Demographic and Health Survey 2009-10 - Timor-Leste Ministry of ...

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with their death, or they may live in a culture that discourages discussion of the dead. The possible occurrence of these data problems in the 2009-10 TLDHS is discussed with reference to the data quality tables in Appendix C. Underreporting of births and deaths is generally more common the further back in time an event has occurred. An unusual pattern in the distribution of births by calendar years is an indication of omission of children or age displacement. In the TLDHS, the cutoff date for asking health questions was January 2004. Table C.4 shows that the overall percentage of births for which a month and year of birth was reported is almost 100 percent for both children who have died and children who are alive. Table C.4 shows some age displacement across this boundary for both living and dead children. The distribution of living children and the total number of children shows a deficit in 2004 and an excess in 2003, as denoted by the calendar year ratios. The deficit in 2004 can be attributed to the transference of births by interviewers out of the period for which health data were collected. Transference is proportionately higher for dead children than for living children, and this displacement may affect mortality rates. The transference of children, especially deceased children, out of the five-year period preceding the survey is likely to result in an underestimate of the true level of childhood mortality for that period. Underreporting of deaths is usually assumed to be more common for deaths that occur very early in infancy. Omission of deaths or misclassification of deaths as stillbirths may also be more common among women who have had several children or in cases where death took place a long time ago. To assess the impact of omission on measures of child mortality, two indicators are used: (1) the percentage of deaths that occurred within seven days of birth to the number that occurred within one month of birth and (2) the percentage of neonatal to infant deaths. It is hypothesized that omission will be more prevalent for those who died immediately after birth than for those who lived longer, and that it will be more common for events that took place in the distant past compared with those that took place in the more recent past. Table C.5 shows data on age at death for early infant deaths. Selective underreporting of early neonatal deaths would result in an abnormally low ratio of deaths within the first seven days of life to all neonatal deaths. Early infant deaths have not been greatly underreported in the TLDHS survey, as suggested by the high ratio of deaths in the first seven days of life to all neonatal deaths (76 percent in the five years preceding the survey). Heaping of the age at death on certain digits is another problem that is inherent in most retrospective surveys. Misreporting of age at death biases age pattern estimates of mortality if the net result is the transference of deaths between age segments for which the rates are calculated. For example, child mortality may be overestimated relative to infant mortality if children who died in the first year of life are reported as having died at age 1 or older. In an effort to minimize misreporting of age at death, interviewers were instructed to record deaths at under 1 month in days and deaths at under 2 years in months. In addition, they were trained to probe deaths reported at exactly 1 year or 12 months to ensure that they had actually occurred at 12 months. The distribution of deaths under 2 years during the 20 years prior to the survey by month of death shows that there is some heaping at 6, 9, and 12 months of age, with corresponding deficits in adjacent months (Table C.6). However, heaping is less pronounced for deaths in the five years preceding the survey, for which the most recent mortality rates are calculated. 8.3 LEVELS AND TRENDS IN INFANT AND CHILD MORTALITY Neonatal, postneonatal, infant, child, and under-5 mortality rates are shown in Table 8.1 for cohorts of children born in three consecutive five-year periods before the survey. Under-5 mortality for the most recent period (0-4 years before the survey or, roughly, during the calendar years 2005- 2009) is 64 deaths per 1,000 live births. This means that 1 in 16 children born in Timor-Leste dies before the fifth birthday. Seventy percent of deaths among children under age 5 occur during the first year of life: infant mortality is 45 deaths per 1,000 live births. During infancy, the risk of neonatal deaths and postneonatal deaths is 22 and 23 per 1,000 live births, respectvely. The proportion of child deaths that occurs in the neonatal period (34 percent) in Timor-Leste is lower than the global estimation of 38 percent (Lawn et al., 2005). 100 | Infant and Child Mortality
Table 8.1 Early childhood mortality rates Neonatal, postneonatal, infant, child, and under-5 mortality rates for five-year periods preceding the survey, Timor-Leste 2009-10 Years preceding the survey Neonatal mortality (NN) Postneonatal mortality 1 (PNN) Infant mortality ( 1q 0) Child mortality ( 4q 1) Under-5 mortality ( 5q 0) 0-4 22 23 45 20 64 5-9 30 37 68 32 98 10-14 36 47 83 36 115 1 Computed as the difference between the infant and neonatal mortality rates Mortality trends can be examined in two ways: by comparing mortality rates for three fiveyear periods preceding a single survey and by comparing mortality estimates obtained from various surveys. However, comparisons between surveys should be interpreted with caution because quality of data, time references, and sample coverage vary. In particular, sampling errors associated with mortality estimates are large and should be taken into account when examining trends between surveys. Data from the TLDHS for the three five-year periods preceding the survey indicate a decline in childhood mortality. For example, infant mortality estimates show a decline from 83 in the 10 to 14 years preceding the survey to 68 in the five- to nine-year period preceding the survey and to 45 during the most recent five-year period. A similar trend is seen for the other under-5 mortality indicators. Comparison of the TLDHS 2009-10 mortality data with the 2003 DHS survey results shows a substantial (23 percent) improvement in child survival (Figure 8.1). For example, under-5 mortality declined from 83 per 1,000 live births during the period 1999-2003 to 64 per 1,000 live births during the period 2005-2009. This is caused principally by a decrease in the infant mortality rate, from 60 per 1,000 for the zero to four years preceding the 2003 DHS to 45 per 1,000 during the same period prior to the 2009-10 TLDHS. The decline in neonatal, infant and under-5 mortality in the five years preceding the TLDHS 2009-10 indicates that Timor-Leste is on track to reduce infant and under-5 mortality to reach the target for Millennium Development Goal (MDG) 4, that is, to reduce under-5 mortality by two-thirds by 2015. It is notable that the proportion of neonatal deaths to under-5 deaths (34 percent) is relatively lower in Timor-Leste than in the other neighboring countries of Indonesia, Philippines, Bangladesh, India, and Nepal as measured in the latest DHS surveys in these countries. Neonatal mortality is generally higher than postneonatal mortality, but the pattern observed in the 2009-10 TLDHS is unusual. The common indicators of data quality, including the proportion of neonatal deaths that occur in the first seven days, the ratio of neonatal deaths to perinatal deaths, and the heaping of deaths around one month do not show obvious problems with data quality; however, it is possible that some neonatal deaths have been omitted. Infant and Child Mortality | 101
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Timor-Leste Demographic and Health
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CONTENTS TABLES AND FIGURES .......
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CHAPTER 7 FERTILITY PREFERENCES 7.1
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14.8 HIV/AIDS-related Knowledge and
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x | Tables and Figures CHAPTER 4 FE
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xii | Tables and Figures Table 11.4
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xiv | Tables and Figures Table 16.4
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FOREWORD The 2009-10 Timor-Leste De
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CONTRIBUTORS TO THE REPORT Elias do
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about three children more than wome
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Postnatal Care. The majority of wom
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However, the level of chronic energ
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MILLENNIUM DEVELOPMENT GOAL INDICAT
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INTRODUCTION 1 1.1 HISTORY, GEOGRAP
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The government of Timor-Leste has l
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1.5 ORGANIZATION OF THE SURVEY The
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1.8 HEMOGLOBIN TESTING In one-third
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In these households, 13,796 women w
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Table 2.1 Household population by a
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The percentage of children not livi
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The Early Childhood Care and Educat
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Table 2.4.2 Educational attainment
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The GAR at the primary school level
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ate (2 percent) than their rural co
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water. Thirty-six percent of househ
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The type of flooring material used
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Table 2.11 Wealth quintiles Percent
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CHARACTERISTICS OF RESPONDENTS 3 Th
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Table 3.2.1 Educational attainment:
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Table 3.3.1 Literacy: Women Percent
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Table 3.4.1 Exposure to mass media:
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Table 3.5.1 Employment status: Wome
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3.4.2 Occupation Respondents who we
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3.4.3 Earnings, Employers, and Cont
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Tables 3.8.1 and 3.8.2 show the per
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Table 3.9.1 Use of tobacco: Women P
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Page 83 and 84: Table 4.2 Fertility by background c
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Page 89 and 90: Table 4.8 Median age at first birth
Page 91 and 92: FAMILY PLANNING 5 In 2002, the Coun
Page 93 and 94: According to the 2003 DHS, knowledg
Page 95 and 96: Table 5.3.1 Ever use of contracepti
Page 97 and 98: Table 5.4 Current use of contracept
Page 99 and 100: Table 5.5 Current use of contracept
Page 101 and 102: Use increases with parity but with
Page 103 and 104: Female and male sterilizations are
Page 105 and 106: Table 5.10 Future use of contracept
Page 107 and 108: Table 5.13 Exposure to family plann
Page 109: Table 5.15 Husband/partner’s know
Page 112 and 113: 6.2 POLYGYNY Polygyny (the practice
Page 114 and 115: 20.9 years. Although the proportion
Page 116 and 117: 84 | Other Proximate Determinants o
Page 118 and 119: Table 6.7.1 Recent sexual activity:
Page 120 and 121: There is little difference in the p
Page 122 and 123: 2 percent among women age 30-34 to
Page 124 and 125: 92 | Fertility Preferences Table 7.
Page 126 and 127: 94 | Fertility Preferences 7.3 NEED
Page 128 and 129: 96 | Fertility Preferences an idea
Page 130 and 131: 98 | Fertility Preferences The perc
Page 134 and 135: 100 80 60 40 20 102 | Infant and Ch
Page 136 and 137: 104 | Infant and Child Mortality Ta
Page 138 and 139: 8.7 HIGH-RISK FERTILITY BEHAVIOR Th
Page 141 and 142: ADULT AND MATERNAL MORTALITY 9 The
Page 143 and 144: 9.2 ADULT MORTALITY Table 9.3 Sibsh
Page 145 and 146: MATERNAL HEALTH 10 Making Pregnancy
Page 147 and 148: among women in the lowest wealth qu
Page 149 and 150: A much lower percentage of Timorese
Page 151 and 152: Table 10.5 Knowledge of danger sign
Page 153 and 154: 10.6.2 Assistance during Delivery O
Page 155 and 156: Table 10.8 Knowledge of danger sign
Page 157 and 158: Table 10.10 Application of material
Page 159 and 160: Table 10.12 Timing of first postnat
Page 161 and 162: Where health services are present,
Page 163 and 164: CHILD HEALTH 11 This chapter presen
Page 165 and 166: In the TLDHS, information on vaccin
Page 167 and 168: Boys (54 percent) are somewhat more
Page 169 and 170: The data indicate that two percent
Page 171 and 172: 11.6 DIARRHEAL DISEASE Dehydration
Page 173 and 174: Table 11.8 Diarrhea treatment Among
Page 175 and 176: Ten percent of children with diarrh
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Page 180 and 181: international reference population
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80 Percent 70 60 50 40 30 20 10 150
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60 50 40 30 20 10 152 | Nutrition o
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Table 12.2 shows the percentages of
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100 Percent 90 80 70 60 50 40 30 20
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Table 12.5 Foods and liquids consum
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Table 12.6 Infant and young child f
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Table 12.7 shows the percentage of
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the most recent distribution preced
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Table 12.10 Nutritional status of w
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Table 12.12 shows data on micronutr
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12.12 PREVALENCE OF ANEMIA IN WOMEN
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MALARIA 13 Malaria remains a leadin
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13.1.2 Use of Mosquito Nets by Chil
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Tables 13.3 and 13.4 show the perce
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The highest prevalence of fever is
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HIV/AIDS-RELATED KNOWLEDGE, ATTITUD
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percent of women and 61 percent of
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person who has AIDS or by sharing c
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Comprehensive knowledge about AIDS
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HIV or AIDS on all four indicators
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Table 14.6 Payment for sexual inter
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14.5 MALE CIRCUMCISION Male circumc
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In the 2009-10 TLDHS, women and men
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100 Percent 80 60 40 20 0 64 Total
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14.8.2 Age at First Sex and Condom
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To assess the extent of condom use
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WOMEN’S EMPOWERMENT AND DEMOGRAPH
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Table 15.2.1 Control over women’s
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Table 15.2.2 Control over men's cas
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Table 15.4.1 Women’s participatio
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Table 15.5.1 Women’s participatio
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15.5 ATTITUDES TOWARD WIFE BEATING
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Table 15.6.2 Attitude toward wife b
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Table 15.7.1 Attitude toward refusi
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Women’s empowerment is closely as
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Table 15.8 Indicators of women’s
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pathways: its negative association
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DOMESTIC VIOLENCE 16 In the words o
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partner] hit, slapped, kicked, or d
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Table 16.1 Experience of physical v
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Among women who have never been mar
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who experienced sexual violence fir
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Domestic violence is not limited to
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Table 16.8 Forms of spousal violenc
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Table 16.9—Continued Emotional vi
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Table 16.10 Spousal violence by hus
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16.14 Physical Violence by Women ag
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16.15 HELP-SEEKING BEHAVIOR OF WOME
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16.17 SOCIAL NORMS AND VALUES The f
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REFERENCES Acharya, M. 2010. Effort
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Ministry of Health (MOH) [Timor-Les
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World Health Organization (WHO), Wo
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256 | Appendix A during the populat
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A.5 SURVEY RESULTS 258 | Appendix A
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ESTIMATES OF SAMPLING ERRORS Append
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Table B.1 List of selected variable
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Table B.3 Sampling errors for Urban
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Table B.5 Sampling errors for Aileu
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Table B.7 Sampling errors for Bauca
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Table B.9 Sampling errors for Coval
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Table B.11 Sampling errors for Erme
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Table B.13 Sampling errors for Liqu
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Table B.15 Sampling errors for Manu
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Table B.17 Sampling errors for Viqu
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282 | Appendix C Table C.2.1 Age di
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284 | Appendix C Table C.5 Reportin
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286 | Appendix C Table C.7 Nutritio
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PERSONS INVOLVED IN THE 2009-10 TIM
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Martinho da Costa Cesaltina Falcao
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QUESTIONNAIRES Appendix E Appendix
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296 | Appendix E Introduction and C
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IF AGE 15 IF AGE 0-17 YEARS IF AGE
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300 | Appendix E HOUSEHOLD CHARACTE
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302 | Appendix E NO. QUESTIONS AND
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306 | Appendix E WEIGHT, HEIGHT AND
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308 | Appendix E WEIGHT, HEIGHT, AN
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310 | Appendix E
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312 | Appendix E INTRODUCTION AND C
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314 | Appendix E SECTION 2. REPRODU
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212 316 | Appendix E 213 214 215 21
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326 | Appendix E LAST BIRTH NEXT-TO
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350 | Appendix E LAST SEXUAL PARTNE
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352 | Appendix E SECTION 7. FERTILI
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356 | Appendix E SECTION 8. HUSBAND
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362 | Appendix E SECTION 10. OTHER
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364 | Appendix E SECTION 11. MATERN
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366 | Appendix E SECTION 12. DOMEST
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372 | Appendix E INSTRUCTIONS: 2 04
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374 | Appendix E INTRODUCTION AND C
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376 | Appendix E SECTION 2. REPRODU
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378 | Appendix E SECTION 3. CONTRAC
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380 | Appendix E 311 Where is that?
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386 | Appendix E SECTION 5. FERTILI
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388 | Appendix E SECTION 6. EMPLOYM
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390 | Appendix E SECTION 7. HIV/AID
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