Egypt Demographic And Health Survey 2008
Egypt 2008Egypt2008Demographic and Health SurveyDemographic andHealth Survey
EgyptDemographic and Health Survey2008Fatma El-ZanatyAnn WayMarch 2009El-Zanaty andAssociatesMinistry of Health
The 2008 Egypt Demographic and Health Survey (2008 EDHS) was conducted on behalf of the Ministry of Health by ElZanaty and Associates. The Central Laboratory at the Ministry of Health was responsible for the hepatitis C testingcomponent of the survey. The 2008 EDHS is part of the worldwide MEASURE DHS project which is funded by theUnited States Agency for International Development (USAID). USAID/Cairo was the main contributor of funding for thesurvey. Support for the survey was also provided by UNICEF. The opinions expressed herein are those of the authors anddo not necessarily reflect the views of USAID and UNICEF.Additional information about the 2008 EDHS may be obtained from the Ministry of Health, 3 Magles El Shaab Street,Cairo, Egypt; Telephone: 20-2-27948555 and Fax: 20-2-27924156.Information about DHS surveys may be obtained from the MEASURE DHS Project, Macro International, 11785Beltsville Drive, Calverton, MD 20705 USA; Telephone: 301-572-0200, Fax: 301-572-0999, E-mail:reports@macrointernational.com, Internet: http://www.measuredhs.com.Recommended citation:El-Zanaty, Fatma and Ann Way. 2009. Egypt Demographic and Health Survey 2008. Cairo, Egypt: Ministry of Health,El-Zanaty and Associates, and Macro International.
CONTENTSPageTABLES AND FIGURES .ixPREFACE . xixACKNOWLEDGMENTS . xxiSUMMARY OF FINDINGS . xxiiiMAP OF EGYPT . xxxCHAPTER 11.11.21.31.41.5CHAPTER 22.12.22.32.42.5CHAPTER 33.1INTRODUCTIONGeography .1Population Size and Structure .1Recent Rate of Natural Increase .12008 Egypt Demographic and Health Survey .31.4.1Organization and Objectives .31.4.2Timetable .31.4.3Sample Design.41.4.4Questionnaire Development.61.4.5Biomarker Data Collection.71.4.6Pretest .71.4.7Data Collection Activities.81.4.8Fieldwork .91.4.9Data Processing Activities.10Survey Coverage .10CHARACTERISTICS OF HOUSEHOLDSCharacteristics of the Household Population .132.1.1Age and Sex Composition.132.1.2Household Composition .15Education of the Household Population .16Housing Characteristics .182.3.1Drinking Water Access and Treatment .182.3.2Drinking Water Storage Practices .202.3.3Sanitation Facilities and Waste Disposal.212.3.4Other Housing Characteristics.22Household Possessions.23Household Wealth.25BACKGROUND CHARACTERISTICS OF RESPONDENTSBackground Characteristics of the Ever-married Women Sample.273.1.1Demographic and Socio-economic Characteristics.27Contents iii
3.23.33.4CHAPTER 44.14.24.34.44.54.64.7CHAPTER 55.15.25.35.45.55.65.7CHAPTER 66.16.26.3iv Contents3.1.2Educational Attainment.293.1.3Literacy.303.1.4Exposure to Mass Media .313.1.5Employment Status .33Women’s Participation in Household Decision-making .373.2.1Disposal of Earnings .373.2.2Women’s Roles in Household Decision-Making.41Women’s Attitude toward Wife Beating .42Background Characteristics of Respondents Eligible for Health IssuesInterview.44FERTILITYCurrent Fertility Levels by Residence .47Fertility Differentials by Background Characteristics.49Fertility Trends .504.3.1Retrospective Data .504.3.2Comparison with Previous Surveys.51Children Ever Born and Living .52Birth Intervals.544.5.1Intervals between Births.544.5.2Attitudes about the Ideal Birth Interval.56Age at First Birth.56Teenage Pregnancy and Motherhood.57KNOWLEDGE, ATTITUDES, AND EVER USE OF FAMILY PLANNINGKnowledge of Family Planning Methods .59Exposure to Family Planning Messages .60Knowledge of Fertile Period .62Knowledge of Breastfeeding as a Family Planning Method.63Ever Use of Family Planning .655.5.1Levels of Ever Use.655.5.2Trends in Ever Use.665.5.3Differentials in Ever Use.67First Use of Family Planning .68Attitude about Timing of Adoption of Contraception.68CURRENT USE OF FAMILY PLANNINGCurrent Use of Family Planning .71Differentials In Current Use Of Family Planning .716.2.1Differentials by Residence.716.2.2Differentials by Selected Background Characteristics.726.2.3Differentials by Governorate .74Trends in Current Use of Family Planning.756.3.1Trends by Method .756.3.2Trends by Urban-Rural Residence and Place of Residence .77
6.46.56.66.76.8CHAPTER 77.17.27.37.47.57.6CHAPTER 88.18.28.38.48.5CHAPTER 99.19.29.39.4CHAPTER 1010.110.210.310.46.3.3Trends by Governorate .78Sources for Modern Family Planning Methods.796.4.1Sources by Method.796.4.2Sources by Method and Residence .806.4.3Trends in Sources of Modern Methods .81Pill Brands.82Cost of Methods.836.6.1Pill Users .836.6.2Injectable Users .836.6.3IUD Users.84Participation in Family Planning Decisions.85Informed Choice .86NONUSE OF FAMILY PLANNING AND INTENTION TO USEDiscontinuation Rates .89Reasons for Discontinuation of Contraceptive Use .91Intention to Use Contraception in the Future .92Reasons for Nonuse .92Preferred Method .93Contact of Nonusers with Outreach Workers/Health Care Providers .93PROXIMATE DETERMINANTS OF FERTILITYMarital Status .97Consanguinity .98Age at First Marriage .99Postpartum Amenorrhea, Abstinence, and Insusceptibility. 101Termination of Exposure to Pregnancy . 103FERTILITY PREFERENCESDesire for More Children . 105Need for Family Planning. 108Ideal Number of Children . 110Unplanned and Unwanted Fertility . 113INFANT AND CHILD MORTALITYAssessment of Data Quality . 115Levels and Trends in Early Childhood Mortality . 11610.2.1 Levels of Mortality . 11610.2.2 Trends in Mortality Based on Retrospective Data . 11610.2.3 Trends in Mortality Based on Data from Multiple Surveys . 117Differentials in Mortality. 11810.3.1 Socioeconomic Differentials . 11810.3.2 Demographic Differentials . 120Perinatal Mortality. 121Contents v
10.5CHAPTER 1111.111.211.311.411.511.611.711.811.9CHAPTER 1212.112.212.312.4CHAPTER 1313.1vi ContentsHigh-Risk Fertility Behavior . 123MATERNAL HEALTH CARE AND OTHER WOMEN’S HEALTH ISSUESPregnancy Care. 12511.1.1 Antenatal Care Coverage . 12511.1.2 Tetanus Toxoid Vaccinations . 12611.1.3 Any Medical Care During Pregnancy . 12711.1.4 Differentials in Pregnancy Care Indicators . 127Content of Pregnancy Care . 129Delivery Care. 13111.3.1 Place of Delivery . 13111.3.2 Assistance at Delivery . 13311.3.3 Caesarean Deliveries . 13511.3.4 Birth Weight . 135Trends in Antenatal and Delivery Care Indicators . 136Postnatal Care. 13811.5.1 Postnatal Checkup for the Mother . 13811.5.2 Postnatal Checkup for the Baby . 140Family Planning and Breastfeeding Advice. 143Exposure to Safe Pregnancy Messages . 143Sexually Transmitted Infections . 145Women’s Access to Health Care . 147CHILD HEALTHImmunization of Children . 14912.1.1 Collection of Data . 14912.1.2 Routine Immunization against Common Childhood Illnesses . 14912.1.3 Trends and Differentials in Vaccination Coverage . 15112.1.4 Participation in National Immunization Days . 153Acute Respiratory Infection . 15312.2.1 Prevalence of ARI . 15312.2.2 Consultation, Treatment, and Feeding Practices. 15412.2.3 Differentials in ARI Prevalence and Responses to the Illness . 155Diarrhea . 15712.3.1 Prevalence of Diarrhea . 15712.3.2 Consultation, Treatment and Feeding Practices. 15812.3.3 Differentials in Feeding and Treatment Practices. 159Disposal of Children’s Stools . 162FEEDING PRACTICES AND MICRONUTRIENT SUPPLEMENTATIONBreastfeeding and Supplementation . 16513.1.1 Initiation of Breastfeeding . 16513.1.2 Introduction of Complementary Feeding . 16713.1.3 Median Durations and Frequency of Breastfeeding andPrevalence of Bottle-feeding . 169
13.213.3CHAPTER 1414.114.214.3CHAPTER 1515.115.215.315.415.515.615.7CHAPTER 1616.116.216.316.416.516.616.7CHAPTER 1717.117.217.3Dietary Diversity among Children and Women . 17113.2.1 Foods and Liquids Consumed by Infants and Young Children . 17113.2.2 Appropriate Infant and Young Child Feeding . 17213.2.3 Foods and Liquids Consumed by Women. 175Micronutrient Supplementation . 17613.3.1 Use of Iodized Salt. 17713.3.2 Micronutrient Intake among Young Children . 17813.3.3 Micronutrient Intake among Mothers. 180NUTRITIONAL STATUSNutritional Status of Children . 18314.1.1 Measurement of Nutritional Status among Young Children . 18314.1.2 Results of Data Collection . 18414.1.3 Levels of Child Malnutrition . 18414.1.4 Trends in Child Nutrition . 188Nutritional Status of Never-married Youth and Young Adults. 18814.2.1 Measurement of Nutritional Status among Youth and Young Adults . 18914.2.2 Results of Data Collection . 18914.2.3 Levels of Malnutrition among Never-married Youth andYoung Adults . 189Nutritional Status of Women and Men . 192FEMALE CIRCUMCISIONPrevalence of Female Circumcision among Women Age 15-49. 197Women’s Circumcision Experience . 198Prevalence of Female Circumcision among Young Girls. 199Circumcision Experience of Young Girls . 201Support for Female Circumcision among Women and Men . 202Reasons for Support of Female Circumcision. 204Exposure to Information about Circumcision . 207AVIAN INFLUENZAHousehold Ownership of Poultry and Other Birds . 209Locations Where Poultry Kept . 211Awareness of Avian Influenza. 213Awareness of Avian Influenza Symptoms in Poultry/Birds . 215Awareness of Avian Influenza Risks and Symptoms Among Humans. 217Awareness of Modes of Transmission and Prevention . 218Attitudes towards Avian Influenza Risks . 221ADULT HEALTH ISSUESUse of Tobacco. 223History of Diabetes and Cardiovascular Disease . 227High Blood Pressure. 228Contents vii
17.417.517.6CHAPTER 1818.118.218.318.4CHAPTER 1919.119.219.319.419.5CHAPTER 2020.120.220.320.4Lifetime History of Medical Procedures and Injections . 235Recent History of Injections . 237Awareness of Safe Injection Practices . 239KNOWLEDGE AND PREVALENCE OF HEPATITIS CHepatitis C Knowledge. 241Self-reported Prevalence of Hepatitis C and Liver Disease . 246Hepatitis C Testing in the 2008 EDHS . 24718.3.1 Heptatitis C Testing Protocol. 24718.3.2 Coverage of the HCV Testing. 24818.3.3 Return of the Results of the HCV Testing . 251Prevalence of Hepatitis C . 251KNOWLEDGE AND ATTITUDES ABOUT HIV/AIDSKnowledge of HIV/AIDS. 259Knowledge of Mother-to-Child Transmission . 263Accepting Attitudes towards People Living with AIDS. 265Knowledge of a Source for HIV Testing . 268Sources of Information about AIDS . 269HEALTH CARE EXPENSES AND HEALTH CARE COVERAGEExpenses Associated with Health Provider Visits . 271Expenses Associated with Hospital Stays. 274Expenses Associated with Maternal Health Services. 276Health Insurance Coverage . 278REFERENCES . 281APPENDIX APERSONS INVOLVED IN THE 2008 EGYPT DEMOGRAPHICAND HEALTH SURVEY . 285APPENDIX BSAMPLE DESIGN . 291APPENDIX CESTIMATES OF SAMPLING ERRORS . 297APPENDIX DDATA QUALITY TABLES . 311APPENDIX ENUTRITIONAL STATUS OF CHILDREN: 2008 EDHS DATAACCORDING TO THE NCHS/CDC/WHO INTERNATIONALREFERENCE POPULATION . 317APPENDIX FQUESTIONNAIRES. 321viii Contents
TABLES AND FIGURESPageCHAPTER 1INTRODUCTIONTable 1.1Table 1.2Table 1.3Table 1.4Population of Egypt, 1990-2007 .1Life expectancy, Egypt .2Survey timetable, 2008 EDHS .4Sample results.11Figure 1.1Trend in Natural Increase Rates. Egypt 1991-2007.2CHAPTER 2CHARACTERISTICS OF HOUSEHOLDSTable 2.1Table 2.2Table 2.3Table 2.4.1Table 2.4.2Table 2.5Table 2.6Table 2.7Table 2.8Table 2.9Table 2.10Household population by age, sex, and residence.13Trends in population distribution by age, 1988-2008.15Household composition by residence .15Educational attainment of male household population by age and residence .17Educational attainment of female household population by age and residence .18Household drinking water access and treatment by residence .19Household drinking water storage practices by residence.20Sanitation facilities by residence.21Dwelling characteristics by residence .23Household possessions by residence .24Wealth quintiles by residence .26Figure 2.1Population Pyramid of Egypt .14CHAPTER 3Table 3.1Table 3.2Table 3.3Table 3.4Table 3.5Table 3.6Table 3.7Table 3.8Table 3.9Table 3.10Table 3.11Table 3.12Table 3.13Table 3.14BACKGROUND CHARACTERISTICS OF RESPONDENTSBackground characteristics of ever-married respondents .28Educational attainment by background characteristics .29Literacy by background characteristics .31Exposure to mass media by background characteristics .33Employment status by background characteristics .34Occupation by background characteristics .36Type of employment.37Relative magnitude of woman's earnings by background characteristics.38Control over woman's earnings .39Control over husband's earnings by background characteristics .40Relative magnitude of earnings and control over woman's andhusband's earnings .41Women's participation in decision-making .41Women's participation in decision-making by background characteristics.42Attitudes towards wife beating by background characteristics .43Tables and Figures ix
Table 3.15Table 3.16Table 3.17Figure 3.1Figure 3.2CHAPTER 4Selected background characteristics of respondents eligible for healthissues interview.44Literacy status and recent exposure to mass media of respondentseligible for health issues interview .45Employment status, occupation, and type of earnings of respondentseligible for health issues interview .45Percentage of Ever-Married Women Exposed to Media at Least OncePer Week.32Occupation among Working Women .35FERTILITYTable 4.1Table 4.2Table 4.3Table 4.4Table 4.5Table 4.6Table 4.7Table 4.8Table 4.9Table 4.10Table 4.11Current fertility by residence .47Fertility by background characteristics .49Trends in age-specific fertility rates.50Trends in fertility.51Trends in fertility by residence .52Children ever born and living.53Birth intervals by background characteristics .55Ideal birth interval by residence .56Age at first birth .
The 2008 Egypt Demographic and Health Survey (2008 EDHS) wa s conducted on behalf of the Ministry of Health by El-Zanaty and Associates. The Central Laboratory at the Ministry of Health was responsible for the hepatitis C testing
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