39467 SOCIO-ECONOMIC DIFFERENCES IN HEALTH, NUTRITION, AND POPULATION CAMEROON 1991, 1998, 2004 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, 2004 1 A. Total Population 3 B. Female and Male Populations 9 C. Rural and Urban Populations 13 Part II. Basic Tables, 1998 19 A. Total Population 21 B. Female and Male Populations 27 C. Rural and Urban Populations 31 Part III. Basic Tables, 1991 37 A. Total Population 39 B. Female and Male Populations 45 C. Rural and Urban Populations 49 Part IV. Technical Notes 55 A. Indicator Definitions 57 B. Data and Methods 71 C. Discussion 75 Part V. Supporting Tables, 2004 81 A. Sample Sizes 83 B. Standard Errors 89 C. Asset Distribution and Weights 95 Part VI. Supporting Tables, 1998 97 A. Sample Sizes 99 B. Standard Errors 105 C. Asset Distribution and Weights 111 Part VII. Supporting Tables, 1991 113 A. Sample Sizes 115 B. Standard Errors 121 C. Asset Distribution and Weights 127 Part VIII. Annexes 129 A. Sources of Additional Information 131 B. Use of Information from this 133 Report to Monitor the Economic Status of People Served by HNP Programs C. Countries Covered by the 139 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, two, and three, 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 four provides supplementary technical information designed to help readers understand the data presented in the three previous parts. This information deals with such issues as how the covered hnp indicators were defined and how the quintile-specific estimates were derived. · Parts five, six, and seven present supporting tables that deal with three of the technical matters covered in part four: the size of the sample for each indicator covered; the 1The average interval of approximately two years between data collection and availability means that the latest surveys covered were conducted in 2005. III standard error 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, eighth 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, 2004 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. Cameroon 2004 - 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 100.5 90.3 82.9 64.2 52.0 81.3 1.93 48.56 -0.1169 0.0358 Under-five mortality rate 188.5 161.6 150.0 116.0 88.2 147.7 2.14 100.35 -0.1297 0.0406 Prevalence of fever 19.1 24.6 24.9 27.1 24.9 23.8 0.77 5.82 0.0567 0.0125 Prevalence of diarrhea 21.1 20.7 16.3 13.3 10.6 17.0 1.99 10.50 -0.1206 0.0155 Prevalence of acute respiratory 10.7 12.1 9.7 11.0 11.7 11.0 0.91 0.99 0.0200 0.0198 infection (ARI) B. Fertility Total fertility rate 6.5 6.0 5.6 4.3 3.2 5.0 2.03 3.31 -0.1404 0.0333 Adolescent fertility rate 203.8 190.4 158.4 114.6 70.3 137.7 2.90 133.51 -0.2033 0.0495 C. Nutritional status (%) Children: Moderate stunting 21.4 21.0 21.8 15.4 9.9 18.6 2.16 11.50 -0.1189 0.0207 Severe stunting 19.6 15.1 14.8 8.0 2.5 13.0 7.77 17.07 -0.2621 0.0262 Moderate underweight 21.9 17.5 14.7 8.2 4.5 14.4 4.85 17.39 -0.2287 0.0251 Severe underweight 6.4 6.1 4.3 1.2 0.2 4.1 27.77 6.17 -0.3451 0.0488 Mild anemia 24.1 23.0 21.5 20.1 25.4 22.8 0.95 1.24 -0.0092 0.0214 Moderate anemia 43.6 43.6 43.9 38.5 30.8 41.0 1.42 12.81 -0.0600 0.0134 Severe anemia 5.6 5.6 5.1 4.6 1.8 4.8 3.13 3.80 -0.1408 0.0481 Women: Malnutrition 8.7 11.2 4.6 5.0 3.6 6.3 2.43 5.12 -0.1682 0.0325 Mild anemia 11.0 12.9 13.7 13.6 14.9 13.3 0.74 3.82 0.0488 0.0220 Moderate anemia 10.9 11.9 11.7 11.4 11.1 11.4 0.98 0.17 -0.0098 0.0230 Severe anemia 1.1 1.1 0.4 1.2 0.6 0.8 1.77 0.46 -0.0469 0.0909 D. Female circumcision (%) Prevalence of circumcision: Girls na na na na na na na na na na Women 9.3 13.8 14.5 26.4 44.3 23.3 0.21 35.05 0.3353 0.0146 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 3.8 6.9 9.7 10.0 11.2 8.6 0.34 7.36 0.1380 0.0188 Men 2.8 2.7 4.0 4.2 5.3 4.0 0.54 2.44 0.1235 0.0412 Prevalence of genital ulcer: Women 1.8 2.3 2.8 3.6 3.6 2.9 0.49 1.85 0.1016 0.0336 Men 0.6 1.5 2.6 2.6 3.2 2.3 0.19 2.59 0.1947 0.0507 - 3 - Cameroon 2004 - 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 71.1 79.6 86.7 92.8 97.4 84.3 0.73 26.29 0.0648 0.0087 Measles coverage 56.6 59.0 65.9 66.4 86.2 65.4 0.66 29.51 0.0832 0.0142 DPT coverage 55.4 62.4 60.9 75.2 86.3 66.4 0.64 30.96 0.0866 0.0143 Full basic coverage 39.4 45.5 46.9 51.7 66.3 48.6 0.59 26.90 0.1030 0.0207 No basic coverage 8.1 5.7 6.0 2.6 0.6 5.0 13.06 7.48 -0.3196 0.0928 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 32.5 34.6 41.5 45.7 52.6 41.0 0.62 20.09 0.0971 0.0180 Treatment in a public facility 26.9 26.6 33.7 26.0 33.3 29.2 0.81 6.40 0.0331 0.0235 Treatment in a private facility 5.5 8.0 7.8 19.7 19.2 11.8 0.29 13.69 0.2557 0.0426 Treatment of acute respiratory infection (ARI): Medical treatment of ARI 30.9 27.4 51.5 47.3 53.4 40.7 0.58 22.51 0.1249 0.0254 Treatment in a public facility 27.0 18.9 39.4 31.9 30.7 29.0 0.88 3.74 0.0449 0.0346 Treatment in a private facility 3.9 8.5 12.1 15.4 22.7 11.7 0.17 18.77 0.3232 0.0595 Treatment of diarrhea: Use of oral rehydration therapy 46.1 55.3 61.9 64.4 74.1 56.9 0.62 27.99 0.0878 0.0146 Medical treatment of diarrhea 17.5 17.7 22.6 32.0 26.2 21.5 0.67 8.76 0.1105 0.0332 Treatment in a public facility 13.2 14.4 19.0 21.9 13.4 15.9 0.98 0.25 0.0562 0.0371 Treatment in a private facility 4.3 3.3 3.6 10.1 12.8 5.6 0.33 8.51 0.2666 0.0770 C. Antenatal and delivery care Antenatal care visits: To a medically-trained person 65.0 75.3 89.6 95.6 97.2 83.4 0.67 32.23 0.0808 0.0036 To a doctor 3.3 7.2 14.4 22.6 40.6 16.5 0.08 37.28 0.4243 0.0185 To a nurse or trained midwife 57.2 64.2 71.6 69.6 55.6 63.6 1.03 1.57 0.0074 0.0066 Multiple visits to a medically-trained person 53.9 64.4 80.3 88.6 91.7 74.5 0.59 37.83 0.1081 0.0045 Antenatal care content: Tetanus toxoid 59.1 70.1 76.4 81.1 79.4 72.5 0.74 20.31 0.0569 0.0051 Prophylactic antimalarial treatment 32.4 47.9 64.1 73.9 82.3 58.4 0.39 49.91 0.1711 0.0062 Iron supplementation 50.2 61.5 80.9 88.0 93.5 73.4 0.54 43.32 0.1193 0.0045 Delivery attendance: By a medically-trained person 29.4 44.7 72.6 86.6 94.5 61.9 0.31 65.15 0.2252 0.0044 By a doctor 1.8 2.8 6.9 11.9 21.4 7.9 0.08 19.60 0.4566 0.0255 By a nurse or trained midwife 27.6 41.9 65.8 74.7 73.2 54.0 0.38 45.55 0.1915 0.0060 In a public facility 19.4 29.3 48.9 56.9 65.7 41.5 0.30 46.27 0.2233 0.0075 In a private facility 8.3 13.2 19.2 27.1 25.7 17.7 0.32 17.37 0.2467 0.0151 At home 71.2 56.8 30.7 14.6 7.9 39.8 8.99 63.32 -0.3414 0.0070 D. Contraceptive services Contraceptive prevalence: Women 2.4 5.1 11.5 20.2 27.2 13.1 0.09 24.76 0.3988 0.0182 Men na na na na na na na na na na - 4 - Cameroon 2004 - 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 (33.9) 38.6 28.4 24.6 25.9 27.2 1.31 59.78 -0.0540 0.0326 Men na na na na na na na na na na Source of contraception - private sector: Women (61.7) 60.5 64.1 70.4 67.7 67.2 0.91 129.45 0.0159 0.0138 Men na na na na na na na na na na E. Treatment of adult illnesses Treatment of genital discharge, ulcer, sore: Women 55.7 48.4 52.0 62.2 70.7 60.7 0.79 14.94 0.0840 0.0142 Men (45.1) (52.6) 54.3 52.6 64.2 56.6 0.70 109.31 0.0634 0.0260 Treatment of genital discharge, ulcer, sore in public facilities: Women 55.7 48.4 52.0 62.2 70.7 60.7 0.79 14.94 0.0840 0.0143 Men (45.1) (52.6) 54.3 52.6 64.2 56.6 0.70 109.31 0.0633 0.0262 Voluntary counseling and testing for HIV/AIDS: Women 5.9 9.7 16.6 28.5 38.2 21.2 0.15 32.28 0.3267 0.0108 Men 5.1 7.6 12.1 17.7 28.8 16.2 0.18 23.67 0.3215 0.0187 - 5 - Cameroon 2004 - 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 14.5 19.0 19.8 24.5 21.8 20.2 0.67 7.25 0.0966 0.0114 Treated bednet ownership na na na na na na na na na na Bednet use: By children 5.0 11.0 15.4 20.4 21.5 13.7 0.23 16.52 0.2686 0.0181 By pregnant women 5.6 12.3 12.3 19.7 14.1 12.3 0.40 8.53 0.1602 0.0467 C. Breastfeeding Exclusive breastfeeding 33.0 34.6 38.0 (25.7) (29.7) 32.7 1.11 62.69 0.0292 0.0507 Timely complementary feeding na na na na na na na na na na Bottle-feeding 1.5 3.7 11.8 20.3 36.9 13.0 0.04 35.40 0.5177 0.0577 D. Micronutrient consumption Iodized salt: Availability of iodized salt 81.0 79.7 79.4 82.5 86.0 81.8 0.94 5.07 0.0199 0.0029 in household Vitamin A: Children 32.2 36.3 36.5 42.6 50.7 38.8 0.64 18.47 0.0996 0.0093 Women 18.2 26.4 28.2 36.8 36.2 28.5 0.50 18.02 0.1429 0.0125 E. Tobacco and alcohol use Tobacco: Women 3.2 2.7 1.9 0.9 1.1 1.9 2.96 2.12 -0.3029 0.0473 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 1.1 2.8 4.0 5.1 6.6 4.1 0.17 5.52 0.2445 0.0286 Men na na na na na na na na na na Condom usage with non-regular partner: Women * (40.5) 49.8 68.5 77.5 63.6 * * * * Men na na na na na na na na na na G. Domestic violence Ever experienced violence na na na na na na na na na na Experienced violence in past year 7.4 6.3 7.4 7.8 6.7 7.2 1.11 0.73 -0.0191 0.0206 - 6 - Cameroon 2004 - 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 23.4 44.0 64.3 81.2 92.5 63.9 0.25 69.15 0.2092 0.0035 Men 44.4 57.0 74.9 86.1 94.2 75.7 0.47 49.87 0.1231 0.0030 School participation: Girls 54.1 71.1 84.1 90.8 98.1 77.4 0.55 43.98 0.1098 0.0050 Boys 73.0 84.9 92.5 97.2 96.7 88.4 0.75 23.73 0.0539 0.0027 B. Exposure to mass media Newspaper readership: Women 1.5 3.9 6.9 14.0 30.6 12.7 0.05 29.17 0.4927 0.0161 Men 10.0 14.0 18.8 28.3 48.4 27.0 0.21 38.43 0.3063 0.0131 Radio listenership: Women 12.0 27.2 40.0 59.4 78.5 46.1 0.15 66.49 0.2897 0.0051 Men 41.3 66.1 73.7 82.2 90.1 74.3 0.46 48.86 0.1095 0.0047 Television viewership: Women 2.4 7.0 19.9 50.5 81.4 35.9 0.03 78.95 0.4916 0.0055 Men 11.2 18.2 31.4 60.8 86.3 48.1 0.13 75.11 0.3550 0.0060 C. Knowledge and attitudes about HIV/AIDS Knowledge about sexual transmission of HIV/AIDS: Women 58.2 68.2 74.8 83.2 90.7 76.2 0.64 32.53 0.0884 0.0031 Men 81.2 89.0 90.0 89.3 94.4 89.6 0.86 13.16 0.0234 0.0028 Knowledge about mother-to-child transmission of HIV/AIDS: Women 47.2 57.8 71.1 82.9 90.3 71.6 0.52 43.07 0.1304 0.0034 Men 80.1 79.5 84.4 85.5 90.7 84.9 0.88 10.59 0.0271 0.0033 Attitudes toward HIV/AIDS: Women 61.2 65.9 71.6 79.5 90.0 75.1 0.68 28.72 0.0805 0.0032 Men 53.8 60.1 67.0 77.2 85.3 71.3 0.63 31.51 0.0887 0.0050 D. Status of women Household decisionmaking: Can seek own health care 12.5 15.6 19.0 25.3 30.4 21.4 0.41 17.95 0.1786 0.0112 Can seek children's health care 81.2 82.3 85.5 89.9 91.4 85.9 0.89 10.19 0.0264 0.0030 Can make daily household purchases 38.3 41.6 42.4 47.4 47.8 43.9 0.80 9.50 0.0399 0.0066 Can make large household purchases 29.2 28.7 30.0 33.3 36.3 31.8 0.81 7.06 0.0468 0.0086 Can make meal-related decisions 55.3 50.5 51.1 48.7 48.0 50.5 1.15 7.34 -0.0369 0.0058 Freedom of movement: Can travel to visit family, relatives 14.5 19.7 25.6 28.4 31.4 24.6 0.46 16.93 0.1270 0.0103 Other decisionmaking, attitudes: Can decide how to spend own money 64.9 68.4 71.5 74.6 77.2 71.7 0.84 12.30 0.0396 0.0055 Can decide whether to have sex 86.4 85.5 84.5 84.7 81.5 84.4 1.06 4.95 -0.0124 0.0026 Justifies domestic violence 57.5 63.0 61.4 55.5 44.5 55.6 1.29 12.98 -0.0524 0.0054 E. Orphanhood Paternal orphan prevalence 5.3 6.1 8.5 7.3 6.3 6.7 0.84 0.99 0.0346 0.0151 Maternal orphan prevalence 2.2 3.3 2.9 3.3 3.5 3.0 0.63 1.30 0.0552 0.0231 Double orphan prevalence 0.5 0.5 0.6 1.2 0.8 0.7 0.54 0.39 0.1534 0.0466 - 7 - Cameroon 2004 - 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 92.8 81.4 74.6 60.9 47.8 74.5 108.1 99.2 91.0 67.5 56.0 88.0 Under-five mortality rate 179.6 145.9 147.0 114.1 87.2 141.0 197.1 177.3 152.9 118.0 89.2 154.3 Prevalence of fever 19.6 23.1 24.1 28.5 22.4 23.3 18.6 26.1 25.7 25.8 27.4 24.3 Prevalence of diarrhea 19.5 19.3 15.7 11.5 11.3 15.9 22.8 22.1 17.0 15.2 10.0 18.0 Prevalence of acute respiratory 10.7 11.5 9.4 12.4 12.1 11.1 10.6 12.7 10.1 9.6 11.3 10.8 infection (ARI) B. Nutritional status Children: Moderate stunting 21.2 18.0 19.6 13.7 8.1 16.9 21.6 24.4 23.7 17.3 11.6 20.3 Severe stunting 22.2 15.4 12.7 9.4 2.6 13.7 16.9 14.8 16.6 6.5 2.4 12.3 Moderate underweight 22.1 16.7 13.1 9.0 7.7 14.7 21.8 18.3 16.1 7.4 1.6 14.2 Severe underweight 8.3 6.7 4.3 1.5 0.5 4.8 4.4 5.4 4.3 0.9 0.0 3.3 Mild anemia 22.1 20.1 20.4 19.5 22.5 20.9 26.2 26.1 22.4 20.8 28.1 24.7 Moderate anemia 43.0 41.9 41.8 37.0 28.6 39.4 44.2 45.4 45.8 40.2 32.9 42.4 Severe anemia 6.4 5.0 4.0 4.4 2.5 4.7 4.8 6.2 6.0 4.8 1.1 4.8 C. Sexually transmitted disease Prevalence of genital discharge: Women na na na na na na Men 1.1 0.7 1.3 1.3 1.3 1.1 Prevalence of genital ulcer: Women na na na na na na Men 0.8 0.7 0.4 1.6 1.1 0.9 - 9 - Cameroon 2004 - 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 72.0 79.6 89.8 93.1 97.5 85.5 70.2 79.6 84.1 92.5 97.3 83.2 Measles coverage 60.6 60.0 68.9 61.5 82.0 65.8 52.8 58.3 63.4 71.7 90.5 65.0 DPT coverage 60.5 58.8 64.9 75.9 84.8 68.0 50.5 65.2 57.4 74.6 88.0 64.9 Full basic coverage 46.2 42.7 51.2 53.3 61.0 50.3 32.9 47.8 43.2 50.0 71.9 47.1 No basic coverage 9.6 2.8 3.9 4.1 1.2 4.7 6.7 8.1 7.8 1.0 0.0 5.3 Hepatitis B coverage na na na na na na na na na na na na Yellow fever coverage na na na na na na na na na na na na B. Treatment of childhood illnesses Treatment of fever: Medical treatment of fever 33.0 37.9 38.6 45.5 48.5 40.3 32.0 31.4 44.2 46.1 55.8 41.6 Treatment in a public facility 27.4 31.3 32.0 25.3 34.7 29.8 26.4 22.2 35.2 26.8 32.3 28.6 Treatment in a private facility 5.5 6.7 6.6 20.1 13.9 10.6 5.6 9.2 9.0 19.2 23.5 13.0 Treatment of acute respiratory infection (ARI): Medical treatment of ARI 32.5 28.3 47.1 41.8 53.4 39.5 29.2 26.5 55.5 54.7 53.4 41.9 Treatment in a public facility 29.3 22.3 38.5 24.5 33.6 29.1 24.7 15.5 40.2 41.9 27.8 28.9 Treatment in a private facility 3.2 5.9 8.5 17.3 19.9 10.4 4.6 11.0 15.3 12.7 25.6 13.0 Treatment of diarrhea: Use of oral rehydration therapy 48.3 56.3 55.2 69.6 75.5 57.5 44.1 54.5 67.8 60.4 72.5 56.3 Medical treatment of diarrhea 18.6 17.3 24.1 29.3 32.6 22.3 16.5 18.1 21.2 34.1 19.2 20.7 Treatment in a public facility 13.7 14.4 19.9 20.0 21.8 16.8 12.8 14.4 18.3 23.4 4.3 15.1 Treatment in a private facility 4.9 2.8 4.3 9.3 10.8 5.5 3.7 3.7 2.9 10.7 14.9 5.6 C. Contraceptive services Contraceptive prevalence: Women 22.5 27.7 31.5 41.8 49.3 34.9 Men 14.6 17.7 26.5 40.2 38.0 27.3 Source of contraception - public sector: Women 73.0 71.1 58.2 50.1 40.5 54.9 Men na na na na na na Source of contraception - private sector: Women 7.8 18.5 32.6 42.7 55.1 36.4 Men na na na na na na D. Treatment of adult illnesses Treatment of genital discharge, ulcer, sore: Women na na na na na na Men * * * (72.0) (72.0) 62.1 Treatment of genital discharge, ulcer, sore in public facilities: Women na na na na na na Men * * * (72.0) (72.0) 62.1 Voluntary counseling and testing for HIV/AIDS: Women na na na na na na Men 0.4 1.0 2.9 6.3 13.7 5.3 - 10 - Cameroon 2004 - 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 5.0 11.0 15.4 20.4 21.5 13.7 C. Breastfeeding Exclusive breastfeeding (35.1) (35.1) (28.2) * * 31.7 (31.2) * * * * 33.9 Timely complementary feeding na na na na na na na na na na na na Bottle-feeding 0.5 6.3 11.9 19.7 38.8 13.4 2.4 0.6 11.7 21.1 35.0 12.5 D. Micronutrient consumption Vitamin A: Children 32.6 35.6 34.4 40.1 48.8 37.5 31.8 37.1 38.5 45.1 52.6 40.1 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 1.3 0.8 0.8 0.9 1.2 1.0 Men 4.7 7.3 6.1 8.1 12.7 8.0 Condom usage with non-regular partner: Women (2.4) (9.1) (16.4) (15.4) 35.6 18.2 Men (15.9) 26.3 29.5 48.8 47.6 38.4 - 11 - Cameroon 2004 - 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 36.4 57.1 73.5 84.6 93.3 72.6 Men 60.5 78.5 88.0 93.1 97.9 85.2 School participation: Girls 41.9 39.5 58.7 77.4 85.4 57.1 Boys 86.0 82.9 88.0 96.0 97.4 89.3 B. Exposure to mass media Newspaper readership: Women 6.4 20.8 38.7 53.6 71.5 42.4 Men 11.6 32.1 56.9 67.4 83.4 53.0 Radio listenership: Women 62.0 82.5 85.6 89.7 91.0 83.8 Men 78.0 91.4 92.5 94.1 90.9 89.9 Television viewership: Women 6.5 41.8 83.7 94.0 98.3 71.0 Men 10.6 49.7 86.0 95.3 98.5 71.4 C. Knowledge and attitudes about HIV/AIDS Knowledge about sexual transmission of HIV/AIDS: Women 58.2 68.2 74.8 83.2 90.7 76.2 Men 81.2 89.0 90.0 89.3 94.4 89.6 Knowledge about mother-to-child transmission of HIV/AIDS: Women 47.2 57.8 71.1 82.9 90.3 71.6 Men 80.1 79.5 84.4 85.5 90.7 84.9 Attitudes toward HIV/AIDS: Women 61.2 65.9 71.6 79.5 90.0 75.1 Men 53.8 60.1 67.0 77.2 85.3 71.3 D. Orphanhood Paternal orphan prevalence 4.7 5.7 7.6 7.5 5.7 6.2 5.8 6.4 9.5 7.0 6.8 7.1 Maternal orphan prevalence 2.0 3.0 2.7 3.8 3.0 2.9 2.4 3.7 3.0 2.8 4.0 3.2 Double orphan prevalence 0.3 0.3 0.5 1.4 0.7 0.6 0.6 0.7 0.7 1.0 1.0 0.8 - 12 - Cameroon 2004 - 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 99.4 91.8 78.5 73.0 93.3 91.1 110.4 83.1 89.3 62.0 50.0 68.2 Under-five mortality rate 190.6 165.5 141.3 130.5 123.9 168.7 169.8 143.5 162.5 112.5 86.4 119.8 Prevalence of fever 19.5 24.3 26.1 29.2 (21.2) 23.0 15.6 25.6 23.2 26.6 25.1 24.8 Prevalence of diarrhea 22.1 20.4 15.9 10.6 (11.8) 19.3 13.3 21.8 17.1 14.0 10.6 14.0 Prevalence of acute respiratory infection 11.1 11.3 9.3 8.6 (8.0) 10.6 7.1 15.6 10.4 11.6 11.8 11.5 B. Fertility Total fertility rate 6.5 6.1 5.8 5.5 3.5 6.1 6.5 5.7 5.3 4.0 3.2 4.0 Adolescent fertility rate 203.3 188.6 166.5 157.8 87.7 183.7 208.8 198.3 149.0 107.3 69.8 104.9 C. Nutritional status Children: Moderate stunting 22.0 21.5 21.4 16.7 * 21.1 16.9 19.0 22.3 15.1 10.1 15.3 Severe stunting 20.5 16.3 14.5 10.9 * 17.1 12.3 10.3 15.1 7.2 2.4 7.8 Moderate underweight 22.4 17.5 12.3 9.7 * 17.7 17.6 17.4 18.0 7.8 4.5 10.2 Severe underweight 6.7 5.9 4.3 0.9 * 5.5 3.7 6.8 4.4 1.3 0.0 2.1 Mild anemia 24.3 25.1 21.2 21.3 * 23.7 22.8 14.1 21.9 19.8 25.5 21.7 Moderate anemia 43.4 42.5 43.1 40.4 * 42.9 45.2 48.3 45.1 38.0 30.1 38.3 Severe anemia 5.8 5.6 6.7 8.0 * 6.1 4.0 5.5 2.8 3.6 1.5 2.9 Women: Malnutrition 8.6 9.7 4.7 5.6 0.0 7.6 9.2 16.9 4.4 4.9 3.7 5.3 Mild anemia 11.4 12.9 13.0 12.2 (9.4) 12.3 7.8 13.0 14.6 14.0 15.1 14.2 Moderate anemia 9.9 12.3 10.9 9.3 (13.4) 10.9 19.6 10.5 12.9 11.9 11.0 11.8 Severe anemia 1.0 0.6 0.3 0.4 0.0 0.7 1.3 2.7 0.5 1.4 0.6 1.0 D. Female circumcision Prevalence of circumcision: Girls na na na na na na na na na na na na Women 9.2 13.4 11.8 25.3 (52.6) 13.3 9.8 15.0 18.1 26.6 44.1 31.6 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 3.7 7.4 9.5 9.8 7.1 6.7 5.3 4.7 9.9 10.1 11.4 10.1 Men 2.3 2.3 3.0 1.3 7.4 2.5 6.4 4.2 5.5 5.0 5.2 5.1 Prevalence of genital ulcer: Women 1.7 2.7 2.8 2.3 1.4 2.3 2.9 0.8 2.9 3.9 3.7 3.4 Men 0.7 1.3 1.8 2.3 8.3 1.5 0.0 2.5 3.7 2.7 3.0 2.8 - 13 - Cameroon 2004 - 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 69.4 79.0 85.5 (83.0) * 77.3 * (81.7) 88.7 95.3 98.0 92.9 Measles coverage 55.3 59.2 63.0 (53.2) * 58.2 * (58.3) 70.3 69.8 87.4 74.2 DPT coverage 51.9 62.2 59.9 (68.2) * 58.3 * (63.1) 62.4 77.0 86.6 76.1 Full basic coverage 36.0 45.5 43.7 (40.3) * 41.1 * (45.8) 51.8 54.6 67.0 57.8 No basic coverage 8.8 6.3 7.1 (4.9) * 7.3 * (3.7) 4.3 2.0 0.6 2.2 Hepatitis B coverage na na na na na na na na na na na na Yellow fever coverage na na na na na na na na na na na na B. Treatment of childhood diseases Treatment of fever: Medical treatment of fever 33.3 34.2 41.5 43.0 * 36.7 (23.1) 36.3 41.6 46.5 52.4 45.9 Treatment in a public facility 27.8 26.4 33.5 26.0 * 28.6 (17.8) 27.4 34.1 26.0 33.7 29.9 Treatment in a private facility 5.6 7.7 8.0 17.0 * 8.1 (5.3) 8.9 7.5 20.4 18.6 16.0 Treatment of acute respiratory infection (ARI): Medical treatment of ARI 32.2 26.9 48.9 * * 34.5 * (29.0) 54.9 48.1 53.5 47.7 Treatment in a public facility 28.1 20.3 38.4 * * 27.9 * (14.3) 40.8 31.4 30.8 30.2 Treatment in a private facility 4.2 6.6 10.5 * * 6.5 * (14.7) 14.1 16.7 22.7 17.5 Treatment of diarrhea: Use of oral rehydration therapy 45.7 54.8 61.8 (55.2) * 52.1 * 57.6 62.0 66.1 73.7 65.1 Medical treatment of diarrhea 17.5 17.0 14.3 (25.7) * 17.1 * 20.5 34.0 33.2 26.1 29.0 Treatment in a public facility 13.3 14.4 12.6 (15.7) * 13.7 * 14.5 27.9 23.1 12.7 19.7 Treatment in a private facility 4.1 2.6 1.8 (9.9) * 3.4 * 6.0 6.1 10.1 13.4 9.3 C. Antenatal and delivery care Antenatal care visits: To a medically-trained person 63.3 73.5 88.3 93.0 (100.0) 74.5 80.7 83.1 91.4 96.2 97.0 93.8 To a doctor 3.0 7.2 13.1 16.7 (29.4) 7.9 6.0 7.2 16.1 24.1 41.2 26.5 To a nurse or trained midwife 55.8 62.4 70.6 71.2 (70.6) 62.3 70.6 72.3 72.9 69.3 54.9 65.1 Multiple visits to a medically-trained person 52.8 62.4 78.9 88.7 (94.2) 64.6 63.6 73.4 82.2 88.6 91.6 86.0 Antenatal care content: Tetanus toxoid 58.1 68.0 77.8 85.7 (83.9) 67.7 68.1 79.5 74.5 79.9 79.2 78.1 Prophylactic antimalarial treatment 32.2 48.1 63.2 70.8 (85.0) 47.3 34.0 47.2 65.3 74.7 82.1 71.4 Iron supplementation 49.4 60.2 81.0 84.2 (94.1) 62.7 57.7 67.6 80.8 89.0 93.5 85.9 Delivery attendance: By a medically-trained person 27.7 41.3 67.8 73.8 93.3 44.3 44.8 59.9 79.6 89.8 94.6 84.4 By a doctor 1.9 2.9 7.0 6.7 17.3 3.8 0.8 2.3 6.7 13.1 21.6 13.1 By a nurse or trained midwife 25.8 38.4 60.8 67.1 76.0 40.5 44.0 57.6 72.9 76.6 73.0 71.3 In a public facility 18.7 27.5 45.2 46.8 58.1 29.4 26.0 37.2 54.4 59.4 66.0 56.9 In a private facility 7.3 11.1 18.6 24.6 33.9 12.4 17.7 22.2 20.2 27.7 25.3 24.4 At home 73.2 60.5 35.3 28.4 6.4 57.4 53.5 40.2 24.0 11.2 8.0 17.4 D. Contraceptive services Contraceptive prevalence: Women 2.4 5.0 12.2 12.0 23.9 6.3 2.9 5.2 10.6 22.0 27.3 20.2 Men na na na na na na na na na na na na - 14 - Cameroon 2004 - 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 (29.6) 33.7 33.2 (32.0) * 32.4 * * 20.6 23.7 25.8 25.4 Men na na na na na na na na na na na na Source of contraception - private sector: Women (65.4) 65.2 64.0 (61.8) * 64.0 * * 64.2 71.4 68.0 68.2 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 55.1 51.1 50.1 (54.3) * 52.1 * * 54.4 63.7 71.0 65.1 Men * (49.2) (41.2) * * 45.1 * * (66.0) 52.8 67.0 60.9 Treatment of genital discharge, ulcer, sore in public facilities: Women 55.1 51.1 50.1 (54.3) * 52.1 * * 54.4 63.7 71.0 65.1 Men * (49.2) (41.2) * * 45.1 * * (66.0) 52.8 67.0 60.9 Voluntary counseling and testing for HIV/AIDS: Women 5.3 10.0 16.6 25.3 27.3 11.3 11.1 8.5 16.5 29.1 38.6 29.4 Men 5.3 6.9 11.4 14.2 34.3 9.1 4.1 10.1 13.1 18.6 28.6 21.4 - 15 - Cameroon 2004 - 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 13.3 17.5 17.2 22.3 23.4 16.6 25.2 26.3 23.3 24.9 21.7 23.5 Treated bednet ownership na na na na na na na na na na na na Bednet use: By children 4.4 11.3 12.1 14.4 15.3 8.9 10.7 9.5 20.3 21.9 21.8 19.9 By pregnant women 5.5 12.6 10.8 (18.7) * 10.1 (6.4) (11.0) 14.6 19.9 13.5 15.1 C. Breastfeeding Exclusive breastfeeding 31.6 (37.8) (41.9) * * 36.1 * * * (24.3) (29.7) 28.4 Timely complementary feeding na na na na na na na na na na na na Bottle-feeding 1.6 4.4 12.6 (20.8) * 6.4 * * 10.4 20.1 37.9 22.0 D. Micronutrient consumption Iodized salt: Availability of iodized salt 80.3 78.5 78.5 78.3 79.4 79.1 87.0 85.2 80.8 83.5 86.3 84.4 in household Vitamin A: Children 32.1 35.5 39.4 42.9 (50.9) 35.7 33.5 40.0 32.2 42.5 50.7 42.7 Women 17.8 24.5 26.4 38.1 (30.6) 23.3 21.8 35.1 30.9 36.5 36.5 34.6 E. Tobacco and alcohol use Tobacco: Women 3.3 2.6 1.9 1.2 0.0 2.5 2.8 3.2 2.0 0.8 1.1 1.3 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 1.0 2.8 3.6 3.4 6.8 2.4 2.1 2.6 4.6 5.4 6.6 5.5 Men na na na na na na na na na na na na Condom usage with non-regular partner: Women * (36.8) (38.3) * * 42.6 * * (61.1) 69.3 77.7 71.3 Men na na na na na na na na na na na na G. Domestic violence Ever experienced violence na na na na na na na na na na na na Experienced violence in past year 7.2 6.2 7.2 7.1 5.4 6.9 9.5 6.6 7.6 8.0 6.8 7.4 - 16 - Cameroon 2004 - 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 23.1 43.0 65.6 81.7 92.8 45.3 25.5 47.8 62.4 81.2 92.5 79.2 Men 42.8 56.5 76.3 85.6 94.7 61.5 55.8 59.5 72.9 86.3 94.2 86.0 School participation: Girls 51.8 69.3 84.4 90.2 (100.0) 68.0 75.0 79.1 83.6 91.0 98.0 90.0 Boys 72.3 83.6 92.6 96.6 96.9 83.2 78.1 90.3 92.3 97.3 96.7 94.7 B. Exposure to mass media Newspaper readership: Women 1.5 3.2 5.8 10.3 24.4 4.2 1.3 6.6 8.2 14.7 30.9 19.7 Men 10.3 12.7 17.4 23.4 53.5 15.5 8.1 19.0 21.0 29.6 48.2 35.6 Radio listenership: Women 11.7 27.1 40.5 55.7 82.6 27.8 15.0 27.4 39.3 60.2 78.3 61.2 Men 42.1 67.8 74.0 82.3 91.1 64.3 35.5 60.0 73.3 82.2 90.1 81.7 Television viewership: Women 2.0 6.5 15.4 40.5 66.4 10.7 6.2 9.5 25.6 52.4 81.9 56.8 Men 10.8 14.9 25.9 48.8 72.1 21.9 13.9 30.5 39.4 64.0 86.9 67.5 C. Knowledge and attitudes about HIV/AIDS Knowledge about sexual transmission of HIV/AIDS: Women 57.1 67.3 75.7 82.5 88.7 67.0 67.8 72.0 73.7 83.3 90.8 83.8 Men 82.5 90.0 90.8 90.0 91.0 88.1 72.8 85.6 88.9 89.1 94.5 90.8 Knowledge about mother-to-child transmission of HIV/AIDS: Women 45.9 55.5 69.5 81.4 88.9 57.9 58.7 67.5 73.3 83.2 90.3 82.9 Men 80.7 80.0 83.3 83.9 93.8 81.9 76.1 77.9 85.9 86.0 90.6 87.2 Attitudes toward HIV/AIDS: Women 61.0 66.2 70.0 73.3 91.2 66.3 63.3 65.0 73.8 80.7 89.9 82.1 Men 54.5 57.9 65.9 76.1 87.3 61.8 49.3 68.2 68.5 77.5 85.2 78.4 D. Status of women Household decisionmaking: Can seek own health care 12.3 14.9 15.3 15.7 20.9 14.2 14.4 18.4 23.9 27.2 30.8 27.3 Can seek children's health care 81.7 81.8 86.5 89.0 (85.2) 83.4 76.7 84.2 84.1 90.1 91.6 88.5 Can make daily household purchases 38.3 41.5 43.0 41.4 58.7 41.0 38.4 42.2 41.6 48.6 47.4 46.3 Can make large household purchases 29.6 29.2 28.0 29.4 43.6 29.3 25.5 26.6 32.6 34.1 36.0 33.9 Can make meal-related decisions 55.0 51.6 52.0 50.2 61.4 53.1 57.5 45.9 49.9 48.4 47.5 48.4 Freedom of movement: Can travel to visit family, relatives 14.4 19.6 21.6 21.4 30.2 18.5 15.5 20.3 30.9 29.8 31.5 29.6 Other decisionmaking, attitudes: Can decide how to spend own money 64.5 68.0 64.7 66.9 (72.2) 66.0 68.1 70.5 81.2 76.1 77.4 76.8 Can decide whether to have sex 86.3 84.6 85.3 87.1 81.8 85.5 87.3 89.3 83.5 84.3 81.5 83.4 Justifies domestic violence 58.2 63.7 61.0 61.6 43.7 60.5 51.0 60.1 62.0 54.3 44.5 51.5 E. Orphanhood Paternal orphan prevalence 5.3 6.5 8.8 6.5 2.9 6.5 5.2 4.0 8.1 7.5 6.4 6.8 Maternal orphan prevalence 2.1 3.3 3.0 3.1 6.4 2.8 2.8 3.5 2.6 3.4 3.4 3.2 Double orphan prevalence 0.4 0.5 0.5 0.9 1.0 0.5 1.1 0.7 0.6 1.3 0.8 0.9 - 17 - PART II. BASIC TABLES, 1998 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. Cameroon 1998 - 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 108.4 86.3 72.6 58.7 55.8 79.8 1.94 52.6 -0.1426 0.0008 Under-five mortality rate 199.2 161.7 135.7 117.4 86.8 146.3 2.29 112.4 -0.1524 0.0010 Prevalence of fever 25.0 35.5 33.0 33.4 25.1 30.1 1.00 0.1 -0.0015 0.0183 Prevalence of diarrhea 22.2 25.3 15.9 15.1 14.2 18.9 1.56 8.0 -0.1109 0.0254 Prevalence of acute respiratory 16.7 21.8 21.7 22.7 16.3 19.7 1.02 0.4 0.0001 0.0242 infection (ARI) B. Fertility Total fertility rate 5.9 5.7 5.0 4.3 3.6 4.8 1.64 2.3 -0.1040 0.0004 Adolescent fertility rate 202.0 198.0 162.0 100.0 63.0 137.0 3.21 139.0 -0.2267 0.0022 C. Nutritional status (%) Children: Moderate stunting 20.5 21.2 20.2 19.1 10.1 18.6 2.03 10.4 -0.1006 0.0274 Severe stunting 15.9 11.0 11.7 6.9 5.2 10.7 3.06 10.7 -0.2118 0.0384 Moderate underweight 25.4 19.7 15.5 13.7 7.6 17.4 3.34 17.8 -0.2108 0.0291 Severe underweight 7.2 6.1 5.0 2.9 1.5 4.8 4.80 5.7 -0.2443 0.0558 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 12.4 9.8 6.4 3.9 4.3 7.9 2.88 8.1 -0.2457 0.0489 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 0.7 0.9 0.7 1.4 1.2 1.0 0.58 0.5 0.1348 0.0798 Men 4.2 6.9 11.7 11.0 10.2 9.2 0.41 6.0 0.1097 0.0358 Prevalence of genital ulcer: Women 0.3 0.7 0.9 0.5 0.5 0.6 0.60 0.2 0.0113 0.0997 Men 1.1 1.7 3.5 3.6 4.4 3.0 0.25 3.3 0.2153 0.0627 - 21 - Cameroon 1998 - 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 58.6 59.3 82.3 90.4 92.3 74.8 0.63 33.7 0.1065 0.0118 Measles coverage 36.6 36.8 60.8 69.2 78.2 54.2 0.47 41.6 0.1702 0.0187 DPT coverage 34.0 34.5 52.1 67.8 74.4 50.5 0.46 40.4 0.1908 0.0192 Full basic coverage 23.5 24.0 37.5 45.6 56.9 35.8 0.41 33.4 0.2071 0.0279 No basic coverage 23.7 20.7 7.4 2.9 3.9 12.8 6.08 19.8 -0.3827 0.0542 Hepatitis B coverage na na na na na na na na na na Yellow fever coverage 3.7 0.6 8.6 8.3 9.9 5.9 0.37 6.2 0.2779 0.0887 B. Treatment of childhood illnesses Treatment of fever: Medical treatment of fever 12.6 14.0 16.0 30.5 32.3 20.2 0.39 19.7 0.2332 0.0477 Treatment in a public facility 9.2 9.1 11.1 17.3 22.0 13.1 0.42 12.8 0.1906 0.0623 Treatment in a private facility 2.6 4.9 4.8 13.2 10.3 6.9 0.25 7.7 0.2971 0.0836 Treatment of acute respiratory infection (ARI): Medical treatment of ARI 25.4 21.6 30.6 44.2 52.4 33.6 0.48 27.0 0.1947 0.0374 Treatment in a public facility 20.3 13.5 24.9 27.6 38.1 23.9 0.53 17.8 0.1591 0.0506 Treatment in a private facility 5.2 8.0 5.7 15.3 14.3 9.4 0.36 9.1 0.2868 0.0907 Treatment of diarrhea: Use of oral rehydration therapy 68.4 69.7 75.2 79.0 81.5 73.1 0.84 13.1 0.0412 0.0180 Medical treatment of diarrhea 23.2 20.7 39.3 37.3 31.3 28.2 0.74 8.1 0.1112 0.0434 Treatment in a public facility 17.4 12.6 21.9 33.7 17.6 19.4 0.99 0.2 0.0992 0.0563 Treatment in a private facility 5.8 8.0 16.1 3.6 13.8 8.7 0.42 8.0 0.1429 0.0905 C. Antenatal and delivery care Antenatal care visits: To a medically-trained person 60.5 69.3 87.8 92.9 95.9 79.2 0.63 35.4 0.0972 0.0064 To a doctor 6.8 8.5 20.9 23.0 33.4 17.1 0.20 26.6 0.3419 0.0275 To a nurse or trained midwife 53.7 60.8 66.9 69.9 62.5 62.0 0.86 8.8 0.0301 0.0100 Multiple visits to a medically-trained person 47.4 59.4 76.1 80.3 88.1 67.9 0.54 40.7 0.1280 0.0083 Antenatal care content: Tetanus toxoid 54.1 59.8 80.6 82.3 82.9 70.1 0.65 28.8 0.0928 0.0081 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 27.9 43.4 63.5 84.3 89.2 58.2 0.31 61.3 0.2339 0.0088 By a doctor 3.2 4.9 8.5 13.7 16.9 8.8 0.19 13.7 0.3682 0.0396 By a nurse or trained midwife 24.7 38.5 54.9 70.6 72.3 49.5 0.34 47.6 0.2102 0.0110 In a public facility 19.2 28.4 42.4 55.7 58.7 38.7 0.33 39.5 0.2287 0.0145 In a private facility 5.7 10.5 17.2 23.9 26.9 15.7 0.21 21.2 0.2980 0.0275 At home 73.7 59.8 39.1 18.9 13.5 44.3 5.46 60.2 -0.3018 0.0117 D. Contraceptive services Contraceptive prevalence: Women 1.4 2.2 6.1 10.5 16.6 7.1 0.08 15.2 0.4538 0.0361 Men 2.2 6.3 10.7 16.9 30.3 13.1 0.07 28.1 0.4267 0.0391 - 22 - Cameroon 1998 - 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 * * (57.8) 34.9 40.9 43.4 * * * * Men na na na na na na na na na na Source of contraception - private sector: Women * * (42.2) 64.4 58.6 56.1 * * * * Men na na na na na na na na na na E. Treatment of adult illnesses Treatment of genital discharge, ulcer, sore: Women * * * (77.8) 88.3 81.3 * * * * Men * * (58.8) 58.8 59.0 56.9 * * * * Treatment of genital discharge, ulcer, sore in public facilities: Women na na na na na na na na na na Men * * (96.3) 87.5 87.9 91.6 * * * * 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 - Cameroon 1998 - 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 15.6 (13.1) (18.2) (7.8) 22.9 15.8 0.68 7.3 0.0624 0.0919 Timely complementary feeding 72.5 (63.1) (76.0) 75.6 80.1 73.0 0.91 7.6 0.0392 0.0213 Bottle-feeding 8.6 16.3 16.4 27.2 29.0 18.3 0.30 20.4 0.2775 0.0435 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 6.4 6.6 9.4 7.6 8.8 7.8 0.73 2.4 0.0592 0.0259 Men 17.6 29.9 31.2 32.1 36.0 30.2 0.49 18.4 0.0943 0.0170 Condom usage with non-regular partner: Women 8.4 (5.1) 11.8 17.4 28.0 15.6 0.30 19.6 0.2792 0.0662 Men 12.6 19.0 27.8 29.9 44.7 30.5 0.28 32.1 0.2058 0.0294 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 - Cameroon 1998 - 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 24.8 38.5 54.1 74.5 82.8 56.3 0.30 58.0 0.2307 0.0058 Men 38.9 55.8 71.8 83.0 90.0 71.4 0.43 51.1 0.1369 0.0047 School participation: Girls 42.5 61.6 76.4 85.0 90.3 70.1 0.47 47.8 0.1398 0.0081 Boys 48.3 55.6 77.1 88.0 94.3 71.3 0.51 46.0 0.1424 0.0075 B. Exposure to mass media Newspaper readership: Women 1.8 3.2 7.2 15.8 34.6 13.4 0.05 32.8 0.5978 0.0210 Men 6.2 16.1 24.3 40.8 56.7 32.0 0.11 50.5 0.3409 0.0146 Radio listenership: Women 16.0 35.3 49.2 64.2 82.5 50.5 0.19 66.5 0.2702 0.0066 Men 38.4 64.4 79.3 84.9 92.1 74.8 0.42 53.7 0.1234 0.0066 Television viewership: Women 6.5 8.9 20.9 43.3 75.1 32.9 0.09 68.6 0.4794 0.0090 Men 10.7 18.9 32.7 58.8 81.4 45.1 0.13 70.7 0.3584 0.0091 C. Knowledge and attitudes about HIV/AIDS Knowledge about sexual transmission of HIV/AIDS: Women 58.3 75.8 80.5 87.3 93.2 79.2 0.63 34.9 0.0854 0.0040 Men 86.4 94.5 96.4 98.1 99.7 95.7 0.87 13.3 0.0324 0.0035 Knowledge about mother-to-child transmission of HIV/AIDS: Women 58.9 50.9 66.3 76.5 83.4 64.6 0.71 24.5 0.1381 0.0054 Men 64.2 59.9 68.0 73.1 78.5 68.1 0.82 14.3 0.0716 0.0076 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 na na na na na na na na na na Can decide whether to have sex na na na na na na na na na na Justifies domestic violence na na na na na na na na na na E. Orphanhood Paternal orphan prevalence 6.3 6.7 7.8 7.6 5.1 6.7 1.24 1.2 -0.0209 0.0203 Maternal orphan prevalence 3.0 3.7 4.2 2.0 1.9 3.0 1.58 1.1 -0.1011 0.0295 Double orphan prevalence 0.4 0.6 1.3 0.4 0.4 0.6 1.00 0.0 0.0201 0.0574 - 25 - Cameroon 1998 - 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 95.0 83.3 65.6 57.0 59.6 74.6 122.1 89.5 79.7 60.4 52.0 85.1 Under-five mortality rate 181.5 (169.6) 144.4 114.4 89.4 144.2 217.2 (154.0) 127.2 120.8 84.2 148.5 Prevalence of fever 23.7 33.4 30.5 32.1 23.4 28.4 26.3 37.9 35.2 34.8 26.8 31.9 Prevalence of diarrhea 24.1 24.8 13.3 12.4 13.3 18.3 20.4 25.8 18.2 17.9 15.1 19.6 Prevalence of acute respiratory 15.5 21.2 19.9 22.4 16.8 19.0 17.8 22.4 23.2 23.1 15.8 20.3 infection (ARI) B. Nutritional status Children: Moderate stunting 18.2 23.5 19.6 15.9 11.9 18.1 23.0 18.6 20.7 22.2 8.5 19.1 Severe stunting 13.2 10.6 6.9 6.0 5.0 9.0 18.6 11.5 16.1 7.8 5.4 12.5 Moderate underweight 25.0 19.2 9.8 11.7 6.4 15.8 25.8 20.3 20.7 15.6 8.6 18.9 Severe underweight 6.1 7.0 4.0 2.9 1.5 4.6 8.4 5.1 5.9 2.9 1.6 5.1 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 0.7 0.9 0.7 1.4 1.2 1.0 Men 4.2 6.9 11.7 11.0 10.2 9.2 Prevalence of genital ulcer: Women 0.3 0.7 0.9 0.5 0.5 0.6 Men 1.1 1.7 3.5 3.6 4.4 3.0 - 27 - Cameroon 1998 - 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 58.3 57.9 81.8 88.8 91.4 73.5 58.9 60.5 82.7 91.9 93.2 76.0 Measles coverage 40.4 36.9 56.2 68.4 71.9 52.9 32.8 36.7 64.6 69.9 83.8 55.4 DPT coverage 31.3 35.2 51.0 65.4 71.8 48.5 36.7 33.8 53.0 70.0 76.8 52.4 Full basic coverage 24.8 24.6 34.1 43.2 57.4 35.0 22.1 23.4 40.4 47.9 56.4 36.6 No basic coverage 24.8 22.8 9.1 3.0 1.6 13.7 22.6 18.6 6.0 2.8 5.9 11.9 Hepatitis B coverage na na na na na na na na na na na na Yellow fever coverage 2.6 1.2 11.1 6.9 9.2 5.7 4.9 0.0 6.5 9.6 10.5 6.1 B. Treatment of childhood illnesses Treatment of fever: Medical treatment of fever 10.3 17.4 18.5 30.5 36.1 21.4 14.8 10.8 13.9 30.6 29.1 19.0 Treatment in a public facility 6.7 12.4 10.6 16.3 23.0 13.1 11.5 5.9 11.6 18.4 21.2 13.1 Treatment in a private facility 1.8 5.0 8.0 14.2 13.1 8.0 3.3 4.8 2.4 12.2 7.9 5.9 Treatment of acute respiratory infection (ARI): Medical treatment of ARI (29.4) (24.8) (33.3) 43.1 (54.6) 35.9 (22.0) (18.2) (28.5) 45.3 (50.2) 31.4 Treatment in a public facility (26.6) (16.9) (20.4) 28.5 (35.3) 25.0 (14.6) (10.1) (28.5) 26.7 (41.0) 22.9 Treatment in a private facility (2.7) (7.9) (13.0) 14.6 (19.3) 10.9 (7.3) (8.2) 0.0 15.9 (9.2) 7.9 Treatment of diarrhea: Use of oral rehydration therapy 63.3 (67.1) * (76.0) (82.6) 71.0 (74.5) (72.4) (69.3) (81.2) (80.6) 75.0 Medical treatment of diarrhea 24.8 (22.4) * (47.9) (32.8) 30.3 (21.3) (18.9) (37.7) (29.7) (30.1) 26.3 Treatment in a public facility 23.1 (13.4) * (44.7) (19.0) 22.3 (10.6) (11.8) (23.6) (25.8) (16.4) 16.6 Treatment in a private facility 1.8 (9.0) * (3.3) (13.8) 8.0 (10.6) (7.1) (11.8) (3.9) (13.7) 9.2 C. Contraceptive services Contraceptive prevalence: Women 1.4 2.2 6.1 10.5 16.6 7.1 Men 2.2 6.3 10.7 16.9 30.3 13.1 Source of contraception - public sector: Women * * (57.8) 34.9 40.9 43.4 Men na na na na na na Source of contraception - private sector: Women * * (42.2) 64.4 58.6 56.1 Men na na na na na na D. Treatment of adult illnesses Treatment of genital discharge, ulcer, sore: Women * * * (77.8) 88.3 81.3 Men * * (58.8) 58.8 59.0 0.0 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 - Cameroon 1998 - 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 (16.8) (18.7) (21.3) * (23.8) 17.0 (14.4) * * * (21.9) 14.2 Timely complementary feeding * * * (67.8) * 68.3 (73.3) * * (85.4) (78.6) 76.8 Bottle-feeding 11.8 16.5 19.6 33.2 25.9 20.7 5.6 16.0 13.6 19.1 31.7 15.9 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 6.4 6.6 9.4 7.6 8.8 7.8 Men 17.6 29.9 31.2 32.1 36.0 30.2 Condom usage with non-regular partner: Women 8.4 (5.1) 11.8 17.4 28.0 15.6 Men 12.6 19.0 27.8 29.9 44.7 30.5 - 29 - Cameroon 1998 - 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 24.8 38.5 54.1 74.5 82.8 56.3 Men 38.9 55.8 71.8 83.0 90.0 71.4 School participation: Girls 42.5 61.6 76.4 85.0 90.3 70.1 Boys 48.3 55.6 77.1 88.0 94.3 71.3 B. Exposure to mass media Newspaper readership: Women 1.8 3.2 7.2 15.8 34.6 13.4 Men 6.2 16.1 24.3 40.8 56.7 32.0 Radio listenership: Women 16.0 35.3 49.2 64.2 82.5 50.5 Men 38.4 64.4 79.3 84.9 92.1 74.8 Television viewership: Women 6.5 8.9 20.9 43.3 75.1 32.9 Men 10.7 18.9 32.7 58.8 81.4 45.1 C. Knowledge and attitudes about HIV/AIDS Knowledge about sexual transmission of HIV/AIDS: Women 58.3 75.8 80.5 87.3 93.2 79.2 Men 86.4 94.5 96.4 98.1 99.7 95.7 Knowledge about mother-to-child transmission of HIV/AIDS: Women 58.9 50.9 66.3 76.5 83.4 64.6 Men 64.2 59.9 68.0 73.1 78.5 68.1 Attitudes toward HIV/AIDS: Women na na na na na na Men na na na na na na D. Orphanhood Paternal orphan prevalence 6.0 6.9 7.9 7.9 4.4 6.6 6.7 6.2 7.9 7.3 5.6 6.7 Maternal orphan prevalence 3.1 3.3 4.0 2.3 1.6 2.9 2.9 4.2 4.1 1.7 2.2 3.0 Double orphan prevalence 0.5 0.9 1.2 0.6 0.3 0.7 0.4 0.3 1.5 0.3 0.4 0.6 - 30 - Cameroon 1998 - 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 106.3 87.8 76.1 60.4 * 86.9 * * (58.1) 56.9 57.4 61.0 Under-five mortality rate 197.2 161.6 136.5 (120.5) * 160.1 * * (132.4) 114.2 89.7 110.7 Prevalence of fever 24.6 35.8 32.8 33.9 25.0 30.4 * (31.0) 33.5 32.9 25.2 29.3 Prevalence of diarrhea 22.4 26.0 14.3 12.6 9.4 19.7 * (12.2) 22.2 17.8 15.5 17.0 Prevalence of acute respiratory infection 16.7 22.3 20.8 22.4 10.9 19.5 * (10.7) 25.4 23.1 17.7 20.2 B. Fertility Total fertility rate 5.9 5.6 5.1 (4.7) * 5.4 * * * (4.0) 3.4 3.8 Adolescent fertility rate 202.0 198.0 164.0 (105.0) * 167.8 * * * (95.0) 62.0 85.7 C. Nutritional status Children: Moderate stunting 20.7 20.4 20.6 19.9 5.1 19.6 * * 18.7 18.1 11.6 15.6 Severe stunting 15.8 11.1 12.1 7.3 5.1 12.2 * * 10.0 6.5 5.2 6.7 Moderate underweight 25.1 19.3 17.8 15.2 3.4 19.7 * * 6.5 11.8 8.8 10.8 Severe underweight 7.1 6.4 3.7 2.6 0.0 5.3 * * 10.0 3.2 2.0 3.5 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 11.7 9.8 4.2 2.9 4.9 8.1 * * 16.5 5.0 4.1 7.1 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 0.7 1.0 0.5 1.3 1.3 0.9 0.0 0.0 1.3 1.5 1.1 1.2 Men 3.8 7.2 12.7 9.8 9.0 8.3 * * 7.1 12.0 10.5 10.6 Prevalence of genital ulcer: Women 0.4 0.6 0.7 0.5 0.0 0.5 0.0 (2.2) 1.5 0.4 0.6 0.7 Men 1.1 1.7 3.7 2.6 4.5 2.4 * * 2.2 4.5 4.4 4.1 - 31 - Cameroon 1998 - 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 58.0 57.0 80.4 90.3 * 68.6 * * (90.2) 90.5 93.1 91.8 Measles coverage 36.7 33.6 62.0 77.4 * 49.3 * * (55.6) 59.8 76.5 67.6 DPT coverage 34.0 31.8 53.3 69.4 * 44.2 * * (47.1) 66.0 76.0 67.9 Full basic coverage 23.3 20.6 38.0 51.6 * 31.2 * * (35.2) 38.8 58.0 48.6 No basic coverage 24.0 21.5 7.6 3.2 * 16.0 * * (6.5) 2.5 3.5 3.8 Hepatitis B coverage na na na na na na na na na na na na Yellow fever coverage 3.3 0.0 9.8 8.1 * 4.9 * * (3.3) 8.6 9.8 8.8 B. Treatment of childhood diseases Treatment of fever: Medical treatment of fever 12.5 13.7 14.9 27.1 * 16.9 * * (20.2) 34.3 29.2 29.1 Treatment in a public facility 8.9 8.5 11.5 13.6 * 11.3 * * (9.6) 21.6 17.9 18.1 Treatment in a private facility 2.7 5.1 3.4 13.6 * 5.4 * * (10.5) 12.8 11.3 11.0 Treatment of acute respiratory infection (ARI): Medical treatment of ARI 25.0 20.5 30.9 (33.3) * 28.0 * * (29.7) 55.7 46.9 47.7 Treatment in a public facility 19.7 12.3 27.3 (20.5) * 21.2 * * (17.0) 35.1 30.2 30.7 Treatment in a private facility 5.3 8.2 3.6 (10.3) * 6.4 * * (12.7) 20.6 16.7 16.9 Treatment of diarrhea: Use of oral rehydration therapy 68.6 70.6 (73.7) * * 71.1 * * * (83.9) 78.5 78.9 Medical treatment of diarrhea 23.5 21.2 (39.5) * * 25.7 * * * (41.6) 33.7 35.9 Treatment in a public facility 17.6 12.9 (21.1) * * 17.8 * * * (35.2) 17.7 24.1 Treatment in a private facility 5.9 8.2 (18.4) * * 7.9 * * * (6.4) 16.0 11.0 C. Antenatal and delivery care Antenatal care visits: To a medically-trained person 60.4 68.8 89.6 91.8 96.4 74.4 * (79.7) 80.0 94.3 95.8 92.0 To a doctor 6.8 8.5 19.2 24.1 35.7 13.5 * (8.1) 28.0 21.8 32.8 27.1 To a nurse or trained midwife 53.5 60.3 70.4 67.6 60.7 61.0 * (71.6) 52.0 72.4 63.0 64.9 Multiple visits to a medically-trained person 46.9 59.0 76.8 76.5 83.9 61.9 * (67.5) 73.3 84.7 89.1 84.3 Antenatal care content: Tetanus toxoid 54.0 59.6 83.2 82.4 83.9 66.6 * (63.5) 69.5 82.2 82.6 79.6 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 27.5 41.8 62.1 79.6 91.0 48.2 * (72.1) 69.3 89.5 88.7 84.9 By a doctor 3.0 4.2 7.0 13.1 14.9 6.0 * (17.5) 15.1 14.4 17.4 16.0 By a nurse or trained midwife 24.5 37.6 55.1 66.5 76.1 42.2 * (54.6) 54.2 75.1 71.3 68.9 In a public facility 19.0 26.7 43.2 54.5 61.2 32.7 * (58.1) 39.1 57.2 58.0 54.7 In a private facility 5.5 10.3 14.4 20.9 20.9 11.4 * (14.0) 29.2 27.2 28.5 27.2 At home 74.3 61.6 41.1 23.6 16.4 54.7 * (27.9) 30.7 13.7 12.7 16.8 D. Contraceptive services Contraceptive prevalence: Women 1.3 2.2 5.9 11.6 13.4 4.5 (7.4) (3.2) 7.0 9.2 17.2 13.1 Men 2.2 5.4 11.7 15.8 (43.9) 9.6 * * 6.0 17.9 26.8 21.2 - 32 - Cameroon 1998 - 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 * * * (31.4) * 51.1 * * * (40.2) 36.4 37.2 Men * * * * * 100.0 0.0 * * (100.0) 100.0 100.0 Source of contraception - private sector: Women * * * (68.6) * 48.9 * * * (57.9) 63.1 62.0 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 * * * * * 75.5 0.0 * * * 89.9 88.8 Men * * (53.7) (63.0) * 56.3 * 0.0 * 55.1 53.8 57.8 Treatment of genital discharge, ulcer, sore in public facilities: Women na na na na na na na na na na na na Men * * (95.5) (94.1) * 95.2 * 0.0 * 80.9 87.6 86.9 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 - Cameroon 1998 - 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 15.9 (14.0) (17.6) * * 14.9 * * * * 24.3 18.5 Timely complementary feeding 73.1 (61.9) (74.1) * * 70.3 * * * (80.8) 78.7 80.0 Bottle-feeding 8.8 15.3 16.3 26.2 * 14.6 * * (16.9) 28.3 32.2 28.3 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 6.5 6.6 9.4 7.3 8.8 7.4 (2.3) 7.0 9.5 7.9 8.8 8.4 Men 17.9 29.8 32.0 33.0 36.1 28.4 * * 28.0 31.3 35.9 33.2 Condom usage with non-regular partner: Women 8.5 (2.3) 8.8 (15.2) * 9.7 * * * 19.4 27.8 25.2 Men 12.7 18.6 24.7 19.2 46.7 21.9 * * 41.7 40.4 44.3 42.5 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 - Cameroon 1998 - 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 24.8 38.7 55.5 75.1 85.2 46.6 (23.3) 35.9 49.1 74.0 82.3 73.9 Men 38.9 55.6 73.3 84.4 91.4 63.6 (38.7) 58.8 66.1 81.9 89.7 83.5 School participation: Girls 42.9 61.2 78.3 85.1 93.4 64.4 * * 69.0 84.9 89.6 83.3 Boys 48.4 54.7 77.9 86.4 89.3 64.1 (46.4) (72.3) 73.7 89.7 95.4 88.0 B. Exposure to mass media Newspaper readership: Women 1.8 3.3 7.3 10.9 27.0 6.2 (2.3) (1.2) 7.0 20.7 36.1 26.7 Men 6.2 16.0 22.8 35.7 55.4 21.4 * * 30.5 45.6 57.0 49.4 Radio listenership: Women 16.1 35.8 51.7 59.9 86.8 39.6 (13.6) (26.1) 40.1 68.3 81.7 70.4 Men 38.6 64.6 79.5 85.1 88.0 67.0 * * 78.2 84.8 92.9 87.5 Television viewership: Women 6.3 8.5 18.5 38.8 69.2 18.3 (13.6) (15.3) 29.3 47.7 76.3 59.7 Men 10.1 17.2 29.7 54.3 74.7 29.0 * * 44.7 63.0 82.8 71.6 C. Knowledge and attitudes about HIV/AIDS Knowledge about sexual transmission of HIV/AIDS: Women 77.7 86.1 86.9 88.9 92.5 84.3 (77.3) 84.7 82.2 89.6 94.2 90.9 Men 86.0 94.5 96.4 98.2 100.0 93.9 * * 96.6 97.9 99.6 98.7 Knowledge about mother-to-child transmission of HIV/AIDS: Women 42.2 50.7 66.9 77.1 82.4 57.5 (47.7) 52.9 64.0 76.0 83.6 77.7 Men 53.2 60.3 69.0 73.8 71.1 63.8 * * 64.3 72.5 79.9 75.3 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 * * * * * * * * * * * * 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 6.2 6.7 8.0 6.3 3.3 6.6 9.2 7.1 7.2 9.0 5.5 6.9 Maternal orphan prevalence 3.1 3.8 4.1 2.3 2.1 3.4 0.8 2.1 4.2 1.7 1.9 2.1 Double orphan prevalence 0.4 0.6 1.2 0.2 0.0 0.6 0.0 0.7 1.7 0.7 0.5 0.7 - 35 - PART III. BASIC TABLES, 1991 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. Cameroon 1991 - 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 103.9 101.0 78.8 65.1 51.2 80.3 2.03 52.70 -0.1405 0.0011 Under-five mortality rate 200.7 171.1 142.2 120.3 81.7 144.0 2.46 119.00 -0.1594 0.0013 Prevalence of fever 17.2 24.6 19.2 25.4 24.9 22.6 0.69 7.70 0.0532 0.0188 Prevalence of diarrhea 21.9 20.6 18.4 15.0 12.8 17.6 1.71 9.10 -0.1201 0.0214 Prevalence of acute respiratory 7.7 12.3 6.2 8.2 8.4 8.7 0.92 0.70 -0.0525 0.0337 infection (ARI) B. Fertility Total fertility rate 6.2 6.8 6.1 5.3 4.8 5.8 1.29 1.40 -0.0621 0.0004 Adolescent fertility rate 208.0 207.0 184.0 150.0 101.0 164.0 2.06 107.00 -0.1387 0.0021 C. Nutritional status (%) Children: Moderate stunting 18.9 19.6 22.4 15.2 7.9 16.4 2.39 11.00 -0.1874 0.0241 Severe stunting 15.9 13.9 13.7 5.3 2.5 9.6 6.36 13.40 -0.3268 0.0350 Moderate underweight 17.3 12.6 14.5 11.0 4.3 11.3 4.02 13.00 -0.2315 0.0309 Severe underweight 7.5 4.8 4.6 1.8 2.0 3.8 3.75 5.50 -0.3012 0.0581 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 na na na na na na na na na na 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 na na na na na na na na na na Men na na na na na na na na na na Prevalence of genital ulcer: Women na na na na na na na na na na Men na na na na na na na na na na - 39 - Cameroon 1991 - 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 64.3 58.9 70.8 84.5 94.9 75.5 0.68 30.60 0.0985 0.0121 Measles coverage 46.8 43.4 46.0 61.5 77.6 56.0 0.60 30.80 0.1442 0.0188 DPT coverage 38.0 33.3 36.0 53.6 71.0 47.4 0.54 33.00 0.1780 0.0227 Full basic coverage 27.4 27.3 29.9 46.5 63.5 40.0 0.43 36.10 0.2223 0.0279 No basic coverage 30.7 35.6 24.9 15.5 4.7 21.6 6.53 26.00 -0.2919 0.0390 Hepatitis B coverage na na na na na na na na na na Yellow fever coverage 2.5 2.6 1.1 0.9 4.3 2.3 0.58 1.80 0.1611 0.1800 B. Treatment of childhood illnesses Treatment of fever: Medical treatment of fever 25.3 30.5 38.8 49.1 53.3 40.8 0.47 28.00 0.1380 0.0254 Treatment in a public facility 15.2 20.0 23.9 32.2 35.0 26.4 0.43 19.80 0.1537 0.0347 Treatment in a private facility 10.1 9.0 13.7 11.3 11.9 11.1 0.85 1.80 0.0594 0.0548 Treatment of acute respiratory infection (ARI): Medical treatment of ARI (19.2) 41.4 (48.7) 65.4 54.1 46.4 0.35 73.30 0.1475 0.0376 Treatment in a public facility (3.2) 21.9 (38.3) 25.0 33.8 24.4 0.09 37.00 0.1996 0.0587 Treatment in a private facility (16.0) 18.0 (10.4) 24.9 15.6 17.5 1.03 31.60 0.0641 0.0669 Treatment of diarrhea: Use of oral rehydration therapy 54.1 60.3 67.1 71.8 82.7 65.9 0.65 28.60 0.0905 0.0178 Medical treatment of diarrhea 15.0 17.8 22.2 21.9 25.7 20.1 0.58 10.70 0.1078 0.0564 Treatment in a public facility 12.7 13.8 16.4 16.2 17.9 15.2 0.71 5.20 0.0834 0.0652 Treatment in a private facility 2.3 4.0 4.6 3.8 7.2 4.2 0.32 4.90 0.1601 0.1209 C. Antenatal and delivery care Antenatal care visits: To a medically-trained person 50.9 69.0 77.9 91.7 98.8 78.2 0.52 47.90 0.1222 0.0060 To a doctor 4.7 6.3 11.9 19.1 33.2 15.2 0.14 28.50 0.4380 0.0307 To a nurse or trained midwife 46.2 62.7 66.0 72.6 65.6 63.0 0.70 19.40 0.0456 0.0102 Multiple visits to a medically-trained person 39.5 54.5 63.4 78.0 89.1 65.4 0.44 49.60 0.1605 0.0081 Antenatal care content: Tetanus toxoid 43.6 56.9 69.0 84.5 87.7 68.8 0.50 44.10 0.1274 0.0079 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 32.0 48.4 57.8 81.2 94.7 63.5 0.34 62.70 0.2089 0.0064 By a doctor 2.2 3.8 3.5 7.4 14.7 6.4 0.15 12.50 0.4869 0.0460 By a nurse or trained midwife 29.8 44.5 54.3 73.8 80.0 57.1 0.37 50.20 0.1779 0.0083 In a public facility 27.2 36.2 47.0 66.1 69.8 49.7 0.39 42.60 0.1919 0.0098 In a private facility 4.0 10.6 10.0 13.4 23.2 12.5 0.17 19.20 0.2949 0.0280 At home 67.5 50.2 43.0 19.8 6.3 36.6 10.71 61.20 -0.3513 0.0111 D. Contraceptive services Contraceptive prevalence: Women 0.7 1.2 2.8 4.4 12.5 4.3 0.06 11.80 0.5952 0.0573 Men na na na na na na na na na na - 40 - Cameroon 1991 - 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 * * * (24.1) 25.3 30.6 * * * * Men na na na na na na na na na na Source of contraception - private sector: Women * * * (66.4) 70.3 64.9 * * * * Men na na na na na na na na na na E. Treatment of adult illnesses Treatment of genital discharge, ulcer, sore: Women na na na na na na na na na na Men na na na na na na na na na na Treatment of genital discharge, ulcer, sore in public facilities: Women na na na na na na na na na na Men na na na na na na na na na na Voluntary counseling and testing for HIV/AIDS: Women na na na na na na na na na na Men na na na na na na na na na na - 41 - Cameroon 1991 - 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 (8.4) (5.2) (11.6) 7.8 4.1 7.3 2.05 12.50 0.0158 0.1437 Timely complementary feeding (84.3) (73.4) (82.5) (76.4) 70.0 77.4 1.20 154.30 -0.0359 0.0198 Bottle-feeding 3.2 8.5 4.7 19.8 35.6 14.3 0.09 32.40 0.5603 0.0605 D. Micronutrient consumption Iodized salt: Availability of iodized salt na na na na na na na na na na in household Vitamin A: Children na na na na na na na na na na Women na na na na na na na na na na E. Tobacco and alcohol use Tobacco: Women na na na na na na na na na na Men na na na na na na na na na na Alcohol: Women na na na na na na na na na na Men na na na na na na na na na na F. Sexual practices Non-regular sexual partnerships: Women na na na na na na na na na na Men na na na na na na na na na na Condom usage with non-regular partner: Women na na na na na na na na na na Men na na na na na na na na na na G. Domestic violence Ever experienced violence na na na na na na na na na na Experienced violence in past year na na na na na na na na na na - 42 - Cameroon 1991 - 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 13.8 24.9 38.9 57.6 81.8 45.3 0.17 68.00 0.3406 0.0073 Men 32.7 44.6 60.8 74.0 91.4 62.9 0.36 58.70 0.2018 0.0058 School participation: Girls 30.5 42.5 60.4 75.0 88.8 58.6 0.34 58.30 0.2210 0.0101 Boys 45.8 56.9 68.6 77.2 91.0 67.5 0.50 45.20 0.1415 0.0091 B. Exposure to mass media Newspaper readership: Women na na na na na na na na na na Men na na na na na na na na na na Radio listenership: Women na na na na na na na na na na Men na na na na na na na na na na Television viewership: Women 4.4 8.9 18.8 38.1 85.9 34.0 0.05 81.50 0.5355 0.0097 Men na na na na na na na na na na C. Knowledge and attitudes about HIV/AIDS Knowledge about sexual transmission of HIV/AIDS: Women na na na na na na na na na na Men na na na na na na na na na na Knowledge about mother-to-child transmission of HIV/AIDS: Women na na na na na na na na na na Men na na na na na na na na na na Attitudes toward HIV/AIDS: Women na na na na na na na na na na Men na na na na na na na na na na D. Status of women Household decisionmaking: Can seek own health care na na na na na na na na na na Can seek children's health care na na na na na na na na na na Can make daily household purchases na na na na na na na na na na Can make large household purchases na na na na na na na na na na Can make meal-related decisions na na na na na na na na na na Freedom of movement: Can travel to visit family, relatives na na na na na na na na na na Other decisionmaking, attitudes: Can decide how to spend own money na na na na na na na na na na Can decide whether to have sex na na na na na na na na na na Justifies domestic violence na na na na na na na na na na E. Orphanhood Paternal orphan prevalence 4.7 4.9 4.0 6.4 4.6 4.9 1.02 0.10 -0.0011 0.0256 Maternal orphan prevalence 2.5 1.2 3.1 2.6 1.9 2.3 1.32 0.60 -0.0274 0.0380 Double orphan prevalence 0.6 0.3 0.5 0.3 0.5 0.4 1.20 0.10 -0.0987 0.0990 - 43 - Cameroon 1991 - 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 (105.7) 98.3 74.5 54.3 36.9 74.3 (102.2) 103.9 83.1 76.0 65.3 86.4 Under-five mortality rate (218.6) (165.2) (145.0) (116.3) 70.5 143.5 (183.9) (177.4) (139.7) (124.7) 92.5 144.5 Prevalence of fever 18.5 22.5 16.4 24.2 25.3 21.6 16.1 26.7 22.2 26.7 24.6 23.5 Prevalence of diarrhea 18.6 17.8 17.8 13.3 14.0 16.2 24.8 23.4 19.0 16.6 11.6 19.0 Prevalence of acute respiratory 8.4 12.8 6.6 6.5 7.9 8.5 7.2 11.8 5.7 9.9 8.8 8.8 infection (ARI) B. Nutritional status Children: 17.9 20.3 18.8 12.9 6.1 14.8 19.9 18.9 26.1 17.3 9.7 17.9 Moderate stunting 15.9 13.8 15.0 4.3 3.1 9.8 15.8 13.9 12.3 6.2 2.0 9.4 Severe stunting 20.9 12.0 14.4 11.4 5.0 11.9 13.8 13.2 14.5 10.7 3.5 10.7 Moderate underweight 10.7 5.2 5.2 2.2 2.1 4.6 4.3 4.4 3.9 1.5 1.9 3.1 Severe underweight na na na na na na na na na na na na Mild anemia na na na na na na na na na na na na Moderate anemia na na na na na na na na na na na na Severe anemia C. Sexually transmitted disease Prevalence of genital discharge: Women na na na na na na Men na na na na na na Prevalence of genital ulcer: Women na na na na na na Men na na na na na na - 45 - Cameroon 1991 - 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 (63.1) 48.7 (70.9) 85.8 96.1 74.6 (65.3) 67.9 70.7 83.1 93.7 76.4 Measles coverage (35.0) 42.4 (44.7) 61.5 73.9 53.8 (55.4) 44.4 47.0 61.5 81.4 58.0 DPT coverage (33.9) 27.6 (33.0) 49.5 68.8 44.4 (41.1) 38.5 38.4 58.3 73.2 50.1 Full basic coverage (26.2) 25.6 (26.0) 43.3 61.9 38.6 (28.2) 28.7 33.0 50.1 65.1 41.3 No basic coverage (36.9) 43.5 (24.3) 14.2 3.9 22.9 (26.2) 28.6 25.4 16.9 5.6 20.4 Hepatitis B coverage na na na na na na na na na na na na Yellow fever coverage (2.9) 1.9 (2.4) 0.7 4.4 2.4 (2.1) 3.1 0.0 1.2 4.1 2.2 B. Treatment of childhood illnesses Treatment of fever: Medical treatment of fever (21.0) 27.3 (34.4) 42.7 49.1 36.5 (29.6) 33.2 42.1 54.8 57.6 44.7 Treatment in a public facility (15.2) 19.3 (19.3) 26.7 35.1 24.4 (15.2) 20.6 27.5 37.1 35.0 28.2 Treatment in a private facility (5.7) 6.5 (15.1) 9.3 7.6 8.6 (14.4) 11.2 12.7 13.1 16.3 13.4 Treatment of acute respiratory infection (ARI): Medical treatment of ARI * (30.4) * * (58.5) 41.8 * (53.6) * (71.0) (50.1) 50.8 Treatment in a public facility * (16.3) * * (31.7) 20.4 * (28.3) * (32.9) (35.7) 28.3 Treatment in a private facility * (11.3) * * (18.9) 14.8 * (25.4) * (29.6) (12.6) 20.1 Treatment of diarrhea: Use of oral rehydration therapy (57.0) 59.7 (65.2) (68.9) 83.6 66.4 52.2 60.8 69.0 74.1 81.6 65.5 Medical treatment of diarrhea (16.1) 14.3 (25.3) (26.7) 23.1 20.8 14.3 20.5 19.1 18.2 28.8 19.5 Treatment in a public facility (13.3) 10.2 (18.4) (18.7) 17.4 15.3 12.4 16.7 14.5 14.3 18.4 15.1 Treatment in a private facility (2.9) 4.1 (7.0) (3.7) 4.5 4.5 1.9 3.8 2.3 3.9 10.3 4.0 C. Contraceptive services Contraceptive prevalence: Women 0.7 1.2 2.8 4.4 12.5 4.3 Men na na na na na na Source of contraception - public sector: Women * * * (24.1) 25.3 30.6 Men na na na na na na Source of contraception - private sector: Women * * * (66.4) 70.3 64.9 Men na na na na na na D. Treatment of adult illnesses Treatment of genital discharge, ulcer, sore: Women na na na na na na Men na na na na na na Treatment of genital discharge, ulcer, sore in public facilities: Women na na na na na na Men na na na na na na Voluntary counseling and testing for HIV/AIDS: Women na na na na na na Men na na na na na na - 46 - Cameroon 1991 - 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 * * * (10.5) (2.4) 10.0 * * * (4.8) * 4.5 Timely complementary feeding * * (79.3) * (63.4) 75.8 * * * * * 79.2 Bottle-feeding (4.5) 9.3 3.4 23.2 38.6 16.3 (2.0) 7.9 6.2 16.6 31.5 12.2 D. Micronutrient consumption Vitamin A: Children na na na na na na na na na na na na E. Tobacco and alcohol use Tobacco: Women na na na na na na Men na na na na na na Alcohol: Women na na na na na na Men na na na na na na F. Sexual practices Non-regular sexual partnerships: Women na na na na na na Men na na na na na na Condom usage with non-regular partner: Women na na na na na na Men na na na na na na - 47 - Cameroon 1991 - 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 13.8 24.9 38.9 57.6 81.8 45.3 Men 32.7 44.6 60.8 74.0 91.4 62.9 School participation: Girls 30.5 42.5 60.4 75.0 88.8 58.6 Boys 45.8 56.9 68.6 77.2 91.0 67.5 B. Exposure to mass media Newspaper readership: Women na na na na na na Men na na na na na na Radio listenership: Women na na na na na na Men na na na na na na Television viewership: Women 4.4 8.9 18.8 38.1 85.9 34.0 Men na na na na na na C. Knowledge and attitudes about HIV/AIDS Knowledge about sexual transmission of HIV/AIDS: Women na na na na na na Men na na na na na na Knowledge about mother-to-child transmission of HIV/AIDS: Women na na na na na na Men na na na na na na Attitudes toward HIV/AIDS: Women na na na na na na Men na na na na na na D. Orphanhood Paternal orphan prevalence 3.7 4.8 3.7 6.0 4.0 4.4 5.6 5.1 4.3 6.9 5.2 5.4 Maternal orphan prevalence 2.4 1.3 2.7 2.2 1.8 2.1 2.5 1.1 3.6 3.1 2.1 2.5 Double orphan prevalence 0.4 0.6 0.4 0.1 0.5 0.4 0.9 0.0 0.5 0.5 0.4 0.5 - 48 - Cameroon 1991 - 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 103.6 95.6 78.2 (46.5) * 85.8 * * (80.4) 76.9 51.8 71.7 Under-five mortality rate 200.0 166.4 145.8 (82.8) * 158.6 * * (133.2) 143.6 79.2 120.3 Prevalence of fever 17.9 25.8 21.9 29.6 34.5 23.8 (8.4) 13.9 12.1 22.5 23.5 20.7 Prevalence of diarrhea 20.8 20.5 15.6 12.6 13.2 18.0 (36.9) 20.9 25.7 16.6 12.7 16.8 Prevalence of acute respiratory infection 8.0 12.9 6.4 8.4 9.2 9.4 (3.8) 7.4 5.5 8.1 8.3 7.7 B. Fertility Total fertility rate (6.3) (6.9) (5.9) * * 6.3 * * * (5.2) 4.7 5.2 Adolescent fertility rate (219.0) (211.0) (184.0) * * 189.4 * * * (157.0) 101.0 130.4 C. Nutritional status Children: Moderate stunting 18.1 19.0 24.7 15.7 9.2 19.3 * 24.9 15.2 14.8 7.7 12.1 Severe stunting 15.9 14.3 12.6 5.9 5.2 12.5 * 9.6 17.1 4.8 2.2 5.4 Moderate underweight 17.5 12.6 13.6 11.2 2.0 13.1 * 13.4 17.5 10.9 4.6 8.6 Severe underweight 6.9 5.0 4.4 0.6 0.0 4.3 * 3.2 5.3 2.8 2.3 3.1 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 na na na na na na na na na na na na Mild anemia na na na na na na na na na na na na Moderate anemia na na na na na na na na na na na na Severe anemia na na na na na na na na na na na na 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 na na na na na na na na na na na na Men na na na na na na na na na na na na Prevalence of genital ulcer: Women na na na na na na na na na na na na Men na na na na na na na na na na na na - 49 - Cameroon 1991 - 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 63.5 57.9 73.6 (86.0) * 68.8 * * (62.7) 83.6 95.1 85.3 Measles coverage 47.0 44.4 50.5 (67.3) * 51.0 * * (33.4) 57.9 79.0 63.2 DPT coverage 37.1 32.9 34.4 (58.5) * 39.2 * * (40.5) 50.6 73.4 59.3 Full basic coverage 26.8 26.6 32.9 (53.8) * 32.9 * * (21.4) 41.9 66.8 50.5 No basic coverage 31.3 35.8 20.5 (14.0) * 26.5 * * (37.3) 16.4 4.4 14.5 Hepatitis B coverage na na na na na na na na na na na na Yellow fever coverage 2.5 2.9 1.5 0.0 * 2.3 * * 0.0 1.5 3.9 2.3 B. Treatment of childhood diseases Treatment of fever: Medical treatment of fever 24.3 29.0 39.0 45.1 * 35.6 * * (37.8) 52.7 49.9 50.1 Treatment in a public facility 13.9 17.8 22.9 31.0 * 22.6 * * (28.7) 33.3 31.5 33.1 Treatment in a private facility 10.4 9.6 14.7 11.4 * 11.4 * * (9.1) 11.2 11.6 10.7 Treatment of acute respiratory infection (ARI): Medical treatment of ARI (19.9) 41.2 * * * 42.1 * * * (57.0) 54.8 54.5 Treatment in a public facility (3.3) 20.4 * * * 20.6 * * * (23.7) 33.9 31.7 Treatment in a private facility (16.6) 19.2 * * * 19.6 * * * (13.7) 15.4 13.6 Treatment of diarrhea: Use of oral rehydration therapy 54.0 63.0 66.7 (80.4) * 63.6 * * (67.8) 67.2 81.9 69.6 Medical treatment of diarrhea 15.4 16.7 29.3 (11.4) * 18.2 * * (10.7) 27.5 27.8 23.2 Treatment in a public facility 12.8 12.7 19.9 (7.6) * 13.3 * * (10.7) 20.8 20.6 18.3 Treatment in a private facility 2.6 4.0 7.5 (3.8) * 4.5 * * 0.0 3.8 6.5 3.7 C. Antenatal and delivery care Antenatal care visits: To a medically-trained person 49.1 67.4 79.9 89.4 (97.4) 69.3 * 81.5 72.1 93.2 98.9 92.0 To a doctor 5.0 6.3 13.4 16.0 (30.8) 9.8 * 6.2 7.8 21.0 33.5 23.6 To a nurse or trained midwife 44.1 61.1 66.5 73.3 (66.6) 59.5 * 75.4 64.3 72.2 65.5 68.5 Multiple visits to a medically-trained person 38.6 54.4 67.3 73.1 (87.2) 56.8 * 55.1 52.3 81.1 89.3 78.8 Antenatal care content: Tetanus toxoid 42.6 55.4 70.4 80.4 (85.5) 59.8 * 69.2 64.9 87.1 87.9 82.8 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 29.9 46.5 57.0 78.3 97.0 50.9 (61.7) 63.7 60.0 83.1 94.3 83.3 By a doctor 2.3 3.9 4.2 6.0 4.4 3.8 0.0 3.5 1.5 8.3 16.1 10.4 By a nurse or trained midwife 27.6 42.6 52.8 72.3 92.6 47.0 (61.7) 60.2 58.5 74.8 78.2 72.9 In a public facility 25.0 34.3 46.1 62.0 73.3 39.9 (57.7) 51.6 49.3 68.9 69.4 65.1 In a private facility 4.0 11.0 10.3 13.6 17.8 9.6 (4.1) 7.7 9.1 13.2 23.9 16.9 At home 70.1 51.5 43.6 23.5 5.9 49.0 (31.3) 39.7 41.2 17.4 6.4 17.3 D. Contraceptive services Contraceptive prevalence: Women 0.7 1.3 2.4 5.9 14.9 2.5 0.0 1.0 3.7 3.4 12.1 7.1 Men na na na na na na na na na na na na - 50 - Cameroon 1991 - 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 * * * * * (41.9) 0.0 * * * 22.0 24.0 Men na na na na na na na na na na na na Source of contraception - private sector: Women * * * * * (52.3) 0.0 * * * 74.9 72.2 Men na na na na na na na na na na na na E. Treatment of adult illnesses Treatment of genital discharge, ulcer, sore: Women na na na na na na na na na na na na Men na na na na na na na na na na na na Treatment of genital discharge, ulcer, sore in public facilities: Women na na na na na na na na na na na na Men na na na na na na na na na na na na Voluntary counseling and testing for HIV/AIDS: Women na na na na na na na na na na na na Men na na na na na na na na na na na na - 51 - Cameroon 1991 - 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 (8.5) (6.3) * * * 9.0 * * * (7.6) 4.8 4.7 Timely complementary feeding (83.9) (72.2) (80.7) * * 80.4 * * * (66.3) 65.6 72.1 Bottle-feeding 3.5 9.6 6.7 (18.2) * 8.6 * * 0.0 20.8 38.4 22.9 D. Micronutrient consumption Iodized salt: Availability of iodized salt na na na na na na na na na na na na in household Vitamin A: Children na na na na na na na na na na na na Women na na na na na na na na na na na na E. Tobacco and alcohol use Tobacco: Women na na na na na na na na na na na na Men na na na na na na na na na na na na Alcohol: Women na na na na na na na na na na na na Men na na na na na na na na na na na na F. Sexual practices Non-regular sexual partnerships: Women na na na na na na na na na na na na Men na na na na na na na na na na na na Condom usage with non-regular partner: Women na na na na na na na na na na na na Men na na na na na na na na na na na na G. Domestic violence Ever experienced violence na na na na na na na na na na na na Experienced violence in past year na na na na na na na na na na na na - 52 - Cameroon 1991 - 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 13.8 25.8 40.2 60.9 78.0 33.2 13.5 18.9 35.2 55.6 82.2 62.0 Men 32.1 44.3 63.6 85.4 95.4 52.8 38.3 47.1 54.2 68.7 90.8 75.2 School participation: Girls 29.0 43.9 64.9 83.3 (90.8) 51.8 * (31.3) 45.5 69.1 88.4 71.1 Boys 45.7 58.1 75.7 80.8 (94.5) 63.0 * (48.3) 50.7 73.9 90.4 75.3 B. Exposure to mass media Newspaper readership: 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 Radio listenership: 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 Television viewership: Women 4.2 8.8 17.8 32.6 85.4 16.7 (6.6) 9.8 21.5 41.7 85.9 57.8 Men na na na na na na na na na na na na C. Knowledge and attitudes about HIV/AIDS Knowledge about sexual transmission of HIV/AIDS: Women na na na na na na na na na na na na Men na na na na na na na na na na na na Knowledge about mother-to-child transmission of HIV/AIDS: Women na na na na na na na na na na na na Men na na na na na na na na na na na na Attitudes toward HIV/AIDS: Women na na na na na na na na na na na na Men na na na na na na na na na na na na D. Status of women Household decisionmaking: Can seek own health care na na na na na na na na na na na na Can seek children's health care na na na na na na na na na na na na Can make daily household purchases na na na na na na na na na na na na Can make large household purchases na na na na na na na na na na na na Can make meal-related decisions na na na na na na na na na na na na Freedom of movement: Can travel to visit family, relatives na na na na na na na na na na na na Other decisionmaking, attitudes: Can decide how to spend own money na na na na na na na na na na na na Can decide whether to have sex na na na na na na na na na na na na Justifies domestic violence na na na na na na na na na na na na E. Orphanhood Paternal orphan prevalence 4.6 5.0 3.7 6.9 6.3 4.9 5.7 4.9 4.8 6.0 4.3 5.0 Maternal orphan prevalence 2.7 1.1 2.6 4.1 6.3 2.6 0.0 2.4 4.4 1.4 1.2 1.8 Double orphan prevalence 0.7 0.3 0.5 0.5 1.8 0.5 0.0 0.3 0.4 0.1 0.2 0.2 - 53 - PART IV. 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.) - 57 - 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. - 58 - 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. - 59 - 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. - 60 - 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. - 61 - 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). 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). 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. - 62 - 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. - 63 - 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. - 64 - 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. - 65 - 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. - 66 - 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. Knowledge about Mother-to-Child Transmission of HIV/AIDS 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.) - 67 - 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). - 68 - 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. - 69 - 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. - 71 - 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. 77) 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. - 72 - 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.) - 73 - 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. - 75 - 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 - 76 - 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. - 77 - 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.) - 78 - 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 - 79 - 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. - 80 - PART V. SUPPORTING TABLES, 2004 A. SAMPLE SIZES B. STANDARD ERRORS C. ASSET DISTRIBUTION AND WEIGHTS Cameroon 2004 - SAMPLE SIZES TOTAL SAMPLE Indicator Wealth Quintiles Pop. Low 2nd 3rd 4th High Total Number of household members All 9,869 9,956 10,125 10,009 9,881 49,840 Urban 1,064 1,768 3,930 8,005 9,474 24,241 Rural 8,804 8,188 6,195 2,004 407 25,598 Female 5,143 5,185 5,224 4,998 4,847 25,398 Male 4,725 4,767 4,896 5,009 5,033 24,430 Part I: HNP STATUS Indicator Wealth Quintiles Pop. Low 2nd 3rd 4th High Total Mortality rates All 4,190 3,146 3,141 2,781 2,280 15,539 Urban 426 560 1,293 2,228 2,175 6,683 Rural 3,764 2,586 1,848 552 105 8,855 Female 2,069 1,584 1,545 1,402 1,128 7,729 Male 2,120 1,562 1,596 1,379 1,152 7,810 Prevalence of fever, diarrhea, acute respiratory infection All 1,814 1,471 1,493 1,346 1,152 7,275 Urban 183 274 604 1,085 1,102 3,249 Rural 1,630 1,196 889 260 50 4,025 Female 914 759 731 686 569 3,658 Male 900 712 762 660 583 3,617 Total fertility rate All 2,011 1,758 2,046 2,298 2,586 10,699 Urban 205 343 898 1,922 2,495 5,862 Rural 1,806 1,416 1,148 376 92 4,837 Age-specific fertility rate 15-19 All 378 454 541 619 697 2,688 Urban 45 90 247 531 678 1,592 Rural 332 364 294 88 19 1,097 Children's nutritional status All 800 681 647 563 480 3,172 Urban 85 133 270 441 459 1,388 Rural 715 548 377 122 21 1,784 Female 404 360 304 294 232 1,593 Male 397 321 343 270 248 1,578 Children's anemia status All 752 635 606 503 421 2,917 Urban 79 121 248 385 401 1,234 Rural 673 514 358 118 20 1,683 Female 371 328 286 261 204 1,450 Male 381 307 320 242 217 1,466 - 83 - Cameroon 2004 - SAMPLE SIZES Part I: HNP STATUS (Cont.) Indicator Wealth Quintiles Pop. Low 2nd 3rd 4th High Total Women's nutritional status All 949 891 991 1,085 1,247 5,163 Urban 103 188 428 883 1,203 2,804 Rural 847 703 563 202 44 2,359 Women's anemia status All 942 896 985 1,069 1,214 5,105 Urban 97 187 419 864 1,170 2,737 Rural 846 709 566 204 43 2,367 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 964 918 1,023 1,149 1,328 5,382 Urban 103 194 440 936 1,284 2,956 Rural 862 724 583 212 44 2,425 Prevalence of genital discharge, ulcer, sore Female 1,989 1,749 2,042 2,290 2,583 10,653 Urban Female 201 340 897 1,917 2,492 5,846 Rural Female 1,788 1,409 1,145 373 91 4,806 Male 751 905 1,003 1,218 1,462 5,340 Urban Male 101 194 406 962 1,404 3,067 Rural Male 650 711 597 256 59 2,273 - 84 - Cameroon 2004 - 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 181 164 177 150 114 786 Urban 20 35 71 119 111 355 Rural 161 129 107 30 3 431 Female 89 72 83 77 58 379 Male 92 92 94 73 56 407 Treatment of fever All 347 361 373 366 287 1,733 Urban 29 70 140 290 276 805 Rural 318 291 233 76 11 928 Female 179 175 177 195 127 853 Male 167 186 196 171 160 880 Treatment of acute respiratory infection All 194 178 145 148 134 799 Urban 13 43 63 125 130 375 Rural 181 135 82 22 4 425 Female 98 88 69 85 69 408 Male 96 91 77 63 66 392 Treatment of diarrhea All 368 291 231 169 117 1,176 Urban 183 58 97 142 111 433 Rural 344 233 134 26 6 743 Female 171 138 109 74 61 553 Male 198 153 123 95 56 623 Antenatal and delivery care All 1,263 1,037 1,086 1,030 921 5,337 Urban 122 193 453 829 877 2,476 Rural 1,140 844 632 201 44 2,861 Contraceptive prevalence Female 1,643 1,321 1,363 1,441 1,426 7,194 Urban Female 157 245 566 1,178 1,371 3,518 Rural Female 1,486 1,075 797 262 55 3,676 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 40 67 157 291 388 942 Urban Female 5 13 60 259 375 711 Rural Female 35 54 97 32 13 232 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 94 135 234 283 369 1,116 Urban Female 15 17 104 238 362 736 Rural Female 79 118 129 45 8 379 Male 28 44 65 100 139 376 Urban Male 10 14 35 87 128 274 Rural Male 18 30 31 13 10 102 - 85 - Cameroon 2004 - 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 1,707 2,257 2,059 2,254 2,182 10,459 Urban 170 393 862 1,863 2,087 5,374 Rural 1,537 1,864 1,197 391 96 5,085 Bednet use by children All 2,063 1,649 1,676 1,501 1,243 8,132 Urban 201 301 684 1,203 1,185 3,575 Rural 1,862 1,348 992 297 57 4,557 Bednet use by pregnant women All 260 256 197 192 179 1,084 Urban 30 37 80 155 170 472 Rural 30 37 80 155 170 472 Exclusive breastfeeding All 57 56 54 41 38 246 Urban 6 9 22 33 38 109 Rural 51 47 32 8 na 137 Female 26 31 29 21 22 130 Male 31 24 25 20 16 117 Timely complementary breastfeeding 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 Bottle-feeding All 197 169 165 135 127 793 Urban 21 25 64 103 122 335 Rural 177 144 100 32 5 458 Female 99 92 82 77 61 413 Male 98 76 83 58 66 381 - 86 - Cameroon 2004 - 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 1,600 2,017 1,829 1,919 1,992 9,357 Urban 157 358 760 1,562 1,905 4,743 Rural 1,442 1,659 1,069 357 87 4,614 Vitamin A supplementation All 1,690 1,410 1,429 1,267 1,101 6,896 Urban 162 258 574 1,019 1,054 3,067 Rural 162 258 574 1,019 1,054 3,067 Female 829 677 729 625 556 3,417 Male 829 677 729 625 556 3,417 Tobacco and alcohol use, casual sexual partners, condom use for casual sex Female 2,007 1,753 2,038 2,282 2,582 10,663 Urban Female 205 341 894 1,910 2,490 5,840 Rural Female 1,802 1,412 1,144 372 92 4,822 Male na na na na na na Urban Male na na na na na na Rural Male na na na na na na Domestic violence All na na na na na na Urban na na na na na na Rural na na na na na na - 87 - Cameroon 2004 - SAMPLE SIZES Part IV: UNDERLYING DETERMINANTS OF HNP STATUS Indicator Wealth Quintiles Pop. Low 2nd 3rd 4th High Total School completion (Grade 5) Female 2,184 2,037 2,314 2,608 2,919 12,062 Urban female 224 401 1,002 2,185 2,814 6,627 Rural female 1,959 1,636 1,312 423 105 5,435 Male 1,586 1,851 2,075 2,681 3,144 11,337 Urban male na na na na na na Rural male na na na na na na School participation Female 921 832 784 716 581 3,833 Urban female 90 155 287 553 553 1,638 Rural female 831 677 496 163 28 2,195 Male 1,483 1,449 1,483 1,376 1,193 6,983 Urban male na na na na na na Rural male na na na na na na Mass media exposure Female 2,009 1,758 2,040 2,291 2,574 10,671 Urban female 205 343 895 1,915 2,482 5,839 Rural female 1,804 1,416 1,145 375 92 4,831 Male 752 906 1,002 1,219 1,458 5,338 Urban male 101 194 405 963 1,400 3,063 Rural male 651 712 597 256 59 2,275 Knowledge of HIV/AIDS prevention Female 2,011 1,758 2,046 2,298 2,586 10,699 Urban female 205 343 898 1,922 2,495 5,862 Rural female 1,806 1,416 1,148 376 92 4,837 Male 751 901 999 1,204 1,425 5,280 Urban male 101 194 404 956 1,372 3,028 Rural male 649 707 595 248 53 2,252 Household decisionmaking and justification of violence All 2,011 1,758 2,046 2,298 2,586 10,699 Urban 205 343 898 1,922 2,495 5,862 Rural 205 343 898 1,922 2,495 5,862 Orphanhood All 5,265 4,833 4,795 4,302 3,739 22,934 Urban 556 829 1,818 3,378 3,568 10,148 Rural 4,709 4,004 2,977 924 171 12,786 Female 2,559 2,389 2,364 2,136 1,845 11,294 Male 2,706 2,440 2,427 2,164 1,892 11,629 - 88 - Cameroon 2004 - 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 7.32 5.95 5.37 6.26 5.65 3.27 Under-five mortality rate 9.92 8.83 8.67 8.19 7.43 5.08 Prevalence of fever 1.54 1.30 1.31 1.46 1.43 0.76 Prevalence of diarrhea 1.75 1.78 1.40 1.16 1.12 0.92 Prevalence of acute respiratory infection 1.50 1.28 0.87 1.34 1.17 0.73 B. Fertility Total fertility rate 0.80 0.51 0.42 0.35 0.29 0.21 Adolescent fertility rate 27.85 23.89 15.78 15.30 9.15 8.60 C. Nutritional status Children: Moderate stunting 1.45 1.48 1.89 1.77 1.48 0.76 Severe stunting 1.97 1.72 1.70 1.23 0.73 0.82 Moderate underweight 1.80 1.86 2.00 1.33 1.12 0.88 Severe underweight 0.96 1.20 0.99 0.53 0.23 0.45 Mild anemia 1.63 2.03 1.51 1.72 2.18 0.85 Moderate anemia 2.25 2.36 2.55 2.41 2.73 1.24 Severe anemia 0.87 1.02 0.87 1.00 0.63 0.43 Women: Malnutrition 1.57 1.91 0.72 0.81 0.76 0.68 Mild anemia 1.02 1.37 1.25 1.28 1.06 0.58 Moderate anemia 1.20 1.34 1.09 1.15 1.02 0.52 Severe anemia 0.36 0.50 0.19 0.36 0.25 0.15 D. Female circumcision Prevalence of circumcision: Girls na na na na na na Women 1.41 2.27 1.68 1.68 1.68 1.13 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 0.70 0.83 0.77 0.77 0.76 0.43 Men 0.75 0.53 0.69 0.69 0.69 0.35 Prevalence of genital ulcer: Women 0.35 0.38 0.35 0.48 0.44 0.20 Men 0.29 0.41 0.53 0.46 0.49 0.23 - 89 - Cameroon 2004 - 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 3.99 4.19 3.06 2.54 1.59 1.87 Measles coverage 4.60 4.83 4.07 4.24 3.53 2.26 DPT coverage 4.80 4.62 4.27 3.93 3.72 2.23 Full basic coverage 4.63 4.64 4.22 4.60 5.04 2.24 No basic coverage 2.15 2.36 1.78 1.54 0.62 0.87 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 3.33 3.65 3.22 2.84 3.36 1.71 Treatment in a public facility 3.23 3.38 3.14 2.79 3.22 1.60 Treatment in a private facility 1.75 1.74 1.34 2.53 2.98 1.10 Treatment of acute respiratory infection (ARI): Medical treatment of ARI 4.62 4.88 4.81 5.39 5.29 2.70 Treatment in a public facility 4.29 4.01 4.69 4.80 4.82 2.31 Treatment in a private facility 3.18 2.37 2.85 3.69 4.26 1.65 Treatment of diarrhea: Use of oral rehydration therapy 3.27 3.63 3.68 4.34 4.94 1.75 Medical treatment of diarrhea 2.89 2.73 2.99 4.66 4.22 1.75 Treatment in a public facility 2.55 2.48 2.92 4.38 3.45 1.58 Treatment in a private facility 1.73 1.07 1.23 2.57 2.93 0.86 C. Antenatal and delivery care Antenatal care (ANC) visits: To a medically-trained person 3.18 2.38 1.24 0.85 0.67 1.47 To a doctor 0.68 0.87 1.27 1.66 2.11 1.01 To a nurse or trained midwife 3.20 2.24 1.54 1.85 2.14 1.32 Multiple visits to a medically-trained person 2.94 2.61 1.69 1.24 1.07 1.55 Antenatal care content: Tetanus toxoid 2.78 1.97 1.44 1.40 1.57 1.19 Prophylactic antimalarial treatment 2.00 2.44 2.11 1.65 1.40 1.60 Iron supplementation 2.64 2.72 1.67 1.23 1.09 1.65 Delivery attendance: By a medically-trained person 3.04 3.14 2.33 1.55 0.83 2.33 By a doctor 0.42 0.52 0.79 1.08 1.69 0.57 By a nurse or trained midwife 2.86 2.99 2.23 1.82 1.76 2.05 In a public facility 2.13 2.64 2.11 1.99 1.84 1.76 In a private facility 1.62 1.78 1.80 1.92 1.74 1.19 At home 2.86 3.12 2.34 1.55 1.13 2.29 D. Contraceptive services Contraceptive prevalence: Women 0.50 0.72 1.03 1.29 1.31 0.74 Men na na na na na na Source of contraception - public sector: Women 7.69 5.85 3.60 2.83 2.32 1.63 Men na na na na na na - 90 - Cameroon 2004 - 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 7.96 5.97 3.50 3.10 2.60 1.76 Men na na na na na na E. Treatment of adult illnesses Treatment of genital discharge, ulcer, sore: Women 4.40 4.47 2.97 3.32 2.65 1.64 Men 9.18 7.11 7.26 5.66 4.59 2.80 Treatment of genital discharge, ulcer, sore in public facilities: Women 4.40 4.47 2.97 3.32 2.65 1.64 Men 9.18 7.11 7.26 5.66 4.59 2.80 Voluntary counseling and testing for HIV/AIDS: Women 0.98 1.00 1.10 1.21 1.07 0.94 Men 0.87 1.02 1.22 1.28 1.41 0.76 - 91 - Cameroon 2004 - 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 2.13 2.12 1.63 1.62 1.28 1.09 Treated bednet ownership na na na na na na Bednet use: By children 0.91 1.85 1.84 2.06 1.93 1.02 By pregnant women 1.58 3.01 2.74 3.52 2.75 1.38 C. Breastfeeding Exclusive breastfeeding 6.99 7.01 7.54 8.63 7.76 3.55 Timely complementary feeding na na na na na na Bottle-feeding 0.78 1.38 2.50 3.75 4.91 1.44 D. Micronutrient consumption Iodized salt: Availability of iodized salt in household 2.11 2.29 1.61 1.90 1.71 1.26 Vitamin A: Children 2.36 2.09 2.12 2.03 2.09 1.24 Women 1.81 2.13 1.83 1.79 2.02 1.12 E. Tobacco and alcohol use Tobacco: Women 0.47 0.43 0.33 0.21 0.22 0.17 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 0.25 0.46 0.47 0.56 0.52 0.27 Men na na na na na na Condom usage with non-regular partner: Women * 5.68 6.09 4.46 3.51 2.66 Men na na na na na na G. Domestic violence Ever experienced violence na na na na na na Experienced violence in past year 0.63 0.64 0.58 0.61 0.56 0.28 - 92 - Cameroon 2004 - 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 2.59 2.97 2.33 1.73 0.75 2.02 Men 3.24 3.03 1.91 1.27 0.57 1.58 School participation: Girls 3.17 3.04 1.98 1.77 0.57 1.84 Boys 2.63 1.80 1.18 0.68 1.65 1.16 B. Exposure to mass media Newspaper readership: Women 0.33 0.61 0.68 1.01 1.35 0.76 Men 1.39 1.60 1.36 1.51 1.58 1.04 Radio listenership: Women 1.12 1.72 1.74 1.40 1.11 1.57 Men 2.34 2.20 1.65 1.42 0.93 1.21 Television viewership: Women 0.46 0.84 1.30 1.61 1.05 1.71 Men 1.47 2.23 1.86 1.78 1.18 1.75 C. Knowledge and attitudes about HIV/AIDS Knowledge about sexual transmission of HIV/AIDS: Women 2.23 1.53 1.21 0.96 0.71 0.95 Men 1.99 1.25 1.12 1.15 0.71 0.63 Knowledge about mother-to-child transmission of HIV/AIDS: Women 2.49 2.08 1.42 0.97 0.76 1.27 Men 1.98 1.53 1.27 1.28 0.92 0.67 Attitudes toward HIV/AIDS: Women 1.61 1.51 1.30 1.00 0.70 0.86 Men 2.49 2.01 1.77 1.50 1.07 1.04 D. Status of women Household decisionmaking: Can seek own health care 1.08 1.22 1.05 1.31 1.18 0.77 Can seek children's health care 2.24 1.58 1.29 1.07 1.09 0.94 Can make daily household purchases 2.25 2.00 1.50 1.37 1.17 0.92 Can make large household purchases 1.97 1.49 1.30 1.26 1.21 0.78 Can make meal-related decisions 2.15 2.02 1.28 1.30 1.35 0.85 Freedom of movement: Can travel to visit family/relatives 1.15 1.42 1.18 1.31 1.18 0.79 Other decisionmaking, attitudes: Can decide how to spend own money 2.46 2.19 1.81 1.70 1.65 1.09 Can decide whether to have sex 1.16 1.06 0.97 0.87 0.92 0.49 Justifies domestic violence 2.45 1.60 1.31 1.55 1.48 0.97 E. Orphanhood Paternal orphan prevalence 0.65 0.56 0.79 0.65 0.72 0.32 Maternal orphan prevalence 0.28 0.43 0.34 0.35 0.43 0.16 Double orphan prevalence 0.14 0.12 0.14 0.20 0.19 0.07 - 93 - Cameroon 2004 - 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 0.463 0.499 0.3% 7.3% 34.8% 87.0% 99.6% 45.8% 0.11831 Has radio 0.637 0.481 30.1% 57.2% 68.3% 81.6% 94.7% 66.4% 0.06657 Has television 0.221 0.415 0.0% 0.2% 4.0% 41.2% 87.4% 26.6% 0.11243 Has refrigerator 0.109 0.311 0.0% 0.0% 0.1% 9.6% 58.9% 13.7% 0.09660 Has bicycle 0.156 0.363 46.1% 29.4% 20.9% 12.4% 11.0% 23.9% -0.02921 Has motorcycle or scooter 0.071 0.256 5.7% 9.2% 12.0% 15.4% 13.6% 11.2% 0.01475 Has car or truck 0.048 0.215 0.0% 0.3% 2.4% 5.2% 26.2% 6.8% 0.06438 Has telephone 0.016 0.125 0.0% 0.0% 0.0% 0.5% 11.1% 2.3% 0.04781 Has electric or gas oven 0.319 0.466 0.0% 3.3% 14.7% 41.5% 89.2% 29.8% 0.11447 Has mobile phone 0.223 0.416 0.0% 0.4% 7.6% 34.8% 85.4% 25.6% 0.11188 Has a domestic worker not related to household head 0.000 0.010 0.0% 0.0% 0.0% 0.0% 0.1% 0.0% 0.00254 Works own or family's agricultural land 0.242 0.428 79.3% 38.8% 31.0% 12.2% 2.7% 32.7% -0.06541 Uses water piped into residence 0.073 0.260 0.0% 0.1% 1.9% 6.2% 35.5% 8.8% 0.07637 Uses water from a neighbor's faucet 0.059 0.235 0.0% 0.5% 3.5% 12.2% 11.5% 5.5% 0.02881 Uses water from a piped public system 0.220 0.415 0.3% 12.8% 24.9% 38.2% 26.3% 20.5% 0.03179 Uses water from a well with a pump 0.112 0.316 17.3% 21.5% 13.6% 7.6% 2.6% 12.5% -0.02357 Uses water from an unprotected well 0.110 0.313 29.1% 18.4% 11.7% 3.7% 0.1% 12.6% -0.03956 Uses water from a protected surface source 0.074 0.261 1.0% 5.9% 8.3% 9.3% 6.3% 6.2% 0.00229 Uses water from a protected well with no pump 0.060 0.238 9.1% 9.8% 7.9% 5.8% 1.8% 6.9% -0.01602 Uses unprotected surface water 0.235 0.424 43.1% 30.3% 23.9% 8.6% 1.6% 21.5% -0.05944 Uses water piped to yard 0.043 0.204 0.0% 0.4% 3.2% 5.9% 11.6% 4.2% 0.03058 Uses other source of water 0.013 0.115 0.0% 0.1% 0.6% 2.5% 2.8% 1.2% 0.01948 Uses own flush toilet 0.060 0.237 0.0% 0.0% 0.1% 1.6% 34.0% 7.1% 0.08222 Uses shared flush toilet 0.010 0.098 0.0% 0.0% 0.1% 0.5% 3.0% 0.7% 0.02424 Uses shared improved latrine 0.141 0.348 0.0% 1.7% 7.8% 23.7% 19.2% 10.5% 0.04341 Uses bush or field as latrine 0.064 0.245 24.1% 9.3% 2.0% 0.7% 0.1% 7.2% -0.03575 Uses a shared pit latrine 0.221 0.415 7.8% 27.4% 23.7% 18.6% 10.7% 17.7% -0.01243 Uses own improved pit latrine 0.136 0.342 0.3% 4.4% 19.1% 32.6% 23.1% 15.9% 0.02728 Uses own pit latrine 0.355 0.478 67.7% 56.1% 45.6% 20.3% 7.4% 39.4% -0.06939 Has dirt or sand flooring 0.491 0.500 100.0% 96.8% 47.6% 9.4% 1.7% 51.1% -0.11605 Has cement, vinyl, and other types of flooring 0.400 0.490 0.0% 2.9% 49.6% 81.7% 64.0% 39.7% 0.07103 Has tile and parquet flooring 0.031 0.175 0.0% 0.0% 0.5% 2.0% 18.5% 4.2% 0.05917 Has vinyl or asphalt strips flooring 0.051 0.220 0.0% 0.1% 0.9% 4.7% 10.9% 3.3% 0.04054 Has dung (primary), wood, palm, or bamboo flooring 0.006 0.080 0.0% 0.1% 0.9% 0.6% 0.1% 0.4% -0.00119 Has carpeted flooring 0.018 0.134 0.0% 0.0% 0.0% 1.4% 4.5% 1.2% 0.02970 Uses wood or dung for cooking 0.706 0.456 99.8% 94.8% 88.2% 76.4% 28.9% 77.6% -0.10013 Uses gas for cooking 0.129 0.335 0.0% 0.1% 0.1% 2.7% 53.5% 11.3% 0.10474 Uses kerosene for cooking 0.076 0.265 0.0% 0.0% 1.0% 10.6% 11.5% 4.6% 0.03696 Uses charcoal for cooking 0.051 0.220 0.0% 3.7% 8.3% 7.2% 5.4% 4.9% 0.00219 Uses other fuel for cooking 0.035 0.184 0.1% 1.0% 1.9% 2.6% 0.7% 1.2% 0.00201 Number of members per sleeping room 1.842 1.271 2.5 2.3 2.1 2.2 2.0 2.2 -0.01352 - 95 - PART VI. SUPPORTING TABLES, 1998 A. SAMPLE SIZES B. STANDARD ERRORS C. ASSET DISTRIBUTION AND WEIGHTS Cameroon 1998 - SAMPLE SIZES TOTAL SAMPLE Indicator Wealth Quintiles Pop. Low 2nd 3rd 4th High Total Number of household members All 5,139 5,157 5,162 5,141 5,158 25,757 Urban 197 281 1,029 2,534 4,218 8,260 Rural 4,942 4,875 4,133 2,607 941 17,497 Female 2,751 2,659 2,618 2,613 2,560 13,201 Male 2,382 2,482 2,526 2,513 2,591 12,495 Part I: HNP STATUS Indicator Wealth Quintiles Pop. Low 2nd 3rd 4th High Total Mortality rates All 2,331 1,604 1,556 1,535 1,397 8,423 Urban 77 66 299 738 1,115 2,296 Rural 2,254 1,537 1,257 797 282 6,127 Female 1,180 819 782 783 695 4,259 Male 1,151 784 774 753 702 4,164 Prevalence of fever, diarrhea, acute respiratory infection All 592 439 419 426 384 2,260 Urban 12 22 81 204 303 622 Rural 580 417 338 222 82 1,639 Female 299 229 200 217 187 1,132 Male 294 209 219 209 197 1,128 Total fertility rate All 3,379 2,497 2,746 3,224 3,479 15,325 Urban 105 125 594 1,636 2,912 5,372 Rural 3,275 2,372 2,152 1,588 567 9,954 Age-specific fertility rate 15-19 All 735 673 665 933 952 3,958 Urban 22 35 128 462 826 1,473 Rural 713 638 537 472 125 2,485 Children's nutritional status All 526 376 340 357 324 1,923 Urban 8 19 67 164 249 507 Rural 518 357 273 193 75 1,416 Female 267 201 161 176 155 960 Male 259 175 179 181 169 963 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 - 99 - Cameroon 1998 - SAMPLE SIZES Part I: HNP STATUS (Cont.) Indicator Wealth Quintiles Pop. Low 2nd 3rd 4th High Total Women's nutritional status All 448 332 299 315 265 1,659 Urban 11 18 55 141 212 437 Rural 437 314 245 173 52 1,221 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 1,123 841 899 1,041 1,115 5,019 Urban Female 34 41 195 542 922 1,734 Rural Female 1,089 801 704 499 193 3,286 Male 347 388 422 512 554 2,223 Urban Male 8 15 80 264 468 835 Rural Male 339 373 343 248 86 1,389 - 100 - Cameroon 1998 - 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 194 146 144 149 115 748 Urban 3 10 27 70 91 201 Rural 191 136 117 79 24 547 Female 98 73 66 73 55 365 Male 96 73 79 76 61 385 Treatment of fever All 148 156 138 142 97 681 Urban 5 7 27 67 76 182 Rural 143 149 111 75 20 498 Female 77 79 77 73 53 359 Male 71 77 61 70 44 323 Treatment of acute respiratory infection All 99 95 91 97 63 444 Urban 2 2 21 47 54 126 Rural 97 93 70 50 9 319 Female 46 49 40 49 31 215 Male 52 47 51 48 31 229 Treatment of diarrhea All 132 111 67 64 55 428 Urban 2 3 18 36 47 106 Rural 130 108 48 28 8 322 Female 72 57 27 27 25 208 Male 60 54 40 37 30 221 Antenatal and delivery care All 573 426 393 408 348 2,148 Urban 13 22 74 191 277 577 Rural 560 404 319 217 71 1,571 Contraceptive prevalence Female 939 668 652 697 720 3,676 Urban Female 24 28 133 313 597 1,095 Rural Female 916 640 519 384 124 2,583 Male 292 246 253 261 259 1,310 Urban Male 4 10 45 131 207 397 Rural Male 287 236 208 130 53 914 Contraceptive source Female 13 15 40 73 119 261 Urban Female 2 1 9 29 103 144 Rural Female 11 14 31 45 17 117 Male na na na na na na Urban Male na na na na na na Rural Male na na na na na na Treatment of genital discharge, ulcer, sore Female na na na na na na Urban Female na na na na na na Rural Female na na na na na na Male na na na na na na Urban Male na na na na na na Rural Male na na na na na na - 101 - Cameroon 1998 - 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 90 58 57 35 43 283 Urban 2 4 13 14 35 68 Rural 88 55 43 20 8 214 Female 44 24 27 10 20 125 Male 46 34 30 24 23 157 Timely complementary breastfeeding All 68 55 41 53 45 262 Urban 2 2 6 27 36 73 Rural 66 54 34 26 9 189 Female 38 30 25 23 29 145 Male 30 25 16 30 17 118 Bottle-feeding All 222 165 148 147 134 816 Urban 4 7 31 70 104 216 Rural 218 158 117 78 29 600 Female 114 80 79 63 72 408 Male 108 85 70 85 62 410 - 102 - Cameroon 1998 - 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 1,198 900 986 1,161 1,256 5,501 Urban Female 39 46 215 588 1,053 1,941 Rural Female 1,159 854 771 573 203 3,560 Male 407 437 485 587 646 2,562 Urban Male 12 20 96 304 539 971 Rural Male 395 417 389 284 107 1,592 Domestic violence All na na na na na na Urban na na na na na na Rural na na na na na na - 103 - Cameroon 1998 - SAMPLE SIZES Part IV: UNDERLYING DETERMINANTS OF HNP STATUS Indicator Wealth Quintiles Pop. Low 2nd 3rd 4th High Total School completion (Grade 5) Female 1,172 964 1,009 1,194 1,312 5,651 Urban female 37 53 221 602 1,100 2,014 Rural female 1,135 911 788 593 212 3,638 Male 797 911 980 1,232 1,359 5,279 Urban male 27 50 197 668 1,124 2,067 Rural male 770 861 783 564 234 3,212 School participation Female 465 407 391 387 399 2,049 Urban female 18 20 79 176 323 616 Rural female 447 387 312 210 76 1,433 Male 459 436 429 372 382 2,080 Urban male 24 22 89 179 312 626 Rural male 435 415 341 193 70 1,453 Mass media exposure Female 1,198 900 986 1,161 1,256 5,501 Urban female 39 46 215 588 1,053 1,941 Rural female 1,159 854 771 573 203 3,560 Male 407 437 485 587 646 2,562 Urban male 12 20 96 304 539 971 Rural male 395 417 389 284 107 1,591 Knowledge of HIV/AIDS prevention Female 1,887 900 986 1,161 1,256 6,190 Urban female 39 46 215 588 1,053 1,941 Rural female 1,159 854 771 573 203 3,560 Male 407 437 485 587 646 2,562 Urban male 12 20 96 304 539 971 Rural male 395 417 389 284 107 1,592 Household decisionmaking and justification of violence All 1,198 900 986 1,161 1,256 5,501 Urban 39 46 215 588 1,053 1,941 Rural 1,159 854 771 573 203 3,560 Orphanhood All 2,622 2,287 2,302 2,170 2,174 11,553 Urban 103 122 454 1,017 1,758 3,454 Rural 2,519 2,165 1,848 1,152 416 8,100 Female 1,321 1,116 1,107 1,110 1,094 5,749 Male 1,297 1,156 1,180 1,048 1,074 5,755 - 104 - Cameroon 1998 - 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 10.39 9.45 8.61 6.41 7.07 4.46 Under-five mortality rate 14.04 13.53 10.36 9.30 8.78 7.14 Prevalence of fever 2.83 3.10 3.01 2.24 1.96 1.38 Prevalence of diarrhea 1.85 2.74 1.78 1.78 1.78 0.99 Prevalence of acute respiratory infection 2.56 2.69 2.18 2.43 1.65 1.18 B. Fertility Total fertility rate 0.28 0.24 0.22 0.23 0.23 0.14 Adolescent fertility rate 16.00 16.00 15.00 11.00 9.00 8.00 C. Nutritional status Children: Moderate stunting 2.00 2.14 2.22 2.35 1.59 0.97 Severe stunting 2.02 1.82 2.43 1.46 1.41 0.85 Moderate underweight 2.31 2.61 2.87 2.45 1.37 1.18 Severe underweight 1.62 1.47 1.36 1.07 0.66 0.73 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 2.14 1.96 1.77 1.28 1.12 0.87 Mild anemia na na na na na na Moderate anemia na na na na na na Severe anemia na na na na na na D. Female circumcision Prevalence of circumcision: Girls 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 0.35 0.32 0.31 0.35 0.26 0.16 Men 1.16 1.43 1.77 1.34 1.03 0.59 Prevalence of genital ulcer: Women 0.25 0.26 0.36 0.22 0.17 0.12 Men 0.73 0.62 0.90 0.86 0.87 0.36 - 105 - Cameroon 1998 - 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 4.26 5.01 4.20 2.89 2.51 2.40 Measles coverage 4.24 4.88 5.34 4.50 3.30 2.76 DPT coverage 4.16 5.47 5.53 4.17 4.05 2.76 Full basic coverage 4.02 4.81 4.59 4.14 4.36 2.62 No basic coverage 3.70 4.25 2.25 1.47 1.99 1.60 Hepatitis B coverage na na na na na na Yellow fever coverage 1.53 0.60 2.67 2.53 2.33 0.88 B. Treatment of childhood illnesses Treatment of fever: Medical treatment of fever 2.76 3.09 4.04 3.53 4.64 1.77 Treatment in a public facility 2.60 2.48 3.56 3.49 3.97 1.54 Treatment in a private facility 1.55 2.12 1.92 2.87 2.73 1.10 Treatment of acute respiratory infection (ARI): Medical treatment of ARI 5.08 4.60 5.33 4.58 5.74 2.40 Treatment in a public facility 5.02 4.30 5.07 5.09 6.37 2.56 Treatment in a private facility 3.01 3.34 2.54 3.37 4.34 1.64 Treatment of diarrhea: Use of oral rehydration therapy 6.31 5.18 6.59 5.42 3.85 2.75 Medical treatment of diarrhea 4.03 5.58 6.89 6.06 6.20 2.62 Treatment in a public facility 3.99 4.13 5.96 5.86 5.52 2.20 Treatment in a private facility 2.26 3.80 4.87 2.13 3.63 1.66 C. Antenatal and delivery care Antenatal care (ANC) visits: To a medically-trained person 5.07 4.77 2.73 1.57 0.98 2.79 To a doctor 1.16 1.79 2.57 2.47 2.57 1.13 To a nurse or trained midwife 3.50 3.71 3.17 2.55 2.54 1.74 Multiple visits to a medically-trained person 3.69 3.69 3.12 2.18 1.68 1.63 Antenatal care content: Tetanus toxoid 3.61 3.35 2.84 2.17 2.03 1.53 Prophylactic antimalarial treatment na na na na na na Iron supplementation na na na na na na Delivery attendance: By a medically-trained person 3.44 3.48 3.73 2.38 2.32 2.18 By a doctor 0.71 1.25 1.62 1.70 1.83 0.73 By a nurse or trained midwife 3.29 3.48 3.73 2.45 2.22 1.99 In a public facility 2.69 2.96 3.67 3.25 3.80 1.93 In a private facility 1.57 2.27 2.85 3.12 2.97 1.55 At home 3.22 3.10 3.70 2.56 2.33 2.03 D. Contraceptive services Contraceptive prevalence: Women 0.48 0.85 1.34 1.39 1.77 0.62 Men 0.94 1.56 2.02 2.39 2.67 1.10 Source of contraception - public sector: Women * * 9.32 4.97 4.70 3.30 Men na na na na na na - 106 - Cameroon 1998 - 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 * * 9.02 5.85 4.73 3.25 Men na na na na na na E. Treatment of adult illnesses Treatment of genital discharge, ulcer, sore: Women * * * 9.64 4.66 4.57 Men * * 6.48 6.96 5.62 3.75 Treatment of genital discharge, ulcer, sore in public facilities: Women 0.35 0.32 0.31 0.35 0.26 0.16 Men * * 1.75 1.89 1.33 0.77 Voluntary counseling and testing for HIV/AIDS: Women na na na na na na Men na na na na na na - 107 - Cameroon 1998 - 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 4.53 6.12 4.97 4.68 6.05 2.38 Timely complementary feeding 7.98 7.60 7.48 6.16 5.50 3.05 Bottle-feeding 2.46 4.29 3.69 4.25 4.01 1.91 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 0.98 1.19 1.08 0.76 0.74 0.44 Men 2.13 3.08 2.58 2.20 1.93 1.10 Condom usage with non-regular partner: Women 4.40 2.99 3.28 3.81 3.35 1.92 Men 4.45 3.36 3.95 3.52 3.40 1.87 G. Domestic violence Ever experienced violence na na na na na na Experienced violence in past year na na na na na na - 108 - Cameroon 1998 - 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 2.33 2.99 2.85 2.10 2.03 1.54 Men 3.10 3.16 2.34 1.50 0.98 1.36 School participation: Girls 3.79 4.37 2.62 2.93 2.05 1.89 Boys 3.71 3.69 2.61 1.88 1.54 1.76 B. Exposure to mass media Newspaper readership: Women 0.37 0.68 1.01 1.30 1.37 0.79 Men 1.30 2.40 2.40 2.30 2.68 1.63 Radio listenership: Women 1.70 3.01 2.87 1.85 1.30 1.53 Men 3.31 3.35 2.52 1.68 1.02 1.30 Television viewership: Women 0.91 1.54 2.16 1.97 1.52 1.55 Men 2.31 3.23 3.14 3.07 1.60 2.19 C. Knowledge and attitudes about HIV/AIDS Knowledge about sexual transmission of HIV/AIDS: Women 3.86 2.69 2.26 1.46 0.87 1.87 Men 3.98 1.78 1.00 0.78 0.32 0.81 Knowledge about mother-to-child transmission of HIV/AIDS: Women 3.35 2.44 2.07 1.54 1.17 1.15 Men 4.70 3.21 2.57 2.22 1.84 1.39 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 na na na na na na 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 1.02 0.86 1.05 0.76 0.57 0.44 Maternal orphan prevalence 0.48 0.61 0.79 0.33 0.31 0.25 Double orphan prevalence 0.21 0.27 0.44 0.14 0.12 0.12 - 109 - Cameroon 1998 - 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 0.497 0.500 0.0% 3.7% 32.7% 72.0% 98.9% 41.5% 0.13666 Has radio 0.572 0.495 9.0% 49.8% 64.0% 72.1% 95.1% 58.0% 0.09593 Has television 0.217 0.412 0.0% 0.0% 4.9% 19.1% 78.6% 20.5% 0.12275 Has refrigerator 0.138 0.345 0.0% 0.0% 0.8% 4.2% 53.2% 11.7% 0.11204 Has bicycle 0.121 0.327 29.0% 15.2% 18.0% 13.7% 8.5% 16.9% -0.02416 Has motorcycle 0.070 0.255 2.8% 5.9% 9.0% 12.9% 19.5% 10.0% 0.02722 Has car 0.055 0.228 0.0% 0.2% 0.6% 3.7% 24.1% 5.7% 0.07567 Has telephone 0.028 0.165 0.0% 0.0% 0.0% 0.2% 12.5% 2.5% 0.06808 Has stove 0.343 0.475 0.0% 2.0% 12.9% 32.9% 80.1% 25.6% 0.12586 Works own or family's agricultural land 0.329 0.470 96.6% 63.6% 50.6% 30.5% 8.9% 50.0% -0.08800 Uses water piped into residence 0.106 0.308 0.0% 0.0% 0.6% 1.8% 35.3% 7.6% 0.10329 Uses water from a well in courtyard 0.046 0.209 0.0% 0.0% 0.8% 4.9% 13.2% 3.8% 0.03538 Uses water from a neighbor's faucet 0.047 0.212 0.0% 0.0% 2.8% 5.7% 8.1% 3.3% 0.02309 Uses rainwater for drinking 0.000 0.015 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.00176 Uses water from a piped public system 0.250 0.433 2.0% 13.1% 23.5% 37.5% 24.2% 20.1% 0.02304 Uses water from a vendor 0.015 0.121 0.0% 0.3% 1.8% 1.9% 1.3% 1.1% 0.00483 Uses water from a well without a pump 0.160 0.367 28.3% 21.6% 14.3% 17.4% 7.7% 17.8% -0.03607 Uses water from a well with a pump 0.070 0.255 16.5% 11.8% 7.8% 5.9% 2.1% 8.8% -0.03014 Uses river, canal, or surface water 0.303 0.460 52.7% 53.0% 47.5% 24.7% 7.9% 37.2% -0.07359 Uses other source of water 0.001 0.036 0.0% 0.0% 0.0% 0.0% 0.2% 0.1% 0.00633 Uses a flush toilet 0.096 0.294 0.0% 0.0% 0.0% 0.8% 31.2% 6.4% 0.10382 Uses a pit latrine 0.542 0.498 74.5% 83.1% 81.5% 44.9% 15.5% 59.9% -0.09371 Uses bush or field as latrine 0.090 0.286 25.4% 15.4% 7.0% 1.2% 0.1% 9.8% -0.05028 Uses a VIP latrine 0.268 0.443 0.0% 1.6% 10.3% 52.9% 52.9% 23.5% 0.06911 Uses other type of latrine 0.002 0.046 0.1% 0.0% 0.3% 0.1% 0.1% 0.1% -0.00107 Has dirt, sand, or dung as principal flooring 0.470 0.499 100.0% 100.0% 68.3% 9.3% 0.7% 55.6% -0.14068 Has wood plank as principal flooring 0.003 0.055 0.0% 0.0% 0.4% 0.6% 0.2% 0.3% 0.00099 Has cement as principal flooring 0.468 0.499 0.0% 0.0% 30.4% 88.5% 83.0% 40.4% 0.10516 Has tile as flooring 0.049 0.215 0.0% 0.0% 0.0% 0.4% 14.3% 2.9% 0.07370 Has some kind of finished flooring 0.008 0.088 0.0% 0.0% 0.0% 0.7% 1.9% 0.5% 0.02161 Number of members per sleeping room 1.877 1.185 2.5 2.1 2.0 2.2 2.0 2.2 -0.01436 - 111 - PART VII. SUPPORTING TABLES, 1991 A. SAMPLE SIZES B. STANDARD ERRORS C. ASSET DISTRIBUTION AND WEIGHTS Cameroon 1991 - SAMPLE SIZES TOTAL SAMPLE Indicator Wealth Quintiles Pop. Low 2nd 3rd 4th High Total Number of household members All 3,958 3,953 3,957 3,957 3,958 19,783 Urban 318 487 1,078 2,377 3,427 7,686 Rural 3,640 3,466 2,879 1,581 531 12,097 Female 2,008 2,087 2,070 2,049 1,994 10,207 Male 1,950 1,864 1,885 1,899 1,964 9,563 Part I: HNP STATUS Indicator Wealth Quintiles Pop. Low 2nd 3rd 4th High Total Mortality rates All 1,260 1,501 1,310 1,320 1,326 6,717 Urban 82 175 374 807 1,143 2,581 Rural 1,178 1,327 936 513 182 4,136 Female 608 765 653 663 654 3,342 Male 652 737 657 657 672 3,375 Prevalence of fever, diarrhea, acute respiratory infection All 529 711 617 659 672 3,189 Urban 36 76 168 388 586 1,254 Rural 493 636 449 271 86 1,935 Female 246 361 318 327 337 1,589 Male 283 351 299 332 335 1,600 Total fertility rate All 1,840 2,094 2,072 2,328 2,453 10,787 Urban 125 264 566 1,440 2,168 4,563 Rural 1,715 1,830 1,506 887 285 6,223 Age-specific fertility rate 15-19 All 379 527 521 650 664 2,741 Urban 18 47 123 424 586 1,198 Rural 360 481 398 226 78 1,543 Children's nutritional status All 313 528 471 503 565 2,380 Urban 23 51 111 281 498 964 Rural 290 476 361 222 67 1,416 Female 158 259 238 241 280 1,176 Male 156 269 234 262 285 1,206 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 - 115 - Cameroon 1991 - SAMPLE SIZES Part I: HNP STATUS (Cont.) Indicator Wealth Quintiles Pop. Low 2nd 3rd 4th High Total Women's nutritional status All na na na na na na Urban na na na na na na Rural na na na na na na Women's anemia status All na na na na na na Urban na na na na na na Rural na na na na na na Girls' circumcision All 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 na na na na na na Urban Female na na na na na na Rural Female na na na na na na Male na na na na na na Urban Male na na na na na na Rural Male na na na na na na - 116 - Cameroon 1991 - 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 107 143 121 145 147 663 Urban 4 18 32 89 126 269 Rural 103 125 89 56 21 394 Female 45 67 54 77 75 318 Male 62 76 67 68 72 345 Treatment of fever All 91 175 119 168 168 720 Urban 3 11 20 87 138 259 Rural 88 164 98 80 30 460 Female 46 94 66 89 82 377 Male 46 81 52 79 85 343 Treatment of acute respiratory infection All 41 88 38 54 56 277 Urban 1 6 9 31 48 95 Rural 40 82 29 23 8 182 Female 21 46 21 21 27 136 Male 20 41 17 33 30 141 Treatment of diarrhea All 116 146 113 99 86 560 Urban 13 16 43 64 75 211 Rural 103 130 70 34 11 348 Female 46 64 57 43 47 257 Male 70 82 57 55 39 303 Antenatal and delivery care 2,453 All 382 488 414 442 441 2,168 Urban 22 53 108 270 390 843 Rural 360 435 306 173 51 1,325 Contraceptive prevalence Female 562 614 554 571 568 2,868 Urban Female 34 79 144 348 492 1,097 Rural Female 528 534 410 222 76 1,770 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 4 8 15 25 71 123 Urban Female 0 1 5 12 60 78 Rural Female 4 7 10 13 11 45 Male na na na na na na Urban Male na na na na na na Rural Male na na na na na na Treatment of genital discharge, ulcer, sore Female na na na na na na Urban Female na na na na na na Rural Female na na na na na na Male na na na na na na Urban Male na na na na na na Rural Male na na na na na na - 117 - Cameroon 1991 - 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 2,453 na Exclusive breastfeeding All 47 50 35 49 38 219 Urban 1 9 11 33 32 86 Rural 46 42 24 16 5 133 Female 25 26 17 24 15 107 Male 22 24 19 25 23 113 Timely complementary breastfeeding All 47 54 59 44 48 252 Urban 6 2 18 24 42 92 Rural 41 52 41 21 6 161 Female 25 29 26 18 17 115 Male 22 25 33 26 31 137 Bottle-feeding All 124 155 141 145 133 698 Urban 11 17 42 89 116 275 Rural 113 139 99 55 17 423 Female 65 85 64 74 56 344 Male 59 71 77 71 77 355 - 118 - Cameroon 1991 - SAMPLE SIZES Part III: Intermediate Determinants of HNP Status - INDIVIDUAL AND HOUSEHOLD BEHAVIOR (Cont.) Indicator Wealth Quintiles Pop. Low 2nd 3rd 4th High Total Iodized salt in household All na na na na na na Urban na na na na na na Rural na na na na na na Vitamin A supplementation All na na na na na na Urban na na na na na na Rural na na na na na na Female na na na na na na Male na na na na na na Tobacco and alcohol use, casual sexual partners, condom use for casual sex Female na na na na na na Urban Female na na na na na na Rural Female na na na na na na Male na na na na na na Urban Male na na na na na na Rural Male na na na na na na Domestic violence All na na na na na na Urban na na na na na na Rural na na na na na na - 119 - Cameroon 1991 - SAMPLE SIZES Part IV: UNDERLYING DETERMINANTS OF HNP STATUS Indicator Wealth Quintiles Pop. Low 2nd 3rd 4th High Total School completion (Grade 5) Female 732 798 814 910 914 4,167 Urban female 62 99 211 566 817 1,755 Rural female 669 699 603 344 97 2,412 Male 698 713 658 854 922 3,845 Urban male 60 93 194 584 811 1,742 Rural male 638 620 465 269 111 2,103 School participation Female 344 333 334 312 307 1,630 Urban female 24 37 77 182 251 571 Rural female 321 296 257 130 56 1,060 Male 332 332 345 271 326 1,607 Urban male 19 40 99 144 280 582 Rural male 313 292 246 127 47 1,025 Mass media exposure Female 654 757 738 834 887 3,871 Urban female 43 91 199 510 782 1,625 Rural female 612 666 540 325 105 2,247 Male na na na na na na Urban male na na na na na na Rural male na na na na na na Knowledge of HIV/AIDS prevention Female na na na na na na Urban female na na na na na na Rural female na na na na na na Male na na na na 2,453 na Urban male na na na na na na Rural male na na na na na na Household decisionmaking and justification of violence All 654 757 738 834 887 3,871 Urban 43 91 199 510 782 1,625 Rural 612 666 540 325 105 2,247 Orphanhood All 1,804 1,931 1,933 1,834 1,865 9,367 Urban 137 232 538 1,008 1,582 3,497 Rural 1,668 1,699 1,395 826 282 5,870 Female 887 988 971 933 944 4,722 Male 918 942 962 892 920 4,634 - 120 - Cameroon 1991 - 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 10.03 8.69 9.51 7.74 6.37 5.12 Under-five mortality rate 17.51 12.44 14.05 16.52 8.51 8.12 Prevalence of fever 2.47 2.14 2.43 2.22 1.59 1.07 Prevalence of diarrhea 2.60 2.22 1.82 2.02 1.44 1.09 Prevalence of acute respiratory infection 1.52 1.65 1.27 0.97 1.01 0.63 B. Fertility Total fertility rate 0.31 0.32 0.34 0.26 0.24 0.14 Adolescent fertility rate 27.00 20.00 23.00 15.00 14.00 10.00 C. Nutritional status Children: Moderate stunting 2.81 1.96 2.41 1.53 1.28 1.02 Severe stunting 2.73 1.86 2.03 1.08 0.78 0.82 Moderate underweight 2.71 1.66 2.05 1.46 0.68 0.76 Severe underweight 2.36 1.08 0.87 0.55 0.94 0.60 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 na na na na na na Mild anemia na na na na na na Moderate anemia na na na na na na Severe anemia na na na na na na D. Female circumcision Prevalence of circumcision: Girls 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 na na na na na na Men na na na na na na Prevalence of genital ulcer: Women na na na na na na Men na na na na na na - 121 - Cameroon 1991 - 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 7.34 5.78 4.55 4.01 1.48 2.76 Measles coverage 8.41 5.07 5.60 5.41 3.34 3.07 DPT coverage 8.02 6.11 4.76 5.37 3.37 3.05 Full basic coverage 8.15 5.59 4.88 5.59 3.55 3.08 No basic coverage 7.08 5.23 4.47 4.01 1.50 2.68 Hepatitis B coverage na na na na na na Yellow fever coverage 1.72 1.52 1.11 0.67 1.41 0.60 B. Treatment of childhood illnesses Treatment of fever: Medical treatment of fever 6.13 4.41 4.48 3.76 3.58 2.50 Treatment in a public facility 5.26 3.45 4.53 4.52 3.83 2.59 Treatment in a private facility 3.82 4.08 3.57 2.87 3.14 1.89 Treatment of acute respiratory infection (ARI): Medical treatment of ARI 7.24 8.09 10.54 6.47 6.69 3.86 Treatment in a public facility 3.09 5.31 10.07 8.49 6.35 3.71 Treatment in a private facility 7.01 7.40 5.44 7.44 6.06 3.74 Treatment of diarrhea: Use of oral rehydration therapy 8.07 4.40 5.52 3.82 3.65 2.94 Medical treatment of diarrhea 4.16 3.57 4.89 3.79 5.04 1.98 Treatment in a public facility 4.20 3.25 4.14 3.72 4.04 1.77 Treatment in a private facility 1.56 1.72 3.58 2.07 2.72 1.11 C. Antenatal and delivery care Antenatal care (ANC) visits: To a medically-trained person 6.70 4.58 3.77 2.18 0.71 3.10 To a doctor 1.33 1.37 2.32 2.21 2.13 1.09 To a nurse or trained midwife 5.46 3.58 3.32 2.83 2.24 2.13 Multiple visits to a medically-trained person 4.88 3.46 4.10 2.77 1.60 2.24 Antenatal care content: Tetanus toxoid 5.06 3.51 3.41 2.33 2.14 2.15 Prophylactic antimalarial treatment na na na na na na Iron supplementation na na na na na na Delivery attendance: By a medically-trained person 4.62 3.98 3.96 3.90 1.01 2.43 By a doctor 0.77 1.07 1.38 1.38 1.79 0.75 By a nurse or trained midwife 4.39 3.87 4.01 3.81 1.81 2.34 In a public facility 4.45 3.89 3.87 3.51 2.05 2.34 In a private facility 1.43 2.07 1.81 2.26 1.96 1.15 At home 4.72 4.07 3.97 3.95 1.31 2.43 D. Contraceptive services Contraceptive prevalence: Women 0.53 0.65 1.29 1.22 1.62 0.56 Men na na na na na na Source of contraception - public sector: Women * * * 8.27 5.50 4.84 Men na na na na na na - 122 - Cameroon 1991 - 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 * * * 9.59 5.00 4.97 Men na na na na na na E. Treatment of adult illnesses Treatment of genital discharge, ulcer, sore: Women na na na na na na Men na na na na na na Treatment of genital discharge, ulcer, sore in public 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 - 123 - Cameroon 1991 - 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 4.48 3.54 6.21 3.83 2.66 2.01 Timely complementary feeding 5.78 6.52 5.36 6.54 7.07 2.70 Bottle-feeding 1.62 3.37 2.44 3.45 4.24 1.62 D. Micronutrient consumption Iodized salt: Availability of iodized salt in household na na na na na na Vitamin A: Children na na na na na na Women na na na na na na E. Tobacco and alcohol use Tobacco: Women na na na na na na Men na na na na na na Alcohol: Women na na na na na na Men na na na na na na F. Sexual practices Non-regular sexual partnerships: Women na na na na na na Men na na na na na na Condom usage with non-regular partner: Women na na na na na na Men na na na na na na G. Domestic violence Ever experienced violence na na na na na na Experienced violence in past year na na na na na na - 124 - Cameroon 1991 - 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 2.30 2.54 3.86 5.10 1.85 2.44 Men 3.00 3.07 3.65 5.11 1.22 2.17 School participation: Girls 5.22 4.02 4.37 5.31 2.26 2.68 Boys 4.62 3.94 4.76 4.28 2.12 2.33 B. Exposure to mass media Newspaper readership: Women na na na na na na Men na na na na na na Radio listenership: Women na na na na na na Men na na na na na na Television viewership: Women 0.91 1.10 2.32 3.24 1.75 2.02 Men na na na na na na C. Knowledge and attitudes about HIV/AIDS Knowledge about sexual transmission of HIV/AIDS: Women na na na na na na Men na na na na na na Knowledge about mother-to-child transmission of HIV/AIDS: Women na na na na na na Men na na na na na na Attitudes toward HIV/AIDS: Women na na na na na na Men na na na na na na D. Status of women Household decisionmaking: Can seek own health care na na na na na na Can seek children's health care na na na na na na Can make daily household purchases na na na na na na Can make large household purchases na na na na na na Can make meal-related decisions na na na na na na Freedom of movement: Can travel to visit family/relatives na na na na na na Other decisionmaking, attitudes: Can decide how to spend own money na na na na na na 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 0.93 0.89 0.77 1.03 0.70 0.37 Maternal orphan prevalence 0.66 0.32 0.66 0.75 0.48 0.27 Double orphan prevalence 0.22 0.14 0.19 0.13 0.22 0.09 - 125 - Cameroon 1991 - 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 0.398 0.489 0.0% 0.5% 8.4% 49.9% 97.6% 31.3% 0.13916 Has radio 0.593 0.491 0.5% 67.4% 63.3% 76.2% 97.1% 60.9% 0.09232 Has television 0.200 0.400 0.0% 0.0% 0.9% 9.7% 81.2% 18.4% 0.13205 Has refrigerator 0.154 0.361 0.0% 0.0% 0.1% 1.7% 60.7% 12.5% 0.12843 Has bicycle 0.136 0.342 19.8% 26.7% 28.0% 11.7% 7.9% 18.8% -0.02884 Has motorcycle 0.073 0.260 0.0% 5.7% 13.9% 15.6% 19.2% 10.9% 0.01918 Has car 0.071 0.256 0.0% 0.0% 0.8% 3.9% 32.0% 7.3% 0.09040 Has gas or electric oven 0.128 0.334 0.0% 0.0% 0.1% 2.6% 46.9% 9.9% 0.11724 Has gas or electric portable stove 0.134 0.340 0.0% 0.7% 8.1% 12.4% 30.8% 10.4% 0.06666 Has a domestic worker not related to household head 0.001 0.038 0.0% 0.0% 0.0% 0.0% 0.7% 0.1% 0.01079 Works own or family's agricultural land 0.721 0.449 76.2% 85.9% 86.0% 87.8% 93.9% 86.0% 0.03259 Uses water piped into residence 0.088 0.284 0.0% 0.0% 0.0% 1.6% 35.4% 7.4% 0.10682 Uses water piped from a public system 0.235 0.424 0.4% 9.4% 20.6% 41.7% 23.9% 19.2% 0.02191 Uses water piped into the yard 0.062 0.240 0.0% 0.0% 1.3% 5.3% 16.7% 4.7% 0.04457 Uses water from river, canal, or surface water 0.298 0.458 65.3% 48.0% 36.6% 19.1% 6.2% 35.0% -0.07465 Uses rainwater for drinking 0.001 0.038 0.1% 0.0% 0.4% 0.0% 0.2% 0.1% -0.00344 Uses water from a well with a handpump 0.068 0.251 8.8% 10.3% 8.7% 6.0% 3.0% 7.4% -0.02677 Uses water from a well without a handpump 0.168 0.374 24.7% 29.6% 26.9% 17.6% 4.4% 20.6% -0.04139 Uses bottled water 0.015 0.121 0.7% 1.1% 3.7% 2.5% 1.1% 1.8% -0.00379 Uses water from another source 0.004 0.065 0.0% 1.4% 0.8% 0.0% 0.2% 0.5% -0.00115 Uses water from neighbor's tap 0.060 0.237 0.0% 0.0% 1.1% 5.9% 8.8% 3.2% 0.02847 Uses own flush toilet 0.085 0.279 0.0% 0.0% 0.0% 0.3% 32.5% 6.6% 0.10816 Uses traditional pit latrine 0.389 0.488 72.1% 75.6% 48.1% 24.9% 5.5% 45.2% -0.08966 Uses a bucket latrine 0.407 0.491 0.0% 3.0% 40.7% 72.5% 61.8% 35.6% 0.06145 Uses bush or field as latrine 0.118 0.323 27.7% 21.3% 11.2% 2.2% 0.3% 12.6% -0.05124 Uses other type of latrine 0.000 0.017 0.2% 0.0% 0.0% 0.0% 0.0% 0.0% -0.00310 Has dirt, earth as principal flooring 0.479 0.500 100.0% 98.2% 67.4% 10.6% 0.6% 55.4% -0.13202 Has wood plank as principal flooring 0.004 0.061 0.0% 1.8% 0.4% 0.1% 0.2% 0.5% -0.00604 Has cement as principal flooring 0.470 0.499 0.0% 0.0% 31.7% 88.6% 80.3% 40.1% 0.09936 Has tile flooring 0.045 0.208 0.0% 0.0% 0.0% 0.7% 18.2% 3.8% 0.07795 Has other type of flooring 0.002 0.048 0.0% 0.0% 0.0% 0.1% 0.7% 0.2% 0.01240 Number of members per sleeping room 1.921 1.219 2.1 2.3 2.2 2.2 2.3 2.2 0.00622 - 127 - PART VIII. 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. - 131 - 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. - 132 - 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: 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. - 133 - · 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. · 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. 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). - 134 - · 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 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. - 135 - Cameroon 2004 - ASSET QUESTIONNAIRE Question Score if Score if Item "Yes" "No" Score 1. In your household, is/are there? Electricity 0.12736 -0.10990 One or more radios 0.05026 -0.08816 Onre or more televisions 0.21131 -0.05981 One or more refrigerators 0.27635 -0.03376 One or more bicycles -0.06804 0.01254 One or more motorcycles, scooters 0.05353 -0.00406 One or more cars, trucks 0.28554 -0.01451 One or more telephones 0.37534 -0.00609 One or more electric, gas ovens 0.16733 -0.07830 One or more mobile phones 0.20866 -0.05998 2. Does your household have a domestic worker not related to head? 0.25956 -0.00002 3. Do the members of your household work their own or family's agricultural land? -0.11575 0.03696 4. What is the principal source of drinking water for your household? Piped water in residence 0.27227 -0.02142 Piped water from a neighbor 0.11546 -0.00719 Piped water in public tap 0.05979 -0.01690 Piped water to tap in yard, plot 0.14357 -0.00651 Well with pump -0.06629 0.00838 Protected well with no pump -0.06334 0.00405 Protected surface source 0.00810 -0.00064 Unprotected surface water -0.10726 0.03294 Other 0.16786 -0.00226 5. What is the principal type of fuel for cooking used by your household? Gas 0.27233 -0.04028 Kerosene 0.12906 -0.01059 Wood, dung -0.06460 0.15518 Charcoal 0.00946 -0.00051 Other 0.01057 -0.00038 6. What is the principal type of toilet facility used by your household? Private flush toilet 0.32618 -0.02072 Shared flush toilet 0.24551 -0.00239 Private pit latrine -0.09361 0.05144 Shared pit latrine -0.02330 0.00663 Shared improved latrine 0.10723 -0.01757 Own improved pit latrine 0.06888 -0.01080 Bush, field as latrine -0.13677 0.00934 7. What is the principal material used for the floors in your household? Dirt, sand -0.11826 0.11387 Cement (includes other types) 0.08692 -0.05805 Ceramic tile (includes parquet) 0.32838 -0.01066 Dung (primary), wood, palm, bamboo -0.01481 0.00010 Vinyl, asphalt strips 0.17444 -0.00942 Carpet 0.21720 -0.00406 8. How many people are there for each sleeping room in your household? # people -1.84x-0.014 1.27 Total Household Asset Score (sum of individual item scores) - 137 - Cameroon 2004 - QUINTILE CUT-OFF POINTS Asset Index Value Wealth Quintile Bottom Cut-Off Top Cut-Off Low Low -0.96721 Second -0.96721 -0.64185 Third -0.64185 -0.01722 Fourth -0.01722 0.92386 High 0.92386 High - 138 - 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 - 139 -