39456 SOCIO-ECONOMIC DIFFERENCES IN HEALTH, NUTRITION, AND POPULATION NICARAGUA 1997/98, 2001 Davidson R. Gwatkin, Shea Rutstein, Kiersten Johnson, Eldaw Suliman, Adam Wagstaff, and Agbessi Amouzou TABLE OF CONTENTS Foreword I Introduction III Part I. Basic Tables, 2001 1 A. Total Population 3 B. Female and Male Populations 9 C. Rural and Urban Populations 13 Part II. Basic Tables, 1997 / 98 19 A. Total Population 21 B. Female and Male Populations 27 C. Rural and Urban Populations 31 Part III. Technical Notes 37 A. Indicator Definitions 39 B. Data and Methods 53 C. Discussion 57 Part IV. Supporting Tables, 2001 63 A. Sample Sizes 65 B. Standard Errors 71 C. Asset Distribution and Weights 77 Part V. Supporting Tables, 1997 / 98 81 A. Sample Sizes 83 B. Standard Errors 89 C. Asset Distribution and Weights 95 Part VI. Annexes 97 A. Sources of Additional Information 99 B. Use of Information from this 101 Report to Monitor the Economic Status of People Served by HNP Programs C. Countries Covered by the 109 HNP-Poverty Report Project FOREWORD The World Bank shares the desire of its member states and client countries to ensure that the poor partake fully in the health gains that the countries achieve. To assist in this, the Bank, in cooperation with the Dutch and Swedish Governments, has sponsored the set of reports providing basic information about health inequalities within countries to which this document belongs. The information shows clearly that disparities in both health conditions and health service use are unacceptably large. As countries and the Bank work to reduce important inequalities among regions and countries, there is a clear need for equally vigorous efforts to lessen the inequity represented by intra-country differences among socio-economic groups. My colleagues and I hope that all concerned with equity in health will find this information useful in making the case for effective actions to improve the health of the poor, and in designing programs to achieve this crucial objective. Joy Phumaphi Vice President Human Development Network The World Bank - I - INTRODUCTION This report is one in a series that provides basic information about health, nutrition, and population (hnp) inequalities within fifty-six developing countries. The series to which the report belongs is an expanded and updated version of a set covering forty- five countries that was published in 2000. The fifty-six reports in the current series cover almost all DHS surveys undertaken during the period beginning in 1990 and ending with the date of the last survey for which data were publicly available as of June 2006.1 The report's contents are intended to facilitate preparation of country analyses and the development of activities to benefit poor people. To this end, the report presents data about hnp status, service use, and related matters among individuals belonging to different socio-economic classes. The principal focus is on differences among groups of individuals defined in terms of the wealth or assets of the households where they reside. The source of data is the Demographic and Health Survey (DHS) program, a large, multi-country household survey project. The figures in this and the other reports in the series draw on responses to questions about household wealth or assets included in the DHS questionnaire, which were similar for all the surveys covered. These responses served as the basis for the construction of a wealth index, which was used to rank individuals according to the index value for the household to which they belonged. The individuals were then divided into quintiles, and the mean value for each of up to approximately 120 indicators was calculated for each quintile. The report is organized in four principal parts: · Parts one and two, which constitute the report's core, consist of tables presenting quintile-specific data for each hnp indicator covered from the two most recent DHS surveys available at the time of the report's publication. In each part there are three sets of tables: the first provides quintile-specific information for the total population; the second presents data separately for quintiles of females and males; the third features quintile-specific information presented separately for rural and urban residents. Each of these sets is divided into four sections: one dealing with hnp status, the second with the use of hnp services, the third with hnp-related behavior, and the fourth with other hnp status determinants. · Part three provides supplementary technical information designed to help readers understand the data presented in parts one and two. This information deals with such issues as how the covered hnp indicators were defined and how the quintile-specific estimates were derived. · Parts four and five present supporting tables that deal with three of the technical matters covered in part three: the size of the sample for each indicator covered; the standard error 1The average interval of approximately two years between data collection and availability means that the latest surveys covered were conducted in 2005. - III - for each quintile-specific estimate in the total population; and the items used in constructing the wealth index, along with the weight assigned to each. An additional, sixth part consists of three annexes, for readers interested in applying the approach used in the report or in learning more about the other reports in this series. The first annex is an annotated bibliography containing further information about the technical issues concerning the approach used in the report, and about employing that approach to examine additional issues using DHS or other data sets. The second shows how the report's approach can be applied to monitor the distribution of benefits from other hnp programs, and provides a tool for doing so. The third annex is a list of all fifty-six countries for which reports are available, along with an indication of how to obtain copies of the reports dealing with them. ********************************* The authors thank the Dutch and Swedish Governments for the generous support that made production of this report possible. - IV - PART I. BASIC TABLES, 2001 A. TOTAL POPULATION B. FEMALE AND MALE POPULATIONS C. RURAL AND URBAN POPULATIONS Notes: ­ Each of the three sections referred to above consists of four divisions, presenting data for: I) hnp status; II) hnp service use; III) hnp-related individual and household behavior; and IV) other, underlying determinants of hnp status. ­ Full definitions of all indicators covered in the tables are provided in section A of the technical notes found in part II. ­ "na" appears in the table cells when data are not available, usually because the DHS survey concerned did not collect information about the indicator(s) in question. ­ Figures in the tables shown within parentheses indicate the absence of adequate observations to produce acceptably reliable values. Asterisks appear when the number of observations was too small to justify the presentation even of figures within parentheses. (For further information, see the section on "Sampling Errors" in the presentation of data and methods in part II.B.) Asterisks also will be found in columns showing statistical indices of inequality when the amount of quintile-specific information available is inadequate to permit computation of the value for the index concerned. ­ Female/male tables include only indicators relevant for both sexes; those pertaining to only one sex (e.g., fertility, women's nutritional status, antenatal care, attended deliveries) have been omitted. Nicaragua 2001 - TOTAL POPULATION Part I: HNP STATUS Indicator Wealth Quintiles Low/High Low-High Concentration Index Ratio Diff. Value Standard Low 2nd 3rd 4th High Avg. (Abs. Val.) Errors A. Childhood illness and mortality Infant mortality rate 49.6 40.6 32.2 25.7 16.3 35.3 3.04 33.30 -0.1825 0.0012 Under-five mortality rate 64.3 52.2 38.6 32.4 19.2 44.6 3.35 45.10 -0.1961 0.0012 Prevalence of fever 26.2 28.0 24.8 22.4 21.1 24.9 1.24 5.10 -0.0504 0.0128 Prevalence of diarrhea 15.4 14.0 13.5 11.8 8.2 13.1 1.88 7.20 -0.0884 0.0187 Prevalence of acute respiratory 34.5 34.4 31.2 26.8 23.4 30.9 1.47 11.10 -0.0664 0.0111 infection (ARI) B. Fertility Total fertility rate 5.6 3.9 3.1 2.4 2.1 3.2 2.67 3.50 -0.1972 0.0005 Adolescent fertility rate 193.0 150.0 122.0 94.0 70.0 119.0 2.76 123.00 -0.1913 0.0011 C. Nutritional status (%) Children: Moderate stunting 22.4 18.4 12.3 5.4 4.1 13.9 5.46 18.30 -0.2798 0.0189 Severe stunting 12.8 7.4 3.3 3.0 0.4 6.2 32.00 12.40 -0.4069 0.0311 Moderate underweight 12.8 9.5 7.2 4.0 2.2 7.9 5.82 10.60 -0.2497 0.0258 Severe underweight 3.2 2.0 1.0 1.2 0.5 1.8 6.40 2.70 -0.3714 0.0626 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 3.4 2.4 3.8 3.5 4.0 3.5 0.85 0.60 0.0179 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 * * * * * * * * * * Women * * * * * * * * * * E. Sexually transmitted disease Prevalence of genital discharge: Women 13.8 12.9 12.9 11.9 10.3 12.2 1.34 3.50 -0.0838 0.0154 Men na na na na na na na na na na Prevalence of genital ulcer: Women 2.9 2.4 2.5 1.3 1.1 1.9 2.64 1.80 -0.2149 0.0414 Men na na na na na na na na na na - 3 - Nicaragua 2001 - TOTAL POPULATION Part II: Intermediate Determinants of HNP Status - HNP SERVICE USE Indicator Wealth Quintiles Low/High Low-High Concentration Index Ratio Diff. Value Standard Low 2nd 3rd 4th High Avg. (Abs. Val.) Errors A. Childhood immunization BCG coverage 92.0 95.3 96.6 97.8 98.7 95.5 0.93 6.70 0.0159 0.0032 Measles coverage 76.2 90.8 91.3 85.9 93.8 86.4 0.81 17.60 0.0397 0.0065 DPT coverage 76.5 86.0 85.2 85.7 82.9 82.7 0.92 6.40 0.0331 0.0074 Full basic coverage 63.6 77.2 78.0 71.4 71.0 71.6 0.90 7.40 0.0439 0.0100 No basic coverage 4.3 2.2 0.6 1.0 1.3 2.2 3.31 3.00 -0.3974 0.1146 Hepatitis B coverage 1.4 0.4 1.3 2.0 8.4 2.3 0.17 7.00 0.2877 0.1196 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 49.2 65.8 68.7 59.5 72.7 61.5 0.68 23.50 0.0775 0.0125 Treatment in a public facility 46.2 59.3 54.4 46.4 35.9 49.6 1.29 10.30 -0.0006 0.0166 Treatment in a private facility 3.0 6.4 12.1 13.2 36.3 11.4 0.08 33.30 0.4183 0.0449 Treatment of acute respiratory infection (ARI): Medical treatment of ARI 45.0 61.1 62.6 59.2 74.5 57.7 0.60 29.50 0.0956 0.0120 Treatment in a public facility 42.4 55.8 47.9 43.6 33.6 45.8 1.26 8.80 0.0016 0.0155 Treatment in a private facility 2.5 5.0 12.0 13.6 40.6 11.0 0.06 38.10 0.4793 0.0429 Treatment of diarrhea: Use of oral rehydration therapy 61.4 71.3 67.2 70.6 77.0 67.7 0.80 15.60 0.0432 0.0143 Medical treatment of diarrhea 37.6 49.2 51.8 41.6 41.9 44.1 0.90 4.30 0.0490 0.0234 Treatment in a public facility 36.9 44.5 39.7 29.1 22.0 36.6 1.68 14.90 -0.0395 0.0264 Treatment in a private facility 0.7 4.8 11.0 11.6 19.9 7.2 0.04 19.20 0.5244 0.0790 C. Antenatal and delivery care Antenatal care visits: To a medically trained person 68.8 85.2 90.8 94.6 96.6 86.2 0.71 27.80 0.0668 0.0038 To a doctor 34.1 49.8 55.5 54.9 41.6 46.8 0.82 7.50 0.0740 0.0091 To a nurse or trained midwife 34.7 35.4 35.4 39.7 55.1 39.4 0.63 20.40 0.0639 0.0104 Multiple visits to a medically trained person 57.7 76.4 83.0 89.6 92.5 78.5 0.62 34.80 0.0940 0.0043 Antenatal care content: Tetanus toxoid 76.7 83.9 86.2 86.8 83.5 83.1 0.92 6.80 0.0218 0.0040 Prophylactic antimalarial treatment na na na na na na na na na na Iron supplementation 62.7 78.4 82.6 84.7 91.4 78.9 0.69 28.70 0.0703 0.0042 Delivery attendance: By a medically trained person 77.5 88.5 95.0 97.2 99.3 89.7 0.78 21.80 0.0567 0.0027 By a doctor 27.1 58.3 79.1 88.2 95.2 64.2 0.28 68.10 0.2363 0.0044 By a nurse or trained midwife 50.3 30.2 15.9 9.0 4.1 25.6 12.27 46.20 -0.3963 0.0120 In a public facility 28.7 60.3 76.3 82.0 70.7 59.8 0.41 42.00 0.1997 0.0059 In a private facility 0.3 1.0 5.2 8.1 25.5 6.5 0.01 25.20 0.4903 0.0308 At home 70.4 38.3 18.1 9.4 3.3 33.3 21.33 67.10 -0.4551 0.0085 D. Contraceptive services Contraceptive prevalence: Women 50.2 65.8 71.2 71.1 71.0 66.1 0.71 20.80 0.0623 0.0051 Men na na na na na na na na na na - 4 - Nicaragua 2001 - TOTAL POPULATION Part II: Intermediate Determinants of HNP Status - HNP SERVICE USE (Cont.) Indicator Wealth Quintiles Low/High Low-High Concentration Index Ratio Diff. Value Standard Low 2nd 3rd 4th High Avg. (Abs. Val.) Errors D. Contraceptive services (cont.) Source of contraception - public sector: Women 79.3 77.2 68.0 62.7 41.3 64.0 1.92 38.00 -0.1017 0.0061 Men na na na na na na na na na na Source of contraception - private sector: Women 16.7 20.3 28.9 34.5 55.2 32.8 0.30 38.50 0.2025 0.0116 Men na na na na na na na na na na E. Treatment of adult illnesses Treatment of genital discharge, ulcer, sore: Women 2.6 3.6 7.6 12.2 8.4 7.1 0.31 5.80 0.2405 0.0534 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 0.9 2.5 5.9 8.3 12.1 6.6 0.07 11.20 0.3164 0.0189 Men na na na na na na na na na na - 5 - Nicaragua 2001 - TOTAL POPULATION Part III: Intermediate Determinants of HNP Status - INDIVIDUAL AND HOUSEHOLD BEHAVIOR Indicator Wealth Quintiles Low/High Low-High Concentration Index Ratio Diff. Value Standard Low 2nd 3rd 4th High Avg. (Abs. Val.) Errors A. Hygienic practices Disposal of children's stools: Sanitary disposal 24.5 57.8 73.9 73.8 74.3 58.7 0.33 49.80 0.1960 0.0066 Handwashing: Wash hands prior to preparing food 98.1 98.4 98.0 97.4 94.3 97.0 1.04 3.80 -0.0067 0.0010 Handwashing facilities in household 2.1 34.7 77.2 93.3 99.1 64.2 0.02 97.00 0.3324 0.0023 B. Bednet ownership and use Bednet ownership: Bednet ownership 29.3 40.4 51.4 49.6 38.5 42.1 0.76 9.20 0.1010 0.0067 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 27.5 40.1 36.0 39.3 14.4 31.9 1.91 13.10 0.0536 0.0343 C. Breastfeeding Exclusive breastfeeding 53.0 53.5 24.9 32.7 (14.5) 39.3 3.66 67.50 -0.1527 0.0338 Timely complementary feeding 73.2 75.1 66.2 68.0 (52.0) 67.5 1.41 125.20 -0.0587 0.0226 Bottle-feeding 38.6 41.9 67.7 66.9 75.1 55.8 0.51 36.50 0.1462 0.0144 D. Micronutrient consumption Iodized salt: Availability of iodized salt na na na na na na na na na na in household Vitamin A: Children 52.0 67.3 70.6 71.8 72.2 65.3 0.72 20.20 0.0790 0.0059 Women 16.0 27.6 28.7 32.5 31.6 26.7 0.51 15.60 0.1238 0.0132 E. Tobacco and alcohol use Tobacco: Women 2.1 3.2 4.1 5.5 9.4 5.3 0.22 7.30 0.2387 0.0223 Men na na na na na na na na na na Alcohol: Women na na na na na na na na na na Men na na na na na na na na na na F. Sexual practices Non-regular sexual partnerships: Women 0.9 0.9 1.2 1.1 1.3 1.1 0.69 0.40 0.0429 0.0479 Men na na na na na na na na na na Condom usage with non-regular partner: Women * (10.3) (19.7) (13.7) (31.7) 19.6 * * * * 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 - 6 - Nicaragua 2001 - TOTAL POPULATION Part IV: UNDERLYING DETERMINANTS OF HNP STATUS Indicator Wealth Quintiles Low/High Low-High Concentration Index Ratio Diff. Value Standard Low 2nd 3rd 4th High Avg. (Abs. Val.) Errors A. Education School completion: Women 19.9 42.2 64.8 81.0 91.7 64.1 0.22 71.80 0.2400 0.0028 Men 18.3 36.9 61.7 80.2 94.4 59.8 0.19 76.10 0.2726 0.0029 School participation: Girls 55.3 79.5 88.2 91.2 95.2 79.6 0.58 39.90 0.1118 0.0046 Boys 49.5 71.8 82.6 89.2 92.3 74.3 0.54 42.80 0.1330 0.0048 B. Exposure to mass media Newspaper readership: Women 10.6 25.4 41.6 52.2 68.2 43.0 0.16 57.60 0.2761 0.0050 Men na na na na na na na na na na Radio listenership: Women 72.2 80.0 85.5 88.6 90.3 84.4 0.80 18.10 0.0412 0.0024 Men na na na na na na na na na na Television viewership: Women 7.5 42.6 81.0 92.6 96.6 69.4 0.08 89.10 0.2707 0.0026 Men na na na na na na na na na na C. Knowledge and attitudes about HIV/AIDS Knowledge about sexual transmission of HIV/AIDS: Women 20.8 30.8 36.0 44.9 49.7 38.2 0.42 28.90 0.1713 0.0065 Men na na na na na na na na na na Knowledge about mother-to-child transmission of HIV/AIDS: Women 77.4 71.9 82.2 86.0 91.8 79.5 0.84 14.40 0.0885 0.0027 Men na na na na na na na na na na Attitudes toward HIV/AIDS: Women 24.7 23.8 25.4 23.1 20.2 22.6 1.22 4.50 0.0052 0.0100 Men na na na na na na na na na na D. Status of women Household decisionmaking: Can seek own health care 32.6 38.2 40.5 42.5 43.3 40.0 0.75 10.70 0.0428 0.0065 Can seek children's health care 94.7 98.4 99.2 99.5 99.0 98.0 0.96 4.30 0.0102 0.0015 Can make daily household purchases na na na na na na na na na na Can make large household purchases 41.7 47.8 49.7 53.4 53.1 49.8 0.79 11.40 0.0445 0.0052 Can make meal-related decisions 52.4 53.6 53.5 53.1 46.9 51.6 1.12 5.50 -0.0258 0.0050 Freedom of movement: Can travel to visit family, relatives 16.8 21.0 25.2 28.3 28.5 24.7 0.59 11.70 0.0929 0.0090 Other decisionmaking, attitudes: Can decide how to spend own money 78.0 86.6 89.4 91.4 90.6 89.2 0.86 12.60 0.0139 0.0031 Can decide whether to have sex 92.3 95.4 95.8 97.6 98.1 96.2 0.94 5.80 0.0097 0.0011 Justifies domestic violence 22.1 17.4 12.9 9.8 5.4 12.5 4.09 16.70 -0.2667 0.0134 E. Orphanhood Paternal orphan prevalence 3.6 3.5 3.6 3.9 2.5 3.5 1.44 1.10 -0.0185 0.0218 Maternal orphan prevalence 1.0 1.0 0.9 1.8 0.9 1.1 1.11 0.10 0.0344 0.0402 Double orphan prevalence 0.2 0.3 0.1 0.6 0.3 0.3 0.67 0.10 0.1202 0.0770 - 7 - Nicaragua 2001 - FEMALE / MALE POPULATIONS Part I: HNP STATUS Indicator Wealth Quintiles - Female Wealth Quintiles - Male Low 2nd 3rd 4th High Avg. Low 2nd 3rd 4th High Avg. A. Childhood mortality and morbidity Infant mortality rate 42.5 39.2 26.6 21.8 18.1 31.7 56.3 41.9 37.5 29.3 14.5 38.8 Under-five mortality rate 59.1 50.1 28.0 29.7 21.2 40.5 69.2 54.2 48.6 34.9 17.2 48.4 Prevalence of fever 26.5 30.0 26.1 18.2 19.8 24.8 25.8 26.0 23.6 26.1 22.3 25.0 Prevalence of diarrhea 16.1 13.3 13.9 10.1 6.4 12.6 14.9 14.8 13.1 13.3 10.0 13.5 Prevalence of acute respiratory 33.1 35.1 32.4 24.2 21.9 30.2 35.8 33.8 30.0 29.2 24.9 31.4 infection (ARI) B. Nutritional status Children: Moderate stunting 22.0 18.6 12.2 4.3 4.1 13.7 22.8 18.1 12.5 6.4 4.1 14.1 Severe stunting 13.7 7.6 2.9 2.0 0.2 6.2 11.9 7.1 3.8 4.0 0.6 6.2 Moderate underweight 12.1 10.1 5.8 2.1 2.1 7.2 13.4 8.9 8.5 5.7 2.3 8.5 Severe underweight 3.6 1.5 0.8 1.1 1.1 1.8 2.9 2.5 1.3 1.3 0.0 1.8 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 C. Sexually transmitted disease Prevalence of genital discharge: Women 13.8 12.9 12.9 11.9 10.3 12.2 Men na na na na na na Prevalence of genital ulcer: Women 2.9 2.4 2.5 1.3 1.1 1.9 Men na na na na na na - 9 - Nicaragua 2001 - FEMALE / MALE POPULATIONS Part II: Intermediate Determinants of HNP Status - HNP SERVICE USE Indicator Wealth Quintiles - Female Wealth Quintiles - Male Low 2nd 3rd 4th High Avg. Low 2nd 3rd 4th High Avg. A. Childhood immunization BCG coverage 91.7 96.8 98.3 96.9 97.2 95.6 92.3 93.7 95.2 98.5 100.0 95.5 Measles coverage 75.1 92.4 90.8 84.8 91.8 85.5 77.4 89.0 91.7 86.8 95.5 87.1 DPT coverage 75.4 86.9 82.2 85.4 78.2 81.1 77.8 85.1 87.6 86.0 87.0 84.2 Full basic coverage 62.3 82.0 75.2 67.0 67.8 70.5 65.0 72.0 80.3 74.8 73.9 72.6 No basic coverage 4.8 1.9 1.0 0.4 2.8 2.5 3.8 2.4 0.4 1.5 0.0 1.8 Hepatitis B coverage 1.1 0.4 0.0 2.3 9.6 2.1 1.8 0.4 2.3 1.7 7.4 2.4 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 51.1 61.2 63.5 61.8 69.5 59.8 47.3 71.1 74.2 58.1 75.4 63.1 Treatment in a public facility 48.8 55.6 48.2 46.4 29.3 47.8 43.6 63.8 61.0 46.3 41.4 51.3 Treatment in a private facility 2.3 5.7 12.7 15.4 40.2 11.5 3.8 7.4 11.4 11.8 33.0 11.4 Treatment of acute respiratory infection (ARI): Medical treatment of ARI 47.0 60.0 60.2 62.4 67.3 57.3 43.2 62.2 65.1 56.9 80.6 58.1 Treatment in a public facility 44.6 54.5 45.0 43.4 27.1 45.2 40.4 57.2 50.8 43.7 39.2 46.5 Treatment in a private facility 2.4 5.0 13.1 16.8 40.2 11.3 2.7 4.9 10.8 11.3 40.9 10.6 Treatment of diarrhea: Use of oral rehydration therapy 59.3 65.2 55.9 (73.2) (74.2) 63.0 63.5 76.9 78.7 68.8 (78.7) 72.0 Medical treatment of diarrhea 36.9 45.7 51.2 (44.5) (34.8) 42.8 38.4 52.5 52.4 39.6 (46.2) 45.3 Treatment in a public facility 36.4 42.1 38.6 (34.0) (9.5) 35.8 37.5 46.6 40.8 25.8 (29.7) 37.3 Treatment in a private facility 0.5 3.6 10.4 (10.5) (25.2) 6.5 0.9 5.8 11.7 12.4 (16.6) 7.8 C. Contraceptive services Contraceptive prevalence: Women 50.2 65.8 71.2 71.1 71.0 66.1 Men na na na na na na Source of contraception - public sector: Women 79.3 77.2 68.0 62.7 41.3 64.0 Men na na na na na na Source of contraception - private sector: Women 16.7 20.3 28.9 34.5 55.2 32.8 Men na na na na na na D. Treatment of adult illnesses Treatment of genital discharge, ulcer, sore: Women 2.6 3.6 7.6 12.2 8.4 7.1 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 0.9 2.5 5.9 8.3 12.1 6.6 Men na na na na na na - 10 - Nicaragua 2001 - FEMALE / MALE POPULATIONS Part III: Intermediate Determinants of HNP Status - INDIVIDUAL AND HOUSEHOLD BEHAVIOR Indicator Wealth Quintiles - Female Wealth Quintiles - Male Low 2nd 3rd 4th High Avg. Low 2nd 3rd 4th High Avg. A. Hygienic practices Disposal of children's stools: Sanitary disposal 24.5 57.8 73.9 73.8 74.3 58.7 Handwashing: Wash hands prior to preparing food 98.1 98.4 98.0 97.4 94.3 97.0 Handwashing facilities in household 2.1 34.7 77.2 93.3 99.1 64.2 B. Bednet ownership and use Bednet use: By children na na na na na na C. Breastfeeding Exclusive breastfeeding 48.9 49.7 (33.3) (36.8) * 38.5 56.2 56.5 (18.6) (27.4) * 39.9 Timely complementary feeding 77.7 (75.8) (60.8) (73.1) (64.9) 70.5 68.8 (74.4) (74.7) * * 63.9 Bottle-feeding 36.7 40.2 68.9 59.1 75.9 54.3 40.5 43.4 66.5 75.7 74.4 57.2 D. Micronutrient consumption Vitamin A: Children 51.4 69.2 68.5 71.1 71.5 64.8 52.6 65.4 72.7 72.4 72.7 65.7 E. Tobacco and alcohol use Tobacco: Women 2.1 3.2 4.1 5.5 9.4 5.3 Men na na na na na na Alcohol: Women na na na na na na Men na na na na na na F. Sexual practices Non-regular sexual partnerships: Women 0.9 0.9 1.2 1.1 1.3 1.1 Men na na na na na na Condom usage with non-regular partner: Women * (10.3) (19.7) (13.7) (31.7) 19.6 Men na na na na na na - 11 - Nicaragua 2001 - FEMALE / MALE POPULATIONS Part IV: UNDERLYING DETERMINANTS OF HNP STATUS Indicator Wealth Quintiles - Female Wealth Quintiles - Male Low 2nd 3rd 4th High Avg. Low 2nd 3rd 4th High Avg. A. Education School completion: Women 19.9 42.2 64.8 81.0 91.7 64.1 Men 18.3 36.9 61.7 80.2 94.4 59.8 School participation: Girls 55.3 79.5 88.2 91.2 95.2 79.6 Boys 49.5 71.8 82.6 89.2 92.3 74.3 B. Exposure to mass media Newspaper readership: Women 10.6 25.4 41.6 52.2 68.2 43.0 Men na na na na na na Radio listenership: Women 72.2 80.0 85.5 88.6 90.3 84.4 Men na na na na na na Television viewership: Women 7.5 42.6 81.0 92.6 96.6 69.4 Men na na na na na na C. Knowledge and attitudes about HIV/AIDS Knowledge about sexual transmission of HIV/AIDS: Women 20.8 30.8 36.0 44.9 49.7 38.2 Men na na na na na na Knowledge about mother-to-child transmission of HIV/AIDS: Women 77.4 71.9 82.2 86.0 91.8 79.5 Men na na na na na na Attitudes toward HIV/AIDS: Women 24.7 23.8 25.4 23.1 20.2 22.6 Men na na na na na na D. Orphanhood Paternal orphan prevalence 3.3 3.3 3.8 4.4 3.0 3.6 3.9 3.8 3.3 3.4 2.0 3.4 Maternal orphan prevalence 1.0 1.1 1.2 1.7 1.0 1.2 1.1 0.9 0.7 1.8 0.8 1.1 Double orphan prevalence 0.2 0.3 0.2 0.7 0.4 0.3 0.1 0.3 0.0 0.4 0.2 0.2 - 12 - Nicaragua 2001 - RURAL / URBAN POPULATIONS Part I: HNP STATUS Indicator Wealth Quintiles - Rural Wealth Quintiles - Urban Low 2nd 3rd 4th High Avg. Low 2nd 3rd 4th High Avg. A. Childhood illness and mortality Infant mortality rate 48.4 42.7 28.9 (20.4) * 42.8 * 35.1 33.8 26.3 16.6 27.7 Under-five mortality rate 63.7 54.6 35.2 (22.4) * 55.3 * 46.0 40.3 33.7 19.5 33.9 Prevalence of fever 26.3 26.9 23.5 19.0 * 25.8 22.4 30.7 25.5 22.9 21.0 24.0 Prevalence of diarrhea 15.4 13.7 12.3 11.8 * 14.4 15.7 14.8 14.1 11.8 8.1 11.7 Prevalence of acute respiratory infection 34.7 33.5 30.7 24.6 * 33.2 28.9 36.8 31.4 27.2 23.7 28.5 B. Fertility Total fertility rate 5.7 3.9 3.0 (3.1) * 4.4 * (4.0) 3.1 2.4 2.1 2.6 Adolescent fertility rate 195.0 140.0 108.0 (127.0) * 153.0 * (176.0) 129.0 89.0 71.0 98.8 C. Nutritional status Children: Moderate stunting 22.4 19.2 13.7 1.5 * 19.2 23.0 16.4 11.7 6.0 4.1 8.6 Severe stunting 12.4 8.5 3.7 5.6 * 9.7 22.3 4.8 3.2 2.6 0.4 2.8 Moderate underweight 12.3 10.1 6.8 5.7 * 10.6 25.0 8.2 7.3 3.7 2.2 5.2 Severe underweight 3.3 2.7 1.7 1.7 * 2.8 0.0 0.4 0.7 1.1 0.6 0.7 Mild anemia na na na na na na na na na na na na Moderate anemia na na na na na na na na na na na na Severe anemia na na na na na na na na na na na na Women: Malnutrition 3.4 2.4 4.0 3.8 0.0 3.1 3.6 2.6 3.7 3.5 4.1 3.7 Mild anemia na na na na na na na na na na na na Moderate anemia na na na na na na na na na na na na Severe anemia na na na na na na na na na na na na 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 * * * * * * * * * * * * Women * * * * * * * * * * * * E. Sexually transmitted disease Prevalence of genital discharge: Women 13.9 13.1 13.5 10.1 (3.1) 13.2 13.4 12.4 12.6 12.2 10.4 11.6 Men na na na na na na na na na na na na Prevalence of genital ulcer: Women 2.7 2.9 3.2 0.6 0.0 2.7 5.9 1.0 2.1 1.4 1.1 1.5 Men na na na na na na na na na na na na - 13 - Nicaragua 2001 - RURAL / URBAN POPULATIONS Part II: Intermediate Determinants of HNP Status - HNP SERVICE USE Indicator Wealth Quintiles - Rural Wealth Quintiles - Urban Low 2nd 3rd 4th High Avg. Low 2nd 3rd 4th High Avg. A. Childhood immunization BCG coverage 91.6 94.1 92.9 (92.2) * 92.5 (100.0) 97.9 98.8 98.8 98.6 98.7 Measles coverage 75.6 90.3 93.5 (90.4) * 83.1 (86.7) 91.7 90.0 85.1 93.7 89.8 DPT coverage 75.9 84.6 85.9 (93.7) * 80.7 (89.2) 89.2 84.8 84.3 82.6 84.7 Full basic coverage 63.2 77.4 75.1 (79.5) * 69.4 (69.9) 76.7 79.8 69.9 72.2 73.9 No basic coverage 4.6 3.2 0.6 0.0 * 3.4 0.0 0.0 0.7 1.2 1.4 0.9 Hepatitis B coverage 1.5 0.5 1.0 0.0 * 1.5 0.0 0.0 1.5 2.3 7.2 3.2 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 48.8 62.0 60.5 (61.4) * 54.8 * 73.9 72.1 59.3 72.5 68.7 Treatment in a public facility 45.7 56.4 45.7 (43.3) * 49.1 * 65.6 58.1 46.7 35.2 50.2 Treatment in a private facility 3.1 5.6 8.6 (18.0) * 5.1 * 8.3 13.5 12.6 36.7 18.2 Treatment of acute respiratory infection (ARI): Medical treatment of ARI 44.7 59.2 57.9 (59.0) * 51.1 (52.7) 65.0 64.7 59.2 74.4 65.4 Treatment in a public facility 42.1 54.4 41.4 (37.5) * 45.6 (52.7) 59.1 50.8 44.4 33.7 46.1 Treatment in a private facility 2.6 4.5 10.8 (21.5) * 4.8 0.0 6.0 12.5 12.6 40.4 18.1 Treatment of diarrhea: Use of oral rehydration therapy 60.8 69.4 (65.0) * * 65.0 * 75.5 68.1 67.9 76.2 71.1 Medical treatment of diarrhea 38.0 50.4 (50.2) * * 43.1 * 46.7 52.5 41.4 41.4 45.4 Treatment in a public facility 37.2 47.4 (36.6) * * 39.4 * 37.8 40.9 30.2 22.7 33.2 Treatment in a private facility 0.7 3.0 (11.0) * * 3.4 * 8.8 11.0 10.3 18.7 11.7 C. Antenatal and delivery care Antenatal care visits: To a medically trained person 68.2 84.9 92.9 96.9 * 78.5 82.2 85.8 89.9 94.3 96.6 92.7 To a doctor 33.9 47.9 56.4 58.7 * 42.8 39.0 54.3 55.0 54.4 41.4 50.2 To a nurse or trained midwife 34.3 37.0 36.5 38.2 * 35.8 43.2 31.4 34.9 39.9 55.2 42.5 Multiple visits to a medically trained person 57.3 75.9 83.8 88.4 * 68.7 67.3 77.6 82.6 89.8 92.3 86.9 Antenatal care content: Tetanus toxoid 76.4 84.5 85.6 85.2 * 80.8 84.1 82.5 86.4 87.0 83.3 85.1 Prophylactic antimalarial treatment na na na na na na na na na na na na Iron supplementation 62.7 77.1 83.5 87.8 * 71.5 64.4 81.4 82.2 84.3 91.5 85.3 Delivery attendance: By a medically trained person 77.3 86.9 94.5 94.3 * 83.1 80.8 92.4 95.2 97.7 99.2 96.5 By a doctor 26.0 53.6 72.4 83.0 * 42.7 56.8 69.8 82.2 89.0 95.2 86.0 By a nurse or trained midwife 51.4 33.3 22.1 11.3 * 40.4 24.0 22.6 13.0 8.7 4.1 10.5 In a public facility 27.5 55.2 73.5 73.8 * 43.5 61.5 72.7 77.5 83.2 71.0 76.4 In a private facility 0.3 0.6 2.1 10.0 * 1.2 0.0 1.9 6.6 7.9 25.3 11.8 At home 71.6 43.8 23.6 15.8 * 54.7 38.5 25.0 15.6 8.4 3.3 11.5 D. Contraceptive services Contraceptive prevalence: Women 49.8 63.9 71.3 75.9 (79.6) 60.0 59.9 71.5 71.2 70.4 70.8 70.7 Men na na na na na na na na na na na na - 14 - Nicaragua 2001 - RURAL / URBAN POPULATIONS Part II: Intermediate Determinants of HNP Status - HNP SERVICE USE (Cont.) Indicator Wealth Quintiles - Rural Wealth Quintiles - Urban Low 2nd 3rd 4th High Avg. Low 2nd 3rd 4th High Avg. D. Contraceptive services (cont.) Source of contraception - public sector: Women 79.2 76.4 67.3 66.7 * 74.3 81.8 79.4 68.3 62.0 41.5 57.6 Men na na na na na na na na na na na na Source of contraception - private sector: Women 16.6 20.7 30.3 30.9 * 22.5 18.2 19.1 28.1 35.1 55.0 39.3 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 2.3 4.9 7.4 (7.8) * 4.4 * 0.0 7.7 12.6 8.4 9.0 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 0.9 1.7 3.7 5.0 (12.0) 2.1 1.0 4.6 7.0 8.8 12.1 9.3 Men na na na na na na na na na na na na - 15 - Nicaragua 2001 - RURAL / URBAN POPULATIONS Part III: Intermediate Determinants of HNP Status - INDIVIDUAL AND HOUSEHOLD BEHAVIOR Indicator Wealth Quintiles - Rural Wealth Quintiles - Urban Low 2nd 3rd 4th High Avg. Low 2nd 3rd 4th High Avg. A. Hygienic practices Disposal of children's stools: Sanitary disposal na na na na na na na na na na na na Handwashing: Wash hands prior to preparing food 98.0 98.5 98.6 98.3 (89.9) 98.2 98.8 98.1 97.7 97.3 94.4 96.3 Handwashing facilities in household 1.8 26.9 65.1 88.0 (95.3) 27.8 8.2 54.5 83.8 94.1 99.2 88.9 B. Bednet ownership and use Bednet ownership: Bednet ownership 28.5 36.1 49.5 60.5 (40.1) 36.9 43.7 51.1 52.5 48.1 38.5 45.7 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 27.3 35.7 (28.0) * * 32.1 * (50.5) 39.1 35.6 12.9 31.8 C. Breastfeeding Exclusive breastfeeding 53.0 54.0 * * 0.0 49.3 * (52.0) (25.8) (31.7) (14.5) 28.8 Timely complementary feeding 73.1 78.1 * * 0.0 73.6 * * 65.2 69.2 (52.0) 62.6 Bottle-feeding 38.5 38.0 65.4 (61.4) * 42.6 * 51.5 68.6 68.0 75.1 67.9 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 51.6 65.7 68.8 71.2 * 58.9 65.2 71.2 71.4 71.9 72.1 71.6 Women 15.7 27.1 30.4 36.0 * 22.4 22.2 28.6 28.0 32.0 31.7 30.3 E. Tobacco and alcohol use Tobacco: Women 1.8 2.5 1.4 3.5 (3.4) 2.1 8.6 4.9 5.5 5.8 9.4 7.1 Men na na na na na na na na na na na na Alcohol: Women na na na na na na na na na na na na Men na na na na na na na na na na na na F. Sexual practices Non-regular sexual partnerships: Women 0.8 0.7 1.7 0.3 (5.7) 1.0 1.2 1.7 0.9 1.2 1.2 1.2 Men na na na na na na na na na na na na Condom usage with non-regular partner: Women * * * * * (14.9) * * * (14.2) (33.9) 21.8 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 - 16 - Nicaragua 2001 - RURAL / URBAN POPULATIONS Part IV: UNDERLYING DETERMINANTS OF HNP STATUS Indicator Wealth Quintiles - Rural Wealth Quintiles - Urban Low 2nd 3rd 4th High Avg. Low 2nd 3rd 4th High Avg. A. Education School completion: Women 19.5 39.7 60.1 76.3 (92.5) 38.5 25.9 48.7 67.1 81.7 91.7 79.3 Men 18.0 35.2 58.7 76.7 92.0 35.6 24.1 42.1 63.3 80.8 94.4 77.6 School participation: Girls 55.0 79.0 87.2 89.1 * 69.1 62.1 80.5 88.8 91.4 95.1 89.6 Boys 49.3 70.9 85.7 94.9 * 63.8 52.1 74.2 81.1 88.5 92.2 84.6 B. Exposure to mass media Newspaper readership: Women 10.3 23.7 35.7 48.5 (66.9) 22.8 17.3 29.5 44.5 52.7 68.3 54.8 Men na na na na na na na na na na na na Radio listenership: Women 72.4 80.8 87.2 92.5 (86.1) 79.5 68.1 78.1 84.6 88.1 90.4 87.3 Men na na na na na na na na na na na na Television viewership: Women 6.9 38.0 80.9 93.4 (97.8) 38.0 20.3 54.3 81.0 92.4 96.6 87.8 Men na na na na na na na na na na na na C. Knowledge and attitudes about HIV/AIDS Knowledge about sexual transmission of HIV/AIDS: Women 20.8 27.9 33.2 38.7 (57.9) 27.1 21.1 38.3 37.4 45.8 49.6 44.6 Men na na na na na na na na na na na na Knowledge about mother-to-child transmission of HIV/AIDS: Women 54.2 68.6 81.6 82.7 (90.5) 66.4 72.3 80.3 82.5 86.5 91.9 87.1 Men na na na na na na na na na na na na Attitudes toward HIV/AIDS: Women 20.3 24.0 24.8 26.9 (14.4) 23.0 19.0 23.4 25.7 22.6 20.3 22.4 Men na na na na na na na na na na na na D. Status of women Household decisionmaking: Can seek own health care 32.0 35.4 34.5 31.2 (43.1) 33.6 45.0 45.5 43.5 44.1 43.3 43.8 Can seek children's health care 94.5 98.6 98.5 99.6 * 96.6 100.0 98.0 99.6 99.5 99.0 99.2 Can make daily household purchases na na na na na na na na na na na na Can make large household purchases 41.3 46.3 46.0 52.9 (51.3) 44.8 49.7 51.6 51.5 53.5 53.1 52.7 Can make meal-related decisions 52.1 51.3 53.2 48.0 (55.8) 51.8 58.2 59.4 53.6 53.8 46.8 51.5 Freedom of movement: Can travel to visit family, relatives 16.2 19.2 19.6 17.4 (22.8) 18.0 28.2 25.3 28.0 29.8 28.6 28.6 Other decisionmaking, attitudes: Can decide how to spend own money 76.2 83.2 86.6 83.4 * 82.3 90.9 92.0 90.4 92.3 90.9 91.3 Can decide whether to have sex 92.1 94.8 93.6 96.1 (100.0) 93.6 95.8 97.2 96.9 97.8 98.1 97.6 Justifies domestic violence 22.1 17.3 13.5 14.2 (2.5) 18.1 21.3 17.8 12.6 9.2 5.4 9.3 E. Orphanhood Paternal orphan prevalence 3.5 3.2 2.7 2.3 1.8 3.2 5.8 4.4 4.0 4.1 2.5 3.7 Maternal orphan prevalence 1.0 1.0 0.9 0.7 3.0 1.0 2.8 0.9 1.0 1.9 0.8 1.3 Double orphan prevalence 0.1 0.3 0.2 0.0 1.8 0.2 0.7 0.2 0.0 0.6 0.3 0.3 - 17 - . PART II. BASIC TABLES, 1997 / 98 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. Nicaragua 1997 / 98 - 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 50.7 53.7 45.7 40.2 25.8 45.2 1.97 24.90 -0.0943 0.0010 Under-five mortality rate 68.8 66.6 52.5 48.5 29.7 56.0 2.32 39.10 -0.1241 0.0010 Prevalence of fever 26.1 23.1 24.2 22.4 16.6 23.2 1.57 9.50 -0.0728 0.0120 Prevalence of diarrhea 16.1 14.0 14.2 14.4 8.7 14.0 1.85 7.40 -0.0988 0.0161 Prevalence of acute respiratory 29.1 27.4 24.6 27.1 20.8 26.4 1.40 8.30 -0.0609 0.0111 infection (ARI) B. Fertility Total fertility rate 6.6 4.6 3.5 2.7 1.9 3.6 3.47 4.70 -0.2348 0.0006 Adolescent fertility rate 213.0 176.0 147.0 90.0 58.0 130.0 3.67 155.00 -0.2419 0.0014 C. Nutritional status (%) Children: Moderate stunting 22.6 19.2 15.0 8.6 5.6 15.7 4.04 17.00 -0.2135 0.0159 Severe stunting 15.5 9.9 7.7 4.4 2.7 9.2 5.74 12.80 -0.2810 0.0229 Moderate underweight 15.0 12.1 9.9 5.6 3.4 10.3 4.41 11.60 -0.2274 0.0199 Severe underweight 3.4 2.1 1.5 0.9 0.5 1.9 6.80 2.90 -0.2872 0.0920 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 4.1 4.2 4.0 5.1 4.2 4.4 0.98 0.10 0.0283 0.0248 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 12.6 11.3 11.4 9.4 9.1 10.7 1.38 3.50 -0.0729 0.0166 Men 2.1 2.2 3.1 1.5 1.0 2.0 2.10 1.10 -0.1841 0.0764 Prevalence of genital ulcer: Women 2.1 2.0 1.5 1.7 1.2 1.7 1.75 0.90 -0.1199 0.0424 Men 1.6 0.6 1.1 0.3 0.9 0.9 1.78 0.70 -0.0546 0.1250 - 21 - Nicaragua 1997 / 98 - 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 91.0 96.1 95.8 99.7 94.7 95.0 0.96 3.70 0.0181 0.0037 Measles coverage 77.6 86.9 87.8 91.7 90.4 85.7 0.86 12.80 0.0437 0.0063 DPT coverage 69.2 81.7 85.1 89.5 77.7 79.7 0.89 8.50 0.0545 0.0082 Full basic coverage 61.0 74.6 75.3 85.7 73.1 72.6 0.83 12.10 0.0736 0.0094 No basic coverage 5.5 1.7 0.3 0.0 2.8 2.3 1.96 2.70 -0.4895 0.1239 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 37.4 48.1 50.6 52.3 54.2 46.6 0.69 16.80 0.0885 0.0154 Treatment in a public facility 34.5 44.8 40.4 36.3 23.9 37.3 1.44 10.60 0.0217 0.0188 Treatment in a private facility 2.9 3.3 10.2 15.8 25.6 8.8 0.11 22.70 0.3859 0.0495 Treatment of acute respiratory infection (ARI): Medical treatment of ARI 45.2 56.2 62.6 67.1 73.9 57.8 0.61 28.70 0.0925 0.0113 Treatment in a public facility 42.1 51.0 54.6 49.8 37.7 47.4 1.12 4.40 0.0295 0.0146 Treatment in a private facility 3.1 5.2 8.0 16.9 32.5 10.0 0.10 29.40 0.4038 0.0423 Treatment of diarrhea: Use of oral rehydration therapy 68.8 71.7 74.1 69.5 71.1 70.8 0.97 2.30 0.0215 0.0121 Medical treatment of diarrhea 39.8 46.3 45.9 42.9 50.7 43.9 0.79 10.90 0.0512 0.0209 Treatment in a public facility 38.5 41.4 38.1 27.4 22.1 35.8 1.74 16.40 -0.0523 0.0247 Treatment in a private facility 0.9 4.1 7.7 15.5 28.5 7.8 0.03 27.60 0.4939 0.0768 C. Antenatal and delivery care Antenatal care visits: To a medically trained person 70.2 83.7 88.8 91.7 96.1 84.9 0.73 25.90 0.0635 0.0033 To a doctor 29.9 41.4 46.4 45.6 40.3 40.2 0.74 10.40 0.0711 0.0093 To a nurse or trained midwife 40.3 42.3 42.5 46.1 55.8 44.6 0.72 15.50 0.0585 0.0086 Multiple visits to a medically trained person 55.3 71.7 78.8 84.5 91.3 74.5 0.61 36.00 0.1004 0.0042 Antenatal care content: Tetanus toxoid 78.9 86.5 89.1 89.4 88.0 86.0 0.90 9.10 0.0240 0.0031 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 32.9 58.8 79.8 86.0 92.3 64.6 0.36 59.40 0.2094 0.0040 By a doctor 20.8 36.5 46.7 47.3 42.3 36.7 0.49 21.50 0.1733 0.0084 By a nurse or trained midwife 12.1 22.3 33.1 38.7 49.9 27.9 0.24 37.80 0.2571 0.0100 In a public facility 32.2 57.7 75.4 80.7 78.2 60.6 0.41 46.00 0.1947 0.0048 In a private facility 0.3 0.4 3.3 4.4 11.6 3.1 0.03 11.30 0.4694 0.0417 At home 66.0 39.9 20.2 13.0 8.6 34.8 7.67 57.40 -0.3797 0.0076 D. Contraceptive services Contraceptive prevalence: Women 40.2 55.5 60.3 65.4 64.2 57.4 0.63 24.00 0.0953 0.0056 Men 45.2 59.5 63.1 67.8 68.5 61.1 0.66 23.30 0.0851 0.0109 - 22 - Nicaragua 1997 / 98 - 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 74.4 69.7 62.5 59.5 49.4 61.6 1.51 25.00 -0.0718 0.0065 Men na na na na na na na na na na Source of contraception - private sector: Women 23.5 28.4 35.3 37.2 47.4 35.8 0.50 23.90 0.1206 0.0112 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 - 23 - Nicaragua 1997 / 98 - 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 40.5 30.5 24.2 27.3 19.3 29.6 2.10 21.20 -0.1404 0.0376 Timely complementary feeding 69.6 57.7 58.7 49.5 60.3 60.0 1.15 9.30 -0.0565 0.0211 Bottle-feeding 62.7 74.7 72.3 80.8 84.8 73.4 0.74 22.10 0.0593 0.0087 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 72.2 69.7 66.0 64.7 61.4 66.4 1.18 10.80 -0.0329 0.0076 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 27.9 30.5 31.8 29.1 23.9 28.6 1.17 4.00 -0.0849 0.0105 Experienced violence in past year 12.0 12.8 14.3 13.9 9.4 12.5 1.28 2.60 -0.0908 0.0159 - 24 - Nicaragua 1997 / 98 - 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 20.2 41.2 61.8 78.6 88.7 61.9 0.23 68.50 0.2342 0.0029 Men 19.8 38.7 61.6 80.0 90.3 60.1 0.22 70.50 0.2536 0.0031 School participation: Girls 52.8 71.0 81.2 86.1 89.4 73.8 0.59 36.60 0.1120 0.0050 Boys 47.4 67.1 74.9 80.3 89.4 69.5 0.53 42.00 0.1253 0.0054 B. Exposure to mass media Newspaper readership: Women 20.4 36.7 50.2 63.2 75.2 52.1 0.27 54.80 0.2135 0.0041 Men 24.5 40.3 59.6 72.6 79.3 57.4 0.31 54.80 0.1973 0.0084 Radio listenership: Women 53.9 70.9 80.6 83.8 83.9 76.2 0.64 30.00 0.0741 0.0031 Men 76.1 84.7 88.5 89.5 93.2 87.0 0.82 17.10 0.0382 0.0046 Television viewership: Women 10.2 39.9 80.1 91.0 96.4 68.4 0.11 86.20 0.2718 0.0025 Men 22.3 49.9 87.9 95.3 97.4 73.6 0.23 75.10 0.2236 0.0054 C. Knowledge and attitudes about HIV/AIDS Knowledge about sexual transmission of HIV/AIDS: Women 78.8 89.2 95.0 97.5 97.8 92.7 0.81 19.00 0.0403 0.0016 Men 96.1 98.1 99.9 99.6 100.0 98.9 0.96 3.90 0.0073 0.0015 Knowledge about mother-to-child transmission of HIV/AIDS: Women na na na na na na na na na na Men 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 Men na na na na na na na na na na D. Status of women Household decisionmaking: Can seek own health care 30.8 37.0 40.4 38.3 38.1 37.2 0.81 7.30 0.0311 0.0066 Can seek children's health care 20.0 27.7 32.9 30.7 30.0 27.8 0.67 10.00 0.0565 0.0136 Can make daily household purchases na na na na na na na na na na Can make large household purchases 29.8 33.4 35.7 34.4 34.1 33.7 0.87 4.30 0.0231 0.0071 Can make meal-related decisions 32.3 29.0 30.6 24.8 26.2 28.2 1.23 6.10 -0.0593 0.0081 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 64.5 78.2 80.1 75.7 73.5 75.3 0.88 9.00 0.0016 0.0048 Can decide whether to have sex 67.0 65.9 62.8 57.8 53.7 60.7 1.25 13.30 -0.0530 0.0042 Justifies domestic violence 31.4 27.2 20.8 16.5 12.0 20.5 2.62 19.40 -0.2233 0.0095 E. Orphanhood Paternal orphan prevalence 3.7 3.7 3.4 3.6 2.1 3.4 1.76 1.60 -0.0682 0.0194 Maternal orphan prevalence 1.2 1.2 1.1 0.8 0.7 1.0 1.71 0.50 -0.1092 0.0346 Double orphan prevalence 0.2 0.1 0.1 0.2 0.1 0.2 2.00 0.10 -0.1743 0.0979 - 25 - Nicaragua 1997 / 98 - 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 41.7 56.4 37.5 35.8 21.2 40.2 59.8 51.1 53.9 44.8 30.5 50.2 Under-five mortality rate 61.8 67.1 42.4 44.9 22.7 50.5 75.8 66.1 62.8 52.2 37.0 61.6 Prevalence of fever 26.8 22.2 23.3 22.3 15.2 22.8 25.3 24.0 25.1 22.5 18.1 23.6 Prevalence of diarrhea 16.7 13.2 13.3 14.3 7.6 13.7 15.5 14.7 15.2 14.5 9.8 14.3 Prevalence of acute respiratory 28.7 27.1 25.5 25.3 18.7 25.8 29.5 27.6 23.6 28.9 23.0 27.0 infection (ARI) B. Nutritional status Children: Moderate stunting 21.4 19.1 15.2 6.6 5.2 15.0 23.8 19.2 14.8 10.7 6.0 16.5 Severe stunting 14.6 8.6 6.5 5.0 2.1 8.4 16.6 11.2 9.1 3.7 3.3 10.0 Moderate underweight 14.1 11.7 10.1 4.4 2.8 9.6 16.0 12.5 9.8 7.0 3.9 10.9 Severe underweight 3.8 1.2 0.8 1.1 0.0 1.7 3.0 2.9 2.2 0.7 1.1 2.2 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 12.6 11.3 11.4 9.4 9.1 10.7 Men 2.1 2.2 3.1 1.5 1.0 2.0 Prevalence of genital ulcer: Women 2.1 2.0 1.5 1.7 1.2 1.7 Men 1.6 0.6 1.1 0.3 0.9 0.9 - 27 - Nicaragua 1997 / 98 - 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 90.5 94.8 94.8 99.4 95.5 94.5 91.5 97.1 96.9 100.0 93.8 95.6 Measles coverage 80.8 84.8 86.0 91.9 90.1 85.9 74.4 88.5 90.0 91.4 90.8 85.5 DPT coverage 71.1 79.8 82.2 88.3 74.1 78.6 67.2 83.1 88.5 90.8 82.1 80.7 Full basic coverage 62.4 73.4 72.9 84.5 69.6 71.6 59.5 75.6 78.1 86.9 77.4 73.6 No basic coverage 4.9 3.3 0.5 0.0 2.3 2.4 6.1 0.5 0.0 0.0 3.5 2.3 Hepatitis B coverage na na na na na na na na na na na na Yellow fever coverage na na na na na na na na na na na na B. Treatment of childhood illnesses Treatment of fever: Medical treatment of fever 37.6 50.2 51.7 51.1 51.3 46.7 37.1 46.2 49.5 53.5 56.7 46.4 Treatment in a public facility 34.3 45.6 41.9 35.3 26.9 37.8 34.7 44.1 38.9 37.2 21.3 36.8 Treatment in a private facility 3.3 4.6 9.9 15.3 24.4 8.8 2.5 2.1 10.6 16.3 26.6 8.7 Treatment of acute respiratory infection (ARI): Medical treatment of ARI 49.7 56.7 64.4 64.9 75.5 59.3 40.8 55.7 60.5 69.2 72.6 56.3 Treatment in a public facility 46.2 50.6 56.2 48.1 44.0 49.3 38.0 51.4 52.7 51.3 32.3 45.4 Treatment in a private facility 3.5 6.1 8.2 16.3 31.5 9.9 2.8 4.3 7.8 17.4 33.4 10.0 Treatment of diarrhea: Use of oral rehydration therapy 68.5 64.5 72.1 71.9 (69.0) 69.1 69.0 77.8 76.0 67.1 (72.8) 72.5 Medical treatment of diarrhea 41.1 44.2 52.1 39.2 (56.9) 44.8 38.3 48.1 39.9 46.6 (45.6) 43.0 Treatment in a public facility 40.9 40.1 42.4 25.4 (29.3) 37.4 35.8 42.4 34.0 29.5 (16.3) 34.2 Treatment in a private facility 0.0 3.1 9.7 13.8 (27.6) 7.1 1.9 4.9 5.9 17.1 (29.3) 8.5 C. Contraceptive services Contraceptive prevalence: Women 40.2 55.5 60.3 65.4 64.2 57.4 Men 45.2 59.5 63.1 67.8 68.5 61.1 Source of contraception - public sector: Women 74.4 69.7 62.5 59.5 49.4 61.6 Men na na na na na na Source of contraception - private sector: Women 23.5 28.4 35.3 37.2 47.4 35.8 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 - 28 - Nicaragua 1997 / 98 - 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 40.2 34.4 (27.0) (33.2) (22.2) 32.0 40.8 27.2 (21.6) (21.9) (15.5) 27.2 Timely complementary feeding 60.0 65.0 (62.2) (54.8) (58.6) 60.0 78.7 51.8 (54.9) (42.3) (62.7) 60.0 Bottle-feeding 59.5 73.4 66.3 82.0 88.4 72.0 65.8 75.9 78.5 79.4 80.7 74.7 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 72.2 69.7 66.0 64.7 61.4 66.4 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 - 29 - Nicaragua 1997 / 98 - 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 20.2 41.2 61.8 78.6 88.7 61.9 Men 19.8 38.7 61.6 80.0 90.3 60.1 School participation: Girls 52.8 71.0 81.2 86.1 89.4 73.8 Boys 47.4 67.1 74.9 80.3 89.4 69.5 B. Exposure to mass media Newspaper readership: Women 20.4 36.7 50.2 63.2 75.2 52.1 Men 24.5 40.3 59.6 72.6 79.3 57.4 Radio listenership: Women 53.9 70.9 80.6 83.8 83.9 76.2 Men 76.1 84.7 88.5 89.5 93.2 87.0 Television viewership: Women 10.2 39.9 80.1 91.0 96.4 68.4 Men 22.3 49.9 87.9 95.3 97.4 73.6 C. Knowledge and attitudes about HIV/AIDS Knowledge about sexual transmission of HIV/AIDS: Women 78.8 89.2 95.0 97.5 97.8 92.7 Men 96.1 98.1 99.9 99.6 100.0 98.9 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 3.0 3.9 2.7 3.8 2.3 3.2 4.3 3.4 4.3 3.3 1.9 3.6 Maternal orphan prevalence 1.0 1.2 1.0 0.8 0.8 1.0 1.5 1.2 1.1 0.7 0.5 1.1 Double orphan prevalence 0.4 0.2 0.0 0.2 0.2 0.2 0.1 0.1 0.2 0.1 0.0 0.1 - 30 - Nicaragua 1997 / 98 - 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 50.9 54.1 48.6 (41.2) * 51.1 49.4 53.2 44.4 40.1 23.6 40.0 Under-five mortality rate 69.0 67.2 50.8 (43.0) * 64.3 (66.9) 65.7 53.3 49.3 27.8 48.8 Prevalence of fever 25.7 21.3 21.8 26.6 30.0 24.1 29.5 26.0 25.1 21.7 15.5 22.3 Prevalence of diarrhea 16.2 12.2 11.4 12.1 11.1 14.2 14.7 16.8 15.4 14.8 8.5 13.8 Prevalence of acute respiratory infection 29.2 27.6 20.8 29.1 23.8 27.6 27.7 27.0 26.1 26.8 20.5 25.2 B. Fertility Total fertility rate 6.6 4.5 3.3 * * 5.0 * 4.7 3.6 2.7 1.9 2.9 Adolescent fertility rate 213.0 164.0 113.0 * * 167.0 * 202.0 161.0 89.0 59.0 108.9 C. Nutritional status Children: Moderate stunting 22.4 19.5 16.2 9.1 4.4 19.9 24.0 18.7 14.5 8.5 5.7 12.0 Severe stunting 15.1 8.7 7.1 4.1 8.8 11.6 19.9 11.9 8.0 4.5 2.3 6.9 Moderate underweight 14.7 11.2 9.1 5.3 14.0 12.5 17.7 13.7 10.3 5.7 2.6 8.2 Severe underweight 3.1 1.1 0.6 3.8 0.0 2.2 6.6 3.7 1.8 0.5 0.6 1.7 Mild anemia na na na na na na na na na na na na Moderate anemia na na na na na na na na na na na na Severe anemia na na na na na na na na na na na na Women: Malnutrition 4.1 3.7 4.4 3.1 4.1 4.0 3.9 5.0 3.8 5.4 4.2 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 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 12.5 11.0 12.3 9.9 7.7 11.7 14.3 11.8 11.0 9.3 9.2 10.1 Men 2.3 2.4 3.4 0.0 0.0 2.3 0.0 1.7 3.0 1.8 1.0 1.7 Prevalence of genital ulcer: Women 2.1 1.6 1.4 1.6 0.3 1.7 2.0 2.7 1.6 1.7 1.2 1.6 Men 1.5 0.7 1.5 0.0 0.0 1.1 (2.3) 0.4 0.9 0.3 1.0 0.8 - 31 - Nicaragua 1997 / 98 - 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 90.3 96.5 98.9 (100.0) * 93.2 (97.5) 95.4 94.5 99.6 95.8 96.6 Measles coverage 76.4 90.5 91.3 (91.2) * 82.6 (90.2) 81.3 86.5 91.7 91.3 88.5 DPT coverage 67.3 82.8 90.8 (91.3) * 75.2 (87.4) 79.8 82.8 89.3 78.6 83.6 Full basic coverage 58.8 77.8 85.8 (89.3) * 68.2 (82.1) 69.6 71.2 85.1 75.1 76.6 No basic coverage 5.8 0.8 0.0 0.0 * 3.8 (2.5) 3.1 0.4 0.0 1.7 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 36.8 46.5 49.0 (44.3) * 41.4 42.0 50.1 51.2 53.7 54.1 51.5 Treatment in a public facility 34.0 43.8 38.9 (33.8) * 36.6 38.2 46.0 40.9 36.7 24.7 37.9 Treatment in a private facility 2.8 2.7 10.1 (10.5) * 4.6 3.8 4.0 10.3 16.7 25.6 12.9 Treatment of acute respiratory infection (ARI): Medical treatment of ARI 43.0 54.5 66.3 (70.2) * 50.5 67.4 58.9 61.5 66.7 73.0 65.1 Treatment in a public facility 39.8 50.3 57.6 (54.2) * 44.8 64.8 52.1 53.6 49.1 39.2 49.9 Treatment in a private facility 3.2 4.2 8.8 (16.0) * 5.4 2.6 6.7 7.8 17.0 31.0 14.5 Treatment of diarrhea: Use of oral rehydration therapy 67.2 69.0 (78.7) * * 69.2 (85.0) 74.8 72.7 70.1 68.0 72.3 Medical treatment of diarrhea 38.1 44.3 (59.7) * * 41.6 (57.4) 48.6 41.7 44.2 51.2 46.0 Treatment in a public facility 36.7 40.0 (48.8) * * 37.9 (57.4) 42.9 34.9 27.6 23.2 33.8 Treatment in a private facility 1.0 4.3 (10.9) * * 3.5 0.0 3.9 6.8 16.6 28.0 11.8 C. Antenatal and delivery care Antenatal care visits: To a medically trained person 68.4 82.2 87.7 90.2 93.8 76.8 87.7 86.1 89.3 92.0 96.3 91.3 To a doctor 28.8 39.8 46.5 47.5 45.8 35.8 40.0 43.9 46.3 45.3 39.8 43.7 To a nurse or trained midwife 39.5 42.4 41.2 42.6 48.0 41.0 47.7 42.2 43.0 46.6 56.5 47.6 Multiple visits to a medically trained person 53.9 71.4 77.0 84.4 86.6 64.6 68.0 72.3 79.5 84.6 91.7 82.5 Antenatal care content: Tetanus toxoid 78.4 85.7 89.8 90.2 88.9 83.0 83.6 87.9 88.8 89.3 88.0 88.4 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 30.4 50.5 69.7 69.7 80.2 43.6 56.9 71.8 83.9 88.3 93.2 83.9 By a doctor 19.5 31.3 42.9 41.9 35.4 27.0 33.2 44.6 48.3 48.1 42.9 45.6 By a nurse or trained midwife 10.9 19.2 26.9 27.8 44.8 16.6 23.7 27.3 35.6 40.2 50.3 38.2 In a public facility 29.8 49.1 64.5 66.4 59.6 41.7 54.2 71.0 79.8 82.7 79.7 77.8 In a private facility 0.2 0.3 3.0 1.9 19.1 1.0 1.4 0.6 3.4 4.8 11.0 4.9 At home 68.5 48.6 31.3 30.6 21.3 55.8 42.2 26.1 15.7 10.5 7.6 15.5 D. Contraceptive services Contraceptive prevalence: Women 39.6 52.8 62.4 64.2 55.3 49.3 46.5 60.4 59.3 65.5 64.8 62.8 Men 45.1 56.6 72.2 (69.2) * 55.2 (46.5) 66.6 59.2 67.6 68.5 65.2 - 32 - Nicaragua 1997 / 98 - 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 73.4 68.0 62.6 58.8 49.3 67.4 83.5 72.5 62.5 59.6 49.5 58.6 Men na na na na na na na na na na na na Source of contraception - private sector: Women 24.3 30.2 34.6 36.5 49.7 30.2 15.5 25.6 35.7 37.3 47.2 38.7 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 - 33 - Nicaragua 1997 / 98 - 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 41.6 32.8 * * * 37.8 * (27.2) 20.7 28.1 19.4 23.4 Timely complementary feeding 70.6 65.7 (71.6) * * 67.4 * (46.8) 52.0 51.2 61.1 53.4 Bottle-feeding 61.7 72.2 76.4 (86.2) * 67.7 (71.9) 78.2 70.8 80.1 85.5 78.2 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 72.2 71.4 60.4 75.7 (70.9) 70.1 71.6 65.6 68.7 63.2 60.9 64.0 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 26.3 26.5 26.2 22.5 29.4 26.2 42.4 37.3 34.2 30.1 23.5 30.0 Experienced violence in past year 11.1 10.8 10.5 7.7 12.2 10.7 20.5 16.2 16.0 14.8 9.3 13.6 - 34 - Nicaragua 1997 / 98 - 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 19.3 36.7 55.1 69.2 81.2 36.6 28.0 48.8 64.7 79.8 89.0 75.6 Men 19.4 32.8 54.9 68.3 86.9 34.9 24.1 50.3 64.6 81.7 90.5 76.0 School participation: Girls 51.9 68.7 83.5 89.5 (84.8) 63.8 62.1 74.2 80.1 85.5 89.7 82.3 Boys 46.9 66.1 75.4 86.6 (93.6) 59.9 52.1 68.6 74.7 79.2 89.1 77.7 B. Exposure to mass media Newspaper readership: Women 20.0 34.3 45.9 57.3 72.1 33.4 23.9 40.7 52.1 64.0 75.4 62.2 Men 23.4 37.2 53.3 63.7 (70.5) 37.2 35.8 47.7 62.5 73.8 79.8 70.1 Radio listenership: Women 55.0 73.4 81.1 85.9 76.0 68.1 44.3 66.8 80.4 83.6 84.3 80.5 Men 77.6 84.3 88.2 90.5 (93.9) 83.0 61.4 85.4 88.6 89.3 93.1 89.5 Television viewership: Women 8.4 34.4 78.9 92.1 95.6 37.8 25.9 49.0 80.6 90.8 96.5 84.9 Men 19.8 44.2 82.9 80.7 (97.7) 45.1 47.6 63.5 90.2 97.2 97.4 91.4 C. Knowledge and attitudes about HIV/AIDS Knowledge about sexual transmission of HIV/AIDS: Women 78.4 87.1 92.5 97.4 93.6 85.4 82.5 92.7 96.1 97.5 98.1 96.6 Men 96.5 97.3 100.0 100.0 (100.0) 97.7 92.8 100.0 99.9 99.6 100.0 99.7 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 31.1 36.6 40.5 41.3 40.0 35.5 28.0 37.6 40.4 37.9 38.0 38.2 Can seek children's health care 19.5 23.6 30.8 32.3 (30.8) 23.2 25.3 34.7 33.9 30.5 30.0 31.7 Can make daily household purchases na na na na na na na na na na na na Can make large household purchases 29.9 33.6 35.9 39.6 40.8 33.2 29.5 33.0 35.5 33.8 33.7 33.9 Can make meal-related decisions 33.4 30.3 32.6 28.3 32.2 31.9 22.0 26.8 29.7 24.3 25.9 26.2 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 61.7 74.4 71.0 69.1 72.6 69.0 78.6 82.1 82.9 76.3 73.5 77.2 Can decide whether to have sex 67.4 66.2 61.8 63.0 58.4 65.4 63.5 65.5 63.2 57.1 53.5 58.1 Justifies domestic violence na na na na na na na na na na na na E. Orphanhood Paternal orphan prevalence 3.5 3.2 2.7 3.6 0.0 3.2 5.8 4.5 3.8 3.6 2.3 3.5 Maternal orphan prevalence 1.3 1.2 0.9 1.1 0.9 1.2 0.5 1.0 1.1 0.7 0.7 0.8 Double orphan prevalence 0.2 0.1 0.1 0.2 0.0 0.2 0.3 0.1 0.1 0.1 0.1 0.1 - 35 - PART III. TECHNICAL NOTES A. INDICATOR DEFINITIONS B. DATA AND METHODS C. DISCUSSION INDICATOR DEFINITIONS Part I: HNP STATUS A. CHILDHOOD MORTALITY AND ILLNESS 2 Infant mortality rate: number of deaths to children under 12 months of age per 1,000 live births, based on experience during the ten years preceding the survey. Under-five mortality rate: number of deaths to children under five years of age per 1,000 live births, based on experience during the ten years preceding the survey. Prevalence of fever: percent of children who had fever, whether or not accompanied by cough or rapid breathing, in the two weeks before the survey. Prevalence of diarrhea: percent of children who had diarrhea in the two weeks before the survey. Prevalence of acute respiratory infection: percent of children who had a cough accompanied by rapid or difficult breathing in the two weeks before the survey. B. FERTILITY Total fertility rate (TFR): average number of births a woman could expect to have during her lifetime if she followed the levels of fertility currently observed at every age. The TFR is calculated as the sum of average annual age-specific fertility rates for all reproductive age groups (usually 15-49 years) in the three years before the survey. Adolescent fertility rate: age-specific fertility rate for women 15-19 years of age. This is the average number of births among women aged 15-19 years per 1,000 women in that age group, based on births in the three years before the survey and expressed as annual averages. 2Figures for the prevalence of fever, diarrhea, and acute respiratory infection refer to percent of children under three, four, or five years of age, depending upon the country. (The specific ages covered for in particular country may be determined by consulting the full report on that country's DHS, which may be found at: www.measuredhs.com/countries.) - 39 - C. NUTRITIONAL STATUS Children 3, 4, 5 Moderate stunting (height-for-age): percent of children with a height-for-age Z-score of between ­2 and ­3 standard deviations of the median reference standard for their age (as defined in fn. 4). Severe stunting (height-for-age): percent of children with a height-for-age Z-score of below ­3 standard deviations of the median reference standard for their age (as defined in fn. 4). Moderate underweight (weight-for-age): percent of children with a weight-for-age Z-score of between ­2 and ­3 standard deviations of the median reference standard for their age (as defined in fn. 4). Severe underweight (weight-for-age): percent of children with a weight-for-age Z-score of below ­3 standard deviations of the median reference standard for their age (as defined in fn. 4). Mild anemia: percent of children with a hemoglobin level of between 10.0g/dl and 10.9 g/dl, the World Health Organization criterion for mild anemia. Moderate anemia: percent of children with a hemoglobin level of between 7.0g/dl and 9.9g/dl, the World Health Organization criterion for moderate anemia. Severe anemia: percent of children with a hemoglobin level of below 7.0g/dl, the World Health Organization criterion for severe anemia. Women 6, 7 Malnutrition: percent of women aged 15-49 years with a Body Mass Index (BMI) of less than 18.5, where BMI ­ commonly used to indicate adult nutritional status ­ is defined as weight in kilograms divided by the square of height in meters. Mild anemia: percent of women aged 15-49 years with a hemoglobin level of between 10.0g/dl and 10.9g/dl for pregnant women and between 10.0g/dl and 11.9g/dl for non-pregnant women, the World Health Organization criterion for mild anemia. Moderate anemia: percent of women aged 15-49 years with a hemoglobin level of between 7.0g/dl and 9.9g/dl, the World Health Organization criterion for moderate anemia. Severe anemia: percent of women aged 15-49 years with a hemoglobin level of less than 7.0g/dl, the World Health Organization criterion for severe anemia. 3 All figures related to children's nutrition status refer to children under three, four, or five years of age, depending upon the country. (The specific ages covered for in particular country may be determined by consulting the full report on the DHS of the country concerned, which is available at: www.measuredhs.com/countries.) 4 The reference standards used for stunting and underweight are those established in the 1970s by the World Health Organization, the U.S. Centers for Disease Control, and the U.S. National Center for Health Statistics. Updated stunting and underweight figures based on the recently-released, 2006 World Health Organization reference standards are currently under preparation. When complete, they will be available at: www.worldbank.org/povertyandhealth/ countrydata. 5The anemia figures for children living at an altitude above 1,000 meters have been adjusted to reflect the higher level of hemoglobin required. 6In some countries, the BMI is presented for all women; in others, the figure is available only for mothers of children under five years of age. The reference population for any given country can be determined by consulting the full report on the DHS for the country concerned. An electronic version of this report is located at: www.measuredhs.com/ countries. 7 Anemia cut-off points for respondents who live at an altitude above 1,000 meters and/or who smoke have been adjusted to account for their higher hemoglobin requirements. - 40 - D. FEMALE CIRCUMCISION Prevalence of Circumcision Girls: percent of women aged 15-49 years with one or more daughters, at least one of whom had been circumcised. Women: percent of women aged 15-49 years who had been circumcised. Prevalence of Occlusion Girls: percent of women aged 15-49 years with one or more daughters, at least one of whom had been circumcised with the vaginal area sewn closed. Women: percent of women aged 15-49 years whose vaginal area had been sewn closed. E. SEXUALLY TRANSMITTED DISEASES Prevalence of Genital Discharge Women: percent of women aged 15-49 years who had had abnormal genital discharge in the twelve months before the survey. Men: percent of men aged 15-54 years who had had abnormal genital discharge in the twelve months before the survey. Prevalence of Genital Ulcer or Sore Women: percent of women aged 15-49 years who had had a genital ulcer or sore in the twelve months before the survey. Men: percent of men aged 15-54 years who had had a genital ulcer or sore in the twelve months before the survey. - 41 - Part II: INTERMEDIATE DETERMINANTS OF HNP STATUS ­ HEALTH SERVICE USE A. CHILDHOOD IMMUNIZATION 8 BCG coverage: percent of children who had received a dose of BCG vaccine by the time of the survey. Measles coverage: percent of children who had received a dose of measles vaccine by the time of the survey. DPT coverage: percent of children who had received three doses of DPT vaccine by the time of the survey. Full basic coverage: percent of children who had received a dose of BCG vaccine, measles vaccine, and three doses of DPT and polio vaccines by the time of the survey, excluding polio vaccine given at birth. No basic coverage: percent of children who had received no vaccination against the six early- childhood diseases (TB, measles, polio, diphtheria, pertusis, and tetanus) by the time of the survey. Hepatitis B coverage: percent of children who had received three doses of hepatitis B vaccine by the time of the survey. Yellow fever coverage: percent of children who had received a dose of yellow fever vaccine by the time of the survey. B. TREATMENT OF CHILDHOOD ILLNESSES 9 Treatment of Fever Medical treatment of fever: percent of children with fever, with or without cough or rapid breathing, in the two weeks before the survey who had sought medical advice for fever from any health facility or health provider, whether public or private. Treatment in a public facility: percent of children with fever, with or without cough or rapid breathing, in the two weeks before the survey who had sought medical advice for fever from a public-sector health facility or provider (as defined in fn. 9). Treatment in a private facility: percent of children with fever, with or without cough or rapid breathing, in the two weeks before the survey who had sought medical advice for fever from a private-sector health facility or provider (as defined in fn. 9). 8Childhood immunization figures refer to rates among children 12-23 months of age in all countries except those in Latin America and the Caribbean. There, the figures refer to rates among children 18-29 months of age. All figures are based on information recorded on the child's vaccination card; or, in cases where a card was not seen by the interviewer, on the mother's report. 9Figures for illness treatment in a public facility refer to treatment in government hospitals, health centers, health posts, or dispensaries; or in facilities operated by government-affiliated social securing programs. Figures for treatment in private facilities cover treatment in private hospitals or clinics, in private doctors' offices, or in facilities operated by other private medical providers (such as non-governmental organizations) as defined in the country concerned; but exclude treatment obtained in private pharmacies or shops. - 42 - Treatment of Acute Respiratory Infection (ARI) Medical treatment of ARI: percent of children with a cough and rapid breathing in the two weeks before the survey who had been taken for treatment at any medical facility or provider, whether public or private. Treatment in a public facility: percent of children with a cough and rapid breathing in the two weeks before the survey who had been taken for treatment at a public-sector health facility or provider (as defined in fn. 9). Treatment in a private facility: percent of children with a cough and rapid breathing in the two weeks before the survey who had been taken for treatment at a private-sector health facility or provider (as defined in fn. 9). Treatment of Diarrhea Use of oral rehydration therapy: percent of children with diarrhea in the two weeks before the survey who had received oral rehydration therapy (ORT) (defined as including consumption of oral rehydration salts, other recommended home fluids, or other increased liquids). Medical treatment of diarrhea: percent of children with diarrhea in the two weeks before the survey who had been taken for treatment at any medical facility or provider, whether public or private. Treatment in a public facility: percent of children with diarrhea in the two weeks before the survey who had been taken for treatment at a public-sector health facility or provider (as defined in fn. 9). Treatment in a private facility: percent of children with diarrhea in the two weeks before the survey who had been taken for treatment at a private-sector health facility or provider (as defined in fn. 9). C. ANTENATAL AND DELIVERY CARE 10 Antenatal Care (ANC) Visits To a medically-trained person: percent of women with one or more births in the five years before the survey who had received at least one antenatal care consultation from a medically- trained person (as defined in fn. 10) before her most recent birth. To a doctor: percent of women with one or more births in the five years before the survey who had received at least one antenatal care consultation from a doctor before her most recent birth. To a nurse or trained midwife: percent of women with one or more births in the five years before the survey who had received at least one antenatal care consultation from a nurse or trained midwife (as defined in fn. 10) before her most recent birth. Multiple visits to a medically-trained person: percent of women with one or more births in the five years before the survey who had received at least three antenatal care consultations from any medically-trained provider (as defined in fn. 10) before her most recent birth. 10When speaking of antenatal and delivery care, medically-trained persons are defined as doctors, nurses, and trained midwives. The definition excludes traditional midwives or other traditional birth attendants, whether trained or untrained. - 43 - Antenatal Care (ANC) Content Tetanus toxoid: percent of women with one or more births in the five years before the survey who had received at least one tetanus toxoid injection during her most recent pregnancy. Prophylactic antimalarial treatment: percent of women with one or more births in the five years before the survey who had received prophylactic treatment with any anti-malarial drug during her most recent pregnancy. Iron supplementation: percent of women with one or more births in the five years before the survey who had taken iron tablets during her most recent pregnancy. Delivery Attendance By a medically-trained person: percent of births in the five years before the survey attended by a medically-trained person (as defined in fn. 10). By a doctor: percent of births in the five years before the survey attended by a doctor. By a nurse or trained midwife: percent of births in the five years before the survey attended to by a nurse or a trained midwife (as defined in fn. 10). In a public facility: percent of all deliveries in the five years before the survey occurring in a public-sector health facility (as defined in fn. 9). In a private facility: percent of all deliveries in the five years before the survey occurring in a private-sector health facility (as defined in fn. 9). At home: percent of all deliveries in the five years before the survey occurring at home (defined as the woman's own or any other home). D. CONTRACEPTIVE SERVICES Contraceptive Prevalence 11 Women: percent of married or in-union women aged 15-49 years who used any modern means of contraception (as defined in fn. 11). Men: percent of married or in-union men aged 15-54 years who used any modern means of contraception (as defined in fn. 11). Source of Contraception - Public Sector Women: percent of married women who obtained their current method of contraception from a public-sector health facility or provider (as defined in fn. 9). Men: percent of married men who obtained their current method of contraception from a public- sector health facility or provider (as defined in fn. 9). 11Figures refer to use of modern means of contraception, defined as male/female sterilization, oral contraceptive pill, contraceptive injection, intrauterine device, male/female condom, diaphragm, cervical cap, contraceptive jelly or foam, implant, or some country-specific modern method. - 44 - Source of Contraception - Private Sector Women: percent of married women who obtained their current method of contraception from a private-sector health facility or provider (as defined in fn. 9, except that private pharmacies and shops are included rather than excluded). Men: percent of married women who obtained their current method of contraception from a private-sector health facility or provider (as defined in fn. 9, except that private pharmacies and shops are included rather than excluded). E. TREATMENT OF ADULT ILLNESSES Treatment of Genital Discharge, Ulcer, or Sore Women: percent of women with genital discharge, ulcer, or sore who sought any medical treatment for resulting symptoms. Men: percent of men with genital discharge, ulcer, or sore who sought any medical treatment for resulting symptoms. Treatment of Genital Discharge, Ulcer, or Sore in a Public Facility Women: percent of women with genital discharge, ulcer, or sore who sought treatment from a public-sector health facility or provider (as defined in fn. 9). Men: percent of men with genital discharge, ulcer, or sore who sought treatment from a public- sector health facility or provider (as defined in fn. 9). Voluntary Counseling and Testing for HIV/AIDS Women: percent of women aged 15-49 years who had been tested for HIV at any time before the survey. Men: percent of men aged 15-54 years who had been tested for HIV at any time before the survey. - 45 - Part III: INTERMEDIATE DETERMINANTS OF HNP STATUS ­ INDIVIDUAL AND HOUSEHOLD BEHAVIOR A. HYGIENIC PRACTICES Disposal of Children's Stools Sanitary disposal: percent of mothers with at least one child under five years of age who disposed of the stools of their youngest child in a sanitary manner (defined as dropping stool into a latrine, burying it, or using disposable diapers). Handwashing Wash hands prior to preparing food: percent of women aged 15-49 years preparing meals who washed hands before handling food. Handwashing facilities in household: percent of households that had hand-washing materials or facilities, as determined by direct observation of interviewers. B. BEDNET OWNERSHIP AND USE Bednet Ownership Bednet ownership: percent of households owning one or more bednets. Treated bednet ownership: percent of households owning one or more bednets that had recently been treated with insecticides. Bednet Use By children: percent of households with at least one child under five years of age, some or all of whom had slept under a bednet the night before the survey. By pregnant women: percent of currently pregnant women who had slept under a bednet the night before the survey. C. BREASTFEEDING Exclusive breastfeeding: percent of children 0-3 months of age who had received only breast milk in the 24 hours before the survey. Timely complementary feeding: percent of children 6-9 months of age who had received breast milk and solid or semi-solid foods in the twenty-four hours before the survey. Bottle-feeding: percent of children under 12 months of age who had received any food or drink from a bottle with a nipple in the twenty-four hours before the survey. - 46 - D. MICRONUTRIENT CONSUMPTION Iodized Salt Availability of iodized salt in household: percent of households with cooking salt testing positive for iodine/iodate at the recommended level of 15 or 25 parts per million or more (depending on the country). 12 Vitamin A Children: percent of children13 who had received at least one dose of vitamin A in the six months before the survey, as reported by the mothers. Women: percent of women who had received a dose of vitamin A within two months of the last birth, in the five years before the survey. E. TOBACCO AND ALCOHOL USE Tobacco 14 Women: percent of women aged 15-49 years who currently were smoking or chewing tobacco products. Men: percent of men aged 15-54 years who currently were smoking or chewing tobacco products. Alcohol Women: percent of women aged 15-49 years who had gotten intoxicated due to excessive consumption of alcohol in the three months before the survey. Men: percent of men aged 15-54 years who had gotten intoxicated due to excessive consumption of alcohol in the three months before the survey. F. SEXUAL PRACTICES Non-Regular Sexual Partnerships Women: percent of women aged 15-49 years who had had sex with a non-regular partner at least once in the twelve months before the survey. Men: percent of men aged 15-54 years who had had sex with a non-regular partner at least once in the twelve months before the survey. 12Which of these two levels is recommended in any particular country may be determined by consulting the full report on that country's DHS, which may be found at: www.measuredhs.com/countries. 13Figures refer to children over six months of age and under three, four, or five years of age, depending upon the country. (The specific ages covered for in a particular country may be determined by consulting the full report on that country's DHS, which is available at: www.measuredhs.com/countries.) 14Tobacco products include cigarettes, pipes, cigars, leaves, etc. - 47 - Condom Usage with Non-Regular Partner Women: percent of women aged 15-49 years with non-regular sexual partner who had used a condom in the last sexual intercourse with such a partner in the twelve months before the survey. Men: percent of men aged 15-54 years with non-regular sexual partner who had used a condom in the last sexual intercourse with such a partner in the twelve months before the survey. G. DOMESTIC VIOLENCE Ever experienced violence: percent of women aged 15-49 years who had ever been hit or beaten by current or former husband/partner. Experienced violence in past year: percent of women aged 15-49 years who had been hit or beaten by current or former husband/partner in the twelve months before the survey. - 48 - Part IV: UNDERLYING DETERMINANTS OF HNP STATUS A. EDUCATION School Completion Women: percent of women aged 15-49 years who had completed the fifth grade. Men: percent of men aged 15-54 years who had completed the fifth grade. School Participation Girls: percent of girls aged 6-10 years who were attending school at the time of the survey. Boys: percent of boys aged 6-10 years who were attending school at the time of the survey. B. EXPOSURE TO MASS MEDIA Newspaper Readership Women: percent of women aged 15-49 years who read a newspaper at least once a week. Men: percent of men aged 15-54 years who read a newspaper at least once a week. Radio Listenership Women: percent of women aged 15-49 years who listened to radio at least once a week. Men: percent of men aged 15-54 years who listened to radio at least once a week. Television Viewership Women: percent of women aged 15-49 years who watched television at least once a week. Men: percent of men aged 15-54 years who watched television at least once a week. C. KNOWLEDGE AND ATTITUDES ABOUT HIV/AIDS Knowledge about Sexual Transmission of HIV/AIDS 15 Women: percent of women aged 15-49 years who knew of HIV/AIDS and of at least one of the following ways to avoid it through interruption of its sexual transmission route: abstinence; using a condom; avoiding multiple sex partners, sex with prostitutes, and unprotected homosexual sex. Men: percent of men aged 15-54 years who knew of HIV/AIDS and of at least one of the ways to avoid HIV/AIDS referred to in the preceding definition. 15In most countries, the survey sample included both married and unmarried individuals. Where this was the case, all respondents, regardless of marital status, were asked the question covered in this section. Where the survey covered only individuals who were or had been married, the data pertain only to individuals who had ever been married. (The marital status of people covered for in particular country is indicated in the full report on that country's DHS, which is located at: www.measuredhs.com/countries.) - 49 - Knowledge about Mother-to-Child Transmission of HIV/AIDS Women: percent of women aged 15-49 years who knew of at least one way HIV/AIDS can be transmitted from mother to child during pregnancy, delivery, or breastfeeding. Men: percent of men aged 15-54 years who knew of at least one way HIV/AIDS can be transmitted from mother to child during pregnancy, delivery, or breastfeeding. Attitudes toward HIV/AIDS Women: percent of women aged 15-49 years who believed that people with HIV/AIDS should be allowed to continue working or that HIV test results should remain confidential. Men: percent of men aged 15-54 years who believed that people with HIV/AIDS should be allowed to continue working or that HIV test results should remain confidential. D. STATUS OF WOMEN Household Decisionmaking Can seek own health care: percent of women age 15-49 years who could decide by themselves to seek their own health care. Can seek children's health care: percent of women aged 15-49 years, whose children live with them, who could decide by themselves to seek health care for their children. Can make daily household purchases: percent of women aged 15-49 years who could decide by themselves or jointly with others to make daily household purchases. Can make large household purchases: percent of women aged 15-49 years who could decide by themselves or jointly with others to make large household purchases. Can make meal-related decisions: percent of women aged 15-49 years who could decide by themselves what food to cook daily. Freedom of Movement Can travel to visit family, relatives: percent of women aged 15-49 years who could decide by themselves to visit family and relatives. Other Decisionmaking, Attitudes Can decide how to spend own money: percent of women aged 15-49 years who work for cash who could decide by themselves on how to use the money they earn. Can decide whether to have sex: percent of women aged 15-49 years agreeing that they can refuse to have sex with their husband for at least one of the following reasons: he has a sexually- transmitted disease; he has had sexual relations with another woman; or the woman is tired, not in mood, or recently has given birth. Justify domestic violence: percent of women aged 15-49 years believing that a husband/male partner would be justified in beating his wife/female partner for at least one of the following reasons: he suspects her of being unfaithful; she argues with him; she goes out without telling him; she neglects the children; she burns the food; or other, country-specific reasons (for example, she shows disrespect for her in-laws or her family does not give the expected dowry). - 50 - E. ORPHANHOOD Maternal orphan prevalence: percent of children under 15 years of age whose natural mother had died before the survey. Paternal orphan prevalence: percent of children under 15 years of age whose natural father had died before the survey. Double orphan prevalence: percent of children under 15 years of age both of whose natural parents had died before the survey. - 51 - DATA AND METHODS Any assessment of the figures featured in this report requires an appreciation of how they were prepared. The first need is to understand the basic features of the data and methods employed. A. SOURCE OF FIGURES The figures appearing in this report are all derived from data collected under the Demographic and Health Surveys (DHS) program conducted by ORC Macro, with support from the U.S. Agency for International Development and other external assistance organizations. Large DHS household surveys have been carried out, usually at periodic intervals, in approximately seventy- five countries across Africa, Asia, Latin America, the Middle East, and the former Soviet Union.16 This series of reports covers the fifty-six of those countries that had one or more DHS surveys undertaken since 1990, for which data were publicly available as of June 2006. (Annex C is a list of the countries for which reports have been prepared.) In each country, the DHS program has gathered information on a large number of indicators about health, nutrition, and population (hnp) status and service use; about relevant behaviors of household members; and about household characteristics like those described below. It has done this through a set of questionnaires, similar in all countries, to collect data at the individual, household, and community levels. The data presented here draw on responses to the individual and household questionnaires. In most cases, they are based on responses from women or other family members interviewed. The principal exceptions concern nutritional status, which is based on anthropometric measurement; immunization, which typically relies to the extent possible on record cards maintained at the household level; and those other items where a source other than interviewer response is specifically identified. B. MEASUREMENT OF ECONOMIC STATUS Wealth or Asset Approach Economic status has been expressed in terms of wealth or assets: specifically, on the basis of information about household characteristics gathered through the DHS household questionnaire. (Such information was normally provided for at least 25-30, and often many more, characteristics like the presence, availability, or use of a fan, radio receiver, or automobile; housing materials like wood or concrete flooring, tile or tin roofing, or cement block walls; superior sources of water like piped or a protected well; and other attributes related to economic status.) 16Further information about the DHS program is available at the program's website: www.measuredhs.com. - 53 - Index Construction A single, consolidated index of living standards17 was constructed by using principal components analysis (PCA) to generate a weight for each household item with available information. A wealth index score was calculated for each household by weighting the response with respect to each item pertaining to that household by the coefficient of the first principal component as determined by application of principal components analysis, and summing the results. The resulting household scores were standardized in relation to a standard normal distribution with a mean of zero and a standard deviation of one. All individuals usually present in each household were assigned the household's standardized wealth index score, and all individuals in the sample population were ranked according to that score. The sample population was then divided into quintiles of individuals, with all individuals in a single household being assigned to the same quintile. The same standardized household wealth index scores originally derived for the total population sample, as just described, were also used in preparing the disaggregated estimates for female and male members of the sample population, and for rural and urban residents. In preparing those disaggregated estimates, the entire population sample was divided into quintiles of individuals; the females and males, and the rural and urban residents in each quintile of the entire sample were then separated from one another; and the mean for each of the ten resulting subgroups (five female, five male; or five rural, five urban) was calculated. This procedure was carried out separately for each of the surveys covered. C. CALCULATION AND PRESENTATION OF RATES Use of Sampling Weights Rates for all health, nutrition, and population indicators are calculated after applying the DHS sampling weights. (DHS surveys often over-sample certain small subgroups of interest ­ residents of a particular geographic area, for example ­ in order to get sample sizes large enough to produce statistically-significant results. The DHS sampling weights are used to compensate for such over-sampling in order to ensure that the results are representative of the population as a whole and not just of the DHS sample.) Calculation of Total Population Averages The average for the total population presented alongside the quintile-specific rates for each indicator is calculated without reference to quintile divisions. It thus equals the weighted mean of the quintile rates, with the weight assigned to each quintile rate being the proportion of the number of individuals at risk (as defined on p. 59) for the indicator concerned. Sampling Errors Information needed to assess the statistical significance of differences among the quintile-specific rates is presented in three ways: · First, in all the basic tables presented in part I, rates are shown in parentheses or replaced by asterisks in cases where the standard error is likely to be unacceptably high because 17 Such an index is usually referred to as either an "asset index" or a "wealth index." The two expressions are used interchangeably in this report; for ease of communication, "wealth index" appears more frequently despite the inexact correspondence between the items included in the index's construction and those appearing in more conventional, financially-based definitions of wealth. - 54 - of small sample size. The number of observations used to determine how to present the data for the different indicators covered were as follows: Indicator Unit of measure Number of observations used to determine how quintile-specific rate was presented Without With Replaced by parentheses parentheses asterisk Infant and child Number of deaths >500 250-499 <250 mortality Total and adolescent Number of births >250 125-249 <125 fertility All other indicators Number of >50 25-49 <25 individuals · Second, the standard error for each quintile-specific rate (except for any rate replaced by an asterisk) appearing in the total population table is provided in part III.B. (Standard errors for the quintile-specific rates presented in the female-male and rural-urban tables are not available.) · Third, the right-hand column of the total population table provides the standard error for the concentration index, one of the measures of inequality shown, as indicated below. D. MEASUREMENT OF INEQUALITY Accompanying each of the indicators presented in the total population table are the values for three statistical measures of inequality: · Low/High Quintile Ratio: the ratio between the rate prevailing in the lowest (poorest) population quintile and that found in the highest (least poor) quintile. · Low-High Quintile Difference: the value of the lowest quintile minus the value of the highest, expressed as an absolute value. · Concentration Index: twice the area in a Lorenz-type diagram between the line of equality and the concentration curve for the indicator in question, the curve being the graph of the cumulative share of the indicator against the cumulative share in the asset distribution. (The value, which can range from -1 to +1, is negative when the hnp indicator is higher among the poor (e.g., fertility), positive when it is higher among the better-off (e.g., modern contraceptive use), and zero when on balance the indicator shows no systematic relationship with wealth.)18 18Adam Wagstaff, Pierella Paci, and Eddy van Doorslaer, "On the Measurement of Inequalities of Health," Social Science and Medicine 33 (1991): 545-57. (See also chapter eight in the volume by O'Donnell, van Doorslaer, Wagstaff, and Lindelow described in the annotated bibliography that constitutes annex A.) - 55 - DISCUSSION While a basic understanding of the data and methods employed is necessary to adequately appreciate the figures appearing in this report, it is not sufficient. For the application of the approach taken involves many subtleties that also need to be understood. Among the more important are: A. DESCRIPTIVE NATURE OF THE RELATIONSHIPS The hnp-poverty relationships shown in this report are no more than descriptive. They should not be taken to imply any direct causal relationships, for several reasons. One reason is the possibility that it is not wealth or asset possession per se that determine a person's health condition. Rather, the determining factors could be other characteristics (such as education or ethnic background) that are simultaneously associated with both asset ownership and health status. It is also possible that the health-poverty relationships shown are driven primarily by particular items included in the index (e.g., water and sanitation). Should this be the case, improvements in health conditions among the poor might be more effectively brought about by focusing on changing those particular components of the wealth index rather than by a general effort to increase economic status as measured by the index as a whole. B. IMPLICATIONS OF A WEALTH/ASSET APPROACH Wealth or Assets as a Measure of Economic Status Reliance on a wealth index to measure economic status is a rather recent development in research on economic disparities, where such status traditionally has been defined in terms of consumption or income. The principal reason for the choice of the wealth index is pragmatic rather than conceptual: the DHS surveys, which are of interest because of the plethora of hnp information that they contain, do not collect consumption or income data; but they do have detailed information on households' physical characteristics, and on the household-level presence of and access to a wide range of goods and services. While there is some disagreement about the relative merits of using such wealth/asset information or consumption data to measure economic status, several recent studies suggest that the asset-consumption relationship is quite close.19 To the extent this is the case, an index of wealth or asset possession/availability can be taken as a 19See, for example, Deon Filmer and Lant H. Pritchett, "Estimating Wealth Effects without Expenditure ­ or Tears: An Application to Educational Enrollments in States of India," Demography 38, no. 1 (February 2001): 115-32; Shea Rutstein and Kiersten Johnson, The DHS Wealth Index, DHS Comparative Reports No. 6 (Calverton, Maryland, USA: ORC Macro, August 2004) esp. 10-14; Adam Wagstaff and Naoko Watanabe, "What Difference Does the Choice of SES Make in Health Inequality Measurement?" Health Economics 12 (2003): 885-90. - 57 - reasonably satisfactory proxy for consumption, rather than or in addition to serving as an indicator of economic status in its own right. C. ECONOMIC STATUS AS A MEASURE OF SOCIO-ECONOMIC WELL-BEING Like consumption or income, a wealth index defines disparities that are primarily economic. This is by no means the only way to define inter-group inequalities that are of potential concern. Other possibilities include gender, place of residence, education, ethnic background, or other factors associated with social exclusion. Thus the economic perspective provides only a partial view of the multidimensional concepts of poverty, inequality, and inequity. By including tables on female-male and rural-urban inequalities, this report pays adequate attention to two of inequality's other important dimensions to justify the use of the term "socio- economic" rather than simply "economic" in its title. However, the centrality of tabulations based on the wealth index means that the primary focus is on the economic dimension. The justification for this lies not in the greater importance of economic considerations, but rather in the recently-improved ability to analyze and thus begin dealing with them. Until the development of the wealth/asset approach, the assessment of economic status had been based on consumption, expenditures, or income, all of which are far more difficult to measure than such other, non- economic dimensions of inequality as gender, ethnic identity, educational level, and place of residence. As a result, assessments of health inequalities by economic status had lagged well behind measurements in terms of these other dimensions, especially gender and education. The focus on inequality's economic aspect applied here represents an effort to redress this imbalance. D. INDEX CONSTRUCTION Choice of Items Use of a wealth index requires decisions about which items to include in it. In the case of secondary analyses like the one featured in this report, the choice is limited to those items included in the data sets being used. But even with this constraint, there nonetheless remains considerable room for choice, given the large number of items for which information is collected by the DHS. The decision made in preparing this report was to include all items in each DHS household questionnaire that relate to ownership of household goods; to dwelling unit construction and characteristics; and to access to services and resources like electricity, water, and sanitation facilities. Also included were other potential indicators of wealth, such as live-in domestic servants. This decision, admittedly somewhat arbitrary, has both advantages and disadvantages. The principal advantage is practical: use of a large number of assets increases the degree of variation across household asset scores and facilitates a more regular distribution of individuals across quintiles. It also reduces the possibility of subjectivity in selecting only some of the variables for inclusion on some a priori basis; and it may increase a wealth index's accuracy as a proxy for consumption. However, including all variables is far from satisfying conceptually. For example, it means failing to discriminate with respect to the items' differing natures. It is not clear, for instance, whether access to water, sanitation, electricity, or other publicly-provided resources should be included in an index that purports to measure private household wealth. Further, many items that are candidates for inclusion in a DHS-based wealth index might be seen as directly influencing health status: water and sanitation for infant and child mortality, for - 58 - example. It would be desirable to include quintile-specific estimates for such items; but to the extent that such items have large index coefficients, any estimates for those items would be suspect. Such items appear to be relatively few and of limited statistical significance in the index used here. However, for the sake of caution, quintile-specific estimates for items appearing in the index have nonetheless been excluded from the basic tables and appear only in supporting table III.C Additional issues arise when comparing the findings for two different points in time covered in the basic tables. Because the nature and number of asset questions included in DHS surveys has been evolving, the items included in the wealth index differ somewhat for each of the surveys reported upon. As such, the results presented in the basic tables might differ to some extent from findings produced by some other approach, such as including in the index only those items appearing in each survey covered. Weighting of Items A further decision required in construction of an index concerns the weight to attach to each of the respective items. As noted earlier, the method used in this report is principal components analysis (PCA). Adoption of this method was based on the findings, referred to earlier, that its use resulted in outcomes that approximated reasonably well those produced by taking a consumption or expenditure approach. Further, it often provides greater discrimination in economic status than does the use of consumption/expenditures. It has also emerged as the standard approach for use in analyses of the sort presented here, so that its adoption is largely non-controversial. Yet this choice, too, is not without an arbitrary aspect; for alternative plausible methods exist. Examples include the "inverse possession" approach, which gives more weight to items possessed by only a few and less to those possessed by many;20 or, perhaps, the common practice of simply assigning the same weight to each index item. Also, the weights for any particular item vary from survey to survey, since the weights were determined separately for the population of each survey included in the basic tables. The results thus produced can be expected to differ from those generated in some other manner, such as generating common weights for all the surveys covered by pooling the data sets. Use of Principal Components Analysis with Dichotomous Variables An additional issue concerns the use of a technique like PCA, developed for use with continuous variables, in the construction of an index based primarily on dichotomous variables. While legitimate in principle, any reservations in this regard are of limited practical consequence, since the considerable experimentation undertaken in preparation for the tabulations presented here indicated that any inaccuracy introduced by applying PCA to the analysis of the dichotomous values used is minimal. Economies of Scale Calculating the values for a household wealth index also requires a decision concerning economies of scale that exist in the households covered. The calculations presented here assume complete economies of scale. The implicit assumption is that additional members do not add to household expenses on items included in the index. 20Saul S. Morris et al., "Validity of Rapid Estimates of Household Wealth and Income for Health Surveys in Rural Africa," Journal of Epidemiology and Community Health 54 (2000): 381-87. - 59 - E. DEFINITION OF QUINTILES Quintiles of Individuals As noted earlier, the quintile-specific figures presented in this report refer to quintiles of individuals in the household population. Such quintiles need to be distinguished from quintiles of households or quintiles of only those people in the population who are "at risk": that is, subject to the particular condition, eligible for the particular service, or capable of behaving in a particular way (children born alive for infant and under-five mortality, for example; or adult men and women for condom use or non-regular sexual partnerships). The expression of findings in terms of quintiles of individuals has several implications: · Because fertility is often higher in lower economic households than among better-off ones, the number of individuals per household will frequently be larger among the poor than among higher-income groups. In such cases, the number of households will vary systematically across quintiles of individuals, and the results expressed in terms of quintiles of households can differ significantly from those presented here. · The proportion of individuals "at risk" with regard to a particular indicator is also likely to vary across quintiles in many cases. (For example, in cases where fertility is higher among poor people, a higher-than-average proportion of poor populations will consist of newborns at risk from infant mortality, young children subject to malnutrition, and pregnant women for whom antenatal care is relevant.) To facilitate the work of any investigators wishing to undertake calculations based on people at risk, the number of such people in each quintile of individuals is shown in part III.A. · As previously indicated, the population average figure provided for each indicator is equivalent to the weighted sum of the quintile rates for that indicator, where the weight assigned to each quintile rate is the number of people at risk in each quintile as presented in part III.A. As a result of this weighting, the population average will usually differ from a simple mean of the population quintile estimates. Quintiles of Males and Females, of Rural and Urban Residents As also reported in the data and methods section, the tables on rural and urban residents and on men and women were prepared using the same asset scores as for the total population; and rural- urban residents and females-males were separated from one another only after the entire sample had been disaggregated into quintiles of individuals. This means that the figures given in the rural-urban and female-male tables refer to females-males and rural-urban residents belonging to each quintile of individuals in the total population, as distinct from quintiles of females, of males, of rural residents, or of urban residents alone. The consequence of this distinction is particularly evident with regard to rural and urban residents. Since rural residents tend to be poorer than urban dwellers, they normally form a considerably higher proportion of individuals in the lower economic quintiles of the total population than in the higher ones. Conversely, urban residents tend to be concentrated in the higher economic groups. As a result, the number of individuals in each of the urban and rural quintiles usually varies greatly and systematically; and when this is the case, the figures presented in the rural-urban tables can differ significantly from those produced by a computation procedure that places the same number of rural and urban residents in each rural quintile or each urban quintile. (The results may also differ significantly from application of an approach featuring the separate calculation of index values for urban and for rural groups. While such separate index values may well be preferable conceptually, their calculation involves complexities that prevented their preparation for this report.) - 60 - F. COMPARISON OF QUINTILES ACROSS COUNTRIES Reliance on population quintiles as basic presentational format for the data appearing in this report implicitly incorporates a relative concept of poverty. This differs from an absolute concept of poverty under which the population would be divided into groups of different sizes according to some absolute standard of living (such as people earning less than one dollar a day, between one and two dollars a day, and more than two dollars a day). This means that, when comparing values of an indicator among people in a given quintile across countries, the comparison is between groups of people whose economic status can be quite different. The lowest quintile of a Latin American population, for example, will usually be considerably better-off than the lowest quintile in an African country. G. COMPARISON OF QUINTILES OVER TIME Another implication is that the wealth status of any given quintile within a particular country is likely to change over time. For instance, when a country is progressing economically, the wealth of the households in the population will tend to increase. This will raise the average asset score in most, possibly all population quintiles. As a result, the living standard enjoyed by individuals in any quintile covered by a recent survey is likely to be higher than that of individuals in that same quintile as measured in a prior survey. H. STATISTICAL INDICATORS OF INEQUALITY The available statistical indicators of inequality are far too numerous to permit use of more than a small proportion of them in presenting the findings featured in this report. The three indicators employed have been selected to provide a wide range of perspectives. Two are designed for ease of understanding, the third for greater technical accuracy. The low/high quintile ratio and low-high quintile difference are the two presented for ease of understanding. The former is a relative measure, the latter an absolute measure that can produce a significantly different impression from that provided by the former. The concentration index is provided for the benefit of technical specialists wishing greater accuracy. It measures the degree of inequality in an hnp indicator across the full wealth index distribution, rather than differences between only two of the five quintiles, and also reflects the relative size of the different asset-based divisions of the study population. I. COMPARABILITY WITH OTHER REPORTS Tabulations similar to those presented here can also be found in the initial series of hnp/poverty country reports, issued in 2000, and in the recent country reports issued by the DHS program. The figures presented in those reports normally resemble quite closely those appearing here for any given indicator; but there are often slight differences for one or more of several reasons. The most common is a difference in the definition of the indicator in question. (These differences are usually small and subtle. But there is one important exception: the definition of moderate malnutrition among children. In the 2000 reports, this was defined as second and third degree malnutrition taken together. Here, it is defined as second degree malnutrition alone.) Another reason, with respect to infant and child mortality, is that the figures in the DHS documents are typically based on experience during the five years before the survey in question, rather than - 61 - during the ten previous years as in this report. A further frequent reason is the use of an improved computational technique. In addition, asset-based, quintile-specific tabulations of hnp indicators have begun to appear in an increasing number of other documents. Given the basic similarity of approach, such tabulations usually produce results that are generally congruent with those shown in part I of this report. However, significant divergences have occasionally been reported; and the absence of adequately detailed information about data and methods often prevents any fully-satisfying understanding of the approaches used. As a result, occasional doubts and frequent uncertainties about approach comparability remain. - 62 - PART IV. SUPPORTING TABLES, 2001 A. SAMPLE SIZES B. STANDARD ERRORS C. ASSET DISTRIBUTION AND WEIGHTS Nicaragua 2001 - SAMPLE SIZES TOTAL SAMPLE Indicator Wealth Quintiles Pop. Low 2nd 3rd 4th High Total Number of household members All 11,974 11,983 11,995 11,964 11,981 59,898 Urban 583 3,262 7,920 10,452 11,775 33,992 Rural 11,391 8,721 4,075 1,513 206 25,906 Female 5,772 5,851 6,077 6,163 6,530 30,393 Male 6,203 6,132 5,918 5,801 5,451 29,505 Part I: HNP STATUS Indicator Wealth Quintiles Pop. Low 2nd 3rd 4th High Total Mortality rates All 3,775 3,113 2,645 2,417 2,030 13,980 Urban 156 860 1,808 2,142 1,993 6,960 Rural 3,619 2,253 837 275 37 7,021 Female 1,845 1,504 1,274 1,182 990 6,794 Male 1,931 1,609 1,370 1,236 1,040 7,187 Prevalence of fever, diarrhea, acute respiratory infection All 1,713 1,352 1,191 1,087 953 6,295 Urban 61 395 821 945 937 3,159 Rural 1,652 957 370 142 16 3,137 Female 838 680 579 509 468 3,074 Male 875 672 612 578 485 3,222 Total fertility rate All 5,573 6,252 7,164 8,211 9,059 36,260 Urban 268 1,757 4,780 7,220 8,925 22,950 Rural 5,305 4,495 2,384 991 134 13,309 Age-specific fertility rate 15-19 All 1,338 1,582 1,943 2,056 2,061 8,980 Urban 52 426 1,308 1,781 2,028 5,595 Rural 1,286 1,156 635 276 32 3,385 Children's nutritional status All 1,456 1,215 1,067 979 800 5,516 Urban 50 360 728 846 791 2,775 Rural 1,406 854 339 133 9 2,741 Female 713 614 521 459 405 2,712 Male 744 601 546 519 394 2,804 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 - 65 - Nicaragua 2001 - SAMPLE SIZES Part I: HNP STATUS (Cont.) Indicator Wealth Quintiles Pop. Low 2nd 3rd 4th High Total Women's nutritional status All 1,695 2,005 2,370 2,736 3,030 11,838 Urban 87 561 1,574 2,404 2,985 7,611 Rural 1,609 1,445 797 332 45 4,228 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 1,694 1,864 2,021 2,212 2,378 10,169 Urban Female 84 534 1,371 1,947 2,345 6,281 Rural Female 1,610 1,330 650 264 33 3,887 Male na na na na na na Urban Male na na na na na na Rural Male na na na na na na - 66 - Nicaragua 2001 - SAMPLE SIZES Part II: Intermediate Determinants of HNP Status - HNP SERVICE USE Indicator Wealth Quintiles Pop. Low 2nd 3rd 4th High Total Immunization coverage All 391 295 257 225 202 1,370 Urban 19 93 159 191 198 660 Rural 371 202 98 34 3 708 Female 207 153 114 100 95 669 Male 184 142 144 125 107 702 Treatment of fever All 448 378 296 243 201 1,567 Urban 14 121 209 217 197 758 Rural 435 257 87 27 4 810 Female 226 175 145 151 108 805 Male 222 204 151 93 92 762 Treatment of acute respiratory infection All 591 465 371 292 223 1,942 Urban 18 145 258 257 222 900 Rural 573 320 114 35 1 1,043 Female 278 238 188 123 102 929 Male 313 227 184 168 121 1,013 Treatment of diarrhea All 265 190 161 128 78 822 Urban 10 59 115 111 76 371 Rural 255 131 46 17 3 452 Female 135 90 81 52 30 388 Male 130 99 80 77 48 434 Antenatal and delivery care All 1,138 1,031 948 908 823 4,848 Urban 48 305 654 794 808 2,609 Rural 1,090 727 293 114 15 2,239 Contraceptive prevalence Female 1,402 1,420 1,434 1,577 1,590 7,424 Urban Female 54 354 936 1,368 1,560 4,272 Rural Female 1,347 1,066 498 209 30 3,150 Male na na na na na na Urban Male na na na na na na Rural Male na na na na na na Contraceptive source Female 704 934 1,021 1,121 1,129 4,909 Urban Female 33 253 666 963 1,105 3,019 Rural Female 671 681 355 159 24 1,890 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 267 272 324 329 299 1,491 Urban Female 13 72 207 299 297 888 Rural Female 254 200 118 30 2 604 Male na na na na na na Urban Male na na na na na na Rural Male na na na na na na - 67 - Nicaragua 2001 - SAMPLE SIZES Part III: Intermediate Determinants of HNP Status - INDIVIDUAL AND HOUSEHOLD BEHAVIOR Indicator Wealth Quintiles Pop. Low 2nd 3rd 4th High Total Sanitary disposal of stools All na na na na na na Urban na na na na na na Rural na na na na na na Wash hands prior to preparing food All 2,010 2,273 2,611 2,931 3,234 13,059 Urban 96 637 1,747 2,578 3,187 8,245 Rural 1,914 1,636 864 353 47 4,814 Handwashing facilities in household? All 1,943 2,105 2,175 2,319 2,488 11,030 Urban 101 595 1,412 2,030 2,438 6,576 Rural 1,842 1,510 763 289 50 4,454 Bednet ownership All 1,943 2,105 2,175 2,319 2,488 11,030 Urban 101 595 1,412 2,030 2,438 6,576 Rural 1,842 1,510 763 289 50 4,454 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 164 134 137 113 99 647 Urban 5 39 99 103 97 343 Rural 159 95 39 10 2 305 Exclusive breastfeeding All 98 94 65 67 53 377 Urban 6 26 46 54 53 185 Rural 93 68 19 14 0 194 Female 56 52 37 30 28 203 Male 43 42 28 38 25 176 Timely complementary breastfeeding All 96 63 64 69 62 354 Urban 4 19 53 58 62 196 Rural 91 45 11 11 0 158 Female 49 35 25 28 24 161 Male 47 29 39 41 38 194 Bottle-feeding All 303 234 197 221 186 1,141 Urban 13 67 144 184 185 593 Rural 289 167 53 37 1 547 Female 158 123 96 103 89 569 Male 145 111 101 117 97 571 - 68 - Nicaragua 2001 - SAMPLE SIZES Part III: Intermediate Determinants of HNP Status - INDIVIDUAL AND HOUSEHOLD BEHAVIOR (Cont.) Indicator Wealth Quintiles Pop. Low 2nd 3rd 4th High Total Iodized salt in household All na na na na na na Urban na na na na na na Rural na na na na na na Vitamin A supplementation All 1,570 1,229 1,103 982 866 5,750 Urban 53 359 758 859 850 2,879 Rural 1,517 870 345 123 16 2,871 Female 798 608 563 527 446 2,942 Male 772 621 540 455 421 2,809 Tobacco and alcohol use, casual sexual partners, condom use for casual sex Female 2,010 2,273 2,611 2,931 3,234 13,059 Urban Female 96 637 1,747 2,578 3,187 8,245 Rural Female 1,914 1,636 864 353 47 4,814 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 - 69 - Nicaragua 2001 - SAMPLE SIZES Part IV: UNDERLYING DETERMINANTS OF HNP STATUS Indicator Wealth Quintiles Pop. Low 2nd 3rd 4th High Total School completion (Grade 5) Female 2,322 2,620 2,948 3,271 3,756 14,917 Urban female 110 728 1,974 2,852 3,704 9,368 Rural female 2,212 1,892 974 419 52 5,548 Male 2,557 2,757 2,796 2,989 2,956 14,054 Urban male 115 699 1,811 2,579 2,886 8,090 Rural male 2,442 2,058 985 410 69 5,964 School participation Female 1,050 952 869 775 591 4,237 Urban female 50 277 567 692 580 2,166 Rural female 1,001 675 303 83 11 2,072 Male 1,115 1,068 878 794 611 4,466 Urban male 68 282 590 701 602 2,243 Rural male 1,047 786 288 93 9 2,223 Mass media exposure Female 2,010 2,273 2,611 2,931 3,234 13,060 Urban female 96 637 1,747 2,578 3,187 8,246 Rural female 1,914 1,636 864 353 47 4,814 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 4,884 2,273 2,611 2,931 3,234 15,933 Urban female 96 637 1,747 2,578 3,187 8,245 Rural female 1,914 1,636 864 353 47 4,814 Male na na na na na na Urban male na na na na na na Rural male na na na na na na Household decisionmaking and justification of violence All 2,010 2,273 2,611 2,931 3,234 13,060 Urban 96 637 1,747 2,578 3,187 8,246 Rural 1,914 1,636 864 353 47 4,814 Orphanhood All 5,824 5,281 4,813 4,299 3,358 23,576 Urban 283 1,477 3,250 3,783 3,303 12,096 Rural 5,541 3,804 1,564 516 56 11,480 Female 2,856 2,562 2,378 2,118 1,660 11,575 Male 2,968 2,719 2,435 2,181 1,698 12,001 - 70 - Nicaragua 2001 - 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 3.30 3.77 3.74 4.11 4.15 1.79 Under-five mortality rate 4.04 4.36 4.33 4.41 4.28 2.09 Prevalence of fever 1.29 1.47 1.30 1.73 2.12 0.72 Prevalence of diarrhea 1.15 1.07 1.21 1.32 1.13 0.55 Prevalence of acute respiratory infection 1.35 1.69 1.59 1.79 2.32 0.81 B. Fertility Total fertility rate 0.19 0.14 0.11 0.12 0.13 0.08 Adolescent fertility rate 12.00 10.00 8.00 8.00 7.00 4.00 C. Nutritional status Children: Moderate stunting 1.08 1.10 1.04 0.84 0.91 0.58 Severe stunting 1.11 0.94 0.72 0.73 0.19 0.47 Moderate underweight 1.05 0.86 0.99 0.73 0.70 0.47 Severe underweight 0.47 0.38 0.40 0.46 0.36 0.19 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 0.42 0.33 0.51 0.47 0.59 0.22 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 * * * * * * Women * * * * * * E. Sexually transmitted disease Prevalence of genital discharge: Women 0.85 0.83 0.95 0.88 0.94 0.43 Men na na na na na na Prevalence of genital ulcer: Women 0.41 0.36 0.42 0.41 0.30 0.17 Men na na na na na na - 71 - Nicaragua 2001 - 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 1.56 1.37 1.49 1.34 1.28 0.81 Measles coverage 2.39 1.76 2.57 2.95 2.28 1.19 DPT coverage 2.78 2.14 2.90 3.17 3.91 1.42 Full basic coverage 3.05 2.93 3.03 4.06 4.88 1.64 No basic coverage 1.13 0.85 0.38 0.62 1.28 0.44 Hepatitis B coverage 0.68 0.26 0.65 0.93 2.82 0.52 Yellow fever coverage na na na na na na B. Treatment of childhood illnesses Treatment of fever: Medical treatment of fever 3.03 3.08 3.91 4.31 4.98 1.79 Treatment in a public facility 2.96 3.26 4.05 4.17 5.96 1.79 Treatment in a private facility 0.77 1.46 2.67 2.68 5.40 1.12 Treatment of acute respiratory infection (ARI): Medical treatment of ARI 2.88 2.83 4.01 3.93 3.54 1.65 Treatment in a public facility 2.86 2.93 3.88 3.94 5.66 1.68 Treatment in a private facility 0.69 1.23 2.77 2.91 5.18 1.00 Treatment of diarrhea: Use of oral rehydration therapy 3.10 3.41 4.34 5.74 6.33 2.01 Medical treatment of diarrhea 3.58 3.78 4.33 6.33 7.10 2.08 Treatment in a public facility 3.53 3.64 4.28 5.65 5.93 1.94 Treatment in a private facility 0.46 1.57 3.12 3.40 5.76 1.11 C. Antenatal and delivery care Antenatal care (ANC) visits: To a medically trained person 2.29 1.48 1.30 1.21 1.12 0.91 To a doctor 1.75 1.66 2.38 2.29 2.12 1.05 To a nurse or trained midwife 2.04 1.66 2.49 2.30 2.28 1.07 Multiple visits to a medically trained person 2.57 1.75 1.44 1.44 1.24 1.12 Antenatal care content: Tetanus toxoid 1.70 1.32 1.37 1.38 2.09 0.76 Prophylactic antimalarial treatment na na na na na na Iron supplementation 2.31 1.58 1.46 1.60 1.23 0.97 Delivery attendance: By a medically trained person 1.53 1.18 0.72 0.63 0.32 0.74 By a doctor 2.06 1.91 1.49 1.58 0.92 1.77 By a nurse or trained midwife 1.74 1.83 1.30 1.35 0.87 1.29 In a public facility 2.14 1.95 1.61 1.81 2.38 1.57 In a private facility 0.18 0.32 1.08 1.40 2.45 0.65 At home 2.16 1.94 1.39 1.49 0.81 1.76 D. Contraceptive services Contraceptive prevalence: Women 1.95 1.45 1.32 1.54 1.63 0.83 Men na na na na na na Source of contraception - public sector: Women 1.59 1.42 1.89 2.11 1.88 1.14 Men na na na na na na - 72 - Nicaragua 2001 - 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 1.54 1.33 1.85 2.15 1.94 1.12 Men na na na na na na E. Treatment of adult illnesses Treatment of genital discharge, ulcer, sore: Women 0.86 1.12 1.69 2.15 2.13 0.83 Men na na na na na na Treatment of genital discharge, ulcer, sore in public facilities: Women 0.85 0.83 0.95 0.88 0.94 0.43 Men na na na na na na Voluntary counseling and testing for HIV/AIDS: Women 0.22 0.44 0.65 0.78 0.85 0.40 Men na na na na na na - 73 - Nicaragua 2001 - 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 1.62 1.98 1.73 2.12 2.28 1.35 Handwashing: Wash hands prior to preparing food 0.27 0.27 0.34 0.40 0.62 0.22 Handwashing facilities in household 0.42 2.10 1.92 1.52 0.30 1.87 B. Bednet ownership and use Bednet ownership: Bednet ownership 1.95 1.91 2.01 2.31 2.01 1.24 Treated bednet ownership na na na na na na Bednet use: By children na na na na na na By pregnant women 3.88 5.30 5.43 5.70 4.63 2.57 C. Breastfeeding Exclusive breastfeeding 4.54 5.25 5.92 6.99 5.37 2.85 Timely complementary feeding 4.62 4.79 6.62 6.70 9.63 2.96 Bottle-feeding 2.74 3.35 3.73 4.00 4.08 1.77 D. Micronutrient consumption Iodized salt: Availability of iodized salt in household na na na na na na Vitamin A: Children 2.17 2.12 2.16 2.14 2.66 1.20 Women 1.26 1.54 1.92 1.99 2.23 0.88 E. Tobacco and alcohol use Tobacco: Women 0.33 0.48 0.55 0.61 0.83 0.32 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 0.17 0.22 0.26 0.25 0.33 0.12 Men na na na na na na Condom usage with non-regular partner: Women * 6.10 7.59 5.62 8.65 3.63 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 - 74 - Nicaragua 2001 - 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 1.30 1.26 1.17 1.03 0.82 1.23 Men 1.23 1.19 1.24 1.23 0.70 1.32 School participation: Girls 2.60 1.61 1.44 1.56 1.41 1.16 Boys 2.45 1.80 1.95 1.79 1.94 1.25 B. Exposure to mass media Newspaper readership: Women 0.85 1.28 1.41 1.34 1.44 1.13 Men na na na na na na Radio listenership: Women 1.57 1.17 1.01 0.88 0.75 0.56 Men na na na na na na Television viewership: Women 0.91 1.91 1.24 0.74 0.46 1.49 Men na na na na na na C. Knowledge and attitudes about HIV/AIDS Knowledge about sexual transmission of HIV/AIDS: Women 1.16 1.27 1.37 1.58 1.23 0.94 Men na na na na na na Knowledge about mother-to-child transmission of HIV/AIDS: Women 1.85 1.30 1.11 0.87 0.73 0.82 Men na na na na na na Attitudes toward HIV/AIDS: Women 1.09 1.06 1.08 0.94 1.01 0.52 Men na na na na na na D. Status of women Household decisionmaking: Can seek own health care 1.36 1.13 1.17 1.41 1.36 0.71 Can seek children's health care 0.92 0.44 0.28 0.33 0.52 0.29 Can make daily household purchases na na na na na na Can make large household purchases 1.31 1.13 1.14 1.19 1.32 0.63 Can make meal-related decisions 1.36 1.17 1.35 1.33 1.43 0.70 Freedom of movement: Can travel to visit family/relatives 1.02 0.92 0.98 1.18 1.05 0.57 Other decisionmaking, attitudes: Can decide how to spend own money 2.25 1.50 0.97 0.91 0.97 0.55 Can decide whether to have sex 0.85 0.61 0.64 0.47 0.39 0.33 Justifies domestic violence 1.01 0.94 0.83 0.77 0.61 0.46 E. Orphanhood Paternal orphan prevalence 0.38 0.43 0.46 0.59 0.47 0.21 Maternal orphan prevalence 0.18 0.18 0.21 0.38 0.30 0.11 Double orphan prevalence 0.07 0.09 0.06 0.22 0.19 0.06 - 75 - Nicaragua 2001 - 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 0.658 0.474 0.8% 50.4% 98.1% 99.8% 100.0% 69.8% 0.07298 Has radio 0.799 0.401 67.5% 74.6% 81.3% 88.3% 95.8% 81.5% 0.02572 Has television 0.523 0.499 1.1% 27.2% 73.8% 89.9% 98.0% 58.0% 0.06982 Has refrigerator 0.210 0.407 0.0% 0.8% 12.5% 33.8% 72.2% 23.9% 0.05900 Has bicycle 0.266 0.442 7.6% 24.2% 34.7% 37.1% 29.2% 26.6% 0.02220 Has motorcycle/scooter 0.021 0.142 0.0% 0.5% 1.5% 3.1% 5.2% 2.1% 0.01487 Has car/truck 0.079 0.270 0.0% 1.6% 2.5% 9.8% 33.4% 9.5% 0.03700 Has telephone 0.093 0.291 0.0% 0.0% 0.7% 6.0% 49.9% 11.3% 0.04934 Works on own or family's agricultural land 0.834 0.373 90.3% 89.8% 90.8% 91.6% 91.3% 90.7% 0.00172 Uses piped drinking water in residence 0.269 0.443 0.0% 3.8% 15.1% 42.2% 82.9% 28.8% 0.06231 Uses piped drinking water outside residence 0.286 0.452 2.0% 30.1% 63.1% 50.9% 12.1% 31.6% 0.01042 Uses water from public piped source outside residence 0.039 0.193 6.2% 7.6% 2.6% 0.5% 0.0% 3.4% -0.01430 Uses private well drinking water 0.132 0.338 21.3% 25.2% 10.8% 4.1% 0.3% 12.3% -0.02260 Uses river, canal or surface water for drinking 0.050 0.217 17.8% 3.5% 0.3% 0.0% 0.0% 4.3% -0.02607 Uses rain for drinking water 0.003 0.052 0.3% 0.3% 0.2% 0.1% 0.2% 0.2% -0.00220 Uses a public well 0.084 0.278 16.4% 15.0% 3.5% 0.6% 0.1% 7.1% -0.02359 Uses bottled water 0.012 0.107 0.0% 0.0% 0.1% 0.4% 4.1% 0.9% 0.01598 Uses water from private piped source outside residence 0.035 0.184 3.4% 5.9% 3.2% 1.0% 0.1% 2.7% -0.00901 Uses other source of drinking water 0.001 0.033 0.0% 0.2% 0.0% 0.1% 0.1% 0.1% -0.00024 Uses pit latrine 0.524 0.499 34.8% 67.5% 78.2% 61.8% 8.4% 50.2% -0.01243 Uses VIP latrine 0.110 0.313 8.7% 16.2% 14.7% 11.1% 2.3% 10.6% -0.00420 Uses pit used to collect manure for latrine 0.005 0.072 0.2% 1.5% 0.6% 0.4% 0.0% 0.6% -0.00278 Uses bush,field as latrine 0.170 0.375 55.8% 14.1% 3.6% 0.7% 0.0% 14.8% -0.04658 Uses a hanging latrine 0.001 0.028 0.2% 0.2% 0.0% 0.1% 0.0% 0.1% -0.00245 Shares toilet with other households 0.066 0.249 2.5% 6.7% 10.3% 9.0% 3.9% 6.5% 0.00191 Has connection to a sewer 0.114 0.318 0.0% 0.0% 0.5% 13.5% 69.4% 16.7% 0.05244 Has connection to a septic system 0.016 0.127 0.0% 0.0% 0.3% 2.9% 3.6% 1.4% 0.01469 Has connection to an open sewer 0.052 0.222 0.0% 0.3% 1.1% 8.5% 15.4% 5.1% 0.02846 Has connection to a river or creek 0.006 0.078 0.0% 0.1% 0.9% 0.7% 0.6% 0.5% 0.00526 Has connection to rainwater (toilet) 0.000 0.013 0.0% 0.0% 0.0% 0.1% 0.0% 0.0% 0.00091 Has earth, dung principal floor in dwelling 0.487 0.500 84.5% 68.2% 53.7% 19.9% 1.2% 45.5% -0.05908 Has wood, plank principal floor in dwelling 0.056 0.231 13.5% 7.4% 4.7% 1.8% 0.0% 5.5% -0.01548 Has cement principal floor 0.257 0.437 0.1% 2.5% 12.8% 42.3% 82.9% 28.1% 0.06433 Has tile flooring 0.178 0.383 1.5% 20.5% 26.1% 32.2% 12.3% 18.5% 0.01030 Has floor of mub bricks 0.018 0.132 0.0% 1.1% 2.5% 3.2% 3.2% 2.0% 0.00777 Has other type of flooring 0.000 0.016 0.1% 0.0% 0.0% 0.0% 0.0% 0.0% -0.00111 Has cane, palm, trunks for walls 0.025 0.155 8.4% 1.4% 0.3% 0.1% 0.0% 2.0% -0.01990 Has stone walls 0.054 0.226 0.5% 2.9% 8.8% 6.6% 4.8% 4.7% 0.01208 Has wood planks for walls 0.275 0.446 59.7% 37.1% 20.3% 7.6% 2.5% 25.4% -0.04214 Has bricks, cement blocks, concrete walls 0.307 0.461 0.6% 15.1% 32.1% 52.7% 71.4% 34.4% 0.05082 Has other material for walls 0.001 0.035 0.6% 0.0% 0.0% 0.0% 0.0% 0.1% -0.00403 has adobe wall 0.109 0.311 19.2% 14.2% 4.7% 2.1% 2.2% 8.5% -0.01976 Has earthen bricks or blocks for walls 0.124 0.329 3.4% 14.3% 16.5% 14.1% 8.2% 11.3% 0.00910 Has walls from waste material 0.032 0.177 6.0% 6.6% 3.2% 0.9% 0.0% 3.3% -0.01469 Has walls from plycem or Nicalit tiles 0.011 0.102 0.3% 2.6% 2.1% 0.9% 0.3% 1.2% -0.00167 Has roof from palm leaves and similar 0.039 0.194 16.2% 1.2% 0.0% 0.1% 0.0% 3.5% -0.02742 Has roof from zinc 0.708 0.455 52.2% 69.6% 74.7% 85.4% 81.9% 72.7% 0.02256 Has roof from plycem or Nicalit tiles 0.198 0.399 25.1% 25.8% 19.3% 9.5% 5.8% 17.1% -0.01485 - 77 - Nicaragua 2001 - 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 roofing tiles 0.198 0.399 25.1% 25.8% 19.3% 9.5% 5.8% 17.1% -0.01485 Has other roofing 0.005 0.073 2.5% 0.1% 0.1% 0.0% 0.3% 0.6% -0.00741 Rents dwelling 0.038 0.192 0.3% 1.4% 2.5% 5.1% 7.8% 3.4% 0.01569 Has other tenancy of dwelling 0.001 0.027 0.2% 0.0% 0.0% 0.0% 0.0% 0.0% -0.00268 Uses wood or straw as cooking fuel 0.681 0.466 99.7% 98.0% 84.1% 39.9% 3.2% 65.0% -0.07211 Uses kerosene as cooking fuel 0.006 0.076 0.0% 0.3% 1.3% 1.2% 0.7% 0.7% 0.00414 Uses gas as cooking fuel 0.296 0.456 0.0% 0.9% 12.9% 56.3% 94.3% 32.9% 0.07186 Uses electricity as cooking fuel 0.006 0.074 0.0% 0.0% 0.5% 1.4% 1.6% 0.7% 0.00655 Uses other cooking fuel 0.000 0.009 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.00074 Does not cook 0.007 0.081 0.1% 0.3% 0.2% 0.4% 0.1% 0.2% 0.00044 Uses charcoal for cooking 0.004 0.066 0.0% 0.4% 1.0% 0.8% 0.0% 0.4% 0.00028 Uses light from generator 0.005 0.074 0.4% 1.4% 0.5% 0.0% 0.0% 0.5% -0.00406 Uses light from gas or kerosene 0.340 0.474 98.9% 49.4% 1.8% 0.1% 0.0% 30.0% -0.07283 Uses electricity as lighting fuel 0.653 0.476 0.3% 48.9% 97.6% 99.8% 100.0% 69.3% 0.07333 Uses light from other 0.001 0.030 0.3% 0.0% 0.0% 0.0% 0.0% 0.1% -0.00294 Uses public collection trash disposal 0.302 0.459 0.2% 2.3% 21.1% 57.7% 90.3% 34.3% 0.06800 Burns trash 0.433 0.495 47.5% 65.5% 57.4% 26.3% 3.2% 40.0% -0.03270 Buries trash 0.052 0.221 5.1% 8.1% 5.2% 3.2% 0.5% 4.4% -0.00930 Uses street cleaner for trash disposal 0.003 0.059 0.0% 0.0% 0.3% 1.0% 0.8% 0.4% 0.00442 Has private collection for trash 0.016 0.124 0.0% 0.5% 2.1% 3.9% 2.1% 1.7% 0.00778 Uses public container for trash disposal 0.012 0.109 0.1% 1.0% 2.5% 2.9% 2.6% 1.8% 0.00549 Uses yard open land for trash disposal 0.182 0.386 47.1% 22.5% 11.3% 5.1% 0.5% 17.3% -0.03832 Uses others means of trash disposal 0.000 0.013 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% -0.00057 Owns dwelling with deed 0.581 0.493 40.4% 48.5% 56.6% 65.2% 76.9% 57.5% 0.02828 Owns dwelling without deed 0.288 0.453 44.5% 38.0% 34.7% 25.5% 12.5% 31.0% -0.02650 Owned dwelling with mortgage, loan, being paid off 0.002 0.046 0.1% 0.1% 0.2% 0.5% 0.5% 0.3% 0.00251 Loans dwelling 0.088 0.283 14.5% 11.8% 5.8% 3.6% 2.0% 7.5% -0.01768 Lives in a house 0.935 0.247 82.8% 92.4% 97.5% 98.6% 98.6% 94.0% 0.02480 Lives in a farm house 0.005 0.074 0.5% 0.4% 0.8% 0.5% 0.7% 0.6% -0.00084 Lives in a room 0.006 0.076 0.2% 0.8% 0.3% 0.8% 0.7% 0.6% 0.00107 Lives in a ranch 0.033 0.179 12.2% 2.3% 0.1% 0.0% 0.0% 2.9% -0.02501 Lives in an improvised home 0.019 0.137 4.2% 3.8% 1.1% 0.0% 0.0% 1.8% -0.01241 Lives in an apartment or room 0.000 0.019 0.0% 0.0% 0.1% 0.0% 0.0% 0.0% 0.00004 Lives in a store 0.001 0.030 0.0% 0.1% 0.0% 0.1% 0.1% 0.0% 0.00164 Uses water from a spring 0.090 0.286 32.6% 8.5% 1.2% 0.0% 0.0% 8.5% -0.03363 Uses wash water piped inside residence 0.276 0.447 0.0% 3.7% 14.7% 42.1% 86.1% 29.3% 0.06493 Uses wash water piped outside residence 0.288 0.453 1.8% 30.1% 63.2% 51.2% 13.1% 31.9% 0.01118 Uses wash water from public tap 0.033 0.178 4.6% 6.4% 2.1% 0.9% 0.0% 2.8% -0.01248 Uses wash water from private tap 0.024 0.153 2.3% 4.3% 1.8% 0.5% 0.1% 1.8% -0.00789 Uses wash water from covered public well 0.069 0.254 12.0% 12.9% 3.5% 0.6% 0.0% 5.8% -0.02048 Uses wash water from private covered well 0.132 0.339 18.1% 25.8% 12.7% 4.4% 0.7% 12.3% -0.01974 Uses wash water from surface (river, stream, pond) 0.098 0.297 33.7% 8.4% 0.8% 0.1% 0.0% 8.6% -0.03569 Uses wash water from spring 0.076 0.265 27.0% 7.9% 1.0% 0.0% 0.0% 7.2% -0.03004 Uses wash water from rain 0.002 0.049 0.4% 0.3% 0.1% 0.0% 0.0% 0.2% -0.00331 Uses tank with lid as water recipient 0.007 0.085 0.0% 0.9% 0.9% 0.8% 0.6% 0.6% 0.00331 Uses tank without lid as water recipient 0.001 0.035 0.1% 0.1% 0.1% 0.2% 0.0% 0.1% 0.00160 Uses jerry can with lid as water recipient 0.266 0.442 31.0% 25.9% 24.9% 21.0% 17.9% 24.1% -0.00766 Uses jerry can without lid as water recipient 0.016 0.124 3.9% 1.6% 0.8% 0.9% 0.3% 1.5% -0.00907 - 78 - Nicaragua 2001 - ASSETS AND FACTOR SCORES (Cont.) (FACTOR SCORE) Asset Variable Unweighted Wealth Quintiles Factor Low 2nd 3rd 4th High Avg. Score Mean Std. Percentage of Population Devia- tion Uses bucket or pail with lid as water recipient 0.404 0.491 47.4% 43.8% 41.6% 41.7% 25.6% 40.0% -0.01221 Uses bucket or pail without lid as water recipient 0.018 0.132 3.7% 2.4% 0.6% 0.7% 0.2% 1.5% -0.01003 Uses barrel with lid as water recipient 0.061 0.239 2.7% 4.9% 10.5% 7.4% 6.3% 6.3% 0.00418 Uses barrel without lid as water recipient 0.005 0.074 0.4% 0.6% 1.1% 0.3% 0.7% 0.6% 0.00015 Uses cooking pot as water recipient 0.007 0.085 0.0% 0.9% 0.9% 0.8% 0.6% 0.6% 0.00331 Uses other as water recipient 0.002 0.040 0.1% 0.0% 0.1% 0.2% 0.6% 0.2% 0.00410 Does not use water recipient 0.137 0.344 1.1% 5.1% 9.7% 22.3% 46.6% 17.0% 0.03889 Uses public sewer for water disposal 0.132 0.339 0.1% 0.5% 2.0% 18.2% 72.9% 18.7% 0.05380 Uses septic system for water disposal 0.058 0.234 0.0% 0.9% 3.6% 11.8% 12.1% 5.7% 0.02491 Uses yard or patio for water disposal 0.594 0.491 62.1% 77.8% 78.3% 49.0% 7.3% 54.9% -0.03462 Uses river or gorge for water disposal 0.154 0.361 37.1% 18.2% 8.9% 5.9% 1.6% 14.3% -0.02925 Uses street for water disposal 0.056 0.231 0.3% 1.8% 7.1% 14.6% 5.8% 5.9% 0.01599 Uses other place for water disposal 0.004 0.062 0.5% 0.4% 0.2% 0.3% 0.1% 0.3% -0.00318 Number of members per sleeping room 5.376 2.686 7.4 6.9 6.7 6.3 5.7 6.6 -0.01539 - 79 - PART V. SUPPORTING TABLES, 1997 / 98 A. SAMPLE SIZES B. STANDARD ERRORS C. ASSET DISTRIBUTION AND WEIGHTS Nicaragua 1997 / 98 - SAMPLE SIZES TOTAL SAMPLE Indicator Wealth Quintiles Pop. Low 2nd 3rd 4th High Total Number of household members All 12,784 12,666 12,731 12,767 12,723 63,671 Urban 1,177 4,606 8,762 11,115 12,056 37,717 Rural 11,607 8,060 3,969 1,652 667 25,954 Female 6,337 6,244 6,419 6,724 6,901 32,624 Male 6,448 6,422 6,312 6,040 5,822 31,044 Part I: HNP STATUS Indicator Wealth Quintiles Pop. Low 2nd 3rd 4th High Total Mortality rates All 4,365 3,574 3,267 2,864 2,162 16,231 Urban 438 1,400 2,279 2,493 1,997 8,607 Rural 3,927 2,173 989 370 165 7,624 Female 2,189 1,753 1,633 1,453 1,110 8,137 Male 2,176 1,821 1,634 1,411 1,051 8,093 Prevalence of fever, diarrhea, acute respiratory infection All 2,114 1,686 1,532 1,314 997 7,642 Urban 200 651 1,094 1,148 921 4,014 Rural 1,913 1,035 438 166 76 3,628 Female 1,068 821 800 668 510 3,867 Male 1,045 864 732 646 487 3,774 Total fertility rate All 6,088 6,416 7,461 8,391 9,318 37,674 Urban 620 2,417 5,195 7,421 8,859 24,512 Rural 5,468 3,999 2,266 969 458 13,160 Age-specific fertility rate 15-19 All 1,509 1,603 1,884 2,008 2,101 9,106 Urban 154 528 1,338 1,772 1,999 5,791 Rural 1,355 1,075 546 237 102 3,315 Children's nutritional status All 1,776 1,469 1,313 1,137 801 6,497 Urban 169 570 946 991 750 3,426 Rural 1,607 899 367 146 51 3,070 Female 912 719 690 584 409 3,314 Male 864 751 623 553 392 3,183 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 - Nicaragua 1997 / 98 - SAMPLE SIZES Part I: HNP STATUS (Cont.) Indicator Wealth Quintiles Pop. Low 2nd 3rd 4th High Total Women's nutritional status All 1,870 2,066 2,399 2,753 3,047 12,136 Urban 188 785 1,646 2,445 2,900 7,964 Rural 1,683 1,281 753 308 147 4,172 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 1,890 1,911 2,165 2,273 2,354 10,593 Urban Female 201 739 1,536 2,006 2,224 6,706 Rural Female 1,690 1,172 630 266 130 3,888 Male 430 482 537 521 625 2,595 Urban Male 38 141 374 457 590 1,600 Rural Male 392 341 163 64 35 995 - 84 - Nicaragua 1997 / 98 - 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 431 310 293 270 182 1,486 Urban 40 121 211 237 173 782 Rural 391 189 82 33 9 704 Female 219 135 159 140 99 752 Male 212 174 134 131 82 733 Treatment of fever All 551 389 370 294 166 1,770 Urban 59 170 275 250 143 897 Rural 492 220 95 44 23 874 Female 265 207 184 145 88 889 Male 286 182 186 149 78 881 Treatment of acute respiratory infection All 615 461 377 356 207 2,016 Urban 55 176 286 307 189 1,013 Rural 560 286 91 48 18 1,003 Female 307 222 204 169 95 997 Male 308 239 173 187 112 1,019 Treatment of diarrhea All 340 236 218 190 87 1,070 Urban 29 110 168 169 78 554 Rural 311 126 50 20 8 515 Female 178 109 106 96 39 528 Male 162 127 112 94 48 543 Antenatal and delivery care All 1,354 1,207 1,138 1,042 851 5,593 Urban 132 470 805 914 789 3,110 Rural 1,223 736 334 128 63 2,484 Contraceptive prevalence Female 1,563 1,472 1,658 1,647 1,704 8,045 Urban Female 130 520 1,146 1,435 1,599 4,830 Rural Female 1,433 952 512 213 105 3,215 Male 323 342 349 338 372 1,724 Urban Male 28 98 244 296 350 1,016 Rural Male 294 243 105 42 22 706 Contraceptive source Female 629 817 999 1,077 1,095 4,617 Urban Female 60 314 680 940 1,037 3,031 Rural Female 568 503 320 136 58 1,585 Male 323 342 349 338 372 1,724 Urban Male 28 98 244 296 350 1,016 Rural Male 294 243 105 42 22 706 Treatment of genital discharge, ulcer, sore Female 281 254 327 319 375 1,556 Urban Female 32 103 234 287 363 1,019 Rural Female 248 151 93 32 12 536 Male 18 22 32 28 19 119 Urban Male 1 6 26 28 19 80 Rural Male 17 16 6 0 1 40 - 85 - Nicaragua 1997 / 98 - 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 124 93 104 66 72 459 Urban 12 37 86 61 68 264 Rural 113 55 18 5 5 196 Female 62 50 55 35 31 233 Male 62 43 49 31 41 226 Timely complementary breastfeeding All 142 117 81 95 69 504 Urban 13 49 53 85 64 264 Rural 129 67 28 10 4 238 Female 73 65 39 40 28 245 Male 69 52 42 55 41 259 Bottle-feeding All 405 337 278 249 204 1,473 Urban 40 141 206 221 188 796 Rural 365 196 73 28 16 678 Female 207 182 137 116 96 738 Male 198 154 142 133 108 735 - 86 - Nicaragua 1997 / 98 - 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 2,199 2,336 2,712 3,041 3,347 13,635 Urban Female 226 876 1,879 2,691 3,181 8,853 Rural Female 1,972 1,460 832 351 165 4,780 Male 489 542 599 598 683 2,911 Urban Male 44 162 407 528 647 1,788 Rural Male 445 380 192 71 36 1,124 Domestic violence All 2,199 2,336 2,712 3,041 3,347 13,634 Urban 226 876 1,879 2,691 3,181 8,853 Rural 1,972 1,460 832 351 165 4,781 - 87 - Nicaragua 1997 / 98 - SAMPLE SIZES Part IV: UNDERLYING DETERMINANTS OF HNP STATUS Indicator Wealth Quintiles Pop. Low 2nd 3rd 4th High Total School completion (Grade 5) Female 2,463 2,619 3,014 3,384 3,794 15,274 Urban female 256 980 2,090 2,998 3,611 9,935 Rural female 2,207 1,639 924 386 183 5,339 Male 2,487 2,688 2,946 2,984 3,094 14,198 Urban male 204 906 2,027 2,610 2,930 8,677 Rural male 2,283 1,782 919 374 164 5,522 School participation Female 1,156 970 892 829 667 4,514 Urban female 109 402 598 713 622 2,444 Rural female 1,046 568 294 116 45 2,070 Male 1,100 1,025 909 864 630 4,528 Urban male 98 384 625 735 595 2,437 Rural male 1,002 641 285 129 35 2,091 Mass media exposure Female 2,199 2,336 2,712 3,041 3,347 13,634 Urban female 226 876 1,879 2,691 3,181 8,853 Rural female 1,972 1,460 832 351 165 4,781 Male 489 542 599 598 683 2,912 Urban male 44 162 407 528 647 1,788 Rural male 445 380 192 71 36 1,124 Knowledge of HIV/AIDS prevention Female 5,048 2,336 2,712 3,041 3,347 16,484 Urban female 226 876 1,879 2,691 3,181 8,853 Rural female 1,972 1,460 832 351 165 4,780 Male 489 542 599 598 683 2,912 Urban male 44 162 407 528 647 1,788 Rural male 445 380 192 71 36 1,124 Household decisionmaking and justification of violence All 2,199 2,336 2,712 3,041 3,347 13,634 Urban 226 876 1,879 2,691 3,181 8,853 Rural 1,972 1,460 832 351 165 4,781 Orphanhood All 6,664 5,864 5,491 4,924 3,936 26,879 Urban 618 2,235 3,798 4,242 3,691 14,583 Rural 6,047 3,629 1,693 681 245 12,295 Female 3,317 2,701 2,920 2,560 2,043 13,541 Male 3,344 3,163 2,571 2,361 1,893 13,332 - 88 - Nicaragua 1997 / 98 - 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 3.36 4.57 4.76 5.20 4.28 2.04 Under-five mortality rate 4.20 5.08 5.10 5.55 4.42 2.36 Prevalence of fever 1.28 1.19 1.56 1.52 1.91 0.67 Prevalence of diarrhea 0.99 1.00 1.33 1.18 1.15 0.52 Prevalence of acute respiratory infection 1.30 1.42 1.69 1.75 2.07 0.73 B. Fertility Total fertility rate 0.18 0.16 0.14 0.11 0.10 0.09 Adolescent fertility rate 9.00 11.00 11.00 7.00 7.00 5.00 C. Nutritional status Children: Moderate stunting 0.87 1.11 0.89 0.96 0.98 0.53 Severe stunting 1.10 0.88 1.05 0.73 0.65 0.50 Moderate underweight 0.88 1.00 1.13 0.85 0.91 0.48 Severe underweight 0.17 0.24 0.23 0.20 0.00 0.09 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 0.44 0.47 0.45 0.51 0.51 0.23 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 0.78 0.82 0.93 0.80 0.81 0.42 Men 0.58 0.68 0.87 0.66 0.73 0.33 Prevalence of genital ulcer: Women 0.32 0.34 0.28 0.45 0.27 0.15 Men 0.70 0.32 0.42 0.20 0.44 0.19 - 89 - Nicaragua 1997 / 98 - 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 1.25 1.11 1.78 0.32 2.31 0.67 Measles coverage 2.05 2.08 2.40 2.18 3.00 1.08 DPT coverage 2.57 2.42 3.25 2.41 3.85 1.33 Full basic coverage 2.38 2.53 3.92 2.75 3.86 1.37 No basic coverage 1.05 0.84 0.29 0.00 1.72 0.41 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 2.40 2.92 3.72 3.67 4.63 1.49 Treatment in a public facility 2.27 2.87 3.42 3.42 4.35 1.39 Treatment in a private facility 0.79 1.03 2.21 2.80 4.82 0.92 Treatment of acute respiratory infection (ARI): Medical treatment of ARI 2.28 2.66 3.04 3.43 3.55 1.44 Treatment in a public facility 2.12 2.67 3.23 3.86 4.34 1.48 Treatment in a private facility 0.77 1.24 1.82 2.80 3.83 0.86 Treatment of diarrhea: Use of oral rehydration therapy 2.80 3.16 3.49 4.41 6.97 1.53 Medical treatment of diarrhea 2.88 3.81 4.29 5.35 6.38 1.79 Treatment in a public facility 2.90 3.91 4.06 4.32 5.64 1.70 Treatment in a private facility 0.56 1.49 2.68 3.33 6.75 1.17 C. Antenatal and delivery care Antenatal care (ANC) visits: To a medically trained person 2.01 1.17 1.21 0.97 0.92 0.82 To a doctor 1.38 1.67 1.89 1.77 2.09 0.91 To a nurse or trained midwife 1.55 1.64 1.80 1.86 2.07 0.91 Multiple visits to a medically trained person 1.81 1.47 1.39 1.33 1.34 0.78 Antenatal care content: Tetanus toxoid 1.42 1.01 1.03 1.16 1.26 0.61 Prophylactic antimalarial treatment na na na na na na Iron supplementation na na na na na na Delivery attendance: By a medically trained person 1.66 1.69 1.40 1.55 1.07 1.03 By a doctor 1.30 1.60 1.82 1.94 2.16 0.88 By a nurse or trained midwife 0.87 1.32 1.62 1.94 2.19 0.79 In a public facility 1.69 1.69 1.45 1.64 1.73 1.03 In a private facility 0.13 0.17 0.62 0.78 1.40 0.28 At home 1.76 1.74 1.48 1.38 1.17 1.04 D. Contraceptive services Contraceptive prevalence: Women 1.54 1.44 1.20 1.35 1.42 0.75 Men 2.55 2.54 3.37 3.14 2.99 1.27 Source of contraception - public sector: Women 1.85 1.67 1.82 1.75 1.91 0.89 Men na na na na na na - 90 - Nicaragua 1997 / 98 - 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 1.86 1.67 1.83 1.76 1.79 0.89 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 0.78 0.82 0.93 0.80 0.81 0.42 Men 0.92 1.01 1.25 1.49 0.95 0.55 Voluntary counseling and testing for HIV/AIDS: Women na na na na na na Men na na na na na na - 91 - Nicaragua 1997 / 98 - 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: na na na na na na Sanitary disposal 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 4.11 5.10 5.14 6.23 5.50 2.40 Timely complementary feeding 3.71 5.04 5.73 5.61 7.67 2.37 Bottle-feeding 2.17 2.43 2.72 2.87 3.35 1.23 D. Micronutrient consumption Iodized salt: na na na na na na Availability of iodized salt in household 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 2.03 1.89 2.43 2.14 2.16 1.03 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 0.85 0.80 0.80 0.83 0.54 0.39 Experienced violence in past year 0.54 0.58 0.60 0.67 0.42 0.28 - 92 - Nicaragua 1997 / 98 - 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 0.87 1.14 1.26 0.96 0.78 0.79 Men 1.16 1.21 1.33 1.03 0.81 0.80 School participation: Girls 1.90 1.79 1.56 1.71 1.45 0.91 Boys 1.92 1.81 1.88 2.04 1.74 0.95 B. Exposure to mass media Newspaper readership: Women 1.02 1.27 1.31 1.26 1.16 1.08 Men 2.23 2.35 2.47 2.14 2.01 1.23 Radio listenership: Women 1.59 1.18 1.04 0.88 0.88 0.67 Men 2.33 1.76 1.58 1.83 1.22 0.82 Television viewership: Women 0.86 1.52 1.12 0.66 0.48 1.41 Men 2.46 2.74 1.48 1.02 0.90 1.08 C. Knowledge and attitudes about HIV/AIDS Knowledge about sexual transmission of HIV/AIDS: Women 1.42 0.67 0.52 0.32 0.35 0.35 Men 0.94 0.78 0.11 0.36 0.00 0.22 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 0.98 0.94 1.14 1.08 1.11 0.53 Can seek children's health care 1.06 1.37 1.58 1.68 2.17 0.73 Can make daily household purchases na na na na na na Can make large household purchases 0.94 0.97 1.10 1.09 1.12 0.53 Can make meal-related decisions 1.01 0.97 1.14 0.91 1.13 0.53 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 2.35 1.48 1.49 1.51 1.75 0.78 Can decide whether to have sex 0.95 1.04 1.20 1.07 0.91 0.54 Justifies domestic violence 0.98 0.90 0.87 0.79 0.78 0.44 E. Orphanhood Paternal orphan prevalence 0.34 0.38 0.45 0.50 0.37 0.19 Maternal orphan prevalence 0.19 0.20 0.23 0.17 0.19 0.09 Double orphan prevalence 0.08 0.05 0.05 0.07 0.08 0.03 - 93 - Nicaragua 1997 / 98 - 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 0.639 0.480 2.4% 48.7% 92.4% 98.5% 98.6% 68.1% 0.13893 Has radio 0.764 0.424 50.1% 70.5% 84.2% 90.9% 98.6% 78.9% 0.07844 Has television 0.493 0.500 0.2% 15.0% 68.2% 89.8% 98.6% 54.4% 0.14713 Has refrigerator 0.197 0.398 0.0% 0.2% 5.2% 26.6% 77.2% 21.8% 0.12805 Has bicycle 0.188 0.391 3.4% 14.7% 24.5% 25.8% 28.0% 19.2% 0.04653 Has motorcycle 0.019 0.137 0.0% 0.1% 1.0% 2.6% 6.9% 2.1% 0.03387 Has car 0.075 0.264 0.1% 0.8% 2.1% 6.6% 35.8% 9.1% 0.08452 Has telephone 0.083 0.276 0.0% 0.0% 0.3% 2.9% 46.6% 10.0% 0.10109 Works on own or family's agricultural land 0.190 0.392 53.0% 22.8% 11.1% 5.4% 4.0% 19.3% -0.07338 Uses piped drinking water in residence 0.425 0.494 0.2% 13.8% 48.2% 76.9% 94.7% 46.7% 0.13764 Uses piped drinking water outside residence 0.145 0.352 3.3% 21.7% 28.7% 16.3% 4.0% 14.8% -0.00432 Uses private well drinking water 0.140 0.347 23.3% 25.0% 12.1% 4.4% 1.0% 13.2% -0.04644 Uses river, canal or surface water for drinking 0.120 0.325 40.5% 11.0% 1.5% 0.4% 0.0% 10.7% -0.07831 Uses rain for drinking water 0.000 0.013 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% -0.00047 Uses a public well 0.101 0.302 22.4% 15.9% 5.2% 1.2% 0.0% 9.0% -0.05292 Uses piped water public/private 0.041 0.198 7.2% 7.6% 2.0% 0.3% 0.1% 3.4% -0.02963 Uses bottled water 0.009 0.097 0.9% 1.6% 0.8% 0.1% 0.1% 0.7% -0.01101 Uses other source of drinking water 0.017 0.130 2.0% 2.9% 1.3% 0.3% 0.0% 1.3% -0.01550 Uses pit latrine 0.596 0.491 39.9% 79.9% 88.0% 61.6% 12.2% 56.3% -0.03249 Uses VIP latrine 0.028 0.166 1.7% 4.1% 5.0% 3.5% 1.2% 3.1% -0.00190 Uses pit used to collect manure for latrine 0.005 0.070 0.4% 0.9% 0.8% 0.6% 0.0% 0.5% -0.00452 Uses a hanging latrine 0.005 0.070 1.3% 0.6% 0.1% 0.1% 0.0% 0.4% -0.01214 Uses bush,field as latrine 0.163 0.369 56.6% 13.0% 2.2% 0.5% 0.0% 14.5% -0.09431 Has connection to a sewer 0.168 0.374 0.0% 0.7% 2.3% 29.6% 76.3% 21.8% 0.11997 Has connection to a septic system 0.012 0.108 0.0% 0.1% 0.2% 1.2% 3.9% 1.1% 0.02733 Has connection to an open sewer 0.017 0.131 0.0% 0.0% 0.6% 2.5% 5.9% 1.8% 0.03325 Has connection to a river or creek 0.002 0.041 0.0% 0.2% 0.3% 0.2% 0.0% 0.2% 0.00217 Has connection to rainwater (toilet) 0.000 0.013 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.00303 Has earth, dung principal floor in dwelling 0.489 0.500 85.4% 74.4% 59.0% 11.2% 0.9% 46.2% -0.12621 Has wood, plank principal floor in dwelling 0.066 0.249 13.0% 8.8% 5.5% 3.8% 0.9% 6.4% -0.03150 Has cement principal floor 0.263 0.440 0.0% 2.4% 10.9% 48.5% 81.7% 28.7% 0.12931 Has tile flooring 0.135 0.341 1.2% 12.5% 20.9% 27.2% 8.9% 14.1% 0.01947 Has floor of mub bricks 0.047 0.211 0.3% 1.6% 3.6% 9.2% 7.7% 4.5% 0.03565 Has other type of flooring 0.001 0.023 0.1% 0.1% 0.0% 0.0% 0.0% 0.0% -0.00392 Number of members per sleeping room 3.875 2.614 6.9 5.4 4.4 3.6 2.2 4.5 -0.09320 - 95 - PART VI. ANNEXES A. SOURCES OF ADDITIONAL INFORMATION B. USE OF INFORMATION FROM THIS REPORT TO MONITOR THE ECONOMIC STATUS OF PEOPLE SERVED BY HNP PROGRAMS C. COUNTRIES COVERED BY THE HNP- POVERTY REPORT PROJECT ANNEX A. SOURCES OF ADDITIONAL INFORMATION ADDITIONAL INEQUALITY DATA World Bank HNP/Poverty Country Report Website: http://www.worldbank.org/hnp/povertyandhealth/countrydata. This World Bank website provides the full texts and tables for all fifty-six countries covered by the HNP/Poverty Country Report Project. (A list of the countries covered appears in annex C, at the end of this report.) Also available at the site are summary tables, organized by indicator, designed to facilitate cross-country comparisons in inequality with respect to particular indicators. DHS Country Reports: http://www.measuredhs.com/countries. All DHS final country reports produced since 2003 include quintile-specific tabulations in approximately 50-100 of the reports' HNP indicator tables. The tables deal with some of the indicators covered in this volume, and with many that are not. UNICEF Multi-Indicator Cluster Survey Website: http://www.childinfo.org/MICS2/natlMICSrepz/MICSnatrep.htm. The UNICEF Multi-Indicator Cluster Survey (MICS) project is generally similar to the DHS program, but covers a somewhat different set of countries and indicators. The "standard tables" section for each country listed at the MICS website provides wealth- based, quintile-specific information in around 40-45 of the tables related to hnp, education, and child labor. In deriving these quintile-specific estimates, the MICS investigators have employed a wealth index similar to the one used here. World Health Organization World Health Survey Website: http://www.who.int/healthinfo/survey/en/index.html. The World Health Organization's World Health Survey (WHS) includes such issues as self-assessed adult health status; coverage of interventions against adult chronic diseases and against maternal and child health problems; household health expenditures; insurance coverage; and health system responsiveness. Approximately seventy countries ­ developed as well as developing ­ have been covered thus far. Household wealth information has been collected and used to prepare quintile-specific estimates for many of the indicators appearing in the reports on these countries. - 99 - 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. - 100 - ANNEX B. USE OF INFORMATION FROM THIS REPORT TO MONITOR THE ECONOMIC STATUS OF PEOPLE SERVED BY HNP PROGRAMS The wealth or asset approach employed in this report can be used to monitor the economic status of people served by health, nutrition, and population (hnp) programs in two ways. The first, simpler way is suitable for monitoring nationwide, facility-based programs. A second, fuller version can also be employed for other types of programs, such as initiatives undertaken only in some parts of a country, or activities like mass education or outreach programs that do not operate through facilities. BASIC MONITORING OF NATIONWIDE FACILITY-BASED PROGRAMS The economic distribution of patients in a nationwide, facility-based program (say, a network of rural health posts, antenatal care clinics, emergency obstetrical facilities, or hospitals) can be determined through an exit survey of facility patients, using the wealth questionnaire and the set of quintile cut-off points that immediately follow this text, and which have been created using the information presented in part III.C. The questionnaire can be employed to measure the economic status of any individual responding to the questions on it. The set of cut-off points can serve to compare the distribution of the respondents' economic status with that of the nationally- representative sample of people interviewed by the DHS survey on which the present report is based. The first step is to use the questionnaire in interviewing an adequately-large sample of patients attending the facility-based services of interest. The wealth score for each patient can then be calculated by multiplying the response to each question by the item scores also provided on the questionnaire, and summing the results. After this has been done, the quintile cut-off points can be used to place each individual in the economic quintile to which (s)he belongs. The number of patients and percentage of total patients in each quintile can then be calculated. Since each quintile defined by the cut-off points contains 20 percent of the individuals in the nationally-representative DHS sample, the patients belonging to any such quintile containing significantly more (or less) than 20 percent of the total are over- (under-) represented relative to the national population. When the percentage of patients in each of the five quintiles is viewed as a whole, the result is a frequency distribution that indicates the spread of service beneficiaries across economic classes of individuals.21 For example: · A service that favors the poorest people would have substantially more than 20 percent of its patients in each of the lowest one or two economic quintiles; considerably less than 20 percent of its patients in each of the highest quintiles. 21That is, across economic classes of all individuals in the sample population. Estimates pertaining to quintiles of only those individuals needing services require adjusting the results of the procedure described here through application of the relevant quintile-specific, sample-size figures presented in part III.A. - 101 - · A service that reaches all economic classes equally would draw roughly the same proportion of total patients from the lower and upper quintiles. · A service that favors the least poor population groups would have well over 20 percent of its patients in each of the highest one or two quintiles, considerably less than 20 percent of its patients in each of the lowest quintiles. FULLER MONITORING OF FACILITY-BASED AND OF OTHER PROGRAMS While capable of providing far more information than currently exists about the distribution of a program's beneficiaries, the approach just described has important limitations. For example, it cannot deal with the many important types of health programs that do not deliver services primarily through facilities ­ mass media health education, household visits by health workers, and many social marketing initiatives, for example. It is also limited in its ability to assess programs working only with certain areas within a country: it can compare the economic status of the programs' beneficiaries with that of the national population, but not with that of the specific sub-national areas where the programs are active. Further, it focuses primarily on only one of the two important dimensions of monitoring the distribution of program beneficiaries: that is, incidence or focus ­ the percentage of program benefits that flow to the poor. It cannot deal nearly so well with the second dimension, which concerns coverage, or the percentage of the poor that the program reaches. These limitations can be overcome by a modified version of the approach described above that relies on a household- rather than facility-based survey. A household survey can generate a set of data containing the full range of information needed to produce an equity assessment by collecting two types of information: first, about the household's wealth or assets, using the questions in the left-hand column of the attached questionnaire;22 and second, about the household members' use of or exposure to the services provided by the program(s) of interest. The collected data can be analyzed in either (or both) of two ways, depending on the type of information desired: · One way would be to use only data from the household survey. The procedure would be analogous to that for a DHS survey employed in this report: ­ Asset information from the survey-generated data set would be used as the basis for the construction of a wealth index, weighting the individual items using some method like principal components analysis. ­ The individuals in the sample would be ranked in order of the index values for their households, then divided into groups like quintiles. ­ The coverage rates in each quintile for the service of interest would be calculated. · A second approach would be to use the weights for each item appearing on the attached questionnaire in determining the wealth of each individual, instead of calculating the weights from the new household data set. Once the individuals' wealth is determined, the individuals would be ranked, divided into quintiles, and the coverage rate in each quintile would be calculated. In the case of programs undertaken in only one region of the country, it would 22Or, if one is willing to forego the benefits of the second analytical approach described below, using any of several other asset questionnaires that exist. Examples include the INDEPTH health equity survey tool (available at: www.indepth-network.org/core_documents/indepthtools.htm) or the model questionnaire developed by M. Mahood Khan and David Hotchkiss of the PHR Plus project (which can be found at: www.phrplus.org). - 102 - 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. - 103 - Nicaragua 2001 - ASSET QUESTIONNAIRE Question Score if Score if Item "Yes" "No" Score 1. In your household, is/are there? Electricity 0.05256 -0.10132 One or more radios 0.01290 -0.05127 One or more televisions 0.06669 -0.07309 One or more refrigerators 0.11439 -0.03043 One or more bicycles 0.03688 -0.01336 One or more motorcycles, scooters 0.10235 -0.00216 One or more cars, trucks 0.12618 -0.01085 One or more telephones 0.15389 -0.01582 2. Do the members of your household work their own or family's agricultural land? 0.00077 -0.00384 3. What is the principal source of drinking water for your household? Piped drinking water in residence 0.10279 -0.03777 Piped drinking water outside residence 0.01647 -0.00659 Private piped source outside residence -0.04728 0.00172 Public piped water outside residence -0.07104 0.00288 Private well -0.05796 0.00881 Public well -0.07774 0.00716 River, canal, surface water -0.11399 0.00596 Rainwater -0.04192 0.00012 Spring -0.10697 0.01057 Bottled water 0.14774 -0.00173 Other -0.00741 0.00001 4. What is the principal source of washing water for your household? Piped water in residence 0.10503 -0.04014 Piped water outside residence 0.01759 -0.00710 Public tap -0.06763 0.00230 Private tap -0.05052 0.00123 Covered public well -0.07512 0.00559 Private covered well -0.05052 0.00771 Surface (river, stream, pond) -0.10845 0.01175 Spring -0.10467 0.00862 Rain -0.06777 0.00016 5. What is the main water receptacle in your household? Tank with lid 0.03848 -0.00028 Tank without lid 0.04555 -0.00006 Jerry can with lid -0.01272 0.00461 Jerry can without lid -0.07196 0.00114 Bucket or pail with lid -0.01484 0.01005 Bucket or pail without lid -0.07462 0.00135 Barrel with lid 0.01644 -0.00106 Barrel without lid 0.00198 -0.00001 Cooking pot 0.03848 -0.00028 Other 0.10287 -0.00016 Does not use water recipient 0.09747 -0.01552 - 105 - Nicaragua 2001 - ASSET QUESTIONNAIRE (Cont.) Question Score if Score if Item "Yes" "No" Score 6. What is the principal means of water disposal in your household? (Cont.) Public sewer 0.13776 -0.02101 Septic system 0.10040 -0.00618 Yard or patio -0.02864 0.04185 River or gorge -0.06848 0.01249 Street 0.06543 -0.00391 Other -0.05086 0.00020 7. What is the principal type of fuel for cooking used by your household? Wood or straw -0.04939 0.10529 Kerosene 0.05414 -0.00032 Gas 0.11084 -0.04658 Electricity 0.08762 -0.00049 Charcoal 0.00414 -0.00002 Other 0.07845 -0.00001 Does not cook 0.00542 -0.00004 8. What is the principal type of toilet facility used by your household? VIP latrine -0.01194 0.00148 Pit latrine -0.01184 0.01304 Pit used to collect manure for latrine -0.03844 0.00020 Hanging latrine -0.08693 0.00007 Bush, field as latrine -0.10301 0.02106 9. Does your household share a toilet with other households? 0.00719 -0.00051 10. What is the principal type of sewer connection of your household? Connection to a sewer 0.14629 -0.01880 Connection to a septic system 0.11369 -0.00190 Connection to an open sewer 0.12164 -0.00666 Connection to a river or creek 0.06723 -0.00041 Connection to rainwater (toilet) 0.06829 -0.00001 11. What is the principal material used for the floors in your household? Earth, dung -0.06062 0.05757 Wood, plank -0.06328 0.00379 Has cement principal floor 0.10935 -0.03784 Tile 0.02210 -0.00480 Mub bricks 0.05794 -0.00104 Other -0.06814 0.00002 12. What is the principal material used for the walls of your household? Cane, palm, trunks -0.12546 0.00316 Stone 0.05067 -0.00288 Wood planks -0.06846 0.02593 Bricks, cement blocks, concrete 0.07628 -0.03385 Adobe -0.05655 0.00690 Earthen bricks or blocks 0.02421 -0.00342 Waste material -0.08037 0.00268 Plycem or Nicalit tiles -0.01619 0.00017 Other -0.11462 0.00014 - 106 - Nicaragua 2001 - ASSET QUESTIONNAIRE (Cont.) Question Score if Score if Item "Yes" "No" Score 13. What is the principal material used for the roof of your household? Palm leaves and similar -0.13543 0.00555 Zinc 0.01448 -0.03515 Plycem or Nicalit tiles -0.02988 0.00738 Tiles -0.02988 0.00738 Other -0.10153 0.00054 14. What is the principal source of lighting in your household? Generator -0.05474 0.00030 Gas or kerosene -0.10152 0.05225 Electricity 0.05345 -0.10059 Other -0.09877 0.00009 15. What is the principal means of trash disposal in your household? Public collection trash disposal 0.10332 -0.04476 Burns trash -0.03743 0.02857 Buries trash -0.03987 0.00217 Street cleaner 0.07517 -0.00026 Private collection 0.06175 -0.00098 Public container 0.04996 -0.00060 Yard open land -0.08128 0.01807 Others -0.04297 0.00001 16. What type of tenant is your household? Owns dwelling with deed 0.02401 -0.03332 Owns dwelling without deed -0.04168 0.01684 Owns dwelling with mortgage or loan being paid off 0.05457 -0.00012 Loans dwelling -0.05693 0.00549 Rents dwelling 0.07841 -0.00314 Other -0.10086 0.00007 17. In what type of dwelling does your household reside? House 0.00655 -0.09393 Farmhouse -0.01127 0.00006 Room 0.01412 -0.00008 Ranch -0.13533 0.00462 Improvised home -0.08904 0.00173 Apartment or room 0.00192 0.00000 Store 0.05510 -0.00005 18. How many people are there for each sleeping room in your household? # people-5.38×-0.015 2.69 Total Household Asset Score (sum of individual item scores) - 107 - Nicaragua 2001 - QUINTILE CUT-OFF POINTS Asset Index Value Wealth Quintile Bottom Cut-Off Top Cut-Off Low Low -0.99732 Second -0.99732 -0.24161 Third -0.24161 0.38187 Fourth 0.38187 1.16478 High 1.16478 High - 108 - 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 - 109 -