The Gambia - Demographic and Health Survey - 2014

Publication date: 2014

The Gambia Demographic and Health Survey 2013 The G am bia 2013 D em ographic and H ealth Survey Republic of The Gambia The Gambia Demographic and Health Survey 2013 Gambia Bureau of Statistics Banjul, The Gambia ICF International Rockville, Maryland USA September 2014 The Global Fund To Fight AIDS, Tuberculosis and Malaria REPUBLIC OF THE GAMBIA This report summarizes the findings of the 2013 Gambia Demographic and Health Survey (GDHS) carried out by The Gambia Bureau of Statistics (GBOS). The survey was funded by the government of The Gambia, the US Agency for International Development (USAID), the United Nations Population Fund (UNFPA), the United Nations Development Program (UNDP), the United Nations Children’s Fund (UNICEF), the Joint United Nations Programme on HIV/AIDS (UNAIDS), the World Health Organization (WHO), and the Global Fund. ICF International provided technical assistance through its MEASURE DHS program, which is designed to collect data on fertility, family planning, maternal and child health, maternal mortality, and domestic violence. Additional information about The Gambia DHS survey may be obtained from The Gambia Bureau of Statistics, Kanifing Institutional Layout, PO Box 3504, Serrekunda, The Gambia; Telephone: (220) 437-7847; Fax: (220) 437-7848/437-7917. Information about the DHS Program may be obtained from ICF International, 530 Gaither Road, Suite 500, Rockville, MD 20850-5971, USA; Telephone: +1-301-407-6500; Fax: +1-301-407-6501; Email: reports@DHSprogram.com; Internet: www.DHSprogram.com. Cover photo of two bearded barbets ©2012 Alastair Stewart, used with permission. Cover photo of the Gambia River ©2011 Ardjan van der Blonk, used with permission. Suggested citation: The Gambia Bureau of Statistics (GBOS) and ICF International. 2014. The Gambia Demographic and Health Survey 2013. Banjul, The Gambia, and Rockville, Maryland, USA: GBOS and ICF International. Contents • iii CONTENTS TABLES AND FIGURES . ix FOREWORD . xv MILLENNIUM DEVELOPMENT GOAL INDICATORS . xvii MAP OF THE GAMBIA . xviii 1 INTRODUCTION . 1 1.1 History, Geography, and Economy . 1 1.1.1 History . 1 1.1.2 Geography . 1 1.1.3 Economy . 2 1.2 Population . 2 1.3 Population and Health Policies . 2 1.3.1 National Population Policy . 2 1.3.2 National Health Policy . 3 1.4 Objectives of the 2013 Gambia Demographic and Health Survey . 3 1.5 Organisation of the Survey . 4 1.6 Sample Design . 4 1.7 Questionnaires . 5 1.8 Listing, Pretest, Main Training, Fieldwork, and Data Processing . 6 1.8.1 Listing . 6 1.8.2 Pretest and Main Training . 7 1.8.3 Fieldwork . 7 1.8.4 Data Processing . 7 1.9 Anthropometry, Anaemia, Malaria, and HIV Testing . 8 1.9.1 Height and Weight Measurements . 8 1.9.2 Anaemia Testing . 8 1.9.3 Malaria Testing . 8 1.9.4 HIV Testing . 8 1.10 Response Rates . 9 2 HOUSING CHARACTERISTICS AND HOUSEHOLD POPULATION . 11 2.1 Household Characteristics . 11 2.1.1 Drinking Water . 11 2.1.2 Household Sanitation Facilities . 13 2.1.3 Housing Characteristics . 14 2.1.4 Household Possessions . 15 2.2 Wealth Index . 16 2.3 Hand Washing . 17 2.4 Population by Age and Sex . 18 2.5 Household Composition . 20 2.6 Birth Registration . 20 2.7 Children’s Living Arrangements and Parental Survival . 21 2.8 Education of the Household Population . 23 2.8.1 School Attendance by Survivorship of Parents . 23 2.8.2 Educational Attainment . 24 2.8.3 School Attendance Ratios . 27 2.9 Disability . 29 iv • Contents 3 CHARACTERISTICS OF RESPONDENTS . 31 3.1 Characteristics of Survey Respondents . 31 3.2 Educational Attainment by Background Characteristics . 33 3.3 Literacy . 35 3.4 Access to Mass Media . 36 3.5 Employment . 38 3.6 Occupation . 41 3.7 Health Insurance Coverage . 44 3.9 Smoking . 46 4 MARRIAGE AND SEXUAL ACTIVITY . 49 4.1 Current Marital Status . 49 4.2 Polygyny . 50 4.3 Age at First Marriage . 52 4.4 Age at First Sexual Intercourse . 53 4.5 Recent Sexual Activity . 54 5 FERTILITY LEVELS, TRENDS, AND DIFFERENTIALS . 59 5.1 Introduction . 59 5.2 Current Fertility . 59 5.3 Fertility Trends . 61 5.4 Children Ever Born and Children Surviving . 61 5.5 Birth Intervals . 63 5.6 Postpartum Amenorrhoea, Abstinence, and Insusceptibility . 64 5.7 Menopause . 65 5.8 Age at First Birth . 65 5.9 Teenage Fertility . 66 6 FERTILITY PREFERENCES . 69 6.1 Desire for More Children . 69 6.2 Desire to Limit Childbearing by Background Characteristics. 70 6.3 Ideal Number of Children . 71 6.4 Mean Ideal Number of Children by Background Characteristics . 73 6.5 Fertility Planning Status . 73 6.6 Wanted Fertility Rates . 74 7 FAMILY PLANNING . 75 7.1 Knowledge of Contraceptive Methods . 75 7.2 Knowledge of Contraceptive Methods by Background Characteristics . 77 7.3 Current Use of Contraceptive Methods . 78 7.4 Differentials in Contraceptive Use by Background Characteristics . 80 7.5 Source of Contraception . 80 7.6 Brands of Pills Used and Informed Choice . 81 7.7 Contraceptive Discontinuation . 82 7.8 Knowledge of the Fertile Period . 84 7.9 Need for Family Planning Services . 84 7.10 Future Use of Contraception . 87 7.11 Exposure to Family Planning Messages in the Media. 87 7.12 Contact of Nonusers with Family Planning Providers . 89 8 INFANT AND CHILD MORTALITY . 91 8.1 Assessment of Data Quality . 92 8.2 Levels and Trends in Infant and Child Mortality . 93 8.2.1 Early Childhood Mortality Rates . 93 8.2.2 Trends in Early Childhood Mortality . 93 8.3 Early Childhood Mortality Rates by Socioeconomic Characteristics . 94 8.4 Demographic Differentials in Early Childhood Mortality . 94 8.5 Perinatal Mortality . 95 8.6 High-Risk Fertility Behaviour . 97 Contents • v 9 REPRODUCTIVE HEALTH . 99 9.1 Antenatal Care . 99 9.1.1 Number and Timing of Antenatal Visits . 100 9.1.2 Components of Antenatal Care . 101 9.1.3 Tetanus Toxoid Injections . 102 9.2 Delivery . 103 9.2.1 Place of Delivery . 103 9.2.2 Assistance during Delivery . 104 9.3 Postnatal Care . 106 9.3.1 Timing of First Postnatal Checkup for the Mother . 106 9.3.2 Type of Provider of First Postnatal Checkup for the Mother . 107 9.3.3 Timing of First Postnatal Checkup for the Newborn . 108 9.3.4 Type of Provider of First Postnatal Checkup for the Newborn . 109 9.4 Problems in Accessing Health Care . 110 10 CHILD HEALTH . 113 10.1 Child’s Size at Birth . 113 10.2 Vaccination Coverage . 115 10.2.1 Vaccination Coverage by Background Characteristics . 116 10.3 Trends in Vaccination Coverage . 117 10.4 Acute Respiratory Infection . 117 10.5 Fever . 119 10.6 Diarrhoeal Disease . 120 10.6.1 Prevalence of Diarrhoea . 120 10.6.2 Treatment of Diarrhoea . 121 10.6.3 Feeding Practices during Diarrhoea . 123 10.7 Knowledge of ORS Packets . 125 10.8 Stool Disposal . 125 11 NUTRITION OF WOMEN AND CHILDREN . 127 11.1 Nutritional Status of Children . 128 11.1.1 Measurement of Nutritional Status among Young Children . 128 11.1.2 Data Collection . 129 11.1.3 Levels of Child Malnutrition . 129 11.2 Initiation of Breastfeeding . 131 11.3 Breastfeeding Status by Age . 133 11.4 Duration of Breastfeeding . 135 11.5 Types of Complementary Foods . 135 11.6 Infant and Young Child Feeding Practices . 136 11.7 Prevalence of Anaemia in Children . 139 11.8 Micronutrient Intake among Children . 140 11.9 Nutritional Status of Women . 143 11.10 Prevalence of Anaemia in Women . 144 11.11 Micronutrient Intake among Mothers . 145 12 MALARIA . 149 12.1 Ownership of Mosquito Nets . 150 12.2 Indoor Residual Spraying . 153 12.3 Access to an Insecticide-Treated Net (ITN) . 154 12.4 Use of Mosquito Nets . 155 12.4.1 Use of Mosquito Nets by Persons in the Household . 155 12.4.2 Use of Existing Mosquito Nets . 157 12.4.3 Use of Mosquito Nets by Children Under Age 5 . 158 12.4.4 Use of Mosquito Nets by Pregnant Women . 159 12.5 Use of Intermittent Preventive Treatment of Malaria during Pregnancy . 160 12.6 Prevalence, Diagnosis, and Prompt Treatment of Children with Fever . 161 12.7 Prevalence of Low Haemoglobin in Children . 164 12.8 Prevalence of Malaria in Children . 164 vi • Contents 13 HIV- AND AIDS-RELATED KNOWLEDGE, ATTITUDES, AND BEHAVIOUR . 167 13.1 Knowledge of AIDS and of HIV Prevention Methods . 167 13.2 Comprehensive Knowledge about AIDS . 169 13.3 Knowledge of Prevention of Mother-to-Child Transmission of HIV . 172 13.4 Attitudes towards Those Living with HIV and AIDS . 173 13.5 Attitudes towards Negotiating Safer Sex . 175 13.6 Adult Support for Education about Condom Use . 176 13.7 Higher-Risk Sex . 177 13.7.1 Multiple Sexual Partners . 177 13.7.2 Point Prevalence . 179 13.7.3 Payment for Sex . 180 13.8 Coverage of HIV Testing and Counselling . 181 13.9 HIV Testing during Antenatal Care . 183 13.10 Self-Reported Sexually Transmitted Infections . 185 13.11 Prevalence of Medical Injections . 186 13.12 HIV- and AIDS-Related Knowledge and Behaviour among Youth . 187 13.12.1 Knowledge about HIV and AIDS and of Sources for Condoms . 188 13.12.2 Age at First Sexual Intercourse among Youth . 189 13.12.3 Premarital Sex . 190 13.12.4 Multiple Sexual Partners among Youth . 190 13.12.5 Age Mixing in Sexual Relationships among Young Women Age 15-19 . 190 13.12.6 Recent HIV Tests among Youth . 191 14 HIV PREVALENCE . 193 14.1 Coverage Rates for HIV Testing . 193 14.2 HIV Prevalence . 196 14.2.1 HIV Prevalence by Age and Sex . 196 14.2.2 HIV Prevalence by Socioeconomic Characteristics . 196 14.2.3 HIV Prevalence by Demographic Characteristics. 197 14.2.4 HIV Prevalence by Sexual Behaviour . 198 14.3 HIV Prevalence among Young People . 200 14.4 HIV Prevalence by Other Characteristics Related to HIV Risk . 201 14.5 HIV Prevalence among Couples . 202 15 WOMEN’S EMPOWERMENT AND DEMOGRAPHIC AND HEALTH OUTCOMES . 205 15.1 Women’s and Men’s Employment . 206 15.2 Women’s Control over their Own Earnings and Relative Magnitude of Women’s Earnings . 207 15.3 Ownership of Assets . 210 15.4 Women’s Participation in Household Decision Making . 212 15.5 Attitudes towards Wife Beating . 214 15.6 Women’s Empowerment Indicators . 216 15.7 Current Use of Contraception by Women’s Empowerment Status . 217 15.8 Ideal Family Size and Unmet Need by Women’s Status . 218 15.9 Women’s Status and Reproductive Health Care . 219 15.10 Differentials in Infant and Child Mortality by Women’s Status . 219 15.11 Female Genital Cutting . 220 15.11.1 Knowledge of Female Genital Cutting . 220 15.11.2 Prevalence of Female Genital Cutting . 221 15.11.3 Attitudes towards Female Genital Cutting . 223 16 DOMESTIC VIOLENCE . 225 16.1 Valid Measures of Domestic Violence . 226 16.1.1 Use of Valid Measures of Violence . 226 16.1.2 Ethical Considerations in the 2013 GDHS . 227 16.1.3 Sample for the Violence Module . 227 16.2 Women Experiencing Physical Violence . 227 16.3 Persons Committing Physical Violence . 229 16.4 Experience of Sexual Violence . 229 16.5 Persons Committing Sexual Violence . 231 Contents • vii 16.6 Age at First Experience of Sexual Violence . 231 16.7 Experience of Different Forms of Violence . 231 16.8 Violence during Pregnancy . 232 16.9 Marital Control by Husband. 232 16.10 Experience of Spousal Violence . 234 16.11 Spousal Violence by Background Characteristics . 235 16.12 Spousal Violence by Husband’s Characteristics and Women’s Empowerment Indicators . 236 16.13 Recent Physical or Sexual Violence by Any Husband or Partner . 237 16.14 Experience of Spousal Violence by Duration of Marriage . 238 16.15 Physical Consequences of Spousal Violence . 238 16.16 Women’s Violence Against Their Husbands . 239 16.17 Help-Seeking Behaviour by Women Who Experience Violence . 241 16.18 Sources of Help to Stop Violence . 242 17 ADULT AND MATERNAL MORTALITY . 243 17.1 Assessment of Data Quality . 243 17.2 Estimates of Adult Mortality . 244 17.3 Estimates of Maternal Mortality . 245 REFERENCES . 247 APPENDIX A SAMPLE DESIGN . 251 APPENDIX B ESTIMATES OF SAMPLING ERRORS . 263 APPENDIX C DATA QUALITY TABLES . 279 APPENDIX D PARTICIPANTS IN THE 2013 GAMBIA DEMOGRAPHIC AND HEALTH SURVEY . 287 APPENDIX E QUESTIONNAIRES . 293 Tables and Figures • ix TABLES AND FIGURES 1 INTRODUCTION . 1 Table 1.1 Basic demographic indicators . 2 Table 1.2 Results of the household and individual interviews . 10 2 HOUSING CHARACTERISTICS AND HOUSEHOLD POPULATION . 11 Table 2.1 Household drinking water . 12 Table 2.2 Household sanitation facilities . 13 Table 2.3 Household characteristics . 14 Table 2.4 Household possessions . 16 Table 2.5 Wealth quintiles . 17 Table 2.6 Hand washing . 18 Table 2.7 Household population by age, sex, and residence . 19 Table 2.8 Household composition . 20 Table 2.9 Birth registration of children under age 5 . 21 Table 2.10 Children’s living arrangements and orphanhood . 22 Table 2.11 School attendance by survivorship of parents . 23 Table 2.12.1 Educational attainment of the female household population . 25 Table 2.12.2 Educational attainment of the male household population . 26 Table 2.13 School attendance ratios . 27 Table 2.14 Prevalence of physical disability . 30 Figure 2.1 Population pyramid . 19 Figure 2.2 Age-specific attendance rates . 29 3 CHARACTERISTICS OF RESPONDENTS . 31 Table 3.1 Background characteristics of respondents . 32 Table 3.2.1 Educational attainment: Women . 33 Table 3.2.2 Educational attainment: Men . 34 Table 3.3.1 Literacy: Women . 35 Table 3.3.2 Literacy: Men . 36 Table 3.4.1 Exposure to mass media: Women . 37 Table 3.4.2 Exposure to mass media: Men . 38 Table 3.5.1 Employment status: Women . 40 Table 3.5.2 Employment status: Men . 41 Table 3.6.1 Occupation: Women . 42 Table 3.6.2 Occupation: Men . 43 Table 3.7 Type of employment: Women . 44 Table 3.8.1 Health insurance coverage: Women . 45 Table 3.8.2 Health insurance coverage: Men . 45 Table 3.9 Use of tobacco: Men . 47 Figure 3.1 Women’s employment status in the past 12 months . 39 4 MARRIAGE AND SEXUAL ACTIVITY . 49 Table 4.1 Current marital status . 50 Table 4.2.1 Number of women’s co-wives . 51 Table 4.2.2 Number of men’s wives . 51 Table 4.3 Age at first marriage . 52 Table 4.4 Median age at first marriage by background characteristics . 53 x • Tables and Figures Table 4.5 Age at first sexual intercourse . 54 Table 4.6 Median age at first sexual intercourse by background characteristics . 54 Table 4.7.1 Recent sexual activity: Women . 55 Table 4.7.2 Recent sexual activity: Men . 56 5 FERTILITY LEVELS, TRENDS, AND DIFFERENTIALS . 59 Table 5.1 Current fertility . 60 Table 5.2 Fertility by background characteristics . 60 Table 5.3 Trends in age-specific fertility rates . 61 Table 5.4 Children ever born and living . 62 Table 5.5 Birth intervals . 63 Table 5.6 Postpartum amenorrhoea, abstinence, and insusceptibility . 64 Table 5.7 Median duration of amenorrhoea, postpartum abstinence, and postpartum insusceptibility . 65 Table 5.8 Menopause . 65 Table 5.9 Age at first birth . 66 Table 5.10 Median age at first birth . 66 Table 5.11 Teenage pregnancy and motherhood . 67 6 FERTILITY PREFERENCES . 69 Table 6.1 Fertility preferences by number of living children . 70 Table 6.2.1 Desire to limit childbearing: Women . 71 Table 6.2.2 Desire to limit childbearing: Men . 71 Table 6.3 Ideal number of children by number of living children . 72 Table 6.4 Mean ideal number of children . 73 Table 6.5 Fertility planning status . 74 Table 6.6 Wanted fertility rates . 74 7 FAMILY PLANNING . 75 Table 7.1 Knowledge of contraceptive methods . 76 Table 7.2 Knowledge of contraceptive methods by background characteristics . 77 Table 7.3 Current use of contraception by age . 79 Table 7.4 Current use of contraception by background characteristics . 80 Table 7.5 Source of modern contraception methods . 81 Table 7.6 Informed choice . 82 Table 7.7 Twelve-month contraceptive discontinuation rates . 83 Table 7.8 Reasons for discontinuation . 84 Table 7.9 Knowledge of fertile period . 84 Table 7.10 Need and demand for family planning among currently married women . 86 Table 7.11 Future use of contraception . 87 Table 7.12 Exposure to family planning messages . 88 Table 7.13 Contact of nonusers with family planning providers . 89 8 INFANT AND CHILD MORTALITY . 91 Table 8.1 Early childhood mortality rates . 93 Table 8.2 Early childhood mortality rates by socioeconomic characteristics . 94 Table 8.3 Early childhood mortality rates by demographic characteristics . 95 Table 8.4 Perinatal mortality . 96 Table 8.5 High-risk fertility behaviour . 97 Tables and Figures • xi 9 REPRODUCTIVE HEALTH . 99 Table 9.1 Antenatal care . 100 Table 9.2 Number of antenatal care visits and timing of first visit . 101 Table 9.3 Components of antenatal care . 102 Table 9.4 Tetanus toxoid injections . 103 Table 9.5 Place of delivery . 104 Table 9.6 Assistance during delivery . 105 Table 9.7 Timing of first postnatal checkup . 107 Table 9.8 Type of provider of first postnatal checkup for the mother . 108 Table 9.9 Timing of first postnatal checkup for the newborn . 109 Table 9.10 Type of provider of first postnatal checkup for the newborn . 110 Table 9.11 Problems in accessing health care . 111 Figure 9.1 Mother’s duration of stay in the health facility after giving birth . 106 10 CHILD HEALTH . 113 Table 10.1 Child’s size and weight at birth. 114 Table 10.2 Vaccinations by source of information . 115 Table 10.3 Vaccinations by background characteristics . 116 Table 10.4 Vaccinations in first year of life . 117 Table 10.5 Prevalence and treatment of symptoms of ARI . 118 Table 10.6 Prevalence and treatment of fever . 119 Table 10.7 Prevalence of diarrhoea . 120 Table 10.8 Diarrhoea treatment . 122 Table 10.9 Feeding practices during diarrhoea . 124 Table 10.10 Knowledge of ORS packets or pre-packaged liquids. 125 Table 10.11 Disposal of children’s stools . 126 11 NUTRITION OF WOMEN AND CHILDREN . 127 Table 11.1 Nutritional status of children . 130 Table 11.2 Initial breastfeeding . 132 Table 11.3 Breastfeeding status by age . 133 Table 11.4 Median duration of breastfeeding . 135 Table 11.5 Foods and liquids consumed by children in the day or night preceding the interview . 136 Table 11.6 Infant and young child feeding (IYCF) practices . 138 Table 11.7 Prevalence of anaemia in children . 140 Table 11.8 Micronutrient intake among children . 141 Table 11.9 Presence of iodised salt in household . 143 Table 11.10 Nutritional status of women . 144 Table 11.11 Prevalence of anaemia in women . 145 Table 11.12 Micronutrient intake among mothers . 147 Figure 11.1 Nutritional status of children by age . 131 Figure 11.2 Infant feeding practices by age . 134 Figure 11.3 IYCF indicators on breastfeeding status . 135 12 MALARIA . 149 Table 12.1 Household possession of mosquito nets . 152 Table 12.2 Indoor residual spraying against mosquitoes . 153 Table 12.3 Access to an insecticide-treated net (ITN) . 154 Table 12.4 Use of mosquito nets by persons in the household . 156 Table 12.5 Use of existing ITNs . 157 xii • Tables and Figures Table 12.6 Use of mosquito nets by children . 159 Table 12.7 Use of mosquito nets by pregnant women . 160 Table 12.8 Use of Intermittent Preventive Treatment (IPTp) by women during pregnancy . 161 Table 12.9 Prevalence, diagnosis, and prompt treatment of children with fever . 162 Table 12.10 Source of advice or treatment for children with fever . 163 Table 12.11 Haemoglobin <8.0 g/dl in children . 164 Table 12.12 Coverage of malaria testing among children by background characteristics . 165 Table 12.13 Prevalence of malaria in children . 166 Figure 12.1 Percentage of the de facto population with access to an ITN in the household . 155 Figure 12.2 Ownership of, access to, and use of ITNs . 157 13 HIV- AND AIDS-RELATED KNOWLEDGE, ATTITUDES, AND BEHAVIOUR . 167 Table 13.1 Knowledge of AIDS . 168 Table 13.2 Knowledge of HIV prevention methods . 169 Table 13.3.1 Comprehensive knowledge about AIDS: Women . 170 Table 13.3.2 Comprehensive knowledge about AIDS: Men . 171 Table 13.4 Knowledge of prevention of mother-to-child transmission of HIV . 172 Table 13.5.1 Accepting attitudes towards those living with HIV/AIDS: Women . 173 Table 13.5.2 Accepting attitudes towards those living with HIV/AIDS: Men . 174 Table 13.6 Attitudes toward negotiating safer sexual relations with husband . 175 Table 13.7 Adult support of education about condom use to prevent AIDS . 176 Table 13.8.1 Multiple sexual partners: Women . 177 Table 13.8.2 Multiple sexual partners: Men . 178 Table 13.9 Point prevalence and cumulative prevalence of concurrent sexual partners . 180 Table 13.10 Payment for sexual intercourse and condom use at last paid sexual intercourse . 181 Table 13.11.1 Coverage of prior HIV testing: Women . 182 Table 13.11.2 Coverage of prior HIV testing: Men . 183 Table 13.12 Pregnant women counselled and tested for HIV . 184 Table 13.13 Self-reported prevalence of sexually transmitted infections (STIs) and STI symptoms . 185 Table 13.14 Prevalence of medical injections . 187 Table 13.15 Comprehensive knowledge about AIDS and of a source of condoms among youth . 188 Table 13.16 Age at first sexual intercourse among young people . 189 Table 13.17 Premarital sexual intercourse and condom use during premarital sexual intercourse among youth . 190 Table 13.18 Age mixing in sexual relationships among women and men age 15-19 . 191 Table 13.19 Recent HIV tests among youth . 191 Figure 13.1 Women and men seeking treatment for STIs . 186 14 HIV PREVALENCE . 193 Table 14.1 Coverage of HIV testing by residence and Local Government Area . 194 Table 14.2 Coverage of HIV testing by selected background characteristics . 195 Table 14.3 HIV prevalence by age . 196 Table 14.4 HIV prevalence by socioeconomic characteristics . 197 Table 14.5 HIV prevalence by demographic characteristics . 198 Table 14.6 HIV prevalence by sexual behaviour . 199 Table 14.7 HIV prevalence among young people by background characteristics . 200 Tables and Figures • xiii Table 14.8 HIV prevalence among young people by sexual behaviour . 201 Table 14.9 HIV prevalence by other characteristics . 202 Table 14.10 Prior HIV testing by current HIV status . 202 Table 14.11 HIV prevalence among couples . 203 15 WOMEN’S EMPOWERMENT AND DEMOGRAPHIC AND HEALTH OUTCOMES . 205 Table 15.1 Employment and cash earnings of currently married women and men . 206 Table 15.2.1 Control over women’s cash earnings and relative magnitude of women’s cash earnings . 208 Table 15.2.2 Control over men’s cash earnings . 209 Table 15.3 Women’s control over their own earnings and over those of their husbands . 210 Table 15.4.1 Ownership of assets: Women . 211 Table 15.4.2 Ownership of assets; Men . 212 Table 15.5 Participation in decision making . 213 Table 15.6 Women’s participation in decision making by background characteristics . 213 Table 15.7.1 Attitude towards wife beating: Women . 215 Table 15.7.2 Attitude towards wife beating: Men . 216 Table 15.8 Indicators of women’s empowerment . 217 Table 15.9 Current use of contraception by women’s empowerment . 218 Table 15.10 Ideal number of children and unmet need for family planning by women’s empowerment . 218 Table 15.11 Reproductive health care by women's empowerment . 219 Table 15.12 Early childhood mortality rates by women’s status . 220 Table 15.13 Knowledge of female circumcision . 221 Table 15.14 Prevalence of female circumcision . 222 Table 15.15 Age at circumcision . 222 Table 15.16 Person performing circumcision among circumcised women age 15-49 . 223 Table 15.17 Attitudes towards female genital cutting . 223 Figure 15.1 Number of decisions in which currently married women participate . 214 16 DOMESTIC VIOLENCE . 225 Table 16.1 Experience of physical violence . 228 Table 16.2 Persons committing physical violence . 229 Table 16.3 Experience of sexual violence. 230 Table 16.4 Persons committing sexual violence . 231 Table 16.5 Experience of different forms of violence . 231 Table 16.6 Experience of violence during pregnancy . 232 Table 16.7 Marital control exercised by husbands . 233 Table 16.8 Forms of spousal violence . 234 Table 16.9 Spousal violence by background characteristics . 235 Table 16.10 Spousal violence by husband’s characteristics and empowerment indicators . 236 Table 16.11 Physical or sexual violence in the past 12 months by any husband/partner . 237 Table 16.12 Experience of spousal violence by duration of marriage . 238 Table 16.13 Injuries to women due to spousal violence . 238 Table 16.14 Women’s violence against their spouse . 239 Table 16.15 Women’s violence against their spouse . 240 Table 16.16 Help seeking to stop violence . 241 Table 16.17 Sources of help to stop the violence . 242 xiv • Tables and Figures 17 ADULT AND MATERNAL MORTALITY . 243 Table 17.1 Adult mortality rates . 244 Table 17.2 Adult mortality probabilities . 245 Table 17.3 Maternal mortality . 245 APPENDIX A SAMPLE DESIGN . 251 Table A.1 Households . 252 Table A.2 Population . 252 Table A.3 Enumeration areas . 252 Table A.4 Sample allocation of clusters and households . 253 Table A.5 Sample allocation of completed interviews with women and men . 254 Table A.6 Sample implementation: Women . 255 Table A.7 Sample implementation: Men . 265 Table A.8 Coverage of HIV testing by social and demographic characteristics: Women . 258 Table A.9 Coverage of HIV testing by social and demographic characteristics: Men . 259 Table A.10 Coverage of HIV testing by sexual behaviour characteristics: Women . 260 Table A.11 Coverage of HIV testing by sexual behaviour characteristics: Men . 261 APPENDIX B ESTIMATES OF SAMPLING ERRORS . 263 Table B.1 List of selected variables for sampling errors, Gambia 2013 . 265 Table B.2 Sampling errors: Total sample, Gambia 2013 . 267 Table B.3 Sampling errors: Urban sample, Gambia 2013 . 268 Table B.4 Sampling errors: Rural sample, Gambia 2013 . 269 Table B.5 Sampling errors: Banjul sample, Gambia 2013 . 270 Table B.6 Sampling errors: Kanifing sample, Gambia 2013 . 271 Table B.7 Sampling errors: Brikama sample, Gambia 2013 . 272 Table B.8 Sampling errors: Mansakonko sample, Gambia 2013 . 273 Table B.9 Sampling errors: Kerewan sample, Gambia 2013 . 274 Table B.10 Sampling errors: Kuntaur sample, Gambia 2013 . 275 Table B.11 Sampling errors: Janjanbureh sample, Gambia 2013 . 276 Table B.12 Sampling errors: Basse sample, Gambia 2013 . 277 Table B.13 Sampling errors for adult and maternal mortality rates, Gambia, 2013 . 278 APPENDIX C DATA QUALITY TABLES . 279 Table C.1 Household age distribution . 279 Table C.2.1 Age distribution of eligible and interviewed women . 280 Table C.2.2 Age distribution of eligible and interviewed men . 280 Table C.3 Completeness of reporting . 281 Table C.4 Births by calendar years . 282 Table C.5 Reporting of age at death in days . 282 Table C.6 Reporting of age at death in months . 283 Table C.7 Nutritional status of children based on the NCHS/CDC/WHO International Reference Population . 284 Foreword • xv FOREWORD he 2013 Gambia Demographic and Health Survey (GDHS) was conducted by the Gambia Bureau of Statistics (GBoS) in collaboration with the Ministry of Health and Social Welfare and the National Population Secretariat Commission. The National Public Health Laboratory Services was responsible for HIV testing of dried blood samples. This is the first Demographic and Health Survey (DHS) conducted in The Gambia under the worldwide DHS programme, a project funded by the United States Agency for International Development (USAID) that provides support and technical assistance in the implementation of population and health surveys in countries worldwide. The main objective of the survey was to provide comprehensive data on fertility and mortality, family planning, maternal and child health and nutrition, as well as information on maternal mortality and domestic violence. The survey also provides household-based data on the prevalence of malaria and HIV, two of the most life-threatening infectious diseases in sub-Saharan Africa. The survey was intentionally planned to be fielded at the beginning of the last term of the Millennium Development Goals (MDGs) reporting period so that it would provide information on progress towards the attainment of set MDG targets in The Gambia. Furthermore, the 2013 GDHS, in conjunction with statistical information obtained from the Integrated Household Survey (2010), provides critical information for monitoring and evaluating targets set in the Programme for Accelerated Growth and Employment as well as various sector development policies and programmes. The survey covers a nationally representative sample and was designed to produce estimates of the major survey variables at the national, urban and rural areas, and Local Government Area levels (Banjul municipality, Kanifing municipality, Brikama, Mansakonko, Kerewan, Kuntaur, Janjanbureh, and Basse). A total of 6,217 households were contacted during the survey. In these households, 10,233 women age 15-49 and 3,821 men age 15-59 were interviewed. Major stakeholders from various government, nongovernmental, and United Nations (UN) agencies were involved in contributing technically and financially towards the success of the survey. The GBoS management and staff appreciate the individual and institutional contributions in various ways to the successful completion of the 2013 GDHS. The Bureau is grateful for the commitment of the Government of The Gambia towards the success of the survey. On behalf of the Government, I wish to express sincere appreciation for all the support received from USAID, the United Nations Population Fund (UNFPA), the United Nations Children’s Fund (UNICEF), the United Nations Development Programme (UNDP), the World Health Organization (WHO), the Global Fund (through the Malaria, HIV/AIDS, and TB grants and ActionAid Gambia); and the Joint United Nations Programme on HIV/AIDS (UNAIDS). In addition, the Bureau wishes to express its gratitude to ICF International, which provided technical assistance through the worldwide DHS programme. On behalf of the Bureau I wish to extend special thanks to the Office of The Vice President for the overall coordination of the implementation process; the Ministry of Finance and Economic Affairs for ensuring that government commitments in terms of financial contributions were fulfilled; and the Ministry of Health and Social Welfare for coordination and undertaking of voluntary counselling and testing activities. We are also appreciative of the invaluable contribution of all to the institutions represented in the 2013 GDHS Steering Committee and Technical Advisory Committee (Office of the Vice President, the Ministry of Finance and Economic Affairs, the Ministry of Health and Social Welfare, the Ministry of Agriculture, the Ministry of Information and Communication Technology, the Ministry of Basic and Secondary Education, the National Nutrition Agency, the National Malaria Control Programme, the National AIDS Secretariat, the National Leprosy and Tuberculosis Programme, the Women’s Bureau, the National Population Commission Secretariat, the Association of Non-Governmental Organisations, the Department T xvi • Foreword of Social Welfare, UNICEF, UNDP, WHO, UNAIDS, UNFPA, and USAID) towards the success of GDHS. Special thanks also go to the National Public Health Laboratory Services, which handled the complicated task of testing the dry blood samples collected in the field and worked with a consultant to determine survey respondents’ HIV status. We also wish to acknowledge the tireless efforts of all Bureau staff who were in the field or the office that made this survey a success. The contribution of every staff member of the Bureau was critical to the successful completion of this survey. Nyakassi M.B. Sanyang Statistician General Gambia Bureau of Statistics Millennium Development Goal Indicators • xvii MILLENNIUM DEVELOPMENT GOAL INDICATORS Millennium Development Goal Indicators Gambia 2013 Indicator Sex Total Female Male 1. Eradicate extreme poverty and hunger 1.8 Prevalence of underweight children under age 5 14.9 17.5 16.2 2. Achieve universal primary education 2.1 Net attendance ratio in primary education1 61.0 60.8 60.9 2.3 Literacy rate of 15-24 year-olds2 62.7 76.7a 69.7b 3. Promote gender equality and empower women 3.1 Ratio of girls to boys in primary, secondary, and tertiary education 3.1a Ratio of girls to boys in primary education3 na na 1.0 3.1b Ratio of girls to boys in secondary education3 na na 0.9 3.1c Ratio of girls to boys in tertiary education3 na na 1.0 4. Reduce child mortality 4.1 Under-5 mortality rate4 59 65 54 4.2 Infant mortality rate4 38 42 34 4.3 Proportion of 1-year-old children immunized against measles 88.1 87.6 87.8 5. Improve maternal health 5.1 Maternal mortality ratio5 na na 433 5.2 Percentage of births attended by skilled health personnel6 na na 57.2 5.3 Contraceptive prevalence rate7 9.0 na na 5.4 Adolescent birth rate8 88.1 na na 5.5 Antenatal care coverage 5.5a Antenatal care coverage: at least one visit9 98.9 na na 5.5b Antenatal care coverage: four or more visits10 77.6 na na 5.6 Unmet need for family planning 24.9 na na 6. Combat HIV/AIDS, malaria, and other diseases 6.1 HIV prevalence among the population age 15-24 0.4 0.2 0.3 6.2 Condom use at last high-risk sex11 26.7 59.8 43.3 6.3 Percentage of the population age 15-24 with comprehensive correct knowledge of HIV/AIDS12 25.8 32.3a 29.1b 6.4 Ratio of school attendance of orphans to school attendance of non-orphans age 10-14 0.92 0.88 0.90 6.7 Percentage of children under 5 sleeping under insecticide-treated bed nets 46.6 47.3 47.0 6.8 Percentage of children under 5 with fever who are treated with appropriate antimalarial drugs13 5.9 7.4 6.7 Urban Rural Total 7. Ensure environmental sustainability 7.8 Percentage of population using an improved drinking water source14 94.3 84.8 89.6 7.9 Percentage of population with access to improved sanitation15 50.4 29.0 39.8 na = Not applicable 1 The ratio is based on reported attendance, not enrolment, in primary education among primary school age children (age 7-12). The rate also includes children of primary school age enrolled in secondary education. This is a proxy for MDG indicator 2.1, Net enrolment ratio. 2 Refers to respondents who attended secondary school or higher or who could read a whole sentence or part of a sentence 3 Based on reported net attendance, not gross enrolment, among 7-12 year-olds for primary, 13-17 year-olds for secondary, and 18-22 year-olds for tertiary education 4 Expressed in terms of deaths per 1,000 live births. Mortality by sex refers to a 10-year reference period preceding the survey. Mortality rates for males and females combined refer to the 5-year period preceding the survey. 5 Expressed in terms of maternal deaths per 100,000 live births in the 7-year period preceding the survey 6 Among births in the five years preceding the survey 7 Percentage of currently married women age 15-49 using any method of contraception 8 Equivalent to the age-specific fertility rate for women age 15-19 for the 3-year period preceding the survey, expressed in terms of births per 1,000 women age 15-19 9 With a skilled provider 10 With any health care provider 11 High-risk sex refers to sexual intercourse with a nonmarital, noncohabitating partner. Expressed as a percentage of men and women age 15- 24 who had high-risk sex in the past 12 months. 12 Comprehensive knowledge means knowing that consistent use of a condom during sexual intercourse and having just one uninfected faithful partner can reduce the chance of getting HIV, knowing a healthy-looking person can have HIV, and rejecting the two most common local misconceptions about transmission or prevention of HIV. 13 Measured as the percentage of children age 0-59 months who were ill with a fever in the two weeks preceding the interview and received any antimalarial drug 14 Percentage of de jure population whose main source of drinking water is a household connection (piped), public tap or standpipe, tubewell or borehole, protected dug well, or bottled water. 15 Percentage of de jure population whose household has a flush toilet, ventilated improved pit latrine, pit latrine with a slab, or composting toilet and does not share this facility with other households a Restricted to men in sub-sample of households selected for the male interview b The total is calculated as the simple arithmetic mean of the percentages in the columns for male and females. xviii • Map of The Gambia Introduction • 1 INTRODUCTION 1 1.1 HISTORY, GEOGRAPHY, AND ECONOMY 1.1.1 History fter over two centuries of colonial rule under the British, The Gambia became self-governing in 1963 and gained full independence and dominion status on February 18, 1965. The country became a sovereign republic in 1970. Maintenance of multiparty democracy, adherence to the rule of law, and preservation of fundamental human rights are integral parts of the country’s political framework. In July 1994, the country came under military rule following a coup d’état. After a two-year transition period, presidential elections were held in September 1996, and the democratic civilian rule was restored. Since then, presidential and parliamentary elections have been held every five years. The president nominates five non-voting members to the National Assembly. Council members are selected through local government elections held every four years. The country is divided into seven administrative areas (two municipalities and five regions): Banjul municipality (the seat of the government), Kanifing municipality, and the West Coast, Lower River, North Bank, Central River, and Upper River regions. The municipalities are headed by mayors and the regions by governors. The regions are administered by chiefs. Councils in the provincial regions are headed by elected chairpersons. Districts and municipalities are divided into wards headed by elected councillors. For the purposes of surveys and censuses, the country is divided into eight Local Government Areas (LGAs): Banjul, Kanifing, Brikama, Mansakonko, Kerewan, Kuntaur, Janjabureh, and Basse. 1.1.2 Geography The Gambia is located midway on the bulge of the West Africa coast and stretches over 400 kilometres inland from west to east on either side of the River Gambia, varying in width from about 50 km near the mouth of the river to about 24 km upstream. The country is bound to the north, south, and east by the Republic of Senegal and to the west by the Atlantic Ocean. The River Gambia, which runs the entire length of the country from the Futa Jallon highlands in the Republic of Guinea to the Atlantic Ocean, divides the country’s land area of 10,689 square kilometres almost equally into two halves: the South Bank and the North Bank (Gambia Bureau of Statistics [GBoS], 2007). A Key Findings • The 2013 Gambia Demographic and Health Survey (GDHS) is a nationally representative survey of 10,233 women age 15-49 and 3,821 men age 15-59. • The 2013 GDHS is the first comprehensive survey conducted in The Gambia as part of the worldwide Demographic and Health Surveys program. • The primary purpose of the GDHS is to furnish policymakers and planners with detailed information on fertility; family planning; infant, child, adult, and maternal mortality; maternal and child health; nutrition; and knowledge of HIV/AIDS and other sexually transmitted infections. • A subsample of one in every two households was selected for the male survey and for collection of blood samples for HIV, anaemia, and malaria testing. 2 • Introduction The Gambian climate is typically Sahelian, with a long dry season from November to May and a short rainy season between June and October. The estuary basin of the River Gambia is virtually a tidal inlet with salt water intrusion ranging from 180 km upstream in the rainy season to 250 km in the dry season. Irrigable land areas are limited, and therefore agriculture, which is the backbone of the Gambian economy, is mostly rain fed. As a result, agricultural activities are subject to wide seasonal fluctuations and production levels are vulnerable to variations in rainfall. 1.1.3 Economy The Gambia has a market-based economy characterised by traditional subsistence agriculture and a significant tourism industry. The World Bank estimates the 2012 gross domestic product (GDP) in The Gambia at $944 million (current prices) and $707 million (constant prices). The services sector continues to be the leading contributor to the GDP. Agriculture accounted for roughly 22 percent of the GDP in 2012 and 2013, and this sector employs about 70 percent of the labour force.1 The Gambian economy continues to recover from the drought experienced in 2011, which caused a decrease in GDP of 4.3 percent. This was due to a fall in crop production of about 40 percent (Ministry of Agriculture, 2013). Preliminary figures show a rebound in GDP growth of 6.1 percent in 2012 as a result of recovery in crop production and strong growth in tourism, wholesale and retail, and construction activities. The increase in crop production is largely attributed to the significant investments made in the agricultural sector by the government and its development partners to mitigate the effects of the drought. 1.2 POPULATION The 2003 population and housing census estimated the population of The Gambia at 1.4 million (GBoS, 2007). The 2013 census estimated it at 1.9 million, an annual growth rate of 3.3 percent (GBoS, 2013). According to the 2003 census, 50 percent of the country’s residents live in rural areas, and women constitute 51 percent of the total population. The total fertility rate is 5.4 births per woman. This high fertility level has resulted in a very youthful population structure. Forty-two percent of the country’s residents are below age 15, and about 22 percent are between age 15 and age 24. Average life expectancy at birth is 63.4 years (62.5 years for males and 65 years for females) (GBoS, 2007). Life expectancy increased between the 1993 and 2003 censuses (GBoS, 1994; GBoS, 2007). Table 1.1 provides a summary of the basic demographic indicators for The Gambia from the 1993, 2003, and 2013 censuses. Table 1.1 Basic demographic indicators Indicator 1993 census1 2003 census2 2013 census3 Population (millions) 1.0 1.4 1.9 Growth rate (percentage) 4.2 2.7 3.1 Density (population/km2) 97 127 173.7 Percentage urban 37.1 50 na Life expectancy (years) Male 58.3 62.5 na Female 60.0 65.0 na na = Not available 1 GBoS, 1994 2 GBoS, 2007 3 GBoS, 2013 1.3 POPULATION AND HEALTH POLICIES 1.3.1 National Population Policy The overall goal of the 2007-2015 National Population Policy is to improve quality of life in The Gambia by raising the standard of living (National Population Commission Secretariat, 2010). The 1 Source: L. Fox, C. Haines, J.H. Munoz, and A. Thomas. 2013. Africa’s Got Work to Do: Employment Prospect in the New Century. IMF Working Paper. Introduction • 3 National Population Policy responds to the priorities reflected in Vision 2020 and the Programme for Accelerated Growth and Employment (PAGE). It seeks to achieve universal access to sexual and reproductive health, promote reproductive rights, reduce maternal mortality, and accelerate progress toward Millennium Development Goal (MDG) 5 and the International Conference on Population and Development agenda. The National Population Policy is implemented through the collaborative participation of national, regional, and district entities. 1.3.2 National Health Policy The main philosophy of the National Health Policy 2012-2020 is that “a healthy population is a wealthy population.” This philosophy is based on the belief that a healthy population can contribute to improved productivity, increased GDP, and sustained economic growth (MoH&SW, 2011). The National Health Policy seeks to make quality health care accessible for the country’s population by providing services within an enabling environment and ensuring that care at all levels is delivered by adequately trained, skilled, and motivated personnel. Thus, services will be accessible at the point of demand, especially for women, children, and marginalised and underserved individuals, irrespective of political, ethnic, or religious affiliations; in addition, gender-sensitive issues, including equal involvement of women in decision making, will be addressed in care delivery. The National Health Policy is expected to reform the health system by addressing both the major traditional health problems and new challenges, as well as the double burden of communicable and noncommunicable diseases and the HIV and AIDS pandemic. Its primary objective is “to reduce morbidity and mortality in The Gambia in order to contribute significantly to the improvement of quality of life of the population.” This reform is in line with local government decentralisation and planning based on the 2002 Local Government Act, Vision 2020, and PAGE. Thus, implementation of the National Health Policy is expected to result in reductions in morbidity and mortality related to major diseases, to promote healthy lifestyles, and to reduce health risks and exposures associated with negative environmental consequences. Morbidity and mortality rates due to both communicable and noncommunicable diseases are high in The Gambia, especially among infants, children, and women. Some of the diseases and conditions of concern include malaria, pneumonia, anaemia, diarrhoeal diseases, pregnancy complications, cardiovascular diseases, tuberculosis, and HIV and AIDS. Other important factors that contribute to high morbidity among the country’s population include poverty, unhealthy environments, unsafe working conditions, poor sanitation, poor nutrition, road traffic accidents, lack of or poor access to safe water, and poor housing conditions. The National Health Policy provides an institutional and legal framework for implementation of the various measures it entails. Furthermore, it identifies relevant stakeholders that can contribute to health service delivery and mobilises sector-wide resources for health development. The policy provides an impetus and a new direction for health sector development that will serve as the basis for driving the health sector in the next few years. 1.4 OBJECTIVES OF THE 2013 GAMBIA DEMOGRAPHIC AND HEALTH SURVEY The 2013 Gambia Demographic and Health Survey (GDHS) is the first survey conducted in The Gambia under the auspices of the worldwide Demographic and Health Surveys (DHS) programme. The primary objective of the 2013 GDHS is to provide current data on fertility and family planning behaviour, child mortality, adult and maternal mortality, children’s nutritional status, use of maternal and child health services, knowledge of HIV/AIDS, and the prevalence of HIV/AIDS and anaemia. The specific objectives are to: • Collect data at the national level that will allow calculation of key demographic trends • Analyse the direct and indirect factors that determine fertility levels and trends 4 • Introduction • Measure women’s and men’s contraceptive knowledge and practices • Collect high-quality data on family health, including immunisation coverage among children, prevalence and treatment of diarrhoea and other diseases among children under age 5, and maternity care indicators such as antenatal visits and assistance at delivery • Collect data on infant and child mortality and maternal mortality • Obtain data on child feeding practices, including breastfeeding, and administer anthropometric measurements to assess the nutritional status of women and children • Estimate the prevalence of malaria among children • Collect data on women’s and men’s knowledge of and attitudes toward sexually transmitted diseases and HIV/AIDS and evaluate condom use patterns • Conduct haemoglobin testing among women age 15-49 and children age 6-59 months to provide information on the prevalence of anaemia in these groups • Carry out anonymous HIV testing among women and men of reproductive age to provide information on the prevalence of HIV The medium- and long-term objectives of the survey include strengthening the technical capacity of the Gambia Bureau of Statistics and other partners in the National Statistical System to plan, conduct, and process and analyse data from complex national population and health surveys. The 2013 GDHS provides national and regional estimates on population and health that are comparable to information collected in similar surveys in other developing countries and to data that will be gathered in future DHS surveys in The Gambia. Data collected in the 2013 GDHS add to the large and growing international database of demographic and health indicators. 1.5 ORGANISATION OF THE SURVEY The 2013 GDHS was conducted at the request of the Gambian government, the Ministry of Health and Social Welfare (MoH&SW), the Gambia Bureau of Statistics, the National Population Secretariat Office of the Vice President, key stakeholders, and donors and partners. All parties played an important role in the planning of the survey and in the analysis of the results. The GBoS and the MoH&SW served as the implementing agencies for the GDHS. The Gambia Bureau of Statistics was responsible for operational matters, including planning and conducting fieldwork, data entry and processing, and report writing. More specifically, the GBoS was in charge of recruitment and training of the field, data entry, and data processing personnel; of transportation during fieldwork; and of supervision of survey activities. The MoH&SW provided the laboratory staff for HIV testing and malaria microscopy, as well as health technicians for the field teams. The 2013 GDHS was funded by the government of The Gambia, the U.S. Agency for International Development (USAID), the United Nations Population Fund (UNFPA), the United Nations Development Programme (UNDP), the United Nations Children’s Fund (UNICEF), the Joint United Nations Programme on HIV/AIDS (UNAIDS), the World Health Organization (WHO), and the Global Fund. ICF International provided technical assistance through the worldwide Demographic and Health Surveys programme. 1.6 SAMPLE DESIGN The Gambia is divided into eight Local Government Areas. In turn, each LGA is subdivided into districts and each district (with the exception of Banjul) into settlements. An enumeration area (EA) is a Introduction • 5 geographic section delineated so that a team of enumerators can easily cover it during a census. In the case of The Gambia, an EA can be a settlement, a cluster of small settlements, or part of a large settlement. The 2013 GDHS sample was designed to produce reliable estimates of the most important variables for the country as a whole, for urban and rural areas, and for each of the municipalities and LGAs. The sampling frame used for the 2013 GDHS was the latest population and housing census, conducted in 2003 (census data were provided by the Gambia Bureau of Statistics). The frame excluded individuals living in collective housing units such as hotels, hospitals, work camps, prisons, and boarding schools. The 2013 GDHS sample was a stratified sample selected in two stages. Stratification was done by dividing each LGA into urban and rural areas (except Banjul and Kanifing, which are entirely urban settlements), achieving a total of 14 sampling strata. In the first stage, 281 EAs were selected with probability proportional to size and with independent selection in each sampling stratum. These EAs constituted the primary sampling units (PSUs). After selection of the EAs and before the main fieldwork, a household listing operation was carried out in all of the selected EAs. The listing operation consisted of visiting each of the 281 selected EAs, drawing a location map and detailed sketch map, and recording on the household listing forms all structures found in the EA, as well as all residential households within these structures (including the address and name of the household head). The resulting list of households served as the sampling frame for the selection of households in the second stage of sampling. In the second stage, 25 households per EA were selected via equal probability systematic selection. All women age 15-49 who were usual household members or who spent the night before the survey in the selected households were eligible for individual interviews. A subsample of one in every two sampled households was selected for the male survey (all men age 15-59 who were usual household members or who spent the night before the survey in the household were eligible for individual interviews) as well as for collection of blood samples for HIV, anaemia, and malaria testing. 1.7. QUESTIONNAIRES Three questionnaires were used in the 2013 GDHS: the Household Questionnaire, the Woman’s Questionnaire, and the Man’s Questionnaire. These questionnaires were based on the models developed by the DHS programme and were adapted to reflect The Gambia’s specific needs, based on discussions between ICF International and a technical working group that included staff from various governmental institutions, nongovernmental organisations, donors, and development partners. The Household Questionnaire was used to list all usual household members as well as non- members who spent the night preceding the interview in the selected households. Information was obtained on relationship to the head of the household and the age, sex, and educational attainment of each individual age 3 or older listed in the household. In addition, several questions were included to determine the physical characteristics of the dwelling, such as source of water, presence of sanitation facilities, and availability of durable goods. The Household Questionnaire was also used to identify women and men eligible for individual interviews (women age 15-49 in all households and men age 15-59 in half of the households). In the households selected for the male survey, the Household Questionnaire was used to determine individuals eligible for anthropometry measurements and collection of biomarkers as follows: • All women age 15-49 were eligible for anthropometry measurements and for anaemia and HIV testing. • All men age 15-59 were eligible for HIV testing. 6 • Introduction • All children age 0-59 months were eligible for anthropometry measurements. • All children age 6-59 months were tested for anaemia and malaria. The Woman’s Questionnaire was administered to women age 15-49 in all of the survey households. Information was collected on the following topics: • Background characteristics • Birth history • Knowledge of, attitudes toward, and use of family planning and exposure to family planning messages • Maternal health, including antenatal, delivery, and postnatal care • Immunisation and health of children under age 5 • Breastfeeding and infant feeding practices • Marriage, sexual activity, and husband’s background characteristics • Fertility preferences • Employment • Knowledge of AIDS and sexually transmitted infections • Other women’s health issues, including female circumcision • Maternal mortality • Domestic violence The Man’s Questionnaire was administered to all men age 15-59 in half of the households. It collected much of the same information as the Woman’s Questionnaire but was shorter because it did not contain a detailed reproductive history or questions on maternal and child health. 1.8 LISTING, PRETEST, MAIN TRAINING, FIELDWORK, AND DATA PROCESSING 1.8.1 Listing Training of trainers (of mapping and listing supervisors) took place in April 2012 and was led by a specialist from ICF. A manual that described the listing and mapping procedures was prepared as a guideline, and the training involved both classroom demonstrations and field practice. Training of trainers was followed by the recruitment and training of 30 mappers and listers and three coordinators in August 2012. After the selection of the 281 clusters throughout the eight regions, a listing operation was conducted for six weeks, starting in August 2012. The listing was performed by organising the listing staff into 15 teams, each composed of one lister and one mapper. Three supervisors from the GBoS were also assigned to perform quality checks and handle all of the administrative and financial aspects of the listing operation. Introduction • 7 1.8.2 Pretest and Main Training The training of interviewers and supervisors was conducted from November 26 through December 14, 2012, and training of health technicians took place from December 10-14, with assistance from ICF consultants. Because of some delays with the schedule, a decision was made to train all of the main fieldwork interviewers during the pretest training and provide a two-week refresher training session prior to launching the main fieldwork. A total of 105 individuals were recruited for training. Interviewer training consisted of instructions on interviewing techniques and field procedures, a detailed review of the questionnaire content, instruction and practice in weighing and measuring children, mock interviews between participants in the classroom, and practice interviews with real respondents in areas outside the 2013 GDHS sample points. Team supervisors and editors were trained in data quality control procedures and fieldwork coordination. Sixteen individuals with previous experience in lab techniques and handling blood samples were trained as health technicians for the survey. In addition, three interviewers were trained in the preparation of dry blood spot samples and in conducting anaemia and rapid diagnostic tests to support the health technicians in the field if necessary. Pretest fieldwork was carried out from December 15-21, 2012, in four areas that were not selected for the main survey. A total of 24 field staff participated, divided into four teams. Each team consisted of three female interviewers, one male interviewer, one health technician, and one supervisor. Four field coordinators were also assigned to coordinate and supervise the teams in the field. A total of 90 interviewers were selected for the main fieldwork. They underwent a six-day refreshment training session that was conducted between January 28 and February 2, 2013. 1.8.3 Fieldwork A total of 15 teams carried out data collection for the 2013 GDHS. Each team consisted of one supervisor, one editor, two female interviewers, one male interviewer, one health technician, and one driver. Data collection took place between February 2 and April 28, 2013. Six regional coordinators, three from the GBoS, two from the MoH&SW, and one from the National Population Commission Secretariat, were responsible for supervising the data collection teams and monitoring data quality. They regularly visited the field teams, checked the quality of the data collected in the field, and transported completed questionnaires and blood samples to GBoS. 1.8.4 Data Processing All questionnaires and blood samples for the 2013 GDHS were returned to the GBoS office in Kanifing for data processing, which consisted of office editing, coding of open-ended questions, data entry, and editing computer-identified errors. The data were processed by a team of data entry operators, office editors, secondary editors, and supervisors, supported with technical assistance from ICF International. Data entry and editing were accomplished using CSPro software. Processing of data was initiated in March 2013 and completed in May; tabulations were completed in July 2013 by the GBoS in collaboration with ICF International. Analyses of blood tests were conducted at the National Public Health Laboratories (NPHL) in Kotu. Questionnaires were incinerated to ensure that HIV data could not be linked to individual respondents. The 2013 GDHS preliminary report was prepared and launched in July 2013. 8 • Introduction 1.9 ANTHROPOMETRY, ANAEMIA, MALARIA, AND HIV TESTING Anthropometry measurements and biomarker testing were done in half of the households selected for the male survey. 1.9.1 Height and Weight Measurements Height and weight measurements were carried out on women age 15-49 and children age 0-59 months in half of the households selected for the male survey. Weight measurements were obtained using lightweight SECA mother-infant scales with digital screens, designed and manufactured under the guidance of UNICEF. Height measurements were carried out using a measuring board. Children younger than age 24 months were measured for height while lying down, and older children were measured while standing. 1.9.2 Anaemia Testing Blood specimens were collected for anaemia testing from all children age 6-59 months and from women age 15-49 who voluntarily consented to testing. Blood samples were drawn from a drop of blood taken from a finger prick (or a heel prick in the case of young children with small fingers) and collected in a microcuvette. Haemoglobin analysis was carried out on-site using a battery-operated portable HemoCue analyser. Results were given verbally and in writing. Parents of children with a haemoglobin level under 7 g/dl (considered to be severely anaemic) were instructed to take the child to a health facility for follow-up care. Likewise, non-pregnant women were referred for follow-up care if their haemoglobin level was below 7 g/dl and pregnant women were referred to a health facility for follow-up care if their haemoglobin level was below 9 g/dl. 1.9.3 Malaria Testing Children age 6-59 months were also tested for malaria in the field using SDBioline Malaria Ag P.f/Pan, a rapid diagnostic test. This high-sensitivity and high-specificity test detects malaria antigens from capillary blood samples. Respondents were informed of their results, and a free referral was given to the nearest health facility. In addition, blood was collected on glass slides and sent to the NPHL for malaria microscopy through reading of thick-smear slides. 1.9.4 HIV Testing Blood specimens for laboratory testing of HIV were collected by the GDHS health technicians from all women age 15-49 and men age 15-59 who consented to the test. The protocol for blood specimen collection and analysis was based on the anonymous linked protocol developed for the DHS programme. This protocol allows for the merging of HIV test results with sociodemographic data collected in the individual questionnaires after all information that can potentially identify an individual respondent has been destroyed. Interviewers explained the procedure, the confidentiality of the data, and the fact that the test results would not be made available to the respondent. If a respondent consented to HIV testing, five blood spots from the finger prick were collected on a filter paper card labelled with a barcode unique to the respondent. Respondents were asked whether they would consent to having the laboratory store their blood sample for future unspecified testing. If they did not consent to additional testing using their sample, the words “no additional testing” were written on the filter paper card. For each barcoded blood sample, a duplicate label was attached to the biomarker data collection form. A third copy of the same barcode was affixed to the blood sample transmittal form to track the blood Introduction • 9 samples from the field to the laboratory. Blood samples were dried overnight and packaged for storage the following morning. Samples were periodically collected in the field, along with the completed questionnaires, and transported to the GBoS in Kanifing to be logged in and checked; the samples were then transported to the National Public Health Laboratories in Kotu and submitted for testing. Upon arrival at the NPHL, each blood sample was logged into the CSPro HIV Test Tracking System (CHTTS) database, given a laboratory number, and stored at −20˚C until tested. The HIV testing protocol stipulates that testing of blood can be conducted only after questionnaire data entry is completed, verified, and cleaned and all unique identifiers except the anonymous barcode number are removed from the questionnaire file. At the first level, the protocol used the Vironostika HIV Ag/Ab; positive samples in the first level and 10 percent of negative samples were tested with the Enzygnost HIV Integral II assay, and discordant samples were tested with the Western blot. The final result was considered positive if the Western blot confirmed it to be positive and negative if the Western blot confirmed it to be negative. When the Western blot results were indeterminate, the sample result was recorded as indeterminate. Following laboratory testing, the HIV test results for the 2013 GDHS were entered into the CHTTS database with a barcode as the unique identifier. The barcodes identifying HIV test results were linked with the data from the individual interviews to enable analysis and publication of HIV data linked with other GDHS data. 1.10 RESPONSE RATES Table 1.2 shows household and individual response rates for the 2013 GDHS. A total of 7,0092 households were selected for the sample, of which 6,543 were occupied during data collection. Of the occupied households, 6,217 were successfully interviewed, yielding a response rate of 95 percent. In the interviewed households, 11,279 eligible women were identified for individual interviews. Complete interviews were conducted with 10,233 women, yielding a response rate of 91 percent. Similarly, a total of 4,668 eligible men were identified for individual interviews in the households selected for the male survey. Complete interviews were conducted with 3,821 men, yielding a response rate of 82 percent. In general, response rates were higher in rural areas than urban areas among both women and men. 2 Two of the 281 EAs had less than 25 listed households (11 and 23 households, respectively), resulting in a total of 7,009 households. 10 • Introduction Table 1.2 Results of the household and individual interviews Number of households, number of interviews, and response rates, according to residence (unweighted), The Gambia 2013 Result Residence Total Urban Rural Household interviews Households selected 3,661 3,348 7,009 Households occupied 3,322 3,221 6,543 Households interviewed 3,095 3,122 6,217 Household response rate1 93.2 96.9 95.0 Interviews with women age 15-49 Number of eligible women 5,043 6,236 11,279 Number of eligible women interviewed 4,498 5,735 10,233 Eligible women response rate2 89.2 92.0 90.7 Interviews with men age 15-59 Number of eligible men 2,343 2,325 4,668 Number of eligible men interviewed 1,831 1,990 3,821 Eligible men response rate2 78.1 85.6 81.9 1 Households interviewed/households occupied 2 Respondents interviewed/eligible respondents Housing Characteristics and Household Population • 11 HOUSING CHARACTERISTICS AND HOUSEHOLD POPULATION 2 his chapter summarises demographic and socioeconomic characteristics of the population sampled in the 2013 GDHS. The survey collected information from all usual residents of a selected household (the de jure population) and persons who had stayed in the household the night before the interview (the de facto population). Since the difference between these two populations is very small, and to maintain comparability with other DHS reports, all tables in this report refer to the de facto population unless otherwise specified. In the GDHS, a household was defined as a person or a group of related or unrelated persons who live together in the same dwelling unit(s) or in connected premises, who acknowledge one adult member as the head of the household, and who have common arrangements for cooking and eating. The Household Questionnaire (see Appendix E) included a schedule collecting basic demographic and socioeconomic information (e.g., age, sex, educational attainment, and current school attendance) from all usual residents and from visitors who spent the night preceding the interview in the household. The Household Questionnaire also obtained information on housing characteristics (e.g., sources of water supply and sanitation facilities) and household possessions. The information presented in this chapter is intended to facilitate interpretation of the key demographic, socioeconomic, and health indices presented later in the report. It is also intended to assist in the assessment of the representativeness of the survey sample. 2.1 HOUSEHOLD CHARACTERISTICS The physical characteristics of a household’s environment are important determinants of the health status of household members, especially children. They can also serve as indicators of the socioeconomic status of households. The 2013 GDHS asked respondents about their household environment, including access to electricity, source of drinking water, type of sanitation facility, type of flooring material, and number of rooms in the dwelling. Results are presented for households and for the de jure population. 2.1.1 Drinking Water Increasing access to improved drinking water is one of the Millennium Development Goals being adopted worldwide (United Nations General Assembly, 2002). Table 2.1 includes a number of indicators T Key Findings • Ninety-one percent of households in The Gambia use an improved source of drinking water. • Thirty-seven percent of households in The Gambia use improved toilet facilities that are not shared with other households. • Forty-five percent of households have access to electricity, with a large disparity between urban and rural areas (66 percent and 13 percent, respectively). • Ninety-one percent of households use solid fuel for cooking. • More than seven in ten children under age 5 (72 percent) have been registered with civil authorities and more than half (57 percent) have a birth certificate. • Approximately 8 percent of children under age 18 are orphaned (that is, one or both parents are not living). • Fifty-two percent of females and 43 percent of males age 6 and older have never attended school. 12 • Housing Characteristics and Household Population that are useful in monitoring household access to improved drinking water (WHO and UNICEF, 2012a). The source of drinking water is an indicator of whether it is suitable for drinking. Sources that are more likely to provide water suitable for drinking are identified in Table 2.1 as improved sources. These include a piped source within the dwelling, yard, or plot; a public tap, tube well, or borehole; a hand pump/protected well or protected spring; and rainwater or bottled water.1 Lack of ready access to a water source may limit the quantity of suitable drinking water that is available to a household. Even if the water is obtained from an improved source, it may be contaminated during transport or storage if it is fetched from a source that is not immediately accessible to the household,. Home water treatment can be effective in improving the quality of household drinking water. Table 2.1 Household drinking water Percent distribution of households and the de jure population by source of drinking water, time to obtain drinking water, and treatment of drinking water, according to residence, The Gambia 2013 Characteristic Households Population Urban Rural Total Urban Rural Total Source of drinking water Improved source 95.3 84.7 91.0 94.3 84.8 89.6 Piped into dwelling 5.5 0.4 3.4 4.3 0.3 2.3 Piped to yard/plot 60.4 6.1 38.2 59.2 5.0 32.5 Public tap/standpipe 24.6 44.7 32.8 25.2 44.7 34.8 Tubewell or borehole 1.8 18.9 8.8 1.6 18.6 10.0 Protected well 2.4 14.5 7.4 3.9 16.1 9.9 Bottled water 0.6 0.1 0.4 0.1 0.0 0.1 Non-improved source 3.7 14.5 8.1 4.3 14.6 9.4 Unprotected well 3.7 14.3 8.0 4.3 14.5 9.3 Surface water 0.0 0.2 0.1 0.0 0.1 0.1 Other source 0.9 0.7 0.8 1.3 0.5 0.9 Total 100.0 100.0 100.0 100.0 100.0 100.0 Time to obtain drinking water (round trip) Water on premises 69.8 11.8 46.1 67.2 10.8 39.4 Less than 30 minutes 24.6 67.7 42.3 25.6 67.2 46.1 30 minutes or longer 5.1 19.3 10.9 6.6 21.1 13.8 Don’t know/missing 0.4 1.2 0.7 0.6 1.0 0.8 Total 100.0 100.0 100.0 100.0 100.0 100.0 Water treatment prior to drinking1 Boiled 0.3 0.2 0.2 0.2 0.1 0.1 Bleach/chlorine added 2.9 3.1 3.0 3.0 3.1 3.1 Strained through cloth 5.1 23.5 12.6 7.3 25.5 16.2 Ceramic, sand, or other filter 0.3 0.1 0.2 0.2 0.1 0.1 Other 0.2 0.4 0.3 0.2 0.2 0.2 No treatment 91.2 73.5 84.0 89.7 71.9 81.0 Percentage using an appropriate treatment method2 3.4 3.3 3.4 3.3 3.3 3.3 Number 3,671 2,546 6,217 25,939 25,202 51,142 1 Respondents may report multiple treatment methods, so the sum of treatment may exceed 100 percent. 2 Appropriate water treatment methods include boiling, bleaching, filtering, and solar disinfecting. Table 2.1 shows that 9 out of 10 households in The Gambia (91 percent) get their drinking water from an improved source. However, disparities exist by urban-rural residence, with a higher proportion of urban households (95 percent) than rural households (85 percent) having an improved source of drinking water. The most common source of improved drinking water is piped water into the plot (38 percent), with a much higher percentage in urban than in rural areas (60 percent versus 6 percent). Thirty-three percent of households have access to drinking water from a public tap/standpipe, and this is the leading improved drinking water source among rural households (45 percent). Eight percent of households in The Gambia get their drinking water from a non-improved source, mainly unprotected wells (8 percent). More than three times as many rural households as urban households use non-improved sources of drinking water (15 percent versus 4 percent). 1 The categorisation into improved and non-improved categories follows that proposed by the WHO/UNICEF Joint Monitoring Programme for Water Supply and Sanitation (WHO/UNICEF, 2012). Housing Characteristics and Household Population • 13 Forty-six percent of all households have water on their premises, with a huge urban-rural disparity (70 percent of urban households compared with 12 percent of rural households). Overall, 42 percent of households report that it takes less than 30 minutes for the round trip to obtain drinking water (25 percent in urban areas and 68 percent in rural areas). The remaining households (11 percent) must travel 30 minutes or longer (round trip) to obtain their drinking water (19 percent of rural households versus 5 percent of urban households). Very few households (3 percent) in The Gambia treat their drinking water using an appropriate treatment method, and there are no urban-rural differences. The main method of treatment is straining through cloth (13 percent of households), with 24 percent of rural households following this method compared with only 5 percent of households in urban areas. Three percent of households add bleach or chlorine to make water safer for drinking. 2.1.2 Household Sanitation Facilities Ensuring adequate sanitation facilities is another Millennium Development Goal that The Gambia shares with other countries. A household is classified as having an improved toilet if the toilet is used only by members of one household (i.e., it is not shared) and if the facility used by the household separates waste from human contact (WHO and UNICEF, 2012a). The types of facilities considered improved are toilets that flush or pour flush into a piped sewer system, septic tank, or pit latrine; ventilated improved pit (VIP) latrines; and pit latrines with a slab. As shown in Table 2.2, more than one-third (37 percent) of households in The Gambia use an improved toilet facility that is not shared with other households. Urban households are much more likely than rural households to have an improved toilet facility that is not shared (46 percent and 24 percent, respectively). Twenty-four percent of all households use an improved toilet facility that is shared with other households (32 percent of households in urban areas compared with 13 percent of those in rural areas). About four in ten households use a non-improved sanitation facility, with a much higher percentage in rural than in urban areas (63 percent and 23 percent, respectively). Overall, only 2 percent of households have no toilet facility at all, almost all in rural areas (5 percent). Table 2.2 Household sanitation facilities Percent distribution of households and the de jure population by type of toilet/latrine facilities, according to residence, The Gambia 2013 Type of toilet/latrine facility Households Population Urban Rural Total Urban Rural Total Improved, not shared facility 45.9 24.3 37.0 50.4 29.0 39.8 Flush/pour flush to piped sewer system 2.0 0.0 1.2 1.9 0.0 1.0 Flush/pour flush to septic tank 26.2 2.0 16.3 25.6 1.7 13.8 Flush/pour flush to pit latrine 2.1 0.4 1.4 2.2 0.5 1.4 Ventilated improved pit (VIP) latrine 4.3 4.2 4.2 5.8 4.2 5.0 Pit latrine with slab 11.3 17.7 13.9 14.8 22.5 18.6 Shared facility1 31.5 12.8 23.8 26.8 10.8 18.9 Flush/pour flush to piped sewer system 2.3 0.0 1.3 1.2 0.0 0.6 Flush/pour flush to septic tank 4.6 0.2 2.8 3.9 0.1 2.1 Flush/pour flush to pit latrine 1.5 0.2 1.0 1.3 0.2 0.8 Ventilated improved pit (VIP) latrine 6.9 2.1 4.9 6.1 1.7 4.0 Pit latrine with slab 16.3 10.2 13.8 14.1 8.8 11.5 Non-improved facility 22.6 62.9 39.1 22.9 60.2 41.3 Pit latrine without slab/open pit 22.1 58.0 36.8 22.6 56.5 39.3 No facility/bush/field 0.3 4.7 2.1 0.2 3.5 1.8 Other 0.1 0.2 0.1 0.0 0.1 0.1 Total 100.0 100.0 100.0 100.0 100.0 100.0 Number 3,671 2,546 6,217 25,939 25,202 51,142 1 Facilities that would be considered improved if they were not shared by 2 or more households 14 • Housing Characteristics and Household Population The most common types of facilities among urban households are toilets that flush or pour flush into a septic tank (26 percent), followed by pit latrines with a slab (11 percent not shared and 16 percent shared). In rural areas, the leading type of sanitation facility is an open pit latrine without a slab or an open pit (58 percent), followed by a pit latrine with a slab (18 percent not shared and 10 percent shared). 2.1.3 Housing Characteristics Table 2.3 presents information on housing characteristics in The Gambia, which reflect a household’s socioeconomic situation. They also may influence environmental conditions (for example, use of biomass fuels and resulting exposure to indoor air pollution) that have a direct bearing on the health and welfare of household members. Table 2.3 Household characteristics Percent distribution of households by housing characteristics, percentage using solid fuel for cooking, and percent distribution by frequency of smoking in the home, according to residence, The Gambia 2013 Housing characteristic Residence Total Urban Rural Electricity Yes 66.4 12.9 44.5 No 33.6 87.0 55.5 Total 100.0 100.0 100.0 Flooring material Earth, sand 2.7 40.9 18.4 Parquet or polished wood 0.0 0.3 0.1 Vinyl or asphalt strips 0.0 0.2 0.1 Ceramic tiles 27.9 4.0 18.1 Cement 24.4 41.1 31.3 Carpet 5.7 1.0 3.8 Plastic carpet 38.6 12.1 27.8 Other 0.5 0.1 0.3 Total 100.0 100.0 100.0 Rooms used for sleeping One 24.6 9.5 18.4 Two 29.8 19.3 25.5 Three or more 44.3 70.7 55.1 Missing 1.3 0.5 1.0 Total 100.0 100.0 100.0 Place for cooking In the house 4.3 1.2 3.1 In a separate building 54.0 81.0 65.0 Outdoors 32.4 15.2 25.3 No food cooked in household 9.2 2.5 6.5 Total 100.0 100.0 100.0 Cooking fuel Electricity 0.0 0.0 0.0 LPG/natural gas/biogas 3.6 0.4 2.3 Kerosene 0.2 0.0 0.1 Charcoal 41.0 4.1 25.9 Wood 44.3 92.7 64.1 Straw/shrubs/grass 0.1 0.2 0.1 Saw dust 1.4 0.1 0.9 No food cooked in household 9.2 2.5 6.5 Total 100.0 100.0 100.0 Percentage using solid fuel for cooking1 86.8 97.1 91.0 Frequency of smoking in the home Daily 22.2 26.5 24.0 Weekly 2.2 2.4 2.3 Monthly 0.5 0.8 0.6 Less than monthly 0.7 0.8 0.8 Never 74.3 69.3 72.2 Total 100.0 100.0 100.0 Number 3,671 2,546 6,217 LPG = Liquid petroleum gas 1 Includes charcoal, wood/straw/shrubs/grass, and saw dust Housing Characteristics and Household Population • 15 Less than half (45 percent) of households in The Gambia have electricity, with a large disparity between urban (66 percent) and rural (13 percent) areas. About three in ten households (31 percent) live in dwellings with floors made of cement (24 percent of urban households and 41 percent of rural households). The next most common type of flooring material is plastic carpet, accounting for 28 percent of all households (39 percent in urban areas compared with 12 percent in rural areas). Earth or sand floors and ceramic floors each account for 18 percent of flooring materials. As expected, earth or sand floors are much more common in rural households than in urban households (41 percent versus 3 percent), while floors made of ceramic tiles are much more common in urban than in rural households (28 percent versus 4 percent). The number of rooms used for sleeping is an indicator of the extent of crowding in households. Overcrowding increases the risk of contracting diseases such as acute respiratory infections, tuberculosis, and skin diseases. Overall, more than half of households in The Gambia use three or more rooms for sleeping (55 percent), while slightly more than one-quarter (26 percent) use two rooms. The remainder (18 percent) use one room for sleeping. Urban households tend to have fewer rooms for sleeping; 25 percent use only one room for sleeping (compared with 10 percent of rural households), and 44 percent use three or more rooms (compared with 71 percent of rural households). With regard to cooking arrangements, the large majority of households in The Gambia (65 percent) cook in a separate building (54 percent in urban households compared with 81 percent in rural households). One in four households (25 percent) do their cooking outdoors (32 percent in urban areas and 15 percent in rural areas). Very few households in The Gambia (3 percent) do their cooking inside the house (4 percent of urban households compared with 1 percent of rural households). Cooking and heating with solid fuels can lead to high levels of indoor smoke, a complex mix of health-damaging pollutants that can increase the risk of acute respiratory diseases. Solid fuels are defined as charcoal, wood, straw, shrubs, and saw dust. In the 2013 GDHS, household respondents were asked about their primary source of fuel for cooking. Table 2.3 shows that 91 percent of households use solid fuel for cooking (87 percent of urban households and 97 percent of rural households). The most common cooking fuel in The Gambia is wood, used by close to two-thirds (64 percent) of households, with a much higher percentage in rural (93 percent) than urban (44 percent) households. Twenty-six percent of households use charcoal as cooking fuel, with the proportion being substantially higher in urban households (41 percent) than in rural households (4 percent). Use of other types of cooking fuels is not common in The Gambia. Information on frequency of smoking inside the home was obtained to assess the percentage of households in which there is exposure to second-hand smoke, which causes health risks in children and adults who do not smoke. Pregnant women who are exposed to second-hand smoke have a higher risk of delivering a low birth weight baby (Windham et al., 1999), and children exposed to second-hand smoke are at increased risk for respiratory and ear infections and poor lung development (U.S. Department of Health and Human Services, 2006). About one in four (24 percent) households in The Gambia report that someone smokes at the home daily, 2 percent report that someone smokes at least once a week, and less than 1 percent report that someone smokes monthly or less frequently than once a month. In 72 percent of households, smoking never occurs in the home. Overall, smoking inside the home is somewhat less frequent in urban areas than in rural areas; 74 percent of urban households report that smoking never occurs in the home, as compared with 69 percent of rural households. 2.1.4 Household Possessions Possession of durable consumer goods is another indicator of a household’s socioeconomic status. Moreover, particular goods have specific benefits. For instance, a radio or a television can bring household members information and new ideas, a refrigerator prolongs the wholesomeness of foods, and a means of transport can increase access to many services that are beyond walking distance. 16 • Housing Characteristics and Household Population Table 2.4 shows the extent of possession of selected consumer goods by urban-rural residence. Ownership of durable goods varies according to residence and the nature of the asset. Of the 12 selected items asked about in the survey, mobile phones and radios stand out as the assets most commonly owned by households. More than 9 in every 10 households in The Gambia (91 percent) own a mobile phone and about three-fourths (74 percent) own a radio, with no major difference by residence. About half (49 percent) of households own a television, and less than one in four (23 percent) own a refrigerator. Television ownership is about three times as high in urban as in rural households (67 percent versus 22 percent). Similarly, 35 percent of urban households own a refrigerator, as compared with only 5 percent of rural households. Looking at means of transport, less than half of households own a bicycle (47 percent), with a much higher percentage in rural areas (56 percent) than in urban areas (41 percent). Animal-drawn carts are owned by 16 percent of households (2 percent in urban areas compared with 35 percent in rural areas). Eleven percent of households own a car or truck, with the percentage being three times as high in urban as in rural areas (15 percent versus 5 percent). Agricultural land is owned by 37 percent of households, and 51 percent own farm animals (cattle, cows, bulls, horses, donkeys, mules, goats, sheep, or chickens). As expected, ownership of agricultural land and farm animals is notably higher among rural households (74 percent and 85 percent, respectively) than among urban households (12 percent and 28 percent, respectively). Table 2.4 Household possessions Percentage of households possessing various household effects, means of transportation, agricultural land, and livestock/farm animals by residence, The Gambia 2013 Possession Residence Total Urban Rural Household effects Radio 72.9 74.7 73.6 Television 66.6 22.4 48.5 Mobile telephone 93.4 86.6 90.6 Non-mobile telephone 5.7 1.3 3.9 Refrigerator 34.8 5.3 22.7 Means of transport Bicycle 41.1 55.6 47.0 Animal-drawn cart 2.3 35.0 15.7 Motorcycle/scooter 4.8 10.4 7.1 Car/truck 15.3 5.3 11.2 Boat with a motor 0.2 0.6 0.4 Ownership of agricultural land 11.8 73.8 37.2 Ownership of farm animals1 27.6 85.1 51.1 Number 3,671 2,546 6,217 1 Cattle, cows, bulls, horses, donkeys, goats, sheep, or chickens 2.2 WEALTH INDEX Information on household assets was used to create an index that is used throughout this report to represent the wealth of the households interviewed in the 2013 GDHS. This method for calculating a country-specific wealth index was developed and tested in a large number of countries in relation to inequalities in household income, use of health services, and health outcomes (Rutstein and Johnson, 2004). It has been shown to be consistent with expenditure and income measures. The wealth index is constructed using household asset data, including ownership of consumer items ranging from a television to a bicycle or car, as well as dwelling characteristics, such as source of drinking water, sanitation facilities, and type of flooring material. In its current form, which takes account of urban-rural differences in these items and characteristics, the wealth index is created in three steps. In the first step, a subset of indicators common to urban and rural areas is used to create wealth scores for Housing Characteristics and Household Population • 17 households in both areas. For purposes of creating scores, categorical variables are transformed into separate dichotomous (0-1) indicators. These indicators and those that are continuous are then examined using a principal components analysis to produce a common factor score for each household. In the second step, separate factor scores are produced for households in urban and rural areas using area-specific indicators (Rutstein, 2008). The third step combines the separate area-specific factor scores to produce a nationally applicable combined wealth index by adjusting area-specific scores through a regression on the common factor scores. The resulting combined wealth index has a mean of zero and a standard deviation of one. Once the index is computed, national-level wealth quintiles (from lowest to highest) are formed by assigning the household score to each de jure household member, ranking each person in the population by that score, and then dividing the ranking into five equal categories, each comprising 20 percent of the population. Thus, throughout this report, wealth quintiles are expressed in terms of quintiles of individuals in the overall population rather than quintiles of individuals at risk for any one health or population indicator. For example, quintile rates for infant mortality refer to infant mortality rates per 1,000 live births among all people in the population quintile concerned, as distinct from quintiles of live births or newly born infants, who constitute the only members of the population at risk of mortality during infancy. Table 2.5 presents wealth quintiles by residence and Local Government Area (LGA). Also included in the table is the Gini coefficient, which indicates the level of concentration of wealth (0 being an equal distribution and 1 a totally unequal distribution). Wealth is concentrated in urban areas, with 36 percent and 39 percent of the population in these areas falling in the fourth and highest wealth quintiles, respectively. In contrast, those living in rural areas are poorer, with 37 percent and 35 percent, respectively, falling in the lowest and second lowest wealth quintiles. Less than 1 percent of the rural population falls in the highest wealth quintile. In the urban LGAs of Banjul and Kanifing, 68 percent and 52 percent of residents, respectively, are in the highest wealth quintile. By contrast, 44 percent of the population in Mansakonko, a predominantly rural LGA, falls in the lowest wealth quintile, and 32 percent falls in the second lowest quintile. Table 2.5 Wealth quintiles Percent distribution of the de jure population by wealth quintiles, and the Gini coefficient, according to residence and Local Government Area, The Gambia 2013 Residence/Local Government Area Wealth quintile Total Number of persons Gini coefficient Lowest Second Middle Fourth Highest Residence Urban 3.7 5.3 16.3 35.6 39.1 100.0 25,939 0.15 Rural 36.7 35.2 23.8 4.0 0.3 100.0 25,202 0.08 Local Government Area Banjul 0.0 0.2 1.5 30.5 67.8 100.0 989 0.03 Kanifing 0.0 3.0 10.9 34.1 52.0 100.0 9,890 0.13 Brikama 18.2 14.8 18.1 25.8 23.0 100.0 17,656 0.28 Mansakonko 44.1 32.1 15.7 6.3 1.7 100.0 2,696 0.06 Kerewan 31.8 35.9 21.5 8.6 2.2 100.0 6,043 0.33 Kuntaur 35.6 35.4 22.9 6.0 0.2 100.0 3,173 0.03 Janjanbureh 36.0 29.8 23.2 9.7 1.3 100.0 4,009 0.18 Basse 19.8 29.4 38.2 10.9 1.7 100.0 6,687 0.25 Total 20.0 20.0 20.0 20.0 20.0 100.0 51,142 0.25 2.3 HAND WASHING Hand washing with soap and water is ideal. However, hand washing with a non-soap cleansing agent such as ash or sand is an improvement over not using any cleansing agent. To obtain information on hand washing, interviewers asked to see the place where members of the household most often washed their hands; information on the availability of water, cleansing agents, or both was recorded only for households where a hand washing place was observed. Interviewers observed a place for hand washing in only 10 percent of households. 18 • Housing Characteristics and Household Population Among the households where a hand washing place was observed, 61 percent had soap and water, less than 1 percent had water and a cleansing agent other than soap, 19 percent had only water, 3 percent had soap but no water, and 13 percent had no water, soap, or any other cleansing agent at the hand washing place (Table 2.6). The percentage of households using soap and water for hand washing was higher in urban than rural areas (66 percent versus 26 percent) and increased with increasing wealth, reaching 79 percent among households in the highest wealth quintile. Table 2.6 Hand washing Percentage of households in which the place most often used for washing hands was observed, and among households in which the place for hand washing was observed, percent distribution by availability of water, soap, and other cleansing agents, The Gambia 2013 Background characteristic Percentage of households where place for washing hands was observed Number of households Among households where place for hand washing was observed, percentage with: Number of households with place for hand washing observed Soap and water1 Water and cleansing agent2 other than soap only Water only Soap but no water2 No water, no soap, no other cleansing agent Missing Total Residence Urban 14.9 3,671 66.4 0.2 20.2 2.5 10.2 0.4 100.0 546 Rural 3.1 2,546 25.8 0.0 10.0 2.1 33.1 29.0 100.0 79 Local Government Area Banjul 21.5 188 62.1 0.4 24.1 4.6 7.7 1.0 100.0 40 Kanifing 17.1 1,520 68.9 0.3 16.6 3.0 11.2 0.0 100.0 260 Brikama 13.2 2,160 59.6 0.0 22.2 1.8 15.3 1.0 100.0 284 Mansakonko 5.1 356 (10.2) (0.0) (10.7) (2.5) (23.1) (53.5) 100.0 18 Kerewan 2.1 721 * * * * * * 100.0 15 Kuntaur 0.3 296 * * * * * * 100.0 1 Janjanbureh 1.1 410 * * * * * * 100.0 5 Basse 0.2 566 * * * * * * 100.0 1 Wealth quintile Lowest 2.5 1,423 (4.1) (0.0) 22.2) (3.3) (47.8) (22.6) 100.0 35 Second 3.5 995 28.3) (0.0) (7.7) (0.0) (32.4) (31.5) 100.0 35 Middle 4.0 1,053 23.5) (0.0) 23.0) (6.3) (37.7) (9.5) 100.0 42 Fourth 6.7 1,404 31.9 0.0 47.3 3.6 15.1 2.1 100.0 94 Highest 31.2 1,342 79.3 0.2 12.7 2.0 5.7 0.1 100.0 419 Total 10.1 6,217 61.3 0.2 18.9 2.5 13.1 4.1 100.0 625 Note: Figures in parentheses are based on 25-49 unweighted cases. An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. 1 Soap includes soap or detergent in bar, liquid, powder, or paste form. This column includes households with soap and water only as well as those that had soap and water and another cleansing agent. 2 Includes households with soap only as well as those with soap and another cleansing agent 2.4 POPULATION BY AGE AND SEX Age and sex are important demographic variables and are the primary basis for demographic classifications in vital statistics, censuses, and surveys. They are also very important variables in the study of mortality, fertility, and marriage. The distribution of the de facto household population in the 2013 GDHS is shown in Table 2.7 by five-year age groups, according to sex and residence. A total of 49,553 individuals resided in the 6,217 households successfully interviewed; the female population (25,649) was slightly higher than the male population (23,904). Housing Characteristics and Household Population • 19 Table 2.7 Household population by age, sex, and residence Percent distribution of the de facto household population by five-year age groups, according to sex and residence, The Gambia 2013 Age Urban Rural Male Female Total Male Female Total Male Female Total <5 16.2 15.3 15.7 21.0 17.6 19.2 18.5 16.4 17.4 5-9 14.3 13.7 14.0 19.2 16.9 18.0 16.6 15.3 15.9 10-14 11.6 11.7 11.7 14.1 13.3 13.7 12.8 12.5 12.6 15-19 11.0 11.3 11.2 9.5 9.5 9.5 10.3 10.4 10.3 20-24 10.2 10.8 10.5 6.7 7.4 7.1 8.5 9.1 8.8 25-29 8.3 9.3 8.8 5.1 6.6 5.9 6.8 8.0 7.4 30-34 6.7 7.3 7.0 4.2 5.7 5.0 5.5 6.5 6.0 35-39 5.4 5.0 5.2 3.5 4.4 4.0 4.5 4.7 4.6 40-44 4.4 3.2 3.8 3.1 3.3 3.2 3.8 3.3 3.5 45-49 3.0 2.5 2.7 2.7 2.4 2.5 2.9 2.4 2.6 50-54 2.2 3.7 3.0 1.9 4.4 3.2 2.1 4.1 3.1 55-59 1.6 1.5 1.6 1.5 2.4 1.9 1.5 1.9 1.7 60-64 2.1 1.6 1.9 2.4 2.1 2.3 2.3 1.9 2.1 65-69 1.4 1.2 1.3 1.6 1.2 1.4 1.5 1.2 1.3 70-74 0.8 0.7 0.7 1.2 1.2 1.2 1.0 0.9 1.0 75-79 0.4 0.3 0.3 1.0 0.6 0.8 0.7 0.5 0.6 80+ 0.5 0.8 0.7 1.1 1.3 1.2 0.8 1.0 0.9 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number 12,462 12,891 25,352 11,443 12,758 24,201 23,904 25,649 49,553 The age-sex structure of the population is shown in the population pyramid in Figure 2.1. The broad base of the pyramid indicates that the population in The Gambia is young, a scenario typical of countries with high fertility rates. The proportion of the population under age 15 was 46 percent in 2013. Individuals age 15-64 accounted for 50 percent of the total population, and those age 65 and older made up 4 percent of the population. This indicates an age dependency ratio of 99 in The Gambia.2 The pyramid shows a rather sharp increase in population size between women age 45-49 and those age 50-54. To a certain extent, this may be due to a tendency on the part of some interviewers to estimate the ages of women as above the cut-off age of 49 for eligibility for individual interviews, thus reducing their workload. A similar trend is observed for men age 55-59 and those age 60-64. Figure 2.1 Population pyramid 10 5 0 5 10 <5 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80+ Percent Age group GDHS 2013 Male Female 2 The age dependency ratio is defined as the sum of all persons under age 15 or over age 64 divided by the number of persons age 15-64, multiplied by 100. 20 • Housing Characteristics and Household Population 2.5 HOUSEHOLD COMPOSITION Table 2.8 presents information about the composition of households by sex of the household head and size of the household. These characteristics are important because they are associated with household welfare. Results show that households in The Gambia are predominantly headed by men (78 percent). Twenty-two percent of households are headed by women, and such households are more common in urban areas (26 percent) than in rural areas (17 percent). The average household size is 8.2 persons, with rural households (9.9 persons) having more members than urban households (7.1 persons). Overall, more than one-third of households have nine or more members (37 percent), and households of this size are more common in rural (48 percent) than urban (30 percent) areas. Table 2.8 Household composition Percent distribution of households by sex of head of household and by household size, mean size of household, and percentage of households with orphans and foster children under age 18, according to residence, The Gambia 2013 Characteristic Residence Total Urban Rural Household headship Male 73.9 83.1 77.7 Female 26.1 16.9 22.3 Total 100.0 100.0 100.0 Number of usual members 1 11.2 4.5 8.5 2 7.2 2.9 5.5 3 8.5 5.2 7.1 4 8.6 5.7 7.4 5 11.1 7.9 9.8 6 9.4 9.4 9.4 7 8.1 8.8 8.4 8 5.8 7.5 6.5 9+ 30.1 48.0 37.4 Total 100.0 100.0 100.0 Mean size of households 7.1 9.9 8.2 Percentage of households with orphans and foster children under age 18 Foster children1 32.7 40.6 35.9 Double orphans 2.4 2.7 2.5 Single orphans2 12.9 18.2 15.1 Foster and/or orphan children 36.1 46.4 40.3 Number of households 3,671 2,546 6,217 Note: Table is based on de jure household members (i.e., usual residents). 1 Foster children are those under age 18 living in households with neither their mother nor their father present. 2 Includes children with one dead parent and an unknown survival status of the other parent Table 2.8 also provides information on the proportion of households with foster children (that is, children who live in households with neither biological parent present), double orphans (children with both parents dead), and single orphans (children with one parent dead). Overall, 40 percent of households in The Gambia have foster children and/or orphans under age 18. Thirty-six percent of households have foster children (33 percent in urban areas and 41 percent in rural areas). In addition, 3 percent of households have double orphans (2 percent of urban households and 3 percent of rural households) and 15 percent have single orphans, with a higher percentage in rural than in urban areas (18 percent versus 13 percent). 2.6 BIRTH REGISTRATION Birth registration is the inscription of the facts of the birth into an official log kept at the registrar’s office. A birth certificate is issued as proof of the registration of the birth. Birth registration is basic to ensuring a child’s legal status and, thus, fundamental rights (UNICEF, 2006; United Nations General Assembly, 2002). Housing Characteristics and Household Population • 21 Table 2.9 shows the percentage of children under age 5 whose births were officially registered and the percentage who had a birth certificate at the time of the survey. Not all children who are registered have a birth certificate because some certificates may have been lost or never issued. However, all children with a certificate have been registered. More than seven in ten children under age 5 in The Gambia (72 percent) have been registered with civil authorities; more than half (57 percent) have a birth certificate, and 15 percent have been registered but do not have a birth certificate. The percentage of children whose births have been registered is higher among those age 2-4 (78 percent) than among those younger than age 2 (64 percent). There are only slight variations by sex, urban-rural residence, and wealth. There are, however, variations by LGA; the percentage of registered births ranges from a high of 77 percent in Brikama to a low of 62 percent in Mansakonko. Table 2.9 Birth registration of children under age 5 Percentage of de jure children under age 5 whose births are registered with the civil authorities, according to background characteristics, The Gambia 2013 Background characteristic Children whose births are registered Number of children Percentage with a birth certificate Percentage without a birth certificate Percentage registered Age <2 44.9 19.4 64.4 3,689 2-4 65.9 11.6 77.5 5,077 Sex Male 58.2 15.1 73.3 4,485 Female 55.9 14.7 70.6 4,281 Residence Urban 58.4 13.3 71.7 4,011 Rural 55.9 16.3 72.2 4,755 Local Government Area Banjul 54.5 16.8 71.4 128 Kanifing 47.9 16.4 64.3 1,475 Brikama 67.3 10.0 77.3 2,910 Mansakonko 45.0 16.5 61.5 463 Kerewan 58.1 17.3 75.4 1,069 Kuntaur 60.2 13.0 73.2 618 Janjanbureh 52.2 13.7 65.9 746 Basse 49.8 22.8 72.6 1,356 Wealth quintile Lowest 55.4 13.2 68.5 1,867 Second 56.1 17.6 73.7 1,960 Middle 55.8 17.5 73.4 1,809 Fourth 58.5 11.5 70.0 1,666 Highest 60.5 14.3 74.8 1,464 Total 57.1 14.9 72.0 8,765 2.7 CHILDREN’S LIVING ARRANGEMENTS AND PARENTAL SURVIVAL Information was collected on the living arrangements and parental survival status of all children under age 18 residing in the GDHS sample households to assess the potential burden on households of the need to provide for orphaned or foster children. These data were also used to assess the situation from the perspective of the children themselves. Table 2.10 presents the proportion of children under age 18 who are not living with one or both parents, either because the parent(s) died or for other reasons. Forty percent of children under age 18 in The Gambia are not living with both parents. Twelve percent are not living with either parent, even if both are alive. Eight percent of children under age 18 are orphaned (that is, one or both parents are dead). The percentage of orphaned children increases rapidly with age, from 3 percent among children under age 5 to 17 percent among children age 15-17. There is no variation in the percentage of orphans by sex or urban-rural residence. Mansakonko and Kuntaur have the lowest percentage of orphaned children (6 percent each), while Banjul and Kanifing have the highest percentage (9 percent each). The percentage of children with one or both parents dead is somewhat higher among those in the lowest wealth quintile (10 percent) than among those in the other wealth quintiles (7 to 8 percent). 22 • H ou si ng C ha ra ct er is tic s an d H ou se ho ld P op ul at io n Ta bl e 2. 10 C hi ld re n’ s liv in g ar ra ng em en ts a nd o rp ha nh oo d P er ce nt d is tri bu tio n of d e ju re c hi ld re n un de r ag e 18 b y liv in g ar ra ng em en ts a nd s ur vi va l s ta tu s of p ar en ts , t he p er ce nt ag e of c hi ld re n no t l iv in g w ith a b io lo gi ca l p ar en t, an d th e pe rc en ta ge o f c hi ld re n w ith o ne o r bo th p ar en ts d ea d, ac co rd in g to b ac kg ro un d ch ar ac te ris tic s, T he G am bi a 20 13 B ac kg ro un d ch ar ac te ris tic Li vi ng w ith bo th p ar en ts Li vi ng w ith m ot he r bu t n ot w ith fa th er Li vi ng w ith fa th er bu t n ot w ith m ot he r N ot li vi ng w ith e ith er p ar en t To ta l P er ce nt ag e no t l iv in g w ith a bi ol og ic al pa re nt P er ce nt ag e w ith o ne o r bo th p ar en ts de ad 1 N um be r o f ch ild re n Fa th er al iv e Fa th er de ad M ot he r al iv e M ot he r de ad B ot h al iv e O nl y fa th er al iv e O nl y m ot he r al iv e B ot h de ad M is si ng in fo rm at io n on fa th er / m ot he r A ge 0- 4 68 .8 22 .3 1. 6 1. 2 0. 2 4. 9 0. 2 0. 3 0. 1 0. 2 10 0. 0 5. 6 2. 5 8, 76 5 <2 71 .2 26 .1 1. 0 0. 4 0. 1 0. 8 0. 1 0. 0 0. 0 0. 3 10 0. 0 0. 9 1. 2 3, 68 9 2- 4 67 .1 19 .6 2. 0 1. 8 0. 3 7. 9 0. 3 0. 5 0. 2 0. 2 10 0. 0 9. 0 3. 5 5, 07 7 5- 9 60 .9 14 .8 3. 2 3. 9 0. 8 13 .3 0. 9 1. 1 0. 7 0. 4 10 0. 0 16 .0 6. 7 7, 99 4 10 -1 4 53 .7 12 .0 5. 4 5. 3 1. 3 16 .2 1. 6 2. 8 1. 2 0. 5 10 0. 0 21 .8 12 .3 6, 33 3 15 -1 7 44 .6 9. 0 7. 3 4. 7 1. 7 21 .0 1. 8 4. 7 1. 9 3. 3 10 0. 0 29 .4 17 .4 2, 90 0 Se x M al e 61 .8 15 .7 3. 6 3. 8 0. 9 10 .4 0. 8 1. 6 0. 7 0. 6 10 0. 0 13 .5 7. 7 12 ,9 77 Fe m al e 58 .2 16 .3 3. 7 3. 0 0. 7 13 .7 1. 1 1. 7 0. 8 0. 8 10 0. 0 17 .3 8. 0 13 ,0 16 R es id en ce U rb an 58 .0 17 .2 3. 5 3. 5 0. 5 12 .7 1. 2 1. 7 0. 9 0. 8 10 0. 0 16 .5 7. 8 12 ,0 52 R ur al 61 .7 15 .0 3. 8 3. 4 1. 1 11 .5 0. 8 1. 6 0. 6 0. 6 10 0. 0 14 .5 7. 9 13 ,9 41 Lo ca l G ov er nm en t A re a B an ju l 51 .3 23 .0 4. 5 2. 8 0. 4 13 .1 0. 8 3. 0 0. 5 0. 7 10 0. 0 17 .5 9. 2 40 4 K an ifi ng 54 .8 18 .9 3. 7 3. 8 0. 5 13 .2 0. 9 2. 0 1. 3 0. 8 10 0. 0 17 .5 8. 6 4, 45 3 B rik am a 61 .3 13 .9 3. 3 3. 8 0. 9 12 .2 1. 1 1. 9 0. 8 0. 8 10 0. 0 16 .0 8. 0 8, 61 0 M an sa ko nk o 55 .7 19 .2 3. 2 3. 3 0. 8 15 .0 0. 4 1. 0 0. 3 1. 2 10 0. 0 16 .6 5. 6 1, 46 3 K er ew an 59 .5 15 .4 3. 0 3. 3 0. 8 14 .1 1. 1 1. 8 0. 5 0. 5 10 0. 0 17 .5 7. 2 3, 31 6 K un ta ur 68 .3 10 .5 2. 2 3. 2 0. 9 11 .6 0. 9 1. 6 0. 2 0. 6 10 0. 0 14 .3 5. 8 1, 82 6 Ja nj an bu re h 59 .1 16 .0 4. 0 4. 0 1. 3 12 .1 1. 2 1. 3 0. 8 0. 4 10 0. 0 15 .3 8. 5 2, 15 6 B as se 62 .9 18 .5 5. 6 2. 2 0. 8 7. 4 0. 5 0. 8 0. 7 0. 5 10 0. 0 9. 5 8. 5 3, 76 5 W ea lth q ui nt ile Lo w es t 61 .4 13 .3 4. 9 2. 9 1. 4 11 .9 1. 0 1. 5 1. 0 0. 7 10 0. 0 15 .4 9. 8 5, 54 4 S ec on d 62 .4 14 .4 3. 3 3. 3 1. 0 12 .1 0. 8 1. 7 0. 4 0. 6 10 0. 0 15 .1 7. 1 5, 60 2 M id dl e 60 .2 16 .4 3. 2 4. 5 0. 7 11 .1 0. 9 1. 6 0. 6 0. 7 10 0. 0 14 .3 7. 1 5, 47 5 Fo ur th 62 .7 15 .4 2. 9 2. 9 0. 7 10 .9 1. 0 1. 7 0. 9 0. 9 10 0. 0 14 .5 7. 2 4, 96 9 H ig he st 51 .9 21 .5 4. 0 3. 4 0. 2 14 .6 1. 1 1. 7 0. 8 0. 7 10 0. 0 18 .2 7. 9 4, 40 3 To ta l < 15 61 .9 16 .9 3. 2 3. 3 0. 7 10 .9 0. 8 1. 3 0. 6 0. 4 10 0. 0 13 .6 6. 6 23 ,0 93 To ta l < 18 60 .0 16 .0 3. 6 3. 4 0. 8 12 .1 0. 9 1. 6 0. 8 0. 7 10 0. 0 15 .4 7. 8 25 ,9 93 N ot e: T ab le is b as ed o n de ju re h ou se ho ld m em be rs (i .e ., us ua l r es id en ts ). 1 I nc lu de s ch ild re n w ith fa th er d ea d, m ot he r d ea d, b ot h de ad , a nd o ne p ar en t d ea d bu t m is si ng in fo rm at io n on th e su rv iv al s ta tu s of th e ot he r p ar en t 22 • Housing Characteristics and Household Population Housing Characteristics and Household Population • 23 2.8 EDUCATION OF THE HOUSEHOLD POPULATION Education is a key determinant of individual opportunities, attitudes, and economic and social status. Studies have consistently shown that educational attainment has a strong effect on reproductive behaviour, fertility, infant and child mortality and morbidity, and attitudes and awareness related to family health, use of family planning, and sanitation. The 2013 GDHS collected data on educational attainment among household members and school attendance among youth. In The Gambia, the basic structure of the education system includes preschool, lower basic education (grades 1-6), upper basic education (grades 7-9), senior secondary education (grades 10-12), and postsecondary or tertiary education (grades higher than 12). Tertiary education covers all postsecondary education programmes, particularly technical education, teacher education, university education, and research. The official age of school enrolment is 7 years. 2.8.1 School Attendance by Survivorship of Parents The survival status of parents has an impact on their children’s school attendance. Table 2.11 shows the percentage of children age 10-14 attending school by parental survival, along with the ratio of attendance by parental survival, according to background characteristics. Children with both parents dead are less likely to attend school (67 percent) than children who have both parents alive and who are living with at least one parent (74 percent), resulting in a ratio of 0.90 between the percentage of children with both parents deceased and the percentage with both parents alive and living with a parent. Table 2.11 School attendance by survivorship of parents Among de jure children age 10-14, the percentage attending school by parental survival and the ratio of the percentage attending by parental survival, according to background characteristics, The Gambia 2013 Percentage attending school by survivorship of parents Background characteristic Both parents deceased Number Both parents alive and living with at least one parent Number Ratio1 Sex Male (66.7) 43 75.4 2,265 0.88 Female (66.9) 30 73.0 2,229 0.92 Residence Urban (71.2) 37 84.7 2,091 0.84 Rural (62.3) 36 65.1 2,403 0.96 Local Government Area Banjul * 1 89.7 68 0.65 Kanifing * 25 85.6 752 0.82 Brikama * 20 84.3 1,463 0.85 Mansakonko * 2 83.2 270 1.20 Kerewan * 6 66.6 583 1.00 Kuntaur * 1 45.4 337 0.00 Janjanbureh * 3 57.1 349 0.82 Basse * 14 64.3 671 0.88 Wealth quintile Lowest * 13 66.6 921 1.30 Second * 11 66.7 934 0.82 Middle * 14 68.8 982 0.56 Fourth * 19 79.9 933 0.87 Highest * 15 93.6 724 0.86 Total 66.8 73 74.2 4,494 0.90 Notes: Table is based only on children who usually live in the household. Figures in parentheses are based on 25-49 unweighted cases. An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. 1 Ratio of the percentage with both parents deceased to the percentage with both parents alive and living with a parent 24 • Housing Characteristics and Household Population 2.8.2 Educational Attainment The 2013 GDHS results can be used to look at educational attainment among household members and school attendance ratios among youth. Tables 2.12.1 and 2.12.2 show the percent distribution of the de facto female and male household population age 6 and older by highest level of education attended or completed, according to background characteristics. A comparison of the two tables reveals that there is a substantial gap in educational attainment between females and males. There are proportionally more females than males with no education (52 percent versus 43 percent). By contrast, a higher percentage of males than females have attended or completed secondary school (27 percent versus 21 percent) or have more than a secondary education (5 percent versus 3 percent). The gap in the proportion of females and males who have no education exists for all age categories other than the 6-9 age group, wherein females are slightly less likely to have no education than males (57 percent versus 58 percent). The disparity is highest in the 55-59 age group, with a gap of 30 percentage points (93 percent of women in this age group have no education, as compared with 63 percent of men). Educational attainment differs markedly by residence and among LGAs. Forty-one percent of females and 33 percent of males in urban areas have no education, as compared with 62 percent of females and 54 percent of males in rural areas. By LGA, the largest proportion of the household population over age 6 that has never been to school is found in Kuntaur (72 percent for both females and males). Banjul has the lowest proportion of household members who have never attended school (33 percent of females and 30 percent of males). The percentage of males and females with no education is inversely associated with wealth. For example, the percentage of females with no education decreases from 63 percent among those in the lowest wealth quintile to 30 percent among those in the highest quintile. Nationally, the median number of years of schooling completed is slightly higher for males (1.1 years) than females (0.0 years). Median number of years of schooling completed is highest among females age 15-24 and males age 20-29, among urban residents, among those in Banjul and Kanifing, and among those in the highest wealth quintile. H ou si ng C ha ra ct er is tic s an d H ou se ho ld P op ul at io n • 2 5 Ta bl e 2. 12 .1 E du ca tio na l a tta in m en t o f t he fe m al e ho us eh ol d po pu la tio n P er ce nt d is tri bu tio n of th e de fa ct o fe m al e ho us eh ol d po pu la tio n ag e 6 an d ov er b y hi gh es t l ev el o f s ch oo lin g at te nd ed o r c om pl et ed a nd m ed ia n ye ar s co m pl et ed , a cc or di ng to b ac kg ro un d ch ar ac te ris tic s, T he G am bi a 20 13 B ac kg ro un d ch ar ac te ris tic N o ed uc at io n S om e pr im ar y C om pl et ed pr im ar y1 S om e se co nd ar y C om pl et ed se co nd ar y2 M or e th an se co nd ar y D on ’t kn ow / m is si ng To ta l N um be r M ed ia n ye ar s co m pl et ed A ge 6- 9 56 .6 42 .9 0. 1 0. 0 0. 0 0. 0 0. 5 10 0. 0 3, 16 5 0. 0 10 -1 4 25 .8 60 .7 3. 7 9. 2 0. 4 0. 0 0. 3 10 0. 0 3, 20 1 2. 3 15 -1 9 24 .8 13 .9 7. 1 49 .8 2. 9 1. 1 0. 3 10 0. 0 2, 66 2 6. 2 20 -2 4 32 .2 6. 6 5. 1 31 .0 16 .7 8. 3 0. 1 10 0. 0 2, 32 6 7. 6 25 -2 9 47 .6 7. 9 4. 2 19 .6 11 .7 8. 4 0. 5 10 0. 0 2, 04 6 2. 9 30 -3 4 58 .7 7. 9 4. 6 14 .2 9. 1 5. 5 0. 1 10 0. 0 1, 67 0 0. 0 35 -3 9 68 .4 7. 4 4. 8 9. 7 5. 3 4. 2 0. 3 10 0. 0 1, 20 0 0. 0 40 -4 4 74 .5 3. 2 5. 4 10 .5 2. 5 3. 5 0. 5 10 0. 0 83 6 0. 0 45 -4 9 80 .0 2. 5 4. 3 7. 0 2. 6 3. 1 0. 3 10 0. 0 62 3 0. 0 50 -5 4 90 .3 2. 7 0. 8 3. 4 1. 5 1. 0 0. 4 10 0. 0 1, 04 0 0. 0 55 -5 9 92 .8 1. 1 1. 0 2. 9 1. 3 0. 8 0. 1 10 0. 0 49 8 0. 0 60 -6 4 92 .8 0. 3 1. 4 1. 2 1. 5 2. 5 0. 3 10 0. 0 48 0 0. 0 65 + 94 .2 0. 3 0. 6 1. 3 0. 6 1. 7 1. 3 10 0. 0 92 5 0. 0 R es id en ce U rb an 41 .1 19 .0 4. 1 21 .9 8. 1 5. 5 0. 3 10 0. 0 10 ,5 70 2. 2 R ur al 62 .3 22 .5 3. 1 9. 7 1. 5 0. 5 0. 5 10 0. 0 10 ,1 11 0. 0 Lo ca l G ov er nm en t A re a B an ju l 32 .9 17 .9 4. 4 26 .2 11 .3 6. 7 0. 5 10 0. 0 41 4 4. 7 K an ifi ng 37 .4 19 .4 3. 8 22 .8 10 .0 6. 5 0. 2 10 0. 0 4, 17 6 3. 3 B rik am a 44 .3 20 .5 4. 5 20 .0 6. 1 4. 1 0. 4 10 0. 0 6, 90 6 1. 0 M an sa ko nk o 53 .1 26 .6 3. 5 13 .0 2. 3 1. 1 0. 4 10 0. 0 1, 11 0 0. 0 K er ew an 63 .0 20 .5 2. 8 10 .7 2. 2 0. 4 0. 4 10 0. 0 2, 47 2 0. 0 K un ta ur 72 .0 16 .5 2. 6 7. 8 0. 7 0. 1 0. 4 10 0. 0 1, 25 8 0. 0 Ja nj an bu re h 62 .9 19 .6 2. 8 12 .1 1. 2 0. 9 0. 5 10 0. 0 1, 65 6 0. 0 B as se 67 .0 24 .1 2. 7 5. 5 0. 3 0. 2 0. 3 10 0. 0 2, 68 9 0. 0 W ea lth q ui nt ile Lo w es t 62 .8 22 .4 3. 1 9. 5 1. 5 0. 2 0. 5 10 0. 0 4, 05 6 0. 0 S ec on d 60 .7 22 .0 3. 3 11 .0 1. 8 0. 8 0. 4 10 0. 0 4, 08 0 0. 0 M id dl e 58 .9 21 .3 3. 6 13 .0 2. 1 0. 7 0. 3 10 0. 0 4, 08 4 0. 0 Fo ur th 46 .8 20 .8 4. 1 19 .8 5. 3 3. 0 0. 3 10 0. 0 3, 99 8 0. 3 H ig he st 30 .2 17 .4 3. 9 25 .5 12 .8 9. 9 0. 3 10 0. 0 4, 46 4 5. 5 To ta l 51 .5 20 .7 3. 6 15 .9 4. 9 3. 0 0. 4 10 0. 0 20 ,6 81 0. 0 N ot e: T ot al in cl ud es 8 c as es fo r w ho m in fo rm at io n on a ge is m is si ng . 1 C om pl et ed g ra de 6 a t t he p rim ar y le ve l 2 C om pl et ed g ra de 1 2 at th e se co nd ar y le ve l Housing Characteristics and Household Population • 25 26 • H ou si ng C ha ra ct er is tic s an d H ou se ho ld P op ul at io n Ta bl e 2. 12 .2 E du ca tio na l a tta in m en t o f t he m al e ho us eh ol d po pu la tio n P er ce nt d is tri bu tio n of th e de fa ct o m al e ho us eh ol d po pu la tio n ag e 6 an d ov er b y hi gh es t l ev el o f s ch oo lin g at te nd ed o r c om pl et ed a nd m ed ia n ye ar s co m pl et ed , a cc or di ng to b ac kg ro un d ch ar ac te ris tic s, T he G am bi a 20 13 B ac kg ro un d ch ar ac te ris tic N o ed uc at io n S om e pr im ar y C om pl et ed pr im ar y1 S om e se co nd ar y C om pl et ed se co nd ar y2 M or e th an se co nd ar y D on ’t kn ow / m is si ng To ta l N um be r M ed ia n ye ar s co m pl et ed A ge 6- 9 57 .6 41 .9 0. 0 0. 0 0. 0 0. 0 0. 5 10 0. 0 3, 23 7 0. 0 10 -1 4 24 .0 62 .7 3. 7 9. 1 0. 2 0. 0 0. 2 10 0. 0 3, 06 2 2. 2 15 -1 9 21 .9 15 .7 6. 8 52 .2 2. 6 0. 6 0. 1 10 0. 0 2, 45 8 6. 3 20 -2 4 24 .0 7. 2 4. 7 36 .4 19 .0 8. 4 0. 4 10 0. 0 2, 03 9 8. 3 25 -2 9 34 .3 5. 6 3. 8 22 .3 21 .6 12 .2 0. 1 10 0. 0 1, 61 6 8. 1 30 -3 4 43 .1 4. 3 5. 1 18 .6 19 .3 9. 4 0. 2 10 0. 0 1, 32 3 5. 5 35 -3 9 43 .5 6. 6 6. 4 18 .6 17 .2 7. 1 0. 5 10 0. 0 1, 07 7 4. 8 40 -4 4 54 .5 4. 2 4. 8 17 .6 9. 6 9. 0 0. 3 10 0. 0 89 9 0. 0 45 -4 9 60 .5 3. 6 5. 0 13 .7 9. 5 7. 2 0. 5 10 0. 0 68 4 0. 0 50 -5 4 65 .6 3. 0 2. 1 9. 1 7. 5 11 .2 1. 5 10 0. 0 49 5 0. 0 55 -5 9 63 .2 6. 7 4. 9 7. 6 8. 7 8. 3 0. 7 10 0. 0 36 7 0. 0 60 -6 4 81 .6 1. 8 1. 4 6. 4 3. 2 4. 7 0. 8 10 0. 0 54 1 0. 0 65 + 89 .8 0. 7 0. 3 2. 0 3. 0 3. 3 1. 0 10 0. 0 93 9 0. 0 R es id en ce U rb an 32 .6 20 .1 4. 2 23 .9 11 .9 6. 9 0. 4 10 0. 0 10 ,1 22 4. 2 R ur al 54 .2 24 .5 3. 1 12 .4 3. 6 1. 8 0. 4 10 0. 0 8, 62 1 0. 0 Lo ca l G ov er nm en t A re a B an ju l 30 .1 18 .1 5. 0 26 .9 13 .1 6. 5 0. 4 10 0. 0 40 6 5. 3 K an ifi ng 31 .8 19 .5 3. 6 23 .5 12 .6 8. 5 0. 6 10 0. 0 3, 78 8 4. 6 B rik am a 33 .6 22 .0 4. 3 23 .8 10 .5 5. 5 0. 3 10 0. 0 6, 90 5 3. 5 M an sa ko nk o 39 .8 29 .9 3. 9 17 .2 5. 6 3. 3 0. 3 10 0. 0 94 6 0. 9 K er ew an 51 .0 25 .2 3. 7 13 .6 4. 2 2. 0 0. 3 10 0. 0 2, 11 8 0. 0 K un ta ur 72 .0 15 .3 2. 2 7. 2 1. 9 0. 6 0. 7 10 0. 0 1, 03 6 0. 0 Ja nj an bu re h 58 .3 18 .9 3. 4 12 .5 4. 0 2. 5 0. 4 10 0. 0 1, 38 1 0. 0 B as se 61 .1 26 .6 2. 4 6. 9 1. 9 0. 7 0. 3 10 0. 0 2, 16 4 0. 0 W ea lth q ui nt ile Lo w es t 53 .8 24 .6 3. 5 12 .8 3. 8 1. 2 0. 4 10 0. 0 3, 51 5 0. 0 S ec on d 51 .6 24 .6 3. 1 14 .1 4. 0 2. 1 0. 5 10 0. 0 3, 55 0 0. 0 M id dl e 48 .6 22 .8 3. 7 16 .4 5. 7 2. 5 0. 4 10 0. 0 3, 72 3 0. 0 Fo ur th 38 .4 20 .4 4. 4 22 .9 9. 0 4. 6 0. 4 10 0. 0 4, 01 8 2. 7 H ig he st 22 .8 18 .8 3. 6 25 .8 16 .9 11 .8 0. 4 10 0. 0 3, 93 7 6. 9 To ta l 42 .5 22 .1 3. 7 18 .6 8. 1 4. 6 0. 4 10 0. 0 18 ,7 44 1. 1 N ot e: T ot al in cl ud es 5 c as es fo r w ho m in fo rm at io n on a ge is m is si ng . 1 C om pl et ed g ra de 6 a t t he p rim ar y le ve l 2 C om pl et ed g ra de 1 2 at th e se co nd ar y le ve l 26 • Housing Characteristics and Household Population Housing Characteristics and Household Population • 27 2.8.3 School Attendance Ratios Table 2.13 shows data on net attendance ratios (NARs) and gross attendance ratios (GARs) for the de facto household population by school level and sex, according to residence, region, and wealth index. The NAR for primary school is the total number of students of primary school age (age 7-12), expressed as the percentage of the population of primary school age. The NAR for secondary school is the percentage of the population of secondary school age (age 13-18) that attends secondary school. By definition, the NAR cannot exceed 100 percent. Table 2.13 School attendance ratios Net attendance ratios (NARs) and gross attendance ratios (GARs) for the de facto household population by sex and level of schooling, and the Gender Parity Index (GPI), according to background characteristics, The Gambia 2013 Net attendance ratio1 Gross attendance ratio2 Background characteristic Male Female Total Gender Parity Index3 Male Female Total Gender Parity Index3 PRIMARY SCHOOL Residence Urban 73.4 72.6 73.0 0.99 96.7 97.0 96.8 1.00 Rural 57.8 61.3 59.5 1.06 83.8 83.5 83.7 1.00 Local Government Area Banjul 76.5 79.6 78.0 1.04 99.3 108.8 104.0 1.10 Kanifing 73.7 77.2 75.4 1.05 98.5 101.5 100.0 1.03 Brikama 72.7 71.2 72.0 0.98 99.4 95.4 97.5 0.96 Mansakonko 73.2 76.9 75.0 1.05 104.0 102.5 103.3 0.99 Kerewan 60.8 58.2 59.6 0.96 84.7 83.8 84.3 0.99 Kuntaur 35.7 44.2 40.0 1.24 51.7 61.2 56.5 1.18 Janjanbureh 52.0 53.6 52.8 1.03 73.2 74.2 73.7 1.01 Basse 56.9 63.7 60.3 1.12 82.1 84.3 83.2 1.03 Wealth quintile Lowest 60.8 61.1 61.0 1.00 88.2 80.8 84.4 0.92 Second 59.1 62.4 60.7 1.06 84.3 85.0 84.7 1.01 Middle 60.5 62.6 61.5 1.04 81.4 86.7 83.9 1.07 Fourth 69.0 72.7 70.8 1.05 95.0 95.8 95.4 1.01 Highest 78.8 76.3 77.6 0.97 103.6 104.0 103.8 1.00 Total 64.8 66.4 65.6 1.02 89.6 89.5 89.6 1.00 SECONDARY SCHOOL Residence Urban 53.7 50.0 51.8 0.93 72.4 65.0 68.6 0.90 Rural 31.5 26.4 28.8 0.84 46.0 32.9 39.1 0.71 Local Government Area Banjul 55.0 63.0 59.3 1.15 75.0 76.4 75.8 1.02 Kanifing 53.1 52.6 52.8 0.99 72.3 65.9 68.9 0.91 Brikama 51.4 45.6 48.5 0.89 70.1 61.1 65.7 0.87 Mansakonko 45.4 37.5 41.5 0.83 63.7 46.1 55.1 0.72 Kerewan 36.3 32.2 34.1 0.89 54.5 40.4 47.0 0.74 Kuntaur 23.7 26.0 25.0 1.10 34.1 33.8 33.9 0.99 Janjanbureh 34.7 34.5 34.6 0.99 51.5 42.2 46.0 0.82 Basse 19.3 10.3 14.4 0.53 25.3 12.7 18.5 0.50 Wealth quintile Lowest 35.7 26.6 30.8 0.75 53.5 32.5 42.2 0.61 Second 32.5 31.4 32.0 0.97 46.0 38.1 42.0 0.83 Middle 34.7 29.7 32.0 0.86 51.7 38.8 44.8 0.75 Fourth 47.7 44.4 46.1 0.93 61.6 58.6 60.2 0.95 Highest 65.8 59.4 62.2 0.90 87.9 77.4 82.1 0.88 Total 43.5 38.8 41.0 0.89 60.3 49.8 54.8 0.83 1 The NAR for primary school is the percentage of the primary school age (7-12 years) population that is attending primary school. The NAR for secondary school is the percentage of the secondary school age (13-18 years) population that is attending secondary school. By definition, the NAR cannot exceed 100 percent. 2 The GAR for primary school is the total number of primary school students expressed as a percentage of the official primary school age population. The GAR for secondary school is the total number of secondary school students expressed as a percentage of the official secondary school age population. If there are significant numbers of overage and underage students at a given level of schooling, the GAR can exceed 100 percent. 3 The Gender Parity Index for primary school is the ratio of the primary school NAR (GAR) for females to the NAR (GAR) for males. The Gender Parity Index for secondary school is the ratio of the secondary school NAR(GAR) for females to the NAR (GAR) for males. 28 • Housing Characteristics and Household Population The GAR for primary school is the total number of primary school students of any age, expressed as a percentage of the official primary school age population. The GAR for secondary school is the total number of secondary school students of any age, expressed as a percentage of the official secondary school age population. If there are significant numbers of overage and underage students at a given level of schooling, the GAR can exceed 100 percent. Finally, the gender parity index (GPI), which is the ratio of female to male attendance rates at the primary and secondary levels, indicates the magnitude of the gender gap in school attendance. A GPI below one indicates that a smaller proportion of females than males attend school. Individuals are considered to be attending school currently if they attended formal academic school at any point during the school year. The results in Table 2.13 show that 66 percent of primary school age children attend primary school (65 percent of males and 66 percent of females) and that 41 percent of secondary school age youth attend secondary school (44 percent of males and 39 percent of females). At both levels, the NAR is much higher in urban areas than in rural areas (73 percent and 60 percent, respectively, at the primary school level and 52 percent and 29 percent, respectively, at the secondary school level). There are also large differences by LGA. For example, at the primary level, Banjul has the highest NAR (78 percent) and Kuntaur has the lowest (40 percent). At the secondary level, the NAR ranges from 14 percent in Basse to 59 percent in Banjul. The NAR is highest among children in the wealthiest households (78 percent at the primary level and 62 percent at the secondary level). The GAR at the primary school level is 90 percent. This figure exceeds the primary school NAR (66 percent) by 24 percentage points, indicating that a large number of children outside the official school age population are attending primary school. At the secondary level, the GAR (55 percent) is somewhat closer to the NAR (41 percent), indicating that fewer youth outside of the official school age population are attending secondary school than is the case for primary school. At the primary school level, the GPI is 1.02 for the NAR and 1.00 for the GAR, indicating that there is gender parity in primary school. However, at the secondary school level, the GPI is 0.89 for the NAR and 0.83 for the GAR, pointing to gender disparity in favour of males. This disparity is especially pronounced in rural areas. The GPI associated with the secondary school NAR is 0.84 in rural areas, as compared with 0.93 in urban areas; the GPI associated with the secondary school GAR is 0.71 and 0.90 in rural areas and urban areas, respectively. Large GPI differences are also observed according to LGA and wealth. The GPI for the NAR and GAR at the secondary school level is lowest among children living in Basse (0.53 and 0.50, respectively) and among children in the poorest households (0.75 and 0.61, respectively). Housing Characteristics and Household Population • 29 Figure 2.2 shows the age-specific attendance rates (ASARs) for the population age 5 and over, by sex. The ASAR indicates participation in schooling at any level, from primary to higher levels of education. At age 5 and age 6, attendance among males (8 percent and 22 percent, respectively) is higher than that among females (6 percent and 20 percent, respectively). However, from age 7 to age 9, female attendance is higher than male attendance. Attendance peaks at age 11 for males and age 12 for females. As school attendance begins to decline from age 14 onward, the gender differential increases, with more male than female youths attending. Figure 2.2 Age-specific attendance rates 8 22 45 62 65 74 75 72 72 70 67 67 60 49 48 33 23 21 16 16 6 20 47 63 73 71 71 76 73 69 60 60 44 40 37 18 17 16 7 7 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 Percentage Age Male Female GDHS 2013 2.9 DISABILITY In the 2013 GDHS, the Household Questionnaire asked if any household member(s) age 7 to age 69 had any form of disability and, if so, what type of disability. The objective of these questions was to provide estimates of the prevalence of physical disability among the household population, which are important for policy formulation and programmatic interventions. For example, disaggregating physical disability prevalence by LGA allows identification of areas in The Gambia where the problem is more common and, consequently, targeting of those areas with educational and rehabilitation programmes. Table 2.14 shows the prevalence of physical disability among the de facto household population by various background characteristics, such as age, sex, residence, LGA, education, and wealth, according to type of disability. The total prevalence of any physical disability among household members age 7-69 is 3 percent; 2 percent have difficulty seeing, less than 1 percent have difficulty hearing, and slightly over 1 percent have difficulty using their legs. Very few household members age 7-69 (less than 1 percent) use crutches, canes, or a wheelchair. Physical disability increases with increasing age, reaching its peak at 13 percent among individuals age 55-64. There are no major variations by sex, residence, or wealth. The prevalence of physical disability is lowest among those living in Basse (1 percent) and highest among those living in Banjul and Janjanbureh (6 percent each). In addition, physical disability is most common among individuals with no education and those in the lowest wealth quintile (4 percent each). 30 • Housing Characteristics and Household Population Table 2.14 Prevalence of physical disability Percentage of de facto household members age 7-69 with a reported physical disability1 by type of disability, according to background characteristics, The Gambia 2013 Type of disability Any disability Use crutches, canes, or wheelchair Number Background characteristic Difficulty seeing Difficulty hearing Difficulty using the legs Age 7-14 0.4 0.2 0.2 0.9 0.0 10,830 15-24 0.8 0.3 0.3 1.4 0.0 9,486 25-34 1.0 0.4 1.1 2.3 0.1 6,657 35-44 1.9 0.6 1.4 3.5 0.1 4,012 45-54 4.4 1.1 3.8 7.7 0.2 2,842 55-64 6.8 1.9 6.7 12.8 0.8 1,887 65+ 2.4 1.2 3.5 5.7 0.7 1,864 Sex Male 1.3 0.5 1.0 2.6 0.2 17,827 Female 1.7 0.5 1.5 3.2 0.1 19,763 Residence Urban 1.4 0.5 1.4 2.9 0.2 19,856 Rural 1.6 0.5 1.2 2.9 0.1 17,734 Local Government Area Banjul 2.9 0.8 2.9 5.6 0.2 795 Kanifing 1.8 0.4 1.4 3.2 0.1 7,648 Brikama 1.3 0.5 1.1 2.5 0.1 13,190 Mansakonko 0.9 0.3 0.5 1.6 0.1 1,958 Kerewan 2.0 0.6 2.2 4.1 0.2 4,373 Kuntaur 1.4 0.4 1.0 2.3 0.1 2,158 Janjanbureh 3.1 1.6 2.2 5.6 0.1 2,877 Basse 0.3 0.3 0.5 1.0 0.2 4,591 Education No education 1.9 0.7 1.9 3.8 0.2 17,108 Primary 0.8 0.3 0.6 1.5 0.0 9,554 Secondary or higher 1.5 0.5 1.0 2.6 0.1 10,792 Wealth quintile Lowest 1.9 0.7 1.4 3.5 0.2 7,133 Second 1.6 0.4 1.3 2.9 0.1 7,264 Middle 1.2 0.5 1.1 2.4 0.2 7,420 Fourth 1.0 0.5 1.1 2.3 0.1 7,669 Highest 1.8 0.5 1.5 3.4 0.1 8,104 Total 1.5 0.5 1.3 2.9 0.1 37,590 Note: Total includes 13 cases for whom information on age is missing and 136 cases for whom information on education level is missing. 1 Disability as reported by the respondent on the Household Questionnaire Characteristics of Respondents • 31 CHARACTERISTICS OF RESPONDENTS 3 his chapter provides a demographic and socioeconomic profile of the respondents interviewed in the 2013 GDHS, that is, women and men age 15-49. Information is presented on a number of basic characteristics including age at the time of the survey, religion, marital status, residence, education, literacy, media access, smoking status, and health insurance coverage. In addition, the chapter explores adults’ employment status, occupation, and earnings. An analysis of these variables provides the socioeconomic context within which demographic and reproductive health issues are examined in the subsequent chapters. 3.1 CHARACTERISTICS OF SURVEY RESPONDENTS Table 3.1 presents the percent distribution of women and men age 15-49 by age, marital status, residence, Local Government Area (LGA), education, wealth, religion, and ethnicity. The distribution of the respondents according to age shows a generally similar pattern for men and women. As expected, the proportion of women and men in each age group declines with increasing age. Forty-four percent of women and 47 percent of men are in the 15-24 age group, 33 percent of women and 28 percent of men are age 25-34, and the remaining respondents are age 35-49. Sixty-six percent of women are currently married, as compared with 38 percent of men. On the other hand, 61 percent of men age 15-49 have never been married, compared with 29 percent of women. About 2 percent of women are widowed and 3 percent are either divorced or separated. Among men, these proportions are 1 percent or lower. Overall, 56 percent of women and 62 percent of men live in urban areas, while 44 percent and 38 percent, respectively, live in rural areas. Within the eight LGAs, Brikama has the largest proportions of both female and male respondents (35 percent and 41 percent, respectively), and Banjul has the smallest proportions (2 percent each). T Key Findings • Sixty-six percent of women and 38 percent of men are married, while 5 percent of women and 1 percent of men are divorced, separated, or widowed. • Forty-seven percent of women have no education, as compared with 31 percent of men. • A large majority of the respondents (96 percent of both women and men) are Muslims. • The majority of the respondents are members of the Mandinka/Jahanka ethnic group (34 percent of women and 35 percent of men), followed by the Fula/Tukulur/Lorobo ethnic group (22 percent of women and 23 percent of men). • Literacy rates are 45 percent for women and 70 percent for men. • Thirty percent of women and 16 percent of men do not have weekly access to newspapers, television, or a radio. • Ten percent of women working in agriculture are not paid. • Twenty-two percent of men age 15-49 use tobacco products. 32 • Characteristics of Respondents Table 3.1 Background characteristics of respondents Percent distribution of women and men age 15-49 by selected background characteristics, The Gambia 2013 Women Men Background characteristic Weighted percentage Weighted number Unweighted number Weighted percentage Weighted number Unweighted number Age 15-19 23.5 2,407 2,463 23.4 836 867 20-24 20.8 2,125 2,101 23.7 849 789 25-29 17.8 1,822 1,755 16.4 586 547 30-34 14.7 1,504 1,480 11.9 425 399 35-39 10.3 1,056 1,098 10.9 391 385 40-44 7.4 761 765 7.6 270 274 45-49 5.5 559 571 6.2 220 261 Religion Islam 95.7 9,793 9,916 95.9 3,430 3,425 Christianity 4.2 427 302 4.0 144 93 No religion 0.1 6 3 0.0 2 2 Missing 0.1 6 12 0.0 1 2 Ethnic group Mandinka/Jahanka 33.8 3,462 3,366 34.5 1,234 1,153 Wollof 12.2 1,253 1,387 13.6 485 484 Jola/Karoninka 10.9 1,119 851 10.0 359 278 Fula/Tukulur/Lorobo 22.1 2,262 2,470 23.1 826 901 Serere 3.2 323 388 3.3 117 111 Serahuleh 7.0 714 744 5.4 192 208 Creole/Aku Marabout 0.8 79 88 0.6 21 33 Manjago 2.1 218 143 2.1 74 49 Bambara 1.0 107 123 1.1 38 52 Other 0.9 95 105 1.0 35 38 Non-Gambian 5.2 528 479 5.3 191 212 Missing 0.7 72 89 0.1 5 3 Marital status Never married 29.0 2,963 2,866 60.9 2,177 2,093 Married 66.1 6,764 6,871 38.0 1,358 1,385 Living together 0.3 27 34 0.1 2 3 Divorced/separated 3.2 326 321 1.1 38 37 Widowed 1.5 153 141 0.1 2 4 Residence Urban 56.0 5,730 4,498 62.3 2,228 1,692 Rural 44.0 4,503 5,735 37.7 1,349 1,830 Local Government Area Banjul 2.2 225 1,073 2.4 85 411 Kanifing 22.9 2,342 1,506 24.0 858 553 Brikama 34.7 3,550 1,833 40.6 1,454 742 Mansakonko 4.8 490 1,041 3.9 141 339 Kerewan 10.8 1,107 1,448 9.0 323 455 Kuntaur 5.1 526 1,039 4.0 141 310 Janjanbureh 7.2 739 1,024 6.7 240 326 Basse 12.3 1,254 1,269 9.4 336 386 Education No education 46.5 4,757 5,079 30.5 1,090 1,229 Primary 13.7 1,405 1,438 13.8 493 512 Secondary 34.3 3,512 3,268 46.5 1,665 1,508 More than secondary 5.5 559 448 9.2 330 273 Wealth quintile Lowest 17.1 1,745 2,144 14.4 517 680 Second 18.4 1,882 2,251 17.2 614 747 Middle 18.8 1,927 1,991 16.4 588 621 Fourth 20.9 2,135 1,714 26.3 940 700 Highest 24.9 2,545 2,133 25.7 919 774 Total 15-49 100.0 10,233 10,233 100.0 3,577 3,522 50-59 na na na na 244 299 Total 15-59 na na na na 3,821 3,821 Note: Education categories refer to the highest level of education attended, whether or not that level was completed. na = Not applicable Characteristics of Respondents • 33 Table 3.1 also shows that men are more educated than women. Forty-seven percent of women age 15-49 have no education, as compared with 31 percent of men. Furthermore, 56 percent of men have a secondary education or higher, compared with 40 percent of women. About half of the respondents (46 percent of women and 52 percent of men) are in the highest two wealth quintiles, and the smallest proportions are in the lowest quintile (17 percent of women and 14 percent of men). The distribution of respondents by religion shows that the vast majority of both women and men (96 percent) believe in Islam, whereas 4 percent believe in Christianity. A negligible proportion of respondents (less than 1 percent) claimed to have no religion. Ethnic affiliation is associated with various demographic behaviours because of differences in cultural beliefs. For example, in The Gambia, certain ethnic groups encourage the practice of female genital cutting. Survey data show that the majority of the respondents are from the Mandinka/Jahanka ethnic group (34 percent of women and 35 percent of men), followed by the Fula/Tukulur/Lorobo ethnic group (22 percent of women and 23 percent of men). 3.2 EDUCATIONAL ATTAINMENT BY BACKGROUND CHARACTERISTICS Tables 3.2.1 and 3.2.2 summarise the educational attainment of women and men, respectively, by their highest level of schooling attended or completed according to background characteristics. Table 3.2.1 Educational attainment: Women Percent distribution of women age 15-49 by highest level of schooling attended or completed, and median years completed, according to background characteristics, The Gambia 2013 Highest level of schooling Total Median years completed Number of women Background characteristic No education Some primary Completed primary1 Some secondary Completed secondary2 More than secondary Age 15-24 27.9 10.2 6.4 41.5 9.0 5.0 100.0 6.7 4,532 15-19 23.9 13.4 7.8 50.7 3.1 1.3 100.0 6.4 2,407 20-24 32.5 6.6 4.9 31.1 15.7 9.3 100.0 7.5 2,125 25-29 47.9 8.4 4.5 20.0 10.7 8.5 100.0 2.7 1,822 30-34 58.0 8.2 4.2 14.9 9.0 5.8 100.0 0.0 1,504 35-39 69.4 6.8 4.8 9.5 5.0 4.4 100.0 0.0 1,056 40-44 74.8 2.8 6.0 11.0 1.8 3.6 100.0 0.0 761 45-49 79.8 2.5 4.6 7.4 2.9 2.8 100.0 0.0 559 Residence Urban 34.1 6.2 5.7 33.0 12.2 8.9 100.0 6.8 5,730 Rural 62.3 10.9 5.2 17.9 2.7 1.0 100.0 0.0 4,503 Local Government Area Banjul 25.7 7.4 4.3 38.0 14.1 10.5 100.0 8.3 225 Kanifing 31.5 5.9 4.9 33.0 14.6 10.3 100.0 7.4 2,342 Brikama 36.9 7.6 7.0 31.8 9.4 7.2 100.0 5.7 3,550 Mansakonko 51.4 11.7 6.0 24.1 4.7 2.0 100.0 0.0 490 Kerewan 60.0 9.3 4.5 20.5 4.6 1.0 100.0 0.0 1,107 Kuntaur 73.9 6.7 2.9 14.9 1.6 0.1 100.0 0.0 526 Janjanbureh 61.8 8.2 4.0 21.5 2.6 1.9 100.0 0.0 739 Basse 71.0 13.2 4.9 9.9 0.7 0.3 100.0 0.0 1,254 Wealth quintile Lowest 62.7 11.2 5.6 17.5 2.4 0.5 100.0 0.0 1,745 Second 59.1 9.2 5.5 21.2 3.5 1.5 100.0 0.0 1,882 Middle 56.8 10.4 5.9 21.8 3.7 1.4 100.0 0.0 1,927 Fourth 42.5 7.4 5.9 30.9 8.0 5.2 100.0 5.0 2,135 Highest 21.5 4.7 4.6 35.8 18.3 15.1 100.0 8.8 2,545 Total 46.5 8.3 5.5 26.3 8.0 5.5 100.0 3.2 10,233 1 Completed 6th grade at the primary level 2 Completed 12th grade at the secondary level 34 • Characteristics of Respondents Table 3.2.1 shows that 47 percent of women age 15-49 have no education. Fourteen percent have some primary education, 34 percent have some secondary education, and 6 percent have more than a secondary education. The percentage of women with no education increases steadily with age, from 24 percent among women age 15-19 to 80 percent among those age 45-49. A higher proportion of women in rural areas have no education (62 percent) than those in urban areas (34 percent). Fifty-four percent of urban women have attended or completed schooling at a secondary level or higher, as compared with only 22 percent of rural women. The percentage of women with no education ranges from a low of 26 percent in Banjul to a high of 74 percent in Kuntaur. The percentage of women with no education decreases steadily from 63 percent among the poorest women to 22 percent among those in the highest wealth quintile. By contrast, less than 1 percent of women in the lowest quintile have more than a secondary education, compared with 15 percent of women in the highest quintile. Table 3.2.2 shows that a much lower percentage of men than women have no education (31 percent versus 47 percent). Overall, patterns among men are similar to those among women. Men age 45- 49 are most likely to have no education (64 percent), whereas the youngest men (age 15-19) are least likely to have no education (18 percent). Twenty-one percent of urban men have no education, as compared with 47 percent of rural men. By LGA, the lowest percentage of men with no education is in Kanifing (19 percent), and the highest is in Kuntaur (67 percent). The percentage of uneducated men ranges from 13 percent among those in the highest wealth quintile to 43 percent among those in the lowest quintile. Table 3.2.2 Educational attainment: Men Percent distribution of men age 15-49 by highest level of schooling attended or completed, and median years completed, according to background characteristics, The Gambia 2013 Highest level of schooling Total Median years completed Number of men Background characteristic No education Some primary Completed primary1 Some secondary Completed secondary2 More than secondary Age 15-24 19.6 10.6 6.5 44.8 13.1 5.4 100.0 7.5 1,685 15-19 18.0 14.7 7.5 55.1 3.8 0.9 100.0 6.7 836 20-24 21.3 6.6 5.4 34.8 22.2 9.7 100.0 8.6 849 25-29 27.2 6.3 4.7 24.4 21.6 15.8 100.0 8.4 586 30-34 39.7 5.8 5.9 18.0 16.4 14.3 100.0 5.8 425 35-39 42.7 5.1 6.6 22.0 14.0 9.6 100.0 5.3 391 40-44 45.5 5.0 5.9 24.9 4.7 14.0 100.0 4.7 270 45-49 63.9 4.2 3.3 19.8 4.0 4.7 100.0 0.0 220 Residence Urban 20.6 6.3 5.7 37.0 18.2 12.2 100.0 8.6 2,228 Rural 46.8 10.5 6.1 25.8 6.5 4.3 100.0 2.8 1,349 Local Government Area Banjul 20.6 7.7 5.8 39.5 14.9 11.6 100.0 8.5 85 Kanifing 18.6 4.6 5.1 38.1 19.4 14.3 100.0 9.0 858 Brikama 22.6 7.8 5.9 37.8 15.9 10.1 100.0 8.1 1,454 Mansakonko 28.8 12.4 8.0 34.5 7.4 8.9 100.0 6.1 141 Kerewan 39.4 8.8 8.3 30.8 8.4 4.4 100.0 5.2 323 Kuntaur 67.4 7.6 3.6 16.6 3.3 1.6 100.0 0.0 141 Janjanbureh 47.7 7.6 6.2 20.6 11.1 6.8 100.0 3.0 240 Basse 61.8 14.7 5.3 12.6 4.1 1.6 100.0 0.0 336 Wealth quintile Lowest 43.1 11.8 7.4 27.7 7.3 2.7 100.0 4.1 517 Second 40.7 9.7 5.5 29.5 8.1 6.4 100.0 4.9 614 Middle 38.3 10.1 8.3 27.8 10.1 5.4 100.0 5.2 588 Fourth 29.4 6.3 4.5 36.2 14.3 9.4 100.0 7.8 940 Highest 12.6 4.6 5.2 37.4 23.1 17.0 100.0 9.9 919 Total 15-49 30.5 7.9 5.9 32.8 13.8 9.2 100.0 7.1 3,577 50-59 61.9 7.8 4.1 11.3 6.3 8.7 100.0 0.0 244 Total 15-59 32.5 7.9 5.8 31.4 13.3 9.2 100.0 6.7 3,821 1 Completed 6th grade at the primary level 2 Completed 12th grade at the secondary level Characteristics of Respondents • 35 3.3 LITERACY The ability to read and write is an important personal asset, increasing an individual’s opportunities in life. In addition, literacy statistics can help programme managers, especially those working in health and family planning, decide how to reach women and men with their messages. The literacy status of 2013 GDHS respondents was determined by assessing their ability to read all or part of a simple sentence from a card. The literacy test was administered only to respondents who had less than a secondary school education; those with a secondary education or higher were assumed to be literate. Tables 3.3.1 and 3.3.2, respectively, present literacy results for women and men age 15-49. Table 3.3.1 Literacy: Women Percent distribution of women age 15-49 by level of schooling attended and level of literacy, and percentage literate, according to background characteristics, The Gambia 2013 Background characteristic Secondary school or higher No schooling or primary school Total Percentage literate1 Number of women Can read a whole sentence Can read part of a sentence Cannot read at all No card with required language Missing Age 15-24 55.5 2.7 4.5 36.8 0.2 0.2 100.0 62.7 4,532 15-19 55.0 4.1 5.8 34.7 0.1 0.4 100.0 64.8 2,407 20-24 56.0 1.1 3.1 39.2 0.4 0.1 100.0 60.3 2,125 25-29 39.2 0.5 2.9 57.0 0.2 0.2 100.0 42.5 1,822 30-34 29.6 1.3 2.8 65.8 0.3 0.2 100.0 33.7 1,504 35-39 18.9 0.5 3.3 77.0 0.0 0.3 100.0 22.7 1,056 40-44 16.4 0.2 2.3 80.5 0.3 0.3 100.0 18.9 761 45-49 13.0 1.5 2.2 82.4 0.4 0.6 100.0 16.7 559 Residence Urban 54.1 2.1 3.2 40.1 0.3 0.2 100.0 59.3 5,730 Rural 21.6 1.0 4.0 72.9 0.1 0.3 100.0 26.7 4,503 Local Government Area Banjul 62.6 1.1 3.2 32.4 0.1 0.5 100.0 66.9 225 Kanifing 57.8 2.1 2.3 36.8 0.6 0.4 100.0 62.2 2,342 Brikama 48.4 2.0 4.1 45.0 0.3 0.2 100.0 54.5 3,550 Mansakonko 30.9 1.4 5.4 62.1 0.3 0.0 100.0 37.7 490 Kerewan 26.2 1.4 4.3 67.8 0.0 0.3 100.0 31.9 1,107 Kuntaur 16.6 1.1 3.2 78.8 0.0 0.3 100.0 20.9 526 Janjanbureh 26.0 0.8 2.7 70.3 0.0 0.2 100.0 29.5 739 Basse 10.8 0.8 3.7 84.6 0.0 0.1 100.0 15.4 1,254 Wealth quintile Lowest 20.5 1.3 3.7 73.8 0.4 0.4 100.0 25.4 1,745 Second 26.2 0.7 4.2 68.7 0.0 0.1 100.0 31.1 1,882 Middle 26.9 1.6 4.1 66.8 0.4 0.2 100.0 32.6 1,927 Fourth 44.2 1.8 3.3 50.1 0.4 0.2 100.0 49.3 2,135 Highest 69.2 2.3 2.8 25.4 0.1 0.3 100.0 74.3 2,545 Total 39.8 1.6 3.6 54.6 0.2 0.2 100.0 45.0 10,233 1 Refers to women who attended secondary school or higher and women who can read a whole sentence or part of a sentence The data reveal that men are more literate than women (70 percent versus 45 percent). Among both women and men, the percentage who are literate decreases with age. For example, 65 percent of women age 15-19 are literate, as compared with only 17 percent of women age 45-49. In addition, literacy is much more common in urban areas (59 percent of women and 80 percent of men) than in rural areas (27 percent of women and 53 percent of men). Only 15 percent of women in Basse are literate, as compared with 67 percent of women in Banjul. Similarly, literacy among men ranges from a low of 38 percent in Basse to a high of 81 percent in Banjul. Respondents in the lowest wealth quintile have the lowest level of literacy (25 percent of women and 55 percent of men). Literacy increases substantially with wealth to 74 percent of women and 88 percent of men in the highest wealth quintile. 36 • Characteristics of Respondents Table 3.3.2 Literacy: Men Percent distribution of men age 15-49 by level of schooling attended and level of literacy, and percentage literate, according to background characteristics, The Gambia 2013 Background characteristic Secondary school or higher No schooling or primary school Total Per- centage literate1 Number of men Can read a whole sentence Can read part of a sentence Cannot read at all No card with required language Blind/ visually impaired Missing Age 15-24 63.3 2.8 10.6 22.5 0.1 0.0 0.6 100.0 76.7 1,685 15-19 59.9 4.0 12.5 22.7 0.1 0.0 0.8 100.0 76.4 836 20-24 66.7 1.7 8.7 22.2 0.2 0.0 0.5 100.0 77.1 849 25-29 61.8 1.4 8.0 27.5 0.4 0.0 0.8 100.0 71.2 586 30-34 48.6 3.8 11.8 35.3 0.5 0.0 0.0 100.0 64.2 425 35-39 45.5 3.4 16.0 34.7 0.1 0.0 0.3 100.0 64.9 391 40-44 43.6 3.7 14.6 36.3 1.1 0.0 0.7 100.0 61.9 270 45-49 28.6 5.1 10.0 55.8 0.0 0.0 0.6 100.0 43.7 220 Residence Urban 67.4 2.7 10.2 18.8 0.4 0.0 0.5 100.0 80.2 2,228 Rural 36.6 3.4 12.8 46.5 0.1 0.0 0.6 100.0 52.8 1,349 Local Government Area Banjul 66.0 4.9 9.6 18.0 0.9 0.0 0.7 100.0 80.5 85 Kanifing 71.8 2.8 5.2 18.9 0.8 0.0 0.5 100.0 79.8 858 Brikama 63.7 2.6 13.6 19.3 0.2 0.0 0.6 100.0 79.9 1,454 Mansakonko 50.7 4.1 13.1 31.1 0.2 0.0 0.7 100.0 68.0 141 Kerewan 43.6 2.3 11.5 42.7 0.0 0.0 0.0 100.0 57.3 323 Kuntaur 21.5 6.6 11.3 60.1 0.0 0.0 0.6 100.0 39.4 141 Janjanbureh 38.5 1.5 11.1 48.1 0.0 0.0 0.8 100.0 51.1 240 Basse 18.2 4.2 15.3 61.7 0.0 0.0 0.6 100.0 37.7 336 Wealth quintile Lowest 37.6 3.8 13.3 44.4 0.1 0.0 0.8 100.0 54.7 517 Second 44.0 3.0 10.8 41.2 0.5 0.0 0.6 100.0 57.7 614 Middle 43.3 4.0 11.4 40.5 0.0 0.0 0.7 100.0 58.8 588 Fourth 59.8 2.1 13.4 23.6 0.5 0.0 0.6 100.0 75.3 940 Highest 77.5 2.7 7.8 11.4 0.3 0.0 0.3 100.0 88.1 919 Total 15-49 55.8 3.0 11.2 29.3 0.3 0.0 0.6 100.0 69.9 3,577 50-59 26.3 4.5 13.6 54.8 0.3 0.3 0.2 100.0 44.5 244 Total 15-59 53.9 3.1 11.3 30.9 0.3 0.0 0.5 100.0 68.3 3,821 1 Refers to men who attended secondary school or higher and men who can read a whole sentence or part of a sentence 3.4 ACCESS TO MASS MEDIA The 2013 GDHS collected information on respondents’ exposure to common print and electronic media. Respondents were asked how often they read a newspaper, listened to the radio, or watched television. This information is important because it indicates the extent to which people in The Gambia are regularly exposed to mass media, which are often used to convey messages on family planning and other health topics. Tables 3.4.1 and 3.4.2 show the percentages of female and male respondents, respectively, who were exposed to different types of mass media by age, residence, LGA, level of education, and wealth quintile. Sixty percent of women and 73 percent of men listen to the radio at least once a week, 47 percent of women and 61 percent of men watch television on a weekly basis, and 9 percent of women and 20 percent of men read newspapers at least once a week. Overall, only 7 percent of women and 14 percent of men are exposed to all three media at least once per week. Three in ten women (30 percent) and one in six men (16 percent) are not exposed to any of the three media on a regular basis. Characteristics of Respondents • 37 There are only slight variations by age, with the youngest and oldest age groups having a tendency to be less exposed to any of the three media than the other age groups. Huge disparities exist in media exposure by urban-rural residence. For example, 14 percent of women and 27 percent of men in urban areas read a newspaper at least once a week, as compared with only 3 percent of women and 9 percent of men in rural areas. Exposure to newspapers and television is highest among women and men in Banjul and Kanifing. For example, 23 percent of women in Banjul and 18 percent of those on Kanifing read a newspaper weekly, compared with 1 percent to 10 percent of women from other LGAs. Women and men with higher levels of education and in the higher wealth quintiles are more likely to access any of the three media. For example, less than 1 percent of women with no education have access to all three media, as compared with 16 percent of women with a secondary education or higher. Eighteen percent of women in the highest wealth quintile and only 1 percent of those in the lowest quintile have weekly access to all three media. Table 3.4.1 Exposure to mass media: Women Percentage of women age 15-49 who are exposed to specific media on a weekly basis, by background characteristics, The Gambia 2013 Background characteristic Reads a newspaper at least once a week Watches television at least once a week Listens to the radio at least once a week Accesses all three media at least once a week Accesses none of the three media at least once a week Number of women Age 15-19 9.3 48.6 58.6 7.1 30.3 2,407 20-24 11.9 51.8 64.7 8.6 25.3 2,125 25-29 10.8 46.5 61.8 8.2 29.1 1,822 30-34 7.6 47.4 60.1 6.0 29.3 1,504 35-39 6.3 44.1 58.7 5.5 30.8 1,056 40-44 4.6 39.9 52.8 2.6 36.0 761 45-49 6.0 35.9 59.4 5.0 34.6 559 Residence Urban 14.1 62.8 63.5 10.8 22.8 5,730 Rural 2.5 26.7 56.2 1.8 38.3 4,503 Local Government Area Banjul 22.5 77.1 61.9 16.4 14.0 225 Kanifing 18.2 72.4 66.6 14.4 16.3 2,342 Brikama 10.2 53.4 67.5 7.6 23.3 3,550 Mansakonko 2.0 34.1 67.9 1.2 27.6 490 Kerewan 2.9 26.7 35.9 1.9 56.1 1,107 Kuntaur 1.5 22.8 44.8 1.1 48.7 526 Janjanbureh 1.9 17.0 36.4 1.2 58.5 739 Basse 1.4 26.2 66.7 0.8 27.4 1,254 Education No education 0.2 32.0 51.4 0.1 40.1 4,757 Primary 2.1 46.9 63.8 1.8 26.7 1,405 Secondary or higher 21.7 64.2 69.4 16.4 18.3 4,071 Wealth quintile Lowest 2.2 20.2 53.2 1.2 42.8 1,745 Second 3.2 29.7 56.6 2.5 37.1 1,882 Middle 3.5 34.7 57.8 2.5 34.4 1,927 Fourth 8.2 61.0 62.0 6.4 25.2 2,135 Highest 22.8 75.3 68.3 17.6 15.1 2,545 Total 9.0 46.9 60.3 6.8 29.6 10,233 38 • Characteristics of Respondents Table 3.4.2 Exposure to mass media: Men Percentage of men age 15-49 who are exposed to specific media on a weekly basis, by background characteristics, The Gambia 2013 Background characteristic Reads a newspaper at least once a week Watches television at least once a week Listens to the radio at least once a week Accesses all three media at least once a week Accesses none of the three media at least once a week Number of men Age 15-19 11.7 58.9 68.2 7.0 17.8 836 20-24 22.0 66.6 75.7 17.0 14.5 849 25-29 25.1 61.6 72.5 15.6 13.0 586 30-34 22.3 67.9 74.4 17.6 13.0 425 35-39 25.7 59.3 76.5 18.3 13.2 391 40-44 22.4 51.4 73.2 17.4 18.4 270 45-49 12.7 44.0 71.9 9.0 21.9 220 Residence Urban 26.5 74.1 76.1 19.4 10.0 2,228 Rural 9.3 38.8 67.7 5.5 24.5 1,349 Local Government Area Banjul 32.6 79.2 73.7 24.5 9.7 85 Kanifing 28.1 76.1 75.1 20.3 11.4 858 Brikama 24.2 65.5 76.3 17.3 11.8 1,454 Mansakonko 4.3 39.3 70.6 2.2 19.0 141 Kerewan 12.4 43.0 62.4 8.1 27.5 323 Kuntaur 3.9 28.7 49.1 1.5 39.4 141 Janjanbureh 10.1 40.6 73.0 7.2 18.3 240 Basse 5.5 51.2 73.5 3.3 18.1 336 Education No education 3.6 46.3 68.3 3.3 23.5 1,090 Primary 3.8 59.7 71.6 2.8 17.9 493 Secondary or higher 33.0 69.0 75.8 22.9 10.4 1,994 Wealth quintile Lowest 8.7 34.4 71.9 6.4 22.2 517 Second 11.0 42.2 69.5 5.3 22.1 614 Middle 13.9 51.4 71.3 8.7 19.3 588 Fourth 24.1 72.9 77.0 18.3 10.5 940 Highest 32.1 81.7 72.6 23.7 9.8 919 Total 15-49 20.0 60.8 72.9 14.2 15.5 3,577 50-59 16.0 41.6 71.6 11.1 20.1 244 Total 15-59 19.7 59.6 72.8 14.0 15.8 3,821 3.5 EMPLOYMENT Respondents were asked whether they were employed at the time of the survey (i.e., whether they had worked in the past 7 days) and, if not, whether they were employed at any time in the 12 months that preceded the survey. Because employment is viewed as a stock concept (measured at a particular point in time), the corresponding statistics must, in principle, refer to a precise moment in time. Respondents were asked a number of questions to elicit their current employment status and continuity of employment in the 12 months prior to the survey. Figure 3.1 and Table 3.5.1 present the proportion of women who were currently employed, the proportion who were not currently employed but had been employed at some time during the 12 months before the survey, and the proportion who had not been employed at any time during the 12-month period. Table 3.5.2 presents employment status data for men. Overall, 43 percent of women reported that they were currently employed. An additional 7 percent of women were not currently employed but had worked in the 12 months preceding the survey. Characteristics of Respondents • 39 Figure 3.1 Women’s employment status in the past 12 months Currently employed 43% Not currently employed, but worked in last 12 months 7% Not employed in the 12 months preceding the survey 50% GDHS 2013 Sixty-six percent of men were currently employed, and an additional 6 percent had worked in the year prior to the survey. The proportion of currently employed respondents is lowest in the 15-19 age group (17 percent of women and 30 percent of men), mostly due to the fact that many in this age cohort are students. Women and men who have never been married are less likely to be currently employed (25 percent and 50 percent, respectively) than those currently or previously married. Respondents with no children are less likely to be employed than those who have children. The percentage of women who are currently employed increases with increasing number of living children, while there are no variations among men according to number of children. A higher percentage of rural than urban women are currently employed (45 percent versus 41 percent), while the opposite is true among men; urban men are somewhat more likely to be currently employed than rural men (68 percent versus 64 percent). Women from Janjanbureh are least likely to be currently employed (38 percent), and those from Mansakonko and Banjul are most likely to be employed (50 percent and 49 percent, respectively). By contrast, men from Janjanbureh have the highest level of current employment (79 percent). Respondents with no education are more likely to be currently employed (51 percent of women and 80 percent of men) than respondents in the other education categories. 40 • Characteristics of Respondents Table 3.5.1 Employment status: Women Percent distribution of women age 15-49 by employment status, according to background characteristics, The Gambia 2013 Background characteristic Employed in the 12 months preceding the survey Not employed in the 12 months preceding the survey Total Number of women Currently employed1 Not currently employed Age 15-19 16.7 4.6 78.7 100.0 2,407 20-24 33.6 6.7 59.6 100.0 2,125 25-29 50.7 8.7 40.6 100.0 1,822 30-34 53.7 8.5 37.8 100.0 1,504 35-39 59.0 10.2 30.8 100.0 1,056 40-44 67.7 8.8 23.4 100.0 761 45-49 67.5 7.9 24.6 100.0 559 Marital status Never married 24.5 3.1 72.4 100.0 2,963 Married or living together 49.5 9.3 41.2 100.0 6,791 Divorced/separated/widowed 57.9 7.1 35.0 100.0 478 Number of living children 0 25.2 4.0 70.8 100.0 3,530 1-2 45.2 8.4 46.4 100.0 2,644 3-4 50.8 9.5 39.8 100.0 1,955 5+ 61.2 10.1 28.7 100.0 2,103 Residence Urban 40.8 2.8 56.4 100.0 5,730 Rural 44.9 13.3 41.7 100.0 4,503 Local Government Area Banjul 49.0 3.4 47.6 100.0 225 Kanifing 41.8 2.5 55.7 100.0 2,342 Brikama 41.8 4.0 54.2 100.0 3,550 Mansakonko 49.8 3.5 46.6 100.0 490 Kerewan 46.4 1.9 51.7 100.0 1,107 Kuntaur 42.9 13.6 43.5 100.0 526 Janjanbureh 37.7 9.3 53.0 100.0 739 Basse 42.2 29.6 28.1 100.0 1,254 Education No education 50.5 10.3 39.2 100.0 4,757 Primary 39.1 9.2 51.8 100.0 1,405 Secondary or higher 34.7 3.4 61.9 100.0 4,071 Wealth quintile Lowest 45.8 11.0 43.1 100.0 1,745 Second 45.3 11.1 43.5 100.0 1,882 Middle 43.0 9.8 47.1 100.0 1,927 Fourth 42.9 4.3 52.8 100.0 2,135 Highest 37.9 3.1 59.0 100.0 2,545 Total 42.6 7.4 49.9 100.0 10,233 1 “Currently employed” is defined as having done work in the past 7 days. Includes persons who did not work in the past 7 days but who are regularly employed and were absent from work for leave, illness, vacation, or any other such reason. Characteristics of Respondents • 41 Table 3.5.2 Employment status: Men Percent distribution of men age 15-49 by employment status, according to background characteristics, The Gambia 2013 Background characteristic Employed in the 12 months preceding the survey Not employed in the 12 months preceding the survey Total Number of men Currently employed1 Not currently employed Age 15-19 30.3 5.9 63.8 100.0 836 20-24 54.8 5.5 39.6 100.0 849 25-29 81.5 6.1 12.4 100.0 586 30-34 89.2 6.0 4.8 100.0 425 35-39 91.1 5.1 3.9 100.0 391 40-44 92.6 3.4 3.9 100.0 270 45-49 87.0 10.0 2.9 100.0 220 Marital status Never married 50.4 5.5 44.1 100.0 2,177 Married or living together 91.2 6.3 2.5 100.0 1,360 Divorced/separated/widowed (90.8) (4.6) (4.6) 100.0 40 Number of living children 0 52.8 5.5 41.7 100.0 2,282 1-2 90.1 6.2 3.7 100.0 558 3-4 90.1 6.5 3.4 100.0 336 5+ 90.4 6.6 3.0 100.0 400 Residence Urban 67.7 2.0 30.3 100.0 2,228 Rural 64.2 12.1 23.7 100.0 1,349 Local Government Area Banjul 73.8 5.0 21.2 100.0 85 Kanifing 67.1 2.7 30.1 100.0 858 Brikama 64.8 1.8 33.4 100.0 1,454 Mansakonko 61.9 4.1 34.0 100.0 141 Kerewan 69.6 0.5 29.8 100.0 323 Kuntaur 59.2 19.8 21.0 100.0 141 Janjanbureh 78.7 8.1 12.8 100.0 240 Basse 61.8 29.5 8.7 100.0 336 Education No education 80.2 10.2 9.6 100.0 1,090 Primary 68.1 5.7 26.3 100.0 493 Secondary or higher 58.3 3.5 38.2 100.0 1,994 Wealth quintile Lowest 66.0 8.3 25.7 100.0 517 Second 66.4 8.7 24.9 100.0 614 Middle 65.4 10.3 24.3 100.0 588 Fourth 70.0 3.5 26.4 100.0 940 Highest 63.3 2.0 34.6 100.0 919 Total 15-49 66.3 5.8 27.8 100.0 3,577 50-59 84.3 6.8 8.9 100.0 244 Total 15-59 67.5 5.9 26.6 100.0 3,821 Note: Figures in parentheses are based on 25-49 unweighted cases. 1 “Currently employed” is defined as having done work in the past 7 days. Includes persons who did not work in the past 7 days but who are regularly employed and were absent from work for leave, illness, vacation, or any other such reason. 3.6 OCCUPATION Respondents who were currently employed were asked about their occupation. The results are presented in Tables 3.6.1 and 3.6.2 for women and men age 15-49, respectively. The highest proportion of working women (44 percent) are engaged in sales and services, while the highest proportion of working men (40 percent) are engaged in skilled manual work. The next major occupation category among working women and men is agriculture (41 percent of women and 19 percent of men). Among women, 5 percent work in professional, technical, or managerial jobs, and 3 percent each work in domestic service and skilled manual labour. Among men, 19 percent are employed in sales and services; 14 percent work in professional, technical, or managerial jobs; and 2 percent are employed in unskilled manual labour. 42 • Characteristics of Respondents Table 3.6.1 Occupation: Women Percent distribution of women age 15-49 employed in the 12 months preceding the survey by occupation, according to background characteristics, The Gambia 2013 Background characteristic Pro- fessional/ technical/ managerial Clerical Sales and services Skilled manual Unskilled manual Domestic service Agriculture Missing Total Number of women Age 15-19 0.9 0.0 32.0 3.0 0.1 1.8 58.7 3.5 100.0 512 20-24 5.2 2.2 43.1 2.6 1.1 3.7 40.6 1.6 100.0 858 25-29 7.1 1.2 48.5 2.0 0.8 3.4 34.4 2.7 100.0 1,083 30-34 6.2 0.9 43.9 3.0 1.4 3.0 40.1 1.4 100.0 936 35-39 5.4 0.7 45.9 2.0 1.2 2.8 40.9 1.0 100.0 731 40-44 5.4 0.0 43.5 3.3 1.5 4.4 41.2 0.6 100.0 582 45-49 4.8 0.4 45.1 1.4 1.3 3.4 42.9 0.6 100.0 421 Marital status Never married 8.7 2.5 47.6 3.5 1.0 6.9 26.7 3.2 100.0 819 Married or living together 4.6 0.6 41.9 2.1 1.1 2.3 45.9 1.5 100.0 3,993 Divorced/separated/widowed 5.9 1.2 59.1 4.8 1.3 6.1 20.5 1.1 100.0 311 Number of living children 0 7.8 2.3 42.2 2.9 0.9 3.6 36.9 3.4 100.0 1,031 1-2 8.1 1.1 45.2 2.5 1.1 3.2 36.7 2.1 100.0 1,416 3-4 4.6 0.6 45.7 2.6 0.9 3.9 40.4 1.2 100.0 1,178 5+ 1.7 0.0 42.4 2.0 1.3 2.5 49.4 0.7 100.0 1,498 Residence Urban 8.9 1.7 67.6 3.9 1.4 5.9 7.8 2.7 100.0 2,501 Rural 2.0 0.2 21.2 1.1 0.8 0.7 73.2 0.8 100.0 2,623 Local Government Area Banjul 11.0 2.0 62.5 6.2 1.8 12.7 1.1 2.8 100.0 118 Kanifing 9.9 2.6 66.2 4.3 2.6 9.0 2.1 3.3 100.0 1,038 Brikama 7.6 0.8 65.8 3.0 1.1 3.0 17.0 1.7 100.0 1,626 Mansakonko 4.7 0.5 30.3 1.0 1.0 0.7 61.2 0.6 100.0 261 Kerewan 2.2 0.2 28.5 1.0 1.0 1.1 64.9 1.1 100.0 535 Kuntaur 0.3 0.3 9.1 2.0 0.0 0.0 87.0 1.4 100.0 297 Janjanbureh 2.5 0.3 24.2 1.5 0.0 0.5 69.5 1.6 100.0 347 Basse 0.3 0.0 8.3 0.8 0.0 0.0 90.0 0.7 100.0 901 Education No education 0.5 0.0 38.6 1.9 1.1 2.5 54.7 0.8 100.0 2,893 Primary 1.0 0.0 44.3 3.0 0.5 4.5 46.0 0.8 100.0 678 Secondary or higher 16.4 3.0 53.6 3.3 1.3 4.1 14.3 3.8 100.0 1,553 Wealth quintile Lowest 1.4 0.0 29.4 0.7 0.9 1.1 65.5 1.0 100.0 993 Second 2.3 0.5 29.3 1.6 1.0 1.7 62.4 1.2 100.0 1,061 Middle 3.1 0.0 32.6 1.8 0.2 2.8 58.8 0.6 100.0 1,019 Fourth 5.0 0.3 61.8 4.6 1.6 7.0 17.3 2.3 100.0 1,007 Highest 14.8 3.6 66.1 3.8 1.6 3.7 2.9 3.4 100.0 1,043 Total 5.4 0.9 43.9 2.5 1.1 3.3 41.3 1.7 100.0 5,123 Urban women are most often employed in sales and services (68 percent) and urban men in skilled manual labour (46 percent). As expected, the majority of women (73 percent) and men (45 percent) in rural areas are employed in agriculture. The highest percentage of women and men who work in agriculture is in Basse (90 percent and 59 percent, respectively) and Kuntaur (87 percent and 60 percent, respectively). Kanifing and Brikama have the highest proportion of women working in sales and services (66 percent each) and the highest proportion of men engaged in skilled manual labour (44 percent and 49 percent, respectively). Occupation also varies with level of education. Sixteen percent of women and 24 percent of men with a secondary education or higher are employed in the professional, technical, and managerial sector, as compared with 1 percent to 6 percent of respondents with no education or a primary education. On the other hand, women and men with no education are much more likely to work in agriculture (55 percent of women and 35 percent of men). Employed women and men in the bottom three wealth quintiles are much more likely to work in agriculture. The percentage of women and men employed in professional, technical, or managerial jobs increases notably with increasing wealth. Characteristics of Respondents • 43 Table 3.6.2 Occupation: Men Percent distribution of men age 15-49 employed in the 12 months preceding the survey by occupation, according to background characteristics, The Gambia 2013 Background characteristic Pro- fessional/ technical/ managerial Clerical Sales and services Skilled manual Unskilled manual Domestic service Agriculture Missing Total Number of men Age 15-19 1.2 0.1 10.1 45.9 1.7 1.2 34.6 5.1 100.0 302 20-24 12.3 0.5 14.5 47.8 2.6 1.2 17.0 4.2 100.0 512 25-29 19.5 1.6 19.4 37.2 3.9 0.5 12.4 5.4 100.0 513 30-34 13.8 2.2 23.1 38.5 1.0 0.8 16.7 4.0 100.0 404 35-39 16.4 1.5 25.9 37.8 0.8 0.4 14.3 2.8 100.0 376 40-44 17.3 1.2 22.7 31.2 1.7 0.7 21.2 4.0 100.0 259 45-49 11.9 0.6 16.4 31.9 3.2 1.8 30.7 3.6 100.0 214 Marital status Never married 11.4 0.9 16.0 44.8 2.9 1.2 17.5 5.4 100.0 1,217 Married or living together 15.8 1.4 21.2 34.9 1.6 0.6 21.2 3.3 100.0 1,326 Divorced/separated/widowed (15.6) (0.7) 33.1) 38.5) (1.4) (0.0) (8.9) (1.8) 100.0 38 Number of living children 0 12.4 0.5 16.6 43.4 2.8 1.0 18.0 5.4 100.0 1,330 1-2 16.0 2.6 22.2 38.8 1.1 0.6 15.6 3.1 100.0 538 3-4 14.4 2.8 22.0 37.1 1.6 0.4 19.0 2.8 100.0 325 5+ 14.9 0.1 20.1 29.8 2.1 1.0 28.9 3.2 100.0 388 Residence Urban 18.2 1.8 23.3 46.0 2.5 0.9 2.3 4.9 100.0 1,553 Rural 7.0 0.1 12.4 30.0 1.8 0.7 44.9 3.2 100.0 1,029 Local Government Area Banjul 13.8 2.7 29.8 40.0 5.1 1.2 2.4 5.0 100.0 67 Kanifing 19.6 3.3 24.5 44.0 2.1 0.8 1.4 4.2 100.0 600 Brikama 16.5 0.6 19.0 48.6 3.4 0.6 5.5 5.7 100.0 969 Mansakonko 15.1 0.0 13.8 40.3 0.3 0.9 28.9 0.8 100.0 93 Kerewan 9.9 0.0 16.8 37.9 1.2 0.8 31.4 2.0 100.0 226 Kuntaur 3.5 0.0 9.8 24.3 0.9 0.0 60.0 1.6 100.0 112 Janjanbureh 8.4 0.3 14.0 24.4 1.5 3.2 42.3 5.9 100.0 209 Basse 3.2 0.4 15.4 19.3 0.3 0.4 59.1 1.9 100.0 306 Education No education 3.6 0.0 20.1 37.2 1.6 0.4 34.7 2.5 100.0 986 Primary 5.8 0.1 14.6 53.4 1.0 0.6 22.1 2.4 100.0 364 Secondary or higher 24.2 2.4 19.3 37.4 3.1 1.3 6.1 6.2 100.0 1,232 Wealth quintile Lowest 8.4 0.0 13.5 34.1 2.4 0.4 37.2 4.0 100.0 384 Second 6.3 0.5 11.7 36.7 2.2 0.6 39.2 2.9 100.0 461 Middle 10.5 0.4 14.9 41.0 2.3 1.2 26.2 3.4 100.0 445 Fourth 14.6 1.1 24.9 43.4 1.2 1.0 7.8 6.0 100.0 691 Highest 24.3 2.9 24.1 39.9 3.2 1.0 0.6 4.0 100.0 601 Total 15-49 13.7 1.1 19.0 39.6 2.2 0.9 19.3 4.2 100.0 2,581 50-59 13.1 1.5 21.9 27.3 1.2 2.0 27.9 5.1 100.0 222 Total 15-59 13.7 1.2 19.2 38.6 2.1 0.9 20.0 4.3 100.0 2,803 Note: Figures in parentheses are based on 25-49 unweighted cases. Table 3.7 presents the percent distribution of employed women age 15-49 by type of earnings and employer characteristics, according to type of employment (agricultural or nonagricultural). Sixty-five percent of women receive cash only for their work, 26 percent are paid in cash and in-kind, and 6 percent are not paid at all. Women employed in agricultural work are much more likely to be paid in cash and in- kind only (45 percent) or not be paid at all (10 percent) than women employed in nonagricultural work (13 percent and 2 percent, respectively). Sixty-six percent of women are self-employed, 20 percent are employed by a non-family member, and 14 percent are employed by a family member. Women working in the agricultural sector are more likely to be self-employed (74 percent) or employed by a family member (21 percent) than are women working in nonagricultural jobs (61percent and 8 percent, respectively). By contrast, women who do nonagricultural work (31 percent) are more likely to be employed by non-family members than those who work in agriculture (5 percent). Most women who work in agriculture are engaged in seasonal work (66 percent), while the majority of women who do nonagricultural work have continuous yearly employment (81 percent). 44 • Characteristics of Respondents Table 3.7 Type of employment: Women Percent distribution of women age 15-49 employed in the 12 months preceding the survey by type of earnings, type of employer, and continuity of employment, according to type of employment (agricultural or nonagricultural), The Gambia 2013 Employment characteristic Agricultural work Nonagricultural work Total Type of earnings Cash only 39.8 83.1 64.9 Cash and in-kind 45.0 13.0 26.2 In-kind only 4.8 1.2 2.8 Not paid 10.1 2.3 5.6 Total 100.0 100.0 100.0 Type of employer Employed by family member 20.8 8.2 13.5 Employed by non-family member 4.7 30.9 20.4 Self-employed 74.1 60.7 65.7 Total 100.0 100.0 100.0 Continuity of employment All year 32.2 81.3 60.7 Seasonal 66.1 13.8 35.6 Occasional 1.4 4.7 3.3 Total 100.0 100.0 100.0 Number of women employed during the past 12 months 2,116 2,919 5,123 Note: Total includes women with missing information on type of employment who are not shown separately. 3.7 HEALTH INSURANCE COVERAGE Medical insurance provides peace of mind and, most importantly, essential care to save the life and/or ensure the well-being of the person with insurance coverage. In the 2013 GDHS, women and men were asked if they were covered by any health insurance and, if so, what type of insurance. Tables 3.8.1 and 3.8.2 indicate that only a small percentage of women and men in The Gambia have health insurance coverage (2 percent and 3 percent, respectively), mostly employer-based insurance. Health insurance coverage is more common among urban women and men (4 percent each), those in Banjul (5 percent and 6 percent, respectively), those with a secondary education or higher (5 percent each), and those in the highest wealth quintile (6 percent and 7 percent, respectively). Characteristics of Respondents • 45 Table 3.8.1 Health insurance coverage: Women Percentage of women age 15-49 with specific types of health insurance coverage, according to background characteristics, The Gambia 2013 Background characteristic Employer-based insurance Privately purchased commercial insurance None Number of women Age 15-19 0.6 0.4 98.9 2,407 20-24 2.1 0.2 97.8 2,125 25-29 3.0 0.2 96.7 1,822 30-34 2.6 0.5 96.9 1,504 35-39 2.7 0.4 96.8 1,056 40-44 1.0 0.0 99.0 761 45-49 1.4 1.0 97.6 559 Residence Urban 3.2 0.6 96.3 5,730 Rural 0.3 0.1 99.5 4,503 Local Government Area Banjul 4.9 0.5 94.5 225 Kanifing 3.6 0.6 95.9 2,342 Brikama 2.6 0.5 96.9 3,550 Mansakonko 0.3 0.1 99.6 490 Kerewan 0.4 0.2 99.4 1,107 Kuntaur 0.4 0.0 99.5 526 Janjanbureh 0.3 0.2 99.5 739 Basse 0.0 0.0 99.9 1,254 Education No education 0.5 0.1 99.4 4,757 Primary 0.9 0.0 99.1 1,405 Secondary or higher 4.0 0.8 95.3 4,071 Wealth quintile Lowest 0.2 0.0 99.8 1,745 Second 0.3 0.0 99.6 1,882 Middle 0.8 0.2 98.9 1,927 Fourth 1.8 0.3 97.8 2,135 Highest 5.2 1.0 93.9 2,545 Total 1.9 0.3 97.7 10,233 Table 3.8.2 Health insurance coverage: Men Percentage of men age 15-49 with specific types of health insurance coverage, according to background characteristics, The Gambia 2013 Background characteristic Employer-based insurance Privately purchased commercial insurance None Number of men Age 15-19 0.2 0.1 99.4 836 20-24 1.1 0.4 98.5 849 25-29 3.6 0.4 95.5 586 30-34 4.1 0.1 95.8 425 35-39 3.5 0.7 95.5 391 40-44 9.7 0.1 90.1 270 45-49 3.5 0.0 96.5 220 Residence Urban 3.9 0.4 95.4 2,228 Rural 0.7 0.1 99.2 1,349 Local Government Area Banjul 6.1 0.3 93.4 85 Kanifing 5.0 0.3 94.5 858 Brikama 2.6 0.4 96.6 1,454 Mansakonko 0.3 0.2 99.5 141 Kerewan 0.6 0.1 99.3 323 Kuntaur 0.0 0.4 99.6 141 Janjanbureh 0.7 0.2 99.1 240 Basse 2.0 0.0 98.0 336 Education No education 0.7 0.0 99.3 1,090 Primary 0.8 0.1 99.1 493 Secondary or higher 4.3 0.4 94.9 1,994 Wealth quintile Lowest 0.0 0.1 99.9 517 Second 1.6 0.1 98.3 614 Middle 0.3 0.0 99.7 588 Fourth 2.8 0.4 96.8 940 Highest 6.4 0.5 92.3 919 Total 15-49 2.7 0.3 96.8 3,577 50-59 2.7 1.4 95.9 244 Total 15-59 2.7 0.3 96.7 3,821 46 • Characteristics of Respondents 3.9 SMOKING Smoking and other forms of tobacco use can cause a wide variety of diseases and can lead to death. Smoking is a risk factor for cardiovascular disease, lung cancer, and other forms of cancer, and it contributes to the severity of pneumonia, emphysema, and chronic bronchitis symptoms. Also, second- hand smoke may adversely affect the health of children and aggravate childhood illnesses. In the 2013 GDHS, both women and men were asked a number of questions to ascertain the prevalence of use of tobacco products, and cigarette smokers were asked about the number of cigarettes smoked in the last 24 hours. Less than 1 percent of women age 15-49 smoke cigarettes or use any other types of tobacco (data not shown). Table 3.9 presents information on use of tobacco among men. Twenty-six percent of men age 15-49 use tobacco products. The majority (20 percent) smoke cigarettes, and 5 percent use other forms of tobacco. Use of tobacco gradually increases with age. For example, only 4 percent of men age 15-19 smoke cigarettes; this percentage peaks in the 35-39 age group (36 percent), after which it drops slightly. Cigarette smoking among men is highest in Janjanbureh (27 percent), while use of other types of tobacco is highest in Basse (13 percent). Tobacco use is highest among men with no education and those in the lowest wealth quintile. Among men who smoke cigarettes, the largest proportion (50 percent) smoked 10 or more cigarettes during the 24 hours preceding the survey; 30 percent smoked 3-5 cigarettes, and 11 percent smoked 6-9 cigarettes. C ha ra ct er is tic s of R es po nd en ts • 4 7 Ta bl e 3. 9 U se o f t ob ac co : M en P er ce nt ag e of m en a ge 1 5- 49 w ho s m ok e ci ga re tte s or a p ip e or u se o th er to ba cc o pr od uc ts a nd th e pe rc en t d is tri bu tio n of c ig ar et te s m ok er s by n um be r of c ig ar et te s sm ok ed in th e pr ec ed in g 24 h ou rs , a cc or di ng to ba ck gr ou nd c ha ra ct er is tic s, T he G am bi a 20 13 B ac kg ro un d ch ar ac te ris tic U se s to ba cc o D oe s no t u se to ba cc o N um be r o f m en P er ce nt d is tri bu tio n of m en w ho s m ok e ci ga re tte s by n um be r o f c ig ar et te s sm ok ed in th e pa st 2 4 ho ur s To ta l N um be r o f ci ga re tte sm ok er s C ig ar et te s P ip e O th er to ba cc o 0 1- 2 3- 5 6- 9 10 + D on ’t kn ow / m is si ng A ge 15 -1 9 3. 6 0. 0 1. 1 95 .8 83 6 (1 2. 6) (6 .8 ) (1 7. 1) (8 .6 ) (4 2. 3) (1 2. 6) 10 0. 0 30 20 -2 4 16 .3 0. 1 4. 6 82 .8 84 9 1. 3 7. 2 46 .9 8. 8 33 .1 2. 8 10 0. 0 13 9 25 -2 9 23 .7 0. 3 6. 1 74 .1 58 6 0. 5 6. 4 31 .3 16 .4 40 .9 4. 5 10 0. 0 13 9 30 -3 4 28 .5 0. 1 8. 7 67 .5 42 5 0. 0 0. 7 43 .2 10 .2 44 .3 1. 7 10 0. 0 12 1 35 -3 9 35 .7 0. 1 5. 1 62 .5 39 1 0. 7 7. 9 16 .8 9. 2 65 .4 0. 0 10 0. 0 14 0 40 -4 4 34 .2 0. 3 9. 2 62 .2 27 0 0. 2 2. 0 18 .0 13 .1 65 .9 0. 8 10 0. 0 92 45 -4 9 29 .6 0. 2 8. 8 65 .9 22 0 1. 1 5. 1 20 .4 9. 6 62 .6 1. 1 10 0. 0 65 R es id en ce U rb an 19 .8 0. 0 4. 8 78 .2 2, 22 8 1. 1 5. 0 27 .0 10 .6 53 .1 3. 2 10 0. 0 44 0 R ur al 21 .2 0. 3 5. 7 77 .1 1, 34 9 1. 2 5. 5 35 .2 12 .0 44 .9 1. 2 10 0. 0 28 5 Lo ca l G ov er nm en t A re a B an ju l 22 .0 0. 0 8. 6 74 .5 85 7. 1 7. 2 32 .7 11 .0 39 .8 2. 1 10 0. 0 19 K an ifi ng 17 .1 0. 1 4. 7 81 .0 85 8 1. 6 7. 9 24 .1 8. 4 53 .3 4. 7 10 0. 0 14 7 B rik am a 21 .0 0. 0 4. 4 76 .9 1, 45 4 0. 7 4. 1 31 .3 11 .4 49 .9 2. 6 10 0. 0 30 5 M an sa ko nk o 23 .2 0. 0 4. 3 75 .1 14 1 1. 2 5. 7 28 .0 13 .5 51 .6 0. 0 10 0. 0 33 K er ew an 22 .3 0. 3 4. 6 75 .5 32 3 2. 6 2. 7 26 .7 10 .7 55 .3 2. 1 10 0. 0 72 K un ta ur 12 .7 2. 2 2. 3 85 .3 14 1 (0 .0 ) (1 0. 6) 27 .3 ) (2 2. 3) (3 9. 8) (0 .0 ) 10 0. 0 18 Ja nj an bu re h 26 .6 0. 2 3. 1 71 .6 24 0 0. 0 5. 4 29 .6 15 .9 48 .1 1. 0 10 0. 0 64 B as se 20 .5 0. 0 12 .5 78 .5 33 6 0. 0 4. 6 44 .1 8. 3 43 .0 0. 0 10 0. 0 69 Ed uc at io n N o ed uc at io n 22 .7 0. 3 6. 9 75 .0 1, 09 0 0. 7 5. 2 27 .8 10 .0 53 .4 2. 9 10 0. 0 24 7 P rim ar y 23 .0 0. 1 4. 2 75 .4 49 3 0. 3 3. 0 32 .9 14 .2 48 .1 1. 6 10 0. 0 11 4 S ec on da ry o r h ig he r 18 .3 0. 1 4. 5 79 .9 1, 99 4 1. 7 5. 9 31 .0 11 .0 48 .0 2. 3 10 0. 0 36 5 W ea lth q ui nt ile Lo w es t 26 .1 0. 7 5. 5 71 .6 51 7 0. 3 6. 2 39 .1 9. 4 42 .9 2. 0 10 0. 0 13 5 S ec on d 19 .8 0. 1 5. 5 78 .6 61 4 1. 4 5. 0 28 .7 11 .9 48 .0 5. 0 10 0. 0 12 1 M id dl e 20 .4 0. 1 5. 2 77 .5 58 8 2. 0 3. 1 33 .6 15 .1 45 .5 0. 6 10 0. 0 12 0 Fo ur th 20 .6 0. 0 6. 0 78 .0 94 0 0. 8 5. 0 28 .4 8. 6 54 .3 2. 9 10 0. 0 19 4 H ig he st 17 .0 0. 1 3. 9 80 .7 91 9 1. 3 6. 4 23 .4 12 .3 55 .1 1. 4 10 0. 0 15 6 To ta l 1 5- 49 20 .3 0. 1 5. 2 77 .8 3, 57 7 1. 1 5. 2 30 .2 11 .2 49 .9 2. 4 10 0. 0 72 6 50 -5 9 23 .3 0. 4 5. 5 73 .6 24 4 0. 3 5. 7 21 .7 18 .2 54 .1 0. 0 10 0. 0 57 To ta l 1 5- 59 20 .5 0. 2 5. 2 77 .5 3, 82 1 1. 1 5. 2 29 .6 11 .7 50 .2 2. 2 10 0. 0 78 2 N ot e: F ig ur es in p ar en th es es a re b as ed o n 25 -4 9 un w ei gh te d ca se s. Characteristics of Respondents • 47 Marriage and Sexual Activity • 49 MARRIAGE AND SEXUAL ACTIVITY 4 his chapter addresses the principal factors, other than contraception, that affect a woman’s risk of becoming pregnant. These factors include marriage, polygyny, age at marriage, age at first sexual intercourse, and recent sexual activities. The chapter also includes information on direct measures of the beginning of exposure to pregnancy and level of exposure. 4.1 CURRENT MARITAL STATUS Marriage is a primary indication of the regular exposure of women to the risk of pregnancy, and therefore it is important for an understanding of fertility. Populations in which age at first marriage is low tend to have early childbearing and high fertility. Table 4.1 presents the percent distribution of all women and men by marital status, according to age. The term married refers to legal or formal marriage, and the phrase living together designates an informal union in which a man and a woman live together even if a formal civil or religious ceremony has not occurred. In the tables that do not list living together as a separate category, these women and men are included in the currently married group. About three in ten women age 15-49 (29 percent) have never been married. Sixty-six percent of women are either married or living together with a man, and the remaining 5 percent are divorced, separated, or widowed. Very few women age 30 and older have never been married (5 percent or less). A much higher percentage of men than women (61 percent versus 29 percent) have never been married. Thirty-eighty percent of men are currently married or living together with a woman, while only 1 percent are divorced, separated, or widowed. T Key Findings • Women are much more likely than men to be married: 66 percent of women and 38 percent of men age 15-49 are currently married. • Polygynous marriages are common in The Gambia, with 39 percent of currently married women and 18 percent of currently married men living in polygynous unions. • Women in The Gambia tend to marry much earlier in life than men. The median age at first marriage is 18.6 years for women age 25-49 and 28.4 years for men age 30-49. • Among those in the 25-49 age group, women initiated sexual activity much earlier than men (18.6 years versus 23.1 years). • Among women and men age 15-49 who have never been married, men are five times as likely to report having had sexual intercourse in the past four weeks (10 percent versus 2 percent). 50 • Marriage and Sexual Activity Table 4.1 Current marital status Percent distribution of women and men age 15-49 by current marital status, according to age, The Gambia 2013 Age Marital status Total Percentage of respondents currently in union Number of respondents Never married Married Living together Divorced Separated Widowed WOMEN 15-19 75.7 23.8 0.0 0.5 0.0 0.1 100.0 23.8 2,407 20-24 38.8 58.1 0.1 2.0 0.4 0.6 100.0 58.2 2,125 25-29 12.6 83.3 0.5 2.8 0.3 0.4 100.0 83.9 1,822 30-34 4.5 87.6 0.1 4.5 1.4 1.9 100.0 87.7 1,504 35-39 1.4 90.7 0.8 4.4 0.5 2.2 100.0 91.5 1,056 40-44 0.2 88.0 0.3 4.4 1.3 5.8 100.0 88.4 761 45-49 0.6 88.4 0.3 3.5 0.9 6.3 100.0 88.7 559 Total 29.0 66.1 0.3 2.6 0.5 1.5 100.0 66.4 10,233 MEN 15-19 99.7 0.3 0.0 0.0 0.0 0.0 100.0 0.3 836 20-24 93.0 6.8 0.0 0.2 0.0 0.0 100.0 6.8 849 25-29 65.6 33.2 0.4 0.5 0.3 0.0 100.0 33.6 586 30-34 26.0 72.3 0.0 1.2 0.5 0.0 100.0 72.3 425 35-39 9.7 88.0 0.0 1.3 0.9 0.1 100.0 88.0 391 40-44 6.0 90.6 0.0 1.9 1.0 0.4 100.0 90.6 270 45-49 1.9 94.3 0.0 2.1 1.5 0.2 100.0 94.3 220 Total 15-49 60.9 38.0 0.1 0.7 0.4 0.1 100.0 38.0 3,577 50-59 2.1 95.5 0.1 1.4 0.5 0.3 100.0 95.6 244 Total 15-59 57.1 41.6 0.1 0.7 0.4 0.1 100.0 41.7 3,821 4.2 POLYGYNY Polygyny (having more than one wife) is common in Africa and has implications for frequency of sexual activity and fertility. Table 4.2.1 shows the percent distribution of currently married women by number of co-wives, according to background characteristics. Polygyny was measured by asking all currently married female respondents whether their husband or partner had other wives and, if so, how many. About four in ten currently married women (39 percent) live in polygynous unions (i.e., they have one or more co-wife). Older women are much more likely to be in polygynous unions than younger women. Polygyny is more prevalent in rural than in urban areas. The distribution by Local Government Area (LGA) shows substantial variation, with Basse having the highest proportion of women in polygynous marriages (53 percent) and Banjul having the lowest proportion (23 percent). The percentage of women in polygynous marriages decreases with increasing education, from 47 percent among women with no education to 22 percent among those with a secondary or higher education. Women in the highest two wealth quintiles are least likely to have co-wives (32-33 percent). Men were also asked if they had more than one wife. Data on polygynous unions among currently married men age 15-49 are shown in Table 4.2.2. Eighteen percent of currently married men report having more than one wife. Variations in polygyny among men by background characteristics follow patterns similar to those observed for women. Marriage and Sexual Activity • 51 Table 4.2.1 Number of women’s co-wives Percent distribution of currently married women age 15-49 by number of co-wives, according to background characteristics, The Gambia 2013 Background characteristic Number of co-wives Total Number of women 0 1 2+ Age 15-19 84.0 13.1 2.7 100.0 573 20-24 76.9 19.3 3.4 100.0 1,237 25-29 70.2 23.8 5.5 100.0 1,528 30-34 58.3 32.1 9.0 100.0 1,319 35-39 46.8 35.8 17.2 100.0 966 40-44 38.0 40.6 21.3 100.0 673 45-49 31.4 44.6 23.5 100.0 496 Residence Urban 68.2 23.1 8.3 100.0 3,356 Rural 53.8 34.0 11.8 100.0 3,435 Local Government Area Banjul 76.7 20.3 2.3 100.0 114 Kanifing 68.8 23.9 6.8 100.0 1,258 Brikama 66.7 24.0 8.8 100.0 2,282 Mansakonko 54.4 31.6 13.9 100.0 344 Kerewan 59.1 31.7 9.0 100.0 801 Kuntaur 50.5 36.3 12.7 100.0 427 Janjanbureh 56.3 32.8 10.8 100.0 550 Basse 46.9 36.6 15.9 100.0 1,015 Education No education 52.3 34.0 13.3 100.0 4,125 Primary 67.8 25.0 6.6 100.0 912 Secondary or higher 77.6 17.8 4.3 100.0 1,754 Wealth quintile Lowest 61.0 31.7 7.0 100.0 1,303 Second 53.9 33.6 11.9 100.0 1,404 Middle 56.1 29.2 14.1 100.0 1,386 Fourth 66.8 23.8 9.3 100.0 1,344 Highest 67.2 24.5 7.8 100.0 1,354 Total 60.9 28.6 10.1 100.0 6,791 Table 4.2.2 Number of men’s wives Percent distribution of currently married men age 15-49 by number of wives, according to background characteristics, The Gambia 2013 Background characteristic Number of wives Total Number of men 1 2+ Age 15-19 * * 100.0 2 20-24 99.5 0.5 100.0 57 25-29 95.9 4.1 100.0 197 30-34 93.8 6.2 100.0 307 35-39 85.3 14.7 100.0 344 40-44 68.6 31.4 100.0 245 45-49 58.8 41.2 100.0 208 Residence Urban 88.3 11.7 100.0 758 Rural 74.8 25.2 100.0 602 Local Government Area Banjul 89.0 11.0 100.0 30 Kanifing 89.4 10.6 100.0 286 Brikama 86.7 13.3 100.0 508 Mansakonko 78.0 22.0 100.0 59 Kerewan 73.8 26.2 100.0 143 Kuntaur 70.7 29.3 100.0 73 Janjanbureh 81.6 18.4 100.0 92 Basse 70.3 29.7 100.0 170 Education No education 75.2 24.8 100.0 649 Primary 85.1 14.9 100.0 161 Secondary or higher 89.9 10.1 100.0 550 Wealth quintile Lowest 77.9 22.1 100.0 247 Second 78.1 21.9 100.0 248 Middle 82.8 17.2 100.0 246 Fourth 82.0 18.0 100.0 330 Highest 89.7 10.3 100.0 289 Total 15-49 82.3 17.7 100.0 1,360 50-59 65.1 34.9 100.0 233 Total 15-59 79.8 20.2 100.0 1,593 Note: An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. 52 • Marriage and Sexual Activity 4.3 AGE AT FIRST MARRIAGE Marriage is generally associated with fertility because it is correlated with exposure to risk of conception. Duration of exposure to the risk of pregnancy depends primarily on the age at which women first marry. Women who marry earlier, on average, have their first child earlier and give birth to more children, contributing to higher fertility rates. Table 4.3 shows the percentages of women and men who have married by specific ages, according to their current age. Sixteen percent of women age 20-49 married by age 15, and 41 percent married by age 18. The proportion of women who were married by age 15 and age 18 rises substantially with increasing age. For example, 25 percent of women in the 45-49 age group married by age 15, as compared with only 6 percent of those age 15-19. Almost no men age 20-49 married by age 15, and only 2 percent married before their 18th birthday. Table 4.3 Age at first marriage Percentage of women and men age 15-49 who were first married by specific exact ages and median age at first marriage, according to current age, The Gambia 2013 Current age Percentage first married by exact age: Percentage never married Number of respondents Median age at first marriage 15 18 20 22 25 WOMEN 15-19 6.0 na na na na 75.7 2,407 a 20-24 9.3 30.4 46.9 na na 38.8 2,125 a 25-29 13.0 36.7 52.7 65.5 80.5 12.6 1,822 19.6 30-34 17.1 42.1 59.5 71.4 82.9 4.5 1,504 18.8 35-39 20.2 50.1 67.3 79.2 89.2 1.4 1,056 18.0 40-44 23.9 53.8 68.4 78.2 89.2 0.2 761 17.6 45-49 25.2 58.2 73.7 84.2 90.7 0.6 559 17.3 20-49 15.7 41.0 57.4 na na 14.6 7,826 19.0 25-49 18.1 45.0 61.4 73.1 84.9 5.6 5,701 18.6 MEN 15-19 0.0 na na na na 99.7 836 a 20-24 0.0 0.7 2.6 na na 93.0 849 a 25-29 0.0 0.7 3.8 7.4 20.4 65.6 586 a 30-34 0.0 2.0 8.0 12.8 22.8 26.0 425 28.4 35-39 0.0 4.3 7.5 14.6 24.8 9.7 391 28.4 40-44 0.0 2.6 10.1 20.0 34.2 6.0 270 28.1 45-49 0.0 2.4 9.3 14.1 25.4 1.9 220 28.5 20-49 0.0 1.8 5.7 na na 49.0 2,741 a 25-49 0.0 2.2 7.0 12.7 24.4 29.2 1,892 a 20-59 0.0 1.9 5.6 na na 45.2 2,985 a 25-59 0.0 2.4 6.8 12.2 24.3 26.1 2,136 a Note: Age at first marriage is defined as the age at which the respondent began living with her/his first spouse/partner. na = Not applicable due to censoring a = Omitted because less than 50 percent of the women or men began living with their spouse or partner for the first time before reaching the beginning of the age group Table 4.4 shows the median age at first marriage for women and men according to background characteristics. Because of the small numbers of married respondents below age 20 among women and below age 30 among men, these data have been omitted. Urban women age 25-49 tend to marry about two years later than their rural counterparts. The difference by LGA is more pronounced. Women from Banjul and Kanifing marry at older ages than women from other areas. For example, the median age at marriage among women in Banjul is four years older than that among women in Kuntaur (21.0 versus 17.0). Median age at marriage among women increases in a linear manner with increases in education and wealth. Marriage and Sexual Activity • 53 Men tend to marry later in life. The median age at marriage among men age 30-49 is 28.4 years. Similar to women, men in urban areas marry more than two years later than their rural counterparts (29.3 versus 27.0). Median age at marriage among men age 30-49 by background characteristics follows patterns similar to those for women. Table 4.4 Median age at first marriage by background characteristics Median age at first marriage among women age 20-49 and age 25-49, and median age at first marriage among men age 30-49 and age 30-59, according to background characteristics, The Gambia 2013 Background characteristic Women age Men age 20-49 25-49 30-49 30-59 Residence Urban a 19.7 29.3 29.2 Rural 17.7 17.5 27.0 27.1 Local Government Area Banjul a 21.0 a a Kanifing a 20.1 a 29.7 Brikama 19.5 19.0 28.2 28.3 Mansakonko 17.9 17.3 28.5 28.1 Kerewan 17.7 17.3 27.9 28.2 Kuntaur 17.2 17.0 26.3 26.4 Janjanbureh 18.3 18.1 27.0 27.2 Basse 17.5 17.6 27.2 27.4 Education No education 17.4 17.3 26.9 27.2 Primary 18.2 18.2 28.9 29.5 Secondary or higher a 22.2 29.7 29.4 Wealth quintile Lowest 17.6 17.2 27.1 27.2 Second 17.9 17.6 27.3 27.4 Middle 18.3 17.9 28.2 28.2 Fourth 19.5 19.3 29.1 29.1 Highest a 20.8 29.8 29.5 Total 19.0 18.6 28.4 28.3 Note: Age at first marriage is defined as the age at which the respondent began living with her/his first spouse/partner. a = Omitted because less than 50 percent of the respondents began living with their spouse/partner for the first time before reaching the beginning of the age group 4.4 AGE AT FIRST SEXUAL INTERCOURSE Although age at first marriage is often used as a proxy for first exposure to intercourse, the two events do not necessarily occur at the same time. Women and men sometimes engage in sexual relations before marriage. In the 2013 GDHS, women and men were asked how old they were when they first had sexual intercourse. The percentage of women and men who had sexual intercourse by exact ages is shown in Table 4.5. Overall, 15 percent of women age 20-49 had sex before age 15 and 42 percent before age 18. The proportion of women who first had sexual intercourse by the ages of 15 and 18 is notably higher among older age groups, peaking at 24 percent and 54 percent, respectively, among women age 45-49. The median age at first sexual intercourse for women age 25-49 years is 18.6 years, which is the same as the median age at first marriage of 18.6 years. This suggests that women in The Gambia generally begin sexual intercourse at the time of their first marriage. Women’s sexual debut occurs much earlier than that of men (18.6 years for women versus 23.1 years for men). 54 • Marriage and Sexual Activity Table 4.5 Age at first sexual intercourse Percentage of women and men age 15-49 who had first sexual intercourse by specific exact ages, percentage who never had sexual intercourse, and median age at first sexual intercourse, according to current age, The Gambia 2013 Current age Percentage who had first sexual intercourse by exact age: Percentage who never had intercourse Number Median age at first intercourse15 18 20 22 25 WOMEN 15-19 5.7 na na na na 75.2 2,407 na 20-24 10.1 34.3 51.7 na na 32.3 2,125 19.8 25-29 13.2 38.5 55.5 67.8 80.2 9.1 1,822 19.3 30-34 15.3 40.4 58.4 70.7 81.3 2.9 1,504 18.9 35-39 20.0 49.8 65.3 75.0 83.5 0.7 1,056 18.0 40-44 23.2 53.5 67.5 77.4 86.4 0.0 761 17.6 45-49 23.9 54.4 71.9 79.1 85.5 0.0 559 17.6 20-49 15.4 41.8 58.7 na na 11.5 7,826 18.9 25-49 17.4 44.6 61.3 72.3 82.4 3.8 5,701 18.6 15-24 7.8 na na na na 55.1 4,532 a MEN 15-19 6.1 na na na na 77.3 836 a 20-24 3.0 22.2 38.9 na na 46.6 849 a 25-29 1.5 17.2 34.6 48.4 64.5 23.2 586 22.4 30-34 1.0 11.3 28.4 46.6 54.8 6.9 425 23.4 35-39 0.8 15.2 29.3 45.1 61.7 1.3 391 22.7 40-44 1.1 8.2 22.7 42.4 54.6 0.7 270 23.4 45-49 0.2 4.7 19.1 36.5 47.1 1.0 220 25.5 20-49 1.7 15.7 31.8 na na 20.8 2,741 a 25-49 1.1 12.7 28.6 45.1 58.3 9.2 1,892 23.1 15-24 4.6 na na na na 61.8 1,685 a 20-59 1.7 15.1 30.5 na na 19.1 2,985 a 25-59 1.1 12.2 27.2 43.6 57.2 8.2 2,136 23.3 na = Not applicable due to censoring a = Omitted because less than 50 percent of the respondents had sexual intercourse for the first time before reaching the beginning of the age group Differentials in median age at first sexual intercourse among women age 25-49 and men age 25-59 by background characteristics are shown in Table 4.6. Women in rural areas begin engaging in sexual activity about one and a half years earlier than their urban counterparts (17.7 versus 19.4). The median age at first sexual intercourse among women is youngest in Kuntaur (17.0) and oldest in Banjul (20.8). With respect to education, women with a secondary or higher education begin engaging in sexual activity almost four years later than those with no education (21.5 versus 17.5). Age at first sexual intercourse increases steadily with increasing wealth, from 17.4 years among the poorest women to 20.6 years among those in the highest quintile. The data for men show no major differences in median age at first sexual intercourse by urban-rural residence, LGA, education, or wealth. 4.5 RECENT SEXUAL ACTIVITY In the absence of contraception, the probability of pregnancy is related to the frequency of intercourse. Thus, information on sexual activity can be used to refine measures of exposure to pregnancy. Tables 4.7.1 and 4.7.2 show the percent distribution of women and men age 15-49, respectively, by timing of last sexual intercourse, according to background characteristics. Table 4.6 Median age at first sexual intercourse by background characteristics Median age at first sexual intercourse among women age 25-49, and median age at first sexual intercourse among men age 25-59, according to background characteristics, The Gambia 2013 Background characteristic Women age 25-49 Men age 25-59 Residence Urban 19.4 23.4 Rural 17.7 23.3 Local Government Area Banjul 20.8 22.8 Kanifing 19.7 22.7 Brikama 18.9 23.5 Mansakonko 17.4 21.9 Kerewan 17.4 22.4 Kuntaur 17.0 a Janjanbureh 18.5 23.3 Basse 17.9 24.2 Education No education 17.5 23.8 Primary 18.2 21.0 Secondary or higher 21.5 23.1 Wealth quintile Lowest 17.4 23.1 Second 17.7 23.4 Middle 18.0 24.7 Fourth 19.0 23.4 Highest 20.6 22.7 Total 18.6 23.3 a = Omitted because less than 50 percent of the respondents had sexual intercourse for the first time before reaching the beginning of the age group Marriage and Sexual Activity • 55 Table 4.7.1 Recent sexual activity: Women Percent distribution of women age 15-49 by timing of last sexual intercourse, according to background characteristics, The Gambia 2013 Timing of last sexual intercourse Never had sexual intercourse Total Number of women Background characteristic Within the past 4 weeks Within 1 year1 One or more years Missing Age 15-19 12.6 9.5 2.6 0.0 75.2 100.0 2,407 20-24 33.1 22.5 11.9 0.3 32.3 100.0 2,125 25-29 49.5 29.1 12.1 0.2 9.1 100.0 1,822 30-34 56.4 24.3 16.3 0.1 2.9 100.0 1,504 35-39 60.7 24.3 14.3 0.0 0.7 100.0 1,056 40-44 58.6 23.2 17.9 0.4 0.0 100.0 761 45-49 65.3 15.9 18.7 0.0 0.0 100.0 559 Marital status Never married 1.7 5.0 5.3 0.2 87.8 100.0 2,963 Married or living together 60.9 27.1 10.4 0.1 1.5 100.0 6,791 Divorced/separated/widowed 4.8 27.9 65.6 0.4 1.3 100.0 478 Marital duration2 0-4 years 53.3 32.6 8.5 0.0 5.6 100.0 1,696 5-9 years 55.7 30.2 13.1 0.3 0.7 100.0 1,311 10-14 years 62.3 26.4 11.3 0.0 0.0 100.0 1,070 15-19 years 66.5 22.0 11.5 0.0 0.0 100.0 824 20-24 years 69.9 20.0 10.0 0.0 0.0 100.0 578 25+ years 67.5 21.8 10.4 0.2 0.0 100.0 541 Married more than once 67.0 25.4 7.4 0.2 0.0 100.0 771 Residence Urban 37.8 18.0 12.3 0.2 31.7 100.0 5,730 Rural 45.4 24.3 10.4 0.1 19.9 100.0 4,503 Local Government Area Banjul 31.5 18.1 15.6 0.7 34.1 100.0 225 Kanifing 32.3 19.0 13.8 0.2 34.7 100.0 2,342 Brikama 42.3 18.9 11.0 0.2 27.6 100.0 3,550 Mansakonko 43.2 23.6 9.8 0.1 23.4 100.0 490 Kerewan 51.3 19.5 5.4 0.0 23.7 100.0 1,107 Kuntaur 51.1 23.7 8.0 0.0 17.2 100.0 526 Janjanbureh 39.1 25.7 13.4 0.0 21.9 100.0 739 Basse 43.2 25.5 14.1 0.1 17.1 100.0 1,254 Education No education 54.8 23.9 12.8 0.1 8.4 100.0 4,757 Primary 38.3 24.4 8.8 0.3 28.1 100.0 1,405 Secondary or higher 26.1 15.8 10.8 0.1 47.1 100.0 4,071 Wealth quintile Lowest 45.9 24.5 10.0 0.1 19.5 100.0 1,745 Second 44.7 23.8 10.4 0.1 20.9 100.0 1,882 Middle 44.5 21.6 11.6 0.2 22.1 100.0 1,927 Fourth 40.8 19.5 11.3 0.2 28.3 100.0 2,135 Highest 32.9 16.3 13.4 0.2 37.3 100.0 2,545 Total 41.1 20.8 11.5 0.1 26.5 100.0 10,233 1 Excludes women who had sexual intercourse within the last 4 weeks 2 Excludes women who are not currently married 56 • Marriage and Sexual Activity Table 4.7.2 Recent sexual activity: Men Percent distribution of men age 15-49 by timing of last sexual intercourse, according to background characteristics, The Gambia 2013 Background characteristic Timing of last sexual intercourse Never had sexual intercourse Total Number of men Within the past 4 weeks Within 1 year1 One or more years Missing Age 15-19 4.8 8.6 9.3 0.0 77.3 100.0 836 20-24 15.7 19.0 18.6 0.1 46.6 100.0 849 25-29 32.3 26.7 17.1 0.7 23.2 100.0 586 30-34 52.4 28.9 10.5 1.3 6.9 100.0 425 35-39 58.4 34.4 5.7 0.2 1.3 100.0 391 40-44 68.5 21.9 8.1 0.8 0.7 100.0 270 45-49 75.2 16.2 6.4 1.3 1.0 100.0 220 Marital status Never married 10.4 16.9 17.0 0.2 55.5 100.0 2,177 Married or living together 67.6 27.0 3.9 0.8 0.6 100.0 1,360 Divorced/separated/widowed (45.7) (17.5) (36.7) (0.0) (0.0) 100.0 40 Marital duration2 0-4 years 58.2 35.2 3.4 1.5 1.8 100.0 393 5-9 years 67.5 30.0 2.5 0.0 0.0 100.0 305 10-14 years 69.2 25.4 5.0 0.3 0.0 100.0 184 15-19 years 68.2 24.5 6.7 0.7 0.0 100.0 97 20-24 years (58.8) (25.7) (11.8) (3.8) (0.0) 100.0 39 25+ years * * * * * 100.0 8 Married more than once 79.4 15.8 3.8 0.8 0.3 100.0 334 Residence Urban 30.1 22.5 13.0 0.5 33.8 100.0 2,228 Rural 36.6 17.7 11.0 0.3 34.3 100.0 1,349 Local Government Area Banjul 33.4 25.3 14.7 1.1 25.5 100.0 85 Kanifing 31.8 22.9 12.5 1.2 31.5 100.0 858 Brikama 29.2 21.6 13.6 0.1 35.5 100.0 1,454 Mansakonko 33.1 23.7 9.4 0.8 33.1 100.0 141 Kerewan 38.1 16.8 8.8 0.4 35.8 100.0 323 Kuntaur 41.7 12.9 4.8 0.9 39.7 100.0 141 Janjanbureh 31.0 24.6 17.2 0.0 27.2 100.0 240 Basse 40.4 13.6 9.0 0.0 37.0 100.0 336 Education No education 45.1 21.2 9.7 0.5 23.6 100.0 1,090 Primary 28.6 16.0 11.0 0.3 44.2 100.0 493 Secondary or higher 26.7 21.7 14.0 0.5 37.2 100.0 1,994 Wealth quintile Lowest 37.1 18.7 9.8 0.0 34.5 100.0 517 Second 34.3 20.0 11.8 0.2 33.7 100.0 614 Middle 29.5 21.2 12.7 0.5 36.1 100.0 588 Fourth 28.1 23.4 14.2 0.6 33.7 100.0 940 Highest 35.4 19.4 11.7 0.7 32.8 100.0 919 Total 15-49 32.6 20.7 12.2 0.5 34.0 100.0 3,577 50-59 75.1 11.1 13.0 0.7 0.2 100.0 244 Total 15-59 35.3 20.1 12.3 0.5 31.8 100.0 3,821 Note: Figures in parentheses are based on 25-49 unweighted cases. An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. 1 Excludes men who had sexual intercourse within the last 4 weeks 2 Excludes men who are not currently married Twenty-seven percent of women and 34 percent of men age 15-49 have never had sexual intercourse. The percentages of respondents who have never had sexual intercourse are highest among those in the youngest age group, with three-quarters of women and men age 15-19 never having had sex. Marriage and Sexual Activity • 57 More than one in ten women and men age 15-49 (12 percent each) report that their last sexual encounter occurred more than one year before the survey, and 41 percent of women and 33 percent of men reported that it occurred in the past four weeks. Recent sexual activity is more common among currently married respondents, with 61 percent of women and 68 percent of men having had sex in the four weeks before the survey. Among never-married respondents, the proportion of men who report a recent sexual encounter is five times that of women (10 percent and 2 percent, respectively). Respondents who live in rural area

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