Cambodia - Demographic and Health Survey - 2011

Publication date: 2011

Cambodia Demographic and Health Survey 2010 C am bodia 2010 D em ographic and H ealth Survey Cambodia Demographic and Health Survey 2010 National Institute of Statistics Ministry of Planning Phnom Penh, Cambodia Directorate General for Health Ministry of Health Phnom Penh, Cambodia MEASURE DHS ICF Macro Calverton, Maryland, USA September 2011 The analysis of the Cambodia Demographic and Health Survey 2010 was achieved through the joint efforts of: Darith Hor, NIS/MoP Rathavy Tung, DGH/MoH Mondol Loun, DGH/MoH Rathavuth Hong, ICF Macro Bernard Barrère, ICF Macro Joy Fishel, ICF Macro Kia Reinis, ICF Macro Lyndsey Wilson-Williams, ICF Macro Monica Kothari, ICF Macro Bunsoth Mao, ICF Macro See Appendix D for a list of contributors to the implementation of the CDHS. The 2010 Cambodia Demographic and Health Survey (2010 CDHS) is part of the worldwide MEASURE DHS project which assists countries in the collection of data to monitor and evaluate population, health, and nutrition programs. Funding was provided by the United States Agency for International Development (USAID) the United Nations Population Fund (UNFPA), the United Nations Children’s Fund (UNICEF), the Japan International Cooperation Agency (JICA), and the Health Sector Support Program – Second Phase (HSSP-2). Additional information about the survey can be obtained from the National Institute of Statistics; 386 Monivong Boulevard, Sangkat Beong Keng Kang 1, Chamkar Mon, Phnom Penh, Cambodia; Telephone: (855) 23-213650; E-mail: ssythan@hotmail.com; Internet: www.nis.gov.kh and the Directorate General for Health, Ministry of Health 151-153 Kampuchea Krom Boulevard, Phnom Penh, Cambodia; Telephone: (855) 23-722873; E-mail: webmaster@moh.gov.kh; Internet: www.moh.gov,kh. Additional information about the MEASURE DHS project can be obtained from ICF Macro, 11785 Beltsville Drive, Calverton, MD 20705 USA; Telephone: 301-572-0200, Fax: 301-572-0999, E-mail: info@measuredhs.com, Internet: www.measuredhs.com. Suggested citation: National Institute of Statistics, Directorate General for Health, and ICF Macro, 2011. Cambodia Demographic and Health Survey 2010. Phnom Penh, Cambodia and Calverton, Maryland, USA: National Institute of Statistics, Directorate General for Health, and ICF Macro. Cover photo of Prasat Preah Vihear ©2010 Andy Kim [www.andykimphotography.net] Contents | iii CONTENTS Page TABLES AND FIGURES . ix FOREWORD . xv ACKNOWLEDGMENTS . xvii SUMMARY OF FINDINGS . xix MAP OF CAMBODIA . xxiv CHAPTER 1 INTRODUCTION 1.1 Geodemography, History, and Economy. 1 1.1.1 Geodemography . 1 1.1.2 History. 1 1.1.3 Economy . 2 1.2 Health Status and Policy . 2 1.3 Objective and Survey Organization. 3 1.4 Sample Design . 4 1.5 Questionnaires . 5 1.6 Training and Fieldwork . 6 1.7 Data Processing . 6 1.8 Sample Coverage . 7 CHAPTER 2 HOUSEHOLD POPULATION AND HOUSING CHARACTERISTICS 2.1 Characteristics of the Household Population . 9 2.1.1 Age and Sex Composition . 9 2.1.2 Household Composition . 11 2.2 Education of the Household Population . 11 2.2.1 School Attendance Ratios . 14 2.3 Housing Characteristics . 16 2.3.1 Water Supply . 16 2.3.2 Sanitation Facilities . 18 2.3.3 Cooking Arrangements . 19 2.4 Household Possessions . 20 2.5 Household Wealth . 21 2.6 Birth Registration . 22 CHAPTER 3 UTILIZATION OF HEALTH SERVICES FOR ACCIDENT, ILLNESS, OR INJURY 3.1 Accidental Death or Injury . 25 3.1.1 Frequency of Accidental Death or Injury . 25 3.1.2 Type of Accident . 26 iv | Contents 3.2 Physical Impairment . 28 3.3 Prevalence and Severity of Illness or Injury . 29 3.4 Treatment Sought for Illness or Injury . 30 3.5 Utilization of Health Care Facilities . 31 3.6 Cost for Health Care . 33 3.6.1 Distribution of Cost for Health Care . 33 3.6.2 Expenditures for Health Care . 34 CHAPTER 4 RESPONDENT CHARACTERISTICS 4.1 Characteristics of Survey Respondents . 39 4.2 Educational Attainment and Literacy . 40 4.3 Access to Mass Media . 44 4.4 Employment . 47 4.4.1 Employment Status . 47 4.4.2 Occupation . 50 4.4.3 Earnings, Employers, and Continuity of Employment . 52 4.5 Health Insurance . 53 4.6 Use of Tobacco . 54 CHAPTER 5 FERTILITY 5.1 Current Fertility Levels and Differentials . 57 5.2 Fertility Trends . 59 5.2.1 Comparison of Current and Cumulative Fertility Levels . 59 5.2.2 Retrospective Data . 59 5.2.3 Comparison with Previous CDHS . 60 5.3 Children Ever Born and Living . 61 5.4 Birth Intervals . 63 5.5 Age at First Birth . 64 5.6 Teenage Pregnancy and Motherhood . 65 CHAPTER 6 PRACTICE OF ABORTION 6.1 Number of Induced Abortions in the Past Five Years . 67 6.2 Practice of Abortion in the Past Five Years . 69 6.2.1 Pregnancy Duration at the Time of Abortion . 69 6.2.2 Place of Abortion . 70 6.2.3 Persons Who Helped with the Abortion . 71 6.2.4 Method Used for the Abortion . 71 CHAPTER 7 FAMILY PLANNING 7.1 Knowledge of Contraceptive Methods . 73 7.2 Current Use of Contraceptive Methods . 74 7.3 Use of Social Marketing Brands . 79 7.4 Knowledge of Fertile Period . 80 7.5 Timing of Sterilization . 80 7.6 Source of Family Planning Methods . 81 Contents | v 7.7 Informed Choice . 82 7.8 Future Use of Contraception . 83 7.9 Exposure to Family Planning Messages . 83 7.10 Contact of Nonusers with Family Planning Providers . 85 CHAPTER 8 OTHER PROXIMATE DETERMINANTS OF FERTILITY 8.1 Marital Status . 87 8.2 Age at First Marriage . 88 8.3 Age at First Sexual Intercourse . 90 8.4 Recent Sexual Activity . 93 8.5 Postpartum Amenorrhea, Abstinence, and Insusceptibility . 96 8.6 Termination of Exposure to Pregnancy . 98 CHAPTER 9 FERTILITY PREFERENCES 9.1 Desire for More Children . 99 9.2 Need for Family Planning Services . 101 9.3 Ideal Family Size . 103 9.4 Fertility Planning . 105 CHAPTER 10 ADULT AND MATERNAL MORTALITY 10.1 Data Quality Issues . 109 10.2 Adult Mortality . 110 CHAPTER 11 INFANT AND CHILD MORTALITY 11.1 Assessment of Data Quality. 113 11.2 Levels and Trends in Childhood Mortality . 114 11.3 Socioeconomic Differentials in Childhood Mortality . 115 11.4 Demographic Differentials in Mortality . 117 11.5 High-Risk Fertility Behavior . 118 CHAPTER 12 MATERNAL HEALTH 12.1 Antenatal Care . 121 12.1.1 Source of Antenatal Care . 121 12.1.2 Components of Antenatal Care . 123 12.1.3 Tetanus Toxoid Vaccinations . 124 12.2 Childbirth and Delivery . 126 12.2.1 Place of Delivery . 126 12.2.2 Assistance at Delivery . 127 12.3 Postnatal Care and Practices . 128 12.4 Perceived Problems in Accessing Women’s Health Care . 131 vi | Contents CHAPTER 13 CHILD HEALTH 13.1 Child’s Size at Birth . 133 13.2 Immunization of Children . 134 13.2.1 Trends in Vaccination Coverage . 136 13.3 Acute Respiratory Infection . 137 13.4 Fever . 139 13.5 Diarrhea . 141 13.6 Feeding Practices . 143 13.7 Knowledge of ORS Packets . 145 13.8 Stool Disposal . 145 CHAPTER 14 NUTRITION OF CHILDREN AND WOMEN 14.1 Nutritional Status of Children . 147 14.1.1 Measurement of Nutritional Status among Young Children . 147 14.1.2 Measures of Child Nutritional Status . 149 14.1.3 Trends in Children’s Nutritional Status . 151 14.2 Initiation of Breastfeeding . 152 14.3 Breastfeeding Status by Age . 154 14.4 Duration of Breastfeeding . 156 14.5 Types of Complementary Foods . 157 14.6 Infant and Young Child Feeding (IYCF) Practices . 158 14.7 Prevalence of Anemia in Children . 161 14.8 Micronutrient Intake among Children . 163 14.9 Use of Iodized Salt . 165 14.10 Nutritional Status of Women . 166 14.11 Prevalence of Anemia in Women . 168 14.12 Micronutrient Intake among Mothers . 170 CHAPTER 15 HIV/AIDS-RELATED KNOWLEDGE, ATTITUDES, AND BEHAVIOR 15.1 Knowledge of HIV/AIDS and of Transmission and Prevention Methods . 173 15.1.1 Awareness of AIDS . 173 15.1.2 HIV Prevention Methods . 174 15.1.3 Knowledge about Transmission . 175 15.1.4 Knowledge of Mother-to-Child Transmission . 178 15.2 Stigma Associated with AIDS and Attitudes Related to HIV/AIDS . 179 15.3 Attitudes towards Negotiating Safer Sex . 181 15.4 Multiple Sexual Partnerships . 183 15.5 Testing for HIV . 186 15.6 Reports of Recent Sexually Transmitted Infections . 189 15.7 Injections . 191 15.8 HIV/AIDS-Related Knowledge and Behavior among Youth . 192 15.8.1 Knowledge about HIV/AIDS and Source for Condoms . 192 15.8.2 Age at First Sex and Condom Use at First Sexual Intercourse . 194 15.8.3 Recent Sexual Activity . 195 15.8.4 Multiple Sexual Partnerships . 196 15.8.5 HIV Testing . 197 Contents | vii CHAPTER 16 WOMEN’S EMPOWERMENT AND DEMOGRAPHIC AND HEALTH OUTCOMES 16.1 Employment and Forms of Earnings . 199 16.2 Control over Women’s and Men’s Earnings. 199 16.3 Women’s Participation in Household Decision-making . 203 16.4 Attitudes towards Wife Beating . 206 16.5 Women’s Empowerment Indicators . 209 16.6 Current Use of Contraception by Women’s Status . 209 16.7 Ideal Family Size and Unmet Need by Women’s Status . 210 16.8 Reproductive Health Care and Women’s Empowerment Status . 211 REFERENCES . 213 APPENDIX A SAMPLE IMPLEMENTATION . 215 A.1 Introduction . 215 A.2 Sampling Frame . 215 A.3 Sampling Procedure . 216 A.4 Sampling Probabilities . 218 APPENDIX B ESTIMATES OF SAMPLING ERRORS . 223 APPENDIX C DATA QUALITY TABLES . 249 APPENDIX D PERSONS INVOLVED IN THE 2010 CAMBODIA DEMOGRAPHIC AND HEALTH SURVEY . 255 APPENDIX E QUESTIONNAIRES . 259 Tables and Figures | ix TABLES AND FIGURES Page CHAPTER 1 INTRODUCTION Table 1.1 Results of the household and individual interviews . 7 CHAPTER 2 HOUSEHOLD POPULATION AND HOUSING CHARACTERISTICS Table 2.1 Household population by age, sex, and residence . 10 Table 2.2 Population by age according to selected sources . 11 Table 2.3 Household composition . 11 Table 2.4.1 Educational attainment of the female household population . 12 Table 2.4.2 Educational attainment of the male household population . 13 Table 2.5 School attendance ratios . 14 Table 2.6 Household drinking water . 17 Table 2.7 Household sanitation facilities . 19 Table 2.8 Household characteristics . 20 Table 2.9 Household durable goods . 21 Table 2.10 Wealth quintiles . 22 Table 2.11 Birth registration of children under age five . 23 Figure 2.1 Population Pyramid . 10 Figure 2.2 Age-specific Attendance Rates . 16 CHAPTER 3 UTILIZATION OF HEALTH SERVICES FOR ACCIDENT, ILLNESS, OR INJURY Table 3.1 Injury or death in an accident . 26 Table 3.2 Injury or death in an accident by type of accident. 27 Table 3.3 Physical impairment . 28 Table 3.4 Prevalence and severity of illness or injury in previous 30 days . 30 Table 3.5 Percentage of ill or injured population who sought treatment . 31 Table 3.6 Percentage of ill or injured population who sought treatment, by place of treatment . 32 Table 3.7 Distribution of cost for health care . 34 Table 3.8 Expenditures for health care . 35 Table 3.9 Source of money spent by persons who sought treatment for health care . 36 Figure 3.1 Percentage of Household Members Ill or Injured Seeking Treatment by Order of Treatment and Sector of Health Care . 33 CHAPTER 4 RESPONDENT CHARACTERISTICS Table 4.1 Background characteristics of respondents . 40 Table 4.2.1 Educational attainment: Women . 41 Table 4.2.2 Educational attainment: Men . 42 Table 4.3.1 Literacy: Women . 43 x | Tables and FIgures Table 4.3.2 Literacy: Men . 44 Table 4.4.1 Exposure to mass media: Women . 45 Table 4.4.2 Exposure to mass media: Men . 46 Table 4.5.1 Employment status: Women . 48 Table 4.5.2 Employment status: Men . 49 Table 4.6.1 Occupation: Women . 50 Table 4.6.2 Occupation: Men . 51 Table 4.7 Type of employment: Women . 52 Table 4.8.1 Health insurance coverage: Women . 53 Table 4.8.2 Health insurance coverage: Men . 54 Table 4.9.1 Use of tobacco: Women . 55 Table 4.9.2 Use of tobacco: Men . 56 Figure 4.1 Women’s Employment Status in the Past 12 Months . 47 CHAPTER 5 FERTILITY Table 5.1 Current fertility . 57 Table 5.2 Fertility by background characteristics . 58 Table 5.3.1 Trends in age-specific fertility rates . 60 Table 5.3.2 Trends in age-specific and total fertility rates . 61 Table 5.4 Children ever born and living . 62 Table 5.5 Birth intervals . 63 Table 5.6 Age at first birth . 64 Table 5.7 Median age at first birth . 65 Table 5.8 Teenage pregnancy and motherhood . 66 Figure 5.1 Age-specific Fertility Rates for Five-year Periods Preceding the Survey . 60 Figure 5.2 Trends in Age-specific Fertility Rates, Various Sources, 2000-2010 . 61 CHAPTER 6 PRACTICE OF ABORTION Table 6.1 Number of induced abortions . 68 Table 6.2 Pregnancy duration at the time of abortion . 70 Table 6.3 Place of abortion . 70 Table 6.4 Persons who helped with abortion . 71 Table 6.5 Method used for the abortion . 72 Figure 6.1 Distribution of Number of Abortions for Women Who Report Having an Induced Abortion . 69 CHAPTER 7 FAMILY PLANNING Table 7.1 Knowledge of contraceptive methods . 73 Table 7.2 Knowledge of contraceptive methods by background characteristics . 74 Table 7.3 Current use of contraception by age . 75 Table 7.4.1 Current use of contraception by background characteristics . 77 Table 7.4.2 Trends in current use of contraception . 78 Table 7.5 Use of social marketing brand pills and condoms . 79 Table 7.6 Knowledge of fertile period . 80 Table 7.7 Timing of sterilization . 80 Table 7.8 Source of modern contraception methods . 81 Table 7.9 Informed choice . 82 Tables and Figures | xi Table 7.10 Future use of contraception . 83 Table 7.11 Exposure to family planning messages . 84 Table 7.12 Contact of nonusers with family planning providers . 85 Figure 7.1 Trends in Contraceptive Use among Currently Married Women . 78 CHAPTER 8 OTHER PROXIMATE DETERMINANTS OF FERTILITY Table 8.1 Current marital status . 87 Table 8.2 Age at first marriage . 88 Table 8.3.1 Median age at first marriage: Women . 89 Table 8.3.2 Median age at first marriage: Men . 90 Table 8.4 Age at first sexual intercourse . 91 Table 8.5.1 Median age at first intercourse: Women . 92 Table 8.5.2 Median age at first intercourse: Men . 93 Table 8.6.1 Recent sexual activity: Women . 94 Table 8.6.2 Recent sexual activity: Men . 95 Table 8.7 Postpartum amenorrhea, abstinence, and insusceptibility . 96 Table 8.8 Median duration of amenorrhea, postpartum abstinence, and postpartum insusceptibility . 97 Table 8.9 Menopause . 98 CHAPTER 9 FERTILITY PREFERENCES Table 9.1 Fertility preferences by number of living children . 99 Table 9.2.1 Desire to limit childbearing: Women . 100 Table 9.2.2 Desire to limit childbearing: Men . 101 Table 9.3 Need and demand for family planning among currently married women . 102 Table 9.4 Ideal number of children . 104 Table 9.5 Mean ideal number of children. 105 Table 9.6 Fertility planning status . 106 Table 9.7 Wanted fertility rates . 107 CHAPTER 10 ADULT AND MATERNAL MORTALITY Table 10.1 Data on siblings . 109 Table 10.2 Sibship size and sex ratio of siblings . 110 Table 10.3 Adult mortality rates . 111 Figure 10.1 Confidence Interval of the Maternal Mortality Rates for the Period of 2000-2005 (CDHS 2005) and 2005-2010 (CDHS 2010) . 112 CHAPTER 11 INFANT AND CHILD MORTALITY Table 11.1 Early childhood mortality rates . 114 Table 11.2 Early childhood mortality rates by socioeconomic characteristics . 116 Table 11.3 Early childhood mortality rates by demographic characteristics . 117 Table 11.4 High-risk fertility behavior . 119 Figure 11.1 Trends in Childhood Mortality, 2000, 2005, and 2010 CDHS . 115 Figure 11.2 Infant Mortality Rates by Socioeconomic Characteristics . 116 Figure 11.3 Infant Mortality Rates by Demographic Characteristics . 118 xii | Tables and FIgures CHAPTER 12 MATERNAL HEALTH Table 12.1 Antenatal care . 122 Table 12.2 Number of antenatal care visits and timing of first visit . 123 Table 12.3 Components of antenatal care . 124 Table 12.4 Tetanus toxoid injections . 125 Table 12.5 Place of delivery . 127 Table 12.6 Assistance during delivery . 128 Table 12.7 Timing of first postnatal checkup. 129 Table 12.8 Type of provider of first postnatal checkup . 130 Table 12.9 Problems in accessing health care . 131 CHAPTER 13 CHILD HEALTH Table 13.1 Child’s weight and size at birth . 134 Table 13.2 Vaccinations by source of information . 135 Table 13.3 Vaccinations by background characteristics . 136 Table 13.4 Prevalence and treatment of symptoms of ARI . 138 Table 13.5 Prevalence and treatment of fever . 140 Table 13.6 Prevalence of diarrhea . 141 Table 13.7 Diarrhea treatment . 142 Table 13.8 Feeding practices during diarrhea . 144 Table 13.9 Knowledge of ORS packets . 145 Table 13.10 Disposal of children’s stools . 146 Figure 13.1 Trend in Vaccination by 12 Months of Age among Children 12-23 Months . 137 CHAPTER 14 NUTRITION OF CHILDREN AND WOMEN Table 14.1 Nutritional status of children . 150 Table 14.2 Initial breastfeeding . 153 Table 14.3 Breastfeeding status by age . 154 Table 14.4 Median duration of breastfeeding . 156 Table 14.5 Foods and liquids consumed by children in the day or night preceding the interview . 158 Table 14.6 Infant and young child feeding (IYCF) practices . 160 Table 14.7 Prevalence of anemia in children . 162 Table 14.8 Micronutrient intake among children . 164 Table 14.9 Presence of iodized salt in household . 166 Table 14.10 Nutritional status of women . 167 Table 14.11 Prevalence of anemia in women . 169 Table 14.12 Micronutrient intake among mothers . 171 Figure 14.1 Nutritional Status of Children by Age . 151 Figure 14.2 Trends in Nutritional Status of Children under Five Years . 152 Figure 14.3 Infant Feeding Practices by Age . 155 Figure 14.4 IYCF Indicators on Breastfeeding Status . 157 Figure 14.5 Trends in the Infant and Young Child Feeding (IYCF) Practices . 161 Figure 14.6 Trends in Anemia Status among Children under Five Years . 163 Figure 14.7 Trends in Nutritional Status among Women 15-49 Years . 168 Figure 14.8 Trends in Anemia Status among Women 15-49 Years . 170 Tables and Figures | xiii CHAPTER 15 HIV/AIDS-RELATED KNOWLEDGE, ATTITUDES, AND BEHAVIOR Table 15.1 Knowledge of AIDS. 173 Table 15.2 Knowledge of HIV prevention methods . 175 Table 15.3.1 Comprehensive knowledge about AIDS: Women . 176 Table 15.3.2 Comprehensive knowledge about AIDS: Men . 177 Table 15.4 Knowledge of prevention of mother-to-child transmission of HIV . 179 Table 15.5.1 Accepting attitudes toward those living with HIV/AIDS: Women . 180 Table 15.5.2 Accepting attitudes toward those living with HIV/AIDS: Men . 181 Table 15.6 Attitudes toward negotiating safer sexual relations with husband . 182 Table 15.7.1 Multiple sexual partners in the past 12 months: Women . 184 Table 15.7.2 Multiple sexual partners in the past 12 months: Men . 185 Table 15.8 Payment for sexual intercourse and condom use at last paid sexual intercourse: Men . 186 Table 15.9.1 Coverage of prior HIV testing: Women . 187 Table 15.9.2 Coverage of prior HIV testing: Men . 188 Table 15.10 Pregnant women counseled and tested for HIV . 189 Table 15.11 Self-reported prevalence of sexually transmitted infections (STIs) and STI symptoms . 190 Table 15.12 Prevalence of medical injections . 192 Table 15.13 Comprehensive knowledge about AIDS and of a source of condoms among youth . 193 Table 15.14 Age at first sexual intercourse among youth . 195 Table 15.15 Premarital sexual intercourse and condom use during premarital sexual intercourse among youth . 196 Table 15.16 Multiple sexual partners in the past 12 months among youth . 197 Table 15.17 Recent HIV tests among youth . 198 Figure 15.1 Women and Men Seeking Treatment for STIs . 191 CHAPTER 16 WOMEN’S EMPOWERMENT AND DEMOGRAPHIC AND HEALTH OUTCOMES Table 16.1 Employment and cash earnings of currently married women and men . 200 Table 16.2.1 Control over women’s cash earnings and relative magnitude of women’s earning . 201 Table 16.2.2 Control over men’s cash earnings . 202 Table 16.3 Women’s control over their own earnings and over those of their husband . 203 Table 16.4 Women’s participation in decision-making . 204 Table 16.5 Women’s participation in decision-making by background characteristics . 205 Table 16.6.1 Attitude toward wife beating: Women . 207 Table 16.6.2 Attitude toward wife beating: Men . 208 Table 16.7 Indicators of women’s empowerment . 209 Table 16.8 Current use of contraception by women’s status . 210 Table 16.9 Women’s empowerment and ideal number of children and unmet need for family planning . 211 Table 16.10 Reproductive health care by women’s empowerment . 211 xiv | Tables and FIgures APPENDIX A SAMPLE IMPLEMENTATION Table A.1 Percentage distribution of households and number of EAs by province and by type of residence (Sampling frame, Cambodia GPC 2008) . 216 Table A.2 Percentage distribution of households and number of EAs by domain and by type of residence (Sampling frame, Cambodia GPC 2008) . 216 Table A.3 Sample allocation of EAs and households by domain and by type of residence (CDHS 2010) . 218 Table A.4 Sample allocation of expected number of interviews of women and men by domain and by type of residence (CDHS 2010) . 218 Table A.5 Sample implementation: women . 220 Table A.6 Sample implementation: men . 221 APPENDIX B ESTIMATES OF SAMPLING ERRORS Table B.1 List of selected variables for sampling errors, Cambodia DHS 2010 . 225 Table B.2 Sampling errors: Total sample, Cambodia DHS 2010 . 226 Table B.3 Sampling errors: Urban sample, Cambodia DHS 2010 . 227 Table B.4 Sampling errors: Rural sample, Cambodia DHS 2010 . 228 Table B.5 Sampling errors: Banteay Mean Chey sample, Cambodia DHS 2010 . 229 Table B.6 Sampling errors: Kampong Cham sample, Cambodia DHS 2010 . 230 Table B.7 Sampling errors: Kampong Chhnang sample, Cambodia DHS 2010 . 231 Table B.8 Sampling errors: Kampong Speu sample, Cambodia DHS 2010 . 232 Table B.9 Sampling errors: Kampong Thom sample, Cambodia DHS 2010 . 233 Table B.10 Sampling errors: Kandal sample, Cambodia DHS 2010 . 234 Table B.11 Sampling errors: Kratie sample, Cambodia DHS 2010 . 235 Table B.12 Sampling errors: Phnom Penh sample, Cambodia DHS 2010 . 236 Table B.13 Sampling errors: Prey Veng sample, Cambodia DHS 2010 . 237 Table B.14 Sampling errors: Pursat sample, Cambodia DHS 2010 . 238 Table B.15 Sampling errors: Siem Reap sample, Cambodia DHS 2010 . 239 Table B.16 Sampling errors: Svay Rieng sample, Cambodia DHS 2010 . 240 Table B.17 Sampling errors: Takeo sample, Cambodia DHS 2010 . 241 Table B.18 Sampling errors: Otdar Mean Chey sample, Cambodia DHS 2010 . 242 Table B.19 Sampling errors: Battambang & Pailin sample, Cambodia DHS 2010 . 243 Table B.20 Sampling errors: Kampot & Kep sample, Cambodia DHS 2010 . 244 Table B.21 Sampling errors: Preah Sihanouk & Koh Kong sample, Cambodia DHS 2010 . 245 Table B.22 Sampling errors: Preah Vihear & Steung Tre sample, Cambodia DHS 2010 . 246 Table B.23 Sampling errors: Mondol Kiri & Rattanak Ki sample, Cambodia DHS 2010 . 247 APPENDIX C DATA QUALITY TABLES Table C.1 Household age distribution . 249 Table C.2.1 Age distribution of eligible and interviewed women . 250 Table C.2.2 Age distribution of eligible and interviewed men . 250 Table C.3 Completeness of reporting . 251 Table C.4 Births by calendar years . 251 Table C.5 Reporting of age at death in days . 252 Table C.6 Reporting of age at death in months . 253 Table C.7 Nutritional status of children . 254 Foreword | xv FOREWORD The 2010 Cambodia Demographic and Health Survey (2010 CDHS) is the third survey of its kind to be conducted successfully in Cambodia. Sponsors are the United States Agency for International Development (USAID), United Nations Population Fund (UNFPA), United Nations Children’s Fund (UNICEF), Japan International Cooperation Agency (JICA), and the Health Sector Support Program-Second Phase (HSSP-2). Technical assistance is provided by ICF Macro. The Directorate General for Health (DGH) of the Ministry of Health and the National Institute of Statistics (NIS) of the Ministry of Planning are the project implementation agencies. This report includes information on demography, family planning, maternal mortality, infant and child mortality, and women’s health care status, including related information, such as breastfeeding, antenatal care, children’s immunization, childhood diseases, and HIV/AIDS. The questionnaires (Household, Man’s, and Woman’s questionnaires) are designed to evaluate the nutritional status of mothers and children and to measure the prevalence of anemia. The 2010 CDHS findings are expected to be used by policymakers and program managers to evaluate Cambodia’s demographic and health status and then to formulate appropriate population and health policies and programs. The programs of reproductive health and child health and health facilities need to be expanded and improved based on the survey findings. We would like to thank USAID, UNFPA, UNICEF, JICA, and HSSP2 for sponsoring this survey project and ICF Macro for providing technical assistance. We gratefully acknowledge the support and encouragement extended by H.E. San Sy Than, Director General, National Institute of Statistics (NIS); Prof. Sann Chan Sœung; Deputy Director General for Health, Directorate General for Health; Dr. Sao Sovanratnak, CDHS Survey Coordinator and Deputy Director, Planning and Health Information Department; Hor Darith, CDHS Survey Coordinator and Deputy Director General, NIS; and other members of the 2010 CDHS Executive Committee and Technical Committee who contributed to the survey activities. We express our sincere thanks to all persons involved in the implementation, analysis, and writing of the 2010 CDHS and especially thank the NIS, DGH, and ICF Macro staff, whose contributions made the survey a success. H.E. Prof. Eng Huot Secretary of State For Minister of Health H.E. Ouk Chay Secretary of State For Senior Minister Minister of Planning Acknowledgments | xvii ACKNOWLEDGMENTS The 2010 Cambodia Demographic and Health Survey (2010 CDHS) represents the continuing commitment and efforts in Cambodia to obtain data on population and health. The survey also reflects interest in obtaining information on maternal health, child health, and anemia prevalence. The 2010 CDHS was sponsored by the United States Agency for International Development (USAID), United Nations Population Fund (UNFPA), United Nations Children’s Fund (UNICEF), Japan International Cooperation Agency JICA), and the Cambodian Health Sector Support Program-Second Phase (HSSP-2). The survey was implemented by the Directorate General for Health (DGH) of the Ministry of Health (MOH) and by the National Institute of Statistics (NIS) of the Ministry of Planning (MOP). This survey could not have been completed without the active support and the efforts of many institutions and individuals. The active support and guidance of the Excellencies Secretaries of State; H.E. Prof. Eng Huot, Ministry of Health, and H.E. Ouk Chay, Ministry of Planning, are acknowledged with deep gratitude. We also gratefully acknowledge the representatives of USAID, UNFPA, UNICEF, JICA, and HSSP-2 and their staff for their support and valuable comments throughout the survey activities. Our deep appreciation also goes to the ICF Macro team led by Mr. Bernard Barrère and his colleagues, Dr. Rathavuth Hong, and others. They are acknowledged with gratitude for their support as they facilitated the survey and ensured its success. We would like to express our appreciation for all team leaders, field editors, and interviewers from NIS, DGH, and the central and local offices of the Ministry of Planning and Ministry of Health, whose dedicated efforts ensured the quality and timeliness of the survey, and to all respondents for contributing their time and for giving the required information, enabling us to produce high-quality data for the country. Finally, we would like to thank Dr. Sao Sovanratnak, CDHS Survey Coordinator and Deputy Director, Planning and Health Information Department; Mr. Hor Darith, CDHS Survey Coordinator and Deputy Director General of the NIS; and Mr. Phan Chinda, CDHS Survey Coordinator and Deputy Director, Social Statistics Department, NIS. His Excellency San Sy Than Director General National Institute of Statistics Professor Sann Chan Sœung Deputy Director General for Health Directorate General for Health Summary of Findings | xix SUMMARY OF FINDINGS The 2010 Cambodia Demographic and Health Survey (CDHS) is a nationally represent- ative sample survey of 18,754 women and 8,239 men age 15-49. The 2010 CDHS is the third comprehensive survey conducted in Cambodia as part of the worldwide MEASURE DHS project. The primary purpose of the CDHS is to provide policymakers and planners with up-to- date, reliable data on fertility; family planning; infant, child, and maternal mortality; maternal and child health; nutrition; malaria; knowledge of HIV/AIDS, and women’s status. FERTILITY Survey results indicate that the total fertility rate has declined, from 3.4 births per woman in 2005 to 3.0 births per woman in 2010. The rate continues to be lower in urban areas (2.2 births per woman) than in rural areas (3.3 births per woman). There is a substantial differential in fertility by region, ranging from a low of 2.0 births per woman in Phnom Penh to a high of 4.5 births per woman in Mondol Kiri/Rattanak Kiri. Both education and wealth affect fertility. Wom- en with secondary or higher education have 1.3 fewer children than women with no education. The poorest women have more than twice as many children as the wealthiest. Women age 25-49 begin having children at a median age of 22.3 years. Women living in ur- ban areas have their first birth two years later than women living in rural areas. Their age at first birth is lowest in Mondol Kiri/Rattanak Kiri (21.0 years) and highest in Phnom Penh (24.8 years). Women with secondary and higher edu- cation begin childbearing at a later age than those who do not attend school and those who complete only a primary education. Marriage and sexual initiation patterns are important determinants of fertility levels. Sixty- two percent of women interviewed are currently in a union, that is, married or living with a man. Women get married at a median age of 20.3. The median age at first marriage has been stable for the past 20 years. Women generally begin hav- ing sexual intercourse at about the same time as their first marriage, at the median age of 20.8. Women in urban areas tend to get married and initiate sexual activity around two years later than those living in rural areas. Women with higher levels of education also tend to marry and initiate sex later than those with lower levels of education. Men marry at a median age of 22.6 and initiate sex slightly before marriage at a me- dian age of 22.1. The interval between births is relatively long in Cambodia. The median number of months since the preceding birth is 40.0. Sixteen percent of non-first births occur within 24 months of the previous birth, and 26 percent occur 24 to 35 months after the previous birth. Thirty-two per- cent occur 36 to 59 months after a previous birth, and 25 percent occur 60 months or more after a previous birth. More than half (56 percent) of currently married Cambodian women say they do not want any more children or they say they are sterilized. Another 25 percent would like to wait at least two years before having their next child. On av- erage, Cambodian women would like to have 3.1 children. About 5 percent of women have had an abortion in the past five years. Among those who have had an induced abortion, 26 percent have had more than one. Abortions most frequently take place in a private health facility or in some- one’s home. In almost 67 percent of cases, a doctor, nurse, midwife, or other health worker assists with the abortion. FAMILY PLANNING Practically all women are familiar with at least some methods of contraception. The daily contraceptive pill, the male condom, the IUD, and injectables are known to more than 95 per- cent of married women. Seventy-five percent of women know at least one traditional method of family planning. Fifty-one percent of married women are cur- rently using a contraceptive method; 35 percent xx | Summary of Findings are using a modern method and 16 percent are using a traditional method. Use of contraception has increased substantially since 2005 when 27 percent of married women were using a modern method. Use of modern methods of contraception is more common in rural areas than in urban areas (36 percent compared with 31 percent). Use of modern methods does not vary much by level of education. Use of modern methods is highest in Otdar Mean Chey (44 percent) and lowest in Kratie (24 percent). Women obtain contraception from a variety of sources. The majority of users of female steri- lization, injectables, IUDs, and implants obtain their method from the public sector. Forty-three percent of pill users rely on the public sector (mostly health centers), and 31 percent rely on the private sector (mostly pharmacies). Fifty- three percent of users of male condoms obtain the method from the private sector, and 47 per- cent get them from the public sector. Just over half (53 percent) of currently mar- ried women who are not using a contraceptive method say that they intend to use a method in the future. Seventeen percent of currently married women have an unmet need for family planning. That is, they do not want any more children or they want to wait at least two years before their next birth, but they are not currently using a me- thod of contraception. The unmet need for limit- ing births (11 percent) is higher than the unmet need for spacing births (6 percent). Unmet need is especially high among women in the lowest wealth quintile and among women with a prima- ry education or no schooling. Currently, 76 per- cent of the total need for family planning is be- ing met. CHILD HEALTH The 2010 CDHS data show a remarkable decline in childhood mortality. Currently there are 45 infant deaths for every 1,000 live births and 54 under-five deaths for every 1,000 live births. In 2005, infant mortality was 66 and un- der-five mortality was 83. Childhood mortality varies throughout Cam- bodia. It is much higher in rural areas (with an under-five mortality of 75) than in urban areas (where under-five mortality is 29). Under-five mortality ranges from a high of 118 in Preah Vihear/Steung Treng to a low of 18 in Phnom Penh. Wealth and education are strongly linked with childhood death. Children whose mothers are in the lowest wealth quintile have a three times greater risk of dying before age 5 than those whose mothers are in the highest wealth quintile. Under-five mortality is also much high- er among mothers who have received no school- ing (87 percent) than among those whose moth- ers have attended secondary or higher levels of schooling (35 percent). Survival of infants and children is also strongly influenced by sex of the child, mother’s age at birth, birth order, and birth interval. Male children are more likely to die than female child- ren. Childhood mortality is also highest among children whose mothers are over 40 years of age at birth. Childhood mortality increases with birth order. That is, first, second, and third children are at less risk of death than fourth and higher birth-order children. Finally, children who are born less than two years after a sibling are at a much more increased risk of infant and child- hood death than those born two or more years after a sibling. Four in five children age 12-23 months have received all the basic recommended vaccinations (BCG, three doses each of tetravalent/ pentava- lent and polio, and measles). In 2005, only 67 percent of children had received all of these vac- cinations. More than 90 percent have received BCG, tetravalent/pentavalent 2, and polio 2, while fewer have received the third doses of te- travalent/pentavalent and polio, and 82 percent have received the measles vaccine. Four percent of children have received no vaccinations at all. Vaccination coverage increases with household wealth and level of mother’s education. Vaccina- tion coverage is highest in Banteay Mean Chey (93 percent) and lowest in lowest in Mondol Ki- ri/Rattanak Kiri (28 percent). Diagnosis and treatment of childhood dis- eases are essential to reducing mortality. Among children who had symptoms of acute respiratory infection in the two weeks before the survey, 64 percent were taken to a health facility or provid- er. Sixty-three percent of children with fever received this same treatment. Fifty-nine percent of children with diarrhea were taken to a health Summary of Findings | xxi provider. Fifty-three percent of children with diarrhea were treated with either oral rehydration therapy or increased fluids. Only 34 percent of children with diarrhea were given more fluids than usual during their illness. MATERNAL HEALTH Antenatal care from a health professional has increased substantially since 2005. Eighty- nine percent of women who had a live birth in the five years preceding the survey received an- tenatal care in 2010 compared with only 69 per- cent in 2005. Antenatal care coverage is more common in urban areas (97 percent) than in rural areas (88 percent). Ninety-six percent of women with secondary and higher education receive antenatal care compared with only 77 percent of those with no education. Antenatal care coverage is highest in Phnom Penh (99 percent) and low- est in Mondol Kiri/Rattanak Kiri (62 percent). Fifty-nine percent of women have four or more antenatal care visits. The same proportion starts antenatal care in the first three months of preg- nancy. Only 80 percent of those who received ante- natal care reported that they were informed of the signs of pregnancy complications. Eighty-five percent of women with a birth in the five years before the survey were protected from neonatal tetanus, either because they re- ceived two tetanus toxoid injections or because they received injections during earlier pregnan- cies. Just over half (54 percent) of the births that occur in the five years before the survey took place in a health facility, and 45 percent took place at home. This marks a great improvement since 2005 when only 22 percent of births oc- curred in a health facility. Health facility births are far more common in urban areas (86 percent) than in rural areas (48 percent) and among wom- en with secondary or higher education and those in the highest wealth quintile. Seventy-one per- cent of births were assisted by a trained health professional (doctor, nurse, or midwife). This also represents a great improvement because only 44 percent of births received trained assis- tance in 2005. Ninety-five percent of births in urban areas received assistance from a trained health provider compared with 67 percent in ru- ral areas. Trained assistance at delivery is most common in Phnom Penh (99 percent of births) and least common in Preah Vihear/Steung Treng (28 percent). The 2010 CDHS reports a maternal mortali- ty rate of 206 deaths per 100,000 live births. BREASTFEEDING AND NUTRITION Almost all Cambodian children are breastfed. About two-thirds begin breastfeeding within an hour of birth, while 86 percent begin breastfeeding within a day of birth. Children are breastfed for an average of 20.3 months, but they are exclusively breastfed for only 4.9 months. Seventy-four percent of infants under age of 6 months are exclusively breastfed, as recom- mended by WHO. The 2010 CDHS includes biomarker testing for anemia as well as information on micronu- trient intake. Fifty-five percent of childrenage6- 59 months have some degree of anemia. The anemia is moderate or severe in 27 percent of children. The majority of children age 6-23 months had consumed foods rich in vitamin A and iron on the day before the survey. Seventy- one percent of children age 6-59 months had received vitamin A supplements in the 6 months before the survey. Only 2 percent had received iron supplements in the week before the survey. Eighty-three percent of households had ade- quately iodized salt. The nutritional status of children has not changed much in the past five years. Currently, 40 percent of children are stunted and 11 percent are wasted, compared with 43 and 8 percent in 2005. Stunting is most common in Preah Vi- hear/Steung Treng (56 percent) and least com- mon in Phnom Penh (25 percent). In general, children with uneducated mothers and those liv- ing in the poorest households are most likely to be malnourished. Women also suffer from nutritional defi- ciencies. Forty-four percent of women have some degree of anemia. Forty-four percent of women received a vitamin A dose postpartum. Only 57 percent took iron tablets or syrup for 90 or more days during pregnancy, as recommend- ed. Nineteen percent of Cambodian women age 15-49 are considered thin, while 11 percent are xxii | Summary of Findings overweight or obese. The percentage of under- weight women has remained stable over the last 10 years, while the percentage of overweight women has increased since 2000. HIV/AIDS Practically all Cambodians have heard of AIDS. Three in four women and 80 percent of men age 15-49 know the two major methods of preventing HIV transmission: using condoms and limiting sexual intercourse to one uninfected partner. Misconceptions about HIV/AIDS are still fairly common. Only sixty-three percent of women and 61 percent of men know that a healthy-looking person can have the AIDS virus, and only 71 percent of women and 75 percent of men know that AIDS cannot be transmitted by mosquito bites. Almost nine in ten women know that HIV can be transmitted to an infant through breastfeeding, but only 58 percent know that this risk can be minimized if the mother takes special drugs during pregnancy. Certain behaviors put individuals at higher risk for contracting HIV. Almost no women and less than 2 percent of men reportedly had two or more sexual partners during the 12 months pre- ceding the survey. Only 40 percent of these men reported wearing a condom at last sexual inter- course. Eleven percent of men reported ever paying for sex, and 4 percent reported paying for sex in the year before the survey. Only 82 per- cent of the men who paying for sex in the past year reported using a condom the last time they paid for sex. HIV testing is relatively uncommon in Cam- bodia. About 7 of 10 men and women know where to get an HIV test, but only 23 percent of women and 24 percent of men have ever taken an HIV test and received the results. WOMEN’S STATUS Cambodian women are usually involved in all three of the specific household decisions asked about in the survey, although the extent of their involvement depends on the issue being decided. About 45 percent of women say they alone make decisions about their own health care. However, decisions about major household purchases and visits to the wife’s family or rela- tives are usually made jointly by the husband and wife. The 2010 CDHS gathered information on women’s and men’s attitudes toward wife beat- ing, a proxy for women’s status. Respondents were asked whether a husband is justified in beating his wife if she burns the food, argues with him, goes out without telling him, neglects the children, refuses to have sex with him, and asks him to use a condom. Nearly half of women (46 percent) but only 22 percent of men believe that a husband is justified in beating his wife for at least one of the six specified reasons. Only 8 percent of women and 3 percent of men believe that wife beating is justified if a woman asks her husband to use a condom. USE OF HEALTH SERVICES FOR ACCIDENT OR INJURY Two percent of household members were in- jured or killed in an accident in the year before the survey. Two-thirds of injuries and deaths are attributed to road accidents. Eleven percent of household members had an illness or injury in the month before the survey. Among them, 92 percent sought a first treatment, 23 percent sought a second treatment, and 8 percent sought a third treatment. Mean costs for first, second, and third treatments (including cost of transport) are $30.49, $43.92, and $21.50, respectively. Mean cost of transport increases with treatment order, from $2.08 for the first treatment to $3.00 for the second treatment and then $4.04 for the third treatment. xxiv | Map of Cambodia Introduction | 1 INTRODUCTION 1 1.1 GEODEMOGRAPHY, HISTORY, AND ECONOMY 1.1.1 Geodemography Cambodia is an agricultural country located in Southeast Asia. It borders with Thailand to the west, Laos and Thailand to the north, the Gulf of Thailand to the southwest, and Vietnam to the east and the south. It has a total land area of 181,035 square kilometers. Cambodia has a tropical climate with two distinct monsoon seasons that set the rhythm of rural life. From November to February, the cool, dry northeastern monsoon brings little rain, whereas from May to October the southwestern monsoon carries strong winds, high humidity, and heavy rains. The mean annual temperature for Phnom Penh, the capital city, is 27°C. The 1962 population census was the last official census to be conducted prior to 1998; it revealed a population of 5.7 million. The population census in 1998 recorded a population of 11.4 million with an annual growth rate of 2.5 percent (National Institute of Statistics, 1999). The 2004 Inter-Censal Population Survey showed that the annual growth rate had declined to 1.8 percent, with a total population of 13.1 million (National Institute of Statistics, 2004). The 2008 General Population Census (GPC) showed a further decrease in the annual growth rate to 1.54, with a total population of 13.4 million (National Institute of Statistics, 2009). The proportion of the population living in rural areas is 80.5 percent; only 19.5 percent of the country’s residents live in urban areas. The population density in the country as a whole is 75 per square kilometer, with approximately 1.3 million inhabitants living in Phnom Penh. The average size of the Cambodian household is 4.7. The total male to female sex ratio is 94.7. The literacy rate among adults age 15 and older is 78 percent, with the male adult literacy rate (85 percent) being considerably higher than the rate among females (71 percent). Currently, it is estimated that approximately 28 percent of the total population lives below the poverty line. 1.1.2 History Cambodia gained complete independence from France under the leadership of Prince Norodom Sihanouk on 9 November 1953. In March 1970, a military coup led by General Lon Nol overthrew Prince Sihanouk. On 17 April 1975, the Khmer Rouge ousted the Lon Nol regime and took control of the country. Under the new regime, the country was renamed Democratic Kampuchea. Nearly 2 million Cambodian people died during the Khmer Rouge’s radical and genocidal regime. On 7 January 1979, the revolutionary army of the National Front for Solidarity and Liberation of Cambodia defeated the Khmer Rouge regime and proclaimed the country the People’s Republic of Kampuchea and later, in 1989, the State of Cambodia. The country’s most important political event was the free elections held in May 1993 under the close supervision of the United Nations Transitional Authority in Cambodia (UNTAC). At that time Cambodia was proclaimed the Kingdom of Cambodia, and is a constitutional monarchy. Three additional free and fair elections took place in 1998, 2003, and 2008. Now Cambodia is stable and well on its way to democracy and a promising future. 2 | Introduction 1.1.3 Economy Since the 1991 Paris Peace Accord, Cambodia’s economy has made significant progress after more than two decades of political unrest. However, Cambodia still remains one of the poorest and least developed countries in Asia, with the gross domestic product per capita estimated at approximately 3.3 million Riel or $805 in 2010 (US$1 = 4,087 Riel) (International Monetary Fund, 2011). Agriculture, mainly rice production, is still the main economic activity in Cambodia. Small- scale subsistence agriculture, such as fisheries, forestry, and livestock, is another important sector. Garment factories and tourism services are also important components of foreign direct investments. 1.2 HEALTH STATUS AND POLICY Health outcomes have improved recently. The infant mortality rate has decreased from 66 per 1,000 live births in 2005 to 45 per 1,000 live births in 2010. The under-five mortality rate decreased from 83 per 1,000 live births to 54 per 1,000 live births in the same period. Life expectancy at birth is 60.5 years for males and 64.3 years for females (National Institute of Statistics, 2009). General government expenditures on health per capita increased from US$4 in 2000 to US$7 in 2005 and US$11 in 2009 (WHO, 2011). The health status of the Cambodian people has steadily improved in a number of key areas. Nonetheless, challenges remain in many other areas. To improve the health status of the Cambodian people, the Ministry of Health developed the Health Sector Strategic Plan for 2008-2015 (Ministry of Health, 2008). Its policy direction is as follows: • Make services more responsive and closer to the public through implementation of a decentralized service delivery function and a management function guided by the national “Policy on Service Delivery” and the policy on “Decentralization and Deconcentration.” • Strengthen sector-wide governance through implementation of a sector wide approach, focusing on increased national ownership and accountability to improved health outcomes, harmonization and alignment, greater coordination and effective partnerships among all stakeholders. • Scale up access to and coverage of health services, especially comprehensive reproductive, maternal, newborn and child health services both demand and supply side through mechanisms such as institutionalization and expansion of contracting through Special Operating Agencies, exemptions for the poor, health equity funds, and health insurance. • Implement pro-poor health financing systems, including exemptions for the poor and expansion of health equity funds, in combination with other forms of social assistance mechanisms. • Reinforce health legislation, professional ethics and code of conduct, and strengthen regulatory mechanisms, including for the production and distribution of pharmaceuticals, drug quality control, cosmetics, food safety and hygiene, to protect providers and consumers’ rights and their health. • Improve quality in service delivery and management through establishment of and compliance with the national protocols, clinical practice guidelines and quality standards, in particular establishment of accreditation systems. • Increase competency and skills of health workforce to deal with increased demand for account-ability and high quality care, including through strengthening allied technical Introduction | 3 skills and advanced technology through increased quality practice of training, career development, right incentives, and good working environment. • Strengthen and invest in health information system and health research for evidence- based policy-making, planning, monitoring performance and evaluation. • Increase investment in physical infrastructures and medical care equipment and advanced technology, as well as in improvement of non-medical support services including management, maintenance, blood safety, and supply systems for drugs and commodities. • Promote quality of life and healthy lifestyles of the population by raising health awareness and creating supportive environments, including through strengthening institutional structures, financial and human resources, and IEC materials for health promotion, behavior change communication and appropriate health-seeking practices. • Prevent and control communicable and selected chronic and non-communicable diseases, and strengthen disease surveillance systems for effective response to emerging and remerging diseases. • Strengthen public health interventions to deal with cross-cutting challenges, especially gender, health of minorities, hygiene and sanitation, school health, environmental health risks, substance abuse/mental health, injury, occupational health, disaster, through timely response, effective collaboration and coordination with other sectors. • Promote effective public and private partnerships in service provision based on policy, regulation, legislations and technical standards. • Encourage community engagement in health service delivery activities, management of health facilities and continuous quality improvement. • Systematically strengthen institutions at all levels of the health system to implement policy agenda listed under the previous 14 elements. 1.3 OBJECTIVE AND SURVEY ORGANIZATION The 2010 Cambodia Demographic and Health Survey (CDHS) is the third nationally representative survey conducted in Cambodia on population and health issues. It uses the same methodology as its predecessors, the 2000 and the 2005 Cambodia Demographic and Health Surveys, allowing policymakers to use these surveys to assess trends over time. The primary objective of the CDHS is to provide the Ministry of Health (MOH), Ministry of Planning (MOP), and other relevant institutions and users with updated and reliable data on infant and child mortality, fertility preferences, family planning behavior, maternal mortality, utilization of maternal and child health services, health expenditures, women’s status, and knowledge and behavior regarding HIV/AIDS and other sexually transmitted infections. This information contributes to policy decisions, planning, monitoring, and program evaluation for the development of Cambodia at both the national and local government levels. The long-term objectives of the survey are to build the capacity of the Ministry of Health and the National Institute of Statistics (NIS) of the Ministry of Planning for planning, conducting, and analyzing the results of further surveys. The 2010 CDHS survey was conducted by the Directorate General for Health (DGH) of the Ministry of Health and the National Institute of Statistics of the Ministry of Planning. The CDHS executive committee and technical committee were established to oversee all technical aspects of implementation. They consisted of representatives from the Ministry of Health, the Ministry of 4 | Introduction Planning, the National Institute of Statistics, the U.S. Agency for International Development (USAID), the United Nations Population Fund (UNFPA), the United Nations Children’s Fund (UNICEF), and the Japan International Cooperation Agency (JICA). Funding for the survey came from USAID, UNFPA, UNICEF, JICA, and the Health Sector Support Program–Second Phase (HSSP-2). Technical assistance was provided by ICF Macro. 1.4 SAMPLE DESIGN The 2010 CDHS sample is a nationally representative sample of women and men between the ages of 15 and 49 who completed interviews. To achieve a balance between the ability to provide estimates at the subnational level and limiting the sample size, 19 sampling domains were defined, 14 of which correspond to individual provinces and 5 of which correspond to grouped provinces. • Fourteen individual provinces: Banteay Mean Chey, Kampong Cham, Kampong Chhnang, Kampong Speu, Kampong Thom, Kandal, Kratie, Phnom Penh, Prey Veng, Pursat, Siem Reap, Svay Rieng, Takeo, and Otdar Mean Chey • Five groups of provinces: Battambang and Pailin, Kampot and Kep, Preah Sihanouk and Koh Kong, Preah Vihear and Steung Treng, and Mondol Kiri and Rattanak Kiri The sample of households was allocated to the sampling domains in such a way that national- level estimates of indicators could be produced with precision, separately for urban and rural areas of the country and for each of the 19 sampling domains. The sampling frame used for the 2010 CDHS was the complete list of all villages enumerated in the 2008 Cambodia General Population Census provided by NIS. It included the entire country and consisted of 28,764 enumeration areas (EAs). The GPC also created maps that delimited the boundaries of every EA. Overall, 4,301 EAs were designated as urban and 24,373 as rural, with an average size of 98 households per EA. The survey was based on a stratified sample selected in two stages. Stratification was achieved by separating every reporting domain into urban and rural areas. Thus, the 19 domains were stratified into a total of 38 sampling strata. Samples were selected independently in every stratum through a two-stage selection process. Implicit stratifications were achieved at each of the lower geographical or administrative levels by sorting the sampling frame according to geographical/administrative order and by using a probability proportional to size selection strategy at the first stage of selection. In the first stage, 611 EAs were selected with probability proportional to size. The size of an EA was defined according to the number of households in the EA. Some of the largest EAs (more than 200 households) were further divided into segments; only one segment was selected randomly to be included in the survey. Thus, the 611 CDHS clusters were either an EA or a segment of an EA. A listing of all households was carried out in each of the 611 selected EAs during the months of February through April 2010. Listing teams also drew fresh maps delineating EA boundaries and identifying all households. These maps and lists were used by field teams during data collection. The household listings provided the frame from which households were selected in the second stage. To ensure a sample size large enough to calculate reliable estimates for each study domain, it was necessary to restrict the total number of households selected to 24 in each urban EA and 28 in each rural EA. Small areas and urban areas were oversampled, and this oversampling was corrected in the analysis using sampling weights to ensure the natural representation of the sample for all 38 strata (19 domains by urban or rural area). Appendix A provides a complete description of the sample design and weighting procedures. All women age 15-49 years who were either usual residents of the selected households or visitors present in the household on the night before the survey were eligible to be interviewed. In addition, in a subsample of every other household selected for the survey, all men age 15-49 were Introduction | 5 eligible to be interviewed (if they were either usual residents of the selected households or visitors present in the household on the night before the survey). The minimum sample size was larger for women than men because complex indicators (such as total fertility and infant and child mortality rates) require larger sample sizes to achieve a reasonable level of precision, and these data come from interviews with women. In the subsample of households chosen for the male interviews (50 percent of the total sample), all women eligible for interview and all children under the age of five were eligible for anemia testing. These same women and children were also eligible for height and weight measurements to determine their nutritional status. 1.5 QUESTIONNAIRES Three questionnaires were used: the Household Questionnaire, the Woman’s Questionnaire, and the Man’s Questionnaire. The content of these questionnaires was based on model questionnaires developed by the MEASURE DHS project. Technical meetings between experts and representatives of the Cambodian government and national and international organizations were held to discuss the content of the questionnaires. Input generated from these meetings was used to modify the model questionnaires to reflect the needs of users and relevant population, family planning, and health issues in Cambodia. Final questionnaires were translated from English to Khmer, and a great deal of refinement to the translation was accomplished during the pretest of the questionnaires. The Household Questionnaire served multiple purposes: • It was used to list all of the usual members of and visitors to the selected households and was the vehicle for identifying women and men who were eligible for the individual interviews. • It collected basic information on the characteristics of each person listed, including age, sex, education, and relationship to the head of the household. • It collected information on characteristics of the household’s dwelling unit, ownership of various durable goods, and testing of salt for iodine content. • It collected anthropometric (height and weight) measurements and hemoglobin levels. • It had a module on recent illness or death. • It had a module on utilization of health services. The Woman’s Questionnaire covered a wide variety of topics divided into 11 sections: • Respondent Background • Reproduction (including an abortion module) • Family Planning • Pregnancy and Postnatal Care • Immunization, Health, and Children’s Nutrition • Marriage and Sexual Activity • Fertility Preferences • Husband’s Background and Woman’s Work • HIV/AIDS and Other Sexually Transmitted Infections • Other Health Problems • Adult and Maternal Mortality The Man’s Questionnaire was administered to all eligible men age 15-49 living in every second household of the 2010 CDHS sample. The Man’s Questionnaire collected information similar to that of the Woman’s Questionnaire but was shorter in that it did not contain as detailed a reproductive history and did not include questions on maternal and child health, nutrition, or adult and maternal mortality. 6 | Introduction The CDHS underwent a full pretest in May 2010. Twenty-four women and 23 men were trained in the administration of the CDHS survey instruments and blood collection techniques. Training and fieldwork included the Household Questionnaire (not including anthropometry or testing of salt for iodine), the Woman’s Questionnaire, and the Man’s Questionnaire. The classroom training was followed by five days of field practice and one day of interviewer debriefing. Constructive input from interviewers was used to refine the survey instruments and survey logistics. These pretest activities were used to finalize the questionnaires. 1.6 TRAINING AND FIELDWORK The goal of training was to create 19 field teams capable of collecting data for the 2010 CDHS. Each team was responsible for data collection in one of the 19 survey domains (comprising the 23 provinces and the Capital City of Phnom Penh). Field teams were each composed of six people: a team leader, a field editor, three female interviewers, and one male interviewer. Nineteen fully staffed field teams would require 114 field personnel, and at the end of training 109 field personnel were retained. Twenty-six days of training included four days of field practice in Kandal province. Data processing personnel (3 data processing supervisors, 10 office editors/coders, 19 data entry operators, and 5 in reserves) also attended classroom training. Training began with the Household Questionnaire and was followed by the Woman’s Questionnaire. Additional time was spent reviewing the Household Questionnaire, including consent statements for hemoglobin testing, and conversion of ages and dates of birth from the Khmer calendar to the Gregorian calendar. One week was devoted to additional activities, including the Man’s Questionnaire, measurement of women’s and children’s height and weight, sample implementation and household selection, testing of household salt for iodine, and organization of documents and materials for return to the head office. After completion of training, including field practice, fieldwork was launched and teams disbursed to their assigned provinces. During the training period, the 19 CDHS team leaders were provided with the cluster information for the provinces in which they would be working so that they could devise a data collection sequence for their sample points. Team leaders were best equipped to perform this task because they hailed from their own provinces. They also conducted the CDHS household listing operation (described in Appendix A: Sample Implementation) and therefore were well acquainted with the areas in which they would be working. The progression of fieldwork by geographic location had to take into account weather conditions during the rainy season. Fieldwork supervision was carried out regularly by three CDHS survey coordinators from NIS and MOH along with an ICF Macro consultant. Supervision visits were conducted throughout the six months of data collection and included retrieval of questionnaires from the field. In addition, a quality control program was run by the data processing team to detect key data collection errors for each team. These data checks were used to provide regular feedback to each team based on its specific performance. Data collection was conducted from 23 July 2010 to 20 January 2011. 1.7 DATA PROCESSING Data entry on 20 personal computers began on 26 August 2010; four weeks after the first interviews were conducted. Data entry personnel attended questionnaire training of interviewers to become familiar with the survey instruments. Data processing personnel included a data processing chief, two assistants, 20 entry operators, and nine office editors. Completed questionnaires were delivered from the field by survey coordinators, and questionnaires were logged by the office editors. Questionnaire data were entered at NIS using CSPro, a program developed jointly by the United States Census Bureau, the ICF Macro MEASURE DHS program, and Serpro S.A. All questionnaires were entered twice to minimize data entry error. Data entry was completed on 5 February 2011. Internal consistency verification and secondary editing were completed on 25 February 2011. Introduction | 7 1.8 SAMPLE COVERAGE All of the 611 clusters selected for the sample were surveyed in the 2010 CDHS. A total of 16,344 households were selected, of which 15,829 were found to be occupied during data collection. Among these households, 15,667 completed the Household Questionnaire, yielding a response rate of 99 percent (Table 1.1). In these interviewed households, 19,237 women were identified as eligible for the individual interview. Interviews were completed with 98 percent of these women. Of the 8,665 eligible men identified in every other household, 95 percent were successfully interviewed. There was little variation in response rates by urban-rural residence. Table 1.1 Results of the household and individual interviews Number of households, number of interviews, and response rates, according to residence, Cambodia 2010 Result Residence Total Urban Rural Household interviews Households selected 4,584 11,760 16,344 Households occupied 4,435 11,394 15,829 Households interviewed 4,385 11,282 15,667 Household response rate 98.9 99.0 99.0 Individual interviews: women Number of eligible women 6,228 13,009 19,237 Number of eligible women interviewed 6,077 12,677 18,754 Eligible women response rate 97.6 97.4 97.5 Individual interviews: men Number of eligible men 2,722 5,943 8,665 Number of eligible men interviewed 2,606 5,633 8,239 Eligible men response rate 95.7 94.8 95.1 Household Population and Housing Characteristics | 9 HOUSEHOLD POPULATION AND HOUSING CHARACTERISTICS 2 This chapter summarizes the socioeconomic characteristics of households and respondents surveyed, including age, sex, residence (urban-rural), educational status, household facilities, and household characteristics. The profile of the households provided in this chapter will help in understanding the results of the 2010 Cambodia Demographic and Health Survey (CDHS) in the following chapters. In addition, it may provide useful information for social and economic development planning. Throughout this report, numbers in the tables reflect weighted numbers. Due to the way the sample was designed, the number of weighted cases in some regions appears small, because they are weighted to make the regional distribution nationally representative. However, roughly the same number of households and women and men were interviewed in each province or group of provinces, and the number of unweighted cases is always large enough to calculate the presented estimates. Estimates based on an insufficient number of cases are shown in parentheses or not shown at all. The 2010 CDHS collected information from all usual residents of a selected household (de jure population) and persons who had stayed in the selected household the night before the interview (de facto population). Although the difference between these two populations is small, to avoid double counting all tables in this report refer to the de facto population unless otherwise specified. The CDHS used the same definition of households as the 2008 census conducted by the National Institute of Statistics. A household was defined as a person or group of related and unrelated persons who live together in the same dwelling unit(s) or in connected premises, who acknowledge one adult member as the head of the household, and who have common arrangements for cooking and eating meals. 2.1 CHARACTERISTICS OF THE HOUSEHOLD POPULATION 2.1.1 Age and Sex Composition Age and sex are important demographic variables and are the primary basis of demographic classification in vital statistics, censuses, and surveys. They are also important variables in the study of mortality, fertility, and nuptiality. The effect of variations in sex composition from one population group to another should be taken into account in comparative studies of mortality. In general, a cross- classification with sex is useful for the effective analysis of all forms of data obtained in surveys. The survey collected information on age in completed years for each household member. When the age was not known, interviewers inquired further for dates of birth in the Gregorian calendar, the Khmer calendar, and a historical calendar. Age was then calculated using conversion charts specifically designed for this purpose. Table 2.1 presents the percent distribution of the household population by age, according to urban-rural residence and sex. The population spending the night before the survey in the households selected for the survey included 71,584 individuals, of whom 48 percent were males and 52 percent were females. The age structure of the household population is typical of a society with a young population and recently declining fertility. The sex and age distribution of the population is also shown in the population pyramid in Figure 2.1. Cambodia has a relatively broad-based pyramid structure because 45 percent of the population is under 20 years of age. 10 | Household Population and Housing Characteristics Table 2.1 Household population by age, sex, and residence Percent distribution of the de facto household population by five-year age groups, according to sex and residence, Cambodia 2010 Age Urban Rural Total Total Male Female Total Male Female Total Male Female <5 10.0 8.8 9.4 12.7 10.9 11.8 12.2 10.5 11.3 5-9 9.6 8.0 8.8 12.3 11.0 11.7 11.8 10.5 11.1 10-14 9.7 8.9 9.2 13.5 11.9 12.7 12.8 11.4 12.1 15-19 11.5 11.4 11.5 11.4 9.6 10.4 11.4 9.9 10.6 20-24 12.4 11.5 11.9 8.4 7.9 8.2 9.2 8.6 8.8 25-29 10.8 10.4 10.6 7.9 8.1 8.0 8.4 8.5 8.5 30-34 7.1 6.4 6.7 6.0 5.9 5.9 6.2 6.0 6.1 35-39 4.8 5.3 5.1 4.9 5.4 5.2 4.9 5.4 5.2 40-44 6.4 5.9 6.1 5.7 6.1 5.9 5.8 6.0 5.9 45-49 5.2 6.0 5.6 4.9 5.6 5.3 5.0 5.7 5.4 50-54 4.1 5.1 4.6 3.3 4.6 3.9 3.4 4.7 4.1 55-59 3.0 3.8 3.4 2.7 3.9 3.3 2.7 3.9 3.3 60-64 2.2 2.9 2.6 2.2 3.0 2.6 2.2 3.0 2.6 65-69 1.2 1.9 1.6 1.4 2.2 1.8 1.4 2.1 1.8 70-74 1.1 1.8 1.5 1.1 1.7 1.4 1.1 1.7 1.4 75-79 0.5 1.0 0.8 0.8 1.2 1.0 0.8 1.2 1.0 80 + 0.4 0.7 0.6 0.8 1.0 0.9 0.7 0.9 0.8 Don’t know/missing 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number 6,156 6,881 13,037 28,162 30,382 58,547 34,318 37,263 71,584 Note: Total includes 1 person whose sex was not stated. Figure 2.1 Population Pyramid CDHS 2010 80+ 75-79 70-74 65-69 60-64 55-59 50-54 45-49 40-44 35-39 30-34 25-29 20-24 15-19 10-14 5-9 <5 Ag e gr o u p 01234567 0 1 2 3 4 5 6 7 Percent MaleFemale Above the age of 10 years, the pyramid follows a typical pattern of decreasing numbers as age increases. However, the percentage of people age 30 to 39 is less than would be expected because these are the two age groups born in the decade of the 1970s. The early 1970s saw escalating civil war, and in the late 1970s the Khmer Rouge ruled. This period of time was characterized by few births and high infant and child mortality. Cambodia has a large dependent population of children and adolescents, although with decreasing fertility the proportion of the population under age 15 has recently declined. The proportion of those ages 50 or older has slightly increased. Table 2.2 shows that children under age 15 Household Population and Housing Characteristics | 11 account for 35 percent of the population. Sixty-one percent of the population is in the 15-64 age group, and 5 percent are age 65 or older. Table 2.2 Population by age according to selected sources Percent distribution of the de facto population by age group, according to selected sources, Cambodia 2010 Age 1998 census1 2000 CDHS2 2004 CIPS3 2005 CDHS4 2008 census5 2010 CDHS <15 42.8 42.7 38.6 38.9 33.7 34.5 15-49 46.9 46.3 49.5 47.9 53.4 50.5 50-64 6.8 7.4 8.0 8.6 8.6 10.0 65+ 3.5 3.6 3.9 4.6 4.3 5.0 Total 100.0 100.0 100.0 100.0 100.0 100.0 1 General Population Census of Cambodia, 1998 (National Institute of Statistics, 1999) 2 Cambodia Demographic and Health Survey, 2000 (National Institute of Statistics and ORC Macro, 2001) 3 Cambodia Inter-Censal Population Survey, 2004 (National Institute of Statistics, 2004) 4 Cambodia Demographic and Health Survey, 2005 (National Institute of Statistics and ORC Macro, 2006) 5 General Population Census of Cambodia, 2008 (National Institute of Statistics, 2009) 2.1.2 Household Composition Table 2.3 shows the distribution of households in the survey by the sex of the head of the household, the number of household members, and urban and rural residence. Households in Cambodia are predominantly male-headed. However, 27 percent of households are headed by women (28 and 27 percent in urban and rural areas, respectively). The average household size is 4.7 persons, smaller than the 5.0 persons per household observed in the 2005 CDHS. Urban households have 5.0 persons per household on average and are slightly larger than rural households (4.7 persons). Households with six or more members are more common in urban areas (36 percent) than in rural areas (30 percent). 2.2 EDUCATION OF THE HOUSEHOLD POPULATION Many behaviors, including those in the realms of reproduction, contraceptive use, child health, and proper hygiene, are affected by the education of household members. Information on the educational level of the male and female population age 6 and above is presented in Tables 2.4.1 and 2.4.2. Survey results show that although the majority of Cambodians have not completed primary school, the country has experienced strong improvement in educational attainment over time. Overall, 21 percent of females have never attended school, as compared with 11 percent of males. Improvements over time have resulted in only 3 percent each of girls and boys age 10-14 having never attended school at all. Table 2.3 Household composition Percent distribution of households by sex of head of household and by household size; and mean size of household, according to residence, Cambodia 2010 Characteristic Residence Total Urban Rural Household headship Male 72.2 73.1 72.9 Female 27.8 26.9 27.1 Total 100.0 100.0 100.0 Number of usual members 0 0.0 0.0 0.0 1 2.4 2.9 2.8 2 8.8 7.8 8.0 3 13.9 16.4 16.0 4 21.1 22.7 22.4 5 17.8 20.3 19.9 6 14.6 13.8 13.9 7 9.2 7.9 8.2 8 5.1 4.5 4.6 9+ 7.1 3.6 4.2 Total 100.0 100.0 100.0 Mean size of households 5.0 4.7 4.7 Number of households 2,652 13,015 15,667 Note: Table is based on de jure household members, i.e., usual residents. 12 | Household Population and Housing Characteristics Table 2.4.1 Educational attainment of the female household population Percent distribution of the de facto female household population age 6 and over by highest level of schooling attended or completed and median grade completed, according to background characteristics, Cambodia 2010 Background characteristic No schooling Some primary Completed primary1 Some secondary Completed secondary2 More than secondary Don’t know/ missing Total Number Median years completed Age 6-9 16.7 83.3 0.0 0.0 0.0 0.0 0.0 100.0 3,136 0.4 10-14 2.5 69.0 3.2 25.3 0.0 0.0 0.0 100.0 4,235 3.7 15-19 4.0 23.4 9.6 60.0 0.6 2.3 0.0 100.0 3,697 6.8 20-24 9.7 31.2 11.5 34.2 5.3 8.1 0.1 100.0 3,187 5.8 25-29 15.6 44.4 9.3 22.0 4.2 4.4 0.1 100.0 3,182 4.2 30-34 21.4 48.2 6.7 19.0 3.0 1.8 0.0 100.0 2,224 3.4 35-39 19.7 49.3 6.1 20.8 2.7 1.3 0.0 100.0 2,020 3.4 40-44 21.9 52.3 5.0 17.9 1.8 0.9 0.1 100.0 2,251 2.9 45-49 34.2 53.4 2.5 8.3 0.6 0.8 0.2 100.0 2,126 1.6 50-54 35.6 51.4 3.9 7.4 1.0 0.4 0.4 100.0 1,745 1.6 55-59 35.8 49.0 4.3 8.8 1.0 0.7 0.5 100.0 1,445 1.7 60-64 44.1 44.3 3.0 6.7 1.3 0.2 0.4 100.0 1,118 0.9 65+ 75.5 19.2 1.7 2.8 0.3 0.3 0.3 100.0 2,200 0.0 Don’t know/missing 100.0 0.0 0.0 0.0 0.0 0.0 0.0 100.0 2 0.0 Residence Urban 11.7 38.2 5.7 31.2 5.2 7.9 0.1 100.0 6,154 5.0 Rural 23.6 50.6 5.4 18.8 0.9 0.5 0.1 100.0 26,413 2.5 Province Banteay Mean Chey 22.3 53.3 4.6 17.6 1.4 0.9 0.0 100.0 1,341 2.2 Kampong Cham 25.3 47.1 7.0 18.7 1.0 0.9 0.1 100.0 3,765 2.7 Kampong Chhnang 20.1 57.1 5.9 15.4 0.9 0.5 0.0 100.0 1,280 2.3 Kampong Speu 16.5 51.0 5.6 25.2 1.1 0.7 0.0 100.0 1,809 3.4 Kampong Thom 24.8 52.2 4.7 16.4 1.1 0.8 0.0 100.0 1,659 2.1 Kandal 17.6 47.1 6.3 26.4 1.6 0.9 0.0 100.0 3,272 3.5 Kratie 22.0 51.1 5.8 19.1 1.7 0.4 0.0 100.0 771 2.6 Phnom Penh 8.8 36.0 5.3 32.1 6.2 11.6 0.0 100.0 3,272 5.8 Prey Veng 25.4 53.0 5.0 15.5 0.8 0.3 0.0 100.0 2,468 2.5 Pursat 22.2 52.1 4.5 18.4 1.3 1.6 0.0 100.0 996 2.3 Siem Reap 22.6 52.5 5.4 15.7 2.1 1.0 0.6 100.0 2,108 2.3 Svay Rieng 26.7 48.8 3.8 19.4 0.9 0.4 0.0 100.0 1,314 2.4 Takeo 22.3 49.1 6.4 20.2 0.9 1.0 0.0 100.0 2,206 2.7 Otdar Mean Chey 25.7 52.0 4.4 16.8 0.7 0.3 0.0 100.0 433 2.2 Battambang/Pailin 21.0 46.8 5.4 24.5 1.1 1.0 0.4 100.0 2,358 3.0 Kampot/Kep 21.1 46.2 5.7 24.6 1.3 0.6 0.4 100.0 1,609 2.9 Preah Sihanouk/Koh Kong 26.7 42.3 4.1 23.2 1.5 2.1 0.0 100.0 713 2.7 Preah Vihear/Steung Treng 29.0 50.7 4.2 13.9 0.8 0.5 0.8 100.0 733 1.7 Mondol Kiri/Rattanak Kiri 44.4 39.2 3.8 11.7 0.6 0.2 0.1 100.0 459 0.2 Wealth quintile Lowest 33.0 55.0 4.3 7.5 0.0 0.0 0.1 100.0 6,265 1.2 Second 26.5 54.7 5.5 12.7 0.3 0.1 0.2 100.0 6,389 2.0 Middle 22.3 52.0 5.7 18.8 0.7 0.3 0.2 100.0 6,408 2.7 Fourth 16.7 45.9 6.4 28.5 1.7 0.7 0.0 100.0 6,595 3.7 Highest 9.7 34.9 5.5 36.6 5.4 7.9 0.1 100.0 6,910 5.8 Total 21.4 48.2 5.5 21.2 1.7 1.9 0.1 100.0 32,567 2.9 1 Completed grade 6 at the primary level 2 Completed grade 12 at the secondary level Household Population and Housing Characteristics | 13 Table 2.4.2 Educational attainment of the male household population Percent distribution of the de facto male household population age 6 and over by highest level of schooling attended or completed and median grade completed, according to background characteristics, Cambodia 2010 Background characteristic No schooling Some primary Completed primary1 Some secondary Completed secondary2 More than secondary Don’t know/ missing Total Number Median years completed Age 6-9 18.4 81.6 0.0 0.0 0.0 0.0 0.0 100.0 3,202 0.2 10-14 3.1 75.2 2.5 19.2 0.0 0.0 0.0 100.0 4,396 3.3 15-19 2.9 25.4 8.4 60.2 0.9 2.1 0.0 100.0 3,912 6.6 20-24 6.1 27.2 9.7 40.5 5.1 11.3 0.1 100.0 3,141 6.6 25-29 9.6 34.0 8.0 32.4 6.5 9.2 0.3 100.0 2,885 5.8 30-34 11.2 35.0 7.4 33.1 6.9 6.1 0.3 100.0 2,129 5.5 35-39 11.7 34.6 8.6 32.9 7.0 4.8 0.4 100.0 1,687 5.4 40-44 10.8 34.5 5.8 35.1 7.2 6.1 0.5 100.0 1,993 5.7 45-49 17.3 48.4 5.4 21.7 3.4 3.2 0.6 100.0 1,711 3.2 50-54 18.6 51.3 6.6 16.7 3.2 2.3 1.3 100.0 1,169 2.9 55-59 16.2 43.3 9.0 22.2 4.7 2.7 1.9 100.0 934 4.0 60-64 13.8 44.1 13.0 21.9 3.8 2.7 0.7 100.0 746 4.0 65+ 30.3 41.5 8.6 16.0 1.5 0.9 1.2 100.0 1,359 2.7 Don’t know/missing 100.0 0.0 0.0 0.0 0.0 0.0 0.0 100.0 1 0.0 Residence Urban 4.8 30.1 5.0 35.3 8.5 16.0 0.3 100.0 5,413 7.0 Rural 12.1 49.7 6.7 27.7 2.2 1.3 0.4 100.0 23,852 3.7 Province Banteay Mean Chey 13.0 51.6 5.3 25.8 2.7 1.4 0.1 100.0 1,088 3.4 Kampong Cham 16.1 47.1 7.2 26.8 1.6 1.1 0.1 100.0 3,457 3.6 Kampong Chhnang 11.5 54.1 8.0 22.4 2.8 1.3 0.0 100.0 1,245 3.3 Kampong Speu 7.4 45.5 6.8 35.5 2.8 2.0 0.0 100.0 1,613 4.7 Kampong Thom 17.5 50.5 5.9 21.6 2.6 1.5 0.3 100.0 1,486 3.1 Kandal 5.7 43.4 7.1 37.3 3.7 2.8 0.0 100.0 2,854 5.1 Kratie 12.2 50.8 8.3 24.1 3.9 0.8 0.0 100.0 677 3.5 Phnom Penh 3.4 25.4 4.2 34.5 9.4 23.2 0.0 100.0 2,915 8.2 Prey Veng 9.5 50.6 6.7 29.8 2.4 1.0 0.0 100.0 2,137 3.9 Pursat 11.7 52.2 6.0 24.7 3.0 2.2 0.1 100.0 973 3.5 Siem Reap 14.3 51.8 5.9 21.9 3.1 1.8 1.1 100.0 1,846 3.0 Svay Rieng 12.3 48.4 4.4 31.0 2.7 1.3 0.0 100.0 1,154 4.0 Takeo 7.9 46.1 7.7 33.1 2.3 2.8 0.1 100.0 2,036 4.6 Otdar Mean Chey 14.6 53.5 6.1 22.2 2.7 0.9 0.0 100.0 433 3.2 Battambang/Pailin 9.0 44.5 7.2 31.2 3.2 2.8 2.1 100.0 2,158 4.5 Kampot/Kep 6.7 49.1 7.2 30.9 2.8 2.5 0.7 100.0 1,387 4.4 Preah Sihanouk/Koh Kong 13.1 45.4 4.0 29.6 3.1 4.8 0.0 100.0 671 4.1 Preah Vihear/Steung Treng 19.0 54.6 3.9 17.8 1.9 1.1 1.7 100.0 670 2.4 Mondol Kiri/Rattanak Kiri 26.6 48.9 5.3 16.9 1.4 0.8 0.1 100.0 467 1.8 Wealth quintile Lowest 21.8 57.4 6.0 13.9 0.4 0.0 0.4 100.0 5,417 2.1 Second 13.3 57.5 6.7 20.9 1.0 0.3 0.3 100.0 5,732 3.1 Middle 10.7 49.0 7.4 30.2 1.6 0.8 0.4 100.0 5,964 4.0 Fourth 6.5 41.5 6.9 39.1 3.7 1.9 0.4 100.0 5,980 5.2 Highest 2.8 27.2 4.8 39.3 9.5 16.2 0.3 100.0 6,173 7.6 Total 10.7 46.1 6.4 29.1 3.4 4.0 0.3 100.0 29,266 4.2 1 Completed grade 6 at the primary level 2 Completed grade 12 at the secondary level Forty-eight percent of females and 46 percent of males in the household population have had some primary schooling without having completed primary school. However, 37 percent of the male population has gone on to attend secondary or higher schooling, whereas only 25 percent of females have had secondary or higher schooling. Approximately three of five males and females age 15-19 have gone on to secondary school. About 57 percent of males and 48 percent of females age 20-24 have done so. As would be expected, higher percentages of males and females in urban areas have gone on to secondary schooling than have males and females in rural areas. There is a great deal of regional variation in educational attainment across provinces. The outliers are Mondol Kiri/Rattanak Kiri and Phnom Penh, where 27 percent and 3 percent of males, respectively, and 44 percent and 9 percent of females, respectively, have never been to school. 14 | Household Population and Housing Characteristics 2.2.1 School Attendance Ratios Data on net attendance ratios (NARs) and gross attendance ratios (GARs) by school level, sex, residence, and province are shown in Table 2.5. The NAR indicates participation in primary schooling for the population age 6-12 and secondary schooling for the population age 13-18. The GAR measures participation at each level of schooling among those age 6-24. The GAR is nearly always higher than the NAR for the same level because the GAR includes participation by those who may be older or younger than the official age range for that level. A NAR of 100 percent would indicate that all of those in the official age range for the level are attending at that level. The GAR can exceed 100 percent if there is significant overage or underage participation at a given level of schooling. Overage participation for a given level of schooling occurs when students start school earlier, repeat one or more grades, or drop out of school and later return. Table 2.5 School attendance ratios Net attendance ratios (NARs) and gross attendance ratios (GARs) for the de facto household population by sex and level of schooling; and gender parity index (GPI), according to background characteristics, Cambodia 2010 Background characteristic Net attendance ratio1 Gross attendance ratio2 Male Female Total Gender parity index Male Female Total Gender parity index3 PRIMARY SCHOOL Residence Urban 85.5 84.5 85.0 0.99 99.1 91.9 95.5 0.93 Rural 84.6 85.0 84.8 1.01 103.1 98.4 100.7 0.95 Province Banteay Mean Chey 82.6 82.9 82.8 1.00 94.3 91.7 92.9 0.97 Kampong Cham 82.3 86.7 84.4 1.05 93.1 95.6 94.2 1.03 Kampong Chhnang 88.5 89.4 88.9 1.01 112.5 107.5 110.2 0.96 Kampong Speu 89.2 89.1 89.2 1.00 107.0 101.3 104.1 0.95 Kampong Thom 80.1 80.8 80.4 1.01 100.5 101.4 100.9 1.01 Kandal 86.2 82.5 84.4 0.96 104.0 89.2 96.6 0.86 Kratie 82.1 79.5 80.7 0.97 94.6 89.5 91.9 0.95 Phnom Penh 84.8 85.3 85.0 1.01 99.3 94.5 97.0 0.95 Prey Veng 87.1 86.0 86.6 0.99 102.6 95.5 99.1 0.93 Pursat 79.9 82.7 81.2 1.04 101.8 104.0 102.8 1.02 Siem Reap 84.8 85.8 85.3 1.01 103.9 98.7 101.2 0.95 Svay Rieng 90.7 91.8 91.2 1.01 105.9 104.7 105.3 0.99 Takeo 85.3 84.9 85.1 1.00 108.6 97.8 103.2 0.90 Otdar Mean Chey 89.7 89.6 89.7 1.00 111.1 106.1 108.7 0.95 Battambang/Pailin 83.0 86.9 85.0 1.05 107.5 103.2 105.2 0.96 Kampot /Kep 89.9 85.3 87.7 0.95 104.1 94.5 99.5 0.91 Preah Sihanouk/Koh Kong 85.8 82.6 84.2 0.96 99.8 96.4 98.1 0.97 Preah Vihear/Steung Treng 82.3 81.5 81.9 0.99 106.6 102.2 104.4 0.96 Mondol Kiri/Rattanak Kiri 65.4 62.1 63.8 0.95 103.2 86.4 95.3 0.84 Wealth quintile Lowest 77.6 81.1 79.3 1.05 95.1 97.1 96.1 1.02 Second 84.4 86.4 85.4 1.02 103.9 98.8 101.4 0.95 Middle 87.5 85.6 86.5 0.98 107.6 101.7 104.7 0.95 Fourth 89.2 88.7 88.9 0.99 106.5 98.6 102.6 0.93 Highest 88.1 83.9 86.0 0.95 101.3 89.2 95.2 0.88 Total 84.7 84.9 84.8 1.00 102.5 97.4 100.0 0.95 Continued… Household Population and Housing Characteristics | 15 Table 2.5—Continued Background characteristic Net attendance ratio1 Gross attendance ratio2 Male Female Total Gender parity index Male Female Total Gender parity index3 SECONDARY SCHOOL Residence Urban 62.4 54.3 58.2 0.87 80.8 68.0 74.2 0.84 Rural 41.5 41.1 41.3 0.99 50.8 49.1 50.0 0.97 Province Banteay Mean Chey 48.5 39.7 43.5 0.82 57.7 52.3 54.7 0.91 Kampong Cham 50.1 46.6 48.4 0.93 59.2 54.7 57.1 0.92 Kampong Chhnang 35.0 38.1 36.3 1.09 42.1 44.7 43.2 1.06 Kampong Speu 50.1 44.6 47.3 0.89 58.6 52.0 55.2 0.89 Kampong Thom 33.0 34.6 33.7 1.05 41.8 40.8 41.3 0.97 Kandal 46.7 46.4 46.5 0.99 57.7 55.2 56.5 0.96 Kratie 33.7 34.5 34.2 1.02 44.2 42.2 43.1 0.96 Phnom Penh 64.3 53.8 58.8 0.84 87.9 66.0 76.4 0.75 Prey Veng 48.1 43.7 46.2 0.91 57.3 50.8 54.5 0.89 Pursat 33.5 37.1 35.2 1.11 42.7 44.0 43.4 1.03 Siem Reap 32.4 37.5 35.0 1.16 44.2 48.3 46.3 1.09 Svay Rieng 49.5 48.7 49.1 0.98 59.4 56.9 58.2 0.96 Takeo 51.4 47.9 49.7 0.93 63.2 56.4 60.1 0.89 Otdar Mean Chey 27.1 32.2 29.6 1.19 34.5 38.0 36.3 1.10 Battambang/Pailin 40.4 39.7 40.1 0.98 47.7 49.3 48.4 1.03 Kampot/Kep 50.1 58.6 54.4 1.17 64.3 72.0 68.2 1.12 Preah Sihanouk/Koh Kong 50.9 45.2 48.0 0.89 60.7 56.1 58.4 0.92 Preah Vihear/Steung Treng 27.9 29.8 28.8 1.07 36.0 38.4 37.2 1.07 Mondol Kiri/Rattanak Kiri 20.9 21.3 21.1 1.02 28.3 24.0 26.3 0.85 Wealth quintile Lowest 20.1 20.2 20.2 1.01 24.4 23.8 24.1 0.98 Second 30.1 34.3 32.1 1.14 37.7 39.8 38.7 1.06 Middle 44.7 42.6 43.8 0.95 54.0 51.1 52.7 0.95 Fourth 57.2 52.1 54.7 0.91 70.0 63.4 66.7 0.91 Highest 69.1 62.7 65.8 0.91 89.0 77.5 83.1 0.87 Total 44.9 43.6 44.3 0.97 55.7 52.6 54.2 0.94 1 The NAR for primary school is the percentage of the primary school age (6-12 years) population that is attending primary school. The NAR for secondary school is the percentage of the secondary school age (13-18 years) population that is attending secondary school. By definition the NAR cannot exceed 100 percent. 2 The GAR for primary school is the total number of primary school students, expressed as a percentage of the official primary school age population. The GAR for secondary school is the total number of secondary school students, expressed as a percentage of the official secondary school age population. If there are significant numbers of overage and underage students at a given level of schooling, the GAR can exceed 100 percent. 3 The gender parity index for primary school is the ratio of the primary school NAR (GAR) for females to the NAR (GAR) for males. The gender parity index for secondary school is the ratio of the secondary school NAR (GAR) for females to the NAR (GAR) for males. Of those children who should be attending primary school, 85 percent are currently doing so. In 2005, 77 percent of children who should have been attending primary school were doing so. The NAR is significantly lower at the secondary school level but has improved since 2005 as well. Forty- four percent of secondary school age youths are in school at that level, an increase from 28 percent in 2005. Similar to 2005, there is little difference between the NAR of males and females at both the primary and the secondary level. Table 2.5 also shows the gender parity index (GPI) for primary and secondary school. The GPI for primary school is the ratio of the primary school NAR/GAR for females to the NAR/GAR for males. The GPI for secondary school is the ratio of the secondary school NAR/GAR for females to the NAR/GAR for males. The primary school GPI for NAR of 1.00 indicates gender parity at the primary level in both urban and rural areas. The GPI for NAR of 0.97 at the secondary school level indicates near gender parity at the secondary level. The GPI for NAR in urban areas of 0.87 reflects the fact that smaller proportions of girls than boys attend secondary school, and the measure of gender parity varies across provinces far more greatly at the secondary school level than at the primary school level. The primary school GPI for GAR and the secondary school GPI for GAR follow patterns of the GPI for NAR. 16 | Household Population and Housing Characteristics Figure 2.2 illustrates age-specific attendance rates, the percentage of a given age cohort attending school regardless of the level attended (primary, secondary, or higher). Although the minimum age for schooling in Cambodia is 6 years, some children enroll prior to this age, and only three in every five children 6 years of age are attending school. Figure 2.2 Age-specific Attendance Rates CDHS 2010 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 Age (years) 0 20 40 60 80 100 Percent Female Male Similar to 2005, boys and girls attend school in about equal proportions up to and including age 14. Up to and including age 10, the proportion of girls attending school is slightly higher than for boys, and then it is slightly lower than for boys up to age 14. It is after age 14 that boys attend school at a noticeably higher proportion than girls. 2.3 HOUSING CHARACTERISTICS Types of water sources and sanitation facilities are important determinants of the health status of household members and particularly of children. Proper hygienic and sanitation practices can reduce exposure to and the seriousness of major childhood diseases such as diarrhea. The CDHS asked respondents about the household source of drinking water, the time required round trip to obtain that water, and the type of sanitation facility used by the household. In Cambodia, the source of drinking water can vary between the dry season and the rainy season, so separate questions were asked for the different seasons. If households had more than one source of drinking water, respondents were asked to identify the most commonly used source. 2.3.1 Water Supply Table 2.6 shows that sources of drinking water were the same during the dry and rainy seasons for 85 percent of urban households and 64 percent of rural households. The source of drinking water is an indicator of whether it is suitable for drinking. Sources which are considered likely to be of suitable quality are listed under “Improved source” and those that may not be of suitable quality are listed under “Non-improved source,” reflecting the categorizations proposed by the World Health Organization (WHO), the United Nations Children’s Fund (UNICEF), and the Joint Monitoring Programme (JMP) for Water Supply and Sanitation. Household Population and Housing Characteristics | 17 During the dry season, 40 percent of households in Cambodia consume drinking water from a non-improved source. This percentage declines to 20 percent of households during the rainy season, when more households utilize rainwater for drinking water. The main source of drinking water during the rainy season is rainwater for more than one-third of households. Rainwater is the most common source of drinking water during the rainy season for rural households and for urban households that do not have water piped into their dwelling or property. Even if water is not piped directly into the dwelling or yard, it is common for the source of water to be on the household premises, especially during the rainy season. Eighty-five percent of urban households and nearly three-quarters of rural households report that their source of drinking water during the rainy season is located on the household premises. During the dry season, the percentage of households with their source of drinking water on the premises declines to 77 percent and 49 percent among urban and rural households, respectively. For those households neither having a source of drinking water on the premises nor having water delivered, the majority is within a 30 minutes or less in round trip time of obtaining it. During the dry season only about 9 percent of households are 30 minutes or longer away from a source (or don’t know the time required), and during the rainy season that number drops to just over 3 percent requiring 30 minutes or more (or not knowing the time required). Table 2.6 Household drinking water Percent distribution of households and de jure population by source, time to collect, and percentage using various modes to treat drinking water, according to residence, Cambodia 2010 Characteristic Households Population Urban Rural Total Total Source of drinking water during dry season Improved source 87.0 53.1 58.8 58.3 Piped water into dwelling/yard/plot 57.2 5.3 14.1 14.7 Public tap/standpipe 1.0 0.3 0.4 0.5 Tube well or borehole 11.4 35.5 31.4 30.5 Protected dug well 1.7 3.6 3.3 3.3 Protected spring 0.1 0.4 0.4 0.4 Rainwater 5.2 7.3 6.9 6.6 Bottled water 10.5 0.6 2.3 2.3 Non-improved source 10.4 45.6 39.7 40.1 Unprotected dug well 2.7 17.2 14.7 14.9 Unprotected spring 0.1 1.0 0.8 0.9 Tanker truck/cart with small tank 4.4 4.4 4.4 4.4 Surface water 3.2 23.1 19.7 19.8 Other 2.5 1.3 1.5 1.6 Total 100.0 100.0 100.0 100.0 Time to obtain drinking water (round trip) during dry season Water on premises 76.8 49.3 54.0 54.3 Less than 30 minutes 19.4 41.0 37.4 36.8 30 minutes or longer 1.4 7.5 6.5 6.6 Don’t know/missing 2.4 2.2 2.2 2.2 Total 100.0 100.0 100.0 100.0 Source of drinking water during rainy season Improved source 94.1 76.0 79.1 78.6 Piped water into dwelling/yard/plot 54.0 3.8 12.3 12.9 Public tap/standpipe 0.6 0.2 0.3 0.3 Tube well or borehole 9.6 27.9 24.8 24.0 Protected dug well 1.3 2.5 2.3 2.4 Protected spring 0.0 0.3 0.3 0.3 Rainwater 19.5 40.8 37.2 36.8 Bottled water1 9.0 0.4 1.9 1.8 Non-improved source 4.2 23.2 20.0 20.5 Unprotected dug well 1.8 12.9 11.0 11.1 Unprotected spring 0.1 0.9 0.8 0.8 Tanker truck/cart with small tank 1.5 1.0 1.1 1.2 Surface water 0.9 8.5 7.2 7.5 Other 1.6 0.6 0.8 0.8 Total 100.0 100.0 100.0 100.0 Continued… 18 | Household Population and Housing Characteristics Table 2.6—Continued Characteristic Households Population Urban Rural Total Total Time to obtain drinking water (round trip) during rainy season Water on premises 84.9 73.5 75.4 75.7 Less than 30 minutes 12.8 23.1 21.3 20.9 30 minutes or longer 0.5 2.2 1.9 1.9 Don’t know/missing 1.8 1.2 1.3 1.4 Total 100.0 100.0 100.0 100.0 Percentage using same water within dry and rainy season2 85.4 64.4 68.0 68.0 Boiled 75.0 65.1 66.8 66.4 Bleach/chlorine 0.0 0.1 0.1 0.1 Strained through cloth 1.0 1.2 1.2 1.2 Ceramic, sand, or other filter 13.0 10.2 10.7 11.1 Solar disinfection 0.4 0.1 0.1 0.2 Stand and settle 2.9 4.2 3.9 4.1 Other 0.4 0.3 0.3 0.3 No treatment 16.2 26.5 24.8 25.0 Percentage using an appropriate treatment method3 83.4 72.5 74.3 74.1 Number 2,652 13,015 15,667 74,416 1 Because the quality of bottled water is not known, households using bottled water for drinking are classified as using an improved or non-improved source according to their water source for cooking and washing. 2 Respondents may report multiple treatment methods so the sum of treatment may exceed 100 percent. 3 Appropriate water treatment methods include boiling, bleaching, straining, filtering, and solar disinfecting. Sixty-five percent of rural households boil their water prior to drinking, and three-quarters of urban households do so. Among those who do not boil their water, the most common action is to do nothing to treat the water prior to drinking. Approximately one-fourth of rural (27 percent) and one- sixth of urban (16 percent) households report that they do nothing to treat their drinking water before consuming it. Overall, a quarter of households do nothing to treat their water prior to drinking. Eleven percent of households use a ceramic, sand, or other type of filter to filter their water prior to drinking. 2.3.2 Sanitation Facilities A household’s toilet facility is classified as hygienic if it is used only by household members (is not shared by other households) and if the type of toilet effectively separates human waste from human contact. The types of facilities most likely to accomplish this are flush or pour flush into a piped sewer system, septic tank, or pit latrine; ventilated improved pit (VIP) latrine; pit latrine with a slab; and composting toilet. Households that share their toilet facility or do not effectively separate human waste from human contact are classified as unhygienic. Categories are those proposed by WHO, UNICEF, and JMP. Household Population and Housing Characteristics | 19 Table 2.7 Household sanitation facilities Percent distribution of households and de jure population by type of toilet/latrine facilities, according to residence, Cambodia 2010 Type of toilet/latrine facility Households Population Urban Rural Total Total Improved, not shared facility Flush/pour flush to piped sewer system 37.3 0.2 6.5 7.0 Flush/pour flush to septic tank 39.4 22.0 24.9 26.0 Flush/pour flush to pit latrine 0.7 0.9 0.8 0.9 Ventilated improved pit (VIP) latrine 0.1 0.1 0.1 0.1 Pit latrine with slab 0.3 1.4 1.2 1.3 Composting toilet 0.0 0.1 0.1 0.1 Non-improved facility Any facility shared with other households 9.4 7.1 7.5 7.0 Flush/pour flush not to sewer/septic tank/pit latrine 0.1 0.2 0.2 0.2 Pit latrine without slab/open pit 0.0 0.3 0.2 0.3 Bucket 0.0 0.4 0.3 0.3 Hanging toilet/hanging latrine 0.4 1.1 1.0 1.0 No facility/bush/field 11.9 65.9 56.7 55.3 Other 0.2 0.3 0.3 0.3 Missing 0.1 0.0 0.0 0.0 Total 100.0 100.0 100.0 100.0 Number 2,652 13,015 15,667 74,416 Households vary greatly in access to hygienic facilities by urban and rural residence, as shown in Table 2.7. The majority of households in rural areas have no toilet facility, with two in three households reporting no toilet facility and making use of fields or bush areas. In urban areas, one in eight households has no toilet facility; however, 77 percent of urban households use a flush or pour toilet that is piped to a sewer or septic system. Table 2.8 presents the distribution of households by the characteristics of the dwelling in which they live. In urban areas 9 of 10 households live in dwellings with electricity, whereas in rural areas only one in every five households has electricity. Ceramic tiles are the most common type of flooring material in urban areas, and wood planks are the most common material in rural areas. Forty- one percent of urban households live in dwellings with ceramic tiles, followed by 28 percent who live in dwellings with wood planks. In rural areas, approximately half of households live in dwellings with wood plank flooring, followed by one-third who live in dwellings with palm or bamboo flooring. If there was more than one type of flooring, interviewers recorded the predominant flooring material. Eight of 10 rural households sleep together in one room, whereas about half of urban households do so. In urban areas, 53 percent of households use two or more rooms for sleeping. 2.3.3 Cooking Arrangements Firewood is the most common source of fuel for cooking in rural areas, with 9 in 10 rural households using firewood for this purpose. There is more variability in urban areas as to what is used for cooking fuel. Twenty-eight percent of urban households use firewood, 49 percent use liquid petroleum gas, and 21 percent use charcoal. Sixty-five percent of urban households and 38 percent of rural households report that they do their cooking in the house. 20 | Household Population and Housing Characteristics Table 2.8 Household characteristics Percent distribution of households and de jure population by housing characteristics and percentage using solid fuel for cooking according to residence, Cambodia 2010 Housing characteristic Households Population Urban Rural Total Total Electricity Yes 91.3 18.8 31.1 32.2 No 8.6 81.2 68.9 67.8 Missing 0.1 0.0 0.0 0.0 Total 100.0 100.0 100.0 100.0 Flooring material Earth, sand 3.8 7.5 6.9 6.2 Wood/planks 27.7 48.4 44.9 46.8 Palm/bamboo 5.1 32.7 28.0 26.6 Parquet or polished wood 0.2 0.2 0.2 0.3 Vinyl or asphalt strips 0.1 0.1 0.1 0.1 Ceramic tiles 40.9 3.6 9.9 10.7 Cement tiles 7.5 1.6 2.6 2.5 Cement 14.6 5.5 7.1 6.7 Floating house 0.0 0.2 0.2 0.2 Other 0.2 0.1 0.1 0.2 Total 100.0 100.0 100.0 100.0 Rooms used for sleeping One 47.1 79.1 73.7 70.8 Two 28.4 16.1 18.2 19.4 Three or more 24.4 4.5 7.8 9.4 Missing 0.1 0.3 0.3 0.3 Total 100.0 100.0 100.0 100.0 Cooking fuel Electricity 1.3 0.1 0.3 0.3 Liquid petroleum gas 49.1 2.9 10.7 10.7 Biogas 1.1 0.5 0.6 0.6 Coal/lignite 0.0 0.0 0.0 0.0 Charcoal 20.5 5.7 8.2 8.7 Wood 27.6 90.1 79.5 79.3 Straw/shrubs/grass 0.0 0.0 0.0 0.0 Agricultural crop 0.0 0.0 0.0 0.0 Animal dung 0.0 0.2 0.2 0.2 No food cooked in household 0.2 0.2 0.2 0.1 Other 0.1 0.2 0.2 0.1 Total 100.0 100.0 100.0 100.0 Place for cooking In the house 64.8 37.8 42.3 41.7 In a separate building 13.2 32.3 29.1 29.9 Outdoors 20.7 26.6 25.6 25.7 Other 1.0 3.1 2.8 2.6 Missing 0.2 0.2 0.2 0.1 Total 100.0 100.0 100.0 100.0 Number 2,652 13,015 15,667 74,416 2.4 HOUSEHOLD POSSESSIONS Information on ownership of durable goods and other possessions is presented in Table 2.9. The availability of durable consumer goods is a good indicator of household socioeconomic level, and particular goods have specific benefits. For example, radio access can increase exposure to innovative ideas, whereas transport vehicles can provide access to services out of the local area. Sixty-two percent of households in Cambodia own a television, and another 62 percent own a mobile telephone. Ownership of mobile telephones is far more common among urban households (90 percent) than rural households (56 percent). Nearly half of households own a generator/battery or a solar panel. Twenty-two percent of urban households now own a car or truck, an increase from 15 percent in 2005. More than half of all households own a motorcycle, an increase from one-third of households in 2005. The percentage of households owning a boat remains unchanged at 9 percent. Household Population and Housing Characteristics | 21 The 2010 CDHS found that nearly 68 percent of all households own some land, which is slightly lower than the 2005 figure of 72 percent. Sixty-seven percent of all households own at least one farm animal, which is also lower than the 73 percent reported in 2005. Table 2.9 Household durable goods Percentage of households and de jure population possessing various household effects, means of transportation, agricultural land, and livestock/farm animals by residence, Cambodia 2010 Possession Households Population Urban Rural Total Total Household effects Radio 58.3 40.7 43.7 44.8 Television 89.0 56.9 62.4 65.0 Mobile telephone 90.1 56.2 61.9 65.0 Non-mobile telephone 16.2 6.4 8.1 9.4 Refrigerator 29.1 0.6 5.4 6.2 Wardrobe 70.4 30.0 36.8 38.6 Sewing machine 14.9 6.8 8.1 8.8 CD/DVD 58.0 25.6 31.1 33.8 Generator/battery/solar 8.2 56.0 47.9 49.0 Watch 47.1 21.1 25.5 27.9 Means of transport Bicycle/cyclo 60.4 66.5 65.5 68.9 Motorcycle/scooter 75.9 49.0 53.5 57.1 Motorcycle-cart 3.4 1.4 1.8 2.1 Oxcart/horse-cart 1.9 20.9 17.7 19.4 Car/truck/van 22.4 3.2 6.5 7.6 Boat with a motor 1.2 4.4 3.8 4.4 Boat without a motor 1.2 5.7 4.9 5.4 Ownership of agricultural land 20.9 77.5 67.9 68.3 Ownership of farm animals1 21.3 76.6 67.3 69.2 Number 2,652 13,015 15,667 74,416 1 Cattle, cows, bulls, horses, donkeys, goats, sheep, or chickens 2.5 HOUSEHOLD WEALTH In addition to standard background characteristics, many of the results in this report are shown by wealth quintiles, an indicator of the economic status of households. The 2010 CDHS did not collect data on consumption or income, but the information collected on dwelling and household characteristics, consumer goods, and assets is used as a measure of socioeconomic status. The resulting wealth index is an indicator of level of wealth that is used as a proxy for expenditure and income measures. Each household asset for which information is collected is assigned a weight or factor score generated through principal components analysis. The resulting asset scores are standardized in relation to a standard normal distribution with a mean of zero and a standard deviation of one. These standardized scores are then used to create the break points that define wealth quintiles. Each household is assigned a standardized score for each asset, where the score differs depending on whether or not the household owns that asset (or, in the case of sleeping arrangements, the number of people per room). These scores are summed by household, and individuals are ranked according to the total score of the household in which they reside. The sample is then divided into population quintiles (i.e., five groups with the same number of individuals in each). At the national level, approximately 20 percent of the household population is grouped into each wealth quintile. A single asset index is developed on the basis of data from the entire country sample and used in all of the tabulations presented. The reader should keep in mind that wealth quintiles are expressed in terms of quintiles of individuals in the population rather than quintiles of individuals at risk for any one health or population indicator. For example, the quintile rates for infant mortality refer to the infant mortality rates per 1,000 live births among all people in the population quintile concerned, as 22 | Household Population and Housing Characteristics distinct from quintiles of live births or newly born infants, who constitute the only members of the population at risk of mortality during infancy. The wealth index has been compared against both poverty rates and gross domestic product per capita in India and against expenditure data from household surveys in Nepal, Pakistan, and Indonesia (Filmer and Pritchett, 1998) as well as Guatemala (Rutstein, 1999). The evidence from those studies suggests that the asset index is highly comparable to conventionally measured consumption expenditures. Table 2.10 shows the distribution of the household population into five wealth quintiles (five equally divided levels) based on the wealth index by residence. These distributions indicate the degree to which wealth is evenly (or unevenly) distributed across Cambodia. As expected, urban areas are wealthier than rural areas. For example, 90 percent of Phnom Penh’s population falls in the highest wealth quintile. By contrast, Prey Veng has the lowest representation in the highest wealth quintile, with only 5 percent of its population falling in that quintile. Table 2.10 Wealth quintiles Percent distribution of the de jure population by wealth quintiles according to residence and region, Cambodia 2010 Residence/region Wealth quintile Total Number of population Lowest Second Middle Fourth Highest Residence Urban 1.5 2.6 5.8 16.1 74.0 100.0 13,231 Rural 24.0 23.8 23.1 20.8 8.3 100.0 61,186 Province Banteay Mean Chey 12.9 18.9 20.7 26.6 20.9 100.0 3,127 Kampong Cham 23.4 22.4 24.0 22.8 7.4 100.0 8,787 Kampong Chhnang 30.8 26.1 20.5 16.0 6.5 100.0 2,994 Kampong Speu 20.8 19.4 22.8 24.1 13.0 100.0 4,303 Kampong Thom 30.2 22.4 22.7 13.6 11.0 100.0 3,840 Kandal 10.1 16.4 18.2 36.7 18.5 100.0 7,222 Kratie 34.1 18.5 18.1 16.8 12.5 100.0 1,823 Phnom Penh 0.0 0.1 1.0 8.7 90.2 100.0 6,964 Prey Veng 21.4 28.9 29.2 15.6 4.9 100.0 5,765 Pursat 27.6 22.7 22.2 16.5 11.0 100.0 2,324 Siem Reap 29.4 20.6 21.6 15.3 13.1 100.0 4,786 Svay Rieng 21.6 29.2 26.7 15.3 7.1 100.0 2,836 Takeo 19.4 27.2 23.8 21.1 8.6 100.0 5,089 Otdar Mean Chey 24.4 19.5 19.6 19.9 16.6 100.0 1,009 Battambang/Pailin 14.6 16.6 19.9 27.0 22.0 100.0 5,414 Kampot/Kep 22.7 24.8 22.9 16.0 13.6 100.0 3,632 Preah Sihanouk/Koh Kong 16.2 11.4 11.8 20.6 40.0 100.0 1,622 Preah Vihear/Steung Treng 46.2 25.1 12.3 9.1 7.3 100.0 1,727 Mondol Kiri/Rattanak Kiri 25.9 28.7 19.7 15.4 10.2 100.0 1,152 Total 20.0 20.0 20.0 20.0 20.0 100.0 74,416 2.6 BIRTH REGISTRATION The registration of births is the inscription of the facts of a birth into an official log. A birth certificate is issued as proof of the registration of the birth. Information on the registration of births was collected in the household interview by asking whether children under age 5 had a birth certificate. If the interviewer was told that the child did not have a birth certificate, the interviewer probed further to ascertain whether the child’s birth had been registered with the civil authority. Similar to 2005, only half of children had a birth certificate, and a total of 62 percent of children under age 5 were registered; however, levels of registration varied greatly across the country, as shown in Table 2.11. Household Population and Housing Characteristics | 23 Table 2.11 Birth registration of children under age five Percentage of de jure children under 5 years of age whose births are registered with the civil authorities, according to background characteristics, Cambodia 2010 Background characteristic Percentage of children whose births are registered Number of children Had a birth certificate Did not have a birth certificate Total registered Age <2 45.5 9.9 55.4 3,164 2-4 54.0 12.3 66.3 4,958 Sex Male 50.7 11.3 62.0 4,201 Female 50.8 11.4 62.1 3,921 Residence Urban 67.3 7.1 74.4 1,217 Rural 47.8 12.1 59.9 6,905 Province Banteay Mean Chey 56.1 11.6 67.7 349 Kampong Cham 44.7 21.6 66.2 958 Kampong Chhnang 54.5 14.1 68.6 361 Kampong Speu 60.3 4.8 65.1 463 Kampong Thom 31.6 20.2 51.8 429 Kandal 50.4 15.8 66.1 825 Kratie 34.7 4.6 39.3 247 Phnom Penh 80.6 1.1 81.6 591 Prey Veng 44.7 10.7 55.4 670 Pursat 33.0 1.9 34.9 270 Siem Reap 59.5 10.7 70.2 573 Svay Rieng 70.5 7.0 77.6 280 Takeo 53.3 4.0 57.2 530 Otdar Mean Chey 65.8 14.9 80.6 104 Battambang/Pailin 40.0 13.2 53.2 579 Kampot/Kep 46.2 15.7 61.9 350 Preah Sihanouk/Koh Kong 55.8 3.0 58.8 166 Preah Vihear/Steung Treng 45.8 7.8 53.6 219 Mondol Kiri/Rattanak Kiri 26.7 12.1 38.8 157 Wealth quintile Lowest 38.0 10.1 48.1 2,123 Second 46.8 13.4 60.2 1,749 Middle 50.3 14.3 64.5 1,498 Fourth 55.6 12.0 67.7 1,458 Highest 71.8 6.4 78.2 1,293 Total 50.7 11.3 62.1 8,122 Utilization of Health Services for Accident, Illness, or Injury | 25 UTILIZATION OF HEALTH SERVICES FOR ACCIDENT, ILLNESS, OR INJURY 3 When the 1998 National Health Survey was undertaken, the Ministry of Health was beginning to implement a redesigned health coverage plan created to improve the accessibility and quality of government health services. The major aim of the new health care plan was to create a network of health centers throughout the country delivering the “Minimum Package of Activities” services. The data collected in the 1998 National Health Survey were considered to be a baseline of health conditions in the country before implementation of the new health coverage plan. The 2000 Cambodia Demographic and Health Survey (CDHS) data were used to provide a first-round analysis of health care delivery under the new plan; the 2005 CDHS assessed progress in the first five years under the new coverage plan; and the 2010 CDHS provides updated progress on those health conditions. Utilization of health services was assessed in the Household Questionnaire. The questions were asked to all households in the sample. First, information was collected to assess the prevalence of injuries and deaths due to accidents in the past year. Second, the respondent was asked whether any household members suffered from any physical impairment. Third, the respondent was asked about the severity of illness or injury and the subsequent utilization of health services among all members of the household who had been ill or injured in the 30 days preceding the interview. 3.1 ACCIDENTAL DEATH OR INJURY All households reported on whether any household member had suffered accidental injury or death in the 12 months preceding the day of the household interview. If anyone had been injured, the cause of the injury was recorded. The respondent to the Household Questionnaire was further asked whether the accident victim was alive or dead and, if dead, whether the death was the result of the reported accident. The questions were designed in this order to definitively assess the cause of injury and, if a death was noted, the cause of death. 3.1.1 Frequency of Accidental Death or Injury Accidental injuries and deaths in Cambodia were not common (Table 3.1). Two percent of the population had suffered an injury or death by accident in the past 12 months. Accidental injuries were much more common than accidental deaths; for every 1,000 people in the population, 17 suffered an injury and 1 suffered an accidental death. The percentage of the population injured in the past 12 months increased with age from 0.9 percent among children age 0-9 years to a peak of 2.5 percent among adults age 20-39 years. The percentage experiencing accidental injury decreased thereafter, to 1.7 percent among adults age 40-59 and 1.1 percent among those 60 and above. Males were more than twice as likely as females to be injured in an accident. Overall, 2.4 percent of males had been injured in an accident in the past 12 months, as compared with 1.1 percent of females. Although there were no substantial differences in accidental injuries by urban-rural residence, there were differences across provinces. The highest percentage of accidental injury was reported in Kampong Speu, with 3.1 percent of the household population experiencing an injury in the preceding 12 months. The lowest rates of accidental injury were in Prey Veng (0.6 percent), Svay Rieng (0.6 percent), and Otdar Mean Chey (0.8 percent). The percentage of accidental death ranged from 0.0 to 0.2 percent across provinces. 26 | Utilization of Health Services for Accident, Illness, or Injury Table 3.1 Injury or death in an accident Percentage of the de jure household population injured or killed in an accident in the past 12 months, according to background characteristics, Cambodia 2010 Background characteristic Result of accident Total injured or killed Total number of de jure household members Injured Killed Age 0-9 0.9 na na 16,138 10-19 1.7 na na 16,912 20-39 2.5 na na 21,908 40-59 1.7 na na 13,938 60+ 1.1 na na 5,520 Sex Male 2.4 na na 36,138 Female 1.1 na na 38,276 Residence Urban 2.0 0.1 2.1 13,231 Rural 1.7 0.1 1.7 61,186 Province Banteay Mean Chey 1.5 0.0 1.5 3,127 Kampong Cham 1.2 0.1 1.3 8,787 Kampong Chhnang 2.0 0.2 2.2 2,994 Kampong Speu 3.1 0.1 3.2 4,303 Kampong Thom 1.8 0.1 1.9 3,840 Kandal 2.1 0.0 2.1 7,222 Kratie 1.2 0.1 1.3 1,823 Phnom Penh 2.3 0.1 2.4 6,964 Prey Veng 0.6 0.1 0.7 5,765 Pursat 1.0 0.0 1.0 2,324 Siem Reap 2.8 0.1 2.9 4,786 Svay Rieng 0.6 0.1 0.6 2,836 Takeo 1.9 0.0 1.9 5,089 Otdar Mean Chey 0.8 0.0 0.8 1,009 Battambang/Pailin 2.0 0.0 2.0 5,414 Kampot/Kep 1.3 0.1 1.5 3,632 Preah Sihanouk/Koh Kong 1.6 0.1 1.7 1,622 Preah Vihear/Steung Treng 1.0 0.0 1.0 1,727 Mondol Kiri/Rattanak Kiri 1.4 0.1 1.5 1,152 Total 1.7 0.1 1.8 74,416 na: Not applicable 3.1.2 Type of Accident Table 3.2 presents data on injury in an accident by type of accident and according to the background characteristics of age, sex, residence, and province. Data on accidental deaths are also shown, but these data are not available by age and sex. Road accidents accounted for the greatest proportion of accidental injuries and deaths. Two- thirds of those who had been injured or killed in the previous 12 months was as a result of a road accident. Twelve percent of injuries/deaths were the result of a fall, and 5 percent were the result of an animal bite. Three percent of injuries/deaths were the result of some form of violence, and an additional 2 percent were the result of a gunshot. Fatalities due to landmines have decreased in the past five years, dropping from 0.7 percent of cases in the 2005 CDHS to 0.2 percent of all injuries/deaths in 2010. Eight percent of injuries/deaths were due to other or unknown causes. Utilization of Health Services for Accident, Illness, or Injury | 27 Table 3.2 Injury or death in an accident by type of accident Percentage of the de jure household population injured or killed in an accident in the past 12 months by type of accident, according to background characteristics, Cambodia 2010 Background characteristic Type of accident Total Number of persons injured/ killed Landmine/ unexploded bomb Gun shot Road accident Severe burning Snake/ animal bite Fall from tree/ building Drown- ing Poison- ing (chemi- cal) Vio- lence Other Don’t know/ missing INJURED Age 0-9 0.0 2.8 43.6 1.9 3.6 31.3 1.0 1.7 3.6 6.1 4.3 100.0 143 10-19 0.0 1.9 64.6 0.2 7.1 14.2 0.0 0.0 3.6 4.5 3.9 100.0 291 20-39 0.0 2.3 79.1 0.8 3.6 4.7 0.2 0.8 2.8 2.2 3.5 100.0 544 40-59 0.5 1.1 69.0 0.4 5.8 10.5 0.0 0.0 2.9 5.9 3.9 100.0 244 60+ 3.2 4.2 41.6 1.8 13.5 17.0 0.0 0.0 3.2 8.9 6.5 100.0 60 Sex Male 0.4 2.6 67.1 0.7 5.2 11.2 0.3 0.6 3.5 4.1 4.3 100.0 865 Female 0.0 1.2 70.5 1.0 5.4 12.1 0.0 0.3 2.1 4.3 3.1 100.0 416 Total 0.2 2.1 68.2 0.8 5.3 11.5 0.2 0.5 3.1 4.2 3.9 100.0 1,282 INJURED OR KILLED Residence Urban 0.0 0.2 74.3 1.7 4.4 9.2 0.0 0.0 2.8 5.0 2.5 100.0 274 Rural 0.3 2.7 65.8 0.5 5.3 12.1 0.9 0.7 3.2 4.4 4.1 100.0 1,057 Province Banteay Mean Chey 0.0 6.8 64.0 1.0 8.4 10.9 0.0 0.0 4.6 4.3 0.0 100.0 48 Kampong Cham 0.0 2.2 64.6 0.6 3.6 21.4 0.0 0.0 6.4 0.7 0.5 100.0 114 Kampong Chhnang 0.0 7.8 54.2 0.0 14.1 11.6 3.1 0.0 1.0 1.1 7.1 100.0 66 Kampong Speu 0.0 0.0 79.4 0.0 3.6 5.6 0.0 1.0 2.0 3.6 4.7 100.0 136 Kampong Thom 0.0 1.5 73.6 0.0 7.1 12.4 0.0 0.0 0.0 2.6 2.8 100.0 74 Kandal 0.0 3.4 66.0 0.0 4.0 10.4 0.0 3.4 2.9 3.9 5.9 100.0 150 Kratie (0.0) (0.0) (74.1) (0.0) (0.0) (9.3) (0.0) (0.0) (2.6) (12.2) (1.8) 100.0 24 Phnom Penh 0.0 0.5 75.4 1.7 4.3 9.7 0.0 0.0 1.0 5.6 1.8 100.0 166 Prey Veng (0.0) (4.6) (50.4) (0.0) (5.0) (26.4) (0.0) (0.0) (0.0) (9.4) (4.2) 100.0 42 Pursat (3.5) (3.4) (61.1) (0.0) (6.2) (10.0) (0.0) (0.0) (6.9) (6.1) (2.8) 100.0 23 Siem Reap 0.0 0.0 60.0 1.6 8.1 15.1 2.0 0.0 4.9 5.1 3.2 100.0 141 Svay Rieng (0.0) (18.2) (37.6) (0.0) (4.7) (10.8) (4.6) (4.7) (9.4) (5.0) (5.0) 100.0 18 Takeo 0.0 4.7 64.1 2.8 0.0 7.1 1.4 0.0 0.0 9.5 10.5 100.0 98 Otdar Mean Chey (3.9) (0.0) (70.0) (3.9) (17.8) (4.4) (0.0) (0.0) (0.0) (0.0) (0.0) 100.0 8 Battambang/Pailin 1.8 0.0 77.3 0.0 3.4 3.8 0.0 0.0 7.9 2.7 3.1 100.0 107 Kampot/Kep 0.0 0.0 67.7 0.0 7.3 17.5 4.9 0.0 0.0 1.8 0.8 100.0 53 Preah Sihanouk/Koh Kong 0.0 0.0 74.6 0.0 0.0 8.4 0.0 0.0 5.3 9.4 2.3 100.0 28 Preah Vihear/Steung Treng (0.0) (0.0) (45.7) (2.6) (9.1) (17.3) (0.0) (0.0) (11.1) (5.9) (8.2) 100.0 18 Mondol Kiri/Rattanak Kiri 0.0 0.0 68.8 0.0 3.8 15.2 0.0 0.0 0.5 9.1 2.6 100.0 18 Total 0.2 2.2 67.5 0.7 5.1 11.5 0.7 0.6 3.1 4.5 3.8 100.0 1,331 Note: Figures in parentheses are based on 25-49 unweighted cases. Cause of injury varied by age, but road accidents were the most commonly cited source of injury for people of all ages, especially those age 20-39. Animal bites accounted for 14 percent of injuries among people age 60 or above. Gunshots and landmines accounted for a higher percentage of injuries (4 and 3 percent, respectively) among people age 60 and above than for any other age group. Falls from trees or buildings and poisonings accounted for a higher percentage among injured children less than 10 (31 and 2 percent, respectively) than among other age groups. There were significant differences in accidental injuries in the preceding 12 months by sex. Males were more likely than females to be injured as a result of unspecified violence (4 percent versus 2 percent) or by gunshot (3 percent versus 1 percent). There were other significant differences in accidental injuries/deaths in the preceding 12 months by urban-rural residence and province. Not surprisingly, road accidents accounted for a higher percentage of injuries/deaths in urban areas (74 percent) than in rural areas (66 percent). Falls accounted for a higher proportion of accidental injuries or deaths in rural areas than in urban areas (12 percent versus 9 percent). The distribution of causes of injuries/deaths by province should be analyzed with caution because sample sizes were small in some provinces. 28 | Utilization of Health Services for Accident, Illness, or Injury Table 3.3 Physical impairment Percentage of the de jure household population physically impaired and percent distribution of the impaired de jure household population by cause of impairment, according to background characteristics, Cambodia 2010 Background characteristic Physically impaired Number of household members Cause of impairment Total Number of impaired persons Birth Illness Landmine Gun Road accident Other accident Don’t know/ missing Age 0-9 0.4 16,138 53.9 22.3 0.0 0.0 2.6 21.2 0.0 100.0 71 10-19 0.9 16,912 38.0 23.8 3.7 0.7 7.9 25.8 0.0 100.0 159 20-39 1.6 21,908 28.8 24.2 5.5 2.9 14.5 23.5 0.6 100.0 360 40-59 3.3 13,938 8.7 31.9 23.0 10.5 9.5 16.4 0.0 100.0 453 60+ 4.4 5,520 5.3 63.3 6.8 2.4 8.0 14.1 0.1 100.0 241 Sex Male 2.2 36,138 19.5 26.6 16.1 7.2 10.1 20.2 0.3 100.0 788 Female 1.3 38,276 20.4 46.0 4.0 1.6 9.9 18.1 0.1 100.0 497 Residence Urban 1.3 13,231 17.8 45.3 7.6 4.9 14.2 10.0 0.2 100.0 171 Rural 1.8 61,186 20.1 32.4 12.0 5.1 9.4 20.8 0.2 100.0 1,114 Province Banteay Mean Chey 2.5 3,127 24.3 32.8 20.0 6.4 7.1 9.5 0.0 100.0 79 Kampong Cham 1.7 8,787 17.5 30.7 10.3 2.2 12.7 26.6 0.0 100.0 147 Kampong Chhnang 2.0 2,994 17.2 28.9 13.6 8.7 11.2 20.2 0.0 100.0 59 Kampong Speu 1.8 4,303 12.3 39.2 5.4 16.1 13.4 13.5 0.0 100.0 78 Kampong Thom 2.6 3,840 16.2 35.7 9.2 0.2 16.5 22.2 0.0 100.0 101 Kandal 0.9 7,222 (28.5) (40.7) (5.7) (0.0) (1.1) (23.9) (0.0) 100.0 67 Kratie 1.5 1,823 16.9 46.9 3.5 4.1 6.9 21.7 0.0 100.0 27 Phnom Penh 1.2 6,964 12.2 52.5 3.5 5.1 16.2 10.4 0.0 100.0 83 Prey Veng 1.7 5,765 33.2 35.6 0.0 1.5 6.2 23.5 0.0 100.0 99 Pursat 1.9 2,324 22.8 24.3 10.5 5.6 8.7 28.1 0.0 100.0 45 Siem Reap 2.3 4,786 24.5 26.1 17.9 1.4 8.9 19.5 1.7 100.0 110 Svay Rieng 1.9 2,836 30.2 25.5 4.7 7.3 9.4 22.5 0.2 100.0 54 Takeo 1.6 5,089 18.9 37.3 5.1 6.9 15.0 16.7 0.0 100.0 83 Otdar Mean Chey 2.0 1,009 16.0 11.0 42.9 6.9 5.1 18.0 0.0 100.0 20 Battambang/Pailin 2.4 5,414 12.6 32.7 20.7 8.0 8.9 17.1 0.0 100.0 132 Kampot/Kep 1.6 3,632 16.6 41.0 14.3 9.4 1.6 17.1 0.0 100.0 57 Preah Sihanouk/Koh Kong 0.9 1,622 (24.8) (35.2) (17.3) (2.7) (16.1) (4.0) (0.0) 100.0 14 Preah Vihear/Steung Treng 1.3 1,727 14.7 21.5 33.4 0.6 5.0 24.0 0.8 100.0 23 Mondol Kiri/Rattanak Kiri 0.6 1,152 (21.9) (26.8) (10.3) (5.7) (8.0) (22.6) (4.6) 100.0 6 Total 1.7 74,416 19.8 34.1 11.4 5.1 10.0 19.4 0.2 100.0 1,285 Note: Figures in parentheses are based on 25-49 unweighted cases. 3.2 PHYSICAL IMPAIRMENT Questions on physical impairment included one asking whether any living household member is physically impaired and, if so, what was the cause. In 2010, 1.7 percent of the Cambodian population had a physical impairment (Table 3.3). Physical impairments increased with age. People age 60 years and older were more likely than younger people to have physical impairments (4.4 percent versus 3.3 percent or less). Males were more likely (2.2 percent) to be impaired physically than females (1.3 percent). There were small differences in physical impairments by urban-rural residence (1.3 and 1.8 percent, respectively). Differences by province were larger. The percentage of the population with a physical impairment was highest in Kampong Thom (2.6 percent) and lowest in Mondol Kiri/Rattanak Kiri (0.6 percent). Table 3.3 also shows the causes of physical impairments in Cambodia. The most common cause of impairment was illness (34 percent). Other causes of impairments were birth defects (20 percent) and unspecified accidents (19 percent). Causes of impairments are presented by age, sex, residence, and province. Impairments at birth were most likely to be reported for children age 0-9 years (54 percent). Other causes of impairment increased with age. For example, the percentage of the population impaired by illness increased from 22 percent for children age 0-9 to 63 percent for people age 60 and older. Landmines and gunshots mostly affected persons age 40-59, and impairments caused by road accidents primarily affected those age 20-39. Males were much more likely than females to have been impaired by landmines (16 percent versus 4 percent) and gunshot accidents (7 percent versus 2 percent). Impairments caused by Utilization of Health Services for Accident, Illness, or Injury | 29 landmines and other unspecified causes were more prevalent in rural than in urban areas, whereas impairments due to illness and road accidents were higher in urban areas. As in Table 3.2, interpretation of the causes of physical impairment by province in Table 3.3 is complicated by the small number of cases in some provinces. 3.3 PREVALENCE AND SEVERITY OF ILLNESS OR INJURY All households were asked whether any members had been sick or injured at any time in the 30 days before the interview. If any members had been sick, their names were recorded to ask specifically about their conditions in the questions that followed. The Household Questionnaire allotted space for information to be recorded for up to three household members. Interviewers were instructed to use extra questionnaires to record the information on all household members who were ill or injured. The respondent was asked to judge the illness or injury as slight, moderate, or severe. Finally, questions were asked as to whether ill or injured household members sought care, where they sought care, how much they spent on transport, and how much they spent on treatment. These questions were repeated to collect information on patterns of health care-seeking behavior. For example, a man might first seek treatment from a Kru Khmer traditional healer but later visit a health clinic if the illness continued. Up to three care-seeking attempts were recorded on the questionnaire for each ill or injured person. Eleven percent of household members had been ill in the 30 days prior to the interview (Table 3.4). However, this percentage may under-represent the actual prevalence of morbidity and injury for two reasons. The questions were asked only about living household members at the time of the interview. Therefore, the recorded episodes of illness and injury excluded any cases that ended in the death of a household member in the 30 days prior to the interview. Furthermore, the responses were based on the 30-day recall of one respondent in the household. That respondent might not have been aware of all of the illnesses or injuries that had occurred within the household. It is likely that illnesses or injuries that occurred at the beginning of the 30-day period or that were of mild severity were forgotten and not reported. Eighty-six percent of all illnesses or injuries were slight or moderate in severity. Only 1.5 percent of household members experienced a serious illness or injury. The highest percentage of illness or injury was found among persons age 60 years and older; 6 percent had slight illness or injury, 10 percent had moderate illness or injury, and 3 percent reported serious illness or injury. Females and rural residents suffered more illnesses and injuries than males and urban residents. The highest percentages of illness or injury were found in Kampong Chhnang (18 percent), Kandal (17 percent), and Kampong Speu (15 percent). 30 | Utilization of Health Services for Accident, Illness, or Injury Table 3.4 Prevalence and severity of illness or injury in previous 30 days Percent distribution of the de jure household population ill or injured in the previous 30 days by severity of illness or injury, according to background characteristics, Cambodia 2010 Background characteristic Severity of illness or injury Total Number of population Not ill or injured Slight Moderate Serious Age 0-9 84.7 7.9 5.8 1.6 100.0 16,138 10-19 95.0 1.8 2.3 0.8 100.0 16,912 20-39 92.6 2.6 3.6 1.2 100.0 21,908 40-59 86.5 4.3 7.0 2.2 100.0 13,938 60+ 80.5 5.8 10.3 3.4 100.0 5,520 Sex Male 90.9 3.4 4.2 1.5 100.0 36,138 Female 88.0 4.8 5.6 1.6 100.0 38,276 Residence Urban 92.2 2.9 3.9 1.0 100.0 13,231 Rural 88.8 4.4 5.2 1.7 100.0 61,186 Province Banteay Mean Chey 90.4 3.5 3.9 2.3 100.0 3,127 Kampong Cham 89.1 4.8 4.8 1.2 100.0 8,787 Kampong Chhnang 82.0 7.1 8.8 2.1 100.0 2,994 Kampong Speu 85.1 6.4 6.8 1.8 100.0 4,303 Kampong Thom 90.7 3.2 3.8 2.4 100.0 3,840 Kandal 83.2 11.7 4.8 0.3 100.0 7,222 Kratie 88.8 3.2 5.9 2.1 100.0 1,823 Phnom Penh 94.6 1.1 3.3 1.0 100.0 6,964 Prey Veng 94.2 0.9 4.2 0.8 100.0 5,765 Pursat 92.0 1.3 5.3 1.3 100.0 2,324 Siem Reap 87.0 4.5 5.9 2.6 100.0 4,786 Svay Rieng 94.1 0.6 2.4 2.9 100.0 2,836 Takeo 89.6 2.5 5.2 2.6 100.0 5,089 Otdar Mean Chey 94.9 1.2 3.2 0.7 100.0 1,009 Battambang/Pailin 88.1 6.3 4.5 1.1 100.0 5,414 Kampot/Kep 88.5 1.1 8.3 2.0 100.0 3,632 Preah Sihanouk/Koh Kong 94.5 0.8 3.2 1.5 100.0 1,622 Preah Vihear/Steung Treng 90.6 2.4 5.3 1.7 100.0 1,727 Mondol Kiri/Rattanak Kiri 91.7 4.6 3.2 0.5 100.0 1,152 Total 89.4 4.1 4.9 1.5 100.0 74,416 3.4 TREATMENT SOUGHT FOR ILLNESS OR INJURY Table 3.5 presents the percentage of the ill or injured population who sought treatment according to the number of times they did so. The type of treatment recorded included, but was not limited to, care provided by medically trained professionals. For example, if a sick child was first given a remedy by a Kru Khmer traditional healer, this was recorded as the first treatment. If the parents later observed that the child was still ill and went to a shop in the market for medicine, this was recorded as the second treatment. If the medicine was not effective and the parents took the child to a doctor at a private clinic, this was recorded as the third treatment. Ninety-two percent of household members who were ill sought at least one treatment (Table 3.5), a percentage that has not changed since the 2005 CDHS. Twenty-three percent of those ill or injured sought at least two treatments, and 8 percent sought at least three treatments. In general, there was a positive relationship between the severity of illness or injury and the number of times treatment was sought. Persons with serious illnesses or injuries were more likely to seek treatment than those with moderate illnesses or injuries. These latter individuals in turn were more likely to seek treatment than those with slight illnesses or injuries. Eighty-eight percent of those with a slight illness, 95 percent of those with a moderate illness, and 96 percent of those with a serious illness or injury sought a first treatment. The corresponding percentages among those who sought a second treatment were 15 percent, 25 percent, and 35 percent. Five percent of slight illnesses or injuries were treated three times or more, as compared with 14 percent of serious illnesses or injuries. There were small differences in health-seeking behavior by sex and age. Rural residents were more likely to seek a second or third treatment than urban residents. Utilization of Health Services for Accident, Illness, or Injury | 31 The provinces with the highest percentages of ill or injured persons seeking treatment were Pursat, Kampong Chhnang, and Prey Veng (98 percent each), whereas the province with the lowest percentage was Preah Sihanouk/Koh Kong (85 percent). Table 3.5 Percentage of ill or injured population who sought treatment Percentage of de jure household members who were ill or injured in the past 30 days who sought a first, second, and third treatment, according to background characteristics, Cambodia 2010 Background characteristic Treatment for illness or injury Number of ill/injured population First treatment Second treatment Third treatment Severity of illness or injury Slight 87.7 14.9 4.5 3,065 Moderate 94.7 25.0 9.1 3,669 Serious 96.1 35.4 14.0 1,149 Age 0-9 94.3 23.0 6.8 2,464 10-19 95.1 20.5 8.0 843 20-39 92.0 21.7 8.8 1,621 40-59 89.0 22.8 7.6 1,886 60+ 90.9 24.0 10.4 1,074 Sex Male 92.4 23.3 7.3 3,300 Female 92.0 22.0 8.6 4,587 Residence Urban 95.4 17.9 4.9 1,027 Rural 91.7 23.3 8.5 6,861 Province Banteay Mean Chey 90.6 12.5 2.7 301 Kampong Cham 96.7 23.3 9.0 956 Kampong Chhnang 98.5 30.9 10.7 538 Kampong Speu 93.7 13.4 2.9 642 Kampong Thom 90.6 19.5 4.7 358 Kandal 88.0 19.4 7.9 1,215 Kratie 93.8 7.9 0.4 204 Phnom Penh 97.2 17.5 2.4 375 Prey Veng 97.7 39.5 17.9 337 Pursat 98.7 11.4 1.3 185 Siem Reap 86.6 19.4 6.5 622 Svay Rieng 91.3 31.3 14.2 166 Takeo 92.0 41.8 21.3 528 Otdar Mean Chey 93.9 23.0 4.7 52 Battambang/Pailin 86.1 18.7 7.1 643 Kampot/Kep 94.2 39.3 11.1 417 Preah Sihanouk/Koh Kong 85.2 9.5 1.6 89 Preah Vihear/Steung Treng 87.6 8.6 0.7 163 Mondol Kiri/Rattanak Kiri 93.3 14.3 2.7 96 Total 92.2 22.6 8.0 7,888 3.5 UTILIZATION OF HEALTH CARE FACILITIES Information on the location of health care providers was collected to determine where persons who were ill or injured went for treatment. Health care providers were distinguished by public sector, private sector, and non-medical sector. Interviewers were provided with descriptions of the different types of hospitals, clinics, pharmacies, and other health venues. If, during data collection, the interviewer had difficulties distinguishing among the various types, the team supervisor or field editor ascertained the correct designation from local sources. Table 3.6 presents data on utilization of health services by type of residence (urban-rural). Small differences in patterns of health care use can be observed, with the private sector in general used most often, followed by the public sector and then the non-medical sector. Urban and rural residents sought a first, second, or third treatment in about equal proportions. 32 | Utilization of Health Services for Accident, Illness, or Injury Table 3.6 Percentage of ill or injured population who sought treatment, by place of treatment Percent distribution of de jure household members who were ill or injured in the past 30 days by place of treatment, according to urban-rural residence, Cambodia 2010 Place of treatment Residence Total Urban Rural First treatment Second treatment Third treatment First treatment Second treatment Third treatment First treatment Second treatment Third treatment Did not seek treatment 4.6 82.1 95.1 8.3 76.7 91.5 7.8 77.4 92.0 Public sector 25.7 4.4 1.3 29.4 6.8 2.3 28.9 6.5 2.2 National hospital (PP) 12.2 1.9 0.3 4.3 1.5 0.6 5.3 1.5 0.6 Provincial hospital (RH) 5.1 0.8 0.3 3.3 1.0 0.2 3.6 1.0 0.2 District hospital (RH) 2.0 0.4 0.2 3.2 0.7 0.4 3.1 0.7 0.3 Health center 5.8 1.0 0.2 17.5 3.4 1.1 16.0 3.1 1.0 Health post 0.0 0.0 0.1 0.3 0.1 0.0 0.2 0.1 0.0 Outreach 0.0 0.0 0.0 0.4 0.1 0.1 0.4 0.1 0.1 Other public 0.6 0.3 0.1 0.3 0.0 0.0 0.3 0.1 0.0 Private sector 65.7 12.2 3.2 55.5 14.1 5.0 56.8 13.9 4.8 Private hospital 4.1 0.6 0.4 4.0 0.7 0.2 4.0 0.7 0.2 Private clinic 27.1 5.6 1.1 16.0 4.7 1.7 17.4 4.8 1.6 Private pharmacy 20.0 2.9 1.0 7.7 2.2 0.8 9.3 2.3 0.8 Home/office of trained health worker/nurse 6.3 1.2 0.5 8.4 2.2 0.6 8.1 2.0 0.6 Visit of trained health worker/nurse 7.5 1.7 0.4 17.7 3.8 1.6 16.4 3.6 1.4 Other private medical 0.8 0.2 0.0 1.7 0.5 0.2 1.6 0.5 0.2 Non-medical sector 2.8 0.6 0.2 5.9 2.0 1.0 5.4 1.9 0.9 Shop/market 2.4 0.6 0.2 4.9 1.4 0.7 4.6 1.3 0.6 Kru Khmer/magician 0.4 0.1 0.0 0.9 0.6 0.3 0.8 0.5 0.2 Monk/religious leader 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Traditional birth attendant 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Outside of country/other 1.2 0.7 0.2 1.0 0.3 0.1 1.0 0.3 0.2 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number 1,027 1,027 1,027 6,861 6,861 6,861 7,888 7,888 7,888 Within the public sector, health centers were most often sought for treatment of illnesses and injuries (18 percent) in rural areas, whereas national hospitals were most often sought for treatment (12 percent) in urban areas. Within the private sector, private clinics were most often sought for treatment in both urban areas (27 percent) and rural areas (16 percent). Private pharmacies were much more likely to be visited for first treatment in urban areas than in rural areas (20 percent versus 8 percent), whereas trained health workers and nurses were more commonly sought out for first-time treatment in rural areas than in urban areas (18 percent versus 8 percent). Within the non-medical sector, shops or markets were the overwhelming choice as a source of health care. Figure 3.1 summarizes the findings detailed in Table 3.6. The public sector is about twice as likely to be visited for all three treatments. After the public sector, people most often choose the private sector for first, second, and third treatments. Utilization of Health Services for Accident, Illness, or Injury | 33 Figure 3.1 Percentage of Household Members Ill or Injured Seeking Treatment by Order of Treatment and Sector of Health Care CDHS 2010 29 7 2 57 14 5 5 2 1 First treatment Second treatment Third treatment 0 10 20 30 40 50 60 Percent Public sector Private sector Non-medical sector 3.6 COST FOR HEALTH CARE 3.6.1 Distribution of Cost for Health Care For each ill or injured person, the respondent was asked to state the costs expended for transportation and treatment for each visit to a health care provider. These costs were reported only for living people who had been recently ill or injured and did not include costs incurred for people who had died in the 30 days preceding the interview. Costs are presented in US dollars in Table 3.7. In the case of all treatments, 15 percent of household members spent $1 or less for transportation and treatment for illness or injury, and 21 percent spent $1 to $4. About 8 percent of all household members spent $50-$99 for transportation and treatment for illness or injury, whereas 7 percent of all ill or injured persons spent $100 or more. These expenditures varied by type of spending. For transport, 56 percent of household members spent less than $1, 29 percent spent $1 to $4, 7 percent spent $5 to $9, and the rest (7 percent) spent $10 or more. For health care, almost 7 in 10 households spent up to $19, 16 percent spent between $20 and $49, 8 percent spent between $50 and $99, and 7 percent spent $100 or more. There were small variations in spending according to order of treatment. 34 | Utilization of Health Services for Accident, Illness, or Injury Table 3.7 Distribution of cost for health care Percent distribution of de jure household members who were ill or injured in the past 30 days and sought treatment by amount in United States dollars spent for transport and health care, according to number of treatments, Cambodia 2010 Amount spent for transport and health care Treatment for illness or injury First treatment Second treatment Third treatment All treatments Transport Health care Total Transport Health care Total Transport Health care Total Transport Health care Total Monetary cost $0-$1 58.2 25.5 17.7 52.5 25.2 17.1 55.6 22.7 16.2 56.1 22.1 15.3 $1-$4 29.3 19.8 23.8 34.4 21.5 25.5 30.1 26.8 29.5 28.6 18.3 21.1 $5-$9 6.5 12.6 13.7 6.5 16.3 17.6 7.3 16.2 17.0 7.4 12.3 13.2 $10-$19 3.5 14.9 16.1 2.9 13.3 14.5 2.9 13.3 15.6 4.2 15.4 16.5 $20-$49 1.4 14.4 15.2 1.7 13.2 13.5 2.2 8.6 8.5 2.1 15.7 16.4 $50-$99 0.4 6.0 6.3 0.8 4.5 5.1 0.6 6.2 6.0 0.6 7.7 8.1 $100+ 0.2 5.6 5.8 0.5 4.6 4.8 1.3 3.9 5.0 0.4 7.0 7.4 Non-monetary cost In kind 0.0 0.0 0.0 0.0 0.1 0.1 0.0 0.0 0.0 0.0 0.0 0.0 Don’t know/missing 0.6 1.1 1.4 0.6 1.3 1.6 0.0 2.2 2.2 0.7 1.5 1.9 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number 7,270 7,270 7,270 1,780 1,780 1,780 633 633 633 7,270 7,270 7,270 3.6.2 Expenditures for Health Care Table 3.8 presents the mean cost of transport and treatment by order of treatment and background characteristics. Mean costs for first, second, and third treatments are $30.49, $43.92, and $21.50, respectively. Mean cost of transport increases with treatment order, from $2.08 for the first treatment to $3.00 for the second treatment and then $4.04 for the third treatment. The mean cost of transport and health care varies according to type of health sector, severity of illness or injury, age group, sex, residence, and province. Examining total costs by type of health sector shows that the highest mean expenditure is for “outside of country/other” treatment, which may include going to Singapore, Thailand, or Vietnam or seeking specialized services. This is true for both costs of transport and costs of health care. The total cost for treatment, in both the public and private sectors, diminishes as the number of treatments sought increases (Table 3.8). Whereas the cost of transport in these two sectors increases from the first through the third treatment cycles, the cost of health care decreases considerably. Total cost has substantially increased in the past five years. Increases have been observed across all sectors, in every treatment cycle, and in both transport costs and health care costs. Total “outside of country/other” costs have increased dramatically from the 2005 CDHS, from $10.94 to $324.26. “Outside of country/other” treatment is the most expensive treatment option due to high transport ($19.92) and health care ($304.34) costs. Utilization of Health Services for Accident, Illness, or Injury | 35 Table 3.8 Expenditures for health care Mean expenditures in United States dollars for transport and health care by de jure household members who were ill or injured in the past 30 days and sought treatment by order of treatments, according to background characteristics, Cambodia 2010 Background characteristic Treatment for illness or injury First treatment Second treatment Third treatment All treatments Transport Health care Total Transport Health care Total Transport Health care Total Transport Health care Total Type of health sector Public 3.04 32.41 35.45 4.45 29.69 34.14 5.15 20.31 25.46 3.41 31.25 34.65 Private 1.52 27.06 28.58 1.87 24.69 26.56 2.79 16.62 19.41 1.66 25.96 27.63 Non-medical 1.04 8.42 9.46 1.24 25.69 26.93 0.58 6.45 7.03 1.04 12.07 13.11 Outside of country/other 11.42 96.89 108.31 * * * * * * 19.92 304.34 324.26 Severity of illness or injury Slight 0.80 6.57 7.37 1.04 23.33 24.37 0.28 2.99 3.27 0.81 8.75 9.56 Moderate 2.01 25.48 27.49 2.31 15.86 18.16 3.30 11.25 14.54 2.16 22.63 24.78 Serious 5.41 90.97 96.37 6.83 118.44 125.27 8.85 42.94 51.79 6.08 92.99 99.07 Age 0-9 1.57 9.51 11.08 2.34 7.95 10.28 2.32 6.35 8.66 1.76 9.04 10.80 10-19 1.67 20.84 22.51 2.05 16.27 18.32 4.15 13.99 18.14 1.90 19.64 21.54 20-39 2.21 36.85 39.05 2.26 76.38 78.64 1.79 15.73 17.51 2.19 42.28 44.47 40-59 2.65 33.95 36.60 4.97 39.84 44.82 9.29 22.34 31.63 3.51 34.35 37.86 60+ 2.45 57.67 60.12 2.85 84.68 87.53 2.81 33.34 36.15 2.56 60.91 63.47 Sex Male 2.30 32.75 35.05 3.04 45.35 48.39 4.28 18.20 22.48 2.56 34.28 36.83 Female 1.92 25.28 27.20 2.98 37.54 40.52 3.90 17.01 20.90 2.24 26.90 29.15 Residence Urban 2.43 63.61 66.04 3.05 142.01 145.06 6.63 46.89 53.52 2.69 74.79 77.49 Rural 2.02 22.91 24.94 3.00 29.21 32.21 3.82 14.90 18.72 2.33 23.55 25.88 Province Banteay Mean Chey 3.39 32.63 36.03 (4.11) (30.13) (34.24) * * * 3.57 32.03 35.60 Kampong Cham 1.49 22.51 24.00 3.79 19.72 23.51 (6.98) (12.50) (19.48) 2.30 21.28 23.59 Kampong Chhnang 1.31 18.12 19.43 1.39 33.45 34.84 1.17 14.28 15.45 1.32 21.20 22.52 Kampong Speu 1.47 28.01 29.47 1.58 18.10 19.68 * * * 1.52 26.40 27.92 Kampong Thom 1.83 32.00 33.84 4.92 105.96 110.88 * * * 2.33 43.47 45.80 Kandal 1.00 13.48 14.48 2.22 11.20 13.42 (2.83) (12.17) (15.00) 1.33 13.01 14.33 Kratie 7.01 50.76 57.77 (21.82) (49.82) (71.64) * * * 8.14 50.50 58.63 Phnom Penh 1.88 113.06 114.94 (4.10) (467.06) (471.16) * * * 2.21 166.90 169.10 Prey Veng 3.20 30.98 34.18 2.69 17.50 20.19 (1.11) (6.64) (7.75) 2.83 24.76 27.59 Pursat 3.36 29.58 32.94 (3.42) (22.10) (25.52) * * * 3.39 28.70 32.09 Siem Reap 2.01 22.42 24.43 2.69 11.00 13.68 (1.91) (12.07) (13.97) 2.12 19.88 22.00 Svay Rieng 3.30 32.39 35.70 2.27 37.22 39.49 (4.80) (31.46) (36.26) 3.24 33.35 36.59 Takeo 1.55 18.65 20.20 1.33 10.89 12.21 1.59 9.84 11.43 1.50 15.31 16.80 Otdar Mean Chey 3.65 16.58 20.23 1.70 12.52 14.23 * * * 3.19 16.07 19.27 Battambang/Pailin 2.80 35.31 38.11 7.92 51.40 59.32 (22.76) (37.71) (60.47) 4.75 38.17 42.92 Kampot/Kep 1.17 12.22 13.39 1.09 19.82 20.91 (1.78) (22.13) (23.92) 1.20 15.05 16.24 Preah Sihanouk/Koh Kong 5.91 34.54 40.45 (4.81) (29.12) (33.93) * * * 5.71 34.55 40.26 Preah Vihear/Steung Treng 3.12 18.35 21.47 (6.97) (28.15) (35.11) * * * 3.44 19.11 22.55 Mondol Kiri/Rattanak Kiri 5.19 28.01 33.20 (3.37) (18.93) (22.30) * * * 5.09 27.86 32.94 Total 2.08 28.41 30.49 3.00 40.92 43.92 4.04 17.46 21.50 2.38 29.99 32.37 Note: Figures in parentheses are based on 25-49 unweighted cases. An asterisk indicates that a figure is based on fewer than 25 unweighted cases and has been suppressed. In general, health care costs rose significantly by severity of illness or injury. The total mean cost of health care increased from $8.75 for slight illness or injury to $92.99 for serious conditions. This followed the same trend established in the 2005 CDHS ($3.13 for slight illness or injury to $47.17 for serious illnesses), although, as noted above, overall costs have increased in the past five years. Total health care costs rise with the patient’s age, from $9.04 for children age 0-9 to $42.28 for people age 20-39. The total cost for people age 40-59 is $34.35, increasing to $60.91 for people 60 years or older. Health care expenditures by sex show that men spent more than women on health care ($34.28 versus $26.90). A comparison with the findings of the 2005 CDHS shows that health care spending seems to have become less equitable. In 2005, men spent about the same as women on health care ($14.09 versus $13.91). Total health care costs have remained higher in urban areas than in rural areas since the 2005 CDHS. In urban areas costs increased from $22.89 in 2005 to $74.79 in 2010, and in rural areas costs increased from $12.76 in 2005 to $23.55 in 2010. By contrast, whereas transport costs in rural areas have not changed much over the past five years ($1.17 versus $2.33), transport costs in urban areas have more than doubled ($0.94 versus $2.69). 36 | Utilization of Health Services for Accident, Illness, or Injury Health care expenditures vary greatly in Cambodia’s provinces. The cost of health care is highest in Phnom Penh ($166.90) and lowest in Kandal ($13.01). Because the health care system in Cambodia is largely fee based, it is important to know the source of the money used to pay for health care. One goal of the health care system is to have appropriate funding mechanisms for the population to acquire health care without deepening poverty. Table 3.9 shows the different sources of money spent by people seeking treatment for health care. Percentages could sum to greater than 100 because a person could use money from more than one source. Forty-five percent of the money spent on health care came from wages or pocket money and 51 percent from savings. Gifts from relatives or friends and sale of assets accounted for 9 percent and 8 percent of the sources used for funding of health care. Only 2 percent of money spent came from a health equity fund. There are small differences in the source of money spent on health care by type of health sector. Across all sectors, savings is the most common source of funding (47 percent to 52 percent), followed by wages or pocket money (38 percent to 48 percent). Money borrowed with interest is the next most common source of funding for health care (10 percent to 16 percent). The source of money for treatment varied by the severity of illness or injury. Wages or pocket money and savings were the most common sources of money used for care of slight illnesses. With severe illnesses, the source shifted to money borrowed with interest (from 6 percent for slight illness to 21 percent for severe illness), money borrowed without interest (from 4 percent for slight illness to 15 percent for severe illness), sale of assets (from 5 percent for slight illness to 17 percent for severe illness), and gifts from relatives or friends (from 5 percent for slight illness to 13 percent for severe illness). Table 3.9 Source of money spent by persons who sought treatment for health care Percentage of the source of expenditures for transport and health care, according to background characteristics, Cambodia 2010 Background characteristic Source of money for health care Commu- nity- based health insurance Health insurance through employer Health equity fund Other privately pur- chased commer- cial health insurance Wages/ pocket money Gift from relative/ friend Savings Borrow (no interest) Borrow (with interest) Sale of assets NGO Tong Tin Other/ missing Number Type of health sector Public 1.4 0.7 6.6 0.1 40.7 7.4 47.4 7.6 9.6 8.4 0.4 0.1 1.6 2,088 Private 0.1 0.1 0.3 0.0 48.3 9.1 52.1 7.8 10.6 8.0 0.1 0.0 2.3 4,611 Non-medical 0.5 0.0 1.3 0.0 37.6 9.2 50.0 5.2 12.0 6.7 0.3 0.0 2.8 468 Other 1.3 0.4 0.9 1.7 39.1 12.2 49.0 1.8 15.5 16.2 0.0 0.0 8.0 103 Severity of illness or injury Slight 0.3 0.2 1.9 0.1 51.6 5.2 49.3 3.5 6.0 4.8 0.0 0.1 1.6 2,689 Moderate 0.6 0.2 2.0 0.0 43.1 9.8 54.1 8.2 10.7 8.1 0.1 0.0 2.4 3,473 Serious 0.5 0.3 3.3 0.1 36.9 13.4 42.3 15.1 20.8 16.7 0.6 0.0 3.1 1,104 Monetary cost $0-$1 2.3 0.8 7.2 0.3 45.9 3.6 43.4 2.5 2.8 3.6 0.2 0.0 2.4 1,113 $1-$4 0.3 0.4 2.7 0.0 51.8 5.6 49.4 4.0 4.5 5.5 0.1 0.0 1.1 1,532 $5-$9 0.3 0.0 1.3 0.1 48.0 7.5 57.0 6.8 7.5 6.1 0.2 0.0 0.8 963 $10-$19 0.0 0.0 0.8 0.0 46.0 9.1 55.4 7.6 10.4 7.2 0.1 0.0 2.1 1,200 $20-$49 0.2 0.0 0.9 0.0 40.7 10.4 51.5 10.3 18.0 9.8 0.1 0.0 3.0 1,193 $50-$99 0.0 0.2 0.5 0.2 40.7 13.4 47.5 14.6 19.1 12.0 0.1 0.0 2.9 592 $100+ 0.3 0.2 0.0 0.0 34.6 17.0 47.4 13.8 24.5 24.1 0.7 0.0 3.2 538 Sex Male 0.3 0.3 2.6 0.1 44.8 7.2 50.4 8.4 11.8 8.3 0.2 0.0 1.9 3,048 Female 0.6 0.2 1.8 0.1 45.6 9.7 50.7 6.9 9.5 8.1 0.2 0.0 2.4 4,222 Residence Urban 0.2 0.6 0.7 0.1 54.1 13.5 63.0 5.1 5.1 4.3 0.3 0.2 1.4 979 Rural 0.5 0.2 2.4 0.1 43.9 7.9 48.6 7.9 11.3 8.8 0.2 0.0 2.3 6,291 Continued… Utilization of Health Services for Accident, Illness, or Injury | 37 Table 3.9—Continued Background characteristic Source of money for health care Commu- nity- based health insurance Health insurance through employer Health equity fund Other privately pur- chased commer- cial health insurance Wages/ pocket money Gift from relative/ friend Savings Borrow (no interest) Borrow (with interest) Sale of assets NGO Tong Tin Other/ missing Number Province Banteay Mean Chey 0.2 0.0 6.9 0.0 28.8 4.9 65.6 5.8 13.0 2.9 0.2 0.0 2.6 273 Kampong Cham 0.0 0.0 4.3 0.0 56.9 4.0 35.1 3.6 12.2 8.6 0.0 0.0 2.9 924 Kampong Chhnang 0.0 0.0 0.8 0.0 29.1 4.8 77.3 6.8 8.3 25.5 0.8 0.0 1.2 530 Kampong Speu 0.0 0.0 0.2 0.0 71.7 6.4 25.3 9.0 6.8 6.0 0.0 0.0 0.8 602 Kampong Thom 2.4 0.3 5.0 0.0 73.9 14.4 17.1 15.0 22.8 6.0 0.1 0.0 0.9 325 Kandal 0.0 0.2 0.0 0.1 54.9 7.7 52.5 4.6 7.4 2.9 0.0 0.0 1.0 1,069 Kratie 0.0 0.2 4.0 1.0 44.0 7.6 61.8 7.0 12.8 4.0 0.6 0.0 1.4 191 Phnom Penh 0.0 1.0 0.8 0.0 64.3 17.9 68.1 6.2 6.6 4.1 0.4 0.0 0.5 364 Prey Veng 0.6 0.0 0.0 0.0 24.5 10.2 57.5 7.2 12.8 1.2 0.0 0.0 0.0 329 Pursat 0.6 0.0 12.7 0.0 11.2 6.4 61.9 9.1 24.2 18.0 1.1 0.0 0.9 183 Siem Reap 1.7 1.5 0.5 0.0 72.0 7.4 11.3 9.3 5.9 5.6 0.0 0.0 4.9 539 Svay Rieng 0.0 0.0 2.3 0.0 23.7 6.2 54.1 8.1 8.2 20.4 0.0 0.0 9.0 152 Takeo 1.1 0.0 2.3 0.0 26.2 19.6 66.0 14.7 13.7 12.4 0.3 0.0 2.9 486 Otdar Mean Chey 9.5 0.8 1.3 0.0 58.8 3.6 36.5 3.3 10.0 5.2 0.4 0.0 0.8 49 Battambang/Pailin 0.0 0.0 1.1 0.3 21.0 10.7 61.4 8.3 16.2 8.5 0.0 0.3 5.8 554 Kampot/Kep 0.6 0.3 2.5 0.3 11.6 9.0 75.0 7.0 4.8 12.4 0.0 0.0 1.0 393 Preah Sihanouk/ Koh Kong 0.0 0.0 2.1 0.0 36.2 6.4 47.7 5.2 9.2 1.2 0.0 0.0 3.0 76 Preah Vihear/ Steung Treng 1.6 0.0 1.3 0.0 46.8 7.8 71.6 11.3 4.6 1.5 0.6 0.0 1.1 143 Mondol Kiri/ Rattanak Kiri 1.1 0.4 6.6 0.0 22.7 3.3 78.3 3.6 3.5 1.1 0.7 0.0 0.8 89 Total 0.5 0.2 2.2 0.1 45.3 8.6 50.6 7.5 10.5 8.2 0.2 0.0 2.2 7,270 The monetary costs of health care treatment show a pattern similar to those described above. Wages and pocket money were the most common source of funding for health costs under $99 (41 percent to 52 percent). The use of wages and pocket money decreased as the cost of health care treatment increased over $99 (35 percent). Savings contributed nearly half (47 percent) of the funding when spending was $100 or more. Money borrowed with interest and sale of assets were the next important sources of money for treatment costs of $100 or more. There were no substantial differences in the source of money used for health care costs by the patient’s sex. Urban residents were more likely than rural residents to use wages or pocket money (54 percent versus 44 percent) or savings (63 percent compared with 49 percent) for health care. Large differences were found in the sources of money for health care costs by province. Patients in Kampong Speu, Kampong Thom, and Siem Reap were the most likely to use their wages or pocket money to pay for their health care (72 to 74 percent) and the least likely to use their savings (11 to 25 percent). Conversely, Kampong Chhnang and Mondol Kiri/Rattanak Kiri were the provinces most likely to use savings for health care spending (77 and 78 percent, respectively). Pursat and Kampot/Kep were least likely to use their wages/pocket money for health care spending (11 and 12 percent, respectively). Patients in Kampong Chhnang (26 percent) had the highest reliance on sale of assets for health care spending. Patients in Pursat had the highest percentages of use of money borrowed with interest and a health equity fund to finance their health care spending. Approximately 10 percent of patients in Otdar Mean Chey reported that community-based health insurance was their source of funding for health care costs. Respondent Characteristics | 39 RESPONDENT CHARACTERISTICS 4 This chapter provides a demographic and socioeconomic profile of respondents interviewed in the 2010 Cambodia Demographic and Health Survey (CDHS). Such background information is essential to the interpretation of findings and for understanding the results presented later in the report. Basic characteristics collected include age, level of education, marital status, religion, and wealth status. Exposure to mass media and literacy status were examined, and detailed information was collected on employment status, occupation, and earnings. In addition, the CDHS collected data on knowledge and attitudes concerning health insurance coverage and use of tobacco. 4.1 CHARACTERISTICS OF SURVEY RESPONDENTS Background characteristics of the 18,754 women age 15-49 and the 8,239 men age 15-49 interviewed in the 2010 CDHS are shown in Table 4.1. This table is important in that it provides a background for interpreting findings presented later in the report. The distribution of the population of women and men by age reflects recent Cambodian history. Note that 20 percent of women and 23 percent of men fall into the 15-19 age group, whereas 17 percent of women and men fall into the 20-24 age group and the same percentage into the 25-29 age group. Smaller proportions of women and men are found in the older age groups. Between 10 and 12 percent of women and men fall into each of the five-year age groups between 30 and 49. This age distribution of respondents is unusual and reflects the effects of the Khmer Rouge regime (1975- 1979), during which fertility rates declined and were coupled with higher than normal mortality due to national conflict. Between one and two million people are estimated to have been killed during the reign of the Khmer Rouge. These events are reflected in the smaller than expected proportions of women and men in the 30-34 and 35-39 age groups. Approximately 60 percent of Cambodians are married or living with their partner. The proportion not currently married varies by gender, with 3 in 10 women never married as compared with almost 4 in 10 men. Women are more than twice as likely as men to be divorced, separated, or widowed (7 percent and 3 percent, respectively). Access to services and exposure to information pertaining to reproductive health and other aspects of life are often determined by one’s area of residence. The majority of respondents reside in rural areas, with only 21 percent of Cambodian women and men residing in urban areas. Slightly more than 11 percent of men and women live in Kampong Cham, and 12 percent live in the capital city of Phnom Penh. Cambodians are predominantly Buddhist (97 percent); 1 percent are Moslem and less than 1 percent are Christian. The majority of Cambodians have some formal schooling, and educational levels of women have improved within the past 10 years. The percentage of women with no schooling declined from 28 percent in the 2000 CDHS to 19 percent in the 2005 CDHS and 16 percent in the 2010 CDHS. Moreover, the percentage of women who attended any secondary school increased from 25 percent in 2005 to 35 percent in 2010. However, Table 4.1 shows there are still notable differences in educational attainment between women and men. Twice as many women as men have no schooling (16 percent versus 8 percent), and men are approximately one and a half times more likely than women to have attended secondary school (51 percent versus 35 percent). 40 | Respondent Characteristics Table 4.1 Background characteristics of respondents Percent distribution of women and men age 15-49 by selected background characteristics, Cambodia 2010 Background characteristic Women Men Weighted percentage Weighted number Unweighted number Weighted percentage Weighted number Unweighted number Age 15-19 19.9 3,734 3,915 22.6 1,863 1,859 20-24 16.8 3,155 3,172 17.0 1,402 1,428 25-29 17.4 3,262 3,209 16.7 1,377 1,370 30-34 11.6 2,167 2,178 12.3 1,014 1,017 35-39 10.9 2,044 1,995 10.1 835 819 40-44 12.3 2,300 2,225 11.6 956 932 45-49 11.2 2,093 2,060 9.6 792 814 Marital status Never married 30.8 5,783 5,926 38.6 3,181 3,247 Married 61.4 11,515 11,439 58.4 4,815 4,755 Living together 0.6 112 97 0.4 37 40 Divorced/separated 4.2 781 738 1.8 152 147 Widowed 3.0 564 554 0.7 54 50 Residence Urban 21.0 3,936 6,077 20.6 1,697 2,606 Rural 79.0 14,818 12,677 79.4 6,542 5,633 Province Banteay Mean Chey 3.8 719 919 3.3 275 355 Kampong Cham 11.3 2,111 909 12.0 990 403 Kampong Chhnang 3.9 739 1,132 4.1 341 497 Kampong Speu 5.7 1,060 958 5.7 468 399 Kampong Thom 5.0 935 969 4.7 390 407 Kandal 10.2 1,920 992 9.7 796 418 Kratie 2.3 438 937 2.3 191 413 Phnom Penh 11.6 2,183 1,376 11.5 945 592 Prey Veng 7.1 1,341 874 7.3 598 388 Pursat 2.8 534 847 3.1 256 397 Siem Reap 6.6 1,233 985 6.3 517 424 Svay Rieng 4.0 753 991 4.0 331 425 Takeo 6.3 1,175 901 6.4 525 399 Otdar Mean Chey 1.3 252 947 1.5 122 459 Battambang/Pailin 7.0 1,320 879 7.3 603 390 Kampot/Kep 4.8 891 910 4.4 362 381 Preah Sihanouk/Koh Kong 2.3 439 1,088 2.5 203 526 Preah Vihear/Steung Treng 2.3 430 1,054 2.3 193 476 Mondol Kiri/Rattanak Kiri 1.5 281 1,086 1.6 132 490 Education No schooling 15.9 2,973 3,203 7.8 641 676 Primary 49.4 9,265 8,796 41.2 3,394 3,354 Secondary and higher 34.7 6,516 6,755 51.0 4,205 4,209 Wealth quintile Lowest 18.1 3,388 3,260 17.6 1,454 1,412 Second 18.7 3,516 3,159 18.7 1,544 1,420 Middle 19.2 3,594 3,242 19.9 1,637 1,451 Fourth 20.4 3,827 3,735 20.6 1,696 1,661 Highest 23.6 4,428 5,358 23.2 1,908 2,295 Religion Buddhist 97.3 18,245 17,799 97.3 8,020 7,812 Moslem 1.4 259 312 1.1 91 123 Christian 0.5 92 111 0.6 49 59 Other 0.8 156 528 0.9 77 243 Total 100.0 18,754 18,754 100.0 8,239 8,239 Note: Education categories refer to the highest level of education attended, whether or not that level was completed. 4.2 EDUCATIONAL ATTAINMENT AND LITERACY Tables 4.2.1 and 4.2.2 present a detailed distribution of educational attainment among Cambodian women and men according to background characteristics. The general pattern evident in Table 4.2.1 indicates a decrease in the proportion of women with no schooling from the oldest to the youngest cohorts. Men, with the exception of those in the 40-44 age group, exhibit the same pattern (Table 4.2.2). Women born during the reign of the Khmer Rouge (those currently age 30-34) are Respondent Characteristics | 41 somewhat more likely than the surrounding age groups to have no schooling. Men born during the time of the Khmer Rouge as well as those born just before (men currently age 30-39) are also more likely to have no schooling. The data presented in Tables 4.2.1 and 4.2.2 provide evidence of an increase in educational attainment among the youngest age cohort. For example, 56 percent of women age 15-19 have attended some secondary school, as compared with only 34 percent of women age 20- 24. A similar trend is seen in young men, with 60 percent of those age 15-19 and 39 percent of those age 20-24 having attended some secondary school. Table 4.2.1 Educational attainment: Women Percent distribution of women age 15-49 by highest level of schooling attended or completed, and median years completed, according to background characteristics, Cambodia 2010 Background characteristic Highest level of schooling Total Median years completed Number of women No schooling Some primary Completed primary1 Some secondary Completed secondary2 More than secondary Age 15-24 6.1 26.5 11.3 45.9 5.1 5.0 100.0 6.5 6,889 15-19 3.5 22.3 11.1 56.2 4.2 2.6 100.0 7.0 3,734 20-24 9.1 31.6 11.5 33.6 6.2 8.0 100.0 5.8 3,155 25-29 15.4 45.4 9.4 21.2 4.4 4.1 100.0 4.2 3,262 30-34 20.9 48.9 6.9 18.8 3.0 1.5 100.0 3.4 2,167 35-39 19.3 49.4 6.1 21.5 2.5 1.2 100.0 3.4 2,044 40-44 21.3 53.4 4.8 17.2 2.1 1.1 100.0 2.9 2,300 45-49 34.1 54.5 2.3 8.1 0.4 0.6 100.0 1.6 2,093 Residence Urban 6.6 28.7 7.3 36.6 9.2 11.6 100.0 6.8 3,936 Rural 18.3 44.6 8.3 25.8 2.1 0.8 100.0 3.7 14,818 Province Banteay Mean Chey 18.1 47.1 6.5 22.2 4.6 1.4 100.0 3.3 719 Kampong Cham 20.0 43.3 9.0 24.2 1.8 1.7 100.0 3.5 2,111 Kampong Chhnang 15.3 52.4 8.2 21.5 1.9 0.8 100.0 3.4 739 Kampong Speu 11.8 41.3 9.2 34.1 2.7 0.9 100.0 4.7 1,060 Kampong Thom 19.7 48.0 7.0 21.7 2.2 1.4 100.0 3.2 935 Kandal 9.4 40.4 8.9 37.0 2.7 1.6 100.0 5.0 1,920 Kratie 20.5 42.2 7.7 24.7 4.4 0.6 100.0 3.7 438 Phnom Penh 4.2 26.5 6.4 35.9 10.7 16.2 100.0 7.5 2,183 Prey Veng 21.4 45.7 8.5 21.5 2.2 0.6 100.0 3.6 1,341 Pursat 16.7 44.1 6.1 27.3 3.6 2.3 100.0 3.8 534 Siem Reap 21.3 45.9 7.0 20.6 3.8 1.4 100.0 2.9 1,233 Svay Rieng 20.7 43.0 6.7 27.5 1.5 0.6 100.0 3.3 753 Takeo 11.5 43.4 11.4 28.6 2.9 2.1 100.0 4.5 1,175 Otdar Mean Chey 25.3 41.4 7.6 23.6 1.6 0.5 100.0 3.0 252 Battambang/Pailin 14.8 38.1 9.4 33.5 2.7 1.6 100.0 4.7 1,320 Kampot/Kep 11.1 44.0 9.2 32.0 2.8 1.0 100.0 4.4 891 Preah Sihanouk/Koh Kong 24.0 35.4 5.3 28.5 3.3 3.4 100.0 3.9 439 Preah Vihear/Steung Treng 26.6 42.8 8.1 19.6 2.1 0.9 100.0 2.8 430 Mondol Kiri/Rattanak Kiri 46.2 32.2 5.6 14.1 1.6 0.4 100.0 1.0 281 Wealth quintile Lowest 31.5 51.0 7.1 10.3 0.1 0.0 100.0 1.9 3,388 Second 22.3 51.2 8.5 17.4 0.6 0.1 100.0 2.9 3,516 Middle 14.9 47.5 9.6 25.8 1.7 0.5 100.0 3.9 3,594 Fourth 9.8 37.2 9.3 38.6 4.0 1.2 100.0 5.3 3,827 Highest 4.8 24.5 6.4 42.9 9.8 11.6 100.0 7.4 4,428 Total 15.9 41.3 8.1 28.1 3.6 3.1 100.0 4.2 18,754 1 Completed 6th grade at the primary level 2 Completed 12th grade at the secondary level Urban women have higher levels of education than rural women. More than one-third of urban women have attended some secondary school, as compared with approximately one-fourth of rural women. Tables 4.2.1 and 4.2.2 show great variation in education across provinces. Mondol Kiri/Rattanak Kiri has an exceptionally low rate of school attendance, with 46 percent of women and 22 percent of men having no formal education. By contrast, only 4 percent of women and 2 percent of men in Phnom Penh have no schooling. Median number of years of education completed is highest in Phnom Penh (7.5 for women and 10 for men). 42 | Respondent Characteristics Educational attainment rises dramatically with wealth quintile. Thirty-two percent of women in the lowest quintile have no formal education, as compared with 5 percent of women in the highest wealth quintile. The percentage of women who have attended some secondary school increases from 10 percent in the lowest wealth quintile to 43 percent in the highest. The pattern of variation in educational attainment by wealth among men is similar to that among women. Table 4.2.2 Educational attainment: Men Percent distribution of men age 15-49 by highest level of schooling attended or completed, and median years completed, according to background characteristics, Cambodia 2010 Background characteristic Highest level of schooling Total Median years completed Number of men No schooling Some primary Completed primary1 Some secondary Completed secondary2 More than secondary Age 15-24 3.2 24.2 10.0 50.6 5.4 6.6 100.0 7.0 3,265 15-19 1.7 21.9 9.9 59.5 4.3 2.9 100.0 7.2 1,863 20-24 5.2 27.2 10.1 38.9 6.9 11.7 100.0 6.8 1,402 25-29 8.1 36.4 7.7 33.8 5.6 8.4 100.0 5.7 1,377 30-34 10.5 39.8 7.1 32.3 4.5 5.8 100.0 5.0 1,014 35-39 11.6 34.5 8.2 34.1 5.4 6.3 100.0 5.5 835 40-44 9.6 35.5 4.9 37.7 6.7 5.7 100.0 6.0 956 45-49 16.4 53.0 4.3 21.1 2.1 3.2 100.0 3.0 792 Residence Urban 2.5 17.3 4.6 41.3 11.1 23.2 100.0 8.8 1,697 Rural 9.1 37.4 8.8 39.1 3.6 2.0 100.0 5.4 6,542 Province Banteay Mean Chey 10.9 35.3 8.5 40.8 2.5 2.0 100.0 5.4 275 Kampong Cham 12.4 34.0 9.5 37.5 3.9 2.6 100.0 5.4 990 Kampong Chhnang 8.9 42.4 10.4 32.2 4.6 1.5 100.0 4.8 341 Kampong Speu 6.1 29.4 8.2 48.7 3.8 3.8 100.0 6.5 468 Kampong Thom 11.0 46.2 7.5 29.4 3.9 2.0 100.0 4.3 390 Kandal 3.0 30.4 7.1 50.0 5.6 3.9 100.0 6.7 796 Kratie 9.3 41.6 9.3 32.8 5.5 1.6 100.0 4.9 191 Phnom Penh 2.2 13.2 2.4 39.6 10.6 32.0 100.0 10.0 945 Prey Veng 8.9 35.2 10.1 39.8 4.5 1.4 100.0 5.6 598 Pursat 9.7 39.2 8.1 33.5 5.6 4.0 100.0 5.1 256 Siem Reap 14.7 39.2 9.4 28.0 4.9 3.8 100.0 4.5 517 Svay Rieng 6.8 42.8 2.8 42.4 2.1 3.1 100.0 5.1 331 Takeo 3.4 31.4 9.1 50.0 3.4 2.7 100.0 6.5 525 Otdar Mean Chey 11.5 40.7 10.2 31.8 4.8 1.0 100.0 4.8 122 Battambang/Pailin 2.2 30.9 9.4 47.2 5.5 4.9 100.0 6.6 603 Kampot/Kep 5.6 35.1 11.2 39.7 4.5 4.0 100.0 5.7 362 Preah Sihanouk/Koh Kong 11.9 32.4 7.0 34.9 7.4 6.5 100.0 5.8 203 Preah Vihear/Steung Treng 14.9 49.7 7.1 22.9 4.6 0.8 100.0 3.5 193 Mondol Kiri/Rattanak Kiri 22.2 41.5 8.3 23.5 2.9 1.5 100.0 3.4 132 Wealth quintile Lowest 18.7 51.3 8.8 20.5 0.6 0.1 100.0 3.1 1,454 Second 9.6 47.1 8.6 32.1 2.1 0.5 100.0 4.4 1,544 Middle 7.8 35.3 11.3 41.7 2.6 1.2 100.0 5.6 1,637 Fourth 3.8 26.4 7.5 52.8 6.3 3.2 100.0 6.9 1,696 Highest 1.5 12.7 4.1 46.4 12.3 23.1 100.0 9.1 1,908 Total 7.8 33.3 7.9 39.5 5.1 6.4 100.0 6.1 8,239 1 Completed 6th grade at the primary level 2 Completed 12th grade at the secondary level The 2010 CDHS assessed literacy levels among respondents who had never been to school or who had attended only primary school by asking them to read all or part of a sentence in whatever language they were familiar. Those with at least a middle school education were assumed to be literate. Literacy results are shown in Tables 4.3.1 and 4.3.2. Table 4.3.1 shows that more than 70 percent of women are literate, and Table 4.3.2 shows that 83 percent of men are literate. Literacy is associated with access to education. In general, for both women and men, younger age groups are more likely to be literate than older age groups. Illiteracy decreases from 44 percent among women age 45-49 to 10 percent among women age 15-19. However, illiteracy is higher among women in the 30-34 age group than in the surrounding age cohorts. As can be seen in Table 4.2.1, these women were less likely to have attended school than women in the age groups before and after them. A similar pattern is observed in men. Respondent Characteristics | 43 Table 4.3.1 Literacy: Women Percent distribution of women age 15-49 by level of schooling attended and level of literacy, and percentage literate, according to background characteristics, Cambodia 2010 Background characteristic Secondary school or higher No schooling or primary school Total Percent- age literate1 Number Can read a whole sentence Can read part of a sentence Cannot read at all No card with required language Blind/ visually impaired Missing Age 15-19 63.0 15.2 11.6 10.1 0.0 0.1 0.0 100.0 89.8 3,734 20-24 47.8 19.2 16.1 16.9 0.0 0.0 0.0 100.0 83.1 3,155 25-29 29.8 21.8 21.0 27.4 0.0 0.0 0.0 100.0 72.6 3,262 30-34 23.3 20.2 21.1 35.4 0.0 0.0 0.0 100.0 64.6 2,167 35-39 25.2 21.6 21.5 31.6 0.0 0.1 0.0 100.0 68.2 2,044 40-44 20.5 20.8 24.6 33.6 0.0 0.4 0.1 100.0 66.0 2,300 45-49 9.2 18.9 27.2 44.2 0.0 0.5 0.0 100.0 55.3 2,093 Residence Urban 57.4 19.5 13.3 9.7 0.0 0.0 0.1 100.0 90.2 3,936 Rural 28.7 19.4 21.1 30.6 0.0 0.2 0.0 100.0 69.2 14,818 Province Banteay Mean Chey 28.3 22.7 17.4 31.5 0.1 0.0 0.0 100.0 68.4 719 Kampong Cham 27.7 23.9 18.0 30.2 0.0 0.2 0.0 100.0 69.6 2,111 Kampong Chhnang 24.1 21.3 27.2 27.2 0.0 0.0 0.1 100.0 72.7 739 Kampong Speu 37.7 14.9 22.7 24.4 0.0 0.3 0.0 100.0 75.3 1,060 Kampong Thom 25.3 16.0 28.2 29.7 0.0 0.9 0.0 100.0 69.4 935 Kandal 41.3 25.0 12.5 21.2 0.0 0.0 0.0 100.0 78.8 1,920 Kratie 29.7 15.0 25.6 29.7 0.0 0.0 0.0 100.0 70.3 438 Phnom Penh 62.9 18.6 12.6 5.9 0.0 0.0 0.1 100.0 94.0 2,183 Prey Veng 24.3 19.5 23.3 32.9 0.0 0.0 0.0 100.0 67.1 1,341 Pursat 33.1 11.9 27.0 27.8 0.0 0.0 0.2 100.0 72.0 534 Siem Reap 25.8 16.2 29.4 28.5 0.0 0.1 0.0 100.0 71.4 1,233 Svay Rieng 29.6 11.7 18.8 39.9 0.0 0.0 0.0 100.0 60.1 753 Takeo 33.6 25.0 11.2 29.8 0.0 0.4 0.0 100.0 69.8 1,175 Otdar Mean Chey 25.7 9.5 31.8 32.6 0.0 0.4 0.0 100.0 67.0 252 Battambang/Pailin 37.8 17.0 23.5 21.6 0.0 0.2 0.0 100.0 78.2 1,320 Kampot/Kep 35.8 21.5 15.6 27.1 0.0 0.0 0.0 100.0 72.9 891 Preah Sihanouk/Koh Kong 35.2 13.8 21.4 29.5 0.0 0.0 0.0 100.0 70.5 439 Preah Vihear/Steung Treng 22.5 21.1 17.2 39.2 0.1 0.0 0.0 100.0 60.7 430 Mondol Kiri/Rattanak Kiri 16.1 19.4 10.7 53.7 0.1 0.0 0.0 100.0 46.2 281 Wealth quintile Lowest 10.4 16.7 22.8 49.8 0.0 0.2 0.0 100.0 49.9 3,388 Second 18.0 21.0 23.6 37.1 0.0 0.2 0.0 100.0 62.7 3,516 Middle 28.0 20.7 23.7 27.4 0.0 0.2 0.0 100.0 72.5 3,594 Fourth 43.7 21.4 17.9 16.8 0.0 0.0 0.0 100.0 83.1 3,827 Highest 64.3 17.4 11.6 6.6 0.0 0.1 0.1 100.0 93.2 4,428 Total 34.7 19.4 19.5 26.2 0.0 0.1 0.0 100.0 73.6 18,754 1 Refers to women who attended secondary school or higher and women who can read a whole sentence or part of a sentence Ninety percent of women residing in urban areas are literate, as compared with 69 percent of their rural counterparts. Similarly, urban men show higher rates of literacy than rural men (94 percent and 80 percent, respectively). Differences in literacy across provinces are marked, with the highest literacy rate among women in Phnom Penh (94 percent) and the lowest among women in Mondol Kiri/Rattanak Kiri (46 percent). Among men, literacy is highest in Battambang/Pailin (97 percent) and lowest in Kampong Cham (73 percent). Literacy levels increase along with wealth status among both women and men. For example, literacy levels almost double from 50 percent among women in the lowest wealth quintile to 93 percent among women in the highest wealth quintile. Women’s overall illiteracy rate has continued to decline since the 2000 CDHS (32 percent in 2000 versus 31 percent in 2005 and 26 percent in 2010). A large decrease in illiteracy has occurred among the 15-19 age group within the past 10 years. In 2000, 25 percent of women age 15-19 were illiterate, as compared with 16 percent in 2005 and 10 percent of women in the current survey. This reflects an increase in the level of educational attainment in this cohort since the previous two surveys (see Table 4.2.1). Changes over time in illiteracy rates among Cambodian men cannot be assessed because they were not measured in the previous surveys. 44 | Respondent Characteristics Table 4.3.2 Literacy: Men Percent distribution of men age 15-49 by level of schooling attended and level of literacy, and percentage literate, according to background characteristics, Cambodia 2010 Background characteristic Secondary school or higher No schooling or primary school Total Percent- age literate1 Number Can read a whole sentence Can read part of a sentence Cannot read at all Blind/ visually impaired Missing Age 15-19 66.6 8.8 13.9 10.8 0.0 0.0 100.0 89.2 1,863 20-24 57.4 11.1 18.4 12.9 0.0 0.2 100.0 86.9 1,402 25-29 47.8 13.9 21.2 17.0 0.0 0.0 100.0 83.0 1,377 30-34 42.6 14.5 19.9 22.9 0.1 0.1 100.0 77.0 1,014 35-39 45.7 12.2 20.9 21.2 0.0 0.0 100.0 78.8 835 40-44 50.1 14.7 16.9 18.2 0.2 0.0 100.0 81.7 956 45-49 26.3 15.9 32.3 25.4 0.1 0.0 100.0 74.5 792 Residence Urban 75.6 7.2 10.9 6.2 0.0 0.1 100.0 93.7 1,697 Rural 44.7 13.8 21.7 19.8 0.1 0.0 100.0 80.1 6,542 Province Banteay Mean Chey 45.3 28.1 6.9 19.0 0.2 0.5 100.0 80.3 275 Kampong Cham 44.1 9.4 19.2 27.4 0.0 0.0 100.0 72.6 990 Kampong Chhnang 38.4 27.0 20.7 14.0 0.0 0.0 100.0 86.0 341 Kampong Speu 56.3 15.1 18.0 10.3 0.2 0.0 100.0 89.5 468 Kampong Thom 35.3 23.3 15.6 25.8 0.0 0.0 100.0 74.2 390 Kandal 59.5 17.4 4.1 19.0 0.0 0.0 100.0 81.0 796 Kratie 39.8 7.3 30.6 22.0 0.0 0.3 100.0 77.7 191 Phnom Penh 82.3 2.8 9.7 5.3 0.0 0.0 100.0 94.7 945 Prey Veng 45.7 1.0 30.5 22.4 0.3 0.0 100.0 77.3 598 Pursat 43.1 13.9 20.8 22.2 0.0 0.0 100.0 77.8 256 Siem Reap 36.7 11.0 31.2 21.2 0.0 0.0 100.0 78.8 517 Svay Rieng 47.6 20.7 15.9 15.8 0.0 0.0 100.0 84.2 331 Takeo 56.1 19.3 5.8 18.7 0.0 0.0 100.0 81.3 525 Otdar Mean Chey 37.6 30.8 18.0 13.6 0.0 0.0 100.0 86.4 122 Battambang/Pailin 57.5 4.8 34.5 3.1 0.0 0.0 100.0 96.9 603 Kampot/Kep 48.2 7.1 26.7 17.6 0.0 0.4 100.0 82.0 362 Preah Sihanouk/Koh Kong 48.8 15.0 24.9 11.3 0.0 0.0 100.0 88.7 203 Preah Vihear/Steung Treng 28.4 2.1 52.9 16.6 0.0 0.0 100.0 83.4 193 Mondol Kiri/Rattanak Kiri 28.0 22.2 26.2 23.5 0.0 0.0 100.0 76.5 132 Wealth quintile Lowest 21.1 14.6 28.8 35.3 0.1 0.0 100.0 64.6 1,454 Second 34.7 15.8 26.5 22.8 0.1 0.1 100.0 77.0 1,544 Middle 45.6 14.0 22.7 17.7 0.0 0.0 100.0 82.3 1,637 Fourth 62.2 12.4 15.3 10.0 0.0 0.1 100.0 89.9 1,696 Highest 81.7 6.8 7.5 3.9 0.0 0.0 100.0 96.1 1,908 Total 51.0 12.5 19.4 17.0 0.0 0.0 100.0 82.9 8,239 1 Refers to men who attended secondary school or higher and men who can read a whole sentence or part of a sentence 4.3 ACCESS TO MASS MEDIA The 2010 CDHS collected information on the exposure of respondents to both broadcast and print media. This information is important because it provides an indication of the exposure of women to mass media that can be used to disseminate family planning, health, and other information. Access to mass media is relatively high in Cambodia. Table 4.4.1 shows that 68 percent of women have some weekly exposure to mass media. Watching television is the most common way of accessing the media: 58 percent of women watch television at least once a week. Listening to the radio is also common (one-third of women listen at least once a week), with newspapers being the least utilized form of media (12 percent read a newspaper at least once a week). There is no strong trend in access to the three types of media by age. The youngest group of women (15-19 years old) is most likely to access each form of media, particularly television and newspapers. However, women in the oldest age group are not always the least likely to access media. Women in the 45-49 age group are least likely to read a newspaper at least once a week (5 percent), and women ages 35-39 are least likely to listen to the radio (28 percent). Residence, by contrast, is associated with differences in media exposure. Urban women have better access to television and newspaper sources than their rural counterparts. The proportion of Respondent Characteristics | 45 women who listen to the radio is the same in urban and rural areas (34 percent). The greatest differential between residence and media usage is found in those who watch television at least once a week; urban women are 1.7 times more likely than rural women to watch television weekly (85 percent versus 50 percent). Media exposure among women varies by province as well. Women residing in Kratie have the greatest exposure to all three media (16 percent), followed by women in Preah Sihanouk/Koh Kong (14 percent). Women residing in Banteay Mean Chey are least likely to be exposed to the media (59 percent have no weekly access to media). Table 4.4.1 Exposure to mass media: Women Percentage of women age 15-49 who are exposed to specific media on a weekly basis, by background characteristics, Cambodia 2010 Background characteristic Reads a newspaper at least once a week Watches television at least once a week Listens to the radio at least once a week All three media at least once a week No media at least once a week Number Age 15-19 16.7 64.2 42.3 9.3 24.5 3,734 20-24 14.4 60.9 36.8 8.8 29.5 3,155 25-29 11.5 59.3 33.7 5.5 30.3 3,262 30-34 10.2 53.6 30.0 6.7 37.7 2,167 35-39 9.8 53.0 27.9 5.4 38.6 2,044 40-44 7.9 50.6 29.9 3.8 39.3 2,300 45-49 4.5 53.2 31.8 2.2 36.1 2,093 Residence Urban 15.9 84.8 33.9 9.1 11.8 3,936 Rural 10.3 50.2 34.3 5.6 38.0 14,818 Province Banteay Mean Chey 4.6 35.8 12.7 1.9 59.1 719 Kampong Cham 8.7 38.5 26.5 3.0 49.1 2,111 Kampong Chhnang 5.5 48.4 40.9 3.9 39.2 739 Kampong Speu 10.9 74.1 53.1 7.8 17.8 1,060 Kampong Thom 21.9 54.4 42.3 12.4 31.1 935 Kandal 11.2 75.2 41.3 8.8 17.7 1,920 Kratie 24.1 47.7 46.2 16.2 36.2 438 Phnom Penh 11.8 92.9 28.0 5.6 6.1 2,183 Prey Veng 8.6 69.5 32.9 5.4 23.7 1,341 Pursat 15.5 67.2 45.4 11.4 23.3 534 Siem Reap 6.4 39.2 31.2 4.4 51.9 1,233 Svay Rieng 6.0 46.2 18.9 2.2 48.5 753 Takeo 16.1 44.0 31.0 9.2 44.9 1,175 Otdar Mean Chey 11.9 31.5 25.8 3.0 52.7 252 Battambang/Pailin 15.2 65.1 48.3 8.7 20.1 1,320 Kampot/Kep 12.9 31.8 23.5 1.1 46.3 891 Preah Sihanouk/Koh Kong 20.7 67.7 40.4 13.9 22.5 439 Preah Vihear/Steung Treng 3.8 26.5 32.8 1.4 51.5 430 Mondol Kiri/Rattanak Kiri 10.2 35.8 33.4 4.3 46.4 281 Education No schooling 0.3 35.7 20.9 0.2 55.5 2,973 Primary 7.4 52.0 32.0 3.7 36.9 9,265 Secondary and higher 22.3 75.2 43.5 12.8 15.8 6,516 Wealth quintile Lowest 4.1 25.2 22.5 1.6 61.7 3,388 Second 6.9 41.5 30.2 3.1 44.9 3,516 Middle 9.0 53.5 35.9 4.7 33.5 3,594 Fourth 14.3 70.2 41.3 8.5 21.3 3,827 Highest 20.2 87.1 38.9 12.0 9.2 4,428 Total 11.5 57.5 34.2 6.3 32.5 18,754 Media exposure increases with both the educational level and wealth quintile of the respondent. For example, 87 percent of women in the highest wealth quintile watch television at least once per week, as compared with 25 percent of women in the lowest wealth quintile. Similarly, 75 percent of women with a secondary education or higher and 36 percent of women with no schooling watch television once a week. In addition, 22 percent of women with a secondary education or higher read a newspaper at least once a week, as compared with 7 percent of women with a primary school education. 46 | Respondent Characteristics Table 4.4.2 Exposure to mass media: Men Percentage of men age 15-49 who are exposed to specific media on a weekly basis, by background characteristics, Cambodia 2010 Background characteristic Reads a newspaper at least once a week Watches television at least once a week Listens to the radio at least once a week All three media at least once a week No media at least once a week Number Age 15-19 18.4 61.7 44.2 10.1 27.3 1,863 20-24 22.5 57.6 47.3 12.5 28.0 1,402 25-29 17.6 55.0 42.0 8.0 31.1 1,377 30-34 15.1 56.6 41.1 9.3 32.7 1,014 35-39 16.2 52.0 40.7 9.1 34.7 835 40-44 18.2 53.3 44.7 10.4 32.0 956 45-49 13.0 55.5 50.0 8.0 29.6 792 Residence Urban 46.3 66.8 50.2 19.4 12.6 1,697 Rural 10.4 54.1 42.7 7.3 34.8 6,542 Province Banteay Mean Chey 23.5 91.7 68.7 19.7 6.0 275 Kampong Cham 1.1 9.4 11.1 0.3 82.5 990 Kampong Chhnang 11.7 53.8 47.9 8.1 31.5 341 Kampong Speu 11.9 66.3 54.6 9.1 19.4 468 Kampong Thom 9.0 81.0 64.5 5.9 7.6 390 Kandal 13.0 61.3 44.8 9.2 29.0 796 Kratie 12.3 32.7 43.5 6.1 39.5 191 Phnom Penh 60.0 55.2 44.5 15.2 10.1 945 Prey Veng 14.0 93.5 70.5 11.6 3.7 598 Pursat 7.2 53.8 28.9 4.8 35.9 256 Siem Reap 6.4 46.0 26.4 4.1 45.7 517 Svay Rieng 16.2 74.4 51.2 9.7 14.3 331 Takeo 2.3 44.2 25.6 1.2 44.0 525 Otdar Mean Chey 23.5 49.0 61.9 14.4 21.5 122 Battambang/Pailin 34.8 86.0 77.1 30.4 7.6 603 Kampot/Kep 8.8 38.1 24.4 2.3 46.0 362 Preah Sihanouk/Koh Kong 6.6 66.2 23.0 4.0 31.0 203 Preah Vihear/Steung Treng 38.4 83.2 90.6 36.0 6.3 193 Mondol Kiri/Rattanak Kiri 4.6 15.0 21.5 0.7 65.0 132 Education No schooling 0.5 36.1 26.4 0.5 54.6 641 Primary 6.1 51.3 38.9 4.1 37.6 3,394 Secondary and higher 29.9 64.2 51.2 15.8 20.6 4,205 Wealth quintile Lowest 3.9 32.9 30.7 2.4 54.3 1,454 Second 6.3 49.4 41.4 3.6 35.7 1,544 Middle 8.6 56.1 44.4 6.0 33.9 1,637 Fourth 16.8 68.3 48.8 12.4 23.7 1,696 Highest 46.4 70.9 52.5 21.4 10.1 1,908 Total 17.8 56.7 44.2 9.8 30.2 8,239 A comparison of Tables 4.4.1 and 4.4.2 shows that women and men have relatively the same access to all three media at least once per week (6 percent of women versus 10 percent of men). The slight difference between the levels of exposure can be explained by greater access of men to printed material: 18 percent of men read a newspaper at least once per week, as compared with 12 percent of women. In general, rates of media utilization have decreased since 2005, when nearly four in five women were exposed to some source of mass media. Specifically, the greatest difference between media exposure in the 2005 CDHS and the 2010 CDHS was found among women who listened to the radio at least once a week. In 2005, half of the women interviewed listened to the radio once a week, whereas only 34 percent of women in 2010 reported listening to the radio on a weekly basis. There was a similar decrease in men’s exposure to mass media between the 2005 CDHS and the 2010 CDHS. In 2005, only 18 percent of men were not exposed to a mass media source on a weekly basis, whereas this proportion increased to 30 percent in 2010. Respondent Characteristics | 47 4.4 EMPLOYMENT 4.4.1 Employment Status The 2010 CDHS included a number of questions regarding respondents’ employment status, including whether they were working in the seven days preceding the survey and, if not, whether they had worked in the 12 months before the survey. Employment status results for women and men are presented in Tables 4.5.1 and 4.5.2. At the time of the survey, 70 percent of women were currently employed, and an additional 11 percent were not employed but had worked sometime during the preceding 12 months (Figure 4.1). The proportion of women currently employed generally increases with increasing age. A similar pattern is observed for men’s employment status. Women who are divorced, separated, or widowed are more likely to be employed than other women. Among men, in contrast, those who are married are more likely to be employed than those who are divorced, separated, or widowed and those who have never married. Figure 4.1 Women’s Employment Status in the Past 12 Months CDHS 2010 Currently employed 70.2% Not currently employed 10.6% 19.2% Not employed in the 12 months preceding the survey Urban and rural women are roughly equally likely to be currently employed (66 percent versus 71 percent). However, rural women are almost four times more likely than urban women to have worked in the past 12 months (13 percent versus 3 percent). As a result, urban women are more likely than rural women not to have been employed at all in the 12 months preceding the survey (31 percent versus 16 percent). Women in Pursat are most likely to be currently employed (90 percent). In contrast, women in Phnom Penh and Kratie are most likely not to have been employed at any time in the 12 months preceding the survey (32 percent and 30 percent, respectively). Women with a secondary education or higher and those in the highest wealth quintile are most likely to have not worked in the 12 months preceding the survey. The proportion of men currently employed is somewhat higher than that of women (81 percent versus 70 percent). Employment status differentials for men are similar to those for women. As with women, urban men are more likely not to have worked in the 12 months preceding the survey, as are men with a secondary education or higher and those in the highest wealth quintile. The proportion of men currently employed ranges from a low of 65 percent in Kampot/Kep to a high of 97 percent in Preah Vihear/Steung Treng. Kampong Chhnang has the highest percentage of men who are not currently employed but have worked at some point in the previous 12 months, and Phnom Penh has the lowest. 48 | Respondent Characteristics The level of female employment in 2010 is similar to that in 2005; however, there is a difference between the two surveys in the proportions of women who were not employed at the time of data collection but had worked sometime during the preceding 12 months. In 2005, 15 percent of women in Cambodia were not employed at the time of the interview but had been employed in the previous 12 months, whereas this proportion decreased to 11 percent of women in 2010. Levels of employment for men have not changed since 2005. Table 4.5.1 Employment status: Women Percent distribution of women age 15-49 by employment status, according to background characteristics, Cambodia 2010 Background characteristic Employed in the 12 months preceding the survey Not employed in the 12 months preceding the survey Missing/ don’t know Total Number of women Currently employed1 Not currently employed Age 15-19 51.7 7.2 41.0 0.0 100.0 3,734 20-24 69.2 11.2 19.6 0.0 100.0 3,155 25-29 73.3 13.0 13.7 0.0 100.0 3,262 30-34 76.1 10.7 13.2 0.0 100.0 2,167 35-39 77.8 10.7 11.4 0.1 100.0 2,044 40-44 78.4 11.0 10.6 0.0 100.0 2,300 45-49 77.3 11.0 11.7 0.0 100.0 2,093 Marital status Never married 63.2 5.8 31.0 0.0 100.0 5,783 Married or living together 72.5 12.9 14.5 0.0 100.0 11,626 Divorced/separated/widowed 80.3 10.4 9.3 0.0 100.0 1,345 Number of living children 0 64.5 7.1 28.4 0.0 100.0 6,810 1-2 71.8 12.6 15.6 0.0 100.0 6,107 3-4 75.4 11.8 12.7 0.1 100.0 3,965 5+ 74.6 13.6 11.8 0.0 100.0 1,871 Residence Urban 66.2 3.2 30.6 0.0 100.0 3,936 Rural 71.2 12.5 16.2 0.0 100.0 14,818 Province Banteay Mean Chey 70.3 9.5 20.1 0.0 100.0 719 Kampong Cham 74.7 12.6 12.7 0.1 100.0 2,111 Kampong Chhnang 70.6 16.0 13.4 0.0 100.0 739 Kampong Speu 66.5 20.3 13.2 0.0 100.0 1,060 Kampong Thom 77.7 13.2 9.1 0.0 100.0 935 Kandal 67.8 7.8 24.5 0.0 100.0 1,920 Kratie 63.5 6.6 29.9 0.0 100.0 438 Phnom Penh 66.6 1.3 32.1 0.0 100.0 2,183 Prey Veng 68.5 19.4 12.2 0.0 100.0 1,341 Pursat 89.6 3.1 7.3 0.0 100.0 534 Siem Reap 64.5 13.5 22.1 0.0 100.0 1,233 Svay Rieng 64.2 24.8 10.9 0.1 100.0 753 Takeo 77.7 5.7 16.6 0.0 100.0 1,175 Otdar Mean Chey 68.2 24.5 7.4 0.0 100.0 252 Battambang/Pailin 64.2 7.0 28.7 0.0 100.0 1,320 Kampot/Kep 73.9 5.2 20.9 0.0 100.0 891 Preah Sihanouk/Koh Kong 60.2 11.0 28.7 0.0 100.0 439 Preah Vihear/Steung Treng 79.8 5.9 14.2 0.0 100.0 430 Mondol Kiri/Rattanak Kiri 78.9 3.8 17.3 0.0 100.0 281 Education No schooling 75.2 12.9 11.9 0.0 100.0 2,973 Primary 74.0 12.7 13.3 0.0 100.0 9,265 Secondary and higher 62.5 6.5 31.0 0.0 100.0 6,516 Wealth quintile Lowest 71.5 16.3 12.2 0.0 100.0 3,388 Second 72.3 14.5 13.2 0.0 100.0 3,516 Middle 71.1 12.8 16.0 0.1 100.0 3,594 Fourth 68.8 8.8 22.4 0.0 100.0 3,827 Highest 67.9 2.7 29.4 0.0 100.0 4,428 Total 70.2 10.6 19.2 0.0 100.0 18,754 1 “Currently employed” is defined as having done work in the past seven days. Includes persons who did not work in the past seven days but who are regularly employed and were absent from work for leave, illness, vacation, or any other such reason. Respondent Characteristics | 49 Table 4.5.2 Employment status: Men Percent distribution of men age 15-49 by employment status, according to background characteristics, Cambodia 2010 Background characteristic Employed in the 12 months preceding the survey Not employed in the 12 months preceding the survey Total Number of men Currently employed1 Not currently employed Age 15-19 50.3 8.1 41.6 100.0 1,863 20-24 78.5 5.4 16.0 100.0 1,402 25-29 91.7 5.4 2.9 100.0 1,377 30-34 95.0 4.8 0.2 100.0 1,014 35-39 94.6 4.5 0.9 100.0 835 40-44 93.9 4.5 1.6 100.0 956 45-49 92.4 6.0 1.6 100.0 792 Marital status Never married 60.9 7.1 32.1 100.0 3,181 Married or living together 94.1 4.9 0.9 100.0 4,852 Divorced/separated/widowed 87.9 6.7 5.4 100.0 206 Number of living children 0 64.8 6.9 28.3 100.0 3,656 1-2 94.7 4.4 0.9 100.0 2,338 3-4 93.7 5.7 0.6 100.0 1,539 5+ 93.2 4.9 1.8 100.0 706 Residence Urban 75.3 1.8 22.8 100.0 1,697 Rural 82.6 6.8 10.5 100.0 6,542 Province Banteay Mean Chey 85.9 4.0 10.0 100.0 275 Kampong Cham 82.1 0.7 17.2 100.0 990 Kampong Chhnang 69.2 20.8 10.0 100.0 341 Kampong Speu 82.9 1.1 16.0 100.0 468 Kampong Thom 87.6 8.8 3.6 100.0 390 Kandal 85.4 1.6 13.0 100.0 796 Kratie 94.7 4.3 1.0 100.0 191 Phnom Penh 73.0 0.0 27.0 100.0 945 Prey Veng 96.5 1.9 1.5 100.0 598 Pursat 93.1 0.6 6.3 100.0 256 Siem Reap 79.6 12.6 7.8 100.0 517 Svay Rieng 66.7 20.4 12.9 100.0 331 Takeo 73.1 19.5 7.4 100.0 525 Otdar Mean Chey 89.2 5.1 5.6 100.0 122 Battambang/Pailin 80.0 1.5 18.5 100.0 603 Kampot/Kep 65.4 15.1 19.5 100.0 362 Preah Sihanouk/Koh Kong 75.0 0.4 24.6 100.0 203 Preah Vihear/Steung Treng 97.4 1.1 1.5 100.0 193 Mondol Kiri/Rattanak Kiri 89.0 6.4 4.6 100.0 132 Education No schooling 91.9 6.3 1.8 100.0 641 Primary 89.4 6.3 4.2 100.0 3,394 Secondary and higher 72.8 5.3 21.9 100.0 4,205 Wealth quintile Lowest 86.4 7.5 6.0 100.0 1,454 Second 83.3 9.2 7.5 100.0 1,544 Middle 83.8 7.3 8.8 100.0 1,637 Fourth 78.2 4.4 17.4 100.0 1,696 Highest 75.6 1.7 22.7 100.0 1,908 Total 81.1 5.8 13.1 100.0 8,239 1 “Currently employed” is defined as having done work in the past seven days. Includes persons who did not work in the past seven days but who are regularly employed and were absent from work for leave, illness, vacation, or any other such reason. 50 | Respondent Characteristics 4.4.2 Occupation Respondents who were currently employed or had worked in the 12 months preceding the survey were further asked to specify their occupation. Tables 4.6.1 and 4.6.2 show data on occupation of employed women and men, respectively. Most employed persons are engaged in the agricultural sector, including 56 percent of women and 59 percent of men. More than one-fifth of women are employed in sales and services, along with 10 percent of men. Fifteen percent of women are employed in skilled manual labor and 2 percent are employed in unskilled manual labor. Men are more likely than women to be employed in skilled manual labor, with 21 percent engaged in this type of occupation. Four percent of women are employed in professional, technical, and managerial fields. Table 4.6.1 Occupation: Women Percent distribution of women age 15-49 employed in the 12 months preceding the survey by occupation, according to background characteristics, Cambodia 2010 Background characteristic Professional/ technical/ managerial Clerical Sales and services Skilled manual Unskilled manual Agri- culture Missing Total Number of women Age 15-19 1.9 0.9 15.9 24.5 3.5 53.2 0.1 100.0 2,201 20-24 6.4 1.4 22.3 21.2 2.0 46.6 0.1 100.0 2,535 25-29 6.6 1.4 23.4 16.0 1.7 50.8 0.1 100.0 2,814 30-34 2.9 0.8 24.0 11.9 1.4 59.0 0.0 100.0 1,881 35-39 3.7 0.6 23.0 9.2 1.6 61.8 0.1 100.0 1,808 40-44 4.2 0.5 22.5 8.3 1.4 63.1 0.0 100.0 2,055 45-49 2.7 0.3 23.5 6.6 1.7 65.1 0.0 100.0 1,848 Marital status Never married 6.5 1.5 19.2 23.8 3.9 45.0 0.1 100.0 3,989 Married or living together 3.5 0.6 22.9 11.0 1.1 60.8 0.1 100.0 9,933 Divorced/separated/widowed 3.1 1.2 24.4 13.1 2.5 55.6 0.0 100.0 1,220 Number of living children 0 6.4 1.4 19.8 22.9 3.6 45.9 0.1 100.0 4,879 1-2 4.3 1.1 24.5 13.7 1.2 55.0 0.1 100.0 5,152 3-4 2.7 0.2 24.2 8.1 1.3 63.5 0.1 100.0 3,460 5+ 1.3 0.1 16.6 6.3 0.8 75.0 0.0 100.0 1,651 Residence Urban 13.4 2.8 45.5 23.6 6.6 8.1 0.1 100.0 2,733 Rural 2.3 0.5 16.9 12.6 0.9 66.8 0.1 100.0 12,409 Province Banteay Mean Chey 3.5 0.7 25.3 12.5 2.3 55.7 0.0 100.0 574 Kampong Cham 2.4 0.1 18.1 8.4 0.8 70.3 0.0 100.0 1,842 Kampong Chhnang 1.1 0.3 14.2 12.4 0.5 71.5 0.0 100.0 640 Kampong Speu 1.2 0.4 17.1 25.9 0.6 54.8 0.0 100.0 920 Kampong Thom 2.9 0.6 20.2 6.8 0.8 68.6 0.0 100.0 849 Kandal 3.5 0.6 26.6 38.3 3.0 28.1 0.0 100.0 1,450 Kratie 4.1 0.4 21.0 5.1 0.8 68.5 0.1 100.0 307 Phnom Penh 17.1 3.2 40.1 30.8 6.8 1.8 0.1 100.0 1,483 Prey Veng 1.6 0.3 15.8 5.4 0.5 76.3 0.1 100.0 1,178 Pursat 4.1 0.0 17.5 3.6 0.6 74.3 0.0 100.0 495 Siem Reap 4.1 0.9 22.0 8.8 3.6 60.4 0.2 100.0 961 Svay Rieng 1.7 0.8 11.1 8.6 0.3 77.4 0.0 100.0 670 Takeo 2.9 0.2 22.4 16.9 0.8 56.8 0.0 100.0 981 Otdar Mean Chey 2.1 0.8 18.0 4.8 1.0 73.4 0.0 100.0 233 Battambang/Pailin 5.3 2.7 23.8 8.3 3.3 56.2 0.5 100.0 941 Kampot/Kep 3.2 1.2 17.9 5.4 0.8 71.3 0.1 100.0 705 Preah Sihanouk/Koh Kong 4.0 1.5 47.5 13.0 2.8 31.3 0.0 100.0 313 Preah Vihear/Steung Treng 2.0 0.4 12.1 2.4 0.8 82.1 0.2 100.0 369 Mondol Kiri/Rattanak Kiri 2.9 0.4 14.1 5.2 0.5 77.0 0.0 100.0 233 Education No schooling 0.5 0.0 13.5 6.4 1.8 77.7 0.2 100.0 2,620 Primary 1.0 0.2 20.0 13.6 2.0 63.2 0.0 100.0 8,029 Secondary and higher 12.4 2.6 30.7 21.1 1.9 31.1 0.1 100.0 4,493 Wealth quintile Lowest 0.1 0.0 5.9 6.9 1.2 85.8 0.1 100.0 2,976 Second 0.6 0.0 7.8 10.5 0.7 80.4 0.0 100.0 3,053 Middle 2.0 0.1 14.2 14.1 0.7 68.8 0.1 100.0 3,017 Fourth 3.1 0.8 30.7 21.9 1.8 41.6 0.1 100.0 2,971 Highest 15.2 3.5 50.7 19.4 5.1 6.0 0.1 100.0 3,125 Total 4.3 0.9 22.1 14.6 1.9 56.2 0.1 100.0 15,142 Respondent Characteristics | 51 Table 4.6.2 Occupation: Men Percent distribution of men age 15-49 employed in the 12 months preceding the survey by occupation, according to background characteristics, Cambodia 2010 Background characteristic Professional/ technical/ managerial Clerical Sales and services Skilled manual Unskilled manual Agri- culture Missing Total Number of men Age 15-19 1.9 0.8 4.8 18.2 1.7 72.6 0.1 100.0 1,088 20-24 5.0 0.7 10.1 28.0 1.1 55.0 0.0 100.0 1,178 25-29 8.9 1.9 9.3 25.9 0.6 53.4 0.0 100.0 1,337 30-34 7.9 1.7 8.9 21.1 0.9 59.4 0.0 100.0 1,013 35-39 9.9 2.7 11.8 18.6 0.3 56.7 0.0 100.0 827 40-44 9.6 2.4 13.9 18.5 1.3 54.2 0.0 100.0 940 45-49 6.6 1.2 13.1 13.9 1.0 64.2 0.0 100.0 779 Marital status Never married 6.1 1.8 7.9 24.1 1.4 58.7 0.0 100.0 2,161 Married or living together 7.6 1.5 10.9 19.2 0.8 59.9 0.0 100.0 4,806 Divorced/separated/widowed 3.6 2.0 10.1 40.3 0.1 43.8 0.1 100.0 194 Number of living children 0 6.6 1.8 8.6 24.1 1.2 57.7 0.0 100.0 2,621 1-2 7.9 1.9 12.2 22.3 0.8 54.9 0.0 100.0 2,318 3-4 6.8 1.5 11.1 19.2 0.6 60.8 0.0 100.0 1,530 5+ 6.3 0.3 5.7 11.5 1.4 74.8 0.0 100.0 693 Residence Urban 21.2 6.1 21.6 38.2 1.8 11.2 0.0 100.0 1,310 Rural 3.9 0.6 7.4 17.5 0.8 69.8 0.0 100.0 5,852 Province Banteay Mean Chey 6.5 0.9 11.5 21.5 1.7 57.9 0.0 100.0 247 Kampong Cham 4.0 0.1 4.6 19.8 0.8 70.6 0.0 100.0 820 Kampong Chhnang 2.3 0.9 6.1 13.7 0.2 76.8 0.0 100.0 307 Kampong Speu 3.1 1.2 8.7 20.8 0.8 65.5 0.0 100.0 393 Kampong Thom 4.4 0.1 10.3 16.6 0.6 68.0 0.0 100.0 376 Kandal 8.6 0.4 11.0 34.0 2.6 43.3 0.0 100.0 693 Kratie 4.1 0.1 11.8 19.7 0.7 63.6 0.0 100.0 190 Phnom Penh 27.5 8.4 21.6 38.2 1.4 2.9 0.0 100.0 690 Prey Veng 2.7 0.8 7.1 9.1 0.8 79.5 0.0 100.0 589 Pursat 6.8 0.1 4.1 16.4 0.2 72.4 0.0 100.0 240 Siem Reap 6.3 1.6 9.9 20.7 1.1 60.2 0.0 100.0 476 Svay Rieng 5.9 0.7 6.4 11.5 0.3 75.3 0.0 100.0 288 Takeo 3.5 0.4 10.7 21.9 0.9 62.5 0.0 100.0 486 Otdar Mean Chey 3.1 2.2 8.7 10.0 0.3 75.7 0.0 100.0 115 Battambang/Pailin 4.7 2.1 12.5 19.3 0.5 60.9 0.0 100.0 492 Kampot/Kep 4.2 1.7 8.1 25.6 1.0 59.3 0.0 100.0 292 Preah Sihanouk/Koh Kong 10.2 2.7 15.4 28.4 1.0 42.2 0.0 100.0 153 Preah Vihear/Steung Treng 2.3 0.6 5.6 7.7 0.7 83.0 0.1 100.0 190 Mondol Kiri/Rattanak Kiri 5.1 1.9 9.5 10.7 0.1 71.6 1.0 100.0 126 Education No schooling 0.5 0.0 3.2 12.9 0.4 83.1 0.0 100.0 629 Primary 2.2 0.1 6.6 18.7 1.1 71.3 0.0 100.0 3,250 Secondary and higher 13.0 3.4 14.7 25.4 1.0 42.5 0.0 100.0 3,283 Wealth quintile Lowest 0.9 0.0 1.4 11.2 1.2 85.3 0.0 100.0 1,366 Second 2.1 0.1 3.3 13.9 0.5 80.1 0.0 100.0 1,428 Middle 4.0 0.0 6.3 15.8 0.8 73.1 0.0 100.0 1,493 Fourth 7.0 1.1 10.8 31.8 1.4 47.9 0.0 100.0 1,400 Highest 20.6 6.5 27.6 33.2 1.1 10.9 0.0 100.0 1,474 Total 7.0 1.6 10.0 21.3 1.0 59.1 0.0 100.0 7,162 Residence has an effect on type of occupation. Women and men in urban areas are more likely than those in rural areas to hold jobs in the professional, technical, and managerial; clerical; and sales and services sectors. In contrast, rural women and men are more likely than those in urban areas to be engaged in agricultural work. Those with lower levels of education and those in lower wealth quintiles are also more likely to work in agriculture. For example, 78 percent of women with no schooling work in the field of agriculture, whereas only 31 percent of women with a secondary education or higher work in agriculture. 52 | Respondent Characteristics 4.4.3 Earnings, Employers, and Continuity of Employment Table 4.7 shows the percent distribution of employed women by type of earnings and employment characteristics. Because all of the employment variables in the table are strongly influenced by the sector in which a woman is employed, data are grouped according to agricultural or nonagricultural work. Table 4.7 Type of employment: Women Percent distribution of women age 15-49 employed in the 12 months preceding the survey by type of earnings, type of employer, and continuity of employment, according to type of employment (agricultural or nonagricultural), Cambodia 2010 Employment characteristic Agricultural work Nonagricultural work Missing Total Type of earnings Cash only 18.0 92.7 * 50.7 Cash and in-kind 38.8 3.4 * 23.3 In-kind only 36.2 0.5 * 20.6 Not paid 6.9 3.5 * 5.4 Missing 0.0 0.0 * 0.0 Total 100.0 100.0 100.0 100.0 Type of employer Employed by family member 16.3 8.1 * 12.7 Employed by non-family member 10.5 40.5 * 23.7 Self-employed 73.2 51.4 * 63.6 Missing 0.0 0.0 * 0.0 Total 100.0 100.0 100.0 100.0 Continuity of employment All year 11.5 87.1 * 44.6 Seasonal 86.2 8.7 * 52.2 Occasional 2.3 4.2 * 3.1 Missing 0.0 0.0 * 0.0 Total 100.0 100.0 100.0 100.0 Number of women employed during the past 12 months 8,507 6,623 12 15,142 Note: Total includes

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