Zambia Demographic and Health Survey 2001-2002 - Measure DHS

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In looking at issues that might cause the difference between the two estimates, potential biasesand differences in methodology between ANC surveillance and ZDHS need to be recognised. ANC sentinelsurveillance collects HIV prevalence data by testing currently pregnant women age 15-39 who attendantenatal care clinics during their pregnancy. These data are then used to derive estimates of HIV prevalencein the general population. It is recognized that there are a number of potential problems with thisapproach (UNAIDS/WHO Working Group on Global HIV/AIDS and STI Surveillance, 2000). First,there is a gender gap due to the fact that men are not tested in ANC clinics, and HIV prevalence levelstypically differ between men and women. Furthermore, women who attend antenatal care clinics are defacto sexually active. Thus, the HIV prevalence will necessarily be higher in this group than in the femalepopulation as a whole, where some women are not sexually active and hence not exposed to the virus.HIV prevalence levels also vary with age, and women who attend antenatal care clinics have a differentage distribution than the female population at large. Geographic coverage is another issue with the ANCsentinel data. Generally, the data come from a limited number of antenatal care clinic sites that tend to beconcentrated in urban or semi-urban areas, where HIV rates are higher. In the ANC surveillance in Zambiain 1998, there were 22 ANC sentinel sites, only 5 of which were characterised as rural.Results from population-based surveys like the 2001-2002 ZDHS can more accurately portray theHIV prevalence in a community because they involve nationally representative samples. Thus, the pool ofpeople tested closely mirrors the entire population. However, surveys are not completely without problems.First, a survey involves a sample of the population and, thus, is subject to natural variability inherentin the process of drawing a sample. Participation biases can also affect the representativeness of thesurvey data. Because individuals can refuse to be tested, population-based surveys may under-representsome groups. As discussed earlier (see Section 14.1.3), the ZDHS HIV data were weighted to take intoaccount differential response rates by sex and province.In assessing the factors that might underlie the difference between the 2001-2002 ZDHS and theANC surveillance estimates, two approaches are employed (Dzekedzeke, 2003). First, to more directlycompare the ZDHS and ANC results, a “catchment” approach is used. For this approach, all ZDHS clusterswithin a 2-kilometer radius of urban antenatal care sentinel sites and within a 5-kilometer radius ofrural sentinel sites were identified. There were 29 of these “catchment” clusters, out of a total of 320 clustersin the 2001-2002 ZDHS. The “catchment” clusters were located near 16 of a total of 22 antenatal caresentinel sites. HIV prevalence estimates were recalculated for the “catchment” subsets from the ZDHSand ANC surveillance. Results show that the HIV prevalence rate for the ANC clients in these 16 antenatalcare sentinel sites is 20 percent, while the rate for the adult population 15-49 in the 29 ZDHS “catchment”clusters is 19 percent.A second approach was used to explore the hypothesis that the limited coverage of ANC sentinelsites and specifically the concentration of sites in urbanized locations might be responsible for the differencebetween the survey and surveillance estimates. Nearly 3 out of every 5 women tested in the ANCsurveillance were tested at sites classified as urban. In contrast, only around 30 percent of pregnantwomen in the ZDHS sample live in urban areas. In the second approach, HIV prevalence rates for urbanand rural areas estimated based on the ANC surveillance were weighted using the urban-rural distributionof currently pregnant women in the 2001-2002 ZDHS. When the ZDHS urban-rural distribution is appliedto the ANC surveillance results, the adjusted HIV prevalence rate for the total population is 17 percentcompared with the overall rate of 16 percent as estimated in the 2001-2002 ZDHS.Based on these analyses, it can be concluded that there is fairly close correspondence between the2001-2002 ZDHS and ANC surveillance HIV prevalence rates when adjusted for the biased geographiccoverage of the ANC surveillance system.240 | Prevalence of HIV and Syphilis
ADULT MORTALITY15Ann A. WayData collected in the 2001-2002 ZDHS on the survivorship of respondents’ siblings allows for theestimation of adult mortality. This information is useful in assessing the impact of the AIDS epidemic onsurvivorship of adults in Zambia. The inclusion of questions to determine if the deaths of female siblingswere maternity-related also permits the estimation of the level of maternal mortality, a major indicator ofmaternal health and well-being.15.1 ADULT MORTALITY DATA15.1.1 Data Collection ProceduresWomen in the 2001-2002 ZDHS were asked about the survivorship of all live births of their naturalmother (i.e., their siblings). To obtain these data, each female respondent was first asked to give thetotal number of her mother’s live births. Then she was asked to provide a list of the children born to hermother starting with the first-born. For each sibling named, information was obtained on whether the siblingwas still alive at the survey date. For living siblings, current age was collected; for deceased siblings,age at death and years since death were collected. Interviewers were instructed that when a respondentcould not provide precise information on age at death or years since death, approximate answers wereacceptable. For sisters who died at age 12 or older, three questions were used to determine if the deathwas maternity-related: “Was [NAME OF SISTER] pregnant when she died?” and if negative, “Did she dieduring childbirth?” and if negative, “Did she die within six weeks of the birth of a child or pregnancytermination?”The direct approach to estimating adult and maternal mortality maximises use of these data forestimating adult mortality. The number of person-years of exposure to mortality risk for all siblings andthe number of sibling deaths is aggregated for defined calendar periods. Rates of maternal (and adult)mortality are obtained for the calendar periods by dividing maternal (or all female and male adult) deathsby person-years of exposure (Rutenberg and Sullivan, 1991).15.1.2 Data Quality AssessmentEstimation of adult and maternal mortality requires reasonably accurate reporting of the numberof sisters and brothers that the respondent ever had, the number who have died, and the number of sisterswho have died of maternity-related causes. There is no definitive procedure for establishing the completenessor accuracy of retrospective data on sibling survivorship. However, Table 15.1 looks at severalindicators relevant to the quality of sibling survivorship data including the sex ratio of the siblings reportedby respondents and the completeness of the data on siblings’ survival status (i.e., current age, ageat death, and years since death).The sex ratio of enumerated siblings (the ratio of brothers to sisters) is 1.01, only slightly lowerthan the expected value of 1.02 or 1.03 (see Table 15.1). Respondents were knowledgeable about theirsiblings’ survival status, with only 9 out of over 50,000 siblings missing this information. Ages weremissing for only a few living siblings (0.1 percent). In the case of deceased siblings, complete reportingof age at death and years since death were also nearly universal; almost all (>99 percent) of deceasedAdult Mortality │ 241
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ZambiaDemographic andHealth Survey2
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This report summarises the findings
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Page3.6 Women’s Employment ......
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Page11.3.2 Micronutrient Intake amo
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PageA.7 Sample Selection ..........
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PageTable 3.11 Decision on use of e
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Table 7.7 Wanted fertility rates ..
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PageTable 13.5 Discussion of HIV/AI
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PREFACEThe Zambia Demographic and H
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FAMILY PLANNINGKnowledge of contrac
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According to mothers’ reports, ar
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ZAMBIALake TanganyikaLake MweruTanz
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The 1980s marked the start of the f
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the peripheral structures. An impor
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ing in private households in the co
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subjects agreed) received a referra
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confidentiality.Finally, in additio
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CHARACTERISTICS OF HOUSEHOLDS AND2R
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Figure 2.2 Distribution of De Facto
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2.4 EDUCATIONAL LEVEL OF HOUSEHOLD
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Figure 2.3 Percent Distribution of
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Figure 2.4 Net and Gross Attendance
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2.5 HOUSING CHARACTERISTICS ANDHOUS
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Thirty percent of households own a
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CHARACTERISTICS OF RESPONDENTS3AND
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enrolment ratios suggest that educa
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3.3 LITERACYThe ability to read is
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Figure 3.1 Youth Literacy100 Percen
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3.5 MEN’S EMPLOYMENTMale responde
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Table 3.6 Occupation: menPercent di
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Table 3.8 Employment status: womenP
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non-agricultural occupations, since
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Table 3.12 Women’s control over e
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Table 3.14.1 Women’s participatio
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Table 3.14.2 Women’s participatio
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Table 3.15.1 Women’s attitudes to
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3.7.3 Attitudes toward Refusing Sex
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Table 3.16.2 Men’s attitudes towa
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Table 3.17.1 Smoking of tobacco: wo
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FERTILITY4Richard Banda and Margare
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As the comparison in Figure 4.1 ind
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Figure 4.3 Total Fertility Rate by
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Table 4.4 Trends in fertility by ba
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Results from the 2001-2002 ZDHS ind
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The median birth interval is 33 mon
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4.6 TEENAGE FERTILITYAdolescent chi
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FERTILITY REGULATION5Mika Bwembya a
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Table 5.1.2 Knowledge of contracept
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Seventy percent of currently marrie
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Table 5.4 Current use of contracept
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Table 5.7 Number of children at fir
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Table 5.10 Source of contraceptionP
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The pattern is slightly different f
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5.14 EXPOSURE TO FAMILY PLANNING ME
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Table 5.16.1 Exposure to specific r
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Table 5.17 shows that 18 percent of
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Table 5.19 Attitudes of couples tow
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Table 6.1 shows that one-fourth of
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Table 6.3 Age at first marriagePerc
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Table 6.5 Age at first sexual inter
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Table 6.7.1 Recent sexual activity:
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Almost four in ten (38 percent) of
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FERTILITY PREFERENCES AND UNMET NEE
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The above results show an increase
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7.3 UNMET NEED FOR FAMILY PLANNINGW
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Figure 7.4 Unmet Need for Spacing a
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The mean ideal number of children f
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Table 7.7 shows the total wanted fe
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Fifty-nine percent of all neonatal
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Table 8.3 Early childhood mortality
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Table 8.5 Early childhood mortality
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Only 27 percent of births are in a
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MATERNAL AND CHILD HEALTH9Miriam Ch
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Expectant mothers should beginanten
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There are particularly sharp differ
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Table 9.5 Place of deliveryPercent
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Table 9.7 shows that only 2 percent
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Table 9.8 Postnatal carePercent dis
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Table 9.9 Visits by health workersP
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Table 9.10.2 Neighbourhood Health C
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No major variations were observed w
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Table 9.13 Vaccinations by backgrou
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Table 9.14 Prevalence of injections
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Eastern province has the highest pr
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Table 9.18 Diarrhoea treatmentPerce
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Table 9.20 Household knowledge and
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10.1.1 Use of Bednets by Children a
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Table 10.4 Use of antimalarial drug
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Luapula province has the highest pe
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INFANT FEEDING, NUTRITIONAL PRACTIC
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than half (51 percent) of the infan
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tamination after cleaning, the nipp
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11.2 COMPLEMENTARY FEEDING11.2.1 Ty
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Few children under two years of age
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Table 11.6 Iodisation of household
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11.3.2 Micronutrient Intake among C
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11.3.3 Micronutrient Supplementatio
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11.4 HOUSEHOLD FOOD SECURITYFood se
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Table 11.12 Nutritional status of c
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Table 11.12 indicates that children
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VIOLENCE AGAINST WOMEN 12Mary Kazun
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Table 12.2 Experience of beatings o
Page 209 and 210: Results show that almost eight out
Page 211 and 212: Table 12.5 Experience of sexual vio
Page 213 and 214: More than four out of ten never-mar
Page 215 and 216: AIDS/HIV/STI-RELATED KNOWLEDGE AND1
Page 217 and 218: Table 13.2 Knowledge of ways to avo
Page 219 and 220: Knowledge of HIV prevention methods
Page 221 and 222: Table 13.5 Discussion of HIV/AIDS w
Page 223 and 224: The view that HIV status of a famil
Page 225 and 226: Table 13.8 Knowledge of “Trendset
Page 227 and 228: Figure 13.1 Unmet Need for HIV Test
Page 229 and 230: Table 13.10 Men's attitudes toward
Page 231 and 232: Men in sales and services and skill
Page 233 and 234: Table 13.13 Alcohol consumption by
Page 235 and 236: Table 13.14.2 Knowledge of symptoms
Page 237 and 238: The peak age for having STI symptom
Page 239 and 240: used condoms, 34 percent took medic
Page 241 and 242: The practice of having multiple par
Page 243 and 244: Table 13.21 Use of condoms by type
Page 245 and 246: PREVALENCE OF HIV AND SYPHILIS 14Ku
Page 247 and 248: 14.1.2 Coverage for HIV Testing by
Page 249 and 250: 14.1.3 Approach to Weighting Syphil
Page 251 and 252: 14.2 SYPHILIS PREVALENCE RATES 1Tab
Page 253 and 254: Table 14.8 Syphilis prevalence by a
Page 255 and 256: The 2001-2002 ZDHS data can be used
Page 257 and 258: Figure 14.2 illustrates the distinc
Page 259: Figure 14.3 HIV Prevalence AmongWom
Page 263 and 264: Table 15.2 Adult mortality ratesDir
Page 265 and 266: While again not definitive, the res
Page 267 and 268: 124 | ReferencesGaisie, K., A. Cros
Page 269 and 270: SAMPLE DESIGNAppendix AA.1 INTRODUC
Page 271 and 272: Table A.2. Expected number of selec
Page 273 and 274: Similarly, a total of 2,658 potenti
Page 275 and 276: Table A.5 Sample implementation: me
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Page 279 and 280: Table B.2 Sampling errors for selec
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Page 289 and 290: Table B.12 Sampling errors for sele
Page 291 and 292: DATA QUALITY TABLESAppendix CTable
Page 293 and 294: Table C.3 Completeness of reporting
Page 295 and 296: Table C.6 Reporting of age at death
Page 297 and 298: Provincial CoordinatorsMr Martin Nj
Page 299 and 300: Data Processing StaffMr Mathews Muv
Page 301 and 302: 286 | Appendix E
Page 303 and 304: HOUSEHOLD SCHEDULENow we would like
Page 305 and 306: LINENO.USUAL RESIDENTSAND VISITORSR
Page 307 and 308: NO. QUESTIONS AND FILTERS CODING CA
Page 309 and 310: NO. QUESTIONS AND FILTERS CODING CA
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INFORMED CONSENT FOR SYPHILIS AND H
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September 28, 20012001 ZAMBIA DEMOG
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SECTION 1. RESPONDENT’S BACKGROUN
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SECTION 2: REPRODUCTIONNO. QUESTION
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212 213 214 215 216 217IF ALIVE:218
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NO QUESTIONS AND FILTERS CODING CAT
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NO. QUESTIONS AND FILTERS CODING CA
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NO. QUESTION AND FILTERS CODING CAT
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NO. QUESTION AND FILTERS CODING CAT
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407AWhere did the first antenatal v
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NAMELAST BIRTHNEXT-TO-LAST-BIRTHNAM
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NAMELAST BIRTHNEXT-TO-LAST-BIRTHNAM
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SECTION 4B. IMMUNIZATION, HEALTH AN
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LAST BIRTHNEXT-TO-LAST BIRTHNAMENAM
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LAST BIRTHNEXT-TO-LAST BIRTH474B CH
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LAST BIRTHNEXT-TO-LAST BIRTH480 Wha
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NO QUESTIONS AND FILTERS CODING CAT
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SECTION 5. MARRIAGE AND SEXUAL ACTI
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SECTION 6. FERTILITY PREFERENCESNO.
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SECTION 7. HUSBAND'S BACKGROUND AND
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SECTION 9. MATERNAL MORTALITYNO. QU
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904 What wasname given toyour oldes
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NAME OF EDITOR:____________________
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SUPERVISOR FIELD EDITOR OFFICE EDIT
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14 Have you heard of any other ways
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SECTION 5. FERTILITY PREFERENCESNO.
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SECTION 7. AIDS AND OTHER SEXUALLY
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Zambia Demographic and Health Survey 2001-2002 - Measure DHS

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