Armenia 2000. - BVSDE

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Armenia 2000. - BVSDE

TABLE OF CONTENTSForewordIntroductionIIIIPart I. Basic Tables 1A. Total Population 3B. Female and Male Populations 9C. Rural and Urban Populations 13Part II. Technical Notes 19A. Indicator Definitions 21B. Data and Methods 35C. Discussion 39Part III. Supporting Tables 45A. Sample Sizes 47B. Standard Errors 53C. Asset Distribution and Weights 59Part IV. Annexes 61A. Sources of Additional Information 63B. Use of Information from this 65Report to Monitor the EconomicStatus of People Served by HNPProgramsC. Countries Covered by the 71HNP-Poverty Report Project


FOREWORDThe World Bank shares the desire of its member states and client countries to ensure that the poorpartake fully in the health gains that the countries achieve. To assist in this, the Bank, incooperation with the Dutch and Swedish Governments, has sponsored the set of reports providingbasic 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 areunacceptably large. As countries and the Bank work to reduce important inequalities amongregions and countries, there is a clear need for equally vigorous efforts to lessen the inequityrepresented by intra-country differences among socio-economic groups.My colleagues and I hope that all concerned with equity in health will find this information usefulin making the case for effective actions to improve the health of the poor, and in designingprograms to achieve this crucial objective.Joy PhumaphiVice PresidentHuman Development NetworkThe World Bank- I -


INTRODUCTIONThis report is one in a series that provides basic information about health, nutrition, andpopulation (hnp) inequalities within fifty-six developing countries.The series to which the report belongs is an expanded and updated version of a set covering fortyfivecountries that was published in 2000. The fifty-six reports in the current series cover almostall DHS surveys undertaken during the period beginning in 1990 and ending with the date of thelast survey for which data were publicly available as of June 2006. 1The report’s contents are intended to facilitate preparation of country analyses and thedevelopment of activities to benefit poor people. To this end, the report presents data about hnpstatus, service use, and related matters among individuals belonging to different socio-economicclasses. The principal focus is on differences among groups of individuals defined in terms of thewealth or assets of the households where they reside. The source of data is the Demographic andHealth 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 abouthousehold wealth or assets included in the DHS questionnaire, which were similar for all thesurveys 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 theybelonged. The individuals were then divided into quintiles, and the mean value for each of up toapproximately 120 indicators was calculated for each quintile.The report is organized in four principal parts:• Part one, which constitutes the report’s core, consists of tables presenting quintilespecificdata for each hnp indicator covered from the two most recent DHS surveys available atthe time of the report’s publication. In each part there are three sets of tables: the first providesquintile-specific information for the total population; the second presents data separately forquintiles of females and males; the third features quintile-specific information presentedseparately for rural and urban residents. Each of these sets is divided into four sections: onedealing with hnp status, the second with the use of hnp services, the third with hnp-relatedbehavior, and the fourth with other hnp status determinants.• Part two provides supplementary technical information designed to help readersunderstand the data presented in part one. This information deals with such issues as how thecovered hnp indicators were defined and how the quintile-specific estimates were derived.• Part three presents supporting tables that deal with three of the technical matterscovered in part two: the size of the sample for each indicator covered; the standard error for each1 The average interval of approximately two years between data collection and availability means that the latest surveyscovered were conducted in 2005.- III -


quintile-specific estimate in the total population; and the items used in constructing the wealthindex, along with the weight assigned to each.An additional, fourth part consists of three annexes, for readers interested in applying theapproach used in the report or in learning more about the other reports in this series. The firstannex is an annotated bibliography containing further information about the technical issuesconcerning the approach used in the report, and about employing that approach to examineadditional issues using DHS or other data sets. The second shows how the report’s approach canbe applied to monitor the distribution of benefits from other hnp programs, and provides a tool fordoing so. The third annex is a list of all fifty-six countries for which reports are available, alongwith 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 madeproduction of this report possible.- IV -


PART I. BASIC TABLESA. TOTAL POPULATIONB. FEMALE AND MALE POPULATIONSC. RURAL AND URBAN POPULATIONSNotes:– Each of the three sections referred to above consists offour divisions, presenting data for: I) hnp status; II) hnpservice use; III) hnp-related individual and householdbehavior; and IV) other, underlying determinants of hnpstatus.– Full definitions of all indicators covered in the tablesare provided in section A of the technical notes found inpart II.– “na” appears in the table cells when data are notavailable, usually because the DHS survey concerneddid not collect information about the indicator(s) inquestion.– Figures in the tables shown within parenthesesindicate the absence of adequate observations to produceacceptably reliable values. Asterisks appear when thenumber of observations was too small to justify thepresentation even of figures within parentheses. (Forfurther information, see the section on “SamplingErrors” in the presentation of data and methods in partII.B.) Asterisks also will be found in columns showingstatistical indices of inequality when the amount ofquintile-specific information available is inadequate topermit computation of the value for the index concerned.– Female/male tables include only indicators relevantfor both sexes; those pertaining to only one sex (e.g.,fertility, women’s nutritional status, antenatal care,attended deliveries) have been omitted.


Armenia2000 - TOTAL POPULATIONPart I: HNP STATUSIndicatorWealth QuintilesLow/High Low-HighRatio Diff.Low 2nd 3rd 4th High Avg. (Abs. Val.)Concentration IndexValue StandardErrorsA. Childhood illness and mortalityInfant mortality rate 52.3 50.0 36.8 49.6 27.3 44.1 1.92 25.00 -0.0906 0.0025Under-five mortality rate 60.9 53.5 40.1 49.6 29.6 48.0 2.06 31.30 -0.1121 0.0023Prevalence of fever 15.8 14.9 15.5 22.9 14.0 16.5 1.13 1.80 0.0343 0.0324Prevalence of diarrhea 9.1 6.7 8.8 7.7 7.0 7.8 1.30 2.10 -0.0128 0.0512Prevalence of acute respiratory infection 10.2 11.2 10.4 14.6 11.0 11.4 0.93 0.80 0.0218 0.0419B. FertilityTotal fertility rate 2.5 1.8 1.4 1.5 1.6 1.7 1.56 0.90 -0.0918 0.0009Adolescent fertility rate 107.0 61.0 27.0 35.0 32.0 50.0 3.34 75.00 -0.2562 0.0034C. Nutritional status (%)Children:Moderate stunting 15.7 11.2 10.1 6.2 7.9 10.5 1.99 7.80 -0.1652 0.0445Severe stunting 3.3 4.3 1.8 1.2 1.4 2.5 2.36 1.90 -0.1430 0.0850Moderate underweight 2.9 2.6 4.1 1.2 1.1 2.4 2.64 1.80 -0.1308 0.0861Severe underweight 0.5 0.1 0.0 0.0 0.4 0.2 1.25 0.10 -0.2853 0.4343Mild anemia 19.8 15.7 12.1 12.1 8.7 14.0 2.28 11.10 -0.1381 0.0379Moderate anemia 17.0 12.2 6.6 2.5 7.0 9.6 2.43 10.00 -0.2294 0.0471Severe anemia 0.8 0.2 0.8 0.0 0.2 0.4 4.00 0.60 -0.1844 0.3021Women:Malnutrition 2.5 3.1 3.6 4.2 3.9 3.5 0.64 1.40 0.0728 0.0393Mild anemia 14.4 12.7 11.2 7.9 6.1 10.2 2.36 8.30 -0.1242 0.0212Moderate anemia 2.4 2.9 1.6 1.9 1.4 2.0 1.71 1.00 -0.0954 0.0533Severe anemia 0.3 0.4 0.0 0.3 0.2 0.3 1.50 0.10 -0.1392 0.1611D. Female circumcision (%)Prevalence of circumcision:Girls na na na na na na na na na naWomen na na na na na na na na na naPrevalence of occlusion:Girls * * * * * * * * * *Women * * * * * * * * * *E. Sexually transmitted diseasePrevalence of genital discharge:Women 28.1 25.0 21.2 22.0 17.5 22.6 1.61 10.60 -0.0767 0.0158Men 0.9 0.4 0.0 0.4 0.5 0.4 1.80 0.40 -0.1219 0.3035Prevalence of genital ulcer:Women 9.5 10.3 7.6 9.2 7.5 8.8 1.27 2.00 -0.0346 0.0281Men na na na na na na na na na na- 3 -


Armenia2000 - TOTAL POPULATIONPart II: Intermediate Determinants of HNP Status - HNP SERVICE USEIndicatorWealth QuintilesLow/High Low-HighRatio Diff.Low 2nd 3rd 4th High Avg. (Abs. Val.)Concentration IndexValue StandardErrorsA. Childhood immunizationBCG coverage 89.6 90.9 89.4 95.1 (88.1) 90.6 1.02 177.70 -0.0026 0.0110Measles coverage 67.8 72.5 78.4 81.3 (74.1) 74.3 0.91 141.90 0.0291 0.0204DPT coverage 89.3 93.0 86.9 95.5 (83.5) 89.7 1.07 172.80 -0.0069 0.0120Full basic coverage 66.2 70.6 72.8 81.3 (68.0) 71.4 0.97 134.20 0.0224 0.0219No basic coverage 7.3 1.4 6.1 4.5 (9.0) 5.7 0.81 16.30 0.0861 0.1581Hepatitis B coverage 7.5 3.7 0.0 4.9 (2.4) 4.0 3.13 9.90 -0.1603 0.1393Yellow fever coverage na na na na na na na na na naB. Treatment of childhood illnessesTreatment of fever: 16.9 20.3 (32.5) 26.6 (36.4) 25.7 0.46 53.30 0.1046 0.0628Medical treatment of fever 15.2 20.3 (29.8) 22.4 (36.4) 23.9 0.42 51.60 0.0949 0.0685Treatment in a public facility 0.0 0.0 (2.7) 4.1 0.0 1.5 na 0.00 0.0598 0.2266Treatment in a private facilityTreatment of acute respiratory infection:Medical treatment of ARI (20.2) (27.7) (30.5) (35.1) (16.4) 26.2 1.23 3.80 0.0210 0.0698Treatment in a public facility (20.2) (27.7) (26.5) (31.8) (16.4) 24.9 1.23 3.80 0.0083 0.0702Treatment in a private facility 0.0 0.0 (4.0) (3.2) 0.0 1.4 na 0.00 0.2532 0.2320Treatment of diarrhea:Use of oral rehydration therapy (38.1) (69.2) * * * 59.7 * * * *Medical treatment of diarrhea (19.1) (47.1) * * * 26.5 * * * *Treatment in a public facility (19.1) (47.1) * * * 26.5 * * * *Treatment in a private facility na na na na na na na na na naC. Antenatal and delivery careAntenatal care visits:To a medically-trained person 84.6 90.3 95.4 96.6 96.8 92.4 0.87 12.20 0.0324 0.0051To a doctor 65.8 80.4 89.6 92.3 94.0 83.8 0.70 28.20 0.0700 0.0075To a nurse or trained midwife 18.8 9.9 5.8 4.3 2.8 8.6 6.71 16.00 -0.3284 0.0524Multiple visits to a medically-trained person 46.8 67.1 83.6 84.2 91.1 73.6 0.51 44.30 0.1227 0.0096Antenatal care content:Tetanus toxoid na na na na na na na na na naProphylactic antimalarial treatment na na na na na na na na na naIron supplementation 11.6 19.9 22.2 21.8 21.4 19.2 0.54 9.80 0.1315 0.0341Delivery attendance:By a medically-trained person 93.3 94.2 99.4 98.8 100.0 96.8 0.93 6.70 0.0163 0.0027By a doctor 69.9 76.6 85.3 92.8 95.5 83.0 0.73 25.60 0.0644 0.0063By a nurse or trained midwife 23.5 17.6 14.0 6.0 4.5 13.8 5.22 19.00 -0.2733 0.0349In a public facility 81.5 84.1 97.5 98.4 99.8 91.3 0.82 18.30 0.0450 0.0045In a private facility na na na na na na na na na naAt home 18.5 15.8 1.9 1.2 0.2 8.5 92.50 18.30 -0.4925 0.0482- 4 -


Armenia2000 - TOTAL POPULATIONPart II: Intermediate Determinants of HNP Status - HNP SERVICE USE (Cont.)Indicator Wealth Quintiles Low/High Low-High Concentration IndexRatio Diff. Value StandardLow 2nd 3rd 4th High Avg. (Abs. Val.)ErrorsD. Contraceptive servicesContraceptive prevalence:Women 15.5 20.9 22.4 22.3 29.2 22.3 0.53 13.70 0.0943 0.0159Men na na na na na na na na na naSource of contraception - public sector:Women 81.2 89.8 82.5 81.2 77.8 82.1 1.04 3.40 -0.0141 0.0094Men na na na na na na na na na naSource of contraception - private sector:Women 14.7 5.3 7.7 8.1 10.6 9.1 1.39 4.10 -0.0207 0.0639Men na na na na na na na na na naE. Treatment of adult illnessesTreatment of genital discharge, ulcer,sore:Women 32.6 45.6 39.0 41.7 51.8 42.1 0.63 19.20 0.0637 0.0195Men * * * * * * * * * *Treatment of genital discharge, ulcer,sore in public facilities:Women na na na na na na na na -0.0767 0.0158Men * * * * * * * * * *Voluntary counseling and testing forHIV/AIDS:Women 3.9 4.6 6.5 7.7 9.1 6.5 0.43 5.20 0.1553 0.0278Men 4.5 3.5 2.6 5.6 2.9 3.8 1.55 1.60 0.0272 0.0643- 5 -


Armenia2000 - TOTAL POPULATIONPart III: Intermediate Determinants of HNP Status - INDIVIDUAL AND HOUSEHOLD BEHAVIORIndicatorWealth QuintilesLow/High Low-HighRatio Diff.Low 2nd 3rd 4th High Avg. (Abs. Val.)Concentration IndexValue StandardErrorsA. Hygienic practicesDisposal of children's stools:Sanitary disposal 77.0 73.6 86.4 91.3 87.5 82.7 0.88 10.50 0.0360 0.0075Handwashing:Wash hands prior to preparing food 97.4 95.6 93.9 94.2 95.2 95.2 1.02 2.20 -0.0039 0.0014Handwashing facilities in household 11.4 34.1 70.2 89.5 96.7 61.7 0.12 85.30 0.3102 0.0038B. Bednet ownership and useBednet ownership:Bednet ownership na na na na na na na na na naTreated bednet ownership na na na na na na na na na naBednet use:By children na na na na na na na na na naBy pregnant women na na na na na na na na na naC. BreastfeedingExclusive breastfeeding * * * * * 44.0 * * * *Timely complementary feeding (20.4) (61.2) * * * 42.7 * * * *Bottle-feeding 53.8 38.4 31.6 (41.1) (51.1) 43.7 1.05 104.90 -0.0268 0.0386D. Micronutrient consumptionIodized salt:Availability of iodized saltin household 74.8 83.4 82.2 88.2 91.6 84.2 0.82 16.80 0.0384 0.0033Vitamin A:Children na na na na na na na na na naWomen na na na na na na na na na naE. Tobacco and alcohol useTobacco:Women 0.4 0.8 1.2 3.4 8.2 3.1 0.05 7.80 0.4277 0.0433Men 69.2 67.3 68.3 68.5 64.8 67.5 1.07 4.40 -0.0092 0.0098Alcohol:Women na na na na na na na na na naMen 10.7 6.3 6.5 8.6 4.7 7.2 2.28 6.00 -0.1196 0.0498F. Sexual practicesNon-regular sexual partnerships:Women 0.1 0.1 0.2 0.0 0.0 0.1 na 0.10 -0.3682 0.2404Men 8.1 9.7 14.2 13.2 15.4 12.4 0.53 7.30 0.1099 0.0359Condom usage with non-regularpartner:Women * * * * * * * * * *Men 37.1 36.7 55.0 66.3 73.0 57.6 0.51 35.90 0.1199 0.0328G. Domestic violenceEver experienced violence na na na na na na na na na naExperienced violence in past year na na na na na na na na na na- 6 -


Armenia2000 - TOTAL POPULATIONPart IV: UNDERLYING DETERMINANTS OF HNP STATUSIndicatorWealth QuintilesLow/High Low-HighRatio Diff.Low 2nd 3rd 4th High Avg. (Abs. Val.)Concentration IndexValue StandardErrorsA. EducationSchool completion:Women 98.7 99.4 99.8 99.6 99.8 99.5 0.99 1.10 0.0017 0.0005Men 98.5 99.4 99.2 99.2 99.7 99.2 0.99 1.20 0.0025 0.0007School participation:Girls 82.7 84.3 84.2 87.9 87.0 84.9 0.95 4.30 0.0081 0.0071Boys 82.6 82.3 82.9 82.9 81.8 82.5 1.01 0.80 0.0030 0.0079B. Exposure to mass mediaNewspaper readership:Women 11.3 20.9 30.4 32.8 44.3 29.0 0.26 33.00 0.2194 0.0107Men 11.7 20.5 26.6 39.2 42.7 29.0 0.27 31.00 0.2253 0.0197Radio listenership:Women 12.6 21.3 32.0 38.2 51.0 32.3 0.25 38.40 0.2392 0.0106Men 14.3 26.2 37.9 44.3 54.2 36.6 0.26 39.90 0.2126 0.0171Television viewership:Women 76.0 87.3 88.7 91.4 95.3 88.4 0.80 19.30 0.0382 0.0033Men 85.7 90.7 93.7 95.7 97.6 93.0 0.88 11.90 0.0311 0.0045C. Knowledge and attitudes aboutHIV/AIDSKnowledge about sexual transmissionof HIV/AIDS:Women 41.6 49.3 59.5 67.1 72.5 59.1 0.57 30.90 0.1180 0.0062Men 51.1 64.5 77.2 76.3 85.3 71.9 0.60 34.20 0.0942 0.0088Knowledge about mother-to-childtransmission of HIV/AIDS:Women 72.7 72.3 73.2 77.5 82.4 74.4 0.88 9.70 0.0451 0.0042Men 74.9 70.3 79.4 87.1 85.7 77.9 0.87 10.80 0.0550 0.0076Attitudes toward HIV/AIDS:Women 87.6 89.1 86.2 82.9 79.8 85.3 1.10 7.80 -0.0251 0.0030Men 80.2 80.5 79.9 80.8 80.1 80.9 1.00 0.10 -0.0138 0.0065D. Status of womenHousehold decisionmaking:Can seek own health care 26.0 27.9 34.0 37.3 41.7 33.9 0.62 15.70 0.0909 0.0099Can seek children's health care 84.2 84.4 84.7 89.4 89.8 86.4 0.94 5.60 0.0137 0.0065Can make daily household purchases 55.7 54.8 58.9 58.4 60.5 57.9 0.92 4.80 0.0242 0.0063Can make large household purchases 49.0 48.0 55.0 51.5 58.4 52.7 0.84 9.40 0.0387 0.0069Can make meal-related decisions 58.3 53.5 55.3 54.4 52.2 54.6 1.12 6.10 -0.0192 0.0067Other decisionmaking, attitudes:Can decide how to spend own money 36.8 45.3 50.2 54.0 52.8 50.2 0.70 16.00 0.0441 0.0160Can decide whether to have sex 89.0 88.5 91.1 91.9 94.5 91.2 0.94 5.50 0.0184 0.0022Justifies domestic violence 56.8 43.4 29.6 23.7 15.2 32.3 3.74 41.60 -0.2537 0.0101E. OrphanhoodPaternal orphan prevalence 3.5 3.3 3.0 3.6 3.2 3.3 1.09 0.30 -0.0200 0.0399Maternal orphan prevalence 0.1 0.7 1.1 0.8 0.6 0.6 0.17 0.50 0.1891 0.0747Double orphan prevalence 0.0 0.2 0.2 0.0 0.1 0.1 0.00 0.10 0.0301 0.1493- 7 -


Armenia2000 - FEMALE / MALE POPULATIONSPart I: HNP STATUSIndicatorWealth Quintiles - FemaleWealth Quintiles - MaleLow 2nd 3rd 4th High Avg. Low 2nd 3rd 4th High Avg.A. Childhood mortality and morbidityInfant mortality rate (61.6) (47.7) (25.4) (42.9) (22.6) 41.9 43.8 52.0 (46.7) (55.4) (31.0) 46.1Under-five mortality rate 68.5 51.5 (27.6) (42.9) (22.6) 44.9 54.2 55.2 (50.9) (55.4) (35.2) 50.7Prevalence of fever 12.3 14.2 18.2 21.1 21.4 17.0 18.4 15.5 13.5 24.3 8.9 16.0Prevalence of diarrhea 7.0 5.5 12.4 4.8 5.4 6.8 10.6 7.6 6.1 10.0 8.1 8.6Prevalence of acute 12.0 6.8 10.0 15.8 15.5 11.8 8.9 14.7 10.7 13.7 7.9 11.2respiratory infectionB. Nutritional statusChildren:Moderate stunting 17.4 11.2 11.6 8.7 9.9 12.0 14.4 11.1 9.0 4.2 6.6 9.3Severe stunting 2.7 4.0 2.5 0.0 0.0 2.0 3.8 4.6 1.3 2.1 2.3 3.0Moderate underweight 2.6 4.2 2.9 1.4 1.2 2.6 3.1 1.4 5.0 1.1 1.0 2.2Severe underweight 0.8 0.2 0.0 0.0 0.0 0.2 0.3 0.0 0.0 0.0 0.7 0.2Mild anemia 17.5 11.4 10.4 9.3 12.1 12.4 21.7 18.9 13.4 14.4 6.4 15.2Moderate anemia 17.6 10.9 4.2 5.7 6.6 9.6 16.5 13.2 8.5 0.0 7.2 9.6Severe anemia 0.4 0.4 0.0 0.0 0.0 0.2 1.0 0.0 1.4 0.0 0.3 0.5C. Sexually transmitted diseasePrevalence of genital discharge:Women 28.1 25.0 21.2 22.0 17.5 22.6Men 0.9 0.4 0.0 0.4 0.5 0.4Prevalence of genital ulcer:Women 9.5 10.3 7.6 9.2 7.5 8.8Men na na na na na na- 9 -


Armenia2000 - FEMALE / MALE POPULATIONSPart II: Intermediate Determinants of HNP Status - HNP SERVICE USEIndicatorWealth Quintiles - FemaleWealth Quintiles - MaleLow 2nd 3rd 4th High Avg. Low 2nd 3rd 4th High Avg.A. Childhood immunizationMeasles coverage (76.4) * * * * 79.1 61.8 (71.2) (78.5) (79.1) (67.4) 71.0DPT coverage (89.3) * * * * 89.3 89.3 (93.6) (87.0) (96.0) (81.7) 90.0Full basic coverage (74.5) * * * * 76.5 60.4 (71.2) (68.8) (79.1) (60.0) 67.9No basic coverage (7.0) * * * * 6.6 7.5 (1.4) (4.6) (4.0) (8.2) 5.0Hepatitis B coverage 0.0 * * * * 1.1 12.7 (5.5) 0.0 (8.0) 0.0 5.9Yellow fever coverage na na na na na na na na na na na naB. Treatment of childhood illnessesTreatment of fever:Medical treatment of fever * (26.2) * * * 34.0 (12.2) (16.1) * (19.4) * 19.1Treatment in a public facility * (26.2) * * * 31.0 (12.2) (16.1) * (15.9) * 18.2Treatment in a private facility * 0.0 * * * 2.1 0.0 0.0 * (3.5) * 0.9Treatment of acute respiratoryinfection (ARI):Medical treatment of ARI * * * * * 28.8 * (26.5) * * * 24.2Treatment in a public facility * * * * * 25.7 * (26.5) * * * 24.2Treatment in a private facility * * * * * 3.1 na na na na na naTreatment of diarrhea:Use of oral rehydration therapy * * * * * (65.2) (30.2) * * * * 56.4Medical treatment of diarrhea * * * * * (30.6) (22.3) * * * * 24.1Treatment in a public facility * * * * * (30.6) (22.3) * * * * 24.1Treatment in a private facility na na na na na na na na na na na naC. Contraceptive servicesContraceptive prevalence:Women 15.5 20.9 22.4 22.3 29.2 22.3Men na na na na na naSource of contraception - public sector:Women 81.2 89.8 82.5 81.2 77.8 82.1Men na na na na na naSource of contraception - private sector:Women 14.7 5.3 7.7 8.1 10.6 9.1Men na na na na na naD. Treatment of adult illnessesTreatment of genital discharge, ulcer,sore:Women 32.6 45.6 39.0 41.7 51.8 42.1Men * * 0.0 * * *Treatment of genital discharge, ulcer,sore in public medical facilities:Women na na na na na naMen na na na na na naVoluntary counseling and testingfor HIV/AIDS:Women 3.9 4.6 6.5 7.7 9.1 6.5Men 4.5 3.5 2.6 5.6 2.9 3.8- 10 -


Armenia2000 - FEMALE / MALE POPULATIONSPart III: Intermediate Determinants of HNP Status - INDIVIDUAL AND HOUSEHOLD BEHAVIORIndicatorWealth Quintiles - FemaleWealth Quintiles - MaleLow 2nd 3rd 4th High Avg. Low 2nd 3rd 4th High Avg.A. Hygenic practicesSanitary disposal 77.0 73.6 86.4 91.3 87.5 82.7Handwashing:Wash hands prior to preparing food 97.4 95.6 93.9 94.2 95.2 95.2Handwashing facilities in household 11.4 34.1 70.2 89.5 96.7 61.7B. Bednet ownership and useBednet use:By children na na na na na naC. BreastfeedingExclusive breastfeeding * * * * * (48.9) * * * * * 40.1Timely complementary feeding * * * * * (50.3) * * * * * 36.8Bottle-feeding (52.6) (41.9) * * * 44.5 54.7 (34.6) (29.4) (39.8) (51.9) 43.1D. Micronutrient consumptionVitamin A:Children na na na na na na na na na na na naE. Tobacco and alcohol useTobacco:Women 0.4 0.8 1.2 3.4 8.2 3.1Men 69.2 67.3 68.3 68.5 64.8 67.5Alcohol:Women na na na na na naMen 10.7 6.3 6.5 8.6 4.7 7.2F. Sexual practicesNon-regular sexual partnerships:Women 0.1 0.1 0.2 0.0 0.0 0.1Men 8.1 9.7 14.2 13.2 15.4 12.4Condom usage with non-regularpartner:Women * * * 0.0 0.0 *Men 37.1 36.7 55.0 66.3 73.0 57.6- 11 -


Armenia2000 - FEMALE / MALE POPULATIONSPart IV: UNDERLYING DETERMINANTS OF HNP STATUSIndicatorWealth Quintiles - FemaleWealth Quintiles - MaleLow 2nd 3rd 4th High Avg. Low 2nd 3rd 4th High Avg.A. EducationWomen 98.7 99.4 99.8 99.6 99.8 99.5Men 98.5 99.4 99.2 99.2 99.7 99.2School participation:Girls 82.7 84.3 84.2 87.9 87.0 84.9Boys 82.6 82.3 82.9 82.9 81.8 82.5B. Exposure to mass mediaNewspaper readership:Women 11.3 20.9 30.4 32.8 44.3 29.0Men 11.7 20.5 26.6 39.2 42.7 29.0Radio listenership:Women 12.6 21.3 32.0 38.2 51.0 32.3Men 14.3 26.2 37.9 44.3 54.2 36.6Television viewership:Women 76.0 87.3 88.7 91.4 95.3 88.4Men 85.7 90.7 93.7 95.7 97.6 93.0C. Knowledge and attitudes aboutHIV/AIDSKnowledge about sexualtransmission of HIV/AIDS:Women 41.6 49.3 59.5 67.1 72.5 59.1Men 51.1 64.5 77.2 76.3 85.3 71.9Knowledge about mother-to-childtransmission of HIV/AIDS:Women 72.7 72.3 73.2 77.5 82.4 74.4Men 74.9 70.3 79.4 87.1 85.7 77.9Attitudes toward HIV/AIDS:Women 87.6 89.1 86.2 82.9 79.8 85.3Men 80.2 80.5 79.9 80.8 80.1 80.9D. OrphanhoodPaternal orphan prevalence 3.7 3.2 2.7 3.9 3.7 3.5 3.2 3.4 3.3 3.3 2.8 3.2Maternal orphan prevalence 0.1 0.5 0.8 1.2 1.3 0.7 0.1 0.8 1.3 0.4 0.1 0.6Double orphan prevalence 0.0 0.2 0.0 0.0 0.3 0.1 0.0 0.2 0.4 0.0 0.0 0.1- 12 -


Armenia2000 - RURAL / URBAN POPULATIONSPart I: HNP STATUSIndicatorWealth Quintiles - RuralWealth Quintiles - UrbanLow 2nd 3rd 4th High Avg. Low 2nd 3rd 4th High Avg.A. Childhood illness and mortalityInfant mortality rate 52.1 51.5 * * * 52.7 * * (23.8) 49.4 28.4 35.9Under-five mortality rate 61.3 55.9 (72.1) * * 59.2 * * 26.1 49.4 30.8 37.3Prevalence of fever 15.9 13.5 9.3 (22.3) * 14.2 * 20.6 18.4 22.9 14.8 18.6Prevalence of diarrhea 9.2 5.9 7.6 (11.2) * 7.8 * 9.8 9.3 7.3 7.0 7.8Prevalence of acute 10.7 12.6 9.2 (15.7) * 11.4 * 5.3 11.0 14.5 11.2 11.5respiratory infectionB. FertilityTotal fertility rate 2.6 1.8 * * * 2.1 * * (1.2) 1.5 1.5 1.5Adolescent fertility rate 107.0 54.0 * * * 75.0 * * (18.0) 33.0 28.0 33.0C. Nutritional statusChildren:Moderate stunting 15.4 12.2 7.7 (2.9) * 12.5 * 6.9 11.2 6.5 8.3 8.5Severe stunting 3.4 4.6 2.3 0.0 * 3.6 * 3.3 1.6 1.3 1.5 1.6Moderate underweight 2.5 2.4 4.5 (0.9) * 2.5 * 3.8 3.9 1.3 1.1 2.2Severe underweight 0.5 0.1 0.0 0.0 * 0.3 * 0.0 0.0 0.0 0.4 0.2Mild anemia 19.6 16.9 14.7 (13.8) * 17.5 * 10.2 11.0 12.0 8.8 10.6Moderate anemia 17.3 12.5 16.1 (11.9) * 14.6 * 10.7 2.7 1.4 7.4 4.8Severe anemia 0.8 0.2 1.8 0.0 * 0.6 * 0.0 0.4 0.0 0.2 0.2Women:Malnutrition 2.5 2.9 2.8 2.0 (0.7) 2.6 2.8 4.0 3.9 4.4 4.0 4.1Mild anemia 14.7 13.5 13.8 8.1 (3.4) 13.6 10.8 10.3 10.2 7.8 6.2 8.1Moderate anemia 2.5 3.1 1.9 0.5 (5.8) 2.6 0.8 2.3 1.5 2.0 1.3 1.6Severe anemia 0.4 0.5 0.0 0.5 0.0 0.3 0.0 0.4 0.1 0.2 0.2 0.2D. Female circumcisionPrevalence of circumcision:Girls na na na na na na na na na na na naWomen na na na na na na na na na na na naPrevalence of occlusion:Girls * * * * * * * * * * * *Women * * * * * * * * * * * *E. Sexually transmitted diseasePrevalence of genital discharge:Women 28.7 27.1 20.7 30.0 (39.2) 27.2 20.3 17.7 21.4 21.0 16.8 19.4Men 0.9 0.0 0.0 0.0 * 0.4 * 1.7 0.0 0.4 0.6 0.4Prevalence of genital ulcer:Women 9.5 11.1 7.9 17.5 (19.6) 10.4 9.6 7.4 7.5 8.3 7.1 7.6Men na na na na na na na na na na na na- 13 -


Armenia2000 - RURAL / URBAN POPULATIONSPart II: Intermediate Determinants of HNP Status - HNP SERVICE USEIndicatorWealth Quintiles - RuralWealth Quintiles - UrbanLow 2nd 3rd 4th High Avg. Low 2nd 3rd 4th High Avg.A. Childhood immunizationBCG coverage 90.5 90.5 * * * 90.6 * * (89.4) (95.1) (87.8) 90.6Measles coverage 67.3 76.6 * * * 72.1 * * (76.1) (83.3) (73.6) 76.0DPT coverage 90.1 96.4 * * * 93.1 * * (84.9) (95.1) (83.2) 87.1Full basic coverage 65.6 74.1 * * * 69.1 * * (73.2) (83.3) (67.3) 73.2No basic coverage 6.3 1.8 * * * 4.0 * * (7.7) (4.9) (9.2) 7.0Hepatitis B coverage 6.3 5.0 * * * 5.1 * * 0.0 (5.3) (2.5) 3.1Yellow fever coverage na na na na na na na na na na na naB. Treatment of childhood diseasesTreatment of fever:Medical treatment of fever 17.6 (15.6) * * 0.0 19.0 * * (35.5) 24.1 (36.4) 30.6Treatment in a public facility 15.8 (15.6) * * 0.0 18.1 * * (32.2) 19.4 (36.4) 28.1Treatment in a private facility na na na na na na * * (3.3) 4.6 0.0 2.5Treatment of acute respiratoryinfection (ARI):Medical treatment of ARI (20.2) (29.0) * * * 24.5 0.0 * * (36.8) (17.0) 27.9Treatment in a public facility (20.2) (29.0) * * * 24.5 0.0 * * (33.1) (17.0) 25.3Treatment in a private facility na na na na na na 0.0 * * (3.7) 0.0 2.7Treatment of diarrhea:Use of oral rehydration therapy (39.3) * * * * 53.9 * * * * * 65.3Medical treatment of diarrhea (19.7) * * * * 27.0 * * * * * 26.1Treatment in a public facility (19.7) * * * * 27.0 * * * * * 26.1Treatment in a private facility na na na na na na na na na na na naC. Antenatal and delivery careAntenatal care visits:To a medically-trained person 84.5 90.7 94.6 (100.0) * 88.9 * 88.8 95.8 96.2 97.1 95.6To a doctor 65.5 79.2 84.2 (82.3) * 74.1 * 85.3 92.1 93.6 94.2 92.3To a nurse or trained midwife 19.0 11.5 10.4 (17.7) * 14.8 * 3.5 3.7 2.6 2.9 3.3Multiple visits to a medically-trained person 45.7 66.1 76.0 (75.2) * 59.2 * 71.2 87.1 85.4 91.2 86.3Antenatal care content:Tetanus toxoid na na na na na na na na na na na naProphylactic antimalarial treatment na na na na na na na na na na na naIron supplementation 11.6 17.7 26.2 (27.6) * 16.6 * 28.7 20.3 21.0 21.2 21.4Delivery attendance:By a medically-trained person 93.0 94.1 98.2 (100.0) * 94.5 * 94.5 100.0 98.6 100.0 99.1By a doctor 69.4 73.4 81.0 (89.9) * 73.7 * 89.7 87.6 93.2 95.2 92.1By a nurse or trained midwife 23.6 20.7 17.2 (10.1) * 20.8 * 4.8 12.4 5.4 4.8 7.0In a public facility 81.2 81.9 93.2 (96.7) * 83.9 * 93.1 99.7 98.6 99.8 98.5In a private facility na na na na na na * 0.0 0.3 0.0 0.0 0.1At home 18.8 18.0 5.6 (3.3) * 15.9 * 6.9 0.0 0.9 0.2 1.3D. Contraceptive servicesContraceptive prevalence:Women 14.5 20.6 26.7 18.2 (43.1) 19.2 28.9 22.3 20.5 22.8 28.8 24.5Men na na na na na na na na na na na na- 14 -


Armenia2000 - RURAL / URBAN POPULATIONSPart II: Intermediate Determinants of HNP Status - HNP SERVICE USE (Cont.)IndicatorWealth Quintiles - RuralWealth Quintiles - UrbanLow 2nd 3rd 4th High Avg. Low 2nd 3rd 4th High Avg.D. Contraceptive services (cont.)Source of contraception - public sector:Women 81.8 91.0 85.4 * * 86.7 * (85.2) 80.9 80.2 77.6 79.5Men na na na na na na na na na na na naSource of contraception - private sector:Women 13.5 4.5 9.7 * * 9.0 * (8.2) 6.6 8.2 10.2 9.1Men na na na na na na na na na na na naE. Treatment of adult illnessesTreatment of genital discharge, ulcer,sore:Women 33.7 48.0 41.1 (44.4) * 40.9 * (33.8) 38.2 41.2 52.6 43.1Men * 0.0 0.0 0.0 0.0 * 0.0 * 0.0 * * *Treatment of genital discharge, ulcer,sore in public medical facilities:Women na na na na na na na na na na na naMen * 0.0 0.0 0.0 0.0 * 0.0 0.0 0.0 * * *Voluntary counseling and testingfor HIV/AIDS:Women 3.8 4.1 5.9 7.7 (4.5) 4.4 5.3 6.2 6.7 7.7 9.2 7.9Men 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0- 15 -


Armenia2000 - RURAL / URBAN POPULATIONSPart III: Intermediate Determinants of HNP Status - INDIVIDUAL AND HOUSEHOLD BEHAVIORIndicatorWealth Quintiles - RuralWealth Quintiles - UrbanLow 2nd 3rd 4th High Avg. Low 2nd 3rd 4th High Avg.A. Hygienic practicesDisposal of children's stools:Sanitary disposal na na na na na na na na na na na naHandwashing:Wash hands prior to preparing food 97.6 95.7 95.7 96.3 (93.7) 96.5 95.0 95.5 93.1 94.0 95.2 94.4Handwashing facilities in household 11.6 34.5 69.8 82.7 (95.6) 31.7 9.3 32.9 70.3 90.1 96.7 81.0B. Bednet ownership and useBednet ownership:Bednet ownership na na na na na na na na na na na naTreated bednet ownership na na na na na na na na na na na naBednet use:By children na na na na na na na na na na na naBy pregnant women na na na na na na na na na na na naC. BreastfeedingExclusive breastfeeding * * * * 0.0 (43.3) * * * * * 44.5Timely complementary feeding (20.8) * * * * 40.6 * * * * * (45.9)Bottle-feeding 55.1 46.9 (33.6) * * 47.4 * * (29.5) (40.5) (53.4) 39.5D. Micronutrient consumptionIodized salt:Availability of iodized saltin household 75.1 85.2 85.7 90.8 (89.6) 81.0 71.7 77.7 80.9 88.0 91.6 86.3Vitamin A:Children na na na na na na na na na na na naWomen na na na na na na na na na na na naE. Tobacco and alcohol useTobacco:Women 0.4 0.6 1.0 0.9 0.0 0.6 0.0 1.3 1.3 3.6 8.4 4.6Men 69.1 63.6 56.1 (70.8) * 64.8 * 81.0 73.3 68.3 65.3 69.4Alcohol:Women na na na na na na na na na na na naMen 10.3 6.1 3.9 (11.8) * 7.5 * 7.2 7.6 8.3 4.9 7.0F. Sexual practicesNon-regular sexual partnerships:Women 0.1 0.1 0.0 0.0 0.0 0.1 na na na na na naMen 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0Condom usage with non-regularpartner:Women * * 0.0 0.0 0.0 * 0.0 0.0 * 0.0 0.0 *Men 30.1 37.2 12.2 (66.7) 0.0 32.4 * 35.3 66.1 66.2 73.0 67.4G. Domestic violenceEver experienced violence na na na na na na na na na na na naExperienced violence in past year na na na na na na na na na na na na- 16 -


Armenia2000 - RURAL / URBAN POPULATIONSPart IV: UNDERLYING DETERMINANTS OF HNP STATUSIndicatorWealth Quintiles - RuralWealth Quintiles - UrbanLow 2nd 3rd 4th High Avg. Low 2nd 3rd 4th High Avg.A. EducationSchool completion:Women 98.7 99.4 99.7 99.0 (100.0) 99.2 98.9 99.6 99.8 99.6 99.7 99.7Men 98.4 99.6 99.3 100.0 (100.0) 99.1 99.3 98.8 99.1 99.1 99.7 99.3School participation:Girls 81.4 84.0 82.5 * * 82.7 * 85.1 84.9 88.6 86.7 86.9Boys 82.0 79.6 78.8 * * 81.2 * 92.1 84.4 82.1 81.3 83.7B. Exposure to mass mediaNewspaper readership:Women 10.5 19.9 29.7 29.2 (20.8) 18.0 21.5 24.3 30.7 33.2 44.9 36.0Men 11.8 20.7 17.6 (18.7) * 16.3 * 19.5 30.3 41.0 44.6 37.7Radio listenership:Women 12.4 20.8 33.1 30.7 (44.3) 20.1 14.2 23.0 31.6 39.0 51.1 40.0Men 14.3 24.8 29.3 (1.7) * 20.0 * 31.5 41.4 48.2 56.3 47.8Television viewership:Women 75.8 88.2 92.0 94.1 (90.7) 84.2 77.5 84.3 87.4 91.1 95.4 91.0Men 86.0 90.3 96.2 (95.7) * 90.0 * 92.2 92.6 95.7 97.5 95.1C. Knowledge and attitudes aboutHIV/AIDSKnowledge about sexual transmissionof HIV/AIDS:Women 40.7 45.9 55.4 64.4 (54.2) 46.3 52.7 60.7 61.2 67.4 73.0 67.2Men 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0Knowledge about mother-to-childtransmission of HIV/AIDS:Women 62.4 71.5 73.3 82.6 (71.3) 68.7 75.4 74.8 73.1 77.0 82.7 78.0Men 64.4 71.5 81.2 (96.4) * 71.6 * 65.7 78.6 86.2 85.6 82.2Attitudes toward HIV/AIDS:Women 91.8 89.1 82.6 83.7 (90.4) 88.9 86.9 88.8 87.5 82.8 79.5 83.2Men 84.1 78.2 79.4 (96.0) * 81.2 * 89.8 80.1 79.4 80.6 80.7D. Status of womenHousehold decisionmaking:Can seek own health care 25.0 24.2 29.5 22.9 (30.2) 25.3 38.0 40.2 35.8 38.8 42.0 39.3Can seek children's health care 84.0 83.3 77.5 (94.8) * 83.8 * 88.4 87.9 88.8 89.4 88.8Can make daily household purchases 55.6 55.2 55.3 58.2 (58.8) 55.6 57.4 53.8 60.4 58.4 60.5 59.3Can make large household purchases 48.8 46.5 48.9 48.8 (43.5) 47.8 50.8 53.1 57.3 51.8 58.8 55.7Can make meal-related decisions 58.0 53.7 54.5 60.8 (44.8) 55.8 61.7 52.6 55.6 53.8 52.4 53.8Freedom of movement:Can travel to visit family, relatives 16.3 13.7 15.6 15.0 (13.7) 15.1 19.3 21.0 18.4 19.1 18.5 18.9Other decisionmaking, attitudes:Can decide how to spend own money 36.3 43.0 37.0 (41.2) * 39.1 * (51.5) 54.7 55.3 53.1 53.8Can decide whether to have sex 88.7 88.6 88.6 90.8 (90.4) 88.8 92.8 88.4 92.1 92.0 94.7 92.8Justifies domestic violence 58.4 46.6 34.2 30.9 (49.2) 48.8 36.6 32.8 27.8 23.0 14.3 22.0E. OrphanhoodPaternal orphan prevalence 3.4 2.2 1.3 7.8 (3.1) 2.9 3.6 7.7 3.8 3.2 3.2 3.8Maternal orphan prevalence 0.1 0.2 0.8 0.0 0.0 0.2 0.0 2.4 1.2 0.9 0.7 1.0Double orphan prevalence na na na na na na 0.0 0.8 0.3 0.0 0.1 0.2- 17 -


PART II. TECHNICAL NOTESA. INDICATOR DEFINITIONSB. DATA AND METHODSC. DISCUSSION


INDICATOR DEFINITIONSPart I: HNP STATUSA. CHILDHOOD MORTALITY AND ILLNESS 2Infant 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 livebirths, 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 orrapid breathing, in the two weeks before the survey.Prevalence of diarrhea: percent of children who had diarrhea in the two weeks before thesurvey.Prevalence of acute respiratory infection: percent of children who had a cough accompanied byrapid or difficult breathing in the two weeks before the survey.B. FERTILITYTotal fertility rate (TFR): average number of births a woman could expect to have during herlifetime if she followed the levels of fertility currently observed at every age. The TFR iscalculated 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 theaverage 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.2 Figures 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 bedetermined by consulting the full report on that country’s DHS, which may be found at:www.measuredhs.com/countries.)- 21 -


C. NUTRITIONAL STATUS3, 4, 5ChildrenModerate 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 –3standard 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 ofbetween –2 and –3 standard deviations of the median reference standard for their age (as definedin 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, theWorld 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 HealthOrganization criterion for severe anemia.Women 6, 7Malnutrition: percent of women aged 15-49 years with a Body Mass Index (BMI) of less than18.5, where BMI – commonly used to indicate adult nutritional status – is defined as weight inkilograms 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/dland 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 between7.0g/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, dependingupon the country. (The specific ages covered for in particular country may be determined by consulting the full reporton 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 HealthOrganization, the U.S. Centers for Disease Control, and the U.S. National Center for Health Statistics. Updatedstunting and underweight figures based on the recently-released, 2006 World Health Organization reference standardsare currently under preparation. When complete, they will be available at: www.worldbank.org/povertyandhealth/countrydata.5 The anemia figures for children living at an altitude above 1,000 meters have been adjusted to reflect the higher levelof hemoglobin required.6 In some countries, the BMI is presented for all women; in others, the figure is available only for mothers of childrenunder five years of age. The reference population for any given country can be determined by consulting the full reporton 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 beenadjusted to account for their higher hemoglobin requirements.- 22 -


D. FEMALE CIRCUMCISIONPrevalence of CircumcisionGirls: percent of women aged 15-49 years with one or more daughters, at least one of whom hadbeen circumcised.Women: percent of women aged 15-49 years who had been circumcised.Prevalence of OcclusionGirls: percent of women aged 15-49 years with one or more daughters, at least one of whom hadbeen 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 DISEASESPrevalence of Genital DischargeWomen: percent of women aged 15-49 years who had had abnormal genital discharge in thetwelve months before the survey.Men: percent of men aged 15-54 years who had had abnormal genital discharge in the twelvemonths before the survey.Prevalence of Genital Ulcer or SoreWomen: percent of women aged 15-49 years who had had a genital ulcer or sore in the twelvemonths before the survey.Men: percent of men aged 15-54 years who had had a genital ulcer or sore in the twelve monthsbefore the survey.- 23 -


Part II: INTERMEDIATE DETERMINANTS OF HNP STATUS – HEALTHSERVICE USEA. CHILDHOOD IMMUNIZATION 8BCG coverage: percent of children who had received a dose of BCG vaccine by the time of thesurvey.Measles coverage: percent of children who had received a dose of measles vaccine by the timeof the survey.DPT coverage: percent of children who had received three doses of DPT vaccine by the time ofthe survey.Full basic coverage: percent of children who had received a dose of BCG vaccine, measlesvaccine, and three doses of DPT and polio vaccines by the time of the survey, excluding poliovaccine given at birth.No basic coverage: percent of children who had received no vaccination against the six earlychildhooddiseases (TB, measles, polio, diphtheria, pertusis, and tetanus) by the time of thesurvey.Hepatitis B coverage: percent of children who had received three doses of hepatitis B vaccine bythe time of the survey.Yellow fever coverage: percent of children who had received a dose of yellow fever vaccine bythe time of the survey.B. TREATMENT OF CHILDHOOD ILLNESSES 9Treatment of FeverMedical treatment of fever: percent of children with fever, with or without cough or rapidbreathing, in the two weeks before the survey who had sought medical advice for fever from anyhealth facility or health provider, whether public or private.Treatment in a public facility: percent of children with fever, with or without cough or rapidbreathing, in the two weeks before the survey who had sought medical advice for fever from apublic-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 rapidbreathing, in the two weeks before the survey who had sought medical advice for fever from aprivate-sector health facility or provider (as defined in fn. 9).8 Childhood immunization figures refer to rates among children 12-23 months of age in all countries except those inLatin America and the Caribbean. There, the figures refer to rates among children 18-29 months of age. All figures arebased on information recorded on the child’s vaccination card; or, in cases where a card was not seen by theinterviewer, on the mother’s report.9 Figures 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 inprivate facilities cover treatment in private hospitals or clinics, in private doctors’ offices, or in facilities operated byother private medical providers (such as non-governmental organizations) as defined in the country concerned; butexclude treatment obtained in private pharmacies or shops.- 24 -


Treatment of Acute Respiratory Infection (ARI)Medical treatment of ARI: percent of children with a cough and rapid breathing in the two weeksbefore the survey who had been taken for treatment at any medical facility or provider, whetherpublic or private.Treatment in a public facility: percent of children with a cough and rapid breathing in the twoweeks before the survey who had been taken for treatment at a public-sector health facility orprovider (as defined in fn. 9).Treatment in a private facility: percent of children with a cough and rapid breathing in the twoweeks before the survey who had been taken for treatment at a private-sector health facility orprovider (as defined in fn. 9).Treatment of DiarrheaUse of oral rehydration therapy: percent of children with diarrhea in the two weeks before thesurvey who had received oral rehydration therapy (ORT) (defined as including consumption oforal rehydration salts, other recommended home fluids, or other increased liquids).Medical treatment of diarrhea: percent of children with diarrhea in the two weeks before thesurvey who had been taken for treatment at any medical facility or provider, whether public orprivate.Treatment in a public facility: percent of children with diarrhea in the two weeks before thesurvey who had been taken for treatment at a public-sector health facility or provider (as definedin fn. 9).Treatment in a private facility: percent of children with diarrhea in the two weeks before thesurvey who had been taken for treatment at a private-sector health facility or provider (as definedin fn. 9).C. ANTENATAL AND DELIVERY CARE 10Antenatal Care (ANC) VisitsTo a medically-trained person: percent of women with one or more births in the five yearsbefore the survey who had received at least one antenatal care consultation from a medicallytrainedperson (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 whohad 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 beforethe survey who had received at least one antenatal care consultation from a nurse or trainedmidwife (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 thefive years before the survey who had received at least three antenatal care consultations from anymedically-trained provider (as defined in fn. 10) before her most recent birth.10 When speaking of antenatal and delivery care, medically-trained persons are defined as doctors, nurses, and trainedmidwives. The definition excludes traditional midwives or other traditional birth attendants, whether trained oruntrained.- 25 -


Antenatal Care (ANC) ContentTetanus toxoid: percent of women with one or more births in the five years before the surveywho 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 yearsbefore the survey who had received prophylactic treatment with any anti-malarial drug during hermost recent pregnancy.Iron supplementation: percent of women with one or more births in the five years before thesurvey who had taken iron tablets during her most recent pregnancy.Delivery AttendanceBy a medically-trained person: percent of births in the five years before the survey attended by amedically-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 bya 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 apublic-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 aprivate-sector health facility (as defined in fn. 9).At home: percent of all deliveries in the five years before the survey occurring at home (definedas the woman’s own or any other home).D. CONTRACEPTIVE SERVICESContraceptive Prevalence 11Women: percent of married or in-union women aged 15-49 years who used any modern means ofcontraception (as defined in fn. 11).Men: percent of married or in-union men aged 15-54 years who used any modern means ofcontraception (as defined in fn. 11).Source of Contraception - Public SectorWomen: percent of married women who obtained their current method of contraception from apublic-sector health facility or provider (as defined in fn. 9).Men: percent of married men who obtained their current method of contraception from a publicsectorhealth facility or provider (as defined in fn. 9).11 Figures 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.- 26 -


Source of Contraception - Private SectorWomen: percent of married women who obtained their current method of contraception from aprivate-sector health facility or provider (as defined in fn. 9, except that private pharmacies andshops are included rather than excluded).Men: percent of married women who obtained their current method of contraception from aprivate-sector health facility or provider (as defined in fn. 9, except that private pharmacies andshops are included rather than excluded).E. TREATMENT OF ADULT ILLNESSESTreatment of Genital Discharge, Ulcer, or SoreWomen: percent of women with genital discharge, ulcer, or sore who sought any medicaltreatment for resulting symptoms.Men: percent of men with genital discharge, ulcer, or sore who sought any medical treatment forresulting symptoms.Treatment of Genital Discharge, Ulcer, or Sore in a Public FacilityWomen: percent of women with genital discharge, ulcer, or sore who sought treatment from apublic-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 publicsectorhealth facility or provider (as defined in fn. 9).Voluntary Counseling and Testing for HIV/AIDSWomen: percent of women aged 15-49 years who had been tested for HIV at any time before thesurvey.Men: percent of men aged 15-54 years who had been tested for HIV at any time before thesurvey.- 27 -


Part III: INTERMEDIATE DETERMINANTS OF HNP STATUS – INDIVIDUALAND HOUSEHOLD BEHAVIORA. HYGIENIC PRACTICESDisposal of Children’s StoolsSanitary disposal: percent of mothers with at least one child under five years of age whodisposed of the stools of their youngest child in a sanitary manner (defined as dropping stool intoa latrine, burying it, or using disposable diapers).HandwashingWash hands prior to preparing food: percent of women aged 15-49 years preparing meals whowashed hands before handling food.Handwashing facilities in household: percent of households that had hand-washing materials orfacilities, as determined by direct observation of interviewers.B. BEDNET OWNERSHIP AND USEBednet OwnershipBednet ownership: percent of households owning one or more bednets.Treated bednet ownership: percent of households owning one or more bednets that had recentlybeen treated with insecticides.Bednet UseBy children: percent of households with at least one child under five years of age, some or all ofwhom had slept under a bednet the night before the survey.By pregnant women: percent of currently pregnant women who had slept under a bednet thenight before the survey.C. BREASTFEEDINGExclusive breastfeeding: percent of children 0-3 months of age who had received only breastmilk in the 24 hours before the survey.Timely complementary feeding: percent of children 6-9 months of age who had received breastmilk 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 drinkfrom a bottle with a nipple in the twenty-four hours before the survey.- 28 -


D. MICRONUTRIENT CONSUMPTIONIodized SaltAvailability of iodized salt in household: percent of households with cooking salt testing positivefor iodine/iodate at the recommended level of 15 or 25 parts per million or more (depending onthe country). 12Vitamin AChildren: percent of children 13 who had received at least one dose of vitamin A in the six monthsbefore the survey, as reported by the mothers.Women: percent of women who had received a dose of vitamin A within two months of the lastbirth, in the five years before the survey.E. TOBACCO AND ALCOHOL USETobacco 14Women: percent of women aged 15-49 years who currently were smoking or chewing tobaccoproducts.Men: percent of men aged 15-54 years who currently were smoking or chewing tobaccoproducts.AlcoholWomen: percent of women aged 15-49 years who had gotten intoxicated due to excessiveconsumption of alcohol in the three months before the survey.Men: percent of men aged 15-54 years who had gotten intoxicated due to excessive consumptionof alcohol in the three months before the survey.F. SEXUAL PRACTICESNon-Regular Sexual PartnershipsWomen: percent of women aged 15-49 years who had had sex with a non-regular partner at leastonce 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 oncein the twelve months before the survey.12 Which of these two levels is recommended in any particular country may be determined by consulting the full reporton that country’s DHS, which may be found at: www.measuredhs.com/countries.13 Figures refer to children over six months of age and under three, four, or five years of age, depending upon thecountry. (The specific ages covered for in a particular country may be determined by consulting the full report on thatcountry’s DHS, which is available at: www.measuredhs.com/countries.)14 Tobacco products include cigarettes, pipes, cigars, leaves, etc.- 29 -


Condom Usage with Non-Regular PartnerWomen: percent of women aged 15-49 years with non-regular sexual partner who had used acondom 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 condomin the last sexual intercourse with such a partner in the twelve months before the survey.G. DOMESTIC VIOLENCEEver experienced violence: percent of women aged 15-49 years who had ever been hit or beatenby current or former husband/partner.Experienced violence in past year: percent of women aged 15-49 years who had been hit orbeaten by current or former husband/partner in the twelve months before the survey.- 30 -


Part IV: UNDERLYING DETERMINANTS OF HNP STATUSA. EDUCATIONSchool CompletionWomen: 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 ParticipationGirls: 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 MEDIANewspaper ReadershipWomen: 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 ListenershipWomen: 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 ViewershipWomen: 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/AIDSKnowledge about Sexual Transmission of HIV/AIDS 15Women: percent of women aged 15-49 years who knew of HIV/AIDS and of at least one of thefollowing ways to avoid it through interruption of its sexual transmission route: abstinence; usinga 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 toavoid HIV/AIDS referred to in the preceding definition.15 In most countries, the survey sample included both married and unmarried individuals. Where this was the case, allrespondents, regardless of marital status, were asked the question covered in this section. Where the survey coveredonly individuals who were or had been married, the data pertain only to individuals who had ever been married. (Themarital status of people covered for in particular country is indicated in the full report on that country’s DHS, which islocated at: www.measuredhs.com/countries.)- 31 -


Knowledge about Mother-to-Child Transmission of HIV/AIDSWomen: percent of women aged 15-49 years who knew of at least one way HIV/AIDS can betransmitted 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 betransmitted from mother to child during pregnancy, delivery, or breastfeeding.Attitudes toward HIV/AIDSWomen: percent of women aged 15-49 years who believed that people with HIV/AIDS should beallowed 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 beallowed to continue working or that HIV test results should remain confidential.D. STATUS OF WOMENHousehold DecisionmakingCan seek own health care: percent of women age 15-49 years who could decide by themselves toseek their own health care.Can seek children’s health care: percent of women aged 15-49 years, whose children live withthem, 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 bythemselves or jointly with others to make daily household purchases.Can make large household purchases: percent of women aged 15-49 years who could decide bythemselves or jointly with others to make large household purchases.Can make meal-related decisions: percent of women aged 15-49 years who could decide bythemselves what food to cook daily.Freedom of MovementCan travel to visit family, relatives: percent of women aged 15-49 years who could decide bythemselves to visit family and relatives.Other Decisionmaking, AttitudesCan decide how to spend own money: percent of women aged 15-49 years who work for cashwho 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 canrefuse to have sex with their husband for at least one of the following reasons: he has a sexuallytransmitteddisease; he has had sexual relations with another woman; or the woman is tired, not inmood, or recently has given birth.Justify domestic violence: percent of women aged 15-49 years believing that a husband/malepartner would be justified in beating his wife/female partner for at least one of the followingreasons: he suspects her of being unfaithful; she argues with him; she goes out without tellinghim; she neglects the children; she burns the food; or other, country-specific reasons (forexample, she shows disrespect for her in-laws or her family does not give the expected dowry).- 32 -


E. ORPHANHOODMaternal orphan prevalence: percent of children under 15 years of age whose natural motherhad died before the survey.Paternal orphan prevalence: percent of children under 15 years of age whose natural father haddied before the survey.Double orphan prevalence: percent of children under 15 years of age both of whose naturalparents had died before the survey.- 33 -


DATA AND METHODSAny assessment of the figures featured in this report requires an appreciation of how they wereprepared. The first need is to understand the basic features of the data and methods employed.A. SOURCE OF FIGURESThe figures appearing in this report are all derived from data collected under the Demographicand Health Surveys (DHS) program conducted by ORC Macro, with support from the U.S.Agency for International Development and other external assistance organizations. Large DHShousehold surveys have been carried out, usually at periodic intervals, in approximately seventyfivecountries across Africa, Asia, Latin America, the Middle East, and the former SovietUnion. 16 This series of reports covers the fifty-six of those countries that had one or more DHSsurveys undertaken since 1990, for which data were publicly available as of June 2006. (AnnexC 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 indicatorsabout health, nutrition, and population (hnp) status and service use; about relevant behaviors ofhousehold members; and about household characteristics like those described below. It has donethis 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. Inmost cases, they are based on responses from women or other family members interviewed. Theprincipal exceptions concern nutritional status, which is based on anthropometric measurement;immunization, which typically relies to the extent possible on record cards maintained at thehousehold level; and those other items where a source other than interviewer response isspecifically identified.B. MEASUREMENT OF ECONOMIC STATUSWealth or Asset ApproachEconomic status has been expressed in terms of wealth or assets: specifically, on the basis ofinformation about household characteristics gathered through the DHS household questionnaire.(Such information was normally provided for at least 25-30, and often many more, characteristicslike the presence, availability, or use of a fan, radio receiver, or automobile; housing materialslike wood or concrete flooring, tile or tin roofing, or cement block walls; superior sources ofwater like piped or a protected well; and other attributes related to economic status.)16 Further information about the DHS program is available at the program’s website: www.measuredhs.com.- 35 -


Index ConstructionA single, consolidated index of living standards 17 was constructed by using principal componentsanalysis (PCA) to generate a weight for each household item with available information. Awealth index score was calculated for each household by weighting the response with respect toeach item pertaining to that household by the coefficient of the first principal component asdetermined by application of principal components analysis, and summing the results. Theresulting household scores were standardized in relation to a standard normal distribution with amean of zero and a standard deviation of one.All individuals usually present in each household were assigned the household’s standardizedwealth index score, and all individuals in the sample population were ranked according to thatscore. The sample population was then divided into quintiles of individuals, with all individualsin a single household being assigned to the same quintile.The same standardized household wealth index scores originally derived for the total populationsample, as just described, were also used in preparing the disaggregated estimates for female andmale members of the sample population, and for rural and urban residents. In preparing thosedisaggregated 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 werethen separated from one another; and the mean for each of the ten resulting subgroups (fivefemale, five male; or five rural, five urban) was calculated.C. CALCULATION AND PRESENTATION OF RATESUse of Sampling WeightsRates for all health, nutrition, and population indicators are calculated after applying the DHSsampling 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 enoughto produce statistically-significant results. The DHS sampling weights are used to compensate forsuch over-sampling in order to ensure that the results are representative of the population as awhole and not just of the DHS sample.)Calculation of Total Population AveragesThe average for the total population presented alongside the quintile-specific rates for eachindicator is calculated without reference to quintile divisions. It thus equals the weighted mean ofthe quintile rates, with the weight assigned to each quintile rate being the proportion of thenumber of individuals at risk (as defined on p. 41) for the indicator concerned.Sampling ErrorsInformation needed to assess the statistical significance of differences among the quintile-specificrates is presented in three ways:• First, in all the basic tables presented in part I, rates are shown in parentheses orreplaced by asterisks in cases where the standard error is likely to be unacceptably high becauseof small sample size. The number of observations used to determine how to present the data forthe different indicators covered were as follows:17 Such an index is usually referred to as either an “asset index” or a “wealth index.” The two expressions are usedinterchangeably in this report; for ease of communication, “wealth index” appears more frequently despite the inexactcorrespondence between the items included in the index’s construction and those appearing in more conventional,financially-based definitions of wealth.- 36 -


Indicator Unit of measure Number of observations used todetermine how quintile-specificrate was presentedWithoutparenthesesWithparenthesesReplaced byasteriskInfant and childmortalityTotal and adolescentfertilityNumber of deaths >500 250-499 250 125-249 50 25-49


DISCUSSIONWhile a basic understanding of the data and methods employed is necessary to adequatelyappreciate the figures appearing in this report, it is not sufficient. For the application of theapproach taken involves many subtleties that also need to be understood. Among the moreimportant are:A. DESCRIPTIVE NATURE OF THE RELATIONSHIPSThe hnp-poverty relationships shown in this report are no more than descriptive. They should notbe 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 aperson’s health condition. Rather, the determining factors could be other characteristics (such aseducation or ethnic background) that are simultaneously associated with both asset ownership andhealth status.It is also possible that the health-poverty relationships shown are driven primarily by particularitems included in the index (e.g., water and sanitation). Should this be the case, improvements inhealth conditions among the poor might be more effectively brought about by focusing onchanging those particular components of the wealth index rather than by a general effort toincrease economic status as measured by the index as a whole.B. IMPLICATIONS OF A WEALTH/ASSET APPROACHWealth or Assets as a Measure of Economic StatusReliance on a wealth index to measure economic status is a rather recent development in researchon economic disparities, where such status traditionally has been defined in terms of consumptionor income. The principal reason for the choice of the wealth index is pragmatic rather thanconceptual: the DHS surveys, which are of interest because of the plethora of hnp informationthat they contain, do not collect consumption or income data; but they do have detailedinformation on households’ physical characteristics, and on the household-level presence of andaccess to a wide range of goods and services. While there is some disagreement about therelative merits of using such wealth/asset information or consumption data to measure economicstatus, several recent studies suggest that the asset-consumption relationship is quite close. 19 Tothe extent this is the case, an index of wealth or asset possession/availability can be taken as a19 See, 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; SheaRutstein 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 ofSES Make in Health Inequality Measurement?” Health Economics 12 (2003): 885-90.- 39 -


easonably satisfactory proxy for consumption, rather than or in addition to serving as anindicator of economic status in its own right.C. ECONOMIC STATUS AS A MEASURE OF SOCIO-ECONOMIC WELL-BEINGLike consumption or income, a wealth index defines disparities that are primarily economic. Thisis by no means the only way to define inter-group inequalities that are of potential concern. Otherpossibilities include gender, place of residence, education, ethnic background, or other factorsassociated with social exclusion. Thus the economic perspective provides only a partial view ofthe multidimensional concepts of poverty, inequality, and inequity.By including tables on female-male and rural-urban inequalities, this report pays adequateattention to two of inequality’s other important dimensions to justify the use of the term “socioeconomic”rather than simply “economic” in its title. However, the centrality of tabulationsbased on the wealth index means that the primary focus is on the economic dimension. Thejustification for this lies not in the greater importance of economic considerations, but rather inthe recently-improved ability to analyze and thus begin dealing with them. Until the developmentof 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, noneconomicdimensions of inequality as gender, ethnic identity, educational level, and place ofresidence. As a result, assessments of health inequalities by economic status had lagged wellbehind measurements in terms of these other dimensions, especially gender and education. Thefocus on inequality’s economic aspect applied here represents an effort to redress this imbalance.D. INDEX CONSTRUCTIONChoice of ItemsUse of a wealth index requires decisions about which items to include in it. In the case ofsecondary analyses like the one featured in this report, the choice is limited to those itemsincluded in the data sets being used. But even with this constraint, there nonetheless remainsconsiderable room for choice, given the large number of items for which information is collectedby the DHS.The decision made in preparing this report was to include all items in each DHS householdquestionnaire that relate to ownership of household goods; to dwelling unit construction andcharacteristics; and to access to services and resources like electricity, water, and sanitationfacilities. Also included were other potential indicators of wealth, such as live-in domesticservants. 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 ofvariation across household asset scores and facilitates a more regular distribution of individualsacross quintiles. It also reduces the possibility of subjectivity in selecting only some of thevariables for inclusion on some a priori basis; and it may increase a wealth index’s accuracy as aproxy for consumption.However, including all variables is far from satisfying conceptually. For example, it meansfailing 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 beincluded in an index that purports to measure private household wealth.- 40 -


Further, many items that are candidates for inclusion in a DHS-based wealth index might be seenas directly influencing health status: water and sanitation for infant and child mortality, forexample. It would be desirable to include quintile-specific estimates for such items; but to theextent that such items have large index coefficients, any estimates for those items would besuspect. Such items appear to be relatively few and of limited statistical significance in the indexused here. However, for the sake of caution, quintile-specific estimates for items appearing in theindex have nonetheless been excluded from the basic tables and appear only in supporting tableIII.CWeighting of ItemsA further decision required in construction of an index concerns the weight to attach to each ofthe respective items. As noted earlier, the method used in this report is principal componentsanalysis (PCA).Adoption of this method was based on the findings, referred to earlier, that its use resulted inoutcomes that approximated reasonably well those produced by taking a consumption orexpenditure approach. Further, it often provides greater discrimination in economic status thandoes the use of consumption/expenditures. It has also emerged as the standard approach for usein 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 itemspossessed by only a few and less to those possessed by many; 20 or, perhaps, the common practiceof simply assigning the same weight to each index item.Use of Principal Components Analysis with Dichotomous VariablesAn additional issue concerns the use of a technique like PCA, developed for use with continuousvariables, in the construction of an index based primarily on dichotomous variables. Whilelegitimate in principle, any reservations in this regard are of limited practical consequence, sincethe considerable experimentation undertaken in preparation for the tabulations presented hereindicated that any inaccuracy introduced by applying PCA to the analysis of the dichotomousvalues used is minimal.Economies of ScaleCalculating the values for a household wealth index also requires a decision concerningeconomies of scale that exist in the households covered. The calculations presented here assumecomplete economies of scale. The implicit assumption is that additional members do not add tohousehold expenses on items included in the index.E. DEFINITION OF QUINTILESQuintiles of IndividualsAs noted earlier, the quintile-specific figures presented in this report refer to quintiles ofindividuals in the household population. Such quintiles need to be distinguished from quintiles ofhouseholds or quintiles of only those people in the population who are “at risk”: that is, subjectto the particular condition, eligible for the particular service, or capable of behaving in aparticular way (children born alive for infant and under-five mortality, for example; or adult menand women for condom use or non-regular sexual partnerships).20 Saul S. Morris et al., “Validity of Rapid Estimates of Household Wealth and Income for Health Surveys in RuralAfrica,” Journal of Epidemiology and Community Health 54 (2000): 381-87.- 41 -


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-offones, the number of individuals per household will frequently be larger among the poor thanamong higher-income groups. In such cases, the number of households will vary systematicallyacross quintiles of individuals, and the results expressed in terms of quintiles of households candiffer significantly from those presented here.• The proportion of individuals “at risk” with regard to a particular indicator is alsolikely to vary across quintiles in many cases. (For example, in cases where fertility is higheramong poor people, a higher-than-average proportion of poor populations will consist ofnewborns at risk from infant mortality, young children subject to malnutrition, and pregnantwomen for whom antenatal care is relevant.) To facilitate the work of any investigators wishingto undertake calculations based on people at risk, the number of such people in each quintile ofindividuals is shown in part III.A.• As previously indicated, the population average figure provided for each indicator isequivalent to the weighted sum of the quintile rates for that indicator, where the weight assignedto each quintile rate is the number of people at risk in each quintile as presented in part III.A. Asa result of this weighting, the population average will usually differ from a simple mean of thepopulation quintile estimates.Quintiles of Males and Females, of Rural and Urban ResidentsAs also reported in the data and methods section, the tables on rural and urban residents and onmen and women were prepared using the same asset scores as for the total population; and ruralurbanresidents and females-males were separated from one another only after the entire samplehad been disaggregated into quintiles of individuals. This means that the figures given in therural-urban and female-male tables refer to females-males and rural-urban residents belonging toeach 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 urbanresidents. Since rural residents tend to be poorer than urban dwellers, they normally form aconsiderably higher proportion of individuals in the lower economic quintiles of the totalpopulation than in the higher ones. Conversely, urban residents tend to be concentrated in thehigher economic groups. As a result, the number of individuals in each of the urban and ruralquintiles usually varies greatly and systematically; and when this is the case, the figures presentedin the rural-urban tables can differ significantly from those produced by a computation procedurethat places the same number of rural and urban residents in each rural quintile or each urbanquintile. (The results may also differ significantly from application of an approach featuring theseparate calculation of index values for urban and for rural groups. While such separate indexvalues may well be preferable conceptually, their calculation involves complexities that preventedtheir preparation for this report.)- 42 -


F. COMPARISON OF QUINTILES ACROSS COUNTRIESReliance on population quintiles as basic presentational format for the data appearing in thisreport implicitly incorporates a relative concept of poverty. This differs from an absolute conceptof poverty under which the population would be divided into groups of different sizes accordingto some absolute standard of living (such as people earning less than one dollar a day, betweenone 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 acrosscountries, the comparison is between groups of people whose economic status can be quitedifferent. The lowest quintile of a Latin American population, for example, will usually beconsiderably better-off than the lowest quintile in an African country.G. STATISTICAL INDICATORS OF INEQUALITYThe available statistical indicators of inequality are far too numerous to permit use of more than asmall proportion of them in presenting the findings featured in this report. The three indicatorsemployed have been selected to provide a wide range of perspectives. Two are designed for easeof understanding, the third for greater technical accuracy.The low/high quintile ratio and low-high quintile difference are the two presented for ease ofunderstanding. The former is a relative measure, the latter an absolute measure that can producea significantly different impression from that provided by the former.The concentration index is provided for the benefit of technical specialists wishing greateraccuracy. It measures the degree of inequality in an hnp indicator across the full wealth indexdistribution, rather than differences between only two of the five quintiles, and also reflects therelative size of the different asset-based divisions of the study population.H. COMPARABILITY WITH OTHER REPORTSTabulations similar to those presented here can also be found in the initial series of hnp/povertycountry 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 forany given indicator; but there are often slight differences for one or more of several reasons. Themost common is a difference in the definition of the indicator in question. (These differences areusually small and subtle. But there is one important exception: the definition of moderatemalnutrition among children. In the 2000 reports, this was defined as second and third degreemalnutrition taken together. Here, it is defined as second degree malnutrition alone.) Anotherreason, with respect to infant and child mortality, is that the figures in the DHS documents aretypically based on experience during the five years before the survey in question, rather thanduring the ten previous years as in this report. A further frequent reason is the use of an improvedcomputational technique.In addition, asset-based, quintile-specific tabulations of hnp indicators have begun to appear in anincreasing number of other documents. Given the basic similarity of approach, such tabulationsusually 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 adequatelydetailed information about data and methods often prevents any fully-satisfying understanding ofthe approaches used. As a result, occasional doubts and frequent uncertainties about approachcomparability remain.- 43 -


PART III. SUPPORTING TABLESA. SAMPLE SIZESB. STANDARD ERRORSC. ASSET DISTRIBUTION AND WEIGHTS


Armenia2000 - SAMPLE SIZESTOTAL SAMPLEIndicatorWealth QuintilesPop.Low 2nd 3rd 4th High TotalNumber of household membersAll 5,126 5,258 5,208 5,177 5,191 25,961Urban 395 1,172 3,677 4,703 5,055 15,002Rural 4,731 4,086 1,532 474 136 10,959Female 2,575 2,734 2,693 2,752 2,742 13,496Male 2,551 2,525 2,516 2,425 2,449 12,466Part I: HNP STATUSIndicatorWealth QuintilesPop.Low 2nd 3rd 4th High TotalMortality ratesAll 874 925 680 658 659 3,796Urban 53 192 470 594 633 1,943Rural 821 733 210 64 26 1,853Female 413 439 315 305 299 1,771Male 460 486 365 354 360 2,025Prevalence of fever, diarrhea,acute respiratory infectionAll 360 367 271 290 308 1,596Urban 16 72 182 258 291 819Rural 345 295 89 32 16 777Female 156 162 114 128 125 685Male 205 204 156 163 182 910Total fertility rateAll 3,047 3,523 3,635 3,772 4,190 18,170Urban 216 810 2,627 3,418 4,088 11,159Rural 2,830 2,713 1,008 353 105 7,009Age-specific fertility rate 15-19All 553 668 678 697 777 3,372Urban 41 128 474 626 762 2,031Rural 512 540 203 71 15 1,341Children's nutritional statusAll 326 347 237 267 287 1,463Urban 13 66 162 239 270 750Rural 314 281 74 28 16 713Female 141 154 102 116 113 626Male 185 193 134 150 174 836Children's anemia statusAll 294 320 216 237 268 1,334Urban 8 59 153 213 251 684Rural 286 261 62 24 16 649Female 162 181 121 133 159 756Male 132 139 94 104 109 578- 47 -


Armenia2000 - SAMPLE SIZESPart I: HNP STATUS (Cont.)IndicatorWealth QuintilesPop.Low 2nd 3rd 4th High TotalWomen's nutritional statusAll 958 1,160 1,205 1,262 1,375 5,962Urban 66 267 877 1,148 1,339 3,697Rural 892 893 328 114 36 2,263Women's anemia statusAll 1,016 1,205 1,243 1,285 1,388 6,137Urban 67 276 899 1,167 1,351 3,760Rural 949 929 343 118 37 2,376Girls' circumcisionAll na na na na na naUrban na na na na na naRural na na na na na naWomen's circumcisionAll na na na na na naUrban na na na na na naRural na na na na na naPrevalence of genital discharge, ulcer, soreFemale 838 897 910 946 1,001 4,592Urban Female 57 196 643 849 971 2,716Rural Female 781 700 266 98 29 1,874Male 237 274 294 298 311 1,414Urban Male 12 62 214 271 298 857Rural Male 225 212 80 26 12 555- 48 -


Armenia2000 - SAMPLE SIZESPart II: Intermediate Determinants of HNP Status - HNP SERVICE USEIndicatorWealth QuintilesPop.Low 2nd 3rd 4th High TotalImmunization coverageAll 74 61 52 56 57 300Urban 4 16 41 51 56 168Rural 70 45 11 5 1 132Female 30 20 22 22 28 122Male 43 41 30 34 29 177Treatment of feverAll 57 55 42 66 43 263Urban 2 15 34 59 43 153Rural 55 40 8 7 0 110Female 38 32 21 39 16 146Male 19 23 21 27 27 117Treatment of acute respiratory infectionAll 37 41 28 42 34 182Urban 0 4 20 37 33 94Rural 37 37 8 5 1 88Female 19 11 11 20 19 80Male 18 30 17 22 14 101Treatment of diarrheaAll 33 24 24 22 22 125Urban 1 7 17 19 21 65Rural 32 17 7 4 1 61Female 11 9 14 6 7 47Male 22 16 10 16 15 79Antenatal and delivery careAll 270 277 216 236 250 1,248Urban 13 56 148 208 239 664Rural 256 221 68 27 11 583Contraceptive prevalenceFemale 769 819 827 831 879 4,125Urban Female 50 168 577 743 852 2,390Rural Female 719 650 250 88 27 1,734Male na na na na na naUrban Male na na na na na naRural Male na na na na na naContraceptive sourceFemale 119 171 185 186 257 918Urban Female 14 38 119 170 245 585Rural Female 104 134 67 16 12 332Male na na na na na naUrban Male na na na na na naRural Male na na na na na naTreatment of genital discharge, ulcer, soreFemale 259 278 232 255 231 1,255Urban Female 15 46 168 216 218 663Rural Female 244 232 64 40 13 593Male na na na na na naUrban Male na na na na na naRural Male na na na na na na- 49 -


Armenia2000 - SAMPLE SIZESPart III: Intermediate Determinants of HNP Status - INDIVIDUAL AND HOUSEHOLD BEHAVIORIndicatorWealth QuintilesPop.Low 2nd 3rd 4th High TotalSanitary disposal of stoolsAll na na na na na naUrban na na na na na naRural na na na na na naWash hands prior to preparing foodAll 1,074 1,253 1,286 1,349 1,467 6,429Urban 78 286 925 1,222 1,429 3,940Rural 996 967 361 126 38 2,488Handwashing facilities in household?All 1,162 1,089 1,184 1,240 1,248 5,923Urban 112 258 864 1,144 1,223 3,601Rural 1,051 831 320 96 25 2,323Bednet ownershipAll na na na na na naUrban na na na na na naRural na na na na na naBednet use by childrenAll na na na na na naUrban na na na na na naRural na na na na na naBednet use by pregnant womenAll na na na na na naUrban na na na na na naRural na na na na na naExclusive breastfeedingAll 22 16 20 21 16 95Urban 5 6 9 18 16 54Rural 17 9 11 2 0 39Female 10 5 12 12 12 51Male 11 11 8 8 4 42Timely complementary breastfeedingAll 26 22 21 14 14 97Urban 1 4 12 10 13 40Rural 25 19 9 4 1 58Female 17 7 16 6 9 55Male 8 16 6 7 6 43Bottle-feedingAll 74 69 53 51 52 299Urban 5 18 27 43 50 143Rural 69 52 27 8 2 158Female 44 33 35 27 39 178Male 30 37 18 24 13 122- 50 -


Armenia2000 - SAMPLE SIZESPart III: Intermediate Determinants of HNP Status - INDIVIDUAL AND HOUSEHOLD BEHAVIOR (Cont.)IndicatorWealth QuintilesPop.Low 2nd 3rd 4th High TotalIodized salt in householdAll 1,150 1,085 1,182 1,225 1,243 5,885Urban 109 255 863 1,129 1,218 3,574Rural 1,041 829 319 96 25 2,310Vitamin A supplementationAll na na na na na naUrban na na na na na naRural na na na na na naFemale na na na na na naMale na na na na na naTobacco and alcohol use, casual sexual partners,condom use for casual sexFemale 1,074 1,253 1,286 1,349 1,467 6,429Urban Female 78 286 925 1,222 1,429 3,940Rural Female 996 967 361 126 38 2,488Male 289 340 353 357 380 1,719Urban Male 14 71 250 327 361 1,023Rural Male 274 268 103 30 19 694Domestic violenceAll na na na na na naUrban na na na na na naRural na na na na na na- 51 -


Armenia2000 - SAMPLE SIZESPart IV: UNDERLYING DETERMINANTS OF HNP STATUSIndicatorWealth QuintilesPop.Low 2nd 3rd 4th High TotalSchool completion (Grade 5)Female 1,180 1,384 1,421 1,489 1,565 7,040Urban female 87 319 1,013 1,347 1,526 4,292Rural female 1,093 1,065 409 142 40 2,749Male 1,270 1,306 1,313 1,283 1,320 6,491Urban male 89 278 926 1,151 1,277 3,721Rural male 1,181 1,028 387 132 42 2,770School participationFemale 260 280 213 175 168 1,096Urban female 17 76 153 158 164 568Rural female 243 205 60 16 4 528Male 269 272 230 202 187 1,161Urban male 17 60 169 184 182 612Rural male 252 212 61 18 5 548Mass media exposureFemale 1,074 1,253 1,286 1,349 1,467 6,430Urban female 78 286 925 1,222 1,429 3,942Rural female 996 967 361 126 38 2,488Male 289 340 353 357 380 1,719Urban male 14 71 250 327 361 1,024Rural male 274 268 103 30 19 695Knowledge of HIV/AIDS preventionFemale 2,539 1,253 1,286 1,349 1,467 7,894Urban female 78 286 925 1,222 1,429 3,940Rural female 996 967 361 126 38 2,488Male 289 340 353 357 380 1,719Urban male 14 71 250 327 361 1,023Rural male 274 268 103 30 19 694Household decisionmaking andjustification of violenceAll 1,074 1,253 1,286 1,349 1,467 6,430Urban 78 286 925 1,222 1,429 3,942Rural 996 967 361 126 38 2,488OrphanhoodAll 1,410 1,416 1,212 1,175 1,111 6,323Urban 89 300 839 1,066 1,069 3,364Rural 1,320 1,115 373 109 42 2,959Female 666 674 561 556 513 2,971Male 743 742 651 619 598 3,353- 52 -


Armenia2000 - STANDARD ERRORS OF QUINTILE ESTIMATES FOR TOTAL POPULATIONPart I: HNP STATUSIndicatorWealth QuintilesPop.Low 2nd 3rd 4th High Avg.A. Childhood illness and mortalityInfant mortality rate 8.73 9.25 9.61 10.23 11.06 4.58Under-five mortality rate 9.05 9.65 10.58 11.20 11.14 5.06Prevalence of fever 2.23 2.00 2.20 2.81 2.18 1.00Prevalence of diarrhea 1.86 1.35 1.95 1.97 1.93 0.90Prevalence of acute respiratory infection 2.13 1.86 2.08 2.66 2.36 0.95B. FertilityTotal fertility rate 0.32 0.27 0.27 0.22 0.14 0.13Adolescent fertility rate 17.00 13.00 7.00 7.00 8.00 5.00C. Nutritional statusChildren:Moderate stunting 2.19 2.11 2.15 1.72 2.01 1.03Severe stunting 1.05 1.21 1.01 0.73 0.73 0.50Moderate underweight 0.84 0.98 1.24 0.69 0.65 0.41Severe underweight 0.39 0.07 0.00 0.00 0.41 0.12Mild anemia 1.94 1.72 2.41 2.22 1.94 0.90Moderate anemia 2.77 1.82 1.84 1.07 1.64 0.92Severe anemia 0.47 0.18 0.58 0.00 0.21 0.15Women:Malnutrition 0.48 0.61 0.52 0.68 0.70 0.27Mild anemia 1.33 0.97 0.98 0.87 0.79 0.47Moderate anemia 0.48 0.48 0.43 0.38 0.35 0.19Severe anemia 0.17 0.19 0.05 0.12 0.14 0.06D. Female circumcisionPrevalence of circumcision:Girls na na na na na naWomen na na na na na naPrevalence of occlusion:Girls * * * * * *Women * * * * * *E. Sexually transmitted diseasePrevalence of genital discharge:Women 1.93 1.62 1.45 1.41 1.55 0.77Men 0.56 0.37 0.00 0.21 0.44 0.16Prevalence of genital ulcer:Women 1.27 1.34 0.94 1.08 1.16 0.55Men na na na na na na- 53 -


Armenia2000 - STANDARD ERRORS OF QUINTILE ESTIMATES FOR TOTAL POPULATIONPart II: Intermediate Determinants of HNP Status - HNP SERVICE USEIndicatorWealth QuintilesPop.Low 2nd 3rd 4th High Avg.A. Childhood immunizationBCG coverage 2.93 4.15 4.63 2.79 4.43 1.41Measles coverage 5.55 5.15 5.23 5.80 7.35 2.73DPT coverage 3.23 3.18 4.39 2.76 4.93 1.56Full basic coverage 5.38 5.80 5.89 5.80 6.94 2.71No basic coverage 2.66 1.04 3.63 2.76 4.19 1.09Hepatitis B coverage 3.78 2.59 0.00 3.22 2.36 1.30Yellow fever coverage na na na na na naB. Treatment of childhood illnessesTreatment of fever:Medical treatment of fever 4.58 5.11 8.41 6.48 8.71 2.84Treatment in a public facility 4.58 5.11 8.11 6.23 8.71 2.74Treatment in a private facility 1.68 0.00 2.74 2.88 0.00 0.93Treatment of acute respiratory infection (ARI):Medical treatment of ARI 7.02 7.72 9.68 11.37 8.03 4.00Treatment in a public facility 7.02 7.72 9.67 10.86 8.03 3.97Treatment in a private facility 0.00 0.00 3.82 3.27 0.00 0.98Treatment of diarrhea:Use of oral rehydration therapy 11.36 10.50 * * * 5.19Medical treatment of diarrhea 6.95 9.64 * * * 3.97Treatment in a public facility 6.95 9.64 * * * 3.97Treatment in a private facility na na na na na naC. Antenatal and delivery careAntenatal care (ANC) visits:To a medically-trained person 2.77 2.48 1.41 1.26 1.29 1.11To a doctor 3.63 3.39 2.10 1.86 1.62 1.34To a nurse or trained midwife 3.14 1.94 1.66 1.31 0.86 1.03Multiple visits to a medically-trained person 3.58 3.29 2.77 2.55 2.14 1.68Antenatal care content:Tetanus toxoid na na na na na naProphylactic antimalarial treatment na na na na na naIron supplementation 1.90 2.70 2.68 3.25 2.60 1.29Delivery attendance:By a medically-trained person 1.59 2.10 0.43 0.62 0.00 0.64By a doctor 3.82 3.66 2.41 1.86 1.69 1.48By a nurse or trained midwife 3.55 2.69 2.43 1.77 1.69 1.35In a public facility 3.67 3.56 0.98 0.71 0.19 1.20In a private facility 0.00 0.00 0.20 0.00 0.00 0.03At home 3.67 3.56 0.91 0.68 0.19 1.20D. Contraceptive servicesContraceptive prevalence:Women 1.52 1.23 1.79 1.79 1.81 0.83Men na na na na na naSource of contraception - public sector:Women 3.87 2.47 2.84 3.23 3.83 1.49Men na na na na na na- 54 -


Armenia2000 - STANDARD ERRORS OF QUINTILE ESTIMATES FOR TOTAL POPULATIONPart II: Intermediate Determinants of HNP Status - HNP SERVICE USE (Cont.)IndicatorWealth QuintilesPop.Low 2nd 3rd 4th High Avg.D. Contraceptive services (cont.)Source of contraception - private sector:Women 3.51 1.69 2.62 2.27 3.27 1.30Men na na na na na naE. Treatment of adult illnessesTreatment of genital discharge, ulcer, sore:Women 3.14 3.20 3.74 3.26 3.19 1.46Men * * 40.82 * * *Treatment of genital discharge, ulcer, sore in public facilities:Women 1.93 1.62 1.45 1.41 1.55 0.77Men * 0.37 0.00 * * *Voluntary counseling and testingfor HIV/AIDS:Women 0.78 0.73 0.70 0.86 0.95 0.39Men 1.10 1.01 0.97 1.48 0.94 0.52- 55 -


Armenia2000 - STANDARD ERRORS OF QUINTILE ESTIMATES FOR TOTAL POPULATIONPart III: Intermediate Determinants of HNP Status - INDIVIDUAL AND HOUSEHOLD BEHAVIORIndicatorWealth QuintilesPop.Low 2nd 3rd 4th High Avg.A. Hygenic practicesDisposal of children's stools:Sanitary disposal 2.86 2.73 2.70 1.96 3.06 1.36Handwashing:Wash hands prior to preparing food 0.42 0.73 0.75 0.79 0.59 0.34Handwashing facilities in household 1.15 2.00 2.04 1.21 0.59 1.34B. Bednet ownership and useBednet ownership:Bednet ownership na na na na na naTreated bednet ownership na na na na na naBednet use:By children na na na na na naBy pregnant women na na na na na naC. BreastfeedingExclusive breastfeeding * * * * * 4.98Timely complementary feeding 7.15 8.75 * * * 5.59Bottle-feeding 5.05 6.88 6.21 8.17 8.25 3.29D. Micronutrient consumptionIodized salt:Availability of iodized salt in household 1.99 1.31 1.51 1.46 1.22 0.83Vitamin A:Children na na na na na naWomen na na na na na naE. Tobacco and alcohol useTobacco:Women 0.20 0.25 0.39 0.66 0.96 0.33Men 2.61 2.47 2.65 2.91 2.48 1.12Alcohol:Women na na na na na naMen 1.82 1.65 1.41 1.67 1.26 0.65F. Sexual practicesNon-regular sexual partnerships:Women 0.11 0.09 0.11 0.00 0.00 0.03Men 1.74 1.68 1.87 2.00 2.38 0.91Condom usage with non-regular partner:Women * * * na na *Men 11.41 10.08 7.12 6.70 4.92 3.22G. Domestic violenceEver experienced violence na na na na na naExperienced violence in past year na na na na na na- 56 -


Armenia2000 - STANDARD ERRORS OF QUINTILE ESTIMATES FOR TOTAL POPULATIONPart IV: UNDERLYING DETERMINANTS OF HNP STATUSIndicatorWealth QuintilesPop.Low 2nd 3rd 4th High Avg.A. EducationSchool completion:Women 0.40 0.21 0.11 0.17 0.14 0.09Men 0.37 0.22 0.30 0.26 0.16 0.12School participation:Girls 2.56 1.95 2.49 2.64 3.04 1.15Boys 2.27 2.11 2.80 3.16 3.17 1.12B. Exposure to mass mediaNewspaper readership:Women 1.17 1.19 1.42 1.61 1.75 0.75Men 2.10 2.06 2.87 2.94 3.56 1.29Radio listenership:Women 1.19 1.54 1.95 2.12 1.76 0.95Men 2.04 2.92 3.69 3.54 3.86 1.57Television viewership:Women 1.69 1.23 1.46 1.36 0.93 0.61Men 1.94 1.48 1.58 1.18 0.97 0.66C. Knowledge and attitudes about HIV/AIDSKnowledge about sexual transmission of HIV/AIDS:Women 1.70 1.85 1.85 1.58 2.32 0.96Men 3.64 2.94 3.04 2.80 2.07 1.50Knowledge about mother-to-child transmissionof HIV/AIDS:Women 2.31 1.56 1.95 1.40 1.41 0.86Men 3.30 2.74 2.90 2.28 2.34 1.40Attitudes toward HIV/AIDS:Women 1.03 1.20 1.39 1.49 1.64 0.64Men 3.12 2.68 2.55 2.72 2.94 1.39D. Status of womenHousehold decisionmaking:Can seek own health care 1.52 1.61 1.65 1.43 1.67 0.77Can seek children's health care 2.23 2.39 2.98 2.56 3.25 1.20Can make daily household purchases 1.40 1.36 1.50 1.50 1.66 0.71Can make large household purchases 1.60 1.63 1.56 1.60 1.75 0.75Can make meal-related decisions 1.55 1.43 1.54 1.39 1.56 0.74Freedom of movement:Can travel to visit family, relatives 1.25 1.17 1.29 1.03 1.27 0.57Other decisionmaking, attitudes:Can decide how to spend own money 3.97 4.24 3.19 3.34 3.02 1.50Can decide whether to have sex 1.45 1.07 0.89 0.85 0.58 0.53Justifies domestic violence 1.85 1.62 1.74 1.65 1.46 0.87E. OrphanhoodPaternal orphan prevalence 0.84 0.62 0.90 0.74 0.78 0.33Maternal orphan prevalence 0.08 0.33 0.43 0.37 0.32 0.14Double orphan prevalence 0.00 0.18 0.15 0.00 0.12 0.05- 57 -


Armenia2000 - ASSET DISTRIBUTION AND WEIGHTS(FACTOR SCORES)Asset VariableUnweightedMeanStd.DeviationWealth QuintilesLow 2nd 3rd 4th High Avg.Percentage of PopulationFactorScoreHas electricity 0.989 0.104 98.1% 99.0% 99.4% 99.7% 100.0% 99.2% 0.02448Has radio 0.388 0.487 13.5% 27.8% 37.8% 44.3% 68.8% 38.5% 0.08415Has television 0.874 0.332 77.9% 91.3% 92.2% 93.8% 99.5% 91.0% 0.05821Has refrigerator 0.738 0.440 50.3% 76.7% 76.5% 83.9% 97.2% 77.0% 0.07593Has bicycle 0.062 0.241 7.3% 10.7% 9.0% 8.1% 6.7% 8.4% -0.00243Has motorcycle, scooter 0.018 0.134 3.1% 2.2% 2.4% 1.2% 0.5% 1.9% -0.01095Has car, truck 0.238 0.426 23.0% 31.8% 25.9% 26.3% 30.9% 27.6% 0.00954Has telephone 0.608 0.488 23.2% 50.4% 54.9% 77.1% 100.0% 61.2% 0.11138Works own or family's agricultural land 0.771 0.420 85.8% 90.7% 87.5% 87.0% 91.7% 88.6% 0.01582Uses piped water in residence for drinking 0.593 0.491 1.1% 28.5% 76.6% 97.9% 100.0% 60.9% 0.17821Uses water piped into yard, plot for drinking 0.257 0.437 58.7% 50.4% 16.7% 1.2% 0.0% 25.4% -0.12210Uses water from public faucet (piped) for drinking 0.058 0.233 14.0% 8.7% 3.7% 0.3% 0.0% 5.3% -0.05326Uses water from open well in residence for drinking 0.001 0.026 0.2% 0.2% 0.0% 0.0% 0.0% 0.1% -0.00562Uses water from open well in yard, plot for drinking 0.004 0.059 1.3% 0.4% 0.1% 0.0% 0.0% 0.4% -0.01683Uses water from open public well for drinking 0.002 0.047 0.9% 0.2% 0.1% 0.0% 0.0% 0.2% -0.01047Uses water from covered well in residence for drinking 0.000 0.013 0.1% 0.0% 0.0% 0.0% 0.0% 0.0% -0.00629Uses water from covered well in yard, plot for drinking 0.001 0.032 0.0% 0.3% 0.3% 0.0% 0.0% 0.1% -0.00369Uses water from public covered well for drinking 0.000 0.013 0.0% 0.0% 0.0% 0.0% 0.0% 0.0% 0.00005Uses water from river, canal or surface for drinking 0.001 0.037 0.7% 0.0% 0.0% 0.0% 0.0% 0.1% -0.01187Uses water from spring for drinking 0.067 0.250 19.8% 7.6% 1.8% 0.1% 0.0% 5.8% -0.06822Uses rain water for drinking 0.000 0.013 0.1% 0.0% 0.0% 0.0% 0.0% 0.0% -0.00290Uses tanker truck for drinking water 0.011 0.105 2.4% 2.8% 0.6% 0.2% 0.0% 1.2% -0.01612Uses other source of drinking water 0.005 0.067 0.7% 1.1% 0.1% 0.4% 0.0% 0.4% -0.01055Uses own flush toilet 0.555 0.497 0.4% 14.7% 79.8% 90.9% 100.0% 57.2% 0.18104Uses pit latrine 0.376 0.485 93.3% 75.1% 12.4% 0.9% 0.0% 36.3% -0.17402Uses latrine 0.001 0.034 0.0% 0.1% 0.3% 0.3% 0.0% 0.1% -0.00012Uses shared flush toilet 0.032 0.175 0.2% 3.1% 6.1% 8.0% 0.0% 3.5% 0.00897Uses shared pit latrine 0.033 0.178 5.6% 6.6% 1.4% 0.0% 0.0% 2.7% -0.03675Uses shared latrine 0.001 0.037 0.2% 0.3% 0.0% 0.0% 0.0% 0.1% -0.00807Uses bush, field as latrine 0.001 0.034 0.3% 0.1% 0.0% 0.0% 0.0% 0.1% -0.01111Uses other type of latrine 0.000 0.013 0.0% 0.0% 0.1% 0.0% 0.0% 0.0% 0.00001Has dirt, sand, dung as principal floor in dwelling 0.016 0.125 2.7% 2.0% 0.8% 1.1% 0.0% 1.3% -0.02162Has wood plank, principal floor in dwelling 0.532 0.499 80.6% 79.9% 74.2% 33.1% 0.0% 53.6% -0.12382Has cement as principal floor in dwelling 0.062 0.240 12.9% 8.0% 5.4% 0.2% 0.0% 5.3% -0.05058Has parquet, polished wood as principal floor in dwelling 0.325 0.468 0.6% 4.8% 11.5% 52.0% 95.7% 32.9% 0.15512Has linoleum as principal floor in dwelling 0.035 0.185 3.2% 4.0% 5.6% 4.4% 0.0% 3.4% -0.00560Has carpet as principal floor in dwelling 0.029 0.169 0.1% 1.1% 2.1% 9.1% 4.3% 3.3% 0.03017Has other type of flooring in dwelling 0.001 0.032 0.0% 0.1% 0.2% 0.2% 0.0% 0.1% -0.00067Uses electricity for cooking 0.347 0.476 8.4% 32.4% 37.6% 52.2% 51.0% 36.4% 0.07799Uses gas for cooking 0.132 0.339 10.2% 20.3% 29.1% 15.0% 3.5% 15.7% -0.00187Uses liquid gas for cooking 0.176 0.381 1.6% 14.1% 14.9% 25.1% 44.7% 20.1% 0.07050Uses kerosene for cooking 0.011 0.106 0.6% 1.0% 1.0% 1.3% 0.8% 0.9% 0.00248Uses charcoal for cooking 0.006 0.077 0.8% 0.6% 0.8% 0.4% 0.0% 0.5% -0.00688Uses wood for cooking 0.189 0.392 38.9% 19.6% 11.3% 5.6% 0.0% 15.0% -0.08022Uses dung, manure for cooking 0.136 0.343 39.3% 11.9% 5.1% 0.3% 0.0% 11.3% -0.09204Uses other fuel for cooking 0.001 0.034 0.0% 0.1% 0.1% 0.1% 0.0% 0.1% -0.00059- 59 -


PART IV. ANNEXESA. SOURCES OF ADDITIONALINFORMATIONB. USE OF INFORMATION FROM THISREPORT TO MONITOR THEECONOMIC STATUS OF PEOPLESERVED BY HNP PROGRAMSC. COUNTRIES COVERED BY THE HNP-POVERTY REPORT PROJECT


ANNEX A. SOURCES OF ADDITIONAL INFORMATIONADDITIONAL INEQUALITY DATAWorld 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 countriescovered by the HNP/Poverty Country Report Project. (A list of the countries coveredappears in annex C, at the end of this report.) Also available at the site are summarytables, organized by indicator, designed to facilitate cross-country comparisons ininequality with respect to particular indicators.DHS Country Reports: http://www.measuredhs.com/countries.All DHS final country reports produced since 2003 include quintile-specific tabulationsin approximately 50-100 of the reports’ HNP indicator tables. The tables deal with someof 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 theDHS program, but covers a somewhat different set of countries and indicators. The“standard tables” section for each country listed at the MICS website provides wealthbased,quintile-specific information in around 40-45 of the tables related to hnp,education, and child labor. In deriving these quintile-specific estimates, the MICSinvestigators 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 asself-assessed adult health status; coverage of interventions against adult chronic diseasesand against maternal and child health problems; household health expenditures; insurancecoverage; and health system responsiveness. Approximately seventy countries –developed as well as developing – have been covered thus far. Household wealthinformation has been collected and used to prepare quintile-specific estimates for manyof the indicators appearing in the reports on these countries.- 63 -


METHODS AND RESOURCES FOR FURTHER INEQUALITY ANALYSISShea Oscar Rutstein and Kiersten Johnson, The DHS Wealth Index, DHS Comparative ReportsNo. 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 detailthe 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 – orTears: 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 closerelationship between results produced using wealth and those based on consumption as anindicator of household economic status.Owen O’Donnell, Eddy van Doorslaer, Adam Wagstaff, and Magnus Lindelow. QuantitativeTechniques for Health Equity Analysis. Washington D.C.: The World Bank, forthcoming.Among the topics covered in this comprehensive overview of available quantitativetechniques are the measurement of living standards using a wealth index and otherapproaches (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 ofinformation for each household that are designed to help investigators prepare quintilespecifictabulations for any indicator. These are: 1) the household wealth score; and 2)the economic quintile to which individuals in the household belong. Any tabulationusing these pieces of information will be comparable to the figures appearing here.- 64 -


ANNEX B. USE OF INFORMATION FROM THIS REPORTTO MONITOR THE ECONOMIC STATUS OF PEOPLESERVED BY HNP PROGRAMSThe wealth or asset approach employed in this report can be used to monitor the economic statusof 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, fullerversion can also be employed for other types of programs, such as initiatives undertaken only insome parts of a country, or activities like mass education or outreach programs that do not operatethrough facilities.BASIC MONITORING OF NATIONWIDE FACILITY-BASED PROGRAMSThe economic distribution of patients in a nationwide, facility-based program (say, a network ofrural health posts, antenatal care clinics, emergency obstetrical facilities, or hospitals) can bedetermined through an exit survey of facility patients, using the wealth questionnaire and the setof quintile cut-off points that immediately follow this text, and which have been created using theinformation presented in part III.C. The questionnaire can be employed to measure the economicstatus of any individual responding to the questions on it. The set of cut-off points can serve tocompare the distribution of the respondents’ economic status with that of the nationallyrepresentativesample of people interviewed by the DHS survey on which the present report isbased.The first step is to use the questionnaire in interviewing an adequately-large sample of patientsattending the facility-based services of interest. The wealth score for each patient can then becalculated by multiplying the response to each question by the item scores also provided on thequestionnaire, and summing the results. After this has been done, the quintile cut-off points canbe used to place each individual in the economic quintile to which (s)he belongs. The number ofpatients 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 thenationally-representative DHS sample, the patients belonging to any such quintile containingsignificantly more (or less) than 20 percent of the total are over- (under-) represented relative tothe national population. When the percentage of patients in each of the five quintiles is viewed asa whole, the result is a frequency distribution that indicates the spread of service beneficiariesacross economic classes of individuals. 21 For example:21 That is, across economic classes of all individuals in the sample population. Estimates pertaining to quintiles of onlythose individuals needing services require adjusting the results of the procedure described here through application ofthe relevant quintile-specific, sample-size figures presented in part III.A.- 65 -


• A service that favors the poorest people would have substantially more than 20percent of its patients in each of the lowest one or two economic quintiles; considerably less than20 percent of its patients in each of the highest quintiles.• A service that reaches all economic classes equally would draw roughly the sameproportion of total patients from the lower and upper quintiles.• A service that favors the least poor population groups would have well over 20percent of its patients in each of the highest one or two quintiles, considerably less than 20percent of its patients in each of the lowest quintiles.FULLER MONITORING OF FACILITY-BASED AND OF OTHER PROGRAMSWhile capable of providing far more information than currently exists about the distribution of aprogram’s beneficiaries, the approach just described has important limitations. For example, itcannot deal with the many important types of health programs that do not deliver servicesprimarily 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 assessprograms working only with certain areas within a country: it can compare the economic statusof the programs’ beneficiaries with that of the national population, but not with that of thespecific sub-national areas where the programs are active. Further, it focuses primarily on onlyone of the two important dimensions of monitoring the distribution of program beneficiaries: thatis, incidence or focus – the percentage of program benefits that flow to the poor. It cannot dealnearly so well with the second dimension, which concerns coverage, or the percentage of the poorthat the program reaches.These limitations can be overcome by a modified version of the approach described above thatrelies on a household- rather than facility-based survey. A household survey can generate a set ofdata containing the full range of information needed to produce an equity assessment bycollecting two types of information: first, about the household’s wealth or assets, using thequestions in the left-hand column of the attached questionnaire; 22 and second, about thehousehold 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 ofinformation desired:• One way would be to use only data from the household survey. The procedure wouldbe analogous to that for a DHS survey employed in this report:– Asset information from the survey-generated data set would be used asthe basis for the construction of a wealth index, weighting the individual items usingsome method like principal components analysis.– The individuals in the sample would be ranked in order of the indexvalues for their households, then divided into groups like quintiles.– The coverage rates in each quintile for the service of interest would becalculated.22 Or, if one is willing to forego the benefits of the second analytical approach described below, using any of severalother 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. MahoodKhan and David Hotchkiss of the PHR Plus project (which can be found at: www.phrplus.org).- 66 -


• A second approach would be to use the weights for each item appearing on theattached questionnaire in determining the wealth of each individual, instead of calculating theweights from the new household data set. Once the individuals’ wealth is determined, theindividuals would be ranked, divided into quintiles, and the coverage rate in each quintile wouldbe calculated. In the case of programs undertaken in only one region of the country, it wouldprovide a comparison of the economic status of the people served with that of the entire countryrather than of only the region where the programs are active;23 in the case of nationwide as wellas regional programs, it would permit a comparison with the other service programs covered inthis report.23 This additional perspective could be particularly helpful in an assessment of a program seeking to reach the poor byfocusing on especially backward districts. A report presenting only a finding that the program was reaching the betteroffpeople in those districts could produce an impression that it had failed to reach its intended beneficiaries. But acomparison between the economic status of the program’s beneficiaries with that of the national population might wellreveal that most of the beneficiaries were poor by national standards and that the program was thus considerably moresuccessful than otherwise thought.- 67 -


Armenia2000 - ASSET QUESTIONNAIREQuestion Score if Score if Item"Yes" "No" Score1. In your household, is/are there?Electricity 0.00259 -0.23172One or more radios 0.10561 -0.06704One or more televisions 0.02207 -0.15347One or more refrigerators 0.04518 -0.12758One or more bicycles -0.00946 0.00062One or more motorcycles, scooters -0.08034 0.00149One or more cars, trucks 0.01708 -0.00533One or more telephones 0.08942 -0.138702. Do the members of your household work their own or family's agricultural land? 0.00863 -0.029013. What is the principal source of drinking water for your household?Piped water in residence 0.14753 -0.21523Piped water in yard, plot -0.20759 0.07181Piped water in public tap -0.21492 0.01320Protected well in residence -0.48604 0.00008Protected public well 0.00419 0.00000Protected well in yard, plot -0.11648 0.00012Unprotected well in residence -0.21727 0.00015Unprotected well in yard, plot -0.28344 0.00100Unprotected public well -0.22438 0.00049Rainwater -0.22423 0.00004Springwater -0.25477 0.01826River, canal, surface water -0.32432 0.00043Tanker truck -0.15139 0.00172Other -0.15660 0.000714. What is the principal type of fuel for cooking used by your household?Electricity 0.10690 -0.05689Gas -0.00479 0.00073Liquid gas 0.15257 -0.03257Kerosene 0.02315 -0.00027Charcoal -0.08836 0.00054Wood -0.16608 0.03874Dung, manure -0.23153 0.03659Other -0.01711 0.000025. What is the principal type of toilet facility used by your household?Private flush toilet 0.16198 -0.20231Shared flush toilet 0.04965 -0.00162Private pit latrine -0.22396 0.13519Shared pit latrine -0.19965 0.00677Private latrine -0.00337 0.00000Shared latrine -0.22056 0.00030Bush, field as latrine -0.32451 0.00038Other type of latrine 0.00065 0.00000- 69 -


Armenia2000 - ASSET QUESTIONNAIRE (Cont.)Question Score if Score if Item"Yes" "No" Score6. What is the principal material used for the floors in your household?Dirt, earth -0.17013 0.00275Cement -0.19752 0.01295Wood plank -0.11614 0.13199Parquet, polished wood 0.22374 -0.10752Linoleum -0.02927 0.00107Carpet 0.17375 -0.00524Other -0.02121 0.00002Total Household Asset Score (sum of individual item scores)2000 - QUINTILE CUT-OFF POINTSWealth QuintileBottom Cut-OffAsset Index ValueTop Cut-OffLow Low -0.99899Second -0.99899 -0.26867Third -0.26867 0.58439Fourth 0.58439 1.16402High 1.16402 High- 70 -


ANNEX C. COUNTRIES COVERED BY THE HNP - POVERTYREPORT PROJECT*East Asia and PacificCambodia 2000Indonesia 1997, 2002-03Philippines 1998, 2003Vietnam 1997, 2002Europe and Central AsiaArmenia 2000Kazakhstan 1995, 1999Kyrgyz Rep. 1997Turkey 1993, 1998Turkmenistan 2000Uzbekistan 1996Latin America and the CaribbeanBolivia 1998, 2003Brazil 1996Colombia 1995, 2000, 2005Dominican Rep. 1996, 2002Guatemala 1995, 1998-99Haiti 1994-95, 2000Nicaragua 1997- 98, 2001Paraguay 1990Peru 1996, 2000Middle East and North AfricaEgypt 1995, 2000Jordan 1997Morocco 1992, 2003-04Yemen 1997South AsiaBangladesh 1996-97, 1999-2000, 2004India 1992-93, 1998-99Nepal 1996, 2001Pakistan 1990-91Sub-Saharan AfricaBenin 1996, 2001Burkina Faso 1992-3, 1998-9, 2003Cameroon 1991, 1998, 2004Central African Rep. 1994-95Chad 1996-97, 2004Comoros 1996Cote d'Ivoire 1994Eritrea 1995Ethiopia 2000Gabon 2000Ghana 1993, 1998, 2003Guinea 1999Kenya 1993, 1998, 2003Madagascar 1997Malawi 1992, 2000Mali 1995-96, 2001Mauritania 2000-01Mozambique 1997, 2003Namibia 1992, 2000Niger 1998Nigeria 1990, 2003Rwanda 2000Senegal 1997South Africa 1998Tanzania 1996, 1999, 2004Togo 1998Uganda 1995, 2000-01Zambia 1996, 2001-02Zimbabwe 1994, 1999* Note: electronic versions of reports for all countriesare currently available at: www.worldbank.org/povertyandhealth/countrydata. While supplies last,paper copies may be obtained at no charge by sendinga request to the World Bank’s health advisory service:healthpop@worldbank.org.- 71 -


About this series...This series is produced by the Health, Nutrition, and Population (HNP)Family of the World Bank’s Human Development Network. The findings,interpretations, and conclusions expressed in this paper areentirely those of the authors and should not be attributed in any mannerto the World Bank, to its affiliated organizations or to the members of itsBoard of Executive Directors or the countries they represent.For free copies of the papers in this series please contact the HNPAdvisory Service (healthpop@worldbank.org, tel 1-202-473-2256,fax 1-202-522-3234).The world bank1818 H Street, NWWashington, DC USA 20433Telephone: 202 473 1000Facsimile: 202 477 6391Internet: www.worldbank.orgE-mail: feedback@worldbank.org

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