39447 SOCIO-ECONOMIC DIFFERENCES IN HEALTH, NUTRITION, AND POPULATION INDIA 1992/93, 1998/99 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, 1998 / 99 1 A. Total Population 3 B. Female and Male Populations 9 C. Rural and Urban Populations 13 Part II. Basic Tables, 1992 / 93 19 A. Total Population 21 B. Female and Male Populations 27 C. Rural and Urban Populations 31 Part III. Technical Notes 37 A. Indicator Definitions 39 B. Data and Methods 53 C. Discussion 57 Part IV. Supporting Tables, 1998 / 99 63 A. Sample Sizes 65 B. Standard Errors 71 C. Asset Distribution and Weights 77 Part V. Supporting Tables, 1992 / 93 79 A. Sample Sizes 81 B. Standard Errors 87 C. Asset Distribution and Weights 93 Part VI. Annexes 95 A. Sources of Additional Information 97 B. Use of Information from this 99 Report to Monitor the Economic Status of People Served by HNP Programs C. Countries Covered by the 107 HNP-Poverty Report Project FOREWORD The World Bank shares the desire of its member states and client countries to ensure that the poor partake fully in the health gains that the countries achieve. To assist in this, the Bank, in cooperation with the Dutch and Swedish Governments, has sponsored the set of reports providing basic information about health inequalities within countries to which this document belongs. The information shows clearly that disparities in both health conditions and health service use are unacceptably large. As countries and the Bank work to reduce important inequalities among regions and countries, there is a clear need for equally vigorous efforts to lessen the inequity represented by intra-country differences among socio-economic groups. My colleagues and I hope that all concerned with equity in health will find this information useful in making the case for effective actions to improve the health of the poor, and in designing programs to achieve this crucial objective. Joy Phumaphi Vice President Human Development Network The World Bank - I - INTRODUCTION This report is one in a series that provides basic information about health, nutrition, and population (hnp) inequalities within fifty-six developing countries. The series to which the report belongs is an expanded and updated version of a set covering forty- five countries that was published in 2000. The fifty-six reports in the current series cover almost all DHS surveys undertaken during the period beginning in 1990 and ending with the date of the last survey for which data were publicly available as of June 2006.1 The report's contents are intended to facilitate preparation of country analyses and the development of activities to benefit poor people. To this end, the report presents data about hnp status, service use, and related matters among individuals belonging to different socio-economic classes. The principal focus is on differences among groups of individuals defined in terms of the wealth or assets of the households where they reside. The source of data is the Demographic and Health Survey (DHS) program, a large, multi-country household survey project. The figures in this and the other reports in the series draw on responses to questions about household wealth or assets included in the DHS questionnaire, which were similar for all the surveys covered. These responses served as the basis for the construction of a wealth index, which was used to rank individuals according to the index value for the household to which they belonged. The individuals were then divided into quintiles, and the mean value for each of up to approximately 120 indicators was calculated for each quintile. The report is organized in four principal parts: · Parts one and two, which constitute the report's core, consist of tables presenting quintile-specific data for each hnp indicator covered from the two most recent DHS surveys available at the time of the report's publication. In each part there are three sets of tables: the first provides quintile-specific information for the total population; the second presents data separately for quintiles of females and males; the third features quintile-specific information presented separately for rural and urban residents. Each of these sets is divided into four sections: one dealing with hnp status, the second with the use of hnp services, the third with hnp-related behavior, and the fourth with other hnp status determinants. · Part three provides supplementary technical information designed to help readers understand the data presented in parts one and two. This information deals with such issues as how the covered hnp indicators were defined and how the quintile-specific estimates were derived. · Parts four and five present supporting tables that deal with three of the technical matters covered in part three: the size of the sample for each indicator covered; the standard error 1The average interval of approximately two years between data collection and availability means that the latest surveys covered were conducted in 2005. - III - for each quintile-specific estimate in the total population; and the items used in constructing the wealth index, along with the weight assigned to each. An additional, sixth part consists of three annexes, for readers interested in applying the approach used in the report or in learning more about the other reports in this series. The first annex is an annotated bibliography containing further information about the technical issues concerning the approach used in the report, and about employing that approach to examine additional issues using DHS or other data sets. The second shows how the report's approach can be applied to monitor the distribution of benefits from other hnp programs, and provides a tool for doing so. The third annex is a list of all fifty-six countries for which reports are available, along with an indication of how to obtain copies of the reports dealing with them. ********************************* The authors thank the Dutch and Swedish Governments for the generous support that made production of this report possible. - IV - PART I. BASIC TABLES, 1998 / 99 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. India 1998 / 99 - 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 96.5 80.7 76.3 55.3 38.1 73.0 2.53 58.40 -0.1178 0.0003 Under-five mortality rate 141.3 117.8 101.3 69.9 45.5 101.3 3.11 95.80 -0.1588 0.0003 Prevalence of fever 30.1 28.6 29.7 29.3 26.5 29.0 1.14 3.60 -0.0164 0.0052 Prevalence of diarrhea 20.4 18.8 20.3 17.9 16.4 18.9 1.24 4.00 -0.0264 0.0070 Prevalence of acute respiratory 21.5 20.6 20.3 17.6 13.9 19.1 1.55 7.60 -0.0755 0.0067 infection (ARI) B. Fertility Total fertility rate 3.4 3.1 2.6 2.3 1.8 2.8 1.89 1.60 -0.1205 0.0001 Adolescent fertility rate 134.0 130.0 102.0 78.0 36.0 107.0 3.72 98.00 -0.2127 0.0008 C. Nutritional status (%) Children: Moderate stunting 25.0 23.6 22.8 22.1 17.4 22.5 1.44 7.60 -0.0566 0.0066 Severe stunting 33.1 28.5 24.1 16.3 9.3 23.0 3.56 23.80 -0.2113 0.0065 Moderate underweight 32.5 31.7 30.8 26.9 21.1 29.0 1.54 11.40 -0.0808 0.0057 Severe underweight 28.2 22.3 18.4 12.0 5.3 18.0 5.32 22.90 -0.2551 0.0076 Mild anemia 23.3 22.6 21.9 22.4 23.8 22.8 0.98 0.50 0.0074 0.0075 Moderate anemia 49.6 50.5 47.4 44.3 36.4 46.2 1.36 13.20 -0.0517 0.0043 Severe anemia 5.9 5.9 5.8 5.6 3.7 5.5 1.59 2.20 -0.0864 0.0163 Women: Malnutrition 50.4 46.5 41.0 30.3 14.5 36.2 3.48 35.90 -0.2028 0.0025 Mild anemia 40.3 38.2 34.8 32.5 30.3 35.2 1.33 10.00 -0.0594 0.0027 Moderate anemia 19.8 16.8 14.5 13.3 10.2 14.9 1.94 9.60 -0.1383 0.0048 Severe anemia 2.6 2.1 2.2 1.6 1.1 1.9 2.36 1.50 -0.1463 0.0133 D. Female circumcision (%) Prevalence of circumcision: Girls na na na na na na na na na na Women na na na na na na na na na na Prevalence of occlusion: Girls * * * * * * * * * * Women * * * * * * * * * * E. Sexually transmitted disease Prevalence of genital discharge: Women na na na na na na na na na na Men na na na na na na na na na na Prevalence of genital ulcer: Women na na na na na na na na na na Men na na na na na na na na na na - 3 - India 1998 / 99 - 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 50.9 61.9 74.5 85.7 94.2 71.6 0.54 43.30 0.1387 0.0032 Measles coverage 28.4 38.7 52.2 64.5 81.2 50.7 0.35 52.80 0.2315 0.0048 DPT coverage 36.3 43.3 58.8 72.3 85.0 57.2 0.43 48.72 0.2014 0.0044 Full basic coverage 21.3 28.2 41.0 52.2 63.8 39.4 0.33 42.50 0.2546 0.0064 No basic coverage 25.4 20.3 12.2 6.9 2.2 14.4 11.55 23.20 -0.3869 0.0142 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 40.5 46.9 55.1 55.7 56.8 50.2 0.71 16.30 0.0785 0.0060 Treatment in a public facility 8.1 10.9 10.5 10.6 8.8 9.8 0.92 0.70 0.0447 0.0178 Treatment in a private facility 31.5 34.8 42.7 43.6 46.6 39.1 0.68 15.10 0.0880 0.0071 Treatment of acute respiratory infection (ARI): Medical treatment of ARI 53.3 60.6 71.2 78.4 82.2 66.6 0.65 28.90 0.1007 0.0052 Treatment in a public facility 11.5 14.1 14.6 16.0 14.0 13.9 0.82 2.50 0.1043 0.0187 Treatment in a private facility 41.0 45.2 54.1 60.3 65.7 51.0 0.62 24.70 0.1022 0.0070 Treatment of diarrhea: Use of oral rehydration therapy 36.6 37.9 42.0 48.1 54.9 42.7 0.67 18.22 0.1221 0.0089 Medical treatment of diarrhea 54.6 57.3 67.4 74.1 81.5 65.2 0.67 26.90 0.0880 0.0053 Treatment in a public facility 12.8 13.0 14.9 16.2 12.2 13.9 1.05 0.60 0.0503 0.0180 Treatment in a private facility 40.7 42.8 50.3 54.9 66.2 49.3 0.61 25.50 0.1023 0.0071 C. Antenatal and delivery care Antenatal care visits: To a medically trained person 44.1 55.3 68.6 80.3 92.8 65.7 0.48 48.70 0.1536 0.0023 To a doctor 26.9 37.0 48.6 65.1 83.3 49.3 0.32 56.40 0.2400 0.0029 To a nurse or trained midwife 17.2 18.3 20.0 15.2 9.5 16.5 1.81 7.70 -0.0712 0.0073 Multiple visits to a medically trained person 21.1 30.5 43.9 60.3 81.0 44.2 0.26 59.90 0.2846 0.0032 Antenatal care content: Tetanus toxoid 56.9 67.5 79.1 88.3 95.5 75.5 0.60 38.60 0.1188 0.0018 Prophylactic antimalarial treatment na na na na na na na na na na Iron supplementation 36.8 46.9 60.7 73.1 84.9 58.0 0.43 48.10 0.1846 0.0025 Delivery attendance: By a medically trained person 16.4 25.9 42.0 60.6 84.4 42.4 0.19 68.00 0.3220 0.0031 By a doctor 9.6 16.6 27.6 43.8 69.2 30.3 0.14 59.60 0.3788 0.0044 By a nurse or trained midwife 6.7 9.4 14.4 16.8 15.2 12.1 0.44 8.50 0.1796 0.0085 In a public facility 7.4 11.6 17.8 25.0 23.6 16.3 0.31 16.20 0.3129 0.0074 In a private facility 3.5 6.6 13.6 24.7 50.8 17.4 0.07 47.30 0.4299 0.0071 At home 88.3 81.1 67.9 50.0 25.3 65.8 3.49 63.00 -0.1915 0.0020 D. Contraceptive services Contraceptive prevalence: Women 29.3 34.9 44.9 49.7 54.6 42.8 0.54 25.30 0.1292 0.0022 Men na na na na na na na na na na - 4 - India 1998 / 99 - 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 91.9 89.2 86.0 76.2 51.6 76.0 1.78 40.30 -0.1170 0.0017 Men na na na na na na na na na na Source of contraception - private sector: Women 7.3 9.7 13.0 22.3 46.4 22.6 0.16 39.10 0.3800 0.0055 Men na na na na na na na na na na E. Treatment of adult illnesses Treatment of genital discharge, ulcer, sore: Women na na na na na na na na na na Men na na na na na na na na na na Treatment of genital discharge, ulcer, sore in public facilities: Women na na na na na na na na na na Men na na na na na na na na na na Voluntary counseling and testing for HIV/AIDS: Women na na na na na na na na na na Men na na na na na na na na na na - 5 - India 1998 / 99 - 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 63.9 60.5 57.1 49.4 36.8 55.3 1.74 27.10 -0.1037 0.0084 Timely complementary feeding 23.5 29.1 33.1 40.9 45.0 33.7 0.52 21.50 0.1391 0.0134 Bottle-feeding 8.9 10.0 13.1 21.6 32.1 16.0 0.28 23.20 0.3273 0.0135 D. Micronutrient consumption Iodized salt: Availability of iodized salt 33.0 37.4 42.5 55.9 81.5 49.9 0.40 48.50 0.2174 0.0017 in household Vitamin A: Children 8.8 10.0 14.2 16.3 19.4 13.3 0.45 10.60 0.2052 0.0094 Women na na na na na na na na na na E. Tobacco and alcohol use Tobacco: Women 20.9 15.4 12.4 8.8 4.3 12.3 4.86 16.60 -0.2639 0.0054 Men na na na na na na na na na na Alcohol: Women 5.6 2.7 1.8 0.6 0.2 2.2 28.00 5.40 -0.5263 0.0166 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 27.5 24.2 20.3 15.4 7.8 19.0 3.53 19.70 -0.2131 0.0038 Experienced violence in past year 16.5 13.8 10.9 7.4 3.4 10.4 4.85 13.10 -0.2600 0.0055 - 6 - India 1998 / 99 - 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 9.7 20.5 37.3 57.7 85.6 44.1 0.11 75.90 0.3698 0.0013 Men 36.0 53.4 69.0 81.5 94.9 68.8 0.38 58.90 0.1715 0.0010 School participation: Girls 58.1 72.2 84.1 91.6 97.5 78.2 0.60 39.40 0.1119 0.0017 Boys 70.7 82.5 89.2 94.1 97.6 85.2 0.72 26.90 0.0681 0.0014 B. Exposure to mass media Newspaper readership: Women 1.7 4.5 11.5 24.9 60.9 20.8 0.03 59.20 0.5924 0.0036 Men na na na na na na na na na na Radio listenership: Women 14.3 26.9 38.5 45.9 56.4 36.5 0.25 42.10 0.2480 0.0024 Men na na na na na na na na na Television viewership: Women 9.5 15.9 37.4 71.3 93.6 45.7 0.10 84.10 0.4117 0.0015 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 4.6 8.7 19.3 33.6 59.6 25.3 0.08 55.05 0.4822 0.0030 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 24.4 24.6 26.8 30.3 34.3 28.1 0.71 9.90 0.0867 0.0032 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 38.8 38.0 40.4 42.9 47.5 41.6 0.82 8.70 0.0509 0.0024 Can make meal-related decisions 75.8 72.6 71.6 69.6 66.4 71.2 1.14 9.40 -0.0310 0.0013 Freedom of movement: Can travel to visit family, relatives 19.4 18.7 22.9 25.9 34.9 24.4 0.56 15.50 0.1425 0.0036 Other decisionmaking, attitudes: Can decide how to spend own money 38.1 34.6 37.9 50.8 56.2 41.2 0.68 18.10 0.1084 0.0046 Can decide whether to have sex na na na na na na na na na na Justifies domestic violence 62.0 62.1 63.5 57.0 39.1 56.7 1.59 22.90 -0.1012 0.0018 E. Orphanhood Paternal orphan prevalence na na na na na na na na na na Maternal orphan prevalence na na na na na na na na na na Double orphan prevalence na na na na na na na na na na - 7 - India 1998 / 99 - 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 95.3 76.9 75.2 55.8 32.0 71.1 97.6 84.4 77.3 54.8 43.6 74.8 Under-five mortality rate 149.5 120.9 105.4 73.1 40.4 105.1 133.6 114.9 97.5 66.9 50.2 97.8 Prevalence of fever 29.6 27.3 28.2 29.0 24.8 28.0 30.5 29.8 31.1 29.6 28.1 29.9 Prevalence of diarrhea 21.0 19.0 17.6 17.7 16.7 18.6 19.7 18.6 23.0 18.0 16.2 19.2 Prevalence of acute respiratory 19.9 19.2 17.9 16.9 12.8 17.7 23.2 22.0 22.7 18.2 14.9 20.5 infection (ARI) B. Nutritional status Children: Moderate stunting 24.4 23.7 22.5 23.6 17.9 22.7 25.7 23.5 23.1 20.8 16.9 22.3 Severe stunting 34.0 30.2 26.0 16.5 10.2 24.3 32.2 26.9 22.3 16.2 8.4 21.9 Moderate underweight 32.6 32.7 30.5 28.2 22.5 29.7 32.3 30.8 31.2 25.8 19.8 28.4 Severe underweight 28.9 23.8 20.8 12.1 5.1 19.1 27.4 20.9 16.0 11.8 5.4 16.9 Mild anemia 24.3 23.2 23.1 23.0 24.6 23.6 22.3 22.0 20.6 22.0 23.2 22.0 Moderate anemia 48.1 49.5 46.9 41.9 35.4 45.0 51.0 51.4 47.9 46.2 37.3 47.2 Severe anemia 4.8 5.1 5.1 6.2 2.7 4.9 6.9 6.6 6.5 5.1 4.6 6.0 C. Sexually transmitted disease Prevalence of genital discharge: Women na na na na na na Men na na na na na na Prevalence of genital ulcer: Women na na na na na na Men na na na na na na - 9 - India 1998 / 99 - 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 49.0 60.5 73.7 85.2 93.3 70.3 52.7 63.3 75.4 86.2 95.0 72.8 Measles coverage 27.3 37.0 52.8 64.6 79.3 49.7 29.3 40.3 51.7 64.5 82.8 51.6 DPT coverage 32.1 39.5 57.3 71.8 81.3 53.9 36.0 44.5 57.4 69.4 83.8 56.3 Full basic coverage 20.9 25.5 41.3 51.7 62.0 38.2 21.6 30.8 40.7 52.5 65.4 40.4 No basic coverage 27.4 21.0 12.4 8.1 2.1 15.3 23.6 19.7 12.0 5.7 2.3 13.5 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 36.4 40.3 51.7 53.2 56.8 46.5 44.3 52.4 58.1 57.9 56.7 53.5 Treatment in a public facility 7.2 8.6 9.1 10.0 7.9 8.5 9.0 12.9 11.7 11.2 9.4 10.9 Treatment in a private facility 28.4 31.0 39.6 41.2 47.9 36.4 34.6 37.9 45.3 45.7 45.6 41.4 Treatment of acute respiratory infection (ARI): Medical treatment of ARI 49.3 54.5 70.1 76.9 81.0 63.3 56.6 65.6 72.0 79.6 83.2 69.2 Treatment in a public facility 9.7 11.2 14.7 14.8 14.0 12.5 13.0 16.4 14.5 16.9 14.0 15.0 Treatment in a private facility 38.8 42.1 51.3 60.1 65.8 49.0 42.7 47.7 56.3 60.5 65.6 52.7 Treatment of diarrhea: Use of oral rehydration therapy 44.1 41.8 46.8 54.0 58.1 47.8 37.8 43.6 46.6 53.2 63.9 47.5 Medical treatment of diarrhea 53.2 55.4 66.7 72.7 80.8 63.6 56.1 59.0 67.9 75.3 82.2 66.6 Treatment in a public facility 12.6 11.8 15.3 14.8 10.9 13.1 13.1 14.1 14.7 17.4 13.4 14.5 Treatment in a private facility 39.4 42.5 48.7 54.2 67.7 48.4 42.0 43.1 51.4 55.6 64.7 50.0 C. Contraceptive services Contraceptive prevalence: Women 29.3 34.9 44.9 49.7 54.6 42.8 Men na na na na na na Source of contraception - public sector: Women 91.9 89.2 86.0 76.2 51.6 76.0 Men na na na na na na Source of contraception - private sector: Women 7.3 9.7 13.0 22.3 46.4 22.6 Men na na na na na na D. Treatment of adult illnesses Treatment of genital discharge, ulcer, sore: Women na na na na na na Men na na na na na na Treatment of genital discharge, ulcer, sore in public facilities: Women na na na na na na Men na na na na na na Voluntary counseling and testing for HIV/AIDS: Women na na na na na na Men na na na na na na - 10 - India 1998 / 99 - 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 63.5 62.2 56.3 53.0 34.8 56.0 64.2 58.9 57.8 46.0 38.7 54.7 Timely complementary feeding 22.9 28.7 33.8 42.1 44.0 33.6 24.1 29.3 32.4 40.1 46.0 33.7 Bottle-feeding 7.6 8.4 12.6 20.2 31.4 14.7 10.3 11.4 13.6 22.7 32.7 17.1 D. Micronutrient consumption Vitamin A: Children 8.1 9.4 14.0 15.5 18.3 12.6 9.4 10.7 14.3 16.9 20.3 13.9 E. Tobacco and alcohol use Tobacco: Women 20.9 15.4 12.4 8.8 4.3 12.3 Men na na na na na na Alcohol: Women 5.6 2.7 1.8 0.6 0.2 2.2 Men na na na na na na F. Sexual practices Non-regular sexual partnerships: Women na na na na na na Men na na na na na na Condom usage with non-regular partner: Women na na na na na na Men na na na na na na - 11 - India 1998 / 99 - 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 9.7 20.5 37.3 57.7 85.6 44.1 Men 36.0 53.4 69.0 81.5 94.9 68.8 School participation: Girls 58.1 72.2 84.1 91.6 97.5 78.2 Boys 70.7 82.5 89.2 94.1 97.6 85.2 B. Exposure to mass media Newspaper readership: Women 1.7 4.5 11.5 24.9 60.9 20.8 Men na na na na na na Radio listenership: Women 14.3 26.9 38.5 45.9 56.4 36.5 Men na na na na na na Television viewership: Women 9.5 15.9 37.4 71.3 93.6 45.7 Men na na na na na na C. Knowledge and attitudes about HIV/AIDS Knowledge about sexual transmission of HIV/AIDS: Women 4.6 8.7 19.3 33.6 59.6 25.3 Men na na na na na na Knowledge about mother-to-child transmission of HIV/AIDS: Women na na na na na na Men na na na na na na Attitudes toward HIV/AIDS: Women na na na na na na Men na na na na na na D. Orphanhood Paternal orphan prevalence na na na na na na na na na na na na Maternal orphan prevalence na na na na na na na na na na na na Double orphan prevalence na na na na na na na na na na na na - 12 - India 1998 / 99 - 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 96.6 81.8 76.1 59.3 41.9 79.7 93.9 63.7 77.2 48.7 36.4 49.2 Under-five mortality rate 141.7 119.2 99.2 73.4 49.0 111.4 129.6 95.6 113.2 64.1 44.0 65.4 Prevalence of fever 30.1 28.9 29.6 28.2 27.5 29.2 29.4 23.7 30.4 31.2 26.1 28.2 Prevalence of diarrhea 20.3 18.7 19.9 15.7 16.3 18.8 23.9 19.7 22.6 21.7 16.5 19.3 Prevalence of acute respiratory infection 21.5 20.7 20.2 17.8 15.7 20.1 22.5 19.7 20.8 17.2 13.0 16.0 B. Fertility Total fertility rate 3.4 3.2 2.6 2.3 2.0 3.1 (3.1) 2.9 2.6 2.3 1.7 2.3 Adolescent fertility rate 133.0 131.0 101.0 77.0 45.0 121.0 (149.0) 112.0 108.0 79.0 32.0 68.3 C. Nutritional status Children: Moderate stunting 25.1 23.8 22.9 21.5 17.4 23.2 23.7 19.8 22.1 23.2 17.4 20.2 Severe stunting 33.1 28.2 23.8 16.2 9.9 25.3 32.4 33.3 26.1 16.5 9.0 15.5 Moderate underweight 32.1 32.0 30.4 25.5 18.3 29.7 43.5 27.3 33.4 29.3 22.3 26.8 Severe underweight 28.4 22.0 18.0 10.8 5.5 19.9 22.1 26.5 20.6 13.9 5.2 11.6 Mild anemia 23.3 22.7 21.6 21.8 24.1 22.6 23.1 20.6 23.2 23.5 23.7 23.4 Moderate anemia 49.5 50.4 47.1 43.5 37.2 47.4 53.4 52.5 49.5 45.6 36.0 42.3 Severe anemia 5.9 5.7 5.6 5.4 4.2 5.6 5.9 9.4 7.3 6.0 3.5 5.2 Women: Malnutrition 50.2 46.4 41.5 31.1 17.6 41.1 56.0 47.6 38.4 29.0 13.3 22.7 Mild anemia 40.3 38.2 34.8 32.0 30.5 36.2 39.3 37.1 35.3 33.4 30.2 32.2 Moderate anemia 19.7 16.7 14.3 13.4 10.0 15.8 21.7 17.9 16.0 13.1 10.2 12.3 Severe anemia 2.5 2.1 2.1 1.5 1.2 2.0 4.7 2.1 2.6 1.9 1.0 1.6 D. Female circumcision Prevalence of circumcision: Girls na na na na na na na na na na na na Women na na na na na na na na na na na na Prevalence of occlusion: Girls * * * * * * * * * * * * Women * * * * * * * * * * * * E. Sexually transmitted disease Prevalence of genital discharge: Women na na na na na na na na na na na na Men na na na na na na na na na na na na Prevalence of genital ulcer: Women na na na na na na na na na na na na Men na na na na na na na na na na na na - 13 - India 1998 / 99 - 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 50.9 61.5 74.4 86.1 92.7 67.1 52.8 70.0 75.3 85.0 94.9 86.8 Measles coverage 28.2 38.1 52.0 66.0 78.6 45.3 31.9 49.4 53.4 62.0 82.3 69.2 DPT coverage 34.0 41.8 56.9 70.8 79.1 49.8 38.4 46.2 59.8 70.0 84.1 73.4 Full basic coverage 21.2 27.9 40.7 53.3 61.0 34.9 24.2 32.6 42.9 50.3 65.0 54.8 No basic coverage 25.6 20.6 12.1 6.4 2.5 16.8 19.8 14.8 13.1 7.6 2.1 6.3 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 diseases Treatment of fever: Medical treatment of fever 40.1 46.7 54.2 53.6 56.8 48.1 53.7 50.6 60.3 59.0 56.7 57.6 Treatment in a public facility 8.1 10.8 10.3 10.3 11.3 9.9 8.1 12.6 12.0 11.2 7.5 9.7 Treatment in a private facility 31.2 34.7 41.8 42.2 44.1 37.0 43.2 36.7 47.6 45.9 47.9 46.5 Treatment of acute respiratory infection (ARI): Medical treatment of ARI 53.0 60.7 70.1 77.8 82.1 64.0 (60.8) 58.9 77.3 79.5 82.3 78.0 Treatment in a public facility 11.6 14.4 13.7 16.5 15.1 13.7 (6.6) 9.0 19.5 15.0 13.4 14.4 Treatment in a private facility 40.5 45.0 53.5 59.5 63.9 48.5 (54.3) 48.3 57.6 61.9 66.7 61.8 Treatment of diarrhea: Use of oral rehydration therapy 41.0 42.8 45.4 51.5 57.9 44.8 40.9 42.0 53.4 56.2 62.6 57.0 Medical treatment of diarrhea 54.3 57.3 65.7 73.3 80.7 61.8 64.8 56.8 76.2 75.1 81.9 76.6 Treatment in a public facility 12.9 13.3 14.3 17.4 14.5 14.0 10.7 8.8 18.0 14.8 11.2 13.3 Treatment in a private facility 40.2 42.6 49.4 53.1 62.5 46.0 54.2 45.7 54.9 57.3 67.8 60.4 C. Antenatal and delivery care Antenatal care visits: To a medically trained person 43.5 54.2 67.3 78.5 90.1 59.8 64.6 74.1 76.2 83.4 94.1 86.4 To a doctor 26.3 36.0 46.5 61.2 75.1 41.7 46.5 55.1 60.9 72.0 87.0 76.0 To a nurse or trained midwife 17.2 18.2 20.8 17.4 15.0 18.2 18.1 19.0 15.2 11.4 7.0 10.5 Multiple visits to a medically trained person 20.8 29.8 42.4 57.4 75.3 36.9 31.5 43.4 52.9 65.3 83.6 70.1 Antenatal care content: Tetanus toxoid 56.7 66.7 78.6 88.8 94.9 71.5 63.4 79.7 82.0 87.5 95.8 89.5 Prophylactic antimalarial treatment na na na na na na na na na na na na Iron supplementation 36.4 46.3 60.6 72.3 83.6 52.8 48.2 57.9 61.7 74.4 85.4 76.2 Delivery attendance: By a medically trained person 15.6 25.1 39.7 56.1 76.6 33.5 43.4 39.6 55.2 68.3 88.0 73.3 By a doctor 9.3 16.3 26.2 41.5 59.2 23.0 20.4 20.5 35.6 47.7 73.8 55.8 By a nurse or trained midwife 6.2 8.8 13.5 14.6 17.4 10.5 23.1 19.1 19.6 20.6 14.2 17.5 In a public facility 6.9 11.0 15.7 19.0 19.0 12.6 23.8 21.7 30.6 35.3 25.7 29.1 In a private facility 3.4 6.3 13.2 25.1 42.2 12.1 8.7 11.4 15.9 24.0 54.7 36.0 At home 88.9 82.0 70.5 55.6 38.4 74.7 66.4 66.4 52.7 40.3 19.2 34.5 D. Contraceptive services Contraceptive prevalence: Women 29.1 34.6 45.1 49.8 53.7 39.9 37.3 40.4 43.4 49.4 54.9 51.2 Men na na na na na na na na na na na na - 14 - India 1998 / 99 - RURAL / URBAN POPULATIONS Part II: Intermediate Determinants of HNP Status - HNP SERVICE USE (Cont.) Indicator Wealth Quintiles - Rural Wealth Quintiles - Urban Low 2nd 3rd 4th High Avg. Low 2nd 3rd 4th High Avg. D. Contraceptive services (cont.) Source of contraception - public sector: Women 92.1 89.5 86.3 76.9 60.5 83.2 87.0 85.9 83.8 75.0 48.0 60.1 Men na na na na na na na na na na na na Source of contraception - private sector: Women 7.1 9.4 12.6 21.6 37.9 15.6 13.0 12.9 15.4 23.7 49.8 38.1 Men na na na na na na na na na na na na E. Treatment of adult illnesses Treatment of genital discharge, ulcer, sore: Women na na na na na na na na na na na na Men na na na na na na na na na na na na Treatment of genital discharge, ulcer, sore in public facilities: Women na na na na na na na na na na na na Men na na na na na na na na na na na na Voluntary counseling and testing for HIV/AIDS: Women na na na na na na na na na na na na Men na na na na na na na na na na na na - 15 - India 1998 / 99 - 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 63.7 61.0 58.5 52.6 42.1 58.9 * 53.9 47.3 42.6 34.4 41.0 Timely complementary feeding 23.4 28.5 34.1 39.3 40.7 31.1 (27.4) (38.7) 27.4 43.4 47.3 42.1 Bottle-feeding 8.9 9.6 12.8 20.6 31.3 13.2 10.7 17.7 14.7 23.3 32.5 25.7 D. Micronutrient consumption Iodized salt: Availability of iodized salt 32.9 36.9 41.2 52.5 74.6 42.0 37.3 43.1 48.7 60.9 84.0 70.3 in household Vitamin A: Children 8.7 10.1 14.1 17.0 22.3 12.5 11.4 8.4 14.6 15.1 18.1 16.0 Women na na na na na na na na na na na na E. Tobacco and alcohol use Tobacco: Women 20.7 15.1 11.9 7.9 3.3 13.6 25.9 19.8 15.4 10.4 4.7 8.6 Men na na na na na na na na na na na na Alcohol: Women 5.6 2.8 2.0 0.8 0.3 2.8 4.7 1.7 0.7 0.3 0.2 0.4 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 27.1 23.6 19.6 13.7 7.7 20.6 38.0 32.7 24.7 18.3 7.9 14.4 Experienced violence in past year 16.3 13.4 10.5 6.5 3.0 11.5 21.0 19.7 13.0 9.1 3.5 7.2 - 16 - India 1998 / 99 - 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 9.5 20.4 37.9 58.7 83.5 34.3 14.1 21.1 34.0 55.9 86.5 68.9 Men 35.9 53.7 70.2 83.7 94.8 62.4 38.3 49.4 62.9 78.0 94.9 83.8 School participation: Girls 58.0 72.5 85.0 93.6 98.1 75.0 60.8 67.8 78.4 88.5 97.3 89.3 Boys 70.7 82.9 90.7 95.3 97.9 83.3 69.8 77.7 81.2 92.3 97.6 91.7 B. Exposure to mass media Newspaper readership: Women 1.7 4.4 11.5 24.8 53.8 12.8 1.9 6.4 11.3 25.1 63.9 43.5 Men na na na na na na na na na na na na Radio listenership: Women 14.2 27.0 39.3 49.0 60.3 33.0 16.6 25.7 33.7 40.3 54.8 46.4 Men na na na na na na na na na na na na Television viewership: Women 9.0 14.9 35.3 68.1 91.0 33.4 27.6 32.9 50.1 76.7 94.7 80.6 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 44.7 43.9 47.3 54.6 66.1 48.5 48.2 44.8 50.6 55.9 70.8 62.8 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 24.2 24.1 25.7 27.9 30.6 25.7 33.1 32.2 33.3 34.6 35.8 35.0 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 38.5 37.4 39.0 39.8 42.8 38.9 49.2 47.9 48.9 48.4 49.5 49.0 Can make meal-related decisions 75.7 72.3 70.5 66.8 63.8 71.1 76.5 76.5 78.2 74.7 67.4 71.2 Freedom of movement: Can travel to visit family, relatives 19.1 17.9 21.5 22.5 27.7 20.6 29.7 30.4 31.3 31.9 37.8 35.0 Other decisionmaking, attitudes: Can decide how to spend own money 37.6 33.3 34.6 42.8 47.1 36.5 51.0 48.8 53.2 60.2 58.8 57.0 Can decide whether to have sex na na na na na na na na na na na na Justifies domestic violence 62.0 62.0 63.2 56.7 44.9 60.0 62.6 63.3 65.6 57.5 36.7 47.4 E. Orphanhood Paternal orphan prevalence na na na na na na na na na na na na Maternal orphan prevalence na na na na na na na na na na na na Double orphan prevalence na na na na na na na na na na na na - 17 - . PART II. BASIC TABLES, 1992 / 93 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. India 1992 / 93 - TOTAL POPULATION Part I: HNP STATUS Indicator Wealth Quintiles Low/High Low-High Concentration Index Ratio Diff. Value Standard Low 2nd 3rd 4th High Avg. (Abs. Val.) Errors A. Childhood illness and mortality Infant mortality rate 109.2 106.3 89.7 65.6 44.0 86.3 2.48 65.20 0.1096 0.0025 Under-five mortality rate 154.7 152.9 119.5 86.9 54.3 118.8 2.85 100.40 0.1096 0.0035 Prevalence of fever 20.9 21.5 19.6 19.5 17.9 20.0 1.17 3.00 -0.0347 0.0055 Prevalence of diarrhea 10.2 10.4 10.2 10.1 8.5 9.9 1.20 1.70 -0.0105 0.0083 Prevalence of acute respiratory 7.0 7.2 7.3 5.7 4.2 6.4 1.67 2.80 -0.0862 0.0104 infection (ARI) B. Fertility Total fertility rate 4.1 3.6 3.2 2.8 2.1 3.4 1.95 2.00 -0.1244 0.0001 Adolescent fertility rate 135.0 140.0 116.0 84.0 45.0 116.0 3.00 90.00 -0.1950 0.0005 C. Nutritional status (%) Children: Moderate stunting 23.5 23.2 24.2 23.7 20.3 23.1 1.16 3.20 -0.0317 0.0064 Severe stunting 36.7 35.6 30.2 24.1 14.0 28.8 2.62 22.70 -0.1659 0.0052 Moderate underweight 31.6 33.5 35.1 32.0 25.2 31.7 1.25 6.40 -0.0489 0.0050 Severe underweight 29.4 27.1 21.9 16.5 10.4 21.5 2.83 19.00 -0.1935 0.0062 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 * * * * * * * * * * Women * * * * * * * * * * E. Sexually transmitted disease Prevalence of genital discharge: Women na na na na na na na na na na Men na na na na na na na na na na Prevalence of genital ulcer: Women na na na na na na na na na na Men na na na na na na na na na na - 21 - India 1992 / 93 - 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 41.5 50.6 63.7 75.6 88.3 62.2 0.47 46.80 0.1657 0.0038 Measles coverage 22.8 28.7 42.4 55.5 71.0 42.2 0.32 48.20 0.2604 0.0058 DPT coverage 30.8 36.4 52.7 65.8 83.2 51.7 0.37 52.40 0.2231 0.0047 Full basic coverage 17.1 21.7 34.7 48.2 65.0 35.4 0.26 47.90 0.3061 0.0069 No basic coverage 48.4 40.8 27.5 18.0 7.9 30.0 6.13 40.50 -0.2876 0.0072 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 57.9 61.1 69.0 79.9 81.1 68.5 0.71 23.20 0.0817 0.0042 Treatment in a public facility 17.6 16.3 19.7 19.6 11.6 17.2 1.52 6.00 -0.0069 0.0136 Treatment in a private facility 39.6 43.8 47.9 58.7 68.5 50.1 0.58 28.90 0.1140 0.0059 Treatment of acute respiratory infection (ARI): Medical treatment of ARI 63.8 60.6 67.4 77.7 85.5 68.6 0.75 21.70 0.0724 0.0069 Treatment in a public facility 18.3 18.3 20.4 19.4 13.6 18.5 1.35 4.70 0.0112 0.0222 Treatment in a private facility 44.3 41.3 45.2 56.8 68.8 48.6 0.64 24.50 0.1009 0.0103 Treatment of diarrhea: Use of oral rehydration therapy 29.0 29.8 37.5 40.7 48.3 36.0 0.60 19.30 0.1303 0.0112 Medical treatment of diarrhea 51.8 56.6 60.7 69.1 73.1 61.2 0.71 21.30 0.0688 0.0066 Treatment in a public facility 16.2 14.4 20.2 16.6 12.9 16.3 1.26 3.30 -0.0237 0.0184 Treatment in a private facility 34.7 41.0 38.7 50.0 58.7 43.3 0.59 24.00 0.1052 0.0091 C. Antenatal and delivery care Antenatal care visits: To a medically trained person 25.8 35.0 47.8 66.6 89.6 50.3 0.29 63.80 0.2643 0.0026 To a doctor 19.4 27.1 37.5 53.4 82.1 41.2 0.24 62.70 0.3108 0.0031 To a nurse or trained midwife 6.4 7.9 10.3 13.2 7.5 9.0 0.85 1.10 0.1432 0.0094 Multiple visits to a medically trained person 21.6 30.4 42.8 56.9 81.4 44.1 0.27 59.80 0.2854 0.0029 Antenatal care content: Tetanus toxoid 41.0 49.9 62.3 77.0 92.7 62.4 0.44 51.70 0.1813 0.0020 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 11.9 18.2 30.1 47.9 78.7 34.3 0.15 66.80 0.3794 0.0034 By a doctor 5.2 8.6 16.0 28.7 62.4 21.5 0.08 57.20 0.4935 0.0052 By a nurse or trained midwife 6.6 9.6 14.1 19.2 16.3 12.8 0.40 9.70 0.1877 0.0070 In a public facility 5.1 8.8 13.4 21.6 29.8 14.6 0.17 24.70 0.3733 0.0068 In a private facility 1.2 2.3 5.4 13.9 40.8 10.9 0.03 39.60 0.5952 0.0090 At home 93.2 88.1 80.4 63.9 29.0 73.9 3.21 64.20 -0.1522 0.0015 D. Contraceptive services Contraceptive prevalence: Women 24.9 27.5 36.1 42.0 50.6 36.5 0.49 25.70 0.1446 0.0024 Men na na na na na na na na na na - 22 - India 1992 / 93 - TOTAL POPULATION Part II: Intermediate Determinants of HNP Status - HNP SERVICE USE (Cont.) Indicator Wealth Quintiles Low/High Low-High Concentration Index Ratio Diff. Value Standard Low 2nd 3rd 4th High Avg. (Abs. Val.) Errors D. Contraceptive services (cont.) Source of contraception - public sector: Women 94.2 91.5 89.7 81.6 55.3 78.8 1.70 38.90 -0.1132 0.0017 Men na na na na na na na na na na Source of contraception - private sector: Women 4.3 7.5 9.1 17.4 43.1 19.9 0.10 38.80 0.3700 0.0077 Men na na na na na na na na na na E. Treatment of adult illnesses Treatment of genital discharge, ulcer, sore: Women na na na na na na na na na na Men na na na na na na na na na na Treatment of genital discharge, ulcer, sore in public facilities: Women na na na na na na na na na na Men na na na na na na na na na na Voluntary counseling and testing for HIV/AIDS: Women na na na na na na na na na na Men na na na na na na na na na na - 23 - India 1992 / 93 - 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 66.5 59.2 52.8 40.7 24.1 51.1 2.76 42.40 -0.1542 0.0084 Timely complementary feeding 28.4 25.8 30.5 35.0 39.8 31.5 0.71 11.40 0.0792 0.0134 Bottle-feeding 5.9 8.6 12.7 17.5 31.7 14.2 0.19 25.80 0.4445 0.0145 D. Micronutrient consumption Iodized salt: Availability of iodized salt na na na na na na na na na na in household Vitamin A: Children na na na na na na na na na na Women na na na na na na na na na na E. Tobacco and alcohol use Tobacco: Women na na na na na na na na na na Men na na na na na na na na na na Alcohol: Women na na na na na na na na na na Men na na na na na na na na na na F. Sexual practices Non-regular sexual partnerships: Women na na na na na na na na na na Men na na na na na na na na na na Condom usage with non-regular partner: Women na na na na na na na na na na Men na na na na na na na na na na G. Domestic violence Ever experienced violence na na na na na na na na na na Experienced violence in past year na na na na na na na na na na - 24 - India 1992 / 93 - 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 7.3 14.0 25.2 46.7 80.7 36.6 0.09 73.40 0.4388 0.0016 Men 35.3 44.9 58.8 75.4 92.5 63.0 0.38 57.20 0.1961 0.0011 School participation: Girls 35.0 46.9 63.0 81.6 94.0 61.2 0.37 59.00 0.2039 0.0022 Boys 57.1 66.0 78.0 87.2 95.4 74.9 0.60 38.30 0.1077 0.0017 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 15.5 27.5 40.4 56.5 75.5 43.5 0.21 60.00 0.2950 0.0019 Men na na na na na na na na na na Television viewership: Women 4.2 8.1 15.9 41.9 86.9 31.8 0.05 82.70 0.5720 0.0023 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 * * * * * * * * * * Can decide whether to have sex na na na na na na na na na na Justifies domestic violence na na na na na na na na na na E. Orphanhood Paternal orphan prevalence na na na na na na na na na na Maternal orphan prevalence na na na na na na na na na na Double orphan prevalence na na na na na na na na na na - 25 - India 1992 / 93 - FEMALE / MALE POPULATIONS Part I: HNP STATUS Indicator Wealth Quintiles - Female Wealth Quintiles - Male Low 2nd 3rd 4th High Avg. Low 2nd 3rd 4th High Avg. A. Childhood mortality and morbidity Infant mortality rate 110.1 102.7 84.8 62.0 42.4 83.9 108.3 109.7 94.2 69.0 45.5 88.6 Under-five mortality rate 163.9 158.2 120.3 87.5 54.1 122.5 146.2 147.9 118.8 86.3 54.4 115.4 Prevalence of fever 20.1 20.7 18.7 18.4 16.8 19.1 21.6 22.3 20.5 20.5 18.9 20.9 Prevalence of diarrhea 9.7 10.5 10.2 9.1 8.6 9.7 10.7 10.2 10.2 11.0 8.4 10.2 Prevalence of acute respiratory 6.0 6.8 7.0 5.0 3.7 5.8 7.9 7.7 7.6 6.3 4.7 7.0 infection (ARI) B. Nutritional status Children: Moderate stunting 21.5 22.5 23.6 23.0 20.7 22.3 25.4 24.0 24.8 24.5 19.8 23.8 Severe stunting 37.3 35.3 30.9 25.7 13.5 29.3 36.2 36.0 29.6 22.6 14.5 28.3 Moderate underweight 30.8 32.9 34.1 32.6 24.9 31.3 32.3 34.2 36.1 31.5 25.5 32.1 Severe underweight 29.5 26.0 22.8 17.0 10.2 21.6 29.2 28.3 21.0 16.0 10.5 21.4 Mild anemia na na na na na na na na na na na na Moderate anemia na na na na na na na na na na na na Severe anemia na na na na na na na na na na na na C. Sexually transmitted disease Prevalence of genital discharge: Women na na na na na na Men na na na na na na Prevalence of genital ulcer: Women na na na na na na Men na na na na na na - 27 - India 1992 / 93 - 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 38.8 48.5 62.6 74.4 87.4 60.3 44.1 52.7 64.6 76.6 89.1 64.0 Measles coverage 20.7 26.6 42.1 54.4 70.5 40.6 24.7 30.9 42.7 56.5 71.6 43.7 DPT coverage 28.4 34.6 51.4 65.0 81.6 49.8 33.0 38.3 53.9 66.5 84.6 53.5 Full basic coverage 15.8 20.4 33.6 47.7 64.1 34.1 18.4 23.0 35.7 48.7 65.7 36.7 No basic coverage 52.6 43.7 28.5 18.7 8.5 32.3 44.3 37.8 26.5 17.3 7.3 27.8 Hepatitis B coverage na na na na na na na na na na na na Yellow fever coverage na na na na na na na na na na na na B. Treatment of childhood illnesses Treatment of fever: Medical treatment of fever 52.7 57.9 66.8 76.3 78.2 64.9 62.4 64.1 70.9 82.9 83.6 71.6 Treatment in a public facility 15.9 15.3 19.5 20.2 10.2 16.5 19.0 17.2 19.8 19.0 12.8 17.9 Treatment in a private facility 36.2 41.6 45.8 54.8 67.1 47.3 42.5 46.0 49.7 62.0 69.7 52.5 Treatment of acute respiratory infection (ARI): Medical treatment of ARI 56.8 55.1 64.6 73.2 77.1 63.1 68.7 65.5 69.9 81.0 91.7 73.0 Treatment in a public facility 19.0 15.5 20.4 17.9 14.6 17.8 17.8 20.8 20.4 20.6 12.9 19.1 Treatment in a private facility 36.6 38.9 43.2 53.7 58.3 43.9 49.6 43.5 47.0 59.1 76.6 52.3 Treatment of diarrhea: Use of oral rehydration therapy 26.8 28.7 35.4 39.9 46.9 34.4 30.8 30.9 39.5 41.3 49.8 37.4 Medical treatment of diarrhea 48.4 56.5 57.0 67.4 72.2 59.1 54.6 56.7 64.2 70.5 74.0 63.0 Treatment in a public facility 14.9 14.2 21.2 18.2 12.9 16.4 17.3 14.5 19.3 15.4 13.0 16.1 Treatment in a private facility 32.6 40.8 34.9 46.7 57.6 41.2 36.3 41.2 42.3 52.6 59.7 45.2 C. Contraceptive services Contraceptive prevalence: Women 24.9 27.5 36.1 42.0 50.6 36.5 Men na na na na na na Source of contraception - public sector: Women 94.2 91.5 89.7 81.6 55.3 78.8 Men na na na na na na Source of contraception - private sector: Women 4.3 7.5 9.1 17.4 43.1 19.9 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 - 28 - India 1992 / 93 - 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 67.7 61.0 56.3 43.1 26.7 53.7 65.5 57.3 48.9 38.5 22.1 48.7 Timely complementary feeding 29.4 25.6 30.8 34.8 46.5 32.8 27.4 26.0 30.2 35.2 33.4 30.2 Bottle-feeding 4.7 8.5 10.9 16.3 31.2 13.3 7.0 8.7 14.5 18.7 32.1 15.2 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 - 29 - India 1992 / 93 - 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 7.3 14.0 25.2 46.7 80.7 36.6 Men 35.3 44.9 58.8 75.4 92.5 63.0 School participation: Girls 35.0 46.9 63.0 81.6 94.0 61.2 Boys 57.1 66.0 78.0 87.2 95.4 74.9 B. Exposure to mass media Newspaper readership: Women na na na na na na Men na na na na na na Radio listenership: Women 15.5 27.5 40.4 56.5 75.5 43.5 Men na na na na na na Television viewership: Women 4.2 8.1 15.9 41.9 86.9 31.8 Men na na na na na na C. Knowledge and attitudes about HIV/AIDS Knowledge about sexual transmission of HIV/AIDS: Women na na na na na na Men na na na na na na Knowledge about mother-to-child transmission of HIV/AIDS: Women na na na na na na Men na na na na na na Attitudes toward HIV/AIDS: Women na na na na na na Men na na na na na na D. Orphanhood Paternal orphan prevalence na na na na na na na na na na na na Maternal orphan prevalence na na na na na na na na na na na na Double orphan prevalence na na na na na na na na na na na na - 30 - India 1992 / 93 - 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 108.9 107.2 90.3 64.9 51.3 94.3 121.2 94.2 85.1 67.1 41.9 59.4 Under-five mortality rate 155.0 153.8 119.5 85.4 63.9 130.9 143.6 141.6 119.5 90.0 51.5 78.3 Prevalence of fever 20.8 21.2 19.6 20.0 20.2 20.4 26.4 25.4 19.5 18.5 17.2 18.5 Prevalence of diarrhea 10.3 10.2 10.4 10.3 10.2 10.3 4.9 12.0 9.0 9.5 8.0 8.7 Prevalence of acute respiratory infection 7.0 7.2 7.3 5.8 5.2 6.8 6.8 7.8 7.7 5.3 4.0 5.1 B. Fertility Total fertility rate 4.1 3.7 3.2 2.8 2.2 3.7 (4.3) 3.5 3.2 2.9 2.1 2.7 Adolescent fertility rate 135.0 138.0 115.0 84.0 57.0 130.9 (146.0) 156.0 126.0 82.0 41.0 75.3 C. Nutritional status Children: Moderate stunting 23.2 23.2 23.9 23.7 19.3 23.2 35.2 23.4 26.1 23.8 20.6 22.6 Severe stunting 36.7 35.2 30.5 22.2 12.7 30.8 36.9 42.0 28.2 28.5 14.5 21.9 Moderate underweight 31.2 33.6 35.2 30.7 26.2 32.3 48.1 32.5 34.5 35.4 24.9 29.7 Severe underweight 29.4 26.8 21.4 15.6 8.8 23.1 28.4 31.3 24.4 18.7 10.9 16.1 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 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 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 * * * * * * * * * * * * Women * * * * * * * * * * * * E. Sexually transmitted disease Prevalence of genital discharge: Women na na na na na na na na na na na na Men na na na na na na na na na na na na Prevalence of genital ulcer: Women na na na na na na na na na na na na Men na na na na na na na na na na na na - 31 - India 1992 / 93 - 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 41.4 50.8 63.6 76.4 89.3 57.6 46.4 48.5 63.7 73.7 87.9 77.6 Measles coverage 22.6 29.1 42.5 57.9 72.7 37.7 28.7 24.2 41.7 50.1 70.5 57.5 DPT coverage 30.7 36.8 52.9 68.0 82.0 46.6 32.4 31.5 50.8 60.9 83.5 68.9 Full basic coverage 17.1 21.9 34.8 50.8 66.0 30.9 16.6 18.0 33.9 42.5 64.7 50.8 No basic coverage 48.4 40.6 27.7 17.1 8.3 34.0 46.1 42.8 25.6 19.9 7.7 16.4 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 57.8 59.8 67.9 78.3 80.7 65.3 62.1 75.0 76.3 83.7 81.3 80.2 Treatment in a public facility 17.7 16.5 20.6 19.8 18.2 18.4 12.1 14.4 14.0 19.1 9.3 13.0 Treatment in a private facility 39.3 42.5 45.8 56.8 60.9 45.7 50.0 58.1 61.6 63.4 71.2 66.1 Treatment of acute respiratory infection (ARI): Medical treatment of ARI 63.3 60.1 67.5 78.7 84.1 66.6 * 65.6 67.1 75.1 86.0 77.5 Treatment in a public facility 17.9 18.5 20.2 19.3 11.0 18.6 * 15.4 21.7 19.8 14.6 18.1 Treatment in a private facility 44.1 40.6 45.4 57.8 70.0 46.5 * 50.2 44.3 54.4 68.4 57.8 Treatment of diarrhea: Use of oral rehydration therapy 29.1 29.4 37.4 42.1 50.4 34.5 * 33.7 38.5 37.4 47.6 41.8 Medical treatment of diarrhea 51.9 55.4 60.5 69.5 78.4 59.2 * 69.2 62.1 68.2 71.1 68.7 Treatment in a public facility 16.0 13.6 20.8 17.2 24.2 17.1 * 22.1 16.2 15.3 8.6 13.0 Treatment in a private facility 34.8 40.7 38.1 49.8 52.6 40.6 * 43.9 43.1 50.6 60.9 53.7 C. Antenatal and delivery care Antenatal care visits: To a medically trained person 25.5 33.8 45.9 64.7 86.3 42.0 41.6 50.7 60.9 70.7 90.6 78.2 To a doctor 19.1 25.9 35.2 49.2 72.3 32.3 32.1 43.0 53.5 62.5 85.0 71.5 To a nurse or trained midwife 6.4 7.9 10.7 15.5 14.0 9.7 9.4 7.6 7.4 8.2 5.6 6.7 Multiple visits to a medically trained person 21.4 30.2 42.1 56.9 77.3 37.2 28.0 34.0 47.2 57.0 82.6 67.3 Antenatal care content: Tetanus toxoid 40.7 49.3 61.8 77.9 91.3 56.6 53.5 57.7 65.4 75.0 93.1 81.9 Prophylactic antimalarial treatment na na na na na na na na na na na na Iron supplementation na na na na na na na na na na na na Delivery attendance: By a medically trained person 11.5 16.9 27.7 44.6 69.8 25.1 26.5 35.6 45.7 55.1 81.3 65.5 By a doctor 5.1 7.8 14.7 26.0 52.7 13.9 10.6 19.2 24.5 34.7 65.3 47.7 By a nurse or trained midwife 6.4 9.1 13.0 18.6 17.1 11.3 15.9 16.5 21.2 20.4 16.1 17.9 In a public facility 4.8 7.5 11.3 17.3 23.6 10.0 17.9 25.4 26.9 31.3 31.6 30.2 In a private facility 1.2 2.2 5.0 13.5 33.6 6.0 1.6 3.6 7.9 15.0 42.9 27.5 At home 93.5 89.5 82.9 68.7 42.8 83.4 80.5 70.8 64.2 53.3 24.9 41.8 D. Contraceptive services Contraceptive prevalence: Women 24.9 27.2 36.3 42.7 50.5 33.3 27.0 31.1 34.2 40.3 50.6 45.3 Men na na na na na na na na na na na na - 32 - India 1992 / 93 - RURAL / URBAN POPULATIONS Part II: Intermediate Determinants of HNP Status - HNP SERVICE USE (Cont.) Indicator Wealth Quintiles - Rural Wealth Quintiles - Urban Low 2nd 3rd 4th High Avg. Low 2nd 3rd 4th High Avg. D. Contraceptive services (cont.) Source of contraception - public sector: Women 94.2 91.9 90.3 82.3 63.9 86.8 91.2 86.2 84.5 79.7 52.8 61.9 Men na na na na na na na na na na na na Source of contraception - private sector: Women 4.2 7.0 8.5 16.9 35.4 12.1 5.9 13.0 14.2 18.4 45.3 36.2 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 - 33 - India 1992 / 93 - 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 66.8 59.3 53.9 41.6 22.1 55.6 * 56.9 45.7 38.3 24.8 33.8 Timely complementary feeding 28.0 26.8 30.8 35.4 42.1 30.4 * 13.2 28.7 34.1 39.1 34.9 Bottle-feeding 5.8 8.4 12.4 17.1 29.4 11.1 9.0 12.1 14.7 18.5 32.3 24.8 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 Men na na na na na na na na na na na na G. Domestic violence Ever experienced violence na na na na na na na na na na na na Experienced violence in past year na na na na na na na na na na na na - 34 - India 1992 / 93 - 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 7.3 14.1 25.0 49.5 80.1 26.4 5.3 12.8 25.9 40.3 80.9 62.8 Men 35.4 45.5 59.8 79.0 92.9 56.1 33.3 37.5 52.5 67.8 92.5 79.6 School participation: Girls 34.9 46.6 63.1 83.3 95.4 54.9 37.5 50.0 62.5 78.1 93.7 81.9 Boys 57.2 66.4 78.8 89.0 96.5 71.4 52.4 60.9 72.9 83.7 95.1 86.2 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 15.3 27.3 40.1 58.3 76.1 36.4 25.7 29.4 42.1 52.3 75.3 63.5 Men na na na na na na na na na na na na Television viewership: Women 4.0 7.4 14.4 39.2 81.1 18.9 11.6 17.2 26.8 48.3 88.5 68.2 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 * * * * * * * * * * * * Can decide whether to have sex na na na na na na na na na na na na Justifies domestic violence na na na na na na na na na na na na E. Orphanhood Paternal orphan prevalence na na na na na na na na na na na na Maternal orphan prevalence na na na na na na na na na na na na Double orphan prevalence na na na na na na na na na na na na - 35 - PART III. TECHNICAL NOTES A. INDICATOR DEFINITIONS B. DATA AND METHODS C. DISCUSSION INDICATOR DEFINITIONS Part I: HNP STATUS A. CHILDHOOD MORTALITY AND ILLNESS 2 Infant mortality rate: number of deaths to children under 12 months of age per 1,000 live births, based on experience during the ten years preceding the survey. Under-five mortality rate: number of deaths to children under five years of age per 1,000 live births, based on experience during the ten years preceding the survey. Prevalence of fever: percent of children who had fever, whether or not accompanied by cough or rapid breathing, in the two weeks before the survey. Prevalence of diarrhea: percent of children who had diarrhea in the two weeks before the survey. Prevalence of acute respiratory infection: percent of children who had a cough accompanied by rapid or difficult breathing in the two weeks before the survey. B. FERTILITY Total fertility rate (TFR): average number of births a woman could expect to have during her lifetime if she followed the levels of fertility currently observed at every age. The TFR is calculated as the sum of average annual age-specific fertility rates for all reproductive age groups (usually 15-49 years) in the three years before the survey. Adolescent fertility rate: age-specific fertility rate for women 15-19 years of age. This is the average number of births among women aged 15-19 years per 1,000 women in that age group, based on births in the three years before the survey and expressed as annual averages. 2Figures for the prevalence of fever, diarrhea, and acute respiratory infection refer to percent of children under three, four, or five years of age, depending upon the country. (The specific ages covered for in particular country may be determined by consulting the full report on that country's DHS, which may be found at: www.measuredhs.com/countries.) - 39 - C. NUTRITIONAL STATUS Children 3, 4, 5 Moderate stunting (height-for-age): percent of children with a height-for-age Z-score of between ­2 and ­3 standard deviations of the median reference standard for their age (as defined in fn. 4). Severe stunting (height-for-age): percent of children with a height-for-age Z-score of below ­3 standard deviations of the median reference standard for their age (as defined in fn. 4). Moderate underweight (weight-for-age): percent of children with a weight-for-age Z-score of between ­2 and ­3 standard deviations of the median reference standard for their age (as defined in fn. 4). Severe underweight (weight-for-age): percent of children with a weight-for-age Z-score of below ­3 standard deviations of the median reference standard for their age (as defined in fn. 4). Mild anemia: percent of children with a hemoglobin level of between 10.0g/dl and 10.9 g/dl, the World Health Organization criterion for mild anemia. Moderate anemia: percent of children with a hemoglobin level of between 7.0g/dl and 9.9g/dl, the World Health Organization criterion for moderate anemia. Severe anemia: percent of children with a hemoglobin level of below 7.0g/dl, the World Health Organization criterion for severe anemia. Women 6, 7 Malnutrition: percent of women aged 15-49 years with a Body Mass Index (BMI) of less than 18.5, where BMI ­ commonly used to indicate adult nutritional status ­ is defined as weight in kilograms divided by the square of height in meters. Mild anemia: percent of women aged 15-49 years with a hemoglobin level of between 10.0g/dl and 10.9g/dl for pregnant women and between 10.0g/dl and 11.9g/dl for non-pregnant women, the World Health Organization criterion for mild anemia. Moderate anemia: percent of women aged 15-49 years with a hemoglobin level of between 7.0g/dl and 9.9g/dl, the World Health Organization criterion for moderate anemia. Severe anemia: percent of women aged 15-49 years with a hemoglobin level of less than 7.0g/dl, the World Health Organization criterion for severe anemia. 3 All figures related to children's nutrition status refer to children under three, four, or five years of age, depending upon the country. (The specific ages covered for in particular country may be determined by consulting the full report on the DHS of the country concerned, which is available at: www.measuredhs.com/countries.) 4 The reference standards used for stunting and underweight are those established in the 1970s by the World Health Organization, the U.S. Centers for Disease Control, and the U.S. National Center for Health Statistics. Updated stunting and underweight figures based on the recently-released, 2006 World Health Organization reference standards are currently under preparation. When complete, they will be available at: www.worldbank.org/povertyandhealth/ countrydata. 5The anemia figures for children living at an altitude above 1,000 meters have been adjusted to reflect the higher level of hemoglobin required. 6In some countries, the BMI is presented for all women; in others, the figure is available only for mothers of children under five years of age. The reference population for any given country can be determined by consulting the full report on the DHS for the country concerned. An electronic version of this report is located at: www.measuredhs.com/ countries. 7 Anemia cut-off points for respondents who live at an altitude above 1,000 meters and/or who smoke have been adjusted to account for their higher hemoglobin requirements. - 40 - D. FEMALE CIRCUMCISION Prevalence of Circumcision Girls: percent of women aged 15-49 years with one or more daughters, at least one of whom had been circumcised. Women: percent of women aged 15-49 years who had been circumcised. Prevalence of Occlusion Girls: percent of women aged 15-49 years with one or more daughters, at least one of whom had been circumcised with the vaginal area sewn closed. Women: percent of women aged 15-49 years whose vaginal area had been sewn closed. E. SEXUALLY TRANSMITTED DISEASES Prevalence of Genital Discharge Women: percent of women aged 15-49 years who had had abnormal genital discharge in the twelve months before the survey. Men: percent of men aged 15-54 years who had had abnormal genital discharge in the twelve months before the survey. Prevalence of Genital Ulcer or Sore Women: percent of women aged 15-49 years who had had a genital ulcer or sore in the twelve months before the survey. Men: percent of men aged 15-54 years who had had a genital ulcer or sore in the twelve months before the survey. - 41 - Part II: INTERMEDIATE DETERMINANTS OF HNP STATUS ­ HEALTH SERVICE USE A. CHILDHOOD IMMUNIZATION 8 BCG coverage: percent of children who had received a dose of BCG vaccine by the time of the survey. Measles coverage: percent of children who had received a dose of measles vaccine by the time of the survey. DPT coverage: percent of children who had received three doses of DPT vaccine by the time of the survey. Full basic coverage: percent of children who had received a dose of BCG vaccine, measles vaccine, and three doses of DPT and polio vaccines by the time of the survey, excluding polio vaccine given at birth. No basic coverage: percent of children who had received no vaccination against the six early- childhood diseases (TB, measles, polio, diphtheria, pertusis, and tetanus) by the time of the survey. Hepatitis B coverage: percent of children who had received three doses of hepatitis B vaccine by the time of the survey. Yellow fever coverage: percent of children who had received a dose of yellow fever vaccine by the time of the survey. B. TREATMENT OF CHILDHOOD ILLNESSES 9 Treatment of Fever Medical treatment of fever: percent of children with fever, with or without cough or rapid breathing, in the two weeks before the survey who had sought medical advice for fever from any health facility or health provider, whether public or private. Treatment in a public facility: percent of children with fever, with or without cough or rapid breathing, in the two weeks before the survey who had sought medical advice for fever from a public-sector health facility or provider (as defined in fn. 9). Treatment in a private facility: percent of children with fever, with or without cough or rapid breathing, in the two weeks before the survey who had sought medical advice for fever from a private-sector health facility or provider (as defined in fn. 9). 8Childhood immunization figures refer to rates among children 12-23 months of age in all countries except those in Latin America and the Caribbean. There, the figures refer to rates among children 18-29 months of age. All figures are based on information recorded on the child's vaccination card; or, in cases where a card was not seen by the interviewer, on the mother's report. 9Figures for illness treatment in a public facility refer to treatment in government hospitals, health centers, health posts, or dispensaries; or in facilities operated by government-affiliated social securing programs. Figures for treatment in private facilities cover treatment in private hospitals or clinics, in private doctors' offices, or in facilities operated by other private medical providers (such as non-governmental organizations) as defined in the country concerned; but exclude treatment obtained in private pharmacies or shops. - 42 - Treatment of Acute Respiratory Infection (ARI) Medical treatment of ARI: percent of children with a cough and rapid breathing in the two weeks before the survey who had been taken for treatment at any medical facility or provider, whether public or private. Treatment in a public facility: percent of children with a cough and rapid breathing in the two weeks before the survey who had been taken for treatment at a public-sector health facility or provider (as defined in fn. 9). Treatment in a private facility: percent of children with a cough and rapid breathing in the two weeks before the survey who had been taken for treatment at a private-sector health facility or provider (as defined in fn. 9). Treatment of Diarrhea Use of oral rehydration therapy: percent of children with diarrhea in the two weeks before the survey who had received oral rehydration therapy (ORT) (defined as including consumption of oral rehydration salts, other recommended home fluids, or other increased liquids). Medical treatment of diarrhea: percent of children with diarrhea in the two weeks before the survey who had been taken for treatment at any medical facility or provider, whether public or private. Treatment in a public facility: percent of children with diarrhea in the two weeks before the survey who had been taken for treatment at a public-sector health facility or provider (as defined in fn. 9). Treatment in a private facility: percent of children with diarrhea in the two weeks before the survey who had been taken for treatment at a private-sector health facility or provider (as defined in fn. 9). C. ANTENATAL AND DELIVERY CARE 10 Antenatal Care (ANC) Visits To a medically-trained person: percent of women with one or more births in the five years before the survey who had received at least one antenatal care consultation from a medically- trained person (as defined in fn. 10) before her most recent birth. To a doctor: percent of women with one or more births in the five years before the survey who had received at least one antenatal care consultation from a doctor before her most recent birth. To a nurse or trained midwife: percent of women with one or more births in the five years before the survey who had received at least one antenatal care consultation from a nurse or trained midwife (as defined in fn. 10) before her most recent birth. Multiple visits to a medically-trained person: percent of women with one or more births in the five years before the survey who had received at least three antenatal care consultations from any medically-trained provider (as defined in fn. 10) before her most recent birth. 10When speaking of antenatal and delivery care, medically-trained persons are defined as doctors, nurses, and trained midwives. The definition excludes traditional midwives or other traditional birth attendants, whether trained or untrained. - 43 - Antenatal Care (ANC) Content Tetanus toxoid: percent of women with one or more births in the five years before the survey who had received at least one tetanus toxoid injection during her most recent pregnancy. Prophylactic antimalarial treatment: percent of women with one or more births in the five years before the survey who had received prophylactic treatment with any anti-malarial drug during her most recent pregnancy. Iron supplementation: percent of women with one or more births in the five years before the survey who had taken iron tablets during her most recent pregnancy. Delivery Attendance By a medically-trained person: percent of births in the five years before the survey attended by a medically-trained person (as defined in fn. 10). By a doctor: percent of births in the five years before the survey attended by a doctor. By a nurse or trained midwife: percent of births in the five years before the survey attended to by a nurse or a trained midwife (as defined in fn. 10). In a public facility: percent of all deliveries in the five years before the survey occurring in a public-sector health facility (as defined in fn. 9). In a private facility: percent of all deliveries in the five years before the survey occurring in a private-sector health facility (as defined in fn. 9). At home: percent of all deliveries in the five years before the survey occurring at home (defined as the woman's own or any other home). D. CONTRACEPTIVE SERVICES Contraceptive Prevalence 11 Women: percent of married or in-union women aged 15-49 years who used any modern means of contraception (as defined in fn. 11). Men: percent of married or in-union men aged 15-54 years who used any modern means of contraception (as defined in fn. 11). Source of Contraception - Public Sector Women: percent of married women who obtained their current method of contraception from a public-sector health facility or provider (as defined in fn. 9). Men: percent of married men who obtained their current method of contraception from a public- sector health facility or provider (as defined in fn. 9). 11Figures refer to use of modern means of contraception, defined as male/female sterilization, oral contraceptive pill, contraceptive injection, intrauterine device, male/female condom, diaphragm, cervical cap, contraceptive jelly or foam, implant, or some country-specific modern method. - 44 - Source of Contraception - Private Sector Women: percent of married women who obtained their current method of contraception from a private-sector health facility or provider (as defined in fn. 9, except that private pharmacies and shops are included rather than excluded). Men: percent of married women who obtained their current method of contraception from a private-sector health facility or provider (as defined in fn. 9, except that private pharmacies and shops are included rather than excluded). E. TREATMENT OF ADULT ILLNESSES Treatment of Genital Discharge, Ulcer, or Sore Women: percent of women with genital discharge, ulcer, or sore who sought any medical treatment for resulting symptoms. Men: percent of men with genital discharge, ulcer, or sore who sought any medical treatment for resulting symptoms. Treatment of Genital Discharge, Ulcer, or Sore in a Public Facility Women: percent of women with genital discharge, ulcer, or sore who sought treatment from a public-sector health facility or provider (as defined in fn. 9). Men: percent of men with genital discharge, ulcer, or sore who sought treatment from a public- sector health facility or provider (as defined in fn. 9). Voluntary Counseling and Testing for HIV/AIDS Women: percent of women aged 15-49 years who had been tested for HIV at any time before the survey. Men: percent of men aged 15-54 years who had been tested for HIV at any time before the survey. - 45 - Part III: INTERMEDIATE DETERMINANTS OF HNP STATUS ­ INDIVIDUAL AND HOUSEHOLD BEHAVIOR A. HYGIENIC PRACTICES Disposal of Children's Stools Sanitary disposal: percent of mothers with at least one child under five years of age who disposed of the stools of their youngest child in a sanitary manner (defined as dropping stool into a latrine, burying it, or using disposable diapers). Handwashing Wash hands prior to preparing food: percent of women aged 15-49 years preparing meals who washed hands before handling food. Handwashing facilities in household: percent of households that had hand-washing materials or facilities, as determined by direct observation of interviewers. B. BEDNET OWNERSHIP AND USE Bednet Ownership Bednet ownership: percent of households owning one or more bednets. Treated bednet ownership: percent of households owning one or more bednets that had recently been treated with insecticides. Bednet Use By children: percent of households with at least one child under five years of age, some or all of whom had slept under a bednet the night before the survey. By pregnant women: percent of currently pregnant women who had slept under a bednet the night before the survey. C. BREASTFEEDING Exclusive breastfeeding: percent of children 0-3 months of age who had received only breast milk in the 24 hours before the survey. Timely complementary feeding: percent of children 6-9 months of age who had received breast milk and solid or semi-solid foods in the twenty-four hours before the survey. Bottle-feeding: percent of children under 12 months of age who had received any food or drink from a bottle with a nipple in the twenty-four hours before the survey. - 46 - D. MICRONUTRIENT CONSUMPTION Iodized Salt Availability of iodized salt in household: percent of households with cooking salt testing positive for iodine/iodate at the recommended level of 15 or 25 parts per million or more (depending on the country). 12 Vitamin A Children: percent of children13 who had received at least one dose of vitamin A in the six months before the survey, as reported by the mothers. Women: percent of women who had received a dose of vitamin A within two months of the last birth, in the five years before the survey. E. TOBACCO AND ALCOHOL USE Tobacco 14 Women: percent of women aged 15-49 years who currently were smoking or chewing tobacco products. Men: percent of men aged 15-54 years who currently were smoking or chewing tobacco products. Alcohol Women: percent of women aged 15-49 years who had gotten intoxicated due to excessive consumption of alcohol in the three months before the survey. Men: percent of men aged 15-54 years who had gotten intoxicated due to excessive consumption of alcohol in the three months before the survey. F. SEXUAL PRACTICES Non-Regular Sexual Partnerships Women: percent of women aged 15-49 years who had had sex with a non-regular partner at least once in the twelve months before the survey. Men: percent of men aged 15-54 years who had had sex with a non-regular partner at least once in the twelve months before the survey. 12Which of these two levels is recommended in any particular country may be determined by consulting the full report on that country's DHS, which may be found at: www.measuredhs.com/countries. 13Figures refer to children over six months of age and under three, four, or five years of age, depending upon the country. (The specific ages covered for in a particular country may be determined by consulting the full report on that country's DHS, which is available at: www.measuredhs.com/countries.) 14Tobacco products include cigarettes, pipes, cigars, leaves, etc. - 47 - Condom Usage with Non-Regular Partner Women: percent of women aged 15-49 years with non-regular sexual partner who had used a condom in the last sexual intercourse with such a partner in the twelve months before the survey. Men: percent of men aged 15-54 years with non-regular sexual partner who had used a condom in the last sexual intercourse with such a partner in the twelve months before the survey. G. DOMESTIC VIOLENCE Ever experienced violence: percent of women aged 15-49 years who had ever been hit or beaten by current or former husband/partner. Experienced violence in past year: percent of women aged 15-49 years who had been hit or beaten by current or former husband/partner in the twelve months before the survey. - 48 - Part IV: UNDERLYING DETERMINANTS OF HNP STATUS A. EDUCATION School Completion Women: percent of women aged 15-49 years who had completed the fifth grade. Men: percent of men aged 15-54 years who had completed the fifth grade. School Participation Girls: percent of girls aged 6-10 years who were attending school at the time of the survey. Boys: percent of boys aged 6-10 years who were attending school at the time of the survey. B. EXPOSURE TO MASS MEDIA Newspaper Readership Women: percent of women aged 15-49 years who read a newspaper at least once a week. Men: percent of men aged 15-54 years who read a newspaper at least once a week. Radio Listenership Women: percent of women aged 15-49 years who listened to radio at least once a week. Men: percent of men aged 15-54 years who listened to radio at least once a week. Television Viewership Women: percent of women aged 15-49 years who watched television at least once a week. Men: percent of men aged 15-54 years who watched television at least once a week. C. KNOWLEDGE AND ATTITUDES ABOUT HIV/AIDS Knowledge about Sexual Transmission of HIV/AIDS 15 Women: percent of women aged 15-49 years who knew of HIV/AIDS and of at least one of the following ways to avoid it through interruption of its sexual transmission route: abstinence; using a condom; avoiding multiple sex partners, sex with prostitutes, and unprotected homosexual sex. Men: percent of men aged 15-54 years who knew of HIV/AIDS and of at least one of the ways to avoid HIV/AIDS referred to in the preceding definition. 15In most countries, the survey sample included both married and unmarried individuals. Where this was the case, all respondents, regardless of marital status, were asked the question covered in this section. Where the survey covered only individuals who were or had been married, the data pertain only to individuals who had ever been married. (The marital status of people covered for in particular country is indicated in the full report on that country's DHS, which is located at: www.measuredhs.com/countries.) - 49 - Knowledge about Mother-to-Child Transmission of HIV/AIDS Women: percent of women aged 15-49 years who knew of at least one way HIV/AIDS can be transmitted from mother to child during pregnancy, delivery, or breastfeeding. Men: percent of men aged 15-54 years who knew of at least one way HIV/AIDS can be transmitted from mother to child during pregnancy, delivery, or breastfeeding. Attitudes toward HIV/AIDS Women: percent of women aged 15-49 years who believed that people with HIV/AIDS should be allowed to continue working or that HIV test results should remain confidential. Men: percent of men aged 15-54 years who believed that people with HIV/AIDS should be allowed to continue working or that HIV test results should remain confidential. D. STATUS OF WOMEN Household Decisionmaking Can seek own health care: percent of women age 15-49 years who could decide by themselves to seek their own health care. Can seek children's health care: percent of women aged 15-49 years, whose children live with them, who could decide by themselves to seek health care for their children. Can make daily household purchases: percent of women aged 15-49 years who could decide by themselves or jointly with others to make daily household purchases. Can make large household purchases: percent of women aged 15-49 years who could decide by themselves or jointly with others to make large household purchases. Can make meal-related decisions: percent of women aged 15-49 years who could decide by themselves what food to cook daily. Freedom of Movement Can travel to visit family, relatives: percent of women aged 15-49 years who could decide by themselves to visit family and relatives. Other Decisionmaking, Attitudes Can decide how to spend own money: percent of women aged 15-49 years who work for cash who could decide by themselves on how to use the money they earn. Can decide whether to have sex: percent of women aged 15-49 years agreeing that they can refuse to have sex with their husband for at least one of the following reasons: he has a sexually- transmitted disease; he has had sexual relations with another woman; or the woman is tired, not in mood, or recently has given birth. Justify domestic violence: percent of women aged 15-49 years believing that a husband/male partner would be justified in beating his wife/female partner for at least one of the following reasons: he suspects her of being unfaithful; she argues with him; she goes out without telling him; she neglects the children; she burns the food; or other, country-specific reasons (for example, she shows disrespect for her in-laws or her family does not give the expected dowry). - 50 - E. ORPHANHOOD Maternal orphan prevalence: percent of children under 15 years of age whose natural mother had died before the survey. Paternal orphan prevalence: percent of children under 15 years of age whose natural father had died before the survey. Double orphan prevalence: percent of children under 15 years of age both of whose natural parents had died before the survey. - 51 - DATA AND METHODS Any assessment of the figures featured in this report requires an appreciation of how they were prepared. The first need is to understand the basic features of the data and methods employed. A. SOURCE OF FIGURES The figures appearing in this report are all derived from data collected under the Demographic and Health Surveys (DHS) program conducted by ORC Macro, with support from the U.S. Agency for International Development and other external assistance organizations. Large DHS household surveys have been carried out, usually at periodic intervals, in approximately seventy- five countries across Africa, Asia, Latin America, the Middle East, and the former Soviet Union.16 This series of reports covers the fifty-six of those countries that had one or more DHS surveys undertaken since 1990, for which data were publicly available as of June 2006. (Annex C is a list of the countries for which reports have been prepared.) In each country, the DHS program has gathered information on a large number of indicators about health, nutrition, and population (hnp) status and service use; about relevant behaviors of household members; and about household characteristics like those described below. It has done this through a set of questionnaires, similar in all countries, to collect data at the individual, household, and community levels. The data presented here draw on responses to the individual and household questionnaires. In most cases, they are based on responses from women or other family members interviewed. The principal exceptions concern nutritional status, which is based on anthropometric measurement; immunization, which typically relies to the extent possible on record cards maintained at the household level; and those other items where a source other than interviewer response is specifically identified. B. MEASUREMENT OF ECONOMIC STATUS Wealth or Asset Approach Economic status has been expressed in terms of wealth or assets: specifically, on the basis of information about household characteristics gathered through the DHS household questionnaire. (Such information was normally provided for at least 25-30, and often many more, characteristics like the presence, availability, or use of a fan, radio receiver, or automobile; housing materials like wood or concrete flooring, tile or tin roofing, or cement block walls; superior sources of water like piped or a protected well; and other attributes related to economic status.) 16Further information about the DHS program is available at the program's website: www.measuredhs.com. - 53 - Index Construction A single, consolidated index of living standards17 was constructed by using principal components analysis (PCA) to generate a weight for each household item with available information. A wealth index score was calculated for each household by weighting the response with respect to each item pertaining to that household by the coefficient of the first principal component as determined by application of principal components analysis, and summing the results. The resulting household scores were standardized in relation to a standard normal distribution with a mean of zero and a standard deviation of one. All individuals usually present in each household were assigned the household's standardized wealth index score, and all individuals in the sample population were ranked according to that score. The sample population was then divided into quintiles of individuals, with all individuals in a single household being assigned to the same quintile. The same standardized household wealth index scores originally derived for the total population sample, as just described, were also used in preparing the disaggregated estimates for female and male members of the sample population, and for rural and urban residents. In preparing those disaggregated estimates, the entire population sample was divided into quintiles of individuals; the females and males, and the rural and urban residents in each quintile of the entire sample were then separated from one another; and the mean for each of the ten resulting subgroups (five female, five male; or five rural, five urban) was calculated. This procedure was carried out separately for each of the surveys covered. C. CALCULATION AND PRESENTATION OF RATES Use of Sampling Weights Rates for all health, nutrition, and population indicators are calculated after applying the DHS sampling weights. (DHS surveys often over-sample certain small subgroups of interest ­ residents of a particular geographic area, for example ­ in order to get sample sizes large enough to produce statistically-significant results. The DHS sampling weights are used to compensate for such over-sampling in order to ensure that the results are representative of the population as a whole and not just of the DHS sample.) Calculation of Total Population Averages The average for the total population presented alongside the quintile-specific rates for each indicator is calculated without reference to quintile divisions. It thus equals the weighted mean of the quintile rates, with the weight assigned to each quintile rate being the proportion of the number of individuals at risk (as defined on p. 59) for the indicator concerned. Sampling Errors Information needed to assess the statistical significance of differences among the quintile-specific rates is presented in three ways: · First, in all the basic tables presented in part I, rates are shown in parentheses or replaced by asterisks in cases where the standard error is likely to be unacceptably high because 17 Such an index is usually referred to as either an "asset index" or a "wealth index." The two expressions are used interchangeably in this report; for ease of communication, "wealth index" appears more frequently despite the inexact correspondence between the items included in the index's construction and those appearing in more conventional, financially-based definitions of wealth. - 54 - of small sample size. The number of observations used to determine how to present the data for the different indicators covered were as follows: Indicator Unit of measure Number of observations used to determine how quintile-specific rate was presented Without With Replaced by parentheses parentheses asterisk Infant and child Number of deaths >500 250-499 <250 mortality Total and adolescent Number of births >250 125-249 <125 fertility All other indicators Number of >50 25-49 <25 individuals · Second, the standard error for each quintile-specific rate (except for any rate replaced by an asterisk) appearing in the total population table is provided in part III.B. (Standard errors for the quintile-specific rates presented in the female-male and rural-urban tables are not available.) · Third, the right-hand column of the total population table provides the standard error for the concentration index, one of the measures of inequality shown, as indicated below. D. MEASUREMENT OF INEQUALITY Accompanying each of the indicators presented in the total population table are the values for three statistical measures of inequality: · Low/High Quintile Ratio: the ratio between the rate prevailing in the lowest (poorest) population quintile and that found in the highest (least poor) quintile. · Low-High Quintile Difference: the value of the lowest quintile minus the value of the highest, expressed as an absolute value. · Concentration Index: twice the area in a Lorenz-type diagram between the line of equality and the concentration curve for the indicator in question, the curve being the graph of the cumulative share of the indicator against the cumulative share in the asset distribution. (The value, which can range from -1 to +1, is negative when the hnp indicator is higher among the poor (e.g., fertility), positive when it is higher among the better-off (e.g., modern contraceptive use), and zero when on balance the indicator shows no systematic relationship with wealth.)18 18Adam Wagstaff, Pierella Paci, and Eddy van Doorslaer, "On the Measurement of Inequalities of Health," Social Science and Medicine 33 (1991): 545-57. (See also chapter eight in the volume by O'Donnell, van Doorslaer, Wagstaff, and Lindelow described in the annotated bibliography that constitutes annex A.) - 55 - DISCUSSION While a basic understanding of the data and methods employed is necessary to adequately appreciate the figures appearing in this report, it is not sufficient. For the application of the approach taken involves many subtleties that also need to be understood. Among the more important are: A. DESCRIPTIVE NATURE OF THE RELATIONSHIPS The hnp-poverty relationships shown in this report are no more than descriptive. They should not be taken to imply any direct causal relationships, for several reasons. One reason is the possibility that it is not wealth or asset possession per se that determine a person's health condition. Rather, the determining factors could be other characteristics (such as education or ethnic background) that are simultaneously associated with both asset ownership and health status. It is also possible that the health-poverty relationships shown are driven primarily by particular items included in the index (e.g., water and sanitation). Should this be the case, improvements in health conditions among the poor might be more effectively brought about by focusing on changing those particular components of the wealth index rather than by a general effort to increase economic status as measured by the index as a whole. B. IMPLICATIONS OF A WEALTH/ASSET APPROACH Wealth or Assets as a Measure of Economic Status Reliance on a wealth index to measure economic status is a rather recent development in research on economic disparities, where such status traditionally has been defined in terms of consumption or income. The principal reason for the choice of the wealth index is pragmatic rather than conceptual: the DHS surveys, which are of interest because of the plethora of hnp information that they contain, do not collect consumption or income data; but they do have detailed information on households' physical characteristics, and on the household-level presence of and access to a wide range of goods and services. While there is some disagreement about the relative merits of using such wealth/asset information or consumption data to measure economic status, several recent studies suggest that the asset-consumption relationship is quite close.19 To the extent this is the case, an index of wealth or asset possession/availability can be taken as a 19See, for example, Deon Filmer and Lant H. Pritchett, "Estimating Wealth Effects without Expenditure ­ or Tears: An Application to Educational Enrollments in States of India," Demography 38, no. 1 (February 2001): 115-32; Shea Rutstein and Kiersten Johnson, The DHS Wealth Index, DHS Comparative Reports No. 6 (Calverton, Maryland, USA: ORC Macro, August 2004) esp. 10-14; Adam Wagstaff and Naoko Watanabe, "What Difference Does the Choice of SES Make in Health Inequality Measurement?" Health Economics 12 (2003): 885-90. - 57 - reasonably satisfactory proxy for consumption, rather than or in addition to serving as an indicator of economic status in its own right. C. ECONOMIC STATUS AS A MEASURE OF SOCIO-ECONOMIC WELL-BEING Like consumption or income, a wealth index defines disparities that are primarily economic. This is by no means the only way to define inter-group inequalities that are of potential concern. Other possibilities include gender, place of residence, education, ethnic background, or other factors associated with social exclusion. Thus the economic perspective provides only a partial view of the multidimensional concepts of poverty, inequality, and inequity. By including tables on female-male and rural-urban inequalities, this report pays adequate attention to two of inequality's other important dimensions to justify the use of the term "socio- economic" rather than simply "economic" in its title. However, the centrality of tabulations based on the wealth index means that the primary focus is on the economic dimension. The justification for this lies not in the greater importance of economic considerations, but rather in the recently-improved ability to analyze and thus begin dealing with them. Until the development of the wealth/asset approach, the assessment of economic status had been based on consumption, expenditures, or income, all of which are far more difficult to measure than such other, non- economic dimensions of inequality as gender, ethnic identity, educational level, and place of residence. As a result, assessments of health inequalities by economic status had lagged well behind measurements in terms of these other dimensions, especially gender and education. The focus on inequality's economic aspect applied here represents an effort to redress this imbalance. D. INDEX CONSTRUCTION Choice of Items Use of a wealth index requires decisions about which items to include in it. In the case of secondary analyses like the one featured in this report, the choice is limited to those items included in the data sets being used. But even with this constraint, there nonetheless remains considerable room for choice, given the large number of items for which information is collected by the DHS. The decision made in preparing this report was to include all items in each DHS household questionnaire that relate to ownership of household goods; to dwelling unit construction and characteristics; and to access to services and resources like electricity, water, and sanitation facilities. Also included were other potential indicators of wealth, such as live-in domestic servants. This decision, admittedly somewhat arbitrary, has both advantages and disadvantages. The principal advantage is practical: use of a large number of assets increases the degree of variation across household asset scores and facilitates a more regular distribution of individuals across quintiles. It also reduces the possibility of subjectivity in selecting only some of the variables for inclusion on some a priori basis; and it may increase a wealth index's accuracy as a proxy for consumption. However, including all variables is far from satisfying conceptually. For example, it means failing to discriminate with respect to the items' differing natures. It is not clear, for instance, whether access to water, sanitation, electricity, or other publicly-provided resources should be included in an index that purports to measure private household wealth. Further, many items that are candidates for inclusion in a DHS-based wealth index might be seen as directly influencing health status: water and sanitation for infant and child mortality, for - 58 - example. It would be desirable to include quintile-specific estimates for such items; but to the extent that such items have large index coefficients, any estimates for those items would be suspect. Such items appear to be relatively few and of limited statistical significance in the index used here. However, for the sake of caution, quintile-specific estimates for items appearing in the index have nonetheless been excluded from the basic tables and appear only in supporting table III.C Additional issues arise when comparing the findings for two different points in time covered in the basic tables. Because the nature and number of asset questions included in DHS surveys has been evolving, the items included in the wealth index differ somewhat for each of the surveys reported upon. As such, the results presented in the basic tables might differ to some extent from findings produced by some other approach, such as including in the index only those items appearing in each survey covered. Weighting of Items A further decision required in construction of an index concerns the weight to attach to each of the respective items. As noted earlier, the method used in this report is principal components analysis (PCA). Adoption of this method was based on the findings, referred to earlier, that its use resulted in outcomes that approximated reasonably well those produced by taking a consumption or expenditure approach. Further, it often provides greater discrimination in economic status than does the use of consumption/expenditures. It has also emerged as the standard approach for use in analyses of the sort presented here, so that its adoption is largely non-controversial. Yet this choice, too, is not without an arbitrary aspect; for alternative plausible methods exist. Examples include the "inverse possession" approach, which gives more weight to items possessed by only a few and less to those possessed by many;20 or, perhaps, the common practice of simply assigning the same weight to each index item. Also, the weights for any particular item vary from survey to survey, since the weights were determined separately for the population of each survey included in the basic tables. The results thus produced can be expected to differ from those generated in some other manner, such as generating common weights for all the surveys covered by pooling the data sets. Use of Principal Components Analysis with Dichotomous Variables An additional issue concerns the use of a technique like PCA, developed for use with continuous variables, in the construction of an index based primarily on dichotomous variables. While legitimate in principle, any reservations in this regard are of limited practical consequence, since the considerable experimentation undertaken in preparation for the tabulations presented here indicated that any inaccuracy introduced by applying PCA to the analysis of the dichotomous values used is minimal. Economies of Scale Calculating the values for a household wealth index also requires a decision concerning economies of scale that exist in the households covered. The calculations presented here assume complete economies of scale. The implicit assumption is that additional members do not add to household expenses on items included in the index. 20Saul S. Morris et al., "Validity of Rapid Estimates of Household Wealth and Income for Health Surveys in Rural Africa," Journal of Epidemiology and Community Health 54 (2000): 381-87. - 59 - E. DEFINITION OF QUINTILES Quintiles of Individuals As noted earlier, the quintile-specific figures presented in this report refer to quintiles of individuals in the household population. Such quintiles need to be distinguished from quintiles of households or quintiles of only those people in the population who are "at risk": that is, subject to the particular condition, eligible for the particular service, or capable of behaving in a particular way (children born alive for infant and under-five mortality, for example; or adult men and women for condom use or non-regular sexual partnerships). The expression of findings in terms of quintiles of individuals has several implications: · Because fertility is often higher in lower economic households than among better-off ones, the number of individuals per household will frequently be larger among the poor than among higher-income groups. In such cases, the number of households will vary systematically across quintiles of individuals, and the results expressed in terms of quintiles of households can differ significantly from those presented here. · The proportion of individuals "at risk" with regard to a particular indicator is also likely to vary across quintiles in many cases. (For example, in cases where fertility is higher among poor people, a higher-than-average proportion of poor populations will consist of newborns at risk from infant mortality, young children subject to malnutrition, and pregnant women for whom antenatal care is relevant.) To facilitate the work of any investigators wishing to undertake calculations based on people at risk, the number of such people in each quintile of individuals is shown in part III.A. · As previously indicated, the population average figure provided for each indicator is equivalent to the weighted sum of the quintile rates for that indicator, where the weight assigned to each quintile rate is the number of people at risk in each quintile as presented in part III.A. As a result of this weighting, the population average will usually differ from a simple mean of the population quintile estimates. Quintiles of Males and Females, of Rural and Urban Residents As also reported in the data and methods section, the tables on rural and urban residents and on men and women were prepared using the same asset scores as for the total population; and rural- urban residents and females-males were separated from one another only after the entire sample had been disaggregated into quintiles of individuals. This means that the figures given in the rural-urban and female-male tables refer to females-males and rural-urban residents belonging to each quintile of individuals in the total population, as distinct from quintiles of females, of males, of rural residents, or of urban residents alone. The consequence of this distinction is particularly evident with regard to rural and urban residents. Since rural residents tend to be poorer than urban dwellers, they normally form a considerably higher proportion of individuals in the lower economic quintiles of the total population than in the higher ones. Conversely, urban residents tend to be concentrated in the higher economic groups. As a result, the number of individuals in each of the urban and rural quintiles usually varies greatly and systematically; and when this is the case, the figures presented in the rural-urban tables can differ significantly from those produced by a computation procedure that places the same number of rural and urban residents in each rural quintile or each urban quintile. (The results may also differ significantly from application of an approach featuring the separate calculation of index values for urban and for rural groups. While such separate index values may well be preferable conceptually, their calculation involves complexities that prevented their preparation for this report.) - 60 - F. COMPARISON OF QUINTILES ACROSS COUNTRIES Reliance on population quintiles as basic presentational format for the data appearing in this report implicitly incorporates a relative concept of poverty. This differs from an absolute concept of poverty under which the population would be divided into groups of different sizes according to some absolute standard of living (such as people earning less than one dollar a day, between one and two dollars a day, and more than two dollars a day). This means that, when comparing values of an indicator among people in a given quintile across countries, the comparison is between groups of people whose economic status can be quite different. The lowest quintile of a Latin American population, for example, will usually be considerably better-off than the lowest quintile in an African country. G. COMPARISON OF QUINTILES OVER TIME Another implication is that the wealth status of any given quintile within a particular country is likely to change over time. For instance, when a country is progressing economically, the wealth of the households in the population will tend to increase. This will raise the average asset score in most, possibly all population quintiles. As a result, the living standard enjoyed by individuals in any quintile covered by a recent survey is likely to be higher than that of individuals in that same quintile as measured in a prior survey. H. STATISTICAL INDICATORS OF INEQUALITY The available statistical indicators of inequality are far too numerous to permit use of more than a small proportion of them in presenting the findings featured in this report. The three indicators employed have been selected to provide a wide range of perspectives. Two are designed for ease of understanding, the third for greater technical accuracy. The low/high quintile ratio and low-high quintile difference are the two presented for ease of understanding. The former is a relative measure, the latter an absolute measure that can produce a significantly different impression from that provided by the former. The concentration index is provided for the benefit of technical specialists wishing greater accuracy. It measures the degree of inequality in an hnp indicator across the full wealth index distribution, rather than differences between only two of the five quintiles, and also reflects the relative size of the different asset-based divisions of the study population. I. COMPARABILITY WITH OTHER REPORTS Tabulations similar to those presented here can also be found in the initial series of hnp/poverty country reports, issued in 2000, and in the recent country reports issued by the DHS program. The figures presented in those reports normally resemble quite closely those appearing here for any given indicator; but there are often slight differences for one or more of several reasons. The most common is a difference in the definition of the indicator in question. (These differences are usually small and subtle. But there is one important exception: the definition of moderate malnutrition among children. In the 2000 reports, this was defined as second and third degree malnutrition taken together. Here, it is defined as second degree malnutrition alone.) Another reason, with respect to infant and child mortality, is that the figures in the DHS documents are typically based on experience during the five years before the survey in question, rather than - 61 - during the ten previous years as in this report. A further frequent reason is the use of an improved computational technique. In addition, asset-based, quintile-specific tabulations of hnp indicators have begun to appear in an increasing number of other documents. Given the basic similarity of approach, such tabulations usually produce results that are generally congruent with those shown in part I of this report. However, significant divergences have occasionally been reported; and the absence of adequately detailed information about data and methods often prevents any fully-satisfying understanding of the approaches used. As a result, occasional doubts and frequent uncertainties about approach comparability remain. - 62 - PART IV. SUPPORTING TABLES, 1998 / 99 A. SAMPLE SIZES B. STANDARD ERRORS C. ASSET DISTRIBUTION AND WEIGHTS India 1998 / 99 - SAMPLE SIZES TOTAL SAMPLE Indicator Wealth Quintiles Pop. Low 2nd 3rd 4th High Total Number of household members All 99,564 99,571 99,570 99,567 99,570 497,840 Urban 2,976 6,105 14,607 36,964 71,337 131,989 Rural 96,588 93,465 84,963 62,603 28,232 365,851 Female 49,195 48,445 48,207 48,077 48,526 242,450 Male 50,369 51,125 51,363 51,489 51,044 255,390 Part I: HNP STATUS Indicator Wealth Quintiles Pop. Low 2nd 3rd 4th High Total Mortality rates All 29,801 26,661 23,669 21,619 17,241 118,991 Urban 856 1,522 3,485 8,121 12,016 26,000 Rural 28,945 25,139 20,184 13,498 5,226 92,991 Female 14,619 12,893 11,431 10,300 8,190 57,433 Male 15,183 13,767 12,238 11,319 9,051 61,558 Prevalence of fever, diarrhea, acute respiratory infection All 6,948 6,810 6,198 5,972 4,740 30,668 Urban 206 384 900 2,189 3,249 6,928 Rural 6,741 6,427 5,298 3,783 1,491 23,740 Female 3,425 3,264 3,048 2,775 2,236 14,748 Male 3,523 3,546 3,150 3,197 2,505 15,921 Total fertility rate All 62,872 64,772 69,837 73,442 79,083 316,022 Urban 2,058 4,201 10,325 27,113 57,202 100,899 Rural 60,808 60,594 59,536 46,341 21,772 249,051 Age-specific fertility rate 15-19 All 12,975 15,650 17,444 18,369 17,650 71,151 Urban 404 892 2,373 6,411 12,679 22,759 Rural 12,551 14,773 15,063 11,931 4,938 59,256 Children's nutritional status All 5,333 5,475 5,087 4,969 3,994 24,858 Urban 163 315 728 1,866 2,737 5,809 Rural 5,170 5,160 4,358 3,104 1,258 19,050 Female 2,608 2,613 2,499 2,297 1,887 11,904 Male 2,724 2,862 2,588 2,673 2,108 12,955 Children's anemia status All 4,400 4,363 4,231 3,992 3,200 20,186 Urban 141 249 620 1,502 2,164 4,676 Rural 4,259 4,114 3,610 2,490 1,036 15,509 Female 2,238 2,279 2,136 2,188 1,714 10,555 Male 2,162 2,084 2,094 1,804 1,486 9,630 - 65 - India 1998 / 99 - SAMPLE SIZES Part I: HNP STATUS (Cont.) Indicator Wealth Quintiles Pop. Low 2nd 3rd 4th High Total Women's nutritional status All 14,565 15,039 15,398 15,371 15,896 76,270 Urban 450 926 2,126 5,553 11,274 20,329 Rural 14,116 14,113 13,272 9,817 4,622 55,940 Women's anemia status All 15,569 16,100 16,348 16,269 16,300 80,586 Urban 482 992 2,262 5,838 11,520 21,094 Rural 15,086 15,108 14,086 10,431 4,781 59,492 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 - 66 - India 1998 / 99 - 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 2,343 2,212 2,125 1,891 1,622 10,193 Urban 77 113 293 699 1,125 2,307 Rural 2,266 2,099 1,833 1,192 497 7,887 Female 1,126 1,099 1,079 907 758 4,969 Male 1,217 1,112 1,047 984 864 5,224 Treatment of fever All 2,091 1,947 1,840 1,750 1,257 8,885 Urban 61 91 273 682 847 1,954 Rural 2,030 1,856 1,567 1,068 411 6,932 Female 1,075 1,058 979 947 703 4,762 Male 1,015 890 861 803 554 4,123 Treatment of acute respiratory infection All 1,497 1,406 1,259 1,052 658 5,872 Urban 46 76 187 377 424 1,110 Rural 1,450 1,330 1,072 675 235 4,762 Female 681 627 545 468 285 2,606 Male 816 779 714 584 373 3,266 Treatment of diarrhea All 1,415 1,280 1,260 1,068 779 5,802 Urban 49 75 204 474 535 1,337 Rural 1,366 1,205 1,056 594 244 4,465 Female 721 619 535 492 372 2,739 Male 694 661 725 576 406 3,062 Antenatal and delivery care All 6,792 6,473 5,740 5,394 4,380 28,779 Urban 195 359 829 1,950 3,025 6,358 Rural 6,597 6,114 4,911 3,444 1,355 22,421 Contraceptive prevalence Female 16,336 16,873 16,996 17,026 17,451 84,682 Urban Female 446 961 2,317 6,031 12,386 22,141 Rural Female 15,889 15,912 14,679 10,995 5,065 62,540 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 4,787 5,891 7,630 8,455 9,523 36,286 Urban Female 166 388 1,006 2,980 6,800 11,341 Rural Female 4,621 5,503 6,624 5,475 2,722 24,945 Male na na na na na na Urban Male na na na na na na Rural Male na na na na na na Treatment of genital discharge, ulcer, sore Female na na na na na na Urban Female na na na na na na Rural Female na na na na na na Male na na na na na na Urban Male na na na na na na Rural Male na na na na na na - 67 - India 1998 / 99 - 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 853 861 695 663 483 3,555 Urban 20 56 91 216 330 713 Rural 834 805 604 447 154 2,844 Female 428 439 354 348 251 1,820 Male 425 423 341 315 232 1,736 Timely complementary breastfeeding All 777 722 732 742 552 3,525 Urban 32 37 115 283 361 828 Rural 744 685 617 460 191 2,697 Female 413 420 382 440 291 1,946 Male 364 302 350 302 261 1,579 Bottle-feeding All 2,404 2,376 2,086 2,119 1,558 10,543 Urban 70 140 299 752 1,059 2,320 Rural 2,334 2,236 1,787 1,368 498 8,223 Female 1,201 1,293 1,089 1,155 812 5,550 Male 1,203 1,083 998 964 746 4,994 - 68 - India 1998 / 99 - 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 18,784 17,685 17,324 17,020 17,840 88,653 Urban 615 1,230 2,865 6,808 13,149 24,667 Rural 18,169 16,455 14,459 10,211 4,690 63,984 Vitamin A supplementation All 5,614 5,462 5,137 4,893 3,975 25,081 Urban 175 298 752 1,838 2,727 5,790 Rural 5,439 5,164 4,385 3,055 1,247 19,290 Female 2,864 2,834 2,591 2,623 2,120 13,032 Male 2,751 2,628 2,546 2,270 1,854 12,049 Tobacco and alcohol use, casual sexual partners, condom use for casual sex Female 17,755 18,056 18,197 18,071 18,223 90,302 Urban Female 523 1,081 2,570 6,523 12,946 23,643 Rural Female 17,232 16,975 15,628 11,548 5,277 66,660 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 17,755 18,056 18,197 18,071 18,223 90,303 Urban 523 1,081 2,570 6,523 12,946 23,643 Rural 17,232 16,975 15,628 11,548 5,277 66,660 - 69 - India 1998 / 99 - SAMPLE SIZES Part IV: UNDERLYING DETERMINANTS OF HNP STATUS Indicator Wealth Quintiles Pop. Low 2nd 3rd 4th High Total School completion (Grade 5) Female 22,378 23,128 24,360 25,400 27,455 122,721 Urban female 678 1,441 3,479 9,348 19,827 34,773 Rural female 21,700 21,687 20,881 16,052 7,628 87,948 Male 22,032 23,893 25,655 27,083 28,187 126,851 Urban male 661 1,587 4,000 10,606 20,679 37,533 Rural male 21,372 22,306 21,655 16,477 7,508 89,318 School participation Female 7,708 6,866 6,034 5,491 4,570 30,670 Urban female 213 401 901 2,190 3,265 6,970 Rural female 7,495 6,465 5,133 3,301 1,305 23,700 Male 8,302 7,405 6,619 6,000 4,922 33,249 Urban male 220 439 1,020 2,351 3,504 7,534 Rural male 8,083 6,965 5,599 3,650 1,418 25,715 Mass media exposure Female 17,755 18,056 18,197 18,071 18,223 90,303 Urban female 523 1,081 2,570 6,523 12,946 23,643 Rural female 17,232 16,975 15,628 11,548 5,277 66,660 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 36,253 18,056 18,197 18,071 18,223 108,800 Urban female 523 1,081 2,570 6,523 12,946 23,643 Rural female 17,232 16,975 15,628 11,548 5,277 66,660 Male na na na na na na Urban male na na na na na na Rural male na na na na na na Household decisionmaking and justification of violence All 17,755 18,056 18,197 18,071 18,223 90,303 Urban 523 1,081 2,570 6,523 12,946 23,643 Rural 17,232 16,975 15,628 11,548 5,277 66,660 Orphanhood All 41,739 38,873 35,647 33,333 28,267 177,860 Urban 1,191 2,335 5,325 12,695 19,885 41,432 Rural 40,548 36,538 30,322 20,638 8,383 136,428 Female 20,111 18,662 17,162 15,941 13,522 85,398 Male 21,628 20,211 18,485 17,392 14,746 92,462 - 70 - India 1998 / 99 - 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 7.03 6.98 7.50 5.94 6.41 3.14 Under-five mortality rate 8.66 8.24 8.13 6.54 6.92 3.69 Prevalence of fever 0.70 0.74 0.71 0.79 0.75 0.35 Prevalence of diarrhea 0.65 0.69 0.63 0.65 0.66 0.34 Prevalence of acute respiratory infection 0.72 0.67 0.69 0.64 0.62 0.34 B. Fertility Total fertility rate 0.14 0.14 0.10 0.10 0.09 0.05 Adolescent fertility rate 14.00 10.00 9.00 10.00 6.00 4.00 C. Nutritional status Children: Moderate stunting 0.82 0.80 0.72 0.72 0.71 0.37 Severe stunting 0.79 0.84 0.71 0.57 0.52 0.37 Moderate underweight 0.85 0.79 0.83 0.83 0.76 0.37 Severe underweight 0.82 0.78 0.67 0.53 0.42 0.36 Mild anemia 0.82 0.88 0.79 0.73 0.90 0.36 Moderate anemia 1.01 1.03 1.04 0.90 0.97 0.51 Severe anemia 0.44 0.46 0.50 0.48 0.41 0.23 Women: Malnutrition 0.58 0.60 0.57 0.50 0.35 0.35 Mild anemia 0.51 0.48 0.47 0.46 0.46 0.25 Moderate anemia 0.60 0.42 0.36 0.36 0.28 0.22 Severe anemia 0.21 0.17 0.24 0.18 0.15 0.13 D. Female circumcision Prevalence of circumcision: Girls na na na na na na Women na na na na na na Prevalence of occlusion: Girls * * * * * * Women * * * * * * E. Sexually transmitted disease Prevalence of genital discharge: Women na na na na na na Men na na na na na na Prevalence of genital ulcer: Women na na na na na na Men na na na na na na - 71 - India 1998 / 99 - STANDARD ERRORS OF QUINTILE ESTIMATES FOR TOTAL POPULATION Part II: Intermediate Determinants of HNP Status - HNP SERVICE USE Indicator Wealth Quintiles Low 2nd 3rd 4th High Avg. A. Childhood immunization BCG coverage 1.26 1.34 1.23 0.94 0.64 0.64 Measles coverage 1.18 1.32 1.35 1.30 1.21 0.73 DPT coverage 1.64 1.54 1.55 1.36 1.17 0.87 Full basic coverage 1.07 1.20 1.33 1.30 1.52 0.66 No basic coverage 1.23 1.15 0.89 0.73 0.41 0.51 Hepatitis B coverage na na na na na na Yellow fever coverage na na na na na na B. Treatment of childhood illnesses Treatment of fever: Medical treatment of fever 1.38 1.41 1.40 1.30 1.45 0.67 Treatment in a public facility 0.75 0.97 0.98 1.05 1.03 0.45 Treatment in a private facility 1.22 1.31 1.49 1.35 1.53 0.64 Treatment of acute respiratory infection (ARI): Medical treatment of ARI 1.79 1.54 1.48 1.49 1.71 0.79 Treatment in a public facility 1.22 1.42 1.29 1.26 1.70 0.66 Treatment in a private facility 1.80 1.65 1.80 1.69 2.35 0.84 Treatment of diarrhea: Use of oral rehydration therapy 1.70 1.89 1.79 1.79 1.99 0.92 Medical treatment of diarrhea 1.69 1.62 1.64 1.47 1.53 0.79 Treatment in a public facility 1.11 1.22 1.25 1.47 1.49 0.57 Treatment in a private facility 1.72 1.73 1.74 1.69 1.80 0.86 C. Antenatal and delivery care Antenatal care (ANC) visits: To a medically-trained person 0.93 1.00 0.91 0.73 0.63 0.48 To a doctor 0.83 0.89 0.94 0.91 0.88 0.51 To a nurse or trained midwife 0.63 0.70 0.70 0.63 0.66 0.34 Multiple visits to a medically-trained person 0.74 0.86 0.94 1.00 0.81 0.52 Antenatal care content: Tetanus toxoid 1.09 0.91 0.69 0.53 0.38 0.51 Prophylactic antimalarial treatment na na na na na na Iron supplementation 1.09 0.99 0.99 0.95 0.83 0.62 Delivery attendance: By a medically-trained person 0.63 0.82 0.93 0.92 0.71 0.57 By a doctor 0.49 0.65 0.81 0.88 0.88 0.46 By a nurse or trained midwife 0.43 0.56 0.65 0.60 0.64 0.31 In a public facility 0.40 0.55 0.74 0.92 0.84 0.37 In a private facility 0.31 0.43 0.66 0.87 1.11 0.41 At home 0.52 0.68 0.93 1.04 0.93 0.56 D. Contraceptive services Contraceptive prevalence: Women 0.81 0.69 0.62 0.61 0.59 0.43 Men na na na na na na Source of contraception - public sector: Women 0.56 0.62 0.64 0.66 0.83 0.51 Men na na na na na na - 72 - India 1998 / 99 - STANDARD ERRORS OF QUINTILE ESTIMATES FOR TOTAL POPULATION Part II: Intermediate Determinants of HNP Status - HNP SERVICE USE (Cont.) Indicator Wealth Quintiles Low 2nd 3rd 4th High Avg. D. Contraceptive services (cont.) Source of contraception - private sector: Women 0.54 0.58 0.65 0.69 0.82 0.62 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 - 73 - India 1998 / 99 - STANDARD ERRORS OF QUINTILE ESTIMATES FOR TOTAL POPULATION Part III: Intermediate Determinants of HNP Status - INDIVIDUAL AND HOUSEHOLD BEHAVIOR Indicator Wealth Quintiles Low 2nd 3rd 4th High Avg. A. Hygienic practices Disposal of children's stools: Sanitary disposal na na na na na na Handwashing: Wash hands prior to preparing food na na na na na na Handwashing facilities in household na na na na na na B. Bednet ownership and use Bednet ownership: Bednet ownership na na na na na na Treated bednet ownership na na na na na na Bednet use: By children na na na na na na By pregnant women na na na na na na C. Breastfeeding Exclusive breastfeeding 2.42 2.25 2.20 2.28 2.87 1.15 Timely complementary feeding 1.89 2.22 2.33 2.18 2.36 0.98 Bottle-feeding 0.72 0.75 0.81 1.16 1.31 0.45 D. Micronutrient consumption Iodized salt: Availability of iodized salt in household 0.80 0.65 0.68 0.64 0.62 0.52 Vitamin A: Children 0.54 0.60 0.68 0.64 0.75 0.31 Women na na na na na na E. Tobacco and alcohol use Tobacco: Women 0.58 0.43 0.39 0.31 0.23 0.25 Men na na na na na na Alcohol: Women 0.47 0.22 0.20 0.10 0.05 0.15 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 0.51 0.44 0.46 0.38 0.30 0.24 Experienced violence in past year 0.40 0.36 0.37 0.26 0.19 0.18 - 74 - India 1998 / 99 - 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 0.29 0.38 0.52 0.52 0.42 0.45 Men 0.60 0.55 0.50 0.44 0.24 0.38 School participation: Girls 0.97 0.89 0.63 0.54 0.30 0.46 Boys 0.89 0.64 0.52 0.45 0.26 0.36 B. Exposure to mass media Newspaper readership: Women 0.12 0.21 0.32 0.46 0.66 0.35 Men na na na na na na Radio listenership: Women 0.42 0.50 0.57 0.53 0.63 0.32 Men na na na na na na Television viewership: Women 0.36 0.43 0.55 0.57 0.31 0.50 Men na na na na na na C. Knowledge and attitudes about HIV/AIDS Knowledge about sexual transmission of HIV/AIDS: Women 0.30 0.42 0.59 0.69 0.84 0.56 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 0.51 0.48 0.52 0.51 0.57 0.29 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 0.57 0.53 0.55 0.55 0.59 0.31 Can make meal-related decisions 0.52 0.55 0.49 0.49 0.53 0.30 Freedom of movement: Can travel to visit family/relatives 0.52 0.48 0.54 0.58 0.61 0.32 Other decisionmaking, attitudes: Can decide how to spend own money 0.95 0.94 1.03 1.23 1.12 0.59 Can decide whether to have sex na na na na na na Justifies domestic violence 0.75 0.65 0.65 0.64 0.75 0.40 E. Orphanhood Paternal orphan prevalence na na na na na na Maternal orphan prevalence na na na na na na Double orphan prevalence na na na na na na - 75 - India 1998 / 99 - 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 0.665 0.472 1.1% 32.4% 72.9% 94.2% 99.5% 60.0% 0.054905 Has radio 0.416 0.493 7.6% 25.7% 40.8% 52.9% 72.8% 40.0% 0.0395448 Has television 0.390 0.488 0.0% 1.2% 17.4% 64.1% 94.6% 35.4% 0.0636285 Has refrigerator 0.143 0.351 0.0% 0.0% 0.3% 2.2% 51.1% 10.7% 0.0577999 Has bicycle 0.436 0.496 27.2% 48.7% 56.0% 63.0% 68.7% 52.7% 0.0182404 Has motorcycle 0.126 0.332 0.1% 0.4% 2.1% 11.4% 47.9% 12.4% 0.0461291 Has car 0.024 0.154 0.0% 0.0% 0.1% 0.4% 8.6% 1.8% 0.0280232 Has telephone 0.101 0.301 0.0% 0.0% 0.2% 1.4% 36.5% 7.6% 0.0509859 Has separate room used as a kitchen 0.548 0.498 18.9% 38.3% 52.1% 63.4% 86.8% 51.9% 0.0376116 Owns agricultural land 0.492 0.500 59.1% 63.4% 61.2% 49.8% 34.2% 53.6% -0.0184393 Owns livestock 0.468 0.499 63.2% 65.9% 62.2% 48.2% 24.1% 52.7% -0.0260479 Has mattress 0.578 0.494 7.0% 26.2% 47.9% 72.3% 95.8% 49.8% 0.0498117 Has pressure cooker 0.383 0.486 0.2% 2.3% 11.2% 44.4% 92.5% 30.1% 0.062298 Has chair 0.527 0.499 4.3% 19.8% 43.2% 71.6% 95.4% 46.9% 0.0530166 Has cot or bed 0.838 0.368 69.2% 77.6% 82.4% 89.8% 97.6% 83.3% 0.0228189 Has table 0.490 0.500 2.0% 14.4% 34.6% 64.2% 92.0% 41.4% 0.0540781 Has clock or watch 0.712 0.453 16.5% 53.4% 80.4% 96.5% 99.8% 69.3% 0.0481179 Has fan 0.487 0.500 0.7% 5.5% 41.6% 86.4% 98.5% 46.5% 0.0597377 Has bicycle 0.436 0.496 27.2% 48.7% 56.0% 63.0% 68.7% 52.7% 0.0182404 Has sewing maching 0.240 0.427 0.6% 4.1% 11.8% 28.7% 58.6% 20.8% 0.045951 Has water pump 0.081 0.273 1.7% 5.9% 8.5% 12.0% 21.6% 9.9% 0.0185208 Has bullock cart 0.060 0.238 5.8% 10.2% 12.7% 10.7% 5.2% 8.9% -0.004982 Has thresher 0.017 0.130 0.9% 2.3% 3.7% 4.0% 3.5% 2.9% 0.002127 Has tractor 0.016 0.127 0.1% 0.7% 2.6% 4.1% 4.8% 2.4% 0.0067705 Has a domestic worker not related to head 0.000 0.021 0.0% 0.0% 0.0% 0.0% 0.2% 0.1% 0.0031894 Works own or family's agric. land 0.194 0.395 29.3% 32.9% 31.4% 21.4% 8.6% 24.7% -0.01880 Uses water piped into residence for drinking 0.263 0.440 0.7% 3.1% 9.6% 25.8% 63.9% 20.6% 0.05045 Uses water piped into public tap for drinking 0.178 0.383 10.4% 15.7% 23.2% 22.1% 8.0% 15.9% -0.00745 Uses water from well in residence for drinking 0.012 0.110 0.8% 1.2% 1.5% 1.6% 1.3% 1.3% 0.00133 Uses water from a public well for drinking 0.059 0.235 4.8% 6.7% 7.7% 8.3% 5.1% 6.5% -0.00258 Uses water from spring for drinking 0.019 0.138 0.6% 0.7% 0.9% 0.5% 0.1% 0.5% -0.00552 Uses water from river, canal or surface for drinking 0.031 0.172 3.6% 2.8% 2.4% 1.2% 0.2% 2.0% -0.00851 Uses rainwater for drinking 0.001 0.034 0.0% 0.0% 0.1% 0.1% 0.0% 0.1% 0.00011 Uses water from tanker truck for drinking 0.002 0.047 0.1% 0.2% 0.2% 0.2% 0.2% 0.2% 0.00005 Uses water from a covered public well for drinking 0.010 0.102 1.7% 1.4% 1.0% 0.7% 0.1% 1.0% -0.00453 Uses water from other source for drinking 0.005 0.068 0.5% 0.5% 0.6% 0.5% 0.3% 0.5% -0.00119 Has private flush toilet 0.225 0.418 0.0% 1.1% 4.6% 19.6% 67.9% 18.7% 0.05548 Has public flush toilet 0.030 0.170 0.2% 0.6% 1.8% 6.3% 3.2% 2.4% 0.00531 Uses shared flush toilet 0.037 0.189 0.0% 0.3% 1.3% 4.7% 4.7% 2.2% 0.00906 Uses private pit latrine 0.137 0.344 1.1% 5.5% 11.5% 20.2% 16.2% 10.9% 0.00581 Uses public pit latrine 0.007 0.081 0.2% 0.6% 0.7% 1.2% 0.5% 0.7% -0.00057 Uses shared pit latrine 0.020 0.141 0.1% 0.6% 1.2% 2.3% 0.8% 1.0% 0.00026 Uses bush,field as latrine 0.544 0.498 98.3% 91.0% 78.7% 45.5% 6.7% 64.1% -0.05563 Uses other type of latrine 0.001 0.034 0.1% 0.2% 0.2% 0.1% 0.0% 0.1% -0.00140 Uses clay kitchenware 0.010 0.101 1.8% 1.0% 0.6% 0.4% 0.4% 0.9% -0.00416 Uses aluminum kitchenware 0.363 0.481 57.1% 42.3% 41.0% 34.4% 18.9% 38.7% -0.02541 Has kitchenware made of cast iron 0.003 0.052 0.5% 0.4% 0.2% 0.2% 0.2% 0.3% -0.00159 Uses brass or copper kitchenware 0.014 0.117 1.6% 1.2% 1.2% 1.1% 0.8% 1.2% 0.00032 - 77 - India 1998 / 99 - ASSETS AND FACTOR SCORES (Cont.) (FACTOR SCORE) Asset Variable Unweighted Wealth Quintiles Factor Low 2nd 3rd 4th High Avg. Score Mean Std. Percentage of Population Devia- tion Uses stainless steel kitchenware 0.610 0.488 39.0% 55.0% 56.9% 63.9% 79.7% 58.9% 0.02601 Uses other kind of kitchenware 0.000 0.006 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.00044 Uses water from a public open well for drinking 0.100 0.299 19.4% 14.5% 10.8% 5.5% 1.1% 10.3% -0.01824 Uses water from residential handpump for drinking 0.130 0.337 13.8% 20.9% 19.1% 20.7% 15.8% 18.0% -0.00079 Uses water from public handpump for drinking 0.189 0.392 43.5% 32.2% 23.1% 12.8% 3.9% 23.1% -0.02654 Uses electricity for lighting 0.665 0.472 1.1% 32.4% 72.9% 94.2% 99.5% 60.0% 0.05490 Uses kerosene for lighting 0.331 0.470 98.3% 67.0% 26.6% 5.6% 0.5% 39.6% -0.05463 Uses gas for lighting 0.001 0.023 0.1% 0.1% 0.1% 0.1% 0.0% 0.1% -0.00095 Uses oil for lighting 0.001 0.036 0.3% 0.2% 0.1% 0.0% 0.0% 0.1% -0.00255 Uses other source for lighting 0.002 0.040 0.1% 0.1% 0.2% 0.1% 0.0% 0.1% -0.00227 Uses wood as cooking fuel 0.577 0.494 75.2% 76.9% 79.1% 59.0% 12.9% 60.6% -0.04729 Uses dung as cooking fuel 0.052 0.222 10.1% 11.5% 8.1% 5.6% 1.3% 7.3% -0.01138 Uses coal as cooking fuel 0.016 0.125 0.5% 1.4% 2.5% 4.6% 2.6% 2.3% 0.00091 Uses charcoal as cooking fuel 0.003 0.055 0.0% 0.1% 0.3% 0.6% 0.2% 0.3% 0.00038 Uses kerosene as cooking fuel 0.087 0.282 0.2% 0.9% 4.7% 17.9% 9.2% 6.6% 0.00828 Uses LPG as cooking fuel 0.215 0.411 0.0% 0.1% 0.3% 8.2% 71.0% 15.9% 0.06148 Uses biogas as cooking fuel 0.004 0.066 0.0% 0.0% 0.1% 0.8% 1.6% 0.5% 0.00570 Uses crop residual as cooking fuel 0.036 0.187 13.6% 8.8% 4.8% 2.2% 0.3% 5.9% -0.01383 Uses electricity as cooking fuel 0.008 0.089 0.0% 0.0% 0.2% 0.9% 0.9% 0.4% 0.00477 Uses other source as cooking fuel 0.002 0.040 0.3% 0.1% 0.1% 0.1% 0.0% 0.1% -0.00098 House is made of high quality materials 0.351 0.477 1.0% 6.3% 20.2% 46.8% 84.3% 31.7% 0.05461 House is made of low quality materials 0.296 0.457 69.8% 48.6% 29.0% 11.8% 1.9% 32.2% -0.04038 House is made of mixed quality materials 0.351 0.477 29.0% 44.8% 50.6% 41.3% 13.7% 35.9% -0.01593 Size of land under cultivation in acres 2.392 10.014 1.7 2.3 3.3 3.4 3.1 2.8 0.0007758 Size of irrigated land under cultivation in acres 1.209 6.961 0.7 1.1 1.6 1.9 2.1 1.5 0.0026557 Number of members per sleeping room 2.286 1.881 3.9 3.2 2.8 2.5 1.7 2.8 -0.02920 - 78 - PART V. SUPPORTING TABLES, 1992 / 93 A. SAMPLE SIZES B. STANDARD ERRORS C. ASSET DISTRIBUTION AND WEIGHTS India 1992 / 93 - SAMPLE SIZES TOTAL SAMPLE Indicator Wealth Quintiles Pop. Low 2nd 3rd 4th High Total Number of household members All 100,179 100,151 100,123 100,168 100,133 500,755 Urban 2,443 7,167 12,781 30,789 78,916 132,096 Rural 97,736 92,984 87,343 69,379 21,217 368,658 Female 48,239 49,281 48,669 48,243 48,711 243,143 Male 51,923 50,833 51,422 51,912 51,405 257,495 Part I: HNP STATUS Indicator Wealth Quintiles Pop. Low 2nd 3rd 4th High Total Mortality rates All 29,939 28,776 26,528 24,689 19,739 129,671 Urban 710 2,111 3,503 7,943 15,328 29,595 Rural 29,229 26,665 23,024 16,746 4,411 100,076 Female 14,474 14,218 12,765 11,941 9,539 62,936 Male 15,465 14,558 13,763 12,748 10,200 66,734 Prevalence of fever, diarrhea, acute respiratory infection All 10,065 9,906 9,482 9,158 7,328 45,939 Urban 228 723 1,265 2,843 5,658 10,717 Rural 9,837 9,183 8,217 6,315 1,670 35,222 Female 4,823 5,036 4,612 4,459 3,567 22,497 Male 5,242 4,870 4,869 4,700 3,761 23,442 Total fertility rate All 58,306 63,429 66,764 72,664 78,195 306,088 Urban 1,302 4,788 8,665 21,585 61,485 97,825 Rural 56,994 58,677 58,103 51,159 16,914 241,847 Age-specific fertility rate 15-19 All 13,150 15,193 16,542 19,529 18,725 71,582 Urban 252 1,025 1,920 5,341 14,611 23,149 Rural 12,890 14,170 14,597 14,182 4,256 60,095 Children's nutritional status All 5,564 5,361 4,970 5,367 4,302 25,564 Urban 128 342 691 1,558 3,160 5,879 Rural 5,436 5,019 4,279 3,809 1,142 19,685 Female 2,704 2,736 2,402 2,596 2,095 12,533 Male 2,859 2,625 2,568 2,771 2,207 13,030 Children's anemia status All na na na na na na Urban na na na na na na Rural na na na na na na Female na na na na na na Male na na na na na na - 81 - India 1992 / 93 - 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 - 82 - India 1992 / 93 - 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 2,607 2,581 2,415 2,396 1,846 11,845 Urban 66 183 314 733 1,413 2,709 Rural 2,541 2,398 2,101 1,663 433 9,136 Female 1,275 1,305 1,200 1,136 881 5,797 Male 1,331 1,276 1,215 1,260 965 6,047 Treatment of fever All 2,103 2,130 1,859 1,788 1,309 9,189 Urban 60 184 246 526 971 1,987 Rural 2,043 1,946 1,613 1,262 338 7,202 Female 1,134 1,086 999 965 709 4,893 Male 968 1,043 861 823 600 4,295 Treatment of acute respiratory infection All 704 717 695 519 310 2,945 Urban 15 57 97 151 224 544 Rural 689 661 598 368 86 2,402 Female 291 341 322 221 132 1,307 Male 413 377 372 298 179 1,639 Treatment of diarrhea All 1,029 1,026 965 923 622 4,566 Urban 11 87 114 270 452 934 Rural 1,018 939 851 653 171 3,632 Female 467 529 470 406 306 2,178 Male 562 497 495 518 316 2,388 Antenatal and delivery care All 8,550 8,423 7,794 7,349 6,011 38,128 Urban 189 601 998 2,286 4,642 8,716 Rural 8,362 7,822 6,796 5,063 1,369 29,412 Contraceptive prevalence Female 16,167 16,598 16,962 17,166 17,434 84,328 Urban Female 367 1,156 2,004 4,984 13,524 22,035 Rural Female 15,800 15,443 14,958 12,182 3,910 62,293 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 4,031 4,556 6,120 7,217 8,813 30,738 Urban Female 99 360 685 2,010 6,837 9,992 Rural Female 3,932 4,197 5,435 5,207 1,976 20,747 Male na na na na na na Urban Male na na na na na na Rural Male na na na na na na Treatment of genital discharge, ulcer, sore Female na na na na na na Urban Female na na na na na na Rural Female na na na na na na Male na na na na na na Urban Male na na na na na na Rural Male na na na na na na - 83 - India 1992 / 93 - 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 930 906 796 749 561 3,942 Urban 18 58 107 198 428 809 Rural 912 848 688 551 133 3,132 Female 491 449 382 386 309 2,017 Male 439 456 414 364 252 1,925 Timely complementary breastfeeding All 882 943 819 880 713 4,237 Urban 28 71 116 288 548 1,051 Rural 854 872 703 592 165 3,186 Female 459 474 433 432 365 2,163 Male 423 469 386 448 348 2,074 Bottle-feeding All 2,700 2,652 2,445 2,399 1,909 12,105 Urban 66 181 337 708 1,480 2,772 Rural 2,634 2,471 2,109 1,691 429 9,334 Female 1,411 1,299 1,225 1,220 977 6,132 Male 1,289 1,353 1,220 1,179 932 5,973 - 84 - India 1992 / 93 - SAMPLE SIZES Part III: Intermediate Determinants of HNP Status - INDIVIDUAL AND HOUSEHOLD BEHAVIOR (Cont.) Indicator Wealth Quintiles Pop. Low 2nd 3rd 4th High Total Iodized salt in household All na na na na na na Urban na na na na na na Rural na na na na na na Vitamin A supplementation All na na na na na na Urban na na na na na na Rural na na na na na na Female na na na na na na Male na na na na na na Tobacco and alcohol use, casual sexual partners, condom use for casual sex Female na na na na na na Urban Female na na na na na na Rural Female na na na na na na Male na na na na na na Urban Male na na na na na na Rural Male na na na na na na Domestic violence All na na na na na na Urban na na na na na na Rural na na na na na na - 85 - India 1992 / 93 - SAMPLE SIZES Part IV: UNDERLYING DETERMINANTS OF HNP STATUS Indicator Wealth Quintiles Pop. Low 2nd 3rd 4th High Total School completion (Grade 5) Female 21,637 22,843 23,387 24,157 26,604 118,628 Urban female 495 1,618 2,959 7,142 21,060 33,274 Rural female 21,142 21,225 20,427 17,015 5,544 85,353 Male 22,411 23,229 24,307 25,811 27,835 123,594 Urban male 561 1,714 3,270 8,408 22,173 36,125 Rural male 21,850 21,516 21,036 17,403 5,662 87,468 School participation Female 7,763 7,047 6,701 6,021 5,183 32,715 Urban female 193 499 849 1,999 4,134 7,674 Rural female 7,570 6,548 5,853 4,022 1,049 25,041 Male 8,416 7,458 7,067 6,450 5,597 34,989 Urban male 213 562 945 2,160 4,447 8,328 Rural male 8,203 6,896 6,122 4,290 1,150 26,661 Mass media exposure Female 17,151 17,941 18,228 18,258 18,199 89,777 Urban female 388 1,287 2,247 5,389 14,144 23,455 Rural female 16,763 16,654 15,981 12,869 4,055 66,322 Male na na na na na na Urban male na na na na na na Rural male na na na na na na Knowledge of HIV/AIDS prevention Female na na na na na na Urban female na na na na na na Rural female na na na na na na Male na na na na na na Urban male na na na na na na Rural male na na na na na na Household decisionmaking and justification of violence All 17,151 17,941 18,228 18,258 18,199 89,777 Urban 388 1,287 2,247 5,389 14,144 23,455 Rural 16,763 16,654 15,981 12,869 4,055 66,322 Orphanhood All 42,631 39,707 38,377 36,180 31,300 188,195 Urban 1,100 2,891 5,014 11,530 24,644 45,179 Rural 41,531 36,817 33,363 24,650 6,655 143,016 Female 20,320 19,320 18,424 17,413 15,214 90,692 Male 22,305 20,358 19,947 18,757 16,079 97,446 - 86 - India 1992 / 93 - STANDARD ERRORS OF QUINTILE ESTIMATES FOR TOTAL POPULATION Part I: HNP STATUS Indicator Wealth Quintiles Low 2nd 3rd 4th High Avg. A. Childhood illness and mortality Infant mortality rate 2.89 2.66 2.49 2.00 1.97 1.38 Under-five mortality rate 3.51 3.20 2.84 2.27 2.11 1.70 Prevalence of fever 0.63 0.64 0.58 0.54 0.66 0.29 Prevalence of diarrhea 0.41 0.47 0.45 0.36 0.40 0.21 Prevalence of acute respiratory infection 0.32 0.35 0.39 0.30 0.29 0.16 B. Fertility Total fertility rate 0.06 0.06 0.05 0.04 0.03 0.03 Adolescent fertility rate 4.00 3.00 3.00 3.00 2.00 1.00 C. Nutritional status Children: Moderate stunting 0.73 0.78 0.76 0.73 0.72 0.33 Severe stunting 1.02 0.94 0.85 0.82 0.87 0.48 Moderate underweight 0.93 0.77 0.88 0.80 0.84 0.40 Severe underweight 0.91 0.83 0.79 0.68 0.69 0.44 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 * * * * * * Women * * * * * * E. Sexually transmitted disease Prevalence of genital discharge: Women na na na na na na Men na na na na na na Prevalence of genital ulcer: Women na na na na na na Men na na na na na na - 87 - India 1992 / 93 - STANDARD ERRORS OF QUINTILE ESTIMATES FOR TOTAL POPULATION Part II: Intermediate Determinants of HNP Status - HNP SERVICE USE Indicator Wealth Quintiles Low 2nd 3rd 4th High Avg. A. Childhood immunization BCG coverage 1.40 1.43 1.46 1.29 1.20 0.70 Measles coverage 1.11 1.29 1.38 1.46 1.53 0.66 DPT coverage 1.25 1.32 1.40 1.41 1.24 0.70 Full basic coverage 0.97 1.12 1.24 1.39 1.53 0.63 No basic coverage 1.46 1.37 1.32 1.03 1.02 0.68 Hepatitis B coverage na na na na na na Yellow fever coverage na na na na na na B. Treatment of childhood illnesses Treatment of fever: Medical treatment of fever 1.50 1.35 1.46 1.18 1.36 0.61 Treatment in a public facility 1.38 1.02 1.30 1.16 1.14 0.55 Treatment in a private facility 1.63 1.58 1.61 1.42 1.65 0.74 Treatment of acute respiratory infection (ARI): Medical treatment of ARI 2.49 2.06 2.45 2.37 2.48 1.08 Treatment in a public facility 1.82 1.71 2.20 2.00 2.39 0.89 Treatment in a private facility 2.82 2.15 2.56 2.56 2.74 1.25 Treatment of diarrhea: Use of oral rehydration therapy 1.89 1.87 1.96 2.11 2.50 0.92 Medical treatment of diarrhea 1.97 2.09 1.99 1.72 1.99 1.03 Treatment in a public facility 1.59 1.68 1.64 1.63 1.60 0.78 Treatment in a private facility 2.09 2.17 1.89 1.60 2.30 1.00 C. Antenatal and delivery care Antenatal care (ANC) visits: To a medically trained person 0.80 0.77 0.80 0.75 0.64 0.46 To a doctor 0.65 0.70 0.83 0.84 0.71 0.44 To a nurse or trained midwife 0.40 0.44 0.52 0.51 0.45 0.24 Multiple visits to a medically trained person 0.75 0.77 0.96 0.78 0.74 0.48 Antenatal care content: Tetanus toxoid 0.99 0.92 0.86 0.72 0.43 0.51 Prophylactic antimalarial treatment na na na na na na Iron supplementation na na na na na na Delivery attendance: By a medically trained person 0.48 0.66 0.78 0.95 0.80 0.44 By a doctor 0.31 0.47 0.57 0.75 0.95 0.37 By a nurse or trained midwife 0.36 0.47 0.52 0.63 0.70 0.27 In a public facility 0.28 0.41 0.56 0.69 0.92 0.31 In a private facility 0.17 0.19 0.29 0.57 1.08 0.26 At home 0.36 0.49 0.64 0.87 0.85 0.41 D. Contraceptive services Contraceptive prevalence: Women 0.69 0.67 0.64 0.61 0.55 0.35 Men na na na na na na Source of contraception - public sector: Women 0.51 0.58 0.48 0.59 0.95 0.44 Men na na na na na na - 88 - India 1992 / 93 - STANDARD ERRORS OF QUINTILE ESTIMATES FOR TOTAL POPULATION Part II: Intermediate Determinants of HNP Status - HNP SERVICE USE (Cont.) Indicator Wealth Quintiles Low 2nd 3rd 4th High Avg. D. Contraceptive services (cont.) Source of contraception - private sector: Women 0.39 0.47 0.44 0.55 0.88 0.40 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 - 89 - India 1992 / 93 - 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 1.96 2.27 2.37 2.04 2.26 1.07 Timely complementary feeding 2.10 1.87 1.74 1.86 2.25 0.88 Bottle-feeding 0.63 0.70 0.90 1.00 1.47 0.44 D. Micronutrient consumption Iodized salt: Availability of iodized salt in household na na na na na na Vitamin A: Children na na na na na na Women na na na na na na E. Tobacco and alcohol use Tobacco: Women na na na na na na Men na na na na na na Alcohol: Women na na na na na na Men na na na na na na F. Sexual practices Non-regular sexual partnerships: Women na na na na na na Men na na na na na na Condom usage with non-regular partner: Women na na na na na na Men na na na na na na G. Domestic violence Ever experienced violence na na na na na na Experienced violence in past year na na na na na na - 90 - India 1992 / 93 - 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 0.29 0.37 0.44 0.58 0.53 0.42 Men 0.67 0.58 0.53 0.46 0.32 0.37 School participation: Girls 1.04 0.99 0.85 0.85 0.52 0.55 Boys 1.02 0.98 0.68 0.62 0.39 0.48 B. Exposure to mass media Newspaper readership: Women na na na na na na Men na na na na na na Radio listenership: Women 0.51 0.59 0.55 0.60 0.57 0.35 Men na na na na na na Television viewership: Women 0.23 0.32 0.43 0.63 0.49 0.39 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 * * * * * * Can decide whether to have sex na na na na na na Justifies domestic violence na na na na na na E. Orphanhood Paternal orphan prevalence na na na na na na Maternal orphan prevalence na na na na na na Double orphan prevalence na na na na na na - 91 - India 1992 / 93 - 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 0.514 0.500 0.4% 10.1% 54.8% 92.2% 99.5% 51.4% 0.07869 Has radio 0.419 0.493 9.4% 23.6% 38.8% 57.6% 80.1% 41.9% 0.05460 Has television 0.221 0.415 0.0% 0.2% 2.6% 25.5% 81.9% 22.1% 0.08260 Has refrigerator 0.068 0.252 0.0% 0.1% 0.2% 1.0% 32.8% 6.8% 0.06308 Has bicycle 0.471 0.499 31.7% 40.1% 46.0% 54.5% 63.4% 47.1% 0.02313 Has motorcycle 0.090 0.286 0.1% 0.4% 2.1% 7.3% 35.3% 9.0% 0.05653 Has car 0.013 0.113 0.0% 0.0% 0.1% 0.4% 6.0% 1.3% 0.02920 Has sewing machine 0.202 0.402 1.3% 4.5% 10.8% 27.8% 56.8% 20.2% 0.05874 Has Clock/watch 0.568 0.495 15.3% 36.9% 53.5% 80.5% 97.5% 56.8% 0.06058 Has sofa set 0.097 0.296 0.0% 0.1% 1.0% 6.2% 41.1% 9.7% 0.06413 Has fan 0.334 0.472 0.2% 0.9% 10.2% 59.8% 96.1% 33.4% 0.08603 Has VCR/VCP 0.027 0.163 0.1% 0.5% 1.0% 1.3% 10.7% 2.7% 0.03430 Has tractor 0.017 0.130 0.2% 0.4% 1.5% 3.6% 3.0% 1.7% 0.00844 Has separate room used as kitchen 0.558 0.497 29.8% 42.1% 57.4% 66.7% 83.2% 55.8% 0.04006 Owns agricultural land 0.560 0.496 76.9% 60.0% 62.1% 53.2% 27.6% 56.0% -0.03620 Owns any livestock 0.587 0.492 95.2% 62.4% 63.9% 53.6% 18.5% 58.7% -0.05255 Owns bullock 0.262 0.440 48.0% 28.8% 30.1% 19.6% 4.4% 26.2% -0.03352 Owns cows 0.316 0.465 51.2% 32.3% 34.5% 28.8% 10.9% 31.6% -0.02889 Owns buffalo 0.258 0.438 34.1% 25.5% 31.1% 29.6% 8.7% 25.8% -0.02071 Owns goats 0.155 0.362 34.0% 17.5% 13.9% 9.6% 2.6% 15.5% -0.02743 Owns sheeps 0.017 0.129 3.2% 1.6% 2.2% 1.3% 0.2% 1.7% -0.00766 Owns camels 0.005 0.070 0.9% 0.5% 0.6% 0.5% 0.0% 0.5% -0.00402 Owns other animals 0.025 0.157 4.4% 2.9% 2.5% 2.0% 0.8% 2.5% -0.00806 Works own or family's agric. land 0.886 0.318 89.8% 88.5% 88.7% 88.5% 87.4% 88.6% -0.00271 Uses water piped into residence for drinking 0.180 0.384 0.4% 1.8% 5.5% 19.5% 62.6% 18.0% 0.06812 Uses water piped into public tap for drinking 0.135 0.342 6.0% 11.2% 18.9% 21.7% 9.8% 13.5% 0.00191 Uses water from well in residence for drinking 0.076 0.265 5.0% 6.9% 8.8% 10.1% 7.2% 7.6% 0.00094 Uses water from a public well for drinking 0.187 0.390 33.9% 24.9% 20.9% 11.7% 1.9% 18.7% -0.03018 Uses water from spring for drinking 0.007 0.082 0.8% 0.8% 1.1% 0.6% 0.1% 0.7% -0.00359 Uses water from river, canal or surface for drinking 0.031 0.172 5.6% 4.3% 3.3% 1.8% 0.3% 3.1% -0.01155 Uses rainwater for drinking 0.000 0.013 0.0% 0.0% 0.0% 0.1% 0.0% 0.0% 0.00062 Uses water from tanker truck for drinking 0.003 0.057 0.1% 0.1% 0.2% 0.6% 0.6% 0.3% 0.00389 Uses water from residential handpump for drinking 0.157 0.364 11.0% 18.2% 16.9% 19.7% 12.8% 15.7% -0.00209 Uses water from public handpump for drinking 0.209 0.407 36.2% 29.7% 22.2% 12.5% 4.0% 20.9% -0.02974 Uses water from other source for drinking 0.015 0.120 1.0% 1.8% 2.2% 1.7% 0.5% 1.5% -0.00306 Uses private flush toilet 0.168 0.374 0.0% 0.2% 2.2% 13.3% 68.2% 16.8% 0.07629 Uses shared flush toilet 0.024 0.152 0.0% 0.1% 1.0% 3.7% 7.1% 2.4% 0.01725 Uses public flush toilet 0.017 0.130 0.1% 0.2% 1.2% 3.6% 3.4% 1.7% 0.00995 Uses bush,field as latrine 0.701 0.458 99.0% 95.2% 86.3% 63.5% 6.6% 70.1% -0.08138 Uses other type of latrine 0.001 0.028 0.0% 0.0% 0.1% 0.1% 0.1% 0.1% 0.00140 Uses private latrine 0.068 0.252 0.7% 3.5% 7.1% 11.6% 11.1% 6.8% 0.01404 Uses public latrine 0.009 0.094 0.1% 0.3% 1.1% 1.9% 1.1% 0.9% 0.00443 Uses shared latrine 0.012 0.111 0.1% 0.4% 1.2% 2.3% 2.3% 1.2% 0.00754 Uses electricity for lighting 0.514 0.500 0.4% 10.1% 54.8% 92.2% 99.5% 51.4% 0.07868 Uses kerosene for lighting 0.482 0.500 98.9% 89.3% 44.5% 7.6% 0.4% 48.2% -0.07820 Uses gas for lighting 0.001 0.026 0.1% 0.1% 0.1% 0.0% 0.0% 0.1% -0.00079 Uses oil for lighting 0.002 0.039 0.3% 0.2% 0.2% 0.0% 0.0% 0.2% -0.00295 Uses other source for lighting 0.002 0.042 0.3% 0.2% 0.3% 0.1% 0.0% 0.2% -0.00270 - 93 - India 1992 / 93 - ASSETS AND FACTOR SCORES (Cont.) (FACTOR SCORE) Asset Variable Unweighted Wealth Quintiles Factor Low 2nd 3rd 4th High Avg. Score Mean Std. Percentage of Population Devia- tion Uses electricity as cooking fuel 0.003 0.056 0.0% 0.0% 0.0% 0.3% 1.2% 0.3% 0.00880 Uses wood as cooking fuel 0.647 0.478 79.5% 76.0% 80.5% 69.8% 17.6% 64.7% -0.05266 Uses dung as cooking fuel 0.108 0.310 14.2% 15.3% 11.8% 10.3% 2.5% 10.8% -0.01619 Uses coal as cooking fuel 0.036 0.187 0.7% 2.3% 3.5% 5.3% 6.3% 3.6% 0.00888 Uses charcoal as cooking fuel 0.004 0.060 0.1% 0.2% 0.4% 0.5% 0.7% 0.4% 0.00307 Uses kerosene as cooking fuel 0.063 0.243 0.0% 0.2% 1.5% 10.3% 19.6% 6.3% 0.02878 Uses LPG as cooking fuel 0.102 0.302 0.0% 0.0% 0.1% 1.1% 49.6% 10.2% 0.07308 Uses biogas as cooking fuel 0.006 0.080 0.0% 0.0% 0.3% 1.0% 1.9% 0.6% 0.00965 Uses other cooking fuel 0.025 0.155 5.0% 5.4% 1.2% 0.6% 0.1% 2.5% -0.01287 House is made of high quality materials 0.235 0.424 0.3% 2.6% 9.2% 27.9% 77.6% 23.5% 0.07483 House is made of low quality materials 0.484 0.500 88.8% 75.5% 51.9% 22.9% 2.9% 48.4% -0.06652 House is made of mixed quality materials 0.279 0.448 10.8% 21.7% 38.7% 49.0% 19.2% 27.9% 0.00330 Has animals sleeping inside house 0.170 0.375 29.4% 19.4% 17.8% 14.1% 4.1% 17.0% -0.02287 Has animals sleeping outside house 0.415 0.493 65.5% 42.7% 45.8% 39.3% 14.3% 41.5% -0.03504 Number of rooms in household 2.985 2.267 2.1 2.5 2.9 3.4 3.9 3.0 0.03037 Size of non-irr agricul land in acres 3.058 36.420 3.1 2.1 3.4 2.9 3.9 3.1 0.00079 Size of irrigated land in acres 3.155 40.200 3.2 2.8 2.8 3.4 3.6 3.2 0.00052 Number of members per sleeping room 2.947 2.224 3.9 3.2 2.9 2.6 2.1 2.9 -0.02901 - 94 - PART VI. ANNEXES A. SOURCES OF ADDITIONAL INFORMATION B. USE OF INFORMATION FROM THIS REPORT TO MONITOR THE ECONOMIC STATUS OF PEOPLE SERVED BY HNP PROGRAMS C. COUNTRIES COVERED BY THE HNP- POVERTY REPORT PROJECT ANNEX A. SOURCES OF ADDITIONAL INFORMATION ADDITIONAL INEQUALITY DATA World Bank HNP/Poverty Country Report Website: http://www.worldbank.org/hnp/povertyandhealth/countrydata. This World Bank website provides the full texts and tables for all fifty-six countries covered by the HNP/Poverty Country Report Project. (A list of the countries covered appears in annex C, at the end of this report.) Also available at the site are summary tables, organized by indicator, designed to facilitate cross-country comparisons in inequality with respect to particular indicators. DHS Country Reports: http://www.measuredhs.com/countries. All DHS final country reports produced since 2003 include quintile-specific tabulations in approximately 50-100 of the reports' HNP indicator tables. The tables deal with some of the indicators covered in this volume, and with many that are not. UNICEF Multi-Indicator Cluster Survey Website: http://www.childinfo.org/MICS2/natlMICSrepz/MICSnatrep.htm. The UNICEF Multi-Indicator Cluster Survey (MICS) project is generally similar to the DHS program, but covers a somewhat different set of countries and indicators. The "standard tables" section for each country listed at the MICS website provides wealth- based, quintile-specific information in around 40-45 of the tables related to hnp, education, and child labor. In deriving these quintile-specific estimates, the MICS investigators have employed a wealth index similar to the one used here. World Health Organization World Health Survey Website: http://www.who.int/healthinfo/survey/en/index.html. The World Health Organization's World Health Survey (WHS) includes such issues as self-assessed adult health status; coverage of interventions against adult chronic diseases and against maternal and child health problems; household health expenditures; insurance coverage; and health system responsiveness. Approximately seventy countries ­ developed as well as developing ­ have been covered thus far. Household wealth information has been collected and used to prepare quintile-specific estimates for many of the indicators appearing in the reports on these countries. - 97 - METHODS AND RESOURCES FOR FURTHER INEQUALITY ANALYSIS Shea Oscar Rutstein and Kiersten Johnson, The DHS Wealth Index, DHS Comparative Reports No. 6 (Calverton, Maryland, USA: ORC Macro, August 2004) (Available at: http://www.measuredhs.com/pubs/pub_details.cfm?ID =470&srchTp=type). This DHS publication, by two of the co-authors of the current report, describes in detail the construction of the wealth index that underlies the data presented in the basic tables. Deon Filmer and Lant H. Pritchett, "Estimating Wealth Effects without Expenditure Data ­ or Tears: An Application to Education Enrollments in States in India," Demography 38, no.1 (February 2001): 115-132. This seminal piece gave birth to the wealth index procedure used in the current volume. It also includes three of the previously-cited country case studies demonstrating the close relationship between results produced using wealth and those based on consumption as an indicator of household economic status. Owen O'Donnell, Eddy van Doorslaer, Adam Wagstaff, and Magnus Lindelow. Quantitative Techniques for Health Equity Analysis. Washington D.C.: The World Bank, forthcoming. Among the topics covered in this comprehensive overview of available quantitative techniques are the measurement of living standards using a wealth index and other approaches (chapter 6) and the concentration index as a measure of inequality (chapter 8). DHS Country Data Sets: http://www.measuredhs.com/accesssurveys/search. The data sets for all DHS surveys undertaken since 2003 include two pieces of information for each household that are designed to help investigators prepare quintile- specific tabulations for any indicator. These are: 1) the household wealth score; and 2) the economic quintile to which individuals in the household belong. Any tabulation using these pieces of information will be comparable to the figures appearing here. - 98 - ANNEX B. USE OF INFORMATION FROM THIS REPORT TO MONITOR THE ECONOMIC STATUS OF PEOPLE SERVED BY HNP PROGRAMS The wealth or asset approach employed in this report can be used to monitor the economic status of people served by health, nutrition, and population (hnp) programs in two ways. The first, simpler way is suitable for monitoring nationwide, facility-based programs. A second, fuller version can also be employed for other types of programs, such as initiatives undertaken only in some parts of a country, or activities like mass education or outreach programs that do not operate through facilities. BASIC MONITORING OF NATIONWIDE FACILITY-BASED PROGRAMS The economic distribution of patients in a nationwide, facility-based program (say, a network of rural health posts, antenatal care clinics, emergency obstetrical facilities, or hospitals) can be determined through an exit survey of facility patients, using the wealth questionnaire and the set of quintile cut-off points that immediately follow this text, and which have been created using the information presented in part III.C. The questionnaire can be employed to measure the economic status of any individual responding to the questions on it. The set of cut-off points can serve to compare the distribution of the respondents' economic status with that of the nationally- representative sample of people interviewed by the DHS survey on which the present report is based. The first step is to use the questionnaire in interviewing an adequately-large sample of patients attending the facility-based services of interest. The wealth score for each patient can then be calculated by multiplying the response to each question by the item scores also provided on the questionnaire, and summing the results. After this has been done, the quintile cut-off points can be used to place each individual in the economic quintile to which (s)he belongs. The number of patients and percentage of total patients in each quintile can then be calculated. Since each quintile defined by the cut-off points contains 20 percent of the individuals in the nationally-representative DHS sample, the patients belonging to any such quintile containing significantly more (or less) than 20 percent of the total are over- (under-) represented relative to the national population. When the percentage of patients in each of the five quintiles is viewed as a whole, the result is a frequency distribution that indicates the spread of service beneficiaries across economic classes of individuals.21 For example: · A service that favors the poorest people would have substantially more than 20 percent of its patients in each of the lowest one or two economic quintiles; considerably less than 20 percent of its patients in each of the highest quintiles. 21That is, across economic classes of all individuals in the sample population. Estimates pertaining to quintiles of only those individuals needing services require adjusting the results of the procedure described here through application of the relevant quintile-specific, sample-size figures presented in part III.A. - 99 - · A service that reaches all economic classes equally would draw roughly the same proportion of total patients from the lower and upper quintiles. · A service that favors the least poor population groups would have well over 20 percent of its patients in each of the highest one or two quintiles, considerably less than 20 percent of its patients in each of the lowest quintiles. FULLER MONITORING OF FACILITY-BASED AND OF OTHER PROGRAMS While capable of providing far more information than currently exists about the distribution of a program's beneficiaries, the approach just described has important limitations. For example, it cannot deal with the many important types of health programs that do not deliver services primarily through facilities ­ mass media health education, household visits by health workers, and many social marketing initiatives, for example. It is also limited in its ability to assess programs working only with certain areas within a country: it can compare the economic status of the programs' beneficiaries with that of the national population, but not with that of the specific sub-national areas where the programs are active. Further, it focuses primarily on only one of the two important dimensions of monitoring the distribution of program beneficiaries: that is, incidence or focus ­ the percentage of program benefits that flow to the poor. It cannot deal nearly so well with the second dimension, which concerns coverage, or the percentage of the poor that the program reaches. These limitations can be overcome by a modified version of the approach described above that relies on a household- rather than facility-based survey. A household survey can generate a set of data containing the full range of information needed to produce an equity assessment by collecting two types of information: first, about the household's wealth or assets, using the questions in the left-hand column of the attached questionnaire;22 and second, about the household members' use of or exposure to the services provided by the program(s) of interest. The collected data can be analyzed in either (or both) of two ways, depending on the type of information desired: · One way would be to use only data from the household survey. The procedure would be analogous to that for a DHS survey employed in this report: ­ Asset information from the survey-generated data set would be used as the basis for the construction of a wealth index, weighting the individual items using some method like principal components analysis. ­ The individuals in the sample would be ranked in order of the index values for their households, then divided into groups like quintiles. ­ The coverage rates in each quintile for the service of interest would be calculated. · A second approach would be to use the weights for each item appearing on the attached questionnaire in determining the wealth of each individual, instead of calculating the weights from the new household data set. Once the individuals' wealth is determined, the individuals would be ranked, divided into quintiles, and the coverage rate in each quintile would be calculated. In the case of programs undertaken in only one region of the country, it would 22Or, if one is willing to forego the benefits of the second analytical approach described below, using any of several other asset questionnaires that exist. Examples include the INDEPTH health equity survey tool (available at: www.indepth-network.org/core_documents/indepthtools.htm) or the model questionnaire developed by M. Mahood Khan and David Hotchkiss of the PHR Plus project (which can be found at: www.phrplus.org). - 100 - provide a comparison of the economic status of the people served with that of the entire country rather than of only the region where the programs are active;23 in the case of nationwide as well as regional programs, it would permit a comparison with the other service programs covered in this report. 23This additional perspective could be particularly helpful in an assessment of a program seeking to reach the poor by focusing on especially backward districts. A report presenting only a finding that the program was reaching the better- off people in those districts could produce an impression that it had failed to reach its intended beneficiaries. But a comparison between the economic status of the program's beneficiaries with that of the national population might well reveal that most of the beneficiaries were poor by national standards and that the program was thus considerably more successful than otherwise thought. - 101 - India 1998 / 99 - ASSET QUESTIONNAIRE Question Score if Score if Item "Yes" "No" Score 1. In your household, is/are there? Electricity 0.03894 -0.07741 One or more radios 0.04682 -0.03340 One or more televisions 0.07965 -0.05083 One or more refrigerators 0.14123 -0.02365 One or more bicycles 0.02075 -0.01603 One or more motorcycles 0.12131 -0.01754 One or more cars 0.17751 -0.00442 One or more telephones 0.15227 -0.01707 One or more mattresses 0.04259 -0.05825 One or more pressure cookers 0.07914 -0.04904 One or more chairs 0.05023 -0.05596 One or more cots, beds 0.01002 -0.05198 One or more tables 0.05523 -0.05295 One or more clocks, watches 0.03059 -0.07569 One or more fans 0.06126 -0.05825 One or more sewing machines 0.08175 -0.02583 One or more water pumps 0.06221 -0.00551 One or more bullock carts -0.01964 0.00126 One or more threshers 0.01614 -0.00028 One or more tractors 0.05253 -0.00087 A separate room used as a kitchen 0.03418 -0.04139 2. Does your household own? Agricultural land -0.01873 0.01815 Livestock -0.02778 0.02442 3. Does your household have a domestic worker not related to head? 0.15333 -0.00007 4. Do the members of your household work their own or family's agricultural land? -0.03836 0.00921 5. What is your household's principal source of drinking water? Piped water in residence 0.08449 -0.03012 Piped water in public tap -0.01599 0.00347 Well in residence 0.01187 -0.00015 Public well -0.01034 0.00064 Public open well -0.05483 0.00607 Covered public well -0.04415 0.00046 Residential handpump -0.00204 0.00031 Public handpump -0.05492 0.01282 River, canal, surface water -0.04787 0.00151 Springwater -0.03921 0.00078 Rainwater 0.00319 0.00000 Tanker truck 0.00115 0.00000 Other source -0.01739 0.00008 6. What is the principal type of fuel for cooking used by your household? Wood -0.04053 0.05519 Dung -0.04851 0.00267 Coal 0.00715 -0.00011 Charcoal 0.00685 -0.00002 - 103 - India 1998 / 99 - ASSET QUESTIONNAIRE (Cont.) Question Score if Score if Item "Yes" "No" Score 6. What is the principal type of fuel for cooking used by your household? (Cont.) Kerosene 0.02679 -0.00256 LPG 0.11752 -0.03216 Biogas 0.08637 -0.00038 Crop residual -0.07130 0.00268 Electricity 0.05349 -0.00043 Other source -0.02453 0.00004 7. What is the principal type of kitchenware for your household? Clay -0.04089 0.00042 Aluminum -0.03367 0.01918 Cast iron -0.03048 0.00008 Brass or copper 0.00272 -0.00004 Stainless steel 0.02081 -0.03252 Other 0.07704 0.00000 8. What is the principal type of toilet facility used by your household? Private flush toilet 0.10299 -0.02988 Shared flush toilet 0.04622 -0.00177 Public flush toilet 0.03039 -0.00093 Private pit latrine 0.01459 -0.00231 Shared pit latrine 0.00180 -0.00004 Public pit latrine -0.00699 0.00005 Bush, field as latrine -0.05097 0.06070 Other -0.04159 0.00005 9. What is the principal source of lighting for your household? Electricity -0.07773 0.03839 Kerosene -0.04035 0.00002 Gas -0.07085 0.00009 Oil -0.05701 0.00009 Other -0.04053 0.05519 10. What is the quality of the principal household materials? High quality (pucca) materials 0.07426 -0.04016 Low quality (katcha) materials -0.06224 0.02620 Mixed quality materials -0.02167 0.01171 11. How much of your household land is under cultivation? size - 2.39 × 0.001 10.01 12. How much irrigated land does your household own? size6 - 1.21 × 0.003 .96 13. How many people are there for each sleeping room in your household? # people- 2.29× -0.029 1.88 Total Household Asset Score (sum of individual item scores) - 104 - India 1998 / 99 - QUINTILE CUT-OFF POINTS Asset Index Value Wealth Quintile Bottom Cut-Off Top Cut-Off Low Low -1.03013 Second -1.03013 -0.65339 Third -0.65339 -0.10694 Fourth -0.10694 0.67560 High 0.67560 High - 105 - 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 - 107 -