39458 SOCIO-ECONOMIC DIFFERENCES IN HEALTH, NUTRITION, AND POPULATION PERU 1996, 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, 1996 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, 1996 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. Peru 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 63.5 53.9 32.6 26.5 13.9 43.2 4.57 49.60 -0.2266 0.0010 Under-five mortality rate 92.6 75.5 43.9 34.5 17.6 60.4 5.26 75.00 -0.2473 0.0011 Prevalence of fever 30.9 28.2 25.8 20.4 17.8 25.9 1.74 13.10 -0.0712 0.0089 Prevalence of diarrhea 18.7 17.9 16.2 11.2 7.7 15.4 2.43 11.00 -0.0964 0.0122 Prevalence of acute respiratory 21.0 21.4 20.6 17.9 18.1 20.2 1.16 2.90 -0.0295 0.0104 infection (ARI) B. Fertility Total fertility rate 5.5 3.7 2.6 2.0 1.6 2.8 3.44 3.90 -0.2408 0.0004 Adolescent fertility rate 163.0 98.0 56.0 38.0 23.0 66.0 7.09 140.00 -0.3670 0.0012 C. Nutritional status (%) Children: Moderate stunting 29.4 22.7 13.2 6.2 4.2 17.8 7.00 25.20 -0.2952 0.0111 Severe stunting 17.6 7.9 3.5 0.9 0.3 7.7 58.67 17.30 -0.4949 0.0196 Moderate underweight 13.0 6.5 3.2 2.1 0.7 6.2 18.57 12.30 -0.4238 0.0226 Severe underweight 2.2 0.7 0.2 0.0 0.0 0.8 na 2.20 -0.6267 0.0693 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 1.2 0.9 0.7 1.7 1.7 1.3 0.71 0.50 0.1114 0.0371 Mild anemia 29.6 30.2 23.9 23.1 22.9 25.4 1.29 6.70 -0.0715 0.0132 Moderate anemia 8.5 4.8 6.3 5.9 4.5 5.9 1.89 4.00 -0.1247 0.0296 Severe anemia 0.3 0.3 0.3 0.4 0.2 0.3 1.50 0.10 -0.1170 0.1337 D. Female circumcision (%) Prevalence of circumcision: Girls na na na na na na na na na na Women na na na na na na na na na na Prevalence of occlusion: Girls * * * * * * * * * * Women * * * * * * * * * * E. Sexually transmitted disease Prevalence of genital discharge: Women 18.0 22.8 26.7 25.0 20.7 22.9 0.87 2.70 0.0688 0.0075 Men na na na na na na na na na na Prevalence of genital ulcer: Women 2.4 2.4 4.1 3.9 3.7 3.4 0.65 1.30 0.1216 0.0207 Men na na na na na na na na na na - 3 - Peru 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 92.1 96.7 97.0 98.5 99.8 96.2 0.92 7.70 0.0174 0.0026 Measles coverage 80.8 82.1 83.4 88.8 92.3 84.4 0.88 11.50 0.0267 0.0048 DPT coverage 76.2 83.9 87.5 90.4 93.0 84.7 0.82 16.80 0.0422 0.0051 Full basic coverage 57.9 62.5 68.1 72.4 81.1 66.3 0.71 23.20 0.0766 0.0082 No basic coverage 4.2 1.0 1.1 1.1 0.2 1.8 21.00 4.00 -0.3815 0.0978 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 47.3 48.3 55.6 65.2 76.8 54.0 0.62 29.50 0.0759 0.0094 Treatment in a public facility 45.6 46.3 49.2 56.3 45.9 47.9 0.99 0.30 0.0330 0.0108 Treatment in a private facility 1.5 1.9 5.8 8.2 29.7 5.7 0.05 28.20 0.4500 0.0458 Treatment of acute respiratory infection (ARI): Medical treatment of ARI 47.9 50.6 61.3 69.2 78.9 57.9 0.61 31.00 0.0965 0.0100 Treatment in a public facility 46.9 48.0 55.1 61.0 46.9 50.9 1.00 0.00 0.0493 0.0118 Treatment in a private facility 0.7 2.5 5.4 6.3 28.3 6.0 0.02 27.60 0.4953 0.0530 Treatment of diarrhea: Use of oral rehydration therapy 64.8 69.6 75.7 60.3 78.3 68.7 0.83 13.50 0.0329 0.0086 Medical treatment of diarrhea 35.1 38.0 39.0 38.3 57.3 38.5 0.61 22.20 0.0437 0.0167 Treatment in a public facility 34.6 36.1 33.8 31.8 35.4 34.6 0.98 0.80 -0.0027 0.0179 Treatment in a private facility 0.4 1.9 4.8 5.9 18.7 3.5 0.02 18.30 0.4986 0.0772 C. Antenatal and delivery care Antenatal care visits: To a medically trained person 41.1 42.7 43.7 58.4 74.3 49.7 0.55 33.20 0.0827 0.0059 To a doctor 10.6 21.1 35.8 54.6 72.6 34.6 0.15 62.00 0.3107 0.0071 To a nurse or trained midwife 30.6 21.6 7.9 3.8 1.7 15.0 18.00 28.90 -0.4289 0.0133 Multiple visits to a medically trained person 53.6 70.3 83.7 91.9 95.9 76.3 0.56 42.30 0.1174 0.0030 Antenatal care content: Tetanus toxoid 66.3 72.6 79.4 80.5 73.0 73.9 0.91 6.70 0.0241 0.0036 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 13.0 34.3 62.2 74.8 87.5 46.9 0.15 74.50 0.3176 0.0043 By a doctor 6.8 21.1 47.2 60.7 79.0 35.7 0.09 72.20 0.3642 0.0058 By a nurse or trained midwife 6.1 13.3 15.0 14.2 8.6 11.2 0.71 2.50 0.1748 0.0146 In a public facility 10.4 28.4 55.9 66.9 63.2 39.3 0.16 52.80 0.3397 0.0056 In a private facility 0.5 2.8 4.7 9.8 21.4 5.9 0.02 20.90 0.4091 0.0217 At home 56.2 44.0 20.6 7.8 3.0 32.0 18.73 53.20 -0.3480 0.0060 D. Contraceptive services Contraceptive prevalence: Women 36.8 45.8 54.4 56.3 58.0 50.4 0.63 21.20 0.0918 0.0044 Men na na na na na na na na na na - 4 - Peru 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 (cont.) Source of contraception - public sector: Women 94.1 90.2 87.8 78.7 55.3 80.1 1.70 38.80 -0.0827 0.0032 Men na na na na na na na na na na Source of contraception - private sector: Women 1.9 7.9 10.4 19.8 41.7 17.6 0.05 39.80 0.3908 0.0144 Men na na na na na na na na na na E. Treatment of adult illnesses Treatment of genital discharge, ulcer, sore: Women 40.7 50.9 66.2 73.8 72.5 63.0 0.56 31.80 0.1054 0.0060 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 0.9 4.0 10.1 16.0 21.8 11.8 0.04 20.90 0.3478 0.0093 Men na na na na na na na na na na - 5 - Peru 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 19.1 37.2 65.6 70.8 63.3 48.3 0.30 44.20 0.2740 0.0055 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 87.9 74.2 60.9 64.4 59.4 72.5 1.48 28.50 -0.0911 0.0131 Timely complementary feeding 70.5 72.7 78.2 85.9 57.5 73.2 1.23 13.00 0.0306 0.0144 Bottle-feeding 10.7 24.4 39.8 46.0 57.7 31.1 0.19 47.00 0.2877 0.0165 D. Micronutrient consumption Iodized salt: Availability of iodized salt 92.0 95.5 98.9 99.5 99.3 97.0 0.93 7.30 0.0149 0.0007 in household Vitamin A: Children 10.0 6.7 5.7 5.0 5.1 6.9 1.96 4.90 -0.1999 0.0232 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 1.9 2.1 2.8 2.8 3.1 2.6 0.61 1.20 0.0810 0.0225 Men na na na na na na na na na na Condom usage with non-regular partner: Women 4.8 15.3 16.8 32.1 31.3 23.1 0.15 26.50 0.2309 0.0370 Men na na na na na na na na na na G. Domestic violence Ever experienced violence 30.4 33.0 33.2 25.8 17.7 27.4 1.72 12.70 -0.1117 0.0057 Experienced violence in past year na na na na na na na na na na - 6 - Peru 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 46.8 71.6 89.0 94.6 97.4 82.9 0.48 50.60 0.1198 0.0016 Men 71.9 87.0 94.5 97.7 98.9 91.0 0.73 27.00 0.0576 0.0012 School participation: Girls 88.4 95.1 95.7 98.6 97.5 94.3 0.91 9.10 0.0209 0.0017 Boys 90.3 95.6 96.1 97.2 97.6 94.8 0.93 7.30 0.0161 0.0016 B. Exposure to mass media Newspaper readership: Women 2.8 11.1 22.9 32.8 47.7 26.0 0.06 44.90 0.3399 0.0055 Men na na na na na na na na na na Radio listenership: Women 42.2 60.8 69.5 71.5 73.4 65.3 0.57 31.20 0.1120 0.0027 Men na na na na na na na na na na Television viewership: Women 7.0 43.5 75.0 82.9 83.6 63.2 0.08 76.60 0.2520 0.0024 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 34.6 47.8 66.4 77.6 81.1 64.5 0.43 46.50 0.1852 0.0026 Men na na na na na na na na na na Knowledge about mother-to-child transmission of HIV/AIDS: Women 69.3 54.8 81.6 90.3 92.9 73.7 0.75 23.60 0.1788 0.0020 Men na na na na na na na na na na Attitudes toward HIV/AIDS: Women 51.9 61.9 45.0 33.4 23.8 41.2 2.18 28.10 -0.2159 0.0043 Men na na na na na na na na na na D. Status of women Household decisionmaking: Can seek own health care 38.7 46.9 61.6 65.6 70.9 58.7 0.55 32.20 0.1046 0.0030 Can seek children's health care 93.8 96.5 98.1 97.5 98.5 96.6 0.95 4.70 0.0103 0.0012 Can make daily household purchases 58.2 65.4 67.4 62.2 54.0 61.3 1.08 4.20 -0.0208 0.0029 Can make large household purchases 50.2 55.4 60.1 56.9 51.9 55.1 0.97 1.70 -0.0032 0.0033 Can make meal-related decisions 64.7 62.2 55.3 49.1 38.0 52.3 1.70 26.70 -0.0936 0.0033 Freedom of movement: Can travel to visit family, relatives 23.2 29.5 36.3 38.2 38.1 34.0 0.61 14.90 0.0974 0.0050 Other decisionmaking, attitudes: Can decide how to spend own money 60.1 71.0 78.0 81.4 85.7 79.0 0.70 25.60 0.0496 0.0028 Can decide whether to have sex 88.6 95.1 98.5 99.0 99.2 96.7 0.89 10.60 0.0178 0.0008 Justifies domestic violence na na na na na na na na na na E. Orphanhood Paternal orphan prevalence 4.8 3.1 2.9 2.3 1.7 3.2 2.82 3.10 -0.1765 0.0177 Maternal orphan prevalence 2.4 1.6 1.0 0.9 1.1 1.5 2.18 1.30 -0.2034 0.0262 Double orphan prevalence 0.2 0.2 0.1 0.2 0.2 0.2 1.00 0.00 -0.0506 0.0736 - 7 - Peru 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 55.8 54.5 30.2 21.7 14.8 40.2 71.2 53.3 34.8 30.9 13.1 46.0 Under-five mortality rate 86.3 73.5 39.4 28.5 17.5 56.5 98.9 77.3 48.1 40.2 17.6 64.0 Prevalence of fever 30.1 27.7 26.1 18.3 16.6 25.1 31.7 28.8 25.6 22.6 18.7 26.7 Prevalence of diarrhea 17.4 15.3 16.0 12.2 5.9 14.4 19.9 20.2 16.4 10.1 9.2 16.4 Prevalence of acute respiratory 20.1 19.1 19.4 17.2 16.1 18.8 21.9 23.4 21.9 18.6 20.0 21.5 infection (ARI) B. Nutritional status Children: Moderate stunting 29.1 23.3 14.1 6.3 3.1 17.9 29.8 22.2 12.4 6.2 5.1 17.7 Severe stunting 18.1 7.7 3.4 1.0 0.5 7.8 17.1 8.1 3.6 0.9 0.1 7.5 Moderate underweight 13.5 6.9 3.0 2.1 0.5 6.4 12.5 6.0 3.4 2.1 0.9 6.0 Severe underweight 2.2 0.8 0.1 0.0 0.0 0.8 2.3 0.6 0.2 0.0 0.0 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 C. Sexually transmitted disease Prevalence of genital discharge: Women 18.0 22.8 26.7 25.0 20.7 22.9 Men na na na na na na Prevalence of genital ulcer: Women 2.4 2.4 4.1 3.9 3.7 3.4 Men na na na na na na - 9 - Peru 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 92.3 97.4 97.3 98.7 100.0 96.4 91.9 96.0 96.7 98.3 99.7 96.0 Measles coverage 80.9 83.6 85.5 91.1 87.1 84.7 80.7 80.8 81.3 86.8 96.8 84.0 DPT coverage 75.9 84.3 87.5 89.8 92.1 84.2 76.6 83.5 87.5 90.9 93.7 85.2 Full basic coverage 58.1 64.2 72.5 71.1 77.2 66.6 57.7 60.9 63.9 73.5 84.4 66.0 No basic coverage 4.6 1.2 0.9 0.9 0.0 2.0 3.7 0.8 1.3 1.4 0.3 1.7 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 48.9 48.1 54.3 67.1 74.9 54.1 45.9 48.5 56.9 63.6 78.3 54.0 Treatment in a public facility 47.5 45.5 48.4 61.7 43.5 48.6 43.8 47.0 50.1 52.0 47.8 47.3 Treatment in a private facility 1.4 2.6 5.5 4.4 30.3 5.2 1.7 1.3 6.0 11.3 29.3 6.2 Treatment of acute respiratory infection (ARI): Medical treatment of ARI 47.8 51.5 63.0 71.9 79.6 58.8 47.9 49.9 59.8 66.8 78.4 57.1 Treatment in a public facility 47.7 49.9 56.1 64.4 50.2 52.8 46.3 46.5 54.2 57.8 44.5 49.3 Treatment in a private facility 0.1 1.6 6.4 3.8 29.1 5.3 1.3 3.1 4.6 8.6 27.7 6.6 Treatment of diarrhea: Use of oral rehydration therapy 64.7 70.0 75.0 63.5 (82.8) 69.1 64.9 69.4 76.3 56.5 75.7 68.4 Medical treatment of diarrhea 33.8 43.0 37.6 35.6 (59.2) 38.4 36.2 34.7 40.4 41.5 56.3 38.5 Treatment in a public facility 33.8 40.3 30.4 30.0 (28.6) 33.8 35.3 33.2 37.3 33.9 39.3 35.2 Treatment in a private facility 0.0 2.5 6.5 4.6 (21.9) 3.8 0.8 1.4 3.1 7.6 17.0 3.3 C. Contraceptive services Contraceptive prevalence: Women 36.8 45.8 54.4 56.3 58.0 50.4 Men na na na na na na Source of contraception - public sector: Women 94.1 90.2 87.8 78.7 55.3 80.1 Men na na na na na na Source of contraception - private sector: Women 1.9 7.9 10.4 19.8 41.7 17.6 Men na na na na na na D. Treatment of adult illnesses Treatment of genital discharge, ulcer, sore: Women 40.7 50.9 66.2 73.8 72.5 63.0 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 0.9 4.0 10.1 16.0 21.8 11.8 Men na na na na na na - 10 - Peru 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 19.1 37.2 65.6 70.8 63.3 48.3 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 86.3 78.4 57.6 (66.8) (55.5) 71.5 89.2 70.8 64.4 61.6 (63.6) 73.5 Timely complementary feeding 70.5 75.5 80.1 (87.8) * 75.1 70.5 70.1 75.9 (83.3) (60.0) 71.4 Bottle-feeding 10.4 28.4 36.3 48.5 62.7 32.6 10.9 20.8 43.5 43.0 53.5 29.7 D. Micronutrient consumption Vitamin A: Children 9.9 7.2 5.3 3.7 5.6 6.8 10.1 6.3 6.1 6.3 4.7 7.1 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 1.9 2.1 2.8 2.8 3.1 2.6 Men na na na na na na Condom usage with non-regular partner: Women 4.8 15.3 16.8 32.1 31.3 23.1 Men na na na na na na - 11 - Peru 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 46.8 71.6 89.0 94.6 97.4 82.9 Men 71.9 87.0 94.5 97.7 98.9 91.0 School participation: Girls 88.4 95.1 95.7 98.6 97.5 94.3 Boys 90.3 95.6 96.1 97.2 97.6 94.8 B. Exposure to mass media Newspaper readership: Women 2.8 11.1 22.9 32.8 47.7 26.0 Men na na na na na na Radio listenership: Women 42.2 60.8 69.5 71.5 73.4 65.3 Men na na na na na na Television viewership: Women 7.0 43.5 75.0 82.9 83.6 63.2 Men na na na na na na C. Knowledge and attitudes about HIV/AIDS Knowledge about sexual transmission of HIV/AIDS: Women 34.6 47.8 66.4 77.6 81.1 64.5 Men na na na na na na Knowledge about mother-to-child transmission of HIV/AIDS: Women 69.3 54.8 81.6 90.3 92.9 73.7 Men na na na na na na Attitudes toward HIV/AIDS: Women 51.9 61.9 45.0 33.4 23.8 41.2 Men na na na na na na D. Orphanhood Paternal orphan prevalence 5.0 3.2 2.8 2.3 1.6 3.2 4.5 3.0 2.9 2.3 1.9 3.1 Maternal orphan prevalence 2.6 1.7 0.9 0.8 0.7 1.5 2.1 1.6 1.2 1.0 1.5 1.5 Double orphan prevalence 0.2 0.2 0.1 0.1 0.1 0.2 0.1 0.2 0.1 0.3 0.3 0.2 - 12 - Peru 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 64.1 57.5 50.0 * * 60.3 55.7 46.9 28.8 25.8 13.3 28.4 Under-five mortality rate 93.2 80.7 61.1 * * 85.3 85.5 65.2 40.1 34.2 17.1 39.0 Prevalence of fever 30.8 30.5 24.3 18.5 * 29.9 32.0 24.4 26.1 20.5 18.0 22.6 Prevalence of diarrhea 18.3 17.0 16.5 15.5 * 17.6 24.1 19.5 16.1 11.0 7.8 13.6 Prevalence of acute respiratory infection 20.7 21.1 18.8 17.8 * 20.6 25.1 21.9 21.0 17.9 18.2 19.8 B. Fertility Total fertility rate 5.5 3.7 2.5 * * 4.3 * 3.8 2.6 2.0 1.6 2.2 Adolescent fertility rate 163.0 90.0 63.0 * * 118.2 * 113.0 55.0 37.0 24.0 44.8 C. Nutritional status Children: Moderate stunting 29.6 24.3 15.9 13.1 * 26.5 26.4 20.0 12.7 5.9 4.1 10.6 Severe stunting 17.7 9.8 3.3 0.0 * 13.7 15.2 4.8 3.6 1.0 0.3 2.7 Moderate underweight 12.9 7.6 2.7 1.9 * 10.1 15.2 4.6 3.3 2.1 0.7 3.0 Severe underweight 2.2 1.0 0.7 0.0 * 1.7 2.3 0.3 0.1 0.0 0.0 0.1 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 1.1 0.9 0.4 0.5 0.3 0.9 2.0 1.0 0.8 1.7 1.7 1.4 Mild anemia 29.6 31.2 25.5 21.3 * 29.4 29.7 28.2 23.5 23.2 22.8 23.6 Moderate anemia 8.5 5.1 8.2 7.3 * 7.3 8.0 4.0 5.9 5.9 4.5 5.3 Severe anemia 0.3 0.4 0.5 0.3 * 0.4 0.0 0.2 0.2 0.4 0.2 0.3 D. Female circumcision Prevalence of circumcision: 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 Prevalence of occlusion: Girls * * * * * * * * * * * * Women * * * * * * * * * * * * E. Sexually transmitted disease Prevalence of genital discharge: Women 18.1 22.4 27.5 22.5 (8.9) 20.9 17.0 23.6 26.6 25.0 20.8 23.8 Men na na na na na na na na na na na na Prevalence of genital ulcer: Women 2.4 2.2 3.8 2.9 0.0 2.5 1.5 2.9 4.1 4.0 3.8 3.8 Men na na na na na na na na na na na na - 13 - Peru 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 91.5 96.4 100.0 * * 93.9 100.0 97.2 96.4 98.4 99.8 98.0 Measles coverage 80.2 83.2 92.3 * * 82.2 88.4 80.5 81.6 89.1 92.2 86.1 DPT coverage 75.3 80.6 92.2 * * 78.8 88.0 89.2 86.5 90.0 92.8 89.4 Full basic coverage 56.8 58.9 78.6 * * 59.6 72.1 68.3 66.1 72.2 80.8 71.6 No basic coverage 4.5 1.5 0.0 * * 3.1 0.0 0.2 1.3 1.2 0.2 0.8 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 47.6 47.9 57.6 * 0.0 48.5 43.4 49.1 55.2 65.4 76.8 60.0 Treatment in a public facility 45.9 46.5 49.4 * 0.0 46.4 41.6 45.7 49.2 56.5 45.9 49.5 Treatment in a private facility 1.7 1.2 5.7 * 0.0 1.8 0.0 3.3 5.8 8.2 29.7 10.0 Treatment of acute respiratory infection (ARI): Medical treatment of ARI 46.7 53.5 68.4 * * 51.2 60.9 45.6 60.0 68.3 78.8 63.6 Treatment in a public facility 45.9 51.7 59.9 * * 49.3 58.6 41.8 54.2 59.7 47.2 52.2 Treatment in a private facility 0.8 1.6 5.1 * * 1.6 0.0 3.9 5.5 6.6 27.7 9.9 Treatment of diarrhea: Use of oral rehydration therapy 65.0 66.8 75.9 * 0.0 66.4 62.9 73.8 75.6 59.8 78.3 71.2 Medical treatment of diarrhea 35.3 40.7 40.9 * 0.0 37.6 32.4 33.9 38.6 37.9 57.3 39.4 Treatment in a public facility 34.9 39.6 33.6 * 0.0 36.3 32.4 30.8 33.9 31.5 35.4 32.7 Treatment in a private facility 0.5 1.1 5.3 * 0.0 1.1 0.0 3.0 4.7 5.8 18.7 6.1 C. Antenatal and delivery care Antenatal care visits: To a medically trained person 42.0 44.4 38.9 48.6 * 42.8 29.3 39.9 44.7 58.8 74.5 54.6 To a doctor 10.3 17.6 27.8 39.9 * 15.1 13.9 27.1 37.5 55.2 72.7 48.6 To a nurse or trained midwife 31.7 26.8 11.1 8.7 * 27.7 15.5 12.8 7.2 3.6 1.7 5.9 Multiple visits to a medically trained person 53.5 67.9 83.0 90.3 * 61.8 55.7 74.3 83.8 92.0 96.0 86.8 Antenatal care content: Tetanus toxoid 65.6 70.5 77.0 82.9 * 68.5 75.6 76.2 79.9 80.3 73.1 77.8 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 12.1 24.6 50.7 60.4 * 20.1 25.0 51.4 64.6 75.5 87.6 69.3 By a doctor 6.0 13.6 34.6 43.0 * 11.5 18.8 34.1 49.9 61.5 78.9 56.0 By a nurse or trained midwife 6.1 11.0 16.0 17.4 * 8.6 6.2 17.2 14.8 14.0 8.7 13.3 In a public facility 9.2 18.2 44.9 57.2 * 15.8 28.0 46.3 58.2 67.3 63.3 59.0 In a private facility 0.3 2.1 1.9 6.8 * 1.2 2.0 3.9 5.3 10.0 21.5 9.9 At home 57.3 54.0 33.2 16.6 * 53.6 40.7 26.4 18.0 7.4 2.9 13.8 D. Contraceptive services Contraceptive prevalence: Women 36.1 40.6 51.0 65.3 (48.6) 40.3 46.1 55.9 55.2 55.8 58.1 56.1 Men na na na na na na na na na na na na - 14 - Peru 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 94.1 91.2 91.2 78.5 * 91.6 94.7 88.7 87.0 78.7 55.3 75.5 Men na na na na na na na na na na na na Source of contraception - private sector: Women 2.0 6.5 6.9 21.2 * 5.6 0.8 10.0 11.1 19.8 41.7 22.4 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 40.3 50.2 66.8 89.4 * 49.7 45.6 52.0 66.0 73.2 72.8 68.5 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 0.7 1.8 3.8 8.3 7.8 1.8 3.4 8.0 11.5 16.3 22.0 16.1 Men na na na na na na na na na na na na - 15 - Peru 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 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 87.4 75.0 (69.0) * 0.0 81.7 * 72.6 58.5 64.5 59.4 64.0 Timely complementary feeding 70.2 67.8 (87.8) * * 71.8 (74.2) 81.5 75.1 85.8 55.7 74.6 Bottle-feeding 10.5 23.9 32.8 * * 16.6 13.4 25.3 41.6 47.0 58.4 43.5 D. Micronutrient consumption Iodized salt: Availability of iodized salt 91.6 94.3 98.9 99.1 100.0 93.5 97.3 97.9 98.9 99.5 99.3 99.1 in household Vitamin A: Children 9.9 7.0 6.2 8.5 * 8.6 11.4 6.2 5.6 4.8 5.1 5.6 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 1.8 1.6 1.5 2.3 0.0 1.7 3.3 3.0 3.1 2.9 3.1 3.0 Men na na na na na na na na na na na na Condom usage with non-regular partner: Women 3.3 5.7 * * 0.0 5.4 * 24.9 16.9 33.1 31.3 27.3 Men na na na na na na na na na na na na G. Domestic violence Ever experienced violence 29.5 30.0 26.5 19.5 19.1 28.9 41.4 38.5 34.7 26.1 17.7 26.7 Experienced violence in past year na na na na na na na na na na na na - 16 - Peru 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 46.0 67.8 86.1 91.6 95.3 61.0 57.3 78.3 89.7 94.7 97.4 92.3 Men 71.1 85.0 92.8 96.3 96.5 79.8 81.0 90.5 94.8 97.7 98.9 96.4 School participation: Girls 88.2 94.8 97.6 98.2 * 91.5 90.9 95.7 95.3 98.6 97.5 96.6 Boys 90.4 95.4 95.4 93.6 * 92.7 89.3 96.0 96.3 97.3 97.5 96.6 B. Exposure to mass media Newspaper readership: Women 2.4 7.2 14.6 27.8 30.8 6.8 7.9 18.0 24.8 33.0 47.8 34.3 Men na na na na na na na na na na na na Radio listenership: Women 42.8 62.3 69.4 69.7 63.7 54.6 34.1 58.0 69.5 71.6 73.5 69.9 Men na na na na na na na na na na na na Television viewership: Women 6.0 36.4 74.3 81.0 91.8 29.2 18.5 56.6 75.2 83.0 83.5 77.9 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 33.2 41.8 57.3 72.8 77.2 41.1 52.1 58.6 68.5 77.8 81.1 74.5 Men na na na na na na na na na na na na Knowledge about mother-to-child transmission of HIV/AIDS: Women 27.3 45.5 73.4 89.4 95.0 42.5 47.3 71.7 83.5 90.3 92.9 87.2 Men na na na na na na na na na na na na Attitudes toward HIV/AIDS: Women 70.5 64.7 52.3 41.2 22.0 62.9 68.6 57.8 43.4 33.1 23.8 34.9 Men na na na na na na na na na na na na D. Status of women Household decisionmaking: Can seek own health care 37.7 40.2 54.1 57.3 64.0 41.5 51.5 59.2 63.3 65.9 70.9 66.1 Can seek children's health care 93.5 95.4 97.2 98.1 * 94.6 96.9 98.3 98.3 97.4 98.5 98.1 Can make daily household purchases 57.4 62.0 64.0 65.1 64.1 60.3 68.2 71.6 68.2 62.1 53.9 61.8 Can make large household purchases 49.8 52.3 55.9 60.7 52.3 51.9 54.7 61.2 61.1 56.7 51.9 56.5 Can make meal-related decisions 64.8 61.8 56.5 55.2 44.6 62.1 63.4 63.1 55.1 48.8 37.9 48.1 Freedom of movement: Can travel to visit family, relatives 22.2 24.6 32.1 32.6 43.9 24.9 34.9 38.6 37.3 38.4 38.0 38.0 Other decisionmaking, attitudes: Can decide how to spend own money 57.6 62.3 67.0 72.2 (76.8) 62.4 73.6 79.7 80.1 81.7 85.8 82.5 Can decide whether to have sex 88.1 93.7 96.9 99.8 100.0 91.8 95.1 97.8 98.8 99.0 99.2 98.9 Justifies domestic violence na na na na na na na na na na na na E. Orphanhood Paternal orphan prevalence 4.7 3.0 3.0 1.1 2.4 3.9 6.3 3.2 2.9 2.4 1.7 2.6 Maternal orphan prevalence 2.4 1.5 1.0 0.5 6.7 1.9 2.4 1.9 1.1 0.9 1.1 1.2 Double orphan prevalence 0.2 0.2 0.0 0.5 0.0 0.2 0.2 0.2 0.1 0.2 0.2 0.2 - 17 - . PART II. BASIC TABLES, 1996 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. Peru 1996 - 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 78.3 53.6 34.4 36.0 19.5 49.9 4.02 58.80 -0.2224 0.0007 Under-five mortality rate 110.0 76.2 48.0 44.1 22.1 68.4 4.98 87.90 -0.2450 0.0008 Prevalence of fever 34.1 29.4 27.2 23.7 17.6 27.9 1.94 16.50 -0.1047 0.0073 Prevalence of diarrhea 21.4 20.3 18.6 14.1 9.3 17.9 2.30 12.10 -0.1113 0.0096 Prevalence of acute respiratory 24.9 21.6 18.3 18.9 13.4 20.4 1.86 11.50 -0.1016 0.0091 infection (ARI) B. Fertility Total fertility rate 6.6 4.6 3.4 2.6 1.7 3.5 3.88 4.90 -0.2525 0.0004 Adolescent fertility rate 169.0 126.0 77.0 45.0 18.0 75.0 9.39 151.00 -0.3825 0.0014 C. Nutritional status (%) Children: Moderate stunting 28.2 21.6 14.8 8.6 4.5 17.8 6.27 23.70 -0.2726 0.0097 Severe stunting 17.4 9.2 4.0 1.4 0.7 8.0 24.86 16.70 -0.5047 0.0172 Moderate underweight 14.1 6.8 4.2 1.8 0.9 6.7 15.67 13.20 -0.4448 0.0193 Severe underweight 2.5 1.1 0.4 0.1 0.5 1.1 5.00 2.00 -0.5911 0.0566 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 1.3 0.8 1.3 1.4 1.1 1.2 1.18 0.20 -0.0064 0.0579 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 na na na na na na na na na na Women na na na na na na na na na na 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 0.0 0.1 0.1 0.0 0.0 0.0 na 0.00 0.1447 0.1500 Men 1.0 0.7 0.4 0.4 1.5 0.8 0.67 0.50 0.1611 0.1777 Prevalence of genital ulcer: Women 0.0 0.0 0.0 0.0 0.0 0.0 na 0.00 0.4872 0.6198 Men 0.9 0.9 1.5 1.1 3.3 1.6 0.27 2.40 0.1849 0.0859 - 21 - Peru 1996 - 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 86.6 96.6 97.8 98.9 95.6 94.3 0.91 9.00 0.0281 0.0029 Measles coverage 78.1 87.2 86.3 91.9 91.8 85.8 0.85 13.70 0.0367 0.0042 DPT coverage 68.2 75.7 79.0 85.4 84.7 77.0 0.81 16.50 0.0523 0.0054 Full basic coverage 55.3 63.8 63.5 71.7 66.0 63.0 0.84 10.70 0.0545 0.0076 No basic coverage 5.4 0.6 0.2 0.4 0.1 1.8 54.00 5.30 -0.5497 0.0864 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 24.7 34.3 35.0 42.2 38.4 32.7 0.64 13.70 0.0956 0.0117 Treatment in a public facility 24.0 32.0 30.7 34.0 20.2 28.5 1.19 3.80 0.0440 0.0129 Treatment in a private facility 0.6 2.1 4.3 8.1 16.9 4.0 0.04 16.30 0.4762 0.0454 Treatment of acute respiratory infection (ARI): Medical treatment of ARI 35.8 44.6 51.5 56.2 56.4 45.7 0.63 20.60 0.0953 0.0105 Treatment in a public facility 34.8 40.6 44.3 44.1 32.2 39.3 1.08 2.60 0.0426 0.0123 Treatment in a private facility 0.9 3.7 6.7 11.6 21.7 5.9 0.04 20.80 0.4608 0.0430 Treatment of diarrhea: Use of oral rehydration therapy 57.2 69.3 71.7 76.5 68.4 66.8 0.84 11.20 0.0628 0.0072 Medical treatment of diarrhea 28.8 30.6 28.4 34.5 33.5 30.2 0.86 4.70 0.0295 0.0157 Treatment in a public facility 28.7 28.3 26.2 28.8 22.8 27.7 1.26 5.90 -0.0085 0.0165 Treatment in a private facility 0.1 2.2 2.1 5.3 10.8 2.4 0.01 10.70 0.4765 0.0684 C. Antenatal and delivery care Antenatal care visits: To a medically trained person 41.6 66.8 80.9 88.6 96.5 71.7 0.43 54.90 0.1626 0.0030 To a doctor 10.8 26.3 37.3 50.3 69.9 35.2 0.15 59.10 0.2876 0.0062 To a nurse or trained midwife 30.7 40.5 43.5 38.3 26.6 36.5 1.15 4.10 0.0523 0.0069 Multiple visits to a medically trained person 28.7 54.9 71.5 81.8 93.7 62.3 0.31 65.00 0.2171 0.0033 Antenatal care content: Tetanus toxoid 61.3 74.7 79.6 79.7 72.7 73.2 0.84 11.40 0.0512 0.0033 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 13.7 48.0 75.1 90.3 96.6 56.4 0.14 82.90 0.3192 0.0026 By a doctor 5.2 24.4 41.2 54.5 67.0 32.2 0.08 61.80 0.3570 0.0055 By a nurse or trained midwife 8.5 23.6 34.0 35.7 29.6 24.2 0.29 21.10 0.2690 0.0074 In a public facility 8.5 36.5 60.9 72.5 70.9 43.4 0.12 62.40 0.3293 0.0041 In a private facility 0.4 3.4 5.4 10.9 21.0 6.2 0.02 20.60 0.4186 0.0186 At home 89.3 57.7 31.4 14.8 5.5 48.3 16.24 83.80 -0.3595 0.0031 D. Contraceptive services Contraceptive prevalence: Women 24.0 37.5 45.2 48.9 50.3 41.3 0.48 26.30 0.1376 0.0049 Men 22.7 37.7 42.8 46.1 62.0 43.1 0.37 39.30 0.1586 0.0154 - 22 - Peru 1996 - 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 (cont.) Source of contraception - public sector: Women 92.4 82.7 76.6 68.9 47.8 71.1 1.93 44.60 -0.1092 0.0039 Men na na na na na na na na na na Source of contraception - private sector: Women 6.8 15.8 21.7 28.6 48.9 26.8 0.14 42.10 0.2600 0.0105 Men na na na na na na na na na na E. Treatment of adult illnesses Treatment of genital discharge, ulcer, sore: Women * (76.4) (85.4) (68.3) (86.4) 77.2 * * * * Men * * * * * * * * * * 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 - Peru 1996 - 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 77.1 69.8 57.4 36.9 42.9 61.5 1.80 34.20 -0.1128 0.0150 Timely complementary feeding 68.8 74.4 74.7 79.7 65.7 72.5 1.05 3.10 0.0124 0.0114 Bottle-feeding 19.7 30.9 42.5 56.3 62.7 37.4 0.31 43.00 0.1966 0.0125 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 0.0 0.1 0.1 0.0 0.1 0.1 0.00 0.10 0.0947 0.1328 Men 6.4 6.3 9.2 8.2 8.3 7.9 0.77 1.90 0.1005 0.0409 Condom usage with non-regular partner: Women * * * * * * * * * * Men 6.5 38.1 22.4 45.1 56.8 37.1 0.11 50.30 0.1158 0.0450 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 - Peru 1996 - 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 38.2 65.1 83.4 90.7 94.8 77.6 0.40 56.60 0.1486 0.0017 Men 61.4 80.4 91.3 95.8 97.7 86.9 0.63 36.30 0.0847 0.0013 School participation: Girls 80.7 86.2 90.2 90.2 92.7 87.1 0.87 12.00 0.0272 0.0024 Boys 82.4 85.6 87.7 90.3 90.3 86.6 0.91 7.90 0.0200 0.0023 B. Exposure to mass media Newspaper readership: Women 22.7 52.7 75.0 84.1 89.9 68.6 0.25 67.20 0.1944 0.0020 Men 45.3 69.2 86.2 91.8 95.6 81.5 0.47 50.30 0.1148 0.0058 Radio listenership: Women 55.9 73.4 80.2 82.5 81.9 76.2 0.68 26.00 0.0731 0.0021 Men 73.4 80.1 87.5 88.4 83.5 83.6 0.88 10.10 0.0347 0.0055 Television viewership: Women 16.9 66.2 92.2 96.7 98.3 78.5 0.17 81.40 0.1990 0.0017 Men 34.0 70.3 94.5 98.4 98.6 84.4 0.34 64.60 0.1410 0.0055 C. Knowledge and attitudes about HIV/AIDS Knowledge about sexual transmission of HIV/AIDS: Women 67.1 83.7 93.1 96.0 97.8 89.2 0.69 30.70 0.0648 0.0013 Men 83.2 92.5 98.9 99.5 100.0 96.2 0.83 16.80 0.0331 0.0030 Knowledge about mother-to-child transmission of HIV/AIDS: Women 79.1 69.8 86.9 91.5 93.5 78.9 0.85 14.40 0.1417 0.0018 Men 80.7 71.9 87.6 93.0 94.4 83.7 0.85 13.70 0.0915 0.0055 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 45.6 57.1 60.1 66.4 72.0 63.7 0.63 26.40 0.0584 0.0035 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 3.9 3.8 2.6 3.0 2.1 3.2 1.86 1.80 -0.1481 0.0146 Maternal orphan prevalence 2.3 2.2 1.8 1.5 2.2 2.0 1.05 0.10 -0.0504 0.0182 Double orphan prevalence 0.2 0.2 0.2 0.3 0.4 0.3 0.50 0.20 0.0284 0.0513 - 25 - Peru 1996 - 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 71.7 47.8 27.9 31.3 12.2 43.5 84.8 59.1 40.9 40.6 27.2 56.1 Under-five mortality rate 106.4 70.3 40.8 40.4 13.7 62.7 113.4 81.8 55.1 47.7 30.8 74.0 Prevalence of fever 34.0 30.2 27.6 21.4 16.2 27.5 34.3 28.7 26.7 26.1 19.2 28.3 Prevalence of diarrhea 19.9 20.5 16.9 12.8 8.8 16.9 22.9 20.1 20.2 15.5 9.8 19.0 Prevalence of acute respiratory 24.4 21.6 16.9 18.6 12.0 19.7 25.4 21.6 19.8 19.3 14.9 21.1 infection (ARI) B. Nutritional status Children: Moderate stunting 27.8 22.2 15.1 7.1 5.2 17.5 28.6 21.0 14.6 10.1 3.6 18.0 Severe stunting 17.1 9.0 3.6 1.1 0.5 7.6 17.7 9.3 4.4 1.6 1.0 8.4 Moderate underweight 14.2 5.7 4.1 1.9 0.9 6.4 14.1 7.8 4.2 1.7 0.9 7.0 Severe underweight 2.4 1.0 0.4 0.2 0.5 1.0 2.6 1.2 0.5 0.0 0.4 1.1 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 0.0 0.1 0.1 0.0 0.0 0.0 Men 1.0 0.7 0.4 0.4 1.5 0.8 Prevalence of genital ulcer: Women 0.0 0.0 0.0 0.0 0.0 0.0 Men 0.9 0.9 1.5 1.1 3.3 1.6 - 27 - Peru 1996 - 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 86.4 94.9 97.0 99.9 95.5 93.8 86.8 98.0 98.6 98.0 95.8 94.7 Measles coverage 77.7 87.8 88.1 93.5 95.2 86.9 78.6 86.7 84.6 90.5 87.6 84.7 DPT coverage 68.7 75.8 79.0 90.9 88.2 78.6 67.7 75.7 79.1 80.3 80.1 75.4 Full basic coverage 55.2 63.9 63.1 77.6 69.3 64.3 55.4 63.6 63.9 66.2 61.7 61.6 No basic coverage 5.6 1.0 0.0 0.0 0.1 1.8 5.2 0.3 0.3 0.7 0.0 1.7 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 25.6 31.8 33.0 41.1 39.8 31.7 23.8 36.8 37.0 43.1 37.1 33.5 Treatment in a public facility 25.5 29.3 28.0 34.5 18.1 27.6 22.6 34.8 33.4 33.5 22.1 29.3 Treatment in a private facility 0.1 2.5 4.9 6.4 20.8 4.0 1.0 1.7 3.6 9.6 13.4 3.9 Treatment of acute respiratory infection (ARI): Medical treatment of ARI 37.9 41.8 53.3 52.5 53.2 45.1 33.8 47.2 49.9 59.9 59.1 46.2 Treatment in a public facility 37.6 37.9 43.9 42.0 29.8 39.0 32.2 43.2 44.7 46.2 34.2 39.6 Treatment in a private facility 0.3 3.8 9.4 10.3 22.2 6.0 1.4 3.7 4.4 13.0 21.3 5.9 Treatment of diarrhea: Use of oral rehydration therapy 54.2 68.2 73.1 78.0 72.0 66.2 59.8 70.4 70.5 75.3 65.0 67.3 Medical treatment of diarrhea 28.7 29.4 26.3 32.8 40.4 29.7 28.9 31.6 30.2 35.9 26.9 30.7 Treatment in a public facility 28.6 26.4 24.2 28.1 29.7 27.1 28.8 30.1 27.9 29.4 16.1 28.3 Treatment in a private facility 0.1 3.0 2.1 4.7 10.8 2.6 0.1 1.4 2.1 5.8 10.8 2.3 C. Contraceptive services Contraceptive prevalence: Women 24.0 37.5 45.2 48.9 50.3 41.3 Men 22.7 37.7 42.8 46.1 62.0 43.1 Source of contraception - public sector: Women 92.4 82.7 76.6 68.9 47.8 71.1 Men na na na na na na Source of contraception - private sector: Women 6.8 15.8 21.7 28.6 48.9 26.8 Men na na na na na na D. Treatment of adult illnesses Treatment of genital discharge, ulcer, sore: Women * (76.4) (85.4) (68.3) (86.4) 77.2 Men * * * * * 42.8 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 - Peru 1996 - 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 78.2 68.4 57.8 34.0 (57.2) 62.2 76.0 71.1 57.1 40.1 (27.2) 60.8 Timely complementary feeding 69.4 73.3 73.6 86.3 (68.3) 73.3 68.1 75.5 75.7 72.3 (62.0) 71.7 Bottle-feeding 18.1 29.7 40.5 57.8 59.3 36.1 21.3 31.8 44.2 55.0 66.2 38.5 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 0.0 0.1 0.1 0.0 0.1 0.1 Men 6.4 6.3 9.2 8.2 8.3 7.9 Condom usage with non-regular partner: Women * * * * * * Men 6.5 38.1 22.4 45.1 56.8 37.1 - 29 - Peru 1996 - 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 38.2 65.1 83.4 90.7 94.8 77.6 Men 61.4 80.4 91.3 95.8 97.7 86.9 School participation: Girls 80.7 86.2 90.2 90.2 92.7 87.1 Boys 82.4 85.6 87.7 90.3 90.3 86.6 B. Exposure to mass media Newspaper readership: Women 22.7 52.7 75.0 84.1 89.9 68.6 Men 45.3 69.2 86.2 91.8 95.6 81.5 Radio listenership: Women 55.9 73.4 80.2 82.5 81.9 76.2 Men 73.4 80.1 87.5 88.4 83.5 83.6 Television viewership: Women 16.9 66.2 92.2 96.7 98.3 78.5 Men 34.0 70.3 94.5 98.4 98.6 84.4 C. Knowledge and attitudes about HIV/AIDS Knowledge about sexual transmission of HIV/AIDS: Women 67.1 83.7 93.1 96.0 97.8 89.2 Men 83.2 92.5 98.9 99.5 100.0 96.2 Knowledge about mother-to-child transmission of HIV/AIDS: Women 79.1 69.8 86.9 91.5 93.5 78.9 Men 80.7 71.9 87.6 93.0 94.4 83.7 Attitudes toward HIV/AIDS: Women na na na na na na Men na na na na na na D. Orphanhood Paternal orphan prevalence 3.8 3.6 2.5 3.4 2.4 3.2 3.9 3.9 2.6 2.5 1.8 3.1 Maternal orphan prevalence 2.5 2.6 1.9 1.5 1.8 2.1 2.1 1.8 1.8 1.5 2.6 1.9 Double orphan prevalence 0.3 0.3 0.1 0.3 0.3 0.3 0.2 0.1 0.4 0.3 0.4 0.3 - 30 - Peru 1996 - 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 79.0 65.3 31.2 (40.7) * 71.0 71.1 41.9 34.9 35.8 19.0 34.9 Under-five mortality rate 110.4 90.6 51.0 (60.3) * 99.6 104.5 61.8 47.5 43.4 21.6 46.4 Prevalence of fever 34.4 31.6 29.1 19.4 * 33.0 31.2 27.4 26.8 23.8 17.5 24.5 Prevalence of diarrhea 21.2 18.9 20.4 8.2 * 20.3 23.5 21.6 18.3 14.3 9.2 16.4 Prevalence of acute respiratory infection 24.7 22.2 24.1 12.1 * 23.7 27.2 21.0 17.3 19.2 13.5 18.2 B. Fertility Total fertility rate 6.5 4.9 (3.6) * * 5.6 * 4.4 3.4 2.6 1.7 2.8 Adolescent fertility rate 167.0 123.0 (72.0) * * 138.6 * 129.0 78.0 45.0 18.0 54.8 C. Nutritional status Children: Moderate stunting 28.2 24.4 16.4 9.9 * 25.9 28.6 19.1 14.6 8.5 4.3 12.5 Severe stunting 17.7 10.6 6.6 1.5 * 14.5 14.4 7.9 3.6 1.4 0.6 3.7 Moderate underweight 14.3 8.3 5.4 0.8 * 11.7 12.1 5.4 4.0 1.8 0.8 3.4 Severe underweight 2.5 1.1 0.6 0.6 * 2.0 2.4 1.0 0.4 0.1 0.4 0.5 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 1.2 1.2 0.7 0.0 * 1.2 1.6 0.5 1.4 1.4 1.0 1.1 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 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 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 0.0 0.1 0.1 0.0 0.0 0.0 0.0 0.2 0.1 0.0 0.0 0.0 Men 1.1 0.3 0.0 * * 0.6 0.0 1.1 0.5 0.5 1.6 0.9 Prevalence of genital ulcer: Women 0.0 0.1 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Men 0.9 0.0 0.8 * * 0.5 0.0 2.0 1.6 1.1 3.3 2.0 - 31 - Peru 1996 - 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 86.4 96.0 99.3 (100.0) * 90.3 88.9 97.2 97.5 98.9 95.6 97.1 Measles coverage 79.0 87.9 91.2 (90.7) * 82.7 68.8 86.5 85.4 92.0 91.7 88.0 DPT coverage 68.4 77.9 81.8 (100.0) * 72.7 66.2 73.6 78.5 84.8 84.5 80.0 Full basic coverage 55.7 65.0 70.3 (73.4) * 59.8 51.3 62.5 62.2 71.6 65.6 65.1 No basic coverage 5.0 0.1 0.1 0.0 * 3.2 9.5 1.2 0.2 0.4 0.1 0.8 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 24.7 32.1 38.9 (32.7) * 27.7 24.4 36.7 34.2 42.5 38.5 37.1 Treatment in a public facility 24.2 31.0 34.7 (16.9) * 26.7 21.4 33.2 30.0 34.4 20.0 30.1 Treatment in a private facility 0.5 1.1 4.2 (15.8) * 1.0 1.9 3.1 4.3 7.9 17.2 6.6 Treatment of acute respiratory infection (ARI): Medical treatment of ARI 36.2 44.2 53.0 * * 39.8 32.3 45.1 51.1 56.2 56.1 50.8 Treatment in a public facility 35.4 41.5 49.5 * * 38.1 29.4 39.9 43.1 44.3 31.7 40.3 Treatment in a private facility 0.8 2.7 3.5 * * 1.7 1.7 4.8 7.4 11.3 21.9 9.6 Treatment of diarrhea: Use of oral rehydration therapy 55.8 64.1 81.4 * * 60.0 70.4 73.4 69.9 77.0 67.9 72.3 Medical treatment of diarrhea 29.6 33.9 35.8 * * 31.2 20.9 27.9 27.1 34.7 33.8 29.5 Treatment in a public facility 29.6 32.6 35.8 * * 30.8 20.2 24.8 24.4 28.9 22.8 25.2 Treatment in a private facility 0.1 1.3 0.0 * * 0.4 0.7 3.0 2.5 5.4 10.9 4.1 C. Antenatal and delivery care Antenatal care visits: To a medically trained person 40.4 63.4 77.9 92.4 * 51.4 54.2 69.9 81.4 88.5 96.4 83.5 To a doctor 10.3 20.9 26.5 48.8 * 15.5 17.1 31.3 39.1 50.4 70.2 46.6 To a nurse or trained midwife 30.2 42.5 51.4 43.5 * 35.9 37.1 38.7 42.2 38.1 26.2 36.9 Multiple visits to a medically trained person 27.9 49.8 64.1 81.9 * 38.5 37.0 59.5 72.7 81.8 93.7 76.0 Antenatal care content: Tetanus toxoid 60.3 72.5 77.3 86.1 * 65.7 73.1 76.7 80.0 79.5 72.8 77.5 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 11.7 31.4 53.8 89.3 (68.7) 21.5 35.5 63.8 78.7 90.3 96.9 80.5 By a doctor 4.2 13.0 25.9 54.7 (48.0) 9.1 16.5 35.2 43.8 54.5 67.2 48.3 By a nurse or trained midwife 7.5 18.4 27.9 34.5 (20.7) 12.4 18.9 28.6 35.0 35.8 29.7 32.3 In a public facility 6.8 21.2 38.5 58.6 (46.4) 14.0 27.0 51.2 64.7 72.9 71.2 63.9 In a private facility 0.4 2.0 5.4 16.1 (2.4) 1.4 0.6 4.9 5.4 10.7 21.2 9.5 At home 91.3 75.4 55.4 25.1 (48.7) 83.2 67.0 40.9 27.4 14.4 5.1 24.0 D. Contraceptive services Contraceptive prevalence: Women 23.0 31.3 35.4 44.4 (39.5) 27.4 36.9 43.6 46.8 49.1 50.4 47.8 Men 21.6 34.1 21.5 * * 26.6 (38.8) 42.2 47.0 46.5 61.9 50.5 - 32 - Peru 1996 - 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 92.5 84.2 85.2 75.5 * 87.8 91.2 81.7 75.5 68.7 47.6 66.7 Men na na na na na na na na na na na na Source of contraception - private sector: Women 6.8 13.5 14.0 22.8 * 10.9 6.9 17.3 22.6 28.8 49.1 31.0 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 * * * * * (72.4) * * (88.8) (67.9) (86.0) 78.6 Men * * * * * * * * * * * (43.7) 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 - Peru 1996 - 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 76.0 75.2 (63.9) * * 73.3 * 64.5 56.2 37.9 43.7 52.2 Timely complementary feeding 68.4 67.4 * * * 70.1 (73.8) 82.4 71.4 79.3 65.2 74.5 Bottle-feeding 19.5 29.8 34.6 * * 24.3 22.3 31.9 43.8 55.9 62.5 46.9 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 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.2 0.1 0.0 0.1 0.1 Men 5.5 6.2 6.5 * * 6.4 (19.4) 6.5 9.9 7.7 8.3 8.5 Condom usage with non-regular partner: Women * * * * * * * * * * * * Men 0.0 44.4 9.2 * * 17.6 (33.0) 29.8 24.5 49.4 57.3 42.7 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 - Peru 1996 - 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 37.0 58.2 79.0 86.7 93.2 49.8 52.0 71.9 84.0 90.8 94.8 87.7 Men 60.7 76.4 86.9 95.7 97.5 70.1 70.2 85.0 92.1 95.9 97.7 93.8 School participation: Girls 80.6 86.8 93.4 89.9 * 83.7 81.3 85.6 89.7 90.2 92.7 89.4 Boys 82.6 87.0 89.9 89.7 * 84.7 80.0 84.0 87.3 90.4 90.3 87.9 B. Exposure to mass media Newspaper readership: Women 20.6 38.3 61.9 67.8 (63.9) 32.1 48.1 66.4 77.1 84.7 90.1 81.8 Men 43.4 59.6 68.2 * * 54.9 (71.5) 82.6 90.5 91.7 95.5 91.5 Radio listenership: Women 56.0 74.2 84.6 89.4 (71.5) 65.8 54.0 72.7 79.6 82.2 82.0 79.9 Men 73.2 77.8 94.9 * * 78.9 (75.2) 83.3 85.7 88.3 83.5 85.4 Television viewership: Women 14.3 51.3 85.9 93.0 (96.9) 36.3 47.6 80.5 93.2 96.9 98.4 93.7 Men 32.6 55.2 89.3 * * 51.9 (54.8) 91.2 95.7 98.5 98.6 96.6 C. Knowledge and attitudes about HIV/AIDS Knowledge about sexual transmission of HIV/AIDS: Women 66.3 78.5 87.1 94.0 93.0 73.3 75.7 88.7 94.0 96.0 97.8 94.9 Men 82.0 88.4 98.1 * * 87.5 (100.0) 98.1 99.1 99.5 100.0 99.4 Knowledge about mother-to-child transmission of HIV/AIDS: Women 35.5 57.9 77.9 88.9 81.3 48.8 61.7 81.2 88.3 91.6 93.5 89.7 Men 55.1 63.6 81.0 * * 63.1 (69.9) 83.4 89.2 93.4 94.4 91.4 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 16.4 26.0 36.2 46.8 (43.4) 22.6 44.2 57.3 57.3 61.6 67.5 61.9 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 3.9 4.2 2.7 1.3 0.8 3.8 3.0 3.3 2.6 3.0 2.1 2.7 Maternal orphan prevalence 2.3 2.7 1.7 0.3 4.7 2.3 3.2 1.8 1.9 1.5 2.2 1.9 Double orphan prevalence 0.2 0.3 0.3 0.0 0.0 0.3 0.2 0.1 0.2 0.3 0.4 0.3 - 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 Peru 2000 - SAMPLE SIZES TOTAL SAMPLE Indicator Wealth Quintiles Pop. Low 2nd 3rd 4th High Total Number of household members All 26,029 26,019 26,044 26,073 26,073 130,237 Urban 1,810 8,755 21,170 25,113 25,771 82,620 Rural 24,218 17,264 4,874 960 302 47,618 Female 12,791 12,617 12,802 12,973 13,434 64,618 Male 13,237 13,402 13,242 13,100 12,639 65,620 Part I: HNP STATUS Indicator Wealth Quintiles Pop. Low 2nd 3rd 4th High Total Mortality rates All 7,141 6,314 5,289 4,043 3,070 25,857 Urban 517 2,160 4,344 3,872 3,028 13,920 Rural 6,624 4,154 945 171 42 11,937 Female 3,546 3,035 2,561 1,952 1,458 12,552 Male 3,595 3,279 2,728 2,090 1,612 13,304 Prevalence of fever, diarrhea, acute respiratory infection All 3,253 2,777 2,347 1,906 1,470 11,754 Urban 219 1,015 1,953 1,823 1,453 6,463 Rural 3,034 1,762 394 83 18 5,291 Female 1,621 1,321 1,189 958 693 5,782 Male 1,633 1,457 1,158 949 778 5,975 Total fertility rate All 11,433 13,837 16,341 17,519 18,873 78,004 Urban 848 4,921 13,355 16,867 18,684 54,675 Rural 10,586 8,916 2,986 652 189 23,329 Age-specific fertility rate 15-19 All 2,212 2,765 3,285 3,570 3,990 15,822 Urban 148 980 2,668 3,470 3,956 11,222 Rural 2,063 1,785 616 100 35 4,599 Children's nutritional status All 2,900 2,488 2,150 1,729 1,210 10,477 Urban 196 923 1,794 1,657 1,195 5,765 Rural 2,704 1,565 356 71 15 4,711 Female 1,440 1,196 1,093 876 561 5,166 Male 1,460 1,292 1,056 852 649 5,309 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 - 65 - Peru 2000 - SAMPLE SIZES Part I: HNP STATUS (Cont.) Indicator Wealth Quintiles Pop. Low 2nd 3rd 4th High Total Women's nutritional status All 3,607 4,521 5,352 5,683 6,156 25,320 Urban 263 1,579 4,359 5,462 6,089 17,752 Rural 3,344 2,942 993 221 67 7,567 Women's anemia status All 946 1,050 1,341 1,378 1,469 6,184 Urban 60 362 1,074 1,325 1,456 4,277 Rural 887 688 267 52 12 1,906 Girls' circumcision All na na na na na na Urban na na na na na na Rural na na na na na na Women's circumcision All na na na na na na Urban na na na na na na Rural na na na na na na Prevalence of genital discharge, ulcer, sore Female 3,486 3,975 4,461 4,439 4,344 20,705 Urban Female 263 1,439 3,661 4,270 4,295 13,928 Rural Female 3,223 2,536 800 169 48 6,776 Male na na na na na na Urban Male na na na na na na Rural Male na na na na na na - 66 - Peru 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 650 552 474 385 292 2,353 Urban 45 211 395 369 287 1,307 Rural 606 342 78 16 4 1,046 Female 349 267 234 179 134 1,163 Male 301 286 240 206 158 1,191 Treatment of fever All 1,006 784 606 389 261 3,046 Urban 70 248 510 374 261 1,463 Rural 936 537 96 15 0 1,584 Female 518 419 296 214 146 1,593 Male 488 365 310 175 115 1,453 Treatment of acute respiratory infection All 683 594 483 342 267 2,369 Urban 55 222 409 327 265 1,278 Rural 628 372 74 15 2 1,091 Female 326 253 230 165 112 1,086 Male 357 341 253 177 155 1,283 Treatment of diarrhea All 607 497 380 213 113 1,810 Urban 53 198 315 200 113 879 Rural 555 299 65 13 0 932 Female 283 202 190 117 41 833 Male 325 295 190 96 72 978 Antenatal and delivery care All 2,339 2,205 1,992 1,684 1,316 9,535 Urban 166 819 1,653 1,614 1,300 5,552 Rural 2,172 1,386 339 70 16 3,983 Contraceptive prevalence Female 2,889 3,204 3,409 3,273 2,852 15,628 Urban Female 201 1,084 2,765 3,127 2,815 9,992 Rural Female 2,688 2,121 644 146 38 5,637 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 1,062 1,466 1,856 1,842 1,654 7,880 Urban Female 93 606 1,527 1,746 1,636 5,608 Rural Female 969 861 329 95 18 2,272 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 672 973 1,307 1,222 1,025 5,199 Urban Female 48 372 1,071 1,180 1,021 3,692 Rural Female 624 601 235 42 4 1,506 Male na na na na na na Urban Male na na na na na na Rural Male na na na na na na - 67 - Peru 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 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 207 144 119 120 83 673 Urban 14 49 92 113 83 351 Rural 193 95 27 6 0 321 Female 113 80 57 55 40 345 Male 93 64 62 65 42 326 Timely complementary breastfeeding All 197 162 150 91 81 681 Urban 14 58 114 89 77 352 Rural 183 104 36 2 3 328 Female 99 85 69 38 50 341 Male 98 78 81 53 30 340 Bottle-feeding All 606 486 409 347 265 2,113 Urban 40 179 325 336 262 1,142 Rural 566 308 84 11 3 972 Female 315 256 200 156 144 1,071 Male 291 230 209 191 121 1,042 - 68 - Peru 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 5,363 5,203 5,269 5,372 5,272 26,479 Urban 354 1,780 4,267 5,194 5,218 16,813 Rural 5,009 3,423 1,002 178 54 9,666 Vitamin A supplementation All 2,950 2,552 2,164 1,726 1,332 10,724 Urban 200 935 1,806 1,651 1,314 5,906 Rural 2,750 1,618 358 75 18 4,819 Female 1,474 1,337 1,067 862 713 5,453 Male 1,476 1,215 1,097 863 619 5,270 Tobacco and alcohol use, casual sexual partners, condom use for casual sex Female 4,104 4,964 5,837 6,240 6,698 27,843 Urban Female 304 1,754 4,766 6,002 6,627 19,453 Rural Female 3,800 3,211 1,070 238 71 8,390 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 4,104 4,964 5,837 6,240 6,698 27,843 Urban 304 1,754 4,766 6,002 6,627 19,453 Rural 3,800 3,211 1,070 238 71 8,390 - 69 - Peru 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 4,706 5,575 6,524 7,020 7,628 31,453 Urban female 340 1,972 5,331 6,757 7,545 21,945 Rural female 4,366 3,603 1,193 264 83 9,509 Male 5,319 6,180 6,860 7,172 6,911 32,441 Urban male 398 2,169 5,599 6,916 6,843 21,924 Rural male 4,922 4,011 1,261 256 68 10,517 School participation Female 2,064 1,900 1,598 1,272 906 7,740 Urban female 167 607 1,315 1,228 893 4,210 Rural female 1,897 1,293 283 44 14 3,530 Male 2,077 1,942 1,752 1,281 992 8,044 Urban male 149 638 1,416 1,236 972 4,412 Rural male 1,928 1,304 335 45 20 3,633 Mass media exposure Female 4,104 4,964 5,837 6,240 6,698 27,843 Urban female 304 1,754 4,766 6,002 6,627 19,453 Rural female 3,800 3,211 1,070 238 71 8,390 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 10,801 4,964 5,837 6,240 6,698 34,540 Urban female 304 1,754 4,766 6,002 6,627 19,453 Rural female 3,800 3,211 1,070 238 71 8,390 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 4,104 4,964 5,837 6,240 6,698 27,843 Urban 304 1,754 4,766 6,002 6,627 19,453 Rural 3,800 3,211 1,070 238 71 8,390 Orphanhood All 11,463 10,406 9,145 7,459 5,748 44,221 Urban 802 3,515 7,503 7,165 5,654 24,640 Rural 10,660 6,891 1,641 294 94 19,581 Female 5,696 5,057 4,467 3,653 2,749 21,622 Male 5,767 5,349 4,678 3,806 2,999 22,599 - 70 - Peru 2000 - STANDARD ERRORS OF QUINTILE ESTIMATES FOR TOTAL POPULATION Part I: HNP STATUS Indicator Wealth Quintiles Low 2nd 3rd 4th High Avg. A. Childhood illness and mortality Infant mortality rate 2.89 3.63 2.98 3.64 3.12 1.64 Under-five mortality rate 3.88 4.22 3.54 4.06 3.68 2.05 Prevalence of fever 0.97 1.16 1.26 1.36 1.48 0.55 Prevalence of diarrhea 0.86 0.84 1.03 0.92 0.99 0.42 Prevalence of acute respiratory infection 0.86 1.05 1.29 1.32 1.52 0.52 B. Fertility Total fertility rate 0.13 0.10 0.08 0.08 0.07 0.06 Adolescent fertility rate 7.00 6.00 5.00 4.00 4.00 3.00 C. Nutritional status Children: Moderate stunting 0.90 0.93 0.90 0.77 0.90 0.49 Severe stunting 0.90 0.67 0.54 0.35 0.24 0.36 Moderate underweight 0.68 0.52 0.43 0.42 0.33 0.27 Severe underweight 0.30 0.19 0.10 0.01 0.00 0.10 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 0.16 0.16 0.11 0.22 0.27 0.10 Mild anemia 1.68 1.63 1.69 1.63 1.64 0.77 Moderate anemia 1.06 0.72 0.84 0.98 0.77 0.41 Severe anemia 0.16 0.17 0.15 0.24 0.19 0.09 D. Female circumcision Prevalence of circumcision: Girls na na na na na na Women na na na na na na Prevalence of occlusion: Girls * * * * * * Women * * * * * * E. Sexually transmitted disease Prevalence of genital discharge: Women 0.80 0.76 0.91 0.89 1.01 0.42 Men na na na na na na Prevalence of genital ulcer: Women 0.27 0.26 0.35 0.40 0.41 0.16 Men na na na na na na - 71 - Peru 2000 - STANDARD ERRORS OF QUINTILE ESTIMATES FOR TOTAL POPULATION Part II: Intermediate Determinants of HNP Status - HNP SERVICE USE Indicator Wealth Quintiles Low 2nd 3rd 4th High Avg. A. Childhood immunization BCG coverage 1.09 0.90 1.03 0.80 0.13 0.46 Measles coverage 1.57 1.92 2.54 2.34 2.69 0.97 DPT coverage 1.87 1.61 1.99 1.90 2.12 0.88 Full basic coverage 2.19 2.43 2.89 3.29 3.46 1.27 No basic coverage 0.80 0.42 0.74 0.76 0.13 0.31 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 1.69 2.45 2.87 3.21 3.79 1.21 Treatment in a public facility 1.65 2.43 2.86 3.65 4.71 1.22 Treatment in a private facility 0.43 0.52 1.39 2.09 3.90 0.62 Treatment of acute respiratory infection (ARI): Medical treatment of ARI 2.01 2.67 2.93 3.59 4.00 1.39 Treatment in a public facility 2.01 2.67 3.15 3.87 5.01 1.44 Treatment in a private facility 0.40 0.69 1.35 2.07 4.53 0.74 Treatment of diarrhea: Use of oral rehydration therapy 2.12 2.30 2.73 4.46 5.84 1.29 Medical treatment of diarrhea 1.97 2.55 3.17 3.64 6.08 1.35 Treatment in a public facility 1.99 2.52 3.06 3.79 6.70 1.36 Treatment in a private facility 0.29 0.69 1.53 2.17 5.60 0.59 C. Antenatal and delivery care Antenatal care (ANC) visits: To a medically trained person 1.34 1.36 1.58 1.65 1.63 0.76 To a doctor 0.77 1.08 1.54 1.67 1.83 0.75 To a nurse or trained midwife 1.41 1.18 0.71 0.57 0.54 0.54 Multiple visits to a medically trained person 1.43 1.21 0.98 0.84 0.90 0.65 Antenatal care content: Tetanus toxoid 1.19 1.09 1.14 1.24 2.08 0.62 Prophylactic antimalarial treatment na na na na na na Iron supplementation na na na na na na Delivery attendance: By a medically trained person 0.78 1.47 1.63 1.46 1.45 1.22 By a doctor 0.51 1.06 1.63 1.54 1.59 0.75 By a nurse or trained midwife 0.52 0.88 1.00 1.05 1.04 0.45 In a public facility 0.66 1.21 1.46 1.48 2.03 0.77 In a private facility 0.12 0.42 0.61 0.90 1.88 0.35 At home 0.73 1.14 1.16 0.78 0.62 0.60 D. Contraceptive services Contraceptive prevalence: Women 1.27 1.19 1.07 1.22 1.35 0.59 Men na na na na na na Source of contraception - public sector: Women 0.79 0.98 0.97 1.34 2.07 0.68 Men na na na na na na - 72 - Peru 2000 - STANDARD ERRORS OF QUINTILE ESTIMATES FOR TOTAL POPULATION Part II: Intermediate Determinants of HNP Status - HNP SERVICE USE (Cont.) Indicator Wealth Quintiles Low 2nd 3rd 4th High Avg. D. Contraceptive services (cont.) Source of contraception - private sector: Women 0.49 0.88 0.88 1.27 2.03 0.64 Men na na na na na na E. Treatment of adult illnesses Treatment of genital discharge, ulcer, sore: Women 2.02 1.86 1.63 1.71 2.06 0.85 Men na na na na na na Treatment of genital discharge, ulcer, sore in public facilities: Women 0.80 0.76 0.91 0.89 1.01 0.42 Men na na na na na na Voluntary counseling and testing for HIV/AIDS: Women 0.13 0.38 0.63 0.72 0.76 0.30 Men na na na na na na - 73 - Peru 2000 - STANDARD ERRORS OF QUINTILE ESTIMATES FOR TOTAL POPULATION Part III: Intermediate Determinants of HNP Status - INDIVIDUAL AND HOUSEHOLD BEHAVIOR Indicator Wealth Quintiles Low 2nd 3rd 4th High Avg. A. Hygienic practices Disposal of children's stools: Sanitary disposal 1.20 1.47 1.66 1.50 2.06 0.87 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 2.29 4.39 5.45 5.40 7.02 2.13 Timely complementary feeding 3.03 4.42 4.66 3.82 8.60 2.01 Bottle-feeding 1.30 2.18 2.90 3.64 4.22 1.29 D. Micronutrient consumption Iodized salt: Availability of iodized salt in household 0.80 0.55 0.18 0.14 0.17 0.23 Vitamin A: Children 0.63 0.55 0.59 0.75 0.90 0.29 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 0.20 0.24 0.30 0.29 0.31 0.13 Men na na na na na na Condom usage with non-regular partner: Women 1.99 4.48 3.47 5.41 4.93 2.19 Men na na na na na na G. Domestic violence Ever experienced violence 0.85 0.79 0.77 0.76 0.70 0.41 Experienced violence in past year na na na na na na - 74 - Peru 2000 - STANDARD ERRORS OF QUINTILE ESTIMATES FOR TOTAL POPULATION Part IV: UNDERLYING DETERMINANTS OF HNP STATUS Indicator Wealth Quintiles Low 2nd 3rd 4th High Avg. A. Education School completion: Women 1.32 0.92 0.49 0.39 0.27 0.41 Men 1.10 0.56 0.43 0.25 0.18 0.28 School participation: Girls 0.84 0.61 0.84 0.39 0.77 0.36 Boys 0.80 0.50 0.66 0.71 0.87 0.33 B. Exposure to mass media Newspaper readership: Women 0.29 0.78 0.84 0.96 1.09 0.69 Men na na na na na na Radio listenership: Women 1.42 1.15 0.84 0.90 0.89 0.55 Men na na na na na na Television viewership: Women 0.62 1.35 0.79 0.73 0.71 0.93 Men na na na na na na C. Knowledge and attitudes about HIV/AIDS Knowledge about sexual transmission of HIV/AIDS: Women 1.31 1.35 0.98 0.80 0.82 0.83 Men na na na na na na Knowledge about mother-to-child transmission of HIV/AIDS: Women 1.21 1.20 0.70 0.54 0.49 0.49 Men na na na na na na Attitudes toward HIV/AIDS: Women 1.08 1.04 0.99 0.89 0.93 0.56 Men na na na na na na D. Status of women Household decisionmaking: Can seek own health care 1.14 1.09 0.94 0.92 0.92 0.63 Can seek children's health care 0.62 0.47 0.38 0.50 0.50 0.23 Can make daily household purchases 1.23 0.93 0.81 0.85 1.04 0.50 Can make large household purchases 1.19 1.03 0.88 0.88 0.96 0.49 Can make meal-related decisions 0.80 0.87 0.83 0.93 0.92 0.54 Freedom of movement: Can travel to visit family/relatives 0.80 0.82 0.82 0.91 0.95 0.44 Other decisionmaking, attitudes: Can decide how to spend own money 1.83 1.38 0.88 0.90 0.84 0.52 Can decide whether to have sex 1.03 0.53 0.21 0.18 0.14 0.26 Justifies domestic violence na na na na na na E. Orphanhood Paternal orphan prevalence 0.36 0.26 0.30 0.28 0.28 0.14 Maternal orphan prevalence 0.22 0.19 0.19 0.17 0.26 0.09 Double orphan prevalence 0.04 0.08 0.07 0.09 0.09 0.03 - 75 - Peru 2000 - ASSET DISTRIBUTION AND WEIGHTS (FACTOR SCORE) Asset Variable Unweighted Wealth Quintiles Factor Low 2nd 3rd 4th High Avg. Score Mean Std. Percentage of Population Devia- tion Has electricity 0.617 0.486 4.8% 51.4% 92.5% 99.1% 100.0% 69.6% 0.08584 Has radio 0.810 0.392 61.7% 85.2% 89.9% 95.9% 98.8% 86.3% 0.04601 Has television 0.599 0.490 5.1% 58.7% 90.5% 97.6% 99.8% 70.3% 0.08447 Has refrigerator 0.269 0.443 0.0% 2.3% 24.3% 61.2% 96.8% 36.9% 0.08483 Has bicycle 0.212 0.408 8.5% 27.8% 28.6% 24.9% 31.2% 24.2% 0.02063 Has motorcycle 0.036 0.187 0.2% 1.1% 3.3% 3.4% 5.3% 2.6% 0.01684 Has car 0.078 0.267 0.4% 2.0% 4.2% 9.0% 38.4% 10.8% 0.04405 Has telephone 0.159 0.365 0.0% 0.3% 5.5% 28.6% 86.6% 24.2% 0.07352 Has computer 0.037 0.188 0.0% 0.0% 0.3% 2.4% 27.0% 5.9% 0.04053 Has a domestic worker not related to head 0.014 0.117 0.0% 0.2% 0.6% 0.9% 9.3% 2.2% 0.02113 Works on own or family's agricultural land 0.728 0.445 80.2% 84.8% 87.6% 87.2% 88.3% 85.6% 0.01781 Uses piped drinking water in residence 0.550 0.498 11.6% 49.5% 64.4% 89.6% 99.1% 62.8% 0.07379 Uses water that is piped into the building 0.040 0.196 1.8% 4.4% 7.4% 2.7% 0.2% 3.3% -0.00106 Uses a public faucet (piped) 0.078 0.268 11.1% 11.0% 7.0% 2.0% 0.1% 6.2% -0.01790 Has a well in residence 0.035 0.185 3.6% 6.6% 4.7% 1.5% 0.2% 3.3% -0.00766 Uses a traditional public well 0.046 0.209 7.2% 8.7% 3.5% 0.7% 0.0% 4.0% -0.01662 Uses river, canal or surface water for drinking 0.213 0.409 62.4% 12.0% 2.2% 0.2% 0.0% 15.4% -0.06305 Uses rain for drinking water 0.001 0.024 0.1% 0.0% 0.0% 0.0% 0.0% 0.0% -0.00291 Uses drinking water from tanker truck 0.017 0.128 0.4% 4.5% 7.7% 2.5% 0.3% 3.1% 0.00112 Uses other source of drinking water 0.021 0.144 1.7% 3.1% 3.2% 0.7% 0.1% 1.8% -0.00746 Uses a flush toilet in residence/private 0.352 0.478 0.1% 4.8% 43.0% 82.5% 97.7% 45.6% 0.09049 Uses a private latrine 0.268 0.443 33.5% 47.1% 30.8% 7.7% 1.1% 24.0% -0.03089 Uses a public latrine 0.028 0.166 2.6% 4.4% 2.8% 0.4% 0.0% 2.0% -0.00991 Uses bush,field as latrine 0.297 0.457 63.2% 39.0% 11.6% 1.4% 0.0% 23.0% -0.06543 Uses a flush toilet in residence/public 0.025 0.157 0.0% 1.1% 4.9% 6.0% 1.2% 2.6% 0.01015 Uses a flush toilet outside residence/private 0.006 0.078 0.4% 1.0% 1.4% 0.6% 0.0% 0.7% -0.00047 Uses a flush toilet outside of residence/public 0.022 0.146 0.1% 2.5% 5.2% 1.4% 0.0% 1.9% 0.00313 Uses other type of latrine 0.001 0.027 0.1% 0.1% 0.2% 0.0% 0.0% 0.1% -0.00065 Share a toilet with other households 0.075 0.264 2.7% 8.0% 12.9% 7.8% 1.2% 6.5% 0.00155 Has dirt, sand, dung as principal floor in dwelling 0.499 0.500 89.5% 85.4% 38.8% 5.0% 0.1% 43.8% -0.08338 Has wood, plank principal floor in dwelling 0.077 0.266 7.1% 5.7% 7.8% 2.8% 0.5% 4.8% -0.01160 Has cement principal floor 0.338 0.473 0.1% 8.3% 52.0% 82.1% 48.8% 38.3% 0.06843 Has parquet or polished wood floors 0.020 0.141 0.0% 0.2% 0.2% 1.3% 18.5% 4.1% 0.02846 Has tiles for main flooring material 0.034 0.181 0.0% 0.1% 0.7% 6.3% 22.3% 5.9% 0.03341 Has vinyl or asphalt strips as flooring material 0.019 0.137 0.0% 0.0% 0.1% 1.9% 9.4% 2.3% 0.02615 Has other type of flooring 0.013 0.112 3.2% 0.2% 0.4% 0.6% 0.4% 1.0% -0.01117 Uses wood as cooking fuel 0.432 0.495 87.3% 68.3% 19.6% 2.7% 0.1% 35.6% -0.08122 Uses dung, manure as cooking fuel 0.051 0.220 9.4% 8.9% 1.5% 0.0% 0.0% 4.0% -0.02218 Uses charcoal for cooking 0.015 0.120 0.4% 1.3% 1.6% 0.6% 0.1% 0.8% -0.00153 Uses kerosene as cooking fuel 0.158 0.365 0.8% 13.7% 37.0% 32.0% 9.2% 18.5% 0.02205 Uses gas as cooking fuel 0.308 0.462 0.1% 6.0% 38.2% 63.3% 87.2% 39.0% 0.07935 Uses electricity as cooking fuel 0.008 0.087 0.0% 0.0% 0.3% 0.7% 3.3% 0.8% 0.01455 Uses other cooking fuel 0.004 0.063 1.4% 0.4% 0.2% 0.0% 0.0% 0.4% -0.00716 Does not cook 0.020 0.140 0.3% 0.7% 0.9% 0.5% 0.1% 0.5% -0.00021 Has wood planks for walls 0.115 0.319 16.7% 9.8% 6.1% 0.8% 0.0% 6.7% -0.02763 Has other material for walls 0.011 0.106 2.9% 0.7% 0.2% 0.1% 0.0% 0.8% -0.01262 - 77 - Peru 2000 - ASSET DISTRIBUTION AND WEIGHTS (Cont.) (FACTOR SCORE) Asset Variable Unweighted Wealth Quintiles Factor Low 2nd 3rd 4th High Avg. Score Mean Std. Percentage of Population Devia- tion Has walls of stone with lime or cement 0.011 0.104 0.7% 0.9% 1.8% 1.1% 0.2% 1.0% -0.00162 Has walls from adobe (sun-dried brick) 0.466 0.499 71.0% 72.9% 46.2% 14.7% 0.7% 41.1% -0.05744 Has walls from bamboo with mud 0.036 0.187 4.7% 5.8% 2.8% 1.1% 0.0% 2.9% -0.00762 Has walls from stone with mud 0.015 0.122 3.3% 0.9% 0.1% 0.0% 0.0% 0.9% -0.01555 Has walls from plywood 0.007 0.084 0.5% 1.4% 3.8% 1.1% 0.0% 1.4% -0.00024 Has walls from rustic mats 0.115 0.319 16.7% 9.8% 6.1% 0.8% 0.0% 6.7% -0.02763 Has walls from bare brick, cement blocks 0.329 0.470 0.1% 4.8% 37.0% 81.0% 99.0% 44.4% 0.09092 Has wood roof 0.011 0.105 0.2% 1.0% 3.8% 4.3% 0.7% 2.0% 0.00605 Has calamine, cement fibre roof 0.407 0.491 34.5% 54.7% 49.6% 27.6% 3.1% 33.9% -0.01827 Has bamboo or rustic mat with mud for roof 0.078 0.269 1.9% 11.6% 23.0% 10.0% 1.0% 9.5% 0.00635 Has roof from palm leaf, thatch 0.124 0.329 36.0% 6.6% 0.6% 0.1% 0.0% 8.7% -0.04811 Has roof from cement 0.221 0.415 0.0% 0.4% 12.0% 54.6% 94.4% 32.3% 0.08258 Has ceramic tiles for roof 0.150 0.357 26.0% 25.2% 10.6% 2.9% 0.7% 13.1% -0.03049 Has other roofing 0.008 0.090 1.3% 0.4% 0.4% 0.4% 0.0% 0.5% -0.00978 No. of room in the household 2.821 1.599 2.0 2.7 3.0 3.6 5.0 3.3 0.06303 Number of members per sleeping room 2.685 1.843 4.5 3.4 3.0 2.4 1.6 3.0 -0.04465 - 78 - PART V. SUPPORTING TABLES, 1996 A. SAMPLE SIZES B. STANDARD ERRORS C. ASSET DISTRIBUTION AND WEIGHTS Peru 1996 - SAMPLE SIZES TOTAL SAMPLE Indicator Wealth Quintiles Pop. Low 2nd 3rd 4th High Total Number of household members All 27,296 27,108 27,064 27,298 27,371 136,137 Urban 1,917 12,439 22,799 26,329 27,193 90,678 Rural 25,379 14,669 4,265 968 178 45,458 Female 13,513 13,255 13,444 13,687 14,155 68,054 Male 13,775 13,847 13,616 13,611 13,215 68,064 Part I: HNP STATUS Indicator Wealth Quintiles Pop. Low 2nd 3rd 4th High Total Mortality rates All 8,698 7,309 6,434 4,976 3,424 30,841 Urban 675 3,676 5,506 4,792 3,388 18,036 Rural 8,024 3,634 928 184 35 12,805 Female 4,270 3,548 3,199 2,457 1,756 15,230 Male 4,428 3,761 3,234 2,519 1,668 15,611 Prevalence of fever, diarrhea, acute respiratory infection All 4,063 3,481 3,112 2,513 1,708 14,877 Urban 337 1,811 2,661 2,431 1,691 8,931 Rural 3,726 1,670 451 82 17 5,946 Female 2,027 1,679 1,552 1,271 885 7,414 Male 2,036 1,801 1,560 1,242 823 7,462 Total fertility rate All 12,623 14,076 16,480 18,236 19,571 80,986 Urban 940 7,220 14,237 17,659 19,443 59,499 Rural 11,684 6,856 2,244 577 128 21,489 Age-specific fertility rate 15-19 All 2,421 3,000 3,474 4,116 4,582 17,593 Urban 178 1,507 3,052 4,005 4,556 13,298 Rural 2,242 1,493 422 111 27 4,295 Children's nutritional status All 3,590 3,184 2,840 2,321 1,497 13,432 Urban 307 1,666 2,426 2,248 1,480 8,127 Rural 3,283 1,518 414 73 16 5,304 Female 1,785 1,535 1,419 1,197 786 6,722 Male 1,805 1,649 1,420 1,125 711 6,710 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 - Peru 1996 - SAMPLE SIZES Part I: HNP STATUS (Cont.) Indicator Wealth Quintiles Pop. Low 2nd 3rd 4th High Total Women's nutritional status All 2,224 2,187 2,082 1,813 1,299 9,605 Urban 186 1,150 1,787 1,760 1,284 6,167 Rural 2,038 1,038 295 53 15 3,439 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 na na na na na na Urban na na na na na na Rural na na na na na na Women's circumcision All na na na na na na Urban na na na na na na Rural na na na na na na Prevalence of genital discharge, ulcer, sore Female 3,790 4,071 4,519 4,512 4,362 21,254 Urban Female 287 2,111 3,900 4,365 4,327 14,990 Rural Female 3,503 1,960 618 147 34 6,262 Male 287 383 478 513 526 2,187 Urban Male 20 163 393 499 524 1,599 Rural Male 267 220 84 13 2 586 - 82 - Peru 1996 - 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 840 676 606 519 332 2,973 Urban 73 341 510 498 328 1,750 Rural 767 335 97 20 4 1,223 Female 416 310 303 249 186 1,464 Male 424 366 304 270 146 1,510 Treatment of fever All 1,387 1,023 845 596 301 4,152 Urban 105 496 714 580 296 2,191 Rural 1,282 527 131 16 5 1,961 Female 698 517 417 324 158 2,114 Male 689 507 429 272 143 2,040 Treatment of acute respiratory infection All 1,012 751 570 476 229 3,038 Urban 92 380 461 466 228 1,627 Rural 920 371 109 10 1 1,411 Female 494 362 262 236 106 1,460 Male 518 389 308 240 123 1,578 Treatment of diarrhea All 869 707 578 356 158 2,668 Urban 79 392 486 349 156 1,462 Rural 790 316 92 7 2 1,207 Female 403 345 263 162 78 1,251 Male 467 362 315 193 81 1,418 Antenatal and delivery care All 2,713 2,577 2,418 2,084 1,501 11,293 Urban 221 1,352 2,074 2,021 1,485 7,153 Rural 2,492 1,225 345 64 16 4,142 Contraceptive prevalence Female 3,223 3,375 3,653 3,519 3,115 16,885 Urban Female 239 1,707 3,131 3,393 3,084 11,554 Rural Female 2,984 1,668 523 126 30 5,331 Male 235 287 300 318 290 1,430 Urban Male 16 127 250 308 289 990 Rural Male 218 161 50 10 2 441 Contraceptive source Female 775 1,267 1,651 1,722 1,568 6,982 Urban Female 88 744 1,465 1,666 1,556 5,519 Rural Female 687 523 185 56 12 1,462 Male 235 287 300 318 290 1,430 Urban Male 16 127 250 308 289 0 Rural Male 218 161 50 10 2 0 Treatment of genital discharge, ulcer, sore Female 13 26 38 38 35 150 Urban Female 0 12 33 37 34 116 Rural Female 12 15 5 0 1 33 Male 5 5 10 8 29 57 Urban Male 0 4 10 8 28 50 Rural Male 5 1 1 0 0 7 - 83 - Peru 1996 - 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 249 212 176 138 82 857 Urban 15 106 148 129 81 479 Rural 233 106 28 10 1 378 Female 126 114 104 67 39 450 Male 122 98 72 71 43 406 Timely complementary breastfeeding All 283 236 191 121 102 933 Urban 20 111 165 118 101 515 Rural 263 125 25 2 2 417 Female 137 121 100 57 41 456 Male 145 114 90 64 61 474 Bottle-feeding All 815 710 593 435 305 2,858 Urban 62 358 509 423 301 1,653 Rural 754 351 84 12 4 1,205 Female 413 383 321 222 150 1,489 Male 403 327 272 213 155 1,370 - 84 - Peru 1996 - 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 4,512 5,018 5,927 6,553 6,941 28,951 Urban Female 346 2,562 5,121 6,342 6,895 21,266 Rural Female 4,167 2,456 806 210 45 7,684 Male 316 440 559 577 595 2,487 Urban Male 20 185 451 562 593 1,811 Rural Male 295 256 108 15 2 676 Domestic violence All na na na na na na Urban na na na na na na Rural na na na na na na - 85 - Peru 1996 - SAMPLE SIZES Part IV: UNDERLYING DETERMINANTS OF HNP STATUS Indicator Wealth Quintiles Pop. Low 2nd 3rd 4th High Total School completion (Grade 5) Female 5,188 5,716 6,685 7,474 8,088 33,151 Urban female 394 2,864 5,775 7,236 8,038 24,306 Rural female 4,794 2,853 910 238 51 8,845 Male 5,324 6,088 6,956 7,306 7,388 33,062 Urban male 360 2,876 5,859 7,060 7,343 23,498 Rural male 4,965 3,211 1,096 246 45 9,564 School participation Female 2,221 2,011 1,793 1,348 1,127 8,500 Urban female 168 982 1,526 1,299 1,110 5,084 Rural female 2,054 1,029 267 49 17 3,416 Male 2,340 2,002 1,846 1,479 1,109 8,776 Urban male 174 922 1,559 1,416 1,103 5,174 Rural male 2,166 1,080 286 64 6 3,602 Mass media exposure Female 4,512 5,018 5,927 6,553 6,941 28,951 Urban female 346 2,562 5,121 6,342 6,895 21,266 Rural female 4,167 2,456 806 210 45 7,685 Male 316 440 559 577 595 2,487 Urban male 20 185 451 562 593 1,810 Rural male 295 256 108 15 2 677 Knowledge of HIV/AIDS prevention Female 10,945 5,018 5,927 6,553 6,941 35,384 Urban female 346 2,562 5,121 6,342 6,895 21,266 Rural female 4,167 2,456 806 210 45 7,684 Male 316 440 559 577 595 2,487 Urban male 20 185 451 562 593 1,811 Rural male 295 256 108 15 2 676 Household decisionmaking and justification of violence All 4,512 5,018 5,927 6,553 6,941 28,951 Urban 346 2,562 5,121 6,342 6,895 21,266 Rural 4,167 2,456 806 210 45 7,685 Orphanhood All 13,001 11,602 10,665 8,789 6,685 50,742 Urban 970 5,571 9,054 8,434 6,623 30,652 Rural 12,030 6,031 1,611 356 62 20,091 Female 6,424 5,645 5,283 4,264 3,698 25,314 Male 6,572 5,953 5,382 4,525 2,986 25,418 - 86 - Peru 1996 - STANDARD ERRORS OF QUINTILE ESTIMATES FOR TOTAL POPULATION Part I: HNP STATUS Indicator Wealth Quintiles Low 2nd 3rd 4th High Avg. A. Childhood illness and mortality Infant mortality rate 3.65 3.35 2.98 3.47 3.04 1.80 Under-five mortality rate 4.45 3.96 3.57 3.67 3.14 2.26 Prevalence of fever 0.94 1.04 1.15 1.09 1.33 0.51 Prevalence of diarrhea 0.75 0.88 0.83 0.93 0.84 0.39 Prevalence of acute respiratory infection 0.88 0.82 0.99 1.14 1.23 0.45 B. Fertility Total fertility rate 0.15 0.12 0.10 0.08 0.07 0.07 Adolescent fertility rate 9.00 8.00 6.00 4.00 3.00 3.00 C. Nutritional status Children: Moderate stunting 0.88 0.97 0.84 0.84 0.70 0.45 Severe stunting 0.80 0.58 0.48 0.29 0.28 0.30 Moderate underweight 0.69 0.54 0.45 0.34 0.30 0.28 Severe underweight 0.26 0.18 0.12 0.06 0.21 0.09 Mild anemia 3.24 3.28 3.63 3.47 4.89 1.70 Moderate anemia 2.80 3.44 3.13 3.49 5.62 1.59 Severe anemia 1.33 0.46 0.65 0.98 0.00 0.40 Women: Malnutrition 0.23 0.20 0.38 0.33 0.38 0.14 Mild anemia 2.45 2.63 2.94 2.86 2.35 1.20 Moderate anemia 1.41 1.68 1.78 1.42 1.52 0.69 Severe anemia 0.42 0.60 0.12 0.36 0.00 0.15 D. Female circumcision Prevalence of circumcision: Girls na na na na na na Women na na na na na na 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 0.00 0.07 0.03 0.02 0.02 0.02 Men 0.43 0.33 0.25 0.47 0.71 0.23 Prevalence of genital ulcer: Women 0.00 0.03 0.00 0.01 0.00 0.01 Men 0.54 0.67 0.62 0.43 1.13 0.35 - 87 - Peru 1996 - STANDARD ERRORS OF QUINTILE ESTIMATES FOR TOTAL POPULATION Part II: Intermediate Determinants of HNP Status - HNP SERVICE USE Indicator Wealth Quintiles Low 2nd 3rd 4th High Avg. A. Childhood immunization BCG coverage 1.43 0.79 0.66 0.59 1.38 0.53 Measles coverage 1.72 1.54 1.71 1.37 2.39 0.80 DPT coverage 2.05 1.90 2.23 2.28 2.58 1.04 Full basic coverage 2.47 2.02 2.33 2.80 3.69 1.14 No basic coverage 0.98 0.29 0.14 0.29 0.09 0.30 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 1.44 1.71 2.02 2.94 4.17 0.94 Treatment in a public facility 1.43 1.76 1.96 2.90 3.45 0.93 Treatment in a private facility 0.20 0.53 0.83 1.54 3.21 0.40 Treatment of acute respiratory infection (ARI): Medical treatment of ARI 1.96 2.31 2.79 3.30 4.56 1.24 Treatment in a public facility 1.94 2.29 2.77 3.29 4.12 1.17 Treatment in a private facility 0.30 0.91 1.35 2.15 3.89 0.60 Treatment of diarrhea: Use of oral rehydration therapy 1.81 1.96 2.21 2.79 4.58 1.07 Medical treatment of diarrhea 1.94 1.99 2.25 2.82 4.87 1.13 Treatment in a public facility 1.94 2.00 2.13 2.99 4.36 1.09 Treatment in a private facility 0.09 0.72 0.79 1.50 3.34 0.37 C. Antenatal and delivery care Antenatal care (ANC) visits: To a medically trained person 1.63 1.19 1.06 1.10 0.89 0.69 To a doctor 0.69 1.17 1.40 1.63 1.66 0.72 To a nurse or trained midwife 1.35 1.25 1.34 1.46 1.60 0.67 Multiple visits to a medically trained person 1.33 1.36 1.16 1.23 0.76 0.72 Antenatal care content: Tetanus toxoid 1.28 1.17 1.05 1.31 1.72 0.65 Prophylactic antimalarial treatment na na na na na na Iron supplementation na na na na na na Delivery attendance: By a medically trained person 0.85 1.56 1.41 0.95 0.60 0.87 By a doctor 0.39 1.27 1.47 1.56 1.80 0.69 By a nurse or trained midwife 0.65 1.14 1.23 1.42 1.75 0.59 In a public facility 0.60 1.47 1.65 1.40 1.76 0.83 In a private facility 0.10 0.48 0.51 1.01 1.59 0.31 At home 0.67 1.62 1.55 1.13 0.75 0.87 D. Contraceptive services Contraceptive prevalence: Women 1.24 1.12 1.06 1.12 1.28 0.56 Men 2.58 3.34 3.73 3.50 3.57 1.61 Source of contraception - public sector: Women 1.10 1.42 1.47 1.61 1.84 0.84 Men na na na na na na - 88 - Peru 1996 - STANDARD ERRORS OF QUINTILE ESTIMATES FOR TOTAL POPULATION Part II: Intermediate Determinants of HNP Status - HNP SERVICE USE (Cont.) Indicator Wealth Quintiles Low 2nd 3rd 4th High Avg. D. Contraceptive services (cont.) Source of contraception - private sector: Women 0.99 1.39 1.41 1.58 1.82 0.83 Men na na na na na na E. Treatment of adult illnesses Treatment of genital discharge, ulcer, sore: Women * 11.05 6.25 12.30 7.57 4.21 Men * * * * * 10.65 Treatment of genital discharge, ulcer, sore in public facilities: Women 0.00 0.07 0.03 0.02 0.02 0.02 Men 0.66 0.71 0.69 0.64 1.50 0.45 Voluntary counseling and testing for HIV/AIDS: Women na na na na na na Men na na na na na na - 89 - Peru 1996 - STANDARD ERRORS OF QUINTILE ESTIMATES FOR TOTAL POPULATION Part III: Intermediate Determinants of HNP Status - INDIVIDUAL AND HOUSEHOLD BEHAVIOR Indicator Wealth Quintiles 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 2.73 3.95 5.16 5.44 7.62 2.11 Timely complementary feeding 3.28 3.19 3.28 4.83 6.17 1.73 Bottle-feeding 1.47 2.39 2.65 3.17 4.10 1.16 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 0.01 0.05 0.05 0.02 0.05 0.02 Men 1.34 1.11 1.48 1.44 1.45 0.63 Condom usage with non-regular partner: Women * * * * * * Men 4.54 8.96 5.04 8.68 8.26 3.46 G. Domestic violence Ever experienced violence na na na na na na Experienced violence in past year na na na na na na - 90 - Peru 1996 - STANDARD ERRORS OF QUINTILE ESTIMATES FOR TOTAL POPULATION Part IV: UNDERLYING DETERMINANTS OF HNP STATUS Indicator Wealth Quintiles Low 2nd 3rd 4th High Avg. A. Education School completion: Women 1.28 1.03 0.69 0.53 0.37 0.48 Men 1.20 0.75 0.50 0.35 0.31 0.37 School participation: Girls 1.04 0.96 0.93 1.10 1.01 0.48 Boys 1.00 0.92 1.07 0.98 1.19 0.49 B. Exposure to mass media Newspaper readership: Women 1.15 1.42 0.90 0.75 0.55 0.91 Men 2.93 3.13 2.49 1.47 1.26 1.00 Radio listenership: Women 1.28 0.90 0.85 0.72 0.80 0.48 Men 3.05 2.75 2.21 1.82 2.14 1.04 Television viewership: Women 1.13 1.55 0.55 0.32 0.22 0.97 Men 2.80 3.20 1.43 0.59 0.70 0.81 C. Knowledge and attitudes about HIV/AIDS Knowledge about sexual transmission of HIV/AIDS: Women 1.63 0.89 0.48 0.41 0.26 0.39 Men 2.26 1.57 0.55 0.30 0.00 0.43 Knowledge about mother-to-child transmission of HIV/AIDS: Women 1.46 1.03 0.61 0.55 0.43 0.48 Men 2.92 3.17 1.77 1.23 1.21 0.93 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 2.18 1.45 1.27 1.10 1.16 0.72 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 0.27 0.31 0.25 0.32 0.31 0.13 Maternal orphan prevalence 0.21 0.23 0.22 0.23 0.30 0.11 Double orphan prevalence 0.05 0.05 0.06 0.11 0.12 0.04 - 91 - Peru 1996 - ASSET DISTRIBUTION AND WEIGHTS (FACTOR SCORE) Asset Variable Unweighted Wealth Quintiles Factor Low 2nd 3rd 4th High Avg. Score Mean Std. Percentage of Population Devia- tion Has electricity 0.598 0.490 2.6% 43.7% 90.3% 99.1% 99.9% 67.1% 0.13066 Has radio 0.813 0.390 63.7% 82.3% 89.0% 96.2% 99.4% 86.1% 0.06572 Has television 0.580 0.493 4.3% 49.6% 86.4% 97.0% 99.8% 67.4% 0.12564 Has refrigerator 0.280 0.449 0.0% 2.3% 21.5% 56.0% 96.1% 35.2% 0.12010 Has bicycle 0.221 0.415 8.1% 21.8% 28.8% 24.7% 42.7% 25.2% 0.04477 Has motorcycle 0.042 0.200 0.2% 1.5% 3.2% 3.5% 8.5% 3.4% 0.03319 Has car 0.076 0.265 0.2% 2.0% 4.2% 8.1% 38.0% 10.5% 0.06535 Has telephone 0.135 0.341 0.0% 0.1% 1.9% 12.2% 78.9% 18.7% 0.09962 Has computer 0.020 0.141 0.0% 0.0% 0.2% 0.7% 14.5% 3.1% 0.04554 Has a domestic worker not related to head 0.016 0.126 0.0% 0.3% 0.8% 1.4% 11.0% 2.7% 0.03571 Works on own or family's agricultural land 0.203 0.402 60.4% 25.1% 6.9% 2.5% 0.9% 19.2% -0.07960 Uses piped drinking water in residence 0.507 0.500 3.6% 34.3% 57.6% 89.9% 98.0% 56.7% 0.11833 Uses a well in residence 0.038 0.191 4.2% 7.1% 5.2% 1.1% 0.2% 3.5% -0.01106 Uses river, canal or surface water for drinking 0.214 0.410 65.6% 14.5% 2.1% 0.1% 0.0% 16.5% -0.09763 Uses rain for drinking water 0.001 0.033 0.3% 0.0% 0.0% 0.0% 0.0% 0.1% -0.00406 Uses a public faucet (piped) 0.078 0.269 8.4% 14.0% 12.7% 2.5% 0.3% 7.6% -0.02099 Uses a traditional public well 0.048 0.213 7.9% 7.6% 2.4% 0.5% 0.2% 3.7% -0.02446 Uses water that is piped into the building 0.033 0.177 1.5% 3.7% 6.9% 2.0% 0.4% 2.9% -0.00307 Uses bottled water 0.028 0.165 0.5% 8.2% 8.5% 3.2% 0.9% 4.2% -0.00178 Uses other source of drinking water 0.052 0.223 8.1% 10.2% 4.5% 0.8% 0.1% 4.7% -0.02281 Uses a flush toilet in residence/private 0.325 0.469 0.0% 2.2% 28.3% 75.9% 96.5% 40.7% 0.12768 Uses bush,field as latrine 0.325 0.468 76.6% 40.4% 11.1% 0.7% 0.0% 25.8% -0.10937 Uses a private latrine 0.236 0.425 19.5% 44.6% 36.6% 10.3% 0.5% 22.2% -0.02554 Uses a public latrine 0.032 0.177 2.9% 5.8% 4.4% 0.8% 0.0% 2.8% -0.01108 Uses a flush toilet in residence/public 0.046 0.210 0.1% 2.0% 10.7% 10.5% 2.5% 5.1% 0.01927 Uses a flush toilet outside residence/private 0.005 0.070 0.1% 0.8% 1.5% 0.4% 0.0% 0.5% 0.00013 Uses a flush toilet outside of residence/public 0.014 0.116 0.3% 1.6% 4.1% 0.9% 0.2% 1.4% 0.00296 Uses other type of latrine 0.015 0.120 0.4% 2.2% 3.3% 0.6% 0.1% 1.3% -0.00056 Has dirt, sand, dung as principal floor in dwelling 0.501 0.500 92.0% 84.4% 44.3% 6.3% 0.1% 45.4% -0.12065 Has wood, plank principal floor in dwelling 0.072 0.259 3.4% 5.5% 7.8% 4.5% 2.0% 4.6% -0.00342 Has cement principal floor 0.336 0.472 0.3% 8.7% 44.5% 81.8% 52.5% 37.6% 0.09794 Has other type of flooring 0.020 0.140 4.4% 1.0% 1.1% 1.1% 0.8% 1.7% -0.01749 Has parquet or polished wood floors 0.026 0.160 0.0% 0.1% 0.5% 0.9% 21.0% 4.5% 0.04472 Has tiles for main flooring material 0.028 0.165 0.0% 0.0% 1.0% 4.4% 17.8% 4.7% 0.04024 Has vinyl or asphalt strips as flooring material 0.015 0.121 0.0% 0.0% 0.6% 0.9% 6.0% 1.5% 0.02990 Number of members per sleeping room 3.087 2.010 5.0 3.9 3.5 2.8 1.8 3.4 -0.07101 - 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 - Peru 2000 - ASSET QUESTIONNAIRE Question Score if Score if Item "Yes" "No" Score 1. In your household, is/are there? Electricity 0.06768 -0.10886 One or more radios 0.02227 -0.09503 One or more televisions 0.06918 -0.10315 One or more refrigerators 0.13994 -0.05142 One or more bicycles 0.03981 -0.01069 One or more motorcycles 0.08688 -0.00326 One or more cars 0.15196 -0.01277 One or more telephones 0.16931 -0.03193 One or more computers 0.20728 -0.00792 2. Does your household have a domestic worker notnot related to head? 0.17881 -0.00250 3. Do the members of your household work their own or family's agricultural land? 0.01089 -0.02913 4. What is the principal source of drinking water for your household? Piped water in residence 0.06681 -0.08150 Piped water in the building -0.00519 0.00022 Public faucet (piped) -0.06169 0.00520 Well in residence -0.04007 0.00147 Traditional public well -0.07592 0.00364 River, canal or surface water -0.12123 0.03279 Rainwater -0.11985 0.00007 Tanker truck 0.00863 -0.00015 Other -0.05079 0.00110 5. What is the principal source of fuel for cooking used by your household? Wood -0.09319 0.07078 Dung, manure -0.09559 0.00515 Charcoal -0.01255 0.00019 Kerosene 0.05088 -0.00955 Gas 0.11895 -0.05293 Electricity 0.16576 -0.00128 Other -0.11279 0.00045 Does not cook -0.00151 0.00003 6. What is the principal type of toilet facility used by your household?: Private flush toilet in residence 0.12270 -0.06673 Shared flush toilet in residence 0.06311 -0.00163 Private flush toilet outside residence -0.00593 0.00004 Shared flush toilet outside of residence 0.02097 -0.00047 Private latrine -0.05111 0.01867 Public latrine -0.05812 0.00169 Bush, field as latrine -0.10060 0.04256 Other -0.02409 0.00002 7. Does your household share a toilet with other households? 0.00543 -0.00044 - 103 - Peru 2000 - ASSET QUESTIONNAIRE (Cont.) Question Score if Score if Item "Yes" "No" Score 8. What is the principal material used for the floors in your household? Dirt, sand, dung -0.08354 0.08321 Cement 0.09578 -0.04889 Wood plank -0.04027 0.00334 Parquet, polished wood 0.19714 -0.00411 Tile 0.17788 -0.00628 Vinyl, asphalt strips 0.18773 -0.00364 Other -0.09849 0.00127 9. What is the principal material used for the walls of your household? Bare brick, cement blocks 0.12994 -0.06361 Stone with lime or cement -0.01535 0.00017 Adobe (sun-dried brick) -0.06151 0.05364 Bamboo with mud -0.03916 0.00148 Stone with mud -0.12519 0.00193 Wood plank -0.07659 0.00997 Plywood -0.00286 0.00002 Rustic mats -0.07659 0.00997 Other -0.11725 0.00136 10. What is the principal material used for the roof of your household? Cement 0.15526 -0.04392 Ceramic tiles -0.07258 0.01281 Wood 0.05721 -0.00064 Calamine, cement fibre -0.02203 0.01515 Bamboo, rustic mat with mud 0.02177 -0.00185 Palm leaf, thatch -0.12800 0.01808 Other -0.10827 0.00088 11. How many rooms are there in your household? # people- 2.82× -0.063 1.60 12. How many people are there for each sleeping room in your household? # people- 2.69× -0.045 1.84 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 -0.85898 Second -0.85898 -0.16560 Third -0.16560 0.72126 Fourth 0.72126 1.37943 High 1.37943 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 -