19.0 18.4 Rural 18.7 18.7 17.8 17.5 17.1 17.1 18.1 17.8 Zanzibar 18.3 17.4 16.5 15.3 15.8 15.8 16.8 16.4 Education No education 17.0 16.7 16.6 16.9 16.5 16.7 16.7 16.7 Primary incomplete 17.8 18.1 16.5 17.1 17.4 17.9 17.5 17.4 Completed primary 19.4 20.1 19.5 19.6 19.9 18.3 19.6 19.9 Secondary/Higher a (23,0) (23.5) * * * a 23.0 Total 19.0 19.0 17.7 17.5 17.2 17.2 18.3 17.9 Note: Medians ere not shown for women 15-19 because less than 50 percent have married by age 15 in all subgroups shown in the table. Rates shown in parentheses are based on 25-49 women, whereas an asterisk means the rate is based on fewer than 25 women and has been suppressed. aOmitted because less than 50 percent of the women in the age group were first married by age 20. 55 5.4 Age at First Intercourse Though age at first marriage is widely used as a proxy for exposure to sexual intercourse, this is not useful in Tanzania because many women engage in sexual activities before they are married. As Table 5.6 shows, the median age at first intercourse (16.8 years) is one and a half years lower than the median age at first marriage (18.3 years, Table 5.5). By age 15, 23 percent of women had had sexual intercourse and by age 18, the legal age at marriage, 65 percent of women had had sexual intercourse, whereas only half had married by this age. By age 20, 83 percent of women had had sexual intercourse but only 67 percent were married. Table 5.6 also shows that there is a moderate increase of the age at first sexual intercourse from 16.4 years among women 30-49 years to 17.3 years among women 20-24 years. Table 5.6 Age at first sexual intercourse Percentage of women who had first sexual intercourse by exact age 15, 18, 20, 22, and 25, and median age at first intercourse, according to current age, Tanzania 1991/92 Cttrtent age 15 Percentage of women who had Percentage Median first intercourse by exact age: who Number age at never had of first 18 20 22 25 intercourse women intercourse 15-19 11.2 NA NA NA NA 48.7 2183 a 20-24 16.6 60.1 82.6 NA NA 8.4 1882 I7.3 25-29 19.3 59.8 79.5 89.4 94.7 1.5 1599 17.2 30-34 28.1 68.5 82.5 90.8 94.9 1.2 1165 16.4 35-39 25.5 70.0 86.3 93.2 96.6 0.4 1000 16.4 40~-4 27.3 71.1 86.0 92.2 96.1 0.2 715 16.3 4549 30.6 67.1 81.0 91.8 95.4 0.0 695 16.4 20~19 22.8 64.6 82.6 90.8 94.2 2.9 7055 16.8 25-49 25.1 66.3 82.6 91.1 95.4 0.8 5174 16.6 NA = Not applicable aOmitted because less than 50 percent of the women in the age group x to x+4 had had intercourse by age x Overall, women become sexually active at almost the same age regardless of the geographical area, though with minor differences (Table 5.7). However, the relationship between education and sexual activity is quite strong. The median age at first sexual intercourse among women with secondary or higher education is 20 years, 18 years among women who have completed primary education, and about 16 years for women with incomplete primary education or no education. 5.5 Recent Sexual Activity In a situation where contraception is not practiced, the probability of pregnancy is closely related to the frequency of sexual intercourse. Therefore, such information is very useful as a measure of exposure to pregnancy. Table 5.6 shows that all but 3 percent of women 20-49 in the TDHS had sexual intercourse. However, not all women who ever had sexual intercourse are currently sexually active. 56 Table 5.7 Median age at first intercourse Median age at first sexual intercourse among women age 20-49 years, by current age and selected background characteristics, Tanzania 1991/92 Current age Women Women Background age age characteristic 20-24 25-29 30-34 35-39 40-44 45-49 20-49 25-49 Residence Malnla_nd 17.3 17.2 16.4 16.4 16.3 16.4 16.8 16.6 Dares Salaam 17.8 17.7 16.9 (16.7) (16.4) (15.8) 17.2 16.8 Other urban 17.8 17.9 16.2 16.3 16.5 16.7 17.0 16.7 Rural 17.0 17.0 16.5 16.4 16.2 16.4 16.7 16.6 Zanzibar 18.3 17.3 16.6 (15.3) (15.8) (16.0) 16.8 16.4 Education No education Primary incomplete Completed primary Secondary/Higher 16.1 15.6 15.7 15.9 15.9 16.2 15.9 15.8 16.3 16.3 15.8 16.3 16.4 17.o 16.3 16.3 17.6 18.1 17.6 18.1 18.4 17.8 17.8 18.0 a 20.5 20.4 * * * a 20.4 Total 17.3 17.2 16.4 16.4 16.3 16.4 16.8 16.6 Note: Medians were not shown for women 15-19 because less than 50 percent had had intercourse by ago 15 in all subgroups shown in the table. Rates shown in parentheses are based on 25-49 women, whereas an asterisk means the rate is based on fewer than 25 women and has been suppressed. Table 5.8 shows the percent distribution of women who have ever had sexual intercourse by sexual activity in the four weeks prior to the survey and duration of abstinence by whether or not postpartum. Women are considered to be sexually active if they had sexual intercourse at least once in the four weeks prior to the survey. Women who are not sexually active may be abstaining for various reasons, such as having given birth. Overall, 61 percent of women were sexually active during the 4 weeks period before the survey, 18 percent were postpartum abstaining, and 21 percent were abstaining for reasons other than having recently given birth. The proportion of sexually active women varies very little by age of the woman. Women who have ever had sexual intercourse but have never been in union are also sexually active (43 percent), but less so than ever-married women. Twenty-two percent of single women who ever had sexual intercourse were postpartum abstaining and 35 percent were abstaining for other reasons. There appears to be no appreciable decline in the proportion of women sexually active according to duration since first marriage, except among those married for 25 years or more. Regional data show that sexual activity was highest in Mwanza, Zanzibar and Shinyanga (over 70 percent had intercourse in the last 4 weeks), and lowest in Iringa and Ruvuma (below 50 percent). The latter two regions had the highest proportion of women in the period of postpartum abstinence. The proportion sexually active decreases slightly with increasing levels of education. Women with secondary or higher education had markedly higher levels of abstinence for reasons other than giving birth. This may be due to the fact that the better educated women are more likely to be younger and single. As expected, women who are using a family planning method are more likely to be sexually active than those who are not using any method. Among users of a family planning method, the proportion of women sexually active varies according to the method used: the highest level of sexual activity was found among users of the pill. 57 Table 5.8 Recent sexual activity Percent distribution of women who have ever had sexual intercourse by sexual activity in the four weeks preceding the survey and the duration of abstinence by whether or not postpartum, according to selected background characteristics, Tanzania 1991/92 Not sexually active in last 4 weeks Sexually Abstaining Abstaining active (postpartum) (not postpartum) Number Background in last of characteristic 4 weeks 0-1 years 2+ years 0-1 years 2+ years Missing Total women Age of mother 15-19 57.8 18.1 0.9 21.7 1.5 0.0 100.0 1121 20-24 59.9 19.9 1.8 17.1 1.2 0.1 100.0 1724 25-29 61.2 20.8 2.5 14.3 1.1 0.1 100.0 1576 30-34 63.8 16.4 2.2 15.8 1.8 0.1 100.0 1151 35-39 63.3 13.6 2.7 18.2 2.0 0.3 100.0 997 40-44 64.7 8.3 1.6 18.6 6.6 0.1 100.0 714 45-49 56.8 3.7 2.2 22.2 14.5 0,6 100.0 695 Duration of union 0-4 64.6 20.5 0.7 13.8 0.4 0.0 100.0 1752 5-9 63.9 19.9 1.5 14.1 0.5 0.0 100.0 1409 10-14 65.0 18.4 1.3 14.4 0.9 0.0 100.0 986 15-19 62.5 13.7 2.6 18.7 2.3 0.1 100.0 975 20-24 65.4 12.5 2.1 16.2 3.0 0.8 100.0 809 25+ 60.0 5.7 1.9 20.2 12.1 0.2 100.0 1047 Never in union 42.8 16.8 4.9 30.5 4.7 0.2 100.0 1000 Residence Mainland 60.7 16.3 2.0 17.7 3.1 0.1 100.0 7776 Dares Salaam 69.3 12.2 1.2 13.4 3.9 0.0 100.0 500 Other urban 56.5 15.3 1.3 23.1 3.6 0.1 100.0 1451 Rural 61.0 16.9 2.3 16.8 2.9 0.2 100.0 5825 Zanzibar 73.3 6.6 0.2 16.8 2.5 0.7 100,0 202 Region Dodoma 56.4 20,7 L4 17.6 3.9 0.0 100.0 606 Arusha 51.2 24.6 3.8 17.4 2.5 0.5 100.0 507 Kilin~anjaro 58,0 11.3 2.9 22.7 5.1 0.0 100.0 371 Tanga 63.1 11.1 1.4 22.8 1.6 0.0 100.0 393 Morogoro 56.1 16.9 3.3 20.7 2.8 0.2 100.0 472 Coast 58.1 17.8 1.7 18.9 3.2 0.4 100.0 142 Lindi 51.0 25.1 2.7 18.5 2.8 0.0 100.0 205 Mtwara 59.4 21.7 2.4 14.8 1.7 0.0 100.0 335 Ruvuma 47.4 28.6 3.2 18.9 1.9 0.0 100.0 288 lringa 40.7 31.7 7.0 15.8 4.4 0.4 100.0 429 Mbeya 62.3 15.8 1.2 16.6 4.0 0.0 100.0 388 Singida 52.4 18.2 2.2 22.5 4.1 0.6 100.0 291 Tabora 60.3 16.0 1.7 20.1 1.9 0.0 100.0 247 Rukwa 60.0 20.8 1.0 16.8 1.4 0.0 100.0 196 Kigoma 65.0 10.3 2.2 18.2 4.3 0.0 100.0 289 Shinyanga 71,9 10.3 0.0 16.6 1.2 0.0 100.0 685 Kagera 67.2 8.3 1,4 17,2 5.7 0.2 100.0 480 Mwanza 74.8 9.0 0,6 14.2 1.5 0.0 100.0 596 Mara 66.4 10.9 0.9 17.7 3.5 0.5 100.0 356 Education No education 62.7 14.0 1.7 17.0 4.3 0.2 100.0 2991 Primary incomplete 63.6 13.8 2.4 16.6 3.6 0.1 100.0 1499 Completed primary 58.7 19.5 2.1 17.8 1.7 0.1 100.0 3209 Secondary/l ligher 55.1 10.5 1.0 30.6 2.8 0.0 100.0 278 Current contraceptive No method 59.5 17.4 2.1 17.6 3.2 0.1 100.0 7106 Pill 80.1 1.4 0.4 17.4 0.0 0.6 100.0 279 IUD (76.3) (0.0) (0.0) (23.7) (0.0) 0.0 100.0 31 Sterilisatlon 59.3 7.5 1.2 20.7 11.2 0.0 100.0 134 Periodic abstinence 63.1 7.4 1.3 26.2 2.0 0.0 100.0 152 Other 77.7 7.6 1.0 13.7 0.0 0.0 100.0 275 Total 61.0 16.1 2.0 17.7 3.1 0.1 100.0 7978 Note: Rates shown in paxenthese are based on 25-19 women. 58 5.6 Postpartum Amenorrhoea, Abstinence, and Insusceptibility For women who are not using contraception, exposure to the risk of pregnancy in the period following birth is influenced by two factors, namely breastfeeding and sexual abstinence. Breastfeeding can prolong postpartum protection from conception by lengthening the duration of amenorthoea (the period following a birth, but prior to return of menses) and by delaying the resumption of sexual relations. Table 5.9 shows the percentage of births whose mothers are postpartum amenorrhoeic, abstaining, and postpartum insusceptible by the number of months since birth. Women who are insusceptible are defined as those who are either amenorrhoeic or abstaining following a birth and, thus, are not exposed to the risk of pregnancy. The data refer to whether or not the woman was amenorrhoeic or abstaining at the time of the survey. Table 5.9 Postpartum amcnorrhoea) abstinenc% and insuscepfibflit), Percentage of births whose mothers are postp~tum amenorrhoeie, abstaining, and insusceptible, by number of months since birth, and median and mean durations, Tanzania 1991/92 Number Months Amanor- Insus- of since birth rhoeie Abstaining ceptible births < 2 97.0 91.8 100.0 242 2-3 85.5 72.1 91.6 283 4-5 86.1 53.4 90.8 337 6-7 68.0 49.3 80.3 289 8-9 71.4 46.6 80.3 276 10-11 61.4 30.6 69.4 287 12-13 54.2 30.5 61.1 306 14-15 45.4 28.4 55.7 296 16-17 33.6 24.0 46.6 304 18-19 26.8 24.5 36.9 291 20-21 21.9 18.8 31.3 252 22-23 15.9 15.9 24.6 299 24-25 9.7 12.8 21.4 268 26-27 5.4 7.9 11.5 256 28-29 1.6 4.3 5.9 292 30-31 4.1 5.3 9.5 266 32-33 3.9 2.4 5.5 279 34-35 2.5 3.8 5.5 230 Total 39.4 29.3 46.9 Median 13.3 6.5 15.6 Mean 14.2 10.7 16.8 Prevalence/Incidence mean 14.0 10.4 16.7 5051 About 8-9 months after giving birth, 71 percent of women in Tanzania remain amenorrhoeic, 47 percent are abstaining from sexual relations, and only 20 percent are susceptible to pregnancy. At 18-19 months postpartum, 27 percent remain amenorrhoeic, 25 percent are still abstaining and 63 percent are susceptible to pregnancy. At 24 months, only 10 percent are amenorrhoeic and 13 percent are still abstaining 59 from sexual relations, while 79 percent are susceptible to pregnancy. The median duration of postpartum amenorrhoea is 13.3 months and of postpartum sexual abstinence 6.5 months, resulting in a postpartum insusceptible period of 15.6 months. Table 5.10 shows the median durations of postpartum insusceptibility by background characteristics of the mothers. Older women have longer periods of insusceptibility mainly because they are amenorrhoeic for a longer period. Women in Dar-es-Salaam have very short periods of postpartum amenorrhoea (median 6 months), whereas women in Zanzibar practice postpartum abstinence only for a short period (3 months). Differences by education are small, except that women with more education have short durations of amenorrhoea. Table 5.10 Median duration of postpartum insusceptibility by background characteristics Median number of months of postpartum amenorrhoea, postpartum abstinence, and postpartum insusceptibility, by selected background characteristics, Tanz~mia 1991/92 Postpartum Number Background Postpartum Postpartum insuseep- of characteristic amenorrhoea abstinence tibility women Age <30 12,3 6.2 14.5 3271 30+ 15.4 7.1 17.3 1780 Residence Mainland 13.4 6.8 15.8 4906 Dares Salaam 6.1 7.1 9.5 226 Other urban 10.9 9.8 13.2 843 Rural 14.2 6.1 16.1 3837 Zanzibar 11.1 3.2 11.6 146 Education No education 14.3 5.9 17.5 1693 Primary incomplete 15.1 4.7 16.2 932 Completed primary 12.2 7.4 14.5 2271 Secondary/Higher 6.6 7.2 11.0 156 Total 13.3 6.5 15.6 5051 Note: Medians are based on current status. 5.7 Termination of Exposure to Pregnancy The onset of infertility with increasing age reduces the proportion of women who are exposed to the risk of pregnancy. Three measures of decreasing exposure--menopause, terminal infertility, and long-term abstinence--are shown in Table 5.11. For this analysis women are considered to be menopausal if they are neither pregnant nor postpartum amenorrhoeic, but have not had a menstrual period in the six months preceding the survey. The proportion of women who are menopausal rises with age, particularly after age 40, and reaches 38 percent in the oldest age group (48-49). 60 Table 5.11 Termination of exposure to the risk of pregnancy Indicators of menopause, terminal infertility and long-term abst'mence among currently married women age 30-49, by age, Tanzania 1991/92 Long-term Menopause I abstinence 2 Age Percent Number Percent Number 30-34 2.0 548 0.9 935 35-39 5.8 529 0.9 841 40-41 9.2 224 1.3 308 42-43 15.6 179 2.6 224 44-45 24.4 199 5.1 235 46-47 28.7 171 4.2 191 48-49 38.1 173 4.2 189 Total 12.6 2024 1.8 2923 tPercentage of non-pregnant, non-arnenorrhoeic currently married women whose last menstrual period occurred six or more months preceding the survey or who report that they are menopausal. 2Percentage of eta'rently married women who did not have intercourse in the three years preceding the survey. The second indicator ofinfecundity is obtained from a demonstrated lack of fertility. I f a woman was married at least five years before the survey, has never used contraception, did not give birth in the five years before the survey, and is not currently pregnant, she is considered terminally infertile. By their mid-fourties, almost 60 percent appear to be terminally infertile and by their late fourties, three quarters are infertile. The last indicator is long-term abstinence, which is the percentage of currently married women who did not have sexual intercourse in the three years preceding the survey. This percentage is quite low even among older women (about 4-5 percent). 61 CHAPTER 6 FERTILITY PREFERENCES In the TDHS several questions were asked to all women in order to determine their fertility preferences: their desire to have a(nother) child; i f so, how long they would prefer to wait before the next child; and i f they could start afresh, how many children they would want. The responses obtained from these questions provided information that was used to classify women by their preferences according to age as well as other background characteristics. 6.1 Des i re fo r More Ch i ld ren In Tanzania, where contraceptive prevalence is still low and where cultural as well as husbands' influences on reproductive decisions are still strong, the desire for children is widespread. Table 6.1 and Figure 6.1 show the percent distribution of currently married women by their fertility preferences. One- quarter of currently married women indicated that they wanted another child soon, 42 percent wanted another child later, and 23 percent wanted no more children (including 2 percent who have been sterilised). The proportion of currently married women who want another child soon decreases rapidly with the increasing numberof l iv ing children. For example, 35 percent of currently married women with one l iving child wanted another child soon compared to only 8 percent of women with 6 children or more. A similar pattern can be observed with the proportion of women who wanted another child later, at least among women with 2 or more children. However, the proportion of currently married women who wanted no more children increased with the increasing number of l iving children. More than half of women with at least six children did not want any more children. Table 6.1 Fertility preference by number of living children Percent distribution of currently married women by desire for more children, according to number of living children, Tanzania 1991/92 Number of living children 1 Desire for children 0 1 2 3 4 5 6+ Total Have another soon 2 79.9 34.5 25.1 22.9 22.0 18.5 8.4 26.1 Have another later 3 5.1 57.7 59.5 57.6 45.1 34.8 18.6 41.7 Have another, undecided when 3.3 1.8 0.9 1.0 1.2 1.2 0.7 1.3 Undecided 0.7 0.5 1.7 2.7 2.7 4.8 5.3 2.8 Wants no more 1.2 1.7 8.2 11.1 23.5 33.3 55.5 21.4 Sterilised 0.6 1.1 0.3 0.9 1.7 1.7 4.1 1.7 Declared infecund 8.6 2.5 3.8 3.4 3.6 5.3 7.3 4.8 Missing 0.7 0.1 0.4 0.5 0.3 0.4 0.2 0.3 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number of women 472 1031 1014 890 738 598 1294 6038 1Includes current pregnancy 2Wents next birth within 2 years 3Wants to delay next birth for 2 or more years 63 Figure 6.1 Fertility Preferences among Currently Married Women 15-49 Want Child Later 42% (>2 years) Child Soon 26% '<2 years) Infecund 5% Undecided 4% 40 More 23% (Includes sterilisstion) TDHS 1991/92 The percent distribution of currently married women by desire for children according to age is shown in Table 6.2. Older women are much more likely than younger women to want no more children. The desire to l imit births increases rapidly with age. Only 2 percent of currently married women 15-19 years want no more children, but the proportion increases to 49 percent for women 40-44. Table 6.2 Fertility preferences by age Percent distiibudon of currently married women by desire for more children, according to age, Tanzania 1991/92 Desire for Age of woman children 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Total Have another soon I 36.8 26.1 28.4 27.0 24.7 22.5 14.1 26.1 Have another later 2 58.1 64.9 55.1 41.9 23.4 8.7 3.4 41.7 Have another, undecided when 2.0 1.3 1.2 1.2 1.1 1.1 1.5 1.3 Undecided 0.6 1.3 2.4 3.7 5.9 3.5 2.2 2.8 Wmats no more 2.1 5.3 12.2 22.6 36.2 48.9 45.8 21.4 Sterilised 0.0 0.3 0.3 1.2 3.9 4.9 3.6 1.7 Declared infectmd 0.3 0.6 0.3 2.4 4.1 10.3 28.8 4.8 Missing 0.2 0.3 0.3 0.2 0.7 0.1 0.6 0.3 Total 100.0 100,0 100.0 100.0 100.0 100.0 100.0 100.0 Number 558 1283 1274 935 841 603 545 6038 IWmats next birth within 2 years 2Wants to delay next birth for 2 or more years 64 The desire to have no more children varies by background characteristics of the women. Table 6.3 shows that there is only limited variation by urbalVroral residence or between Zanzibar and Mainland Tanzania. However, there is considerable regionalvariation. InKilimanjaro almosthalfofcurrentlymarried women did not want another child (47 percent). Singida and Arusha follow with almost one-third of women wanting no more children. In eight regions, less than 20 percent of currently married women wanted no more children, including Shinyanga as the lowest with 14 percent. At the regional level, there was no clear relationship between percent wanting no more children and respondent's level of education. Table 6.3 Desire to limit childbearing Percentage of currently married women who want no more children, by nttmber of living children and selected background characteristics, Tanzania 1991/92 Number of living children I Background characteristic 0 1 2 3 4 5 6+ Total Residence Mainland 1.6 2.8 8.5 12.0 25.5 34.9 59.8 23.1 Dares Salaam (0.0) 7.3 26.0 (20.3) (47.6) * (72.0) 27.9 Other urban 3.4 1.7 18.5 11.8 37.4 41.2 73.2 27.3 Rural 1.6 2.7 5.3 11.4 21.3 33.0 56.9 21.9 Zanzibar (5.8) 2.6 8.1 (12.3) 15.7 (34.8) 53.6 22.1 Education No education 1.0 3.3 6.1 12.9 22.3 30.9 52.6 26.6 Primary incomplete 4.7 5.2 3.4 13.5 27.7 44.6 71.6 33.6 Completed primary 1.3 2.1 10.0 10.1 26.4 33.0 67.6 13.6 Secondary/Higher * (0.9) 24.2 (20.9) * * * 23.6 Total 1.7 2.8 8.5 12.0 25.2 34.9 59.6 23.1 Note: Women who have been sterilised are considered to want no more children. Rates shown in parentheses arc based on 25-49 women, whereas an asterisk means the rate is based on fewer than 25 women and has been suppressed. llnchides current pregnancy 6.2 Demand for Fami ly P lanning Services Women who are currently married, and who indicate that they either want no more children or want to wait for two or more years before having another child, but are not using contraception, are considered to have an unmet need for family planning. Women with unmet need and those currently using contraception (met need) constitute the total demand for family planning. Table 6.4 shows the percentage of currently married women with unmet need and met need and the total demand for family planning services by background characteristics. Forty-one percent of currently married women can be considered to constitute total demand for family planning, of which 24 percent is a demand for spacing purposes and 17 percent is a demand for limiting purposes. The demand for family planning services appears to be highest among currently married women living in urban areas (Dar-es-Salaam or other urban areas, about 50 percent), among women with secondary or higher education (62 percent, mostly more demand for spacing) and in selected regions. In Kilimanjaro, Arusha, and Morogoro, the total demand exceeds 50 percent. 65 Table 6.4 Need for family planning seawiees Percentage of currently mamed women with unmet need f~ family planning, met need for fanfily planning, and the total demand for farnily planning services, by selected background characteristics, Tanzania 1991/92 Met need for Unrnet need for family planning Total demand for Percentage fan~y planning I (currently using) 2 family planning of demand Number For For For For For For saris- of spacing limiting Total spacing limiting Total spacing limiting Total fled women Background charactefisfc Age 15-19 17.5 3.0 20-24 24.8 3.1 25-29 25.4 6.5 30-34 21.9 10.4 35-39 11.3 20.8 40-44 5.9 27.8 45-49 2.5 27.6 Residence Mainland 17.7 12.1 Dares Salaam 19.9 13.8 Other urban 18.6 14.8 Rural 17.4 11.4 Zanzibar 27.2 10.9 Region Dodoma 20.9 9.6 Arusha 21.7 Kilimanjaro 17.5 Tanga 21.4 Morogoro 24.6 Coast 17.8 Lindi 17.6 Mtwara 14.7 Ruvuma 20.7 Idnga 15.4 Mbeya 20.9 Singida 15.9 Tabora 12.4 Rukwa 20.9 Kigoma 15.2 Shinyanga 14.0 Kagera 12.3 Mwanza 16.0 Mara 15.5 Education No education 14.6 Primary incomplete 14.5 Completed primary 24.0 Secondary/Higher 14.3 Total 18.0 20.5 5.2 0.0 5.2 22.8 3.0 25.8 20.3 558 27.8 9.1 0.9 10.0 33.9 3.9 37.8 26.3 1283 31.9 8.3 1.6 9.9 33.7 8.1 41.8 23.8 1274 32.2 7.9 6.0 13.8 29.7 16.3 46.0 30.0 935 32.1 3.2 10.1 13.3 14.5 30.9 45.4 29.3 841 33.7 0.8 10.1 10.9 6.7 37.9 44.6 24.5 603 30.1 0.1 7.0 7.1 2.6 34.6 37.2 19.0 545 29.8 6.0 4.5 10.5 23.7 16.6 40.4 26.1 5870 33.7 7.3 8.5 15.7 27.2 22.3 49.5 31.8 349 33.4 11.0 7.7 18.7 29.6 22.5 52.1 36.0 966 28.8 4.8 3.5 8.4 22.2 14.9 37.2 22.5 4555 38.1 3.1 4.0 7.1 30.3 14.9 45.2 15.7 168 30.5 4.5 5.1 9.6 25.4 14.7 40.1 24.0 445 13.3 35.0 11.9 5.5 17.3 33.6 18.8 52.3 33.1 350 19.8 37.3 15.0 18.1 33.1 32.5 37.8 70.3 47.0 258 12.0 33.4 10.3 5.5 15.8 31.7 17.6 49.2 32.1 306 15.4 40.1 6.7 3.9 10.6 31.3 19.3 50.6 20.9 334 9.9 27.7 9.3 4.3 13.6 27.1 14.2 41.3 33.0 98 13.3 30.9 6.0 5.6 11.5 23.6 18.9 42.5 27.1 155 12.6 27.4 1.6 0.7 2.3 16.4 13.4 29.7 7.9 249 10.8 31.6 2.3 5.6 7.8 23.0 16.4 39.4 19.8 210 9.2 24.6 8.2 2.9 11.1 23.6 12.1 35.7 31.1 338 11.0 31.9 9.0 3.1 12.1 29.9 14.1 44.0 27.6 333 14.4 30.3 7.9 6.1 14.0 23.8 20.5 44.4 31.7 190 17.1 29.5 4.0 5.0 9.0 16.4 22.1 38.5 23.4 174 11.0 31.9 3.3 2.3 5.6 24.2 13.3 37.5 14.9 158 9.1 24.3 3.8 1.1 4.9 19.0 10.2 29.2 16.7 245 10.9 24.9 3.6 0.7 4.2 17.6 11.6 29.2 14.6 578 10.8 23.1 2.9 5.5 8.4 15.2 16.3 31.5 26.5 371 11.2 27.1 1.8 2.2 4.0 17.7 13.4 31.1 12.8 444 11.0 26.5 4.3 3.6 7.9 19.8 14.6 34.4 22.9 285' 15.0 29.6 1.3 2.4 3.7 15.9 17.4 33.3 I1.1 2505 17.9 32.4 5.1 7.8 12.9 19.6 25.7 45.2 28.5 1166 6.1 30.1 10.0 4.5 14.6 34.0 10.6 44.6 32.6 2215 5.2 19.5 28.6 13.8 42.4 42.9 19.0 62.0 68.5 152 12.1 30.1 5.9 4.5 10.4 23.9 16.6 40.5 25.7 6038 tUnmet need for spacing includes pregnant women whose pregnancy was mistimed, amenocthoeic women whose last birth was mistimed, and women who are neither pregnant nor amenorrhoeic and who are not using any method of family planning and say they want to wait 2 or more yeats for their next birth.Also included in unmet need for spacing are women who are unsure whether they want another child or who want another child but are unsme when to have the birth. Unmet need for limiting refers to pregnant women whose pregnancy was unwanted, an~enorrhoeic women whose last child w~ unwanted and women who axe neither pregnant nor amenorrhoeio and who are not using any method of family planning and who want no more children. 2Using for spacing is defined as women who ale using sorr~ method of family planning and say they want to have another child or are undecided whether to have another. Using for limiting is defined as women who axe using and who want no more children. Note that the specific methods used are not taken into account here. 66 The need for family p la~ing is not fulfilled for the majority of t-he women. About one quarter of the total demand is satisfied: 30 percent of married women have an unmet need for family planning services. The lowest proportions of demand satisfied can be observed among women under 20 years and 45-49 years, among women in Zanzibar (16 percent of the demand satisfied), and among women with no education. The highest proportion of demand satisfied occurs among women with secondary or higher education (69 percent) and in Kilimanjam region (47 percent). It appears that educated women are much more successful than other women in meeting their family planning needs. 6.3 Ideal and Actual Number of Children In addition to the actual number of children that women have, the TDHS examined the ideal number of children that women desired. The question required the respondent to consider abstractly and independently of her family size and give the number of children she would like to have if she could start all over again. Table 6.5 shows the percent distribution of all women by ideal number of children and mean ideal number of children for all women and currently married women, according to the number of living children. About 14 percent of women gave a non-numeric response, such as "up to God" or "as many as possible." Table 6.5 Ideal number of children Percent distribution of all women by ideal number of children and mean ideal number of children for all women and for currently married women, according to number of living children, Tanzania 1991/92 Number of living children t Ideal number of children 0 1 2 3 4 5 6+ Total 0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 1 0.4 0.3 0.1 0.1 0.0 0.3 0.1 0.2 2 4.5 3.0 3.3 1.0 0.6 0.8 0.9 2.5 3 7.7 10,6 6.6 4.5 2.2 1.6 1.2 5.7 4 24.9 27,4 20.1 18.3 13.8 6.9 11.6 19.4 5 16.2 16.9 19.2 12.8 12.5 14.6 6.1 14.3 6+ 31.8 34,1 40.5 50.2 57.4 58.8 59.7 44.3 Non-numeric response 14.6 7.8 10.2 13.1 13.4 17.1 20.3 13.7 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number of women 2345 1545 1275 1043 870 694 1466 9238 Mean ideal number 5.4 5.4 5.8 6.1 6.5 7.1 7.4 6.1 Number of women 2002 1425 1145 907 753 575 1168 7976 Mean for women in union 5.8 5.6 5.9 6.2 6.6 7.2 7.4 6.4 Number of women in union 403 935 901 775 639 496 1032 5181 Note: The means exclude women who gave non-numeric responses. llncindes current pregnancy The mean ideal family size among all women was 6.1 children and among currently married women 6.4 children. There is a correlation between the actual and ideal family size. The mean ideal number of children increases from 5.4 among childless women to 7.4 among women with 6 or more living children. 67 The reason for this is twofold. First, to the extent that women implement their preferences, those who want larger families will tend to achieve larger families. Secondly, women may adjust their ideal family size upwards as the actual number increases. Forty-four percent of all women want at least six children, 59 percent at least five, and 78 percent at least four. Only 8 percent of respondents considered three children or fewer an ideal family size. This proportion is slightly higher among women with none or one child: 13 percent of women with no child or with one child wanted three children or less. Despite the pronatalist attitudes of most women, there is some evidence of unwanted fertility; 10 percent of women with 5 children and 20 percent of those with 6 or more children reported ideal numbers of children that were less than the actual number of children they have. Table 6.6 presents the mean ideal number of children for all women by age and selected background characteristics. Women with secondary or higher education and women in Kilimanjaro region wanted fewer than five children (means of 4.2 and 4.3, respectively). Women with no education have the largest mean ideal number of children (7.3). Women in Zanzibar want more children on average (6.8) than women on mainland Tanzania (6.0). Table 6.6 Mean ideal number of children by background characteristics Mean ideal number of children for all women, by age and selected background characteristics, Tanzania 1991/92 Age of woman Background characteristic 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Total Residence Mainland 5.5 5.4 5.8 6.4 7.0 7.2 7.5 6.0 Dares Salaam 4.5 4.6 5.3 5.6 (6.1) (7.2) * 5.2 Other urban 4.8 4.6 5.2 5.9 6.7 6.1 7.2 5.4 Rural 5.8 5.7 5.9 6.6 7.1 7.5 7.6 6.3 Zanzibar 6.0 5.9 7.2 7.7 (6.9) (7.6) (9.4) 6.8 Region Dodoma 5.7 5.1 6.1 (6.7) (8.3) (7.1) (7.3) 6.3 Arusha 4.9 4.8 5.2 (5.6) (6.6) (6.0) (6.9) 5.4 Kilimanj aro 3.8 4.0 4.1 (4.8) 4.8 (5.6) (4.4) 4.3 Tanga 4.8 4.8 5.6 6.3 (5.8) (6.3) (6,3) 5.5 Morogoro 5,4 5.8 5.8 6.4 8.1 (8.6) (8.1) 6.5 Coast 5.2 5.6 (6.6) (7.3) (8.1) (9.2) (9,9) 6.8 Lindi 4.9 5.5 5.4 (5.7) (7.0) (7.2) (7,8) 6.0 Mtwara 4.9 5.7 5.1 (6.6) (6.7) (7.0) (7,6) 6.0 Ruvurna 4.8 4.9 5.9 6.3 6.7 (6.4) (6,6) 5.7 Iringa (5.0) 4.6 4.8 6.0 6.4 * (8,2) 5.5 Mbe:ca 5.5 5.1 5.3 (6.2) (7.4) * * 5.8 Sing~da 5.7 5.6 6.2 (6.6) (6.6) (7,7) (8.9) 6.4 Tabora 6.5 6.4 5.6 6.2 (7.4) 7.4 (7,6) 6.6 Rukwa 5.8 5.6 6.5 6.6 6.7 (8.4) (6,3) 6,3 Ki~oma 6.2 6.4 7.0 7.0 8.3 (8.0) (9,5) 6.9 Shmyanga 6.5 6.5 6.7 6.8 7.9 (7.9) (9,0) 6.9 Kagera 5.9 6.0 5.9 6.5 6.9 (8.1) (7,9) 6.3 Mwanza 6.4 6.1 6.8 7.1 (7.4) (7.4) (7,9) 6.7 Mara 5.7 5.9 6.0 7.0 7.3 7.1 (8,3) 6.4 Education No education 6.3 6.6 6.9 7.0 7.7 7.8 8,0 7.3 Primary incomplete 5.7 6.3 5.9 6.6 6.9 6.7 6.4 6.3 Completed primary 5.4 5.1 5.4 5.7 5.2 6.3 5.5 5.3 Secondary/Higher 4.3 4.2 3.8 4.7 * * * 4.2 Total 5.5 5.4 5.8 6.4 7.0 7.2 7.5 6.1 Note: Rates shown in parentheses are based on 25-49 women, whereas an asterisk means the rate is based on fewer than 25 women and has been suppressed. 68 6.4 Fertility Planning In the TDHS, women were asked questions for each child born in the preceding five years and any pregnancy to determine whether the pregnancy was planned (wanted then), wanted but at a later time, or unwanted (wanted no more). The answers indicate the degree to which couples are successfully controlling fertility. However, it must be noted that these questions required the respondent to accurately recall her wishes at one or more points in the last five years and to report them honestly. Here, the danger of rationalization is present since an unwanted conception may become a cherished child. Therefore, the values presented here are likely to be underestimates of the proportion of couples successfully controlling their fertility. Table 6.7 shows the percent distribution of births in the five years preceding the survey by planned fertility status, according to birth order and mother's age at birth. Three-quarters of births in the last five years were wanted at the time they were conceived, 15 percent were wanted later, and 8 percent were not wanted at all. These proportions vary according to birth order. Eleven percent of the fourth or higher order births were not wanted, 18 percent were wanted at a later time, and 70 percent were wanted at that time. The proportion of births that were not wanted at all generally increases with age of the mother. On the other hand, the older the women, the lower the proportion of births that were wanted at the time they were conceived. The proportion of births wanted later is low at the youngest age group, reaches a peak among age 25-29, and then decreases. Table 6.7 Fertility planning status Percent distxibution of births in the five years preceding the survey by fertility planning status, according to birth order and mother's age, Tanzania 1991D2 Planning status of birth 1 Birth order Wanted Number and mother's Wanted Wanted no of age then later more Missing Total bkths Birth order 1 84,2 6.4 8.4 0.9 100.0 2005 2 78,4 17.1 4.1 0.5 100,0 1669 3 76,3 18,2 4.1 1.4 100.0 1284 4+ 69.7 17.9 10.8 1.6 100.0 4106 Age at birth <19 80.4 9.9 8.9 0.9 100.0 1627 20-24 78,4 16.1 4,7 0.8 100.0 2656 25-29 73.2 20.1 5.5 1.3 100.0 2148 30-34 73.5 16.7 7.9 1.9 100.0 1299 35-39 71.6 12.2 14,4 1.7 100,0 874 40-44 65.2 8,5 24.9 1.4 100.0 381 45-49 60.0 7.8 26.8 5,4 100.0 79 Total 75.5 15.2 8.1 1.2 100.0 9065 llncludes current pregnancy. 69 The potential demographic impact of avoiding unwanted births can be estimated by calculating the wanted fertility rate. This calculation proceeds in the same way as the total fertility rate, but the unwanted births are excluded from the numerator. In this context unwanted births are defined as births that exceed the number considered ideal by the respondent. The rate that is obtained from these calculations represents the level of fertility that woul~d have prevailed during the three years preceding the survey if all unwanted births were prevented. Comparison of actual rates with wanted rates indicates the potential demographic impact of the elimination of unwanted births. Table 6.8 shows the wanted total fertility rate and the actual total fertility rate for the three years preceding the survey by selected background characteristics. Overall, the wanted total fertility rate is 11 percent lower than the actual total fertility rate. Thus, if the unwanted births were eliminated, the total fertility rate in Tanzania would be 5.6 children born per woman. The differences between actual and wanted fertility rates are fairly similar by urban/rural residence and level of education (less than 1 child). The one exception is among women in the northern highlands, where the wanted total fertility rate (4.6) is more than one child less than the actual total fertility rate (6.0). However, in general, even if women in Tanzania were to control their childbearing, fertility rates would remain high, either because women still prefer large families or they are not familiar with the idea of conscious reproductive choice. Hence, the demographic impact of family planning can be increased by promoting a desire for smaller families. Table 6.8 Wanted fe~lity rates Total wanted fertility rates and total fertility rates for the three years preceding the survey, by selected background characteristics, Tanzania 1991/92 Total wanted Total Background fertility fertility characteristic rate rate Residence Mainland 5.57 6.24 Dares Salaam 3.72 4.04 Other urban 4.77 5.56 Rural 5.91 6.58 Zanzibar 5.73 6.38 Zone Coastal 5.06 5.66 Northern Highlands 4.63 6.01 Lake 6.18 6.88 Central 6.65 7.06 Southern Highlands 5.81 6.25 South 4.55 5.11 Education No education 5.93 6.50 Primary incomplete 5.47 6.44 Completed primary 5.32 5.99 Secondary/Higher 3.69 4.22 Total 5.57 6.25 Note: Rates are based on births to women 15-49 in the period 1-36 months preceding the survey. The total fertility rates are the same as those presented in Table 3.2. 70 CHAPTER 7 INFANT AND CHILD MORTALITY Including an estimation of infant and child mortality rates in the demographic assessment of Tanzania is important because mortality levels in children below the age of five may have profound impact on a number of demographic parameters. Childhood mortality data are also useful in assessing the impact of child survival programmes and identifying child populations that are at high risk. Mortality estimates were calculated from information collected in the birth history section of the individual questionnaire. The section began with questions about the overall childbearing experience of respondents (i.e., the number of sons and daughters who live in the household, those who live elsewhere, and those who have died). These questions were followed by a retrospective bi~h history in which data were obtained on sex, date of birth, survivorship status, and current age or age at death of each of the respondents' live births. The rates presented in this chapter are defined as follows: Neonatal mortality: the probability of dying within the first month of life Postneonatal mortality: the difference between infant and neonatal mortality Infant mortality: the probability of dying before the first birthday Child mortality: the probability of dying between the first and fifth birthday Under-five mortality: the probability of dying before the fifth birthday. All rates are presented per 1,000 live births. The only exception is the child mortality probability (1-4 years), which is expressed per 1,000 children aged 1 year exactly. 7.1 Infant and Child Mortality Neonatal, postneonatal, infant, child and under-five mortality rates are shown in Table 7.1 for three five-year periods in the 15 years preceding the survey. For the most recent five-year period (1987-91) under- Table 7.1 Infant and child mortality Infant ~md child mortality rates by five-year periods preceding the survey, Tanzania 1991/92 Y~al-s preceding survey Neonatal Posmeonatal Infant Child Under-five mortality mortality mortality mortality mortality (NN) (PNN) (lq0) (4q0 (sqd 0-4 37.9 53.7 91.6 54.6 141.2 5-9 42.4 66.2 108.6 66.9 168.2 10-14 41.2 52.4 93.7 76.0 162.6 71 five mortality was 141 per 1,000 live births and infant mortality 92 per 1,000 live births, t Among all deaths under five years, 27 percent occurred during the neonatal period, 38 percent during the postneonatal period, and 35 percent at ages 1-4 years. During the fifteen years preceding the TDHS, under-five mortality fell from 163 deaths to 141 deaths per thousand live births. Virtually all of the decline was due to a decline in mortality at 1-4 years. Infant mortality remained at the same level during 1987-91 as it was during 1977-81. During the period 1982-86, infant mortality was estimated at 109 per 1,000 live births, which was an increase compared to the preceding five-year period (1977-81, 94 per 1,000 live births). The increase was entirely due to higher postneonatal mortality, since neonatal mortality did not change. Under five and infant mortality estimates from TDHS can be compared in Figure 7.1 with estimates based on the 1978 and 1988 censuses. Since the census estimates are based on the indirect method of estimation, indirect mortality estimates are also presented for TDHS in addition to the direct estimates. Indirect estimates of infant and child mortality were produced using the Trussell variant of the Brass method. This method uses the reports on the number of children ever bom and still alive by age of the respondent to estimate mortality levels and trends. In contrast to the direct approach, which is based on birth history data, 250 200 150 100 50 0 Figure 7.1 Trends in Mortality, Infants and Children Under Five, Direct and Indirect Estimates Deaths per 1000 Live Births r , , , , , , I I , I i , , I 1975 1980 1985 1990 Year ~-Q5 Census 11- IMR Census ! - -Q5 TDH9 Direct -~ Q5 TDHS ~ndirect lEE I ~-IMR TDH9 Direct A)'IMR TDHS Indirect Note: Census data from 1978 and 1988 r 1995 TDHS 1991/92 1 Using the jackknife model, sampling errors can be calculated for mortality estimates, which take into account the number of clusters of the TDHS. For infant mortality, the 95 percent confidence interval is 80.1-103.1 per 1,000 live births; the corresponding interval for under-five mortality is 128.1 - 154.3 per 1,000 live births. 72 no information is used on ages at death; model life tables are used to obtain indirect mortality estimates. The indirect estimates tend to be higher than the direct estimates of mortality, particularly the most recent estimate, which is based on the child mortality experience of women 20-24 years.2 For the indirect estimates in both TDHS and the 1988 census, North model life tables were used. There are marked discrepancies between census and TDHS estimates of under-five mortality, whereas infant mortality data are fairly consistent. The census estimates of under-five mortality are 231 and 192 per 1,000 live births for 1975 and 1985, respectively (Bureau of Statistics, undated). The census estimate for 1985 is about 30 points higher than the indirect and direct estimates from the TDHS, which are at a remarkably similar level. Part of the difference may be due to the fact that the 1985 census estimate was based on women 20-24, who may have excess mortality, as noted above. Analysis of the indirect mortality census data for women 20-44 may provide further insights. Table 7.2 and Figures 7.2 and 7.3 present neonatal, posmeonatal, infant, child and under-five mortality rates by selected background characteristics for the ten-year period (1982 - 1991) preceding the survey. There was no difference in mortality rates between rural and urban areas. As expected, all mortality rates decreased with increasing level of education. The largest education-related differentials are observed Table 7,2 Infant and child mortality by background characteristics Infant and child mortality rates for the tan-year period preceding the survey, by selected background characteristics, Tanzania 1991/92 Neonatal Posmeonatal Infant Child Under-five Background mortality mortality mortality mortality mortality characterlsdc (NN) (PNN) (lqo) (4£11) (sqe) Residence ! Urban 52.1 56.2 108.3 57.1 159.2 Rural 36.9 60.3 97.2 61.0 152.2 Zone Coastal 44.7 62.3 107.0 59.7 160.3 Northern Highlands 34.4 21.1 55.5 24.4 78.6 Lake 38.1 69.6 107.7 68.5 168.9 Central 51.2 76.6 127.9 71.9 190.6 Southern Highlands 31.8 48.1 79.9 54.7 130.2 South 41.5 57.6 99.1 71.0 163.1 Education No education 43.1 60.3 103.3 65.8 162.3 Primary incomplete 35.4 59.5 95.0 67.0 155.6 Completed primary 39.7 59.7 99.4 47.9 142.5 Secondary/Higher 29.0 42.8 71.8 31.3 100.8 Medical maternity care No antenatal/Delivery ca,re 41.0 54.9 95.9 69.5 158.7 Either antenatal or delivery 33.6 55.1 88.7 54.4 138.2 Both antenatal & delivery 38.7 53.5 92.3 39.6 128.3 Total 40.0 59.5 99.4 60.2 153.6 INumber of observations for Dar es Salaam and Zanzibar is too small for mortality estimations. 2 This is because women 20-24 are on average 22.5 years at the time of the survey, so an important part of their births occur when these women are very young. Infant and child mortality for births to such women is much higher, as 'also shown by the direct estimates of mortality by maternal age in Table 7.3. 73 Figure 7.2 Infant Mortality in the Ten Years Preceding the Survey by Selected Characteristics ZONES Coastal Northern Highlands Lake Central Southern Highlands South EDUCATIO| No Educatlol Incomplete Prlmar I Completed Prlmar I Secondary/Highs 20 40 60 80 100 120 Deaths per 1,000 Live Births 140 TDHS 1991/92 Figure 7.3 Child Mortality (1-4 years) in the Ten Years Preceding the Survey by Selected Characteristics ZONES Coastal Northern Highlands Lake Central Southern Highlands South EDUCATION No Education Incomplete Primary Completed Primary Secondary/Higher 20 40 60 80 100 Deaths per 1,000 Chi ldren Age 1 Year Exactly 120 TDHS 1991/92 74 for mortality during ages 1-4 years. The benefits of higher levels of mother's education become most evident if the mother has at least some secondary education; the differences between no formal education and primary education are small. Nonformal adult education may have contributed to reducing the excess mortality risk of children of mothers without formal education compared to children of mothers with primary education. Regional differences in childhood mortality were observed by collapsing the administrative regions into six ecological/geographical zones. This strategy allowed the necessary geographical comparisons to be made because it provided relatively large numbers of deaths in each zone and thereby reduced sampling error. However it should be noted that these "zones" do not conform to the administrative zones of the United Republic of Tanzania. The classification of regions into the zones is as shown below: Coastal zone: Northem Highlands zone: Lake zone: Central zone: Southern Highlands zone: Southern zone: Tanga, Morogoro, Coast, Dares Salaam, and Zanzibar Arasha and Kilimanjaro Tabora, Kigoma, Shinyanga, Kagera, Mwanza, and Mare Dodoma and Singida Iringa, Mbeya, and Rukwa Lindi, Mtwara, and Ruvuma. With the exception of neonatal mortality, mortality rates were lowest in the Northern Highlands; infant mortality was 56 per 1,000 live births, while under-five mortality was 79 per 1,000 live births. Mortality levels among children living in the Southern Highlands were also somewhat lower than average; infant mortality and under-five mortality were 80 and 130 per 1,000 live births, respectively. The Coastal, Lake, and Southern zones take an intermediate position, with infant mortality rates on the order of 100 per 1,000 and under-five mortality rates of about 160 per 1,000 live births. Finally, mortality rates were found to be highest in the Central zone (infant mortality 128 and under-five mortality 191 per 1,000 live births). Quality of care received during the antenatal and delivery periods is known to be an important determinant of neonatal survival. Respondents were asked to report on services they received while pregnant or during delivery. Neonatal mortality among those who received neither antenatal nor delivery care was 50 per thousand live births; among those who received both services mortality during the first month of life was 39 per thousand live births for the five-year period prior to the survey (no maternity care data were collected for births more than 5 years before the survey). All other measures of mortality (especially childhood and under-five mortality) were relatively higher among women who receive no antenatal nor delivery care. Table 7.3 presents mortality rates for the ten years preceding the survey by selected demographic characteristics. Male children have slightly higher mortality than female children in all three age periods. Children borne to mothers below 20 years of age had higher mortality than children borne to mothers at older ages. Paradoxically, children borne by older women (40-49 years) had the lowest mortality. Parity was also associated with mortality. First-bom and high-parity children had higher mortality than children of birth orders 2-6, but this association is largely restricted to the neonatal period. The relationship between birth intervals and mortality was also assessed. Shorter birth intervals were associated with much higher mortality both during and after infancy. All mortality measures among children born less than two years after the previous birth were more than 100 percent higher than those of children bom at least four years after the previous birth. The difference in mortality was highest (elevated by about 200 percent) in the neonatal period and 1-4 years age group. High mortality associated with shorter birth interval during the neonatal period may be due to prenatal influences, such as maternal depletion, while the observed high mortality in higher age categories may be due to economic stress associated with large family size. In general, these data indicate the importance of child spacing for child survival. 75 Table 7.3 Infant and child mortality by demographic characteristics Infant and child mortality rates for the ten-year period preceding the survey, by selected demographic characteristics, Tanzania 1991/92 Neonatal Postneonatal Infant Child Under-five Demographic mortality mortality mortality mortality mortality characteristic (NN) (PNN) (tq0) (4ql) (sq0) Sex of child Male 42.6 61.2 103.7 63.2 160.4 Female 37.4 57.7 95.1 57.1 146.8 Age of mother at birth <20 54.5 71.9 126.4 76.8 193.5 20-29 34.6 54.4 89.0 57.8 141.7 30-39 41.2 64.1 105.3 52.5 152.3 40-49 34.2 35.7 69.9 55.4 121.4 Birth order 1 53.0 60.3 113.3 60.8 167.3 2-3 34.6 58.7 93.3 63.0 150.4 4-6 32.8 59.8 92.6 60.5 147.5 7* 45.9 59.2 105.1 53.3 152.8 Previous birth interval < 2 yrs 68.6 91.5 160.1 83.8 230.5 2-3 yrs 27.4 52.3 79.7 59.3 134.3 4 yrs + 25.3 39.8 65.1 29.4 92.6 7.2 High-Risk Fertility Behaviour Generally, infants and children have a greater probability of dying if they are bom to mothers who are too young or too old, if they are born after a short birth interval, or if they are of high parity. In the analysis of the effects of high-risk fertility behaviour on child survival, a mother is classified as "too young" if she is less than 18 years of age, and "too old" if she is over 34 years of age at the time of delivery. A "short birth interval" is defined by a birth occurring less than 24 months after the previous birth, and a child is of "high birth order" if the mother had previously given birth to three or more living children (i.e., if the child is of birth order 4 or higher). Children can be further cross-classified by combinations of these characteristics. First births, although often at increased risk, are not included in this analysis because they are not considered an avoidable risk. The first column in Table 7.4 shows the percentage of children born in the five years preceding the survey who fall into specific risk categories. Thirty-eight percent of children had a single risk characteristic, while 21 percent had more than one high-risk characteristic and were thus placed in the multiple risk category. Overall, over a half of children (59 percent) were at elevated risk as a result of the mother's fertility pattern. 76 Table 7.4 High-risk fertility behavinur Percent distxibution of children bern in the five years preceding the survey who are at elevated risk of mortality, and the Imreent distribution of currently married women at risk of conceiving a child with an elevated risk of mortality, by category of increased risk, Tanzania 1991/92 Births in the 5 years preceding the survey Percentage of currently Risk Percentage Risk married category of births ratio women a Not in any high-risk category 41.5 1.00 24.5 b Single high-risk category Mother's age < 18 6.6 1.80 1.1 Mother's age > 34 0.2 * 2.7 Birth interval < 24 5.9 (1.31) 10.4 Birth order > 3 25.2 0.94 17,5 Subtotal 38.0 1.16 31,7 Multiple high-risk category Age <18 & birth interval <24 c 0.2 * 0.4 Age >34 & birth interval<24 0.0 * 0.1 Age >34 & birth order>3 12.7 0,92 24.9 Age >34 & birth interval <24 & birth order >3 1.7 * 5,4 Birth interval <24 & birth order >3 5.9 (1.46) 12.9 Subtotal 20.5 1.15 43.8 58,5 1.16 75.5 100.0 100.0 In any high-risk category Total Number 8036 6038 Note: Risk ratio is the ratio of the proportion dead of births in a specific risk category to the proportion dead of births not in any high-risk category. Figures in parentheses are ratios based on fewer than 250-499 cases. An asterisk means the data are b~Lsed on fewer than 250 cases and have been suppressed. aWomen were assigned to risk categories according to the status they would have at the birth of a child, if the child were conceived at the time of the survey: age less than 17 years and 3 months, ago older than 34 years and 2 months, latest birth less than 15 months ago, and latest birth of order 3 or ~gher. ncludes sterilised women Clncludes the combined categories age <18 and birth order >3. Forty-six percent of all children were of birth order 4 or higher. Among births with a single risk characteristic, high birth order was the most common one (25 percent of all births). Common combinations of risk factors were matemal age 35 years and over with birth order 4 or higher, and birth interval less than 24 months and birth order 4 and over. 77 To obtain an idea of the magnitude of the mortality risk associated with fertility behaviour, risk ratios were calculated for each of the risk categories, as shown in the second column of Table 7.4. A risk ratio in this context is defined as the ratio of the proportion of children in the category who have died to the proportion who have died in the not in any risk category. Children were classified not to be in any risk category if they were born to mothers age 18-34, at an interval of 24 months or more after the previous birth, and with birth order 3 or less. Compared to children not in any risk category, the risk of mortality among children in at least one risk category was increased by 16 percent only. The increased risk of dying was similar in children in single and multiple risk categories. Among children with a single risk factor, the highest risk of dying was noted among those bom to mothers younger than 18 years of age (elevated by 80 percent). Children born less than 24 months after the previous birth and of birth order 4 or higher had the highest risk of dying (risk increased by 46 percent) in the multiple risk category. Based on this brief analysis of high-risk fertility behaviour, the question can be asked: How many women currently have the potential for having a high-risk birth? This may be answered by simulating the distribution of currently married women by the risk category into which a currently conceived birth would fall. In other words, a woman's current age, time elapsed since last birth, and parity are used to determine into which category her next birth would fall, if she were to conceive at the time of the survey. To determine what proportion of women in the simulation have the potential for a high-risk birth, it is assumed that all but sterilised women conceive. The results of this hypothetical situation are shown in column 3 of Table 7.4. The simulation results indicate that without any form of fertility control among women who share a high-tisk profile, the percentage of estimated high-risk births (in any category) will increase. This can be seen by comparing the proportion of women who currently have the potential for a high-risk birth (76 percent) with the proportion of births in the five years preceding the survey that were classified as high-risk (59 percent). This hypothetical increase in high-risk births is related to increases in the percentage of births in the multiple risk categories, from 21 to 44 percent. These findings clearly show the importance of family planning in prevention of mortality among children and suggests that impact on mortality can be achieved by targeting family planning services to significant women in risk categories. 78 CHAPTER 8 MATERNAL AND CHILD HEALTH Findings in three areas of importance to maternal and child health~maternity care, vaccinations, and common childhood illnesses and their treatment--are presented in this chapter. This information can be used to assess progress in the implementation of child survival programmes and to identify the characteristics of nonusers of maternal and child health services. Data were obtained for all live births occurring in the five years preceding the survey. 8.1 Antenatal Care and Delivery Assistance Table 8.1 shows the percent distribution of live births in the five years preceding the survey by source of antenatal care received during pregnancy, according to maternal and background characteristics. Interviewers were instructed to record all persons a woman may have seen for care, but in the table, only the provider with the highest qualifications is considered (if more than one person was seen). The findings of this survey indicate very high utilization of antenatal care in Tanzania (for most pregnancies 96 percent). According to mothers' reports, more than 9 of 10 births received antenatal care from a medical professional (92 percent). Mostly, antenatal care was provided by a trained nurse/midwife (56 percent) or a MCH aide (30 percent). Doctors provided 7 percent of antenatal care and traditional birth attendants grBAs) 4 percent. During the five-year period preceding the survey, mothers who received no antenatal care accounted for only 3 percent of births. Differences in attendance of antenatal care were small by bilth order of the child and age of the mother, attendance was high in all categories. Births to women in Zanzibar were more likely to receive antenatal care than births on Tanzania mainland. More pronounced differences were observed in the sources of antenatal care for births in urban and rural areas. Women in urban areas were more likely to receive antenatal care from a doctor or trained nurse or midwife, while women in rural areas were more likely to receive antenatal care from MCH aides and TBAs. These differences may be due to the fact that some service providers such as doctors are mainly located in urban areas making them less accessible to rural women. Doctors were prominent particularly in Dares Salaam where they accounted for 43 percent of antenatal care. At the other extreme is Zanzibar, where only 2 percent of births received antenatal care from a doctor. There is some regional variation in utilization of antenatal care. Morogoro and Arusha had the largest number of births reportedly receiving no antenatal care (10 and 11 percent, respectively) whereas Iringa, Mbeya, Rukwa, and Shinyanga had relatively high ulilisation of traditional birth attendants for antenatal care (all in the range of 11-12 percent of births). Apart from Dares Salaam the proportion of women who reportedly received antenatal services from doctors was high in the Coast region (26 percent). Births to women with no education were more likely not to receive any antenatal care than those to women with at least primary education (7 and 1 percent, respectively). Also there were significant differences in the sources o f antenatal care for births according to mother's education. Women with secondary education or higher were more likely to receive antenatal care from a doctor or trained nurse midwife, whereas women with no education were more likely to receive care from a MCH aide or birth attendant. 79 Table 8.1 Antenatal care Percent dista-ibution of live births in the five years preceding the survey by source of antenatal care during pregnancy, according to selected background characteristics, Tanzania 1991/92 Antenatal care provider I Trained Trad. Number Background nurse/ MCH birth Don't know/ of characteristic Doctor Midwife aide attendant No one Missing Total births Mother's age at birth < 20 6.2 54.5 30.9 4.6 3.0 0.8 100.0 1472 20-34 7.1 55.8 29.5 4.2 2.8 0.5 100.0 5385 35+ 3.8 56.8 28.4 4.3 5.9 0.7 100.0 1174 Birth order 1 8.4 56.1 28.7 3.8 2.4 0.7 100.0 1795 2-3 7.4 55.8 29.6 4.2 2.6 0.4 100.0 2580 4-5 5.1 54.4 31.8 4.4 3.6 0.6 100.0 1642 6+ 4.6 56.3 28.7 4.8 4.6 0.9 100.0 2014 Residence Mainland 6.6 55.5 29.5 4.4 3.3 0.6 100.0 7793 Dares Salaam 43.0 48.0 6.5 0.0 2.5 0.0 100.0 373 Other urban 10.6 68.4 19.1 1.2 0.5 0.3 100.0 1273 Rural 3.6 53.2 33.1 5.4 4.0 0.7 100.0 6148 Zanzibar 1.9 64.3 32.7 0.0 1.0 0.0 100.0 238 Region Dodoma 4.8 39.4 47.9 5.1 2.8 0.0 100.0 623 Arusha 10.0 55.7 19.5 2.2 11.2 1.3 100.0 534 Kilimanjaro 7.6 67.1 24.1 0.0 0.5 0.8 100.0 368 Tanga 2.3 46.2 51.1 0.0 0.2 0.2 100.0 406 Morogoro 10.7 54.9 19.9 4.2 10.1 0.3 100.0 471 Coast 25.5 62.0 3.6 0.4 7.4 1.1 100.0 116 Lindi 8.7 58.8 27.6 0.6 2.8 1.4 100.0 178 Mtwara 1.9 54.0 43.7 0.0 0.5 0.0 100.0 208 Ruvuma 2.0 63.1 34.8 0.0 0.0 0.2 1(30.0 271 Idnga 10.2 39.7 35.6 11.6 1.8 1.1 100.0 439 Mbeya 0.7 51.2 34.3 10.9 2.8 0.0 100.0 375 Singida 6.2 50.1 29.9 8.3 5.6 0.0 100.0 306 Tabora 1.3 68.0 29.4 0.6 0.5 0.1 100.0 231 Rukwa 3.0 40.1 41.3 10.7 3.1 1.8 100.0 223 Kigoma 2.7 52.9 39.2 3.7 0.4 1.1 100.0 358 Shinyanga 0.2 63.7 21.2 11.0 2.5 1.5 100.0 791 Kagera 0.8 66.3 29.8 0.7 2.4 0.0 100.0 554 Mwanza 2.3 64.3 26.3 3.5 2.7 1.0 100.0 605 Mare 6.5 63.8 21.5 3.8 3.8 0.6 100.0 363 Mother's education No education 3.2 53.0 30.2 6.2 6.5 0.9 100.0 2841 Some primary 5.8 57.0 30.5 3.8 2.0 0.9 100.0 1501 Completed primary 8.2 57.1 29.9 3.3 1.3 0.3 100.0 3448 Secondary/Higher 25.3 60.2 13.6 0.0 0.2 0.7 100.0 242 Total 6.5 55.7 29.6 4.3 3.3 0.6 100.0 8032 Note: Figures are for births in the period 1-59 months preceding the survey. The coding categories in the TDHS questionnaire are: doctor/medical assistant, rural medical aide, nurse/midwife, MCH aide, village health worker, trained traditional birth attendant, uaditional birth attendant (I'BA), and other. tIf the respondent mentioned more than one provider, only the most qualified provider is considered 80 Pregnancy monitoring and detection of complications are the main objectives of antenatal care. The advantage of starting antenatal care within the first three months of pregnancy is that a woman's normal baseline health can be assessed and monitoring can be done regularly. Obstetricians generally recommend that antenatal care be started at 12 weeks (3 months) of gestation and visits be made on a monthly basis to the 28th week (7th month), fortnightly to the 36th week (8th month), and then weekly until the 40th week or delivery. If the first antenatal visit is made at the third month of pregnancy, this schedule translates to a total of about 12 visits during the pregnancy. To detect possible delivery complications at least one visit is required during the last weeks of pregnancy. Figure 8.1 shows the distribution of number of antenatal visits made by pregnant mothers. In about 70 percent of all births, mothers made four or more antenatal care visits. The median number of antenatal visits per pregnancy was five. Clearly, most women make fewer than the recommended number of visits during pregnancy. This may be related to the stage of pregnancy at the first antenatal care visit. One third of birdas (32 percent) received antenatal care before five months of gestation and 28 percent went for the first visit at five months of pregnancy. The median duration of gestation at which the first antenatal care visit was made was 5.6 months. Figure 8.1 Number of Antenatal Care Visits and Timing of First Visit NUMBER OF VISITS No Visits 1 Visit 2-3 Visits 4+ Visits Don't Know/Miss ing TIMING OF FIRST VISIT No Visit _<4 Months 5 Months 6-7 Months 8+ Months Don't Know/Miss ing 3.6 I1.1 23.5 , , 69,5 z4 3,6 S2.2 '*4.0 ~1.7 0.5 20 40 60 80 100 Percent of Births TDHS 1991/92 To obtain information about tetanus toxoid vaccination, women were asked to report if they received these injections against tetanus during pregnancy for all births in the five years preceding the survey; the results are presented in Table 8.2. These injections provide protection against neonatal tetanus, one of the principal causes of death among neonates in many developing countries. For full protection, a pregnant woman should receive two doses of the toxoid with at least one month between the doses. However, if a woman has been vaccinated during previous pregnancies, she may only require one booster dose during a current pregnancy, whereas five doses of tetanus toxoid are considered to provide lifetime protection. 81 Table 8.2 Tetanus toxoid vaccination Percent dist~ibutiun of births in the five years preceding the survey, by number of tetanus texoid injectiom given to the mother during pregnancy and whether the respondent received an antenatel card, according to selected background characteristics, Tanzania 1991/92 Number of tetanus texoid injections Percentage Two given Number Background One doses Don't know/ antenatal of characteristic None dose or more Missing Total card births Mother's age at birth < 20 7.6 14.8 77.2 0.4 100.0 95.4 1472 20-34 9.8 18.8 70.7 0.7 100.0 95.5 5385 35+ 14.0 17.4 68.0 0.6 100.0 92.2 1174 Birth order 1 6.6 13,4 79.4 0.6 100.0 95.5 1795 2-3 9.0 18.7 71.8 0.5 100.0 95.8 2580 4-5 11.6 21.2 66.3 0.8 100.0 95.0 1642 6+ 13.0 18.0 68.3 0.7 100.0 93.4 2014 Resldenee Mainland 10.1 16.8 72.5 0.6 100.0 94.9 7793 Dares Salaam 4.4 15.6 79.6 0.4 100.0 96.6 373 Other urban 7.0 15.7 76.6 0.7 100.0 98.6 1273 Rural 11.0 17.1 71.3 0.6 100.0 94.1 6148 Zanzibar 8.1 52.4 37.6 1.9 100.0 96,6 238 Region Dodoma 8.2 14.5 77.2 0.1 100.0 96.3 623 Atusha 24.8 14.4 60.8 0.1 100.0 84.3 534 Kilimmjaro 6.1 21.0 71.7 1.1 100.0 96.9 368 Tonga 10.0 15.7 73.5 0.8 100.0 98.5 406 Morogoro 14.2 10.5 75.3 0.0 100.0 89.4 471 Coast 10.5 20.1 68.2 1.2 100.0 89.8 116 Lindi 6.9 14.7 76.6 1.7 100.0 93.0 178 Mtwara 6.3 20.1 73.1 0.5 100.0 97.7 208 Ruvuma 8.5 18.3 72.7 0.5 100.0 99.1 271 Iringa 5.2 18.6 74.4 1.8 100.0 94.5 439 Mbeya 10.9 14.7 71.8 2.6 100.0 94.9 375 Singida 11.8 18.3 69.7 0.2 100.0 93.4 306 Tabora 5.2 16.2 77.9 0.7 100.0 99.1 231 Rukwa 14.4 12.6 72.7 0.4 100.0 89.0 223 Kigoma 10.4 20.8 68.5 0,3 100,0 98.4 358 Shinyanga 10.4 17.7 71.8 0.1 100.0 96.8 791 Kagera 10.1 21.0 68.2 0.7 100.0 96.6 554 Mwanza 8.0 17.2 74.6 0.2 100.0 97.0 605 Mara 6.8 16.2 76.1 0.9 100.0 95.0 363 Mother's education No education 14.7 18.8 65.8 0.7 100.0 91.5 2841 Primary incomplete 8.8 18.7 71.7 0.8 100.0 96.8 1501 Completed primary 7.0 16.5 76.0 0.5 100.0 97.0 3448 Secondary/Higher 5.3 21.8 72.4 0.5 100.0 95.9 242 All births 10.0 17.8 71.5 0.6 100.0 95.0 8032 Note: Figures are for births in the period i-59 months preceding the survey. For the majority of births (72 percent), the mothers received at least two doses of tetanus toxoid during pregnancy. However, 10 percent were not protected by any tetanus toxoid vaccination. Birth mothers 35 years or above and mothers of births of order 4 and above were less likely to receive tetanus vaccination. 82 The proportions of births where the mothers received no tetanus toxoid is similar in Tanzania mainland and Zanzibar. However, mothers in Zanzibar were much more likely to receive only one dose of tetanus toxoid, whereas their counterparts in Tanzania mainland were more likely to receive at least two doses. Tetanus vaccination status varied by mainland region. Ten regions had at least 10 percent of births with no tetanus toxoid injections during pregnancy at all. The highest proportions with no tetanus toxoid were observed in Arosha (25 percent of births), Rukwa (14 percent), and Morogoro (14 percent). However, in all regions more than 60 percent of all births in the five years preceding the survey received at least two doses of tetanus toxoid, but no region exceeded 80 percent coverage. Vaccination status was found to be associated with education of mothers. The proportion of women who had live births and did not receive tetanus vaccination decreased steadily from 15 percent among women with no education to 5 percent among women with secondary education or above. This may be partly due to higher utilization of antenatal care among educated women (see Table 8.1). For most births (95 percen0 mothers had antenatal cards. In all categories of the background characteristics in Table 8.2, more than 90 percent had antenatal cards with the exception of four regions: Arusha, Rukwa, Morogoro, and Coast. Table 8.3 presents the distribution of births in the five years preceding the survey by place of delivery. Slightly more than half of births took place in health facilities, whereas 46 percent took place at home. The proportion of births delivered in health facilities decreased with increasing mother's age and birth order. Births in Zanzibar were considerably less likely to take place in health facilities than in mainland Tanzania. Within Tanzania mainland, births were much more likely to take place in health facilities in urban areas than in rural areas. Among the mainland regions home deliveries were most common in the Lake regions. More than three-quarters of births in Dares Salaam, Ruvuma, and Kilimanjaro took place in health facilities. Births of educated women were more likely to take place in health facilities than those of uneducated women. The largest differences can be observed by antenatal care attendance; among women not receiving antenatal care, 80 percent delivered at home; of women who made 1-3 antenatal visits during pregnancy, 55 percent delivered at home; and of women who made at least 4 visits, 40 percent delivered at home. In general, the proportion of all births taking place in health facilities (53 percent) was much lower than the proportion of births where the woman was reported to have received antenatal care during pregnancy (96 percent). These figures suggest that women seek antenatal care to get checked and if there are no complications they prefer to deliver at home. In addition to the place of delivery, the TDHS collected data on the type of personnel assisting during delivery. This information is important because the nature of assistance, and hence the quality of care provided, depends on the competence of the service provider. Overall, 6 percent of all births were delivered without assistance; 27 percent of the births were delivered after being assisted by a relative or "other" (see Table 8.4). About 53 percent of all births were assisted by either doctors, trained nurse/midwife, or MCH aide. Traditional birth attendants assisted at 13 percent of all births. In Zanzibar, TBAs were the most common provider (64 percent of all births). In mainland Tanzania, TBAs were most common in Rukwa (32 percent of births), Iringa (30 percent), and Coast regions (23 percent). Traditional birth attendants were rarely mentioned as a source of assistance during delivery in Ruvuma, Mwanza, and Tabora (3 percent of births for each). 83 Table 8.3 Place of delivery Percent distribution of births in the five years preceding the survey, by place of delivery, according to selected background characteristics, Tanzania 1991/92 Number Background Health At Don't know/ of characteristic facility home Other Missing Total births Mother's age at birth < 20 56.4 42.0 0.0 1.7 100.0 1472 20-34 52.6 45.4 0.0 2.0 100.0 5385 35+ 47.8 50.5 0.1 1.6 100.0 1174 Birth order 1 62.1 36.3 0.0 1.6 100.0 1795 2-3 52.5 45.3 0.1 2.1 100.0 2580 4-5 48.8 49.1 0.0 2.1 100.0 1642 6+ 47.2 51.0 0.1 1.7 100.0 2014 Residence Mainland 53.2 44.8 0.0 1.9 100.0 7793 Dares Salaam 85.5 14.1 0.0 0.3 100.0 373 Other urban 84.5 13.1 0.0 2.4 100.0 1273 Rural 44.7 53.3 0.1 2.0 100.0 6148 Zaazibar 32.6 67.4 0.0 0.0 100.0 238 Region Dodoma 59.3 40.2 0.0 0.6 100.0 623 Arusha 47.5 49.7 0.0 2.8 100.0 534 Kilimanjaro 75.7 21.4 0.0 2.9 100.0 368 Tanga 54.1 44.4 0.0 1.5 100.0 406 Morogoro 49.6 45.3 0.1 5.0 100.0 471 Coast 48.8 50.0 0.0 1.1 100.0 116 Lindi 65.9 30.1 0.4 3.5 100.0 178 Mtwara 46.3 51.0 0.0 2.7 100.0 208 Ruvuma 81.5 16.3 0.0 2.2 100.0 271 Ifinga 51.8 43.9 0.0 4.3 100.0 439 Mbeya 52.8 45.5 0.0 1.7 100.0 375 Singida 54.3 44.9 0.0 0.8 100.0 306 Tabura 66.7 30.1 0.0 3.2 100.0 231 Rukwa 45.7 52.0 0.0 2.4 100.0 223 Kigoma 42.8 55.7 0.0 1.4 100.0 358 Stfmyanga 47.5 51.7 0.2 0.7 100.0 791 Kagera 39.0 60.0 0.0 1.0 100.0 554 Mwanza 43.0 55.9 0.0 1.1 100.0 605 Mara 35.0 62.1 0.1 2.8 100.0 363 Mother's education No education 38.3 60.2 0.1 1.4 100.0 2841 Primary incomplete 52.3 45.5 0.0 2.2 100.0 1501 Completed primary 62.5 35.2 0.0 2.3 100.0 3448 Secondary/Higher 81.3 18.3 0.0 0.4 100.0 242 Antenatal care visits 0 11.4 79.7 0.2 8.7 100.0 288 1-3 43.6 55.1 0.0 1.3 100.0 1974 4+ 57.9 40.4 0.0 1.7 100.0 5579 Don't know/Misslng 53.5 42.6 0.4 3.4 100.0 191 All births 52.6 45.5 0.0 1.9 100.0 8032 Note: Figures are for births in the period 1-59 months preceding the stavey. 84 Table 8.4 Assistance during delivery Percent distribution of births in the five years preceding the survey, by type of assistance during delivery, according to selected background characteristics, Tanzania 1991/92 Attendant assisting during delivery I Trained Tred. Number Background nurse/ MCH biah Relative/ Don't know/ of characteristic Doctor Midwife A ide attendant Other No one Missing Total births Mother's age at birth < 20 6.6 41.1 8,9 12.5 27.5 3,3 0,2 100.0 1472 20-34 6.1 37.7 9.4 13.2 27.1 6.0 0.5 100.0 5385 35+ 5.5 34.2 8.6 15,7 25.1 10.3 0,5 100,0 1174 Birth order 1 8.0 45.7 8.5 10.6 24.7 2.1 0.3 100.0 1795 2-3 6,7 37.9 8,7 14.2 28.0 4.1 0.3 100.0 2580 4-5 4.6 35.1 9.3 13.6 29.6 7.3 0.5 I00.0 1642 6+ 4.9 32.8 10.4 14.7 25.3 11.3 0,6 I00.0 2014 Residence Mainland 6.3 38.0 9.4 11.9 27.7 6.3 0.4 100.0 7793 Dares Salaam 31.3 54.0 1.3 6.5 6.8 0.2 0.0 100.0 373 Other urban 12.4 68.3 5.6 3.7 8.5 1.4 0.1 100.0 1273 Rural 3,5 30.7 10.7 13.9 32.9 7.7 0.5 100.0 6148 Zanzibar 0,6 31.9 2.7 63.6 1.3 0,0 0,0 100.0 238 Region Dodoma 5.7 32.6 21.2 12.1 27.9 0.4 0.0 100.0 623 Arusha 11.2 36.0 2.3 19.8 27.8 1.9 1,1 100,0 534 Kilimanjaro 10.9 57.8 10.2 6.6 13.5 0.2 0.8 100.0 368 Tanga 3.1 30.6 22.1 15.7 28.3 0.0 0.2 100.0 406 Morogoro 8.0 38.4 5.9 15.9 28.6 2.9 0.3 100.0 471 Coast 15.6 34.2 4.2 23.0 22.0 0.3 0,8 100.0 116 Lindi 6.7 49,3 10.2 3.5 27.5 1,3 1.4 100.0 178 Mtwara 4.9 33.3 9.4 5.8 40.4 6.2 0.0 100.0 208 Ruvuma 6.6 55.8 19,8 2.6 14.5 0.5 0.2 100.0 271 Idnga 4,7 32.6 13.7 30.3 14.6 2,3 1.7 100,0 439 Mbeya 6.0 42.1 6.1 12.6 24.0 8.5 0.7 100.0 375 Singida 2.7 39.5 11.5 6.8 33.7 5.7 0.0 100.0 306 Tabora 3.3 50.3 14.1 3.1 26.4 2.8 0.0 100.0 231 Rukwa 2.8 28.0 11.7 31.6 22.5 2.2 1.2 100.0 223 Kigoma 2.4 30.6 9.0 10.3 40.7 6.4 0.6 1(30.0 358 Shinyanga 2.0 35.0 7.9 5.2 37.4 12.1 0.3 100.0 791 Kagera 2,2 32.7 4.4 15.9 27.4 17.3 0.0 100.0 554 Mwanza 2.5 36.0 4,9 3.0 37.4 16.3 0.0 100.0 605 Mara 3.6 30.6 2.2 11.7 34.5 16.9 0.5 100.0 363 Mother's education No education 3.1 27.1 7.9 16.7 33.9 10.7 0.7 100.0 2841 Primary incomplete 4.7 38.5 9,7 12.1 27.8 6.7 0.5 100.0 1501 Completed primary 8.4 44.6 10.5 11.5 22.4 2.5 0.2 100.0 3448 Secondary~ligher 18.9 61.8 3.1 11.1 4.7 0,0 0.4 100.0 242 Antenatal care visits None 1.8 8.0 1.2 18.8 48.1 13.7 8.4 100.0 288 1-3 visits 3.1 33.4 7,6 13.6 34.1 8.0 0.2 100.0 1974 4 or more visits 7.5 41.0 9.9 13,0 23.5 5.0 0.1 100.0 5579 Don't know/Missing 3.3 34.9 18.3 14.5 20.1 8.8 0.2 100.0 191 Total 6,1 37,8 9.2 13.4 26.9 6.1 0.4 100.0 8032 Note: Figures are for births in the period 1-59 months preceding the survey. IIf the respondent mentioned more than one attendant, only the most qualified attendant is considered. 85 In several subgroups more than 10 percent of birt_hs were delivered without any type of assistance. These included births to women 35 years or above, four Lake regions, births to women with no formal education, and births that had received no antenatal care. Births of order of four or more were also more likely to be delivered without any assistance. Only 2.5 percent of births or 4.8 percent of all deliveries in health facilities were delivered by caesarean section. 8.2 Vaccinations To obtain information about vaccination coverage, the TDHS collected information on vaccination status of all children born in the preceding five years, although data presented here are restric~l to children who were alive at the time of the survey. The immunization programme in Tanzania is implemented by the Ministry of Health through the Expanded Programme of Immunization (EPI) that began in 1975. By 1986, operation of the programme was established throughout the country (Ministry of Health, 1989). The EPI follows the World Health Organisation's (WHO) guidelines for vaccinating children. To be considered fully vaccinated, a child should receive the following vaccinations: BCG, measles, and three doses each of DPT and polio. BCG is given at birth for protection against tuberculosis; DPT is given for protection against diphtheria, pertussis, and tetanus. In Tanzania, the DPT and polio are given at one, two, and three months of age and measles at 9 months. Thus, according to the recommended schedule, cbildren should have completed all vaccinations before their first birthday. Information on vaccination status was obtained from vaccination cards shown to the interviewers during the survey and from mothers' reports. All MCH clinics in Tanzania provide "road to health" cards (MCH form No. 3), which included dates of vaccinations. If these cards were available, the interviewers recorded vaccination dates dircctly. If a vaccination card was presented, but a vaccine had not been recorded on the card as being given, the mother was asked to recall whether that particular vaccine had been given. If there was no card at all for the child, the mother was asked to recall whether the child had received BCG, polio (including the number of doses), or measles vaccinations. For children without a written record, DPT coverage was not asked about but was assumed to be the same as the mother's report for polio vaccine, since polio and DPT are usually given at the same time. Table 8.5 shows the vaccination coverage among 1616 children aged 12-23 months according to the source of the information used to determine coverage. Overall, 96 percent of children aged 12-23 months were reported by their mother to have had MCH cards. However, interviewers managed to obtain the cards and extract vaccination information from only 78 percent of children. Mother's information was used to ascertain vaccination status for an additional 22 percent of children who bad no cards. As part of the EPI evaluation, immunization coverage surveys were conducted by the Ministry of Health in collaboration with UNICEF and DANIDA in 1989 and 1991. Card retention among children covered by these surveys was 95 percent in 1989 and 90 percent in 1991. The TDHS findings indicate overall BCG vaccination coverage against tuberculosis of 95 percent (see also Figure 8.2). This coverage was ascertained by vaccination card for 77 percent of the children and by mother's report for 18 percent of children without vaccination card. Almost all children (93 percent) received the BCG vaccine within the first year of age, as indicated by the coverage estimate by 12 months in Table 8.5. 86 Table 8.5 Vaccinations by source of inforrnation Percentage of children 12-23 months who had received specific vaccines at any time before the survey and the percentage vaccinated by 12 months of age, by whether the information was from a vaccination card cx from the mother, Tanzania 1991/92 Percentage of children who received: DPT polio Number Source of of information BCG 1 2 3+ 1 2 3+ Measles All t None children Vaceinated at any time before the survey Vaccination card 77.3 76.7 74.4 69.2 76.1 73.0 66.4 66,1 61.3 0.3 1616 Mother's report 18.1 17.4 16.1 10.6 17.4 16.1 10.6 15.1 9,8 3,5 1616 Either source 95.4 94.1 90.4 79.8 93.6 89.1 7%1 81.2 71.1 3.8 1616 Vaccinated by 12 months of age 92.7 91.9 86.4 72.6 91.3 83.8 68,3 68.9 56,4 5.5 1616 Note: The DPT coverage rate for children without a written record is assumed to be the same as that for polio vaccine since mothers were specifically asked whether the child had received polio vaccine. For citildran whose information was based on the mother's report, the proportion of vaccinations given during the first year of life was assumed to be the same as for children with a written record of vaccination. 1Children who are fully vaccinated (i.e., those who have received BCG, measles, and three doses of DPT and polio). Figure 8.2 Vaccination Coverage Among Children Age 12-23 Months Percent 100 90 , o ,0 90 ~ ~o ~ ~ 10 . . . . - - - - Y J J~ o ~ BCG 1 2 3 Polio Note: Based on health card information and mothers' reports. I 2 3 Measle DPT All None TDHS 1990 87 Coverage of the first dose of polio and the first dose of DPT were about the same as for BCG. Based on both vaccination card and mother's information, 94 percent of children had received the first dose of polio and DPT vaccine, and 91 percent of children received these vaccinations by 12 months of age. However, coverage of second and third doses of these vaccinations decreased; 77 percent for polio3 and 80 percent for DPT3. Drop-out rates between the first and third doses of DPT (and polio) were 18 and 15 percent, respectively. ~ Eighty-one percent of children had received measles vaccination, and 69 percent had been vaccinated by 12 months of age. The TDHS found that 71 percent were fully vaccinated and slightly more than a half (56 percen0 of children had received all recommended vaccinations during the first year of life. Only 4 percent of children 12-23 months did not receive any vaccination at all. Compared to the EPI immunization coverage surveys in 1989 and 1991 (Ministry of Health, 1989, 1991), vaccination coverage was generally higher in the 1989 survey than in the 1991 and TDHS surveys (see Figure 8.3). The latter two surveys have comparable results, though a slight increase in coverage was observed. The proportion of fully vaccinated children was 71 percent, while in the EPI 1991 survey it was 62 percent. It is noted that TDHS data do not exclude measles vaccinations given before the recommended age of 9 months and DPT/polio vaccinations given at intervals of less than 4 weeks. Figure 8.3 Vaccination Coverage Among Children 12-23 Months, EPI and DHS Surveys Percent 100 80 60 40 20 0 DPT1 DPT3 Polio1 Pol io3 Meas les TDHS 1991/92 In addition to data from multiple surveys, coverage trends can be assessed with TDHS data. Data on vaccination status of children 12-59 months allow for an evaluation of coverage by 12 months among different age groups. Table 8.6 shows the percentage of children by age group who had been vaccinated by 12 months. The coverage estimates, based on card and mother's recall, for each age group refer to a specific The dropout rate is calculated as (DPT3 - DPT1) / DPT1 * 100 %. 88 Table 8.6 Vaccinations in the first ),ear of life Percentage of children one to four years of age for whom a vaccination card was shown to the interviewer and the percentage vaccinated for BCG, DPT, polio, and measles during the first year of life, by current age of the child, Tanzania 1991/92 Current age of child in months Vaccine 12-13 24-35 36-47 48-59 All children 12-59 months Vaccination card shown to Interviewer 78.1 69.1 61.2 48.0 65.0 Percent vaccinated at 0-11 months a BCG 92.7 89.1 87.0 85.0 88.7 DPT 1 b 91.9 88.0 85.3 81.7 87.0 DPT 2 86.4 82.5 80.5 76.5 81.8 DPT 3 72.6 69.5 67.0 62.0 68.1 Polio 1 91.3 86.8 84.3 82.2 86.5 Polio 2 83.8 78.0 79.2 75.3 79.3 Polio 3 68.3 63.9 63.9 60.9 64.4 Measles 68.9 61.1 60.6 58.7 62.7 All vaccinations ¢ 56.4 50.7 51.0 47.0 51.5 No vaccinations 5.5 9.9 12.7 14.7 10.4 Number of children 1616 1425 1281 1296 5618 alnformation was obtained either from a vaccination card or from the mother if there was no written record. For children whose information was based on the mother's report, the proportion of vaccinations given during the first year of life was assumed to be the same as that for children with a written vaccination record. bThe DPT coverage rate for children without a written record is assumed to be the same as that for polio vaccine, since mothers were specifically asked whether the child had received polio vaccine. CChildren who have received BCG, measles, and three doses of DPT and polio VaCCines. period of time before the survey. For instance, coverage by 12 months among children 12-23 months roughly refers to the programme performance the year before the survey (i.e., 1991, since the mid-point data of the TDHS was December 1991), and data on children 24-35 months refer to 1990 etc. Hence, these results may be used to assess immunization coverage during the first year of life for the period 1988 to 1991. Several points emerge from Table 8.6. First, cards were less likely to be shown for older children, making those coverage estimates somewhat less accurate. All vaccines showed an increase of about 10 percent during 1988-91, with the exception of BCG and the third dose of polio. These findings indicate that the proportion of children vaccinated during the first year of life has been increasing over the last four years. Figure 8.4 displays the trend in vaccination coverage of measles and first and third doses of DPT, using the TDHS data. There is an increasing proportion of children receiving vaccinations during the first year of life. During the same time period, the proportion of children not receiving any vaccination decreased from 15 percent to 6 percent. 89 Figure 8.4 Percentage of Children Who Received DPT1, DPT3, and Measles Vaccine by 12 Months of Age, 1988-1992 Percent 100 90 60 40 20 0 1998 1989 1990 1991 [ "~- DPT 1 '~ OPT3 "" Men ales I 1992 TDHS 1991/92 Table 8.7 shows the distribution of vaccination coverage among children 12-23 months old by background variables. Vaccination status does not differ appreciably by the sex or birth order of the child. Vaccination coverage was relatively higher in Zanzibar and urban areas than in mainland Tanzania and rural areas, respectively. Less than half of children aged 12-23 months were fully vaccinated in Shinyanga and Mara. Kilimanjaro region had the highest vaccination coverage. However, numbers of children are small in most regions. (Note: the unweighted number of observations is larger than the weighted number of observations in several subgroups in Table 8.7.) The coverage of all vaccinations was found to increase with increasing level of education of the mother. 90 Table 8.7 Vaccinations by background charactens6c$ Percentage of children 12-23 months who had received specific vaccines by the time of the stawey (according to the vaccination card or the mother's report) and the percentage with a vaccination card, by selected background characteristics, Tanzania 1991/92 Pe~cotege of children who received: Pew;cotage DPT Polio with Number Background e of characteristic BCG 1 2 3+ 1 2 3+ Measles All I None card children Sex Male 95.5 94.7 90.4 78.8 94.3 88.6 75.2 81.3 69.1 3.7 79.4 810 Female 95.4 93.5 90.5 80.9 92.8 89.6 78.9 81.1 73.1 3.9 76.9 806 Birth order 1 97.5 95.8 92.6 80.9 95.7 91.4 76.2 88.2 72.2 2.5 74.8 340 2-3 96.4 95.8 93.3 82.7 95.4 92.4 80.7 83.7 74.4 3.2 77.9 526 4-5 94.8 92.5 87.2 77.6 91.2 85.1 74.8 75.6 67.7 4.0 79.3 332 6+ 93.0 91.9 87.6 77.2 91.3 86.3 75.0 76.7 68.7 5.5 80.4 418 Residence Mainland 95.3 93.9 90.2 79.4 93.4 88.8 76.6 81.0 70.7 3.9 77.7 1565 Dares Salaam (98.3) (98.3) (96.1) (85.0) (98.3) (96.1) (82.6) (87.0) (77.4) (1.7) (59.1) 55 Other urban 99.5 96.7 96.0 89.4 96.9 95.9 88.1 92.3 84.7 0.5 86.3 273 Rural 94.2 93.1 88.6 77.0 92.4 86.9 73.7 78.3 67.3 4.8 76.7 1237 Zanzibar 100.0 100.0 99.2 92.6 100.0 99.2 92.6 86.5 84.2 0.0 91.0 51 Rqlon Dodoma 96.3 96.3 94.7 85.6 96.3 95.5 85.6 90.9 82.4 3.7 85.9 121 Atusha 93.4 82.6 80.9 77.0 81.9 80.1 67.4 70.9 59.3 6.6 73.8 124 Kilimanjaro 100.0 100.0 98.8 93.2 100.0 98.8 93.2 93.0 88.6 0.0 71.2 79 Tanga 92.9 94.8 86.3 76.7 91.0 85.0 75.3 78.6 67.5 3.8 72.4 78 Morogoro 92.0 92.0 89.6 84.1 92.0 87.9 81.2 84.4 77.2 8.0 79.4 104 Coast 96.8 94.8 87.9 76.2 94.8 87.9 73.0 77.3 67.2 3.2 78.7 21 Liedi 98.2 98.2 98.2 89.2 98.2 98.2 87.3 88.7 81.5 1.8 91.6 35 Mtwara 98.0 98.0 96.1 93.9 98.0 96.1 93.9 88.1 86.2 2.0 84.2 51 Ruvuma 98.2 97.5 97.5 90.5 95.7 93.3 89.0 905 85.8 1.8 87.7 54 hlnga 95.3 91.8 90.9 75.0 91.8 90.3 66.0 83.8 61.5 4.7 66.3 114 Mbeya 100.0 100.0 95.0 92.4 100.0 95.0 89.0 91.6 87.2 0.0 76.1 81 Singida 96.7 94.5 89.2 79.3 94.5 89.2 79.5 81.5 73.6 3.3 90.8 59 Tabora 100.0 98.3 97.2 86.6 93.9 92.8 83.8 79.8 75.1 0.0 91.4 43 Rukwa 98.7 95.9 93.3 80.7 94.7 87.1 76.2 76.8 68.7 1.3 81.3 42 Kigoma 98.0 97.2 95.9 91.3 97.1 91.7 83.1 90.4 78.6 2.0 90.6 65 Shinyanga 89.3 88.1 77.7 53.6 88.8 76.3 57.4 65.7 47.0 9.2 72.3 136 Kagera 96.7 97.0 95.9 84.1 95.2 92.8 80.2 81.8 74.7 2.2 77.3 123 Mwanza 91.0 92.3 85.3 71.2 92.3 82.9 68.1 72.9 61.5 5.1 77.5 119 Mesa 92.0 90.9 79.9 56.1 90.0 80.3 54.3 63.3 48.1 5.0 74.4 62 Mother's education No education 90.9 88.3 82.9 70.9 87.8 81.1 67.1 70.5 60.0 7.9 74.2 539 Primary incomplete 94.7 93.8 92.3 80.8 93.3 90.9 79.5 81.7 73.2 4.1 79.5 292 Completed primary 98.7 98.1 94.6 85.7 97.5 93.6 82.9 88.0 77.9 1.0 80.9 736 Secondary/Higher 100.0 100.0 100.0 83.7 100.0 100.0 83.7 93.8 79.2 0.0 72.2 48 Ali children 95.4 94.1 90.4 79.8 93.6 89.1 77.1 81.2 71.1 3.8 78.1 1616 Note: The DPT coverage rate for children without a written record is assumed to be the same as that for polio vaccine since mothers were specifically asked whether the child had received polio vaccine. Figu~s in parentheses are based on 25 to 49 1Children who are fully vaccinated (i.e., those who have recelv~i BCG, measles, and three domes of DPT and polio). 91 8.3 Acute Respiratory Infection Acute respiratory infection (ARI) is one of the major causes of morbidity and mortality in children in Tanzania. Common symptoms associated with severe ARI include fever, cough, and difficult or rapid breathing. However, fever may be due to other infections, such as malaria. Typically, ARI involves the upper respiratory tract and may progress to involve the lower respiratory tract, leading to lung infection. The most common lower respiratory infection is pneumohia which is associated with high mortality risks. Early diagnosis and treatment with antibiotics can prevent a large proportion of pneumohia deaths. To estimate the magnitude of ARI, mothers were asked if their children had experienced coughing, accompanied by difficult or rapid breathing, during the two weeks preceding the survey. The aim of these questions is to capture children with ARI and needing assessment by a health worker. In other words, children with these symptoms should be taken to a health facility. As Table 8.8 shows, 8 percent of children under five years of age had experienced cough and difficult or rapid breathing at some time in the two weeks preceding the survey. Of these children, 65 percent were seen at a health facility, where 22 percent reportedly Table 8.8 Prevalence and treatment of acute respirator,/infection Percentage of children under five years who were ill with a cough accompanied by rapid breathing during the two weeks preceding the survey, and the percentage of ill children who were treated with specific remedies, by selected background characteristics, Tanzania 1991/92 Among children with cough and rapid breathing Percentage Percentage of children taken to Percentage treated with: with cough a health Antibiotic Don't Number Background and rapid facility or pill or Cough Home know/ of charactedstic breathing provider I syrup Injection syrup remedy Other None Missing children Age of child (months) <6 6.2 48.9 6-11 16,2 73.8 12-23 11.6 71.1 24-35 6.1 65.4 36-47 6.4 48.8 48-59 4,6 61,7 Sex of child Male 8.7 65,5 Female 7.7 64.6 Birth order 1 8.1 68.5 2-3 8.8 64.3 4-5 8.6 56,2 6+ 7.2 71.9 Residence Mainland 8.2 64,8 Dares Salaam 11.4 (62.6) Other urban 11,4 77.9 Rural 7.4 60.9 Zanzibar 8.6 (73.7) Education No education 6.8 60.7 Primary incomplete 7,2 65,1 Completed primary 9.9 66.5 Secondary/Higher 7.3 * Total 8.2 65.1 12.0 16.5 38.0 6.6 49.3 16.8 0.6 756 26.1 29.9 49.5 5.2 53.5 3,3 0.6 798 22.8 23.6 55,6 6.2 51.4 4.7 0.5 1616 15.2 23.2 51.8 6.7 42.5 13.0 0.0 1425 23.6 22.7 48.9 6.0 57.5 4.5 3.9 1281 23.5 31.9 36.9 2.9 33.5 13.9 4.4 1296 20.4 29.4 46.8 4.5 54.7 7.8 1.1 3571 23.2 20,2 52.6 7.1 43.6 7.0 1.5 3600 13,4 19.4 57.0 8.3 43.5 8.2 3A 1557 28,4 23.0 48.7 5.2 45.3 7.8 1.1 2332 24,3 26.4 35.8 4.6 58.4 8.9 0.0 1488 16.6 32.5 57.3 5,2 53.2 4.8 1.2 1795 21,6 25.2 49.2 5.6 49.5 7.4 1.4 6949 (52.0) (37.4) (69,2) (0.0) (62.7) (2.8) (0.0) 322 13.4 30.2 55.8 2.3 50.7 3.1 3.1 1110 21.4 22.6 45.3 7.2 47.9 9.2 0.9 5517 (26.7) (19.2) (60.2) (7.9) (49.5) (7.8) (0.0) 222 16.1 26.0 46,0 8.4 47.6 11.6 2.2 2532 19.0 22,4 58.0 9.5 52.9 5,6 0.8 1324 25.3 25.0 48,7 3.3 48.8 5.8 1,0 3093 * * * * * * * 223 21.7 25.0 49.5 5,7 49.5 7.5 1.3 7171 Note: Figures are for children born in the period 1-59 months preceding the survey. Figures in parentheses are based on a small number of cases, An asterisk means the rate is based on fewer than 25 women and has been suppressed llncludes health clinic, health centre, hospital, private doctor 92 received an antibiotic, 25 percent received injections, and 50 percent received cough syrup. It should be noted that it is usually difficult for mothers to distinguish antibiotic syrup from normal cough syrup. Also, some injections reported here may have been antibiotics. Thus, these categories are not mutually exclusive. Only 6 percent received home remedy (which includes drugs that were available at home). The prevalence of ARI was higher from 6 to 23 months of age and in urban areas (including Dares Salaam). Children in these categories were also more likely to be taken to a health facility (more than 70 percent of children taken). 8.4 Fever Malaria is a leading cause of mortality and morbidity among children in Tanzania. Since the major manifestation of malaria is fever, mothers were asked whether their children had fever in the two weeks preceding the survey and what was done to treat it. Table 8.9 shows that 31 percent of children under five years of age were reported to have had fever and over half of sick children (57 percent) were taken to a health facility for treatment. Among children with fever, 50 percent received antimalarials, 16 percent received antibiotics, and 16 percent were giveninjections. Table 8.9 Prevalence and treatment of fever Percentage of children under five years who were ill with a fever during the two weeks preceding the survey, and the percentage of ill children who were treated with specific remedies, by selected background oharaetarlstlcs, Tanzania 1991/92 Among children with fever Percentage Percentage taken to Percentage treated with: of children a health Don't Number Background with facility or Anti- Anti- Home know/ of characteristic fever provider I malarial biotic Injection remedy Other None Missing children ABe of child (months) <6 27.4 57.0 40.5 9.4 11.9 4.9 54,1 11.4 0,9 756 6-11 43.8 60.6 54.5 18.7 19.2 4.7 54.2 6.0 2.4 798 12-23 40.8 60.8 52.2 15.8 15.2 6.0 47.2 8.7 0.7 1616 24-35 30.3 56.3 49.7 15.6 18.1 4.4 47.2 10.6 0.7 1425 36-47 25.5 50.7 49.0 15.1 14.4 6.2 48.6 7.8 1.5 1281 48-59 19.4 53.4 48.2 16.8 16.1 6.4 43.4 10.9 1.7 1296 Sex of child Male 30.7 56.3 47.1 15,9 17.0 4.7 51.8 8.7 1.2 3571 Female 31.4 58.1 52.9 15.4 15.2 6.2 45.8 9.2 1.3 3600 Birth order 1 28.4 63.0 53.0 14.4 14.7 5.6 51.2 7.0 2.7 1557 2-3 32.2 59.0 48.8 17.4 13.9 4.2 48.6 11.3 0.5 2332 4-5 31.1 53.7 44.3 16.7 18.0 6.6 48.1 8.1 1.5 1488 6+ 31.8 53.2 54.1 13.4 18.5 6.1 47.4 8.2 0.8 1795 Residence Mainland 30.8 56.5 49.5 14.6 16.4 5.5 49.0 9.2 1.3 6949 Dares Salaam 38.9 69.1 59.5 34.6 21.7 0.0 60.9 0.7 3.2 322 Other urban 35.4 62.7 48.9 10.1 23.1 1,1 60,7 3.2 1.0 1110 Rural 29.4 54.0 48.8 14.2 14.3 7.0 45.2 11.3 1.2 5517 Zanzibar 38.3 76.5 65.1 41.6 8.8 4.2 42,2 3,1 0.6 222 Education No education 30.1 50.5 49.7 14.3 14.5 8.6 42.9 12.1 0.7 2532 Primary incomplete 31.8 49.7 51.4 11.7 12.9 6.9 51.8 8.0 1.7 1324 Completed primary 31.6 63.7 49.3 17.5 18.0 2.8 52.0 7,3 1.5 3093 Secondary/Higher 29.7 88.2 57.0 29.2 25.1 0.0 47.3 3.8 1.0 223 Total 31.0 57.2 50.1 15.6 16.1 5.5 48.7 9.0 1.2 7171 Note: Figures are for children born in the period 1-59 months preceding the survey. llncludes health clinic, health cenlxe, hospital, pdva~ doctor 93 Fever was more prevalent in the 6 to 23 months age group than in any other age group. Children of more edu- cated women were more likely to be taken to the health facility and given anti- malarials, antibiotics, or injections than those of women with no education. 8.5 Diarrhoea Diarrhoea is a major cause of morbidity and mortality among children in Tanzania. Thirteen percent of children under five years of age were reported to have diarrhoea during the two weeks be- fore the survey, including 2 percent with bloody diarrhoea (see Table 8.10). Four percent were still having an episode of diarrhoea at the time of the survey (diar- rhoea within the last 24 hours). As for ARI and fever, children aged 6 to 23 months were more likely to have a diarrhoeal episode in the two weeks preceding the survey; prevalence is twice as high among these children as all other children. This peak in diarrhoea prevalence is partly due to the hazards as- sociated with the weaning period. Chil- dren of women with secondary education and above had lower prevalence of diar- rhoea than those of less educated women. Dehydration is a major complica- tion of diarrhoea and is the most impor- tant cause of mortality among children with acute diarrhoea. Oral rehydration therapy (ORT) is recommended for pre- vention or treatment of dehydration and includes a solution prepared from com- mercially produced packets of oral re- hydration salts (ORS) or homemade fluids prepared from sugar, salt, and water. In Tanzania, the use of ORS and homemade fluids is being promoted by the Ministry of Health. Increasing the amount of any other type of fluids during a diarrhoea episode can also be considered ORT. Table 8.10 Prevalence of dian'hoea Percentage of children under five years who had d~arrhoea and diarrhoea with blood in the two weeks plecedlng the survey, and the percentage of children who had diarrhoea in the laeceding 24 hours, by selected background characteristics, Tanzania 1991/92 Diarrhoea in the All preceding 2 weeks I diarrhoea in the Number Background All Diarrhoea pt~vdin of characteristic diarrhoea with blood 24 ho~ § children Child's age (months) < 6 11.5 0.7 4.0 756 6-11 26.1 3.5 9.3 798 12-23 21.1 2.5 6.9 1616 24-35 10.5 2.4 3.5 1425 36-47 7.4 2.0 2.4 1281 48-59 4.3 0.7 1,1 1296 Sex Male 12.9 2.1 4.3 3571 Female 13.2 1.9 4.3 3600 Birth order 1 14.5 2,0 4.7 1557 2-3 12.6 1.9 4.2 2332 4-5 13.0 2.0 4.6 1488 6+ 12.5 2.1 3.9 1795 Residence Mainland 13.1 2.0 4.2 6949 Dares Salaam 12.0 3.0 2.3 322 Other urban 15.9 1.9 4.8 1110 Rural 12.6 2.0 4.1 5517 Zanzibar 12.7 0.4 9.5 222 Region Dodoma 17.0 0.1 3.2 532 Arusha 23.3 4.4 9.0 503 KiIimanjaro 10.8 0,9 2.8 348 Tanga 12.3 1.6 3.6 364 Morogoro 22.6 3.9 3.7 394 Coast 18.3 3.4 6.0 102 Lindi 17.8 3.0 6.7 157 Mtwara 10.4 1.8 3.3 186 Ruvuma 10.4 0.5 2.5 243 Ifinga 13.5 2.4 3.4 401 Mbeya 12.2 3.8 4.7 347 Singida 20.8 2.2 5.6 282 Tabour 6.5 0.7 2.1 215 Rukwa 13.7 1.8 4.7 205 Kigoma 11.9 1.2 4.8 319 Shlnyanga 8.4 1.8 4.5 709 Kagera 6.1 0.9 2.9 482 Mwanza 7.7 2.2 3.7 539 Mara 11.1 1.9 3.9 300 Mother's education No education 12.2 1.7 4.5 2532 Primary incomplete 11.3 2.6 3.8 1324 Completed primary 15.0 2.1 4.5 3093 Secondary/Higher 7.4 0.2 2.8 223 All children 13.1 2.0 4.3 7171 Note: Figures are for children born in the period 1-59 months laeoeding the survey. 1Includes diarrhoea in the past 24 hours 94 In TDHS, most mothers (93 percem) who gave birth in the previous five years knew about ORS (see Table 8.11). The level of knowledge did not change significantly with age of the mothers. Women with no education had slightly lower knowledge of ORS than educated women. Two-thirds of mothers reported to have ever used ORS. Younger women and those with no education were less likely to have ever used ORS, Table 8.11 Knowledge and use of ORS packets Percentage of mothers with births in the five years precMing the survey who know about and have ever used ORS packets, by selected background characteristics, Tanzania 1991/92 Know Have ever Number Background about ORS used ORS of characteristic packets packets mothers Age 15-19 89.2 47.6 507 20-24 92.2 63.1 1380 25-29 96.1 70.5 1326 30-34 93.5 73.2 890 35+ 91.5 72.3 1209 Residence Mainland 92.8 67.0 5166 Dares Salaam 89.4 68.2 276 Other urban 95.9 71.3 914 Rural 92.3 65.9 3976 Zanzibar 98.8 76.2 146 Reginn Dodoma 98.0 64.5 410 Arusha 90.7 62.5 366 Kilimanj art 95.2 71.1 249 Tanga 85.3 64.6 283 Morogoro 94.5 56.3 328 Coast 94.6 64.9 81 Liadi 97.9 64.3 133 Mtwara 97.6 74.6 160 Ruvuma 97.8 78.2 181 Iringa 95.7 71.5 313 Mbeya 95.5 72.9 258 Singida 97.2 70.5 205 Tabora 97.6 81.6 149 Rukwa 94.5 67.5 142 Kigoma 90.8 64.3 222 Shinyanga 85.6 61.6 487 Kagera 91.6 66.7 327 Mwanza 89.5 65.1 365 Mara 93.1 70.5 230 Education No education 88.6 63.0 1834 Primary incomplete 94,0 71.2 987 Completed primary 95.5 68.0 2322 Secondary/Higher 98.6 79.7 169 All mothers 93.0 67.2 5312 Note: Figures include mothers who have given ORS for diarrhoea during the preceding two weeks, although they were not asked about knowledge of ORS packets. 95 Diarrhoea treatment practices of children who had diarrhoea in the two weeks preceding the survey is shown in Table 8.12 and Figure 8.5. About 60 percent of children with diarrhoea were taken to a health facility for treatment. Children under 6 months of age and those of uneducated mothers were less likely to be taken to the health facility for diarrhoea treatment. Over half of children (57 percent) were given a solution prepared from ORS packets, while 19 percent received homemade solution of sugar, salt, and water. The use of homemade solution was low probably because many mothers do not know how to prepare the solution or prefer to go to a health facility. Over a quarter (28 percent) of children with diarrhoea were not given either solution nor did they receive an increased amount of fluids. Use of ORS was more common among educated women, with less educated women more likely to use homemade solution. Overall, about a third (30 percent, including those increasing breastfeeding) of children received increased fluids during the recent episode of diarrhoea. Children of educated mothers were much more likely to have increased fluid intake during diarrhoea attack (68 percent). Table 8.12 Treatment of diarrhoea Percentage of children under five years who had diarrhoea in the two weeks preceding the survey who were taken for treatment to a health facility or provider, the percontage who received oral rehydration therapy (ORT), the percentage who received increased fluids, the percentage who received neither ORT nor increased fluids, and the percentage receiving other treatments, according to selected background characteristics, Tanzania 1991/92 Backgl'ound characteristic Oral rehydration Per- Percentage Percentage retrying Percentage therapy (ORT) centage receiving other treatmonts: Number taken to receiving neither of a health in- OPT nee Home children facility or ORS creased increased Anti- In- remedy/ with provider 1 packets RHF fluids fluids biotics jeedon Other None Missing diarrhoea Age of child (months) <6 44.5 47.3 20.2 33.4 33.9 14.5 0.8 20.4 16.7 0.0 87 6-11 64.7 65.0 18.2 34.1 22.3 30.5 7.7 18.5 IL l 0.5 208 12-23 63.2 57.5 20.4 27.7 28.5 14.0 5.0 20,1 12.1 0.0 341 24-35 59.9 54.3 18.2 29.6 31.4 24,3 1.6 27.2 14.0 0.5 149 36-47 51.1 54.7 18.8 25,1 26.3 15.8 3.1 13.3 9.3 1.9 95 48-59 54.4 56.7 13.6 39.5 32.7 29.9 4,9 16.6 15.6 1.0 55 Sex of child Male 56.8 55,8 20.8 30.4 29,0 20.8 1.9 17.9 13.6 0.8 460 Female 62.2 59.0 17.2 30.4 27.2 20.2 6.9 22.0 11.5 0,1 476 Birth order 1 64.2 61.1 16.7 33.8 26.0 21.7 8.0 24.4 12.6 0.0 226 2-3 62.6 59.8 17.2 26.9 29.1 22.8 5.5 18.1 10.0 0.0 293 4-5 55.9 56.6 22.4 33.0 25.2 19.1 1.1 18.2 11.3 0.3 193 6+ 53.8 51.1 20.7 29.4 31.4 17.4 2.5 19.5 16.9 1.6 224 Residence Mainland 59.2 57,5 19.1 30.3 27.8 20.3 4.6 20.3 12.3 0.4 908 Dax es Salaam (62.1) (30.9) (42.7) (34.8) (34.0) (21.8) (5.5) (21.1) (11.8) 0.0 39 Other urban 71.9 60,5 19.7 42.2 24.0 29.5 16.3 18.7 8.6 0.4 176 Rural 55.9 58,2 17.6 27,0 28.4 17.9 1.6 20.6 13.3 0,5 693 Zanzibar 69.0 53,3 15.6 33.7 37.3 25.4 0.0 10.4 20.6 0.0 28 Education No education 53.8 54.8 14.4 20.9 34.0 17.7 1.8 22.2 15.4 1.1 308 Primary incomplete 60.7 51.7 24.4 38.0 22.8 15.5 4.6 16.7 11.9 0.0 149 Primary completed 62.1 60.1 20.7 32.9 26.3 22.6 4,8 20.2 10.9 0.2 462 Secondary/Higher 85.4 81.5 5.8 68.2 16.4 58.1 44.3 2.5 11.2 0.0 16 Total 59.5 57,4 19.0 30.4 28.1 20.5 4.5 20.0 12.5 0.4 936 Note: Figures are for children born in the period 1-59 months preceding the survey. Oral rehydration therapy (ORT) includes solution prepared from ORS packets, and recommended home fluid (sugar-salbwater solution). Increased fluids includes ~ncreased frequency of breasffeeding. Rates shown in parentheses are based on 25-49 women. Includes health post, health centre, hospital, and private doctor. 96 Figure 8.5 Percentage of Children Age 1-59 Months Who Received Treatment for Diarrhoea in the Two Weeks Preceding the Survey by Type of Treatment Taken to Health Fae, ORS Packet Home Solution Increased Fluids Ant ib iot ic/ In ject ion Home Remedy 60 57 10 20 30 40 50 60 Percent 70 TDHS 1991/92 Use of injections in the treatment of diarrhoea was very low (5 percent). Although ORS is generally accepted as a stand- ard modem treatment of diarrhoea, one-fifth (21 percen0 of chil- dren with diarrhoea were given antibiotic treatment. In some cases this may have been justified. For instance, 2 percent of chil- dren reportedly had diarrhoea with blood during the 2 weeks pre- ceding the survey, which requires antibiotic treatment. However, the proportion receiving antibiotics is much larger, which indi- cates that there is a need for educating health workers about appropriate treatment of diarrhoea. Over half the children of edu- cated mothers (58 percent) were given antibiotics. It is possible that educated mothers are more likely to request the health workers to provide antibiotics or to buy antibiotics from private drug stores. Many drug stores in Tanzania sell drugs, including antibiotics, without a medical prescription. Twenty percent of children were given home remedies other than the recommended home solution. Continuing or increasing breastfeeding during diarrhoea is a recommended practice. About 79 percent of breastfed chil- dren who had diarrhoea were breastfed by their mothers at the usual frequency (Table 8.13). Only 8 percent of children had their breastfeeding frequency increased, and 9 percent had their fre- quency reduced. Table 8.13 Feeding practices during diarrhoea Feeding practices among children under five years who had diarrhoea in the two weeks preceding the survey, Tanzania 1991/92 Feeding pr~tiees Percent Breasffeeding IYeqoeney I Same as usual 79.3 Increased 7.5 Reduced 9.4 Stopped 0.4 Don't know/missing 3.4 No ~eastfeeding 27.4 Number of children 831 Amount of fluids given Same as usual 57.7 More 27.2 Less 13.3 Don't know/missing 1.9 Number of children with diarrhoea 936 Note: Figures are for children born in the ~Ariod 1-59 months preceding the survey. pplies only to children who are still breastfed. 97 CHAPTER 9 MATERNAL AND CHILD NUTRITION This chapter focuses on several aspects related to the nutritional status of mothers and children under five years. The TDHS data allow an assessment of infant feeding practices (including breastfeeding practices, introduction of supplementary weaning foods, and use of feeding bottles), birth weight of newborns, child anthropometric status (based on height and weight measurement of the respondent's children under the age of five years), and mother's anthropometric status. 9.1 Breastfeeding and Supplementation Breastfeeding practices and introduction of supplementary foods are important determinants of the health and nutritional status of children, particularly those below the age of two years. Many studies have shown the beneficial effects of breastfeeding on nutritional status, morbidity, and mortality of young infants. Breasffeeding also has an indirect effect on postpartum fertility of the mother, More frequent breastfeeding for longer durations is associated with longer periods of postpartum amenorrhoea. Longer periods of postpartum amenorrhoea are related to longer birth intervals, and thus lower fertility levels. Almost all children born in the five years before the survey (98 percent) were breastfed for some period of time (Table 9.1). The proportion of children ever breasffed was high across all regions and did not vary significantly by other background characteristics. Early initiation of breastfeeding is beneficial for mother and child. From the mother's perspective early sucking stimulates the release of a hormone that helps the uterus to maintain a contracted state. From the child's perspective the first breast milk (colostrum) is important, since it is rich in antibodies. About 44 percent of children were put to the breast within one hour of birth and 82 percent within the first day. Women in Zanzibar were more likely to start breastfeeding within one hour of birth than their counterparts on Tanzania mainland. Women in Tanga, Coast, and Shinyanga were less likely to start breastfeeding within the initial hour after birth than in other regions. Mothers were asked about the current (last 24 hours preceding the interview) breastfeeding status of all living children under five years. The results are presented in Table 9.2. Although exclusive breastfeeding is recommended for the first 4-6 months of life, only 43 percent of children 0-1 months received breast milk only. The proportion of children exclusively breastfed declined further at 2-3 and 4-5 months to 24 and 8 percent, respectively. Many young infants appeared to receive water only in addition to breast milk in Tanzania. This practice, often referred to as full breastfeeding (breasffeeding with or without plain water), is common in many parts of Africa, and has no biomedical benefits. However, it does pose an additional risk of transmitting infections and may also interfere with breastfeeding. More than one-third of children 0-1 months received breast milk with water, and 29 and 16 percent were in this feeding category at 2-3 and 4-5 months, respectively. After 4-6 months of age, exclusive breastfeeding is not sufficient for the child and introduction of supplementary foods is required. Indeed, the majority of childreninTanzania received supplementary foods or liquids in addition to breast milk during the second half of infancy: 84 percent at 6-7 months and more than 90 percent at 8-9 and 10-11 months. 99 Table 9.1 Initial breastfeeding Percentage of children born in the five years preceding the survey who were ever breasffed, and the percentage of last-born children who started breasffeeding within one hour of birth and within one day of birth, by selected background characteristics, Tanzania 1991/92 Among all children: Among last-born children, percentage who started breasffeeding: Percentage Number Within Within Number Background ever of 1 hour 1 day of characteristic breastfed children of birth of birth children Sex M~e 97.5 4111 43.9 82.0 2727 Female 97.7 4007 43.8 81.9 2680 Residence Mainland 97.6 7878 43.4 81.5 5256 Dar es Salaam 95.6 381 39.9 80.9 281 Other urban 97.4 1277 46.1 83.6 934 Rural 97.7 6220 43.0 81,1 4041 Zanzibar 98.7 240 60.7 96.8 151 Region Dodoma 97.3 624 54.9 90.0 419 Arusha 98.2 543 46.5 91.6 376 Kilimanj~o 95.6 372 35.2 84.6 253 Tanga 97.7 410 22.3 68.3 289 Morogoro 96.9 475 65.6 89.7 337 Coast 96.5 117 25.5 79.7 83 Lindi 96.9 178 43.5 92.2 134 Mtwara 96.9 210 47.1 90.9 162 Ruvuma 97.7 273 48.2 93.3 186 lfinga 96.4 446 53.3 82.6 314 Mbe~a 97.4 379 50.4 83.4 266 Singlda 98.7 308 52.1 92.5 207 Tabora 98.9 232 48.4 86.3 151 Rukwa 96.7 223 49.0 83.9 144 Kigoma 95.0 360 53,4 84.8 225 Shinyanga 99.2 807 25.7 64.6 492 Kagera 98.8 564 47.7 81.9 331 Mwanza 98.7 608 30.0 67.3 373 Mara 98.4 368 31.0 67.9 234 Mother's education No education 97.6 Primary incomplete 98.0 Completed primary 97.4 Secondary/Higher 97.6 Assistance at delivery Medically trained person 98.0 Traditional birth attendant 97.5 Other or none 97.9 Missing (28.5) Place of delivery Health facility 98.0 At home 97.8 Other * Missing 73.3 2872 46.5 82.4 1872 1520 40.8 84.0 1000 3480 42.8 80.5 2360 244 47,3 85.3 175 4426 44.2 83.7 2996 977 49.9 85.9 625 2680 41.3 78.0 1774 34 * * 11 4317 44.1 83.7 2915 3700 43.8 80.1 2431 3 * * 2 97 31.5 72.8 59 All children 97.6 8117 43.8 82.0 5407 Note: Rates shown in parentheses are based on 25-49 women, whereas an asterisk means the rate is based on fewer than 25 women and has been suppressed, Table is based on all children born in the five years preceding the survey, whether living or dead at the time of the interview. 100 Table 9.2 Breastfeeding status Percent distribution of living children by breastfeeding status, according to child's age in months, Tanzania 1991/92 Age in months Percentage of living children who are: Breasffeeding and: Number Not Exclusively Plain of breast- breast- water Supple- living feeding fed only ments Total children 0-1 0.8 42.5 35.2 21.6 100.0 237 2-3 0.8 23.5 28.7 47.0 100.0 274 4-5 0,0 7.6 15.7 76,6 100.0 329 6-7 2.5 5.6 7.8 84.1 100,0 264 8-9 0.2 1.4 4.0 94.3 100.0 267 10-11 0.8 0.0 2.6 96.6 100.0 267 12-13 5.2 0.8 3.4 90,7 100.0 285 14-15 5.7 0.7 3.5 90.1 100,0 280 16-17 14.7 0,4 0.6 84.2 100.0 278 18-19 22.4 1,3 0.8 75.5 100.0 262 20-21 32.7 0.0 1.4 65.9 100.0 239 22-23 52.7 0.6 1.2 45.5 100.0 271 24-25 75.6 0.0 0.8 23.6 100.0 244 26-27 85.2 0.0 0.0 14.8 100.0 228 28-29 91.9 0.0 0.0 8.1 100.0 243 30-31 92.0 0.0 0.3 7,7 100.0 248 32-33 94.1 0.0 0.4 5.5 I00.0 249 34-35 93.5 0.0 0.3 6.2 100.0 213 Note: Breasffeeding status refers to preceding 24 hours. Children classified as breastfeeding and plain water only receive no supplements. Continuing breastfeeding beyond the first birthday is common. About 95 percent of children 12-15 months were still breastfed as were 78 percent at 18-19 months. Although most women stopped breastfeeding during the second half of the second year of life, one-fourth of children 24-25 months continued being breastfed. Mothers ofbreastfed children receiving supplementary feeding were asked to name the type of foods they had given their children during the last 24 hours and whether they had used a bottle and teat (nipple). In general, use of infant formula was relatively low (less than 10 percent of infants), although a substantial number of child ren were given other types of milk (Table 9.3). Infant formula is quite expensive in Tanzania and most people cannot afford it. Use of other milk was less common (5 percent) below age of two months, while between the ages of 2 and 24 months, over 20 percent of children were receiving types of milk other than breast milk. Solid or mushy food was introduced into the diet early. About 3 percent of breasffeeding children reportedly received solid or mushy foods before reaching two months of age. However, too few children 6-9 months of age receive solid foods and breast milk (60 percent), the age by which all children should receive complementary solid foods. 101 Table 9.3 Breastfeeding and supplementation by age Percentage of breastfecding children who are receiving specific types of food supplementation, and the percentage who are using a bottle with a nipple, by age in months, Tanz~mia 1991/92 Age in months Percentage of breastfeeding children who axe: Receiving supplemem Using a bottle Number Infant Other Other Solid/ with a of formula milk liquid mushy nipple children 0-1 0.0 5.0 15.4 2.7 0.7 236 2-3 4.5 21.6 26.5 8.7 6.6 272 4-5 7.3 31.1 43.4 30.2 4.2 329 6-7 10.2 28.5 56.3 45.8 7.7 258 8-9 17.7 35.8 55.6 72.9 5.2 266 10-11 6.9 33.3 61.3 80.2 4.9 265 12-13 10.3 26.8 52.5 89.5 3.9 270 14--15 13.5 36.2 62.1 89.6 5.4 264 16-17 14.0 33.2 58.6 91.2 3.3 237 18-19 11.7 37.0 62.9 91.5 4.5 203 20-21 4.4 31.2 63.1 91.6 10.2 161 22-23 14.3 28.2 57.3 94.1 3.6 128 24-25 20.0 23.9 59.1 88.7 2.2 60 Note: Breastfeeding status refers to preceding 24 hours. Percents by type of supplement among breastfeeding children may sum to more thma 100 percent, as children may have received more than one type of supplement. Although a substantial proportion of breastfed children across all age categories were given other milk, bottle feeding was not common. Only 4 percent of children 0-5 months and 6 percent of children 6-11 months received something in a bottle during the last 24 hours. These results suggest that the majority of children receiving other milk are not using a bottle and nipple. Prolonged breastfeeding is common in Tanzania. Based on current status data, the median duration of breastfeeding was 21.6 months (Table 9.4). There was very little difference in median duration of breastfeeding between urban and rural areas. Compared to other regions, the median duration of breastfeeding was found to be lower in Tanga, Shinyanga, and Mbeya. However, the numbers of observations are small and these figures should be interpreted cautiously. Median duration of breastfeeding was found not to vary by mothers education, type of assistance at delivery, and sex of the child. Children were categorized as fully breastfed if they were receiving only breast milk or if water was the only addition to their diet. The median duration of full breastfeeding nationwide was 2.3 months. The median duration of full breastfeeding was longer in rural areas than in urban areas and among women with no education than in educated women. Most educated women and those in urban areas tend to be employed and hence are more likely to introduce supplementary foods to their children early. The longest median duration of full breastfeeding was reported in Shinyanga (5 months), whereas in Dares Salaam, Lindi, and Kigoma it was less than one month. 102 Table 9.4 Median duration and frequency of breastfeeding Median duration of any breastfeeding, exclusive breastfeeding, and full breastfeeding among children under 5 years of age, and the percentage of children under 6 months of age who were breasffed six or more times in the 24 hours preceding the interview, according to background characteristics, Tanzania 1991/92 Children under 6 months Median duration in month.s t Number of Breasffed children 6+ times Any Exclusive Full under in Number Background breast- breast- breast- 3 years preceding of characteristic feeding feeding feeding 2 of age 24 hours children Region Mainland 21.6 0.6 2.3 Dar es Salaam 20.1 0.4 0.6 Other urban 21.3 1.0 1.6 Rural 21.7 0.7 2.5 Zanzibar 21.2 0.4 1.9 Residence Dodoma 24.5 0.9 2.4 Arusha 20.4 0.6 1.6 Kilimanj are 22.6 0.5 1.0 Tanga 16.2 0.4 1.6 Murogoro 22.2 0.4 2.0 Coast 24.9 0.4 1.6 Lindi 23.4 0.5 0.7 Mtwara 23.4 0.4 3.3 Ruvuma 23.1 0.4 1.7 Idnga 22.0 0.6 3.1 Mbeya 17.5 1.7 2.0 Singida 21.2 0.6 2.5 Tabura 22.9 1.2 2.0 Rukwa 21.7 0.5 2.3 Kigoma 20.6 0.4 0.7 Shinyanga 17.2 2.3 5.0 Kagera 24.6 2.4 3.2 Mwanza 20.6 1.4 2.5 Mara 19.3 0.7 1.3 Education No education 21.8 0.7 3.0 Primary incomplete 21.8 0.7 2.3 Completed primary 21.5 0.6 1.9 Secondary/Higher 19.8 0.4 1.9 Assistance at delivery Medically trained 21.6 0.6 2.1 Traditional midwife 21.6 0.6 1.9 Other or none 22.6 0.6 3.2 Missing 20.8 2.0 3.4 Sex of child Male 21.7 0.7 2.4 Female 21.6 0.6 2.2 Total 21.6 0.6 2.3 Mean 21.2 2.2 4.1 Prevalence/Incidence s 21.1 1.5 3.5 4981 93.3 823 229 96.4 44 854 87.7 120 3898 94.1 660 150 (90.7) 17 424 (100.0) 365 86.1) 220 85.4) 258 86.0) 282 73 97.2) 106 89.4) 124 79.0) 168 85.0) 277 98.3) 238 * 202 94.8) 146 (100.0) 141 92.0 223 93.2) 511 98.8 368 98.5) 389 86.1) 236 87.5 82 63 32 44 36 11 20 19 24 45 33 34 29 27 35 84 71 49 41 1720 94.4 268 943 93.0 146 2306 93.9 397 163 75.1 29 2747 93.0 466 620 94.1 106 1433 94.3 224 332 88.4 44 2602 93.3 444 2530 93.2 396 5131 93.2 841 Note: Rates shown in parentheses are based on 25-49 women, whereas an asterisk means the rate is based on fewer than 25 women and has bean suppressed. IMedians and means are based on current status 2Either exclusive breasffeeding or breasffeeding and plain water only 3Prey alence-incidence mean 103 Ninety-three percent of children under six months of age were breastfed six or more times in the 24 hours preceding the interview. An important determinant of child caloric intake is the number of meals given to a child per day. Table 9.5 presents the number of meals given to the child the day before the survey by age of the child. Most children reportedly had three meals (38 percent), while one-third had two meals and 15 percent had less than two meals the day prior to the interview. Only 6 percent of children had four meals or more. There is, however, marked variation by age, which presumably is related to breastfeeding. For instance, most children under 6 months of age did not receive a meal the previous day. Therefore, the focus in this table should be on older children. Almost half of children aged 2 years and over had three meals the previous day, and about one-third had two meals. Less than 5 percent of children aged 2 years and over had less than two meals. Table 9.5 Feeding patterns for children under 5 Percent distribution of children under five years by number of meals in last 24 hours by age, Tanzania 1991/92 Number of meals Age in Don't months 0 1 2 3 4 5 6 know Missing Number < 6 45.4 12.7 13.7 5.9 1.0 0.3 0.2 3.3 17.5 756 6-11 15.6 20.4 32.3 22,9 5.4 1.2 0.0 1.0 1.1 798 12-23 2,0 11.7 39.3 37.6 5.7 1.3 0.2 2,0 0.2 1616 24-35 0,3 3.3 36.4 45.6 5.3 1.2 0.4 7,5 0.3 1425 36-47 0,2 3.7 31.1 49.6 5.4 1.3 0,0 8.8 0.8 1281 48-59 0.1 3.7 30.5 49.5 4.9 0.5 0.3 10.5 t.1 1296 Total 7.1 8.2 32,1 38.3 4.9 1.0 0.2 5.8 2.4 7171 9.2 Birth Weight Data on birth weight are important for two reasons. First, national estimates of the incidence of low birth weight are internationally recognised indicators of the well-being of neonates and women of reproductive age. Second, the weight at birth is a leading determinant of the survival chances of a newbom. The main sources of birth weight data in developing countries are health facility statistics. However, these data are usually limited to babies born within health facilities, a group of babies that is markedly different from the overall population. Recent studies have shown that surveys can provide useful information on birth weight (Moreno and Goldman, 1990). Therefore, TDHS included questions on birth weight for all children born in the five years preceding the survey. The mother was first asked to recall the size of the child at birth: very large, large, average, small, or very small. Then, she was asked whether the child had been weighed at birth, and, if so, what the weight was. Table 9.6 shows that slightly more than half of births in the last five years had been weighed at birth (52 percent). Almost all mothers who reported their child had been weighed could actually recall the weight (50 percent). The proportion of children with numerical birth weight does differ considerably by residence and region. In urban areas (including Dares Salaam) more than 80 percent knew the birth weight of their children, compared to 41 percent in rural mainland and 31 percent in Zanzibar. Kilimanjaro region also had 104 Table 9.6 Birth weight data Among children born in the five years preceding the survey, the proportion weighed at birth and the percent dista'ibution by type of birth weight data (recalled weight or size at birth), according to background characteristics. Tanzania 1991/92 Weighed at birth Type of birth weight data Background Don't know/ Numeric Size charact~rlstic Yes No Missing Total weight only None Total Number Residence Mainland 52.6 46,9 0.5 100.0 50,2 49.4 0.4 100.0 7793 Dares Salaam 86.9 12.6 0.5 100.0 86.9 12,6 0.6 100.0 373 Other urban 86.6 13.1 0.3 100.0 84.9 15.0 0.1 lO0.O 1273 Rural 43,5 56.0 0.5 100.0 40.8 58.7 0.5 100.0 6148 Zanzibar 31.7 68.2 0.2 100.0 30.7 69.3 0.0 1(30.0 238 Region Dodoma 57.7 42.3 0.0 100.0 56.6 43.4 0.0 100.0 623 Arusha 48.9 49.4 1.7 100.0 47.6 52,0 0.3 100.0 534 Kilimanjaro 83.5 15.7 0.8 100.0 81.2 18.8 0,0 100.0 368 Tanga 54.6 44.9 0.5 100.0 51.7 42.8 5.5 100.0 406 Morogoro 55.4 44.2 0.5 100,0 54.1 45.9 0.0 100.0 471 Coast 54.5 44,7 0.8 100.0 54,2 45.8 0.0 100.0 116 Lindi 58,8 38.9 2.3 100.0 54.2 45.8 0.0 100.0 178 Mtwara 46.6 53.4 0.0 100.0 39.7 60.3 0.0 100.0 208 Ruvunm 70.9 28.9 0.2 100.0 64.6 35.4 0,0 100.0 271 lfinga 60.6 38.2 1.1 100.0 58.7 41.3 0.0 1130.0 439 Mbeya 51.2 48.8 0.0 100.0 47.8 52.2 0.0 100.0 375 Singida 53.7 46.0 0.3 100.0 51.0 49.0 0.0 100.0 306 Tabora 66.3 33.7 0.0 100.0 61.8 38.2 0.0 100.0 231 Rukwa 44,1 54.4 1.5 100.0 42.2 57.6 0.2 100.0 223 Kigoma 36.6 62.8 0.6 100.0 34.9 64.7 0.5 100,0 358 Shinyanga 39.5 60.3 0.1 100.0 35.4 64.6 0.0 100.0 791 Kagera 39.0 61,0 0.0 100,0 37.5 61.9 0.6 100.0 554 Mwanza 38.6 61.4 0.0 100.0 36.3 63,4 0.3 100.0 605 Mara 38.0 61.0 0.9 100.0 37.9 62.1 0.0 100.0 363 Education No education 36.5 62.9 0.6 100.0 32.8 66.7 0.5 100.0 2841 Primary incomplete 53.4 45.9 0.7 100.0 51.4 48.2 0.4 100.0 1501 Completed primary 61.8 37.9 0.3 100.0 60.3 39.3 0.4 100.0 3448 Secondary/Higher 83.7 15.8 0.5 100.0 83.3 16.7 0.0 100,0 242 Total 52,0 47.6 0.5 100.0 49.6 50.0 0.4 100.0 8032 more than 80 percent of births with known birth weights. At the lower end are Shinyanga and Kagera with 35 percent of births with known birth weight. Table 9.7 presents a national estimate of the mean birth weight and the incidence of low birth weight for births in the five years preceding the survey. Low birth weight is defined as birth weight less than 2500 grams. Since there was considerable heaping of responses at 2500 grams, half of these births have been considered as below 2500 grams and half of these as at least 2500 grams. The mean birth weight for children with known birth weight was 3024 grams, and the incidence of low birth weight was 16.9 percent. As indicated above, these estimates may be biased, since women delivering in health facilities are a selective sample. Therefore, data on size at birth were used to obtain an estimate of mean birth weight and the incidence of low birth weight for the whole population. 105 Comparing the subjective sizes of chil- dren at birth shows that the distribution among children with no known/reported birth weight is skewed towards smaller sizes compared to chil- dren with known birth weights: there are more small children and fewer large children if the birth weight was not known. Among children with known birth weight there is a strong rela- tionship between birth weight and reported size at birth. The mean birth weights for each size category are used to calculate the mean birth weight among children with no numerical birth weight. Thus, the estimated mean birth weight for all children in Tanzania is 3008 grams and the incidence of low birth weight is 18.0 percent. This indicates that low birth weight is a signifi- cant public health problem in Tanzania. Its rela- tively high incidence may be due to poor health and nutritional status of women, to malaria and other infectious diseases, and to poor nutrition during pregnancy. 9.3 Child Nutritional Status Nutritional status is a major determinant of children's susceptibility to diseases and is in- fluenced by feeding practices as well as infec- Table 9.7 Mean birth weight and incidence of low birth weight Mean birth weight (in grsr~) and inbiden¢¢ of low blgh weight (<2500 grams) estimated from numei'ieal birth*w~ght data and size at birth among children born in the five years preceding the survey, Tanzania 1991,,92 Birth Children with weight numerical known birth weight Mean Low birth Size birth weight at birth Yes No weight (<2500 g) Very large 1.8 1.3 3741 3.3 Large 10.2 6.7 3703 1,l Average 78.6 80.8 3023 14.4 Small 7,0 7.1 2250 70.7 Very small 2.1 2.5 1791 88.3 Don't know/Missing 0.3 1.5 3065 14.0 Total 100,0 100.0 3024 16.9 Low Percent Mean birth of all birth weight births weight (<2500 g) Children with numerical weight 49.8 3024 16.9 Children with no numerical weight 50.2 2992 19.1 All children 100.0 3008 18.0 tions. Provision of inadequate or unbalanced diet and recurrent or chronic diseases are associated with poor nutritional status. To assess the nutritional status of children, height and weight were measured and used to construct the following indices: height-tbr-age, weight-for-height, and weight-for-age. In TDHS, all children under five years whose mothers were present in the sample household the night before the interview were eligible to be included in the anthropometric data collection. However, not all eligible children are included in the results here: height or weight measurements are missing for about 8 percent of eligible children, and one or both of the measurements are grossly improbable in 5 percent of cases. The date of birth was either not known or was incomplete for 3 percent of the cases. Since two of the indices (lleight-for-age and weight-for-age) depend on the accuracy of the child's age, these indices are shown for 84 percent of the eligible children. Although the term "height" is used here, children younger than 24 months were measured lying on a measuring board (recumbent length), while standing height was measured for older children. For the measurement of weight a digital scale with accuracy of 100 grams was used. As recommended by the WHO, the nutritional status of children in the survey was compared with an international reference population defined by the U.S. National Center for Health Statistics (NCHS) and accepted by the U.S. Centers for Disease Control (CDC). Use of this reference population is based on the finding that well-nourished young children of all population groups (for which data exist) follow very similar growth patterns (see Martorell and Habicht, 1986). The reference population serves as a point of comparison, facilitating the examination of differences in the anthropometric status of subgroups in a population and of changes in nutritional status over time. Although there are inherent variations in height and weight, these variations tend to approximate the normal distribution when the population is large. 106 The height-for-age index is an indicator of linear growth retardation. Children whose height-for-age is below minus two standard deviation (-2SD) from the median of the reference population are considered short for their age (also referred to as "stunted"), and are chronically undemourisbed. Children who are below minus three standard deviations (-3SD) from the median of the reference population are considered severely stunted. Stunting reflects the outcome of a failure to receive adequate nutrition over a long period of time, and is also affected by recurrent and chronic illness. Height-for-age, therefore, represents a measure of the long-terra effects of undemntrition in a population and does not vary appreciably according to the season of data collection. The weight-for-height index measures body mass in relation to body length, and describes current nutritional status. Children who are below minus two standard deviations (-2SD) from the median of the reference population are considered thin (also referred to as "wasted"), and are acutely undernourished. Wasting represents the failure to receive adequate nutrition in the period immediately preceding the survey and may be the result of recent episodes of illness, causing loss of weight and the onset of undemutrition. Wasting may also reflect acute food shortage. Children whose weight-for-height is below minus three standard deviations (-3S D) from the median of the reference population are considered to be severely wasted. Weight-for-age is a composite index of height-for-age and weight-for-height that takes into account both acute and chronic undemutrition. It is a useful tool in clinical settings for continuous assessment of nutritional progress and growth. Children whose weight-for-age is below minus two standard deviations from the median of the reference population are classified as "underweight." In the reference population only 2.3 percent of children fall below minus two standard deviation (-2SD) for each of the three indices. Considering weight-for-height, the nutritional status of Tanzanian children remains very close to the reference population (see Figure 9.1 ). However, regarding height-for-age and weight-for-age, their nutritional status falls below the standard population during the first 18 months of age and tends to stabilize thereafter. The deterioration is especially rapid during the first 6 months. Figure 9.1 Nutritional Status of Children Under Five Years, Mean Z-scores by Age in Months Z-score -2 -3 . . • . . . . . . . . . .At ** • i 0 6 12 19 24 30 39 42 48 54 60 Age in months - -He ight /age "Weight /age ~'Welght/helght i Note: Compared to the median of the NCHS/CDC/WHO reference population TDHS 1991/92 107 The distribution of nutritional status based on height-for-age, weight-for-height, and weight-for-age indices, by the child's age and selected demographic characteristics for 6,095 children is shown in Table 9.8, and by socioeconomic characteristics in Table 9.9 and Figure 9.2. Almost half of the children (47 percent) were found to be stunted, and 20 percent were severely stunted. These results indicate that chronic malnutrition is a major public health problem in Tanzania. Although stunting was less common among children below one year of age, it increased rapidly during the first year of life, so that during the second year of life half of the children were stunted. There were no appreciable differences in stunting by sex of the child, birth order, or length of preceding birth interval. Data by region show some interesting differences, although Table 9.8 Nutritional status by demographic characteristics Percentage of children under five years who ~re classified as undernourished according to three anthropometric indices of nutritional status: height-for-age, weight-for-height, and weight-for-age, by selected demographic characteristics, Tanzania 1991/92 Demographic characteristic Helght-for-age Weight-for-height Weight-for-age Percentage Percentage Percentage Percentage Percentage Percentage Number below below below below below below of -3 SD -2 SD l -3 SD -2 SD 1 -3 SD - 2 SD t ehildrert Age (months) <6 1.0 12.0 0.6 2.1 0.4 5.4 705 6-11 7,2 25.6 0.6 6.8 7,5 28.9 735 12-23 19.4 49,5 1.4 9.8 10.9 36.7 1440 24-35 26.6 57.2 1.8 4.9 7.5 32.6 1223 36-47 29.1 59.5 1.0 3.4 6.5 30.2 1028 48-59 25.6 56.8 1.1 4.4 6.2 27.6 963 Sex Male 21.0 48.1 1.2 6.2 6.8 28.7 3030 Female 18.7 45.3 1.2 5.1 7.3 28.9 3065 Birth order 1 17.5 43.8 1.4 6.3 6.0 25.8 1270 2-3 19.5 46.3 1.3 5.0 7.0 27.7 1992 4-5 21,7 46.6 0.9 6.2 7.4 32.9 1289 6+ 20.7 49.6 1.1 5.5 7.9 29,2 1544 Birth Interval (months) First birth 17.5 43.9 1.4 6.3 6.0 26.0 1276 <24 22.9 48.7 0.6 4.7 7.9 30.7 789 24-47 21.0 48.1 1.3 5.6 7.2 29.7 3118 48+ 16.5 43.9 1.1 5.9 7.6 28.0 912 All children 19.8 46.7 1.2 5.6 7.1 28.8 6095 Note: Figures are for children born in the period 1-59 months preceding the survey. Each index is expressed in terms of the number of standard deviation (SD) units from the median of the NCHS/CDC/WHO international reference population, Children are classified as undernourished if their z-scores are below minus two or minus three standard deviations (-2 SD or -3 SD) from the median of the reference population, tlncludes children who are below -3 SD 108 Table 9.9 Nutritional status by socioeconomic characteristics Percentage of children under five years who ere classified as undernourished according to three anthropometrlc indices of nutritional status: height-for-age, weight-fur-height, and weight-for-age, by selected socioeconomic characteristics, Tanzania 1991/92 Socioeconomic characteristic Height-fur-age Weight-for-height Weight-for-age Percentage Percentage Percentage Percentage Percentage Percentage Number below below below below below below of -3 SD -2 SD t -3 SD -2 SD l -3 8D -2 SD t children Residence Mainland 19.7 46,6 1.2 5.5 7.0 28.5 5943 Dares Salaam 11.3 28.5 1.3 6.8 4.0 19.9 277 Other urban 15.5 44.8 0.6 4.4 4.2 27.4 965 Rural 21.1 48.1 1.3 5.6 7.7 29.2 4701 Zanzibar 25.7 47.9 1.5 11.0 12.3 39.9 152 Region Dodoma 28.4 59.1 0.6 2.6 7.2 37.0 469 Arusha 14.8 38.7 0.9 5.9 5.2 29,4 381 Kilimanjaro 19.0 40.1 1.5 5.2 6.8 26.0 306 Tanga 16.6 44.0 3.6 14.7 5.7 30.5 291 Moroguro 23.2 61.1 0.6 5.4 8.3 34.0 361 Coast 28.2 54.8 0.3 6.0 10.5 36.7 91 Lindi 24.3 58.3 1.5 5.8 10.4 28.5 133 Mtwara 37.9 65.0 0.6 6.8 11.4 48.3 160 Ruvuma 27.9 56,8 1.2 4.5 9.0 32,9 217 Iringa 32.7 61.4 0.4 3.1 13.3 37.1 350 Mbeya 21.0 50.4 3.2 5.6 9.5 24.4 277 Singida 15.1 39.8 1.0 6.8 6,8 33.5 247 Tabora 16.9 44.8 0.8 4.8 5.3 24.1 192 Rukwa 19.2 48.3 1.4 4.1 4.0 25.2 159 Kigoma 21.4 52.3 0.7 5.5 7,3 34.1 291 Shinyanga 9.7 35.0 0.8 5.5 6.2 19.7 591 Kagera 19.5 44.3 1.9 5.0 6.0 26.8 431 Mwanza 15.6 39.4 0.5 4.5 5.2 20.7 456 Mara 12.7 37.0 1.3 4.5 2.6 18.9 263 Mother's education No education 22.5 50.3 0.7 6.1 8.6 32.1 2088 Primary incomplete 22.8 51.5 1.5 5.3 8.3 32.3 1177 Completed primary 17.1 42.9 1.5 5.5 5,7 25.4 2659 Secondary/Highar 10.3 27.6 0,4 4.0 2.7 17.7 170 All children 19.8 46.7 1.2 5.6 7.1 28.8 6095 Note: Figures are for children born in the period 1-59 months preceding the survey. Each index is expressed in terms of the number of standard deviation (SD) units from the median of the NCHS/CDC/WHO international reference population. Children are classified as undernourished ff their z-scores are below minus two or minus three standard deviations (-2 SD or -3 SD) from the median of the reference population. lIncludes children who are below -3 SD 109 Figure 9.2 Percentage of Children under Five Years Who Are Underweight by Region TANZANIA REGIONS Mtwara Zanzibar Irlnga Dodoma Coast - - Klgoma ~ . . . . . . . Morogoro Slngida guvuma Tanga Aruaha Llndl Kagera Ki l iman]aro Rukwa Mbeya Tabora awanza Dar as Sa laam Shlnyanga Mara 0 10 20 = = - . . . . . Note: Underweight = below -2SD from the median of the reference population 30 40 50 60 Percent TDHS 1991/92 the small number of observations in most regions should be taken into account. Stunting is less common in Dares Salaam, where 28 percent of children under 5 years are below -2 SD. An additional six regions have less than 40 percent stunting, and three regions (Morogoro, Iringa, and Mtwara) have more than 60 percent stunting. Educational differences were pronounced. More than half of the children of mothers with no or incomplete primary education were stunted versus 28 percent of children of mothers with secondary education. The weight-for-height index gives information about children's recent nutritional status. Severe wasting represents failure to receive adequate nutrition in the period immediately preceding the survey and may be the result of recent illness or of seasonal variations in food supply. Almost 6 percent of children were wasted (i.e., below two standard deviations from the median of the reference population), and one percent was severely wasted (-3SD). Wasting was more common among children between 6-23 months. There was no association between wasting and birth order and length of birth interval. More than 10 percent wasting was observed in the Zanzibar and Tanga regions. Weight-for-age provides an index for chronic and acute undemutrition, but does not distinguish between a child who is underweight because of stunting and one who is underweight because of wasting. Almost two-thirds of children (29 percent) were underweight, and 7 percent were below minus three standard deviations (-3SD) from the median of the reference population and therefore classified as severely underweight. The prevalence of underweight was lowest among children below 6 months of age and varied little by sex, birth order, or birth interval. Larger differences were evident by region. The lowest proportion of underweight children was found in Mara region (19 percent). In Zanzibar, the proportion underweight was twice as high as in Dar es Salaam (40 percent versus 20 percent), while the proportion with severe underweight was three times higher than in Dares Salaam (12 percent versus 4 percent). Mtwara, Zanzibar, and Iringa had the highest prevalence of underweight. The high rate of undemutrition in Iringa was not expected because the region has been the site of the joint UNICEF/WHO Nutrition Support Programme for 110 over six years. Further analysis and larger numbers of measurements are required before coming to any conclusions regarding the anthropometric impact of the programme in Iringa. 9.4 Mother's Nutritional Status Several indicators can be used to assess nutri- tional status of women (Krasovec and Andersen, 1991). During the TDHS, data on height and weight of women with living children under 5 years of age were collected. It is important to note that anthropometric data were not collected for women with no children under five years. This implies that several groups of women are under- represented, for instance, women 15-19 and women45-49 years. The same equipment was used for both child and adult anthropometry. The measuring board was equipped with an extension so that it could measure adults, and a digital bathroom scale with accuracy of 100 grams was used to weigh the women and children. Table 9.10 shows the means and standard devia- tions for three anthropometric measures: height, weight, and body mass index (BMI). Ann circumference was not taken. Height is a good indicator of socioeconomic stat- us and is also useful to identify women at nutritional risk. In addition, maternal height is used to predict the risk of difficult delivery, since a short stature is correlated with a small pelvis. The risk of low birth weight also appears to be higher for children of short women. The optimal cut- off point to identify high-risk deliveries varies among populations, but is likely to be in the range 140-150 cm. The mean height of women was 155.9 cm. The TDHS shows that almost 4 percent of women were shorter than 145 cm, and 17 percent measured below 150 cm. The mean weight was 52.8 kg, excluding pregnant women. Body mass indices are used to assess thinness or obesity. The most commonly used index is the BMI, which is defined as weight in kilograms divided by the square height in metres. A cut-off point of 18.5 has been recommended for defining chronic energy deficiency. Table 9.10 Anthropomelrlc indicators of maternal nua-itional status Percent distribution and mean and standard deviation for women who had a birth in the five years preceding the survey by selected anthropometric indieatoxs (height, weight, and body mass index (BMI)), Tanzania 1991/92 Distribution including Indicator Total missing Height (era) < 140 0.2 0.2 140-144 3.5 3.5 145-149 13.0 12.8 150-159 56.5 55,7 160-169 25,5 25.1 170-179 1.3 1.3 >180 0.1 0.1 ~¢lissing - 1.4 Mean 155.9 Standard deviation 6.4 Dis~bufion Number of women 5238 5312 Weight (kg) < 40 2.5 2.5 40-59 37.2 36.6 50-59 44.5 43,8 60-69 12.4 12.2 >70 3.4 3.4 Missing 1.5 Mean S2.8 Standard deviation 8.3 Distribution Number of women 4307 4372 BMI < 16.0 0.6 0.6 16.0-18.4 8.7 8.6 1S.5-19.9 18.5 18.3 20.0-22.9 45.5 44.8 23.0-25,9 18,7 18.4 26.0-28.9 5.3 5.2 _>29.0 2.7 2.6 Missing 1.5 Mean 21.7 Standard deviation 3.0 Disuibufion Number of women 4305 4372 Obesity has not been defined clearly. The mean BMI was 21.7 among women not pregnant at the time of the survey and having a living child under five years of age. Almost 10 percent of women had a BMI below 18.5, suggesting chronic energy deficiency. 111 Table 9.11 presents mean height, percent below 145 cm, mean BMI, and percent with BMI below 18.5 by background characteristics. Variation in height was limited by urban/rural, education, age, and parity. The largest differences were observed by region. Regions in northern Tanzania (Arusha and Kilimanjaro) and Mara, Mwanza, Kagera, and Shinyanga appeared to have taller women than in most other regions of Tanzania. However, differences in BMI were very small. For instance, the region with the lowest BMI was Mtwara with 20.9 and the highest was Dares Salaam with 22.8. The only subgroup with a higher BMI than all other women were women with at least secondary education (24.0 versus 21-22). Table 9.11 Differentials in maternal anthxopometric indicators Mean height and percentage of woman shorter than 145 centimetres, mean body mass index (BMI), and the percentage of women whose BMI is less than 18.5, according to selected background characteristics. Tanzania 1991/92 Height BMI Background Percent Percent characteristic Mean <145 cm Number Mean <18.5 Number Region Mainland 155.9 3.7 5093 21.7 9,6 4185 Dar as Salaam 154.3 4.6 272 22.8 5.8 230 Other urban 155.2 4.5 899 22.4 6.3 765 Rural 156.2 3.4 3921 21.5 10.7 3189 Zanzibar 154.8 6.3 145 21.3 11.5 120 Residence Dodoma 154.0 7.3 410 21.3 7.5 360 Arusha 157.8 0.2 362 21.7 16.4 314 Kilimanjaso 156.3 2.3 238 21.9 12.6 206 Tanga 154.4 3.9 266 21.2 12.5 221 Morogoro 152.4 10.9 327 21.7 9.2 265 Coast 152.0 11.6 80 21.8 12.6 68 Lindi 153.0 7.4 132 21.3 11.8 113 Mtwara 151.7 11.7 158 20.9 20.7 127 Ruvuma 153.1 8.7 180 21.6 7.6 153 Iringa 154.8 2.9 311 22.2 6.8 253 Mbeya 155.6 3.3 249 22.0 7.9 199 Singida 158.4 0.5 205 21.2 11.7 172 Tabora 156.2 1.9 148 21.6 9.7 121 Rukwa 156.7 2.4 137 21.8 7.3 112 Kigoma 155.7 2,2 221 21.5 11.6 176 Shinyanga 159.1 0.6 480 22.0 3,6 364 Kegcra 157.3 0.7 327 21.8 10,6 265 Mwanza 158.3 0.9 364 22.1 6.9 293 Mara 159.4 0.9 224 21.1 10.4 172 Education No education 155.7 3.5 1816 21.4 12.1 1470 Primary incomplete 155.3 4.2 967 21.4 10.5 816 Completed primary 156.2 3.9 2292 21.9 7.8 1876 Secondary/Higher 156.7 1.5 163 24.0 4.0 143 Age of woman <20 155.4 7.3 495 21.5 9.3 407 20-34 156.0 3.6 3549 21.7 9.0 2859 >_35 155.6 2.7 1193 21.8 11,8 1039 Children ever born 1 156.1 5.1 1100 21.5 10,0 886 2-3 155.8 4.8 1643 21.9 7.5 1312 4-5 155.8 2,7 1084 21.6 9.7 893 6+ 155.8 2.3 1410 21,7 11.8 1215 Total 155.9 3.8 5238 21.7 9.7 4305 I12 CHAPTER 10 RESULTS OF THE MALE SURVEY 10.1 Background Characteristics of the Male Survey Respondents General Characteristics In the TDHS, 2114 men were interviewed to obtain information about background and demographic characteristics, sexuality, family planning knowledge and practice, fertility preference and AIDS knowledge. Men were eligible for the individual interview if they were between age 15 and 60, and stayed in the household the night before the household interview was conducted. One in four households was selected for the male survey and the results are presented here. Results about AIDS knowledge are not presented here but are presented in Chapter 11. Table 10.1 shows the percentage distribution of background characteristics of the respondents. Almost a quarter of men (24 percent) were age 15-19 years. This proportion was much higher than that of men age 20-24 years, a pattern typical of expanding population, although it also appears younger males were more likely to be found at home during the interviewers' visits. Thirty-nine percent of male respondents were unmarried and 56 percent were currently married (either in monogamous or polygamous union). One-fifth of the respondents had no formal education. Among those with formal education, a majority (71 percent) had primary education and only 9 percent had secondary or higher education. A majority of respondents were from the Tanzania mainland (98 percent) and over two-thirds (71 percent) were from rural areas. One-third were Moslems, 27 percent Catholics, and 25 percent Protestants. Differentials in Education Table 10.2 shows the distribution by education level of respondents according to age, rural/urban residence, and region. Compared to men in the younger age categories, older men were more likely to be uneducated. The proportion of men with no education was relatively higher in Zanzibar (where the number of men is small) and in rural areas than in mainland Tanzania and urban areas, respectively. However, Zanzibar also had the largest proportion of men with at least secondary education. The level of education was found to vary in the regions. Tanga, Ruvuma, and Dares Salaam had the lowest proportion of uneducated men, and Mtwara, Shinyanga, and Dodoma had the highest proportion. In mainland Tanzania, Dar es Salaam had the largest proportion of men with secondary and higher education. Access to mass media All eligible men were asked if they usually listen to a radio, watch television, or read a newspaper at least once in a week (Table 10.3). This information can be used in identifying appropriate communication channels that can be used to reach most people. Overall, 77 percent reported listening to the radio dally, and 45 percent reported reading newspapers. As expected, only 5 percent reported watching television at least once a week. Since there is no television station on the Tanzanian mainland, most of the people who reported watching television see programmes from Zanzibar or neighbouring countries. Men less than 40 years and those with at least primary education were more likely to read newspapers and listen to the radio than other men. Men in rural areas were less likely to read newspapers than their counterparts in urban areas. In Dar es Salaam, a majority of men (93 percen0 reported reading newspapers. Radio listening was found to be common in both rural and urban areas. In Zanzibar about a third of the respondents reported watching television at least once a week. l l3 Table 10.1 Background characteristics ofrespondants Percent distribution of men by selected background characteristics, Tanzania 1991/92 Number of women Background Waighted Un- characteristic percent Weighted weighted AI5.19ge 23.6 499 518 20-24 14.6 308 309 25-29 12.4 262 268 30-34 12,1 256 240 35-39 9.5 201 194 40-44 7.5 159 170 45-49 7.3 155 158 50-54 6.0 127 112 55+ 6.1 129 123 Marital status Never married 38.7 819 810 Married, monogamous 47.0 993 993 Married, polygamous 9.0 190 191 Widowed/Divorced/S ep. 5.3 112 120 Education No education 19.8 418 425 Primary incomplete 29.6 625 638 Completed primary 41.5 878 879 Secondary/Higher 9.1 192 172 Residence Mainland 97.6 2063 2010 Dares Salaam 7.2 151 132 Other urban 19.0 402 263 Rural 71.4 1510 1615 Zanzibar 2.4 51 104 Region Dodoma 8.2 173 83 Arusha 5.9 124 93 Kilimanjaro 6.0 128 106 Tanga 4.3 90 74 Morogoro 5.7 120 107 Coast 1.6 34 87 Lindi 2.2 47 75 Mtwara 5.2 109 97 Ruvuma 3.3 70 101 Iringa 5.6 117 91 Mbeya 4.9 103 69 Singida 3.2 67 88 Tabora 3.4 73 106 Rukwa 2.4 51 112 Ki~oma 3.7 79 108 Shmyanga 8.4 177 145 Kagera 5.7 121 79 Mwa.nza 6.7 143 128 Mars 4.0 85 129 Religion Muslim 33.3 703 748 Catholic 27.2 575 594 Protestant 24.5 517 456 None 15.0 318 315 Other religion 0.0 1 1 All men 100.0 2114 2114 114 Table 10.2 Level of education Percent distribution of men by highest level of education attended, according to selected background characteristics. Tanzania 1991/92 Level of education Number Background Primary Completed Secondary/ of characteristic None incomplete primary Higher Total men Age 15-19 11.4 40.1 42.3 6.2 100.0 499 20-24 13.1 11.2 66.1 9.6 100.0 308 25-29 7.5 15.2 68.3 9.0 100.0 262 30-34 11.8 19.2 53.9 15.1 100.0 256 35-39 26.5 31.8 31.3 10.4 100.0 201 40-44 28.3 41.5 22.2 8.0 100.0 159 45-49 30.6 42.6 16.3 10.5 100.0 155 36.4 38.4 13.9 11.2 100.0 127 Residence 52.1 40.9 3.7 3.2 100.0 129 Mainland Dares Salaam 19.6 29.8 42.1 8.5 100.0 2063 Other urban 6.6 20.4 49.7 23.3 100.0 151 Rural 12.2 29.7 39.8 18.3 100.0 402 Zanzibar 22.9 30.8 42.0 4.4 100.0 1510 27.2 21.5 18.6 32.7 100.0 51 Region Dodoma 29.1 22.6 39.0 9.3 100.0 173 Arusha 15.9 22.8 48.6 12.7 100.0 124 Kilimanj aro 7.9 23.8 56.4 11.9 100.0 128 Tanga 5.0 41.1 47.1 6.9 100.0 90 Morogoro 14.6 43.0 36.4 6.0 100.0 120 Coast 20.3 37.2 39.9 2.6 100.0 34 Lindi 21.9 40.1 30.4 7.6 100.0 47 Mtwara 31.6 39.6 26.2 2.6 100.0 109 Ruvuma 5.8 30.7 50.9 2.6 100.0 70 lrlng a 22.4 32.6 40.5 4.5 100.0 117 Mbeya 19.4 23.1 51.4 6.1 100.0 103 Singida 18.6 31.8 42.9 6.8 104].0 67 Tabora 26.7 21.7 45.9 5.7 100.0 73 Rukwa 20.1 35.3 39.6 5.0 100.0 51 Kigoma 23.7 32.9 38.0 5.5 100.0 79 Shinyanga 30.8 28.4 36.1 4.7 100.0 177 Kagera 21.0 26.6 37.3 15.2 100.0 121 Mwanza 25.6 36.0 33.8 4.6 100.0 143 Mara 15.0 28.2 44.5 12.4 100.0 85 Total 19.8 29.6 41.5 9.1 100.0 2114 115 Table 10.3 Access to mass media Percentage of men who usually read a newspaper once a week, watch television once a week, or listen to radio once a week, by selected baokground characteristics, Tanzania 1991/92 Read Watch Listen to Number Background newspaper television radio of characteristic weekly weekly weekly men Age 15-19 47.7 3.2 76.5 499 20-24 52.2 7.0 83.2 308 25-29 49.8 8.6 84.5 262 30-34 51.1 7.4 79.0 256 35-39 44.6 5.9 79.6 201 40-44 31.1 1.3 70.4 159 45-49 40.1 9.6 70.7 155 50-54 29.6 4.3 67.9 127 55+ 32.0 1.3 66.6 129 Education No education 2.9 1.6 51.8 418 Primary incomplete 40.7 2.6 74.4 625 Completed primary 58.7 6.8 85.8 878 Secondary/Higher 83.9 16.9 98.4 192 Residence Mainland 44.7 4.8 76.6 2063 Dares Salaam 93.2 6.7 99.8 151 Other urban 66.7 13.4 93.8 402 Rural 33.9 2.3 69.8 1510 Zanzibar 44.8 30.8 85.4 51 Region Dodoma 46.7 12,2 90.1 173 Arusha 45.2 0.5 78.3 124 Kilimanjaxo 55.8 6.4 96.6 128 Tanga 27.7 0.0 86.5 90 Morogoro 66.8 8.1 87.9 120 Coast 72.2 4.1 89.7 34 Lindi 48.9 3.4 72.9 47 Mtwara 36.7 0.9 65.0 109 Ruvuma 50.6 0.0 71.7 70 lringa 20.5 3.5 68.7 117 Mbeya 26.8 5.3 73.0 103 Singida 32.7 2.6 76.1 67 Tabora 31.7 0.8 57.3 73 Rukwa 23.1 4.1 73.0 51 Kigoma 31.9 0.0 67,1 79 Shinyanga 31.6 7.6 66.2 177 Kagera 22.2 0.0 40.6 121 Mwartza 51.3 7.2 75.3 143 Mara 63.4 8.7 84.1 85 Total 44.7 5.4 76.9 2114 116 10.2 Fertility Regulation Knowledge of Contraception One of the main objectives of the TDHS was to determine the level of knowledge of contraceptive methods and the sources where they can be obtained. Information on contraceptive knowledge was obtained by asking the respondent to name ways or methods that a couple could use to delay or avoid pregnancy. If the respondent failed to name a particular method spontaneously, the interviewer described the method and asked if he recognised it. Table 10.4 shows that 78 percent of all men aged 15-60 know of at least one method of family planning. Moreover, about 72 percent of men know where one can obtain a method of family planning. Among currently married men, 86 percent know a method and 80 percent know a place where it can be obtained. Knowledge of modem contraceptive methods was equally high. The pill was the most commonly known modem contraceptive method. Interestingly, male sterilisation was knownby only a small proportion of men. Periodic abstinence and withdrawal were the most known traditional contraceptive methods. In general, knowledge of traditional methods was relatively low. These findings indicate that the overall knowledge of contraception is high. However, knowledge of some specific methods such as IUD, injection, vaginal methods, and male sterilisation was low. It is obvious that more intensive information, education, and communication (IEC) is needed to inform people about these methods. Table 10.4 Knowledge of contraceptive methods and source for methods Percentage of all men and currently married men who know specific contraceptive methods and who know a source (for information or services), by specific methods, Tanzania 1991/92 Know method Know a source Currently Currently Contraceptive All married All married method men men men men Any method 78.3 85.8 71.5 79.7 Any modern method 76.8 84.2 71.2 79.3 Modern method Pill 65.0 76.0 56.8 67.7 IUD 25.8 34.9 21.7 29.1 Injection 31.8 38.8 29.6 36.4 Diaphragm/foam/jelly 30.0 37.1 25.7 32.2 Condom 64.8 71.2 57.6 63.8 Female sterilisation 50.4 60.4 48.4 58.1 Male sterilisation 21.4 27.7 19.1 24.9 Any traditlonal method 50,7 60.1 NA NA Periodic abstinence 36.3 44.8 30.4 38.9 Mucus method 17.0 23.1 NA NA Withdrawal 39.3 46.3 NA NA Other 12.6 17.8 NA NA Number of men 2114 1184 2114 1184 NA = Not applicable 117 The level of knowledge of contraceptive methods and their source of supply among currently married males and females can be compared in Figure 10.1. In general, males have a relatively higher knowledge of contraceptive methods and places where they could be obtained. Men are more likely to know about condom, withdrawal, and periodic abstinence than women. However, women have relatively better knowledge of injections. Figure 10.1 Contraceptive Knowledge Among Currently Married Men and Women KNOWLEDGE OF METHOD Any Method Any Modern Method Any Traditional Method KNOWLEDGE OF SOURCE Any Method Any Modern Method Any Tradltlonal Method 20 40 60 80 100 Percent TDHS 1991/92 Among currently married men, knowledge of contraceptive methods is fairly high at all ages, especially among men 25-39 years (Table 10.5). Knowledge is high both in Zanzibar and mainland Tanzania and in both rural and urban areas. However, it is low among uneducated men and increases with increasing level of education. Contraceptive knowledge generally is high in most regions, although Shinyanga, Mwanza, and Coast have a relatively low level of knowledge. Ever Use of Contraception All eligible men (aged 15-60) interviewed in the TDHS who had heard of at least one method of family planning were asked if their wives and themselves had ever used contraceptives. Among unmarried men, the question of contraceptive use by their partners was not asked because most of these men are unlikely to know whether such use had ever occurred. Men were classified to have ever used contraceptives if they reported that they had ever used any method. This classification assumes that men were aware of the contraceptive practice of their wives. It is known that some women use contraceptives without the knowledge of their spouse. For example, in an ongoing study in Dares Salaam, about one-third of women attending family plarming clinics reported to have been using contraceptives without knowledge of their spouse (Kapiga et al. 1993). Hence, the results presented here may underestimate the true prevalence of contraceptive use. It should also be noted that the interpretation of this classification is difficult in polygamous marriages where some of the wives may be using contraceptives, and others may not be. 118 Table 10.5 Knowledge of modem contraceptive methods and soume for methods Percentage of currently married men who know at least one modem contracoptive method and who know a source (for information or services), by selected background characteristics, Tanzania 1991/92 Know a Know Know source for Number Background any a modem modem of characteristic method method t method men Age 15-19 * * * 9 20-24 82.1 80.5 74.8 100 25-29 89.7 89.0 86.4 169 30-34 89.9 89.2 85.0 205 35-39 91.5 89.6 84.8 176 40-44 85.2 83.9 77.3 144 45-49 83.2 81.6 76.7 137 50-54 80.5 79.0 70.7 111 55¢ 77.1 72.4 68.9 132 Residence Mainland 85.7 84.0 79.0 1154 Dares Salaam 82.8 82.8 82.8 63 Other urban 98.9 98.9 95.4 234 Rural 82.3 80,1 74.3 857 Zanzibar 90.1 90.1 88.8 30 Region Dodoma 95.6 95.1 94.3 121 Arusha 85.8 75.4 72.0 54 Kilimanj aro 98.2 98.2 98.2 50 Tanga 98.2 98.2 96,4 58 Morogoro 98.2 96.4 94.2 69 Coast (67.0) (67.0) (63.9) 17 Lindi (90.1) (90.1) (87.1) 32 Mtwara 95.6 95.6 95.6 61 Ruvuma 100.0 100.0 98.5 44 Iringa 89.4 84.6 71,5 73 Mbeya 91.8 90.1 83.9 59 Singida (83.0) (82.2) (79.4) 36 Tabera (88.0) (78.4) (75.7) 38 Rukwa (82.5) 81.3 77.0 32 Kigoma 93.3 90.7 85.7 50 Shinyanga 57.3 57.3 49.0 92 Kagera 76.3 76.3 76.3 78 Mwanza 64.2 64.2 44.1 82 Mara 83.8 80.2 63.8 44 Education No education 68.4 64.1 55.5 297 Primary incomplete 88.0 86.6 80,6 357 Completed primary 92.7 92.4 89.8 424 Secondary/Higher 99.4 99.4 98.7 106 Total 85.8 84.2 79.3 1184 Note: Rates shown in parentheses are based on 25-49 men, whereas an asterisk means the rate is based on fewer than 25 men and has bean suppressed. 1Includes pill, IUD, injection, vaginal methods (foaming tablets/diaphragm/ foam/jeUy), condom, female sterilisation, and male sterilisation. 119 Table 10.6 indicates that 45 percent of currently married men had ever used family planning methods. Thirty-five percent of currently married men had ever used traditional methods, and 24 percent had ever used modem contraceptives. Periodic abstinence (23 percent) and withdrawal (19 percent) were the most commonly used traditional methods. Fourteen percent had ever used condoms. Ever use of contraceptive methods among all men is comparable to that of currently married men. Twenty percent had ever used a modem method, mostly a condom (15 percent). Traditional methods were less commonly reported by younger, unmarried men compared to married men. For instance, 27 percent of all men ever usecl traditional methods, compared to 35 percent of currently married men. Table 10.6 Ever use of contraception Percentage of all men and of currently married men who have ever used any contraceptive method, by specific method and age, Tanzania 1991/92 Age Any ll~odem Any meth- method od Modem methods Traditional methods Dia- F~nMe Peri- In phragnd steti- Any odic With- Number jec- foam/ lisa- trad. absti- Mucus draw- of Pill IUD tion jelly Condom tion method nence method al Other men ALL MEN 15-19 14.0 9.7 0.4 0.0 0.4 0.5 8.7 0.0 8.9 2.6 0.8 6.9 0.0 499 20-24 37.5 27.1 2.7 0.0 0.3 0.6 25.6 1.5 25.5 11.6 3.6 16.7 1.7 308 25-29 45.8 23.2 6.9 0.0 0.0 0.2 21.2 0.3 32.8 16.7 6.8 19.8 1.8 262 30-34 46.8 22.7 11.7 0.6 1.3 0.0 19.0 0.0 42.8 32.7 16.5 23.9 1.8 256 35-39 51.2 29.2 14.6 4,2 0.7 1.3 20.3 1.1 41,1 24.7 4.7 22.2 5,3 201 40-44 43.3 22,2 11.7 3.1 1.6 1.4 12.2 5.1 34.0 20.4 4.5 17.7 2.3 159 45-49 40.8 26,5 14.4 0.8 0.0 0.0 11.3 5.2 25.1 16.5 3.9 15.6 1,8 155 50-54 39.8 20,3 10.0 0.0 1.8 0.0 2.8 7.4 29.6 10,7 7.2 19.2 4.5 127 55+ 34.7 14.0 4.4 0.9 2.1 0.9 3.9 7.9 25.9 17,6 4.9 13.2 0.3 148 Total 36.0 20.4 7.0 0.8 0.7 0.5 14.8 2.1 27.0 15.3 5.4 16.0 1.8 2114 CURRENTLY MARRIED MEN 15-19 * * * * * * * 20-24 37.4 24.6 3.8 0.0 0.0 0.0 23.0 25-29 44.9 20.9 6.6 0.0 0.0 0.3 18.8 30-34 50.1 22.5 11.9 0.8 1.4 0.0 18.7 35-39 53.6 29.3 15.5 3.4 0.8 0.3 20.2 40-44 42.7 22.4 12.4 3.4 1.7 1.5 11.5 45-49 43.4 29.4 16.2 0.9 0.0 0.0 12.3 50-54 44.7 23.3 11.4 0.0 2.0 0.0 3.2 55+ 36.4 15.3 4.6 1.0 2.3 1.0 4.1 0.0 33.0 21.7 11.0 15.9 5.2 100 0.0 33.9 19.3 8.2 19.7 2.8 169 0.0 45.7 35.0 19.7 27.1 1.9 205 1.3 44.0 26.3 5.3 23.1 5.2 176 4.8 33.3 22.4 4.9 15.3 2.5 144 5.9 26.1 18.6 4.3 15.3 2.0 137 8.5 33.0 12.2 8.2 21.1 5.1 111 8.9 26.5 19.4 5.4 12.6 0.0 132 Total 45,0 23,5 10.7 1.3 1.0 0.4 14.4 3.2 35.4 22.9 8.8 19,3 3.0 1184 Note: An asterisk means the rate is based on fewer than 25 men and has been suppressed. 120 Current Use of Contraception About 22 percent of currently married men were using family planning methods at the time of the survey (see Table 10.7). Use of traditional methods was reported by 11 percent of currently married men and use of modem methods by about 10 percent. The pill and condoms were reported to be used by 4 percent of currently married men and periodic abstinence by 8 percent. Use of modem contraceptives was low among younger men (below 20 years). Table 10.7 Current use of contraception by age Percent di~u'ibution of all men and of currently manled man by contraceptive method cummtly used, according to age, Tanzania 1991/92 Age Modern methods Traditional methods Any modem Any math- method od Female P=i- steri- Any odic With lisa- tr~l, abe- Mucus &aw- Pill IUD Condom ti~a method ncnc~ method al Oth~ Total Number ALL MEN 15-19 4.6 B.7 0.3 0.0 3.3 0.0 0.9 0.9 0.0 0.0 0.0 4.6 499 20-24 9.9 7.3 0.3 0.0 7.0 0.0 2.6 2.1 0.0 0.5 0.0 9.9 306 25-29 17.5 8.3 2.3 0.0 3.9 0.0 9.2 6.4 0.4 1.5 0.9 17.5 2~ 30-34 20.4 11.9 5.5 0.6 5.8 0.0 8.5 7.0 0.0 0.8 0.6 20.4 256 35-39 30.0 14.0 3.8 0.0 9.0 1.1 16.0 11.8 0.4 2.7 1.1 30.0 201 40-44 21.B ILl 5.2 0.5 3.3 2.1 10.2 6.7 0.0 2.5 0.9 21.3 159 45-49 20.7 12.5 5.4 0.0 2.7 4.4 8.3 5.5 0.0 2.8 0.0 20.7 155 50-54 21.0 9.0 2.5 0.0 0.0 6.5 12.0 3.0 0.0 6.4 2.6 21.0 127 55+ 7.2 2.9 0.0 0.0 1.7 1.3 4.2 2.7 1.0 0.6 0.0 7.2 148 Total 14.9 8.2 2.4 0.1 4.7 1.1 6.7 4.6 0.2 1.4 0.5 143 2114 CURRENTLY MARREDMEN 15-19 * * * * * * * * * * * * 9 20-24 12.4 4.3 0.3 0.0 4.0 0.0 8.1 6.6 0.0 1.5 0.0 12.4 100 25-29 20.9 7.8 3.6 0.0 4.2 0.0 13.1 8.7 0.6 2.4 1.4 20.9 169 30-34 23.9 13.4 6.8 0.8 5.7 0.0 10.5 8.7 0.0 1.0 0.8 23.9 205 35-39 32.9 14.7 4.4 0.0 9.0 1.3 18.3 13.5 0.5 3.1 1.2 32.9 176 40-44 22.6 11.4 5.7 0.6 2.8 2.3 11.2 7.4 0-0 2.8 1.0 22.6 144 45-49 22.9 13.6 6.1 0.0 2.6 4.9 9.3 6.2 0-0 3.1 0.0 22.9 137 50-54 24.1 10.3 2.8 0.0 0.0 7.4 13.8 3.5 0-0 7.3 3.0 24.1 111 55+ 7.0 3.0 0.0 0.0 1.6 1.4 4.0 3.0 1.1 0.0 0.0 7.0 132 Total 21.8 10.4 4.2 0.2 4.1 1.9 11.4 7.7 0.B 2.5 0.9 21.8 1184 Note: An asterisk means the rate is based on fewer titan 25 men and has bean Suppr=Hcd, Figure 10.2 shows current use of contraceptive methods among currently married males and females. Compared to women, men were twice as likely to report that they were currently using contraceptive methods. The reported current use of modem contraceptives was 3 percentage points higher among men. However, the largest differences were in the use of traditional methods; men were about 200 percent more likely to report that they were using traditional methods than women. The observed differences may be due to a number of reasons. Women were asked about their own contraceptive use, while men were asked about use of methods for both themselves and their wives. The high prevalence among men may indicate use of 121 contraceptives by men with women other than their wives. It is also possible that women did not mention some of the methods that were primarily used by their spouse. This may explain the difference in reported condom use. Regarding traditional methods, the main difference concerns abstinence, which is much more commonly reported by men. Different interpretations of this method may play a role as well, Figu re 10.2 Current Use of Contraceptives Among Currently Married Men and Women ANY METHOD ANY MODERN METHOD Pill IUCD Condom Injection Female sterillsatlon ANY TRADITIONAL METHOD Abetlnencel t Withdrawal 0 F P m 10 20 30 4O Percent TDHS 1991/92 Table 10.8 shows the percent distribution of currently married men currently using contraceptives by rural/urban residence, region, educational status, and number of living children. Men in urban areas are more than twice as likely to use modem methods than their counterparts in rural areas. Conversely, use of traditional methods is more common in rural areas than in urban areas. There were significant differences in the prevalence of current contraceptive use among the regions. For example, use of modem methods ranges from 1 percent in Mwanza to 29 percent in Kilimanjaro. These differences need to be interpreted cautiously because of the small numbers of men covered. Contraceptive use among men with formal education is much higher than among men with no education. Contraceptive use increases with increasing level of education from 7 percent among men with no education to 23 percent among men with primary education and to 52 percent among men with secondary or higher education. A similar pattem is observed for modem and traditional contraceptive methods. Furthermore, contraceptive use varies according to the number of living children. Only 1 percent of currently married men with no living child reported using family planning methods. Use of both modem and traditional methods increases with increasing number of living children up to about 3 above which it falls slightly. 122 Table 10.8 Current use of contraception by background characteristics Percent distribution of currently married men by contraceptive method currently used. according to selected background characteristics. Tanzania 1991/92 Modem methods Trtditlct~al methods Any Fe~aale Peti- modern ste, fi- Any odi¢ Muct~ With- Number Background Any meth- CQn- lisa- trad. abni- math, draw- of characteristic method od Pill IUD dora tion math. neaaee od al Othe~ Total meat Residence Mainland 22.3 10.5 4,3 0.2 4,2 1,9 11.7 7.9 0.3 2.6 0.9 22.3 1153 Dares Salaam 30.1 25,3 6.7 0.0 14.8 3.8 4.8 4,8 0.0 0.0 0.0 30.1 63 Other urban 25,9 16,4 7.8 0.0 8.4 0.3 9.4 4.5 0,6 3.3 1.0 25.9 234 Rural 20.7 7.8 3.1 0.3 2,2 2.2 12.9 9.1 0.2 2.5 1.0 20,7 857 Zanzibar 4.1 4.1 1.4 0.0 1.4 1,4 0.0 0.0 0.0 0.0 0.0 4.1 30 Region Dod,maa 27.5 14.0 8.2 0.0 5.8 0.0 13.5 7.2 0.0 6,3 0.0 27.5 121 Amsha 39.2 12.3 1.7 0.0 6.8 3,8 26.9 14.2 0.0 9.9 2.8 39.2 54 Kilimanjaro 50.8 28.5 9,9 5.0 4.4 9.3 22,3 18.9 1.8 1.7 0.0 50.8 50 Tanga 60.7 21.5 5.7 0.0 14.1 1.8 39.2 30.2 0,0 3.9 5.1 60.7 58 Morogoro 23.7 10.0 3.9 0,0 6.1 0,0 13.7 6.6 1.5 2,5 3.0 23.7 69 Coast (7.1) (5.0) (5.0) (0.0) (0,0) (0.0) (2.1) (1.4) (0.0) (0.8 (0.0) ('7,1) 17 Lindi (12.4) (10.3) (6.4) (0.0) (2.0) (1.9) (2.0) (0.0) (0.0) (2.0) (0.0)(12.4) 32 Mtwara 2.7 2.7 2,7 0.0 0.0 0.0 0,0 0,0 0.0 0.0 0.0 2.7 61 Ruvuma 5.1 5.1 0.0 0,0 3.0 2.1 0.0 0.0 0.0 0.0 0.0 5.1 44 Iringa 18.2 11,7 10.4 0.0 1.3 0.0 6.5 1.6 0.0 4.9 0,0 18.2 73 Mbeya 20.0 8.1 0.0 0.0 6.1 2.0 11.9 6.1 2.4 3.4 0.0 20.0 59 Singida (23.6) (6.7) (0.0) (0.0) (6.7) (0,0)(16.9)(16.9) (0.0) (0.0) (0.0)(23.6) 36 Tabora (18.9 (3.1) (1,0) (0.0) (2.1) (0.0)(15,7)(10,9) (0.0) (1.8) (3.1)(18.9) 38 Rukwa (16.9) (9.0) (3.2) (0.0) (3.5) (2.3) (7.8) (3.2) (0,0) (3.0) (1.6)(16.9) 32 Kigoma 21.3 4.5 2.9 0.0 1.7 0.0 16.8 14.2 0,0 0.0 2.6 21.3 50 Shinyanga 10.7 6,0 4.3 0.0 1.7 0,0 4.7 4.7 0.0 0.0 0.0 10.7 92 Kagera 25.3 10.7 0.0 0.0 0.0 103 14.6 9.7 0.0 3.9 1.0 25.3 78 Mwanza 3.5 1.4 1.4 0.0 0.0 0,0 2.1 2.1 0.0 0.0 0.0 3.5 82 Mars 17.8 %0 7.0 0.0 0.0 0,0 10.9 8.1 0.0 1.4 1.3 17.8 44 Education No education 7.4 1.6 0.7 0,0 0,0 0,9 5.9 4.2 0.3 1.0 0.4 7.4 297 Primary incomplete 16.2 5.0 1,9 0,0 1.1 2,0 11.2 5.8 0.7 3.1 1.5 16.2 357 Completed primary 29.0 16.0 6,4 0.2 8.3 1.1 13.1 10.8 0.0 1.6 0.7 29.0 424 Secondary/Higher 52.0 30,8 12.8 1.5 8.7 7.8 21.2 11,9 0.0 8.1 1.2 52.0 106 Number of children 0 1.1 1.1 1,1 0.0 0.0 0.0 0.0 0.0 0.0 0,0 0,0 1.1 96 1 21,5 8.4 4.1 0.0 4.3 0,0 13.1 7.5 0.8 2.9 1.9 21.5 169 2 18.0 4.5 1,3 0.0 3.2 0.0 13.6 11.2 0.7 1.3 0.3 18.0 160 3 32.6 16,3 9.2 1.0 6.1 0.0 16.3 14.0 0.0 1.6 0.7 32.6 158 4+ 23.4 12.4 4.1 0.1 4.4 3.7 10.9 6.5 0.1 3.3 1.0 23.4 601 Total 21,8 10.4 4.2 0.2 4.1 1.9 11.4 7.7 0,3 2.5 0.9 21.8 1184 Note: Rates shown in parentheses are based on 25-49 men, whereas an asterisk means the rate is based tm fewer than 25 men and has been suppressed. 123 Sources of Family Planning Methods All current users of modem methods of family planning were asked to report the source from which they most recently obtained their supplies. Table 10.9 shows that 70 percent of modem contraceptive users obtained their last supplies from public (government) health facilities, of which half were dispensaries. Seventeen percent of users obtained contraceptives from private medical facilities, and only 9 percent obtained their last contraceptive supplies from either private shops or friends and relatives. As observed in Chapter 4, these findings indicate that public (government) health facilities are the main source of con- traceptive supplies in Tanzania. Table 10.9 Source of supply for modem contraceptive methods Percent distribution of current users of modem contraceptive methods by most recent source of supply, according to specific methods, Tanzania 1991/92 All Source of supply Pill Condom methods Public sector 94.7 63.8 69.8 Consultant hospital 1.5 6.8 6.4 Regional hospital 10.8 6.5 7.7 DistrJ.ct hospital 4.9 11.0 11.1 Health centre 26.3 4.8 10.3 Dispensary 51.2 27.2 30.1 Parastatal health facility 0.0 3.8 2.2 Village health post/Worker 0.0 3.8 2. I Medical private sector 5.3 14.0 17.3 Religious org. facility 3.5 0.0 8.4 Private doctor/Hospital 0.0 3.6 2.5 Pharmacy/Medical store 0.0 7.5 4.3 UMATI CBD worker 1.9 2.8 2.1 Other private sector 0.0 15.8 9.3 Shop 0.0 8.6 4.9 Friends, relatives 0.0 7.2 4.4 Other 0.0 2.7 1.5 Missing 0.0 3.8 2.1 Total 100.0 100.0 100.0 Number 50 98 174 UMATI CBD = Family Planning Association of Tanzania community-based distribution Men who are current users of contraceptive methods were asked how long it takes to travel from their home to the place where they obtain the method. Nonusers were asked if they knew a place where they could obtain a modem method and, if so, how long it would take to get there. The results are shown in Table 10.10. 124 Table 10.10 Time to source of supply for modem contraceptive methods Percant distribution of men who are currently using a modem contraceptive method, of men who are not using a modem method, and of man who know a method, by time to reach a source of supply, according to urban- rural residence, Tanzania 1991/92 Men who are currently using a modem method Men who are not using a modem method M~ who know a contraceptive method Minutes to source Urban Rural Total Urban Rural Total Urban Rural Total 0-14 39.8 24.6 31.4 11.4 4.6 6.3 16.4 7.5 10.1 15-29 29.1 9.9 18.4 14.8 4.0 6.6 19.1 5.7 9.5 30-59 13.6 18.4 16.2 17.0 7.4 9.7 18.2 10.3 12.6 60+ 11.3 40.9 27.7 12.6 29.8 25.5 14.4 39.0 31.8 Does not know time 0.0 0.0 0.0 1.8 0.3 0.6 1.8 0.3 0.7 Does not know source 0.0 0.0 0.0 24.3 38.2 34.8 15.4 21.4 19.6 Not stated 6.2 6.3 6.2 18.2 15.8 16.4 14.7 16.0 15.6 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number of men 77 96 173 479 1460 1939 479 1175 1654 Among current users of contraceptive methods, 69 percent of men in urban areas and 35 percent of men in rural areas were within 30 minutes of the place from which they obtain their methods. Eleven percent of users in urban areas and 41 percent of men in rural areas need more than one hour to reach the source of contraceptive supplies. Among men who are not currently using a modem method, 24 percent of men in urban areas and 38 percent of men in rural areas did not know any place where they could obtain contraceptives; 26 percent of urban men and 9 percent of those in rural areas reported that they were within 30 minutes from their source of contraceptive methods. Even among men who know of at least one family planning method, 20 percent said they did not know a place where they can get modem contraceptives, and only 20 percent were within 30 minutes of the source of modem methods. As noted in Chapter 4, these findings indicate that contraceptive users in rural areas cover longer distances to reach their source of supplies. More service delivery points need to be established in rural areas to reduce the distances covered before reaching sources of supplies. The findings in this section suggest that apart from lack of knowledge of contraceptive methods, knowledge of the place where methods could be obtained is also lacking. This particularly pertains to men not currently using modem methods. Intention to Use Family Planning Methods Among Nonusers Currently married men who were not using a modem contraceptive method at the time of the survey were asked if they we re planning to do something to prevent their partners from getting pregnant in the future. According to the results, which are shown in Table 10.11, more than half (56 percent) of men currently not using contraception do not intend to use contraceptive methods in the future. The proportion of men not intending to use contraceptives in the future increases with increasing number of living children. This suggests that men with a large number of living children are more likely to have a negative attitude towards family planning. Therefore, family planning education and counselling should be focused on this population. 125 Table 10.11 Future use of contraception Percent distribution of currently married men who are not using a contraceptive method by past experience with contraception and intention to use in the future, according to nuraber of living children, Tanzania 1991/92 Past experience with contraception and future intentions Number of living children 1 0 1 2 3 4+ Total Never used contraception Intend to use in next 12 months 3.7 8.9 10.1 Intend to use later 10.1 5.5 3.8 Unsure as to timing 2.3 0.0 0.0 Unsure as to intention 24.5 12.1 13.5 Do not intend to use 36.8 41.1 35.0 Missing 0.0 0.0 0.8 Previously used contraception Intend to use in next 12 months 1.4 13.5 14.8 Intend to use later 9.9 10.0 11.3 Unsure as to timing 0.0 0.7 0.0 Unsure as to intention 1.8 0.3 1.7 Do not intend to use 7.0 5.4 9.1 Missing 2.4 2.7 0.0 Total 100.0 100.0 100.0 All currently married nonusers Intend to use in next 12 months 5.0 22.3 24.9 Intend to use later 20.0 15.5 15.1 Unsure as to timing 2.3 0.7 0.0 Unsure as to intention 26.4 12.4 15.2 Do not intend to use 43.8 46.5 44.0 Missing 2.4 2.7 0.8 17.7 8.8 9.5 4.2 2.7 4.2 0.4 0.4 0.5 15.0 8.8 12.2 44.1 48.1 ~.7 1.0 0.2 0.3 5.6 8.7 9.1 2.4 2.4 5.5 0.0 0.9 0.5 0.4 1.2 1.1 7.1 16.8 11.9 2.1 1.1 1.4 100.0 100.0 100.0 23.3 17.5 18.6 6.6 5.1 9.7 0.4 1.2 1.0 15.5 10.0 13.3 51.2 64.9 55.6 3.1 1.3 1.8 Total 100.0 100.0 100.0 100.0 100.0 1(30.0 Number of men 95 133 131 106 461 926 llnclodes current pregnancy Current ly marr ied men who indicated that they did not intend to use modem contracept ives were asked to state thei r reasons. Over ha l f o f men (52 percent) said that they did not intend to use modem contraception because they want children (see Table 10.12). Other reasons given were "their wives were menopausal or had a hysterectomy" (21 percent), "lack of knowledge" (9 percent), "opposed to family planning" (4 percent), and "infrequent sex" (4 percent). Men below 30 years were more likely not to use contraceptives because they want children. On the other hand, men above 30 years of age were more likely not to use contraceptive methods because their wives were menopausal or had a hysterectomy. Lack of knowledge and opposition to family planning were also more common among men age 30 years and over. 126 Table 10.12 Reasons for not using contraception Percent distribution of men who are not using a contraceptive method and who do not intend to use in the future by main reason for not using, according to age, Tanzania 1991/92 Age Reason for not using contraception <30 30+ Total Wants children 82.9 45.1 52.1 Lack of knowledge 3.7 10.1 8.9 Partner opposed 0.3 0.5 0.4 Side effects 1.8 1.0 1.2 Health ceneerrts 0.0 0.1 0.1 Hard to get methods 0.0 0.3 0.3 Religion 0.7 2.4 2.0 Opposed to family planning 1.9 4.6 4.1 Fatalistic 1.8 1.5 1.6 Other people opposed 0.0 0.1 0.l Infrequent sex 2.6 3.7 3.5 Difficult to be pregnant 0.0 0.1 0.0 Menopausal, had hysterectomy 0.3 25.8 21.1 Inconvenient 0.0 0.7 0.6 Not married 0.3 0.0 0.1 Other 0.0 2.4 1.9 Don't know 3.7 1.7 2.0 Total 100.0 100.0 100.0 Number 95 419 515 Table 10.13 Preferred method of contraception fur future use Percent distribution of currently married men who are not using a contraceptive method but who intend to use in the future by preferred method, according to whether they intend to use in the next 12 months or later, Tanzania 1991/92 Intend to use In next After Preferred method 12 12 of contlaception months months Total 1 Pill 44.7 34.5 40.2 IUD 2.4 0.5 1.8 Injections 7.8 13.8 9.4 Condom 12.8 13.1 12.8 Female stedlisation 8.4 10.7 9.9 Male sterilisation 0.7 0.0 0.5 Periodic abstinence 16.3 22.8 18.5 Mucus method 0.6 0.0 0.4 Withdrawal 3.4 0.0 2.1 Other 0.0 1.2 0.4 Missing 2.9 3.5 3.9 Total 100.0 100.0 100.0 Number 172 90 274 linclodas 9 men who were unsure as to timing and 3 missing cases Nonusers who said that they did intend to use family planning in the future were asked to state the method they would prefer to use. Table 10.13 shows that 40 percent of them preferred to use the pill, and 19 percent preferred periodic abstinence. Other methods preferred were condom (13 percent), female sterilization (10 percent), injections (9 percent), withdrawal (2 percent), and IUD (2 percent). Less than one percent preferred male sterilization or the mucus method. Men who intend to use in the next 12 months were more likely to say they wanted to use the pill. Approval of Family Planning All male respondents were asked i f they had heard family planning messages on radio or television in the month preceding the survey (see Table 10.14). A majority of men (68 percent) said they did not hear any family planning message on the radio or television. Thirty-one percent reported that they had heard a message on family planning on the radio, and less than one percent said that they had heard family planning messages on television. Even in Zanzibar where there is a television system, less than 3 percent of men reported hearing family planning messages on television. This indicates that the television system is not used to promote use of family planning methods. 127 Table 10.14 Family planning messages on radio mad television Percent distribution of all men by whether they have heard a family planning message on radio or on television in the month preceding the survey, according to selected background characteristics, Tanzania 1991/92 Heard family planning message on radio or on television Background Radio Television characteristic Neither only only Both Missing Total Number Residence Mainland 67.5 31.5 0.5 0,5 0.1 100,0 2063 Dares Salaam 65.6 34.4 0.0 0.0 0.0 100.0 151 Other urban 56.6 40.7 1.5 1.2 0.0 100.0 402 Rural 70.6 28.7 0.2 0.3 0.1 100.0 1510 Zanzibar 69.9 19.6 2.9 7.6 0.0 100.0 51 Region Dodoma 60.5 39.5 0.0 0.0 0.0 100.0 173 Arosha 65.9 34.1 0.0 0.0 0.0 100.0 124 Kilimanjaro 43.5 52.8 2.2 1.5 0.0 100.0 128 Tanga 40.4 59.6 0.0 0.0 0.0 100.0 90 Murogoro 56.6 40.1 0.0 3.2 0.0 100.0 120 Coast 67.5 31.2 0.0 1.3 0.0 100.0 34 Lindi 72.2 27.8 0.0 0.0 0.0 100.0 47 Mtwara 95.1 4.9 0.0 0.0 0.0 100.0 109 Ruvuma 59.5 40.5 0.0 0.0 0.0 100.0 70 Iringa 67.4 32.6 0.0 0.0 0.0 100.0 117 Mbeya 82.6 16.0 1.4 0.0 0.0 100.0 103 Singida 64.9 35.1 0.0 0.0 0.0 100.0 67 Tabora 80.4 19.6 0.0 0.0 0.0 100.0 73 Rukwa 70.9 26.3 0.0 1.8 1.1 100.0 51 Kigoma 78.6 20.7 0.0 0.0 0.7 100.0 79 Shinyanga 69.8 27.6 1.4 0.6 0.6 100,0 177 Kagera 92.5 7.5 0.0 0.0 0.0 100.0 121 Mwanza 74.8 22.6 2.0 0.6 0.0 100.0 143 Mara 43.9 55.3 0.0 0.8 0.0 100.0 85 Education No education 85.8 13.7 0.4 0.0 0.1 100.0 418 Primary incomplete 68.1 30.7 0.6 0.5 0.2 100.0 625 Completed primary 63.5 35.1 0.4 1.0 0.1 100.0 878 Secundary/Higher 45.0 53.0 1.1 0.9 0.0 100.0 192 Total 67.6 31.2 0.5 0.6 0.1 100.0 2114 Men in urban areas were more likely to hear family planning messages on the radio than those in rural areas. With the exception of Tanga, Kilimanjaro, and Mara, a majority of men in all regions had not heard family planning messages on the radio or television. Uneducated men are more likely not to hear family planning messages than educated men. 128 Table 10,15 presents results from a question on whether men believe it is ac- ceptable to use radio or television to dis- seminate family planning messages, A majority of men (74 percent) think it is ac- ceptable to do so. The acceptability of family planning messages is high across all ages, although the proportion of men stating that family planning messages on the radio or television are not acceptable increases among men above 39 years of age. The acceptability of family planning messages on the radio or television is rela- tively low in rural areas. A substantial proportion of men (more than 20 percent) in Zanzibar, Shinyanga, and Iringa said it was not acceptable to disseminate family planning messages on radio or television. Educated men are more likely to accept family planning messages on radio or tele- vision than uneducated men. To obtain more direct informa- tion about the acceptability of family plan- ning methods, currently married men who are not sterilized and who know about modem contraceptive methods were asked if they approve of the use of family plan- ning methods (see Table 10.16). In a ma- jority of couples (63 percent) both men and their wives approve of family plan- ning, whereas in only 8 percent of couples both the man and wife disapproved of family planning methods. Approval of family planning varies tremendously with background characteristics. Men below 20 years of age were less likely to approve of family planning than other men. Educated men were more likely to approve family planning than uneducated men and also to know their wives' opinion of family plan- ning. Table 10.15 Acceptability of the use of mass media for disseminating family planning messages Percentage of men who believe that it is acceptable to have messages about family planning on radio or television, by selected background characteristics, Tanzania 1991/92 Not Don't Background Accept- accept- know/ charactaristic able able Missing Total Number Age 15-19 61.0 9.1 29,9 100,0 499 20-24 79.8 8.7 11.5 100.0 308 25-29 84.6 8.3 7.0 100.0 262 30-34 78.2 11.9 9.8 100.0 256 35-39 82.4 9.8 7,9 100,0 201 40-44 75.1 17.6 7,4 100.0 159 45-49 71.0 19.6 9.4 100.0 155 50-54 68.4 19.4 12.2 100.0 127 55+ 69.4 18.6 11.9 100.0 148 Residence Mainland 73.7 11.8 14.6 100.0 2063 Dares Salaam 94.1 0,6 5.3 100.0 151 Other urban 83.6 8.1 8.3 100.0 402 Rural 69.0 13.9 17.2 100.0 1510 Zanzibar 71.0 23.2 5.9 100.0 51 Region Dodoma 77.4 16.5 6.1 100.0 173 Arusha 99.4 0.6 0.0 100.0 124 Kilimanjaro 98.7 1.3 0.0 I00.0 128 Tanga 96.1 3.9 0.0 I00.0 90 Morogoro 78.7 14.9 6.4 I00.0 120 Coast 81.8 8.0 10.2 I00.0 34 Lindi 76.9 13.9 9.2 1(30.0 47 Mtwara 59.9 10.6 29.4 100.0 109 Ruvuma 76.3 10.8 12.9 I00.0 70 Iringa 72.2 21.4 6.4 I00,0 117 Mbeya 78.4 11.9 9,7 I00.0 103 Singlda 78.3 13.5 8.2 100,0 67 Tabora 63.2 14.6 22.2 100.0 73 Rukwa 78.0 16.4 5.7 100.0 51 Kigoma 72.5 2.8 24.7 100.0 79 Shinyanga 41.1 22.8 36.0 100.0 177 Kagera 53.1 12.4 34.6 100.0 121 Mwanza 49.4 19,4 31.2 100.0 143 Mara 71.9 12.0 16.1 100.0 85 Education No education 50.9 22.3 26.8 100.0 418 Some primary 69.4 13.9 16.7 100.0 625 Completed primary 83.2 7.6 9.1 100.0 878 Secundary/Higber 92.7 3.9 3.4 100.0 192 Total 73.6 12.0 14.4 100.0 2114 129 Table 10.16 Attitudes of couples towaxd family planning Among currendy married non-sterilised men who know a contraceptive method, the percentage who approve of family planning, by their perception of their wife's attitude and selected background characteristics, Tanzania 1991/92 Respondent Respondent approves disapproves Unsuro Unsure Background Both Wife of Wife of Both characteristic approve disapproves wife approves wife disapprove Missing Total Number Age 15-19 * * * * * * * 100.0 8 20-24 68.4 3.3 4.2 9.7 5.3 5.5 3.5 100.0 82 25-29 66.0 4.5 9.1 4.9 1.4 5.5 8.6 100.0 152 30-34 67.4 1.5 7.5 4.3 4.8 6.5 8.0 100.0 184 35-39 71.1 5.5 6.8 2.6 2.8 8.7 2.5 100.0 159 40-44 65.8 1.3 7.7 5.3 11.2 5.0 3.7 100.0 120 45-49 53.5 3.4 15.4 2.6 12.8 9.8 2.4 100.0 107 50-54 53.0 10.3 9.6 4.0 1.9 14.3 6.8 100.0 81 55+ 52.2 17.1 7.3 2.9 7.0 9.2 4.2 100.0 100 Residence Mainland 63.9 5.2 8.3 4.4 5.6 7.2 5.4 100.0 967 Dares Salaam (93.1) (0.0) (2.4) (0.0) (0.0) (1.8) (2.6) (100.0) 50 Other urban 64.2 8.6 ll.0 3.1 2.7 5.1 5.3 100.0 231 Rural 61.6 4.4 7.8 5.2 7.0 8.3 5.6 100.0 686 Zanzibar (41.6) (6.6) (16.6) (1.5) (4.4) (29.4) (0.0) (100.0) 27 Education No education 44.2 6.3 13.4 5.2 11.7 13.5 5.8 100.0 200 Primary incomplete 58.2 9.1 7.5 4.1 7.8 8.8 4.5 100.0 307 Completed primary 72.9 2.6 6.2 4.7 2.1 5.3 6.2 100.0 388 Secondary/Higher 79.9 1.4 ll.0 1.8 0.0 3.2 2.8 100.0 97 Total 63.3 5.2 8.5 4.3 5.6 7.8 5.2 100.0 993 Note: Rates shown in parentheses are based on 25-49 men, whereas an asterisk means the rate is based on fewer thma 25 men and has been suppressed. 10.3 Nupt ia l i ty and Sexual In tercourse Factors other than contraception that affect a woman's risk of becoming pregnant are considered in this section. This includes nuptiality, as well as more direct measures of the beginning of exposure to pregnancy and the level of exposurc, i.e., age at first sexual intercourse and the frequency of intercourse. Marital Status Table 10.17 shows the current marital status of the eligible men at the time of the survey. The term "married" refers to civil, religious, or traditional marriage, or just l iving together. Men who arc widowed, divorced, or not l iving together (separated) are classified as "ever married" or "ever in union." Very few teenage men have married (about 2 percent). Among men 20-24 year, 37 percent are ever married and above 130 Table 10.17 Current marital status by age Percent distribution of men by current marital status, accord'rag to age, Tanzania 1991/92 Marital status Married, Married, Number Age Never monoga- polyga- Widowed/ of group married mous mous Divorced Total men 15-19 98.0 1.8 0.0 0.2 100.0 499 20-24 63.3 30.2 2.1 4.4 100.0 308 25-29 30.0 57.1 7.6 5.4 100.0 262 30-34 13.3 69.1 11.1 6.5 100.0 256 35-39 4.5 74.6 13.1 7.8 100.0 201 4044 3.2 75.4 15.7 5.7 100.0 159 45-49 1.1 70.4 18.3 10.3 100.0 155 50-54 3.7 71.0 16.3 9.0 100.0 127 55+ 1.1 65.5 23.8 9.6 100.0 148 Total 38.7 47.0 9.0 5.3 100.0 2114 age 24, 70 percent or more are ever married. About 56 percent of men are currently married (compared to 54 percent observed from the 1988 Population Census), of which 47 percent are in monogamous unions and 9 percent are in polygamous unions. Polygyny TaMe 10.18 shows the distribution of currently married men in a polygynous union (expressed as a percentage of all married men) by background characteristics. Overall, 16 percent of currently married men are in a polygynous marriage. The proportion of married men in a polygynous union increases with age of the respondents. Polygynous unions are more common in rural areas than in Dares Salaam or other urban areas. Iringa, Singida, Mara, and Arusha have the highest proportion of married men in a polygynous union and Dares Salaam, Morugoro, Mtwara, and Kilimanjaro have the lowest proportion. The proportions of educated and uneducated married men in polygynous unions are not significantly different. The majority of polygynous marriages consisted of one man and two wives; 14 percent of all currently married men had two wives and only 2 percent had three or more wives (table not shown). 131 Table 10.18 Polygyny Percentage of currently married men in a polygynous union, by age and selected background character- istics, Tanzania 1991/92 Background characteristi~ Total Number Age 15-19 * 9 20-24 11.7 100 25-29 13.8 169 30-34 14,9 205 35-39 17.2 176 40-44 20.6 144 45-49 18.7 137 50+ 26.7 243 Residence Mainland 16.2 1153 Dares Salaam 2.6 63 Other urban 13.1 234 Rural 18.0 857 Zanzibar 12.2 30 Region Dodoma 16.1 121 A.rusha 25.3 54 Kilimanjaro 7.5 50 Tanga 16.7 58 Morogoro 5.3 69 Coast (9.0) 17 Lindi (21.4) 32 Mtwara 7.2 61 Ruvuma 16.3 44 Iringa 32.3 73 Mbeya 10.5 59 Singida (32.2) 36 Tabora (23.5) 38 Rukwa (15.7) 32 Kigoma 18.5 50 Shinyanga 21.1 92 Kagera 12.9 78 Mw~za 9.6 82 M~a 29.3 44 Education No education 19.9 297 Primary incomplete 16.8 357 Primary completed 12.1 424 Secondary/Higher 18.7 106 Total 16.1 1184 Note: Figures in parentheses are based on 25-49 men, whereas an asterisk means the rate is based on fewer than 25 men and has been suppressed. 132 Age at First Marriage Table 10.19 shows the percentage distribution of ever married men by specific exact ages at marriage according to their current age. The overall median age at first marriage among men age 25-49 years is 25 years. Less than 1 percent of ever married men age 20-49 years were married by 15 years of age. This increased to 4 percent by 18 years, 18 percent by 20 years, 34 percent by 22 years, and 49 percent by 25 years. Hence, 18 percent of respondents got married during adolescence. Table 10.19 Age at first marriage Percentage of men who were first married by exact age 15, marriage, according to current age, Tanzania 1991/92 18, 20, 22, and 25, and median age at first Percentage of men who were first married by exact age: Current age 15 18 20 22 Percentage Median who had Number age at never of first 25 married men marriage 15-19 0.0 NA NA NA NA 98.0 499 a 20-24 0.8 5.1 20.6 NA NA 63.3 308 a 25-29 0.6 3.0 13.5 25.1 50.6 30.0 262 24.9 30-34 0.2 3.2 13.2 28.7 47.1 13.3 256 25.2 35-39 0.0 3.4 19.7 33.1 46.7 4.5 201 25.2 40-44 0.4 7.2 21.7 43.7 61.0 3.2 159 22.7 45-49 0.4 4.9 19.3 43.3 61.3 1.l 155 23.0 50-54 1.3 3.9 13.0 32.4 52.5 3.7 127 24.0 55+ 0.6 5.2 26.7 44.3 48.1 1.1 148 25.1 20-49 0.5 4.3 18.1 33.8 48.9 20.4 1615 25-49 0.5 4.2 17.5 34.3 51.7 10.3 13o7 24.6 NA = Not applicable aOmitted because less than 50 percent of the men in the age group x to x+4 were first mm'ried by age x The median age at first marriage has not changed appreciably across age cohorts. This suggests that the age at first marriage in Tanzania has not changed significantly over time. However, these findings may be affected by recall problems among older men who are likely to have been married many years ago and hence, less likely to remember the exact age at the time of the first marriage. The comparison of the median age at first marriage for women and men shows that women tend to marry earlier than men. Among women and men aged 25-49 years, the median age at first marriage was 18 years for women (Table 5.14) and 25 years for men. Table 10.20 shows the median age at first marriage by urban/rural residence and education. In general, the median age at first marriage does not vary much by residence. Men with no education marry earlier than men with at least some education. 133 Table 10.20 Median age at fh'st marriage Median age at first marriage among men age 25-49 years, by current age and selected background characteristles, Tanzania 1991/92 Current age Men Man Background ago age characteristic 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55+ 20-49 25-49 Residence Mainland a 24.9 25.3 25.2 22£ 23.0 24.0 25.2 25.1 24.6 Dares Salaam a a 26.7 26.4 21.3 25.3 22.8 18.2 a a Other urban a a 29.3 25.3 25.6 25.4 28.0 22,0 a a Rural a 24.0 23.4 25.0 22.5 22.0 23.5 25.3 a 23.6 Zanzibar a a 24.2 20.7 27.8 20.8 25.0 20.5 a 23.7 Education No education 19.0 a 21.3 24.0 20.5 20.8 24.8 21.8 a 22.1 Primary incomplete a 22.0 25.4 22.7 22.3 22.8 22.5 25.6 a 22.8 Completed primary a a 25.2 25.5 23.6 24.5 28.7 25.2 a a Secondary/Higher a a 29.4 26.9 25.7 25.4 28.7 25.4 a a Total a 24.9 25.2 25.2 22.7 23.0 24.0 25.1 a 24.6 aOmitted because less than 50 percent of the men in the age group x to x+,4 were first married by age x Age at First Sexual Intercourse Although age at first marriage is commonly used as a proxy for exposure to intercourse, the two events do not necessarily coincide exactly. Sexual relations may begin prior to marriage. To obtain more objective information about this topic, TDHS asked men to report the age at which they first had sexual intercourse (see Table 10.21). Table 10.21 Age at first sexual intercourse Percentage of men who had first sexual intercourse by exact age 15, 18, 20, 22, and 25, and median age at first intercourse, according to current age, Tanzania 1991/92 Current age 15 18 20 22 Percentage of men who had Percentage Median first intercourse by exact age: who Number age at never had of first 25 intercourse men intercourse 15-19 29.6 NA NA NA NA 39.7 499 a 20-24 26.5 68.1 86.8 NA NA 6,2 308 16.2 25-29 19.4 60.1 79.8 86.1 93.0 2.2 262 16.8 30-34 17.2 56.5 78.4 85.0 92,7 0.4 256 17.5 35-39 11.6 47.3 76.8 90.2 93,0 0.8 201 18.1 40-44 21.2 58.7 77.7 86.8 90,4 0.0 159 16.9 45-49 13.9 48.4 75.9 84.6 87,0 0.9 155 18.1 50-54 20.3 53.9 74.7 86.4 91,3 1.7 127 17.5 55+ 17.4 53.7 76.8 86.4 88,2 0.7 148 17.6 20-49 19.0 57.1 79.3 87.6 91,6 2.0 1615 17.2 25-49 17.2 54.5 77.5 86.5 91,2 1.0 1307 17.5 NA = Not applicable aOmitted because less than 50 percent of the men in the age group x to x+4 had had intercourse by age x 134 The results show that 19 percent of men aged 20-49 years have had intercourse by 15 years of age. The percentage of men reporting who had first intercourse increased to 57 percent by lg years, 79 percent by 20 years, 88 percent by 22 years, and 92 percent by 25 years. The overall median age at first sexual intercourse (among men aged 25-49 years) was 18 years, which is about 7 years less than the median age at first marriage. Adolescent sexuality is not uncommon among men covered by TDHS. Over two-thirds (79 percent) of men aged 20-49 years of age were sexually active by 20 years of age. Comparing cohorts suggests that there have been slight changes in the median age at first sexual intercourse during the past thirty years (Table 10.21). The median age at first intercourse was 18 years among men age 45 years and above and 16 years among men less than 25 years of age. The age at initiation of sex seems to be similar in rural and urban areas (Table 10.22). However, the median age at first sexual intercourse is slightly higher among educated men. This suggests that educated men tend to delay sexual relations somewhat compared to less educated counterparts, although differences are small. Table 10.22 Median age at first intercourse Median age at first sexual intercourse among men age 25-49 years, by current age and selected background characteristics, Tanzania 1991/92 Current age Man Men Background age age characteristic 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55+ 20-49 25-49 Residence Mainland 16.2 16.8 17.5 18.1 16.8 18.1 17.4 17.6 17.1 17.4 Dares Salaam 16.8 17.5 17.3 17.1 16.4 18.4 16.4 16.7 16.9 16.9 Other urban 15.5 16.7 17.8 18.5 18.5 18.1 17.5 15.9 17.2 17.7 Rural 16.2 16.7 17.3 17.9 16.8 18.0 18.0 18.2 17.1 17.4 Zanzibar a 20.9 20.3 16.9 19.8 15.9 20.5 17.3 19.4 18.9 Education No education 14.8 15.6 15.9 19.0 15.6 17.3 17.8 17.5 16.8 17.1 Primary incomplete 16.7 16.7 18.2 17.1 18.3 18.2 18.0 17.0 17.7 17.9 Primary completed 16.3 16.8 17.2 18.2 16.8 16.9 18.4 17.4 16.9 17.2 Seanndary/Higher 17.3 18.2 18.5 17.8 17.2 18.5 15.0 20.6 18.2 18.3 Total 16.2 16.8 17.5 18.1 16.9 18.1 17.5 17.6 17.2 17.5 aOmitted because less than 50 percent of the men in the age group x to x+4 had had intercourse by age x Women appear to start sexual activity slightly earlier than men, but the differences are small (see Figure 10.3). Eighty-three percent of women aged 20-49 years had sexualintercourse by 20 years of age (see Table 5.6) compared to 79 percent of men by the same age. The median age at first sexual intercourse was similar for both men and women. 135 Figure 10.3 Percentage of Men and of Women Who Have Ever Had Sexual Intercourse by Exact Age Percent 90 70 50 30 10 15 16 17 18 19 20 21 22 23 24 25 Age (Years) I 'dlr Men "~1" Women TDHS 1991/92 Recent Sexual Activity In the absence of contraception, the probability of pregnancy is related to the frequency of intercourse. Thus, information on sexual activity can be used to refine measures of exposure to pregnancy. Table 10.23 presents data on sexual activity by background characteristics among men who have ever had intercourse. Men were considered to be sexually active if they had intercourse at least once in the four weeks prior to the survey. Among men who ever had sexual intercourse, 78 percent were sexually active in the month prior to the survey. Sexual activity appeared to vary little by age. Never married men were less likely to be sexually active in the month preceding the survey than ever married men. Sexual activity was relatively low in Dar es Salaam and among men with secondary education and above. As expected, men using contraceptive methods are more likely to be sexually active than those who do not. Data on the number of sexual partners are presented in Chapter 11. Recent sexual activity was noted to be slightly higher among men than women. About 78 percent of men reported being sexually active in the last four weeks, compared to 61 percent of women (see Table 5.8) for the same period. 136 Table 10.23 Recent sexual activity Percent of men who have ever had intercourse by sexual activity in the four weeks prior to the survey according to background characteristics, Tanzania 1991/92 Active Background l~st charactexisde 4 weeks Number Age 15-19 76.3 301 20-24 77.3 289 25-29 72.9 256 30-34 78.4 255 35-39 78.2 199 40-44 86.5 159 45-49 79.4 153 50-54 68.8 125 55+ 81.6 147 Duration of marriage <4 83.1 271 5-9 78.8 207 10-14 80.5 196 15-19 82.9 136 20-24 82.3 178 25+ 79.6 289 Don't know/Not shown 71.0 19 Never in union 69.9 589 Residence Mainland 77.8 1847 Dares Salaam 59.1 144 Other urban 80.3 366 Rural 79.1 1337 Zanzibar 63.5 36 Region Dodoma 86.0 150 Arusha 60.8 116 Kilimanjaro 68.2 114 Tanga 85.6 85 Morogoro 87.9 110 Coast 79.9 33 Lindi 81.9 44 Mtwara 93.5 106 Ruvuraa 84.9 68 Iringa 57.9 99 Mbeya 55.4 89 Singida 79.4 58 Tabora 83.4 63 Rukwa 81.9 45 Kigoraa 75.0 61 Shinyenga 90.0 161 Kagera 73.4 100 Mwanza 85.8 124 Mara 94.4 76 Education No education 80.0 381 Primary incomplete 81.2 527 Primary completed 79.4 798 Secondary/Higher 52.8 178 Contraceptive method No method 76.1 1569 Sterilisation (66.6) 22 Periodic abstinence 80.3 96 Other 85.3 144 Total 77.5 1884 Note: Figures in parentheses are based on 25-49 men 137 10.4 Fertility Preferences In the TDHS, currently malTied men were asked about their desire for children. They were also asked about the ideal number of children they wanted by gender, and how long they would like to wait before the birth of the next child. Desire for More Children In Tanzania where contraceptive prevalence rate is low and cultural influences are still strong, one would expect that many currently married men would have desired more children. As Tables 10.24 and 10.25 and Figure 10.4 show, 41 percent of currently married men indical~l they wanted another child soon, 35 percent wanted another child later, and 3 percent were undecided when to have another child. Fifteen percent said that they wanted no more children and 2 percent were sterilized. The proportion who want no more children increases with age and the number of living children. Table 10.24 Fertility preference by number of living children Percent distribution of currently married men by desire for more children, according to number of living children. Tanzania 1991/92 Number of living children t Desire for children 0 1 2 3 4 5 6+ Total Want another soon 2 77.0 40.9 42.0 42.4 32.4 28.9 21.4 40.5 Want another later 3 9.9 45.9 28.0 41.0 41.6 18,0 32.1 34.9 Want another, undecided when 12.1 1.8 3.3 2.8 0.0 4.1 1.5 3.0 Undecided 0.0 0.6 0.8 0.6 6.3 0.6 2.1 1.4 Want no more 0.0 6.5 22.5 8.1 13.8 31.3 31.8 14.5 Wife sterilised 0.0 1.7 1.1 0.2 3.0 1.2 7.2 1.9 Wife declared irdecund 0.0 1.5 0.4 2.8 1.2 2.0 1.6 1.3 Other answer 0.0 0.8 1.1 2.1 1.7 2.5 0.6 1.2 Missing 1.0 0.3 0.9 0.0 0.0 11.3 1.6 1.2 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number of men 96 338 242 178 127 77 125 1184 tIncludes current pregnancy 2Want next birth within 2 years 3Want to delay next birth for 2 or more years 138 Table 10.25 Fertility preferences by age Percent distribution of currently married men by desire for more chilth'en, according to age, Tanzania 1991/92 Current age Desire for children 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55+ Total Have another soon I 51.0 40.7 47.6 39.6 44.7 36,9 33.9 25.8 40.5 Have another later 2 37.6 52.2 41.2 46.8 32.6 21,1 10.9 24.4 34.9 Another, undecided when 1.6 1,8 6.9 0.6 3.5 2.3 5.0 1.3 3.0 Undecided 0.0 0.0 0.5 0.6 0.0 7.8 2.3 0.9 1.4 Want no more 8.7 4.4 3.4 9.4 14.8 21.1 39.1 28.8 14.5 Wife sterilised 0.0 0.0 0.0 1.3 2.3 4.9 7.4 0.9 1.9 Wife declared infecund 0.0 0.0 0.0 0.0 0.5 3,9 1.5 5.8 1.3 Other answer 0.0 0.0 0.5 1.1 1.6 1.4 0.0 3.9 1.2 Missing 1.0 1.0 0.0 0.5 0.0 0.7 0.0 8.1 1,2 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number 100 169 205 176 144 137 111 114 1184 Note: The 15-19 age group was omitted because less than 50 percent were married. lWant next birth within 2 years 2Want to delay next birth for 2 or more years Figure 10.4 Fertility Preferences among Currently Married Men 15-60 Want Chi ld Soon 41% (<2 years) % Undecided 4% TDHS 1991/92 139 Figure 10.5 presents the percent of currently married men who want no more children by the number of living children, rural/urban residence, and educational attainment. The proportion of men who want no more children in rural areas is not significantly different from that in the urban areas. However, the proportion of men with secondary or higher education who want no more children is about twice that of men with primary or no education. Figure 10.5 Percent of Currently Married Men Who Want No More Children NUMBER OF L IV ING CHILDREN 5 6+ RESIDENCE Maln land Dar es Salaam Other Urban Rural Zanz ibar EDUCATION None Pr im. Incomplete Pr im. Completed Secondary + TOTAL 8 24 ~ 8 . , - , - , 1 7 . . . . 3 3 • . , . . 39 . , , 1 7 22 . . . , , 1 7 - " ÷ ~ 1 6 . . . .~ 13 ~ 1 6 32 10 20 30 Percent 40 50 TDHS 1991/92 Ideal and Actual Number of Children Though men do not bear children, they have a very strong influence and, in many cases, the final say, on the number of children they would like to have. Table 10.26 shows the percent distribution of all men by ideal number of children and mean ideal number of children for all men and currently married men, according to number of living children. About 11 percent of the men gave a non-numeric response. Twenty-eight percent of men with no child want four children and 30 percent of them want at least six children. Among men with one child, 19 percent wanted four children and 48 percent wanted six or more children. Among men with 6 or more living children, 14 percent of them would have wanted to have four children and 58 percent were satisfied with the number of children they have, that is six or more children. Overall, irrespective of the number of children still alive, 22 percent of all men wanted four children and 43 percent of them wanted six or more children. AS observed in Chapter 6, there is a correlation between the actual and ideal family size. The mean ideal number of children increases from 5.4 among childless men, to 6.7 among men with two living children, and to 8.9 among men with six or more children. Figure 10.6 shows the mean ideal number of children for all men by age and selected background characteristics. Overall, men with secondary or higher education had the smallest mean ideal number of children, and men with no education had the largest ideal family size (9 children). The mean ideal number of children varies among men of different ages. For example, the youngest men would like to have 5 children, men in the age 20-24 age group would like 6 children, men age 35-39 would like 7 children, and men age 45-49 years would like 9 children. 140 Table 10.26 Ideal number of children Pereant dislzibution of all men by ideal number of children and mean ideal number of children for all men and for currendy manied men, according to number of living children. Tanzania 1991/92 Number of living children I Ideal number of children 0 1 2 3 4 5 6+ Total 0 0.0 0.3 0.0 0.0 0.0 0.0 0.0 0.0 1 0.4 0.1 0.0 0.0 0.0 3.1 0.0 0.3 2 3.4 2.0 2.4 0.6 1.3 1.9 2.6 2.5 3 9.9 4.9 3.8 1.5 0.4 3.4 8.8 6.5 4 28.2 19.2 20.2 18.1 9.3 12.8 13.6 21.9 5 18.8 14.9 15.2 18.0 7.1 3.1 4.8 15.3 6+ 30.4 48.0 48.1 50.4 68.1 60.6 57.6 43.0 Non-numeric response 9.0 10.5 10.4 11.6 13.7 15.1 12.6 10.5 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number of man 912 380 274 195 137 83 132 2114 Mean ideal number 5.4 7.0 6.7 7.5 8.4 8.3 8.9 6.5 Number of man 830 340 246 173 118 71 115 1893 Mean for men in union 5.6 7.2 6.7 7.6 8.5 8.4 8.8 7.4 Number of men in union 85 307 217 157 109 66 109 1049 Nora: The means exclude men who gave non-numeric respormcs. 1Includes current pregnancy I Figure 10.6 Mean Ideal Number of Children among All Men AGE OF RESPONDENT 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55+ I RES IDENCE Ma in land Dar ee Sa laam Other Urban Rura l Zanz ibar ~5 4.5 ]5 .6 EDUCATION None Prln Prlc 5.8 6 .7 8.1 7 6.4 8 .8 0 2 4 6 8 Percent 10 TDHS 1991/92 141 10.5 Couples Background Characteristics Table 10.27 presents the percent distil- bution of husbands by age, number of children, type of union, level of education, urban/rural residence, and region (each couple is counted once). Relatively few husbands (9 percent) are under 25 years of age and only 23 percent of them are under 30 years of age. One in five of the unions considered here are polygynous. It is noted that about 6 percent of couples had different opinions on their marital status; the husbands mostly reported polygynous status, and the wives reported that their husband had only one wife. Table 10.28 shows that men tend to marry younger women. In 94 percent of the couples observed, husbands were older than wives. In about one-third of couples, husbands were 10 years or more older than their wives. Knowledge and Use of Contraception There is a general feeling that matters relating to family planning are focused too of- ten on women despite the fact that husbands are equal partners in the reproductive process and have a greater responsibility for family de- cisions. Moreover, women often look at their husbands as a constraint on the use of contra- ception. Table 10.29 shows the percentage dis- tribution of contraceptive knowledge among married couples by specific method. In about 68 percent of the couples both husband and wife know a modem method of family plan- ning, in 17 percent of the couples only men were aware of any modem method, and in 9 percent of the couples only the wives knew about a modem method of family planning. The proportion of couples in which both the husband and wife had no knowledge of mod- em contraception was small (7 percent). For most methods, if only one spouse knew the method, it was most likely to be the husband, except in the case of injections and "other" methods. Table 10.27 Background characteristics of husbands Percent distribution of husbands by selected background characteristics, Tanzania 1991/92 Number of man Background Weighted Un- characteristic percent Weighted weighted Age 15-19 0.7 6 10 20-24 8.2 78 87 25-29 14.5 139 143 30-34 19.1 182 164 35-39 16.7 159 148 40-44 13.4 128 132 45-49 11.3 108 115 50-54 9.4 90 72 55+ 6.8 65 72 Number of children <2 35.3 337 330 3-4 26.0 248 220 5+ 38.7 370 393 Type of union Monogamous 80.5 768 750 Polygamous 19.5 187 193 Education No education 24.0 229 229 Primary 68.5 654 649 Secondary/Higher 7.5 72 65 Residence Mainland 97.9 935 903 Dares Salaam 4.8 46 40 Other urban 17.3 165 102 Rural 75.8 723 761 Zanzibar 2.1 20 40 Region Dodoma 8.8 84 40 Arusha 3.6 34 25 Kilimanjaro 3.7 36 31 Tanga 5.5 53 42 Morogoro 5.9 56 54 Coast 0.9 9 25 Lindi 1.6 15 21 Mtwara 4.8 46 40 Ruvuma 2.0 19 27 lringa 6.9 66 51 Mbeya 5.7 54 35 Singida 3.2 30 40 Tabera 3.8 36 51 Rukwa 3.0 29 62 Kigoma 5.0 48 67 Shinyanga 8.4 80 63 Kagera 7.2 69 45 Mwanza 8.0 76 71 Mara 5.2 49 73 All men 100.0 955 943 142 Table 10.28 Age difference between spouses Percent distribution of the age difference between spouses according to wife's age Husband's age - wife's age (in ye~s) First Second+ Age Negative 0-4 5-9 10-14 15+ Total wives wives Total Number 15-19 0.5 24.2 38.9 19.0 17.4 100.0 8.9 12.7 9.5 103 20-24 3.4 24.3 38.4 19.2 14.8 100.0 7.9 13.2 8.5 213 25-29 4.3 26.2 42.4 14.7 12.5 100.0 6.9 12,4 7.5 191 30-34 7.3 26.9 25.1 21.7 19.0 100.0 7.8 12.0 8.4 143 35-39 6.1 25.8 31.7 21.8 14.6 100.0 6.9 15.7 7.9 149 40-44 12.3 21.0 28.4 29.0 9.2 100.0 6.5 9.2 6.7 90 45-49 10.5 34.7 31.9 21.5 1.5 100.0 4.6 7.4 5.0 66 Total 5.6 25.7 34.8 20.1 13.8 100.0 7.3 12.3 7.9 955 Table 10.29 Knowledge of methods among married couples Percent distribution of contraceptive knowledge among married couples by specific method, Tanzania 1991/92 Both Husband, Wife, know not not Method method wife husband Neither Total Any method 70.4 15,8 8,0 5.8 100.0 Any modem method 67.7 16.8 8.8 6.8 100.0 Pill 59.2 16.7 13.3 10.8 100.0 IUD 16.4 17.8 17.5 48.3 100.0 Injection 21.3 17.3 21.6 39.8 100.0 Diaphragm/Foam/Jelly 10.1 27.3 12.3 50.3 100.0 Condom 46.6 24.7 9.6 19.1 100.0 Female sterilisation 38.3 24.1 16.4 21.1 100.0 Male sterilisation 5.1 24.4 4.4 66.1 100.0 Any traditional method 34.5 25.8 13.7 26.0 100.0 Periodic abstinence 16.0 29.1 9.1 45.8 100.0 Mucus method 4.5 18.5 6.0 71.0 100.0 Withdrawal 19.4 26.9 8.4 45.3 100.0 Other 4.1 12.6 18.5 64.8 100.0 Approval of Family Planning Husbands and wives were asked about their own approval of family planning. Husbands were also asked to state whether they thought their wives approved or disapproved family planning. Figure 10.7 shows the percentage distribution of couples by approval of family planning. Overall, in 59 percent of the couples both husband and wife approved of family planning, and in 9 percent of the couples both disapproved. In 19 percent of the couples, the wives approved but the husbands did not, and in 10 percent of the couples the husbands approved family planning but the wives did not. 143 Figure 10.7 Spouses Responses on Approval of Family Planning Both Approve 59% Missing 4% Both ,lsapprove 9% Only Wife Approve= "19% Only Husband Approves 10% TDHS 1991/92 Table 10.30 shows the perceptions of their wives' attitude towards family planning among husbands who approve of family plan- ning according to background characteristics. Overall, 81 percent of husbands think that their wives approve of family planning as well, 6 per- cent believe their wives disapprove, and 13 per- cent don't know what their wives think. On the other hand, as Table 10.31 shows, both husbands and wives often have wrong ideas about their spouses' opinion on family planning. Actually, husbands are more favourable towards family planning than their wives thought. In 63 percent of the cases, the wife thought that their husband disapproves of family planning, whereas the husband actually approves it; in 16 percent of cases the husband disapproved whereas the wife thought he ap- proved. A significant proportion of wives does not know the husband's opinion; most of these were husbands who approved family planning (60 percent of cases in which the wife did not know). A similar picture emerges when vali- dating the men's responses about the wives' opinions. For instance, in 65 percent of couples Table 10.30 Attitudes of couples toward family planning Among currently married non-sterilised men who know a contraceptive method, the percentage who approve of family planning, by their perception of their wife's attitude and selected background characteristics, Tanzania 1991/92 Respondent approves Background Both Wife Unsure characteristic approve disapproves of wife Number Age <30 82.2 5.3 12.5 152 30-39 83.0 4.4 12.6 254 40-49 81.1 4.2 14.7 154 50 + 72.3 15.5 12.3 99 Residence Mainland 81.2 6.1 12.7 648 Dares Salaam 87.8 4.8 7.4 42 Other urban 82.3 5.1 12.6 130 Rural 80.3 6.4 13.3 476 Zanzibar (57.7) (14.6) (27.7) 12 Education No education 60.8 13.7 25.6 116 Primary 83.3 5.3 11.5 478 Secondary/Higher 97.8 0.0 2.2 66 Total 80.8 6.2 13.0 660 Note: Rates shown in parentheses are based on 25-49 men. 144 in which the husband thought she disapproved, the wife approved of family planning. In general, this shows that there is considerable scope for improvement of communication between spouses. Table 10.31 Spouse's perception of other spouse's approval of family planning Percentage distribution of spouse's approval of family planning by other spouse's perception, Tanzania 1991/92 Husband Perception Approves Disapproves Unsure Total Number Believe husband approves 81.2 16.0 2.9 100.0 389 Believe husband disapproves 62.9 34.5 2.7 100.0 206 Don't know 59.6 36.0 4.3 100.0 359 Total 69.1 27.5 3.4 100.0 955 Wife Perception Approves Disapproves Unsure Total Number Believe wife approves 87.0 12.7 0.3 100.0 589 Believe wife disapproves 64.6 35.4 0.0 100.0 144 Don't know 73.6 26.4 0.0 100.0 222 Total 80.5 19.3 0.2 100.0 955 10.6 Desire for More Children Husbands were asked about their desire for more children. Table 10.32 shows the percentage distribution of couples by desire for more children according to the number of l iving children each partner has. Overall, in 64 percent of the couples both want more children, in 6 percent of the couples both want no more children, in 4 percent of the couples the wife is infecund and the husband wants more children, in 15 Table 10.32 Desire for more children among couples by number of living children Percentage distribution of couples by desire for more children, according to number of living children, Tanzania 1991/92 Husband Wife Husband wants wants wants more, more, Both Both more, wife husband want Number Number of want wife does does no of living children more infecund not not more Other Total couples Husband 0 79.5 14.1 2.4 0.0 0.0 4.0 100.0 72 1-3 82.4 2.3 10.4 1.5 0.2 3.1 100.0 400 4-6 53.3 2.2 19.4 6.2 9.2 9.6 100.0 288 7-9 36.9 3.5 26.8 6.4 15.5 11.0 100.0 121 10+ 35.5 5.4 20.6 4.9 19.1 14.4 100.0 74 Wife 0 84.0 9.6 2.2 2.4 0.0 1.8 100.0 111 1-3 80.5 2.9 8.3 2.6 1.3 4.5 100.0 470 4-6 45.4 1.7 25.5 5.9 9.8 11.7 100.0 269 7+ 16.6 4.8 35.6 4.3 26.8 11.9 100.0 105 Total 64.0 3.6 15.4 3.7 6.3 7.0 100.0 955 145 percent of the couples the husband wants more children but the wife does not want any more children, and in 4 percent of the couples the wife wants more children but the husband did not. Thirty-seven percent of husbands who had 7 or more living children wanted more children in comparison to only 17 percent of women with 7 or more l iving children, Table 10,33 shows the percentage distribution of couples by the husband's ideal number of children according to the wi fe 's ideal number of children. Overall, 23 percent of the couples wanted the same number of children and in 32 percent of the couples, the husband wanted more children than the wife. In about 37 percent of the couples the wife wanted more children than the husband. This shows that there is little agreement between husbands and wives on the ideal number of children a couple would like to have. Table 10.33 Ideal number of children according to spouses Percent distribution of couples by ideal number of children, according to selected background characteristics, Tanzania 1991/92 Ideal Husband Wife number wants wants same for more more Non- Number Background husband than than numeric of characteristic and wife wife husband response Total couples Age difference Negative 12.7 14.2 61.4 11.7 100.0 53 0-4 23.8 27.5 41.7 7.0 100.0 245 5-9 20.4 37.1 35.7 6.8 100.0 332 10-14 26.1 34.4 29.4 10.2 100.0 192 15+ 24.9 29.3 33.4 12.4 100.0 131 Type of union Monogamous 24.3 31.1 37.8 6.8 100.0 726 Polygamous 18.6 36.8 33.4 11.2 100.0 161 Different I 14.1 26.2 38.1 21.6 100.0 67 Number of more children Same 25.6 29.9 37.2 7.3 100.0 497 Different 19.4 33.8 36.9 9.8 100.0 458 Education Both none 20.0 34.0 29.2 16.8 100.0 160 Wife some, husband none 12.0 34.1 34.7 19.3 100.0 67 Husband some, wife none 20.1 27.9 42.5 9.5 100.0 228 Both some 26.0 32.5 37.5 4.0 1130.0 500 Total 22.6 31.8 37.1 8.5 100.0 955 IWhen asked to def'me type of union, each partner responded differently. 146 CHAPTER 11 AIDS KNOWLEDGE AND SEXUAL PRACTICES The first cases of AIDS were reported in Tanzania in 1983 and, to date, the total is 34,605. This figure is believed to represent only 20 percent of the true number of AIDS cases that have occurred in the cotmtry. The National AIDS Control Programme (NACP) estimates that 800,000 healthy individuals are currently infected with HIV and projects that 2 million people will be infected by the year 2000 (NAC"P, 1992). It is obvious that HIV/AIDS is the major public health problem in Tanzania. In view of the importance of HIV/AIDS in Tanzania, this survey collected information to assess knowledge of HIV/AIDS transmission and prevention from 9,238 women and 2,114 men. 11.1 AIDS Awareness and Knowledge Table 11.1 and Figure 11.1 show the distribution of AIDS awareness and knowledge of specific modes of AIDS transmission by background characteristics for females and males. It is encouraging to note that most respondents (93 percent of females and 98 percent of males) have heard about AIDS. AIDS awareness is high across all age groups, and in both urban and rural areas. Among both males and females, AIDS awareness is relatively low among respondents with no education (94 percent among men, 86 percent among women). To obtain more information about AIDS knowledge, respondents were asked to mention how AIDS is transmitted. Knowledge of sexual transmission of AIDS is very high. About 83 percent of females and 90 percent of males mentioned sexual intercourse as a mode of AIDS transmission. Among both sexes, knowledge o f other modes of transmission of AIDS, such as contaminated needles or blades, mother to child, and blood transfusion, is low. Overall, the proportion mentioning specific modes of transmission of AIDS increases with increasing level of education. As observed in other studies (Kapiga et al., 1991; Gaisie et al., 1993) AIDS awareness is found to be very high in Tanzania. However, a majority of respondents know about sexual transmission of AIDS; knowledge of other modes of transmission is very low. The ongoing AIDS education campaign may need to focus more on these less known transmission modes. 147 Table 11.1 Knowledge of AIDS Percentage of women and men who have ever heard of AIDS and percentage reporting various modes of transmission, by selected background characterisitcs, Tanzania 1991/92 Mode of AIDS trammission Ever Needles, heard Sexual blades. Mother Blood Number Background of inter- skin to trans- Don't of characteristic AIDS course punctures child fusion Other know women FEMALES Age 15-19 93.6 77.9 32.4 6.5 11.3 1.3 14.4 2183 20-24 95.7 87.7 40.3 8.5 16.1 2.0 7.4 1882 25 -29 94.7 87.5 38.9 8.9 15.7 1.0 6.9 1599 30-34 94.7 86.2 34.2 7.4 16.1 1.8 8.0 1165 35-39 91.2 81.0 30.5 8.2 13.1 1.1 9.3 1000 40-44 89.3 78.4 26.7 5.2 9.7 1.1 10.1 715 45-49 86.0 75.5 21.1 4.8 8.0 0.7 10.4 695 Residence Mainland 93.0 82.6 34.1 7.4 13.7 1.4 9.7 8978 Dar es Salaam 96.2 90.8 49.1 5.0 15.3 1.1 5.3 585 Other urban 99.0 93.4 51.3 10.6 22.3 2.3 5.2 1686 Rural 91.2 79.1 28.5 6.8 11.4 1.2 11.2 6707 Zanzibar 99.3 90.8 24.6 7.1 5.7 0.2 8.2 260 Education No education 86.1 71.0 15.7 2.9 7.0 1.1 14.5 3128 Primary incomplete 94.7 82.4 31.1 6.8 10.8 1.7 11.4 1825 Completed primary 97.5 90.8 45.7 10.5 17.4 1.5 6.0 3841 Secondary/Higher 99.5 98.3 70.2 14.9 35.7 0.9 0.6 444 Total 93.2 82.8 33.9 7.4 13.5 1.4 9.7 9238 MALES Age <20 96.1 81.0 28.0 12.0 11.1 0.7 14.8 498 20-24 99.4 95.8 45.8 16.7 21.9 1.7 3.3 307 25-29 99.2 93.6 50.0 19.7 18.3 0.4 5.2 262 30-34 99.1 95.2 48.5 18.8 17.0 1.8 3.9 256 35-39 97.5 94.6 37.8 20.2 18.6 0.6 2.9 201 40-44 97.8 94.6 35.9 16.0 16.7 0.0 3.2 159 45-49 97.0 85.5 38.2 10.9 14.3 2.0 10.1 155 50+ 95.8 87.3 35.9 11.8 12.2 0.4 8.6 274 Age at marriage <30 97.8 88.3 38.5 15.3 16.0 0.9 9.2 1069 30-39 98.5 95.1 43.8 19.6 17.7 1.3 3.5 457 40-49 97.4 90.1 37.1 13.5 15.5 1.0 6.6 313 50 + 95.8 87.3 35.8 11.8 12.2 0.4 8.5 275 Residence Mainland 97.7 90.1 39.3 15.8 16.0 1.0 7.3 2063 Dar es Salaam 99.4 99.1 71.6 62.5 61.8 0.0 0.3 151 Other urban 99.8 95.8 47.9 15.2 15.5 0.0 4.0 402 Rural 97.0 87.7 33.7 11.3 11.6 1.3 8.9 1510 Zanzibar 96.8 83.0 32.0 1.7 7.5 0.8 13.8 51 Educatinn No education 93.9 80.2 11.1 6.9 6.4 0.3 13.7 418 Primary incomplete 97.3 88.2 29.7 9.7 9.2 1.5 8.6 625 Completed primary 99.3 94.1 50.7 19.0 19.5 1.1 4.9 878 Secondary/Higher 99.6 97.4 77.5 37.2 41.0 0.0 2.2 192 Total 97.7 89.9 39.1 15.5 15.8 1.0 7.5 2114 148 Figure 11.1 AIDS Awareness and Knowledge of Modes of Transmission EVER HEARD OF AIDS MODES OF TRANSMISSION Sexual Intercourse Needles/Razor Blood Transfusion Mother to Chi ld Other Don't Know 20 40 60 80 100 Percent "I'DHS 1991/92 11.2 AIDS Misconceptions To assess potential misconceptions about methods of transmission of AIDS, respondents were asked whether they thought they can contract AIDS through hand shaking, hugging, kissing, sharing clothes or eating utensils, stepping on urine or stool, and mosquito bites. The results are presented in Table 11.2 for women and men who knew about AIDS. It is encouraging to note that the majority of respondents did not believe that any of these activities are risk factors for AIDS transmission. Misconceptions were highly prevalent for both sexes: 33 percent of females and 36 percent of males thought urine and stools could transmit the infection, 32 percent of females and 42 percent of males thought mosquito bites could, and 28 percent of women and 33 percent of men thought kissing could. Respondents in rural areas and males are more likely to cite these activities as potential modes of AIDS transmission, whereas males living in Dares Salaam appeared to have more correct knowledge than others. Sixty-two percent of women and 68 percent of men knew a healthy person can have AIDS. A significant proportion of men and women did not know whether a healthy person can have AIDS (21 and 17 percent respectively), while an additional 17 percent of women and 13 percent of men thought a healthy person cannot have AIDS. 149 Table 11.2 AIDS transmission Percentage of women and men who report possibility of transmitting AIDS by various means according to place of residence, Tanzania 1991/92 Mainland Method of Dares Other transmission Total Salaam urban Rural Zanzibar Total FEMALES Shaking hands 12.4 5.9 9.6 13.7 13.4 12.4 Hugging 20.1 12.1 16.1 22.0 14.9 20.0 Kissing 27.9 25.4 27.3 28.3 16.0 27.6 Wearing clothes 22.5 17.6 18.6 24.1 13.4 22.3 Sharing eating utensils 22.4 19.3 17.7 24.0 16.4 22.2 Step on urine/stool 33.4 31.2 32.5 33.8 28.5 33.2 Mosquito etc. bite 31.8 22.8 33.6 32.1 30.5 31.7 Can a healthy person have AIDS? Yes 61.6 78.6 71.9 57.2 58.2 61.5 No 16.5 10.7 14.2 17.7 35.4 17.1 Don't know 21.8 10.7 13.8 25.1 6.4 21.4 Can a mother transmit to child? Yes 59.0 77.5 71.3 53.9 56.0 58.9 No 14.5 9,8 12.9 15.4 31.8 15.0 Don't know 17.6 5.2 8.3 21.3 8.5 17.3 Missing 0,1 0,0 0.2 0. l 0.0 0.1 Total 8350 563 1669 6119 259 8609 MALES Shaking hands 15.9 1.1 9.6 19.1 11,5 15,8 Hugging 24.7 2.5 18.6 28.7 15.7 24.5 Kissing 32.8 5.9 29.0 36.6 23.2 32.6 Wearing clothes 28.2 5.4 18.4 33.3 24.9 28.1 Sharing eating utensils 28.3 5.7 17.0 33.7 28.8 28.3 Step on urine/stool 36.4 6.6 25.9 42.4 37.0 36.4 Mosquito etc. bite 41.5 4.4 32.7 47.8 55.1 41.9 Can a healthy person have AIDS? Yes 67.4 91.4 70.6 64.0 80.0 67.7 No 15.0 7.6 18.0 15.0 4.5 14.8 Don't know 17.1 0.9 10.7 20.6 15.5 17.1 Missing 0.4 0.0 0.7 0.4 0.0 0.4 Can a mother transmit to child? Yes 77.0 98.6 73.1 75.9 77.3 77.0 No 7.3 1.4 14.2 6.0 4.9 7.2 Don't know 15.7 0.0 12.7 18.1 17.8 15.8 Total 2015 150 401 1464 50 2065 11.3 Sources of Information about AIDS Respondents were asked to name the sources of information about AIDS during the month before the survey; the results are presented in Table 11.3 and Figure 11.2. Over half of females cited friends or relatives (62 percent) and radio (56 percent) as a source of information about AIDS, whereas the majority of males interviewed (81 percent) cited the radio. Respondents in Dar-es-Salaam are more likely to get AIDS information from radio and newspapers than respondents in other places. Overall, only 6 percent of females and 5 percent of males reported that they did not hear about AIDS during the month before the survey. These findings indicate that most people in Tanzania are exposed to AIDS information. However, the sources of 150 Table l 1.3 Sources of AIDS information Percentage of women who report hearing of AIDS from various sources in the month before the survey, by urban-raral residence, Tanzania 1991192 Mainland Source of Dares Other information Total Salaam urban Rural Zanzibar Total FEMALES Radio 55.3 95.9 71.8 47.1 79.8 56.1 TV 1.7 6.7 3.3 0.9 10.1 2.0 N~wspaper 19.6 57.5 31.7 12.9 17.1 19.6 Health worker 38.6 46.5 44.1 36.3 12.5 37.8 Mosque/Church 8.3 7.9 10.3 7.8 0.9 8.1 Friend/Relative 61.7 63.4 53.3 63.8 66.4 61.8 School/Teacher 4.9 3.5 6.7 4.6 3.7 4.9 Slogan/Pamphlet/Poster 19.1 35.2 23.4 16.5 7.6 18.8 Committee meeting 11.5 10.4 12.2 11.4 12.0 11.5 CCM office 1.2 0.1 1.8 1.2 2. l 1.3 Other 1.0 0.5 1.7 0.8 0.2 0.9 None 6.3 0.0 4.2 7.5 0.0 6.1 Total 8350 563 I669 6119 259 8609 MALES Radio 81.0 100.0 91.6 76.1 80.2 80.9 TV 2.2 3.0 6.7 0.9 25.6 2,8 Newspaper 38.0 86.0 45.2 31.1 30.4 37.8 Health worker 25.2 5.0 34.2 24.8 13,3 24.9 Mosque/Church 8.4 0.4 11.9 8.2 0.0 8,2 Friend/Ralative 44.7 8.8 39.6 49.8 59,3 45,1 School/Teacher 2.6 0.0 1.8 3.2 2.2 2.6 Singan/Pamphlet/Poster 26.6 62.2 31.9 21.5 24,9 26.6 Committee meeting 16.7 1.6 20.3 17.3 0,0 16.3 CCM office 3.8 1.5 3.1 4.2 3.1 3.8 Other 1.8 0.0 4.1 1.4 0.0 1.8 None 5.3 0.0 1.6 6.8 0.0 5.2 Total 2015 150 401 1464 50 2065 information about AIDS tend to differ between men and women. Men are more likely than women to get information from radio, newspaper and slogan~amphlet/poster; women were more likely than men to hear about AIDS from friends/relatives, and health workers. The differences in the source of information between men and women was also reported in another study conducted in Dares Salaam and Bagamoyo (Kapiga, 1991). These findings indicate that radio and friends or relatives are the principal sources of AIDS information in Tanzania. 151 Figure 11.2 Sources of information about AIDS Radio Friend/Relative Newspaper Health Worker Slogan/Pamphlet/Poster Community Meeting ~x~ Mosque/Church I~ School/Teacher "IV CCM Office Other None • • . . . L P 20 40 60 80 100 Percent TDHS 1991/92 11.4 Attitudes about AIDS Table 11.4 shows the opinion of respondents about what they thought was the most important role of the government in the care of AIDS patients. Sixty-four percent of women and 59 percent of men said the government should provide medical treatment for AIDS complications, an additional 14 percent of women and 7 percent of men said the government should assist relatives to take care of AIDS patients, and 15 percent of women and 32 percent of men thought that the government should isolate or quarantine AIDS patients. Only 5 percent of women and less than 1 percent o f men thought that the government should not be involved. Respondents were then asked about the type of service they would prefer be given to their relative, if they had AIDS. A majority of respondents (60 percent of women and 53 percent of men) preferred AIDS patients to be cared for by their relatives or friends. Thirty-one percent of women and 40 percent of men wanted the govemment to provide care of AIDS patients. 152 Table 11.4 Government and personal action for AIDS patients Percentage of women and men by perception of the most important action government could do for people with AIDS and by preferred caretaker for a relative with AIDS, according to place of residence, Tanzania 1991/92 Mai~and Government Dares Other action Total Salaam urban Rural Zanzibar Total FEMALES Assistance Provide medical training 64.2 45.2 Help relatives/Care 14.0 30.0 Isolation/Quarantine/Jail 15.4 12.0 Not be involved 4.6 11.2 Other 1.5 1.7 Missing 0.3 0,0 Total 100.0 100.0 Preferred care Relatives/Friends 60.7 75.3 Government 30.0 23.2 Religious organisation/Mission 0.4 0.2 Nobody/Abandon 6.1 1.0 Other 2.7 0.4 Missing 0.1 0.0 Total 100.0 100.0 Total 8350 563 64.0 66.0 70.8 64.4 12.5 13.0 15.7 14.1 16.8 15.3 11.8 15.3 3.4 4.3 1.5 4.5 3.3 1.0 0.3 1.5 0.1 0.3 0.0 0.3 100.0 100.0 100.0 100.0 67.9 57.4 48.2 60.3 23.2 32,5 48.2 30.5 0.3 0.5 0.0 0.4 5.1 6.8 2.5 6.0 3.4 2.7 1.1 2.6 0.0 0.1 0.0 0.1 100.0 100.0 100.0 100.0 1669 6119 259 8609 MALES Assistance Provide medical trairmg 58.8 63.9 Help Relatives/Care 7.0 8.5 Isolatinn/Quar antine/J ail 31.4 27.6 Not be involved 0.5 0.0 Other 2.0 0.0 Missing 0.3 0.0 Total 100.0 100.0 Preferred care Relatlves/Friends 53.1 66.7 Government 39.1 32.2 Religious organisation/Mission 0.6 1.1 Nobody/Abandon 2.4 0.0 Other 4.8 0.0 Total 100.0 100.0 Total 2015 150 52.6 59.9 48.5 58.5 6.1 7.1 2.3 6.9 34.5 30.9 49.1 31.8 0.0 0.7 0.0 0.5 6.4 1.1 0.0 2.0 0.4 0.3 0.0 0.3 1~.0 100.0 1~.0 1~,0 66.9 ~,9 ~.9 52.5 27.3 ~.1 71.4 39.9 0.0 0.7 0.7 0.6 0.9 3.0 0.0 2.3 4.9 5.3 0.0 4.7 100.0 1~.0 1~.0 100.0 401 1464 50 2065 153 11.5 Sexual Pract ices Under the auspices of the NACP an intensive information, education and communication (IEC) campaign to raise general awareness of AIDS in Tanzania has been implemented. The findings of the TDHS and reports from the NACP indicate that general awareness about AIDS is high. However, there are limited data in Tanzania to show the impact of increased awareness on sexual behavior among both men and women. Information about recent sexual practise can be used by the NACP to assess the current programme impact and plan for future intervention strategies. To obtain information about recent sexual activity, 7978 women and 1884 men who have had sexual relations were asked the frequency of sexual intercourse in the four weeks preceding the survey (see Table 11.5). Thirty-nine percent of women and 22 percent of men had no intercourse in the last four weeks, but most has intercourse 1-3 times. Men were relatively more sexually active than women. The median coital frequency is 2.7 for men and 2.1 for women. Among both men and women, the frequency of intercourse is higher among married and uneducated than among unmarried and educated. Frequency of intercourse varies moderately with age of the respondents and urban/rural residence. To obtain more general information about frequency of sexual activity, respondents were asked to report how many times they usually have intercourse during one month (see Table 11.6). The median coital frequency for both men and women was 5. The usual frequency reported here was much higher than the frequency reported in the four weeks preceding the survey. This may occur because frequency in the last four weeks is affected by postpartum abstinence, illness, and temporary separation. Sexual activity among women reaches a peak at 25-29 years, while men reported the highest frequency of sexual intercourse at 40-44 and 45-49 years. Respondents were further asked the number of different sex partners they have had in the four weeks preceding the survey (see Table 11.7). No distinction was made between formal partner (polygynous union), casual partner, extra-marital partner, or whether money was given for sex (commercial sex). Compared to women, men were more likely to have more than one sex partner (29 percent of men versus 6 percent of women). Among both men and women, the number of sex parmers was higher among the unmarried and those below 25 years of age. However, the proportion of unmarried respondents is higher among subjects below 25 years of age. As expected, men in polygynous unions reported more than one partner (almost two- thirds of men had more than one partner). The reported number of sex partners does not vary significantly with education and urban/rural residence. Information about condom use was obtained by asking respondents to report if they used a condom during the last four weeks (see Table 11.8). Only a small proportion (9 percent of men and 4 percent of women) responded positively. Men were more likely to report having used a condom than women. Among both men and women, condom use was relatively higher among the unmarried and those below 35 years of age. Condom use is lower among uneducated and residents of rural areas than among educated and urban residents. 154 Table 11.5 Frequency of intercourse in the four weeks preceding the survey Percent distribution of women and men by frequency of intercourse in the last four weeks by selected background characteristics, Tanzania 1991/92 Frequency of intercourse Don't Background know/ Total characteristic 0 1-3 4-7 8-13 14+ Missing percent Number Median FEMALES Marital status Unman'ied 61.2 30.2 Married - monogamous 30.9 30.6 Married - polygamous 33.7 35.0 Age 15-19 42.0 34.3 20-24 39.9 28.8 25-29 38.6 29.6 30-34 36.2 32.5 35-39 36.7 30.1 40-44 35.3 35.8 45-49 42.8 33.3 Education No education 37.1 31.9 Incomplete primary 36.4 34.1 Complete primary 41.1 30.3 Secondary/Higher 44.4 26.1 Residence Mainland 39.2 31.9 Dares Salaam 30.2 37.5 Other urban 43.5 30.9 Rural 38.9 31.6 Zanzibar 26.1 15.4 Total 38.8 31.4 6.5 1.7 0.2 0.2 1~.0 1~9 0.8 21.6 12.6 4.1 0.1 1~.0 4379 2.9 20.4 9.0 1.7 0.2 1~.0 1659 2.4 14.1 6.5 2.8 0.2 1~.0 1121 1.6 17.7 9.7 3.7 0.2 100.0 1724 2.2 18.6 9.8 3,3 0.2 1~.0 1576 2,2 19.0 10.8 1.6 0.0 1~.0 1151 2.3 18.6 12.3 2.3 0.0 1~.0 997 2.5 18.9 8.2 1.9 0.0 1~.0 714 2.3 16.9 5.2 1.4 0.4 1~.0 695 1.7 18.6 9.5 2.8 0.2 1~.0 2991 2.4 19.6 8.2 1.7 0.0 1~.0 1~9 2.2 15.9 9.5 3.1 0.2 1~.0 3209 1.9 18.9 8.8 1.3 0.5 1~.0 278 1.5 17.3 8.9 2.6 0.1 100.0 7776 2.1 20.8 9.2 1.9 0.4 100.0 500 2.5 16.3 7.6 1.7 0.0 100.0 1451 1.6 17.3 9.2 2.9 0.1 100.0 5825 2.1 32.7 22.4 2.8 0.6 100.0 202 4.8 17.7 9.2 2.7 0,2 100.0 7978 2.1 MALES Marital status Unmarried 31.8 50.8 14.2 Married - monogamous 18.0 39.9 22.5 Married - polygamous 10.6 31.8 32.7 Age 15-19 23.7 61.1 12.0 20-24 22.7 49.8 17.8 25-29 27.1 42.1 19.1 30-34 21.6 32.8 27.8 35-39 21.8 32.1 25.4 40-44 13.5 38.6 31.1 45-49 20.6 35.9 20.4 50+ 23.3 41.8 16.9 Education No education 19.3 38.4 25.0 lncomplet~ primary 18.8 46.1 21.0 Complete primary 20.6 46.3 20.2 Secondary/Higher 47.2 30.6 9.9 Residence Mainland 22,1 43.1 20.5 Dares Salaam 40.9 32.0 19.6 Other urban 19.7 40.3 18.2 Rural 20.7 45.1 21.2 Zanzibar 36.5 43.8 16.7 Total 22.4 43.2 20.4 2.2 0.6 0.4 100.0 700 1.9 13.0 6.7 0.0 100.0 992 3.4 14.6 10.3 0.0 100.0 191 4.6 2.4 0.8 0.0 100.0 301 2.1 6.9 2,8 0.0 100.0 289 2.5 7.3 4.4 0.0 1(30.0 256 2.5 11.0 6.7 0.0 100.0 255 3.6 13.7 7.1 0.0 100.0 199 3.6 10.6 6.3 0.0 100.0 159 3.8 14.8 8.3 0.0 100.0 153 3.0 11.6 5.4 0.9 100.0 272 2.7 13.8 2.8 0.7 100.0 381 3.3 8.6 5,6 0.0 100.0 527 2.8 7.7 5.1 0.0 100.0 798 2.7 7.0 5.3 0.0 100.0 178 1.2 9.2 4.9 0.1 100.0 1847 2.8 6.7 0.8 0.0 100.0 144 1.7 12.6 9.2 0.0 100.0 366 3.0 8.6 4.1 0.2 100.0 1337 2.8 2.9 0.0 0.0 100.0 36 2.0 9.1 4.8 0.1 100.0 1884 2.7 155 Table 11.6 Usual frequency of intercourse Percent distribution of women and men by usual frequency of intercourse by selected background charecteristics, Tanzania 1991/92 Frequency of intercourse Don't Background know/ Total characteristic 0 1-3 4-7 8-13 14+ Missing percent Number Median FEMALES Marital status Unmamed 13.5 49.5 24.7 9.7 2.1 0.4 100.0 1939 2.9 Married - monogamous 1.3 20.8 34.2 28.0 15.5 0.3 100.0 4379 6.5 Married - polygamous 1.6 25.0 38.0 25.7 9.3 0.3 100.0 1659 5.5 Age 15-19 5.4 40.6 26.8 17.0 9.7 0.6 100.0 1121 4.3 20-24 3.9 27,1 3L2 23.2 14.3 0.4 100.0 1724 5.4 25-29 2.6 22.3 33.0 29.3 12.4 0.4 100.0 1576 6.2 30-34 3.2 26.7 31.9 27.6 10.3 0.2 100.0 1151 5.4 35-39 2.5 26.6 36.4 23.2 11.3 0.1 100.0 997 5.6 40-44 5.5 28.9 37.3 20.9 7.4 0.0 100.0 714 4.8 45-49 11.0 33.7 36.6 12.7 5.7 0.4 100.0 695 4.2 Education No education 3.8 25,8 35,5 23.6 10,9 0.4 100.0 2991 5.3 Primary incomplete 3.9 29.7 34~7 20.8 10.9 0.1 100.0 1499 4.9 Completed prima.p/ 4.6 30.5 29.0 23.9 11.6 0.4 100.0 3209 4.9 Secondary/Higher 8.5 31.8 35.0 19.5 4.9 0,2 100.0 278 4.5 Residence Mainland 4.4 29.2 32.0 23.0 11.1 0.3 100.0 7776 4.9 Dares Salaam 2.4 42.1 32.6 17.7 4.9 0.3 100.0 500 4.4 Other urban 4.2 35.3 33.8 19.8 6.7 0.1 100.0 1451 4.6 Rural 4.6 26.6 31.6 24.2 12.7 0.4 100.0 5825 5.3 Zanzibar 2.1 7.3 58.1 25.9 6.0 0.6 100.0 202 6.4 Total 4.3 28.6 32.7 23.1 10.9 0.3 100.0 7978 5.0 MALES Marital status Unmarried 6.5 53.3 26.6 9.3 4.3 Married - monogamous 1.4 20.7 30.6 23.9 23.4 Married - polygamous 0.7 11.3 28.1 28.9 30.9 Age 15-19 3.7 57.8 26.4 8.3 3.7 20-24 3.1 39.1 31.2 12.6 14.0 25-29 3.0 29.1 29.1 17.9 20.9 30-34 1.9 28.9 23.4 23.5 22.4 35-39 2.8 19.3 33.5 24.9 19.6 40-44 1.2 19.2 26.4 27.1 26.2 45-49 6.9 16.7 30.3 23.8 22.3 50+ 3.9 26.0 31.3 22.5 16.3 Education No education 3.6 21.5 32.3 23.7 18.9 Primary incomplete 3.4 31.1 26.6 19.8 19.0 Completed prlma~ 1.8 35.0 30.5 16.0 16.6 Secondary/Higher 8.0 42.1 20.9 19.7 9.3 Residence Mainland 3,2 31.5 28.9 19,1 17.3 Dares Salaam 0.0 38.1 39.5 16.6 5.9 Other urban 3.3 32.5 26.6 18.7 18.9 Rural 3.5 30.5 28.4 19.5 18.1 Zanzibar 6,8 51,4 25,1 11.1 5,5 ToLd. 3.2 31.9 28.9 19.0 17.1 100.o 700 3.3 100.0 992 7.0 100.o 191 8.9 100.0 301 3.2 100.0 289 4.5 100.0 256 5.6 100.0 255 6.6 100.0 199 6.9 100.0 159 8.3 100.0 153 7.0 100.0 272 5.0 100.0 381 6.7 100.0 527 5.1 100.0 798 4.9 1oo.0 178 4.0 100,0 1847 5.2 100.0 144 4.4 100.0 366 5.7 100.0 1337 5.4 100.0 36 3.6 100.0 1884 5.1 156 Table 11.7 Number of sexual partners in the four weeks preceding the survey Percent distribution of women and men by number of sexual partners in the fore weeks preceding the survey, by selected background characteristics, Tanzania 1991/92 Number of partners Background Total characteristic 1 2 3+ Missing percent Number FEMALES Marital status Unmarried 79.6 13.8 5.2 1.4 100.0 747 Married - monogamous 97.0 2.1 0.4 0.5 100.0 3025 Married - polygamous 94.2 4.0 0.8 1.1 100.0 1097 Age 15-19 89.6 6.7 2.7 1.1 100.0 648 20-24 93.4 4.1 1.6 0.8 100.0 1034 25-29 92.8 5.2 1.2 0.9 100.0 965 30-34 94.9 4.4 0.4 0.2 100.0 734 35-39 95.9 3.1 0.5 0.5 100.0 631 40-44 95.3 2.6 1.1 1.0 100.0 462 45-49 95.6 2.9 0.4 1.2 100.0 395 Education No education 94.0 4.4 0.8 0.8 100,0 1877 Primary incomplete 94.4 3,7 1.0 0.9 100.0 953 Completed primary 92.7 4.7 1.8 0.8 100.0 1885 Secondary/Higher 96.5 2.8 0.7 0.0 100.0 153 Residence Mainland 93.8 4.2 1.2 0.8 100.0 4721 Dares Salaam 95.5 3.1 0.7 0.6 100.0 347 Other urban 91.8 4.8 2.7 0.8 100.0 820 Rural 94.2 4.1 0.9 0.8 100.0 3554 Zanzibar 88.6 9.0 2.0 0.4 100,0 148 Total 93.7 4.3 1.2 0.8 100.0 4869 MALES Marital status Unmarried 55.8 25.6 Married - monogamous 84.6 8.0 Married - polygamous 35.6 55,2 Age 15-19 54,4 26.5 20-24 61.3 21.9 25-29 75.7 15.6 30-34 74.5 15.3 35-39 68.5 15.6 40-44 73.1 21.3 45-49 81.1 15.6 50+ 75.6 19.1 Education No education 70.0 21.0 Primary incomplete 71.6 19.2 Completed primary 66.5 18.8 Secondary/Higher 77.7 16.9 Residence Mainland 69.2 19.4 Dar es Salaam 84.1 15.4 Other urban 74.4 15.5 Rural 66.6 20.8 Zanzibar 84.3 10.8 Total 69.4 19.3 17.8 0.9 100.0 477 5.4 2.0 100.0 814 8.6 0.7 100.0 171 19.0 0.0 100.0 229 15.9 0.8 100.0 223 7.5 1.2 100.0 187 6.6 3.6 100.0 200 13.1 2.9 100,0 156 4.8 0.7 100,0 137 3.3 0.0 100,0 122 2.8 2.5 100,0 209 7.6 1.3 100.0 307 8.7 0.5 100.0 428 12.4 2.4 100.0 633 4.5 0.9 100.0 94 9.9 1.5 100.0 1439 0.5 0.0 100,0 85 9.7 0.5 100.0 294 10.7 1.9 100.0 1060 4.9 0.0 100,0 23 9.8 1.5 100.0 1462 157 Table 11.8 Condom use Percent distribution of women and men by condom use, by selected backgrmmd characteristics, Tanzania 1991/92 Condom used Background . Total characteristic Yes No Missing percent Number FEMALES Marital status Unmarried 7.9 90.2 1.9 100.0 747 Married - monogamous 2.8 96.1 1.0 100.0 3025 Married - polygamous 3.3 95.6 1.1 100.0 1097 Age 15-19 3.8 95.0 1.2 100.0 648 20-24 7.1 91.8 1.0 100.0 1034 25-29 3.4 95.0 1.6 100.0 965 30-34 3.4 96.0 0.6 100.0 734 35-39 1.8 97.1 1.2 100.0 631 40-44 1.6 96.9 1.5 100.0 462 45-49 1.1 97.6 1.3 100.0 395 Education No education 1.4 97.3 1.3 100.0 1877 Primary incomplete 3.3 95.4 1.4 100.0 953 Completed primary 6.1 92.9 1.1 100.0 1885 Secondary/Higher 5.2 94.8 0.0 100.0 153 Residence Mainland 3.8 95.0 1.2 100.0 4721 Dar us Salaam 7.4 91.4 1.2 100.0 347 Other urban 7.6 91.8 0.6 100.0 820 Rural 2.5 96.1 1.3 100.0 3554 Zanzibar 1.0 98.6 0.4 100.0 148 Total 3.7 95.1 1.2 100.0 4869 MALES Marital status Unmarried 15.7 82.5 1.7 100.0 477 Married - monogamous 6.5 92.5 1.0 100.0 814 Married - polygamous 3.4 96.6 0.0 100.0 171 Age 15-19 12.6 86.3 1.1 100.0 229 20-24 15.0 84.9 0.2 1130.0 223 25-29 14.7 84.4 0.9 100.0 187 30-34 5.6 93.7 0.6 100.0 200 35-39 11.4 88.3 0.4 100.0 156 40-44 7.4 89.0 3.7 100.0 137 45-49 0.5 99.5 0.0 100.0 122 50+ 2.1 95.4 2.4 100.0 209 Education No education 1.6 96.9 1.5 100.0 307 Primary incomplete 3.3 95.1 1.6 100.0 428 Completed primary 15.7 83.7 0.6 100,0 633 Secondary/Higher 16.2 82.2 1.6 100.0 94 Residence Mainland 9.3 89.5 1.1 100.0 1439 Dares Salaam 12.1 80.9 7.0 100.0 85 Other urban 15.6 84.4 0.0 100.0 294 Rural 7.3 91.7 1.0 100.0 1060 Zanzibar 0.0 100.0 0.0 100,0 23 Totai 9.2 89.7 1.1 100.0 1462 158 Men who knew about the condom (N=1369) were asked questions to elicit more information about their knowledge and their attitude about its use (see Table 11.9). Several statements were read to them and they were re- quired to say whether they agreed or disagreed with each. More than three-quarters of men agreed with the statement "Condom is used only for casual sex." Most men are aware that condoms reduce the risk of STDs. It is interesting to note that 75 percent of men reported that the condom re- duces sexual pleasure and 84 percent said women don't like condoms. Only 31 percent agreed that it is embarras- sing to get condoms. One-fourth of the respondents thought that condom use can cause AIDS. As has been reported by the NACP, these findings indicate that, despite a high level of knowledge of AIDS, the quality of this knowledge needs substantial improve- ment and a substantial number of respondents were en- gaged in high-risk sexual behavior. Low reported condom use in this population indicates a big gap between knowl- edge and practice. These findings indicate that knowledge is necessary but not enough in itself to cause changes in sexual behavior. Table 11.9 Men's perceptions about condoms Percentage of men who agree with certain statements about condoms, Tanzania 1991/92 Statement Percent who agree Condoms are used primarily with casual partners Condoms reduce risk of STD Most women don't like men to use condoms Using condoms shows responsibility Condoms are used primarily for family planning purposes Condoms are embarrassing to obtain A condom can be used more than once Condoms make sex less enjoyable Using a condom can give you AIDS 78.2 94.6 83.5 83.1 69.6 30.6 55.6 74.7 23.6 159 CHAPTER 12 LOCAL AVAILABILITY OF FAMILY PLANNING AND HEALTH SERVICES Use of family planning and health services is determined by supply as well as demand. The TDHS included the Tanzania Service Availability Questionnaire (reproduced in Appendix E) to assess the availability, or supply, of family planning and health services. The questionnaire was applied at the community level, that is, one questionnaire was filled for each selected enumeration area. Information was gathered from two sources: groups of knowledgeable informants in the community (assembled by the interviewer) and informants visited in facilities. The information collected in the enumeration area (EA) and in the facilities is assigned to each respondent (individualquestionnaire) to obtain population-based estimates. The number of independent data points, however, remains the same as the number of enumeration areas for which the information was collected: 319 for Mainland Tanzania and 30 for Zanzibar) Due to the small number of actual data points, the service availability estimates are subject to larger sampling errors than are the estimates based on data from individual women in the main survey. The results in this Chapter are presented for women, but it must be kept in mind that these were actually the results of 349 interviews at the cluster level. One interview was held per cluster and, therefore, all service availability data are the same for all women in the cluster. Intracluster variability is not taken into account. 12.1 Service Availability Questionnaire The service availability questionnaire was designed to provide a picture of the service environment available to Tanzanian women. There are two types of mechanisms for providing services: outreach programmes and stationary facilities. The former deliver services directly to people in their communities, whereas the latter function as repositories of services, relying on people to come to them to obtain services. Outreach services are provided by health workers, usually in the context of mobile clinics. The informants assembled for the cluster interview were asked whether their communities are served by such services, and if so, what was the nature of these services. For example, if a health worker visits the community, the informants were asked whether he or she provides family planning methods (and more specifically, the pill, condom, and foaming tablets), basic medications, ORS instruction, vitamins, and immunisations. Many types of stationary facilities exist. Community informants were asked to identify the nearest facility of each of the following types: 1) a hospital (representing either the secondary or tertiary level); 2) a health centre (the most complex primary health care facility); 3) a health clinic (dispensary), maternity centre, or maternity home (facilities offering limited primary health care); 5) a family planning clinic; and 6) a pharmacy. Facilities said to be within six hours' walking distance from the community were eligible to be visited by interviewers. One facility of each type was visited if it met the eligibility requirement. A second facility of each type would be visited if the first one visited did not provide family planning methods. When facilities were visited, detailed information regarding staff, equipment, services, fees, supplies, medications, vaccines, and contraceptives was collected. Attention was focussed on whether facilities had The TDHS included 357 clusters. No service availability data were available for eight clusters. 161 basic supplies, whether they experienced shortages of supplies or medicines, and whether equipment was in working order. Interviewers also verified the existence of equipment and supplies. Health facilities were only visited if the distance from the community to the facility was less than 30 km. In total 191 hospitals, 204 health centres, and 329 dispensaries were visited. 12.2 Availability of Family Planning Services Outreach Programmes Twenty percent of women live in communities served by a health worker who provides family planning services (Table 12.1). Health workers are available to provide family planning services to 69 percent of the women in Zanzibar and to 18 percent of the women in mainland Tanzania. Table 12.1 Distance to nearest family plannlng services according to residence Percent distribution of women 15-49 by distance to nearest family planning services, according to residence, Tanzania 1991/92 Outreach services/ Distance to nearest Dares Other FP services Mainland Salaam urban Rural Zartzibar Total Outreach services Health worker 18.2 10.6 37.3 14.1 69.3 19.6 Kllometres <1 25.3 26.0 48.2 19.4 37.6 25.6 1-4 39.6 55.3 51.3 35.3 55.5 40.1 5-9 21.7 11.1 0.0 28.1 7.0 21.3 10-14 8.3 0.0 0.0 11.1 0.0 8.1 15-29 3.2 0.0 0.5 4.1 0.0 3.1 30+ 1.4 0.0 0.0 1.9 0.0 1.4 Unknown distance 0.5 7.6 0.0 0.0 0.0 0.5 Total 100.0 100.0 100.0 100.0 100.0 100.0 Number 8978 585 1686 6707 260 9238 Campaign 4.7 0.0 4.7 5.1 53.7 6.0 Clusters 319 29 57 233 30 349 Stationary Facilities About one-fourth of women live within 1 km of a facility that provides family planning (see Table 12.1) and two-thirds live within 5 km. Urban women generally are closer to a source of family planning than rural women. For example, in rural areas of mainland Tanzania, 55 percent of women live within 5 krn of a facility that provides family planning, and 17 percent has to travel more than 10 km. In urban areas outside of Dares Salaam, all but a tiny fraction of women live within 5 km of a family planning source. 162 Information Campaigns Informants in the cluster interview were asked whether there had been an information campaign in the community within the past year that included family planning messages promoting specific methods or the general benefits of contraception. Whether or not there had been a family planning campaign in the preceding year varied: 54 percent of women in Zanzibar live in communities that had a campaign in the previous year versus only 5 percent of women in mainland Tanzania. Availability of Family Planning by Type of Facility Tables 12.2 and 12.3 show the distributions of women by distance and one-way travel time to the nearest facility providing family planning. (The medians are for those reporting a distance.) Overall, the median distance to any facility providing family planning services is 3 kin. Health centres and dispensaries with family planning services are closer than hospitals: the median distance for women 15-49 is 15 km for health centres and 5 km for dispensaries compared to 21 km for hospitals. As expected, women living in Dar es Salaam, those living in other urban areas, and those in Zanzibar usually are closer to a source of family planning than women living in rural areas on the mainland. Table 12.2 Distance to nearest facility providing family planning services according to type of facility and residence Percent distribution of women 15-49 by distance to nearest facility providing family planning services/supplies, according to type of facility and residence, Tanzania 1991/92 Type of facility Residence I Distance to Health All Dares Other nearest facility Hospital centre Dispensary Pharmacy types Mainland Salaam urban Rural Zan~bar : Kilometres <1 2,4 6.1 15.8 6.0 25.6 25.3 26.0 48.2 19.4 37,6 1-4 17.4 8.4 35.2 8.2 40.1 39.6 55.3 51.3 35.3 55.5 5-9 10.8 12.4 23.5 5.9 21.3 21.7 11.1 0.0 28.1 7.0 10-14 7.1 11.0 8,7 4.8 8,1 8.3 0.0 0.0 11.1 0.0 15-29 18.2 20.2 6.8 9.2 3.1 3.2 0.0 0.5 4.1 0.0 30+ 41.4 19.6 4.7 32,6 1.4 1.4 0,0 0.0 1.9 0.0 Unknown distance 2.8 4.0 3.5 11.8 0.5 0.5 7.6 0.0 0.0 0.0 None known 0,0 18.5 1.8 21.6 0.0 0.0 0.0 0.0 0.0 0.0 Total 100.0 1130,0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number 9238 9238 9238 9238 9238 8978 585 1686 6707 260 Median 21.0 15.3 4.6 25.5 3.0 3.1 1.9 1.2 4.4 1.4 Clusters 349 349 349 349 349 319 29 57 233 30 Over half of Tanzanian women live within one hour's travel time to a source of family planning; one in three lives within 30 minutes of a family planning outlet. The closest facilities are dispensaries: 42 percent of women live within one hour of a dispensary providing family planning, only 22 percent live within anhour of a hospital, and 17 percent are within one hour of a health centre. 163 Table 12.3 Time to nearest facility providing family planning services according to type of facility and residence Percent distribution of women 15-49 by one-way travel time (in minutes) to nearest facility providing family planning services/supplies, according to facility and residence, Tanzania 1991./92 Type of facility Residence Time to nearest Health All Dares Other facility Hospital centre Dispensary Phm'macy types Mainland Salaam urban Rural Zanzibar Minutes <15 3.5 3.1 12.8 6.1 18.7 18.5 25.8 37.0 13.2 27.6 15-29 6.4 6.5 11.9 3.2 14.6 13.6 25.6 19.8 10.9 51,2 30-59 12.2 7.7 17.3 5.9 21.7 22.0 23.2 34.0 18.9 10,4 60-119 15.4 9.2 25.9 6.8 23.0 23.5 16.5 4.5 28.8 7,7 120+ 19.0 30.3 22.0 12.8 18.8 19.3 0.0 3.9 24.9 0,0 Unknown lime 3.1 5.2 3.9 12.4 1.8 1.8 8.8 0.9 1.3 3,1 Distance >30 km 40.4 19.6 4.4 31.2 1.4 1.4 0.0 0.0 1.9 0,0 None known 0.0 18.5 1.8 21.6 0.0 0.0 0,0 0.0 0.0 0.0 Total 100.0 100.0 100,0 100.0 100.0 100.0 Number 9238 9238 9238 9238 9238 8978 Median 60.7 60.2 60.8 40.8 45.1 Clusters 349 349 349 349 349 319 100.0 100.0 100.0 100.0 585 1686 6707 260 20.8 20.6 60.3 15.6 29 57 233 30 In rural areas, the distances to health centre and dispensary are very close to the national median distances, although travel times in rural areas were slightly longer than elsewhere. Clearly, dispensaries are potentially the most important supplier of contraceptive methods. Their role could even be larger than shown in Chapter 4 (Table 4.8), where dispensaries were reported as the source of supply by 24 percent of current users of contraceptives. Of course dispensaries are not capable of providing a full range of methods; sterilisations and IUD insertions probably are beyond their range of capabilities. 12.3 Availability of Maternal and Child Health Services Antenatal Care Table 12.4 indicates that almost all women live in communities where informants were able to identify a facility that provides antenatal care (92 percent). Half of women in Tanzania live within 5 km of a facility that offers antenatal services, whereas 45 percent of women in rural mainland are within 5 km. 164 Table 12.4 Distance to nearest antenatal care services aceordin~ to residence Percent distribution of women 15-49 by distance to nearest antenatal caro services, according to residence, Tanzania 1991/92 Distance to nearest antenatal Dares Other services Mainland Salaam urban Rural Zanzibar Total Kllometres <1 14.2 0.0 15.3 15.1 38.4 14.8 1-4 35.1 46.6 50.3 30.2 50.3 35.5 5-9 25.8 9.0 28.1 26.7 11.4 25.4 10-14 8,4 0.0 2,2 10.7 0,0 8.1 t5-29 5.6 0.0 1.7 7.0 0,0 5.4 30+ 0.9 0.0 0.0 1.3 0,0 0.9 Unknown distance 2.3 31.6 0.0 0.3 0,0 2.2 None known 7.8 12.7 2.4 8.8 0,0 7.6 Total 100.0 100.0 100.0 100.0 100.0 100.0 Number 8978 585 1686 6707 260 9238 Clusters 319 29 57 233 30 349 Tables 12.5 and 12.6 show that hos- pitals were often named as the source of ante- natal care. Twenty-eight percent of women in Tanzania had a hospital with antenatal services within 5 km and 41 percent within 10 kin. Dispensaries with antenatal services are found within 10 km for two-thirds of women. Del ivery Care According to Table 12.7, half of worn- en live in communities where delivery care is available within 5 km, and three-quarters with- in 10 km. Hospitals, health centres, and dispen- saries were mentioned as delivery care sources. Distances and travel time to the nearest health facility by type of facility are shown in Tables 12.8 and 12.9, respectively. Among ru- ral women, 18 percent had a hospital with de- livery care within one hour travel time, 19 per- cent had a health centre within one hour, and 32 percent a dispensary. It is important to note that more than half of rural women live in communities where the informants could not mention a hospital with delivery care. Table 12.5 Distance to nearest facility providing antenatal care services according to type of facility Percent dislxibution of all women 15-49 by distance to nearest facility providing antenatal care services by type of facility, Tanzania 1991/92 Distance to Health All nearest facility Hospital centre Dispensary types Kllometres <1 5.3 6.3 14.1 14.8 1-4 22.7 19,3 30.3 35.5 5-9 13.3 14,0 20.5 25.4 10-14 3.7 4,4 7.7 8.1 15-29 1.1 3,3 5,4 5.4 30+ 1.8 0.3 0.3 0.9 Unknown distance 1.1 2.4 0.2 2.2 None known 51.0 50.0 21.5 7.6 Total 100.0 100.0 100.0 100.0 Number 9238 9238 9238 9238 Median 4.3 4.7 4.4 4.5 Clust~s 349 349 349 349 165 Table 12.6 Time to nearest facility providing antenatal care services according to type of facility Percent distribution of all women 15-49 by one-way travel time (in minutes) to nearest facility providing antanatal care seffices by type of facility, Tanzania 1991/92 Time to nearest Health All facility Hospital centre Dispertsa.,y types Minutes <15 5.2 3.8 11.1 11.7 15-29 6.9 5.9 9.5 11.0 30-59 11.3 11.0 16.1 19.5 60-119 17.0 14.5 23.3 28.0 120+ 5.6 11.3 17.6 18.0 Unknown time 1.1 3.4 1.0 3.6 Distance >30 km 1.8 0.0 0.0 0.6 None known 51.0 50.0 21.5 7.6 Total 100.0 100.0 100.0 100.0 Number 9238 9238 9238 9238 Median 46.0 60.3 60.2 60.2 Clusmrs 349 349 349 349 Table 12.7 Distance to nearest delivery care services according to residence Percent dista'ibution of women 15-49 by distance (in km) to nearest delivery care services, according to residence, Tanzania 1991/92 Distance to nearest delivery care Dar es Other services Mainland Salaam urban Rural Zanzibar Total Kllometres Under 1 14.3 0.0 10.7 16.5 38.4 15,0 1-4 33.8 32.6 52.4 29.2 50.3 34.3 5-9 24.2 0.0 29.9 24.9 11.4 23.8 10-14 8.0 1.9 1.5 10.2 0.0 7.8 15-29 5.3 0.0 1.7 6.7 0.0 5.2 30+ 0.9 0.0 0.0 1.3 0.0 0,9 Unknown distance 1.2 12.5 0.8 0.3 0.0 1,2 None known 12.2 53.0 3.0 10.9 0.0 11,8 Total 100.0 100.0 100.0 100.0 100.0 100,0 Number 8978 585 1686 6707 260 9238 Clusters 319 29 57 233 30 349 166 Table 12.8 Distance to nearest facility providing delivery care services according to type of facility Percent distribution of all women 15-49 by distance (in kin) to nearest facility providing delivery care service by type of facility, Tanzania 1991/92 Distance to nearest Health All facility Hospital centre Disponsary types Kllometres <1 7.2 5.9 12.7 15.0 1-4 22.2 18.4 24.0 34.3 5-9 12.4 12.3 18.5 23.8 10-14 3.4 4.4 7.7 7.8 15-29 1.5 3.7 4.8 5.2 30-1- 1.8 0.3 0.3 0.9 Unknown distance 1.1 1.0 0.2 1.2 None known 50.3 54.0 31.8 11.8 Total I00.0 I00.0 I00.0 100,0 Number 9238 9238 9238 9238 Median 4.1 4.7 4.6 4.4 Clusters 349 349 349 349 Table 12.9 Time to nearest facility providing delivery assistance according to type of facility Percent distribution of women 15.49 by one-way travel time (in minutes) to nearest facility providing delivery assistance by type of facility, Tanzania 1991/92 Time to nearest Health All facility Hospital centre Dispensary types Minutes <15 5.6 2.7 8.4 10.2 15-29 7.5 6.1 9.2 11.6 30-59 11.8 9.9 13.9 19.0 60-119 16.5 14.6 19.1 27.5 120.i- 5.3 11.4 16.7 17.3 Unknown time 1.1 1.3 1.0 2.0 Distance > 30 km 1.8 0.0 0.0 0.6 None known 50.3 54.0 31.8 11.8 Total 100.0 100.0 1130.0 100.0 Number 9238 9238 9238 9238 Median 45.4 60.5 60.2 60.1 Clusters 349 349 349 349 167 Immunisation Data on the distance and travel time to immunisation services are presented in Tables 12.10 to 12.11, respectively. More than 90 percent of women live in communities where a source of immtmisation was known. Mostly the source was within either 5 km (49 percent) or 10 km (74 percent). Forty-two percent had to travel less than one hour to reach a health facility with immunisation services. Table 12.10 Distance to nearest immunisation services aecurding to residence Percent distlibution of women 15-49 by distance to nearest immunisation services, according to residence, Tanzania 1991/92 Distance to nearest immunisadon Dares Other services Mainland Salaam urban Rural Zanzibar Total Kllometres <1 14.0 0.0 13.0 15.4 38.4 14.6 1-4 34.3 46.6 48.6 29.6 50.3 34.7 5-9 25.1 0.0 29.3 26.3 11.4 24.8 10-14 7.9 0.0 1.5 10.2 0.0 7.7 15-29 6.0 0.0 2.3 7.4 0.0 5.8 30+ 1.4 0.0 0.0 1.8 0.0 1.3 Unknown distance 2.3 31.6 0.0 0.3 0.0 2.2 None known 9.0 21.7 5.3 8.9 0.0 8.8 Total 100.0 100.0 100.0 100.0 100.0 100.0 Number 8978 585 1686 6707 260 9238 Clusters 319 29 57 233 30 349 168 Table 12.11 Time to nearest immunisation services Percent distribution of all women 15~.9 by one-way ~avel time (in minutes) to nearest facility providing immunisation services, Tanzania 1991/92 Time to nearest All types immunisation of services facilities Minutes <15 11.7 15-29 11.1 30-59 18.7 60-119 28.7 120* 17.0 Unknown time 3.0 Distance > 30 km 1.0 None known 8.8 Total 100.0 Number 9238 Median 60.2 Clusters 349 169 REFERENCES Bureau of Statistics [United Republic of Tanzania]. Undated. Tanzania Sensa 1988: Population census; lnfantandchildmortality regionalanddistrictestimates. Dares Salaam: Planning Commission, President's Office. Bureau of Statistics [United Republic of Tanzania]. 1967. Population Census 1967. Volume 6. Dar es Salaam: Bureau of Statistics. Bureau of Statistics [United Republic of Tanzania]. 1978. Population Census 1978. Volume 8. Dar es Salaam: Bureau of Statistics. Bureau of Statistics [United Republic of Tanzania]. 1988. Population Census 1988. NationalProfile. Dares Salaam: Bureau of Statistics. Gaisie, Sam, Anne R. Cross and Geoffrey Nsambukila. 1993. Zambia Demographic and Health Survey 1992: Final Report. Columbia, Maryland: University of Zambia and Central Statistical Office, Lusaka and Macro International Inc. Kapiga, Saidi H., D.J. Hunter, and G. Nachtigal. 1993. Reproductive Knowledge, and Contraceptive Awareness and Practice Among Secondary School Pupils in Bagamoyo and Dares Salaam, Tanzania (in press). Kapiga, Saidi H., G. Nachtigal, and D.J. Hunter. 1991. Knowledge of AIDS among secondary school pupils in Bagamoyo and Dar-es-Salaam, Tanzania. AIDS 5:325-328. Krasovec, Katherine and Mary-Ann Anderson. (editors). 1991. MaternalNutrition and Pregnancy Outcomes: Anthropometric Assessment. Pan American Health Organization (PAHO) Scientific Publication No. 259, Washington DC: PAHO. Martorell, Reynaldo and Jean-Pierre Habicht. 1986. Growth in Early Childhood in Developing Countries. In: Human Growth: A Comprehensive Treaty. ed. by Frank Falkner and J.M. Tanner, Vol. 3,241-262. New York: Plenum Press. Ministry of Health. 1989. Immunisation Coverage Survey, Tanzania. Report in collaboration with UNICEF and DANIDA. Dares Salaam. Ministry of Health. 1991. Immunisation Coverage Survey, Tanzania. Report in collaboration with UNICEF and DANIDA. Dares Salaam. Ministry of Health. 1992. Tanzania Family Planning Situation Analysis, draft report. In collaboration with the Africa OR/TA project, Population Council. Dares Salaam/Nairobi. Moreno, Lorenzo and Noreen Goldman. 1990. An assessment of survey data on birthweight. Social Science and Medicine 31: 491-500. National AIDS Control Programme. 1992. HIV/AIDS/STD surveillance, Report No. 6, May. Dares Salaam: Ministry of Health. 171 APPENDIX A PERSONS INVOLVED IN THE TANZANIA DEMOGRAPHIC AND HEALTH SURVEY 1991/1992 APPENDIX A PERSONS INVOLVED IN THE TANZANIA DEMOGRAPHIC AND HEALTH SURVEY 1991/1992 TDHS HEAD OFFICE STAFF Project Director Mr. S.A.M. Ngallaba Project Statisticians Mrs. A. Komba Mr. S.M. Aboud Mr. J.J. Rubona Mr. I. Ruyobya Mr. S. Ndaki Mr. G. Millinga Anne R. Cross Marilyn Wilkinson Wamucii Njogu David Cantor DODOMA/MOROGORO/SINGIDA Supervisor S. Aboud Editor Y. Sehaba Interviewers N. Almasi M. Cidosa A. Temu V. Mtimba E. Msambili E. Kalyelye A. Yona DHS/MACRO STAFF FIELD STAFF Data Processing Mr. J. Mwaisemba Ms. J. Suka Ms. K. Kaoma Ms. N. Kajakelu Ms. A. Malta Naomi Rutenberg Elizabeth Britton Alfredo Aliaga Ties Boerma KAGERA/KIGOMA/TABORA Supervisor E. Kwelukilwa Editor Caesar Mchunguzi Interviewers Josephine Mathias D.M. Kajuna S. Balige G. Kisambale M.K. Nsalamba A.R. Mbago M. Mutayoba 175 ARUSHA/KILIMANJARO/TANGA IRINGA/MBEYAJRUKWA Supervisor E. Maponde Editor P. Joseph Interviewers J. Mtunguja J. Shaidi L. Macha L.Y, Temu P. Muro S. Massawe D. Mashele LINDUMTWARA/RUVUMA Supervisor G. Millinga Editor E. Kadili Interviewers J. Matindiko A. Ngaiwa B. Ndumbaro E. Hamisi L. Mkolea M. Mkwavila A. Muhabuli ZANZIBAR Supervisor H. Ally Editor H. Masoud Interviewers A.M. Bakari A.M. Kombo T.Z. Salum H. Makame R.A. Mohamed 176 Supervisor I. Ruyobya Editor E. Mwinuka Interviewers E. Kibishi H. Chizi A. Mwanawima R. Nditi J.A. Tagalile N. Achimpota N. Kaoza MARA/MWANZA/SHINYANGA Supervisor S. Ndaki Editor F. Matola Interviewers C. Kapongo J. Chagula F. Tegete R. Mayala S. Joliga S. Mwaituka S. Kazana DAR ES SALAAM/COAST Supervisor J.J. Rubona Editor M. Mtutuma Interviewers J. Mpangala N. Enock J. Shishira A. Nilla S. Kakiziba F. Tumai J. Laurent APPENDIX B SURVEY DESIGN APPENDIX B SURVEY DESIGN B.1 Sample Design The principal objective of the Tanzania Demographic and Health Survey (TDHS) was to collect data on fertility, family planning, and health of the people. This survey involved randomly selected women aged 15-49 and men aged 15-60 in selected households. Before the sampling frame was developed, two possibilities for the TDHS sample design were considered: The 1988 Population census list of Enumeration Areas (EAs) The National Master Sample for Tanzania created in 1986 (NMS). The NMS was intended mainly for agricultural purposes and, at that time, only for rural areas. The NMS was based on the 1978 Census information while the urban frame was still being worked upon. Therefore, it was decided that the TDHS sample design would use the 1988 Census information as the basic sampling frame. Since the TDHS sample was to be clustered, it was necessary to have sampling units of manageable and fairly uniform size and with very well defined boundaries. The 1988 Census frame provided the list of enumeration area units (EAs) that had well defmed boundaries and manageable uniform size. Therefore, EAs were used as primary sampling units (PSUs). The target of the TDHS sample was about 7850 women age 15-49 with completed interviews. This sample should allow for separate analyses in urban and rural areas, and for estimation of contraceptive use in each of the 20 regions located on the mainland and in Zanzibar. Estimates for large domains (by combination of a group of regions) were also taken into consideration. The TDHS used a three-stage sample. The frame was stratified by urban and rural areas. The primary sampling units in the TDHS survey were the wards/brancbes. The design involved the target of 350 completed interviews for each of 19 regions on the mainland and 500 in each of Dar es Salaam and Zanzibar. In the first stage, the wards/branches were systematically selected with probability proportional m size (according to 1988 census information). In a second sampling stage, two EAs per selected rural ward/branch and one EA per selected urban ward/branch were chosen with probability proportional to size (also according to 1988 census information). In total, 357 EAs were selected for the TDHS, 95 in the urban area and 262 in the rural. A new listing of households was made shortly before the TDHS fieldwork by special teams including a total of 14 field workers. These teams visited the selected EAs all over the country to list the names of the heads of the households and obtain the population composition of each household (total number of persons in the household). In urban areas, the address of the dwelling was also recorded in order to make it easy to identify the household during the main survey. A fixed number of 30 households in each rural EA and 20 in each urban EA were selected. About 9560 households were needed to achieve the required sample size, assuming 80 percent overall household completion rate. 179 where The first-stage sampling was implemented with the following process Pa = (ah M~) / M h P1 is the first-stage selection probability ah is the number of wards/branches selected in a particular region M~a is the measure of size of the i-th selected ward/branch M h is the measure of size for the region under consideration. where The second stage was the selection of EAs according to the following sampling probability Pz = (a~ M~j) / M~a P2 is the second-stage selection probability ah~ is the number of EAs selected in the i-th selected ward/branch M~aj is the measure of size of the j-th selected EA M~ is the measure of size for the ward/branch under consideration. The final third stage was implemented according to the following relationship P3 = b/L~j where b is either 20 (urban) or 30 (rural) LhU is the number of households listed in the j-th selected EA. The overall sampling fraction was calculated as the product of the three probabilities of selection; the raw sample weights are just the inverse of this value. The raw sample weights were adjusted by differentials in the household response rate and the individual interview response rate. The final individual weights were calculated by normalizing them for each area so that the total number of weighted cases equals the total number of unweighted cases. A male survey was also designed as a subsample of the selected households; one of every four waS selected and every male between 15 and 60 years old was interviewed. A total of 9238 women aged 15-49 years were successfully interviewed in the 1991 TDHS. The household response rate was about 97.2 on the mainland and 98.9 in Zanzibar. The individual response was 88.9 on the mainland and 79.4 in Zanzibar. B.2 Fieldwork and Data Processing The Questionnaires The household, female, and male questionnaires were designed by following the Model Questionnaire "B" which is for low contraceptive prevalence countries. Some adaptations were made to suit the Tanzania situation, but the core questions were not changed. The original questionnaire was prepared in English and later translated into Kiswahili, the language that is widely spoken in the country. There are parts in the 180 country where people are not very conversant with Kiswahili and would find it difficult to respond in Kiswahili but would understand when they are asked anything. The translated document was given to another translator to translate it back into English and comparisons were made to determine the differences. The final English versions of the questionnaires are given in Appendix E. Pretest A pretest to assess the viability of the survey instruments, particularly the questionnaires and the field organization, was carried out in Iringa Rural District, Iringa Region. It covered 16 enumeration areas with a total of 320 households. The pretest, which took a month to complete, was carded out in November/December, 1990, and covered both rural and urban EAs. The pretest training took two weeks and consisted of classroom training and field practice in neighbourhood areas. In all, 14 newly recruited interviewers and the Census staff were involved. The Census staff who were to be transformed into the TDHS team handled the training for both the fieldwork management and the questionnaire. During the later fieldwork, they supervised the field exercise. During the fieldwork, the administrative structure of the CCM Party, which involved the Party Branch Offices and the ten-cell leadership, were utilised in an effort to secure the maximum confidence and cooperation of the people in the areas where the team was working. At the end of the fieldwork, the interviewers and the supervisory team returned to the head office in Dares Salaam for debriefing and discussion of their field experiences, particularly those related to the questionnaires and the logistic problems that were encountered. All these experiences were used to improve upon the final version of the questionnaires and the overall logistic arrangements. Recruitment of Field Staff One of the most difficult activities that must be done before the interviews begin is recruiting of the right type of personnel, i.e., those who would undertake such a difficult task. Given the nature of the work, the questions to be asked, and the type of respondents involved, interviewers who are selected have to be able to endure the difficult conditions in the field. Since most of the work relates to health and family planning issues, it was believed that persons who are working in the health sector would be the best people to do the job. In general, they are mature, responsible, and familiar with many of the questionnaire topics. The Ministry of Health was consulted to secure the services of the female and male trained nurses. Two female nurses were required from each of the mainland regions and one male nurse in each of the selected regions (since only one male interviewer was needed for each team). For Zanzibar, six female nurses were requested from the Zanzibar Ministry of Health and the Office of the Govemment Statistician in Zanzibar was requested to provide supervisory and other staff to work on the survey in Zanzibar. In all, 62 female interviewers and 16 male interviewers were recruited, and 7 Census and Planning Commission people were selected as supervisors, including some who took part in the pretest. After the four intensive weeks of training, 48 female and 8 male interviewers were selected for the fieldwork. Assessment tests and in-class mock interviews were used in selecting the best candidates. 181 Training of Field Staff The training of the field staff was carried out in two classrooms at one location. The training took place at the National Bank of Commerce, Bankers' Training Institute, Iringa Municipality, Iringa Region. Two teams of two persons from the Census Office, with support of staff from DHS/Macro International and the Tanzania Food and Nutrition Centre, conducted the training. Trial interviews were done in the neighbourhood of the municipality. The four weeks of training were devoted to classroom lectures, classroom mock interviews among the trainees, and interviews with invited volunteers from outside the classrooms with everyone listening. At the end of such interviews, trainees were invited to relate their observations as to how the entire interview was conducted and describe any mistakes that were made by the interviewer under the prevailing conditions. Later, the interviewers were taken out of the classroom to the field where each was assigned a household to interview. When all the interviewers were back in the classroom, each was asked to recount some of the experiences he encountered in the administration of the questionnaire, the behaviour of the respondent, and how he handled the situation. During training, a series of assessment tests were given to the interviewers and supervisors. These tests were graded and the results were used in selecting interviewers. Those candidates who bad a better grasp of the questionnaire and were able to detect errors in completed questionnaires were chosen to be field editors. Two guests were invited to talk to the trainees on family planning and matemal and child health. A staff person from the Tanzania Family Planning Association (UMATI) talked about family planning methods and sources where they can be obtained. Another person who came from the Maternal and Child Health Department in the Regional Hospital of Iringa discussed maternal and child health care and immunization. Anthropometry was taught for a week and was conducted by a DHS consultant on anthropometry who was assisted by a specialist from the Tanzania Food and Nutrition Centre. Arrangements were made with the neighbouring villages for practice measuring of children below age 5 years and their mothers. All trainees received the anthropometric training. Supervisors and editors received additional training on their specific duties in the field. The main purpose was to ensure that all the teams would be following a uniform set of procedures. The forty-eight female interviewers, 8 male interviewers, and 8 editors were selected from the larger pool of trainees at the end of the training course. Eight teams were made up and each team was allocated between two and three regions. Each field team was composed of six female interviewers, one male interviewer, one editor, a supervisor, and a driver (each team had one vehicle). The main fieldwork began immediately after the training. Teams were dispatched to their respective regions with instructions to introduce themselves to the regional, district, ward, and village leaders before beginning the interviews. When a team got into the cluster (enumeration area), it had to identify itself to the local leaders before interviews would begin. This was necessitated by the fact that, in order to get the required maximum cooperation, the leaders bad to be aware of the project and so inform the people about it. This is the usual practice in Tanzania whenever there is anything that involves the participation of the people, be it in urban or rural areas. 182 The fieldwork for the main survey was conducted in the period between October 1991 and March 1992. Thirty households were selected for interview in each cluster (EA). Women and men for the individual interview were identified during the household interview. Team supervisors located the housing units and assigned the selected households to the interviewers. Completed household and individual questionnaires were handed over to the field editors who checked to ensure that all relevant questions were recorded correctly, that the skip pattern instructions were followed properly, and that responses were intemaily consistent. The editing work was done before the team left the EA so that the interviewer could go back to the respondent to resolve any errors. The supervisors were required to ensure that all the selected households and eligible women and men in an EA were interviewed, and that assignment sheets for the interviewers and supervisors were duly filled. The questionnaires and other control forms were submitted to the Head Office in Dares Salaam for data entry. Data Entry The data processing staff for the survey work consisted of four clerks and one supervisor who were staff of the Bureau of Statistics. They were given initial data processing training by the DHS staff. Four microcomputers were installed in the Census Office and were used exclusively to process the TDHS data. Before the questionnaires were passed for data entry, they had to undergo office editing to check for internal consistency of responses recorded in the questionnaire and to see that the skip instructions had been followed, that there were no omissions, and that all entries were legible. Data entry began in November 1991 after the Census Office received questionnaires from the Dares Salaam/Coast team and was completed during the last week of May 1992. When all the data had been entered, a final edit was done. This was completed in July 1992 and the preliminary report was published in September 1992. 183 Table B. 1 Results of the household and individual interviews by residence and zone Results of the household and individual interviews by residence and zone, Tanzania 1991/92 Reset Residence Zone Main- Dares Other land Salaam urban Rural Northern Southern Zanzi- High- High- bar Coastal lands Lake Central lands South Total Selected households Sampled 8686 583 1162 6941 596 2462 876 2570 816 1242 1316 9282 Found 8013 520 1057 6436 548 2266 800 2406 744 1139 1206 8561 Interviewed 7785 478 1005 6302 542 2199 733 2367 731 1126 1171 8327 Household response rate 97.2 91.9 95.1 97.9 98.9 97.0 91.6 98.4 98.3 98.9 97.1 97.3 Eligible women 9112 541 1227 7344 535 2375 848 3213 773 1233 1205 9647 Women interviewed 8718 505 1178 7035 520 2271 805 3089 750 1178 1145 9238 E l ig ib le women response rate 95.7 93.3 96,0 95.8 97,2 95.6 94.9 96.1 97.0 95,5 95.0 95,8 Eligible men 2261 151 301 1809 131 574 224 779 192 328 295 2392 Men interviewed 2010 132 263 1615 104 504 199 695 171 272 273 2114 Eligible men response rate 88.9 87.4 87.4 89.3 79,4 87.8 88.8 89.2 89.1 82.9 92.5 88.4 184 Table B.2 Sample implementation for women according to residence and zone Percent distribution of households and eligible women in the DHS sample by results of the interview and household, eligible women and overall response rates, according to residence and zone, Tanzania 1991/92 Result Re~dence Zone Main- Dares Other land Salaam urban Rural Nortbern Southern Zanzi- High- High- bar Coastal lands Lake Central lands South Total Selected households Completed (C) 89.6 82.0 86.5 90.8 90.9 89.3 83.7 92.1 89.6 90.7 89.0 89.7 Household present but no competent respondent at home (HP) 1.7 4.6 2.3 1.3 0.3 1.8 7.4 0.8 1.1 0.2 0.4 1.6 Refused (R) 0.1 0.9 0.2 0.1 0.0 0.2 0.2 0.1 0.1 0.2 0.0 0.1 Dwelling not found (DNF) 0.8 1.7 2.0 0.5 0.7 0.7 0.0 0.6 0.4 0.6 2.3 0.8 Household absent (HA) 1.6 3.4 2.8 1.3 1.5 1.8 4.6 0.6 1.2 1.6 1.6 1.6 Dwelling vacant (DV) 4.8 6.2 5,6 4.5 5.7 5.2 3.9 4.2 5.1 6.1 4.8 4.8 Dwelling destroyed (DD) 1.1 0.3 0.4 1.3 0.8 0.6 0.2 1.5 2.1 0.2 2.0 1.1 Other (O) 0.2 0.9 0.3 0,1 0.0 0.3 0.0 0.1 0.4 0.3 0.0 0.2 Total percent 100.0 100,0 100.0 100.0 100,0 100.0 100.ll 100.0 100.0 100.0 100.0 100.0 Number 8686 583 1162 6941 596 2462 876 2570 816 1242 1316 9282 Househo ld response rate (HRR) 1 97.2 91.9 95.1 97.9 98.9 97.0 91.6 98.4 98.3 98.9 97.1 97.3 El ig ib le women Completed (EWC) 95.7 93.3 96.0 95.8 97.2 95.6 94.9 96.1 97.0 95.5 95.0 95.8 Not at home (EWNH) 3.2 4.4 2.9 3.1 2,1 3.0 4.2 3.0 1.8 3.6 3.2 3.1 Postponed (EWP) 0.0 0,0 0.0 0.0 0.0 0.0 0.0 0.0 0.1 0.0 0,0 0.0 Refused (EWR) 0.2 1.1 0.2 0.1 0.0 0.3 0.0 0.2 0.0 0.0 0.2 0.2 partly completed (EWPC) 0,I 0.0 0.0 0.1 0.0 0.1 0.0 0.0 0.1 0.0 0.0 0.1 Incapacitated (EWl) 0.9 1.1 0.8 0.9 0.7 1.0 0.8 0.6 0.9 0.8 1.5 0.9 Total percent I00.0 100.0 100.0 100.0 100.0 100.0 100,0 100.0 I00.0 100.ll 100.0 100.0 Number 9112 541 1227 7344 535 2375 848 3213 773 1233 1205 9647 Eligible woman response rate (EWRR) 2 95.7 93.3 96.0 95.8 97.2 95.6 94.9 96.1 97.0 95.5 95.0 95.8 Overall response rate (ORR) 3 93.0 85.8 91.3 93.8 96.1 92.8 87.0 94.6 95.3 94.4 92.3 93.1 Note: The household response rate (HRR) is calculated for completed households as a proportion of completed, no competent respondent, postponed, refused, and household absent. The eligible woman response rate (EWRR) is calculated for completed interviews as a proportion of completed, not at home, postponed, refused, partially completed and "other." The overall response rate is the product of the household and woman response rates. 1Using the number of households falling into specific response categories, the household response rate (HRR) is calculated as: C C+I IP+P+R+HA+O 2Using the number of eligible women fulling into specific response categories, the eligible woman response rate (EWRR) is calculated as: EWC EWC + EWNtl + EWP + EWR + EWPC + EWO + EWI ~Tbe overall response rate (ORR) is calculated as: ORR = t lRR * EWRR 185 o~ Table B.3 Sample implementat ion for women according to region Percent distribution o f households and eligible women in the DHS sample by results of the interview and household, eligible women and overall response rates, according to region, Tanzania 1991/92 Region Selected households Eligible women Household presem bqzt no House- Eligible Over- competent hold woman all respond- Dwelling House- House- re- Not Partly Inca- re- re- Corn- era Re- not hold hold Dwelling Tc~tl sponse Com- at Post- Re- c.om- peci- Total stxaw~ sponse pleted at home fused found absent vac.aatdestroyed Other per- Num- rate pleted home po~ed fused p l~ tared per- Ntma- rate rate ((2) fliP) (R) (DNF) (HA) (DV) (DD) (O) cent beg (HRR) (EWC)(EWNC)(EWP) (EWR)(EWPC)(EW D coat bet (EWRR)(ORR) Dodorna Arusha Kilimanjaro Tanga Morogoro Coast Dar es Salaam Lindi Mtwara Ruvuma Iringa Mbeya Singida Tabora Rukwa Kgoma Shinymga Kagera Mwarlza Mara Zanzibar 91.2 1.9 0.3 0.3 0.5 4.5 I.I 0.3 I00.0 375 97.4 97.7 1.7 0.0 0.0 0.0 0.6 100.0 349 97.7 95.2 80.3 7.I 0.2 0.0 7.8 4.4 0.2 0.0 100.0 436 91.6 93.9 5.1 0.0 0.0 0.0 1.0 100.0 391 93.9 86.0 87.0 7.7 0.2 0.0 1.4 3.4 0.2 0.0 100.0 440 91.6 95.8 3.5 0.0 0.0 0.0 0.7 100.0 457 95.8 87.8 89.9 0.5 0.0 0.7 0.7 6.9 1.1 0.2 1(30.0 437 98.7 96.2 2.8 0.0 0.0 0.0 1.0 100.0 398 96.2 95.0 94.5 0.2 0.0 0.0 1.2 3.6 0.2 0.2 10(3.0 422 99.7 97.4 1.4 0.0 0.0 0.2 1.0 100.0 499 97.4 97.2 91.3 2.8 0.0 0.2 1.7 3.1 0.7 0.2 100.0 424 96.8 93.8 4.5 0.0 0.2 0.5 1.0 100.0 402 93.8 90.7 82.0 4.6 0.9 1.7 3.4 6.2 0.3 0.9 I00.0 583 91.9 93.3 4.4 0.0 1.1 0.0 1.1 100.0 541 933 85.8 85.7 0.7 0.0 2.7 3.4 6.3 1.1 0.0 100.0 442 96.2 96.1 2.8 0.0 0.0 0.0 1.1 100.0 361 96.1 92.5 92.0 0.2 0.0 1.4 0.0 3.7 2.8 0.0 1(30.0 436 98.3 96.1 2.5 0.0 0.0 0.0 1.4 1O0.0 357 96.1 94.4 89.3 0.2 0.0 2.7 1.4 4.3 2.1 0.0 100.0 438 96.8 93.4 4.1 0.0 0.6 0.0 1.8 1O0.0 487 93.4 9(I.4 93.4 0.2 0.5 0.2 1.6 4.1 0.0 0.0 100.0 441 99.0 96.2 2.8 0.0 0.0 0.0 1.0 100.0 393 96.2 95.3 90.9 0.0 0.3 1.1 1.7 5.8 0.0 0.3 100.0 361 98.5 94.1 5.0 0.0 0.0 0.0 0.9 100.0 323 94.1 92.7 88.2 0.5 0.0 0.5 1.8 5.7 2.9 0.5 100.0 441 99.0 96.5 1.9 0.2 0.0 0.2 1.2 100.0 424 96.5 95.5 89.7 1.4 0.0 2.3 0.7 5.0 0.9 0.0 1O0.0 439 96.1 96.5 2.6 0.0 0.0 0.0 0.9 100.0 429 96.5 92.7 87.7 0.2 0.0 0.7 1.6 8.4 0.7 0.7 100.0 440 99.0 95.9 3.5 0.0 0.0 0.0 0.6 100.0 517 95.9 95.0 92.0 1.6 0.0 0.5 1.1 2.7 1.8 0.2 100.0 439 97.8 97.3 2.4 0.0 0.2 0.0 0.2 100.0 510 97.3 95.1 92.7 0.2 0.0 0.5 0.5 5.5 0.5 0.2 I00.0 440 99.3 95.2 3.7 0.0 022 0.0 0.9 100.0 645 95.2 94.5 90.3 1.6 0.5 0.5 0.5 5.5 1.0 0.0 100.0 382 97.2 94.8 3.7 0.0 1.0 0.0 0.5 100.0 405 94.8 92.1 90.8 0.2 0.0 0.0 0.7 4.6 3.4 0.2 1(30.0 436 99.7 97.4 2.1 0.0 0.0 0.0 0.5 100.0 606 97.4 97.1 96.8 0.0 0.0 0.0 0.2 1.8 1.2 0.0 100.0 434 100.0 95.6 3.6 0.2 0.0 0.2 0.5 100.0 618 95.6 95.6 90.9 0.3 0.0 0.7 1.5 5.7 0.8 0.0 100.0 596 98.9 97.2 2.1 0.0 0.0 0.0 0.7 I00.0 535 97.2 96.1 Total 89.7 1.6 0.I 0.8 1.6 4.8 I.I 0.2 I00.0 9282 97.3 95.8 3.1 0.0 0.2 0.I 0.9 I00.0 9647 95.8 93.1 Table B.4 Sample implementation for men according to residence and zone Percent distribution of households and eligible men in the DHS sample by results of the interview and household, eligible men and overall response rates, according to residence and zone, Tanzania 1991192 Result Residence Zone Main- Dares Other land Salaam urban Rural Northem Southern Zanzi- high- high- bar Coastal lands Lake Central lands South Total Selected households Completed (C) 91.3 80.3 88.4 92.7 89.0 89.3 88.2 91.7 93.8 93.3 91.8 91.1 Household present but no competent respondent at home (tIP) 1.3 5.6 1.4 0.9 0.6 2.0 5.5 0.6 0.0 0.0 0.0 1.2 Refused (R) 0.1 2.1 0.0 0.0 0.0 0.5 0.0 0.0 0.0 0.0 0.0 0.1 Dwelling not found (DNF) 0.6 0.7 1.8 0,4 1.3 0.5 0.0 0.5 0.5 0.3 1.9 0.6 Household absent (HA) 1.9 3.5 4.2 1.4 1.9 2.1 5.5 0.8 0.5 2.2 1.9 1.9 Dwelling vacant (DV) 3.5 6.3 3.9 3.2 7.1 5.0 0.9 4.2 2.6 4.1 2.5 3.7 Dweging destroyed (DD) 1.3 0.7 0.0 1.5 0.0 0.5 0.0 2.2 2.1 0.0 1.9 1.2 Other (O) 0.1 0.7 0.4 0.0 0.0 0.2 0.0 0.0 0.5 0.0 0.0 0.1 Total percent 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number 2137 142 284 1711 154 605 220 639 193 315 319 2291 Household response rate (HRR) 1 97.9 90.5 96.5 98.7 97.9 96.8 94.2 98.8 99.5 99.7 98.0 97.9 Eligible men Completed (EMC) 88.9 87.4 87.4 89.3 79.4 87.8 88.8 89.2 89.1 82.9 92.5 88.4 Not at home (EMNH) 8.4 8.6 8.0 8.5 9.9 7.1 9.8 9.8 9.4 10.7 3.7 8.5 Postponed (EMP) 0.0 0.0 0.0 0.1 0.0 0.2 0.0 0.0 0.0 0.0 0.0 0.0 Refused (EMR) 0.3 2.6 0.3 0.1 0.0 0.9 0.0 0.0 0.5 0.0 0.0 0.3 Partly completed (EMPC) 0.1 0.0 0.0 0.1 0.0 0.3 0.0 0.0 0.0 0.0 0.0 0.1 Incapacitated (EMI) 2.3 1.3 4.3 2.0 10.7 3.7 1.3 1.0 1.0 6.4 3.7 2.8 Total percent 100.0 100.0 100.0 100.0 100.0 1130.0 100.0 100.0 100.0 100.0 100.0 100.0 Number 2261 151 301 1809 131 574 224 779 192 328 295 2392 Eligible man response rate (EMRR) 2 88.9 87.4 87.4 89.3 79.4 87.8 88.8 89.2 89.1 82.9 92.5 88.4 Overall response rate (ORR) a 87.0 79,1 84.4 88.1 77.7 85.0 83.7 88.2 88.6 82.6 90.7 86.5 Note: The household response rate is culculated fox completed households as a proportion of completed, no compotant respondent, postponed, refused, and household absent. The eligible man response rate is calculated for completed interviews as a proportion of completed, not at home, postponed, refused, partially completed mad "other." The overall n~sponse rate is the ~reduet of the household and man response rates. Using the number of households falling into specific response categories, the household response rate (HRR) is ealcula~.d as: C C+HP+P+R+HA+O 2Using the number of eligible men falling into specific response categories, the eligible man response rate (EMRR) is calculated as: EMC EMC + EMNH + EMP + EMR + EMPC + EMO + EMI 3The overall response rate (ORR) is calculated as: ORR = ttRR * EMRR 187 ~o Oo Table B.5 Sample implementat ion for men according to region Percent distribution of households and eligible men in the DHS sample by result of the interview and household, el igible men and overall response rates, according to region, Tanzama 1991/92 Region Selec~dhouseholds Eligible men Household I~esent but no House- Eligible Over- competent hold man all respond- DwellingHouse- House- m- Not Partly Inca- re- re- Corn- em Re- not hold hold Dwelling Total spocae Corn- at Post- Re- corn- paci- Total ~ specse pleted at home fused found absent vacant destroyed Other p~r- Num- ratc pleted home poned fused pleted ~ pe~- Num- rate rate (C) fliP) (R) (DNF) (HA) (DV) (DD) (O) cent bet OtRR) (EMC) 0EMNC) (EMP) (EMR) (EMPC) (EMI) cent bet (EMRR) (ORR) DodolYi8 Arusha Kilimanjaro Tanga Morogoro Coast Dares Salaam Lindi Mtwara Ruvuma lringa Mbeya Singida Tabora Rukwa Kgoma Shinyanga Kagera Mwanza Mara Zanzibar 95.5 0.0 0.0 0.0 0.0 3.4 i.I 0.0 I00.0 89 i00.0 89.2 7.5 0.0 I.I 0.0 2.2 I00.0 93 89.2 89.2 84.3 6.5 0.0 0.0 8.3 0.9 0.0 0.0 I00.0 108 92.9 86.1 13.0 0.0 0.0 0.0 0.9 100.0 108 86.1 80.0 92.0 4.5 0.0 0.0 2.7 0.9 0.0 0.0 100.0 112 95.4 91.4 6.9 0.0 0.0 0.0 1.7 100.0 116 91.4 87.1 94.1 0.0 0.0 0.0 1.0 3.9 1.0 0.0 IG0.0 102 100.0 85.1 11.5 0.0 0.0 0.0 3.4 100.0 87 85.I 85.1 94.2 0.0 0.0 0.0 1.9 3.8 0.0 0.0 100.0 104 100.0 97.3 0.9 0.9 0.9 0.0 0.0 100.0 110 97.3 97.3 92.2 2.9 0.0 0.0 1.9 1.9 1.0 0.0 100.0 103 96.9 91.6 4.2 0.0 0.0 2.1 2.1 100.0 95 91.6 88.8 80.3 5.6 2.1 0.7 3.5 6.3 0.7 0.7 100.0 142 90.5 87.4 8.6 0.0 2.6 0.0 1.3 100.0 151 87.4 79.1 89.4 0.0 0.0 1.0 3.8 4.8 1.0 0.0 100.0 I04 98.9 89.3 6.0 0.0 0.0 0.0 4.8 100.0 84 89.3 88.3 95.4 0.0 0.0 0.9 0.0 0.9 2.8 0.0 1O0.0 108 99.0 94.2 1.9 0.0 0.0 0.0 3.9 100.0 103 94.2 93.3 90.7 0.0 0.0 3.7 1.9 1.9 1.9 0.0 100.0 107 96.0 93.5 3.7 0.0 0.0 0.0 2.8 100.0 108 93.5 89.8 94.5 0.0 0.0 0.0 1.8 3.7 0.0 0.0 lfl0.0 109 100.0 90. l 5.9 0.0 0.0 0.0 4.0 lfl0.0 101 90.1 90.1 94.5 0.0 0.0 0.0 1.1 4.4 0.0 0.0 100.0 91 100.0 86.2 7.5 0.0 0.0 0.0 6.3 1O0.0 80 86.2 86.2 92.3 0.0 0.0 1.0 1.0 1.9 2.9 1.0 100.0 104 99.0 88.9 11.1 0.0 0.0 0.0 0.0 100.0 99 88.9 88.0 92.5 0.9 0.0 2.8 1.9 1.9 0.0 0.0 100.0 106 96.1 90.6 9.4 0.0 0.0 0.0 0.0 100.0 117 90.6 87.0 91.3 0.0 0.0 0.9 3.5 4.3 0.0 0.0 I00.0 115 99.1 76.2 15.6 0.0 0.0 0.0 8.2 100.0 147 76.2 75.5 92.5 2.8 0.0 0.0 0.9 0.9 2.8 0.0 100.0 106 97.0 90.0 9.2 0.0 0.0 0.0 0.8 100.0 120 90.0 873 92.5 0.0 0.0 0.0 0.9 5.7 0.9 0.0 lfl0.0 106 100.0 87.3 12.0 0.0 0.0 0.0 0.6 100.0 166 87.3 8%3 88.2 0.0 0.0 0.0 0.0 8.6 3.2 0.0 100.0 93 100.0 81.4 17.5 0.0 0.0 0.0 1.0 100.0 97 81.4 81.4 89.3 0.0 0.0 0.0 0.0 5.4 5.4 0.0 100.0 112 100.0 93.4 5.1 0.0 0.0 0.0 1.5 100.0 137 93.4 93.4 94.8 0.0 0.0 0.0 0.9 3.4 0.9 0.0 100.0 116 100.0 90.8 7.0 0.0 0.0 0.0 2.1 100.0 142 90.8 90.8 89.0 0.6 0.0 1.3 1.9 7.1 0.0 0.0 100.0 154 97.9 79.4 9.9 0.0 0.0 0.0 10.7 IG0.0 131 79.4 77.7 Total 91.1 1.2 0.1 0.6 1.9 3.7 1.2 0.1 IG0.0 2291 97.9 88.4 8.5 0.0 0.3 0.1 2.8 100.0 2392 88.4 86.5 APPENDIX C ESTIMATES OF SAMPLING ERRORS APPENDIX C ESTIMATES OF SAMPLING ERRORS The results from sample surveys are affected by two types of errors, nonsampling error and sampling error. Nonsampling error is due to mistakes made in carrying out field activities, such as failure to locate and interview the correct household, errors in the way the questions are asked, misunderstanding on the part of either the interviewer or the respondent, and data entry errors. Although efforts were made to minimize this type of error during the design and implementation of the TDHS, nonsampling errors are impossible to avoid and difficult to evaluate statistically. Sampling errors, on the other hand, can be measured statistically. The sample of women selected in the TDHS is only one of many samples that could have been selected from the same population, using the same design and expected size. Each one would have yielded results that differed somewhat from the actual sample selected. The sampling error is a measure of the variability between all possible samples; although it is not known exactly, it can be estimated from the survey results. Sampling error is usually measured in terms of s tandard error of a particular statistic (mean, percentage, etc.), which is the square root of the variance. The standard error can be used to calculate confidence intervals within which one can be reasonably assured that, apart from nonsampllng errors, the true value of the variable for the whole population falls. For example, for any given statistic calculated from a sample survey, the value of that same statistic as measured in 95 percent of all possible samples with the same design (and expected size) will fall within a range of plus or minus two times the standard error of that statistic. If the sample of women had been selected as a simple random sample, it would have been possible to use straightforward formulas for calculating sampling errors. However, the TDHS sample design depended on stratification, stages, and clusters. Consequently, it was necessary to utilize more complex formulas. The computer package CLUSTERS, developed by the Intemational Statistical Institute for the World Fertility Survey, was used to assist in computing the sampling errors with the proper statistical methodology. The CLUSTERS program treats any percentage or average as a ratio estimate, r = g/x , where g represents the total sample value for variable y, and x represents the total number of cases in the group or subgroup under consideration. The variance of r is computed using the formula given below, with the standard error being the square root of the variance: l - u mr z~- in which z~ = y~-r .x~ , and z h = Yh- r .xh 191 where h m h Yh~ xh~ f represents the stratum which varies from 1 to H is the total number of EAs selected in the h t~ stratum is the sum of the values of variable y in EA i in the h th stratum is the sum of the number of cases (women) in EA i in the h th stratum is the overall sampling fraction, which is so small that CLUSTERS ignores it. In addition to the standard errors, CLUSTERS computes the design effect (DEFT) for each estimate, which is defined as the ratio between the standard error using the given sample design and the standard error that would result if a simple random sample had been used. A DEFT value of 1.0 indicates that the sample design is as efficient as a simple random sample, while a value greater than 1.0 indicates the increase in the sampling error due to the use of a more complex and less statistically efficient design. CLUSTERS also computes the relative error and confidence limits for the estimates. Sampling errors are presented in Tables C.2-C.15 for variables considered to be of major interest. Results are presented for the urban and rural areas separated and study domains. For each variable, the type of statistic (mean or proportion) and the base population are given in Table C. 1. For each variable, Tables C.2-C.18 present the value of the statistic (R), its standard error (SE), the number of unweighted (N) and weighted cases (WN), the design effect (DEFT), the relative standard error (SE/R), and the 95 percent confidence limits (R+2SE). The confidence limits have the following interpretation. For the mean number of children ever bom (EVBORN), the overall average from the sample is 3.105 and its standard error is 0.038. Therefore, to obtain the 95 percent confidence limits, one adds and subtracts twice the standard error to the sample estimate, i.e., 3.105 + (2 x 0.038), which means that there is a high probability (95 percent) that the true average number of children ever bom is between 3.03 and 3.18. The relative standard error for most estimates for the country as a whole is small, except for estimates of very small proportions. The magnitude of the error increases as estimates for subpopulations such as geographical areas are considered. For the variable children ever born, for instance, the relative standard error (as a percentage of the estimated mean) for the whole country is 1.2 percent and is between 1.2 and 5.3 percent for the different study domains. 192 Table C.1 List of selected variables for samplin,~ errors t Tanzania 1991/92 Variable Type Description Base population URBRUR Proportion SECOND Proportion CURMAR Proportion AGEM20 Proportion SEX18 Proportion PREGNT Proportion EVBORN Mean EVB40 Mean SURVIV Mean KMETHO Proportion KMDMET Proportion KSRCE Proportion EVUSE Proportion CUSE Proportion CUMODE Proportion CUPILL Proportion CUIUD Proportion CUSTER Proportion CUCOND Proportion CUPABS Proportion PSOURC Proportion NOMORE Proportion DELAY Proportion IDEAL Mean TETANU Proportion MEDELI Proportion DIARR1 Proportion DIARR2 Proportion ORSTRE Proportion MEDTRE Proportion HCARD Proportion BCG Proportion DPT3 Proportion POL3 Proportion MEASLE Proportion FULLIM Proportion WGTAGE Proportion HGTLNG Proportion WGTLNG Proportion Urban resident Secondary or more Currently in union Union before 20 Sex before 18 Pregnant Children ever born Children ever born Children surviving Knowing any method Knowing any modern method Knowing method source Ever use any method Using any method Using any modem method Using pill Using IUD Using female sterilisation Using condom Currently using abstinence Public source user Desiring no more children Delay child at least 2 years Ideal number of children Received tetanus Medical attention at birth Diarrhoea last 2 weeks Diarrhoea last 24 hours Received ORS treatment Received medical treatment Had health card Received BCG Received DPT (3 doses) Received polio (3 doses) Received measles Fully immunised Weight for age < 2 standard Height for age < 2 standard Weight for age < 2 standard All women All women All women Ever in union Ever in union Women in union All women Women 4049 All women Women in union Women in union Women in union Women in union Women m umon Women m union Women m union Women m union Women m umon Women m union Women m union User modem method Women in union Women in union All women Births last 5 years Births last 5 years Children < 5 years Children < 5 years Diarrhea last 2 weeks Diarrhea last 2 weeks Children 12-23 months Children 12-23 months Children 12-23 months Children 12-23 months Children 12-23 months Children 12-23 months Children < 3 years Children < 3 years Children < 3 years 193 Table C.2 Sampling errors v entire sarnpl% Tanzania 1991/92 Variable Stand~d Value error (R) (SE) Number of cases Design Relative Confidence limits Unweighted Weighted effect error (N) (WN) (DEFt) (SE/R) R-2SE R+2SE URBRUR SECOND CURMAR AGEM20 SEX18 PREGNT EVBORN EVB40 SURVIV KMETHO KMDMET KSRCE EVUSE CUSE CUMODE CUPILL CUIUD CUSTER CUCOND CUPABS PSOURC NOMORE DELAY IDEAL TETANU MEDELI DIARR1 DIARR2 ORSTRE MEDTRE HCARD BCG DPT3 POL3 MEASLE FULLIM WGTAGE HGTLNG WOTLNG .248 .031 .048 .007 • 654 .009 • 669 .010 .646 .010. • 135 .004 3.105 .038 6.920 .103 2•575 .031 .802 .011 .776 .012 .711 .013 .257 .012 • 104 .006 .066 .006 .034 .004 .004 .000 .016 .002 .007 .001 .013 .002 .729 .023 .214 .007 • 416 .008 6.051 •062 .900 .006 .531 .021 • 131 .006 .043 .003 • 574 .022 .595 .026 .781 .015 .954 .009 .798 .015 .771 .016 .812 .014 .711 .017 .288 .009 .467 .011 .056 .004 9238 9238 6.863 .124 •187 .310 9238 9238 3.005 .139 .035 .061 9238 9238 1.815 .014 .636 .672 7009 7055 1.778 .015 .649 •689 7006 7053 1.715 .015 .627 .666 6091 6038 1.010 .033 .126 .143 9238 9238 1.193 .012 3.030 3.180 1456 1410 1.256 .015 6.715 7.125 9238 9238 1.156 .012 2.514 2.637 6091 6038 2.166 .014 .780 .825 6091 6038 2.227 .015 .753 .800 6091 6038 2.283 .019 .684 .737 6091 6038 2.102 .046 .233 .280 6091 6038 1.546 .058 .092 .116 6091 6038 1.741 .084 .055 .077 6091 6038 1.792 .123 .025 .042 6091 6038 .000 .000 .004 .004 6091 6038 1.129 .112 .013 .020 6091 6038 1.255 .192 .004 .010 6091 6038 1.583 .173 .009 .018 477 545 1.108 .031 .684 .775 6091 6038 1.394 .034 .200 .229 6091 6038 1.256 .019 .400 .432 7957 7976 2.110 .010 5.927 6.175 8062 8035 1.542 .007 .888 .911 8062 8035 3.073 .039 .490 .573 7209 7173 1.481 .046 .119 .142 7209 7173 1.332 .074 .037 .050 934 936 1.306 .038 .530 .617 934 936 1.560 .043 .544 .647 1617 1616 1.453 .019 .751 .812 1617 1616 1.618 .009 .937 .972 1617 1616 1.505 .019 .768 .829 1617 1616 1.544 .021 .738 .803 1617 1616 1.410 .017 .784 .840 1617 1616 1.525 .025 .676 .746 6111 6095 1.471 .031 .270 .306 6111 6095 1.579 .023 .445 .488 6111 6095 1.301 .069 .049 .064 194 Table C.3 Sampling errors T urban, Tanzania 1991/92 Number of cases Variable Standard Value error (R) (SE) Design Relative Confidence limits Unweighted Weighted effect error (N) (WN) (DEFT) (SE/R) R-2SE R+2SE URBRUR SECOND CURMAR AGEM20 SEX18 PREGNT EVBORN EVB40 SURVIV KMETHO KMDMET KSRCE EVUSE CUSE CUMODE CUPILL CUIUD CUSTER CUCOND CUPABS PSOURC NOMORE DELAY IDEAL TETANU MEDELI DIARR1 DIARR2 ORSTRE MEDTRE HCARD BCG DPT3 POL3 MEASLE FULLIM WGTAGE HGTLNG WOTLNG 1.1300 .000 .120 .021 .572 .023 .592 .019 .605 .020 .125 .012 2.580 .100 6.322 .283 2.160 .071 .935 .015 .930 .016 .880 .020 .440 .027 .178 .018 .140 .019 .084 .016 .011 .004 .017 .004 .016 .004 .015 .004 .777 .027 .257 .018 .403 .014 5.342 .179 .934 .016 .859 .013 .148 .018 .043 .009 .561 .048 .701 .064 .824 ,029 .993 .005 .889 .024 .875 ,036 .916 .026 .838 .038 .262 .030 .416 .045 .051 .012 1838 2294 .000 ,000 1.000 1.000 1838 2294 2.809 .178 .077 .162 1838 2294 2.003 .040 .526 .618 1345 1699 1.435 .032 .553 .630 1345 1699 1.508 .033 .565 .645 1055 1312 1.149 .094 .101 ,148 1838 2294 1,538 .039 2,379 2,781 240 292 1.298 .045 5,756 6.888 1838 2294 1.294 .033 2,017 2.302 1055 1312 1.979 .016 ,906 .965 1055 1312 2,015 .017 ,899 .962 1055 1312 1.973 .022 .840 .919 1055 1312 1.758 .061 .386 .494 1055 1312 1.564 .104 .141 .215 1055 1312 1.784 .136 ,101 .178 1055 1312 1.862 .190 .052 .115 1055 1312 1,223 .361 .003 .019 1055 1312 1.098 .256 .008 .026 1055 1312 1.137 .275 .007 .025 1055 1312 1.112 .277 .007 .023 199 262 .928 .035 .722 .832 1055 1312 1.370 ,072 .220 .294 1055 1312 .912 .034 .375 .431 1708 2122 3.119 .034 4.984 5.700 1264 1646 2.068 .017 .903 .965 1264 1646 1.271 .016 .832 .886 1124 1437 1.680 .118 .113 .184 1124 1437 1,518 .210 .025 .061 156 213 1,240 .086 .464 .657 156 213 1.801 .092 .572 .829 247 334 L212 .035 .766 .882 247 334 ,961 .005 ,984 1.003 247 334 1,246 .027 .841 .937 247 334 1,786 .041 .802 .947 247 334 1,557 .029 .863 .969 247 334 1.676 .045 .762 .913 963 1239 1.965 .113 .202 .321 963 1239 2.769 .108 .326 .505 963 1239 1.718 .241 .026 .075 195 Table C.4 Sampling errors~ rural~ Tanzania 1991/92 Number of cases Standard Design Relative Confidence limits Value error Unweighted Weighted effect error Variable (R) (SE) (N) (WN) (DEFT) (SE/R) R-2SE R+2SE URBRUR .000 ,000 7400 6944 .000 .000 .1300 .000 SECOND .024 .005 7400 6944 2.651 .195 .015 .034 CURMAR .681 ,009 7400 6944 1.605 .013 .663 .698 AGEM20 .693 ,010 5664 5356 1.669 .015 .673 .714 SEX18 .660 ,012 5661 5354 1.891 .018 .636 .683 PREGNT .137 ,005 5036 4726 .931 .033 .128 .146 EVBORN 3.279 ,039 7400 6944 1.086 .012 3.201 3.357 EVB40 7.076 .103 1216 1119 1.188 .015 6.870 7.282 SURVIV 2.713 ,032 7400 6944 1.075 .012 2.648 2.777 KMETHO .766 ,011 5036 4726 1.884 .015 .743 .788 KMDMET .734 .012 5036 4726 1.889 .016 .710 .757 KSRCE .664 .013 5036 4726 1.936 .019 .638 .690 EVUSE .206 .010 5036 4726 1.746 .048 .186 .226 CUSE .084 .005 5036 4726 1.353 .063 .073 .094 CUMODE .045 .003 5036 4726 1.106 .072 .039 .051 CUPILL .020 .002 5036 4726 1.270 .126 .015 .025 CUIUD .003 .000 5036 4726 .000 .000 .003 .003 CUSTER .016 .002 5036 4726 1.146 .126 .012 .020 CUCOND .004 .00I 5036 4726 .000 .236 .002 .007 CUPABS .013 .003 5036 4726 1.755 .215 .007 .019 PSOURC .685 .032 278 282 1.137 .046 .622 .749 NOMORE .203 .007 5036 4726 1.147 .032 .190 .216 DELAY .420 .009 5036 4726 1.335 .022 .401 .438 IDEAL 6.308 .061 6249 5854 1.797 .010 6.187 6.429 TETANU .891 .006 6798 6390 1.462 .007 .878 .903 MEDELI .447 .017 6798 6390 2.405 .039 .412 .482 DIARR1 .126 .006 6085 5736 1.317 .045 .115 .137 DIARR2 .043 .003 6085 5736 1.271 .077 .037 .050 ORSTRE .578 .024 778 723 1.308 .042 .529 .626 MEDTRE .564 .028 778 723 1.488 .049 .509 .619 HCARD .770 .017 1370 1282 1.445 .021 .737 .803 BCG .944 .010 1370 1282 1.625 .011 .923 .965 DPT3 .775 .018 1370 1282 1.555 .023 .739 .811 POL3 .743 .018 1370 1282 1.494 .024 .707 .779 MEASLE .785 .014 1370 1282 1.266 .018 .756 .813 FULLIM .678 .019 1370 1282 1.458 .028 .641 .715 WGTAGE .295 .009 5148 4856 1.430 .032 .276 .313 HGTLNG .480 .010 5148 4856 1.361 .021 .460 .500 WGTLNG .058 .004 5148 4856 1.094 .061 .051 .065 196 Table C.5 Sampling errors~ Mainland~Tanzania 1991/92 Variable Standard Value error (R) (SE) Number of cases Design Relative Confidence limits Unweighted Weighted effect error (N) (WN) (DEFY) (SE/R) R-2SE R+2SE URBRUR SECOND CURMAR AGEM20 SEX18 PREGNT EVBORN EVB40 SURVIV KMETHO KMDMET KSRCE EVUSE CUSE CUMODE CUHLL CUIUD CUSTER CUCOND CUPABS PSOURC NOMORE DELAY IDEAL TETANU MEDEH DIARR1 DIARR2 ORSTRE MEDTRE HCARD BCG DPT3 POL3 MEASLE FULLIM WGTAGE HGTLNG WGTLNG .246 .032 8718 8978 .o41 .007 8718 8978 .654 .009 8718 8978 .665 .OlO 6624 6864 .647 .010 6621 6861 .134 .004 5757 5870 3,104 .038 8718 8978 6.921 .105 1378 1371 2.571 .031 8718 8978 .798 .011 5757 5870 .771 .012 5757 5870 .705 .014 5757 5870 .261 .012 5757 5870 .105 .006 5757 5870 .066 .006 5757 5870 .034 .004 5757 5870 .004 .001 5757 5870 .016 .002 5757 5870 .007 .OOl 5757 5870 .014 .002 5757 5870 .723 .023 445 530 .215 .008 5757 5870 .414 .008 5757 5870 6.028 .063 7481 7739 .899 .006 7609 7797 .537 .021 7609 7797 .131 .006 6788 6950 .042 .003 6788 6950 .575 .022 877 907 .592 .027 877 908 .777 .016 1522 1565 .953 .009 1522 1565 .794 .016 1522 1565 ,766 .o17 1522 1565 .810 .014 1522 1565 .707 .018 1522 1565 .285 ,009 5816 5943 ,466 .011 5816 5943 .055 .004 5816 5943 6.899 .129 .182 .309 3.238 .167 .028 .055 1.811 .014 .635 .672 1,757 .015 .645 .686 1.712 .016 .627 .667 1.001 .033 .125 .143 1.189 .012 3.027 3.180 1.259 .015 6.711 7.131 1.153 .012 2.508 2.633 2.153 .014 .775 .821 2.216 .016 .747 .796 2.278 .019 .677 ,732 2.077 .046 .237 .285 1.534 .059 .093 .118 1,735 .086 ,054 .077 1.784 .126 .025 .042 .00O .231 .002 .006 1.122 .115 .013 .020 1.256 .198 .004 .010 1.568 .175 .009 .019 1.103 .032 .676 .769 1.386 .035 .200 .230 1.252 .020 .398 .430 2.116 .010 5.902 6.155 1.538 .007 .887 .911 3.064 .039 .494 ,579 1.478 .047 ,118 .143 1.357 ,080 .035 .o48 1.300 ,o39 .530 .620 1,550 ,045 .539 .645 1.448 .020 .746 .809 1.597 .009 .935 .971 1.492 ,020 .763 .826 1.532 .022 .732 .799 1.407 .018 .781 .839 1.521 .025 ,671 .743 1.471 .032 .267 .303 1.571 .023 ,445 .488 1.288 .071 .047 .063 197 Table C.6 Sampling errors T Dar es Salaam T Tanzania 1991/92 Number of cases Variable Standard Design Relative Confidence limits Value error Unweighted Weighted effect error (R) (SE) (N) (WN) (DEFT) (SE/R) R-2SE R+2SE URBRUR SECOND CURMAR AGEM20 SEX18 PREGNT EVBORN EVB40 SURVIV KMETHO KMDMET KSRCE EVUSE CUSE CUMODE CUPILL CUIUD CUSTER CUCOND CUPABS PSOURC NOMORE DELAY IDEAL TETANU MEDELI DIARR1 DIARR2 ORSTRE MEDTRE HCARD BCG DPT3 POL3 MEASLE FULLIM WGTAGE HGTLNG WGTLNG .889 .027 505 .095 .021 505 .597 ,016 505 .613 .027 374 ,588 .032 374 .105 .014 301 2.354 Al l 505 6.083 .470 56 1.957 .113 505 .917 .033 301 .911 .033 301 .849 .036 301 .495 .033 301 .157 .023 301 .109 .023 301 .057 .015 301 .005 .003 301 .022 .007 301 .019 .006 301 ,006 .004 301 .697 .056 51 ,257 .029 301 ,353 .029 301 5,182 .178 491 ,956 .012 314 ,865 .040 314 ,120 .016 272 ,023 .008 272 ,309 .099 32 ,621 .096 32 ,591 .059 47 .983 .016 47 .850 .038 47 .826 .038 47 .870 .050 47 .774 .054 47 .199 .024 228 .285 .035 228 ,068 .021 228 585 1.931 .030 .835 .943 585 1.580 .218 .053 ,136 585 .741 .027 .564 .629 423 1.066 .044 .559 .667 423 1.237 .054 .525 .651 349 .808 .136 .077 .134 585 .923 .047 2.132 2.576 66 1.089 .077 5.144 7.022 585 1.130 .058 1.730 2.184 349 2.076 .036 .851 .983 349 2.011 .036 .845 .977 349 1.739 .042 .777 .921 349 1.127 .066 .430 .560 349 1.072 .143 .112 .202 349 1.294 .213 .063 .156 349 1.116 .261 .027 ,087 349 .790 ,628 -.001 .012 349 .851 .331 .007 .036 349 .815 .335 .006 ,032 349 .865 ,621 -.002 .014 52 .861 .080 .585 ,809 349 1.143 .112 .199 .315 349 1.055 .082 .295 .411 572 1.532 .034 4.826 5.538 373 1.052 .013 .931 .980 373 1.905 .046 .786 .944 322 .809 .133 .088 .152 322 .896 .354 .007 .039 39 1.118 .321 .110 .508 39 1.106 .154 .429 .812 55 .828 .100 ,473 .708 55 .836 .016 .952 1.015 55 .724 .045 .774 .926 55 .686 ,046 .750 .902 55 1.023 .058 .769 .970 55 .884 .070 .666 .883 277 .934 .122 .151 .248 277 1.227 .123 .215 .355 277 1.272 .304 .027 .110 198 Table C.7 Sampling errors I Other urban (Mainland), Tanzania 1991/92 Number of cases Variable Standard Value error (R) (SE) Design Relative Confidence limits Unweighted Weighted effect error (N) (WN) (DEFT) (SE/R) R-2SE R+2SE URBRUR SECOND CURMAR AGEM20 SEX18 PREGNT EVBORN EVB40 SURVIV KMETHO KMDMET KSRCE EVUSE CUSE CUMODE CUPILL CUIUD CUSTER CUCOND CUPABS PSOURC NOMORE DELAY IDEAL TETANU MEDELI DIARR1 DIARR2 ORSTRE MEDTRE HCARD BCG DPT3 POL3 MEASLE FULLIM WGTAGE HGTLNG WGTLNG 1.000 .000 .107 .028 .573 .031 .582 .O24 .617 .024 .135 .016 2.689 .120 6.421 .353 2.246 .079 .942 .016 .938 .017 .891 .023 .433 .035 .187 .024 .151 .024 .095 .021 .013 .005 .016 .005 .014 .006 .017 .006 .793 .030 .257 .024 .420 .017 5.408 .233 .930 .019 .863 .014 .159 .022 .048 .011 .605 .058 .719 .077 .863 .027 .995 .005 .894 .029 .881 .044 .923 .030 .847 .046 .274 .035 .448 .050 .044 .014 1178 1686 .000 .000 1.000 1.000 1178 1686 3.064 .257 .052 .163 1178 1686 2.155 .054 .511 .635 866 1265 1.416 .041 .534 .629 866 1265 1.424 .038 .570 .664 689 966 1.254 .121 .102 .168 1178 1686 1.452 .045 2.449 2.928 160 220 1.316 .055 5.715 7.128 1178 1686 1.135 .035 2.087 2.405 689 966 1.781 .017 .911 .974 689 966 1.858 .018 .903 .972 689 966 1.903 .025 .846 .936 689 966 1.836 .080 .364 .503 689 966 1.610 .128 .140 .235 689 966 1.765 .160 .103 .199 689 966 1.863 .219 .053 .137 689 966 1.238 .415 .002 .023 689 966 1.079 .323 .006 .026 689 966 1.304 .422 .002 .025 689 966 1.135 .327 .006 .028 136 208 .865 .038 .732 .853 689 966 1.419 .092 .210 .305 689 966 .887 .040 .387 .454 1068 1527 3.377 .043 4.941 5.875 872 1273 2.035 .021 .891 .969 872 1273 1.073 .016 .836 .891 776 1110 1.645 .136 .116 .202 776 1110 1.471 .233 .026 .071 117 176 1.293 .096 .489 .722 117 176 1.871 .107 .565 .874 176 273 1.062 .032 .809 .918 176 273 .954 .005 .986 1.005 176 273 1.280 .032 .837 .951 176 273 1.881 .050 .793 .969 176 273 1.565 .033 .862 .983 176 273 1.750 .054 .756 .939 685 965 1.883 .127 .204 .344 685 965 2.510 .112 .348 .548 685 965 1.675 .307 .017 .071 199 Table C.8 Sampling error% Rural (Mainland)i Tanzania 1991/92 Number of eases Variable Standmd Value error (R) (SE) Design Relative Confidence limits Unweighted Weighted effect error (N) (WN) (DEFT) (SE/R) R.2SE R+2SE URBRUR SECOND CURMAR AGEM20 SEX18 PREGNT EVBORN EVB40 SURVIV KMETHO KMDMET KSRCE EVUSE CUSE CUMODE CUP1LL CUIUD CUSTER CUCOND CUPABS PSOURC NOMORE DELAY IDEAL TETANU MEDELI DIARR1 DIARR2 ORSTRE MEDTRE HCARD BCG DPT3 POL3 MEASLE FULLIM WGTAGE HGTLNG WGTLNG .000 .000 7035 .020 .005 7035 .679 .009 7035 .690 .011 5384 .659 .012 5381 .137 .005 4767 3.273 .040 7035 7.073 .105 1162 2.706 .033 7035 .758 .012 4767 .725 .012 4767 .654 .013 4767 .207 .010 4767 .084 .005 4767 .044 .003 4767 .019 .003 4767 .002 .000 4767 .016 .002 4767 .005 .001 4767 .014 .003 4767 .673 .033 258 .202 .007 4767 .417 .010 4767 6.282 .062 5922 .889 .007 6423 .449 .018 6423 .126 .006 5740 ,041 .003 5740 .582 .025 728 .559 .028 728 .767 .017 1299 .942 .011 1299 .770 .018 1299 .737 .019 1299 .783 .015 1299 .673 .019 1299 .292 .010 4903 .481 .010 4903 .056 .004 4903 6707 .000 .000 .000 .000 6707 2.890 ,241 .010 .030 6707 1.610 .013 .661 .697 5176 1.671 .015 .669 .711 5173 1.904 .019 .635 .684 4555 .924 .034 .127 .146 6707 L086 .012 3.194 3.353 1086 1.196 .015 6.862 7.284 6707 1.077 .012 2.639 2.772 4555 1.866 .015 .735 .781 4555 1.871 .017 .701 .749 4555 1.922 .020 .627 .680 4555 1.752 .050 .186 .227 4555 1.359 .065 .073 .095 4555 1.114 .075 .037 .051 4555 1.295 .135 .014 .024 4555 .000 .000 .002 .002 4555 1.155 .131 .012 .020 4555 .000 .241 .002 .007 4555 1.739 .215 .008 .019 269 1.134 .049 .607 .740 4555 1.122 .032 .189 .215 4555 1.337 .023 .398 .436 5640 1.813 .010 6.158 6.405 6152 1.467 .007 ,876 .902 6152 2.427 .040 ,413 .485 5518 1.327 .047 ,114 .137 5518 1.312 .084 ,034 .048 693 1.310 .043 ,533 .632 693 1.490 .051 ,502 .615 1237 1.446 .022 ,732 .801 1237 1.613 .011 ,920 .964 1237 1.551 .024 ,733 .807 1237 1.490 .025 ,700 .774 1237 1.266 .019 ,753 .812 1237 1.457 .029 ,634 .711 4701 1.429 .033 ,273 .311 4701 1.368 .021 A60 .501 4701 1.076 .063 .049 .064 200 Table C.9 Sampling errors, Zanzibar~ Tanzania 1991/92 Number of cases Standard Design Relative Confidence limits Value error Unweigbted Weighted effect error Variable (R) (SE) (N) (WN) (DEFT) (SE/R) R-2SE R+2SE URBRUR .340 .034 SECOND .280 .031 CURMAR .646 .022 AGEM20 .792 .017 SEX18 .624 .022 PREGNT .140 .022 EVBORN 3.166 .128 EVB40 6.891 .395 SURVIV 2.744 .102 KMETHO .959 .013 KMDMET .959 .013 KSRCE .925 .015 EVUSE .111 .022 CUSE .071 .017 CUMODE .066 .016 CUPILL .029 .010 CUIUD .003 .003 CUSTER .015 .006 CUCOND .008 .003 CUPABS .005 .004 PSOURC .972 .030 NOMORE .207 .026 DELAY .494 .027 IDEAL 6.799 .275 TETANU .919 .015 MEDELI .351 .039 DIARR1 .127 .016 DIARR2 .095 .012 ORSTRE .533 .078 MEDTRE .690 .086 HCARD .910 .026 BCG 1.000 .000 DPT3 .926 .023 POL3 .926 .023 MEASLE .865 .023 FULLIM .842 .030 WGTAGE .399 .044 HGTLNG .479 .033 WGTLNG .110 .021 520 261 1.633 .100 .272 .408 520 261 1.564 .110 .219 .342 520 261 1.066 .035 .601 .691 385 192 .797 .021 .759 .825 385 192 .890 .035 .580 .668 334 168 1.158 .158 .096 .183 520 261 .900 .041 2.909 3.423 78 39 .898 .057 6.101 7.680 520 261 .820 .037 2.539 2.949 334 168 1.198 .014 .932 .985 334 168 1.198 .014 .932 .985 334 168 1.060 .017 .895 .956 334 168 1.261 .195 .068 .155 334 168 1.189 .235 .038 .105 334 168 1.189 .245 .034 .098 334 168 1.126 .357 .008 .050 334 168 .974 1.020 -.003 .008 334 168 .963 .435 .002 .027 334 168 .596 .358 .002 .014 334 168 .943 .715 -.002 .013 32 15 .000 .030 .913 1.031 334 168 1.193 .128 .154 .260 334 168 .974 .054 .441 .548 476 236 1.666 .040 6.249 7.349 453 238 .937 .016 .889 .948 453 238 1.374 .111 .273 .429 421 222 .949 .122 .096 .158 421 222 .868 .130 .070 .119 57 28 1.135 .147 .376 .690 57 28 1.366 .124 .519 .862 95 51 .916 .029 .857 .962 95 51 .000 .000 1.000 1.000 95 51 .891 .025 .879 .972 95 51 .891 .025 .879 .972 95 51 .682 .027 .818 .911 95 51 .830 .036 .782 .903 295 152 1.375 .111 .310 .487 295 152 1.097 .069 .413 .546 295 152 1.222 .194 .067 .152 201 Table C.10 Sampling errors, Coast~ Tanzania 1991/92 Variable Number of cases Standard Design Relative Confidence limits Value error Unweighted Weighted effect error (R) (SE) (N) (WN) (DEBT) (SE/R) R-2SE R+2SE URBRUR SECOND CURMAR AGEM20 SEX18 PREGNT EVBORN EVB40 SURVIV KMETHO KMDMET KSRCE EVUSE CUSE CUMODE CUPILL CUIUD CUSTER CUCOND CUPABS PSOURC NOMORE DELAY IDEAL TETANU MEDELI DIARR 1 DIARR2 ORSTRE MEDTRE HCARD BCG DVF3 POL3 MEASLE FULLIM WGTAGE HGTLNG WGTLNG .428 .025 2271 1988 .078 .010 2271 1988 .632 .012 2271 1988 .665 .014 1716 1507 .625 .016 1715 1507 .132 .010 1425 1256 3.033 .066 2271 1988 6.843 .174 355 307 2.488 .060 2271 1988 .877 .014 1425 1256 .869 .014 1425 1256 .825 .014 1425 1256 .352 .017 1425 1256 .131 .012 1425 1256 .072 .011 1425 1256 .042 .008 1425 1256 .002 .000 1425 1256 .012 .002 1425 1256 .011 .003 1425 1256 .013 .004 1425 1256 .785 .037 153 134 .230 .013 1425 1256 .415 .017 1425 1256 5.928 .105 2111 1855 .903 .011 1818 1604 .587 .029 1818 1604 .156 .009 1612 1405 .044 .005 1612 1405 .584 .046 260 219 .644 .050 260 219 .759 .031 358 309 .950 .022 358 309 .832 .023 358 309 .813 .027 358 309 .833 .023 358 309 .753 .032 358 309 .308 .018 1317 1171 .470 .022 1317 1171 .088 .010 1317 1171 2.406 .058 .378 .478 1.857 .134 .057 .099 1.163 .019 .609 .656 1.225 .021 .637 .693 1.348 .025 .594 .657 1.141 .077 .112 .153 1.033 .022 2.902 3.165 1.038 .025 6.494 7.192 1.137 .024 2.367 2.609 1.551 .015 .850 .904 1.540 .016 .842 .897 1.413 .017 .797 .854 1.371 .049 .317 .386 1.399 .096 .106 .156 1.550 .148 .051 .093 1.539 .195 .026 .058 .000 .000 .002 .002 .832 .197 .007 .017 .952 .243 .005 .016 1.196 .280 .006 .020 1.104 .047 .711 .859 1.197 .058 .203 .256 1.337 .042 .380 .449 1.714 .018 5.717 6.138 1.351 .012 .881 .925 2.057 .049 .529 .645 1.021 .060 .137 .175 .931 .108 .035 .054 1.439 .079 .492 .677 1.594 .077 .545 .743 1.310 .040 .698 .820 1.733 .023 .907 .993 1.133 .028 .786 .879 1.264 .033 .759 .867 1.129 .028 .786 .879 1.361 .043 .688 .817 1.354 .058 .272 .343 1.543 .047 .425 .514 1.239 .110 .069 .108 202 Table C.11 Sampling errors I Nortbem Highlands, Tanzania 1991/92 Number of cases Variable Stand~d Value error (R) (SE) Design Relative Confidence limits Unweighted Weighted effect error (N) (WN) (DEFT) (SE/R) R-2SE R+2SE URBRUR SECOND CURMAR AGEM20 SEX18 PREGNT EVBORN EVB40 SURVIV KMETHO KMDMET KSRCE EVUSE CUSE CUMODE CUPILL CUIUD CUSTER CUCOND CUPABS PSOURC NOMORE DELAY IDEAL TETANU MEDELI DIARR1 DIARR2 ORSTRE MEDTRE HCARD BCG DPT3 POL3 MEASLE FULLIM WGTAGE HGTLNG WGTLNG .275 .099 .123 .035 .558 .045 .490 .023 .440 .027 .113 .013 2.908 .154 7.289 .309 2.651 .140 .806 .028 .777 .035 .735 .034 .507 .028 .240 .022 ,178 .020 .080 .021 .025 .007 .048 .009 .021 .007 .017 .006 .616 .039 ,321 .028 .398 .035 4,839 .176 .828 .025 .615 .051 .182 .024 .064 ,013 .557 .058 ,418 .063 .728 .054 .960 .033 .833 .049 .775 .065 .795 .038 .707 .059 .279 .018 .393 .024 .056 .010 805 1090 6,297 .360 .077 .474 805 1090 3.017 .284 .053 .193 805 1090 2.571 .081 .468 .648 637 861 1,164 .047 .444 .536 637 861 1.371 .061 .386 .494 472 608 .876 .113 .088 .139 805 1090 1.471 .053 2.599 3.217 125 151 1.250 .042 6.671 7.907 805 1090 1.454 .053 2.372 2.931 472 608 1.538 .035 .749 .862 472 608 1.829 .045 .707 .847 472 608 1.689 .047 .666 .803 472 608 1.202 .055 .452 .563 472 608 1.115 .091 .196 .284 472 608 1.136 .112 .138 ,218 472 608 1,672 .262 .038 .122 472 608 .978 .284 .Oll .039 472 608 .899 .185 .030 .066 472 608 1.123 .357 .006 .035 472 608 1.001 .348 .005 .029 102 144 .803 .063 .538 .694 472 608 1.318 .088 .265 .378 472 608 1.561 .088 .328 ,469 760 1026 2.471 .036 4.487 5.192 672 902 1.471 .030 .779 ,878 672 902 2.186 .082 .514 .716 628 852 1.511 .132 .134 .230 628 852 1.333 .207 .038 .091 92 155 1.169 .103 .442 .672 92 155 1.300 .150 .292 .543 144 203 1.477 .074 ,620 .836 144 203 2.020 .034 .895 1.025 144 203 1.534 .059 .735 .931 144 203 1.841 .084 ,645 .905 144 203 1,103 ,048 .719 .871 144 203 1.547 .083 .589 .825 516 687 .849 .065 .243 .315 516 687 1.096 .062 .344 .442 516 687 .991 .187 .035 .077 203 Table C.12 Sampling errors r Lake r Tanzania 1991/92 Variable Number of cases Standard Design Relative Confidence limits Value error Unweighted Weighted effect error (R) (SE) (N) (WN) (DEBT) (SE/R) R-2SE R+2SE URBRUR SECOND CURMAR AGEM20 SEX18 PREGNT EVBORN EVB40 SURVIV KMETHO KMDMET KSRCE EVUSE CUSE CUMODE CUPILL CUIUD CUSTER CUCOND CUPABS PSOURC NOMORE DELAY IDEAL TETANU MEDELI DIARR1 DIARR2 ORSTRE MEDTRE HCARD BCG DPT3 POL3 MEASLE FULLIM WGTAGE HGTLNG WGTLNG • 142 .030 .029 .010 .673 .011 .730 .019 • 722 •023 .154 .007 3.153 ,062 7•305 •188 2.602 .047 .741 ,020 .702 .020 • 613 ,023 .158 .016 • 059 .008 .026 .004 .009 .002 .000 .000 .013 .003 .002 •000 • 020 .006 .740 .068 .181 .010 .411 .012 6•665 .104 • 909 .009 .439 •031 .084 .007 ,038 .005 .482 .039 .546 .038 .785 .027 .935 ,016 • 716 .030 ,696 •030 • 746 •025 .624 .031 .235 •013 .410 .013 ,050 .005 3089 3116 4,802 .213 •081 .202 3089 3116 3,257 .340 .009 .048 3089 3116 1,250 .016 ,652 .694 2275 2304 2.076 .026 .692 .769 2274 2302 2.493 .032 .675 .769 2098 2096 .874 .045 ,141 .168 3089 3116 1.095 .020 3.030 3,276 439 428 1.245 .026 6.930 7.681 3089 3116 .991 ,018 2.509 2.695 2098 2096 2.065 .027 ,702 .781 2098 2096 2.043 .029 .661 .743 2098 2096 2.137 ,037 .567 .658 2098 2096 2.038 .103 .126 .191 2098 2096 1.641 ,143 .042 .076 2098 2096 1,271 ,170 .017 .035 2098 2096 1.076 .245 .005 .014 2098 2096 .000 .000 .000 .000 2098 2096 1.356 .262 .006 .019 2098 2096 .000 .000 .002 .002 2098 2096 1.863 .287 .008 •031 78 77 1,369 .093 .603 .876 2098 2096 1.134 .053 .162 .200 2098 2096 1.153 .030 .386 .436 2534 2547 2.004 .016 6.458 6.873 2912 2905 1.544 .010 .891 .928 2912 2905 2.733 .070 .377 .500 2567 2564 1.205 .079 .071 .097 2567 2564 1•330 •134 .028 .048 226 216 1.127 .081 .404 ,560 226 216 1.113 .070 .469 .623 546 548 1.548 .035 .730 .839 546 548 1.462 .017 .904 .967 546 548 1.540 .042 .655 .776 546 548 1.478 .042 .637 .755 546 548 1.340 .034 .695 .797 546 548 1.464 .049 .563 ,686 2237 2224 1,429 .057 .208 .261 2237 2224 1.141 .031 .385 .436 2237 2224 1.123 .103 .040 .061 204 Table C.13 Sampling errors T Central I Tanzania 1991/92 Number of cases Variable Standard Design Relative Confidence limits Value error Unweighted Weighted effect error (R) (SE) (N) (WN) (DEFT) (SE/R) R-2SE R+2SE URBRUR .347 ,207 750 1004 11.923 .597 -.068 .762 SECOND .035 .011 750 1004 1.659 .320 .013 .057 CURMAR .632 .024 750 1004 1.381 .038 .584 .681 AGEM20 .613 .022 566 769 1.063 .036 .570 .657 SEX18 .705 .023 566 769 1.191 .032 .659 .751 PREONT .101 .013 465 635 .963 .134 .074 .128 EVBORN 3.157 .082 750 1004 .749 .026 2.993 3,320 EVB40 6.161 .310 146 182 1,112 .050 5.541 6.781 SURVIV 2.530 .070 750 1004 .777 .028 2.391 2.670 KMETHO .924 .032 465 635 2.574 .034 .860 .987 K/vlDMET .906 .037 465 635 2.771 .041 .831 .981 KSRCE .853 .047 465 635 2.861 .055 .759 .947 EVUSE .280 .069 465 635 3.332 .248 .141 .419 CUSE .110 .026 465 635 1.785 .236 .058 .161 CUMODE .090 .027 465 635 2.033 .300 .036 .144 CUPILL .056 .015 465 635 1.417 .269 .026 .087 CUIUD .003 .003 465 635 1,147 1.022 -.003 .008 CUSTER .004 .003 465 635 1.077 .772 -.002 .011 CUCOND .016 .007 465 635 1.166 .428 .002 .029 CUPABS .008 .004 465 635 1.042 .544 -.001 .016 PSOURC .792 .052 36 82 .762 .066 .687 .897 NOMORE .243 .035 465 635 1.782 .146 .172 .313 DELAY .478 .029 465 635 1.267 .061 .419 .537 IDEAL 6.347 .149 686 931 1.499 .023 6.049 6.644 TETANU .906 .020 696 929 1.596 .022 .866 .946 MEDELI .577 .113 696 929 5.023 .196 .351 .802 DIARR1 .183 .021 623 814 1.360 .114 .141 .225 DIARR2 .040 .007 623 814 .946 .185 .025 .055 ORSTRE .582 .065 117 149 1.332 .111 .453 .711 MEDTRE .647 .067 117 149 1.438 .103 .513 .781 HCARD .875 .016 144 180 .576 .019 .842 .908 BCG .964 .021 144 180 1.339 .022 .922 1.007 DPT3 .835 .038 144 180 1.196 .046 .759 .912 POL3 .836 .039 144 180 1.229 .047 .757 .914 MEASLE .878 .055 144 180 1.945 .062 .769 .988 FULLIM .795 .049 144 180 1.415 .062 .696 .894 WGTAGE .358 .030 548 716 1.352 .083 .299 .417 HGTLNG ,524 .047 548 716 2,143 .090 .430 .619 WGTLNG .040 .014 548 716 1.623 .340 .013 .067 205 Table C.14 Sampling errors, Southern Highlands, Tanzania 1991/92 Number of cases Standard Design Relative Confidence limits Value error Unweighted Weighted effect error Variable (R) (SE) (N) (WN) (DEFT) (SE/R) R-2SE R+2SE URBRUR .161 .042 1178 1141 3.912 .261 .077 .244 SECOND .018 .011 1178 1141 2.753 .597 -.003 .039 CURMAR .726 .021 1178 1141 1.645 .029 .683 .769 AGEM20 .671 .031 938 922 1.998 .046 .609 .732 SEX18 .590 .029 937 922 1.835 .050 .531 .649 PREGNT .138 .006 857 829 .512 .044 .125 .150 EVBORN 3.223 .127 1178 1141 1.570 .040 2.968 3.478 EVB40 7.116 .228 166 155 1.160 .032 6.660 7.572 SURVIV 2.675 .103 1178 1141 1.539 .039 2.469 2.881 KMETHO .687 .027 857 829 1.727 .040 .633 .742 KMDMET .656 .024 857 829 1.475 .037 .608 .704 KSRCE .630 .027 857 829 1.621 .042 .577 .684 EVUSE .213 .028 857 829 2.020 .133 .157 .270 CUSE .105 .019 857 829 1.769 .177 .068 .142 CUMODE .067 .018 857 829 2.151 .274 .030 .104 CUPILL .044 .015 857 829 2.198 .352 .013 .074 CUIUD .007 .004 857 829 1.509 .600 -.001 .016 CUSTER .013 .004 857 829 1.151 .343 .004 .022 CUCOND .001 .000 857 829 .000 .000 .001 .001 CUPABS .010 .004 857 829 1.320 .454 .001 .019 PSOURC .819 .069 56 70 1.320 .084 .682 .956 NOMORE .177 .011 857 829 .819 .060 .I55 .198 DELAY .429 .019 857 829 1.095 .043 .392 .466 IDEAL 5.764 .117 826 807 1.543 .020 5.530 5.999 TETANU .906 .011 1098 1039 1.023 .012 .885 .927 MEDELI .503 .028 1098 1039 1.586 .056 .446 .559 DIARR1 .131 .015 1010 953 1.348 .112 .101 .160 DIARR2 .042 .009 1010 953 1.399 .211 .024 .059 ORSTRE .695 .046 139 124 1.107 .066 .603 .787 MEDTRE .728 .045 139 124 1.141 .062 .637 .819 HCARD .723 .043 247 237 1.468 .059 .638 .808 BCG .975 .016 247 237 1.637 .017 .943 1.008 DPT3 .820 .039 247 237 1.596 .048 .741 .898 POL3 .756 .037 247 237 1.335 .049 .683 .830 MEASLE .852 .023 247 237 1.015 .027 .806 .898 FULLIM .716 .038 247 237 1.302 .053 .640 .791 WGTAGE .302 .022 825 787 1.280 .072 .258 .346 HGTLNG .549 .025 825 787 1.368 .046 .499 .599 WGTLNG .042 .011 825 787 1.556 .261 .020 .064 206 Table C.15 Sampling errors t South, Tanzania 1991/92 Variable Standard Value error (R) (SE) Number of cases Design Relative Confidence limits Unweighted Weighted effect error (N) (WN) (DEFT) (SE/R) R-2SE R+2SE URBRUR SECOND CURMAR AGEM20 SEX18 PREGNT EVBORN EVB40 SURVIV KMETHO KMDMET KSRCE EVUSE CUSE CUMODE CUPILL CUIUD CUSTER CUCOND CUPABS PSOURC NOMORE DELAY IDEAL TETANU MEDELI DIARR 1 DIARR2 ORSTRE MEDTRE HCARD BCG DPT3 POL3 MEASLE FULLIM WGTAGE HGTLNG WGTLNG .190 .034 .010 .004 .683 .019 .755 .019 .707 .018 .124 ,014 3.132 .088 6,444 .199 2.507 .067 .886 .011 .868 .010 .748 .018 .186 .017 .065 .009 .048 .007 .018 .004 .000 .000 .023 .006 .003 .002 .001 .001 .647 .077 .215 .019 .374 .024 5.883 .141 .927 .010 .669 .026 .124 .013 .039 .008 .628 .047 .641 .052 .874 .026 .981 .010 .914 .038 ,904 .039 .893 .031 .848 .042 .366 .025 .597 .023 .056 .007 1145 899 2,891 .177 .123 .257 1145 899 1.334 .385 .002 .018 1145 899 1.350 .027 .646 .720 877 692 1,292 .025 .717 .792 877 692 1.169 .025 .671 .743 774 614 1.191 .114 .096 .152 1145 899 .996 .028 2.956 3.309 225 187 .928 .031 6.045 6.843 1145 899 .931 .027 2.373 2,641 774 614 .979 .013 .864 .908 774 614 .828 .012 .848 .889 774 614 1.162 .024 .712 .784 774 614 1.229 .092 .152 .221 774 614 1.056 .144 ,047 .084 774 614 .939 .150 .034 .062 774 614 .922 .243 .009 .027 774 614 .0o0 .(300 .0o0 .13o0 774 614 1.108 .260 .011 .035 774 614 1.025 .726 -.0Ol .006 774 614 .970 1,007 -.0Ol .004 52 39 1.144 .118 .494 .800 774 614 1,298 .089 .176 .253 774 614 1.399 .065 .325 .422 104o 811 1,659 .024 5,600 6,165 866 657 1.007 .011 .906 .947 866 657 1.391 .039 .617 .721 769 586 1.062 .105 .098 .150 769 586 1.179 .213 .022 .056 100 73 .916 .075 .534 .723 10o 73 1.013 .081 .537 .745 178 140 1.049 .030 .822 .927 178 140 1.020 .011 .961 1.0o2 178 140 1.80o .o41 .838 .990 178 140 1.775 .043 .825 .982 178 140 1.329 .035 .831 .955 178 140 1.566 .050 .764 .933 668 509 1.307 .069 .315 .417 668 509 1.197 .039 .550 .644 668 509 .742 .119 .042 .069 207 APPENDIX D DATA QUALITY TABLES APPENDIX D DATA QUALITY TABLES Table D.1 Household age distribution Single-year age distribution of the de facto househoM population by sex (weighted), Tanzania 1991/92 Males Females Males Females Age Number Percent Number Percent Age Number Percent Number Percent 0 857 4.0 842 3.8 36 154 0.7 204 0.9 1 831 3.9 764 3.4 37 141 0.7 168 0.8 2 744 3.5 688 3.1 38 158 0.7 228 1.0 3 676 3.2 745 3.3 39 112 0.5 145 0.7 4 750 3.5 731 3.3 40 299 1.4 227 1.0 5 686 3.2 634 2.8 41 95 0.4 144 0.6 6 728 3.4 703 3.2 42 163 0.8 143 0.6 7 668 3.2 660 3.0 43 116 0.5 127 0.6 8 617 2.9 711 3.2 44 72 0.3 86 0.4 9 595 2.8 591 2.7 45 199 0.9 218 1.0 10 641 3.0 646 2.9 46 114 0.5 131 0.6 11 553 2.6 524 2.4 47 89 0.4 101 0.5 12 615 2.9 621 2.8 48 126 0.6 147 0.7 13 652 3.1 666 3.0 49 133 0.6 103 0.5 14 616 2.9 556 2.5 50 198 0.9 176 0.8 15 552 2.6 425 1.9 51 88 0.4 146 0.7 16 557 2.6 488 2.2 52 112 0.5 193 0.9 17 460 2.2 411 1.8 53 66 0.3 158 0.7 18 482 2.3 473 2.1 54 92 0.4 145 0.7 19 324 1.5 500 2.2 55 150 0.7 190 0.9 20 421 2.0 512 2.3 56 93 0.4 139 0.6 21 288 1.4 338 1.5 57 93 0.4 96 0.4 22 269 1.3 388 1.7 58 113 0.5 104 0.5 23 255 1.2 381 1.7 59 75 0.4 62 0.3 24 215 1.0 320 1.4 60 162 0.8 222 1.0 25 314 1.5 393 1.8 61 53 0.3 30 0.1 26 266 1.3 304 1.4 62 109 0.5 100 0.4 27 227 1.1 328 1.5 63 75 0.4 61 0.3 28 256 1.2 324 1.5 64 74 0.3 45 0.2 29 194 0.9 304 1.4 65 124 0.6 136 0.6 30 411 1.9 407 1.8 66 37 0.2 44 0.2 31 148 0.7 198 0.9 67 57 0.3 42 0.2 32 244 1.2 252 1.1 68 66 0.3 58 0.3 33 149 0fl 157 0.7 69 69 0.3 40 0.2 34 142 0'.7 191 0.9 70+ 580 2.7 439 2.0 35 261 1.2 267 1.2 Don't know/ Missing 44 0.2 12 0.1 Total 21170 100.0 22257 100.0 Note: The de facto population includes all residents and nonrasidants who slept in the household the night before the interview. 209 Table D.2 Age distlibution of eligible and interviewed women Five-year age distribution of the de facto household population of women aged 10-54, five-year age distribution of interviewed women aged 1549, and percentage of eligible women who were interviewed (weighted), Tanzania 1991/92 Household population of women Interviewed women Age Number Percent Number Percent Percent interviewed (weighted) 10-14 3013 NA NA NA NA 15-19 2297 24.1 2183 23.6 95.0 20-24 1939 20.3 1882 20.4 97.0 25-29 1653 17.3 1599 17.3 96.7 30-34 1206 12.6 1165 12.6 96.6 25-39 1012 10.6 1000 10.8 98.8 40-44 727 7.6 715 7.7 98.4 45-49 701 7.4 695 7.5 99.I 50-54 818 NA NA NA NA 15-49 9536 NA 9238 NA 96.9 Note: The de facto population includes all residents and nonresidents who slept in the household the hight before interview. NA = Not applicable Table D.3 Completeness of reporting Percentage of observations missing information for selected demographic and health questions (weighted), Tanzania 1991/92 Percentage Number missing of Subject Reference group information cases Birth date Births in l~st 15 years Month only 16.7 20502 Month and year 0.5 20502 Age at death Deaths to births in last 15 years 0.2 2983 Age/date at first union a Ever-married women 10.9 6977 Respondent's education All women 0.0 9238 Child's size at birth Births in last 59 months 1.0 4248 Anthropometry 2 Living children age 0-59 months Height missing 7.2 7257 Weight missing 7.1 7257 Height and weight missing 7.5 7257 Diarrhoea in l~st 2 weeks Living children age 0-59 months 4.4 7257 1Both year mad age missing 2Child not measured 210 Table D.4 Births by calendar year since birth Distribution of births by calendar years since birth for living (L), dead (D), and all (T) children, according to reporting completeness, sex ratio at birth, and ratio of births by calendar year, Tanzania 1991/92 Percentage with Sex ratio Number of births complete birth date I at birth 2 Calendar ratio 3 Male Female Year L D T L D T L D T L D T L D T L D T 90 1602 164 1766 97.6 86.2 96.5 95.2 128,4 97.9 781 92 874 821 72 893 89 1424 198 1622 96.1 84,2 94.7 104.5 144.0 108.6 98,0 108.8 99.2 727 117 844 696 81 778 88 1304 200 1504 93.1 85.7 92.1 91.7 145.3 97.4 96.6 95.5 96.4 624 119 742 680 82 762 87 1276 221 1498 91.1 77.4 89.1 106.6 159.4 113.0 101.8 119.5 104.1 659 136 794 618 85 703 86 1205 170 1375 91,6 71.4 89.1 100.3 90.1 99.0 95.1 62.3 89.3 603 80 684 602 89 691 85 1257 324 1580 80.2 69.3 77.9 93.4 78,6 90,1 107.0 154.8 114.2 607 142 749 650 181 831 84 1144 248 1393 77.8 68.2 76.1 103.0 96.2 101.8 95,9 87.4 94.3 581 122 703 564 127 690 83 1131 245 1375 80,2 63.2 77.2 90,3 129.7 96.2 104.8 113.9 106.3 536 138 674 594 106 701 82 1013 181 1194 78.4 63.4 76.1 116.3 126.5 117.8 96.7 82.0 94.1 545 101 646 468 80 548 81 966 196 1162 77.1 58.8 74,0 88.0 110.9 91.5 NA NA NA 452 103 555 514 93 607 86-90 6811 953 7764 94.2 81.0 92.5 99.3 133.0 102,9 NA NA NA 3394 544 3938 3417 409 3826 81-85 5511 1194 6705 78.8 65.2 76.4 97.5 103.3 98.5 NA NA NA2721 607 3328 2790 587 3377 76-80 4336 916 5253 72.6 54,4 69.4 109.7 106.0 109.0 NA NA NA 2268 471 2740 2068 445 2513 71-75 2949 769 3718 68.3 51.2 64,8 104.8 101.5 104.1 NA NA NA 1509 387 1896 1440 381 1821 <71 2484 962 3445 60.2 47.6 56.7 101.0 113.1 104.2 NA NA NA 1248 510 1758 1236 451 1687 All 22091 4794 26885 78.8 60,5 75.6 101.7 110.8 103.3 NA NA NAllI40 2520 13660 10951 2274 13225 NA = Not applicable 1Both year and month of birth given 2(BJBf)* 100, where B= and Br are the numbers of male and female births, respectively 3[2B,/(B,a+B,+I)]* 100, where B, is the nttrnber of births in calendar year x 211 Table D.5 Reporting of age at death in days Distribution of reported deaths under 1 month of age by age at death in days and the percentage of neonatal deaths reported to occur at ages 0-6 days, for five-year periods of birth preceding the survey, Tanzania 1991/92 Number of years preceding the survey Age at death Total (in days) 0-4 5-9 10-14 15-19 0-19 <1 49 54 31 25 160 1 69 58 54 27 208 2 26 36 24 21 108 3 32 21 18 9 80 4 14 7 6 3 31 5 7 12 1 4 24 6 5 3 9 1 18 7 42 39 30 26 138 8 0 8 5 2 16 9 0 5 8 2 15 10 0 8 1 5 14 11 1 1 0 0 2 12 1 2 0 1 4 13 1 0 0 1 2 14 30 15 15 10 69 15 1 4 3 1 8 16 0 0 2 0 2 18 0 1 3 0 4 19 0 1 1 2 3 20 3 1 1 1 6 21 10 7 5 2 24 23 0 1 0 1 2 24 1 0 0 1 1 25 0 0 1 1 2 26 1 0 0 0 1 27 0 0 1 0 1 28 5 7 4 2 18 29 1 1 1 0 4 30 9 23 5 4 41 31+ 4 5 4 1 14 Missing 0 0 0 2 2 % early neonatal 1 65.6 60.4 62.5 59.3 62.3 To~l 0-30 309 317 229 154 1009 1(0-6 days/0-30 days) * 100 212 Table D.6 Reporting of age at death in months Distribution of reported deaths under 2 years of age by age at death in months and the percentage of infant deaths reported to occur at ages under one month, for five-year periods of birth preceding the survey, Tanzania 1991/92 Number of years preceding the survey Age at death Total (in months) 0-4 5-9 10-14 15-19 0-19 <1 a 309 317 229 155 1011 1 43 47 29 19 139 2 41 43 39 32 156 3 43 65 48 34 191 4 39 28 20 11 98 5 24 41 17 20 101 6 40 59 26 47 171 7 40 38 36 15 130 8 28 29 22 20 98 9 48 44 22 18 131 10 12 16 12 7 47 11 19 16 16 10 61 12 22 37 25 46 130 13 12 21 10 5 48 14 11 6 10 7 34 15 10 10 14 6 41 16 3 3 6 7 19 17 2 4 3 7 17 18 14 35 40 30 120 19 3 1 0 0 5 20 3 2 3 1 9 21 2 1 1 2 6 22 1 4 0 0 5 23 2 1 3 1 7 24+ 6 20 10 6 42 1 year 14 21 35 23 92 Tot~ 0-11 687 742 516 389 2333 Percent neonatal b 45.1 42.7 44.4 40.0 43.3 alncludes deaths under 1 month reported in days b(Under 1 month/under 1 year) * 100 213 APPENDIX E QUESTIONNAIRES UNITED REPUBLIC OF TANZANIA BUREAU OF STATISTICS, PLANNING COMMISS ION TANZANIA DEMOGRAPHIC AND HEALTH SURVEY HOUSEHOLD SCHEDULE NAME OF HOUSEHOLD HEAD TDHS CLUSTER ID . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HOUSEHOLD NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . REGION D ISTR ICT WARD ENUMERATION AREA URBAN/RURAL (urban=l, rural=2) . . . . . . . . . . . . . . . . . . . . . . . . LARGE C I tY /SMALL C ITY /~OWN/COUNTR~SIDE . , . . . . . . . . . . . . . ( large clty=l, smal l c lty=2, town 3, countrys ide=4) HOUSEHOLD SELECTED FOR MALE SURVEY (1=YES, 2=NO) INTERVIEWER VISITS m ~ 0 DATE INTERVIEWER'S NAME RESULT* NEXT VIS IT: DATE T IME *RESULT CODES: i COMPLETED 1 2 3 F INAL VISIT DAY ~ - MONTH YEAR ID NO. RESULT RIIItlItlIIIII l i i i i i i i i i i i i ihi iiii i i i i i TOTAL NUMBER OF VIS ITS TOTAL IN HOUSEHOLD TOTAL ELIGIBLE WOMEN TOTAL ELIGIBLE MEN KEYED BY 2 HOUSEHOLD PRESENT BUT NO COMPETENT RESP. AT HOME 3 HOUSEHOLD ABSENT 4 POSTPONED 5 REFUSED 6 DWELL ING VACANT OR ADDRESS NOT A DWELLING 7 DWELL ING DESTROYED 8 DWELL ING NOT FOUND 9 OTHER (SPECIFY) 217 HOUSEHOLD SCMEOULE: N~ ~ .o~.~td Like o~ Imfo~t l~ ~ t the peop le who ~ l ly a lva In ~P hu+ho ld or who * re mtmyl~ u l th ~ ~. {1) 01 02 O] O4 OS 07 O8 10 o++.+++F+, , +LTL I+,++, ,o.++o+ . - , - i .+ i + , - , , HOUSEHOLD IF AGED 5 YEARS 131 OLDER ~I31'IEM I MEN P le l l l give I l l the ~hlt 11 the in Dc~.l Old Ha old 1411 ~at ( i IF I I IF ALIVI~ 11 IF ALIVE CIRCLE CIRCLE r~ l of the p41rlol~l r'41111tiormhIp (MARIE) (II4RE) (WUqE) I i [NAME) the hlghell AGED (MALqE)III (N~) ' I - - LIME LIME Who ~t ly l ive In +f (NSUqE) to a le ~t t mte4~ (NN4E)? ~er fo~t LESS Pdlturlt DO%~ll f t l tut 'e l l DO~I NUHaER ~[11 ymr houl~-hotd or are the heKI i or Live hera t~ mchmt THAN lather (MAIqE)'I father (NNqE)*I OF kUqEM )F MEN stayi~ll u l th ~ ~o +f the i f - i , hire? t i l t to (N~) 2S &levi? P, i lturel i l l Ivt? r~llturllt ELIGIBLE !LIGIIILI stertir~R With the +~otd?* I ' night? i Ih~ l? ©(Ipleted? YEARS rather father FOR F09 hel+d of the h~ehotd * - - L l~ In Live in 114DI- [MoI- ! th l l thlo V]~AL VKDqJAI_ I i h~e* h~e- ISLES- [lITER- I hold? hold? VIEW VIEW ]1 IF YES: IF YES; (M/~RE) ~lhat I I Uh l t ~I melt& In her r~? h l l m? acho~[ ? RECORD RECTO NOTHEIleS FATHER*S LINE LIME NLJI4BER*** NUMBER*'** (2) ' IS) m l t G ) (S) m, (6 ) (7) , (O) (9) r - - , (10) (11) - - (12) (13) - - ( I / " ) , (15) , (16) N F YES ~ YES ~ IN YEAAS fES [ - -~ t ' ' E ~- - ] ' M mh,m~ m ~ : • m m ~ m m J ~ m ~ m m I m 2 + +VF~ + n- l I l P - - - - - - I I I l i I I I I I T l , + . . ~_.F-l-l, +, r-i-] + , + M-F - I ,+ F-l-I ~--~ I l - - l - - I I YES KiD YES NO DK 2 2 a i - - 2 2 0 i - - 2 2 S i - - 2 2 8 | 2 0 ! 2 8 ! 2 0 ! Z 8 ! Z 8 ! 2 2 0 M M M rA M V~ M YES 140 OK E S 2 E 2 8 2 8 2 E 2 8 2 8 2 8 2 8 1 2 8 [ - -~ m O1 O1 [ ~ 03 03 | | | | I | | | --~ 07 07 ! I ~-~ 09 09 ' 09 I 09 H('XJSEH(~lO SCHEDULE CONTIk~JEO 11 12 I'__ ~ ! 14 15 16 '17 18 N F tEl IKI fEB k~ IN TEARS iTES IJO YES 140 YES NO DR 2 2 2 ! Z 2 1 2 8 • u i ~ i ~-~. ,. , . , , .~-~, , . ~-~. 2. , ,G ~-~ 2 2 2 ~ 1 Z 1 2 8 , . . . . 1 .~-~. ' . ~'~ . ' 2 Z 2 1 Z Z 1 2 O YES DO DK 2 8 h, • 2 8 2 G 2 8 2 8 i, I 2 0 TICK HERE IF CONTIMJATION SHEET USED [~ TOTAL DLI~ER OF ELIGIBLE: LIDE HUMBER OF RESPONOENT TO ilOUSEK(X.D SCHEDULE: Just to mnke sure thee I hevl • cmq)tete | l | t |nD: 1) Are there any other perlonR much Is met children or Infants that v4 hive ~0t I|•tw:r/ 2) In mddltton, ore there any other peQpte •he amy not be mrs of yct~- famity such •• domestic •ervMlt•. Io~er• or frteflcM t~to Nt |y Ll'**t here? 3) DO you hive amy ~t | or tmrary v i i | to re stayl~s here. i here. or anyone erie uho i t~t here Lest night? i meN • CCOE$ F(3~ B.3 RELATIONSHIP TO }rEAD OF K~USEHOLD: DI= READ 03a GRANDCHILD 09g OTHER RELATSVE 02= ~IFE OR HUSBANO 06= PARENT 10= ADOPTEDIF(]STER CI~ILD O$" SON (X~ DAUGHTER D?u PAJtENT'IN*LAU 11" NOT RELATED 0~- $ON (}4 DAUGHIER*|N-LAM Oaa IRXITHEE of liStED ~ DE YES [~ • ENTER EACN lfl TABLE YES ~-~ • ENTER EACfl IN TABLE YES ~ • ENTER EACH IN TABLE ** COOES FOR Q.9 HIGHEST FGtJ4AL SCitOGL: | 11 11 i i • , , ~ • 12 12 14 14 J • -~ 15 15 n ~ ~ - ] 16 16 n, • • tT 17 ~ B NED m ~ i D " ' * QU[STI0US 12 ~ |&: NECOIIO ~001 IF TRD IIATURAL (IIOL(XilGt, L) PARENT IS DOT A I(NIED Of THE I(OJSEI~t.D. 00- LESS THAN 1 TEAR COMPLETED 01" STANDARD1 OS" STANDARDS ~ FORM1 13- FORIq~ GEl STANOAROZ O6,. $TA~AR06 10- FORM2 IA- Fq~'tJq6 03- STANOARD) OTu ITANOARD7 11- FORK3 15- UNIV1ERSITT 0Am STANOARDLt 08 m STANOARDG 12- FOR~ 98,, C~IdT iCl,~ ~. QUESTIONS AJI] FILTERS 17 Whir I i the source of ~ter your household u=~ for h l i '~ lh lng Ind d I lhw l lh lngY ~TIP C~)ING C,tAEC.CI~IES J TO I P I~O INTO ~'~/YARO/PLOT . . . . . 11 - - - - - - -18 PUBLIC TAP . . . . . . . . . . . . . . . . . . . . . 12 | ~ELL IN RE$[DENC]E/YAJLD/PLOT,,.21. >18 P~J6LIC~IELL . . . . . . . . . . . . . . . . . . . . 22 I SPRING . . . . . . . . . . . . . . . . . . . . . . . . . 31 I RIV~R/$TREN4 . . . . . . . . . . . . . . . . . . . ~. PO~D/LAI:E . . . . . . . . . . . . . . . . . . . . . . 33 RAiN tATER . . . . . . . . . . . . . . . . . . . . . 61~18 TAN[ER TRUC.[ . . . . . . . . . . . . . . . . . . . $1 I OTHER 71 I (SPECIFY) "1 I . . I I ,' 19 Does ymae ho~eho id get d r i r~ lng ~ter YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 - ->21 f ron th i s same source? J 20 What i s the so~rce of d r ink ing ~ter fo r mushers of your househoL~ I PIPED INTO NOU~*E/Y~O/PLOT . . . . . 11 - ->ZI PUBLIC TAP . . . . . . . . . . . . . . . . . . . . . 12 I ~,/ELL IM RESIDENCE~YARD/PLOT. . .21--)21 PUeL I C ~IELL . . . . . . . . . . . . . . . . . . . . 22. | SPRING . . . . . . . . . . . . . . . . . . . . . . . . . 31 I R 1VER/STRFJU4 . . . . . . . . . . . . . . . . . . . 32 P~D/LAJ~E . . . . . . . . . . . . . . . . . . . . . . 33 DAJ4 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34 RAIN WATER . . . . . . . . . . . . . . . . . . . . . 61- ->21 TANKER T liMX:K . . . . . . . . . . . . . . . . . . . 51 J OTHER 71 I (SPECIFY) I 21 NOv (ong does i t take to 9o there, get ra ter , | N]NUTES . . . . . . . . . . . . . . . . . I I I I and ccme b~ck? I [ J I I Old PREKIS~$ . . . . . . . . . . . . . . . . . . . °1 ° I ° ° . . . . . I E lec t r i c i ty? ELECTRICITY . . . . . . . . . . . . . . . . 1 2 A rKl(O? RADIO . . . . . . . . . . . . . . . . . . . . . . 1 2 A te |evt | Jon? TELEVISIO~ . . . . . . . . . . . . . . . . . 1 2 A re f r lger l to r? REFRICAERATOR . . . . . . . . . . . . . . . 1 2 Now ~ rooms in your hc~sehotd i re used fo r s leeping? ROOMS . . . . . . . . . ~ I L I I 2A 25 26 MAIN NATERIAL OF THE FLOGt. DOtS any member of your ho~sehotd o~n: A b icyc le? A motorcy¢(e? A car? EARTH/S.~O . . . . . . . . . . . . . . . . . . . . . 11 PLANKS . . . . . . . . . 21 PAR~JET Ca POLISHED k~O . . . . . . . 31 • CERAMIC TILES . . . . . . . . . . . . . . . . . . 32 CEMENT . . . . . . . . 33 OTHER 61 (SPECIFY) YES NO BICYCLE . . . . . . . . . . . . . . . . . . . . 1 2 N~TORCYCLE . . . . . . . . . . . . . . . . . 1 2 CAR . . . . . . . . . . . . . . . . . . . . . . . . 1 2 220 UNITED REPUBL IC OF TANZANIA BUREAU OF STAT IST ICS . PLANNING COMMISSION TANZANIA DEMOGRAPHIC AND HEALTH SURVEY INDIV IDU~TIONNAIRE NAME OF HOUSEHOLD HEAD TDHS CLUSTER ID HOUSEHOLD NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . REGION D ISTR ICT WARD ENUMERATION AREA URBAN/RURAL (urban=l, rural=2) . . . . . . . . . . . . . . . . . . . . . . . . LARGE C ITY /SMALL C ITY /TOWN/COUNTRYSIDE . . . . . . . ~ . . . . . . . . . . . . . ( large city=l, smal l city=2, town=3, countrys lde=4) NAME AND LINE NUMBER OF FEMALE RESPONDENT NAME AND LINE NUMBER OF HUSBAND INTERVIEWER V IS ITS DATE INT~VIEW~'SNAME RESET* NEXT VISIT: DATE T IME 1 F INAL V IS IT 2 3 !!!!!!!!I~!!!!!!!!!!!!!! !!!!!!!!I~!!!!!!!!!!!!!! MONTH YEAR ID NO. RESULT TOTAL NUMBER OF V IS ITS *RESULT CODES: 1 COMPLETED 2 NOT AT HOME 3 POSTPONED 4 REFUSED 5 PARTLY COMPLETED 6 OTHER NAME DATE (SPECIFY) KEYED BY 221 $ECTZOll 1. II~S~CIIKIT'S IAC~C,~JI~ SICIP ilK). | QUESTIONS AMO FILTERS TO i 101 I ItECl~tD THE TINE. I I 10z I F i rs t i bc~Ld Like to esk some ~/.~stlons ~ y~r I t~ckgrc~nd. For ,met of The t im unt i l you uere 12 years old, d id y~J Live in Oar e~4 Seteam city, another urbaln trsa, or in the rural l re l ? I CODING C~,TEGCI lEE I ~ITY (OAR E$ SA~) . 1 OTHER UIILAJI ARE), . . . . . . . . . . . . . . . . 2 IIUI~L /dl rrJ~ ~ i L LIkG£ . . . . . . . . . . . . . . 3 VZSZTOt . . . . . . . . . . . . . . . . . . . . . . . . . ~1C5 I I . ' l SaLaam c i ty , Imother ur iah area, or in th l rural area? OTHER UItBAN AREA . . . . . . . . . . . . . . . . 2 EURAL AREA,~I LLA~ . . . . . . . . . . . . . . 3 I)1( ~TS . . . . . . . . . . . . . . . . . . . . . . . 96 r)i( YEAJI . . . . . . . . . . . . . . . . . . . . . . . . 98 106 I HOW old ~re you st your Lnt b i r th~y? AGE ZN C~IPLETED YE~S . . . . . ~-~ I CCI4PAAE AM~ CC~RECT 105 ~JW/GR 1~ [ f INCC~qSISTEWT. 107 I Can you reed ~d wr i te k i su~i tL l EASILY . . . . . . . . . . . . . . . . . . . . . . . . . . 1 I eas i ly , u i th d i f f i cu l ty , or hot at ILL? ViTH OIFFiCULT¥ . . . . . . . . . . . . . . . . . 2 IK3T AT ALL . . . . . . . . . . . . . . . . . . . . . . ~-~-~109 109 I Have you ever littende~L schooL? I YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 I I SO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Z- - - -~l lT 110 Uhet Is the hiRhest for'niL school you completed? LESS TUN 1 YEAR . . . . . . . . . . . . . . . O0 STANONtD1 . . . . . . . . . . . . . . . . . . . . . . 01 STAIK)AItD2 . . . . . . . . . . . . . . . . . . . . . . 02 STANDHED3 . . . . . . . . . . . . . . . . . . . . . . 03 STANON(D4 . . . . . . . . . . . . . . . . . . . . . . 04 STA~AIWS . . . . . . . . . . . . . . . . . . . . . . GS STA~ARD6 . . . . . . . . . . . . . . . . . . . . . . G6 STANOAID7 . . . . . . . . . . . . . . . . . . . . . . 07" STAN~AJ~8 . . . . . . . . . . . . . . . . . . . . . . 08 TOP.N1 . . . . . . . . . . . . . . . . . . . . . . . . . . 09 FCtJ42 . . . . . . . . . . . . . . . . . . . . . . . . . . 10 F~I(3 . . . . . . . . . . . . . . . . . . . . . . . . . . I1 F (~ . . . . . . . . . . . . . . . . . . . . . . . . . . 12 FCt~ . . . . . . . . . . . . . . . . . . . . . . . . . . 13 FCRN6 . . . . . . . . . . . . . . . . . . . . . . . . . . l& UIIIV£RS] Ty . . . . . . . . . . . . . . . . . . . . . 15 OTHER 16 (SPECIFY) 222 NO" I OUESTICmS ARO FILTERS I 111 I Ooy~.u* i Iy ( ( . te~toa rK l tos t Lmtmce. ~e~? I I I I SSIP COOING CATEGOIIIES ~ TO i i I . . . . . ° . . ,oH.* . . . . . o.°**.*°*~ I I 112 Do y~ ~su~Ity vetch te Iev is |o~ et Ieest once o vze~l(T i YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 I I NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . E 113 t~st Is yc~r re l ig ion? N(~LEN . . . . . . . . . . . . . . . . . . . . . . . . . . 1 ~THOLIC . . . . . . . . . . . . . . . . . . . . . . . . 2 PtOTESTAJIT . . . . . . . . . . . . . . . . . . . . . . 3 R~qE . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 OTHER S (SPECIFY) ~14 m 11S To ~ ich t r ibe do you~etor~? IF NOT A TAREANZAR CITIZEN, RECORD COURTRT OF CITIZENSHIP° I 116 | Mo~ I ~ ld t i ke to ask ab~JT the place in which I you ~u~tty t i re . 0o yc~ L~,,,~LLy I | ve In Der es $1 I l l ¢ i~ . another uri~4~ i r t l . or In the ru ra l sreaT IF OTHER UIRRJUd AREA: In ~ ich to~ do yo~ [ |vet* CHECK O.5 IN THE I.~dSEHO(.O SCHEDULE: THE RESP~NOENT 1S NOT A THE RESPGID[NT IS A USA.LAL RESIDENT OF THE HH USUAL RESIDENT OR THE HR ? I CITY (OAR [S SALAAM) . . . . . . . . . . . . 1 LARGE URBAN AREA . . . . . . . . . . . . . . . . 2 SZMLt. URSAJ~ AREA . . . . . . . . . . . . . . . . 3 IIIJ~l. ARI[A/V I [.LAGE . . . . . . . . . . . . . . 4* >201 I I 1171 In d~ich r i9{~ is that located? I IF USUAl. RESIDENCE IS OUTSIDE OF TANZMIIA. REC~L~ CCUNTRY OF RESIDENCE. I REG]OIi , F r ] 118 R~ I t~JLd Like to esk yo~ abou': the household in d~lch you us~4ILy Lfve? 1.~at is the sccJrct of ~ater y~Jr household use~ fo r h~ash lng ~ci dlsh~ashlng? PJPSO INTO HOJSS/YAAD/PLOT . . . . . 11 ,120 PUBLIC TAP . . . . . . . . . . . . . . . . . . . . . 12 ~ELL IN RESIDENCE/~ARD/PLOT.21 ,120 PUBLIC t/ELL . . . . . . . . . . . . . . . . . . . . ~R ] NG . . . . . . . . . . . . . . . . . . . . . . . . . 31 RIV~n/ST~EXN . . . . . . . . . . . . . . . . . . . P~O/LA~E . . . . . . . . . . . . . . . . . . . . . . 33 DJQ~ . . . . . . . . . . . . . . .o ,o . . .o . . . . . .~ J~* RA]N VATER . . . . . . . . . . . . . . . . . . . . . &l ,120 T/~KER TRUCK . . . . . . . . . . . . . . . . . . . $1 | OTNER 71 I (SFIECIFY) 119 Roy long does i t tnke to go there, get ra ter , NINUTES . . . . . . . . . . . . . . . . . J J J I and come beck? i i i i Oil PRENI SI[S . . . . . . . . . . . . . . . . . . . 996 I 120 Does your HOUSehold get dr ink ing uater YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 . ,12~ f r~ th i s s~w source? RO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 [ m 0.116 LARGE URSAM AREAS ARE k%/ANZA, AJ~USEA, W~O£~4tO, DQOCZqA, NOSNI, TANGA, IRINGA, KOEYA, TAJSOU ANO ZANZIBAR. SMALL URBAN AREAS ARE ALL OTNER TOIAI$. 223 NO, QUESTIOES ANO F]LTER$ t21 Whet 18 the |ource of drlrdg(iNg g4ter fo r m r s of ymw ~,mehola '? SZZP COOING CATEGORIES ~ TO PIPED INTO HOUS(/YARD/PLOT . . . . . 11-~->J 12] PUBLIC TAP . . . . . . . . . . . . . . . . . . . . . t2 | 1dELL IN RESIDEidCE/YARD/Pt.OT,.Zl ) t~t PCJBL[C UIEt.L . . . . . . . . . . . . . . . . . . . . 22 | S~RING . . . . . . . . . . . . . . . . . . . . . . . . . 31 [ l I VER/RTREA/4 . . . . . . . . . . . . . . . . . . . ~12 POlO/LAKE . . . . . . . . . . . . . . . . . . . . . . 0/~14 . . . . . . . . . . , . . . . . , . . . . . , . . , . .~ HAIR MATER . . . . . . . . . . . . . . . . . . . . . &1-~ 123 ?AJdKER TRUCK . . . . . . . . . . . . . . . . . . . 5~ | OTHER 7'~ I (SPECIFY) I 122 J Hou tCe~g does t t take to go [her* , l e t ~ l~er , NIHUTES . . . . . . . . . . . . . . . . . I I I I I a~d ¢mee beck? ON PRE~I SES . . . . . . . . . . . . . . . . . . . 996 12~ J whir kind of to i le t fac i l i ty ok)is your household hive? O~ FLUSH TOILET . . . . . . . . . . . . . . . 11 I SHARER FLUSH TOILET . . . . . . . . . . . . lZ 1RADIT IO~L PET TOZLET . . . . . . . . . 21 VENTSLATED PET LATHIHE . . . . . . . . . 22 MR FAC Z LI TY/~JEHIF I [LO . . . . . . . . . 31 E lec t r i c i ty7 ELECTEICI TY . . . . . . . . . . . . . . . . 1 2 A rDdio? RADIO . . . . . . . . . . . . . . . . . . . . . . 1 2 A t i l e r1 slonT TELEVISION . . . . . . . . . . . . . . . . . 1 2 A re f r igerator? RE FR [ GER~TOR . . . . . . . . . . . . . . . 1 2 l~J HO~aanyroomJnyc~rho~ehoLd . r . u led for . t tep , rq I? R(X~IS . . . . . . . . . . . . . . . . . . . . . . 126 Could you descrtbe the ~ ln mater ia l of the f lmar [AETH/SN40 . . . . . . . . . . . . . . . . . . . . . 11 of your home? UOCO PLAMKS . . . . . . . . . . . . . . . . . . . . Zl PAEQ~T OR P~ISH[D b~O0 . . . . . . . 31 CERAMIC TILES . . . . . . . . . . . . . . . . . . ~2 CENEM? . . . . . . . . . . . . . . . . . . . . . . . . . OTHER 41 (SPECIFY) A b icyc le? BICYCLE . . . . . . . . . . . . . . . . . . . . 1 l A l int o rcyc le? NOTORCTCLE . . . . . . . . . . . . . . . . . 1 Z A car? CAR . . . . . . . . . . . . . . . . . . . . . . . . 1 Z 224 toO. S~CTIO~ Z. REPBCOUCTICII SXIR CU[STIONS AHO FILTEEE I CCOIHG CATEGORIES I TO I I Ho~ l ~m~JLd t lke to ask ~bout al l the b l r th l y~l have I YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I l h~ during your Life, Have you ~r i l v~ birth? I I I + . ,i given b i r th ~o are r~ l iv ing ~ith you? ilK) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2------>204 203 HOW may sons t i v t with you? I S~S AT HONE . . . . . . . . . . . . . . . And ho~ i r ry da~li~terl Live Math you? I DAUGHTERS AT )lORE . . . . . . . . . . IF HONE REC£L~I) tO0*. 204 00 you have any sons or daughters to ~hol you hive I YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 I glven b i r th ~ho are el lve l~Jt do not Live N|th you? I I IK) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 - ->206 And hou ~ dat~ilhters are mLtve but do not l | v t Mlth yo~J? O~HTERS ELSEWHERE . . . . . . . . IF MC44E RECONO *00'. + +. + _ + . _ I ,+ . baby who c r i~ l or showed any sign of tLfe but RO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 -~2. only survived • fay hours or' days? I 207 : In a l l , ho~ ~ny boys have died? ilOTS OEAD . . . . . . . . . . . . . . . . . . And hm many g i r ts have died? G]BLS DEAD . . . . . . . . . . . . . . . . . 209 210 IF HONE RECORD 'OO'. AHBid[RS TO 203t ;)05, AMO 207, AMD EECOND TOTAL. iF HOME RECOItO '~* . TOTAL . . . . . . . . . . . . . . . . . . . . . . ~-~ CHECK 2" : JLJSt to ~ke lure that I have this rioht: you hive had ir~ TOTAL - - tfwe births ~Jrlhg your l i fe . 15 that correct? VeS ? NO ['--] es~e • CONRtCT ZOl-Zoa AS HtOeSS~T v OH= 2. ~ 1 ONE (:it HONE / BO BIRTNS [~ )22.] BIRTHS ¥ 225 211 Boy [ ~Ld l ike to t lLk to ~ dxxJt e l i of your bLrthl , dlether s t i l t i L iv t or not, s t i r t l rq u l th the f l r l t one you had. REECHO MANES OF ALL TI~ IIETHS IN 212, REGERD TWINS AND TRIPLETS CI ~PARATE LLGES. 212 g{wm to your ( f i r s t , r *x t ) bab~ 213 REC~O SINGLE OR NULTIPLE BIRTH STATUS 216 Zs i l~y or • girt? 215 In uhst mnth a~d yeir ~*s ( NA~E ) ~rn7 PROBE : Vhlt is his/ her birthday? OB: In u h i t l ee l~ We1 he/Ihe b~rnT 216 21? IF ALIVE: Is (NAME) How Bid v a l s t i l t (NAME) st IIiYeT his/her t i l t birthday? EE~D AGE %N ~LETED YEARS 21B IF ALlY/E: l* (NNE) I tvtng with you? 219 lE LESS TWGI 15 YRS. OF AGE: With ~ou ~oes he/the Live? IF 15": CO TO NEXT SIRTN IF DEAD: old t,is he/abe uhen he/she dluf/ IF ul Tit, =, PR¢{~: Now ~ I~thu old was (NAME)? REOi~.D DAIS IF LES3 TIM~ 1 IqoBTN,W~TIS IF LESS TKAN T~O T[AXS, OB TEARS. (NA~) N IN ) ¢~) (N I N IN ) SING.--1 BOY.1 HULT.2 GINL.2 SING*.*1 BOY.1 NULT.2 GIRL.,2 SING.1 BOY. 1 RJLT,.2 GIRL,.2 SING,,.1 BOY.,1 MULT,,,2 GIRL.,2 $1NG.*I NOT,,,1 MUTT.2 GIRL.2 SING.1 BOY.1 MULT,_2 GIRL,.2 SING.1 IOY.,.1 MULT., .2 GIRL**2 14~TN. ~ TEAR. J¢)dTH., ~ YEAR. °. TEAR. QTH. . ~L~ TEAR* . . (--T--1 []] TEAR. MOITN. YEAR.,, YES.,.1 1~3.,.2 v 220 YES,./ NO.*.2 I v 220 YES.,. 1 NO-- o,Z I v TEg.1 NO.*.2 I ¥ 22Q YES--.1 110.2 I v 22O TEE.1 i0 . . . .2 I v 220 TEE.1 ¥ Z20 AGE [u YE~S AGE IN YEARS AGE IN TEARS AGE ig TEARS AGE IX AGE ZV yEARS r-N AGE ]U TEARS YES . . . . . . . 1- (GO TO NEXT BIRTK)~ NO . . . . . . . . 2 YES . . . . . . . 1. (GO TO NEXT EIRTN)~ NO . . . . . . . . 2 TES . . . . . . . I (GO TO NEXT] E]RTH)( NO . . . . . . . . 2 YES . . . . . . . 1 (GO TO NEXT BIRTH)x] NO . . . . . . . . 2 TES . . . . . . . 1 (CO TO NEXT BKRTH)~ NO . . . . . . . . 2 YES . . . . . . . 1 (CO TO NEXT BIATH)~ NO . . . . . . . . 2 YES . . . . . . . 1 (CO TO NEXT gIRTH)(] NO . . . . . . . . 2 FATHER . . . . . . . 1- OTHER RELATK'v~E,.2- GO~(3ME ELS~,3- (CO NEXT SIXTH FATHER . . . . . . . 1 OTHER NELATiV'E***2- T, CMEONE ELSE.3- (GO NEXT BIRTH FATHER . . . . . . . I - OTHER EELAT[VE.,.Z- SO4EONE ELSE.~- (GO NEXT DIRT) FATHER . . . . . . . 1 OTHER ~v RELAT%VE.2 SOMEOIiE ELSE. (CO NEXT I%RTH) FATHER . . . . . . . 1 OTHER 2~v RELATIV1E.2 SCHEOBE ELSE. (GO NEXT EIRTN) FATHER . . . . . . . 1 OTHEg RELAT)VE,.2 COe~EC~E ELSE, (GO NEXT E[ETN} FATHER . . . . . . . 1- OTHER RELATIVE.2- S(~IEONE ELSE.3-- (GO NEXT BERTH BATS't* "~ XONTHS, .2 T~RS.3 DAYS.1 i4CN T ML ,E TEARS.3 DAYS.1 MONTHS.2 TEARS,.3 OATS.1 XCXaT#S.2 TEARS., ,3 BAYS.1 W~TNB.2 TEARS.3 gAYS.--*1 MONTHS.2 YEARS.3 DAYS.1 i~dTHg, ,2 TEARS°.3 226 212 iqvlm to your ( f l r l t . f~xt ) 213 EECORD SIRGL[ OR MULTIPLE giRTH STATUS 21& Is (NA.qE) u t )oy~ I girLY Z15 In d~lt luonth yeir van ( R~aE ) bor~T PR~: her hi r tl,,d~y't 0¢: In ~hit Ii¢~ a | ot*i Mill he/she berr~T 216 I ZlT IF ALIbi: Is (NAME) I Nou old I~ILL I ( I L~) I t , l [v*T I Ms/her List blrzh~y? EECZI~ ACE [N C~PLET~ YEAJE 218 219 i IF ALIME: IF LESS THAM | l (14A~E) 15 YRS. OF AGE: Living i vl th ym~T ~lth ~ la l he/she t I,,1t IF 15+: GO TO NEXT BIRTH 22'O IF ~cAD: NOv otd ual he/~e uh~ I~/sht deed1 IF "1 YR.", ~ : Nov mw~y I~nths Did Yes (k~U~)? HECI3RD DAYS IF LE~ TKAR I W3eITH,W3gT~ iF LESS TKAM TWO YEJUtS, OR yEXRS. COMPARE 208 ~ITH NUMBER Of $1RTH$ IN HiSTQHY ABOV'E AND MARK: NUI4RE HS ~ WJI48EHE AJtE ARE SAME ~ DIFFERENT [ I ) (PH(~E AND RE~CILE) / ¥ CHliCR: FOR EACH LIVE RIETH: YEAR OF BIRTH IS RECCRDED J -~ FOR EACH LIVING CHILD: C~JRREMT AI~ IS RECORDED FOR EACH DEAD CHILD: ACE AT DEATH ZS 2EC(:RDED FOR ACE AT DEATH 12 )KIiITH$: PRi~IE TO DETCRM[NE EXACT HUICJ~R OF 14CIdTHS I CHECIC 2~5 AND ENTER THE k~JI4HEE Of BIRTHS SXNCE JAk~ARY 1~ IF R~/E, EHTER O. O 2~ GO" I CUESTICNS AND FSLTEHS 223 I Are ~ pr t~n~t I I SKIP I CGOING ¢,ATEGOitl|S I 1"0 I1,- . , I ~I~. . . . . . . . . . . • • • • . . ° ° °o . * * ° • ° . . °2 - - -~ UNSURE . . . . . . . . . . . . . . . . . . . . . . . . . . 8 )226 22, I I - , . ml 22~ i At the t|me you i :~¢~ pregnant, d id you w4mt to beccae J THEN . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 I pregnant theft, d id y~J ~t to va i t unt t ( ta ter , I LATER . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 or d id y~ not uanT TO be¢cae laCegrdmt I t I t ( ? HOT AT ALL . . . . . . . . . . . . . . . . . . . . . . 3 226 H~ long ago did your (mst mmstrua( perl M st i f f1 , DA1,S AGO . . . . . . . . . . . . . . . . . 1 WEEKS AGO . . . . . . . . . . . . . . . . 2 HEalTHS AGO . . . . . . . . . . . . . . . 3 1.EARS AGO . . . . . . . . . . . . . . . . & IN m£ NOHAUS£ . . . . . . . . . . . . . . . . . . 9~ SEF~E LJ~ST 8[RTH . . . . . . . . . . . . . 9~ HEVER MEHSTtUAT[D . . . . . . . . . . . . . 996 221--hfr*o-- r h I*ES . 1'__ f i r s t day of her next period, mre there ¢erto in t l~ NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2"---'1 u~en she has a greeter charce of be¢caling ;M'e~natlt DK . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 )501 th~ other t im? | 228 O. r ing which times of the monthly cyC|e doe'8 • have th t greatest chance of beccali~g pregrumt1, OUTING HER PERiCO . . . . . . . . . . . . . . . 1 RIGHT AFTER HER PEH]OD HAS ENDED . . . . . . . . . . . . . . . . . . . . . . 2 ]N THE NIDOLE OF THE C1.CLE . . . . . . 3 JUST i~F(~E HE~ PESiOD HEGIH$,.A OTHEI 5 (SPECIF1,) DS . . . . . . . . . . . . . . . . . . . . ° ° . . ° . . . . . 8 228 ~CTIOI I 3: C~qTILACEPT]CJN 301 l i a r I ~¢"JLd L ike to ta lk elx>ut f ru i ty p lann ing - the ver ic4Js Uy~l o r method l that • co~4Ht can use to de lay or" l~O+d l pregl111~'y, k4hich MIyl Or lletl~x:il hls~l you hear.d ~ ? CIRCLE ~E I iN 302 F~ EACH ~T~ ~MTI~ED ~T~E~LY. THEM PROCEED OOqA4 THE C;~LKq+ READING TME NN4E ANO DESCRLPTZON OF EACH NETE43D MOT NEMTIONED S~NTAMECt~SLT. CIRCLE CODE 2 XF ~T~ IS RECOG.MIZB, ~ ~E 3 I f kGT RECOG~IIZED. THEM, FOA EACH M~THOD VITH CODE 1 OR 2 CIRCLED IN 302+ AS[ 303"]04 8EfCIRE PRCQE~IMG TO THE iQ[XT ~T~. 302 Have you e~r 303 H ive you ever ~.$ Do y~J kno~ ~ere EACH NETHCO. to get (NETHOR+)T READ OESC-qIPTIDN OF 0_~ P iLL Vome~ c~ take a p iLL every day. •J IIJD I/omen ca.~ h ive a Loop or co i l p laced tns i~ them by a 6actor o r • r , J rse . •J lkJECTIOI4S ~c i~n ca~ have I¢t in jec t ion by a doctor , o r ~rae d l i ch s to l~ thm f rom becoming p*'ege'~lw~t fo r severa l ao~ths . •J DIAPHILAC~4,fOAM,JELLY ~oe~ c~ p lace a spooge, suppos i to ry , d ia l~hragm, jeLLy or cre~ in" s ide them before interco~Jrse . ahe l th dur ;ng sex~( In ter - c~se ~0 avo id p r ~ y . The r~k~er sheath i s aLlO used to p revmt t ra l '~ iS l lOq of d i seases |uch aa AIDS and fo r cLe~L i r~sa . F~LE STERIL I~T ioR c~ have ~ o¢>eratio~ to avo(d havL~ ~ ~re ch i ld ren . 71 14LtLE STEf l l L IZA I ION Men can h lye ~n ¢~oerat ion to avo id havLng I~y ~ore ch i ld ren . •j C.ALEMO/dI CcxJpies ca~hawl lex tm| in tercourse on ly dur ing th~ sa fe I>er{od o f the month ly c~r~cLe, that LS the t~m du¢(ng the month ly cyc le v~en the ~ i s Least L ikeLy To tx~ ome pr ngn~t . NL?CUS NET~ A wman can (~bserve da i ly the s t i l e o f the i J¢~ ariel avo id sexua l In terc~J rse a t the t ime ~i~en the euC~al i s coLor iees M~d ext remely e las t i c . 0[ ~ITHDRAWAL M¢~ can be care fu l pu l l out before cL~msx. YES/S~T . . . . . . . . . . . . . . . . . . . 1 TE$/PR~ . . . . . . . . . . . . . . . . . . 2 NO, ¥ g YES/~T . . . . . . . . . . . . . . . . . . . 1 YE~/~ . . . . . ° . ° . . ° . . . . . . ,2 i v YE$/~T . . . . . . . . . . . . . . . . . . . 1 YE$/~D . . . . . . . . . . . . . . . . . . 2 . . . . . . . . . . . . . . . . . • o**°H. .~ v YE~/SPONT . . . . . . . . . . . . . . . . . . . 1 YE$/~OREO . . . . . . . . . . . . . . . . . . 2 v YES/S~ORT . . . . . . . . . . . . . . . . + . .~ YE~/~ORED . . . . . , . . . . . . . . . • . .2 ~. . . , . ° . . . . . . . . . , . . . . . . . . . .~ v YES/~T . . . . . . . . . . . . . . . . . . . 1 YES/PROIBC0 . . . . . . . . . . . . . . . . . . 2 NO . . . . . . . . . . . • . . . . . . . . . . . . . .~- Y YES/SF~IIT . . . . . . . . . . . . . . . . . . . 1 YE$/~D . . . . . . . . . . . . . . . . . . 2 MO. . . . . . . . . . • o*** . . . . . . . . ° **~ ¥ YES/S~T . . . . . . . . . . . . . . . . . . . 1 YES/PRORED . . . . . . . . . . . . . . . . . . 2 . . . . . . • ** . . . . . . . . . , * °** . . .~ / I i , ¥ YES/SP~WT . . . . . . . . . . . . . . . . . . . 1 YES/~ORED . . . . . . . . . . . . . . . . . . 2 NO . . . . . . . . . . . * * . * , . . . . . . . . . .~ v YES/S~T . . . . . . . . . . . . . . . . . . . 1 YES/PfloREO . . . . . . . . . . . . . . . . . . 2 / v YES . . . . . . . . . . . . . . . 1 ~S . . . . . . . . . . . . . . . . . . . . . . . . I J I . . . . . . . . . . . . . . . . 2 MO . . . . . . . . . . . . . . . . . . . . . . . . . 2 YES . . . . . . . . . . . . . . . 1 YES . . . . . . . . . . . . . . . . . . . . . . . . 1 140 . . . . . . . . . . . . . . . . 2 I0 . . . . . . . . . . . . . . . . . . . . . . . . . 2 _ J YES . . . . . . . . . . . . . . . 1 YES . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . 2 MO . . . . . . . . . . . . . . . . . . . . . . . . . 2 i YES . . . . . . . . . . . . . . . 1 YES . . . . . . . . . . . . . . . . . . . . . . . . 1 MO . . . . . . . . . . . . . . . . 2 ilO . . . . . . . . . . . . . . . . . . . . . . . . . 2 YES . . . . . . . . . . . . . . . 1 MO. . . * . . * . . . . . . ° .o~ Have you ever h~ K of>eret |cfx to avo id h iv ing I~ Bore ch i ld ren? YES . . . . . . . . . . . . ° . . I MO . . . . . . . . . . . . . . . . 2 YES . . . . . . . . . . . . . . . 1 MO . . . . . . . . . . . . . . . . 2 TEa . . . . . . . . . . . . . . . 1 . . . . . . . . . . . . . . . . 2 YES . . . . . . . . . . . . . . . 1 YES . . . . . . . . . . . . . . . 1 MO. , . . , . . . . . . . . . . . TE$ . . . . . . +. . . . . . . . . . . , , ° . . .1 MO . . . . . . . . . . . . . . . . . . . . . . . . . 2 YES . . . . . . . . . . . . . . . . . . . . . . . . 1 I ( (3 . . . . . . . . . . . . . . , . . . . . . . . . . 2 IRES . . . . . . . . . . . . . . . ° . . . . . . . .1 ! lO . . . . . . . . . . . . . . . . . . . . . . . . . 2 Do you ~ ~herw a 10tcson can obta in Ktv ice on hay to use the Cetendar I~th<>d? YES . . . . . . . . . . . . . . . . . . . . . . . . 1 MO. , . . . . . . . . . . . . , . . . . . . . . . .2 Do you ~ where a person can c(otein 8dv lc l on h~d to ~erve cha~ges In the mucurT ~E$. *** . . . . . . , . . . . . . . . . . .oo l MO . . . . . . . . . . . . . . . . . . . . . . . . . 229 11 uYc 2 "1 C~STIOlI$ ~ FILTERS Have you ever used imythlng or tr{ed in I~y u ly to l~,~lay or avoid gett ing Wegr4nt? KIP I O~OISG CATEGORIES J TO I YES . [] I ! I I CORRECT 303-3~ (AIdO 302 I f i l [CES~Y). I I ~ you f i r s t d id something or ~ed I ~lethod to avoid I gett ing pregr~mt, how ~ living ¢hitdren did you h ive I t that t~llm? IF NOqE RECORO '00 ' . 3o. I c.EoK 2~: I NOT PR£ C4¢NIT P R £ C~Jdl r o* o,~E .[/3 [-1 3~0 I CHECK 303: I ~CI4AN I~T STERIL] ZF.O v~ STESILIZEO ~-~ I RUNS£S OF CHILDREN . . . . . . . . . m I )324 I I ~312J I Are y~J c~Jrrentty do(r~ s~wth|ng or ueir4; Iny iethod to det*y or avoid 9ett|ng I~eg~l~t? I YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 I I NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 - ->32& 312 312A Vhich aethod are you ruing? CIRCLE '06* FOR FEHALE STERILIZATI~. PILL . . . . . . . . . . . . . . . . . . . . . . . . . . . 01 IUlO . . . . . . . . . * . . * . * * . . . . . . . . . . ° .~- - I NJECT lOllS . . . . . . . . . . . . . . . . . . . . . 03 D [ APHRAGI4/FC~J4/J EL LY . . . . . . . . . . . (~14~Y4. . . . . . . . . . , , * **o . . . . .0~ FE]~LE STERILIZATIOR . . . . . . . . . . . 06 KALE STERILIZATION . . . . . . . . . . . . . 07~-- CALENDAR . . . . . . . . . . . . . . . . . . . . . . . I~TI~O . . . . . . . . . . . . . . . . . . . 09 WITNDRA~L . . . . . . . . . . . . . . . . . . . . . 10 OTRER 11- (SPECIFY) .)318 ">323 230 I10. I QUESTIONS kl~ FILTERS 313 I At the Elm y~J f i r s t Stirred ~l lnl l the p i t t , d|d You ¢or~utt I ~tor or I rturs~ T SaCIP ODOING CATEGClIIED I TO I YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I I I SO . . . . . . . , . . . . . . . . . . . . . . . . . . . . . . 31/* I At The ti~ey~J t i l e got plLtm, did you cor~4uLt i~octor| XES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , | I I I 3~5 Miy t i~ the p~ck of pl ies y~J i re us?r4l rmv? (RECt~D ~ OF BRAMO.) I PACX S~ES . . . . . . . . . . . . . . . . . . . . . . . 1M~317 BRA~ ~J~E P/~Z SOT StEM . . . . . . . . . . . . . . . . . . . 2 | 316 I ~hit Is the b~md name of the Nt i s you Ere r~v using? I I (RECORD ILkME OF SR.I, HD.) DI(., . . . . . . . , ° . , . . . . . . . . . . . . . . . 98 317 Hov ~ does or~ pick of p l t | ! cost you? I ,Y . Ff-lq I FREE . . . . . . . . . . . . . . . . . . . . . . . . , .996 DE . . . . . . . . . . . . . . . . . . . . . . . . . . . . 998 318 CHECK 312: SHE/HE STERILIZED ~ USING ANOTHER METHOD I I ¥ V t/here did the Vhers did yo~ Obtl ln s t i r i l l z l t{~ Like (~ETk~D) the l i s t t im? pt eel? (hUge OF P~C£) ]19 MOW tong doer | t take to travel I MIIIUTES . . . . . . . . . . . . . . . 1 frc~ your hose tO this ptecsT I Y~UIS . . . . . . . . . . . . . . . . . 2 IF LESS T~S T~Q K, CUIS, RECITED TILAV1EL TIRE IN R[NUTE$. OTHERWISe, RECORD TRAVEL TIRE IS NOUIIS, D( . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9998 DIFFICULT . . . . . . . . . . . . . . . . . . . . . . . 2 G~VlER~NT A~D PARASTATAL | (:~¢ ~JL TANT :~OSP I TAL . . . . . . . . . . . I'L I I EG IO~L KOSP I TAL . . . . . . . . . . . . . 12 DISTRICT HOSPITAL . . . . . . . . . . . . . 1 ] MEAL T H CENTRE . . . . . . . . . . . . . . . . . 1/* O 15I°ENSARY . . . . . . . . . . . . . . . . . . . . 15 PARASTATAL HEALTH FACILITY,,.,16 VILLAG~£ NEALTN POST/~CI(KER.17 )~1 MEOICAL PRIVATE ,SECTOR SELIGIOUS ORG. FACILITY . . . . . . . 21 PSIV. O~C.TOR/CLIMICIKC~,~PITAL. .22 PHARKACY/)t[O l CAL STORE . . . . . . . . 2.~ UKATI ClIO ;*~ltgER . . . . . . . . . . . . . . 2~. >~1 OTMER PIIIVATE SECTOR I I SHOP . . . . . . . . . . . . . . . . . . . . . . . . . . 31 ME IGHBCI~S/RELAT I VE$ . . . . . . . . . . . 3~ OTiS /.1 ~>121 {SPECIFY) 01[ , . . . . . . . . . . , . . . . . . . . . . . . . . . , °9~ 231 3221 CUESTICmS AND FILTERS CI~CX 312: LPS I IIG SlY/HE v i~ i ANOT~| STERILIZED IDET~ID [~ m MBNI~I~I lU l I I~ i tn ~et month ard y~er ~s the s ter i l i za t ion operet ion performed? $d(lP C~I IG ~.a~TEG~IIEI I TO ,32~ i OATE XONT3 . . . . . . . . . . . . . . . . . . . . . . >3~ (f~BitRENT P~ETI¢:O) conttrsucAJsLy? ~THS . . . . . . . . . . . . . . . . . . . . . 329 [F LESS THJU4 ONE NQIdTR, RECORO ~O~J. 8 YEARS Clll LONGER . . . . . . . . . . . .96 --.J I I ' 32& Oo y~ In t l~d to tee • ~thod to dotsy or tvo ld TES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 >326 ~'eOra~cy a t ~ t t lm in The fu ture? I~ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 Dig . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 )330 325 kl~mt IS the mmlh reason y~J do t~ot Inte¢~ to tae • l thod? WA;dTS CHILDREN . . . . . . . . . . . . . . . . . 01 - - LACZ OF IO~bl.EOGE . . . . . . . . . . . . . . 02 PARTNER CIP PO~ . . . . . . . . . . . . . . . . 03 ~T TOO HIJCH . . . . . . . . . . . . . . . . . . 04 SZDE EFFECTS . . . . . . . . . . . . . . . . . . . 0'5 ILL HEALTH/HEALTH CI~CERHE . . . . . HARO TO GET NET:~ID$ . . . . . . . . . . . . 07 RELIGION . . . . . . . . . . . . . . . . . . . . . . . 08 OPPOSED TO FAMZLT PLAHRIMG . . . . . 09 FATALISTIC . . . . . . . . . . . . . . . . . . . . . 10 OTHER PEOPLE OPPG~O . . . . . . . . . . . 11 IMFRE~J(NT SEX . . . . . . . . . . . . . . . . . 12 THINKS SHC CAJd~T G(T PRECJdAJT.13 NENOPAUSAL/HAO HYSTERECTCRY.14 ;NC~VEMEENT . . . . . . . . . . . . . . . . . . . 13 NOT KARRIED . . . . . . . . . . . . . . . . . . . . 16 OTHER 17 ($~ECIFT) >330 I . '1 u i th in the next t2 eonthsT IdO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 DIE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 327 Vhe~ you use • method, d~ich meEhod ~x,tLd y~J p re fer to useT PILL . . . . . . . . . . . . . . . . . . . . . . . . . . . 01 ILIO . . . . . . . . . . . . . . . . . . . . . . . . . . . . 02 INJECTICNS . . . . . . . . . . . . . . . . . . . . . 01A~H~GN/F~J4J JELL? , , . . . , . . . . .0~ FEKkLE STER] L[ZATIOM . . . . . . . . . . . 06 MALE STElit I L ] 7Jif I ON . . . . . . . . . . . . . 07 C.~LENOAJt . . . . . . . . . . . . . . . . . . . . . . . OS / N,X:US HE T I t~ . . . . . . . . . . . . . . . . . . . 09 | Vt ?ItDRA~/AL . . . . . . . . . . . . . . . . . . . . . 10 OTHER 11 >330 (SPECIFY) ~SUItE . . . . . . . . . . . . . . . . . . . . . . . . . 98 232 NO. m 326 DUESTIONS A~O FILTERS I Vl~eri c~n ycxJ g4t (NETY~O NERtlOkq~ III ~.7)? (IUd~ OF PLACe) ~ lP C~:OIHG CATEGONIES I TO GOVERMM~RT AI~ PAJU~TATAL l C~(SUt.TNI T HC~,~ I TN. . . . . . . . . . . . I1 / lEG I OI~,L N(~P I TAL . . . . . . . , . . . . . 1;! | DISTRICT k~ I TAL . . . . . . . . . . . . . 13 I HEALTH GEHTR£ . . . . . . . . . . . . . . . . . 1A DISPEHSAR? . . . . . . . . . . . . . . , . . . . . 15 PARASTATAL HEALTR ~ACIL IT I . . . . I~ VILLAGE I~.ALTH P~;T /~I3 iR . . . .17 ~'334 ~OICJ~L PRIVATE SECTOR | RELIGIOUS ORG, FACILITY . 21 PRIV. D(X;TON/CL I i I C/I~H~*P I TAL., 22 t>332 pHARMACY/M~D I CAL STORE . . . . . . . . 2~ UMATI CaD ~t~ICER . . . . . . . . . . . . . . 2£ ~'334 OTHER PRIVATE SECTOR I S l '~ . . . . . . . . . . . . . . . . . . . . . . . . . . 31 )332 RE I DH~S/REt.AT IYES . . . . . . . . . . . 3~ ,)334 OTHER ,~t J (S~ECIFY) T KN~ . . . . . . . . . . . . . . . . . . . . . 98 )330 331 0o you kt~o~ of I pLmce vhere you c~ obt i ln I method of Family planning? Vherl is th l t ? (NAME OF PLACE) I YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 | I NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 )334 GOVERNMENT ANO PARASTATAL CON ~JL TAJd T KOSP ITAL . . . . . . . . . . . ~I lEGI DNAL HOSPITAL . . . . . . . . . . . . . 12 REG]OHAL HOSPITAL . . . . . . . . . . . . . 12 DiSTRiCT HOSpiTAL . . . . . . . . . . . . . 13 HEALTH C~NTRE . . . . . . . . . . . . . . . . . l& O I SPEHS,~V . . . . . . . . . . . . . . . . . . . . 15 PARASTATAL HEALTH FACIL|TY.16 VILLAGE HEALTH POSTt~/(~RER.I? ,334 HEDICAL PRIVATE SECTOR RELIGIOUS ORG. TRCILITY . . . . . . . ;~1 PRIV. DOCTOR/ELI R IC/HOSRI TAL. ;~2 PHARMACY/I~ED I C, IL STORE . . . . . . . . 2~ UMAT! ~ ~ORKEH . . . . . . . . . . . . . . ;~/. v~ OTHER PRIVATE SECTOR | SHOP . . . . . . . . . . . . . . . . . . . . . . . . . . 31 I OTHER IE I GHSG~S/RELAT I/eE$ . . . . . . . . . . . 32 t41 I )~& (SP£CITY) I I - . 332 HO~ tong does I t ?eke to t r i ve t fern y~ar home to th l l p l iC l? ROUAS. o . . . . . . . . . , * * . .2 IF LESS THAN T~O ~JA I , RECQItD TRAVI[L T IM IN NII~JTES. OTHERVISE, REC~ TRAVIEL Tlll~ 1N Y~UItS. DR . . . . . . . . . . . . . . . . . . . . . . . . . . . 99911 I "0 . .o . . , I 3~14 Ih the L i l t Ionth r h|ye you helrd or seen i ms lge thou? fami ly pt lmnlng YES NO on the r id l~T ~1)10 . . . . . . . . . . . . . . . . . . . . . . 1 2 on teLevision7 TELEVISION . . . . . . . . . . . . . . . . . 1 2 f r~ ACH aide? 14CH AIDE . . . . . . . . . . . . . . . . . . . 1 2 fr '¢l rw ighbor$ / r l t i t I vet? RE I GHIIOI~S/RE LAT I VES . . . . . . . . 1 2 on plait er l? POSTER . . . . . . . . . . . . . . . . . . . . . t 2 o . o . . , i . 1 I Dlannitvd in format ion to be Drovided on the r l~l io or lOT ACCEPTABLE . . . . . . . . . . . . . . . . . . 2 t e~ evision? {)[ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 233 I~ETIOW ~. PIIEt;~ai~T ~ INtF.ASTFE~)I~ 402 403 CMECX 222 : OBE OR ~RE L IVE ~ ~ LIVE IIBTWE 0INTHS SliCE JAW, 1~ LI--J SINCE JAN+ 1~ [ r ($111 P 70 501) y ENTER THE LIME ~ER, M~q~, AJdO SL,N~VIVAL STATU'S OF EACH BIRTH E[IK[JE JA/eL#UQT I~ IN ?rHE T#JILE. X~J{ THE ¢~.iESTIOWB AJM~JT ALL OF THESE BIRTH0. BEGIN g lTK TN~ LAST I IETM. ( I F THERE AJIE MCdtE T~UI,il ] I IETHE, UEAE ~[T I l~ l tAL F~IRMS). IIC~ I mid Like to i l k yOU l¢lal ~re @$tlc~+il I~o~Jt the heal th of chi ldr l<1 yo~ hed In the ~¢t f lw l ysl l r l , wi l l t l l k ebo~t o~4 ch i ld a t • t tm. LINE WLl~i£l FROM Q, 212 FROM Q. 212 A~O O, 216 At the ~lm~ you b~:m l~ 'eg~a~t w i th (WANE), d [d you v~t to t~cc~ peeBp~a~t the~l, d id y~a I~t to ~ i t un I I l La ter o r d id yo~ u l l~t ~0 l~re ch i~ret~ at m~{? LAST DIBTH NAME ¥ l i l i~ l v TMEN . . . . . . . . . . . . . . . . . . . . . I. (SEIA TO 40~)< LATER . . . . . . . . . . . . . . . . . . . . WE ~E . . . . . . . . . . . . . . . . . . (SKIP TO 60S)~ / NEXT.TO-LAST 01 l id ~C~MD-FROH-LAST BIBTH NAME I LATEE . . . . . . . . . . . . . . . . . . . . ~ LA , . . . . . . . . . . . . . . . . . . . . . ~ .~E . . . . . . . . . . . . . ; h ~ ;~; ; ; ;a~; ; ~l .K ~ TO ,~) '~,.'.'.,_'"" l i ke to ~eve Waite@? ~TMS . . . . . . . . . . . . 1 kOWTNS . . . . . . . . . . . . ~ ~l~}~T~ . . . . . . . . . . . . 1 YEARS . . . . . . . . . . . . . Z T£J~lS . . . . . . . . . . . . . Z TEA.It S . . . . . . . . . . . . . 2 oK . . . . . . . . . . . . . . . . . . . . . 99e or . . . . . . . . . . . . . . . . . . . . . 9~ p{ . . . . . . . . . . . . . . . . . . . . . 9915 I TEE . . . . . . . . . . . . . . . . . . . . . . ~ ~ . ]ll ~ES . . . . . . . . . . . . . . . . . . . . . . 1 40~ Nhe~ yo~ ~re p4"eB~l~t TIES . . . . . . . . . . . . . . . . . . . . . . 1 w i th ( i~) , d id ~ IIN~ I~-afo~ fo r I~nt l f l l t l~ C i te NO . . . . . . . . . . . . . . . . . . . . . . . ~ ~ . . . . . . . . . . . . . . . . . . . . . . . ~ R . . . . . . . . . . . . . . . . . . . . . for th i s ~4"~P4k~Cy~ (SKIP TO 411) ( t (SL IP TO &11)< / (~J([P 19 411)< ~hcm d id )~ lee fo r Iw%[~'ralta[ caret Az~yo~e e lse? RECTO ALL PERSONS [~EBTION~. HEALTH PROFESS]OIO, L OOCTOR/I~EDIC.AL ASST . . . . . . A RUILAL ~01CAL AIOE . . . . . . . i NURSE/NIOVlFE . . . . . . . . . . . . C ~:H AIDE . . . . . . . . . . . . . . . . . O OTHER P'l[i~g~ll VILLAGE N(J~LTH bCI IEER. . . .E TRAINED EIETN ATTEWOANT.,F T~IT I~ I / J~L leiTH ATIE~kWT . . . . . . . . . . . . . . G DINER B (SPECIFI) ~EALTN PRQFESSICIAL ~TOI / ) IEO IC , AL ASOT . . . . . . A PlEOIOJ~L AIOE . . . . . . . B IUt~gE/14IDWIIE . . . . . . . . . . . . O PeW AIDE . . . . . . . . . . . . . . . . . 0 DT~EB PERSON VIL~ HEALTH ~]C~E. . . .E T ILA I~ i IRTN ATTEMDAJ~T,,F TIU~DITZONAL I IRTN ATTEIDNIT . . . . . . . . . . . . . . O ~?HEE N (SPECJFY) )W.-~LTR PI~OFESSIDIWAL DDCTOR[~eEOICAL AOST . . . . . . A iaIEDICAL AlOE . . . . . . . 0 IIJR~/WIOWIFE . . . . . . . . . . . . C i~C~ AIDE . . . . . . . . . . . . . . . . . D OTHER ~RS~II VIL~ HEALTH ~R. , , .E TI,klIIEO EIRTB ATTE~A3~T,,F TRADITIONAL I IBTH AT~AWT . . . . . . . . . . . . . . G (SPECIFY) A07 Where d id yo~ Do fo r th{s ~te~'4t i l c i re I REC~ ALL PLACES VISITED. GOVERWNENT ~ P/dLASTAT/d. H~$P I TAL . . . . . . . . . . . . . . . . . A HEALTH C~NTRE . . . . . . . . . . . . l OiSPENSAIT . . . . . . . . . . . . . . . D HEALTH ~T . . . . . . . . . . . . . . O PAB.kSTATAL KOSJi/CL INTO, , ,E PRIVATE ~OTOR REIGIOUS CRG, KOSP/CLIN.F PRIVATE ~ITAL /CL IB IC . .D GGVEI~IIeEWT ~ NULASTATAL NG~JIITAL . . . . . . . . . . . . . . . . . A HEALTH CENTRE . . . . . . . . . . . . l OI~EWSJ~Y . . . . . . . . . . . . . . . C HfJkLTM ~T . . . . . . . . . . . . . . D PAP.~E?A TAL H~/CL [B IC . . .E ~]VATE 51E OT OR REIGICIJS OI~G. Va[)SP/CLIN.F Pll IVATE MOSPI TAL/CLIBIC, ,G . . . . . . . . . . . . , . . . . . . . . ,H ~Z~eERJIMEHT /did PAJLASTATAL )iGSP I TAL . . . . . . . . . . . . . . . . . A H~.AL TI ~BTBE . . . . . . . . . . . . i O ] 5PtEMEwIJI ¥ . . . . . . . . . . . . . . . C ~EJU. T i P~]GT . . . . . . . . . . . . . . O PAJLAE?ATAL ~/CLZNIC , , ,E ~IVATE SECTOR IEIGIOJS ORG. I~Oe.~/CLIi.F PRIVATE MO~".P I TAL/CL IH I C . ,O A~ I Nere you g iven ~ YES . . . . . . . . . . . . . . . . . . . . . . 1 TEE . . . . . . . . . . . . . . . . . . . . . . 1 TEE . . . . . . . . . . . . . . . . . . . . . . 1 I ante~l taL card fo r BO . . . . . . . . . . . . . . . . . . . . . . . 2 I I th i s p r egf.ar~y? BO . . . . . . . . . . . . . . . . . . . . . . . 2 NO . . . . . . . . . . . . . . . . . . . . . . . 2 ~re ~ ki~en ~ f l r lT N(~NTNE . . . . . . . . . . . . . . bERTHS . . . . . . . . . . . . . . M(31WT~ . . . . . . . . . . . . . . i l l I ~ fo r ~ ai ' l t lh~at lL check ~ th i s p re~y? O1{ . . . . . . . . . . . . . . . . . . . . . . 98 O[ . . . . . . . . . . . . . . . . . . . . . . ~ OIl: . . . . . . . . . . . . . . . . . . . . . . ~ I *° I + -* ' -+ +*' . . . . . . . . . . . Cl,d you have DariEn3 WE, OF V~SITS . . . . . . . . WE. OF VISITS . . . . . . . [ ' : WD. ~ VISITS . . . . . . . t~a~ pr egnar~c y'~ , r 0K . . . . . . . . . . . . . . . . . . . . . . 98 i . . . . . . . . . . . 98 D[ . . . . . . . . . . . . . . . . . . . . . . 9E I 234 I 411 ~l~y~u wre pr t~t u I th (MANE) were y~ 1(iv~m en In jec t ion In the am top revuE theboby f r~ gett ing le t i r~ , thlt is , cor~J[s lc~s e f te r b i r th? LAST DIRTN YES, . . . , . . ,+ .+° . . . , . . ° . . . I BO., . . . . . . . . . , . . . . . . . . . . ,;) ($RXP TO 413)< OE . . . . . . . . . . . , . . . . . , . . . . . GEXT-TO'LAST I l I TM YES,. . . . . . * * . . . . . . . . . . . . o l HO . . . . . . . . . . . . . **o , . . . . . . 2 (SKIP FO 413)< 0[ . . . . . . , . . . . . . . . . . . . . . . . ~J ~CO~O - FS~N - LJ~T 1( l l t l I M (SKIP TO 413)< OK . . . . . . . . . . . . . . . . . . . . . . . "+ + - " - + + + n [] sl get th i l In jec t ion? TIMES . . . . . . . . . . . . . . . . . . TINES . . . . . . . . . . . . . . . . . . TIM£E . . . . . . . . . . . . . . . . . . OK . . . . . . . . . . . . . . . . . . . . . . . 8 0( . . . . . . . . . . . . . . . . . . . . . . . 8 0S . . . . . . . . . . . . . . . . . . . . . . . $ I 413 ~here d id you g ive b{r th to (HN4E)? ~04E YOUIt HOME . . . . . . . . . . . . . . . 11 OTHER HONE . . . . . . . . . . . . , .12 GOV~RI~q~MT AN~ PARARTATAL HOSPITAL . . . . . . . . . . . . . . . . 21 HEALTH C~MTRE . . . . . . . . . . . 22 DISPENSARY . . . . . . . . . . . . .,?,.3 PARASTATAL I~$P/CLINIC,.24 PRIVATE SECTOR RELIGIOUS ONG KOSP/CLIM.31 PR]VATE HOSPITAL/CLIMIC.3;) OTHE1( &1 (SPECIFY) ~GE YOt.q Y04( . . . . . . . . . . . . . . . 11 OTHER H~4E . . . . . . . . . . . . . . 1;) GOVER~HEMT AAO pARASTATAL kK)~#ITAL . . . . . . . . . . . . . . . . 21 H~*ALTK GEHTSE . . . . . . . . . . . 2 ; ) OISsPEMSNIY . . . . . . . . . . . . . . PARASTATAL HOSP/CLIMIC.24 PRIVATE SECTOR RELIGICUS ONG ~OSP/CL11(.31 PfllVRTE HOSPITAL/CL]MIE.32 OTHER 41 {SPECIFY) ~AE YOUR H(:I4E . . . . . . . . . . . . . . . 11 OTl~[S KGI4E . . . . . . . . . . . . . . 1;) GOVER~q£MT ~ PAJU~SIATAL ~ITAL . . . . . . . . . . . . . . . . ;)I HEALFH GENTLE . . . . . . . . . . . 22 D [ SPEHS.~Y . . . . . . . . . . . . . . 23 PARASTATAL k~r~P/CL I MIC, .;)A PRIVATE SECTGE RELIGIOUS O~G HOSP/CLZ1(.31 PRIVATE HO~PI TAL/CL [ M [0.32 OTHER 41 (S~P~Cl FY) 41/+ Who I s l J s t t~ N i th the de l ivery of (M~V~)? k ' r~he else? RECCRO ALL PERS~dS ASSISTIHG. HLkLTH PROFESSIONAL O(~TOR/MEO I EAL ASST . . . . . . A Rt.WAL i4EDICAL AlOE . . . . . . . 1( MUIISE/MIOWI FE . . . . . . . . . . . . C NCH AIDE . . . . . . . . . . . . . . . . . D OTHER PERSOU VILLAGE HEALTH ~KER. . . .E TRAINED gIRTH ATTENOANT.F TRADITIONAL EIRTH ATTEMOANT . . . . . . . . . . . . . . . G NE I GHBGES/RELAT I VIE . . . . . . H OTHER I (SPECIFY) NO ONE . . . . . . . . . . . . . . . . . . . . J HEALIH PROFESSIONAL DCCTGE/HEO % CAL ASST . . . . . . A RUR.4L MEDIEAL AIDE . . . . . . . | MJRS~/M IO;/] FE . . . . . . . . . . . . C MCH AIDE . . . . . . . . . . . . . . . . . 0 OTHES PERS~4 VILULGE HEALTH I~:~KER., . .E TRAINED EIRTH ATTEMOANT.F TRADITIONAL BIRTH ATTENOAMT . . . . . . . . . . . . . . . G HE ] CHBO~S/RELAT i~S . . . . . . H OTHES % HEALTH PI~OFE$S I Ot4AL C)GCT OR/NIEO I CAL ASST . . . . . . A RLItAL i4EOICAL A[O~ . . . . . . . II MU~S~/MIO~/I FE . . . . . . . . . . . . C NCH AIDE . . . . . . . . . . . . . . . . . O OTHE| PERSZ:II VILLAGE NEJU.T)~ ~[ES . . . .E TRAIHED BIRTH ATTENDABT.,F T~IT I (3~ $IRTH ATTEI~AJIT . . . . . . . . . . . . . . . G ME I GHBCQS/SELAT [VES . . . . . . H OTHER I (SPECIFY) MO ONE . . . . . . . . . . . . . . . . . . . . J {SPECIFY) NO (;liE . . . . . . . . . . . . . . . . . . . . J 415 Urns {NNqE) born on t im OM TIME . . . . . . . . . . . . . . . . . . 1 ON T1ME . . . . . . . . . . . . . . . . . . 1 ~ Tilde . . . . . . . . . . . . . . . . . . 1 or prmeturety? PREMATURELY . . . . . . . . . . . . . . 2 PSEKATUeELY . . . . . . . . . . . . . . 2 PREXATUBELT . . . . . . . . . . . . . . 2 01( . . . . . . . . . . . . . . . . . . . . . . . 1( 01( . . . . . . . . . . . . . . . . . . . . . . . 8 51( . . . . . . . . . . . . . . . . . . . . . . . 8 ' l "-'++'+-++ I " . I + . + . I WO . . . . . . . . . . . . . . . . . . . . . . . 2 vo . . . . . . . . . . . . . . . . . . . . . . . 2 MO . . . . . . . . . . . . . . . . . . . . . . . 2 417 ~/hen (NAME) was born, | vA| he/she: I very | t rge , VERY LARGE . . . . . . . . . . . . . . . 1 VERY LARGE., . . . . . . . . . . . . 1 VERy t .~ . . . . . . . . . . . . . . . 1 Imrger than aver|Re, LARGER ?HAM AVERAGE . . . . . . 2 LARGER THNI AVERAGE . . . . . . 2 LA1(GER TIU~ AVERAGE . . . . . . 2 |verN;4% A~RAGE . . . . . . . . . . . . . . . . . . ] AVERAGE . . . . . . . . . . . . . . . . . . 3 AVERAGE . . . . . . . . . . . . . . . . . . 3 mt teP then aver lg~, ~NALLEA THAN AVERAGE . . . . . 4 SMALLER THAJI AVERAGE . . . . . 4 SI~,LLE| TH~ AVERAGE.A or very mi t t VERY SHALL . . . . . . . . . . . . . . . 5 VERY PlALL . . . . . . . . . . . . . . . 5 VERY S;AALL., . . . . . . . . . . . . 5 D[ . . . . . . . . . . . . . . . . . . . . . . . 8 01( . . . . . . . . . . , . . . . . . . . . . . . 8 OK, . . . . . . . . . . . . . . . . . . . . . . 8 418 V . . (MARE) .~ghed " '~] t " ' " " '~ l YES . . . . . . . . . . . . . . . . . . . . . . 1 YES . . . . . . . . . . . . . . . . . . . . . . 1 YES . . . . . . . . . . . . . . . . . . . . . . 1 et b i r th? HO . . . . . . . . . . . . . . . . . . . . , . . ; ) IIO. . . . . . . . . . . . . . . . . **o.~* NO, .+. . . ° . . . , , . . . . . . . . . . . 2 {SKIP TO 420)< {SKIP TO 421)<----J {SKIP TO 4;)I)< &19 RECoRDN°V mJChFRoMdldNcH(MN4E )CARO v~i gh?lF K Z LOGRN4S . . . . . 8 . ~-~ R I LOGENA5 . . . . . [ ] . ~-~ K I LOGJUJAS . . . . . [ ] " ~ I AVAILABLE. OK . . . . . . . . . . . . . . . . . . . . . 9~8 DR . . . . . . . . . . . . . . . . . . . . . 998 D[ . . . . . . . . . . . . . . . . . . . . . 998 235 I LAST l i l TS IEXT-TO-LAKT S ISt l S£C~ID-F I~q*LAST S I IT I l MA~ M~ I YES i;~;;;Miii;~ . ~]11 ~ ~ I (SKIP TO 4Z.~)< ]1 +1o +.r+. . . . . . . . . . . . . . . . . . . . . . . . . 1 i :~t~en ti~e b i r th of (KN4E) ~ (SI(iP TO 625)< ] YES . . . . . . . . . . . . . . . . . . . . . . 1 your next pregnincy? EO . . . . . . . . . . . . . . . . . . . . . . . 2 ;40 . . . . . . . . . . . . . . . . . . . - - (~ lP TO 6~"J)< . . . . /.22 For ho~ ~ I~ ' l th l a f te r the b i r th of (KN4E) d id CHE C:( 2Z.~: pREGVJUdT? /.2/. | Here yce~ rPs t+~l lexua l I r l l l t lO~l l l i t*,Cl the b i r th o f ( ILQ4£ ) ? h~I4THS . . . . . . . . . . . . . . [ - - -~ ! k~lT)¢S . . . . . . . . . . . . . . ~ MCmT MS . . . . . . . . [ ] OK . . . . . . . . . . . . . . . . . . . . . . M DE . . . . . . . . . . . . . . . . . . . . . . M , OK . . . . . . . . . . . . . . . . . . . . . . ~ , MOT PSE~T I ~ i PREGMAMT OR U~E YES . . . . . . . . . . . . . . . . . . . . . . t ~ " ~ . NO . . . . . . . . . . . . . . . . . . . . . . . 2 ~ ~ (SKIP TO 626)( ] ~ - - - - '~- '°I + ' ' - - ' ' ' * ' * the b i r th of (MN~) d id k~ITHS . . . . . . . . . . . . . . M(~THS . . . . . . . . . . . . . . MC~THS . . . . . . . . . . . . . . not h4v~ sexual re la t ions? OK . . . . . . . . . . . . . . . . . . . . . . 96 OK . . . . . . . . . . . . . . . . . . . . . . 9B DS . . . . . . . . . . . . . . . . . . . . . . ~ | I YES . . . . . . . . . . . . . . . . . . . . . . 1 YES . . . . . . . . . . . . . . . . . . . . . . ~ YES . . . . . . . . . . . . . . . . . . . . . . /.26 Dtdbresstfe~you e~er(N/~4£)? (SKIP TO /.28)< 1 MO (SKIP TO &3S)< 2 ~ (SKIP TO 435)< ~l l MO 2 . . . . . . . . . . . . . . . . . . . . . . . v~ . . . . . . . . . . . . . . . . . . . . . . . 2 m /.27 Vhy d id y~J r~t l~¢'eall t f ~ (/(AJqE ) ? MOTHER ILL/~IEk, K . . . . . . . . . . 1 CHILD ILL/~,/EAK . . . . . . . . . . . 2 CHILD DIED . . . . . . . . . . . . . . . ] MIPPLE/MREAST PRC4LEM.4 INSUFFICIEMT MILE . . . . . . . . 5 MOTHER UI~KI~G . . . . . . . . . . . 6 CHILD REFUSED . . . . . . . . . . . . 7 OTHEE (SPECIFY) (SKIP TO &37)< MOTHER ILL,~EAK . . . . . . . . . . I . CHILD ILL /~AK . . . . . . . . . . . 2 CHILD DIED . . . . . . . . . . . . . . . ] tIPPLE/BREAST PROSL~. . . .4 IMS~JFFICIEHT MILK . . . . . . . . 5 NOTHER ~KIMD . . . . . . . . . . . CHILD REFUSED . . . . . . . . . . . . ; OTKES (SPECIFY) (SKIP TO 637)< kCTHER ILL/~/EAK . . . . . . . . . . 1, CHILD ILL/?dEJL¢ . . . . . . . . . . . 2 CHILD DI~ . 3 MIPPLE/DRE,&ST PR~LEM,. . .4: IMSIJFFICIEMT MILK . . . . . . . . ~1 MOTXEH ~IQ~KIMG . . . . . . . . . . . t CHILD HEFUSF.J~ . . . . . . . . . . . . 1 OTI~H (SPECIFY) [SKIP TO 437)< /.28 I NOV tc¢~l i f t t r b i r th d id I y~J f | r s t ~ (IO~IE) to the breest? IF LESS TIUUI I IICUR, l t CI~D t0Oa. IF LESS THNI 24 YOJItS, RECORD I~OURS. OTHERWI~, RECTO DAYS. IMMEDIATELY . . . . . . . . . . . . O~ L~ ~m'~qwmmmmqm~ HOJ¢$ . . . . . . . . . . . . . . 1 ~ DAYS . . . . . . . . . . . . . . . 2 I~T~- - " :E- 236 I 429 I CNErJC 216: CHILD ALIVE? /,30 I Are y~a t t i l l I b~eestfeeding (N~)? I 43,~, 435 LAST IIRTR IIEXI-10-LAST RZRTN UAI4E (SKIP TO 43S) v YES . . . . . . . . . . . . . . . . . . . . . . 1 ~. , ° . . . . . . . . . . . ° .o . , . . . .2 (SKIP TO 43S)( J l *311.o~ ,w,y ti,es atd y~ ~mEX O~ ~-~ brel l t fe~d Last nig l~t NIGHTIME i bet~ s~J~et e~l sunrise? FEEDINGS IF ANSWER IS NOT NUNEEIC, TOR ~PEOXI~TE .~EE. 432 I Eou tony times did y~J NUMBEE OF I breastfeedyester~ly DAYLZGNT I l l during the ~yLig~t hc~JPS? FEEDINGS I IF AM~,/ER IS NOT NUMERIC, . . . . PRC~E FOR APPROXIMATE hI~48EE. 433 At ~ty time yesterday or l i s t night v4s (MA~E) given w~y of the fo t t~ lng? : Pta(n uater? S~gar weter? Juice? 8~Y /ormJi*? ¢ov's s~lk? T t r~ or pov~ered silk? Other Liqui,~? Any so|id or uushy food? CHECK 433 : FOOD OR LIG(JID GIVEN YESTERDAY? For ho~ ~ny l=o¢lthl did you bre i s t f~ (NAME)? N - - , ~ ~ _ ~ ~ ¢ ~ YES PLAIN UATEE . . . . . . . . . . I 2 ~RY E~JLA . . . . . . . . . 1 2 ! FEESN N]LN . . . . . . . . . . . ~ z T I EUED/PCI~)EREO " IL ( . I Z OTEER t tw los . . . . . . . . I Z . . . . . . YES TO NO TO ILL ¥ . _ (SKIP TO 4393 ~_~, -~=_~,~n:~-~ ff~I~TNS . . . . . . . . . . . . . . ~ i MOITRS . . . . . . . . . . . . . . LINTIk(~Op. TO.2~; ; . , . . .96 ] URTILL~EIDp. ;0 . :~; ; . . . . . 96] S~C~liD FRCM LA$I I l IT I ~UU~E ~ m ~-~.~ ~ . I~ -~- -~- r ~ • NC~THE . . . . . . . . . . . . . . [ ~ 436 Why did you stop T~'esstf~eding (EAME)? HOTKEK [LL /~AK . . . . . . . . . 01 CHILD ILL/~JIEAK . . . . . . . . . . 02 CHILD OlEO . . . . . . . . . . . . . . 03 EIPPLE/EREAST PR(~LEN.04 INSUFFICIENT MILK . . . . . . . 05 MOTHER VGEEIMG . . . . . . . . . . GE EH[LD REFUSED . . . . . . . . . . . 07 ~EAMIEG AGE . . . . . . . . . . . . . BECAME PREGNANT . . . . . . . . . 09 STARTEO USING CONT~ACEPTIOX . . . . . . . . . . 10 OTHER 11 ISPECIFY) NOTHER ILL/~EAK . . . . . . . . . D1 CI~[LO ILL/%'EAK . . . . . . . . . . 02 D~ILD DIED . . . . . . . . . . . . . . 03 IIF'OLE/BDEAET ~06LEM.,,~¢4 INEUFFIDIEMT MILK . . . . . . . DS NOTHER ~KIMG . . . . . . . . . . 06 CHILD REFUSED . . . . . . . . . . . 07 ~ ING ACE . . . . . . . . . . . . . 08 BEGANE PREGMAMT . . . . . . . . . 09 STAJ~TED USZMG C~{~TEACEPT]ON . . . . . . . . . . 10 OTXER I1 (SPECIFY) ~OTHER ILL/~a~A£ . . . . . . . . . 01 CHILD ILt/~,~( . . . . . . . . . . 02 CHILD DIED . . . . . . . . . . . . . . 03 NIPPLE/E2EAET P2OgLER,.,~ IMSUFFIClEMT NILK . . . . . . . 05 MOTHER ~KING . . . . . . . . . . 06 CHILD REFUSED . . . . . . . . . . . 07 WEAHIUG A~E . . . . . . . . . . . . . 08 B~CJJLE PREGNANT . . . . . . . . . 09 STARTED UDI~G C(~TRACEPTIO~ . . . . . . . . . . 10 OTHER 11 (SPECIFT) 237 CM[(~ 2t6 : CHILD ALIVE? 43~S i Was (~) ever gtve~ Iny i k~Iter+ or iom~th{r~ e|se tO ~{~ or eat (o ther then i~e ls t l i t k )? LAST I ISTM i ~ 'TO- I .~ST IlSTM +++ °-? ,++ 0+? (SKIP TO &39) (5XIP TO +39) YeS . . . . . . . . . . . . . . . . . . . . . . 1 YES . . . . . . . . . . . . . . . . . . . . . . 1 Me . . . . . . . . . . . . . . . . . . . . . . . 2 k~ . . . . . . . . . . . . . . . . . . . . . . . (SKIP TO 4/4~)< ] (~ le TO IJ, A )<-~-~ S~ C~IID - FSal- LAST SISTI ALIVE E~ DEAD ¥ ($i~IP TO &."9) YES . . . . . . . . . . . . . . . . . . . . . . I l I &39 Soy Inny n~ths otd ~el (MARE) kdae, n yo~ s tar ted g lv i~s the foLlowing on • regular I~ is? : FOrlUte or l i t k o ther thm bress tn i Lk? P la in water? Other t 1~+~7 so l id or uhy foc~]? I f LESS TKAM ¢I1£ 14CldTK, AGS IN NOI4THS . . . . . . . I I I MOT GIVES . . . . . . . . . . . . . . . 96 AG~ IN kiCqTHS . . . . . . . I l l MOT GIVEN . . . . . . . . . . . . . . . 96 kGE IM Y+ONTHS . . . . . . . I I I NOt GIVEN . . . . . . . . . . . . . . . 96 AC,~ IN ~THS . . . . . . . J I I NOT GIVEN . . . . . . . . . . . . . . . % IM MOlT HS . . . . . . . I I I M(~T GIVEM . . . . . . . . . . . . . . . 96 AG£ IM MCIdTHS . . . . . . . AC~[ IN MCIITHS . . . . . . . AG~[ IM HCddTHS . . . . . . . ~ '~ (SLIP TO (SKIP TO 41*~) MI*I48ER Of 14£AL, . . . . . . . . ~ MIJIB.ES Of NEJLS . . . . . . . . i ['t( . . . . . . . . . . . . . . . . . . . . . . . 8 O( . . . . . . . . . . . . . . . . . . . . . . . 8 AG~ IN W31+TN$ . . . . . . . ~ '~ 1~3T G | VEIl . . . . . . . . . . . . . . . 96 MOT GIVEM . . . . . . . . . . . . . . . % AGS IM NONTN$ . . . . . . . • ! MOT GIVEM . . . . . . . . . . . . . . . % AG£ IM MC44TI<S . . . . . . . Me? GIVEM . . . . . . . . . . . . . . . ALIVE D~AD (SI~IP TO I~,J+i V I ~,mss oF ~+~s . . . . . . . . l--~l - - I o r . . . . . . . . . . . . . . . . . . . . . . . s I I /~12 | D|¢I (MAll[) e l t ~ other food I III g r~ r l J t s , l i n t b4d4a~4i. ~ or o ther th lnss o r Or l~ ~ so~J yesterday? YS$+.+,** . , . . . . . . . . . . . . . . k~. , . . . . . . . . . . . . . . . . . . . . . ~) 01¢ . . . . . . . . . . . . . . o ,oo , , ,o ,A KS . . . . . . . . . . . . . . . . . . . . . . I . . . . . . . . . . . . . . . . . . . . . . . 2 D4C*******+.o. .o**.o, . . . . . 8 I YES . . . . . . . . . . . . . . . . . . . . . . I l I lJ0 . . . . . . . . . . . . . . . . . . . . . . . 2 DIC . . . . . . . . . . . . ****o . . . . . . II 238 S~CTION ~dl. INN~IIATIOI AND NF.ALTE LINE lUrER FROM O. 212 I FROM D. 212 ARO O. 216 666 I Do y¢~ have • card d~ers (BJU4~'B) VSCCJrdl~{(~4~ ere b~' l t t~n do*~? IF YES: Nsy Z see I t , ptease? I ENTER TI~E LINE ~R, Ibk~4E, /did SIJVIVAL STATUS Of [J~N EISTM IIN(~ JJLMLtedIy 1~ I I T~ TR4LE. A$J( TV3[ GU~STIONB AR~3UT ALL (~¢ TH~ IIHTHS. IIEGIN UITN Till LAST OISTN. (IF TN[It[ ARE NGt~ TKNI 3 B[ATBI, US~ ADOITICI(AL FORMS). LAST BIHTH lANE ALIVE E~ DS~ ?" (~ I ; ;6~; : . . . . . 'I IK) C.~RO . . . . . . . . . . . . . . . . . .~ BEXT-TO* LAST SISTN ~I N~I~3NO - fl(lq - L).ST BIRTH v ImmmmlnlB v v i v ~ ?Es. (~d:;iS~;: . . . . . . ,~ T. (N~;16~;: . . . . . . '~1 ? ' " 7 ,1, ,%" i i ; ;~ . . . . . . 21~ TED, .T ~EK . " l BO N . . . . . . . . . . . . . . . . . . 3 (SHIP TO 450)< I ;40 r.AJ~,,. . . . . . . . . . . . . . . .3 ~1 o,o--h.-._c.,i.**d or , , , s , o o , ] , , . . . . . . . . . . . . . . . . . . . . . . ,~ , o o, j - . . . . . . . . . . . . . . . . . . . . . . ~l (NAME)? NO . . . . . . . . . . . . . . . . . . . . . . . 2 NO . . . . . . . . . . . . . . . . . . . . . . . 2 k~ (SKIP TO 450), • *. . . . . . . . . . . . . . . . . . . . . 2 | k~ (1) C~PY VACCINATION 0ATES F~ EJ~CH VACCINE FROM THE ~. (2) W~ITE '6/~' IN 'DAY' COLUMN, IF CARD SHO~S THAT A VACCIHATIOM 'dAD GIVEN, BUT NO DATE RECORDED. SCG DPT 1 DPT 2 DeT 3 POLIO 1 POLIO 2 P~IO 3 NEASLES BeG 01 D2 D3 Pl P2 P3 NEA DAY 140 YS DAY ~ TK D1 D2 D3 Pl P2 P3 BCG D1 D2 D3 Pl P2 P3 NEA DAY ¥K ~9 B~ (NAME) rec*ived v~cc inat i~ thmt i re not recorded on th is ¢sr~? RECORD 'YES* OBLY JF RE~ENT MENT]~S BCG, OPT, POLIO AND/OR )IEASLES VACCIHATIOIdS. TEE . . . . . . . . o. . . . . , . . . . .1 PItoRE FCe: VACCINATIONS AN0 MSITE '66~ IN THE CC~RESP~DING DAY C~(.LM~ IM 44~ BO . . . . . . . . . . . . . . . . . . . . . . .~ DE . . . . . . . . . . . . . . . . . . . . . . .~ TE$ . . . , . . . . . . . oo . , . . . . . . .1 PR~ FOR VACCZtU~TICW$ AJ4D VRITE JOG s ( l THE C~L~RESF~k~DIMG DAY ( - EOtoMB 11 448 (SKIP TO 452)~ YES . . . . . . . . . . . . . . . . . . . . . . PRCBE felt VACClk~TI01S AJ~O ORITE *66' IH TICS CC~RESPC44DING 0AT COt.LIMB IN NO. . . . . . . . . . . . . . . . . . . . .2 DE. . . . . . . . . . . . . . . . . . . . .8 (SKIP TO 452)< (SHIP TO 452)c------- °1 . 5 . i . ir any vocc l~at io r~ to BO . . . . . . . . . . . . . . . . . . . . . . . 2 NO . . . . . . . . . . . . . . . . . . . . . . . 2 NO . . . . . . . . . . . . . . . . . . . . . . . 2 ~'event him/her from DH (SHIP TO 452)< DK (SKIP TO 4523< (SHIP TO 452)< getting diseases? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . DK . . . . . . . . . . . . . . . . . . . . . . . 239 451 Ptme te t t m I f (NA.qE) (h im) rece(ved ~ of the foL Lowlr~ v~¢ I r4 t I oh l : A IC1; V lKCi r~l t lon Ig l l i~ l t t c lx rcutoeq l , thet ~s, in jec t ion tn the r ig~t ~L~r thor te f t I I c l r ? PoLio vocc i r~, that iS . drope in the uouth? IF YES: many t im? An in jec t ion l t l in l t LAST B[BTN M YES . . . . . . . . . . . . . . . . . . . . . . 1 NO. . . . ° ° . ** . *** . . . . . * .+o°~ O~ . . . . . . . . . . . . . . . . . . . . . . . 8 YES. . . ° . . * ** . , . ° . . . , , , , . . I NO. . . . . . . . . . . . . . . . . . . . . . ~) OK****. , . . . . . . . . . . . . , . , . .8 N~kSEB OF T%NES . . . . . . . ,~ YES° , . . . ° , . . . . . o . ° . . . . , . .1 NO° . . . . . . . . . . . . . . . ° , , , . . °~ OK . . . . . . . . . . . . . . . . . . . . . . . $ IERT.TO-LAST l%lT i M YES,** . , . . . . . , . ° . . . . . . . . . 1 NO . . . . . . . . , . . . . . . . . . . . . . . YES . . . . . . . . . . . . . . . . . . . . . . 1 ; D[ . . . . . . . . . . . . . . . . . . . . . . . 8 kq.14BEB OF T%KES . . . . . . . . TE$° , , . , . , , , . ° . . . . . , . . . . . t NO, , , , . , . . . . . . . . . . . . . . . . . DR, . , . , . , . ° . * *** . ° . . . . . . . S $ECOIIO" F RON- LAST BIRTH IN4E YES . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . [31{ . . . . . . . . . . . . . . . . . . . . . . . g YES . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . * . . . . . . OK . . . . . . . . . . . . . . . . . . . . . . . 8 NU[48£R OF T%NE$ . . . . . . . . TIES,**, . . . . . . . . , . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . o , . . .2 DE . . . . . . . . . . . . . . . . . . . . . . . S I 4sz Iw , , (WE) ~,~r ILl with I YES . . . . . . . . . . . . . . . . , * . , . .1 NO . . . . . . . . . . . . . . . . • . . . . . .Z YES . . . . . . . . . . . . . . . . . . . . . . I 453 I CHECIC 216: CHIL~ AL IVIE? 454 | GO IACX TO I (SKIP TO 45S) (SKIP TO 455) V FOr HEXT BIRTH; OBt IF NO NORE BIRTHS, SKIp TO ~.8S. ¥ (SKIP TO 455) y i 240 li 455 I MALHE LAST RIRTN i~ NEXT-TO-LAST I l ITR l i~C~-HI3 -LART BIRTH J J R~i (II~/HE) been I l l vt th YES . . . . . . . . . . . . . . . . . . . . . . I YES . . . . . . . . . . . . . . . . . . . . . . 1 TEl . . . . . . . . . . . . . . . . . . . . . . 1 | I Eev~ ~t ~ t |me tn RO . . . . . . . . . . . . . . . . . . . . . . . 2 MO . . . . . . . . . . . . . . . . . . . . . . . 2 RO . . . . . . . . . . . . . . . . . . . . . . . 2 I the I . t 2 ~.~eks? OR . . . . . . . . . . . . . . . . . . . . . . . 8 i~ . . . . . . . . . . . . . . . . . . . . . . . 8 ~R . . . . . . . . . . . . . . . . . . . . . . . 8 AS6 I Has (~) been I l l u i th YES . . . . . . . . . . . . . . . . . . . . . . 1 YES . . . . . . . . . . . . . . . . . . . . . . 1 YES . . . . . . . . . . . . . . . . . . . . . . 1 I . co~. , .ov t , . ,~ ~o . . . . . . . . . . . . . . . . . . . . . . . ~ . . . . . . . . . . . . . . . . . . . . . . . . z~ ,o . . . . . . . . . . . . . . . . . . . . . . . ~ , I the LAst 2 Weeks? (SKIP TO ~)< (SKIP TO ~)< (SKIP TO ~)< DE . . . . . . . . . . . . . . . . . . . . . . . 8 DK . . . . . . . . . . . . . . . . . . . . . . . OK . . . . . . . . . . . . . . . . . . . . . . . 457 , H.S (R~ME) he~ i l l uiTh YES . . . . . . . . . . . . . . . . . . . . . . 1 YES . . . . . . . . . . . . . . . . . . . . . . 1 YES . . . . . . . . . . . . . . . . . . . . . . 1l I • cough ~T *ny t (ne In k~ . . . . . . . . . . . . . . . . . . . . . . . 2 NO . . . . . . . . . . . . . . . . . . . . . . . 2 RO . . . . . . . . . . . . . . . . . . . . . . . 2 I I the L l~t 24 hour i ? OR . . . . . . . . . . . . . . . . . . . . . . . 8 DR . . . . . . . . . . . . . . . . . . . . . . . 8 DE . . . . . . . . . . . . . . . . . . . . . . . 8 i - . . t , , oAT* . . . . . . . . . . . . . . . . EAT, . . . . . . . . . . . . . . . . BATR . . . . . . . . . . . . . . . . J IF LESS THAN 1 DAY, REC~D *~'1 L59 YES . . . . . . . . . . . . . . . . . . . . . . 1 I 461 ~62 ~en (NAME) he~J the I l Lnm u l th i co~)h, d id he/she breathe fe l le r than u~ual WItH shor t , rspfd breeths? CHECR~ A55 AND 456: FEVER OR COUGH? Ves I~y~hi~g give~ to t reat the fever/coug~7 HO,,o . . . . . . . . . ° , . * *****° .2 DR . . . . . . . . . . . . . . . . . . . . . . . 8 TEE . . . , , , . , , . . , * **** , . . , .1 OH . . . . . . . , ° ° , . , .o . . . . . ° , .8 "YES a IH EITHER "YES ~ IN EITHER &55 OR ¢56 455 OR 456 >(SKIP >(SKIP TO /.65) TO ~651 v YES . . . . . . . . . . . . . . . . . . . . . . 1 YES . . . . . . . . . . . . . . . . . . . . . . 1 IK) . . . . . . . . . . . . . . . . . . . . . . . 2 ~0 . . . . . . . . . . . . . . . . . . . . . . . 2 (SKIP TO ~6] ) ' 8] D (SKIP TO &6])" ~ OR . . . . . . . . . , . , . o , . . . , . . . . . . . . . . . . . ° . , . . . , . . . . . . . YES . . . . . . . . . . . . . . . . . . . . . . 1 OR° , . ° , °° . . . . . . , ° . . . . . . . °8 "TEE ~ IN EITHER 455 OR 456 E~ OTHER TO 465) v ~ES . . . . . . . . . . . . . . . . . . . . . . i J ~ . . . . . . . . . . . . . . . . . . . . . . . 2 (SKIP TO 663)< [H~ . . . . . . . . . . . * . . . . ° * . . . . . I~ l t ~ls given to t re l t the feverlco~gh? ~h{r)g else? REC~I~D ALL TREATMENTS ~ENTIORED. INJEOTIOH . . . . . . . . . . . . . . . . A AHTIHIOTIC (PILL ~t STRUP) . . . . . . . . . $ ANTIHALARIAL (PILL OR SYRUP) . . . . . . . . . C COUGH SYRUP . . . . . . . . . . . . . . D OTHER PILL (~ SYRUP . . . . . . [ ORiOiO~ PILL Oil SYI~P. . .E HERE RE~IEDT/ HERBAL HEOIEIIE . . . . . . . . . G OTHER H INJECT IOR . . . . . . . . . . . . . . . . A AJ~TIBIOTIC (PILL GE SYRUP) . . . . . . . . . i ANT IKALARIAL (PILL OR SYRUP) . . . . . . . . . C COUOH SYRUP . . . . . . . . . . . . . . O OTHER PILL OR STIKJP . . . . . . E UHl~Ol,ld PILL OR STRUP.F HOME RE~t~Y/ HERBAL NEO [ CIt4E . . . . . . . . . ; OTHER H IRJECTIOM . . . . . . . . . . . . . . . . A ANTIBIOTIC (PILL OR SYRUP) . . . . . . . . . R ANT1MJ, LARIAL (PILL Oil SYRUP) . . . . . . . . . E CCUGH STRUP . . . . . . . . . . . . . . O OTHER PILL O~ STRUP . . . . . . E U ~ PILL OR ETRUP.F YX]~E REMEDY/ HEREAL ME'lOIRE . . . . . . . . . G OTHER I (SPECIFY) (SPECIFY) ($PECIFT) J (sKip TO ~.ss~ ] ~ . . . . . . . . . . . . . . . . . . . . . . . 2] OidtputmentYOU leekfor ~dv~cethe or . . . . . . . . . . . . . . . . . . . . . . (SKIP TO 465)< 1 YES . . . . . . . . . . . . . . . . . . . . . . 1 YES . . . . . . . . . . . . . . . . . . . . . . I YES 1 IdO . . . . . . . . . . . . . . . . . . . . . . . 2 I~ . . . . . . . . . . . . . . . . . . . . . . . E (SX P TO /,65)< f lrver/eo~lh? Fram ~hom or where d~d you seek ~dvice or t re , tment? Anyone else? CIRCLE ALL PERSONS SEEN AklO PLACES VISITED. GOVERNMENT AND PAgJLSTATAL ItOSPITAL . . . . . . . . . . . . . . . . . A HEALTH CENTRE . . . . . . . . . . . . | 015PEHSARY . . . . . . . . . . . . . . . 0 PARASTATAL HOSP/CLINIE.D VILLAGE HEALTH POST/ IA~EER . . . . . . . . . . . . . . . . . E MEDICAL PRIVATE HECTOr RELIGIOUS ORG. )~SPICLIN.T PRIVATE DOCTGE/HOSP/CL]N.G PHARMACY/MEDICAL $TORE.H OTHER PRIVATE SECTOI TRAOiTIO(¢AL PBAOTI(~dER.,.| HEIGHH~S/HELATIYES . . . . . . J OTHER R (SPECIFY) GOYERHMENT AND PAJUtSTATAL HOSPITAL . . . . . . . . . . . . . . . . . A HEALTH CENTRE . . . . . . . . . . . . I DISPENSARY . . . . . . . . . . . . . . . ¢ pAAASTATAL HOSPICLINIC.O VILLAGE HEALTH POST/ VGEKER . . . . . . . . . . . . . . . . . E ~OICAL PRIVATE E~CTOR RELIGIOUS ORG. ~/CL IH .F PRIVATE D~CTC~/I~SP/ELIH.G PHARHACT/Iq~OICAL STORE.H OTHER PRIVATE SECTOR TBAD[TIORAL PRACT]OHER.I #EIGHHGRS/RELATI'~I[S . . . . . . J OTHER E (SPECIFT) GOVERWCENT AHO PAP, ASTATAL HOSPITAL . . . . . . . . . . . . . . . . . H HEALTH CENTRE . . . . . . . . . . . . I DISPEMSAJIY . . . . . . . . . . . . . . . C PARASTATAL I~P/CLIRIC. . .O VZLLAGE HEALTH POST/ ~ la~R . . . . . . . . . . . . . . . . . E ~OICAL PRIVATE SECTCII RELIGIOUS ORO. HC~P/C~.IM.F PRIVATE DOCTOR/HOSP/CLIH.G PKARP4ACY/14EOICAL STCILE.H OTHER PRIVATE SECT(~ TRADITIOIdAL PRACTIO~I. I NEIGHBORS/RELATIVES . . . . . . J 3THEH [ (SPECIFY) 241 I LAST SlITH M~E ~s I HI . ( .~) h.~ d la r rhH (SKIP TO 467)< ] TES . . . . . . . . . . . . . . . . . . . . . . 1 ( th ree or mre k~tery | tooLs ) I i n the L&st t~ ',~l'ekl? DK . . . . . . . . . . . . . . . . . . . . . . . 8 I I I ~ ILACS TO 4/*6 FOR NEXT BIRTH; OR. I f RO NOtrE SIRTRS, SI~IP TO i~EXT'TO't.AST I IRTM I ,ES . ; ;~; ;+; . ;~+; : . . . . . . . '11 D'~II:1211::2:22::I:1221:2~ t S~ C3~ • F RClM" L)~T RIRTN I MA~ YI~$ . . . . . . . . . . . . . . . . . . . . . . T (~[P TO ~67)< ]1 DH . . . . . . . . . . . . . . . . . . . . . . . 8 | 4~.7 | N I l (N/~IIE) had d ia r rhea YES . . . . . . . . . . . . . . . . . . . . . . I TES . . . . . . . . . . . . . . . . . . . . . . 1 +ES . . . . . . . . . . . . . . . . . . . . . . 11 I ( th r~ '~ or more ~tery s t~Ls) NO . . . . . . . . . . . . . . . . . . . . . . . 2 MG . . . . . . . . . . . . . . . . . . . . . . . 2 HO . . . . . . . . . . . . . . . . . . . . . . . E I |n the taat 26 hour i ? OK . . . . . . . . . . . . . . . . . . . . . . . 8 DIC . . . . . . . . . . . . . . . . . . . . . . . S D( . . . . . . . . . . . . . . . . . . . . . . . 8 +I +''+''+ . . . . . . . . . . . . . . . . r - rn . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . the d i * r rhea tmat? I f LESS THAN 1 DAY, REC,~O '01~' YES . . . . . . . . . . . . . . . . . . . . . . 1 NO. , . . . . . . . . . . . . . . . . . . . , ,~ /~69 | Was there ~ry b lood I Ln the s too ls? I+l+,+ LAST CHILD ST ILL aREAS?FED? 671 | Our~t~g (MA;41[)' I d i l r rhe l , I d id you chl ,~ge the f re~y o f b reast f eedir~g? YES MO ~] y YES . . . . . . . . . . . . . . . . . . . . . . 1 HO . . . . . . . . . . . . . . . . . . . . . . . (SKIP TO 6~)< YES . . . . . . . . . . . . . . . . . . . . . . 1 OK . . . . . . . . . . . . . . . . . . . . . . . 8 (SKIP TO 6T~) ~,2 . . . . . - - YES . . . . . . . . . . . . . . . . . . . . . . O[ . . . . . . . . . , , , . , . . , . , , . , ,8 (SKIP TO 6T~) ' ° I ° ' °+ + ' - ° ' . I fee¢~ o¢ re~x:e them, or d id REDUCED . . . . . . . . . . . . . . . . . . 2 ~-~-- -=~--~-~.-~-~- ' -~-~ yo~ StOp comptetetyT SIORP£D t~I~LETELY . . . . . . . 3 ~- . . . . . . . . . . . . . . ~ - - 1411 he /she R iven the s~ SA,~ . . . . . . . . . . . . . . . . . . . . . 1 ~ . . . . . . . . . . . . . . . . . . . . . 1 ~ . . . . . . . . . . . . . . . . . . . . . 1 mou~t to d r ink as be fore ~C~E . . . . . . . . . . . . . . . . . . . . . 2 ~K~E . . . . . . . . . . . . . . . . . . . . . 2 Im3~E . . . . . . . . . . . . . . . . . . . . . 2 the d ia r rhea , o r more , o r LESS . . . . . . . . . . . . . . . . . . . . . ) LESS . . . . . . . . . . . . . . . . . . . . . 3 LESS . . . . . . . . . . . . . . . . . . . . . 3 tess? DK . . . . . . . . . . . . . . . . . . . . . . . 8 D[ . . . . . . . . . . . . . . . . . . . . . . . B DE . . . . . . . . . . . . . . . . . . . . . . . 8 674 Wml ~h lng R iven to t reat YES . . . . . . . . . . . . . . . . . . . . . . 1 YES . . . . . . . . . . . . . . . . . . . . . . 1 rES . . . . . . . . . . . . . . . . . . . . . . 11 the d ia r rhea ? NO . . . . . . . . . . . . . . . . . . . . . . . 2~ IK) . . . . . . . . . . . . . . . . . . . . . . . 2~ NO . . . . . . . . . . . . . . . . . . . . . . . 2 (SKIP TO 676)< 8J [SKIP TO &76)< ~ [SKIP TO 676)< OK . . . . . . . . . . . . . . . . . . . . . . . OS . . . . . . . . . . . . . . . . . . . . . . . OS . . . . . . . . . . . . . . . . . . . . . . . 6~ Whet ~S g ive~ to t ra i t the d ia r rhea? Anyth i r~ e l se? RECORD ALL TREATNEMTS HENTIOI4ED* FLUID FROM ORS PACIIOET.,A RECO~[NOEI) Ka4£ FLUIO* . .S AMTISIOTIC PILL OIL SYRUP . . . . . . . . . . . . . . . . . . . C OTHER PILL OR SYRUP . . . . . . D INJECTIOU . . . . . . . . . . . . . . . . £ DRIP . . . . . . . . . . . . . . . . . . . . . F HO~E RE)~DIES/ HERBAL MEDICINES . . . . . . . . G OTHEE H (~*~ECLFT) FLUID FR~ a~S PACKET. . . .R RECOkl4EMOED KOI4E FLU ID ' . . | AMTISIOTIC P ILL Oil SYRUP . . . . . . . . . . . . . . . . . . . C OTHER PILL OR SYRUP . . . . . . D ]NJECTI(3¢ . . . . . . . . . . . . . . . . E DR]P . . . . . . . . . . . . . . . . . . . . . F HONE REMEDIES/ HERBAL NEDICIMES . . . . . . . . G OTHER H (SPECIFT) FLUIO FRON (~S PACICET.A SECCN4Ek~ED NO4E FLU ID* , . | AJITIBEOT]C P ILL C I t EY [%11P . . . . . . . . . . . . . . . . . . . C OTHER PILL OQ S~1rdP . . . . . . O INJECTION . . . . . . . . . . . . . . . . E DRIP . . . . . . . . . . . . . . . . . . . . . F RENEDIES/ HERBAL ~EDICIMES . . . . . . . . G OTHER N (SPECIFY] • RECOI4HEMOED HOI4E FLUID i~ADE FR(~4 SUCa/LR, SALT AND WATER ILkIO/CIR CEREAL Oit THIM P<~RIDC~E. 242 I 4;'6 i ODd y~J seek i~vtce or I t rxment for the dl~rrhee? LAST l l tTH YES . . . . . . . . . . . . . . . . . . . . . . 1 I~H. . . . . . * *oo , . . . . . . . . . .2 1 (S~IP TO &78)< I u,qE NEXT-tO-LAST DIRTS I YES . . . . . . . . . . . . . . . . . . . . . . 1 ************************* (S¢IP TO 471~)~ / SECCM)-fSQE-LAST 8LE?H I ~qE ~l[S . . . . . . . . . . . . . . . . . . . . . . I I i 40 . ** . . .o* . ** .o . . .o . . . . . .~ (SEIP TO 4;'~)< 477 4?? F~o~ ~o~ or vhere did you seek edvlce or treatment? A~rc~e else? CliChE ALL F~RSa4S SEEN pL~l~S VISITEO. Vss (IUO~) Divert ftuLd from ORS p~¢ket v~e~he/she ~ad the dllrrhea? GO'~RkU4[HT ~ pAJ~STATAL HC~P [ TAL . . . . . . . . . . . . . . . . . A H[ALTH CENTSE . . . . . . . . . . . . I DISPEH~tY . . . . . . . . . . . . . . . C PKIL4STA?AL HGDP/CLL 11~¢*.D i V[LL~G~ I~LT~ POST/ UOMI~I . . . . . . . . . . . . . . . . . | MED[C,~L PRIVATE S~¢TOR RELIGIOUS OMG, Y~$P/O.|IoF PR]VAfE DOC TOM/~¢aP/CL | H, G P~dUU4ACY/14£D I CAL STCI~.D OTHER P~ VAT£ SECTOR TROD [ T IO~AL PSLACT IOMI[H., 1 N£ I GHIK3tS/RELAT I~S . . . . . . J OTHER [ (SPECIFY) TEE. ORS fLUID W[HTIONED TO ~K)) FEE**,°.°, . . . . . , . ° . . ° . , , .1 J~ . . .o° . . . , , .o .o . . . . . . o.,~ (SLIP TO &81)~ J DE,,,. .° . . . . . . o.o.° . . . . . GOV[Ik~[NT AND PAJU~$TATAL HOSPITAL . . . . . . . . . . , . . . . . . A HEALTH C:ENFSE . . . . . . . . . . . . 0 DISEEDSAtT . . . . . . . . . . . . . . . C PAXASTATAL NGSP/CL[NIC.O VlLL~Gl[ llE~LTN P~T/ IRSlCER . . . . . . . . . . . . . . . . . E N£DICAI. P~IVATE ~J[CTOR RELIGIOUS OMG* J~SPIC~.IS.F PRIVATE OGCTGO/k~5~/CL I S. G P~JU4ACY~ [ CAL STONE.N OTIS| PDLVAT[ SECTO~ TP~D I T I CI4AL PRACT[OMEt. 1 SE ] GI~ORS/IU[LAT [VI[$ . . . . . . J OTI~E [ (SPECLFT) OMS FLUID mS FLUID SOT SENT ]OMED SEHT IOREO )(~ELP TO GSO) YES . . . . . . . . . . . . . . . . . . . . . . 1 (SLIP TO ~f)< | DH. , . * * , . . . . o . . . . . . . . . . . . 8~ ~QV'EENN[IIT AND PA,~ASTATAL J~PL TAL . . . . . . . . . . . . . . . . . A HF, J,L TH CIENTIL£ . . . . . . . . . . . . | DIS~[N~U~¥ . . . . . . . . . . . . . . . C PkstASTA;AL ~P/CL INIC.D VILLA~ HF~kLTU P(~T/ VCGI~E . . . . . . . . . . . . . . . . . £ H[OICAL PR]VAfE SECTOR I~ELIGLOU~ OMG* Y~SP/C3-IH.F J~t [VATS DCCTOt/Y~0~5~/C1.1N . G PHA~U4ACY/I(EDICAL STORE.N 3~EE Pt|VATE ~CTOR TRAO I T [ OR~J. ~CT ]O~l[J~. L 0~ ] GJ/JIOES/RELAT I ~[ $ . . . . . . J )TREE I: (~PI[CI FY) ORS FLUID OMS FLUID IK)T J4£HT LOM£D ~EHT [ONF~ >(SKIP TO 480) TEE . . . . . . . . . . . . . . . . . . . . . . 1 (~ lP 10 &81)< 6~0 | for h¢~ May days ~as r (IL~4[) D iv~ f lu id f rc l the ORS pecker ? IF LFES THAN f DAY, RECCAO ~OO* HE~OIE HDED ~ FLUID •NEiIT IONEO? 482 | vu (~41~) given • re¢cew,~ded I hem f lu id uncle from s~otr~ J i l t and v4ter arid/or cetsa~ or ~.hin porridge vd~en he/she J had ~he d[srrhee? DAYS . . . . . . . . . . . . . . . . ~- -~ DE, , ***° .o . * . . * ** , **°* , . " EQ. YES, Y~4~[ FLUID HONE fLUID NOT IeEHT IOM[D 14SET ioM[D TO ~531 I~°°°.*.o.o*°°**.,* oo**.*~ (DEIP TO ~1< OE. . . . ° .oo . . . . . . . ° . . . .o . . DATE . . . . . . . . . . . . . . . . DE°H° . . . . . . . . . . . . . . . ° . . , UOp YES, FLUID HOp~ FLU[O UO| SEHT [OMED SENT IOM[D [~) (SZ IP TO ~83) YEE . . . . . . . . . . . . . . . . . . . . . . 1 (S~IP TO 46~)< DE 8J . . * ** .o . . . . * .oo* . . .o . .o DAYS . . . . . . . . . . . . . . . . DE . . . . . . . . . . . . . . . . . . . . . . 98 llO. YES. HCE~ FLUID KCI4E fLUID VOT W[HT ZONED I4£HT IC~[D _ TO /~3) YES . . . . . . . . . . . . . . . . . . . . . . 1 J I I~ . . . . . . . . * , * . . .o . . * . . , . .~ I I {SEIP 10 ~.8~) DE .o . . . . . . . . . . . . . . (t~4[) given the f lu id perle DAYS . . . . . . . . . . . . . . . . frmt i~ l r , l a | t , I~d ~ l t l r tnd/or cere|L or =bin ~rrSdge? DE . . . . . . . . . . . . . . . . . . . . . . 96 OATE . . . . . . . . . . . . . . . m l OATS . . . . . . . . . . . . . . . [ ] ON . . . . . . . . . . . . . . . . . . . . . .0 . . . . . . . . . . . . . . . . . . . . . . . . IF LESS THAN 1 DAY. HECC~9 GOI, FOE NEXT DIRT)t; GO, I f I~ MCmE SIETKSp GO TO • IEC~IO41[;dOEO HClq~ FLUID KADE FROM SUGAJ(, SALT AND UATER A.qO/OR CEREAL OM THIN P~H[D~. 243 ~" I (~ IRG CATEGORIES 4aS 486 QUESTIOIrS AJqO EILtEIrl CJ~CIC A73 and &?9: ORS FLUID ER()l PAO~ET GZYEH TO ANy CHILD l I ORS FLU[O FROM PACKET NOT GIVEN TO ANY CHILD r~ OR &?~ ARO 4?9 NOT ASJO~ v HaW you aver heard of I Sl:~ClaL ~roduct e l ided (LOCJU. IUUqE) you elm get fo r the t reat~t of d iarrhea? I TO I I I YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1- ->4~8 I40 . . . . . • . . . . . . . . . . . . . . . . . . . . . . . . ~ I +1 M'+" + ' r ' - ' ' ' * ''"*h'' +*" I * " . 11 ($HQU PA~T) NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 - - )A92 &88 I Have you ever prepared I so lu t ion w i th ohm of these | YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 | I packets to t reat d(arrhea In yourse l f or $~meon4 e lse? I I (SNOUPACJCET) NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-~--->491 +1 '+ + ' ' ' ' ' + ' ' I . I I:W~ket, d id y¢~ pre~ar l the k~ole pe¢k l t I t ~ l Or o~(y I~r t o f the ~hat? PART OF PACKET . . . . . . . . . . . . . . . . . . 2 - ->&91 HO~ m~ch uatar d id y~J ~e to prepare (LOC.~L NAME OF ORS PACI(ET) the les t t ime you i (~e I t ? ++l 491 E 493 Uhe~e curt ~ Hat the (LOCAL NAME) J :~ket~ pHCa~E: Ar~y~J~ere elEcT CIRCLE ALL PLACES NENTZORED. 1\2 LITER . . . . . . . . . . . . . . . . . . . . . . . 1 1 LITER . . . . . . . . . . . . . . . . . . . . . . . . . 2 1 1\2 LITERS . . . . . . . . . . . . . . . . . . . . 3 2 LITERS . . . . . . . . . . . . . . . . . . . . . . . . & FOLLOk~D PACI~GE INSTRUCTIONS.5 OTHER 6 (SPECZF¥) DE . . . . . . . . . . • . . . . . . . . . . . , . . . . . . . 8 G~'ER~NT AJaD PAAASTATAL ~ITAL . . . . . . . . . . . . . . . . . . . . . . . . A HF.AL TH C~EHTRE . . . . . . . . . . . . . . . . . . . H O I SPENS)Jt T . . . . . . . . . . . . . . . . . . . . . . PAJ~ETATAL ICG~P/CL J MIC . . . . . . . . . . O VZLLAC.E HEALTH POST/NCt~k'ER . . . . . . E ~IEOICAL PRIVATE ,TAECTOR RELIGIOUS ORG. KOSPICLIIdIC . . . . . . F PRIVATE DOCTORIKOSP/CL]NIC . . . . . . G PHARMACY/'NED I CAL STORE . . . . . . . . . . H OTHER PRZVATE SECTOR S~ . . . . . . . . . . . . . . . . . . . . . . . . . . . . L TAADI T IOHJLL PRACT IOqER . . . . . . . . . . J ME 1GHI~3R$/RELAT IV~$ . . . . . . . . . . . . . IC OTHEE L (SPECJFY) ~er l d id ~ Learn to ~ep l re the recomemlded home f lu id made from sugar, aa l t , a r~ l~ter I~ J /o r cerea l or por r idge 81ve~ to (N~) k~lenhe/she hed d ia r rhea? GOVERNMENT ~ PAXAETATAL HOSPITAL . . . . . . . . . . . . . . . . . . . . . . . . A HgALTN CENTRE . . . . . . . . . . . . . . . . . . . l OI$PENSAR¥ . . . . . . . . . . . . . . . . . . . . . . O PAKASTATAL HOSP/CL [NJC . . . . . . . . . . D VILLAGE HEALTH F'~ST/~ORiCEE . . . . . . E MED[CAL PR[VATE SECTOR RELIGIOUS ORG. HGSP/CLIMIC . . . . . . F PRIVATE O~CTOR/i~SP/CL [ H I C . . . . . . G PHARMACT/1410 Z ~L STOd(E . . . . . . . . . . H OTHER PRIVATE SECTOR SHOP . . . . . . . . . . . . . . . . . . . . . . . . . . . . I TRAD l TICIWAL PR.ICT l C~E R . . . . . . . . . . J NE [GH~S/RELATI~E . . . . . . . . . . . . . K OTHER L (SPECIFY) 244 Y~CTICU 5. HNtR;AGE I& IP Im. I CIJEBTIONR AND ,,LTEtS 1 C~OI,G CATEGOIIIE| I TO 501 I Hive y~J ever been i r r led or Livid uith i in? I YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I l I I I 110 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2------>512 502 J t*lck~ed,Are yo~ ~or divorcedmarr ted OrortlVlngr~ I~ger;dlth l iv ihg • m~, together?°r are you novJ i4ARRIEDLIVING TOGETHEr . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 211 I I W I ~l~rO . . . . . . . . . . , . . . . . . . . . . . . , . DIV(~CEO/KO LONGER LIVIMG 507 TOGETHER . . . . . . . . . . . . . . . . . . . . . . ( SO/* i DC~ your h~bancl/partner hsve shy other wives besides J YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 J I your•el f? I I MO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2---~.507' +1 +_o+__+_ I - . D, . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9~ -'-SO? ~1 ~r+++ - - + l - - . ~1 + i _ +_ .+, .o**_ + , . _ ~ + _ . . _ ,+ + i .o_ . . . . . . . . . . . . . . . . . . . . . . + ~+ . , '1 I o,+o ++ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . i 509 H~ old wre you k~en y~ stsrted t lv lr~l u i th your I AGE . . . . . . . . . . . . . . . . . . . . . . . . [ -~ ( f i r s t ) husband or partner? I I ] OK AG~ 9tl I 510 CHECK 508 AMO 509: y£JUI Ak~ AGE GIVER? TES NO I I 511 CHECX CONSISTENCY OF 5GE AMO 509: YEAR OF BIRTH (105) PLUS + AGE AT KARRIAGE (509) ~ '~ CALCULATED TEAR Of MARRIAGE ]11 L I I IF HECESSAJtYj CAL~JLJ4TE YEAR OF BXRTH: Hllt~J$ CIJRHEHT AGE (106) CAL(~JLATE~ YEAR OF BIBTH I I I I l l IS THE CALCULATED YEAR OF 14ARRIAGE WITHIH ONE YEAR OF THE REPORTED YEAR OF ~IARRIAGE (508)? YES ~] ~ • PROBE AMO CORRECT 508 AND 509. V 5KIP TO 513 ~513 245 NO. QUESTIONS AND FILTEJR $12 IF HEVER M~d~RIED OR LI'~[D ~[TN A Jqkq: Hsve y~ ever h id sexuml |ntercourseT S4CIP C~) I I (~ CATEGORIES I TO m YIEI . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 l l RO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 - - - - .520 513 Nov ~ need some ~etsiLs ~x~t ~ar se~tJaL ac t iv i ty In order to I~t I bet ter ur~ierstw~dinH of fami ly p l~nnlr~ w~d fe r t i l i t y , Hoe Mny t i JeS d id you h ive sex~t in terc~r ie in the Les: f~Jr ~eks? TILES . . . . . . . . . . . . . . . . . . . . . . [ ~ 514 How a~y t lm In i month do y~a mulL ly hew $ex~l Intercourse? TINES . . . . . . . . . . . . . . . . . . . . . . ~- -~ S1S CHEOC 513: S4[)CUAL INTERNS4- ~ T ~EE OR HOlE ZERO TINES 517 J Did you t~e i condom wi th any of these men? YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 I HO . . . . . . . . . . , . . . . . . . . . . . . . . o,.°.~l $18 Uhen ~41 the LiLt t ime you hid lexu l l tntercourseT )518 I r-'-[----i DAYS AGO . . . . . . . . . . . . . . . . . 1 I I J WEEKS AGO . . . . . . . . . . . . . . . . 2 MONTHS AGO . . . . . . . . . . . . . . . 3 TEARS AGO . . . . . . . . . . . . . . . . 4 DEFCt~E LAST EIRTH . . . . . . . . . . . . . 996 519 521 521 How old were you when ~ f i r s : had sex~( In terc~rse? PRESENCE OF OTHERS AT THIS POIST. IIo~ [ h ive O few c~st lc~s ~ e very Important topl=.J Hlvt you he l rd of In I lLness cal led A]DS7 I FIRST TIME kqCEl KARSIEO . . . . . . . . 96 CH|LDRER UNOEE 10 . . . . . . . . . . 1 k~. . . . . . . . . . . *oo . . .o ,o l OTHER HALES . . . . . . . . . . . . . . . . 1 OTHER FENALES . . . . . . . . . . . . . . 1 I YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 J I i E¢ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-----)601 522 Froa ~ l¢h sc~rces of In fo re i t ion or persons have you he l rd shout AIDS in the lest month? RECORD ALL HENTI~EO. R~(O. . . . . . . . . . . . . . . . . . ooo . . . . . . A TV .o . . . . . . . , o , . . . . . . . . . . . oo . . . . . S NEUSPAPERS . . . . . . . . . . . . . . . . . . . . . . C HEALTH ~RI~ES . . . . . . . . . . . . . . . . . . D ~O¢~UES/CNUICN~S . . . . . . . . . . . . . . . . E FRIEk~S/SELATIVES . . . . . . . . . . . . . . . F SCHOCCS/~JRkl TEACHERS . . . . . . . . . . G SLOGANS/pN4PH~ETS/POSTERS . . . . . . . H C¢~44UIIITT iq£ETlHGS . . . . . . . . . . . . . . ] CC;q OFFICE . . . . . . . . . . . . . . . . . . . . . . d OTHER [ (SPECIFY) HC~NE . . . . . . . . . . . . . . . . . . . . . . . . . . . . L 246 IIQ. CUESTiONS AND FILTERS I 52~ NOW Is AIDS trer~aitted? EECCRO ALL MENTII~ED. tlqp I CCCtImG CATEC~StlES I TO III~EDLEEI$~ES/SICIM ~glCT1AIES. . . | ROTHgl TO CHILD . . . . . . . . . . . . . . . . . C TRANSFUSIOR OF IhFECTED SLOCO.O OTHER t (SPECIFT) DOU'T ~hOk¢ . . . . . . . . . . . . . . . . . . . . . . F 524 Do you thiAIt th| t yo~ can get AIDS from shaking hsncbl u i th somec~c v~o has AIDS? huggir~ sceeeL~ ~ho hss AIDS? k l s t i r~ |omeone vho has AIDS? uesrtr~ the ctothem of s0e~or4 vho has AIDS? shJrlr~l eatfn9 u te~l l s v i th s~me~e no has &lOS? t t~ ing on the ur l r~ or s t~ l of s ~ who has AIDS? mosc~ito, flea or ~ bites? YES go HJU~DSHAKING . . . . . . . . . . . . . . . . 1 2 ~ IDG . . . . . . . . . . . . . . . . . . . . 1 2 KISSING . . . . . . . . . . . . . . . . . . . . 1 2 EHARING CLOTHES . . . . . . . . . . . . 1 2 SIOJ~ZRG UTIDG UTEHSILS.1 2 SIEPPIHG ON URINE/STOOL.1 2 I¢C'S~¢JKTO/FL[~VBEDBUG BITES.1 2 I . '1 to have AIDE? NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 DE . . . . . . . . . . . . . . . . . . . . . . • . . . . . . . 8 I I . I g ive b i r th to • ch i ld wi th the AIDS v i rus? go . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 DK . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 I I . I goveerm~nt should do for pe<q)L~vho hive AIDS? HELP RELAT]VI[S PHO~IGE C-~E . . . . . 2 ISOLATE/QUAII~JWTIHE/JAtL . . . . . . . . . 3 NOT IR INV~Y~D . . . . . . . . . . . . . . . . . 6 OTHER 5 (SPECIFY) I I $28 | I f your relat|ve I t sufferir~l with AIDS, ~o v~td | SELATIVES/FRIEk@S . . . . . . . , . . . . . . . I I you ~efer To cart for hia/her? I DCVERMMEDT . . . . . . . . . . . . . . . . . . . . . . 2 RELIGIOUS ONG./HISSI~I . . . . . . . . . . 3 I I ogoDY/A~ON . . . . . . . . . . . . . . . . . . 6 OTHER 5 (SPEC%FT) 247 RO. 603 ¢~¢X 312: SHE/RE JK3T STERILIZED E~CTIOE 6. FE|T[LLTY Pt~EFEk|MC~$ QI.JESTIORS NdD FILTERS | C~[NG C~TEG~IES )RE OR Site STESIL IZ[D [~ gCtP TO 1~607 CHEC[ 501ANO 502: CtJ~RERTLY NARRIED O~ LIVING TOGETHER [~ ROT MARRIEO/ l~Y LIV%NG I ~'614 CNE~ 22~: NOT PREGNANT OR ~q~llE [~ / I V Rc~ I h,ve S~ qJestlonm ai0out the future. ~o~Ld you Like to hive (a /~ther ) ch i ld or u~JLd yo~J prefer not to have ~ {more) chi ldren? PREGNANT [~ I V Nov I hive some cNestto~ ~oout the future. After the ch i ld you sre expet:t(~g, ~(d yogi ( |ke to hsve ~other ch i ld or would you prefer not to have any ~r t children? NAVE A (A;IOTHER) CHXLD . . . . . . . . . . 1 NO MORE/I~ORE . . . . . . . . . . . . . . . . . . . . Z~ SAYS SHE CAJJIT GET PREGI~NdT . . . . . 3 >610 UiCDECXOED OR D~ . . . . . . . . . . . . . . . . . $ 604 CHEC~ 223: k~T PREC*;dANT OR Lk~S~JRE [~ / I V Hey lor~l ~ ld ymJ Like to ~eit from ~ before the b i r th of Ca/another) th i rd? C~EC[ 216: HAS LiVXIG CHILDREN PREGXNIT PREC~ANT ? I ¥ NOv 1ct',9 w~aldyou Like to ~ i t after tha b i r th of the ch i ld y~a are expecting before the b i r th of ~nother chLLd? )4CddTHS . . . . . . . . . . . . . . . . . . . 111~" YEARS . . . . . . . . . . . . . . . . . . . . 2 SO~/N(~ . . . . . . . . . . . . . . . . . . . . . . 994 SAYS SHE P.kM'T GET PRECJU~T*.*99~ OT½EE (SPECIFY) O[ . . . . . * . * . . . . . . . . .** . . . . . . . . . 998 ~IV IVG C.lLOt[N [ -~ >610 ~610 606 CH£r.~C 27.3: NOT PREGNANT OR UWSURE (~ PR£GNAUT [~ I I ¥ V xc~ old u~Jld y~J Like Hov old would y~J Like your youngest ch i ld to the chSld y~J are be uben y~J r~xt ch i ld expecting to b~ vhenyour is born? rtext c~l ld is born? AGE OF YOL~GEST CHILD i YEARS . . . . . . . . . . . . . . . . . . . . . . O[ . . . . . . . . , , . . , . . . . . . . °, o °. , o, ,9~- >610 248 IQ. I QUESTIC~S AND F[LTk']IS ~' I "'""-- ~'*o h.~''* ~ thl¢|~tlitW~ell+c~erlt(o n not to y~J ~ld IDke (f have any y~Jthehed~mtO CIO It C~IO t MG I I TE$. . . . . . . . . . . . . . . . . . . . . . . . . o l l l o . .2 S~|P TO 6~ not 00 Y~to havereereti~vthlt(more) children? y~ {your husbend) hid the operltlon J YES. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 J >614 +,o i . . . . . . . . . . . . . . . . . . . . . . 611 I f~mi|y p(mnning in H~ often hove you theti(ked to your h~band/partner yeir? J ONCEME~R" . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . OFTEM. TWICE ,2 +1 I +. I +l I°:. +++ +1 I OTHERYEAR$''''''''**''"'"'"z~?H$** . . * ' I ~ ' T KMQI,I 998 ($PEctF¥) [~99~* I 'l ++1-,, I++ . . +"1 I - . . . . . . . . . +1 249 NO. 618 QUESTIONS AND FILTERS CHECX 216: KAS LIVING CHILDREN ~ NO LIVING CHILDREN / / I L V ¥ I f yOU ¢~Ld So b4¢k to The ] f y~ could c~o~e time yo~J did not have ~ exsctty The ruder of ch i ld ren ~ coutd choose c~I tdr~ to hero Ifl exact ly the rumer of chi tdre~y~Jr WhoLe Life, hov to have in your whole l l f l ib~f M id that beY ho~B=e~f ~o~td th*t be? RECORD SINGLE ~q4GER ON OTHER AJ~S~ER. CODING CATEGI~ INS X~NBER . . . . . . . . . . . . . . . . . . . . . OTHER AN~dER (SPECIFY) T~ I 619 the chi ldren yo~ ~t to h lw , how ~ wutd y~a prefer to b~ boys ~d ho~ w~y to be | i r l sT I,IJ4BER Of S~S . . . . . . . . . . . . [ J f IUqBER OF DAL~HTERS . . . . . . . I~SEX PREFERE#C~E . . . . . . . . . . . . 9~ OTHER A~S'b~N 96 (SPECIFY) 62O yemrs bet~-e~ the b i r th of ot~ child and the b i r th of the next chi ld? yEARS . . . . . . . . . . . . . . . . . . . . 2 OTHER 996 (SPECIFY) DCId'T KNO~ . . . . . . . . . . . . . . . . . . . . 99~ 250 SECTION 7, 11USIUUID'S IMCXCAOJgD ~ UCI4A~'S ~K NO. I OUESTIC4dS ANO FILTERS I CC~IMG CATEGORIES CHEC.~ 501: YES, IqA.RRIED OR ~ NO, MEVER KkRRI~O LIVED I~ITH A RAN OR Li'~F.O WITN A ~ ~ / V ASK ~UESTIOW$ ABO, JT CURREMT OR MOST RECIEMT IIUe-dlAJIO/PARTMER, 5XIP I TO I I I 702 C~ (couLd) yc~Jhusb4nd/partner read and ur l te m F~SlLT . . . . . . . . . . . . . . . . . . . . . . . . . . I | [ I su~hi l l eesHy, v f th d i f f i cu l ty , or not at altT i WITH OIFFIOJt.TY . . . . . . . . . . . . . . . . . 2 I Y, OT AT ALL . . . . . . . . . . . . . . . . . . . . . . i I ,+ . i 704 kr~st was the highest formH school he completed? L£SS THAN 1 TEAR . . . . . . . . . . . . . . . OO ST/~D/~D1 . . . . . . . . . . . . . . . . . . . . . . 01 STANOAR92 . . . . . . . . . . . . . . . . . . . . . . 02 STAHOARD3 . . . . . . . . . . . . . . . . . . . . . . O~ STAMOAJtO& . . . . . . . . . . . . . . . . . . . . . . 04 5TAMOARD3 . . . . . . . . . . . . . . . . . . . . . . OS STAMOARD6 . . . . . . . . . . . . . . . . . . . . . . 06 STAHOARO7 . . . . . . . . . . . . . . . . . . . . . . OT STAMCIARD8 . . . . . . . . . . . . . . . . . . . . . . FQRM1 . . . . . . . . . . . . . . . . . . . . . . . . . . 09 F~2 . . . . . . . . . . . . . . . . . . . . . . . . . . 10 FORK3 . . . . . . . . . . . . . . . . . . . . . . . . . . 11 FCCW. . . . . . . . . . . . . . . . . . . . . . . . . . . 12 FO~ . . . . . . . . . . . . . . . . . . . . . . . . . . 13 Fgl~6 . . . . . . . . . . . . . . . . . . . . . . . . . . 14 UglVlEHSITT . . . . . . . . . . . . . . . . . . . . . 1S OTME| 16 (SPECIFY) 705 E m 707 t~et k i r~ of ~ork @oRs (did) your ( tes t ) h~l>M~/part~r Imin lydo? Does (did) y~r h~berd/partrmr wrk i l l i n |y on his c~ land or f~ i ty I~ , or does (did) he font lard, or does (did) he ~K~¢k on s~w~¢¢~ e l le* l Ilno~ I HI$/FANIL¥ UU~ . . . . . . . . . . . . . . . . . 1 REMTED LIU4D . . . . . . . . . . . . . . . . . . . . . 2 S04£~E ELSE'S ~ . . . . . . . . . . . . . 3 251 NO, I OLESTIOqS NdO FILTERS i I AIido f r~ l y~,~¢ o~ hc~alev~rk, i re yo~ curr~tLy I keorking? l I P ~IMO ~TEGQ~IES I TO I YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I - - )T IO I 709 AS y~ k~, scme vn~en take up jo~ for ~hlch they i re ~ id In + or kind. Others SeLL things, have a ro l l IxJsine~s or kmrh on the f~ i ly faPa or In the f l l i ly lx~ i r~sll. Are you currentLy doing ~ of these things or ~ny other ~*ork? I YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 I I IC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 +717 710 IA~IT l i your oCC~l~itton, that f l , ~d~lt kir~ of ~ork ~ y~4J dot IT3 I FOR Fk'qlLY NENSER . . . . . . . . . . . . . . . 1 F(~ S~KE(314E ELSE . . . . . . . . . . . . . . . . 2 5£L F" £I~LOYED . . . . . . . . . . . . . . . . . . . 3 711 In y~r current work, do you ~rk fop a mm/)er of yc~r fmi ty , for scmec~e else, or I re yo~ self-amp(DyeD'? 712 Do ~J earn ¢~.J~ for this v~rkT I TEe . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I FROGS: DO you ike ic/~y for ~rk ing? l + . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 713 Do you do this work at hem or euay from h~me? I 714 i CHECI( 215/216/218: HAS CHILD IK3EM SIMC3[ YES JAM. 1986 A)ID LIVIMG r---1 V WITH RESP~IDENT? Y 715 White yc~ are k~rklnD, ~y'o~Iul~.P, l l l y hlwl (MA~ OF TCUdCd[ST CHILD AT KOAE) with yc~J, scm~tlmts hive hI l /~er with you, or he~r hive hlw~ner with yc~ I HCJME . . . . . . . . . . . . . . . . . . . . . . . . . . . . I AWAY . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 V-1 j~717 J I i USUALLY . . . . . . . . . . . . . . . . . . . . . . . . . 1 - - )} '17 SCI4ET IN~S . . . . . . . . . . . . . . . . . . . . . . . 2 MEVI[R . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 716 ~ho usua(ty take~ c,re of {~ OF TOI,IWCd[ST CHILD AT H(~I¢E) ~l le you are working7 RECi~DTHE TIME HUSB/JiD/PARTMER . . . . . . . . . . . . . . . . 01 OLDER CRILD{R£M) . . . . . . . . . . . . . . . 02 OTH£I RELATIVES . . . . . . . . . . . . . . . . 03 MEIGHRG~S . . . . . . . . . . . . . . . . . . . . . . 04 FRIEMOS . . . . . . . . . . . . . . . . . . . . . . . . GS S~RVAHTS/HIRED HELP . . . . . . . . . . . . 06 CHILD IS IM SCHOOl. . . . . . . . . . . . . . O? IMSTITUTICI4AL CHILDCA~[ . . . . . . . . 08 OTHED 09 (SPECIFY) ,, i;;iiiiiiiiiiiiiiiiiiii 252 S~ECTION 8. ~[GNT ANO GEIGNT CH~CX 222: ON~ OR DIRTHS SIH(2 JAN. 19~6 NO BIRTHS SINCe[ JAN. 1986 L ~ ) 9Q1 INTERVIEkER: |M 802 (COLUMNS 2-4) FE~ THE LiME N~q~B FOE EACH CHILD ~N SliCE JAkq~dY 1~ ANO STILL ALIVE. IN 803 ANO 804 FEC~D THE NAME ANO GIRTH DATE FOE THE HESP~VOENT ANO FOR ALL LIVING CHILDREN ~N SINCE JANUARY 19~6. iX 806 AKG ~08 BECSP~D HEIGHT ANO WEIGHT OF TH~ HESP~ENT A~O T~ LIVING CHILDREN, (NOTE: ALL RESP~OENT$ W(TH C~E OR K(~E BIRTHS S]NC~ JAk~RY 1986 S~LD ~ k~IGKED ANO M~A~D EVEN IF ALL OF THE CHILDREN KAV~ O[~D. IF THERE ~E N~E THAN 3 LIVING CHILDREN ~N SIHC~ JAk~U~Y 1~ USE ADDITIOIdAL FORMS). 8O2 LINE NO. FROM 0212 803 NAME FROM 0.~12 FOR CHILDREN 8O4 DATE OF DIRTN FRON Q215 F(~ HESP~3iiOENT FROM O.21S FON CHILOREN, AND ASK FOR DAY OF BIRTH 80S RCG SCAR ON TOP OF RIGHT SHOJLDER 8O6 HEIGHT ( in cent imeters ) 807 kLqS HEIGHT/LENGTH OF CN]LD ~AUED WHILE CHILD UAS LYING Do'q4 GE STAJ4OING UPRIGHTT 8O8 UEIGNT ( In k l I ogrm) 809 DATE DEIGNED ANO MEASURED 810 RE~JI.T 811 NANE OF MEAS~EB: ~J RESPONDENT (HJQ4£) W~TH. , . , i ~ ] I I I YEAR. * * , . DAY . . . . . . MONTH . . . . YEAR . . . . . MEASURED . . . . . . . 1 NOT PRESENT.3 HEFUSED . . . . . . . . 4 OTHER . . . . . . . . . . 6 (SPECIFY) r-N [• TOL~GEST LIVING CHILD m CNN4£) OAY . . . . . . N~rTN . . . . YEAR . . . . . SCJUt SEEN . . . . . . 1 NO $~ . . . . . . . . 2 N- D LYING . . . . . . . . . . 1 STANDING . . . . . . . 2 -qD DAY . . . . . . )K3NTB . . . . YEAR . . . . . CH I t , NEAUED. 1 CHI t , S|CX . . . . . 2 CHILl) NOT PItES~NT . . . . . . . 3 CHILD REFUSED.& MOTOR RE FUSED. S OTNEB . . . . . . . . . . 6 (SPECIFY) NAME OF ASSISTANT: NEXT-TO - YOUNGEST LIVING CHILD DAY . . . . . . )K3NTH . . . . YEAR . . . . . SCAR SEEN . . . . . . 1 JiG HC~ . . . . . . . . 2 LYING . . . . . . . . . . STANOING . . . . . . . 2 N--V1.D DAY . . . . . . M(IHTH . . . . YEAR . . . . . CHILD NF~SUR£0.1 CHILD EICX . . . . . 2 CHI t , NOT PRESENT . . . . . . . 3 CHILD REFUSED.4 NQTHEE RSFUSED.$ OTHER . . . . . . . . . . 6 (SP£CIFY) & EECCNO-TO* YOUNGEST LIVING CHILD m (~) GAY . . . . . . W~qTN . . . . TEAR . . . . . SCAR SEER . . . . . . 1 NO SCAR . . . . . . . . 2 LYING . . . . . . . . . . 1 $TANO[NG . . . . . . . 2 BAY . . . . . . Ma4TH . . . . YEAR . . . . . ¢HILD NEAUED. t CHILD SICK . . . . . 2 CHILD NOT PRESENT . . . . . . . 3 CHILD REFUSED.4 MOTHER REFUSHD.S OTHER . . . . . . . . . . 6 (SPECIFY) M 253 HECTION 9. LANGUAGE IMFCFU4ATION NO. ~ CUESTI~E ANO FILTERS Q01 ~ IR ~4AT LANGUAGE OlO YOU C(~DUCT THE tNTNEVIE'd7 a I KIP ~ ING~TE~IES ITO I I H,LI . °'1 OTHER ~'~ 9OZ FOR IK3k/ 14JCR OF THE INTERVIEW DID YOU DEPERD ON A THIRD pER.T.GR TO INTERPRET FOR YOU? I IICI4E OF THE INTF.RVIEV . . . . . . . . . . . ~ "EBB STKE OF THE IHTERVIEV . . . . . . . . . . . 2 | 14C6T OF THE IIITERVILrW . . . . . . . . . . . $ I ALL OF THE INTERVIEV . . . . . . . . . . . & OTHER 5 (SPECIFY) 903 IF Nd INTERPRETER WAS USEO, INDICATE THE SEX A~) APPROXINATE AGE OF INTERPRETER. AD~.T FEMALE . . . . . . . . . . . . . . . . . . . . 1 TEENAGE FEMALE . . . . . . . . . . . . . . . . . . 2 A~JLT MALE . . . . . . . . . . . . . . . . . . . . . . 3 TEENAGE )tALE . . . . . . . . . . . . . . . . . . . . & OTHER (SPECIFY) 254 INTERVIEWER'S OBSERVATIONS (To be filled in after completing interview) Comments About Respondent: Comments on Specific Questions: Any Other Comments: SUPERVISOR'S OBSERVATIONS Name of Supervisor: Date: EDITOR'S OBSERVATIONS Name of Field Editor: Date: 255 256 UNITED REPUBL IC OF TANZANIA BUREAU OF STATISTICS, PLANNING COMMISSION TANZANIA DEMOGRAPHIC AND HEALTH SURVEY INDIV IDUALM~STIONNAIRE IDENTIF ICAT ION NAME OF HOUSEHOLD HEAD TDHS CLUSTER ID . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . HOUSEHOLD NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . REGION D ISTR ICT WARD ENUMERATION AREA URBAN/RURAL (urban=l, rural=2) . . . . . . . . . . . . . . . . . . . . . . . . . . . LARGE C ITY /SMALL CITY/~OWN/COUNTRYSIDE . ~ . . . . . . . . . . . ( large city=l, smal l clty=2, town=3, countryslde=4) NAME AND L INE NUMBER OF MALE RESPONDENT NAME AND L INE NUMBER OF WIFE NAME AND L INE NUMBER OF WIFE NAME AND L INE NUMBER OF WIFE r INTERVIEWER VIS ITS DATE INTERVIEWER'S NAME RESULT* NEXT VIS IT: DATE T IME 1 2 3 F INAL VIS IT i iiiiii i ii i i i i i i i~ i iiii i i i i i i i i i i~ °AY I MONTH YEAR ID NO. RESULT TOTAL NUMBER OF V IS ITS [ ] *RESULT CODES: 1 COMPLETED 2 NOT AT HOME 3 POSTPONED F IELD EDITED BY NAME DATE 4 REFUSED 5 PARTLY COMPLETED 6 OTHER OFFICE EDITED BY KEYED BY KEYED BY 257 IECTIOII 1. RES~IIDEMT*I II~GIICLUD S~IP NO,. I ~JESTICiE AJ~ EILTEIIS | ~ l l l~ CATE~IEI | TO m10~ REC(~O TI~( TIME. I F i rs t I kmutd t lke to i l k totm CFJ~tlonl ~ b4ckero~nd. For ~t of the t im ~nt l t y~ ver l 12 ye l r l o ld, d id you t i l l In Dar as St[ I~I c i ty , I~Other urbl~ er ie , or in the rurlL Irt~l? .~iiiiiiiiiiiiiiiiiiii~ I CITY (OAJ IS SJU.Jukq) . . . . . . . . . . . . I I OTHER ~ ARF_A . . . . . . . . . . . . . . . . 2 I AREA/~ l LL/~E . . . . . . . . . . . . . . 3 NlO~ ] CSJRREMTHOV t°ng h ive ~u bee~ l i v l r~ ¢c~t l~m~Y Ih (IIJUC O f p L A C E Of IIESIDEMC:E)? ~YsYEJJIS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ~ I V]SITOI . . . . . . . . . . . . . . . . . . . . . . . . 96 1~.1¢105 - I I . '1 S i l l clty, ~t~ ~ Irl l , or in the r '~ l l Irel? OTII~R IJEJLIA KIIEA . . . . . . . . . . . . . ,.Z RURAL AR~I/'V 1 LI.~GE . . . . . . . . . . . . . . 3 DK NGI~TII . . . . . . . . . . . . . . . . . . . . . . . 98 YF.JUI . . . . . . . . . . . . . . . . . . . . . . * ~ ++1 +°+- '+ '* -+*++ . m CCI4PARE AHO CORRECT lO'J AM0/OIt 106 IF INCONSISTEMT. 14107 | t in you reed awd vr i t * kil~lhhlll | EASILY . . . . . . . . . . . . . . . . . . . . . . . . . . 1 I I l l t l y# vJth d i f f i cu l ty , or not I t l i l T I WlTI DIFFICU4.Ty . . . . . . . . . . . . . . . . . 2 MOT AT ALL . . . . . . . . . . . . . . . . . . . . . . 3----Y~1109 - I °° ~-+ ~' ' -+ °~- ' ' ' ' ' + ' - - I ' + * . . I ++1 -~ ' -~+°+ I " ' . ' l lio . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 - -~Ml l l Nl10 tdhit I i the highest forlm( school ¢clpletedT LES~I f i lm 1 TF~ . . . . . . . . . . . . . . . GO STAMDARD 1 . . . . . . . . . . . . . . . . . . . . . 01 S T/dlID ARO Z . . . . . . . . . . . . . . . . . . . . . 02 STANDARD 3 . . . . . . . . . . . . . . . . . . . . . 03 STAHDAItD 4 . . . . . . . . . . . . . . . . . . . . . 04 STAJlDAIID $ . . . . . . . . . . . . . . . . . . . . . 05 STAHIDARD 6 . . . . . . . . . . . . . . . . . . . . . 06 STNIIOAII9 7 . . . . . . . . . . . . . . . . . . . , .07 STA)IDAIIO 8 . . . . . . . . . . . . . . . . . . . . . 98 FOI~ 1 . . . . . . . . . . . . . . . . . . . . . . . . . 09 FO~ 2 . . . . . . . . . . . . . . . . . . . . . . . . . 10 FO~ 3 . . . . . . . . . . . . . . . . . . . . . . . . . 11 FO~I & . . . . . . . . . . . . . . . . . . . . . . . . . 12 FORJI 5 . . . . . . . . . . . . . . . . . . . . . . . . . 13 FORN 6 . . . . . . . . . . . . . . . . . . . . . . . . . 14 UgiV~HSZTT . . . . . . . . . . . . . . . . . . . . . 15 OTHRR 16 (SPECZ FY) +' I ° '+-*+'+" ' ° '+° ' * +- ' - ' I '+ + . . .~ '1 '"~ I ° °+-+'+ +' " ' " +"* - ' - ' I '" ,o . . ~ '1 258 lEO, Rtl$ I l l& #115 QUESTIONS AMD FILTE|S Hhat klrv:l of ~ do y~ l in ty do? CCO I fIG CATEGOl I ES E Ip TO CHECJ( Nl13: 1 ~KH iCES IN AGRICUt.TtJRE [~ MOTEl AG~I~Jt.TI~qlE~K [--1 )Mlt v | DO you Work mlnty ~ ~ ct~ txi~d or f i i (y l ind , I Oi/B/FARILY LA~ . . . . . . . . . . . . . . . . . I or do yogi r lmt l ind, or do ~ llork ci~ io~l t eLle~l I RENT LAJ~ . . . . . . . . . . . . . . . . . . . . . . . 2 Ian:ft' $O~E(~4E ELS~+S ~ . . . . . . . . . . . . . Hl16 Set is your reLIgton? i IIIJSLIN . . . . . . . . . . . . . . . . . . . . . . . . . . 1 CATHOLIc . . . . . . . . . . . . . . . . . . . . . . . . 2 PROTESTAHT . . . . . . . . . . . . . . . . . . . . . . 3 HONE . . . . . . . . . . . . . . . . . . . . . . . . . . . . & OTHER S (S~ECIFY) M117 ?o k41ich t r ibe do y+ubetcr+l? l I r ~HEC[ 0.5 ]N THE I~GUSEHOLO SCHED(J~[; THE RESPt~I4OEHT IS NOT A TKIEEESP~OENT IS A U~L HESIOENT Of THE HH ~k RESIDENT OF THE HH Nl19 H~ I Mc~Jld ISkl to ISk + th l p ike tn ld l l ch yo~ usual ly t l~ . 0o y~J us~mlly Live In Oar ell Salaam city, Inother + l r l l , Or in the rUrlL I re i? IF OTHER UROJU4 AAU: In ~4Hich tmdoymJ Liver* I CITY (DkE ES SALAN4) . . . . . . . . . . . . 1 Lklt~ t~ ktF~ . . . . . . . . . . . . . . . . 2 Sl4ALL UIIIl+ldl kHEA*, . . . . . . . . . . . . . . 3 RUI~L AREAJ¥] LI.AGE . . . . . . . . . . . . . . & ~,47.01 +I I + m IF USUAL EESIBEIIG[ IS OUTSIDE OF TAMZN41A, HE~D C(~UMTRY Of HESIOEHC4E. E leCt r i c i tY? ELECTRICITY . . . . . . . . . . . . . . . . I 2 A r~dio? RADIO . . . . . . . . . . . . . . . . . . . . . . 1 2 A te levt l le~? TELEVI$]OI . . . . . . . . . . . . . . . . . 1 2 A re f r f | l~r l tor? EEFH I GEIL~TOI . . . . . . . . . . . . . . . ~ 2 n122 | CouLd y~u describe th l ra in IwtePil( Of the ftoor | EARTH/SAhD . . . . . . . . . . . . . . . . . . . . . 11 I of your home? ] H(X~O PLNImS . . . . . . . . . . . . . . . . . . . . 21 pARQUET ~ P~.IEHED IJCCO . . . . . . . 31 C£RAXIC TILES . . . . . . . . . . . . . . . . . . 32 CEMEMT . . . . . . . . . . . . . . . . . . . . . . . . . ~3 OTHER 41 (SPECIFY) N123 [ Does atOm emlr of your ho~ehoLd ot~: I A bicycte? A motorcycle? A cart I YES BICYCLE . . . . . . . . . . . . . . . . . . . . 1 Z HOTOI~ETCL[ . . . . . . . . . . . . . . . . . 1 2 * O. M119 LARGE URBAN AREAS ARE ~AHZ~+ ARUSHA. HC~OGOitO, DODCNA. NOSHI, TAMGA, IRiHGA, MHEYA, TAB(~A ANO Z~NZlHAR. SMALl. URBAN AR~A$ ARE ALL OTHER TO~,I~S. 259 NO. II,~01 S~CT[OM 2. REPRC©4X;TIOM Sa(IP OUEETIC~S N~ FILTEgS ¢~011~ ¢ATEGOIIEE ~ TO m ~oy~hav~inysoM or d iu i~ter td~o i rehcv Living YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ~ I ulth I I govmm~y so~l Live v l th y~? SC~S AT HaE . . . . . . . . . . . . . . . I I I | And ho~ aw~y do~ghtors L Iw v l th I DAUGHTERS AT F~I4E . . . . . . . . . . IF N~E ENTEg '00~. M203 Ooyou have eref sonl or deughters ~hodo not Live YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 J uLth you? I Sou Bany sons are a l i ve Ix'r( do not l i~ v l th you? S~S ELSEt/HEgE . . . . . . . . . . . . . ~ J And hc~ •any daughters are aLLy• ~ do not Live with I DAUGHTERS ELS~NEJI~ . . . . . . . . IF k~3qE ENTEg '00~. Nave y~J ever had * sc~ or daughter uho ua8 born a l ive YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 I la ter died? I NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 - -> i4207 14206 In eLL, hcva ~ boy~ h|ve died? And h¢~ many g i r l s have dim=7 ~06 IF NOHE ESTEI '00 I . SUq A J~RS TO N202o ~120~. AND ~, A~O ENTE| TOTAL. [F gONE ENTEg 'O0'. CHECk( 1¢2D7: Jt~t to make sure that [ have this r ight: yOU hev~ TOTAL - - ch i ldren born a l ive during your L i fe . IS that correct? I TOTAL . m l • ¢~HECT N201-N207 AS NRC~SSAEY 1¢*.-~09 I RelYing!r1 the f i r s t day of a ~°s period wld the I YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 J r f i r s t doy of her next per l~l , i re ~hera certa in t im NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2----i uhen she he~ • greeter charge of becoming pr~t D[ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 ~N301 than other T~mT | 1(210 During uh|ch tfJN of the monthly cycle do~ I u~n hart the greatest chance of becoming pregr~t? DURING HER ~IIOD . . . . . . . . . . . . . . . 1 SIGHT AFTEg HEB PERIOD IMR ENDED . . . . . . . . . . . . . . . . . . . . . . 2 IN THE mlDOLE OF THE CYCLE . . . . . . 3 JUST SEFCAE ~ER PERIOD BEGZNS.6 OTHER 5 (SPECIfy) 2~ S~CTICU 3: CCUTILA£F.PTI~II I 1 | 8ow l ~outd l i ke to t•Ik about f lm i ly p lanning - the wr taue ueys or mt l~da tMt • couple ran me to I de lay or aVOid I pregnancy, k lHch ~ly~ m" Imtho~l h4v~ y~ heard ~/ t? ¢]ECLE C~OE 1 IN ~[302 FOI EACH AETNOD JqEMTiON~ ~TADEOUSLY. T~H ~ROC~ED DO~ THE C01.Ulgl, EEADING THE NNqE AJID OE$C.tlPTIOII OF F.A£H Iq[TNOD ~1 ~NTIOW~[~ SPONTAiHEOLI~r4.T. CIHCLE CCOE 2 IF RETNCD IS RECOGNIZED, A~ CCOE 3 IF NOT I IECO~IZ[D. T~IEN, F~ EJCH M~T~ WITH ~OE 1 OR 2 CIRCLB IN [(302, ASI~ 1¢303 AMD ~0~ EEFOtE PRC(~EDI~ TO THE H~-XT H~T~. 1J PILL V~me~ can tak• ap lL t everyday . 02 IUD c~n h ive a Lo~ or co i l p l~ced ~r~lda thmby • doctor or • nurse . 03• IHJECTIONS V~q~n ¢~n have a~ In jec t ion by • doctor or ~urse ~d~ich stobe the= f rc~b4~c4 ing Preg~nt fo r severa l ~the . G4 OlAPK~Q¢.FOAN,JELLY ~ can 0~ p lace • sponge, suppos i tory , diaphragm, je l l y or c ram In - a ide them before In terco~rs• , O~ CONO0~ He~ ¢~n use • rubb•r OSI sheath ~ar tng s•xu*t In ter - cour t . The r l~t>er s~ea~h ts ~ed to avo id pcegn~-~--f, to prevent t r l~u.a l isston of disea•e~l such aa ALOE, or fo r c lean l iness . 0 6 • FEHALE STERIL[ZATIOII cM1 h•v• MI O l~r•t lon to avo id hav l~ l any•ore ch i ld ren . 0• HALE STERILIZATION k~ c l~ have ~(1 opeFat|o~ to avoid hav i r~ lK~yBore ¢h i td~m. 08• CALENOAR CoupLes can have sex~ml In tercourse on ly dur ing the s~fe per iod o f the Ionthty cyc le , th•t i s the t im dur ing the mOnthLy cycle "~h~ the ~ |s Least L ike ly to became I~eg~t . 09 14JOJS ~ETNOD A wren can 91 ~4~e~ve da i ly the s ta te of the m.~ua and ovo id sexual In ter - course et the t ime ~h~q the mJCU~ I s co lo r less ext rmely e las t i c . tOI VITHORAWAL Men c•n be care fu l i~d pu l l out be fore c t imu. 14302 He~ " r~ ever heard of (METI~O)? READ OESCH IPT IGU EACH NETI400. YES/SP~IT . . . . . . . . . . . . . . . . . . . 1 YES/PROGED . . . . . . . . . . . . . . . . . . 2 ~ . . .o* . ° .oo .o . . . . ° . . °oooo . .~ )1303 I lew ycu (or your v l re /per tr ier) ever used (NETI~¢O)? (NETI~O)? YES . . . . . . . . . . . . . . . 1 11~. , . . . . , . . . °o , ***2 1(304 Do you kn~ ~herQ • person co~|d go to g4t (METe)? YES .* . . . . * . . ° . * . . . . . . ° . . . . .1 UO. . . . . . . . . . . . . . . . . . - , . . , . .2 YEE/S,~I~T . . . . . . . . . . . . . . . . . . . I YES . . . . . . . . . . . . . . . 1 YES . . . . . . . . . . . . . . . . . . . . . . . . 1 ves/P~e~'o . . . . . . . . . . . . . . . . . . 2 NO . . . . . . . . . . . . . . . . . . . . . . . . . . 31 NO . . . . . . . . . . . . . . . . 2 I NO . . . . . . . . . . . . . . . . . . . . . . . . . 2 v i i YES/SP~tT . . . . . . . . . . . . . . . . . . . 1 YES/PROEED . . . . . . . . . . . . . . . . . . 2 NO. . . . . . . o. . . . . . . . . . ,o , . . . . . / Y YES/S~T . . . . . . . . . . . . . . . . . . . 1 YE$/PRC~ED . . . . . . . . . . . . . . . . . . 2 k~O . . . . . . . . . . . . . oo .oo° . . , . °o°31 Y YES/SP~T . . . . . . . . . . . . . . . . . . . 1 YES/PR06[O . . . . . . . . . . . . . . . . . . 2 hO. . ** . . . . . . . . . . . . . . *o* . . - . .~ / v YES/SF~NT . . . . . . . . . . . . . . . . . . . 1 YES/PROSED . . . . . . . . . . . . . . . . . . 2 ~ . . . * * . .o . .o . ° . . . . . . . o . . . * *~ ¥ YES/SPq31T . . . . . . . . . . . . . . . . . . . 1 YES/PRO|ED . . . . . . . . . , . . . . . . . . 2 k~.* . . .o .ooo , . ° . .o . * . . . . . . . . w YES/SPQHT . . . . . . . . . . . . . . . . . . . 1 YES/PRCIED . . . . . . . . . . . . . . . . . . 2 I (0. . . . . . . oooo*.*ooo. . . . . . . oo~.1 ¥ YES/SP~T . . . . . . . . . . . . . . . . . . . t YES/PR(~ED . . . . . . . . . . . . . . . . . . 2 NO. . . . * . , . . . . . * *o , . .o*H* . . .3~ YES . . . . . . . . . . . . . . . 1 NO.°°*°°° . . . . . . . . . 2 YES . . . . . . . . . . . . . . . t ~K)* . . , . . . . . . . . ° * . °2 YES . . . . . . . . . . . . . . . 1 ~o . . . . ° ** . . . . . . . .2 YES. . . . . . . . . . . . . . . . . , . . . . . t NO . . . . . . . . . . . * . . . . . . . , . . . . . 2 v YES/$F~IT . . . . . . . . . . . . . . . . . . . 1 YES/PRiED . . . . . . . . . . . . . . . . . . ¥ YES . . . . . . . . . . . . . . . . . . , . . . . . 1 NO. . . . . . . . . - . . . . . . . . . , . . . . .2 YES. . . . . . . . . . . . . . . . . . . . . . . .1 NO. . . . . . . . . . . . - - - . - . . . . . . .2 YES . . . . . . . . . . . . . . . I YES . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . 2 NO . . . . . . . . . . . . . . . . . . . . . . . . . 2 i Havo you ewr had a~ YES . . . . . . . . . . . . . . . . . . . . . . . . t o¢)er l tLon tO avoid hav|rql any Bore NO . . . . . . . . . . . . . . . . . . . . . . . . . :t ch I idren? YES . . . . . . . . . . . . . . . 1 ~K) . . . . . . . . . . . . . . , .Z i YES . . . . . . . . . . . . . . . 1 Oo y~J knov u l t ra • person can obta in advice on how to NO . . . . . . . . . . . . . . . . 2 use th~ caLendar method? YES . . . . . . . . . . . . . . . . . . . . . . . . t NO. . . . . . , . . . . . . . . o . . . . . . . . .2 i YES . . . . . . . . . . . . . . . 1 Oo you Enou Here • person con obta in ~(¢e on hOW to NO . . . . . . . . . . . . . . . . 2 obeer~e cha~gee in the mJcus7 YES . . . . . . . . . . . . . . . . . . . . . . . . 1 NO,*** . ** . . , ,o . . * . . * oo.o. . .~) i YES . . . . . . . . . . . . . . . t NO . . . . . . . . . . . . . . . . 2 261 1] N i t OTk~R NETNGOS I (5PECI FY) 2 (SPECIFY) "1 GUESTIORS Ak~ FILTERS Haw y~ (or ym~r w~fe/~rtner) ever wed erefthing or tr ied In ~ ~y to delay or avoid havirlg I chll4? S~lP I CODING CATE~IES I TO I . ! +i I CORRECT ~- I~OAJ (AMD ~ IF NECESSARY). STERILIZE~ STERILIZED v l 14309 I Are yo~ (or y~Jr wife/partrmr) ¢urre~tty doing I~eeth~ng I I or uMng ~ ~:hod To ~tay or avoid hlvirqi • chi ld ' / I I I+01 I TEE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I I U I~ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2--:.~G15 14310 ~ic~ method are you umtng? CIRCLE '07' FOR PALE STERILIZATZOM. I PILL . . . . . . . . . . . . . . . . . . . . . . . . . . . 01 I IUD*** .** . . . . . **** . . . . . .***** .o~ I IMJ'ECT IORS . . . . . . . . . . . . . . . . . . . . . 03 D IAPNRAGq/FGNq/JELLY . . . . . . . . . . . O~ (~0(~1. +. . . . . . . . . * *** , * . . .o . *~ FEMALE STER I k ITJ~T ZOR . . . . . . . . . . . 06 KALE $TERILIZATZOR . . . . . . . . . . . . . 07 CALEMDAIt . . . . . . . . . . . . . . . . . . . . . . . MIJ(3~ NET~O . . . . . . . . . . . . . . . . . . . 09 V [ T flDILAMAL . . . . . . . . . . . . . . . . . . . . . ~(315 OTl~R 11~ (SPECIFY) I K311 CHEOR M310 SHE/NE STERILIZED ? USING ANOTHER NETRCO ? I I V V b~ere did the ~ere did you (or s ter i t i za t tm take wife/partner) ~ta J f l pike? (RETIED) L i l t t i l l ? GO~Rk~NT AMD PAJLARTATAL I CCIJgJI.TJWT )K~ITAL . . . . . . . . . . . 11 I REGICIAL NU~P|TAL . . . . . . . . . . . . . 12 DISTRICT IIOSPZTAL . . . . . . . . . . . . . 13 HEJLTR CENTRE . . . . . . . . . . . . . . . . . l& DISP[NGARY . . . . . . . . . . . . . . . . . . . . 15 PAAASTATAL HEALTN F.U:lLITY.16 VILLAGE REALTR PQGTAORIC~R.17-->I(31& MEDICAL PRIVATE $ECTGI I RELIGtCUS ORG. FACILITY . . . . . . . 21 I Ftt|Y. OOCTOI/DLIR]C/HOSPITAL.Z2 PHAJUMCY,QGD t CAL STORE . . . . . . . . 23 LINAT[ C30 ~JCRlaER . . . . . . . . . . . . . . ZE ~(31A OTMER PRIVATE S~CTOR I SI~ 1 . . . . . . . . . . . . . . . . . . . . . . . . . . 31 I NEIGHiK~S/RELATlYER . . . . . . . . . . . 32 OTHER 41 I~14 (SPECIFY) DR.,.,. . .o,Q~ I 312 I HO~ Long does i t take to t r ivet I fros yc~Jr home to th i | pike? [~ LESS THAN TVQ HOURS. EECORO TRAVEL yr . : OT~E~W{SE, RECORD TRAVEL TIME ]g HOURS* I MINUTES . . . . . . . . . . . . . . . 1 [0 i ~S . . . . . . . . . . . . . . . . . 2 DI( . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99~ 262 OO-I X313 I 1~15 I QUESTIONS N4D FILTERS I s I t e leyo+ d i f f i cu l t to ~et there? CHECX ~109/1(310: HOT CURRENTLY ~ USIM~ v Marl you used • condom In the t i l t fmr lilqfklT I ~111¢ ~ILTE~IIIEI OIFFICULT . . . . . . . . . . . . . . . . . . . . . . . l I;TIP ~ To I !-I i YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 I 1(316 I kl~at IS the brand ~ of the cot~o l you t i l t tmedT J- m i Oq{, . . .o** . . . . . . . . * . . °o , . . . . . . . . .~ l PARTRER (~TA 1111~ . . . . . . . . . . . . . . . . 91J FREE . . . . . . . . . . . . . . . . . . . . . . . . . . . . 96 ~S. . *** . . . . . . . . . . . . * . . . . . . . . . . ,ogE 14316 | Do you use lo re ¢ondcml r~ i than • year Igo, ~ k~E . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 I the same ru loer , or feverT SANE MUI4~II . . . . . . . . . . . . . . . . . . . . . 2----1 FEbA[S . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 / >1(320 J4319 ~d~at I s the ~e ln reasc, n yoqJ use amre condom r~u th~ a y~ur aS~T FEAR OF G~TTING AIDI . . . . . . . . . . . . I FEAR OF G~TTIHG OTk~S STO . . . . . . . 2 FAMILY PLANH lllG . . . . . . . . . . . . . . . . . 3 LESS EXP~NSIVE k~U . . . . . . . . . . . . . . 4 MORE AVAILABLE ~ . . . . . . . . . . . . . . 5 OTHER 6 (SPECIFY) J~( . . . . . . . . . , , , .H . . , . . . . . . . * ** . .E I 11321 Do y~ Intend to tale a mth(x l to de is t ~ avoid TEE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 - - )~23 hav i r¢ l • c~ l ld a t any t l lm In the fu tureF SO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 | >1(327 DI( . . . . . . . . . . . . . . . . . . . . . . o . . . . . . . ~ | 11322 ~hat Is the main ream ~ do r~t intend to e l l a method? ~AI~I T $ CHI LOSES . . . . . . . . . . . . . . . . . 01 - - LACIC OF SNO~.ED~ . . . . . . . . . . . . . . 02 pAATHES OPEq~ED . . . . . . . . . . . . . . . . 03 COST TOO NUCR . . . . . . . . . . . . . . . . . . 04 SIDE EFFECTS . . . . . . . . . . . . . . . . . . . 05 I~EALTN (~)NCE the . . . . . . . . . . . . . . . . HARD TO G~T H£TIIOOS . . . . . . . . . . . . 07 RELIGION . . . . . . . . . . . . . . . . . . . . . . . 08 OPPOSED TO FAMILY PLANNING . . . . . 09 FATAL I ST I D . . . . . . . . . . . . . . . . . . . . . 10 OTHER PEOPLE OPP~,ED . . . . . . . . . . . 11 INFREQUENT SEX . . . . . . . . . . . . . . . . . lZ UIFE/PUTNEi I NFECUND . . . . . . . . . . 13 IHCO~VEN IEDT . . . . . . . . . . . . . . . . . . . 1S NOT KARRIED/NO PARTNER . . . . . . . . . 16 OTHER 17 (SPECIFY) DE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ~N327 °+1 i *Es . '1 ~ith in the r~ext 12 nlOnths? RO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 01{ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . a 263 ,,o.I gUENTIONE AND FILTERS ¢C0 [ i~ CATEGCI [ E l S~lP I TO 14~24 ',/him ym~ ~ase i I~th~l , Which mth~d ~out~ ymJ prefer to l i e? PILL . . . . . . . . . . . . . . . . . . . . . . . . . . . 01 IUJECTICIIS . . . . . . . . . . . . . . . . . . . . . n~[ DIAPH~F~*4~(/~ELLY . . . . . . . . . . . O& ¢~IdD(~.oo . . . . . . . . . . . . . . . o . . . . . .0~ FE]4ALE STERILIZMICII . . . . . . . . . . . 06 ~L~ ETEEILIZ.ATICI . . . . . . . . . . . . . 07 CAL£kOAR . . . . . . . . . . . . . . . . . . . . . . . ~ - mJCUS I~T k~O . . . . . . . . . . . . . . . . . . . 0¢ W I T ~DRAkL~L . . . . . . . . . . . . . . . . . . . . . 10 OTIS! 1t (SPECIFY) UliSURE . . . . . . . . . . . . . . . . . . . . . . . . . 96--- ~4327 X32S k~hlrl ¢~ you get (~4[T~ [4[U~ION[D IN M.~2/*)T (HAIqlE OF PL4C~) GOVERNNENT ANO PAJLASTATAL | CO~SU/. TART V~SP l TAL . . . . . . . . . . . 1t 1 REGI OIIAL Y~SP I TAL . . . . . . . . . . . . . 12 | DISTRICT Y,O~PITAL . . . . . . . . . . . . . 15 I~329 HEALTH ¢~[NTEE . . . . . . . . . . . . . . . . . 16 O [ $FI[MSARY . . . . . . . . . . . . . . . . . . . . 1~ PAJLASTATAL HEJU.TH FACILITY.,. .16 VILLA r'J NEALTN .~$T,~IU(I [R. . . . I~' >~31 MEDICAL PNIVATE S1[CTO~ | RELIGIOUS G~G. FACILITY . . . . . . . 21 Pl l IV. DOCTCdt/CL [ N I C/ltOSP [ TAL. ~ ~(329 PHJUO~ACY/MED [ CAL NTOEE . . . . . . . . 2~ LR4ATI C90 I/CRNEN . . . . . . . . . . . . . . 2~ >14331 OTHER PRIVATE .~[CTL~ | S~OP . . . . . . . . . . . . . . . . . . . . . . . . . . 31 ~q329 ME I GHBG~S/RE L.AT I ~d[ S . . . . . . . . . . . 3~ ] )i4331 OTHER 41 I (SPECZFY) DOH'T KHCV . . . . . . . . . . . . . . . . . . . . . 98 >~27 +"1 Do ~ kr~ of I p l l l¢ l ~her l yma Can or)f l i r t • mthed of fmlLy p l~n lng? ~t328 klhere ~1 th l tT (H~JAE Of PLAttE) GOVERNMENT ANO P.t, RASTATAL | CCIASIJLTA;AT Y~SP ] TAL . . . . . . . . . . . 11 I REG| ORAL NOSP I TAL . . . . . . . . . . . . . 12 REGIONAL HC~P l TAL . . . . . . . . . . . . . 12 DISTRICT Y~SP 1TAL . . . . . . . . . . . . . 13 HF_AJ. T H CENTRE . . . . . . . . . . . . . . . . . l& D I SPENSANY . . . . . . . . . . . . . . . . . . . . 15 PA/UASTATAL HEALTH FACILITY. .16 VILLAGE NE.ALTN P~;T,'~RE1[R.17 ~4(331 INEDICAL PRIVATE SECTON | RELIGICUS C~qG. FACILITY . . . . . . . 21 I PRIV* D~CT~/CL | N I C/HOSP l TAL. ZZ PHAIU4ACT/NED I CAL NT{~E . . . . . . . . UKATI Clio ~ICER . . . . . . . . . . . . . . 2( OTHER PRIVATE S£CTON | SHOt . . . . . . . . . . . . . . . . . . . . . . . . . . 31 I ~331 HE ] GHEOAS/RELATIVES . . . . . . . . . . . 32 "*~31 OTHER 41 (SPECIFY) 32~) HOw long ~ i t t l ke to t r i ve t MIIPJTES . . . . . . . . . . . . . . . 1 I f r~ your home to th i s pLKI? [ ~LJ~E . . . . . . . . . . . . . . . . . 2 0 IF LESS THAN CiIE HCIJl~, REr.~:L~D TRAVEL TIRE IN NIk~JTES. OT:4ENI~ISE, NEC(XtD TIL4VI[L TIlE IN X~LItS. O[ . . . . . . . . . . . . . . . . . . . . . . . . . . . . ++°J* + *°++++*° + I + 0,+,+ . . +1 264 m[lP .o . I QUESTIONS A~ FILTERS I ¢OOt~ eATEr IES | TO 11331 [n the tu [ ~t .h , heve you heard Or seen ii Imss4ge id=(xr¢ f la iL) ' ptannlne: on the ri¢lfo? on tetevtsion? froJ a lurmt Redl¢i l eide? fr0m i MCH aide? from ne Ig~bors/ret at | yes? on posters? TEl I10 ~[0 . . . . . . . . . . . . . . . . . . . . . . 1 2 TELEVISIOII . . . . . . . . . . . . . . . . . 1 2 ~JItAL NEOICAL A I : ( . . . . . . . . . 1 Z ~N AI~E . . . . . . . . . . . . . . . . . . . 1 2 HE I GHIKIS/12LAt IVI[$ . . . . . . . . 1 Z P~TERS . . . . . . . . . . . . . . . . . . . . 1 2 14332 1~34 Is [t scceptibLe or r~t acceptlbte to y~u for family pLirnlng InforsmttQn to be provided on the radio or te levis ion? I ACCEPTNILE . . . . . . . . . . . . . . . . . . . . . . I DOT ACCZPTA~.I . . . . . . . . . . . . . . . . . . 2 CKECK IC1¢2: [~ ~s UOT [ '7 CONDOR I~O~ CODO~i Y Do you leree or d|sigree with the fotto~tn8 stateim~ts: READ AIO OBTAIN A RESPONSE FOR EACH $1ATENEIIT. Condom i re ~ed prlmmrtty ~lth casual ~mrtrmre. Cornom reduce r i sk of *exu i l ty t r~n la i t ted diseases. ACJUEE Dt SAt.DEE 1 2 1 2 ~ost ~ don't Like men to vse ¢ond~i . Uslr e ¢ondcll s~ows respons ib i l i ty . Condowm ~re used pr |Nr t ty for fmi ty pt*,'~n~re purposes. Cot l~ art elgotrissJt~g tO abtaino A consul c ln be used ware th in once. Condo1 wske sex tess enJoyibte. Using I ¢~.~,-. cl~ Dive you AIDS. 1 2 1 2 1 2 1 2 1 2 1 2 1 2 -I 265 ~IRCTIGO &, KAJUtlAGE Si(IP RO" I CUESTIONS AND FILTERS ~IRO CAT|GGtI|G | TO m N~Ol ] Haw you ~ been ;tarried or [Iv~d v l th e ~ ? YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I I I ! RO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2-----~4~0S +°1 * ++*r++°r+ + +r*+*r+l JtkNR I EO . . . . . . . . . . . . . . . . . . . . . . . . . 1 vldoved, or divorced or no ((x~er Living together? LIVING TOGETHER . . . . . . . . . . . . . . . . . 2 WIC~R]) . . . . . . . . . . . . . . . . . . . . . . . . . 3---- DIVCqC1~/RO LONGER LIVING ]+>I~0~ TC~TNER . . . . . . . . . . . . . . . . . . . . . . t+ / 16~G3 I HOv unr~ uiv~s do you hive? I XUH~N . . . . . . . . . . . . . . . . . . . . . ~ I 14¢0& Hov old vere you vhen you s t l r t ld llvir'q uith ~ J~ . . . . . . . . . . . . . . . . . . . . . . . . ~vt~ ( f i r s t ) utfa or Farther? I I~0'~ | IF NEV1ER KARRIEO GIG LIV~D WITH A I~1: I Have you e~er had sexual Interc~Jrse? I YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 I GO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 ~13 I I 1~06 I Nov u~ reed some details abo*Jt your sexual aPct(vity in I order to get a I~tter ~a~derst~r~li~l of family p l~ lnR a~i health. Houme.-~ t (m dldymJhaW sexual Intercourse (n the Last f~Jr k~-ks? J TINES . . . . . . . . . . . . . . . . . . . . . . J '~ HK07 ] HOv ~ times In a ~th do you Us~l iy hive I sexu41 intercourse? TINES . . . . . . . . . . . . . . . . . . . . . . I 08 I CHECK ~06: I KAD SEXUAL iMTERCCL,IGSE ONE 0~ i401tE ZERO TINES TINES IN LAST E~lt VEEI(S (~ ~q&l +1 I +++ . M&lO I Old y~J Usa a corv*m vlth ~ of these ~ ? Idhen uas the Last time you had sexu4t Intercc~rseT I YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I i I l l~ . , . .+ , . , , . . . , . . . . . , , . , . . . . . . . . :) GAYS AGO . . . . . . . . . . . . . . . . . 1 I I r V£ EICS AGO . . . . . . . . . . . . . . . . 2 1401iT HS AGO . . . . . . . . . . . . . . . 3 YF~NS AGO . . . . . . . . . . . . . . . . & W,~2 Ho~ old ~re yo4J When you f i r s t hKI sexu4t intercourse? PRESENCE OF OTHERS AT THIS POINT. AGE . . . . . . . . . . . , . . . . ° . . . . . . FIRST TII~ VHEM KARR[ED . . . . . . . . 96 YES 1~ CH|LOREM MEG 10 . . . . . . . . . . I VIFE . . . . . . . . . . . . . . . . . . . . . . . ~ 2 OTHER FEKA~.EE . . . . . . . . . . . . . . 1 z OTHER KALES . . . . . . . . . . . . . . . . 1 Z 266 SI[CTICII S. AIDS 13(O~EDGE MQ. ~ DUESTIOMS AND FILTERS I~01 I I~ I have I fay cF~tstlans I~a~/t I very Imp°rtlnt t°pic ' J Hl~'~ ~ hesrd of ~ ILlness caLLed AIDS? RIP CI~IMG ~TEGGtlES ~ TO I . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 ~q6C1 ~02 Frol ~ i¢h so~rcH of Jnfornmtl~ or persol~ll haw y~J heard ~ AIDS In the L i l t month? REC~D ALL HEMTIOM~. IL/~IO . . . . . . . . , . . . . . . . oo . ,o**o** .A T~. , ***** . .o . , , , , . . . . . . . . . . . . . . . J SEVSPAPERS . . . . . . . . . . . . . . . . . . . . . . C HEALTM'#[~KSRS . . . . . . . . . . . . . . . . . . D I~ JES /C~C ~ES . . . . . . . . . . . . . . . . E El [EMOS/RELAT I VES . . . . . . . . . . . . . . . F SC)K3OI_ S/QU~N TF.ACHESS . . . . . . . . . . G SLCC.u4NS/~N4PHLETS/POSTEAS . . . . . . . M CCN4.MITY IHEETIMOS . . . . . . . . . . . . . . I COI OFFIC~ . . . . . . . . . . . . . . . . . . . . . . J 01"HER • (SFECIF¥) I1~S.o. . , . , . . . . . . . . , . .oo . .o . °o . .L I ~O,~J HO~ Is AIDS tr~-laftted? t REC,~D ALL HEMTI(INED. SEXUAL INTERL'~URSE . . . . . . . . . . . . . . A II[£OLES/3LADES/SglH PUNCT1JRES.S MOTHER TO CHILD . . . . . . . . . . . . . . . . . C TIUUISFUSIOM OF INFECTED flLCOO.D OTHER E (SPECIFY) DG~'T S]eOV . . . . . . . . . . . . . . . . . . . . . . F 11504 Do you third( that you can get AIDS fraa shaking hendl ulth sam~one d~o has AIDS? h~sgtng scme,o~ ~o has AIDS? k i l l i ng |cmeone~o hal AIDS? ~ar ing the clothes of someor~ uho has AIDS? Iharlng e i t{N uterlliLa ~ith someone cho has AIDS? stepping on the urine or stool of someone u~o has AIDS? Iosqulto, flea or bed~A~lbitel? YES NO ~ddOS~llG . . . . . . . . . . . . . . . . 1 2 HUGGING . . . . . . . . . . . . . . . . . . . . 1 2 ~ISSIN6 . . . . . . . . . . . . . . . . . . . . 1 2 SI~AIIMG CLOTHES . . . . . . . . . . . . 1 2 SI~qSING EATING UTENSILS.°.1 STEPPING Oil ~RIHE/STOOL.~ E NOS~ITOIFLEAIBEDB~G SITES.1 2 NSOS J Is I t PassibLe for a healthy took|rig person J YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 I So hive AIDS? J I0 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 . . . . . . . . . o .o ,o . . .ooooo .ooo . .oo8 ~O6 J la I t pos|Jble for I ~n who has the AIDS v im to TEl . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 I give b i r th to I child with the AIDS vlr~Jm? k~ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 K . . . . . . . . . . . . . . . . . . . , * * . . . . . o° .D ~07 Vhnt do you suggest I I the most fmpertmnt thing the Doverrment ShouLd do for people uho hive AIDS? ++1 I f your re lat ive Is suffering wlth AIDS, k/nO would you prefer to care for hlw/her? PDOVIDE HEDIC.~L TREAT)4EDT . . . . . . . 1 HELP RELATIVES PROVIDE CARE . . . . . I$~XATEIr IUARAMI IHEI JA I t . . . . . . . . . ] I)T K INVOLVED . . . . . . . . . . . . . . . . . & OTHED S (SPECIFY) RELATIVES/FRIENDS . . . . . . . . . . . . . . . 1 G~VERMMEHT . . . . . . . . . . . . . . . . . . . . . . 2 RELIGIOUS ORG./NISSlON . . . . . . . . . . ] iliCI~OY/AJU~HDON . . . . . . . . . . . . . . . . . . A DTHSS 5 {SPECIFY) 267 UCTIGII 6. FERTILITY IqtEFERLEif42ES NO. I QUESTIONIE ANO FILTERlE q601 CICEC~ 14310: s.~/HLE Wr .E ~ SHE SFERItIZ~ [--I STERILIZED R *602 C~4ECX ~01 AI~ W.02: CL,IREMTLT KARHII~ NOT MARRIED/ Ca LIVING [~ IOT LIVING TOCd[THEE TOGETHEIE I I ~] I Nov I hlyw some ~t |o r l at)out the future. I ~ld y~J t i ke to have a (armother) ¢~l td or v~Jtd prefer not to have ~ more ¢hitdrlm? I~IP CCOllEG CATIEGOIEIII I TO I )~609 I I Hov Ic~l b~Jid y~ t|ke to ue l t frcm now before the b i r th of • (er~ther) chi ld? I IONTHS . . . . . . . . . . . . . . . . . . . 1 ~ I l i b TE)*RS . . . . . . . . . . . . . . . . . . . . 2 ~- -~ I _ . . . . 5CX~/;4G~ . . . . . . . . . . . . . . . . . . . . . . 995 OTHER {SPECIFY) I DE . . . . . . . . . . . . . o. . . . . . o.o°o.~9~ - i i YEs _ , . . , . . .h,. _d . . _ . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 I dec is ion to have an operation r~t to have ~ xore NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 - I 0o ,. - . , I * " . ,i PMTNIEI UNITS ANOTHIEE CHILD . . . . . Z SIDLE EFFECTlE . . . . . . . . . . . . . . . . . . . . 3 OT HlEZ IEASCi (SPECIFY) | 268 "-I -i GUESTIOOS /did FILTERS Do you thEN( that ~ v l fe (v fm) /ber tn* r ( | ) Iq)r¢~¢l or d i s~oves of C~JpLU ~lmfno m method to Ivold pre~vcy? l I P I C~qNO ~JtT,GCIIE, I TO I . 1 I OlSAqqlO~S . . . . . . . . . . . . . . . . . . . . . 1 ******************************** Nov Long should • co~te ~ l t before sterl ing sexual [ntercc~r|e after the berth of a baby? ;KIqTNS . . . . . . . . . . . . . . . . . . . 1 f ~ I yEA.itS . . . . . . . . . . . . . . . . . . . . Z OTHEI 996 (SPECIFY) I I x610 I ~outd a mother veil u'~t i t ~* has ccnpL,tety stcgp*ci VAST . . . . . . . . . . . . . . . . . . . . . . . . . . . . t I I breastfeedlng befoi'e startfn0 to hnve aex~t reLat|onls I again, or doesn't I t wetter? D(XSO*T NATTEII . . . . . . . . . . . . . . . . . . 2 IM l l ~ In ~rat , do you appr~ or dfsipprov¢ of coqptes APP I~. . , . . . . . . . . . . . . . . . . . . . . . . 1 i I US|no • ~thed to r~ id pr¢llnancy? DISN~PItO~ . . . . . . . . . . . . . . . . . . . . . . 2 I [4612 CHEEK 14202 ANO N20&: P--1 r ' l HAS LIVING CHILDgEN ~ NO LIVING CHILDREN L~ ! / [ I ¥ ¥ I f yceJ cc~td go b~k to the I f YOU could choose t im VOQ did r~t hart May exactly the hUM)or Of chltdrene~d cOULd chcmee children to have ih exKt iy the tuner of chiLdren your uhole Life, hay to have In your uhoLe Life many ~JLd that bet h~O ~y ~Ld that bet RECORD SINGLE ~H OR OTHER AN~R, --E'. m OTHER AIiS~I (SPECIFY) ~614 ~13 N~ weny of those children ~td be s~s? Ard hc~ ~ny ~¢uLd be dmJghteraT kUHSEm OF SCala . . . . . . . . . . . . ' [ J I liuNgI[R OF DN)GNTSRS . . . . . . . . [ ~ 110 SEX PItEFEAEN¢I[ . . . . . . . . . . . . . . OTHER AMSbGg 96 (SPECIFY) M614 What do you thir~k is the I~t number of amnths or ynrn bet~¢m the birth of ~ chi ld arcl the birth of the r~xt child? RECORD THE TiME f f ' r -1 m TF.~S . . . . . . . . . . . . . . . . . . . . 2 OTP~N 996 (SPECIFY) Dai'T ~ . . . . . . . . . . . . . . . . . . . . 9~ .,' i iiiiiiiiiiiiiiiiiiii 269 SECTION 7. LANGUAGE INFCIIMATIOI I NO" I IXJEETIONS AND ,ILTEIlI; I K IP C~OING CATEGORIES I TO m m [15"~AHILI . . . . . . . . . . . . . . . . . . . . . . OI I I OTHER THIRD PEESCN TO INTEHPRET FCIt YOU? I NDNE OF TI4E IHTERVIEW . . . . . . . . . . . 1 )END Of THE INTERVIEW . . . . . . . . . . . Z MOST OF TI~ IHTERVIEV . . . . . . . . . . . 3 ALL OF TMIE INTERVIEld . . . . . . . . . . . 4 OTHEE 5 (SPEEIFT) 14~03 IF AN IHTERPRETEH VA$ U~O, INOICATE THE SEX AJd) APPROXINATE AGE OF INTERPRETER. J ADUI.T FEMALE . . . . . . . . . . . . . . . . . . . . 1 TEENAG~ FEMALE . . . . . . . . . . . . . . . . . . 2 ADULT MALE . . . . . . . . . . . . . . . . . . . . . . 3 TEENAGE MALE . . . . . . . . . . . . . . . . . . . . & OTHER 5 (SPECIFY) 270 INTERVIEWER'S OBSERVATIONS (To be filled in after completing interview) Comments About Respondent: Comments on Specific Questions: Any Other Comments: SUPERVISOR'S OBSERVATIONS Name of Supervisor: Date: EDITOR'S OBSERVATIONS Name of Field Editor: Date: 271 2"/2 T&M2.AJIIA D[!qcC, JLAPNIC ~ MEALTR UVI |YS SERVIa[ AVAILJUIILITY (X,IESTIONNAIR| T/Ji?.NdlA BI;REJU.I OF STATISTICS. PLAMNIMG CCPg41SSION i IDENTIFICATION PLACE MAJ41[ DHS CLUSTER Id~14BER . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . lEGION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . DISTRICT . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . - - * ****************************************************** EMUMERATION AREA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I ~BAM/RURAL (urban- I , ruret,2) . . . . . . . . . . . . . . . . . . . . . . . . . . . . LOCALITY TYPE (major tov~l , Large tour~2, s.qwtt toun-$. I viLLage-&) I I I r q INTERVIEUI[R MIUR~: CLUSTER VISIT START DATE: CLUSTER VISIT EMO DATE: OAT OAT ~E ~TR Mt~TR 273 274 i CO~ING CATEGORIES i S(IP TO SECTION 1A. (:~J,~NITT CKARACTERISTICS ',NO. I ,,, QUESTIONS ~U~STIONS 101 TO 102 ARE TO BE APSVERED BY THE IHTERVIE~R I I I 11001~IYRE Of LOCALITY ( In ~htch c luster I t foun~nesrest to c lus ter ) DENSITY OF VILLAG~ UPO~ ARRIVAL A? THE CLL~TER. I I I I~JCR TO~N . . . . . . . . . . . . . . . . . . . . . . 1.~1 ~ I l l LAR~ TOUI~ . . . . . . . . . . . . . . . . . . . . . . ~ 111 : : : : : : : : : : : : : : : : : : : : : : : : : : : : : - , . SCATTERED, . . . . . . . . . . . . . . . . 2 THE REPU, IS:SG QUESTioNS IN SECTIONS C~E AMO T~O AAE TO BE ANS~RED BY KNOULEDGEABLE IHFO~J4AHTS FROH THE CLUSTER. 103 i04 lOS 106 107 109 110 I11 112 113 114 t/hat ts the ~ of the nearest urban center? Nov far is I t in kt|ometer$ to the r~esrest urban center? I0¢. TO NEAREST U.AB .NtER . . . . . . I I I I ~at are the most commonly used types of t r=nspor t i t ion to go to the r~earest urban center? (CIRCLE ALL APPLICABLE) CAR/BUS . . . . . . . . . . . . . . . . . . . . . . . . . A ANIMAL . . . . . . . . . . . . . . . . . . . . . . . . . . | ~/AL[ING . . . . . . . . . . . . . . . . . . . . . . . . . C CYCLING . . . . . . . . . . . . . . . . . . . . . . . . . D OTHER . . .E Does th i s v i t l sge /com~i ty keep records of b i r ths ar~l deaths? YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NOo,o .ooo . .oo .o ,o I too . .=~. , .o . , .2 i ~It is the ty1~ of the ea|n sccess road to th is community/ ALL t~ATHER RC~O . . . . . . . . . . . . . . . . 1 v i l lage? SEASONAL I~ . . . . . . . . . . . . . . . . . . . 2 PATH . . . . . . . . . . . . . . . . . . . . . . . . . . . . OTHER (RIV~R/RAtLWAY) . . . . . . . . . . . 4 I Vnet is the KAJOR eccx~c~ic ac t iv i ty of to ta l i ty /v i l l age AGRICULTURAL . . . . . . . . . . . . . . . . . . . . 1 inhabitants? (CIRCE ONE) '~at is the ICAIN source of dr |nking wts r In th is community/ v i l lage? FISHING . . . . . . . . . . . . . . . . . . . . . . . . . 2 TRADING/HARKETIHG . . . . . . . . . . . . . . . 3 MA~JFACTURING . . . . . . . . . . . . . . . . . . . 4 MINING . . . . . . . . . . . . . . . . . . . . . . . . . . S LIVESTOC~ . . . . . . . . . . . . . . . . . . . . . . . 6 HU~ITING . . . . . . . . . . . . . . . . . . . . . . . . . 7 OTHER , . .8 PIPED TO I~USES . . . . . . . . . . . . . . . . . 1 - PUBLIC TAP . . . . . . . . . . . . . . . . . . . . . . 2 UELL . . . . . . . . . . . . . . . . . . . . . . . . . . . . LAKE o RIVI[R~ SPIIING . . . . . . . . . . . . . & RAINWATER TANK . . . . . . . . . . . . . . . . . . S OTHER - , .6 Hou far Is t t in meters to the =*tin s~Jrce of d r ink i t~ water? METERS TO WATER . I I I I ] / Is there e lec t r i c i ty in th i s ¢cz'nmurHty/vitlage? ! YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . , . . . . . . . . 2 I I t,~at is the main method of waste disposal in th i s community/ PIT INSIDE/OUTSIOE CCIC=OU~O . . . . . 1 vi I lage? RUBBISH BIN . . . . . . . . . . . 2 THRO~ INSIOE/OUTSIOE COHPOUND,.3 OTHER .4 Is there tetep/~one service or I radio ca l l for th is conm.~ity/ YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 v i l l a ;e? NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 t~at :ype of to i le t fac i l i t i es are used by most households FLUSH . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 in t~;s conT~i ty /v i I tage? PIT AND OTHER . . . . . . . . . . . . . . . . . . . 2 NO FAC,LI . .$/= . . . . =u~ . . . . . . . . 3 • 111 1-1 p . .~ . "~" :~ "" 275 ~CI ION I1. IlT(lVlE~,~g: AVAILAJIILITY O/ F'I~ILIC SERVICES NENtEST TO ON IN TIC[ COe4~II~r/VILLAGI[: Nov I vould like to ask y~ sl:,~Jt the distances to the hesrest of ver lo~ types of schoOls ird services, boy ~u usustly go there ~ how long I t takes to set there frcu here. S~RVIG[ A. EDUCATION 1 PrImry Schc~| | Dly Sesondlry SchoOL 3 Post Primacy TechnfcsL Centre | . GEaERAL SERVICES 1 Post Office/l(alt Service 2 Veekty Market 3 Shc~ (Duke) 4 Piece Vtth Bus Service Available $ PLace Here Most VILLage/ Comu~ity Residents SeLL Cash ¢ro(:~ 115 How far is I t to the nearest (SEI- VICE] In hi? Let IF '(X) I - - 4 IF '00' --R- 3 L, ,oo;,~ 116 ~.~et Is the most common tr ins l~rt to [SJ[RVlCE)? ~DI I I I I I I I I I I I1 11T ,ov 1o~¢ doe* I t take to get to [SERVICEI? I(CURS XINUTES I l l -R I I I -~ I I I -r] I I I~ I I 1~ l l l -~ I l r l ] i Jl-[ ] CODES: El] 96 • 96* O0 • Less than 1/tocet~l In viLLage 9tS • Ms knovn fac i l i ty t~ Carlll~ Anl l l l Vitklns Cyct Ir~ Other 1 2 3 6 5 I 118 [ Are there adult titerecy classes (Klsomo Chenye MarfJfse) in this comllunity/villege? I TES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I I COMMENTS: 1-2 276 SECTIOId lC. WEALTH A~D FAJ(ILY PLAWWING PROGJ~S IN THE ~LTY Woo ] 119 119e 120 121 122 122e 122b I 123c 12~d QUESTIONS I• there • t rad f t tc~l b i r th attendant •ve i l °h ie to women her• Who regular ly essfsts d~rl~g del ivery? ~INGCAIEGCI|IE$ YES, , , , , . . . . , , , , , , , , , . . . . . , , , , , ,1 ~Oee° , , , ,ee°eeoau~,¢ee , ,e ,o~eee° 2 Ha• the t rad i t lo r4 t b i r th a t te r~mt had ~ s~ie l t re in in9 YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 from the HOH or other o rgY |ser i f ? NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 I Is th is community visJt~d ~ a in terna l ~ ch i ld health (HCH) YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 a i~? WO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 I I I s there • tradit ior.st healer av•t ieb ie in th i s c~mJn i ty / YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 v i l l age? NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 : I I Does • f~ i ty pLar~ing f ie ld worker from UKATI v i s i t th i s YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I conmJ~ity/vit lege? (OV~ Or DU~ Or NU¢) NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 - j " I flow often does the f ru i ty p ie ing f ie ld worker c~e to th i s comn~.Jnity/v|ttage end 9i'te aot ivet |on4i ta lks? NO. OF TIldES i I I PIER IIONTN.I TEAR.2 Ooes the fami ly ptJmnlr, g worker d i s t r ibute any coq~traceptlves YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 dur ing the v i s i t ? NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 t Does th is ccd~munity/viliage hove c~e or more v i l l age heal th YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 ~rkers7 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 - - Have ~ny of the v i l lage health workers been trelr~ed? YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I NO, , ** , , , , ° , , , , , , , , , , , , , , , , , , o* ,~ Are ~ of the v i l lage he•tth ~rkers paid ~ the v i l l age / YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 community as a group? NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 - I Has the v i l l age health worker been paid In the last 3 a~the? YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 Does • v i l l age health worker prov|,~-: Ch t orcx;uine syr~4~? F~l ty pterv~tr~g Motivetion? Condoms? ~S Instruct ic~? ~S Packets? Antenatal Care? Grovth Honi tot ir~? Enviroc~entat San i ta t i~ Talks? CHL~O(~UIWE: YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 ~, , ,o , ,o , , , ,¢ , te , , , , , o , , , , , , , o ,2 FN41LY pLAHWING MOTIVATION: Y£S . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO*. , * . . . . , .~ .o , t **** , * t * . ,e , Je .2 ~DCMS: YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 N~l , , , , ,ee t~, , l , , , o . . , . , . , ° °o . ° , .2 CI~S I WSTRUCT I 011: Y£S . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NOooueeee*eeee°eaoee°ouooeommea°2 ORS PA(~C~T$: YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 ~0, , .o , *q , *oo9 , , *° . . ° , ° , ° , , , . ° , °2 ANTEWATAL C.~J~E: YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I GROWTW HOWl TORIWG: YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 HOe, , * . , , , , , , , , , , , ° , , , , , • , , • • • ,o2 SANITATION TAL[S: YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 ~0. . . ,o , ,oo .o .o , . . . . . . . . . . . . . . . . S~CIP TO ~, 120 • 124 ., l?_~d 1-3 C~MEN~S: 277 1o. Q~ESTtONS ! ~z6; 127 127a 12~ 128c IS th is conmanl ty /v f t toge v i s i ted lwc~e or more outreach programs from • d i sper~ary , health centre or hosp i ta l ? Does in c~treach I:,rogramp~'ovide: Growth Moni tor ing? lninunIsation? Antenatal Care? Condom? FamiLy PLanning Mot | rat ion? Contraceptive P~tts? I t there an ac t ive v | t taoe health committee (VNC)/primery hea l th cc~m~ttee in th i s c~m~Jnity/vit lege? Have yx>~ had a v | [ toge HeaLth Day In the Last 3 tenth°? ~as i t organised by the vilLage/community9 Have you had any AIDS ca.~p~gns in th i s cc~nmz,~ity/vftlage? No~ ma~y AiDS campalgn~ have you hall In the ta le year? Xave you had an AiDS co~i ign in the test three months? Other then for AIDS, have yOU ever had any heal th or fami ly planning campaigns in th i s comnu~ity/vittage? How many hea l th and fami ly p l lnn l~o campalgns have you had In the test year? Nave you had • hea l th or family p[ar~Ing cmign tn the Last three n~ths? ~hat ~as the hea l th ca~:~aign abodt? (CIRCLE ALL APPLICABLE) C~OING CAtEGCIII|B SXIP TO I I YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 - I • 12S GROI/TH NCI~ITORING: YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I WO, , , , i . l , o , ° . . , . . , , o , l * * , ,o , . °o~ | N¢UNI SAT ION: YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I NO,** , *o . . . , , . . . * .~* .o , ,e , . , , , ° .~ ANTENATAL CARE: YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 CONOO4S: ~S*******oo.o*°o°, ,*°°°.e,o°,o,1 I~O,*o°°°o°.o°°°,°°°loo°°o,.l°oo° ~ FAMILY PLANNING 14OTIVATION: YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NOe°*e*~oo°oo,°oellaO~aeeeee°o°~ PILLS: YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 HO., .o,~toooo°oo,, , , lo,o, , ,° , , . ,~ YES. . . . . . . . . . . . . . . . . . . . . . . . . . . . .1 ~. . . . . . - . . . . . - . . . . . . . . . . . . . . . . .2 YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . | NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 -J • 127 YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I I NOo.o,. . .°,*. .o, , , .o,o*ooo,o**o.~ YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NUKBER OF AIDS CN4PAIGNS IN LAST YE~. . I I I [ I I YES. . . . . .o . , . . . , . . , . . . , . . . . . . . . . I NO. . . . . . . , . , . . . . . . . . . , . . . . . . . . . .2 YES****.o.o.*****o.o**g**ooI***I NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 - - - -~ Section 2 NUNBER OF NE~LTN C, NdPAIGI4S IN LAST TESUI . . I I I I I I YES. . . . . * * . . . . . . . * . . . . . . . . . . . . . .1 ~. - . . . . . . . . . . . . . . . . . . . . . . , . . . . .2 - - - -~ --* Section 2 BENEFITS OF PRO!.ONGEO LACTATICILA EPI . . . . . . . . . . . . . . . . . . . . . . . . . . . . . B ORS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . C kL~LAR ]A . . . . . . . . . . . . . . . . . . . . . . . . . O NUTRITION (FOOD 1$ LIFE) . . . . . . . . E SAJ4I TAT ION . . . . . . . . . . . . . . . . . . . . . F FP RADIO PEOGR,~ . . . . . . . . . . . . . . . . G BENEFITS OF CKILD SPACING . . . . . . . N SPECIFIC NETHOD(S) PROHOTIOI4 . . . . I OTHER (SPECIFY) . j 1-4 278 SECIIOR Z, FACILITY IDERTIFICATION ~AECTION I . l E lV l [~ l : I m p~srwinQ to v i s i t f t c l t l t fes providing isterr~t end chi ld hestth services Inct~cllng family plmrrir~ I thro~.~;i~out T&r~z~Ji Snd to~ether we Cl~ identify those in this I re l this I Mm Interested In, I p l tn to v |s l t pr lv:te doctors (~hich include those In private c l in ics) , p r lwte pharmacies or ledtcst stores, disl>enssr|es, health c~terz I~1 hospitets. Uhst is the r~ of the HEAREST (YA [ARIBU ZlkOI IOJLIKO ZOK) doctor to th|s coamJnity with I pr ivets pr~t{~e if1 i I>rivste clinic? (A DOCIOA VITH A PRIVATE PRJ~CTiC£ IS A DOCTOR ~ SEES ~£11 ARD CRILDRER ~/HERE TIUE PATIEIlT liJST PAT ~O~ 1HE VISIT. OFTEM IH IkHZARIA, THIS DOCTOR ~ILL ~K Ill A GOVER)4)~.EMT FACILITY DUR|HG t~CtRI:IHG )lOIS S~[ PATIENTS PRSVATFLY AFTER HOURS.) Vhat I t the r~me of the HEAREST private pharmacy or me<ilcet i to r t to this c~| ty~ (A PRIVATE PItARNAC'f IS I STCIRE OR SHOP WERE HEDICIHE IS SOLD AND ~/~ERE THERE KAY BE A TILAIHED PH.~RKACIST ~ r.)Ji FILL PRESCRIPTIONS.) Whir is the r~e~e of the HEAREST dispenssry (zahersati) providing health services For won~n End chi ldren to this sommunlty? (DISPEHSAR]ES ARE WARD LEV1EL FACILITIES STAFFED IT k RURAL HEDICAL AIDE. THESE FACILITIES PR~I~ lUOTR lu~SIC CXJRATIV1E A)4D PREVENTIVE CARE ARO GEHEL~LLY KAV1E FEW ~ t~O BEDS. PATIENTS ARE GENERALLY MOT AOI~ITT1ED IR DI~EHSARZES.) Uhet Is the ~ of the NEAREST health centre (kituo chs efya) providing health services for ~ ~ chitck'in to this community? (HFJLLTH CEHTRES ARE AT THE DIVIS](]4 LEV1EL, ARE U l it llEDICJLL ASSlSTARTS ~ HAV1E JUI ADDITIONAL SEVEN (~ EIGHT HEALTH VORKERS. THEY TEND TO PROVIDE THE SAJqE TYPES Of BASIC PREV1ERTIV1E AND (:IJPJkTI~IE CARE AS DISPENSARIES ~ H.~VE 14eRE SLEDS AND PATIENTS ARE ADHITTED.) Vhst Is the name of the NEAREST hospital prov|dtn~ hesith services For women end children to th is ¢omauntty? (HOSPITALS ARE AT THE ZONAL. REGZONAL AND DISTRICT LEVEL AJ~ ARE RUN BY MEDICAL OFFIr~RSo THEY PROVIDE C~J~ATI~ AND PREVEHT;V~ HEALTH SERVICES AND ARE THE fINAL I~FERRAL ~HTER. THEY PROVIDE THE I~T C~PtEH[I~I~ CARE AJar) ARE STAFFED BY OOCTONS. HOSPITALS CAM RE CALLED C;~NSULTART, REGIOILkI. OR DISTRICT HOSPITALS.) 2-1 279 INTERVL£'dER: IA. |O. ~201 ~.0~ ~, Io ~211 A212 Uo~ I m so in S to ask some edd l t f¢~t q~est lonl ebc~Jt the f lK l | l t i e l that you j~t ¢~'~tlot~"d. INIIVATE DOCTOR J QU£STIONS UA~ O~ PRIVAfi ~O(:TO~ (¢O~Y FRUIt SECTIOII 2 COVER PAGE). ~ere Is the prtvete doctor ' s p ract i ce Located? Hov fmr is I t ( in fans) f rc~ here? (t,~ITE IN '00 ~ IF LESS THAN 1 KILOMETER. IF 1 TO 9~ [%LCI4ETERS, bq~lTE IN NUKI~ AS GIVEN IN CLUSTER. IF 96 [ILOMETERS C~ 14~E, ~RITE IN '96~.) ~,~at is the most COmmOn type of trar~sport to the doctor*s practice? How Long does I t take to get from here to (PRIVATE DOCTOR,S NAME) using moSt O~. -~ type of transport? C)oee this prlvete doctor provide fmmlty planning services? I~o is the rye|rest doctor u i th e pr ivate practLce ~'~o provides fatniiy pear.in R services to th i s ¢om;u~lty? 1.1~ere is his/her proct ice located? How far is I t ( in Ices) from here? (VRITE IN '00' IF L£S$ THAN 1 KILOMETER. I f 1 TO 9~ EILONETERS UIITE IN NUMII~2 AS GIVEN IN CLUSTER. IF 96 KILOMETERS OR 140~E, ~ITE IN *96*.) kenst is the m06t com~on type of t ransport to the doctor* | pr&cticeT H~ tong d~rs i t take to get from here to (PRIVATE DOCTOR'S Hkl4[) using most common typeof transport? How m~ny private doctor pract ices in to ta l are there ~ i th in 30 kilometers? COOING CATEC-~R I ES PRIVATE OOCTOR*S NANE NOT IJ~LICAJ|LE . . . . . . . . . . . . . . . . . . . . ~ . LOCALITY KILOqETERS, IF MOA£ THAN 3010¢- C~USoo.**°°.o,°.°,,o,o°.o°o°.°.~ ANIKAL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 WAL[%NG . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 CYCLING . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 OT~ 5 . I I NINUTES . . . . . . . . . . . . . . . . . . . . [ ~ : YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 - ; NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 i DON'T [NOW . . . . . . . . . . . . . . . . . . . . . . . . . it PRIVATE DOCTOR'S HJ~ NOT APPLIC~J|LE . . . . . . . . . . . . . . . . . . . . 9t5 ---~ LOCALITY KILaMETERS. IF MORE THAN 30 01- CJ~i~U~**,°,,.,.***o.o,.**.oo.oo,S AXIHAL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 WAL~ING . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 CTC21NG . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 OTa[~ 5 . I I MIL_:TES . . . . . . . . . . . . . . . . . . . . SKIP .b 8201 FFi -~ A206 I I I I FF1 --~ A212 A212 FY1 -~ A212 I 1 ~xE$ DI THE 'SLIP TO' COLL~H ARE TO HE USED IN THE INSTANCE OF MIS%D£k~IFICAT%OI4. 2-2 280 NO. 0201 S20~ I 1203 N20~ 1205 1206 1207 1209 I~'lO I~.11 i212 QU£STICqS NAJ4£ OF PHARKACY (C~PT FROM SECTION 2 COVER PAGE). 1,~ere is (PHARHACy NAME) located? Now far is i t ( In ~) from here? (WRITE IN '001 IF LESS TMAN 1 KILOliTER. IF 1 TO 95 KILOMETERS W~IIE IN NUMBER AS GIVEN IN CLUSTER. I f 96 I{ILCI4ETERS OR NORE, WRITE IN ' 96 ' . ) t~1~at is the most common type of transport to the pharmacy? Wow [c,~g does i t take to get from here to (PHARMACY I~) using ~St C~IIIIU~ t~4 [~ Of trer~s~)rt? CCR) I WG CAIEGZ31t I ES PNAH~CY HA,HI! i NOT APPLICABLE . . . . . . . . . . . . . . . . . . . . 98 - LOCJ~LITY KILOMETERS. I f NOtE THAW 30 IS4.- CAR/SUS . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 ANIMAL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 WALKING . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 CYCLING . . . . . . . . . . . . . . . . . . . . . . . . . . . . & OTHER S H ,S . . . . . . . . . . . . . . . . . . . . . . I ] MZNU,. . . . . . . . . . . . . . . . . . . . . KIP TO -.'* C201 II I I r-l- Does th i s pharmacy sets fami ly p ie ing supplies? ! YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 --~" 0212 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 DOMgT KNOW . . . . . . . . . . . . . . . . . . . . . . . . . 8 I L Met is the na~e of the nearest gt~ir~cy d~ich se l l s fatuity PHARKACY pieri~ing suppl ies to th i s cc, rm-.~iw? NAME Mere is i t located? NOw far is i t ( in i~s) from here? (~ ITE IN *00' IF LESS THAW 1 [ILONEIEN. iF 1 TO 95 KILOMETERS I~ITE IN NUMOER AS GIVEN IN CLUSTEI. IF 96 [ILCI4ETERS OR MORE, WRITE IN 196' . ) Met is the most ¢ ~ type of transport to the I~ar'~cy? i NOT APPLICABLE . . . . . . . . . . . . . . . . . . . . 98 - -~ LOCALITY I(1LCI4ETERS . . . . . . . . . . . . . . . . . IF 140RE THAI4 ]0 ¢AR/IK,IS . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 ANIMAL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 WALKING . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 CYCLING . . . . . . . . . . . . . . . . . . . . . . . . . . . . & OTHER $ N N, . I ] MINUTES . . . . . . . . . . . . . . . . . . . . OWE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 ?WO° °° o° ** , . ° , , , H o ° , , , , , ° ° , . , , , , , , 2 THREE OR FOU~ . . . . . . . . . . . . . . . . . . . . . . 3 FIVE OR MCRE . . . . . . . . . . . . . . . . . . . . . . . 4 |212 --* D212 I I Nov tong does i t take to set from here ¢o (PHARMACY HJUqE) using most common type of trar~port? How many pr ivate pharmacies in totes are there w i th in 30 ki lometers? EGXES IN THE 'SKIP TO ~ COLUMN ARE TO BE USED ]N THE ]kSTAHCE OF fllSIDEMTIFICATION, 2"3 COMWEHTS: 281 I C, fo° :201 :202 :203 ~20~ C20~ O I SPENSAJIY J C206 C207 C20~ C209 C210 r~11 C212 QLRSTIONS OF DISPEMCARY ( (~Y FROH SECTION 2 COVER PAGE). ~J~ere Is (DISPENSA.RY NA/~E) located? Now f i r is I t ( in k~) from here? (WRITE IN '00' I f LESS THAN 1 KILOliTER. IF 1 TO 95 KILO~TERS, VRITE IN M, IMB£R AS GIVEN IN C~USTER. IF 96 KILCNETERS OR 14~E, ~I~ITE IN '96%) t,lhat is the most common type of t ransport to the d l s l~ary? CODING CATEGORIES DISPENSARY NAN£ NOT APPLICABLE . . . . . . . . . . . . . . . . . . . . ~IS - LOCALITY KILOMETERS, IF ~E THAX ~ 01- CAJ~/~JS . . . . . . . . . . . . . . . . . . . . . . . . . . . . I ANIHAL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 UALKING . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 CYCLING . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 OTHER 5 I1o~ tong does i t take to get from here to (DISPENSARY N,I,~E) I I U~tng IIIOSt ¢ommol~ t~ l~ Of t r~por tY )~lU~ S . . . . . . . . . . . . . . . . . . . . . . m i MIN1JTES . . . . . . . . . . . . . . . . . . . . Does th |a d|spensery provide foml |y ptann|ng services? YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 - D~'T KNOW . . . . . . . . . . . . . . . . . . . . . . . . . 8 ~hat Is the ~ of the nearest dispensary providing family DISPENSARY p(anning services to th i s ccmw~ity? IOWCE -~" D201 Vhere t s i t toceted? Ko~ far Is I t ( in km) from here? (~ ITE IN '00' IF LESS THAN 1 KILOMETER. IF 1 TO 95 [ILOHETERS, URITE IN IrdMBER AS G|VEN IN CLUSTER. IF 96 K]LOI~TERS OR I~ORE, ~ ITE IB ,96' .) SKIP T= ~het IS the f t c~mon type of trw~sport to the d|spensary? HOW tong does I t take to get from here to (DISPENSARY HAICE) t~sing most c,J,,,=~l type of transport? Hoe many dispensaries in tota l are there w i th in 30 kilctneters? -~ c206 I I "~ ~12 NOT APPLICABLE . . . . . . . . . . . . . . . . . . . . 96 -~ C212 LOCALITY IF MCRE THAN 30 -'~ C212 I I I I IN KILONETERS. C~/~,°° , °° , . . . . . . , , e ° . .o . , ,o=°=ol ANIMAL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1~ VALKING . . . . . . . . . . . . . . . . . . . . . . . . . . . . ] CYCLING . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 OTHER 5 . I I NINUTES . . . . . . . . . . . . . . . . . . . . ~ ) r~o . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Z THREE OR FOUR . . . . . . . . . . . . . . . . . . . . . . ] F~VE OR w~;E . . . . . . . . . . . . . . . . . . . . . . . ~, BOXES IN THE *SKIP TO' COLUMk ARE TO BE USED iN THE INSTANCE OF MISIDENTIFXCATI01¢. 2-4 CO"MENTS: 282 I O. NEALTN CENTRE ] )201 D202 D203 p204 P205 D206 D207 0209 D210 D211 D212 QUESTIOMS NAJqE Of HEALTH CEHIRE (C13~Y FROM SECTIOI~ 2 COVER pAC.~). Utters is (HEALTH CENTRE NAP4E) tocetect/ How for is i t ( In l ms) from here? (NRITE IN '00' IF LESS TKAN I KILOMETER. IF I TO9SKILOMETERS, ~ ITE |H NUMBER AS GIVEN IN CLUSTER, IF 96 KILOMETERS OR MORE, ~ l t l IE IN ~96',) ~et Is the ~ost c~,,,., type of transport to the hearth centre? COPING C.ATEGORIES HEALTH CENTRE NSU4£ HOT APPLICASLE . . . . . . . . . . . . . . . . . . . . 98 - LOCALITY EILCI~ETERS. IF MC~E THAN 30 IO4-- CAR/BUS . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 MIIHAL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 I/.~LKI NG . . . . . . . . . . . . . . . . . . . . . . . . . . . . ] CYCLING . . . . . . . . . . . . . . . . . i . . . . . . . . . . 4 OTXER S Hou |ong does i t t lke to get from here to (HEALTH CENTRE NAME) us|r~gmostc~,, , , , . . - , typeoftra~nsport? HOURS . . . . . . . . . . . . . . . . . . . . . . I I MINUTES . . . . . . . . . . . . . . . . . . . . Ooel th i s heetth centre provtd~ f i l | l y ptari ' l ing services? YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 -~ . HO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Z I ~ON'T I~Ob' . . . . . . . . . . . . . . . . . . . . . . . . . 8 , '~et is the ~ of the r~eerest health centre provid ing fa,~ity p lenn ing servlce~ to th l s commJnity? Uhere ts I t Ic,:ated? No~ far is i t ( tn k~s) from here? (IAHTE IN IO0~ IF LESS THAN 1EILONETER. IF 1 ?0 95 KILOMETERS, WRITE IN HUNBER AS GIVEN IN CLUSTER. IF 96 K%LOMETERS OR MORE, WRITE IN M96m.) t /n i t is the most ¢omm~ type of transport tO the heal th centre? Now long does i t take to get from here to (HEALTH CENTRE NAME) ~es|ng most c~, . . , type of transport? HEALTH ~NTRE H~ SNIP TO *E201 "* D206 I1 ~-~ 0212 NOT A~PLICASLE . . . . . . . . . . . . . . . . . . . . 98 - - -~ D212 LOCALITY - * D212 KILOMETERS. |F HeRE THAN 30 CAN/BUS . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 AMIKtL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 UALKING . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 CYCLING . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 OTHER 5 =HI . . . . . . . . . . . . . . . . . . . . . . I I NINUTES . . . . . . . . . . . . . . . . . . . . How many health c~tres in Iota| are there w i th in 30 HONE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 k i t orneters? ONE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 T~/O . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 THREE C~ FOUR . . . . . . . . . . . . . . . . . . . . . . 3 I I F]VH ~R M~RE . . . . . . . . . . . . . . . . . . . . . . . 4 I BOXES IN THE 'SHIP TO' COLUMN ARE TO BE USED IN THE INSTANCE OF MISZDENT%FICJIT]OR. 2"5 COM'EH~S: 283 I | . MO~I]ALS I IO° E~01 t202 E203 E20~ E20S E206 I E2071 E208 E209 E210 E211 E212 CK.q[ST ICIdS NA~qE OF I~)SPITAL (C~Y FRQI< SECTION 2 COVER PAGE). ~ere Is (HOSPITAL NN4E) located? No~ fer is i t ( in kins) from here? (~|TE IN ~001 IF LESS THJU( | i[ILOKETER, iF 1 TO 95 [|LCI4ETENS. kmlTE | i NUI48ER AS GIVEN IN CLUSTER. IF 96 iCILOIqETERS OR /40RE, ~ItITE ZN ~96~,) Wl~et is the most cc, i,;~,~ type of t r~s l :~r t to the hospitaL? CODING CATEG~IE$ HOSPITAL IUm, E HOT APPLICABLE . . . . . . . . . . . . . . . . . . . . M LOCALITY KILOMETERS. . I I J IF 140RE THAN 30 I:)q- CAR/BUS . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 AHI~kL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 b/ALKING . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 CYCLING . . . . . . . . . . . . . . . . . . . . . . . . . . . . & OTHER S SKIP TO - -~ 213 -~ E206 E] Mo~ |ot~g does i t teke tO get f r~ here to (HOSPITAL NAME) using I I aost coml~on type of t r.nspor t? ,OURS . . . . . . . . . . . . . . . . . . . . . . I I i i MI TES . . . . . . . . . . . . . . . . . . . . r -1 - ] I DOer (HO~ITAL NAME) provide f i lmily p lanning ser~'tcee? YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 - - -~ E212 NO. . , , , . o , . . °o . . . . . , . , , . . , , , . . . , , °o~ DOn'T I0~0~/ . . . . . . . . . . . . . . . . . . . . . . . . . 8 I,l~et is the ~ of the nearest hospital provid ing f&mity planning services to th is community'/ tmq~ere is i t |ocated7 HOSPITAL NOT APPLICABLE . . . . . . . . . . . . . . . . . . . . ~ - -~ LOCALITY [ILCX4ETERS . . . . . . . . . . . . . . . . . IF MORE TKN4 30~- C]~R/~,°o,°**,.,°o°,.o,Qo°°°°,o.o,1 A~ |~d[AL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 UALKING . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3 CYCLING . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 OTHER S NQU~S°°* , ,~ ,~.° . ° , , , ° °° . °° .{~ MINUTES . . . . . . . . . . . . . . . . . . . . NONE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 0 O~E.ooo . , , . . . . . ° . . . . , . ° . ° , . ° . . . . . . .1 T~d~, o . ° . . . . ° . . , . ° ° . . . . ° .o , , ° . . ° .~° .2 THREE OR FCU! . . . . . . . . . . . . . . . . . . . . . . 3 FIVE OR U(CR£ . . . . . . . . . . . . . . . . . . . . . . . ~, No~ far is i t ( in kms] from here? (WRITE IN '00' IF LESS TIU~ I [ILOI4ETER. IF 1 TO q'3 KILOMETERS. 1ELITE IN NLI4BER AS GIVEN IN CLUSTER. IF 96 [ILCINETERS OR MORE, kq~ITE IN '961.) Uhat is the most common type of trlnsl~x)rt to the hosp i t l{? Row Long does i t take to get from here to (Y~SPITAL NAME) using most common type of trensport? HOW m ar~f hosp i ta ls in total ire there w i th in 30 kitometersT BCXES IN THE 'SKIP TO j COLt~N ARE TO BE USED iR THE INSTANCE OF M]SIDERTIFICATIO~. 2-6 C:~MENTS: 284 E212 --~ EZ12 I I COkTL~C~PTIYE IIETNOD IDEIITIFIr.,,ATIOH No. 213 214 21S 216 217 218 219 220 221 222 223 224 (~(ST IOMS Met Is the name of the nearest fac i l i ty or ~ovider to th is community Sere b i r th c~tro I p i l l s can be obteIne<rt COOING C,,ATEGOItIE$ NEAREST PILL PROVIDER NA)q~ N~ fir IS I t (in Lee) from here? (WRITE IN '00' I f LESS TKAN KILOMETER. IF I TO 95 KILOI~TER$~I KILOMETERS . . . . . . . . . . . . . . . . . I l I URITE IN NUI~ER AS GIVEN IN CLUSTER. IF 96 KILOMETERS OR MC~E, ~RITE IN '96 ' . ) I I~et is the name of the nearest fac i l i ty or provider to th is i NEAREST COI~DON PROVIDER NAME COrmu~i~'y Sere c ~ can be obtained? Nov fer is I t (in k~s) from here? (MITE IN ,00, IF LESS ?HAIl KILOI~TER. IF I TO 95 KILOMETERS, KILO~4~TERS . II] WRITE IN I~J~BER AS GIVEN IH CLUSTER. IF 96 KILOMETERS OR MORE, WRITE IN ' 96 ' . ) Met is the narr, e of the nearest fac i l i ty or provider to th is NEAREST INJECTABLE PROVIDER NAME community ~i~ere injectebles (Oepo Proverm) can be obtelr, ed? SXIP TO How far is i t (in tots) from here? IN '00' IF LESS THAN KILOMETER. IF 1 TO 95 KILC~ETERS, I[ILC~ETERS . . . . . . . . . . . . . . . . . J I I (~RITE k~ITE IN ~JNSER AS GIVEN IN CLUSTER. IF 96 KILCM[TERS OR MORE, I 1 r k~RITE IN '96M.) t Mhat is the name of the r~erest f&c i t l ty or provider to th is NEAREST FOAMING TASLET PROVIDER NJU¢E ccmmJnity ~here foaming tab lets , fo~ or Jet ty can be obtel+'~l? Rc~ far is i t { in funs) from here? (~/RITE IN *00' IF LESS THAN K]LO4ETER. IF | TO 95 KIL(~ETERS, KILOMETERS . . . . . . . . . . . . . . . . . I I J !,~ITE IN NUMBER AS GIV£N IN CLUSTER. IF 96 ICILOI,~TERS OR NOeE, I I J ~,IIITE IN *~ ' . ) Met Is the name of the netrest fec tL l ty or provider to th is i NEAREST IU(:O PROVIDER IUU4E com~tanity uhers IUCDI ( I~ l~ l ) can be Inserted? / No~ far is i t ( in lugs) frc~ here? (~/~ITE IN *00' IF LESS THAN [ILC~ETER. IF I TO 95 KILD~ETERS, KILOIqETERS . . . . . . . . . . . . . . . . . J J J ~ITE IN NUI4BER AS GIVEN IN CLUSTER. IF 96 KILOMETERS Oil ~40RE, I J I WI~ITE IR '96u.) t Uhmt i$ the name of the nearest fec |L t ty or prcNlder to th is NEAREST STERILISATIOM PROVIDER MANE commJnity ~here contrmceptlve s ter i l l sa t lon cBn be obtained? K~ far i | i t t in kms) frc~l here? IN 'OO' IF LESS THAN KILOMETER. IF I TO 95 I[ILC~ETERS, KILOHETERS . . . . . . . . . . . . . . . . . 1 I I (~ITE ~ItE IN Nt~BER AS GIVEN IN CLUSTER. IF 96 KILOMETERS OR V~k~E, L J I W¥~ITE IN ~96'.) 2"7 285 225. CLUSTER IHF[~!CANT$ NAME POSITICNITITLEIOCCUI~ATION I . 2. 3. 4. ~o 226. TOTAL NUMBER OF INFORMAHTS IN THE CLUSTER . . . . . . END OF CLUSTER INTERVIEW. LOG OF FACILITIES TO RE VISITED DIRECTIONS: AND A-E209. FACILITY TYPE & NAME: LIST BELOW ALL FACILITIES THAT ~RE CITED AS BEING WITHIN 30 KILO- METERS OF THE CLUSTER. GET THIS INFORMATION FI~q gUESTIONS A-EE03 OISTANCE FRCM CLUSTER LOCATION: DATE VISITED: z-8 286 | | S CTiOM S. It,ma: J ,O *ITAL v SIT J D , . : m IF THE k'OS~ITAL IS 30 KILO~TERS 011 LESS A'Y . IT IS TO lie ViSiTED. CONPLETE ~lOESTl~l~S 300 AJ~ 302 UPON U l IV~ AT THE FACILITT BASED 014 yOUR OUR O~SERVAIIOSS, TltElt FIND A nOUI.EDGEABLE SCU~CE AT l~E FACILITY TO A~S~R Tlte RE IHIN s toMs. C~LETE VISIT IF THiS FACILITY HAS ALREADY BEEIT VISITED FCI A DIFFERENT CLUSTER, RECORD OltS CLUSTER 1~I48ER HERE: IF THE FACILIFY HAS ALREADY BEEN VISITED, A SECONO VISIT IS MOT NEEDED, 300 IF THIS IS THE FIRST FACILITY VISITED AFTER TltE CLUSTER VISIT RECORD DISTANCE FROM CLUSTER FROM THE OD~4ETER. 301 302 DISTANCE FRON CLUSTER . . . . I I I NOT FIRST FACiLiTY ViSiTED . . . . . . 95 O0 YOU THINK THAT THE ESTIMATE OF DISTANCE TO THE FACILITY REASO~ADLE . . . . I GIVEN IN THE CLUSTER IS REASOEABLE? OVERESTIMATEO . . . . . . . . . . . . . . . . . . . . . 2 , UI~ERESTIMATED . . . . . . . . . . . . . . . . . . . . 3 DO YOU TITINK THAT THE ESTIMATE OF Tl~ TiME TO THE FACILITY REAS~4ABLE . . . . . . 1 GIVEIT IN THE CLUSTER IS REASONABLE? OV~RESTIMATEO . . . . . . . . . . . . . . . . . . . . . 2 , U~DERESTIMATED . . . . . . . . . . . . . . . . . . . . 3 CCJEST]O~S TO BE ASKED OF STAFF PERS.~ AT FACiLiTY: Io, 104 QUESTIONS CCOIHG CATEG~IES J SXIP TO i In what year d id th i s hospitst open? ~ I TF.AR OPEVED . . . . . . . . . . . . . t91 J j I Under whet author i ty is this hospltat operated? ; GOVERNMENT . . . . . . . . . . . . . . . . . . . . . . . . 1 ~OS 106 507 308 ~at is the status of th is hospital? PRIVATE . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 VOLUNTARY AGENCY . . . . . . . . . . . . . . . . . . 3 OTHER ,4 (~DNSU1.TANT . . . . . . . . . . . . . . . . . . . . . . . . 1 ItEGIONAL . . . . . . . . . . . . . . . . . . . . . . . . . . 2 OISTRICT/T)ESIGXATED DIST. ~ . . . . . $ I t~dE e , , , * * , , . o , o o , , . o o , , o o l , , . . o , .4 Ho~ many beds doer th i l hospitsI hl~,l? ~MBER OF BEDS . . . . . . . . I I I I I On iverage, how many o~t~t ients are seen da i ly at th i s fac i l i ty? NCI~BER OF DAILY , t ti ts .re De. ,o* sI*, OUT.TiENTS . . . . . . . I I I I I who go home the same day) HOW lany regular s~sff of the fot io~ing types does the hospitaI have? Doctors Medical assistants Rural medical aides PubLic health nurses Trained mid~iv~ MCH aides Aux i l i a ry staff (health o~:cers , health attendants, ~ER OF: OOCT(~S . . . . . . . . . . . . . . . . . . . ~ - ~ MEDICAL ASSISTANTS . . . . . . . . ~ - ~ EUlUL NEDICAL AIDES . . . . . . . ~RJRSES . . . . . . . . . . . . . . . . . . . . ~I:CWIVE. e . . . . . . . . . . . . . . . . . . MElt AIDES . . . . . . . . . . . . . . . . . AL:Xl L LARY STAFF . . . . . . . . . . . 3-1 c~.E~rs: 287 NO. 3O9 310 311 312 313 314 315 316 317 318 OUESTIONS CODING C.4TEG(~IES S~IP tO I J Does th is fK i l i ty normet ly use d ispossb le needier ~e~ l i v ing YEs . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 in jec t ions for I~CN l iu~fsat i~r~s? NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 - -~312 I Is th i s fa¢ i t i ty out ~ or hae i t run out of i t s $~ppty of NCN TEe . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 disposable needles st w~y time in the test 6 ~thsT NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 Oo~s th ie f~c i l i ty ever re~e d isposable neediest YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO. .o .oo ,o , . . .o° , . . , . . . o , . . . . . . ° . °~ Does th i s f~c i l l ty nor~e l (y ~;e d isposabte stoves? YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 - -~314 Is th i s f~c i l i ty c~Jt r~w or h is i t run out of disposable glove| YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 s t shy time in the l i s t 6 months? NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 I /h i t iS the me|had HOST f requent ly used for the s ter l t i ss t ion of medical instruments (not L insne)? (CIRCLE ONE) Has the fac i l i~ f NOT been able to s te r i t i se ~ ica l ins t r~ent l for any reason (e .g . ec~Jil:~e~t broken, no e~ect r i c i ty , no fue l ) at I~y t im in the l i s t Six months? Does the f i c i t i ty have the fo( iow|ng items in workir~ order/ ELECTRIC STERILISER . . . . . . . . . . . . . . . I AUT(~ L~VE . . . . . . . . . . . . . . . . . . . . . . . . . 2 STEAM PRESSLtE STERILZSER . . . . . . . . . 3 BOiL OVER KEROSENE STOVE . . . . . . . . . . 4 BOIL OVER C~U~COAL/VOCO STOV~ . . . . . S 14ONE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 OTHER 7 YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO. . . . . . . . . . . . . . . . . . . . . . . . . . . . . ° . .2 YES NO in stock: Running v#ter? E lec t r i c i ty? Ref r iger i to r? [erc~ene? Tete~o~ or radio t ransmi t te r? VehicLe? ~torbike? Operetlng theat re In ~ork ine order? Oet ivery lx , d? DeLivery k i t ? Weit ir~ sres for wa~en in (Woof? lto<x:l bank? txa inet [on couch? RUNNING ~ATER . . . . . . . . . . . . . 1 ELECTRJCITT . . . . . . . . . . . . . . . I REFRIGERATOR . . . . . . . . . . . . . . 1 KEROSENE . . . . . . . . . . ~ . . . . . . . 1 TELEPN~E . . . . . . . . . . . . . . . . . I VEHICLE . . . . . . . . . . . . . . . . . . . 1 MOTORBIKE . . . . . . . . . . . . . . . . . 1 OPERATING TNE.4TRE . . . . . . . . . 1 DELIVERY BED . . . . . . . . . . . . . . | DELIVERY KIT . . . . . . . . . . . . . . 1 ~rAITING AREA . . . . . . . . . . . . . . 1 BLOOD SANK . . . . . . . . . . . . . . . . 1 EXAM C~UCN . . . . . . . . . . . . . . . . 1 Examination t ight for gy~e~otoQicet ex~i r~t lm? IUC~ (toep Inser t ion) k i t ? N in i tsp k i t for tubal r iga | ton? Veighin9 scales for ch i ld ren? Adutt weighing scale? Growth cards? Linens? G~Jze? Cotton woo|? Ant isept ics? Stoed pressure machine? Memogloblnometer for d iagnos is of #~emil? Xicroscope? kIDS test (Et iSa tes t )? LIGHT*GYM EXJU~ . . . . . . . . . . . I [UCO KIT . . . . . . . . . . . . . . . . . . 1 NINiLAP KIT . . . . . . . . . . . . . . . 1 ~EIGHING SCJLLE-CHILD . . . . . . 1 A~JLT SCALE . . . . . . . . . . . . . . . 1 C~OWTN CARDS . . . . . . . . . . . . . . 1 LINENS . . . . . . . . . . . . . . . . . . . . 1 COTTON UOOL . . . . . . . . . . . . . . . 1 ~ul~ZEo. . . .o . . J . o . . . . . . . . . .1 ANT ISEPT I~ . . . . . . . . . . . . . . . 1 8LOCO PRESSURE MACHINE . . . . I HEI4C)GLOBINOIqETER . . . . . . . . . . 1 MICROSCOPE . . . . . . . . . . . . . . . . 1 AIDS TEST . . . . . . . . . . . . . . . . . 1 2 2 2 2 2 2 2 2 2 2 2 --,.316 Do you have ~ c~treech Progrlrn? YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 - -~320 Hou ~any vi i |ages/communit ies do yr~ regu ler ty v i s i t ? NUI4BEN OF SITES . . . . . . . . . . . . . . . . . . . . . ~-~ CC~MENTS: 3-2 288 SENVICES AVAILABLE AT TNE FACILITY: NoN I uc~atd Like to I.tk yc~ ~ maternal end ch i ld health services ev i l |abLe i t tk is hol, p l t s | . ASK 0.320 FOR t l~ FIRST SERVICE. I f THIS SERVICE IS AVAILABLE, CONTINUE ACROSS TNE TABLE, IF HOT, ASK ABOUt TNE NEXT SERVICE. SERVIC~ 3.'~0 IS (SERVICE) svaltabte? 321 No~ many day~ per we~k Is 322 In u~at year was (SERVICE) (SERVICE) ive i | ib t l ? f i r s t o f fered here? 1 J ~tenate | c.re YES . . . . . . . . . . . . . . . . . . . . . ' i ~ NO . . . . . . . . . . . . . . . . . . . . . . 2 19 I I • I I 2 I DeLivery care YES . . . . . . . . . . . . . . . . . . . . . I J NO . . . . . . . . . . . . . . . . . . . . . . 2 . . . . . . ~ . -~-~ 19 I I • I I | I Postnatal care YES . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . ' I J "[-[- l I • I I l , I ch,td I*~u~I.tion session* NO ,ES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 ' I Ij. 19 ~J~ I I • I 5 J Ch i ld grouth YES . . . . . . . . . . . . . . . . . . . . . 1 I I mo~l to t ing sessions NO . . . . . . . . . . . . . . . . . . . . . . 2 19 I 6 I Rehy~ret i~ un i t YES . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . ' i I J " l - - - - [ - - 3~, , - . J , i I I I NEDICATIC~ AVAILABILITY AT THE FACILITY: No~ I w~Jtd Like to ssk you about medicatJc~s and other suppl ies avaiLabLe et th is fac i l i ty . Vhe~ I have f in i shed , I v(LL nee~ to see the medJcaticns you have |n stock, kSl( 0.323 FOR EACH NEDICATION. IF THE ~ICATIG~ IS AVAILABLE, ASK 0.32&, IF NOT ks: Q.32~. IF THE NED;CATICN KAS AT S~I4E TIME BEEN AVAILABLE, ASK 0.326° IF 0.32.3 1$ ~$~ IE_CTm__ h trdETHER YOU SEE THE NEDICATION MEDICATION 323 Is (NED ICATION) ave ab e no~? YES . . . . . . . 1 Ch Loroc~ir~ syrup 324 At ~y time (n the last 6 months d id yo~ run mat of (MEDKCATI~)? YES . . . . . . . . . . . . . . . . . 1-- I No . . . . . . . . . . . . . . ia' 3 Nave you ever 326 Uhy do you 32.7 I~DI~TIOI i h~ed (HEOICATION)? not have (HEDICA- SEEN/NOT SEEN T ON) no~? is1 STATUS YES . . . . . . . . . . . . 1 NO . . . . . . . . . SEEN . . . . . . . . 1 NOT STEN. . . .2 C ondo~s YES . . . . . . . . . 1 YES . . . . . . . . . . . . . . . . . 1-~ YES . . . . . . . . . . . . 1 i SEEN . . . . . . . . 1 NO . . . . . . . . . . 3,5 ~2 a<, ----I i a , , - - / NO . . . . . . . . . . . . . . :,.~:. 2- J NO . . . . . . . . . ;:,~,. 2~ NOT SEEN . . . . 2 i CODES: [a] Ir~suf¢i¢ient funds • I Not designated to carry z 3 Other = arable to get res~iy • 2 ~at of current month,s s~[y z 4 3-3 289 2 Q~|nina YES . . . . . . . . . I YES . . . . . . . . . . . . . . . . . 1 - I YES . . . . . . . . . . . . 1 I SEEN . . . . . . . . 1 NO . . . . . . . . . . 2 1 NOT SEEN . . . . 2 No . . . . . . . . . . . . . . ia' NO . . . . . . . . . i i i I ] Pen ic iL t |n YES . . . . . . . . . 1 YES . . . . . . . . . . . . . . . . . 1-- I YES . . . . . . . . . . . . 1 SEEN . . . . . . . . 1 NO . . . . . . . . . . 2 NO . . . . . . . . . . . . . . . . . .2 - -~ NO . . . . . . . . . . . . .2 -~ NOT SEEN. . . .2 325 *-J 323- J i i i i YES . . . . . . . . . . . . 1 SEEN . . . . . . . . 1 Ir~'~ tablets YES . . . . . . . . . 1 YES . . . . . . . . . . . . . . . . . 1--1 NO . . . . . . . . . . 2 NO . . . . . . . . . . . . . . . . . .2 - -~ - J NO . . . . . . . . . . 2-~ NOT SEEN 2 325 -~J 323 --J , . J i i i FO||C acid YES . . . . . . . . . I YES . . . . . . . . . . . . . . . . . 1-1 YES . . . . . . . . . . . . | SEEN . . . . . . . . 1 NO . . . . . . . . . . 2 NO . . . . . . . . . . . . . . . . . .2 - -~ NO . . . . . . . . . . . . .2 - -1 NOT SEEN, . . .2 325 -~ 323 ,-J i i i Olt$ packets YES . . . . . . . . . 1 YES . . . . . . . . . . . . . . . . . 1"-I YES . . . . . . . . . . . . 1 SEEN . . . . . . . . 1 NO . . . . . . . . . . 2 NO . . . . . . . . . . . . . . . . . . 2--[--I NO . . . . . . . . . . . . .2 -~ NOT SEEN.2 3;5 - J 323 , .d 323, J IO. ;29 L30 ~31 332 333 What I$ your pos i t ion or t i t le here? QUESIIOI~ I CODING CAtEG~IIES SKIP TO I I Oo yc~ h ive enough space In th is foc l t l ty for 14(:1( serv ices? YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 HO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 I 1 ' Are femunlset lo r4 lV l I I~ la for ch i ld ren roe? YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 I I At ~ t ime In the las t 6 wonthe have you run out of vaccines? YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 ~, o ,oo ,o . ** .o .ooo . .ooo oo . .++.oo* .2 ! I I need to see your supply of vucc lne l n~4. VACCINES SEER IM REFRIGERATOR . . . . . I VACCINES SEEN 1~3T IN REFRIGERATOL2 I VACCINES k~t SEEN . . . . . . . . . . . . . . . . . 3 I I Does th i s fac i l i ty provide family pLsr~ing services? YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 _ -b 338 ~. . . °o° .oo°o~.°°o .°° . . . . °o . ° . , ,o°~ 33~ 335 336 IF THE FAMILY PLANNING INFORJ4ATION IS OBTAINED FRON A SECOND FACILITY+ SEGIM QUESTIONNAIRE WITH 0.33~. In *hat year d id th i s hospital open? Under *hat author i ty is th is hosp l t l [ operated? YEAR OPENED . . . . . . . . . . . . . 19~-~ GOV~RHIqENT . . . . . . . . . . . . . . . . . . . . . . . . 1 PRIVATE . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 VOLL~TARY AGENCY . . . . . . . . . . . . . . . . . . 3 OTHER ,A ~et Is the s ta tus of th is hospitaL? C~SULTART . . . . . . . . . . . . . . . . . . . . . . . . 1 REGIONAL . . . . . . . . . . . . . . . . . . . . . . . . . . 2 DISTRICT/I)ESI~TED DIST. HOS . . . . . 3 NONE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . & 337 Does the 33,8 I 339 fac i l i ty have the fo i lo~ ing items In worklrvg order: Running water? E lec t r I c t t , ( t 09~rat lng theatre ]n uorktng order? Exa=ttnat Ion couch? Examfnatlo~'t l ight for Syf~ecologlcal examination? BlOOd pressure wh l r , e? IUC9 ( loop Insertion) k i t? I¢ in i tap k i t for tubol t igat ion? YES NO RUNNING ~L~TEI . . . . . . . . . . . . . 1 2 ELECTRICITT . . . . . . . . . . . . . . . 1 2 OPERATING THEATRE . . . . . . . . . I 2 EXAR ~ . . . . . . . . . . . . . . . . 1 2 LIGHT-GYM EXAI~ . . . . . . . . . . . I 2 BLOOD PRESSURE KACNINE . . . . 1 2 IUCO KIT . . . . . . . . . . . . . . . . . . I 2 NINII.AP KIT . . . . . . . . . . . . . . . I 2 3z,1 3¢0 Does the hosp i ta l have the fe l ioutng types of s ta f f who are t ra ined in fami ly p lanning provis ion? YES NO Doctors? DOCTORS . . . . . . . . . . . . . . . . . . . 1 2 ----~ ~,~ Medic i | Ass i s t~ts? NEDICAI. ASSISTARTS . . . . . . . . | 2 Rural Medical Aides? RURAL NEDICEL AIDES . . . . . . . 1 2 Nurses? NURSES . . . . . . . . . . . . . . . . . . . . 1 2 MCH Aides? NCN AIDES . . . . . . . . . . . . . . . . . 1 2 I I Are w~y fami ly p ior~ing doctors t ra ined In s te r i t i sa t lon YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 procedures ( tuba l l lg | t lon or vasect(x~y)? NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 Are the fo l lo~ ing types of s ta f f , i f ava i lab le , t ra ined in IUCO ( loop) inser t ion? YES NO IIA Doctors? DOCTORS . . . . . . . . . . . . . . . . . . . 1 E 7 Xedlca l Asslstl.~ts? NEDIEAL ASS[STk~TS . . . . . . . . 1 2 ? Rural Nedicai Aides? RURAL MEDICAL AIDES . . . . . . . I 2 7 Nurses? NURSES . . . . . . . . . . . . . . . . . . . . I 2 7 NCH Aides? 14CN ~'DES . . . . . . . . . . . . . . . . . 1 2 7 I I Durir~ an average month, hou many ~ come to get fami ly I piannirx3 for the f i r s t time? NEV PATIENTS . . . . . . . . . . 3-/. 290 IO. 342 343 344 Q~ESTICX4S COOING CATEGORIES SKIP TO I I ~t l r~ l w~ sver*ge ~th , hov many ~ come bec~ they need u~e f~ty pl*r~ir~ (resuppLy)? EESUPPLY PATIENTS . . . . . 111 Go ~ fiLL out Im NCH 3 form (Teer i f l ye mah~ur io )1 aklt~l TEE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 mma ru ~toto Awe ruezl eu n~ake) regular ly? NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Z ---~ ]KS I I ~F~t do y~do th is form? SEND TO NOR . . . . . . . . . . . . . . . . . . . . . . . 1 SEND TO DISTRICT OFFICER . . . . . . . . . . 2 SEND TO ZOKAL OFFICE . . . . . . . . . . . . . . 3 KEEP IN FILE . . . . . . . . . . . . . . . . . . . . . . NOTHING/DON'T KNOW . . . . . . . . . . . . . . . . 8 I I I I COMTILAC~PTIVE METHOD AVAILABILITY: Nov I u~td Like to ask you ll:x)~t which fami ly ptar~l~R uetheds ere ev l i t s~te i t th i s hospitaL, I mat else see :~ aethoda uh~m ~ ere f inished, ASK ABOUT THE FIRST METHOD, IF THIS METHCO iS AVAILABLE F~ THE HOSPITAL. MOVIE AC~C~S TNE TAJLE. |F TH~ ~ETH~O IS NOT AVAILABLE NOW, AS[ Q.3SO AND THEE ~GIN AGAIN UITN THE NEXT METHOD. 01 PiLt I~TK~ 02 IUCD (Lo,:~) 03 In ject ion O& Fo~l~i~g tab lets / foam~jetty OS Contraceptive ster- I t | s i t i~ (tUbaL tigetla~/vesectcmy) 06 Other Spec i fy NO. $$1 553 345 IN I (METHOD) I avaiLabLe no~? YES . . . . . 1 NO . . . . . . 2 350 YES . . . . . 11 NO . . . . . . 2; 35O 346 Nou many 347 In u~et (Jays per ~eelc yesr d id you iS (NETHOD) f i r s t of fer sval ~able? (~THOD)? 348 Is your stock 1349 METHOD of (METNOD) in date SEEN/NOT SEER or out of date? STATUS IN DATE . . . . . . . . . . f CUT OF DATE . . . . . . 2 BOTH . . . . . . . . . . . . . 3 IN DATE . . . . . . . . . . 1 OUT OF DATE . . . . . . 2 ROTN . . . . . . . . . . . . . 3 I I I I I SEEN . . . . . . . . I NOT SEEN.2 SEEN . . . . . . . . I NOT SEEN.2 350 ucu many ~ d id y~runout of ~ $. ~ s . YES . . . . . 1 I I ~-~- IN DATE . . . . . . . . . . 1 SEER . . . . . . . . I ~ NO . . . . . . 2 I / 191 [ OUT OF DATE . . . . . . 2 NOT SEEN.2 I I I~S" 350 ~-~ | J BOTH . . . . . . . . . . . . . 3 i J ~ES . . . . . ' , , ~T "~ I~DATE . . . . . . . . . . I SEEN . . . . . . . . 1 ~ NO . . . . . . ~ J , 191 J ~ OF DATE . . . . . . 2 NOT SEER. . . .~ I I I ~S* 350 ~J t ~ ~OTN . . . . . . . . . . . . . 3 YES . . . . . 1 NO . . . . . . 2 350~-J YES . . . . . 1 NO . . . . . . 2 350---J COOES: Is] 97 • Rever stocked uethed I I QUESTI~S Do you haw your coatracept|ves del ivered or must you go got thee? Nov far ( in ki lometers) must you go to get thamT ~l t is y~ur posi t ion or t i t le here7 CCOLNG CATEGORIES S~IP TO I DELIVERED . . . . . . . . . . . . . . . . . . . . . . . . . 1 -~ 353 PICK TNEN UP . . . . . . . . . . . . . . . . . . . . . . 2 I TO PIC3C UP ~TR~PT LVES . . . . . . . . . . . . I QUESTIONS 354 AND 3S5 ARE TO EE ANS~RED i1 TNE I~TERVIE~ER AFTER THE FACIL|TT VISIT I$ CC~LETE. 3S4 t DID TEE INFOE)(AHT SEEM KNC~LEDGEABLE? YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I ! NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 3~5 ~DIT:.~AL CC3~ENTS: 3-S 291 I cTIoN , . R . : I LT. CEHTRE visit I ° ' " : . m IF THE HEALTH CENTRE IS 30 KILCB4ETERS OR LESS AWAY, IT IS TO BE VISITED. COV;)LEtE QUESTIONS 400 ANO 602 UPOI AXRIVAL AT THE FACtL|TT BASED 0i4 YOUR ~ OeSERVATIONS. THEN FIND A KHOI.~EDGF.~6LE SOJ.RCE AT THIE FACILITY TO AHSldEi THE REKAINING G~STIONS. COMPLETE VISIT IF THIS FACILITY HAS ALREADY BEEN VISITED FOi~ A DIFFERENT CLUSTER, REC~D DKS CLUSTER liUMBER HERE: IF THE ~ACILITY HAS ALREADY BEEN VISITED, A SECONO VISIT IS NOT HEED[O. I ] I I i 6O0 IF THIS IS THE FIRST FACILITY VISITED AFTER THE CLUSTER V iS i t RECCXQO DISTAHCE FRON CLUSTER FRON THE ODOMETER. I - - - '1 - - - I DIS?JUiCE FROICLUSTER . . . . J J J NOT FIRST FACILITY VISITED . . . . . . 9S DO T~J THINK THAT THE ESTIKATE OF DISTANC~ TO THE FACILITY REASOkABLE . . . . . . . . . . . . . . . . . . . . . . . . T GIVER IN THE CLUSTER IS REASONASLET OVERESTIKATED . . . . . . . . . . . . . . . . . . . . . 2 UKOERESTIHATEO . . . . . . . . . . . . . . . . . . . . 3 REX~ABLE . . . . . . . . . . . . . . . . . . . . . . . . 1 OV[RESTIKATEO . . . . . . . . . . . . . . . . . . . . . UNDERESTIHATEO . . . . . . . . . . . . . . . . . . . . ] CODING CATEGORIES SKiP ": l TE~q OPENED . . . . . . . . . . . . . 19[~- I "~ [ I A 601 O0 YOU THINK THAT THE ESTIKATE OF THE TIME TO THE FACILITY GIVEN IN THE CLUSTER |S REASONABLE? i QUESTIONS TO BE ASI~D OF STAFF PERSON AT FACILITY: HO. QUESTIONS L03 In ~ i t year d id th i s heal th centre open? Under ~at euthor{ty Is th i s health centre operated? I HO~ e~sny beds ~ th i l health centre have? I On averigej how many ~t l~t ients ere seen da l ly i t th i s F ie| l iLy? GOVERNMENT . . . . . . . . . . . . . . . . . . . . . . . . 1 PRIVATE . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 VOLLA~TAJIY Ar-rNCy . . . . . . . . . . . . . . . . . . 5 OTHER .4 606 407 406 I~IKBER OF BEDS . . . . . . . . I I I I i k~IKBER OF DAlLy (Outpatients are people seen for pcevent|ve care lu.,d sick: pe~|e OUTPATIENTS . . . . . . . [ I i I ] uho go h~e the same day) Hou uany relpJtar s tB f f of the fo l lou lng types does the health centre here? Medical assistants Rural ItedJcel a|dell Public hea l th nurses ?retted midwives HCH aides Aux i l i a ry s ta f f (health off icers~ heal th atter'~ant$, other r~JrSes) NUNBER OF: I~DICAL ASSISTANTS . . . . . . . . ~ - ~ RURAL NEDICAL AIDES . . . . . . . ~ - ~ NURSES . . . . . . . . . . . . . . . . . . . . ~ 1 HID~IVES . . . . . . . . . . . . . . . . . . NCH AIDES . . . . . . . . . . . . . . . . . AUX]LL~Y STAFF . . . . . . . . . . . COI~EHTS: 6-1 292 io. 410 411 412 413 414 615 ¢16 DU,£ST IONS Does ih ts f i . .~ l l ty nemal iy ~e disposable needles d~eng lv lng In JK t lon l fo r MCH Imun leet tomt l l th i s fK l i l ty out now or hes I t run out of I t s supply of d isposable needles I t eny t ime In the test 6 In~nths? Ooq th i s fac i l i ty ever reuse d i s lx~te needles? Does th i s fac i l i ty normaLLy use disposable gloves? Is th l s f l c l l l ty c~t nee or h i s t t run out of i t s supply of d i spos~te gloves et i~y t ime in the Last 6 Inonths? t/hat Is the mathocl 140~T f rec luent iy used for the e ter i l i se t lon of eed ics t instruments (not Hnene)? (CIRCLE ONE) HaS the fac i l i ty HOT been ab le to s te r i i t se medical Instruments for any reason (e .g . equ iprent broken, no e lec t r i c i ty , no fueL) I t ony t ime In the les t s ix =no.the? Does the fec i t l ty have the fo t iou lng |taml In work ing order/ CODING CATEG(~IES I SXlP TC I TES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . ; . . . . . . . . . . . . . . . . . . . . . . Z - - - ,412 YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1 UO. . . . . . . . . . . . . . . , . . . . . . . . . . . . . . . .Z YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ,1 YES. . . . . . . . . . , . . . . . . . . . . . . . , . . . . . . t NO. . . . . , . . . . . . . . . . . . . . . . . . . . . . . . . .2 TES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . , . I MO. . . . . . . . . , , , . . . . . . . . . . . . . . . . . . . .2 ELECTRIC STERILISER . . . . . . . . . . . . . . . 1 AUTCCLAVE . . . . . . . . . . . . . . . . . . . . . . . . . 2 STEAJ4 PRESSURE STERILIS~R . . . . . . . . . 3 BOIL OVER KEROSENE STO~ . . . . . . . . . . & BOIL OVER CHARCOAL/VOQO STOVE . . . . . S NONE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 OTHER 7 YES° .** , .o**o . ° , , , * **°o . °***** , , .o l NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 YES I0 - -~16 in s tc~k: Running Niter? ELect r i c i ty? Refr |geretor? Ke~osone? TeLephone or r~|o t r snsa l t te r? VehicLe? Motorbike? B icyc le? DeLivery bed? Oet ivery k i t ? Wai t ing i res fo r ~ In lobar? Blood bank/ Examination couch? RUNNING WATER . . . . . . . . . . . . . 1 ELECTRICITY . . . . . . . . . . . . . . . 1 REFRIGERATOR . . . . . . . . . . . . . . 1 KEROSENE . . . . . . . . . . . . . . . . . . 1 TELEPHOI(E . . . . . . . . . . . . . . . . . I VEHICLE . . . . . . . . . . . . . . . . . . . 1 MOTORBIKE . . . . . . . . . . . . . . . . . 1 BICYCLE . . . . . . . . . . . . . . . . . . . 1 DELIVERY lED . . . . . . . . . . . . . . 1 DELIVERY ElL . . . . . . . . . . . . . . 1 UAITING AREA . . . . . . . . . . . . . . | RLO00 DAN[ . . . . . . . . . . . . . . . . I EXAJ< COUCH . . . . . . . . . . . . . . . . I Examination t ight for SVn~otoQIcei examination? IUCO (Loop Inser t ion) k i t ? Weighing scales for ¢h i td rm? Adu l t ve lgh lng scale? Groeth card=? L iners? Gauze? Cotton uoot? Ant Isept |cs? Blood pressure machine? TetcNist method for diagnosis of 8.neffll|? Microscope? AIDS tes t (E i i sa test)T LIGHT-GYN EXAMS . . . . . . . . . . . 1 IUCO LIT . . . . . . . . . . . . . . . . . . 1 WEIGHING SCALE-CHILO . . . . . . 1 2 ADULT SCALE . . . . . . . . . . . . . . . 1 2 ~(~TH r.Juto$ . . . . . . . . . . . . . . 1 2 LINENS . . . . . . . . . . . . . . . . . . . . 1 2 COT TCli ~ . . . . . . . . . . . . . . . 1 Z GAUZE . . . . . . . . . . . . . . . . . . . . . 1 2 AMT I SEPT ICS . . . . . . . . . . . . . . . 1 2 BLOOD PRESSURE K~CNINE. . . I 2 TALCUI ST 1~ TI~O . . . . . . . . . . . 1 2 MI CROSCOPE . . . . . . . . . . . . . . . . 1 2 AIDS TEST . . . . . . . . . . . . . . . . . 1 2 417 Do you have an outreach program? YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 -- , , .419 i i 418 u~ many v i lLages/communit ies do you regu lar ly v i s i t ? NU~SER OF SITES . . . . . . . . . . . . . . . . . . . . . i 619 [ Do you rece ive an EDP k i t every month? YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 E HO. , . . .oo .oo . , . , . . . . . . , . . . * * . ** . . .2 C3M~E~TS: 293 ~RVICtS AVAILA~t.E AT TME FACILITY: NO~ I ~ouid Like to ~*k yo~ ebotat ~ter r~L end ch i ld hest th serv l¢~ svi l t~date st th i s hee l th centre . A~X B.4~O FOR T~ FIRST ,¢~2VICE. IF TNI$ SERVICE IS AVAILABLE, Ct~TINU( ACROSS THE TABLE, IF NOT, AS[ ABOUT THE NEXT SERVICE. I I ~EMVICt A20 I t (SERVICE) avaiLabLe? 421 Mou wr i t dayt I~r ~,e~k i t 422 (SERVICE) evs i l sb te? mE I 2 ] Del ivery csre YES . . . . . . . . . . . . . . . . . . . . . 1 . . . . . . . ~- . . . . . . . . . . . . . . ~ .~.~!~. :~.~ / I I I 3 J Post r~ts t t i re 4 ] t~ i td tmun i ta t ion sess|or~ $ I C~itd growth eo~Jtor~r~6 sesslor4 YES . . . . . . . . . . . . . . . . . . . . . 1 NOo,° ,~, ,~o°° ,o , , * * , °°o°~ I YES . . . . . . . . . . . . . . . . . . . . . ¶ NO . . . . . . . . . . . . . . . . . . . . . . 2 I YES***o . ,o . *** , .o .o . , * ** I NO. oo ,o~,oooo .o~. ,oooooo2 423~ 14EDICJtTIOI~ AVAIl.ABILITY AT THE FACILITY: In u~et year ~IS (SEBVICt) f i r | t of fered here? I J "1 ,91 ,91 I I No~ I ~td t l ke to ~sk you about med icet Io~ end other suppl ies svs i tabte et th i s f~c l t l ty . When I have f in i shed, I v~tt need to see the medications you have in stock. ASX Q,~2.~ FC~ EACX NEDIC~tTI~. IF THE ~EDICATIO~ IS AVAILABLE. ASR Q.~2&, IF UCT A G.A~, lF THE I~DICATION HAS AT ~E TIME BEEN AVAILABLE, ASK Q.~26.,F 0.423 IS YES, RECORD ~ETKER YOU ~E THE NEO]CA~:~. 1 ~7 ~Ep:-,*lo~ S~EN/NO~ S~EN STAT~ SEEN . . . . . . . . I NOT SELl . . . .2 , o , . 1,2, A, ,,- ,° ,h. i,o 1,2, NEDICATI TM (HEDICATION) tes t 6 I~nths d id you hod (i4EDICATION)T not have (14EDICA svn leb le no¢~ run out of (XEDIC.4TION)T TION) no~t/ [~ YES . . . . . . . I . o . . . . ; .~ ; .~ YES . . . . . . . . . . . . . . . . . 1~ NO . . . . . . . . . . . . . . ~ YES . . . . . . . . . . . . . . . . . 1~ ,~ .~ ,o . . . . . . . . . . . . . . ~ ;~.~ YES . . . . . . . . . . . . 1 No . . . . . . . . . i~ '~ II YES . . . . . . . . . . . . 1 No . . . . . . . . . ; . ;~ .~ 1 C:~ t or oqul ne syrup 2 ~[n Jne YES . . . . . . . . . 1 YES . . . . . . . . . . . . . . . . . 1--i YES . . . . . . . . . . . . 1 SEEN . . . . . . . . 1 l i I I I [ peq' l t C | t I I . YES . . . . . . . . . 1 YES . . . . . . . . . . . . . . . . . I " 7 YES . . . . . . . . . . . . t , i .~EN . . . . . . . . ' .o . . . . . . . . . . 2 No . . . . . . . . . . . . . . ~ ; ;~ J NO . . . . . . . . . ~ ; ;~ I I NOTRE, ' I 4zs ,2 I I I I I , ,r to,et. , . . . . . . . . . . , , . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . SEEN . . . . . . . . __._.J I ,o . . . . . . . . . . 2 ,o . . . . . . . . . . . . . . ~;~.2.- I ,o . . . . . . . . . ~ .27 [ j MoT SE~. .2 ] 425 ~-J .qi=ml ~ I I I I I EO I i¢ K id Y~S . . . . . . . . . 1 YES . . . . . . . . . . . . . . . . . 1 - - 1 YES . . . . . . . . . . . . ' z , SEEN . . . . . . . . 1 .o . . . . . . . . . . , , . . . . . . . . . . . . . . . - . z~ J ,o . . . . . . . . . . _ .2~ I J ~T~, . .2 4Z3.2 4~.2 I I I 6 atS packets YES . . . . . . . . . 1 S£EM . . . . . . . . 1 NO . . . . . . . . . . 2 MOT SEE~.2 7 Cor~Jcns YES . . . . . . . . . 1 YES . . . . . . . . . . . . . . . . . 14 YES . . . . . . . . . . . . I , , SEEM . . . . . . . . 1 .o . . . . . . . . . . , No . . . . . . . . . . . . . . --,.2-t" NO . . . . . . . . . . . . . 2~ [ J ,OTSE~. .2 4~ 4-J 4Z7 ~-J . 427 COOES: [a] Insu f f i c ient funds - I Hot desigrmte<l t . carrot • 3 Other • 5 UnabLe to get resuppty • 2 O~t of cur rent m~x~th's supply • 4 4-3 294 |Oo QUESTIONS L28 Do yo~ hsve enoul~ SlaKe In th i s f l c l l l ty for NCK services? I 4~ Are InmJnlsstlor=l sv lHabte for ch i ldren I 63D At ~ tim= in the test 6 months have you run o~t of vaccines? I 431 ! need to see yo~r supply of vac¢|nes no~. 432 Does th i s fac i l i ty l~ovlde fe,~iiy planning services? I 6~ Uhet Is vour Posit ion or t i t le here? 434 635 COOING CATE(~IES ~S. . . . . . . . . . . . . . . . . . . . . . . . , , . . . . . t 1~. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2 TES* ,o* , , ,o*o*o** , ** , , , *o , *******~! NO*o , I * ,o , ***** ,o* , *o . , * . ****** I * ,2 TES. . . . . . . . . . . . . . . . . , . . . . . . . . . . . . . t NO. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2 VACCINES SEEN IN REFRIGERATOR . . . . . 1 VACCINES SEEN NOT IN REFRIGERATOR.2 VACCINESNOT SEEN . . . . . . . . . . . . . . . . . 3 YES. , . . . . . . . . , , . . . , . . . . . . . . . . , , . . .1 1~. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2 S~CIP TC - -~432 - - * 438 - -~ 4S4 IF TNE FN4ILT PLANKING INFORMATIOI~ IS CGTAIHED FROM A SECOND FACILITY, BEGIN QUESTI~4NAIRE VITN 0 .4~. In what year did th is health centre o~T Under what suthor l ty Is th i s health centre operated? fac i l i ty have the foLlowing I tm in working order: llunlM ng water? E lectr ic i ty? Examination couch? ixamlnstlon Light for gynecotogicm| exmutnstlen? Blood I~essure mchlneT IUCD (Ioo~ insert ion) k i t ? heelth centre have the foL l~ ing types of s ta f f who ere in famtty planning provision? Neclicll Assistants? Rursl NedicsL Aides? Nurses? MCH A|desT TEJUt OPEXED . . . . . . . . . . . . . t 9 ~ GOrE R ¢",ENT . . . . . . . . . . . . . . . . . . . . . . . . I PRZVATE . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 VCN.tJII( TABF ACJE N CY . . . . . . . . . . . . . . . . . . 3 DTNEN .4 YES NO RUNNING HATEI . . . . . . . . . . . . . 1 2 ELECTRICITY . . . . . . . . . . . . . . . 1 2 EXA)t CO.C~ . . . . . . . . . . . . . . . . 1 2 LI GNT-GTH EXAMS . . . . . . . . . . . 1 2 BLOOD i~ES$1~E ~4CKlllE . . . . 1 2 IUCD t IT . . . . . . . . . . . . . . . . . . 1 2 YES NO MEDICAL ASSISTANTS . . . . . . . . 1 2 RURAL MEDICAL AIDES . . . . . . . 1 2 N~S£S . . . . . . . . . . . . . . . . . . . . 1 2 MCH ALOES . . . . . . . . . . . . . . . . . 1 2 437 Does the i I 438 Does the t re tned I#.0 U.2 Are the fo l lowing types of stef fo I f eva f t lb te , t ra ined in IUCD (Seep) insertion? YES NO HA Ned|eli Assistants? I~DICAL ASSISTANTS . . . . . . . . 1 Z 7 Rural Me<HceL Aides? IRJIC4L N~)ICAL ALOES . . . . . . . 1 2 7 NurseS? NUIt~rS . . . . . . . . . . . . . . . . . . . . 1 2 7 )1¢1¢ AIdesT MeN ALOES . . . . . . . . . . . . . . . . . I 2 7 I During an aversge month, how many ~ come to get fatnity ptann i r~ for the f i r s t time? NEW PATIENTS . . . . . . . . . . I I I I I During an average month, how mar'~f t.~rc-n corns because they need =ore fami ly pt lnning ( res~pIy )T ' RESUPPLT PATIENTS . . . . . 1 I l l 4-4 295 I10. ~3 444 CUEST thus Do you f i l l out in MCN 3 form (Tesr i fe y~ ~udhur lo ya eklna n~ vetoto k~e |~ez i ~ nu~eke) re~ls r ly l M~et do you do th i s fore? C~DIHG C ITE~IES YES , . .1 NOo~t . . . , . . . , . , , ° . ° . *** , . . . . ,~ , , °o~ SEND TO ICOR . . . . . . . . . . 1 SEND TO DISTRICT OFFICEB . . . . . . . . . . SEKO TO ZCI~L OFFICE . . . . . . . . . . . . . . 3 ~EEP IN fILE . . . . . . . . 4 NOTHING/DON'T [NOb' . . . . . . . . . . . . . . . . 8 S~CIP TO - -~5 CCNTRACEPTIVE NETHCO AVAILABILITY: Nee I ~ ld l i ke to esk you about uh lch family p lanning methods ere eve l tebte et th is hea l th cent re . I must e lse see the methods ~e~ we ere f in i shed . AS[ ABOUT TEE FIRST NETNO0. i f TNIS IqETNOO IS AVAILABLE FRON THE HEALTH CEVTIJE, MOVE A_r)"¢$ THE TABLE. IF THE METHOD IS MOT AVAILABLE MO~, ASK Q.&BO AND THEN BEGIN AGAIH ~ITK THE NEXT lETHe. 1 ~5 Is ~I~TI~D (MET~O) ive i l~bte 01 |P t t l i YES . . . . . I J NO . . . . . . 2 ~50 I 02 I IUCO (lOOp) YES . . . . . 1 J . . . . . . 2 450 "~ I 03 [ In jec t ion YES . . . . . 1 I ~50 ,,i-.J I 04 I foaming tab le ts / YES . . . . . 1 I fo~/ Je l l y NO . . . . . . &SO I 06 I Other YES . . . . . 1 J NO . . . . . . 2 Spec i fy l ~50 ~-J C~OES: days per ~-.ek Is {~TaCO) ave l t~teT el el I I 447 ln~et yeer d id you f l r t t o f fer (NETN~O)? "F- F-) "F-q-] ',Flq I I 97 • Never stocked method L,x,8 Is y~Jr stock /,/.9 14~T~ of (I~TI~O) in date SEEN/NOT ~EI or c~dt of dater STATUS IN DATE . . . . . . . . . . 1 OUT OF DATE . . . . . . 2 BOTH . . . . . . . . . . . . . 3 IN DATE . . . . . . . . . . 1 OUT Of DATE . . . . . . BOTH . . . . . . . . . . . . . 3 IN DATE . . . . . . . . . . I OUT OF DATE . . . . . . 2 BOTH . . . . . . . . . . . . . 3 IN DATE . . . . . . . . . . 1 OUT OF DATE . . . . . . 2 BOTH . . . . . . . . . . . . . 3 SEEN . . . . . . . . I NOT SEER. . . ] SEEK . . . . . . . . 1 HOT $EEH.,.2 SEEH . . . . . . . . I HOT SEEN.2 SEEN . . . . . . . . I NOT SEEN. . . .2 ~$0 NOV me'y weeks ego did you run o~x of (METHOD)? Ia] - -~ JCS. NO. 451 452 453 QUEST IONS Do you here your contracept ives del ivered or must you go Bet themT Ho~ far ( in k i lometers ) must yo~ 9o to get them? ~,1~et I t your pos i t ion or t i t le here? CO01HG CJ~TEGORIES DELIVEREO . . . . . . . . . . . . . . . . . . . . . . . . . 1 PICIC THEN UP . . . . . . . . . . . . . . . . . . . . . . 2 TO PIC3C UP C~OI~TRACEPT IV~5 . . . . . . . . . . . . QUESTIONS 4S4 AND 455 AJtE TO BE ANS~JERED BY THE INTERVIEt,/ER AFTER THE FACILITT VISIT IS CCIqPLETE. &~, DID THE INFORMANT SEEM KI¢OWLEDGEABLE? 455 ADDITIONAL C~gCENTS: YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 HO. . ,o .o . .oo , ,o . . . ,oo .ooo .o .oo .o . .~ S~IP TO ~' 453 {.-5 296 | I ~ECTIOR So lam: ~ OlS~EmSJUtV VISIT i Date: | | IF Ts£ DISP~MSA~T IS 30 RILOKETERS OR LESS AWAY, IT I$ TO S£ VISITED. COMPLETE QL,'ESTIONS SO0 ANO 502 UP,if UEIVAL AT Tli~ fACiLiTY I.~Sk'D 014 T(AJ~ ~ ORSERVATIORS. THEN F l~ A L'I~OWI.EDGEAELE S~L~qCE AT 1dE FACILITY TO AN~E TNI[ REMAINING QUESTIONS. C~PLETE VISIT IF THIS FACILITY ~U~$ ALREAOT SEEN VISITED FOR A DIFEEREHT C1.USTER, RECORD OHS CLUSTER NUNRER HERE: IF THE FACiLiTY HAS ALREAOY SEER VISITED, A SE~ VISit IS NOT NEEDED. I I I I I I SO0 IF THIS IS T~ FIRST FACILITY VISITED AFTEE THE CLUSTER' VISIT REC~I~D DISTANCE FROI4 CLUSTER FR~ THE CO(3~(ETER. $01 O0 YOU TRIMK IMAT THE ESTIMATE OF DISTANCE TO TlSE FACILITY GIVI~N I i THE CLUSTEt IS REASOliADLE? SO~ DO YOU THIHC THAT Tl~E ESTIMATE OF THE TIldE TO TX£ FACILITY GIVI[M IM THE CLUSTER IS REA~ABLET I QUESTIONS TO ~ ASKED OF STAFF PERSI3~ AT FACILITY: I ' - ' -T- ' - ' l DISTANCE FROM CLUSTER . . . . I I I NOT FIRST FACILITY VISITED . . . . . . 9a~ IO. REASONABLE . . . . . . . . . . . . . . . . . I OVERESTIMATED . . . . . . . . . . . 2 UNOERESTIMATI'~ . . . . . . . . . . . . . . . . . . . . $ ~03 ~04 ~06 ~07 508 REASONABLE . . . . . . . . . . . . . . . . . . . 1 OVEREST IMATEO . . . . 2 , ~EREST I~T~D- - . . . . . . . . . . . . . . . . . S , QUESTIOtiS COOING CATEGGqIES ,~lP TO I i In ~at year did thls dtsper~ssry open? YEAR (X~EMED . . . . . . . . . . . . . 191.11 I Under *a t ~Jthority Is this dlsper~aryopersted/ GOVERXNENT . . . . . . . . . . . . . . . . . . . . . . . . 1 PRIVATE . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 VOLUNTJLRY AGENCY . . . . . . . . . . . . . . . . . . $ OTHER . . . . . 4 I1o~ uany beds does this disper~sary have? I~JKRER OF BEDS . . . . . . . . I I I ] I Or1 everld~e, ho~ marly outpatients are seen daily i t tht l f&o|LItyT NUI~ER OF DALLY (C~tFatIents are Pe~°le seen f ° r preventive care" sick Pc°Pie CUTPATIEHTS . . . . . . . I I I 1 uho go home the same day) No~ ~ re~ular s t i f f of tht fo | lo~lr~ Types does the dfsl>e~.4ryhmve? Rural medical eldas Public health nursetl Trii/~ed lldWlvtwA I~X aldel AuxiLiary s t i f f (health of f icers, health attendants, other nurses) NURSER OF: RURAL MEDICAL AIDES . . . . . . . ~ ' ~ IH.qGES . . . . . . . . . . . . . . . . . . . . NI~/IV1ES . . . . . . . . . . . . . . . . . . ~ ' ~ ~H ALOES . . . . . . . . . . . . . . . . . ~ - ~ AUXIL~RY STAFF . . . . . . . . . . . ~NTS: 5-1 297 No. 5O9 510 511 512 513 516 515 516 517 518 519 519a CIJEST I ORS Does th i s f~c l l t ty nor~mt[y use disposable ~e~tes uhee g lv t~ |e jec t ions / (33DIWG CATEGORIES YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 HO. to , . . ,~ , . . . . . . ~ , . . . . . . o . . , . . e . .~ S~IP~ ) -~S12 Is th i s f l c l t l ty c~t nou or h i s I t run c~t of I t s supply of YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I d isposable needles mt ~ t |~e in the Last 6 months? NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 [ [ Oo~s th i s fac i l i ty ever reuse disposabte needles? YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 ~O*.ee4 ,eeteet~e~e, , , . .~set . s .~s2 I I Do~s th i s f~c lL I ty ~or~[y ~se disposable Gloves? YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 -~ 'S I& Is th i s f~c l t l ty ~t now or has I t run o~t of I t s supply of YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 disbosab[e gloves at ~ t |~ tn the Last 6 months? NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ~hat ts the ~thod MOST f requent ly used for the s ter i l i sa t i c~ of L*d icat Ins t r~entS (not tfner, s)? ELECTRIC STERiLISER . . . . . . . . . . . . . . . I AUTOCLAVE . . . . . . . . . . . . . . . . . . . . . . . . . 2 STEA.q PRESSURE STERILISER . . . . . . . . . ] BOIL O'~q[R KEROSENE STOVI[ . . . . . . . . . . & BOIL MR CHARCCAL/I,KXIO STOVE . . . . . 5 RCX~E . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6 OTHER 7 (CIRCLE OWE) - " '516 ( Has the fac i l i ty NOT ~ ib i s to s te r i t i se ~ ica( |nstr~-c~ts YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . T fo r ~ reason (e .g . ecfaipme~t broken w no e lec t r i c i ty , no fue l ) NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 st any time in the Last s ix ~ths? D~ the f~ i l l ty have the fo t Iov I~ t tm In ~rk in~ er~erl YES IO in stock: RUNNING WATER . . . . . . . . . . . . . 1 2 ELECTRICITY . . . . . . . . . . . . . . . 1 2 REFRIGERJLT~ . . . . . . . . . . . . . . I 2 KEROSENE . . . . . . . . . . . . . . . . . . 1 2 BICYCLE . . . . . . . . . . . . . . . . . . . 1 2 DELIVERY BED . . . . . . . . . . . . . . I DE L l VEERY KIT . . . . . . . . . . . . . . I WAITING AREA . . . . . . . . . . . . . . I EXN4 COUCH . . . . . . . . . . . . . . . . T Runnirq~ water? E lec t r i c i ty? Ref r igerator? [erosene? Slcycte? DeLivery beD'? Del ivery k i t ? Wait ing are for ~ in tabor? ExarDIr~l t l~couch? LIGHT-GTW EX.AJqS . . . . . . . . . . . I IUCO KIT . . . . . . . . . . . . . . . . . . 1 2 2 2 2 2 2 ~IGHING SGALE-CNILO . . . . . . 1 2 AOU1.T SCALE . . . . . . . . . . . . . . . 1 2 GROWTH CARDS . . . . . . . . . . . . . . I 2 LINENS . . . . . . . . . . . . . . . . . . . . 1 2 COTTON ~ . . . . . . . . . . . . . . . I 2 GAUZE . . . . . . . . . . . . . . . . . . . . . 1 E ANTISEPTICS . . . . . . . . . . . . . . . 1 2 BLCX3D PRESSURE ~LACNINE.,.I 2 TALQUIST KETHO0 . . . . . . . . . . . 1 E Exm|nat |m t ight for gyr~'cotogicat examir~tion? IUCg ( loop Inser t i c~) k i t ? Weighing scs les for chitdrenT Adutt weighing sc | |e? Growth cards? Linens? Gauze? Cottc¢~ woo|? Ant i sept ics? BLood pressure mch i r~? Ta l~ is t method for diagnosis of anemia? i 0o y~¢a have an c~atre~h progr ln? YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 - -'519 I I Nov ~ny v i t tages /ccmnJnf t fes do you regutarLy v ts i t ? WLW, I$ER Of SITES . . . . . . . . . . . . . . . . . . . . . ~ T ~ I Do yo~ receive an EDP k i t every monthT YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 WO . . . . . . . . . . . . . . . . . . . . ~ . . . . . . . . . . . 2 I/here do y~J re fer dL f f | cut t cases (pat ients the dispensary is ~r~bte to t reat )? HEALTH CENTRE . . . . . . . . . . . . . . . . . . . . . 1 HOSPITAL . . . . . . . . . . . . . . . . . . . . . . . . . . 2 OC~N'T REFER PATIENTS . . . . . . . . . . . . . . 3 OTHER .4 5-2 C~WEWT$: ~8 S(IVICES AVAILAOLE AT THE FACILITY: Nov I u~J Id Like to esk y~J about Nterns t ~1 ch i ld hea l th serv ices svsft l~bie et th i s d l spe~ery . ASE 0,520 FOI TIE f i rST SERVICE. I f THIS SERVICE IS AVAILAJILE, C~NTINIJE ACROSS THE TABLE, IF NOT, ASK ABOUT TIC[ NEXT S£IVICE. yES~, , , ° °° , . ° °° , , ° , ,o~, ,~ NO°~°°°°°o .°°°° , °°°~°°~ I SERV|CE I 1 J k~te f la ts i t i re 2 i OetLvery cere YES. . J NO° . , , ° °° ,~11 t YES . . . . . . . . . . . . . . . . . . . . . I I 3 J Posti~atlL cere & J C~i td Immunlsatton I se te lon~ YES . . . . . . . 5 i ChiLd growth YES . . . . . . . . . . I uu)n l to r ing NO . . . . . . . . . . . sessions t NEDIr.~TION AVAILABILITY AT THE FACILITT: ,Q#,**eo l i o ,°°°°o~2 5~,.A (SERVICE) ev i l t ib te? II f i r s t of fered he~? ,,r-l-i ,,r-l-1 I J I I I "l- l - I Nov I would t i ke to ask you about redicmti~'et avs l tebte at th i s fac i t i ty .~/hen I have f in i shed, I w i l l need to see the medlcet ior4 Y~ h ive in stock. ASK Q.523 F~ ~ACN MEDICATION. IF THE MEDICATION IS AVAILABLE, ASK Q.524, IF NOT ASK 0.525. IF THE I~01CATI~ HAS AT SClCE TiME BEEN AVAILABLE, ASK 0.526. IF 0.523 IS YES, RECORD VHETHEB TNE NEOICATiON IS SEEN (~ NOT. 524 At any time in the 5~ Hive you ever 526 t~y do you 527 MEDICATION I l i s t 6 e,~ths d id you not have (I~DICA- S~JI/NOT SEEN I IEDICATION had (14ED CAT ON)? run out of (MEDICATION)? T ON) nov? (~ STATUS I ~ loroq~lne syr~l~ 523 Is (MEDICATIOn) Iv l I,J~te no~ YES . . . . . . . 1 YES . . . . . . . . . . . . . . . . . I - - NO,° ,e , , ,+° . . . * * , ° . .2 ~ 523 4-. YES . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . 2- 523 ~- 3 Pen|c t I l ln YES . . . . . . . . . I , YES . . . . . . . . . . . . . . . . . 1-- YES . . . . . . . . . . . . 1 NO . . . . . . . . . . 2 : NO . . . . . . . . . . . . . . . . . . 2 - NO . . . . . . . . . . . . . 2 - 525 4-J , $73 "-" 523 ~- i I I I & I ron tab le ts YES . . . . . . . . . 1 YES . . . . . . . . . . . . . . . . . I - - YES . . . . . . . . . . . . 1 NO . . . . . . . . . . 2 NO . . . . . . . . . . . . . . . . . . 2-- NO . . . . . . . . . . . . . 2 - SZS ~ 523 ~- 523 ~-- I 1 J 5 FOLIo actd YES . . . . . . . . . 1 YES . . . . . . . . . . . . . . . . . 1-- YES . . . . . . . . . . . . 1 NO . . . . . . . . . . 2 NO . . . . . . . . . . . . . . . . . . 2 - NO . . . . . . . . . . . . . 2- I I t ORS packets i YES . . . . . . . . . 1 YES . . . . . . . . . . . . . . . . . 1-- YES . . . . . . . . . . . . 1 NO . . . . . . . . . . 2 NO . . . . . . . . . . . . . . . . . . 2 - NO . . . . . . . . . . . . . 2 - S~ 4-J 523 4 - 523 ~- Condoms CODES: ( i ) YES . . . . . . . . . . . . . . . . . 1-- NO, o . , . , . , . . . . . . ° ,o .2~ 527 ~-- YES . . . . . . . . . 1 NO . . . . . . . . . . 2 YES . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . 2- 527 ~- ~,oQ, j ,19q~ NOT SEEN . . . . 2 U.t"11 . . . . . . . . 1 lOT SEEN . . . . 2 I ~] ~ . . . . . . . . 1 NOT SEEN . . . . 2 I . . . . . . . . 1 I I NOTSEEN 2 . . . . I SEtN . . . . . . . . 1 I ] NOTSEEN 2 . . . . I . . . . . . . . 1 I J NOTSEEN 2 . . . . Insu f f i c ient funds • 1 UnabLe to get res~oLy • 2 Not ~sig~tecJ to carry • 3 Out of curr~t ~th Js supply • & Other • 5 5-3 299 532 533 QU£ST I~S Do you have enough Ipoce In th i s fac i l i ty for HEN services? Are In~n iset lo~ avmilabte for ch i ld ren rout I0. ;28 ;Z9 ~30 531 CODING ~ATEG~IES ~34 535 YES. . . . . . . . . . . . . . . . . . . . . . , . . . . . . . .1 NO. . . . . . . . . . . . . . , . . . . . . . . . . . . . . . . .2 TES . . . . . . . , ,¢ . . . . . , . . . . . . . . . , . . , . .1 N0. . . . . . . . . . . . . . . . . . . . .4 . . . . . . . . . .2 -~ 532 SJCIP ~. At ~ t i~e In the last 6 m~onths have you run c~t of vaccines? YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NOvv.evvst44ttv,ev*gsuttet,,¢t.vte2 I I | need to see your SUl~ply of VaCCines no~. VACCINES SEEN IN REFRIC~ERATOR . . . . . 1 VACCINES SEEN NOT IN REFRIGERATOR.2 VACCINES 1401 SEEN . . . . . . . . . . . . . . . . . 3 I I Does this f~ i t | ty provide fam~iy planning services? YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 - -~ S~ NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 I I t/net I I your pos i t ion or t i t le here? 554 IF THE FAMILY PLANNING IHFC~MATION IS OBTAINED FROM A SECOND FACILITY, BEGIN OU£STIOMNAIRE VlTH Q.5~. In wt~st year did th i s dispensary open7 Under uhst outhor i ty Is th i s dispensary operated? 537 Oo~s the 5~ Do~S the ?reined 540 fac i l i ty have the fo t tou lng Items In working order: Running aster? E lec t r i c i ty? Examination couc:h? Examination l ight for gynecotngicat examination? Stood pressure =~ch|ns? lUG) ( |oop inser t ion) k i t ? YEAR ~¢>E N£O . . . . . . . . . . . . . 19 ~ - ~ GOVERNMENT . . . . . . . . . . . . . . . . . . . . . . . . 1 PRIVATE . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 VOLUIdTAJ~Y AGENCY . . . . . . . . . . . . . . . . . . 3 OTHER .& YES mO RUNNING WATER . . . . . . . . . . . . . I 2 ELECTRIClTT . . . . . . . . . . . . . . . 1 2 EXAM COUCH . . . . . . . . . . . . . . . . 1 2 LIGHT-GYN EX~S . . . . . . . . . . . 1 2 BLOCO PRESSURE MACHIHE . . . . I 2 IUC~ KIT . . . . . . . . . . . . . . . . . . 1 2 dispensary have the fo l loutng types of s ta f f who are in fami ly planning provis ion? YES NO Nursi Medical Aides? RUIUIL NEDICAL AIDES . . . . . . . 1 2 Nurses? NURSES . . . . . . . . . . . . . . . . . . . . 1 2 14CN Aides? HER AIDES . . . . . . . . . . . . . . . . . 1 2 Kideivee? NtOUl~S . . . . . . . . . . . . . . . . . . 1 2 Are the foLtowfng types of s ta f f , i f avai labta, t ra ined In IUCO (|oop) Insert ion? YES NO U Rural Medical Aides? RURAL MEDICAL AIDES . . . . . . . 1 2 7 H~.'see? NURSES . . . . . . . . . . . . . . . . . . . . 1 2 7 MCH Aides? MCH AIDES . . . . . . . . . . . . . . . . . 1 2 7 During mn average mir th , how marly ~ come to get fami ly ptar~ing for the f i r s t time? NEW PATIENTS . . . . . . . . . . t During an average month, how many uomen come because they need more f~ i ly ptannlng ( res~ty)? : RE .PLY PATIENTS . $41 542 5-4 300 NO. 543 544 OdESllCl~S Do you f i t s o~ ~ MEN 3 form (?ser i f s yu lh~lh~lo ye ek l r~ mme r~ ~atoto kvn euezl ~ Iksk l ; regu lar ly? t /net do y~ do th i s foraT C~0[NG CATEGORIES TES,o° , . . . , o° , . ° . , , , , . I . . . . , ° °o , ° , I NO. 2 $~MO TO ~ . . . . . . 1 S~k~ TO OISTIICT OFFICEN . . . . . . . . . . 2 BENO TO ZOe,~L Of FICI~ . . . . . . . . . . . . . . 3 ~EP IN FILE . . . . . . . . . . . . . . . . . . . . . . 4 NOTNIHG/1)~4'T L'M~J . . . . . . . . . . . . . . . . 8 $1CIP TO II I I I I II I C~TRACEPTIV~ METHOD AVAILABILITY: Ilov I u~qJld l i ke to ask yc~ aLxxJt uhich fami ly p l~ l~g hethods ere ava i lab le at th i s dispensary. I en~t also see the methods ~e~ we are f in ished. ASK ABOUT THE FIRST I~T~O. IF THIS KET~ IS AVAILNILE FRO~ THE OISPENSART, MGVE ACROSS THE TABLE. IF THE I~THOD IS NOT AVAILABLE NOU, ASK Q.550 AND THEN BEGIN AGAIN NITN THE NEXT METHOD. I i l i l l METNOO (METHOD) day~ per week year d id you of ( I~T~) |n date SEEN/NOT SEES ~ ego d id eve||ebLe Is (HETHOD) f i r s t o f fe r or o~ of date? STATUS you r~n out of sou? ava i lab le? (METHOD)? (METHCO)? [el II 0, t . , . TES , . [ ] ~ IROATE . ' "ER . , [ - -~ NO . . . . . . 2 19 CUT OF DATE . . . . . . 2 NOT SEEN . . . . 2 ~,SCS. 550 4-.J BOTH . . . . . . . . . . . . . 3 I [ I f t I ~l ,~,~o. , TES , . F~ I-- l--1 IN°A?E . , .EN . ' FT - - J NO . . . . . . 2 ! 19 CUT OF DATE . . . . . . 2 NOT SEEN . . . . 2 MCS. 550 "~ BOTH . . . . . . . . . . . . . 3 I t ! t t t i . i , o j . . i on TEs . . . . ' 11 ( - - l - - I IN°A?E . . . . . . . . . . ,~EN . . . . . . . . ' i - - I - - ) NO . . . . . . 2 19 OUT Of DATE . . . . . . 2 NOT SEEN . . . . 2 M(S. 550 4,-I i i~TH . . . . . . . . . . . . . 3 I i i i i ° ' l ' - - '~"b ie ' " 'Es ' . . . . . I1 l - - F - I IN°A'E . . . . . . . . . . 'SEER . . . . . . . . ' F ~ fo6 '~ je tLy NO . . . . . . 2 19 CUT OF °ATE . . . . . . 2 NOT SEEN . . . . 2 MCS. 550 4--1 , / ; BOTH . . . . . . . . . . . . . 3 , J J i 0~ Other YEs . . . . . ~ =~'~'~'~:~-'::~:::'::*':~ ~ ' ~ ~ i~ i~ i . . . . . . . . . : . . . . , • ~ii~ !~.~ i.~: ~ ~ i i~ i I I I I I I I CCOES: |el 97 • Never stocked method I Iio, QUESTIONS {:~]DING CATEGORIES SXIF TO i i I 551 Do y~u have your contraceptives de l ivered or aust you go DELIVERED . . . . . . . . . . . . . . . . . . . . . . . . . 1 J, ~ 553 Bet them? PlCI{ THEN UP . . . . . . . . . . . . . . . . . . . . . . 2 I i i 552 No~ fer ( In k i lometers) m.~t you go to get th in1 ICM. TO PI r r UP CONTRAC~PT IVES . . . . . . . . . . . . ~ . . . . i 553 k~et Is your ix)~t lon or t i t le here? (~IJEBTIONS 554 AHO 555 ARE TO lie ANSI,~RED $Y THE IHTERVIE~/TR AFTER THE FACILITY VISIT IS COMPLETE. I $54 | DID THE INFO~CAHT SEE]4 L"NO~'LEDGEABLE? YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 I NO, , , . ° . ° ,oo ,oo*** , ° . .o , . ,q ,o , , . , °2 555 ADO I T LONAL CCNCEHTS: 5-5 301 SECTioN 6, Wuae: J P~BMACY VISIT J Pete: iF THE pKARKACY ON IqEDICAL STORE IS 30 KILOMETERS OR LESS A~Y e IT IS TO I1[ VISIT[D. C~Ii~LETE OUq[STIONS 600 ANO 602 UF~* ARRIVAL AT THE FACILITY SAS~O ON YOUR Oq,/N rmSERVAT[ONS. THEN FiND A KNO~LEOGJ[ABLE SOJRCE At THE FACILITY TO ANb'WIEN THJE REMA liiIHG ObqEST IONS. CCICPLET[ VISIT i f THIS FACILITY KAS ALREADY SEEN VISITED FOR A DIFFERENT CLUSTER, RECORD OHS CLUSTEB kU4BEE HERE: i f THE FACILITY HAS ALREADY EEEH VISITED, A SECOND VISIT I$ NOT NEEOED. 600 IF THIS IS THE FIRST FACILITY VISITED AFTER THE CLUSTER VISIT RECONO DISTANCE FAON CLUSTER FROM THE OOCI4ETER. 601 DO TOU THIHK THAT THE ESTIHATE OF OISTAWCE TO THE FACILITY GIV~N IN THE CLUSTER IS REASOkABLE? 602 DO YOU THINK THAT THE ESTIMATE OF THE TiME TO THE FACILITY GIV1EN IN THE CLUSTER IS REASONABLE? OUESTIONS TO BE ASKED OF STAFF PERSON AT FACILITY: OiSTANCE Fli~ CLUSTER . . . . I l l IK)T FIRST FACILITY VISITED . . . . . . 95 R F-ASCllk;;. E . . . . . . . . . . . . . . . . . . . . . . . . 1 OV~EEEST ] I~TF~ . . . . . . . . . . . . . . . . . . . . . , UKDEREST tl~tEO . . . . . . . . . . . . . . . . . . . . 3 BEAS~ . . . . . . . . . . . . . . . . . . . . . . . . 1 OVERE ST I]~T[D . . . . . : . • .2 U~ERESTIAATEO . . . . . . . . . . . . . . . . . . . . 3 |0 . ~)3 504 OUESTIONS C:Z~ING CATEC~3NIES SKIP TO H~ many hocJre ~r day is the I:~ar'macy open? r- - -T-- -1 HOLMS P£J DAY . . . . . . t J J How many days per ~ek Is the I:~armacy open? OATS PEE MEEK . . . . . . . . MEDICATION AVAILABILITY AT THE FACILITY: Mo~ I ~ J td Like to i l k you shout Pe~icattc~s avai lable at th i s f i c l t | ty . ASK O.60S FOR EACH NEDICATIOH. IF THE MEDICA- TION IS AVAILABLE, ASK 0.606, IF HOT ASK 0.607. IF THE MEDICATiON HAS AT ~ TIlqE BEEN AVAILABLE, ASK Q.~. 1 I Ch lo ro~lne Byrd.9 YES . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . 2 YES . . . . . . . . . . . . . . . . . . . . . . . 17 . o . . . . . . . . . . . . . . . . . . . . TEE . . . . . . . . . . . . 1 HO.*° . . * . ,o . * . ,2 60S 4--J [-] 7 I Condoms YES . . . . . . . . . . . . 1 YES . . . . . . . . . . T-~ ~E$ . . . . . . . . . . . . I r~ J No . . . . . . . . . . . . . 2 HO . . . . . . . . . . . . . . . . . . ~ uO . . . . . . . . . . . . . 2 Ir 60;' ,,.-J ~ 609 ,,-J CODES: [a] Insuff~cienl fu~s • 1 Hot desigr~ted to carry • 3 Other • 5 Unabte :o ge~ res~c)~Ly = 2 Wot interes:ed in Ca*'yincJ = 0"I 302 2 I ouioir.e TeE . . . . . . . . . . . . 1 Tee . . . . . . . . . . . . . . . . . . . . . . . 1 ~S . . . . . . . . . . . . I r -~ No . . . . . . . . . . . . . 6oz.~2 NO . . . . . . ~,~ ~ NO . . . . . . . . . . . . . 60S-JZ 3 ] ,~n ic i lUn Tee . . . . . . . . . . . . T YES . . . . . . . . . . . . . . . . TZ] T~S . . . . . . . . . . . . 1 ~--~ .0 . . . . . . . . . . . . . 60;' --JZ ,0 . . . . . . . . . . . . . . . . . . . . ~.~.~.~ .0 . . . . . . . . . . . . . eOS --JZ & J Iron tablets YES . . . . . . . . . . . . 1 YES . . . . . . . . . . . . . . . . . . . . . . . I -~ TEE . . . . . . . . . . . . 1 RO . . . . . . . . . . . . . , o . . . . . . . . . . . . . . . . . . . . . . . . . . . . _ ,2 , rFoii .o,o T , . . . . . . . . . . . . , TEE . . . . . . . . . . . . . . . . . . . . . . T F - - J No . . . . . . . . . . . . . 2 HO . . . . . . . . ~0 . . . . . . . . . . . . . 2 6074-,I ~ 605 4-,I 6 I (~S packets TEe . . . . . . . . . . . . 1 TEE . . . . . . . . . . . . . . 1T TES . . . . . . . . . . . . 1 ~] NO . . . . . . . . . . . . . 607~--J2 NO . . . . . . . . . . . . . . . . . . . . ~>~.~.~ mO . . . . . . . . . . . . . 605.~--J2 I o . (XJESTIOI(S C'~3DING CATEGOelE$ ~]P TC 611 612 613 I0° In ~hat l~r d id the ~ i r l .~y olx, n? YEAR ~EHEO . . . . . . . . . . . . . 1 9 ~ Is there e t ra ind pha~cIet eve l tebteY YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 Does the f~ i t l ty hays the foLLowing i tems in work i~ order? YES NO Running eater? : RUNNING MATER . . . . . . . . . . . . . 1 2 E l~t r i c i t~ ELECIRICITY . . . . . . . . . . . . . . . 1 2 Refrigerator? REFRIGERAT~ . . . . . . . . . . . . . . I 2 Does th is ~a~acy carry fa~i ty p lanning methods? TEa . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 - - -~ 617 HO. , , , , , . ° . , . , , ° , ° , , ,~ . , , , ,o ,~ .~, ,2 ~het Is ~ l~alti¢~ or t i t le here? IF THE FM41LY PLANNING INFORMATIOII 1$ OBTAINED FRON A S~COI~O FACILITY, BEGIM gUIESTICIdHAIRE WITX 0.614. OIJESTIOIIS CODING CATEC.ORIES S~IP T( Now Jenny hours per week i s the p~art~cy open? H(~JR$ P[R keEE[ . . . . . . . . . . . . I I J HO~ many days per ~eek Is the l~arm~cy open? I I In vhst year did th is pharmacy open? 01 I PtLL . . . . . . . . . . . . . . . . . 1 ,11 610 COMTILtCEPTIVI[ )qETHCO AVAILARILITY Io~ I uoutd l ike to ssk you about which fami ly p lanning mthods srs avai lable i t th is phlre~cy. AS[ ABOUT THE FIRST METHCO. IF THIS METNCO IS AVAILABLE FROM THE pNARt4ACY, ASK 0.618, IF ~T , ASK 0.619. IF CONTRACEPTIVE gAS SEEM AVALLABLE, kS~ 0,620. I I M£TNOD 617 IS (METH~O) ava i lab le nov? YES . . . . . . . . . . . . 1 618 In the List 6 months have you run ~ of (NETHO0)? YES . . . . . . . . . . . . . . . . . . . . . . 1--] $19 Have yo~ ever had (METRO)? YES . . . . . . . . . . . . 1 NO. , . . , , , , . ° .o ,2 617 *-J 620 ghy do y~ not kav (NETX00) nov? [a] 11 619 4--t i J 02 J IUCO (Loop) YES, 1 YES . . . . . . . . . . . . . . . . 1-~ YES . . . . . . . . . . . . 1 .~ J NO. . . . . . . . . . . . ,2 J No . . . . . . . . . . . . . . . . . . . . o . . . . . . . . . . . . . 2 619 - J 617 --J 617 4-J n l I Foaning tab lets / YES . . . . . . . . . . . . 1 YES . . . . . . . . . . . . . . . . . . . . . . 1-- I YES . . . . . . . . . . . . 1 foa i~ je t ty NO . . . . 2 . o . . . . . . . . . 2-1 . . . . . . . . . . . . . 2 IJ 619 4-J 617 CCOE$: [ I ] Ins~rff icient fundl m 1 Mot deslQnated to carry • ] Other • $ Unable to get resuppty • 2 Mot interested in cerrytng = 4 NO. QUESTIONS CCOZNG CATEGORIES Sx:P TO 621 V~et is y~r pos i t i~ or t i t le here? C(JEST!'~NS 622 10 ~ ARE TO BE ANS~ERED BY THE INTERVIE~R AFTER THE FACiL|TY VISIT IS COMPLETED. 622 J DID THE ]kFOR~ANT SEEN KNC~dLEDGEABLE? 62] ! ~OlTIO~A~ CO~ENTS: 6-2 3O3 YES. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .2 I | • ECTION 7. Nm: I PRIVATE ~F~ VISIT J Dste: m IF THE PRIVATE ~3CTO~'S PRACTICE I$ ]O KLLCI~ETERS C~ LESS A~AY, ICE/SHE IS TO |E viSitED. COMPLETE OUESTIONS 700 TO ~02 ARRIVAL SASED ON YOUR ~ 06SERVATLONS. THEN FIND A KNOI~.EDGEABLE $OI.J~CE AT TKE OOCTOR*S OFFICE TO ANS~dER TNE REMAINING QUESTIONS, I f THiS FACILITY HAS ALREAOT REEH VISITED FOR A DIFFERENT CLUSTER, RECC~D DHS CLUSTER NLJqBER HERE: LF THE FACiliTY HAS ALREADY SEEH VISITED, A SECONO VISIT IS NOT NEEDED. | 700 I f THIS IS THE FIRST FACILITY VISITED AFTER THE CLUSTER VISIT HECO~D DISTANCE FRCI4 CLUSTER FROM THE COOMETER. ~01 DO YOU THLHK THAT THE ESTZHATE OF DISTANCE TO THE FACILITY GIVER I I THE CLUSTER IS rEASONABLE? ?02 DO YOU TH]N[ THAT THE ESTIMATE OF THE TIME TO THE FACLL]T¥ GIVEN IH THE CLUSTER 15 REASONABLE? GUESTLONS TO BE ASKED OF STAFF PERSON AT FACILLTT: COMPLETE V iS i t DISTANCE FHON CLUSTER . . . . I ] J MOT FIRST FACILITY VISITED . . . . . . 9~ REASOICABLE . . . . . . . . . . . . . . . . . . . . . . . . 1 OV1ERESTLKATED . . . . . . . . . . . . . , UNDERESTLHATEO . . . . . . . . . . . . . . . . . . . . ~ , REASONABLE . . . . . . . . . 1 OVERESTIRATED . . . . . . . . . . . . . . 2 , UNDEHEST%~UkTED . . . . . . . . . . . . . . . . . . . . ] , I~o. 7O3 70~ 705 706 707 7O8 709 710 711 712 OUEST IONS Approxi r~tety how mas'~patients does the doctor (do yo~) see at th i s Wact ice each day? ~%NG CATEGORIES 1~IASER OF PATIENTS . . . . . . . . ~ - ~ HO¢ mc~y hc~rs per week is the doctor (are you) evaLtabie to see pat ients at th i s to<atCon? HOURS PER ~,~EK . . . . . . . . . . . . I I I I I How ~ day~ per ~ek is the doctor (are y~) ava i lab le to see I 1 pet |ents at th i s iDeation? DAYS PEg GEK . . . . . . . . . . . . . . . . . I [ In ~at year d id the doctor (you) f i r s t begin to see I~t ients st th i s tocmt ion? YE~ . . . . . . . . . . . . . . . . . . . . 191 I j i Does th i s fac i l i ty normally use d lsposabte needles when g iv ing YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 in ject ion~? NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 - -~ 710 i IS th i s fac i l i ty o~t r~w or has t t run out of i t s supply of YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 disposable needles st lay time in the Last 6 months? NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 i Does th i s fac i l i ty ever reuse disposable r~edLes? YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 ~0o • * , ,o , • , ** , o , *o , .o** . , . ,o , o . , * ,2 I I Whet is the method HOST freq, aent iy used for the s ter i L i sa t i~ ELECTRIC STERILISER . . . . . . . . . . . . . . . 1 of me~icat |~tP-'I~.'~tS? AUTOCLAVE . . . . . . . . . . . . . . . . . . . . . . . . . 2 STEAM PRESSURE STERLLLSER . . . . . . . . . BOLL OVI[R KEROSENE STOVE . . . . . . . . . . ¢ BOIL OVER CHARCOAL/~OOD STOVE . . . . . 5 OTHER 6 - - -~ 712 Has the fac i l i ty NOT been able to s te r i t i se inst rc~ents For some YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 reason (e.g. equipment I~oken, ~ e lec t r i c i ty , no Fuel) at any NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 time in the Last s ix ~ths? Does the f~ i t i ty have the fo l low ing items: ~unni~g water? E lec t r i c i ty? Refr igerator? Exa~ninatic~ co~ch? Examination t ight for gynecoLo<jicat examination? Ueighing sea[as for ch i ld ren? HLoc~ pres~.re machine~ ]UCD (LooI:~ insertion) kit~ Ninitap kit for tut~L iigation? YES NO RUHHIHG ~kTER . . . . . . . . . . . . . 1 2 ELECTRICITY . . . . . . . . . . . . . . . I Z HEFRIGEPJ~TOR . . . . . . . . . . . . . . 1 2 EXM4 COUCH . . . . . . . . . . . . . . . . 1 2 LJGHT-GTN EXAMS . . . . . . . . . . . 1 2 ~IGHING SCALE-CHILD . . . . . . 1 2 , BLCX~C ;;ESSURE wAC~[NE.~ 2 I~CD K~T . . . . . . . . . . . . . . . . . . I 2 M]NILAP KiT . . . . . . . . . . . . . . . 1 2 SKIP T: 7-1 3O4 Re. 7~3 714 715 7'~6 717 718 719 72O ~4 C~JE ST 1 (X~S CODING C~,T E G~R IE $ ! Does the doctor (DO you) see pat ients rout ine ly st th i s locat ion YES NO fo r : Antermtei care? ANTEKATAL C~£ . . . . . . . . . . . 1 2 DeLivery care? DELIVERY CARE . . . . . . . . . . . . 1 2 Postr~atsl corot POSTNATAL CARE . . . . . . . . . . . 1 Z Child grovth m~'~|torir41? GRO~/TH HONITORIIG . . . . . . . . 1 2 Does the doctor (Do you) d|sl:~r~e ORS packets? YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 I Does the doctor (Do you) give recoi l .sT YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO. . .o . . . .o . . . * . . . . . o . • . . . . . . . . . o2 At ~ t im in the test s ix months have you run ¢~at of vaccines? YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 ~ , , , , , , , , . o o , o ° , , , . , , o , ° o o . . . , o o 2 Are COndOl avBl i~bts here? YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 NO. . . o . . * ~ * . o H . . . *Q°o . . . . ° o . . . . .2 At any time in the test s ix moaths have you run out of cor~ol~S? YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . | NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 Does th i s doctor (Do you) provide f ru i ty p lann ing services? YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 - -~ ;;26 )~0o . ,o ,o . . ,o . ° , . . . . . , . o , . , , , . o . , .o2 t,~st is your pos l t io~ or t | t te here? I IF THE FAMILY PLANNING INFOR)~ATION IS O6TAINED FROM A SECOND ~3CTOR, BEGIN QUESTI~L~%RE VITN 0.721. No~ ~ hours per reek Is the doctor (are y~u) avs i tabte to see ps t lents st th i s locat ion? HOURS PER ~,~E[ . . . . . . . . . . . . ~ - ~ HO~ ~ny days per w~ek is the doctor (are yo~J) avai lable to see ~-~ I:¢tfents st this ideation? DAYS PER ~EK . . . . . . . . . . . . . . . . . In ~hst year d id the doctor (you) f i r s t begin to see pat ients st th i s Iocat Ion? YEAR . . . . . . . . . . . . . . . . . . . . 19 I I I Is the doctor (Are you) i ra |ned In contracept ive s ter l t t sa t lon YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I proce~tJres ( tuba l tlgatloCV'vasectcxly)? NO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 Is the doctor (Are you) i ra |ned in IUCO ( loop) Ir~sertion? YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . I NO* ~ o t . , , . • . , . . * , , . , , ° .o . , . oo o** , ,~ i CCI41'~NTS: ~lP TC I - -~ 717 - -* 719 - -" 73S i 7-2 305 I CI~TUCEPTIV~E I~IHOD AVAiLAB iL iTY : Mo~ I u~td l i ke to ask you ab<~t which fami ly p l i~ning methods era iV l J l l b |e from this doctor . AS[ ASCUT THE f IRST I q~. I f TelS NETI~O IS AVAILABLE FROM THE DOCTOR, NO~,~ ACROSS THE TABLE. I f THE METXOD IS ROT AVAILABLE NOLO, AS[ Q350 Ak~ ~IE]I BEGIR A~A1R ~[TI4 THE NEXT METHOD. I 7"Z6 la (METtOD) 7"27 How many days 728 In whet year 7~9 Is your stock KETHCO ava i lab le I~o~? per u~eek ts did you f i r s t of (METHOD) In date I I(~THO0) evai labte?l offer (METHCO)? or out of date? o, i , i l l T,S . . . . . . . . . , I I ~T~ iR OAT, . . . . . . . . . . NO . . . . . . . . . . 2 19 CUT OF DATE . . . . . . 2 730 ~-J BOTH . . . . . . . . . . . . . I I ] I NO . . . . . . . . . . 2 19 730 I I I NO . . . . . . . . . . 2 19 730 I . t I ~, ,~ ,~ ta~ota, TE, . . . . . . . . . , I ) I - - I - - ) fo,en/jel iy NO . . . . . . . . . . 2 19 730 ,~ I I I YES . . . . . . . . . | to . . . . . . . . . . , I I '~ 73D ~ 06 J Other Specify I I I 0° '32 r33 CODES: [a] 97 • Never stocked method OUESTIONS On iverage, how many l~t let~ts v i s i t monthly for fami ly pie~ni~g? Do yo~ have yOUr contraceptives dai lvered or must you go get ~hem? Hou f i r ( in k l to~eters) must you 9o to get them? I/hat I t your pos i t ion or t i t le here? 7~0 tou mar~y ~.~ks ago did you r~- ¢,~, IN DATE . . . . . . . . . . 1 OUT OF DATE . . . . . . 2 ~]~i~. BOTH . . . . . . . . . . . . . ] I I IN DATE . . . . . . . . . . I OUT OF DATE . . . . . . 2 ~-~td~. BOTH . . . . . . . . . . . . . 3 J l IN DATE . . . . . . . . . . 1 OUT OF DATE . . . . . . 2 [ - - -~k l~, BOTH . . . . . . . . . . . . . 3 I I I T CODING CATEGORIES SKIP T~ i HONTHLT NUMBER OF f~ILY PLA. I . [ I I I PATIENTS . . . . . . . . . . . . . . - - I I DELIVERED . . . . . . . . . . . . . . . . . . . . . . . . . 1 - -~ 7"~ PiCK THEM UP . . . . . . . . . . . . . . . . . . . . . . I I 10 PICKUP C~)NTUAEPTIVES . . . . . . . . . . . . ~ - ~ 735 I OUEST)ONS ;~5 10 T56 ARE TO BE ANSVERED BY THE INTERVIEN~E AFTER THE FACiLiTY ViSiT IS CO@LETED. BID THE INFOAHANT S(EM [NO~LEDGEABLET I YES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 I NO . . . . . . . . . . . . . . . . . . . . , . . . . . . . . . . . 2 ADOITIONAL COHHERTS: ?-3 306 Front Matter Title Page Survey Information Table of Contents List of Tables List of Figures Acronyms Preface Map of Tanzania Chapter 1 - Introduction Chapter 2 - Characteristics of Households and Respondents Chapter 3 - Fertility Chapter 4 - Fertility Regulation Chapter 5 - Proximate Determinants of Fertility Chapter 6 - Fertility Preferences Chapter 7 - Infant and Child Mortality Chapter 8 - Maternal and Child Health Chapter 9 - Maternal and Child Nutrition Chapter 10 - Results of the Male Survey Chapter 11 - AIDS Knowledge and Sexual Practices Chapter 12 - Local Availability of Family Planning and Health Services References Appendix A - Persons Involved Appendix B - Survey Design Appendix C - Estimates of Sampling Errors Appendix D - Data Quality Tables Appendix E Pages 215-256 Appendix E Pages 257-306

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