39440 SOCIO-ECONOMIC DIFFERENCES IN HEALTH, NUTRITION, AND POPULATION BENIN 1996, 2001 Davidson R. Gwatkin, Shea Rutstein, Kiersten Johnson, Eldaw Suliman, Adam Wagstaff, and Agbessi Amouzou TABLE OF CONTENTS Foreword I Introduction III Part I. Basic Tables, 2001 1 A. Total Population 3 B. Female and Male Populations 9 C. Rural and Urban Populations 13 Part II. Basic Tables, 1996 19 A. Total Population 21 B. Female and Male Populations 27 C. Rural and Urban Populations 31 Part III. Technical Notes 37 A. Indicator Definitions 39 B. Data and Methods 53 C. Discussion 57 Part IV. Supporting Tables, 2001 63 A. Sample Sizes 65 B. Standard Errors 71 C. Asset Distribution and Weights 77 Part V. Supporting Tables, 1996 79 A. Sample Sizes 81 B. Standard Errors 87 C. Asset Distribution and Weights 93 Part VI. Annexes 95 A. Sources of Additional Information 97 B. Use of Information from this 99 Report to Monitor the Economic Status of People Served by HNP Programs C. Countries Covered by the 107 HNP-Poverty Report Project FOREWORD The World Bank shares the desire of its member states and client countries to ensure that the poor partake fully in the health gains that the countries achieve. To assist in this, the Bank, in cooperation with the Dutch and Swedish Governments, has sponsored the set of reports providing basic information about health inequalities within countries to which this document belongs. The information shows clearly that disparities in both health conditions and health service use are unacceptably large. As countries and the Bank work to reduce important inequalities among regions and countries, there is a clear need for equally vigorous efforts to lessen the inequity represented by intra-country differences among socio-economic groups. My colleagues and I hope that all concerned with equity in health will find this information useful in making the case for effective actions to improve the health of the poor, and in designing programs to achieve this crucial objective. Joy Phumaphi Vice President Human Development Network The World Bank - I - INTRODUCTION This report is one in a series that provides basic information about health, nutrition, and population (hnp) inequalities within fifty-six developing countries. The series to which the report belongs is an expanded and updated version of a set covering forty- five countries that was published in 2000. The fifty-six reports in the current series cover almost all DHS surveys undertaken during the period beginning in 1990 and ending with the date of the last survey for which data were publicly available as of June 2006.1 The report's contents are intended to facilitate preparation of country analyses and the development of activities to benefit poor people. To this end, the report presents data about hnp status, service use, and related matters among individuals belonging to different socio-economic classes. The principal focus is on differences among groups of individuals defined in terms of the wealth or assets of the households where they reside. The source of data is the Demographic and Health Survey (DHS) program, a large, multi-country household survey project. The figures in this and the other reports in the series draw on responses to questions about household wealth or assets included in the DHS questionnaire, which were similar for all the surveys covered. These responses served as the basis for the construction of a wealth index, which was used to rank individuals according to the index value for the household to which they belonged. The individuals were then divided into quintiles, and the mean value for each of up to approximately 120 indicators was calculated for each quintile. The report is organized in four principal parts: · Parts one and two, which constitute the report's core, consist of tables presenting quintile-specific data for each hnp indicator covered from the two most recent DHS surveys available at the time of the report's publication. In each part there are three sets of tables: the first provides quintile-specific information for the total population; the second presents data separately for quintiles of females and males; the third features quintile-specific information presented separately for rural and urban residents. Each of these sets is divided into four sections: one dealing with hnp status, the second with the use of hnp services, the third with hnp-related behavior, and the fourth with other hnp status determinants. · Part three provides supplementary technical information designed to help readers understand the data presented in parts one and two. This information deals with such issues as how the covered hnp indicators were defined and how the quintile-specific estimates were derived. · Parts four and five present supporting tables that deal with three of the technical matters covered in part three: the size of the sample for each indicator covered; the standard error 1The average interval of approximately two years between data collection and availability means that the latest surveys covered were conducted in 2005. - III - for each quintile-specific estimate in the total population; and the items used in constructing the wealth index, along with the weight assigned to each. An additional, sixth part consists of three annexes, for readers interested in applying the approach used in the report or in learning more about the other reports in this series. The first annex is an annotated bibliography containing further information about the technical issues concerning the approach used in the report, and about employing that approach to examine additional issues using DHS or other data sets. The second shows how the report's approach can be applied to monitor the distribution of benefits from other hnp programs, and provides a tool for doing so. The third annex is a list of all fifty-six countries for which reports are available, along with an indication of how to obtain copies of the reports dealing with them. ********************************* The authors thank the Dutch and Swedish Governments for the generous support that made production of this report possible. - IV - PART I. BASIC TABLES, 2001 A. TOTAL POPULATION B. FEMALE AND MALE POPULATIONS C. RURAL AND URBAN POPULATIONS Notes: ­ Each of the three sections referred to above consists of four divisions, presenting data for: I) hnp status; II) hnp service use; III) hnp-related individual and household behavior; and IV) other, underlying determinants of hnp status. ­ Full definitions of all indicators covered in the tables are provided in section A of the technical notes found in part II. ­ "na" appears in the table cells when data are not available, usually because the DHS survey concerned did not collect information about the indicator(s) in question. ­ Figures in the tables shown within parentheses indicate the absence of adequate observations to produce acceptably reliable values. Asterisks appear when the number of observations was too small to justify the presentation even of figures within parentheses. (For further information, see the section on "Sampling Errors" in the presentation of data and methods in part II.B.) Asterisks also will be found in columns showing statistical indices of inequality when the amount of quintile-specific information available is inadequate to permit computation of the value for the index concerned. ­ Female/male tables include only indicators relevant for both sexes; those pertaining to only one sex (e.g., fertility, women's nutritional status, antenatal care, attended deliveries) have been omitted. Benin 2001 - TOTAL POPULATION Part I: HNP STATUS Indicator Wealth Quintiles Low/High Low-High Concentration Index Ratio Diff. Value Standard Low 2nd 3rd 4th High Avg. (Abs. Val.) Errors A. Childhood illness and mortality Infant mortality rate 111.5 108.2 106.3 78.1 50.0 94.8 2.23 61.50 -0.1121 0.0014 Under-five mortality rate 198.2 176.1 181.1 132.2 93.1 162.7 2.13 105.10 -0.1118 0.0012 Prevalence of fever 45.4 43.7 44.3 39.5 29.6 41.2 1.53 15.80 -0.0637 0.0100 Prevalence of diarrhea 15.2 15.3 13.1 12.6 9.7 13.4 1.57 5.50 -0.0809 0.0213 Prevalence of acute 12.0 11.5 11.6 13.3 11.3 12.0 1.06 0.70 0.0036 0.0235 respiratory infection B. Fertility Total fertility rate 7.2 6.6 6.5 5.0 3.5 5.6 2.06 3.70 -0.1350 0.0007 Adolescent fertility rate 176.0 151.0 155.0 90.0 35.0 109.0 5.03 141.00 -0.2757 0.0035 C. Nutritional status (%) Children: Moderate stunting 21.9 22.5 20.1 18.7 14.3 19.7 1.53 7.60 -0.0702 0.0185 Severe stunting 13.5 14.4 10.1 10.3 3.9 10.7 3.46 9.60 -0.1646 0.0249 Moderate underweight 21.5 22.3 18.3 16.7 9.0 17.9 2.39 12.50 -0.1333 0.0192 Severe underweight 7.5 8.0 4.5 3.0 1.2 5.0 6.25 6.30 -0.2592 0.0391 Mild anemia 18.1 22.0 27.3 21.1 20.5 21.7 0.88 2.40 0.0267 0.0238 Moderate anemia 58.9 51.4 51.3 51.9 39.5 51.6 1.49 19.40 -0.0528 0.0126 Severe anemia 10.2 13.1 7.8 6.4 5.1 8.8 2.00 5.10 -0.1512 0.0392 Women: Malnutrition 16.3 12.8 12.2 9.1 5.9 10.7 2.76 10.40 -0.1919 0.0229 Mild anemia 40.5 38.5 40.5 41.0 42.5 40.7 0.95 2.00 0.0169 0.0126 Moderate anemia 21.2 21.4 21.8 18.9 25.0 21.8 0.85 3.80 0.0203 0.0201 Severe anemia 1.5 3.1 1.7 2.2 1.0 1.8 1.50 0.50 -0.0769 0.0665 D. Female circumcision (%) Prevalence of circumcision: Girls 15.4 12.8 11.2 4.2 0.4 8.7 38.50 15.00 -0.3462 0.0346 Women 25.7 25.5 22.0 13.1 3.3 16.8 7.79 22.40 -0.2874 0.0156 Prevalence of occlusion: Girls 1.2 4.6 4.7 * * 3.8 * * * * Women 2.4 2.7 4.9 4.0 (4.5) 3.5 0.53 6.90 -0.2101 0.0807 E. Sexually transmitted disease Prevalence of genital discharge: Women 1.0 1.2 0.8 2.6 4.9 2.3 0.20 3.90 0.3977 0.0594 Men 1.9 1.1 2.1 3.3 3.9 2.5 0.49 2.00 0.1940 0.0773 Prevalence of genital ulcer: Women 0.5 0.8 0.6 0.6 1.9 0.9 0.26 1.40 0.2520 0.0915 Men 1.0 1.0 1.1 1.8 1.8 1.4 0.56 0.80 0.1137 0.1075 - 3 - Benin 2001 - TOTAL POPULATION Part II: Intermediate Determinants of HNP Status - HNP SERVICE USE Indicator Wealth Quintiles Low/High Low-High Concentration Index Ratio Diff. Value Standard Low 2nd 3rd 4th High Avg. (Abs. Val.) Errors A. Childhood immunization BCG coverage 80.6 86.7 90.2 97.2 96.1 89.9 0.84 15.50 0.0394 0.0066 Measles coverage 56.9 61.8 65.5 75.7 83.1 68.0 0.68 26.20 0.0798 0.0125 DPT coverage 63.0 65.1 71.9 76.9 88.8 72.5 0.71 25.80 0.0733 0.0109 Full basic coverage 52.6 57.2 59.9 67.9 79.5 62.8 0.66 26.89 0.0879 0.0142 No basic coverage 18.1 10.5 6.4 1.7 2.5 8.1 6.00 15.59 -0.4219 0.0697 Hepatitis B coverage na na na na na na na na na na Yellow fever coverage na na na na na na na na na na B. Treatment of childhood illnesses Treatment of fever: Medical treatment of fever 24.2 29.8 31.4 37.7 43.2 31.8 0.56 19.00 0.1089 0.0198 Treatment in a public facility 20.2 23.5 24.1 27.2 18.6 23.0 1.09 1.60 0.0305 0.0240 Treatment in a private facility 3.7 5.5 7.1 10.3 23.5 8.3 0.16 19.80 0.3168 0.0499 Treatment of acute respiratory infection (ARI): Medical treatment of ARI 26.3 33.1 35.5 36.1 49.3 35.1 0.53 23.00 0.1096 0.0348 Treatment in a public facility 20.6 25.8 24.9 33.0 23.7 25.7 0.87 3.10 0.0670 0.0425 Treatment in a private facility 5.7 7.3 9.9 3.1 24.2 9.0 0.24 18.50 0.2453 0.0857 Treatment of diarrhea: Use of oral rehydration therapy 53.5 44.3 62.1 62.7 56.7 55.1 0.94 3.20 0.0434 0.0217 Medical treatment of diarrhea 23.1 21.1 25.8 24.7 23.7 23.5 0.97 0.60 0.0391 0.0421 Treatment in a public facility 19.4 17.8 18.8 16.5 11.0 17.4 1.76 8.40 -0.0374 0.0480 Treatment in a private facility 3.8 3.4 7.0 7.3 11.2 5.8 0.34 7.40 0.3001 0.1028 C. Antenatal and delivery care Antenatal care visits: To a medically trained person 73.0 82.7 90.1 95.6 99.5 87.4 0.73 26.50 0.0636 0.0037 To a doctor 1.5 1.3 4.3 3.9 22.0 5.9 0.07 20.50 0.5474 0.0492 To a nurse or trained midwife 71.5 81.3 85.7 91.7 77.5 81.5 0.92 6.00 0.0289 0.0053 Multiple visits to a medically trained 59.3 69.3 77.7 87.7 92.4 76.3 0.64 33.10 0.0919 0.0052 person Antenatal care content: Tetanus toxoid 63.6 66.4 73.2 76.3 74.4 70.5 0.85 10.80 0.0395 0.0064 Prophylactic antimalarial treatment 71.2 77.3 86.2 87.0 92.6 82.2 0.77 21.40 0.0547 0.0045 Iron supplementation 71.8 80.0 85.9 91.2 95.0 84.1 0.76 23.20 0.0569 0.0041 Delivery attendance: By a medically trained person 49.6 60.5 76.9 90.2 99.3 72.9 0.50 49.70 0.1436 0.0044 By a doctor 1.6 1.7 2.0 4.9 16.6 4.5 0.10 15.00 0.5093 0.0489 By a nurse or trained midwife 48.0 58.7 74.9 85.4 82.7 68.4 0.58 34.70 0.1196 0.0056 In a public facility 50.3 58.8 74.7 76.4 66.8 64.8 0.75 16.50 0.0786 0.0063 In a private facility 4.9 6.8 6.1 14.3 31.4 11.2 0.16 26.50 0.3667 0.0267 At home 43.3 32.8 18.1 8.1 1.3 22.7 33.31 42.00 -0.3945 0.0139 - 4 - Benin 2001 - TOTAL POPULATION Part II: Intermediate Determinants of HNP Status - HNP SERVICE USE (Cont.) Indicator Wealth Quintiles Low/High Low-High Concentration Index Ratio Diff. Value Standard Low 2nd 3rd 4th High Avg. (Abs. Val.) Errors D. Contraceptive services (cont.) Contraceptive prevalence: Women 4.0 3.2 6.7 8.3 14.7 7.2 0.27 10.70 0.2753 0.0328 Men 10.1 8.5 8.8 16.6 22.5 13.0 0.45 12.40 0.2034 0.0392 Source of contraception - public sector: Women (54.6) (49.6) 70.3 56.8 50.1 56.0 1.09 104.70 -0.0299 0.0306 Men na na na na na na na na na na Source of contraception - private sector: Women (28.5) (43.5) 24.3 37.0 45.5 37.3 0.63 74.00 0.0849 0.0413 Men na na na na na na na na na na E. Treatment of adult illnesses Treatment of genital discharge, ulcer, sore: Women * * * (61.6) 70.7 58.1 * * * * Men * * * * (74.2) 55.3 * * * * Treatment of genital discharge, ulcer, sore in public facilities: Women na na na na na na na na na na Men na na na na na na na na na na Voluntary counseling and testing for HIV/AIDS: Women 1.3 1.0 2.6 5.1 12.9 5.1 0.10 11.60 0.5053 0.0372 Men 2.2 2.6 5.8 6.5 14.8 6.8 0.15 12.60 0.4153 0.0455 - 5 - Benin 2001 - TOTAL POPULATION Part III: Intermediate Determinants of HNP Status - INDIVIDUAL AND HOUSEHOLD BEHAVIOR Indicator Wealth Quintiles Low/High Low-High Concentration Index Ratio Diff. Value Standard Low 2nd 3rd 4th High Avg. (Abs. Val.) Errors A. Hygienic practices Disposal of children's stools: Sanitary disposal 1.7 2.0 7.7 26.7 64.9 18.5 0.03 63.20 0.6217 0.0220 Handwashing: Wash hands prior to preparing food 87.2 91.4 93.7 95.4 94.2 92.6 0.93 7.00 0.0152 0.0022 Handwashing facilities in household 0.0 0.0 0.1 0.2 8.7 1.9 0.00 8.70 0.8916 0.0942 B. Bednet ownership and use Bednet ownership: Bednet ownership 29.3 29.9 34.6 43.7 63.5 40.4 0.46 34.20 0.1759 0.0092 Treated bednet ownership na na na na na na na na na na Bednet use: By children 24.7 24.9 26.1 39.3 57.0 33.8 0.43 32.30 0.1903 0.0143 By pregnant women 27.4 31.1 24.3 35.9 53.0 33.2 0.52 25.60 0.1238 0.0325 C. Breastfeeding Exclusive breastfeeding 49.8 46.8 46.9 53.6 (42.0) 48.2 1.19 91.80 -0.0065 0.0319 Timely complementary feeding 57.1 63.9 71.5 65.4 (72.1) 65.3 0.79 129.20 0.0461 0.0235 Bottle-feeding 2.0 1.6 2.3 6.0 28.0 6.5 0.07 26.00 0.5987 0.0902 D. Micronutrient consumption Iodized salt: Availability of iodized salt 81.3 75.2 73.0 67.0 62.1 71.6 1.31 19.20 -0.0529 0.0050 in household Vitamin A: Children 9.1 12.3 14.2 24.8 37.4 18.3 0.24 28.30 0.2867 0.0203 Women 11.1 16.9 15.6 22.1 39.9 20.2 0.28 28.80 0.2367 0.0205 E. Tobacco and alcohol use Tobacco: Women 8.9 4.7 2.7 1.1 0.2 3.2 44.50 8.70 -0.5456 0.0471 Men na na na na na na na na na na Alcohol: Women 2.4 2.3 1.5 2.9 3.5 2.6 0.69 1.10 0.0762 0.0469 Men na na na na na na na na na na F. Sexual practices Non-regular sexual partnerships: Women 0.6 0.8 0.9 1.3 2.3 1.3 0.26 1.70 0.2718 0.0712 Men 11.8 11.6 13.2 21.4 25.0 17.1 0.47 13.20 0.1810 0.0253 Condom usage with non-regular partner: Women * * * * (30.4) 20.3 * * * * Men 25.2 25.9 30.3 47.8 54.5 41.9 0.46 29.30 0.1869 0.0288 G. Domestic violence Ever experienced violence na na na na na na na na na na Experienced violence in past year na na na na na na na na na na - 6 - Benin 2001 - TOTAL POPULATION Part IV: UNDERLYING DETERMINANTS OF HNP STATUS Indicator Wealth Quintiles Low/High Low-High Concentration Index Ratio Diff. Value Standard Low 2nd 3rd 4th High Avg. (Abs. Val.) Errors A. Education School completion: Women 3.0 5.4 8.9 20.6 54.5 20.7 0.06 51.50 0.5191 0.0138 Men 14.0 22.8 34.0 48.6 77.0 42.2 0.18 63.00 0.3214 0.0073 School participation: Girls 26.3 31.3 47.8 57.5 68.8 45.8 0.38 42.50 0.2050 0.0116 Boys 37.9 46.7 56.6 71.3 89.1 58.0 0.43 51.20 0.1683 0.0084 B. Exposure to mass media Newspaper readership: Women 0.3 0.9 2.3 5.2 14.3 5.3 0.02 14.00 0.5498 0.0361 Men 1.9 2.6 5.4 13.8 29.8 11.8 0.06 27.90 0.5323 0.0324 Radio listenership: Women 46.9 58.0 64.3 67.5 73.2 62.9 0.64 26.30 0.0763 0.0061 Men 75.4 87.3 85.4 87.9 85.8 84.1 0.88 10.40 0.0269 0.0054 Television viewership: Women 2.3 4.1 6.1 16.6 66.0 22.0 0.03 63.70 0.5915 0.0139 Men 7.7 11.4 17.1 36.7 78.7 33.0 0.10 71.00 0.4661 0.0130 C. Knowledge and attitudes about HIV/AIDS Knowledge about sexual transmission of HIV/AIDS: Women 41.3 53.1 57.7 60.7 72.5 58.2 0.57 31.20 0.1123 0.0062 Men 71.1 75.1 80.8 81.6 88.6 79.7 0.80 17.50 0.0571 0.0058 Knowledge about mother-to-child transmission of HIV/AIDS: Women 72.0 69.5 74.4 82.8 87.7 75.2 0.82 15.70 0.0846 0.0042 Men 70.9 71.2 70.6 78.3 85.3 73.2 0.83 14.40 0.0772 0.0066 Attitudes toward HIV/AIDS: Women 78.6 78.9 78.3 77.6 59.0 73.4 1.33 19.60 -0.0559 0.0049 Men 68.0 66.9 69.3 61.8 36.9 59.9 1.84 31.10 -0.1238 0.0089 D. Status of women Household decisionmaking: Can seek own health care 17.2 19.5 20.0 22.0 20.4 19.9 0.84 3.20 0.0270 0.0146 Can seek children's health care 72.3 77.7 84.5 86.3 93.2 82.3 0.78 20.90 0.0510 0.0045 Can make daily household purchases 55.3 54.7 56.0 56.1 48.7 53.9 1.14 6.60 -0.0343 0.0070 Can make large household purchases 28.3 31.2 30.2 33.9 29.9 30.8 0.95 1.60 0.0000 0.0111 Can make meal-related decisions 46.0 44.3 45.5 49.0 41.6 45.1 1.11 4.40 -0.0261 0.0082 Freedom of movement: Can travel to visit family, relatives 15.6 17.6 15.6 23.1 22.8 19.3 0.68 7.20 0.0753 0.0153 Other decisionmaking, attitudes: Can decide how to spend own money 71.2 72.6 79.6 86.1 89.4 80.2 0.80 18.20 0.0506 0.0043 Can decide whether to have sex 91.6 94.3 96.0 95.1 95.6 94.6 0.96 4.00 0.0076 0.0019 Justifies domestic violence 68.4 71.7 69.6 61.2 38.7 60.4 1.77 29.70 -0.1127 0.0062 E. Orphanhood Paternal orphan prevalence 4.7 4.7 4.9 4.5 5.7 4.8 0.82 1.00 0.0282 0.0240 Maternal orphan prevalence 2.0 1.8 2.2 1.9 1.7 1.9 1.18 0.30 0.0098 0.0360 Double orphan prevalence 0.5 0.4 0.5 0.6 0.4 0.5 1.25 0.10 -0.0056 0.0749 - 7 - Benin 2001 - FEMALE / MALE POPULATIONS Part I: HNP STATUS Indicator Wealth Quintiles - Female Wealth Quintiles - Male Low 2nd 3rd 4th High Avg. Low 2nd 3rd 4th High Avg. A. Childhood mortality and morbidity Infant mortality rate 105.4 119.9 97.8 68.9 47.9 92.0 117.7 96.8 114.1 87.3 52.0 97.6 Under-five mortality rate 208.3 185.4 171.7 123.2 (90.7) 163.3 188.2 167.1 189.7 141.1 95.4 162.3 Prevalence of fever 44.3 43.1 43.8 38.8 29.0 40.4 46.5 44.3 44.7 40.3 30.3 42.0 Prevalence of diarrhea 13.9 17.0 14.2 11.5 10.8 13.6 16.5 13.7 12.1 13.9 8.6 13.2 Prevalence of acute 10.5 10.9 14.5 13.3 10.4 11.9 13.5 11.9 9.0 13.3 12.3 12.0 respiratory infection B. Nutritional status Children: Moderate stunting 20.0 23.7 21.3 18.7 13.2 19.5 23.9 21.5 18.8 18.7 15.5 19.9 Severe stunting 14.3 15.3 8.1 10.7 3.9 10.5 12.8 13.7 12.0 9.8 3.9 10.8 Moderate underweight 19.2 21.7 17.8 16.7 6.9 16.7 23.7 22.7 18.8 16.6 11.3 19.0 Severe underweight 7.7 7.3 3.4 2.8 1.3 4.5 7.3 8.7 5.6 3.3 1.0 5.4 Mild anemia 13.7 25.2 26.3 20.5 19.0 20.6 22.6 19.2 28.2 21.7 22.3 22.8 Moderate anemia 58.0 51.5 53.5 49.8 37.9 51.1 59.8 51.4 49.3 54.0 41.3 52.2 Severe anemia 12.5 10.1 5.9 6.3 6.5 8.6 7.8 15.7 9.4 6.4 3.4 9.0 C. Sexually transmitted disease Prevalence of genital discharge: Women 1.0 1.2 0.8 2.6 4.9 2.3 Men 1.9 1.1 2.1 3.3 3.9 2.5 Prevalence of genital ulcer: Women 0.5 0.8 0.6 0.6 1.9 0.9 Men 1.0 1.0 1.1 1.8 1.8 1.4 - 9 - Benin 2001 - FEMALE / MALE POPULATIONS Part II: Intermediate Determinants of HNP Status - HNP SERVICE USE Indicator Wealth Quintiles - Female Wealth Quintiles - Male Low 2nd 3rd 4th High Avg. Low 2nd 3rd 4th High Avg. A. Childhood immunization BCG coverage 77.2 88.4 91.3 97.1 95.8 89.5 84.5 84.9 89.2 97.2 96.3 90.2 Measles coverage 57.8 62.5 60.4 73.6 83.3 67.0 55.8 61.0 70.1 77.8 82.8 69.1 DPT coverage 59.1 63.8 70.6 78.8 88.8 71.4 67.4 66.4 73.1 74.9 88.8 73.6 Full basic coverage 51.5 50.5 50.9 64.4 75.0 57.9 46.6 56.3 62.7 65.5 70.8 60.1 No basic coverage 15.4 9.6 3.5 1.7 1.3 6.7 14.5 13.3 5.8 1.7 3.7 7.9 Hepatitis B coverage na na na na na na na na na na na na Yellow fever coverage na na na na na na na na na na na na B. Treatment of childhood illnesses Treatment of fever: Medical treatment of fever 23.4 27.5 30.9 36.9 39.5 30.5 25.0 31.8 31.9 38.6 46.9 33.0 Treatment in a public facility 21.2 23.9 22.0 27.1 15.4 22.4 19.2 23.2 26.1 27.2 22.0 23.5 Treatment in a private facility 1.8 3.2 8.5 9.7 23.1 7.6 5.4 7.5 5.8 10.9 23.8 9.0 Treatment of acute respiratory infection: Medical treatment of ARI 22.8 28.6 39.0 35.6 (45.6) 34.0 29.1 36.9 (30.1) 36.6 (52.7) 36.2 Treatment in a public facility 20.9 26.9 26.4 35.6 (18.1) 26.3 20.4 24.9 (22.6) 30.2 (28.7) 25.1 Treatment in a private facility 1.9 1.7 11.5 0.0 (24.5) 6.9 8.8 12.0 (7.5) 6.4 (24.0) 11.1 Treatment of diarrhea: Use of oral rehydration therapy 52.7 41.3 61.8 58.8 (55.5) 53.2 54.2 47.7 62.4 66.3 (58.3) 57.1 Medical treatment of diarrhea 20.8 16.6 26.1 26.3 (22.1) 22.0 25.2 26.2 25.4 23.2 (25.7) 25.1 Treatment in a public facility 19.6 16.6 15.5 20.3 (12.6) 17.2 19.2 19.1 22.5 13.1 (8.9) 17.6 Treatment in a private facility 1.2 0.0 10.6 4.1 (6.9) 4.1 5.9 7.2 2.9 10.1 (16.9) 7.5 C. Contraceptive services Contraceptive prevalence: Women 4.0 3.2 6.7 8.3 14.7 7.2 Men 10.1 8.5 8.8 16.6 22.5 13.0 Source of contraception public sector: Women (54.6) (49.6) 70.3 56.8 50.1 56.0 Men na na na na na na Source of contraception - private sector: Women (28.5) (43.5) 24.3 37.0 45.5 37.3 Men na na na na na na D. Treatment of adult illnesses Treatment of genital discharge, ulcer, sore: Women * * * (61.6) 70.7 58.1 Men * * * * (74.2) 55.3 Treatment of genital discharge, ulcer, sore in public facilities: Women na na na na na na Men na na na na na na Voluntary counseling and testing for HIV/AIDS: Women 1.3 1.0 2.6 5.1 12.9 5.1 Men 2.2 2.6 5.8 6.5 14.8 6.8 - 10 - Benin 2001 - FEMALE / MALE POPULATIONS Part III: Intermediate Determinants of HNP Status - INDIVIDUAL AND HOUSEHOLD BEHAVIOR Indicator Wealth Quintiles - Female Wealth Quintiles - Male Low 2nd 3rd 4th High Avg. Low 2nd 3rd 4th High Avg. A. Hygienic practices Disposal of children's stools: Sanitary disposal 1.7 2.0 7.7 26.7 64.9 18.5 Handwashing: Wash hands prior to preparing food 87.2 91.4 93.7 95.4 94.2 92.6 Handwashing facilities in household 0.0 0.0 0.1 0.2 8.7 1.9 B. Bednet ownership and use Bednet use: By children 24.7 24.9 26.1 39.3 57.0 33.8 C. Breastfeeding Exclusive breastfeeding (48.4) (51.3) (56.3) (51.3) (39.0) 49.8 (51.2) (42.2) (38.7) (56.6) * 46.4 Timely complementary feeding (70.5) (69.3) (75.5) (73.0) (73.4) 72.4 47.2 (59.1) (67.3) (58.5) * 58.5 Bottle-feeding 1.8 0.9 3.6 7.2 36.7 8.5 2.2 2.1 0.8 4.9 18.0 4.5 D. Micronutrient consumption Vitamin A: Children 10.1 10.8 12.6 27.0 36.4 18.4 8.2 13.7 15.6 22.5 38.5 18.3 E. Tobacco and alcohol use Tobacco: Women 8.9 4.7 2.7 1.1 0.2 3.2 Men na na na na na na Alcohol: Women 2.4 2.3 1.5 2.9 3.5 2.6 Men na na na na na na F. Sexual practices Non-regular sexual partnerships: Women 0.6 0.8 0.9 1.3 2.3 1.3 Men 11.8 11.6 13.2 21.4 25.0 17.1 Condom usage with non-regular partner: Women * * * * (30.4) 20.3 Men 25.2 25.9 30.3 47.8 54.5 41.9 - 11 - Benin 2001 - FEMALE / MALE POPULATIONS Part IV: UNDERLYING DETERMINANTS OF HNP STATUS Indicator Wealth Quintiles - Female Wealth Quintiles - Male Low 2nd 3rd 4th High Avg. Low 2nd 3rd 4th High Avg. A. Education School completion: Women 3.0 5.4 8.9 20.6 54.5 20.7 Men 14.0 22.8 34.0 48.6 77.0 42.2 School participation: Girls 26.3 31.3 47.8 57.5 68.8 45.8 Boys 37.9 46.7 56.6 71.3 89.1 58.0 B. Exposure to mass media Newspaper readership: Women 0.3 0.9 2.3 5.2 14.3 5.3 Men 1.9 2.6 5.4 13.8 29.8 11.8 Radio listenership: Women 46.9 58.0 64.3 67.5 73.2 62.9 Men 75.4 87.3 85.4 87.9 85.8 84.1 Television viewership: Women 2.3 4.1 6.1 16.6 66.0 22.0 Men 7.7 11.4 17.1 36.7 78.7 33.0 C. Knowledge and attitudes about HIV/AIDS Knowledge about sexual transmission of HIV/AIDS: Women 41.3 53.1 57.7 60.7 72.5 58.2 Men 71.1 75.1 80.8 81.6 88.6 79.7 Knowledge about mother-to-child transmission of HIV/AIDS: Women 72.0 69.5 74.4 82.8 87.7 75.2 Men 70.9 71.2 70.6 78.3 85.3 73.2 Attitudes toward HIV/AIDS: Women 78.6 78.9 78.3 77.6 59.0 73.4 Men 68.0 66.9 69.3 61.8 36.9 59.9 D. Orphanhood Paternal orphan prevalence 4.5 4.4 4.9 4.3 5.4 4.7 4.7 5.0 4.8 4.7 6.0 5.0 Maternal orphan prevalence 1.9 2.1 2.0 2.4 1.8 2.0 2.0 1.5 2.4 1.4 1.7 1.8 Double orphan prevalence 0.6 0.4 0.3 0.7 0.4 0.5 0.5 0.4 0.6 0.5 0.4 0.5 - 12 - Benin 2001 - RURAL / URBAN POPULATIONS Part I: HNP STATUS Indicator Wealth Quintiles - Rural Wealth Quintiles - Urban Low 2nd 3rd 4th High Avg. Low 2nd 3rd 4th High Avg. A. Childhood illness and mortality Infant mortality rate 113.7 109.6 106.5 85.0 * 104.5 (100.1) (99.3) (105.4) 67.8 50.1 72.9 Under-five mortality rate 199.0 176.8 178.9 136.2 * 175.5 (194.1) * (190.4) 126.3 89.6 133.6 Prevalence of fever 45.0 44.0 45.2 41.8 27.5 43.7 47.6 41.9 40.6 36.2 29.9 35.9 Prevalence of diarrhea 14.4 15.4 13.8 14.0 12.0 14.4 19.2 14.2 9.9 10.6 9.4 11.3 Prevalence of acute 12.4 11.9 11.9 13.3 11.7 12.3 10.1 8.7 10.4 13.3 11.3 11.3 respiratory infection B. Fertility Total fertility rate (7.3) 6.6 6.7 (5.1) * 6.4 * * * (4.8) 3.4 4.4 Adolescent fertility rate (178.0) 146.0 155.0 (98.0) * 141.9 * * * (83.0) 30.0 71.7 C. Nutritional status Children: Moderate stunting 21.6 22.5 21.8 18.7 21.7 21.3 24.0 22.3 12.8 18.8 13.3 16.4 Severe stunting 13.6 14.7 9.9 10.6 5.2 12.1 13.3 12.7 10.9 9.8 3.7 7.8 Moderate underweight 22.0 22.5 18.9 16.0 11.0 19.8 18.8 20.6 16.0 17.7 8.8 13.8 Severe underweight 7.3 7.9 4.0 2.4 1.0 5.5 8.8 8.8 6.8 4.0 1.2 3.9 Mild anemia 19.8 21.7 27.9 22.4 (22.4) 22.7 10.5 24.3 25.5 19.3 20.2 19.8 Moderate anemia 57.1 51.6 49.6 53.0 (49.7) 53.0 67.2 49.8 56.8 50.3 37.8 48.8 Severe anemia 10.4 13.2 8.6 6.8 0.0 9.8 9.1 12.6 5.0 5.8 5.9 6.7 Women: Malnutrition 16.6 12.4 11.1 8.0 6.4 11.9 15.0 15.5 16.2 10.5 5.9 9.1 Mild anemia 38.5 38.4 40.0 40.0 40.1 39.2 51.0 38.8 42.6 42.0 42.8 43.0 Moderate anemia 20.8 20.7 21.9 19.6 18.4 20.7 23.2 25.8 21.6 18.3 25.8 23.3 Severe anemia 1.6 2.5 1.3 2.2 1.0 1.9 1.0 6.9 3.1 2.2 0.9 1.8 D. Female circumcision Prevalence of circumcision: Girls 14.2 11.5 10.7 3.9 0.0 10.1 21.0 20.0 12.9 4.5 0.4 6.3 Women 24.9 22.8 20.2 12.8 0.6 19.7 30.0 42.7 28.8 13.4 3.6 12.6 Prevalence of occlusion: Girls 1.6 3.9 (6.5) * * 4.0 * * * * * 3.3 Women 3.0 3.0 5.0 4.3 * 3.7 0.0 1.8 4.8 3.8 (4.6) 3.0 E. Sexually transmitted disease Prevalence of genital discharge: Women 1.0 1.2 0.9 3.1 4.9 1.6 0.6 1.6 0.5 1.9 4.9 3.2 Men 1.9 1.0 2.3 2.5 4.3 1.9 2.1 1.5 1.3 4.1 3.8 3.4 Prevalence of genital ulcer: Women 0.6 0.5 0.6 0.6 1.4 0.6 0.0 2.2 0.5 0.6 1.9 1.3 Men 0.8 0.9 1.3 0.8 1.6 1.0 2.0 1.5 0.0 2.7 1.8 1.9 - 13 - Benin 2001 - RURAL / URBAN POPULATIONS Part II: Intermediate Determinants of HNP Status - HNP SERVICE USE Indicator Wealth Quintiles - Rural Wealth Quintiles - Urban Low 2nd 3rd 4th High Avg. Low 2nd 3rd 4th High Avg. A. Childhood immunization BCG coverage 83.8 87.2 91.3 96.6 * 89.3 (66.1) (83.4) (85.0) 97.9 96.1 91.0 Measles coverage 57.8 61.0 65.1 74.3 * 64.1 (52.7) (66.2) (67.4) 77.4 83.4 75.3 DPT coverage 65.3 64.3 71.7 72.8 * 68.4 (52.4) (69.8) (72.7) 81.9 90.1 80.1 Full basic coverage 50.2 53.6 57.4 63.6 * 56.1 (44.8) (52.6) (55.8) 66.6 72.5 64.4 No basic coverage 14.6 11.1 5.0 2.3 * 8.7 (16.9) (13.6) (3.3) 1.0 2.3 4.7 Hepatitis B coverage na na na na na na na na na na na na Yellow fever coverage na na na na na na na na na na na na B. Treatment of childhood diseases Treatment of fever: Medical treatment of fever 24.5 30.4 30.8 37.1 (58.3) 30.4 22.7 25.7 33.9 38.8 41.2 35.2 Treatment in a public facility 20.2 23.7 23.8 29.5 (39.2) 23.9 20.2 22.1 25.8 23.2 16.0 20.5 Treatment in a private facility 3.9 5.7 6.9 7.6 (14.3) 6.0 2.5 3.7 8.2 14.8 24.6 14.3 Treatment of acute respirator infection (ARI): Medical treatment of ARI 24.7 32.7 36.8 39.7 * 33.5 * * * (30.8) 47.9 38.8 Treatment in a public facility 19.1 25.7 24.0 39.7 * 26.5 * * * (23.2) 21.3 24.0 Treatment in a private facility 5.7 7.0 12.0 0.0 * 6.8 * * * (7.6) 25.0 14.1 Treatment of diarrhea: Use of oral rehydration therapy 60.3 40.4 61.2 55.9 * 53.7 (27.3) * * (76.1) 58.4 58.9 Medical treatment of diarrhea 24.6 21.8 23.3 16.0 * 22.2 (17.6) * * (41.4) 22.6 27.3 Treatment in a public facility 19.8 18.0 16.9 12.9 * 17.3 (17.6) * * (23.4) 10.3 17.6 Treatment in a private facility 4.7 3.8 6.4 3.1 * 4.8 0.0 * * (15.4) 10.6 8.4 C. Antenatal and delivery care Antenatal care visits: To a medically trained person 75.4 82.9 90.8 94.7 100.0 85.4 61.0 81.1 86.9 96.9 99.4 91.5 To a doctor 1.8 1.4 4.8 4.5 14.6 3.3 0.0 1.1 2.3 3.1 22.9 11.3 To a nurse or trained midwife 73.6 81.5 86.0 90.2 85.4 82.1 61.0 80.0 84.5 93.8 76.5 80.2 Multiple visits to a medically trained 61.4 69.4 78.3 86.6 93.7 73.1 48.7 68.7 75.3 89.2 92.2 82.7 person Antenatal care content: Tetanus toxoid 65.6 66.1 73.6 76.5 72.0 69.8 53.9 68.3 71.5 76.1 74.7 71.8 Prophylactic antimalarial treatment 73.4 77.4 87.0 85.5 95.0 80.6 60.3 76.7 82.7 89.1 92.3 85.5 Iron supplementation 73.9 80.9 86.2 90.1 95.8 82.3 61.3 74.1 84.8 92.7 94.9 87.7 Delivery attendance: By a medically trained person 51.9 61.2 77.6 89.1 98.7 68.4 37.5 55.9 74.0 91.8 99.4 82.9 By a doctor 1.6 1.6 2.1 3.5 11.2 2.3 1.4 2.9 1.8 6.9 17.4 9.5 By a nurse or trained midwife 50.3 59.6 75.5 85.6 87.6 66.1 36.1 53.0 72.2 85.0 82.0 73.4 In a public facility 51.8 59.5 75.9 79.3 83.3 65.4 42.3 53.8 69.4 72.3 64.5 63.5 In a private facility 5.3 6.7 5.4 9.8 16.7 6.8 2.8 7.1 8.7 20.9 33.4 21.0 At home 41.2 32.2 17.4 9.4 0.0 26.3 54.0 37.1 21.0 6.1 1.4 14.6 D. Contraceptive services Contraceptive prevalence: Women 3.5 3.3 6.2 9.8 18.8 5.8 6.8 2.4 8.6 6.0 14.2 9.8 Men 10.9 8.7 8.9 20.8 (26.5) 11.7 6.0 7.4 8.4 12.5 22.0 15.2 - 14 - Benin 2001 - RURAL / URBAN POPULATIONS Part II: Intermediate Determinants of HNP Status - HNP SERVICE USE (Cont.) Indicator Wealth Quintiles - Rural Wealth Quintiles - Urban Low 2nd 3rd 4th High Avg. Low 2nd 3rd 4th High Avg. D. Contraceptive services (cont.) Source of contraception - public sector: Women (48.4) (47.7) (62.0) 59.6 * 56.9 * * * * 47.9 54.9 Men na na na na na na na na na na na na Source of contraception - private sector: Women (31.8) (48.6) (30.7) 35.4 * 35.8 * * * * 46.9 39.0 Men na na na na na na na na na na na na E. Treatment of adult illnesses Treatment of genital discharge, ulcer, sore: Women * * * * * 41.6 * * * * 71.8 70.6 Men * * * * * (40.2) * * * * (74.0) 67.4 Treatment of genital discharge, ulcer, sore in public facilities: Women na na na na na na na na na na na na Men na na na na na na na na na na na na Voluntary counseling and testing for HIV/AIDS: Women 0.9 0.8 2.2 2.8 8.0 1.9 3.2 2.6 4.4 7.9 13.4 9.9 Men 2.1 2.8 5.4 4.8 15.0 4.1 2.6 1.3 7.5 8.2 14.8 10.7 - 15 - Benin 2001 - RURAL / URBAN POPULATIONS Part III: Intermediate Determinants of HNP Status - INDIVIDUAL AND HOUSEHOLD BEHAVIOR Indicator Wealth Quintiles - Rural Wealth Quintiles - Urban Low 2nd 3rd 4th High Avg. Low 2nd 3rd 4th High Avg. A. Hygienic practices Disposal of children's stools: Sanitary disposal na na na na na na na na na na na na Handwashing: Wash hands prior to preparing food 87.9 92.5 94.0 94.5 96.7 92.3 83.8 84.1 92.3 96.4 93.9 93.0 Handwashing facilities in household 0.0 0.0 0.1 0.2 5.4 0.3 0.0 0.0 0.0 0.2 9.2 4.5 B. Bednet ownership and use Bednet ownership: Bednet ownership 29.7 29.5 35.2 45.7 60.8 35.0 27.0 32.0 32.2 41.3 63.8 49.4 Treated bednet ownership na na na na na na na na na na na na Bednet use: By children 24.6 24.4 26.3 39.8 50.6 28.4 25.5 27.9 25.4 38.7 57.8 43.9 By pregnant women 27.3 34.0 22.4 39.8 * 30.5 (28.1) * * (28.7) 54.5 39.0 C. Breastfeeding Exclusive breastfeeding 50.6 49.6 47.2 (51.0) * 49.5 * * * * (41.6) 45.3 Timely complementary feeding 60.5 64.6 70.1 (73.7) * 66.8 * * * * (71.5) 61.1 Bottle-feeding 1.9 1.8 1.8 4.1 * 2.4 (2.5) 0.0 (4.0) 9.1 30.6 15.4 D. Micronutrient consumption Iodized salt: Availability of iodized salt 80.5 75.6 72.2 66.9 51.4 73.6 84.8 72.9 76.1 67.2 63.5 68.3 in household Vitamin A: Children 9.0 12.9 14.0 18.3 24.3 13.4 9.6 8.8 14.7 34.4 39.3 29.0 Women 10.7 16.1 14.1 15.0 27.2 14.2 13.0 22.6 21.8 32.1 41.5 32.1 E. Tobacco and alcohol use Tobacco: Women 9.0 4.3 3.0 1.2 0.0 4.4 8.4 7.2 1.7 0.9 0.2 1.5 Men na na na na na na na na na na na na Alcohol: Women 2.2 1.9 1.5 2.9 6.3 2.3 3.0 4.7 1.6 2.8 3.1 3.0 Men na na na na na na na na na na na na F. Sexual practices Non-regular sexual partnerships: Women 0.5 0.7 1.1 1.1 2.9 0.9 1.0 1.4 0.4 1.6 2.2 1.8 Men 11.5 12.9 13.8 20.5 16.5 14.0 13.0 4.2 10.7 22.1 26.1 21.4 Condom usage with non-regular partner: Women * * * * * (3.0) * * * * (35.3) (33.4) Men 25.9 25.5 31.9 35.9 43.7 30.3 22.5 33.3 21.8 58.3 55.3 52.5 G. Domestic violence Ever experienced violence na na na na na na na na na na na na Experienced violence in past year na na na na na na na na na na na na - 16 - Benin 2001 - RURAL / URBAN POPULATIONS Part IV: UNDERLYING DETERMINANTS OF HNP STATUS Indicator Wealth Quintiles - Rural Wealth Quintiles - Urban Low 2nd 3rd 4th High Avg. Low 2nd 3rd 4th High Avg. A. Education School completion: Women 2.7 5.2 7.6 16.7 47.9 9.3 4.7 6.8 14.0 25.4 55.3 37.6 Men 14.1 22.5 33.7 48.1 73.7 30.1 13.9 24.0 35.0 49.1 77.4 58.9 School participation: Girls 23.0 31.8 47.0 54.6 71.4 39.2 43.0 28.1 50.7 62.5 68.4 58.8 Boys 35.7 47.5 54.3 71.0 (93.1) 51.6 48.6 42.0 67.7 71.8 88.6 72.6 B. Exposure to mass media Newspaper readership: Women 0.3 0.9 2.2 4.0 11.2 2.1 0.6 1.4 2.8 6.5 14.7 9.8 Men 1.7 2.9 5.3 12.8 19.4 5.3 2.8 1.4 5.8 14.8 31.1 20.9 Radio listenership: Women 47.0 57.7 64.1 68.5 73.1 59.4 46.1 59.4 65.0 66.2 73.2 68.0 Men 75.3 87.0 84.5 89.3 85.0 83.1 75.8 88.9 89.0 86.6 85.9 85.5 Television viewership: Women 2.2 4.0 5.4 14.7 63.1 8.6 2.7 4.7 8.6 19.0 66.3 41.4 Men 7.6 11.5 14.9 32.3 73.2 17.1 8.2 10.7 26.2 40.8 79.4 55.4 C. Knowledge and attitudes about HIV/AIDS Knowledge about sexual transmission of HIV/AIDS: Women 41.1 53.4 57.8 64.7 72.4 54.5 42.5 50.6 57.3 55.9 72.5 63.7 Men 70.6 74.3 79.4 79.3 88.3 75.7 73.7 79.4 86.7 83.8 88.7 85.4 Knowledge about mother-to-child transmission of HIV/AIDS: Women 56.5 69.7 74.2 83.6 92.0 71.2 52.2 68.2 74.9 81.8 87.2 81.0 Men 58.5 72.3 69.8 81.4 92.3 69.8 58.5 65.1 73.6 75.4 84.4 77.9 Attitudes toward HIV/AIDS: Women 78.9 79.1 78.8 78.3 55.6 77.7 76.2 77.9 76.6 76.7 59.4 67.3 Men 74.1 67.0 72.3 70.3 41.5 69.6 65.9 66.0 57.3 53.9 36.4 46.5 D. Status of women Household decisionmaking: Can seek own health care 18.3 20.2 19.4 20.6 17.3 19.5 11.4 14.6 22.4 23.7 20.8 20.5 Can seek children's health care 72.1 79.1 84.2 86.6 89.3 80.1 73.5 68.2 85.9 85.8 93.7 86.6 Can make daily household purchases 56.2 54.8 56.6 55.7 47.0 55.4 51.0 54.7 53.5 56.5 48.9 51.6 Can make large household purchases 29.1 32.2 30.6 32.3 28.9 30.9 24.6 25.4 28.6 35.7 30.1 30.5 Can make meal-related decisions 46.6 45.9 48.5 49.7 40.4 47.2 43.1 34.3 33.9 48.1 41.7 42.1 Freedom of movement: Can travel to visit family, relatives 15.4 18.3 16.2 19.6 18.3 17.3 16.4 13.4 13.5 27.5 23.3 22.2 Other decisionmaking, attitudes: Can decide how to spend own money 70.3 71.7 79.3 83.2 84.9 76.0 75.7 78.5 80.7 89.8 90.0 87.0 Can decide whether to have sex 92.2 94.9 95.5 94.5 97.4 94.4 88.7 89.9 97.9 95.9 95.4 94.9 Justifies domestic violence 68.6 72.2 68.9 67.7 56.5 68.9 67.0 68.4 72.3 53.3 36.6 48.0 E. Orphanhood Paternal orphan prevalence 4.8 4.6 4.9 4.5 5.0 4.7 3.9 5.3 4.8 4.5 5.8 5.1 Maternal orphan prevalence 2.0 1.9 2.3 1.8 2.0 2.0 1.9 1.3 2.0 2.2 1.7 1.8 Double orphan prevalence 0.6 0.4 0.4 0.4 0.8 0.5 0.5 0.5 0.6 0.9 0.3 0.5 - 17 - . PART II. BASIC TABLES, 1996 A. TOTAL POPULATION B. FEMALE AND MALE POPULATIONS C. RURAL AND URBAN POPULATIONS Notes: ­ Each of the three sections referred to above consists of four divisions, presenting data for: I) hnp status; II) hnp service use; III) hnp-related individual and household behavior; and IV) other, underlying determinants of hnp status. ­ Full definitions of all indicators covered in the tables are provided in section A of the technical notes found in part II. ­ "na" appears in the table cells when data are not available, usually because the DHS survey concerned did not collect information about the indicator(s) in question. ­ Figures in the tables shown within parentheses indicate the absence of adequate observations to produce acceptably reliable values. Asterisks appear when the number of observations was too small to justify the presentation even of figures within parentheses. (For further information, see the section on "Sampling Errors" in the presentation of data and methods in part II.B.) Asterisks also will be found in columns showing statistical indices of inequality when the amount of quintile-specific information available is inadequate to permit computation of the value for the index concerned. ­ Female/male tables include only indicators relevant for both sexes; those pertaining to only one sex (e.g., fertility, women's nutritional status, antenatal care, attended deliveries) have been omitted. Benin 1996 - TOTAL POPULATION Part I: HNP STATUS Indicator Wealth Quintiles Low/High Low-High Concentration Index Ratio Diff. Value Standard Low 2nd 3rd 4th High Avg. (Abs. Val.) Errors A. Childhood illness and mortality Infant mortality rate 119.4 111.1 105.8 103.8 63.3 103.5 1.89 56.10 -0.0800 0.0012 Under-five mortality rate 208.3 201.7 196.7 178.4 110.1 183.9 1.89 98.20 -0.0814 0.0012 Prevalence of fever 55.4 59.0 56.6 51.6 43.5 54.0 1.27 11.90 -0.0413 0.0104 Prevalence of diarrhea 28.4 30.4 25.5 24.8 18.4 26.1 1.54 10.00 -0.0733 0.0190 Prevalence of acute 17.1 18.8 15.0 12.3 14.2 15.7 1.20 2.90 -0.0701 0.0264 respiratory infection B. Fertility Total fertility rate 7.3 6.9 6.8 5.4 3.8 6.0 1.92 3.50 -0.1168 0.0008 Adolescent fertility rate 178.0 175.0 143.0 113.0 33.0 119.0 5.39 145.00 -0.2518 0.0042 C. Nutritional status (%) Children: Moderate stunting 17.0 20.1 17.7 17.6 12.1 17.2 1.40 4.90 -0.0481 0.0263 Severe stunting 10.0 9.9 6.5 6.6 4.7 7.8 2.13 5.30 -0.1430 0.0431 Moderate underweight 25.5 27.7 20.1 18.7 14.3 21.8 1.78 11.20 -0.1122 0.0227 Severe underweight 11.9 8.0 6.9 4.6 4.5 7.4 2.64 7.40 -0.2151 0.0440 Mild anemia na na na na na na na na na na Moderate anemia na na na na na na na na na na Severe anemia na na na na na na na na na na Women: Malnutrition 21.0 16.7 14.1 12.2 7.0 15.0 3.00 14.00 -0.1762 0.0289 Mild anemia na na na na na na na na na na Moderate anemia na na na na na na na na na na Severe anemia na na na na na na na na na na D. Female circumcision (%) Prevalence of circumcision: Girls na na na na na na na na na na Women na na na na na na na na na na Prevalence of occlusion: Girls na na na na na na na na na na Women na na na na na na na na na na E. Sexually transmitted disease Prevalence of genital discharge: Women 0.2 0.2 0.0 0.1 0.3 0.2 0.67 0.10 0.0948 0.2584 Men 4.1 3.4 4.1 5.1 2.5 3.8 1.64 1.60 -0.0114 0.0569 Prevalence of genital ulcer: Women 0.0 0.0 0.0 0.0 0.2 0.0 0.00 0.20 0.7511 0.5347 Men 1.8 0.6 2.1 2.0 1.3 1.6 1.38 0.50 0.0248 0.0877 - 21 - Benin 1996 - TOTAL POPULATION Part II: Intermediate Determinants of HNP Status - HNP SERVICE USE Indicator Wealth Quintiles Low/High Low-High Concentration Index Ratio Diff. Value Standard Low 2nd 3rd 4th High Avg. (Abs. Val.) Errors A. Childhood immunization BCG coverage 69.9 81.6 93.3 93.2 95.7 85.4 0.73 25.80 0.0680 0.0085 Measles coverage 48.7 59.8 71.2 70.1 79.9 64.3 0.61 31.20 0.0921 0.0139 DPT coverage 46.5 63.5 74.2 72.8 87.9 66.9 0.53 41.40 0.1132 0.0128 Full basic coverage 37.8 53.4 62.7 59.2 73.6 55.6 0.51 35.80 0.1136 0.0171 No basic coverage 27.8 16.9 6.7 6.3 4.3 13.6 6.47 23.50 -0.3817 0.0497 Hepatitis B coverage na na na na na na na na na na Yellow fever coverage na na na na na na na na na na B. Treatment of childhood illnesses Treatment of fever: Medical treatment of fever 9.6 12.0 11.0 11.6 24.7 12.6 0.39 15.10 0.1257 0.0428 Treatment in a public facility 8.2 10.3 9.4 8.1 11.4 9.3 0.72 3.20 0.0272 0.0475 Treatment in a private facility 1.2 1.2 1.6 3.1 12.4 2.9 0.10 11.20 0.4127 0.1079 Treatment of acute respiratory infection (ARI): Medical treatment of ARI 23.8 27.3 28.4 31.4 (62.4) 31.7 (0.38) 86.20 0.1635 0.0393 Treatment in a public facility 18.5 24.3 24.2 20.5 (24.2) 22.2 (0.76) 42.70 0.0728 0.0484 Treatment in a private facility 3.9 2.3 4.2 9.4 (29.4) 7.6 (0.13) 33.30 0.4211 0.1044 Treatment of diarrhea: Use of oral rehydration therapy 53.1 57.0 61.9 57.3 74.7 58.8 0.71 21.60 0.0443 0.0167 Medical treatment of diarrhea 24.4 20.3 23.0 23.2 42.0 24.6 0.58 17.60 0.0701 0.0408 Treatment in a public facility 20.1 17.7 19.7 16.7 26.1 19.4 0.77 6.00 0.0223 0.0434 Treatment in a private facility 3.0 1.0 2.4 5.0 14.2 3.8 0.21 11.20 0.2487 0.1118 C. Antenatal and delivery care Antenatal care visits: To a medically trained person 59.0 74.1 87.9 93.9 98.6 80.5 0.60 39.60 0.1045 0.0054 To a doctor 2.1 2.7 4.3 5.0 20.5 5.8 0.10 18.40 0.4323 0.0555 To a nurse or trained midwife 56.9 71.5 83.7 88.9 78.1 74.7 0.73 21.20 0.0792 0.0071 Multiple visits to a medically trained 45.6 59.1 74.0 80.9 92.1 67.7 0.50 46.50 0.1423 0.0071 person Antenatal care content: Tetanus toxoid 53.4 67.9 81.5 81.7 82.4 71.8 0.65 29.00 0.0914 0.0071 Prophylactic antimalarial treatment na na na na na na na na na na Iron supplementation na na na na na na na na na na Delivery attendance: By a medically trained person 34.4 53.1 66.1 87.6 97.5 63.9 0.35 63.10 0.2035 0.0067 By a doctor 2.2 3.1 2.7 5.5 20.6 5.7 0.11 18.40 0.4131 0.0525 By a nurse or trained midwife 32.2 49.9 63.5 82.2 76.9 58.3 0.42 44.70 0.1832 0.0084 In a public facility 31.5 49.7 61.6 70.4 69.4 54.4 0.45 37.90 0.1613 0.0097 In a private facility 2.6 3.7 5.3 17.0 26.9 9.5 0.10 24.30 0.4358 0.0375 At home 64.7 44.4 32.0 11.9 3.4 34.9 19.03 61.30 -0.3604 0.0120 - 22 - Benin 1996 - TOTAL POPULATION Part II: Intermediate Determinants of HNP Status - HNP SERVICE USE (Cont.) Indicator Wealth Quintiles Low/High Low-High Concentration Index Ratio Diff. Value Standard Low 2nd 3rd 4th High Avg. (Abs. Val.) Errors D. Contraceptive services (cont.) Contraceptive prevalence: Women 1.3 1.4 1.7 4.6 9.0 3.4 0.14 7.70 0.3859 0.0544 Men 3.3 3.4 8.0 14.5 20.0 9.5 0.17 16.70 0.4055 0.0476 Source of contraception - public sector: Women * * * (50.1) 52.0 51.3 * * * * Men na na na na na na na na na na Source of contraception - private sector: Women * * * (36.4) 46.1 40.6 * * * * Men na na na na na na na na na na E. Treatment of adult illnesses Treatment of genital discharge, ulcer, sore: Women * * * * * * * * * * Men * * * * * 38.5 * * * * Treatment of genital discharge, ulcer, sore in public facilities: Women na na na na na na na na na na Men na na na na na na na na na na Voluntary counseling and testing for HIV/AIDS: Women na na na na na na na na na na Men na na na na na na na na na na - 23 - Benin 1996 - TOTAL POPULATION Part III: Intermediate Determinants of HNP Status - INDIVIDUAL AND HOUSEHOLD BEHAVIOR Indicator Wealth Quintiles Low/High Low-High Concentration Index Ratio Diff. Value Standard Low 2nd 3rd 4th High Avg. (Abs. Val.) Errors A. Hygienic practices Disposal of children's stools: Sanitary disposal na na na na na na na na na na Handwashing: Wash hands prior to preparing food na na na na na na na na na na Handwashing facilities in household na na na na na na na na na na B. Bednet ownership and use Bednet ownership: Bednet ownership na na na na na na na na na na Treated bednet ownership na na na na na na na na na na Bednet use: By children na na na na na na na na na na By pregnant women na na na na na na na na na na C. Breastfeeding Exclusive breastfeeding 4.5 6.1 12.6 (30.0) (30.1) 14.1 (0.15) 34.60 0.3774 0.0843 Timely complementary feeding 79.1 86.3 85.7 90.5 (81.5) 84.8 (0.97) 160.60 0.0131 0.0141 Bottle-feeding 0.0 2.2 1.9 9.7 14.4 4.5 0.00 14.40 0.5498 0.0962 D. Micronutrient consumption Iodized salt: Availability of iodized salt 67.1 80.5 80.7 81.8 82.2 78.7 0.82 15.10 0.0364 0.0050 in household Vitamin A: Children 9.6 4.5 4.7 1.2 2.0 4.7 4.80 7.60 -0.3933 0.0641 Women na na na na na na na na na na E. Tobacco and alcohol use Tobacco: Women na na na na na na na na na na Men na na na na na na na na na na Alcohol: Women na na na na na na na na na na Men na na na na na na na na na na F. Sexual practices Non-regular sexual partnerships: Women 0.9 1.0 0.5 0.7 0.2 0.6 4.50 0.70 -0.2241 0.1010 Men 25.1 26.0 31.2 30.5 37.4 30.3 0.67 12.30 0.0880 0.0177 Condom usage with non-regular partner: Women * * * * * (13.2) * * * * Men 1.2 10.8 12.2 25.1 43.9 21.7 0.03 42.70 0.4104 0.0397 G. Domestic violence Ever experienced violence na na na na na na na na na na Experienced violence in past year na na na na na na na na na na - 24 - Benin 1996 - TOTAL POPULATION Part IV: UNDERLYING DETERMINANTS OF HNP STATUS Indicator Wealth Quintiles Low/High Low-High Concentration Index Ratio Diff. Value Standard Low 2nd 3rd 4th High Avg. (Abs. Val.) Errors A. Education School completion: Women 1.3 1.5 5.5 15.8 44.4 14.9 0.03 43.10 0.5681 0.0201 Men 7.8 15.8 24.9 44.9 70.8 35.0 0.11 63.00 0.3877 0.0093 School participation: Girls 11.0 20.3 25.9 42.9 66.9 33.8 0.16 55.90 0.3238 0.0155 Boys 22.0 35.0 50.5 62.3 83.3 49.3 0.26 61.30 0.2385 0.0103 B. Exposure to mass media Newspaper readership: Women 0.3 1.3 2.7 8.9 25.4 8.4 0.01 25.10 0.5875 0.0314 Men 4.7 11.8 13.0 28.7 52.9 23.4 0.09 48.20 0.4200 0.0266 Radio listenership: Women 5.3 8.3 10.3 14.8 25.8 13.4 0.21 20.50 0.3008 0.0212 Men 27.8 30.0 36.3 54.2 60.3 42.3 0.46 32.50 0.1911 0.0169 Television viewership: Women 24.5 39.2 47.2 59.6 82.1 51.9 0.30 57.60 0.2215 0.0068 Men 41.2 55.9 70.5 82.1 92.9 68.9 0.44 51.70 0.1678 0.0085 C. Knowledge and attitudes about HIV/AIDS Knowledge about sexual transmission of HIV/AIDS: Women 79.5 80.1 83.8 88.8 90.8 84.9 0.88 11.30 0.0331 0.0033 Men 91.1 95.0 95.0 96.3 99.8 95.5 0.91 8.70 0.0174 0.0025 Knowledge about mother-to-child transmission of HIV/AIDS: Women 56.9 51.8 61.9 74.1 82.1 61.6 0.69 25.20 0.1646 0.0057 Men 73.6 68.4 79.3 83.8 90.8 76.4 0.81 17.20 0.0909 0.0063 Attitudes toward HIV/AIDS: Women na na na na na na na na na na Men na na na na na na na na na na D. Status of women Household decisionmaking: Can seek own health care na na na na na na na na na na Can seek children's health care na na na na na na na na na na Can make daily household purchases na na na na na na na na na na Can make large household purchases na na na na na na na na na na Can make meal-related decisions na na na na na na na na na na Freedom of movement: Can travel to visit family, relatives na na na na na na na na na na Other decisionmaking, attitudes: Can decide how to spend own money 82.1 81.8 80.0 80.8 86.8 82.3 0.95 4.69 0.0060 0.0040 Can decide whether to have sex na na na na na na na na na na Justifies domestic violence na na na na na na na na na na E. Orphanhood Paternal orphan prevalence 4.2 4.1 3.7 5.8 4.9 4.5 0.86 0.70 0.0448 0.0255 Maternal orphan prevalence 2.8 2.5 2.1 2.8 1.8 2.4 1.56 1.00 -0.0435 0.0343 Double orphan prevalence 0.2 0.4 0.3 0.2 0.4 0.3 0.50 0.20 0.0575 0.1028 - 25 - Benin 1996 - FEMALE / MALE POPULATIONS Part I: HNP STATUS Indicator Wealth Quintiles - Female Wealth Quintiles - Male Low 2nd 3rd 4th High Avg. Low 2nd 3rd 4th High Avg. A. Childhood mortality and morbidity Infant mortality rate 118.7 117.6 89.9 85.9 61.5 97.6 120.1 104.6 121.4 119.7 65.3 109.3 Under-five mortality rate 214.5 204.1 181.6 158.6 113.2 179.1 202.4 199.2 211.4 196.3 107.0 188.6 Prevalence of fever 49.8 58.8 57.2 50.7 42.4 52.4 60.9 59.3 56.1 52.5 44.7 55.6 Prevalence of diarrhea 26.8 29.6 23.4 22.3 18.7 24.7 29.9 31.2 27.8 27.1 18.1 27.5 Prevalence of acute 16.2 19.0 14.3 11.0 15.4 15.3 18.0 18.6 15.8 13.5 12.9 16.1 respiratory infection B. Nutritional status Children: Moderate stunting 19.6 19.2 15.8 15.6 11.9 16.7 14.8 20.9 19.7 19.4 12.2 17.7 Severe stunting 8.4 7.9 4.7 4.2 4.3 6.0 11.6 12.0 8.3 8.8 5.0 9.5 Moderate underweight 23.9 26.3 19.6 15.4 12.7 20.1 27.0 29.2 20.5 21.8 16.0 23.5 Severe underweight 10.8 5.3 6.3 1.9 6.2 6.1 12.8 10.8 7.4 7.3 2.7 8.7 Mild anemia na na na na na na na na na na na na Moderate anemia na na na na na na na na na na na na Severe anemia na na na na na na na na na na na na C. Sexually transmitted disease Prevalence of genital discharge: Women 0.2 0.2 0.0 0.1 0.3 0.2 Men 4.1 3.4 4.1 5.1 2.5 3.8 Prevalence of genital ulcer: Women 0.0 0.0 0.0 0.0 0.2 0.0 Men 1.8 0.6 2.1 2.0 1.3 1.6 - 27 - Benin 1996 - FEMALE / MALE POPULATIONS Part II: Intermediate Determinants of HNP Status - HNP SERVICE USE Indicator Wealth Quintiles - Female Wealth Quintiles - Male Low 2nd 3rd 4th High Avg. Low 2nd 3rd 4th High Avg. A. Childhood immunization BCG coverage 75.7 81.0 95.6 95.8 94.6 87.4 64.8 82.3 91.3 91.0 96.9 83.5 Measles coverage 47.8 59.5 74.4 70.8 82.8 65.4 49.4 60.0 68.5 69.5 76.9 63.4 DPT coverage 46.8 62.8 76.4 72.9 90.0 67.8 46.1 64.4 72.3 72.7 85.5 66.1 Full basic coverage 37.7 52.7 62.9 58.9 81.0 56.8 37.9 54.3 62.4 59.5 65.6 54.5 No basic coverage 22.8 17.1 4.4 4.2 5.4 11.8 32.1 16.6 8.7 8.2 3.1 15.3 Hepatitis B coverage na na na na na na na na na na na na Yellow fever coverage na na na na na na na na na na na na B. Treatment of childhood illnesses Treatment of fever: Medical treatment of fever 6.7 11.3 12.4 8.5 29.4 12.1 12.0 12.7 9.6 14.3 20.0 13.0 Treatment in a public facility 6.2 8.8 10.0 6.0 16.5 8.9 9.8 11.8 8.9 10.0 6.4 9.7 Treatment in a private facility 0.5 1.4 2.4 2.5 11.3 2.8 1.8 0.9 0.8 3.6 13.5 3.0 Treatment of acute respiratory infection: Medical treatment of ARI 17.0 23.5 (31.6) (24.3) (65.5) 29.7 29.7 31.3 (25.3) (36.9) * 33.6 Treatment in a public facility 12.5 20.4 (25.7) (10.1) (30.1) 19.5 23.7 28.4 (22.8) (28.4) * 24.7 Treatment in a private facility 2.9 1.7 (5.9) (14.3) (23.0) 7.6 4.6 2.9 (2.5) (5.7) * 7.6 Treatment of diarrhea: Use of oral rehydration therapy 56.6 52.1 59.9 51.0 (72.2) 56.9 50.2 61.9 63.7 62.2 (77.3) 60.6 Medical treatment of diarrhea 19.0 24.3 30.9 17.0 (29.5) 23.6 29.2 16.2 16.0 27.9 (55.3) 25.5 Treatment in a public facility 16.9 19.3 25.0 13.8 (20.8) 19.1 22.9 16.2 15.0 18.9 (31.7) 19.7 Treatment in a private facility 2.0 2.0 4.0 1.4 (8.7) 3.0 3.8 0.0 1.0 7.7 (20.0) 4.5 C. Contraceptive services Women 1.3 1.4 1.7 4.6 9.0 3.4 Men 3.3 3.4 8.0 14.5 20.0 9.5 Source of contraception - public sector: Women * * * (50.1) 52.0 51.3 Men na na na na na na Source of contraception - private sector: Women * * * (36.4) 46.1 40.6 Men na na na na na na D. Treatment of adult illnesses Treatment of genital discharge, ulcer, sore: Women * * * * * * Men * * * * * 38.5 Treatment of genital discharge, ulcer, sore in public facilities: Women na na na na na na Men na na na na na na Voluntary counseling and testing for HIV/AIDS: Women na na na na na na Men na na na na na na - 28 - Benin 1996 - FEMALE / MALE POPULATIONS Part III: Intermediate Determinants of HNP Status - INDIVIDUAL AND HOUSEHOLD BEHAVIOR Indicator Wealth Quintiles - Female Wealth Quintiles - Male Low 2nd 3rd 4th High Avg. Low 2nd 3rd 4th High Avg. A. Hygienic practices Disposal of children's stools: Sanitary disposal na na na na na na Handwashing: Wash hands prior to preparing food na na na na na na Handwashing facilities in household na na na na na na B. Bednet ownership and use Bednet use: By children na na na na na na C. Breastfeeding Exclusive breastfeeding (4.7) (9.2) (17.1) * * 14.3 (4.3) (2.4) (7.9) (37.3) * 14.0 Timely complementary feeding 79.8) (89.1) (79.5) (87.9) * 84.7 (78.4) (83.9) (91.9) (93.1) * 84.8 Bottle-feeding 0.0 0.6 0.6 12.8 17.1 4.7 0.0 4.1 3.2 6.7 11.4 4.3 D. Micronutrient consumption Vitamin A: Children 8.6 2.2 5.2 1.0 1.9 4.0 10.6 6.9 4.2 1.5 2.1 5.5 E. Tobacco and alcohol use Tobacco: Women na na na na na na Men na na na na na na Alcohol: Women na na na na na na Men na na na na na na F. Sexual practices Non-regular sexual partnerships: Women 0.9 1.0 0.5 0.7 0.2 0.6 Men 25.1 26.0 31.2 30.5 37.4 30.3 Condom usage with non-regular partner: Women * * * * * (13.2) Men 1.2 10.8 12.2 25.1 43.9 21.7 - 29 - Benin 1996 - FEMALE / MALE POPULATIONS Part IV: UNDERLYING DETERMINANTS OF HNP STATUS Indicator Wealth Quintiles - Female Wealth Quintiles - Male Low 2nd 3rd 4th High Avg. Low 2nd 3rd 4th High Avg. A. Education School completion: Women 1.3 1.5 5.5 15.8 44.4 14.9 Men 7.8 15.8 24.9 44.9 70.8 35.0 School participation: Girls 11.0 20.3 25.9 42.9 66.9 33.8 Boys 22.0 35.0 50.5 62.3 83.3 49.3 B. Exposure to mass media Newspaper readership: Women 0.3 1.3 2.7 8.9 25.4 8.4 Men 4.7 11.8 13.0 28.7 52.9 23.4 Radio listenership: Women 5.3 8.3 10.3 14.8 25.8 13.4 Men 27.8 30.0 36.3 54.2 60.3 42.3 Television viewership: Women 24.5 39.2 47.2 59.6 82.1 51.9 Men 41.2 55.9 70.5 82.1 92.9 68.9 C. Knowledge and attitudes about HIV/AIDS Knowledge about sexual transmission of HIV/AIDS: Women 79.5 80.1 83.8 88.8 90.8 84.9 Men 91.1 95.0 95.0 96.3 99.8 95.5 Knowledge about mother-to-child transmission of HIV/AIDS: Women 56.9 51.8 61.9 74.1 82.1 61.6 Men 73.6 68.4 79.3 83.8 90.8 76.4 Attitudes toward HIV/AIDS: Women na na na na na na Men na na na na na na D. Orphanhood Paternal orphan prevalence 4.8 5.2 4.2 5.2 4.7 4.8 3.6 3.0 3.1 6.5 5.2 4.2 Maternal orphan prevalence 2.9 2.7 2.9 2.4 1.9 2.6 2.7 2.3 1.3 3.2 1.8 2.3 Double orphan prevalence 0.1 0.4 0.5 0.3 0.5 0.4 0.3 0.3 0.1 0.2 0.2 0.2 - 30 - Benin 1996 - RURAL / URBAN POPULATIONS Part I: HNP STATUS Indicator Wealth Quintiles - Rural Wealth Quintiles - Urban Low 2nd 3rd 4th High Avg. Low 2nd 3rd 4th High Avg. A. Childhood illness and mortality Infant mortality rate 124.7 110.6 111.3 102.5 * 112.3 * (113.8) (83.9) 105.5 62.3 84.4 Under-five mortality rate 219.1 202.9 202.6 175.9 * 199.5 * * * 181.6 113.1 150.0 Prevalence of fever 55.9 60.7 59.1 51.6 61.0 57.4 52.8 49.9 47.2 51.6 40.8 46.8 Prevalence of diarrhea 27.9 29.2 26.6 21.6 31.8 27.0 31.3 36.9 21.5 29.0 16.4 24.2 Prevalence of acute 16.9 20.8 15.4 15.0 22.5 17.4 18.2 7.9 13.6 8.7 12.9 12.0 respiratory infection B. Fertility Total fertility rate 7.3 (6.7) (6.9) (5.9) * 6.7 * * * (4.9) 3.8 4.9 Adolescent fertility rate 186.0 (175.0) (142.0) (121.0) * 154.1 * * * (106.0) 32.0 76.2 C. Nutritional status Children: Moderate stunting 17.1 20.2 18.0 18.2 (16.0) 18.3 16.7 19.4 16.6 16.8 11.4 14.8 Severe stunting 9.9 9.9 6.3 5.8 (8.9) 8.3 10.7 9.9 7.2 7.7 4.0 6.6 Moderate underweight 25.6 27.9 19.8 16.9 (16.4) 23.0 24.7 26.7 21.2 21.2 13.9 19.1 Severe underweight 12.0 8.1 7.0 4.3 (11.8) 8.3 11.2 7.9 6.3 5.1 3.3 5.4 Mild anemia na na na na na na na na na na na na Moderate anemia na na na na na na na na na na na na Severe anemia na na na na na na na na na na na na Women: Malnutrition 21.4 16.5 13.5 12.6 (10.5) 16.5 18.5 17.9 16.3 11.8 6.5 11.8 Mild anemia na na na na na na na na na na na na Moderate anemia na na na na na na na na na na na na Severe anemia na na na na na na na na na na na na D. Female circumcision Prevalence of circumcision: Girls na na na na na na na na na na na na Women na na na na na na na na na na na na Prevalence of occlusion: Girls na na na na na na na na na na na na Women na na na na na na na na na na na na E. Sexually transmitted disease Prevalence of genital discharge: Women 0.2 0.2 0.0 0.2 1.4 0.2 0.0 0.0 0.0 0.0 0.1 0.1 Men 3.0 3.9 3.0 5.7 (5.2) 3.7 (11.7) 0.0 7.6 4.4 2.2 3.8 Prevalence of genital ulcer: Women 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.3 0.1 Men 1.6 0.7 2.2 1.3 (2.2) 1.5 (3.0) 0.0 2.0 2.7 1.2 1.7 - 31 - Benin 1996 - RURAL / URBAN POPULATIONS Part II: Intermediate Determinants of HNP Status - HNP SERVICE USE Indicator Wealth Quintiles - Rural Wealth Quintiles - Urban Low 2nd 3rd 4th High Avg. Low 2nd 3rd 4th High Avg. A. Childhood immunization BCG coverage 74.2 81.4 92.9 95.4 * 84.4 (44.3) (82.4) * 90.4 96.8 87.5 Measles coverage 52.9 61.5 71.0 71.6 * 63.3 (24.0) (51.1) * 68.2 79.7 66.6 DPT coverage 50.7 66.0 73.8 79.4 * 65.8 (21.5) (51.1) * 64.2 88.6 69.3 Full basic coverage 41.8 55.3 61.8 62.2 * 54.6 (14.0) (43.8) * 55.3 72.6 57.8 No basic coverage 23.0 16.7 7.1 3.8 * 14.1 (55.7) (17.6) * 9.6 3.2 12.5 Hepatitis B coverage na na na na na na na na na na na na Yellow fever coverage na na na na na na na na na na na na B. Treatment of childhood diseases Treatment of fever: Medical treatment of fever 9.4 11.0 10.2 11.8 (22.0) 10.8 (10.7) (18.5) (15.0) 11.3 25.2 17.2 Treatment in a public facility 8.5 9.1 9.6 9.4 (12.8) 9.2 (6.9) (18.5) (8.4) 6.4 11.1 9.7 Treatment in a private facility 0.7 1.3 0.6 1.7 (9.2) 1.3 (3.9) 0.0 (6.6) 4.9 13.2 7.3 Treatment of acute respiratory infection (ARI): Medical treatment of ARI 22.0 25.8 24.6 (34.7) * 26.6 * * * * (65.3) 47.6 Treatment in a public facility 17.9 22.6 23.1 (26.5) * 22.0 * * * * (23.7) 22.6 Treatment in a private facility 2.4 2.4 1.6 (5.9) * 3.5 * * * * (30.6) 20.3 Treatment of diarrhea: Use of oral rehydration therapy 55.9 58.7 61.9 50.3 * 57.8 (39.5) (49.3) * 64.2 (77.5) 61.4 Medical treatment of diarrhea 24.7 18.6 19.3 23.3 * 22.6 (23.0) (27.6) * 23.1 (37.0) 29.5 Treatment in a public facility 20.2 15.5 17.4 17.8 * 18.6 (19.8) (27.6) * 15.6 (21.0) 21.3 Treatment in a private facility 2.9 1.2 1.9 4.0 * 2.7 (3.3) 0.0 * 5.9 (13.8) 6.5 C. Antenatal and delivery care Antenatal care visits: To a medically trained person 61.6 74.0 87.3 92.4 94.3 76.8 43.9 75.1 90.4 95.7 99.3 88.3 To a doctor 1.9 2.9 4.9 1.6 13.6 3.2 3.4 1.5 1.8 9.1 21.6 11.4 To a nurse or trained midwife 59.8 71.1 82.4 90.9 80.7 73.7 40.5 73.6 88.6 86.6 77.7 76.8 Multiple visits to a medically trained 47.2 59.2 74.6 81.5 90.5 63.6 36.4 58.6 71.9 80.3 92.3 76.4 person Antenatal care content: Tetanus toxoid 55.9 67.9 81.6 81.9 92.3 70.4 39.0 67.8 80.9 81.5 80.8 74.9 Prophylactic antimalarial treatment na na na na na na na na na na na na Iron supplementation na na na na na na na na na na na na Delivery attendance: By a medically trained person 36.0 51.6 64.7 86.7 91.6 56.5 25.1 61.0 71.5 88.7 98.4 79.9 By a doctor 2.4 3.1 2.5 3.1 16.2 3.1 1.0 3.4 3.3 8.5 21.3 11.2 By a nurse or trained midwife 33.5 48.5 62.2 83.7 75.4 53.4 24.1 57.6 68.1 80.3 77.1 68.7 In a public facility 33.2 48.0 61.5 75.6 75.2 51.8 21.0 58.7 62.0 63.8 68.5 60.0 In a private facility 2.3 4.0 3.8 11.2 16.8 4.9 4.1 2.2 10.9 24.3 28.5 19.4 At home 62.9 46.1 33.5 12.6 8.0 42.0 74.9 35.2 26.2 11.1 2.7 19.7 D. Contraceptive services Contraceptive prevalence: Women 1.3 1.1 2.1 3.3 9.9 2.1 1.5 2.5 0.0 6.1 8.8 5.8 Men 3.3 2.7 8.5 11.3 (24.5) 6.3 (3.0) * (5.9) 17.8 19.4 15.5 - 32 - Benin 1996 - RURAL / URBAN POPULATIONS Part II: Intermediate Determinants of HNP Status - HNP SERVICE USE (Cont.) Indicator Wealth Quintiles - Rural Wealth Quintiles - Urban Low 2nd 3rd 4th High Avg. Low 2nd 3rd 4th High Avg. D. Contraceptive services (cont.) Source of contraception - public sector: Women * * * * * 50.5 * * * * (51.9) 51.8 Men na na na na na na na na na na na na Source of contraception - private sector: Women * * * * * 37.7 * * * * (45.8) 42.6 Men na na na na na na na na na na na na E. Treatment of adult illnesses Treatment of genital discharge, ulcer, sore: Women * * * * * * * * * * * * Men * * * * * 31.4 * * * * * * Treatment of genital discharge, ulcer, sore in public facilities: Women na na na na na na na na na na na na Men na na na na na na na na na na na na Voluntary counseling and testing for HIV/AIDS: Women na na na na na na na na na na na na Men na na na na na na na na na na na na - 33 - Benin 1996 - RURAL / URBAN POPULATIONS Part III: Intermediate Determinants of HNP Status - INDIVIDUAL AND HOUSEHOLD BEHAVIOR Indicator Wealth Quintiles - Rural Wealth Quintiles - Urban Low 2nd 3rd 4th High Avg. Low 2nd 3rd 4th High Avg. A. Hygienic practices Disposal of children's stools: Sanitary disposal na na na na na na na na na na na na Handwashing: Wash hands prior to preparing food na na na na na na na na na na na na Handwashing facilities in household na na na na na na na na na na na na B. Bednet ownership and use Bednet ownership: Bednet ownership na na na na na na na na na na na na Treated bednet ownership na na na na na na na na na na na na Bednet use: By children na na na na na na na na na na na na By pregnant women na na na na na na na na na na na na C. Breastfeeding Exclusive breastfeeding 5.5 6.8 13.6 (29.1) * 11.0 * * * * (32.1) 21.3 Timely complementary feeding 79.7 82.9 86.3 (86.5) * 83.2 * * * * (83.0) 87.9 Bottle-feeding 0.0 2.1 2.4 8.5 * 2.6 0.0 (3.0) 0.0 11.4 15.7 8.7 D. Micronutrient consumption Iodized salt: Availability of iodized salt 65.7 79.2 81.5 77.3 73.7 75.6 78.1 88.6 78.0 86.5 83.2 83.6 in household Vitamin A: Children 10.5 3.9 3.4 0.4 (2.1) 5.1 4.0 7.7 9.7 2.3 2.0 3.9 Women na na na na na na na na na na na na E. Tobacco and alcohol use Tobacco: Women na na na na na na na na na na na na Men na na na na na na na na na na na na Alcohol: Women na na na na na na na na na na na na Men na na na na na na na na na na na na F. Sexual practices Non-regular sexual partnerships: Women 0.7 0.9 0.4 0.2 0.0 0.6 1.7 1.5 0.9 1.2 0.2 0.7 Men 26.3 24.5 30.7 28.2 (32.4) 27.3 (17.0) (36.3) 32.7 32.9 38.0 34.7 Condom usage with non-regular partner: Women * * * * * * * * * * * * Men 1.3 9.1 14.5 24.3 (24.6) 11.3 0.0 (18.4) 5.0 25.8 45.6 34.1 G. Domestic violence Ever experienced violence na na na na na na na na na na na na Experienced violence in past year na na na na na na na na na na na na - 34 - Benin 1996 - RURAL / URBAN POPULATIONS Part IV: UNDERLYING DETERMINANTS OF HNP STATUS Indicator Wealth Quintiles - Rural Wealth Quintiles - Urban Low 2nd 3rd 4th High Avg. Low 2nd 3rd 4th High Avg. A. Education School completion: Women 1.4 1.6 4.4 9.4 30.6 5.0 0.8 0.6 9.4 22.5 46.4 29.9 Men 8.3 16.8 25.3 43.2 62.0 22.8 4.2 10.5 23.5 46.7 71.9 52.3 School participation: Girls 11.5 19.4 23.9 40.3 61.4 24.4 7.1 26.0 32.0 46.8 68.0 50.7 Boys 22.7 34.5 46.7 54.9 71.4 39.4 16.9 37.4 62.9 72.4 85.5 69.0 B. Exposure to mass media Newspaper readership: Women 0.3 1.5 2.2 3.9 13.5 2.4 0.0 0.0 4.4 14.1 27.1 17.7 Men 4.7 11.8 11.6 24.0 (36.5) 12.4 (4.8) (12.0) 17.6 33.8 54.6 40.0 Radio listenership: Women 5.4 7.5 9.7 11.4 16.7 8.6 5.1 12.6 12.4 18.3 27.1 20.8 Men 26.1 28.6 33.0 53.6 (72.5) 34.4 (39.0) (38.8) 47.0 54.8 59.0 54.2 Television viewership: Women 24.8 40.2 47.7 55.7 72.8 42.0 23.0 33.4 45.3 63.7 83.5 66.8 Men 40.7 56.4 68.5 82.5 (86.1) 59.6 (44.2) (52.6) 77.0 81.7 93.5 83.2 C. Knowledge and attitudes about HIV/AIDS Knowledge about sexual transmission of HIV/AIDS: Women 78.9 78.6 84.6 89.0 88.2 82.4 82.9 88.6 81.4 88.7 91.2 88.8 Men 91.2 95.3 96.0 95.3 (97.9) 94.3 (90.5) (92.9) 91.5 97.3 100.0 97.4 Knowledge about mother-to-child transmission of HIV/AIDS: Women 34.8 51.8 62.5 75.1 73.6 54.8 23.5 52.0 59.8 73.1 83.3 72.0 Men 61.1 68.5 78.5 85.2 (86.0) 71.8 (41.7) (67.7) 81.9 82.4 91.3 83.4 Attitudes toward HIV/AIDS: Women na na na na na na na na na na na na Men na na na na na na na na na na na na D. Status of women Household decisionmaking: Can seek own health care na na na na na na na na na na na na Can seek children's health care na na na na na na na na na na na na Can make daily household purchases na na na na na na na na na na na na Can make large household purchases na na na na na na na na na na na na Can make meal-related decisions na na na na na na na na na na na na Freedom of movement: Can travel to visit family, relatives na na na na na na na na na na na na Other decisionmaking, attitudes: Can decide how to spend own money 71.5 70.6 71.0 69.3 77.0 71.0 78.6 87.6 79.4 77.0 79.2 79.2 Can decide whether to have sex na na na na na na na na na na na na Justifies domestic violence na na na na na na na na na na na na E. Orphanhood Paternal orphan prevalence 4.3 4.2 3.6 4.8 3.7 4.2 3.6 3.7 4.2 7.1 5.1 5.2 Maternal orphan prevalence 3.1 2.4 2.1 2.7 1.9 2.6 0.8 2.5 2.2 2.9 1.8 2.1 Double orphan prevalence 0.2 0.4 0.4 0.3 0.3 0.3 0.0 0.3 0.0 0.2 0.4 0.3 - 35 - PART III. TECHNICAL NOTES A. INDICATOR DEFINITIONS B. DATA AND METHODS C. DISCUSSION INDICATOR DEFINITIONS Part I: HNP STATUS A. CHILDHOOD MORTALITY AND ILLNESS 2 Infant mortality rate: number of deaths to children under 12 months of age per 1,000 live births, based on experience during the ten years preceding the survey. Under-five mortality rate: number of deaths to children under five years of age per 1,000 live births, based on experience during the ten years preceding the survey. Prevalence of fever: percent of children who had fever, whether or not accompanied by cough or rapid breathing, in the two weeks before the survey. Prevalence of diarrhea: percent of children who had diarrhea in the two weeks before the survey. Prevalence of acute respiratory infection: percent of children who had a cough accompanied by rapid or difficult breathing in the two weeks before the survey. B. FERTILITY Total fertility rate (TFR): average number of births a woman could expect to have during her lifetime if she followed the levels of fertility currently observed at every age. The TFR is calculated as the sum of average annual age-specific fertility rates for all reproductive age groups (usually 15-49 years) in the three years before the survey. Adolescent fertility rate: age-specific fertility rate for women 15-19 years of age. This is the average number of births among women aged 15-19 years per 1,000 women in that age group, based on births in the three years before the survey and expressed as annual averages. 2Figures for the prevalence of fever, diarrhea, and acute respiratory infection refer to percent of children under three, four, or five years of age, depending upon the country. (The specific ages covered for in particular country may be determined by consulting the full report on that country's DHS, which may be found at: www.measuredhs.com/countries.) - 39 - C. NUTRITIONAL STATUS Children 3, 4, 5 Moderate stunting (height-for-age): percent of children with a height-for-age Z-score of between ­2 and ­3 standard deviations of the median reference standard for their age (as defined in fn. 4). Severe stunting (height-for-age): percent of children with a height-for-age Z-score of below ­3 standard deviations of the median reference standard for their age (as defined in fn. 4). Moderate underweight (weight-for-age): percent of children with a weight-for-age Z-score of between ­2 and ­3 standard deviations of the median reference standard for their age (as defined in fn. 4). Severe underweight (weight-for-age): percent of children with a weight-for-age Z-score of below ­3 standard deviations of the median reference standard for their age (as defined in fn. 4). Mild anemia: percent of children with a hemoglobin level of between 10.0g/dl and 10.9 g/dl, the World Health Organization criterion for mild anemia. Moderate anemia: percent of children with a hemoglobin level of between 7.0g/dl and 9.9g/dl, the World Health Organization criterion for moderate anemia. Severe anemia: percent of children with a hemoglobin level of below 7.0g/dl, the World Health Organization criterion for severe anemia. Women 6, 7 Malnutrition: percent of women aged 15-49 years with a Body Mass Index (BMI) of less than 18.5, where BMI ­ commonly used to indicate adult nutritional status ­ is defined as weight in kilograms divided by the square of height in meters. Mild anemia: percent of women aged 15-49 years with a hemoglobin level of between 10.0g/dl and 10.9g/dl for pregnant women and between 10.0g/dl and 11.9g/dl for non-pregnant women, the World Health Organization criterion for mild anemia. Moderate anemia: percent of women aged 15-49 years with a hemoglobin level of between 7.0g/dl and 9.9g/dl, the World Health Organization criterion for moderate anemia. Severe anemia: percent of women aged 15-49 years with a hemoglobin level of less than 7.0g/dl, the World Health Organization criterion for severe anemia. 3 All figures related to children's nutrition status refer to children under three, four, or five years of age, depending upon the country. (The specific ages covered for in particular country may be determined by consulting the full report on the DHS of the country concerned, which is available at: www.measuredhs.com/countries.) 4 The reference standards used for stunting and underweight are those established in the 1970s by the World Health Organization, the U.S. Centers for Disease Control, and the U.S. National Center for Health Statistics. Updated stunting and underweight figures based on the recently-released, 2006 World Health Organization reference standards are currently under preparation. When complete, they will be available at: www.worldbank.org/povertyandhealth/ countrydata. 5The anemia figures for children living at an altitude above 1,000 meters have been adjusted to reflect the higher level of hemoglobin required. 6In some countries, the BMI is presented for all women; in others, the figure is available only for mothers of children under five years of age. The reference population for any given country can be determined by consulting the full report on the DHS for the country concerned. An electronic version of this report is located at: www.measuredhs.com/ countries. 7 Anemia cut-off points for respondents who live at an altitude above 1,000 meters and/or who smoke have been adjusted to account for their higher hemoglobin requirements. - 40 - D. FEMALE CIRCUMCISION Prevalence of Circumcision Girls: percent of women aged 15-49 years with one or more daughters, at least one of whom had been circumcised. Women: percent of women aged 15-49 years who had been circumcised. Prevalence of Occlusion Girls: percent of women aged 15-49 years with one or more daughters, at least one of whom had been circumcised with the vaginal area sewn closed. Women: percent of women aged 15-49 years whose vaginal area had been sewn closed. E. SEXUALLY TRANSMITTED DISEASES Prevalence of Genital Discharge Women: percent of women aged 15-49 years who had had abnormal genital discharge in the twelve months before the survey. Men: percent of men aged 15-54 years who had had abnormal genital discharge in the twelve months before the survey. Prevalence of Genital Ulcer or Sore Women: percent of women aged 15-49 years who had had a genital ulcer or sore in the twelve months before the survey. Men: percent of men aged 15-54 years who had had a genital ulcer or sore in the twelve months before the survey. - 41 - Part II: INTERMEDIATE DETERMINANTS OF HNP STATUS ­ HEALTH SERVICE USE A. CHILDHOOD IMMUNIZATION 8 BCG coverage: percent of children who had received a dose of BCG vaccine by the time of the survey. Measles coverage: percent of children who had received a dose of measles vaccine by the time of the survey. DPT coverage: percent of children who had received three doses of DPT vaccine by the time of the survey. Full basic coverage: percent of children who had received a dose of BCG vaccine, measles vaccine, and three doses of DPT and polio vaccines by the time of the survey, excluding polio vaccine given at birth. No basic coverage: percent of children who had received no vaccination against the six early- childhood diseases (TB, measles, polio, diphtheria, pertusis, and tetanus) by the time of the survey. Hepatitis B coverage: percent of children who had received three doses of hepatitis B vaccine by the time of the survey. Yellow fever coverage: percent of children who had received a dose of yellow fever vaccine by the time of the survey. B. TREATMENT OF CHILDHOOD ILLNESSES 9 Treatment of Fever Medical treatment of fever: percent of children with fever, with or without cough or rapid breathing, in the two weeks before the survey who had sought medical advice for fever from any health facility or health provider, whether public or private. Treatment in a public facility: percent of children with fever, with or without cough or rapid breathing, in the two weeks before the survey who had sought medical advice for fever from a public-sector health facility or provider (as defined in fn. 9). Treatment in a private facility: percent of children with fever, with or without cough or rapid breathing, in the two weeks before the survey who had sought medical advice for fever from a private-sector health facility or provider (as defined in fn. 9). 8Childhood immunization figures refer to rates among children 12-23 months of age in all countries except those in Latin America and the Caribbean. There, the figures refer to rates among children 18-29 months of age. All figures are based on information recorded on the child's vaccination card; or, in cases where a card was not seen by the interviewer, on the mother's report. 9Figures for illness treatment in a public facility refer to treatment in government hospitals, health centers, health posts, or dispensaries; or in facilities operated by government-affiliated social securing programs. Figures for treatment in private facilities cover treatment in private hospitals or clinics, in private doctors' offices, or in facilities operated by other private medical providers (such as non-governmental organizations) as defined in the country concerned; but exclude treatment obtained in private pharmacies or shops. - 42 - Treatment of Acute Respiratory Infection (ARI) Medical treatment of ARI: percent of children with a cough and rapid breathing in the two weeks before the survey who had been taken for treatment at any medical facility or provider, whether public or private. Treatment in a public facility: percent of children with a cough and rapid breathing in the two weeks before the survey who had been taken for treatment at a public-sector health facility or provider (as defined in fn. 9). Treatment in a private facility: percent of children with a cough and rapid breathing in the two weeks before the survey who had been taken for treatment at a private-sector health facility or provider (as defined in fn. 9). Treatment of Diarrhea Use of oral rehydration therapy: percent of children with diarrhea in the two weeks before the survey who had received oral rehydration therapy (ORT) (defined as including consumption of oral rehydration salts, other recommended home fluids, or other increased liquids). Medical treatment of diarrhea: percent of children with diarrhea in the two weeks before the survey who had been taken for treatment at any medical facility or provider, whether public or private. Treatment in a public facility: percent of children with diarrhea in the two weeks before the survey who had been taken for treatment at a public-sector health facility or provider (as defined in fn. 9). Treatment in a private facility: percent of children with diarrhea in the two weeks before the survey who had been taken for treatment at a private-sector health facility or provider (as defined in fn. 9). C. ANTENATAL AND DELIVERY CARE 10 Antenatal Care (ANC) Visits To a medically-trained person: percent of women with one or more births in the five years before the survey who had received at least one antenatal care consultation from a medically- trained person (as defined in fn. 10) before her most recent birth. To a doctor: percent of women with one or more births in the five years before the survey who had received at least one antenatal care consultation from a doctor before her most recent birth. To a nurse or trained midwife: percent of women with one or more births in the five years before the survey who had received at least one antenatal care consultation from a nurse or trained midwife (as defined in fn. 10) before her most recent birth. Multiple visits to a medically-trained person: percent of women with one or more births in the five years before the survey who had received at least three antenatal care consultations from any medically-trained provider (as defined in fn. 10) before her most recent birth. 10When speaking of antenatal and delivery care, medically-trained persons are defined as doctors, nurses, and trained midwives. The definition excludes traditional midwives or other traditional birth attendants, whether trained or untrained. - 43 - Antenatal Care (ANC) Content Tetanus toxoid: percent of women with one or more births in the five years before the survey who had received at least one tetanus toxoid injection during her most recent pregnancy. Prophylactic antimalarial treatment: percent of women with one or more births in the five years before the survey who had received prophylactic treatment with any anti-malarial drug during her most recent pregnancy. Iron supplementation: percent of women with one or more births in the five years before the survey who had taken iron tablets during her most recent pregnancy. Delivery Attendance By a medically-trained person: percent of births in the five years before the survey attended by a medically-trained person (as defined in fn. 10). By a doctor: percent of births in the five years before the survey attended by a doctor. By a nurse or trained midwife: percent of births in the five years before the survey attended to by a nurse or a trained midwife (as defined in fn. 10). In a public facility: percent of all deliveries in the five years before the survey occurring in a public-sector health facility (as defined in fn. 9). In a private facility: percent of all deliveries in the five years before the survey occurring in a private-sector health facility (as defined in fn. 9). At home: percent of all deliveries in the five years before the survey occurring at home (defined as the woman's own or any other home). D. CONTRACEPTIVE SERVICES Contraceptive Prevalence 11 Women: percent of married or in-union women aged 15-49 years who used any modern means of contraception (as defined in fn. 11). Men: percent of married or in-union men aged 15-54 years who used any modern means of contraception (as defined in fn. 11). Source of Contraception - Public Sector Women: percent of married women who obtained their current method of contraception from a public-sector health facility or provider (as defined in fn. 9). Men: percent of married men who obtained their current method of contraception from a public- sector health facility or provider (as defined in fn. 9). 11Figures refer to use of modern means of contraception, defined as male/female sterilization, oral contraceptive pill, contraceptive injection, intrauterine device, male/female condom, diaphragm, cervical cap, contraceptive jelly or foam, implant, or some country-specific modern method. - 44 - Source of Contraception - Private Sector Women: percent of married women who obtained their current method of contraception from a private-sector health facility or provider (as defined in fn. 9, except that private pharmacies and shops are included rather than excluded). Men: percent of married women who obtained their current method of contraception from a private-sector health facility or provider (as defined in fn. 9, except that private pharmacies and shops are included rather than excluded). E. TREATMENT OF ADULT ILLNESSES Treatment of Genital Discharge, Ulcer, or Sore Women: percent of women with genital discharge, ulcer, or sore who sought any medical treatment for resulting symptoms. Men: percent of men with genital discharge, ulcer, or sore who sought any medical treatment for resulting symptoms. Treatment of Genital Discharge, Ulcer, or Sore in a Public Facility Women: percent of women with genital discharge, ulcer, or sore who sought treatment from a public-sector health facility or provider (as defined in fn. 9). Men: percent of men with genital discharge, ulcer, or sore who sought treatment from a public- sector health facility or provider (as defined in fn. 9). Voluntary Counseling and Testing for HIV/AIDS Women: percent of women aged 15-49 years who had been tested for HIV at any time before the survey. Men: percent of men aged 15-54 years who had been tested for HIV at any time before the survey. - 45 - Part III: INTERMEDIATE DETERMINANTS OF HNP STATUS ­ INDIVIDUAL AND HOUSEHOLD BEHAVIOR A. HYGIENIC PRACTICES Disposal of Children's Stools Sanitary disposal: percent of mothers with at least one child under five years of age who disposed of the stools of their youngest child in a sanitary manner (defined as dropping stool into a latrine, burying it, or using disposable diapers). Handwashing Wash hands prior to preparing food: percent of women aged 15-49 years preparing meals who washed hands before handling food. Handwashing facilities in household: percent of households that had hand-washing materials or facilities, as determined by direct observation of interviewers. B. BEDNET OWNERSHIP AND USE Bednet Ownership Bednet ownership: percent of households owning one or more bednets. Treated bednet ownership: percent of households owning one or more bednets that had recently been treated with insecticides. Bednet Use By children: percent of households with at least one child under five years of age, some or all of whom had slept under a bednet the night before the survey. By pregnant women: percent of currently pregnant women who had slept under a bednet the night before the survey. C. BREASTFEEDING Exclusive breastfeeding: percent of children 0-3 months of age who had received only breast milk in the 24 hours before the survey. Timely complementary feeding: percent of children 6-9 months of age who had received breast milk and solid or semi-solid foods in the twenty-four hours before the survey. Bottle-feeding: percent of children under 12 months of age who had received any food or drink from a bottle with a nipple in the twenty-four hours before the survey. - 46 - D. MICRONUTRIENT CONSUMPTION Iodized Salt Availability of iodized salt in household: percent of households with cooking salt testing positive for iodine/iodate at the recommended level of 15 or 25 parts per million or more (depending on the country). 12 Vitamin A Children: percent of children13 who had received at least one dose of vitamin A in the six months before the survey, as reported by the mothers. Women: percent of women who had received a dose of vitamin A within two months of the last birth, in the five years before the survey. E. TOBACCO AND ALCOHOL USE Tobacco 14 Women: percent of women aged 15-49 years who currently were smoking or chewing tobacco products. Men: percent of men aged 15-54 years who currently were smoking or chewing tobacco products. Alcohol Women: percent of women aged 15-49 years who had gotten intoxicated due to excessive consumption of alcohol in the three months before the survey. Men: percent of men aged 15-54 years who had gotten intoxicated due to excessive consumption of alcohol in the three months before the survey. F. SEXUAL PRACTICES Non-Regular Sexual Partnerships Women: percent of women aged 15-49 years who had had sex with a non-regular partner at least once in the twelve months before the survey. Men: percent of men aged 15-54 years who had had sex with a non-regular partner at least once in the twelve months before the survey. 12Which of these two levels is recommended in any particular country may be determined by consulting the full report on that country's DHS, which may be found at: www.measuredhs.com/countries. 13Figures refer to children over six months of age and under three, four, or five years of age, depending upon the country. (The specific ages covered for in a particular country may be determined by consulting the full report on that country's DHS, which is available at: www.measuredhs.com/countries.) 14Tobacco products include cigarettes, pipes, cigars, leaves, etc. - 47 - Condom Usage with Non-Regular Partner Women: percent of women aged 15-49 years with non-regular sexual partner who had used a condom in the last sexual intercourse with such a partner in the twelve months before the survey. Men: percent of men aged 15-54 years with non-regular sexual partner who had used a condom in the last sexual intercourse with such a partner in the twelve months before the survey. G. DOMESTIC VIOLENCE Ever experienced violence: percent of women aged 15-49 years who had ever been hit or beaten by current or former husband/partner. Experienced violence in past year: percent of women aged 15-49 years who had been hit or beaten by current or former husband/partner in the twelve months before the survey. - 48 - Part IV: UNDERLYING DETERMINANTS OF HNP STATUS A. EDUCATION School Completion Women: percent of women aged 15-49 years who had completed the fifth grade. Men: percent of men aged 15-54 years who had completed the fifth grade. School Participation Girls: percent of girls aged 6-10 years who were attending school at the time of the survey. Boys: percent of boys aged 6-10 years who were attending school at the time of the survey. B. EXPOSURE TO MASS MEDIA Newspaper Readership Women: percent of women aged 15-49 years who read a newspaper at least once a week. Men: percent of men aged 15-54 years who read a newspaper at least once a week. Radio Listenership Women: percent of women aged 15-49 years who listened to radio at least once a week. Men: percent of men aged 15-54 years who listened to radio at least once a week. Television Viewership Women: percent of women aged 15-49 years who watched television at least once a week. Men: percent of men aged 15-54 years who watched television at least once a week. C. KNOWLEDGE AND ATTITUDES ABOUT HIV/AIDS Knowledge about Sexual Transmission of HIV/AIDS 15 Women: percent of women aged 15-49 years who knew of HIV/AIDS and of at least one of the following ways to avoid it through interruption of its sexual transmission route: abstinence; using a condom; avoiding multiple sex partners, sex with prostitutes, and unprotected homosexual sex. Men: percent of men aged 15-54 years who knew of HIV/AIDS and of at least one of the ways to avoid HIV/AIDS referred to in the preceding definition. 15In most countries, the survey sample included both married and unmarried individuals. Where this was the case, all respondents, regardless of marital status, were asked the question covered in this section. Where the survey covered only individuals who were or had been married, the data pertain only to individuals who had ever been married. (The marital status of people covered for in particular country is indicated in the full report on that country's DHS, which is located at: www.measuredhs.com/countries.) - 49 - Knowledge about Mother-to-Child Transmission of HIV/AIDS Women: percent of women aged 15-49 years who knew of at least one way HIV/AIDS can be transmitted from mother to child during pregnancy, delivery, or breastfeeding. Men: percent of men aged 15-54 years who knew of at least one way HIV/AIDS can be transmitted from mother to child during pregnancy, delivery, or breastfeeding. Attitudes toward HIV/AIDS Women: percent of women aged 15-49 years who believed that people with HIV/AIDS should be allowed to continue working or that HIV test results should remain confidential. Men: percent of men aged 15-54 years who believed that people with HIV/AIDS should be allowed to continue working or that HIV test results should remain confidential. D. STATUS OF WOMEN Household Decisionmaking Can seek own health care: percent of women age 15-49 years who could decide by themselves to seek their own health care. Can seek children's health care: percent of women aged 15-49 years, whose children live with them, who could decide by themselves to seek health care for their children. Can make daily household purchases: percent of women aged 15-49 years who could decide by themselves or jointly with others to make daily household purchases. Can make large household purchases: percent of women aged 15-49 years who could decide by themselves or jointly with others to make large household purchases. Can make meal-related decisions: percent of women aged 15-49 years who could decide by themselves what food to cook daily. Freedom of Movement Can travel to visit family, relatives: percent of women aged 15-49 years who could decide by themselves to visit family and relatives. Other Decisionmaking, Attitudes Can decide how to spend own money: percent of women aged 15-49 years who work for cash who could decide by themselves on how to use the money they earn. Can decide whether to have sex: percent of women aged 15-49 years agreeing that they can refuse to have sex with their husband for at least one of the following reasons: he has a sexually- transmitted disease; he has had sexual relations with another woman; or the woman is tired, not in mood, or recently has given birth. Justify domestic violence: percent of women aged 15-49 years believing that a husband/male partner would be justified in beating his wife/female partner for at least one of the following reasons: he suspects her of being unfaithful; she argues with him; she goes out without telling him; she neglects the children; she burns the food; or other, country-specific reasons (for example, she shows disrespect for her in-laws or her family does not give the expected dowry). - 50 - E. ORPHANHOOD Maternal orphan prevalence: percent of children under 15 years of age whose natural mother had died before the survey. Paternal orphan prevalence: percent of children under 15 years of age whose natural father had died before the survey. Double orphan prevalence: percent of children under 15 years of age both of whose natural parents had died before the survey. - 51 - DATA AND METHODS Any assessment of the figures featured in this report requires an appreciation of how they were prepared. The first need is to understand the basic features of the data and methods employed. A. SOURCE OF FIGURES The figures appearing in this report are all derived from data collected under the Demographic and Health Surveys (DHS) program conducted by ORC Macro, with support from the U.S. Agency for International Development and other external assistance organizations. Large DHS household surveys have been carried out, usually at periodic intervals, in approximately seventy- five countries across Africa, Asia, Latin America, the Middle East, and the former Soviet Union.16 This series of reports covers the fifty-six of those countries that had one or more DHS surveys undertaken since 1990, for which data were publicly available as of June 2006. (Annex C is a list of the countries for which reports have been prepared.) In each country, the DHS program has gathered information on a large number of indicators about health, nutrition, and population (hnp) status and service use; about relevant behaviors of household members; and about household characteristics like those described below. It has done this through a set of questionnaires, similar in all countries, to collect data at the individual, household, and community levels. The data presented here draw on responses to the individual and household questionnaires. In most cases, they are based on responses from women or other family members interviewed. The principal exceptions concern nutritional status, which is based on anthropometric measurement; immunization, which typically relies to the extent possible on record cards maintained at the household level; and those other items where a source other than interviewer response is specifically identified. B. MEASUREMENT OF ECONOMIC STATUS Wealth or Asset Approach Economic status has been expressed in terms of wealth or assets: specifically, on the basis of information about household characteristics gathered through the DHS household questionnaire. (Such information was normally provided for at least 25-30, and often many more, characteristics like the presence, availability, or use of a fan, radio receiver, or automobile; housing materials like wood or concrete flooring, tile or tin roofing, or cement block walls; superior sources of water like piped or a protected well; and other attributes related to economic status.) 16Further information about the DHS program is available at the program's website: www.measuredhs.com. - 53 - Index Construction A single, consolidated index of living standards17 was constructed by using principal components analysis (PCA) to generate a weight for each household item with available information. A wealth index score was calculated for each household by weighting the response with respect to each item pertaining to that household by the coefficient of the first principal component as determined by application of principal components analysis, and summing the results. The resulting household scores were standardized in relation to a standard normal distribution with a mean of zero and a standard deviation of one. All individuals usually present in each household were assigned the household's standardized wealth index score, and all individuals in the sample population were ranked according to that score. The sample population was then divided into quintiles of individuals, with all individuals in a single household being assigned to the same quintile. The same standardized household wealth index scores originally derived for the total population sample, as just described, were also used in preparing the disaggregated estimates for female and male members of the sample population, and for rural and urban residents. In preparing those disaggregated estimates, the entire population sample was divided into quintiles of individuals; the females and males, and the rural and urban residents in each quintile of the entire sample were then separated from one another; and the mean for each of the ten resulting subgroups (five female, five male; or five rural, five urban) was calculated. This procedure was carried out separately for each of the surveys covered. C. CALCULATION AND PRESENTATION OF RATES Use of Sampling Weights Rates for all health, nutrition, and population indicators are calculated after applying the DHS sampling weights. (DHS surveys often over-sample certain small subgroups of interest ­ residents of a particular geographic area, for example ­ in order to get sample sizes large enough to produce statistically-significant results. The DHS sampling weights are used to compensate for such over-sampling in order to ensure that the results are representative of the population as a whole and not just of the DHS sample.) Calculation of Total Population Averages The average for the total population presented alongside the quintile-specific rates for each indicator is calculated without reference to quintile divisions. It thus equals the weighted mean of the quintile rates, with the weight assigned to each quintile rate being the proportion of the number of individuals at risk (as defined on p. 59) for the indicator concerned. Sampling Errors Information needed to assess the statistical significance of differences among the quintile-specific rates is presented in three ways: · First, in all the basic tables presented in part I, rates are shown in parentheses or replaced by asterisks in cases where the standard error is likely to be unacceptably high because 17 Such an index is usually referred to as either an "asset index" or a "wealth index." The two expressions are used interchangeably in this report; for ease of communication, "wealth index" appears more frequently despite the inexact correspondence between the items included in the index's construction and those appearing in more conventional, financially-based definitions of wealth. - 54 - of small sample size. The number of observations used to determine how to present the data for the different indicators covered were as follows: Indicator Unit of measure Number of observations used to determine how quintile-specific rate was presented Without With Replaced by parentheses parentheses asterisk Infant and child Number of deaths >500 250-499 <250 mortality Total and adolescent Number of births >250 125-249 <125 fertility All other indicators Number of >50 25-49 <25 individuals · Second, the standard error for each quintile-specific rate (except for any rate replaced by an asterisk) appearing in the total population table is provided in part III.B. (Standard errors for the quintile-specific rates presented in the female-male and rural-urban tables are not available.) · Third, the right-hand column of the total population table provides the standard error for the concentration index, one of the measures of inequality shown, as indicated below. D. MEASUREMENT OF INEQUALITY Accompanying each of the indicators presented in the total population table are the values for three statistical measures of inequality: · Low/High Quintile Ratio: the ratio between the rate prevailing in the lowest (poorest) population quintile and that found in the highest (least poor) quintile. · Low-High Quintile Difference: the value of the lowest quintile minus the value of the highest, expressed as an absolute value. · Concentration Index: twice the area in a Lorenz-type diagram between the line of equality and the concentration curve for the indicator in question, the curve being the graph of the cumulative share of the indicator against the cumulative share in the asset distribution. (The value, which can range from -1 to +1, is negative when the hnp indicator is higher among the poor (e.g., fertility), positive when it is higher among the better-off (e.g., modern contraceptive use), and zero when on balance the indicator shows no systematic relationship with wealth.)18 18Adam Wagstaff, Pierella Paci, and Eddy van Doorslaer, "On the Measurement of Inequalities of Health," Social Science and Medicine 33 (1991): 545-57. (See also chapter eight in the volume by O'Donnell, van Doorslaer, Wagstaff, and Lindelow described in the annotated bibliography that constitutes annex A.) - 55 - DISCUSSION While a basic understanding of the data and methods employed is necessary to adequately appreciate the figures appearing in this report, it is not sufficient. For the application of the approach taken involves many subtleties that also need to be understood. Among the more important are: A. DESCRIPTIVE NATURE OF THE RELATIONSHIPS The hnp-poverty relationships shown in this report are no more than descriptive. They should not be taken to imply any direct causal relationships, for several reasons. One reason is the possibility that it is not wealth or asset possession per se that determine a person's health condition. Rather, the determining factors could be other characteristics (such as education or ethnic background) that are simultaneously associated with both asset ownership and health status. It is also possible that the health-poverty relationships shown are driven primarily by particular items included in the index (e.g., water and sanitation). Should this be the case, improvements in health conditions among the poor might be more effectively brought about by focusing on changing those particular components of the wealth index rather than by a general effort to increase economic status as measured by the index as a whole. B. IMPLICATIONS OF A WEALTH/ASSET APPROACH Wealth or Assets as a Measure of Economic Status Reliance on a wealth index to measure economic status is a rather recent development in research on economic disparities, where such status traditionally has been defined in terms of consumption or income. The principal reason for the choice of the wealth index is pragmatic rather than conceptual: the DHS surveys, which are of interest because of the plethora of hnp information that they contain, do not collect consumption or income data; but they do have detailed information on households' physical characteristics, and on the household-level presence of and access to a wide range of goods and services. While there is some disagreement about the relative merits of using such wealth/asset information or consumption data to measure economic status, several recent studies suggest that the asset-consumption relationship is quite close.19 To the extent this is the case, an index of wealth or asset possession/availability can be taken as a 19See, for example, Deon Filmer and Lant H. Pritchett, "Estimating Wealth Effects without Expenditure ­ or Tears: An Application to Educational Enrollments in States of India," Demography 38, no. 1 (February 2001): 115-32; Shea Rutstein and Kiersten Johnson, The DHS Wealth Index, DHS Comparative Reports No. 6 (Calverton, Maryland, USA: ORC Macro, August 2004) esp. 10-14; Adam Wagstaff and Naoko Watanabe, "What Difference Does the Choice of SES Make in Health Inequality Measurement?" Health Economics 12 (2003): 885-90. - 57 - reasonably satisfactory proxy for consumption, rather than or in addition to serving as an indicator of economic status in its own right. C. ECONOMIC STATUS AS A MEASURE OF SOCIO-ECONOMIC WELL-BEING Like consumption or income, a wealth index defines disparities that are primarily economic. This is by no means the only way to define inter-group inequalities that are of potential concern. Other possibilities include gender, place of residence, education, ethnic background, or other factors associated with social exclusion. Thus the economic perspective provides only a partial view of the multidimensional concepts of poverty, inequality, and inequity. By including tables on female-male and rural-urban inequalities, this report pays adequate attention to two of inequality's other important dimensions to justify the use of the term "socio- economic" rather than simply "economic" in its title. However, the centrality of tabulations based on the wealth index means that the primary focus is on the economic dimension. The justification for this lies not in the greater importance of economic considerations, but rather in the recently-improved ability to analyze and thus begin dealing with them. Until the development of the wealth/asset approach, the assessment of economic status had been based on consumption, expenditures, or income, all of which are far more difficult to measure than such other, non- economic dimensions of inequality as gender, ethnic identity, educational level, and place of residence. As a result, assessments of health inequalities by economic status had lagged well behind measurements in terms of these other dimensions, especially gender and education. The focus on inequality's economic aspect applied here represents an effort to redress this imbalance. D. INDEX CONSTRUCTION Choice of Items Use of a wealth index requires decisions about which items to include in it. In the case of secondary analyses like the one featured in this report, the choice is limited to those items included in the data sets being used. But even with this constraint, there nonetheless remains considerable room for choice, given the large number of items for which information is collected by the DHS. The decision made in preparing this report was to include all items in each DHS household questionnaire that relate to ownership of household goods; to dwelling unit construction and characteristics; and to access to services and resources like electricity, water, and sanitation facilities. Also included were other potential indicators of wealth, such as live-in domestic servants. This decision, admittedly somewhat arbitrary, has both advantages and disadvantages. The principal advantage is practical: use of a large number of assets increases the degree of variation across household asset scores and facilitates a more regular distribution of individuals across quintiles. It also reduces the possibility of subjectivity in selecting only some of the variables for inclusion on some a priori basis; and it may increase a wealth index's accuracy as a proxy for consumption. However, including all variables is far from satisfying conceptually. For example, it means failing to discriminate with respect to the items' differing natures. It is not clear, for instance, whether access to water, sanitation, electricity, or other publicly-provided resources should be included in an index that purports to measure private household wealth. Further, many items that are candidates for inclusion in a DHS-based wealth index might be seen as directly influencing health status: water and sanitation for infant and child mortality, for - 58 - example. It would be desirable to include quintile-specific estimates for such items; but to the extent that such items have large index coefficients, any estimates for those items would be suspect. Such items appear to be relatively few and of limited statistical significance in the index used here. However, for the sake of caution, quintile-specific estimates for items appearing in the index have nonetheless been excluded from the basic tables and appear only in supporting table III.C Additional issues arise when comparing the findings for two different points in time covered in the basic tables. Because the nature and number of asset questions included in DHS surveys has been evolving, the items included in the wealth index differ somewhat for each of the surveys reported upon. As such, the results presented in the basic tables might differ to some extent from findings produced by some other approach, such as including in the index only those items appearing in each survey covered. Weighting of Items A further decision required in construction of an index concerns the weight to attach to each of the respective items. As noted earlier, the method used in this report is principal components analysis (PCA). Adoption of this method was based on the findings, referred to earlier, that its use resulted in outcomes that approximated reasonably well those produced by taking a consumption or expenditure approach. Further, it often provides greater discrimination in economic status than does the use of consumption/expenditures. It has also emerged as the standard approach for use in analyses of the sort presented here, so that its adoption is largely non-controversial. Yet this choice, too, is not without an arbitrary aspect; for alternative plausible methods exist. Examples include the "inverse possession" approach, which gives more weight to items possessed by only a few and less to those possessed by many;20 or, perhaps, the common practice of simply assigning the same weight to each index item. Also, the weights for any particular item vary from survey to survey, since the weights were determined separately for the population of each survey included in the basic tables. The results thus produced can be expected to differ from those generated in some other manner, such as generating common weights for all the surveys covered by pooling the data sets. Use of Principal Components Analysis with Dichotomous Variables An additional issue concerns the use of a technique like PCA, developed for use with continuous variables, in the construction of an index based primarily on dichotomous variables. While legitimate in principle, any reservations in this regard are of limited practical consequence, since the considerable experimentation undertaken in preparation for the tabulations presented here indicated that any inaccuracy introduced by applying PCA to the analysis of the dichotomous values used is minimal. Economies of Scale Calculating the values for a household wealth index also requires a decision concerning economies of scale that exist in the households covered. The calculations presented here assume complete economies of scale. The implicit assumption is that additional members do not add to household expenses on items included in the index. 20Saul S. Morris et al., "Validity of Rapid Estimates of Household Wealth and Income for Health Surveys in Rural Africa," Journal of Epidemiology and Community Health 54 (2000): 381-87. - 59 - E. DEFINITION OF QUINTILES Quintiles of Individuals As noted earlier, the quintile-specific figures presented in this report refer to quintiles of individuals in the household population. Such quintiles need to be distinguished from quintiles of households or quintiles of only those people in the population who are "at risk": that is, subject to the particular condition, eligible for the particular service, or capable of behaving in a particular way (children born alive for infant and under-five mortality, for example; or adult men and women for condom use or non-regular sexual partnerships). The expression of findings in terms of quintiles of individuals has several implications: · Because fertility is often higher in lower economic households than among better-off ones, the number of individuals per household will frequently be larger among the poor than among higher-income groups. In such cases, the number of households will vary systematically across quintiles of individuals, and the results expressed in terms of quintiles of households can differ significantly from those presented here. · The proportion of individuals "at risk" with regard to a particular indicator is also likely to vary across quintiles in many cases. (For example, in cases where fertility is higher among poor people, a higher-than-average proportion of poor populations will consist of newborns at risk from infant mortality, young children subject to malnutrition, and pregnant women for whom antenatal care is relevant.) To facilitate the work of any investigators wishing to undertake calculations based on people at risk, the number of such people in each quintile of individuals is shown in part III.A. · As previously indicated, the population average figure provided for each indicator is equivalent to the weighted sum of the quintile rates for that indicator, where the weight assigned to each quintile rate is the number of people at risk in each quintile as presented in part III.A. As a result of this weighting, the population average will usually differ from a simple mean of the population quintile estimates. Quintiles of Males and Females, of Rural and Urban Residents As also reported in the data and methods section, the tables on rural and urban residents and on men and women were prepared using the same asset scores as for the total population; and rural- urban residents and females-males were separated from one another only after the entire sample had been disaggregated into quintiles of individuals. This means that the figures given in the rural-urban and female-male tables refer to females-males and rural-urban residents belonging to each quintile of individuals in the total population, as distinct from quintiles of females, of males, of rural residents, or of urban residents alone. The consequence of this distinction is particularly evident with regard to rural and urban residents. Since rural residents tend to be poorer than urban dwellers, they normally form a considerably higher proportion of individuals in the lower economic quintiles of the total population than in the higher ones. Conversely, urban residents tend to be concentrated in the higher economic groups. As a result, the number of individuals in each of the urban and rural quintiles usually varies greatly and systematically; and when this is the case, the figures presented in the rural-urban tables can differ significantly from those produced by a computation procedure that places the same number of rural and urban residents in each rural quintile or each urban quintile. (The results may also differ significantly from application of an approach featuring the separate calculation of index values for urban and for rural groups. While such separate index values may well be preferable conceptually, their calculation involves complexities that prevented their preparation for this report.) - 60 - F. COMPARISON OF QUINTILES ACROSS COUNTRIES Reliance on population quintiles as basic presentational format for the data appearing in this report implicitly incorporates a relative concept of poverty. This differs from an absolute concept of poverty under which the population would be divided into groups of different sizes according to some absolute standard of living (such as people earning less than one dollar a day, between one and two dollars a day, and more than two dollars a day). This means that, when comparing values of an indicator among people in a given quintile across countries, the comparison is between groups of people whose economic status can be quite different. The lowest quintile of a Latin American population, for example, will usually be considerably better-off than the lowest quintile in an African country. G. COMPARISON OF QUINTILES OVER TIME Another implication is that the wealth status of any given quintile within a particular country is likely to change over time. For instance, when a country is progressing economically, the wealth of the households in the population will tend to increase. This will raise the average asset score in most, possibly all population quintiles. As a result, the living standard enjoyed by individuals in any quintile covered by a recent survey is likely to be higher than that of individuals in that same quintile as measured in a prior survey. H. STATISTICAL INDICATORS OF INEQUALITY The available statistical indicators of inequality are far too numerous to permit use of more than a small proportion of them in presenting the findings featured in this report. The three indicators employed have been selected to provide a wide range of perspectives. Two are designed for ease of understanding, the third for greater technical accuracy. The low/high quintile ratio and low-high quintile difference are the two presented for ease of understanding. The former is a relative measure, the latter an absolute measure that can produce a significantly different impression from that provided by the former. The concentration index is provided for the benefit of technical specialists wishing greater accuracy. It measures the degree of inequality in an hnp indicator across the full wealth index distribution, rather than differences between only two of the five quintiles, and also reflects the relative size of the different asset-based divisions of the study population. I. COMPARABILITY WITH OTHER REPORTS Tabulations similar to those presented here can also be found in the initial series of hnp/poverty country reports, issued in 2000, and in the recent country reports issued by the DHS program. The figures presented in those reports normally resemble quite closely those appearing here for any given indicator; but there are often slight differences for one or more of several reasons. The most common is a difference in the definition of the indicator in question. (These differences are usually small and subtle. But there is one important exception: the definition of moderate malnutrition among children. In the 2000 reports, this was defined as second and third degree malnutrition taken together. Here, it is defined as second degree malnutrition alone.) Another reason, with respect to infant and child mortality, is that the figures in the DHS documents are typically based on experience during the five years before the survey in question, rather than - 61 - during the ten previous years as in this report. A further frequent reason is the use of an improved computational technique. In addition, asset-based, quintile-specific tabulations of hnp indicators have begun to appear in an increasing number of other documents. Given the basic similarity of approach, such tabulations usually produce results that are generally congruent with those shown in part I of this report. However, significant divergences have occasionally been reported; and the absence of adequately detailed information about data and methods often prevents any fully-satisfying understanding of the approaches used. As a result, occasional doubts and frequent uncertainties about approach comparability remain. - 62 - PART IV. SUPPORTING TABLES, 2001 A. SAMPLE SIZES B. STANDARD ERRORS C. ASSET DISTRIBUTION AND WEIGHTS Benin 2001 - SAMPLE SIZES TOTAL SAMPLE Indicator Wealth Quintiles Pop. Low 2nd 3rd 4th High Total Number of household members All 5,982 6,022 5,941 5,982 5,981 29,908 Urban 1,023 882 1,151 2,440 5,290 10,785 Rural 4,959 5,140 4,790 3,542 692 19,123 Female 2,967 3,033 3,027 3,157 3,189 15,374 Male 3,014 2,989 2,909 2,824 2,792 14,529 Part I: HNP STATUS Indicator Wealth Quintiles Pop. Low 2nd 3rd 4th High Total Mortality rates All 2,447 2,248 2,237 1,987 1,419 10,338 Urban 397 296 422 789 1,250 3,155 Rural 2,049 1,952 1,815 1,198 169 7,183 Female 1,232 1,111 1,071 993 710 5,118 Male 1,215 1,136 1,166 994 709 5,220 Prevalence of fever, diarrhea, acute respiratory infection All 1,058 999 984 930 728 4,698 Urban 172 134 191 378 638 1,513 Rural 886 865 792 552 90 3,185 Female 536 473 478 484 375 2,346 Male 522 525 506 446 353 2,352 Total fertility rate All 3,177 3,223 3,240 3,691 4,209 17,539 Urban 544 436 666 1,655 3,765 7,066 Rural 2,633 2,787 2,574 2,035 444 10,473 Age-specific fertility rate 15-19 All 629 695 686 781 1,171 3,962 Urban 149 104 159 381 1,037 1,830 Rural 480 591 527 400 135 2,133 Children's nutritional status All 789 761 826 803 639 3,818 Urban 126 96 158 317 562 1,259 Rural 663 665 669 485 77 2,559 Female 392 350 409 426 331 1,908 Male 397 411 417 377 309 1,911 Children's anemia status All 498 428 410 412 286 2,034 Urban 89 53 97 176 246 661 Rural 409 375 313 236 39 1,372 Female 244 228 217 205 131 1,025 Male 254 200 193 208 155 1,010 - 65 - Benin 2001 - SAMPLE SIZES Part I: HNP STATUS (Cont.) Indicator Wealth Quintiles Pop. Low 2nd 3rd 4th High Total Women's nutritional status All 916 942 968 1,108 1,386 5,320 Urban 154 129 210 512 1,231 2,236 Rural 762 813 757 596 155 3,083 Women's anemia status All 576 581 530 670 768 3,125 Urban 93 77 106 332 685 1,293 Rural 483 504 424 338 83 1,832 Girls' circumcision All 527 539 557 586 550 2,759 Urban 92 83 126 268 484 1,053 Rural 435 456 431 318 66 1,707 Women's circumcision All 1,104 1,139 1,149 1,298 1,530 6,219 Urban 188 155 238 584 1,364 2,529 Rural 916 984 911 713 166 3,690 Prevalence of genital discharge, ulcer, sore Female 1,026 1,027 1,045 1,182 1,327 5,607 Urban Female 172 143 216 529 1,184 2,244 Rural Female 854 885 829 653 143 3,364 Male 538 452 410 430 579 2,409 Urban Male 95 68 76 225 518 982 Rural Male 443 384 334 205 61 1,427 - 66 - Benin 2001 - SAMPLE SIZES Part II: Intermediate Determinants of HNP Status - HNP SERVICE USE Indicator Wealth Quintiles Pop. Low 2nd 3rd 4th High Total Immunization coverage All 202 193 180 197 160 932 Urban 36 29 32 89 139 325 Rural 166 164 148 108 20 606 Female 107 95 85 101 79 467 Male 95 98 95 96 81 465 Treatment of fever All 480 436 436 368 216 1,936 Urban 82 56 78 137 191 544 Rural 398 380 358 231 25 1,392 Female 243 233 226 180 107 989 Male 237 204 209 188 109 947 Treatment of acute respiratory infection All 127 114 115 124 82 562 Urban 17 12 20 50 72 171 Rural 109 103 95 73 10 390 Female 56 52 69 64 39 280 Male 71 63 46 59 43 282 Treatment of diarrhea All 161 152 129 117 71 630 Urban 33 19 19 40 60 171 Rural 127 133 110 77 11 458 Female 74 81 68 55 40 318 Male 86 72 61 62 30 311 Antenatal and delivery care All 773 742 732 691 585 3,524 Urban 130 97 141 285 520 1,173 Rural 643 645 591 406 66 2,351 Contraceptive prevalence Female 956 922 922 942 821 4,563 Urban Female 152 130 184 381 726 1,573 Rural Female 804 792 739 561 95 2,991 Male 397 341 287 274 309 1,607 Urban Male 69 56 60 137 276 598 Rural Male 328 285 228 137 32 1,010 Contraceptive source Female 38 29 62 78 121 328 Urban Female 10 3 16 23 103 155 Rural Female 28 26 46 55 18 173 Male 397 341 287 274 309 1,607 Urban Male 69 56 60 137 276 598 Rural Male 328 285 228 137 32 1,010 Treatment of genital discharge, ulcer, sore Female na na na na na na Urban Female na na na na na na Rural Female na na na na na na Male na na na na na na Urban Male na na na na na na Rural Male na na na na na na - 67 - Benin 2001 - SAMPLE SIZES Part III: Intermediate Determinants of HNP Status - INDIVIDUAL AND HOUSEHOLD BEHAVIOR Indicator Wealth Quintiles Pop. Low 2nd 3rd 4th High Total Sanitary disposal of stools All na na na na na na Urban na na na na na na Rural na na na na na na Wash hands prior to preparing food All 1,104 1,139 1,149 1,298 1,530 6,220 Urban 188 155 238 584 1,364 2,529 Rural 916 984 911 713 166 3,690 Handwashing facilities in household? All 1,092 1,191 1,081 1,173 1,178 5,715 Urban 186 174 206 530 1,043 2,139 Rural 906 1,017 875 643 135 3,576 Bednet ownership All 1,092 1,191 1,081 1,173 1,178 5,715 Urban 186 174 206 530 1,043 2,139 Rural 906 1,017 875 643 135 3,576 Bednet use by children All 713 704 668 649 609 3,343 Urban 120 104 120 270 538 1,152 Rural 593 600 548 379 71 2,191 Bednet use by pregnant women All 160 156 146 146 109 717 Urban 30 20 24 51 99 224 Rural 130 136 122 94 9 491 Exclusive breastfeeding All 76 80 72 68 47 343 Urban 13 12 12 25 44 106 Rural 63 68 61 43 3 238 Female 38 39 39 29 21 166 Male 38 41 33 39 26 177 Timely complementary breastfeeding All 87 73 81 65 44 350 Urban 14 7 14 20 36 91 Rural 74 65 68 45 8 260 Female 50 39 40 34 17 180 Male 37 34 42 31 27 171 Bottle-feeding All 233 232 240 208 152 1,065 Urban 38 32 48 80 133 331 Rural 195 201 192 128 18 734 Female 128 124 115 102 71 540 Male 106 108 125 106 81 526 - 68 - Benin 2001 - SAMPLE SIZES Part III: Intermediate Determinants of HNP Status - INDIVIDUAL AND HOUSEHOLD BEHAVIOR (Cont.) Indicator Wealth Quintiles Pop. Low 2nd 3rd 4th High Total Iodized salt in household All 1,023 1,102 989 1,067 1,084 5,265 Urban 177 165 194 477 963 1,976 Rural 846 937 796 590 121 3,290 Vitamin A supplementation All 946 886 861 828 642 4,163 Urban 152 114 166 333 561 1,326 Rural 794 772 695 494 81 2,836 Female 465 465 446 401 315 2,092 Male 481 421 415 427 327 2,071 Tobacco and alcohol use, casual sexual partners, condom use for casual sex Female 1,104 1,139 1,149 1,298 1,530 6,220 Urban Female 188 155 238 584 1,364 2,529 Rural Female 916 984 911 713 166 3,690 Male 594 498 443 492 682 2,709 Urban Male 105 74 86 253 607 1,125 Rural Male 488 424 357 239 74 1,582 Domestic violence All na na na na na na Urban na na na na na na Rural na na na na na na - 69 - Benin 2001 - SAMPLE SIZES Part IV: UNDERLYING DETERMINANTS OF HNP STATUS Indicator Wealth Quintiles Pop. Low 2nd 3rd 4th High Total School completion (Grade 5) Female 1,205 1,233 1,252 1,384 1,632 6,705 Urban female 200 182 255 619 1,451 2,707 Rural female 1,004 1,050 997 766 181 3,998 Male 1,047 1,015 1,011 1,117 1,440 5,630 Urban male 174 176 201 518 1,291 2,359 Rural male 874 839 811 599 149 3,271 School participation Female 509 529 486 531 448 2,503 Urban female 84 73 101 197 381 837 Rural female 425 455 385 333 67 1,665 Male 585 571 566 530 389 2,640 Urban male 96 89 96 175 350 807 Rural male 488 481 470 355 39 1,833 Mass media exposure Female 1,104 1,139 1,149 1,298 1,530 6,219 Urban female 188 155 238 584 1,364 2,529 Rural female 916 984 911 713 166 3,690 Male 594 498 443 492 682 2,709 Urban male 105 74 86 253 607 1,126 Rural male 488 424 357 239 74 1,583 Knowledge of HIV/AIDS prevention Female 2,288 1,139 1,149 1,298 1,530 7,404 Urban female 188 155 238 584 1,364 2,529 Rural female 916 984 911 713 166 3,690 Male 594 498 443 492 682 2,709 Urban male 105 74 86 253 607 1,125 Rural male 488 424 357 239 74 1,582 Household decisionmaking and justification of violence All 1,104 1,139 1,149 1,298 1,530 6,219 Urban 188 155 238 584 1,364 2,529 Rural 916 984 911 713 166 3,690 Orphanhood All 2,997 2,910 2,884 2,816 2,383 13,989 Urban 492 402 546 1,054 2,085 4,579 Rural 2,505 2,508 2,338 1,762 298 9,411 Female 1,411 1,365 1,354 1,412 1,268 6,810 Male 1,584 1,543 1,524 1,404 1,115 7,170 - 70 - Benin 2001 - STANDARD ERRORS OF QUINTILE ESTIMATES FOR TOTAL POPULATION Part I: HNP STATUS Indicator Wealth Quintiles Pop. Low 2nd 3rd 4th High Avg. A. Chilhoodd illness and mortality Infant mortality rate 8.32 6.57 7.53 7.34 6.56 3.63 Under-five mortality rate 10.69 8.35 9.58 9.12 9.01 4.85 Prevalence of fever 1.98 1.68 1.79 1.90 1.82 0.91 Prevalence of diarrhea 1.40 1.33 1.30 1.46 1.14 0.72 Prevalence of acute respiratory infection 1.61 1.45 1.22 1.26 1.32 0.79 B. Fertility Total fertility rate 0.23 0.22 0.24 0.19 0.16 0.13 Adolescent fertility rate 17.00 13.00 16.00 12.00 5.00 7.00 C. Nutritional status Children: Moderate stunting 1.50 1.80 1.40 1.51 1.46 0.69 Severe stunting 1.22 1.35 1.08 1.11 0.76 0.53 Moderate underweight 1.36 1.45 1.51 1.49 1.28 0.65 Severe underweight 1.05 1.02 0.68 0.63 0.42 0.40 Mild anemia 2.01 2.20 2.39 2.36 2.61 0.99 Moderate anemia 2.57 2.48 2.88 2.89 3.65 1.37 Severe anemia 1.27 2.00 1.29 1.15 1.69 0.72 Women: Malnutrition 1.40 1.19 1.18 1.01 0.72 0.56 Mild anemia 2.15 2.14 2.10 2.13 1.84 0.96 Moderate anemia 1.84 1.78 1.87 1.64 1.63 0.87 Severe anemia 0.55 0.72 0.54 0.58 0.37 0.25 D. Female circumcision Prevalence of circumcision: Girls 2.41 1.64 1.84 0.79 0.26 0.94 Women 3.05 2.62 2.04 1.46 0.60 1.21 Prevalence of occlusion: Girls 1.16 2.50 3.25 * * 1.52 Women 0.22 0.28 0.27 0.24 0.10 0.12 E. Sexually transmitted disease Prevalence of genital discharge: Women 0.39 0.43 0.27 0.46 0.60 0.22 Men 0.71 0.48 1.00 0.88 0.69 0.34 Prevalence of genital ulcer: Women 0.21 0.29 0.23 0.22 0.40 0.13 Men 0.38 0.45 0.45 0.62 0.59 0.22 - 71 - Benin 2001 - STANDARD ERRORS OF QUINTILE ESTIMATES FOR TOTAL POPULATION Part II: Intermediate Determinants of HNP Status - HNP SERVICE USE Indicator Wealth Quintiles Pop. Low 2nd 3rd 4th High Avg. A. Childhood immunization BCG coverage 3.36 3.12 2.42 1.13 2.07 1.42 Measles coverage 4.15 4.05 3.71 3.24 2.85 2.01 DPT coverage 3.91 3.85 3.47 3.33 2.92 1.93 Full basic coverage 4.03 4.28 3.79 3.61 3.36 2.08 No basic coverage 3.28 2.82 1.82 0.85 1.43 1.30 Hepatitis B coverage na na na na na na Yellow fever coverage na na na na na na B. Treatment of childhood illnesses Treatment of fever: Medical treatment of fever 2.44 2.44 2.55 2.63 3.97 1.41 Treatment in a public facility 2.17 2.49 2.52 2.44 2.73 1.29 Treatment in a private facility 1.74 1.33 1.45 1.87 3.47 0.93 Treatment of acute respiratory infection (ARI): Medical treatment of ARI 4.54 4.67 4.24 5.24 6.31 2.25 Treatment in a public facility 4.88 4.58 3.90 4.88 4.80 2.21 Treatment in a private facility 2.72 2.40 3.96 1.90 4.69 1.48 Treatment of diarrhea: Use of oral rehydration therapy 4.91 5.55 4.74 5.38 6.53 2.64 Medical treatment of diarrhea 3.14 3.81 4.15 3.84 4.92 1.80 Treatment in a public facility 3.02 3.68 3.99 3.57 3.66 1.67 Treatment in a private facility 2.22 2.16 2.23 2.83 3.85 1.22 C. Antenatal and delivery care Antenatal care (ANC) visits: To a medically trained person 3.25 2.49 1.58 0.80 0.30 1.45 To a doctor 0.45 0.46 0.80 0.87 2.04 0.54 To a nurse or trained midwife 3.14 2.25 1.63 1.17 2.09 1.32 Multiple visits to a medically trained person 2.63 2.70 1.68 1.48 1.07 1.25 Antenatal care content: Tetanus toxoid 2.49 2.25 1.84 1.76 1.97 1.23 Prophylactic antimalarial treatment 2.36 2.04 1.43 1.28 1.08 0.98 Iron supplementation 2.62 2.32 1.72 1.02 0.92 1.24 Delivery attendance: By a medically trained person 3.20 2.84 2.29 1.41 0.29 1.78 By a doctor 0.40 0.47 0.46 0.80 1.67 0.37 By a nurse or trained midwife 3.13 2.81 2.28 1.63 1.68 1.72 In a public facility 2.79 2.91 2.38 1.83 2.12 1.65 In a private facility 1.14 1.25 1.01 1.54 2.03 0.79 At home 2.80 2.73 2.01 1.41 0.36 1.55 D. Contraceptive services Contraceptive prevalence: Women 0.86 0.76 1.09 1.17 1.34 0.55 Men 1.70 1.58 2.06 2.19 2.11 0.94 Source of contraception - public sector: Women 7.35 8.71 5.95 6.29 5.25 3.20 Men na na na na na na - 72 - Benin 2001 - STANDARD ERRORS OF QUINTILE ESTIMATES FOR TOTAL POPULATION Part II: Intermediate Determinants of HNP Status - HNP SERVICE USE (Cont.) Indicator Wealth Quintiles Pop. Low 2nd 3rd 4th High Avg. D. Contraceptive services (cont.) Source of contraception - private sector: Women 7.65 8.86 6.01 6.50 5.10 3.31 Men na na na na na na E. Treatment of adult illnesses Treatment of genital discharge, ulcer, sore: Women * * * 8.64 5.98 4.52 Men * * * * 7.53 5.63 Treatment of genital discharge, ulcer, sore in public medical facilities: Women 0.39 0.43 0.27 0.46 0.60 0.22 Men 0.74 0.80 1.12 1.03 0.98 0.42 Voluntary counseling and testing for HIV/AIDS: Women 0.36 0.29 0.55 0.68 1.06 0.33 Men 0.62 0.74 1.13 1.25 1.56 0.51 - 73 - Benin 2001 - STANDARD ERRORS OF QUINTILE ESTIMATES FOR TOTAL POPULATION Part III: Intermediate Determinants of HNP Status - INDIVIDUAL AND HOUSEHOLD BEHAVIOR Indicator Wealth Quintiles Pop. Low 2nd 3rd 4th High Avg. A. Hygienic practices Disposal of children's stools: Sanitary disposal 0.48 0.55 1.21 2.36 2.57 1.09 Handwashing: Wash hands prior to preparing food 1.66 1.04 0.78 0.61 0.77 0.53 Handwashing facilities in household 0.00 0.00 0.09 0.14 0.86 0.18 B. Bednet ownership and use Bednet ownership: Bednet ownership 3.07 2.66 2.66 2.27 2.11 1.61 Treated bednet ownership na na na na na na Bednet use: By children 2.97 2.63 2.30 2.72 2.53 1.58 By pregnant women 4.83 4.06 4.07 4.83 4.11 2.33 C. Breastfeeding Exclusive breastfeeding 5.87 5.93 5.98 5.69 7.19 2.96 Timely complementary feeding 5.16 5.24 5.17 7.19 7.29 2.56 Bottle-feeding 0.85 0.77 1.06 1.42 3.92 0.84 D. Micronutrient consumption Iodized salt: Availability of iodized salt in household 2.04 1.88 1.92 2.01 2.33 1.18 Vitamin A: Children 1.69 1.44 1.52 2.08 2.50 1.00 Women 1.47 1.92 1.59 1.95 2.43 0.94 E. Tobacco and alcohol use Tobacco: Women 1.44 0.99 0.47 0.32 0.11 0.46 Men na na na na na na Alcohol: Women 0.65 0.45 0.36 0.57 0.51 0.26 Men na na na na na na F. Sexual practices Non-regular sexual partnerships: Women 0.29 0.27 0.28 0.30 0.44 0.16 Men 1.34 1.55 1.68 1.94 1.99 0.84 Condom usage with non-regular partner: Women * * * * 8.50 4.67 Men 4.82 6.12 6.53 5.28 4.45 2.70 G. Domestic violence Ever experienced violence na na na na na na Experienced violence in past year na na na na na na - 74 - Benin 2001 - STANDARD ERRORS OF QUINTILE ESTIMATES FOR TOTAL POPULATION Part IV: UNDERLYING DETERMINANTS OF HNP STATUS Indicator Wealth Quintiles Pop. Low 2nd 3rd 4th High Avg. A. Education School completion: Women 0.48 0.74 0.91 1.34 1.46 0.90 Men 1.46 1.66 1.97 1.90 1.31 1.33 School participation: Girls 2.79 3.17 2.88 2.76 2.29 1.63 Boys 2.40 3.19 2.86 2.21 1.99 1.68 B. Exposure to mass media Newspaper readership: Women 0.16 0.27 0.49 0.62 1.12 0.38 Men 0.52 0.68 1.25 1.42 1.90 0.71 Radio listenership: Women 2.19 2.11 1.79 1.46 1.66 1.01 Men 2.79 1.56 1.96 1.66 1.59 0.96 Television viewership: Women 0.48 0.58 0.87 1.32 1.61 1.05 Men 1.34 1.52 2.10 2.56 1.62 1.41 C. Knowledge and attitudes about HIV/AIDS Knowledge about sexual transmission of HIV/AIDS: Women 2.20 2.06 1.77 1.68 1.19 1.02 Men 2.58 2.28 2.18 1.98 1.62 1.11 Knowledge about mother-to-child transmission of HIV/AIDS: Women 2.49 1.83 1.54 1.29 1.07 0.89 Men 2.42 2.19 2.30 2.16 1.68 1.13 Attitudes toward HIV/AIDS: Women 1.91 1.41 1.51 1.29 1.75 0.83 Men 2.05 2.17 2.52 2.46 2.21 1.25 D. Status of women Household decisionmaking: Can seek own health care 1.41 1.33 1.49 1.30 1.29 0.65 Can seek children's health care 2.26 2.01 1.75 1.73 1.02 1.10 Can make daily household purchases 2.26 2.05 1.73 1.60 1.40 0.89 Can make large household purchases 1.71 1.71 1.58 1.43 1.32 0.79 Can make meal-related decisions 2.34 2.10 2.14 1.71 1.42 1.10 Freedom of movement: Can travel to visit family/relatives 1.26 1.39 1.24 1.27 1.32 0.67 Other decisionmaking, attitudes: Can decide how to spend own money 2.47 2.36 1.79 1.48 1.14 1.08 Can decide whether to have sex 1.21 0.85 0.65 0.62 0.69 0.46 Justifies domestic violence 1.93 1.64 1.81 2.06 1.68 0.93 E. Orphanhood Paternal orphan prevalence 0.72 0.60 0.72 0.58 0.59 0.30 Maternal orphan prevalence 0.37 0.30 0.39 0.38 0.35 0.17 Double orphan prevalence 0.18 0.13 0.16 0.18 0.14 0.07 - 75 - Benin 2001 - ASSET DISTRIBUTION AND WEIGHTS (FACTOR SCORES) Asset Variable Unweighted Wealth Quintiles Factor Low 2nd 3rd 4th High Avg. Score Mean Std. Percentage of Population Devia- tion Has electricity 0.211 0.408 0.0% 0.3% 0.7% 14.3% 94.3% 21.9% 0.08970 Has radio 0.711 0.453 61.3% 68.6% 79.9% 81.8% 94.0% 77.1% 0.02920 Has television 0.150 0.358 0.0% 0.4% 1.6% 14.0% 72.4% 17.7% 0.07636 Has refrigerator 0.058 0.233 0.0% 0.0% 0.0% 2.2% 32.3% 6.9% 0.05907 Has bicycle 0.454 0.498 76.0% 66.7% 65.3% 42.9% 19.3% 54.0% -0.03803 Has motorcycle/scooter 0.249 0.432 4.4% 20.7% 34.9% 40.4% 58.0% 31.7% 0.03783 Has car/truck 0.041 0.199 0.0% 0.1% 2.6% 4.7% 21.1% 5.7% 0.04274 Has telephone 0.035 0.184 0.0% 0.0% 0.0% 1.3% 20.5% 4.4% 0.05010 Owns a boat 0.029 0.169 1.3% 3.4% 3.7% 4.6% 0.2% 2.7% -0.00642 Has a domestic worker not related to head 0.005 0.073 0.0% 0.0% 0.0% 0.0% 3.5% 0.7% 0.02110 Works own or family's agric. land 0.297 0.457 73.2% 53.9% 39.3% 17.8% 0.4% 36.9% -0.04336 Uses piped drinking water in residence 0.106 0.307 0.0% 0.0% 0.6% 4.3% 49.3% 10.8% 0.07076 Uses water that is piped into yard/plot 0.197 0.398 0.5% 4.9% 12.5% 34.0% 37.7% 17.9% 0.03256 Uses a public faucet (piped) 0.124 0.330 13.1% 16.3% 23.9% 13.9% 3.4% 14.1% -0.01503 Uses an open well 0.222 0.416 26.8% 27.1% 26.0% 22.1% 5.9% 21.6% -0.02299 Uses manual pumped well for drinking water 0.121 0.327 21.1% 19.8% 12.1% 9.7% 0.6% 12.7% -0.02190 Uses a protected well 0.054 0.225 5.8% 6.1% 8.0% 5.7% 2.1% 5.5% -0.00883 Uses river, canal or surface water for drinking 0.105 0.307 28.6% 14.4% 8.1% 2.5% 0.1% 10.7% -0.02544 Uses spring for drinking water 0.017 0.131 1.6% 3.1% 1.0% 0.8% 0.4% 1.4% -0.00730 Uses rain for drinking water 0.052 0.222 2.4% 8.3% 7.8% 6.9% 0.4% 5.2% -0.01027 Uses drinking water from tanker truck 0.001 0.026 0.1% 0.0% 0.2% 0.0% 0.0% 0.1% -0.00191 Uses bottled water 0.000 0.019 0.0% 0.0% 0.0% 0.1% 0.0% 0.0% 0.00334 Uses a flush toilet in residence/private 0.022 0.147 0.0% 0.0% 0.0% 0.0% 10.5% 2.1% 0.04433 Uses a pit or unventilated latrine 0.036 0.186 0.0% 0.5% 1.6% 8.0% 13.1% 4.6% 0.01892 Uses a VIP latrine 0.032 0.177 0.0% 0.0% 0.4% 3.4% 16.7% 4.1% 0.03089 Uses a shared flush toilet 0.003 0.057 0.0% 0.0% 0.0% 0.0% 1.4% 0.3% 0.01382 Uses a shared pit or unventilated latrine 0.107 0.310 0.0% 1.5% 8.7% 25.7% 17.2% 10.6% 0.01793 Uses a shared VIP latrine 0.112 0.316 0.0% 0.7% 3.7% 11.3% 33.3% 9.8% 0.04501 Uses bush, field as latrine 0.679 0.467 100.0% 96.5% 84.9% 49.9% 6.9% 67.7% -0.07742 Use other type of latrine 0.008 0.090 0.0% 0.9% 0.7% 1.2% 0.9% 0.7% 0.00145 Has dirt, sand, dung as principal floor in dwelling 0.436 0.496 97.2% 69.8% 29.1% 8.9% 0.7% 41.2% -0.06074 Has wood, plank principal floor in dwelling 0.001 0.029 0.0% 0.2% 0.0% 0.0% 0.0% 0.0% -0.00180 Has palm/bamboo for principal floor 0.004 0.062 0.1% 0.1% 1.5% 0.3% 0.0% 0.4% -0.00234 Has parquet or polished wood floors 0.000 0.013 0.0% 0.0% 0.0% 0.0% 0.1% 0.0% 0.00379 Has vinyl or asphalt strips as flooring material 0.016 0.126 0.0% 0.0% 0.0% 0.1% 8.1% 1.7% 0.03795 Has other type of flooring 0.001 0.029 0.0% 0.0% 0.2% 0.2% 0.2% 0.1% 0.00401 Has earth for walls 0.576 0.494 96.9% 89.3% 69.4% 29.8% 2.3% 57.5% -0.07086 Has walls of stone with lime or cement 0.002 0.044 0.0% 0.2% 0.2% 0.7% 0.2% 0.3% 0.00071 Has wood planks for walls 0.003 0.057 0.0% 0.6% 0.1% 0.2% 0.1% 0.2% -0.00152 Has palm planks for walls 0.055 0.228 2.8% 7.0% 5.2% 5.0% 2.6% 4.5% -0.00465 Has walls from bare brick, cement blocks 0.283 0.451 0.0% 0.0% 3.1% 46.6% 90.9% 28.1% 0.08187 Has walls from mixed brick, cement blocks 0.078 0.268 0.1% 2.3% 21.7% 17.3% 3.9% 9.0% -0.00235 Has other material for walls 0.003 0.056 0.2% 0.5% 0.2% 0.2% 0.1% 0.3% -0.00232 - 77 - Benin 2001 - ASSET DISTRIBUTION AND WEIGHTS (Cont.) (FACTOR SCORES ) Asset Variable Unweighted Wealth Quintiles Factor Low 2nd 3rd 4th High Avg. Score Mean Std. Percentage of Population Devia- tion Has natural material roofing 0.246 0.431 73.9% 24.9% 11.4% 3.8% 0.1% 22.8% -0.04391 Has roof from palm leaf, thatch 0.004 0.063 0.0% 0.5% 0.9% 0.4% 0.0% 0.4% -0.00212 Has wood roof 0.000 0.019 0.1% 0.0% 0.0% 0.1% 0.0% 0.0% -0.00092 Has tole tiles for roof 0.718 0.450 26.0% 74.3% 87.7% 92.6% 86.5% 73.4% 0.02796 Has tuile tiles for roof 0.010 0.097 0.0% 0.0% 0.0% 1.6% 3.3% 1.0% 0.01427 Has roof from cement 0.021 0.143 0.0% 0.3% 0.0% 1.3% 9.7% 2.3% 0.03465 Has other roofing 0.000 0.019 0.0% 0.0% 0.0% 0.1% 0.2% 0.1% 0.00217 Uses gas as cooking fuel 0.008 0.091 0.0% 0.0% 0.0% 0.0% 3.6% 0.7% 0.02834 Uses charcoal for cooking 0.153 0.360 0.0% 0.3% 1.9% 15.9% 53.8% 14.4% 0.06190 Uses wood as cooking fuel 0.785 0.411 100.0% 99.6% 97.7% 80.5% 28.4% 81.2% -0.07996 Uses gasoline for cooking fuel 0.044 0.206 0.0% 0.0% 0.1% 2.2% 12.2% 2.9% 0.03537 Uses other cooking fuel 0.008 0.090 0.0% 0.0% 0.2% 1.1% 1.9% 0.6% 0.00774 Use closed channel for water disposal 0.027 0.163 3.8% 3.4% 1.0% 1.7% 3.7% 2.7% 0.00521 Uses open channel for water disposal 0.005 0.067 0.0% 0.0% 0.0% 0.4% 1.7% 0.4% 0.01232 Uses yard for water disposal 0.156 0.363 9.4% 15.5% 16.6% 17.4% 12.7% 14.3% -0.00167 Uses bush/field for water disposal 0.784 0.412 86.4% 80.1% 81.2% 77.7% 72.6% 79.6% -0.01266 Uses open hole for water disposal 0.011 0.104 0.0% 0.0% 0.0% 0.0% 5.9% 1.2% 0.02933 Uses well for water disposal 0.008 0.090 0.2% 0.3% 0.4% 1.1% 1.8% 0.8% 0.00739 Uses electricity lighting 0.205 0.404 0.0% 0.1% 0.5% 12.4% 93.1% 21.2% 0.08953 Uses petrol lighting 0.769 0.421 97.6% 94.7% 94.7% 84.3% 6.1% 75.5% -0.08415 Uses gas lighting 0.014 0.117 1.4% 2.7% 2.5% 1.4% 0.3% 1.7% -0.00418 Uses community Group Electricity lighting 0.000 0.013 0.0% 0.0% 0.0% 0.2% 0.0% 0.0% 0.00082 Uses private Group Electricity lighting 0.001 0.029 0.0% 0.0% 0.0% 0.4% 0.2% 0.1% 0.00170 Uses other lighting 0.003 0.051 0.0% 0.1% 0.1% 0.2% 0.1% 0.1% 0.00199 Uses public removal of trash 0.009 0.093 0.0% 0.0% 0.0% 0.9% 3.8% 1.0% 0.01617 Uses private removal of trash 0.092 0.289 0.0% 0.0% 0.0% 4.3% 40.7% 9.0% 0.06432 Buries trash 0.016 0.124 0.1% 1.1% 1.7% 3.7% 1.9% 1.7% 0.00313 Burns trash 0.048 0.214 0.5% 3.2% 5.8% 8.9% 6.0% 4.9% 0.00458 Throws trash in yard 0.019 0.136 0.5% 1.9% 3.0% 2.1% 1.3% 1.8% -0.00029 Throws trash in bush/fields 0.800 0.400 98.5% 93.0% 87.0% 77.2% 44.6% 80.1% -0.05344 Uses Other disposal of trash 0.017 0.129 0.3% 0.8% 2.4% 2.6% 1.7% 1.6% 0.00001 - 78 - PART V. SUPPORTING TABLES, 1996 A. SAMPLE SIZES B. STANDARD ERRORS C. ASSET DISTRIBUTION AND WEIGHTS Benin 1996 - SAMPLE SIZES TOTAL SAMPLE Indicator Wealth Quintiles Pop. Low 2nd 3rd 4th High Total Number of household members All 5,404 5,389 5,388 5,376 5,403 26,959 Urban 717 809 1,261 2,449 4,682 9,918 Rural 4,687 4,579 4,127 2,927 721 17,041 Female 2,671 2,740 2,756 2,786 2,804 13,758 Male 2,730 2,644 2,626 2,584 2,593 13,177 Part I: HNP STATUS Indicator Wealth Quintiles Pop. Low 2nd 3rd 4th High Total Mortality rates All 2,305 2,120 2,055 1,900 1,425 9,804 Urban 308 332 417 832 1,206 3,095 Rural 1,996 1,788 1,638 1,068 218 6,708 Female 1,130 1,071 1,020 894 731 4,846 Male 1,174 1,049 1,035 1,006 694 4,958 Prevalence of fever, diarrhea, acute respiratory infection All 648 574 563 512 381 2,678 Urban 99 87 116 221 330 853 Rural 549 487 447 291 50 1,824 Female 318 294 288 247 194 1,341 Male 330 280 275 265 186 1,336 Total fertility rate All 3,070 2,897 2,913 3,237 3,457 15,574 Urban 429 420 642 1,584 3,017 6,092 Rural 2,641 2,476 2,271 1,653 441 9,482 Age-specific fertility rate 15-19 All 594 563 547 717 895 3,316 Urban 93 79 156 384 799 1,511 Rural 501 485 391 333 96 1,806 Children's nutritional status All 485 503 486 462 337 2,273 Urban 64 70 92 194 289 709 Rural 421 434 394 267 48 1,564 Female 231 254 245 225 173 1,128 Male 254 249 241 237 164 1,145 Children's anemia status All na na na na na na Urban na na na na na na Rural na na na na na na Female na na na na na na Male na na na na na na - 81 - Benin 1996 - SAMPLE SIZES Part I: HNP STATUS (Cont.) Indicator Wealth Quintiles Pop. Low 2nd 3rd 4th High Total Women's nutritional status All 527 464 430 416 299 2,137 Urban 80 75 91 182 258 686 Rural 447 390 339 234 42 1,452 Women's anemia status All na na na na na na Urban na na na na na na Rural na na na na na na Girls' circumcision All na na na na na na Urban na na na na na na Rural na na na na na na Women's circumcision All na na na na na na Urban na na na na na na Rural na na na na na na Prevalence of genital discharge, ulcer, sore Female 1,001 939 924 1,011 1,051 4,926 Urban Female 142 139 203 494 907 1,885 Rural Female 859 800 721 516 144 3,040 Male 319 279 264 278 351 1,491 Urban Male 40 34 61 134 318 587 Rural Male 279 245 203 145 33 905 - 82 - Benin 1996 - SAMPLE SIZES Part II: Intermediate Determinants of HNP Status - HNP SERVICE USE Indicator Wealth Quintiles Pop. Low 2nd 3rd 4th High Total Immunization coverage All 209 193 172 169 129 872 Urban 30 31 27 74 115 277 Rural 179 162 145 95 15 596 Female 98 103 80 78 67 426 Male 112 91 92 91 62 448 Treatment of fever All 359 339 319 264 166 1,447 Urban 52 43 55 114 135 399 Rural 307 296 264 150 31 1,048 Female 201 166 154 139 83 743 Male 158 173 165 125 82 703 Treatment of acute respiratory infection All 111 108 85 63 54 421 Urban 18 7 16 19 43 103 Rural 93 101 69 44 11 318 Female 51 56 41 27 30 205 Male 60 52 43 36 24 215 Treatment of diarrhea All 184 174 144 127 70 699 Urban 31 32 25 64 54 206 Rural 153 142 119 63 16 493 Female 85 87 67 55 36 330 Male 99 87 77 72 34 369 Antenatal and delivery care All 641 550 534 505 367 2,597 Urban 96 85 112 226 316 835 Rural 545 465 421 279 51 1,761 Contraceptive prevalence Female 941 848 827 835 747 4,198 Urban Female 136 133 170 387 633 1,459 Rural Female 805 715 657 448 114 2,739 Male 267 225 206 218 215 1,131 Urban Male 34 24 42 108 188 396 Rural Male 232 201 164 110 28 735 Contraceptive source Female 13 11 14 38 67 144 Urban Female 2 3 0 24 56 85 Rural Female 11 8 14 15 11 59 Male 267 225 206 218 215 1,131 Urban Male 34 24 42 108 188 396 Rural Male 232 201 164 110 28 735 Treatment of genital discharge, ulcer, sore Female 3 3 1 1 9 17 Urban Female 1 0 1 0 7 9 Rural Female 2 3 0 1 2 8 Male 18 12 13 17 13 73 Urban Male 5 0 5 8 11 29 Rural Male 13 12 9 9 2 45 - 83 - Benin 1996 - SAMPLE SIZES Part III: Intermediate Determinants of HNP Status - INDIVIDUAL AND HOUSEHOLD BEHAVIOR Indicator Wealth Quintiles Pop. Low 2nd 3rd 4th High Total Sanitary disposal of stools All na na na na na na Urban na na na na na na Rural na na na na na na Wash hands prior to preparing food All na na na na na na Urban na na na na na na Rural na na na na na na Handwashing facilities in household? All na na na na na na Urban na na na na na na Rural na na na na na na Bednet ownership All na na na na na na Urban na na na na na na Rural na na na na na na Bednet use by children All na na na na na na Urban na na na na na na Rural na na na na na na Bednet use by pregnant women All na na na na na na Urban na na na na na na Rural na na na na na na Exclusive breastfeeding All 85 69 84 50 44 332 Urban 15 7 16 23 41 102 Rural 70 62 68 27 3 230 Female 44 31 41 26 22 164 Male 40 38 43 24 22 167 Timely complementary breastfeeding All 71 74 75 62 43 325 Urban 11 15 21 26 37 110 Rural 60 59 54 36 6 215 Female 36 40 38 30 19 163 Male 36 34 37 32 25 164 Bottle-feeding All 248 222 238 180 133 1,021 Urban 40 34 55 77 116 322 Rural 208 188 183 103 17 699 Female 122 100 116 90 64 492 Male 126 123 122 91 70 532 - 84 - Benin 1996 - SAMPLE SIZES Part III: Intermediate Determinants of HNP Status - INDIVIDUAL AND HOUSEHOLD BEHAVIOR (Cont.) Indicator Wealth Quintiles Pop. Low 2nd 3rd 4th High Total Iodized salt in household All 780 873 791 874 890 4,208 Urban 84 120 178 431 796 1,609 Rural 696 753 613 443 94 2,599 Vitamin A supplementation All 518 470 431 426 313 2,158 Urban 75 73 89 185 268 690 Rural 443 397 341 241 45 1,467 Female 263 232 215 222 155 1,087 Male 255 238 215 204 158 1,070 Tobacco and alcohol use, casual sexual partners, condom use for casual sex Female 1,065 1,014 1,015 1,147 1,250 5,491 Urban Female 149 150 226 566 1,090 2,181 Rural Female 916 863 790 581 160 3,310 Male 327 289 270 286 363 1,535 Urban Male 43 37 62 137 330 609 Rural Male 284 252 207 148 34 925 Domestic violence All na na na na na na Urban na na na na na na Rural na na na na na na - 85 - Benin 1996 - SAMPLE SIZES Part IV: UNDERLYING DETERMINANTS OF HNP STATUS Indicator Wealth Quintiles Pop. Low 2nd 3rd 4th High Total School completion (Grade 5) Female 1,093 1,068 1,077 1,199 1,297 5,733 Urban female 158 157 248 581 1,131 2,275 Rural female 935 911 829 618 165 3,458 Male 989 932 921 974 1,246 5,062 Urban male 127 154 227 474 1,112 2,093 Rural male 862 778 694 501 135 2,968 School participation Female 464 446 459 471 480 2,321 Urban female 56 64 116 192 402 830 Rural female 408 382 344 279 78 1,491 Male 488 497 528 472 402 2,387 Urban male 63 72 122 200 340 796 Rural male 425 426 406 271 62 1,590 Mass media exposure Female 1,065 1,014 1,015 1,147 1,250 5,491 Urban female 149 150 226 566 1,090 2,181 Rural female 916 863 790 581 160 3,310 Male 327 289 270 286 363 1,535 Urban male 43 37 62 137 330 610 Rural male 284 252 207 148 34 925 Knowledge of HIV/AIDS prevention Female 2,029 1,014 1,015 1,147 1,250 6,455 Urban female 149 150 226 566 1,090 2,181 Rural female 916 863 790 581 160 3,310 Male 327 289 270 286 363 1,535 Urban male 43 37 62 137 330 609 Rural male 284 252 207 148 34 925 Household decisionmaking and justification of violence All na na na na na na Urban na na na na na na Rural na na na na na na Orphanhood All 2,756 2,624 2,672 2,570 2,417 13,038 Urban 365 388 600 1,106 2,057 4,516 Rural 2,391 2,236 2,072 1,463 360 8,522 Female 1,466 1,346 1,395 1,407 1,332 6,947 Male 1,287 1,262 1,264 1,162 1,083 6,059 - 86 - Benin 1996 - STANDARD ERRORS OF QUINTILE ESTIMATES FOR TOTAL POPULATION Part I: HNP STATUS Indicator Wealth Quintiles Pop. Low 2nd 3rd 4th High Avg. A. Childhood illness and mortality Infant mortality rate 8.70 8.42 6.70 8.07 7.25 3.98 Under-five mortality rate 11.41 11.12 9.05 10.25 9.14 5.59 Prevalence of fever 2.26 2.54 2.09 2.68 2.90 1.16 Prevalence of diarrhea 2.06 2.26 1.84 2.29 2.17 1.09 Prevalence of acute respiratory infection 1.56 1.73 1.52 1.62 2.11 0.87 B. Fertility Total fertility rate 0.20 0.23 0.24 0.20 0.22 0.14 Adolescent fertility rate 16.00 15.00 16.00 13.00 6.00 7.00 C. Nutritional status Children: Moderate stunting 1.76 1.65 1.80 1.97 1.91 0.84 Severe stunting 1.43 1.34 1.08 1.24 1.30 0.56 Moderate underweight 1.80 1.97 1.72 1.87 2.10 0.79 Severe underweight 1.38 1.21 1.15 0.94 1.12 0.56 Mild anemia na na na na na na Moderate anemia na na na na na na Severe anemia na na na na na na Women: Malnutrition 2.18 1.99 1.61 1.62 1.68 0.88 Mild anemia na na na na na na Moderate anemia na na na na na na Severe anemia na na na na na na D. Female circumcision Prevalence of circumcision: Girls na na na na na na Women na na na na na na Prevalence of occlusion: Girls na na na na na na Women na na na na na na E. Sexually transmitted disease Prevalence of genital discharge: Women 0.12 0.13 0.00 0.10 0.17 0.06 Men 1.25 1.14 1.19 1.53 1.06 0.58 Prevalence of genital ulcer: Women 0.00 0.00 0.00 0.00 0.16 0.03 Men 0.74 0.47 0.83 0.91 0.64 0.33 - 87 - Benin 1996 - STANDARD ERRORS OF QUINTILE ESTIMATES FOR TOTAL POPULATION Part II: Intermediate Determinants of HNP Status - HNP SERVICE USE Indicator Wealth Quintiles Pop. Low 2nd 3rd 4th High Avg. A. Childhood immunization BCG coverage 3.93 3.50 1.83 1.95 1.75 1.77 Measles coverage 4.19 3.89 3.35 3.58 4.13 2.05 DPT coverage 5.33 3.99 3.53 4.01 3.41 2.42 Full basic coverage 4.65 4.04 3.80 4.02 4.09 2.23 No basic coverage 3.90 3.24 1.83 1.90 1.75 1.69 Hepatitis B coverage na na na na na na Yellow fever coverage na na na na na na B. Treatment of childhood illnesses Treatment of fever: Medical treatment of fever 1.92 1.76 1.64 2.25 3.99 0.96 Treatment in a public facility 1.84 1.70 1.47 2.21 2.85 0.90 Treatment in a private facility 0.68 0.72 0.92 1.09 2.61 0.53 Treatment of acute respiratory infection (ARI): Medical treatment of ARI 4.63 4.32 5.19 7.44 6.75 2.70 Treatment in a public facility 4.36 4.36 5.09 6.92 6.42 2.40 Treatment in a private facility 2.51 1.48 2.30 3.18 6.34 1.69 Treatment of diarrhea: Use of oral rehydration therapy 4.43 4.40 4.11 4.47 6.22 2.23 Medical treatment of diarrhea 3.65 3.50 3.29 4.01 6.57 1.86 Treatment in a public facility 3.48 3.48 3.24 3.49 5.74 1.73 Treatment in a private facility 2.28 1.30 1.43 2.55 4.63 1.07 C. Antenatal and delivery care Antenatal care (ANC) visits: To a medically trained person 4.30 2.72 1.76 1.39 0.60 2.04 To a doctor 0.56 0.72 1.13 1.08 2.21 0.53 To a nurse or trained midwife 4.21 2.63 2.08 1.63 2.19 1.82 Multiple visits to a medically trained person 3.58 2.76 2.30 2.08 1.52 1.77 Antenatal care content: Tetanus toxoid 3.70 2.63 1.59 2.14 2.17 1.72 Prophylactic antimalarial treatment na na na na na na Iron supplementation na na na na na na Delivery attendance: By a medically trained person 3.50 3.52 3.32 1.95 0.93 2.37 By a doctor 0.72 0.88 0.85 1.15 2.28 0.56 By a nurse or trained midwife 3.45 3.36 3.39 2.15 2.43 2.24 In a public facility 3.39 3.98 3.38 2.83 2.37 2.34 In a private facility 0.73 0.98 1.36 2.60 2.45 1.07 At home 3.54 3.73 3.22 1.83 0.97 2.38 D. Contraceptive services Contraceptive prevalence: Women 0.55 0.55 0.72 1.08 1.31 0.42 Men 0.93 1.19 1.93 2.24 2.80 0.97 Source of contraception - public sector: Women * * * 8.78 7.24 5.02 Men na na na na na na - 88 - Benin 1996 - STANDARD ERRORS OF QUINTILE ESTIMATES FOR TOTAL POPULATION Part II: Intermediate Determinants of HNP Status - HNP SERVICE USE (Cont.) Indicator Wealth Quintiles Pop. Low 2nd 3rd 4th High Avg. D. Contraceptive services (cont.) Source of contraception - private sector: Women * * * 8.24 6.62 4.32 Men na na na na na na E. Treatment of adult illnesses Treatment of genital discharge, ulcer, sore: Women * * * * * * Men * * * * * 6.45 Treatment of genital discharge, ulcer, sore in public medical facilities: Women 0.12 0.13 0.00 0.10 0.17 0.06 Men 1.34 1.23 1.28 1.62 1.16 0.65 Voluntary counseling and testing for HIV/AIDS: Women na na na na na na Men na na na na na na - 89 - Benin 1996 - STANDARD ERRORS OF QUINTILE ESTIMATES FOR TOTAL POPULATION Part III: Intermediate Determinants of HNP Status - INDIVIDUAL AND HOUSEHOLD BEHAVIOR Indicator Wealth Quintiles Pop. Low 2nd 3rd 4th High Avg. A. Hygienic practices Disposal of children's stools: Sanitary disposal na na na na na na Handwashing: Wash hands prior to preparing food na na na na na na Handwashing facilities in household na na na na na na B. Bednet ownership and use Bednet ownership: Bednet ownership na na na na na na Treated bednet ownership na na na na na na Bednet use: By children na na na na na na By pregnant women na na na na na na C. Breastfeeding Exclusive breastfeeding 2.56 2.68 4.22 7.68 8.95 2.44 Timely complementary feeding 5.03 4.31 4.10 3.47 6.03 2.15 Bottle-feeding 0.00 0.85 0.91 2.70 2.94 0.68 D. Micronutrient consumption Iodized salt: Availability of iodized salt in household 3.34 2.38 2.29 2.48 1.79 1.58 Vitamin A: Children 1.97 1.03 1.22 0.52 0.90 0.69 Women na na na na na na E. Tobacco and alcohol use Tobacco: Women na na na na na na Men na na na na na na Alcohol: Women na na na na na na Men na na na na na na F. Sexual practices Non-regular sexual partnerships: Women 0.32 0.28 0.22 0.24 0.14 0.13 Men 2.66 2.53 2.78 2.59 3.41 1.32 Condom usage with non-regular partner: Women * * * * * 5.84 Men 1.21 4.00 3.79 5.21 6.65 2.60 G. Domestic violence Ever experienced violence na na na na na na Experienced violence in past year na na na na na na - 90 - Benin 1996 - STANDARD ERRORS OF QUINTILE ESTIMATES FOR TOTAL POPULATION Part IV: UNDERLYING DETERMINANTS OF HNP STATUS Indicator Wealth Quintiles Pop. Low 2nd 3rd 4th High Avg. A. Education School completion: Women 0.36 0.39 0.83 1.42 1.96 1.05 Men 1.05 1.53 2.22 2.37 1.87 1.45 School participation: Girls 2.05 2.72 2.65 2.77 2.88 1.82 Boys 2.78 2.80 2.94 2.83 2.34 1.85 B. Exposure to mass media Newspaper readership: Women 0.16 0.36 0.48 1.12 1.45 0.68 Men 1.20 2.00 2.09 3.35 3.37 1.51 Radio listenership: Women 0.95 1.16 1.24 1.39 1.52 0.69 Men 3.30 2.63 3.02 3.18 3.32 1.58 Television viewership: Women 2.38 2.42 2.39 2.28 2.11 1.64 Men 4.07 3.52 3.59 2.44 1.62 1.81 C. Knowledge and attitudes about HIV/AIDS Knowledge about sexual transmission of HIV/AIDS: Women 2.58 2.11 1.55 1.14 1.08 0.91 Men 1.77 1.38 1.38 1.46 0.21 0.67 Knowledge about mother-to-child transmission of HIV/AIDS: Women 2.69 2.40 2.25 1.88 1.65 1.32 Men 3.75 3.35 2.97 2.38 1.63 1.57 Attitudes toward HIV/AIDS: Women na na na na na na Men na na na na na na D. Status of women Household decisionmaking: Can seek own health care na na na na na na Can seek children's health care na na na na na na Can make daily household purchases na na na na na na Can make large household purchases na na na na na na Can make meal-related decisions na na na na na na Freedom of movement: Can travel to visit family/relatives na na na na na na Other decisionmaking, attitudes: Can decide how to spend own money 1.99 1.78 1.57 1.67 1.48 1.00 Can decide whether to have sex na na na na na na Justifies domestic violence na na na na na na E. Orphanhood Paternal orphan prevalence 0.59 0.54 0.61 0.73 0.56 0.31 Maternal orphan prevalence 0.34 0.29 0.35 0.44 0.36 0.17 Double orphan prevalence 0.10 0.14 0.12 0.11 0.15 0.05 - 91 - Benin 1996 - ASSET DISTRIBUTION AND WEIGHTS (FACTOR SCORES) Asset Variable Unweighted Wealth Quintiles Factor Low 2nd 3rd 4th High Avg. Score Mean Std. Percentage of Population Devia- tion Has electricity 0.126 0.332 0.0% 0.3% 0.3% 4.9% 66.0% 14.3% 0.10860 Has radio 0.526 0.499 38.3% 42.5% 57.5% 69.4% 89.4% 59.4% 0.05877 Has television 0.092 0.289 0.0% 0.0% 0.2% 4.2% 54.7% 11.8% 0.09860 Has refrigerator 0.039 0.193 0.0% 0.1% 0.1% 0.4% 24.2% 5.0% 0.07473 Has bicycle 0.444 0.497 69.0% 60.5% 61.6% 41.9% 20.7% 50.7% -0.04730 Has motorcycle 0.210 0.407 2.7% 12.1% 23.3% 36.2% 63.6% 27.6% 0.07303 Has car 0.033 0.178 0.0% 0.0% 1.7% 3.7% 20.1% 5.1% 0.05682 Has a domestic worker not related to head 0.005 0.068 0.0% 0.2% 0.0% 0.2% 2.5% 0.6% 0.02367 Works own or family's agricultural land 0.415 0.493 83.3% 67.3% 58.7% 31.2% 6.7% 49.4% -0.07196 Uses piped drinking water in residence 0.065 0.247 0.0% 0.0% 0.0% 1.9% 32.8% 6.9% 0.08442 Uses piped drinking water outside of the house 0.168 0.374 0.4% 3.9% 9.4% 30.0% 37.3% 16.2% 0.05300 If uses river, canal or surface water for drinking water 0.164 0.371 45.7% 20.1% 11.8% 4.3% 0.5% 16.5% -0.05063 Uses rainwater for drinking water 0.081 0.273 3.9% 13.1% 10.9% 7.6% 2.5% 7.6% -0.01250 Uses a public faucet (piped) for drinking water 0.064 0.245 3.2% 9.1% 7.7% 5.4% 2.2% 5.5% -0.00880 Uses a protected well for drinking water 0.087 0.281 10.1% 8.4% 10.0% 9.4% 6.7% 8.9% -0.00746 Uses an unprotected well for drinking water 0.211 0.408 15.5% 24.8% 30.1% 28.5% 14.2% 22.6% -0.00884 Uses a well with a pump for drinking water 0.158 0.365 21.1% 20.5% 19.8% 12.7% 3.7% 15.6% -0.02893 Other source of drinking water 0.000 0.015 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% -0.00234 Uses covered latrine 0.166 0.372 0.0% 0.4% 3.1% 16.8% 69.1% 17.9% 0.09629 Uses open latrine 0.058 0.235 0.0% 0.7% 4.8% 13.1% 12.3% 6.2% 0.02558 Uses pit latrine connected to septic system 0.015 0.121 0.0% 0.0% 0.1% 0.4% 6.8% 1.5% 0.04763 Uses bush, field as latrine 0.756 0.430 100.0% 98.6% 91.0% 68.3% 10.9% 73.8% -0.11133 Uses other type of latrine 0.004 0.060 0.0% 0.1% 0.6% 1.0% 0.9% 0.5% 0.00408 Has dirt, sand, dung as principal floor in dwelling 0.500 0.500 99.9% 93.6% 34.1% 8.3% 0.2% 47.2% -0.10964 Has wood, plank principal floor in dwelling 0.002 0.047 0.0% 0.2% 0.4% 0.8% 0.0% 0.3% -0.00084 Has cement principal floor 0.485 0.500 0.0% 5.5% 63.3% 89.6% 98.2% 51.3% 0.10777 Has other material as principal floor 0.010 0.097 0.0% 0.1% 1.6% 1.2% 1.7% 0.9% 0.01230 Has brick or stone walls 0.245 0.430 0.0% 0.1% 1.5% 38.2% 89.2% 25.8% 0.11684 Has cane, palm, trunks for walls 0.676 0.468 95.7% 92.2% 90.9% 51.6% 6.2% 67.3% -0.10721 Has bamboo for walls 0.057 0.231 1.1% 6.7% 6.1% 6.6% 2.5% 4.6% -0.00222 Has walls made of semi-solid materials 0.010 0.101 0.0% 0.0% 0.4% 3.1% 2.0% 1.1% 0.01314 Has other material for walls 0.010 0.098 3.0% 0.9% 0.7% 0.3% 0.0% 1.0% -0.00929 Has natural material roofing 0.322 0.467 99.7% 34.9% 14.6% 2.9% 0.1% 30.5% -0.08766 Has roof made of tole 0.658 0.475 0.3% 64.8% 84.4% 96.2% 91.6% 67.4% 0.07566 Has other roofing 0.000 0.021 0.0% 0.0% 0.0% 0.0% 0.2% 0.0% 0.00491 Has roof made of tuile material 0.006 0.080 0.0% 0.1% 0.1% 0.5% 2.0% 0.6% 0.01457 Has roofs made of cement 0.012 0.107 0.0% 0.0% 0.0% 0.2% 6.2% 1.3% 0.03602 Number of members per sleeping room 2.229 1.345 2.6 2.4 2.4 2.5 2.4 2.5 -0.00923 - 93 - PART VI. ANNEXES A. SOURCES OF ADDITIONAL INFORMATION B. USE OF INFORMATION FROM THIS REPORT TO MONITOR THE ECONOMIC STATUS OF PEOPLE SERVED BY HNP PROGRAMS C. COUNTRIES COVERED BY THE HNP- POVERTY REPORT PROJECT ANNEX A. SOURCES OF ADDITIONAL INFORMATION ADDITIONAL INEQUALITY DATA World Bank HNP/Poverty Country Report Website: http://www.worldbank.org/hnp/povertyandhealth/countrydata. This World Bank website provides the full texts and tables for all fifty-six countries covered by the HNP/Poverty Country Report Project. (A list of the countries covered appears in annex C, at the end of this report.) Also available at the site are summary tables, organized by indicator, designed to facilitate cross-country comparisons in inequality with respect to particular indicators. DHS Country Reports: http://www.measuredhs.com/countries. All DHS final country reports produced since 2003 include quintile-specific tabulations in approximately 50-100 of the reports' HNP indicator tables. The tables deal with some of the indicators covered in this volume, and with many that are not. UNICEF Multi-Indicator Cluster Survey Website: http://www.childinfo.org/MICS2/natlMICSrepz/MICSnatrep.htm. The UNICEF Multi-Indicator Cluster Survey (MICS) project is generally similar to the DHS program, but covers a somewhat different set of countries and indicators. The "standard tables" section for each country listed at the MICS website provides wealth- based, quintile-specific information in around 40-45 of the tables related to hnp, education, and child labor. In deriving these quintile-specific estimates, the MICS investigators have employed a wealth index similar to the one used here. World Health Organization World Health Survey Website: http://www.who.int/healthinfo/survey/en/index.html. The World Health Organization's World Health Survey (WHS) includes such issues as self-assessed adult health status; coverage of interventions against adult chronic diseases and against maternal and child health problems; household health expenditures; insurance coverage; and health system responsiveness. Approximately seventy countries ­ developed as well as developing ­ have been covered thus far. Household wealth information has been collected and used to prepare quintile-specific estimates for many of the indicators appearing in the reports on these countries. - 97 - METHODS AND RESOURCES FOR FURTHER INEQUALITY ANALYSIS Shea Oscar Rutstein and Kiersten Johnson, The DHS Wealth Index, DHS Comparative Reports No. 6 (Calverton, Maryland, USA: ORC Macro, August 2004) (Available at: http://www.measuredhs.com/pubs/pub_details.cfm?ID =470&srchTp=type). This DHS publication, by two of the co-authors of the current report, describes in detail the construction of the wealth index that underlies the data presented in the basic tables. Deon Filmer and Lant H. Pritchett, "Estimating Wealth Effects without Expenditure Data ­ or Tears: An Application to Education Enrollments in States in India," Demography 38, no.1 (February 2001): 115-132. This seminal piece gave birth to the wealth index procedure used in the current volume. It also includes three of the previously-cited country case studies demonstrating the close relationship between results produced using wealth and those based on consumption as an indicator of household economic status. Owen O'Donnell, Eddy van Doorslaer, Adam Wagstaff, and Magnus Lindelow. Quantitative Techniques for Health Equity Analysis. Washington D.C.: The World Bank, forthcoming. Among the topics covered in this comprehensive overview of available quantitative techniques are the measurement of living standards using a wealth index and other approaches (chapter 6) and the concentration index as a measure of inequality (chapter 8). DHS Country Data Sets: http://www.measuredhs.com/accesssurveys/search. The data sets for all DHS surveys undertaken since 2003 include two pieces of information for each household that are designed to help investigators prepare quintile- specific tabulations for any indicator. These are: 1) the household wealth score; and 2) the economic quintile to which individuals in the household belong. Any tabulation using these pieces of information will be comparable to the figures appearing here. - 98 - ANNEX B. USE OF INFORMATION FROM THIS REPORT TO MONITOR THE ECONOMIC STATUS OF PEOPLE SERVED BY HNP PROGRAMS The wealth or asset approach employed in this report can be used to monitor the economic status of people served by health, nutrition, and population (hnp) programs in two ways. The first, simpler way is suitable for monitoring nationwide, facility-based programs. A second, fuller version can also be employed for other types of programs, such as initiatives undertaken only in some parts of a country, or activities like mass education or outreach programs that do not operate through facilities. BASIC MONITORING OF NATIONWIDE FACILITY-BASED PROGRAMS The economic distribution of patients in a nationwide, facility-based program (say, a network of rural health posts, antenatal care clinics, emergency obstetrical facilities, or hospitals) can be determined through an exit survey of facility patients, using the wealth questionnaire and the set of quintile cut-off points that immediately follow this text, and which have been created using the information presented in part III.C. The questionnaire can be employed to measure the economic status of any individual responding to the questions on it. The set of cut-off points can serve to compare the distribution of the respondents' economic status with that of the nationally- representative sample of people interviewed by the DHS survey on which the present report is based. The first step is to use the questionnaire in interviewing an adequately-large sample of patients attending the facility-based services of interest. The wealth score for each patient can then be calculated by multiplying the response to each question by the item scores also provided on the questionnaire, and summing the results. After this has been done, the quintile cut-off points can be used to place each individual in the economic quintile to which (s)he belongs. The number of patients and percentage of total patients in each quintile can then be calculated. Since each quintile defined by the cut-off points contains 20 percent of the individuals in the nationally-representative DHS sample, the patients belonging to any such quintile containing significantly more (or less) than 20 percent of the total are over- (under-) represented relative to the national population. When the percentage of patients in each of the five quintiles is viewed as a whole, the result is a frequency distribution that indicates the spread of service beneficiaries across economic classes of individuals.21 For example: · A service that favors the poorest people would have substantially more than 20 percent of its patients in each of the lowest one or two economic quintiles; considerably less than 20 percent of its patients in each of the highest quintiles. 21That is, across economic classes of all individuals in the sample population. Estimates pertaining to quintiles of only those individuals needing services require adjusting the results of the procedure described here through application of the relevant quintile-specific, sample-size figures presented in part III.A. - 99 - · A service that reaches all economic classes equally would draw roughly the same proportion of total patients from the lower and upper quintiles. · A service that favors the least poor population groups would have well over 20 percent of its patients in each of the highest one or two quintiles, considerably less than 20 percent of its patients in each of the lowest quintiles. FULLER MONITORING OF FACILITY-BASED AND OF OTHER PROGRAMS While capable of providing far more information than currently exists about the distribution of a program's beneficiaries, the approach just described has important limitations. For example, it cannot deal with the many important types of health programs that do not deliver services primarily through facilities ­ mass media health education, household visits by health workers, and many social marketing initiatives, for example. It is also limited in its ability to assess programs working only with certain areas within a country: it can compare the economic status of the programs' beneficiaries with that of the national population, but not with that of the specific sub-national areas where the programs are active. Further, it focuses primarily on only one of the two important dimensions of monitoring the distribution of program beneficiaries: that is, incidence or focus ­ the percentage of program benefits that flow to the poor. It cannot deal nearly so well with the second dimension, which concerns coverage, or the percentage of the poor that the program reaches. These limitations can be overcome by a modified version of the approach described above that relies on a household- rather than facility-based survey. A household survey can generate a set of data containing the full range of information needed to produce an equity assessment by collecting two types of information: first, about the household's wealth or assets, using the questions in the left-hand column of the attached questionnaire;22 and second, about the household members' use of or exposure to the services provided by the program(s) of interest. The collected data can be analyzed in either (or both) of two ways, depending on the type of information desired: · One way would be to use only data from the household survey. The procedure would be analogous to that for a DHS survey employed in this report: ­ Asset information from the survey-generated data set would be used as the basis for the construction of a wealth index, weighting the individual items using some method like principal components analysis. ­ The individuals in the sample would be ranked in order of the index values for their households, then divided into groups like quintiles. ­ The coverage rates in each quintile for the service of interest would be calculated. · A second approach would be to use the weights for each item appearing on the attached questionnaire in determining the wealth of each individual, instead of calculating the weights from the new household data set. Once the individuals' wealth is determined, the individuals would be ranked, divided into quintiles, and the coverage rate in each quintile would be calculated. In the case of programs undertaken in only one region of the country, it would 22Or, if one is willing to forego the benefits of the second analytical approach described below, using any of several other asset questionnaires that exist. Examples include the INDEPTH health equity survey tool (available at: www.indepth-network.org/core_documents/indepthtools.htm) or the model questionnaire developed by M. Mahood Khan and David Hotchkiss of the PHR Plus project (which can be found at: www.phrplus.org). - 100 - provide a comparison of the economic status of the people served with that of the entire country rather than of only the region where the programs are active;23 in the case of nationwide as well as regional programs, it would permit a comparison with the other service programs covered in this report. 23This additional perspective could be particularly helpful in an assessment of a program seeking to reach the poor by focusing on especially backward districts. A report presenting only a finding that the program was reaching the better- off people in those districts could produce an impression that it had failed to reach its intended beneficiaries. But a comparison between the economic status of the program's beneficiaries with that of the national population might well reveal that most of the beneficiaries were poor by national standards and that the program was thus considerably more successful than otherwise thought. - 101 - Benin 2001 - ASSET QUESTIONNAIRE Question Score If Score If Item "Yes" "No" Score 1. In your household, is/are there? Electricity 0.17356 -0.04635 One or more radios 0.01862 -0.04579 One or more televisions 0.18143 -0.03213 One or more refrigerators 0.23865 -0.01462 One or more bicycles -0.04167 0.03470 One or more motorcycles, scooters 0.06570 -0.02177 One or more cars, trucks 0.20600 -0.00886 One or more telephones 0.26233 -0.00957 One or more boats -0.03696 0.00112 2. Does your household have a domestic worker not related to head? 0.28704 -0.00155 3. Do the members of your household work their own or family's agricultural land? -0.06675 0.02817 4. What is the principal source of drinking water for your household? Piped water in residence 0.20594 -0.02431 Piped water in yard, plot 0.06571 -0.01613 Piped water in public tap -0.03986 0.00567 Protected well in residence -0.03713 0.00210 Open well -0.04299 0.01229 Manually pumped well -0.05892 0.00814 Springwater -0.05493 0.00097 Rainwater -0.04391 0.00240 River, canal, surface water -0.07418 0.00872 Tanker truck -0.07245 0.00005 Bottle water 0.17915 -0.00006 5. What is the principal source of fuel for cooking used by your household? Gas 0.30933 -0.00260 Charcoal 0.14589 -0.02626 Wood -0.04181 0.15288 Gasoline 0.16413 -0.00762 Other 0.08542 -0.00070 6. What is the principal type of toilet facility used by your household? Private flush toilet 0.29545 -0.00665 Shared flush toilet 0.24034 -0.00079 Private pit latrine 0.16922 -0.00564 Shared pit latrine 0.12662 -0.01599 Private latrine 0.09832 -0.00364 Shared latrine 0.05166 -0.00622 Bush, field as latrine -0.05327 0.11249 Other type of latrine 0.01601 -0.00013 7. What is the principal material used for the floors in your household? Dirt, sand, dung -0.06905 0.05341 Wood, plank -0.06103 0.00005 Palm, bamboo -0.03780 0.00014 Parquet, polished wood 0.28812 -0.00005 Vinyl, asphalt strips 0.29647 -0.00486 Other 0.13631 -0.00012 - 103 - Benin 2001 - ASSET QUESTIONNAIRE Question Score If Score If Item "Yes" "No" Score 8. What is the principal material used for the walls of your household? Earth, dirt -0.06081 0.08255 Stone with lime or cement 0.01628 -0.00003 Wood planks -0.02648 0.00009 Palm planks -0.01930 0.00112 Bare brick, cement blocks 0.13029 -0.05144 Mixed brick, cement blocks -0.00809 0.00068 Other -0.04139 0.00013 9. What is the principal material used for the roof of your household? Natural material -0.07687 0.02508 Palm leafs, thatch -0.03344 0.00013 Wood roof -0.04942 0.00002 Tole tiles 0.01751 -0.04465 Tuile tiles 0.14547 -0.00140 Cement 0.23673 -0.00507 Other 0.11648 -0.00004 10. What is the principal source of water disposal in your household? Closed channel 0.03116 -0.00087 Open channel 0.18303 -0.00083 Yard -0.00388 0.00072 Bush, field -0.00665 0.02410 Open hole 0.27909 -0.00308 Well 0.08156 -0.00067 11. What is the principal source of lighting in your household? Electricity 0.17635 -0.04544 Private group electricity 0.05788 -0.00005 Community group electricity 0.06237 -0.00001 Petrole -0.04610 0.15356 Gas -0.03527 0.00050 Other 0.03903 -0.00010 12. What is the principal means of trash removal of trash in your household? Public removal -0.00151 -0.00151 Private removal -0.02044 -0.02044 Bury -0.00039 -0.00039 Burn -0.00103 -0.00103 Throw in yard 0.00004 0.00004 Throw in bush, field 0.10681 0.10681 Other 0.00000 0.00000 Total Household Asset Score (sum of individual item scores) - 104 - Benin 2001 - QUINTILE CUT-OFF POINTS Asset Index Value Wealth Quintile Bottom Cut-Off Top Cut-Off Low Low -0.73475 Second -0.73475 -0.54097 Third -0.54097 -0.26902 Fourth -0.26902 0.82388 High 0.82388 High - 105 - ANNEX C. COUNTRIES COVERED BY THE HNP - POVERTY REPORT PROJECT* East Asia and Pacific Sub-Saharan Africa Cambodia 2000 Benin 1996, 2001 Indonesia 1997, 2002-03 Burkina Faso 1992-3, 1998-9, 2003 Philippines 1998, 2003 Cameroon 1991, 1998, 2004 Vietnam 1997, 2002 Central African Rep. 1994-95 Chad 1996-97, 2004 Europe and Central Asia Comoros 1996 Armenia 2000 Cote d'Ivoire 1994 Kazakhstan 1995, 1999 Eritrea 1995 Kyrgyz Rep. 1997 Ethiopia 2000 Turkey 1993, 1998 Gabon 2000 Turkmenistan 2000 Ghana 1993, 1998, 2003 Uzbekistan 1996 Guinea 1999 Kenya 1993, 1998, 2003 Latin America and the Caribbean Madagascar 1997 Bolivia 1998, 2003 Malawi 1992, 2000 Brazil 1996 Mali 1995-96, 2001 Colombia 1995, 2000, 2005 Mauritania 2000-01 Dominican Rep. 1996, 2002 Mozambique 1997, 2003 Guatemala 1995, 1998-99 Namibia 1992, 2000 Haiti 1994-95, 2000 Niger 1998 Nicaragua 1997- 98, 2001 Nigeria 1990, 2003 Paraguay 1990 Rwanda 2000 Peru 1996, 2000 Senegal 1997 South Africa 1998 Middle East and North Africa Tanzania 1996, 1999, 2004 Egypt 1995, 2000 Togo 1998 Jordan 1997 Uganda 1995, 2000-01 Morocco 1992, 2003-04 Zambia 1996, 2001-02 Yemen 1997 Zimbabwe 1994, 1999 South Asia * Note: electronic versions of reports for all countries Bangladesh 1996-97, 1999-2000, 2004 are currently available at: www.worldbank.org/ povertyandhealth/countrydata. While supplies last, India 1992-93, 1998-99 paper copies may be obtained at no charge by sending Nepal 1996, 2001 a request to the World Bank's health advisory service: healthpop@worldbank.org. Pakistan 1990-91 - 107 -