39444 SOCIO-ECONOMIC DIFFERENCES IN HEALTH, NUTRITION, AND POPULATION EGYPT 1995, 2000 Davidson R. Gwatkin, Shea Rutstein, Kiersten Johnson, Eldaw Suliman, Adam Wagstaff, and Agbessi Amouzou TABLE OF CONTENTS Foreword I Introduction III Part I. Basic Tables, 2000 1 A. Total Population 3 B. Female and Male Populations 9 C. Rural and Urban Populations 13 Part II. Basic Tables, 1995 19 A. Total Population 21 B. Female and Male Populations 27 C. Rural and Urban Populations 31 Part III. Technical Notes 37 A. Indicator Definitions 39 B. Data and Methods 53 C. Discussion 57 Part IV. Supporting Tables, 2000 63 A. Sample Sizes 65 B. Standard Errors 71 C. Asset Distribution and Weights 77 Part V. Supporting Tables, 1995 79 A. Sample Sizes 81 B. Standard Errors 87 C. Asset Distribution and Weights 93 Part VI. Annexes 95 A. Sources of Additional Information 97 B. Use of Information from this 99 Report to Monitor the Economic Status of People Served by HNP Programs C. Countries Covered by the 105 HNP-Poverty Report Project FOREWORD The World Bank shares the desire of its member states and client countries to ensure that the poor partake fully in the health gains that the countries achieve. To assist in this, the Bank, in cooperation with the Dutch and Swedish Governments, has sponsored the set of reports providing basic information about health inequalities within countries to which this document belongs. The information shows clearly that disparities in both health conditions and health service use are unacceptably large. As countries and the Bank work to reduce important inequalities among regions and countries, there is a clear need for equally vigorous efforts to lessen the inequity represented by intra-country differences among socio-economic groups. My colleagues and I hope that all concerned with equity in health will find this information useful in making the case for effective actions to improve the health of the poor, and in designing programs to achieve this crucial objective. Joy Phumaphi Vice President Human Development Network The World Bank - I - INTRODUCTION This report is one in a series that provides basic information about health, nutrition, and population (hnp) inequalities within fifty-six developing countries. The series to which the report belongs is an expanded and updated version of a set covering forty- five countries that was published in 2000. The fifty-six reports in the current series cover almost all DHS surveys undertaken during the period beginning in 1990 and ending with the date of the last survey for which data were publicly available as of June 2006.1 The report's contents are intended to facilitate preparation of country analyses and the development of activities to benefit poor people. To this end, the report presents data about hnp status, service use, and related matters among individuals belonging to different socio-economic classes. The principal focus is on differences among groups of individuals defined in terms of the wealth or assets of the households where they reside. The source of data is the Demographic and Health Survey (DHS) program, a large, multi-country household survey project. The figures in this and the other reports in the series draw on responses to questions about household wealth or assets included in the DHS questionnaire, which were similar for all the surveys covered. These responses served as the basis for the construction of a wealth index, which was used to rank individuals according to the index value for the household to which they belonged. The individuals were then divided into quintiles, and the mean value for each of up to approximately 120 indicators was calculated for each quintile. The report is organized in four principal parts: · Parts one and two, which constitute the report's core, consist of tables presenting quintile-specific data for each hnp indicator covered from the two most recent DHS surveys available at the time of the report's publication. In each part there are three sets of tables: the first provides quintile-specific information for the total population; the second presents data separately for quintiles of females and males; the third features quintile-specific information presented separately for rural and urban residents. Each of these sets is divided into four sections: one dealing with hnp status, the second with the use of hnp services, the third with hnp-related behavior, and the fourth with other hnp status determinants. · Part three provides supplementary technical information designed to help readers understand the data presented in parts one and two. This information deals with such issues as how the covered hnp indicators were defined and how the quintile-specific estimates were derived. · Parts four and five present supporting tables that deal with three of the technical matters covered in part three: the size of the sample for each indicator covered; the standard error 1The average interval of approximately two years between data collection and availability means that the latest surveys covered were conducted in 2005. - III - for each quintile-specific estimate in the total population; and the items used in constructing the wealth index, along with the weight assigned to each. An additional, sixth part consists of three annexes, for readers interested in applying the approach used in the report or in learning more about the other reports in this series. The first annex is an annotated bibliography containing further information about the technical issues concerning the approach used in the report, and about employing that approach to examine additional issues using DHS or other data sets. The second shows how the report's approach can be applied to monitor the distribution of benefits from other hnp programs, and provides a tool for doing so. The third annex is a list of all fifty-six countries for which reports are available, along with an indication of how to obtain copies of the reports dealing with them. ********************************* The authors thank the Dutch and Swedish Governments for the generous support that made production of this report possible. - IV - PART I. BASIC TABLES, 2000 A. TOTAL POPULATION B. FEMALE AND MALE POPULATIONS C. RURAL AND URBAN POPULATIONS Notes: ­ Each of the three sections referred to above consists of four divisions, presenting data for: I) hnp status; II) hnp service use; III) hnp-related individual and household behavior; and IV) other, underlying determinants of hnp status. ­ Full definitions of all indicators covered in the tables are provided in section A of the technical notes found in part II. ­ "na" appears in the table cells when data are not available, usually because the DHS survey concerned did not collect information about the indicator(s) in question. ­ Figures in the tables shown within parentheses indicate the absence of adequate observations to produce acceptably reliable values. Asterisks appear when the number of observations was too small to justify the presentation even of figures within parentheses. (For further information, see the section on "Sampling Errors" in the presentation of data and methods in part II.B.) Asterisks also will be found in columns showing statistical indices of inequality when the amount of quintile-specific information available is inadequate to permit computation of the value for the index concerned. ­ Female/male tables include only indicators relevant for both sexes; those pertaining to only one sex (e.g., fertility, women's nutritional status, antenatal care, attended deliveries) have been omitted. Egypt 2000 - TOTAL POPULATION Part I: HNP STATUS Indicator Wealth Quintiles Low/High Low-High Concentration Index Ratio Diff. Value Standard Low 2nd 3rd 4th High Avg. (Abs. Val.) Errors A. Childhood illness and mortality Infant mortality rate 75.6 63.9 53.9 43.9 29.6 54.7 2.55 46.00 -0.1627 0.0007 Under-five mortality rate 97.9 80.3 70.5 53.5 33.7 69.2 2.91 64.20 -0.1783 0.0008 Prevalence of fever 19.0 18.7 18.4 18.7 13.3 17.7 1.43 5.70 -0.0600 0.0121 Prevalence of diarrhea 8.6 7.2 7.8 6.6 5.1 7.1 1.69 3.50 -0.0820 0.0199 Prevalence of acute 11.8 10.9 9.5 8.2 6.9 9.5 1.71 4.90 -0.1050 0.0173 respiratory infection B. Fertility Total fertility rate 4.0 3.4 3.3 3.2 2.9 3.5 1.38 1.10 -0.0594 0.0002 Adolescent fertility rate 57.0 71.0 55.0 44.0 16.0 51.0 3.56 41.00 -0.1784 0.0018 C. Nutritional status (%) Children: Moderate stunting 16.4 15.0 12.4 10.3 7.9 12.4 2.08 8.50 -0.1403 0.0147 Severe stunting 10.1 6.5 6.3 4.8 3.1 6.2 3.26 7.00 -0.2048 0.0230 Moderate underweight 5.4 4.0 3.2 2.7 2.2 3.5 2.45 3.20 -0.1881 0.0302 Severe underweight 1.2 0.5 0.5 0.4 0.1 0.5 12.00 1.10 -0.3617 0.0849 Mild anemia 22.6 21.2 21.7 15.5 13.1 18.9 1.73 9.50 -0.1054 0.0165 Moderate anemia 14.5 12.8 12.1 11.3 6.0 11.4 2.42 8.50 -0.1556 0.0234 Severe anemia 0.5 0.0 0.4 0.0 0.0 0.2 na 0.50 -0.3579 0.2022 Women: Malnutrition 1.4 0.7 0.5 0.4 0.1 0.6 14.00 1.30 -0.4485 0.0757 Mild anemia 25.6 22.2 24.4 22.9 19.3 22.7 1.33 6.30 -0.0476 0.0121 Moderate anemia 5.2 5.5 4.8 4.8 3.0 4.6 1.73 2.20 -0.1155 0.0285 Severe anemia 0.9 0.3 0.1 0.1 0.2 0.3 4.50 0.70 -0.4564 0.1608 D. Female circumcision (%) Prevalence of circumcision: Girls 57.3 57.6 53.9 46.3 33.9 49.5 1.69 23.40 -0.0949 0.0054 Women 98.0 99.1 99.2 98.7 92.2 97.3 1.06 5.80 -0.0056 0.0014 Prevalence of occlusion: Girls na na na na na na na na na na Women na na na na na na na na na na E. Sexually transmitted disease Prevalence of genital discharge: Women na na na na na na na na na na Men na na na na na na na na na na Prevalence of genital ulcer: Women na na na na na na na na na na Men na na na na na na na na na na - 3 - Egypt 2000 - TOTAL POPULATION Part II: Intermediate Determinants of HNP Status - HNP SERVICE USE Indicator Wealth Quintiles Low/High Low-High Concentration Index Ratio Diff. Value Standard Low 2nd 3rd 4th High Avg. (Abs. Val.) Errors A. Childhood immunization BCG coverage 98.2 99.4 99.6 99.4 100.0 99.3 0.98 1.80 0.0040 0.0013 Measles coverage 95.0 96.1 97.2 97.4 99.0 96.9 0.96 4.00 0.0090 0.0025 DPT coverage 93.6 94.3 94.3 95.1 92.6 94.0 1.01 1.00 0.0022 0.0036 Full basic coverage 91.2 91.9 91.8 94.0 92.0 92.2 0.99 0.80 0.0052 0.0040 No basic coverage 0.8 0.0 0.1 0.3 0.0 0.2 na 0.80 -0.7212 0.3889 Hepatitis B coverage na na na na na na na na na na Yellow fever coverage na na na na na na na na na na B. Treatment of childhood illnesses Treatment of fever: Medical treatment of fever 29.8 35.4 35.3 36.9 39.8 35.1 0.75 10.00 0.0770 0.0173 Treatment in a public facility 16.0 16.2 14.2 10.0 3.6 12.6 4.44 12.40 -0.1240 0.0317 Treatment in a private facility 13.0 18.1 20.8 26.5 34.9 21.7 0.37 21.90 0.1928 0.0242 Treatment of acute respiratory infection: Medical treatment of ARI 52.5 63.7 66.8 81.2 74.0 66.0 0.71 21.50 0.0897 0.0128 Treatment in a public facility 28.7 27.5 22.0 21.0 9.4 23.1 3.05 19.30 -0.0892 0.0316 Treatment in a private facility 23.0 34.4 44.4 58.7 61.7 41.5 0.37 38.70 0.1932 0.0202 Treatment of diarrhea: Use of oral rehydration therapy 52.8 51.3 49.8 35.1 44.7 47.3 1.18 8.10 -0.0577 0.0209 Medical treatment of diarrhea 42.7 42.5 47.0 52.6 48.3 46.3 0.88 5.60 0.0688 0.0222 Treatment in a public facility 21.7 18.2 13.2 13.4 7.1 15.6 3.06 14.60 -0.1180 0.0501 Treatment in a private facility 21.1 23.7 32.6 37.5 41.2 30.0 0.51 20.10 0.1713 0.0300 C. Antenatal and delivery care Antenatal care visits: To a medically trained person 31.1 41.3 52.4 68.1 84.4 55.7 0.37 53.30 0.2028 0.0050 To a doctor 30.8 41.0 52.2 68.0 84.4 55.6 0.36 53.60 0.2044 0.0048 To a nurse or trained midwife 0.3 0.2 0.1 0.1 0.0 0.2 na 0.30 -0.3039 0.1438 Multiple visits to a medically trained 19.4 28.7 41.8 53.8 73.6 43.7 0.26 54.20 0.2614 0.0062 person Antenatal care content: Tetanus toxoid 64.4 74.9 78.8 79.2 62.2 72.1 1.04 2.20 0.0012 0.0046 Prophylactic antimalarial treatment na na na na na na na na na na Iron supplementation 13.4 16.1 22.8 29.5 50.3 26.5 0.27 36.90 0.2762 0.0104 Delivery attendance: By a medically trained person 31.4 45.5 61.1 76.2 94.2 60.9 0.33 62.80 0.2189 0.0036 By a doctor 25.9 37.8 53.8 65.8 88.2 53.5 0.29 62.30 0.2376 0.0042 By a nurse or trained midwife 5.4 7.7 7.3 10.4 6.1 7.4 0.89 0.70 0.0838 0.0188 In a public facility 13.1 15.7 23.1 29.7 30.2 22.2 0.43 17.10 0.1708 0.0102 In a private facility 8.8 16.2 23.1 31.0 54.3 26.0 0.16 45.50 0.3422 0.0089 At home 78.1 68.0 53.6 39.2 15.3 51.7 5.10 62.80 -0.2457 0.0044 - 4 - Egypt 2000 - TOTAL POPULATION Part II: Intermediate Determinants of HNP Status - HNP SERVICE USE (Cont.) Indicator Wealth Quintiles Low/High Low-High Concentration Index Ratio Diff. Value Standard Low 2nd 3rd 4th High Avg. (Abs. Val.) Errors D. Contraceptive services Contraceptive prevalence: Women 42.6 49.9 54.2 58.1 60.8 53.7 0.70 18.20 0.0716 0.0044 Men na na na na na na na na na na Source of contraception - public sector: Women 63.8 56.9 51.8 49.7 31.3 48.6 2.04 32.50 -0.1309 0.0066 Men na na na na na na na na na na Source of contraception - private sector: Women 36.1 43.0 48.2 50.3 68.6 51.3 0.53 32.50 0.1149 0.0066 Men na na na na na na na na na na E. Treatment of adult illnesses Treatment of genital discharge, ulcer, sore: Women na na na na na na na na na na Men na na na na na na na na na na Treatment of genital discharge, ulcer, sore in public facilities: Women na na na na na na na na na na Men na na na na na na na na na na Voluntary counseling and testing for HIV/AIDS: Women na na na na na na na na na na Men na na na na na na na na na na - 5 - Egypt 2000 - TOTAL POPULATION Part III: Intermediate Determinants of HNP Status - INDIVIDUAL AND HOUSEHOLD BEHAVIOR Indicator Wealth Quintiles Low/High Low-High Concentration Index Ratio Diff. Value Standard Low 2nd 3rd 4th High Avg. (Abs. Val.) Errors A. Hygienic practices Disposal of children's stools: Sanitary disposal na na na na na na na na na na Handwashing: Wash hands prior to preparing food na na na na na na na na na na Handwashing facilities in household 11.7 40.8 71.8 92.2 98.9 67.5 0.12 87.20 0.2657 0.0021 B. Bednet ownership and use Bednet ownership: Bednet ownership na na na na na na na na na na Treated bednet ownership na na na na na na na na na na Bednet use: By children na na na na na na na na na na By pregnant women na na na na na na na na na na C. Breastfeeding Exclusive breastfeeding 71.8 74.8 67.5 61.6 56.8 66.9 1.26 15.00 -0.0516 0.0146 Timely complementary feeding 42.2 48.7 45.6 52.1 47.7 47.4 0.88 5.50 0.0115 0.0212 Bottle-feeding 13.5 14.4 22.7 27.3 23.5 20.5 0.57 10.00 0.1339 0.0238 D. Micronutrient consumption Iodized salt: Availability of iodized salt 39.7 44.5 47.8 55.6 80.8 55.9 0.49 41.10 0.1622 0.0035 in household Vitamin A: Children 10.1 9.6 11.5 15.1 16.6 12.6 0.61 6.50 0.1354 0.0158 Women 7.0 8.6 10.9 14.2 18.7 11.9 0.37 11.70 0.1886 0.0170 E. Tobacco and alcohol use Tobacco: Women 0.2 0.5 0.3 0.2 0.6 0.4 0.33 0.40 0.0418 0.0839 Men na na na na na na na na na na Alcohol: Women na na na na na na na na na na Men na na na na na na na na na na F. Sexual practices Non-regular sexual partnerships: Women na na na na na na na na na na Men na na na na na na na na na na Condom usage with non-regular partner: Women na na na na na na na na na na Men na na na na na na na na na na G. Domestic violence Ever experienced violence na na na na na na na na na na Experienced violence in past year na na na na na na na na na na - 6 - Egypt 2000 - TOTAL POPULATION Part IV: UNDERLYING DETERMINANTS OF HNP STATUS Indicator Wealth Quintiles Low/High Low-High Concentration Index Ratio Diff. Value Standard Low 2nd 3rd 4th High Avg. (Abs. Val.) Errors A. Education School completion: Women 21.8 38.0 54.7 71.2 91.1 57.3 0.24 69.30 0.2513 0.0024 Men 56.1 69.9 78.9 84.7 95.1 77.5 0.59 39.00 0.0978 0.0020 School participation: Girls 66.4 83.8 87.2 90.7 94.8 83.8 0.70 28.40 0.0729 0.0038 Boys 81.4 89.2 86.9 88.8 93.8 87.5 0.87 12.40 0.0308 0.0031 B. Exposure to mass media Newspaper readership: Women 3.2 7.2 15.1 31.9 61.5 25.3 0.05 58.30 0.4791 0.0070 Men na na na na na na na na na na Radio listenership: Women 48.2 66.6 73.7 81.0 84.1 71.7 0.57 35.90 0.1013 0.0030 Men na na na na na na na na na na Television viewership: Women 76.4 92.6 95.6 97.1 98.5 92.6 0.78 22.10 0.0508 0.0019 Men na na na na na na na na na na C. Knowledge and attitudes about HIV/AIDS Knowledge about sexual transmission of HIV/AIDS: Women na na na na na na na na na na Men na na na na na na na na na na Knowledge about mother-to-child transmission of HIV/AIDS: Women na na na na na na na na na na Men na na na na na na na na na na Attitudes toward HIV/AIDS: Women na na na na na na na na na na Men na na na na na na na na na na D. Status of women Household decisionmaking: Can seek own health care 31.4 31.4 33.0 41.1 43.2 36.4 0.73 11.80 0.0576 0.0061 Can seek children's health care 83.0 87.7 93.6 95.7 96.9 91.6 0.86 13.90 0.0394 0.0024 Can make daily household purchases 62.3 65.2 67.6 75.6 78.4 70.3 0.79 16.10 0.0496 0.0032 Can make large household purchases 30.9 35.7 43.1 46.2 52.8 42.3 0.59 21.90 0.1055 0.0053 Can make meal-related decisions 64.1 60.3 64.1 70.7 71.1 66.3 0.90 7.00 0.0212 0.0034 Freedom of movement: Can travel to visit family, relatives 18.1 16.4 16.7 16.3 16.5 16.8 1.10 1.60 -0.0135 0.0104 Other decisionmaking, attitudes: Can decide how to spend own money 38.6 42.8 39.2 41.8 43.7 42.2 0.88 5.10 0.0022 0.0140 Can decide whether to have sex na na na na na na na na na na Justifies domestic violence na na na na na na na na na na E. Orphanhood Paternal orphan prevalence 4.6 4.3 3.6 3.3 2.1 3.7 2.19 2.50 -0.1206 0.0180 Maternal orphan prevalence 1.2 1.0 0.9 1.0 0.7 1.0 1.71 0.50 -0.0937 0.0374 Double orphan prevalence 0.2 0.1 0.1 0.1 0.1 0.1 2.00 0.10 -0.2364 0.1177 - 7 - Egypt 2000 - FEMALE / MALE POPULATIONS Part I: HNP STATUS Indicator Wealth Quintiles - Female Wealth Quintiles - Male Low 2nd 3rd 4th High Avg. Low 2nd 3rd 4th High Avg. A. Childhood mortality and morbidity Infant mortality rate 85.2 66.7 46.7 41.6 26.4 54.5 67.0 61.3 60.8 46.3 32.8 55.0 Under-five mortality rate 109.2 85.6 63.5 50.5 31.1 69.7 87.8 75.3 77.2 56.8 36.4 68.8 Prevalence of fever 17.6 19.9 17.3 18.4 13.3 17.4 20.3 17.6 19.4 19.0 13.2 18.1 Prevalence of diarrhea 8.3 8.0 7.5 5.1 5.0 6.8 8.9 6.5 8.1 8.1 5.1 7.4 Prevalence of acute 11.4 10.6 8.0 7.9 6.1 8.8 12.2 11.2 10.8 8.5 7.8 10.2 respiratory infection B. Nutritional status Children: Moderate stunting 15.3 15.1 12.2 8.9 6.9 11.6 17.3 14.9 12.6 11.8 8.8 13.2 Severe stunting 9.3 5.8 6.7 5.0 2.2 5.8 10.7 7.2 5.9 4.7 3.9 6.6 Moderate underweight 5.6 3.3 2.6 2.3 2.3 3.2 5.2 4.6 3.7 3.2 2.1 3.8 Severe underweight 1.1 0.5 0.4 0.1 0.0 0.4 1.2 0.5 0.7 0.6 0.1 0.6 Mild anemia 23.8 21.5 24.0 17.4 14.2 20.2 21.5 20.9 19.7 13.6 12.1 17.7 Moderate anemia 13.6 11.5 11.8 10.3 5.2 10.5 15.4 13.9 12.3 12.3 6.9 12.3 Severe anemia 0.4 0.1 0.5 0.0 0.0 0.2 0.5 0.0 0.3 0.0 0.1 0.2 C. Sexually transmitted disease Prevalence of genital discharge: Women na na na na na na Men na na na na na na Prevalence of genital ulcer: Women na na na na na na Men na na na na na na - 9 - Egypt 2000 - FEMALE / MALE POPULATIONS Part II: Intermediate Determinants of HNP Status - HNP SERVICE USE Indicator Wealth Quintiles - Female Wealth Quintiles - Male Low 2nd 3rd 4th High Avg. Low 2nd 3rd 4th High Avg. A. Childhood immunization BCG coverage 98.7 99.3 99.9 98.8 100.0 99.3 97.8 99.5 99.4 100.0 100.0 99.3 Measles coverage 96.5 95.4 98.4 97.0 98.8 97.2 93.6 96.6 96.1 97.7 99.2 96.6 DPT coverage 94.8 93.8 93.8 95.6 92.2 94.1 92.5 94.7 94.7 94.6 92.9 93.9 Full basic coverage 92.1 90.3 92.6 94.1 91.9 92.3 90.3 93.2 91.2 93.9 92.1 92.1 No basic coverage 0.2 0.0 0.0 0.6 0.0 0.2 1.3 0.0 0.1 0.0 0.0 0.3 Hepatitis B coverage na na na na na na na na na na na na Yellow fever coverage na na na na na na na na na na na na B. Treatment of childhood illnesses Treatment of fever: Medical treatment of fever 29.9 36.4 34.8 35.4 42.8 35.4 29.8 34.3 35.7 38.3 36.9 34.7 Treatment in a public facility 17.1 18.3 15.6 12.4 5.1 14.2 15.3 14.2 13.0 7.7 2.0 11.2 Treatment in a private facility 11.8 17.6 19.2 22.6 35.7 20.5 13.9 18.6 22.3 30.4 34.0 22.8 Treatment of acute respiratory infection(ARI): Medical treatment of ARI 50.5 60.8 67.9 80.1 65.1 63.9 54.1 66.1 66.0 82.3 80.9 67.7 Treatment in a public facility 32.4 29.0 28.5 26.1 8.1 26.5 25.6 26.1 17.4 16.1 10.4 20.3 Treatment in a private facility 16.6 30.9 39.5 51.3 52.6 35.6 28.2 37.4 47.9 65.7 68.7 46.3 Treatment of diarrhea: Use of oral rehydration therapy 55.8 48.6 49.9 30.5 46.4 47.3 50.5 54.2 49.7 38.1 43.0 47.3 Medical treatment of diarrhea 39.9 39.6 51.9 50.7 48.6 45.6 45.0 45.6 42.6 53.9 48.1 47.0 Treatment in a public facility 20.4 19.9 14.4 11.0 9.7 15.9 22.7 16.4 12.1 15.0 4.7 15.4 Treatment in a private facility 19.5 19.7 36.2 35.3 38.9 28.7 22.3 28.0 29.4 38.9 43.4 31.2 C. Contraceptive services Contraceptive prevalence: Women 42.6 49.9 54.2 58.1 60.8 53.7 Men na na na na na na Source of contraception - public sector: Women 63.8 56.9 51.8 49.7 31.3 48.6 Men na na na na na na Source of contraception - private sector: Women 36.1 43.0 48.2 50.3 68.6 51.3 Men na na na na na na D. Treatment of adult illnesses Treatment of genital discharge, ulcer, sore: Women na na na na na na Men na na na na na na Treatment of genital discharge, ulcer, sore in public facilities: Women na na na na na na Men na na na na na na Voluntary counseling and testing for HIV/AIDS: Women na na na na na na Men na na na na na na - 10 - Egypt 2000 - FEMALE / MALE POPULATIONS Part III: Intermediate Determinants of HNP Status - INDIVIDUAL AND HOUSEHOLD BEHAVIOR Indicator Wealth Quintiles - Female Wealth Quintiles - Male Low 2nd 3rd 4th High Avg. Low 2nd 3rd 4th High Avg. A. Hygienic practices Disposal of children's stools: Sanitary disposal na na na na na na Handwashing: Wash hands prior to preparing food na na na na na na Handwashing facilities in household 11.7 40.8 71.8 92.2 98.9 67.5 B. Bednet ownership and use Bednet use: By children na na na na na na C. Breastfeeding Exclusive breastfeeding 73.2 70.6 69.0 57.5 64.9 66.7 70.7 78.7 65.9 66.3 49.3 67.2 Timely complementary feeding 41.7 46.9 49.2 53.4 50.1 48.7 42.8 50.4 41.8 50.8 45.2 46.2 Bottle-feeding 15.7 14.0 22.7 25.5 22.9 20.5 11.5 14.7 22.8 29.4 24.0 20.5 D. Micronutrient consumption Vitamin A: Children 8.9 9.4 11.1 16.0 16.7 12.5 11.3 9.8 11.9 14.2 16.5 12.6 E. Tobacco and alcohol use Tobacco: Women 0.2 0.5 0.3 0.2 0.6 0.4 Men na na na na na na Alcohol: Women na na na na na na Men na na na na na na F. Sexual practices Non-regular sexual partnerships: Women na na na na na na Men na na na na na na Condom usage with non-regular partner: Women na na na na na na Men na na na na na na - 11 - Egypt 2000 - FEMALE / MALE POPULATIONS Part IV: UNDERLYING DETERMINANTS OF HNP STATUS Indicator Wealth Quintiles - Female Wealth Quintiles - Male Low 2nd 3rd 4th High Avg. Low 2nd 3rd 4th High Avg. A. Education School completion: Women 21.8 38.0 54.7 71.2 91.1 57.3 Men 56.1 69.9 78.9 84.7 95.1 77.5 School participation: Girls 66.4 83.8 87.2 90.7 94.8 83.8 Boys 81.4 89.2 86.9 88.8 93.8 87.5 B. Exposure to mass media Newspaper readership: Women 3.2 7.2 15.1 31.9 61.5 25.3 Men na na na na na na Radio listenership: Women 48.2 66.6 73.7 81.0 84.1 71.7 Men na na na na na na Television viewership: Women 76.4 92.6 95.6 97.1 98.5 92.6 Men na na na na na na C. Knowledge and attitudes about HIV/AIDS Knowledge about sexual transmission of HIV/AIDS: Women na na na na na na Men na na na na na na Knowledge about mother-to-child transmission of HIV/AIDS: Women na na na na na na Men na na na na na na Attitudes toward HIV/AIDS: Women na na na na na na Men na na na na na na D. Orphanhood Paternal orphan prevalence 4.5 4.3 3.5 3.3 2.0 3.6 4.7 4.4 3.7 3.3 2.1 3.7 Maternal orphan prevalence 1.3 1.0 1.0 0.8 0.7 1.0 1.1 0.9 0.9 1.2 0.8 1.0 Double orphan prevalence 0.2 0.1 0.1 0.2 0.1 0.1 0.2 0.1 0.1 0.1 0.1 0.1 - 12 - Egypt 2000 - RURAL / URBAN POPULATIONS Part I: HNP STATUS Indicator Wealth Quintiles - Rural Wealth Quintiles - Urban Low 2nd 3rd 4th High Avg. Low 2nd 3rd 4th High Avg. A. Childhood illness and mortality Infant mortality rate 75.8 63.1 55.6 37.7 (26.5) 61.8 (73.2) 69.6 49.7 47.7 29.9 43.1 Under-five mortality rate 96.8 79.1 73.7 47.4 (33.9) 79.2 (111.9) 88.7 62.5 57.2 33.7 52.8 Prevalence of fever 19.3 18.7 19.9 18.4 18.8 19.1 16.4 18.6 14.6 19.0 12.7 15.5 Prevalence of diarrhea 8.9 7.2 8.1 6.3 5.0 7.8 5.3 7.4 7.0 6.8 5.1 6.1 Prevalence of acute 12.1 10.8 10.2 8.3 5.9 10.6 8.6 11.8 7.5 8.2 7.0 7.8 respiratory infection B. Fertility Total fertility rate * * * * * 3.9 * * * * * 3.1 Adolescent fertility rate * * * * * 64.9 * * * * * 33.7 C. Nutritional status Children: Moderate stunting 16.5 15.1 13.0 10.3 6.6 14.1 14.5 14.2 10.7 10.4 8.0 9.8 Severe stunting 10.2 6.8 6.6 6.0 4.8 7.7 7.7 4.9 5.4 4.1 2.9 4.0 Moderate underweight 5.5 3.6 3.6 3.2 0.8 4.1 4.1 7.1 2.0 2.4 2.3 2.6 Severe underweight 1.2 0.5 0.4 0.1 0.0 0.6 0.0 0.5 0.9 0.5 0.1 0.4 Mild anemia 23.4 21.4 22.2 16.3 11.9 21.3 14.1 19.7 20.5 15.0 13.3 15.2 Moderate anemia 14.3 12.9 12.8 12.5 2.9 13.0 16.8 12.0 9.9 10.6 6.4 9.0 Severe anemia 0.5 0.0 0.4 0.0 0.0 0.3 0.0 0.4 0.2 0.0 0.0 0.1 Women: Malnutrition 1.4 0.6 0.4 0.5 0.0 0.7 1.2 1.3 0.6 0.3 0.1 0.3 Mild anemia 24.8 20.9 24.9 20.3 23.3 23.0 34.3 30.6 23.3 24.3 18.9 22.4 Moderate anemia 5.4 5.8 5.5 6.0 2.8 5.6 3.7 3.3 3.2 4.2 3.0 3.5 Severe anemia 0.9 0.3 0.2 0.0 0.0 0.4 1.0 0.2 0.0 0.2 0.2 0.2 D. Female circumcision Prevalence of circumcision: Girls 57.6 57.7 52.4 38.8 32.1 53.4 54.0 57.0 57.2 50.2 34.0 44.4 Women 98.1 99.2 99.6 98.8 97.4 98.9 97.5 98.2 98.2 98.6 91.8 95.3 Prevalence of occlusion: Girls na na na na na na na na na na na na Women na na na na na na na na na na na na E. Sexually transmitted disease Prevalence of genital discharge: Women na na na na na na na na na na na na Men na na na na na na na na na na na na Prevalence of genital ulcer: Women na na na na na na na na na na na na Men na na na na na na na na na na na na - 13 - Egypt 2000 - RURAL / URBAN POPULATIONS Part II: Intermediate Determinants of HNP Status - HNP SERVICE USE Indicator Wealth Quintiles - Rural Wealth Quintiles - Urban Low 2nd 3rd 4th High Avg. Low 2nd 3rd 4th High Avg. A. Childhood immunization BCG coverage 98.2 99.4 99.7 99.2 (100.0) 99.1 (99.2) 99.6 99.6 99.5 100.0 99.7 Measles coverage 94.8 96.1 96.9 99.0 (96.6) 96.2 (98.0) 96.2 97.8 96.4 99.3 97.8 DPT coverage 93.8 94.3 93.9 96.0 (96.6) 94.3 (90.0) 93.6 95.1 94.6 92.1 93.5 Full basic coverage 91.3 91.6 90.8 94.2 (96.6) 91.8 (89.2) 93.6 94.1 93.9 91.4 92.8 No basic coverage 0.8 0.0 0.0 0.0 0.0 0.3 0.0 0.0 0.2 0.5 0.0 0.2 Hepatitis B coverage na na na na na na na na na na na na Yellow fever coverage na na na na na na na na na na na na B. Treatment of childhood diseases Treatment of fever: Medical treatment of fever 30.0 35.9 34.5 30.2 (29.6) 32.7 (27.7) (31.9) 37.9 41.2 41.4 39.6 Treatment in a public facility 16.4 15.3 15.0 4.4 (4.8) 13.8 (11.2) (22.8) 11.6 13.7 3.4 10.4 Treatment in a private facility 12.7 19.3 19.2 25.8 (24.8) 18.2 (16.6) (9.1) 26.3 26.9 36.5 28.5 Treatment of acute respiratory infection (ARI): Medical treatment of ARI 51.3 63.3 63.9 74.1 * 60.6 * (66.3) 77.0 86.1 72.9 77.4 Treatment in a public facility 29.1 23.9 21.8 14.5 * 23.9 * (51.4) 22.8 25.4 10.0 21.3 Treatment in a private facility 21.7 37.3 41.5 57.7 * 35.6 * (14.9) 54.2 59.3 59.7 54.2 Treatment of diarrhea: Use of oral rehydration therapy 53.3 52.6 51.8 43.0 * 51.8 * * 43.8 30.2 42.8 38.3 Medical treatment of diarrhea 41.6 41.5 43.5 52.6 * 43.4 * * 57.5 52.7 48.3 52.2 Treatment in a public facility 21.0 15.5 14.3 10.2 * 16.4 * * 10.0 15.5 7.3 14.0 Treatment in a private facility 20.6 25.3 29.2 42.4 * 26.8 * * 42.7 34.4 41.0 36.4 C. Antenatal and delivery care Antenatal care visits: To a medically trained person 30.8 40.5 51.9 63.1 79.0 44.7 35.4 46.8 53.5 71.2 84.9 72.0 To a doctor 30.4 40.3 51.7 62.9 79.0 44.4 35.4 46.4 53.5 71.2 84.9 71.9 To a nurse or trained midwife 0.4 0.2 0.2 0.2 0.0 0.2 na na na na na na Multiple visits to a medically trained 19.2 27.9 41.1 53.2 72.8 33.4 22.9 34.5 43.4 54.1 73.7 58.8 person Antenatal care content: Tetanus toxoid 64.2 75.0 80.2 85.0 70.9 74.3 67.4 73.7 75.2 75.5 61.3 68.9 Prophylactic antimalarial treatment na na na na na na na na na na na na Iron supplementation 13.7 15.8 22.3 27.7 40.2 19.2 8.9 18.3 24.0 30.6 51.3 37.2 Delivery attendance: By a medically trained person 30.4 44.6 58.1 70.9 84.8 48.0 43.1 51.8 68.5 79.8 95.3 81.4 By a doctor 24.9 37.5 51.4 61.0 75.6 41.0 39.1 40.3 59.9 69.0 89.5 73.3 By a nurse or trained midwife 5.6 7.2 6.7 9.9 9.2 7.0 4.0 11.5 8.6 10.7 5.7 8.1 In a public facility 11.9 14.3 17.9 18.6 22.4 15.2 27.4 26.3 36.5 37.0 31.0 33.4 In a private facility 8.8 16.9 24.5 34.5 48.0 19.4 8.3 11.3 19.5 28.6 55.0 36.4 At home 79.2 68.8 57.4 46.7 29.6 65.3 64.3 61.8 43.9 34.3 13.8 30.0 D. Contraceptive services Contraceptive prevalence: Women 42.1 49.9 54.3 55.7 57.8 49.8 48.2 50.1 53.9 59.5 61.0 58.7 Men na na na na na na na na na na na na - 14 - Egypt 2000 - RURAL / URBAN POPULATIONS Part II: Intermediate Determinants of HNP Status - HNP SERVICE USE (Cont.) Indicator Wealth Quintiles - Rural Wealth Quintiles - Urban Low 2nd 3rd 4th High Avg. Low 2nd 3rd 4th High Avg. D. Contraceptive services (cont.) Source of contraception - public sector: Women 63.9 56.6 50.7 47.1 39.6 54.8 61.8 59.0 54.4 51.0 30.7 41.9 Men na na na na na na na na na na na na Source of contraception - private sector: Women 35.9 43.3 49.3 52.7 59.7 45.1 38.2 41.0 45.6 49.0 69.3 58.0 Men na na na na na na na na na na na na E. Treatment of adult illnesses Treatment of genital discharge, ulcer, sore: Women na na na na na na na na na na na na Men na na na na na na na na na na na na Treatment of genital discharge, ulcer, sore in public facilities: Women na na na na na na na na na na na na Men na na na na na na na na na na na na Voluntary counseling and testing for HIV/AIDS: Women na na na na na na na na na na na na Men na na na na na na na na na na na na - 15 - Egypt 2000 - RURAL / URBAN POPULATIONS Part III: Intermediate Determinants of HNP Status - INDIVIDUAL AND HOUSEHOLD BEHAVIOR Indicator Wealth Quintiles - Rural Wealth Quintiles - Urban Low 2nd 3rd 4th High Avg. Low 2nd 3rd 4th High Avg. A. Hygienic practices Disposal of children's stools: Sanitary disposal na na na na na na na na na na na na Handwashing: Wash hands prior to preparing food na na na na na na na na na na na na Handwashing facilities in household 10.9 39.1 69.6 92.1 99.1 46.7 19.1 49.4 75.7 92.3 98.9 88.6 B. Bednet ownership and use Bednet ownership: Bednet ownership na na na na na na na na na na na na Treated bednet ownership na na na na na na na na na na na na Bednet use: By children na na na na na na na na na na na na By pregnant women na na na na na na na na na na na na C. Breastfeeding Exclusive breastfeeding 72.5 72.8 71.4 70.7 * 72.6 * * 58.2 55.3 52.0 57.3 Timely complementary feeding 42.6 49.1 47.7 48.9 * 47.0 * * (38.3) 54.4 47.1 48.1 Bottle-feeding 14.0 13.8 21.0 24.7 (16.2) 17.5 (8.2) 17.9 27.2 29.3 24.3 25.2 D. Micronutrient consumption Iodized salt: Availability of iodized salt 39.7 45.3 49.2 53.7 75.7 46.6 40.4 40.1 45.1 56.4 81.2 65.4 in household Vitamin A: Children 9.9 10.2 11.5 14.8 12.3 11.1 13.1 4.8 11.6 15.4 17.1 14.8 Women 6.6 8.6 11.5 13.7 20.3 9.8 12.2 8.4 9.3 14.5 18.6 15.1 E. Tobacco and alcohol use Tobacco: Women 0.1 0.4 0.2 0.1 0.1 0.2 1.3 1.8 0.6 0.2 0.6 0.6 Men na na na na na na na na na na na na Alcohol: Women na na na na na na na na na na na na Men na na na na na na na na na na na na F. Sexual practices Non-regular sexual partnerships: Women na na na na na na na na na na na na Men na na na na na na na na na na na na Condom usage with non-regular partner: Women na na na na na na na na na na na na Men na na na na na na na na na na na na G. Domestic violence Ever experienced violence na na na na na na na na na na na na Experienced violence in past year na na na na na na na na na na na na - 16 - Egypt 2000 - RURAL / URBAN POPULATIONS Part IV: UNDERLYING DETERMINANTS OF HNP STATUS Indicator Wealth Quintiles - Rural Wealth Quintiles - Urban Low 2nd 3rd 4th High Avg. Low 2nd 3rd 4th High Avg. A. Education School completion: Women 21.2 37.7 53.9 73.2 90.2 42.6 29.1 40.1 56.4 70.3 91.1 75.0 Men 56.8 70.6 79.6 87.1 93.7 71.2 48.4 65.8 77.3 83.6 95.2 85.4 School participation: Girls 66.7 84.0 87.9 91.9 90.3 80.0 62.9 82.8 85.6 90.0 95.2 89.8 Boys 82.9 89.5 88.6 90.1 94.2 87.0 61.6 86.7 83.1 88.1 93.7 88.2 B. Exposure to mass media Newspaper readership: Women 3.1 7.4 15.7 32.5 50.0 12.7 3.7 6.0 13.8 31.6 62.4 41.3 Men na na na na na na na na na na na na Radio listenership: Women 48.2 67.8 75.4 82.8 81.7 66.3 48.2 57.9 70.0 80.0 84.2 78.5 Men na na na na na na na na na na na na Television viewership: Women 76.5 93.5 96.4 98.1 98.4 90.0 75.0 86.5 93.7 96.5 98.5 95.9 Men na na na na na na na na na na na na C. Knowledge and attitudes about HIV/AIDS Knowledge about sexual transmission of HIV/AIDS: Women na na na na na na na na na na na na Men na na na na na na na na na na na na Knowledge about mother-to-child transmission of HIV/AIDS: Women na na na na na na na na na na na na Men na na na na na na na na na na na na Attitudes toward HIV/AIDS: Women na na na na na na na na na na na na Men na na na na na na na na na na na na D. Status of women Household decisionmaking: Can seek own health care 31.5 30.7 30.8 34.3 29.8 31.4 30.3 35.8 38.0 44.7 44.3 42.7 Can seek children's health care 82.7 88.1 93.0 95.8 94.0 88.9 87.7 85.2 95.2 95.7 97.2 95.4 Can make daily household purchases 62.3 64.5 65.8 72.8 73.7 65.6 61.5 69.6 71.7 77.0 78.7 76.2 Can make large household purchases 30.7 35.9 42.3 48.9 53.8 38.2 33.2 34.5 44.9 44.8 52.7 47.6 Can make meal-related decisions 63.7 59.1 61.3 63.0 67.0 61.7 68.9 69.1 70.4 74.8 71.4 72.1 Freedom of movement: Can travel to visit family, relatives 18.2 15.5 15.4 14.6 14.4 16.1 17.9 22.5 19.7 17.2 16.6 17.6 Other decisionmaking, attitudes: Can decide how to spend own money 40.3 39.9 33.4 29.1 35.8 35.2 * (59.2) 51.7 49.3 44.3 46.1 Can decide whether to have sex na na na na na na na na na na na na Justifies domestic violence na na na na na na na na na na na na E. Orphanhood Paternal orphan prevalence 4.7 4.0 3.2 2.9 0.9 3.9 3.4 6.4 4.5 3.6 2.2 3.3 Maternal orphan prevalence 1.2 0.9 0.7 0.4 1.4 0.9 1.2 1.4 1.5 1.3 0.7 1.1 Double orphan prevalence 0.2 0.1 0.1 0.0 0.0 0.1 0.0 0.1 0.2 0.2 0.1 0.1 - 17 - . PART II. BASIC TABLES, 1995 A. TOTAL POPULATION B. FEMALE AND MALE POPULATIONS C. RURAL AND URBAN POPULATIONS Notes: ­ Each of the three sections referred to above consists of four divisions, presenting data for: I) hnp status; II) hnp service use; III) hnp-related individual and household behavior; and IV) other, underlying determinants of hnp status. ­ Full definitions of all indicators covered in the tables are provided in section A of the technical notes found in part II. ­ "na" appears in the table cells when data are not available, usually because the DHS survey concerned did not collect information about the indicator(s) in question. ­ Figures in the tables shown within parentheses indicate the absence of adequate observations to produce acceptably reliable values. Asterisks appear when the number of observations was too small to justify the presentation even of figures within parentheses. (For further information, see the section on "Sampling Errors" in the presentation of data and methods in part II.B.) Asterisks also will be found in columns showing statistical indices of inequality when the amount of quintile-specific information available is inadequate to permit computation of the value for the index concerned. ­ Female/male tables include only indicators relevant for both sexes; those pertaining to only one sex (e.g., fertility, women's nutritional status, antenatal care, attended deliveries) have been omitted. Egypt 1995 - TOTAL POPULATION Part I: HNP STATUS Indicator Wealth Quintiles Low/High Low-High Concentration Index Ratio Diff. Value Standard Low 2nd 3rd 4th High Avg. (Abs. Val.) Errors A. Childhood illness and mortality Infant mortality rate 109.7 88.7 64.6 50.6 31.8 72.9 3.45 77.90 -0.2161 0.0008 Under-five mortality rate 147.2 118.7 85.4 62.0 39.1 95.9 3.76 108.10 -0.2310 0.0009 Prevalence of fever 38.8 38.9 41.8 39.8 42.0 40.2 0.92 3.20 0.0137 0.0069 Prevalence of diarrhea 15.9 15.5 17.0 17.3 13.8 15.9 1.15 2.10 -0.0187 0.0125 Prevalence of acute 21.5 23.7 25.0 24.9 21.1 23.2 1.02 0.40 0.0040 0.0101 respiratory infection B. Fertility Total fertility rate 4.4 3.8 3.4 3.1 2.7 3.6 1.63 1.70 -0.0984 0.0002 Adolescent fertility rate 93.0 73.0 69.0 37.0 25.0 61.0 3.72 68.00 -0.2263 0.0013 C. Nutritional status (%) Children: Moderate stunting 18.6 19.4 17.0 15.1 10.6 16.4 1.75 7.97 -0.1018 0.0126 Severe stunting 19.8 14.4 11.7 10.1 9.6 13.4 2.07 10.20 -0.1452 0.0145 Moderate underweight 13.2 11.0 8.7 8.3 6.9 9.8 1.90 6.26 -0.1478 0.0186 Severe underweight 4.2 3.2 2.1 1.8 1.4 2.6 2.95 2.77 -0.2417 0.0380 Mild anemia na na na na na na na na na na Moderate anemia na na na na na na na na na na Severe anemia na na na na na na na na na na Women: Malnutrition 2.6 1.9 1.7 0.4 0.4 1.4 6.58 2.18 -0.3659 0.0602 Mild anemia na na na na na na na na na na Moderate anemia na na na na na na na na na na Severe anemia na na na na na na na na na na D. Female circumcision (%) Prevalence of circumcision: Girls 39.2 39.9 39.9 39.6 26.1 36.6 1.50 13.10 -0.0464 0.0062 Women 99.3 99.6 99.6 98.8 88.9 97.0 1.12 10.40 -0.0053 0.0016 Prevalence of occlusion: Girls 1.4 2.6 2.8 1.6 3.4 2.3 0.41 2.00 0.0873 0.0450 Women 0.3 0.6 0.7 1.1 1.0 0.7 0.30 0.70 0.2171 0.0532 E. Sexually transmitted disease Prevalence of genital discharge: Women na na na na na na na na na na Men na na na na na na na na na na Prevalence of genital ulcer: Women na na na na na na na na na na Men na na na na na na na na na na - 21 - Egypt 1995 - TOTAL POPULATION Part II: Intermediate Determinants of HNP Status - HNP SERVICE USE Indicator Wealth Quintiles Low/High Low-High Concentration Index Ratio Diff. Value Standard Low 2nd 3rd 4th High Avg. (Abs. Val.) Errors A. Childhood immunization BCG coverage 89.0 93.7 95.5 97.3 98.8 94.7 0.90 9.80 0.0317 0.0037 Measles coverage 79.9 82.6 91.7 94.3 99.5 89.2 0.80 19.60 0.0580 0.0045 DPT coverage 70.7 78.1 84.8 90.3 93.7 83.0 0.75 23.00 0.0691 0.0057 Full basic coverage 65.1 72.8 81.0 86.6 92.5 79.1 0.70 27.40 0.0819 0.0064 No basic coverage 5.5 4.0 0.6 1.7 0.3 2.5 18.33 5.20 -0.7434 0.1040 Hepatitis B coverage 47.5 53.2 53.9 63.2 69.9 57.0 0.68 22.40 0.0984 0.0101 Yellow fever coverage na na na na na na na na na na B. Treatment of childhood illnesses Treatment of fever: Medical treatment of fever 33.8 42.8 48.3 55.3 61.6 47.6 0.55 27.80 0.1076 0.0089 Treatment in a public facility 12.6 13.5 13.7 11.1 8.6 12.0 1.47 4.00 -0.0411 0.0224 Treatment in a private facility 20.8 28.3 34.0 43.4 51.9 34.8 0.40 31.10 0.1609 0.0112 Treatment of acute respiratory infection (ARI): Medical treatment of ARI 47.9 55.7 62.6 69.4 77.8 61.7 0.62 29.90 0.0965 0.0088 Treatment in a public facility 19.2 18.6 17.6 15.3 13.5 17.1 1.42 5.70 -0.0469 0.0237 Treatment in a private facility 28.0 35.3 44.1 53.4 62.7 43.5 0.45 34.70 0.1543 0.0122 Treatment of diarrhea: Use of oral rehydration therapy 69.1 66.1 67.1 68.1 62.6 66.9 1.10 6.50 -0.0020 0.0098 Medical treatment of diarrhea 42.6 45.3 51.6 49.4 49.6 47.5 0.86 7.00 0.0357 0.0143 Treatment in a public facility 16.5 15.0 17.1 12.4 4.3 13.7 3.84 12.20 -0.1446 0.0315 Treatment in a private facility 25.6 29.1 33.4 36.7 45.3 33.2 0.57 19.70 0.1095 0.0181 C. Antenatal and delivery care Antenatal care visits: To a medically trained person 18.9 24.3 40.1 53.1 80.9 42.5 0.23 62.00 0.2703 0.0065 To a doctor 18.9 24.3 40.1 53.0 80.9 42.4 0.23 62.00 0.2829 0.0063 To a nurse or trained midwife 0.0 0.0 0.0 0.1 0.0 0.0 na 0.00 0.1833 0.6392 Multiple visits to a medically trained 11.1 15.6 31.7 45.6 75.3 34.9 0.15 64.20 0.3580 0.0074 person Antenatal care content: Tetanus toxoid 62.9 68.1 74.0 76.8 63.4 68.9 0.99 0.50 0.0177 0.0047 Prophylactic antimalarial treatment na na na na na na na na na na Iron supplementation na na na na na na na na na na Delivery attendance: By a medically trained person 20.5 29.8 47.0 62.1 86.4 46.2 0.24 65.90 0.2911 0.0047 By a doctor 15.5 22.9 38.7 51.3 79.6 38.9 0.19 64.10 0.3114 0.0059 By a nurse or trained midwife 5.0 6.9 8.3 10.7 6.8 7.4 0.74 1.80 0.1842 0.0195 In a public facility 6.9 10.9 20.8 26.9 29.5 17.9 0.23 22.60 0.2472 0.0113 In a private facility 5.2 6.0 10.1 16.6 42.3 14.6 0.12 37.10 0.4379 0.0143 At home 87.7 83.0 69.0 56.0 26.5 67.0 3.31 61.20 -0.1630 0.0035 - 22 - Egypt 1995 - TOTAL POPULATION Part II: Intermediate Determinants of HNP Status - HNP SERVICE USE (Cont.) Indicator Wealth Quintiles Low/High Low-High Concentration Index Ratio Diff. Value Standard Low 2nd 3rd 4th High Avg. (Abs. Val.) Errors D. Contraceptive services Contraceptive prevalence: Women 28.2 39.0 47.1 52.0 57.4 45.5 0.49 29.20 0.1608 0.0050 Men na na na na na na na na na na Source of contraception - public sector: Women 44.2 45.5 39.5 34.1 25.6 35.7 1.73 18.60 -0.1388 0.0099 Men na na na na na na na na na na Source of contraception - private sector: Women 53.4 53.1 58.9 64.5 73.1 62.8 0.73 19.70 0.0792 0.0057 Men na na na na na na na na na na E. Treatment of adult illnesses Treatment of genital discharge, ulcer, sore: Women na na na na na na na na na na Men na na na na na na na na na na Treatment of genital discharge, ulcer, sore in public facilities: Women na na na na na na na na na na Men na na na na na na na na na na Voluntary counseling and testing for HIV/AIDS: Women na na na na na na na na na na Men na na na na na na na na na na - 23 - Egypt 1995 - TOTAL POPULATION Part III: Intermediate Determinants of HNP Status - INDIVIDUAL AND HOUSEHOLD BEHAVIOR Indicator Wealth Quintiles Low/High Low-High Concentration Index Ratio Diff. Value Standard Low 2nd 3rd 4th High Avg. (Abs. Val.) Errors A. Hygienic practices Disposal of children's stools: Sanitary disposal na na na na na na na na na na Handwashing: Wash hands prior to preparing food na na na na na na na na na na Handwashing facilities in household na na na na na na na na na na B. Bednet ownership and use Bednet ownership: Bednet ownership na na na na na na na na na na Treated bednet ownership na na na na na na na na na na Bednet use: By children na na na na na na na na na na By pregnant women na na na na na na na na na na C. Breastfeeding Exclusive breastfeeding 71.6 75.3 68.0 68.0 53.2 67.9 1.35 18.40 -0.0461 0.0139 Timely complementary feeding 59.2 64.8 72.3 74.1 80.6 69.5 0.73 21.40 0.0735 0.0140 Bottle-feeding 15.7 15.9 16.8 24.2 32.2 20.5 0.49 16.50 0.1576 0.0242 D. Micronutrient consumption Iodized salt: Availability of iodized salt na na na na na na na na na na in household Vitamin A: Children na na na na na na na na na na Women na na na na na na na na na na E. Tobacco and alcohol use Tobacco: Women na na na na na na na na na na Men na na na na na na na na na na Alcohol: Women na na na na na na na na na na Men na na na na na na na na na na F. Sexual practices Non-regular sexual partnerships: Women na na na na na na na na na na Men na na na na na na na na na na Condom usage with non-regular partner: Women na na na na na na na na na na Men na na na na na na na na na na G. Domestic violence Ever experienced violence na na na na na na na na na na Experienced violence in past year na na na na na na na na na na - 24 - Egypt 1995 - TOTAL POPULATION Part IV: UNDERLYING DETERMINANTS OF HNP STATUS Indicator Wealth Quintiles Low/High Low-High Concentration Index Ratio Diff. Value Standard Low 2nd 3rd 4th High Avg. (Abs. Val.) Errors A. Education School completion: Women 16.3 30.6 49.9 69.5 89.2 53.1 0.18 72.90 0.2913 0.0026 Men 51.1 62.8 76.4 85.1 94.6 75.1 0.54 43.50 0.1212 0.0021 School participation: Girls 48.6 71.2 88.6 96.4 98.5 78.9 0.49 49.90 0.1444 0.0038 Boys 77.4 87.6 92.7 94.8 97.8 89.1 0.79 20.40 0.0545 0.0027 B. Exposure to mass media Newspaper readership: Women 1.5 6.0 14.4 30.6 62.8 24.6 0.02 61.30 0.5044 0.0073 Men na na na na na na na na na na Radio listenership: Women 40.0 55.1 64.8 74.6 81.4 64.0 0.49 41.40 0.1443 0.0034 Men na na na na na na na na na na Television viewership: Women 51.0 77.2 85.7 90.9 95.6 80.8 0.53 44.60 0.1224 0.0025 Men na na na na na na na na na na C. Knowledge and attitudes about HIV/AIDS Knowledge about sexual transmission of HIV/AIDS: Women na na na na na na na na na na Men na na na na na na na na na na Knowledge about mother-to-child transmission of HIV/AIDS: Women na na na na na na na na na na Men na na na na na na na na na na Attitudes toward HIV/AIDS: Women na na na na na na na na na na Men na na na na na na na na na na D. Status of women Household decisionmaking: Can seek own health care na na na na na na na na na na Can seek children's health care na na na na na na na na na na Can make daily household purchases na na na na na na na na na na Can make large household purchases na na na na na na na na na na Can make meal-related decisions na na na na na na na na na na Freedom of movement: Can travel to visit family, relatives na na na na na na na na na na Other decisionmaking, attitudes: Can decide how to spend own money 56.8 43.0 40.0 37.9 38.6 41.1 1.47 18.16 -0.0621 0.0145 Can decide whether to have sex na na na na na na na na na na Justifies domestic violence na na na na na na na na na na E. Orphanhood Paternal orphan prevalence na na na na na na na na na na Maternal orphan prevalence na na na na na na na na na na Double orphan prevalence na na na na na na na na na na - 25 - Egypt 1995 - FEMALE / MALE POPULATIONS Part I: HNP STATUS Indicator Wealth Quintiles - Female Wealth Quintiles - Male Low 2nd 3rd 4th High Avg. Low 2nd 3rd 4th High Avg. A. Childhood mortality and morbidity Infant mortality rate 110.1 95.0 62.9 49.1 31.0 73.3 109.3 82.7 66.1 52.0 32.5 72.5 Under-five mortality rate 156.4 129.1 85.3 59.6 38.5 99.3 138.7 108.9 85.6 64.2 39.7 92.6 Prevalence of fever 37.4 39.2 40.6 39.7 40.2 39.3 40.2 38.6 43.0 39.8 43.9 41.0 Prevalence of diarrhea 14.7 16.0 15.9 17.4 11.2 15.1 16.9 15.1 17.9 17.1 16.5 16.7 Prevalence of acute 19.8 23.3 24.3 23.4 21.5 22.4 23.0 24.0 25.6 26.3 20.7 24.0 respiratory infection B. Nutritional status Children: Moderate stunting na na na na na na na na na na na na Severe stunting na na na na na na na na na na na na Moderate underweight na na na na na na na na na na na na Severe underweight na na na na na na na na na na na na Mild anemia na na na na na na na na na na na na Moderate anemia na na na na na na na na na na na na Severe anemia na na na na na na na na na na na na C. Sexually transmitted disease Prevalence of genital discharge: Women na na na na na na Men na na na na na na Prevalence of genital ulcer: Women na na na na na na Men na na na na na na - 27 - Egypt 1995 - FEMALE / MALE POPULATIONS Part II: Intermediate Determinants of HNP Status - HNP SERVICE USE Indicator Wealth Quintiles - Female Wealth Quintiles - Male Low 2nd 3rd 4th High Avg. Low 2nd 3rd 4th High Avg. A. Childhood immunization BCG coverage 87.8 92.8 96.9 97.4 99.7 94.9 90.0 94.3 94.1 97.2 97.8 94.4 Measles coverage 75.3 80.5 91.7 95.8 99.7 88.7 83.7 84.3 91.7 92.9 99.2 89.7 DPT coverage 67.6 75.8 86.9 89.4 93.3 82.7 73.2 79.9 82.6 91.1 94.0 83.4 Full basic coverage 62.4 70.7 83.9 87.3 92.8 79.5 67.4 74.4 78.1 85.9 92.2 78.7 No basic coverage 6.4 6.2 0.2 2.4 0.0 3.0 4.8 2.1 1.0 1.0 0.7 2.1 Hepatitis B coverage 41.8 51.4 53.5 63.8 69.6 55.9 52.2 54.6 54.3 62.7 70.1 58.1 Yellow fever coverage na na na na na na na na na na na na B. Treatment of childhood illnesses Treatment of fever: Medical treatment of fever 29.5 39.6 46.3 57.6 58.2 45.6 37.5 45.6 50.2 53.2 64.7 49.5 Treatment in a public facility 14.9 14.1 12.8 10.8 8.0 12.3 10.6 12.9 14.5 11.4 9.2 11.8 Treatment in a private facility 14.6 25.5 32.9 45.4 49.6 32.8 26.0 30.7 35.0 41.6 54.0 36.6 Treatment of acute respiratory infection(ARI): Medical treatment of ARI 42.0 48.4 61.3 69.1 74.8 58.5 52.6 61.8 63.8 69.7 81.1 64.5 Treatment in a public facility 22.8 18.6 18.0 16.3 12.5 17.8 16.3 18.6 17.3 14.5 14.5 16.4 Treatment in a private facility 19.2 29.4 42.5 51.8 61.2 40.0 34.9 40.3 45.5 54.8 64.2 46.5 Treatment of diarrhea: Use of oral rehydration therapy 67.4 55.9 67.6 62.9 53.4 62.2 70.3 75.4 66.7 73.0 68.9 70.8 Medical treatment of diarrhea 37.9 37.0 51.0 46.2 43.8 43.1 46.4 52.7 52.0 52.4 53.7 51.1 Treatment in a public facility 17.5 17.9 20.5 14.4 4.5 15.8 15.8 12.4 14.2 10.5 4.3 11.9 Treatment in a private facility 20.4 19.2 28.1 31.2 39.4 26.7 29.7 38.1 37.8 41.8 49.4 38.6 C. Contraceptive services Contraceptive prevalence: Women 28.2 39.0 47.1 52.0 57.4 45.5 Men na na na na na na Source of contraception - public sector: Women 44.2 45.5 39.5 34.1 25.6 35.7 Men na na na na na na Source of contraception - private sector: Women 53.4 53.1 58.9 64.5 73.1 62.8 Men na na na na na na D. Treatment of adult illnesses Treatment of genital discharge, ulcer, sore: Women na na na na na na Men na na na na na na Treatment of genital discharge, ulcer, sore in public facilities: Women na na na na na na Men na na na na na na Voluntary counseling and testing for HIV/AIDS: Women na na na na na na Men na na na na na na - 28 - Egypt 1995 - FEMALE / MALE POPULATIONS Part III: Intermediate Determinants of HNP Status - INDIVIDUAL AND HOUSEHOLD BEHAVIOR Indicator Wealth Quintiles - Female Wealth Quintiles - Male Low 2nd 3rd 4th High Avg. Low 2nd 3rd 4th High Avg. A. Hygienic practices Disposal of children's stools: Sanitary disposal na na na na na na Handwashing: Wash hands prior to preparing food na na na na na na Handwashing facilities in household na na na na na na B. Bednet ownership and use Bednet use: By children na na na na na na C. Breastfeeding Exclusive breastfeeding 73.1 70.3 72.2 (71.9) 60.6 70.0 69.5 79.8 63.7 66.0 46.2 65.9 Timely complementary feeding 65.5 70.6 66.6 69.5 85.0 70.7 51.7 59.4 78.7 78.6 (76.1) 68.1 Bottle-feeding 15.7 16.6 13.9 20.6 27.8 18.5 15.8 15.2 19.9 26.8 36.5 22.4 D. Micronutrient consumption Vitamin A: Children na na na na na na na na na na na na E. Tobacco and alcohol use Tobacco: Women na na na na na na Men na na na na na na Alcohol: Women na na na na na na Men na na na na na na F. Sexual practices Non-regular sexual partnerships: Women na na na na na na Men na na na na na na Condom usage with non-regular partner: Women na na na na na na Men na na na na na na - 29 - Egypt 1995 - FEMALE / MALE POPULATIONS Part IV: UNDERLYING DETERMINANTS OF HNP STATUS Indicator Wealth Quintiles - Female Wealth Quintiles - Male Low 2nd 3rd 4th High Avg. Low 2nd 3rd 4th High Avg. A. Education School completion: Women 16.3 30.6 49.9 69.5 89.2 53.1 Men 51.1 62.8 76.4 85.1 94.6 75.1 School participation: Girls 48.6 71.2 88.6 96.4 98.5 78.9 Boys 77.4 87.6 92.7 94.8 97.8 89.1 B. Exposure to mass media Newspaper readership: Women 1.5 6.0 14.4 30.6 62.8 24.6 Men na na na na na na Radio listenership: Women 40.0 55.1 64.8 74.6 81.4 64.0 Men na na na na na na Television viewership: Women 51.0 77.2 85.7 90.9 95.6 80.8 Men na na na na na na C. Knowledge and attitudes about HIV/AIDS Knowledge about sexual transmission of HIV/AIDS: Women na na na na na na Men na na na na na na Knowledge about mother-to-child transmission of HIV/AIDS: Women na na na na na na Men na na na na na na Attitudes toward HIV/AIDS: Women na na na na na na Men na na na na na na D. Orphanhood Paternal orphan prevalence na na na na na na na na na na na na Maternal orphan prevalence na na na na na na na na na na na na Double orphan prevalence na na na na na na na na na na na na - 30 - Egypt 1995 - RURAL / URBAN POPULATIONS Part I: HNP STATUS Indicator Wealth Quintiles - Rural Wealth Quintiles - Urban Low 2nd 3rd 4th High Avg. Low 2nd 3rd 4th High Avg. A. Childhood illness and mortality Infant mortality rate 110.4 87.4 67.0 51.8 34.4 86.8 (98.8) 93.9 60.4 50.0 31.4 51.1 Under-five mortality rate 147.6 117.5 92.7 62.5 (40.6) 116.0 (139.9) 123.9 73.3 61.7 38.9 64.5 Prevalence of fever 38.6 36.4 41.0 39.6 37.9 38.6 42.6 50.3 43.2 39.9 42.7 42.7 Prevalence of diarrhea 15.8 15.3 16.7 17.2 17.4 16.0 17.4 16.8 17.4 17.4 13.3 15.7 Prevalence of acute 21.3 22.6 26.3 22.5 24.3 23.0 23.6 28.7 22.7 26.4 20.6 23.5 respiratory infection B. Fertility Total fertility rate 4.4 3.9 3.5 3.3 (3.9) 4.2 * 3.6 3.1 2.9 2.5 3.0 Adolescent fertility rate 94.0 76.0 79.0 51.0 (51.0) 80.4 * 58.0 52.0 26.0 21.0 37.2 C. Nutritional status Children: Moderate stunting 18.6 20.3 17.9 15.2 12.4 18.3 18.9 15.1 15.5 15.0 10.4 13.4 Severe stunting 20.0 15.2 12.9 14.3 10.3 16.1 17.4 10.6 9.6 7.5 9.5 9.4 Moderate underweight 13.3 11.2 9.0 7.7 6.5 10.9 11.7 10.2 8.1 8.6 7.0 8.2 Severe underweight 4.2 3.5 2.4 2.4 0.4 3.3 4.8 1.8 1.7 1.4 1.6 1.7 Mild anemia na na na na na na na na na na na na Moderate anemia na na na na na na na na na na na na Severe anemia na na na na na na na na na na na na Women: Malnutrition 2.4 1.9 1.9 0.4 1.0 1.8 5.7 1.8 1.3 0.4 0.3 0.8 Mild anemia na na na na na na na na na na na na Moderate anemia na na na na na na na na na na na na Severe anemia na na na na na na na na na na na na D. Female circumcision Prevalence of circumcision: Girls 39.6 40.0 38.4 38.5 34.9 39.1 32.9 39.9 42.4 40.2 25.2 33.7 Women 99.3 99.8 99.7 99.3 98.7 99.5 99.3 99.1 99.4 98.5 87.9 94.0 Prevalence of occlusion: Girls 1.5 2.1 3.8 1.9 1.7 2.2 0.0 4.5 1.5 1.4 3.7 2.4 Women 0.3 0.7 0.8 1.1 0.8 0.6 0.0 0.4 0.4 1.0 1.0 0.9 E. Sexually transmitted disease Prevalence of genital discharge: Women na na na na na na na na na na na na Men na na na na na na na na na na na na Prevalence of genital ulcer: Women na na na na na na na na na na na na Men na na na na na na na na na na na na - 31 - Egypt 1995 - RURAL / URBAN POPULATIONS Part II: Intermediate Determinants of HNP Status - HNP SERVICE USE Indicator Wealth Quintiles - Rural Wealth Quintiles - Urban Low 2nd 3rd 4th High Avg. Low 2nd 3rd 4th High Avg. A. Childhood immunization BCG coverage 88.5 93.9 93.8 98.7 100.0 92.8 (96.7) 92.5 98.4 96.6 98.6 97.3 Measles coverage 79.2 83.5 92.0 97.9 99.2 86.2 (89.7) 77.9 91.3 92.6 99.5 93.5 DPT coverage 70.1 77.9 82.7 93.6 89.4 78.6 (78.3) 78.7 88.1 88.6 94.4 89.5 Full basic coverage 64.7 73.4 77.2 90.9 88.6 73.9 (71.3) 69.4 87.3 84.5 93.2 86.5 No basic coverage 5.9 4.0 1.0 0.3 0.0 3.4 (0.6) 4.0 0.0 2.4 0.4 1.3 Hepatitis B coverage 45.7 52.3 52.5 67.0 69.7 52.5 (73.0) 57.6 56.2 61.4 69.9 63.6 Yellow fever coverage na na na na na na na na na na na na B. Treatment of childhood diseases Treatment of fever: Medical treatment of fever 32.5 40.4 49.4 55.4 60.9 42.1 50.9 50.8 46.5 55.3 61.6 55.4 Treatment in a public facility 10.7 11.3 11.0 8.6 6.1 10.5 37.5 20.5 18.2 12.7 9.0 14.1 Treatment in a private facility 21.5 28.7 38.2 46.0 54.8 31.3 10.8 26.8 27.1 41.8 51.5 39.9 Treatment of acute respiratory infection (ARI): Medical treatment of ARI 47.4 52.6 62.7 72.6 71.9 56.3 (54.4) 67.2 62.5 67.8 78.9 70.0 Treatment in a public facility 18.0 16.3 11.9 12.8 6.0 15.0 (34.8) 27.0 29.3 16.6 14.8 20.2 Treatment in a private facility 29.0 35.6 50.0 59.2 65.9 40.7 (14.8) 34.3 32.0 50.5 62.1 47.8 Treatment of diarrhea: Use of oral rehydration therapy 67.6 63.1 64.3 79.0 (67.4) 67.0 (88.0) 78.8 71.9 61.4 61.6 66.6 Medical treatment of diarrhea 41.0 44.5 47.0 47.3 (50.5) 44.4 (63.1) 48.3 59.2 50.7 49.5 52.4 Treatment in a public facility 14.5 12.0 11.7 5.5 (4.1) 11.7 (42.1) 27.6 26.2 16.6 4.4 16.8 Treatment in a private facility 25.9 31.8 35.3 41.0 (46.4) 32.2 (21.0) 17.3 30.1 34.1 45.1 34.6 C. Antenatal and delivery care Antenatal care visits: To a medically trained person 18.7 23.8 36.3 49.7 72.5 29.8 21.9 26.2 46.7 55.0 82.1 60.6 To a doctor 18.7 23.8 36.3 49.4 72.5 29.7 21.9 26.2 46.7 55.0 82.1 60.6 To a nurse or trained midwife 0.0 0.0 0.0 0.3 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Multiple visits to a medically trained 10.7 15.1 25.8 39.1 65.7 20.8 16.6 17.5 42.0 49.4 76.7 55.0 person Antenatal care content: Tetanus toxoid 63.4 70.2 77.5 84.6 77.6 71.4 56.7 59.0 68.0 72.2 61.4 65.3 Prophylactic antimalarial treatment na na na na na na na na na na na na Iron supplementation na na na na na na na na na na na na Delivery attendance: By a medically trained person 20.2 27.6 42.1 57.0 75.9 32.8 25.1 39.6 55.9 65.2 88.0 67.9 By a doctor 15.3 20.8 33.5 45.3 65.9 25.7 19.3 32.6 48.0 55.0 81.7 60.2 By a nurse or trained midwife 4.9 6.9 8.6 11.6 10.0 7.1 5.8 6.9 7.9 10.2 6.3 7.7 In a public facility 6.6 8.6 13.9 17.2 19.8 10.3 12.3 21.2 33.3 32.8 31.0 30.2 In a private facility 5.5 5.6 9.9 15.5 32.0 8.4 1.6 7.7 10.5 17.2 43.8 24.5 At home 87.8 85.7 76.1 67.3 47.5 81.1 85.9 71.0 56.2 49.3 23.3 44.3 D. Contraceptive services Contraceptive prevalence: Women 28.4 37.8 43.9 49.8 55.2 38.5 23.9 43.9 52.4 53.1 57.7 53.6 Men na na na na na na na na na na na na - 32 - Egypt 1995 - RURAL / URBAN POPULATIONS Part II: Intermediate Determinants of HNP Status - HNP SERVICE USE (Cont.) Indicator Wealth Quintiles - Rural Wealth Quintiles - Urban Low 2nd 3rd 4th High Avg. Low 2nd 3rd 4th High Avg. D. Contraceptive services (cont.) Source of contraception - public sector: Women 44.3 44.5 36.3 26.5 16.6 37.7 (42.5) 48.8 43.8 37.7 26.5 34.0 Men na na na na na na na na na na na na Source of contraception - private sector: Women 53.1 54.0 61.4 71.6 79.8 60.2 (57.5) 49.9 55.5 61.1 72.4 65.0 Men na na na na na na na na na na na na E. Treatment of adult illnesses Treatment of genital discharge, ulcer, sore: Women na na na na na na na na na na na na Men na na na na na na na na na na na na Treatment of genital discharge, ulcer, sore in public facilities: Women na na na na na na na na na na na na Men na na na na na na na na na na na na Voluntary counseling and testing for HIV/AIDS: Women na na na na na na na na na na na na Men na na na na na na na na na na na na - 33 - Egypt 1995 - RURAL / URBAN POPULATIONS Part III: Intermediate Determinants of HNP Status - INDIVIDUAL AND HOUSEHOLD BEHAVIOR Indicator Wealth Quintiles - Rural Wealth Quintiles - Urban Low 2nd 3rd 4th High Avg. Low 2nd 3rd 4th High Avg. A. Hygienic practices Disposal of children's stools: Sanitary disposal na na na na na na na na na na na na Handwashing: Wash hands prior to preparing food na na na na na na na na na na na na Handwashing facilities in household na na na na na na na na na na na na B. Bednet ownership and use Bednet ownership: Bednet ownership na na na na na na na na na na na na Treated bednet ownership na na na na na na na na na na na na Bednet use: By children na na na na na na na na na na na na By pregnant women na na na na na na na na na na na na C. Breastfeeding Exclusive breastfeeding 70.2 75.2 67.5 (71.6) * 71.0 * * (68.9) 66.0 52.1 62.9 Timely complementary feeding 58.9 63.9 74.1 65.5 * 64.7 * (68.1) 69.6 79.9 80.5 76.0 Bottle-feeding 15.8 14.6 15.5 25.7 35.0 17.4 (15.3) 21.0 18.8 23.2 31.7 24.9 D. Micronutrient consumption Iodized salt: Availability of iodized salt na na na na na na na na na na na na in household Vitamin A: Children na na na na na na na na na na na na Women na na na na na na na na na na na na E. Tobacco and alcohol use Tobacco: Women na na na na na na na na na na na na Men na na na na na na na na na na na na Alcohol: Women na na na na na na na na na na na na Men na na na na na na na na na na na na F. Sexual practices Non-regular sexual partnerships: Women na na na na na na na na na na na na Men na na na na na na na na na na na na Condom usage with non-regular partner: Women na na na na na na na na na na na na Men na na na na na na na na na na na na G. Domestic violence Ever experienced violence na na na na na na na na na na na na Experienced violence in past year na na na na na na na na na na na na - 34 - Egypt 1995 - RURAL / URBAN POPULATIONS Part IV: UNDERLYING DETERMINANTS OF HNP STATUS Indicator Wealth Quintiles - Rural Wealth Quintiles - Urban Low 2nd 3rd 4th High Avg. Low 2nd 3rd 4th High Avg. A. Education School completion: Women 16.3 29.9 48.7 69.5 83.1 37.1 15.6 33.5 51.7 69.5 89.8 71.1 Men 51.0 63.6 79.8 88.0 93.8 67.9 52.9 59.6 71.3 83.7 94.6 83.4 School participation: Girls 47.4 71.4 88.7 96.9 98.0 69.7 70.3 70.3 88.5 96.1 98.6 92.3 Boys 78.0 89.5 93.4 94.3 100.0 86.6 69.8 80.2 91.6 95.0 97.5 92.7 B. Exposure to mass media Newspaper readership: Women 1.6 6.2 16.1 33.9 57.3 12.4 0.5 5.5 11.7 28.9 63.4 38.7 Men na na na na na na na na na na na na Radio listenership: Women 40.4 56.2 67.3 76.7 82.6 57.1 34.4 50.6 60.8 73.6 81.3 72.0 Men na na na na na na na na na na na na Television viewership: Women 51.3 78.5 86.5 91.2 93.8 73.6 46.4 71.6 84.3 90.8 95.8 89.3 Men na na na na na na na na na na na na C. Knowledge and attitudes about HIV/AIDS Knowledge about sexual transmission of HIV/AIDS: Women na na na na na na na na na na na na Men na na na na na na na na na na na na Knowledge about mother-to-child transmission of HIV/AIDS: Women na na na na na na na na na na na na Men na na na na na na na na na na na na Attitudes toward HIV/AIDS: Women na na na na na na na na na na na na Men na na na na na na na na na na na na D. Status of women Household decisionmaking: Can seek own health care na na na na na na na na na na na na Can seek children's health care na na na na na na na na na na na na Can make daily household purchases na na na na na na na na na na na na Can make large household purchases na na na na na na na na na na na na Can make meal-related decisions na na na na na na na na na na na na Freedom of movement: Can travel to visit family, relatives na na na na na na na na na na na na Other decisionmaking, attitudes: Can decide how to spend own money na na na na na na na na na na na na Can decide whether to have sex na na na na na na na na na na na na Justifies domestic violence na na na na na na na na na na na na E. Orphanhood Paternal orphan prevalence na na na na na na na na na na na na Maternal orphan prevalence na na na na na na na na na na na na Double orphan prevalence na na na na na na na na na na na na - 35 - PART III. TECHNICAL NOTES A. INDICATOR DEFINITIONS B. DATA AND METHODS C. DISCUSSION INDICATOR DEFINITIONS Part I: HNP STATUS A. CHILDHOOD MORTALITY AND ILLNESS 2 Infant mortality rate: number of deaths to children under 12 months of age per 1,000 live births, based on experience during the ten years preceding the survey. Under-five mortality rate: number of deaths to children under five years of age per 1,000 live births, based on experience during the ten years preceding the survey. Prevalence of fever: percent of children who had fever, whether or not accompanied by cough or rapid breathing, in the two weeks before the survey. Prevalence of diarrhea: percent of children who had diarrhea in the two weeks before the survey. Prevalence of acute respiratory infection: percent of children who had a cough accompanied by rapid or difficult breathing in the two weeks before the survey. B. FERTILITY Total fertility rate (TFR): average number of births a woman could expect to have during her lifetime if she followed the levels of fertility currently observed at every age. The TFR is calculated as the sum of average annual age-specific fertility rates for all reproductive age groups (usually 15-49 years) in the three years before the survey. Adolescent fertility rate: age-specific fertility rate for women 15-19 years of age. This is the average number of births among women aged 15-19 years per 1,000 women in that age group, based on births in the three years before the survey and expressed as annual averages. 2Figures for the prevalence of fever, diarrhea, and acute respiratory infection refer to percent of children under three, four, or five years of age, depending upon the country. (The specific ages covered for in particular country may be determined by consulting the full report on that country's DHS, which may be found at: www.measuredhs.com/countries.) - 39 - C. NUTRITIONAL STATUS Children 3, 4, 5 Moderate stunting (height-for-age): percent of children with a height-for-age Z-score of between ­2 and ­3 standard deviations of the median reference standard for their age (as defined in fn. 4). Severe stunting (height-for-age): percent of children with a height-for-age Z-score of below ­3 standard deviations of the median reference standard for their age (as defined in fn. 4). Moderate underweight (weight-for-age): percent of children with a weight-for-age Z-score of between ­2 and ­3 standard deviations of the median reference standard for their age (as defined in fn. 4). Severe underweight (weight-for-age): percent of children with a weight-for-age Z-score of below ­3 standard deviations of the median reference standard for their age (as defined in fn. 4). Mild anemia: percent of children with a hemoglobin level of between 10.0g/dl and 10.9 g/dl, the World Health Organization criterion for mild anemia. Moderate anemia: percent of children with a hemoglobin level of between 7.0g/dl and 9.9g/dl, the World Health Organization criterion for moderate anemia. Severe anemia: percent of children with a hemoglobin level of below 7.0g/dl, the World Health Organization criterion for severe anemia. Women 6, 7 Malnutrition: percent of women aged 15-49 years with a Body Mass Index (BMI) of less than 18.5, where BMI ­ commonly used to indicate adult nutritional status ­ is defined as weight in kilograms divided by the square of height in meters. Mild anemia: percent of women aged 15-49 years with a hemoglobin level of between 10.0g/dl and 10.9g/dl for pregnant women and between 10.0g/dl and 11.9g/dl for non-pregnant women, the World Health Organization criterion for mild anemia. Moderate anemia: percent of women aged 15-49 years with a hemoglobin level of between 7.0g/dl and 9.9g/dl, the World Health Organization criterion for moderate anemia. Severe anemia: percent of women aged 15-49 years with a hemoglobin level of less than 7.0g/dl, the World Health Organization criterion for severe anemia. 3 All figures related to children's nutrition status refer to children under three, four, or five years of age, depending upon the country. (The specific ages covered for in particular country may be determined by consulting the full report on the DHS of the country concerned, which is available at: www.measuredhs.com/countries.) 4 The reference standards used for stunting and underweight are those established in the 1970s by the World Health Organization, the U.S. Centers for Disease Control, and the U.S. National Center for Health Statistics. Updated stunting and underweight figures based on the recently-released, 2006 World Health Organization reference standards are currently under preparation. When complete, they will be available at: www.worldbank.org/povertyandhealth/ countrydata. 5The anemia figures for children living at an altitude above 1,000 meters have been adjusted to reflect the higher level of hemoglobin required. 6In some countries, the BMI is presented for all women; in others, the figure is available only for mothers of children under five years of age. The reference population for any given country can be determined by consulting the full report on the DHS for the country concerned. An electronic version of this report is located at: www.measuredhs.com/ countries. 7 Anemia cut-off points for respondents who live at an altitude above 1,000 meters and/or who smoke have been adjusted to account for their higher hemoglobin requirements. - 40 - D. FEMALE CIRCUMCISION Prevalence of Circumcision Girls: percent of women aged 15-49 years with one or more daughters, at least one of whom had been circumcised. Women: percent of women aged 15-49 years who had been circumcised. Prevalence of Occlusion Girls: percent of women aged 15-49 years with one or more daughters, at least one of whom had been circumcised with the vaginal area sewn closed. Women: percent of women aged 15-49 years whose vaginal area had been sewn closed. E. SEXUALLY TRANSMITTED DISEASES Prevalence of Genital Discharge Women: percent of women aged 15-49 years who had had abnormal genital discharge in the twelve months before the survey. Men: percent of men aged 15-54 years who had had abnormal genital discharge in the twelve months before the survey. Prevalence of Genital Ulcer or Sore Women: percent of women aged 15-49 years who had had a genital ulcer or sore in the twelve months before the survey. Men: percent of men aged 15-54 years who had had a genital ulcer or sore in the twelve months before the survey. - 41 - Part II: INTERMEDIATE DETERMINANTS OF HNP STATUS ­ HEALTH SERVICE USE A. CHILDHOOD IMMUNIZATION 8 BCG coverage: percent of children who had received a dose of BCG vaccine by the time of the survey. Measles coverage: percent of children who had received a dose of measles vaccine by the time of the survey. DPT coverage: percent of children who had received three doses of DPT vaccine by the time of the survey. Full basic coverage: percent of children who had received a dose of BCG vaccine, measles vaccine, and three doses of DPT and polio vaccines by the time of the survey, excluding polio vaccine given at birth. No basic coverage: percent of children who had received no vaccination against the six early- childhood diseases (TB, measles, polio, diphtheria, pertusis, and tetanus) by the time of the survey. Hepatitis B coverage: percent of children who had received three doses of hepatitis B vaccine by the time of the survey. Yellow fever coverage: percent of children who had received a dose of yellow fever vaccine by the time of the survey. B. TREATMENT OF CHILDHOOD ILLNESSES 9 Treatment of Fever Medical treatment of fever: percent of children with fever, with or without cough or rapid breathing, in the two weeks before the survey who had sought medical advice for fever from any health facility or health provider, whether public or private. Treatment in a public facility: percent of children with fever, with or without cough or rapid breathing, in the two weeks before the survey who had sought medical advice for fever from a public-sector health facility or provider (as defined in fn. 9). Treatment in a private facility: percent of children with fever, with or without cough or rapid breathing, in the two weeks before the survey who had sought medical advice for fever from a private-sector health facility or provider (as defined in fn. 9). 8Childhood immunization figures refer to rates among children 12-23 months of age in all countries except those in Latin America and the Caribbean. There, the figures refer to rates among children 18-29 months of age. All figures are based on information recorded on the child's vaccination card; or, in cases where a card was not seen by the interviewer, on the mother's report. 9Figures for illness treatment in a public facility refer to treatment in government hospitals, health centers, health posts, or dispensaries; or in facilities operated by government-affiliated social securing programs. Figures for treatment in private facilities cover treatment in private hospitals or clinics, in private doctors' offices, or in facilities operated by other private medical providers (such as non-governmental organizations) as defined in the country concerned; but exclude treatment obtained in private pharmacies or shops. - 42 - Treatment of Acute Respiratory Infection (ARI) Medical treatment of ARI: percent of children with a cough and rapid breathing in the two weeks before the survey who had been taken for treatment at any medical facility or provider, whether public or private. Treatment in a public facility: percent of children with a cough and rapid breathing in the two weeks before the survey who had been taken for treatment at a public-sector health facility or provider (as defined in fn. 9). Treatment in a private facility: percent of children with a cough and rapid breathing in the two weeks before the survey who had been taken for treatment at a private-sector health facility or provider (as defined in fn. 9). Treatment of Diarrhea Use of oral rehydration therapy: percent of children with diarrhea in the two weeks before the survey who had received oral rehydration therapy (ORT) (defined as including consumption of oral rehydration salts, other recommended home fluids, or other increased liquids). Medical treatment of diarrhea: percent of children with diarrhea in the two weeks before the survey who had been taken for treatment at any medical facility or provider, whether public or private. Treatment in a public facility: percent of children with diarrhea in the two weeks before the survey who had been taken for treatment at a public-sector health facility or provider (as defined in fn. 9). Treatment in a private facility: percent of children with diarrhea in the two weeks before the survey who had been taken for treatment at a private-sector health facility or provider (as defined in fn. 9). C. ANTENATAL AND DELIVERY CARE 10 Antenatal Care (ANC) Visits To a medically-trained person: percent of women with one or more births in the five years before the survey who had received at least one antenatal care consultation from a medically- trained person (as defined in fn. 10) before her most recent birth. To a doctor: percent of women with one or more births in the five years before the survey who had received at least one antenatal care consultation from a doctor before her most recent birth. To a nurse or trained midwife: percent of women with one or more births in the five years before the survey who had received at least one antenatal care consultation from a nurse or trained midwife (as defined in fn. 10) before her most recent birth. Multiple visits to a medically-trained person: percent of women with one or more births in the five years before the survey who had received at least three antenatal care consultations from any medically-trained provider (as defined in fn. 10) before her most recent birth. 10When speaking of antenatal and delivery care, medically-trained persons are defined as doctors, nurses, and trained midwives. The definition excludes traditional midwives or other traditional birth attendants, whether trained or untrained. - 43 - Antenatal Care (ANC) Content Tetanus toxoid: percent of women with one or more births in the five years before the survey who had received at least one tetanus toxoid injection during her most recent pregnancy. Prophylactic antimalarial treatment: percent of women with one or more births in the five years before the survey who had received prophylactic treatment with any anti-malarial drug during her most recent pregnancy. Iron supplementation: percent of women with one or more births in the five years before the survey who had taken iron tablets during her most recent pregnancy. Delivery Attendance By a medically-trained person: percent of births in the five years before the survey attended by a medically-trained person (as defined in fn. 10). By a doctor: percent of births in the five years before the survey attended by a doctor. By a nurse or trained midwife: percent of births in the five years before the survey attended to by a nurse or a trained midwife (as defined in fn. 10). In a public facility: percent of all deliveries in the five years before the survey occurring in a public-sector health facility (as defined in fn. 9). In a private facility: percent of all deliveries in the five years before the survey occurring in a private-sector health facility (as defined in fn. 9). At home: percent of all deliveries in the five years before the survey occurring at home (defined as the woman's own or any other home). D. CONTRACEPTIVE SERVICES Contraceptive Prevalence 11 Women: percent of married or in-union women aged 15-49 years who used any modern means of contraception (as defined in fn. 11). Men: percent of married or in-union men aged 15-54 years who used any modern means of contraception (as defined in fn. 11). Source of Contraception - Public Sector Women: percent of married women who obtained their current method of contraception from a public-sector health facility or provider (as defined in fn. 9). Men: percent of married men who obtained their current method of contraception from a public- sector health facility or provider (as defined in fn. 9). 11Figures refer to use of modern means of contraception, defined as male/female sterilization, oral contraceptive pill, contraceptive injection, intrauterine device, male/female condom, diaphragm, cervical cap, contraceptive jelly or foam, implant, or some country-specific modern method. - 44 - Source of Contraception - Private Sector Women: percent of married women who obtained their current method of contraception from a private-sector health facility or provider (as defined in fn. 9, except that private pharmacies and shops are included rather than excluded). Men: percent of married women who obtained their current method of contraception from a private-sector health facility or provider (as defined in fn. 9, except that private pharmacies and shops are included rather than excluded). E. TREATMENT OF ADULT ILLNESSES Treatment of Genital Discharge, Ulcer, or Sore Women: percent of women with genital discharge, ulcer, or sore who sought any medical treatment for resulting symptoms. Men: percent of men with genital discharge, ulcer, or sore who sought any medical treatment for resulting symptoms. Treatment of Genital Discharge, Ulcer, or Sore in a Public Facility Women: percent of women with genital discharge, ulcer, or sore who sought treatment from a public-sector health facility or provider (as defined in fn. 9). Men: percent of men with genital discharge, ulcer, or sore who sought treatment from a public- sector health facility or provider (as defined in fn. 9). Voluntary Counseling and Testing for HIV/AIDS Women: percent of women aged 15-49 years who had been tested for HIV at any time before the survey. Men: percent of men aged 15-54 years who had been tested for HIV at any time before the survey. - 45 - Part III: INTERMEDIATE DETERMINANTS OF HNP STATUS ­ INDIVIDUAL AND HOUSEHOLD BEHAVIOR A. HYGIENIC PRACTICES Disposal of Children's Stools Sanitary disposal: percent of mothers with at least one child under five years of age who disposed of the stools of their youngest child in a sanitary manner (defined as dropping stool into a latrine, burying it, or using disposable diapers). Handwashing Wash hands prior to preparing food: percent of women aged 15-49 years preparing meals who washed hands before handling food. Handwashing facilities in household: percent of households that had hand-washing materials or facilities, as determined by direct observation of interviewers. B. BEDNET OWNERSHIP AND USE Bednet Ownership Bednet ownership: percent of households owning one or more bednets. Treated bednet ownership: percent of households owning one or more bednets that had recently been treated with insecticides. Bednet Use By children: percent of households with at least one child under five years of age, some or all of whom had slept under a bednet the night before the survey. By pregnant women: percent of currently pregnant women who had slept under a bednet the night before the survey. C. BREASTFEEDING Exclusive breastfeeding: percent of children 0-3 months of age who had received only breast milk in the 24 hours before the survey. Timely complementary feeding: percent of children 6-9 months of age who had received breast milk and solid or semi-solid foods in the twenty-four hours before the survey. Bottle-feeding: percent of children under 12 months of age who had received any food or drink from a bottle with a nipple in the twenty-four hours before the survey. - 46 - D. MICRONUTRIENT CONSUMPTION Iodized Salt Availability of iodized salt in household: percent of households with cooking salt testing positive for iodine/iodate at the recommended level of 15 or 25 parts per million or more (depending on the country). 12 Vitamin A Children: percent of children13 who had received at least one dose of vitamin A in the six months before the survey, as reported by the mothers. Women: percent of women who had received a dose of vitamin A within two months of the last birth, in the five years before the survey. E. TOBACCO AND ALCOHOL USE Tobacco 14 Women: percent of women aged 15-49 years who currently were smoking or chewing tobacco products. Men: percent of men aged 15-54 years who currently were smoking or chewing tobacco products. Alcohol Women: percent of women aged 15-49 years who had gotten intoxicated due to excessive consumption of alcohol in the three months before the survey. Men: percent of men aged 15-54 years who had gotten intoxicated due to excessive consumption of alcohol in the three months before the survey. F. SEXUAL PRACTICES Non-Regular Sexual Partnerships Women: percent of women aged 15-49 years who had had sex with a non-regular partner at least once in the twelve months before the survey. Men: percent of men aged 15-54 years who had had sex with a non-regular partner at least once in the twelve months before the survey. 12Which of these two levels is recommended in any particular country may be determined by consulting the full report on that country's DHS, which may be found at: www.measuredhs.com/countries. 13Figures refer to children over six months of age and under three, four, or five years of age, depending upon the country. (The specific ages covered for in a particular country may be determined by consulting the full report on that country's DHS, which is available at: www.measuredhs.com/countries.) 14Tobacco products include cigarettes, pipes, cigars, leaves, etc. - 47 - Condom Usage with Non-Regular Partner Women: percent of women aged 15-49 years with non-regular sexual partner who had used a condom in the last sexual intercourse with such a partner in the twelve months before the survey. Men: percent of men aged 15-54 years with non-regular sexual partner who had used a condom in the last sexual intercourse with such a partner in the twelve months before the survey. G. DOMESTIC VIOLENCE Ever experienced violence: percent of women aged 15-49 years who had ever been hit or beaten by current or former husband/partner. Experienced violence in past year: percent of women aged 15-49 years who had been hit or beaten by current or former husband/partner in the twelve months before the survey. - 48 - Part IV: UNDERLYING DETERMINANTS OF HNP STATUS A. EDUCATION School Completion Women: percent of women aged 15-49 years who had completed the fifth grade. Men: percent of men aged 15-54 years who had completed the fifth grade. School Participation Girls: percent of girls aged 6-10 years who were attending school at the time of the survey. Boys: percent of boys aged 6-10 years who were attending school at the time of the survey. B. EXPOSURE TO MASS MEDIA Newspaper Readership Women: percent of women aged 15-49 years who read a newspaper at least once a week. Men: percent of men aged 15-54 years who read a newspaper at least once a week. Radio Listenership Women: percent of women aged 15-49 years who listened to radio at least once a week. Men: percent of men aged 15-54 years who listened to radio at least once a week. Television Viewership Women: percent of women aged 15-49 years who watched television at least once a week. Men: percent of men aged 15-54 years who watched television at least once a week. C. KNOWLEDGE AND ATTITUDES ABOUT HIV/AIDS Knowledge about Sexual Transmission of HIV/AIDS 15 Women: percent of women aged 15-49 years who knew of HIV/AIDS and of at least one of the following ways to avoid it through interruption of its sexual transmission route: abstinence; using a condom; avoiding multiple sex partners, sex with prostitutes, and unprotected homosexual sex. Men: percent of men aged 15-54 years who knew of HIV/AIDS and of at least one of the ways to avoid HIV/AIDS referred to in the preceding definition. 15In most countries, the survey sample included both married and unmarried individuals. Where this was the case, all respondents, regardless of marital status, were asked the question covered in this section. Where the survey covered only individuals who were or had been married, the data pertain only to individuals who had ever been married. (The marital status of people covered for in particular country is indicated in the full report on that country's DHS, which is located at: www.measuredhs.com/countries.) - 49 - Knowledge about Mother-to-Child Transmission of HIV/AIDS Women: percent of women aged 15-49 years who knew of at least one way HIV/AIDS can be transmitted from mother to child during pregnancy, delivery, or breastfeeding. Men: percent of men aged 15-54 years who knew of at least one way HIV/AIDS can be transmitted from mother to child during pregnancy, delivery, or breastfeeding. Attitudes toward HIV/AIDS Women: percent of women aged 15-49 years who believed that people with HIV/AIDS should be allowed to continue working or that HIV test results should remain confidential. Men: percent of men aged 15-54 years who believed that people with HIV/AIDS should be allowed to continue working or that HIV test results should remain confidential. D. STATUS OF WOMEN Household Decisionmaking Can seek own health care: percent of women age 15-49 years who could decide by themselves to seek their own health care. Can seek children's health care: percent of women aged 15-49 years, whose children live with them, who could decide by themselves to seek health care for their children. Can make daily household purchases: percent of women aged 15-49 years who could decide by themselves or jointly with others to make daily household purchases. Can make large household purchases: percent of women aged 15-49 years who could decide by themselves or jointly with others to make large household purchases. Can make meal-related decisions: percent of women aged 15-49 years who could decide by themselves what food to cook daily. Freedom of Movement Can travel to visit family, relatives: percent of women aged 15-49 years who could decide by themselves to visit family and relatives. Other Decisionmaking, Attitudes Can decide how to spend own money: percent of women aged 15-49 years who work for cash who could decide by themselves on how to use the money they earn. Can decide whether to have sex: percent of women aged 15-49 years agreeing that they can refuse to have sex with their husband for at least one of the following reasons: he has a sexually- transmitted disease; he has had sexual relations with another woman; or the woman is tired, not in mood, or recently has given birth. Justify domestic violence: percent of women aged 15-49 years believing that a husband/male partner would be justified in beating his wife/female partner for at least one of the following reasons: he suspects her of being unfaithful; she argues with him; she goes out without telling him; she neglects the children; she burns the food; or other, country-specific reasons (for example, she shows disrespect for her in-laws or her family does not give the expected dowry). - 50 - E. ORPHANHOOD Maternal orphan prevalence: percent of children under 15 years of age whose natural mother had died before the survey. Paternal orphan prevalence: percent of children under 15 years of age whose natural father had died before the survey. Double orphan prevalence: percent of children under 15 years of age both of whose natural parents had died before the survey. - 51 - DATA AND METHODS Any assessment of the figures featured in this report requires an appreciation of how they were prepared. The first need is to understand the basic features of the data and methods employed. A. SOURCE OF FIGURES The figures appearing in this report are all derived from data collected under the Demographic and Health Surveys (DHS) program conducted by ORC Macro, with support from the U.S. Agency for International Development and other external assistance organizations. Large DHS household surveys have been carried out, usually at periodic intervals, in approximately seventy- five countries across Africa, Asia, Latin America, the Middle East, and the former Soviet Union.16 This series of reports covers the fifty-six of those countries that had one or more DHS surveys undertaken since 1990, for which data were publicly available as of June 2006. (Annex C is a list of the countries for which reports have been prepared.) In each country, the DHS program has gathered information on a large number of indicators about health, nutrition, and population (hnp) status and service use; about relevant behaviors of household members; and about household characteristics like those described below. It has done this through a set of questionnaires, similar in all countries, to collect data at the individual, household, and community levels. The data presented here draw on responses to the individual and household questionnaires. In most cases, they are based on responses from women or other family members interviewed. The principal exceptions concern nutritional status, which is based on anthropometric measurement; immunization, which typically relies to the extent possible on record cards maintained at the household level; and those other items where a source other than interviewer response is specifically identified. B. MEASUREMENT OF ECONOMIC STATUS Wealth or Asset Approach Economic status has been expressed in terms of wealth or assets: specifically, on the basis of information about household characteristics gathered through the DHS household questionnaire. (Such information was normally provided for at least 25-30, and often many more, characteristics like the presence, availability, or use of a fan, radio receiver, or automobile; housing materials like wood or concrete flooring, tile or tin roofing, or cement block walls; superior sources of water like piped or a protected well; and other attributes related to economic status.) 16Further information about the DHS program is available at the program's website: www.measuredhs.com. - 53 - Index Construction A single, consolidated index of living standards17 was constructed by using principal components analysis (PCA) to generate a weight for each household item with available information. A wealth index score was calculated for each household by weighting the response with respect to each item pertaining to that household by the coefficient of the first principal component as determined by application of principal components analysis, and summing the results. The resulting household scores were standardized in relation to a standard normal distribution with a mean of zero and a standard deviation of one. All individuals usually present in each household were assigned the household's standardized wealth index score, and all individuals in the sample population were ranked according to that score. The sample population was then divided into quintiles of individuals, with all individuals in a single household being assigned to the same quintile. The same standardized household wealth index scores originally derived for the total population sample, as just described, were also used in preparing the disaggregated estimates for female and male members of the sample population, and for rural and urban residents. In preparing those disaggregated estimates, the entire population sample was divided into quintiles of individuals; the females and males, and the rural and urban residents in each quintile of the entire sample were then separated from one another; and the mean for each of the ten resulting subgroups (five female, five male; or five rural, five urban) was calculated. This procedure was carried out separately for each of the surveys covered. C. CALCULATION AND PRESENTATION OF RATES Use of Sampling Weights Rates for all health, nutrition, and population indicators are calculated after applying the DHS sampling weights. (DHS surveys often over-sample certain small subgroups of interest ­ residents of a particular geographic area, for example ­ in order to get sample sizes large enough to produce statistically-significant results. The DHS sampling weights are used to compensate for such over-sampling in order to ensure that the results are representative of the population as a whole and not just of the DHS sample.) Calculation of Total Population Averages The average for the total population presented alongside the quintile-specific rates for each indicator is calculated without reference to quintile divisions. It thus equals the weighted mean of the quintile rates, with the weight assigned to each quintile rate being the proportion of the number of individuals at risk (as defined on p. 59) for the indicator concerned. Sampling Errors Information needed to assess the statistical significance of differences among the quintile-specific rates is presented in three ways: · First, in all the basic tables presented in part I, rates are shown in parentheses or replaced by asterisks in cases where the standard error is likely to be unacceptably high because 17 Such an index is usually referred to as either an "asset index" or a "wealth index." The two expressions are used interchangeably in this report; for ease of communication, "wealth index" appears more frequently despite the inexact correspondence between the items included in the index's construction and those appearing in more conventional, financially-based definitions of wealth. - 54 - of small sample size. The number of observations used to determine how to present the data for the different indicators covered were as follows: Indicator Unit of measure Number of observations used to determine how quintile-specific rate was presented Without With Replaced by parentheses parentheses asterisk Infant and child Number of deaths >500 250-499 <250 mortality Total and adolescent Number of births >250 125-249 <125 fertility All other indicators Number of >50 25-49 <25 individuals · Second, the standard error for each quintile-specific rate (except for any rate replaced by an asterisk) appearing in the total population table is provided in part III.B. (Standard errors for the quintile-specific rates presented in the female-male and rural-urban tables are not available.) · Third, the right-hand column of the total population table provides the standard error for the concentration index, one of the measures of inequality shown, as indicated below. D. MEASUREMENT OF INEQUALITY Accompanying each of the indicators presented in the total population table are the values for three statistical measures of inequality: · Low/High Quintile Ratio: the ratio between the rate prevailing in the lowest (poorest) population quintile and that found in the highest (least poor) quintile. · Low-High Quintile Difference: the value of the lowest quintile minus the value of the highest, expressed as an absolute value. · Concentration Index: twice the area in a Lorenz-type diagram between the line of equality and the concentration curve for the indicator in question, the curve being the graph of the cumulative share of the indicator against the cumulative share in the asset distribution. (The value, which can range from -1 to +1, is negative when the hnp indicator is higher among the poor (e.g., fertility), positive when it is higher among the better-off (e.g., modern contraceptive use), and zero when on balance the indicator shows no systematic relationship with wealth.)18 18Adam Wagstaff, Pierella Paci, and Eddy van Doorslaer, "On the Measurement of Inequalities of Health," Social Science and Medicine 33 (1991): 545-57. (See also chapter eight in the volume by O'Donnell, van Doorslaer, Wagstaff, and Lindelow described in the annotated bibliography that constitutes annex A.) - 55 - DISCUSSION While a basic understanding of the data and methods employed is necessary to adequately appreciate the figures appearing in this report, it is not sufficient. For the application of the approach taken involves many subtleties that also need to be understood. Among the more important are: A. DESCRIPTIVE NATURE OF THE RELATIONSHIPS The hnp-poverty relationships shown in this report are no more than descriptive. They should not be taken to imply any direct causal relationships, for several reasons. One reason is the possibility that it is not wealth or asset possession per se that determine a person's health condition. Rather, the determining factors could be other characteristics (such as education or ethnic background) that are simultaneously associated with both asset ownership and health status. It is also possible that the health-poverty relationships shown are driven primarily by particular items included in the index (e.g., water and sanitation). Should this be the case, improvements in health conditions among the poor might be more effectively brought about by focusing on changing those particular components of the wealth index rather than by a general effort to increase economic status as measured by the index as a whole. B. IMPLICATIONS OF A WEALTH/ASSET APPROACH Wealth or Assets as a Measure of Economic Status Reliance on a wealth index to measure economic status is a rather recent development in research on economic disparities, where such status traditionally has been defined in terms of consumption or income. The principal reason for the choice of the wealth index is pragmatic rather than conceptual: the DHS surveys, which are of interest because of the plethora of hnp information that they contain, do not collect consumption or income data; but they do have detailed information on households' physical characteristics, and on the household-level presence of and access to a wide range of goods and services. While there is some disagreement about the relative merits of using such wealth/asset information or consumption data to measure economic status, several recent studies suggest that the asset-consumption relationship is quite close.19 To the extent this is the case, an index of wealth or asset possession/availability can be taken as a 19See, for example, Deon Filmer and Lant H. Pritchett, "Estimating Wealth Effects without Expenditure ­ or Tears: An Application to Educational Enrollments in States of India," Demography 38, no. 1 (February 2001): 115-32; Shea Rutstein and Kiersten Johnson, The DHS Wealth Index, DHS Comparative Reports No. 6 (Calverton, Maryland, USA: ORC Macro, August 2004) esp. 10-14; Adam Wagstaff and Naoko Watanabe, "What Difference Does the Choice of SES Make in Health Inequality Measurement?" Health Economics 12 (2003): 885-90. - 57 - reasonably satisfactory proxy for consumption, rather than or in addition to serving as an indicator of economic status in its own right. C. ECONOMIC STATUS AS A MEASURE OF SOCIO-ECONOMIC WELL-BEING Like consumption or income, a wealth index defines disparities that are primarily economic. This is by no means the only way to define inter-group inequalities that are of potential concern. Other possibilities include gender, place of residence, education, ethnic background, or other factors associated with social exclusion. Thus the economic perspective provides only a partial view of the multidimensional concepts of poverty, inequality, and inequity. By including tables on female-male and rural-urban inequalities, this report pays adequate attention to two of inequality's other important dimensions to justify the use of the term "socio- economic" rather than simply "economic" in its title. However, the centrality of tabulations based on the wealth index means that the primary focus is on the economic dimension. The justification for this lies not in the greater importance of economic considerations, but rather in the recently-improved ability to analyze and thus begin dealing with them. Until the development of the wealth/asset approach, the assessment of economic status had been based on consumption, expenditures, or income, all of which are far more difficult to measure than such other, non- economic dimensions of inequality as gender, ethnic identity, educational level, and place of residence. As a result, assessments of health inequalities by economic status had lagged well behind measurements in terms of these other dimensions, especially gender and education. The focus on inequality's economic aspect applied here represents an effort to redress this imbalance. D. INDEX CONSTRUCTION Choice of Items Use of a wealth index requires decisions about which items to include in it. In the case of secondary analyses like the one featured in this report, the choice is limited to those items included in the data sets being used. But even with this constraint, there nonetheless remains considerable room for choice, given the large number of items for which information is collected by the DHS. The decision made in preparing this report was to include all items in each DHS household questionnaire that relate to ownership of household goods; to dwelling unit construction and characteristics; and to access to services and resources like electricity, water, and sanitation facilities. Also included were other potential indicators of wealth, such as live-in domestic servants. This decision, admittedly somewhat arbitrary, has both advantages and disadvantages. The principal advantage is practical: use of a large number of assets increases the degree of variation across household asset scores and facilitates a more regular distribution of individuals across quintiles. It also reduces the possibility of subjectivity in selecting only some of the variables for inclusion on some a priori basis; and it may increase a wealth index's accuracy as a proxy for consumption. However, including all variables is far from satisfying conceptually. For example, it means failing to discriminate with respect to the items' differing natures. It is not clear, for instance, whether access to water, sanitation, electricity, or other publicly-provided resources should be included in an index that purports to measure private household wealth. Further, many items that are candidates for inclusion in a DHS-based wealth index might be seen as directly influencing health status: water and sanitation for infant and child mortality, for - 58 - example. It would be desirable to include quintile-specific estimates for such items; but to the extent that such items have large index coefficients, any estimates for those items would be suspect. Such items appear to be relatively few and of limited statistical significance in the index used here. However, for the sake of caution, quintile-specific estimates for items appearing in the index have nonetheless been excluded from the basic tables and appear only in supporting table III.C Additional issues arise when comparing the findings for two different points in time covered in the basic tables. Because the nature and number of asset questions included in DHS surveys has been evolving, the items included in the wealth index differ somewhat for each of the surveys reported upon. As such, the results presented in the basic tables might differ to some extent from findings produced by some other approach, such as including in the index only those items appearing in each survey covered. Weighting of Items A further decision required in construction of an index concerns the weight to attach to each of the respective items. As noted earlier, the method used in this report is principal components analysis (PCA). Adoption of this method was based on the findings, referred to earlier, that its use resulted in outcomes that approximated reasonably well those produced by taking a consumption or expenditure approach. Further, it often provides greater discrimination in economic status than does the use of consumption/expenditures. It has also emerged as the standard approach for use in analyses of the sort presented here, so that its adoption is largely non-controversial. Yet this choice, too, is not without an arbitrary aspect; for alternative plausible methods exist. Examples include the "inverse possession" approach, which gives more weight to items possessed by only a few and less to those possessed by many;20 or, perhaps, the common practice of simply assigning the same weight to each index item. Also, the weights for any particular item vary from survey to survey, since the weights were determined separately for the population of each survey included in the basic tables. The results thus produced can be expected to differ from those generated in some other manner, such as generating common weights for all the surveys covered by pooling the data sets. Use of Principal Components Analysis with Dichotomous Variables An additional issue concerns the use of a technique like PCA, developed for use with continuous variables, in the construction of an index based primarily on dichotomous variables. While legitimate in principle, any reservations in this regard are of limited practical consequence, since the considerable experimentation undertaken in preparation for the tabulations presented here indicated that any inaccuracy introduced by applying PCA to the analysis of the dichotomous values used is minimal. Economies of Scale Calculating the values for a household wealth index also requires a decision concerning economies of scale that exist in the households covered. The calculations presented here assume complete economies of scale. The implicit assumption is that additional members do not add to household expenses on items included in the index. 20Saul S. Morris et al., "Validity of Rapid Estimates of Household Wealth and Income for Health Surveys in Rural Africa," Journal of Epidemiology and Community Health 54 (2000): 381-87. - 59 - E. DEFINITION OF QUINTILES Quintiles of Individuals As noted earlier, the quintile-specific figures presented in this report refer to quintiles of individuals in the household population. Such quintiles need to be distinguished from quintiles of households or quintiles of only those people in the population who are "at risk": that is, subject to the particular condition, eligible for the particular service, or capable of behaving in a particular way (children born alive for infant and under-five mortality, for example; or adult men and women for condom use or non-regular sexual partnerships). The expression of findings in terms of quintiles of individuals has several implications: · Because fertility is often higher in lower economic households than among better-off ones, the number of individuals per household will frequently be larger among the poor than among higher-income groups. In such cases, the number of households will vary systematically across quintiles of individuals, and the results expressed in terms of quintiles of households can differ significantly from those presented here. · The proportion of individuals "at risk" with regard to a particular indicator is also likely to vary across quintiles in many cases. (For example, in cases where fertility is higher among poor people, a higher-than-average proportion of poor populations will consist of newborns at risk from infant mortality, young children subject to malnutrition, and pregnant women for whom antenatal care is relevant.) To facilitate the work of any investigators wishing to undertake calculations based on people at risk, the number of such people in each quintile of individuals is shown in part III.A. · As previously indicated, the population average figure provided for each indicator is equivalent to the weighted sum of the quintile rates for that indicator, where the weight assigned to each quintile rate is the number of people at risk in each quintile as presented in part III.A. As a result of this weighting, the population average will usually differ from a simple mean of the population quintile estimates. Quintiles of Males and Females, of Rural and Urban Residents As also reported in the data and methods section, the tables on rural and urban residents and on men and women were prepared using the same asset scores as for the total population; and rural- urban residents and females-males were separated from one another only after the entire sample had been disaggregated into quintiles of individuals. This means that the figures given in the rural-urban and female-male tables refer to females-males and rural-urban residents belonging to each quintile of individuals in the total population, as distinct from quintiles of females, of males, of rural residents, or of urban residents alone. The consequence of this distinction is particularly evident with regard to rural and urban residents. Since rural residents tend to be poorer than urban dwellers, they normally form a considerably higher proportion of individuals in the lower economic quintiles of the total population than in the higher ones. Conversely, urban residents tend to be concentrated in the higher economic groups. As a result, the number of individuals in each of the urban and rural quintiles usually varies greatly and systematically; and when this is the case, the figures presented in the rural-urban tables can differ significantly from those produced by a computation procedure that places the same number of rural and urban residents in each rural quintile or each urban quintile. (The results may also differ significantly from application of an approach featuring the separate calculation of index values for urban and for rural groups. While such separate index values may well be preferable conceptually, their calculation involves complexities that prevented their preparation for this report.) - 60 - F. COMPARISON OF QUINTILES ACROSS COUNTRIES Reliance on population quintiles as basic presentational format for the data appearing in this report implicitly incorporates a relative concept of poverty. This differs from an absolute concept of poverty under which the population would be divided into groups of different sizes according to some absolute standard of living (such as people earning less than one dollar a day, between one and two dollars a day, and more than two dollars a day). This means that, when comparing values of an indicator among people in a given quintile across countries, the comparison is between groups of people whose economic status can be quite different. The lowest quintile of a Latin American population, for example, will usually be considerably better-off than the lowest quintile in an African country. G. COMPARISON OF QUINTILES OVER TIME Another implication is that the wealth status of any given quintile within a particular country is likely to change over time. For instance, when a country is progressing economically, the wealth of the households in the population will tend to increase. This will raise the average asset score in most, possibly all population quintiles. As a result, the living standard enjoyed by individuals in any quintile covered by a recent survey is likely to be higher than that of individuals in that same quintile as measured in a prior survey. H. STATISTICAL INDICATORS OF INEQUALITY The available statistical indicators of inequality are far too numerous to permit use of more than a small proportion of them in presenting the findings featured in this report. The three indicators employed have been selected to provide a wide range of perspectives. Two are designed for ease of understanding, the third for greater technical accuracy. The low/high quintile ratio and low-high quintile difference are the two presented for ease of understanding. The former is a relative measure, the latter an absolute measure that can produce a significantly different impression from that provided by the former. The concentration index is provided for the benefit of technical specialists wishing greater accuracy. It measures the degree of inequality in an hnp indicator across the full wealth index distribution, rather than differences between only two of the five quintiles, and also reflects the relative size of the different asset-based divisions of the study population. I. COMPARABILITY WITH OTHER REPORTS Tabulations similar to those presented here can also be found in the initial series of hnp/poverty country reports, issued in 2000, and in the recent country reports issued by the DHS program. The figures presented in those reports normally resemble quite closely those appearing here for any given indicator; but there are often slight differences for one or more of several reasons. The most common is a difference in the definition of the indicator in question. (These differences are usually small and subtle. But there is one important exception: the definition of moderate malnutrition among children. In the 2000 reports, this was defined as second and third degree malnutrition taken together. Here, it is defined as second degree malnutrition alone.) Another reason, with respect to infant and child mortality, is that the figures in the DHS documents are typically based on experience during the five years before the survey in question, rather than - 61 - during the ten previous years as in this report. A further frequent reason is the use of an improved computational technique. In addition, asset-based, quintile-specific tabulations of hnp indicators have begun to appear in an increasing number of other documents. Given the basic similarity of approach, such tabulations usually produce results that are generally congruent with those shown in part I of this report. However, significant divergences have occasionally been reported; and the absence of adequately detailed information about data and methods often prevents any fully-satisfying understanding of the approaches used. As a result, occasional doubts and frequent uncertainties about approach comparability remain. - 62 - PART IV. SUPPORTING TABLES, 2000 A. SAMPLE SIZES B. STANDARD ERRORS C. ASSET DISTRIBUTION AND WEIGHTS Egypt 2000 - SAMPLE SIZES TOTAL SAMPLE Indicator Wealth Quintiles Pop. Low 2nd 3rd 4th High Total Number of household members All 17,774 17,774 17,828 17,723 17,765 88,865 Urban 1,350 2,420 5,656 11,998 16,613 38,037 Rural 16,425 15,354 12,172 5,725 1,152 50,827 Female 8,573 8,550 8,649 8,830 8,877 43,479 Male 9,202 9,224 9,179 8,894 8,886 45,384 Part I: HNP STATUS Indicator Wealth Quintiles Pop. Low 2nd 3rd 4th High Total Mortality rates All 5,101 4,627 4,536 4,403 3,958 22,624 Urban 383 576 1,279 2,718 3,618 8,573 Rural 4,718 4,051 3,257 1,685 340 14,051 Female 2,407 2,245 2,215 2,254 2,002 11,122 Male 2,695 2,382 2,321 2,149 1,956 11,502 Prevalence of fever, diarrhea, acute respiratory infection All 2,290 2,092 2,177 2,314 1,983 10,855 Urban 167 249 617 1,385 1,791 4,209 Rural 2,122 1,843 1,560 929 192 6,646 Female 1,072 977 1,076 1,178 986 5,289 Male 1,218 1,114 1,101 1,136 997 5,566 Total fertility rate All 2,745 2,971 3,114 3,293 3,451 15,573 Urban 202 372 941 2,149 3,207 6,871 Rural 2,543 2,599 2,173 1,144 244 8,702 Age-specific fertility rate 15-19 All 135 172 144 123 42 615 Urban 12 17 33 63 32 158 Rural 123 154 111 60 10 458 Children's nutritional status All 2,129 1,949 2,045 2,201 1,871 10,194 Urban 156 237 575 1,319 1,686 3,973 Rural 1,972 1,712 1,470 882 186 6,222 Female 990 906 1,017 1,118 912 4,943 Male 1,138 1,043 1,028 1,082 959 5,250 Children's anemia status All 973 946 872 934 880 4,605 Urban 77 122 226 571 795 1,791 Rural 896 824 646 364 85 2,815 Female 505 490 462 462 446 2,365 Male 468 455 411 472 434 2,240 - 65 - Egypt 2000 - SAMPLE SIZES Part I: HNP STATUS (Cont.) Indicator Wealth Quintiles Pop. Low 2nd 3rd 4th High Total Women's nutritional status All 2,385 2,599 2,739 2,902 3,040 13,664 Urban 178 329 837 1,916 2,847 6,107 Rural 2,207 2,270 1,902 985 193 7,557 Women's anemia status All 1,364 1,483 1,481 1,592 1,657 7,575 Urban 112 200 434 1,043 1,537 3,326 Rural 1,251 1,283 1,047 549 120 4,250 Girls' circumcision All 2,153 2,252 2,317 2,378 2,440 11,540 Urban 152 291 713 1,572 2,269 4,999 Rural 2,001 1,961 1,603 806 170 6,542 Women's circumcision All 2,745 2,971 3,114 3,293 3,451 15,573 Urban 202 372 941 2,149 3,207 6,871 Rural 2,542 2,599 2,173 1,144 244 8,702 Prevalence of genital discharge, ulcer, sore Female na na na na na na Urban Female na na na na na na Rural Female na na na na na na Male na na na na na na Urban Male na na na na na na Rural Male na na na na na na - 66 - Egypt 2000 - SAMPLE SIZES Part II: Intermediate Determinants of HNP Status - HNP SERVICE USE Indicator Wealth Quintiles Pop. Low 2nd 3rd 4th High Total Immunization coverage All 446 449 436 456 383 2,170 Urban 24 54 136 286 343 843 Rural 423 395 300 170 40 1,328 Female 211 201 206 242 176 1,036 Male 235 248 230 214 207 1,134 Treatment of fever All 436 391 399 433 263 1,923 Urban 27 46 90 263 227 653 Rural 409 345 310 171 36 1,271 Female 247 197 214 216 131 1,005 Male 189 194 186 217 132 918 Treatment of acute respiratory infection All 270 229 206 190 137 1,032 Urban 14 29 46 113 126 328 Rural 256 199 160 77 11 703 Female 122 104 87 93 60 466 Male 148 125 119 97 77 566 Treatment of diarrhea All 197 151 170 152 101 771 Urban 9 18 43 94 91 255 Rural 189 133 127 58 10 517 Female 89 79 81 60 50 359 Male 108 72 89 92 51 412 Antenatal and delivery care All 1,551 1,519 1,616 1,728 1,539 7,953 Urban 113 186 463 1,059 1,399 3,220 Rural 1,438 1,333 1,154 669 140 4,734 Contraceptive prevalence Female 2,462 2,745 2,871 3,066 3,238 14,382 Urban Female 179 328 833 1,984 3,005 6,329 Rural Female 2,283 2,417 2,038 1,083 233 8,054 Male na na na na na na Urban Male na na na na na na Rural Male na na na na na na Contraceptive source Female 1,050 1,374 1,559 1,786 1,980 7,748 Urban Female 86 164 449 1,182 1,845 3,727 Rural Female 964 1,209 1,110 604 135 4,022 Male na na na na na na Urban Male na na na na na na Rural Male na na na na na na Treatment of genital discharge, ulcer, sore Female na na na na na na Urban Female na na na na na na Rural Female na na na na na na Male na na na na na na Urban Male na na na na na na Rural Male na na na na na na - 67 - Egypt 2000 - SAMPLE SIZES Part III: Intermediate Determinants of HNP Status - INDIVIDUAL AND HOUSEHOLD BEHAVIOR Indicator Wealth Quintiles Pop. Low 2nd 3rd 4th High Total Sanitary disposal of stools All na na na na na na Urban na na na na na na Rural na na na na na na Wash hands prior to preparing food All na na na na na na Urban na na na na na na Rural na na na na na na Handwashing facilities in household? All 2,974 2,828 3,187 3,762 4,327 17,078 Urban 264 457 1,127 2,581 4,061 8,490 Rural 2,711 2,372 2,060 1,180 266 8,589 Bednet ownership All na na na na na na Urban na na na na na na Rural na na na na na na Bednet use by children All na na na na na na Urban na na na na na na Rural na na na na na na Bednet use by pregnant women All na na na na na na Urban na na na na na na Rural na na na na na na Exclusive breastfeeding All 169 170 164 181 128 812 Urban 16 18 49 107 109 299 Rural 153 152 116 73 18 512 Female 95 89 80 84 66 414 Male 74 81 85 97 62 399 Timely complementary breastfeeding All 151 134 163 188 164 800 Urban 15 18 37 110 149 329 Rural 136 116 125 78 15 470 Female 80 68 80 90 80 398 Male 71 67 83 98 84 403 Bottle-feeding All 464 439 485 538 436 2,362 Urban 41 59 131 311 393 935 Rural 422 380 354 227 43 1,426 Female 249 230 241 254 226 1,200 Male 215 209 244 284 211 1,163 - 68 - Egypt 2000 - SAMPLE SIZES Part III: Intermediate Determinants of HNP Status - INDIVIDUAL AND HOUSEHOLD BEHAVIOR (Cont.) Indicator Wealth Quintiles Pop. Low 2nd 3rd 4th High Total Iodized salt in household All 2,972 2,826 3,184 3,755 4,323 17,060 Urban 262 457 1,126 2,577 4,058 8,480 Rural 2,709 2,369 2,058 1,178 266 8,580 Vitamin A supplementation All 2,034 1,847 1,934 2,049 1,779 9,643 Urban 144 218 549 1,229 1,613 3,753 Rural 1,890 1,629 1,385 819 167 5,890 Female 1,078 987 987 1,018 884 4,954 Male 955 860 947 1,031 895 4,688 Tobacco and alcohol use, casual sexual partners, condom use for casual sex Female 2,745 2,971 3,114 3,293 3,451 15,574 Urban Female 202 372 941 2,149 3,207 6,871 Rural Female 2,542 2,599 2,173 1,144 244 8,702 Male na na na na na na Urban Male na na na na na na Rural Male na na na na na na Domestic violence All na na na na na na Urban na na na na na na Rural na na na na na na - 69 - Egypt 2000 - SAMPLE SIZES Part IV: UNDERLYING DETERMINANTS OF HNP STATUS Indicator Wealth Quintiles Pop. Low 2nd 3rd 4th High Total School completion (Grade 5) Female 3,949 4,283 4,460 4,784 4,983 22,459 Urban female 292 585 1,433 3,257 4,674 10,241 Rural female 3,657 3,698 3,027 1,527 309 12,218 Male 4,193 4,599 4,781 4,796 4,719 23,087 Urban male 333 643 1,540 3,306 4,416 10,238 Rural male 3,860 3,956 3,241 1,490 303 12,849 School participation Female 1,142 1,070 1,003 928 921 5,064 Urban female 91 162 292 593 851 1,988 Rural female 1,052 908 711 335 70 3,076 Male 1,318 1,139 1,040 913 863 5,273 Urban male 96 130 316 595 816 1,953 Rural male 1,222 1,009 725 318 47 3,321 Mass media exposure Female 2,745 2,971 3,114 3,293 3,451 15,573 Urban female 202 372 941 2,149 3,207 6,871 Rural female 2,542 2,599 2,173 1,144 244 8,702 Male na na na na na na Urban male na na na na na na Rural male na na na na na na Knowledge of HIV/AIDS prevention Female na na na na na na Urban female na na na na na na Rural female na na na na na na Male na na na na na na Urban male na na na na na na Rural male na na na na na na Household decisionmaking and justification of violence All 2,745 2,971 3,114 3,293 3,451 15,573 Urban 202 372 941 2,149 3,207 6,871 Rural 2,542 2,599 2,173 1,144 244 8,702 Orphanhood All 7,465 6,854 6,605 6,252 5,753 32,929 Urban 546 871 1,992 4,031 5,310 12,750 Rural 6,919 5,983 4,613 2,221 443 20,180 Female 3,519 3,308 3,233 3,158 2,893 16,111 Male 3,946 3,547 3,372 3,094 2,860 16,819 - 70 - Egypt 2000 - STANDARD ERRORS OF QUINTILE ESTIMATES FOR TOTAL POPULATION Part I: HNP STATUS Indicator Wealth Quintiles Pop. Low 2nd 3rd 4th High Avg. A. Childhood illness and mortality Infant mortality rate 4.54 4.41 4.14 3.49 2.97 1.97 Under-five mortality rate 4.79 4.88 4.50 4.06 3.16 2.34 Prevalence of fever 0.95 1.08 0.94 1.03 0.88 0.48 Prevalence of diarrhea 0.66 0.66 0.65 0.63 0.64 0.31 Prevalence of acute respiratory infection 0.73 0.88 0.78 0.60 0.79 0.37 B. Fertility Total fertility rate 0.10 0.10 0.09 0.08 0.08 0.05 Adolescent fertility rate 6.00 6.00 5.00 4.00 4.00 2.00 C. Nutritional status Children: Moderate stunting 0.93 0.93 0.90 0.78 0.73 0.43 Severe stunting 0.87 0.61 0.57 0.58 0.48 0.31 Moderate underweight 0.52 0.54 0.46 0.42 0.43 0.22 Severe underweight 0.28 0.18 0.17 0.14 0.06 0.08 Mild anemia 1.30 1.33 1.54 1.37 1.24 0.66 Moderate anemia 1.21 1.21 1.23 1.15 1.00 0.56 Severe anemia 0.21 0.05 0.19 0.00 0.04 0.06 Women: Malnutrition 0.26 0.17 0.11 0.12 0.06 0.06 Mild anemia 1.21 1.22 1.25 1.16 1.41 0.62 Moderate anemia 0.66 0.76 0.61 0.55 0.47 0.30 Severe anemia 0.25 0.14 0.09 0.08 0.11 0.06 D. Female circumcision Prevalence of circumcision: Girls 1.34 1.10 1.14 1.23 1.27 0.64 Women 0.65 0.24 0.27 0.24 0.96 0.28 Prevalence of occlusion: Girls na na na na na na Women na na na na na na E. Sexually transmitted disease Prevalence of genital discharge: Women na na na na na na Men na na na na na na Prevalence of genital ulcer: Women na na na na na na Men na na na na na na - 71 - Egypt 2000 - STANDARD ERRORS OF QUINTILE ESTIMATES FOR TOTAL POPULATION Part II: Intermediate Determinants of HNP Status - HNP SERVICE USE Indicator Wealth Quintiles Pop. Low 2nd 3rd 4th High Avg. A. Childhood immunization BCG coverage 0.68 0.36 0.25 0.44 0.00 0.19 Measles coverage 1.19 1.15 0.83 0.83 0.52 0.43 DPT coverage 1.47 1.36 1.14 1.17 1.46 0.61 Full basic coverage 1.67 1.62 1.39 1.25 1.51 0.68 No basic coverage 0.41 0.00 0.06 0.33 0.00 0.11 Hepatitis B coverage na na na na na na Yellow fever coverage na na na na na na B. Treatment of childhood illnesses Treatment of fever: Medical treatment of fever 2.81 3.11 2.71 2.63 3.32 1.42 Treatment in a public facility 2.48 2.28 1.96 1.67 1.50 1.01 Treatment in a private facility 2.03 2.63 2.33 2.69 3.32 1.22 Treatment of acute respiratory infection (ARI): Medical treatment of ARI 3.73 3.94 3.61 3.51 4.26 1.90 Treatment in a public facility 3.41 4.30 3.26 3.54 3.34 1.57 Treatment in a private facility 3.03 3.53 3.98 4.29 4.86 1.95 Treatment of diarrhea: Use of oral rehydration therapy 3.89 4.45 4.30 4.62 5.39 1.87 Medical treatment of diarrhea 3.58 4.52 4.40 4.55 5.80 2.14 Treatment in a public facility 3.03 3.41 3.19 3.00 2.70 1.56 Treatment in a private facility 3.03 4.06 4.08 4.19 4.73 1.95 C. Antenatal and delivery care Antenatal care (ANC) visits: To a medically trained person 1.35 1.42 1.43 1.27 1.18 0.83 To a doctor 1.38 1.54 1.43 1.34 1.21 0.87 To a nurse or trained midwife 0.15 0.14 0.10 0.08 0.00 0.05 Multiple visits to a medically trained person 1.05 1.46 1.47 1.38 1.37 0.86 Antenatal care content: Tetanus toxoid 1.67 1.54 1.18 1.06 1.82 0.75 Prophylactic antimalarial treatment na na na na na na Iron supplementation 1.06 1.25 1.25 1.44 1.72 0.89 Delivery attendance: By a medically trained person 1.54 1.90 1.52 1.44 0.73 1.10 By a doctor 1.34 1.78 1.43 1.66 1.03 1.02 By a nurse or trained midwife 1.03 1.00 0.89 1.01 0.83 0.60 In a public facility 1.01 1.22 1.30 1.40 1.65 0.77 In a private facility 0.91 1.32 1.28 1.65 1.99 0.86 At home 1.28 1.68 1.46 1.65 1.11 1.02 D. Contraceptive services Contraceptive prevalence: Women 1.58 1.56 1.23 1.07 1.00 0.80 Men na na na na na na Source of contraception - public sector: Women 1.65 1.80 1.72 1.36 1.51 0.94 Men na na na na na na - 72 - Egypt 2000 - STANDARD ERRORS OF QUINTILE ESTIMATES FOR TOTAL POPULATION Part II: Intermediate Determinants of HNP Status - HNP SERVICE USE (Cont.) Indicator Wealth Quintiles Pop. Low 2nd 3rd 4th High Avg. D. Contraceptive services (cont.) Source of contraception - private sector: Women 1.61 1.76 1.70 1.43 1.74 0.96 Men na na na na na na E. Treatment of adult illnesses Treatment of genital discharge, ulcer, sore: Women na na na na na na Men na na na na na na Treatment of genital discharge, ulcer, sore in public medical facilities: Women na na na na na na Men na na na na na na Voluntary counseling and testing for HIV/AIDS: Women na na na na na na Men na na na na na na - 73 - Egypt 2000 - STANDARD ERRORS OF QUINTILE ESTIMATES FOR TOTAL POPULATION Part III: Intermediate Determinants of HNP Status - INDIVIDUAL AND HOUSEHOLD BEHAVIOR Indicator Wealth Quintiles Pop. Low 2nd 3rd 4th High Avg. A. Hygienic practices Disposal of children's stools: Sanitary disposal na na na na na na Handwashing: Wash hands prior to preparing food na na na na na na Handwashing facilities in household 0.72 1.16 1.08 0.53 0.19 0.95 B. Bednet ownership and use Bednet ownership: Bednet ownership na na na na na na Treated bednet ownership na na na na na na Bednet use: By children na na na na na na By pregnant women na na na na na na C. Breastfeeding Exclusive breastfeeding 3.57 3.35 3.97 3.97 4.70 1.92 Timely complementary feeding 3.66 4.49 3.91 4.54 4.31 1.91 Bottle-feeding 1.61 1.96 2.13 2.30 2.11 1.02 D. Micronutrient consumption Iodized salt: Availability of iodized salt in household 1.47 1.39 1.55 1.41 1.10 1.02 Vitamin A: Children 1.00 0.89 1.00 0.96 1.21 0.50 Women 0.71 0.84 0.90 1.01 1.30 0.49 E. Tobacco and alcohol use Tobacco: Women 0.07 0.15 0.11 0.08 0.15 0.06 Men na na na na na na Alcohol: Women na na na na na na Men na na na na na na F. Sexual practices Non-regular sexual partnerships: Women na na na na na na Men na na na na na na Condom usage with non-regular partner: Women na na na na na na Men na na na na na na G. Domestic violence Ever experienced violence na na na na na na Experienced violence in past year na na na na na na - 74 - Egypt 2000 - STANDARD ERRORS OF QUINTILE ESTIMATES FOR TOTAL POPULATION Part IV: UNDERLYING DETERMINANTS OF HNP STATUS Indicator Wealth Quintiles Pop. Low 2nd 3rd 4th High Avg. A. Education School completion: Women 0.95 1.19 1.08 0.91 0.64 0.90 Men 1.20 1.05 0.85 0.73 0.53 0.60 School participation: Girls 1.90 1.42 1.20 1.06 0.80 0.77 Boys 1.39 1.15 1.18 1.19 0.93 0.61 B. Exposure to mass media Newspaper readership: Women 0.36 0.55 0.74 1.04 1.39 0.73 Men na na na na na na Radio listenership: Women 1.35 1.29 0.95 0.87 0.91 0.64 Men na na na na na na Television viewership: Women 1.14 0.58 0.45 0.37 0.27 0.33 Men na na na na na na C. Knowledge and attitudes about HIV/AIDS Knowledge about sexual transmission of HIV/AIDS: Women na na na na na na Men na na na na na na Knowledge about mother-to-child transmission of HIV/AIDS: Women na na na na na na Men na na na na na na Attitudes toward HIV/AIDS: Women na na na na na na Men na na na na na na D. Status of women Household decisionmaking: Can seek own health care 1.15 1.19 1.07 1.29 1.33 0.62 Can seek children's health care 1.30 1.11 0.71 0.55 0.53 0.43 Can make daily household purchases 1.37 1.14 1.02 0.96 1.02 0.55 Can make large household purchases 1.12 1.20 1.16 1.26 1.21 0.62 Can make meal-related decisions 1.21 1.23 1.16 1.15 1.18 0.62 Freedom of movement: Can travel to visit family/relatives 0.91 0.92 0.79 0.79 0.85 0.42 Other decisionmaking, attitudes: Can decide how to spend own money 4.34 3.30 3.32 2.49 1.89 1.19 Can decide whether to have sex na na na na na na Justifies domestic violence na na na na na na E. Orphanhood Paternal orphan prevalence 0.46 0.41 0.37 0.32 0.26 0.18 Maternal orphan prevalence 0.20 0.19 0.18 0.20 0.16 0.09 Double orphan prevalence 0.09 0.05 0.06 0.06 0.04 0.03 - 75 - Egypt 2000 - ASSET DISTRIBUTION AND WEIGHTS (FACTOR SCORES) Asset Variable Unweighted Wealth Quintiles Factor Low 2nd 3rd 4th High Avg. Score Mean Std. Percentage of Population Devia- tion Has electricity 0.973 0.161 89.2% 99.6% 99.9% 100.0% 100.0% 97.7% 0.04090 Has radio 0.818 0.386 48.0% 79.0% 89.3% 93.9% 98.8% 81.8% 0.06135 Has television 0.891 0.312 67.7% 91.8% 95.6% 98.1% 99.6% 90.5% 0.05459 Has refrigerator 0.660 0.474 5.8% 35.0% 74.4% 92.8% 99.7% 61.5% 0.08876 Has bicycle 0.158 0.365 8.6% 19.5% 24.2% 19.0% 10.5% 16.4% 0.00233 Has motorcycle/scooter 0.018 0.134 0.4% 1.1% 3.2% 2.6% 2.4% 1.9% 0.00631 Has car/truck 0.086 0.281 1.3% 2.6% 4.1% 5.3% 25.2% 7.7% 0.03820 Has telephone 0.291 0.454 0.5% 3.5% 13.4% 27.9% 79.4% 24.9% 0.07654 Has video player 0.119 0.324 0.1% 0.3% 1.2% 4.4% 44.2% 10.0% 0.05868 Has electric fan 0.710 0.454 27.2% 54.5% 75.0% 87.8% 97.8% 68.5% 0.07019 Has water heater 0.355 0.478 0.1% 0.9% 7.6% 39.4% 95.1% 28.6% 0.09172 Has sewing machine 0.086 0.281 0.6% 2.9% 7.9% 9.6% 18.8% 7.9% 0.02933 Has automatic washing machine 0.113 0.316 0.0% 0.1% 0.3% 2.5% 43.2% 9.2% 0.05927 Has other washing machine 0.764 0.424 41.8% 84.7% 93.8% 95.8% 74.1% 78.0% 0.03719 Owns farm, other land 0.207 0.405 37.7% 44.5% 30.3% 11.7% 7.8% 26.4% -0.03374 Owns livestock, poultry 0.381 0.486 77.2% 75.1% 56.5% 22.3% 4.2% 47.1% -0.06775 Works own or family's agricultural land 0.806 0.396 89.1% 91.4% 90.3% 86.5% 83.7% 88.2% -0.00134 Uses water piped into residence for drinking 0.805 0.396 31.6% 66.2% 89.3% 98.0% 99.4% 76.9% 0.07399 Uses water piped into yard/plot for drinking 0.011 0.105 2.4% 1.9% 1.1% 0.1% 0.0% 1.1% -0.01329 Uses water from a public faucet (piped) for drinking 0.064 0.245 25.8% 7.6% 1.7% 0.2% 0.0% 7.1% -0.04552 Uses water from an open well in residence for drinking 0.005 0.072 1.8% 0.8% 0.3% 0.0% 0.0% 0.6% -0.01127 Uses water from outside open well for drinking 0.003 0.056 1.1% 0.3% 0.1% 0.0% 0.0% 0.3% -0.01141 Uses water from a traditional public well for drinking 0.009 0.097 3.4% 0.5% 0.0% 0.0% 0.0% 0.8% -0.02191 Uses water from covered well in residence for drinking 0.005 0.072 1.8% 0.8% 0.3% 0.0% 0.0% 0.6% -0.01127 Uses water from covered well in yard/plot for drinking 0.003 0.056 1.1% 0.3% 0.1% 0.0% 0.0% 0.3% -0.01141 Uses water from public covered well for drinking 0.009 0.097 3.4% 0.5% 0.0% 0.0% 0.0% 0.8% -0.02191 Uses water from Nile/canals or surface for drinking 0.000 0.020 0.2% 0.1% 0.0% 0.0% 0.0% 0.0% -0.00262 Uses bottled water for drinking 0.001 0.025 0.0% 0.0% 0.0% 0.0% 0.4% 0.1% 0.00458 Uses water bought from a car for drinking 0.010 0.099 1.6% 2.4% 1.1% 0.2% 0.1% 1.1% -0.00981 Uses a modern flush toilet 0.343 0.475 0.0% 0.5% 2.3% 35.9% 95.0% 26.7% 0.09284 Uses a traditional flush toilet with tank flush 0.031 0.173 1.1% 2.8% 4.9% 6.4% 0.7% 3.2% 0.00048 Uses a traditional toilet with bucket flush 0.511 0.500 65.7% 85.0% 83.4% 53.1% 3.2% 58.1% -0.05861 Uses a pit latrine 0.026 0.159 13.2% 2.4% 0.5% 0.1% 0.0% 3.2% -0.03018 Uses a shared modern flush toilet 0.006 0.078 0.0% 0.0% 0.1% 0.9% 1.0% 0.4% 0.00828 Uses a shared traditional flush toilet with tank flush 0.003 0.057 0.1% 0.2% 0.9% 0.5% 0.0% 0.3% -0.00171 Uses a shared traditional toilet with bucket flush 0.045 0.208 5.5% 7.5% 7.5% 3.1% 0.0% 4.7% -0.01554 Uses a shared pit latrine 0.003 0.059 1.5% 0.4% 0.1% 0.0% 0.0% 0.4% -0.00966 Uses bush, field as latrine 0.031 0.174 12.9% 1.1% 0.2% 0.0% 0.0% 2.8% -0.03904 Has dirt, sand, dung as principal floor material in dwelling 0.204 0.403 70.3% 39.3% 9.2% 0.5% 0.0% 23.8% -0.07616 Has rud. wood, plank as principal floor material in dwelling 0.001 0.030 0.0% 0.0% 0.2% 0.1% 0.1% 0.1% 0.00099 Has parquet or polished wood as principal floor material in dw 0.003 0.057 0.0% 0.1% 0.0% 0.1% 1.1% 0.2% 0.00860 Has tiles as principal floor material in dwelling 0.038 0.192 0.1% 0.3% 0.6% 1.1% 12.0% 2.8% 0.02963 Has cement tiles as principal floor material in dwelling 0.479 0.500 3.8% 14.9% 52.0% 89.1% 69.6% 45.9% 0.05897 Has cement as principal floor material in dwelling 0.194 0.395 25.8% 45.4% 37.2% 4.9% 0.3% 22.7% -0.03964 Has carpet as principal floor material in dwelling 0.072 0.258 0.0% 0.0% 0.7% 3.9% 15.5% 4.0% 0.03708 Has vinyl or asphalt strips as principal floor material in dwelli 0.008 0.092 0.0% 0.0% 0.0% 0.3% 1.3% 0.3% 0.01202 Uses electricity as cooking fuel 0.003 0.057 0.2% 0.4% 0.2% 0.3% 0.5% 0.3% 0.00184 Uses gas as cooking fuel 0.826 0.379 21.2% 86.5% 97.5% 99.4% 99.5% 80.8% 0.07951 - 77 - Egypt 2000 - ASSET DISTRIBUTION AND WEIGHTS (Cont.) (FACTOR SCORES) Asset Variable Unweighted Wealth Quintiles Factor Low 2nd 3rd 4th High Avg. Score Mean Std. Percentage of Population Devia- tion Uses kerosene as cooking fuel 0.150 0.358 67.0% 12.7% 2.3% 0.4% 0.0% 16.5% -0.07252 Uses coal as cooking fuel 0.001 0.033 0.6% 0.0% 0.0% 0.0% 0.0% 0.1% -0.00761 Uses charcoal as cooking 0.001 0.038 1.0% 0.0% 0.0% 0.0% 0.0% 0.2% -0.00782 Uses wood as cooking fuel 0.014 0.118 8.4% 0.4% 0.0% 0.0% 0.0% 1.8% -0.02647 Uses dung, manure as cooking fuel 0.002 0.047 1.5% 0.1% 0.0% 0.0% 0.0% 0.3% -0.01022 Uses other cooking fuel 0.001 0.035 0.1% 0.0% 0.0% 0.0% 0.0% 0.0% -0.00425 Dwelling is in Apartment 0.489 0.500 2.9% 7.5% 26.0% 75.7% 96.7% 41.7% 0.09102 Dwelling is in Free standing house 0.478 0.500 93.6% 88.8% 68.8% 22.6% 3.3% 55.5% -0.08564 Dwelling is in One\Two rooms 0.001 0.031 0.1% 0.2% 0.2% 0.0% 0.0% 0.1% -0.00334 Dwelling is Owned 0.617 0.486 80.1% 78.2% 71.5% 53.4% 39.2% 64.5% -0.03867 Dwelling is Owned jointly 0.107 0.309 12.9% 15.1% 16.4% 11.5% 4.8% 12.2% -0.01138 Dwelling is Rented 0.232 0.422 4.1% 3.9% 8.6% 29.9% 51.9% 19.7% 0.05160 Dwelling is Owned by the family 0.000 0.022 0.0% 0.0% 0.1% 0.1% 0.0% 0.0% 0.00021 Dwelling is Owned by the employer 0.002 0.041 0.1% 0.1% 0.1% 0.2% 0.2% 0.1% 0.00076 Number of members per room 1.217 1.067 2.1 1.8 1.5 1.3 0.9 1.5 -0.03857 - 78 - PART V. SUPPORTING TABLES, 1995 A. SAMPLE SIZES B. STANDARD ERRORS C. ASSET DISTRIBUTION AND WEIGHTS Egypt 1995 - SAMPLE SIZES TOTAL SAMPLE Indicator Wealth Quintiles Pop. Low 2nd 3rd 4th High Total Number of household members All 16,572 16,567 16,577 16,446 16,663 82,826 Urban 1,053 3,239 6,536 10,902 14,978 36,708 Rural 15,520 13,328 10,042 5,544 1,684 46,118 Female 8,200 8,014 8,039 8,025 8,258 40,536 Male 8,372 8,553 8,539 8,421 8,405 42,290 Part I: HNP STATUS Indicator Wealth Quintiles Pop. Low 2nd 3rd 4th High Total Mortality rates All 5,955 5,199 4,652 4,173 4,164 24,143 Urban 363 981 1,729 2,678 3,670 9,422 Rural 5,593 4,218 2,922 1,495 494 14,722 Female 2,845 2,508 2,203 2,037 2,046 11,640 Male 3,110 2,691 2,448 2,136 2,118 12,503 Prevalence of fever, diarrhea, acute respiratory infection All 2,498 2,211 2,183 1,919 1,879 10,689 Urban 163 392 791 1,193 1,630 4,169 Rural 2,335 1,819 1,392 726 249 6,521 Female 1,197 1,023 1,054 921 950 5,145 Male 1,301 1,188 1,129 997 929 5,544 Total fertility rate All 11,468 11,615 12,642 13,291 13,889 58,583 Urban 776 2,379 5,149 9,403 12,637 30,344 Rural 10,728 9,290 7,556 4,222 1,334 33,130 Age-specific fertility rate 15-19 All 2,510 2,723 3,108 3,109 2,519 13,442 Urban 201 538 1,230 2,446 2,264 6,679 Rural 2,328 2,223 1,894 971 324 7,740 Children's nutritional status All na na na na na na Urban na na na na na na Rural na na na na na na Female na na na na na na Male na na na na na na Children's anemia status All na na na na na na Urban na na na na na na Rural na na na na na na Female na na na na na na Male na na na na na na - 81 - Egypt 1995 - SAMPLE SIZES Part I: HNP STATUS (Cont.) Indicator Wealth Quintiles Pop. Low 2nd 3rd 4th High Total Women's nutritional status All na na na na na na Urban na na na na na na Rural na na na na na na Women's anemia status All na na na na na na Urban na na na na na na Rural na na na na na na Girls' circumcision All 2,107 2,047 2,130 2,198 2,356 10,838 Urban 125 401 863 1,455 2,120 4,963 Rural 1,982 1,646 1,268 743 236 5,875 Women's circumcision All 2,796 2,761 2,933 2,965 3,325 14,779 Urban 175 539 1,127 1,961 3,007 6,809 Rural 2,621 2,222 1,806 1,004 317 7,970 Prevalence of genital discharge, ulcer, sore Female na na na na na na Urban Female na na na na na na Rural Female na na na na na na Male na na na na na na Urban Male na na na na na na Rural Male na na na na na na - 82 - Egypt 1995 - SAMPLE SIZES Part II: Intermediate Determinants of HNP Status - HNP SERVICE USE Indicator Wealth Quintiles Pop. Low 2nd 3rd 4th High Total Immunization coverage All 443 431 439 401 371 2,085 Urban 29 74 165 270 315 853 Rural 414 358 273 131 56 1,232 Female 200 193 221 192 196 1,002 Male 243 239 217 208 175 1,082 Treatment of fever All 970 860 912 763 790 4,295 Urban 69 197 342 476 696 1,780 Rural 900 663 571 288 94 2,516 Female 523 459 485 397 408 2,272 Male 447 401 427 366 382 2,023 Treatment of acute respiratory infection All 536 523 545 478 396 2,479 Urban 38 113 179 315 336 981 Rural 498 410 366 164 60 1,498 Female 237 238 256 215 204 1,150 Male 299 285 289 263 192 1,328 Treatment of diarrhea All 396 343 370 332 260 1,701 Urban 28 66 138 207 217 656 Rural 368 277 233 125 43 1,046 Female 176 164 168 161 107 776 Male 220 180 202 171 153 926 Antenatal and delivery care All 1,706 1,559 1,591 1,461 1,480 7,797 Urban 109 299 584 927 1,294 3,213 Rural 1,597 1,260 1,007 534 185 4,583 Contraceptive prevalence Female 2,502 2,547 2,712 2,775 3,175 13,711 Urban Female 152 494 1,028 1,825 2,872 6,371 Rural Female 2,349 2,054 1,683 950 303 7,339 Male na na na na na na Urban Male na na na na na na Rural Male na na na na na na Contraceptive source Female 705 992 1,278 1,442 1,824 6,240 Urban Female 36 217 539 970 1,657 3,418 Rural Female 668 776 739 473 167 2,822 Male na na na na na na Urban Male na na na na na na Rural Male na na na na na na Treatment of genital discharge, ulcer, sore Female na na na na na na Urban Female na na na na na na Rural Female na na na na na na Male na na na na na na Urban Male na na na na na na Rural Male na na na na na na - 83 - Egypt 1995 - SAMPLE SIZES Part III: Intermediate Determinants of HNP Status - INDIVIDUAL AND HOUSEHOLD BEHAVIOR Indicator Wealth Quintiles Pop. Low 2nd 3rd 4th High Total Sanitary disposal of stools All na na na na na na Urban na na na na na na Rural na na na na na na Wash hands prior to preparing food All na na na na na na Urban na na na na na na Rural na na na na na na Handwashing facilities in household? All na na na na na na Urban na na na na na na Rural na na na na na na Bednet ownership All na na na na na na Urban na na na na na na Rural na na na na na na Bednet use by children All na na na na na na Urban na na na na na na Rural na na na na na na Bednet use by pregnant women All na na na na na na Urban na na na na na na Rural na na na na na na Exclusive breastfeeding All 170 160 150 147 125 752 Urban 15 17 54 93 111 290 Rural 154 142 96 54 15 461 Female 73 84 73 97 64 391 Male 96 75 76 50 61 358 Timely complementary breastfeeding All 174 132 137 138 124 705 Urban 18 28 56 82 112 296 Rural 157 104 82 56 12 411 Female 79 68 64 70 62 343 Male 95 64 73 68 63 363 Bottle-feeding All 498 461 443 416 388 2,206 Urban 42 88 174 257 331 892 Rural 457 373 269 159 57 1,315 Female 238 243 213 237 195 1,126 Male 261 218 230 179 192 1,080 - 84 - Egypt 1995 - SAMPLE SIZES Part III: Intermediate Determinants of HNP Status - INDIVIDUAL AND HOUSEHOLD BEHAVIOR (Cont.) Indicator Wealth Quintiles Pop. Low 2nd 3rd 4th High Total Iodized salt in household All na na na na na na Urban na na na na na na Rural na na na na na na Vitamin A supplementation All na na na na na na Urban na na na na na na Rural na na na na na na Female na na na na na na Male na na na na na na Tobacco and alcohol use, casual sexual partners, condom use for casual sex Female na na na na na na Urban Female na na na na na na Rural Female na na na na na na Male na na na na na na Urban Male na na na na na na Rural Male na na na na na na Domestic violence All na na na na na na Urban na na na na na na Rural na na na na na na - 85 - Egypt 1995 - SAMPLE SIZES Part IV: UNDERLYING DETERMINANTS OF HNP STATUS Indicator Wealth Quintiles Pop. Low 2nd 3rd 4th High Total School completion (Grade 5) Female 3,573 3,751 4,063 4,196 4,470 20,053 Urban female 213 727 1,629 2,834 4,043 9,446 Rural female 3,360 3,024 2,434 1,362 427 10,607 Male 3,645 4,071 4,269 4,466 4,485 20,935 Urban male 245 800 1,681 2,995 4,048 9,769 Rural male 3,400 3,271 2,588 1,471 437 11,167 School participation Female 1,264 1,172 1,049 1,034 979 5,498 Urban female 68 233 386 678 875 2,240 Rural female 1,196 939 663 356 104 3,258 Male 1,420 1,248 1,088 1,009 1,044 5,810 Urban male 104 258 423 651 943 2,379 Rural male 1,316 990 665 358 101 3,431 Mass media exposure Female 2,796 2,761 2,933 2,965 3,325 14,779 Urban female 175 539 1,127 1,961 3,007 6,809 Rural female 2,621 2,222 1,806 1,004 317 7,970 Male na na na na na na Urban male na na na na na na Rural male na na na na na na Knowledge of HIV/AIDS prevention Female 5,694 2,761 2,933 2,965 3,325 17,678 Urban female 175 539 1,127 1,961 3,007 6,809 Rural female 2,621 2,222 1,806 1,004 317 7,970 Male na na na na na na Urban male na na na na na na Rural male na na na na na na Household decisionmaking and justification of violence All na na na na na na Urban na na na na na na Rural na na na na na na Orphanhood All 7,437 6,895 6,431 6,033 5,773 32,569 Urban 466 1,339 2,489 3,894 5,110 13,298 Rural 6,971 5,556 3,942 2,139 663 19,270 Female 4,225 3,792 3,612 3,192 3,202 18,023 Male 3,209 3,103 2,818 2,841 2,571 14,542 - 86 - Egypt 1995 - STANDARD ERRORS OF QUINTILE ESTIMATES FOR TOTAL POPULATION Part I: HNP STATUS Indicator Wealth Quintiles Pop. Low 2nd 3rd 4th High Avg. A. Childhood illness and mortality Infant mortality rate 5.98 4.95 4.75 4.31 3.82 2.73 Under-five mortality rate 7.35 5.55 5.38 5.03 4.02 3.30 Prevalence of fever 1.27 1.52 1.48 1.50 1.59 0.73 Prevalence of diarrhea 0.90 0.97 1.01 1.20 1.13 0.46 Prevalence of acute respiratory infection 1.01 1.27 1.29 1.60 1.42 0.63 B. Fertility Total fertility rate 0.11 0.11 0.09 0.09 0.08 0.05 Adolescent fertility rate 7.00 6.00 6.00 4.00 4.00 2.00 C. Nutritional status Children: Moderate stunting 0.99 1.09 1.06 1.11 1.06 0.52 Severe stunting 1.40 1.11 1.01 1.04 1.09 0.65 Moderate underweight 0.88 0.85 0.83 0.90 0.79 0.43 Severe underweight 0.56 0.52 0.40 0.39 0.37 0.23 Mild anemia na na na na na na Moderate anemia na na na na na na Severe anemia na na na na na na Women: Malnutrition 0.44 0.38 0.40 0.18 0.20 0.16 Mild anemia na na na na na na Moderate anemia na na na na na na Severe anemia na na na na na na D. Female circumcision Prevalence of circumcision: Girls 1.21 1.14 1.07 1.16 1.30 0.60 Women 0.20 0.21 0.21 0.31 1.23 0.30 Prevalence of occlusion: Girls 0.23 0.33 0.41 0.21 0.28 0.14 Women 0.11 0.17 0.19 0.25 0.20 0.09 E. Sexually transmitted disease Prevalence of genital discharge: Women na na na na na na Men na na na na na na Prevalence of genital ulcer: Women na na na na na na Men na na na na na na - 87 - Egypt 1995 - STANDARD ERRORS OF QUINTILE ESTIMATES FOR TOTAL POPULATION Part II: Intermediate Determinants of HNP Status - HNP SERVICE USE Indicator Wealth Quintiles Pop. Low 2nd 3rd 4th High Avg. A. Childhood immunization BCG coverage 1.59 1.31 1.26 1.00 0.71 0.60 Measles coverage 2.15 2.13 1.69 1.70 0.36 0.82 DPT coverage 2.55 2.45 2.13 1.86 1.63 1.04 Full basic coverage 2.50 2.45 2.41 2.25 1.73 1.11 No basic coverage 1.15 1.00 0.51 0.85 0.35 0.42 Hepatitis B coverage 2.69 2.81 2.81 2.72 2.98 1.33 Yellow fever coverage na na na na na na B. Treatment of childhood illnesses Treatment of fever: Medical treatment of fever 1.95 2.25 2.28 2.48 2.20 1.02 Treatment in a public facility 1.64 1.77 1.58 1.47 1.41 0.73 Treatment in a private facility 1.68 2.03 2.31 2.50 2.50 0.99 Treatment of acute respiratory infection (ARI): Medical treatment of ARI 2.85 2.78 2.65 3.53 2.57 1.31 Treatment in a public facility 2.63 2.54 2.29 2.37 2.60 1.01 Treatment in a private facility 2.68 2.71 3.21 3.52 2.92 1.32 Treatment of diarrhea: Use of oral rehydration therapy 2.78 2.69 2.98 3.05 3.49 1.29 Medical treatment of diarrhea 2.73 2.89 3.25 3.88 3.96 1.48 Treatment in a public facility 2.22 2.28 2.68 2.35 1.68 1.08 Treatment in a private facility 2.40 2.75 3.08 3.65 4.06 1.42 C. Antenatal and delivery care Antenatal care (ANC) visits: To a medically trained person 1.10 1.27 1.74 1.68 1.22 0.92 To a doctor 1.08 1.22 1.75 1.71 1.22 0.92 To a nurse or trained midwife 0.02 0.00 0.00 0.09 0.00 0.02 Multiple visits to a medically trained person 0.85 1.04 1.68 1.64 1.40 0.89 Antenatal care content: Tetanus toxoid 1.69 1.72 1.51 1.60 1.82 0.80 Prophylactic antimalarial treatment na na na na na na Iron supplementation na na na na na na Delivery attendance: By a medically trained person 1.22 1.58 1.85 1.83 1.35 1.04 By a doctor 1.08 1.35 1.80 1.78 1.51 0.98 By a nurse or trained midwife 0.69 0.95 0.96 1.16 0.89 0.50 In a public facility 0.70 0.93 1.30 1.49 1.78 0.65 In a private facility 0.66 0.73 1.14 1.28 2.10 0.73 At home 0.94 1.12 1.71 1.78 1.87 0.98 D. Contraceptive services Contraceptive prevalence: Women 1.69 1.54 1.29 1.17 1.05 0.84 Men na na na na na na Source of contraception - public sector: Women 2.75 1.92 1.86 1.90 1.57 0.96 Men na na na na na na - 88 - Egypt 1995 - STANDARD ERRORS OF QUINTILE ESTIMATES FOR TOTAL POPULATION Part II: Intermediate Determinants of HNP Status - HNP SERVICE USE (Cont.) Indicator Wealth Quintiles Pop. Low 2nd 3rd 4th High Avg. D. Contraceptive services (cont.) Source of contraception - private sector: Women 2.68 1.95 1.91 1.89 1.52 0.95 Men na na na na na na E. Treatment of adult illnesses Treatment of genital discharge, ulcer, sore: Women na na na na na na Men na na na na na na Treatment of genital discharge, ulcer, sore in public medical facilities: Women na na na na na na Men na na na na na na Voluntary counseling and testing for HIV/AIDS: Women na na na na na na Men na na na na na na - 89 - Egypt 1995 - STANDARD ERRORS OF QUINTILE ESTIMATES FOR TOTAL POPULATION Part III: Intermediate Determinants of HNP Status - INDIVIDUAL AND HOUSEHOLD BEHAVIOR Indicator Wealth Quintiles Pop. Low 2nd 3rd 4th High Avg. A. Hygienic practices Disposal of children's stools: Sanitary disposal na na na na na na Handwashing: Wash hands prior to preparing food na na na na na na Handwashing facilities in household na na na na na na B. Bednet ownership and use Bednet ownership: Bednet ownership na na na na na na Treated bednet ownership na na na na na na Bednet use: By children na na na na na na By pregnant women na na na na na na C. Breastfeeding Exclusive breastfeeding 3.89 3.67 4.67 5.49 5.67 2.20 Timely complementary feeding 3.99 5.10 4.45 4.23 4.19 1.82 Bottle-feeding 1.83 2.08 2.37 2.54 2.85 1.07 D. Micronutrient consumption Iodized salt: Availability of iodized salt in household na na na na na na Vitamin A: Children na na na na na na Women na na na na na na E. Tobacco and alcohol use Tobacco: Women na na na na na na Men na na na na na na Alcohol: Women na na na na na na Men na na na na na na F. Sexual practices Non-regular sexual partnerships: Women na na na na na na Men na na na na na na Condom usage with non-regular partner: Women na na na na na na Men na na na na na na G. Domestic violence Ever experienced violence na na na na na na Experienced violence in past year na na na na na na - 90 - Egypt 1995 - STANDARD ERRORS OF QUINTILE ESTIMATES FOR TOTAL POPULATION Part IV: UNDERLYING DETERMINANTS OF HNP STATUS Indicator Wealth Quintiles Pop. Low 2nd 3rd 4th High Avg. A. Education School completion: Women 0.87 1.04 1.09 0.96 0.69 0.81 Men 1.39 1.17 1.04 0.81 0.63 0.61 School participation: Girls 2.04 1.93 1.20 0.70 0.51 0.96 Boys 1.78 1.23 0.98 0.91 0.63 0.65 B. Exposure to mass media Newspaper readership: Women 0.25 0.52 0.80 1.15 1.38 0.73 Men na na na na na na Radio listenership: Women 1.65 1.19 1.21 1.11 1.09 0.66 Men na na na na na na Television viewership: Women 1.47 1.03 0.93 0.72 0.53 0.54 Men na na na na na na C. Knowledge and attitudes about HIV/AIDS Knowledge about sexual transmission of HIV/AIDS: Women na na na na na na Men na na na na na na Knowledge about mother-to-child transmission of HIV/AIDS: Women na na na na na na Men na na na na na na Attitudes toward HIV/AIDS: Women na na na na na na Men na na na na na na D. Status of women Household decisionmaking: Can seek own health care na na na na na na Can seek children's health care na na na na na na Can make daily household purchases na na na na na na Can make large household purchases na na na na na na Can make meal-related decisions na na na na na na Freedom of movement: Can travel to visit family/relatives na na na na na na Other decisionmaking, attitudes: Can decide how to spend own money 3.60 4.28 3.82 2.87 2.20 1.48 Can decide whether to have sex na na na na na na Justifies domestic violence na na na na na na E. Orphanhood Paternal orphan prevalence na na na na na na Maternal orphan prevalence na na na na na na Double orphan prevalence na na na na na na - 91 - Egypt 1995 - ASSET DISTRIBUTION AND WEIGHTS (FACTOR SCORES) Asset Variable Unweighted Wealth Quintiles Factor Low 2nd 3rd 4th High Avg. Score Mean Std. Percentage of Population Devia- tion Has electricity 0.941 0.237 80.7% 99.0% 99.6% 99.9% 100.0% 95.8% 0.05661 Has radio 0.634 0.482 30.1% 56.6% 64.2% 77.8% 94.5% 64.6% 0.07036 Has television 0.771 0.420 43.9% 79.3% 87.4% 94.2% 98.9% 80.7% 0.07500 Has refrigerator 0.553 0.497 2.9% 18.8% 54.5% 91.7% 99.1% 53.4% 0.10663 Has bicycle 0.178 0.382 6.6% 15.4% 21.5% 20.8% 21.2% 17.1% 0.02800 Has for cooking 0.661 0.473 20.5% 49.6% 72.0% 90.4% 98.9% 66.3% 0.08874 Has black and white television 0.464 0.499 42.4% 73.0% 67.6% 49.3% 22.4% 50.9% -0.01217 Has video player 0.068 0.251 0.2% 0.2% 0.7% 2.6% 29.4% 6.7% 0.05445 Has electric fan 0.537 0.499 9.9% 34.4% 53.6% 76.5% 94.4% 53.8% 0.08590 Has gas, electric stove 0.594 0.491 2.6% 25.9% 72.0% 96.8% 99.7% 59.4% 0.10881 Has water heater 0.239 0.427 0.1% 0.4% 2.4% 16.0% 89.2% 21.7% 0.09391 Has sewing machine 0.171 0.377 1.3% 6.1% 12.1% 21.6% 40.8% 16.4% 0.05373 Has auto washer 0.070 0.256 0.0% 0.3% 0.9% 0.8% 31.1% 6.6% 0.05586 Has other washer 0.688 0.463 20.9% 66.5% 89.3% 97.3% 85.3% 71.8% 0.07852 Has car, motorcycle 0.081 0.273 0.8% 2.9% 4.1% 6.2% 26.1% 8.0% 0.04411 Owns farm, other land 0.249 0.432 43.4% 38.3% 29.2% 14.0% 11.3% 27.2% -0.03864 Owns livestock 0.256 0.436 56.9% 45.5% 28.0% 9.8% 2.8% 28.6% -0.06162 Has a domestic worker not related to head 0.000 0.014 0.0% 0.0% 0.0% 0.0% 0.1% 0.0% 0.00333 Works own or family's agricultural land 0.112 0.315 32.6% 23.0% 11.3% 3.3% 0.9% 14.2% -0.04478 Uses water piped into residence for drinking 0.709 0.454 16.2% 57.2% 82.1% 96.0% 99.3% 70.2% 0.08620 Uses water from a well in residence for drinking 0.078 0.268 19.7% 13.9% 7.6% 1.9% 0.4% 8.7% -0.03699 Uses water from river, canal or surface for drinking 0.001 0.035 0.5% 0.2% 0.0% 0.0% 0.0% 0.2% -0.00634 Uses water from a public faucet (piped) for drinking 0.087 0.283 31.2% 16.5% 5.4% 0.7% 0.0% 10.8% -0.04601 Uses water from a traditional public well for drinking 0.058 0.235 24.0% 6.9% 1.9% 0.1% 0.0% 6.6% -0.04527 Uses water from other source for drinking 0.065 0.247 8.4% 5.3% 2.9% 1.2% 0.3% 3.6% -0.02175 Uses modern flush toilet 0.272 0.445 0.2% 0.7% 3.8% 21.2% 89.6% 23.2% 0.09617 Uses a trad. flush toilet with a tank flush 0.019 0.137 0.5% 0.6% 1.7% 3.4% 1.5% 1.5% 0.00771 Uses a trad. flush toilet with bucket flush 0.528 0.499 44.6% 76.6% 87.8% 73.2% 8.8% 58.1% -0.02859 Uses a traditional pit toilet 0.100 0.300 29.2% 17.5% 5.7% 1.6% 0.1% 10.8% -0.04588 Uses bush,field as latrine 0.066 0.249 21.4% 3.7% 0.9% 0.6% 0.0% 5.3% -0.05134 Uses other type of latrine 0.014 0.118 4.0% 0.8% 0.3% 0.0% 0.0% 1.0% -0.02533 Has dirt, sand, dung as principal floor material in dwelling 0.342 0.474 90.1% 58.6% 20.6% 1.7% 0.2% 34.2% -0.10128 Has cement as principal floor material in dwelling 0.168 0.374 9.2% 32.6% 37.5% 11.2% 1.1% 18.3% -0.01530 Has other type of floor material in dwelling 0.006 0.077 0.0% 0.0% 0.2% 0.5% 1.9% 0.5% 0.01130 Has parquet or polished wood as principal floor material in dw 0.009 0.093 0.0% 0.1% 0.1% 0.3% 4.4% 1.0% 0.01783 Has tiles as principal floor material in dwelling 0.450 0.497 0.7% 8.5% 41.2% 85.4% 83.6% 43.9% 0.09405 Has carpeted as principal floor material in dwelling 0.025 0.156 0.0% 0.0% 0.4% 0.8% 8.7% 2.0% 0.02842 Number of members per sleeping room 2.680 1.563 3.8 3.5 3.0 2.6 2.0 3.0 -0.05081 - 93 - PART VI. ANNEXES A. SOURCES OF ADDITIONAL INFORMATION B. USE OF INFORMATION FROM THIS REPORT TO MONITOR THE ECONOMIC STATUS OF PEOPLE SERVED BY HNP PROGRAMS C. COUNTRIES COVERED BY THE HNP- POVERTY REPORT PROJECT ANNEX A. SOURCES OF ADDITIONAL INFORMATION ADDITIONAL INEQUALITY DATA World Bank HNP/Poverty Country Report Website: http://www.worldbank.org/hnp/povertyandhealth/countrydata. This World Bank website provides the full texts and tables for all fifty-six countries covered by the HNP/Poverty Country Report Project. (A list of the countries covered appears in annex C, at the end of this report.) Also available at the site are summary tables, organized by indicator, designed to facilitate cross-country comparisons in inequality with respect to particular indicators. DHS Country Reports: http://www.measuredhs.com/countries. All DHS final country reports produced since 2003 include quintile-specific tabulations in approximately 50-100 of the reports' HNP indicator tables. The tables deal with some of the indicators covered in this volume, and with many that are not. UNICEF Multi-Indicator Cluster Survey Website: http://www.childinfo.org/MICS2/natlMICSrepz/MICSnatrep.htm. The UNICEF Multi-Indicator Cluster Survey (MICS) project is generally similar to the DHS program, but covers a somewhat different set of countries and indicators. The "standard tables" section for each country listed at the MICS website provides wealth- based, quintile-specific information in around 40-45 of the tables related to hnp, education, and child labor. In deriving these quintile-specific estimates, the MICS investigators have employed a wealth index similar to the one used here. World Health Organization World Health Survey Website: http://www.who.int/healthinfo/survey/en/index.html. The World Health Organization's World Health Survey (WHS) includes such issues as self-assessed adult health status; coverage of interventions against adult chronic diseases and against maternal and child health problems; household health expenditures; insurance coverage; and health system responsiveness. Approximately seventy countries ­ developed as well as developing ­ have been covered thus far. Household wealth information has been collected and used to prepare quintile-specific estimates for many of the indicators appearing in the reports on these countries. - 97 - METHODS AND RESOURCES FOR FURTHER INEQUALITY ANALYSIS Shea Oscar Rutstein and Kiersten Johnson, The DHS Wealth Index, DHS Comparative Reports No. 6 (Calverton, Maryland, USA: ORC Macro, August 2004) (Available at: http://www.measuredhs.com/pubs/pub_details.cfm?ID =470&srchTp=type). This DHS publication, by two of the co-authors of the current report, describes in detail the construction of the wealth index that underlies the data presented in the basic tables. Deon Filmer and Lant H. Pritchett, "Estimating Wealth Effects without Expenditure Data ­ or Tears: An Application to Education Enrollments in States in India," Demography 38, no.1 (February 2001): 115-132. This seminal piece gave birth to the wealth index procedure used in the current volume. It also includes three of the previously-cited country case studies demonstrating the close relationship between results produced using wealth and those based on consumption as an indicator of household economic status. Owen O'Donnell, Eddy van Doorslaer, Adam Wagstaff, and Magnus Lindelow. Quantitative Techniques for Health Equity Analysis. Washington D.C.: The World Bank, forthcoming. Among the topics covered in this comprehensive overview of available quantitative techniques are the measurement of living standards using a wealth index and other approaches (chapter 6) and the concentration index as a measure of inequality (chapter 8). DHS Country Data Sets: http://www.measuredhs.com/accesssurveys/search. The data sets for all DHS surveys undertaken since 2003 include two pieces of information for each household that are designed to help investigators prepare quintile- specific tabulations for any indicator. These are: 1) the household wealth score; and 2) the economic quintile to which individuals in the household belong. Any tabulation using these pieces of information will be comparable to the figures appearing here. - 98 - ANNEX B. USE OF INFORMATION FROM THIS REPORT TO MONITOR THE ECONOMIC STATUS OF PEOPLE SERVED BY HNP PROGRAMS The wealth or asset approach employed in this report can be used to monitor the economic status of people served by health, nutrition, and population (hnp) programs in two ways. The first, simpler way is suitable for monitoring nationwide, facility-based programs. A second, fuller version can also be employed for other types of programs, such as initiatives undertaken only in some parts of a country, or activities like mass education or outreach programs that do not operate through facilities. BASIC MONITORING OF NATIONWIDE FACILITY-BASED PROGRAMS The economic distribution of patients in a nationwide, facility-based program (say, a network of rural health posts, antenatal care clinics, emergency obstetrical facilities, or hospitals) can be determined through an exit survey of facility patients, using the wealth questionnaire and the set of quintile cut-off points that immediately follow this text, and which have been created using the information presented in part III.C. The questionnaire can be employed to measure the economic status of any individual responding to the questions on it. The set of cut-off points can serve to compare the distribution of the respondents' economic status with that of the nationally- representative sample of people interviewed by the DHS survey on which the present report is based. The first step is to use the questionnaire in interviewing an adequately-large sample of patients attending the facility-based services of interest. The wealth score for each patient can then be calculated by multiplying the response to each question by the item scores also provided on the questionnaire, and summing the results. After this has been done, the quintile cut-off points can be used to place each individual in the economic quintile to which (s)he belongs. The number of patients and percentage of total patients in each quintile can then be calculated. Since each quintile defined by the cut-off points contains 20 percent of the individuals in the nationally-representative DHS sample, the patients belonging to any such quintile containing significantly more (or less) than 20 percent of the total are over- (under-) represented relative to the national population. When the percentage of patients in each of the five quintiles is viewed as a whole, the result is a frequency distribution that indicates the spread of service beneficiaries across economic classes of individuals.21 For example: · A service that favors the poorest people would have substantially more than 20 percent of its patients in each of the lowest one or two economic quintiles; considerably less than 20 percent of its patients in each of the highest quintiles. 21That is, across economic classes of all individuals in the sample population. Estimates pertaining to quintiles of only those individuals needing services require adjusting the results of the procedure described here through application of the relevant quintile-specific, sample-size figures presented in part III.A. - 99 - · A service that reaches all economic classes equally would draw roughly the same proportion of total patients from the lower and upper quintiles. · A service that favors the least poor population groups would have well over 20 percent of its patients in each of the highest one or two quintiles, considerably less than 20 percent of its patients in each of the lowest quintiles. FULLER MONITORING OF FACILITY-BASED AND OF OTHER PROGRAMS While capable of providing far more information than currently exists about the distribution of a program's beneficiaries, the approach just described has important limitations. For example, it cannot deal with the many important types of health programs that do not deliver services primarily through facilities ­ mass media health education, household visits by health workers, and many social marketing initiatives, for example. It is also limited in its ability to assess programs working only with certain areas within a country: it can compare the economic status of the programs' beneficiaries with that of the national population, but not with that of the specific sub-national areas where the programs are active. Further, it focuses primarily on only one of the two important dimensions of monitoring the distribution of program beneficiaries: that is, incidence or focus ­ the percentage of program benefits that flow to the poor. It cannot deal nearly so well with the second dimension, which concerns coverage, or the percentage of the poor that the program reaches. These limitations can be overcome by a modified version of the approach described above that relies on a household- rather than facility-based survey. A household survey can generate a set of data containing the full range of information needed to produce an equity assessment by collecting two types of information: first, about the household's wealth or assets, using the questions in the left-hand column of the attached questionnaire;22 and second, about the household members' use of or exposure to the services provided by the program(s) of interest. The collected data can be analyzed in either (or both) of two ways, depending on the type of information desired: · One way would be to use only data from the household survey. The procedure would be analogous to that for a DHS survey employed in this report: ­ Asset information from the survey-generated data set would be used as the basis for the construction of a wealth index, weighting the individual items using some method like principal components analysis. ­ The individuals in the sample would be ranked in order of the index values for their households, then divided into groups like quintiles. ­ The coverage rates in each quintile for the service of interest would be calculated. · A second approach would be to use the weights for each item appearing on the attached questionnaire in determining the wealth of each individual, instead of calculating the weights from the new household data set. Once the individuals' wealth is determined, the individuals would be ranked, divided into quintiles, and the coverage rate in each quintile would be calculated. In the case of programs undertaken in only one region of the country, it would 22Or, if one is willing to forego the benefits of the second analytical approach described below, using any of several other asset questionnaires that exist. Examples include the INDEPTH health equity survey tool (available at: www.indepth-network.org/core_documents/indepthtools.htm) or the model questionnaire developed by M. Mahood Khan and David Hotchkiss of the PHR Plus project (which can be found at: www.phrplus.org). - 100 - provide a comparison of the economic status of the people served with that of the entire country rather than of only the region where the programs are active;23 in the case of nationwide as well as regional programs, it would permit a comparison with the other service programs covered in this report. 23This additional perspective could be particularly helpful in an assessment of a program seeking to reach the poor by focusing on especially backward districts. A report presenting only a finding that the program was reaching the better- off people in those districts could produce an impression that it had failed to reach its intended beneficiaries. But a comparison between the economic status of the program's beneficiaries with that of the national population might well reveal that most of the beneficiaries were poor by national standards and that the program was thus considerably more successful than otherwise thought. - 101 - Egypt 2000 - ASSET QUESTIONNAIRE Question Score if Score if Item "Yes" "No" Score 1. In your household, is/are there? Electricity 0.00678 -0.24689 One or more radios 0.02891 -0.13019 One or more televisions 0.01909 -0.15610 One or more refrigerators 0.06370 -0.12369 One or more bicycles 0.00537 -0.00101 One or more motorcycles 0.04622 -0.00086 One or more cars, trucks 0.12446 -0.01173 One or more telephones 0.11942 -0.04905 One or more video players 0.15942 -0.02160 One or more electric fans 0.04491 -0.10969 One or more water heaters 0.12375 -0.06798 One or more sewing machines 0.09556 -0.00900 One or more automatic washing machines 0.16626 -0.02113 One or more other washing machines 0.02066 -0.06695 2. Do any of the members of your household own? Farm, other land -0.06611 0.01722 Livestock -0.08630 0.05319 3. What is the principal source of drinking water for your household? Piped water in residence 0.03637 -0.15051 Piped water in yard, plot -0.12548 0.00141 Piped water in public faucet -0.17393 0.01191 Open well in residence -0.15604 0.00081 Open well in yard, plot -0.20372 0.00064 Covered well in residence -0.15604 0.00081 Covered well in yard, plot -0.20372 0.00064 Public covered well -0.22447 0.00214 Traditional public well -0.22447 0.00214 Nile, canals, surface water -0.12880 0.00005 Bottled water 0.17993 -0.00012 Water bought from a car -0.09833 0.00098 4. What is the principal source of fuel for cooking in your household? Electricity 0.03233 -0.00011 Gas 0.03648 -0.17329 Kerosene -0.17234 0.03052 Coal -0.22731 0.00025 Charcoal -0.20765 0.00029 Wood -0.22044 0.00318 Dung, manure -0.21570 0.00048 Other -0.12077 0.00015 5. What is the principal type of toilet facility used by your household? Modern flush toilet 0.12850 -0.06708 Traditional flush toilet with tank flush 0.00269 -0.00009 Traditional toilet with bucket flush -0.05736 0.05988 Pit latrine -0.18489 0.00493 - 103 - Egypt 2000 - ASSET QUESTIONNAIRE (Cont.) Question Score if Score if Item "Yes" "No" Score 5. What is the principal type of toilet facility used by your household? (cont.) Shared modern flush toilet 0.10589 -0.00065 Shared traditional flush toilet with tank flush -0.02966 0.00010 Shared traditional toilet with bucket flush -0.07151 0.00338 Shared pit latrine -0.16347 0.00057 Bush, field as latrine -0.21669 0.00703 6. What is the principal material used for the floors in your household? Dirt, sand, dung -0.15031 0.03859 Wood plank 0.03327 -0.00003 Parquet, polished wood 0.14934 -0.00049 Tiles 0.14816 -0.00592 Cement tiles 0.06153 -0.05651 Cement -0.08086 0.01943 Carpet 0.13348 -0.01030 Vinyl, asphalt strips 0.12992 -0.00111 7. What type of dwelling does your household live in? Apartment 0.09310 -0.08898 Free standing house -0.08953 0.08192 One, two rooms -0.10879 0.00010 8. Is your dwelling owned by your household or not? Owned -0.03046 0.04909 Owned jointly -0.03282 0.00394 Rented 0.09383 -0.02837 Owned by the family 0.00968 0.00000 Owned by the employer 0.01867 -0.00003 9. How many people are there for each sleeping room in your household? # people - 2.22x-0.039 1.07 Total Household Asset Score (sum of individual item scores) 2000 - QUINTILE CUT-OFF POINTS Asset Index Value Wealth Quintile Bottom Cut-Off Top Cut-Off Low Low -1.03581 Second -1.03581 -0.47891 Third -0.47891 0.09823 Fourth 0.09823 0.84200 High 0.84200 High - 104 - ANNEX C. COUNTRIES COVERED BY THE HNP - POVERTY REPORT PROJECT* East Asia and Pacific Sub-Saharan Africa Cambodia 2000 Benin 1996, 2001 Indonesia 1997, 2002-03 Burkina Faso 1992-3, 1998-9, 2003 Philippines 1998, 2003 Cameroon 1991, 1998, 2004 Vietnam 1997, 2002 Central African Rep. 1994-95 Chad 1996-97, 2004 Europe and Central Asia Comoros 1996 Armenia 2000 Cote d'Ivoire 1994 Kazakhstan 1995, 1999 Eritrea 1995 Kyrgyz Rep. 1997 Ethiopia 2000 Turkey 1993, 1998 Gabon 2000 Turkmenistan 2000 Ghana 1993, 1998, 2003 Uzbekistan 1996 Guinea 1999 Kenya 1993, 1998, 2003 Latin America and the Caribbean Madagascar 1997 Bolivia 1998, 2003 Malawi 1992, 2000 Brazil 1996 Mali 1995-96, 2001 Colombia 1995, 2000, 2005 Mauritania 2000-01 Dominican Rep. 1996, 2002 Mozambique 1997, 2003 Guatemala 1995, 1998-99 Namibia 1992, 2000 Haiti 1994-95, 2000 Niger 1998 Nicaragua 1997- 98, 2001 Nigeria 1990, 2003 Paraguay 1990 Rwanda 2000 Peru 1996, 2000 Senegal 1997 South Africa 1998 Middle East and North Africa Tanzania 1996, 1999, 2004 Egypt 1995, 2000 Togo 1998 Jordan 1997 Uganda 1995, 2000-01 Morocco 1992, 2003-04 Zambia 1996, 2001-02 Yemen 1997 Zimbabwe 1994, 1999 South Asia * Note: electronic versions of reports for all countries Bangladesh 1996-97, 1999-2000, 2004 are currently available at: www.worldbank.org/ povertyandhealth/countrydata. While supplies last, India 1992-93, 1998-99 paper copies may be obtained at no charge by sending Nepal 1996, 2001 a request to the World Bank's health advisory service: healthpop@worldbank.org. Pakistan 1990-91 - 105 -