Tanzania - Demographic and Health Survey - 2000

Publication date: 2000

Tanzania 1999Reproductive and ChildHealth Survey National Bureau of Statistics MEASURE DHS+ Macro International Inc. Tanzania Reproductive and Child Health Survey 1999 National Bureau of Statistics Dar es Salaam, Tanzania Macro International Inc. Calverton, Maryland, U.S.A. November 2000 National Bureau of Statistics United Nations Children’s Fund U.S. Agency for United Nations Population Fund International Development This report presents results from the 1999 Tanzania Reproductive and Child Health Survey (TRCHS) which was undertaken by the National Bureau of Statistics in collaboration with the Reproductive and Child Health Section of the Ministry of Health. Financial assistance for the survey was provided by the U.S. Agency for International Development (USAID/Tanzania), UNICEF/Tanzania, and the United Nations Population Fund (UNFPA/Tanzania). The TRCHS is part of the worldwide MEASURE Demographic and Health Surveys (DHS+) project which is designed to collect, analyse and disseminate data on fertility, family planning, maternal and child health, and HIV/AIDS. Additional information about the TRCHS may be obtained free of charge from the National Bureau of Statistics, P.O. Box 796, Dar es Salaam (telephone: 135-602; fax: 135-601). Information about the MEASURE DHS+ project may be obtained from Macro International Inc., 11785 Beltsville Drive, Suite 300, Calverton, MD 20705 (telephone: 301-572-0200; fax: 301-572-0999). Suggested citation: National Bureau of Statistics [Tanzania] and Macro International Inc. 2000. Tanzania Reproductive and Child Health Survey 1999. Calverton, Maryland: National Bureau of Statistics and Macro International Inc. Contents * iii CONTENTS Page Tables and Figures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . vii Foreword . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xiii Summary of Findings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xv Map of Tanzania . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xviii CHAPTER 1 INTRODUCTION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 1.1 Geography, History, and the Economy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1 1.2 Demographic Statistics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 1.3 Population and Family Planning Policies and Programmes . . . . . . . . . . . . . . . . . 2 1.4 Health Priorities and Programmes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 1.5 Objectives and Organisation of the Survey . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4 CHAPTER 2 CHARACTERISTICS OF HOUSEHOLDS AND RESPONDENTS . . . . . . . . . . 9 2.1 Population by Age and Sex . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 9 2.2 Household Composition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 2.3 Fosterhood and Orphanhood . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 2.4 Education Level of Household Population . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 2.5 School Attendance . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14 2.6 Child Labour . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15 2.7 Housing Characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 2.8 Background Characteristics of Respondents . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 2.9 Educational Level of Survey Respondents . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21 2.10 Access to Media . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25 2.11 Employment and Occupation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26 CHAPTER 3 FERTILITY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31 3.1 Current Fertility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31 3.2 Fertility Differentials . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32 3.3 Fertility Trends . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33 3.4 Children Ever Born . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34 3.5 Births Intervals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35 3.6 Age at First Birth . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37 3.7 Teenage Pregnancy and Motherhood . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37 iv * Contents Page CHAPTER 4 FERTILITY REGULATION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41 4.1 Knowledge of Family Planning Methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41 4.2 Trends in Contraceptive Knowledge . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43 4.3 Ever Use of Family Planning Methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44 4.4 Current Use of Family Planning Methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45 4.5 Sources of Family Planning Methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51 4.6 Contact of Nonusers with Family Planning Providers . . . . . . . . . . . . . . . . . . . . 52 4.7 Intention to Use Family Planning Among Nonusers . . . . . . . . . . . . . . . . . . . . . 54 4.8 Reasons for Nonuse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55 4.9 Exposure to Family Planning Messages . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55 4.10 Exposure to Reproductive and Child Health Dramas . . . . . . . . . . . . . . . . . . . . . 56 4.11 Knowledge of Family Planning Logo . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58 4.12 Knowledge of Salama Condom . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62 4.13 Attitudes towards Family Planning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62 CHAPTER 5 PROXIMATE DETERMINANTS OF FERTILITY . . . . . . . . . . . . . . . . . . . . . . . . 65 5.1 Current Marital Status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65 5.2 Age at First Marriage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65 5.3 Age at First Intercourse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67 5.4 Recent Sexual Activity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69 5.5 Postpartum Amenorrhoea, Abstinence, and Insusceptibility . . . . . . . . . . . . . . . 73 5.6 Termination of Exposure to Pregnancy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 74 CHAPTER 6 FERTILITY PREFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75 6.1 Reproductive Preferences . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75 6.2 Need for Family Planning Services . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78 6.3 Ideal Number of Children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 80 6.4 Fertility Planning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83 CHAPTER 7 INFANT AND CHILD MORTALITY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 85 7.1 Definitions, Methodology, and Assessment of Data Quality . . . . . . . . . . . . . . . . 85 7.2 Childhood Mortality Levels and Trends . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 86 7.3 Childhood Mortality Differentials . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87 7.4 High-Risk Fertility Behaviour . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 90 Contents * v Page CHAPTER 8 REPRODUCTIVE AND CHILD HEALTH . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93 8.1 Antenatal Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93 8.2 Delivery Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 98 8.3 Postnatal Care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 102 8.4 Birth Registration . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103 8.5 Childhood Vaccinations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 104 8.6 Acute Respiratory Infection and Fever . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 107 8.7 Use of Bednets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 108 8.8 Prevalence and Treatment of Diarrhoea . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 110 8.9 Knowledge of Signs of Illness . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111 CHAPTER 9 INFANT FEEDING AND CHILDHOOD NUTRITION . . . . . . . . . . . . . . . . . 115 9.1 Breastfeeding and Supplementation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 115 9.2 Nutritional Status in Early Childhood . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 119 9.3 Vitamin A Supplementation among Children . . . . . . . . . . . . . . . . . . . . . . . . . . 123 CHAPTER 10 KNOWLEDGE OF AIDS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 125 10.1 Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 125 10.2 Knowledge of AIDS Transmission . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 125 10.3 Perceptions of Personal Risk of Getting AIDS . . . . . . . . . . . . . . . . . . . . . . . . . . 128 10.4 Knowledge and Use of Condoms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 130 10.5 Acceptability of Condom Use . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 132 10.6 Number of Sexual Partners . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 133 10.7 AIDS Testing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 137 10.8 Knowledge of Condom’s Dual Protection . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 138 REFERENCES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 145 APPENDIX A SAMPLE IMPLEMENTATION . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 147 APPENDIX B ESTIMATES OF SAMPLING ERROR . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 149 APPENDIX C DATA QUALITY TABLES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 165 APPENDIX D 1999 TRCHS HOUSEHOLD SURVEY STAFF . . . . . . . . . . . . . . . . . . . . . . 171 APPENDIX E QUESTIONNAIRES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 173 Tables and Figures * vii TABLE AND FIGURES Page CHAPTER 1 INTRODUCTION Table 1.1 Demographic characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2 Table 1.2 Results of the household and individual interviews . . . . . . . . . . . . . . . . . . . . . . 7 CHAPTER 2 CHARACTERISTICS OF HOUSEHOLDS AND RESPONDENTS Table 2.1 Household population by age, residence, and sex . . . . . . . . . . . . . . . . . . . . . . . 9 Table 2.2 Population by age from selected sources . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 Table 2.3 Household composition . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11 Table 2.4 Fosterhood and orphanhood . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12 Table 2.5.1 Educational level of the female household population . . . . . . . . . . . . . . . . . . 13 Table 2.5.2 Educational level of the male household population . . . . . . . . . . . . . . . . . . . . 14 Table 2.6 Early childhood education . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16 Table 2.7 School attendance ratios . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 Table 2.8 Child labour . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18 Table 2.9 Housing characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19 Table 2.10 Household durable goods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 Table 2.11 Iodised salt . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20 Table 2.12 Background characteristics of children under five . . . . . . . . . . . . . . . . . . . . . 21 Table 2.13 Background characteristics of respondents . . . . . . . . . . . . . . . . . . . . . . . . . . . 22 Table 2.14.1 Level of education: women . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23 Table 2.14.2 Level of education: men . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23 Table 2.15 Literacy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24 Table 2.16 Access to mass media . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25 Table 2.17 Employment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27 Table 2.18 Employer and form of earnings . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28 Table 2.19.1 Occupation: women . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29 Table 2.19.2 Occupation: men . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30 Figure 2.1 Population pyramid, Tanzania 1999 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10 Figure 2.2 Level of education for women and men, Tanzania 1999 . . . . . . . . . . . . . . . . 15 Figure 2.3 Percentage of children age 7-13 attending primary school, by sex and residence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17 CHAPTER 3 FERTILITY Table 3.1 Current fertility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31 Table 3.2 Fertility by background characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33 Table 3.3 Trends in fertility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34 Table 3.4 Age-specific fertility rates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34 viii * Tables and Figures Page Table 3.5 Children ever born and living . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35 Table 3.6 Birth intervals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36 Table 3.7 Age at first birth . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37 Table 3.8 Median age at first birth by background characteristics . . . . . . . . . . . . . . . . . 38 Table 3.9 Teenage pregnancy and motherhood . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38 Figure 3.1 Age-specific fertility rates by urban-rural residence . . . . . . . . . . . . . . . . . . . . 32 Figure 3.2 Total fertility rates by background characteristics . . . . . . . . . . . . . . . . . . . . . 33 Figure 3.3 Pregnancy and childbearing among women age 15-19 . . . . . . . . . . . . . . . . . 39 CHAPTER 4 FERTILITY REGULATION Table 4.1 Knowledge of contraceptive methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42 Table 4.2 Couples’ knowledge of contraceptive methods . . . . . . . . . . . . . . . . . . . . . . . . 43 Table 4.3.1 Ever use of contraception: women . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45 Table 4.3.2 Ever use of contraception: men . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46 Table 4.4.1 Current use of contraception: women . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47 Table 4.4.2 Current use of contraception: men . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48 Table 4.5.1 Current use of contraception by background characteristics: women . . . . . . 49 Table 4.5.2 Current use of contraception by background characteristics: men . . . . . . . . 51 Table 4.6 Source of supply for contraceptive methods . . . . . . . . . . . . . . . . . . . . . . . . . . 53 Table 4.7 Contact of nonusers with family planning providers . . . . . . . . . . . . . . . . . . . 54 Table 4.8 Future use of contraception . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55 Table 4.9 Reasons for not intending to use contraception . . . . . . . . . . . . . . . . . . . . . . . 56 Table 4.10.1 Heard family planning message: women . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57 Table 4.10.2 Heard family planning message: men . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58 Table 4.11 Exposure to family planning dramas . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59 Table 4.12.1 Green Star logo family planning symbol: women . . . . . . . . . . . . . . . . . . . . . . 60 Table 4.12.2 Green Star logo family planning symbol: men . . . . . . . . . . . . . . . . . . . . . . . . 61 Table 4.13 Knowledge of Salama condom . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62 Table 4.14 Discussion of family planning with husband . . . . . . . . . . . . . . . . . . . . . . . . . . 63 Table 4.15 Attitudes of couples toward family planning . . . . . . . . . . . . . . . . . . . . . . . . . . 64 Table 4.16 Spouse’s perception of their spouse’s approval of family planning . . . . . . . . . 64 Figure 4.1 Trends in contraceptive knowledge among women age 15-49, 1991-1999 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44 Figure 4.2 Contraceptive use among all women age 15-49 by residence and education . . . . . . . . . . . . . . . . . . . . . . . . 50 Figure 4.3 Trends in contraceptive use among all women age 15-49, 1991-1999 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52 Tables and Figures * ix Page CHAPTER 5 PROXIMATE DETERMINANTS OF FERTILITY Table 5.1 Current marital status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66 Table 5.2 Age at first marriage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67 Table 5.3 Median age at first marriage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68 Table 5.4 Age at first sexual intercourse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69 Table 5.5 Median age at first intercourse . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70 Table 5.6.1 Recent sexual activity: women . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71 Table 5.6.2 Recent sexual activity: men . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72 Table 5.7 Postpartum amenorrhoea, abstinence, and insusceptibility . . . . . . . . . . . . . . 73 Table 5.8 Median duration of postpartum insusceptibility by background characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 74 Table 5.9 Menopause . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 74 CHAPTER 6 FERTILITY PREFERENCES Table 6.1 Fertility preferences by number of living children . . . . . . . . . . . . . . . . . . . . . . 75 Table 6.2 Fertility preferences by age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77 Table 6.3 Desire to stop childbearing by background characteristics . . . . . . . . . . . . . . . 78 Table 6.4 Need for family planning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79 Table 6.5 Ideal number of children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 81 Table 6.6 Mean ideal number of children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 82 Table 6.7 Fertility planning status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 83 Table 6.8 Wanted fertility rates . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 84 Figure 6.1 Fertility preferences of women age 15-49 . . . . . . . . . . . . . . . . . . . . . . . . . . . . 76 Figure 6.2 Desire to stop childbearing among women age 15-49, by number of living children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77 Figure 6.3 Trends in mean ideal family size among women and men, 1991-1999 . . . . . 82 CHAPTER 7 INFANT AND CHILD MORTALITY Table 7.1 Infant and child mortality . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 86 Table 7.2 Infant and child mortality by background characteristics . . . . . . . . . . . . . . . 87 Table 7.3 Infant and child mortality by biodemographic characteristics . . . . . . . . . . . . 89 Table 7.4 High-risk fertility behaviour . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91 Figure 7.1 Under-five mortality by selected background characteristics . . . . . . . . . . . . . 88 CHAPTER 8 REPRODUCTIVE AND CHILD HEALTH Table 8.1 Antenatal care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 94 Table 8.2 Number of antenatal care visits and stage of pregnancy . . . . . . . . . . . . . . . . 95 Table 8.3 Antenatal care content . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 96 x * Tables and Figures Page Table 8.4 Tetanus toxoid vaccinations . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97 Table 8.5 Place of delivery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99 Table 8.6 Assistance during delivery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100 Table 8.7 Delivery characteristics . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 101 Table 8.8 Postnatal care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 102 Table 8.9 Postpartum vitamin A supplements . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103 Table 8.10 Birth registration coverage . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 104 Table 8.11 Vaccinations by source of information . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 105 Table 8.12 Vaccinations by background characteristics . . . . . . . . . . . . . . . . . . . . . . . . . 107 Table 8.13 Prevalence and treatment of acute respiratory infection and prevalence of fever . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109 Table 8.14 Use of bednets . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 110 Table 8.15 Prevalence of diarrhoea . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111 Table 8.16 Treatment of diarrhoea . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 112 Table 8.17 Feeding practices during diarrhoea . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 113 Table 8.18 Knowledge of health complications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 113 Table 8.19 Knowledge of pregnancy complications . . . . . . . . . . . . . . . . . . . . . . . . . . . . 114 Figure 8.1 Antenatal and delivery care indicators . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 98 Figure 8.2 Percentage of children age 12-23 months with specific vaccinations according to vaccination cards and mothers’ reports . . . . . . . . . . . . . . . . . . 106 CHAPTER 9 INFANT FEEDING AND CHILDHOOD NUTRITION Table 9.1 Breastfeeding status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 116 Table 9.2 Median duration and frequency of breastfeeding . . . . . . . . . . . . . . . . . . . . . 117 Table 9.3 Infant feeding indicators . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 118 Table 9.4 Ideal duration of breastfeeding . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 119 Table 9.5 Nutritional status of children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 122 Table 9.6 Trends in nutritional status of children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 123 Table 9.7 Vitamin A supplementation among children . . . . . . . . . . . . . . . . . . . . . . . . . 124 CHAPTER 10 KNOWLEDGE OF AIDS Table 10.1 Knowledge of HIV/AIDS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 126 Table 10.2.1 Knowledge of specific ways to avoid HIV/AIDS: women . . . . . . . . . . . . . . . 127 Table 10.2.2 Knowledge of specific ways to avoid HIV/AIDS: men . . . . . . . . . . . . . . . . . . 128 Table 10.3 Knowledge (prompted) of the main ways to avoid HIV/AIDS . . . . . . . . . . . . 129 Table 10.4 Misconceptions about HIV/AIDS transmission . . . . . . . . . . . . . . . . . . . . . . . 130 Table 10.5.1 Knowledge and perception of HIV/AIDS: women . . . . . . . . . . . . . . . . . . . . . 131 Table 10.5.2 Knowledge and perception of HIV/AIDS: men . . . . . . . . . . . . . . . . . . . . . . . 132 Table 10.6 Knowledge of mother-child transmission of HIV/AIDS . . . . . . . . . . . . . . . . . 133 Table 10.7 Perception of the risk of getting HIV/AIDS . . . . . . . . . . . . . . . . . . . . . . . . . . 134 Table 10.8 Reasons for perception of small/no risk of getting HIV/AIDS . . . . . . . . . . . 135 Tables and Figures * xi Page Table 10.9 Reasons for perception of moderate/great risk of getting HIV/AIDS . . . . . . 135 Table 10.10 Knowledge of condoms . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 136 Table 10.11.1 Use of condoms: women . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 137 Table 10.11.2 Use of condoms: men . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 138 Table 10.12 Acceptability of women prompting use of condoms . . . . . . . . . . . . . . . . . . . 139 Table 10.13.1 Number of sexual partners: women . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 140 Table 10.13.2 Number of sexual partners: men . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 141 Table 10.14.1 Testing for HIV/AIDS: women . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 142 Table 10.14.2 Testing for HIV/AIDS: men . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 143 Table 10.15 Knowledge of dual protection of condoms . . . . . . . . . . . . . . . . . . . . . . . . . . 144 APPENDIX A SAMPLE IMPLEMENTATION Table A.1.1 Sample implementation: women . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 147 Table A.1.2 Sample implementation: men . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 148 APPENDIX B ESTIMATES OF SAMPLING ERROR Table B.1 List of selected variables for sampling errors, Tanzania 1999 . . . . . . . . . . . 152 Table B.2 Sampling errors for women - Total sample: Tanzania 1999 . . . . . . . . . . . . 153 Table B.3 Sampling errors for women - Urban sample: Tanzania 1999 . . . . . . . . . . . . 154 Table B.4 Sampling errors for women - Rural sample: Tanzania 1999 . . . . . . . . . . . . 155 Table B.5 Sampling errors for women - Mainland sample: Tanzania 1999 . . . . . . . . . 156 Table B.6 Sampling errors for women - Zanzibar sample: Tanzania 1999 . . . . . . . . . 157 Table B.7 Sampling errors for women - Pemba sample: Tanzania 1999 . . . . . . . . . . . 158 Table B.8 Sampling errors for women - Unguja sample: Tanzania 1999 . . . . . . . . . . . 159 Table B.9 Sampling errors for men - Total sample: Tanzania 1999 . . . . . . . . . . . . . . . 160 Table B10 Sampling errors for men - Urban sample: Tanzania 1999 . . . . . . . . . . . . . . 160 Table B.11 Sampling errors for men - Rural sample: Tanzania 1999 . . . . . . . . . . . . . . . 161 Table B.12 Sampling errors for men - Mainland sample: Tanzania 1999 . . . . . . . . . . . 161 Table B.13 Sampling errors for men - Zanzibar sample: Tanzania 1999 . . . . . . . . . . . . 162 Table B.14 Sampling errors for men - Pemba sample: Tanzania 1999 . . . . . . . . . . . . . . 162 Table B.15 Sampling errors for men - Unguja sample: Tanzania 1999 . . . . . . . . . . . . . 163 APPENDIX C DATA QUALITY TABLES Table C.1 Household age distribution . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 165 Table C.2 Age distribution of eligible and interviewed women . . . . . . . . . . . . . . . . . . . 166 Table C.3 Completeness of reporting . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 166 Table C.4 Births by calendar years . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 167 Table C.5 Reporting of age at death in days . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 168 Table C.6 Reporting of age at death in months . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 169 Foreward * xiii FOREWORD The National Bureau of Statistics takes pleasure in presenting this report on the 1999 Reproductive and Child Health Survey (TRCHS). The 1999 TRCHS is the latest in a series of periodic surveys to measure levels, patterns, and trends in demographic and health indicators, the first having been the 1991-92 Tanzania Demographic and Health Survey (TDHS). This report contains findings from the 1999 TRCHS regarding data from the households visited. The tables and text cover the most important indicators and should be of use to policy makers and program administrators who need up-to-date data for evaluating their activities and planning future directions. Findings from the survey covering health facilities will be produced in a separate report. The successful completion of the 1999 TRCHS was made possible by the joint effort of a number of organisations and individuals, whose participation we would like to acknowledge with gratitude. First, is the U.S. Agency for International Development (USAID)/Tanzania which has long supported the collection and utilisation of data to evaluate the family planning and health programmes in Tanzania and which initiated planning for this survey and provided the bulk of the funding to implement it. UNICEF/Tanzania and UNFPA/Tanzania also contributed substantially to both the survey design and the funding for the survey. Many other organisations contributed to the questionnaire content and/or the field staff training, including the Reproductive and Child Health Unit at the Ministry of Health, the Tanzania Food and Nutrition Centre, and the National AIDS Control Programme and Mount Meru Hospital. We would also like to thank the Demographic and Health Surveys program of Macro International Inc. in Calverton, Maryland, U.S.A. for providing technical assistance in all phases of the project. The survey would not have gotten off the ground without the exemplary and tireless efforts of the staff at the National Bureau of Statistics. Their many long days of overtime work have served to make this survey effort a success. Similarly, the nurses who acted as interviewers for the survey deserve our heartfelt thanks. Finally, we are ever more grateful to the survey respondents who contributed generously part of their time to enable us to gather crucial data for our country’s future planning. Cletus P.B. Mkai Director General National Bureau of Statistics Dar es Salaam, Tanzania Summary of Findings * xv SUMMARY OF FINDINGS The 1999 Tanzania Reproductive and Child Health Survey (TRCHS) is a nationally- representative sample survey covering 4,029 women age 15-49 and 3,542 men age 15-59. The TRCHS was designed to provide informa- tion on levels and trends of fertility, family planning knowledge and use, infant and child mortality, and indicators of maternal and child health and nutrition. Fieldwork for the TRCHS took place from early September to late-No- vember 1999. Survey data generally confirm patterns observed in the 1996 Tanzania Demographic and Health Survey (TDHS), showing increas- ing contraceptive use and more widespread knowledge about HIV/AIDS; however, results show that many challenges still exist. FERTILITY Fertility Decline. The TRCHS data indicate that there has been a small decline in fertility since the 1996 survey. The total fertil- ity rate has dropped from 5.8 births per woman in the period 1994-96 to 5.6 births for the period 1997-99. The rate of decline may be slowing somewhat, however, and the level of fertility is still high. Large Fertility Differentials. Signifi- cant differences in fertility levels are evident from survey data. For example, the total fertility rate among rural women is twice that of urban women (6.5 versus 3.2). Fertility levels are closely related to women's education. Women with no formal education give birth to an average of 6.5 children in their lifetime, compared with 4.9 for women who have com- pleted primary school. Unplanned Fertility. One reason for the relatively high fertility levels is that un- planned pregnancies are still common. Over- all, more than one in five births in the three years prior to the survey were reported to be unplanned; 11 percent were mistimed (wanted later) and 11 percent were unwanted. Un- wanted births are disproportionately high among older women who already have several children, the very women who are at higher risk of fertility-related illness and higher child mortality. If unwanted births could be elimi- nated altogether, the total fertility rate in Tanzania would be 4.8 births per woman instead of the actual level of 5.6. Ideal Family Size. Although a reduc- tion in the number of unplanned births would reduce fertility substantially, Tanzanian women and men still want to have large families. Even those who have two children or fewer say they would ideally like to have al- most five children on average. FAMILY PLANNING Increasing Use of Contraception. A major cause of the declining fertility in Tanza- nia has been the slow but steady increase in contraceptive use over the last decade. The contraceptive prevalence rate has doubled since 1991-92, from 10 to 22 percent of all women. Use of modern methods has grown from 6 to 16 percent of all women. Overall, there has been a steady growth in the contra- ceptive prevalence rate with an average in- crease of one and a half percentage points a year. Method Mix. In terms of “method mix,” the dominant change over the last 8 years has been the large increase in the num- ber of women using injectable contraception. The proportion of women relying on injectables increased from less than half a percent in 1991-92 to over 5 percent in 1999 and the injectable now accounts for one- quarter of all contraceptive use. Use of condoms, periodic abstinence and withdrawal have also increased somewhat over the past few years. A levelling off in pill use may indicate that some women are switch- xvi * Summary of Findings ing from the pill to injectables. The low level of use of permanent methods such as sterilisa- tion and implants is of concern, given the high level of unplanned births among high-parity, older women. Differentials in Family Planning Use. Differentials in current use of family planning are large. Urban women are almost twice as likely as rural women to be using a contra- ceptive method (33 versus 18 percent). Women in the Mainland are more likely to use than those on Zanzibar. However, the largest differences are found by education—contra- ceptive use among women with some second- ary education is three times higher than among those with no education. Knowledge of Contraception. The proportion of women and men who know of at least one contraceptive method has been over 75 percent for some time and the TRCHS results indicate that the proportion has in- creased to over 90 percent. Moreover, the mean number of methods that women and men say they have heard of has grown from 4 in 1996 to 6 in 1999. Knowing about more methods provides a basis for wider choice. Unmet Need for Family Planning. Unmet need for family planning has declined slightly since 1996. Data from the 1996 TDHS show that 19 percent of all women were in need of services, compared with 17 percent in the 1999 TRCHS. Two-thirds of the unmet need is comprised of women who want to space their next birth, while just one third is for women who do not want any more chil- dren (limiters). If all women who say they want to space or limit their children were to use methods, the contraceptive prevalence rate could be increased from 22 percent to 40 percent of all women. Currently, 56 percent of this “total demand” for family planning is being met. Family Planning Messages. Survey data show that family planning messages are continuing to get through to couples. As in 1996, just over 40 percent of women have heard a family planning message on the radio in the six months prior to the survey, while 5 percent have seen a message on the television and one-fifth have seen a poster. Taking all sources into account, two-thirds of women and 70 percent of men say they have seen or heard a family planning message in the last six months. The proportion of women and men who say they have seen or heard specific pro- grams such as Zinduka! and Twende na Wakati has also increased since 1996. MATERNAL AND CHILD HEALTH Maternal Health Care. TRCHS data point to several areas regarding maternal health care in which improvements could be made. Although the proportion of Tanzanian mothers who receive antenatal care from a doctor, nurse, midwife or medical aide has remained steady at just over 90 percent since 1991-92, there has been a shift in providers from nurses and midwives to the less well- trained health aides. The proportion of preg- nant women receiving at least one tetanus toxoid injection has declined from 92 percent in 1996 to 83 in 1999. The data also show a disturbingly steady decline in the proportion of births that occur in a health facility—from 53 percent in 1991-92 to 47 percent in 1996 to 44 percent in 1999. Because of this decline, the proportion of births assisted by trained medical personnel (doctors, nurses, midwives) has declined from 44 percent in 1991-92 to 36 percent in 1999. Less than one in five of those who deliver at home go to a health facility for a postnatal check-up within a month after delivery. Possible Leveling Off of Childhood Mortality Decline. Survey results imply that the decline in childhood mortality documented in the 1996 TDHS may be stagnating or even increasing slightly. The TRCHS rates show that almost 1 in 7 children born in Tanzania dies before reaching the fifth birthday, an indication that there is still much improvement to be made. The under-five mortality rate measured in the survey is 147 deaths per 1,000 births; the infant mortality rate is 99 per 1,000. Summary of Findings * xvii Childhood Vaccination Coverage. The 1999 TRCHS results show that 68 percent of children age 12-23 months are fully vacci- nated, close to the 71 percent in 1996. Childhood Health. The TRCHS pro- vides data on some of the more common childhood illness and their treatment. Just over 1 in 3 children under age five had a fever and 14 percent had respiratory illness in the two weeks before the survey. Of these, two- thirds were taken to a health facility for treat- ment. Twelve percent of children under five were reported to have had diarrhoea in the two weeks preceeding the survey. The fact that two-thirds of children with diarrhoea received some type of oral rehydration therapy (fluid made from an ORS packet or increased fluids) is encouraging. Breastfeeding Practices. The TRCHS results document a relatively long duration of breastfeeding, with a median duration of 21 months. Although breastfeeding has beneficial effects on both the child and the mother, TRCHS data indicate that supplementation of breastfeeding with other liquids and foods occurs too early in Tanzania. For example, among newborns less than four months of age, 60 percent are already receiving comple- mentary foods or liquids. Nutritional Status of Children. Re- sults show no appreciable change in the nutri- tional status of children in Tanzania. Over 40 percent of children under five show evidence of chronic malnutrition or stunting, while 5 percent are acutely malnourished (wasted). Vitamin A Supplementation. Over the past decade, several studies have proved the importance of adequate vitamin A in mitigat- ing the severity of maternal and childhood illnesses and thereby reducing mortality. Supplementing young children and post- partum women with a capsule containing a high dose of vitamin A is an easy way to en- sure adequate intake. However, survey data show that only 14 percent of children aged 6- 59 months received a high-dose vitamin A supplement in the six months prior to the survey. Vitamin A supplementation for postpartum women has about the same cover- age; 12 percent of women received a supple- ment within 2 months after delivering. HIV/AIDS-RELATED INDICATORS Awareness of AIDS. The TRCHS results confirm the fact that 97 percent of women and 99 percent of men have heard of HIV/AIDS. They also indicate an improvement in knowledge about how the disease is spread, which is reflected in an increase in the propor- tion of women and men who can list most of the major ways to avoid getting the illness. Around three-quarters or more of respondents know that HIV can be passed from a mother to her child and that a healthy-looking person can be infected. Condom Use. One of the main objec- tives of the Tanzanian AIDS control program- me is to encourage consistent use of condoms, especially with partners who may be exposed to HIV with other partners or through other risky behaviour. TRCHS data show that con- dom use with extramarital partners has in- creased since 1996 for women but not for men. Almost one in four women and 34 per- cent of men who had sex with someone other than a husband or wife in the previous 12 months said they used a condom the last time. Half of the respondents feel it is acceptable for a woman to ask a man to use a condom, while almost 60 percent say that if a man has a sexually transmitted disease, it is acceptable for his wife to ask him to use condoms or to refuse to have sex with him. HIV Testing. TRCHS data show that 7 percent of women and 12 percent of men have been tested for HIV, which represents a slight increase from 1996 (4 and 11 percent, respec- tively). As before, about two-thirds of those not tested say they would like to be. Major reasons for not getting tested are not knowing where to go and not having the time to go. Introduction * 1 INTRODUCTION 1 1.1 GEOGRAPHY, HISTORY, AND THE ECONOMY GEOGRAPHY The United Republic of Tanzania is the largest country in East Africa, covering 940,000 square kilometres, 60,000 of which are inland water. Tanzania lies south of the equator and shares borders with eight countries: Kenya and Uganda to the north; Rwanda, Burundi, Democratic Republic of Congo, and Zambia to the west; and Malawi and Mozambique to the south. Tanzania has an abundance of inland water, with several lakes and rivers. Lake Tanganyika runs along the western 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 and then to the Mediterranean Sea. The Rufiji River is Tanzania’s largest river and drains into the Indian Ocean south of Dar es Salaam. Although there are many rivers, only the Rufiji and 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 geologic faulting throughout eastern Africa and is associated with volcanic activity in the northeastern regions of the country. Two branches of the Great Rift Valley run through Tanzania. The western branch holds Lakes Tanganyika, Rukwa, and Nyasa, while the eastern 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 200 metres or more above sea level and much of the country is higher than 1,000 metres. In the north, Mount Kilimanjaro rises to 5,895 metres—the highest point in Africa. The main climatic feature for most of the country is the long dry spell from May to October, followed by a period of rainfall between November and April. The main rainy season along the coast and the areas around Mount 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 period between March and May. HISTORY Tanzania (then Tanganyika) became independent of British colonial rule in December 1961. One year later, on December 9, 1962, it became a republic, severing all links with the British crown except for its membership in the Commonwealth. The off-shore island of Zanzibar became independent on January 12, 1964, after the overthrow of the rule of the Sultanate. On April 26, 1964, Tanganyika and Zanzibar united to form the United Republic of Tanzania. Administratively, the Mainland of Tanzania is divided into 20 regions and Zanzibar is divided into five regions. Each region is subdivided into districts. 2 * Introduction Table 1.1 Demographic characteristics Selected demographic indicators, Tanzania: 1967-1996 _____________________________________________________ Year _____________________________ Index 1967 1978 1988 1996 ____________________________________________________ Population (millions) 12.3 17.5 23.1 U Intercensal growth rate 2.6 3.2 2.8 U Sex ratio 95.2 96.2 94.2 93.2 Crude birth rate 47 49 46 41 Total fertility rate 6.6 6.9 6.5 5.8 Crude death rate 24 19 15 U Infant mortality rate 155 137 115 88 Percent urban 6.4 13.8 18.3 19.8 Density (pop/km2) 14 20 26 U ______________________________________________________ U = Unknown (not available) Source: Bureau of Statistics, 1967; 1978; 1988; Bureau of Statistics and Macro International, 1997 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 4.8 percent in 1999 according to the constant 1992 prices, compared with 4.0 percent recorded in 1998. However, this growth did not reach the target of 5.8 percent, which was predicted in the 1995-96 to 1997-98 Economic Recovery Programmes. The economic growth rate attained in 1999 is higher than the predicted population growth rate of 2.8 percent. 1.2 DEMOGRAPHIC STATISTICS Table 1.1 gives the demographic indices as compiled from the censuses since 1967. The 1967 population cen- sus of Tanzania reported a total popula- tion of 12.3 million. According to the 1988 census, the population had in- creased to 23.1 million. Tanzania is still sparsely populated, although the popu- lation density is high in some parts of the country and has been increasing over time. In 1967, the average popula- tion density was 14 persons per square kilometre; by 1988, it had increased to 26 persons per square kilometre. Al- though the population is still predomi- nantly rural, the proportion of urban residents has been increasing steadily, from 6 percent in 1967 to 18 percent in 1988. While the crude death rate in Tanzania has been decreasing for some time, the total fertility rate—among the highest in Africa—is only now beginning to decline. Although many small-scale surveys have been conducted in the country, censuses and the 1991-92 and 1996 Tanzania Demographic and Health Surveys have been the only sources of demographic statistics in Tanzania. Civil registration has never been used as a source of demographic statistics because its coverage is incomplete. 1.3 POPULATION AND FAMILY PLANNING POLICIES AND PROGRAMMES The population size of Tanzania has trebled from 7.7 million in 1948 to 23.1 million in 1988. It is estimated that the annual population increase is now more than 600,000 persons per year. It is projected that the population is now about 33 million. However, the national economy did not grow significantly in the past decade, owing to various constraints; therefore, the resources available per head increased by about 1 percent per annum between 1992 and 1999. During that period the economy grew at an average of 3.8 percent, while the per capita income increased by 0.38 percent. However, the population continued to grow at a high rate, the consequences of which are felt acutely and visibly in the public budgets for health, education, and related fields of human resource Introduction * 3 development. It is evident, therefore, that improvement in the quality and expansion of these services is unlikely to happen without controlling rapid population growth and strengthening the national economy. It is against this background that Tanzania adopted the 1992 National Population Policy. The principal objective of the policy is to reinforce national development through developing available resources to improve the quality of life of the people. Special emphasis is put on regulating the population growth rate, enhancing population quality, and improving the health and welfare of women and children. The primary concerns of the Population Policy are to safeguard, as much as possible, the satisfaction of the basic needs of the vulnerable groups in the population, and to develop human resources for current and future national socioeconomic progress. Since Tanzania was concerned with population and development issues before the adoption of an explicit population policy, the country has a tradition of taking into account population issues in its development plans. With specific reference to family planning, the goals of the policy are to strengthen family planning services to promote the health and welfare of the family, the community, and the nation and eventually to reduce the rate of population growth. 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 and women. The Family Planning Association of Tanzania (UMATI) introduced family planning services to Tanzania in 1959. During the early years the services were mostly provided in a few urban areas with little support from the government. With the expansion of UMATI in the early 70s, services were extended to cover more areas in the country. The government became actively involved in providing family planning services following the launch of the integrated Maternal and Child Health programme in 1974. At the 1994 International Conference for Population and Development in Cairo, Tanzania endorsed the comprehensive approach toward reproductive health. The government now aims at providing universal access to high-quality, affordable reproductive health services, including family planning. Currently, reproductive health services are provided by both governmental and nongovernmental organisations under the coordination of the Reproductive and Child Health Section of the Ministry of Health. Clinical services are complemented by community- based services. There have been various national efforts to control the spread of HIV/AIDS since 1985. Initial efforts were mainly implemented by the Ministry of Health through the National AIDS Control Programme. Over time, involvement of other public sector, nongovernmental, and community-based organisations has occurred. Population Services International operates a social marketing programme in Tanzania. Its purpose is to provide low-cost reproductive health, family planning, and child health products and services to low income people. The objective of the program, which has been in place since 1994, is to reduce disease and deaths by making health products accessible and affordable to low income Tanzanians, providing information, creating awareness, and promoting behaviour change through social marketing techniques. Social marketing of Salama condoms started in 1993 as part of the larger nationwide AIDS/STD control programme; social marketing of Care female condoms started in 1998. Social marketing of mosquito bednets and insecticide started in 1998. 1 Data collection for the survey of health facilities was carried out as a separate but integrated operation, and the data will appear in a separate report. 4 * Introduction 1.4 HEALTH PRIORITIES AND PROGRAMMES The Tanzanian government emphasises equity in the distribution of health services and views access to services as a basic human right. To respond to the worldwide efforts to attain the social goal of “Health to 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. The main objective of the PHC programme is to strengthen district management capacity, multisectoral collaboration and community involvement. More than 60 percent of health services are provided by the government and the remainder are provided by nongovernmental organisations. With an extensive network of health facilities in the country, at the national level there are four consultant hospitals and two special hospitals, one of which is the university teaching hospital. Most regions have a regional hospital and there are a total of 195 hospitals in the country. There are 302 health centres and about 3,500 dispensaries. At the village level, village health posts have been established staffed with at least two village health workers. There are more than 5,550 village health workers in the country. Private institutions are increasingly playing an important role in the provision of health care, especially in urban areas. Recently, the government has undertaken a health sector reform programme, which emphasises decentralisation from the national to the regional and district levels. 1.5 OBJECTIVES AND ORGANISATION OF THE SURVEY The 1999 Tanzania Reproductive and Child Health Survey (TRCHS) is the fourth in a series of national sample surveys. The first was the 1991-92 Tanzania Demographic and Health Survey (TDHS), which was followed by the Tanzania Knowledge, Attitudes and Practices Survey (TKAP) in 1994 and then by the 1996 Tanzania Demographic and Health Survey (TDHS). The primary objective of the 1999 TRCHS was to collect data at the national level (with breakdowns by urban-rural and Mainland-Zanzibar residence wherever warranted) on fertility levels and preferences, family planning use, maternal and child health, breastfeeding practices, nutritional status of young children, childhood mortality levels, knowledge and behaviour regarding HIV/AIDS, and the availability of specific health services within the community.1 Related objectives were to produce these results in a timely manner and to ensure that the data were disseminated to a wide audience of potential users in governmental and nongovernmental organisations within and outside Tanzania. The ultimate intent is to use the information to evaluate current programmes and to design new strategies for improving health and family planning services for the people of Tanzania. The survey was undertaken by the National Bureau of Statistics in collaboration with the Reproductive and Child Health Section of the Ministry of Health. The survey was initiated and jointly funded by the U.S. Agency for International Development (USAID/Tanzania), UNICEF/Tanzania, and the United Nations Population Fund (UNFPA/Tanzania). Technical assistance was provided by Macro International Inc. as part of the worldwide MEASURE Demographic and Health Surveys (DHS+) project, which is designed to collect, analyse, and disseminate data on fertility, family planning, maternal and child health, and HIV/AIDS. Introduction * 5 SAMPLE DESIGN The TRCHS used a three-stage sample design. Overall, 176 census enumeration areas were selected (146 on the Mainland and 30 in Zanzibar) with probability proportional to size on an approximately self-weighting basis on the Mainland, but with oversampling of urban areas and Zanzibar. To reduce costs and maximise the ability to identify trends over time, these enumeration areas were selected from the 357 sample points that were used in the 1996 TDHS, which in turn were selected from the 1988 census frame of enumeration in a two-stage process (first wards/branches and then enumeration areas within wards/branches). Before the data collection, fieldwork teams visited the selected enumeration areas to list all the households. From these lists, households were selected to be interviewed. The sample was designed to provide estimates for the whole country, for urban and rural areas separately, and for Zanzibar and, in some cases, Unguja and Pemba separately. The health facilities component of the TRCHS involved visiting hospitals, health centres, and pharmacies located in areas around the households interviewed. In this way, the data from the two components can be linked and a richer dataset produced. QUESTIONNAIRES The household survey component of the TRCHS involved three questionnaires: 1) a Household Questionnaire, 2) a Women’s Questionnaire for all individual women age 15-49 in the selected households, and 3) a Men’s Questionnaire for all men age 15-59. The health facilities survey involved six questionnaires: 1) a Community Questionnaire administered to men and women in each selected enumeration area; 2) a Facility Questionnaire; 3) a Facility Inventory; 4) a Service Provider Questionnaire; 5) a Pharmacy Inventory Questionnaire; and 6) a questionnaire for the District Medical Officers. All these instruments were based on model questionnaires developed for the MEASURE programme, as well as on the questionnaires used in the 1991-92 TDHS, the 1994 TKAP, and the 1996 TDHS. These model questionnaires were adapted for use in Tanzania during meetings with representatives from the Ministry of Health, the University of Dar es Salaam, the Tanzania Food and Nutrition Centre, USAID/Tanzania, UNICEF/Tanzania, UNFPA/Tanzania, and other potential data users. The questionnaires and manual were developed in English and then translated into and printed in Kiswahili. The Household Questionnaire was used to list all the usual members and visitors in the selected households. Some basic information was collected on the characteristics of each person listed, including his/her age, sex, education, and relationship to the head of the household. The main purpose of the Household Questionnaire was to identify women and men who were eligible for individual interview and children under five who were to be weighed and measured. Information was also collected about the dwelling itself, such as the source of water, type of toilet facilities, materials used to construct the house, ownership of various consumer goods, and use of iodised salt. Finally, the Household Questionnaire was used to collect some rudimentary information about the extent of child labour. The Women’s Questionnaire was used to collect information from women age 15-49. These women were asked questions on the following topics: C Background characteristics (age, education, religion, type of employment) C Birth history C Knowledge and use of family planning methods C Antenatal, delivery, and postnatal care C Breastfeeding and weaning practices C Vaccinations, birth registration, and health of children under age five C Marriage and recent sexual activity 6 * Introduction C Fertility preferences C Knowledge and behaviour concerning HIV/AIDS. The Men’s Questionnaire covered most of these same issues, except that it omitted the sections on the detailed reproductive history, maternal health, and child health. The final versions of the English questionnaires are provided in Appendix E. Before the questionnaires could be finalised, a pretest was done in July 1999 in Kibaha District to assess the viability of the questions, the flow and logical sequence of the skip pattern, and the field organisation. Modifications to the questionnaires, including wording and translations, were made based on lessons drawn from the exercise. TRAINING AND FIELDWORK Competency was the guiding factor in recruiting interviewers. As with 1991-92, 1994, and 1996 surveys, the Ministry of Health was requested to secure the services of trained nurses to be interviewers in the 1999 TRCHS. A similar request was made to the Zanzibar Ministry of Health to provide nurses to serve as interviewers. The training of field staff for the main survey was conducted over a three-week period from mid-August to the first week of September 1999, at the Golden Rose Hotel in Arusha Municipality. A total of 100 nurses were recruited and trained by experienced statisticians and demographers from the National Bureau of Statistics, with support from staff at Macro International Inc. and guest lecturers from the Arusha Regional Hospital and staff from the Tanzania Food and Nutrition Centre. Trial interviews were conducted in the nearby villages and in some parts of Arusha Municipality. Trainees also visited day care centres to gain experience in measuring children. Data processing staff participated in the training to acquaint themselves with the questionnaires. The training course consisted of instructions in interviewing techniques and field procedures, as well as a detailed review of items on the questionnaires. It also covered use of salt testing kits, weighing and measuring children, mock interviews between participants in the classroom, and practice interviews with real respondents in and around Arusha Municipality. During training, a series of assessment tests were given to the class. These tests were graded, and the results were used to select interviewers. Those who showed a high level of understanding of the questionnaires and were also able to detect errors in completed questionnaires were later chosen to be field editors. Supervisors and editors participated in further training to discuss their duties and responsibilities. Ensuring data quality was emphasised. The supervisor was required to act as the leader of the field team and to be responsible for the well-being and safety of team members, as well as the completion of the assigned workload and the maintenance of data quality. Responsibilities of the editor included monitoring interviewer performance and checking all questionnaires for completeness and consistency. Close supervision of the interviewers and editing of completed questionnaires was emphasised to ensure accurate and complete data collection. The fieldwork began the first week of September and continued until the third week of November 1999. Data collection for the 1999 TRCHS was implemented by ten teams, nine of which were composed of six female interviewers, one male interviewer, a field editor, a supervisor, and a driver. The tenth team was for quality control and was composed of a supervisor, two interviewers, and a driver. The list of persons who were involved in the survey is presented in Appendix D. The quality control team visited all the teams to check the quality of their work by reviewing Introduction * 7 Table 1.2 Results of the household and individual interviews Number of households, number of interviews, and response rates, by urban-rural residence, Tanzania 1999 ________________________________________________________ Residence _________________ Result Urban Rural Total ________________________________________________________ Household interviews Households sampled 1,304 2,522 3,826 Households occupied 1,233 2,444 3,677 Households interviewed 1,192 2,423 3,615 Household response rate 96.7 99.1 98.3 Individual interviews: women Number of eligible women 1,446 2,672 4,118 Number of eligible women interviewed 1,418 2,611 4,029 Eligible woman response rate 98.1 97.7 97.8 Individual interviews: men Number of eligible men 1,367 2,425 3,792 Number of eligible men interviewed 1,250 2,292 3,542 Eligible man response rate 91.4 94.5 93.4 completed questionnaires, observing interviews, and reinterviewing a subsample of households to check that the original interviews were completed and all eligible respondents were correctly identified. Problems found in one team were immediately communicated to other teams through the head office. DATA PROCESSING All the questionnaires for the TDHS were returned to the National Bureau of Statistics for data processing, which consisted of office editing, coding of open-ended questions, data entry, and editing of computer-identified errors. All data were processed on microcomputers and a software programme developed for DHS surveys, called the Integrated System for Survey Analysis (ISSA). The data processing staff for the survey consisted of eight data entry operators, one editor and two supervisors who were staff of the National Bureau of Statistics. Data entry was 100 percent verified. Office editing and data processing activities were initiated immediately after the beginning of fieldwork and were completed in mid-January 2000. RESPONSE RATES A summary of response rates from the household and individual interviews is shown in Table 1.2. In all, 3,826 households were selected for the sample, out of which 3,677 were occupied. Of the households found, 3,615 were interviewed, representing a response rate of 98 percent. The shortfall is primarily due to dwellings that were vacant or in which the inhabitants were not at home despite of several callbacks. In the interviewed house- holds, a total of 4,118 eligible women (i.e., women age 15-49) were identified for the individual interview, and 4,029 women were actually interviewed, yielding a re- sponse rate of 98 percent. A total of 3,792 eligible men (i.e., men age 15- 59), were identified for the individ- ual interview, of whom 3,542 were interviewed, representing a response rate of 93 percent. The principal rea- son for nonresponse among both eligible men and women was the failure to find them at home despite repeated visits to the household. The lower response rate among men than women was due to the more frequent and longer absences of men. The response rates are lower in urban areas due to longer absence of respondents from their homes. One-member households are more common in urban areas and are more difficult to 8 * Introduction interview because they keep their houses locked most of the time. In urban settings, neighbours often do not know the whereabouts of such people. Introduction * 9 Characteristics of Households * 9 Table 2.1 Household population by age, residence, and sex Percent distribution of the de facto household population by five-year age group, according to urban-rural residence and sex, Tanzania 1999 __________________________________________________________________________________________________ Urban Rural Total _______________________ _______________________ _______________________ Age group Male Female Total Male Female Total Male Female Total __________________________________________________________________________________________________ 0-4 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80 + Total Number 14.7 12.9 13.7 19.0 17.2 18.0 18.0 16.2 17.1 14.6 13.9 14.2 18.0 15.6 16.7 17.3 15.2 16.2 12.6 10.9 11.7 14.8 13.4 14.1 14.3 12.8 13.5 11.3 10.5 10.9 9.3 10.0 9.7 9.8 10.1 9.9 8.9 12.7 10.9 6.3 8.0 7.2 6.8 9.1 8.0 8.9 11.1 10.1 6.0 7.2 6.6 6.7 8.1 7.4 6.5 6.2 6.4 4.1 5.3 4.7 4.6 5.5 5.1 6.3 6.0 6.1 5.0 4.8 4.9 5.3 5.1 5.2 4.0 3.6 3.8 2.4 3.0 2.7 2.8 3.1 2.9 3.3 3.5 3.4 3.2 3.3 3.2 3.2 3.3 3.3 3.3 2.1 2.7 2.4 3.6 3.0 2.6 3.3 2.9 1.7 1.7 1.7 2.1 2.6 2.3 2.0 2.4 2.2 2.0 2.2 2.1 1.9 2.3 2.1 1.9 2.3 2.1 0.7 1.0 0.9 2.6 1.7 2.1 2.2 1.6 1.9 0.7 0.6 0.7 1.3 0.9 1.1 1.2 0.8 1.0 0.4 0.5 0.4 0.9 0.5 0.7 0.8 0.5 0.6 0.2 0.5 0.3 0.7 0.8 0.7 0.6 0.7 0.7 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 1,822 2,122 3,944 6,544 7,120 13,665 8,366 9,242 17,609 2CHARACTERISTICS OF HOUSEHOLDS AND RESPONDENTS The purpose of this chapter is to provide a short descriptive summary of some demographic and socioeconomic characteristics of the population in the sampled households and the individual respondents interviewed, such as age, sex, residence, and educational level. Also examined are environmental conditions such as housing facilities and household characteristics. This information on the characteristics of the households and the individual women and men interviewed is essential for the interpretation of survey findings and can provide an approximate indication of the representativeness of the survey. For the purposes of the 1999 TRCHS, a household was defined as a person or a group of persons who live together and share a common source of food. The Household Questionnaire (see Appendix E) was used to collect information on all usual residents and visitors who spent the night preceding the interview in the household. This method of data collection allows the calculation of either de jure (usual residents) or de facto (those there at the time of the survey) populations. 2.1 POPULATION BY AGE AND SEX The distribution of the household population in the TRCHS is shown in Table 2.1 by five-year age groups, according to sex and urban-rural residence. Because of relatively high levels of fertility in the past, Tanzania has a larger proportion of its population in the younger age groups than in the older age groups (Figure 2.1). This pattern is similar to the one observed in the censuses and the 1991-92 and 1996 TDHS surveys, except that the pattern is smoother in 1999. Most notable is the 10 * Characteristics of Households Figure 2.1 Population Pyramid, Tanzania 1999 80+ 75-79 70-74 65-69 60-64 55-59 50-54 45-49 40-44 35-39 30-34 25-29 20-24 15-19 10-14 5-9 0-4 0246810 0 2 4 6 8 10 Percent Male Female TRCHS 1999 absence of the heaping of women’s ages on 14 and 50 that was seen in the earlier surveys, which probably resulted from a deliberate tactic of interviewers to reduce their workload (see Table C.1). Table 2.2 shows that the population structure by broad age groups is similar to that found in the 1967, 1978, and 1988 censuses as well as that observed in the 1991-92 and 1996 TDHS surveys. Just under half of the population is below age 15, with most of the other half in the 15-64 age group; the remaining 4 percent are age 65 and over. The population has a low median age of 16 years. Table 2.2 also shows the age dependency ratio, which is an indicator of the dependency responsibility of adults in their productive years. It is defined as the ratio of the total number of persons below age 15 and above age 65 divided by the number of persons age 15 to 64. In 1999, the dependency ratio was 104, which implies that there are 104 dependents for every 100 persons in the productive ages. 2.2 HOUSEHOLD COMPOSITION Information about the composition of households by sex of the head of the household and size of the household is presented in Table 2.3. This table also shows the percentage of households with foster children. The data shows that men head 77 percent of households in Tanzania, similar to the level observed in the1996 TDHS (78 percent). Female-headed households are more common in urban (27 percent) than rural areas (22 percent). The average household size in Tanzania is 5 persons. Rural households are larger than urban households; the mean household size is 5.3 in rural areas and 4.3 in urban areas. Characteristics of Households * 11 Table 2.2 Population by age from selected sources Percent distribution of the population by age group, according to selected sources, Tanzania 1967-1999 ______________________________________________________________________ 1967 1978 1988 1991-92 1994 1996 1999 Age group Census Census Census TDHS TKAPS TDHS TRCHS ______________________________________________________________________ <15 43.9 46.1 45.8 46.8 49.3 47.2 46.8 15-64 50.5 49.9 49.9 49.3 46.4 48.5 49.1 65+ 5.6 4.0 4.3 3.9 4.3 4.3 4.1 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Median age U U U 16.4 15.4 16.4 16.4 Dependency ratio 98 100 100 103 115 106 104 ______________________________________________________________________ Sources: Bureau of Statistics, 1967-1999 U = Unknown (not available) Table 2.3 Household composition Percent distribution of households by sex of head of household, household size, and presence of foster children, according to urban-rural residence, Tanzania 1999 ___________________________________________________ Residence ______________ Characteristic Urban Rural Total ___________________________________________________ Household headship Male Female Total Number of usual members 1 2 3 4 5 6 7 8 9+ Total Mean size Percentage of households with foster children 73.0 78.3 76.9 .27.0 21.7 23.1 100.0 100.0 100.0 15.4 7.1 9.2 14.0 10.0 11.1 14.7 13.3 13.7 14.9 15.5 15.3 13.2 14.7 14.3 9.2 13.2 12.1 7.0 7.9 7.7 5.2 6.1 5.9 6.4 12.2 10.7 100.0 100.0 100.0 4.3 5.3 5.0 20.0 22.5 21.8 ___________________________________________________ Note: Table is based on de jure members, i.e., usual residents. By convention, foster children are those who are not living with either biological parent. This includes orphans, i.e., children with both parents dead. More than one-fifth (22 percent) of households have foster children, that is, children under age 15 living in a household with neither their biological mother nor father present. The high proportion of households with foster children certainly intensifies the economic burden on these households. With the current high preva- lence of AIDS, the percentage of households with foster children in Tanzania is likely to rise. 2.3 FOSTERHOOD AND ORPHANHOOD Information regarding fosterhood and orphanhood of children under age 15 is presented in Table 2.4. The table shows that 63 percent of children under 15 are living with both their biological parents, while 17 percent are living with their mothers (but not with their fathers), 5 percent are living with their fathers (but not with their moth- ers) and 14 percent are living with neither of their natural parents. The table also provides data on the extent of orphanhood, that is, the proportion of children whose biological parents have both died. Of children under 15 years, 6 percent have lost their fathers and 3 percent have lost their mothers. One percent of children have lost both their natural parents (orphaned). 12 * Characteristics of Households Table 2.4 Fosterhood and orphanhood Percent distribution of de jure children under age 15 by survival status of parents and child's living arrangements, according to selected background characteristics, Tanzania 1999 ________________________________________________________________________________________________________ Living Living with mother with father Not living with but not father but not mother either parent Missing Living ____________ _____________ ___________________________ informa- with Father Mother tion on Number Background both Father Father Mother Mother Both only only Both father/ of characteristic parents alive dead alive dead alive alive alive dead mother Total children ________________________________________________________________________________________________________ Age <2 3-5 6-9 10-14 Sex Male Female Residence Urban Rural Mainland/Zanzibar Mainland Urban Rural Zanzibar Pemba Unguja Total 75.2 19.9 1.4 0.3 0.2 2.4 0.2 0.0 0.0 0.4 100.0 1,862 70.1 13.0 2.3 2.7 0.1 9.2 0.8 0.8 0.3 0.7 100.0 1,725 58.4 12.5 3.6 5.8 1.2 11.5 1.7 2.4 1.4 1.5 100.0 2,319 51.4 11.2 5.6 7.0 1.9 12.9 2.1 3.7 2.1 2.1 100.0 2,388 63.0 13.6 3.2 4.8 0.8 8.6 1.3 1.9 1.4 1.4 100.0 4,204 62.2 14.1 3.6 3.7 1.1 10.1 1.2 1.9 0.7 1.2 100.0 4,091 55.8 16.3 3.3 6.5 1.1 10.7 1.7 2.1 1.0 1.6 100.0 1,598 64.2 13.3 3.4 3.8 0.9 9.1 1.2 1.9 1.1 1.2 100.0 6,697 62.6 13.9 3.4 4.3 1.0 9.3 1.3 1.9 1.1 1.3 100.0 8,071 55.5 16.4 3.2 6.6 1.1 10.7 1.7 2.1 1.0 1.6 100.0 1,536 64.2 13.3 3.5 3.8 1.0 9.0 1.2 1.9 1.1 1.2 100.0 6,534 64.1 14.2 2.7 3.2 0.0 11.2 0.8 1.8 0.4 1.5 100.0 224 67.7 12.7 3.1 4.0 0.1 8.9 0.5 2.0 0.4 0.7 100.0 110 60.7 15.6 2.4 2.5 0.0 13.4 1.2 1.6 0.4 2.2 100.0 114 62.6 13.9 3.4 4.3 1.0 9.4 1.3 1.9 1.1 1.3 100.0 8,294 ________________________________________________________________________________________________________ Note: By convention, foster children are those who are not living with either biological parent. This includes orphans, i.e., children with both parents dead. Differentials in fosterhood and orphanhood are not large. Obviously, younger children are more likely than older children to be living with one or both parents, and their parents are more likely to be living. Also, children in Zanzibar are less likely to be orphaned than children in the Mainland. 2.4 EDUCATION LEVEL OF HOUSEHOLD POPULATION Education is a key determinant of the life style and status an individual enjoys in a society. It affects many aspects of human life, including demographic and health behaviour. Studies have consistently shown that educational attainment has strong effects on reproductive behaviour, contraceptive use, fertility, infant and child mortality, morbidity, and issues related to family health and hygiene. In the 1999 TRCHS, information on educational attainment was collected for every member of the household. Tables 2.5.1 and 2.5.2 show the percent distribution of the de facto female and male population ages six and older, by the highest level of education attended and the median of years of schooling completed, according to selected background characteristics. Characteristics of Households * 13 Table 2.5.1 Educational level of the female household population Percent distribution of the de facto female household population age six and over by highest level of education attended, and median number of years of schooling, according to selected background characteristics, Tanzania 1999 __________________________________________________________________________________________ Level of education _____________________________________________ Some Median Number Background No Primary Completed secondary years of of characteristic education incomplete primary or higher Total schooling females __________________________________________________________________________________________ Age 6-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65+ Residence Urban Rural Mainland/Zanzibar Mainland Urban Rural Zanzibar Pemba Unguja Total 64.1 35.3 0.0 0.5 100.0 0.0 1,118 25.6 72.8 1.3 0.2 100.0 1.3 1,185 19.7 35.9 38.9 5.4 100.0 5.2 931 17.0 15.8 60.9 6.3 100.0 6.3 838 17.0 13.4 63.0 6.6 100.0 6.3 749 21.5 16.7 55.1 6.7 100.0 6.2 511 39.6 16.9 40.0 3.6 100.0 3.7 468 52.3 17.2 25.3 5.2 100.0 0.0 287 64.6 24.8 7.2 3.3 100.0 0.0 310 75.4 18.9 4.9 0.8 100.0 0.0 302 76.8 15.3 2.5 5.3 100.0 0.0 219 85.9 9.4 1.6 3.0 100.0 0.0 211 87.8 8.0 1.8 2.4 100.0 0.0 331 22.7 31.0 37.0 9.3 100.0 4.7 1,792 45.5 29.9 22.8 1.7 100.0 0.0 5,669 40.1 30.1 26.6 3.2 100.0 1.1 7,266 22.7 30.9 37.9 8.5 100.0 4.8 1,731 45.5 29.8 23.1 1.5 100.0 0.0 5,535 37.8 34.4 10.1 17.7 100.0 1.2 195 44.8 35.1 7.8 12.3 100.0 0.0 87 32.2 33.8 11.9 22.1 100.0 2.5 107 40.1 30.2 26.2 3.6 100.0 1.1 7,461 There is a strong differential in educational attainment between the sexes, especially as age increases. Overall, 40 percent of women in Tanzania have never been to school, compared with 31 percent of men (Figure 2.2). The proportion with no education increases with age. For example, the proportion of women who have never attended any formal schooling increases from 17 percent in age group 20-24 to 88 percent among those age 65 and older. For men, the proportion increases from 11 percent (age group 15-19) to 66 percent (age group 65 and older). Thirty percent of women and 34 percent of men have completed primary school, with just under 5 percent having attended some secondary school. The median number of years of schooling is 1.1 for women and 2.6 for men. Overall, educational attainment is higher in urban areas than in rural areas. The proportion of women and men with no education in urban areas is half that of rural areas. Conversely, the percentage with primary and secondary education is higher for urban than for rural women and men. 14 * Characteristics of Households Table 2.5.2 Educational level of the male household population Percent distribution of the de facto male household population age six and over by highest level of education attended, and median number of years of schooling, according to selected background characteristics, Tanzania 1999 __________________________________________________________________________________________ Level of education _____________________________________________ Some Median Number Background No Primary Completed secondary years of of characteristic education incomplete primary or higher Total schooling males __________________________________________________________________________________________ Age 6-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65+ Residence Urban Rural Mainland/Zanzibar Mainland Urban Rural Zanzibar Pemba Unguja Total 72.8 26.4 0.0 0.7 100.0 0.0 1,171 24.6 73.7 1.3 0.4 100.0 1.0 1,197 11.4 41.0 42.9 4.7 100.0 5.3 818 11.3 17.5 62.3 8.9 100.0 6.3 571 10.1 14.9 67.1 7.9 100.0 6.4 557 9.3 15.4 65.0 10.3 100.0 6.4 385 10.7 15.0 62.8 11.5 100.0 6.4 443 22.1 27.0 40.2 10.6 100.0 6.0 231 28.6 36.1 29.5 5.7 100.0 3.5 267 25.9 42.3 25.0 6.8 100.0 3.6 217 33.1 53.4 10.9 2.6 100.0 3.3 167 45.3 43.7 6.8 4.3 100.0 1.1 161 65.6 25.0 6.9 2.5 100.0 0.0 398 16.4 36.1 34.9 12.6 100.0 4.7 1,508 34.9 35.5 27.2 2.4 100.0 1.9 5,074 30.7 35.5 29.4 4.4 100.0 2.6 6,416 16.4 36.0 35.6 12.0 100.0 4.7 1,456 34.9 35.3 27.6 2.2 100.0 1.9 4,960 28.8 41.3 11.6 18.3 100.0 2.4 166 34.9 43.3 7.7 14.0 100.0 1.0 74 23.8 39.7 14.8 21.7 100.0 3.7 92 30.7 35.6 29.0 4.7 100.0 2.6 6,582 Educational attainment is higher in Zanzibar than in the Mainland. For example, although the proportions of both women and men with no education are only slightly lower in Zanzibar than in the Mainland, the proportions with at least some secondary school are far higher in Zanzibar than in the Mainland. This difference in educational attainment is because compulsory education in Zanzibar incorporates three years of secondary education. 2.5 SCHOOL ATTENDANCE The 1999 TRCHS collected more detailed information about school attendance than previous surveys. The survey also included information about early childhood education programs. Table 2.6 presents data on the proportion of children age 3 and 4 years listed on the Household Questionnaire who are attending some form of early childhood education (nursery school, kindergarten). Less than 3 percent of children age 36-59 months were reported to be attending some sort of school. As might be expected, pre-school education coverage is higher among Characteristics of Households * 15 Figure 2.2 Level of Education for Women and Men, Tanzania 1999 TRCHS 1999 40 30 26 4 31 36 29 5 No Education Primary Incomplete Primary Complete Secondary/ Higher 0 10 20 30 40 50 Percent Women Men urban children, among children age 4, and among children whose mothers have some secondary education. Table 2.7 and Figure 2.3 present the percentage of the primary-school-age population (ages 7-13) who are currently attending primary school by age, sex, and urban-rural residence. These percentages are also referred to as net attendance ratios. As shown in the table, attendance ratios are low in Tanzania, with only slightly more than half of primary-school-age children attending primary school. Girls are more likely than boys to be attending school (56 versus 51 percent), which shows that the overall low attendance rate is not due to keeping girls out of school. Attendance is higher for children in Zanzibar than for those in the Mainland (67 versus 53 percent). It is also higher for urban than for rural children and for older children. That attendance ratios are substantially higher at ages 11-13 than at 7-10 implies that many children start school late. 2.6 CHILD LABOUR In many societies, poor families cannot afford to send their children to school because the child’s labour is a valuable asset to the family. Despite policies and sometimes laws designed to eliminate child labour, the practice continues in many countries. In order to measure the extent of child labour in Tanzania, the 1999 TRCHS asked a series of questions about all children age 5-14. Questions included whether the child was doing any kind of work for pay, whether he/she regularly did unpaid family work on the farm or in a family business, and whether the child regularly helped with household chores at home, like cleaning, caring for animals, or cooking. The results are shown in Table 2.8. Caution should be used in interpreting these data, as the rather lengthy questions usually recommended by labour experts could not be accommodated in this particular survey. It is encouraging to note that only a tiny fraction (less than 2 percent) of Tanzanian children age 5-14 are working for pay. However, more than one in five children are doing unpaid work in a family business, and almost four out of five regularly help out with domestic chores. One-quarter 16 * Characteristics of Households Table 2.6 Early childhood education Percentage of de facto children age 36-59 months who are attending some form of organised early childhood education (ECE), by selected background characteristics, Tanzania 1999 ___________________________________________ Percentage Number Background attending ECE of characteristic programme children ___________________________________________ Child’s age 36-47 months 48-59 months Sex Male Female Residence Urban Rural Mainland/Zanzibar Mainland Urban Rural Zanzibar Pemba Unguja Mother’s education No education Primary incomplete Primary complete Secondary+ Missing Total 0.9 560 3.9 588 1.8 554 3.1 594 10.1 197 0.8 952 2.4 1,116 10.4 188 0.8 928 3.0 32 2.3 16 3.6 16 0.0 287 0.5 153 3.3 477 (18.6) 27 3.0 204 2.4 1,148 ___________________________________________ Note: Figures in parentheses are based on 25-49 unweighted cases of children spend four or more hours a day in domes- tic chores. As expected, older children, rural children and, to a lesser extent, male children are more likely to be working. Children in Zanzibar are far less likely than children in the Mainland to be working, especially doing unpaid family work or domestic chores. 2.7 HOUSING CHARACTERISTICS Socioeconomic conditions in Tanzania were assessed by asking respondents about their house- hold environment, e.g., their access to electricity, sources of drinking water, time to water sources, type of toilet facilities, and floor materials. This information is summarised in Table 2.9. As the table shows, only 8 percent of house- holds in Tanzania have electricity. Electricity is much more common in urban areas; 27 percent of urban households have electricity, compared with only 1 percent of rural households. The source of drinking water is important because waterborne diseases, including diarrhoea and dysentery, are prevalent in the country. Sources of water expected to be relatively free of these diseases are piped water, protected wells, tube wells, and protected springs. Other sources, like unpro- tected wells, rivers and streams, and ponds and lakes, are more likely to carry the bacteria that cause these diseases. Table 2.9 shows that about two-thirds of Tanzanian households have safe drinking water; 38 percent of all households have access to piped water, while 28 percent get their drinking water from other relatively safe sources—protected dug wells, tube wells, or protected springs. One-third of all households rely on sources of drinking water that are less safe, such as unprotected wells and springs and surface water from ponds and rivers. As expected, a far greater proportion of urban than rural households have safe sources of drinking water (92 versus 56 percent). In urban areas, 62 percent of the households have access to water within 15 minutes, compared with 26 percent of rural households. Modern sanitation facilities are not yet available to a large proportion of Tanzanian households. The use of traditional pit toilets is still common in both urban and rural areas, accounting for 86 percent of all households. Households with no toilet facilities are more exposed to the risk of diseases such as dysentery, diarrhoea, and typhoid fever. Overall, about 12 percent of the households in Tanzania have no toilet facilities. This problem is more common in rural areas, where 16 percent of the households have no toilet facilities, compared with 1 percent of households in urban areas. Characteristics of Households * 17 Table 2.7 School attendance ratios Percentage of de facto children of primary school age (7-13) attending primary school, by selected background characteristics, Tanzania 1999 ________________________________________________________________________________ Males Females Total Background _________________ _________________ ________________ characteristic Attending Number Attending Number Attending Number ________________________________________________________________________________ Age 7-8 years 9-10 years 11-12 years 13 years Residence Urban Rural Mainland/Zanzibar Mainland Urban Rural Zanzibar Pemba Unguja Total 27.0 581 34.8 582 30.9 1,163 48.1 521 54.5 528 51.3 1,050 72.6 487 73.4 495 73.0 982 72.2 269 71.2 250 71.7 519 71.0 336 71.3 367 71.1 703 47.1 1,522 51.7 1,488 49.4 3,010 51.0 1,809 55.2 1,801 53.1 3,610 70.6 323 70.8 352 70.7 675 46.8 1,486 51.4 1,449 49.1 2,935 65.5 49 68.1 54 66.9 103 63.2 27 61.8 26 62.5 53 68.5 21 73.8 28 71.5 50 51.4 1,858 55.6 1,855 53.5 3,713 Figure 2.3 Percentage of Children Age 7-13 Attending Primary School, by Sex and Residence 56 71 5251 71 47 Total Urban Rural 0 20 40 60 80 Percent Female Male TRCHS 1999 18 * Characteristics of Households Table 2.8 Child labour Percentage of de facto children 5-14 years of age who are currently working, by selected background characteristics Tanzania 1999 ___________________________________________________________________________ Currently Currently doing doing domestic work for: unpaid ___________________ Currently family Less 4 or doing work on a than more Number Background work farm or 4 hours hours Currently of characteristic for pay business per day per day working1 children ____________________________________________________________________________ Age 5-9 10-14 Sex Male Female Residence Urban Rural Mainland/Zanzibar Mainland Urban Rural Zanzibar Pemba Unguja Total 0.4 8.3 47.1 18.2 24.1 2,850 3.0 38.1 60.1 33.7 60.2 2,382 2.0 23.6 49.6 25.8 42.6 2,643 1.2 20.1 56.6 24.8 38.4 2,589 1.9 12.6 55.3 17.8 28.0 1,023 1.5 24.1 52.5 27.1 43.6 4,209 1.6 22.4 52.9 25.8 41.3 5,086 1.9 13.0 55.0 18.3 28.7 984 1.5 24.7 52.4 27.6 44.3 4,102 3.8 3.4 58.2 8.3 13.4 145 5.0 2.8 57.9 10.7 15.4 74 2.6 4.0 58.4 5.8 11.3 71 1.6 21.9 53.0 25.3 40.5 5,231 _____________________________________________________________________________ 1 “Working“means either doing paid or unpaid work or doing domestic work for four or more hours a day. The type of material used for flooring is an indicator not only of the quality of housing but also of health risk. Overall, 79 percent of all households in Tanzania live in residences with floors made of earth or sand, while 21 percent live in houses with cement floors. Earth flooring is almost universal in rural areas (93 percent). In general, rural households have poorer quality floors than urban households. Respondents were also asked about their household’s ownership of particular durable goods. Besides providing an indicator of socioeconomic status, ownership of these goods provides measures of other aspects of life. Ownership of a radio and a television is a measure of access to mass media; refrigerator ownership indicates a capacity for more hygienic food storage; and ownership of a bicycle, motorcycle, or a private car shows the means of transport available to households. Information on ownership of these items is presented in Table 2.10. Possession of durable goods is not common in Tanzania because many households cannot afford them. Nationally, only 43 percent of households own a radio and only 2 percent of households own a television. Refrigerators are also uncommon; only 2 percent of households have a refrigerator. Bicycles are the most common type of transportation owned by households; almost one-third of households have a bicycle. Ownership of motorised transportation is extremely rare. Only 1 percent of households have a car and even fewer have a motorcycle. As expected, urban 1 Salt that contains at least 15 parts per million of iodine is considered to be adequately iodised. Characteristics of Households * 19 Table 2.9 Housing characteristics Percent distribution of households by housing characteristics, according to urban-rural residence, Tanzania 1999 ___________________________________________________ Residence _______________ Characteristic Urban Rural Total ___________________________________________________ Electricity No Yes Missing Source of drinking water Piped into residence Piped into yard Public tap Unprotected well Protected dug well Borehole or tube well Protected spring Unprotected spring Pond, river, stream Tanker truck Time to water source (in minutes) <15 minutes (percent) Median time to source Sanitation facilities Flush toilet Traditional pit toilet Vent. imp. pit latrine No facilities/bush Floor material Earth/sand Cement Other Total Number of households 72.6 98.7 91.9 27.3 1.1 8.0 0.1 0.2 0.2 9.0 1.0 3.1 39.2 3.1 12.6 31.9 18.2 21.8 2.2 18.4 14.2 5.2 18.5 15.0 6.0 10.4 9.2 0.8 5.1 4.0 0.9 8.2 6.3 1.9 16.9 13.0 2.7 0.1 0.8 61.7 25.5 35.0 4.1 29.1 19.6 4.1 0.6 1.5 91.5 83.4 85.5 3.2 0.2 1.0 1.1 15.8 12.0 37.2 93.4 78.7 62.6 6.4 21.1 0.2 0.2 0.1 100.0 100.0 100.0 946 2,669 3,615 households are more likely than rural house holds to own all the items listed, except for bicycles. For example, two-thirds of urban households have radios, compared with only one-third of rural households. Half the rural households surveyed do not possess any of the items listed, compared with only 27 percent of urban households. Ownership of radios, televisions, and bicycles has hardly changed since 1996. The only item that shows any appreciable change is the radio; the proportion of households with a radio has increased from 41 to 43 percent. Another household characteristic measured in the TRCHS was the use of io- dised salt. Iodine deficiency in the diet can lead to serious nutritional deficiencies that can result in health problems such as goitre, stunting, mental retardation, and cretinism. The government of Tanzania has emphasised the addition of iodine to salt to prevent these health problems. Interviewers asked house- hold respondents for a teaspoon of salt that was used for cooking. They then tested the salt for iodine content using portable test kits. Interviewers succeeded in testing the salt in 97 percent of households. As shown in Table 2.11, two-thirds of households were found to have an ade- quate level of iodisation, while the salt used by one-third of the households was not iodised.1 Urban households and those in the Mainland are more likely to use iodised salt. Health officials should make efforts to improve the situation in Pemba, where less than 10 percent of households use iodised salt. 2.8 BACKGROUND CHARACTERISTICS OF RESPONDENTS Table 2.12 shows the distribution of children under five by selected background characteris- tics. As expected, there are an equal number of boys and girls under five listed in the Household Questionnaire. They have a similar distribution by place of residence as the general population, i.e., 97 percent live in the Mainland and 3 percent live in Zanzibar. However, children under five are somewhat less urbanised than the general population, with less than 20 percent living in urban areas, compared with about 22 percent of the general population. 20 * Characteristics of Households Table 2.10 Household durable goods Percentage of households possessing various durable consumer goods, by urban-rural residence, Tanzania 1999 ___________________________________________________ Residence Durable _______________ good Urban Rural Total ___________________________________________________ Radio Television Refrigerator Bicycle Motorcycle Private car or truck None of the above Number of households 66.9 34.7 43.2 8.5 0.2 2.4 7.1 0.2 2.0 27.3 34.1 32.3 1.5 0.5 0.7 3.6 0.2 1.1 26.9 49.5 43.6 946 2,669 3,615 Table 2.11 Iodised salt Percent distribution of households by whether salt was tested for iodine and, among those tested, percent distribution by iodine content, according to selected background characteristics, Tanzania 1999 ____________________________________________________________________________________________________ Among households tested, Salt testing in households percentage with iodine level: ___________________________ ___________________________ Percentage Background Percentage not 0 ppm 50 ppm Number of characteristic tested tested Total (no iodine) 25 ppm or more Total households ____________________________________________________________________________________________________ Residence Urban Rural Mainland/Zanzibar Mainland Urban Rural Zanzibar Pemba Unguja Total 95.3 4.7 100.0 13.9 8.3 77.8 100.0 946 97.0 3.0 100.0 40.0 14.7 45.3 100.0 2,669 96.7 3.3 100.0 32.4 13.2 54.4 100.0 3,526 95.4 4.6 100.0 12.6 8.3 79.0 100.0 920 97.2 2.8 100.0 39.3 14.9 45.8 100.0 2,605 92.2 7.8 100.0 66.5 6.9 26.6 100.0 89 94.3 5.7 100.0 90.9 1.6 7.5 100.0 38 90.7 9.3 100.0 48.0 11.0 41.0 100.0 52 96.6 3.4 100.0 33.2 13.0 53.7 100.0 3,615 _____________________________________________________________________________________________________ ppm = parts per million Table 2.13 shows the distribution of female and male respondents by selected background characteristics. To assess their age, respondents were asked two questions in the individual interview: "In what month and year were you born?" and "How old were you at your last birthday?" Interviewers were trained to probe in situations in which respondents did not know their age or date of birth, and they were instructed to record their best estimate of the respondent’s age as a last resort. Results show the same steep drop-off with age seen in the general population, which is indicative of a high fertility population. As with children under five, the vast majority of women and men live in the Mainland (98 percent), while only 3 percent live in Zanzibar. Twenty-eight percent of women and 27 percent of men live in urban areas. Data on marital status at the time of the survey show that 23 percent of women age 15-49 and 36 percent of men age 15-59 have never married; 66 percent of women and 58 percent of men were currently in unions; and 11 percent of women and 5 percent of men were divorced, separated, or widowed. Characteristics of Households * 21 Table 2.12 Background characteristics of children under five Percent distribution of de facto children under age five by selected background characteristics, Tanzania 1999 ____________________________________________________ Number of children __________________ Background Weighted Un- characteristic percent Weighted weighted _____________________________________________________ Child’s age < 6 months 6-11 months 12-23 months 24-35 months 36-47 months 48-59 months Sex Male Female Residence Urban Rural Mainland/Zanzibar Mainland Urban Rural Zanzibar Pemba Unguja Mother’s education No education Primary incomplete Primary complete Secondary+ Missing Total 11.3 338 339 10.6 318 302 20.0 597 575 19.9 594 584 18.7 559 579 19.5 584 554 50.4 1,506 1,473 49.6 1,484 1,460 17.9 535 750 82.1 2,455 2,183 97.3 2,910 2,183 17.1 513 508 80.2 2,397 1,675 2.7 80 750 1.3 40 339 1.4 41 411 25.5 762 723 14.8 442 456 45.8 1,368 1,126 3.4 101 302 10.6 316 326 100.0 2,990 2,933 The proportion of women who have never attended school is almost twice that of men (27 versus 14 percent). Just under half of women and just over half of men have completed primary education only, while 5 percent of women and 7 percent of men have gone beyond primary education. One-third of women and men are Muslim, an almost equal proportion are Catholic, one-fourth are Protestants, and 13 percent adhere to traditional religions or have no religion. 2.9 EDUCATIONAL LEVEL OF SURVEY RESPONDENTS Tables 2.14.1 and 2.14.2 present the distribution of women and men by level of education, according to selected characteristics. As mentioned earlier, men are generally better educated than women. While 27 percent of women age 15-49 have had no formal education, only 14 percent of men age 15-59 have had no schooling. The proportion of respondents who have had some secondary education is higher among men than among women. Education is inversely related to age; older women and men are generally less educated than younger women and men. The percentage of women with no education rises with age, from 20 percent or less among women in their 20s and early 30s to 67 percent among women in the age group 45-49. This differential in education means that younger women and men have had better educational opportunities than older people. The correlation is also reflected in the higher percentage of women in the age group 20-24 who completed primary education (67 percent), compared with women age 45-49 (9 percent). Urban women and men are much more likely than rural women and men to go to school. Thirty-three percent of rural women have no education, compared with only 13 percent of urban women. Conversely, 69 percent of urban women have completed primary education and 13 percent have been to secondary school, while 45 percent of rural women completed primary education and only 2 percent have been to secondary school. Similar patterns exist for the men. At least in part as a result of the difference in the secondary education system between the Mainland and Zanzibar, a higher proportion of women with some secondary education is observed in Zanzibar (34 percent), compared with the Mainland (5 percent). The proportion of men with some secondary education is also higher in Zanzibar (34 percent) than in the Mainland (7 percent). 22 * Characteristics of Households Table 2.13 Background characteristics of respondents Percent distribution of women and men by selected background characteristics, Tanzania 1999 _________________________________________________________________________________ Women Men ____________________________ __________________________ Number of women Number of men _________________________________ Background Weighted Un- Weighted Un- characteristic percent Weighted weighted percent Weighted weighted __________________________________________________________________________________ Age 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 Residence Urban Rural Mainland/Zanzibar Mainland Urban Rural Zanzibar Pemba Unguja Marital status Never married Married Living together Widowed Divorced Not living together Education No education Primary incomplete Primary complete Secondary+ Religion Muslim Catholic Protestant Traditional or no religion Other Total 22.6 909 933 22.3 790 803 20.1 811 773 15.2 540 550 18.6 749 751 15.4 546 530 12.2 490 491 10.5 371 367 11.3 456 491 12.6 445 451 7.4 299 301 6.2 219 250 7.8 315 289 7.3 259 249 NA NA NA 5.7 201 185 NA NA NA 4.8 171 157 27.9 1,122 1,418 26.6 941 1,250 72.1 2,907 2,611 73.4 2,601 2,292 97.5 3,929 3,060 97.5 3,452 2,673 27.0 1,088 1,036 25.7 909 898 70.5 2,841 2,024 71.8 2,543 1,775 2.5 100 969 2.5 90 869 1.1 44 396 1.0 36 316 1.4 56 573 1.5 55 553 23.4 943 977 36.4 1,289 1,344 58.5 2,357 2,369 54.6 1,936 1,874 7.3 295 239 3.6 128 124 3.2 128 126 0.8 29 29 3.5 140 185 1.8 64 71 4.1 165 133 2.7 97 100 27.1 1,093 1,026 14.0 495 479 21.2 854 821 28.2 1,000 966 46.3 1,866 1,640 50.6 1,791 1,566 5.3 215 542 7.2 256 531 32.6 1,315 1,940 32.6 1,153 1,710 30.0 1,208 974 31.1 1,103 892 24.2 975 759 22.1 784 578 12.9 520 344 13.4 475 336 0.3 11 12 0.7 27 26 100.0 4,029 4,029 100.0 3,542 3,542 ___________________________________________________________________________________ NA = Not applicable Characteristics of Households * 23 Table 2.14.1 Level of education: women Percent distribution of women by the highest level of education attended, according to selected background characteristics, Tanzania 1999 _________________________________________________________________________________ Level of education: women ______________________________________________ Number Background No edu- Primary Primary Secon- of characteristic cation incomplete complete dary+ Total women __________________________________________________________________________________ Age 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Residence Urban Rural Mainland/Zanzibar Mainland Urban Rural Zanzibar Pemba Unguja Total 20.8 35.0 39.1 5.1 100.0 909 17.3 15.8 60.7 6.3 100.0 811 16.1 14.5 62.3 7.1 100.0 749 20.0 16.9 56.9 6.3 100.0 490 38.9 18.8 39.1 3.2 100.0 456 53.1 18.3 24.3 4.3 100.0 299 66.5 24.5 7.1 1.9 100.0 315 13.2 17.4 56.1 13.3 100.0 1,122 32.5 22.7 42.5 2.3 100.0 2,907 27.1 21.2 47.1 4.6 100.0 3,929 13.2 17.4 57.3 12.0 100.0 1,088 32.4 22.7 43.1 1.8 100.0 2,841 28.4 20.3 17.5 33.8 100.0 100 39.3 23.3 14.3 23.2 100.0 44 19.8 18.0 20.1 42.1 100.0 56 27.1 21.2 46.3 5.3 100.0 4,029 Table 2.14.2 Level of education: men Percent distribution of men by the highest level of education attended, according to selected background characteristics, Tanzania 1999 _________________________________________________________________________________ Level of education: men ______________________________________________ Number Background No edu- Primary Primary Secon- of characteristic cation incomplete complete dary+ Total men __________________________________________________________________________________ Age 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 Residence Urban Rural Mainland/Zanzibar Mainland Urban Rural Zanzibar Pemba Unguja Total 11.6 42.8 41.1 4.5 100.0 790 11.0 19.1 62.6 7.4 100.0 540 8.7 16.1 65.5 9.7 100.0 546 9.6 14.8 66.6 8.9 100.0 371 10.4 16.0 63.1 10.5 100.0 445 16.8 28.8 43.0 11.5 100.0 219 26.7 35.4 34.1 3.8 100.0 259 27.0 46.6 21.4 4.9 100.0 201 32.3 56.5 9.8 1.4 100.0 171 7.0 21.8 54.1 17.0 100.0 941 16.5 30.5 49.3 3.7 100.0 2,601 13.9 28.2 51.4 6.5 100.0 3,452 7.0 21.9 55.2 15.9 100.0 909 16.4 30.5 50.0 3.2 100.0 2,543 17.6 28.6 19.6 34.2 100.0 90 26.2 29.6 13.5 30.6 100.0 36 11.9 28.0 23.6 36.5 100.0 55 14.0 28.2 50.6 7.2 100.0 3,542 24 * Characteristics of Households Table 2.15 Literacy Percent distribution of women and men by literacy level, according to selected background characteristics, Tanzania 1999 ________________________________________________________________________________________________________ Women Men _______________________________________ ________________________________________ Can Can Can Can read read read read Cannot part of whole Number Cannot part of whole Number Background read sen- sen- of read sen- sen- of characteristic at all tence tence Refused Total women at all tence tence Refused Total men ________________________________________________________________________________________________________ Age 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 Residence Urban Rural Mainland/Zanzibar Mainland Urban Rural Zanzibar Pemba Unguja Education No education Primary incomplete Primary complete Secondary+ Total 31.1 6.5 62.2 0.1 100.0 909 25.2 10.8 63.6 0.4 100.0 790 27.3 5.0 67.6 0.1 100.0 811 20.7 5.4 72.2 1.7 100.0 540 25.9 7.5 66.6 0.0 100.0 749 21.2 5.4 73.3 0.0 100.0 546 29.8 7.0 63.1 0.1 100.0 490 16.9 4.4 78.5 0.2 100.0 371 46.9 7.7 45.3 0.1 100.0 456 16.4 4.3 79.4 0.0 100.0 445 56.3 8.8 33.3 1.6 100.0 299 18.9 5.5 75.5 0.0 100.0 219 69.4 7.0 23.2 0.4 100.0 315 27.0 6.8 66.1 0.0 100.0 259 NA NA NA NA NA NA 26.1 8.2 64.6 1.1 100.0 201 NA NA NA NA NA NA 32.7 11.3 55.9 0.1 100.0 171 19.3 5.0 75.3 0.5 100.0 1,122 11.1 3.4 84.3 1.2 100.0 941 42.3 7.5 50.1 0.1 100.0 2,907 26.0 8.2 65.6 0.2 100.0 2,601 36.0 6.8 57.0 0.2 100.0 3,929 22.2 6.8 70.6 0.4 100.0 3,452 19.4 5.0 75.1 0.4 100.0 1,088 11.1 3.3 84.4 1.2 100.0 909 42.3 7.5 50.1 0.1 100.0 2,841 26.1 8.1 65.6 0.1 100.0 2,543 30.9 7.1 60.7 1.3 100.0 100 18.8 10.4 69.2 1.7 100.0 90 42.6 9.2 46.9 1.3 100.0 44 23.8 13.5 61.3 1.4 100.0 36 21.8 5.5 71.4 1.3 100.0 56 15.5 8.4 74.2 1.9 100.0 55 95.9 1.3 2.7 0.0 100.0 1,093 86.1 4.1 9.7 0.1 100.0 495 31.1 15.5 52.6 0.8 100.0 854 24.4 14.1 60.6 0.9 100.0 1,000 7.0 6.8 86.1 0.1 100.0 1,866 6.2 4.7 88.8 0.3 100.0 1,791 0.0 0.0 100.0 0.0 100.0 215 0.0 0.0 100.0 0.0 100.0 256 35.9 6.8 57.1 0.2 100.0 4,029 22.1 6.9 70.6 0.4 100.0 3,542 ________________________________________________________________________________________________________ Note: Respondents who reached secondary school were not tested but were assumed to be able to read the whole sentence. NA = Not applicable The level of literacy is often viewed as an indicator of the basic level of socioeconomic development of a country. In the TRCHS, women age 15-49 and men age 15-59 who were interviewed individually were asked to read a simple sentence in Swahili. Interviewers then coded their reading ability on the questionnaire. This small literacy test marks a departure from previous surveys in which respondents were asked whether they could read. Table 2.15 shows the percent distribution of both women and men by level of literacy according to background characteristics. Illiteracy is high among women, compared with men. Thirty-six percent of all women respondents are illiterate, compared with only 22 percent of men. Seven percent of all women could read only part of the sentence and 57 percent of all women could read the whole sentence. Among men, 7 percent could read part of the sentence and 71 percent could read the whole sentence. As expected, illiteracy rates are higher in rural than in urban areas and among the less educated population. For both sexes, illiteracy is slightly higher in the Mainland than in Zanzibar. Characteristics of Households * 25 Table 2.16 Access to mass media Percentage of women and men who usually read a newspaper once a week, watch television once a week, or listen to the radio weekly, by selected background characteristics, Tanzania 1999 _______________________________________________________________________________________________________ Women Men ________________________________________________________________________________ Read Watch Read Watch No news- tele- Listen to All Number No news- tele- Listen to All Number Background mass paper vision radio three of mass paper vision radio three of characteristic media weekly weekly weekly media women media weekly weekly weekly media men _______________________________________________________________________________________________________ Age 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 Residence Urban Rural Mainland/Zanzibar Mainland Urban Rural Zanzibar Pemba Unguja Education No education Primary incomplete Primary complete Secondary+ Total 72.4 4.1 4.1 23.4 0.3 909 58.4 7.3 9.2 36.4 2.0 790 67.4 5.8 5.6 30.3 2.0 811 44.0 14.4 14.4 50.6 4.5 540 66.4 8.1 4.7 29.9 1.6 749 45.2 19.5 7.4 50.4 3.3 546 69.7 4.2 4.0 27.1 0.2 490 46.1 16.9 8.3 48.5 4.8 371 68.3 5.1 3.3 30.8 0.8 456 43.9 17.0 9.0 51.7 6.3 445 71.1 4.2 4.1 26.7 1.6 299 48.6 17.2 15.8 47.6 9.5 219 75.0 2.5 2.2 23.3 0.7 315 56.5 11.2 7.5 39.2 3.0 259 NA NA NA NA NA NA 55.7 12.0 9.1 41.8 5.2 201 NA NA NA NA NA NA 58.9 5.2 1.8 39.1 0.4 171 47.2 14.2 12.4 45.1 3.1 1,122 29.3 34.3 24.9 60.1 13.0 941 78.2 1.7 1.1 20.7 0.3 2,907 57.7 6.1 3.9 39.8 0.8 2,601 70.3 5.2 3.8 26.9 1.0 3,929 50.8 13.5 8.8 44.8 4.0 3,452 47.9 14.2 11.3 44.7 3.0 1,088 29.7 34.4 23.9 60.0 12.9 909 78.9 1.7 0.9 20.1 0.3 2,841 58.4 6.0 3.4 39.4 0.7 2,543 41.0 6.8 24.4 51.0 3.4 100 25.9 16.5 35.6 61.9 8.1 90 52.6 4.1 12.7 43.2 2.0 44 29.3 11.6 21.2 64.3 4.5 36 32.0 8.9 33.5 57.0 4.4 56 23.8 19.7 45.1 60.3 10.4 55 84.7 0.0 0.8 14.8 0.0 1,093 72.3 2.1 3.7 26.9 0.9 495 74.1 2.7 1.9 22.7 0.1 854 57.1 6.4 8.1 39.3 2.2 1,000 63.6 6.9 4.5 33.3 1.2 1,866 46.0 16.0 9.1 48.2 3.8 1,791 27.1 26.9 29.3 60.7 9.0 215 9.7 46.8 29.4 83.1 18.9 256 69.6 5.2 4.3 27.5 1.1 4,029 50.2 13.6 9.5 45.2 4.1 3,542 _______________________________________________________________________________________________________ NA = Not applicable 2.10 ACCESS TO MEDIA Female and male respondents were asked in the survey if they usually read a newspaper, listen to the radio, or watch television at least once a week. This information is of use in planning the dissemination of family planning and health messages. Table 2.16 shows the percentage of female and male respondents exposed to different types of mass media by age, residence, and level of education. Results show that 5 percent of women and 14 percent of men read a newspaper or magazine weekly, while 28 percent of women and 45 percent of men listen to the radio at least once a week. Only 4 percent of women and 10 percent of men watch television at least once a week. The vast majority of respondents do not use any of these media (70 percent of women and 50 percent of men). 26 * Characteristics of Households Access to mass media is somewhat higher among younger respondents and among those living in urban rather than rural areas. It is also higher among residents of Zanzibar than among residents of the Mainland. As expected, educated persons are more likely to read newspapers or magazines, watch television, and listen to the radio than less-educated persons. Overall, data indicate that of the three media, radio is by far the most widespread compared with the other two. It is interesting to note that access to mass media appears to have fallen considerably over recent years. For example, the proportion of women who read newspapers weekly increased from 25 percent in 1991-92 to 31 percent in 1994, then declined to 13 percent in 1996 and further to 5 percent in 1999. A similar pattern exists for television viewing and radio listening habits. While some of the trend may be real, most is probably due to changes in the wording of the questions in the 1996 survey and again in the 1999 survey. For example, while the two earlier surveys asked if the respondent usually reads a newspaper at least once a week, the 1996 TDHS asked an open- ended question (“How often do you read a newspaper?”) with a set of six possible codes from which the interviewer was to choose the closest to the respondent’s answer. In the 1999 TRCHS, the question was: “Do you read a newspaper or magazine almost every day, at least once a week, less than once a week or not at all?” While the simpler yes-no question that was used in the first two surveys might have lead the respondent to answer affirmatively, it is not apparent why the wordings of the questions used in the 1996 and 1999 surveys would have lead to an apparent decline in coverage. 2.11 EMPLOYMENT AND OCCUPATION In the 1999 TRCHS, information was collected about current employment, earnings, and occupation for women age 15-49 and men age 15-59. Although data were collected from female and male respondents, the analysis in this section concentrates on women. Women were asked several questions designed to elicit whether or not they were working. First, they were asked if they were doing any work other than their own housework. If the answer was negative, they were asked a more probing question, suggesting that some women may sell things, have a small business or work on the family farm or business. Data in Table 2.17 indicate that 24 percent of women report being unemployed. The proportion not working is higher among younger women and those residing in urban areas. The proportion of women not working is also higher in Zanzibar and surprisingly, among the better educated. Most women who work do so on a seasonal basis; just under one-half of all women work part of the year, while one-quarter work throughout the year. The proportion of women who are not currently working seems to have declined over time, from 46 percent in 1996 to 24 percent in 1999; however, the questions asked differed in the two surveys. Therefore, much of the decline is probably spurious. Women who reported themselves as employed at the time of the survey were asked whether they worked for a member of their family, worked for someone else, or were self-employed. They were also asked if they earned cash for their work (Table 2.18). Thirty-seven percent of working women are self-employed, while 9 percent work for others and 54 percent work in a family business. Most working women (73 percent) earn cash for their work. Rural working women are more likely to work in a family business, while urban women are more likely to work for others or for themselves. Urban women who work are also more likely than rural women to receive cash earnings (88 vs. 68 percent). Women in Zanzibar who work are more likely to be self-employed or to work for an employer and less likely to work in family businesses than women in the Mainland. Characteristics of Households * 27 Table 2.17 Employment Percentage of women in various employment categories, according to selected background characteristics, Tanzania 1999 _____________________________________________________________________________________ Not currently employed Currently employed ________________ _____________________ No work Worked Number Background for last 12 last 12 All Season- Occa- of characteristic months months year ally sionally Missing Total women ____________________________________________________________________________________ Age 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Residence Urban Rural Mainland/Zanzibar Mainland Urban Rural Zanzibar Pemba Unguja Education No education Primary incomplete Primary complete Secondary+ Total 38.6 5.1 15.6 37.4 3.3 0.0 100.0 909 18.1 6.6 24.0 46.0 5.2 0.2 100.0 811 16.6 5.2 26.3 46.1 5.7 0.1 100.0 749 11.7 5.0 27.5 54.1 1.7 0.0 100.0 490 11.7 3.1 29.9 52.9 1.5 0.9 100.0 456 6.9 2.0 34.2 55.5 1.5 0.0 100.0 299 11.1 4.0 26.0 55.2 3.3 0.3 100.0 315 26.9 6.9 34.6 26.4 5.2 0.0 100.0 1,122 16.8 4.0 20.7 55.3 3.0 0.3 100.0 2,907 19.3 4.8 24.6 47.6 3.5 0.2 100.0 3,929 26.7 6.9 34.5 26.5 5.3 0.0 100.0 1,088 16.5 4.0 20.7 55.7 2.9 0.2 100.0 2,841 30.4 7.3 23.1 32.7 6.0 0.4 100.0 100 29.9 6.8 9.6 46.4 7.2 0.2 100.0 44 30.9 7.7 33.7 22.0 5.1 0.6 100.0 56 16.3 3.7 19.3 58.2 2.2 0.3 100.0 1,093 28.7 4.7 22.1 39.6 4.9 0.0 100.0 854 15.7 5.6 26.8 47.8 3.8 0.2 100.0 1,866 33.5 5.0 41.1 16.7 3.7 0.0 100.0 215 19.6 4.8 24.5 47.2 3.6 0.2 100.0 4,029 Table 2.19.1 indicates the type of occupation in which working women are engaged. Seventy- two percent of employed women are involved in agricultural activities, mostly working on their own or family-owned land. Twenty percent of working women are involved in unskilled manual jobs. Only 2 percent of women are doing professional, managerial, or technical jobs. Table 2.19.2 presents similar data for men. It shows that only 11 percent of men are not currently employed. Sixty-two percent of all men 15-59 work in agriculture, mostly on their own or family land. Four percent have professional, technical, or managerial jobs, while 21 percent work as manual laborers. Among both women and men, agricultural jobs are more common in rural than in urban areas. Educated women and men are more likely to be employed in professional and technical occupations. 28 * Characteristics of Households Table 2.18 Employer and form of earnings Percent distribution of employed women by employer and form of earnings, according to background characteristics, Tanzania 1999 ___________________________________________________________________________________________ Employed by Employed by Self-employed a nonrelative a relative _______________ _______________ ______________ Does Does Does Number Background Earns not earn Earns not earn Earns not earn of characteristic cash cash cash cash cash cash Missing Total women ____________________________________________________________________________________________ Age 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Residence Urban Rural Mainland/Zanzibar Mainland Urban Rural Zanzibar Pemba Unguja Education No education Primary incomplete Primary complete Secondary+ Total 20.8 2.0 9.2 0.2 33.5 34.1 0.2 100.0 511 36.3 4.3 10.1 0.2 30.1 18.8 0.2 100.0 611 36.8 6.8 7.5 0.0 32.5 16.3 0.0 100.0 586 32.5 6.2 4.8 0.0 33.3 23.2 0.0 100.0 408 28.3 7.5 10.3 0.0 34.9 18.3 0.7 100.0 388 30.2 4.4 10.9 0.0 32.3 22.1 0.0 100.0 273 35.3 7.6 4.7 0.0 33.3 19.1 0.0 100.0 266 47.2 3.0 28.0 0.0 12.8 9.0 0.0 100.0 743 26.6 6.1 2.0 0.1 39.1 25.8 0.2 100.0 2,300 31.3 5.0 8.3 0.1 33.2 22.0 0.2 100.0 2,981 46.7 2.9 28.1 0.0 13.1 9.2 0.0 100.0 722 26.4 5.7 1.9 0.1 39.7 26.1 0.2 100.0 2,260 49.7 22.4 13.9 0.3 5.0 8.7 0.0 100.0 62 35.4 33.7 10.2 0.0 5.9 14.7 0.0 100.0 28 61.2 13.3 16.9 0.5 4.3 3.8 0.0 100.0 34 23.8 7.2 3.2 0.1 38.6 26.9 0.2 100.0 874 32.8 5.1 5.9 0.0 33.8 22.4 0.0 100.0 569 35.3 4.6 9.6 0.1 30.1 20.0 0.2 100.0 1,468 37.7 2.7 39.4 0.1 16.3 3.8 0.0 100.0 132 31.6 5.3 8.4 0.1 32.7 21.7 0.2 100.0 3,043 Characteristics of Households * 29 Table 2.19.1 Occupation: women Percent distribution of employed women by current occupation and type of agricultural land worked or type of nonagricultural employment, according to selected background characteristics, Tanzania 1999 _______________________________________________________________________________________________________ Agricultural Nonagricultural ____________________________ ______________________________________ Pro- Number Background Own Family Rented Other’s fessional/ Sales/ Skilled Unskilled of characteristic land land land land technical service manual manual Other Total women _______________________________________________________________________________________________________ Age 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Residence Urban Rural Mainland/Zanzibar Mainland Urban Rural Zanzibar Pemba Unguja Education No education Primary incomplete Primary complete Secondary+ Total 12.2 64.1 0.1 0.7 0.2 2.2 1.4 17.1 2.0 100.0 511 23.3 39.9 1.5 1.2 1.2 4.1 1.0 22.8 5.1 100.0 611 25.8 39.4 0.0 0.3 2.9 1.7 1.1 26.4 2.4 100.0 586 28.7 41.8 0.2 0.7 2.5 1.4 1.9 19.9 2.8 100.0 408 27.8 38.7 0.8 1.6 2.7 3.5 1.1 22.2 1.6 100.0 388 33.4 42.2 0.3 1.2 6.9 0.3 0.6 15.1 0.1 100.0 273 39.8 41.4 2.6 0.5 2.5 0.8 0.4 10.4 1.6 100.0 266 9.6 14.2 1.0 0.5 7.0 6.6 2.4 50.6 8.1 100.0 743 30.7 54.0 0.6 1.0 0.8 0.8 0.7 10.5 0.8 100.0 2,300 25.5 45.1 0.7 0.7 2.2 2.3 0.9 20.0 2.6 100.0 2,981 9.8 14.6 1.1 0.4 6.7 6.7 2.1 50.4 8.3 100.0 722 30.6 54.8 0.6 0.8 0.8 0.8 0.5 10.3 0.8 100.0 2,260 28.2 6.7 0.3 7.2 7.4 1.8 14.0 32.6 1.8 100.0 62 42.2 10.2 0.6 12.4 4.9 0.3 10.3 18.7 0.3 100.0 28 16.9 3.9 0.0 3.0 9.3 3.0 17.0 43.7 3.1 100.0 34 29.4 56.1 0.4 1.3 0.5 0.5 0.4 10.8 0.6 100.0 874 24.6 49.5 1.6 0.8 0.4 0.6 0.7 17.2 4.5 100.0 569 25.6 38.2 0.6 0.6 2.0 3.2 1.2 25.6 3.0 100.0 1,468 4.5 11.3 0.1 1.1 27.0 10.3 6.9 37.2 1.7 100.0 132 25.6 44.3 0.7 0.9 2.3 2.2 1.1 20.3 2.6 100.0 3,043 30 * Characteristics of Households Table 2.19.2 Occupation: men Percent distribution of men by current occupation and type of nonagricultural employment, according to selected background characteristics, Tanzania 1999 _______________________________________________________________________________________________________ Not Agricultural Nonagricultural curr- ________________________ _________________________________ ently Pro- Number Background em- Own Family Rented Other’s fessional/ Sales/ Skilled Unskilled of characteristic ployed land land land land technical service manual manual Other Total men _______________________________________________________________________________________________________ Age 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 Residence Urban Rural Mainland/Zanzibar Mainland Urban Rural Zanzibar Pemba Unguja Education No education Primary incomplete Primary complete Secondary+ Total 31.7 12.5 31.3 0.5 3.8 0.9 2.7 2.2 13.8 0.6 100.0 790 9.3 23.4 28.1 2.5 5.1 1.0 3.5 7.6 18.9 0.5 100.0 540 3.5 29.1 26.7 3.0 4.9 2.5 3.1 9.1 17.9 0.1 100.0 546 3.0 32.3 22.7 6.6 4.1 4.5 2.9 8.3 14.8 0.9 100.0 371 2.1 23.1 32.0 3.2 4.4 8.0 1.9 7.8 17.3 0.3 100.0 445 5.2 33.0 25.7 2.4 6.4 10.4 1.0 5.5 9.9 0.4 100.0 219 3.8 45.1 24.4 1.0 3.8 6.6 0.7 7.2 7.2 0.0 100.0 259 2.8 29.5 33.8 0.8 4.4 10.6 0.2 6.3 11.4 0.1 100.0 201 6.1 51.0 26.4 2.8 2.3 0.3 5.1 1.7 4.2 0.1 100.0 171 13.9 7.9 8.7 2.5 2.9 9.3 6.5 15.3 31.8 1.1 100.0 941 9.5 33.4 35.5 2.5 4.9 2.0 1.1 2.9 8.1 0.1 100.0 2,601 10.6 26.8 29.0 2.5 4.1 3.8 2.5 6.1 14.2 0.4 100.0 3,452 14.0 8.1 9.0 2.6 2.9 8.9 6.5 15.3 31.7 1.1 100.0 909 9.4 33.6 36.1 2.5 4.6 2.0 1.0 2.8 7.9 0.1 100.0 2,543 12.3 17.2 4.8 0.7 14.2 10.3 5.3 9.0 24.7 1.5 100.0 90 13.7 24.0 6.0 1.3 15.6 9.4 3.7 7.8 17.3 1.3 100.0 36 11.4 12.7 4.0 0.4 13.3 11.0 6.3 9.8 29.5 1.7 100.0 55 6.1 34.3 38.1 2.5 5.7 0.5 1.6 1.9 9.3 0.1 100.0 495 17.9 27.5 28.7 2.2 4.0 0.6 2.1 4.4 12.0 0.7 100.0 1,000 6.6 27.1 28.2 2.6 4.3 3.7 2.8 7.6 16.6 0.3 100.0 1,791 19.7 4.2 8.9 2.5 3.8 25.9 3.9 12.1 18.4 0.6 100.0 256 10.7 26.6 28.3 2.5 4.4 4.0 2.5 6.2 14.4 0.4 100.0 3,542 Fertility * 31 Table 3.1 Current fertility Age-specific and cumulative fertility rates and the crude birth rate for the five years preceding the survey, by urban-rural residence, Tanzania 1999____________________________________________________ Residence______________ Age group Urban Rural Total____________________________________________________ 15-19 20-24 25-29 30-34 35-39 40-44 45-49 TFR women 15-49 TFR women 15-44 General fertility rate Crude birth rate 95 154 138 199 301 268 170 269 240 93 262 213 58 165 138 17 96 78 0 49 37 3.16 6.48 5.55 3.16 6.24 5.37 128 223 195 34.4 43.5 41.4 ____________________________________________________ Note: Rates are for the period 1-59 months preceding the survey. Rates for age group 45-49 may be slightly biased due to truncation. Total fertility rate expressed per woman. General fertility rate (births divided by number of women 15-49), expressed per 1,000 women. Crude birth rate expressed per 1,000 population. FERTILITY 3 The fertility measures presented in this chapter are based on the reported birth histories of women age 15-49 who were interviewed in the 1999 Tanzania Reproductive and Child Health Survey (TRCHS). Estimates of fertility are based on carefully gathered survey data. Each woman was first asked about the number of sons and daughters who were living with her, were living elsewhere, or had died. Each woman was also 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 those questions was used to calculate measures of current and completed fertility, i.e., the number of children ever born. 3.1 CURRENT FERTILITY Table 3.1 presents age-specific fertility rates and other summary indica- tors calculated from survey data such as the total fertility rate, the general fertility rate, and the crude birth rate. The age- specific fertility rate is defined as the number of live births during a specified period to women in a particular age group divided by the number of woman- years lived in that age group during the specified period. It is a valuable measure of the current childbearing performance of women. The total fertility rate (TFR) is the number of children a woman would have from age 15 to age 49 if she were to bear children at the prevailing age-spe- cific rates (or the average number of children a woman would have if she experienced a given set of age-specific fertility rates through her lifetime). It is obtained by summing the age-specific fertility rates and multiplying by five. It is a useful summary measure of age-specific fertility rates. The general fertility rate is the number of live births occurring during a specified period per 1,000 women of reproductive age (in this case,15-49). Finally, the crude birth rate is the number of births per 1,000 population. Measures of current fertility are estimated for the three-year period preceding the survey, which corresponds roughly to 1997-1999. The choice of the reference period is a compromise between providing the most recent information, avoiding problems of omission or displacement of births due to recall lapse for older women, and obtaining enough cases to reduce the sampling errors. 32 * Fertility The TFR in Tanzania is 5.6 births per woman. The TFR in rural areas is 6.5, compared with 3.2 in urban areas. In other words, rural women will have on average three more children than their urban counterparts. The crude birth rate in Tanzania is 41 births per 1,000 population. As with the TFR, there is a clear differential in this rate by residence: 44 in rural areas and 34 in urban areas. The general fertility rate in Tanzania is 195 per 1,000 women, with the rate being much higher in rural areas (223) than in urban areas (128). The age-specific fertility rates calculated on the basis of the three years preceding the survey indicate that Tanzanian women have a broad-peaked fertility pattern (age-specific fertility rates in age groups 20-24 and 25-29 differ only slightly), as shown in Figure 3.1. However, fertility declines sharply after the mid-30s, with the age-specific fertility rates being only 37 births per 1,000 women at age group 45-49. 3.2 FERTILITY DIFFERENTIALS Table 3.2 and Figure 3.2 present fertility differentials according to urban-rural residence, for Mainland/Zanzibar, and by level of education. The large urban-rural differentials in fertility measures have already been noted. Looking at differences between the Mainland and Zanzibar, the results show almost identical total fertility rates of 5.6 each. However, the data indicate large differences in fertility rates by level of education. Women who completed primary school have a total fertility rate of 4.9 children per woman, which is lower than the rates for women with incomplete primary education (5.1) and women with no education (6.5). Fertility * 33 Table 3.2 Fertility by background characteristics Total fertility rate for the three years preceding the survey, percentage currently pregnant, and mean number of children ever born to women age 40-49, by selected background characteristics, Tanzania 1999___________________________________________________ Mean number of children Total Percentage ever born Background fertility currently to women characteristic rate1 pregnant age 40-49___________________________________________________ Residence Urban Rural Mainland/Zanzibar Mainland Urban Rural Zanzibar Education No education Incomplete primary Complete primary+ Total 3.16 5.8 5.33 6.48 10.8 7.11 5.55 9.4 6.67 3.12 5.7 5.30 6.48 10.8 7.10 5.59 9.4 7.32 6.53 8.4 7.04 5.13 9.1 6.91 4.85 10.0 5.29 5.55 9.4 6.69 ___________________________________________________ 1 Women age 15-49 years Table 3.2 also shows the mean number of live births for women age 40- 49. This figure is an indicator of com- pleted fertility or cumulative fertility for women who are approaching the end of their childbearing years. A comparison of the total fertility rate (5.6) and the cumu- lative fertility rate (6.7) gives an indica- tion of fertility trends over time. For all women, the mean number of live births has been decreasing in Tanzania, and this pattern is true for all groups. Nine percent of interviewed women reported that they were pregnant at the time of interview. Variations in this proportion are minimal except that urban women are far less likely than rural women to be pregnant. 3.3 FERTILITY TRENDS Fertility trends can be analysed in two ways. One is to compare the 1999 TRCHS data with previous data, namely the 1988 population census and the 1991-92 and 1996 TDHS surveys. 34 * Fertility Table 3.3 Trends in fertility Age-specific fertility rates (per 1,000 women) and total fertility rates for 1988 Census and selected surveys, Tanzania 1988-1999 _____________________________________________________________ Census TDHS TDHS TRCHS Age group 1988 1991-92 1996 1999_____________________________________________________________ 15-19 20-24 25-29 30-34 35-39 40-44 45-49 TFR women age 15-49 106 144 135 138 280 282 260 268 310 270 255 240 272 231 217 213 206 177 167 138 105 108 87 78 17 37 42 37 6.5 6.3 5.8 5.6 _____________________________________________________________ Note: Rates refer to the three-year period preceding the survey. Rates for the age group 45-49 may be slightly biased due to truncation. Source: Bureau of Statistics and Macro International, 1997:31 Table 3.4 Age-specific fertility rates Age-specific fertility rates for 5-year periods preceding the survey, Tanzania 1999 ______________________________________________ Number of years preceding the survey Age _________________________________ group 0-4 5-9 10-14 15-19 ______________________________________________ 15-19 20-24 25-29 30-34 35-39 40-44 45-49 137 139 159 167 271 280 272 310 233 270 250 278 210 231 272 [234] 148 191 [168] - 89 [134] - - [32] - - - ______________________________________________ Note: Age-specific fertility rates per 1,000 women. Esti- mates enclosed in brackets are truncated. Table 3.3 reveals that fer- tility has declined gradually but steadily over time, from 6.5 chil- dren per woman in the 1988 cen- sus to 5.6 children per woman in the 1999 TRCHS. For women in the two youngest age groups, the trend is erratic: first rising, then falling, then rising slightly again. However, for women age 25-44, the trend in age-specific rates is generally a steady decline. Rates for the oldest age group are again erratic, which could be due to the small sample size, which is subject to high sampling errors. A second way of analysing fertility trends is using TRCHS data alone. Because women age 50 and above were not interviewed in the survey, the rates are successively truncated as the number of years before the survey increases (see Table 3.4). The data also indicate a gradual decline in fertility in Tanzania during the past 20 years. 3.4 CHILDREN EVER BORN Table 3.5 shows the distribution of all women and currently married women by age and number of children ever born. The table also shows the mean number of children ever born to women in each age group, an indicator of the momentum of childbearing. Data on the number of children ever born reflect the accu- mulation of births over the past 30 years and therefore have limited relevance to current fertility levels, especially if the country has experienced a decline in fertility. The data indicate that one-fifth (20 percent) of all women age 15-19 years have given birth. On average, women have given birth to almost three children by their late 20s, five children by their late 30s, and seven children by the end of their childbearing years. As expected, currently married women have had more births than all women in all age groups. The reason is undoubtedly that currently married women are more consistently exposed to the risk of pregnancy. The percentage of women in their 40s who have never had children provides an indicator of the level of primary infertility—the proportion of women who are unable to bear children at all. Since voluntary childlessness is rare in Tanzania, it is likely that married women with no births are unable to bear children. The TRCHS results suggest that primary infertility is low, less than 2 percent. It should be noted that this estimate of primary infertility does not include women who may have had one or more births but who are unable to have more (secondary infertility). Fertility * 35 Table 3.5 Children ever born and living Percent distribution of all women and of currently married women by number of children ever born and mean number of children ever born (CEB) and mean number of living children, according to five-year age groups, Tanzania 1999 ______________________________________________________________________________________________________ Mean Mean number Number of children ever born Number number of Age __________________________________________________________ of of living group 0 1 2 3 4 5 6 7 8 9 10+ Total women CEB children ______________________________________________________________________________________________________ ALL WOMEN ______________________________________________________________________________________________________ 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Total 80.3 17.2 2.0 0.5 0.0 0.0 0.0 0.0 0.0 0.0 0.0 100.0 909 0.23 0.19 21.6 35.9 27.1 12.4 2.3 0.7 0.0 0.0 0.0 0.0 0.0 100.0 811 1.40 1.18 8.0 15.1 20.9 25.7 18.2 8.2 2.9 0.9 0.0 0.0 0.0 100.0 749 2.72 2.30 5.6 6.6 8.2 13.9 20.5 19.7 15.1 5.9 2.7 1.7 0.0 100.0 490 4.15 3.52 3.3 5.2 9.8 10.5 18.7 10.5 11.8 11.4 10.9 3.6 4.3 100.0 456 4.98 4.04 1.9 4.8 4.8 4.6 8.0 14.1 12.0 11.9 14.1 9.8 13.9 100.0 299 6.40 5.15 0.6 5.7 2.8 5.9 5.8 9.5 13.7 8.6 14.2 15.2 18.0 100.0 315 6.96 5.57 25.2 16.1 12.5 11.0 9.5 7.0 5.7 3.7 3.7 2.5 2.9 100.0 4,029 2.93 2.41 ______________________________________________________________________________________________________ CURRENTLY MARRIED WOMEN ______________________________________________________________________________________________________ 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Total 46.4 44.5 7.3 1.8 0.0 0.0 0.0 0.0 0.0 0.0 0.0 100.0 227 0.64 0.53 10.1 35.6 35.7 14.2 3.5 1.0 0.0 0.0 0.0 0.0 0.0 100.0 550 1.68 1.45 5.7 11.6 20.9 28.3 19.9 9.3 3.3 1.1 0.0 0.0 0.0 100.0 615 2.92 2.48 3.8 5.6 7.5 10.6 21.5 21.2 17.3 7.2 3.2 2.0 0.0 100.0 407 4.43 3.80 2.5 4.2 7.9 10.5 19.6 8.8 12.6 11.5 12.6 4.5 5.4 100.0 364 5.26 4.24 2.0 2.1 2.2 5.0 6.7 15.8 12.6 12.4 14.0 11.9 15.4 100.0 239 6.78 5.43 0.0 6.0 3.5 3.5 6.4 9.9 11.8 8.9 16.1 14.8 19.1 100.0 251 7.10 5.72 8.5 16.1 15.6 13.5 12.5 9.2 7.4 4.9 5.0 3.4 3.9 100.0 2,653 3.77 3.11 3.5 BIRTHS INTERVALS A birth interval is defined as the length of time between two successive live births. Research has shown that short birth intervals adversely affect the health of mothers and their children's chances of survival. Table 3.6 shows the percent distribution of non-first births that occurred in the five years before the TRCHS by the number of months since the previous birth. The data show that most Tanzanian children are born after a “safe” interval of two or more years (83 percent). Fewer than one in five births (17 percent) occurs after an interval of less than 24 months. The median birth interval is 33 months. Birth interval length has not changed since 1991-92 nor since 1996. As expected, younger women have shorter birth intervals than older women, presumably because younger women are more fecund and want to build their families. The median birth interval for women age 15-19 is 25 months, compared with 37 months for women over age 40. A shorter median interval also prevails for children whose preceding sibling has died, compared with those whose preceding sibling is living. The overall median birth interval is about 7 months shorter for children whose preceding sibling died compared with children whose preceding sibling survived. This pattern presumably reflects a shortened breastfeeding period due to the death of the preceding sibling, as well as minimal use of contraceptives. 36 * Fertility Table 3.6 Birth intervals Percent distribution of non-first births in the five years preceding the survey by number of months since previous birth and median length of birth interval, according to selected demographic and socioeconomic characteristics, Tanzania 1999 _____________________________________________________________________________________________________ Median number of months Number of months since previous birth Number since ____________________________________________ of previous Characteristic 7-17 18-23 24-35 36-47 48+ Total births birth ______________________________________________________________________________________________________ Age of mother 15-19 20-29 30-39 40 + Birth order 2-3 4-6 7 + Sex of prior birth Male Female Survival of prior birth Dead Living Residence Urban Rural Mainland/Zanzibar Mainland Urban Rural Zanzibar Pemba Unguja Education No education Incomplete primary Complete primary Secondary+ Total (40.8) (6.9) (43.6) (1.4) (7.3) 100.0 26 24.5 7.1 13.4 45.3 19.8 14.5 100.0 1,287 31.2 2.8 8.8 36.3 25.1 27.1 100.0 931 36.4 1.7 11.4 34.8 22.3 29.8 100.0 267 37.3 8.0 12.4 38.5 22.0 19.1 100.0 1,099 32.6 3.2 10.7 43.2 19.7 23.2 100.0 933 33.3 3.1 10.5 41.3 25.4 19.6 100.0 480 34.4 5.7 11.4 39.7 22.2 21.1 100.0 1,314 33.6 4.8 11.5 42.0 21.4 20.2 100.0 1,198 33.0 19.0 17.7 31.8 13.6 18.0 100.0 404 27.3 2.7 10.2 42.5 23.4 21.2 100.0 2,108 34.1 4.3 6.3 23.9 22.6 42.9 100.0 387 43.2 5.5 12.3 43.9 21.7 16.7 100.0 2,125 32.2 5.2 11.3 40.9 21.8 20.8 100.0 2,439 33.4 4.2 5.8 23.3 22.8 43.9 100.0 369 43.7 5.4 12.3 44.0 21.7 16.7 100.0 2,070 32.2 8.6 15.1 38.5 21.1 16.7 100.0 73 31.6 11.0 17.1 39.5 20.3 12.1 100.0 37 30.1 6.1 13.1 37.4 21.9 21.5 100.0 36 33.6 4.7 11.6 40.5 22.8 20.4 100.0 759 33.7 5.7 12.0 39.2 23.5 19.5 100.0 420 33.3 5.5 11.0 41.9 20.6 20.9 100.0 1,263 33.0 4.8 13.1 33.2 22.2 26.8 100.0 70 35.1 5.3 11.4 40.8 21.8 20.7 100.0 2,512 33.3 ____________________________________________________________________________________________________ Note: The interval for multiple births is the number of months since the end of the preceding pregnancy that ended in a live birth. Numbers in parentheses are based on 25 to 49 respondents (unweighted). The median birth interval is 11 months longer in urban than in rural areas. Eleven percent of births in urban areas occur at intervals of less than 24 months, compared with 18 percent of rural births. By region, the results show that about 17 percent of births in the Mainland versus 24 percent of births in Zanzibar occur after intervals of less than 24 months. Birth intervals vary little by mother’s education. Fertility * 37 Table 3.7 Age at first birth Percent distribution of women 15-49 by age at first birth and median age at first birth, according to current age, Tanzania 1999 ____________________________________________________________________________________________________ Women Median with Age at first birth Number age at no _____________________________________________ of first Current age births <15 15-17 18-19 20-21 22-24 25+ Total women birth ____________________________________________________________________________________________________ 15-19 20-24 25-29 30-34 35-39 40-44 45-49 80.3 1.2 11.7 6.8 NA NA NA 100.0 909 a 21.6 3.1 23.3 29.8 17.9 4.3 NA 100.0 811 19.6 8.0 3.3 26.6 26.3 21.9 11.1 2.8 100.0 749 19.5 5.6 5.7 29.2 27.6 15.8 9.0 7.1 100.0 490 19.1 3.3 7.2 28.1 24.0 16.1 13.2 8.0 100.0 456 18.9 1.9 7.4 43.7 21.6 11.2 7.5 6.7 100.0 299 17.9 0.6 6.3 36.6 18.7 16.9 12.0 9.0 100.0 315 18.9 ____________________________________________________________________________________________________ NA = Not applicablea Omitted because less than 50 percent of women in the age group had a birth before entering the age group. 3.6 AGE AT FIRST BIRTH The age at which childbearing begins influences the number of children a woman bears throughout her reproductive period in the absence of any active control. Table 3.7 shows the percent distribution of women by age at first birth, according to age at the time of the survey. For women age 20 and older, the median age at first birth is presented in the last column of the table. The results confirm findings from the 1991-92 and 1996 TDHS which show that childbearing begins early in Tanzania, with most women becoming mothers before they reach the age of 20. The median age at first birth is between 18 and 20. The data show that the median age at first birth has increased slightly from around 18 or 19 for older women to over 19 for women in their early 20s. This slight change to later age at first birth is reflected in the smaller proportion of younger women whose first births occurred before age 15; about 6-7 percent of women in their 30s and 40s report having had their first birth before age 15, compared with only 1 percent of women age 15-19. Table 3.8 shows the median age at first birth among women aged 20-49 years by current age and selected background characteristics. There is not much variation in age at first birth by place of residence, with urban women having only slightly higher ages at first birth than rural women. The median age at first birth shows an inverse relationship with educational attainment: as low as 18 years for women with no education or incomplete primary education and increasing to 23 years for women with at least some secondary education. 3.7 TEENAGE PREGNANCY AND MOTHERHOOD Early childbearing, particularly among teenagers (those under 20 years of age) has negative demographic, socioeconomic, and sociocultural consequences. Teenage mothers are more likely to suffer from severe complications during delivery, which result in higher morbidity and mortality for both themselves and their children. In addition, the socioeconomic advancement of teenage mothers in the areas of educational attainment and accessibility to job opportunities may be curtailed. 38 * Fertility Table 3.8 Median age at first birth by background characteristics Median age at first birth among women 20-49, by current age and selected background characteristics, Tanzania 1999_____________________________________________________________________________________________________ Current age Women Women Background ____________________________________________________ age age characteristic 20-24 25-29 30-34 35-39 40-44 45-49 20-49 25-49_____________________________________________________________________________________________________ Residence Urban Rural Mainland/Zanzibar Mainland Urban Rural Zanzibar Education No education Incomplete primary Complete primary Secondary+ Total 20.5 19.8 19.9 20.1 17.7 18.8 19.8 19.5 19.3 19.3 18.9 18.7 18.1 18.9 19.0 18.9 19.6 19.5 19.1 18.9 17.9 18.9 19.2 19.0 a 19.8 19.9 20.2 17.7 18.8 19.8 19.5 19.3 19.3 18.9 18.7 18.1 19.0 19.0 18.9 a 19.6 19.7 18.3 17.0 15.7 19.0 18.7 18.6 19.2 17.7 18.0 17.5 19.1 18.2 18.1 18.7 18.9 17.4 19.5 18.4 18.1 18.5 18.4 19.8 19.3 19.5 20.2 18.0 19.2 19.6 19.5 a 23.5 23.5 23.0 20.4 23.2 a 23.4 19.6 19.5 19.1 18.9 17.9 18.9 19.2 19.0 _____________________________________________________________________________________________________ a Omitted because less than 50 percent of women in the age group had a birth before entering the age group. Table 3.9 Teenage pregnancy and motherhood Percentage of women 15-19 who are mothers or pregnant with their first child, by selected background characteristics, Tanzania 1999_______________________________________________________________ Percentage who are: Percentage_________________ who have Pregnant begun Number Background with first child- of characteristic Mothers child bearing women_______________________________________________________________ Age 15 16 17 18 19 Residence Urban Rural Mainland/Zanzibar Mainland Urban Rural Zanzibar Pemba Unguja Education No education Incomplete primary Complete primary Secondary+ Total 2.0 0.6 2.6 217 5.8 4.7 10.5 210 16.9 7.5 24.4 182 39.1 6.9 46.0 137 47.9 6.0 53.9 163 20.4 2.6 23.1 217 19.4 5.5 25.0 692 19.9 4.9 24.7 884 20.7 2.7 23.4 208 19.6 5.5 25.1 676 12.8 4.5 17.2 25 8.9 6.8 15.7 12 16.3 2.3 18.6 13 23.9 8.8 32.7 189 15.9 0.8 16.8 318 22.2 6.5 28.7 356 8.5 3.8 12.3 46 19.7 4.9 24.5 909 Table 3.9 shows the percentage of women age 15-19 years who are mothers or pregnant with their first child by background characteristics. One in five teenage women in Tanzania is a mother and another 5 percent are pregnant with their first child. Thus, 25 percent of teen- age women have begun child- bearing. There has been a slight decline in this proportion since the 1996 TDHS, which indicated that 26 percent of women age 15-19 had begun childbearing (21 percent had delivered a child and 5 percent were pregnant with their first child) (Bureau of Statistics and Macro International Inc., 1997:38). As expected, the propor- tion of women who have begun childbearing rises rapidly with age, from 3 percent of those age 15 to 54 percent of those age 19 (see Figure 3.3). Those residing in the Mainland and especially those with no education are also more likely than others to have begun childbearing. Fertility * 39 Fertility Regulation * 41 FERTILITY REGULATION 4 Knowledge of family planning methods and where they can be obtained is necessary in deciding whether to adopt a contraceptive method and which method to choose. This chapter presents information on contraceptive knowledge, attitudes, behaviour, and sources. In presenting the findings on fertility regulation, the primary focus is on women of reproductive age, with some analogous survey results from men, who play an important role in the realisation of reproductive goals. 4.1 KNOWLEDGE OF FAMILY PLANNING METHODS As in the 1996 TDHS, information about knowledge of family planning methods among women and men was collected in two ways in the 1999 TRCHS. First, respondents were asked to name methods or ways couples can use to prevent or delay pregnancy. When a respondent failed to mention a method spontaneously, the interviewer described the method and then asked if the respondent knew it. Using this approach, information was collected for nine modern family planning methods: female and male sterilisation, the pill, IUD, injectables, implants, male condom, female condom, and vaginal methods (foam/jelly/diaphragm). Information was also collected on three traditional methods: the calendar (rhythm) method, lactational amenorrhoea, and withdrawal. Provision was also made in the questionnaire to record any other methods named spontaneously by respondents. Both prompted and unprompted knowledge are combined in this report. Table 4.1 shows the level of knowledge of specific contraceptives among all women and men, currently married women and men, sexually active unmarried women and men, and women with no sexual experience. The level of knowledge of any contraceptive method among all women age 15-49 years is high; almost all women (91 percent) have heard of at least one contraceptive method. Almost all of the women who have heard of any contraceptive method have heard of a modern method (91 percent), while slightly more than a half (58 percent) of the women have heard of a traditional contraceptive method. The results show that contraceptive knowledge is higher among currently married women (95 percent) than sexually active unmarried women (92 percent) and women with no sexual experience (65 percent). The most commonly recognised contraceptive methods among all women age 15-49 in Tanzania are the pill (86 percent), male condoms (83 percent), injectables (81 percent), female sterilisation (63 percent), the IUD (54 percent), female condoms (41 percent), and implants (40 percent). About a quarter of women (27 percent) know about male sterilisation, and about a fifth (21 percent) know about vaginal contraceptives (diaphragm/foam/jelly). Concerning the traditional methods, a substantial number of women know about withdrawal (39 percent) and periodic abstinence (37 percent), and one-quarter (25 percent) have heard about lactational amenorrhoea. Knowledge of other methods was found to be generally low (18 percent). Men are slightly more likely than women to have heard of at least one family planning method (93 versus 91 percent). As expected, men are more likely than women to know about male- oriented methods and less likely to know about female methods. For example, 90 percent of men compared with 83 percent of women know about the male condom and 33 percent of men compared with 27 percent of women know about male sterilisation. Men are also more knowledgeable of some traditional contraceptive methods; 47 percent of men compared with 42 * Fertility Regulation Table 4.1 Knowledge of contraceptive methods Percentage of all women 15-49 and men 15-59, of currently married women and men, of sexually active unmarried women and men, and of women with no sexual experience who know specific contraceptive methods, Tanzania 1999_______________________________________________________________________________________________ Women Men_______________________________________ ________________________ Sexually Sexually Currently active No Currently active Contraceptive All married unmarried sexual All married unmarried method women women women experience men men men_______________________________________________________________________________________________ Any method Any modern method Pill IUD Injectables Diaphragm/Foam/Jelly Male condom Female condom Female sterilisation Male sterilisation Implants Any traditional method Periodic abstinence Withdrawal LAM Other Number of respondents Mean number of methods 90.9 95.3 91.6 65.4 92.8 97.1 96.1 90.5 94.9 90.7 65.3 92.0 96.0 95.8 86.3 93.0 86.4 48.0 78.9 89.2 80.3 53.8 59.5 60.6 17.0 39.7 51.3 30.4 80.9 87.7 81.7 41.5 67.7 80.3 65.6 20.6 22.7 30.2 2.6 14.9 19.1 12.4 83.2 87.2 86.6 57.7 90.4 94.4 95.4 41.4 45.5 51.6 10.9 44.8 53.3 40.5 62.5 69.1 64.3 24.9 63.1 75.7 57.9 27.3 29.5 32.9 7.9 32.8 40.0 30.3 40.3 44.7 46.4 9.4 21.7 28.2 16.5 58.4 66.2 67.4 14.0 61.7 76.4 51.2 36.6 40.0 47.1 11.0 43.0 53.2 34.1 39.2 45.6 45.8 4.8 46.9 59.2 41.2 24.6 28.1 27.1 5.0 20.7 28.4 13.0 18.4 22.4 17.4 1.2 14.4 20.5 7.4 4,029 2,653 366 496 3,542 2,063 551 6.2 6.7 6.8 2.4 5.8 6.9 5.3 ______________________________________________________________________________________________ LAM = Lactational amenorrhoea method 39 percent of women know about withdrawal and 43 percent of men as compared with 37 percent of women know about periodic abstinence. However, men are much less likely than women to have heard about female-oriented methods, especially the IUD, injectables, implants, and the pill. On average, all women and men know about six contraceptive methods, whereas married women and men know about seven methods. Table 4.2 shows the correspondence in contraceptive knowledge between husbands and wives for the 1,820 couples interviewed in the 1999 TRCHS sample. Knowledge of at least one contraceptive method by both spouses was found to be high (95 percent). For couples in which only one partner knows of a method, husbands are more likely to know about methods in which they take part, such as male condoms, male sterilisation, periodic abstinence, and withdrawal, while wives are more likely to know about methods like the pill, IUD, injectables, vaginal methods, and implants. Surprisingly, however, husbands are more likely than their wives to have heard of female sterilisation, the female condom, and lactational amenorrheoa. Some methods were not recognised by either the husband or the wife, the most notable being vaginal methods, male sterilisation, and implants, which were unknown to 65 percent, 48 percent, and 46 percent of the couples, respectively. Fertility Regulation * 43 Table 4.2 Couples’ knowledge of contraceptive methods Percent distribution of couples by knowledge of specific contraceptive methods, Tanzania 1999___________________________________________________________________ Wife Husband knows Both knows method, Neither Contraceptive know method, husband knows method method wife doesn’t doesn’t method Total ___________________________________________________________________ Any method Any modern method Pill IUD Injectables Diaphragm/Foam/Jelly Male condom Female condom Female sterilisation Male sterilisation Implants Any traditional method Periodic abstinence Withdrawal LAM Other 94.5 3.0 1.7 0.9 100.0 93.5 2.9 2.3 1.3 100.0 86.0 3.4 7.8 2.8 100.0 38.5 13.8 21.3 26.4 100.0 73.0 7.3 15.0 4.6 100.0 6.1 13.1 16.2 64.6 100.0 85.8 8.9 2.6 2.7 100.0 29.7 24.8 15.0 30.5 100.0 57.0 19.5 12.9 10.6 100.0 16.6 23.5 12.1 47.8 100.0 18.7 9.5 25.3 46.4 100.0 56.3 20.1 10.3 13.4 100.0 26.6 26.9 12.3 34.2 100.0 35.8 24.0 11.6 28.6 100.0 11.7 17.2 16.0 55.0 100.0 6.4 13.6 15.5 64.4 100.0 __________________________________________________________________ Note: Table is based on 1,820 couples LAM = Lactational amenorrhoea method 44 * Fertility Regulation Figure 4.1 Trends in Contraceptive Knowledge Among Women Age 15-49, 1991-1999 74 72 44 84 84 47 91 91 58 Any Method Any Modern Method Any Traditional Method 0 20 40 60 80 100 Percent 1991-92 TDHS 1996 TDHS 1999 TRCHS 4.2 TRENDS IN CONTRACEPTIVE KNOWLEDGE There has been a substantial increase over time in the proportion of women and men who are aware of contraceptive methods. The proportion of all women who have heard of at least one contraceptive method has increased from 74 percent in 1991-92 to 84 percent in 1996 to 91 percent in 1999 (see Figure 4.1). Knowledge of specific contraceptive methods has increased more dramatically. In 1991-92, only 40 percent of women had heard of the injectable contraceptive; by 1999, this figure had increased to 81 percent. Similarly, the proportion of women who know of male condoms grew from 51 percent among all women to 83 percent in 1999. Generally, the level of knowledge among all women has increased since 1996 for all methods except vaginal contraceptives (diaphragm/foam/jelly), which declined from 31 percent in 1996 to 21 percent in 1999. The largest increases in knowledge among women over the three-year period between 1996 and 1999 occurred for implants (from 24 percent to 40 percent), male condoms (from 72 percent to 83 percent), and injectables (from 71 percent to 81 percent). For men, the increase in the proportion who have heard of any method has been less steep than for women—from 89 percent in 1996 to 93 percent in 1999. Still, the level of knowledge has increased since 1996 for all methods except vaginal contraceptives (which declined from 35 to 15 percent of all men) and male sterilisation (which declined from 35 to 33 percent). Both women and men registered a substantial level of knowledge of the female condom, which was not asked about in prior surveys. 4.3 EVER USE OF FAMILY PLANNING METHODS All women and men interviewed in the 1999 TRCHS who said that they had heard of a contraceptive method were asked if they had ever used that method. In this context, ever use refers Fertility Regulation * 45 to the use of a contraceptive method at any time with no distinction between past and current use. Tables 4.3.1 and 4.3.2 show the percentage of women and men who have ever used contraceptive methods, according to method, age, and marital status. The results show that 41 percent of women 15-49 have used a contraceptive method at some time in their lives. Women have used modern methods more frequently (30 percent) than traditional methods (21 percent). The modern contraceptive methods commonly used by women are the pill (16 percent), injectables (12 percent), and male condoms (11 percent); while the traditional methods commonly used by women are withdrawal (11 percent), periodic abstinence (8 percent) and lactational amenorrhoea (4 percent). Ever use of any contraceptive method is higher for sexually active unmarried women (52 percent) than for currently married women (47 percent). With regard to men (Table 4.3.2), the results show that almost half (48 percent) of all men have used a method at some time, with modern methods having been used more frequently (38 percent) than traditional methods (26 percent). The modern contraceptive methods commonly used by men are the male condom (28 percent), the pill (12 percent), and injectables (7 percent); while the traditional methods commonly used by men are withdrawal (15 percent) and periodic abstinence (14 percent). As opposed to what is observed among women, ever use of any contraceptive is higher for currently married men (60 percent) than sexually active unmarried men (48 percent). However, the order is reversed for ever use of any modern contraceptive, which is slightly higher among sexually active unmarried men (46 percent) than among currently married men (44 percent). 46 * Fertility Regulation Table 4.3.1 Ever use of contraception: women Percentage of all women, of currently married women, and of sexually active unmarried women who have ever used a contraceptive method, by method and age, Tanzania 1999 _____________________________________________________________________________________________________________________ Modern method Traditional method ____________________________________________________ _______________________________ Any Any Female tradi- Periodic Number Any modern Inject- Male Female sterili- Im- tional absti- With- Other of Age method method Pill IUD ables condom condom sation plant method nence drawal LAM methods women _____________________________________________________________________________________________________________________ ALL WOMEN ____________________________________________________________________________________________________________________ 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Total 13.3 10.1 1.8 0.0 1.7 7.6 0.3 0.0 0.0 5.2 3.0 1.8 0.6 0.3 909 46.1 35.9 18.3 0.7 11.8 17.1 0.1 0.1 0.2 21.7 10.1 11.8 2.8 1.1 811 52.3 39.8 23.6 2.9 19.2 13.6 0.3 1.0 0.8 25.4 10.6 14.1 5.6 3.3 749 51.5 37.2 24.4 2.7 16.4 9.1 0.0 1.7 0.8 25.9 8.3 13.3 5.2 6.9 490 50.0 35.0 19.9 1.6 14.8 12.5 0.0 2.0 0.3 30.0 7.8 17.7 10.1 4.8 456 50.6 35.3 21.2 2.1 15.0 6.0 0.0 5.9 0.7 30.7 11.4 16.3 4.2 6.8 299 36.6 24.4 14.6 4.7 10.3 1.8 0.0 6.0 0.0 18.8 8.2 7.9 2.9 3.3 315 40.5 29.9 16.4 1.7 11.9 10.8 0.1 1.5 0.4 20.6 8.1 10.9 4.1 3.1 4,029 _____________________________________________________________________________________________________________________ CURRENTLY MARRIED WOMEN ____________________________________________________________________________________________________________________ 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Total 24.5 15.5 5.3 0.2 3.6 8.8 0.0 0.0 0.0 11.8 6.5 4.4 1.6 0.3 227 45.0 32.6 17.9 0.5 11.8 12.5 0.0 0.1 0.0 22.1 8.0 13.1 3.8 1.4 550 52.1 38.6 23.1 2.8 18.7 12.7 0.1 1.3 0.9 24.5 9.7 14.3 5.6 3.2 615 52.8 37.4 24.0 2.4 16.5 7.5 0.0 2.0 0.9 26.9 8.3 14.7 4.8 7.4 407 50.6 33.4 19.8 1.0 14.9 11.0 0.0 1.6 0.0 33.4 8.4 19.8 11.6 5.4 364 48.8 31.8 18.5 1.2 16.3 5.0 0.0 5.4 0.9 29.7 9.4 18.9 3.8 5.3 239 40.3 26.8 14.8 5.5 11.3 1.3 0.0 7.1 0.0 20.6 9.3 9.0 2.3 3.6 251 46.7 32.7 19.0 1.9 14.2 9.5 0.0 2.0 0.4 24.6 8.6 13.9 5.1 3.8 2,653 ___________________________________________________________________________________________________________________ SEXUALLY ACTIVE, UNMARRIED WOMEN ___________________________________________________________________________________________________________________ Total 51.9 44.4 24.8 1.8 13.3 25.9 0.7 0.1 0.4 27.1 12.9 10.5 2.5 4.9 366 _____________________________________________________________________________________________________________________ Note: Less than one-half of one percent of women reported ever using diaphragm/foam/jelly. LAM = Lactational amenorrhoea method There has been a gradual increase in the level of ever use of modern contraceptives among women and men in recent years. In 1991-92, 14 percent of all women had used a modern method at some time, compared with 21 percent in 1994, 23 percent in 1996, and 30 percent in 1999. Absolute increases in ever use were greatest for injectables. Among men, ever use of a modern contraceptive method increased from 20 percent in 1991-92 to 24 percent in 1994, 26 percent in 1996, and to 38 percent in 1999. The increase in ever use was greatest for the male condom. 4.4 CURRENT USE OF FAMILY PLANNING METHODS Level of Contraceptive Use The level of current use of contraceptive methods is one of the indicators most frequently used to assess the success of family planning programme activities. It is also widely used as a measure in analysing the determinants of fertility. This section focuses on the levels and differentials in current use of family planning with particular emphasis on the method mix among users. Trends in contraceptive use in Tanzania are also described. Fertility Regulation * 47 Table 4.3.2 Ever use of contraception: men Percentage of all men, of currently married men, and of sexually active unmarried men who have ever used a contraceptive method, by method and age, Tanzania 1999 ____________________________________________________________________________________________________________________ Modern method Traditional method ______________________________________________________ ______________________________ Any Any Female tradi- Periodic Number Any modern Inject- Male Female sterili- Im- tional absti- With- Other of Age method method Pill IUD ables condom condom sation plant method nence drawal LAM methods men _____________________________________________________________________________________________________________________ ALL MEN ____________________________________________________________________________________________________________________ 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 Total 17.8 16.5 1.4 0.0 0.4 16.0 0.3 0.0 0.1 5.3 2.6 3.3 0.0 0.2 790 48.7 44.2 4.9 0.0 1.9 42.0 1.4 0.1 0.4 17.9 8.6 11.1 0.2 0.5 540 63.9 53.8 18.9 0.5 12.4 41.4 1.6 0.0 0.1 30.5 16.0 16.2 5.5 2.3 546 54.3 41.4 14.9 2.0 8.2 31.3 1.3 0.4 0.0 31.5 17.8 20.1 3.8 3.8 371 66.5 50.7 18.2 1.4 12.4 36.5 0.3 1.6 0.7 40.1 21.4 24.3 8.8 3.3 445 59.5 43.0 25.0 2.2 9.0 23.6 0.3 5.2 0.0 44.0 24.4 23.3 10.1 7.4 219 52.6 35.6 16.6 1.1 13.2 17.5 0.0 3.7 0.0 39.5 20.2 25.2 4.1 4.7 259 53.7 35.6 13.7 5.1 8.8 12.9 0.0 5.9 1.1 37.6 16.9 18.4 3.8 11.0 201 47.9 20.0 10.2 0.2 7.2 4.4 0.0 5.0 0.0 35.8 17.3 12.0 10.5 7.2 171 48.2 37.7 11.9 1.0 7.1 27.9 0.7 1.4 0.3 26.4 13.7 15.0 4.0 3.1 3,542 ____________________________________________________________________________________________________________________ CURRENTLY MARRIED MEN1 ____________________________________________________________________________________________________________________ 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 Total 55.9 45.8 10.0 0.0 3.9 40.2 1.5 0.0 1.0 25.3 12.3 15.9 0.7 1.6 158 65.1 52.4 21.4 0.7 14.0 36.6 1.5 0.0 0.1 35.3 18.1 18.6 7.0 2.9 401 55.5 41.7 15.8 2.2 9.1 30.5 1.5 0.4 0.0 32.1 17.8 19.7 3.9 4.2 334 69.3 52.4 18.7 1.2 14.4 36.5 0.3 1.8 0.8 43.2 23.7 26.6 10.0 2.9 381 62.8 44.1 27.4 1.9 9.1 22.1 0.0 6.0 0.0 47.7 26.8 24.8 11.1 8.4 193 53.2 35.5 16.3 1.0 14.2 16.3 0.0 4.1 0.1 41.6 21.4 25.9 4.4 4.9 236 56.4 37.3 14.6 5.5 9.4 12.8 0.0 6.3 1.1 40.1 18.2 19.5 4.1 11.8 187 52.1 21.9 11.3 0.3 8.0 4.6 0.0 5.5 0.0 38.8 18.4 12.7 11.6 7.9 154 60.0 43.5 17.5 1.5 11.1 27.5 0.7 2.4 0.4 37.9 19.9 21.0 6.7 4.9 2,063 _____________________________________________________________________________________________________________________ SEXUALLY ACTIVE, UNMARRIED MEN _____________________________________________________________________________________________________________________ Total 48.4 45.9 8.1 0.5 1.8 44.0 1.4 0.1 0.1 16.0 6.3 11.4 0.7 0.5 551 ____________________________________________________________________________________________________________________ Note: One-tenth of one percent of men reported ever using diaphragm/foam/jelly. LAM = Lactational amenorrhoea method 1There are too few married men age 15-19 to show separately. Overall, 22 percent of all women in Tanzania are currently using a contraceptive method, with 16 percent using modern methods (Table 4.4.1). The most widely used methods are injectables (5 percent), the pill (5 percent), and the male condom (4 percent). Less than 2 percent of women have been sterilised. Seven percent of women are currently using traditional methods, the most popular among these being withdrawal (3 percent). Contraceptive use is lowest among teenagers (15-19 years) and older women (45-49 years); at all other age groups, use is surprisingly constant at 26-29 percent of women. The lower levels of contraceptive use among younger women may reflect lower levels of sexual activity or a desire to start their families, while the drop in contraceptive use among older women may reflect declining fecundity or lower levels of sexual activity. Male condoms are the most popular contraceptives currently used by teenage women (15-19 years), while the pill and injectables are the most widely used methods among women 20-39 years. Among women in their early 40s, 48 * Fertility Regulation Table 4.4.1 Current use of contraception: women Percent distribution of all women, of currently married women, and of sexually active unmarried women by contraceptive method currently used, according to age, Tanzania 1999 _____________________________________________________________________________________________________________ Modern method Traditional method ______________________________________ ______________________________ Any Any Female tradi- Periodic Not Number Any modern Inject- Male sterili- tional absti- With- Other currently of Age method method Pill IUD ables condom sation method nence drawal LAM methods using Total women _____________________________________________________________________________________________________________ ALL WOMEN _____________________________________________________________________________________________________________ 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Total 7.7 5.8 1.1 0.0 0.7 3.7 0.0 1.9 1.2 0.4 0.3 0.3 92.3 100.0 909 29.4 22.0 8.2 0.3 7.2 6.0 0.1 7.4 2.9 2.8 1.7 0.2 70.6 100.0 811 26.0 18.3 5.4 0.7 7.5 3.5 1.0 7.7 1.9 3.3 1.3 1.4 74.0 100.0 749 27.5 17.8 7.7 0.7 6.6 0.7 1.7 9.7 3.4 3.3 2.2 1.2 72.5 100.0 490 27.5 19.0 5.5 0.3 5.9 5.3 2.0 8.4 1.5 3.5 2.5 0.9 72.5 100.0 456 28.7 16.1 1.3 0.2 8.0 0.7 5.9 12.6 4.2 5.0 1.0 2.4 71.3 100.0 299 15.4 12.3 0.5 1.6 3.5 0.7 6.0 3.1 1.4 0.6 0.3 0.9 84.6 100.0 315 22.3 15.6 4.6 0.5 5.4 3.5 1.5 6.7 2.2 2.5 1.3 0.9 77.7 100.0 4,029 _____________________________________________________________________________________________________________ CURRENTLY MARRIED WOMEN ____________________________________________________________________________________________________________ 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Total 10.6 6.5 2.9 0.0 2.1 1.4 0.0 4.1 1.3 1.7 1.1 0.0 89.4 100.0 227 28.4 20.4 8.4 0.3 6.8 4.9 0.1 8.0 2.6 3.0 2.4 0.0 71.6 100.0 550 24.9 16.4 4.1 0.3 7.6 3.1 1.3 8.5 1.6 4.0 1.5 1.5 75.1 100.0 615 29.5 19.1 8.9 0.9 6.2 0.5 2.0 10.4 3.5 3.9 2.2 1.2 70.5 100.0 407 28.4 18.5 5.9 0.0 5.6 5.3 1.6 10.0 1.7 4.4 3.1 0.8 71.6 100.0 364 30.7 17.2 1.3 0.0 9.8 0.7 5.4 13.6 3.6 6.3 1.2 2.5 69.3 100.0 239 16.9 13.5 0.6 2.1 3.3 0.3 7.1 3.5 1.3 0.7 0.3 1.1 83.1 100.0 251 25.4 16.9 5.3 0.4 6.3 2.7 2.0 8.5 2.2 3.5 1.9 1.0 74.6 100.0 2,653 ____________________________________________________________________________________________________________ SEXUALLY ACTIVE, UNMARRIED WOMEN _____________________________________________________________________________________________________________ Total 33.0 26.1 9.3 0.7 5.5 9.5 0.1 7.0 4.9 0.6 0.5 2.0 67.0 100.0 366 ___________________________________________________________________________________________________________ LAM = Lactational amenorrhoea method injectables are clearly the most popular method, whereas women in their late 40s are more likely to have been sterilised. Current use of contraception among men is slightly higher than among women. Twenty- nine percent of all men age 15-59 in Tanzania are currently using a contraceptive method, with 21 percent using modern methods and 9 percent using traditional methods (Table 4.4.2). The contraceptive methods most widely used by men are the male condom (12 percent), periodic abstinence (4 percent), and the pill (4 percent). The major difference in current use among women and men is the proportionally higher use of male condoms and periodic abstinence by men. Among women, current use of any contraceptive method is higher among married women (25 percent) than among all women (22 percent), but it is highest among unmarried sexually active women, 33 percent of whom are using some method. Among men, married men are the Fertility Regulation * 49 Table 4.4.2 Current use of contraception: men Percent distribution of all men, of currently married men, and of sexually active unmarried men by contraceptive method currently used, according to age, Tanzania 1999 ____________________________________________________________________________________________________________ Modern method Traditional method ______________________________________ _______________________________ Any Any Female tradi- Periodic Not Number Any modern Inject- Male sterili- tional absti- With- Other currently of Age method method Pill IUD ables condom sation method nence drawal LAM methods using Total men ____________________________________________________________________________________________________________ ALL MEN ____________________________________________________________________________________________________________ 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 Total 11.8 11.0 0.2 0.0 0.1 10.6 0.0 0.8 0.6 0.3 0.0 0.0 88.2 100.0 790 25.7 23.5 1.9 0.0 0.5 20.9 0.1 2.2 1.9 0.3 0.0 0.2 74.3 100.0 540 40.1 28.4 7.2 0.0 4.9 16.0 0.0 11.7 5.6 2.6 3.5 0.3 59.9 100.0 546 32.9 22.1 7.7 0.9 3.3 9.7 0.4 10.8 5.3 4.2 0.9 0.5 67.1 100.0 371 40.6 27.5 6.4 0.4 4.7 14.6 1.3 13.1 3.7 5.8 2.6 1.0 59.4 100.0 445 43.6 25.8 7.3 0.4 4.5 8.3 5.2 17.7 7.8 3.9 4.9 1.1 56.4 100.0 219 36.4 20.2 3.6 0.0 7.0 5.8 3.7 16.2 9.7 4.6 1.5 0.5 63.6 100.0 259 27.1 17.2 2.3 1.5 4.8 2.9 5.7 9.9 5.0 1.2 1.8 1.8 72.9 100.0 201 24.0 12.5 2.4 0.0 5.1 0.0 5.0 11.5 5.9 2.3 3.3 0.0 76.0 100.0 171 29.3 20.8 4.0 0.3 3.1 12.0 1.4 8.5 4.1 2.4 1.6 0.5 70.7 100.0 3,542 ___________________________________________________________________________________________________________ CURRENTLY MARRIED MEN1 ____________________________________________________________________________________________________________ 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 Total 22.7 17.7 4.9 0.0 1.5 11.3 0.0 5.0 4.9 0.0 0.0 0.0 77.3 100.0 158 41.7 26.1 8.6 0.0 6.2 11.0 0.0 15.6 7.2 3.5 4.8 0.5 58.3 100.0 401 34.9 23.0 8.6 1.0 3.7 9.3 0.4 11.9 5.8 4.6 1.0 0.5 65.1 100.0 334 43.8 28.5 7.3 0.5 5.5 13.7 1.5 15.3 4.3 6.7 3.1 1.2 56.2 100.0 381 47.2 27.0 8.3 0.5 5.1 7.1 6.0 20.2 8.9 4.5 5.6 1.2 52.8 100.0 193 37.9 20.1 3.7 0.0 7.7 4.6 4.0 17.9 10.6 5.1 1.6 0.6 62.1 100.0 236 29.0 18.4 2.4 1.6 5.1 3.1 6.1 10.6 5.4 1.3 2.0 1.9 71.0 100.0 187 25.7 13.9 2.7 0.0 5.7 0.0 5.5 11.9 6.3 2.0 3.6 0.0 74.3 100.0 154 37.0 23.0 6.4 0.4 5.2 8.6 2.3 14.0 6.6 3.9 2.8 0.8 63.0 100.0 2,063 ____________________________________________________________________________________________________________ SEXUALLY ACTIVE, UNMARRIED MEN ____________________________________________________________________________________________________________ Total 30.5 29.5 1.7 0.0 0.3 27.2 0.1 1.0 0.3 0.7 0.0 0.2 69.5 100.0 551 ____________________________________________________________________________________________________________ LAM = Lactational amenorrhoea method 1 There are too few married men age 15-19 to show separately most likely to be using a method (37 percent), while unmarried sexually active men are only slightly more likely than all men to be using a method (31 versus 29 percent). The male condom is the overwhelming choice among unmarried sexually active men (27 percent) and it is more popular than the pill among unmarried sexually active women. This preference for the male condom among unmarried women and men suggests that it is a popular method for premarital sex because of the dual protection it offers: protection from pregnancy and protection from sexually transmitted diseases. 50 * Fertility Regulation Table 4.5.1 Current use of contraception by background characteristics: women Percentage distribution of all women by contraceptive method currently used, according to selected background characteristics, Tanzania 1999 _______________________________________________________________________________________________________________ Modern method Traditional method _____________________________________ ____________________________ Any Any Female tradi- Periodic Not Number Background Any modern Inject- Male sterili- tional absti- With- Other currently of characteristic method method Pill IUD ables condom sation method nence drawal LAM methods using Total women _______________________________________________________________________________________________________________ Residence Urban Rural Mainland/Zanzibar Mainland Urban Rural Zanzibar Pemba Unguja Education No education Incomplete primary Complete primary Secondary + No. of living children None 1 2 3 4 5 6+ Total 33.0 28.9 8.9 1.2 9.9 6.7 1.8 4.1 2.8 0.8 0.0 0.9 67.0 100.0 1,122 18.2 10.5 3.0 0.2 3.6 2.2 1.4 7.7 2.0 3.1 1.8 0.9 81.8 100.0 2,907 22.5 15.7 4.6 0.5 5.4 3.5 1.6 6.8 2.2 2.5 1.3 0.9 77.5 100.0 3,929 33.4 29.3 8.9 1.2 10.0 6.9 1.8 4.1 2.9 0.8 0.0 0.9 66.6 100.0 1,088 18.3 10.6 2.9 0.2 3.6 2.3 1.5 7.8 2.0 3.2 1.8 0.9 81.7 100.0 2,841 13.6 10.9 4.8 0.6 3.9 1.1 0.7 2.7 1.2 0.9 0.4 0.2 86.4 100.0 100 6.8 4.9 1.1 0.2 2.5 0.0 1.1 2.0 1.0 0.8 0.2 0.0 93.2 100.0 44 18.9 15.6 7.6 0.8 4.9 2.0 0.3 3.3 1.4 0.9 0.5 0.4 81.1 100.0 56 14.0 6.8 1.8 0.2 2.5 1.3 1.0 7.2 1.4 3.2 1.7 0.9 86.0 100.0 1,093 17.8 11.7 3.8 0.3 3.2 2.0 2.2 6.1 2.5 1.6 1.3 0.9 82.2 100.0 854 26.8 20.5 6.4 0.3 7.9 4.5 1.3 6.3 2.0 2.5 1.2 0.8 73.2 100.0 1,866 42.8 33.5 6.3 3.9 6.7 12.0 3.5 9.2 6.3 2.4 0.0 1.6 57.2 100.0 215 7.3 5.9 1.7 0.0 0.1 3.9 0.0 1.4 1.4 0.0 0.0 0.3 92.7 100.0 1,104 28.0 20.8 6.6 1.0 6.2 5.6 1.2 7.2 2.9 3.0 1.2 0.3 72.0 100.0 733 26.4 19.7 6.4 0.6 9.4 1.9 1.1 6.7 2.3 2.0 1.9 0.8 73.6 100.0 618 29.1 21.5 4.9 0.6 6.6 6.4 2.6 7.6 2.7 2.8 1.2 1.2 70.9 100.0 427 25.6 18.2 6.1 0.0 7.1 3.4 1.6 7.4 1.1 2.6 2.0 1.7 74.4 100.0 381 28.5 18.0 7.8 0.1 8.2 0.5 1.4 10.5 2.0 6.6 1.1 0.8 71.5 100.0 276 30.3 16.2 2.7 1.1 6.8 0.5 5.1 14.1 3.4 5.2 3.2 2.2 69.7 100.0 489 22.3 15.6 4.6 0.5 5.4 3.5 1.5 6.7 2.2 2.5 1.3 0.9 77.7 100.0 4,029 _______________________________________________________________________________________________________________ LAM = Lactational amenorrhoea method Differentials in Contraceptive Use Some women are more likely to use contraceptive methods than others (Table 4.5.1 and Figure 4.2). The proportion of women currently using contraceptives in urban areas (33 percent) is almost double that of rural areas (18 percent). Among both rural and urban women, injectables are the most popular method, followed by the pill. The third most used contraceptive method is the condom among urban women and withdrawal among rural women. There are differences in the levels of current use between the Mainland and Zanzibar. Women who live in the Mainland are more likely to use a contraceptive method (23 percent) than women who live in Zanzibar (14 percent). Contraceptive use is particularly low in Pemba (7 percent), in comparison with Unguja (19 percent). Compared with the 1996 TDHS, contraceptive use has increased in all areas except Pemba, where it has remained unchanged. Education is clearly related to the use of contraceptive methods. Only 14 percent of women with no formal education are currently using any contraceptive, compared with 18 percent of women with incomplete primary school, 27 percent of women who have completed primary school, and 43 percent of women with at least some secondary education. Women with no education are Fertility Regulation * 51 Table 4.5.2 Current use of contraception by background characteristics: men Percentage distribution of all men by contraceptive method currently used, according to selected background characteristics, Tanzania 1999 ______________________________________________________________________________________________________________ Modern method Traditional method __________________________________ _____________________________ Any Any Female tradi- Periodic Not Number Background Any modern Inject- Male sterili- tional absti- With- Other currently of characteristic method method Pill IUD ables condom sation method nence drawal LAM methods using Total men _______________________________________________________________________________________________________________ Residence Urban Rural Mainland/Zanzibar Mainland Urban Rural Zanzibar Pemba Unguja Education No education Incomplete primary Complete primary Secondary + No. of living children None 1 2 3 4 5 6+ Total 38.5 31.8 6.8 0.6 3.9 19.0 1.2 6.7 4.1 1.4 1.2 0.2 61.5 100.0 941 26.0 16.8 3.0 0.1 2.8 9.5 1.4 9.2 4.1 2.8 1.8 0.6 74.0 100.0 2,601 29.7 21.1 4.0 0.3 3.1 12.2 1.4 8.6 4.1 2.4 1.7 0.5 70.3 100.0 3,452 39.0 32.3 6.9 0.6 4.0 19.4 1.3 6.7 4.1 1.4 1.2 0.2 61.0 100.0 909 26.3 17.0 3.0 0.1 2.9 9.6 1.4 9.3 4.1 2.8 1.8 0.6 73.7 100.0 2,543 16.4 11.3 4.3 0.2 1.4 5.2 0.2 5.1 2.8 1.7 0.5 0.0 83.6 100.0 90 9.9 3.7 1.4 0.3 0.5 1.0 0.6 6.2 3.6 1.7 0.8 0.0 90.1 100.0 36 20.7 16.3 6.2 0.2 2.0 8.0 0.0 4.4 2.3 1.8 0.3 0.0 79.3 100.0 55 14.9 8.6 1.7 0.0 1.6 2.8 2.5 6.3 3.0 1.5 1.5 0.3 85.1 100.0 495 22.7 15.1 3.3 0.4 2.2 7.3 1.8 7.7 3.7 2.2 1.2 0.6 77.3 100.0 1,000 34.5 24.8 4.6 0.0 3.7 15.8 0.7 9.6 4.5 2.8 2.0 0.3 65.5 100.0 1,791 46.8 38.8 7.5 2.0 5.0 21.6 1.8 8.1 4.6 2.1 0.7 1.4 53.2 100.0 256 16.1 15.5 0.8 0.0 0.2 14.4 0.0 0.6 0.4 0.2 0.0 0.1 83.9 100.0 1,482 36.8 28.4 7.3 0.5 5.3 14.8 0.3 8.4 6.5 1.3 0.6 0.3 63.2 100.0 395 39.5 26.0 7.9 0.0 2.6 14.9 0.7 13.5 7.0 2.3 3.6 0.5 60.5 100.0 369 43.4 28.7 6.0 0.9 5.4 14.3 2.1 14.7 5.3 5.5 3.3 0.6 56.6 100.0 314 35.7 21.9 3.8 0.0 4.1 12.5 1.3 13.8 3.5 7.3 2.3 0.7 64.3 100.0 213 38.1 22.7 11.0 0.0 7.3 3.0 1.4 15.4 5.2 7.7 1.9 0.6 61.9 100.0 194 38.7 20.6 4.3 0.7 6.5 3.5 5.6 18.2 9.2 3.6 4.0 1.4 61.3 100.0 574 29.3 20.8 4.0 0.3 3.1 12.0 1.4 8.5 4.1 2.4 1.6 0.5 70.7 100.0 3,542 _______________________________________________________________________________________________________________ LAM = Lactational amenorrhoea method relatively more likely to rely on traditional methods such as withdrawal, while those with some education favour modern contraceptives such as injectables and pills. Women with some secondary education are most likely to use condoms, followed by injectables and periodic abstinence. As expected, current contraceptive use rises with the number of living children. The percentage of women using any contraceptive increases rapidly from 7 percent among women with no living children to 28 percent among those with one child and only rises gradually to 30 percent among those with six or more children. Almost the same trend is observed for the current use of modern and traditional contraceptive methods. Differentials in contraceptive use among men follow patterns similar to those that among women (Table 4.5.2). Trends in Contraceptive Use 52 * Fertility Regulation Figure 4.2 Contraceptive Use among All Women Age 15-49 by Residence and Education 33 18 23 14 14 18 27 43 RESIDENCE Urban Rural MAINLAND/ZANZIBAR Mainland Zanzibar EDUCATION No Education Primary Incomplete Primary Complete Secondary+ 0 10 20 30 40 50 Percent of Women Modern Traditional TRCHS 1999 Contraceptive use has substantially increased over the past decade. In 1991-92, only 10 percent of all women were using any contraceptive method; that proportion has more than doubled to 22 percent (Figure 4.3). On the other hand, in 1991-92, current use of any modern contraceptive method among all women was at 6 percent, and the percentage has almost tripled to 16 percent in 1999. Focusing on specific methods, most notable is the steady rise in use of injectables, from less than 1 percent of women in 1991-92 to 5 percent in 1999. Use of male condoms has also increased from less than 1 percent of women in 1991-92 to about 4 percent in 1999. Two trends are of special note: & Use of female sterilisation. In spite of the sizeable proportion of women who say that they do not want to have any more children, the proportion of women who have been sterilised has changed little. & Use of traditional methods. Current use of traditional methods has increased from about 4 percent in 1991-92 to 7 percent in 1999, despite the increased knowledge of modern contraceptive methods since 1991-92. Fertility Regulation * 53 Figure 4.3 Trends in Contraceptive Use among All Women Age 15-49, 1991-1999 10 6 16 12 22 16 Any Method Any Modern Method 0 5 10 15 20 25 Percent 1991-92 TDHS 1996 TDHS 1999 TRCHS 4.5 SOURCES OF FAMILY PLANNING METHODS Women who reported using a modern contraceptive method at the time of the survey were then asked where they obtained the method the last time. It is likely that some women may have misreported the type of place where they obtained the method, since the distinction between hospitals, clinics, and sometimes between public and private sources may not be clear to them. Table 4.6 shows that current users of modern contraceptives in Tanzania are more likely to obtain their supplies from the public (government) sector (67 percent) than the private medical sector (22 percent) or other private sources (11 percent). These results show that the public sector is the source of modern contraceptives to seven of every ten current users. Public sources include dispensaries which supply the bulk (27 percent) of the users, followed by government health centres (18 percent), district hospitals (13 percent), and regional hospitals (8 percent). About two in ten current users get their supplies from the private medical sector. The prominent institutions among this source are pharmacies (10 percent), religious/mission hospitals (5 percent), and private doctors and clinics/hospitals (4 percent). The type of source varies greatly by method. Those using methods requiring medical expertise like sterilisation and injectables are more likely to get them from the public sector. As expected, the majority of condom users obtain their supplies from private sources such as pharmacies and shops. There has been some shift from public to private sources of contraception since 1991-92. However, the public sector has remained a dominant source of contraceptives, supplying almost all of the injectables (88 percent), pills (79 percent), and female sterilisations (70 percent). 54 * Fertility Regulation Table 4.6 Source of supply for contraceptive methods Percent distribution of current users of modern contraceptive methods by most recent source of supply or information, according to specific method, Tanzania 1999_____________________________________________________________________________ Female All Inject- Male sterili- modern Source of supply Pill ables condom sation methods1_____________________________________________________________________________ Public sector Regional hospital District hospital Government health centre Dispensary Village health worker Private medical Mission hospital Private hospital/clinic Pharmacy CBD worker Other private Shop Friends/relatives Health education/bar girls Other Don’t know Missing Total Number 79.4 88.1 18.1 69.8 67.2 2.3 5.1 0.5 41.1 7.6 12.6 15.9 4.0 24.8 13.1 27.7 26.7 3.2 0.0 18.3 34.1 40.5 7.8 3.9 26.9 2.6 0.0 2.5 0.0 1.3 17.7 11.9 38.8 26.9 21.8 3.7 4.3 0.0 25.4 5.3 0.3 6.7 3.0 1.5 3.8 8.1 0.0 33.8 0.0 10.1 5.6 1.0 1.9 0.0 2.5 2.9 0.0 42.2 0.0 10.5 0.2 0.0 27.2 0.0 6.3 2.5 0.0 14.6 0.0 4.0 0.0 0.0 0.4 0.0 0.1 0.2 0.0 0.0 0.0 0.1 0.0 0.0 1.0 0.0 0.2 0.0 0.0 0.0 3.3 0.3 100.0 100.0 100.0 100.0 100.0 186 216 140 62 630 _____________________________________________________________________________ CBD = Community-based distribution 1Total includes 19 IUD users, 4 implant users, and 3 female condom users 4.6 CONTACT OF NONUSERS WITH FAMILY PLANNING PROVIDERS Family planning fieldworkers who are largely based in rural areas are expected to visit women and men of reproductive age, especially those who are not using any modern contraceptive method. One of the objectives of such visits is to discuss the options and, when indicated, motivate the nonusers to adopt a method of family planning. Health facility and extension workers are also expected to visit or discuss and motivate families for family planning while providing other health services. To get an indication of the frequency of such visits or discussions, women were asked whether a family planning fieldworker had visited them within the previous 12 months. Table 4.7 shows that not much has changed since the 1996 TDHS, with only 5 percent of nonusers having been visited by a family planning fieldworker during the 12 months preceding the survey. In the 12 months preceding the survey, more than half (53 percent) of nonusers visited a health facility; however, only 14 percent of nonusers (or 27 percent of those who visited a facility) said that someone at the facility spoke to them about family planning. This finding gives insight into the level of missed opportunities (contacts between nonusers and health workers that were not used to motivate nonusers to adopt family planning). No one at the health facility spoke to three-quarters of the nonusers about family planning. About eight in ten (81 percent) nonusers were neither visited by a family planning worker Fertility Regulation * 55 Table 4.7 Contact of nonusers with family planning providers Percent distribution of nonusers by whether they were visited by a family planning (FP) worker or spoke with a health facility staff member about family planning methods during the 12 months prior to interview, according to selected background characteristics, Tanzania 1999_____________________________________________________________________________________________________ Visited by family Not visited by family planning fieldworker planning fieldworker ______________________ _______________________ Visited Visited health facility health facility No FP ______________ Did not ______________ Did not services Dis- Did not visit Dis- Did not visit or infor- Number Background cussed discuss health cussed discuss health mation of characteristic FP FP facility FP FP facility Missing provided Total nonusers _____________________________________________________________________________________________________ Age 15-19 20-24 25-59 30-34 35-39 40-44 45-49 Residence Urban Rural Mainland/Zanzibar Mainland Urban Rural Zanzibar Pemba Unguja Education No education Incomplete primary Complete primary Secondary + Total 0.8 0.3 1.1 5.3 29.6 62.9 0.1 92.4 100.0 839 2.1 0.7 0.6 21.9 36.9 37.6 0.3 74.5 100.0 572 6.0 1.3 0.6 20.9 39.1 32.1 0.0 71.2 100.0 554 2.5 1.4 1.6 20.2 36.7 37.7 0.0 74.4 100.0 355 1.9 3.4 1.1 15.8 38.3 39.5 0.0 77.8 100.0 331 3.8 0.9 1.9 13.2 34.7 44.9 0.6 79.6 100.0 213 2.3 0.7 1.9 5.2 31.8 57.3 0.9 89.1 100.0 267 5.8 3.1 3.2 13.2 37.7 36.9 0.1 74.6 100.0 752 1.6 0.4 0.4 14.8 34.0 48.6 0.2 82.6 100.0 2,379 2.6 1.0 1.1 14.4 34.4 46.4 0.2 80.7 100.0 3,044 5.9 3.1 3.2 13.1 37.0 37.6 0.1 74.6 100.0 724 1.5 0.4 0.4 14.8 33.5 49.1 0.2 82.7 100.0 2,320 2.8 2.1 1.4 16.2 52.9 24.2 0.4 77.1 100.0 86 1.5 0.8 1.1 14.5 55.2 26.1 0.8 81.3 100.0 41 4.0 3.3 1.6 17.7 50.9 22.5 0.0 73.4 100.0 46 1.2 0.1 0.5 12.1 34.1 51.6 0.4 85.7 100.0 940 2.2 0.8 0.6 11.3 30.2 54.6 0.2 84.9 100.0 702 3.7 1.3 1.6 17.5 37.5 38.4 0.0 76.0 100.0 1,365 3.3 7.6 3.1 15.5 37.9 32.1 0.5 70.0 100.0 123 2.6 1.1 1.1 14.4 34.9 45.8 0.2 80.6 100.0 3,131 nor spoken to about family planning when they visited a health facility. This lack of contact with family planning providers actually represents a slight improvement from the 1996 TDHS level of 87 percent. However, it still indicates there is a large pool of potential users of family planning that could be targeted for family planning counseling. To reach these potential users, a vigorous outreach programme is needed. With the onset of the decentralisation initiative focusing on the district and community levels, the approaches can include encouraging all health workers to discuss fertility preference issues and the option of family planning whenever the opportunity arises. 4.7 INTENTION TO USE FAMILY PLANNING AMONG NONUSERS An important indicator of changing demand for contraception is the extent to which nonusers of contraception intend to use family planning services in the future. During the 1999 TRCHS, respondents who were not using contraception at the time of the survey were asked whether they intended to use a contraceptive method in the next 12 months. Table 4.8 shows that 35 percent of women and 31 percent of men who were not using a 56 * Fertility Regulation Table 4.8 Future use of contraception Percent distribution of all women and men who are not using a contraceptive method by intention to use a method in the next 12 months, according to number of living children, Tanzania 1999 ___________________________________________________________________________________________ Number of living children1_________________________________________ Total Total Future use of contraception 0 1 2 3 4+ women men__________________________________________________________________________________________ Intend to use in next 12 months Unsure as to intention Do not intend to use in next 12 months Don’t know/Missing Total Number of women/men 17.8 43.7 45.3 43.6 39.0 34.9 31.3 19.3 5.2 5.3 5.6 4.9 9.4 12.5 62.2 50.7 49.4 50.3 55.6 55.3 55.5 0.7 0.4 0.1 0.5 0.5 0.5 0.6 100.0 100.0 100.0 100.0 100.0 100.0 100.0 934 544 453 329 871 3,131 2,503 ___________________________________________________________________________________________ 1 Includes current pregnancy contraceptive reported that they intended to use one some time in the next 12 months. Intention to use among women seems to be related to the number of living children; it is lower among those without children and then rises with an increase in the number of children. 4.8 REASONS FOR NONUSE Respondents who were not currently using any contraception and said they did not intend to use any method in the next 12 months were asked about their reasons for nonuse. Table 4.9 presents data on the main reasons for not using contraceptives given by both women and men. A desire to have more children was the most prominent reason for nonuse among women (23 percent) and was commonly cited by men as well (22 percent). Among men, however, the most common reason for nonuse is not being married (33 percent). Other common reasons for nonuse among women and men are that the respondent is opposed to contraceptive use or that the respondent is not sexually active. The desire for children has been the major reason for nonuse of contraception among women since 1991-92. Menopause or hysterectomy are also common reasons for nonuse, especially among women and men age 30 and older. 4.9 EXPOSURE TO FAMILY PLANNING MESSAGES The media, especially radio and television, are the major potential sources of information about family planning. To asses the effectiveness of such media for the dissemination of family planning information, all female and male respondents in the survey were asked if they had heard or seen messages about family planning on the radio, television, or in various print media during the six months before the interview. Tables 4.10.1 and 4.10.2 show that, as in the 1996 TDHS, a higher proportion of men than women are exposed to family planning messages. Seven in ten men (70 percent) and 66 percent of women reported that they had heard or seen a family planning message in the past six months. Radio remains the most dominant of the media; less than 10 percent of respondents had seen a family planning message on television. Medical professionals are an important source of family planning information, especially among women (49 percent). Among women, the next most effective media are billboards, posters, and live dramas. Among men, the most important sources Fertility Regulation * 57 Table 4.9 Reasons for not intending to use contraception Percent distribution of all women and men who are not using a contraceptive method and who do not intend to use in the future, by main reason for not intending to use, according to age, Tanzania 1999 _______________________________________________________________________________ Women Men ________________________ ______________________ Age Age Reason for not intending ______________ Total ______________ Total to use contraception <30 30-49 women <30 30-49 men_______________________________________________________________________________ Not married No sex Infrequent sex Menopausal/hysterectomy Subfecund/infecund Postpartum/amenorrheic Breastfeeding Wants more children Respondent opposed Partner opposed Others opposed Religious prohibition Knows no method Knows no source Health concerns Fear side effects Lack of access Costs too much Inconvenient to use Interferes with body processes Methods not reliable Other Don't know Number of women/men 28.3 2.2 16.6 54.5 8.3 32.6 19.2 6.3 13.4 16.3 3.2 10.1 3.1 6.9 4.8 5.3 5.2 5.3 0.6 18.8 8.8 0.0 16.1 7.6 1.4 5.1 3.1 0.0 2.8 1.3 1.5 3.8 2.5 0.6 2.5 1.5 4.4 1.6 3.2 0.6 1.5 1.0 22.0 23.2 22.6 16.3 27.4 21.6 19.7 22.0 20.7 12.7 24.3 18.2 9.8 8.0 9.0 0.8 4.0 2.3 0.6 0.7 0.7 0.0 0.8 0.4 1.3 2.3 1.7 3.1 5.3 4.2 7.2 3.4 5.5 10.0 5.9 8.1 2.2 0.7 1.5 5.6 4.0 4.9 0.7 3.7 2.0 0.6 1.8 1.2 7.4 7.5 7.5 2.9 7.1 4.9 0.4 0.5 0.4 0.0 0.0 0.0 0.1 0.3 0.2 0.4 0.1 0.3 0.4 0.6 0.5 4.2 0.3 2.3 1.3 2.8 2.0 0.6 2.7 1.6 4.1 2.7 3.5 0.0 0.0 0.0 5.1 6.3 5.6 2.5 3.1 2.8 2.6 0.4 1.6 1.8 1.0 1.4 954 776 1,730 730 660 1,390 of family planning information are radio, billboards, and medical staff (doctors, nurses). About one- third of women and men said they had not seen or heard a family planning message in the past six months. Exposure to family planning messages is higher among younger women and men than among older respondents, and it increases steeply with education level. Urban women and men are more exposed to family planning messages than respondents in the rural areas. Exposure to family planning messages is higher in Zanzibar than in the Mainland. The pattern of exposure of family planning messages through radio and television by age has not changed since the 1996 TDHS. Also, the sharp contrast in exposure to family planning messages through radio and television still exists between urban and rural areas and between Mainland and Zanzibar. Access to family planning messages through radio and television is much higher in Zanzibar than in the Mainland for both women and men. 58 * Fertility Regulation Table 4.10.1 Heard family planning message: women Percentage of all women who heard a message about family planning in the six months preceding the interview, by source of message and selected background characteristics, Tanzania 1999 _______________________________________________________________________________________________________ Commu- Number Background Any Newspaper/ Leaflet/ Bill- nity Live Doctor/ No of characteristic source Radio TV magazine Poster Pamphlet board events drama nurse message women ______________________________________________________________________________________________________ Age 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Residence Urban Rural Mainland/Zanzibar Mainland Urban Rural Zanzibar Pemba Unguja Education No education Incomplete primary Complete primary Secondary + Total 47.2 31.6 3.3 9.1 14.2 7.5 16.4 7.8 12.6 22.7 52.8 909 75.7 47.6 6.3 17.4 24.5 21.1 29.7 10.7 22.1 57.9 24.3 811 76.2 48.3 6.9 14.3 25.2 18.6 27.4 13.0 24.3 63.4 23.8 749 74.9 41.0 6.6 16.2 21.0 17.6 27.5 13.0 19.8 63.4 25.1 490 72.8 47.2 7.4 12.0 19.7 15.7 27.6 15.8 20.7 54.4 27.2 456 63.6 39.2 4.1 14.3 17.1 16.1 20.7 14.7 20.4 49.8 36.4 299 52.1 32.5 1.7 4.9 9.0 4.5 14.8 10.9 12.8 35.4 47.9 315 84.6 63.3 15.0 29.4 39.1 29.3 44.9 16.4 43.3 61.8 15.4 1,122 59.1 33.0 1.7 6.7 12.0 9.3 15.8 9.8 9.7 43.9 40.9 2,907 65.9 41.1 4.8 12.9 19.6 14.9 23.9 11.6 18.5 48.9 34.1 3,929 84.5 63.2 13.9 29.6 39.4 29.5 45.3 16.5 42.7 62.1 15.5 1,088 58.8 32.6 1.4 6.5 12.0 9.3 15.6 9.7 9.3 43.8 41.2 2,841 76.0 56.3 26.1 15.3 19.9 13.5 26.7 14.3 39.5 49.8 24.0 100 69.9 46.1 15.4 12.0 13.9 9.9 23.7 15.2 24.8 49.3 30.1 44 80.8 64.3 34.5 17.8 24.5 16.3 29.0 13.7 51.1 50.3 19.2 56 46.1 23.5 1.5 0.8 3.5 1.2 9.4 7.8 7.1 34.4 53.9 1,093 59.4 34.5 2.6 6.0 16.0 8.5 16.7 9.8 12.9 41.3 40.6 854 78.0 51.3 5.5 18.4 26.5 22.9 31.9 13.1 24.7 59.2 22.0 1,866 92.1 74.8 34.6 55.9 55.2 39.9 57.2 25.6 55.6 63.7 7.9 215 66.2 41.5 5.4 13.0 19.6 14.9 23.9 11.6 19.1 48.9 33.8 4,029 4.10 EXPOSURE TO REPRODUCTIVE AND CHILD HEALTH DRAMAS Beginning in 1993, Radio Tanzania Dar es Salaam, the national radio station, started airing two radio soap operas carrying family planning messages. Airing of Twende na Wakati started in July 1993, and airing of Zinduka! began in October 1993. Since then, these programmes have been improved and several other radio dramas carrying reproductive health messages, including family planning and HIV/AIDS, have been developed and aired. Of special concern is the emergence of radio dramas targeting youth, such as Vijana Wetu and Sema Naye. As a measure of the success of the radio campaigns, respondents in the survey were asked to mention the radio programmes they had listened to in the past six months. Table 4.11 shows that in general more men than women listen to the reproductive health dramas and that Twende na Wakati and Zinduka! are still the most popular radio dramas. The findings show that, in the six months preceding the survey, 34 percent of women and 47 percent of men had listened to Zinduka! During the same period, 31 percent of the women and 46 percent of the men had listened to Twende na Wakati. Other dramas that women have listened to include Ukimwi Kifo (29 percent), Geuza Mwendo (23 percent), Vijana Wetu (19 percent), and Sema Naye (18 percent). Other dramas that men have listened to include Ukimwi Kifo (40 percent), Geuza Mwendo (35 percent), Vijana Wetu (27 percent), and Sema Naye (26 percent). Fertility Regulation * 59 Table 4.10.2 Heard family planning message: men Percentage of all men who heard a message about family planning in the six months preceding the interview, by source of message and selected background characteristics, Tanzania 1999 _______________________________________________________________________________________________________ Commu- Number Background Any Newspaper/ Leaflet/ Bill- nity Live Doctor/ No of characteristic source Radio TV magazine Poster Pamphlet board events drama nurse message men ______________________________________________________________________________________________________ Age 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 Residence Urban Rural Mainland/Zanzibar Mainland Urban Rural Zanzibar Pemba Unguja Education No education Incomplete primary Complete primary Secondary + Total 53.3 42.2 6.3 14.3 18.9 13.5 20.2 8.7 20.9 14.3 46.7 790 72.0 61.6 9.2 30.3 32.2 24.5 36.9 19.1 35.7 28.1 28.0 540 77.1 62.9 12.2 29.9 31.9 25.2 37.5 20.8 33.0 34.1 22.9 546 78.8 65.2 13.0 33.1 34.6 26.7 40.5 21.5 37.0 41.6 21.2 371 77.6 65.3 12.9 36.4 40.7 26.4 41.1 27.6 35.7 42.7 22.4 445 79.4 64.5 11.6 32.7 38.0 23.8 42.2 23.7 37.5 46.1 20.6 219 66.9 53.7 5.9 22.4 23.0 16.2 33.7 19.7 18.9 29.3 33.1 259 71.9 60.1 7.2 27.8 28.3 15.4 27.4 20.9 25.2 39.1 28.1 201 61.3 53.1 6.0 13.1 21.3 9.4 26.0 19.5 19.5 27.0 38.7 171 84.3 70.4 24.4 46.2 51.3 35.2 52.2 25.5 48.5 36.6 15.7 941 64.3 52.7 4.1 19.2 21.5 15.5 26.3 16.4 22.8 28.9 35.7 2,601 69.3 57.2 8.7 26.3 29.4 20.6 33.0 18.6 28.9 30.9 30.7 3,452 84.2 70.3 23.3 46.4 51.6 35.3 52.4 25.2 47.6 36.6 15.8 909 64.0 52.4 3.6 19.1 21.5 15.4 26.1 16.2 22.2 28.8 36.0 2,543 81.1 66.7 39.3 28.2 31.1 24.1 40.1 28.9 58.4 34.9 18.9 90 78.4 65.0 31.5 23.2 23.9 17.3 39.7 26.0 45.1 36.9 21.6 36 82.9 67.8 44.3 31.5 35.7 28.6 40.3 30.8 67.1 33.6 17.1 55 43.2 31.9 1.1 3.4 3.8 1.3 8.4 10.3 11.3 18.5 56.8 495 61.8 50.1 4.8 13.7 19.7 11.4 24.5 14.7 21.0 23.0 38.2 1,000 78.1 65.2 10.4 33.8 37.3 26.8 40.3 21.9 34.9 36.2 21.9 1,791 91.4 80.6 38.1 68.2 62.2 52.2 65.2 30.0 61.7 49.8 8.6 256 69.6 57.4 9.5 26.3 29.4 20.7 33.2 18.8 29.6 31.0 30.4 3,542 Urban women and men are more likely to have listened to the reproductive health dramas than their rural counterparts. As level of education increases, both women and men are more likely to listen to any of the six reproductive health radio dramas. The Vijana Wetu and Sema Naye radio dramas tailored for youth attracted a higher proportion of young men than of young women. Since 1996, the proportion of women and men who have listened to Zinduka! has increased. For example, in 1996, 25 percent of women and 39 percent of men said they had listened to Zinduka!; in 1999, these figures were 34 and 47 percent, respectively. The proportion of women who have listened to Twende na Wakati has grown from 23 to 31 percent, while for men, the figures are 37 to 46 percent. 4.11 KNOWLEDGE OF FAMILY PLANNING LOGO The national family planning logo—a green star—was developed and introduced in 1993. The objective of this logo is to promote use of family planning services. After the introduction of the logo, a number of efforts were made to promote it. Beginning in 1993, the logo was launched in four venues (Dar es Salaam, Arusha, Mwanza, and Mbeya), and logo promotional messages were disseminated in the print and electronic media. In late 1995 and early 1996, Green Star logo campaigns were launched, covering all regional headquarters that were not covered in 1993. During these campaigns, logo promotional messages were disseminated in the print and electronic media, live dramas were performed, and people were made aware of the logo throughout the country. 60 * Fertility Regulation Table 4.11 Exposure to family planning dramas Percentage of all women and men who have listened to specific family planning and health programmes on the radio during the six months prior to the interview, by selected background characteristics, Tanzania 1999 _______________________________________________________________________________________________ Number Background Twende na Geuza Ukimwi Sema Vijana of characteristic Zinduka! Wakati Mwendo Kifo Naye Wetu women/men_______________________________________________________________________________________________ WOMEN _______________________________________________________________________________________________ Age 15-19 20-24 25-59 30-34 35-39 40-44 45-49 Residence Urban Rural Mainland/Zanzibar Mainland Urban Rural Zanzibar Pemba Unguja Education No education Incomplete primary Complete primary Secondary + Total 29.2 24.7 18.7 25.2 13.1 14.5 909 38.6 36.4 26.1 33.1 20.9 21.3 811 39.4 38.6 29.2 35.5 22.7 22.4 749 33.8 29.5 23.7 30.6 20.0 19.9 490 34.1 33.6 24.5 27.0 18.6 21.4 456 27.7 27.5 21.8 27.9 15.2 21.4 299 22.8 20.3 12.7 18.3 12.2 14.0 315 56.3 53.7 41.8 48.1 32.9 35.7 1,122 24.7 22.4 16.0 22.0 12.3 12.9 2,907 33.7 31.3 23.5 29.5 18.3 19.5 3,929 57.1 54.6 42.9 48.9 33.8 36.5 1,088 24.7 22.4 16.1 22.1 12.4 13.0 2,841 26.2 23.4 8.8 19.4 6.0 9.4 100 25.7 20.3 7.2 17.7 5.2 9.6 44 26.6 25.7 10.1 20.8 6.7 9.2 56 15.5 15.2 10.3 15.1 8.4 8.5 1,093 26.3 23.3 19.2 24.7 13.6 13.7 854 43.6 40.6 29.9 36.5 23.5 24.8 1,866 65.7 61.3 45.9 55.8 36.5 47.3 215 33.5 31.1 23.2 29.2 18.0 19.2 4,029 ______________________________________________________________________________________________ MEN ______________________________________________________________________________________________ Age 15-19 20-24 25-59 30-34 35-39 40-44 45-49 50-54 55-59 Residence Urban Rural Mainland/Zanzibar Mainland Urban Rural Zanzibar Pemba Unguja Education No education Incomplete primary Complete primary Secondary + Total 38.3 32.7 28.2 29.2 18.5 19.1 790 51.6 50.0 40.3 45.3 31.2 31.9 540 54.4 51.6 39.1 42.7 29.5 29.2 546 54.1 55.3 43.3 45.8 27.2 27.6 371 51.8 52.9 38.3 46.1 34.2 34.4 445 53.9 54.1 35.7 51.4 21.5 30.3 219 39.1 42.3 31.3 39.3 22.2 25.2 259 42.2 41.9 32.3 35.4 27.8 24.4 201 30.1 35.1 26.9 33.8 23.4 21.7 171 63.6 57.3 44.4 48.1 34.5 31.5 941 41.0 41.6 32.2 37.5 23.2 25.3 2,601 47.3 46.2 36.0 40.4 26.7 27.3 3,452 64.6 58.3 45.6 48.6 35.4 32.2 909 41.0 41.8 32.6 37.5 23.6 25.5 2,543 37.2 31.4 13.1 35.1 10.1 15.0 90 36.4 31.3 12.9 33.9 9.1 14.5 36 37.7 31.5 13.2 35.9 10.7 15.3 55 21.2 21.2 17.1 22.4 11.5 11.5 495 37.8 36.7 27.3 35.4 21.9 22.6 1,000 55.9 54.5 42.2 46.9 31.3 32.6 1,791 70.7 68.0 55.0 47.5 36.5 34.7 256 47.0 45.8 35.4 40.3 26.2 27.0 3,542 ______________________________________________________________________________________________ Fertility Regulation * 61 Table 4.12.1 Green Star logo family planning symbol: women Percentage of women who know the Green Star (GS) logo, and of those, the percentage who know that it refers to family planning (FP) and the percentage who cited various sources where they heard of Green Star, by selected background characteristics, Tanzania 1999 _____________________________________________________________________________________________________ All women Women who know Green Star logo ________________ ____________________________________________________________ Knows Knows Source of knowledge about Green Star Green Number GS logo _____________________________________________ Number Background Star of refers Bill- Clinic Service of characteristic logo women to FP board Poster Leaflets Radio sign provider women _____________________________________________________________________________________________________ Age 15-19 20-24 25-59 30-34 35-39 40-44 45-49 Residence Urban Rural Mainland/Zanzibar Mainland Urban Rural Zanzibar Pemba Unguja Education No education Incomplete primary Complete primary Secondary + No. of living children None 1 2 3 4 5 6+ Total 40.2 909 71.2 21.8 17.2 5.6 50.0 35.4 17.9 366 64.8 811 85.1 16.4 13.1 6.6 37.6 54.9 35.7 526 67.7 749 82.0 19.9 16.3 11.6 43.0 60.4 46.5 507 61.3 490 83.5 11.9 13.6 7.3 39.1 58.1 44.7 300 54.0 456 82.0 16.3 20.1 5.7 46.4 49.7 41.1 246 52.5 299 81.6 15.2 15.3 8.6 41.3 57.6 40.9 157 39.7 315 84.5 23.9 11.8 4.0 45.3 41.9 30.9 125 79.6 1,122 89.0 28.0 22.3 11.3 54.7 54.1 37.0 893 45.9 2,907 76.1 11.0 10.8 5.1 34.8 51.0 37.3 1,334 55.9 3,929 81.4 17.9 15.6 7.6 42.8 52.5 37.3 2,196 80.8 1,088 89.2 28.3 22.6 11.4 54.9 54.4 37.1 879 46.4 2,841 76.2 11.1 10.9 5.1 34.7 51.3 37.5 1,318 31.1 100 73.3 8.0 3.1 2.7 38.9 34.0 24.0 31 22.7 44 64.6 2.1 3.7 1.8 29.7 27.1 21.9 10 37.7 56 77.4 10.7 2.8 3.1 43.3 37.3 25.0 21 32.1 1,093 71.7 11.3 10.9 1.2 25.2 49.5 38.6 351 46.2 854 75.7 13.4 14.6 5.4 42.3 46.0 29.0 394 69.7 1,866 84.2 18.5 15.6 8.9 45.0 56.2 39.6 1,301 84.2 215 91.4 34.9 25.0 14.6 62.1 43.4 34.0 181 43.6 1,104 75.6 23.7 20.0 7.9 56.2 33.3 17.7 482 68.4 733 84.6 18.9 11.9 5.2 41.8 50.3 38.2 501 64.2 618 84.6 17.1 15.4 12.0 41.6 64.2 42.1 397 63.3 427 83.7 19.0 15.4 4.6 36.9 60.3 51.0 270 58.1 381 81.1 14.1 18.0 4.6 42.3 59.4 45.5 221 52.9 276 84.3 11.7 11.6 12.4 34.7 53.2 49.1 146 42.9 489 74.9 9.6 13.5 7.7 30.1 59.4 35.0 210 55.3 4,029 81.3 17.8 15.4 7.6 42.8 52.3 37.1 2,227 Since these campaigns, promotional efforts have been maintained throughout the country. To measure the success of the promotion of the family planning logo, during the 1999 TRCHS survey, respondents were asked if they had seen or heard about the Green Star symbol, sources of that information, and their understanding of the logo. Tables 4.12.1 and 4.12.2 show that more than half of women and men (55 percent of women and 51 percent of men ) know about the Green Star logo. Among those who know about the logo, around 80 percent know that the Green Star logo is related to family planning. Most women learned about the Green Star family planning logo from clinic signs (52 percent) and the radio (43 percent). Women also learned about the Green Star logo from service providers (37 percent), billboards (18 percent), posters (15 percent), and leaflets (8 percent). Men overwhelmingly learned about the Green Star logo from the radio (69 percent). Far fewer men learned about the Green Star logo from billboards (23 percent), posters (20 percent), clinic signs (19 percent), service providers (19 percent), and leaflets (11 percent). 62 * Fertility Regulation Table 4.12.2 Green Star logo family planning symbol: men Percentage of men who know the Green Star (GS) logo, and of those, the percentage who know that it refers to family planning (FP) and the percentage who cited various sources where they heard of Green Star, by selected background characteristics, Tanzania 1999 _____________________________________________________________________________________________________ All men Men who know Green Star logo ________________ ____________________________________________________________ Knows Knows Source of knowledge about Green Star Green Number GS logo _____________________________________________ Number Background Star of refers Bill- Clinic Service of characteristic logo men to FP board Poster Leaflets Radio sign provider men _____________________________________________________________________________________________________ Age 15-19 20-24 25-59 30-34 35-39 40-44 45-49 50-54 55-59 Residence Urban Rural Mainland/Zanzibar Mainland Urban Rural Zanzibar Pemba Unguja Education No education Incomplete primary Complete primary Secondary + No. of living children None 1 2 3 4 5 6+ Total 37.2 790 69.8 22.7 13.6 7.1 65.3 12.3 12.5 294 54.6 540 82.7 31.1 27.3 14.4 73.9 13.4 13.1 295 61.2 546 85.6 21.6 19.0 9.3 65.4 17.9 22.2 334 65.4 371 81.0 20.7 21.8 14.6 74.7 18.8 20.9 243 56.5 445 81.7 22.9 25.2 10.3 58.3 36.2 21.7 252 56.1 219 83.3 18.6 14.8 7.3 72.4 22.2 23.5 123 43.2 259 75.2 19.8 13.5 11.4 75.4 16.7 19.9 112 46.0 201 80.2 22.6 20.1 14.1 80.4 22.9 23.9 92 35.7 171 86.7 24.4 17.9 4.0 75.8 3.8 23.2 61 74.0 941 88.6 36.5 29.0 15.0 70.8 16.5 19.1 696 42.6 2,601 75.2 14.9 14.5 8.0 68.3 20.5 18.9 1,109 51.5 3,452 80.4 23.3 20.3 10.8 69.2 19.1 19.0 1,779 75.3 909 88.8 36.6 29.4 15.2 70.8 16.7 19.1 685 43.0 2,543 75.2 15.0 14.6 8.0 68.3 20.6 19.0 1,094 29.6 90 75.2 18.8 5.6 4.9 70.8 8.5 13.7 27 22.5 36 60.6 4.6 5.2 2.4 61.3 9.5 16.3 8 34.3 55 81.4 24.9 5.8 6.0 74.8 8.0 12.6 19 25.8 495 62.2 9.3 2.6 4.8 68.7 13.9 13.1 128 38.4 1,000 74.2 18.1 16.8 8.3 72.0 16.6 13.1 384 60.5 1,791 82.4 24.1 21.1 11.2 67.9 20.3 19.1 1,084 81.7 256 92.5 36.5 31.8 16.0 71.7 19.2 32.4 209 44.6 1,482 76.5 26.5 19.9 9.9 71.5 14.9 11.9 661 67.6 395 83.8 24.6 22.3 14.3 64.7 14.3 24.8 267 64.2 369 86.2 24.2 23.6 5.5 64.8 23.2 25.8 237 57.8 314 84.9 20.5 15.8 5.9 69.3 23.2 14.5 182 50.6 213 80.1 26.1 27.9 15.3 66.0 29.4 25.6 108 53.6 194 78.0 6.9 6.7 14.9 69.6 28.2 19.1 104 42.9 574 79.0 19.6 20.4 13.8 73.7 19.0 25.2 246 51.0 3,542 80.4 23.2 20.1 10.7 69.3 18.9 18.9 1,805 Education is highly related to knowledge of the Green Star family planning logo; 84 percent of women and 82 percent of men with some secondary education know about the logo as compared with 32 percent of women and 26 percent of men without any formal education. Urban women and men are more likely than rural residents to know the Green Star logo. Four in five women (80 percent) and 74 percent of men in urban areas know about the logo as compared with 46 percent of women and 43 percent of men in rural areas. Knowledge of the Green Star logo has increased substantially since 1996, from 36 to 55 percent of women and from 38 to 51 percent of men. Fertility Regulation * 63 Table 4.13 Knowledge of Salama condom Percentage of all women and men who have heard or seen a message about Salama condoms in the six months preceding the survey, by selected background characteristics, Tanzania 1999___________________________________________________________ All women All men __________________ __________________ Knows Number Knows Number Background Salama of Salama of characteristic condom women condom men ___________________________________________________________ Age 15-19 20-24 25-59 30-34 35-39 40-44 45-49 50-54 55-59 Residence Urban Rural Mainland/Zanzibar Mainland Urban Rural Zanzibar Pemba Unguja Education No education Incomplete primary Complete primary Secondary + Marital status Never married Currently married Formerly married Total 38.9 909 50.4 790 60.6 811 72.8 540 56.9 749 72.8 546 52.5 490 69.2 371 50.6 456 70.0 445 42.6 299 60.8 219 33.6 315 46.8 259 NA NA 49.4 201 NA NA 40.2 171 76.0 1,122 82.8 941 39.2 2,907 53.8 2,601 49.8 3,929 61.9 3,452 76.9 1,088 83.4 909 39.5 2,841 54.2 2,543 34.0 100 47.8 90 22.5 44 26.1 36 42.9 56 62.0 55 28.2 1,093 37.6 495 39.8 854 49.7 1,000 62.1 1,866 71.1 1,791 85.4 215 87.5 256 47.8 943 58.8 1,289 49.0 2,653 63.2 2,063 55.9 433 61.4 190 49.4 4,029 61.5 3,542 __________________________________________________________ NA = Not applicable 4.12 KNOWLEDGE OF SALAMA CONDOM Women and men were asked during the survey whether they had ever heard of a condom called Salama, the brand that is sold through the social marketing programme. Results in Table 4.13 show that more men (62 percent) than women (49 percent) are aware of Salama condoms. Aware- ness of Salama condoms is slightly higher among younger women and men than among older respon- dents. Among both women and men, awareness of Salama con- doms is considerably higher in urban than in rural areas. Three in four women (76 percent) in urban areas have heard of Salama con- doms, compared with 39 percent in rural areas; 83 percent of men in urban areas are aware of Salama condoms, compared with 54 percent in rural areas. Awareness of Salama condoms improves greatly with education level among both women and men. More than eight in ten women (85 percent) with some secondary education know about Salama condoms, compared with 28 percent of women with no education. The same is true among men. Awareness of Salama con- doms has increased slightly for women since 1996, from 43 to 49 percent; however, it has decreased slightly for men, from 65 to 62 percent. 4.13 ATTITUDES TOWARDS FAMILY PLANNING Communication between partners is an important factor in the decision to use family planning. Table 4.14 shows that four in ten married women (43 percent) say they have not discussed family planning with their husbands in the year prior to the survey. About a quarter of the couples (23 percent) have discussed family planning once or twice within the past 12 months, and about a third (34 percent) discussed it more often. Discussions about family planning with husbands increase with the age of the woman up to 30 years and then gradually decrease. The likelihood of never having discussed family planning is higher among teenage women (55 percent) and women age 45-49 years (60 percent). 64 * Fertility Regulation Table 4.14 Discussion of family planning with husband Percent distribution of currently married nonsterilised women who know a contraceptive method by the number of times they discussed family planning with their husband in the past year, according to current age, Tanzania 1999 ______________________________________________________________________________ Number of times family planning discussed with husband _______________________________ Number Once or More of Age Never twice often Missing Total women ______________________________________________________________________________ 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Total 55.2 27.1 17.4 0.3 100.0 201 38.4 26.7 34.4 0.5 100.0 535 38.3 24.6 36.9 0.2 100.0 592 40.2 21.3 38.2 0.3 100.0 400 41.9 21.4 36.6 0.0 100.0 350 47.8 19.6 32.6 0.0 100.0 229 59.7 12.8 26.0 1.5 100.0 223 43.2 22.8 33.7 0.3 100.0 2,529 Decisions to start using a modern contraceptive, to continue use, and to switch to a more appropriate method are facilitated when couples have a positive attitude toward family planning. Attitudinal data were collected by asking married women whether they approve of couples using family planning and what they perceive as their husband’s attitude toward family planning. This information is useful in formulating reproductive health policies since it indicates the extent to which further information, education, and communication (IEC) initiatives are needed to gain or increase acceptance of family planning. Generally, widespread disapproval of contraception acts as a barrier to adopting family planning initiatives. During the survey, both women and men in the same household were interviewed, providing an opportunity to link the couples’ responses. Table 4.15 shows the couples’ approval of family planning according to age and education differences. The results show that, when linked, 72 percent of the couples are in agreement about family planning. In about two-thirds of the couples (66 percent), both spouses approve of family planning, and in less than one in ten couples (6 percent), both disapprove of family planning. Joint approval of family planning is highest among couples in which the husband is less than five years older than the wife (73 percent) and lowest when the wife is older than her husband (57 percent). Couples are more likely to jointly approve of family planning when both husband and wife are educated. Table 4.16 shows to what extent wives and husbands report accurately on their spouse’s attitudes. The findings show that, when wives and husbands report that their spouses approve of family planning, they are generally accurate. In 94 percent of the couples in which the wife reported that her husband approves of family planning, the husband also stated that he approves of family planning. Similarly, for 87 percent of the couples in which the husband reported that his wife approves of family planning, the wife actually does approve of family planning. However, in the cases in which the wife thinks that her husband does not approve, about two-thirds of the wives (67 percent) are wrong (actually the husband approves). Among couples in which the husband thinks that his wife does not approve, half of them were wrong (actually the wife approves). Fertility Regulation * 65 Table 4.15 Attitudes of couples toward family planning Percent distribution of couples by approval of family planning, according to age difference between spouses and level of education, Tanzania 1999 ______________________________________________________________________________________________________ Wife Husband Percentage approves, approves, Don’t of couples Number Age difference/ Both Both husband wife know/ in of education approve disapprove disapproves disapproves Missing Total agreement couples______________________________________________________________________________________________________ Wife older 57.0 12.3 0.1 25.8 4.8 100.0 69.3 67 Husband older by: 0-4 years 72.9 3.9 6.2 8.7 8.3 100.0 76.8 601 5-9 years 66.0 6.6 9.6 9.8 8.0 100.0 72.6 667 10-14 years 60.7 5.0 7.5 9.2 17.6 100.0 65.7 300 15 years + 59.2 7.2 11.7 12.4 9.5 100.0 66.4 185 Education Both not educated 29.9 17.7 15.2 10.8 26.3 100.0 47.6 185 Wife educated, husband not 49.7 8.7 21.6 9.3 10.8 100.0 58.4 101 Husband educated, wife not 55.1 8.4 4.8 17.1 14.5 100.0 63.6 352 Both educated 76.8 2.8 6.7 8.2 5.6 100.0 79.6 1,181 Total 66.4 5.7 8.0 10.2 9.7 100.0 72.1 1,820 Table 4.16 Spouse’s perception of their spouse’s approval of family planning Percent distribution of couples by husband's and wife's actual attitude towards family planning, according to their spouse's perception of their attitude, Tanzania 1999 _________________________________________________________________________ Spouse’s actual attitude towards family planning Number ___________________________ of Perception Approves Disapproves Unsure Total couples_________________________________________________________________________ Wife’s perception of husband’s attitude Approves 93.8 5.2 1.1 100.0 911 Disapproves 66.7 31.0 2.3 100.0 459 Don’t know 68.6 20.5 11.0 100.0 450 Total 80.7 15.5 3.8 100.0 1,820 Husband’s perception of wife’s attitude Approves 86.5 9.5 4.1 100.0 1,237 Disapproves 49.6 41.9 8.5 100.0 226 Don’t know 56.0 24.4 19.6 100.0 358 Total 75.9 16.5 7.7 100.0 1,820 Proximate Determinants of Fertility * 65 PROXIMATE DETERMINANTS OF FERTILITY 5 This chapter presents data concerning the principal factors other than contraception that affect a woman’s risk of becoming pregnant. These factors include marriage, sexual intercourse, postpartum amenorrhoea, abstinence from sexual relations, and termination of exposure to pregnancy. Marriage and the beginning of sexual activities are important indicators of exposure of women to the risk of pregnancy. Postpartum amenorrhoea and abstinence from sexual relations affect the length of birth intervals. It is therefore important to study these factors to understand fertility. 5.1 CURRENT MARITAL STATUS In this report, the term “marriage” includes both formal and informal unions. Informal unions are those in which a man and a woman stay together intending to have a lasting relationship, even if a formal civil or religious ceremony has not been conducted. Table 5.1 presents the current marital status of eligible women and men at the time of the survey. The upper panel of Table 5.1 shows the distribution of women according to their current marital status. The table shows that 23 percent of women 15-49 in Tanzania have never married; 66 percent are currently married; and 11 percent are either widowed, divorced, or no longer living together with a partner. As expected, the proportion of women who have never married declines sharply with age from 73 percent of women age 15-19 to less than 3 percent of those age 35 years and above. Thus, marriage is almost universal in Tanzania. The proportion of women currently married increases with age up to 30-34 and then declines. As expected, the proportion of women who are widowed or divorced increases with age, while that of women who are no longer living together does not show a clear pattern. The lower panel of Table 5.1 shows that 36 percent of men age 15-59 have never been married; 58 percent are currently married; and 5 percent are either widowed, divorced, or separated. Men tend to marry at older ages than women, which is why the overall proportion of men who have never married is higher than that of women (36 percent of men compared with 23 percent of women); however, the proportion who eventually marry is as high for men as for women. For example, the proportion never married among men decreases from 97 percent among teenage males to less than 1 percent among those in their late 40s, or about the same level as for women. A comparison of these findings with those from the 1996 Tanzania Demographic and Health Survey shows little change in marital status over the past few years. 5.2 AGE AT FIRST MARRIAGE In many societies, marriage is highly associated with fertility since it directly affects the risk of conception. Biologically, a woman has a given number of years in which she can give birth. If she spends all those years in marriage, she will produce more children than if she spends only part of the period in marriage. As such, early marriage tends to lead to early childbearing, resulting in higher fertility rates. Table 5.2 presents the percentage of women and men who have married by specific ages and the median age at first marriage according to current age. 66 * Proximate Determinants of Fertility Table 5.1 Current marital status Percent distribution of women and men by current marital status, according to age, Tanzania 1999 ________________________________________________________________________________________ Current marital status ________________________________________________________ Number Never Living Not living of Age married Married together Widowed Divorced together Total women/men ________________________________________________________________________________________ WOMEN________________________________________________________________________________________ 15-19 72.8 22.2 2.8 0.2 0.7 1.4 100.0 909 20-24 22.7 59.7 8.1 1.3 3.0 5.2 100.0 811 25-29 8.0 72.8 9.4 2.3 2.9 4.7 100.0 749 30-34 4.3 75.0 8.0 3.2 5.4 4.0 100.0 490 35-39 2.5 70.0 9.7 5.3 5.8 6.6 100.0 456 40-44 1.0 70.4 9.7 7.4 6.0 5.6 100.0 299 45-49 0.8 72.8 6.8 11.5 5.3 2.8 100.0 315 Total 23.4 58.5 7.3 3.2 3.5 4.1 100.0 4,029 ________________________________________________________________________________________ MEN________________________________________________________________________________________ 15-19 96.5 2.2 0.2 0.0 0.9 0.3 100.0 790 20-24 66.9 24.9 4.5 0.4 1.6 1.8 100.0 540 25-29 19.6 69.4 4.2 0.0 2.0 4.9 100.0 546 30-34 5.6 79.3 10.7 0.3 0.4 3.8 100.0 371 35-39 6.9 84.0 1.6 1.6 2.4 3.5 100.0 445 40-44 1.9 84.5 3.4 1.7 5.3 3.2 100.0 219 45-49 0.8 85.7 5.2 1.7 3.5 3.1 100.0 259 50-54 0.5 90.4 2.8 1.3 2.1 2.8 100.0 201 55-59 0.0 87.0 3.4 4.7 0.6 4.3 100.0 171 Total 36.4 54.6 3.6 0.8 1.8 2.7 100.0 3,542 Overall, almost half of women marry before age 18 and two-thirds marry before age 20. Although the median age at first marriage appears to have risen from 17 among women age 45-49 to about 19 among women age 20-24, much of this increase could be because of recall error on the part of older respondents. Compared with the 1991-92 and 1996 TDHS results, the median age at first marriage for women has remained almost the same at slightly over 18 years. Men marry considerably later than women. The median age at first marriage for men age 25- 59 is 24, almost six years later than the median of 18 for women. Only 19 percent of men age 25-59 were married by age 20, compared with 69 percent of women age 25-49. Compared with the 1996 TDHS results, the median age at first marriage for men has declined by one year, from 25 to 24. Table 5.3 shows the median ages at first marriage for women age 20-49 and 25-49 years and men age 25-59 years by selected background characteristics. In all age groups, urban women and men marry later than their counterparts in rural areas. The median age at first marriage for women in the Mainland is at least one year higher than in Zanzibar; for men, there is no difference in median age at marriage between the Mainland and Zanzibar. As expected, age at first marriage increases with increasing level of education. Among women age 25-49, the median age at first marriage for those with no formal education is 16.7 compared with 18.9 years for those who completed primary education and 23.2 years for those with secondary education or higher. Proximate Determinants of Fertility * 67 Table 5.2 Age at first marriage Percentage of women age 15-49 and men age 15-59 who were first married by selected exact ages, and median age at first marriage, according to current age, Tanzania 1999 ____________________________________________________________________________________________ WOMEN____________________________________________________________________________________________ Percentage who were Percentage Median first married by exact age: who had age at Number _________________________________________ never first of Current age 15 18 20 22 25 married marriage women ____________________________________________________________________________________________ 15-19 3.9 NA NA NA NA 72.8 a 909 20-24 6.4 39.3 61.8 NA NA 22.7 19.0 811 25-29 9.7 42.4 62.5 79.2 90.1 8.0 18.8 749 30-34 9.9 44.9 68.2 81.8 88.8 4.3 18.5 490 35-39 14.3 49.8 66.7 80.8 91.6 2.5 18.0 456 40-44 22.1 61.2 78.9 87.3 92.7 1.0 16.8 299 45-49 18.2 57.5 76.9 85.3 92.7 0.8 17.3 315 Women 20-49 11.6 46.4 66.9 80.2 87.3 9.0 18.4 3,120 Women 25-49 13.4 48.9 68.7 82.0 90.8 4.2 18.1 2,309 ____________________________________________________________________________________________ MEN____________________________________________________________________________________________ Percentage who were Percentage Median first married by exact age: who had age at Number _________________________________________ never first of Current age 20 22 25 28 30 married marriage men ____________________________________________________________________________________________ 25-29 15.3 32.5 66.8 NA NA 19.6 23.4 546 30-34 21.9 33.9 60.1 77.7 88.8 5.6 23.8 371 35-39 15.9 29.9 58.1 75.0 80.1 6.9 24.3 445 40-44 19.2 31.9 53.1 76.1 86.9 1.9 24.3 219 45-49 22.1 35.7 57.6 75.4 83.6 0.8 24.0 259 50-54 17.7 35.3 66.1 78.8 88.2 0.5 23.1 201 55-59 23.1 46.2 65.2 81.2 86.6 0.0 22.5 171 Men 25-59 18.5 33.8 61.3 77.4 84.0 7.5 23.7 2,212 ___________________________________________________________________________________________ NA = Not applicable.a Omitted because less than 50 percent of women in age group 15-19 were first married by age 15. 5.3 AGE AT FIRST INTERCOURSE In many societies, age at first marriage is often used as a proxy for the onset of women’s exposure to the risk of conception. However, this is not the case in Tanzania, as many women and men engage in sexual activities before marriage. As such, the 1999 TRCHS collected information on the age at which men and women had their first sexual intercourse. Table 5.4 presents the percentage of women and men who had sexual intercourse by selected exact ages and the median age at first sexual intercourse. The upper panel of the table shows that the median age at first intercourse for women is just under 17 years, more than one year less than the median age at first marriage of about 18 (Table 5.2). By age 15, about 20 percent of women have had sexual intercourse and by age 18—the legal age at marriage—68 percent of women have had sexual intercourse, whereas only 46 percent of them have married. By age 20, 85 percent of women have had sexual intercourse, although only 67 percent have ever been married by that age. 68 * Proximate Determinants of Fertility Table 5.3 Median age at first marriage Median age at first marriage among women age 20-49 years, by current age and selected background characteristics, and among men age 25-59 years by selected background characteristics, Tanzania 1999 __________________________________________________________________________________________________ Current age Women Women Men Background _____________________________________________________ age age age characteristic 20-24 25-29 30-34 35-39 40-44 45-49 20-49 25-49 25-59 __________________________________________________________________________________________________ Residence Urban Rural Mainland/Zanzibar Mainland Urban Rural Zanzibar Pemba Unguja Education No education Incomplete primary Complete primary Secondary+ Total a 19.5 19.1 18.5 17.1 17.8 19.5 18.8 24.9 18.2 18.5 18.3 17.9 16.7 17.1 18.0 18.0 23.3 19.0 18.8 18.5 18.1 16.8 17.4 18.4 18.1 23.7 a 19.6 19.1 18.6 17.2 17.9 19.5 18.8 24.9 18.2 18.5 18.4 18.0 16.7 17.1 18.0 18.0 23.3 19.1 17.9 17.7 16.3 15.2 14.8 17.3 16.9 23.6 18.7 16.8 17.3 16.7 15.5 15.2 17.0 16.5 22.4 19.3 18.3 17.9 15.9 15.1 14.6 17.5 17.1 24.3 17.3 18.2 16.6 16.5 16.1 16.8 16.8 16.7 23.0 17.9 17.6 17.5 18.4 17.2 17.5 17.7 17.6 23.0 19.4 18.8 19.0 19.2 17.9 (20.0) 19.0 18.9 23.8 a 24.3 23.5 21.7 (22.2) * a 23.2 a 19.0 18.8 18.5 18.0 16.8 17.3 18.4 18.1 23.7 __________________________________________________________________________________________________ a Omitted because less than 50 percent of respondents in the age group had married before entering the group. Note: Figures in parentheses are based on 25 to 49 respondents (unweighted); an asterisk indicates that a figure has been suppressed because it is based on fewer than 25 respondents. The lower panel of Table 5.4 shows that men become sexually active later than women. The median age at first intercourse among men is about 18. On average men enter into marriage six years later than women, but they start sexual relations only about one year later than women. Whereas the median age at first intercourse has increased slightly from 16.2 years among women age 45-49 to 16.8 years among those age 25-29, that of men declined from 18.1 years among those age 55-59 to 17.5 years among those age 20-24 years. Table 5.5 shows differentials in the median age at first intercourse by background characteristics for women age 20-49 years and men age 25-59 years. Irrespective of the age of the woman, the median age at first intercourse among urban women is slightly higher than that of their counterparts in rural areas. There is no apparent urban-rural difference for men. Although the median age at first sexual intercourse is slightly higher among women in Zanzibar than for those in the Mainland, the difference is much larger among men. Men in Zanzibar initiate sex about three years later than men in the Mainland. With respect to education, women with secondary education or higher start sexual relations three years later than those with no formal education. Proximate Determinants of Fertility * 69 Table 5.4 Age at first sexual intercourse Percentage of women and men who had sexual intercourse by selected exact ages and median age at first intercourse, according to current age, Tanzania 1999 ____________________________________________________________________________________________ Percentage who had Percentage Median Number first intercourse by exact age: who age at of _________________________________________ never had first women/ Current age 15 18 20 22 25 intercourse intercourse men ____________________________________________________________________________________________ WOMEN____________________________________________________________________________________________ 15-19 14.5 NA NA NA NA 47.4 a 909 20-24 16.5 65.4 85.6 NA NA 6.2 a 811 25-29 18.0 66.0 83.2 91.0 94.3 1.1 16.8 749 30-34 16.2 63.4 82.8 86.2 88.8 0.8 16.9 490 35-39 22.1 71.8 86.4 93.0 94.9 0.3 16.3 456 40-44 32.9 74.1 88.8 93.1 95.8 0.0 16.0 299 45-49 21.9 70.7 86.3 91.4 95.8 0.0 16.2 315 Women 20-49 19.7 67.5 85.1 90.9 93.2 2.1 16.7 3,120 Women 25-49 20.9 68.3 84.9 90.7 93.6 0.6 16.6 2,309 ____________________________________________________________________________________________ MEN____________________________________________________________________________________________ 15-19 23.9 NA NA NA NA 43.4 a 790 20-24 14.4 56.6 81.5 NA NA 10.5 17.5 540 25-29 12.2 53.7 75.3 89.9 97.5 1.3 17.6 546 30-34 14.4 54.4 80.7 90.6 95.1 0.5 17.6 371 35-39 9.3 53.3 73.8 86.2 94.4 0.6 17.7 445 40-44 13.2 51.3 79.1 89.1 94.0 1.0 17.9 219 45-49 7.3 48.5 78.9 90.1 95.3 0.1 18.1 259 50-54 8.7 42.2 64.1 78.6 87.1 0.5 18.4 201 55-59 11.8 48.5 74.7 89.1 97.1 0.0 18.1 171 Men 25-59 11.2 51.4 75.7 88.1 94.9 0.7 17.9 2,212 ____________________________________________________________________________________________ NA = Not applicable.a Omitted because less than 50 percent of respondents in the age group 15 to 19 were first married by age 15. 5.4 RECENT SEXUAL ACTIVITY The frequency of sexual intercourse is closely related to the probability of pregnancy, especially where use of contraception is low or not commonly practiced. Therefore, information on recent sexual activity is a useful measure of exposure to pregnancy. However, not all women and men who have ever had sex are currently sexually active. Tables 5.6.1 and 5.6.2 present information on the level of sexual activity of women and men in the four weeks prior to the survey by background characteristics. In the four weeks before the survey, 59 percent of women age 15-49 years were sexually active, 12 percent were practicing postpartum abstinence, 17 percent were abstaining for reasons other than having recently given birth, and 12 percent had never had sexual intercourse. 70 * Proximate Determinants of Fertility Table 5.5 Median age at first intercourse Median age at first sexual intercourse among women age 20-49 years, by age group and background characteristics, and among men age 25-59 by background characteristics, Tanzania 1999 ________________________________________________________________________________________________ Current age Women Women Men Background _______________________________________________ age age age characteristic 20-24 25-29 30-34 35-39 40-44 45-49 20-49 25-49 25-59 ________________________________________________________________________________________________ Residence Urban Rural Mainland/Zanzibar Mainland Urban Rural Zanzibar Pemba Unguja Education No education Incomplete primary Complete primary Secondary+ All men/women 17.2 17.1 17.8 16.8 16.5 16.7 17.1 17.0 17.9 16.8 16.7 16.7 16.2 16.0 16.0 16.5 16.4 17.9 16.9 16.8 16.9 16.3 16.1 16.3 16.7 16.6 17.8 17.1 17.1 17.8 16.8 16.5 16.7 17.0 17.0 17.8 16.8 16.7 16.6 16.2 16.0 16.0 16.5 16.4 17.8 18.8 17.7 17.9 16.3 15.5 14.8 17.2 16.8 21.0 19.2 16.6 18.0 16.9 16.8 15.0 17.3 16.8 22.2 18.5 18.1 17.8 15.9 15.1 14.7 17.2 16.8 20.5 16.2 16.4 15.5 15.7 15.6 16.1 15.9 15.8 17.4 16.2 16.4 16.6 15.9 16.5 16.0 16.2 16.3 18.0 17.0 16.9 17.2 17.4 16.4 (17.8) 17.0 17.0 17.8 19.2 18.8 19.6 18.2 (18.3) * 18.9 18.8 18.5 16.9 16.8 16.9 16.3 16.0 16.2 16.7 16.6 17.9 _________________________________________________________________________________________________ Note: Figures in parentheses are based on 25 to 49 respondents (unweighted); an asterisk indicates that a figure has been suppressed because it is based on fewer than 25 respondents. The proportion of women who are sexually active varies little by age, except that the youngest women are far less likely to be having sexual intercourse. As expected, the proportion of women who are sexually active is lower for women who have never been in union than for women who are currently in union. However, there is no appreciable decline in the proportion sexually active according to the duration of marriage, except among those married for 30 years or more. The proportion of women who are sexually active is higher in the Mainland than in Zanzibar. Recent sexual activity appears to decline with increasing education; however, the pattern is not straightforward. The proportion of women who are sexually active is highest among women with no formal education and lowest for those with some secondary education. As expected, women who are using a contraceptive method are more likely to be sexually active than those who are not. The proportion of women who have been abstaining for less than two years declines at older ages and at longer marital durations. Women in rural areas and those who are not using any form of contraception, as well as those who use periodic abstinence as a method of family planning, are more likely to be postpartum abstaining. The proportion of women who have been abstaining for reasons other than child birth is higher among women age 35-49 years and among women who have been married for more than 20 years. Proximate Determinants of Fertility * 71 Table 5.6.1 Recent sexual activity: women Percent distribution of women by sexual activity in the four weeks preceding the survey, and among those not sexually active, the length of time they have been abstaining and whether postpartum or not postpartum, according to selected background characteristics and contraceptive method currently used, Tanzania 1999 _______________________________________________________________________________________________________ Not sexually active in past four weeks _________________________________ Background Sexually Abstaining Abstaining characteristic/ active (postpartum) (not postpartum) Never Number contraceptive in past _________________ _________________ had of method 4 weeks 0-1 years 2+ years 0-1 years 2+ years sex Missing Total women _____________________________________________________________________________________________________ Age 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Duration of union (years) Never married 0-4 5-9 10-14 15-19 20-24 25-29 30+ Residence Urban Rural Mainland/Zanzibar Mainland Urban Rural Zanzibar Pemba Unguja Education No education Incomplete primary Complete primary Secondary+ Contraceptive method No method Pill IUD Sterilisation Periodic abstinence Other Total 28.8 8.6 0.6 13.9 0.6 47.4 0.1 100.0 909 64.9 13.2 1.9 13.4 0.2 6.2 0.2 100.0 811 68.1 15.0 1.8 13.1 0.4 1.1 0.5 100.0 749 68.6 13.3 0.7 13.9 2.1 0.8 0.5 100.0 490 70.8 8.6 0.5 13.8 5.3 0.3 0.7 100.0 456 72.1 5.2 0.4 14.1 7.6 0.0 0.6 100.0 299 68.6 2.0 0.9 18.1 10.1 0.0 0.3 100.0 315 19.4 6.8 0.5 19.0 1.4 52.5 0.3 100.0 943 69.5 16.2 3.4 10.7 0.0 0.0 0.1 100.0 713 72.0 14.6 1.0 11.2 0.5 0.0 0.7 100.0 684 75.3 11.3 0.2 10.6 2.1 0.0 0.5 100.0 551 69.6 12.5 0.7 14.0 3.2 0.0 0.0 100.0 395 73.1 6.5 0.1 14.0 5.3 0.0 1.0 100.0 307 76.5 2.4 1.0 14.2 6.0 0.0 0.0 100.0 275 57.5 3.5 0.7 22.0 15.6 0.0 0.7 100.0 161 60.3 7.9 0.4 16.2 3.5 11.5 0.2 100.0 1,122 58.9 11.5 1.4 13.1 2.1 12.6 0.4 100.0 2,907 59.6 10.5 1.1 14.0 2.4 12.0 0.4 100.0 3,929 60.8 7.9 0.4 16.3 3.4 11.0 0.2 100.0 1,088 59.2 11.5 1.4 13.1 2.0 12.4 0.4 100.0 2,841 45.1 9.4 1.3 13.2 5.9 24.7 0.5 100.0 100 41.4 10.1 1.9 13.4 6.7 26.1 0.4 100.0 44 48.0 8.9 0.8 13.0 5.2 23.6 0.6 100.0 56 64.0 11.0 1.6 11.9 4.6 6.2 0.6 100.0 1,093 53.3 7.9 0.8 12.4 1.8 23.5 0.3 100.0 854 61.2 11.3 1.0 14.4 1.5 10.4 0.2 100.0 1,866 42.3 12.1 0.3 27.0 2.7 14.8 0.8 100.0 215 53.9 12.5 1.3 13.3 2.8 15.8 0.4 100.0 3,131 89.0 0.8 1.1 9.2 0.0 0.0 0.0 100.0 186 66.1 0.0 0.0 33.4 0.5 0.0 0.0 100.0 19 76.3 0.0 0.0 13.4 10.4 0.0 0.0 100.0 62 65.2 16.2 0.7 15.0 3.0 0.0 0.0 100.0 89 77.3 3.0 0.0 19.1 0.4 0.0 0.3 100.0 543 59.3 10.5 1.1 14.0 2.5 12.3 0.4 100.0 4,029 72 * Proximate Determinants of Fertility Table 5.6.2 Recent sexual activity: men Percent distribution of men by sexual activity in the four weeks preceding the survey, according to selected background characteristics, Tanzania 1999 __________________________________________________________________________ Not Sexually sexually active active Number Background in past in past Never of characteristic 4 weeks 4 weeks had sex Total men __________________________________________________________________________ Age 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 Marital status Never married In union Formerly married Residence Urban Rural Mainland/Zanzibar Mainland Urban Rural Zanzibar Pemba Unguja Education No education Incomplete primary Complete primary Secondary+ Total 28.4 28.2 43.4 100.0 790 57.4 32.2 10.5 100.0 540 76.7 22.0 1.3 100.0 546 80.9 18.6 0.5 100.0 371 78.3 21.1 0.6 100.0 445 80.4 18.5 1.0 100.0 219 81.4 18.5 0.1 100.0 259 82.0 17.5 0.5 100.0 201 77.9 22.1 0.0 100.0 171 34.5 33.4 32.2 100.0 1,289 84.1 15.9 0.0 100.0 2,063 56.2 43.8 0.0 100.0 190 61.8 29.1 9.1 100.0 941 65.5 21.8 12.7 100.0 2,601 65.0 23.8 11.2 100.0 3,452 62.4 29.3 8.3 100.0 909 66.0 21.8 12.2 100.0 2,543 46.8 22.3 30.9 100.0 90 46.4 21.4 32.2 100.0 36 47.1 22.9 30.1 100.0 55 65.2 22.4 12.4 100.0 495 58.0 23.0 18.9 100.0 1,000 68.5 23.8 7.7 100.0 1,791 61.0 28.8 10.2 100.0 256 64.6 23.7 11.7 100.0 3,542 Two-thirds of the men interviewed were sexually active in the four weeks before the survey. About one-quarter of the men interviewed had had sex, but not in the preceding four weeks, and 12 percent had never had sex. Sexual activity increases with age up to the late 20s and then remains remarkably constant. Men in union are much more likely to be sexually active (84 percent) than those who were formerly married (56 percent) or who have never been married (35 percent). As with women, men in Zanzibar are less likely than men in the Mainland to have had sex in the four weeks before the survey. Proximate Determinants of Fertility * 73 Table 5.7 Postpartum amenorrhoea, abstinence, and insusceptibility Percentage of births in the three years preceding the survey for which mothers are postpartum amenorrhoeic, abstaining and insusceptible, by number of months since birth, and median and mean durations, Tanzania 1999 _____________________________________________________________ Number Amenor- Insus- of Months since birth rhoeic Abstaining ceptible births _____________________________________________________________ <2 2-3 4-5 6-7 8-9 10-11 12-13 14-15 16-17 18-19 20-21 22-23 24-25 26-27 28-29 30-31 32-33 34-35 Total Median Mean Prevalence/incidence mean1 97.0 93.5 100.0 102 75.4 68.0 92.5 130 78.7 45.3 85.2 111 62.8 32.6 70.5 118 61.8 33.4 69.8 111 54.1 21.3 65.8 112 51.9 14.3 58.8 83 41.1 24.9 52.9 141 28.1 18.2 41.3 115 30.5 19.6 39.5 107 17.5 13.5 26.5 99 12.3 3.6 14.8 105 6.3 9.7 14.3 99 5.3 9.4 10.5 121 6.4 2.1 8.4 107 1.8 5.6 7.4 125 5.5 0.9 6.4 126 2.7 3.6 6.2 88 35.7 23.7 43.2 2,001 12.0 4.4 14.7 - 13.0 8.7 15.7 - 12.7 8.4 15.3 - _____________________________________________________________ 1 The prevalence-incidence mean is defined as the number of children whose mothers are amenorrhoeic (prevalence) divided by the average number of births per month (incidence). 5.5 POSTPARTUM AMENORRHOEA, ABSTINENCE, AND INSUSCEPTIBILITY For women who are not using contraceptives, exposure to the risk of pregnancy in the period after birth is influenced by two factors, namely, breast- feeding and sexual abstinence. Breastfeeding can prolong the postpartum protection from conception through its effect on the duration of amenorrhoea (the period after a birth prior to return of menses). Protec- tion can also be prolonged by delaying the resumption of sex- ual relations. Women who are insusceptible are those who are not exposed to the risk of preg- nancy either because they are amenorrhoeic or are still ab- staining after a birth. Table 5.7 presents information on the percentage of women who gave birth in the three years prior to the survey and who are still amenorrhoeic, abstaining, and insusceptible. The data are grouped in intervals of two m o n t h s t o m i n i m i s e fluctuations in the estimates. Within the first two months of delivery, all women are insusceptible to the risk of pregnancy. By 4-5 months after birth, 79 percent of the women remain amenorrhoeic, and 85 percent are still insusceptible, but only 45 percent are abstaining from sexual relations. At 18-19 months postpartum, 31 percent remain amenorrhoeic, 20 percent are still abstaining, and 40 percent are insusceptible to pregnancy. The results show that the median duration of insusceptibility (either due to amenorrhoea or abstinence) for Tanzanian women is 15 months. The proportion of women experiencing postpartum insusceptibility falls from 100 percent in the period less than two months after birth to 66 percent at 10-11 months and to 15 percent among women who had a birth 22-23 months before the survey. Table 5.8 shows the median duration of postpartum amenorrhoea, abstinence and insusceptibility by background characteristics for women who gave birth in the three years prior to the survey. Women age 30 years and older have a longer period of insusceptibility (18 months) than younger ones (14 months) due to longer periods of amenorrhoea. The period of amenorrhoea is considerably higher among rural women (13 months) than among their counterparts in urban areas (4 months). Differences between women in the Mainland and in Zanzibar are minimal. 74 * Proximate Determinants of Fertility Table 5.8 Median duration of postpartum insusceptibility by background characteristics Median number of months of postpartum amenorrhoea, postpartum abstinence, and postpartum insusceptibility, by selected background characteristics, Tanzania 1999 _________________________________________________________ Median duration of postpartum: _____________________________ Number Background Amenor- Insuscep- of characteristic rhoea Abstinence tibility births _________________________________________________________ Age <30 30+ Residence Urban Rural Mainland/Zanzibar Mainland Urban Rural Zanzibar Pemba Unguja Education No education Incomplete primary Complete primary Secondary+ Total 10.7 4.9 13.9 1,330 14.0 3.8 17.9 671 3.8 6.1 8.7 384 13.2 4.2 15.0 1,617 12.1 4.5 14.8 1,951 3.7 6.2 8.8 371 13.2 4.2 15.1 1,580 11.2 3.6 11.5 50 11.9 3.5 12.2 24 9.3 3.7 10.7 26 14.2 4.3 19.0 533 8.8 5.2 11.1 344 12.6 4.2 14.8 1,042 10.6 7.8 11.7 83 12.0 4.4 14.7 2,001 _________________________________________________________ Note: Medians are based on current status. Table 5.9 Menopause Indicators of menopause among women age 30-49, by age, Tanzania 1999 ___________________________________ Menopause1 _________________ Age Percent Number ___________________________________ 30-34 2.4 490 35-39 3.9 456 40-41 5.7 171 42-43 14.5 97 44-45 30.5 108 46-47 15.7 118 48-49 43.2 120 Total 10.1 1,560 ___________________________________ 1 Percentage of all women who are not pregnant, not postpartum amenorrhoeic and whose last menstrual period occurred six or more months preceding the survey. Postpartum amenorrhoea is inversely related to mother’s education, decreasing from 14 months for women with no education to 11 months for women with secondary education and above. The median duration of insusceptibility for women with no education is 19 months, compared with 12 months for those with secondary education and above. 5.6 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. One indication of this reduced risk is the proportion of women who are menopausal. Table 5.9 presents data on menopause. In this report, women are considered menopausal if they are neither pregnant nor postpartum amenorrhoeic, but have not had a menstrual period in the six months preceding the survey. As expected, the proportion of women who are menopausal increases with age from less than 3 percent for women age 30-34 years to 43 percent for women age 48-49 years. Fertility Preferences * 75 Table 6.1 Fertility preferences by number of living children Percent distribution of all women by desire for more children, according to number of living children, Tanzania 1999 ____________________________________________________________________________________________________ Number of living children1 _____________________________________________________________ Desire for children 0 1 2 3 4 5 6+ Total ____________________________________________________________________________________________________ Have another soon2 Have another later3 Have another, undecided when Undecided Want no more Sterilised Declared infecund Missing Total Number of women 29.2 34.8 27.1 20.0 14.0 14.3 7.6 23.6 12.6 51.3 48.4 45.0 26.5 20.6 14.3 31.1 16.8 2.6 0.9 1.2 1.0 0.1 0.2 5.1 32.3 1.8 3.7 4.1 6.6 4.6 3.0 10.8 5.3 5.9 16.2 23.1 47.0 54.4 60.6 23.7 0.0 1.2 1.1 2.5 1.6 1.3 4.9 1.5 2.6 2.3 2.7 4.2 3.4 4.7 9.5 3.9 1.2 0.2 0.1 0.0 0.0 0.0 0.0 0.3 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 1,015 749 616 453 385 295 515 4,029 ____________________________________________________________________________________________________ 1 Includes current pregnancy 2 Want next birth within two years 3 Want to delay next birth for two or more years FERTILITY PREFERENCES 6 Several questions dealing with fertility preferences were included in the 1999 TRCHS questionnaire. All women who were not pregnant or were unsure of their status at the time of the survey were asked whether they would like to have a (another) child and, if so, how long they would prefer to wait before the next child. Pregnant women were asked whether they would like to have another child after the one they were expecting and, if so, when. Women were also asked the number of children they would like to have if they could start afresh. It is assumed that individuals will strive to achieve their preferred family size if family planning services are available, accessible, and affordable. However, this is not always the case when there are pressures from other people, particularly from spouses whose fertility preferences may be different from those of the respondent. 6.1 REPRODUCTIVE PREFERENCES Table 6.1 presents data concerning future reproductive preferences among women according to the number of living children. Although 60 percent of all women say that they want more children, 31 percent say they want to wait for two or more years before having their next child. These women can be considered as potential contraceptive users for the purpose of spacing (Figure 6.1). Twenty-four percent of women say they want another child soon, while 5 percent want another child but are undecided on the timing of the next birth. Eleven percent are unsure of whether they want another child. One in four women either wants no more children or has already been sterilised. Four percent of women consider themselves to be infecund. 76 * Fertility Preferences TRCHS 1999 Wants no more children 25% Undecided 11% 5% 31% 24% Declared infecund 4% Figure 6.1 Fertility Preferences of Women Age 15-49 Wants child later (2+ years) 31% Wants child, unsure timing 5% Wants child soon (<2 years) 24% Note: "Want no more" includes sterilised women. As expected, the proportion of women who want no more children or are already sterilised increases with increasing number of living children, from 5 percent of childless women to 66 percent of those with six or more children (Figure 6.2). Conversely, the desire to have a child soon declines as the number of living children rises. For instance, 35 percent of women with one child want to have another child soon, compared with only 8 percent among those with six or more children. The proportion of women who want another child later increases from 13 percent for childless women to 51 percent for those with one child. Thereafter, the desire to space children decreases as the number of living children increases. The percent distribution of women by reproductive preferences according to age is shown in Table 6.2. The desire to have another child soon is lower among the youngest and oldest women and relatively constant in between. The proportion of women who want no more children or are sterilised increases with increasing age, from 7 percent among women age 15-19 to 59 percent among those age 40-44 years. The proportion of women who declare themselves infecund increases from less than two percent among women age 15-34 years to 26 percent among those age 45-49. The desire to stop childbearing differs according to women’s circumstances. Table 6.3 shows the percentage of women who want no more children, according to the number of living children they already have and selected background characteristics. The desire to have no more children is greater among urban than among rural women, regardless of the number of children they already have. Similarly, the proportion of women who want no more children is substantially higher in the Mainland than in Zanzibar. For example, among women with 5 children, 57 percent of those in the Mainland want no more children, Fertility Preferences * 77 Table 6.2 Fertility preferences by age Percent distribution of all women by desire for more children, according to age, Tanzania 1999 ________________________________________________________________________________________ Age of woman _____________________________________________________ Desire for children 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Total________________________________________________________________________________________ Have another soon1 Have another later2 Have another, undecided when Undecided Want no more Sterilised Declared infecund Missing Total Number of women 16.7 23.4 30.9 24.6 31.5 23.3 13.8 23.6 27.3 54.5 42.5 30.8 13.6 5.5 4.5 31.1 .15.7 4.5 1.2 1.9 0.8 0.5 0.5 5.1 31.2 6.8 5.8 4.3 4.3 2.2 2.1 10.8 6.9 10.1 18.0 34.3 44.3 52.8 47.2 23.7 0.0 0.1 1.0 1.7 2.0 5.9 6.0 1.5 1.9 0.4 0.4 1.0 3.5 9.8 26.0 3.9 0.3 0.3 0.2 1.4 0.0 0.0 0.0 0.3 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 909 811 749 490 456 299 315 4,029 ________________________________________________________________________________________ 1 Want next birth within two years 2 Want to delay next birth for two or more years Figure 6.2 Desire to Stop Childbearing among Women Age 15-49, by Number of Living Children TRCHS 1999 5 7 17 26 49 56 66 0 1 2 3 4 5 6+ No. of Living Children 0 10 20 30 40 50 60 70 Percent compared with only 22 percent of women in Zanzibar. Overall, there is an inverse relationship between the proportion of women who want no more children and women’s level of education. However, the relationship becomes less clear when the number of children is taken into account. 78 * Fertility Preferences Table 6.3 Desire to stop childbearing by background characteristics Percentage of all women who want no more children, by number of living children and selected background characteristics, Tanzania 1999 ________________________________________________________________________________________ Number of living children1 Background __________________________________________________ All characteristic 0 1 2 3 4 5 6+ women _________________________________________________________________________________________ Residence Urban Rural Mainland/Zanzibar Mainland Urban Rural Zanzibar Pemba Unguja Education No education Primary incomplete Primary complete Secondary+ Total women 4.0 8.8 17.5 43.2 64.8 68.7 74.1 23.8 5.8 6.0 17.1 17.9 43.0 53.5 64.3 25.8 5.4 7.1 17.3 25.7 49.3 56.7 66.1 25.4 4.1 8.8 17.8 43.8 66.1 (71.0) 75.2 24.0 6.0 6.0 17.2 17.9 43.6 54.3 65.0 26.0 1.1 4.6 11.8 18.1 18.1 21.8 49.0 17.5 1.3 (3.9) (13.8) (20.4) (7.3) (12.9) 42.7 16.6 1.0 5.0 10.9 16.4 25.0 (29.0) 57.1 18.3 5.3 6.8 15.1 20.0 47.2 49.8 61.8 31.5 7.9 9.4 12.7 21.5 54.6 56.8 70.4 25.6 2.9 5.0 18.8 29.0 49.0 59.1 69.4 22.0 7.9 18.5 23.5 (38.1) (30.4) (74.3) (63.5) 20.8 5.3 7.0 17.2 25.6 48.5 55.7 65.4 25.2 _________________________________________________________________________________________ Note: Figures in parentheses are based on 25-49 cases. 1 Includes current pregnancy 6.2 NEED FOR FAMILY PLANNING SERVICES Women 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. Pregnant women are considered to have unmet need for spacing or limiting if their pregnancy was mistimed or unwanted, respectively. Amenorrhoeic women are also considered to have unmet need if their last birth was mistimed or unwanted. Women with unmet need and those who are currently using contraception (met need) constitute the total demand for family planning. Table 6.4 shows the percent distribution of women with unmet need, with met need, and the total demand for family planning by selected background characteristics. Data are presented for all women, regardless of marital status, though summary lines are also presented for currently married and unmarried women. The total demand for family planning among all women is 40 percent, and 56 percent of the demand is satisfied. The demand for spacing purposes is higher (25 percent) than the demand for limiting purposes (14 percent). Overall, 17 percent of women have an unmet need for family planning, of which 12 percent is for spacing and 6 percent is for limiting births. As expected, unmet need for family planning is much higher among currently married women (22 percent) and much lower among unmarried women (8 percent) than among all women (17 percent). Fertility Preferences * 79 Table 6.4 Need for family planning Percentage of all women with unmet need for family planning, and with met need for family planning, and the total demand for family planning, by selected background characteristics, Tanzania 1999 ______________________________________________________________________________________________________ Met need for Unmet need for family planning Total demand for Percentage family planning1 (currently using)2 family planning of ____________________ ____________________ ____________________ demand Number Background For For For For For For satis- of characteristic spacing limiting Total spacing limiting Total spacing limiting Total fied women______________________________________________________________________________________________________ Age 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Residence Urban Rural Mainland/Zanzibar Mainland Urban Rural Zanzibar Pemba Unguja Education No education Primary incomplete Primary complete Secondary+ All women Currently married women Unmarried women 9.4 1.3 10.7 7.2 0.5 7.7 16.6 1.8 18.4 42.0 909 17.4 1.9 19.3 26.3 3.1 29.4 43.7 5.0 48.7 60.4 811 17.0 4.4 21.4 19.3 6.7 26.0 36.3 11.1 47.4 54.9 749 12.0 8.4 20.4 16.2 11.4 27.5 28.2 19.7 47.9 57.5 490 5.4 13.8 19.2 11.0 16.5 27.5 16.4 30.3 46.7 58.8 456 3.2 8.9 12.1 2.4 26.3 28.7 5.6 35.2 40.8 70.4 299 4.7 13.4 18.1 0.7 14.7 15.4 5.4 28.1 33.5 46.0 315 9.5 4.2 13.7 22.3 10.7 33.0 31.8 14.9 46.7 70.6 1,122 12.2 6.4 18.6 10.7 7.4 18.2 23.0 13.8 36.8 49.4 2,907 11.3 5.8 17.1 14.0 8.5 22.5 25.4 14.3 39.7 56.8 3,929 9.4 4.2 13.6 22.5 10.9 33.4 31.9 15.1 47.0 71.0 1,088 12.1 6.4 18.5 10.8 7.6 18.3 22.9 14.0 36.8 49.8 2,841 16.6 4.3 20.9 10.6 3.0 13.6 27.2 7.3 34.6 39.4 100 19.3 3.9 23.2 4.3 2.6 6.8 23.6 6.5 30.1 22.8 44 14.5 4.7 19.2 15.6 3.3 18.9 30.1 8.0 38.1 49.6 56 10.3 8.1 18.4 6.9 7.1 14.0 17.2 15.2 32.4 43.2 1,093 6.9 5.9 12.8 9.7 8.1 17.8 16.6 14.0 30.7 58.2 854 14.5 4.9 19.3 18.2 8.6 26.8 32.7 13.5 46.2 58.1 1,866 9.4 1.2 10.6 29.8 12.9 42.8 39.2 14.1 53.3 80.2 215 11.5 5.8 17.2 14.0 8.3 22.3 25.4 14.1 39.5 56.4 4,029 13.8 8.0 21.8 15.1 10.3 25.4 28.9 18.3 47.2 53.7 2,653 7.0 1.4 8.4 11.8 4.6 16.4 18.8 6.0 24.8 66.1 1,376 _____________________________________________________________________________________________________ 1 Unmet need for spacing includes pregnant women whose pregnancy was mistimed, amenorrhoeic women whose last birth was mistimed, and women who are neither pregnant nor amenorrhoeic and who are not using any method of family planning but say they want to wait two or more years 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 unsure when to have the birth. Unmet need for limiting refers to pregnant women whose pregnancy was unwanted, amenorrhoeic women whose last child was unwanted, and women who are neither pregnant nor amenorrhoeic and who are not using any method of family planning but want no more children. Excluded from the unmet need category are menopausal or infecund women and unmarried women who have not had sexual intercourse in the four weeks prior to the interview. 2 Using for spacing is defined as women who are using some 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 are using and who want no more children. Note that the specific methods used are not taken into account here. Unmet need for family planning is lowest among women age 15-19 years, probably due to lower levels of sexual activity and greater desires to have children. Unmet need for family planning is greater among rural than among urban women. Unmet need—especially for spacing children—is higher among Zanzibari women than women in the Mainland. 80 * Fertility Preferences The relationship between unmet need and women’s level of education is unclear. However, there is a positive relationship between total demand for family planning and level of education. The total demand for family planning increases from 32 percent for women with no education to 53 percent for those with secondary education or higher. Similarly, the percentage of demand satisfied increases with increasing level of education from 43 percent among those with no formal education to 80 percent among those with secondary education or higher. There has been a decline in the level of unmet need over time, from 30 percent among currently married women in 1991-92, to 24 percent in 1996, to 22 percent in 1999. 6.3 IDEAL NUMBER OF CHILDREN In the 1999 TRCHS, women and men were asked what they consider to be the ideal family size. This information was obtained by asking the respondents two questions. Respondents who had no children were asked, “If you could choose exactly the number of children to have in your whole life, how many would that be?” For respondents who had children, the question was, “If you could go back to the time when you did not have any children and could choose exactly the number of children to have in your whole life, how many would that be?” The distribution of respondents by ideal number of children is presented in Table 6.5. It should be noted that respondents were not forced to give an exact number of children and 3 percent of women and 4 percent of men gave non- numeric responses to the question on ideal family size (e.g., “as many as God wishes”, “any number is okay”). The data show a general desire for large families in Tanzania. More than half of women and men report that five or more children are ideal and another one-quarter cite four children as ideal. Only 6 percent of women and 5 percent of men say that two children are ideal, which is the level of fertility required for long-term population growth stabilisation. There is a positive correlation between the actual and ideal number of children for both men and women. For instance, the mean ideal number of children increases from 4.5 among childless women to 7.3 among women with 6 or more living children. The corresponding increase for men is from 4.6 children among men with no children to 9.0 among those with 6 or more. This relationship is most likely due to the reluctance of respondents who have more children to admit that they might have wanted fewer. Also, those who wanted more children are more likely to have them. However, it is also likely that there has been a gradual decline in family size preferences over time. This latter explanation is borne out by a comparison of data from previous surveys (Figure 6.3). The mean ideal family size among women has declined from 6.1 in 1991-92 to 5.5 in 1996 and to 5.3 in 1999. Among men, the decline has been from 6.5 in 1991-92 to 5.9 in 1996 to 5.6 in 1999. In all surveys, the mean ideal number of children among men is consistently higher than among women. Table 6.6 shows the mean ideal number of children by age of woman and selected background characteristics. The mean ideal number of children increases with increasing age, from 4.6 children among women age 15-19 years to 7.3 children among those age 45-49 years. The trend is similar for men. On average, rural women want one more child than urban women (5.6 versus 4.3). This preference for more children among rural women is true for all age groups. Similarly, the mean ideal number of children among men is higher in rural areas than in urban areas. Fertility Preferences * 81 Table 6.5 Ideal number of children Percent distribution of all respondents by ideal number of children and mean ideal number of children for all respondents and currently married respondents, according to number of living children, Tanzania 1999 ____________________________________________________________________________________________________ Number of living children1 _____________________________________________________________ Ideal number of children 0 1 2 3 4 5 6+ Total____________________________________________________________________________________________________ WOMEN____________________________________________________________________________________________________ 0 1 2 3 4 5 6+ Non-numeric response Total Number of women Mean2 ideal number for: All women Number of women Currently married women Number of women 0.0 0.0 0.0 0.1 0.0 0.0 0.0 0.0 0.7 0.6 0.0 0.0 0.8 0.0 0.0 0.4 11.6 9.1 3.6 1.6 2.4 4.0 1.2 6.0 18.6 20.4 11.3 6.9 3.0 1.9 2.4 11.7 27.3 30.9 37.0 32.0 27.3 14.6 13.7 27.3 16.1 18.1 19.6 20.0 18.1 22.6 12.5 17.7 20.7 19.3 27.1 38.0 45.6 54.2 67.1 34.1 4.9 1.6 1.4 1.5 2.8 2.7 3.2 2.8 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 1,015 749 616 453 385 295 515 4,029 4.5 4.5 4.9 5.4 5.8 6.2 7.3 5.3 965 737 608 446 375 287 499 3,916 5.4 4.8 4.9 5.5 5.8 6.3 7.3 5.7 203 491 498 378 321 265 435 2,592 ____________________________________________________________________________________________________ MEN____________________________________________________________________________________________________ 0 1 2 3 4 5 6+ Non-numeric response Total Number of men Mean2 ideal number for: All men Number of men Currently married men Number of men 0.2 0.0 0.0 0.0 0.0 0.0 0.0 0.1 0.6 0.5 0.0 0.0 0.0 0.0 0.2 0.3 9.0 5.4 3.2 2.0 2.8 0.0 1.3 5.3 20.7 21.6 16.2 8.0 4.1 5.4 2.3 14.4 26.7 30.4 35.4 29.8 28.2 11.4 14.8 25.6 15.7 18.3 16.9 22.9 15.4 22.4 5.1 15.4 22.6 22.0 25.2 35.6 45.2 59.1 71.1 35.2 4.5 1.8 3.1 1.9 4.2 1.7 5.2 3.8 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 1,482 395 369 314 213 194 574 3,542 4.6 4.7 4.9 5.4 5.8 6.7 9.0 5.6 1,415 388 358 308 204 191 544 3,409 4.8 4.8 5.0 5.3 5.8 6.7 9.0 6.3 172 307 323 288 194 184 529 1,998 ____________________________________________________________________________________________________ 1 Includes current pregnancy 2 Means are calculated excluding the respondents who gave non-numeric responses. The mean ideal number of children among women and men in Zanzibar (6.8 children for women and 8.1 children for men) is higher than for respondents in the Mainland (5.2 children for women and 5.5 children for men ). The high ideal number of children in Zanzibar can be attributed almost entirely to the large families desired by women and men in Pemba. For instance, the mean ideal number of children desired by women in Pemba is 8.1, compared with 5.8 in Unguja. Similarly, the mean ideal number of children desired by men in Pemba is 10.8 children, compared with 6.3 in 82 * Fertility Preferences Table 6.6 Mean ideal number of children Mean ideal number of children for all women and all men by age and selected background characteristics, Tanzania 1999 ____________________________________________________________________________________________________ Age of woman Total Total Background _____________________________________________________ women men characteristic 15-19 20-24 25-29 30-34 35-39 40-44 45-49 15-49 15-59 _____________________________________________________________________________________________________ Residence Urban Rural Mainland/Zanzibar Mainland Urban Rural Zanzibar Pemba Unguja Education No education Primary incomplete Primary complete Secondary+ Total women Total men 3.8 3.7 4.1 4.6 4.7 5.4 6.3 4.3 4.3 4.9 4.9 5.4 5.9 6.2 6.8 7.6 5.6 6.1 4.6 4.4 5.0 5.5 5.7 6.5 7.3 5.2 5.5 3.8 3.6 4.1 4.6 4.6 5.4 6.3 4.3 4.3 4.9 4.8 5.4 5.8 6.1 6.8 7.6 5.6 6.0 6.1 6.2 6.4 7.3 8.0 7.5 7.7 6.8 8.1 7.4 7.4 7.4 8.9 8.8 (9.1) * 8.1 10.8 4.9 5.5 5.8 5.9 7.3 (6.3) (6.6) 5.8 6.3 5.8 6.1 5.8 6.5 6.4 7.1 8.0 6.6 8.0 4.5 4.8 5.4 5.5 6.5 6.7 6.4 5.3 6.0 4.2 4.0 4.8 5.3 5.0 5.4 (5.5) 4.6 4.9 3.8 3.7 4.4 4.2 4.6 (3.7) 4.4 4.0 4.2 4.6 4.5 5.0 5.5 5.8 6.5 7.3 5.3 NA 4.8 4.3 5.1 5.1 6.1 6.7 7.6 NA 5.6 _____________________________________________________________________________________________________ Note: Figures in parentheses are based on 25-49 cases; an asterisk indicates that a figure is based on fewer than 25 cases and has been suppressed. NA = Not applicable Figure 6.3 Trends in Mean Ideal Family Size Among Women and Men, 1991-1999 6.1 6.5 5.5 5.9 5.3 5.6 Women Men 0 2 4 6 8 No. of children 1991-92 TDHS 1996 TDHS 1999 TRCHS Unguja. Irrespective of age, the mean ideal number of children desired by women and men with some Fertility Preferences * 83 Table 6.7 Fertility planning status Percent distribution of births (including current pregnancies) in the five years preceding the survey by fertility planning status, according to birth order and mother's age at birth, Tanzania 1999 ___________________________________________________________________ Planning status of pregnancy Birth order ____________________________________ Number and mother's Wanted Wanted Not of age at birth then later wanted Missing Total births1 ___________________________________________________________________ Birth order 1 2 3 4+ Age at birth <19 20-24 25-29 30-34 35-39 40-49 Total 85.1 4.0 10.6 0.3 100.0 845 80.1 13.2 6.7 0.0 100.0 681 78.0 13.8 7.9 0.4 100.0 553 72.2 13.7 14.1 0.0 100.0 1,581 80.9 7.3 11.7 0.1 100.0 624 81.5 10.2 8.0 0.4 100.0 1,182 75.9 17.7 6.3 0.0 100.0 806 73.2 13.2 13.5 0.1 100.0 586 73.0 8.6 18.4 0.0 100.0 291 67.3 3.3 29.4 0.0 100.0 172 77.5 11.4 11.0 0.2 100.0 3,660 ___________________________________________________________________ 1 Includes current pregnancies secondary education is considerably lower than that desired by women and men with no formal education. 6.4 FERTILITY PLANNING In the 1999 TRCHS, for each child born in the preceding five years and any current pregnancy, women were asked whether the pregnancy was planned (wanted then), wanted but at a later time (mistimed), or unwanted (wanted no more children). The answers to these questions help to show the degree to which couples are able to control fertility. The validity of the answers depends on the extent to which the respondents were able to accurately recall their pregnancies in the last five years and their wishes with respect to each pregnancy, and how honest they were in reporting their wishes. This measure has a limitation in that mistimed or unwanted pregnancies may turn out to be wanted children after birth. As such, the results presented here are likely to be underestimates of the proportion of births that were unwanted at the time of conception. Table 6.7 shows the percent distribution of births (including current pregnancy) in the five years preceding the survey by fertility planning status, according to birth order and mother’s age at birth. The data show that 78 percent of births in the past five years were wanted at the time of conception, while 11 percent were wanted later and 11 percent were not wanted at the time they were conceived. The percentage of births that were mistimed or unwanted increases from 15 percent of first births to 28 percent of fourth or higher order births. The proportion of unwanted births is much higher among women age 30-49 years than among younger women. The potential demographic impact of avoiding unwanted births can be estimated by 84 * Fertility Preferences Table 6.8 Wanted fertility rates Total wanted fertility rates and total fertility rates for the three years preceding the survey, by selected background characteristics, Tanzania 1999 _______________________________________________ Total wanted Total Background fertility fertility characteristic rate rate _______________________________________________ Residence Urban Rural Mainland/Zanzibar Mainland Urban Rural Zanzibar Education No education Primary incomplete Primary complete+ Total 2.9 3.2 5.5 6.5 4.8 5.6 2.9 3.1 5.5 6.5 5.1 5.6 5.6 6.5 4.4 5.1 4.3 4.9 4.8 5.6 _______________________________________________ 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. calculating the “total wanted fertility rate.” The total wanted fertility rate is calculated in the same manner as the total fertility rate, but 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. Therefore, wanted fertility represents the level of fertility that would have prevailed during the three years preceding the survey if all unwanted births were prevented. A comparison between actual rates and wanted rates indicates the potential demographic impact of the elimination of unwanted births. Table 6.8 presents the wanted and actual fertility rates according to selected background characteristics. Overall, the total wanted fertility rate is 14 percent lower than the actual fertility. Thus, if all unwanted births were to be eliminated, the total fertility rate of Tanzania would be 4.8 children per woman. The difference between the wanted and actual fertility rate is 1 child in rural areas and 0.3 in urban areas. Although the gap between wanted fertility and actual fertility is higher in the Mainland than in Zanzibar (0.8 versus 0.5), the wanted fertility rate in Zanzibar is higher than that of the Mainland (5.1 versus 4.8). With respect to education, the gap between wanted and actual fertility is smaller among women who have completed primary school than among those with no education. This differential implies that women with an education are better able to realise their desired fertility. Infant and Child Mortality * 85 INFANT AND CHILD MORTALITY 7 This chapter presents levels, trends, and differentials in mortality among children under five years of age in Tanzania. Specifically it includes details on neonatal, postneonatal, infant, and child mortality. Additional information is provided on high-risk fertility behaviour among Tanzanian women. Rates of infant and child mortality reflect a country's level of socioeconomic development and quality of life. The analysis provides an opportunity to assess programmes aimed at the reduction of infant and child mortality in Tanzania. The information is essential for planning and updating current polices. 7.1 DEFINITIONS, METHODOLOGY, AND ASSESSMENT OF DATA QUALITY Estimates of childhood mortality are based on information from the birth history section of the questionnaire administered to individual women. The section began with questions about the aggregate childbearing experience of respondents (i.e., the number of sons and daughters who live with the mother, the number who live elsewhere, and the number who have died). For each of these births, information was then collected on the sex, the month and year of birth, survivorship status and current age, or, if the child had died, the age at death. This information is used to directly estimate mortality rates. In this report, mortality in early childhood is measured using the following five rates: 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 between birth and fifth birthday. All rates are expressed per 1,000 live births, except for child mortality, which is expressed per 1,000 children surviving to 12 months of age. In developing countries like Tanzania, population censuses and demographic surveys are the major sources of mortality data. Vital registration is another source of mortality data in Tanzania, but unfortunately, the information is not widely used because it is incomplete and disproportionately represents the urban population. Also, mortality information from the Health Management Information System (HMIS) does not reflect the mortality picture from a population perspective, because it is facility-based data and thus does not include deaths that occur outside of facilities. The Adult Morbidity and Mortality Project (AMMP) in Tanzania reported that 60 percent of child deaths in Dar es Salaam took place in a hospital; however, in Morogoro, only 20 percent of children died in a hospital. In this case, birth history information from surveys gives the most robust estimates of infant and child mortality. Estimates of mortality from the censuses employed indirect techniques that adjust reported data for expected errors, while estimates from the series of TDHS surveys are based on data as reported directly, with no adjustments. Results from direct estimates are viewed 86 * Infant and Child Mortality Table 7.1 Infant and child mortality Infant and child mortality rates by five-year periods preceding the survey, Tanzania 1999 __________________________________________________________________ Years Neonatal Postneonatal Infant Child Under-five preceding mortality mortality mortality mortality mortality survey (NN) (PNN) (1q0) (4q1) (5q0) __________________________________________________________________ 0-4 40.4 58.7 99.1 52.7 146.6 5-9 50.6 67.0 117.6 68.5 178.0 10-14 31.4 78.9 110.2 67.8 170.5 with a certain degree of uncertainty since they can underestimate mortality rates. Women tend to omit the deaths of babies who died shortly after birth or deaths that occured early in infancy. The incidence of omission or misstatement of date of birth and age at death is likely to be greater among older women, who may have more difficulty remembering events. Examination of data relating to child mortality does not indicate that there are any serious biases in reporting (Appendix Tables C.5 and C.6). 7.2 CHILDHOOD MORTALITY LEVELS AND TRENDS Neonatal, postneo- natal, infant, child, and under-five mortality rates by five-year periods preceding the survey are shown in Ta- ble 7.1. Levels shown reflect up to 15 years before the survey. Analysing the most recent five-year period (0-4 years preceding the survey or mid-1994 to mid-1999), under-five mortality is esti- mated at 147 per 1,000 live births, and infant mortality is 99 per 1000 live births. These figures indicate that one in seven children born in Tanzania dies before reaching the fifth birthday. The pattern shows that 28 percent of deaths under five occur during the neonatal period, while 40 percent occur during the postneonatal period and 36 percent of deaths occur at ages 1-4 years. There are two ways to measure trends in mortality, each giving a different indication of the direction of change. Data from the 1999 TRCHS birth histories were used to construct mortality rates for successive time periods prior to the survey. As shown in Table 7.1, this method implies that under-five mortality has declined substantially from 178 deaths per 1,000 births in the period 5-9 years before the survey (approximately 1990-94) to 147 for the period 0-4 years before the survey. Because this method relies on mothers’ memories of events that may have taken place some years ago, the data are potentially subject to various distortions due to misreporting of events and/or their timing. The second method of measuring trends in mortality is to compare data from two successive surveys. A comparison of data from the 1999 TRCHS and the 1996 TDHS indicates that childhood mortality has increased, from 137 per 1,000 births to 147 for the under-five mortality rate. Infant mortality has increased by from 88 to 99 per 1,000 births (BOS and MI, 1997: 98). A recent study took a closer look at all the data on mortality levels from the 1999 TRCHS as well as from the 1991-92 and 1996 TDHS surveys (MEASURE DHS+ and MEASURE Evaluation, unpublished presentation). The trend analysis focused on the comparison of four-year rates in urban and rural Mainland Tanzania and on the possible role of the AIDS epidemic. It was concluded that there is a need to be very cautious in interpreting mortality trends because sampling errors associated with measures of childhood mortality are large. The problem of sampling errors is largest in the urban areas, where sample sizes are smaller. In urban Mainland Tanzania, child mortality levels appear to have increased after 1996, especially in the neonatal period. However, it cannot Infant and Child Mortality * 87 Table 7.2 Infant and child mortality by background characteristics Neonatal, postneonatal, infant, and childhood mortality by selected background characteristics for the 10-year period preceding the survey, Tanzania 1999 _________________________________________________________________________ Post- Neonatal neonatal Infant Child Under-five Background mortality mortality mortality mortality mortality characteristic (NN) (PNN) (1q0) (4q1) (5q0)_________________________________________________________________________ Residence Urban Rural Mainland/Zanzibar Mainland Urban Rural Zanzibar Education No education Primary incomplete Primary complete+ Total 52.0 35.3 87.3 59.6 141.6 43.4 69.5 113.0 59.7 165.9 45.4 63.0 108.5 60.5 162.4 53.2 35.6 88.8 61.4 144.7 43.5 69.9 113.4 60.2 166.8 35.2 47.9 83.0 34.1 114.3 52.1 65.6 117.7 54.1 165.4 47.0 67.1 114.0 64.0 170.7 40.5 59.4 99.9 61.4 155.2 45.2 62.6 107.8 59.7 161.1 be excluded that the urban estimate for 1996 underestimated child mortality and exaggerated the decline during the early 1990s. It still appears that urban mortality has increased some- what—compared with the estimates for 1987-91 from the TDHS 1991—and part of this increase is likely due to HIV/AIDS. Overall, Tanzanian mortality levels and trends are largely determined by what happens in the rural areas, where the majority of the population lives. There is some evidence of a modest increase or levelling off in the rural Mainland after 1996. In Zanzibar, child mortality levels are lower than in Mainland Tanzania. There is no evidence of any further decline during the nineties. 7.3 CHILDHOOD MORTALITY DIFFERENTIALS Table 7.2 presents mortality differentials by selected background characteristics, such as place of residence and level of education of mothers. A ten-year period (1990–99) is used to calculate the mortality estimates in order to have a sufficient number of cases in each category, except for size at birth, for which a five-year period is used. As expected, urban mortality rates are generally lower than in rural areas, as can be seen in Table 7.2 and Figure 7.1, where the urban under-five mortality rate is 142 per 1,000 versus 166 for rural areas. The difference is largest at the postneonatal period, while surprisingly, neonatal mortality is higher in urban areas. Comparing the Tanzanian Mainland and Zanzibar, as in the 1991- 92 and 1996 surveys, mortality rates in Zanzibar continue to be lower than in the Mainland. From the 1999 TRCHS, infant mortality in Zanzibar is 24 percent lower than it is in the Mainland, while the under-five mortality rate is lower by 30 percent. Table 7.2 also shows that mother’s education has an inverse relationship with infant and under-five mortality. This conforms to the universal observation that children of educated mothers 88 * Infant and Child Mortality Figure 7.1 Under-five Mortality by Selected Background Characteristics Note: Rates are for the 10-year period preceding the survey. TRCHS 1999 142 166 227 149 142 106 195 152 112 RESIDENCE Urban Rural AGE OF MOTHER <20 20-29 30-39 40-49 BIRTH INTERVAL <2 Years 2-3 Years 4+ Years 0 50 100 150 200 Deaths per 1,000 Live Births have lower mortality than those whose mothers are uneducated. Table 7.2 reveals that mortality rates for children born to mothers with no education are higher than those whose mothers have completed primary. Studies have shown that demographic factors of both mother and child can have an impact on infant and child mortality. These factors include sex of the child, age of the mother at child’s birth, birth order, length of previous birth interval, and the size of the child at birth. Table 7.3 presents mortality rates for the ten years preceding the survey by selected demographic characteris- tics. The results show that male children experience higher mortality than female children, with under-five mortality rates of 172 and 150 deaths per 1,000 live births, for males and females, respectively. Children born to mothers younger than 20 years of age had higher mortality than children born to older mothers. Paradoxically, children born to older women (40-49 years) had the lowest under-five mortality (see Figure 7.1); however, for postneonatal mortality and infant mortality, the pattern is a U-shaped curve. As expected, first births and higher order births experience higher infant mortality. For example, the infant mortality rate for first births (130 per 1,000) and births of order seven and higher (108) are substantially higher than the rate of 90 for birth order 4-6. Information provided in Table 7.3 and Figure 7.1 shows that short birth intervals pose a high risk for child survival both during and after infancy. Children born less than two years after a preceding sibling are more likely to die before reaching age five than those born four or more years after a preceding sibling (195 versus 112 per 1,000). A similar pattern is observed for neonatal mortality, postneonatal mortality, and infant mortality. The findings suggest the need to reduce Infant and Child Mortality * 89 Table 7.3 Infant and child mortality by biodemographic characteristics Infant and child mortality rates for the 10-year period preceding the survey, by selected biodemographic characteristics, Tanzania 1999 _________________________________________________________________________ Post- Neonatal neonatal Infant Child Under-five Biodemographic mortality mortality mortality mortality mortality characteristic (NN) (PNN) (1q0) (4q1) (5q0)_________________________________________________________________________ Sex of child Male Female Age of mother at birth < 20 20-29 30-39 40-49 Birth order 1 2-3 4-6 7+ Previous birth interval < 2 years 2-3 years 4 or more years Size at birth1 Small or very small Average or larger 55.5 62.5 118.0 61.1 171.8 34.4 62.8 97.2 58.3 149.8 76.1 88.2 164.4 74.5 226.6 35.0 53.6 88.6 66.7 149.3 45.6 61.1 106.7 39.7 142.1 (32.7) (70.6) (103.3) (3.1) (106.0) 64.0 66.4 130.4 63.3 185.5 42.1 65.6 107.7 71.2 171.2 27.2 62.6 89.8 59.0 143.5 57.5 50.5 108.0 28.8 133.7 51.7 89.7 141.4 62.9 195.4 38.9 54.3 93.2 64.3 151.5 28.5 51.1 79.6 34.9 111.7 90.1 79.5 169.6 NA NA 33.6 55.3 88.8 NA NA __________________________________________________________________________ Note: Figures in parentheses are rates based on 250-499 births. 1 Refers to births in the three years before the survey NA = Not applicable mortality risks for Tanzanian children by promoting use of family planning and traditional practices, such as breastfeeding, to space children farther apart. The size of a child at birth provides an important indicator of its survival during infancy. In the 1999 TRCHS, mothers were asked whether their young children were very small, small, average, large, or very large at birth. The mother’s perception has been shown to correlate closely with the child’s actual weight at birth, which is an important indicator for child growth monitoring. Newborns perceived by their mothers to be small or very small are much more likely to die in the first year of life (170 per 1,000 live births) than those perceived as average or larger in size (89 per 1,000 live births). A similar pattern of mortality is evident during the neonatal and postneonatal periods. 7.4 HIGH-RISK FERTILITY BEHAVIOUR Certain patterns of childbearing are associated with elevated levels of infant and child mortality. Typically, infants and children have a greater probability of dying early if they are born to mothers who are especially young or old, if they are born after a short birth interval, or if they are of high birth order. Data to examine these relationships are presented in Table 7.4, which shows the 90 * Infant and Child Mortality distribution of births in the five years preceding the survey and of currently married women according to these categories of increased risk. In this analysis, a mother is classified as “too young” if she is less than 18 years of age and “too old” if she is over 34 years of age. A “short birth interval” is defined as a birth occurring less than 24 months after a previous birth, and a child is of “high birth order” if the mother had previously given birth to three or more children (i.e., if the child is of birth order 4 or higher). First births, although often at increased risk, are not placed in a high-risk category since they are not considered an avoidable risk. Table 7.4 is further divided into two categories, with births falling into single high-risk categories (such as those born to mothers below the age of 18 or over the age of 34, those born within 24 months of a previous birth, and those of birth order higher than three) and those falling into multiple high-risk categories (e.g., those born within 24 months of a previous birth to mothers who are below the age of 18, or children of birth order greater than 3 who are born to mothers who are over 34 years, etc.). The results indicate that well over half (57 percent) of children born in the five years before the survey have an elevated risk of dying; 39 percent of births are in a single high-risk category, while 18 percent are in a multiple high-risk category. The results also show that the most common high-risk category is high birth order. Looking at the single-risk categories, 26 percent of children are at increased risk because they are fourth births or higher, while 7 percent are born to mothers younger than 18 years and 6 percent are born less than two years after a prior birth. Among multiple high-risk categories, 11 percent of children are of birth order 4 or higher and were born to mothers age 35 and older. About 26 percent of recent births do not fall into any high-risk category and 16 percent fall into the unavoidable risk category. The second column of Table 7.4 indicates the relative risk of dying for children born in the five years before the survey by comparing the proportion dead in each high-risk category with the proportion dead among children not in any high-risk category. Young age of mother at birth of child is a significant risk factor (relative risk ratio of 1.76), with 7 percent of births falling into this category. Older age of mother at birth of child is also associated with high mortality risks (relative risk ratio of 2.34). At even greater risk are births to young mothers that occur after a short birth interval (relative risk ratio of 2.85). Fortunately, however, the proportion of recent births falling in these two categories is very small, so that even though the fertility behaviour results in much higher risk of dying for the child, few children are subject to that higher risk. Column 3 of Table 7.4 shows the distribution of currently married, non-sterilised women by risk category into which a currently conceived birth would fall. Three in four currently married women (73 percent) are at risk of conceiving a child who will have an elevated risk of dying. Forty- one percent of women are at risk due to multiple high-risk factors, while 32 percent are at risk due to a single high-risk factor. The most likely risks are due to high birth order alone (17 percent) or in combination with older age of mother at birth of child (24 percent of women). Infant and Child Mortality * 91 Table 7.4 High-risk fertility behaviour Percent distribution of children born in the five years preceding the survey by category of elevated risk of dying and risk ratio, and percent distribution of currently married women at risk of conceiving a child with an elevated risk of dying, by category of increased risk, Tanzania 1999 _____________________________________________________________________ Births in the 5 years preceding the survey Percent- ___________________ age of Per- currently Risk centage Risk married category of births ratio womena ____________________________________________________________________ Not in any high-risk category Unavoidable risk category First births to women 18-34 Single high-risk category Mother's age <18 Mother's age >34 Birth interval <24 months Birth order >3 Subtotal Multiple high-risk category Age <18 & birth interval <24 monthsc Age >34 & birth interval <24 months Age >34 & birth order >3 Age >34 & birth interval <24 months & birth order >3 Birth interval <24 months & birth order >3 Subtotal In any high-risk category Total Number of births 26.2 1.00 20.7b 17.2 1.27 6.4 6.5 1.76 1.5 0.2 2.34 3.5 6.3 1.32 9.4 25.8 0.84 17.2 38.9 1.08 31.6 0.5 2.85 0.4 0.0 0.00 0.1 11.3 1.19 24.0 1.3 1.51 5.4 4.6 1.00 11.4 17.7 1.21 41.3 56.6 1.12 72.9 100.0 - 100.0 3,282 - 2,653 _______________________________________________________________________ Note: Risk ratio is the ratio of the proportion dead of births in a specific high-risk category to the proportion dead of births not in any high-risk category. a Women were assigned to risk categories according to the status they would have at the birth of a child, if the child were conceived at the time of the survey: age less than 17 years and 3 months, age older than 34 years and 2 months, latest birth less than 15 months ago, and latest birth of order 3 or higher. b Includes sterilised women c Includes the combined categories Age <18 and birth order >3 Reproductive and Child Health * 93 REPRODUCTIVE AND CHILD HEALTH 8 This chapter presents findings related to maternal and child health in Tanzania. The areas examined include maternity care, vaccinations, and the prevalence and treatment of common childhood illnesses. The 1999 TRCHS information is important as it provides a critical look into the performance of the Maternal Child Health programme in Tanzania. The programme was initiated to support one of the health policy objectives, namely, the reduction of infant and maternal morbidity and mortality. The programme tries to improve the survival and development of women and children, who constitute 75 percent of the population of Tanzania. Provision of medical care during pregnancy and at delivery is essential for the survival of both the mother and the infant. Therefore, the survey results provide an opportunity to identify critical issues affecting the situation of women and children in Tanzania. The information will assist policy makers, planners, and other collaborators in the health sector to formulate appropriate strategies to improve maternal and child health care. 8.1 ANTENATAL CARE Prevalence and Source of Antenatal Care Table 8.1 shows the percent distribution of the most recent births to women who had a birth in the five years preceding the survey by source of antenatal care received by the mother, according to selected background characteristics. Interviewers asked women about all the people who provided care during the pregnancy; however, if more than one person was mentioned, then the one with the highest qualifications was recorded. The results show that almost all pregnant women in Tanzania (98 percent) receive antenatal care. More than nine in ten births receive antenatal care from a medical professional (93 percent), mostly from health aides (44 percent) or nurses and midwives (43 percent)(see Figure 8.1). Doctors and medical assistants provide about 6 percent of all antenatal care services. Birth attendants provide only 1 percent of antenatal care. Data on antenatal care by mother’s age at birth shows that younger women are more likely to obtain antenatal care from more medically qualified personnel than older women. For example, 53 percent of women below age 20 who gave birth received antenatal care from a doctor or nurse of midwife, compared with 39 percent of women age 35 or above. The same pattern is observed for women according to birth order: lower order births are more likely to receive antenatal care from a doctor or nurse or midwife. Significant variation in antenatal care is noted between rural and urban areas. Urban women are more likely than rural women to receive antenatal care from a doctor, nurse, or midwife (76 versus 41 percent). Half of pregnant women in rural areas receive antenatal care from a less-trained rural medical aide or maternal and child health (MCH) aide, probably because rural people receive most of their health care services from dispensaries that are run by these health aides. In the Mainland, a greater percentage of antenatal care is provided by nurses and midwives than in Zanzibar (44 versus 14 percent); however, in Zanzibar, three-quarters of antenatal care is provided by health aides. Mothers in Unguja were more likely than those in Pemba to attend antenatal care clinics with doctors and nurses or midwives. 94 * Reproductive and Child Health Table 8.1 Antenatal care Among women who had births in the five years preceding the survey, percent distribution of the most recent births by source of antenatal care received by the mother, according to selected background characteristics, Tanzania 1999 ____________________________________________________________________________________________________ Antenatal care provider1 _______________________________________________________ Number Background Nurse/ Health Birth of characteristic Doctor Midwife aide attendant Other No one Total births ____________________________________________________________________________________________________ Mother's age at birth < 20 20-34 35+ Birth order 1 2-3 4-5 6+ Residence Urban Rural Mainland/Zanzibar Mainland Urban Rural Zanzibar Pemba Unguja Mother’s education No education Primary incomplete Primary complete Secondary+ Total 2.2 50.5 39.5 0.6 3.8 3.4 100.0 368 7.1 43.0 43.8 0.6 4.0 1.5 100.0 1,486 3.1 35.6 47.6 2.3 5.9 5.6 100.0 329 6.3 49.7 37.1 0.0 3.1 3.9 100.0 498 7.5 44.4 41.8 1.6 3.8 0.8 100.0 719 4.6 41.0 49.1 0.0 4.8 0.5 100.0 479 3.4 36.7 47.7 1.6 5.5 5.2 100.0 487 15.3 60.9 22.0 0.3 0.9 0.5 100.0 502 2.8 37.8 50.1 1.0 5.2 3.0 100.0 1,681 5.6 43.8 42.9 0.9 4.3 2.4 100.0 2,131 15.5 62.0 20.8 0.3 1.0 0.4 100.0 487 2.7 38.5 49.4 1.1 5.3 3.0 100.0 1,644 7.1 14.2 76.1 0.0 0.2 2.3 100.0 52 2.2 7.4 88.2 0.0 0.4 1.8 100.0 24 11.2 20.1 65.9 0.0 0.0 2.8 100.0 28 1.5 31.2 49.5 2.4 8.6 6.8 100.0 581 6.5 41.7 46.2 0.3 3.3 2.0 100.0 370 6.1 49.3 41.0 0.4 2.7 0.5 100.0 1,143 23.7 47.2 28.9 0.0 0.0 0.2 100.0 89 5.7 43.1 43.7 0.9 4.2 2.4 100.0 2,183 _____________________________________________________________________________________________________ Note: “Health aide” refers to both rural medical aides and MCH aides; “birth attendant” refers to both trained and traditional birth attendants. Village health workers are included in the “other” category. 1 If the respondent mentioned more than one provider, only the most qualified provider was considered. More-educated mothers are more likely to receive antenatal care from qualified medical personnel, such as doctors, nurses, and midwives, than are mothers with less education or no education. Some of this pattern is due to the concentration of doctors, nurses, and midwives, as well as more highly educated women, in urban areas. Number and Timing of Antenatal Visits Pregnant women are advised to start attending antenatal clinics before the 20th week of gestation so that their normal baseline health can be assessed and monitored regularly. At the first antenatal visit, a detailed history should be obtained and a full examination should be carried out. The recommended protocol for antenatal care calls for a woman with a normal pregnancy to visit an antenatal clinic at monthly intervals until the 28th week of pregnancy, then fortnightly until the 36th week, and weekly thereafter until labour begins. If the schedule is followed consistently, it is Reproductive and Child Health * 95 Table 8.2 Number of antenatal care visits and stage of pregnancy Percent distribution of live births in the past five years by number of antenatal care visits (ANC), and by the stage of pregnancy at the time of the first visit, Tanzania 1991-1999 _________________________________________ Number and timing TDHS TDHS TRCHS of ANC visits 1991-92 1996 1999a __________________________________________ Number of visits None 3.6 2.1 2.4 1 1.1 1.5 2.9 2-3 visits 23.5 22.5 23.1 4+ visits 69.5 69.5 69.9 Don’t know/missing 2.4 4.4 1.6 Total 100.0 100.0 100.0 Medianb 5.0 3.9 4.1 Number of months pregnant at first visit No antenatal care 3.6 2.1 2.4 < 6 months 60.1 60.5 61.4 6-7 months 34.0 34.7 32.0 8+ months 1.7 1.7 2.9 Don’t know/missing 0.5 1.0 1.2 Total 100.0 100.0 100.0 Medianb 5.6 5.6 5.5 Number of births 8,032 6,916 2,183 __________________________________________ a Refers to most recent birth only b For those with ANC anticipated that about 12 to 13 visits will be made. Pregnancy monitoring and detection of complications are the main objectives of antenatal care. The Ministry of Health considers women with the following characteristics to be at higher risk: gravida 5 or over, age under 16 or over 35, height under 150 cm, three consecutive abortions, prior caesarean section, anaemia, oedema, high blood pressure, proteinuria, failure to gain weight, antepartum haemorrhage, and abnormal lie. In the event of any complication, either more frequent antenatal visits are advisable or admission to a hospital may become necessary. Table 8.2 presents data on the number of antenatal visits made by pregnant mothers and the stage of pregnancy at the first visit. Seventy percent of women whose last birth occurred in the five years before the survey made four or more antenatal care visits. However, the median number of antenatal visits is four, which indicates that most women do not make the recommended 12 to 13 antenatal visits. This low number of antenatal care visits is partly because pregnant women start antenatal care late, with the median month of first visit being 5.5 months. Comparing data from the 1991-92, 1996, and 1999 surveys shows only minor variation in antenatal care coverage, the number of visits, and the timing of the first visit. Antenatal Care Content In the TRCHS, women who delivered a child in the five years before the survey were asked several questions about the types of ante- natal care they received during the pregnancy that led to their most recent birth. Specifically, they were asked whether they were informed of the signs associated with serious pregnancy complications; whether they received a card listing the immunisations they received; and whether they were given or bought iron tablets or antimalarial medication. As shown in Table 8.3, about four in ten women said they were informed about pregnancy complications, while roughly the same proportion said they were given a card that showed the immunisations they had received. Forty-four percent of women said they were given or bought iron tablets during their last pregnancy, and about one- third said they had access to anti-malarial medicine. Differences in antenatal care content by background characteristics are not large. Generally, urban women are more likely than rural women to have received all four items asked about, except that immunisation cards are more commonly given to rural women than to urban women. Similarly, better-educated women are more likely to receive all four antenatal care services than women with less education. 96 * Reproductive and Child Health Table 8.3 Antenatal care content Among women who have had births in the five years preceding the survey, percentage of the most recent births for which specific antenatal care was received, by content of antenatal care and selected background characteristics, Tanzania 1999 _________________________________________________________________________ Content of antenatal care ____________________________________ Has a Informed card Given/ Given/ of with bought bought Number Background pregnancy immuni- iron anti- of characteristic complications sations tablets malarials births _________________________________________________________________________ Mother's age at birth < 20 20-34 35+ Birth order 1 2-3 4-5 6+ Residence Urban Rural Mainland/Zanzibar Mainland Urban Rural Zanzibar Pemba Unguja Mother’s education No education Primary incomplete Primary complete Secondary+ Total 33.2 39.3 45.4 23.0 368 43.0 40.7 45.4 34.7 1,486 42.4 33.2 38.8 32.5 329 37.6 38.2 45.9 33.2 498 42.2 43.4 47.0 30.0 719 44.0 41.4 44.1 35.9 479 41.1 32.6 39.5 31.7 487 52.6 37.0 49.8 41.9 502 37.9 40.0 42.8 29.6 1,681 41.4 39.4 44.6 32.4 2,131 52.7 37.1 49.9 42.2 487 38.0 40.0 43.0 29.5 1,644 38.5 39.0 38.1 31.7 52 26.7 37.6 29.3 35.2 24 48.4 40.1 45.6 28.7 28 28.9 33.8 36.8 26.7 581 41.2 38.6 43.6 27.5 370 46.2 42.5 86.3 47.5 1,143 58.6 37.2 86.5 58.6 89 41.3 39.3 44.4 32.4 2,183 ___________________________________________________________________________ Note: “Health aide” refers to both rural medical aides and MCH aides; while “birth attendant” refers to both trained and traditional birth attendants. Village health workers are included in the “other” category. 1 If the respondent mentioned more than one provider, only the most qualified provider was considered. Tetanus Toxoid Vaccination Another important aspect of antenatal care is tetanus toxoid immunisation. Tetanus is still a relatively common cause of death among newborns in Tanzania and other developing countries. To address this problem, the Ministry of Health requires all women of reproductive age to be vaccinated with tetanus toxoid before they become pregnant. A baby is considered protected if the Reproductive and Child Health * 97 Table 8.4 Tetanus toxoid vaccinations Among women who had births in the years preceding the survey, percent distribution of the most recent births by number of tetanus toxoid injections received during pregnancy, according to selected background characteristics, Tanzania 1999 ____________________________________________________________________________________ Number of tetanus toxoid injections _______________________________________ Two Number Background One doses Don't know/ of characteristic None dose or more missing Total births ____________________________________________________________________________________ Mother's age at birth < 20 20-34 35+ Birth order 1 2-3 4-5 6+ Residence Urban Rural Mainland/Zanzibar Mainland Urban Rural Zanzibar Pemba Unguja Mother’s education No education Primary incomplete Primary complete Secondary+ Total 12.8 15.4 70.8 0.9 100.0 368 15.1 23.1 60.9 0.9 100.0 1,486 26.9 21.5 51.3 0.3 100.0 329 11.4 14.3 73.1 1.1 100.0 498 14.4 25.9 59.1 0.6 100.0 719 15.2 22.9 61.2 0.7 100.0 479 26.0 21.5 51.6 0.8 100.0 487 7.9 16.9 74.4 0.7 100.0 502 19.1 23.0 57.1 0.8 100.0 1,681 16.5 21.2 61.5 0.8 100.0 2,131 7.8 16.4 75.1 0.7 100.0 487 19.1 22.7 57.4 0.8 100.0 1,644 16.9 35.8 45.4 1.9 100.0 52 19.5 35.4 43.2 1.9 100.0 24 14.6 36.2 47.2 2.0 100.0 28 25.0 24.4 50.0 0.6 100.0 581 15.8 22.5 61.1 0.5 100.0 370 12.7 19.6 66.8 0.9 100.0 1,143 11.8 25.5 61.0 1.8 100.0 89 16.5 21.6 61.1 0.8 100.0 2,183 mother received two doses of tetanus toxoid during pregnancy, with the second at least two weeks before delivery. However, if a woman was vaccinated during a previous pregnancy, she may only require one dose for the current pregnancy. Five doses are considered adequate to provide lifetime protection. To assess the status of tetanus vaccination coverage, women who gave birth during the five years before the survey were asked if they had received tetanus toxoid injections during the pregnancy for their most recent birth and, if so, how many. The results reveal that 83 percent of women receive tetanus toxoid vaccinations during pregnancy (Table 8.4). However, only 61 percent receive the recommended two doses of the vaccine (Figure 8.1). Younger mothers and women pregnant with their first births are more likely than other women to receive two doses of tetanus toxoid. Urban women are also more likely than rural women to receive two doses of tetanus toxoid during pregnancy. The data imply that a substantial proportion of births in rural areas (around 42 percent) may not be protected against tetanus. Pregnant women in the Mainland are substantially more likely than women in Zanzibar to 98 * Reproductive and Child Health Figure 8.1 Antenatal and Delivery Care Indicators Note: Percentages are based on most recent birth in the five years preceding the survey. "Birth attendant" includes both trained and traditional birth attendants. 6 43 44 8 17 22 61 44 56 7 28 8 18 29 9 ANTENATAL CARE Doctor Nurse/Midwife Health Aide Other/No One TETANUS VACCINATION None One Two+ PLACE OF DELIVERY Health Facility Home DELIVERY ASSISTANCE Doctor Nurse/Midwife Medical Aide Birth Attendant Relative/Friend Other/No One 0 20 40 60 80 Percent TRCHS 1999 receive two doses of tetanus toxoid (62 versus 45 percent). As expected, the proportion of regnant women who are vaccinated against tetanus increases with education. 8.2 DELIVERY CARE Place of Delivery Information about the place of delivery provides insight into the quality of services provided since deliveries at health facilities are regarded as more hygienic than those occurring at home. Proper medical attention and hygienic conditions during delivery can reduce the risk of complica- tions and infections that can cause death or serious illness to either the mother or the baby. Table 8.5 presents the distribution of births in the five years preceding the survey by place of delivery. Just under half (44 percent) of births in Tanzania are delivered at a health facility of any kind, while 56 percent are delivered at home (Figure 8.1). It is interesting to note that the proportion of births delivered in health facilities has been declining steadily over time, from 53 percent in 1991-92 to 47 percent in 1996 and to 44 percent in 1999 (Ngallaba et al., 1993: 84 and Bureau of Statistics and Macro International, 1997: 110). The proportion of births that take place in health facilities differs according to characteristics of the mother and the child. Births to younger women, first births, and births to urban women are much more likely than others to take place in a health facility. Women in the Mainland are also somewhat more likely to deliver in a health facility than women in Zanzibar. As expected, births to more-educated women are more likely to take place in hospitals and health centres. Reproductive and Child Health * 99 Table 8.5 Place of delivery Percent distribution of births in the five years preceding the survey by place of delivery, according to selected background characteristics, Tanzania 1999 _________________________________________________________________________ Place of delivery ______________________________ Number Background Health Don't know/ of characteristic facility Home missing Total births __________________________________________________________________________ Mother's age at birth < 20 20-34 35+ Birth order 1 2-3 4-5 6+ Residence Urban Rural Mainland/Zanzibar Mainland Urban Rural Zanzibar Pemba Unguja Mother’s education No education Primary incomplete Primary complete Secondary+ Total 54.0 46.0 0.0 100.0 575 43.9 55.8 0.3 100.0 2,286 27.1 72.6 0.2 100.0 422 59.9 40.0 0.0 100.0 769 46.6 53.3 0.1 100.0 1,100 38.3 61.2 0.5 100.0 715 25.8 73.7 0.5 100.0 698 82.8 17.2 0.1 100.0 614 34.5 65.3 0.3 100.0 2,668 43.7 56.1 0.2 100.0 3,196 83.4 16.5 0.1 100.0 591 34.7 65.0 0.3 100.0 2,605 36.6 62.8 0.6 100.0 86 26.2 72.8 1.0 100.0 42 46.3 53.4 0.2 100.0 45 24.4 75.2 0.4 100.0 907 44.2 55.7 0.1 100.0 548 51.0 48.7 0.2 100.0 1,711 78.8 21.2 0.0 100.0 116 43.5 56.3 0.2 100.0 3,282 Assistance during Delivery The type of assistance a woman receives during childbirth has important health consequences for both mother and child. Therefore, besides collecting information on the place of delivery, the 1999 TDHS collected data on the type of personnel who assisted during delivery. Table 8.6 shows the percent distribution of births in the five years before the survey by type of assistance during delivery, according to background characteristics. Overall, 36 percent of births are assisted by the most highly trained medical personnel (doctors, nurses and midwives), while 8 percent are assisted by lower-level health aides (rural medical aides and MCH aides). About 20 percent of deliveries are assisted by birth attendants (trained birth attendants and traditional birth attendants) or village health workers, some of whom may have received special training. Finally, 29 percent of births are assisted by only relatives and friends of the mother, while 7 percent are delivered without assistance. First births and births to younger women are more likely than other births to be assisted by highly qualified health personnel. This finding is encouraging, given that medical staff recommend that young women and women expecting their first child deliver in a hospital since they are subject to higher risks. 100 * Reproductive and Child Health Table 8.6 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 1999 _______________________________________________________________________________________________________________ Attendant assisting during delivery1 __________________________________________________________________________ Rural Village Trained Trad. Don't Number Background Nurse/ medical MCH health birth birth Relative/ No know/ of characteristic Doctor Midwife aide aide worker attend. attend. other one missing Total births _________________________________________________________________________________________________________ Mother's age at birth < 20 20-34 35+ Birth order 1 2-3 4-5 6+ Residence Urban Rural Mainland/Zanzibar Mainland Urban Rural Zanzibar Pemba Unguja Mother’s education No education Primary incomplete Primary complete Secondary+ Total 9.8 33.2 4.8 5.4 3.0 8.1 5.7 27.6 2.5 0.0 100.0 575 7.0 29.5 2.3 5.6 1.6 11.3 7.3 28.1 6.9 0.3 100.0 2,286 6.5 16.0 2.0 3.1 1.3 12.6 5.6 39.2 13.8 0.0 100.0 422 11.5 38.5 5.2 3.9 2.4 7.3 6.8 23.0 0.8 0.4 100.0 769 7.5 31.4 2.2 6.3 1.6 12.0 6.1 27.9 4.8 0.1 100.0 1,100 6.6 25.1 0.8 6.0 2.0 12.4 7.0 30.9 8.8 0.5 100.0 715 3.7 16.1 2.6 4.3 1.3 11.4 7.5 37.5 15.5 0.1 100.0 698 16.6 60.1 3.5 3.1 0.7 6.1 2.4 6.0 1.1 0.4 100.0 614 5.3 21.1 2.5 5.8 2.1 12.0 7.8 34.8 8.4 0.2 100.0 2,668 7.6 28.2 2.8 5.3 1.9 10.5 6.2 30.2 7.2 0.2 100.0 3,196 17.1 60.0 3.6 3.1 0.8 6.0 1.9 6.1 1.1 0.4 100.0 591 5.4 21.1 2.6 5.8 2.1 11.5 7.1 35.6 8.6 0.2 100.0 2,605 1.5 35.3 0.5 3.9 0.1 26.1 28.9 2.2 0.6 0.8 100.0 86 0.8 24.5 0.2 3.1 0.3 44.3 24.1 1.2 0.0 1.4 100.0 42 2.0 45.4 0.7 4.7 0.0 9.1 33.5 3.1 1.2 0.2 100.0 45 5.3 14.1 2.0 4.0 1.4 7.7 8.2 46.5 10.4 0.3 100.0 907 5.1 28.7 3.0 6.4 1.9 10.8 5.1 30.6 8.1 0.1 100.0 548 8.4 33.8 3.1 5.9 2.1 12.9 6.4 21.6 5.3 0.2 100.0 1,711 20.0 59.6 0.9 0.9 0.0 5.4 8.9 4.1 0.1 0.1 100.0 116 7.4 28.4 2.7 5.3 1.8 10.9 6.8 29.4 7.0 0.2 100.0 3,282 _______________________________________________________________________________________________________ 1 If the respondent mentioned more than one attendant, only the most qualified attendant was considered. As expected, births in urban areas are more likely than rural births to be assisted by qualified medical personnel. More than three-quarters of births in urban areas are assisted by doctors, nurses or midwives, compared with only 26 percent of births in rural areas. In the Mainland, births are more likely to be assisted by relatives and friends (30 percent) or to be delivered without assistance; however, in Zanzibar, births are more likely to be supervised by nurses or midwives or by birth attendants, whether trained or traditional. The mother’s education is also associated with the type of delivery assistance. The percentage of births assisted by doctors, nurses and midwives increases from 19 percent of births to women with no education to 80 percent of births to women who have some secondary school. Characteristics of Delivery Other aspects of maternal health that were included in the survey are information on delivery by caesarean section, birth weight, and the mother’s estimate of the baby’s size at birth (Table 8.7). Only 3 percent of babies are delivered by caesarean section, which is fractionally higher than the 2 percent found in the 1996 TDHS. Caesarean deliveries decline among older Reproductive and Child Health * 101 Table 8.7 Delivery characteristics: caesarean section, birth weight and size Among births in the five years preceding the survey, the percentage of deliveries by caesarean section, and the percent distribution by birth weight and by the mother's estimate of baby's size at birth, according to selected background characteristics, Tanzania 1999 _____________________________________________________________________________________________________ Birth weight Size of child at birth ____________________ _____________________________ Delivery Less 2.5 kg Smaller Average Number Background by than or Don't Very than or Don't of characteristic C-section 2.5 kg more know Total small average larger know Total births ____________________________________________________________________________________________________ Mother's age at birth <20 20-34 35+ Birth order 1 2-3 4-5 6+ Residence Urban Rural Mainland/Zanzibar Mainland Urban Rural Zanzibar Pemba Unguja Mother’s education No education Primary incomplete Primary complete Secondary+ Total 4.9 6.9 46.9 46.1 100.0 5.7 7.6 86.5 0.2 100.0 575 2.9 3.4 41.5 55.1 100.0 3.1 7.3 89.4 0.1 100.0 2,286 0.7 1.5 25.0 73.6 100.0 3.9 7.8 88.3 0.0 100.0 422 7.6 6.5 51.3 42.2 100.0 5.9 7.7 86.2 0.2 100.0 769 2.4 2.9 45.2 51.9 100.0 2.5 6.4 91.0 0.0 100.0 1,100 0.9 2.7 38.0 59.3 100.0 1.9 7.5 90.2 0.4 100.0 715 0.7 3.4 22.7 74.0 100.0 4.8 8.8 86.5 0.0 100.0 698 6.8 6.2 75.9 17.9 100.0 4.5 4.7 90.7 0.2 100.0 614 2.1 3.2 32.1 64.7 100.0 3.5 8.1 88.3 0.1 100.0 2,668 3.0 3.8 40.6 55.6 100.0 3.6 7.3 89.0 0.1 100.0 3,196 7.0 6.2 76.6 17.2 100.0 4.5 4.5 90.9 0.1 100.0 591 2.1 3.2 32.4 64.4 100.0 3.4 7.9 88.6 0.1 100.0 2,605 1.1 4.0 29.6 66.4 100.0 7.0 14.3 78.0 0.7 100.0 86 0.9 3.4 17.3 79.4 100.0 9.6 19.8 69.4 1.2 100.0 42 1.2 4.6 41.1 54.2 100.0 4.5 9.2 86.1 0.2 100.0 45 0.9 3.3 21.0 75.7 100.0 2.9 10.1 86.9 0.1 100.0 907 1.4 3.8 42.4 53.8 100.0 4.5 5.9 89.4 0.3 100.0 548 4.4 4.1 47.5 48.5 100.0 3.7 6.8 89.3 0.2 100.0 1,711 4.2 3.2 75.6 21.2 100.0 4.2 3.7 92.1 0.0 100.0 116 2.9 3.8 40.3 55.9 100.0 3.7 7.4 88.7 0.1 100.0 3,282 mothers and among higher-order births. Also, caesarean sections are less common among rural women, women in Zanzibar, and women with little or no education. Information on birth weight was available for only 44 percent of births. However, it shows that 9 percent of those weighed (4 percent of all births) were reported to have a weight of less than 2.5 kg, which is considered low birth weight. Younger mothers are more likely to give birth to babies of low birth weight than older mothers. Although it appears as if urban mothers have a higher percentage of low birth weight babies than rural mothers, the differential disappears when only those who were weighed are considered. According to the respondent’s assessment of her baby’s size at birth, the vast majority of births (89 percent) are classified as average or larger than average. Only 11 percent of births were reported to be either small (7 percent) or very small (4 percent). There has been no significant change in these proportions since 1996. 8.3 POSTNATAL CARE 102 * Reproductive and Child Health Table 8.8 Postnatal care Among women who had births in the five years preceding the survey, percent distribution of the most recent births by whether mother received postnatal care, and timing of first postnatal check-up for women who delivered at home, according to background characteristics, Tanzania 1999 ____________________________________________________________________________________________________ Delivered Timing of first postnatal check-up in health for women who delivered at home facility _____________________________________________ (received Within 2 3-7 days 8-27 days 4+ weeks No post- Number Background postnatal days of after after after natal of characteristic care) birth birth birth birth care Total births ____________________________________________________________________________________________________ Mother's age at birth < 20 20-34 35+ Birth order 1 2-3 4-5 6+ Residence Urban Rural Mainland/Zanzibar Mainland Urban Rural Zanzibar Pemba Unguja Mother’s education No education Primary incomplete Primary complete Secondary+ Total 54.5 6.0 1.7 0.9 4.6 32.3 100.0 368 47.3 5.8 2.9 0.4 7.7 35.8 100.0 1,486 27.8 7.3 3.1 0.0 5.9 55.9 100.0 329 62.1 3.9 1.6 0.2 3.9 28.3 100.0 498 49.3 5.9 2.9 1.0 7.4 33.5 100.0 719 41.2 7.5 2.9 0.0 8.1 40.4 100.0 479 27.7 7.2 3.5 0.3 7.9 53.4 100.0 487 83.4 3.0 2.2 0.4 1.9 9.1 100.0 502 34.3 7.0 2.9 0.5 8.4 47.0 100.0 1,681 45.7 6.1 2.8 0.5 7.0 37.9 100.0 2,131 83.9 2.9 2.3 0.4 1.9 8.6 100.0 487 34.4 7.1 2.9 0.5 8.5 46.6 100.0 1,644 39.9 4.7 0.6 0.0 1.0 53.8 100.0 52 29.5 2.9 0.9 0.0 1.1 65.6 100.0 24 48.7 6.3 0.3 0.0 0.9 43.8 100.0 28 24.5 6.7 3.7 0.0 8.7 56.4 100.0 581 47.2 8.0 3.3 0.0 5.9 35.6 100.0 370 53.2 5.4 2.3 0.8 6.5 31.9 100.0 1,143 78.8 3.5 0.0 1.2 3.9 12.6 100.0 89 45.6 6.1 2.7 0.4 6.9 38.3 100.0 2,183 Postnatal care is the care provided to the mother after delivery to check for any complica- tions arising from the delivery and to provide the mother with important information on how to care for herself and her child. The timing of postnatal care is important. The optimal timing is within two days of delivery, since most maternal and neonatal deaths occur in this period. Proper postnatal care can reduce the risk of maternal mortality, which is still very high in Tanzania. Table 8.8 presents information on postnatal care after the most recent birth for women who gave birth in the five years preceding the survey. Since it was assumed that women who delivered in health facilities would receive a routine postnatal examination, only women who delivered at home were asked about postnatal care. The data show that a large proportion of women do not receive any postnatal care (38 percent). If it is assumed that all women who deliver in health facilities are examined within two days of delivering, then only about half (52 percent) of all new mothers receive postnatal care within the critical two-day period. Encouraging women to seek postnatal care and to do so soon after their child’s birth could serve to reduce maternal morbidity and mortality. This message should be aimed at older mothers in rural areas and in Zanzibar, a large Reproductive and Child Health * 103 Table 8.9 Postpartum vitamin A supplements Percentage of women with a birth in the 12 months preceding the survey who received a vitamin A supplement within two months after delivery, Tanzania 1999 __________________________________________ Number Background Received of characteristic vitamin A women __________________________________________ Residence Urban Rural Mainland/Zanzibar Mainland Urban Rural Zanzibar Pemba Unguja Mother’s education No education Primary incomplete Primary complete Secondary+ Place of delivery Health facility Home Total 13.9 125 11.2 559 12.0 666 14.2 121 11.4 545 2.1 18 1.0 9 3.2 9 9.7 193 9.4 108 12.8 358 20.5 25 18.1 250 8.0 432 11.7 684 majority of whom do not receive any postnatal care. Adequate stores of vitamin A are necessary to maintain good health and fight disease. Since pregnancy and childbirth deplete the body’s supply of vitamin A, women are encouraged to take supplements soon after giving birth (vitamin A supplementation during pregnancy can be toxic). To monitor postpartum supplementation coverage, women who gave birth within 12 months prior to the survey were asked in the TRCHS whether they received a vitamin A supplement within 2 months after the delivery. As shown in Table 8.9, only 12 percent of new mothers said they had received a vitamin A supplement. Coverage is much higher among mothers in the Mainland, among women who deliver in health facilities, and among better-educated women. 8.4 BIRTH REGISTRATION One of the universal rights of children is to have their birth registered and to have a birth certificate. Collection of vital statistics started in Tanzania in the early 1960s. By 1985, the system covered 12 districts in 5 regions. Today most regions and districts are fully covered, except seven regions where the project is yet to extend its ser- vices: Lindi, Mtwara, Ruvuma, Rukwa, Kigoma, Kagera, and Mbeya. In the 1999 TRCHS, mothers of children under five were asked whether their child’s birth had been registered and whether they had a birth certificate for the child. Because it was expected that respondents might confuse hospital or baptism certificates for official birth certificates, interviewers were instructed to examine the certifi- cate carefully. A child’s birth was considered to have been registered if his or her mother could either produce a birth certificate or said the birth was registered. Only 6 percent of births in Tanzania are registered (Table 8.10). The main reasons for not registering births are not knowing that it is neces- sary to register them and not knowing where to go to do so. As might be expected, birth registration is more common in urban areas and among women with more education. It is also considerably higher in Zanzibar than in the Mainland. 104 * Reproductive and Child Health Table 8.10 Birth registration coverage Percent distribution of children under five by whether birth is registered or a certificate seen and reasons for non-registration, Tanzania 1999 _____________________________________________________________________________________________________ Reason birth not registered ________________________________________________________ Didn’t Late, Didn’t Birth Cost Must know did not know Number Background is too travel must be want to where to of characteristic registered much too far registered pay fine register Other Missing Total children _____________________________________________________________________________________________________ Child’s age in months < 6 months 6-11 months 12-23 months 24-35 months 36-47 months 48-59 months Sex Male Female Residence Urban Rural Mainland/Zanzibar Mainland Urban Rural Zanzibar Pemba Unguja Mother’s education No education Primary incomplete Primary complete Secondary+ Total 6.5 4.3 3.1 31.3 2.7 36.2 7.8 8.0 100.0 326 5.3 2.1 5.6 29.3 3.2 46.0 2.5 6.0 100.0 310 5.0 3.3 4.1 37.8 2.6 37.8 3.5 5.9 100.0 593 9.5 3.0 2.9 38.3 3.4 32.3 3.9 6.7 100.0 588 5.3 2.6 4.1 34.7 1.5 39.4 4.0 8.4 100.0 528 6.4 3.2 2.6 41.0 1.6 33.8 2.2 9.3 100.0 554 7.5 2.5 3.2 37.5 2.1 36.3 4.0 6.9 100.0 1,463 5.4 3.6 4.0 35.1 2.8 37.5 3.6 7.9 100.0 1,436 21.8 5.5 1.3 30.6 6.2 20.8 8.1 5.7 100.0 546 2.9 2.5 4.1 37.6 1.6 40.6 2.8 7.8 100.0 2,353 4.7 3.0 3.6 37.1 2.5 37.8 3.7 7.6 100.0 2,820 18.7 5.7 1.4 31.9 6.5 21.7 8.3 5.9 100.0 523 1.5 2.4 4.1 38.3 1.6 41.5 2.7 7.9 100.0 2,297 68.9 4.5 3.7 8.4 1.8 5.4 6.1 1.2 100.0 78 52.4 7.3 7.0 13.2 1.5 9.7 7.7 1.2 100.0 38 84.4 1.9 0.6 3.8 2.0 1.4 4.6 1.3 100.0 40 2.7 0.8 2.7 41.6 0.2 38.8 2.7 10.3 100.0 807 3.7 4.5 5.2 33.3 3.1 40.2 3.6 6.5 100.0 476 6.2 4.0 3.3 36.1 3.3 36.6 4.0 7.8 100.0 1,506 49.2 0.1 6.8 13.6 4.6 12.5 9.6 3.5 100.0 108 6.4 3.1 3.6 36.3 2.4 36.9 3.8 7.4 100.0 2,898 8.5 CHILDHOOD VACCINATIONS Diseases caused by viruses, bacteria, and parasites cause immense human misery and kill many thousands annually, especially young children. One of Tanzania’s health policy objectives is to reduce infant and child mortality by controlling communicable diseases. Vaccines have proven invaluable in fighting several childhood illnesses, including poliomyelitis, measles, rubella, and tetanus. The immunisation programme in Tanzania is implemented by the Ministry of Health through the Expanded Programme on Immunisation (EPI), which started in 1975 and was established throughout the country in 1996. The EPI programme in Tanzania follows the World Health Organisation’s (WHO) guidelines for vaccinating children. To be considered fully vaccinated, a child should receive a dose of BCG vaccine against tuberculosis at birth or soon after; three doses of DPT for the prevention of diphtheria, pertussis (whooping cough), and tetanus; at least three doses of polio vaccine; and a vaccination against measles. The DPT and polio vaccinations should be given at approximately 4, Reproductive and Child Health * 105 Table 8.11 Vaccinations by source of information Percentage of children 12-23 months who had received specific vaccines at any time before the survey, by source of information about vaccination, and the percentage vaccinated by 12 months of age, Tanzania 1999 ____________________________________________________________________________________________________ Percentage of children who had received: ______________________________________________________________________ DPT Polio1 No Number Source of _________________ ______________________ vacci- of information BCG 1 2 3 0 1 2 3 Measles All2 nations children _____________________________________________________________________________________________________ Vaccinated at any time before the survey Vaccination card Mother's report Either source Vaccinated by 12 months of age 73.1 73.1 70.5 68.9 41.1 73.3 71.0 67.7 63.7 60.9 0.0 439 19.6 18.8 16.9 12.1 8.0 19.8 18.6 12.2 14.4 7.4 5.3 154 92.7 91.9 87.4 81.0 49.1 93.1 89.6 79.9 78.1 68.3 5.3 593 92.0 91.4 86.1 77.3 49.1 92.6 88.4 77.2 69.3 58.5 5.3 593 _______________________________________________________________________________________________________ Note: 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 for children with a written record of vaccination. 1 Polio 0 is given at birth. 2 Children who are fully vaccinated (i.e., those who have received BCG, measles, and three doses of DPT and polio (excluding polio 0). 8, and 12 weeks of age; more recently, a dose of polio vaccine at birth has been added to the schedule. Measles vaccine should be given at or soon after the child reaches nine months. Although in Tanzania children’s vaccination schedules are followed up until the child reaches five years of age, WHO recommends that children receive the complete schedule of vaccinations before 12 months of age and that the vaccinations be recorded on a health card given to the parents or caretaker. Information on vaccination status was collected from vaccination cards shown to the interviewer and from mothers’ verbal reports if no card was available. The Child Health Card is given to children at their first contact with health services and is used until the child’s fifth birthday. It is used for recording information on growth monitoring, child immunisations, and morbidity. If the cards were available, the interviewers copied vaccination dates directly onto the questionnaire. If a vaccination card was presented but a vaccine had not been recorded on the card as having been given, the mother was asked to recall whether that particular vaccine had been given. The mother was then asked whether the child had received other vaccinations that were not recorded on the card, and, if so, they too were noted on the questionnaire. If the mother was not able to provide a card for the child, she was asked to recall whether the child had received BCG, polio, DPT (including the number of doses for each), and measles vaccinations. The information collected covered all children under age five, although data presented here are restricted to children age 12-23 months to better reflect children who have reached the age by which they should be fully vaccinated. Information on vaccination coverage among children age 12–23 months is shown in Table 8.11 according to the source of information used to determine coverage, i.e., vaccination record or mother’s report. Health cards were presented for almost three-quarters (74 percent) of the children age 12–23 months. The third row of the table shows the proportion of children who were immunised at any age up to the time of the survey, while the last row shows the proportion who were vaccinated by age 12 months, the age at which vaccination coverage should be complete. According to information from both the vaccination records and mothers’ recall, only 68 percent of Tanzanian children 12-23 months can be considered fully immunised. Although the level of coverage for BCG and the first doses of DPT and polio exceeds 90 percent, the proportion 1 Dropout rate = (Dose 1 - Dose 3) * 100 / Dose 1 106 * Reproductive and Child Health Figure 8.2 Percentage of Children Age 12-23 Months with Specific Vaccinations according to Vaccination Cards and Mothers' Reports 93 92 87 81 49 93 90 80 78 68 5 BCG 1 2 3 0 1 2 3 Measles All None 0 20 40 60 80 100 Percent TRCHS 1999 DPT Polio who go on to receive the third dose of these last two vaccines falls off to 81 percent for DPT and 80 for polio (Figure 8.2); dropout rates1 between the first and third doses of DPT and polio are thus 12 and 14 percent, respectively. Seventy-eight percent of children age 12-23 months have received the measles vaccine. Only 5 percent of children have not received any vaccinations at all. Taking into account WHO recommendations that children should receive the complete schedule by 12 months of age, 59 percent of children age 12–23 months received all of the recommended vaccinations before their first birthday. Overall vaccination coverage since 1991-92 has declined slightly, from 71 to 68 percent of children 12-23 months fully immunised. Table 8.12 shows vaccination coverage among children age 12–23 months by sex, birth order, residence, and mother’s education. The table also includes information on the percentage of children for whom a vaccination card was shown to the interviewer. Boys have slightly higher vaccination coverage than girls, 70 versus 67 percent. The proportion of children fully immunised declines as birth order increases, from 79 percent for first births to 60 percent of sixth and higher births. Reproductive and Child Health * 107 Table 8.12 Vaccinations by background characteristics Percentage of children 12-23 months who had received specific vaccines by the time of the survey (according to the vaccination card or the mother's report), and the percentage with a vaccination card, according to selected background characteristics, Tanzania 1999 _______________________________________________________________________________________________________ Percentage of children who received: ___________________________________________________________________ Percent- DPT Polio1 No age Number Background _________________ ________________________ vacci- with of characteristic BCG 1 2 3 0 1 2 3 Measles All2 nations a card children _______________________________________________________________________________________________________ Child's sex Male Female Birth order 1 2-3 4-5 6+ Residence Urban Rural Mainland/Zanzibar Mainland Urban Rural Zanzibar Pemba Unguja Mother’s education No education Primary incomplete Primary complete Secondary+ Total 91.7 92.6 88.6 83.1 45.8 93.1 90.1 80.4 79.8 69.8 6.0 72.5 334 94.0 91.1 85.9 78.2 53.3 93.2 88.9 79.4 76.0 66.5 4.5 76.2 259 93.8 96.0 93.9 87.7 62.0 97.0 93.1 85.3 91.6 78.8 3.0 74.5 115 92.4 92.9 86.4 84.2 52.2 92.9 91.0 84.2 76.3 70.2 6.6 73.5 210 95.2 90.6 88.6 81.1 53.1 91.2 88.4 73.9 77.5 65.0 3.9 78.4 136 89.8 88.2 82.2 69.9 28.6 92.3 85.4 74.8 70.1 59.6 6.7 70.1 131 100.0 96.0 95.5 89.9 74.8 96.5 95.1 84.8 90.3 80.5 0.0 69.6 112 91.0 91.0 85.6 78.9 43.1 92.4 88.3 78.8 75.3 65.5 6.5 75.1 481 92.6 91.8 87.3 80.9 49.3 93.0 89.5 79.9 78.2 68.3 5.4 74.0 578 100.0 95.9 95.5 90.0 76.0 96.3 95.0 84.6 90.6 80.6 0.0 69.1 107 90.9 90.9 85.5 78.9 43.3 92.3 88.2 78.8 75.4 65.5 6.6 75.2 471 97.8 95.8 92.4 83.3 39.5 97.0 93.6 82.8 75.0 70.0 1.6 75.6 15 95.8 93.5 88.0 71.6 35.3 95.7 90.3 70.6 61.5 51.8 3.2 66.5 8 100.0 98.3 97.0 95.8 44.0 98.3 97.0 95.8 89.4 89.4 0.0 85.4 7 86.2 85.5 74.8 65.4 35.5 87.8 80.7 67.5 63.3 49.5 11.3 67.2 155 90.6 86.7 84.3 74.3 45.4 87.5 85.3 74.0 75.3 66.9 7.6 78.7 112 96.3 96.5 94.2 91.7 56.1 97.5 95.0 87.0 85.2 78.2 1.8 76.1 302 * * * * * * * * * * * * 24 92.7 91.9 87.4 81.0 49.1 93.1 89.6 79.9 78.1 68.3 5.3 74.1 593 _______________________________________________________________________________________________________ Note: 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 for children with a written record of vaccination. An asterisk indicates that a figure has been suppressed because it is based on fewer than 25 respondents. 1 Polio 0 is given at birth. 2 Children who are fully vaccinated (i.e., those who have received BCG, measles, and three doses of DPT and polio (excluding polio 0). As has been observed in prior surveys, vaccination coverage is slightly higher in Zanzibar than in the Mainland. Unguja has considerably higher vaccination coverage (89 percent) than Pemba (52 percent), which is due to the steep dropout rate in Pemba between the second and third doses of DPT and polio vaccine and the low rate of measles immunisation. Immunisation coverage improves substantially as mother’s level of education increases, from 50 percent of children whose mothers have no education to 78 percent of children whose mothers have completed some primary school. 8.6 ACUTE RESPIRATORY INFECTION AND FEVER Acute respiratory infection (ARI) is among the leading causes of morbidity and mortality among young children in Tanzania. Of the acute respiratory diseases, pneumonia is the most serious for young children. Improvement in children’s nutritional status is regarded as the best and most effective strategy for reducing the severity of acute respiratory infections because children could withstand the effects and recover more quickly. Nevertheless, early diagnosis and treatment with antibiotics can prevent a large proportion of deaths from respiratory infection, especially infection 108 * Reproductive and Child Health that includes fever, cough, and difficult or rapid breathing. Fever symptoms are also associated with malaria in many cases. Malaria is a leading cause of outpatient attendance, admissions, and deaths, especially among children under five. According to a survey conducted by the Ministry of Health in three districts (Morogoro Rural, Dar es Salaam, and Hai), malaria causes about 45 percent of all deaths among children under five in Morogoro, about 25 percent in Dar es Salaam, and about 20 percent in Hai. To quantify the prevalence of ARI and fever, mothers were asked whether their children under age five had been ill with a cough accompanied by short rapid breathing or with a fever during the two weeks before the survey. Mothers whose children had experienced these symptoms were asked whether they sought advice or treatment from a health professional or at a health facility. If the child had suffered from fever during the previous two weeks, the mother was asked whether the child took medicine for the fever and, if so, which kind. While information on disease prevalence is highly dependent on correct reporting and proper diagnosis of symptoms, the accuracy of information on treatment practices depends on how much mothers know about the medicines that were given to their children. The aim in the TRCHS was to gain a general knowledge about the management of ill children. Table 8.13 presents the percentage of children under five who were ill with a cough accompanied by fast breathing and the percentage who were ill with fever during the two weeks before the survey. The data show that 14 percent of children had a cough and rapid breathing in the two weeks before the survey. Prevalence of ARI symptoms varies by age of the child, being highest among children age 6-11 months (26 percent) and declining slowly to 8 percent among those age 48-59 months. Variation in ARI prevalence is not significant by child’s sex, birth order, or residence or by mother’s level of education. Zanzibar has a higher prevalence of children with ARI symptoms (18 percent) than the Mainland (14 percent), which is entirely due to the relatively high level in Pemba (23 percent). More than one-third of children under five were reported to have had a fever in the two weeks prior to the survey. Fever is more prevalent among children age 6-23 months and among children who live in Pemba. More than half (53 percent) of children with fever were treated with antimalarial medicine (i.e. chloroquine). More than two-thirds of children with respiratory infections and/or fever were taken to a health facility. 8.7 USE OF BEDNETS Consistent use of insecticide-treated bednets can substantially reduce the transmission of malaria. Donor organisations are supporting commercial marketing of treated bednets in an effort to expand their use. In order to gauge the extent of bednet use, respondents to the household interview were asked whether the household had any bednets and, if so, whether all, some, or none of the children under age five slept under a bednet the night before the interview. They were also asked if the bednets had been treated with an insecticide, since treated bednets are more effective than untreated ones. The data show that use of bednets is minimal in Tanzania (Table 8.14). Of households with at least one child under five, only 21 percent reported that all children under five slept under a bednet the night prior to the interview, while 4 percent reported that only some of the children spent the night under a bednet. Of the households in which some children slept under a bednet, only 10 percent reported that the net had ever been treated with insecticide. There are substantial differences between urban and rural households, with more urban households using bednets Reproductive and Child Health * 109 Table 8.13 Prevalence and treatment of acute respiratory infection and prevalence of fever Among all children under five years of age, the percentage who were ill with a cough accompanied by rapid breathing and the percentage who were ill with fever during the two weeks preceding the survey, the percentage of children with fever given antimalarial medicine, and the percentage of children with fever or cough taken to a health facility or provider, according to selected background characteristics, Tanzania 1999 _____________________________________________________________________________________________________ Among children Among children with fever with fever Percentage percentage or cough, Number with cough Percentage given percentage of children Number Background accompanied by with antimalarial taken to a health with fever of characteristic rapid breathing (ARI) fever medicine facility or provider or cough children _____________________________________________________________________________________________________ Child's age < 6 months 6-11 months 12-23 months 24-35 months 36-47 months 48-59 months Child's sex Male Female Birth order 1 2-3 4-5 6+ Residence Urban Rural Mainland/Zanzibar Mainland Urban Rural Zanzibar Pemba Unguja Mother’s education No education Primary incomplete Primary complete Secondary+ Total 12.3 32.1 45.4 55.5 119 326 26.1 50.7 59.7 70.2 179 310 19.7 50.8 54.0 69.3 319 593 12.3 32.0 51.1 74.2 203 588 9.1 29.4 51.6 66.1 168 528 8.1 20.2 57.0 61.6 129 554 14.4 36.5 54.3 69.2 583 1,463 13.4 33.7 52.4 65.7 534 1,436 14.3 34.1 59.2 69.7 247 655 13.3 35.4 51.6 65.5 379 974 14.1 37.4 52.4 70.6 261 642 14.3 33.4 51.6 64.8 230 628 12.2 33.4 61.7 78.4 201 546 14.3 35.5 51.6 65.1 917 2,353 13.8 35.0 53.0 67.3 1,083 2,820 12.1 33.6 61.2 78.5 193 523 14.1 35.4 51.2 64.9 890 2,297 18.4 38.6 68.4 72.9 34 78 23.3 49.0 67.5 69.8 21 38 13.8 28.8 69.8 77.7 13 40 13.2 37.1 44.3 59.5 312 807 13.4 33.5 51.9 67.7 179 476 14.3 35.4 58.2 71.1 595 1,506 15.1 24.6 (70.3) (77.3) 31 108 13.9 35.1 53.4 67.5 1,117 2,898 ____________________________________________________________________________________________________ Note: Codes for antimalarial medicines included both Fansidar and chloroquine; however, the proportion citing Fansider was less then half a percent. ARI = Acute respiratory infection (52 percent) than rural households (17 percent). Use of bednets is also higher in Zanzibar than in the Mainland. 8.8 PREVALENCE AND TREATMENT OF DIARRHOEA 110 * Reproductive and Child Health Table 8.14 Use of bednets Percent distribution of households with children under five by use of bednets by children under five the night before the interview, and by use of insecticide to treat bednets, according to selected background characteristics, Tanzania 1999 ______________________________________________________________________________________________________ Use of bednets by children under Use of insecticide to five during the previous night treat bednets Number of ________________________________ ________________________ households Don’t Ever Never with Background All Some No know treated treated Don’t children characteristic children children children missing Total bednet bednet know Total under 5 ______________________________________________________________________________________________________ Residence Urban Rural Mainland/Zanzibar Mainland Urban Rural Zanzibar Pemba Unguja Total 47.9 4.5 46.6 1.0 100.0 10.1 83.4 6.5 100.0 415 13.0 4.1 82.1 0.8 100.0 10.3 87.3 2.4 100.0 1,471 20.3 4.1 74.9 0.8 100.0 10.4 85.1 4.5 100.0 1,836 47.6 4.4 47.0 1.0 100.0 10.3 82.9 6.8 100.0 401 12.7 4.0 82.6 0.7 100.0 10.4 87.0 2.5 100.0 1,435 35.1 9.0 54.4 1.6 100.0 5.9 94.1 0.0 100.0 50 27.1 15.4 56.6 0.9 100.0 7.0 93.0 0.0 100.0 24 42.5 3.0 52.4 2.2 100.0 4.9 95.1 0.0 100.0 26 20.7 4.2 74.3 0.8 100.0 10.2 85.5 4.3 100.0 1,886 Diarrhoea is one of the major causes of morbidity and mortality among young children in Tanzania. The problem becomes more prominent in children after six months of age, when children start to crawl and eat supplementary foods. In the 1999 TRCHS, mothers were asked whether their children under five had diarrhoea in the two weeks preceding the survey. If so, the mother was asked what, if anything, had been done to treat the diarrhoea. Since the prevalence of diarrhoea varies seasonally, the results pertain only to the pattern during the September-November period when the TRCHS interviewing took place. Twelve percent of children under five were reported to have had diarrhoea (Table 8.15). As with ARI and fever, children age 6 to 23 months were more likely to suffer from diarrhoea; prevalence is 2 to 3 times higher among these children than among the very young or older children. Treatment of diarrhoea is another issue that was studied in the 1999 TRCHS. The goal was to understand diarrhoea management by mothers of children under five. The administration of oral rehydration therapy (ORT) is a simple means of countering the effects of the dehydration that accompanies diarrhoea. ORT involves giving the child a solution prepared by mixing water with commercially prepared packets of oral rehydration salts (ORS) or any kind of thin, nutritious fluids such as rice water, coconut milk, or watery soup. Reproductive and Child Health * 111 Table 8.15 Prevalence of diarrhoea Percentage of children under five years of age with diarrhoea during the two weeks preceding the survey, by selected background characteristics, Tanzania 1999 __________________________________________ Diarrhoea in the Number Background preceding of characteristic 2 weeks children ___________________________________________ Child's age < 6 months 6-11 months 12-23 months 24-35 months 36-47 months 48-59 months Child's sex Male Female Birth order 1 2-3 4-5 6+ Residence Urban Rural Mainland/Zanzibar Mainland Urban Rural Zanzibar Pemba Unguja Mother’s education No education Primary incomplete Primary complete Secondary+ Total 10.1 326 30.3 310 20.4 593 11.4 588 4.1 528 3.9 554 13.5 1,463 11.1 1,436 12.2 655 11.9 974 13.3 642 12.3 628 9.8 546 12.9 2,353 12.4 2,820 9.9 523 12.9 2,297 11.6 78 16.3 38 7.2 40 8.9 807 14.4 476 13.9 1,506 7.3 108 12.4 2,898 Table 8.16 shows diarrhoea treatment prac- tices for children who had diarrhoea in the two weeks preceding the survey. About two-thirds (63 percent) were taken to a health facility for treatment, while 55 percent were given a solution prepared from ORS packets and 32 percent were given more than the usual amount of fluids. Three- quarters of children with diarrhoea were given soup, uji (porridge), rice water, or coconut milk. However, almost one-third of ill children were given neither ORS nor increased fluids. Differences in diarrhoea treatment by background characteristics are surpris- ingly small and should be viewed cautiously, given the small numbers of ill children. Besides being asked about what was done to treat children with diarrhoea, mothers were specifi- cally asked whether they gave the child more or less fluids and food than usual. Table 8.17 provides information on feeding practices among children under five who had diarrhoea in the two weeks before the survey. The data indicate that 33 percent of children with diarrhoea were given the same amount of fluids as usual, 32 percent received more fluids than usual, and 34 percent received less fluids than usual. These results suggest that one-third of mothers still engage in the dangerous practice of curtailing fluid intake when their children have diarrhoea. Half of the children with diarrhoea were given less than the usual amount of food, which could exacerbate the child’s illness. 8.9 KNOWLEDGE OF SIGNS OF ILLNESS In order to ensure the proper management of childhood illness, it is important for caretakers of children to be aware of the signs of a serious problem that would alert them to the child’s need for help. In the TRCHS, all women with children under five were asked what signs of illness would tell them that they should take the child to a health facility immediately. As shown in Table 8.18, almost three out of four mothers could cite two or more danger signs. The most widely cited sign of serious illness was fever, reported by 91 percent of mothers. Other signs of serious illness were the child becoming sicker (46 percent of mothers), the child breathing rapidly (20 percent), and the child drinking poorly (18 percent). In a similar line of questioning, all women were asked what signs would indicate that a pregnant woman may have a serious health problem for which she should seek medical treatment immediately. Table 8.19 shows that more than half the women know that fever can be a sign of pregnancy complications, and one-third of the women say that profuse bleeding is a sign that a 112 * Reproductive and Child Health Table 8.16 Treatment of diarrhoea Among children under five years who had diarrhoea in the two weeks preceding the survey, the percentage taken for treatment to a health facility or provider, the percentage who received oral rehydration salts (ORS), or increased fluids, the percentage who received neither ORS nor increased fluids, and the percentage given other treatments, according to selected background characteristics, Tanzania 1999 ________________________________________________________________________________ Percentage Soup, taken to Neither rice a health ORS or water or Children Background facility or ORS Increased increased coconut Don’t with characteristic provider1 packets fluids fluids milk know diarrhoea ________________________________________________________________________________ Child's age < 6 months 6-11 months 12-23 months 24-35 months 36-47 months 48-59 months Child's sex Male Female Birth order 1 2-3 4-5 6+ Residence Urban Rural Mainland/Zanzibar Mainland Urban Rural Zanzibar Mother’s education No education Primary incomplete Primary complete Secondary+ Total (62.5) (57.8) (11.3) (36.9) (35.9) (22.3) 33 65.7 63.8 26.6 26.3 74.9 7.5 94 58.2 49.5 33.8 32.7 77.7 12.5 121 62.4 54.6 47.2 28.1 78.2 5.7 67 * * * * * * 22 * * * * * * 21 63.5 55.2 34.0 30.9 71.0 10.8 198 62.9 54.4 29.3 33.8 76.5 10.2 160 70.8 51.9 26.0 40.4 64.5 16.7 80 52.4 46.5 33.1 37.0 80.5 11.1 116 65.5 61.3 42.2 24.2 68.3 7.6 85 69.2 63.4 24.8 25.2 77.9 6.5 77 70.1 51.0 28.9 35.0 85.7 8.3 54 62.0 55.5 32.4 31.7 71.3 10.9 304 63.6 55.5 31.7 31.9 74.0 10.2 349 70.6 52.1 28.6 34.3 86.8 7.9 52 62.4 56.1 32.2 31.5 71.7 10.7 297 47.7 29.4 40.2 42.0 54.2 21.2 9 59.5 61.4 17.6 34.5 65.9 11.7 72 71.6 57.8 33.4 32.5 72.5 15.4 69 61.8 51.8 36.1 31.3 76.3 8.6 209 * * * * * * 8 63.2 54.9 31.9 32.2 73.5 10.5 358 _______________________________________________________________________________ Note: Figures in parentheses are based on 25 to 49 children who had diarrhoea. An asterisk indicates that a figure has been suppressed because it is based on fewer than 25 respondents. 1 Includes health centre, hospital and private doctor. pregnant woman should seek medical assistance. Only 17 percent of women know that swollen hands or feet is a potential warning sign (a symptom of oedema). Thirty-seven percent of women cited other symptoms of pregnancy complications, whereas 20 percent said they did not know of any signs. In interpreting the data, it is useful to keep in mind that all women were asked the question and that knowledge is higher among women who have ever given birth or were pregnant at the time of the survey. For this reason, knowledge of signs of pregnancy complications is relatively lower for the youngest age group of women. Reproductive and Child Health * 113 Table 8.17 Feeding practices during diarrhoea Percent distribution of children under five years who had diarrhoea in the past two weeks by amount of solid foods given and amount of fluids given, Tanzania 1999 _______________________________________ Percentage Feeding practice of children _______________________________________ Amount of fluids given Same 33.0 More 31.9 Less 34.4 Don’t know/missing 0.7 Amount of food given Same 32.5 More 15.8 Less 51.0 Don’t know/missing 0.7 Total 100.0 Number of children 358 Table 8.18 Knowledge of health complications Percentage of mothers of children under five who know a sign indicating the need to seek health care immediately and percentage who know at least two signs, by specific sign and selected background characteristics, Tanzania 1999 ____________________________________________________________________________________________________ Sign indicating need to seek health care immediately _____________________________________________________ Has Has Knows Number Background Drinks Becomes Develops Has rapid difficult blood at least of characteristic poorly sicker a fever breathing breathing in stool 2 signs mothers ____________________________________________________________________________________________________ Residence Urban Rural Mainland/Zanzibar Mainland Urban Rural Zanzibar Pemba Unguja Mother’s education No education Primary incomplete Primary complete Secondary+ Total 23.8 40.1 95.9 22.4 13.3 11.5 77.2 475 16.2 47.4 88.9 19.8 12.6 8.3 70.2 1,581 18.2 45.6 90.3 20.5 12.9 9.2 71.9 2,006 24.2 39.7 95.9 22.7 13.6 11.7 77.4 460 16.5 47.4 88.7 19.8 12.7 8.4 70.3 1,547 7.1 49.3 96.6 16.1 7.7 4.9 67.5 50 4.5 43.0 96.0 20.4 7.9 6.2 64.0 23 9.3 54.8 97.2 12.3 7.5 3.8 70.5 27 14.3 39.5 83.0 17.3 12.1 7.6 60.5 549 20.0 45.0 93.3 18.9 9.4 6.2 70.8 343 18.3 49.5 93.4 22.6 13.9 10.7 77.8 1,080 30.4 40.5 90.0 17.9 15.7 9.7 73.2 84 18.0 45.7 90.5 20.4 12.8 9.1 71.8 2,056 114 * Reproductive and Child Health Table 8.19 Knowledge of pregnancy complications Percentage of all women 15-49 who know specific signs of pregnancy complications, by background characteristics, Tanzania 1999 ____________________________________________________________________________________ Sign of pregnancy complications _______________________________________ Swollen Bleeding Doesn’t Number Background hands/ too know of characteristic Fever feet much Other any signs births ____________________________________________________________________________________ Age 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Residence Urban Rural Mainland/Zanzibar Mainland Urban Rural Zanzibar Pemba Unguja Mother’s education No education Primary incomplete Primary complete Secondary+ Reproductive status Ever had birth Never had birth Currently pregnant Total 35.5 5.1 13.4 19.8 49.6 909 54.2 16.2 31.1 37.4 19.9 811 58.1 22.3 38.6 43.9 10.2 749 53.5 20.3 38.8 42.6 9.4 490 55.9 20.7 46.7 48.6 4.2 456 61.2 26.5 42.9 44.8 5.0 299 56.6 26.3 42.9 39.6 9.2 315 51.6 27.1 42.7 38.2 17.4 1,122 51.5 13.6 29.3 36.9 20.7 2,907 51.8 17.3 33.0 37.3 19.9 3,929 51.9 27.0 42.8 38.2 17.6 1,088 51.7 13.5 29.2 36.9 20.9 2,841 41.1 22.8 34.6 35.5 15.0 100 42.9 17.6 29.7 35.4 12.7 44 39.7 26.8 38.3 35.6 16.8 56 52.9 11.8 29.5 36.2 18.3 1,093 48.9 11.5 28.7 35.9 25.8 854 52.6 21.7 35.0 37.9 18.5 1,866 46.1 32.3 51.4 42.8 15.3 215 58.0 21.4 39.7 43.9 8.5 3,013 32.2 5.5 13.2 17.4 53.5 1,016 57.3 10.5 30.2 45.4 13.1 378 51.5 17.4 33.0 37.2 19.8 4,029 Infant Feeding and Childhood Nutrition * 115 INFANT FEEDING AND CHILDHOOD NUTRITION 9 This chapter covers several related topics: infant feeding (including breastfeeding patterns and introduction of complementary weaning foods), nutritional status of young children and their mothers, and coverage of the vitamin A supplementation programme. Height and weight measurements of the respondents’ children under the age of five years and those of the mothers were taken to determine their nutritional status. 9.1 BREASTFEEDING AND SUPPLEMENTATION Infant feeding has an effect on both the child and the mother. Feeding practices are important determinants of children’s nutritional status, and many studies have shown the beneficial effects of breastfeeding on the nutritional status, morbidity, and mortality of young infants. Exclusive breastfeeding (i.e., only breast milk) is recommended during the first 4-6 months of a child’s life because it limits exposure to disease agents and provides all of the nutrients a baby requires. Breastfeeding also has an indirect effect on the postpartum fecundity of mothers. In particular, more frequent breastfeeding is associated with longer periods of postpartum amenorrhoea, which in turn is related to longer birth intervals, and thus lower fertility levels. Prevalence of Breastfeeding Survey results show that breastfeeding is almost universal in Tanzania. Ninety-five percent of children are breastfed for some period, regardless of the background characteristics of the child or the mother (data not shown). Previous research confirms the universality of breastfeeding in Tanzania (Bureau of Statistics and Macro International, 1997:124). Timing of Introduction of Complementary Foods The timing of introduction of complementary foods in addition to breast milk has important implications for the child and the mother. Breast milk is uncontaminated and contains all the nutrients needed by children in the first few months of life. It also provides some immunity to disease through the mother’s antibodies. Early supplementation, especially under unhygienic conditions, can result in infection with foreign organisms and lower immunity to disease. The timing of introduction of food supplements also has an effect on the length of the mother’s postpartum amenorrhoea. Early initiation of supplementation results in earlier resumption of the mother’s menstrual periods, because supplementation reduces infants’ dependence on breast milk and the frequency of suckling. Mothers were asked about the current breastfeeding status of their children under age five and, if the child was being breastfed, whether various types of liquid or solid foods had been given to the child “yesterday” or “last night”. Children who are exclusively breastfed are defined as receiving breast milk only, while full breastfeeding is defined as receiving breast milk and plain water only. The results shown in Table 9.1 indicate that babies are breastfed for a long time; even among children 12-13 months old, 94 percent are still receiving breast milk (6 percent are weaned). 116 * Infant Feeding and Childhood Nutrition Table 9.1 Breastfeeding status Percent distribution of living children under three years of age by current breastfeeding status, according to child's current age in months, Tanzania 1999 __________________________________________________________________________________ Breastfeeding and: _________________ Using Number Not Plain Comple- bottle of breast- Exclusively water mentary with a living Age in months feeding breastfed only foods Total nipple children ___________________________________________________________________________________ 0-1 2-3 4-5 6-7 8-9 10-11 12-13 14-15 16-17 18-19 20-21 22-23 24-25 26-27 28-29 30-31 32-33 34-35 0-3 months 4-6 months 7-9 months 1.1 57.8 22.6 18.5 100.0 3.6 97 3.0 25.4 24.0 47.6 100.0 8.9 123 3.0 15.5 11.2 70.3 100.0 14.2 106 1.9 1.5 5.5 91.0 100.0 10.5 108 3.6 2.9 4.5 89.0 100.0 9.3 101 4.9 0.0 5.1 90.1 100.0 4.0 100 6.4 0.0 5.0 88.6 100.0 7.1 72 14.9 0.0 0.4 84.8 100.0 6.2 129 13.8 0.0 1.2 85.0 100.0 2.7 102 19.2 0.0 0.0 80.8 100.0 4.5 101 37.8 0.0 0.0 62.2 100.0 1.6 87 64.1 0.0 0.0 35.9 100.0 3.0 102 72.8 0.0 0.0 27.2 100.0 5.5 92 78.7 0.0 1.2 20.1 100.0 6.1 103 82.1 0.0 0.0 17.9 100.0 4.4 97 91.9 0.0 0.0 8.1 100.0 10.5 110 94.5 0.0 0.0 5.5 100.0 1.2 109 92.8 0.0 0.0 7.2 100.0 4.9 78 2.2 39.6 23.4 34.8 100.0 6.6 220 2.7 11.0 9.6 76.6 100.0 9.3 164 3.0 1.9 4.4 90.7 100.0 13.6 152 ___________________________________________________________________________________ Note: Breastfeeding status refers to 24 hours preceding the survey. Children classified as breastfeeding and plain water only receive no complementary foods. However, the data indicate that supplementation of breast milk with other liquids and foods begins early in Tanzania. Among newborns less than two months of age, most are either exclusively breastfed (58 percent) or fully breastfed (23 percent); however, almost 20 percent of these very young babies are already receiving complementary foods or liquids. Among those age 2-3 months, almost half are being given supplements. Duration of Breastfeeding Data on the median duration and frequency of breastfeeding are presented in Table 9.2. The estimates of mean and median duration of breastfeeding are based on current status data, that is, the proportion of children under three who were being breastfed at the time of the survey, as opposed to retrospective data on the length of breastfeeding of older children who are no longer breastfed. The prevalence/incidence mean is also provided for possible comparison with other data sources. Infant Feeding and Childhood Nutrition * 117 Table 9.2 Median duration and frequency of breastfeeding Median duration (months) of any breastfeeding, exclusive breastfeeding, and full breastfeeding among children under three years of age, and the percentage of children under six months of age who were breastfed six or more times in the 24 hours preceding the interview, according to background characteristics, Tanzania 1999 ________________________________________________________________________________ Children under six months Median duration of breastfeeding ________________ among children under 3 years1 ____________________________________ Breasftfed 6 or more Any Exclusive Full Number times in Number Background breast- breast- breast- of preceding of characteristic feeding feeding feeding2 children 24 hours children ________________________________________________________________________________ Child's sex Male Female Residence Urban Rural Mainland/Zanzibar Mainland Urban Rural Zanzibar Pemba Unguja Mother's education No education Primary incomplete Primary complete Secondary+ Assistance at delivery Health professional Traditional midwife Other or none Total Mean1 Prevalence/Incidence mean 21.2 0.7 2.0 1,038 92.2 161 20.3 1.7 3.1 990 96.8 165 19.4 0.7 2.3 388 98.8 59 21.4 1.3 2.4 1,641 93.6 267 20.9 1.2 2.4 1,978 94.4 317 19.4 0.7 2.3 374 98.9 56 21.4 1.3 2.5 1,603 93.5 260 21.0 0.4 1.8 51 97.0 10 21.1 0.4 0.9 25 * 5 20.9 0.5 2.0 27 * 5 21.3 2.1 2.6 546 94.0 103 22.8 0.6 1.0 349 94.5 52 20.2 0.8 2.3 1,050 94.7 154 12.2 0.5 4.1 84 * 17 20.4 0.7 2.0 871 93.8 141 21.9 0.9 2.2 374 97.2 61 21.1 2.0 3.3 783 94.0 124 20.9 1.1 2.4 2,029 94.5 326 20.4 2.6 4.0 95.5 NA NA 19.9 1.9 3.4 NA NA NA ________________________________________________________________________________ Note: An asterisk indicates that a figure has been suppressed because it is based on fewer than 25 respondents. Total includes 24 children under 3 years of age for whom data on assistance at delivery are missing. NA = Not applicable 1 Medians and means are based on current status and durations are in months. 2 Either exclusive breastfeeding or breastfeeding and plain water only. The median duration of breastfeeding in Tanzania is 21 months, with no major variations by background characteristics. The only exception is that babies whose mothers have some secondary school education are breastfed for shorter durations (median of 12 months) than those whose mothers are less educated (20-22 months). There has been no significant change in the median duration of breastfeeding over time. 118 * Infant Feeding and Childhood Nutrition Table 9.3 Infant feeding indicators Percentage of children with specific feeding indicators, by breastfeeding status, age, and selected background characteristics, Tanzania 1999 ____________________________________________________________________________________________________ Children Children Children Children 0-3 months 6-9 months 12-15 months 20-23 months ________________ ________________ ________________ _______________ Percent Percent Number receiving Number Percent Number Percent Number Background exclusively of solid/mushy of still of still of characteristic breastfed children food children breastfed children breastfed children ____________________________________________________________________________________________________ Sex of chid Males Female Residence Urban Rural Mainland/Zanzibar Mainland Urban Rural Zanzibar Education No education Primary incomplete Primary complete Secondary+ Total 37.6 109 65.3 94 82.3 112 45.7 95 45.2 111 63.2 115 95.5 89 50.2 94 39.8 33 66.3 39 84.3 35 26.4 41 41.7 187 63.7 171 89.0 166 53.9 148 42.5 213 63.8 203 88.3 196 47.7 184 42.0 31 65.5 38 84.4 34 25.2 39 42.5 182 63.4 166 89.1 161 53.7 144 8.6 7 74.4 6 83.7 5 58.6 5 42.2 59 48.8 51 81.3 53 43.8 44 36.7 41 63.3 30 89.3 32 66.5 37 45.2 106 70.1 124 94.7 108 44.0 104 * 14 * 5 * 9 * 4 41.4 220 64.1 210 88.2 201 48.0 189 ____________________________________________________________________________________________________ Note: An asterisk indicates that a figure has been suppressed because it is based on fewer than 25 respondents. The early introduction of supplements is reflected in the short duration of exclusive breastfeeding (median duration of one month). Few children receive only plain water as a supplement to breast milk, and thus the median duration of full breastfeeding is also quite short (two months). The duration of postpartum amenorrhoea is affected by both the length of time spent breastfeeding and the frequency of breastfeeding. The child’s health and nutritional status are also affected by the frequency of breastfeeding. Almost all children under the age of six months (95 percent) were reported to have been breastfed at least six times in the 24 hours preceding the survey. Differences among subgroups are minor. Table 9.3 is a summary tabulation of various infant feeding indicators. Although experts recommend that babies be exclusively breastfed for 4-6 months after birth, the TRCHS data show that mothers supplement breast milk too early; only 41 percent of infants 0-3 months are exclusively breastfed with no supplementation. Among older infants, lack of supplementation is the problem. Less than two in three children 6-9 months are receiving other liquids and mushy food in addition to breast milk. Somewhat more encouraging is the fact that breastfeeding durations are long in Tanzania, with 88 percent of children 12-15 months still being breastfed and almost half of those still receiving breast milk at 20-23 months of age. Infant Feeding and Childhood Nutrition * 119 Table 9.4 Ideal duration of breastfeeding Percent distribution of all women 15-49 by ideal length of exclusive breastfeeding, according to selected background characteristics, Tanzania 1999 __________________________________________________________________________________________________ Ideal length of exclusive breastfeeding __________________________________________ Number Background 0-3 4-6 7-11 12+ Don't of characteristic months months months months Other know Total women ___________________________________________________________________________________________________ Age 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Residence Urban Rural Mainland/Zanzibar Mainland Urban Rural Zanzibar Pemba Unguja Education No education Primary incomplete Primary complete Secondary+ Total 37.8 38.4 2.1 0.5 0.2 21.0 100.0 909 38.6 55.1 0.4 1.1 0.1 4.7 100.0 811 37.7 58.1 1.1 0.9 0.7 1.4 100.0 749 34.3 61.7 0.5 0.9 0.1 2.6 100.0 490 39.5 55.7 1.3 1.5 0.8 1.1 100.0 456 36.8 60.1 0.5 1.1 0.1 1.4 100.0 299 41.5 53.0 1.1 1.1 1.0 2.3 100.0 315 39.0 55.4 0.3 0.1 0.0 5.2 100.0 1,122 37.5 52.0 1.4 1.3 0.5 7.3 100.0 2,907 38.0 52.9 1.1 1.0 0.4 6.6 100.0 3,929 39.2 55.4 0.3 0.1 0.0 5.0 100.0 1,088 37.6 52.0 1.4 1.3 0.5 7.2 100.0 2,841 33.8 54.3 0.1 0.0 1.9 9.9 100.0 100 31.7 55.3 0.3 0.0 3.9 8.9 100.0 44 35.5 53.6 0.0 0.0 0.3 10.7 100.0 56 37.4 50.8 1.4 1.5 1.1 7.8 100.0 1,093 35.0 52.3 1.5 0.9 0.2 10.1 100.0 854 39.0 54.7 0.8 0.7 0.1 4.7 100.0 1,866 42.5 51.5 0.8 0.6 0.0 4.7 100.0 215 37.9 53.0 1.1 1.0 0.4 6.7 100.0 4,029 Because studies show that exclusive breastfeeding provides the optimum nutrition for infants up to six months of age, Tanzania has implemented education programmes to convey this fact to women. In the TRCHS, all women 15-49 were asked how long they thought a mother should breastfeed her baby without giving any food or liquid other than breast milk. The results are shown in Table 9.4. They indicate that more than half of women say the ideal duration of exclusive breastfeeding is four to six months. More than one-third say that exclusive breastfeeding should last less than three months, while 7 percent of women say they do not know. Differences by background characteristics of the woman are generally small, except that teenage girls are less likely to have an opinion than older women. 9.2 NUTRITIONAL STATUS IN EARLY CHILDHOOD In addition to questions about breastfeeding practices, the 1999 TRCHS included an anthropometric component in which all children under five listed in the Household Schedule were weighed and measured. Each interviewing team carried a scale and a measuring board. The scales were lightweight, bathroom-type scales with a digital screen designed and manufactured under the authority of UNICEF. The boards were specially designed for use in field surveys. Children younger 120 * Infant Feeding and Childhood Nutrition than 24 months were measured lying down on the board (recumbent length), whereas standing height was measured for older children. Evaluation of nutritional status is based on the rationale that in a well-nourished population, there is a statistically predictable distribution of children of a given age with respect to height and weight. In any large population, there is variation in height and weight; this variation approximates a normal distribution. Use of a standard reference population as a point of comparison facilitates the examination of differences in the anthropometric status of subgroups in a population and of changes in nutritional status over time. The World Health Organisation has recommended the use of the U.S. National Center for Health Statistics (NCHS) reference population. Nutritional Status Indicators Three standard indices of physical growth that describe the nutritional status of children are presented: C Height-for-age (stunting) C Weight-for-height (wasting) C Weight-for-age (underweight). Each of these indices gives different information about growth and body composition that can be used to assess nutritional status. Height-for-age is a measure of linear growth, and its deficits indicate long-term, cumulative inadequacies of health or nutrition. A child who is below minus two standard deviations (-2 SD) from the median of the NCHS reference population in terms of height-for-age is considered short for his/her age, or stunted, a condition reflecting the cumulative effect of chronic malnutrition. If the child is below minus three standard deviations (-3 SD) from the reference median, then the child is considered severely stunted. A child between -2 SD and -3 SD is considered moderately stunted. Stunting reflects failure to receive adequate nutrition over a long period and is frequently associated with poor overall economic conditions, chronic or repeated infections, and inadequate nutrient intake. Height-for-age, therefore, represents a measure of the long-term effects of malnutrition in a population and does not vary appreciably according to the season of data collection. Stunted children are not immediately obvious in a population: a stunted three-year-old child could look like a well-fed two-year-old. Weight-for-height measures body mass in relation to body length and describes current nutritional status. A child who is below minus two standard deviations (-2 SD) from the reference median for weight-for-height is considered too thin for his/her height, or wasted, a condition reflecting acute malnutrition. Wasting indicates a deficit in tissue and fat mass compared with the amount expected in a child of the same height or length and may result either from failure to gain weight or from actual weight loss. Wasting represents the failure to receive adequate nutrition in the period immediately preceding the survey and may be the result of inadequate food intake or recent episodes of illness causing loss of weight and the onset of malnutrition. As with stunting, wasting is considered severe if the child is more than three standard deviations below the reference mean. Severe wasting is closely linked to an elevated risk of mortality. Prevalence of wasting may vary considerably by season. Weight-for-age is primarily a composite index of both weight-for-height and height-for-age, and its summary nature makes interpretation complex. A child can be underweight for his age because he is stunted, wasted, or both. Weight-for-age is a useful tool in clinical settings for 1 Note that this procedure is a change from previous surveys in which the children measured were those born in the five years preceding the survey to women who were interviewed individually. The current procedure is considered less biased because children whose mothers have died or who reside in different households from their mothers are not excluded. Infant Feeding and Childhood Nutrition * 121 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 deviations (-2 SD) for each of these three indices. In the survey, all children under age five who were listed on the Household Questionnaire were eligible for height and weight measurement.1 Of the 2,990 children eligible for measurement, 94 percent were weighed and measured. For 2 percent of the children, data were missing, mostly because the child was not at home. Of the children who were both weighed and measured, a little more than 2 percent were considered to have implausibly low or high values for height-for-age or weight-for-height, while another 1 percent were missing the date of birth information. The following analysis focuses on the 2,820 children under five for whom complete and plausible anthropometric data were collected. Table 9.5 shows the percentage of children who are classified as malnourished according to height-for-age, weight-for-height, and weight-for-age indices, by the child’s age and selected background characteristics. Current Levels of Malnutrition The height-for-age results suggest that 44 percent of children under five are stunted, with 17 percent being severely stunted. Stunting increases from 9 percent among children less than six months old to more than half of the children 12-59 months old. Rural children are much more likely to be short for their age than urban children (48 versus 26 percent). Stunting seems to be less common among children in Zanzibar than in the Mainland. The weight-for-height results show that 5 percent of children under five are wasted, with less than 1 percent being severely wasted. Differences in wasting by background characteristics are small except for some fluctuations by age of the child. The proportion of children classified as underweight for their age is 29 percent. As with stunting, children older than six months of age are much more likely to be underweight than are very young infants. There is a sizeable difference in levels of underweight between urban and rural areas (21 versus 31 percent, respectively). Figure 9.1 shows the distribution of children by age and the extent to which their weight and height deviate from the median of the reference population for height-for-age, weight-for- height, and weight-for-age indices. The results agree with previous findings of the 1991-92 TDHS and 1996 TDHS. For all three anthropometric indices, there is remarkable deterioration in nutritional status that begins shortly after birth, continues through the first year and a half, and then levels off or improves slightly thereafter to the third birthday. 122 * Infant Feeding and Childhood Nutrition Table 9.5 Nutritional status of children Percentage of children under five years of age who are classified as malnourished according to three anthropometric indices of nutritional status: height-for-age, weight-for-height, and weight-for-age, and mean Z-scores, by selected background characteristics, Tanzania 1999 _______________________________________________________________________________________________________ Height-for-age Weight-for-height Weight-for-age ________________________ _______________________ ________________________ Percentage Percentage Percentage Percentage Percentage Percentage Number Background below below below below below below Mean of characteristic -3 SD -2 SD1 Z score -3 SD -2 SD1 Z-score -3 SD - 2 SD1 Z-score children ______________________________________________________________________________________________________ Child's age <6 months 6-11 months 12-23 months 24-35 months 36-47 months 48-59 months Sex Male Female Residence Urban Rural Mainland/Zanzibar Mainland Urban Rural Zanzibar Pemba Unguja Total 2.5 9.2 -0.7 0.0 3.3 0.4 0.0 3.9 -0.1 304 5.5 23.2 -1.3 0.4 5.8 -0.2 3.9 21.5 -1.2 303 21.0 50.8 -2.0 1.0 10.0 -0.8 11.8 41.8 -1.7 571 17.3 48.5 -2.0 1.2 5.4 -0.5 9.0 38.2 -1.6 568 23.9 51.9 -2.1 0.4 1.9 -0.2 6.0 26.4 -1.4 527 20.8 54.5 -2.1 0.4 4.7 -0.2 3.9 29.0 -1.4 547 16.9 44.9 -1.8 0.1 5.4 -0.3 6.0 28.5 -1.3 1,423 17.3 42.7 -1.8 1.2 5.3 -0.3 7.0 30.4 -1.4 1,397 7.7 26.1 -1.3 0.4 5.9 -0.3 4.9 20.6 -1.0 500 19.1 47.6 -1.9 0.7 5.3 -0.3 6.8 31.3 -1.4 2,321 17.2 44.0 -1.8 0.6 5.3 -0.3 6.5 29.5 -1.3 2,746 7.8 26.1 -1.3 0.4 5.9 -0.3 5.0 20.7 -1.0 479 19.2 47.8 -1.9 0.7 5.2 -0.3 6.8 31.4 -1.4 2,268 12.2 35.8 -1.6 0.5 6.3 -0.4 7.0 25.8 -1.3 74 18.3 46.2 -1.8 0.8 9.5 -0.6 12.7 36.0 -1.6 34 7.0 27.0 -1.3 0.3 3.5 -0.3 2.2 17.2 -1.0 40 17.1 43.8 -1.8 0.6 5.4 -0.3 6.5 29.4 -1.3 2,820 _______________________________________________________________________________________________________ Note: Figures are for children born in the period 0-59 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 malnourished 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. 1 Includes children who are below -3 SD Trends in Malnutrition in Tanzania The data collected in the 1999 TDHS to assess nutritional status of children under five years of age are similar to those obtained in the 1991-92 TDHS and the 1996 TDHS, despite the administration of the three surveys in different seasons. The 1991-92 TDHS data collection took place from October 1991 to March 1992, while the 1996 TDHS took place from July to November 1996, and the 1999 TRCHS was conducted from September to mid-November 1999. The difference in timing of the three surveys may affect the results concerning nutritional status of children. The three surveys show that the prevalence of stunting has remained at around 43- 44 percent of children under five (Table 9.6). Although the percentage wasted rose from 6 percent to 7 percent from 1991-92 to 1996, it decreased to 5 percent in 1999. The proportion of children who are underweight has also remained constant at around 29-31 percent. Infant Feeding and Childhood Nutrition * 123 Table 9.6 Trends in nutritional status of children Among children under five years of age, the percentage classified as malnourished according to height-for-age, weight- for-height, and weight-for-age, 1991-92 TDHS, 1996 TDHS, and 1999 TRCHS _____________________________________________________ 1991-92 1996 1999 Index TDHS TDHS TRCHSa ___________________________________________________ Height-for-age < -2 SD 42.6 43.4 43.8 < -3 SD 16.7 17.8 17.1 Weight-for-height < -2 SD 6.0 7.2 5.4 < -3 SD 1.2 1.3 0.6 Weight-for-age < -2 SD 28.8 30.6 29.4 < -3 SD 7.1 7.8 6.5 Number of children 6,097 5,344 2,820 ____________________________________________________ Source: Ngallaba et al., 1992: 108; Bureau of Statistics and Macro International, 1997: 131 a Based on children under five in the household 9.3 VITAMIN A SUPPLEMENTATION AMONG CHILDREN Research has shown that adequate stores of vitamin A can have an enormous effect on the ability to fight diseases and maintain good health. In the absence of sufficient intake of foods rich in vitamin A, due to poor soils and/or cultural habits, health programmes often implement mass vitamin A supplementation programmes, especially for children age six months to five years of age. In order to measure the level of coverage of the vitamin A supplementation programme in Tanzania, women were asked if their children under age five had ever been given a vitamin A supplement and, if so, when they received the most recent dose. In order to minimise confusion with other supplements and, vaccines (e.g., polio vaccine, which is usually also given orally), interviewers were instructed to show the respondent a sample small, reddish vitamin A capsule. Unfortunately, they were not equipped with the blue vitamin A capsule that is distributed as part of the Expanded Programme on Immunisation (EPI). Consequently, the figures given here may underrepresent the level of vitamin A supplementation. 124 * Infant Feeding and Childhood Nutrition Table 9.7 Vitamin A supplementation among children Percent distribution of children age 6-59 months by whether they received a high-dose vitamin A supplement in the six months preceding the survey, according to selected background characteristics, Tanzania 1999 __________________________________________________________________________________________ Received vitamin A supplement ___________________________ Not Within Prior to Not sure if Never Number Background last 6 last 6 sure received received of characteristic months months when vitamin A vitamin A Total children _________________________________________________________________________________________ Child's sex Male Female Residence Urban Rural Mainland/Zanzibar Mainland Urban Rural Zanzibar Pemba Unguja Child's age 6-11 months 12-23 months 24-35 months 36-47 months 48-59 months Education No education Primary incomplete Primary complete Secondary+ Total 12.2 6.1 0.2 2.2 79.3 100.0 1,301 15.5 6.6 0.2 1.3 76.4 100.0 1,271 17.8 9.1 0.5 2.2 70.4 100.0 487 12.9 5.7 0.1 1.7 79.6 100.0 2,085 13.3 6.5 0.2 1.8 78.3 100.0 2,503 16.1 9.4 0.5 2.1 71.8 100.0 467 12.6 5.8 0.1 1.7 79.8 100.0 2,036 33.8 0.7 0.0 3.0 62.5 100.0 69 13.1 0.8 0.0 0.7 85.5 100.0 33 53.1 0.6 0.0 5.1 41.2 100.0 36 17.0 1.2 0.0 0.5 81.3 100.0 310 20.8 5.2 0.4 1.2 72.4 100.0 593 13.8 10.5 0.0 0.5 75.2 100.0 588 9.7 5.3 0.0 3.1 82.0 100.0 528 8.5 7.0 0.5 3.3 80.7 100.0 554 6.6 4.1 0.3 2.2 86.8 100.0 705 16.5 4.3 0.0 1.0 78.2 100.0 424 15.2 8.0 0.2 1.9 74.8 100.0 1,353 37.2 8.5 0.0 1.5 52.8 100.0 91 13.8 6.3 0.2 1.8 77.9 100.0 2,572 The data in Table 9.7 indicate that only 14 percent of children 6-59 months were reported to have received a vitamin A supplement in the previous six months. Another 6 percent received a supplement but not in the previous six months. Coverage is remarkably higher among children in Unguja than in other parts of the country. It is also higher among children of better-educated mothers. Knowledge of AIDS * 125 KNOWLEDGE OF AIDS 10 10.1 INTRODUCTION AIDS and HIV infection have been identified as serious health and socioeconomic problems in Tanzania. The AIDS virus was probably introduced to the country in the early 1980s. Since then, the number of cases has continued to rise, and by 1986, all regions of the country had reported AIDS cases. Because of its fast spread, the control of AIDS has become a top government priority, and the government established the National AIDS Control Programme (NACP) under the Ministry of Health as the focal point for its programmes. The NACP estimates that a total of 8,675 AIDS cases were reported in Tanzania, bringing the cumulative number of AIDS cases to 109,863. The NACP, however, estimates a total of 43,375 new AIDS cases to have occurred in 1998 alone and a cumulative total of 549,315 cases based on the estimate that only one out of five cases are reported. The 1999 TRCHS included questions on AIDS to assess the knowledge and attitudes of respondents regarding transmission mechanisms and prevention of infection with the AIDS virus. Female and male respondents were asked whether they had heard of AIDS and, if so, they were asked to name modes of transmission of the AIDS virus. They were asked whether they thought it was possible to prevent AIDS and, if so, how and whether they thought they had a high or low risk of becoming infected with the disease. 10.2 KNOWLEDGE OF AIDS TRANSMISSION As shown in Table 10.1, all but a tiny fraction of adult women and men in Tanzania have heard of AIDS. There are no significant differences in level of knowledge by sex of respondent or by background characteristics. The level of knowledge of HIV/AIDS has not changed since 1996 (Bureau of Statistics and Macro International, 1997:147, 148). To ascertain the depth of knowledge about AIDS, respondents were asked whether a person can do something to avoid getting AIDS and, if so, what. Tables 10.2.1 and 10.2.2 show the percentage of women and men who spontaneously mentioned specific ways to avoid AIDS. It is encouraging that only 6 percent of women and 4 percent of men say that there is no way to avoid getting the virus. This low level of misinformation means that education programmes are getting the message out that AIDS can be prevented. It is also encouraging to note that the percentage who say there is no way to avoid AIDS has declined since 1996, from 12 to 6 percent of women and from 10 to 4 percent of men (Bureau of Statistics and Macro International, 1997: 150, 151). As for the means of transmission, more than half of women and almost three-quarters of men spontaneously mentioned condom use as a means of prevention. Almost half of women and men mentioned that having only one sexual partner helps to prevent getting the AIDS virus. Other means of prevention that are cited by sizeable proportions of both women and men are abstention, limiting the number of partners, and avoiding injections. Differentials in knowledge of prevention measures are not large, except that mention of condom use varies by urban-rural residence, Main- land/Zanzibar, and education. 126 * Knowledge of AIDS Table 10.1 Knowledge of HIV/AIDS Percentage of women and men who have heard of HIV/AIDS, by background characteristics, Tanzania 1999 _____________________________________________________________ Women Men _______________ _______________ Has Number Has Number Background heard of of heard of of characteristic HIV/AIDS women HIV/AIDS men ______________________________________________________________ Age 15-19 20-24 25-29 30-39 40-49 50-59 Marital status Currently married Formerly in union Never married Residence Urban Rural Mainland/Zanzibar Mainland Urban Rural Zanzibar Pemba Unguja Education No education Primary incomplete Primary complete Secondary+ Total 95.2 909 96.7 790 97.4 811 99.8 540 97.6 749 100.0 546 98.2 946 100.0 817 96.6 614 99.0 478 NA NA 99.8 371 97.1 2,653 99.7 2,063 96.5 433 99.9 190 96.8 943 97.9 1,289 99.8 1,122 99.9 941 95.9 2,907 98.8 2,601 96.9 3,929 99.1 3,452 99.8 1,088 99.9 909 95.8 2,841 98.8 2,543 98.9 100 99.2 90 98.7 44 99.5 36 99.1 56 98.9 55 91.1 1,093 95.9 495 98.4 854 98.9 1,000 99.4 1,866 99.9 1,791 100.0 215 100.0 256 97.0 4,029 99.1 3,542 _______________________________________________________________ NA = Not applicable Knowledge about ways to avoid HIV/AIDS has in- creased significantly since 1996. For example, in 1996, only 39 percent of women cited condom use as a means of prevention. By 1999, this proportion had increased to 56 percent. The proportion of men who cited condom use increased from 55 to 71 per- cent. Similarly, the proportion of women who said that abstaining from sex and having only one partner were ways to prevent HIV/AIDS almost doubled between 1996 and 1999 (from 15 to 28 percent for abstaining and from 25 to 47 percent for having only one partner). After asking an open- ended question about ways of prevention, interviewers followed up by asking specific questions about common ways of AIDS prevention, as well as a n u m b e r o f c o m m o n misconceptions about how the virus is spread. On the basis of the answers to these “ p r o m p t e d ” q u e s t i o n s , knowledge of preventive measures is even higher (Table 10.3). For example, only 28 per- cent of women spontaneously mentioned abstinence as a means of preventing AIDS; however, when asked if it is possible to avoid AIDS by abstaining from sex completely, a majority of all female respondents (71 percent) answered affirmatively. Almost as many women know that having one faithful partner is a way of protecting against the risk of getting AIDS. Eighty percent of women know of at least one of the three methods of protecting against AIDS, and almost half know all three methods. Not only is it important to know about effective ways to avoid AIDS, but it is also useful to be able to identify incorrect ways of avoiding the virus. Common misconceptions about how AIDS spreads are that it can be contracted by sharing food with someone who is infected or that it can be transmitted by mosquitos. A third common misunderstanding is that people who are infected will show signs of illness. Knowledge of AIDS * 127 Table 10.2.1 Knowledge of specific ways to avoid HIV/AIDS: women Percentage of women who know of specific ways to avoid HIV/AIDS, and percentage with misinformation, by background characteristics, Tanzania 1999 ________________________________________________________________________________________________________________ Ways to avoid HIV/AIDS ____________________________________________________________________________ There is no Have Limit Avoid Avoid Doesn’t Percent way to Abstain only number sex with sex with Avoid Avoid Don’t know with Number Background avoid from Use one sex of prosti- homo- trans- inject- share specific misinfor- of characteristic HIV/AIDS sex condoms partner partners tutes sexuals fusions ions razors way mation1 women ________________________________________________________________________________________________________________ Age 15-19 20-24 25-29 30-39 40-49 Marital status Currently married Formerly in union Never married Residence Urban Rural Mainland/Zanzibar Mainland Urban Rural Zanzibar Pemba Unguja Education No education Primary incomplete Primary complete Secondary+ Total 7.9 31.5 41.2 34.1 13.3 7.0 0.1 3.2 12.1 11.9 21.8 1.4 909 5.6 27.6 64.6 44.9 18.2 5.0 0.1 2.3 9.3 9.4 12.9 1.2 811 4.9 24.8 66.7 54.0 21.5 6.7 0.1 3.8 11.6 9.5 10.1 1.3 749 4.8 26.3 62.3 52.6 22.6 6.5 0.0 3.4 10.0 6.9 11.2 2.6 946 7.8 31.3 41.6 50.0 21.5 4.9 0.7 3.9 9.7 7.3 20.4 1.6 614 6.3 23.8 57.7 50.7 21.3 5.8 0.2 3.0 9.3 7.4 14.3 1.5 2,653 4.8 36.8 62.6 41.5 18.3 6.2 0.1 1.7 13.0 8.4 13.4 1.4 433 6.1 36.6 46.8 38.1 13.9 6.8 0.2 4.7 13.1 14.0 18.5 2.2 943 2.1 35.4 73.0 56.8 20.8 6.1 0.2 4.5 13.7 9.3 7.6 2.2 1,122 7.7 25.4 48.9 42.9 18.6 6.1 0.1 2.8 9.4 9.0 18.1 1.5 2,907 6.2 28.5 56.3 46.7 19.0 6.1 0.2 3.3 10.6 9.2 15.2 1.6 3,929 2.1 36.0 73.9 56.8 20.4 6.3 0.3 4.5 13.8 9.4 7.7 2.2 1,088 7.7 25.6 49.5 42.9 18.5 6.1 0.1 2.8 9.4 9.1 18.1 1.4 2,841 4.0 17.8 31.5 46.5 27.1 3.8 0.2 2.2 9.1 5.0 12.4 2.8 100 7.8 15.7 17.6 33.5 20.4 4.4 0.2 1.9 9.9 6.2 19.3 5.2 44 1.1 19.4 42.3 56.6 32.4 3.4 0.2 2.5 8.5 4.2 6.9 0.9 56 10.2 25.2 31.5 37.7 15.8 5.7 0.4 1.0 5.3 5.8 25.4 1.1 1,093 6.4 28.9 54.6 44.7 15.9 5.9 0.0 3.7 10.8 10.1 17.7 1.1 854 4.2 28.3 67.7 51.9 21.7 6.4 0.0 3.7 12.8 9.4 9.5 1.9 1,866 0.6 39.2 78.1 56.3 28.3 6.2 1.3 9.5 17.4 18.8 1.7 5.0 215 6.1 28.2 55.6 46.7 19.2 6.1 0.2 3.3 10.6 9.1 15.2 1.7 4,029 _______________________________________________________________________________________________________________ 1 Includes avoiding kissing and mosquito bites, seeking protection from traditional healer, and other types of misinformation. In the TRCHS, women were asked whether these misconceptions were true. As shown in Table 10.4, most women know that sharing food is not a valid means of transmitting the virus. More than half also say that AIDS cannot be transmitted by mosquito bites. Finally, 69 percent of women know that it is possible for a healthy-looking person to be infected with the AIDS virus. Although 83 percent of women can correctly identify at least one of these misconceptions, only one-third can identify all three. Fourteen percent are not aware of any. Tables 10.5.1 and 10.5.2 present data on whether women and men are aware that it can be transmitted from mother to child. Around 80 percent of women and men recognise this mode of transmission. The data also indicate that 63 percent of women and 68 percent of men know someone who either has AIDS or has died from AIDS. This proportion has increased substantially since 1996, when only 48 percent of women and 52 percent of men said they knew someone with AIDS. 128 * Knowledge of AIDS Table 10.2.2 Knowledge of specific ways to avoid HIV/AIDS: men Percentage of men who know of specific ways to avoid HIV/AIDS, and percentage with misinformation, by background characteristics, Tanzania 1999 _______________________________________________________________________________________________________________ Ways to avoid HIV/AIDS ___________________________________________________________________________ There is no Have Limit Avoid Avoid Doesn’t Percent way to Abstain only number sex with sex with Avoid Avoid Don’t know with Number Background avoid from Use one sex of prosti- homo- trans- inject- share specific misinfor- of characteristic HIV/AIDS sex condoms partner partners tutes sexuals fusions ions razors way mation1 men ________________________________________________________________________________________________________________ Age 15-19 20-24 25-29 30-39 40-49 50-59 Marital status Currently married Formerly in union Never married Residence Urban Rural Mainland/Zanzibar Mainland Urban Rural Zanzibar Pemba Unguja Education No education Primary incomplete Primary complete Secondary+ Total 7.5 28.8 57.7 28.3 9.5 5.8 0.6 3.2 9.0 10.6 21.3 2.4 790 2.6 31.9 83.7 42.7 15.8 6.1 0.0 5.0 9.3 11.8 6.9 1.9 540 2.8 26.1 84.4 55.9 18.5 10.1 0.4 5.0 11.7 10.5 5.2 1.2 546 1.6 33.5 77.9 58.3 21.1 6.6 0.8 7.8 14.7 17.6 5.6 2.1 817 4.4 30.7 64.1 51.1 19.7 7.8 0.8 5.4 9.2 9.2 8.8 2.8 478 4.6 33.7 57.5 57.4 19.1 10.4 0.1 2.1 5.5 7.7 7.3 2.2 371 3.4 29.8 73.7 55.4 20.3 8.1 0.6 4.8 10.8 12.2 6.4 2.0 2,063 2.4 41.4 75.2 46.1 12.4 4.4 0.7 4.7 10.4 10.0 9.2 1.4 190 5.0 30.6 66.8 35.9 12.1 6.8 0.3 5.4 9.8 11.6 15.4 2.4 1,289 2.2 38.8 82.3 55.0 18.9 7.6 1.3 7.1 10.4 10.0 5.5 2.2 941 4.6 27.8 67.3 45.2 16.2 7.4 0.2 4.2 10.4 12.5 11.4 2.1 2,601 4.0 30.7 72.0 48.0 16.8 7.4 0.5 5.1 10.4 12.0 9.9 2.1 3,452 2.3 39.3 83.3 55.4 18.6 7.5 1.3 7.3 10.4 10.1 5.6 2.2 909 4.6 27.7 67.9 45.4 16.2 7.3 0.2 4.3 10.5 12.7 11.4 2.1 2,543 2.9 30.2 44.3 37.8 19.8 10.2 0.4 2.7 9.6 7.1 7.9 1.7 90 4.0 40.8 35.1 25.9 14.4 5.1 0.0 3.7 12.9 9.2 8.2 2.8 36 2.1 23.3 50.4 45.5 23.4 13.5 0.6 2.1 7.4 5.7 7.6 1.0 55 7.2 27.5 49.3 42.3 9.6 6.4 0.3 0.7 2.3 2.9 17.9 1.5 495 4.6 29.2 63.8 39.5 15.1 7.4 0.0 3.4 9.0 8.6 12.7 2.5 1,000 3.0 31.0 80.4 51.8 18.1 8.0 0.6 6.3 11.6 14.3 7.0 1.8 1,791 1.7 41.1 79.4 62.6 29.9 6.1 2.3 10.3 23.6 25.2 2.7 3.6 256 3.9 30.7 71.3 47.8 16.9 7.4 0.5 5.0 10.4 11.9 9.8 2.1 3,542 _______________________________________________________________________________________________________________ 1 Includes avoiding kissing and mosquito bites, seeking protection from traditional healer, and other types of misinformation. Table 10.6 shows more details about women’s knowledge of mother-child transmission of AIDS. Three-quarters of all women age 15-49 say that AIDS can be passed from mother to child during pregnancy, while 70 percent say it can be transferred to the child through breast milk, and 61 percent say the baby can be infected during delivery. More than half of women say that all three modes of transmission exist. 10.3 PERCEPTIONS OF PERSONAL RISK OF GETTING AIDS In the TRCHS, respondents who had heard of AIDS were asked what they thought their chances of getting the disease were. The majority of women and men said they felt they had either no risk or a small risk of getting AIDS (Table 10.7). However, about one-quarter of both sexes said they had a moderate or great risk of getting the disease. Differences in risk assessment are not large; however, young respondents, those who have not married, and those in Zanzibar are more likely to say they have no risk of getting AIDS. Knowledge of AIDS * 129 Table 10.3 Knowledge (prompted) of the main ways to avoid HIV/AIDS Percentage of women age 15-49 who know the main ways of preventing HIV transmission, by background characteristics, Tanzania 1999 ____________________________________________________________________________________________________ Main ways to avoid HIV/AIDS ___________________________ Have Knows Knows Doesn’t Has only Always Abstain all at least know Number Background heard of one use from three one any of characteristic HIV/AIDS partner condom sex ways way way women ____________________________________________________________________________________________________ Age 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Residence Urban Rural Mainland/Zanzibar Mainland Urban Rural Zanzibar Pemba Unguja Education No education Primary incomplete Primary complete Secondary+ Total 95.2 56.3 52.7 62.4 37.8 71.1 24.0 909 97.4 73.1 72.3 68.9 54.0 82.4 14.9 811 97.6 74.2 76.7 76.4 58.4 86.7 10.9 749 97.8 73.9 72.3 79.2 55.8 86.5 11.2 490 98.7 71.7 71.5 75.3 54.2 86.0 12.7 456 100.0 70.5 60.6 68.8 44.9 81.7 18.3 299 93.3 60.5 45.4 65.1 37.2 69.3 24.1 315 99.8 77.8 79.7 76.5 59.3 90.3 9.5 1,122 95.9 64.6 60.2 68.2 45.6 76.7 19.2 2,907 96.9 68.0 65.8 70.4 49.4 80.4 16.6 3,929 99.8 77.4 80.0 76.3 59.2 90.2 9.6 1,088 95.8 64.4 60.4 68.1 45.6 76.6 19.3 2,841 98.9 78.9 59.4 75.6 51.7 85.5 13.4 100 98.7 67.0 46.9 63.2 37.6 76.8 21.9 44 99.1 88.1 69.2 85.3 62.7 92.3 6.8 56 91.1 55.1 42.8 57.9 32.0 64.4 26.7 1,093 98.4 66.4 65.5 70.9 50.6 79.3 19.2 854 99.4 75.0 76.9 76.2 57.2 88.7 10.8 1,866 100.0 84.7 85.1 83.4 65.8 96.2 3.8 215 97.0 68.3 65.7 70.5 49.4 80.5 16.5 4,029 The question about level of risk was followed by a question that asked why the respondent felt their risk was either small or large. As shown in Table 10.8, the main reason that respondents feel they have a low risk of getting AIDS is that they are either abstaining from sexual contact or they are limiting their number of partners. Those who have never married or who were formerly married are likely to say they are abstaining, while married respondents are likely to say they are limiting their number of partners. The main reason that women feel they have a moderate or great risk of getting AIDS is that their partners have other partners (Table 10.9). Among men, the main reason they feel at risk is that they are having unprotected sex. Men are also likely to say they are at risk because they have more than one partner. 130 * Knowledge of AIDS Table 10.4 Misconceptions about HIV/AIDS transmission Percentage of women age 15-49 who correctly identified three common misconceptions about HIV/AIDS transmission, by background characteristics, Tanzania 1999 ____________________________________________________________________________________________________ Percentage who know that: __________________________ A healthy- Did AIDS cannot be looking not transmitted by: person Knows Knows at identify Has ________________ can be in- all three least one any Number Background heard of Sharing Mosquito fected with miscon- miscon- miscon- of characteristic HIV/AIDS food bites HIV/AIDS ceptions ception ceptions women ____________________________________________________________________________________________________ Age 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Residence Urban Rural Mainland/Zanzibar Mainland Urban Rural Zanzibar Pemba Unguja Education No education Primary incomplete Primary complete Secondary+ Total 95.2 50.3 51.9 59.5 32.4 75.8 19.3 909 97.4 57.9 55.5 71.7 36.9 84.8 12.6 811 97.6 63.9 59.6 78.0 42.8 88.6 9.0 749 97.8 68.6 61.6 73.4 44.7 88.6 9.1 490 98.7 66.9 52.9 76.0 40.8 87.7 10.9 456 100.0 58.8 48.7 67.2 32.1 82.4 17.6 299 93.3 43.0 37.7 55.4 17.8 70.4 22.9 315 99.8 73.0 70.8 86.2 54.1 95.1 4.7 1,122 95.9 52.9 47.5 62.7 29.8 78.3 17.6 2,907 96.9 58.4 53.7 69.1 36.3 82.8 14.1 3,929 99.8 72.9 70.6 86.2 53.9 95.1 4.7 1,088 95.8 52.9 47.2 62.5 29.6 78.1 17.7 2,841 98.9 62.0 66.6 74.8 43.9 88.9 10.0 100 98.7 51.9 59.8 62.3 31.3 83.9 14.7 44 99.1 70.0 71.9 84.5 53.8 92.8 6.3 56 91.1 39.2 34.0 48.0 16.4 65.7 25.4 1,093 98.4 54.0 50.3 65.8 31.0 81.6 16.9 854 99.4 68.7 64.6 80.4 47.5 91.9 7.5 1,866 100.0 85.9 78.0 93.4 65.4 98.8 1.1 215 97.0 58.5 54.0 69.2 36.5 83.0 14.0 4,029 10.4 KNOWLEDGE AND USE OF CONDOMS Consistent use of condoms is an effective way to avoid transmitting HIV/AIDS. As shown in Table 10.10, almost all respondents have heard of condoms (92 percent of women and 96 percent of men). Public sources such as government health clinics and hospitals are most commonly mentioned as places to get condoms. Men are also likely to cite pharmacies and other sources as places to get condoms. As expected, pharmacies are more commonly mentioned by urban residents and better-educated respondents. Despite the widespread knowledge about condoms and their ability to prevent disease, condom use is not high in Tanzania. Of respondents who were sexually active during the year before the survey, only 16 percent of women and 37 percent of men had ever used condoms, mostly for family planning purposes and not for disease prevention (Tables 10.11.1 and 10.11.2). Knowledge of AIDS * 131 Table 10.5.1 Knowledge and perception of HIV/AIDS: women Percent distribution of women by knowledge and perception of HIV/AIDS, according to background characteristics, Tanzania 1999 _____________________________________________________________________________________________________ Can the AIDS virus Can a healthy-looking person be transmitted from Knows have the AIDS virus? mother to child? someone ______________________ ______________________ with AIDS or Number Background Don’t Don’t who died of of characteristic Yes No know Yes No know Total HIV/AIDS women __________________________________________________________________________________________________ Age 15-19 20-24 25-29 30-39 40-49 Marital status Currently married Formerly in union Never married Residence Urban Rural Mainland/Zanzibar Mainland Urban Rural Zanzibar Pemba Unguja Education No education Primary incomplete Primary complete Secondary+ Total 59.5 20.8 14.8 67.5 9.9 17.7 100.0 48.3 909 71.7 16.2 9.5 82.3 6.2 8.9 100.0 63.3 811 78.0 12.6 7.0 84.3 6.3 7.0 100.0 69.7 749 74.7 12.4 11.0 85.5 5.2 7.5 100.0 67.7 946 61.1 15.3 20.0 74.3 7.3 15.0 100.0 66.3 614 70.7 15.0 11.3 80.9 6.7 9.5 100.0 64.9 2,653 72.0 10.7 13.8 80.7 7.3 8.5 100.0 67.3 433 63.7 19.3 13.8 72.3 7.7 16.8 100.0 53.9 943 86.2 8.8 4.8 90.2 4.1 5.4 100.0 72.7 1,122 62.7 18.1 15.0 74.5 8.1 13.3 100.0 58.7 2,907 69.1 15.5 12.3 78.6 7.0 11.3 100.0 63.1 3,929 86.2 8.8 4.8 90.2 4.1 5.5 100.0 73.2 1,088 62.5 18.0 15.2 74.2 8.1 13.5 100.0 59.2 2,841 74.8 16.9 6.7 88.2 5.0 5.7 100.0 43.0 100 62.3 28.3 6.8 84.0 7.5 7.1 100.0 42.2 44 84.5 8.0 6.6 91.5 3.0 4.6 100.0 43.6 56 48.0 19.7 23.4 60.9 9.6 20.7 100.0 49.4 1,093 65.8 19.2 13.4 79.8 7.4 11.3 100.0 60.5 854 80.4 12.5 6.3 87.4 5.5 6.5 100.0 69.7 1,866 93.4 5.7 0.7 93.2 4.9 1.9 100.0 76.5 215 69.2 15.5 12.2 78.9 7.0 11.1 100.0 62.6 4,029 Eight percent of women and 16 percent of men said they had used a condom the last time they had had sex. Figures are considerably higher for sexual relations outside of marriage. For example, while only 4 percent of women and 5 percent of men said they had used condoms when they had last had sex with their husband/wife, the figures jump to 22-24 percent of women and 34 percent of men who said they had used condoms the last time they had had sex with either a regular partner (boyfriend or girlfriend) or someone else. Women report more frequent use of condoms over the past few years. In 1996, only 5 percent of women said a condom was used the last time they had had sex; in 1999, the figure was 8 percent. And the proportion who report condom use the last time they had had sex with someone other than their husband increased from 17 percent in 1996 to about 23 percent in 1999. Interestingly, the proportion of men who say they had used condoms the last time they had had sex has not increased since 1996. 132 * Knowledge of AIDS Table 10.5.2 Knowledge and perception of HIV/AIDS: men Percent distribution of men by knowledge and perception of HIV/AIDS, according to background characteristics, Tanzania 1999 _____________________________________________________________________________________________________ Can the AIDS virus Can a healthy-looking person be transmitted from Knows have the AIDS virus? mother to child? someone _______________________ ______________________ with AIDS or Number Background Don’t Don’t who died of of characteristic Yes No know Yes No know Total HIV/AIDS women __________________________________________________________________________________________________ Age 15-19 20-24 25-29 30-39 40-49 50-59 Marital status Currently married Formerly in union Never married Residence Urban Rural Mainland/Zanzibar Mainland Urban Rural Zanzibar Pemba Unguja Education No education Primary incomplete Primary complete Secondary+ Total 62.7 19.0 14.9 64.8 13.4 18.5 100.0 52.6 790 76.6 14.4 8.9 82.1 6.1 11.6 100.0 67.0 540 87.3 9.6 3.1 85.0 6.5 8.5 100.0 73.2 546 83.6 10.0 6.0 91.0 3.3 5.6 100.0 72.3 817 79.5 12.3 7.2 82.1 7.5 9.4 100.0 74.6 478 75.5 14.4 9.9 82.0 10.1 7.7 100.0 77.9 371 81.9 11.2 6.5 86.6 5.8 7.4 100.0 73.1 2,063 78.0 14.1 7.9 82.7 9.6 7.6 100.0 76.6 190 69.2 16.7 12.0 71.0 10.6 16.2 100.0 58.8 1,289 90.7 7.1 2.1 87.7 6.6 5.7 100.0 71.7 941 72.1 15.7 10.9 78.2 8.2 12.4 100.0 66.8 2,601 76.9 13.4 8.7 80.5 7.8 10.7 100.0 68.6 3,452 90.8 7.0 2.1 87.6 6.7 5.5 100.0 72.2 909 71.9 15.7 11.0 78.0 8.2 12.5 100.0 67.4 2,543 81.9 13.7 3.4 88.4 4.2 6.5 100.0 47.7 90 78.2 18.1 3.2 90.0 5.2 4.3 100.0 51.5 36 84.3 10.8 3.6 87.4 3.5 8.0 100.0 45.2 55 53.9 23.6 18.4 61.7 13.6 20.6 100.0 54.5 495 70.9 16.0 11.9 75.2 9.1 14.6 100.0 68.2 1,000 84.3 10.5 5.0 87.5 5.7 6.8 100.0 70.6 1,791 95.0 3.6 1.4 91.8 5.9 2.3 100.0 76.8 256 77.0 13.4 8.6 80.7 7.7 10.6 100.0 68.1 3,542 10.5 ACCEPTABILITY OF CONDOM USE Respondents were asked whether it is acceptable for a woman to ask a man to use a condom. They were also asked whether it is acceptable for a woman to ask a man with a sexually transmitted disease (STD) to use a condom or to refuse to have sex with him. Table 10.12 shows the results for women and men by background characteristics. Forty-nine percent of women believe it is all right for a woman to ask a man to use a condom in general; 55 percent of women believe it is all right for a wife to ask her husband to use a condom or refuse to have sex at all if he has an STD. The level of acceptance in both scenarios is high among those who were formerly in union, the better educated, and those living in urban areas. Only 15 percent of women who have never had sex believe that it is acceptable to ask a partner to use a condom in general. Knowledge of AIDS * 133 Table 10.6 Knowledge of mother-child transmission of HIV/AIDS Percentage of women age 15-49 who know specific ways mother-child transmission of HIV/AID occurs, by background characteristics, Tanzania 1999 ___________________________________________________________________________________ HIV/AIDS can Ways mother-child transmission be transmitted of HIV/AIDS occurs Doesn’t from ____________________________________ know any Number Background mother During At Through All three specific of characteristic to child pregnancy delivery breast milk ways way women ____________________________________________________________________________________ Age 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Residence Urban Rural Mainland/Zanzibar Mainland Urban Rural Zanzibar Pemba Unguja Education No education Primary incomplete Primary complete Secondary+ Total 67.5 61.5 43.3 56.6 38.3 0.5 909 82.3 77.2 64.2 74.5 58.5 0.2 811 84.3 81.4 69.9 74.6 63.1 0.2 749 89.1 84.1 70.3 78.5 61.3 0.4 490 81.7 78.3 67.9 73.9 62.5 0.7 456 78.5 75.1 62.8 70.5 59.1 0.2 299 70.2 65.3 55.5 62.1 51.5 2.6 315 90.2 86.6 71.4 79.2 64.4 0.4 1,122 74.5 69.6 56.9 65.9 51.4 0.6 2,907 78.6 74.1 60.8 69.3 54.9 0.5 3,929 90.2 86.6 71.6 79.0 64.6 0.4 1,088 74.2 69.4 56.7 65.6 51.2 0.6 2,841 88.2 80.2 64.9 83.8 60.3 0.5 100 84.0 73.6 67.9 78.8 61.7 1.2 44 91.5 85.3 62.6 87.6 59.3 0.0 56 60.9 55.8 44.4 53.1 40.4 1.1 1,093 79.8 74.2 56.9 67.5 50.7 0.7 854 87.4 83.6 70.9 79.0 64.6 0.2 1,866 93.2 88.3 74.2 81.1 64.6 0.0 215 78.9 74.3 60.9 69.6 55.1 0.5 4,029 Fifty-six percent of men believe it is acceptable for a woman to ask a man to use a condom in general, and 58 percent believe it is all right for a wife to ask her husband to use a condom or to refuse to have sex with him if he has an STD. It is interesting to note that there is still a significant proportion of the population who believe that it is not right for a woman to prompt the use of condoms even if her husband has an STD. 10.6 NUMBER OF SEXUAL PARTNERS Given the fact that the vast majority of HIV infections in Tanzania are contracted through heterosexual contact, information on sexual behaviour is important in designing and monitoring intervention programmes. Both male and female respondents were asked questions about partners with whom they had had sex in the 12 months preceding the survey. Information about the sexual relationships of women and men is presented in Tables 10.13.1 and 10.13.2, respectively. 134 * Knowledge of AIDS Table 10.7 Perception of the risk of getting HIV/AIDS Percent distribution of women and men, by perception of the risk of getting HIV/AIDS, according to background characteristics, Tanzania 1999 __________________________________________________________________________________________________________________ Women Men _________________________________________________ _________________________________________ Personal chance of getting HIV/AIDS Personal chance of getting HIV/AIDS ___________________________________ Number ____________________________ Number Background No risk Mod- Has Don’t of No risk Mod- Don’t of characteristic at all Small erate Great AIDS know Total women at all Small erate Great know Total men __________________________________________________________________________________________________________________ Age 15-19 20-24 25-29 30-39 40-49 50-64 Marital status Currently married Formerly in union Never married No. of sexual partners other than spouse 0 1 2-3 4+ DK/missing Residence Urban Rural Mainland/Zanzibar Mainland Urban Rural Zanzibar Pemba Unguja Education No education Primary incomplete Primary complete Secondary+ Total 53.3 9.8 7.1 6.3 0.2 23.4 100.0 909 47.8 14.5 10.1 5.4 22.1 100.0 790 31.4 21.7 15.7 11.4 0.0 19.8 100.0 811 35.7 28.2 15.1 8.5 12.5 100.0 540 33.0 14.3 15.9 16.5 0.0 20.2 100.0 749 43.9 25.1 13.7 8.6 8.7 100.0 546 28.2 19.0 14.7 16.3 0.0 21.8 100.0 946 34.6 26.5 20.2 6.3 12.5 100.0 817 32.0 17.9 12.0 13.5 0.0 24.6 100.0 614 38.0 20.2 18.7 8.8 14.2 100.0 478 NA NA NA NA NA NA NA NA 43.3 20.6 15.4 10.5 10.3 100.0 371 32.1 17.4 14.7 14.4 0.1 21.4 100.0 2,653 39.1 23.4 18.0 8.1 11.4 100.0 2,063 30.5 22.6 11.4 13.5 0.0 22.1 100.0 433 32.0 30.0 15.3 11.7 11.0 100.0 190 49.5 10.9 8.9 7.5 0.0 23.2 100.0 943 44.1 19.7 11.4 6.0 18.8 100.0 1,289 38.9 16.3 11.4 12.1 0.0 21.3 100.0 3,093 49.3 21.5 9.7 4.2 15.4 100.0 1,938 28.4 17.1 18.5 12.6 0.0 23.4 100.0 734 34.7 23.8 21.6 8.7 11.2 100.0 987 21.9 13.4 18.8 22.0 0.0 23.9 100.0 170 24.8 23.3 23.7 12.7 15.6 100.0 439 5.0 32.3 7.8 17.2 0.0 37.7 100.0 30 14.5 22.7 22.0 27.9 12.9 100.0 165 0.0 30.6 0.0 0.0 0.0 69.4 100.0 1 38.1 17.7 44.1 0.0 0.0 100.0 14 33.8 18.1 18.0 12.6 0.0 17.5 100.0 1,122 36.5 27.8 15.2 7.0 13.5 100.0 941 36.8 15.8 11.1 12.7 0.0 23.6 100.0 2,907 42.0 20.5 15.5 7.8 14.2 100.0 2,601 35.4 16.4 13.0 12.9 0.0 22.3 100.0 3,929 40.0 22.4 15.6 7.7 14.2 100.0 3,452 33.1 17.9 18.1 12.9 0.0 17.9 100.0 1,088 35.8 27.8 15.4 7.2 13.7 100.0 909 36.2 15.8 11.1 12.9 0.0 24.0 100.0 2,841 41.6 20.5 15.7 7.9 14.4 100.0 2,543 60.3 17.1 11.4 4.1 0.0 7.2 100.0 100 58.3 22.6 8.8 3.6 6.7 100.0 90 61.0 20.5 4.5 6.6 0.0 7.5 100.0 44 55.3 30.0 5.6 4.5 4.6 100.0 36 59.7 14.5 16.8 2.1 0.0 7.0 100.0 56 60.3 17.7 10.8 3.1 8.1 100.0 55 35.0 12.3 10.5 10.0 0.0 32.3 100.0 1,093 38.6 15.9 13.5 9.4 22.6 100.0 495 40.0 13.4 12.1 12.4 0.0 22.0 100.0 854 42.8 19.9 12.9 8.2 16.2 100.0 1,000 34.4 19.4 14.2 14.9 0.1 16.9 100.0 1,866 40.2 23.8 17.0 7.4 11.7 100.0 1,791 38.7 23.4 18.6 7.4 0.0 11.9 100.0 215 37.7 35.3 18.5 2.9 5.7 100.0 256 36.0 16.4 13.0 12.7 0.0 21.9 100.0 4,029 40.5 22.4 15.5 7.6 14.1 100.0 3,542 __________________________________________________________________________________________________________________ Note: Total includes 1 woman and 14 men who reported “Don’t know” to number of sexual partners in past 12 months. NA = Not applicable The table shows that among married women, 7 percent had had two or more partners in the year prior to the survey, including their husbands. Among unmarried women, 11 percent had had two or more partners, while almost half were not sexually active at all in the prior 12 months. Men report had having more sexual partners than women; 29 percent of married men and 25 percent of unmarried men report having had two or more partners in the 12 months before the survey. The proportion of men with two or more sexual partners is higher in rural areas than in urban areas. It is also higher among men in the Mainland than in Zanzibar. Knowledge of AIDS * 135 Table 10.9 Reasons for perception of moderate/great risk of getting HIV/AIDS Among women and men who think they have moderate or great risk of getting HIV/AIDS, percentage citing specific reasons for perception of risk, by marital status Tanzania 1999 ______________________________________________________________________ Number Doesn’t Multiple Partner of Marital use sex has other Other women/ status condom partners partners reason men _________________________________________________________________________ WOMEN________________________________________________________________________ Currently married Formerly in union Never married Total 31.1 6.2 61.7 28.1 771 41.8 19.8 37.3 40.1 108 39.8 8.0 33.7 35.7 155 33.5 7.9 55.0 30.5 1,033 _________________________________________________________________________ MEN_________________________________________________________________________ Currently married Formerly in union Never married Total 38.0 35.2 27.9 23.8 540 35.1 35.4 23.0 25.9 51 55.9 30.3 18.8 20.4 225 42.7 33.9 25.1 23.0 816 Table 10.8 Reasons for perception of small/no risk of getting HIV/AIDS Among women and men who think they have small or no risk of getting HIV/AIDS, percentage citing specific reasons for perception of risk, by marital status, Tanzania 1999 _______________________________________________________________________________ Partner Number Abstains Only has no of Marital from Uses one other Other women/ status sex condoms partner partner reason men ________________________________________________________________________________ WOMEN________________________________________________________________________________ Currently married Formerly in union Never married Total 3.1 4.7 83.6 17.0 8.9 1,312 35.9 14.1 48.4 5.8 5.7 230 62.6 7.1 23.3 4.4 15.4 570 22.7 6.3 63.5 12.4 10.3 2,112 ________________________________________________________________________________ MEN________________________________________________________________________________ Currently married Formerly in union Never married Total 2.6 17.5 82.8 0.0 12.1 1,289 22.4 37.5 37.5 0.0 18.5 118 43.6 26.8 26.1 0.0 16.3 822 18.8 22.0 59.5 0.0 14.0 2,229 136 * Knowledge of AIDS Table 10.10 Knowledge of condoms Among women and men who have ever had sex, percentage who know of condoms and percentage who know of specific sources for condoms, by background characteristics, Tanzania 1999 _________________________________________________________________________________________________________ Source for condoms: women Source for condoms: men ____________________________________ _____________________________________ Knows Number Knows Number Background of Private Pharm- Other Don’t of of Private Pharm- Other Don’t of characteristic condom Public medical acy source know women condom Public medical acy source know men __________________________________________________________________________________________________________ Age 15-19 20-24 25-29 30-39 40-49 50-59 Marital status Currently married Formerly in union Never married Residence Urban Rural Mainland/Zanzibar Mainland Urban Rural Zanzibar Pemba Unguja Education No education Primary incomplete Primary complete Secondary+ Total 87.3 17.9 3.3 8.8 17.3 52.7 478 93.8 12.7 1.7 28.0 29.3 28.2 447 95.5 30.3 5.2 14.0 16.4 34.1 760 97.8 22.2 5.4 27.7 30.3 14.4 483 96.0 33.1 3.0 13.9 14.3 35.8 741 98.4 30.3 4.4 27.4 23.1 14.7 538 93.5 32.4 5.9 10.8 10.0 40.9 940 97.9 31.7 5.3 25.2 20.0 17.8 812 83.6 29.3 0.6 6.3 6.7 57.1 614 94.7 36.8 2.4 17.8 15.0 28.0 476 NA NA NA NA NA NA NA 91.5 27.6 2.7 12.1 14.8 42.7 370 91.9 31.4 3.6 9.8 10.5 44.7 2,653 96.1 33.3 3.6 21.0 18.5 23.6 2,063 90.7 30.6 5.0 13.4 15.0 36.0 433 96.9 26.7 3.7 29.2 20.0 20.4 190 93.2 18.2 3.9 16.3 23.6 38.0 448 96.2 14.2 4.7 28.9 30.9 21.3 874 98.8 29.8 5.3 24.1 19.6 21.2 993 99.8 19.3 3.4 46.0 22.7 8.6 856 89.2 29.5 3.3 6.0 10.0 51.2 2,541 94.8 30.7 4.1 15.3 21.8 28.1 2,271 91.8 29.4 3.9 11.2 13.0 42.5 3,458 96.1 27.4 4.0 23.9 22.5 22.3 3,065 98.8 29.5 5.2 24.5 20.1 20.8 968 99.8 19.0 3.4 46.5 23.2 7.9 833 89.1 29.4 3.3 6.1 10.2 51.0 2,490 94.7 30.5 4.2 15.4 22.2 27.7 2,231 94.1 37.1 3.4 5.0 1.3 53.2 75 97.6 36.8 1.3 14.0 3.2 44.6 62 88.9 28.6 0.0 2.7 1.3 67.3 32 96.7 44.0 0.4 3.7 2.3 49.6 24 98.0 43.5 6.0 6.7 1.3 42.5 43 98.2 32.3 1.9 20.6 3.7 41.5 38 77.9 19.6 1.2 4.9 6.5 67.7 1,025 88.4 23.5 2.1 12.7 14.1 47.5 434 95.0 28.6 1.8 6.1 15.9 47.6 653 95.7 26.3 2.5 20.3 19.9 31.0 810 98.3 36.1 5.6 14.6 14.6 29.1 1,672 97.9 28.8 5.0 26.4 25.2 14.6 1,653 99.9 30.0 10.2 31.4 18.2 10.1 183 99.5 31.3 4.3 36.4 22.3 5.7 230 91.9 29.6 3.8 11.1 12.7 42.8 3,533 96.1 27.6 3.9 23.7 22.1 22.7 3,127 ___________________________________________________________________________________________________________ NA = not applicable Although it appears as if there has been an increase since 1996 in the percentage of both women and men who have had two or more partners during the year before the survey, the differences could be due to a change in the line of questioning about sexual behaviour. In the 1996 TDHS, married respondents were first asked about the last time they had had sex with their spouse. They were then asked if they had had any sexual partner other than their spouse, a particularly sensitive question. In the 1999 TRCHS, all respondents were asked about the last time they had had sex, the type of relationship they had with that partner (spouse, girlfriend/boyfriend, casual acquaintance, etc.), and then whether they had had sex with anyone else in the previous 12 months. It is likely that this “softer” series of questions that did not directly inquire about extramarital relationships elicited more honest reporting of the number of partners. Knowledge of AIDS * 137 Table 10.11.1 Use of condoms: women Among women who have had sex in the past year, the percentage who ever used condoms for family planning (FP) or to avoid STDs, and percentage who used condoms during last sexual intercourse, by type of partner and background characteristics, Tanzania 1999 ________________________________________________________________________________________________________ Used condom Used condom during last sex with: ________________________ ____________________________________________________ Regular Someone Any Either Spouse partner else partner To for FP or Number ___________ ___________ ___________ ___________ Background For avoid to avoid of No. No. No. No. characteristic FP STDs STDs women % women % women % women % women _______________________________________________________________________________________________________ Age 15-19 20-24 25-29 30-39 40-49 Marital status Currently married Formerly in union Never married Residence Urban Rural Mainland/Zanzibar Mainland Urban Rural Zanzibar Pemba Unguja Education No education Primary incomplete Primary complete Secondary+ Total 14.8 4.0 17.7 420 1.6 205 18.6 138 22.4 77 11.0 420 19.5 3.8 21.3 691 4.6 520 21.0 110 33.4 61 9.8 691 14.3 0.9 20.1 673 5.9 564 28.4 52 33.1 56 9.9 673 11.2 0.7 14.8 838 4.3 714 28.7 56 18.2 68 7.1 838 4.5 0.9 6.5 507 1.5 439 12.9 26 11.4 43 2.9 507 10.0 0.6 12.1 2,432 4.0 2,380 9.6 20 20.8 31 4.3 2,432 27.6 7.7 36.4 303 2.5 54 28.9 119 25.4 130 22.7 303 21.2 5.7 27.4 394 5.7 7 19.2 242 23.7 145 20.6 394 21.9 3.5 27.1 909 5.1 607 33.2 180 37.5 122 15.0 909 9.5 1.2 12.0 2,219 3.6 1,834 11.5 202 15.2 184 5.3 2,219 13.3 1.9 16.6 3,064 4.0 2,382 21.8 379 24.2 303 8.2 3,064 22.1 3.6 27.5 888 5.1 589 33.3 179 37.8 121 15.2 888 9.6 1.3 12.2 2,176 3.7 1,793 11.6 200 15.3 183 5.4 2,176 5.3 0.1 6.9 64 2.7 60 7.0 2 4.2 2 2.9 64 0.8 0.0 3.0 27 2.7 27 0.0 0 0.0 0 2.7 27 8.7 0.2 9.7 37 2.7 33 7.6 2 4.2 2 3.0 37 3.7 0.6 6.0 825 1.8 707 11.2 59 7.6 59 2.9 825 9.4 1.1 12.7 601 2.9 455 13.8 77 16.0 69 5.8 601 17.6 2.3 21.0 1,541 5.1 1,188 21.8 188 31.6 166 10.0 1,541 31.7 7.5 39.9 162 11.7 92 43.1 57 46.5 13 25.5 162 13.1 1.9 16.4 3,129 4.0 2,441 21.7 382 24.1 306 8.1 3,129 10.7 AIDS TESTING Tables 10.14.1 and 10.14.2 show the percentage of women and men who have been tested for HIV/AIDS or want to be tested and, of these, the percentage who know of a source of AIDS testing, according to background characteristics. Seven percent of women and 12 percent of men have been tested for AIDS. Testing coverage has increased slightly over time; the corresponding proportions in 1996 were 4 percent for women and 11 percent for men. Interestingly, about two-thirds of women and men say they would like to be tested for HIV/AIDS, and more than half (52 percent of women and 63 percent of men) know a place where they can be tested for HIV/AIDS. For women who have not been tested but would like to be, 35 percent say they have not been tested because they do not know where to go, while 20 percent say they do not have time to get tested, and 18 percent say they have not been tested because it costs too much. Men cite similar reasons for not getting tested; however, they are more likely than women to say they have not been tested because they do not have time. 138 * Knowledge of AIDS Table 10.11.2 Use of condoms: men Among men who have had sex in the past year, the percentage who ever used condoms for family planning (FP) or to avoid STDs, and percentage who used condoms during last sexual intercourse, by type of partner and background characteristics, Tanzania 1999 ________________________________________________________________________________________________________ Used condom Used condom during last sex with: _______________________ ____________________________________________________ Regular Someone Any Either Spouse partner else partner To for FP or Number ___________ ___________ ___________ ___________ Background For avoid to avoid of No. No. No. No. characteristic FP STDs STDs men % men % men % men % men _______________________________________________________________________________________________________ Age 15-19 20-24 25-29 30-39 40-49 50-59 Marital status Currently married Formerly in union Never married Residence Urban Rural Mainland/Zanzibar Mainland Urban Rural Zanzibar Pemba Unguja Education No education Primary incomplete Primary complete Secondary+ Total 31.2 18.2 35.8 397 3.2 18 27.4 134 24.4 245 24.5 397 47.8 15.2 51.4 448 8.3 141 34.6 101 38.6 206 28.2 448 42.9 10.8 47.3 509 10.8 349 47.4 62 45.6 98 22.0 509 35.0 9.3 40.1 790 5.2 645 39.5 42 46.0 103 12.3 790 20.8 3.9 22.8 448 3.3 374 38.5 17 22.8 56 7.1 448 9.4 0.5 11.5 341 0.9 318 6.7 7 5.7 16 1.2 341 28.0 5.0 31.4 2,001 5.4 1,823 32.0 45 31.3 133 7.7 2,001 49.5 18.6 54.0 165 0.0 19 36.4 50 37.3 96 32.7 165 41.1 20.4 46.1 767 0.0 3 34.3 269 33.8 495 33.9 767 46.1 14.7 50.0 796 6.6 459 52.0 119 52.2 218 25.9 796 27.7 8.0 31.5 2,138 4.9 1,387 25.8 245 25.9 506 12.3 2,138 32.9 9.9 36.8 2,877 5.4 1,799 34.4 361 33.8 717 16.1 2,877 46.5 14.9 50.4 775 6.6 444 52.3 117 52.5 214 26.2 775 27.9 8.1 31.8 2,101 5.0 1,355 25.7 243 25.9 503 12.4 2,101 18.8 5.2 20.6 57 3.2 47 29.3 3 32.2 7 8.1 57 5.5 2.9 9.1 22 1.7 21 43.0 1 0.0 0 3.1 22 27.3 6.7 27.9 35 4.5 26 24.7 2 32.7 7 11.3 35 11.7 2.8 15.2 400 2.0 287 7.1 36 14.3 77 4.9 400 24.4 7.4 26.7 750 1.6 480 19.8 82 22.5 189 8.9 750 39.4 12.2 43.8 1,571 7.3 933 40.1 211 40.1 427 20.6 1,571 51.4 13.8 57.2 212 11.6 145 61.5 35 63.5 32 27.6 212 32.7 9.8 36.5 2,933 5.3 1,845 34.3 364 33.8 724 16.0 2,933 10.8 KNOWLEDGE OF CONDOM’S DUAL PROTECTION Respondents were asked whether they knew any method that can protect against pregnancy and STDs. Table 10.15 shows the percentage of respondents who know that condoms can protect against pregnancy and STDs. Men are better informed than women, with 65 percent mentioning that condoms provide dual protection, compared with only 55 percent of women. This knowledge is high for both sexes among those formerly in union, and it is low among those who have never had sex. Women in urban areas are more likely than those in rural areas to know that condoms provide dual protection. Women in the Mainland are more knowledgeable than those in Zanzibar. Fifty- five percent of women in the Mainland know a condom provides dual protection, compared with 36 percent in Zanzibar. Knowledge of AIDS * 139 Table 10.12 Acceptability of women prompting use of condoms Percentage of women and men who believe it is acceptable for a woman to ask a man to use a condom in general, and if he has a STD, by background characteristics, Tanzania 1999 __________________________________________________________________________________________ Women Men ________________________________ _______________________________ If man If man has STD, has STD, acceptable acceptable Acceptable for woman Acceptable for woman for a to ask him for a to ask him woman to to use woman to to use ask man condom Number ask man condom Number Background to use or to refuse of to use or to refuse of characteristic condom sex women condom sex men __________________________________________________________________________________________ Age 15-19 20-24 25-29 30-39 40-49 50-59 Marital status Currently married Formerly in union Never married Had sex Never had sex Residence Urban Rural Mainland/Zanzibar Mainland Urban Rural Zanzibar Pemba Unguja Education No education Primary incomplete Primary complete Secondary+ Total 29.6 35.5 909 38.1 40.1 790 59.4 64.2 811 66.8 68.1 540 63.4 68.4 749 66.9 71.1 546 52.1 58.7 946 65.2 67.4 817 41.5 50.0 614 59.2 58.6 478 NA NA 0 40.8 42.6 371 51.6 59.8 2,653 60.2 63.0 2,063 62.1 63.3 433 64.0 65.6 190 35.5 37.8 943 49.0 49.4 1,289 58.0 56.3 448 63.8 63.2 874 15.1 21.1 496 17.8 20.2 415 68.2 70.4 1,122 72.6 73.1 941 41.6 49.1 2,907 50.4 52.8 2,601 48.9 54.7 3,929 56.9 58.6 3,452 68.3 70.1 1,088 73.6 73.9 909 41.5 48.8 2,841 50.9 53.2 2,543 50.5 67.8 100 35.0 40.5 90 39.4 51.9 44 28.4 35.7 36 59.1 80.2 56 39.4 43.7 55 30.7 41.4 1,093 32.7 36.7 495 42.7 50.1 854 44.8 47.7 1,000 58.5 62.2 1,866 66.0 66.4 1,791 84.3 82.3 215 79.3 83.4 256 49.0 55.1 4,029 56.3 58.2 3,542 _____________________________________________________________________________________________ NA = Not applicable 140 * Knowledge of AIDS Table 10.13.1 Number of sexual partners: women Percent distribution of married and unmarried women by number of persons with whom they had sexual intercourse in the past 12 months (including spouse and excluding spouse), according to background characteristics, Tanzania 1999 _______________________________________________________________________________________________________________________________________ Married women Unmarried women ________________________________________________________________________ ______________________________________ Number of sexual partners Number of sexual partners (including spouse) (excluding spouse) Number of sexual partners ________________________________ ______________________________________ _____________________________________ No. of No. of Background married unmarried characteristic 0 1 2-3 4+ Total 0 1 2-3 4+ Total women 0 1 2-3 4+ Total women ________________________________________________________________________________________________________________________________________ Age 15-19 20-24 25-29 30-39 40-49 Residence Urban Rural Mainland/Zanzibar Mainland Urban Rural Zanzibar Pemba Unguja Marital duration Never married 0-4 5-9 10-14 15+ Education No education Primary incomplete Primary complete Secondary+ Total 8.1 84.0 7.4 0.5 100.0 90.0 8.5 1.5 0.0 100.0 227 66.7 27.3 5.6 0.4 100.0 682 4.1 86.8 8.1 0.9 100.0 89.5 7.0 3.5 0.0 100.0 550 30.1 51.9 13.0 4.9 100.0 261 6.9 88.7 4.3 0.1 100.0 94.2 4.7 1.1 0.0 100.0 615 19.4 62.4 17.8 0.3 100.0 134 5.6 86.8 7.2 0.3 100.0 91.2 7.5 0.9 0.3 100.0 771 26.7 53.4 13.0 6.9 100.0 175 7.1 87.9 5.0 0.0 100.0 93.0 5.3 1.8 0.0 100.0 490 42.6 52.8 4.6 0.0 100.0 124 3.5 86.1 10.0 0.4 100.0 88.1 9.8 1.8 0.3 100.0 622 37.8 47.2 11.9 3.0 100.0 501 6.9 87.6 5.2 0.3 100.0 92.9 5.4 1.7 0.0 100.0 2,031 53.6 37.4 7.4 1.5 100.0 876 6.1 87.0 6.4 0.4 100.0 91.6 6.5 1.8 0.1 100.0 2,591 46.8 41.8 9.3 2.1 100.0 1,338 3.5 85.8 10.3 0.4 100.0 87.9 10.0 1.8 0.3 100.0 602 36.4 48.2 12.2 3.1 100.0 486 6.9 87.4 5.3 0.3 100.0 92.8 5.4 1.7 0.0 100.0 1,989 52.7 38.2 7.6 1.5 100.0 853 3.2 95.2 1.6 0.0 100.0 97.2 2.8 0.0 0.0 100.0 62 86.0 12.9 1.1 0.0 100.0 38 1.6 97.6 0.8 0.0 100.0 98.9 1.1 0.0 0.0 100.0 27 95.4 4.6 0.0 0.0 100.0 16 4.4 93.3 2.3 0.0 100.0 95.8 4.2 0.0 0.0 100.0 34 78.9 19.2 1.9 0.0 100.0 22 NA NA NA NA 100.0 NA NA NA NA 100.0 0 57.7 34.6 6.7 1.0 100.0 943 7.2 85.2 7.4 0.2 100.0 90.8 7.2 2.0 0.0 100.0 645 17.3 61.5 10.5 10.4 100.0 67 5.3 87.9 5.6 1.2 100.0 91.7 5.9 2.2 0.2 100.0 588 15.3 52.1 27.5 5.0 100.0 96 4.9 89.7 5.5 0.0 100.0 93.7 4.8 1.5 0.0 100.0 471 28.8 44.2 19.3 7.7 100.0 81 6.4 86.9 6.5 0.1 100.0 91.5 7.0 1.3 0.1 100.0 949 34.5 58.7 6.3 0.5 100.0 189 8.9 84.0 6.3 0.7 100.0 90.7 7.1 2.1 0.0 100.0 840 47.7 43.8 6.4 2.0 100.0 253 3.9 89.0 7.0 0.1 100.0 91.1 7.7 1.1 0.1 100.0 468 60.4 30.8 7.2 1.7 100.0 386 4.7 88.6 6.5 0.2 100.0 92.4 5.7 1.8 0.1 100.0 1,246 42.1 44.6 10.6 2.7 100.0 620 9.9 89.2 1.0 0.0 100.0 96.6 3.1 0.3 0.0 100.0 99 37.5 49.8 12.8 0.0 100.0 116 6.1 87.2 6.3 0.3 100.0 91.8 6.4 1.7 0.1 100.0 2,653 47.9 41.0 9.0 2.0 100.0 1,376 _________________________________________________________________________________________________________________________________________ NA = Not applicable Knowledge of AIDS * 141 Table 10.13.2 Number of sexual partners: men Percent distribution of married and unmarried men by number of persons with whom they had sexual intercourse in the past 12 months (including spouse and excluding spouse), according to background characteristics, Tanzania 1999 _________________________________________________________________________________________________________________________________________ Married men Unmarried men _________________________________________________________________________ _______________________________________ Number of sexual partners Number of sexual partners (including spouse) (excluding spouse) Number of sexual partners ______________________________ ________________________________________ ________________________________________ No. of No. of Background married unmarried characteristic 0 1 2-3 4+ Total 0 1 2-3 4+ Total men 0 1 2-3 4+ Total men _________________________________________________________________________________________________________________________________________ Age 15-19 20-24 25-29 30-39 40-49 50-59 Residence Urban Rural Mainland/Zanzibar Mainland Urban Rural Zanzibar Pemba Unguja Marital duration Never married 0-4 5-9 10-14 15+ Education No education Primary incomplete Primary complete Secondary+ Total 0.0 68.4 28.5 3.1 100.0 61.8 32.5 2.7 3.1 100.0 18 50.5 31.5 13.4 4.5 100.0 772 0.0 61.9 28.7 9.4 100.0 58.0 21.3 11.4 9.3 100.0 158 23.8 44.0 20.6 11.6 100.0 382 2.8 66.7 27.5 3.0 100.0 65.2 24.2 9.4 1.1 100.0 401 17.2 49.7 24.0 9.1 100.0 144 1.7 69.7 24.9 3.7 100.0 68.6 18.9 9.4 3.1 100.0 716 13.3 56.4 18.9 11.5 100.0 101 4.1 67.8 25.1 2.9 100.0 67.8 21.4 8.6 2.1 100.0 429 18.0 46.3 25.5 10.2 100.0 50 4.1 73.7 18.9 3.4 100.0 75.6 16.1 7.4 0.9 100.0 341 50.1 27.5 17.4 4.9 100.0 30 2.4 74.6 20.4 2.5 100.0 74.4 17.5 5.9 2.1 100.0 504 30.4 41.6 20.6 7.5 100.0 438 2.7 66.8 26.1 4.2 100.0 65.8 21.2 10.0 2.8 100.0 1,559 39.4 37.4 15.7 7.5 100.0 1,041 2.7 68.3 25.1 3.8 100.0 67.4 20.5 9.1 2.7 100.0 2,014 35.5 39.3 17.5 7.7 100.0 1,438 2.4 74.2 20.8 2.5 100.0 74.0 17.7 6.0 2.1 100.0 488 28.9 42.4 21.1 7.6 100.0 421 2.7 66.2 26.4 4.2 100.0 65.2 21.4 10.1 2.8 100.0 1,526 38.3 38.0 16.0 7.7 100.0 1,017 2.5 84.0 11.4 2.1 100.0 84.8 11.7 2.3 1.2 100.0 50 78.7 15.2 4.7 1.2 100.0 41 2.5 93.1 3.6 0.9 100.0 94.0 5.1 0.4 0.4 100.0 22 95.7 2.8 1.3 0.0 100.0 14 2.5 76.7 17.7 3.2 100.0 77.4 16.9 3.8 1.8 100.0 27 70.4 21.4 6.4 1.8 100.0 27 NA NA NA NA 100.0 NA NA NA NA 100.0 0 40.2 37.3 15.8 6.7 100.0 1,289 2.5 68.7 23.6 5.0 100.0 67.7 19.0 8.9 4.2 100.0 475 2.6 51.9 29.0 16.5 100.0 57 1.1 69.7 27.1 1.9 100.0 68.2 22.4 8.2 1.2 100.0 384 4.8 49.7 42.1 3.5 100.0 33 1.9 67.3 25.4 5.0 100.0 64.5 23.5 8.7 3.4 100.0 366 2.9 40.9 16.7 39.6 100.0 23 3.8 68.7 24.0 3.3 100.0 69.7 18.6 9.5 2.0 100.0 838 27.7 45.8 20.2 6.4 100.0 76 3.1 68.9 22.2 5.8 100.0 68.0 17.1 11.6 3.3 100.0 326 47.7 31.5 16.1 4.7 100.0 169 3.0 71.2 22.3 3.2 100.0 70.4 18.5 8.9 2.0 100.0 531 48.9 31.4 14.5 5.2 100.0 469 2.3 66.2 27.4 3.7 100.0 65.3 23.0 8.6 2.8 100.0 1,050 26.3 44.3 19.3 10.2 100.0 740 3.4 74.7 20.0 1.9 100.0 77.5 14.6 6.2 1.8 100.0 156 38.6 42.5 16.0 2.8 100.0 101 2.7 68.7 24.7 3.8 100.0 67.9 20.3 9.0 2.6 100.0 2,063 36.7 38.6 17.2 7.5 100.0 1,479 _______________________________________________________________________________________________________________________________________ A = Not applicable 142 * Knowledge of AIDS Table 10.14.1 Testing for HIV/AIDS: women Percentage of women who have been tested for HIV/AIDS, percentage who would like to be tested, and percentage who know a source for HIV/AIDS testing, and among women who want to be tested for HIV/AIDS, percentage who gave specific reasons why they have not been tested, by background characteristics, Tanzania 1999 _______________________________________________________________________________________________________ Reason women who want to be tested for Number All women HIV/AIDS have not been tested of __________________________________ _______________________________________ women Have been Want Know Don’t Don’t who want tested to be source Number know Costs Afraid have to be Background for tested for for HIV/ of where too to get time tested for characteristic HIV/AIDS HIV/AIDS AIDS test women to go much results to go Other HIV/AIDS ________________________________________________________________________________________________________ Age 15-19 20-24 25-29 30-39 40-49 Marital status Currently married Formerly in union Never married Had sex Never had sex Residence Urban Rural Mainland/Zanzibar Mainland Urban Rural Zanzibar Pemba Unguja Education No education Primary incomplete Primary complete Secondary+ Total 4.0 59.3 38.2 909 43.9 15.8 5.2 15.5 29.0 539 6.0 71.1 54.9 811 33.5 17.5 7.9 20.5 28.0 576 10.0 67.0 59.9 749 31.7 18.8 6.9 19.8 32.5 502 7.0 65.5 58.0 946 32.3 17.1 4.8 24.3 33.3 619 6.0 53.6 47.4 614 35.0 22.5 7.6 21.9 30.2 329 6.6 65.4 52.4 2,653 35.5 16.5 5.3 21.7 30.9 1,735 9.9 63.8 61.2 433 26.2 27.8 11.9 20.7 30.9 276 4.7 58.8 45.1 943 38.8 17.5 6.8 16.2 29.8 555 8.1 65.2 55.7 448 32.2 20.5 9.9 17.6 27.2 292 1.7 53.0 35.6 496 46.1 14.2 3.4 14.7 32.6 263 12.5 61.5 70.9 1,122 23.5 16.6 10.0 21.5 39.1 690 4.2 64.6 44.2 2,907 39.5 18.4 5.0 20.0 27.6 1,877 6.6 63.9 51.7 3,929 35.5 18.3 6.4 20.4 30.1 2,511 12.7 61.8 71.3 1,088 23.3 17.0 10.2 21.5 38.8 672 4.3 64.7 44.1 2,841 39.9 18.8 5.1 20.0 27.0 1,839 3.7 55.1 50.5 100 23.3 1.8 3.6 20.6 54.1 55 2.2 52.4 51.4 44 11.1 0.0 3.4 11.2 76.4 23 4.9 57.2 49.8 56 32.0 3.2 3.8 27.3 38.3 32 2.4 57.1 30.9 1,093 45.5 18.3 3.4 19.2 25.6 625 5.5 63.1 46.6 854 42.3 17.5 5.1 20.2 28.7 539 7.8 68.9 62.2 1,866 29.1 18.2 8.0 21.0 32.6 1,286 20.0 54.0 85.4 215 14.8 14.8 10.2 21.5 45.4 116 6.5 63.7 51.6 4,029 35.2 17.9 6.4 20.4 30.7 2,566 Knowledge of AIDS * 143 Table 10.14.2 Testing for HIV/AIDS: men Percentage of men who have been tested for HIV/AIDS, percentage who would like to be tested, and percentage who know a source for HIV/AIDS testing, and among men who want to be tested, percentage who gave specific reasons why they have not been tested, by background characteristics, Tanzania 1999 _______________________________________________________________________________________________________ Reason men who want to be tested forNumber All men HIV/AIDS have not been tested of ___________________________________ ________________________________________ men Have been Want Know Don’t Don’t who want tested to be source Number know Costs Afraid have to be Background for tested for for HIV/ of where too to get time tested for characteristic HIV/AIDS HIV/AIDS AIDS test men to go much results to go Other HIV/AIDS ______________________________________________________________________________________________________ Age 15-19 20-24 25-29 30-39 40-49 50-64 Marital status Currently married Formerly in union Never married Had sex Never had sex Residence Urban Rural Mainland/Zanzibar Mainland Urban Rural Zanzibar Pemba Unguja Education No education Primary incomplete Primary complete Secondary+ Total 4.0 61.2 45.9 790 40.2 16.5 3.5 28.2 23.1 484 12.3 63.6 64.8 540 25.1 20.9 5.3 34.1 23.6 343 15.5 67.1 72.3 546 20.4 19.3 6.1 34.2 28.8 366 16.6 62.8 75.6 817 17.7 18.9 6.5 31.9 32.1 513 16.6 57.3 67.0 478 26.1 17.5 3.5 34.1 28.4 274 9.4 64.9 65.1 371 27.1 19.8 4.3 26.3 33.4 241 15.4 63.0 70.6 2,063 23.5 17.8 5.6 30.5 31.0 1,301 11.7 67.1 73.7 190 13.5 22.2 3.0 46.6 27.3 127 7.2 61.6 53.5 1,289 32.9 19.6 4.3 30.7 23.0 794 9.5 65.9 62.5 874 26.7 23.6 5.8 34.8 19.9 577 2.3 52.3 34.6 415 49.4 8.9 0.2 19.8 31.2 217 18.9 56.3 79.1 941 14.2 15.1 5.0 40.9 32.4 529 9.8 65.1 59.3 2,601 30.0 19.8 5.0 28.6 26.6 1,692 12.2 62.8 64.7 3,452 26.3 19.1 5.1 31.6 27.4 2,169 19.0 56.3 79.8 909 13.5 15.5 5.1 41.3 32.1 512 9.8 65.2 59.3 2,543 30.2 20.2 5.0 28.6 26.0 1,658 11.5 58.0 57.6 90 24.9 2.0 2.4 27.4 49.2 52 9.6 58.9 68.6 36 10.3 0.6 0.5 10.4 79.3 21 12.7 57.4 50.5 55 34.7 3.0 3.7 38.8 29.0 31 5.0 56.1 42.3 495 35.0 21.1 4.0 29.9 25.4 278 8.7 62.6 55.8 1,000 33.6 16.6 4.8 26.4 26.4 626 13.7 66.3 72.1 1,791 21.9 19.2 5.2 34.5 28.2 1,188 29.3 50.6 88.5 256 11.5 19.2 5.9 32.0 37.9 130 12.2 62.7 64.5 3,542 26.3 18.7 5.0 31.5 28.0 2,222 144 * Knowledge of AIDS Table 10.15 Knowledge of dual protection of condoms Percentage of women and men who know that condoms can protect against both pregnancy and sexually transmitted diseases, by background characteristics, Tanzania 1999 _____________________________________________________________ Percentage Percentage of women of men who know who know condom Number condom Number Background is dual of is dual of characteristic protection women protection men _____________________________________________________________ Age 15-19 20-24 25-29 30-39 40-49 50-59 Marital status Currently married Formerly in union Never married Had sex Never had sex Residence Urban Rural Mainland/Zanzibar Mainland Urban Rural Zanzibar Pemba Unguja Education No education Primary incomplete Primary complete Secondary+ Total 40.6 909 47.4 790 65.3 811 73.6 540 65.2 749 77.0 546 58.5 946 77.2 817 41.5 614 59.1 478 NA NA 52.5 371 55.9 2,653 69.4 2,063 64.1 433 71.8 190 46.2 943 56.7 1,289 67.0 448 70.5 874 27.4 496 27.7 415 74.3 1,122 79.6 941 46.8 2,907 59.7 2,601 54.9 3,929 65.5 3,452 75.2 1,088 80.5 909 47.2 2,841 60.1 2,543 36.4 100 44.4 90 30.3 44 39.0 36 41.1 56 47.9 55 31.5 1,093 39.3 495 48.1 854 55.2 1,000 67.6 1,866 74.4 1,791 83.0 215 86.9 256 54.5 4,029 64.9 3,542 ______________________________________________________________ NA = Not applicable References * 145 REFERENCES Bureau of Statistics [Tanzania]. 1967. Population Census 1967. Vol. 6. Dar es Salaam: Bureau of Statistics. Bureau of Statistics [Tanzania]. 1978. Population Census 1978. Vol. 8. Dar es Salaam: Bureau of Statistics. Bureau of Statistics [Tanzania]. 1988. Population Census 1988. National profile. Dar es Salaam: Bureau of Statistics. Bureau of Statistics [Tanzania]. 1994. Population Census 1988. Analytical report. Dar es Salaam: Bureau of Statistics. Bureau of Statistics [Tanzania] and Macro International. 1997. Tanzania Demographic and Health Survey 1996. Calverton, Maryland: Bureau of Statistics and Macro International. Ngallaba, Sylvester, Saidi H. Kapiga, Ireneus Ruyobya, and J. Ties Boerma. 1993. Tanzania Demographic and Health Survey 1991/1992. Columbia, Maryland: Bureau of Statistics and Macro International Inc. Weinstein, Kia I., Sylvester Ngallaba, Anne R. Cross, and F.M. Mburu. 1995. Tanzania Knowledge, Attitudes and Practices Survey 1994. Calverton, Maryland: Bureau of Statistics [Tanzania] and Macro International Inc. 146 * Characteristics of Households Appendix A * 147 A.1.1 Sample implementation: women Percent distribution of households and eligible women in the 1999 TRCHS sample by results of the household and individual interviews, and household, eligible woman, and overall response rates, according to sample domain and urban- rural residence, Tanzania 1999 _____________________________________________________________________________________________________ Sample domain ______________________________________________ Result of Mainland Zanzibar Residence interview and ________________________ _______________________ _______________ response rate Total Urban Rural Total Pemba Unguja Urban Rural Total ______________________________________________________________________________________________________ Selected households Completed (C) 93.9 89.8 96.1 96.2 94.7 97.2 91.4 96.1 94.5 No competent respondent (HP) 1.3 2.5 0.7 0.7 0.8 0.6 2.1 0.7 1.2 Refused (R) 0.1 0.1 0.1 0.1 0.0 0.2 0.2 0.0 0.1 Dwelling not found (DNF) 0.5 1.1 0.2 0.1 0.0 0.2 0.9 0.1 0.4 Household absent (HA) 0.8 1.3 0.5 0.7 1.1 0.4 1.1 0.6 0.8 Dwelling vacant (DV) 3.1 4.9 2.2 2.2 3.3 1.5 4.1 2.3 2.9 Dwelling destroy (DD) 0.3 0.3 0.3 0.0 0.0 0.0 0.2 0.2 0.2 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number of households 2,924 1,002 1,922 902 361 541 1,304 2,522 2,826 Household response rate (HRR) 1 98.1 96.1 99.1 99.1 99.1 99.1 96.7 99.1 98.3 Eligible women Completed (EWC) 97.9 97.8 97.9 97.7 96.6 98.5 98.1 97.7 97.8 Not at home (EWNH) 1.5 1.4 1.6 1.4 2.4 0.7 1.2 1.6 1.5 Refused (EWR) 0.2 0.5 0.1 0.3 0.0 0.5 0.4 0.1 0.2 Incapacitated (EWI) 0.3 0.3 0.3 0.5 0.7 0.3 0.3 0.4 0.4 Other (EWO) 0.0 0.0 0.0 0.1 0.2 0.0 0.0 0.1 0.0 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number of women 3,126 1,059 2,067 992 410 582 2,446 2,672 3,118 Eligible woman response rate (EWRR) 2 97.9 97.8 97.9 97.7 96.6 98.5 98.1 97.7 97.8 Overall response rate (ORR) 3 96.0 94.0 97.0 96.8 95.7 97.5 94.8 96.9 96.2 __________________________________________________________________________________________________ Note: The household response rate is calculated for completed households as a proportion of completed, no competent respondent, refused, and dwelling not found. The eligible woman response rate is calculated for completed interviews as a proportion of completed, not at home, postponed, refused, partially completed, incapacitated and "other." The overall response rate is the product of the household and eligible woman response rates. 1 Using the number of households falling into specific response categories, the household response rate (HRR) is calculated as: C __________________ * 100 C + HP + R + DNF 2 Using the number of eligible women falling into specific response categories, the eligible woman response rate (EWRR) is calculated as: EWC ___________________________________ * 100 EWC + EWNH + EWR + EWI + EWO 3 The overall response rate (ORR) is calculated as: ORR = (HRR * EWRR) ÷ 100 SAMPLE IMPLEMENTATION APPENDIX A 148 * Appendix A A.1.2 Sample implementation: men Percent distribution of households and eligible men in the 1999 TRCHS sample by results of the household and individual interviews, and household, eligible man, and overall response rates, according to sample domain and urban-rural residence, Tanzania 1999 ______________________________________________________________________________________________________ Sample domain _______________________________________________ Result of Mainland Zanzibar Residence interview and ______________________ _______________________ _______________ response rate Total Urban Rural Total Pemba Unguja Urban Rural Total __________________________________________________________________________________________________ Selected households Completed (C) 93.9 89.8 96.1 96.2 94.7 97.2 91.4 96.1 94.5 No competent respondent (HP) 1.3 2.5 0.7 0.7 0.8 0.6 2.1 0.7 1.2 Refused (R) 0.1 0.1 0.1 0.1 0.0 0.2 0.2 0.0 0.1 Dwelling not found (DNF) 0.5 1.1 0.2 0.1 0.0 0.2 0.9 0.1 0.4 Household absent (HA) 0.8 1.3 0.5 0.7 1.1 0.4 1.1 0.6 0.8 Dwelling vacant (DV) 3.1 4.9 2.2 2.2 3.3 1.5 4.1 2.3 2.9 Dwelling destroy (DD) 0.3 0.3 0.3 0.0 0.0 0.0 0.2 0.2 0.2 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number of households 2,924 1,002 1,922 902 361 541 1,304 2,522 2,826 Household response rate (HRR) 1 98.1 96.1 99.1 99.1 99.1 99.1 96.7 99.1 98.3 Eligible men Completed (EMC) Not at home (EMNH) Postponed (EMP) Refused (EMR) Partly completed (EMPC) Incapacitated (EMI) Other (EMO) Total Number of men Eligible man response rate (EMRR) 2 Overall response rate (ORR) 3 92.6 90.1 93.9 96.0 95.8 96.2 91.4 94.5 93.4 5.7 7.0 5.0 2.1 2.7 1.7 5.9 4.2 4.8 0.1 0.2 0.0 0.0 0.0 0.0 0.1 0.0 0.1 0.5 0.8 0.3 0.9 0.6 1.0 0.7 0.5 0.6 0.1 0.2 0.0 0.0 0.0 0.0 0.1 0.0 0.1 0.8 1.0 0.7 0.8 0.6 0.9 1.0 0.7 0.8 0.3 0.7 0.1 0.2 0.3 0.2 0.6 0.1 0.3 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 2,887 997 1,890 905 330 575 1,367 2,425 3,792 92.6 90.1 93.9 96.0 95.8 96.2 91.4 94.5 93.4 90.8 86.5 93.1 95.1 94.9 95.3 88.4 93.7 91.8 __________________________________________________________________________________________________ Note: The household response rate is calculated for completed households as a proportion of completed, no competent respondent, refused, and dwelling not found. The eligible woman response rate is calculated for completed interviews as a proportion of completed, not at home, postponed, refused, partially completed, incapacitated and "other." The overall response rate is the product of the household and eligible woman response rates. 1 Using the number of households falling into specific response categories, the household response rate (HRR) is calculated as: C __________________ * 100 C + HP + R + DNF 2 Using the number of eligible women falling into specific response categories, the eligible woman response rate (EWRR) is calculated as: EMC ________________________________________________ * 100 EMC + EMNH + EMP + EMR + EMPC + EMI + EMO 3 The overall response rate (ORR) is calculated as: ORR = (HRR * EMRR) ÷ 100 Appendix B * 149 ESTIMATES OF SAMPLING ERRORS APPENDIX B The estimates from a sample survey are affected by two types of errors: (1) nonsampling errors, and (2) sampling errors. Nonsampling errors are the results of mistakes made in implementing data collection and data processing, such as failure to locate and interview the correct household, misunderstanding of the questions on the part of either the interviewer or the respondent, and data entry errors. Although numerous efforts were made during the implementation of the TRCHS to minimise this type of error, nonsampling errors are impossible to avoid and difficult to evaluate statistically. Sampling errors, on the other hand, can be evaluated statistically. The sample of respondents selected in the TRCHS is only one of many samples that could have been selected from the same population, using the same design and expected size. Each of these samples would yield results that differ somewhat from the results of the actual sample selected. Sampling errors are a measure of the variability between all possible samples. Although the degree of variability is not known exactly, it can be estimated from the survey results. A sampling error is usually measured in terms of the standard error for a particular statistic (mean, percentage, etc.), which is the square root of the variance. The standard error can be used to calculate confidence intervals within which the true value for the population can reasonably be assumed to fall. For example, for any given statistic calculated from a sample survey, the value of that statistic will fall within a range of plus or minus two times the standard error of that statistic in 95 percent of all possible samples of identical size and design. If the sample of respondents had been selected as a simple random sample, it would have been possible to use straightforward formulas for calculating sampling errors. However, the TRCHS sample is the result of a two-stage stratified design, and, consequently, it was necessary to use more complex formulae. The computer software used to calculate sampling errors for the TRCHS is the ISSA Sampling Error Module (SAMPERR). This module used the Taylor linearisation method of variance estimation for survey estimates that are means or proportions. The Jackknife repeated replication method is used for variance estimation of more complex statistics such as fertility and mortality rates. The Taylor linearisation method treats any percentage or average as a ratio estimate, r = y/x, where y represents the total sample value for variable y, and x represents the total number of cases in the group or subgroup under consideration. The variance of r is computed using the formula given below, with the standard error being the square root of the variance: 150 * Appendix B in which where h represents the stratum which varies from 1 to H, mh is the total number of clusters selected in the h th stratum, yhi is the sum of the weighted values of variable y in the i th cluster in the hth stratum, xhi is the sum of the weighted number of cases in the i th cluster in the hth stratum, and f is the overall sampling fraction, which is so small that it is ignored. The Jackknife repeated replication method derives estimates of complex rates from each of several replications of the parent sample, and calculates standard errors for these estimates using simple formulae. Each replication considers all but one clusters in the calculation of the estimates. Pseudo-independent replications are thus created. In the TRCHS, there were 176 non-empty clusters. Hence, 176 replications were created. The variance of a rate r is calculated as follows: in which where r is the estimate computed from the full sample of 251 clusters, r(I) is the estimate computed from the reduced sample of 250 clusters (i th cluster excluded), and k is the total number of clusters. In addition to the standard error, SAMPERR 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. SAMPERR also computes the relative error and confidence limits for the estimates. Sampling errors for the TRCHS are calculated for selected variables considered to be of primary interest. Two set of results, one for women and for men, are presented in this appendix for the country as a whole, for urban and rural areas, for each of the four domains: Mainland, Zanzibar, Pemba and Unguja. For each variable, the type of statistic (mean, proportion, or rate) and the base population are given in Table B.1. Tables B.2 to B.15 present the value of the statistic (R), its standard error (SE), the number of unweighted (N) and weighted (WN) cases, the design effect (DEFT), the relative standard error (SE/R), and the 95 percent confidence limits (R±2SE), for each variable. The DEFT is considered undefined when the standard error considering simple random sample is zero (when the estimate is close to 0 or 1). Appendix B * 151 In general, the relative standard error for most estimates for the country as a whole is small, except for estimates of very small proportions. There are some differentials in the relative standard error for the estimates of sub-populations. For example, for the variable using any contraceptive method, the relative standard errors as a percent of the estimated mean for the whole country, for urban areas, and for rural areas are 4.8 percent, 6.4 percent, and 6.7 percent, respectively. The confidence interval (e.g., as calculated for the variable using any method can be interpreted as follows: the overall national sample proportion is 0.223 and its standard error is .011. Therefore, to obtain the 95 percent confidence limits, one adds and subtracts twice the standard error to the sample estimate, ie. 0.223±2×.011. There is a high probability (95 percent) that the true proportion of all women 15-59 using a contraceptive method is between 20.1 and 24.5 percent. 152 * Appendix B Table B.1 List of selected variables for sampling errors, Tanzania 1999 ________________________________________________________________________________________________ Variable Estimate Base Population ________________________________________________________________________________________________ WOMEN________________________________________________________________________________________________ Urban resident Proportion All women 15-49 No education Proportion All women 15-49 Secondary education or more Proportion All women 15-49 Never in union Proportion All women 15-49 Currently in union Proportion All women 15-49 Ever in union before 20 Proportion All women 15-49 Sex before 18 Proportion All women 15-49 Children ever born Mean All women 15-49 Children ever born to women over 40 Mean All women 40-49 Children surviving Mean All women 15-49 Knowing any method Proportion All women 15-49 Knowing any modern method Proportion All women 15-49 Ever used any method Proportion All women 15-49 Using any method Proportion All women 15-49 Using any modern method Proportion All women 15-49 Using pill Proportion All women 15-49 Using IUD Proportion All women 15-49 Using injectables Proportion All women 15-49 Using condom Proportion All women 15-49 Using female sterilisation Proportion All women 15-49 Currently using abstinence Proportion All women 15-49 Using withdrawal Proportion All women 15-49 Public source user Proportion User modern method Desires no more children Proportion All women 15-49 Wants to delay child at least 2 years Proportion All women 15-49 Ideal number of children Mean All women 15-49 Mother received tetanus injection Proportion Most recent birth in last 5 years Mother received medical care at birth Proportion Birth in last 5 years Had diarrhoea in the last 2 weeks Proportion Children under 5 Treated with ORS packets Proportion Children under 5 with diarrhoea in last 2 weeks Sought medical treatment Proportion Children under 5 with diarrhoea in last 2 weeks Having health card Proportion Children 12-23 months Received BCG vaccination Proportion Children 12-23 months Received DPT vaccination (3 doses) Proportion Children 12-23 months Received polio vaccination (3 doses) Proportion Children 12-23 months Received measles vaccination Proportion Children 12-23 months Fully immunised Proportion Children 12-23 months Total fertility rate (3 years) Rate Woman-years of exposure to child bearing Neonatal mortality rate Rate Number of births Infant mortality rate Rate Number of births Child mortality rate Rate Number of births Under-five mortality rate Rate Number of births Postneonatal mortality rate Rate Number of births ________________________________________________________________________________________________ MEN________________________________________________________________________________________________ Urban resident Proportion All men 15-59 No education Proportion All men 15-59 Secondary education or more Proportion All men 15-59 Never in union Proportion All men 15-59 Currently in union Proportion All men 15-59 Knowing any method Proportion All men 15-59 Knowing any modern method Proportion All men 15-59 Ever used any method Proportion All men 15-59 Using any method Proportion All men 15-59 Using any modern method Proportion All men 15-59 Using pill Proportion All men 15-59 Using IUD Proportion All men 15-59 Using injectables Proportion All men 15-59 Using condom Proportion All men 15-59 Using female sterilisation Proportion All men 15-59 Currently using abstinence Proportion All men 15-59 Using withdrawal Proportion All men 15-59 Ideal number of children Mean All men 15-59 Appendix B * 153 Table B.2 Sampling errors for women - Total sample: Tanzania 1999 ____________________________________________________________________________________________________ Number of cases Stan- ________________ Rela- Confidence dard Un- Weight- Design tive intervals Value error weighted ed effect error ____________ Variable (R) (SE) (N) (WN) (DEFT) (SE/R) R-2SE R+2SE ____________________________________________________________________________________________________ Urban resident No education Secondary education or more Never in union Currently in union Ever in union before 20 Sex before 18 Children ever born Children ever born to women over 40 Children surviving Knowing any method Knowing any modern method Ever used any method Using any method Using any modern method Using pill Using IUD Using injectables Using condom Using female sterilisation Currently using abstinence Using withdrawal Public source user Desires no more children Wants to delay child at least 2 years Ideal number of children Mother received tetanus injection Mother received medical care at birth Had diarrhoea in the last 2 weeks Treated with ORS packets Sought medical treatment Having health card Received BCG vaccination Received DPT vaccination (3 doses) Received polio vaccination (3 doses) Received measles vaccination Fully immunised Total fertility rate (3 years) Neonatal mortality rate (5 years) Infant mortality rate (5 years) Child mortality rate (5 years) Under-five mortality rate (5 years) Postneonatal mortality rate (5 years) 0.279 0.029 4029 4029 4.139 0.105 0.220 0.337 0.271 0.019 4029 4029 2.676 0.069 0.234 0.309 0.053 0.007 4029 4029 1.950 0.129 0.040 0.067 0.234 0.010 4029 4029 1.486 0.042 0.214 0.254 0.658 0.012 4029 4029 1.636 0.019 0.634 0.683 0.669 0.013 3096 3120 1.524 0.019 0.643 0.695 0.675 0.012 3096 3120 1.399 0.017 0.652 0.699 2.925 0.070 4029 4029 1.543 0.024 2.785 3.065 6.687 0.187 590 614 1.511 0.028 6.312 7.062 2.410 0.055 4029 4029 1.437 0.023 2.301 2.519 0.909 0.014 4029 4029 2.997 0.015 0.882 0.936 0.905 0.015 4029 4029 3.198 0.016 0.875 0.935 0.405 0.014 4029 4029 1.813 0.035 0.377 0.433 0.223 0.011 4029 4029 1.645 0.048 0.201 0.245 0.156 0.011 4029 4029 1.870 0.068 0.135 0.178 0.046 0.005 4029 4029 1.654 0.119 0.035 0.057 0.005 0.001 4029 4029 1.323 0.304 0.002 0.008 0.054 0.006 4029 4029 1.581 0.105 0.042 0.065 0.035 0.005 4029 4029 1.777 0.147 0.025 0.045 0.015 0.003 4029 4029 1.318 0.166 0.010 0.020 0.022 0.003 4029 4029 1.264 0.133 0.016 0.028 0.025 0.004 4029 4029 1.571 0.155 0.017 0.033 0.672 0.033 621 630 1.751 0.049 0.606 0.738 0.237 0.011 4029 4029 1.587 0.045 0.216 0.258 0.311 0.012 4029 4029 1.587 0.037 0.287 0.334 5.263 0.078 3911 3916 2.005 0.015 5.106 5.419 0.827 0.021 2118 2183 2.653 0.026 0.784 0.870 0.438 0.026 3215 3282 2.557 0.060 0.386 0.491 0.124 0.009 2839 2898 1.417 0.073 0.106 0.142 0.549 0.038 350 358 1.402 0.070 0.472 0.626 0.632 0.036 350 358 1.341 0.056 0.561 0.703 0.741 0.038 561 593 2.118 0.052 0.664 0.818 0.927 0.014 561 593 1.280 0.015 0.899 0.955 0.810 0.033 561 593 2.018 0.041 0.743 0.876 0.799 0.027 561 593 1.589 0.033 0.746 0.852 0.781 0.030 561 593 1.751 0.039 0.721 0.842 0.683 0.034 561 593 1.791 0.050 0.615 0.752 5.554 0.264 NA 11109 2.010 0.047 5.027 6.081 40.414 4.701 3279 3356 1.281 0.116 31.012 49.815 99.139 7.096 3289 3366 1.240 0.072 84.948 113.331 52.675 6.173 3322 3396 1.472 0.117 40.328 65.022 146.593 9.079 3334 3408 1.362 0.062 128.435 164.750 58.726 6.333 3287 3364 1.365 0.108 46.059 71.393 _____________________________________________________________________________________________________ NA = Not applicable 154 * Appendix B Table B.3 Sampling errors for women - Urban sample: Tanzania 1999 ____________________________________________________________________________________________________ Number of cases Stan- ________________ Rela- Confidence dard Un- Weight- Design tive intervals Value error weighted ed effect error ____________ Variable (R) (SE) (N) (WN) (DEFT) (SE/R) R-2SE R+2SE ____________________________________________________________________________________________________ Urban resident No education Secondary education or more Never in union Currently in union Ever in union before 20 Sex before 18 Children ever born Children ever born to women over 40 Children surviving Knowing any method Knowing any modern method Ever used any method Using any method Using any modern method Using pill Using IUD Using injectables Using condom Using female sterilisation Currently using abstinence Using withdrawal Public source user Desires no more children Wants to delay child at least 2 years Ideal number of children Mother received tetanus injection Mother received medical care at birth Had diarrhoea in the last 2 weeks Treated with ORS packets Sought medical treatment Having health card Received BCG vaccination Received DPT vaccination (3 doses) Received polio vaccination (3 doses) Received measles vaccination Fully immunised Total fertility rate (3 years) Neonatal mortality rate (10 years) Infant mortality rate (10 years) Child mortality rate (10 years) Under-five mortality rate (10 years) Postneonatal mortality rate (10 years) 1.000 0.000 1418 1122 NA 0.000 1.000 1.000 0.132 0.021 1418 1122 2.372 0.161 0.090 0.175 0.133 0.023 1418 1122 2.564 0.174 0.087 0.179 0.292 0.014 1418 1122 1.198 0.049 0.263 0.321 0.554 0.021 1418 1122 1.570 0.037 0.512 0.595 0.556 0.021 1109 905 1.405 0.038 0.514 0.598 0.618 0.020 1109 905 1.339 0.032 0.579 0.657 2.161 0.078 1418 1122 1.324 0.036 2.005 2.318 5.334 0.339 189 147 1.710 0.064 4.656 6.012 1.814 0.067 1418 1122 1.338 0.037 1.679 1.948 0.976 0.006 1418 1122 1.455 0.006 0.964 0.988 0.975 0.006 1418 1122 1.456 0.006 0.963 0.987 0.567 0.017 1418 1122 1.281 0.030 0.534 0.601 0.330 0.021 1418 1122 1.682 0.064 0.288 0.372 0.289 0.017 1418 1122 1.421 0.059 0.255 0.323 0.089 0.013 1418 1122 1.783 0.152 0.062 0.115 0.012 0.004 1418 1122 1.336 0.322 0.004 0.020 0.099 0.013 1418 1122 1.596 0.128 0.073 0.124 0.067 0.015 1418 1122 2.239 0.221 0.037 0.097 0.018 0.006 1418 1122 1.688 0.333 0.006 0.030 0.028 0.007 1418 1122 1.549 0.242 0.014 0.042 0.008 0.003 1418 1122 1.178 0.340 0.003 0.014 0.636 0.043 366 324 1.692 0.067 0.551 0.722 0.220 0.027 1418 1122 2.431 0.122 0.166 0.273 0.323 0.021 1418 1122 1.675 0.064 0.282 0.365 4.309 0.097 1388 1107 1.938 0.022 4.115 4.503 0.914 0.018 616 502 1.606 0.020 0.878 0.950 0.833 0.031 820 614 2.007 0.037 0.772 0.895 0.098 0.014 741 546 1.225 0.138 0.071 0.125 0.510 0.088 75 54 1.448 0.173 0.334 0.686 0.701 0.086 75 54 1.542 0.123 0.529 0.873 0.696 0.063 148 112 1.632 0.091 0.570 0.823 1.000 0.000 148 112 NA 0.000 1.000 1.000 0.899 0.062 148 112 2.435 0.069 0.775 1.000 0.848 0.060 148 112 1.981 0.071 0.729 0.968 0.903 0.034 148 112 1.346 0.037 0.835 0.970 0.805 0.059 148 112 1.754 0.073 0.688 0.922 3.160 0.282 NA 3173 2.180 0.089 2.597 3.724 51.979 7.385 1635 1257 1.207 0.142 37.209 66.749 87.274 9.326 1636 1258 1.242 0.107 68.622 105.927 59.557 8.442 1644 1267 1.249 0.142 42.673 76.440 141.633 11.042 1646 1269 1.252 0.078 119.550 163.716 35.296 9.903 1635 1256 2.159 0.281 15.489 55.102 _____________________________________________________________________________________________________ NA = Not applicable Appendix B * 155 Table B.4 Sampling errors for women - Rural sample: Tanzania 1999 ____________________________________________________________________________________________________ Number of cases Stan- ________________ Rela- Confidence dard Un- Weight- Design tive intervals Value error weighted ed effect error ____________ Variable (R) (SE) (N) (WN) (DEFT) (SE/R) R-2SE R+2SE ____________________________________________________________________________________________________ Urban resident No education Secondary education or more Never in union Currently in union Ever in union before 20 Sex before 18 Children ever born Children ever born to women over 40 Children surviving Knowing any method Knowing any modern method Ever used any method Using any method Using any modern method Using pill Using IUD Using injectables Using condom Using female sterilisation Currently using abstinence Using withdrawal Public source user Desires no more children Wants to delay child at least 2 years Ideal number of children Mother received tetanus injection Mother received medical care at birth Had diarrhoea in the last 2 weeks Treated with ORS packets Sought medical treatment Having health card Received BCG vaccination Received DPT vaccination (3 doses) Received polio vaccination (3 doses) Received measles vaccination Fully immunised Total fertility rate (3 years) Neonatal mortality rate (10 years) Infant mortality rate (10 years) Child mortality rate (10 years) Under-five mortality rate (10 years) Postneonatal mortality rate (10 years) 0.000 0.000 2611 2907 NA NA 0.000 0.000 0.325 0.022 2611 2907 2.417 0.068 0.281 0.369 0.023 0.003 2611 2907 1.099 0.141 0.016 0.029 0.212 0.012 2611 2907 1.464 0.055 0.188 0.235 0.699 0.012 2611 2907 1.371 0.018 0.674 0.723 0.715 0.014 1987 2215 1.339 0.019 0.688 0.742 0.699 0.014 1987 2215 1.351 0.020 0.671 0.727 3.220 0.073 2611 2907 1.230 0.023 3.074 3.367 7.114 0.193 401 467 1.298 0.027 6.729 7.500 2.640 0.055 2611 2907 1.109 0.021 2.529 2.750 0.883 0.018 2611 2907 2.844 0.020 0.847 0.919 0.878 0.020 2611 2907 3.046 0.022 0.839 0.917 0.343 0.017 2611 2907 1.792 0.049 0.310 0.376 0.182 0.012 2611 2907 1.604 0.067 0.157 0.206 0.105 0.011 2611 2907 1.894 0.108 0.082 0.128 0.030 0.004 2611 2907 1.346 0.151 0.021 0.039 0.002 0.001 2611 2907 1.231 0.561 0.000 0.004 0.036 0.006 2611 2907 1.528 0.154 0.025 0.047 0.022 0.004 2611 2907 1.531 0.198 0.013 0.031 0.014 0.003 2611 2907 1.149 0.186 0.009 0.020 0.020 0.003 2611 2907 1.140 0.157 0.014 0.026 0.031 0.005 2611 2907 1.472 0.161 0.021 0.041 0.710 0.050 255 305 1.774 0.071 0.609 0.811 0.244 0.010 2611 2907 1.195 0.041 0.224 0.264 0.306 0.014 2611 2907 1.549 0.046 0.278 0.334 5.638 0.077 2523 2809 1.532 0.014 5.483 5.793 0.801 0.026 1502 1681 2.578 0.033 0.748 0.854 0.348 0.024 2395 2668 2.092 0.070 0.299 0.396 0.129 0.011 2098 2353 1.395 0.083 0.108 0.151 0.555 0.042 275 304 1.344 0.076 0.471 0.640 0.620 0.039 275 304 1.262 0.063 0.543 0.698 0.751 0.045 413 481 2.132 0.060 0.661 0.841 0.910 0.016 413 481 1.165 0.018 0.877 0.943 0.789 0.039 413 481 1.917 0.049 0.712 0.866 0.788 0.029 413 481 1.474 0.037 0.729 0.847 0.753 0.036 413 481 1.677 0.047 0.682 0.824 0.655 0.039 413 481 1.694 0.059 0.577 0.733 6.483 0.220 NA 7935 1.397 0.034 6.043 6.923 43.444 4.475 4571 4999 1.340 0.103 34.493 52.395 112.951 7.905 4581 5009 1.479 0.070 97.142 128.761 59.728 5.925 4619 5057 1.354 0.099 47.877 71.579 165.933 10.738 4630 5068 1.669 0.065 144.457 187.409 69.507 5.792 4580 5008 1.329 0.083 57.924 81.091 ____________________________________________________________________________________________________ NA = Not applicable 156 * Appendix B Table B.5 Sampling errors for women - Mainland sample: Tanzania 1999 ____________________________________________________________________________________________________ Number of cases Stan- ________________ Rela- Confidence dard Un- Weight- Design tive intervals Value error weighted ed effect error ____________ Variable (R) (SE) (N) (WN) (DEFT) (SE/R) R-2SE R+2SE ____________________________________________________________________________________________________ Urban resident No education Secondary education or more Never in union Currently in union Ever in union before 20 Sex before 18 Children ever born Children ever born to women over 40 Children surviving Knowing any method Knowing any modern method Ever used any method Using any method Using any modern method Using pill Using IUD Using injectables Using condom Using female sterilisation Currently using abstinence Using withdrawal Public source user Desires no more children Wants to delay child at least 2 years Ideal number of children Mother received tetanus injection Mother received medical care at birth Had diarrhoea in the last 2 weeks Treated with ORS packets Sought medical treatment Having health card Received BCG vaccination Received DPT vaccination (3 doses) Received polio vaccination (3 doses) Received measles vaccination Fully immunised Total fertility rate (3 years) Neonatal mortality rate (10 years) Infant mortality rate (10 years) Child mortality rate (10 years) Under-five mortality rate (10 years) Postneonatal mortality rate (10 years) 0.277 0.030 3060 3929 3.709 0.108 0.217 0.337 0.271 0.019 3060 3929 2.391 0.071 0.233 0.309 0.046 0.007 3060 3929 1.845 0.152 0.032 0.060 0.234 0.010 3060 3929 1.328 0.044 0.213 0.254 0.659 0.013 3060 3929 1.463 0.019 0.634 0.684 0.666 0.013 2367 3045 1.360 0.020 0.640 0.693 0.678 0.012 2367 3045 1.256 0.018 0.653 0.702 2.915 0.072 3060 3929 1.382 0.025 2.772 3.058 6.673 0.191 463 601 1.368 0.029 6.291 7.056 2.398 0.056 3060 3929 1.286 0.023 2.287 2.510 0.908 0.014 3060 3929 2.665 0.015 0.880 0.936 0.904 0.015 3060 3929 2.844 0.017 0.874 0.934 0.408 0.014 3060 3929 1.616 0.035 0.379 0.437 0.225 0.011 3060 3929 1.462 0.049 0.203 0.247 0.157 0.011 3060 3929 1.663 0.070 0.136 0.179 0.046 0.006 3060 3929 1.478 0.122 0.035 0.057 0.005 0.001 3060 3929 1.184 0.313 0.002 0.008 0.054 0.006 3060 3929 1.408 0.107 0.042 0.065 0.035 0.005 3060 3929 1.572 0.148 0.025 0.046 0.016 0.003 3060 3929 1.168 0.168 0.010 0.021 0.022 0.003 3060 3929 1.123 0.134 0.016 0.028 0.025 0.004 3060 3929 1.393 0.157 0.017 0.033 0.671 0.034 509 619 1.609 0.050 0.604 0.738 0.239 0.011 3060 3929 1.416 0.046 0.217 0.261 0.310 0.012 3060 3929 1.419 0.038 0.286 0.333 5.224 0.080 2975 3820 1.810 0.015 5.064 5.384 0.827 0.022 1619 2131 2.372 0.027 0.783 0.871 0.439 0.027 2406 3196 2.288 0.062 0.385 0.493 0.124 0.009 2107 2820 1.265 0.075 0.105 0.142 0.555 0.039 269 349 1.251 0.071 0.476 0.634 0.636 0.036 269 349 1.199 0.057 0.563 0.709 0.740 0.039 426 578 1.890 0.053 0.662 0.819 0.926 0.014 426 578 1.132 0.016 0.897 0.955 0.809 0.034 426 578 1.800 0.042 0.741 0.878 0.799 0.027 426 578 1.416 0.034 0.744 0.853 0.782 0.031 426 578 1.565 0.040 0.720 0.844 0.683 0.035 426 578 1.599 0.052 0.612 0.753 5.55 0.270 NA NA 1.798 0.049 5.010 6.090 45.440 4.004 4612 6086 1.206 0.088 37.431 53.448 108.483 6.851 4622 6097 1.354 0.063 94.781 122.184 60.472 5.101 4659 6152 1.202 0.084 50.270 70.674 162.394 9.031 4671 6166 1.484 0.056 144.332 180.457 63.043 5.518 4620 6094 1.390 0.088 52.007 74.079 _____________________________________________________________________________________________________ NA = Not applicable Appendix B * 157 Table B.6 Sampling errors for women - Zanzibar sample: Tanzania 1999 ____________________________________________________________________________________________________ Number of cases Stan- ________________ Rela- Confidence dard Un- Weight- Design tive intervals Value error weighted ed effect error ____________ Variable (R) (SE) (N) (WN) (DEFT) (SE/R) R-2SE R+2SE ____________________________________________________________________________________________________ Urban resident No education Secondary education or more Never in union Currently in union Ever in union before 20 Sex before 18 Children ever born Children ever born to women over 40 Children surviving Knowing any method Knowing any modern method Ever used any method Using any method Using any modern method Using pill Using IUD Using injectables Using condom Using female sterilisation Currently using abstinence Using withdrawal Public source user Desires no more children Wants to delay child at least 2 years Ideal number of children Mother received tetanus injection Mother received medical care at birth Had diarrhoea in the last 2 weeks Treated with ORS packets Sought medical treatment Having health card Received BCG vaccination Received DPT vaccination (3 doses) Received polio vaccination (3 doses) Received measles vaccination Fully immunised Total fertility rate Neonatal mortality rate (10 years) Infant mortality rate (10 years) Child mortality rate (10 years) Under-five mortality rate (10 years) Postneonatal mortality rate (10 years) 0.344 0.027 969 100 1.752 0.078 0.291 0.398 0.284 0.020 969 100 1.348 0.069 0.244 0.323 0.338 0.018 969 100 1.213 0.055 0.301 0.375 0.259 0.021 969 100 1.469 0.080 0.218 0.300 0.618 0.021 969 100 1.332 0.034 0.576 0.659 0.772 0.014 729 75 0.895 0.018 0.744 0.799 0.587 0.025 729 75 1.360 0.042 0.537 0.637 3.335 0.098 969 100 0.922 0.029 3.138 3.532 7.319 0.303 127 13 1.055 0.041 6.712 7.926 2.859 0.094 969 100 1.023 0.033 2.671 3.047 0.947 0.008 969 100 1.151 0.009 0.930 0.963 0.944 0.009 969 100 1.166 0.009 0.927 0.961 0.301 0.020 969 100 1.341 0.066 0.261 0.340 0.136 0.011 969 100 1.002 0.081 0.114 0.158 0.109 0.011 969 100 1.064 0.098 0.088 0.131 0.048 0.008 969 100 1.202 0.173 0.031 0.064 0.006 0.002 969 100 0.767 0.330 0.002 0.009 0.039 0.006 969 100 0.969 0.155 0.027 0.051 0.011 0.003 969 100 0.917 0.279 0.005 0.017 0.007 0.003 969 100 1.244 0.494 0.000 0.013 0.012 0.004 969 100 1.058 0.305 0.005 0.020 0.009 0.003 969 100 1.145 0.395 0.002 0.015 0.739 0.076 112 11 1.829 0.103 0.587 0.892 0.169 0.014 969 100 1.134 0.081 0.141 0.196 0.349 0.019 969 100 1.217 0.053 0.312 0.386 6.796 0.138 936 96 1.342 0.020 6.520 7.071 0.812 0.013 499 52 0.770 0.016 0.785 0.839 0.412 0.024 809 86 1.133 0.057 0.365 0.459 0.116 0.014 732 78 1.229 0.124 0.087 0.145 0.294 0.051 81 9 0.976 0.174 0.192 0.397 0.477 0.075 81 9 1.365 0.157 0.327 0.627 0.756 0.042 135 15 1.150 0.055 0.673 0.840 0.978 0.017 135 15 1.401 0.018 0.944 1.000 0.833 0.025 135 15 0.780 0.030 0.784 0.882 0.828 0.026 135 15 0.825 0.032 0.776 0.881 0.750 0.059 135 15 1.613 0.079 0.631 0.868 0.700 0.044 135 15 1.129 0.063 0.612 0.788 5.582 0.388 NA NA 1.567 0.069 4.809 6.361 35.154 5.349 1594 170 1.058 0.152 24.455 45.853 83.049 7.709 1595 170 0.991 0.093 67.630 98.468 34.113 6.310 1604 171 1.213 0.185 21.493 46.732 114.328 10.276 1605 171 1.175 0.090 93.776 134.881 47.895 5.779 1595 170 0.946 0.121 36.336 59.454 _____________________________________________________________________________________________________ NA = Not applicable 158 * Appendix B Table B.7 Sampling errors for women - Pemba sample: Tanzania 1999 ____________________________________________________________________________________________________ Number of cases Stan- ________________ Rela- Confidence dard Un- Weight- Design tive intervals Value error weighted ed effect error ____________ Variable (R) (SE) (N) (WN) (DEFT) (SE/R) R-2SE R+2SE ____________________________________________________________________________________________________ Urban resident No education Secondary education or more Never in union Currently in union Ever in union before 20 Sex before 18 Children ever born Children ever born to women over 40 Children surviving Knowing any method Knowing any modern method Ever used any method Using any method Using any modern method Using pill Using IUD Using injectables Using condom Using female sterilisation Currently using abstinence Using withdrawal Public source user Desires no more children Wants to delay child at least 2 years Ideal number of children Mother received tetanus injection Mother received medical care at birth Had diarrhoea in the last 2 weeks Treated with ORS packets Sought medical treatment Having health card Received BCG vaccination Received DPT vaccination (3 doses) Received polio vaccination (3 doses) Received measles vaccination Fully immunised 0.160 0.021 396 44 1.130 0.130 0.118 0.202 0.393 0.032 396 44 1.282 0.080 0.330 0.456 0.232 0.031 396 44 1.469 0.134 0.170 0.294 0.264 0.035 396 44 1.593 0.134 0.193 0.335 0.624 0.039 396 44 1.590 0.062 0.547 0.702 0.791 0.018 290 32 0.761 0.023 0.755 0.827 0.565 0.046 290 32 1.587 0.082 0.473 0.658 3.618 0.108 396 44 0.614 0.030 3.403 3.834 7.700 0.362 49 5 0.798 0.047 6.975 8.424 3.112 0.093 396 44 0.613 0.030 2.926 3.297 0.924 0.014 396 44 1.080 0.016 0.895 0.953 0.920 0.015 396 44 1.130 0.017 0.889 0.951 0.178 0.013 396 44 0.684 0.074 0.151 0.204 0.068 0.009 396 44 0.681 0.126 0.051 0.086 0.049 0.011 396 44 1.030 0.229 0.027 0.071 0.011 0.002 396 44 0.432 0.205 0.007 0.016 0.002 0.002 396 44 0.923 1.020 0.000 0.006 0.025 0.010 396 44 1.301 0.410 0.004 0.045 0.000 0.000 396 44 NA NA 0.000 0.000 0.011 0.007 396 44 1.311 0.631 0.000 0.024 0.010 0.004 396 44 0.803 0.400 0.002 0.018 0.008 0.005 396 44 1.236 0.710 0.000 0.018 1.000 0.000 22 2 NA 0.000 1.000 1.000 0.155 0.022 396 44 1.201 0.141 0.111 0.198 0.368 0.023 396 44 0.930 0.061 0.323 0.413 8.069 0.183 377 41 1.031 0.023 7.704 8.435 0.786 0.023 213 24 0.842 0.030 0.739 0.833 0.287 0.019 361 42 0.688 0.067 0.248 0.326 0.163 0.018 324 38 0.901 0.111 0.127 0.200 0.373 0.057 50 6 0.806 0.152 0.260 0.486 0.474 0.096 50 6 1.395 0.203 0.281 0.666 0.665 0.056 65 8 0.965 0.085 0.552 0.777 0.958 0.033 65 8 1.354 0.035 0.891 1.000 0.716 0.051 65 8 0.915 0.071 0.614 0.817 0.706 0.047 65 8 0.844 0.067 0.612 0.801 0.615 0.098 65 8 1.620 0.159 0.419 0.810 0.518 0.060 65 8 0.962 0.116 0.398 0.639 _____________________________________________________________________________________________________ NA = Not applicable Appendix B * 159 Table B.8 Sampling errors for women - Unguja sample: Tanzania 1999 ____________________________________________________________________________________________________ Number of cases Stan- ________________ Rela- Confidence dard Un- Weight- Design tive intervals Value error weighted ed effect error ____________ Variable (R) (SE) (N) (WN) (DEFT) (SE/R) R-2SE R+2SE ____________________________________________________________________________________________________ Urban resident No education Secondary education or more Never in union Currently in union Ever in union before 20 Sex before 18 Children ever born Children ever born to women over 40 Children surviving Knowing any method Knowing any modern method Ever used any method Using any method Using any modern method Using pill Using IUD Using injectables Using condom Using female sterilisation Currently using abstinence Using withdrawal Public source user Desires no more children Wants to delay child at least 2 years Ideal number of children Mother received tetanus injection Mother received medical care at birth Had diarrhoea in the last 2 weeks Treated with ORS packets Sought medical treatment Having health card Received BCG vaccination Received DPT vaccination (3 doses) Received polio vaccination (3 doses) Received measles vaccination Fully immunised 0.488 0.036 573 56 1.739 0.074 0.415 0.561 0.198 0.023 573 56 1.353 0.114 0.153 0.244 0.421 0.021 573 56 1.033 0.051 0.378 0.464 0.255 0.024 573 56 1.325 0.095 0.207 0.303 0.613 0.022 573 56 1.059 0.035 0.570 0.656 0.757 0.021 439 43 1.008 0.027 0.716 0.798 0.603 0.024 439 43 1.031 0.040 0.555 0.651 3.114 0.152 573 56 1.146 0.049 2.810 3.417 7.058 0.445 78 8 1.199 0.063 6.169 7.947 2.661 0.149 573 56 1.310 0.056 2.364 2.959 0.965 0.008 573 56 1.054 0.008 0.948 0.981 0.963 0.007 573 56 0.942 0.008 0.948 0.978 0.397 0.029 573 56 1.413 0.073 0.339 0.454 0.189 0.017 573 56 1.068 0.092 0.154 0.224 0.156 0.014 573 56 0.933 0.091 0.128 0.185 0.076 0.014 573 56 1.223 0.178 0.049 0.103 0.008 0.003 573 56 0.705 0.323 0.003 0.014 0.049 0.007 573 56 0.774 0.142 0.035 0.063 0.020 0.005 573 56 0.938 0.277 0.009 0.031 0.003 0.002 573 56 0.999 0.741 0.000 0.008 0.014 0.006 573 56 1.206 0.425 0.002 0.026 0.009 0.004 573 56 1.092 0.469 0.001 0.018 0.676 0.092 90 9 1.863 0.137 0.491 0.861 0.180 0.017 573 56 1.044 0.093 0.146 0.213 0.334 0.027 573 56 1.354 0.080 0.281 0.388 5.833 0.194 559 55 1.827 0.033 5.445 6.220 0.834 0.013 286 28 0.616 0.016 0.807 0.861 0.529 0.037 448 45 1.309 0.069 0.456 0.603 0.072 0.014 408 40 1.068 0.188 0.045 0.099 0.126 0.067 31 3 1.088 0.528 0.000 0.260 0.484 0.114 31 3 1.214 0.236 0.256 0.712 0.854 0.059 70 7 1.409 0.069 0.736 0.972 1.000 0.000 70 7 NA 0.000 1.000 1.000 0.958 0.028 70 7 1.162 0.029 0.903 1.000 0.958 0.028 70 7 1.162 0.029 0.903 1.000 0.894 0.038 70 7 1.056 0.043 0.817 0.970 0.894 0.038 70 7 1.056 0.043 0.817 0.970 _____________________________________________________________________________________________________ NA = Not applicable 160 * Appendix B Table B.9 Sampling errors for men - Total sample: Tanzania 1999 ____________________________________________________________________________________________________ Number of cases Stan- ________________ Rela- Confidence dard Un- Weight- Design tive intervals Value error weighted ed effect error ____________ Variable (R) (SE) (N) (WN) (DEFT) (SE/R) R-2SE R+2SE ____________________________________________________________________________________________________ Urban resident No education Secondary education or more Never in union Currently in union Knowing any method Knowing any modern method Ever used any method Using any method Using any modern method Using pill Using IUD Using injectables Using condom Using female sterilisation Currently using abstinence Using withdrawal Ideal number of children 0.266 0.022 3542 3542 2.989 0.083 0.221 0.310 0.140 0.011 3542 3542 1.819 0.076 0.119 0.161 0.071 0.006 3542 3542 1.338 0.082 0.059 0.082 0.364 0.012 3542 3542 1.440 0.032 0.341 0.387 0.582 0.014 3542 3542 1.686 0.024 0.555 0.610 0.928 0.006 3542 3542 1.490 0.007 0.915 0.941 0.920 0.006 3542 3542 1.267 0.006 0.909 0.932 0.482 0.015 3542 3542 1.806 0.031 0.451 0.512 0.293 0.012 3542 3542 1.623 0.042 0.268 0.318 0.208 0.013 3542 3542 1.890 0.062 0.182 0.234 0.040 0.006 3542 3542 1.871 0.153 0.028 0.053 0.003 0.001 3542 3542 1.166 0.384 0.001 0.005 0.031 0.004 3542 3542 1.444 0.136 0.023 0.039 0.120 0.010 3542 3542 1.863 0.085 0.100 0.140 0.014 0.003 3542 3542 1.354 0.194 0.008 0.019 0.041 0.005 3542 3542 1.401 0.114 0.031 0.050 0.024 0.003 3542 3542 1.162 0.124 0.018 0.030 5.609 0.138 3379 3409 2.271 0.025 5.332 5.885 _____________________________________________________________________________________________________ NA = Not applicable Table B.10 Sampling errors for men - Urban sample: Tanzania 1999 ____________________________________________________________________________________________________ Number of cases Stan- ________________ Rela- Confidence dard Un- Weight- Design tive intervals Value error weighted ed effect error ____________ Variable (R) (SE) (N) (WN) (DEFT) (SE/R) R-2SE R+2SE ____________________________________________________________________________________________________ Urban resident No education Secondary education or more Never in union Currently in union Knowing any method Knowing any modern method Ever used any method Using any method Using any modern method Using pill Using IUD Using injectables Using condom Using female sterilisation Currently using abstinence Using withdrawal Ideal number of children 1.000 0.000 1250 941 NA 0.000 1.000 1.000 0.070 0.019 1250 941 2.604 0.268 0.033 0.108 0.165 0.020 1250 941 1.911 0.122 0.125 0.205 0.406 0.025 1250 941 1.823 0.062 0.355 0.456 0.535 0.031 1250 941 2.187 0.058 0.473 0.597 0.973 0.006 1250 941 1.403 0.007 0.961 0.986 0.968 0.007 1250 941 1.471 0.008 0.953 0.982 0.608 0.030 1250 941 2.164 0.049 0.548 0.668 0.385 0.023 1250 941 1.674 0.060 0.339 0.431 0.318 0.029 1250 941 2.180 0.090 0.260 0.375 0.068 0.019 1250 941 2.653 0.277 0.030 0.106 0.006 0.002 1250 941 1.058 0.394 0.001 0.010 0.039 0.009 1250 941 1.679 0.235 0.021 0.058 0.190 0.023 1250 941 2.050 0.120 0.145 0.236 0.012 0.007 1250 941 2.161 0.546 0.000 0.026 0.041 0.009 1250 941 1.589 0.218 0.023 0.059 0.014 0.003 1250 941 0.842 0.198 0.009 0.020 4.327 0.111 1194 909 1.727 0.026 4.105 4.550 _____________________________________________________________________________________________________ NA = Not applicable Appendix B * 161 Table B.12 Sampling errors for men - Mainland sample: Tanzania 1999 ____________________________________________________________________________________________________ Number of cases Stan- ________________ Rela- Confidence dard Un- Weight- Design tive intervals Value error weighted ed effect error ____________ Variable (R) (SE) (N) (WN) (DEFT) (SE/R) R-2SE R+2SE ____________________________________________________________________________________________________ Urban resident No education Secondary education or more Never in union Currently in union Knowing any method Knowing any modern method Ever used any method Using any method Using any modern method Using pill Using IUD Using injectables Using condom Using female sterilisation Currently using abstinence Using withdrawal Ideal number of children 0.263 0.023 2673 3452 2.674 0.087 0.218 0.309 0.139 0.011 2673 3452 1.626 0.078 0.117 0.161 0.063 0.006 2673 3452 1.223 0.091 0.052 0.075 0.363 0.012 2673 3452 1.283 0.033 0.339 0.387 0.583 0.014 2673 3452 1.502 0.025 0.555 0.612 0.927 0.007 2673 3452 1.321 0.007 0.913 0.940 0.919 0.006 2673 3452 1.123 0.006 0.907 0.931 0.487 0.016 2673 3452 1.605 0.032 0.456 0.518 0.297 0.013 2673 3452 1.439 0.043 0.271 0.322 0.211 0.013 2673 3452 1.674 0.063 0.184 0.237 0.040 0.006 2673 3452 1.669 0.158 0.028 0.053 0.003 0.001 2673 3452 1.035 0.391 0.001 0.005 0.031 0.004 2673 3452 1.277 0.137 0.023 0.040 0.122 0.010 2673 3452 1.649 0.086 0.101 0.143 0.014 0.003 2673 3452 1.193 0.194 0.008 0.019 0.041 0.005 2673 3452 1.244 0.116 0.031 0.050 0.024 0.003 2673 3452 1.032 0.127 0.018 0.030 5.548 0.141 2577 3325 2.074 0.025 5.266 5.830 _____________________________________________________________________________________________________ NA = Not applicable Table B.11 Sampling errors for men - Rural sample: Tanzania 1999 ____________________________________________________________________________________________________ Number of cases Stan- ________________ Rela- Confidence dard Un- Weight- Design tive intervals Value error weighted ed effect error ____________ Variable (R) (SE) (N) (WN) (DEFT) (SE/R) R-2SE R+2SE ____________________________________________________________________________________________________ Urban resident No education Secondary education or more Never in union Currently in union Knowing any method Knowing any modern method Ever used any method Using any method Using any modern method Using pill Using IUD Using injectables Using condom Using female sterilisation Currently using abstinence Using withdrawal Ideal number of children 0.000 0.000 2292 2601 NA NA 0.000 0.000 0.165 0.013 2292 2601 1.628 0.077 0.140 0.190 0.036 0.004 2292 2601 1.049 0.113 0.028 0.044 0.349 0.013 2292 2601 1.307 0.037 0.323 0.375 0.600 0.015 2292 2601 1.513 0.026 0.569 0.631 0.911 0.008 2292 2601 1.388 0.009 0.894 0.927 0.903 0.007 2292 2601 1.171 0.008 0.889 0.918 0.436 0.017 2292 2601 1.594 0.038 0.403 0.469 0.260 0.014 2292 2601 1.506 0.053 0.232 0.288 0.168 0.013 2292 2601 1.674 0.078 0.142 0.195 0.030 0.004 2292 2601 1.256 0.148 0.021 0.039 0.001 0.001 2292 2601 1.357 0.741 0.000 0.004 0.028 0.005 2292 2601 1.329 0.163 0.019 0.037 0.095 0.011 2292 2601 1.840 0.119 0.072 0.117 0.014 0.003 2292 2601 1.076 0.188 0.009 0.019 0.041 0.005 2292 2601 1.323 0.134 0.030 0.051 0.028 0.004 2292 2601 1.143 0.142 0.020 0.035 6.075 0.174 2185 2500 2.135 0.029 5.727 6.422 _____________________________________________________________________________________________________ NA = Not applicable 162 * Appendix B Table B.13 Sampling errors for men - Zanzibar sample: Tanzania 1999 ____________________________________________________________________________________________________ Number of cases Stan- ________________ Rela- Confidence dard Un- Weight- Design tive intervals Value error weighted ed effect error ____________ Variable (R) (SE) (N) (WN) (DEFT) (SE/R) R-2SE R+2SE ____________________________________________________________________________________________________ Urban resident No education Secondary education or more Never in union Currently in union Knowing any method Knowing any modern method Ever used any method Using any method Using any modern method Using pill Using IUD Using injectables Using condom Using female sterilisation Currently using abstinence Using withdrawal Ideal number of children 0.356 0.032 869 90 1.951 0.089 0.293 0.420 0.176 0.014 869 90 1.052 0.077 0.148 0.203 0.341 0.019 869 90 1.174 0.055 0.303 0.379 0.406 0.018 869 90 1.071 0.044 0.371 0.442 0.549 0.016 869 90 0.922 0.028 0.518 0.581 0.962 0.006 869 90 0.992 0.007 0.949 0.975 0.962 0.006 869 90 0.992 0.007 0.949 0.975 0.289 0.016 869 90 1.011 0.054 0.258 0.320 0.164 0.011 869 90 0.897 0.069 0.142 0.187 0.113 0.008 869 90 0.780 0.074 0.097 0.130 0.043 0.005 869 90 0.788 0.126 0.032 0.054 0.002 0.001 869 90 0.927 0.717 0.000 0.005 0.014 0.002 869 90 0.600 0.172 0.009 0.019 0.052 0.006 869 90 0.765 0.110 0.041 0.064 0.002 0.002 869 90 1.010 0.729 0.000 0.005 0.028 0.005 869 90 0.923 0.184 0.018 0.038 0.017 0.004 869 90 0.815 0.207 0.010 0.025 8.056 0.408 802 83 2.090 0.051 7.240 8.871 _____________________________________________________________________________________________________ NA = Not applicable Table B.14 Sampling errors for men - Pemba sample: Tanzania 1999 ____________________________________________________________________________________________________ Number of cases Stan- ________________ Rela- Confidence dard Un- Weight- Design tive intervals Value error weighted ed effect error ____________ Variable (R) (SE) (N) (WN) (DEFT) (SE/R) R-2SE R+2SE ____________________________________________________________________________________________________ Urban resident No education Secondary education or more Never in union Currently in union Knowing any method Knowing any modern method Ever used any method Using any method Using any modern method Using pill Using IUD Using injectables Using condom Using female sterilisation Currently using abstinence Using withdrawal Ideal number of children 0.151 0.020 316 36 0.985 0.132 0.111 0.190 0.262 0.024 316 36 0.966 0.091 0.215 0.310 0.306 0.030 316 36 1.159 0.098 0.246 0.366 0.353 0.032 316 36 1.204 0.092 0.288 0.418 0.619 0.027 316 36 0.986 0.044 0.565 0.673 0.954 0.011 316 36 0.945 0.012 0.932 0.977 0.954 0.011 316 36 0.945 0.012 0.932 0.977 0.171 0.018 316 36 0.836 0.104 0.136 0.207 0.099 0.011 316 36 0.626 0.107 0.078 0.120 0.037 0.005 316 36 0.430 0.124 0.028 0.046 0.014 0.006 316 36 0.861 0.404 0.003 0.026 0.003 0.003 316 36 0.910 1.010 0.000 0.008 0.005 0.001 316 36 0.168 0.132 0.004 0.006 0.010 0.007 316 36 1.197 0.688 0.000 0.023 0.006 0.004 316 36 1.016 0.764 0.000 0.014 0.036 0.010 316 36 0.996 0.289 0.015 0.057 0.017 0.005 316 36 0.694 0.294 0.007 0.028 10.791 0.647 288 33 1.815 0.060 9.497 12.085 _____________________________________________________________________________________________________ NA = Not applicable Appendix B * 163 Table B.15 Sampling errors for men - Unguja sample: Tanzania 1999 ____________________________________________________________________________________________________ Number of cases Stan- ________________ Rela- Confidence dard Un- Weight- Design tive intervals Value error weighted ed effect error ____________ Variable (R) (SE) (N) (WN) (DEFT) (SE/R) R-2SE R+2SE ____________________________________________________________________________________________________ Urban resident No education Secondary education or more Never in union Currently in union Knowing any method Knowing any modern method Ever used any method Using any method Using any modern method Using pill Using IUD Using injectables Using condom Using female sterilisation Currently using abstinence Using withdrawal Ideal number of children 0.490 0.039 553 55 1.835 0.080 0.412 0.568 0.119 0.015 553 55 1.117 0.129 0.088 0.150 0.363 0.025 553 55 1.224 0.069 0.313 0.413 0.441 0.017 553 55 0.801 0.038 0.407 0.475 0.504 0.016 553 55 0.743 0.031 0.472 0.535 0.967 0.008 553 55 1.046 0.008 0.951 0.983 0.967 0.008 553 55 1.046 0.008 0.951 0.983 0.365 0.020 553 55 0.984 0.055 0.325 0.406 0.207 0.016 553 55 0.927 0.077 0.175 0.239 0.163 0.012 553 55 0.734 0.071 0.140 0.186 0.062 0.008 553 55 0.761 0.126 0.046 0.077 0.002 0.002 553 55 0.925 1.015 0.000 0.005 0.020 0.004 553 55 0.632 0.191 0.012 0.027 0.080 0.008 553 55 0.717 0.103 0.064 0.097 0.000 0.000 553 55 NA NA 0.000 0.000 0.023 0.005 553 55 0.838 0.234 0.012 0.033 0.018 0.005 553 55 0.891 0.284 0.008 0.028 6.298 0.229 514 51 1.196 0.036 5.841 6.756 _____________________________________________________________________________________________________ NA = Not applicable Appendix C * 165 Table C.1 Household age distribution Single-year age distribution of the de facto household population by sex (weighted), Tanzania 1999 __________________________________________________________________________________________________ Males Females Males Females ________________ ________________ ______________ ________________ Age Number Percent Number Percent Age Number Percent Number Percent __________________________________________________________________________________________________ 0 320 3.8 353 3.8 1 334 4.0 261 2.8 2 302 3.6 288 3.1 3 264 3.2 296 3.2 4 291 3.5 298 3.2 5 275 3.3 286 3.1 6 324 3.9 251 2.7 7 284 3.4 296 3.2 8 297 3.5 286 3.1 9 266 3.2 285 3.1 10 255 3.1 244 2.6 11 210 2.5 239 2.6 12 277 3.3 256 2.8 13 269 3.2 250 2.7 14 186 2.2 197 2.1 15 199 2.4 212 2.3 16 172 2.1 213 2.3 17 150 1.8 197 2.1 18 126 1.5 147 1.6 19 171 2.0 163 1.8 20 167 2.0 188 2.0 21 92 1.1 155 1.7 22 99 1.2 186 2.0 23 118 1.4 153 1.7 24 96 1.1 156 1.7 25 143 1.7 188 2.0 26 99 1.2 149 1.6 27 108 1.3 148 1.6 28 87 1.0 131 1.4 29 119 1.4 133 1.4 30 105 1.2 146 1.6 31 79 0.9 104 1.1 32 66 0.8 79 0.9 33 69 0.8 94 1.0 34 67 0.8 89 1.0 35 122 1.5 143 1.5 36 75 0.9 86 0.9 37 74 0.9 82 0.9 38 80 1.0 88 1.0 39 92 1.1 69 0.7 40 81 1.0 97 1.1 41 40 0.5 58 0.6 42 45 0.5 57 0.6 43 31 0.4 42 0.5 44 33 0.4 33 0.4 45 78 0.9 78 0.8 46 34 0.4 50 0.5 47 61 0.7 72 0.8 48 39 0.5 58 0.6 49 55 0.7 51 0.6 50 68 0.8 43 0.5 51 39 0.5 51 0.6 52 33 0.4 96 1.0 53 42 0.5 61 0.7 54 34 0.4 51 0.6 55 37 0.4 73 0.8 56 29 0.3 61 0.7 57 40 0.5 26 0.3 58 37 0.4 43 0.5 59 24 0.3 15 0.2 60 32 0.4 92 1.0 61 20 0.2 29 0.3 62 57 0.7 49 0.5 63 25 0.3 28 0.3 64 27 0.3 13 0.1 65 56 0.7 61 0.7 66 35 0.4 17 0.2 67 32 0.4 14 0.2 68 35 0.4 33 0.4 69 26 0.3 19 0.2 70+ 214 2.6 187 2.0 Don’t know, missing 1 0.0 1 0.0 Total 8,366 100.0 9,242 100.0 DATA QUALITY TABLES APPENDIX C 166 * Appendix C Table C.2 Age distribution of eligible and interviewed women Percent distribution of the de facto household population of women age 10-54, and of interviewed women age 15-49, and of interviewed women age 15-49, and percentage of eligible women who were interviewed (weighted) by five-year groups, Tanzania 1999 ______________________________________________________________ Household population Percentage of women Interviewed women of eligible age 10-54 age 15-49 women __________________ ________________ interviewed Number Percent Number Percent (weighted) ______________________________________________________________ 10-14 1,185 NA NA NA NA 15-19 931 22.7 906 22.6 97.3 20-24 838 20.5 817 20.3 97.5 25-29 749 18.3 740 18.4 98.9 30-34 511 12.5 504 12.5 98.5 25-39 468 11.4 463 11.5 98.9 40-44 287 7.0 283 7.0 98.5 45-49 310 7.6 302 7.5 97.7 50-54 302 NA NA NA NA 15-49 4,095 NA 4,017 NA 98.1 ______________________________________________________________ Note: The de facto population includes all residents and nonresidents who slept in the household the night before the interview. NA = Not applicable Table C.3 Completeness of reporting Percentage of observations missing information for selected demographic and health questions, Tanzania 1999 __________________________________________________________________________ Percentage Number missing of Subject Reference group information cases __________________________________________________________________________ Birth Date Births in past 15 years Month only 2.94 8,372 Month and year 0.00 8,372 Age at death Deaths to births in past 15 years 0.00 1,281 Age at/date of first union 1 Ever-married women 0.34 3,086 Respondent’s education All women 0.00 4,029 Height or weight missing Children under 5 in household 2.2 2,990 Diarrhoea in last 2 weeks Living children 0-59 months 4.85 2,898 ________________________________________________________________________ 1 Both year and age missing $SSHQGL[�&�� ����� &�� ��% LUWK V�E \�F DOH QG DU� \H DUV 'L VWU LEX WLR Q�R I�E LUWK V�E \�F DOH QG DU� \H DUV �IR U�OL YLQ J�� /�� �GH DG 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BB BB BB BB BB BB BB BB BB BB BB 1$ � �1 RW� DS SOL FDE OH � �% RWK �\H DU� DQ G�P RQ WK� RI� ELU WK� JLY HQ � ��% P�% I� �� ��� ZK HUH �% P �DQ G�% I�DU H�W KH �QX PE HUV �RI �P DOH �DQ G�I HP DOH �EL UWK V��U HVS HF WLY HO\ � �>� % [� �% [ ��� % [� ��@ �� ��� ZK HUH �% [ �LV� WKH �QX PE HU� RI� ELU WKV �LQ �FD OHQ GD U�\ HD U�[ 168 * Appendix C Table C.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 preceding the survey, Tanzania 1999 ________________________________________________________________ Number of years preceding survey Age at death _________________________________ Total (in days) 0-4 5-9 10-14 15-19 0-19 _______________________________________________________________ <1 39 51 14 14 118 1 26 21 6 24 77 2 10 14 3 4 31 3 11 8 1 3 24 4 1 3 0 1 6 5 1 2 2 2 8 6 1 5 6 1 13 7 13 19 9 10 51 8 0 1 5 1 7 9 2 0 2 2 6 10 0 1 1 0 1 12 0 2 1 0 3 13 2 0 0 0 2 14 12 9 9 3 33 16 0 1 0 0 1 17 0 0 1 0 1 19 0 1 0 0 1 20 2 0 0 0 2 21 8 6 2 2 18 22 0 1 0 0 1 23 0 0 1 0 1 26 1 0 0 0 1 28 0 4 1 3 8 29 0 1 1 0 2 30 6 11 5 1 24 31+ 0 1 0 0 1 Total 0-30 137 161 70 72 440 Percent early neonatal1 65.3 65.1 47.9 68.3 62.9 _______________________________________________________________ 1 (0-6 days/0-3 days) * 100 Appendix C * 169 Table C.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 preceding the survey, Tanzania 1999 _____________________________________________________________ Number of years preceding the survey Age at deaths _______________________________ Total (in months) 0-4 5-9 10-14 15-19 0-19 _____________________________________________________________ <1 a 137 161 70 72 440 1 14 13 13 11 51 2 25 26 15 12 78 3 11 24 29 12 76 4 17 18 8 12 55 5 14 21 14 8 57 6 26 32 32 15 105 7 8 22 13 8 52 8 15 12 10 10 46 9 17 12 20 10 58 10 7 2 4 3 16 11 8 6 5 5 24 12 16 36 27 25 105 13 8 4 0 2 14 14 5 4 5 1 15 15 2 4 3 6 15 16 4 3 3 0 10 17 1 2 0 2 6 18 4 7 7 5 24 19 5 1 5 0 11 20 0 1 0 2 3 21 1 0 1 2 4 22 1 1 1 1 4 23 1 1 0 0 2 1 year 0 4 2 1 7 Percent neonatal b 45.8 46.4 30.1 40.5 41.7 Total 0-11 299 348 232 178 1,057 _____________________________________________________________ a Includes deaths under 1 month reported in days. b Under 1 month/under 1 year Appendix D * 171 1999 TRCHS HOUSEHOLD SURVEY STAFF APPENDIX D 1. Dodoma, Singida, and Morogoro Philemon Mahimbo (Supervisor) Yohana Sehaba (Editor) Rehema Mginah Rhobi Kenyunka Fatuma Bwanga Devota Kanani Mary Nchimbi Anna Temu Nuru Almasi Hassan Mteka (Driver) 2. Kilimanjaro, Tanga, and Arusha Gregory Milliga (Supervisor) Leonce Bureta (Editor) Rose Maggie Mercy Mamuya Judith Mtunguja Asha Kimaro Biseti Masudi Victoria Maumba Sifael Masawe Elias Sihika (Driver) 3. Lindi, Mtwara and Ruvuma V. Tesha (Supervisor) M. Mkwavira Student Magomba (Editor) Beatrix Mnegela Rita Chowo Anna Ngaiwa Agness Mahabuki Marry Chambo Gladness Komba Fadhili Magwaja (Driver) 4. Mbeya, Iringa, and Rukwa Mrs. A. Komba (Supervisor) E. Mwinuka (Editor) Hyasinta Chizi M. Mtokambali Elina Malila Agatha Yona Eveline Chimanga Elizabeth Kibishi Titus Mtorangu David Mwaisenye (Driver) 5. Mara, Shinyanga, and Mwanza I. Massanja (Supervisor) Fred Matola (Editor) James Msolomi Concessa Nsanze Dorah Mutase Feliciana Tegete Rosemary Machaka Labbi Magesse Josephine Mathias Ahmad Ngao (Driver) 6. Tabora, Kagera, and Kigoma L. Gambamala (Supervisor) E. Mashenene (Editor) Gosa Kisalamba Mary Nsalamba Hyasinta Makono Magdalena Mutayoba Scholastika Baliga Filigona Bilango Sibia Mutani Simon Milanzi (Driver) 7. Dar es Salaam, Pwani I. Ruyobya (Supervisor) E. Sekwao (Editor) Fabian Tumai S. Jolinga Zaina Ngongi Margaret Luhindila Lina Kinabo Felista Mapunda Beatrice Justine Abdallah Mninge (Driver) Quality Control Ms. A Chuwa (Supervisor) G. Mariki Tetwigis Kapinga Ritha Kileo Venance Kamugisha (Driver) 172 * Appendix D Unguja Mbwana O. Mbwana (Supervisor) Mayasa M. Mwinyi (Editor) Maulid Saleh Fatma Hassan Saleh Khadija Ali Juma Jina Yussf Haji Amina Seyyum Ali Asha Masoud Mohamed Asha Mohamed Ali Juma Ame Juma (Driver) Pemba Omari Salim Salahi (Supervisor) Haroub Ali Masoud (Editor) Khamis J. Saleh Fatma K.H. Issa Khadija A. Omar Mgeni Mahfoudh Mwinyi Rehema Haji Makame Azia Ali Suleiman Rahina Seif Masoud Ali Rahim Khalfan (Driver) Data Processing Joshua Mwaisemba (Supervisor) David Danda (Supervisor) Brown Simon (Editor) Kazi Muhudini Sekela Kasunga Rehema Ramadhani Jane Msoma Catherine Nditi Kalimerita Kaoma Renifrida Chidengi Njili Kajakeli S.M. Aboud Abdallah Maumba (Driver) Macro International Inc. Anne R. 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'$7(��BBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBB (',725¶6�2%6(59$7,216 1$0(�2)�(',725�BBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBB � '$7(��BBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBB Front Matter Title Page Citation Page Table of Contents Tables and Figures Foreword Summary of Findings 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 - Reproductive and Child Health Chapter 9 - Infant Feeding and Childhood Nutrition Chapter 10 - Knowledge of AIDS References Appendix A - Sample Implementation Appendix B - Estimates of Sampling Errors Appendix C - Data Quality Tables Appendix D - 1999 TRCHS Household Survey Staff Appendix E - Questionnaires Household Questionnaire Woman's Questionnaire Man's Questionnaire

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