Ethiopia 2011 Demographic and Health Survey Ethiopia 2011 Demographic and Health Survey Ethiopia Demographic and Health Survey 2011 Central Statistical Agency Addis Ababa, Ethiopia ICF International Calverton, Maryland, USA March 2012 The 2011 Ethiopia Demographic and Health Survey (2011 EDHS) is part of the worldwide MEASURE DHS project which is funded by the United States Agency for International Development (USAID). The survey was implemented by the Ethiopian Central Statistical Agency (CSA). The funding for the EDHS was provided by the HIV/AIDS Prevention and Control Office (HAPCO), USAID, the United Nations Population Fund (UNFPA), the United Kingdom for International Development (DFID), the United Nations Children’s Fund (UNICEF) and the Centers for Disease Control and Prevention (CDC). ICF International provided technical assistance through the MEASURE DHS project. The opinions expressed herein are those of the authors and do not necessarily reflect the views of USAID. Additional information about the 2011 EDHS may be obtained from the Central Statistical Agency, P.O. Box 1143, Addis Ababa, Ethiopia; Telephone: (251) 111 55 30 11/111 15 78 41, Fax: (251) 111 55 03 34, E-mail: csa@ethionet.et. Information about the MEASURE DHS project may be obtained from ICF International, 11785 Beltsville Drive, Suite 300, Calverton, MD 20705, USA; Telephone: 301-572-0200, Fax: 301-572-0999, E-mail: info@measuredhs.com, Internet: http://www.measuredhs.com. Suggested citation: Central Statistical Agency [Ethiopia] and ICF International. 2012. Ethiopia Demographic and Health Survey 2011. Addis Ababa, Ethiopia and Calverton, Maryland, USA: Central Statistical Agency and ICF International. Contents • iii CONTENTS TABLES AND FIGURES ix FOREWORD xv ACKNOWLEDGMENTS xvii MILLENNIUM DEVELOPMENT GOAL INDICATORS xix CHAPTER 1 INTRODUCTION 1.1 History, Geography, and Economy 1 1.2 Population 3 1.3 Population and Health Policies 4 1.4 Objectives of the 2011 EDHS Survey 5 1.5 Organization of the Survey 6 1.6 Sample Design 7 1.7. Questionnaires 7 1.8 Listing, Pretest, Main Training, Fieldwork, and Data Processing 8 1.9 Anthropometry, Anaemia, and HIV Testing 10 1.10 Response Rates 11 CHAPTER 2 HOUSING CHARACTERISTICS AND HOUSEHOLD POPULATION 2.1 Household Environment 13 2.1.1 Drinking Water 13 2.1.2 Household Sanitation Facilities 15 2.1.3 Housing Characteristics 16 2.1.4 Household Possessions 18 2.2 Wealth Index 19 2.3 Population by Age and Sex 20 2.4 Household Composition 21 2.5 Children’s Living Arrangements and Parental Survival 22 2.6 Education of the Household Population 25 2.6.1 School Attendance by Survivorship of Parents 25 2.6.2 Educational Attainment 26 2.6.3 School Attendance Ratios 28 2.7 Child Labour 31 CHAPTER 3 CHARACTERISTICS OF RESPONDENTS 3.1 Characteristics of Survey Respondents 35 3.2 Educational Attainment by Background Characteristics 37 3.3 Literacy 39 3.4 Exposure to Mass Media 41 3.5 Employment 44 3.6 Occupation 48 3.7 Type Of Women’s Employment 50 3.8 Health Iss ues 51 3.8.1 Use of Tobacco 51 3.8.2 Alcohol Consumption 52 3.8.3 Chewing Chat 53 3.8.4 Knowledge and Attitudes concerning Tuberculosis 55 iv • Contents CHAPTER 4 MARRIAGE AND SEXUAL ACTIVITY 4.1 Current Marital Status 59 4.2 Polygyny 60 4.3 Age at First Marriage 62 4.4 Age at First Sexual Intercourse 64 4.5 Recent Sexual Activity 66 CHAPTER 5 FERTILITY LEVELS, TRENDS, AND DIFFERENTIALS 5.1 Current Fertility 69 5.2 Fertility Differentials by Background Characteristics 71 5.3 Fertility Trends 72 5.4 Children Ever Born and Living 73 5.5 Birth Intervals 74 5.6 Postpartum Amenorrhoea, Abstinence, and Insusceptibility 76 5.7 Menopause 77 5.8 Age at First Birth 78 5.9 Teenage Pregnancy and Motherhood 79 CHAPTER 6 FERTILITY PREFERENCES 6.1 Desire for More Children 81 6.2 Desire to Limit Childbearing by Background Characteristics 83 6.3 Ideal Number of Children 86 6.4 Mean Ideal Number of Children by Women’s Background Characteristics 88 6.5 Fertility Planning Status 89 6.6 Wanted Fertility Rates 90 CHAPTER 7 FAMILY PLANNING 7.1 Knowledge of Contraceptive Methods 93 7.2 Current Use of Contraceptive Methods 95 7.2.1 Current Use of Contraceptive Methods By Age 95 7.2.2 Trends in Contraceptive Use 97 7.3 Current Use of Contraception by Background Characteristics 97 7.4 Source of Modern Contraceptive Methods 99 7.5 Informed Choice 99 7.6 Knowledge of the Fertile Period 100 7.7 Need and Demand for Family Planning 101 7.8 Future Use of Contraception 102 7.9 Exposure to Family Planning Messages 102 7.10 Exposure to Specific Type of Family Planning Messages 105 7.11 Contact of Nonusers with F amily Planning Providers 106 7.12 Contraceptive Discontinuation Rate 108 CHAPTER 8 INFANT AND CHILD MORTALITY 8.1 Data Quality 110 8.2 Levels and Trends in Infant and Child Mortality 111 8.2.1 Early Childhood Mortality Rates 111 8.2.2 Trends in Early Childhood Mortality 111 8.3 Early Childhood Mortality Rates by Socioeconomic Characteristics 112 8.4 Demographic Differentials in Infant and Child Mortality 114 8.5 Perinatal Mortality 115 8.6 High-Risk Fertility Behaviour 117 Contents • v CHAPTER 9 MATERNAL HEALTH 9.1 Antenatal Care 119 9.1.1 Coverage of Antenatal Care 120 9.1.2 Number of ANC Visits, Timing of First Visit, and Source Where ANC Was Received 121 9.1.3 Components of Antenatal Care 122 9.1.4 Informed of signs of pregnancy complications during pregnancy 124 9.2 Tetanus Toxoid Injections 124 9.3 Place of Delivery 126 9.4 Assistance during Delivery 127 9.5 Reasons for Not Delivering in a Health Facility 128 9.6 Postnatal Care 129 9.6 Problems in Accessing Health Care 131 CHAPTER 10 CHILD HEALTH 10.1 Child’s Size at Birth 135 10.2 Vaccination Coverage 138 10.2.1 Vaccinations Coverage by Background Characteristics 140 10.3 Trends in Vaccination Coverage 141 10.4 Acute Respiratory Infection 142 10.5 Fever 143 10.6 Diarrhoeal Disease 146 10.6.1 Prevalence of Diarrhoea 146 10.6.2 Treatment of Diarrhoea 148 10.6.3 Feeding Practices during Diarrhoea 150 10.7 Knowledge of ORS Packets 152 10.8 Stool Disposal 153 CHAPTER 11 NUTRITION OF CHILDREN AND ADULTS 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 Children’s Nutritional Status 158 11.1.4 Trends in Children’s Nutritional Status 161 11.2 Breastfeeding and Complementary Feeding 162 11.2.1 Initiation of Breastfeeding 162 11.2.2 Breastfeeding Status by Age 164 11.2.3 Duration of Breastfeeding 168 11.2.4 Types of Complementary Foods 169 11.2.5 Infant and Young Child Feeding (IYCF) Practices 171 11.3 Prevalence of Anaemia in Children 173 11.4 Micronutrient Intake among Children 175 11.5 Iodisation of Household Salt 179 11.6 Nutritional Status of Women and Men 180 11.7 Prevalence of Anaemia in Women 184 11.8 Prevalence of Anaemia in Men 186 11.9 Micronutrient Intake among Mothers 186 vi • Contents CHAPTER 12 HIV/AIDS-RELATED KNOWLEDGE, ATTITUDES, AND BEHAVIOUR 12.1 HIV/AIDS Knowledge, Transmission, and Prevention Methods 190 12.1.1 Awareness of HIV/AIDS 190 12.1.2 Rejection of Misconceptions about HIV/AIDS 192 12.2 Knowledge of Prevention of Mother-to-Child Transmission of HIV 195 12.3 Attitudes towards People Living with HIV/AIDS 196 12.4 Attitudes towards Refusing to Have Sex and Negotiating Safer Sex 198 12.5 Adult Support for Education about Condoms for Children Age 12 14 200 12.6 Higher-Risk Sex 201 12.6.1 Multiple Partners and Condom Use 201 12.6.2 Transactional Sex 205 12.7 Coverage of HIV Testing 206 12.7.1 General HIV Testing 206 12.7.2 HIV Counseling and Testing During Pregnancy 208 12.8 Male Circumcision 210 12.9 Self-Reporting of Sexually Transmitted Infections 211 12.10 Prevalence of Medical Injections 213 12.11 HIV/AIDS Knowledge and Sexual Behaviour among Youth 215 12.11.1 HIV/AIDS-Related Knowledge among Young Adults 215 12.11.2 Age at First Sexual Intercourse 216 12.11.3 Abstinence and Premarital Sex 219 12.11.4 Multiple Partnerships among Young Adults 221 12.11.5 Age-mixing in Sexual Relationships 222 12.11.6 Recent HIV Testing Among Youth 223 12.12 Use of Alcohol or Chat during Sexual Intercourse 224 12.13 Sharing of HIV Test Results Among Couples 226 12.14 Participation in Community Conversation Programme 227 CHAPTER 13 HIV PREVALENCE 13.1 Coverage Rates for HIV Testing 231 13.2 HIV Prevalence 234 13.2.1 HIV Prevalence by Age and Sex 234 13.2.2 HIV Prevalence by Socioeconomic Characteristics 235 13.2.3 HIV Prevalence by Demographic Characteristics 236 13.2.4 HIV Prevalence by Sexual Risk Behaviour 237 13.3 HIV Prevalence among Youth 238 13.3.1 HIV Prevalence by Sexual Behaviour among Youth 239 13.4 HIV Prevalence by Other Characteristics 240 13.4.1 HIV Prevalence and STIs 240 13.4.2 Prior HIV Testing and Current HIV Status 241 13.4.3 HIV Prevalence by Male Circumcision 241 13.5 HIV Prevalence among Cohabiting Couples 243 Contents • vii CHAPTER 14 WOMEN’S EMPOWERMENT AND DEMOGRAPHIC AND HEALTH OUTCOMES 14.1 Employment and Form of Earnings 246 14.2 Control Over and Relative Magnitude of Women’s and Husband’s Earnings 247 14.2.1 Control Over Wife’s Earnings 247 14.2.2 Control Over Husband’s Earnings 249 14.3 Control Over Married Women’s Earnings and Relative Size of Husband’s and Wife’s Earnings 250 14.4 Ownership of Assets 252 14.5 Women’s Participation in Decision-Making 253 14.6 Attitude towards Wife Beating 256 14.7 Women’s Empowerment Indices 259 14.8 Current Use of Contraception by Women’s Status 260 14.9 Ideal Family Size and Unmet Need by Women’s Status 261 14.10 Women’s Status and Reproductive Health Care 262 14.11 Differentials in Infant and Child Mortality by Women’s Status 263 14.12 Men’s Participation in Household Chores 264 14.13 Law Against Domestic Violence 265 CHAPTER 15 ADULT AND MATERNAL MORTALITY 15.1 Assessment of Data Quality 267 15.2 Estimates of Adult Mortality 268 15.3 Estimates of Maternal Mortality 270 REFERENCES 273 APPENDIX A SAMPLE IMPLEMENTATION 275 APPENDIX B ESTIMATES OF SAMPLING ERRORS 287 APPENDIX C DATA QUALITY TABLES 307 APPENDIX D PERSONS INVOLVED IN THE 2011 ETHIOPIA DEMOGRAPHIC AND HEALTH SURVEY 317 APPENDIX E QUESTIONNAIRES 327 [...]... 100 (CSA, 2010) Ethiopia has made an effort to generate reliable demographic data by conducting a number of surveys These include the 1981 Demographic Survey, the 1990 National Family and Fertility Survey (NFFS), the 1995 Fertility Survey of Urban Addis Ababa, and the 2000, 2005, and 2011 Ethiopia Demographic and Health Surveys (EDHS) The 1990 NFFS was the first nationally representative survey to yield... population and health that are comparable to data collected in similar surveys in other developing countries and to Ethiopia s two previous DHS surveys, conducted in 2000 and 2005 Data collected in the 2011 EDHS add to the large and growing international database of demographic and health indicators 1.5 ORGANIZATION OF THE SURVEY The 2011 EDHS was carried out under the aegis of the Ministry of Health (MOH) and. .. the third Demographic and Health Survey (DHS) conducted in Ethiopia, under the worldwide MEASURE DHS project, a USAID-funded project providing support and technical assistance in the implementation of population and health surveys in countries worldwide The three EDHS surveys have been conducted at five-year intervals since 2000, and the 2011 EDHS is the second survey presenting results on HIV and anemia... for sampling errors, Ethiopia 2011 290 Sampling errors for national sample, Ethiopia 2011 291 Sampling errors for urban sample, Ethiopia 2011 292 Sampling errors for rural sample, Ethiopia 2011 293 Sampling errors for Tigray region, Ethiopia 2011 .294 Sampling errors for Affar region, Ethiopia 2011 295 Sampling errors for Amhara region, Ethiopia 2011 296 Sampling... principal objective of the 2011 Ethiopia Demographic and Health Survey (EDHS) is to provide current and reliable data on fertility and family planning behaviour, child mortality, adult and maternal mortality, children’s nutritional status, use of maternal and child health services, knowledge of HIV/AIDS, and prevalence of HIV/AIDS and anaemia The specific objectives are these: • Collect data at the national... Oromiya region, Ethiopia 2011 297 Sampling errors for Somali region, Ethiopia 2011 298 Sampling errors for Benishangul-Gumuz region, Ethiopia 2011 299 Sampling errors for SNNP region, Ethiopia 2011 .300 Sampling errors for Gambela region, Ethiopia 2011 .301 Sampling errors for Harari region, Ethiopia 2011 .302 Sampling errors for Addis Ababa region, Ethiopia 2011 303... Key Findings • The 2011 Ethiopia Demographic and Health Survey (EDHS) is a nationally representative survey of 16,515 women age 15-49 and 14,110 men age 15-59 • The 2011 EDHS is the third comprehensive survey conducted in Ethiopia as part of the worldwide Demographic and Health Surveys project • The primary purpose of the EDHS is to furnish policymakers and planners with detailed information on fertility,... include: democratisation and decentralisation of the health care system; development of the preventive and curative components of health care; ensuring accessibility of health care for all segments of the population; and, promotion of private sector and NGO participation in the health sector The HSDP prioritizes maternal and newborn care, and child health, and aims to halt and reverse the spread of... planning, contraceptive use, and related topics In addition to the topics covered by the NFFS, the 2000, 2005, and 2011 EDHS surveys collected information on maternal and child health, nutrition and breastfeeding practices, and HIV and other sexually transmitted diseases 1.3 POPULATION AND HEALTH POLICIES National Population Policy Population policies had low priority in Ethiopia until the early 1990s... monitoring, and evaluation of programmes on health in general and reproductive health in particular at both the national and regional levels A long-term objective of the survey is to strengthen the technical capacity of the Central Statistical Agency to plan, conduct, process, and analyse data from complex national population and health surveys Moreover, the 2011 EDHS provides national and regional . Ethiopia 2011 Demographic and Health Survey Ethiopia 2011 Demographic and Health Survey Ethiopia Demographic and Health Survey 2011 . Agency [Ethiopia] and ICF International. 2012. Ethiopia Demographic and Health Survey 2011. Addis Ababa, Ethiopia and Calverton, Maryland, USA: Central