39451 SOCIO-ECONOMIC DIFFERENCES IN HEALTH, NUTRITION, AND POPULATION MALI 1995/96, 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, 1995 / 96 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, 1995 / 96 79 A. Sample Sizes 81 B. Standard Errors 87 C. Asset Distribution and Weights 93 Part VI. Annexes 95 A. Sources of Additional Information 97 B. Use of Information from this 99 Report to Monitor the Economic Status of People Served by HNP Programs C. Countries Covered by the 105 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. Mali 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 137.2 125.2 140.6 128.7 89.9 126.2 1.53 47.30 -0.0492 0.0006 Under-five mortality rate 247.8 264.1 262.0 244.4 148.1 238.2 1.67 99.70 -0.0618 0.0008 Prevalence of fever 29.5 26.9 28.1 25.0 24.1 26.8 1.22 5.40 -0.0385 0.0096 Prevalence of diarrhea 20.8 20.5 20.7 16.9 13.0 18.6 1.60 7.80 -0.0725 0.0117 Prevalence of acute respiratory 10.4 9.0 10.8 8.4 10.9 9.9 0.95 0.50 0.0436 0.0184 infection (ARI) B. Fertility Total fertility rate 7.3 7.5 7.3 6.8 5.3 6.8 1.38 2.00 -0.0591 0.0003 Adolescent fertility rate 200.0 246.0 225.0 203.0 108.0 185.0 1.85 92.00 -0.1295 0.0016 C. Nutritional status (%) Children: Moderate stunting 19.7 22.4 19.0 18.4 12.2 18.5 1.61 7.50 -0.0888 0.0122 Severe stunting 25.1 23.8 21.4 15.7 7.5 19.1 3.35 17.60 -0.1681 0.0117 Moderate underweight 26.0 27.3 24.4 20.4 12.8 22.5 2.03 13.20 -0.1139 0.0108 Severe underweight 13.2 14.1 12.3 9.3 3.9 10.8 3.38 9.30 -0.1529 0.0164 Mild anemia 16.1 19.0 15.7 20.1 21.6 18.2 0.75 5.50 0.0329 0.0248 Moderate anemia 56.7 52.2 57.7 51.2 44.5 53.0 1.27 12.20 -0.0344 0.0111 Severe anemia 14.1 11.2 13.8 11.9 4.3 11.5 3.28 9.80 -0.1357 0.0320 Women: Malnutrition 13.0 13.7 13.5 13.3 10.2 12.6 1.27 2.80 -0.0579 0.0149 Mild anemia 42.8 41.0 38.1 40.3 33.3 39.1 1.29 9.50 -0.0248 0.0120 Moderate anemia 21.9 24.6 25.2 20.7 13.4 20.8 1.63 8.50 -0.1044 0.0180 Severe anemia 2.7 4.2 2.8 2.4 2.2 2.8 1.23 0.50 -0.1195 0.0589 D. Female circumcision (%) Prevalence of circumcision: Girls 76.3 73.3 66.0 67.9 79.2 72.4 0.96 2.90 -0.0253 0.0039 Women 95.9 93.8 89.7 88.4 90.6 91.6 1.06 5.30 -0.0202 0.0016 Prevalence of occlusion: Girls 3.4 3.7 5.8 4.7 5.2 4.5 0.65 1.80 -0.0279 0.0374 Women 1.3 1.4 2.0 1.9 2.6 1.9 0.50 1.30 0.0836 0.0420 E. Sexually transmitted disease Prevalence of genital discharge: Women 20.4 17.8 18.6 20.1 29.9 21.5 0.68 9.50 0.0806 0.0110 Men 4.3 5.5 5.5 4.3 4.1 4.7 1.05 0.20 -0.0285 0.0476 Prevalence of genital ulcer: Women 8.2 9.0 8.0 9.1 9.9 8.8 0.83 1.70 0.0158 0.0177 Men 2.9 3.6 1.1 1.7 1.3 2.0 2.23 1.60 -0.1419 0.0801 - 3 - Mali 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 58.1 60.4 59.6 77.6 92.1 69.0 0.63 34.00 0.0995 0.0080 Measles coverage 39.7 39.3 38.3 52.8 76.5 48.7 0.52 36.80 0.1396 0.0133 DPT coverage 28.1 28.7 28.6 45.7 70.7 39.6 0.40 42.60 0.2096 0.0156 Full basic coverage 19.5 20.2 18.7 31.9 56.0 28.7 0.35 36.50 0.2250 0.0210 No basic coverage 29.4 25.8 27.7 17.6 6.1 21.7 4.82 23.30 -0.1924 0.0226 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 18.4 18.9 25.4 29.2 61.1 28.9 0.30 42.70 0.2649 0.0167 Treatment in a public facility 6.5 7.1 11.4 14.2 43.4 15.1 0.15 36.90 0.4135 0.0284 Treatment in a private facility 11.7 11.8 13.6 14.8 17.3 13.6 0.68 5.60 0.0983 0.0272 Treatment of acute respiratory infection (ARI): Medical treatment of ARI 21.6 28.9 26.7 33.6 69.7 35.6 0.31 48.10 0.2510 0.0232 Treatment in a public facility 8.9 9.6 13.0 22.3 49.6 20.3 0.18 40.70 0.4127 0.0378 Treatment in a private facility 12.5 19.3 12.8 11.3 19.3 14.9 0.65 6.80 0.0329 0.0439 Treatment of diarrhea: Use of oral rehydration therapy 64.4 63.7 60.6 66.9 79.8 65.7 0.81 15.40 0.0144 0.0094 Medical treatment of diarrhea 12.3 11.7 12.2 16.6 42.5 16.8 0.29 30.20 0.2120 0.0310 Treatment in a public facility 2.9 2.8 4.3 9.3 27.5 7.5 0.11 24.60 0.4276 0.0536 Treatment in a private facility 9.3 8.8 7.9 7.4 15.0 9.2 0.62 5.70 0.0303 0.0399 C. Antenatal and delivery care Antenatal care visits: To a medically trained person 42.2 44.0 46.2 64.6 91.8 56.8 0.46 49.60 0.1676 0.0052 To a doctor 0.9 1.4 1.8 2.5 7.8 2.7 0.12 6.90 0.4477 0.0471 To a nurse or trained midwife 41.4 42.6 44.4 62.0 84.0 54.1 0.49 42.60 0.1521 0.0057 Multiple visits to a medically trained person 24.7 29.3 30.8 45.8 73.8 40.0 0.33 49.10 0.2294 0.0076 Antenatal care content: Tetanus toxoid 35.1 37.4 37.7 55.0 81.3 48.5 0.43 46.20 0.1725 0.0064 Prophylactic antimalarial treatment 48.5 51.1 52.7 65.7 86.6 60.2 0.56 38.10 0.1174 0.0051 Iron supplementation 25.5 25.5 27.1 40.2 57.2 34.5 0.45 31.70 0.1420 0.0124 Delivery attendance: By a medically trained person 22.0 27.0 29.4 45.8 88.7 40.6 0.25 66.70 0.2769 0.0059 By a doctor 0.4 0.6 1.1 1.2 4.8 1.5 0.08 4.40 0.4471 0.0538 By a nurse or trained midwife 21.5 26.4 28.3 44.6 83.9 39.1 0.26 62.40 0.2704 0.0062 In a public facility 19.7 24.1 26.4 42.7 80.1 36.8 0.25 60.40 0.2821 0.0067 In a private facility 0.4 0.5 0.2 0.5 3.8 1.0 0.11 3.40 0.4801 0.0752 At home 78.9 73.7 72.1 55.7 14.4 60.9 5.48 64.50 -0.1769 0.0040 D. Contraceptive services Contraceptive prevalence: Women 4.2 3.6 3.4 7.3 17.9 7.0 0.23 13.70 0.3423 0.0250 Men 7.6 5.6 6.2 12.7 19.1 10.2 0.40 11.50 0.2941 0.0431 - 4 - Mali 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 33.3 29.9 49.2 54.8 49.1 46.3 0.68 15.80 0.0500 0.0228 Men na na na na na na na na na na Source of contraception - private sector: Women 19.5 32.9 34.9 31.1 44.9 36.6 0.43 25.40 0.1507 0.0258 Men na na na na na na na na na na E. Treatment of adult illnesses Treatment of genital discharge, ulcer, sore: Women 14.7 19.0 15.5 31.6 60.2 32.4 0.24 45.50 0.3067 0.0148 Men (19.7) (20.0) (17.7) (32.7) (34.7) 25.7 0.57 15.00 0.2305 0.0771 Treatment of genital discharge, ulcer, sore in public facilities: Women na na na na na na na na na ma Men na na na na na na na na na na Voluntary counseling and testing for HIV/AIDS: Women 0.8 1.0 1.5 3.6 12.0 4.2 0.07 11.20 0.5528 0.0308 Men 4.6 3.7 3.8 7.0 19.2 8.7 0.24 14.60 0.3983 0.0398 - 5 - Mali 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 na na na na na na na na na na Handwashing: Wash hands prior to preparing food 90.6 90.1 88.3 89.8 92.7 90.4 0.98 2.10 0.0058 0.0017 Handwashing facilities in household 3.0 4.6 7.3 7.6 19.5 8.2 0.15 16.50 0.3604 0.0195 B. Bednet ownership and use Bednet ownership: Bednet ownership 52.7 56.8 50.8 54.1 58.8 54.4 0.90 6.10 0.0335 0.0049 Treated bednet ownership na na na na na na na na na na Bednet use: By children 34.4 38.6 34.9 37.1 48.0 38.3 0.72 13.60 0.0748 0.0086 By pregnant women 33.4 36.6 34.6 36.7 39.4 35.9 0.85 6.00 0.0738 0.0200 C. Breastfeeding Exclusive breastfeeding 38.0 32.2 26.5 24.0 17.9 28.2 2.12 20.10 -0.1152 0.0296 Timely complementary feeding 30.1 24.9 27.7 35.8 44.3 32.4 0.68 14.20 0.0703 0.0294 Bottle-feeding 2.0 2.8 1.9 3.2 12.4 4.2 0.16 10.40 0.4041 0.0710 D. Micronutrient consumption Iodized salt: Availability of iodized salt 40.2 35.2 29.9 33.7 51.9 37.2 0.77 11.70 0.0018 0.0089 in household Vitamin A: Children 34.3 34.6 39.3 42.0 56.2 40.9 0.61 21.90 0.1107 0.0077 Women 9.5 13.3 13.4 22.2 32.1 17.7 0.30 22.60 0.2331 0.0143 E. Tobacco and alcohol use Tobacco: Women na na na na na na na na na na Men na na na na na na na na na na Alcohol: Women na na na na na na na na na na Men na na na na na na na na na na F. Sexual practices Non-regular sexual partnerships: Women 0.4 0.3 0.5 0.7 1.9 0.8 0.21 1.50 0.3978 0.0679 Men 2.4 4.4 6.2 8.5 12.1 7.1 0.20 9.70 0.2745 0.0387 Condom usage with non-regular partner: Women * * * * 34.1 22.3 * * * * Men 36.3 33.8 33.9 70.7 65.1 55.5 0.56 28.80 0.1542 0.0293 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 - Mali 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 2.4 2.8 3.4 10.0 41.8 13.2 0.06 39.40 0.6143 0.0151 Men 8.3 8.3 10.6 20.3 58.3 24.6 0.14 50.00 0.4779 0.0094 School participation: Girls 17.9 18.0 19.5 29.2 65.6 28.3 0.27 47.70 0.3014 0.0130 Boys 28.8 24.2 29.1 39.8 74.1 37.4 0.39 45.30 0.2093 0.0105 B. Exposure to mass media Newspaper readership: Women 0.4 0.5 0.9 3.1 20.0 5.6 0.02 19.60 0.7002 0.0279 Men 1.6 3.2 4.6 7.8 38.2 13.3 0.04 36.60 0.6377 0.0325 Radio listenership: Women 49.7 54.1 51.1 64.8 82.7 61.5 0.60 33.00 0.1099 0.0040 Men 76.3 76.5 80.7 85.6 90.7 82.6 0.84 14.40 0.0429 0.0047 Television viewership: Women 11.2 11.6 12.1 29.6 79.1 31.0 0.14 67.90 0.4408 0.0077 Men 22.2 22.7 23.4 43.5 85.6 43.3 0.26 63.40 0.3164 0.0106 C. Knowledge and attitudes about HIV/AIDS Knowledge about sexual transmission of HIV/AIDS: Women 42.7 41.4 39.3 52.3 80.5 52.6 0.53 37.83 0.1485 0.0048 Men 71.8 69.7 68.8 77.4 88.3 76.3 0.81 16.50 0.0607 0.0055 Knowledge about mother-to-child transmission of HIV/AIDS: Women 32.6 33.5 31.8 43.6 74.5 45.2 0.44 41.90 0.1687 0.0058 Men 52.9 53.5 52.2 62.8 76.2 62.4 0.69 23.30 0.0658 0.0078 Attitudes toward HIV/AIDS: Women 48.2 48.9 47.5 43.9 29.5 43.1 1.63 18.70 -0.1084 0.0062 Men 55.1 56.4 53.8 46.0 27.7 46.3 1.99 27.40 -0.1408 0.0104 D. Status of women Household decisionmaking: Can seek own health care 9.7 8.9 12.4 12.3 13.6 11.5 0.71 3.90 0.1008 0.0151 Can seek children's health care 63.4 64.7 65.7 77.5 83.9 70.7 0.76 20.50 0.0696 0.0043 Can make daily household purchases 26.8 23.8 27.1 25.1 23.7 25.2 1.13 3.10 -0.0231 0.0092 Can make large household purchases 15.1 13.2 18.5 17.3 18.0 16.5 0.84 2.90 0.0455 0.0122 Can make meal-related decisions 50.8 46.9 49.4 44.1 40.2 46.0 1.26 10.60 -0.0517 0.0058 Freedom of movement: Can travel to visit family, relatives 15.8 14.6 18.9 22.1 23.5 19.2 0.67 7.70 0.0957 0.0114 Other decisionmaking, attitudes: Can decide how to spend own money 82.6 82.5 84.4 84.3 86.6 84.4 0.95 4.00 0.0124 0.0033 Can decide whether to have sex 72.7 75.4 73.5 73.1 75.5 74.1 0.96 2.80 0.0102 0.0031 Justifies domestic violence 88.9 90.9 90.2 90.6 84.2 88.8 1.06 4.70 -0.0086 0.0021 E. Orphanhood Paternal orphan prevalence 2.5 3.0 4.1 4.1 5.3 3.7 0.47 2.80 0.1339 0.0182 Maternal orphan prevalence 2.0 2.2 2.1 1.8 2.4 2.1 0.83 0.40 0.0537 0.0237 Double orphan prevalence 0.4 0.7 0.6 0.5 0.6 0.6 0.67 0.20 0.1231 0.0464 - 7 - Mali 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 131.3 113.3 126.3 119.3 77.2 115.6 143.4 136.7 154.3 137.4 102.0 136.4 Under-five mortality rate 233.7 258.1 243.6 233.0 135.3 226.0 262.3 269.8 279.6 255.0 160.3 250.1 Prevalence of fever 31.4 27.1 27.6 23.1 22.6 26.6 27.5 26.7 28.6 26.8 25.5 27.0 Prevalence of diarrhea 19.5 20.0 21.3 14.3 13.1 17.8 22.2 21.1 20.0 19.3 13.0 19.3 Prevalence of acute respiratory 11.5 9.6 11.2 9.0 10.0 10.3 9.3 8.3 10.5 7.9 11.7 9.5 infection (ARI) B. Nutritional status Children: Moderate stunting 18.9 23.7 18.4 18.1 10.6 18.2 20.6 21.2 19.6 18.7 13.7 18.9 Severe stunting 23.4 24.0 22.1 14.6 7.5 18.8 27.0 23.5 20.8 16.8 7.4 19.4 Moderate underweight 24.8 26.4 23.9 18.3 11.0 21.2 27.3 28.2 25.0 22.4 14.6 23.7 Severe underweight 12.4 14.4 12.5 10.1 4.2 11.0 14.1 13.8 12.1 8.7 3.7 10.7 Mild anemia 16.6 21.8 17.4 17.8 23.2 19.1 15.6 16.4 13.8 21.7 20.1 17.4 Moderate anemia 55.1 51.9 60.8 48.6 44.2 52.8 58.4 52.5 54.3 53.2 44.8 53.2 Severe anemia 12.7 12.1 11.9 15.2 6.2 11.8 15.6 10.4 15.8 9.5 2.4 11.2 C. Sexually transmitted disease Prevalence of genital discharge: Women 20.4 17.8 18.6 20.1 29.9 21.5 Men 4.3 5.5 5.5 4.3 4.1 4.7 Prevalence of genital ulcer: Women 8.2 9.0 8.0 9.1 9.9 8.8 Men 2.9 3.6 1.1 1.7 1.3 2.0 - 9 - Mali 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 55.0 59.1 63.4 77.3 92.9 68.7 61.3 61.7 55.8 78.0 91.3 69.3 Measles coverage 36.9 36.7 41.1 51.3 78.3 48.0 42.7 41.6 35.4 54.2 74.8 49.4 DPT coverage 29.3 24.7 27.5 40.8 72.6 38.0 26.7 32.2 29.8 50.2 68.9 41.2 Full basic coverage 22.0 17.0 18.8 32.0 60.0 29.1 17.0 23.2 18.6 31.9 52.4 28.3 No basic coverage 31.5 25.3 27.4 18.6 5.5 22.2 27.3 26.3 28.0 16.8 6.8 21.2 Hepatitis B coverage na na na na na na na na na na na na Yellow fever coverage na na na na na na na na na na na na B. Treatment of childhood illnesses Treatment of fever: Medical treatment of fever 17.2 20.7 25.4 32.4 57.7 28.4 19.8 17.0 25.4 26.6 64.0 29.4 Treatment in a public facility 6.8 7.0 11.1 16.0 40.1 14.4 6.0 7.2 11.7 12.8 46.2 15.7 Treatment in a private facility 10.2 13.7 13.7 16.4 17.2 13.8 13.5 9.9 13.5 13.5 17.3 13.4 Treatment of acute respiratory infection (ARI): Medical treatment of ARI 18.5 34.5 24.4 31.4 65.9 33.2 25.5 22.5 29.2 35.9 72.8 38.2 Treatment in a public facility 8.2 12.4 13.0 20.3 46.7 18.8 9.8 6.3 13.1 24.4 52.0 21.9 Treatment in a private facility 10.0 22.0 9.9 11.1 18.5 13.9 15.7 16.2 15.7 11.5 19.9 16.0 Treatment of diarrhea: Use of oral rehydration therapy 66.3 62.5 64.2 67.5 83.4 67.2 62.7 64.9 56.8 66.6 76.2 64.4 Medical treatment of diarrhea 10.3 14.8 10.8 13.0 42.5 16.2 14.2 8.8 13.8 19.1 42.5 17.4 Treatment in a public facility 2.2 2.3 4.0 4.2 28.2 6.5 3.5 3.2 4.7 12.7 26.8 8.4 Treatment in a private facility 8.0 12.2 6.8 8.9 14.3 9.6 10.4 5.6 9.0 6.4 15.7 8.9 C. Contraceptive services Contraceptive prevalence: Women 4.2 3.6 3.4 7.3 17.9 7.0 Men 7.6 5.6 6.2 12.7 19.1 10.2 Source of contraception - public sector: Women 33.3 29.9 49.2 54.8 49.1 46.3 Men na na na na na na Source of contraception - private sector: Women 19.5 32.9 34.9 31.1 44.9 36.6 Men na na na na na na D. Treatment of adult illnesses Treatment of genital discharge, ulcer, sore: Women 14.7 19.0 15.5 31.6 60.2 32.4 Men (19.7) (20.0) (17.7) (32.7) (34.7) 0.0 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 0.8 1.0 1.5 3.6 12.0 4.2 Men 4.6 3.7 3.8 7.0 19.2 8.7 - 10 - Mali 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 na na na na na na Handwashing: Wash hands prior to preparing food 90.6 90.1 88.3 89.8 92.7 90.4 Handwashing facilities in household 3.0 4.6 7.3 7.6 19.5 8.2 B. Bednet ownership and use Bednet use: By children 34.4 38.6 34.9 37.1 48.0 38.3 C. Breastfeeding Exclusive breastfeeding 32.7 21.7 27.7 20.0 18.2 24.5 43.8 42.9 25.1 28.6 17.8 31.9 Timely complementary feeding 31.1 25.8 25.3 28.4 42.8 31.0 28.7 24.1 29.7 41.1 46.2 33.8 Bottle-feeding 3.2 2.9 1.8 4.7 10.2 4.5 0.6 2.7 1.9 1.7 14.7 4.0 D. Micronutrient consumption Vitamin A: Children 35.0 34.3 39.8 42.4 54.1 40.7 33.6 34.8 38.9 41.7 58.3 41.0 E. Tobacco and alcohol use Tobacco: Women na na na na na na Men na na na na na na Alcohol: Women na na na na na na Men na na na na na na F. Sexual practices Non-regular sexual partnerships: Women 0.4 0.3 0.5 0.7 1.9 0.8 Men 2.4 4.4 6.2 8.5 12.1 7.1 Condom usage with non-regular partner: Women * * * * 34.1 22.3 Men 36.3 33.8 33.9 70.7 65.1 55.5 - 11 - Mali 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 2.4 2.8 3.4 10.0 41.8 13.2 Men 8.3 8.3 10.6 20.3 58.3 24.6 School participation: Girls 17.9 18.0 19.5 29.2 65.6 28.3 Boys 28.8 24.2 29.1 39.8 74.1 37.4 B. Exposure to mass media Newspaper readership: Women 0.4 0.5 0.9 3.1 20.0 5.6 Men 1.6 3.2 4.6 7.8 38.2 13.3 Radio listenership: Women 49.7 54.1 51.1 64.8 82.7 61.5 Men 76.3 76.5 80.7 85.6 90.7 82.6 Television viewership: Women 11.2 11.6 12.1 29.6 79.1 31.0 Men 22.2 22.7 23.4 43.5 85.6 43.3 C. Knowledge and attitudes about HIV/AIDS Knowledge about sexual transmission of HIV/AIDS: Women 42.7 41.4 39.3 52.3 80.5 52.6 Men 71.8 69.7 68.8 77.4 88.3 76.3 Knowledge about mother-to-child transmission of HIV/AIDS: Women 32.6 33.5 31.8 43.6 74.5 45.2 Men 52.9 53.5 52.2 62.8 76.2 62.4 Attitudes toward HIV/AIDS: Women 48.2 48.9 47.5 43.9 29.5 43.1 Men 55.1 56.4 53.8 46.0 27.7 46.3 D. Orphanhood Paternal orphan prevalence 2.8 3.1 4.0 4.3 5.1 3.8 2.3 2.9 4.2 3.8 5.5 3.7 Maternal orphan prevalence 2.2 2.2 2.4 1.7 2.9 2.3 1.9 2.2 1.9 2.0 1.9 2.0 Double orphan prevalence 0.4 0.7 0.7 0.5 0.7 0.6 0.4 0.7 0.4 0.5 0.6 0.5 - 12 - Mali 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 137.8 125.3 140.6 130.7 66.2 131.9 * * (141.5) 123.4 93.5 105.9 Under-five mortality rate 246.2 262.2 263.0 254.4 (138.9) 253.2 * * (252.3) 217.3 149.4 184.6 Prevalence of fever 29.4 26.3 28.3 26.6 25.1 27.7 (32.7) 38.0 25.4 20.7 23.9 24.0 Prevalence of diarrhea 20.8 20.5 21.4 18.2 17.7 20.3 (23.2) 20.9 11.8 13.4 12.3 13.1 Prevalence of acute respiratory infection 10.5 8.7 11.0 9.5 13.4 10.1 (8.0) 14.2 8.3 5.4 10.5 9.3 B. Fertility Total fertility rate 7.3 7.6 7.3 7.1 * 7.3 * * * 6.2 5.2 5.5 Adolescent fertility rate 197.0 250.0 229.0 206.0 * 218.0 * * * 195.0 106.0 129.0 C. Nutritional status Children: Moderate stunting 19.4 21.8 19.7 19.7 13.0 20.0 (33.8) 35.2 10.6 14.9 12.1 13.9 Severe stunting 25.2 24.4 21.6 17.1 11.1 22.1 (19.1) 10.5 19.5 11.8 6.9 9.2 Moderate underweight 25.9 27.4 24.5 21.6 12.3 24.7 (33.3) 26.3 23.2 17.3 12.9 15.5 Severe underweight 13.2 14.4 12.5 10.2 7.0 12.6 (14.2) 8.5 9.4 7.0 3.5 5.1 Mild anemia 16.4 19.3 15.3 18.5 17.5 17.3 * (12.9) (20.3) 25.3 22.2 21.7 Moderate anemia 56.5 51.4 57.8 52.2 53.2 54.6 * (69.0) (56.0) 48.1 43.3 47.0 Severe anemia 13.7 11.6 13.1 13.3 3.9 12.7 * (4.2) (21.9) 7.3 4.4 6.9 Women: Malnutrition 12.9 13.6 13.4 12.9 11.2 13.1 (18.9) 14.9 14.3 14.0 10.1 11.4 Mild anemia 42.8 41.6 39.0 40.3 27.7 40.8 * (30.6) (25.9) 40.2 33.9 35.0 Moderate anemia 21.8 24.6 24.9 21.2 14.7 22.8 * (24.6) (29.7) 19.4 13.2 15.9 Severe anemia 2.8 4.4 2.4 2.6 1.6 3.0 * 0.0 (7.4) 1.8 2.2 2.2 D. Female circumcision Prevalence of circumcision: Girls 76.2 73.1 66.0 67.7 67.1 71.0 (80.9) 76.1 65.8 68.3 80.9 76.7 Women 95.8 94.2 90.4 88.7 92.0 92.5 100.0 86.8 81.7 87.8 90.4 89.5 Prevalence of occlusion: Girls 3.4 3.8 5.8 4.5 3.0 4.3 (4.7) 3.1 5.5 5.1 5.5 5.3 Women 1.2 1.5 2.0 2.5 0.7 1.7 5.6 0.0 1.9 0.5 2.8 2.3 E. Sexually transmitted disease Prevalence of genital discharge: Women 19.9 17.9 18.6 18.2 22.2 18.8 37.5 16.0 17.6 24.9 30.9 28.4 Men 4.3 5.4 5.2 4.3 4.1 4.7 * (7.1) (8.6) 4.5 4.1 4.6 Prevalence of genital ulcer: Women 8.3 9.1 8.2 8.5 6.1 8.5 2.8 7.5 5.7 10.4 10.3 9.8 Men 2.8 3.1 1.0 1.8 2.9 2.3 * (10.4) (2.1) 1.4 1.1 1.5 - 13 - Mali 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 57.4 59.4 58.2 70.9 95.5 62.0 * (77.6) (79.6) 93.3 91.5 90.4 Measles coverage 39.5 39.3 38.1 46.7 67.1 41.3 * (39.7) (40.6) 67.0 78.0 70.8 DPT coverage 27.4 27.9 27.1 35.8 59.3 30.1 * (42.3) (52.0) 68.5 72.5 68.4 Full basic coverage 18.8 19.7 18.8 27.2 47.1 21.5 * (30.3) (17.7) 43.1 57.5 50.3 No basic coverage 29.9 26.5 29.2 23.0 0.0 26.5 * (14.0) (5.8) 5.1 7.1 7.1 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 18.0 17.5 23.3 24.5 48.8 21.3 * (39.0) 56.1 46.0 63.1 56.9 Treatment in a public facility 6.4 6.6 11.5 11.8 21.9 9.2 * (14.1) 11.4 23.0 46.9 36.8 Treatment in a private facility 11.4 10.8 11.7 12.5 27.0 12.0 * (24.9) 41.3 23.0 15.7 19.6 Treatment of acute respiratory infection (ARI): Medical treatment of ARI 20.7 27.0 25.0 31.3 (44.2) 26.2 * * (56.7) (44.8) 74.7 68.4 Treatment in a public facility 8.8 9.5 13.0 20.4 (22.0) 12.8 * * (14.2) (31.8) 55.1 46.4 Treatment in a private facility 11.7 17.5 11.6 10.9 (22.2) 13.3 * * (32.2) (13.0) 18.7 20.7 Treatment of diarrhea: Use of oral rehydration therapy 63.9 63.3 60.6 64.8 71.6 63.3 * * (60.7) 75.0 81.6 78.0 Medical treatment of diarrhea 11.4 11.4 11.2 12.5 39.1 12.3 * * (37.6) 32.4 43.3 39.4 Treatment in a public facility 2.9 2.7 3.7 5.3 15.7 3.8 * * (19.9) 24.3 30.1 25.9 Treatment in a private facility 8.4 8.5 7.5 7.2 23.4 8.4 * * (17.8) 8.0 13.1 13.3 C. Antenatal and delivery care Antenatal care visits: To a medically trained person 41.1 42.8 45.0 57.5 92.1 47.2 (86.7) 67.6 61.7 83.4 91.8 86.9 To a doctor 0.8 1.4 1.4 2.2 8.1 1.6 (2.2) 1.7 7.1 3.6 7.8 6.4 To a nurse or trained midwife 40.2 41.4 43.6 55.4 84.0 45.6 (84.5) 65.9 54.6 79.8 84.0 80.5 Multiple visits to a medically trained person 24.1 28.1 29.3 40.6 65.0 30.8 (48.4) 52.9 49.2 59.6 75.0 68.5 Antenatal care content: Tetanus toxoid 34.1 36.2 36.2 47.6 78.0 39.1 (72.9) 60.0 57.6 74.8 81.8 77.7 Prophylactic antimalarial treatment 48.2 50.3 51.8 63.4 83.5 53.6 (62.2) 65.5 64.1 71.8 87.1 80.8 Iron supplementation 24.8 24.9 26.2 36.3 55.9 28.3 (54.1) 36.3 39.3 50.6 57.4 53.8 Delivery attendance: By a medically trained person 7.2 7.2 9.0 15.1 48.8 10.4 43.0 44.5 43.2 67.1 86.7 76.5 By a doctor 0.4 0.6 1.0 0.7 5.1 0.8 3.4 1.1 2.6 2.6 4.8 3.9 By a nurse or trained midwife 6.9 6.6 8.0 14.4 43.8 9.6 39.7 43.4 40.6 64.6 82.0 72.6 In a public facility 18.4 22.7 24.1 33.2 56.6 24.9 72.9 53.8 55.1 69.3 83.6 76.9 In a private facility 0.4 0.5 0.2 0.4 5.3 0.5 0.0 0.3 0.0 0.8 3.6 2.5 At home 80.2 75.1 74.4 65.5 34.9 73.3 25.8 46.0 43.3 28.5 11.4 19.3 D. Contraceptive services Contraceptive prevalence: Women 4.3 3.5 3.1 5.4 13.9 4.3 1.7 4.0 6.8 12.4 18.5 15.3 Men 7.7 4.9 6.2 10.0 18.4 7.4 * * (7.0) 19.0 19.2 18.2 - 14 - Mali 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 32.7 27.2 48.9 55.3 (47.4) 41.3 * * * 54.1 49.3 50.6 Men (100.0) * * (100.0) * 100.0 0.0 * * * 100.0 100.0 Source of contraception - private sector: Women 19.7 33.2 32.3 22.6 (38.5) 27.4 * * * 40.9 45.5 44.5 Men na na na na na na na na na na na na E. Treatment of adult illnesses Treatment of genital discharge, ulcer, sore: Women 14.4 17.8 14.7 27.1 60.6 19.5 * (41.3) (25.4) 39.8 60.1 54.1 Men (20.1) (23.6) (19.6) (22.9) * 22.1 * * * * (33.3) 32.9 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 0.8 0.8 1.3 1.7 9.9 1.4 0.0 5.0 3.8 8.3 12.2 10.6 Men 4.6 2.5 3.1 2.7 11.6 3.7 * (21.1) 12.5 15.7 20.1 18.7 - 15 - Mali 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 90.5 90.3 88.2 89.3 89.3 89.6 97.2 87.2 88.8 90.9 93.0 92.3 Handwashing facilities in household 3.0 4.8 7.6 7.1 21.8 6.1 0.0 1.1 4.0 8.9 19.2 14.7 B. Bednet ownership and use Bednet ownership: Bednet ownership 52.3 56.3 50.0 53.4 68.7 53.4 (70.0) 66.5 59.8 55.7 57.4 57.6 Treated bednet ownership na na na na na na na na na na na na Bednet use: By children 34.1 38.0 33.6 35.5 54.3 35.8 (51.4) 48.2 53.2 41.4 47.0 46.2 By pregnant women 33.2 36.2 34.9 34.7 (57.8) 35.2 * * * 43.6 37.3 38.6 C. Breastfeeding Exclusive breastfeeding 38.3 32.3 26.4 23.9 * 30.6 * * * (24.5) 16.6 19.5 Timely complementary feeding 30.1 25.0 26.5 35.4 (47.8) 29.7 0.0 * * (36.9) 43.6 40.9 Bottle-feeding 2.0 2.5 2.0 2.8 12.2 2.6 * * 0.0 4.5 12.5 9.7 D. Micronutrient consumption Iodized salt: Availability of iodized salt 40.1 35.6 29.5 30.8 41.8 34.1 (48.3) 27.8 33.9 42.5 53.4 47.6 in household Vitamin A: Children 33.7 33.1 37.6 38.8 51.3 36.1 (60.7) 62.5 61.2 50.6 57.0 56.1 Women 9.2 12.5 12.5 17.4 32.3 13.1 (21.4) 30.5 24.2 34.9 32.1 31.9 E. Tobacco and alcohol use Tobacco: Women na na na na na na na na na na na na Men na na na na na na na na na na na na Alcohol: Women na na na na na na na na na na na na Men na na na na na na na na na na na na F. Sexual practices Non-regular sexual partnerships: Women 0.4 0.3 0.5 0.6 0.3 0.4 0.0 0.0 0.0 1.2 2.0 1.7 Men 2.4 4.0 5.1 7.2 20.3 5.0 * (10.6) 19.4 11.2 11.3 11.5 Condom usage with non-regular partner: Women * * * * * (1.3) * * * * 34.6 35.0 Men 37.8 26.1 36.2 72.9 63.7 47.3 * (75.9) 26.3 68.0 65.4 62.6 G. Domestic violence Ever experienced violence na na na na na na na na na na na na Experienced violence in past year na na na na na na na na na na na na - 16 - Mali 2001 - RURAL / URBAN POPULATIONS Part IV: UNDERLYING DETERMINANTS OF HNP STATUS Indicator Wealth Quintiles - Rural Wealth Quintiles - Urban Low 2nd 3rd 4th High Avg. Low 2nd 3rd 4th High Avg. A. Education School completion: Women 2.4 2.6 3.0 6.6 27.3 4.3 2.5 6.7 7.7 18.4 43.4 34.7 Men 8.1 7.9 10.0 15.1 47.7 11.4 (22.0) 15.1 18.2 31.3 59.4 50.9 School participation: Girls 18.0 17.7 19.4 27.2 54.1 21.0 * 23.7 20.0 34.6 67.3 53.5 Boys 29.0 23.6 28.6 34.2 56.2 29.3 * (40.1) 35.9 53.4 77.6 66.3 B. Exposure to mass media Newspaper readership: Women 0.4 0.4 0.9 2.3 18.3 1.5 0.0 2.1 1.2 5.0 20.1 15.3 Men 1.6 3.0 4.6 7.3 17.8 4.2 * (6.0) 5.4 9.0 40.5 31.7 Radio listenership: Women 49.5 52.7 50.5 60.4 81.4 53.8 57.1 76.4 57.9 75.2 82.8 79.4 Men 76.5 75.7 80.9 85.0 92.1 79.4 * (88.1) 78.4 86.8 90.5 89.0 Television viewership: Women 11.3 10.8 11.2 22.4 60.7 15.0 7.1 23.4 23.1 46.7 81.1 68.2 Men 22.2 20.3 22.3 32.3 75.5 25.6 * (56.7) 36.4 65.7 86.7 79.0 C. Knowledge and attitudes about HIV/AIDS Knowledge about sexual transmission of HIV/AIDS: Women 46.5 45.9 44.7 50.3 76.7 47.7 36.9 56.3 46.2 69.5 82.6 76.5 Men 72.0 69.5 68.8 74.9 77.6 71.4 * (71.5) 69.9 82.3 89.5 86.3 Knowledge about mother-to-child transmission of HIV/AIDS: Women 35.6 31.9 31.1 39.0 72.4 35.5 30.0 59.4 39.7 54.6 74.7 67.8 Men 59.5 52.6 51.8 57.2 66.8 56.1 * (66.6) 57.2 73.9 77.2 75.1 Attitudes toward HIV/AIDS: Women 50.8 49.2 47.3 45.0 36.0 47.8 50.8 45.7 49.3 41.4 28.8 33.1 Men 55.2 56.5 53.2 49.9 14.4 52.6 * (55.4) (61.6) 38.4 29.1 33.8 D. Status of women Household decisionmaking: Can seek own health care 9.9 9.0 11.6 12.0 7.3 10.5 2.8 6.3 21.5 13.2 14.3 14.0 Can seek children's health care 62.7 64.3 64.8 74.5 75.4 66.4 (90.7) 71.1 78.6 86.1 85.1 84.4 Can make daily household purchases 27.1 24.1 26.6 25.1 27.3 25.8 15.0 18.6 33.5 25.1 23.3 23.8 Can make large household purchases 15.2 13.2 17.6 17.3 18.2 15.8 11.7 14.0 28.8 17.2 18.0 18.2 Can make meal-related decisions 50.8 47.1 48.5 45.3 47.7 48.1 50.8 43.1 60.3 41.1 39.4 41.1 Freedom of movement: Can travel to visit family, relatives 16.0 14.5 18.4 22.4 17.9 17.6 11.4 15.9 24.1 21.4 24.1 23.1 Other decisionmaking, attitudes: Can decide how to spend own money 82.3 82.3 85.0 82.9 79.6 83.0 (96.9) (86.4) 78.8 87.3 87.3 87.0 Can decide whether to have sex 73.0 74.8 73.2 71.8 66.7 73.0 62.1 83.9 77.0 76.3 76.4 76.5 Justifies domestic violence 88.6 91.0 90.5 90.9 87.5 90.1 100.0 90.0 87.4 89.7 83.9 85.7 E. Orphanhood Paternal orphan prevalence 2.5 3.0 4.1 3.6 5.2 3.3 3.2 2.0 4.0 5.2 5.3 5.0 Maternal orphan prevalence 2.1 2.2 2.0 1.9 0.7 2.0 0.7 2.7 4.0 1.7 2.7 2.5 Double orphan prevalence 0.4 0.7 0.5 0.4 0.5 0.5 0.0 0.7 1.6 0.9 0.7 0.8 - 17 - . PART II. BASIC TABLES, 1995 / 96 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. Mali 1995 / 96 - 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 151.4 146.9 138.9 129.0 93.2 133.5 1.62 58.20 -0.0753 0.0006 Under-five mortality rate 297.9 283.6 251.8 241.1 169.1 252.2 1.76 128.80 -0.0901 0.0006 Prevalence of fever 41.9 41.4 40.2 38.8 30.3 38.7 1.38 11.60 -0.0462 0.0104 Prevalence of diarrhea 29.0 26.8 27.8 25.7 16.2 25.3 1.79 12.80 -0.0788 0.0135 Prevalence of acute respiratory 15.4 16.6 15.0 15.3 13.9 15.3 1.11 1.50 -0.0183 0.0191 infection (ARI) B. Fertility Total fertility rate 6.9 7.3 7.4 7.1 5.1 6.7 1.35 1.80 -0.0512 0.0005 Adolescent fertility rate 198.0 219.0 210.0 217.0 122.0 187.0 1.62 76.00 -0.0874 0.0017 C. Nutritional status (%) Children: Moderate stunting 14.2 17.5 16.6 17.0 12.1 15.6 1.17 2.10 -0.0270 0.0189 Severe stunting 18.0 17.7 15.1 13.8 7.2 14.5 2.50 10.80 -0.1360 0.0197 Moderate underweight 25.9 27.4 23.0 21.3 19.6 23.5 1.32 6.30 -0.0618 0.0151 Severe underweight 21.3 18.3 16.5 16.8 8.5 16.5 2.51 12.80 -0.1322 0.0185 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 15.9 18.3 16.1 18.1 12.2 16.2 1.30 3.70 -0.0482 0.0206 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 67.6 74.1 76.5 78.9 79.1 75.2 0.85 11.50 0.0221 0.0048 Women 88.0 95.7 96.5 95.8 92.8 93.7 0.95 4.80 0.0005 0.0026 Prevalence of occlusion: Girls na na na na na na na na na na Women 0.2 1.0 0.4 0.4 0.5 0.5 0.40 0.30 0.0201 0.0774 E. Sexually transmitted disease Prevalence of genital discharge: Women 0.1 0.4 0.2 0.4 0.2 0.3 0.50 0.10 0.0541 0.1068 Men 2.1 1.5 2.9 2.3 2.3 2.2 0.91 0.20 0.1239 0.0876 Prevalence of genital ulcer: Women 0.2 0.2 0.2 0.1 0.2 0.2 1.00 0.00 0.0545 0.1347 Men 1.9 3.1 0.6 3.2 0.8 1.9 2.38 1.10 -0.1052 0.0820 - 21 - Mali 1995 / 96 - 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 56.5 70.7 76.2 83.5 94.7 76.3 0.60 38.20 0.0908 0.0075 Measles coverage 34.2 41.3 48.8 52.3 79.7 50.8 0.43 45.50 0.1564 0.0135 DPT coverage 17.4 31.2 31.2 42.4 67.3 37.5 0.26 49.90 0.2481 0.0173 Full basic coverage 15.8 26.2 26.9 34.6 55.6 31.5 0.28 39.80 0.2380 0.0203 No basic coverage 42.5 29.3 22.8 14.5 4.9 22.8 8.67 37.60 -0.3048 0.0248 Hepatitis B coverage na na na na na na na na na na Yellow fever coverage 0.5 1.3 3.1 8.0 27.1 7.6 0.02 26.60 0.6136 0.0604 B. Treatment of childhood illnesses Treatment of fever: Medical treatment of fever 7.6 8.3 14.7 15.3 36.0 14.9 0.21 28.34 0.3317 0.0336 Treatment in a public facility 4.7 4.9 6.8 10.1 18.5 8.3 0.25 13.81 0.2839 0.0482 Treatment in a private facility 2.9 3.4 7.9 5.2 17.5 6.6 0.17 14.53 0.3914 0.0542 Treatment of acute respiratory infection (ARI): Medical treatment of ARI 18.2 19.3 28.2 35.7 68.2 32.3 0.27 49.95 0.2738 0.0292 Treatment in a public facility 13.0 11.2 12.4 23.4 43.5 19.6 0.30 30.54 0.2452 0.0441 Treatment in a private facility 5.3 8.1 15.8 12.3 24.7 12.7 0.21 19.41 0.3178 0.0542 Treatment of diarrhea: Use of oral rehydration therapy 38.4 43.6 38.6 48.6 67.0 45.0 0.57 28.60 0.0912 0.0170 Medical treatment of diarrhea 8.5 19.3 17.6 21.6 35.1 18.8 0.24 26.68 0.2249 0.0333 Treatment in a public facility 4.2 11.9 10.2 13.3 19.9 11.0 0.21 15.72 0.2306 0.0473 Treatment in a private facility 4.3 7.4 7.4 8.3 15.2 7.8 0.28 10.95 0.2165 0.0567 C. Antenatal and delivery care Antenatal care visits: To a medically trained person 20.6 35.2 44.2 58.0 85.7 47.5 0.24 65.10 0.2349 0.0078 To a doctor 0.1 0.6 0.7 1.4 2.9 1.1 0.03 2.80 0.5373 0.1014 To a nurse or trained midwife 20.4 34.6 43.5 56.6 82.7 46.4 0.25 62.30 0.2457 0.0075 Multiple visits to a medically trained person 10.8 21.3 31.7 43.8 69.6 34.3 0.16 58.80 0.3209 0.0098 Antenatal care content: Tetanus toxoid 31.2 41.2 47.5 59.8 82.1 51.4 0.38 50.90 0.1863 0.0071 Prophylactic antimalarial treatment na na na na na na na na na na Iron supplementation na na na na na na na na na na Delivery attendance: By a medically trained person 11.1 22.8 34.1 51.5 80.6 38.7 0.14 69.50 0.3428 0.0080 By a doctor 0.1 0.3 0.3 1.2 2.0 0.7 0.05 1.90 0.4922 0.1112 By a nurse or trained midwife 11.0 22.6 33.9 50.3 78.6 38.0 0.14 67.60 0.3401 0.0082 In a public facility 8.4 16.0 23.6 40.0 67.6 29.9 0.12 59.20 0.3761 0.0107 In a private facility 0.1 0.0 0.2 0.2 2.3 0.5 0.04 2.20 0.7097 0.1537 At home 89.6 78.6 67.2 51.2 19.9 62.7 4.50 69.70 -0.2074 0.0049 D. Contraceptive services Contraceptive prevalence: Women 0.5 1.4 2.0 4.2 15.3 4.5 0.03 14.80 0.6124 0.0381 Men 1.0 3.9 6.5 14.3 18.7 8.4 0.05 17.70 0.4168 0.0486 - 22 - Mali 1995 / 96 - 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 * * (32.6) 53.9 61.8 57.2 * * * * Men na na na na na na na na na na Source of contraception - private sector: Women * * (67.4) 39.0 35.6 39.3 * * * * Men na na na na na na na na na na E. Treatment of adult illnesses Treatment of genital discharge, ulcer, sore: Women * * * * (65.8) 46.4 * * * * Men * * * * * 31.5 * * * * Treatment of genital discharge, ulcer, sore in public facilities: Women na na na na na na na na na na Men na na na na na na na na na na Voluntary counseling and testing for HIV/AIDS: Women na na na na na na na na na na Men na na na na na na na na na na - 23 - Mali 1995 / 96 - 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 10.9 13.5 12.8 13.7 10.4 12.3 1.05 0.50 -0.0576 0.0603 Timely complementary feeding 23.6 27.9 36.8 32.9 45.8 33.0 0.52 22.20 0.1181 0.0330 Bottle-feeding 1.5 1.1 1.8 4.0 8.8 3.2 0.17 7.30 0.4913 0.0932 D. Micronutrient consumption Iodized salt: Availability of iodized salt na na na na na na na na na na in household Vitamin A: Children 1.7 0.5 0.8 1.1 1.0 1.0 1.70 0.70 0.0561 0.1041 Women na na na na na na na na na na E. Tobacco and alcohol use Tobacco: Women na na na na na na na na na na Men na na na na na na na na na na Alcohol: Women na na na na na na na na na na Men na na na na na na na na na na F. Sexual practices Non-regular sexual partnerships: Women na na na na na na na na na na Men 8.1 10.7 16.1 20.7 39.3 19.9 0.21 31.20 0.3203 0.0246 Condom usage with non-regular partner: Women na na na na na na na na na na Men 6.2 13.7 18.3 32.2 52.2 35.5 0.12 46.00 0.2865 0.0317 G. Domestic violence Ever experienced violence na na na na na na na na na na Experienced violence in past year na na na na na na na na na na - 24 - Mali 1995 / 96 - TOTAL POPULATION Part IV: UNDERLYING DETERMINANTS OF HNP STATUS Indicator Wealth Quintiles Low/High Low-High Concentration Index Ratio Diff. Value Standard Low 2nd 3rd 4th High Avg. (Abs. Val.) Errors A. Education School completion: Women 1.4 2.4 3.3 8.7 36.1 10.9 0.04 34.70 0.6303 0.0201 Men 4.6 6.9 9.7 19.3 52.6 20.6 0.09 48.00 0.5111 0.0125 School participation: Girls 5.0 10.6 14.8 26.9 55.2 22.0 0.09 50.20 0.4590 0.0166 Boys 11.8 14.9 21.7 33.2 62.9 28.0 0.19 51.10 0.3478 0.0140 B. Exposure to mass media Newspaper readership: Women 0.5 0.9 1.3 4.9 21.7 6.5 0.02 21.20 0.6886 0.0298 Men 3.1 4.5 6.6 14.0 44.1 15.8 0.07 41.00 0.5493 0.0306 Radio listenership: Women 29.1 50.6 59.0 70.2 85.3 59.8 0.34 56.20 0.1799 0.0045 Men 59.0 76.8 83.1 90.3 93.9 81.3 0.63 34.90 0.0853 0.0059 Television viewership: Women 6.2 12.9 17.3 30.9 73.2 29.8 0.08 67.00 0.4124 0.0089 Men 9.1 15.7 29.5 44.5 82.7 38.3 0.11 73.60 0.3617 0.0129 C. Knowledge and attitudes about HIV/AIDS Knowledge about sexual transmission of HIV/AIDS: Women 63.7 77.9 79.2 85.0 93.7 80.4 0.68 30.00 0.0661 0.0029 Men 90.7 94.4 95.2 94.8 99.0 95.0 0.92 8.30 0.0156 0.0028 Knowledge about mother-to-child transmission of HIV/AIDS: Women 29.6 26.7 32.6 47.2 73.5 40.8 0.40 43.90 0.2724 0.0064 Men 46.6 43.5 50.0 60.1 77.3 55.7 0.60 30.70 0.1427 0.0102 Attitudes toward HIV/AIDS: Women na na na na na na na na na na Men na na na na na na na na na na D. Status of women Household decisionmaking: Can seek own health care na na na na na na na na na na Can seek children's health care na na na na na na na na na na Can make daily household purchases na na na na na na na na na na Can make large household purchases na na na na na na na na na na Can make meal-related decisions na na na na na na na na na na Freedom of movement: Can travel to visit family, relatives na na na na na na na na na na Other decisionmaking, attitudes: Can decide how to spend own money 69.9 77.5 78.6 82.8 87.5 80.5 0.80 17.62 0.0364 0.0047 Can decide whether to have sex na na na na na na na na na na Justifies domestic violence na na na na na na na na na na E. Orphanhood Paternal orphan prevalence 3.8 3.6 3.4 4.1 4.4 3.9 0.86 0.60 0.0523 0.0217 Maternal orphan prevalence 2.5 1.7 2.4 2.0 2.1 2.1 1.19 0.40 0.0046 0.0278 Double orphan prevalence 0.4 0.3 0.4 0.3 0.7 0.4 0.57 0.30 0.1167 0.0698 - 25 - Mali 1995 / 96 - 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 150.1 141.8 131.4 115.6 84.7 126.5 152.9 152.2 146.3 142.1 101.6 140.5 Under-five mortality rate 299.7 274.5 243.3 238.2 161.5 247.1 296.3 292.7 260.1 243.6 176.7 257.3 Prevalence of fever 39.5 43.2 37.8 38.5 26.5 37.4 44.6 39.7 42.6 39.1 34.2 40.1 Prevalence of diarrhea 27.3 27.0 26.4 27.2 13.5 24.6 30.9 26.7 29.2 24.3 19.0 26.1 Prevalence of acute respiratory 16.1 16.8 14.4 15.4 12.7 15.1 14.6 16.4 15.6 15.3 15.0 15.4 infection (ARI) B. Nutritional status Children: Moderate stunting 14.2 18.5 14.4 16.9 11.9 15.3 14.2 16.5 18.9 17.0 12.3 15.9 Severe stunting 16.7 16.2 14.4 14.1 7.1 13.9 19.5 19.3 15.8 13.5 7.3 15.1 Moderate underweight 25.9 28.7 22.2 20.1 22.3 23.9 25.8 26.1 23.8 22.5 17.2 23.1 Severe underweight 21.4 18.0 14.5 17.7 8.7 16.4 21.2 18.6 18.6 16.0 8.4 16.6 Mild anemia na na na na na na na na na na na na Moderate anemia na na na na na na na na na na na na Severe anemia na na na na na na na na na na na na C. Sexually transmitted disease Prevalence of genital discharge: Women 0.1 0.4 0.2 0.4 0.2 0.3 Men 2.1 1.5 2.9 2.3 2.3 2.2 Prevalence of genital ulcer: Women 0.2 0.2 0.2 0.1 0.2 0.2 Men 1.9 3.1 0.6 3.2 0.8 1.9 - 27 - Mali 1995 / 96 - 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 53.0 67.6 73.8 85.0 93.6 74.4 60.7 73.5 79.2 81.8 95.8 78.3 Measles coverage 29.9 36.1 46.8 52.2 72.4 47.0 39.4 46.0 51.3 52.4 87.1 54.9 DPT coverage 16.1 29.1 30.0 44.7 68.8 37.0 19.0 33.1 32.7 39.9 65.8 38.2 Full basic coverage 14.6 24.4 24.3 36.2 57.1 30.7 17.3 27.8 30.1 32.9 54.1 32.4 No basic coverage 46.4 32.4 25.0 13.7 6.4 25.0 37.8 26.5 20.0 15.3 3.4 20.5 Hepatitis B coverage na na na na na na na na na na na na Yellow fever coverage 0.0 0.9 3.1 8.2 25.5 7.0 1.1 1.7 3.0 7.8 28.7 8.2 B. Treatment of childhood illnesses Treatment of fever: Medical treatment of fever 6.8 5.1 6.9 11.5 15.9 8.5 5.4 6.0 9.5 10.2 22.7 10.1 Treatment in a public facility 5.0 4.2 5.5 10.5 15.9 7.4 4.4 5.6 8.1 9.7 19.9 9.0 Treatment in a private facility 1.8 0.9 1.4 1.0 0.0 1.1 1.0 0.4 1.4 0.5 2.8 1.1 Treatment of acute respiratory infection (ARI): Medical treatment of ARI 22.1 13.6 13.6 19.4 33.5 19.7 6.8 14.4 20.0 28.4 50.4 23.6 Treatment in a public facility 17.7 9.1 8.6 16.5 33.5 16.1 6.8 13.2 16.1 28.4 47.4 22.0 Treatment in a private facility 4.4 4.5 5.0 2.9 0.0 3.6 0.0 1.2 3.9 0.0 3.0 1.6 Treatment of diarrhea: Use of oral rehydration therapy 37.1 37.8 42.1 48.2 63.5 43.4 39.6 49.3 35.3 49.0 69.5 46.6 Medical treatment of diarrhea 4.5 12.1 13.2 15.5 18.5 12.0 10.9 18.2 10.8 12.3 24.5 14.6 Treatment in a public facility 3.2 8.4 10.9 14.8 16.8 10.0 5.2 15.4 9.5 11.6 22.1 12.0 Treatment in a private facility 1.3 3.7 2.3 0.7 1.7 2.0 5.7 2.8 1.3 0.7 2.4 2.6 C. Contraceptive services Contraceptive prevalence: Women 0.5 1.4 2.0 4.2 15.3 4.5 Men 1.0 3.9 6.5 14.3 18.7 8.4 Source of contraception - public sector: Women * * (32.6) 53.9 61.8 57.2 Men na na na na na na Source of contraception - private sector: Women * * (67.4) 39.0 35.6 39.3 Men na na na na na na D. Treatment of adult illnesses Treatment of genital discharge, ulcer, sore: Women * * * * (65.8) 46.4 Men * * * * * * 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 - Mali 1995 / 96 - FEMALE / MALE POPULATIONS Part III: Intermediate Determinants of HNP Status - INDIVIDUAL AND HOUSEHOLD BEHAVIOR Indicator Wealth Quintiles - Female Wealth Quintiles - Male Low 2nd 3rd 4th High Avg. Low 2nd 3rd 4th High Avg. A. Hygienic practices Disposal of children's stools: Sanitary disposal na na na na na na Handwashing: Wash hands prior to preparing food na na na na na na Handwashing facilities in household na na na na na na B. Bednet ownership and use Bednet use: By children na na na na na na C. Breastfeeding Exclusive breastfeeding 9.5 15.5 12.1 10.7 9.2 11.3 12.5 11.8 13.5 17.2 11.8 13.3 Timely complementary feeding 22.8 28.2 29.9 28.5 32.6 28.1 24.8 27.7 43.3 36.7 59.1 38.0 Bottle-feeding 1.0 0.5 2.0 5.3 10.0 3.4 2.2 1.6 1.5 2.7 7.7 3.0 D. Micronutrient consumption Vitamin A: Children 1.2 1.0 1.2 1.7 1.4 1.3 2.3 0.0 0.3 0.5 0.6 0.7 E. Tobacco and alcohol use Tobacco: Women na na na na na na Men na na na na na na Alcohol: Women na na na na na na Men na na na na na na F. Sexual practices Non-regular sexual partnerships: Women na na na na na na Men 8.1 10.7 16.1 20.7 39.3 19.9 Condom usage with non-regular partner: Women na na na na na na Men 6.2 13.7 18.3 32.2 52.2 35.5 - 29 - Mali 1995 / 96 - FEMALE / MALE POPULATIONS Part IV: UNDERLYING DETERMINANTS OF HNP STATUS Indicator Wealth Quintiles - Female Wealth Quintiles - Male Low 2nd 3rd 4th High Avg. Low 2nd 3rd 4th High Avg. A. Education School completion: Women 1.4 2.4 3.3 8.7 36.1 10.9 Men 4.6 6.9 9.7 19.3 52.6 20.6 School participation: Girls 5.0 10.6 14.8 26.9 55.2 22.0 Boys 11.8 14.9 21.7 33.2 62.9 28.0 B. Exposure to mass media Newspaper readership: Women 0.5 0.9 1.3 4.9 21.7 6.5 Men 3.1 4.5 6.6 14.0 44.1 15.8 Radio listenership: Women 29.1 50.6 59.0 70.2 85.3 59.8 Men 59.0 76.8 83.1 90.3 93.9 81.3 Television viewership: Women 6.2 12.9 17.3 30.9 73.2 29.8 Men 9.1 15.7 29.5 44.5 82.7 38.3 C. Knowledge and attitudes about HIV/AIDS Knowledge about sexual transmission of HIV/AIDS: Women 63.7 77.9 79.2 85.0 93.7 80.4 Men 90.7 94.4 95.2 94.8 99.0 95.0 Knowledge about mother-to-child transmission of HIV/AIDS: Women 29.6 26.7 32.6 47.2 73.5 40.8 Men 46.6 43.5 50.0 60.1 77.3 55.7 Attitudes toward HIV/AIDS: Women na na na na na na Men na na na na na na D. Orphanhood Paternal orphan prevalence 3.7 3.5 2.9 3.5 4.5 3.6 3.9 3.8 4.0 4.9 4.3 4.2 Maternal orphan prevalence 2.4 1.9 2.1 1.9 2.4 2.1 2.6 1.5 2.7 2.1 1.8 2.1 Double orphan prevalence 0.2 0.3 0.4 0.3 0.6 0.4 0.7 0.2 0.3 0.4 0.9 0.5 - 30 - Mali 1995 / 96 - 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 152.7 149.1 140.7 140.1 121.4 145.0 (127.0) 121.6 126.0 105.6 85.1 98.7 Under-five mortality rate 300.0 284.0 253.0 255.1 223.2 272.6 (257.4) (279.4) (242.6) 211.3 153.4 190.3 Prevalence of fever 40.8 40.8 40.6 40.6 38.3 40.6 66.3 49.3 36.7 35.4 28.4 33.6 Prevalence of diarrhea 28.6 26.8 28.5 27.5 21.9 27.6 38.1 27.5 22.8 22.4 14.9 19.2 Prevalence of acute respiratory infection 15.3 16.9 15.3 15.9 13.9 15.8 17.0 13.3 12.4 14.3 13.9 13.9 B. Fertility Total fertility rate 7.0 7.4 7.6 7.4 * 7.3 * * * (6.6) 4.7 5.4 Adolescent fertility rate 197.0 224.0 216.0 241.0 * 215.6 * * * (180.0) 116.0 140.2 C. Nutritional status Children: Moderate stunting 14.1 17.5 17.0 18.0 14.8 16.5 (16.2) 17.0 13.7 15.0 11.4 13.1 Severe stunting 18.1 18.1 15.5 15.6 9.9 16.6 (14.3) 12.5 12.0 10.3 6.5 8.7 Moderate underweight 26.4 27.6 23.2 22.0 22.9 24.9 (12.8) 25.9 21.2 19.9 18.8 19.6 Severe underweight 20.9 18.5 16.8 17.9 7.5 18.1 (31.7) 15.8 14.3 14.7 8.8 12.1 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 16.3 17.5 15.9 17.6 17.2 16.8 (8.2) 27.4 17.0 19.0 11.0 14.6 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 68.1 74.5 77.0 79.7 81.5 74.7 57.0 69.8 72.8 77.3 78.5 76.4 Women 88.9 97.5 98.3 98.9 95.9 95.6 73.1 77.3 85.5 90.3 92.2 89.8 Prevalence of occlusion: Girls na na na na na na na na na na na na Women 0.2 0.9 0.1 0.2 0.0 0.4 0.0 1.2 2.0 0.7 0.6 0.8 E. Sexually transmitted disease Prevalence of genital discharge: Women 0.1 0.4 0.3 0.2 0.6 0.3 0.1 0.8 0.0 0.9 0.2 0.3 Men 2.0 1.6 3.4 1.3 2.6 2.1 (3.8) 0.0 0.0 3.9 2.3 2.5 Prevalence of genital ulcer: Women 0.2 0.2 0.2 0.0 0.0 0.2 0.0 0.0 0.0 0.4 0.3 0.3 Men 2.0 3.3 0.7 3.6 1.3 2.3 (0.4) (0.8) 0.0 2.6 0.7 1.1 - 31 - Mali 1995 / 96 - 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 (66.8) (87.1) (89.4) 90.5 95.3 92.1 56.0 69.4 74.8 79.8 92.0 70.6 Measles coverage (35.2) (43.2) (59.2) 62.1 80.1 69.8 34.1 41.2 47.7 47.1 78.2 43.9 DPT coverage (17.3) (61.5) (51.5) 62.4 69.6 64.1 17.4 28.8 29.0 31.8 57.4 28.0 Full basic coverage (16.4) (42.7) (45.6) 49.6 56.9 51.9 15.8 24.9 24.8 26.8 50.0 24.2 No basic coverage (33.2) (12.9) (10.6) 8.2 4.2 7.2 43.0 30.6 24.1 17.9 8.0 28.4 Hepatitis B coverage na na na na na na na na na na na na Yellow fever coverage (3.2) (1.4) (10.5) 21.7 31.5 24.5 0.4 1.3 2.3 0.8 7.9 1.5 B. Treatment of childhood diseases Treatment of fever: Medical treatment of fever 3.6 4.9 13.2 10.4 24.2 16.1 6.3 5.6 7.6 11.0 5.8 7.3 Treatment in a public facility 3.6 2.2 13.2 10.3 22.1 14.9 4.8 5.1 6.0 10.0 5.8 6.2 Treatment in a private facility 0.0 2.7 0.0 0.1 2.1 1.2 1.5 0.5 1.6 1.0 0.0 1.1 Treatment of acute respiratory infection (ARI): Medical treatment of ARI * * * 27.3 49.9 37.5 15.9 14.2 16.3 22.3 * 16.6 Treatment in a public facility * * * 24.7 47.9 35.1 13.3 11.8 11.3 21.4 * 13.9 Treatment in a private facility * * * 2.6 2.0 2.4 2.6 2.4 5.0 0.9 * 2.7 Treatment of diarrhea: Use of oral rehydration therapy 39.5 (34.8) 44.6 54.1 75.0 59.2 38.3 44.3 37.9 46.2 (44.4) 41.4 Medical treatment of diarrhea 14.2 (25.9) 13.1 15.8 26.1 20.6 7.3 14.3 11.9 13.3 (10.2) 11.5 Treatment in a public facility 14.2 (21.1) 13.1 14.5 23.3 18.6 3.6 11.2 9.9 12.8 (10.2) 9.1 Treatment in a private facility 0.0 (4.8) 0.0 1.3 2.8 2.0 3.7 3.1 2.0 0.5 0.0 2.4 C. Antenatal and delivery care Antenatal care visits: To a medically trained person 35.3 49.2 68.3 81.4 90.0 81.0 19.9 34.0 40.8 46.3 68.1 35.8 To a doctor 0.4 0.9 1.2 2.1 3.5 2.6 0.1 0.6 0.7 1.0 0.6 0.6 To a nurse or trained midwife 34.9 48.3 67.1 79.2 86.5 78.4 19.7 33.4 40.1 45.3 67.5 35.2 Multiple visits to a medically trained person 25.7 22.9 50.4 65.5 74.8 64.9 10.1 21.2 29.1 33.0 48.3 23.6 Antenatal care content: Tetanus toxoid 42.5 53.9 67.6 79.3 85.9 78.8 30.7 40.1 44.7 50.1 66.4 41.8 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 32.4 46.9 60.6 79.8 88.6 79.0 10.1 20.9 30.5 37.5 48.5 24.9 By a doctor 0.0 0.0 1.4 1.9 2.2 1.9 0.1 0.3 0.1 0.8 0.9 0.3 By a nurse or trained midwife 32.4 46.9 59.1 77.9 86.3 77.1 10.0 20.6 30.4 36.6 47.6 24.5 In a public facility 32.1 46.9 51.0 70.7 75.2 68.4 7.3 13.6 19.8 24.7 36.9 16.6 In a private facility 0.0 0.0 0.0 0.3 2.8 1.6 0.1 0.0 0.3 0.2 0.0 0.1 At home 67.9 52.9 39.6 22.6 11.2 21.6 90.7 80.6 70.9 65.3 55.2 76.8 D. Contraceptive services Contraceptive prevalence: Women 1.5 0.2 5.8 6.1 17.0 11.6 0.4 1.5 1.5 3.3 8.9 1.9 Men (4.9) (5.3) 0.0 15.9 19.2 15.1 0.8 3.8 7.6 13.2 16.2 5.8 - 32 - Mali 1995 / 96 - RURAL / URBAN POPULATIONS Part II: Intermediate Determinants of HNP Status - HNP SERVICE USE (Cont.) Indicator Wealth Quintiles - Rural Wealth Quintiles - Urban Low 2nd 3rd 4th High Avg. Low 2nd 3rd 4th High Avg. D. Contraceptive services (cont.) Source of contraception - public sector: Women * * * (74.7) 62.5 62.9 * * * (35.1) (57.3) 44.9 Men na na na na na na na na na na na na Source of contraception - private sector: Women * * * (21.9) 35.1 34.7 * * * (54.4) (39.4) 49.4 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 * * * * * (66.3) * * * * * (29.5) Men * * * * * (42.9) * * * * * 26.4 Treatment of genital discharge, ulcer, sore in public facilities: Women na na na na na na na na na na na na Men na na na na na na na na na na na na Voluntary counseling and testing for HIV/AIDS: Women na na na na na na na na na na na na Men na na na na na na na na na na na na - 33 - Mali 1995 / 96 - 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 * * * 19.7 11.9 16.5 10.8 11.9 10.9 10.3 * 10.7 Timely complementary feeding * * * (46.2) 49.4 45.1 23.5 27.6 36.8 25.6 * 29.0 Bottle-feeding 0.0 0.6 4.4 7.5 10.2 7.8 1.6 1.1 1.4 2.0 4.1 1.6 D. Micronutrient consumption Iodized salt: Availability of iodized salt na na na na na na na na na na na na in household Vitamin A: Children 0.0 2.0 2.6 0.8 1.3 1.3 1.8 0.4 0.5 1.2 0.0 0.9 Women na na na na na na na na na na na na E. Tobacco and alcohol use Tobacco: Women na na na na na na na na na na na na Men na na na na na na na na na na na na Alcohol: Women na na na na na na na na na na na na Men na na na na na na na na na na na na F. Sexual practices Non-regular sexual partnerships: Women na na na na na na na na na na na na Men 14.7 4.3 22.1 24.7 42.7 34.2 7.5 11.1 15.1 18.3 19.9 12.9 Condom usage with non-regular partner: Women na na na na na na na na na na na na Men 23.4 8.5 44.8 48.9 53.6 51.6 3.4 13.8 11.8 18.3 35.7 14.6 G. Domestic violence Ever experienced violence na na na na na na na na na na na na Experienced violence in past year na na na na na na na na na na na na - 34 - Mali 1995 / 96 - 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 3.3 7.2 4.4 15.2 40.4 28.4 1.3 2.0 3.1 5.2 15.0 3.3 Men 8.6 10.6 15.1 28.7 54.8 42.5 4.4 6.6 8.8 13.5 38.9 9.5 School participation: Girls 1.2 16.7 28.4 38.6 60.1 47.1 5.2 9.9 12.9 21.6 33.6 12.6 Boys 11.6 20.1 32.4 48.1 67.5 52.9 11.8 14.3 20.1 26.3 46.8 19.2 B. Exposure to mass media Newspaper readership: Women 1.7 3.8 2.9 8.6 24.3 17.2 0.4 0.6 1.1 2.9 8.1 1.5 Men 7.4 9.6 19.2 20.0 47.8 35.9 2.7 4.2 4.5 10.4 22.8 6.0 Radio listenership: Women 28.0 56.8 65.4 78.1 87.7 80.0 29.1 50.0 58.0 65.8 72.5 50.4 Men 55.9 78.8 82.7 95.5 95.1 91.8 59.3 76.7 83.2 87.2 87.0 76.1 Television viewership: Women 4.8 15.1 26.7 41.0 76.6 58.8 6.3 12.7 15.7 25.2 55.2 16.3 Men 6.2 15.2 51.2 59.7 87.5 71.8 9.4 15.8 25.9 35.1 54.5 21.9 C. Knowledge and attitudes about HIV/AIDS Knowledge about sexual transmission of HIV/AIDS: Women 59.2 74.8 73.4 89.8 95.0 89.7 64.0 78.2 80.1 82.4 87.0 76.1 Men 75.8 89.9 92.9 98.5 99.6 97.4 92.0 94.7 95.5 92.6 95.7 93.8 Knowledge about mother-to-child transmission of HIV/AIDS: Women 20.9 27.8 40.3 58.8 76.8 65.2 17.6 26.6 31.4 40.7 56.5 29.5 Men 37.1 41.5 45.4 68.9 78.8 70.6 42.7 43.7 50.8 54.8 68.4 48.4 Attitudes toward HIV/AIDS: Women na na na na na na na na na na na na Men na na na na na na na na na na na na D. Status of women Household decisionmaking: Can seek own health care na na na na na na na na na na na na Can seek children's health care na na na na na na na na na na na na Can make daily household purchases na na na na na na na na na na na na Can make large household purchases na na na na na na na na na na na na Can make meal-related decisions na na na na na na na na na na na na Freedom of movement: Can travel to visit family, relatives na na na na na na na na na na na na Other decisionmaking, attitudes: Can decide how to spend own money na na na na na na na na na na na na Can decide whether to have sex na na na na na na na na na na na na Justifies domestic violence na na na na na na na na na na na na E. Orphanhood Paternal orphan prevalence 7.8 6.0 4.9 6.4 5.3 5.6 3.6 3.4 3.2 3.0 1.2 3.2 Maternal orphan prevalence 3.9 1.9 3.2 1.7 2.2 2.2 2.4 1.7 2.3 2.2 1.7 2.1 Double orphan prevalence 1.6 0.4 0.4 0.3 0.8 0.7 0.4 0.3 0.3 0.4 0.3 0.3 - 35 - PART III. TECHNICAL NOTES A. INDICATOR DEFINITIONS B. DATA AND METHODS C. DISCUSSION INDICATOR DEFINITIONS Part I: HNP STATUS A. CHILDHOOD MORTALITY AND ILLNESS 2 Infant mortality rate: number of deaths to children under 12 months of age per 1,000 live births, based on experience during the ten years preceding the survey. Under-five mortality rate: number of deaths to children under five years of age per 1,000 live births, based on experience during the ten years preceding the survey. Prevalence of fever: percent of children who had fever, whether or not accompanied by cough or rapid breathing, in the two weeks before the survey. Prevalence of diarrhea: percent of children who had diarrhea in the two weeks before the survey. Prevalence of acute respiratory infection: percent of children who had a cough accompanied by rapid or difficult breathing in the two weeks before the survey. B. FERTILITY Total fertility rate (TFR): average number of births a woman could expect to have during her lifetime if she followed the levels of fertility currently observed at every age. The TFR is calculated as the sum of average annual age-specific fertility rates for all reproductive age groups (usually 15-49 years) in the three years before the survey. Adolescent fertility rate: age-specific fertility rate for women 15-19 years of age. This is the average number of births among women aged 15-19 years per 1,000 women in that age group, based on births in the three years before the survey and expressed as annual averages. 2Figures for the prevalence of fever, diarrhea, and acute respiratory infection refer to percent of children under three, four, or five years of age, depending upon the country. (The specific ages covered for in particular country may be determined by consulting the full report on that country's DHS, which may be found at: www.measuredhs.com/countries.) - 39 - C. NUTRITIONAL STATUS Children 3, 4, 5 Moderate stunting (height-for-age): percent of children with a height-for-age Z-score of between ­2 and ­3 standard deviations of the median reference standard for their age (as defined in fn. 4). Severe stunting (height-for-age): percent of children with a height-for-age Z-score of below ­3 standard deviations of the median reference standard for their age (as defined in fn. 4). Moderate underweight (weight-for-age): percent of children with a weight-for-age Z-score of between ­2 and ­3 standard deviations of the median reference standard for their age (as defined in fn. 4). Severe underweight (weight-for-age): percent of children with a weight-for-age Z-score of below ­3 standard deviations of the median reference standard for their age (as defined in fn. 4). Mild anemia: percent of children with a hemoglobin level of between 10.0g/dl and 10.9 g/dl, the World Health Organization criterion for mild anemia. Moderate anemia: percent of children with a hemoglobin level of between 7.0g/dl and 9.9g/dl, the World Health Organization criterion for moderate anemia. Severe anemia: percent of children with a hemoglobin level of below 7.0g/dl, the World Health Organization criterion for severe anemia. Women 6, 7 Malnutrition: percent of women aged 15-49 years with a Body Mass Index (BMI) of less than 18.5, where BMI ­ commonly used to indicate adult nutritional status ­ is defined as weight in kilograms divided by the square of height in meters. Mild anemia: percent of women aged 15-49 years with a hemoglobin level of between 10.0g/dl and 10.9g/dl for pregnant women and between 10.0g/dl and 11.9g/dl for non-pregnant women, the World Health Organization criterion for mild anemia. Moderate anemia: percent of women aged 15-49 years with a hemoglobin level of between 7.0g/dl and 9.9g/dl, the World Health Organization criterion for moderate anemia. Severe anemia: percent of women aged 15-49 years with a hemoglobin level of less than 7.0g/dl, the World Health Organization criterion for severe anemia. 3 All figures related to children's nutrition status refer to children under three, four, or five years of age, depending upon the country. (The specific ages covered for in particular country may be determined by consulting the full report on the DHS of the country concerned, which is available at: www.measuredhs.com/countries.) 4 The reference standards used for stunting and underweight are those established in the 1970s by the World Health Organization, the U.S. Centers for Disease Control, and the U.S. National Center for Health Statistics. Updated stunting and underweight figures based on the recently-released, 2006 World Health Organization reference standards are currently under preparation. When complete, they will be available at: www.worldbank.org/povertyandhealth/ countrydata. 5The anemia figures for children living at an altitude above 1,000 meters have been adjusted to reflect the higher level of hemoglobin required. 6In some countries, the BMI is presented for all women; in others, the figure is available only for mothers of children under five years of age. The reference population for any given country can be determined by consulting the full report on the DHS for the country concerned. An electronic version of this report is located at: www.measuredhs.com/ countries. 7 Anemia cut-off points for respondents who live at an altitude above 1,000 meters and/or who smoke have been adjusted to account for their higher hemoglobin requirements. - 40 - D. FEMALE CIRCUMCISION Prevalence of Circumcision Girls: percent of women aged 15-49 years with one or more daughters, at least one of whom had been circumcised. Women: percent of women aged 15-49 years who had been circumcised. Prevalence of Occlusion Girls: percent of women aged 15-49 years with one or more daughters, at least one of whom had been circumcised with the vaginal area sewn closed. Women: percent of women aged 15-49 years whose vaginal area had been sewn closed. E. SEXUALLY TRANSMITTED DISEASES Prevalence of Genital Discharge Women: percent of women aged 15-49 years who had had abnormal genital discharge in the twelve months before the survey. Men: percent of men aged 15-54 years who had had abnormal genital discharge in the twelve months before the survey. Prevalence of Genital Ulcer or Sore Women: percent of women aged 15-49 years who had had a genital ulcer or sore in the twelve months before the survey. Men: percent of men aged 15-54 years who had had a genital ulcer or sore in the twelve months before the survey. - 41 - Part II: INTERMEDIATE DETERMINANTS OF HNP STATUS ­ HEALTH SERVICE USE A. CHILDHOOD IMMUNIZATION 8 BCG coverage: percent of children who had received a dose of BCG vaccine by the time of the survey. Measles coverage: percent of children who had received a dose of measles vaccine by the time of the survey. DPT coverage: percent of children who had received three doses of DPT vaccine by the time of the survey. Full basic coverage: percent of children who had received a dose of BCG vaccine, measles vaccine, and three doses of DPT and polio vaccines by the time of the survey, excluding polio vaccine given at birth. No basic coverage: percent of children who had received no vaccination against the six early- childhood diseases (TB, measles, polio, diphtheria, pertusis, and tetanus) by the time of the survey. Hepatitis B coverage: percent of children who had received three doses of hepatitis B vaccine by the time of the survey. Yellow fever coverage: percent of children who had received a dose of yellow fever vaccine by the time of the survey. B. TREATMENT OF CHILDHOOD ILLNESSES 9 Treatment of Fever Medical treatment of fever: percent of children with fever, with or without cough or rapid breathing, in the two weeks before the survey who had sought medical advice for fever from any health facility or health provider, whether public or private. Treatment in a public facility: percent of children with fever, with or without cough or rapid breathing, in the two weeks before the survey who had sought medical advice for fever from a public-sector health facility or provider (as defined in fn. 9). Treatment in a private facility: percent of children with fever, with or without cough or rapid breathing, in the two weeks before the survey who had sought medical advice for fever from a private-sector health facility or provider (as defined in fn. 9). 8Childhood immunization figures refer to rates among children 12-23 months of age in all countries except those in Latin America and the Caribbean. There, the figures refer to rates among children 18-29 months of age. All figures are based on information recorded on the child's vaccination card; or, in cases where a card was not seen by the interviewer, on the mother's report. 9Figures for illness treatment in a public facility refer to treatment in government hospitals, health centers, health posts, or dispensaries; or in facilities operated by government-affiliated social securing programs. Figures for treatment in private facilities cover treatment in private hospitals or clinics, in private doctors' offices, or in facilities operated by other private medical providers (such as non-governmental organizations) as defined in the country concerned; but exclude treatment obtained in private pharmacies or shops. - 42 - Treatment of Acute Respiratory Infection (ARI) Medical treatment of ARI: percent of children with a cough and rapid breathing in the two weeks before the survey who had been taken for treatment at any medical facility or provider, whether public or private. Treatment in a public facility: percent of children with a cough and rapid breathing in the two weeks before the survey who had been taken for treatment at a public-sector health facility or provider (as defined in fn. 9). Treatment in a private facility: percent of children with a cough and rapid breathing in the two weeks before the survey who had been taken for treatment at a private-sector health facility or provider (as defined in fn. 9). Treatment of Diarrhea Use of oral rehydration therapy: percent of children with diarrhea in the two weeks before the survey who had received oral rehydration therapy (ORT) (defined as including consumption of oral rehydration salts, other recommended home fluids, or other increased liquids). Medical treatment of diarrhea: percent of children with diarrhea in the two weeks before the survey who had been taken for treatment at any medical facility or provider, whether public or private. Treatment in a public facility: percent of children with diarrhea in the two weeks before the survey who had been taken for treatment at a public-sector health facility or provider (as defined in fn. 9). Treatment in a private facility: percent of children with diarrhea in the two weeks before the survey who had been taken for treatment at a private-sector health facility or provider (as defined in fn. 9). C. ANTENATAL AND DELIVERY CARE 10 Antenatal Care (ANC) Visits To a medically-trained person: percent of women with one or more births in the five years before the survey who had received at least one antenatal care consultation from a medically- trained person (as defined in fn. 10) before her most recent birth. To a doctor: percent of women with one or more births in the five years before the survey who had received at least one antenatal care consultation from a doctor before her most recent birth. To a nurse or trained midwife: percent of women with one or more births in the five years before the survey who had received at least one antenatal care consultation from a nurse or trained midwife (as defined in fn. 10) before her most recent birth. Multiple visits to a medically-trained person: percent of women with one or more births in the five years before the survey who had received at least three antenatal care consultations from any medically-trained provider (as defined in fn. 10) before her most recent birth. 10When speaking of antenatal and delivery care, medically-trained persons are defined as doctors, nurses, and trained midwives. The definition excludes traditional midwives or other traditional birth attendants, whether trained or untrained. - 43 - Antenatal Care (ANC) Content Tetanus toxoid: percent of women with one or more births in the five years before the survey who had received at least one tetanus toxoid injection during her most recent pregnancy. Prophylactic antimalarial treatment: percent of women with one or more births in the five years before the survey who had received prophylactic treatment with any anti-malarial drug during her most recent pregnancy. Iron supplementation: percent of women with one or more births in the five years before the survey who had taken iron tablets during her most recent pregnancy. Delivery Attendance By a medically-trained person: percent of births in the five years before the survey attended by a medically-trained person (as defined in fn. 10). By a doctor: percent of births in the five years before the survey attended by a doctor. By a nurse or trained midwife: percent of births in the five years before the survey attended to by a nurse or a trained midwife (as defined in fn. 10). In a public facility: percent of all deliveries in the five years before the survey occurring in a public-sector health facility (as defined in fn. 9). In a private facility: percent of all deliveries in the five years before the survey occurring in a private-sector health facility (as defined in fn. 9). At home: percent of all deliveries in the five years before the survey occurring at home (defined as the woman's own or any other home). D. CONTRACEPTIVE SERVICES Contraceptive Prevalence 11 Women: percent of married or in-union women aged 15-49 years who used any modern means of contraception (as defined in fn. 11). Men: percent of married or in-union men aged 15-54 years who used any modern means of contraception (as defined in fn. 11). Source of Contraception - Public Sector Women: percent of married women who obtained their current method of contraception from a public-sector health facility or provider (as defined in fn. 9). Men: percent of married men who obtained their current method of contraception from a public- sector health facility or provider (as defined in fn. 9). 11Figures refer to use of modern means of contraception, defined as male/female sterilization, oral contraceptive pill, contraceptive injection, intrauterine device, male/female condom, diaphragm, cervical cap, contraceptive jelly or foam, implant, or some country-specific modern method. - 44 - Source of Contraception - Private Sector Women: percent of married women who obtained their current method of contraception from a private-sector health facility or provider (as defined in fn. 9, except that private pharmacies and shops are included rather than excluded). Men: percent of married women who obtained their current method of contraception from a private-sector health facility or provider (as defined in fn. 9, except that private pharmacies and shops are included rather than excluded). E. TREATMENT OF ADULT ILLNESSES Treatment of Genital Discharge, Ulcer, or Sore Women: percent of women with genital discharge, ulcer, or sore who sought any medical treatment for resulting symptoms. Men: percent of men with genital discharge, ulcer, or sore who sought any medical treatment for resulting symptoms. Treatment of Genital Discharge, Ulcer, or Sore in a Public Facility Women: percent of women with genital discharge, ulcer, or sore who sought treatment from a public-sector health facility or provider (as defined in fn. 9). Men: percent of men with genital discharge, ulcer, or sore who sought treatment from a public- sector health facility or provider (as defined in fn. 9). Voluntary Counseling and Testing for HIV/AIDS Women: percent of women aged 15-49 years who had been tested for HIV at any time before the survey. Men: percent of men aged 15-54 years who had been tested for HIV at any time before the survey. - 45 - Part III: INTERMEDIATE DETERMINANTS OF HNP STATUS ­ INDIVIDUAL AND HOUSEHOLD BEHAVIOR A. HYGIENIC PRACTICES Disposal of Children's Stools Sanitary disposal: percent of mothers with at least one child under five years of age who disposed of the stools of their youngest child in a sanitary manner (defined as dropping stool into a latrine, burying it, or using disposable diapers). Handwashing Wash hands prior to preparing food: percent of women aged 15-49 years preparing meals who washed hands before handling food. Handwashing facilities in household: percent of households that had hand-washing materials or facilities, as determined by direct observation of interviewers. B. BEDNET OWNERSHIP AND USE Bednet Ownership Bednet ownership: percent of households owning one or more bednets. Treated bednet ownership: percent of households owning one or more bednets that had recently been treated with insecticides. Bednet Use By children: percent of households with at least one child under five years of age, some or all of whom had slept under a bednet the night before the survey. By pregnant women: percent of currently pregnant women who had slept under a bednet the night before the survey. C. BREASTFEEDING Exclusive breastfeeding: percent of children 0-3 months of age who had received only breast milk in the 24 hours before the survey. Timely complementary feeding: percent of children 6-9 months of age who had received breast milk and solid or semi-solid foods in the twenty-four hours before the survey. Bottle-feeding: percent of children under 12 months of age who had received any food or drink from a bottle with a nipple in the twenty-four hours before the survey. - 46 - D. MICRONUTRIENT CONSUMPTION Iodized Salt Availability of iodized salt in household: percent of households with cooking salt testing positive for iodine/iodate at the recommended level of 15 or 25 parts per million or more (depending on the country). 12 Vitamin A Children: percent of children13 who had received at least one dose of vitamin A in the six months before the survey, as reported by the mothers. Women: percent of women who had received a dose of vitamin A within two months of the last birth, in the five years before the survey. E. TOBACCO AND ALCOHOL USE Tobacco 14 Women: percent of women aged 15-49 years who currently were smoking or chewing tobacco products. Men: percent of men aged 15-54 years who currently were smoking or chewing tobacco products. Alcohol Women: percent of women aged 15-49 years who had gotten intoxicated due to excessive consumption of alcohol in the three months before the survey. Men: percent of men aged 15-54 years who had gotten intoxicated due to excessive consumption of alcohol in the three months before the survey. F. SEXUAL PRACTICES Non-Regular Sexual Partnerships Women: percent of women aged 15-49 years who had had sex with a non-regular partner at least once in the twelve months before the survey. Men: percent of men aged 15-54 years who had had sex with a non-regular partner at least once in the twelve months before the survey. 12Which of these two levels is recommended in any particular country may be determined by consulting the full report on that country's DHS, which may be found at: www.measuredhs.com/countries. 13Figures refer to children over six months of age and under three, four, or five years of age, depending upon the country. (The specific ages covered for in a particular country may be determined by consulting the full report on that country's DHS, which is available at: www.measuredhs.com/countries.) 14Tobacco products include cigarettes, pipes, cigars, leaves, etc. - 47 - Condom Usage with Non-Regular Partner Women: percent of women aged 15-49 years with non-regular sexual partner who had used a condom in the last sexual intercourse with such a partner in the twelve months before the survey. Men: percent of men aged 15-54 years with non-regular sexual partner who had used a condom in the last sexual intercourse with such a partner in the twelve months before the survey. G. DOMESTIC VIOLENCE Ever experienced violence: percent of women aged 15-49 years who had ever been hit or beaten by current or former husband/partner. Experienced violence in past year: percent of women aged 15-49 years who had been hit or beaten by current or former husband/partner in the twelve months before the survey. - 48 - Part IV: UNDERLYING DETERMINANTS OF HNP STATUS A. EDUCATION School Completion Women: percent of women aged 15-49 years who had completed the fifth grade. Men: percent of men aged 15-54 years who had completed the fifth grade. School Participation Girls: percent of girls aged 6-10 years who were attending school at the time of the survey. Boys: percent of boys aged 6-10 years who were attending school at the time of the survey. B. EXPOSURE TO MASS MEDIA Newspaper Readership Women: percent of women aged 15-49 years who read a newspaper at least once a week. Men: percent of men aged 15-54 years who read a newspaper at least once a week. Radio Listenership Women: percent of women aged 15-49 years who listened to radio at least once a week. Men: percent of men aged 15-54 years who listened to radio at least once a week. Television Viewership Women: percent of women aged 15-49 years who watched television at least once a week. Men: percent of men aged 15-54 years who watched television at least once a week. C. KNOWLEDGE AND ATTITUDES ABOUT HIV/AIDS Knowledge about Sexual Transmission of HIV/AIDS 15 Women: percent of women aged 15-49 years who knew of HIV/AIDS and of at least one of the following ways to avoid it through interruption of its sexual transmission route: abstinence; using a condom; avoiding multiple sex partners, sex with prostitutes, and unprotected homosexual sex. Men: percent of men aged 15-54 years who knew of HIV/AIDS and of at least one of the ways to avoid HIV/AIDS referred to in the preceding definition. 15In most countries, the survey sample included both married and unmarried individuals. Where this was the case, all respondents, regardless of marital status, were asked the question covered in this section. Where the survey covered only individuals who were or had been married, the data pertain only to individuals who had ever been married. (The marital status of people covered for in particular country is indicated in the full report on that country's DHS, which is located at: www.measuredhs.com/countries.) - 49 - Knowledge about Mother-to-Child Transmission of HIV/AIDS Women: percent of women aged 15-49 years who knew of at least one way HIV/AIDS can be transmitted from mother to child during pregnancy, delivery, or breastfeeding. Men: percent of men aged 15-54 years who knew of at least one way HIV/AIDS can be transmitted from mother to child during pregnancy, delivery, or breastfeeding. Attitudes toward HIV/AIDS Women: percent of women aged 15-49 years who believed that people with HIV/AIDS should be allowed to continue working or that HIV test results should remain confidential. Men: percent of men aged 15-54 years who believed that people with HIV/AIDS should be allowed to continue working or that HIV test results should remain confidential. D. STATUS OF WOMEN Household Decisionmaking Can seek own health care: percent of women age 15-49 years who could decide by themselves to seek their own health care. Can seek children's health care: percent of women aged 15-49 years, whose children live with them, who could decide by themselves to seek health care for their children. Can make daily household purchases: percent of women aged 15-49 years who could decide by themselves or jointly with others to make daily household purchases. Can make large household purchases: percent of women aged 15-49 years who could decide by themselves or jointly with others to make large household purchases. Can make meal-related decisions: percent of women aged 15-49 years who could decide by themselves what food to cook daily. Freedom of Movement Can travel to visit family, relatives: percent of women aged 15-49 years who could decide by themselves to visit family and relatives. Other Decisionmaking, Attitudes Can decide how to spend own money: percent of women aged 15-49 years who work for cash who could decide by themselves on how to use the money they earn. Can decide whether to have sex: percent of women aged 15-49 years agreeing that they can refuse to have sex with their husband for at least one of the following reasons: he has a sexually- transmitted disease; he has had sexual relations with another woman; or the woman is tired, not in mood, or recently has given birth. Justify domestic violence: percent of women aged 15-49 years believing that a husband/male partner would be justified in beating his wife/female partner for at least one of the following reasons: he suspects her of being unfaithful; she argues with him; she goes out without telling him; she neglects the children; she burns the food; or other, country-specific reasons (for example, she shows disrespect for her in-laws or her family does not give the expected dowry). - 50 - E. ORPHANHOOD Maternal orphan prevalence: percent of children under 15 years of age whose natural mother had died before the survey. Paternal orphan prevalence: percent of children under 15 years of age whose natural father had died before the survey. Double orphan prevalence: percent of children under 15 years of age both of whose natural parents had died before the survey. - 51 - DATA AND METHODS Any assessment of the figures featured in this report requires an appreciation of how they were prepared. The first need is to understand the basic features of the data and methods employed. A. SOURCE OF FIGURES The figures appearing in this report are all derived from data collected under the Demographic and Health Surveys (DHS) program conducted by ORC Macro, with support from the U.S. Agency for International Development and other external assistance organizations. Large DHS household surveys have been carried out, usually at periodic intervals, in approximately seventy- five countries across Africa, Asia, Latin America, the Middle East, and the former Soviet Union.16 This series of reports covers the fifty-six of those countries that had one or more DHS surveys undertaken since 1990, for which data were publicly available as of June 2006. (Annex C is a list of the countries for which reports have been prepared.) In each country, the DHS program has gathered information on a large number of indicators about health, nutrition, and population (hnp) status and service use; about relevant behaviors of household members; and about household characteristics like those described below. It has done this through a set of questionnaires, similar in all countries, to collect data at the individual, household, and community levels. The data presented here draw on responses to the individual and household questionnaires. In most cases, they are based on responses from women or other family members interviewed. The principal exceptions concern nutritional status, which is based on anthropometric measurement; immunization, which typically relies to the extent possible on record cards maintained at the household level; and those other items where a source other than interviewer response is specifically identified. B. MEASUREMENT OF ECONOMIC STATUS Wealth or Asset Approach Economic status has been expressed in terms of wealth or assets: specifically, on the basis of information about household characteristics gathered through the DHS household questionnaire. (Such information was normally provided for at least 25-30, and often many more, characteristics like the presence, availability, or use of a fan, radio receiver, or automobile; housing materials like wood or concrete flooring, tile or tin roofing, or cement block walls; superior sources of water like piped or a protected well; and other attributes related to economic status.) 16Further information about the DHS program is available at the program's website: www.measuredhs.com. - 53 - Index Construction A single, consolidated index of living standards17 was constructed by using principal components analysis (PCA) to generate a weight for each household item with available information. A wealth index score was calculated for each household by weighting the response with respect to each item pertaining to that household by the coefficient of the first principal component as determined by application of principal components analysis, and summing the results. The resulting household scores were standardized in relation to a standard normal distribution with a mean of zero and a standard deviation of one. All individuals usually present in each household were assigned the household's standardized wealth index score, and all individuals in the sample population were ranked according to that score. The sample population was then divided into quintiles of individuals, with all individuals in a single household being assigned to the same quintile. The same standardized household wealth index scores originally derived for the total population sample, as just described, were also used in preparing the disaggregated estimates for female and male members of the sample population, and for rural and urban residents. In preparing those disaggregated estimates, the entire population sample was divided into quintiles of individuals; the females and males, and the rural and urban residents in each quintile of the entire sample were then separated from one another; and the mean for each of the ten resulting subgroups (five female, five male; or five rural, five urban) was calculated. This procedure was carried out separately for each of the surveys covered. C. CALCULATION AND PRESENTATION OF RATES Use of Sampling Weights Rates for all health, nutrition, and population indicators are calculated after applying the DHS sampling weights. (DHS surveys often over-sample certain small subgroups of interest ­ residents of a particular geographic area, for example ­ in order to get sample sizes large enough to produce statistically-significant results. The DHS sampling weights are used to compensate for such over-sampling in order to ensure that the results are representative of the population as a whole and not just of the DHS sample.) Calculation of Total Population Averages The average for the total population presented alongside the quintile-specific rates for each indicator is calculated without reference to quintile divisions. It thus equals the weighted mean of the quintile rates, with the weight assigned to each quintile rate being the proportion of the number of individuals at risk (as defined on p. 59) for the indicator concerned. Sampling Errors Information needed to assess the statistical significance of differences among the quintile-specific rates is presented in three ways: · First, in all the basic tables presented in part I, rates are shown in parentheses or replaced by asterisks in cases where the standard error is likely to be unacceptably high because 17 Such an index is usually referred to as either an "asset index" or a "wealth index." The two expressions are used interchangeably in this report; for ease of communication, "wealth index" appears more frequently despite the inexact correspondence between the items included in the index's construction and those appearing in more conventional, financially-based definitions of wealth. - 54 - of small sample size. The number of observations used to determine how to present the data for the different indicators covered were as follows: Indicator Unit of measure Number of observations used to determine how quintile-specific rate was presented Without With Replaced by parentheses parentheses asterisk Infant and child Number of deaths >500 250-499 <250 mortality Total and adolescent Number of births >250 125-249 <125 fertility All other indicators Number of >50 25-49 <25 individuals · Second, the standard error for each quintile-specific rate (except for any rate replaced by an asterisk) appearing in the total population table is provided in part III.B. (Standard errors for the quintile-specific rates presented in the female-male and rural-urban tables are not available.) · Third, the right-hand column of the total population table provides the standard error for the concentration index, one of the measures of inequality shown, as indicated below. D. MEASUREMENT OF INEQUALITY Accompanying each of the indicators presented in the total population table are the values for three statistical measures of inequality: · Low/High Quintile Ratio: the ratio between the rate prevailing in the lowest (poorest) population quintile and that found in the highest (least poor) quintile. · Low-High Quintile Difference: the value of the lowest quintile minus the value of the highest, expressed as an absolute value. · Concentration Index: twice the area in a Lorenz-type diagram between the line of equality and the concentration curve for the indicator in question, the curve being the graph of the cumulative share of the indicator against the cumulative share in the asset distribution. (The value, which can range from -1 to +1, is negative when the hnp indicator is higher among the poor (e.g., fertility), positive when it is higher among the better-off (e.g., modern contraceptive use), and zero when on balance the indicator shows no systematic relationship with wealth.)18 18Adam Wagstaff, Pierella Paci, and Eddy van Doorslaer, "On the Measurement of Inequalities of Health," Social Science and Medicine 33 (1991): 545-57. (See also chapter eight in the volume by O'Donnell, van Doorslaer, Wagstaff, and Lindelow described in the annotated bibliography that constitutes annex A.) - 55 - DISCUSSION While a basic understanding of the data and methods employed is necessary to adequately appreciate the figures appearing in this report, it is not sufficient. For the application of the approach taken involves many subtleties that also need to be understood. Among the more important are: A. DESCRIPTIVE NATURE OF THE RELATIONSHIPS The hnp-poverty relationships shown in this report are no more than descriptive. They should not be taken to imply any direct causal relationships, for several reasons. One reason is the possibility that it is not wealth or asset possession per se that determine a person's health condition. Rather, the determining factors could be other characteristics (such as education or ethnic background) that are simultaneously associated with both asset ownership and health status. It is also possible that the health-poverty relationships shown are driven primarily by particular items included in the index (e.g., water and sanitation). Should this be the case, improvements in health conditions among the poor might be more effectively brought about by focusing on changing those particular components of the wealth index rather than by a general effort to increase economic status as measured by the index as a whole. B. IMPLICATIONS OF A WEALTH/ASSET APPROACH Wealth or Assets as a Measure of Economic Status Reliance on a wealth index to measure economic status is a rather recent development in research on economic disparities, where such status traditionally has been defined in terms of consumption or income. The principal reason for the choice of the wealth index is pragmatic rather than conceptual: the DHS surveys, which are of interest because of the plethora of hnp information that they contain, do not collect consumption or income data; but they do have detailed information on households' physical characteristics, and on the household-level presence of and access to a wide range of goods and services. While there is some disagreement about the relative merits of using such wealth/asset information or consumption data to measure economic status, several recent studies suggest that the asset-consumption relationship is quite close.19 To the extent this is the case, an index of wealth or asset possession/availability can be taken as a 19See, for example, Deon Filmer and Lant H. Pritchett, "Estimating Wealth Effects without Expenditure ­ or Tears: An Application to Educational Enrollments in States of India," Demography 38, no. 1 (February 2001): 115-32; Shea Rutstein and Kiersten Johnson, The DHS Wealth Index, DHS Comparative Reports No. 6 (Calverton, Maryland, USA: ORC Macro, August 2004) esp. 10-14; Adam Wagstaff and Naoko Watanabe, "What Difference Does the Choice of SES Make in Health Inequality Measurement?" Health Economics 12 (2003): 885-90. - 57 - reasonably satisfactory proxy for consumption, rather than or in addition to serving as an indicator of economic status in its own right. C. ECONOMIC STATUS AS A MEASURE OF SOCIO-ECONOMIC WELL-BEING Like consumption or income, a wealth index defines disparities that are primarily economic. This is by no means the only way to define inter-group inequalities that are of potential concern. Other possibilities include gender, place of residence, education, ethnic background, or other factors associated with social exclusion. Thus the economic perspective provides only a partial view of the multidimensional concepts of poverty, inequality, and inequity. By including tables on female-male and rural-urban inequalities, this report pays adequate attention to two of inequality's other important dimensions to justify the use of the term "socio- economic" rather than simply "economic" in its title. However, the centrality of tabulations based on the wealth index means that the primary focus is on the economic dimension. The justification for this lies not in the greater importance of economic considerations, but rather in the recently-improved ability to analyze and thus begin dealing with them. Until the development of the wealth/asset approach, the assessment of economic status had been based on consumption, expenditures, or income, all of which are far more difficult to measure than such other, non- economic dimensions of inequality as gender, ethnic identity, educational level, and place of residence. As a result, assessments of health inequalities by economic status had lagged well behind measurements in terms of these other dimensions, especially gender and education. The focus on inequality's economic aspect applied here represents an effort to redress this imbalance. D. INDEX CONSTRUCTION Choice of Items Use of a wealth index requires decisions about which items to include in it. In the case of secondary analyses like the one featured in this report, the choice is limited to those items included in the data sets being used. But even with this constraint, there nonetheless remains considerable room for choice, given the large number of items for which information is collected by the DHS. The decision made in preparing this report was to include all items in each DHS household questionnaire that relate to ownership of household goods; to dwelling unit construction and characteristics; and to access to services and resources like electricity, water, and sanitation facilities. Also included were other potential indicators of wealth, such as live-in domestic servants. This decision, admittedly somewhat arbitrary, has both advantages and disadvantages. The principal advantage is practical: use of a large number of assets increases the degree of variation across household asset scores and facilitates a more regular distribution of individuals across quintiles. It also reduces the possibility of subjectivity in selecting only some of the variables for inclusion on some a priori basis; and it may increase a wealth index's accuracy as a proxy for consumption. However, including all variables is far from satisfying conceptually. For example, it means failing to discriminate with respect to the items' differing natures. It is not clear, for instance, whether access to water, sanitation, electricity, or other publicly-provided resources should be included in an index that purports to measure private household wealth. Further, many items that are candidates for inclusion in a DHS-based wealth index might be seen as directly influencing health status: water and sanitation for infant and child mortality, for - 58 - example. It would be desirable to include quintile-specific estimates for such items; but to the extent that such items have large index coefficients, any estimates for those items would be suspect. Such items appear to be relatively few and of limited statistical significance in the index used here. However, for the sake of caution, quintile-specific estimates for items appearing in the index have nonetheless been excluded from the basic tables and appear only in supporting table III.C Additional issues arise when comparing the findings for two different points in time covered in the basic tables. Because the nature and number of asset questions included in DHS surveys has been evolving, the items included in the wealth index differ somewhat for each of the surveys reported upon. As such, the results presented in the basic tables might differ to some extent from findings produced by some other approach, such as including in the index only those items appearing in each survey covered. Weighting of Items A further decision required in construction of an index concerns the weight to attach to each of the respective items. As noted earlier, the method used in this report is principal components analysis (PCA). Adoption of this method was based on the findings, referred to earlier, that its use resulted in outcomes that approximated reasonably well those produced by taking a consumption or expenditure approach. Further, it often provides greater discrimination in economic status than does the use of consumption/expenditures. It has also emerged as the standard approach for use in analyses of the sort presented here, so that its adoption is largely non-controversial. Yet this choice, too, is not without an arbitrary aspect; for alternative plausible methods exist. Examples include the "inverse possession" approach, which gives more weight to items possessed by only a few and less to those possessed by many;20 or, perhaps, the common practice of simply assigning the same weight to each index item. Also, the weights for any particular item vary from survey to survey, since the weights were determined separately for the population of each survey included in the basic tables. The results thus produced can be expected to differ from those generated in some other manner, such as generating common weights for all the surveys covered by pooling the data sets. Use of Principal Components Analysis with Dichotomous Variables An additional issue concerns the use of a technique like PCA, developed for use with continuous variables, in the construction of an index based primarily on dichotomous variables. While legitimate in principle, any reservations in this regard are of limited practical consequence, since the considerable experimentation undertaken in preparation for the tabulations presented here indicated that any inaccuracy introduced by applying PCA to the analysis of the dichotomous values used is minimal. Economies of Scale Calculating the values for a household wealth index also requires a decision concerning economies of scale that exist in the households covered. The calculations presented here assume complete economies of scale. The implicit assumption is that additional members do not add to household expenses on items included in the index. 20Saul S. Morris et al., "Validity of Rapid Estimates of Household Wealth and Income for Health Surveys in Rural Africa," Journal of Epidemiology and Community Health 54 (2000): 381-87. - 59 - E. DEFINITION OF QUINTILES Quintiles of Individuals As noted earlier, the quintile-specific figures presented in this report refer to quintiles of individuals in the household population. Such quintiles need to be distinguished from quintiles of households or quintiles of only those people in the population who are "at risk": that is, subject to the particular condition, eligible for the particular service, or capable of behaving in a particular way (children born alive for infant and under-five mortality, for example; or adult men and women for condom use or non-regular sexual partnerships). The expression of findings in terms of quintiles of individuals has several implications: · Because fertility is often higher in lower economic households than among better-off ones, the number of individuals per household will frequently be larger among the poor than among higher-income groups. In such cases, the number of households will vary systematically across quintiles of individuals, and the results expressed in terms of quintiles of households can differ significantly from those presented here. · The proportion of individuals "at risk" with regard to a particular indicator is also likely to vary across quintiles in many cases. (For example, in cases where fertility is higher among poor people, a higher-than-average proportion of poor populations will consist of newborns at risk from infant mortality, young children subject to malnutrition, and pregnant women for whom antenatal care is relevant.) To facilitate the work of any investigators wishing to undertake calculations based on people at risk, the number of such people in each quintile of individuals is shown in part III.A. · As previously indicated, the population average figure provided for each indicator is equivalent to the weighted sum of the quintile rates for that indicator, where the weight assigned to each quintile rate is the number of people at risk in each quintile as presented in part III.A. As a result of this weighting, the population average will usually differ from a simple mean of the population quintile estimates. Quintiles of Males and Females, of Rural and Urban Residents As also reported in the data and methods section, the tables on rural and urban residents and on men and women were prepared using the same asset scores as for the total population; and rural- urban residents and females-males were separated from one another only after the entire sample had been disaggregated into quintiles of individuals. This means that the figures given in the rural-urban and female-male tables refer to females-males and rural-urban residents belonging to each quintile of individuals in the total population, as distinct from quintiles of females, of males, of rural residents, or of urban residents alone. The consequence of this distinction is particularly evident with regard to rural and urban residents. Since rural residents tend to be poorer than urban dwellers, they normally form a considerably higher proportion of individuals in the lower economic quintiles of the total population than in the higher ones. Conversely, urban residents tend to be concentrated in the higher economic groups. As a result, the number of individuals in each of the urban and rural quintiles usually varies greatly and systematically; and when this is the case, the figures presented in the rural-urban tables can differ significantly from those produced by a computation procedure that places the same number of rural and urban residents in each rural quintile or each urban quintile. (The results may also differ significantly from application of an approach featuring the separate calculation of index values for urban and for rural groups. While such separate index values may well be preferable conceptually, their calculation involves complexities that prevented their preparation for this report.) - 60 - F. COMPARISON OF QUINTILES ACROSS COUNTRIES Reliance on population quintiles as basic presentational format for the data appearing in this report implicitly incorporates a relative concept of poverty. This differs from an absolute concept of poverty under which the population would be divided into groups of different sizes according to some absolute standard of living (such as people earning less than one dollar a day, between one and two dollars a day, and more than two dollars a day). This means that, when comparing values of an indicator among people in a given quintile across countries, the comparison is between groups of people whose economic status can be quite different. The lowest quintile of a Latin American population, for example, will usually be considerably better-off than the lowest quintile in an African country. G. COMPARISON OF QUINTILES OVER TIME Another implication is that the wealth status of any given quintile within a particular country is likely to change over time. For instance, when a country is progressing economically, the wealth of the households in the population will tend to increase. This will raise the average asset score in most, possibly all population quintiles. As a result, the living standard enjoyed by individuals in any quintile covered by a recent survey is likely to be higher than that of individuals in that same quintile as measured in a prior survey. H. STATISTICAL INDICATORS OF INEQUALITY The available statistical indicators of inequality are far too numerous to permit use of more than a small proportion of them in presenting the findings featured in this report. The three indicators employed have been selected to provide a wide range of perspectives. Two are designed for ease of understanding, the third for greater technical accuracy. The low/high quintile ratio and low-high quintile difference are the two presented for ease of understanding. The former is a relative measure, the latter an absolute measure that can produce a significantly different impression from that provided by the former. The concentration index is provided for the benefit of technical specialists wishing greater accuracy. It measures the degree of inequality in an hnp indicator across the full wealth index distribution, rather than differences between only two of the five quintiles, and also reflects the relative size of the different asset-based divisions of the study population. I. COMPARABILITY WITH OTHER REPORTS Tabulations similar to those presented here can also be found in the initial series of hnp/poverty country reports, issued in 2000, and in the recent country reports issued by the DHS program. The figures presented in those reports normally resemble quite closely those appearing here for any given indicator; but there are often slight differences for one or more of several reasons. The most common is a difference in the definition of the indicator in question. (These differences are usually small and subtle. But there is one important exception: the definition of moderate malnutrition among children. In the 2000 reports, this was defined as second and third degree malnutrition taken together. Here, it is defined as second degree malnutrition alone.) Another reason, with respect to infant and child mortality, is that the figures in the DHS documents are typically based on experience during the five years before the survey in question, rather than - 61 - during the ten previous years as in this report. A further frequent reason is the use of an improved computational technique. In addition, asset-based, quintile-specific tabulations of hnp indicators have begun to appear in an increasing number of other documents. Given the basic similarity of approach, such tabulations usually produce results that are generally congruent with those shown in part I of this report. However, significant divergences have occasionally been reported; and the absence of adequately detailed information about data and methods often prevents any fully-satisfying understanding of the approaches used. As a result, occasional doubts and frequent uncertainties about approach comparability remain. - 62 - PART IV. SUPPORTING TABLES, 2001 A. SAMPLE SIZES B. STANDARD ERRORS C. ASSET DISTRIBUTION AND WEIGHTS Mali 2001 - SAMPLE SIZES TOTAL SAMPLE Indicator Wealth Quintiles Pop. Low 2nd 3rd 4th High Total Number of household members All 13,129 13,113 13,117 13,167 13,096 65,622 Urban 261 676 1,028 3,719 11,544 17,228 Rural 12,869 12,437 12,089 9,448 1,552 48,394 Female 6,785 6,670 6,782 6,682 6,636 33,556 Male 6,344 6,443 6,334 6,485 6,459 32,064 Part I: HNP STATUS Indicator Wealth Quintiles Pop. Low 2nd 3rd 4th High Total Mortality rates All 5,714 5,626 5,450 5,301 4,186 26,289 Urban 116 262 412 1,420 3,632 5,842 Rural 5,599 5,365 5,039 3,887 556 20,447 Female 2,924 2,733 2,635 2,574 2,056 12,922 Male 2,790 2,897 2,817 2,731 2,133 13,367 Prevalence of fever, diarrhea, acute respiratory infection All 2,356 2,243 2,293 2,244 2,000 11,143 Urban 53 103 166 590 1,731 2,643 Rural 2,303 2,141 2,127 1,653 269 8,493 Female 1,208 1,104 1,134 1,066 983 5,495 Male 1,148 1,139 1,159 1,178 1,017 5,641 Total fertility rate All 6,994 6,848 7,048 7,176 8,206 36,296 Urban 177 389 562 2,084 7,367 10,579 Rural 6,818 6,462 6,490 5,103 844 25,717 Age-specific fertility rate 15-19 All 1,294 1,300 1,462 1,522 2,425 8,003 Urban 43 89 105 500 2,232 2,969 Rural 1,251 1,211 1,357 1,022 194 5,035 Children's nutritional status All 1,995 1,909 1,954 1,901 1,643 9,408 Urban 40 88 153 500 1,424 2,205 Rural 1,955 1,821 1,801 1,401 219 7,197 Female 1,025 940 941 894 803 4,603 Male 971 969 1,013 1,007 840 4,800 Children's anemia status All 665 527 493 495 407 2,587 Urban 20 25 37 114 359 555 Rural 644 502 456 382 48 2,032 Female 318 273 238 285 203 1,317 Male 346 254 255 211 204 1,270 - 65 - Mali 2001 - SAMPLE SIZES Part I: HNP STATUS (Cont.) Indicator Wealth Quintiles Pop. Low 2nd 3rd 4th High Total Women's nutritional status All 1,869 1,818 1,877 1,997 2,483 10,049 Urban 46 123 152 625 2,242 3,188 Rural 1,823 1,695 1,724 1,372 241 6,855 Women's anemia status All 895 655 641 767 827 3,787 Urban 25 38 43 228 747 1,081 Rural 870 617 598 540 80 2,705 Girls' circumcision All 1,852 1,812 1,824 1,800 1,561 8,855 Urban 45 92 148 503 1,369 2,161 Rural 1,806 1,720 1,675 1,297 191 6,694 Women's circumcision All 2,435 2,392 2,458 2,543 3,012 12,849 Urban 61 139 197 751 2,712 3,863 Rural 2,375 2,254 2,261 1,791 300 8,986 Prevalence of genital discharge, ulcer, sore Female 2,320 2,280 2,337 2,340 2,524 11,801 Urban Female 58 128 190 680 2,258 3,314 Rural Female 2,262 2,153 2,147 1,661 267 8,490 Male 655 441 472 494 774 2,836 Urban Male 9 32 35 165 702 943 Rural Male 646 409 438 329 72 1,894 - 66 - Mali 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 451 471 432 442 401 2,197 Urban 15 26 27 133 346 547 Rural 436 445 405 309 55 1,650 Female 230 224 215 214 192 1,075 Male 221 247 217 227 210 1,122 Treatment of fever All 695 603 644 562 481 2,988 Urban 17 39 42 122 414 634 Rural 678 564 602 440 68 2,352 Female 316 304 331 316 259 1,526 Male 379 299 313 246 222 1,459 Treatment of acute respiratory infection All 246 201 248 189 217 1,102 Urban 4 15 14 32 181 246 Rural 241 186 234 157 36 854 Female 139 106 127 96 98 566 Male 107 94 122 94 119 536 Treatment of diarrhea All 491 461 474 380 261 2,069 Urban 12 21 19 79 213 344 Rural 479 439 455 301 48 1,722 Female 236 221 242 153 128 980 Male 255 240 232 227 133 1,087 Antenatal and delivery care All 1,718 1,694 1,714 1,668 1,492 8,291 Urban 43 81 126 453 1,312 2,015 Rural 1,675 1,612 1,588 1,215 180 6,270 Contraceptive prevalence Female 2,238 2,199 2,217 2,138 1,923 10,723 Urban Female 57 119 176 583 1,684 2,619 Rural Female 2,181 2,079 2,042 1,555 239 8,096 Male 562 370 392 379 412 2,122 Urban Male 8 20 22 115 363 528 Rural Male 554 349 370 264 49 1,586 Contraceptive source Female 94 79 76 155 344 748 Urban Female 1 5 12 72 311 401 Rural Female 93 74 64 83 33 348 Male 562 370 392 379 412 2,122 Urban Male 8 20 22 115 363 528 Rural Male 554 349 370 264 49 1,586 Treatment of genital discharge, ulcer, sore Female 532 487 480 532 876 2,907 Urban Female 23 25 36 191 804 1,079 Rural Female 510 462 443 341 72 1,828 Male 44 36 30 30 45 185 Urban Male 1 6 3 10 42 62 Rural Male 43 31 27 20 3 124 - 67 - Mali 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 2,435 2,392 2,458 2,543 3,012 12,840 Urban 61 139 197 751 2,712 3,860 Rural 2,375 2,254 2,261 1,791 300 8,981 Handwashing facilities in household? All 2,315 2,379 2,747 2,649 2,229 12,319 Urban 46 124 219 711 1,959 3,059 Rural 2,269 2,255 2,528 1,938 271 9,261 Bednet ownership All 2,315 2,379 2,747 2,649 2,229 12,319 Urban 46 124 219 711 1,959 3,059 Rural 2,269 2,255 2,528 1,938 271 9,261 Bednet use by children All 1,588 1,571 1,626 1,590 1,357 7,732 Urban 32 80 110 422 1,179 1,823 Rural 1,556 1,491 1,516 1,168 178 5,909 Bednet use by pregnant women All 379 346 332 318 258 1,633 Urban 8 8 25 71 231 343 Rural 372 338 307 247 27 1,291 Exclusive breastfeeding All 201 202 209 190 159 961 Urban 7 4 9 45 145 210 Rural 193 198 200 145 14 750 Female 96 100 100 89 90 475 Male 105 102 109 100 69 485 Timely complementary breastfeeding All 166 184 196 195 174 915 Urban 0 8 18 51 144 221 Rural 166 175 178 144 30 693 Female 69 102 108 113 77 469 Male 97 81 89 82 97 446 Bottle-feeding All 561 520 597 572 498 2,748 Urban 14 17 40 134 428 633 Rural 547 503 556 438 70 2,114 Female 266 276 307 290 245 1,384 Male 295 244 289 282 253 1,363 - 68 - Mali 2001 - SAMPLE SIZES Part III: Intermediate Determinants of HNP Status - INDIVIDUAL AND HOUSEHOLD BEHAVIOR (Cont.) Indicator Wealth Quintiles Pop. Low 2nd 3rd 4th High Total Iodized salt in household All 1,615 1,589 1,966 1,774 1,323 8,267 Urban 38 85 171 440 1,148 1,882 Rural 1,577 1,504 1,795 1,334 175 6,385 Vitamin A supplementation All 2,038 1,967 1,975 1,939 1,740 9,659 Urban 42 95 147 519 1,503 2,306 Rural 1,997 1,872 1,828 1,420 237 7,354 Female 988 1,003 1,001 1,037 877 4,906 Male 1,050 964 975 902 863 4,754 Tobacco and alcohol use, casual sexual partners, condom use for casual sex Female 2,435 2,392 2,458 2,543 3,012 12,840 Urban Female 61 139 197 751 2,712 3,860 Rural Female 2,375 2,254 2,261 1,791 300 8,981 Male 764 568 553 587 916 3,388 Urban Male 10 37 41 197 826 1,111 Rural Male 754 532 511 391 90 2,278 Domestic violence All na na na na na na Urban na na na na na na Rural na na na na na na - 69 - Mali 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 2,661 2,584 2,664 2,709 3,171 13,789 Urban female 65 149 211 777 2,847 4,049 Rural female 2,596 2,436 2,453 1,932 323 9,740 Male 2,110 2,172 2,102 2,272 3,218 11,874 Urban male 33 116 167 722 2,911 3,948 Rural male 2,077 2,057 1,935 1,550 308 7,926 School participation Female 1,274 1,229 1,148 1,145 944 5,741 Urban female 21 63 82 308 824 1,297 Rural female 1,252 1,167 1,067 837 121 4,443 Male 1,160 1,243 1,166 1,114 902 5,584 Urban male 16 46 80 324 753 1,219 Rural male 1,144 1,197 1,086 790 149 4,365 Mass media exposure Female 2,435 2,392 2,458 2,543 3,012 12,849 Urban female 61 139 197 751 2,712 3,863 Rural female 2,375 2,254 2,261 1,791 300 8,986 Male 764 568 553 587 916 3,405 Urban male 10 37 41 197 826 1,125 Rural male 754 532 511 391 90 2,280 Knowledge of HIV/AIDS prevention Female 4,851 2,392 2,458 2,543 3,012 15,256 Urban female 61 139 197 751 2,712 3,860 Rural female 2,375 2,254 2,261 1,791 300 8,981 Male 764 568 553 587 916 3,405 Urban male 10 37 41 197 826 1,111 Rural male 754 532 511 391 90 2,278 Household decisionmaking and justification of violence All 2,435 2,392 2,458 2,543 3,012 12,849 Urban 61 139 197 751 2,712 3,863 Rural 2,375 2,254 2,261 1,791 300 8,986 Orphanhood All 6,813 6,688 6,466 6,405 5,744 32,123 Urban 141 320 512 1,769 4,953 7,698 Rural 6,672 6,368 5,954 4,635 790 24,426 Female 3,451 3,325 3,231 3,144 2,998 16,153 Male 3,362 3,363 3,233 3,261 2,743 15,966 - 70 - Mali 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 7.63 6.23 7.53 6.54 5.83 3.32 Under-five mortality rate 8.74 9.19 8.62 10.81 8.81 5.48 Prevalence of fever 1.48 1.61 1.21 1.37 1.48 0.78 Prevalence of diarrhea 1.18 1.33 1.13 0.89 1.01 0.61 Prevalence of acute respiratory infection 1.13 0.87 0.82 0.91 1.02 0.49 B. Fertility Total fertility rate 0.19 0.21 0.16 0.24 0.23 0.12 Adolescent fertility rate 13.00 14.00 11.00 14.00 10.00 8.00 C. Nutritional status Children: Moderate stunting 1.08 1.41 1.06 1.09 1.25 0.58 Severe stunting 1.30 1.59 1.22 1.09 1.17 0.68 Moderate underweight 1.04 1.14 1.12 1.18 1.31 0.62 Severe underweight 1.00 1.11 1.00 0.71 0.59 0.52 Mild anemia 1.78 2.86 1.79 1.95 1.98 0.95 Moderate anemia 2.75 3.81 2.85 2.90 3.26 1.75 Severe anemia 1.53 1.86 2.30 1.95 1.34 0.98 Women: Malnutrition 1.17 1.12 1.14 1.05 0.66 0.53 Mild anemia 2.11 2.17 2.09 2.57 2.09 0.93 Moderate anemia 1.60 1.88 1.80 2.25 1.50 0.80 Severe anemia 0.65 0.94 0.74 0.59 0.71 0.33 D. Female circumcision Prevalence of circumcision: Girls 2.10 1.87 2.26 2.02 1.89 1.32 Women 0.73 0.83 1.65 1.86 1.20 0.80 Prevalence of occlusion: Girls 0.39 0.47 0.58 0.56 0.81 0.29 Women 0.26 0.31 0.38 0.47 0.42 0.18 E. Sexually transmitted disease Prevalence of genital discharge: Women 1.39 1.61 1.77 1.54 1.50 0.90 Men 1.36 1.35 1.43 1.11 0.94 0.61 Prevalence of genital ulcer: Women 0.88 0.84 0.75 1.19 0.90 0.45 Men 0.89 1.01 0.44 0.54 0.44 0.32 - 71 - Mali 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 3.82 3.26 3.26 2.75 1.73 1.76 Measles coverage 3.75 3.43 3.03 3.03 2.63 1.80 DPT coverage 3.16 3.16 2.95 3.98 3.43 2.14 Full basic coverage 3.14 2.81 2.51 3.26 3.68 1.85 No basic coverage 3.16 2.67 3.00 2.49 1.60 1.47 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 2.25 2.31 2.98 2.81 1.35 Treatment in a public facility 1.14 1.32 1.78 1.92 3.20 0.99 Treatment in a private facility 2.03 1.81 1.84 2.08 2.83 1.00 Treatment of acute respiratory infection (ARI): Medical treatment of ARI 3.97 4.22 2.87 4.43 3.73 2.03 Treatment in a public facility 1.95 2.36 2.51 3.69 4.83 1.70 Treatment in a private facility 2.92 3.85 2.19 2.65 3.57 1.48 Treatment of diarrhea: Use of oral rehydration therapy 3.01 3.52 2.85 2.61 2.71 1.65 Medical treatment of diarrhea 1.79 1.59 2.01 2.17 3.88 1.17 Treatment in a public facility 0.85 0.79 1.10 1.93 3.49 0.81 Treatment in a private facility 1.65 1.50 1.65 1.40 3.73 0.85 C. Antenatal and delivery care Antenatal care (ANC) visits: To a medically trained person 2.70 2.68 2.42 2.34 0.93 1.85 To a doctor 0.22 0.34 0.47 0.43 1.21 0.30 To a nurse or trained midwife 2.42 2.52 2.32 2.24 1.43 1.52 Multiple visits to a medically trained person 1.80 2.67 2.26 2.24 1.92 1.47 Antenatal care content: Tetanus toxoid 2.22 2.15 1.90 2.37 1.20 1.37 Prophylactic antimalarial treatment 2.07 2.01 1.81 2.04 1.21 1.19 Iron supplementation 1.52 1.61 1.33 1.95 2.29 0.96 Delivery attendance: By a medically trained person 2.32 2.82 2.67 3.17 1.19 2.20 By a doctor 0.16 0.16 0.33 0.47 0.68 0.19 By a nurse or trained midwife 2.30 2.82 2.64 3.09 1.31 2.15 In a public facility 2.16 2.50 2.63 3.03 1.66 1.79 In a private facility 0.20 0.33 0.09 0.21 0.70 0.16 At home 2.18 2.46 2.59 3.11 1.43 1.83 D. Contraceptive services Contraceptive prevalence: Women 0.65 0.63 0.56 1.03 1.49 0.47 Men 1.93 1.65 1.69 2.18 2.54 0.99 Source of contraception - public sector: Women 5.99 7.26 7.37 5.10 3.12 2.32 Men na na na na na na - 72 - Mali 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 3.42 6.33 4.56 3.81 2.93 1.95 Men na na na na na na E. Treatment of adult illnesses Treatment of genital discharge, ulcer, sore: Women 1.86 2.42 2.45 2.47 2.35 1.75 Men 8.85 8.17 7.90 12.21 8.56 4.66 Treatment of genital discharge, ulcer, sore in public facilities: Women 1.39 1.61 1.77 1.54 1.50 0.90 Men 1.52 1.60 1.46 1.19 1.03 0.65 Voluntary counseling and testing for HIV/AIDS: Women 0.18 0.27 0.28 0.66 0.76 0.31 Men 1.03 1.35 0.93 1.52 1.99 0.76 - 73 - Mali 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 na na na na na na Handwashing: Wash hands prior to preparing food 0.92 0.98 1.09 0.91 0.73 0.51 Handwashing facilities in household 0.64 1.00 1.49 1.09 2.11 0.88 B. Bednet ownership and use Bednet ownership: Bednet ownership 2.46 2.10 2.02 2.18 2.56 1.43 Treated bednet ownership na na na na na na Bednet use: By children 2.25 2.38 1.94 2.25 2.42 1.37 By pregnant women 3.66 3.52 3.95 3.59 4.46 1.96 C. Breastfeeding Exclusive breastfeeding 3.66 4.48 3.66 3.87 3.71 1.92 Timely complementary feeding 4.05 3.74 4.68 3.99 4.52 2.04 Bottle-feeding 0.58 0.87 0.52 1.02 1.93 0.51 D. Micronutrient consumption Iodized salt: Availability of iodized salt in household 1.88 1.92 1.67 1.93 2.28 1.06 Vitamin A: Children 2.33 2.06 2.24 3.01 2.50 1.28 Women 1.13 1.68 1.21 1.85 1.87 0.88 E. Tobacco and alcohol use Tobacco: Women na na na na na na Men na na na na na na Alcohol: Women na na na na na na Men na na na na na na F. Sexual practices Non-regular sexual partnerships: Women 0.21 0.13 0.17 0.27 0.44 0.13 Men 0.68 0.95 1.31 1.63 1.51 0.69 Condom usage with non-regular partner: Women * * * * 4.98 3.81 Men 11.33 9.53 10.49 7.44 4.94 3.58 G. Domestic violence Ever experienced violence na na na na na na Experienced violence in past year na na na na na na - 74 - Mali 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 0.40 0.44 0.51 1.13 2.07 0.93 Men 1.10 0.80 1.08 1.35 2.36 1.19 School participation: Girls 1.85 1.79 2.35 2.04 3.14 1.39 Boys 1.81 1.79 2.24 2.19 2.46 1.24 B. Exposure to mass media Newspaper readership: Women 0.12 0.17 0.25 0.48 1.28 0.47 Men 0.50 0.88 1.07 1.24 3.24 1.09 Radio listenership: Women 2.48 2.09 2.09 1.71 1.16 1.39 Men 2.29 2.45 2.10 1.77 1.35 1.06 Television viewership: Women 1.62 1.21 1.19 2.13 1.52 1.31 Men 2.78 3.02 2.66 3.28 2.31 2.02 C. Knowledge and attitudes about HIV/AIDS Knowledge about sexual transmission of HIV/AIDS: Women 2.19 2.42 2.07 1.88 1.10 1.49 Men 1.93 3.05 2.60 2.68 1.80 1.32 Knowledge about mother-to-child transmission of HIV/AIDS: Women 1.71 2.04 2.24 1.68 1.19 1.24 Men 2.32 3.29 2.89 2.78 2.47 1.45 Attitudes toward HIV/AIDS: Women 1.71 2.36 1.45 1.57 1.18 0.96 Men 2.89 3.00 2.59 2.94 2.52 1.48 D. Status of women Household decisionmaking: Can seek own health care 0.79 0.84 1.03 1.28 0.80 0.52 Can seek children's health care 1.95 2.19 1.87 1.61 1.66 1.12 Can make daily household purchases 1.49 1.29 1.52 1.60 1.36 0.85 Can make large household purchases 1.13 1.19 1.28 1.24 1.30 0.70 Can make meal-related decisions 1.74 1.82 1.85 1.81 1.59 1.06 Freedom of movement: Can travel to visit family/relatives 1.22 1.29 1.04 2.43 1.56 0.86 Other decisionmaking, attitudes: Can decide how to spend own money 1.79 1.90 1.69 1.73 1.37 0.83 Can decide whether to have sex 2.07 1.97 1.96 2.04 1.70 1.23 Justifies domestic violence 1.14 0.91 1.27 0.98 1.38 0.68 E. Orphanhood Paternal orphan prevalence 0.41 0.47 0.44 0.50 0.72 0.25 Maternal orphan prevalence 0.32 0.36 0.31 0.28 0.31 0.14 Double orphan prevalence 0.13 0.27 0.16 0.14 0.15 0.09 - 75 - Mali 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 0.108 0.311 0.0% 0.7% 1.6% 5.4% 56.3% 12.8% 0.13708 Has radio 0.675 0.468 62.3% 73.1% 63.8% 76.5% 91.9% 73.5% 0.03933 Has television 0.129 0.335 0.0% 1.0% 4.1% 14.2% 69.8% 17.8% 0.12626 Has refrigerator 0.051 0.220 0.0% 0.0% 0.0% 0.1% 34.5% 6.9% 0.12706 Has bicycle 0.447 0.497 68.1% 67.0% 51.3% 46.7% 43.8% 55.4% -0.02041 Has motorcycle/scooter 0.188 0.391 11.3% 25.1% 15.0% 26.9% 46.5% 24.9% 0.04393 Has car/truck 0.041 0.198 0.0% 0.1% 1.0% 3.5% 25.7% 6.1% 0.09137 Has telephone 0.023 0.151 0.0% 0.0% 0.0% 0.2% 17.1% 3.5% 0.09843 Has horse-drawn cart 0.391 0.488 92.3% 66.7% 26.0% 30.2% 11.9% 45.4% -0.06888 Has plow 0.448 0.497 96.5% 79.3% 36.7% 31.6% 8.1% 50.4% -0.07916 Has horse 0.090 0.287 23.1% 7.6% 3.9% 4.1% 1.2% 8.0% -0.03329 Has wheel barrow 0.016 0.126 2.6% 1.1% 1.8% 1.2% 0.6% 1.4% -0.00560 Has donkey 0.439 0.496 91.2% 71.3% 32.2% 33.1% 9.6% 47.5% -0.07411 Has a domestic worker not related to head 0.012 0.107 0.0% 0.0% 0.0% 0.0% 11.5% 2.3% 0.06996 Works own or family's agric. land 0.275 0.447 59.4% 39.8% 38.2% 22.1% 3.2% 32.6% -0.05072 Uses piped drinking water in residence 0.053 0.224 0.0% 0.0% 0.8% 2.2% 30.5% 6.7% 0.10174 Uses water that is piped into the building 0.023 0.150 0.0% 0.1% 1.7% 2.6% 7.3% 2.3% 0.03938 Uses a public faucet (piped) 0.185 0.388 6.1% 18.4% 15.5% 26.4% 35.2% 20.3% 0.03444 Uses an open well 1 0.093 0.291 5.3% 13.9% 8.5% 14.8% 10.7% 10.6% -0.00341 Uses an open well 2 0.037 0.188 4.7% 4.5% 5.2% 5.1% 2.7% 4.4% -0.00748 Uses an open well 3 0.375 0.484 68.3% 42.4% 40.6% 23.4% 4.3% 35.8% -0.06403 Uses covered well 1 for drinking water 0.042 0.201 3.6% 4.8% 6.1% 5.9% 3.8% 4.8% -0.00309 Uses covered well 2 for drinking water 0.018 0.131 1.0% 2.4% 2.2% 3.8% 2.3% 2.3% 0.00052 Uses covered well 3 for drinking water 0.088 0.283 8.3% 8.8% 9.5% 6.8% 2.0% 7.1% -0.01824 Uses river, canal or surface water for drinking 2 0.068 0.252 1.3% 3.4% 8.0% 7.6% 0.9% 4.3% -0.00871 Uses river, canal or surface water for drinking 3 0.006 0.079 0.8% 0.4% 0.7% 0.2% 0.0% 0.4% -0.00609 Uses river, canal or surface water for drinking 4 0.000 0.009 0.1% 0.0% 0.0% 0.0% 0.0% 0.0% -0.00131 Uses spring for drinking water 0.008 0.087 0.2% 0.5% 0.9% 0.2% 0.0% 0.4% -0.00527 Uses drinking water from tanker truck 0.000 0.013 0.0% 0.0% 0.0% 0.2% 0.0% 0.0% 0.00415 Uses bottled water 0.001 0.030 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.00142 Uses other source of drinking water 0.001 0.036 0.0% 0.1% 0.1% 0.3% 0.2% 0.1% 0.00137 Uses a flush toilet in residence/private 0.040 0.196 0.2% 1.7% 2.5% 2.8% 12.9% 4.0% 0.04780 Uses a pit latrine 0.292 0.455 36.8% 38.2% 35.5% 32.4% 22.2% 33.0% -0.02121 Uses a venitilated improved pit latrine 0.039 0.194 0.2% 2.1% 2.6% 5.8% 12.0% 4.6% 0.02887 Uses a shared flush toilet in residence/private 0.025 0.156 0.2% 1.5% 1.5% 1.7% 5.1% 2.0% 0.02547 Uses a shared pit latrine 0.284 0.451 21.6% 27.2% 28.2% 36.2% 32.0% 29.0% 0.00984 Uses a shared venitilated improved pit latrine 0.056 0.230 0.4% 2.1% 4.4% 8.9% 15.4% 6.2% 0.03623 Uses bush,field as latrine 0.262 0.440 40.4% 27.2% 25.2% 11.3% 0.4% 20.9% -0.05028 Uses other type of latrine 0.000 0.016 0.0% 0.0% 0.1% 0.1% 0.0% 0.0% 0.00062 Has dirt, sand, dung as principal floor in dwelling 0.837 0.370 100.0% 100.0% 99.4% 81.2% 15.3% 79.2% -0.13250 Has wood, plank principal floor in dwelling 0.001 0.025 0.0% 0.0% 0.0% 0.1% 0.1% 0.0% 0.00224 Has tiles for main flooring material 0.000 0.020 0.0% 0.0% 0.0% 0.2% 0.0% 0.0% 0.00373 Has cement principal floor 0.002 0.043 0.0% 0.0% 0.2% 0.7% 0.1% 0.2% 0.00048 Has parquet or polished wood floors 0.013 0.112 0.0% 0.0% 0.0% 0.0% 9.7% 1.9% 0.07679 Has vinyl or asphalt strips as flooring material 0.143 0.350 0.0% 0.0% 0.1% 17.0% 73.4% 18.1% 0.11125 Has bricks for principal floor 0.003 0.053 0.0% 0.0% 0.0% 0.0% 1.3% 0.3% 0.02287 Has other type of flooring 0.000 0.016 0.0% 0.0% 0.0% 0.1% 0.0% 0.0% 0.00060 - 77 - Mali 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 Uses electricity as cooking fuel 0.000 0.016 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.00730 Uses gas as cooking fuel 0.005 0.070 0.0% 0.0% 0.0% 0.0% 1.3% 0.3% 0.03441 Uses biogas as cooking fuel 0.000 0.013 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.00447 Uses kerosene as cooking fuel 0.000 0.016 0.0% 0.0% 0.0% 0.0% 0.1% 0.0% 0.00183 Uses coal as cooking fuel 0.002 0.045 0.0% 0.0% 0.0% 0.1% 1.1% 0.2% 0.01636 Uses charcoal for cooking 0.100 0.299 0.0% 0.0% 1.6% 13.8% 34.4% 10.0% 0.09431 Uses wood as cooking fuel 0.825 0.380 99.8% 98.0% 91.9% 76.9% 62.0% 85.7% -0.08159 Uses dung, manure as cooking fuel 0.054 0.226 0.1% 1.8% 6.2% 7.6% 0.5% 3.2% -0.00525 Uses other cooking fuel 0.013 0.112 0.1% 0.2% 0.3% 1.0% 0.5% 0.4% 0.00447 - 78 - PART V. SUPPORTING TABLES, 1995 / 96 A. SAMPLE SIZES B. STANDARD ERRORS C. ASSET DISTRIBUTION AND WEIGHTS Mali 1995 / 96 - SAMPLE SIZES TOTAL SAMPLE Indicator Wealth Quintiles Pop. Low 2nd 3rd 4th High Total Number of household members All 9,735 9,773 9,767 9,735 9,762 48,772 Urban 531 823 1,321 3,318 7,991 13,983 Rural 9,204 8,950 8,446 6,417 1,772 34,789 Female 5,041 4,989 5,011 4,997 4,978 25,016 Male 4,694 4,784 4,756 4,738 4,784 23,756 Part I: HNP STATUS Indicator Wealth Quintiles Pop. Low 2nd 3rd 4th High Total Mortality rates All 4,264 4,426 4,125 4,216 3,452 20,484 Urban 207 346 494 1,358 2,690 5,095 Rural 4,057 4,080 3,631 2,858 762 15,389 Female 2,140 2,226 2,041 2,086 1,723 10,217 Male 2,124 2,200 2,084 2,130 1,729 10,266 Prevalence of fever, diarrhea, acute respiratory infection All 1,029 1,096 1,072 1,100 940 5,237 Urban 44 85 131 381 759 1,400 Rural 985 1,011 941 719 181 3,837 Female 555 541 550 546 471 2,663 Male 474 555 522 553 469 2,573 Total fertility rate All 5,337 5,406 5,171 5,345 6,145 27,404 Urban 294 464 714 1,897 5,153 8,522 Rural 5,043 4,942 4,457 3,448 992 18,882 Age-specific fertility rate 15-19 All 938 1,036 1,020 1,123 1,561 5,678 Urban 63 119 165 430 1,378 2,155 Rural 875 917 854 693 183 3,522 Children's nutritional status All 933 963 964 990 828 4,678 Urban 37 74 124 337 664 1,236 Rural 896 889 840 654 164 3,443 Female 509 490 495 494 402 2,390 Male 424 473 469 497 426 2,289 Children's anemia status All na na na na na na Urban na na na na na na Rural na na na na na na Female na na na na na na Male na na na na na na - 81 - Mali 1995 / 96 - SAMPLE SIZES Part I: HNP STATUS (Cont.) Indicator Wealth Quintiles Pop. Low 2nd 3rd 4th High Total Women's nutritional status All 810 855 820 828 713 4,026 Urban 44 67 99 287 572 1,069 Rural 766 788 721 541 141 2,957 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 1,276 1,280 1,242 1,262 1,209 6,268 Urban 62 103 155 419 987 1,726 Rural 1,214 1,177 1,087 843 222 4,542 Women's circumcision All 1,870 1,900 1,823 1,891 2,221 9,704 Urban 103 168 257 679 1,867 3,074 Rural 1,767 1,732 1,565 1,213 354 6,630 Prevalence of genital discharge, ulcer, sore Female 1,774 1,791 1,721 1,767 1,951 9,004 Urban Female 97 149 234 619 1,624 2,723 Rural Female 1,677 1,642 1,487 1,147 328 6,281 Male 414 416 361 421 497 2,109 Urban Male 30 25 56 168 426 705 Rural Male 385 391 305 254 71 1,406 - 82 - Mali 1995 / 96 - 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 290 332 313 349 277 1,562 Urban 13 24 31 120 226 414 Rural 277 308 283 229 51 1,148 Female 160 158 175 179 139 811 Male 130 174 138 170 139 751 Treatment of fever All 431 454 431 426 285 2,027 Urban 29 42 48 135 216 470 Rural 402 412 382 292 69 1,557 Female 212 220 222 216 160 1,030 Male 219 234 208 210 125 996 Treatment of acute respiratory infection All 159 182 161 168 130 800 Urban 7 11 16 54 105 193 Rural 151 171 144 114 25 605 Female 90 91 79 84 60 404 Male 69 91 82 85 70 397 Treatment of diarrhea All 298 294 298 283 153 1,326 Urban 17 23 30 85 113 268 Rural 281 271 268 198 40 1,058 Female 152 146 146 148 63 655 Male 147 148 152 135 89 671 Antenatal and delivery care All 1,055 1,102 1,040 1,078 901 5,175 Urban 49 85 129 359 723 1,345 Rural 1,006 1,016 911 719 178 3,830 Contraceptive prevalence Female 1,721 1,722 1,637 1,611 1,531 8,222 Urban Female 90 131 206 530 1,222 2,179 Rural Female 1,631 1,591 1,431 1,082 309 6,044 Male 370 372 288 321 294 1,645 Urban Male 22 24 42 127 239 454 Rural Male 349 348 246 194 56 1,193 Contraceptive source Female 8 25 33 68 235 369 Urban Female 1 0 12 32 207 252 Rural Female 7 24 21 36 27 115 Male 370 372 288 321 294 1,645 Urban Male 22 24 42 127 239 454 Rural Male 349 348 246 194 56 1,193 Treatment of genital discharge, ulcer, sore Female na na na na na na Urban Female na na na na na na Rural Female na na na na na na Male na na na na na na Urban Male na na na na na na Rural Male na na na na na na - 83 - Mali 1995 / 96 - 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 143 133 134 127 120 657 Urban 7 12 17 46 96 178 Rural 136 122 117 81 24 480 Female 63 69 64 59 56 311 Male 80 64 70 68 65 347 Timely complementary breastfeeding All 129 146 150 124 109 658 Urban 6 13 18 44 84 165 Rural 124 133 132 80 25 494 Female 52 76 77 65 55 325 Male 77 71 73 58 55 334 Bottle-feeding All 421 434 445 387 353 2,040 Urban 21 36 55 139 276 527 Rural 400 397 390 248 77 1,512 Female 181 221 220 197 175 994 Male 239 213 225 190 178 1,045 - 84 - Mali 1995 / 96 - 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 804 880 853 893 755 4,185 Urban 31 65 101 301 612 1,110 Rural 773 815 751 592 144 3,075 Female 378 448 414 449 379 2,068 Male 426 432 439 444 376 2,117 Tobacco and alcohol use, casual sexual partners, condom use for casual sex Female 1,870 1,900 1,823 1,891 2,221 9,705 Urban Female 103 168 257 679 1,867 3,074 Rural Female 1,767 1,732 1,565 1,213 354 6,631 Male 472 485 447 491 579 2,474 Urban Male 36 32 64 187 494 813 Rural Male 436 453 383 304 85 1,661 Domestic violence All na na na na na na Urban na na na na na na Rural na na na na na na - 85 - Mali 1995 / 96 - SAMPLE SIZES Part IV: UNDERLYING DETERMINANTS OF HNP STATUS Indicator Wealth Quintiles Pop. Low 2nd 3rd 4th High Total School completion (Grade 5) Female 2,022 2,034 1,995 2,023 2,231 10,303 Urban female 113 168 273 702 1,858 3,114 Rural female 1,908 1,865 1,722 1,321 373 7,189 Male 1,615 1,653 1,628 1,729 2,140 8,766 Urban male 89 128 241 655 1,845 2,957 Rural male 1,526 1,525 1,387 1,074 296 5,809 School participation Female 886 885 837 838 816 4,262 Urban female 40 85 105 261 664 1,155 Rural female 846 800 732 577 152 3,106 Male 824 865 869 892 739 4,190 Urban male 48 85 110 281 573 1,097 Rural male 776 781 759 611 167 3,093 Mass media exposure Female 1,870 1,900 1,823 1,891 2,221 9,704 Urban female 103 168 257 679 1,867 3,074 Rural female 1,767 1,732 1,565 1,213 354 6,630 Male 472 485 447 491 579 2,474 Urban male 36 32 64 187 494 813 Rural male 436 453 383 304 85 1,661 Knowledge of HIV/AIDS prevention Female 3,723 1,900 1,823 1,891 2,221 11,558 Urban female 103 168 257 679 1,867 3,074 Rural female 1,767 1,732 1,565 1,213 354 6,631 Male 472 485 447 491 579 2,474 Urban male 36 32 64 187 494 813 Rural male 436 453 383 304 85 1,661 Household decisionmaking and justification of violence All na na na na na na Urban na na na na na na Rural na na na na na na Orphanhood All 4,601 4,757 4,788 4,816 4,549 23,512 Urban 243 407 602 1,624 3,609 6,484 Rural 4,358 4,351 4,186 3,192 941 17,028 Female 2,718 2,805 2,595 2,709 2,419 13,246 Male 1,883 1,953 2,193 2,107 2,127 10,262 - 86 - Mali 1995 / 96 - STANDARD ERRORS OF QUINTILE ESTIMATES FOR TOTAL POPULATION Part I: HNP STATUS Indicator Wealth Quintiles Low 2nd 3rd 4th High Avg. A. Childhood illness and mortality Infant mortality rate 8.73 9.25 9.61 10.23 11.06 4.58 Under-five mortality rate 9.05 9.65 10.58 11.20 11.14 5.06 Prevalence of fever 1.73 1.86 1.82 1.99 2.18 0.98 Prevalence of diarrhea 1.66 1.39 1.54 1.42 1.45 0.75 Prevalence of acute respiratory infection 1.37 1.34 1.39 1.38 1.18 0.68 B. Fertility Total fertility rate 0.32 0.27 0.27 0.22 0.14 0.13 Adolescent fertility rate 20.00 20.00 20.00 10.00 10.00 10.00 C. Nutritional status Children: Moderate stunting 1.16 1.33 1.23 1.29 1.15 0.57 Severe stunting 1.52 1.34 1.20 1.26 0.99 0.66 Moderate underweight 1.47 1.54 1.39 1.42 1.64 0.73 Severe underweight 1.66 1.41 1.32 1.34 0.96 0.72 Mild anemia na na na na na na Moderate anemia na na na na na na Severe anemia na na na na na na Women: Malnutrition 1.44 1.52 1.46 1.37 1.41 0.75 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 3.47 1.87 1.55 1.47 1.34 1.15 Women 3.19 0.66 0.64 0.68 0.80 0.84 Prevalence of occlusion: Girls na na na na na na Women 0.10 0.27 0.15 0.19 0.17 0.10 E. Sexually transmitted disease Prevalence of genital discharge: Women 0.09 0.15 0.12 0.17 0.12 0.06 Men 0.73 0.61 0.83 0.76 0.73 0.35 Prevalence of genital ulcer: Women 0.10 0.11 0.11 0.09 0.12 0.05 Men 0.69 0.99 0.40 1.02 0.42 0.36 - 87 - Mali 1995 / 96 - 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 4.10 3.35 2.93 2.32 1.57 1.80 Measles coverage 3.75 3.27 3.51 3.34 2.71 1.92 DPT coverage 3.05 3.34 3.28 3.18 3.28 1.99 Full basic coverage 2.98 3.09 3.27 3.21 3.06 1.90 No basic coverage 4.13 3.35 2.92 2.15 1.51 1.80 Hepatitis B coverage na na na na na na Yellow fever coverage 0.34 0.60 0.92 1.87 3.01 0.76 B. Treatment of childhood illnesses Treatment of fever: Medical treatment of fever 1.36 1.49 1.90 1.66 3.03 1.00 Treatment in a public facility 1.13 1.20 1.26 1.46 2.25 0.73 Treatment in a private facility 0.85 1.08 1.36 1.14 2.36 0.65 Treatment of acute respiratory infection (ARI): Medical treatment of ARI 3.71 2.97 3.60 3.84 4.36 2.26 Treatment in a public facility 3.10 2.75 2.69 3.43 5.02 1.84 Treatment in a private facility 2.05 1.96 2.93 3.01 3.78 1.38 Treatment of diarrhea: Use of oral rehydration therapy 3.16 2.85 3.35 3.19 4.68 1.76 Medical treatment of diarrhea 1.91 2.67 2.56 2.51 4.03 1.37 Treatment in a public facility 1.23 2.44 2.08 2.01 4.03 1.07 Treatment in a private facility 1.46 1.52 1.64 1.79 3.60 0.96 C. Antenatal and delivery care Antenatal care (ANC) visits: To a medically trained person 2.13 2.48 2.46 2.41 1.57 1.57 To a doctor 0.13 0.26 0.41 0.32 0.76 0.19 To a nurse or trained midwife 2.24 2.51 2.58 2.62 1.57 1.67 Multiple visits to a medically trained person 1.45 2.00 2.25 2.50 1.74 1.46 Antenatal care content: Tetanus toxoid 1.84 1.94 1.99 2.05 1.51 1.18 Prophylactic antimalarial treatment na na na na na na Iron supplementation na na na na na na Delivery attendance: By a medically trained person 1.34 2.14 2.79 2.78 1.90 1.80 By a doctor 0.08 0.25 0.18 0.43 0.62 0.17 By a nurse or trained midwife 1.33 2.15 2.77 2.75 1.89 1.77 In a public facility 1.20 1.68 2.00 2.83 2.36 1.51 In a private facility 0.09 0.00 0.18 0.14 0.54 0.11 At home 1.36 2.11 2.95 2.92 2.02 1.83 D. Contraceptive services Contraceptive prevalence: Women 0.18 0.44 0.51 0.76 1.31 0.38 Men 0.47 1.03 1.51 2.44 2.85 0.85 Source of contraception - public sector: Women * * 9.13 6.31 3.49 2.97 Men na na na na na na - 88 - Mali 1995 / 96 - 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 * * 9.15 6.25 3.63 3.02 Men na na na na na na E. Treatment of adult illnesses Treatment of genital discharge, ulcer, sore: Women * * * * 11.28 6.30 Men * * * * * 5.81 Treatment of genital discharge, ulcer, sore in public facilities: Women 0.09 0.15 0.12 0.17 0.12 0.06 Men 0.77 1.07 0.82 1.27 0.83 0.48 Voluntary counseling and testing for HIV/AIDS: Women na na na na na na Men na na na na na na - 89 - Mali 1995 / 96 - STANDARD ERRORS OF QUINTILE ESTIMATES FOR TOTAL POPULATION Part III: Intermediate Determinants of HNP Status - INDIVIDUAL AND HOUSEHOLD BEHAVIOR Indicator Wealth Quintiles Low 2nd 3rd 4th High Avg. A. Hygienic practices Disposal of children's stools: Sanitary disposal na na na na na na Handwashing: Wash hands prior to preparing food na na na na na na Handwashing facilities in household na na na na na na B. Bednet ownership and use Bednet ownership: Bednet ownership na na na na na na Treated bednet ownership na na na na na na Bednet use: By children na na na na na na By pregnant women na na na na na na C. Breastfeeding Exclusive breastfeeding 3.31 3.37 3.36 3.58 3.05 1.56 Timely complementary feeding 4.74 3.66 3.88 4.26 4.43 1.87 Bottle-feeding 0.78 0.63 0.67 1.35 1.89 0.48 D. Micronutrient consumption Iodized salt: Availability of iodized salt in household na na na na na na Vitamin A: Children 0.79 0.26 0.39 0.42 0.34 0.25 Women na na na na na na E. Tobacco and alcohol use Tobacco: Women na na na na na na Men na na na na na na Alcohol: Women na na na na na na Men na na na na na na F. Sexual practices Non-regular sexual partnerships: Women na na na na na na Men 1.29 1.55 1.83 1.94 2.79 1.02 Condom usage with non-regular partner: Women na na na na na na Men 3.80 4.65 4.36 5.35 3.47 2.62 G. Domestic violence Ever experienced violence na na na na na na Experienced violence in past year na na na na na na - 90 - Mali 1995 / 96 - 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 0.27 0.38 0.56 0.87 1.77 0.69 Men 0.67 0.86 1.10 1.45 1.99 1.06 School participation: Girls 1.14 1.66 1.95 2.54 2.06 1.38 Boys 1.76 1.82 1.83 2.50 2.19 1.38 B. Exposure to mass media Newspaper readership: Women 0.15 0.24 0.28 0.59 1.43 0.51 Men 0.87 0.99 1.25 1.90 2.84 1.07 Radio listenership: Women 1.74 1.77 1.83 1.58 1.09 1.20 Men 2.51 2.25 2.00 1.42 1.11 1.11 Television viewership: Women 1.08 1.33 1.44 1.79 1.71 1.32 Men 1.88 2.69 3.07 3.47 2.51 1.97 C. Knowledge and attitudes about HIV/AIDS Knowledge about sexual transmission of HIV/AIDS: Women 2.38 1.78 1.69 1.26 0.73 1.05 Men 1.71 1.52 1.16 1.41 0.40 0.63 Knowledge about mother-to-child transmission of HIV/AIDS: Women 1.31 1.38 1.58 1.70 1.41 1.11 Men 2.83 2.43 2.85 2.53 2.15 1.34 Attitudes toward HIV/AIDS: Women na na na na na na Men na na na na na na D. Status of women Household decisionmaking: Can seek own health care na na na na na na Can seek children's health care na na na na na na Can make daily household purchases na na na na na na Can make large household purchases na na na na na na Can make meal-related decisions na na na na na na Freedom of movement: Can travel to visit family/relatives na na na na na na Other decisionmaking, attitudes: Can decide how to spend own money 2.97 2.40 2.37 1.68 1.16 1.28 Can decide whether to have sex na na na na na na Justifies domestic violence na na na na na na E. Orphanhood Paternal orphan prevalence 0.50 0.48 0.49 0.51 0.52 0.24 Maternal orphan prevalence 0.37 0.30 0.30 0.33 0.27 0.14 Double orphan prevalence 0.14 0.09 0.09 0.11 0.16 0.06 - 91 - Mali 1995 / 96 - 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 0.070 0.256 0.0% 0.0% 0.0% 0.4% 37.5% 7.6% 0.17385 Has radio 0.568 0.495 21.4% 44.9% 69.0% 83.3% 92.2% 62.2% 0.08863 Has television 0.078 0.269 0.0% 0.0% 0.1% 1.4% 54.3% 11.2% 0.16504 Has refrigerator 0.033 0.178 0.0% 0.0% 0.0% 0.0% 20.7% 4.2% 0.16000 Has bicycle 0.351 0.476 36.5% 43.9% 53.3% 48.1% 29.5% 42.3% -0.01605 Has motorcycle 0.163 0.369 0.8% 6.0% 12.3% 32.8% 54.5% 21.3% 0.09232 Has car 0.029 0.166 0.0% 0.0% 0.0% 0.0% 20.4% 4.1% 0.13180 Has telephone 0.007 0.083 0.0% 0.0% 0.0% 0.0% 5.3% 1.1% 0.10365 Uses piped drinking water in residence 0.057 0.232 0.0% 0.0% 0.0% 2.1% 26.2% 5.7% 0.13984 Uses piped drinking water in public tap 0.148 0.355 0.6% 2.1% 4.3% 14.7% 34.0% 11.1% 0.04957 Uses inside well drinking water 0.172 0.377 2.4% 8.6% 24.5% 38.3% 24.0% 19.6% 0.02008 Uses river, canal or surface water for drinking 0.040 0.197 7.6% 4.0% 4.7% 4.2% 0.9% 4.3% -0.01777 Uses public well for water 0.438 0.496 77.6% 67.9% 43.7% 23.9% 8.0% 44.2% -0.09247 Uses bore hole for water 0.142 0.349 11.7% 17.2% 21.6% 16.9% 6.7% 14.8% -0.02349 Uses rain for drinking water 0.000 0.011 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% -0.00147 Uses private flush toilet 0.004 0.062 0.0% 0.0% 0.0% 0.0% 2.5% 0.5% 0.06826 Uses a latrine 0.068 0.253 0.0% 1.6% 4.0% 10.8% 22.5% 7.8% 0.07023 Uses shared flush toilet 0.005 0.071 0.0% 0.0% 0.0% 0.0% 3.1% 0.6% 0.07293 Uses traditional pit latrine 0.620 0.485 9.9% 67.9% 85.0% 85.8% 70.9% 63.9% 0.03587 Uses bush, field as latrine 0.298 0.457 89.8% 29.9% 9.7% 3.2% 1.0% 26.7% -0.09692 Uses other type of latrine 0.001 0.030 0.2% 0.2% 0.1% 0.0% 0.0% 0.1% -0.00377 Has dirt, earth principal floor in dwelling 0.589 0.492 87.5% 73.2% 61.0% 40.7% 9.5% 54.4% -0.10815 Has parquet or tile principal floor in dwelling 0.000 0.011 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.00048 Has cement principal floor 0.188 0.391 0.0% 0.0% 0.6% 24.6% 79.2% 20.9% 0.13350 Has tile flooring 0.010 0.098 0.0% 0.0% 0.0% 0.0% 5.4% 1.1% 0.10646 Has other type of flooring 0.000 0.011 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% -0.00088 Has a dung floor 0.205 0.404 12.4% 26.6% 37.2% 34.2% 3.9% 22.9% -0.02812 Has palm or bamboo flooring 0.001 0.030 0.1% 0.1% 0.0% 0.2% 0.0% 0.1% -0.00212 Has vinyl/asphalt flooring 0.001 0.036 0.0% 0.0% 0.0% 0.0% 0.4% 0.1% 0.02270 Has carpeted flooring 0.002 0.047 0.0% 0.0% 0.0% 0.0% 1.0% 0.2% 0.02477 Rooms for sleeping 2.422 1.519 2.0 2.5 3.2 3.5 4.0 3.1 0.06486 Number of members per sleeping room 2.395 1.486 3.0 2.6 2.4 2.5 2.4 2.6 -0.01969 - 93 - PART VI. ANNEXES A. SOURCES OF ADDITIONAL INFORMATION B. USE OF INFORMATION FROM THIS REPORT TO MONITOR THE ECONOMIC STATUS OF PEOPLE SERVED BY HNP PROGRAMS C. COUNTRIES COVERED BY THE HNP- POVERTY REPORT PROJECT ANNEX A. SOURCES OF ADDITIONAL INFORMATION ADDITIONAL INEQUALITY DATA World Bank HNP/Poverty Country Report Website: http://www.worldbank.org/hnp/povertyandhealth/countrydata. This World Bank website provides the full texts and tables for all fifty-six countries covered by the HNP/Poverty Country Report Project. (A list of the countries covered appears in annex C, at the end of this report.) Also available at the site are summary tables, organized by indicator, designed to facilitate cross-country comparisons in inequality with respect to particular indicators. DHS Country Reports: http://www.measuredhs.com/countries. All DHS final country reports produced since 2003 include quintile-specific tabulations in approximately 50-100 of the reports' HNP indicator tables. The tables deal with some of the indicators covered in this volume, and with many that are not. UNICEF Multi-Indicator Cluster Survey Website: http://www.childinfo.org/MICS2/natlMICSrepz/MICSnatrep.htm. The UNICEF Multi-Indicator Cluster Survey (MICS) project is generally similar to the DHS program, but covers a somewhat different set of countries and indicators. The "standard tables" section for each country listed at the MICS website provides wealth- based, quintile-specific information in around 40-45 of the tables related to hnp, education, and child labor. In deriving these quintile-specific estimates, the MICS investigators have employed a wealth index similar to the one used here. World Health Organization World Health Survey Website: http://www.who.int/healthinfo/survey/en/index.html. The World Health Organization's World Health Survey (WHS) includes such issues as self-assessed adult health status; coverage of interventions against adult chronic diseases and against maternal and child health problems; household health expenditures; insurance coverage; and health system responsiveness. Approximately seventy countries ­ developed as well as developing ­ have been covered thus far. Household wealth information has been collected and used to prepare quintile-specific estimates for many of the indicators appearing in the reports on these countries. - 97 - METHODS AND RESOURCES FOR FURTHER INEQUALITY ANALYSIS Shea Oscar Rutstein and Kiersten Johnson, The DHS Wealth Index, DHS Comparative Reports No. 6 (Calverton, Maryland, USA: ORC Macro, August 2004) (Available at: http://www.measuredhs.com/pubs/pub_details.cfm?ID =470&srchTp=type). This DHS publication, by two of the co-authors of the current report, describes in detail the construction of the wealth index that underlies the data presented in the basic tables. Deon Filmer and Lant H. Pritchett, "Estimating Wealth Effects without Expenditure Data ­ or Tears: An Application to Education Enrollments in States in India," Demography 38, no.1 (February 2001): 115-132. This seminal piece gave birth to the wealth index procedure used in the current volume. It also includes three of the previously-cited country case studies demonstrating the close relationship between results produced using wealth and those based on consumption as an indicator of household economic status. Owen O'Donnell, Eddy van Doorslaer, Adam Wagstaff, and Magnus Lindelow. Quantitative Techniques for Health Equity Analysis. Washington D.C.: The World Bank, forthcoming. Among the topics covered in this comprehensive overview of available quantitative techniques are the measurement of living standards using a wealth index and other approaches (chapter 6) and the concentration index as a measure of inequality (chapter 8). DHS Country Data Sets: http://www.measuredhs.com/accesssurveys/search. The data sets for all DHS surveys undertaken since 2003 include two pieces of information for each household that are designed to help investigators prepare quintile- specific tabulations for any indicator. These are: 1) the household wealth score; and 2) the economic quintile to which individuals in the household belong. Any tabulation using these pieces of information will be comparable to the figures appearing here. - 98 - ANNEX B. USE OF INFORMATION FROM THIS REPORT TO MONITOR THE ECONOMIC STATUS OF PEOPLE SERVED BY HNP PROGRAMS The wealth or asset approach employed in this report can be used to monitor the economic status of people served by health, nutrition, and population (hnp) programs in two ways. The first, simpler way is suitable for monitoring nationwide, facility-based programs. A second, fuller version can also be employed for other types of programs, such as initiatives undertaken only in some parts of a country, or activities like mass education or outreach programs that do not operate through facilities. BASIC MONITORING OF NATIONWIDE FACILITY-BASED PROGRAMS The economic distribution of patients in a nationwide, facility-based program (say, a network of rural health posts, antenatal care clinics, emergency obstetrical facilities, or hospitals) can be determined through an exit survey of facility patients, using the wealth questionnaire and the set of quintile cut-off points that immediately follow this text, and which have been created using the information presented in part III.C. The questionnaire can be employed to measure the economic status of any individual responding to the questions on it. The set of cut-off points can serve to compare the distribution of the respondents' economic status with that of the nationally- representative sample of people interviewed by the DHS survey on which the present report is based. The first step is to use the questionnaire in interviewing an adequately-large sample of patients attending the facility-based services of interest. The wealth score for each patient can then be calculated by multiplying the response to each question by the item scores also provided on the questionnaire, and summing the results. After this has been done, the quintile cut-off points can be used to place each individual in the economic quintile to which (s)he belongs. The number of patients and percentage of total patients in each quintile can then be calculated. Since each quintile defined by the cut-off points contains 20 percent of the individuals in the nationally-representative DHS sample, the patients belonging to any such quintile containing significantly more (or less) than 20 percent of the total are over- (under-) represented relative to the national population. When the percentage of patients in each of the five quintiles is viewed as a whole, the result is a frequency distribution that indicates the spread of service beneficiaries across economic classes of individuals.21 For example: · A service that favors the poorest people would have substantially more than 20 percent of its patients in each of the lowest one or two economic quintiles; considerably less than 20 percent of its patients in each of the highest quintiles. 21That is, across economic classes of all individuals in the sample population. Estimates pertaining to quintiles of only those individuals needing services require adjusting the results of the procedure described here through application of the relevant quintile-specific, sample-size figures presented in part III.A. - 99 - · A service that reaches all economic classes equally would draw roughly the same proportion of total patients from the lower and upper quintiles. · A service that favors the least poor population groups would have well over 20 percent of its patients in each of the highest one or two quintiles, considerably less than 20 percent of its patients in each of the lowest quintiles. FULLER MONITORING OF FACILITY-BASED AND OF OTHER PROGRAMS While capable of providing far more information than currently exists about the distribution of a program's beneficiaries, the approach just described has important limitations. For example, it cannot deal with the many important types of health programs that do not deliver services primarily through facilities ­ mass media health education, household visits by health workers, and many social marketing initiatives, for example. It is also limited in its ability to assess programs working only with certain areas within a country: it can compare the economic status of the programs' beneficiaries with that of the national population, but not with that of the specific sub-national areas where the programs are active. Further, it focuses primarily on only one of the two important dimensions of monitoring the distribution of program beneficiaries: that is, incidence or focus ­ the percentage of program benefits that flow to the poor. It cannot deal nearly so well with the second dimension, which concerns coverage, or the percentage of the poor that the program reaches. These limitations can be overcome by a modified version of the approach described above that relies on a household- rather than facility-based survey. A household survey can generate a set of data containing the full range of information needed to produce an equity assessment by collecting two types of information: first, about the household's wealth or assets, using the questions in the left-hand column of the attached questionnaire;22 and second, about the household members' use of or exposure to the services provided by the program(s) of interest. The collected data can be analyzed in either (or both) of two ways, depending on the type of information desired: · One way would be to use only data from the household survey. The procedure would be analogous to that for a DHS survey employed in this report: ­ Asset information from the survey-generated data set would be used as the basis for the construction of a wealth index, weighting the individual items using some method like principal components analysis. ­ The individuals in the sample would be ranked in order of the index values for their households, then divided into groups like quintiles. ­ The coverage rates in each quintile for the service of interest would be calculated. · A second approach would be to use the weights for each item appearing on the attached questionnaire in determining the wealth of each individual, instead of calculating the weights from the new household data set. Once the individuals' wealth is determined, the individuals would be ranked, divided into quintiles, and the coverage rate in each quintile would be calculated. In the case of programs undertaken in only one region of the country, it would 22Or, if one is willing to forego the benefits of the second analytical approach described below, using any of several other asset questionnaires that exist. Examples include the INDEPTH health equity survey tool (available at: www.indepth-network.org/core_documents/indepthtools.htm) or the model questionnaire developed by M. Mahood Khan and David Hotchkiss of the PHR Plus project (which can be found at: www.phrplus.org). - 100 - provide a comparison of the economic status of the people served with that of the entire country rather than of only the region where the programs are active;23 in the case of nationwide as well as regional programs, it would permit a comparison with the other service programs covered in this report. 23This additional perspective could be particularly helpful in an assessment of a program seeking to reach the poor by focusing on especially backward districts. A report presenting only a finding that the program was reaching the better- off people in those districts could produce an impression that it had failed to reach its intended beneficiaries. But a comparison between the economic status of the program's beneficiaries with that of the national population might well reveal that most of the beneficiaries were poor by national standards and that the program was thus considerably more successful than otherwise thought. - 101 - Mali 2001 - ASSET QUESTIONNAIRE Question Score if Score if Item "Yes" "No" Score 1. In your household, is/are there? Electricity 0.39356 -0.04774 One or more radios 0.02727 -0.05671 One or more televisions 0.32874 -0.04849 One or more refrigerators 0.54804 -0.02946 One or more bicycles -0.02269 0.01836 One or more motorcycles, scooters 0.09121 -0.02116 One or more cars, trucks 0.44170 -0.01890 One or more telephones 0.63760 -0.01519 One or more horse-drawn carts -0.08594 0.05520 One or more plows -0.08791 0.07127 One or more horses -0.10564 0.01049 One or more wheelbarrows -0.04371 0.00072 One or more donkeys -0.08381 0.06552 2. Does your household have a domestic worker not related to head? 0.64585 -0.00758 3. Do the members of your household work their own or family's agricultural land? -0.08233 0.03124 4. What is the principal source of drinking water for your household? Piped water in residence 0.42921 -0.02412 Piped water in the building 0.25645 -0.00605 Piped water in public faucet 0.07237 -0.01639 Open well in residence -0.01062 0.00109 Open well in the building -0.03830 0.00146 Public open well -0.08265 0.04961 Covered well in residence -0.01475 0.00065 Covered well in the building 0.00392 -0.00007 Public covered well -0.05873 0.00567 River -0.03216 0.00236 Lake -0.07630 0.00049 Canal -0.14554 0.00001 Springwater -0.06018 0.00046 Tanker truck 0.32589 -0.00005 Bottled water 0.04757 -0.00004 Other 0.03792 -0.00005 5. What is the principal source of fuel for cooking used by your household? Electricity 0.46785 -0.00011 Gas 0.49208 -0.00241 Biogas 0.35100 -0.00006 Kerosene 0.11724 -0.00003 Coal 0.36288 -0.00074 Charcoal 0.28371 -0.03135 Wood -0.03759 0.17710 Dung, manure -0.02197 0.00125 Other 0.03935 -0.00051 - 103 - Mali 2001 - ASSET QUESTIONNAIRE Question Score if Score if Item "Yes" "No" Score 6. What is the principal type of toilet facility used by your household? Private flush toilet in residence 0.23422 -0.00975 Shared flush toilet in residence 0.15938 -0.00407 Private pit latrine -0.03299 0.01363 Shared pit latrine 0.01562 -0.00619 Venitilated improved pit latrine 0.14296 -0.00583 Shared venitilated improved pit latrine 0.14845 -0.00884 Bush, field as latrine -0.08440 0.02995 Other 0.03989 -0.00001 7. What is the principal material used for the floors in your household? Dirt, sand, dung -0.05856 0.29978 Cement 0.01107 -0.00002 Wood plank 0.08809 -0.00006 Parquet, polished wood 0.67836 -0.00869 Tile 0.18538 -0.00008 Vinyl, asphalt strips 0.27254 -0.04541 Brick 0.42858 -0.00122 Other 0.03830 -0.00001 Total Household Asset Score (sum of individual item scores) 2001 - QUINTILE CUT-OFF POINTS Asset Index Value Wealth Quintile Bottom Cut-Off Top Cut-Off Low Low -0.64343 Second -0.64343 -0.42951 Third -0.42951 -0.18055 Fourth -0.18055 0.53873 High 0.53873 High - 104 - 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 - 105 -