| Author(s) |
Ghana Statistical Service, Accra, Ghana Ghana Health Service, Accra, Ghana The DHS Program, ICF International, Rockville, Maryland, USA |
| Table of contents |
TABLES AND FIGURES ................................................................................................................................... ix
FOREWORD ................................................................................................................................................... xvii
ACRONYMS ...................................................................................................................................................... xix
MILLENNIUM DEVELOPMENT GOAL INDICATORS ........................................................................... xxi
MAP OF GHANA ............................................................................................................................................ xxii
1 INTRODUCTION .................................................................................................................................. 1
1.1 Geography, History, and Economy ............................................................................................ 1
1.1.1 Geography ................................................................................................................... 1
1.1.2 History ......................................................................................................................... 1
1.1.3 Economy ...................................................................................................................... 2
1.2 Demographic Profile .................................................................................................................. 2
1.3 Population Policy and Reproductive Health Programmes ......................................................... 3
1.4 Objectives and Organisation of the Survey ................................................................................ 5
1.5 Sample Design ........................................................................................................................... 5
1.6 Questionnaires ............................................................................................................................ 6
1.7 Blood Pressure Measurement, Anthropometry, Anaemia Testing, and HIV Testing ................ 7
1.8 Pretest ......................................................................................................................................... 9
1.9 Training of Field Staff ................................................................................................................ 9
1.10 Fieldwork ................................................................................................................................. 10
1.11 Data Processing ........................................................................................................................ 10
1.12 Response Rates ........................................................................................................................ 10
2 HOUSING CHARACTERISTICS AND HOUSEHOLD POPULATION ...................................... 11
2.1 Household Characteristics ........................................................................................................ 11
2.1.1 Water and Sanitation .................................................................................................. 12
2.1.2 Housing Characteristics ............................................................................................. 14
2.1.3 Household Possessions .............................................................................................. 16
2.2 Socioeconomic Status Index .................................................................................................... 17
2.3 Hand Washing .......................................................................................................................... 18
2.4 Household Population by Age and Sex .................................................................................... 19
2.5 Household Composition ........................................................................................................... 21
2.6 Birth Registration ..................................................................................................................... 22
2.7 Children’s Living Arrangements, Orphanhood, and School Attendance ................................. 23
2.8 Education of Household Population ......................................................................................... 25
2.8.1 Educational Attainment of Household Population ..................................................... 25
2.8.2 School Attendance Ratios .......................................................................................... 28
3 CHARACTERISTICS OF RESPONDENTS .................................................................................... 31
3.1 Characteristics of Survey Respondents .................................................................................... 31
3.2 Educational Attainment by Background Characteristics .......................................................... 33
3.3 School Attendance ................................................................................................................... 35
3.4 Literacy .................................................................................................................................... 37
3.5 Access to Mass Media .............................................................................................................. 39
3.6 Employment ............................................................................................................................. 41
3.6.1 Employment Status .................................................................................................... 41
3.6.2 Occupation ................................................................................................................. 44
3.6.3 Earnings, Employers, and Continuity of Employment .............................................. 47
4 MARRIAGE AND SEXUAL ACTIVITY .......................................................................................... 49
4.1 Current Marital Status .............................................................................................................. 49
4.2 Polygyny .................................................................................................................................. 50
4.3 Age at First Marriage ............................................................................................................... 52
4.4 Median Age at First Marriage .................................................................................................. 53
4.5 Age at First Sexual Intercourse ................................................................................................ 54
4.6 Median Age at First Sexual Intercourse ................................................................................... 55
4.7 Recent Sexual Activity ............................................................................................................. 56
5 FERTILITY .......................................................................................................................................... 59
5.1 Current Fertility ....................................................................................................................... 60
5.2 Fertility Differentials ................................................................................................................ 61
5.3 Fertility Trends ......................................................................................................................... 62
5.4 Children Ever Born and Living ................................................................................................ 64
5.5 Birth Intervals .......................................................................................................................... 65
5.6 Postpartum Amenorrhoea, Abstinence, and Insusceptibility ................................................... 66
5.7 Menopause ............................................................................................................................... 68
5.8 Age at First Birth ..................................................................................................................... 68
5.9 Teenage Pregnancy and Motherhood ....................................................................................... 69
6 FERTILITY PREFERENCES ............................................................................................................ 71
6.1 Desire for More Children ......................................................................................................... 71
6.2 Desire to Limit Childbearing by Background Characteristics.................................................. 72
6.3 Ideal Family Size ..................................................................................................................... 74
6.4 Fertility Planning ..................................................................................................................... 76
6.5 Wanted Fertility Rates ............................................................................................................. 77
7 FAMILY PLANNING ......................................................................................................................... 79
7.1 Knowledge of Contraceptive Methods ..................................................................................... 80
7.2 Current Use of Contraception .................................................................................................. 82
7.3 Current Use of Contraception by Background Characteristics ................................................ 84
7.4 Trends in Current Use of Family Planning .............................................................................. 86
7.5 Timing of Sterilisation ............................................................................................................. 87
7.6 Source of Modern Contraception ............................................................................................. 87
7.7 Brands of Pills and Condoms Used .......................................................................................... 88
7.8 Informed Choice ...................................................................................................................... 88
7.9 Contraceptive Discontinuation Rates ....................................................................................... 89
7.10 Reasons for Discontinuation of Contraceptive Use ................................................................. 90
7.11 Knowledge of Fertile Period .................................................................................................... 91
7.12 Need and Demand for Family Planning Services .................................................................... 91
7.13 Future Use of Contraception .................................................................................................... 93
7.14 Exposure to Family Planning Messages ................................................................................... 94
7.15 Contact of Nonusers with Family Planning Providers ............................................................. 95
7.16 Attitudes towards Family Planning Among Men ..................................................................... 96
8 INFANT AND CHILD MORTALITY ............................................................................................... 99
8.1 Assessment of Data Quality ................................................................................................... 100
8.2 Levels and Trends in Infant and Child Mortality ................................................................... 101
8.2.1 Childhood Mortality Trends 1988-2014 .................................................................. 102
8.2.2 Recent Trends 2008-2014 ........................................................................................ 103
8.3 Socioeconomic Differentials in Childhood Mortality ............................................................ 103
8.4 Demographic Differentials in Mortality ................................................................................. 104
8.5 Perinatal Mortality ................................................................................................................. 105
8.6 High-risk Fertility Behaviour ................................................................................................. 107
9 MATERNAL HEALTH ..................................................................................................................... 109
9.1 Antenatal Care ....................................................................................................................... 109
9.1.1 Antenatal Care Coverage ......................................................................................... 109
9.1.2 Number and Timing of Antenatal Care Visits ......................................................... 110
9.1.3 Components of Antenatal Care ................................................................................ 111
9.1.4 Tetanus Immunisation ............................................................................................. 113
9.2 Delivery Care ......................................................................................................................... 114
9.2.1 Place of Delivery ..................................................................................................... 114
9.2.2 Assistance at Delivery ............................................................................................. 115
9.3 Trends in Maternal Care ........................................................................................................ 117
9.4 Postnatal Care for the Mother ................................................................................................ 118
9.4.1 Timing of First Postnatal Checkup for the Mother .................................................. 118
9.4.2 Type of Provider of First Postnatal Checkup for the Mother ................................... 119
9.5 Postnatal Care for the Newborn ............................................................................................. 120
9.5.1 Type of Provider of First Postnatal Checkup for the Newborn ................................ 121
9.6 Problems in Accessing Health Care ....................................................................................... 122
10 CHILD HEALTH AND EARLY DEVELOPMENT ...................................................................... 125
10.1 Child’s Size and Weight at Birth ........................................................................................... 126
10.2 Vaccination Coverage ............................................................................................................ 127
10.3 Trends in Vaccination Coverage ............................................................................................ 132
10.4 Acute Respiratory Infection ................................................................................................... 133
10.5 Fever ...................................................................................................................................... 135
10.6 Diarrhoeal Disease ................................................................................................................. 136
10.6.1 Prevalence and Treatment of Diarrhoea................................................................... 137
10.6.2 Feeding Practices ..................................................................................................... 139
10.7 Knowledge of ORS Packets ................................................................................................... 141
10.8 Stool Disposal ........................................................................................................................ 142
10.9 Childhood Early Learning and Development ......................................................................... 143
10.9.1 Support for Learning ................................................................................................ 144
10.9.2 Reading, Book Ownership, and Textbook and Reading Materials .......................... 145
10.9.3 Language for Education ........................................................................................... 148
10.9.4 Travel to school ....................................................................................................... 150
11 NUTRITION OF CHILDREN AND WOMEN ............................................................................... 153
11.1 Nutritional Status of Children ................................................................................................ 153
11.1.1 Measurement of Nutritional Status among Young Children .................................... 154
11.1.2 Data Collection ........................................................................................................ 155
11.1.3 Levels of Child Malnutrition ................................................................................... 155
11.1.4 Trends in Children’s Nutritional Status ................................................................... 157
11.2 Breastfeeding and Complementary Feeding .......................................................................... 158
11.2.1 Initiation of Breastfeeding ....................................................................................... 158
11.3 Breastfeeding Status by Age .................................................................................................. 160
11.4 Duration of Breastfeeding ...................................................................................................... 162
11.5 Types of Complementary Foods ............................................................................................ 163
11.6 Infant and Young Child Feeding (IYCF) Practices ................................................................ 164
11.7 Anaemia in children ............................................................................................................... 167
11.8 Micronutrient Intake among Children .................................................................................... 169
11.9 Adult Nutritional Status ......................................................................................................... 172
11.9.1 Nutritional Status of Women ................................................................................... 172
11.9.2 Nutritional Status of Men ........................................................................................ 175
11.10 Prevalence of Anaemia in Women ......................................................................................... 176
11.11 Micronutrient Intake among Mothers .................................................................................... 178
12 MALARIA .......................................................................................................................................... 181
12.1 Ownership of Mosquito Nets ................................................................................................. 181
12.2 Access to an Insecticide-Treated Net ..................................................................................... 184
12.3 Use of Mosquito Nets ............................................................................................................ 185
12.3.1 Use of Mosquito Nets by Persons in the Household ................................................ 185
12 3.2 Use of Existing Mosquito Nets ................................................................................ 187
12.3.3 Use of Mosquito Nets by Children under Age 5 ...................................................... 188
12.3.4 Use of Mosquito Nets by Pregnant Women ............................................................. 189
12.3.5 Trends in Use of Mosquito Nets by Children under Age 5 and Pregnant Women .. 191
12.3.6 Source and Cost of Nets........................................................................................... 191
12.3.7 Disposal of Nets ....................................................................................................... 192
12.4 Indoor Residual Spraying ....................................................................................................... 194
12.5 Use of Intermittent Preventive Treatment of Malaria during Pregnancy ............................... 195
12.6 Prevalence, Diagnosis, and Prompt Treatment of Children with Fever ................................. 196
12.7 Prevalence of Low Haemoglobin in Children ........................................................................ 199
12.8 Prevalence of Malaria in Children ......................................................................................... 200
12.9 Exposure to Messages on Malaria .......................................................................................... 201
12.9.1 Exposure to Specific Messages on Malaria ............................................................. 203
13 HIV/AIDS-RELATED KNOWLEDGE, ATTITUDES, AND BEHAVIOUR .............................. 205
13.1 HIV/AIDS Knowledge, Transmission, and Prevention Methods........................................... 206
13.1.1 Knowledge of AIDS ................................................................................................ 206
13.1.2 Knowledge of HIV Prevention methods .................................................................. 208
13.1.3 Comprehensive Knowledge about HIV/AIDS ......................................................... 209
13.2 Knowledge about Mother-to-Child Transmission .................................................................. 212
13.3 Attitudes towards People Living with HIV/AIDS ................................................................. 214
13.4 Attitudes towards Negotiating Safer Sexual Relations with Husbands .................................. 216
13.5 Attitudes towards Condom Education for Young People ...................................................... 218
13.6 Higher-risk Sex ...................................................................................................................... 219
13.7 Point Prevalence and Cumulative Prevalence of Concurrent Sexual Partners ....................... 221
13.8 Paid Sex ................................................................................................................................. 223
13.9 Coverage of HIV Testing Services......................................................................................... 224
13.10 HIV Testing during Pregnancy .............................................................................................. 226
13.11 Male Circumcision ................................................................................................................. 228
13.12 Self-reporting of Sexually Transmitted Infections ................................................................. 229
13.13 Injections ................................................................................................................................ 230
13.14 HIV/AIDS-Related Knowledge and Behaviour among Young People .................................. 232
13.15 Age at First Sexual Intercourse among Young People ........................................................... 233
13.16 Premarital Sex ........................................................................................................................ 235
13.17 Multiple Sexual Partners among Youth ................................................................................. 236
13.18 Age Mixing in Sexual Relationships ...................................................................................... 238
13.19 Recent HIV Test among the Youth ........................................................................................ 239
14 HIV PREVALENCE .......................................................................................................................... 241
14.1 Coverage Rates for HIV Testing ............................................................................................ 242
14.2 HIV Prevalence ...................................................................................................................... 245
14.2.1 HIV Prevalence by Age and Sex ............................................................................. 245
14.2.2 HIV Prevalence by Socio-economic Characteristics ............................................... 246
14.2.3 HIV Prevalence by Other Socio-demographic and Health Characteristics .............. 248
14.2.4 HIV Prevalence by Sexual Risk Behaviour ............................................................. 249
14.3 HIV Prevalence among Young People ................................................................................... 251
14.4 HIV Prevalence by Other Characteristics Related to HIV Risk ............................................. 253
14.5 HIV Prevalence among Couples ............................................................................................ 254
15 ADULT HEALTH AND LIFESTYLE ............................................................................................. 257
15.1 Blood Pressure ....................................................................................................................... 258
15.1.1 History and Treatment of High Blood Pressure ....................................................... 258
15.1.2 Coverage Rates for Blood Pressure Measurement ................................................... 260
15.1.3 Prevalence of High Blood Pressure ......................................................................... 261
15.2 Consumption of Fruits and Vegetables .................................................................................. 264
15.3 Household Use of Salty Foods ............................................................................................... 265
15.4 Knowledge of Iodised Salt and Its Perceived Benefits .......................................................... 266
15.5 Knowledge and Attitudes on Tuberculosis ............................................................................ 268
15.6 Tobacco Use ........................................................................................................................... 270
15.7 Health Insurance .................................................................................................................... 272
15.7.1 Health Insurance Coverage ...................................................................................... 272
15.7.2 Health Insurance Payment ....................................................................................... 275
15.7.3 Possession of a Valid N/DHIS Card ........................................................................ 277
15.7.4 Out-of-Pocket Payments .......................................................................................... 278
15.7.5 Need for Services Not Covered Under N/DHIS ...................................................... 279
15.8 Perceived Quality of Services and Client Satisfaction ........................................................... 280
15.9 Treatment Seeking and Perceived Quality of Care ................................................................ 284
16 WOMEN’S EMPOWERMENT AND DEMOGRAPHIC AND HEALTH OUTCOMES .......... 289
16.1 Employment and Form of Earnings ....................................................................................... 290
16.2 Women’s Control over Their Own Earnings and Relative Magnitude of Women’s and Their Husbands’ Earnings ... 291
16.3 Control over Husbands’ Earnings .......................................................................................... 292
16.4 Women’s and Men’s Ownership of Selected Assets .............................................................. 295
16.5 Women’s Participation in Decision-making .......................................................................... 297
16.6 Attitudes towards Wife Beating ............................................................................................. 300
16.7 Women’s Empowerment Indicators ....................................................................................... 303
16.8 Current Use of Contraception by Women’s Status ................................................................ 303
16.9 Ideal Family Size and Unmet Need by Women’s Status ....................................................... 304
16.10 Reproductive Health Care and Women’s Empowerment ...................................................... 305
16.11 Infant and Child Mortality and Women’s Empowerment ...................................................... 306
16.12 Entitlement to and Use of Maternity Leave ........................................................................... 307
16.13 Length of Maternity Leave..................................................................................................... 309
16.14 Bridewealth Negotiation ........................................................................................................ 311
REFERENCES ................................................................................................................................................. 313
APPENDIX A SAMPLE DESIGN .................................................................................................................. 317
A.1 Introduction ............................................................................................................................ 317
A.2 Sampling Frame ..................................................................................................................... 317
A.3 Sample Design and Selection ................................................................................................. 318
A.4 Sample Probabilities and Sample Weights ............................................................................. 319
APPENDIX B ESTIMATES OF SAMPLING ERRORS ............................................................................. 327
APPENDIX C DATA QUALITY TABLES ................................................................................................... 343
APPENDIX D PARTICIPANTS IN THE 2014 GHANA DEMOGRAPHIC
AND HEALTH SURVEY ....................................................................................................... 349
APPENDIX E QUESTIONNAIRES ............................................................................................................... 355 |
