39470 SOCIO-ECONOMIC DIFFERENCES IN HEALTH, NUTRITION, AND POPULATION KENYA 1993, 1998, 2003 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, 2003 1 A. Total Population 3 B. Female and Male Populations 9 C. Rural and Urban Populations 13 Part II. Basic Tables, 1998 19 A. Total Population 21 B. Female and Male Populations 27 C. Rural and Urban Populations 31 Part III. Basic Tables, 1993 37 A. Total Population 39 B. Female and Male Populations 45 C. Rural and Urban Populations 49 Part IV. Technical Notes 55 A. Indicator Definitions 57 B. Data and Methods 71 C. Discussion 75 Part V. Supporting Tables, 2003 81 A. Sample Sizes 83 B. Standard Errors 89 C. Asset Distribution and Weights 95 Part VI. Supporting Tables, 1998 97 A. Sample Sizes 99 B. Standard Errors 105 C. Asset Distribution and Weights 111 Part VII. Supporting Tables, 1993 113 A. Sample Sizes 115 B. Standard Errors 121 C. Asset Distribution and Weights 127 Part VIII. Annexes 129 A. Sources of Additional Information 131 B. Use of Information from this 133 Report to Monitor the Economic Status of People Served by HNP Programs C. Countries Covered by the 141 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, two, and three, 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 four provides supplementary technical information designed to help readers understand the data presented in the three previous parts. This information deals with such issues as how the covered hnp indicators were defined and how the quintile-specific estimates were derived. · Parts five, six, and seven present supporting tables that deal with three of the technical matters covered in part four: the size of the sample for each indicator covered; the 1The average interval of approximately two years between data collection and availability means that the latest surveys covered were conducted in 2005. III standard error 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, eighth 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, 2003 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. Kenya 2003 - 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 95.8 75.2 81.9 53.1 62.2 75.5 1.54 33.58 -0.0979 0.0265 Under-five mortality rate 148.9 109.5 120.9 77.3 91.1 112.7 1.63 57.77 -0.1101 0.0299 Prevalence of fever 37.6 43.7 42.1 41.1 39.4 40.7 0.96 1.76 0.0146 0.0094 Prevalence of diarrhea 18.5 17.7 15.2 13.3 16.2 16.4 1.14 2.27 -0.0551 0.0176 Prevalence of acute respiratory 18.1 22.9 17.5 17.5 15.7 18.4 1.15 2.37 -0.0347 0.0161 infection (ARI) B. Fertility Total fertility rate 7.6 5.8 5.1 4.0 3.1 4.9 2.44 4.50 -0.1741 0.0361 Adolescent fertility rate 173.5 141.2 111.3 93.7 80.8 114.2 2.15 92.72 -0.1532 0.0274 C. Nutritional status (%) Children: Moderate stunting 24.8 21.4 19.1 17.8 13.4 19.8 1.85 11.38 -0.0966 0.0155 Severe stunting 13.8 11.2 11.1 10.3 6.1 10.8 2.26 7.66 -0.1628 0.0226 Moderate underweight 21.6 17.2 15.2 14.7 7.5 15.8 2.89 14.14 -0.1858 0.0181 Severe underweight 7.6 3.1 3.6 2.8 1.8 4.0 4.12 5.77 -0.3234 0.0433 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 21.4 15.8 11.9 9.3 4.6 11.8 4.64 16.77 -0.2815 0.0176 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 2.9 2.4 2.8 2.6 2.5 2.6 1.14 0.35 0.0352 0.0367 Men 2.6 2.2 1.3 1.4 1.6 1.8 1.62 0.98 -0.0743 0.0665 Prevalence of genital ulcer: Women 2.6 2.3 1.3 1.9 1.9 2.0 1.38 0.71 -0.0633 0.0408 Men 1.7 1.4 1.3 0.9 1.2 1.2 1.45 0.52 -0.0413 0.0891 - 3 - Kenya 2003 - 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 70.0 88.7 92.9 96.4 96.0 87.3 0.73 25.93 0.0648 0.0071 Measles coverage 54.0 67.9 80.0 80.6 87.6 72.3 0.62 33.61 0.1025 0.0099 DPT coverage 56.3 71.0 85.7 81.3 72.7 72.2 0.77 16.36 0.0753 0.0112 Full basic coverage 37.8 50.2 62.3 56.6 59.5 52.1 0.64 21.68 0.1114 0.0159 No basic coverage 19.7 5.3 4.1 1.1 3.1 7.6 6.45 16.67 -0.5321 0.0737 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 41.6 42.2 45.8 49.5 54.6 46.3 0.76 13.03 0.0688 0.0135 Treatment in a public facility 27.3 27.9 31.0 34.1 25.7 29.0 1.06 1.55 0.0072 0.0192 Treatment in a private facility 14.3 14.3 14.8 15.4 28.9 17.3 0.50 14.58 0.1726 0.0297 Treatment of acute respiratory infection (ARI): Medical treatment of ARI 43.7 41.5 46.1 57.4 63.8 49.1 0.69 20.04 0.0871 0.0190 Treatment in a public facility 31.7 27.0 31.0 38.4 33.6 31.7 0.94 1.85 0.0256 0.0275 Treatment in a private facility 12.0 14.5 15.2 19.1 30.2 17.3 0.40 18.20 0.1999 0.0417 Treatment of diarrhea: Use of oral rehydration therapy 46.6 48.0 53.1 50.2 57.8 50.6 0.81 11.16 0.0423 0.0192 Medical treatment of diarrhea 29.7 25.0 25.2 32.7 37.8 29.7 0.79 8.04 0.0571 0.0328 Treatment in a public facility 22.2 19.0 19.8 24.0 16.0 20.2 1.39 6.17 -0.0269 0.0390 Treatment in a private facility 7.6 6.0 5.5 8.7 21.8 9.5 0.35 14.21 0.2351 0.0729 C. Antenatal and delivery care Antenatal care visits: To a medically-trained person 75.1 87.4 92.4 93.0 94.0 88.1 0.80 18.81 0.0583 0.0039 To a doctor 15.6 16.4 17.3 14.8 24.9 17.9 0.63 9.33 0.1193 0.0212 To a nurse or trained midwife 59.5 71.0 75.1 78.2 69.0 70.2 0.86 9.48 0.0428 0.0066 Multiple visits to a medically-trained person 64.0 75.5 75.9 78.4 84.3 75.5 0.76 20.28 0.0713 0.0052 Antenatal care content: Tetanus toxoid 71.5 87.6 88.9 90.2 90.4 85.4 0.79 18.98 0.0512 0.0045 Prophylactic antimalarial treatment 20.2 18.7 21.0 17.9 19.5 19.5 1.03 0.68 0.0111 0.0179 Iron supplementation 46.3 47.0 46.9 42.0 45.8 45.7 1.01 0.48 0.0175 0.0100 Delivery attendance: By a medically-trained person 17.0 32.8 38.1 55.0 75.4 41.6 0.23 58.38 0.2989 0.0072 By a doctor 4.0 7.8 7.4 13.4 27.5 11.4 0.15 23.45 0.4228 0.0234 By a nurse or trained midwife 13.0 25.0 30.8 41.5 47.9 30.2 0.27 34.93 0.2521 0.0106 In a public facility 9.2 19.1 27.8 38.5 43.5 26.1 0.21 34.33 0.2644 0.0118 In a private facility 6.8 12.3 8.7 14.7 30.3 14.0 0.22 23.52 0.3806 0.0209 At home 82.9 66.7 62.3 45.8 25.8 58.7 3.22 57.12 -0.2060 0.0052 D. Contraceptive services Contraceptive prevalence: Women 11.8 24.2 33.4 41.0 44.5 31.5 0.27 32.68 0.2332 0.0104 Men 12.7 21.9 28.5 37.4 38.1 29.4 0.33 25.41 0.2020 0.0190 - 4 - Kenya 2003 - 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.) Source of contraception - public sector: Women 67.9 64.1 65.4 57.9 38.6 54.7 1.76 29.33 -0.1316 0.0123 Men na na na na na na na na na na Source of contraception - private sector: Women 32.1 35.9 34.4 41.8 61.3 45.1 0.52 29.25 0.1589 0.0149 Men na na na na na na na na na na E. Treatment of adult illnesses Treatment of genital discharge, ulcer, sore: Women (54.1) 59.1 (62.0) 58.5 72.2 61.7 0.75 126.27 0.0515 0.0273 Men * * * * * 72.1 * * * * Treatment of genital discharge, ulcer, sore in public facilities: Women (54.1) 59.1 (62.0) 58.5 72.2 61.7 0.75 126.27 0.0515 0.0271 Men * * * * * 72.1 * * * * Voluntary counseling and testing for HIV/AIDS: Women 5.8 9.9 13.2 15.2 24.4 14.7 0.24 18.62 0.2905 0.0145 Men 9.9 11.2 12.1 13.7 25.2 15.5 0.39 15.24 0.2626 0.0236 - 5 - Kenya 2003 - 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 37.7 61.8 66.8 65.0 66.6 59.1 0.57 28.98 0.1088 0.0074 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 11.2 11.4 14.0 24.5 39.3 21.9 0.28 28.15 0.3277 0.0121 Treated bednet ownership na na na na na na na na na na Bednet use: By children 8.1 9.3 13.5 20.3 36.3 16.7 0.22 28.21 0.3597 0.0201 By pregnant women 5.6 6.3 8.7 17.5 27.5 13.3 0.21 21.90 0.3937 0.0632 C. Breastfeeding Exclusive breastfeeding 21.9 18.1 15.5 14.3 17.4 17.6 1.26 4.50 -0.0505 0.0677 Timely complementary feeding na na na na na na na na na na Bottle-feeding 22.8 24.2 23.9 33.2 35.2 27.5 0.65 12.37 0.1147 0.0258 D. Micronutrient consumption Iodized salt: Availability of iodized salt na na na na na na na na na na in household Vitamin A: Children 28.1 31.1 29.4 35.3 36.6 31.8 0.77 8.43 0.0725 0.0118 Women 9.7 13.6 11.9 13.9 21.9 14.3 0.44 12.25 0.1392 0.0227 E. Tobacco and alcohol use Tobacco: Women 6.1 3.0 2.2 0.8 1.4 2.5 4.46 4.76 -0.3617 0.0487 Men 22.8 24.7 22.7 28.9 23.7 24.7 0.96 0.85 0.0040 0.0165 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 0.7 1.2 1.0 1.4 1.1 1.1 0.64 0.42 0.0369 0.0555 Men 8.1 10.1 4.9 10.0 13.0 9.6 0.62 4.88 0.1282 0.0290 Condom usage with non-regular partner: Women * * * * * 28.1 * * * * Men (58.0) 47.8 (43.2) 56.3 73.1 60.0 0.79 131.09 0.1068 0.0247 G. Domestic violence Ever experienced violence na na na na na na na na na na Experienced violence in past year 21.8 20.1 17.9 13.1 10.5 16.0 2.07 11.24 -0.1555 0.0133 - 6 - Kenya 2003 - 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 48.6 72.5 77.5 86.3 90.6 77.0 0.54 41.97 0.1189 0.0034 Men 61.3 78.4 83.1 86.7 91.3 81.9 0.67 30.09 0.0807 0.0033 School participation: Girls 73.1 90.1 93.3 96.8 96.3 89.0 0.76 23.15 0.0742 0.0048 Boys 86.0 95.5 97.4 98.3 97.2 94.5 0.88 11.28 0.0367 0.0028 B. Exposure to mass media Newspaper readership: Women 5.8 8.2 12.1 25.8 48.0 22.6 0.12 42.23 0.4447 0.0108 Men 19.6 27.8 32.8 50.3 71.7 44.5 0.27 52.11 0.2691 0.0091 Radio listenership: Women 44.4 71.6 77.4 85.3 87.5 75.2 0.51 43.13 0.1143 0.0038 Men 71.8 89.5 92.2 94.9 95.5 90.1 0.75 23.66 0.0451 0.0038 Television viewership: Women 2.8 6.4 14.2 35.3 65.9 28.8 0.04 63.05 0.5142 0.0079 Men 13.2 19.2 30.3 47.4 68.2 39.9 0.19 55.01 0.3262 0.0096 C. Knowledge and attitudes about HIV/AIDS Knowledge about sexual transmission of HIV/AIDS: Women 72.6 82.0 85.4 89.3 90.5 84.8 0.80 17.84 0.0583 0.0030 Men 82.2 88.5 92.1 92.9 95.3 91.1 0.86 13.13 0.0392 0.0035 Knowledge about mother-to-child transmission of HIV/AIDS: Women 74.3 85.7 89.0 91.3 92.1 87.3 0.81 17.80 0.0488 0.0028 Men 78.6 87.3 87.7 89.4 94.4 88.5 0.83 15.85 0.0403 0.0039 Attitudes toward HIV/AIDS: Women 59.8 68.6 71.5 79.4 85.9 74.5 0.70 26.06 0.0787 0.0036 Men 61.1 63.9 70.7 76.3 81.7 72.4 0.75 20.53 0.0574 0.0054 D. Status of women Household decisionmaking: Can seek own health care 29.1 30.4 38.0 43.9 54.1 40.6 0.54 24.91 0.1357 0.0073 Can seek children's health care na na na na na na na na na na Can make daily household purchases 45.8 45.7 45.7 45.8 53.4 47.8 0.86 7.67 0.0396 0.0062 Can make large household purchases 30.1 28.7 30.2 31.1 39.4 32.5 0.76 9.32 0.0637 0.0088 Can make meal-related decisions 61.7 59.3 58.5 57.0 62.6 59.9 0.99 0.89 -0.0094 0.0050 Freedom of movement: Can travel to visit family, relatives 23.2 22.4 24.8 24.2 35.6 26.8 0.65 12.34 0.0964 0.0105 Other decisionmaking, attitudes: Can decide how to spend own money 62.6 63.3 63.9 60.2 74.0 66.3 0.85 11.37 0.0477 0.0063 Can decide whether to have sex 89.6 90.5 91.6 93.9 96.7 92.9 0.93 7.08 0.0194 0.0018 Justifies domestic violence 80.0 75.6 72.9 69.1 50.4 67.9 1.59 29.54 -0.0972 0.0043 E. Orphanhood Paternal orphan prevalence 9.7 10.0 9.6 9.0 7.2 9.3 1.36 2.56 -0.0283 0.0145 Maternal orphan prevalence 4.0 3.2 4.4 4.5 4.1 4.0 0.97 0.12 0.0334 0.0224 Double orphan prevalence 1.9 1.8 2.7 2.6 1.5 2.1 1.26 0.40 0.0452 0.0281 - 7 - Kenya 2003 - 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 87.3 68.2 81.6 35.2 52.9 66.9 103.8 82.2 82.1 70.4 71.4 83.7 Under-five mortality rate 138.0 104.5 117.2 59.0 82.9 103.3 159.0 114.5 124.4 95.0 99.2 121.8 Prevalence of fever 35.7 41.1 45.7 42.0 38.1 40.3 39.5 46.6 38.6 40.2 40.6 41.1 Prevalence of diarrhea 17.6 15.9 13.1 12.3 14.4 14.9 19.4 19.7 17.3 14.3 18.0 17.9 Prevalence of acute respiratory 16.8 22.4 18.1 18.2 14.5 18.1 19.4 23.5 16.9 16.8 16.9 18.8 infection (ARI) B. Nutritional status Children: Moderate stunting 20.3 20.9 17.2 16.1 11.8 17.7 29.1 22.0 21.0 19.4 14.8 21.8 Severe stunting 13.5 11.5 10.4 7.9 4.6 10.0 14.0 10.8 11.7 12.7 7.5 11.5 Moderate underweight 18.2 15.6 13.9 13.4 6.1 13.9 25.0 18.9 16.4 16.0 8.8 17.6 Severe underweight 6.3 2.4 3.2 2.9 1.4 3.4 8.9 3.7 3.9 2.6 2.3 4.6 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 na na na na na na Men 1.1 0.7 1.3 1.3 1.3 1.1 Prevalence of genital ulcer: Women na na na na na na Men 0.8 0.7 0.4 1.6 1.1 0.9 - 9 - Kenya 2003 - 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 74.2 87.2 91.1 97.4 97.5 88.1 65.7 90.0 94.6 95.6 94.3 86.6 Measles coverage 53.4 65.8 79.2 80.1 90.8 72.0 54.6 69.9 80.8 81.1 84.1 72.5 DPT coverage 59.3 70.5 80.1 85.2 81.0 73.8 53.2 71.4 91.0 77.7 63.7 70.6 Full basic coverage 37.4 50.5 60.6 55.5 68.9 53.2 38.3 49.8 63.9 57.7 49.3 51.0 No basic coverage 17.2 5.6 6.1 0.6 1.1 7.1 22.4 5.0 2.2 1.6 5.2 8.2 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 43.4 37.3 44.3 51.6 56.4 46.0 40.0 46.9 47.4 47.5 53.0 46.6 Treatment in a public facility 26.9 22.7 31.0 38.9 22.0 28.1 27.6 32.9 30.9 29.4 29.2 30.0 Treatment in a private facility 16.6 14.6 13.3 12.6 34.4 17.9 12.4 14.0 16.5 18.1 23.8 16.6 Treatment of acute respiratory infection (ARI): Medical treatment of ARI 50.1 36.8 48.1 55.4 58.9 48.4 38.4 46.4 44.2 59.5 67.9 49.7 Treatment in a public facility 32.3 22.1 37.1 41.8 29.3 31.6 31.2 32.0 24.7 34.8 37.1 31.9 Treatment in a private facility 17.8 14.7 11.0 13.6 29.6 16.8 7.1 14.4 19.5 24.7 30.7 17.8 Treatment of diarrhea: Use of oral rehydration therapy 52.1 43.2 57.4 56.5 58.4 52.6 41.9 52.2 49.8 45.2 57.4 49.0 Medical treatment of diarrhea 34.7 19.0 30.8 45.9 44.1 33.5 25.4 30.3 21.1 22.0 32.9 26.6 Treatment in a public facility 25.5 13.6 23.2 35.9 19.2 22.7 19.2 23.8 17.3 14.3 13.6 18.1 Treatment in a private facility 9.2 5.4 7.6 10.0 24.9 10.9 6.1 6.5 3.8 7.7 19.4 8.5 C. Contraceptive services Contraceptive prevalence: Women 22.5 27.7 31.5 41.8 49.3 34.9 Men 14.6 17.7 26.5 40.2 38.0 27.3 Source of contraception - public sector: Women 73.0 71.1 58.2 50.1 40.5 54.9 Men na na na na na na Source of contraception - private sector: Women 7.8 18.5 32.6 42.7 55.1 36.4 Men na na na na na na D. Treatment of adult illnesses Treatment of genital discharge, ulcer, sore: Women na na na na na na Men * * * (72.0) (72.0) 62.1 Treatment of genital discharge, ulcer, sore in public facilities: Women na na na na na na Men * * * (72.0) (72.0) 62.1 Voluntary counseling and testing for HIV/AIDS: Women na na na na na na Men 0.4 1.0 2.9 6.3 13.7 5.3 - 10 - Kenya 2003 - 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 37.7 61.8 66.8 65.0 66.6 59.1 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 8.1 9.3 13.5 20.3 36.3 16.7 C. Breastfeeding Exclusive breastfeeding (18.5) (23.4) (14.4) (9.6) (18.8) 17.0 (25.7) (12.2) (16.8) (20.2) (16.1) 18.3 Timely complementary feeding na na na na na na na na na na na na Bottle-feeding 23.9 23.3 17.0 34.7 41.6 27.6 21.4 25.3 30.6 31.8 29.5 27.5 D. Micronutrient consumption Vitamin A: Children 28.3 28.4 26.4 33.3 34.8 30.0 28.0 33.9 32.3 37.2 38.3 33.5 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 1.3 0.8 0.8 0.9 1.2 1.0 Men 4.7 7.3 6.1 8.1 12.7 8.0 Condom usage with non-regular partner: Women (2.4) (9.1) (16.4) (15.4) 35.6 18.2 Men (15.9) 26.3 29.5 48.8 47.6 38.4 - 11 - Kenya 2003 - 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 36.4 57.1 73.5 84.6 93.3 72.6 Men 60.5 78.5 88.0 93.1 97.9 85.2 School participation: Girls 41.9 39.5 58.7 77.4 85.4 57.1 Boys 86.0 82.9 88.0 96.0 97.4 89.3 B. Exposure to mass media Newspaper readership: Women 6.4 20.8 38.7 53.6 71.5 42.4 Men 11.6 32.1 56.9 67.4 83.4 53.0 Radio listenership: Women 62.0 82.5 85.6 89.7 91.0 83.8 Men 78.0 91.4 92.5 94.1 90.9 89.9 Television viewership: Women 6.5 41.8 83.7 94.0 98.3 71.0 Men 10.6 49.7 86.0 95.3 98.5 71.4 C. Knowledge and attitudes about HIV/AIDS Knowledge about sexual transmission of HIV/AIDS: Women 72.6 82.0 85.4 89.3 90.5 84.8 Men 82.2 88.5 92.1 92.9 95.3 91.1 Knowledge about mother-to-child transmission of HIV/AIDS: Women 74.3 85.7 89.0 91.3 92.1 87.3 Men 78.6 87.3 87.7 89.4 94.4 88.5 Attitudes toward HIV/AIDS: Women 59.8 68.6 71.5 79.4 85.9 74.5 Men 61.1 63.9 70.7 76.3 81.7 72.4 D. Orphanhood Paternal orphan prevalence 9.0 9.5 10.8 8.9 7.1 9.2 10.4 10.5 8.5 9.1 7.3 9.3 Maternal orphan prevalence 3.7 3.4 4.4 4.2 4.6 4.0 4.2 3.0 4.4 4.7 3.6 4.0 Double orphan prevalence 1.4 1.8 2.4 2.4 1.6 1.9 2.5 1.7 2.9 2.7 1.4 2.3 - 12 - Kenya 2003 - 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 95.9 75.3 82.1 53.6 66.3 78.7 92.3 69.8 76.6 50.2 61.0 61.1 Under-five mortality rate 148.8 109.0 122.0 77.0 85.2 116.9 151.4 132.6 92.6 78.7 92.9 93.5 Prevalence of fever 37.7 43.7 42.3 41.3 36.6 40.9 (32.3) * (35.7) 39.8 40.1 39.9 Prevalence of diarrhea 18.5 17.6 14.8 11.3 16.2 16.0 (17.2) * (26.7) 24.7 16.3 18.0 Prevalence of acute respiratory infection 18.0 23.0 17.6 17.5 14.7 18.9 (24.5) * (13.9) 17.3 16.0 16.4 B. Fertility Total fertility rate 7.6 5.8 5.0 4.0 3.6 5.4 7.0 5.4 5.4 4.1 3.0 3.3 Adolescent fertility rate 171.5 142.5 111.6 91.8 73.1 122.9 263.0 86.8 104.6 106.0 82.7 88.5 C. Nutritional status Children: Moderate stunting 24.9 21.4 19.0 17.6 13.3 20.8 * * (23.3) 18.5 13.4 14.9 Severe stunting 13.8 11.3 11.3 8.9 2.7 11.2 * * (5.9) 19.3 7.1 8.9 Moderate underweight 21.9 17.0 15.3 14.2 6.8 17.1 * * (13.3) 17.7 7.7 9.8 Severe underweight 7.4 3.0 3.6 2.4 2.5 4.3 * * (2.8) 5.4 1.7 2.8 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 Women: Malnutrition 21.2 15.8 12.2 9.7 4.8 13.9 (27.2) (15.5) 5.6 6.8 4.5 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 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 3.0 2.4 2.9 2.6 2.2 2.7 0.0 (2.5) 0.7 2.8 2.6 2.5 Men 2.6 2.3 1.4 1.1 2.6 1.9 * * * 2.8 1.3 1.4 Prevalence of genital ulcer: Women 2.6 2.3 1.3 1.9 1.8 2.0 0.0 0.0 0.7 1.9 1.9 1.8 Men 1.7 1.4 1.3 0.7 0.4 1.2 * * * 1.6 1.4 1.4 - 13 - Kenya 2003 - 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 70.1 88.7 92.9 96.8 (91.3) 85.6 * * * (94.6) 97.4 95.7 Measles coverage 54.4 68.1 79.6 81.7 (79.2) 69.5 * * * (74.1) 90.1 85.6 DPT coverage 56.6 71.1 86.2 85.8 (74.0) 72.9 * * * (55.6) 72.2 68.7 Full basic coverage 38.6 50.1 62.4 60.7 (59.9) 51.8 * * * (33.2) 59.4 53.7 No basic coverage 19.5 5.1 4.0 0.4 (8.7) 8.5 * * * (5.4) 1.4 3.3 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 diseases Treatment of fever: Medical treatment of fever 41.3 41.7 45.2 48.9 62.1 44.7 * * * 52.9 52.7 53.4 Treatment in a public facility 26.7 27.5 30.5 33.7 25.2 29.0 * * * 36.5 25.9 29.2 Treatment in a private facility 14.6 14.2 14.7 15.2 36.9 15.6 * * * 16.3 26.9 24.2 Treatment of acute respiratory infection (ARI): Medical treatment of ARI 43.6 41.4 45.2 59.3 (53.5) 46.2 * * * (47.4) 66.4 62.8 Treatment in a public facility 31.2 26.7 30.3 38.6 (25.2) 30.6 * * * (36.9) 35.7 37.1 Treatment in a private facility 12.4 14.7 14.8 20.7 (28.3) 15.6 * * * (10.5) 30.7 25.7 Treatment of diarrhea: Use of oral rehydration therapy 46.4 48.3 52.4 56.6 (59.8) 50.1 * * * (34.2) 57.3 52.4 Medical treatment of diarrhea 29.4 25.4 25.0 37.6 (50.8) 29.5 * * * (20.4) 34.1 30.7 Treatment in a public facility 21.7 19.4 19.8 26.9 (17.0) 21.1 * * * (16.6) 15.7 16.6 Treatment in a private facility 7.7 6.0 5.2 10.7 (33.8) 8.4 * * * (3.8) 18.4 14.2 C. Antenatal and delivery care Antenatal care visits: To a medically-trained person 75.4 87.3 92.4 93.5 91.7 86.8 * * (92.2) 89.8 94.6 93.2 To a doctor 15.4 16.1 16.9 14.3 32.7 16.7 * * (28.3) 17.9 22.8 22.5 To a nurse or trained midwife 60.0 71.2 75.5 79.3 59.0 70.1 * * (63.9) 71.9 71.8 70.7 Multiple visits to a medically-trained person 64.1 75.4 75.8 78.3 82.3 73.5 * * (77.9) 78.9 84.8 83.1 Antenatal care content: Tetanus toxoid 71.5 87.6 88.9 90.0 91.4 84.3 * * (88.7) 91.2 90.2 89.8 Prophylactic antimalarial treatment 20.1 18.8 20.5 17.8 22.2 19.6 * * (33.8) 18.4 18.8 19.3 Iron supplementation 46.7 47.4 46.3 41.5 44.8 45.7 * * (61.8) 45.2 46.1 45.9 Delivery attendance: By a medically-trained person 16.7 32.7 37.5 54.6 66.4 34.5 (32.6) * (53.9) 56.9 77.9 72.0 By a doctor 3.8 7.8 7.3 12.6 30.6 8.5 (13.3) * (9.3) 18.0 26.6 24.0 By a nurse or trained midwife 12.9 24.9 30.2 42.0 35.9 26.0 (19.4) * (44.6) 38.8 51.3 48.0 In a public facility 9.2 19.0 27.2 37.8 30.9 21.8 (10.5) * (44.8) 42.3 47.1 44.9 In a private facility 6.6 12.4 8.7 15.1 34.0 11.4 (15.7) * (9.1) 12.4 29.2 25.3 At home 83.1 66.7 62.9 46.2 34.6 65.5 (72.6) * (46.1) 43.5 23.3 29.2 D. Contraceptive services Contraceptive prevalence: Women 11.8 24.5 33.6 41.4 54.6 29.2 * * (27.4) 38.8 41.7 39.9 Men 12.8 22.1 28.9 37.1 39.6 26.7 * * * 38.5 37.6 36.8 - 14 - Kenya 2003 - 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 67.2 64.1 65.2 56.6 32.5 58.6 * * * 66.1 40.8 44.9 Men na na na na na na na na na na na na Source of contraception - private sector: Women 32.8 35.9 34.6 43.0 67.5 41.3 * * * 33.9 59.1 55.0 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 (54.1) 60.0 (63.4) 55.1 * 58.9 * * * 73.1 na 71.4 Men * * * * * 72.2 * * * * * * Treatment of genital discharge, ulcer, sore in public facilities: Women (54.1) 60.0 (63.4) 55.1 * 58.9 * * * 73.1 na 71.4 Men * * * * * 72.2 * * * * * * Voluntary counseling and testing for HIV/AIDS: Women 5.8 9.9 12.9 14.5 21.3 11.7 (7.0) (8.5) 19.9 19.7 25.2 23.9 Men 10.1 11.0 11.9 13.1 22.8 12.6 * * * 16.7 25.9 24.1 - 15 - Kenya 2003 - 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 37.7 61.8 67.0 66.7 65.4 57.7 * * (63.5) 55.8 67.0 64.6 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 10.7 11.4 13.7 23.9 36.9 16.6 (34.9) (14.0) 21.3 27.9 40.0 37.6 Treated bednet ownership na na na na na na na na na na na na Bednet use: By children 7.6 9.4 12.8 19.8 31.6 12.6 (31.5) * (30.9) 22.9 37.7 34.5 By pregnant women 5.5 6.2 8.8 15.9 * 9.9 * * * * 26.2 25.7 C. Breastfeeding Exclusive breastfeeding 22.4 17.9 15.3 15.1 * 17.9 * * * * 17.7 16.6 Timely complementary feeding na na na na na na na na na na na na Bottle-feeding 23.1 24.3 22.8 35.0 30.6 25.9 * * * (24.5) 36.5 34.3 D. Micronutrient consumption Iodized salt: Availability of iodized salt na na na na na na na na na na na na in household Vitamin A: Children 27.8 30.9 29.2 35.1 26.9 30.1 (43.6) * (35.5) 36.7 39.2 38.9 Women 9.6 13.8 11.4 14.1 24.0 12.8 * * (27.2) 12.6 21.4 20.0 E. Tobacco and alcohol use Tobacco: Women 6.3 2.8 2.1 0.7 1.4 2.8 0.0 (12.8) 5.0 1.3 1.4 1.7 Men 22.9 24.0 22.6 28.8 26.6 24.9 * * * 29.4 22.8 24.2 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 1.2 1.0 1.3 0.8 1.1 (1.2) (0.9) 0.2 1.9 1.2 1.3 Men 8.2 9.9 4.8 9.1 13.1 8.4 * * * 15.1 13.0 13.0 Condom usage with non-regular partner: Women * * * * * 21.8 * * * * * (43.7) Men (58.2) 49.8 (42.3) 55.9 (70.9) 55.0 * * * * 73.8 69.6 G. Domestic violence Ever experienced violence na na na na na na na na na na na na Experienced violence in past year 21.9 20.3 18.1 12.7 11.6 17.7 (14.9) (9.5) 13.0 15.6 10.2 11.0 - 16 - Kenya 2003 - 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 49.0 72.7 78.0 87.4 90.3 73.6 (30.1) (63.7) 65.1 80.1 90.6 87.2 Men 61.6 78.5 83.3 86.7 89.8 79.0 (46.1) (73.8) 77.9 86.4 91.8 90.0 School participation: Girls 73.6 90.1 93.2 97.6 98.6 88.2 * * (95.5) 91.7 95.4 93.2 Boys 86.4 95.5 97.3 98.9 100.0 94.4 (64.6) * (99.4) 94.5 96.2 95.0 B. Exposure to mass media Newspaper readership: Women 5.5 7.9 11.5 26.2 52.3 15.9 (18.9) (18.8) 24.9 23.5 46.8 42.6 Men 19.6 27.0 31.6 47.9 63.5 35.1 * * * 63.2 74.4 72.0 Radio listenership: Women 44.7 71.8 77.7 86.6 89.2 72.1 (32.0) (64.4) 70.0 77.8 87.1 84.3 Men 72.0 89.8 91.9 94.4 95.5 88.4 * * * 97.7 95.5 95.3 Television viewership: Women 2.7 6.1 14.2 37.0 68.3 19.3 (9.1) (16.0) 14.6 24.6 65.2 57.3 Men 13.0 18.8 29.8 46.9 62.6 31.2 * * * 50.4 69.9 65.8 C. Knowledge and attitudes about HIV/AIDS Knowledge about sexual transmission of HIV/AIDS: Women 73.1 82.4 85.6 90.1 89.4 83.5 (52.0) (69.1) 81.1 84.4 90.7 88.8 Men 82.4 88.6 92.1 93.1 96.6 90.0 * * * 91.8 95.0 94.1 Knowledge about mother-to-child transmission of HIV/AIDS: Women 74.5 85.6 89.2 92.1 88.7 85.8 (63.2) (86.2) 85.4 86.4 93.0 91.5 Men 78.7 87.3 87.7 88.8 96.7 86.9 * * * 92.9 93.7 93.1 Attitudes toward HIV/AIDS: Women 59.7 68.5 71.2 79.1 86.3 71.2 (65.2) (70.4) 78.2 80.9 85.7 84.4 Men 61.1 64.4 70.2 76.3 79.7 69.5 * * * 76.3 82.3 80.9 D. Status of women Household decisionmaking: Can seek own health care 29.4 30.2 38.4 43.1 54.6 36.8 (18.5) (39.3) 28.4 48.8 53.9 51.8 Can seek children's health care na na na na na na na na na na na na Can make daily household purchases 45.9 45.7 46.0 45.0 50.0 46.0 (38.9) (47.5) 40.3 50.3 54.4 53.1 Can make large household purchases 30.0 28.4 30.0 29.3 35.0 29.8 (33.5) (39.8) 34.3 41.5 40.6 40.4 Can make meal-related decisions 61.7 59.4 59.1 55.2 61.3 59.0 (60.8) (56.2) 44.7 67.8 62.9 62.8 Freedom of movement: Can travel to visit family, relatives 23.1 22.2 24.9 22.1 27.9 23.4 (28.5) (31.1) 24.2 36.9 37.6 36.9 Other decisionmaking, attitudes: Can decide how to spend own money 62.6 62.9 63.6 59.5 62.6 62.2 * * * 63.9 77.0 75.4 Can decide whether to have sex 89.7 90.5 91.7 93.7 96.4 91.8 (84.6) (89.2) 88.3 94.9 96.8 96.0 Justifies domestic violence 80.0 75.6 72.9 68.4 53.6 72.6 (77.8) (77.8) 74.3 73.6 49.6 54.0 E. Orphanhood Paternal orphan prevalence 9.7 9.9 9.3 8.7 9.4 9.4 10.6 17.0 17.1 11.3 6.4 8.2 Maternal orphan prevalence 4.0 3.1 4.1 4.2 3.2 3.8 3.1 5.3 11.5 6.5 4.4 5.1 Double orphan prevalence 2.0 1.8 2.6 2.4 1.3 2.1 0.4 2.3 3.9 3.4 1.6 2.0 - 17 - PART II. BASIC TABLES, 1998 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. Kenya 1998 - 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 95.8 82.9 58.5 61.0 40.2 70.7 2.38 55.60 -0.1533 0.0010 Under-five mortality rate 136.2 130.4 92.3 84.9 60.7 105.2 2.24 75.50 -0.1486 0.0010 Prevalence of fever 45.5 43.3 42.7 40.7 38.0 42.3 1.20 7.50 -0.0307 0.0121 Prevalence of diarrhea 19.4 18.7 17.8 15.4 13.1 17.1 1.48 6.30 -0.0748 0.0222 Prevalence of acute respiratory 23.1 21.0 19.4 20.6 15.2 20.1 1.52 7.90 -0.0618 0.0200 infection (ARI) B. Fertility Total fertility rate 6.5 5.6 4.7 4.2 3.0 4.7 2.17 3.50 -0.1514 0.0006 Adolescent fertility rate 163.0 143.0 108.0 103.0 63.0 111.0 2.59 100.00 -0.1780 0.0016 C. Nutritional status (%) Children: Moderate stunting 26.7 21.5 19.1 20.8 10.5 20.3 2.54 16.20 -0.1159 0.0171 Severe stunting 17.4 16.0 11.1 9.7 6.6 12.7 2.64 10.80 -0.1881 0.0240 Moderate underweight 24.5 20.5 16.2 13.7 8.2 17.3 2.99 16.30 -0.1674 0.0187 Severe underweight 7.1 6.2 3.8 3.4 2.1 4.8 3.38 5.00 -0.2149 0.0397 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 17.6 15.5 11.5 8.1 5.5 11.9 3.20 12.10 -0.1758 0.0280 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 16.0 15.4 16.3 10.3 6.8 13.0 2.35 9.20 -0.1241 0.0226 Women 45.4 42.9 44.4 35.5 24.1 37.6 1.88 21.30 -0.1093 0.0087 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 1.4 1.1 1.1 0.5 1.4 1.1 1.00 0.00 -0.0728 0.0711 Men 4.0 5.9 5.5 5.2 3.0 4.6 1.33 1.00 -0.0245 0.0465 Prevalence of genital ulcer: Women 0.3 0.6 0.9 0.4 0.5 0.5 0.60 0.20 0.0545 0.0755 Men 3.2 4.1 3.7 3.2 1.5 2.9 2.13 1.70 -0.0848 0.0551 - 21 - Kenya 1998 - 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 93.5 92.7 98.3 97.4 99.0 95.9 0.94 5.50 0.0129 0.0035 Measles coverage 64.3 79.6 84.7 83.8 88.7 79.2 0.72 24.40 0.0632 0.0089 DPT coverage 67.4 78.2 85.9 84.0 84.1 79.2 0.80 16.70 0.0418 0.0095 Full basic coverage 48.1 57.6 71.0 64.6 59.9 59.5 0.80 11.80 0.0577 0.0148 No basic coverage 4.8 3.0 1.1 2.6 1.0 2.7 4.80 3.80 -0.2791 0.1079 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 54.8 60.8 61.7 62.3 73.3 61.7 0.75 18.50 0.0636 0.0126 Treatment in a public facility 39.3 33.9 37.8 35.1 34.2 36.3 1.15 5.10 0.0016 0.0200 Treatment in a private facility 13.6 22.6 21.7 24.3 35.8 22.5 0.38 22.20 0.1686 0.0277 Treatment of acute respiratory infection (ARI): Medical treatment of ARI 54.9 53.6 51.6 55.1 78.5 57.3 0.70 23.60 0.0473 0.0210 Treatment in a public facility 37.9 30.6 34.0 37.4 41.2 35.9 0.92 3.30 0.0163 0.0335 Treatment in a private facility 16.0 22.4 17.7 17.7 35.2 20.6 0.45 19.20 0.1073 0.0494 Treatment of diarrhea: Use of oral rehydration therapy 78.1 84.3 79.2 85.0 86.7 82.0 0.90 8.60 0.0166 0.0112 Medical treatment of diarrhea 41.4 50.2 37.1 45.9 48.5 44.3 0.85 7.10 0.0434 0.0292 Treatment in a public facility 26.3 29.6 24.8 30.5 24.0 27.1 1.10 2.30 0.0199 0.0420 Treatment in a private facility 15.1 20.6 11.6 15.4 22.0 16.7 0.69 6.90 0.1023 0.0624 C. Antenatal and delivery care Antenatal care visits: To a medically-trained person 88.5 90.0 93.2 95.3 96.2 92.3 0.92 7.70 0.0168 0.0036 To a doctor 23.7 23.2 25.8 32.7 38.8 28.3 0.61 15.10 0.1307 0.0177 To a nurse or trained midwife 64.7 66.8 67.3 62.5 57.5 64.0 1.13 7.20 -0.0330 0.0083 Multiple visits to a medically-trained person 77.4 78.5 82.4 84.3 86.5 81.4 0.89 9.10 0.0188 0.0052 Antenatal care content: Tetanus toxoid 87.2 87.8 91.0 92.4 92.3 89.9 0.94 5.10 0.0132 0.0037 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 23.2 33.3 41.9 56.1 79.6 44.4 0.29 56.40 0.2419 0.0104 By a doctor 5.1 8.0 11.6 13.5 28.0 12.3 0.18 22.90 0.3403 0.0286 By a nurse or trained midwife 18.1 25.3 30.3 42.7 51.6 32.0 0.35 33.50 0.2042 0.0141 In a public facility 15.9 24.9 33.3 40.2 48.2 30.9 0.33 32.30 0.2076 0.0146 In a private facility 4.4 5.5 7.7 13.2 30.1 11.2 0.15 25.70 0.4028 0.0315 At home 78.2 68.0 58.1 45.1 21.3 56.6 3.67 56.90 -0.1878 0.0079 D. Contraceptive services Contraceptive prevalence: Women 12.6 24.1 30.7 39.7 50.1 31.5 0.25 37.50 0.2312 0.0115 Men 17.9 28.3 40.4 44.7 54.6 39.1 0.33 36.70 0.1898 0.0166 - 22 - Kenya 1998 - 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.) Source of contraception - public sector: Women 74.6 72.2 72.0 63.8 52.1 63.5 1.43 22.50 -0.0962 0.0119 Men na na na na na na na na na na Source of contraception - private sector: Women 25.4 26.7 27.4 35.0 47.0 35.7 0.54 21.60 0.1823 0.0221 Men na na na na na na na na na na E. Treatment of adult illnesses Treatment of genital discharge, ulcer, sore: Women * (88.8) (81.9) * * 87.9 * * * * Men * (68.5) (52.5) 68.0 (55.2) 63.2 * * * * Treatment of genital discharge, ulcer, sore in public facilities: Women na na na na na na na na na na Men * (81.9) (69.5) 78.5 (64.1) 75.5 * * * * Voluntary counseling and testing for HIV/AIDS: Women 6.5 9.5 12.1 17.5 22.8 14.2 0.29 16.30 0.2050 0.0167 Men 9.2 14.9 13.4 16.2 25.0 16.8 0.37 15.80 0.1558 0.0244 - 23 - Kenya 1998 - 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 15.2 21.0 20.1 13.4 16.2 16.9 0.94 1.00 -0.0151 0.0672 Timely complementary feeding 86.1 94.6 84.8 94.1 86.1 89.3 1.00 0.00 -0.0079 0.0132 Bottle-feeding 20.7 19.6 25.2 27.2 33.7 25.2 0.61 13.00 0.1173 0.0321 D. Micronutrient consumption Iodized salt: Availability of iodized salt na na na na na na na na na na in household Vitamin A: Children na na na na na na na na na na 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 1.6 0.8 1.0 0.7 0.6 0.9 2.67 1.00 -0.2152 0.0741 Men 20.9 22.1 20.6 22.7 20.3 21.3 1.03 0.60 -0.0061 0.0196 Condom usage with non-regular partner: Women * * * * * 25.6 * * * * Men 28.8 39.2 45.7 43.9 63.6 46.2 0.45 34.80 0.1289 0.0232 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 - Kenya 1998 - 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 58.8 69.0 76.0 84.9 90.8 76.8 0.65 32.00 0.0856 0.0036 Men 72.1 80.3 86.0 88.3 92.6 85.1 0.78 20.50 0.0435 0.0029 School participation: Girls 69.2 82.4 86.7 87.9 90.5 82.5 0.76 21.30 0.0500 0.0053 Boys 71.9 79.9 83.9 88.2 91.4 82.2 0.79 19.50 0.0512 0.0051 B. Exposure to mass media Newspaper readership: Women 17.1 23.4 28.8 41.5 65.0 36.9 0.26 47.90 0.2543 0.0085 Men 30.3 45.5 53.4 67.8 85.6 60.6 0.35 55.30 0.1719 0.0074 Radio listenership: Women 30.6 44.2 60.9 68.4 79.5 58.2 0.38 48.90 0.1709 0.0058 Men 61.8 75.1 84.6 85.0 89.5 81.0 0.69 27.70 0.0624 0.0052 Television viewership: Women 6.9 9.6 11.6 21.4 66.5 25.7 0.10 59.60 0.4517 0.0120 Men 17.7 24.3 38.0 51.0 76.1 45.9 0.23 58.40 0.2546 0.0101 C. Knowledge and attitudes about HIV/AIDS Knowledge about sexual transmission of HIV/AIDS: Women 94.5 96.3 97.0 97.9 98.6 97.0 0.96 4.10 0.0094 0.0014 Men 98.5 98.6 99.4 99.3 99.6 99.2 0.99 1.10 0.0023 0.0012 Knowledge about mother-to-child transmission of HIV/AIDS: Women 84.0 83.4 84.6 89.6 89.3 85.1 0.94 5.30 0.0264 0.0029 Men 81.9 81.4 82.4 85.9 88.1 84.5 0.93 6.20 0.0143 0.0042 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 33.8 36.8 45.4 45.3 56.9 44.5 0.59 23.10 0.0988 0.0105 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 8.2 7.9 7.8 6.6 6.3 7.4 1.30 1.90 -0.0729 0.0176 Maternal orphan prevalence 1.9 2.5 3.5 2.9 3.6 2.8 0.53 1.70 0.1011 0.0278 Double orphan prevalence 0.5 0.8 1.2 0.8 1.2 0.9 0.42 0.70 0.1384 0.0507 - 25 - Kenya 1998 - 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 85.5 81.3 49.7 55.4 50.7 66.8 105.1 84.6 67.0 66.4 29.8 74.5 Under-five mortality rate 128.5 131.5 88.0 76.9 68.7 102.6 143.1 129.4 96.5 92.5 52.7 107.8 Prevalence of fever 45.4 44.0 42.7 41.1 36.5 42.2 45.6 42.5 42.8 40.4 39.6 42.4 Prevalence of diarrhea 16.4 18.9 20.7 12.9 12.7 16.4 22.1 18.6 15.1 17.7 13.5 17.8 Prevalence of acute respiratory 24.9 18.8 17.5 20.5 16.6 19.9 21.4 23.3 21.1 20.7 13.6 20.3 infection (ARI) B. Nutritional status Children: Moderate stunting 23.7 21.2 18.2 19.3 8.0 18.6 29.5 21.9 19.9 22.2 13.0 22.0 Severe stunting 16.1 13.3 13.4 9.4 6.4 12.1 18.6 18.8 8.9 10.0 6.8 13.2 Moderate underweight 22.3 20.7 18.6 11.5 8.7 17.0 26.5 20.2 14.0 15.6 7.7 17.6 Severe underweight 7.3 5.9 5.1 3.1 2.3 5.0 6.9 6.5 2.4 3.7 2.0 4.6 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 1.4 1.1 1.1 0.5 1.4 1.1 Men 4.0 5.9 5.5 5.2 3.0 4.6 Prevalence of genital ulcer: Women 0.3 0.6 0.9 0.4 0.5 0.5 Men 3.2 4.1 3.7 3.2 1.5 2.9 - 27 - Kenya 1998 - 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 94.3 93.9 97.7 98.5 100.0 96.7 92.6 91.6 98.9 96.3 97.8 95.0 Measles coverage 63.0 77.9 85.6 86.6 86.6 79.1 65.5 81.1 83.8 80.8 91.2 79.4 DPT coverage 65.6 74.2 84.8 83.3 84.8 77.8 69.3 81.7 86.9 84.7 83.2 80.5 Full basic coverage 46.1 54.7 72.5 67.5 55.6 58.4 50.1 60.1 69.6 61.6 65.2 60.7 No basic coverage 5.4 5.1 1.8 1.5 0.0 2.9 4.3 1.2 0.5 3.7 2.2 2.4 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 55.8 58.8 61.3 61.9 72.6 61.3 53.9 62.9 62.0 62.7 74.1 62.0 Treatment in a public facility 38.9 34.1 37.5 33.1 38.0 36.4 39.7 33.8 38.0 36.9 30.4 36.2 Treatment in a private facility 13.6 22.6 20.5 26.4 29.6 21.7 13.6 22.7 22.9 22.4 42.0 23.3 Treatment of acute respiratory infection (ARI): Medical treatment of ARI 51.3 61.3 53.6 54.1 (79.0) 58.6 58.7 47.3 50.2 55.9 (77.9) 56.0 Treatment in a public facility 39.5 37.5 33.9 37.5 (44.3) 38.6 36.2 24.9 34.0 37.3 (37.1) 33.5 Treatment in a private facility 9.9 23.8 19.7 16.7 (30.8) 18.8 22.5 21.3 16.2 18.7 (40.8) 22.3 Treatment of diarrhea: Use of oral rehydration therapy 74.6 75.1 85.2 (84.3) (85.5) 80.1 80.4 94.0 (71.8) 85.6 (87.9) 83.7 Medical treatment of diarrhea 33.4 43.3 38.7 (38.8) (49.6) 40.2 46.9 57.4 (35.1) 50.6 (47.5) 47.9 Treatment in a public facility 20.9 29.4 21.3 (26.9) (31.1) 25.4 29.9 29.7 (29.1) 32.9 (16.8) 28.6 Treatment in a private facility 12.4 13.9 17.3 (11.9) (13.5) 14.0 17.0 27.7 (4.5) 17.8 (30.6) 19.0 C. Contraceptive services Contraceptive prevalence: Women 12.6 24.1 30.7 39.7 50.1 31.5 Men 17.9 28.3 40.4 44.7 54.6 39.1 Source of contraception - public sector: Women 74.6 72.2 72.0 63.8 52.1 63.5 Men na na na na na na Source of contraception - private sector: Women 25.4 26.7 27.4 35.0 47.0 35.7 Men na na na na na na D. Treatment of adult illnesses Treatment of genital discharge, ulcer, sore: Women * (88.8) (81.9) * * 87.9 Men * (68.5) (52.5) 68.0 (55.2) 0.0 Treatment of genital discharge, ulcer, sore in public facilities: Women na na na na na na Men na na na na na 75.5 Voluntary counseling and testing for HIV/AIDS: Women 6.5 9.5 12.1 17.5 22.8 14.2 Men 9.2 14.9 13.4 16.2 25.0 16.8 - 28 - Kenya 1998 - 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 (9.7) (24.6) (25.1) (11.4) (11.5) 15.5 (19.7) (17.7) (17.1) (14.5) (21.3) 18.0 Timely complementary feeding (86.5) (94.6) (80.3) (93.0) (83.7) 88.1 (85.7) (94.6) (88.8) (95.2) (88.0) 90.4 Bottle-feeding 24.2 17.4 25.7 30.4 31.5 25.6 17.2 22.2 24.9 24.3 35.6 24.8 D. Micronutrient consumption Vitamin A: Children 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 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 1.6 0.8 1.0 0.7 0.6 0.9 Men 20.9 22.1 20.6 22.7 20.3 21.3 Condom usage with non-regular partner: Women * * * * * 25.6 Men 28.8 39.2 45.7 43.9 63.6 46.2 - 29 - Kenya 1998 - 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 58.8 69.0 76.0 84.9 90.8 76.8 Men 72.1 80.3 86.0 88.3 92.6 85.1 School participation: Girls 69.2 82.4 86.7 87.9 90.5 82.5 Boys 71.9 79.9 83.9 88.2 91.4 82.2 B. Exposure to mass media Newspaper readership: Women 17.1 23.4 28.8 41.5 65.0 36.9 Men 30.3 45.5 53.4 67.8 85.6 60.6 Radio listenership: Women 30.6 44.2 60.9 68.4 79.5 58.2 Men 61.8 75.1 84.6 85.0 89.5 81.0 Television viewership: Women 6.9 9.6 11.6 21.4 66.5 25.7 Men 17.7 24.3 38.0 51.0 76.1 45.9 C. Knowledge and attitudes about HIV/AIDS Knowledge about sexual transmission of HIV/AIDS: Women 94.5 96.3 97.0 97.9 98.6 97.0 Men 98.5 98.6 99.4 99.3 99.6 99.2 Knowledge about mother-to-child transmission of HIV/AIDS: Women 84.0 83.4 84.6 89.6 89.3 85.1 Men 81.9 81.4 82.4 85.9 88.1 84.5 Attitudes toward HIV/AIDS: Women na na na na na na Men na na na na na na D. Orphanhood Paternal orphan prevalence 7.2 8.7 7.9 6.8 6.9 7.5 9.1 7.2 7.8 6.3 5.6 7.4 Maternal orphan prevalence 2.1 2.2 3.1 3.0 4.7 2.9 1.7 2.8 3.8 2.7 2.5 2.7 Double orphan prevalence 0.4 0.8 1.1 0.9 1.7 0.9 0.6 0.7 1.3 0.8 0.6 0.8 - 30 - Kenya 1998 - 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 96.2 83.4 56.5 55.8 37.7 73.8 * * * (80.1) 41.8 55.4 Under-five mortality rate 136.7 129.9 90.0 75.6 48.7 108.6 * * * (119.7) 68.2 88.3 Prevalence of fever 45.6 43.5 41.9 38.5 37.3 42.4 * (39.0) (49.9) 47.8 38.4 41.7 Prevalence of diarrhea 19.3 18.5 15.9 14.3 13.8 17.1 * (22.8) (34.5) 19.2 12.7 17.1 Prevalence of acute respiratory infection 23.2 21.4 18.9 18.6 18.0 20.7 * (13.4) (23.4) 27.2 13.5 17.6 B. Fertility Total fertility rate 6.5 5.6 4.7 4.3 (3.6) 5.2 * * * * 2.7 3.1 Adolescent fertility rate 164.0 142.0 104.0 91.0 (52.0) 118.7 * * * * 68.0 89.7 C. Nutritional status Children: Moderate stunting 26.7 21.8 18.9 18.7 7.9 21.0 * (15.0) 21.9 28.3 12.2 17.3 Severe stunting 17.4 16.2 11.3 9.8 7.8 13.8 * (11.1) 9.3 9.4 5.8 7.4 Moderate underweight 24.4 20.1 16.5 13.8 8.6 18.6 * (30.3) 12.8 13.2 8.0 10.9 Severe underweight 7.1 6.4 3.3 3.9 3.1 5.3 * (1.3) 8.7 1.8 1.5 2.3 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 17.3 15.1 11.4 8.7 5.5 13.0 * * 11.9 6.5 5.5 7.5 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 16.1 15.5 16.7 11.7 10.9 14.8 * (12.7) 12.6 4.8 4.5 5.5 Women 45.7 42.7 45.4 38.4 31.6 42.0 (10.7) 46.3 35.6 24.8 20.4 23.1 Prevalence of occlusion: Girls 84.4 90.0 78.9 81.0 (78.7) 83.8 * * * * * (85.5) Women na na na na na na na na na na na na E. Sexually transmitted disease Prevalence of genital discharge: Women 1.5 1.0 1.0 0.3 1.3 1.0 * 2.7 1.2 1.1 1.4 1.3 Men 4.0 5.6 5.7 4.3 4.1 4.8 * (11.9) (4.4) 7.0 2.4 4.0 Prevalence of genital ulcer: Women 0.3 0.6 0.7 0.2 0.2 0.4 * 0.0 2.6 1.1 0.7 0.9 Men 3.2 3.6 4.2 3.4 1.6 3.3 * (11.9) 0.0 2.7 1.4 1.9 - 31 - Kenya 1998 - 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 93.7 92.2 98.1 97.7 100.0 95.3 * * * (96.6) 98.6 98.0 Measles coverage 63.9 78.4 84.8 80.4 80.5 76.1 * * * (95.5) 92.4 92.8 DPT coverage 67.1 79.1 87.1 86.4 88.7 79.2 * * * (75.8) 82.0 79.0 Full basic coverage 47.9 58.1 71.7 64.6 68.5 59.8 * * * (64.7) 56.0 58.3 No basic coverage 4.9 3.2 1.3 2.3 0.0 2.9 * * * (3.4) 1.4 1.6 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 54.5 59.2 58.8 59.5 71.3 58.5 * * * 69.6 74.5 75.6 Treatment in a public facility 38.9 32.9 35.9 31.2 42.6 35.9 * * * 45.1 29.5 38.3 Treatment in a private facility 13.7 21.9 20.5 25.6 26.0 19.9 * * * 21.0 41.3 34.2 Treatment of acute respiratory infection (ARI): Medical treatment of ARI 54.8 53.2 48.1 53.4 (70.4) 54.0 * * * (58.8) (84.8) 73.9 Treatment in a public facility 38.0 30.2 33.0 34.8 (42.7) 34.9 * * * (43.1) (40.0) 41.3 Treatment in a private facility 15.8 22.5 15.1 18.6 (27.7) 18.6 * * * (15.7) (40.9) 30.9 Treatment of diarrhea: Use of oral rehydration therapy 77.8 84.6 74.2 81.1 (78.6) 79.4 * * * * (91.7) 93.4 Medical treatment of diarrhea 41.0 48.8 36.7 43.3 (32.1) 41.9 * * * * (58.7) 54.3 Treatment in a public facility 25.7 28.9 21.9 27.5 (23.3) 25.9 * * * * (24.5) 32.4 Treatment in a private facility 15.3 19.9 13.9 15.8 (8.9) 15.9 * * * * (30.2) 20.0 C. Antenatal and delivery care Antenatal care visits: To a medically-trained person 88.3 90.1 93.1 95.2 94.9 91.4 * (87.4) (94.0) 95.6 97.0 95.9 To a doctor 23.3 22.3 25.3 32.8 33.6 25.9 * (42.3) (30.4) 32.6 41.5 39.0 To a nurse or trained midwife 65.1 67.8 67.8 62.4 61.3 65.6 * (45.2) (63.5) 63.0 55.4 56.9 Multiple visits to a medically-trained person 77.2 78.6 81.1 84.6 82.0 80.0 * (76.5) (94.7) 83.2 88.9 87.6 Antenatal care content: Tetanus toxoid 87.1 87.8 90.3 93.5 91.8 89.4 * (87.4) (97.3) 88.4 92.6 92.0 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 23.1 32.5 40.9 56.3 73.8 38.4 * (49.3) 50.2 55.7 83.0 70.8 By a doctor 5.2 8.1 11.5 13.4 21.8 9.8 * (5.7) 11.6 13.8 31.6 23.6 By a nurse or trained midwife 17.9 24.4 29.4 42.9 52.0 28.6 * (43.6) 38.6 41.9 51.3 47.2 In a public facility 15.7 24.5 32.2 37.8 39.8 26.8 * (32.8) 42.9 47.6 53.0 49.3 In a private facility 4.4 5.7 8.2 15.6 32.1 9.5 * 0.0 2.9 5.9 29.0 18.9 At home 78.4 68.1 58.6 45.4 27.4 62.4 * (67.2) 54.2 44.0 17.8 31.0 D. Contraceptive services Contraceptive prevalence: Women 12.7 24.2 32.0 41.7 55.1 29.0 * (21.1) 17.3 32.9 47.6 41.0 Men 18.2 28.3 41.0 47.0 54.1 35.2 * * (37.2) 41.2 54.8 48.2 - 32 - Kenya 1998 - 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 74.6 73.4 71.8 64.9 53.1 67.3 * * * 59.1 51.5 53.3 Men na na na na na na na na na na na na Source of contraception - private sector: Women 25.4 25.5 27.5 34.2 46.5 32.0 * * * 38.8 47.3 45.5 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 * * (82.2) * * 85.6 * * * * * (92.4) Men * (70.0) (52.8) (62.9) * 63.0 * * * * * (63.9) Treatment of genital discharge, ulcer, sore in public facilities: Women na na na na na na na na na na na na Men * (80.8) (75.4) (77.4) * 76.1 * * * * * (73.3) Voluntary counseling and testing for HIV/AIDS: Women 6.4 9.3 11.5 15.4 16.4 11.1 (10.7) 13.2 17.7 25.4 25.9 24.7 Men na na na na na na na na na na na na - 33 - Kenya 1998 - 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 15.3 20.1 19.2 15.0 (16.1) 17.0 * * * * (16.3) 16.3 Timely complementary feeding 86.0 94.4 84.0 93.0 * 89.5 * * * * (84.0) 88.5 Bottle-feeding 20.6 20.5 26.2 25.8 34.7 24.0 * * * (31.0) 33.1 29.7 D. Micronutrient consumption Iodized salt: Availability of iodized salt na na na na na na na na na na na na in household Vitamin A: Children 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. 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 1.7 0.8 0.9 0.4 0.4 0.9 0.0 0.8 2.7 1.8 0.6 1.0 Men na na na na na na na na na na na na Condom usage with non-regular partner: Women * * * * * 18.0 * * * * * * Men 28.9 39.7 47.3 47.6 55.5 43.2 * (24.6) (37.5) 35.7 69.6 54.6 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 - Kenya 1998 - 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 58.9 69.1 75.7 85.0 90.4 73.5 (47.1) 67.9 78.8 84.5 91.0 88.0 Men 72.0 80.1 86.0 87.8 89.8 82.6 * 83.5 86.2 89.4 94.1 92.1 School participation: Girls 69.3 83.3 86.6 88.8 94.3 82.1 * (61.2) (89.4) 81.8 87.6 84.6 Boys 72.5 80.6 83.6 89.0 93.5 81.5 * * * 82.7 90.1 86.2 B. Exposure to mass media Newspaper readership: Women 17.2 23.1 28.1 39.2 56.4 29.5 * 30.7 35.6 50.3 69.2 61.6 Men 30.0 44.4 52.0 65.2 75.7 52.1 * (68.7) (65.1) 73.9 91.5 83.9 Radio listenership: Women 30.7 44.1 63.1 69.7 81.1 54.1 * 46.8 40.0 63.6 78.7 71.6 Men 61.9 75.3 86.7 88.7 89.7 80.1 * (72.3) (68.1) 76.2 89.4 83.6 Television viewership: Women 6.9 9.3 11.0 19.5 57.1 16.1 * 16.5 17.3 28.3 71.1 57.3 Men 17.6 24.2 35.8 47.9 66.1 36.4 * (27.9) (55.9) 58.2 82.0 71.8 C. Knowledge and attitudes about HIV/AIDS Knowledge about sexual transmission of HIV/AIDS: Women 94.5 96.2 97.1 97.8 98.1 96.5 (93.4) 99.2 96.6 98.1 98.9 98.5 Men na na na na na na na na na na na na Knowledge about mother-to-child transmission of HIV/AIDS: Women 77.3 83.3 84.6 88.4 86.9 83.6 (73.5) 86.6 84.6 94.2 90.4 90.4 Men 81.7 80.8 81.4 83.2 84.2 82.1 * (94.4) (90.8) 92.2 90.4 91.0 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 33.8 36.7 43.2 40.9 50.0 39.5 * (39.2) 67.7 58.4 60.3 59.7 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 8.2 8.0 7.6 7.3 7.8 7.8 11.6 6.0 10.9 2.5 5.2 5.3 Maternal orphan prevalence 1.9 2.5 3.6 3.1 3.9 2.8 5.2 2.8 2.1 1.4 3.4 2.9 Double orphan prevalence 0.5 0.7 1.2 1.0 1.8 0.9 0.0 2.8 1.4 0.0 0.7 0.7 - 35 - PART III. BASIC TABLES, 1993 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. Kenya 1993 - 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 90.0 79.3 52.7 39.1 43.3 62.5 2.08 46.76 -0.1757 0.0184 Under-five mortality rate 129.3 120.2 81.2 61.5 61.9 93.2 2.09 67.44 -0.1684 0.0205 Prevalence of fever 44.2 44.7 40.1 39.2 39.4 41.7 1.12 4.83 -0.0324 0.0095 Prevalence of diarrhea 8.2 10.7 8.7 8.0 6.8 8.6 1.21 1.40 -0.0470 0.0245 Prevalence of acute respiratory 5.8 7.0 5.9 8.2 6.2 6.6 0.94 0.40 0.0166 0.0290 infection (ARI) B. Fertility Total fertility rate 7.2 6.2 5.6 5.3 3.3 5.4 2.17 3.91 -0.1351 0.0444 Adolescent fertility rate 156.5 109.6 120.3 122.1 66.8 110.4 2.34 89.69 -0.1173 0.0641 C. Nutritional status (%) Children: Moderate stunting 23.1 23.6 20.3 22.4 12.1 20.7 1.91 10.98 -0.0828 0.0160 Severe stunting 18.3 13.2 10.8 12.4 6.2 12.5 2.93 12.05 -0.1536 0.0218 Moderate underweight 19.7 18.2 16.0 17.9 11.0 16.8 1.79 8.68 -0.0876 0.0184 Severe underweight 9.9 6.4 5.1 3.6 2.8 5.8 3.49 7.07 -0.2217 0.0359 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 13.2 10.5 9.4 7.8 5.0 9.3 2.64 8.17 -0.1549 0.0288 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 na na na na na na na na na na Men na na na na na na na na na na Prevalence of genital ulcer: Women na na na na na na na na na na Men na na na na na na na na na na - 39 - Kenya 1993 - 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 93.3 94.6 95.7 99.1 99.1 96.2 0.94 5.77 0.0120 0.0031 Measles coverage 69.7 88.5 82.6 90.4 89.8 83.8 0.78 20.13 0.0392 0.0078 DPT coverage 76.7 86.2 86.4 92.8 93.6 86.8 0.82 16.86 0.0302 0.0068 Full basic coverage 64.8 78.0 77.1 86.7 86.4 78.2 0.75 21.59 0.0487 0.0090 No basic coverage 6.2 3.7 4.3 0.9 0.9 3.3 6.67 5.23 -0.2873 0.0870 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 37.8 47.3 42.1 55.1 58.4 47.3 0.65 20.60 0.1082 0.0124 Treatment in a public facility 26.8 34.9 28.3 42.8 31.4 32.6 0.85 4.68 0.0778 0.0175 Treatment in a private facility 11.0 12.4 13.8 12.3 26.9 14.7 0.41 15.92 0.1761 0.0315 Treatment of acute respiratory infection (ARI): Medical treatment of ARI 45.1 64.9 43.2 61.9 58.0 55.3 0.78 12.91 0.0570 0.0291 Treatment in a public facility 31.1 45.5 31.7 52.8 40.5 41.3 0.77 9.40 0.0679 0.0387 Treatment in a private facility 14.0 19.4 11.5 9.1 17.5 14.1 0.80 3.51 0.0227 0.0850 Treatment of diarrhea: Use of oral rehydration therapy 49.8 45.8 40.8 66.4 50.1 50.0 0.99 0.34 0.0345 0.0283 Medical treatment of diarrhea 31.6 50.4 47.4 46.2 40.8 43.7 0.77 9.23 0.0251 0.0299 Treatment in a public facility 21.1 38.8 27.5 40.9 24.6 31.2 0.86 3.47 0.0297 0.0379 Treatment in a private facility 10.4 11.6 19.9 5.3 16.2 12.5 0.64 5.77 0.0148 0.0736 C. Antenatal and delivery care Antenatal care visits: To a medically-trained person 89.0 96.1 96.1 95.9 97.6 94.8 0.91 8.64 0.0141 0.0024 To a doctor 21.1 22.5 23.1 19.1 31.8 23.4 0.66 10.67 0.0723 0.0172 To a nurse or trained midwife 67.9 73.6 73.0 76.8 65.8 71.4 1.03 2.03 -0.0050 0.0061 Multiple visits to a medically-trained person 76.3 85.1 83.9 84.9 87.7 83.4 0.87 11.36 0.0247 0.0042 Antenatal care content: Tetanus toxoid 83.6 89.3 89.6 91.5 92.0 89.1 0.91 8.43 0.0163 0.0034 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 23.1 33.1 45.7 56.7 76.5 45.1 0.30 53.40 0.2270 0.0076 By a doctor 5.7 9.4 11.8 13.6 23.6 12.2 0.24 17.87 0.2891 0.0218 By a nurse or trained midwife 17.3 23.7 33.9 43.1 52.8 32.9 0.33 35.53 0.2040 0.0108 In a public facility 17.7 26.8 34.7 44.0 51.9 33.8 0.34 34.23 0.2021 0.0104 In a private facility 4.8 5.1 9.6 11.3 22.5 10.0 0.21 17.66 0.3198 0.0256 At home 75.8 66.1 54.4 43.8 24.3 54.7 3.12 51.51 -0.1795 0.0064 D. Contraceptive services Contraceptive prevalence: Women 10.3 15.7 27.3 37.5 45.1 27.3 0.23 34.87 0.2638 0.0134 Men 9.4 20.5 34.7 41.0 45.4 31.9 0.21 35.93 0.2261 0.0194 - 40 - Kenya 1993 - 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.) Source of contraception - public sector: Women 77.8 82.6 66.2 78.5 59.6 70.0 1.30 18.16 -0.0691 0.0113 Men na na na na na na na na na na Source of contraception - private sector: Women 16.4 12.1 25.6 15.9 33.2 23.3 0.49 16.85 0.1941 0.0319 Men na na na na na na na na na na E. Treatment of adult illnesses Treatment of genital discharge, ulcer, sore: Women na na na na na na na na na na Men na na na na na na na na na na 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 - 41 - Kenya 1993 - 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 na na na na na na na na na na Timely complementary feeding na na na na na na na na na na Bottle-feeding 11.9 7.9 13.9 9.9 23.2 12.7 0.52 11.21 0.1812 0.0527 D. Micronutrient consumption Iodized salt: Availability of iodized salt na na na na na na na na na na in household Vitamin A: Children 28.3 28.5 32.6 38.1 44.4 33.7 0.64 16.08 0.0829 0.0160 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 na na na na na na na na na na Men na na na na na na na na na na Condom usage with non-regular partner: Women na na na na na na na na na na Men na na na na na na na na na na 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 - 42 - Kenya 1993 - 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 44.8 60.7 69.3 73.9 85.1 68.1 0.53 40.35 0.1057 0.0042 Men 65.7 74.7 83.0 84.5 89.2 80.9 0.74 23.52 0.0506 0.0034 School participation: Girls 50.0 63.5 69.9 75.4 77.9 66.3 0.64 27.93 0.0792 0.0069 Boys 54.1 61.0 67.8 77.8 76.7 67.0 0.71 22.60 0.0735 0.0071 B. Exposure to mass media Newspaper readership: Women 15.9 20.3 23.5 31.0 57.7 31.4 0.28 41.80 0.2584 0.0099 Men 27.3 42.4 57.2 68.1 81.5 59.1 0.34 54.22 0.1909 0.0089 Radio listenership: Women 30.8 54.4 68.7 73.8 86.5 64.7 0.36 55.74 0.1605 0.0046 Men na na na na na na na na na na Television viewership: Women 2.5 3.2 7.0 9.4 43.6 14.9 0.06 41.07 0.5620 0.0205 Men 11.1 14.6 22.5 29.7 56.2 30.7 0.20 45.08 0.3476 0.0176 C. Knowledge and attitudes about HIV/AIDS Knowledge about sexual transmission of HIV/AIDS: Women na na na na na na na na na na Men 35.1 38.0 43.0 45.1 50.4 43.4 0.70 15.26 0.0814 0.0137 Knowledge about mother-to-child transmission of HIV/AIDS: Women na na na na na na na na na na Men 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 na na na na na na na na na na 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 7.5 5.3 5.3 4.6 3.9 5.4 1.94 3.65 -0.1194 0.0189 Maternal orphan prevalence 2.6 1.5 1.3 2.0 1.4 1.8 1.78 1.13 -0.0775 0.0356 Double orphan prevalence 0.3 0.1 0.2 0.3 0.4 0.3 0.56 0.19 0.1974 0.1001 - 43 - Kenya 1993 - 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 77.1 83.0 45.7 38.7 40.7 58.6 103.2 75.5 59.8 39.4 45.9 66.6 Under-five mortality rate 115.3 124.6 77.0 62.8 55.2 89.3 143.7 115.7 85.6 60.2 68.8 97.1 Prevalence of fever 42.1 43.4 41.3 37.4 39.4 40.8 46.4 46.0 38.8 40.8 39.3 42.5 Prevalence of diarrhea 9.4 11.2 6.7 7.0 6.4 8.3 7.0 10.2 10.8 8.9 7.3 8.9 Prevalence of acute respiratory 7.1 6.6 5.5 7.3 6.2 6.6 4.4 7.4 6.3 8.9 6.3 6.7 infection (ARI) B. Nutritional status Children: Moderate stunting 19.8 22.9 18.3 20.3 9.9 18.6 26.6 24.3 22.4 24.3 14.5 22.9 Severe stunting 16.7 11.6 10.4 12.6 6.0 11.7 20.0 14.6 11.3 12.2 6.5 13.3 Moderate underweight 17.0 15.9 15.3 15.8 10.2 15.1 22.4 20.4 16.6 19.7 11.9 18.6 Severe underweight 8.8 5.0 5.9 3.7 3.2 5.5 11.1 7.7 4.3 3.5 2.4 6.0 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 na na na na na na Men na na na na na na Prevalence of genital ulcer: Women na na na na na na Men na na na na na na - 45 - Kenya 1993 - 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 94.2 90.3 97.1 98.0 100.0 95.9 92.4 98.5 94.5 100.0 98.1 96.6 Measles coverage 71.1 89.3 85.7 91.7 87.2 84.4 68.3 87.8 80.0 89.2 92.6 83.2 DPT coverage 74.3 86.9 90.7 91.7 92.2 86.7 79.2 85.5 82.8 93.8 95.1 87.0 Full basic coverage 63.2 77.5 80.9 89.9 83.0 78.2 66.5 78.4 73.9 83.8 90.0 78.1 No basic coverage 4.8 7.8 2.9 2.0 0.0 3.5 7.6 0.0 5.5 0.0 1.9 3.1 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 36.5 44.4 37.8 53.4 59.6 45.3 39.1 49.9 46.7 56.4 57.1 49.2 Treatment in a public facility 23.7 33.7 24.8 42.0 36.4 31.4 29.7 35.9 32.2 43.4 26.2 33.8 Treatment in a private facility 12.7 10.6 13.1 11.4 23.2 13.9 9.3 14.0 14.5 13.0 30.9 15.4 Treatment of acute respiratory infection (ARI): Medical treatment of ARI 49.6 59.6 46.5 40.9 56.6 50.5 37.1 69.6 40.2 77.5 59.4 60.2 Treatment in a public facility 34.3 38.2 33.5 28.5 46.0 35.7 25.4 51.9 30.1 70.8 34.8 46.8 Treatment in a private facility 15.2 21.4 12.9 12.3 10.7 14.8 11.7 17.7 10.1 6.7 24.6 13.4 Treatment of diarrhea: Use of oral rehydration therapy 53.5 46.2 46.0 63.5 59.1 52.5 44.5 45.4 37.5 68.4 41.7 47.7 Medical treatment of diarrhea 27.3 48.3 26.7 44.6 49.1 38.7 37.7 52.5 60.8 47.3 32.9 48.3 Treatment in a public facility 20.7 39.4 10.1 44.0 30.7 29.1 21.8 38.1 38.8 38.8 18.8 33.1 Treatment in a private facility 6.6 9.0 16.6 0.6 18.4 9.6 15.9 14.4 22.0 8.5 14.2 15.2 C. Contraceptive services Contraceptive prevalence: Women 10.3 15.7 27.3 37.5 45.1 27.3 Men 9.4 20.5 34.7 41.0 45.4 31.9 Source of contraception - public sector: Women 77.8 82.6 66.2 78.5 59.6 70.0 Men na na na na na na Source of contraception - private sector: Women 16.4 12.1 25.6 15.9 33.2 23.3 Men na na na na na na D. Treatment of adult illnesses Treatment of genital discharge, ulcer, sore: Women na na na na na na Men na na na na na na 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 - 46 - Kenya 1993 - 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 na na na na na na na na na na na na Timely complementary feeding na na na na na na na na na na na na Bottle-feeding 13.0 8.4 12.5 14.7 28.9 14.8 10.5 7.5 15.2 4.6 16.2 10.4 D. Micronutrient consumption Vitamin A: Children 29.9 29.7 30.0 41.7 48.6 35.2 26.7 27.4 35.4 35.1 39.7 32.2 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 na na na na na na Men na na na na na na Condom usage with non-regular partner: Women na na na na na na Men na na na na na na - 47 - Kenya 1993 - 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 44.8 60.7 69.3 73.9 85.1 68.1 Men 65.7 74.7 83.0 84.5 89.2 80.9 School participation: Girls 50.0 63.5 69.9 75.4 77.9 66.3 Boys 54.1 61.0 67.8 77.8 76.7 67.0 B. Exposure to mass media Newspaper readership: Women 15.9 20.3 23.5 31.0 57.7 31.4 Men 27.3 42.4 57.2 68.1 81.5 59.1 Radio listenership: Women 30.8 54.4 68.7 73.8 86.5 64.7 Men na na na na na na Television viewership: Women 2.5 3.2 7.0 9.4 43.6 14.9 Men 11.1 14.6 22.5 29.7 56.2 30.7 C. Knowledge and attitudes about HIV/AIDS Knowledge about sexual transmission of HIV/AIDS: Women na na na na na na Men 35.1 38.0 43.0 45.1 50.4 43.4 Knowledge about mother-to-child transmission of HIV/AIDS: Women na na na na na na Men na na na na na na Attitudes toward HIV/AIDS: Women na na na na na na Men na na na na na na D. Orphanhood Paternal orphan prevalence 7.2 5.0 5.5 5.2 3.5 5.4 7.9 5.7 5.2 4.0 4.3 5.5 Maternal orphan prevalence 2.5 1.4 1.1 2.0 1.1 1.7 2.7 1.7 1.6 1.9 1.8 1.9 Double orphan prevalence 0.2 0.2 0.2 0.3 0.3 0.2 0.3 0.1 0.2 0.2 0.6 0.3 - 48 - Kenya 1993 - 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 90.0 79.2 50.4 37.8 49.6 64.9 * * * (80.1) 41.8 45.5 Under-five mortality rate 129.3 119.4 77.1 60.1 62.4 95.6 * * * (119.7) 68.2 75.4 Prevalence of fever 44.2 44.9 40.4 39.0 39.6 42.1 na 30.6 34.1 40.3 39.1 38.8 Prevalence of diarrhea 8.2 10.8 8.8 7.0 8.5 8.7 na 6.2 6.7 15.5 5.3 7.4 Prevalence of acute respiratory infection 5.8 7.0 5.8 8.6 7.5 6.8 na 6.0 8.0 5.3 5.0 5.3 B. Fertility Total fertility rate 7.2 6.2 5.6 5.3 3.8 5.8 3.3 5.4 5.1 3.0 3.4 3.4 Adolescent fertility rate 109.7 119.2 118.7 79.7 118.9 156.5 105.2 143.1 143.5 57.1 73.6 74.0 C. Nutritional status Children: Moderate stunting 23.1 23.7 20.0 21.1 14.3 21.4 na 15.7 25.8 33.8 9.9 15.5 Severe stunting 18.3 13.1 10.9 13.3 7.2 13.4 na 19.6 9.1 4.4 5.3 5.7 Moderate underweight 19.7 18.1 16.0 18.5 12.9 17.7 na 23.5 15.0 12.0 9.1 10.4 Severe underweight 9.9 6.4 5.2 3.8 3.0 6.2 na 3.9 3.9 1.6 2.7 2.6 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 13.2 10.5 9.4 8.3 7.0 10.1 na 10.1 9.6 4.7 3.2 4.0 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 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 Prevalence of genital ulcer: 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 - 49 - Kenya 1993 - 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 93.3 94.5 95.4 98.9 100.0 95.8 na 100.0 100.0 100.0 98.4 98.9 Measles coverage 69.7 88.4 82.8 92.0 96.3 83.7 na 90.2 79.9 81.6 84.9 84.0 DPT coverage 76.7 86.1 86.3 92.3 95.4 85.8 na 90.2 88.7 95.4 92.2 92.5 Full basic coverage 64.8 77.9 77.6 87.6 92.1 77.7 na 80.5 68.6 81.6 82.0 80.9 No basic coverage 6.2 3.8 4.6 1.1 0.0 3.7 na 0.0 0.0 0.0 1.6 1.1 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 37.8 47.1 40.9 54.8 56.7 45.6 61.0 68.6 56.5 59.9 na 59.8 Treatment in a public facility 26.8 34.9 27.2 42.2 33.0 32.3 29.3 53.9 46.5 30.0 na 35.0 Treatment in a private facility 11.0 12.2 13.7 12.7 23.6 13.3 31.7 14.7 10.0 29.9 na 24.9 Treatment of acute respiratory infection (ARI): Medical treatment of ARI 45.1 65.1 43.8 58.4 61.4 54.8 50.0 34.6 100.0 53.5 na 60.3 Treatment in a public facility 31.1 45.5 31.5 50.4 42.2 40.7 50.0 34.6 79.6 38.3 na 46.2 Treatment in a private facility 14.0 19.7 12.3 8.0 19.2 14.1 0.0 0.0 20.4 15.2 na 14.1 Treatment of diarrhea: Use of oral rehydration therapy 49.8 45.4 41.8 60.1 42.4 47.7 100.0 14.0 87.5 61.6 na 69.5 Medical treatment of diarrhea 31.6 50.0 48.7 42.6 39.1 43.1 100.0 14.0 58.2 43.3 na 48.4 Treatment in a public facility 21.1 38.3 28.0 35.8 19.6 29.8 100.0 14.0 58.2 32.1 na 42.7 Treatment in a private facility 10.4 11.7 20.6 6.8 19.5 13.3 0.0 0.0 0.0 11.2 na 5.7 C. Antenatal and delivery care Antenatal care visits: To a medically-trained person 89.0 96.1 96.2 95.6 97.3 94.4 100.0 93.9 97.9 97.9 na 97.6 To a doctor 21.1 22.2 23.0 18.7 29.2 22.1 39.5 25.0 22.1 33.9 na 31.3 To a nurse or trained midwife 67.9 73.9 73.2 76.9 68.1 72.3 60.5 68.9 75.8 64.0 na 66.3 Multiple visits to a medically-trained person 76.3 85.0 84.1 84.3 87.8 82.8 89.9 81.0 89.2 87.5 na 87.3 Antenatal care content: Tetanus toxoid 83.6 89.3 89.6 91.0 92.0 88.6 89.1 90.9 94.9 92.1 na 92.4 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 23.1 33.0 44.7 54.1 67.5 40.1 na 45.8 62.6 74.3 84.4 79.7 By a doctor 5.7 9.4 11.3 13.0 20.7 10.6 na 13.5 19.7 17.8 26.3 23.7 By a nurse or trained midwife 17.3 23.6 33.4 41.1 46.9 29.5 na 32.3 42.9 56.6 58.2 55.9 In a public facility 17.7 26.6 33.4 41.0 46.5 30.3 na 35.5 56.0 64.7 56.7 57.7 In a private facility 4.8 5.2 9.9 11.8 18.9 8.6 na 0.0 4.3 7.8 25.6 19.7 At home 75.8 66.1 55.7 46.3 33.0 59.6 na 64.5 33.4 26.7 16.5 21.1 D. Contraceptive services Contraceptive prevalence: Women 10.3 16.0 28.3 38.6 46.9 25.4 na 4.7 10.1 28.4 43.6 37.9 Men 9.4 20.5 35.2 42.8 44.3 28.6 na 20.8 30.2 32.7 46.0 42.4 - 50 - Kenya 1993 - 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 77.8 82.5 66.4 78.3 66.6 73.6 na 100.0 57.7 80.7 53.2 56.5 Men na na na na na na na na na na na na Source of contraception - private sector: Women 16.4 12.2 25.2 15.5 30.3 20.5 na 0.0 42.3 19.3 36.0 34.1 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 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 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 - 51 - Kenya 1993 - 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 na na na na na na na na na na na na Timely complementary feeding na na na na na na na na na na na na Bottle-feeding 11.9 8.0 13.9 9.0 17.8 11.3 na 0.0 13.8 16.4 28.7 24.6 D. Micronutrient consumption Iodized salt: Availability of iodized salt na na na na na na na na na na na na in household Vitamin A: Children 28.3 28.5 31.9 37.7 50.1 32.9 na 29.3 46.2 41.8 38.7 39.7 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 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 Condom usage with non-regular partner: 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 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 - 52 - Kenya 1993 - 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 44.8 60.6 69.0 74.5 82.8 64.9 na 64.8 74.1 69.2 87.0 83.3 Men 65.7 74.9 82.1 85.0 83.8 78.2 na 68.9 91.4 81.8 93.1 90.6 School participation: Girls 50.0 63.6 70.9 76.6 78.5 65.8 na 58.8 45.1 59.8 77.0 70.7 Boys 54.1 61.1 68.2 78.6 78.2 66.5 na 56.9 59.0 66.2 74.5 71.1 B. Exposure to mass media Newspaper readership: Women 15.9 20.2 23.1 30.5 51.6 26.2 na 25.5 30.8 34.9 62.4 55.8 Men 27.3 41.7 55.6 66.1 70.9 50.9 na 57.6 72.8 77.2 88.1 84.6 Radio listenership: Women 30.8 54.4 69.5 74.7 88.3 61.4 na 50.7 55.7 66.7 85.1 79.9 Men na na na na na na na na na na na na Television viewership: Women 2.5 3.2 6.6 8.0 30.2 8.3 na 2.8 13.8 19.9 53.9 45.5 Men 11.1 14.6 20.4 27.7 51.0 23.2 na 15.2 42.9 38.8 59.4 54.0 C. Knowledge and attitudes about HIV/AIDS Knowledge about sexual transmission of HIV/AIDS: Women na na na na na na na na na na na na Men 35.1 37.1 43.6 46.9 50.9 42.1 na 57.4 37.8 36.8 50.0 47.6 Knowledge about mother-to-child transmission of 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 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 na na na na na na na na na na na na 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 7.5 5.4 5.0 4.5 4.2 5.5 na 4.3 13.1 5.1 3.4 4.5 Maternal orphan prevalence 2.6 1.6 1.3 2.0 1.1 1.8 na 0.7 1.0 1.2 1.8 1.6 Double orphan prevalence 0.3 0.1 0.2 0.3 0.2 0.2 na 0.0 1.0 0.0 0.7 0.6 - 53 - PART IV. 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.) - 57 - 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. - 58 - 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. - 59 - 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. - 60 - 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. - 61 - 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). 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). 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. - 62 - 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. - 63 - 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. - 64 - 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. - 65 - 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. - 66 - 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. Knowledge about Mother-to-Child Transmission of HIV/AIDS 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.) - 67 - 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). - 68 - 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. - 69 - 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. - 71 - 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. 77) 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. - 72 - 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.) - 73 - 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. - 75 - 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 - 76 - 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. - 77 - 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.) - 78 - 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 - 79 - 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. - 80 - PART V. SUPPORTING TABLES, 2003 A. SAMPLE SIZES B. STANDARD ERRORS C. ASSET DISTRIBUTION AND WEIGHTS Kenya 2003 - SAMPLE SIZES TOTAL SAMPLE Indicator Wealth Quintiles Pop. Low 2nd 3rd 4th High Total Number of household members All 7,297 7,448 7,440 7,478 7,465 37,128 Urban 157 156 303 986 5,743 7,344 Rural 7,140 7,292 7,137 6,493 1,721 29,784 Female 3,667 3,830 3,839 3,790 3,712 18,837 Male 3,630 3,618 3,601 3,689 3,752 18,291 Part I: HNP STATUS Indicator Wealth Quintiles Pop. Low 2nd 3rd 4th High Total Mortality rates All 2,805 2,388 2,196 1,961 2,042 11,392 Urban 63 45 80 317 1,577 2,081 Rural 2,742 2,343 2,116 1,644 466 9,311 Female 1,360 1,205 1,066 970 1,018 5,619 Male 1,444 1,183 1,130 991 1,024 5,773 Prevalence of fever, diarrhea, acute respiratory infection All 1,339 1,154 1,052 957 1,045 5,547 Urban 28 23 41 153 815 1,061 Rural 1,311 1,131 1,010 803 230 4,486 Female 658 600 516 466 519 2,759 Male 680 554 535 491 526 2,787 Total fertility rate All 1,364 1,475 1,503 1,711 2,141 8,195 Urban 29 37 61 241 1,687 2,056 Rural 1,334 1,438 1,443 1,470 454 6,139 Age-specific fertility rate 15-19 All 316 360 380 401 398 1,856 Urban 7 9 16 46 310 388 Rural 309 351 364 356 88 1,467 Children's nutritional status All 1,202 1,054 952 836 841 4,885 Urban 23 20 36 117 652 849 Rural 1,179 1,034 915 719 188 4,036 Female 593 545 470 411 405 2,423 Male 609 509 482 425 436 2,461 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 - 83 - Kenya 2003 - SAMPLE SIZES Part I: HNP STATUS (Cont.) Indicator Wealth Quintiles Pop. Low 2nd 3rd 4th High Total Women's nutritional status All 1,301 1,406 1,420 1,619 1,973 7,718 Urban 27 37 58 219 1,553 1,894 Rural 1,274 1,369 1,362 1,399 420 5,824 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 1,356 1,472 1,498 1,711 2,139 8,176 Urban Female 29 37 61 241 1,686 2,055 Rural Female 1,327 1,434 1,437 1,470 453 6,121 Male 548 609 648 794 979 3,578 Urban Male 8 16 21 121 742 907 Rural Male 541 593 627 672 237 2,671 - 84 - Kenya 2003 - 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 280 231 218 187 189 1,105 Urban 5 4 7 28 146 189 Rural 275 227 210 160 43 916 Female 143 112 106 91 98 550 Male 137 119 111 96 91 555 Treatment of fever All 504 505 442 393 412 2,255 Urban 9 11 15 61 327 423 Rural 495 494 428 332 84 1,833 Female 235 247 236 196 198 1,111 Male 269 258 206 197 214 1,145 Treatment of acute respiratory infection All 242 265 184 168 165 1,023 Urban 7 4 6 27 131 174 Rural 235 260 178 141 34 849 Female 110 134 93 85 76 499 Male 132 130 91 83 89 524 Treatment of diarrhea All 245 202 158 124 159 888 Urban 28 5 11 35 125 180 Rural 240 197 148 89 35 708 Female 114 94 67 56 69 400 Male 130 108 91 68 90 489 Antenatal and delivery care All 869 830 777 725 851 4,052 Urban 18 16 29 109 663 835 Rural 852 813 748 615 188 3,217 Contraceptive prevalence Female 947 954 915 965 1,139 4,919 Urban Female 18 18 30 134 891 1,091 Rural Female 929 936 885 831 247 3,828 Male 311 282 311 379 530 1,814 Urban Male 3 6 9 65 399 482 Rural Male 308 276 303 313 131 1,332 Contraceptive source Female 112 231 306 396 507 1,551 Urban Female 2 1 8 52 371 435 Rural Female 109 230 298 344 135 1,116 Male na na na na na na Urban Male na na na na na na Rural Male na na na na na na Treatment of genital discharge, ulcer, sore Female 49 57 47 62 67 283 Urban Female 1 1 9 51 na 63 Rural Female 49 56 46 53 16 221 Male 23 15 11 15 25 89 Urban Male 0 5 18 na na 24 Rural Male 23 15 11 10 7 66 - 85 - Kenya 2003 - 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 816 785 726 679 745 3,752 Urban 16 16 27 101 580 740 Rural 800 769 700 578 165 3,012 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 1,391 1,529 1,653 1,723 2,260 8,555 Urban 28 30 56 260 1,763 2,137 Rural 1,363 1,499 1,597 1,463 497 6,418 Bednet use by children All 1,509 1,271 1,159 1,032 1,131 6,102 Urban 30 24 44 162 882 1,143 Rural 1,479 1,247 1,115 870 248 4,959 Bednet use by pregnant women All 128 137 119 117 139 640 Urban 1 1 3 15 115 136 Rural 1 1 3 15 115 136 Exclusive breastfeeding All 91 83 76 76 79 406 Urban 2 3 2 12 65 83 Rural 89 80 75 64 14 323 Female 48 44 41 43 40 216 Male 43 39 35 34 39 191 Timely complementary breastfeeding 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 Bottle-feeding All 300 254 223 211 246 1,234 Urban 5 5 10 35 190 244 Rural 295 249 213 176 56 989 Female 165 132 110 106 115 628 Male 135 122 113 105 131 606 - 86 - Kenya 2003 - 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 na na na na na na Urban na na na na na na Rural na na na na na na Vitamin A supplementation All 1,322 1,143 1,043 929 1,003 5,440 Urban 27 23 41 147 789 1,028 Rural 27 23 41 147 789 1,028 Female 675 551 531 474 509 2,740 Male 675 551 531 474 509 2,740 Tobacco and alcohol use, casual sexual partners, condom use for casual sex Female 1,362 1,474 1,503 1,711 2,140 8,192 Urban Female 29 37 61 241 1,686 2,055 Rural Female 1,333 1,437 1,443 1,470 454 6,137 Male 548 609 647 794 978 3,576 Urban Male 8 16 21 121 741 906 Rural Male 541 593 626 672 237 2,670 Domestic violence All na na na na na na Urban na na na na na na Rural na na na na na na - 87 - Kenya 2003 - SAMPLE SIZES Part IV: UNDERLYING DETERMINANTS OF HNP STATUS Indicator Wealth Quintiles Pop. Low 2nd 3rd 4th High Total School completion (Grade 5) Female 1,492 1,614 1,650 1,858 2,319 8,932 Urban female 33 38 68 271 1,825 2,236 Rural female 1,459 1,576 1,582 1,586 494 6,696 Male 1,339 1,493 1,536 1,754 2,383 8,505 Urban male na na na na na na Rural male na na na na na na School participation Female 656 570 584 535 425 2,770 Urban female 14 12 29 71 307 433 Rural female 642 558 555 464 118 2,337 Male 1,201 1,173 1,127 1,009 793 5,304 Urban male na na na na na na Rural male na na na na na na Mass media exposure Female 1,362 1,474 1,501 1,709 2,139 8,185 Urban female 29 37 61 241 1,686 2,055 Rural female 1,333 1,437 1,440 1,468 452 6,130 Male 548 607 648 794 978 3,576 Urban male 8 16 21 121 741 906 Rural male 541 592 627 672 237 2,670 Knowledge of HIV/AIDS prevention Female 1,364 1,475 1,503 1,711 2,141 8,195 Urban female 29 37 61 241 1,687 2,056 Rural female 1,334 1,438 1,443 1,470 454 6,139 Male 548 609 648 794 979 3,578 Urban male 8 16 21 121 742 907 Rural male 541 593 627 672 237 2,671 Household decisionmaking and justification of violence All 1,364 1,475 1,503 1,711 2,141 8,195 Urban 29 37 61 241 1,687 2,056 Rural 29 37 61 241 1,687 2,056 Orphanhood All 4,026 3,622 3,461 3,160 2,583 16,852 Urban 86 73 140 419 1,940 2,658 Rural 3,940 3,549 3,321 2,741 643 14,194 Female 1,942 1,775 1,723 1,577 1,310 8,328 Male 2,084 1,847 1,738 1,583 1,272 8,524 - 88 - Kenya 2003 - STANDARD ERRORS OF QUINTILE ESTIMATES FOR TOTAL POPULATION Part I: HNP STATUS Indicator Wealth Quintiles Low 2nd 3rd 4th High Avg. A. Childhood illness and mortality Infant mortality rate 8.93 8.37 8.73 6.78 6.68 4.55 Under-five mortality rate 13.33 9.68 11.29 8.59 8.22 6.07 Prevalence of fever 2.01 2.02 2.03 2.37 1.80 1.09 Prevalence of diarrhea 1.45 1.60 1.37 1.41 1.62 0.78 Prevalence of acute respiratory infection 1.49 1.70 1.64 1.54 1.48 0.75 B. Fertility Total fertility rate 0.29 0.21 0.19 0.20 0.17 0.14 Adolescent fertility rate 15.82 13.30 10.78 10.41 9.10 5.69 C. Nutritional status Children: Moderate stunting 1.51 1.56 1.45 1.36 1.19 0.68 Severe stunting 1.21 1.17 1.27 1.43 1.29 0.58 Moderate underweight 1.29 1.43 1.34 1.34 0.98 0.65 Severe underweight 1.18 0.62 0.76 0.71 0.49 0.39 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 1.74 1.40 1.17 0.80 0.52 0.66 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 0.59 0.47 0.53 0.42 0.32 0.22 Men 0.79 0.74 0.51 0.50 0.43 0.29 Prevalence of genital ulcer: Women 0.53 0.50 0.33 0.34 0.33 0.19 Men 0.80 0.57 0.50 0.37 0.32 0.25 - 89 - Kenya 2003 - STANDARD ERRORS OF QUINTILE ESTIMATES FOR TOTAL POPULATION Part II: Intermediate Determinants of HNP Status - HNP SERVICE USE Indicator Wealth Quintiles Low 2nd 3rd 4th High Avg. A. Childhood immunization BCG coverage 3.92 2.33 2.02 1.49 1.35 1.46 Measles coverage 4.25 3.69 3.36 3.82 2.49 1.84 DPT coverage 4.52 3.71 2.83 4.10 3.88 2.02 Full basic coverage 4.03 4.16 3.77 4.99 3.98 2.05 No basic coverage 3.13 1.58 1.71 0.75 1.25 1.13 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 3.20 2.65 3.74 3.83 2.95 1.73 Treatment in a public facility 3.23 2.80 3.22 3.83 2.24 1.69 Treatment in a private facility 2.47 2.01 2.14 2.50 3.08 1.25 Treatment of acute respiratory infection (ARI): Medical treatment of ARI 3.79 3.62 4.68 4.82 3.80 1.96 Treatment in a public facility 4.02 3.67 4.86 5.15 3.72 1.95 Treatment in a private facility 3.16 2.93 2.99 3.90 3.63 1.55 Treatment of diarrhea: Use of oral rehydration therapy 4.07 4.77 4.83 5.59 4.63 2.14 Medical treatment of diarrhea 4.00 4.13 4.37 4.88 4.67 2.01 Treatment in a public facility 3.67 3.59 4.22 4.36 3.03 1.75 Treatment in a private facility 2.88 2.01 1.88 3.04 4.25 1.53 C. Antenatal and delivery care Antenatal care (ANC) visits: To a medically-trained person 2.55 1.47 1.15 1.09 1.04 0.85 To a doctor 1.69 2.01 1.82 1.60 2.07 1.00 To a nurse or trained midwife 2.57 2.29 1.89 1.94 2.27 1.18 Multiple visits to a medically-trained person 2.38 1.73 1.76 1.67 1.48 0.91 Antenatal care content: Tetanus toxoid 2.36 1.38 1.15 1.14 1.14 0.83 Prophylactic antimalarial treatment 2.02 1.92 1.91 1.80 1.63 0.93 Iron supplementation 2.39 2.42 2.48 2.05 2.35 1.29 Delivery attendance: By a medically-trained person 1.70 2.18 2.41 2.66 1.94 1.63 By a doctor 0.84 1.12 0.94 1.36 1.85 0.72 By a nurse or trained midwife 1.47 1.88 2.14 2.48 2.21 1.28 In a public facility 1.22 1.68 2.14 2.32 2.51 1.25 In a private facility 1.27 1.49 1.21 1.76 2.29 0.92 At home 1.63 2.20 2.41 2.70 1.99 1.61 D. Contraceptive services Contraceptive prevalence: Women 1.46 1.96 2.40 2.51 2.12 1.37 Men 2.39 2.87 3.05 3.28 2.53 1.45 Source of contraception - public sector: Women 5.32 4.06 3.39 3.35 2.82 1.95 Men na na na na na na - 90 - Kenya 2003 - STANDARD ERRORS OF QUINTILE ESTIMATES FOR TOTAL POPULATION Part II: Intermediate Determinants of HNP Status - HNP SERVICE USE (Cont.) Indicator Wealth Quintiles Low 2nd 3rd 4th High Avg. D. Contraceptive services (cont.) Source of contraception - private sector: Women 5.32 4.06 3.41 3.34 2.81 1.95 Men na na na na na na E. Treatment of adult illnesses Treatment of genital discharge, ulcer, sore: Women 10.15 6.82 6.95 6.36 4.82 3.21 Men * * * * * 6.34 Treatment of genital discharge, ulcer, sore in public facilities: Women 10.15 6.82 6.95 6.36 4.82 3.21 Men * * * * * 6.34 Voluntary counseling and testing for HIV/AIDS: Women 0.84 0.95 1.09 1.01 1.09 0.61 Men 1.44 1.49 1.42 1.22 1.66 0.79 - 91 - Kenya 2003 - STANDARD ERRORS OF QUINTILE ESTIMATES FOR TOTAL POPULATION Part III: Intermediate Determinants of HNP Status - INDIVIDUAL AND HOUSEHOLD BEHAVIOR Indicator Wealth Quintiles Low 2nd 3rd 4th High Avg. A. Hygienic practices Disposal of children's stools: Sanitary disposal 3.43 2.59 2.27 1.99 2.33 1.59 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 1.66 1.35 1.38 1.87 2.40 1.17 Treated bednet ownership na na na na na na Bednet use: By children 1.48 1.44 1.77 2.20 2.90 1.05 By pregnant women 1.99 2.25 2.96 3.90 4.58 1.56 C. Breastfeeding Exclusive breastfeeding 5.21 4.37 5.01 4.16 4.52 2.18 Timely complementary feeding na na na na na na Bottle-feeding 3.13 3.20 3.34 3.82 3.92 1.62 D. Micronutrient consumption Iodized salt: Availability of iodized salt in household na na na na na na Vitamin A: Children 2.38 2.39 2.24 2.28 2.31 1.28 Women 1.39 1.48 1.43 1.51 1.63 0.79 E. Tobacco and alcohol use Tobacco: Women 1.21 0.67 0.57 0.24 0.24 0.36 Men 1.95 2.41 2.01 2.01 1.56 1.01 Alcohol: Women na na na na na na Men na na na na na na F. Sexual practices Non-regular sexual partnerships: Women 0.23 0.33 0.33 0.31 0.28 0.14 Men 1.67 1.59 0.94 1.27 1.34 0.67 Condom usage with non-regular partner: Women * * * * * 5.82 Men 8.81 9.23 9.11 5.92 4.42 3.42 G. Domestic violence Ever experienced violence na na na na na na Experienced violence in past year 1.56 1.41 1.17 1.15 0.96 0.66 - 92 - Kenya 2003 - STANDARD ERRORS OF QUINTILE ESTIMATES FOR TOTAL POPULATION Part IV: UNDERLYING DETERMINANTS OF HNP STATUS Indicator Wealth Quintiles Low 2nd 3rd 4th High Avg. A. Education School completion: Women 3.11 1.92 1.96 1.16 1.00 1.27 Men 2.69 1.85 1.56 1.10 0.93 0.99 School participation: Girls 3.57 1.71 1.62 0.78 1.05 1.28 Boys 2.00 0.94 0.54 0.45 0.70 0.65 B. Exposure to mass media Newspaper readership: Women 1.01 0.94 1.17 1.74 1.91 1.20 Men 2.64 2.47 2.66 2.68 2.11 1.70 Radio listenership: Women 2.40 1.72 1.54 1.06 1.02 1.05 Men 3.01 1.63 1.38 1.03 0.68 0.82 Television viewership: Women 0.67 0.95 1.44 1.95 2.15 1.60 Men 2.65 2.40 2.67 2.78 2.61 1.81 C. Knowledge and attitudes about HIV/AIDS Knowledge about sexual transmission of HIV/AIDS: Women 2.74 1.53 1.19 0.99 0.81 0.84 Men 2.60 1.53 1.25 1.12 0.95 0.74 Knowledge about mother-to-child transmission of HIV/AIDS: Women 2.66 1.40 1.06 0.87 0.73 0.77 Men 3.03 1.58 1.61 1.28 0.82 0.80 Attitudes toward HIV/AIDS: Women 2.03 1.73 1.59 1.18 1.12 0.93 Men 2.75 2.07 2.29 1.81 1.43 1.08 D. Status of women Household decisionmaking: Can seek own health care 1.70 1.82 1.93 2.15 1.85 1.21 Can seek children's health care na na na na na na Can make daily household purchases 1.79 1.71 1.53 1.30 1.38 0.78 Can make large household purchases 1.55 1.48 1.56 1.31 1.50 0.78 Can make meal-related decisions 1.64 1.54 1.46 1.55 1.53 0.80 Freedom of movement: Can travel to visit family/relatives 1.60 1.60 1.31 1.35 1.23 0.79 Other decisionmaking, attitudes: Can decide how to spend own money 2.98 2.67 1.97 2.44 1.46 1.17 Can decide whether to have sex 1.87 1.35 1.11 0.99 0.42 0.61 Justifies domestic violence 1.51 1.58 1.66 1.48 1.77 1.02 E. Orphanhood Paternal orphan prevalence 0.99 1.18 1.02 1.06 0.77 0.56 Maternal orphan prevalence 0.69 0.50 0.66 0.63 0.63 0.31 Double orphan prevalence 0.47 0.41 0.49 0.52 0.31 0.24 - 93 - Kenya 2003 - ASSET DISTRIBUTION AND WEIGHTS (FACTOR SCORE) Asset Variable Unweighted Wealth Quintiles Factor Low 2nd 3rd 4th High Avg. Score Mean Std. Percentage of Population Devia- tion Has electricity 0.201 0.401 0.0% 0.0% 0.2% 3.7% 59.0% 12.6% 0.08784 Has radio 0.729 0.444 43.0% 72.9% 81.1% 88.3% 87.5% 74.6% 0.03190 Has television 0.217 0.412 0.0% 0.2% 8.2% 29.9% 57.1% 19.1% 0.06762 Has refrigerator 0.063 0.242 0.0% 0.0% 0.0% 0.6% 23.1% 4.7% 0.06149 Has bicycle 0.266 0.442 22.9% 32.8% 40.5% 45.1% 23.1% 32.9% -0.01057 Has motorcycle or scooter 0.008 0.090 0.0% 0.0% 0.5% 2.0% 1.4% 0.8% 0.00687 Has car or truck 0.061 0.239 0.1% 0.1% 0.8% 6.9% 20.6% 5.7% 0.04585 Has telephone 0.161 0.367 0.0% 0.2% 1.9% 10.5% 48.2% 12.2% 0.07241 Has solar power 0.031 0.173 0.1% 0.3% 2.7% 11.2% 4.7% 3.8% 0.00422 Has a domestic worker not related to household head 0.029 0.169 0.0% 0.0% 0.6% 3.1% 12.3% 3.2% 0.03280 Works own or family's agricultural land 0.753 0.431 91.5% 89.6% 85.4% 86.8% 85.5% 87.8% -0.00723 Uses water piped into residence 0.100 0.300 0.0% 0.0% 1.3% 5.1% 33.0% 7.9% 0.05957 Uses water piped into compound or plot 0.143 0.350 0.1% 0.7% 6.6% 15.2% 26.4% 9.8% 0.03554 Uses water from a piped public source 0.122 0.328 2.6% 5.0% 9.6% 10.7% 18.7% 9.3% 0.01117 Uses water from an open well in yard or residence 0.020 0.139 1.0% 1.0% 1.2% 4.1% 1.3% 1.7% -0.00228 Uses water from a public open well 0.059 0.236 10.2% 7.1% 7.1% 3.8% 1.8% 6.0% -0.01647 Uses water from a protected well in yard or residence 0.047 0.211 0.6% 3.1% 5.8% 12.1% 4.0% 5.1% -0.00094 Uses water from a protected public well 0.056 0.229 5.1% 8.0% 9.1% 6.3% 3.4% 6.4% -0.01050 Uses water from a spring 0.111 0.314 13.6% 27.3% 20.9% 9.5% 0.9% 14.4% -0.02408 Uses water from a river, stream, pond, lake, or dam 0.261 0.439 63.0% 43.5% 32.1% 24.3% 1.9% 33.0% -0.04690 Uses rainwater for drinking 0.023 0.151 0.2% 1.2% 2.5% 4.5% 0.8% 1.9% -0.00425 Uses bottled drinking water 0.003 0.056 0.0% 0.0% 0.0% 0.0% 0.8% 0.2% 0.01532 Uses water from another source 0.054 0.226 3.2% 3.0% 3.7% 4.2% 6.9% 4.2% 0.00351 Uses own flush toilet 0.083 0.276 0.0% 0.0% 0.4% 0.5% 30.3% 6.2% 0.06931 Uses shared flush toilet 0.061 0.239 0.0% 0.0% 0.0% 0.1% 13.6% 2.7% 0.04046 Uses own pit latrine 0.293 0.455 28.7% 59.5% 48.1% 46.0% 7.0% 37.9% -0.03688 Uses shared pit latrine 0.307 0.461 9.9% 19.6% 35.9% 31.2% 32.3% 25.8% 0.00091 Uses own VIP latrine 0.036 0.187 0.1% 0.5% 4.1% 13.5% 4.5% 4.6% -0.00043 Uses shared VIP latrine 0.042 0.202 0.1% 0.4% 0.9% 3.8% 9.7% 3.0% 0.01572 Uses bush or field as latrine 0.169 0.375 61.0% 20.0% 10.1% 4.0% 1.4% 19.3% -0.04204 Uses other type of latrine 0.006 0.079 0.1% 0.1% 0.3% 0.5% 1.0% 0.4% 0.00253 Owns household 0.661 0.473 99.8% 99.4% 95.0% 81.4% 20.6% 79.2% -0.08155 Rents home formally 0.281 0.449 0.0% 0.0% 0.0% 8.9% 73.2% 16.4% 0.08165 Rent-free with owner's consent 0.050 0.218 0.0% 0.0% 3.8% 8.7% 5.8% 3.7% 0.00998 Squats in home 0.006 0.080 0.2% 0.6% 1.1% 0.6% 0.3% 0.6% -0.00415 Owns household land 0.594 0.491 97.3% 93.8% 82.5% 71.7% 17.3% 72.5% -0.07451 Rents land formally 0.216 0.411 0.0% 0.1% 0.4% 7.5% 55.4% 12.7% 0.06610 Rent-free land with owner's consent 0.173 0.378 0.2% 5.4% 15.3% 19.2% 26.8% 13.4% 0.02798 Squats on land 0.016 0.126 2.6% 0.6% 1.8% 1.1% 0.3% 1.3% -0.00938 Has earth, mud, dung, or sand as flooring 0.579 0.494 99.8% 99.8% 92.1% 36.7% 6.1% 66.9% -0.08562 Has wood plank as flooring 0.006 0.078 0.0% 0.0% 0.4% 1.0% 1.7% 0.6% 0.01216 Has parquet/polished wood flooring 0.007 0.083 0.0% 0.0% 0.0% 0.0% 2.1% 0.4% 0.02463 Has linoleum as flooring 0.006 0.076 0.0% 0.0% 0.0% 0.3% 1.6% 0.4% 0.01520 Has tile as flooring 0.011 0.106 0.0% 0.0% 0.0% 0.4% 4.2% 0.9% 0.02487 Has cement as flooring 0.373 0.483 0.0% 0.2% 7.3% 60.7% 78.5% 29.3% 0.06665 Has carpeted flooring 0.013 0.113 0.0% 0.0% 0.0% 0.4% 4.5% 1.0% 0.02182 Has other type of flooring 0.004 0.063 0.0% 0.0% 0.0% 0.1% 1.3% 0.3% 0.01309 - 95 - Kenya 2003 - ASSET DISTRIBUTION AND WEIGHTS (Cont.) (FACTOR SCORE) Asset Variable Unweighted Wealth Quintiles Factor Low 2nd 3rd 4th High Avg. Score Mean Std. Percentage of Population Devia- tion Has roof made of grass, thatch, or makuti 0.224 0.417 85.6% 27.2% 13.6% 4.1% 0.7% 26.3% -0.05048 Has roof made of tin cans 0.004 0.061 0.4% 0.4% 0.3% 0.1% 0.2% 0.3% -0.00228 Has roof made of corrugated iron 0.666 0.472 9.1% 68.6% 83.5% 94.0% 68.9% 64.8% 0.00702 Has roof made of asbestos sheets 0.016 0.125 0.0% 0.0% 0.3% 1.1% 4.3% 1.1% 0.01918 Has roof made of concrete 0.043 0.203 0.0% 0.0% 0.0% 0.2% 14.4% 2.9% 0.04444 Has roof made of tile 0.031 0.173 0.0% 0.0% 0.0% 0.0% 10.6% 2.1% 0.04372 Has roof made of other roofing materials 0.015 0.123 4.9% 3.8% 2.1% 0.1% 0.6% 2.3% -0.00959 Uses electricity for cooking 0.005 0.073 0.0% 0.0% 0.0% 0.0% 1.5% 0.3% 0.01765 Uses LPG, natural gas, or biogas for cooking 0.054 0.226 0.0% 0.0% 0.0% 0.2% 17.8% 3.6% 0.05788 Uses kerosene for cooking 0.176 0.381 0.0% 0.0% 0.2% 2.2% 37.8% 8.0% 0.05543 Uses charcoal, lignite, or coal for cooking 0.147 0.354 0.0% 1.5% 9.3% 18.1% 33.2% 12.4% 0.02058 Uses wood, straw, or dung for cooking 0.610 0.488 100.0% 98.5% 90.5% 79.1% 8.7% 75.3% -0.08877 Uses other fuel for cooking 0.006 0.078 0.0% 0.0% 0.0% 0.1% 1.0% 0.2% 0.00639 Waste collected regularly by the government 0.012 0.107 0.0% 0.0% 0.1% 0.2% 3.6% 0.8% 0.01788 Waste collected irregularly by the government 0.009 0.094 0.0% 0.0% 0.0% 0.0% 2.5% 0.5% 0.01535 Waste collected by a private company 0.085 0.279 0.0% 0.0% 0.1% 0.2% 26.2% 5.3% 0.06679 Waste composted 0.244 0.430 14.3% 28.1% 37.1% 35.3% 15.5% 26.1% -0.01428 Waste dumped, buried, or burned in compound or yard 0.459 0.498 66.8% 58.1% 50.0% 50.9% 29.1% 51.0% -0.03313 Waste dumped in street or empty plot 0.141 0.348 14.7% 8.8% 5.7% 6.6% 18.2% 10.8% 0.00371 Waste disposed some other way 0.046 0.210 3.9% 4.9% 6.6% 6.4% 4.6% 5.3% -0.00296 Number of members per sleeping room 2.593 1.727 4.6 3.1 2.8 2.5 2.8 3.2 -0.02709 - 96 - PART VI. SUPPORTING TABLES, 1998 A. SAMPLE SIZES B. STANDARD ERRORS C. ASSET DISTRIBUTION AND WEIGHTS Kenya 1998 - SAMPLE SIZES TOTAL SAMPLE Indicator Wealth Quintiles Pop. Low 2nd 3rd 4th High Total Number of household members All 7,226 6,916 7,418 7,181 7,175 35,916 Urban 63 214 553 1,363 4,447 6,641 Rural 7,163 6,702 6,865 5,818 2,727 29,275 Female 3,703 3,628 3,792 3,590 3,508 18,221 Male 3,520 3,286 3,624 3,588 3,666 17,684 Part I: HNP STATUS Indicator Wealth Quintiles Pop. Low 2nd 3rd 4th High Total Mortality rates All 2,786 2,369 2,019 1,994 1,829 10,996 Urban 20 84 186 432 1,158 1,880 Rural 2,765 2,285 1,833 1,562 671 9,117 Female 1,324 1,209 996 974 909 5,411 Male 1,462 1,160 1,023 1,020 920 5,586 Prevalence of fever, diarrhea, acute respiratory infection 782 663 606 581 573 3,205 All 7 31 61 137 364 600 Urban 775 632 545 444 209 2,605 Rural 374 336 288 278 297 1,573 Female 409 327 318 303 276 1,633 Male Total fertility rate All 4,011 4,117 4,088 4,239 5,443 21,898 Urban 37 170 384 930 3,710 5,231 Rural 3,974 3,947 3,704 3,309 1,732 16,666 Age-specific fertility rate 15-19 All 866 1,049 984 1,006 1,385 5,289 Urban 6 59 117 209 986 1,377 Rural 860 989 867 797 399 3,912 Children's nutritional status All 1,076 947 844 800 746 4,413 Urban 10 35 67 182 457 751 Rural 1,066 913 777 618 289 3,663 Female 518 481 414 383 371 2,167 Male 558 467 430 417 375 2,247 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 - 99 - Kenya 1998 - SAMPLE SIZES Part I: HNP STATUS (Cont.) Indicator Wealth Quintiles Pop. Low 2nd 3rd 4th High Total Women's nutritional status All 685 640 596 584 601 3,106 Urban 6 23 60 146 392 627 Rural 678 617 536 439 209 2,479 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 960 925 855 864 936 4,539 Urban 8 34 73 176 596 888 Rural 951 891 782 688 339 3,651 Women's circumcision All 1,452 1,491 1,480 1,526 1,931 7,881 Urban 14 57 141 319 1,299 1,830 Rural 1,438 1,434 1,340 1,207 632 6,051 Prevalence of genital discharge, ulcer, sore Female 1,265 1,261 1,250 1,300 1,563 6,639 Urban Female 11 55 125 304 1,070 1,565 Rural Female 1,254 1,206 1,124 996 493 5,073 Male 441 501 510 698 821 2,971 Urban Male 5 25 67 225 523 845 Rural Male 436 476 443 473 298 2,126 - 100 - Kenya 1998 - 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 258 250 209 191 189 1,097 Urban 3 14 20 43 130 210 Rural 255 236 189 149 59 888 Female 127 117 102 98 105 549 Male 130 133 108 94 84 549 Treatment of fever All 356 287 259 237 218 1,356 Urban 2 12 31 65 140 250 Rural 353 275 229 171 78 1,106 Female 186 139 136 122 109 692 Male 170 148 123 114 108 663 Treatment of acute respiratory infection All 181 139 117 120 87 644 Urban 0 4 14 37 49 104 Rural 180 135 103 83 38 539 Female 93 63 50 57 49 312 Male 88 76 67 63 38 332 Treatment of diarrhea All 152 124 108 90 75 549 Urban 2 7 21 26 46 102 Rural 150 117 87 63 29 446 Female 61 63 60 36 38 258 Male 90 61 48 54 37 290 Antenatal and delivery care All 732 639 569 544 523 3,007 Urban 7 30 55 119 340 551 Rural 726 610 514 425 183 2,458 Contraceptive prevalence Female 1,020 955 902 916 1,041 4,834 Urban Female 8 36 76 205 685 1,010 Rural Female 1,012 919 825 711 356 3,823 Male 315 316 291 384 486 1,791 Urban Male 4 15 44 153 314 530 Rural Male 311 300 247 231 172 1,261 Contraceptive source Female 128 230 277 364 522 1,521 Urban Female 0 8 13 67 326 414 Rural Female 128 222 264 296 196 1,107 Male 315 316 291 384 486 1,791 Urban Male 4 15 44 153 314 530 Rural Male 311 300 247 231 172 1,261 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 - 101 - Kenya 1998 - 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 91 61 61 68 71 352 Urban 0 5 5 17 41 68 Rural 90 56 57 51 30 284 Female 50 32 38 43 34 197 Male 41 29 23 25 36 154 Timely complementary breastfeeding All 79 79 74 77 68 377 Urban 0 3 13 19 50 85 Rural 78 76 61 58 19 292 Female 38 37 39 40 38 192 Male 41 42 35 38 30 186 Bottle-feeding All 252 207 208 203 217 1,087 Urban 3 9 20 54 138 224 Rural 249 198 187 149 79 862 Female 128 96 118 106 117 565 Male 124 112 90 97 100 523 - 102 - Kenya 1998 - 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 na na na na na na Urban na na na na na na Rural na na na na na na Vitamin A supplementation 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 Tobacco and alcohol use, casual sexual partners, condom use for casual sex Female 1,452 1,491 1,480 1,526 1,931 7,880 Urban Female 14 57 141 319 1,299 1,830 Rural Female 1,438 1,434 1,340 1,207 632 6,051 Male 507 572 615 805 907 3,406 Urban Male 5 26 69 244 570 914 Rural Male 502 546 546 562 337 2,493 Domestic violence All na na na na na na Urban na na na na na na Rural na na na na na na - 103 - Kenya 1998 - SAMPLE SIZES Part IV: UNDERLYING DETERMINANTS OF HNP STATUS Indicator Wealth Quintiles Pop. Low 2nd 3rd 4th High Total School completion (Grade 5) Female 1,470 1,502 1,514 1,541 1,937 7,965 Urban female 13 50 139 322 1,304 1,828 Rural female 1,457 1,452 1,375 1,219 633 6,136 Male 1,196 1,236 1,435 1,610 2,032 7,509 Urban male 9 51 164 463 1,330 2,016 Rural male 1,187 1,185 1,271 1,147 702 5,493 School participation Female 668 602 571 550 424 2,815 Urban female 5 23 33 70 237 367 Rural female 663 579 538 480 187 2,447 Male 723 626 600 558 470 2,977 Urban male 7 17 27 68 293 412 Rural male 715 609 573 490 177 2,565 Mass media exposure Female 1,452 1,491 1,480 1,526 1,931 7,881 Urban female 14 57 141 319 1,299 1,830 Rural female 1,438 1,434 1,340 1,207 632 6,051 Male 507 572 615 805 907 3,407 Urban male 5 26 69 244 570 913 Rural male 502 546 546 562 337 2,494 Knowledge of HIV/AIDS prevention Female 2,972 1,491 1,480 1,526 1,931 9,400 Urban female 14 57 141 319 1,299 1,830 Rural female 1,438 1,434 1,340 1,207 632 6,051 Male 507 572 615 805 907 3,407 Urban male 5 26 69 244 570 914 Rural male 502 546 546 562 337 2,493 Household decisionmaking and justification of violence 1,452 1,491 1,480 1,526 1,931 7,881 All 14 57 141 319 1,299 1,830 Urban 1,438 1,434 1,340 1,207 632 6,051 Rural Orphanhood All 3,842 3,472 3,382 3,164 2,665 16,524 Urban 34 102 205 478 1,557 2,377 Rural 3,808 3,370 3,176 2,686 1,107 14,147 Female 1,843 1,758 1,633 1,594 1,334 8,162 Male 1,996 1,713 1,745 1,568 1,330 8,352 - 104 - Kenya 1998 - STANDARD ERRORS OF QUINTILE ESTIMATES FOR TOTAL POPULATION Part I: HNP STATUS Indicator Wealth Quintiles Low 2nd 3rd 4th High Avg. A. Childhood illness and mortality Infant mortality rate 9.86 7.49 6.35 7.33 6.22 4.28 Under-five mortality rate 12.55 11.18 8.45 8.54 7.51 5.79 Prevalence of fever 2.26 2.26 2.27 2.24 2.78 1.13 Prevalence of diarrhea 1.61 1.71 1.98 1.84 1.81 0.78 Prevalence of acute respiratory infection 2.10 1.84 1.72 2.21 1.97 0.91 B. Fertility Total fertility rate 0.21 0.22 0.17 0.18 0.16 0.11 Adolescent fertility rate 18.00 12.00 10.00 11.00 9.00 6.00 C. Nutritional status Children: Moderate stunting 1.62 1.62 1.48 1.77 1.41 0.76 Severe stunting 1.45 1.48 1.25 1.16 1.16 0.64 Moderate underweight 1.63 1.52 1.48 1.52 1.15 0.73 Severe underweight 0.92 0.99 0.77 0.76 0.54 0.41 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 1.99 1.56 1.59 1.28 1.09 0.74 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 1.45 1.46 1.43 1.24 1.21 0.65 Women 2.49 1.97 1.96 1.92 1.75 1.13 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 0.40 0.34 0.33 0.21 0.38 0.15 Men 0.87 1.00 1.09 0.82 0.74 0.38 Prevalence of genital ulcer: Women 0.20 0.24 0.28 0.19 0.22 0.10 Men 0.84 0.81 0.89 0.68 0.46 0.31 - 105 - Kenya 1998 - STANDARD ERRORS OF QUINTILE ESTIMATES FOR TOTAL POPULATION Part II: Intermediate Determinants of HNP Status - HNP SERVICE USE Indicator Wealth Quintiles Low 2nd 3rd 4th High Avg. A. Childhood immunization BCG coverage 1.75 1.70 0.95 1.29 0.91 0.65 Measles coverage 3.56 3.02 2.74 2.99 2.69 1.39 DPT coverage 3.81 2.58 2.67 2.86 3.08 1.54 Full basic coverage 3.96 3.42 3.52 3.83 4.46 1.81 No basic coverage 1.53 1.19 0.87 1.29 0.91 0.55 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 3.10 3.29 3.66 3.57 3.48 1.47 Treatment in a public facility 3.10 3.29 3.90 3.83 4.04 1.68 Treatment in a private facility 2.34 3.30 3.08 3.24 3.78 1.41 Treatment of acute respiratory infection (ARI): Medical treatment of ARI 4.03 4.67 4.62 6.22 6.40 2.20 Treatment in a public facility 3.88 4.24 4.34 5.36 7.86 2.07 Treatment in a private facility 3.61 3.83 3.99 4.29 6.99 1.99 Treatment of diarrhea: Use of oral rehydration therapy 4.15 3.39 4.62 4.50 4.71 2.08 Medical treatment of diarrhea 4.23 4.85 5.26 5.96 7.13 2.52 Treatment in a public facility 3.92 4.57 4.68 5.99 5.31 2.25 Treatment in a private facility 3.47 4.53 3.71 5.08 5.56 2.01 C. Antenatal and delivery care Antenatal care (ANC) visits: To a medically-trained person 1.25 1.50 1.59 1.27 1.21 0.65 To a doctor 1.71 1.74 2.15 2.29 2.73 1.00 To a nurse or trained midwife 2.04 1.95 2.18 2.58 2.72 1.13 Multiple visits to a medically-trained person 1.65 1.69 1.87 1.69 1.98 0.83 Antenatal care content: Tetanus toxoid 1.56 1.33 1.48 1.31 1.52 0.68 Prophylactic antimalarial treatment na na na na na na Iron supplementation na na na na na na Delivery attendance: By a medically-trained person 2.02 1.81 2.30 2.66 2.34 1.20 By a doctor 1.05 1.14 1.46 1.66 2.33 0.73 By a nurse or trained midwife 1.69 1.59 2.04 2.23 2.80 0.95 In a public facility 1.75 1.69 2.32 2.41 2.87 1.06 In a private facility 0.89 0.95 1.23 1.66 2.62 0.76 At home 1.96 1.78 2.45 2.65 2.39 1.24 D. Contraceptive services Contraceptive prevalence: Women 1.32 1.74 1.83 2.06 1.94 0.93 Men 2.54 2.55 3.25 3.11 2.74 1.45 Source of contraception - public sector: Women 4.57 3.26 2.99 3.11 3.29 1.76 Men na na na na na na - 106 - Kenya 1998 - STANDARD ERRORS OF QUINTILE ESTIMATES FOR TOTAL POPULATION Part II: Intermediate Determinants of HNP Status - HNP SERVICE USE (Cont.) Indicator Wealth Quintiles Low 2nd 3rd 4th High Avg. D. Contraceptive services (cont.) Source of contraception - private sector: Women 4.32 3.03 3.02 3.09 3.09 1.71 Men na na na na na na E. Treatment of adult illnesses Treatment of genital discharge, ulcer, sore: Women * 6.31 8.13 * * 3.23 Men * 8.39 8.31 6.24 9.43 3.62 Treatment of genital discharge, ulcer, sore in public facilities: Women 0.40 0.34 0.33 0.21 0.38 0.15 Men * 1.14 1.21 0.94 0.80 0.43 Voluntary counseling and testing for HIV/AIDS: Women 0.72 0.87 0.88 1.19 1.20 0.50 Men 1.62 1.62 1.69 1.46 1.89 0.79 - 107 - Kenya 1998 - STANDARD ERRORS OF QUINTILE ESTIMATES FOR TOTAL POPULATION Part III: Intermediate Determinants of HNP Status - INDIVIDUAL AND HOUSEHOLD BEHAVIOR Indicator Wealth Quintiles 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 4.36 5.55 5.84 4.43 5.65 2.26 Timely complementary feeding 4.10 2.18 4.45 2.23 4.66 1.65 Bottle-feeding 3.17 2.88 3.56 3.91 3.98 1.62 D. Micronutrient consumption Iodized salt: Availability of iodized salt in household na na na na na na Vitamin A: Children na na na na na na 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 0.39 0.25 0.30 0.22 0.21 0.12 Men 1.84 1.72 2.10 1.75 1.92 0.86 Condom usage with non-regular partner: Women * * * * * 5.80 Men 4.39 4.43 6.64 4.32 4.37 2.37 G. Domestic violence Ever experienced violence na na na na na na Experienced violence in past year na na na na na na - 108 - Kenya 1998 - STANDARD ERRORS OF QUINTILE ESTIMATES FOR TOTAL POPULATION Part IV: UNDERLYING DETERMINANTS OF HNP STATUS Indicator Wealth Quintiles Low 2nd 3rd 4th High Avg. A. Education School completion: Women 1.98 1.37 1.38 1.08 0.76 0.73 Men 1.68 1.20 1.05 1.06 0.79 0.59 School participation: Girls 2.85 1.68 1.63 1.57 1.94 1.01 Boys 2.19 2.02 1.52 1.61 1.70 0.94 B. Exposure to mass media Newspaper readership: Women 1.32 1.31 1.29 1.54 1.48 0.80 Men 2.48 2.52 2.33 2.17 1.63 1.21 Radio listenership: Women 1.95 1.67 1.66 1.44 1.27 0.84 Men 2.87 2.28 1.63 1.68 1.43 0.92 Television viewership: Women 0.96 0.94 0.91 1.22 1.94 0.92 Men 2.11 2.09 2.63 2.20 2.50 1.25 C. Knowledge and attitudes about HIV/AIDS Knowledge about sexual transmission of HIV/AIDS: Women 1.40 0.59 0.54 0.47 0.36 0.35 Men 0.80 0.67 0.55 0.41 0.37 0.25 Knowledge about mother-to-child transmission of HIV/AIDS: Women 1.55 1.08 1.08 0.92 0.92 0.53 Men 1.97 1.86 1.72 1.59 1.31 0.78 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 2.00 2.13 2.11 2.21 1.90 1.08 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 0.76 0.80 0.94 0.81 0.86 0.38 Maternal orphan prevalence 0.31 0.38 0.49 0.49 0.68 0.20 Double orphan prevalence 0.14 0.19 0.25 0.20 0.37 0.11 - 109 - Kenya 1998 - ASSET DISTRIBUTION AND WEIGHTS (FACTOR SCORE) Asset Variable Unweighted Wealth Quintiles Factor Low 2nd 3rd 4th High Avg. Score Mean Std. Percentage of Population Devia- tion Has electricity 0.124 0.329 0.0% 0.2% 0.1% 1.8% 56.7% 11.7% 0.13578 Has radio 0.618 0.486 27.4% 55.3% 75.7% 79.0% 93.9% 66.4% 0.07171 Has television 0.115 0.319 0.0% 0.0% 1.2% 7.5% 60.3% 13.8% 0.12647 Has refrigerator 0.033 0.178 0.0% 0.0% 0.0% 0.0% 18.7% 3.7% 0.11691 Has bicycle 0.248 0.432 15.6% 26.5% 34.7% 35.1% 29.1% 28.3% 0.01143 Has motorcycle 0.008 0.087 0.0% 0.0% 0.1% 0.4% 4.1% 0.9% 0.04382 Has car 0.042 0.200 0.0% 0.0% 0.1% 1.9% 22.9% 5.0% 0.10100 Has telephone 0.023 0.149 0.0% 0.0% 0.0% 0.1% 13.4% 2.7% 0.10408 Has a domestic worker not related to household head 0.013 0.113 0.0% 0.0% 0.0% 0.5% 9.4% 2.0% 0.04947 Works own or family's agricultural land 0.259 0.438 60.0% 48.1% 28.7% 26.3% 8.2% 34.1% -0.05394 Uses water piped into residence 0.209 0.407 0.0% 0.8% 3.4% 27.6% 65.9% 19.5% 0.11241 Uses water from piped public source 0.124 0.330 1.1% 8.0% 12.2% 15.6% 10.0% 9.4% 0.00576 Uses water from an inside well 0.085 0.279 2.9% 8.6% 12.5% 8.5% 7.3% 8.0% -0.00247 Uses water from a river, canal, or surface water 0.374 0.484 71.5% 61.5% 46.6% 26.7% 6.9% 42.5% -0.07490 Uses water from another source 0.021 0.142 0.2% 1.4% 1.7% 3.5% 2.4% 1.8% 0.00361 Uses rainwater for drinking 0.013 0.112 0.1% 0.3% 1.1% 2.0% 2.9% 1.3% 0.01099 Uses water from a public well 0.129 0.336 19.3% 13.2% 15.5% 11.8% 3.8% 12.7% -0.02703 Uses own flush toilet 0.057 0.233 0.0% 0.0% 0.0% 0.6% 32.4% 6.6% 0.12392 Uses shared flush toilet 0.035 0.184 0.0% 0.0% 0.0% 1.0% 14.8% 3.2% 0.04512 Uses pit latrine 0.689 0.463 56.6% 77.2% 87.2% 81.8% 34.9% 67.6% -0.05639 Uses VIP latrine 0.070 0.254 0.0% 0.7% 3.1% 10.3% 16.9% 6.2% 0.02904 Uses bush or field as latrine 0.142 0.349 42.8% 21.7% 9.0% 5.2% 0.8% 15.9% -0.05228 Uses other type of latrine 0.002 0.044 0.2% 0.1% 0.2% 0.2% 0.1% 0.2% -0.00064 Has dirt or earth as principal flooring 0.650 0.477 100.0% 99.9% 98.5% 36.8% 1.4% 67.3% -0.13563 Has wood plank as principal flooring 0.011 0.104 0.0% 0.0% 0.2% 3.4% 0.8% 0.9% 0.00705 Has cement as principal flooring 0.323 0.468 0.0% 0.1% 0.8% 58.4% 90.5% 30.0% 0.12106 Has tile flooring 0.012 0.111 0.0% 0.0% 0.0% 0.3% 7.1% 1.5% 0.06641 Has natural material roofing 0.291 0.454 98.5% 40.8% 5.2% 4.0% 0.3% 29.6% -0.08929 Has other type of flooring 0.000 0.015 0.0% 0.0% 0.0% 0.0% 0.2% 0.0% 0.00361 Has roof made of corrugated iron 0.673 0.469 1.5% 59.2% 93.1% 94.2% 83.1% 66.4% 0.05028 Has roof made of tile 0.026 0.158 0.0% 0.0% 0.0% 0.1% 14.3% 2.9% 0.09478 Has roof made of other material 0.007 0.081 0.0% 0.0% 1.3% 0.8% 1.9% 0.8% 0.02250 Number of members per sleeping room 2.592 1.893 4.6 3.6 2.7 2.6 2.5 3.2 -0.04781 - 111 - PART VII. SUPPORTING TABLES, 1993 A. SAMPLE SIZES B. STANDARD ERRORS C. ASSET DISTRIBUTION AND WEIGHTS Kenya 1993 - SAMPLE SIZES TOTAL SAMPLE Indicator Wealth Quintiles Pop. Low 2nd 3rd 4th High Total Number of household members All 7,728 7,468 7,694 7,597 7,609 38,096 Urban 0 162 406 775 3,785 5,127 Rural 7,728 7,306 7,288 6,822 3,824 32,969 Female 4,102 3,963 4,049 3,879 3,780 19,773 Male 3,626 3,505 3,645 3,718 3,829 18,323 Part I: HNP STATUS Indicator Wealth Quintiles Pop. Low 2nd 3rd 4th High Total Mortality rates All 2,834 2,631 2,471 2,400 2,120 12,455 Urban 0 46 128 272 1,062 1,508 Rural 2,834 2,585 2,343 2,128 1,058 10,947 Female 1,449 1,332 1,251 1,200 1,077 6,309 Male 1,385 1,299 1,220 1,200 1,042 6,146 Prevalence of fever, diarrhea, acute respiratory infection All 1,251 1,175 1,116 1,115 960 5,617 Urban 16 56 141 507 na 721 Rural 1,251 1,159 1,060 974 453 4,897 Female 651 575 568 527 496 2,817 Male 600 599 549 589 464 2,800 Total fertility rate All 1,313 1,431 1,462 1,491 1,843 7,540 Urban 0 34 85 180 1,040 1,339 Rural 1,313 1,397 1,377 1,311 803 6,201 Age-specific fertility rate 15-19 All 273 358 369 348 407 1,754 Urban 0 12 11 32 221 275 Rural 273 346 358 316 186 1,479 Children's nutritional status All 1,044 1,035 978 939 768 4,763 Urban 12 40 97 388 na 537 Rural 1,044 1,022 938 842 380 4,226 Female 536 508 501 442 400 2,386 Male 508 527 476 497 368 2,377 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 - 115 - Kenya 1993 - SAMPLE SIZES Part I: HNP STATUS (Cont.) Indicator Wealth Quintiles Pop. Low 2nd 3rd 4th High Total Women's nutritional status All 801 799 741 742 722 3,805 Urban 14 32 92 384 na 523 Rural 801 784 709 650 337 3,282 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 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 - 116 - Kenya 1993 - 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 247 219 227 210 220 1,124 Urban 5 14 34 124 na 177 Rural 247 214 214 177 95 947 Female 125 105 104 98 113 545 Male 122 114 124 113 107 580 Treatment of fever All 553 525 448 437 378 2,340 Urban 5 19 57 199 na 280 Rural 553 520 428 380 179 2,061 Female 274 249 234 197 195 1,150 Male 279 276 213 240 182 1,190 Treatment of acute respiratory infection All 73 82 66 91 60 372 Urban 1 4 8 26 na 39 Rural 73 81 61 84 34 333 Female 46 38 31 39 31 185 Male 26 44 34 52 29 186 Treatment of diarrhea All 102 124 96 87 63 472 Urban 1 3 20 25 na 49 Rural 102 124 92 67 38 423 Female 61 64 38 36 30 228 Male 42 61 58 51 32 244 Antenatal and delivery care All 1,403 1,308 1,203 1,188 1,027 6,128 Urban 19 68 151 542 na 780 Rural 1,403 1,289 1,134 1,037 485 5,348 Contraceptive prevalence Female 912 961 871 909 975 4,629 Urban Female 20 48 104 525 na 697 Rural Female 912 941 823 805 450 3,932 Male 300 298 272 315 479 1,664 Urban Male 10 27 56 301 na 393 Rural Male 300 289 245 259 178 1,271 Contraceptive source Female 94 151 238 341 440 1,264 Urban Female 1 5 30 229 na 264 Rural Female 94 150 233 311 211 999 Male na na na na na na Urban Male na na na na na na Rural Male na na na na na na 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 - 117 - Kenya 1993 - 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 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 Timely complementary breastfeeding 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 Bottle-feeding All 264 241 215 211 166 1,097 Urban 1 10 25 82 na 117 Rural 264 240 205 186 84 979 Female 151 117 107 109 91 575 Male 114 123 108 102 75 521 - 118 - Kenya 1993 - 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 na na na na na na Urban na na na na na na Rural na na na na na na Vitamin A supplementation All 643 602 546 551 440 2,780 Urban 7 26 59 221 na 314 Rural 643 595 519 491 219 2,467 Female 326 285 282 249 231 1,373 Male 317 317 264 302 209 1,407 Tobacco and alcohol use, casual sexual partners, condom use for casual sex 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 Domestic violence All na na na na na na Urban na na na na na na Rural na na na na na na - 119 - Kenya 1993 - SAMPLE SIZES Part IV: UNDERLYING DETERMINANTS OF HNP STATUS Indicator Wealth Quintiles Pop. Low 2nd 3rd 4th High Total School completion (Grade 5) Female 1,440 1,564 1,585 1,601 2,014 8,203 Urban female 36 92 192 1,132 na 1,453 Rural female 1,440 1,528 1,493 1,409 882 6,751 Male 1,179 1,314 1,408 1,545 2,066 7,511 Urban male 45 137 246 1,198 na 1,626 Rural male 1,179 1,269 1,271 1,299 867 5,886 School participation Female 819 752 781 681 560 3,593 Urban female 20 29 48 239 na 335 Rural female 819 732 752 633 321 3,258 Male 767 615 697 698 549 3,325 Urban male 11 28 48 215 na 303 Rural male 767 604 668 650 333 3,023 Mass media exposure Female 1,313 1,431 1,462 1,491 1,843 7,540 Urban female 34 85 180 1,040 na 1,339 Rural female 1,313 1,397 1,377 1,311 803 6,201 Male na na na na na na Urban male na na na na na na Rural male na na na na na na Knowledge of HIV/AIDS prevention Female na na na na na na Urban female na na na na na na Rural female na na na na na na Male 389 391 417 442 697 2,336 Urban male 17 39 80 430 na 566 Rural male 389 374 378 362 267 1,770 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 4,226 3,860 3,925 3,733 3,190 18,933 Urban 67 150 290 1,400 na 1,907 Rural 4,226 3,792 3,775 3,443 1,790 17,026 Female 2,195 1,992 2,004 1,885 1,660 9,736 Male 2,031 1,868 1,920 1,847 1,530 9,197 - 120 - Kenya 1993 - STANDARD ERRORS OF QUINTILE ESTIMATES FOR TOTAL POPULATION Part I: HNP STATUS Indicator Wealth Quintiles Low 2nd 3rd 4th High Avg. A. Childhood illness and mortality Infant mortality rate 8.09 7.10 5.64 5.04 5.76 3.52 Under-five mortality rate 9.82 8.18 7.64 6.17 6.65 4.44 Prevalence of fever 2.19 2.13 2.13 2.19 2.11 1.10 Prevalence of diarrhea 0.85 1.03 0.91 1.05 1.07 0.46 Prevalence of acute respiratory infection 0.81 0.87 0.74 0.94 0.99 0.43 B. Fertility Total fertility rate 0.23 0.26 0.22 0.28 0.16 0.13 Adolescent fertility rate 13.61 11.06 11.14 11.96 8.56 5.56 C. Nutritional status Children: Moderate stunting 1.61 1.67 1.36 1.75 1.38 0.75 Severe stunting 1.50 1.35 1.08 1.38 1.03 0.64 Moderate underweight 1.27 1.36 1.22 1.46 1.47 0.65 Severe underweight 1.28 0.90 0.82 0.68 0.70 0.45 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 1.67 1.23 1.26 1.16 0.92 0.64 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 na na na na na na Men na na na na na na Prevalence of genital ulcer: Women na na na na na na Men na na na na na na - 121 - Kenya 1993 - STANDARD ERRORS OF QUINTILE ESTIMATES FOR TOTAL POPULATION Part II: Intermediate Determinants of HNP Status - HNP SERVICE USE Indicator Wealth Quintiles Low 2nd 3rd 4th High Avg. A. Childhood immunization BCG coverage 2.01 1.83 1.60 0.91 0.74 0.77 Measles coverage 4.31 2.30 3.01 2.44 2.40 1.53 DPT coverage 3.48 2.65 2.49 2.15 1.83 1.27 Full basic coverage 4.20 3.10 3.22 2.71 2.87 1.61 No basic coverage 1.80 1.56 1.60 0.91 0.74 0.70 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 2.84 2.77 3.06 3.51 3.30 1.55 Treatment in a public facility 2.64 2.92 2.73 3.42 3.14 1.52 Treatment in a private facility 1.67 1.63 2.10 2.19 3.19 1.09 Treatment of acute respiratory infection (ARI): Medical treatment of ARI 7.59 5.85 6.66 6.03 8.02 3.07 Treatment in a public facility 7.58 6.24 6.41 6.24 8.23 3.29 Treatment in a private facility 4.82 5.36 4.00 3.24 5.38 2.14 Treatment of diarrhea: Use of oral rehydration therapy 6.30 5.33 5.95 6.50 6.58 2.82 Medical treatment of diarrhea 4.97 5.33 5.89 6.68 7.55 2.71 Treatment in a public facility 4.61 5.41 5.30 6.29 6.53 2.57 Treatment in a private facility 2.90 3.42 5.02 2.77 6.34 1.93 C. Antenatal and delivery care Antenatal care (ANC) visits: To a medically-trained person 1.76 0.73 0.75 0.79 0.61 0.53 To a doctor 1.74 1.77 1.90 1.63 1.90 0.91 To a nurse or trained midwife 2.21 1.86 1.86 1.83 1.89 1.00 Multiple visits to a medically-trained person 2.13 1.37 1.64 1.49 1.41 0.80 Antenatal care content: Tetanus toxoid 1.94 1.22 1.19 1.13 1.32 0.69 Prophylactic antimalarial treatment na na na na na na Iron supplementation na na na na na na Delivery attendance: By a medically-trained person 1.61 1.93 2.30 2.72 2.18 1.50 By a doctor 0.77 1.10 1.27 1.41 1.74 0.62 By a nurse or trained midwife 1.37 1.58 2.16 2.50 2.69 1.27 In a public facility 1.44 1.74 2.30 2.49 2.30 1.28 In a private facility 0.88 0.93 1.30 1.84 2.00 0.79 At home 1.57 2.02 2.34 2.67 2.17 1.49 D. Contraceptive services Contraceptive prevalence: Women 1.31 1.45 1.86 2.53 1.88 1.26 Men 1.83 2.78 3.14 3.38 2.88 1.61 Source of contraception - public sector: Women 4.89 3.36 3.00 3.06 2.87 1.87 Men na na na na na na - 122 - Kenya 1993 - STANDARD ERRORS OF QUINTILE ESTIMATES FOR TOTAL POPULATION Part II: Intermediate Determinants of HNP Status - HNP SERVICE USE (Cont.) Indicator Wealth Quintiles Low 2nd 3rd 4th High Avg. D. Contraceptive services (cont.) Source of contraception - private sector: Women 4.25 2.99 3.20 2.55 2.65 1.71 Men na na na na na na E. Treatment of adult illnesses Treatment of genital discharge, ulcer, sore: Women na na na na na na Men na na na na na na 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 - 123 - Kenya 1993 - STANDARD ERRORS OF QUINTILE ESTIMATES FOR TOTAL POPULATION Part III: Intermediate Determinants of HNP Status - INDIVIDUAL AND HOUSEHOLD BEHAVIOR Indicator Wealth Quintiles 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 na na na na na na Timely complementary feeding na na na na na na Bottle-feeding 3.14 1.70 2.47 2.27 3.46 1.27 D. Micronutrient consumption Iodized salt: Availability of iodized salt in household na na na na na na Vitamin A: Children 2.39 2.73 2.56 2.67 3.02 1.20 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 na na na na na na Men na na na na na na Condom usage with non-regular partner: Women na na na na na na Men na na na na na na G. Domestic violence Ever experienced violence na na na na na na Experienced violence in past year na na na na na na - 124 - Kenya 1993 - STANDARD ERRORS OF QUINTILE ESTIMATES FOR TOTAL POPULATION Part IV: UNDERLYING DETERMINANTS OF HNP STATUS Indicator Wealth Quintiles Low 2nd 3rd 4th High Avg. A. Education School completion: Women 2.36 1.88 1.48 1.47 1.19 1.13 Men 2.00 1.71 1.24 1.14 0.95 0.76 School participation: Girls 2.59 2.25 1.83 2.00 2.09 1.26 Boys 2.62 2.15 2.12 2.00 2.05 1.15 B. Exposure to mass media Newspaper readership: Women 1.45 1.40 1.51 1.70 1.99 1.23 Men 3.26 3.09 2.90 2.37 2.14 1.71 Radio listenership: Women 1.79 2.03 1.79 1.71 1.15 1.10 Men na na na na na na Television viewership: Women 0.53 0.51 0.87 1.04 2.83 1.25 Men 1.86 2.15 2.37 2.93 3.27 1.83 C. Knowledge and attitudes about HIV/AIDS Knowledge about sexual transmission of HIV/AIDS: Women na na na na na na Men 3.15 3.32 2.69 2.73 2.64 1.43 Knowledge about mother-to-child transmission of HIV/AIDS: Women na na na na na na Men na na na na na na 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 na na na na na na 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 0.89 0.66 0.70 0.65 0.62 0.33 Maternal orphan prevalence 0.44 0.31 0.25 0.38 0.35 0.15 Double orphan prevalence 0.12 0.08 0.07 0.11 0.17 0.05 - 125 - Kenya 1993 - ASSET DISTRIBUTION AND WEIGHTS (FACTOR SCORE) This information is not available for the Kenya 1993 survey. - 127 - PART VIII. 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. - 131 - 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. - 132 - 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: 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. - 133 - · 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. · 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. 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). - 134 - · 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 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. - 135 - Kenya 2003 - ASSET QUESTIONNAIRE Question Score if Score if Item "Yes" "No" Score 1. In your household, is/are there? Electricity 0.17523 -0.04403 One or more radios 0.01944 -0.05233 One or more televisions 0.12848 -0.03559 One or more refrigerators 0.23767 -0.01591 One or more bicycles -0.01757 0.00636 One or more motorcycles, scooters 0.07563 -0.00062 One or more cars, trucks 0.18031 -0.01166 One or more telephones 0.16538 -0.03170 Solar power 0.02363 -0.00075 2. Does your household have a domestic worker not related to head? 0.18873 -0.00570 3. Do the members of your household work their own or family's agricultural land? -0.00414 0.01263 4. What is the principal source of drinking water for your household? Piped water in residence 0.17860 -0.01987 Piped water in compound, plot 0.08701 -0.01452 Piped water in public tap 0.02992 -0.00417 Open well in residence, yard -0.01613 0.00032 Open public well -0.06570 0.00413 Protected well in residence, yard -0.00425 0.00021 Protected public well -0.04320 0.00255 Springwater -0.06823 0.00850 River, stream, pond, lake, dam -0.07895 0.02786 Rainwater -0.02754 0.00066 Bottled water 0.27232 -0.00086 Other 0.01468 -0.00084 5. What is the principal source of cooking fuel in your household? Electricity 0.24009 -0.00130 LPG, natural gas, biogas 0.24206 -0.01384 Kerosene 0.11993 -0.02562 Charcoal, lignite, coal 0.04950 -0.00855 Wood, straw, dung -0.07099 0.11097 Other 0.08091 -0.00050 6. What is the principal type of toilet facility used by your household? Private flush toilet 0.23046 -0.02084 Shared flush toilet 0.15894 -0.01030 Private pit latrine -0.05722 0.02376 Shared pit latrine 0.00137 -0.00061 Private VIP latrine -0.00220 0.00008 Shared VIP latrine 0.07472 -0.00331 Bush, field as latrine -0.09329 0.01894 Other 0.03174 -0.00020 - 137 - Kenya 2003 - ASSET QUESTIONNAIRE (Cont.) Question Score if Score if Item "Yes" "No" Score 7. What is the principal material used for the floors in your household? Earth, mud, dung, sand -0.07302 0.10038 Wood plank 0.15402 -0.00096 Parquet, polished wood 0.29562 -0.00205 Linoleum 0.19832 -0.00117 Tile 0.23230 -0.00266 Cement 0.08650 -0.05135 Carpet 0.19124 -0.00249 Other 0.20730 -0.00083 8. What is the principal material used for the roof of your household? Grass, thatch, makuti -0.09397 0.02711 Tin cans -0.03719 0.00014 Corrugated iron 0.00498 -0.00990 Asbestos sheets 0.15155 -0.00243 Concrete 0.20936 -0.00943 Tile 0.24462 -0.00781 Other -0.07690 0.00119 9. What is the principal means of waste disposal in your household? Collected regularly by the government 0.16531 -0.00193 Collected irregularly by the government 0.16113 -0.00146 Collected by a private company 0.21875 -0.02039 Composted -0.02512 0.00812 Dumped, buried, burned in compound, yard -0.03595 0.03052 Dumped in street, empty plot 0.00917 -0.00150 Other -0.01343 0.00065 10. What type of tenant is your household? Owns -0.05836 0.11393 Rents 0.13074 -0.05099 Lives rent-free with owner's consent 0.04341 -0.00230 Squats -0.05164 0.00033 11. What type of tenant is your household regarding the land that you are living on? Owns -0.06162 0.09010 Rents 0.12611 -0.03465 Lives rent-free land with owner's consent 0.06120 -0.01279 Squats -0.07299 0.00120 12. How many people are there for each sleeping room in your household? # people- 2.59×0.025 1.73 Total Household Asset Score (sum of individual item scores) - 138 - Kenya 2003 - QUINTILE CUT-0FF POINTS Asset Index Value Wealth Quintile Bottom Cut-Off Top Cut-Off Low Low -0.86520 Second -0.86520 -0.73291 Third -0.73291 -0.44955 Fourth -0.44955 0.32185 High 0.32185 High - 139 - 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 - 141 -