39442 SOCIO-ECONOMIC DIFFERENCES IN HEALTH, NUTRITION, AND POPULATION CHAD 1996/97, 2004 Davidson R. Gwatkin, Shea Rutstein, Kiersten Johnson, Eldaw Suliman, Adam Wagstaff, and Agbessi Amouzou TABLE OF CONTENTS Foreword I Introduction III Part I. Basic Tables, 2004 1 A. Total Population 3 B. Female and Male Populations 9 C. Rural and Urban Populations 13 Part II. Basic Tables, 1996 / 97 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, 2004 63 A. Sample Sizes 65 B. Standard Errors 71 C. Asset Distribution and Weights 77 Part V. Supporting Tables, 1996 / 97 79 A. Sample Sizes 81 B. Standard Errors 87 C. Asset Distribution and Weights 93 Part VI. Annexes 95 A. Sources of Additional Information 97 B. Use of Information from this 99 Report to Monitor the Economic Status of People Served by HNP Programs C. Countries Covered by the 105 HNP-Poverty Report Project FOREWORD The World Bank shares the desire of its member states and client countries to ensure that the poor partake fully in the health gains that the countries achieve. To assist in this, the Bank, in cooperation with the Dutch and Swedish Governments, has sponsored the set of reports providing basic information about health inequalities within countries to which this document belongs. The information shows clearly that disparities in both health conditions and health service use are unacceptably large. As countries and the Bank work to reduce important inequalities among regions and countries, there is a clear need for equally vigorous efforts to lessen the inequity represented by intra-country differences among socio-economic groups. My colleagues and I hope that all concerned with equity in health will find this information useful in making the case for effective actions to improve the health of the poor, and in designing programs to achieve this crucial objective. Joy Phumaphi Vice President Human Development Network The World Bank - I - INTRODUCTION This report is one in a series that provides basic information about health, nutrition, and population (hnp) inequalities within fifty-six developing countries. The series to which the report belongs is an expanded and updated version of a set covering forty- five countries that was published in 2000. The fifty-six reports in the current series cover almost all DHS surveys undertaken during the period beginning in 1990 and ending with the date of the last survey for which data were publicly available as of June 2006.1 The report's contents are intended to facilitate preparation of country analyses and the development of activities to benefit poor people. To this end, the report presents data about hnp status, service use, and related matters among individuals belonging to different socio-economic classes. The principal focus is on differences among groups of individuals defined in terms of the wealth or assets of the households where they reside. The source of data is the Demographic and Health Survey (DHS) program, a large, multi-country household survey project. The figures in this and the other reports in the series draw on responses to questions about household wealth or assets included in the DHS questionnaire, which were similar for all the surveys covered. These responses served as the basis for the construction of a wealth index, which was used to rank individuals according to the index value for the household to which they belonged. The individuals were then divided into quintiles, and the mean value for each of up to approximately 120 indicators was calculated for each quintile. The report is organized in four principal parts: · Parts one and two, which constitute the report's core, consist of tables presenting quintile-specific data for each hnp indicator covered from the two most recent DHS surveys available at the time of the report's publication. In each part there are three sets of tables: the first provides quintile-specific information for the total population; the second presents data separately for quintiles of females and males; the third features quintile-specific information presented separately for rural and urban residents. Each of these sets is divided into four sections: one dealing with hnp status, the second with the use of hnp services, the third with hnp-related behavior, and the fourth with other hnp status determinants. · Part three provides supplementary technical information designed to help readers understand the data presented in parts one and two. This information deals with such issues as how the covered hnp indicators were defined and how the quintile-specific estimates were derived. · Parts four and five present supporting tables that deal with three of the technical matters covered in part three: the size of the sample for each indicator covered; the standard error 1The average interval of approximately two years between data collection and availability means that the latest surveys covered were conducted in 2005. - III - for each quintile-specific estimate in the total population; and the items used in constructing the wealth index, along with the weight assigned to each. An additional, sixth part consists of three annexes, for readers interested in applying the approach used in the report or in learning more about the other reports in this series. The first annex is an annotated bibliography containing further information about the technical issues concerning the approach used in the report, and about employing that approach to examine additional issues using DHS or other data sets. The second shows how the report's approach can be applied to monitor the distribution of benefits from other hnp programs, and provides a tool for doing so. The third annex is a list of all fifty-six countries for which reports are available, along with an indication of how to obtain copies of the reports dealing with them. ********************************* The authors thank the Dutch and Swedish Governments for the generous support that made production of this report possible. - IV - PART I. BASIC TABLES, 2004 A. TOTAL POPULATION B. FEMALE AND MALE POPULATIONS C. RURAL AND URBAN POPULATIONS Notes: ­ Each of the three sections referred to above consists of four divisions, presenting data for: I) hnp status; II) hnp service use; III) hnp-related individual and household behavior; and IV) other, underlying determinants of hnp status. ­ Full definitions of all indicators covered in the tables are provided in section A of the technical notes found in part II. ­ "na" appears in the table cells when data are not available, usually because the DHS survey concerned did not collect information about the indicator(s) in question. ­ Figures in the tables shown within parentheses indicate the absence of adequate observations to produce acceptably reliable values. Asterisks appear when the number of observations was too small to justify the presentation even of figures within parentheses. (For further information, see the section on "Sampling Errors" in the presentation of data and methods in part II.B.) Asterisks also will be found in columns showing statistical indices of inequality when the amount of quintile-specific information available is inadequate to permit computation of the value for the index concerned. ­ Female/male tables include only indicators relevant for both sexes; those pertaining to only one sex (e.g., fertility, women's nutritional status, antenatal care, attended deliveries) have been omitted. Chad 2004 - TOTAL POPULATION Part I: HNP STATUS Indicator Wealth Quintiles Low/High Low-High Concentration Index Ratio Diff. Value Standard Low 2nd 3rd 4th High Avg. (Abs. Val.) Errors A. Childhood illness and mortality Infant mortality rate 109.2 122.5 117.4 122.4 100.9 115.2 1.08 8.30 -0.0104 0.0244 Under-five mortality rate 176.0 208.2 211.5 225.0 186.5 202.5 0.94 10.54 0.0157 0.0286 Prevalence of fever 26.5 38.8 32.8 37.7 34.0 34.3 0.78 7.54 -0.0008 0.0103 Prevalence of diarrhea 19.6 31.9 27.8 26.4 27.3 26.9 0.72 7.63 0.0204 0.0119 Prevalence of acute 7.4 10.7 8.0 9.5 10.1 9.2 0.74 2.65 -0.0033 0.0241 respiratory infection B. Fertility Total fertility rate 5.1 6.6 6.9 7.2 6.0 6.3 0.86 0.85 0.0296 0.0363 Adolescent fertility rate 138.8 220.2 223.5 191.9 164.1 187.3 0.85 25.29 0.0075 0.0567 C. Nutritional status (%) Children: Moderate stunting 19.7 15.3 19.7 18.1 16.6 17.8 1.19 3.16 -0.0384 0.0170 Severe stunting 31.0 23.7 25.0 21.1 15.1 23.2 2.05 15.85 -0.1233 0.0140 Moderate underweight 27.5 23.0 22.9 21.3 19.2 22.7 1.43 8.24 -0.0610 0.0147 Severe underweight 20.8 11.9 14.5 14.4 9.3 14.0 2.24 11.53 -0.1393 0.0197 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 29.9 17.8 20.2 18.0 14.7 20.0 2.03 15.18 -0.1354 0.0170 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 47.4 25.4 14.3 13.0 18.1 24.6 2.61 29.24 -0.1989 0.0174 Women 88.1 58.6 34.2 31.6 43.8 53.1 2.01 44.30 -0.1468 0.0066 Prevalence of occlusion: Girls 4.5 3.9 0.9 7.0 3.7 4.1 1.20 0.74 0.0955 0.0929 Women 1.0 1.8 1.8 2.5 5.7 2.3 0.18 4.70 0.5644 0.0877 E. Sexually transmitted disease Prevalence of genital discharge: Women 4.0 4.8 2.1 3.8 7.5 4.5 0.54 3.45 0.1847 0.0345 Men 2.3 0.9 2.0 1.6 2.1 1.8 1.11 0.22 0.1742 0.1040 Prevalence of genital ulcer: Women 1.0 0.9 0.6 0.5 1.5 0.9 0.68 0.47 0.0648 0.0747 Men 0.7 0.9 0.9 2.3 1.1 1.2 0.61 0.43 0.1256 0.1218 - 3 - Chad 2004 - TOTAL POPULATION Part II: Intermediate Determinants of HNP Status - HNP SERVICE USE Indicator Wealth Quintiles Low/High Low-High Concentration Index Ratio Diff. Value Standard Low 2nd 3rd 4th High Avg. (Abs. Val.) Errors A. Childhood immunization BCG coverage 13.8 34.2 41.8 43.3 67.8 40.2 0.20 54.01 0.2744 0.0187 Measles coverage 8.2 16.3 28.2 23.6 38.1 22.8 0.21 29.95 0.2843 0.0315 DPT coverage 4.7 14.2 17.3 22.4 42.3 20.1 0.11 37.58 0.4123 0.0334 Full basic coverage 1.1 7.1 12.4 12.4 23.6 11.3 0.04 22.52 0.3944 0.0479 No basic coverage 29.9 20.4 18.0 18.7 13.0 19.9 2.30 16.90 -0.1491 0.0335 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 7.6 16.8 21.7 20.8 39.0 21.5 0.19 31.43 0.2700 0.0228 Treatment in a public facility 1.8 4.3 5.6 7.9 29.6 9.7 0.06 27.73 0.5290 0.0426 Treatment in a private facility 1.3 0.6 1.4 1.3 4.7 1.8 0.28 3.41 0.7118 0.1271 Treatment of acute respiratory infection: Medical treatment of ARI 7.4 4.9 6.4 9.4 20.3 9.6 0.37 12.87 0.3842 0.0794 Treatment in a public facility 1.8 2.3 1.1 1.8 17.5 5.0 0.11 15.68 0.6116 0.1346 Treatment in a private facility 4.6 0.0 0.0 2.4 1.4 1.5 3.29 3.24 0.3907 0.2273 Treatment of diarrhea: Use of oral rehydration therapy 14.9 40.1 32.2 42.5 49.5 37.5 0.30 34.62 0.1383 0.0177 Medical treatment of diarrhea 1.2 10.2 14.5 18.5 35.2 16.3 0.03 33.97 0.4018 0.0313 Treatment in a public facility 1.2 4.5 11.1 5.8 28.7 10.2 0.04 27.56 0.5495 0.0464 Treatment in a private facility 0.0 0.6 0.0 1.5 3.5 1.1 0.00 3.53 0.7898 0.1937 C. Antenatal and delivery care Antenatal care visits: To a medically trained person 9.2 30.4 43.2 53.7 77.4 42.6 0.12 68.24 0.3228 0.0076 To a doctor 0.3 0.9 2.4 3.3 6.4 2.6 0.04 6.15 0.5845 0.0670 To a nurse or trained midwife 8.9 29.5 40.8 50.5 71.0 40.0 0.13 62.09 0.3055 0.0086 Multiple visits to a medically trained 4.9 19.8 27.4 37.5 64.4 30.5 0.08 59.44 0.4148 0.0107 person Antenatal care content: Tetanus toxoid 11.8 34.0 39.3 51.6 72.5 41.8 0.16 60.67 0.2933 0.0084 Prophylactic antimalarial treatment 11.1 25.3 34.9 40.7 56.4 33.6 0.20 45.36 0.2578 0.0102 Iron supplementation 7.6 16.2 27.5 36.4 57.7 28.7 0.13 50.18 0.3705 0.0120 Delivery attendance: By a medically trained person 1.4 7.2 7.9 14.8 51.4 16.1 0.03 50.06 0.7311 0.0169 By a doctor 0.1 0.3 0.2 0.6 2.7 0.7 0.05 2.52 0.9822 0.1240 By a nurse or trained midwife 1.2 7.0 7.7 14.2 48.8 15.4 0.03 47.53 0.7188 0.0177 In a public facility 0.5 3.7 4.5 9.7 39.8 11.3 0.01 39.30 0.8532 0.0240 In a private facility 0.1 0.2 0.1 0.6 1.4 0.5 0.10 1.28 0.8949 0.1607 At home 97.7 93.6 93.4 87.2 56.4 86.0 1.73 41.32 -0.1159 0.0032 - 4 - Chad 2004 - TOTAL POPULATION Part II: Intermediate Determinants of HNP Status - HNP SERVICE USE (Cont.) Indicator Wealth Quintiles Low/High Low-High Concentration Index Ratio Diff. Value Standard Low 2nd 3rd 4th High Avg. (Abs. Val.) Errors D. Contraceptive services Contraceptive prevalence: Women 0.0 0.2 1.0 0.4 7.3 1.6 0.00 7.32 0.8319 0.0812 Men 0.0 2.0 2.4 5.3 14.1 4.9 na 14.10 0.5895 0.0722 Source of contraception - public sector: Women * * * 64.6 na 63.0 * * * * Men na na na na na na na na na na Source of contraception - private sector: Women * * * 32.3 na 33.2 * * * * Men na na na na na na na na na na E. Treatment of adult illnesses Treatment of genital discharge, ulcer, sore: Women 17.7 29.7 (45.1) 54.6 65.5 45.0 0.27 47.77 0.3160 0.0323 Men * * * * * 59.9 * * * * Treatment of genital discharge, ulcer, sore in public facilities: Women 17.7 29.7 (45.1) 54.6 65.5 45.0 0.27 47.77 0.3157 0.0323 Men * * * * * 59.9 * * * * Voluntary counseling and testing for HIV/AIDS: Women 0.2 0.6 0.1 1.8 7.7 2.1 0.02 7.55 0.8806 0.0643 Men 0.6 0.5 1.0 1.2 12.5 3.9 0.04 11.91 0.8433 0.0802 - 5 - Chad 2004 - TOTAL POPULATION Part III: Intermediate Determinants of HNP Status - INDIVIDUAL AND HOUSEHOLD BEHAVIOR Indicator Wealth Quintiles Low/High Low-High Concentration Index Ratio Diff. Value Standard Low 2nd 3rd 4th High Avg. (Abs. Val.) Errors A. Hygienic practices Disposal of children's stools: Sanitary disposal na na na na na na na na na na Handwashing: Wash hands prior to preparing food na na na na na na na na na na Handwashing facilities in household na na na na na na na na na na B. Bednet ownership and use Bednet ownership: Bednet ownership 73.4 47.4 59.5 64.5 82.3 64.6 0.89 8.86 0.0656 0.0051 Treated bednet ownership na na na na na na na na na na Bednet use: By children 67.0 42.2 49.9 53.6 71.2 55.8 0.94 4.15 0.0718 0.0066 By pregnant women na na na na na na na na na na C. Breastfeeding Exclusive breastfeeding 0.9 1.4 5.3 0.2 1.7 1.8 0.53 0.80 0.0649 0.2053 Timely complementary feeding (54.1) 62.1 71.8 76.8 76.0 69.4 (0.71) 130.19 0.0575 0.0207 Bottle-feeding 0.4 2.9 0.7 0.5 12.4 3.4 0.03 12.02 0.9891 0.1338 D. Micronutrient consumption Iodized salt: Availability of iodized salt 34.2 70.7 74.6 79.2 78.3 65.9 0.44 44.02 0.1351 0.0054 in household Vitamin A: Children 33.7 30.5 22.8 33.5 53.9 34.5 0.63 20.19 0.1644 0.0124 Women na na na na na na na na na na E. Tobacco and alcohol use Tobacco: Women na na na na na na na na na na Men na na na na na na na na na na Alcohol: Women na na na na na na na na na na Men na na na na na na na na na na F. Sexual practices Non-regular sexual partnerships: Women 0.0 0.4 0.4 2.1 1.6 0.9 0.00 1.62 0.4273 0.0777 Men na na na na na na na na na na Condom usage with non-regular partner: Women * * * * * (9.6) * * * * Men na na na na na na na na na na G. Domestic violence Ever experienced violence na na na na na na na na na na Experienced violence in past year na na na na na na na na na na - 6 - Chad 2004 - TOTAL POPULATION Part IV: UNDERLYING DETERMINANTS OF HNP STATUS Indicator Wealth Quintiles Low/High Low-High Concentration Index Ratio Diff. Value Standard Low 2nd 3rd 4th High Avg. (Abs. Val.) Errors A. Education School completion: Women 0.0 3.6 5.8 9.6 35.5 10.8 0.00 35.51 0.7515 0.0213 Men 1.6 21.4 27.9 39.4 58.4 32.3 0.03 56.76 0.3967 0.0088 School participation: Girls 7.1 27.6 26.0 37.4 56.0 29.7 0.13 48.97 0.3135 0.0137 Boys 10.3 40.3 31.4 48.6 64.1 38.6 0.16 53.75 0.2625 0.0103 B. Exposure to mass media Newspaper readership: Women 0.2 0.4 0.3 1.4 13.8 3.2 0.02 13.57 1.0499 0.0556 Men 0.0 3.1 8.3 12.0 33.5 13.3 0.00 33.54 0.6721 0.0328 Radio listenership: Women 4.0 10.9 10.7 22.1 64.1 22.4 0.06 60.19 0.6088 0.0114 Men 16.5 44.5 53.1 67.2 81.6 55.8 0.20 65.19 0.2383 0.0087 Television viewership: Women 0.4 1.1 1.1 1.3 22.5 5.3 0.02 22.13 1.2317 0.0467 Men 1.3 4.8 6.5 8.4 39.3 14.3 0.03 38.05 0.7385 0.0325 C. Knowledge and attitudes about HIV/AIDS Knowledge about sexual transmission of HIV/AIDS: Women 26.0 43.1 43.9 54.0 55.8 44.6 0.47 29.83 0.1416 0.0074 Men 69.1 73.9 59.3 68.4 78.5 70.5 0.88 9.46 0.0318 0.0081 Knowledge about mother-to-child transmission of HIV/AIDS: Women 15.2 51.6 57.0 63.1 73.0 51.9 0.21 57.84 0.2100 0.0055 Men 37.4 70.6 63.6 68.4 78.5 65.6 0.48 41.04 0.1119 0.0093 Attitudes toward HIV/AIDS: Women 63.3 73.3 75.2 73.9 82.2 74.8 0.77 18.90 0.0439 0.0046 Men 60.8 51.9 43.9 47.5 64.4 54.5 0.94 3.59 0.0460 0.0126 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 47.1 50.2 54.6 56.6 85.6 60.5 0.55 38.50 0.1522 0.0083 Can decide whether to have sex 81.8 88.2 84.1 81.8 75.9 82.4 1.08 5.82 -0.0217 0.0034 Justifies domestic violence na na na na na na na na na na E. Orphanhood Paternal orphan prevalence 4.2 5.7 4.8 3.3 7.6 5.1 0.55 3.39 0.1359 0.0200 Maternal orphan prevalence 1.4 2.2 2.7 2.6 4.3 2.6 0.33 2.87 0.2002 0.0271 Double orphan prevalence 0.2 0.6 0.4 0.3 2.0 0.7 0.10 1.76 0.5356 0.0671 - 7 - Chad 2004 - FEMALE / MALE POPULATIONS Part I: HNP STATUS Indicator Wealth Quintiles - Female Wealth Quintiles - Male Low 2nd 3rd 4th High Avg. Low 2nd 3rd 4th High Avg. A. Childhood mortality and morbidity Infant mortality rate 83.4 111.1 120.4 120.8 98.1 107.7 133.9 134.6 114.5 123.9 103.5 122.4 Under-five mortality rate 154.0 201.1 229.0 215.6 184.1 198.0 197.1 216.0 195.6 234.2 188.8 207.0 Prevalence of fever 29.4 37.7 29.9 36.7 31.9 33.5 23.7 40.2 35.4 38.7 36.0 35.1 Prevalence of diarrhea 19.4 32.7 27.0 26.8 24.0 26.5 19.9 30.9 28.4 25.9 30.4 27.3 Prevalence of acute 7.9 11.2 8.8 12.4 10.7 10.3 7.0 10.3 7.2 6.7 9.5 8.1 respiratory infection B. Nutritional status Children: Moderate stunting 21.7 15.9 21.8 18.3 16.5 18.7 17.8 14.6 17.9 17.9 16.6 17.0 Severe stunting 27.7 23.0 25.1 21.3 16.7 22.7 34.2 24.6 24.9 21.0 13.7 23.6 Moderate underweight 23.5 22.0 25.3 22.3 20.0 22.6 31.4 24.0 20.8 20.3 18.5 22.8 Severe underweight 22.9 11.8 14.6 13.5 9.4 14.2 18.8 12.0 14.4 15.3 9.2 13.9 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 4.0 4.8 2.1 3.8 7.5 4.5 Men 2.3 0.9 2.0 1.6 2.1 1.8 Prevalence of genital ulcer: Women 1.0 0.9 0.6 0.5 1.5 0.9 Men 0.7 0.9 0.9 2.3 1.1 1.2 - 9 - Chad 2004 - FEMALE / MALE POPULATIONS Part II: Intermediate Determinants of HNP Status - HNP SERVICE USE Indicator Wealth Quintiles - Female Wealth Quintiles - Male Low 2nd 3rd 4th High Avg. Low 2nd 3rd 4th High Avg. A. Childhood immunization BCG coverage 9.4 35.6 42.2 47.3 66.7 40.1 19.1 32.6 41.5 39.3 69.0 40.2 Measles coverage 7.9 12.9 30.5 25.8 39.1 23.0 8.5 20.1 25.6 21.4 37.0 22.6 DPT coverage 5.9 15.1 16.0 25.0 41.7 20.6 3.3 13.3 18.7 19.7 43.0 19.6 Full basic coverage 1.9 7.4 11.5 14.5 24.2 11.8 0.0 6.7 13.3 10.2 22.9 10.6 No basic coverage 23.9 24.5 12.1 14.5 14.0 17.8 37.3 15.7 24.2 23.1 12.0 22.3 Hepatitis B coverage na na na na na na na na na na na na Yellow fever coverage na na na na na na na na na na na na B. Treatment of childhood illnesses Treatment of fever: Medical treatment of fever 9.4 18.1 29.3 19.3 40.0 22.7 5.5 15.4 16.1 22.3 38.2 20.4 Treatment in a public facility 3.4 5.6 4.5 8.7 33.3 10.6 0.0 2.9 6.4 7.1 26.4 8.8 Treatment in a private facility 2.4 0.0 1.1 2.5 4.2 1.9 0.0 1.2 1.7 0.2 5.2 1.7 Treatment of acute respiratory infection: Medical treatment of ARI 14.3 8.0 9.1 7.1 26.5 12.2 0.0 1.0 3.7 13.7 13.7 6.4 Treatment in a public facility 3.5 4.2 1.8 0.3 25.2 6.6 0.0 0.0 0.4 4.8 9.3 3.0 Treatment in a private facility 8.9 0.0 0.0 3.7 0.2 2.2 0.0 0.0 0.0 0.0 2.7 0.6 Treatment of diarrhea: Use of oral rehydration therapy na na na na na na na na na na na na Medical treatment of diarrhea 0.0 13.0 19.7 20.8 34.7 17.9 2.3 6.8 10.1 16.0 35.5 14.8 Treatment in a public facility 0.0 7.3 13.1 6.6 28.5 10.8 2.3 1.0 9.4 5.0 29.0 9.7 Treatment in a private facility 0.0 1.0 0.0 1.7 5.4 1.6 0.0 0.0 0.0 1.3 2.1 0.7 C. Contraceptive services Women 0.0 0.2 1.0 0.4 7.3 1.6 Men 0.0 2.0 2.4 5.3 14.1 4.9 Source of contraception public sector: Women 43.1 55.5 62.5 64.6 na 63.0 Men na na na na na na Source of contraception - private sector: Women 0.0 44.5 37.5 32.3 na 33.2 Men na na na na na na D. Treatment of adult illnesses Treatment of genital discharge, ulcer, sore: Women 17.7 29.7 45.1 54.6 65.5 45.0 Men 14.7 100.0 66.9 74.3 52.9 59.9 Treatment of genital discharge, ulcer, sore in public facilities: Women 17.7 29.7 45.1 54.6 65.5 45.0 Men 14.7 100.0 66.9 74.3 52.9 59.9 Voluntary counseling and testing for HIV/AIDS: Women 0.2 0.6 0.1 1.8 7.7 2.1 Men 0.6 0.5 1.0 1.2 12.5 3.9 - 10 - Chad 2004 - FEMALE / MALE POPULATIONS Part III: Intermediate Determinants of HNP Status - INDIVIDUAL AND HOUSEHOLD BEHAVIOR Indicator Wealth Quintiles - Female Wealth Quintiles - Male Low 2nd 3rd 4th High Avg. Low 2nd 3rd 4th High Avg. A. Hygienic practices Disposal of children's stools: Sanitary disposal na na na na na na Handwashing: Wash hands prior to preparing food na na na na na na Handwashing facilities in household na na na na na na B. Bednet ownership and use Bednet use: By children 67.0 42.2 49.9 53.6 71.2 55.8 C. Breastfeeding Exclusive breastfeeding 0.0 0.0 13.1 0.5 3.2 2.7 1.6 3.4 0.0 0.0 0.7 1.1 Timely complementary feeding 48.6 55.8 65.9 73.8 76.5 65.7 61.6 68.5 79.3 81.6 75.5 74.1 Bottle-feeding 0.7 2.3 1.7 0.6 14.3 3.6 0.0 3.7 0.0 0.5 10.8 3.1 D. Micronutrient consumption Vitamin A: Children 34.4 32.1 24.3 31.3 50.0 34.0 33.1 28.8 21.5 35.8 57.7 34.9 E. Tobacco and alcohol use Tobacco: Women na na na na na na Men na na na na na na Alcohol: Women na na na na na na Men na na na na na na F. Sexual practices Non-regular sexual partnerships: Women 0.0 0.4 0.4 2.1 1.6 0.9 Men na na na na na na Condom usage with non-regular partner: Women 0.0 0.0 2.7 24.4 na 9.6 Men na na na na na na - 11 - Chad 2004 - FEMALE / MALE POPULATIONS Part IV: UNDERLYING DETERMINANTS OF HNP STATUS Indicator Wealth Quintiles - Female Wealth Quintiles - Male Low 2nd 3rd 4th High Avg. Low 2nd 3rd 4th High Avg. A. Education School completion: Women 0.0 3.6 5.8 9.6 35.5 10.8 Men 1.6 21.4 27.9 39.4 58.4 32.3 School participation: Girls 7.1 27.6 26.0 37.4 56.0 29.7 Boys 10.3 40.3 31.4 48.6 64.1 38.6 B. Exposure to mass media Newspaper readership: Women 0.2 0.4 0.3 1.4 13.8 3.2 Men 0.0 3.1 8.3 12.0 33.5 13.3 Radio listenership: Women 4.0 10.9 10.7 22.1 64.1 22.4 Men 16.5 44.5 53.1 67.2 81.6 55.8 Television viewership: Women 0.4 1.1 1.1 1.3 22.5 5.3 Men 1.3 4.8 6.5 8.4 39.3 14.3 C. Knowledge and attitudes about HIV/AIDS Knowledge about sexual transmission of HIV/AIDS: Women 26.0 43.1 43.9 54.0 55.8 44.6 Men 69.1 73.9 59.3 68.4 78.5 70.5 Knowledge about mother-to-child transmission of HIV/AIDS: Women 15.2 51.6 57.0 63.1 73.0 51.9 Men 37.4 70.6 63.6 68.4 78.5 65.6 Attitudes toward HIV/AIDS: Women 63.3 73.3 75.2 73.9 82.2 74.8 Men 60.8 51.9 43.9 47.5 64.4 54.5 D. Orphanhood Paternal orphan prevalence 4.6 5.4 5.5 3.1 7.7 5.2 3.8 6.1 4.2 3.5 7.5 5.0 Maternal orphan prevalence 1.7 2.4 3.0 2.3 3.9 2.6 1.2 2.0 2.3 2.8 4.6 2.6 Double orphan prevalence 0.4 0.7 0.4 0.4 1.8 0.7 0.0 0.5 0.4 0.3 2.1 0.6 - 12 - Chad 2004 - RURAL / URBAN POPULATIONS Part I: HNP STATUS Indicator Wealth Quintiles - Rural Wealth Quintiles - Urban Low 2nd 3rd 4th High Avg. Low 2nd 3rd 4th High Avg. A. Childhood illness and mortality Infant mortality rate 109.6 122.9 118.3 126.7 128.3 120.0 71.7 104.1 100.0 93.3 93.3 93.8 Under-five mortality rate 176.4 209.0 212.5 230.0 222.9 207.7 145.7 173.8 191.7 191.7 176.6 179.4 Prevalence of fever 26.6 38.7 32.2 38.1 32.3 34.1 18.4 44.5 46.3 35.3 34.5 35.2 Prevalence of diarrhea 19.8 31.9 27.8 27.6 29.8 27.3 7.3 28.2 25.9 18.7 26.7 25.2 Prevalence of acute 7.5 10.9 8.0 9.1 12.8 9.1 3.5 3.5 6.3 12.6 9.4 9.5 respiratory infection B. Fertility Total fertility rate 5.1 6.6 7.0 7.4 7.3 6.5 4.8 5.3 5.1 6.3 5.7 5.7 Adolescent fertility rate 139.4 222.5 226.0 195.6 174.7 195.0 89.0 143.8 185.3 165.1 162.2 162.6 C. Nutritional status Children: Moderate stunting 19.7 15.1 19.8 18.0 21.3 18.1 24.5 26.4 16.7 18.8 15.5 16.4 Severe stunting 31.1 23.8 24.9 21.3 18.8 24.9 18.5 18.3 27.6 19.8 14.3 15.9 Moderate underweight 27.6 23.0 22.5 21.0 19.0 23.2 19.7 21.7 32.7 23.4 19.3 20.6 Severe underweight 20.9 11.9 14.7 15.4 8.1 15.1 18.5 12.4 8.7 7.6 9.6 9.4 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 Women: Malnutrition 30.0 18.1 20.5 17.5 18.0 21.1 19.3 4.3 13.8 21.7 14.0 14.8 Mild anemia na na na na na na na na na na na na Moderate anemia na na na na na na na na na na na na Severe anemia na na na na na na na na na na na na D. Female circumcision Prevalence of circumcision: Girls 47.1 24.6 13.8 10.1 7.2 25.1 64.3 49.4 20.2 27.4 20.3 22.9 Women 88.0 58.1 33.3 28.1 26.3 54.6 92.6 73.2 46.5 49.3 47.0 48.7 Prevalence of occlusion: Girls 4.5 3.6 0.0 8.9 0.0 4.1 3.0 8.9 9.4 3.6 4.0 4.5 Women 1.0 1.8 1.9 1.9 0.0 1.4 1.4 3.0 0.9 4.1 6.3 5.5 E. Sexually transmitted disease Prevalence of genital discharge: Women 4.1 4.8 2.2 3.7 6.8 3.9 2.3 5.8 1.8 4.5 7.6 6.8 Men 2.3 1.0 2.1 1.3 0.0 1.6 5.7 0.0 0.0 3.2 2.4 2.4 Prevalence of genital ulcer: Women 1.0 0.9 0.5 0.3 1.3 0.7 0.0 2.9 1.3 2.0 1.5 1.6 Men 0.6 1.0 0.9 2.5 0.0 1.2 5.7 0.0 0.0 0.3 1.3 1.2 - 13 - Chad 2004 - RURAL / URBAN POPULATIONS Part II: Intermediate Determinants of HNP Status - HNP SERVICE USE Indicator Wealth Quintiles - Rural Wealth Quintiles - Urban Low 2nd 3rd 4th High Avg. Low 2nd 3rd 4th High Avg. A. Childhood immunization BCG coverage 13.6 33.1 42.1 41.5 43.3 33.3 31.1 76.1 37.1 56.3 73.2 68.2 Measles coverage 8.0 14.7 29.4 22.9 28.2 19.2 31.1 76.1 9.9 28.8 40.3 37.5 DPT coverage 4.5 13.9 17.1 21.5 25.6 14.9 31.1 25.4 20.6 28.5 46.0 41.2 Full basic coverage 0.8 6.8 13.0 12.5 20.3 8.9 31.1 16.8 3.5 11.4 24.3 20.9 No basic coverage 30.1 20.9 16.8 19.0 33.2 22.1 0.0 0.0 34.4 16.9 8.5 11.1 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 7.5 16.7 21.0 19.7 33.2 17.6 21.7 19.4 31.7 28.9 40.4 37.4 Treatment in a public facility 1.9 4.0 4.9 6.7 22.7 5.4 0.0 17.6 14.6 16.0 31.2 27.3 Treatment in a private facility 1.3 0.6 1.0 1.4 0.0 1.0 0.0 0.0 7.8 0.8 5.8 5.0 Treatment of acute respiratory infection (ARI): Medical treatment of ARI 7.5 4.8 5.5 8.1 18.4 7.0 0.0 22.7 30.3 15.7 21.0 20.2 Treatment in a public facility 1.9 2.2 0.0 0.0 18.4 2.2 0.0 22.7 30.3 10.4 17.2 16.3 Treatment in a private facility 4.7 0.0 0.0 3.0 0.0 1.5 0.0 0.0 0.0 0.0 1.9 1.4 Treatment of diarrhea: Use of oral rehydration therapy 15.0 39.8 31.4 42.5 44.0 34.8 0.0 58.2 48.6 41.7 51.0 49.9 Medical treatment of diarrhea 1.2 9.9 14.1 18.0 27.7 12.4 0.0 27.8 21.7 22.6 37.2 34.4 Treatment in a public facility 1.2 4.3 11.0 4.7 20.8 6.3 0.0 14.4 12.9 16.6 30.9 27.9 Treatment in a private facility 0.0 0.4 0.0 1.7 0.0 0.5 0.0 6.9 0.0 0.0 4.5 3.8 C. Antenatal and delivery care Antenatal care visits: To a medically trained person 8.9 29.8 41.8 51.4 48.9 33.8 39.1 59.5 71.0 70.3 84.1 80.5 To a doctor 0.3 0.9 2.5 3.3 1.0 1.7 0.0 2.4 1.8 2.8 7.7 6.5 To a nurse or trained midwife 8.6 28.9 39.4 48.1 47.9 32.1 39.1 57.0 69.2 67.5 76.4 74.0 Multiple visits to a medically trained 4.8 19.4 26.3 35.5 35.3 22.2 20.9 38.8 50.2 51.8 71.2 66.1 person Antenatal care content: Tetanus toxoid 11.5 33.7 37.9 49.4 44.3 33.9 36.3 51.5 68.1 67.3 79.1 75.8 Prophylactic antimalarial treatment 11.0 25.0 34.3 40.3 46.1 28.5 20.8 42.2 46.2 43.3 58.9 55.3 Iron supplementation 7.3 16.0 26.3 35.3 35.5 21.8 29.4 29.1 51.1 44.5 63.0 58.6 Delivery attendance: By a medically trained person 1.3 6.7 7.1 10.9 18.0 7.2 10.8 35.1 25.1 42.6 60.1 54.8 By a doctor 0.1 0.2 0.2 0.4 0.6 0.3 0.0 3.3 0.0 2.3 3.2 2.9 By a nurse or trained midwife 1.1 6.5 6.8 10.6 17.4 7.0 10.8 31.8 25.1 40.3 56.9 51.9 In a public facility 0.4 3.4 4.1 6.5 13.3 4.2 9.0 21.5 14.0 32.5 46.7 42.1 In a private facility 0.1 0.2 0.1 0.6 0.0 0.2 0.0 0.0 0.0 0.7 1.8 1.5 At home 97.8 94.0 94.2 90.4 83.0 93.4 91.0 75.2 76.7 64.5 49.5 54.0 D. Contraceptive services Contraceptive prevalence: Women 0.0 0.2 1.0 0.1 2.1 0.4 0.0 0.0 0.0 2.3 8.7 7.1 Men 0.0 2.0 2.5 5.1 0.0 2.4 0.0 0.0 0.0 7.0 16.9 15.0 - 14 - Chad 2004 - RURAL / URBAN POPULATIONS Part II: Intermediate Determinants of HNP Status - HNP SERVICE USE (Cont.) Indicator Wealth Quintiles - Rural Wealth Quintiles - Urban Low 2nd 3rd 4th High Avg. Low 2nd 3rd 4th High Avg. D. Contraceptive services (cont.) Source of contraception - public sector: Women 43.1 55.5 100.0 66.7 na 59.8 48.0 64.5 na na na 63.8 Men na na na na na na na na na na na na Source of contraception - private sector: Women 0.0 44.5 0.0 33.3 na 33.5 52.0 32.3 na na na 33.2 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 17.7 29.3 47.0 54.4 60.7 35.9 40.3 18.7 55.4 66.3 na 63.6 Men 12.3 100.0 66.9 71.8 na 61.3 100.0 100.0 52.9 na na 57.1 Treatment of genital discharge, ulcer, sore in public facilities: Women 17.7 29.3 47.0 54.4 60.7 35.9 40.3 18.7 55.4 66.3 na 63.6 Men 12.3 100.0 66.9 71.8 na 61.3 100.0 100.0 52.9 na na 57.1 Voluntary counseling and testing for HIV/AIDS: Women 0.2 0.6 0.0 1.7 1.2 0.6 0.0 0.0 1.3 1.9 9.1 7.4 Men 0.6 0.6 0.5 0.8 7.9 0.9 0.0 0.0 14.2 4.2 13.1 12.1 - 15 - Chad 2004 - RURAL / URBAN POPULATIONS Part III: Intermediate Determinants of HNP Status - INDIVIDUAL AND HOUSEHOLD BEHAVIOR Indicator Wealth Quintiles - Rural Wealth Quintiles - Urban Low 2nd 3rd 4th High Avg. Low 2nd 3rd 4th High Avg. A. Hygienic practices Disposal of children's stools: Sanitary disposal na na na na na na na na na na na na Handwashing: Wash hands prior to preparing food na na na na na na na na na na na na Handwashing facilities in household na na na na na na na na na na na na B. Bednet ownership and use Bednet ownership: Bednet ownership 73.4 47.3 60.3 64.2 71.8 61.2 75.0 49.8 46.8 66.3 84.2 78.4 Treated bednet ownership na na na na na na na na na na na na Bednet use: By children 66.9 42.1 50.2 53.4 53.9 52.4 78.0 44.9 44.7 55.4 75.6 70.5 By pregnant women na na na na na na na na na na na na C. Breastfeeding Exclusive breastfeeding 0.9 1.4 5.5 0.0 0.0 1.8 0.0 0.0 0.0 1.8 2.2 2.0 Timely complementary feeding 54.4 62.2 70.7 76.8 88.4 67.8 35.1 35.6 94.4 76.9 74.5 75.1 Bottle-feeding 0.4 3.0 0.7 0.0 0.0 1.2 0.0 0.0 0.0 3.3 15.2 12.3 D. Micronutrient consumption Iodized salt: Availability of iodized salt 34.4 70.8 75.3 81.5 85.8 64.1 21.8 66.6 61.8 64.6 76.9 73.3 in household Vitamin A: Children 33.5 30.3 21.8 31.7 32.7 29.4 57.4 40.3 42.6 45.1 58.9 55.7 Women na na na na na na na na na na na na E. Tobacco and alcohol use Tobacco: Women na na na na na na na na na na na na Men na na na na na na na na na na na na Alcohol: Women na na na na na na na na na na na na Men na na na na na na na na na na na na F. Sexual practices Non-regular sexual partnerships: Women 0.0 0.4 0.5 1.8 1.7 0.7 0.0 1.0 0.0 4.2 1.6 1.9 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 0.0 11.9 30.6 na na 24.9 Men na na na na na na na na na na na na G. Domestic violence Ever experienced violence na na na na na na na na na na na na Experienced violence in past year na na na na na na na na na na na na - 16 - Chad 2004 - RURAL / URBAN POPULATIONS Part IV: UNDERLYING DETERMINANTS OF HNP STATUS Indicator Wealth Quintiles - Rural Wealth Quintiles - Urban Low 2nd 3rd 4th High Avg. Low 2nd 3rd 4th High Avg. A. Education School completion: Women 0.0 3.3 5.3 8.6 19.7 4.8 1.3 13.3 12.7 15.7 39.1 33.4 Men 1.5 21.2 27.8 39.1 41.3 23.5 18.0 29.5 29.2 41.0 61.2 57.0 School participation: Girls 6.8 27.6 25.5 38.4 55.7 25.3 40.6 28.0 35.1 31.7 56.1 49.8 Boys 10.3 40.3 32.0 48.2 54.4 33.8 11.7 40.6 18.7 50.7 67.0 60.7 B. Exposure to mass media Newspaper readership: Women 0.2 0.3 0.3 1.4 3.5 0.7 0.0 2.1 1.3 1.4 16.0 12.7 Men 0.0 3.1 8.6 12.1 10.2 6.2 0.0 0.0 1.8 11.4 36.9 32.9 Radio listenership: Women 3.9 10.8 9.7 20.2 37.4 12.1 9.2 13.5 29.2 33.8 69.9 60.6 Men 16.3 45.2 53.3 66.6 70.7 47.1 30.7 5.9 50.3 71.7 83.2 79.9 Television viewership: Women 0.4 1.1 1.0 1.1 5.0 1.1 1.3 0.0 2.1 2.4 26.3 20.8 Men 1.3 4.7 6.5 6.6 24.7 5.8 0.0 9.1 6.6 21.2 41.4 37.9 C. Knowledge and attitudes about HIV/AIDS Knowledge about sexual transmission of HIV/AIDS: Women 25.8 43.1 43.2 54.0 48.4 41.5 40.0 43.2 56.8 54.2 57.4 56.3 Men 68.9 74.0 59.3 66.5 82.3 67.9 82.0 63.8 58.1 81.7 78.0 77.6 Knowledge about mother-to-child transmission of HIV/AIDS: Women 15.1 51.6 56.4 63.9 59.7 46.6 23.6 50.4 66.7 58.1 75.9 71.6 Men 37.8 70.8 63.1 68.7 82.6 61.9 5.7 54.5 75.1 66.2 77.9 75.9 Attitudes toward HIV/AIDS: Women 63.1 73.1 75.5 73.1 78.3 72.5 70.0 80.4 70.7 78.4 83.0 81.6 Men 60.8 51.8 43.8 44.6 48.6 50.0 60.4 56.4 45.7 66.4 66.8 66.0 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 46.8 48.9 52.0 50.9 46.5 49.6 85.0 86.3 92.0 83.3 93.3 91.5 Can decide whether to have sex 81.8 88.6 84.5 81.9 82.7 84.2 78.0 72.8 77.4 81.6 74.5 75.6 Justifies domestic violence na na na na na na na na na na na na E. Orphanhood Paternal orphan prevalence 4.2 5.6 4.7 2.7 2.2 4.3 7.1 10.6 6.5 7.1 9.1 8.7 Maternal orphan prevalence 1.4 2.2 2.5 2.3 3.3 2.2 0.0 1.5 4.9 4.2 4.6 4.4 Double orphan prevalence 0.2 0.6 0.4 0.1 0.6 0.3 0.0 0.5 1.2 2.0 2.3 2.1 - 17 - . PART II. BASIC TABLES, 1996 / 97 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. Chad 1996 / 97 - 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 79.8 136.7 120.2 115.0 89.3 109.8 0.89 9.50 -0.0012 0.0013 Under-five mortality rate 170.6 227.8 224.5 203.5 172.0 201.1 0.99 1.40 -0.0068 0.0008 Prevalence of fever 29.5 32.1 30.7 35.3 32.9 32.1 0.90 3.40 0.0219 0.0103 Prevalence of diarrhea 18.9 21.4 21.7 24.2 21.4 21.5 0.88 2.50 0.0204 0.0130 Prevalence of acute 10.0 12.4 14.0 13.7 13.7 12.7 0.73 3.70 0.0411 0.0184 respiratory infection B. Fertility Total fertility rate 7.1 6.1 6.2 6.4 6.2 6.4 1.15 0.90 -0.0182 0.0003 Adolescent fertility rate 178.0 177.0 191.0 201.0 205.0 190.0 0.87 27.00 0.0333 0.0005 C. Nutritional status (%) Children: Moderate stunting 23.0 20.7 19.9 15.5 18.4 19.6 1.25 4.60 -0.0570 0.0152 Severe stunting 24.2 22.1 21.5 21.0 12.3 20.4 1.97 11.90 -0.1097 0.0140 Moderate underweight 28.1 24.8 26.5 23.0 21.8 24.9 1.29 6.30 -0.0439 0.0127 Severe underweight 21.4 14.5 13.5 12.0 7.0 13.9 3.06 14.40 -0.1853 0.0183 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 27.5 19.4 19.0 18.5 21.0 21.1 1.31 6.50 -0.0307 0.0188 Mild anemia na na na na na na na na na na Moderate anemia na na na na na na na na na na Severe anemia na na na na na na na na na na D. Female circumcision (%) Prevalence of circumcision: Girls na na na na na na na na na na Women na na na na na na na na na na Prevalence of occlusion: Girls na na na na na na na na na na Women na na na na na na na na na na E. Sexually transmitted disease Prevalence of genital discharge: Women 0.2 0.1 0.3 0.6 0.6 0.3 0.33 0.40 0.2618 0.1135 Men 2.3 1.7 1.4 1.8 4.2 2.4 0.55 1.90 0.1981 0.0873 Prevalence of genital ulcer: Women 0.1 0.0 0.0 0.0 0.2 0.1 0.50 0.10 0.4175 0.3666 Men 0.6 1.1 1.0 0.6 1.7 1.1 0.35 1.10 0.2077 0.1457 - 21 - Chad 1996 / 97 - 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 17.3 32.4 30.0 47.1 72.2 38.8 0.24 54.90 0.2921 0.0179 Measles coverage 12.0 18.0 16.4 32.1 38.5 22.8 0.31 26.50 0.2717 0.0300 DPT coverage 8.5 13.5 9.6 25.3 43.6 19.5 0.19 35.10 0.3912 0.0347 Full basic coverage 4.0 8.5 5.7 17.1 23.0 11.3 0.17 19.00 0.3904 0.0466 No basic coverage 65.4 50.8 48.9 33.0 18.7 44.5 3.50 46.70 -0.2141 0.0163 Hepatitis B coverage na na na na na na na na na na Yellow fever coverage 12.0 18.9 20.0 33.8 42.8 24.7 0.28 30.80 0.2952 0.0283 B. Treatment of childhood illnesses Treatment of fever: Medical treatment of fever 1.7 6.2 6.8 10.4 15.7 8.2 0.11 14.00 0.3541 0.0431 Treatment in a public facility 0.2 3.0 0.8 5.1 12.1 4.4 0.02 11.90 0.6058 0.0714 Treatment in a private facility 1.5 3.2 6.0 5.3 3.3 3.8 0.45 1.80 0.0834 0.0548 Treatment of acute respiratory infection: Medical treatment of ARI 4.5 15.5 19.0 18.6 35.5 19.2 0.13 31.00 0.3230 0.0392 Treatment in a public facility 0.5 7.2 6.6 12.4 28.3 11.5 0.02 27.80 0.5380 0.0560 Treatment in a private facility 4.0 8.2 12.4 6.1 5.9 7.4 0.68 1.90 0.0305 0.0661 Treatment of diarrhea: Use of oral rehydration therapy 56.3 62.2 66.1 73.6 78.3 67.3 0.72 22.00 0.0658 0.0101 Medical treatment of diarrhea 8.7 18.6 14.8 21.3 32.6 19.5 0.27 23.90 0.2269 0.0311 Treatment in a public facility 3.7 7.3 5.4 10.0 26.5 10.6 0.14 22.80 0.4429 0.0499 Treatment in a private facility 5.0 11.3 9.4 11.3 5.9 8.9 0.85 0.90 -0.0258 0.0436 C. Antenatal and delivery care Antenatal care visits: To a medically trained person 11.2 19.9 25.8 40.9 71.1 32.6 0.16 59.90 0.3563 0.0111 To a doctor 0.3 0.2 1.1 2.8 6.2 2.0 0.05 5.90 0.7016 0.0752 To a nurse or trained midwife 10.9 19.8 24.8 38.1 64.9 30.7 0.17 54.00 0.3644 0.0113 Multiple visits to a medically trained 8.0 13.4 18.1 30.7 59.4 24.9 0.13 51.40 0.4394 0.0136 person Antenatal care content: Tetanus toxoid 11.1 20.3 23.4 37.9 68.9 31.3 0.16 57.80 0.3820 0.0110 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 2.6 5.6 6.7 15.5 47.4 15.0 0.05 44.80 0.6657 0.0180 By a doctor 0.4 0.1 0.6 1.1 2.8 1.0 0.14 2.40 0.6420 0.0916 By a nurse or trained midwife 2.1 5.4 6.0 14.4 44.6 14.0 0.05 42.50 0.6672 0.0189 In a public facility 1.5 3.5 3.8 9.5 33.6 10.0 0.04 32.10 0.7301 0.0251 In a private facility 0.7 0.7 0.5 1.8 2.1 1.1 0.33 1.40 0.2452 0.0634 At home 97.2 94.2 94.2 87.1 63.7 87.6 1.53 33.50 -0.0835 0.0029 - 22 - Chad 1996 / 97 - TOTAL POPULATION Part II: Intermediate Determinants of HNP Status - HNP SERVICE USE (Cont.) Indicator Wealth Quintiles Low/High Low-High Concentration Index Ratio Diff. Value Standard Low 2nd 3rd 4th High Avg. (Abs. Val.) Errors D. Contraceptive services Contraceptive prevalence: Women 0.1 0.2 0.1 1.0 4.8 1.2 0.02 4.70 0.9427 0.0995 Men 0.6 0.7 0.0 1.9 10.7 3.0 0.06 10.10 0.8614 0.1238 Source of contraception - public sector: Women * * * * 65.7 61.4 * * * * Men na na na na na na na na na na Source of contraception - private sector: Women * * * * 34.3 38.6 * * * * Men na na na na na na na na na na E. Treatment of adult illnesses Treatment of genital discharge, ulcer, sore: Women * * * * * (40.7) * * * * Men * * * * (59.9) 38.7 * * * * 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 - Chad 1996 / 97 - 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 0.0 0.0 1.5 1.3 7.8 2.0 0.00 7.80 0.9031 0.2168 Timely complementary feeding 55.0 78.4 74.1 72.9 77.4 71.2 0.71 22.40 0.0437 0.0164 Bottle-feeding 0.4 0.0 1.5 1.6 11.9 3.0 0.03 11.50 1.0269 0.1242 D. Micronutrient consumption Iodized salt: Availability of iodized salt 55.3 60.1 58.6 62.6 77.4 62.8 0.71 22.10 0.0718 0.0053 in household Vitamin A: Children 0.5 0.3 1.1 1.9 1.0 0.9 0.50 0.50 0.1883 0.0756 Women na na na na na na na na na na E. Tobacco and alcohol use Tobacco: Women na na na na na na na na na na Men na na na na na na na na na na Alcohol: Women na na na na na na na na na na Men na na na na na na na na na na F. Sexual practices Non-regular sexual partnerships: Women 0.3 0.2 0.4 0.8 0.8 0.5 0.38 0.50 0.3675 0.1046 Men 6.6 13.5 18.2 20.5 29.9 19.1 0.22 23.30 0.2321 0.0243 Condom usage with non-regular partner: Women * * * * * (13.8) * * * * Men 0.0 8.6 15.0 13.6 43.9 24.6 0.00 43.90 0.4328 0.0434 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 - Chad 1996 / 97 - 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 0.5 1.0 1.5 5.7 27.0 6.9 0.02 26.50 0.8670 0.0312 Men 6.0 12.5 16.2 31.6 54.5 27.4 0.11 48.50 0.3969 0.0099 School participation: Girls 8.7 17.2 16.2 24.2 48.6 22.7 0.18 39.90 0.3612 0.0183 Boys 20.4 25.3 26.0 40.1 60.7 34.2 0.34 40.30 0.2553 0.0131 B. Exposure to mass media Newspaper readership: Women 0.4 0.8 1.6 3.6 18.4 4.7 0.02 18.00 0.8693 0.0402 Men 2.0 5.5 10.4 17.0 48.0 19.1 0.04 46.00 0.5696 0.0247 Radio listenership: Women 3.5 5.8 20.2 27.2 63.8 22.9 0.05 60.30 0.5658 0.0112 Men 7.6 9.0 37.3 43.4 79.8 38.8 0.10 72.20 0.4263 0.0111 Television viewership: Women 0.2 0.2 0.1 2.5 22.3 4.8 0.01 22.10 1.1514 0.0473 Men 0.0 0.7 0.3 2.6 38.7 10.7 0.00 38.70 1.0107 0.0479 C. Knowledge and attitudes about HIV/AIDS Knowledge about sexual transmission of HIV/AIDS: Women 28.1 41.7 45.2 62.9 85.2 52.2 0.33 57.14 0.2156 0.0053 Men 62.2 77.7 85.0 87.1 95.0 83.4 0.65 32.86 0.0641 0.0056 Knowledge about mother-to-child transmission of HIV/AIDS: Women 28.2 26.6 30.8 43.5 65.7 36.0 0.43 37.50 0.2802 0.0079 Men 41.2 39.9 43.0 46.4 67.6 47.7 0.61 26.40 0.1510 0.0120 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 41.6 49.2 54.9 68.2 84.3 58.0 0.49 42.70 0.1497 0.0065 Can decide whether to have sex na na na na na na na na na na Justifies domestic violence na na na na na na na na na na E. Orphanhood Paternal orphan prevalence 4.4 6.0 4.8 6.4 5.3 5.5 0.83 0.90 0.0354 0.0180 Maternal orphan prevalence 1.5 2.1 3.0 3.0 2.9 2.5 0.52 1.40 0.0962 0.0256 Double orphan prevalence 0.2 0.3 0.5 0.7 1.0 0.5 0.20 0.80 0.3050 0.0604 - 25 - Chad 1996 / 97 - 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 74.5 119.1 109.1 111.1 82.4 100.0 85.6 153.9 130.8 119.0 96.2 119.6 Under-five mortality rate 165.1 208.0 210.5 194.5 164.4 189.0 176.4 247.2 237.5 212.6 179.5 213.1 Prevalence of fever 28.6 30.4 32.6 34.9 31.6 31.5 30.3 33.9 28.8 35.7 34.1 32.7 Prevalence of diarrhea 18.1 18.7 24.7 23.2 20.8 20.8 19.7 24.0 18.6 25.3 22.1 22.2 Prevalence of acute 9.7 12.0 14.2 13.6 13.5 12.5 10.3 12.8 13.7 13.8 14.0 12.9 respiratory infection B. Nutritional status Children: Moderate stunting 23.3 19.6 20.1 13.5 17.2 18.8 22.7 21.6 19.8 17.6 19.6 20.4 Severe stunting 24.7 22.6 20.2 21.6 11.9 20.5 23.6 21.7 22.8 20.3 12.8 20.4 Moderate underweight 26.5 24.1 25.9 21.8 21.0 23.9 29.6 25.4 27.0 24.3 22.6 25.8 Severe underweight 21.0 14.0 13.9 12.3 7.0 13.8 21.8 15.0 13.1 11.6 7.0 14.0 Mild anemia na na na na na na na na na na na na Moderate anemia na na na na na na na na na na na na Severe anemia na na na na na na na na na na na na C. Sexually transmitted disease Prevalence of genital discharge: Women 0.2 0.1 0.3 0.6 0.6 0.3 Men 2.3 1.7 1.4 1.8 4.2 2.4 Prevalence of genital ulcer: Women 0.1 0.0 0.0 0.0 0.2 0.1 Men 0.6 1.1 1.0 0.6 1.7 1.1 - 27 - Chad 1996 / 97 - 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 18.9 35.9 29.5 43.5 70.3 38.4 15.0 29.4 30.6 50.7 74.2 39.2 Measles coverage 12.0 15.5 14.1 27.4 37.2 20.5 12.0 20.1 19.1 36.6 39.9 25.2 DPT coverage 6.9 14.2 6.0 23.2 42.6 17.9 10.8 12.9 13.7 27.3 44.6 21.1 Full basic coverage 3.5 7.5 4.0 16.9 21.7 10.2 4.8 9.3 7.7 17.2 24.2 12.5 No basic coverage 63.4 43.6 53.7 40.0 20.9 45.2 68.1 57.0 43.3 26.0 16.3 43.8 Hepatitis B coverage na na na na na na na na na na na na Yellow fever coverage 11.6 18.0 14.7 31.5 39.4 22.2 12.6 19.7 26.1 36.0 46.4 27.3 B. Treatment of childhood illnesses Treatment of fever: Medical treatment of fever 1.4 4.4 9.0 7.4 18.1 7.9 2.0 7.8 4.3 13.4 13.5 8.5 Treatment in a public facility 0.3 2.8 0.8 3.8 13.6 4.3 0.0 3.2 0.9 6.3 10.8 4.4 Treatment in a private facility 1.0 1.5 8.3 3.6 4.3 3.5 2.0 4.6 3.4 7.1 2.5 4.0 Treatment of acute respiratory infection (ARI): Medical treatment of ARI 3.1 12.4 19.0 11.3 36.2 16.8 5.8 18.3 19.0 25.9 34.9 21.4 Treatment in a public facility 1.0 3.2 5.2 9.1 30.5 10.1 0.0 11.0 8.2 15.9 26.2 12.9 Treatment in a private facility 2.1 9.2 13.8 2.3 5.1 6.6 5.8 7.3 10.9 10.0 6.8 8.1 Treatment of diarrhea: Use of oral rehydration therapy 57.4 59.0 64.3 69.5 78.1 65.6 55.3 64.8 68.5 77.5 78.6 69.0 Medical treatment of diarrhea 10.4 18.4 13.3 17.8 32.5 18.6 7.1 18.8 16.8 24.6 32.7 20.4 Treatment in a public facility 5.5 3.3 5.4 11.0 27.6 10.3 2.0 10.3 5.3 9.0 25.5 10.8 Treatment in a private facility 5.0 15.1 7.9 6.7 5.0 8.2 5.1 8.4 11.4 15.6 6.8 9.5 C. Contraceptive services Contraceptive prevalence: Women 0.1 0.2 0.1 1.0 4.8 1.2 Men 0.6 0.7 0.0 1.9 10.7 3.0 Source of contraception - public sector: Women * * * * 65.7 61.4 Men na na na na na na Source of contraception - private sector: Women * * * * 34.3 38.6 Men na na na na na na D. Treatment of adult illnesses Treatment of genital discharge, ulcer, sore: Women * * * * * (40.7) Men * * * * (59.9) 63.8 Treatment of genital discharge, ulcer, sore in public facilities: Women na na na na na na Men na na na na na na Voluntary counseling and testing for HIV/AIDS: Women na na na na na na Men na na na na na na - 28 - Chad 1996 / 97 - 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 0.0 0.0 0.0 1.0 11.0 2.6 0.0 0.0 (3.0) (1.7) 3.5 1.4 Timely complementary feeding (53.8) (82.0) (78.2) 74.8 75.8 73.6 55.7 (74.6) (70.6) (70.7) 78.9 69.1 Bottle-feeding 0.0 0.0 2.9 1.1 11.0 2.9 0.9 0.0 0.0 2.3 12.8 3.1 D. Micronutrient consumption Vitamin A: Children 0.2 0.2 2.0 1.6 0.7 0.8 0.7 0.4 0.3 2.2 1.3 0.9 E. Tobacco and alcohol use Tobacco: Women na na na na na na Men na na na na na na Alcohol: Women na na na na na na Men na na na na na na F. Sexual practices Non-regular sexual partnerships: Women 0.3 0.2 0.4 0.8 0.8 0.5 Men 6.6 13.5 18.2 20.5 29.9 19.1 Condom usage with non-regular partner: Women * * * * * (13.8) Men 0.0 8.6 15.0 13.6 43.9 24.6 - 29 - Chad 1996 / 97 - 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 0.5 1.0 1.5 5.7 27.0 6.9 Men 6.0 12.5 16.2 31.6 54.5 27.4 School participation: Girls 8.7 17.2 16.2 24.2 48.6 22.7 Boys 20.4 25.3 26.0 40.1 60.7 34.2 B. Exposure to mass media Newspaper readership: Women 0.4 0.8 1.6 3.6 18.4 4.7 Men 2.0 5.5 10.4 17.0 48.0 19.1 Radio listenership: Women 3.5 5.8 20.2 27.2 63.8 22.9 Men 7.6 9.0 37.3 43.4 79.8 38.8 Television viewership: Women 0.2 0.2 0.1 2.5 22.3 4.8 Men 0.0 0.7 0.3 2.6 38.7 10.7 C. Knowledge and attitudes about HIV/AIDS Knowledge about sexual transmission of HIV/AIDS: Women 28.1 41.7 45.2 62.9 85.2 52.2 Men 62.2 77.7 85.0 87.1 95.0 83.4 Knowledge about mother-to-child transmission of HIV/AIDS: Women 28.2 26.6 30.8 43.5 65.7 36.0 Men 41.2 39.9 43.0 46.4 67.6 47.7 Attitudes toward HIV/AIDS: Women na na na na na na Men na na na na na na D. Orphanhood Paternal orphan prevalence 4.3 6.1 4.9 5.8 5.5 5.4 4.5 5.9 4.7 7.1 5.1 5.5 Maternal orphan prevalence 1.6 1.8 2.7 2.4 2.7 2.2 1.4 2.3 3.4 3.5 3.1 2.7 Double orphan prevalence 0.2 0.2 0.5 0.4 1.0 0.5 0.2 0.4 0.4 1.0 0.9 0.6 - 30 - Chad 1996 / 97 - 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 80.4 137.5 120.9 116.0 (59.9) 112.8 * * * 111.9 95.8 99.3 Under-five mortality rate 171.5 229.4 222.1 200.3 (128.9) 204.2 * * * 211.7 181.3 190.1 Prevalence of fever 29.3 32.2 30.4 37.2 30.5 32.0 (35.6) 28.6 37.4 29.0 33.4 32.6 Prevalence of diarrhea 18.8 21.5 21.5 23.8 22.1 21.3 (22.2) 15.9 25.3 25.7 21.3 22.2 Prevalence of acute 9.9 12.5 13.9 14.9 15.3 12.7 (13.3) 7.9 15.4 10.1 13.4 12.6 respiratory infection B. Fertility Total fertility rate 7.2 6.1 6.2 6.7 * 6.5 * * * (5.7) 6.0 5.9 Adolescent fertility rate 177.0 177.0 192.0 221.0 * 189.9 * * * (148.0) 203.0 189.4 C. Nutritional status Children: Moderate stunting 22.7 20.8 19.8 15.0 22.6 20.1 (36.6) (16.4) 23.2 16.9 17.3 17.8 Severe stunting 24.2 21.8 21.7 21.9 13.1 22.0 (22.0) (34.5) 18.3 18.0 12.1 14.5 Moderate underweight 28.2 24.7 26.9 23.3 22.0 25.6 (24.4) (29.1) 18.3 22.2 21.7 22.0 Severe underweight 21.3 14.2 13.5 11.6 6.5 15.0 (26.8) (27.3) 13.4 13.2 7.1 9.7 Mild anemia na na na na na na na na na na na na Moderate anemia na na na na na na na na na na na na Severe anemia na na na na na na na na na na na na Women: Malnutrition 27.1 19.0 18.6 16.5 15.1 20.3 * * (27.3) 24.4 22.4 24.0 Mild anemia na na na na na na na na na na na na Moderate anemia na na na na na na na na na na na na Severe anemia na na na na na na na na na na na na D. Female circumcision Prevalence of circumcision: Girls na na na na na na na na na na na na Women na na na na na na na na na na na na Prevalence of occlusion: Girls na na na na na na na na na na na na Women na na na na na na na na na na na na E. Sexually transmitted disease Prevalence of genital discharge: Women 0.1 0.1 0.2 0.6 1.2 0.3 (2.2) 1.4 1.9 0.7 0.5 0.7 Men 2.4 1.7 1.2 1.2 (2.2) 1.6 * * (3.6) 3.3 4.5 4.1 Prevalence of genital ulcer: Women 0.1 0.0 0.0 0.0 0.6 0.1 0.0 0.0 0.0 0.0 0.1 0.1 Men 0.6 1.2 0.8 0.0 0.0 0.7 * * (3.6) 2.0 1.9 1.9 - 31 - Chad 1996 / 97 - 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 16.9 31.9 27.7 41.7 (60.5) 30.4 * * * 66.3 75.5 71.4 Measles coverage 11.3 17.9 15.4 29.5 (34.2) 18.6 * * * 40.9 39.7 38.9 DPT coverage 7.7 13.5 6.9 23.5 (36.8) 13.8 * * * 31.6 45.5 41.6 Full basic coverage 4.1 8.8 5.4 16.7 (21.1) 9.0 * * * 18.4 23.5 20.5 No basic coverage 66.2 51.4 51.5 36.4 (26.3) 51.3 * * * 21.0 16.5 17.8 Hepatitis B coverage na na na na na na na na na na na na Yellow fever coverage 11.8 19.1 18.5 32.6 (34.2) 20.2 * * * 37.9 45.3 42.0 B. Treatment of childhood diseases Treatment of fever: Medical treatment of fever 1.4 6.2 6.9 9.7 12.1 6.3 * * (5.9) 13.3 16.5 15.1 Treatment in a public facility 0.0 3.0 0.9 3.7 6.9 2.2 * * 0.0 10.5 13.3 11.8 Treatment in a private facility 1.4 3.2 6.0 6.0 5.2 4.0 * * (5.9) 2.8 2.9 3.0 Treatment of acute respiratory infection (ARI): Medical treatment of ARI 4.1 15.4 18.9 15.0 (17.2) 13.9 * * * 35.4 40.7 38.0 Treatment in a public facility 0.0 7.1 6.6 8.4 (10.3) 6.1 * * * 31.3 33.4 31.2 Treatment in a private facility 4.1 8.3 12.3 6.5 (6.9) 7.9 * * * 4.2 5.7 5.6 Treatment of diarrhea: Use of oral rehydration therapy 56.0 62.5 66.5 74.3 (73.8) 64.8 * * * 71.7 79.5 76.0 Medical treatment of diarrhea 8.2 18.6 14.0 22.2 (23.8) 16.4 * * * 18.5 34.9 30.2 Treatment in a public facility 3.3 7.1 4.3 8.2 (16.7) 6.4 * * * 15.3 29.0 25.0 Treatment in a private facility 4.9 11.5 9.8 14.0 (7.1) 10.0 * * * 3.3 5.6 5.0 C. Antenatal and delivery care Antenatal care visits: To a medically trained person 10.8 19.4 23.7 36.1 58.3 22.9 (25.8) (41.9) 62.3 55.0 73.9 67.5 To a doctor 0.3 0.1 0.9 2.4 7.5 1.0 0.0 (2.3) 4.3 3.8 5.9 5.2 To a nurse or trained midwife 10.5 19.3 22.8 33.7 50.8 21.8 (25.8) (39.5) 58.0 51.1 68.0 62.3 Multiple visits to a medically trained 7.6 13.2 16.9 27.0 49.2 16.6 (25.8) (23.3) 39.1 41.3 61.7 54.6 person Antenatal care content: Tetanus toxoid 10.8 20.0 21.6 32.5 62.5 22.1 (22.6) (34.9) 55.1 53.5 70.3 64.2 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 2.2 5.2 5.5 11.0 23.8 6.4 (21.7) 24.3 27.6 29.4 52.8 45.6 By a doctor 0.5 0.1 0.6 1.0 1.5 0.5 0.0 0.0 1.9 1.6 3.1 2.6 By a nurse or trained midwife 1.7 5.0 5.0 10.1 22.3 5.9 (21.7) 24.3 25.7 27.8 49.6 43.0 In a public facility 1.2 3.0 3.1 5.9 12.1 3.5 (17.4) 24.3 17.1 20.4 38.5 33.2 In a private facility 0.6 0.7 0.4 1.9 2.9 1.0 (2.2) 0.0 1.0 1.4 1.9 1.8 At home 97.5 94.6 94.9 90.5 83.0 94.1 (78.3) 75.7 81.0 76.4 59.3 64.5 D. Contraceptive services Contraceptive prevalence: Women 0.0 0.2 0.1 0.8 2.0 0.3 (2.7) 0.0 0.0 1.7 5.4 4.2 Men 0.6 0.7 0.0 0.7 (9.7) 0.9 * * * 5.5 10.8 9.4 - 32 - Chad 1996 / 97 - 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 * * * * * * * * * * 68.3 67.2 Men na na na na na na na na na na na na Source of contraception - private sector: Women * * * * * * * * * * 31.7 32.8 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 * * * * * * * * * * * * Men * * * * * * * * * * (57.5) (54.0) 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 - Chad 1996 / 97 - 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 0.0 0.0 1.6 0.0 * 0.6 * * * (4.7) 8.4 6.8 Timely complementary feeding 54.8 79.2 75.0 72.7 * 70.3 * * * (73.2) 77.2 74.6 Bottle-feeding 0.5 0.0 1.5 0.6 (2.1) 0.7 * * * 4.7 14.4 11.1 D. Micronutrient consumption Iodized salt: Availability of iodized salt 56.1 60.8 58.9 63.2 77.6 60.5 (19.4) 33.9 52.8 60.8 77.3 70.6 in household Vitamin A: Children 0.5 0.3 1.2 2.3 0.6 0.9 0.0 0.0 0.0 0.7 1.1 0.9 Women na na na na na na na na na na na na E. Tobacco and alcohol use Tobacco: Women na na na na na na na na na na na na Men na na na na na na na na na na na na Alcohol: Women na na na na na na na na na na na na Men na na na na na na na na na na na na F. Sexual practices Non-regular sexual partnerships: Women 0.3 0.2 0.3 0.8 0.0 0.3 0.0 0.0 0.9 0.8 1.0 0.9 Men 6.5 13.5 18.2 16.7 43.1 15.4 * (16.0) (18.2) 30.2 28.2 27.7 Condom usage with non-regular partner: Women * * * * 0.0 * * * * * * (30.7) Men 0.0 8.9 14.3 10.8 27.3 12.5 * 0.0 (25.0) 17.5 47.2 40.2 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 - Chad 1996 / 97 - 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 0.3 0.9 1.3 3.4 18.4 2.1 (8.2) 5.7 5.1 12.0 29.0 23.2 Men 6.0 12.3 15.1 28.9 50.5 17.5 (7.1) 16.9 35.6 39.3 55.1 50.6 School participation: Girls 8.6 17.1 16.0 22.2 40.0 17.1 * (20.9) (20.0) 30.5 51.1 43.6 Boys 20.3 25.8 26.3 40.3 56.8 28.9 * (10.8) (20.0) 39.7 61.6 52.9 B. Exposure to mass media Newspaper readership: Women 0.3 0.7 1.4 2.4 10.4 1.5 (2.0) 1.2 5.1 6.6 20.1 15.6 Men 2.0 5.3 8.4 15.8 37.3 8.9 * (12.0) (38.6) 20.1 49.5 42.7 Radio listenership: Women 3.5 5.7 20.5 25.4 52.6 13.7 (2.0) 10.6 15.4 31.7 66.2 53.6 Men 7.5 8.9 38.3 43.2 78.4 25.6 * (12.0) (22.7) 43.8 80.0 69.3 Television viewership: Women 0.2 0.2 0.1 1.7 7.8 0.8 0.0 0.0 0.0 4.7 25.3 18.4 Men 0.0 0.7 0.3 1.8 25.5 1.8 * 0.0 0.0 4.5 40.4 31.3 C. Knowledge and attitudes about HIV/AIDS Knowledge about sexual transmission of HIV/AIDS: Women 82.8 81.9 86.0 83.8 95.8 83.9 90.0 92.9 94.9 91.1 93.0 92.6 Men 89.4 96.6 96.8 94.6 100.0 95.2 * (96.0) (97.7) 97.9 97.3 97.3 Knowledge about mother-to-child transmission of HIV/AIDS: Women 14.9 26.4 30.1 40.7 60.9 28.6 34.0 35.3 42.8 50.7 66.8 60.6 Men 30.7 39.4 42.9 45.5 68.6 41.2 * (56.0) (45.5) 48.8 67.5 62.8 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 40.9 48.4 53.1 64.0 78.1 51.8 (67.6) 77.4 78.1 79.0 86.2 82.9 Can decide whether to have sex na na na na na na na na na na na na Justifies domestic violence na na na na na na na na na na na na E. Orphanhood Paternal orphan prevalence 4.3 5.9 4.5 5.8 3.2 5.1 7.2 10.1 9.5 8.4 5.9 6.7 Maternal orphan prevalence 1.5 2.2 3.0 3.4 3.6 2.5 3.2 1.0 2.8 1.7 2.7 2.5 Double orphan prevalence 0.2 0.3 0.4 0.8 0.6 0.4 0.0 0.0 0.8 0.2 1.1 0.8 - 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, 2004 A. SAMPLE SIZES B. STANDARD ERRORS C. ASSET DISTRIBUTION AND WEIGHTS Chad 2004 - SAMPLE SIZES TOTAL SAMPLE Indicator Wealth Quintiles Pop. Low 2nd 3rd 4th High Total Number of household members All 5,672 6,304 5,296 5,823 5,653 28,747 Urban 70 154 277 817 4,576 5,895 Rural 5,601 6,149 5,020 5,005 1,077 22,852 Female 3,002 3,344 2,651 2,955 2,708 14,659 Male 2,670 2,960 2,645 2,868 2,945 14,088 Part I: HNP STATUS Indicator Wealth Quintiles Pop. Low 2nd 3rd 4th High Total Mortality rates All 2,143 2,757 2,354 2,615 2,096 11,965 Urban 24 59 115 341 1,641 2,180 Rural 2,119 2,698 2,239 2,273 455 9,785 Female 1,042 1,413 1,121 1,293 1,021 5,888 Male 1,102 1,345 1,233 1,322 1,076 6,077 Prevalence of fever, diarrhea, acute respiratory infection All 897 1,153 1,046 1,112 951 5,159 Urban 10 21 49 150 763 994 Rural 887 1,132 996 962 188 4,165 Female 443 617 487 559 464 2,570 Male 454 536 559 553 488 2,589 Total fertility rate All 1,216 1,310 1,100 1,246 1,213 6,085 Urban 16 39 59 176 999 1,289 Rural 1,200 1,271 1,041 1,070 214 4,796 Age-specific fertility rate 15-19 All 279 257 228 288 309 1,360 Urban 3 12 18 40 262 335 Rural 276 245 210 248 47 1,026 Children's nutritional status All 803 1,061 947 993 830 4,635 Urban 10 18 40 136 678 882 Rural 793 1,043 907 857 152 3,753 Female 400 554 438 506 401 2,297 Male 404 508 510 487 429 2,337 Children's anemia status All na na na na na na Urban na na na na na na Rural na na na na na na Female na na na na na na Male na na na na na na - 65 - Chad 2004 - SAMPLE SIZES Part I: HNP STATUS (Cont.) Indicator Wealth Quintiles Pop. Low 2nd 3rd 4th High Total Women's nutritional status All 694 869 747 818 674 3,801 Urban 7 18 35 98 545 704 Rural 687 851 711 721 129 3,098 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 726 725 547 628 654 3,281 Urban 11 23 37 107 547 725 Rural 715 702 511 521 107 2,556 Women's circumcision All 1,032 611 272 305 504 2,723 Urban 15 28 25 80 456 604 Rural 1,017 582 247 225 47 2,119 Prevalence of genital discharge, ulcer, sore Female 1,210 1,304 1,098 1,244 1,206 6,062 Urban Female 16 37 58 176 992 1,279 Rural Female 1,194 1,267 1,040 1,068 214 4,782 Male 302 364 355 368 495 1,885 Urban Male 4 6 14 45 433 502 Rural Male 298 358 341 323 62 1,382 - 66 - Chad 2004 - SAMPLE SIZES Part II: Intermediate Determinants of HNP Status - HNP SERVICE USE Indicator Wealth Quintiles Pop. Low 2nd 3rd 4th High Total Immunization coverage All 174 190 183 222 172 941 Urban 1 5 12 28 141 187 Rural 173 185 171 194 31 755 Female 96 100 94 112 90 492 Male 79 90 89 110 82 449 Treatment of fever All 238 447 343 419 324 1,772 Urban 2 9 23 53 263 350 Rural 236 438 320 366 61 1,422 Female 130 232 145 205 148 862 Male 108 215 198 214 176 910 Treatment of acute respiratory infection All 67 124 83 106 96 476 Urban 0 1 3 19 72 95 Rural 66 123 80 87 24 381 Female 35 69 43 69 50 265 Male 32 55 40 37 46 211 Treatment of diarrhea All 174 365 286 290 255 1,370 Urban 1 6 13 28 200 247 Rural 174 359 273 262 55 1,123 Female 85 199 130 148 109 671 Male 89 166 156 142 146 699 Antenatal and delivery care All 1,019 1,356 1,187 1,333 1,093 5,989 Urban 12 24 55 164 868 1,123 Rural 1,008 1,332 1,132 1,169 225 4,866 Contraceptive prevalence Female 900 1,026 905 985 847 4,663 Urban Female 8 20 36 121 671 857 Rural Female 891 1,005 869 864 176 3,806 Male 193 270 211 259 237 1,170 Urban Male 3 3 5 28 198 236 Rural Male 191 267 206 231 39 933 Contraceptive source Female 2 9 4 62 na 76 Urban Female 3 58 na na na 61 Rural Female 2 9 1 4 na 15 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 53 65 28 50 95 291 Urban Female 3 2 10 81 na 95 Rural Female 53 62 26 40 14 196 Male 8 3 13 18 19 62 Urban Male 0 2 19 na na 21 Rural Male 8 3 13 16 na 41 - 67 - Chad 2004 - SAMPLE SIZES Part III: Intermediate Determinants of HNP Status - INDIVIDUAL AND HOUSEHOLD BEHAVIOR Indicator Wealth Quintiles Pop. Low 2nd 3rd 4th High Total Sanitary disposal of stools All na na na na na na Urban na na na na na na Rural na na na na na na Wash hands prior to preparing food All na na na na na na Urban na na na na na na Rural na na na na na na Handwashing facilities in household? All na na na na na na Urban na na na na na na Rural na na na na na na Bednet ownership All 1,191 1,304 936 965 943 5,340 Urban 16 34 55 151 801 1,058 Rural 1,175 1,270 880 815 142 4,282 Bednet use by children All 1,019 1,356 1,187 1,333 1,093 5,989 Urban 12 24 55 164 868 1,123 Rural 1,008 1,332 1,132 1,169 225 4,866 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 71 117 85 98 73 444 Urban 1 2 4 12 56 74 Rural 70 115 81 87 17 370 Female 30 69 34 43 29 206 Male 41 47 51 55 44 238 Timely complementary breastfeeding All 44 90 69 93 73 368 Urban 1 1 3 14 65 83 Rural 43 89 66 79 8 285 Female 25 46 39 57 37 204 Male 19 44 30 36 36 165 Bottle-feeding All 160 289 226 257 217 1,148 Urban 1 5 8 39 177 230 Rural 159 284 218 218 40 919 Female 85 159 95 130 99 567 Male 75 129 131 127 119 581 - 68 - Chad 2004 - SAMPLE SIZES Part III: Intermediate Determinants of HNP Status - INDIVIDUAL AND HOUSEHOLD BEHAVIOR (Cont.) Indicator Wealth Quintiles Pop. Low 2nd 3rd 4th High Total Iodized salt in household All 1,049 1,050 799 856 796 4,550 Urban 14 28 40 119 674 875 Rural 1,035 1,022 759 736 122 3,675 Vitamin A supplementation All 796 983 922 964 835 4,499 Urban 10 18 45 130 675 878 Rural 786 965 877 834 160 3,621 Female 392 515 442 491 411 2,250 Male 403 468 480 474 424 2,249 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 - 69 - Chad 2004 - SAMPLE SIZES Part IV: UNDERLYING DETERMINANTS OF HNP STATUS Indicator Wealth Quintiles Pop. Low 2nd 3rd 4th High Total School completion (Grade 5) Female 1,280 1,388 1,140 1,281 1,258 6,348 Urban female 16 40 65 182 1,024 1,328 Rural female 1,264 1,348 1,075 1,099 234 5,020 Male 916 1,074 987 1,108 1,400 5,485 Urban male 10 21 54 160 1,205 1,450 Rural male 906 1,053 933 947 196 4,035 School participation Female 571 583 507 545 448 2,654 Urban female 5 14 25 82 348 474 Rural female 566 569 481 464 100 2,179 Male 548 648 486 564 481 2,727 Urban male 8 17 22 73 368 487 Rural male 541 631 464 491 113 2,240 Mass media exposure Female 1,216 1,310 1,100 1,246 1,213 6,085 Urban female 16 39 59 176 999 1,289 Rural female 1,200 1,271 1,041 1,070 214 4,796 Male 302 366 355 368 495 1,887 Urban male 4 6 14 46 433 503 Rural male 298 360 341 323 62 1,384 Knowledge of HIV/AIDS prevention Female 1,216 1,310 1,100 1,246 1,213 6,085 Urban female 16 39 59 176 999 1,289 Rural female 1,200 1,271 1,041 1,070 214 4,796 Male 302 366 355 368 495 1,887 Urban male 4 6 14 46 433 503 Rural male 298 360 341 323 62 1,384 Household decisionmaking and justification of violence All na na na na na na Urban na na na na na na Rural na na na na na na Orphanhood All 2,876 3,317 2,847 3,096 2,689 14,825 Urban 35 75 137 426 2,113 2,786 Rural 2,841 3,242 2,710 2,671 576 12,039 Female 1,439 1,672 1,364 1,527 1,298 7,300 Male 1,437 1,642 1,483 1,569 1,390 7,523 - 70 - Chad 2004 - STANDARD ERRORS OF QUINTILE ESTIMATES FOR TOTAL POPULATION Part I: HNP STATUS Indicator Wealth Quintiles Pop. Low 2nd 3rd 4th High Avg. A. Childhood illness and mortality Infant mortality rate 9.65 10.22 15.93 14.07 7.91 6.66 Under-five mortality rate 10.71 14.82 19.83 17.77 10.57 9.08 Prevalence of fever 2.57 3.24 3.27 3.31 2.41 1.96 Prevalence of diarrhea 2.04 2.38 2.03 2.28 1.70 1.30 Prevalence of acute respiratory infection 1.24 1.83 2.00 1.58 1.60 1.00 B. Fertility Total fertility rate 0.26 0.27 0.28 0.28 0.19 0.15 Adolescent fertility rate 15.21 22.84 22.01 12.51 11.45 9.23 C. Nutritional status Children: Moderate stunting 1.52 1.60 1.65 1.70 1.40 0.76 Severe stunting 2.39 2.73 2.52 2.21 1.40 1.28 Moderate underweight 1.67 1.70 1.72 2.03 1.43 0.91 Severe underweight 2.30 1.90 2.47 2.15 1.00 1.23 Mild anemia na na na na na na Moderate anemia na na na na na na Severe anemia na na na na na na Women: Malnutrition 3.19 2.08 2.34 2.49 1.39 1.45 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 2.90 4.04 3.64 2.54 2.05 2.44 Women 3.65 7.02 5.40 5.09 3.68 4.40 Prevalence of occlusion: Girls 1.78 3.06 0.58 2.94 1.10 1.42 Women 0.41 0.91 1.51 1.29 1.00 0.58 E. Sexually transmitted disease Prevalence of genital discharge: Women 1.17 1.29 0.63 0.91 0.78 0.56 Men 1.13 0.71 0.97 0.76 0.52 0.41 Prevalence of genital ulcer: Women 0.35 0.35 0.27 0.22 0.32 0.16 Men 0.44 0.71 0.74 1.40 0.40 0.43 - 71 - Chad 2004 - STANDARD ERRORS OF QUINTILE ESTIMATES FOR TOTAL POPULATION Part II: Intermediate Determinants of HNP Status - HNP SERVICE USE Indicator Wealth Quintiles Pop. Low 2nd 3rd 4th High Avg. A. Childhood immunization BCG coverage 4.92 5.38 6.09 6.13 4.57 3.55 Measles coverage 3.01 3.79 5.63 5.13 3.79 2.38 DPT coverage 2.24 3.35 3.94 4.40 3.90 2.38 Full basic coverage 0.86 2.17 3.28 3.72 3.06 1.68 No basic coverage 5.47 4.19 4.77 4.48 3.28 2.58 Hepatitis B coverage na na na na na na Yellow fever coverage na na na na na na B. Treatment of childhood illnesses Treatment of fever: Medical treatment of fever 2.62 4.06 3.58 3.08 3.05 2.01 Treatment in a public facility 0.91 1.19 1.87 2.13 3.15 1.40 Treatment in a private facility 1.31 0.56 1.01 1.21 0.97 0.42 Treatment of acute respiratory infection (ARI): Medical treatment of ARI 4.81 2.44 3.45 3.64 4.84 2.10 Treatment in a public facility 1.74 2.00 1.00 0.88 4.57 1.22 Treatment in a private facility 4.56 0.00 0.00 2.32 0.72 0.80 Treatment of diarrhea: Use of oral rehydration therapy 2.81 5.48 5.25 5.86 3.67 3.15 Medical treatment of diarrhea 0.85 2.27 3.23 3.77 3.23 1.66 Treatment in a public facility 0.85 1.22 3.03 2.00 2.88 1.40 Treatment in a private facility 0.00 0.46 0.00 1.07 0.82 0.31 C. Antenatal and delivery care Antenatal care (ANC) visits: To a medically-trained person 1.95 3.37 3.89 4.43 3.63 2.77 To a doctor 0.28 0.39 1.04 1.15 0.90 0.45 To a nurse or trained midwife 1.90 3.38 3.97 4.50 3.43 2.71 Multiple visits to a medically-trained person 1.19 2.97 3.15 3.31 3.37 2.21 Antenatal care content: Tetanus toxoid 2.21 3.79 4.61 4.76 3.47 2.77 Prophylactic antimalarial treatment 1.47 2.44 2.88 3.01 2.38 1.88 Iron supplementation 1.44 2.32 3.16 3.27 3.37 2.01 Delivery attendance: By a medically-trained person 0.53 1.82 1.80 2.64 3.19 1.84 By a doctor 0.14 0.19 0.17 0.38 0.45 0.14 By a nurse or trained midwife 0.48 1.78 1.79 2.64 3.04 1.80 In a public facility 0.29 1.23 1.36 2.26 2.99 1.44 In a private facility 0.15 0.15 0.10 0.40 0.42 0.13 At home 0.74 1.38 1.56 2.70 3.04 1.62 D. Contraceptive services Contraceptive prevalence: Women 0.00 0.12 0.39 0.17 1.18 0.29 Men 0.00 1.74 1.56 1.97 2.35 0.88 Source of contraception - public sector: Women * * * 4.8 na 4.9 Men na na na na na na - 72 - Chad 2004 - STANDARD ERRORS OF QUINTILE ESTIMATES FOR TOTAL POPULATION Part II: Intermediate Determinants of HNP Status - HNP SERVICE USE (Cont.) Indicator Wealth Quintiles Pop. Low 2nd 3rd 4th High Avg. D. Contraceptive services (cont.) Source of contraception - private sector: Women * * * 5.31 na 5.22 Men na na na na na na E. Treatment of adult illnesses Treatment of genital discharge, ulcer, sore: Women 6.61 8.02 13.06 11.03 4.47 5.18 Men * * * * * 7.1 Treatment of genital discharge, ulcer, sore in public medical facilities: Women 6.61 8.02 13.06 11.03 4.47 5.18 Men * * * * * 7.1 Voluntary counseling and testing for HIV/AIDS: Women 0.16 0.27 0.07 0.64 0.95 0.30 Men 0.56 0.55 0.72 0.58 1.79 0.66 - 73 - Chad 2004 - STANDARD ERRORS OF QUINTILE ESTIMATES FOR TOTAL POPULATION Part III: Intermediate Determinants of HNP Status - INDIVIDUAL AND HOUSEHOLD BEHAVIOR Indicator Wealth Quintiles Pop. Low 2nd 3rd 4th High Avg. A. Hygienic practices Disposal of children's stools: Sanitary disposal na na na na na na Handwashing: Wash hands prior to preparing food na na na na na na Handwashing facilities in household na na na na na na B. Bednet ownership and use Bednet ownership: Bednet ownership 3.86 5.30 4.96 5.71 2.10 3.42 Treated bednet ownership na na na na na na Bednet use: By children 3.74 5.20 5.63 5.55 2.83 3.56 By pregnant women na na na na na na C. Breastfeeding Exclusive breastfeeding 0.93 1.39 3.93 0.22 0.98 0.88 Timely complementary feeding 12.56 8.33 7.87 5.83 4.23 3.86 Bottle-feeding 0.39 1.34 0.69 0.34 1.75 0.60 D. Micronutrient consumption Iodized salt: Availability of iodized salt in household 6.61 3.15 2.66 2.09 2.47 3.19 Vitamin A: Children 3.56 3.14 3.59 3.10 3.04 1.98 Women na na na na na na E. Tobacco and alcohol use Tobacco: Women na na na na na na Men na na na na na na Alcohol: Women na na na na na na Men na na na na na na F. Sexual practices Non-regular sexual partnerships: Women 0.00 0.25 0.34 0.76 0.36 0.27 Men na na na na na na Condom usage with non-regular partner: Women * * * * na 4.4 Men na na na na na na G. Domestic violence Ever experienced violence na na na na na na Experienced violence in past year na na na na na na - 74 - Chad 2004 - STANDARD ERRORS OF QUINTILE ESTIMATES FOR TOTAL POPULATION Part IV: UNDERLYING DETERMINANTS OF HNP STATUS Indicator Wealth Quintiles Pop. Low 2nd 3rd 4th High Avg. A. Education School completion: Women 0.02 1.00 1.22 1.45 2.63 1.19 Men 0.69 3.24 3.63 3.70 2.78 2.47 School participation: Girls 1.81 4.01 3.65 4.43 2.96 2.31 Boys 3.26 3.73 4.26 4.01 3.29 2.67 B. Exposure to mass media Newspaper readership: Women 0.12 0.20 0.20 0.51 1.31 0.46 Men 0.00 1.69 2.15 2.94 2.74 1.50 Radio listenership: Women 0.75 1.74 1.52 2.34 2.44 1.75 Men 3.39 5.18 5.36 3.58 2.39 2.74 Television viewership: Women 0.23 0.42 0.57 0.42 2.13 0.69 Men 0.70 1.68 2.14 2.39 2.95 1.87 C. Knowledge and attitudes about HIV/AIDS Knowledge about sexual transmission of HIV/AIDS: Women 4.38 3.41 3.50 3.21 2.11 2.30 Men 4.66 3.59 6.08 6.14 2.58 2.57 Knowledge about mother-to-child transmission of HIV/AIDS: Women 2.88 3.94 3.92 3.47 3.16 3.05 Men 5.19 3.96 6.37 5.74 2.48 2.83 Attitudes toward HIV/AIDS: Women 2.89 2.46 2.28 2.37 1.46 1.32 Men 5.21 3.88 4.40 4.65 2.44 2.14 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 5.73 4.43 5.77 4.77 2.44 3.14 Can decide whether to have sex 2.62 1.38 1.44 1.59 1.72 0.92 Justifies domestic violence na na na na na na E. Orphanhood Paternal orphan prevalence 1.00 0.74 0.78 0.61 0.70 0.39 Maternal orphan prevalence 0.32 0.46 0.59 0.50 0.50 0.23 Double orphan prevalence 0.10 0.20 0.25 0.17 0.32 0.11 - 75 - Chad 2004 - ASSET DISTRIBUTION AND WEIGHTS (FACTOR SCORES) Asset Variable Unweighted Wealth Quintiles Factor Low 2nd 3rd 4th High Avg. Score Mean Std. Percentage of Population Devia- tion Has radio 0.486 0.500 13.3% 18.2% 26.6% 62.2% 85.4% 41.0% 0.07702 Has television 0.080 0.271 0.0% 0.0% 0.0% 0.2% 19.2% 3.9% 0.09083 Has telephone 0.017 0.130 0.0% 0.0% 0.0% 0.0% 4.5% 0.9% 0.05819 Has refrigerator 0.029 0.168 0.0% 0.0% 0.0% 0.0% 6.9% 1.4% 0.07184 Has bicyclette 0.236 0.425 1.0% 9.4% 26.2% 48.5% 50.1% 26.8% 0.04602 Has mobylette/moto 0.097 0.296 0.0% 0.0% 0.5% 2.5% 27.6% 6.1% 0.07901 Has car/truck 0.039 0.194 0.0% 0.0% 0.0% 0.0% 13.0% 2.6% 0.07632 Has boat 0.007 0.080 0.0% 1.1% 0.3% 0.9% 1.1% 0.7% 0.00562 Has cart 0.051 0.219 6.5% 7.7% 9.7% 14.6% 9.6% 9.6% -0.00382 Has camel/horse/donkey 0.331 0.471 83.3% 30.0% 37.9% 28.1% 10.8% 37.7% -0.05912 Uses water from a private modern well for drinking 0.016 0.124 0.1% 0.1% 0.6% 1.6% 4.9% 1.5% 0.01337 Uses water from a public modern well for drinking 0.189 0.392 18.0% 25.1% 33.3% 30.7% 7.7% 22.9% -0.02868 Uses water from a private traditional well for drinking 0.067 0.250 0.2% 8.4% 10.8% 14.4% 15.0% 9.8% 0.00122 Uses piped drinking water in residence 0.107 0.309 0.0% 0.0% 0.0% 0.2% 22.6% 4.5% 0.08846 Uses water from a public traditional well 0.232 0.422 25.8% 47.1% 35.4% 38.4% 9.9% 31.6% -0.04042 Uses surface water for drinking 0.028 0.165 4.7% 3.6% 4.4% 1.4% 0.5% 2.9% -0.01267 Uses water from a protected spring for drinking 0.008 0.087 0.3% 0.4% 0.4% 0.4% 1.5% 0.6% 0.00178 Uses water from an unprotected spring for drinking 0.072 0.258 30.1% 5.6% 2.5% 2.1% 0.3% 8.1% -0.03278 Uses water from a surface source 0.053 0.225 18.0% 6.4% 5.4% 4.0% 0.1% 6.8% -0.02400 Uses water from a vender: modern well 0.081 0.273 0.0% 0.0% 0.2% 0.5% 13.4% 2.8% 0.02918 Uses water from vendor: traditional well 0.005 0.071 0.0% 0.0% 0.1% 0.3% 0.4% 0.2% 0.00059 Uses water from vendor: other source 0.014 0.119 0.3% 0.3% 1.1% 0.2% 1.9% 0.7% 0.00575 Uses public tap water 0.117 0.322 2.3% 2.0% 3.6% 4.8% 20.8% 6.6% 0.01874 Uses other source of drinking water 0.011 0.106 0.2% 0.9% 2.3% 0.9% 0.9% 1.0% 0.00041 Uses own flush toilet 0.004 0.067 0.0% 0.0% 0.0% 0.0% 1.0% 0.2% 0.02912 Uses a shared flush toilet 0.024 0.154 0.0% 0.0% 0.5% 2.0% 5.6% 1.6% 0.01994 Uses an improved latrine 0.056 0.229 0.0% 0.0% 0.0% 0.1% 13.7% 2.8% 0.05991 Uses bush, field as latrine 0.559 0.497 100.0% 99.4% 92.4% 57.4% 7.8% 71.6% -0.09932 Uses a pit latrine 0.356 0.479 0.0% 0.5% 7.1% 40.3% 71.8% 23.8% 0.06387 Has a cement floor (includes vinyl & other floor types) 0.087 0.282 0.0% 0.0% 0.0% 0.0% 23.6% 4.7% 0.09569 Has a dirt or sand floor 0.900 0.301 100.0% 100.0% 99.8% 98.8% 73.2% 94.4% -0.09750 Has floor of ceramic tile (includes parquet floor) 0.004 0.065 0.0% 0.0% 0.0% 0.3% 2.0% 0.5% 0.01834 Has dung (primary), wood, palm, bamboo flooring 0.007 0.086 0.0% 0.0% 0.0% 0.7% 1.0% 0.3% 0.01169 Has walls made of natural materials 0.225 0.418 82.3% 17.4% 6.8% 4.2% 0.8% 22.2% -0.06189 Has walls made of toles 0.006 0.079 0.0% 0.2% 0.3% 0.2% 1.4% 0.4% 0.00625 Has walls made of banco 0.666 0.472 17.7% 82.4% 92.6% 93.8% 68.9% 71.2% -0.00576 Has wall is of semi-durable materials 0.062 0.242 0.0% 0.0% 0.2% 1.4% 18.8% 4.1% 0.06084 Has wall made of durable materials 0.040 0.195 0.0% 0.0% 0.0% 0.1% 9.9% 2.0% 0.06816 Has roof made of natural materials 0.538 0.499 100.0% 97.8% 71.0% 60.4% 7.6% 67.9% -0.09444 Has roof made of banco 0.171 0.376 0.0% 2.2% 29.0% 34.2% 19.6% 16.6% -0.00095 Has roof made of toles 0.285 0.452 0.0% 0.0% 0.0% 5.2% 71.6% 15.2% 0.10046 Has roof made of other materials 0.005 0.069 0.0% 0.0% 0.0% 0.0% 1.2% 0.2% 0.02995 Uses electric lighting 0.067 0.251 0.0% 0.0% 0.0% 0.0% 15.4% 3.1% 0.08899 Uses gas as lighting fuel 0.005 0.073 0.0% 0.3% 0.5% 0.3% 0.7% 0.4% 0.00677 Uses batteries for lighting fuel 0.107 0.309 18.3% 26.4% 10.3% 7.2% 1.0% 12.9% -0.02907 Uses wood as lighting fuel 0.205 0.404 67.5% 34.7% 7.0% 2.2% 0.5% 22.7% -0.05889 Uses kerosene as lighting fuel 0.608 0.488 13.2% 37.9% 81.4% 90.2% 82.1% 60.4% 0.02099 Uses other lighting fuel 0.005 0.069 0.8% 0.4% 0.2% 0.1% 0.1% 0.3% -0.00345 - 77 - PART V. SUPPORTING TABLES, 1996 / 97 A. SAMPLE SIZES B. STANDARD ERRORS C. ASSET DISTRIBUTION AND WEIGHTS Chad 1996 / 97 - SAMPLE SIZES TOTAL SAMPLE Indicator Wealth Quintiles Pop. Low 2nd 3rd 4th High Total Number of household members All 5,871 9,139 6,925 7,242 7,297 36,473 Urban 138 254 338 1,785 5,959 8,474 Rural 5,732 8,885 6,587 5,457 1,338 27,999 Female 3,139 4,905 3,612 3,717 3,482 18,855 Male 2,729 4,230 3,306 3,523 3,809 17,597 Part I: HNP STATUS Indicator Wealth Quintiles Pop. Low 2nd 3rd 4th High Total Mortality rates All 2,855 3,784 2,373 2,698 2,656 14,365 Urban 67 84 136 704 2,174 3,164 Rural 2,788 3,700 2,237 1,994 482 11,201 Female 1,478 1,862 1,162 1,358 1,322 7,182 Male 1,377 1,921 1,211 1,340 1,334 7,183 Prevalence of fever, diarrhea, acute respiratory infection All 1,291 1,654 1,043 1,223 1,235 6,445 Urban 28 39 56 293 989 1,405 Rural 1,263 1,615 987 930 245 5,040 Female 646 824 527 619 614 3,230 Male 644 830 516 604 620 3,214 Total fertility rate All 3,504 5,881 3,534 3,804 3,988 20,711 Urban 88 137 202 1,076 3,292 4,795 Rural 3,417 5,744 3,331 2,728 696 15,916 Age-specific fertility rate 15-19 All 694 1,545 1,007 976 1,084 5,306 Urban 17 40 43 264 889 1,253 Rural 677 1,505 964 711 195 4,052 Children's nutritional status All 1,162 1,478 913 1,082 1,031 5,664 Urban 25 34 51 249 814 1,173 Rural 1,136 1,444 863 833 217 4,493 Female 571 726 455 554 516 2,822 Male 590 751 458 527 515 2,841 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 - Chad 1996 / 97 - SAMPLE SIZES Part I: HNP STATUS (Cont.) Indicator Wealth Quintiles Pop. Low 2nd 3rd 4th High Total Women's nutritional status All 700 935 605 663 646 3,549 Urban 19 22 34 163 526 764 Rural 682 913 571 500 120 2,786 Women's anemia status All na na na na na na Urban na na na na na na Rural na na na na na na Girls' circumcision All na na na na na na Urban na na na na na na Rural na na na na na na Women's circumcision All na na na na na na Urban na na na na na na Rural na na na na na na Prevalence of genital discharge, ulcer, sore Female 1,116 1,877 1,125 1,214 1,263 6,595 Urban Female 28 43 64 340 1,040 1,515 Rural Female 1,089 1,835 1,061 874 222 5,081 Male 233 478 347 326 512 1,896 Urban Male 4 10 18 95 450 577 Rural Male 229 468 329 230 62 1,318 - 82 - Chad 1996 / 97 - 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 257 334 180 219 221 1,211 Urban 5 10 12 49 172 248 Rural 252 324 168 170 49 963 Female 150 154 96 109 113 622 Male 107 180 84 110 108 589 Treatment of fever All 380 531 321 431 406 2,069 Urban 10 11 21 85 331 458 Rural 371 520 300 346 75 1,612 Female 195 281 149 216 211 1,052 Male 185 250 172 216 194 1,017 Treatment of acute respiratory infection All 129 205 146 168 170 816 Urban 4 3 9 30 132 178 Rural 125 201 137 138 37 638 Female 63 99 75 84 83 404 Male 66 106 71 84 87 414 Treatment of diarrhea All 244 354 226 296 264 1,384 Urban 6 6 14 75 210 311 Rural 238 347 212 221 54 1,072 Female 117 154 130 143 127 671 Male 127 199 96 153 137 712 Antenatal and delivery care All 889 1,229 777 856 857 4,608 Urban 19 27 43 219 702 1,010 Rural 870 1,202 735 637 155 3,599 Contraceptive prevalence Female 1,017 1,639 1,030 1,080 1,066 5,832 Urban Female 23 29 52 266 868 1,238 Rural Female 994 1,610 979 813 198 4,594 Male 215 408 276 243 340 1,483 Urban Male 3 5 14 58 298 378 Rural Male 213 404 263 184 42 1,106 Contraceptive source Female 1 4 1 11 51 68 Urban Female 1 0 0 5 47 52 Rural Female 0 4 1 6 4 15 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 - Chad 1996 / 97 - 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 93 139 84 98 104 518 Urban 3 2 6 26 81 118 Rural 90 137 79 72 23 401 Female 44 70 43 36 44 237 Male 49 68 41 62 59 279 Timely complementary breastfeeding All 110 104 102 96 94 506 Urban 2 5 4 25 76 112 Rural 108 99 98 71 18 394 Female 68 51 55 46 49 269 Male 42 53 47 50 45 237 Bottle-feeding All 287 361 265 294 300 1,507 Urban 7 7 13 74 240 341 Rural 280 354 252 221 61 1,168 Female 149 185 133 134 148 749 Male 138 177 132 160 152 759 - 84 - Chad 1996 / 97 - 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 901 1,532 1,353 1,154 1,154 6,094 Urban 19 38 65 302 969 1,393 Rural 882 1,494 1,288 852 185 4,701 Vitamin A supplementation All 1,142 1,443 913 1,057 1,071 5,626 Urban 23 36 49 254 856 1,218 Rural 1,120 1,406 864 803 216 4,409 Female 578 721 454 533 543 2,829 Male 564 722 459 524 529 2,798 Tobacco and alcohol use, casual sexual partners, condom use for casual sex Female 1,252 2,134 1,274 1,364 1,430 7,454 Urban Female 31 52 72 382 1,182 1,719 Rural Female 1,222 2,081 1,202 981 248 5,734 Male 275 580 446 421 598 2,320 Urban Male 6 16 28 120 529 699 Rural Male 270 564 417 301 69 1,621 Domestic violence All na na na na na na Urban na na na na na na Rural na na na na na na - 85 - Chad 1996 / 97 - SAMPLE SIZES Part IV: UNDERLYING DETERMINANTS OF HNP STATUS Indicator Wealth Quintiles Pop. Low 2nd 3rd 4th High Total School completion (Grade 5) Female 1,272 2,215 1,376 1,462 1,502 7,827 Urban female 31 55 74 390 1,229 1,778 Rural female 1,242 2,160 1,302 1,072 273 6,048 Male 856 1,467 1,252 1,336 1,810 6,721 Urban male 18 37 65 351 1,552 2,023 Rural male 839 1,430 1,186 985 258 4,699 School participation Female 654 835 589 664 637 3,380 Urban female 14 27 28 154 492 716 Rural female 640 809 561 510 145 2,664 Male 598 805 572 663 605 3,243 Urban male 15 23 25 156 489 708 Rural male 583 782 546 507 116 2,535 Mass media exposure Female 1,252 2,134 1,274 1,364 1,430 7,454 Urban female 31 52 72 382 1,182 1,720 Rural female 1,222 2,081 1,202 981 248 5,734 Male 275 580 446 421 598 2,320 Urban male 6 16 28 120 529 699 Rural male 270 564 417 301 69 1,621 Knowledge of HIV/AIDS prevention Female 3,408 2,134 1,274 1,364 1,430 9,610 Urban female 31 52 72 382 1,182 1,719 Rural female 1,222 2,081 1,202 981 248 5,734 Male 275 580 446 421 598 2,320 Urban male 6 16 28 120 529 699 Rural male 270 564 417 301 69 1,621 Household decisionmaking and justification of violence All 1,252 2,134 1,274 1,364 1,430 7,454 Urban 31 52 72 382 1,182 1,720 Rural 1,222 2,081 1,202 981 248 5,734 Orphanhood All 3,361 4,562 3,139 3,578 3,438 18,078 Urban 78 124 158 842 2,734 3,937 Rural 3,283 4,438 2,981 2,735 705 14,142 Female 1,714 2,254 1,529 1,782 1,714 8,994 Male 1,646 2,302 1,605 1,793 1,723 9,068 - 86 - Chad 1996 / 97 - STANDARD ERRORS OF QUINTILE ESTIMATES FOR TOTAL POPULATION Part I: HNP STATUS Indicator Wealth Quintiles Pop. Low 2nd 3rd 4th High Avg. A. Childhood illness and mortality Infant mortality rate 6.45 8.35 7.87 8.49 5.78 3.87 Under-five mortality rate 10.77 11.16 12.76 11.01 9.10 5.90 Prevalence of fever 1.87 1.64 1.82 2.22 1.23 0.99 Prevalence of diarrhea 1.30 1.50 1.35 1.64 1.08 0.75 Prevalence of acute respiratory infection 1.31 1.24 1.48 1.34 1.05 0.66 B. Fertility Total fertility rate 0.25 0.21 0.22 0.21 0.19 0.12 Adolescent fertility rate 15.00 13.00 14.00 14.00 11.00 7.00 C. Nutritional status Children: Moderate stunting 1.35 1.10 1.44 1.07 1.05 0.50 Severe stunting 1.67 1.30 1.89 1.47 0.93 0.74 Moderate underweight 1.62 1.45 1.85 1.38 1.27 0.70 Severe underweight 1.35 1.07 1.42 1.15 0.79 0.61 Mild anemia na na na na na na Moderate anemia na na na na na na Severe anemia na na na na na na Women: Malnutrition 2.10 1.63 2.20 1.63 1.70 0.96 Mild anemia na na na na na na Moderate anemia na na na na na na Severe anemia na na na na na na D. Female circumcision Prevalence of circumcision: Girls na na na na na na Women na na na na na na Prevalence of occlusion: Girls na na na na na na Women na na na na na na E. Sexually transmitted disease Prevalence of genital discharge: Women 0.13 0.08 0.18 0.23 0.20 0.07 Men 1.37 0.68 0.69 0.72 0.68 0.37 Prevalence of genital ulcer: Women 0.11 0.00 0.00 0.00 0.12 0.03 Men 0.58 0.50 0.57 0.32 0.40 0.23 - 87 - Chad 1996 / 97 - STANDARD ERRORS OF QUINTILE ESTIMATES FOR TOTAL POPULATION Part II: Intermediate Determinants of HNP Status - HNP SERVICE USE Indicator Wealth Quintiles Pop. Low 2nd 3rd 4th High Avg. A. Childhood immunization BCG coverage 3.38 4.92 4.51 4.70 3.87 2.70 Measles coverage 2.29 3.47 3.09 4.24 3.40 1.85 DPT coverage 2.33 4.07 2.37 4.18 3.48 2.11 Full basic coverage 1.36 2.99 1.91 3.30 2.57 1.50 No basic coverage 4.27 4.32 4.99 3.68 2.88 2.60 Hepatitis B coverage na na na na na na Yellow fever coverage 2.51 2.97 3.34 4.16 2.81 1.70 B. Treatment of childhood illnesses Treatment of fever: Medical treatment of fever 0.69 1.25 2.17 1.74 1.87 0.81 Treatment in a public facility 0.16 0.93 0.57 1.25 1.31 0.46 Treatment in a private facility 0.69 0.86 2.16 1.42 1.12 0.64 Treatment of acute respiratory infection (ARI): Medical treatment of ARI 2.42 2.78 4.93 2.97 4.27 1.76 Treatment in a public facility 0.48 2.06 2.69 2.59 3.71 1.19 Treatment in a private facility 2.38 2.33 4.79 1.87 1.80 1.52 Treatment of diarrhea: Use of oral rehydration therapy 3.82 2.82 4.29 2.49 2.92 1.66 Medical treatment of diarrhea 1.87 2.74 2.97 2.78 3.24 1.49 Treatment in a public facility 1.11 1.43 1.99 2.05 2.94 1.03 Treatment in a private facility 1.64 2.42 2.36 2.30 2.15 1.13 C. Antenatal and delivery care Antenatal care (ANC) visits: To a medically trained person 1.63 1.81 2.31 2.49 2.18 1.47 To a doctor 0.29 0.11 0.56 0.67 0.99 0.31 To a nurse or trained midwife 1.61 1.78 2.17 2.69 1.97 1.50 Multiple visits to a medically trained person 1.26 1.56 1.97 2.31 2.33 1.37 Antenatal care content: Tetanus toxoid 1.58 1.95 2.04 2.52 2.30 1.60 Prophylactic antimalarial treatment na na na na na na Iron supplementation na na na na na na Delivery attendance: By a medically trained person 0.69 0.91 1.17 1.67 1.99 0.94 By a doctor 0.37 0.09 0.28 0.32 0.47 0.16 By a nurse or trained midwife 0.57 0.89 1.09 1.59 1.94 0.87 In a public facility 0.51 0.81 0.77 1.05 1.70 0.65 In a private facility 0.38 0.54 0.26 0.67 0.58 0.43 At home 0.67 1.07 1.00 1.41 1.88 0.84 D. Contraceptive services Contraceptive prevalence: Women 0.07 0.17 0.16 0.46 0.76 0.16 Men 0.63 0.47 0.00 0.75 1.58 0.44 Source of contraception - public sector: Women * * * * 5.32 5.85 Men na na na na na na - 88 - Chad 1996 / 97 - STANDARD ERRORS OF QUINTILE ESTIMATES FOR TOTAL POPULATION Part II: Intermediate Determinants of HNP Status - HNP SERVICE USE (Cont.) Indicator Wealth Quintiles Pop. Low 2nd 3rd 4th High Avg. D. Contraceptive services (cont.) Source of contraception - private sector: Women * * * * 5.39 5.79 Men na na na na na na E. Treatment of adult illnesses Treatment of genital discharge, ulcer, sore: Women * * * * * 7.47 Men * * * * 9.98 7.33 Treatment of genital discharge, ulcer, sore in public medical facilities: Women 0.13 0.08 0.18 0.23 0.20 0.07 Men 1.37 0.73 0.69 0.72 0.70 0.38 Voluntary counseling and testing for HIV/AIDS: Women na na na na na na Men na na na na na na - 89 - Chad 1996 / 97 - STANDARD ERRORS OF QUINTILE ESTIMATES FOR TOTAL POPULATION Part III: Intermediate Determinants of HNP Status - INDIVIDUAL AND HOUSEHOLD BEHAVIOR Indicator Wealth Quintiles Pop. Low 2nd 3rd 4th High Avg. A. Hygienic practices Disposal of children's stools: Sanitary disposal na na na na na na Handwashing: Wash hands prior to preparing food na na na na na na Handwashing facilities in household na na na na na na B. Bednet ownership and use Bednet ownership: Bednet ownership na na na na na na Treated bednet ownership na na na na na na Bednet use: By children na na na na na na By pregnant women na na na na na na C. Breastfeeding Exclusive breastfeeding 0.00 0.00 1.50 1.23 2.14 0.55 Timely complementary feeding 5.87 5.51 4.42 5.39 4.05 2.52 Bottle-feeding 0.45 0.00 0.84 0.63 1.57 0.41 D. Micronutrient consumption Iodized salt: Availability of iodized salt in household 3.80 2.61 2.78 2.59 1.83 1.74 Vitamin A: Children 0.27 0.15 0.48 0.92 0.24 0.27 Women na na na na na na E. Tobacco and alcohol use Tobacco: Women na na na na na na Men na na na na na na Alcohol: Women na na na na na na Men na na na na na na F. Sexual practices Non-regular sexual partnerships: Women 0.18 0.10 0.23 0.24 0.19 0.09 Men 1.61 1.79 2.21 2.14 2.11 1.01 Condom usage with non-regular partner: Women * * * * * 3.85 Men 0.00 3.42 4.36 3.30 3.07 2.12 G. Domestic violence Ever experienced violence na na na na na na Experienced violence in past year na na na na na na - 90 - Chad 1996 / 97 - STANDARD ERRORS OF QUINTILE ESTIMATES FOR TOTAL POPULATION Part IV: UNDERLYING DETERMINANTS OF HNP STATUS Indicator Wealth Quintiles Pop. Low 2nd 3rd 4th High Avg. A. Education School completion: Women 0.25 0.25 0.40 0.67 1.94 0.56 Men 1.18 1.22 1.78 2.14 2.54 1.37 School participation: Girls 1.61 2.48 2.29 2.33 3.29 1.27 Boys 2.87 2.51 2.86 2.81 2.46 1.54 B. Exposure to mass media Newspaper readership: Women 0.19 0.29 0.42 0.55 1.41 0.41 Men 0.96 1.53 1.79 2.58 2.44 1.28 Radio listenership: Women 0.88 0.84 1.74 1.69 1.45 1.03 Men 2.16 1.60 3.19 2.98 1.82 1.62 Television viewership: Women 0.15 0.10 0.10 0.60 1.52 0.39 Men 0.00 0.39 0.30 1.09 2.79 1.05 C. Knowledge and attitudes about HIV/AIDS Knowledge about sexual transmission of HIV/AIDS: Women 3.13 3.33 3.35 2.24 1.15 2.47 Men 4.76 2.72 2.39 1.94 0.90 1.60 Knowledge about mother-to-child transmission of HIV/AIDS: Women 1.70 1.71 2.18 1.98 2.04 1.15 Men 4.43 3.18 3.66 3.40 3.12 2.07 Attitudes toward HIV/AIDS: Women na na na na na na Men na na na na na na D. Status of women Household decisionmaking: Can seek own health care na na na na na na Can seek children's health care na na na na na na Can make daily household purchases na na na na na na Can make large household purchases na na na na na na Can make meal-related decisions na na na na na na Freedom of movement: Can travel to visit family/relatives na na na na na na Other decisionmaking, attitudes: Can decide how to spend own money 2.84 2.83 2.79 2.70 1.48 1.77 Can decide whether to have sex na na na na na na Justifies domestic violence na na na na na na E. Orphanhood Paternal orphan prevalence 0.90 0.71 0.59 0.77 0.47 0.33 Maternal orphan prevalence 0.38 0.30 0.47 0.42 0.42 0.17 Double orphan prevalence 0.10 0.11 0.19 0.20 0.18 0.07 - 91 - Chad 1996 / 97 - ASSET DISTRIBUTION AND WEIGHTS (FACTOR SCORES) Asset Variable Unweighted Wealth Quintiles Factor Low 2nd 3rd 4th High Avg. Score Mean Std. Percentage of Population Devia- tion Has electricity 0.043 0.203 0.0% 0.0% 0.0% 0.5% 13.3% 2.8% 0.10008 Has radio 0.374 0.484 0.0% 4.2% 38.4% 47.5% 81.0% 34.0% 0.07271 Has television 0.032 0.176 0.0% 0.0% 0.0% 0.0% 11.4% 2.3% 0.09607 Has refrigerator 0.016 0.124 0.0% 0.0% 0.0% 0.0% 6.0% 1.2% 0.08945 Has bicycle 0.133 0.340 0.0% 9.7% 7.8% 30.1% 33.9% 16.7% 0.02946 Has motorcycle 0.056 0.230 0.0% 0.0% 0.0% 1.3% 22.5% 4.8% 0.06928 Has car 0.020 0.142 0.0% 0.0% 0.0% 0.0% 8.1% 1.6% 0.07941 Has telephone 0.006 0.079 0.0% 0.0% 0.0% 0.0% 2.2% 0.4% 0.06785 Works on own or family's agricultural land 0.445 0.497 100.0% 84.8% 65.4% 56.0% 13.8% 63.6% -0.06400 Uses piped drinking water in residence 0.054 0.225 0.0% 0.0% 0.0% 0.5% 16.3% 3.4% 0.09364 Uses a traditional well in residence 0.145 0.353 0.0% 1.0% 13.9% 25.1% 26.4% 13.1% 0.01688 Uses a modern well in residence 0.009 0.096 0.0% 0.0% 0.7% 2.0% 2.1% 0.9% 0.00651 Uses river, canal or surface water for drinking 0.093 0.290 9.8% 20.0% 14.4% 11.2% 2.1% 12.0% -0.02252 Uses rain for drinking water 0.004 0.063 0.2% 0.8% 0.8% 0.5% 0.0% 0.5% -0.00455 Uses a public fountain 0.072 0.258 0.0% 1.7% 3.7% 10.8% 12.1% 5.7% 0.00565 Uses water from a tanker truck 0.000 0.021 0.0% 0.0% 0.0% 0.1% 0.0% 0.0% 0.00096 Uses water from a vendor 0.138 0.345 0.0% 0.0% 0.6% 7.4% 25.0% 6.6% 0.03051 Uses a traditional public well 0.340 0.474 83.8% 49.7% 40.3% 23.2% 8.1% 39.8% -0.05184 Uses a modern public well 0.142 0.349 6.3% 26.7% 25.5% 18.1% 7.8% 17.7% -0.02361 Uses other source of drinking water 0.002 0.044 0.0% 0.0% 0.0% 0.8% 0.2% 0.2% 0.00067 Uses own flush toilet 0.002 0.045 0.0% 0.0% 0.0% 0.0% 0.5% 0.1% 0.03737 Uses a shared flush toilet 0.003 0.051 0.0% 0.0% 0.0% 0.0% 0.7% 0.1% 0.03412 Uses bush,field as latrine 0.596 0.491 100.0% 99.7% 94.1% 52.7% 10.4% 71.5% -0.08743 Uses an improved pit latrine 0.124 0.330 0.0% 0.0% 0.0% 1.2% 36.4% 7.5% 0.08360 Uses a septic pit latrine 0.274 0.446 0.0% 0.0% 5.4% 45.8% 52.0% 20.5% 0.02691 Uses other type of latrine 0.001 0.032 0.0% 0.3% 0.3% 0.2% 0.0% 0.2% -0.00223 Has dirt, sand, dung as principal floor in dwelling 0.935 0.247 100.0% 100.0% 100.0% 100.0% 77.3% 95.5% -0.11275 Has tile principal floor in dwelling 0.003 0.051 0.0% 0.0% 0.0% 0.0% 0.9% 0.2% 0.03593 Has cement principal floor 0.063 0.243 0.0% 0.0% 0.0% 0.0% 21.8% 4.4% 0.10734 Has cane, palm, trunks for walls 0.971 0.167 100.0% 100.0% 100.0% 97.9% 91.0% 97.8% -0.08092 Has walls made of cement 0.022 0.147 0.0% 0.0% 0.0% 0.0% 7.6% 1.5% 0.09099 Has other material for walls 0.006 0.076 0.0% 0.0% 0.0% 2.0% 1.3% 0.6% 0.00021 Has natural material roofing 0.765 0.424 100.0% 100.0% 100.0% 98.4% 26.8% 85.0% -0.10474 Has roof is made of sheet metal 0.233 0.423 0.0% 0.0% 0.0% 1.6% 72.7% 14.9% 0.10341 Has roof is made of cement 0.001 0.036 0.0% 0.0% 0.0% 0.0% 0.4% 0.1% 0.01727 Number of members per sleeping room 2.823 1.728 4.7 3.0 2.7 2.9 2.9 3.2 -0.01885 - 93 - PART VI. ANNEXES A. SOURCES OF ADDITIONAL INFORMATION B. USE OF INFORMATION FROM THIS REPORT TO MONITOR THE ECONOMIC STATUS OF PEOPLE SERVED BY HNP PROGRAMS C. COUNTRIES COVERED BY THE HNP- POVERTY REPORT PROJECT ANNEX A. SOURCES OF ADDITIONAL INFORMATION ADDITIONAL INEQUALITY DATA World Bank HNP/Poverty Country Report Website: http://www.worldbank.org/hnp/povertyandhealth/countrydata. This World Bank website provides the full texts and tables for all fifty-six countries covered by the HNP/Poverty Country Report Project. (A list of the countries covered appears in annex C, at the end of this report.) Also available at the site are summary tables, organized by indicator, designed to facilitate cross-country comparisons in inequality with respect to particular indicators. DHS Country Reports: http://www.measuredhs.com/countries. All DHS final country reports produced since 2003 include quintile-specific tabulations in approximately 50-100 of the reports' HNP indicator tables. The tables deal with some of the indicators covered in this volume, and with many that are not. UNICEF Multi-Indicator Cluster Survey Website: http://www.childinfo.org/MICS2/natlMICSrepz/MICSnatrep.htm. The UNICEF Multi-Indicator Cluster Survey (MICS) project is generally similar to the DHS program, but covers a somewhat different set of countries and indicators. The "standard tables" section for each country listed at the MICS website provides wealth- based, quintile-specific information in around 40-45 of the tables related to hnp, education, and child labor. In deriving these quintile-specific estimates, the MICS investigators have employed a wealth index similar to the one used here. World Health Organization World Health Survey Website: http://www.who.int/healthinfo/survey/en/index.html. The World Health Organization's World Health Survey (WHS) includes such issues as self-assessed adult health status; coverage of interventions against adult chronic diseases and against maternal and child health problems; household health expenditures; insurance coverage; and health system responsiveness. Approximately seventy countries ­ developed as well as developing ­ have been covered thus far. Household wealth information has been collected and used to prepare quintile-specific estimates for many of the indicators appearing in the reports on these countries. - 97 - METHODS AND RESOURCES FOR FURTHER INEQUALITY ANALYSIS Shea Oscar Rutstein and Kiersten Johnson, The DHS Wealth Index, DHS Comparative Reports No. 6 (Calverton, Maryland, USA: ORC Macro, August 2004) (Available at: http://www.measuredhs.com/pubs/pub_details.cfm?ID =470&srchTp=type). This DHS publication, by two of the co-authors of the current report, describes in detail the construction of the wealth index that underlies the data presented in the basic tables. Deon Filmer and Lant H. Pritchett, "Estimating Wealth Effects without Expenditure Data ­ or Tears: An Application to Education Enrollments in States in India," Demography 38, no.1 (February 2001): 115-132. This seminal piece gave birth to the wealth index procedure used in the current volume. It also includes three of the previously-cited country case studies demonstrating the close relationship between results produced using wealth and those based on consumption as an indicator of household economic status. Owen O'Donnell, Eddy van Doorslaer, Adam Wagstaff, and Magnus Lindelow. Quantitative Techniques for Health Equity Analysis. Washington D.C.: The World Bank, forthcoming. Among the topics covered in this comprehensive overview of available quantitative techniques are the measurement of living standards using a wealth index and other approaches (chapter 6) and the concentration index as a measure of inequality (chapter 8). DHS Country Data Sets: http://www.measuredhs.com/accesssurveys/search. The data sets for all DHS surveys undertaken since 2003 include two pieces of information for each household that are designed to help investigators prepare quintile- specific tabulations for any indicator. These are: 1) the household wealth score; and 2) the economic quintile to which individuals in the household belong. Any tabulation using these pieces of information will be comparable to the figures appearing here. - 98 - ANNEX B. USE OF INFORMATION FROM THIS REPORT TO MONITOR THE ECONOMIC STATUS OF PEOPLE SERVED BY HNP PROGRAMS The wealth or asset approach employed in this report can be used to monitor the economic status of people served by health, nutrition, and population (hnp) programs in two ways. The first, simpler way is suitable for monitoring nationwide, facility-based programs. A second, fuller version can also be employed for other types of programs, such as initiatives undertaken only in some parts of a country, or activities like mass education or outreach programs that do not operate through facilities. BASIC MONITORING OF NATIONWIDE FACILITY-BASED PROGRAMS The economic distribution of patients in a nationwide, facility-based program (say, a network of rural health posts, antenatal care clinics, emergency obstetrical facilities, or hospitals) can be determined through an exit survey of facility patients, using the wealth questionnaire and the set of quintile cut-off points that immediately follow this text, and which have been created using the information presented in part III.C. The questionnaire can be employed to measure the economic status of any individual responding to the questions on it. The set of cut-off points can serve to compare the distribution of the respondents' economic status with that of the nationally- representative sample of people interviewed by the DHS survey on which the present report is based. The first step is to use the questionnaire in interviewing an adequately-large sample of patients attending the facility-based services of interest. The wealth score for each patient can then be calculated by multiplying the response to each question by the item scores also provided on the questionnaire, and summing the results. After this has been done, the quintile cut-off points can be used to place each individual in the economic quintile to which (s)he belongs. The number of patients and percentage of total patients in each quintile can then be calculated. Since each quintile defined by the cut-off points contains 20 percent of the individuals in the nationally-representative DHS sample, the patients belonging to any such quintile containing significantly more (or less) than 20 percent of the total are over- (under-) represented relative to the national population. When the percentage of patients in each of the five quintiles is viewed as a whole, the result is a frequency distribution that indicates the spread of service beneficiaries across economic classes of individuals.21 For example: · A service that favors the poorest people would have substantially more than 20 percent of its patients in each of the lowest one or two economic quintiles; considerably less than 20 percent of its patients in each of the highest quintiles. 21That is, across economic classes of all individuals in the sample population. Estimates pertaining to quintiles of only those individuals needing services require adjusting the results of the procedure described here through application of the relevant quintile-specific, sample-size figures presented in part III.A. - 99 - · A service that reaches all economic classes equally would draw roughly the same proportion of total patients from the lower and upper quintiles. · A service that favors the least poor population groups would have well over 20 percent of its patients in each of the highest one or two quintiles, considerably less than 20 percent of its patients in each of the lowest quintiles. FULLER MONITORING OF FACILITY-BASED AND OF OTHER PROGRAMS While capable of providing far more information than currently exists about the distribution of a program's beneficiaries, the approach just described has important limitations. For example, it cannot deal with the many important types of health programs that do not deliver services primarily through facilities ­ mass media health education, household visits by health workers, and many social marketing initiatives, for example. It is also limited in its ability to assess programs working only with certain areas within a country: it can compare the economic status of the programs' beneficiaries with that of the national population, but not with that of the specific sub-national areas where the programs are active. Further, it focuses primarily on only one of the two important dimensions of monitoring the distribution of program beneficiaries: that is, incidence or focus ­ the percentage of program benefits that flow to the poor. It cannot deal nearly so well with the second dimension, which concerns coverage, or the percentage of the poor that the program reaches. These limitations can be overcome by a modified version of the approach described above that relies on a household- rather than facility-based survey. A household survey can generate a set of data containing the full range of information needed to produce an equity assessment by collecting two types of information: first, about the household's wealth or assets, using the questions in the left-hand column of the attached questionnaire;22 and second, about the household members' use of or exposure to the services provided by the program(s) of interest. The collected data can be analyzed in either (or both) of two ways, depending on the type of information desired: · One way would be to use only data from the household survey. The procedure would be analogous to that for a DHS survey employed in this report: ­ Asset information from the survey-generated data set would be used as the basis for the construction of a wealth index, weighting the individual items using some method like principal components analysis. ­ The individuals in the sample would be ranked in order of the index values for their households, then divided into groups like quintiles. ­ The coverage rates in each quintile for the service of interest would be calculated. · A second approach would be to use the weights for each item appearing on the attached questionnaire in determining the wealth of each individual, instead of calculating the weights from the new household data set. Once the individuals' wealth is determined, the individuals would be ranked, divided into quintiles, and the coverage rate in each quintile would be calculated. In the case of programs undertaken in only one region of the country, it would 22Or, if one is willing to forego the benefits of the second analytical approach described below, using any of several other asset questionnaires that exist. Examples include the INDEPTH health equity survey tool (available at: www.indepth-network.org/core_documents/indepthtools.htm) or the model questionnaire developed by M. Mahood Khan and David Hotchkiss of the PHR Plus project (which can be found at: www.phrplus.org). - 100 - provide a comparison of the economic status of the people served with that of the entire country rather than of only the region where the programs are active;23 in the case of nationwide as well as regional programs, it would permit a comparison with the other service programs covered in this report. 23This additional perspective could be particularly helpful in an assessment of a program seeking to reach the poor by focusing on especially backward districts. A report presenting only a finding that the program was reaching the better- off people in those districts could produce an impression that it had failed to reach its intended beneficiaries. But a comparison between the economic status of the program's beneficiaries with that of the national population might well reveal that most of the beneficiaries were poor by national standards and that the program was thus considerably more successful than otherwise thought. - 101 - Chad 2004 - ASSET QUESTIONNAIRE Question Score if Score if Item "Yes" "No" Score 1. In your household, is/are there? One or more radios 0.07927 -0.07482 One or more televisions 0.30780 -0.02680 One or more telephones 0.43828 -0.00773 One or more refrigerators 0.41523 -0.01243 One or more bicycles 0.08275 -0.02559 One or more motocycles 0.24125 -0.02587 One or more cars, trucks 0.37731 -0.01543 One or more boats 0.06940 -0.00046 One or more carts -0.01652 0.00088 One or more camels, horses, donkeys -0.08404 0.04158 2. What is the principal source of drinking water for your household? Piped water in residence 0.25564 -0.03060 Piped water in public tap 0.05143 -0.00682 Private modern well 0.10604 -0.00169 Public modern well -0.05937 0.01386 Private traditional well 0.00455 -0.00033 Public traditional well -0.07360 0.02220 Surface water -0.07471 0.00215 Protected spring 0.02034 -0.00016 Unprotected spring -0.11810 0.00910 Vendor: modern well 0.09828 -0.00866 Vendor: traditional well 0.00835 -0.00004 Vendor: other source 0.04763 -0.00069 Other 0.00381 -0.00004 3. What is the principal type of toilet facility used by your household? Private flush toilet 0.43451 -0.00195 Shared flush toilet 0.12660 -0.00314 Improved latrine 0.24713 -0.01452 Pit latrine 0.08591 -0.04748 Bush, field as latrine -0.08821 0.11179 4. What is the principal material used for the floors in your household? Dirt, sand -0.03257 0.29183 Cement (includes vinyl & other) 0.30926 -0.02960 Ceramic tile (includes parquet floor) 0.27958 -0.00120 Dung (primary), wood, palm, bamboo 0.13488 -0.00101 - 103 - Chad 2004 - ASSET QUESTIONNAIRE Question Score if Score if Item "Yes" "No" Score 5. What is the principal material used for the walls of your household? Natural materials -0.11485 0.03334 Toles 0.07825 -0.00050 Banco -0.00407 0.00813 Semi-durable materials 0.23622 -0.01567 Durable materials 0.33533 -0.01385 6. What is the principal material used for the roof of your household? Natural materials -0.08743 0.10200 Banco -0.00210 0.00043 Toles 0.15898 -0.06347 Other 0.42937 -0.00209 7. What is the principal means of lighting in your household? Electricity 0.33092 -0.02393 Gas 0.09180 -0.00050 Batteries -0.08402 0.01006 Wood -0.11580 0.02994 Kerosene 0.01685 -0.02613 Other -0.04939 0.00024 Total Household Asset Score (sum of individual item scores) 2004 - QUINTILE CUT-OFF POINTS Asset Index Value Wealth Quintile Bottom Cut-Off Top Cut-Off Low Low -0.77049 Second -0.77049 -0.57883 Third -0.57883 -0.37609 Fourth -0.37609 0.07235 High 0.07235 High - 104 - ANNEX C. COUNTRIES COVERED BY THE HNP - POVERTY REPORT PROJECT* East Asia and Pacific Sub-Saharan Africa Cambodia 2000 Benin 1996, 2001 Indonesia 1997, 2002-03 Burkina Faso 1992-3, 1998-9, 2003 Philippines 1998, 2003 Cameroon 1991, 1998, 2004 Vietnam 1997, 2002 Central African Rep. 1994-95 Chad 1996-97, 2004 Europe and Central Asia Comoros 1996 Armenia 2000 Cote d'Ivoire 1994 Kazakhstan 1995, 1999 Eritrea 1995 Kyrgyz Rep. 1997 Ethiopia 2000 Turkey 1993, 1998 Gabon 2000 Turkmenistan 2000 Ghana 1993, 1998, 2003 Uzbekistan 1996 Guinea 1999 Kenya 1993, 1998, 2003 Latin America and the Caribbean Madagascar 1997 Bolivia 1998, 2003 Malawi 1992, 2000 Brazil 1996 Mali 1995-96, 2001 Colombia 1995, 2000, 2005 Mauritania 2000-01 Dominican Rep. 1996, 2002 Mozambique 1997, 2003 Guatemala 1995, 1998-99 Namibia 1992, 2000 Haiti 1994-95, 2000 Niger 1998 Nicaragua 1997- 98, 2001 Nigeria 1990, 2003 Paraguay 1990 Rwanda 2000 Peru 1996, 2000 Senegal 1997 South Africa 1998 Middle East and North Africa Tanzania 1996, 1999, 2004 Egypt 1995, 2000 Togo 1998 Jordan 1997 Uganda 1995, 2000-01 Morocco 1992, 2003-04 Zambia 1996, 2001-02 Yemen 1997 Zimbabwe 1994, 1999 South Asia * Note: electronic versions of reports for all countries Bangladesh 1996-97, 1999-2000, 2004 are currently available at: www.worldbank.org/ povertyandhealth/countrydata. While supplies last, India 1992-93, 1998-99 paper copies may be obtained at no charge by sending Nepal 1996, 2001 a request to the World Bank's health advisory service: healthpop@worldbank.org. Pakistan 1990-91 - 105 -