Uzbekistan Health Examination Survey - Demographic And Health Surveys

2002 Uzbekistan Health Examination Survey 2002 Uzbekistan Health Examination Survey

Uzbekistan Health Examination Survey 2002 Analytical and Information Center Ministry of Health Republic of Uzbekistan State Department of Statistics Ministry of Macroeconomics and Statistics Republic of Uzbekistan ORC Macro Calverton, Maryland, USA April 2004 Republic of Uzbekistan ORC Macro

This report summarizes the findings of the 2002 Uzbekistan Health Examination Survey (UHES) carried out by the Analytical and Information Center (Ministry of Health) in partnership with the State Department of Statistics, Ministry of Macroeconomics and Statistics, Republic of Uzbekistan. ORC Macro provided financial and technical assistance for the survey through the USAID-funded MEASURE DHS program, which is designed to assist developing countries to collect data on fertility, family planning, and maternal and child health. Additional information about the UHES may be obtained from the Analytical and Information Center, Ministry of Health of the Republic of Uzbekistan, 12 Navoi Street, Tashkent, Uzbekistan 700011 (Tel: 712-67-62-44; fax: 712-6762-31) or State Department of Statistics, Ministry of Macroeconomics and Statistics, 63, Buyuk Ipak Yuli, Tashkent, Uzbekistan, 700077 (Tel: 712-672367; fax 712-677816). Additional information about the MEASURE DHS project may be obtained by contacting: MEASURE DHS , ORC Macro, 11785 Beltsville Drive, Suite 300, Calverton, MD 20705 (telephone 301-572-0200; fax 301-572-0999; e-mail: reports@orcmacro.com; internet: www.measuredhs.com). Suggested citation: Analytical and Information Center, Ministry of Health of the Republic of Uzbekistan [Uzbekistan], State Department of Statistics, Ministry of Macroeconomics and Statistics [Uzbekistan], and ORC Macro. 2004. Uzbekistan Health Examination Survey 2002. Calverton, Maryland, USA: Analytical and Information Center, State Department of Statistics, and ORC Macro.

CONTENTS Page Tables and Figures . xi Foreword. xix Summary of Findings . xxi Map of Uzbekistan .xxviii CHAPTER 1 INTRODUCTION F.G. Nazirov and G. Semenov 1.1 1.2 1.3 1.4 Geography and Population .1 History of Uzbekistan .2 Economy .2 Health Care System .3 1.4.1 1.4.2 1.4.3 1.4.4 1.4.5 1.4.6 1.4.7 1.5 1.6 1.7 1.8 Systems for Collecting Demographic and Health Data .5 Objectives and Sponsorship of the UHES.6 Sample Design.6 Survey Implementation.8 1.8.1 1.8.2 1.8.3 1.8.4 1.8.5 1.8.6 1.9 Facilities and Human Resources .3 Health Care Reforms .3 Primary, Secondary, and Tertiary Health Care .4 Maternal and Child Health Care .4 Family Planning Services.4 Tuberculosis DOTS Program.5 HIV/AIDS Program.5 Questionnaires .8 Pretest of Survey Instruments .9 Organization of the Survey Teams .9 Main Survey Training and Fieldwork.10 Laboratory Testing in Tashkent and Almaty.10 Data Processing .10 Response Rates.11 CHAPTER 2 HOUSEHOLD POPULATION AND HOUSING CHARACTERISTICS A.M. Hadjibaev and H. Newby 2.1 2.2 2.3 2.4 Population by Age and Sex .13 Household Composition .14 Children’s Living Arrangements and Orphanhood.15 Education .16 Contents iii

2.4.1 2.4.2 2.5 Uzbekistan School System .16 Education Attainment of the Household Population.18 Housing Characteristics.20 2.5.1 2.5.2 Household Durable Goods .22 Measures of Poverty .23 CHAPTER 3 BACKGROUND CHARACTERISTICS OF RESPONDENTS Z.D. Mutalova and H. Newby 3.1 3.2 3.3 3.4 3.5 3.6 3.7 Background Characteristics of Respondents .25 Educational Level of Respondents.27 Employment .29 Occupation .33 Earnings.36 Use of Earnings .38 Men’s Travel Away from Home Community .40 CHAPTER 4 FERTILITY A.I. Kamilov, J.M. Sullivan, and Z.D. Mutalova 4.1 4.2 4.3 4.4 4.4 4.5 4.6 Current Fertility .43 Fertility Trends.45 Children Ever Born and Children Surviving .47 Birth Intervals .47 Birth Intervals .48 Age at First Birth .49 Adolescent Fertility .51 CHAPTER 5 CONTRACEPTION J.M. Sullivan and A.I. Kamilov 5.1 5.2 5.3 5.4 5.5 5.6 Data Collection Procedures .53 Knowledge of Contraceptive Methods .53 Ever Use of Contraception .56 Current Use of Contraception.57 Trends in Current Use of Contraception from 1996 to 2002 .60 Current Use of Contraception by Women’s Status .61 CHAPTER 6 INDUCED ABORTION J.M. Sullivan and A.I. Kamilov 6.1 6.2 6.3 6.4 iv Contents Pregnancy Outcomes.64 Lifetime Experience with Induced Abortion .65 Rates of Induced Abortion .66 Trends in Induced Abortion .68

CHAPTER 7 OTHER PROXIMATE DETERMINANTS OF FERTILITY A.I. Kamilov and J.M. Sullivan 7.1 7.2 7.3 7.4 Marital Status.71 Age at First Marriage .72 Age at First Sexual Intercourse .74 Recent Sexual Activity.75 CHAPTER 8 INFANT AND CHILD MORTALITY J.M. Sullivan and N.K. Tureeva 8.1 8.2 8.3 8.4 8.5 8.6 8.7 8.8 Background and Assessment of Data Quality .77 Levels and Trends in Early Childhood Mortality.78 Recent IMR Estimates from Various Sources.79 Differences in Estimates of Infant Mortality .81 Socioeconomic Differentials in Childhood Mortality .81 Demographic Differentials in Childhood Mortality .82 Differentials in Childhood Mortality by Women’s Status .83 High-Risk Fertility Behavior.84 CHAPTER 9 CHILD HEALTH A.M. Hadjibaev and R.Y. Stallings 9.1 9.2 9.3 9.4 General Health Status and Health Care Utilization.87 Bronchial Asthma .90 Injuries .91 Dental Health.92 CHAPTER 10 NUTRITION R.Y. Stallings and N.K. Tureeva 10.1 Adult Nutritional Status.97 10.1.1 10.1.2 10.1.3 10.2 Measures of Adult Nutritional Status .97 Adult Nutritional Status Based on the 2002 UHES .97 Changes in Adult Nutritional Status Between 1996 and 2002 . 100 Adult Diets . 101 10.2.1 10.2.2 10.2.3 Frequency of Foods Consumed . 101 Consumption of Fried Foods and Addition of Salt and Fats . 104 Food Security . 105 10.3 Child Nutritional Status. 107 10.3.1 10.3.2 10.3.3 Measures of Child Nutritional Status . 107 Child Nutritional Status Based on the 2002 UHES . 108 Changes in Child Nutritional Status Between 1996 and 2002 . 110 Contents v

10.4 Breastfeeding and Supplementation. 112 10.4.1 10.5 Information on Breastfeeding and Supplementation from the 2002 UHES . 113 Anemia in Children . 115 10.5.1 10.5.2 10.5.3 Anemia Testing Procedures in the 2002 UHES . 116 Anemia in Children Based on the 2002 UHES . 116 Changes in Child Anemia from 1996 to 2002 . 118 CHAPTER 11 ADULT SEXUAL BEHAVIOR, HIV/AIDS, AND STIs R.Y. Stallings and S. Aripov 11.1 Preventing the Transmission of HIV through sexual contact. 122 11.1.1 11.1.2 11.1.3 11.2 Knowledge of HIV/AIDS and HIV Prevention . 127 11.2.1 11.2.2 11.2.3 11.3 Number of Sexual Partners . 122 Knowledge of a Source for Condoms . 124 Condom Use by Type of Partner. 126 Awareness of AIDS and Knowledge of HIV Transmission and Prevention. 127 Knowledge of Core HIV Education and Prevention Concepts. 131 Social Aspects of AIDS and HIV Prevention . 134 Sexually Transmitted Infections. 136 11.3.1 11.3.2 Public Health Importance of STIs. 136 Awareness of STIs . 137 CHAPTER 12 CHRONIC DISEASES AND RISK FACTORS G. Semenov and R.L. Usmanov 12.1 Hypertension. 141 12.1.1 12.1.2 12.1.3 12.1.4 12.1.5 12.2 Tobacco Usage . 146 12.2.1 12.2.2 12.2.3 vi Contents Measurement Procedures . 141 Levels of Hypertension . 142 Differentials . 144 Awareness and Control of Hypertension . 144 Summary. 145 Use of Tobacco Products . 146 Cessation of Smoking. 149 Summary . 149

12.3 Self-reported Chronic Conditions. 150 12.3.1 12.3.2 12.3.3 Self-reporting of Illness at the National Level. 150 Self-reporting of Illness by Region . 151 Summary. 153 CHAPTER 13 OTHER ADULT HEALTH ISSUES A.M. Hadjibaev, G. Semenov, and R.Y. Stallings 13.1 Tuberculosis . 155 13.1.1 13.1.2 13.1.3 13.1.4 13.1.5 13.1.6 13.1.7 13.1.8 13.2 Dental Health of Adults . 166 13.2.1 13.2.2 13.2.3 13.2.4 13.2.5 13.3 Introduction . 155 Public Health Importance . 155 Diagnosis, Treatment, and Control. 156 Knowledge of Tuberculosis and Mode of Transmission . 157 Knowledge of Symptoms of Tuberculosis . 158 Knowledge of Tuberculosis Prognosis and Willingness to Care for a Person with Tuberculosis . 163 Self-report of Tuberculosis Diagnosis and Treatment. 165 Summary. 166 Self-reported Dental Condition. 167 Routine Checkups . 168 Dental Problems in the Past 12 Months . 169 Current Dental Needs. 172 Summary. 174 Injury. 174 CHAPTER 14 BIOMARKER STUDIES IN TASHKENT G. Semenov and Z.D. Mutalova 14.1 14.2 Procedures for Collecting Venous Blood . 177 Cholesterol Levels. 177 14.2.1 14.2.2 14.3 Hepatitis B. 181 14.3.1 14.3.2 14.4 Findings. 178 Summary. 180 Findings. 181 Summary. 182 Diabetes Mellitus . 183 14.4.1 14.4.2 Findings. 183 Summary. 184 Contents vii

14.5 Chlamydia Trachomatis . 185 14.5.1 14.5.2 14.5.3 14.6 Procedures for Collecting Chlamydia Specimens. 185 Findings. 185 Summary. 186 Lead Exposure of Children Age 6-59 Months . 186 14.6.1 14.6.2 14.6.3 Procedures for Collecting Capillary Blood . 186 Findings. 186 Summary. 188 CHAPTER 15 VITAMIN A DEFICIENCY IN FERGHANA OBLAST J. Sangha and Z.D. Mutalova 15.1 15.2 15.3 15.4 15.5 15.6 Background . 189 Procedures for Collecting Venous Blood . 189 Measurement of Vitamin A Status . 190 Findings. 190 VAD and Iron Deficiency Anemia . 192 Summary . 192 CHAPTER 16 GENDER ISSUES H. Newby and A.I. Kamilov 16.1 Marriage Patterns. 195 16.1.1 16.1.2 16.1.3 16.1.4 16.2 Decisionmaking within Households . 201 16.2.1 16.3 16.4 Spouse Selection . 195 Consanguinity. 197 Age and Educational Differences Between Wives and Husbands . 198 Coresidence After Marriage . 200 Freedom of Movement. 206 Financial Empowerment . 208 Attitudes Toward Gender Roles . 210 16.4.1 16.4.2 Attitude Toward Wife Beating. 210 Attitude Toward Refusing Sexual Relations . 213 REFERENCES . 219 APPENDIX A SAMPLE DESIGN AND IMPLEMENTATION . 225 APPENDIX B ESTIMATES OF SAMPLING ERRORS . 231 viii Contents

APPENDIX C DATA QUALITY TABLES. 245 APPENDIX D PERSONS PARTICIPATING IN SURVEY . 251 APPENDIX E QUESTIONNAIRES . 253 APPENDIX F CONSENT FORMS . 363 Contents ix

TABLES AND FIGURES CHAPTER 1 Table 1.1 Table 1.2 Table 1.3 CHAPTER 2 INTRODUCTION Page Biodata collection in the 2002 UHES. 9 Topics included in the 2002 UHES women’s and men’s questionnaires. 9 Results of the household and individual interviews . 11 HOUSEHOLD POPULATION AND HOUSING CHARACTERISTICS Table 2.1 Table 2.2 Table 2.3 Table 2.4 Table 2.5 Table 2.6 Table 2.7 Table 2.8 Table 2.9 Table 2.10 Household population by age, sex, and residence . 13 Household composition. 15 Children’s living arrangements and orphanhood . 16 Educational attainment of household population . 17 School attendance ratios. 18 Grade repetition and dropout rates. 20 Household characteristics . 21 Household durable goods. 22 Measures of household financial capability . 23 Household ability to meet financial commitments. 24 Figure 2.1 Figure 2.2 Population pyramid . 14 Age-specific attendance rates. 19 CHAPTER 3 Table 3.1 Table 3.2 Table 3.3.1 Table 3.3.2 Table 3.4.1 Table 3.4.2 Table 3.5.1 Table 3.5.2 Table 3.6.1 Table 3.6.2 Table 3.7 BACKGROUND CHARACTERISTICS OF RESPONDENTS Table 3.8 Table 3.9 Background characteristics of respondents . 26 Ethnicity, religion, and residence by region . 27 Educational attainment by background characteristics: women . 28 Educational attainment by background characteristics: men. 29 Employment status: women. 30 Employment status: men . 32 Occupation: women. 34 Occupation: men . 35 Type of employment: women. 36 Type of employment: men . 37 Decision on use of earnings and contribution of earnings to Household expenditures. 39 Women’s control over earnings . 40 Men’s travel away from home community . 41 Figure 3.1.1 Figure 3.1.2 Figure 3.2 Employment status of women age 15-49 . 31 Employment status of men age 15-59 . 33 Type of earnings of employed women age 15-49. 37 Tables and Figures xi