Tanzania HIV/AIDS and Malaria Indicator Survey ... - Measure DHS

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INTRODUCTION 11.1 BACKGROUND INFORMATIONHIV continues to spread around the world. It has become increasingly apparent that theepidemic does not follow the same course in all societies. It affects different sub-groups in differentways at different times. Tanzania has been struggling against HIV infection and AIDS for almost aquarter of a century. The epidemic started in the Kagera Region with the diagnosis and reporting ofthree cases in 1983. In 1986 all regions reported the epidemic. Since then, HIV has continued tospread and there was a dramatic increase in the number of AIDS cases as more HIV-infected peoplesuccumbed to opportunistic infections arising from suppressed immune systems. As in other sub-Saharan countries, HIV infection is spread predominantly by heterosexual contact.The HIV/AIDS pandemic is an escalating phenomenon. Based on current information fromUNAIDS, 33 million people are living with the HIV virus, the vast majority of whom are in theirprime years as workers and parents. Forty-five percent of all new infections among adults are youngpeople age 15-24.Over the 25 years of the epidemic in Tanzania, emphasis has been placed on the developmentof strategies and approaches to scale up the interventions and deal with the epidemic. Despite all theseefforts, the number of people infected continues to grow because of ongoing new infections. People inurban areas have a higher prevalence relative to those in rural areas. It is estimated that about 2.2million people are living with the virus and about 400,000 are in need of anti-retroviral therapy(MOH, 2004).The devastating impact of the disease is almost incomprehensible. The consequences of theepidemic affect all spheres of life. The human capital loss has a serious social and economic impact inall sectors, and at community and individual levels. The surging of many opportunistic infections suchas tuberculosis and some forms of cancer is a result of HIV infection. The result is that manyresources are diverted from other areas to HIV prevention, care, and treatment.It has been seen that poverty significantly influences the spread of HIV/AIDS, whichultimately leads to a loss of the most productive segment of society, leading to reduction of incomeand suffering for individuals and communities. At the community level, poverty imposes enormousstrains on the extended family structure, leading to a substantial burden of orphans and vulnerablechildren (OVCs) now estimated at 17 percent in Tanzania according to the results of the 2007-08Tanzania HIV/AIDS and Malaria Indicators Survey. A social consequence is the growing number ofchild- and widow-headed households. Morbidity and mortality among parents has severely affectedchildren, especially those in school, who are forced to stay home and take care of sick parents.The economy has been adversely affected by the premature death of women and men in theirprime years of productivity. This also affects the development of institutional capacity, which requiresskilled workers and leaders. Professionals in medical care, education, agriculture, and engineering arenot easily replaced. The demographic consequences of the epidemic are reflected in the country’squality of life indicators, including the increasing level of infant mortality and the decreasing lifeexpectancy.The 2007-08 Tanzania HIV/AIDS and Malaria Indicator Survey (THMIS) was designed tomonitor the trends of HIV infection and behavioural risk factors. It is also designed to provide anestimate of the malaria prevalence among children under five. The THMIS data can be used to guidestrategic planning and evaluation of programmes, and to complement and calibrate estimates obtainedfrom other sources.Introduction | 1
1.2 NATIONAL POLICY ON HIV/AIDSIn response to the HIV/AIDS pandemic, the Government of Tanzania has made substantialvaluable progress in nearly all areas of HIV/AIDS prevention, care, and treatment. Progress has alsobeen made in impact mitigation through communication and advocacy, and community participationthrough multisectoral response, as a basis for the consolidation and expansion of the nationalresponse.The Tanzanian Government recognizes the social development challenges of the epidemicand has taken concrete measures to address these challenges. The challenges of HIV/AIDS needconcerted and multidisciplinary efforts from all sectors, government and non-government, includingcivil society organizations and the community at large. In line with this, the Tanzania Commission forAIDS (TACAIDS) was created by a statute of the Parliament in 2001. TACAIDS is mandated toprovide strategic leadership and coordination of multisectoral response as well as monitoring andevaluation, including research, resource mobilization, and advocacy. The National Policy onHIV/AIDS and the National Multisectoral Strategic Framework (NMSF) are the guiding tools for theimplementation of HIV/AIDS activities. The NMSF 2003-2007 has been completed and the secondNMSF, which covers the period 2008 to 2012, is in place. The new NMSF builds on the achievementsand strengths of the national response to the HIV epidemic in 2003-2007. Through coordination, theNMSF guides the approaches, interventions, and activities that are undertaken by stakeholders in thecountry.HIV/AIDS is among the development agenda in the National Strategy for Poverty Eradication(MKUKUTA), and the National Development Vision of 2025. The policy emphasizes themainstreaming of HIV/AIDS in all sectors. The development of the National Guideline on Preventionand Control of HIV/AIDS in the public sector is an achievement of the Government that shows itscommitment to fight the epidemic and to improve the well-being of the people. The 2007-08 THMISis a potential source of information for monitoring and evaluation of HIV/AIDS programmes in thecountry.1.3 NATIONAL POLICY ON MALARIAMalaria has been and continues to be a major cause of illness and death in both MainlandTanzania and Zanzibar. The disease remains a major impediment to socio-economic growth andwelfare. To reduce the burden of malaria, the Government of Tanzania through the Malaria ControlProgrammes, the National Malaria Control Programme (NMCP), and the Zanzibar Malaria ControlProgramme (ZMCP), have undertaken various actions supported by development partners such as theGlobal Fund to fight against HIV/AIDS, Tuberculosis and Malaria (GFATM), the US President’sMalaria Initiative (PMI), The World Bank, and UNICEF.The long-term goal of malaria control is to significantly reduce morbidity and mortality due tomalaria, with special attention to the most vulnerable groups—children under five, pregnant women,and the poor—and in so doing, to promote economic development.The goal of the National Malaria Medium Term Strategic Plan 2008–2013 is to reduce theburden of malaria by 80 percent. This goal is in line with the Global initiative, that advocates a rapidscaling of interventions to achieve the Roll Back Malaria target of universal coverage of 80 percent by2010 and the Millennium Development Goals by 2015.The main objective of the Zanzibar Malaria Medium Term Strategic Plan 2008-2012 is tofurther reduce the burden of malaria by 70 percent from the 2006 level of 35 percent to 11 percent by2012. This goal will be achieved by maintaining high coverage of effective interventions andestablishing epidemic detection and response mechanisms.2 | Introduction
Page 1 and 2: TanzaniaHIV/AIDS and MalariaIndicat
Page 3 and 4: The 2007-08 Tanzania HIV/AIDS and M
Page 5 and 6: 3.5 Access to Mass Media ..........
Page 7 and 8: 12.2 Orphans and Vulnerable Childre
Page 9 and 10: Table 4.3Table 4.4Table 4.5Table 4.
Page 11 and 12: Figure 9.2 HIV Prevlence by Region/
Page 14: FOREWORDThis report presents the ma
Page 18 and 19: SUMMARY OF FINDINGSThe 2007-08 Tanz
Page 20 and 21: HIV prevalence among youth (women a
Page 23: xxii | Map of Tanzania
Page 27 and 28: To assess levels and trends in know
Page 29 and 30: 1.8 FIELDWORKData collection was ca
Page 31 and 32: Table 1.1 Results of the household
Page 33 and 34: Figure 2.1 presents a graphic pictu
Page 35 and 36: Table 2.3.1 Educational attainment
Page 37 and 38: Educational attainment is higher in
Page 39 and 40: 2.5.1 Energy SourcesTable 2.5 prese
Page 41 and 42: The most common items are agricultu
Page 43 and 44: The 2007-08 THMIS included aquestio
Page 45 and 46: Table 3.1—ContinuedBackgroundchar
Page 47 and 48: Education is positively related to
Page 49 and 50: Table 3.3.2 Employment status: MenP
Page 51 and 52: Table 3.4.1 Exposure to mass media:
Page 53 and 54: 3.6 CURRENT MARITAL STATUSMarriage
Page 55 and 56: Polygyny also varies by household w
Page 57 and 58: Four in ten women age 20-49 marry b
Page 59 and 60: There is a positive relationship be
Page 62 and 63: FERTILITY AND REPRODUCTIVE HEALTH 4
Page 64 and 65: Table 4.2 Fertility by background c
Page 66 and 67: infertility, 1 or the inability to
Page 68 and 69: 4.3 ADOLESCENT FERTILITYAdolescent
Page 70 and 71: Table 4.7 Antenatal carePercent dis
Page 72: Table 4.8 Place of antenatal carePe
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Table 5.1 Knowledge of AIDSPercenta
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The use of condoms as an effective
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Table 5.3.2 Comprehensive knowledge
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more education) and those in the fo
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Table 5.5.1 Exposure to HIV educati
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5.6 KNOWLEDGE AND ATTITUDE CONCERNI
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Table 5.6.2 Knowledge and attitudes
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Table 6.1.1 Accepting attitudes tow
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Stigma is also found to vary with l
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6.3 ATTITUDES OF ADULTS TOWARDS EDU
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HIV/AIDS-RELATED BEHAVIOUR 77.1 INT
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Table 7.2.1 Recent sexual activity:
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Figure 7.1 Recent Sexual Intercours
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Table 7.3.2 Multiple sexual partner
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Table 7.4 Payment for sexual interc
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Table 7.5.1 Coverage of prior HIV t
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Figure 7.2 Prior HIV Testing by Edu
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7.7 PREVALENCE OF SEXUALLY TRANSMIT
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Figure 7.3 Prevalence of STIs and S
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Table 7.8 Prevalence of medical inj
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Table 8.1 Comprehensive knowledge a
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Table 8.2 Age at first sexual inter
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Never-married women and men age 15-
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Figure 8.3 Condom Use at Premarital
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Table 8.5.2 Higher-risk sexual inte
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Table 8.6 Age-mixing in sexual rela
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8.9 HIV TESTING AMONG YOUNG PEOPLEK
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HIV PREVALENCE 99.1 INTRODUCTIONPri
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Table 9.1 Coverage of HIV testing b
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Table 9.1—ContinuedBackgroundchar
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Table 9.3 HIV prevalence by ageAmon
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There are large variations in HIV p
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Table 9.5 shows that men who are cu
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Women who said they had higher-risk
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Table 9.8 shows data on HIV prevale
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Table 9.11 HIV prevalence by male c
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INFANT AND CHILD MORTALITY 1010.1 I
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As expected, the level of infant an
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category (1.41) is 41 percent highe
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11.1 OWNERSHIP AND USE OF MOSQUITO
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carrying mosquitoes. Much of the fi
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11.2 USE OF ANTIMALARIAL DRUGS DURI
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11.3 TREATMENT OF CHILDREN WITH FEV
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11.4.1 Type and Timing of Antimalar
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11.4.2 Availability of Drug at Home
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11.6 SOURCE OF MOSQUITO NETSUntil l
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In spite of steady increases in ITN
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ORPHANS AND VULNERABLE CHILDREN 12P
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12.2 ORPHANS AND VULNERABLE CHILDRE
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12.3.1 School Attendance by Survivo
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While there are no differences in p
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Table 12.7 Widows dispossessed of p
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Table 12.9 External support for orp
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REFERENCESAgot, K.E., J.O. Ndinya-A
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SAMPLE IMPLEMENTATIONAPPENDIX AAppe
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Table A.2 Sample implementation: Me
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Table A.4 Coverage of HIV testing a
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Table A.6 Coverage of HIV testing a
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where h represents the stratum whic
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Table B.2 Sampling errors for Natio
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Table B.4 Sampling errors for Rural
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Table B.6 Sampling errors for Mainl
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Table B.8 Sampling errors for Mainl
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Table B.10 Sampling errors for Zanz
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Table B.12 Sampling errors for Nort
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Table B.14 Sampling errors for Sout
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Table B.16 Sampling errors for East
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Table B.18 Sampling errors for Dodo
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Table B.20 Sampling errors for Kili
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Table B.22 Sampling errors for Moro
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Table B.24 Sampling errors for Dar
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Table B.26 Sampling errors for Mtwa
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Table B.28 Sampling errors for Irin
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Table B.30 Sampling errors for Sing
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Table B.32 Sampling errors for Rukw
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Table B.34 Sampling errors for Shin
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Table B.36 Sampling errors for Mwan
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Table B.38 Sampling errors for Many
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Table B.40 Sampling errors for Pemb
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216 | Appendix B
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Joyce MbambaYulitha MwakasoleRemigi
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QUESTIONNAIRESAppendix DAppendix D
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HOUSEHOLD SCHEDULEIntroduction and
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IF AGE 0-17 YEARSIF AGE 5 YEARS OR
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IF AGE 0-17 YEARSLINE SICK CARE SUR
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HOUSEHOLD CHARACTERISTICSNO. QUESTI
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NO. QUESTIONS AND FILTERS CODING CA
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SUPPORT FOR SICK PEOPLENO. QUESTION
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NO.QUESTIONS AND FILTERSSUPPORT FOR
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NO.QUESTIONS AND FILTERSCODING CATE
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CHILD 4 CHILD 5 CHILD 6502 LINE NUM
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515 CHECK 509:NUMBER OF CHILDREN WI
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UNITED REPUBLIC OF TANZANIATANZANIA
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213 214 215 216217 218219 220221222
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LAST BIRTH NEXT-TO-LAST BIRTH SECON
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LASTSEXUAL PARTNERSECOND-TO-LASTSEX
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SECTION 7 - HIV TESTTHIS PAGE TO BE
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