| Author(s) |
Central Statistical Office, Lusaka, Zambia Ministry of Health, Lusaka, Zambia University of Zambia Teaching Hospital, Virology Laboratory, Lusaka, Zambia University of Zambia Department of Population Studies, Lusaka, Zambia Tropical Diseases Research Ce |
| Table of contents |
TABLES AND FIGURES ................................................................................................................................... ix
PREFACE ........................................................................................................................................................... xv
ACRONYMS ..................................................................................................................................................... xvii
MILLENNIUM DEVELOPMENT GOALS ................................................................................................... xix
MAP OF ZAMBIA ............................................................................................................................................. xx
1 INTRODUCTION .................................................................................................................................. 1
1.1 History, Geography, and Economy ............................................................................................ 1
1.1.1 History ......................................................................................................................... 1
1.1.2 Geography ................................................................................................................... 1
1.1.3 Economy ...................................................................................................................... 1
1.2 Population .................................................................................................................................. 2
1.3 The Population Policy and National Population and Development Programme of Action ........ 3
1.4 Health Priorities and Programmes ............................................................................................. 3
1.5 Strategic Framework to Combat the National HIV/AIDS Epidemic ......................................... 5
1.6 Objectives and Organisation of the Survey ................................................................................ 5
1.6.1 Objectives .................................................................................................................... 5
1.6.2 Organisation ................................................................................................................. 6
1.7 Sample Design ........................................................................................................................... 7
1.8 Questionnaires ............................................................................................................................ 7
1.9 HIV and CD4 Cell Count Testing .............................................................................................. 8
1.9.1 CD4 Measurement and Blood Collection for HIV Incidence Testing ......................... 8
1.9.2 HIV Prevalence Testing ............................................................................................... 9
1.9.3 HIV Incidence Testing ............................................................................................... 10
1.10 Pretest Activities ...................................................................................................................... 11
1.11 Training of Field Staff .............................................................................................................. 12
1.12 Fieldwork ................................................................................................................................. 12
1.13 Data Processing ........................................................................................................................ 12
1.14 Response Rates ........................................................................................................................ 13
2 HOUSING CHARACTERISTICS AND HOUSEHOLD POPULATION ...................................... 15
2.1 Household Characteristics ........................................................................................................ 15
2.1.1 Water and Sanitation .................................................................................................. 15
2.1.2 Housing Characteristics ............................................................................................. 17
2.1.3 Household Possessions .............................................................................................. 19
2.2 Socioeconomic Status Index .................................................................................................... 20
2.3 Hand Washing .......................................................................................................................... 21
2.4 Household Population by Age and Sex .................................................................................... 22
2.5 Household Composition ........................................................................................................... 23
2.6 Birth Registration ..................................................................................................................... 24
2.7 Children’s Living Arrangements, Orphanhood, and School Attendance ................................. 25
2.8 Education of Household Population ......................................................................................... 26
2.8.1 Educational Attainment of Household Population ..................................................... 27
2.8.2 School Attendance Ratios .......................................................................................... 29
3 CHARACTERISTICS OF RESPONDENTS .................................................................................... 33
3.1 Characteristics of Survey Respondents .................................................................................... 33
3.2 Educational Attainment ............................................................................................................ 35
3.3 Literacy .................................................................................................................................... 37
3.4 Exposure to Mass Media .......................................................................................................... 39
3.5 Employment Status .................................................................................................................. 41
3.6 Occupation ............................................................................................................................... 44
3.7 Type of Employment ............................................................................................................... 46
3.8 Health Insurance Coverage ...................................................................................................... 48
3.9 Tobacco Use ............................................................................................................................. 49
3.10 Knowledge and Attitudes Regarding Tuberculosis .................................................................. 51
4 MARRIAGE AND SEXUAL ACTIVITY .......................................................................................... 55
4.1 Current Marital Status .............................................................................................................. 55
4.2 Polygyny .................................................................................................................................. 56
4.3 Age at First Marriage ............................................................................................................... 58
4.4 Median Age at First Marriage .................................................................................................. 60
4.5 Age at First Sexual Intercourse ................................................................................................ 60
4.6 Median Age at First Sexual Intercourse ................................................................................... 62
4.7 Recent Sexual Activity ............................................................................................................. 62
5 FERTILITY .......................................................................................................................................... 67
5.1 Current Fertility ....................................................................................................................... 67
5.2 Fertility Differentials ................................................................................................................ 68
5.3 Fertility Trends ......................................................................................................................... 69
5.4 Children Ever Born and Living ................................................................................................ 71
5.5 Birth Intervals .......................................................................................................................... 72
5.6 Postpartum Amenorrhoea, Abstinence, and Insusceptibility ................................................... 73
5.7 Menopause ............................................................................................................................... 75
5.8 Age at First Birth ..................................................................................................................... 75
5.9 Teenage Pregnancy and Motherhood ....................................................................................... 76
6 FERTILITY PREFERENCES ............................................................................................................ 79
6.1 Desire for More Children ......................................................................................................... 79
6.2 Desire to Limit Childbearing by Background Characteristics.................................................. 80
6.3 Ideal Family Size ..................................................................................................................... 82
6.4 Fertility Planning ..................................................................................................................... 84
6.5 Wanted Fertility Rates ............................................................................................................. 85
7 FAMILY PLANNING ......................................................................................................................... 87
7.1 Knowledge of Contraceptive Methods ..................................................................................... 88
7.2 Current Use of Contraception .................................................................................................. 89
7.3 Current Use of Contraception by Background Characteristics ................................................ 91
7.4 Trends in Current Use of Family Planning .............................................................................. 93
7.5 Source of Contraception ........................................................................................................... 93
7.6 Brands of Pills, Injectables, and Condoms Used ...................................................................... 94
7.7 Informed Choice ...................................................................................................................... 97
7.8 Contraceptive Discontinuation Rates ....................................................................................... 98
7.9 Reasons for Discontinuation of Contraceptive Use ................................................................. 99
7.10 Knowledge of Fertile Period .................................................................................................. 100
7.11 Need and Demand for Family Planning Services .................................................................. 100
7.12 Future Use of Contraception .................................................................................................. 102
7.13 Reasons for Not Intending to Use Contraception in the Future ............................................. 102
7.14 Preferred Method for Future Use ........................................................................................... 103
7.15 Exposure to Family Planning Messages ................................................................................. 103
7.16 Contact of Nonusers with Family Planning Providers ........................................................... 105
7.17 Husband/Partner’s Knowledge of Women’s Contraceptive Use ........................................... 106
8 INFANT AND CHILD MORTALITY ............................................................................................. 109
8.1 Assessment of Data Quality ................................................................................................... 110
8.2 Levels and Trends in Infant and Child Mortality ................................................................... 111
8.3 Socioeconomic Differentials in Childhood Mortality ............................................................ 112
8.4 Demographic Differentials in Mortality ................................................................................. 113
8.5 Perinatal Mortality ................................................................................................................. 114
8.6 High-risk Fertility Behaviour ................................................................................................. 116
9 MATERNAL HEALTH ..................................................................................................................... 119
9.1 Antenatal Care ....................................................................................................................... 119
9.2 Components of Antenatal Care .............................................................................................. 121
9.3 Birth Preparedness ................................................................................................................. 123
9.4 Tetanus Toxoid Vaccination .................................................................................................. 124
9.5 Place of Delivery .................................................................................................................... 126
9.6 Assistance during Delivery .................................................................................................... 127
9.7 Reasons for Not Delivering in a Health Facility .................................................................... 128
9.8 Postnatal Care ........................................................................................................................ 129
9.8.1 Timing of First Postnatal Checkup for the Mother .................................................. 129
9.8.2 Provider of First Postnatal Checkup for the Mother ................................................ 130
9.9 Newborn Care ........................................................................................................................ 131
9.9.1 Timing of First Postnatal Checkup for the Newborn ............................................... 131
9.9.2 Provider of First Postnatal Checkup for the Newborn ............................................. 132
9.10 Problems in Accessing Health Care ....................................................................................... 133
9.11 Knowledge of Fistula and Reporting of Fistula-Like Symptoms ........................................... 134
10 CHILD HEALTH ............................................................................................................................... 137
10.1 Child’s Weight and Size at Birth ........................................................................................... 138
10.2 Vaccination Coverage ............................................................................................................ 139
10.3 Vaccination by Background Characteristics .......................................................................... 140
10.4 Trends in Immunisation Coverage ......................................................................................... 142
10.5 Acute Respiratory Infection ................................................................................................... 143
10.6 Fever ...................................................................................................................................... 145
10.7 Diarrhoea................................................................................................................................ 146
10.8 Diarrhoea Treatment .............................................................................................................. 147
10.9 Feeding Practices during Diarrhoea ....................................................................................... 149
10.10 Knowledge of ORS Packets ................................................................................................... 149
10.11 Disposal of Children’s Stools................................................................................................. 152
11 NUTRITION OF CHILDREN AND WOMEN ............................................................................... 155
11.1 Nutritional Status of Children ................................................................................................ 156
11.1.1 Measurement of Nutritional Status among Young Children .................................... 156
11.1.2 Data Collection ........................................................................................................ 157
11.1.3 Measures of Child Nutritional Status ....................................................................... 157
11.1.4 Trends in Children’s Nutritional Status ................................................................... 161
11.2 Breastfeeding and Complementary Feeding .......................................................................... 162
11.3 Breastfeeding Status by Age .................................................................................................. 163
11.4 Duration of Breastfeeding ...................................................................................................... 166
11.5 Types of Complementary Foods ............................................................................................ 167
11.6 Infant and Young Child Feeding (IYCF) Practices ................................................................ 169
11.7 Micronutrient Intake among Children .................................................................................... 171
11.8 Presence of Iodised Salt in Households ................................................................................. 174
11.9 Nutritional Status of Women ................................................................................................. 175
11.10 Micronutrient Intake among Mothers .................................................................................... 177
12 MALARIA .......................................................................................................................................... 181
12.1 Ownership of Mosquito Nets ................................................................................................. 181
12.2 Indoor Residual Spraying ....................................................................................................... 183
12.3 Access to an Insecticide-Treated Net ..................................................................................... 184
12.4 Use of Mosquito Nets ............................................................................................................ 185
12.4.1 Use of Mosquito Nets by Persons in the Household ................................................ 186
12.4.2 Use of Existing Mosquito Nets ................................................................................ 188
12.4.3 Use of Mosquito Nets by Children under Age 5 ...................................................... 188
12.4.4 Use of Mosquito Nets by Pregnant Women ............................................................. 190
12.5 Use of Intermittent Preventive Treatment of Malaria during Pregnancy ............................... 192
12.6 Prevalence, Diagnosis, and Prompt Treatment of Children with Fever ................................. 193
13 HIV/AIDS-RELATED KNOWLEDGE, ATTITUDES, AND BEHAVIOUR .............................. 197
13.1 HIV and AIDS Knowledge, Transmission, and Prevention Methods .................................... 198
13.1.1 Knowledge of AIDS and Knowledge of HIV Prevention ........................................ 198
13.1.2 Comprehensive Knowledge about HIV and AIDS .................................................. 199
13.2 Knowledge about Mother-to-Child Transmission .................................................................. 202
13.3 Perceived Risk of HIV Infection ............................................................................................ 203
13.4 Knowledge of Antiretroviral Drugs ....................................................................................... 204
13.5 Attitudes toward People Living with HIV and AIDS ............................................................ 206
13.6 Attitudes toward Negotiating Safer Sexual Relations with Husbands ................................... 208
13.7 Attitudes toward Condom Education for Young People ........................................................ 209
13.8 Higher-Risk Sex ..................................................................................................................... 210
13.8.1 Multiple Sexual Partners .......................................................................................... 210
13.8.2 Point Prevalence and Cumulative Prevalence of Concurrent Sexual Partners ......... 213
13.9 Paid Sex ................................................................................................................................. 214
13.10 Coverage of HIV Testing Services......................................................................................... 215
13.11 HIV Counselling and Testing during Pregnancy ................................................................... 218
13.12 Disclosure of HIV Test Results From ANC Visit .................................................................. 220
13.13 Male Circumcision ................................................................................................................. 221
13.14 Self-Reporting of Sexually Transmitted Infections ................................................................ 221
13.15 Injections ................................................................................................................................ 223
13.16 HIV- and AIDS-Related Knowledge and Behaviour among Young People .......................... 224
13.16.1 Knowledge about HIV and AIDS and Source for Condoms ................................... 224
13.16.2 First Sex ................................................................................................................... 225
13.16.3 Premarital Sex .......................................................................................................... 227
13.16.4 Multiple Sexual Partners among Youth ................................................................... 228
13.16.5 Age-Mixing in Sexual Relationships among Youth ................................................ 230
13.16.6 Drunkenness during Sexual Intercourse among Youth ............................................ 230
13.16.7 HIV Testing among Youth ...................................................................................... 231
14 HIV PREVALENCE .......................................................................................................................... 233
14.1 Coverage Rates for HIV Testing ............................................................................................ 234
14.2 HIV Prevalence ...................................................................................................................... 236
14.2.1 HIV Prevalence by Socioeconomic Characteristics ................................................. 236
14.2.2 Trends in HIV Prevalence ........................................................................................ 237
14.2.3 HIV Prevalence by Demographic Characteristics.................................................... 238
14.2.4 HIV Prevalence by Sexual Behaviour ..................................................................... 239
14.3 HIV Prevalence among Young People ................................................................................... 240
14.4 HIV Prevalence by Other Characteristics Related to HIV Risk ............................................. 242
14.5 HIV Prevalence among Couples ............................................................................................ 244
15 ADULT AND MATERNAL MORTALITY .................................................................................... 247
15.1 Assessment of Data Quality ................................................................................................... 248
15.2 Estimates of Adult Mortality .................................................................................................. 249
15.3 Estimates of Maternal Mortality ............................................................................................ 250
16 WOMEN’S EMPOWERMENT AND DEMOGRAPHIC AND HEALTH OUTCOMES .......... 253
16.1 Employment and Form of Earnings ....................................................................................... 254
16.2 Control over Cash Earnings and Relative Magnitude of Earnings ......................................... 254
16.2.1 Women’s Control over Their Cash Earnings ........................................................... 255
16.2.2 Control over Husband’s Cash Earnings ................................................................... 256
16.2.3 Women’s Earnings Relative to Their Husband’s Earnings ...................................... 257
16.3 Women’s and Men’s Ownership of Selected Assets .............................................................. 258
16.4 Women’s Participation in Decision Making .......................................................................... 260
16.5 Attitudes toward Wife Beating ............................................................................................... 264
16.6 Women’s Attitude toward Refusing Sex with Their Husband ............................................... 266
16.7 Women’s Empowerment Indicators ....................................................................................... 269
16.8 Current Use of Contraception by Women’s Status ................................................................ 270
16.9 Ideal Family Size and Unmet Need by Women’s Status ....................................................... 271
16.10 Reproductive Health Care and Women’s Empowerment ...................................................... 272
17 DOMESTIC VIOLENCE .................................................................................................................. 273
17.1 Measurement of Violence ...................................................................................................... 273
17.1.1 Use of Valid Measures of Violence ......................................................................... 273
17.1.2 Ethical Considerations in the 2013-14 ZDHS .......................................................... 274
17.1.3 Subsample for the Violence Module ........................................................................ 275
17.2 Experience of Physical Violence ........................................................................................... 275
17.3 Perpetrators of Physical Violence .......................................................................................... 277
17.4 Experience of Sexual Violence .............................................................................................. 277
17.5 Perpetrators of Sexual Violence ............................................................................................. 279
17.6 Age at First Experience of Sexual Violence .......................................................................... 279
17.7 Experience of Different Forms of Violence ........................................................................... 280
17.8 Violence during Pregnancy .................................................................................................... 280
17.9 Marital Control by Husband................................................................................................... 282
17.10 Forms of Spousal Violence .................................................................................................... 283
17.11 Spousal Violence by Background Characteristics .................................................................. 285
17.12 Violence by Spousal Characteristics and Women’s Empowerment Indicators ...................... 286
17.13 Recent Spousal Violence ....................................................................................................... 288
17.14 Onset of Spousal Violence ..................................................................................................... 290
17.15 Physical Consequences of Spousal Violence ......................................................................... 290
17.16 Violence by Women against Their Husbands ........................................................................ 291
17.17 Help-Seeking Behaviour by Women Who Experience Violence ........................................... 294
REFERENCES ................................................................................................................................................. 297
APPENDIX A SAMPLE SELECTION ....................................................................................................... 303
A.1 Introduction ............................................................................................................................ 303
A.2 Sampling Frame ..................................................................................................................... 303
A.3 Sample Design and Sampling Procedure ............................................................................... 304
A.4 Sampling Probabilities ........................................................................................................... 305
APPENDIX B ESTIMATES OF SAMPLING ERRORS .......................................................................... 313
APPENDIX C DATA QUALITY TABLES ................................................................................................ 345
APPENDIX D PARTICIPANTS IN THE 2013-14 ZAMBIA DEMOGRAPHIC
AND HEALTH SURVEY ................................................................................................... 351
APPENDIX E QUESTIONNAIRES ........................................................................................................... 361 |
