Tanzania Demographic And Health Survey And Malaria Indicator Survey .

Tanzania Demographic and Health Survey and Malaria Indicator Survey 2015-16

United Republic of Tanzania Tanzania Demographic and Health Survey and Malaria Indicator Survey 2015-2016 Final Report Ministry of Health, Community Development, Gender, Elderly and Children Dar es Salaam Ministry of Health Zanzibar National Bureau of Statistics Dar es Salaam Office of Chief Government Statistician Zanzibar ICF Rockville, Maryland USA December 2016

The 2015-16 Tanzania Demographic and Health Survey and Malaria Indicator Survey (2015-16 TDHS-MIS) was implemented by the National Bureau of Statistics (NBS) and Office of the Chief Government Statistician (OCGS), Zanzibar, in collaboration with the Ministry of Health, Community Development, Gender, Elderly and Children, Mainland, and the Ministry of Health, Zanzibar. ICF provided technical assistance. The 201516 TDHS-MIS is part of the worldwide DHS Program, which assists countries in the collection of data to monitor and evaluate population, health, and nutrition programs. The survey was funded by the Government of Tanzania, United States Agency for International Development (USAID), Global Affairs Canada, Irish Aid, United Nations Children’s Fund (UNICEF), and United Nations Population Fund (UNFPA). Additional information about the 2015-16 TDHS-MIS may be obtained from the National Bureau of Statistics, Head Office, 18 Kivukoni Road, P.O. Box 796, 11992, Dar es Salaam, Tanzania. Telephone: 25522-212-2722/3; Fax: 255-22-213-0852; E-mail: dg@nbs.go.tz; Internet: www.nbs.go.tz. Information about The DHS Program can be obtained from ICF, 530 Gaither Road, Suite 500, Rockville, MD 20850 USA. Telephone: 301-407-6500; Fax: 301-407-6501; E-mail: info@DHSprogram.com; Internet: http://www.DHSprogram.com. Recommended citation: Ministry of Health, Community Development, Gender, Elderly and Children (MoHCDGEC) [Tanzania Mainland], Ministry of Health (MoH) [Zanzibar], National Bureau of Statistics (NBS), Office of the Chief Government Statistician (OCGS), and ICF. 2016. Tanzania Demographic and Health Survey and Malaria Indicator Survey (TDHS-MIS) 2015-16. Dar es Salaam, Tanzania, and Rockville, Maryland, USA: MoHCDGEC, MoH, NBS, OCGS, and ICF.

CONTENTS TABLES AND FIGURES . ix FOREWORD . xix ACKNOWLEDGEMENTS . xxi READING AND UNDERSTANDING TABLES FROM THE 2015 TDHS-MIS . xxiii ACRONYMS AND ABBREVIATIONS . xxxiii MAP OF TANZANIA . xxxvi 1 INTRODUCTION AND SURVEY METHODOLOGY . 1 1.1 Geography, History, and the Economy. 1 1.1.1 Geography . 1 1.1.2 History . 1 1.1.3 Economy . 1 1.2 Population . 2 1.3 Population and Health Policies and Programmes . 2 1.3.1 National Population Policy . 2 1.3.2 Vision 2025 . 3 1.3.3 The National Strategy got Growth and Reduction of Poverty (NSGRP) . 3 1.3.4 The 5-Year Development Plan (FYDP I) 2011/12–2015/16 . 3 1.3.5 Big Results Now Initiative . 4 1.3.6 Health Policy. 4 1.3.7 Primary Health Care Service Development Programme (2007-2017) . 5 1.3.8 Health Sector Strategic Plan III (2009-2015). 6 1.3.9 The National Road Map Strategic Plan to Accelerate Reduction of Maternal, Newborn, and Child Deaths in Tanzania-One Plan (2008-2015) . 6 1.3.10 The Sharpened One Plan to Accelerate Progress (2014-2015) . 7 1.3.11 National Nutrition Strategy . 8 1.4 Strategic Direction for the Period 2015 to 2020 . 9 1.4.1 Health Sector Strategic Plan IV (2015-2020) . 9 1.4.2 One Plan II (2016-2020) . 10 1.4.3 National Key Result Area in Health Care . 11 1.5 Objectives and Survey Organization . 12 1.5.1 Objectives . 12 1.5.2 Survey Organization . 13 1.6 Fieldwork. 16 1.6.1 2015-16 TDHS-MIS Field Challenges . 17 1.6.2 Data Processing. 18 1.6.3 Response Rates . 18 2 HOUSING CHARACTERISTICS AND HOUSEHOLD POPULATION . 21 2.1 Drinking Water Sources and Treatment . 22 2.2 Sanitation . 23 2.3 Exposure to Smoke inside the Home . 23 2.4 Housing Characteristics . 23 2.5 Household Wealth . 24 2.6 Hand Washing . 25 2.7 Household Population and Composition . 25 2.9 Birth Registration . 26 Contents iii

2.10 2.11 2.12 Education . 26 2.10.1 Educational Attainment . 27 2.10.2 School Attendance . 27 Household Food Security . 28 Health Expenditures . 29 3 CHARACTERISTICS OF RESPONDENTS . 51 3.1 Basic Characteristics of Survey Respondents. 51 3.2 Education and Literacy . 52 3.3 Exposure to Mass Media and Internet Usage . 53 3.4 Employment . 54 3.5 Occupation. 55 3.6 Type of Employment: Women . 56 3.7 Health Insurance Coverage . 56 3.8 Tobacco Smoking . 57 3.9 Daily Smoking . 57 3.10 Male Circumcision . 57 4 MARRIAGE AND SEXUAL ACTIVITY . 85 4.1 Marital Status. 85 4.2 Polygyny . 86 4.3 Age at First Marriage. 87 4.4 Age at First Sexual Intercourse . 88 4.5 Recent Sexual Activity . 89 4.6 Age at First Sexual Intercourse among Young People . 89 4.7 Premarital Sexual Intercourse and Condom Use during Premarital Sexual Intercourse among Youth . 90 5 FERTILITY . 105 5.1 Current Fertility . 106 5.2 Children Ever Born and Living . 107 5.3 Birth Intervals . 107 5.4 Insusceptibility to Pregnancy. 108 5.5 Age at First Birth . 109 5.6 Teenage Childbearing . 110 6 FERTILITY PREFERENCES. 119 6.1 Desire for Another Child . 120 6.2 Ideal Family Size . 121 6.3 Fertility Planning Status . 122 6.4 Wanted Fertility Rates . 123 7 FAMILY PLANNING . 131 7.1 Contraceptive Knowledge and Use . 132 7.2 Source of Modern Contraceptive Methods . 134 7.3 Informed Choice . 134 7.4 Discontinuation of Contraceptives . 135 7.5 Demand for Family Planning . 135 7.6 Contact of Nonusers with Family Planning Providers. 137 8 INFANT AND CHILD MORTALITY . 157 8.1 Data Quality. 158 8.2 Infant and Child Mortality . 159 8.3 Bio-demographic Risk Factors . 160 8.4 Perinatal Mortality . 161 8.5 High-risk Fertility Behaviour . 161 iv Contents

9 MATERNAL HEALTH CARE . 167 9.1 Antenatal Care Coverage and Content . 168 9.2 Timing and Number of ANC Visits. 169 9.3 Components of ANC Visits . 169 9.4 Protection against Neonatal Tetanus . 170 9.5 Delivery Services. 170 9.6 Skilled Assistance during Delivery . 172 9.7 Caesarean Section . 173 9.8 Postnatal Care for Mothers . 174 9.9 Postnatal Health Checks for Newborns . 175 9.9.1 Timing and Type of Provider . 175 9.9.2 Content of Newborn Care . 175 9.10 Problems in Accessing Health Care . 176 10 CHILD HEALTH. 193 10.1 Birth Weight . 193 10.2 Vaccination of Children. 194 10.3 Symptoms of Acute Respiratory Infection . 196 10.4 Fever . 197 10.5 Diarrhoeal Disease. 198 10.5.1 Prevalence of Diarrhoea . 198 10.5.2 Feeding Practices . 198 10.5.3 Treatment of Diarrhoea . 199 10.5.4 Knowledge of ORS Packets . 200 10.6 Disposal of Children’s Stools . 201 11 NUTRITION OF CHILDREN AND WOMEN . 221 11.1 Nutritional Status of Children. 221 11.1.1 Measurement of Nutritional Status among Young Children . 221 11.1.2 Data Collection . 223 11.1.3 Levels of Child Malnutrition . 223 11.2 Infant and Young Child Feeding Practices . 224 11.2.1 Initiation of Breastfeeding . 224 11.2.2 Exclusive Breastfeeding. 225 11.2.3 Median Duration of Breastfeeding . 226 11.2.4 Complementary Feeding . 226 11.2.5 Minimum Acceptable Diet . 227 11.3 Anaemia Prevalence in Children . 228 11.4 Women’s Nutritional Status . 230 11.5 Anaemia Prevalence in Women. 231 11.6 Presence of Iodised Salt in Households . 231 11.7 Micronutrient Intake and Supplementation among Children. 233 11.8 Micronutrient Intake among Mothers . 234 11.9 Urinary Iodine Concentration Among Women . 234 12 MALARIA . 261 12.1 Ownership of Insecticide-Treated Nets . 262 12.2 Indoor Residual Spraying . 264 12.3 ITN Coverage, Access to an ITN, and Household Use of ITNs . 265 12.4 Use of ITNs by Children and Pregnant Women . 267 12.5 Malaria in Pregnancy . 268 12.6 Case Management of Malaria in Children . 269 12.7 Prevalence of Low Haemoglobin in Children . 271 12.8 Prevalence of Malaria in Children . 271 Contents v

13 MALARIA KNOWLEDGE AND COMMUNICATION . 299 13.1 Recognition of Malaria as a Serious Health Problem . 299 13.2 Knowledge of Malaria Signs or Symptoms . 300 13.3 Knowledge of Malaria Prevention . 301 13.4 Access to Artemisinin-based Combination Therapy (ACTs) and Visits from Health Workers . 302 13.5 Exposure to Malaria Messages . 303 13.6 Attitudes towards Malaria . 304 14 ADULT AND MATERNAL MORTALITY . 317 14.1 Adult and Maternal Mortality Data . 317 14.1.1 Sibling Survival History . 317 14.1.2 Assessment of Data Quality . 318 14.1.3 Assessment of Trends in Maternal Mortality . 318 14.2 Direct Estimates of Adult Mortality . 319 14.3 Direct Estimates of Maternal Mortality . 320 15 WOMEN’S EMPOWERMENT . 325 15.1 Married Women’s and Men’s Employment . 326 15.2 Control over Women’s Earnings . 326 15.3 Control over Men’s Earnings . 327 15.4 Women’s and Men’s Ownership of Assets . 328 15.5. Ownership and Use of Bank Accounts and Mobile Phones . 328 15.6 Women’s Participation in Decision Making . 329 15.7 Attitudes towards Wife Beating . 330 16 FEMALE GENITAL CUTTING . 357 16.1 Knowledge of FGC/M . 358 16.2 Prevalence of and Age at Circumcision among Women . 358 16.2.1 Prevalence and Type of FGC/M . 358 16.2.2 Age at Circumcision . 360 16.3 Prevalence of and Age at Circumcision for Girls Age 0-14 . 360 16.4 Opinions about FGC/M . 361 17 DOMESTIC VIOLENCE . 367 17.1 Measurement of Violence . 368 17.2 Experience of Physical Violence from Anyone . 368 17.2.1 Prevalence of Physical Violence . 368 17.2.2 Perpetrators of Physical Violence . 369 17.3 Experience of Sexual Violence. 369 17.3.1 Prevalence of Sexual Violence . 369 17.3.2 Perpetrators of Sexual Violence. 370 17.4 Experience of Different Forms of Violence . 370 17.5 Marital Control . 370 17.6 Spousal Violence . 371 17.7 Injuries due to Spousal Violence . 373 17.8 Violence Initiated by Women against Husbands/Partners . 373 17.9 Response to Violence . 374 17.9.1 Help Seeking Behaviour to Stop the Violence . 374 17.9.2 Sources for Help . 374 REFERENCES . 401 vi Contents

APPENDIX A APPENDIX B APPENDIX C APPENDIX D APPENDIX E APPENDIX F SAMPLE DESIGN FOR THE 2015-16 TANZANIA DHS-MIS . 405 ESTIMATES OF SAMPLING ERRORS . 413 DATA QUALITY TABLES . 439 PERSONS INVOLVED IN THE 2015-16 TANZANIA DHS-MIS . 443 QUESTIONNAIRES . 449 ADDITIONAL DHS PROGRAM RESOURCES . 591 Contents vii

TABLES AND FIGURES 1 INTRODUCTION AND SURVEY METHODOLOGY . 1 Table 1.1 Selected demographic indicators from various sources, Tanzania 1967-2012 . 19 Table 1.2 Results of the household and individual interviews . 19 2 HOUSING CHARACTERISTICS AND HOUSEHOLD POPULATION . 21 Table 2.1 Household drinking water . 31 Table 2.2 Availability of water . 32 Table 2.3 Household sanitation facilities . 32 Table 2.4 Household characteristics . 33 Table 2.5 Household possessions. 34 Table 2.6 Wealth quintiles . 35 Table 2.7 Hand washing . 36 Table 2.8 Household population by age, sex, and residence. 37 Table 2.9 Household composition . 37 Table 2.10 Children’s living arrangements and orphanhood . 38 Table 2.11 Birth registration of children under age 5 . 40 Table 2.12 School attendance by survivorship of parents . 41 Table 2.13.1 Educational attainment of the female household population . 42 Table 2.13.2 Educational attainment of the male household population . 43 Table 2.14 School attendance ratios . 44 Table 2.15 Household food security . 46 Table 2.16 Annual outpatient visits and inpatient admissions . 47 Table 2.17 Annual per capita expenditure (in TZS) outpatient visits and inpatient admissions . 48 Table 2.18 Annual total health expenditure (in TZS) per household . 49 Figure 2.1 Figure 2.2 Figure 2.3 Figure 2.4 Figure 2.5 Figure 2.6 Figure 2.7 3 Household drinking water by residence . 22 Household toilet facilities by residence . 23 Household wealth by residence. 24 Po

The 2015-16 Tanzania Demographic and Health Survey and Malaria Indicator Survey (2015-16 TDHS-MIS) was implemented by the National Bureau of Statistics (NBS) and Office of the Chief Government Statistician (OCGS), Zanzibar, in collaboration with the Ministry of Health, Community Development, Gender, Elderly