Demographic and Health Survey 2008-09 pptx

Kenya 2008-09 Demographic and Health Survey Kenya 2008-09 Demographic and Health Survey KENYA DEMOGRAPHIC AND HEALTH SURVEY 2008-09 Kenya National Bureau of Statistics Nairobi, Kenya National AIDS Control Council Nairobi, Kenya National AIDS/STD Control Programme Nairobi, Kenya Ministry of Public Health and Sanitation Nairobi, Kenya Kenya Medical Research Institute Nairobi, Kenya National Coordinating Agency for Population and Development Nairobi, Kenya MEASURE DHS, ICF Macro Calverton, Maryland, U.S.A. U.S. Agency for International Development (USAID) Nairobi, Kenya United Nations Population Fund Nairobi, Kenya United Nations Children’s Fund Nairobi, Kenya June 2010 KENYANS AND AMERICANS IN PARTNERSHIP TO FIGHT HIV/AIDS This report summarises the findings of the 2008-09 Kenya Demographic and Health Survey (KDHS) carried out by the Kenya National Bureau of Statistics (KNBS) in partnership with the National AIDS Control Council (NACC), the National AIDS/STD Control Programme (NASCOP), the Ministry of Health and Sanitation, the Kenya Medical Research Institute (KEMRI), and the National Coordinating Agency for Population and Development (NCAPD). ICF Macro provided technical assistance for the survey through the USAID-funded MEASURE DHS programme, which is designed to assist developing countries to collect data on fertility, family planning, and maternal and child health. Funding for the KDHS was received from USAID/Kenya, the United Nations Population Fund (UNFPA), the United Nations Children’s Fund (UNICEF), UNAIDS, and the World Bank. The opinions expressed in this report are those of the authors and do not necessarily reflect the views of the donor organisations. Additional information about the survey may be obtained from the Kenya National Bureau of Statistics (KNBS), P.O. Box 30266, Nairobi (Telephone: 254.20.340.929; Fax: 254.20.315.977, email: director@cbs.go.ke ). Additional information about the DHS programme may be obtained from MEASURE DHS, ICF Macro, 11785 Beltsville Drive, Suite 300, Calverton, MD 20705, U.S.A. (Telephone: 1.301.572.0200; Fax: 1.301.572.0999; e-mail: reports@macrointernational.com ). Recommended citation: Kenya National Bureau of Statistics (KNBS) and ICF Macro. 2010. Kenya Demographic and Health Survey 2008-09. Calverton, Maryland: KNBS and ICF Macro. Contents | iii CONTENTS TABLES AND FIGURES ix FOREWORD xvii ACKNOWLEDGMENTS xix SUMMARY OF FINDINGS xxi MAP OF KENYA xxvi CHAPTER 1 INTRODUCTION 1.1 Geography, History, and the Economy 1 1.1.1 Geography 1 1.1.2 History 1 1.1.3 Economy 2 1.2 Population 3 1.3 Population and Family Planning Policies and Programmes 3 1.4 Health Priorities and Programmes 5 1.5 Strategic Framework to Combat the HIV/AIDS Epidemic 6 1.6 Objectives of the Survey 6 1.7 Survey Organisation 7 1.8 Sample Design 8 1.9 Questionnaires 8 1.10 HIV Testing 9 1.11 Training 10 1.12 Fieldwork 11 1.13 Data Processing 12 1.14 Response Rates 12 CHAPTER 2 HOUSEHOLD POPULATION AND HOUSING CHARACTERISTICS 2.1 Population by Age and Sex 13 2.2 Household Composition 14 2.3 Education of the Household Population 15 2.3.1 Educational Attainment 15 2.3.2 School Attendance Rates 17 2.4 Household Environment 20 2.4.1 Drinking Water 20 2.4.2 Household Sanitation Facilities 22 2.4.3 Housing Characteristics 23 2.5 Household Possessions 24 2.6 Wealth Index 25 2.7 Birth Registration 26 iv | Contents CHAPTER 3 CHARACTERISTICS OF RESPONDENTS 3.1 Characteristics of Survey Respondents 29 3.2 Educational Attainment by Background Characteristics 31 3.3 Literacy 32 3.4 Access to Mass Media 34 3.5 Employment 37 3.6 Occupation 39 3.7 Earnings and Type of Employment 41 3.8 Health Insurance Coverage 43 3.9 Knowledge and Attitudes Concerning Tuberculosis 43 3.10 Smoking 45 CHAPTER 4 FERTILITY LEVELS, TRENDS, AND DIFFERENTIALS 4.1 Introduction 47 4.2 Current Fertility 47 4.3 Fertility Trends 50 4.4 Children Ever Born and Children Surviving 52 4.5 Birth Intervals 53 4.6 Age at First Birth 54 4.7 Teenage Fertility 55 CHAPTER 5 FAMILY PLANNING 5.1 Knowledge of Contraceptive Methods 57 5.2 Ever Use of Family Planning Methods 59 5.3 Current Use of Contraceptive Methods 61 5.4 Differentials in Contraceptive Use by Background Characteristics 64 5.5 Number of Children at First Use of Contraception 66 5.6 Knowledge of Fertile Period 66 5.7 Timing of Sterilisation 67 5.8 Source of Contraception 67 5.9 Cost of Contraceptive Methods 68 5.10 Informed Choice 69 5.11 Contraceptive Discontinuation 70 5.12 Future Use of Contraception 71 5.13 Reasons for Not Intending to Use 71 5.14 Exposure to Family Planning Messages 72 5.15 Contact of Non-users with Family Planning Providers 75 5.16 Husband/Partner’s Knowledge of Women’s Contraceptive Use 76 CHAPTER 6 OTHER PROXIMATE DETERMINANTS OF FERTILITY 6.1 Current Marital Status 79 6.2 Polygyny 80 6.3 Age at First Marriage 82 6.4 Age at First Sexual Intercourse 84 6.5 Recent Sexual Activity 86 6.6 Postpartum Amenorrhoea, Abstinence, and Insusceptibility 89 6.7 Menopause 90 Contents | v CHAPTER 7 FERTILITY PREFERENCES 7.1 Desire for More Children 93 7.2 Desire to Limit Childbearing by Background Characteristics 95 7.3 Need for Family Planning Services 96 7.4 Ideal Number of Children 97 7.5 Mean Ideal Number of Children by Background Characteristics 99 7.6 Fertility Planning Status 99 7.7 Wanted Fertility Rates 101 CHAPTER 8 INFANT AND CHILD MORTALITY 8.1 Levels and Trends in Infant and Child Mortality 103 8.2 Data Quality 105 8.3 Socioeconomic Differentials in Infant and Child Mortality 106 8.4 Demographic Differentials in Infant and Child Mortality 108 8.5 Perinatal Mortality 109 8.6 High-risk Fertility Behaviour 110 CHAPTER 9 MATERNAL HEALTH 9.1 Antenatal Care 113 9.1.1 Antenatal Care Coverage 113 9.1.2 Source of Antenatal Care 115 9.1.3 Number and Timing of Antenatal Care Visits 116 9.1.4 Components of Antenatal Care 116 9.2 Tetanus Toxoid Injections 118 9.3 Place of Delivery 119 9.4 Assistance during Delivery 122 9.5 Postnatal Care 123 CHAPTER 10 CHILD HEALTH 10.1 Weight and Size at Birth 127 10.2 Vaccination Coverage 128 10.3 Acute Respiratory Infection 132 10.4 Fever 134 10.5 Diarrhoeal Disease 135 10.6 Knowledge of ORS Packets 139 10.7 Stool Disposal 139 CHAPTER 11 NUTRITION OF WOMEN AND CHILDREN 11.1 Nutritional Status of Children 141 11.1.1 Measurement of Nutritional Status among Young Children 141 11.1.2 Results of Data Collection 142 11.1.3 Levels of Malnutrition 142 11.2 Initiation of Breastfeeding 146 11.3 Breastfeeding Status by Age 148 vi | Contents 11.4 Duration and Frequency of Breastfeeding 150 11.5 Types of Complementary Foods 151 11.6 Infant and Young Child Feeding Practices 152 11.7 Micronutrient Intake among Children 154 11.8 Nutritional Status of Women 157 11.9 Micronutrient Intake among Mothers 158 CHAPTER 12 MALARIA 12.1 Introduction 161 12.2 Household Ownership of Mosquito Nets 162 12.3 Use of Mosquito Nets 164 12.4 Intermittent Preventive Treatment of Malaria in Pregnancy 167 12.5 Malaria Case Management among Children 168 CHAPTER 13 HIV/AIDS-RELATED KNOWLEDGE, ATTITUDES, AND BEHAVIOUR 13.1 Introduction 173 13.2 HIV/AIDS Knowledge of Transmission and Prevention Methods 173 13.2.1 Awareness of HIV/AIDS 173 13.2.2 Knowledge of HIV Prevention 174 13.2.3 Rejection of Misconceptions about HIV/AIDS 177 13.2.4 Knowledge of Mother-to-Child Transmission of HIV 180 13.3 Attitudes towards People Living with AIDS 181 13.4 Attitudes Towards Condom Education for Youth 185 13.5 Higher Risk Sex 186 13.5.1 Multiple Partners and Condom Use 186 13.5.2 Transactional Sex 190 13.6 Coverage of HIV Counselling and Testing 190 13.6.1 General HIV Testing 190 13.6.2 HIV Counselling and Testing during Pregnancy 193 13.7 Male Circumcision 194 13.8 Self-Reporting of Sexually Transmitted Infections 194 13.9 HIV/AIDS Knowledge and Sexual Behaviour among Youth 195 13.9.1 HIV/AIDS-Related Knowledge among Young Adults 196 13.9.2 Trends in Age at First Sex 197 13.9.3 Condom Use at First Sex 199 13.9.4 Abstinence and Premarital Sex 200 13.9.5 Higher-Risk Sex and Condom Use among Young Adults 202 13.9.6 Cross-generational Sexual Partners 205 13.9.7 Drunkenness during Sex among Young Adults 206 13.9.8 Voluntary HIV Counselling and Testing among Young Adults 207 CHAPTER 14 HIV PREVALENCE AND ASSOCIATED FACTORS 14.1 Coverage of HIV Testing 209 14.2 HIV Prevalence by Age 213 14.3 Trends in HIV Prevalence 214 Contents | vii 14.4 HIV Prevalence by Socioeconomic Characteristics 215 14.5 HIV Prevalence by Demographic Characteristics and Sexual Behaviour 217 14.6 HIV Prevalence among Youth 220 14.7 HIV Prevalence by Other Characteristics 223 14.8 HIV Prevalence by Male Circumcision 224 14.9 HIV Prevalence among Couples 226 14.10 Distribution of the HIV Burden in Kenya 227 CHAPTER 15 WOMEN’S EMPOWERMENT AND DEMOGRAPHIC AND HEALTH OUTCOMES 15.1 Employment and Form of Earnings 229 15.2 Controls over Earnings 230 15.2.1 Control over Wife’s Earnings 230 15.2.2 Control over Husband’s Earnings 231 15.3 Women’s Participation in Decision-making 233 15.4 Attitudes towards Wife Beating 236 15.5 Men’s Attitudes towards Wife’s Refusing Sex 239 15.6 Women’s Empowerment Indicators 241 15.7 Current Use of Contraception by Women’s Status 241 15.8 Ideal Family Size and Unmet Need by Women’s Status 242 15.9 Women’s Status and Reproductive Health Care 243 CHAPTER 16 GENDER-BASED VIOLENCE 16.1 Introduction 245 16.2 Data Collection 245 16.3 Experience of Physical Violence 247 16.4 Experience of Sexual Violence 249 16.5 Marital Control 251 16.6 Marital Violence 253 16.7 Frequency of Spousal Violence 258 16.8 Physical Consequences of Spousal Violence 259 16.9 Violence Initiated by Women Against Husbands 260 16.10 Response to Violence 262 16.11 Female Genital Cutting 264 CHAPTER 17 ADULT AND MATERNAL MORTALITY 17.1 Data 269 17.2 Estimates of Adult Mortality 270 17.3 Estimates of Maternal Mortality 272 REFERENCES 275 APPENDIX A SAMPLE IMPLEMENTATION 283 APPENDIX B ESTIMATES OF SAMPLING ERRORS 289 APPENDIX C DATA QUALITY 305 APPENDIX D LIST OF 2008-09 KDHS PARTICIPANTS 311 APPENDIX E QUESTIONNAIRES 319 Tables and Figures | ix TABLES AND FIGURES CHAPTER 1 INTRODUCTION Table 1.1 Basic demographic indicators 3 Table 1.2 Results of the household and individual interviews 12 CHAPTER 2 HOUSEHOLD POPULATION AND HOUSING CHARACTERISTICS Table 2.1 Household population by age, sex, and residence 13 Table 2.2 Household composition 15 Table 2.3.1 Educational attainment of the female household population 16 Table 2.3.2 Educational attainment of the male household population 17 Table 2.4 School attendance ratios 18 Table 2.5 School attendance 19 Table 2.6 Household drinking water 21 Table 2.7 Household sanitation facilities 22 Table 2.8 Household characteristics 23 Table 2.9 Household durable goods 25 Table 2.10 Wealth quintiles 26 Table 2.11 Birth registration of children under age five 27 Table 2.12 Reason for not registering birth 28 Figure 2.1 Population Pyramid 14 Figure 2.2 Age-specific Attendance Rates of the de-facto Population 5 to 24 Years 20 CHAPTER 3 CHARACTERISTICS OF RESPONDENTS Table 3.1 Background characteristics of respondents 30 Table 3.2.1 Educational attainment: Women 31 Table 3.2.2 Educational attainment: Men 32 Table 3.3.1 Literacy: Women 33 Table 3.3.2 Literacy: Men 34 Table 3.4.1 Exposure to mass media: Women 35 Table 3.4.2 Exposure to mass media: Men 36 Table 3.5.1 Employment status: Women 37 Table 3.5.2 Employment status: Men 38 Table 3.6.1 Occupation: Women 40 Table 3.6.2 Occupation: Men 41 Table 3.7 Type of employment among women 42 Table 3.8.1 Knowledge and attitude concerning tuberculosis: Women 44 Table 3.8.2 Knowledge and attitude concerning tuberculosis: Men 45 Table 3.9 Use of tobacco: Men 46 Figure 3.1 Access to Mass Media 36 Figure 3.2 Women’s Employment Status in the Past 12 Months 39 Figure 3.3 Employment Characteristics among Working Women 42 Figure 3.4 Health Insurance Coverage 43 [...]... HIV-related illnesses and deaths, and mitigate the effects of the epidemic on households and communities (National AIDS Control Council, 2009) 1.6 OBJECTIVES OF THE SURVEY The 2008-09 Kenya Demographic and Health Survey (KDHS) is a population and health survey that Kenya conducts every five years It was designed to provide data to monitor the population and health situation in Kenya and also to be used... fertility preferences, awareness and use of family planning methods, breastfeeding practices, nutritional status of women and young children, childhood and maternal mortality, maternal and child health, and awareness and behaviour regarding HIV/AIDS The survey also included collection information on ownership and use of mosquito nets, domestic violence, and HIV testing of adults The 2008-09 KDHS was implemented... Nzoia, and Mara; and numerous wildlife reserves containing thousands of different animal species The country falls into two regions: lowlands, including the coastal and Lake Basin lowlands, and highlands, which extend on both sides of the Great Rift Valley Rainfall and temperatures are influenced by altitude and proximity to lakes or the ocean The climate along the coast is tropical with rainfall and. .. reproductive and HIV health care (Health Policy Initiative, 2009) This policy emphasises priority actions for the achievement of the ICPD goals and the Millennium Development Goals (MDGs) of improving maternal health, reducing neonatal and child mortality, reducing the spread of HIV/AIDS, and achieving women’s empowerment and gender equality Attainment of sexual and reproductive health and rights will... Bank, and UNICEF Foreword | xvii SUMMARY OF FINDINGS The 2008-09 Kenya Demographic and Health Survey (KDHS) is a nationally representative sample survey of 8,444 women age 15 to 49 and 3,465 men age 15 to 54 selected from 400 sample points (clusters) throughout Kenya It is designed to provide data to monitor the population and health situation in Kenya as a follow-up to the 1989, 1993, 1998, and 2003... status of women and young children, childhood and maternal mortality, maternal and child health, malaria and use of mosquito nets, domestic violence, awareness and behaviour regarding HIV/AIDS and other sexually transmitted infections (STIs), and HIV prevalence among adults The results of the current survey present evidence of a resumption of the fertility decline observed in the 1980s and the 1990s... reproductive health issues and challenges: adolescent sexual health and reproductive rights; harmful practices, including early marriage, female genital cutting, and gender-based violence; drug and substance abuse; socioeconomic factors; and the special needs of adolescents and young people with disabilities (Odini, 2008) Introduction | 3 The Ministry of Health (MOH) formally approved and adopted the... the previous KDHS surveys in 1989, 1993, 1998, and 2003 From the current survey, information was collected on fertility levels; marriage; sexual activity; fertility preferences; awareness and use of family planning methods; breastfeeding practices; nutritional status of women and young children; childhood and maternal mortality; maternal and child 6 | Introduction health; and awareness and behaviour regarding... prevalence of HIV infection at the national and provincial levels and by urban-rural residence, and use the data to corroborate the rates from the sentinel surveillance system The 2008-09 KDHS information provides data to assist policymakers and programme implementers as they monitor and evaluate existing programmes and design new strategies for demographic, social, and health policies in Kenya The data will... Development Goals As in 2003, the 2008-09 KDHS survey was designed to cover the entire country, including the arid and semi-arid districts, and especially those areas in the northern part of the country that were not covered in the earlier KDHS surveys The survey collected information on demographic and health issues from a sample of women at the reproductive age of 15-49 and from a sample of men age 15-54 . Kenya 2008-09 Demographic and Health Survey Kenya 2008-09 Demographic and Health Survey KENYA DEMOGRAPHIC AND HEALTH SURVEY 2008-09 Kenya National Bureau. Bureau of Statistics (KNBS) and ICF Macro. 2010. Kenya Demographic and Health Survey 2008-09. Calverton, Maryland: KNBS and ICF Macro. Contents | iii CONTENTS TABLES AND FIGURES ix FOREWORD. agencies and institutions that culminated in the compilation of the 2008-09 Kenya Demographic and Health Survey (KDHS). The survey was conducted in close collaboration with the National Public Health