| Table of contents |
TABLES AND FIGURES ........................................................................................................................... ix
FOREWORD ............................................................................................................................................ xvii
ACRONYMS AND ABBREVIATIONS .................................................................................................. xix
READING AND UNDERSTANDING TABLES FROM THE 2019-20 GAMBIA
DEMOGRAPHIC AND HEALTH SURVEY (GDHS) ............................................................. xxi
SUSTAINABLE DEVELOPMENT GOAL INDICATORS ................................................................ xxix
MAP OF THE GAMBIA ...................................................................................................................... xxx
1 INTRODUCTION AND SURVEY METHODOLOGY .............................................................. 1
1.1 Survey Objectives ................................................................................................................ 1
1.2 Sample Design ..................................................................................................................... 2
1.3 Questionnaires ..................................................................................................................... 2
1.4 Anthropometry, Malaria Testing, and Anaemia Testing ..................................................... 3
1.4.1 Anthropometric Measurements .............................................................................. 4
1.4.2 Malaria Testing ...................................................................................................... 4
1.4.3 Anaemia Testing .................................................................................................... 4
1.5 Pretest .................................................................................................................................. 5
1.6 Training of Field Staff ......................................................................................................... 5
1.7 Fieldwork ............................................................................................................................. 7
1.8 Data Processing ................................................................................................................... 7
1.9 Response Rates .................................................................................................................... 7
2 HOUSING CHARACTERISTICS AND HOUSEHOLD POPULATION ................................ 9
2.1 Drinking Water Sources and Treatment .............................................................................. 9
2.2 Sanitation ........................................................................................................................... 10
2.3 Exposure to Smoke inside the Home ................................................................................. 11
2.4 Household Wealth ............................................................................................................. 12
2.4.1 Household Durable Goods ................................................................................... 12
2.4.2 Wealth Index ........................................................................................................ 12
2.5 Handwashing ..................................................................................................................... 12
2.6 Household Population and Composition ........................................................................... 13
2.7 Children’s Living Arrangements and Parental Survival .................................................... 13
2.8 Birth Registration .............................................................................................................. 14
2.9 Education ........................................................................................................................... 15
2.9.1 Educational Attainment ....................................................................................... 15
2.9.2 School Attendance ............................................................................................... 15
3 CHARACTERISTICS OF RESPONDENTS ............................................................................. 31
3.1 Basic Characteristics of Survey Respondents .................................................................... 31
3.2 Education and Literacy ...................................................................................................... 32
3.3 Mass Media Exposure ....................................................................................................... 33
3.4 Employment ...................................................................................................................... 34
3.5 Occupation ......................................................................................................................... 35
3.6 Health Insurance Coverage ................................................................................................ 35
3.7 Tobacco Use ...................................................................................................................... 35
3.8 History of Diabetes ............................................................................................................ 36
3.9 History of High Blood Pressure ......................................................................................... 36
4 MARRIAGE AND SEXUAL ACTIVITY .................................................................................. 61
4.1 Marital Status ..................................................................................................................... 61
4.2 Polygyny ............................................................................................................................ 62
4.3 Age at First Marriage ......................................................................................................... 63
4.4 Age at First Sexual Intercourse ......................................................................................... 63
4.5 Recent Sexual Activity ...................................................................................................... 64
5 FERTILITY ................................................................................................................................... 73
5.1 Current Fertility ................................................................................................................. 73
5.2 Children Ever Born and Living ......................................................................................... 74
5.3 Birth Intervals .................................................................................................................... 74
5.4 Insusceptibility to Pregnancy ............................................................................................. 75
5.5 Age at First Birth ............................................................................................................... 76
5.6 Teenage Childbearing ........................................................................................................ 77
5.7 Sexual and Reproductive Behaviours Before Age 15 ....................................................... 78
6 FERTILITY PREFERENCES ..................................................................................................... 87
6.1 Desire for Another Child ................................................................................................... 87
6.2 Ideal Family Size ............................................................................................................... 88
6.3 Fertility Planning Status .................................................................................................... 89
6.4 Wanted Fertility Rates ....................................................................................................... 90
7 FAMILY PLANNING .................................................................................................................. 97
7.1 Contraceptive Knowledge and Use ................................................................................... 97
7.2 Source of Modern Contraceptive Methods ........................................................................ 99
7.3 Informed Choice .............................................................................................................. 100
7.4 Discontinuation of Contraceptives .................................................................................. 100
7.5 Demand for Family Planning .......................................................................................... 101
7.5.1 Decision Making about Family Planning ........................................................... 102
7.5.2 Future Use of Contraception .............................................................................. 102
7.5.3 Exposure to Family Planning Messages in the Media ....................................... 102
7.6 Contact of Nonusers with Family Planning Providers ..................................................... 103
8 INFANT AND CHILD MORTALITY ...................................................................................... 119
8.1 Infant and Child Mortality ............................................................................................... 120
8.2 Biodemographic Risk Factors ......................................................................................... 121
8.3 Perinatal Mortality ........................................................................................................... 122
8.4 High-risk Fertility Behaviour .......................................................................................... 122
9 MATERNAL HEALTH CARE ................................................................................................. 129
9.1 Antenatal Care Coverage and Content ............................................................................ 129
9.1.1 Skilled Providers ................................................................................................ 129
9.1.2 Timing and Number of ANC Visits ................................................................... 130
9.2 Components of ANC Visits ............................................................................................. 130
9.3 Protection against Neonatal Tetanus ............................................................................... 131
9.4 Delivery Services ............................................................................................................. 131
9.4.1 Institutional Deliveries ....................................................................................... 131
9.4.2 Skilled Assistance during Delivery .................................................................... 133
9.4.3 Delivery by Caesarean Section .......................................................................... 133
9.5 Postnatal Care .................................................................................................................. 134
9.5.1 Postnatal Health Check for Mothers .................................................................. 134
9.5.2 Postnatal Health Check for Newborns ............................................................... 135
9.6 Problems in Accessing Health Care ................................................................................ 135
9.7 Obstetric Fistula ............................................................................................................... 136
10 CHILD HEALTH ........................................................................................................................ 151
10.1 Birth Weight .................................................................................................................... 151
10.2 Vaccination of Children ................................................................................................... 152
10.3 Symptoms of Acute Respiratory Infection ...................................................................... 155
10.4 Fever ................................................................................................................................ 155
10.5 Diarrhoeal Disease ........................................................................................................... 156
10.5.1 Prevalence of Diarrhoea and Treatment-seeking Behaviour .............................. 156
10.5.2 Feeding Practices ............................................................................................... 156
10.5.3 Oral Rehydration Therapy and Other Treatments .............................................. 157
10.5.4 Knowledge of ORS Packets ............................................................................... 158
10.6 Treatment of Childhood Illness ....................................................................................... 158
10.7 Disposal of Children’s Stools .......................................................................................... 158
11 NUTRITION OF CHILDREN AND WOMEN ........................................................................ 173
11.1 Nutritional Status of Children .......................................................................................... 173
11.1.1 Anthropometry Training and Data Collection ................................................... 174
11.1.2 Levels of Child Malnutrition ............................................................................. 175
11.2 Infant and Young Child Feeding Practices ...................................................................... 176
11.2.1 Early Initiation of Breastfeeding ........................................................................ 176
11.2.2 Exclusive Breastfeeding ..................................................................................... 177
11.2.3 Median Duration of Breastfeeding ..................................................................... 178
11.2.4 Bottle Feeding .................................................................................................... 178
11.2.5 Introduction of Complementary Foods .............................................................. 179
11.2.6 Minimum Dietary Diversity, Minimum Meal Frequency, and Minimum Acceptable Diet ...... 179
11.3 Anaemia Prevalence in Children ..................................................................................... 181
11.4 Presence of Iodised Salt in Households ........................................................................... 182
11.5 Micronutrient Intake and Supplementation among Children ........................................... 182
11.6 Women’s Nutritional Status ............................................................................................ 183
11.7 Anaemia Prevalence in Women....................................................................................... 184
11.8 Micronutrient Supplementation and Deworming during Pregnancy ............................... 185
12 MALARIA ................................................................................................................................... 201
12.1 Ownership of Insecticide-treated Nets ............................................................................. 201
12.2 Household Access to and Use of ITNs ............................................................................ 203
12.3 Use of ITNs by Children and Pregnant Women .............................................................. 204
12.4 Malaria in Pregnancy ....................................................................................................... 205
12.5 Case Management of Malaria in Children ....................................................................... 206
12.6 Prevalence of Low Haemoglobin in Children ................................................................. 207
12.7 Prevalence of Malaria in Children ................................................................................... 207
13 HIV/AIDS-RELATED KNOWLEDGE, ATTITUDES, AND BEHAVIOUR ....................... 219
13.1 HIV/AIDS Knowledge, Transmission, and Prevention Methods .................................... 219
13.2 Knowledge about Mother-to-Child Transmission ........................................................... 220
13.3 Discriminatory Attitudes towards People Living with HIV ............................................ 221
13.4 Multiple Sexual Partners ................................................................................................. 222
13.5 Paid Sex ........................................................................................................................... 223
13.6 Coverage of HIV Testing Services .................................................................................. 223
13.6.1 Awareness of HIV Testing Services and Experience with HIV Testing ........... 223
13.6.2 HIV Testing of Pregnant Women ...................................................................... 224
13.7 Self-reporting of Sexually Transmitted Infections .......................................................... 224
13.8 HIV/AIDS-related Knowledge and Behaviour among Young People ............................ 225
13.8.1 Knowledge ......................................................................................................... 225
13.8.2 First Sex ............................................................................................................. 225
13.8.3 Premarital Sex .................................................................................................... 226
13.8.4 Multiple Sexual Partners .................................................................................... 226
13.8.5 Coverage of HIV Testing Services .................................................................... 226
14 ADULT AND MATERNAL MORTALITY ............................................................................. 243
14.1 Data ................................................................................................................................. 243
14.2 Direct Estimates of Adult Mortality ................................................................................ 244
14.3 Trends in Adult Mortality ................................................................................................ 245
14.4 Direct Estimates of Maternal Mortality ........................................................................... 245
14.5 Trends in Pregnancy-related Mortality ............................................................................ 246
15 WOMEN’S EMPOWERMENT ................................................................................................ 251
15.1 Married Women’s and Men’s Employment .................................................................... 251
15.2 Control over Women’s Earnings ..................................................................................... 252
15.3 Control over Men’s Earnings .......................................................................................... 253
15.4 Women’s and Men’s Ownership of Assets ..................................................................... 254
15.4.1 Documentation of Ownership of Assets ............................................................ 254
15.4.2 Bank Accounts and Mobile Phones ................................................................... 254
15.5 Women’s Participation in Decision Making .................................................................... 255
15.6 Attitudes toward Wife Beating ........................................................................................ 255
15.7 Negotiating Sexual Relations .......................................................................................... 256
16 DOMESTIC VIOLENCE ........................................................................................................... 275
16.1 Measurement of Violence ................................................................................................ 275
16.2 Women’s Experience of Physical Violence .................................................................... 276
16.2.1 Prevalence of Physical Violence ........................................................................ 276
16.2.2 Perpetrators of Physical Violence ...................................................................... 277
16.3 Experience of Sexual Violence ........................................................................................ 277
16.3.1 Prevalence of Sexual Violence .......................................................................... 277
16.3.2 Perpetrators of Sexual Violence ......................................................................... 278
16.4 Experience of Different Forms of Violence .................................................................... 278
16.5 Marital Control by Husband ............................................................................................ 278
16.6 Forms of Spousal Violence .............................................................................................. 279
16.6.1 Prevalence of Spousal Violence ......................................................................... 279
16.6.2 Experience of Spousal Violence by Duration of Marriage ................................ 281
16.7 Injuries to Women due to Spousal Violence ................................................................... 281
16.8 Violence Initiated by Women against Husbands ............................................................. 281
16.9 Help Seeking among Women Who Have Experienced Violence .................................... 282
17 FEMALE GENITAL MUTILATION/CUTTING ................................................................... 299
17.1 Respondents’ Knowledge of Female Genital Mutilation/Cutting ................................... 300
17.2 Prevalence of Female Genital Mutilation/Cutting ........................................................... 300
17.2.1 Type of Circumcision ........................................................................................ 300
17.2.2 Age at Circumcision .......................................................................................... 301
17.3 Circumcision of Daughters .............................................................................................. 301
17.4 Person Who Performed the Circumcision ....................................................................... 302
17.5 Attitudes Towards Female Circumcision ........................................................................ 302
17.6 Justifications for Continuing or Ending Female Circumcision ........................................ 302
17.7 Knowledge of FGM/C Legality ....................................................................................... 303
REFERENCES.......................................................................................................................................... 315
Appendix A SAMPLE DESIGN ........................................................................................................ 317
A.1 Introduction ..................................................................................................................... 317
A.2 Sample Frame .................................................................................................................. 317
A.3 Sample Design and Implementation ................................................................................ 318
A.4 Sample Probabilities and Sampling Weights ................................................................... 319
Appendix B ESTIMATES OF SAMPLING ERRORS ................................................................... 323
Appendix C DATA QUALITY TABLES ......................................................................................... 349
Appendix D CONTRIBUTORS TO THE 2019-20 GAMBIA DEMOGRAPHIC AND HEALTH SURVEY ........ 357
Appendix E QUESTIONNAIRES ..................................................................................................... 361
Household ..................................................................................................................................... 363
Woman’s ....................................................................................................................................... 383
Man’s ......................................................................................................................................... 467
Biomarker ...................................................................................................................................... 495
Fieldworker ................................................................................................................................... 521 |
