Liberia Demographic and Health Survey 2019-20

Publication date: 2021

Liberia Demographic and Health Survey 2019-20 Liberia 2019-20 D em ographic and H ealth S urvey Liberia Demographic and Health Survey 2019-20 Liberia Institute of Statistics and Geo-Information Services (LISGIS) Monrovia, Liberia Ministry of Health Monrovia, Liberia The DHS Program ICF Rockville, Maryland, USA April 2021 The 2019-20 Liberia Demographic and Health Survey (2019-20 LDHS) was implemented by the Liberia Institute of Statistics and Geo-Information Services (LISGIS). Data collection lasted from October 2019 to February 2020. Funding for the 2019-20 LDHS was provided by the United States Agency for International Development (USAID). Additional funding was provided by the United States Centers for Disease Control and Prevention (CDC), the United Nations Population Fund (UNFPA), UNICEF, the Embassy of Ireland (Irish Aid), the United Nations Development Programme (UNDP), the World Health Organization (WHO), UN Women, and the Global Alliance for Vaccine and Immunization (GAVI). ICF provided technical assistance through The DHS Program, a USAID-funded project providing support and technical assistance in the implementation of population and health surveys in countries worldwide. Additional information about the 2019-20 LDHS may be obtained from the Liberia Institute of Statistics and Geo-Information Services (LISGIS), Statistics House, Capitol Hill, P.O. Box 629, Monrovia, Liberia; telephone: +231 886 560 435/+231 770 129 883; internet: www.lisgis.net. Information about The DHS Program may be obtained from ICF, 530 Gaither Road, Suite 500, Rockville, MD 20850, USA; telephone: +1-301-407-6500; fax: +1-301-407-6501; email: info@DHSprogram.com; internet: www.DHSprogram.com. Suggested citation: Liberia Institute of Statistics and Geo-Information Services (LISGIS), Ministry of Health [Liberia], and ICF. 2021. Liberia Demographic and Health Survey 2019-20. Monrovia, Liberia and Rockville, Maryland, USA: Liberia Institute of Statistics and Geo-Information Services (LISGIS), Ministry of Health, and ICF. Contents • iii CONTENTS TABLES AND FIGURES . ix FOREWORD . xix ACRONYMS AND ABBREVIATIONS . xxi READING AND UNDERSTANDING TABLES FROM THE 2019-20 LDHS . xxv SUSTAINABLE DEVELOPMENT GOALS INDICATORS . xxxiii MAP OF LIBERIA . xxxiv 1 INTRODUCTION AND SURVEY METHODOLOGY . 1 1.1 Survey Objectives . 1 1.2 Sample Design . 2 1.3 Questionnaires . 3 1.4 Anthropometry, Anemia, HIV, Hepatitis, and EVD Testing . 4 1.4.1 Anthropometric Measurements . 5 1.4.2 Anemia Testing . 5 1.4.3 HIV Testing . 5 1.5 Pretest . 6 1.6 Training of Field Staff . 7 1.7 Fieldwork . 8 1.8 Data Processing . 9 1.9 Response Rates . 9 2 HOUSING CHARACTERISTICS AND HOUSEHOLD POPULATION . 11 2.1 Drinking Water Sources and Treatment . 11 2.2 Sanitation . 13 2.3 Exposure to Smoke inside the Home . 13 2.4 Household Wealth . 14 2.4.1 Household Durable Goods . 14 2.4.2 Wealth Index . 14 2.5 Handwashing . 15 2.6 Household Population and Composition . 15 2.7 Children’s Living Arrangements and Parental Survival . 16 2.8 Birth Registration . 16 2.9 Education . 17 2.9.1 Educational Attainment . 17 2.9.2 School Attendance . 18 3 CHARACTERISTICS OF RESPONDENTS . 37 3.1 Basic Characteristics of Survey Respondents . 37 3.2 Education and Literacy . 38 3.3 Mass Media Exposure . 39 3.4 Employment . 40 3.5 Occupation . 41 3.6 Health Insurance Coverage . 42 3.7 Tobacco Use . 42 3.8 Knowledge of Tuberculosis . 43 3.9 Possession of Identity Documents . 43 iv • Contents 4 MARRIAGE AND SEXUAL ACTIVITY . 69 4.1 Marital Status . 69 4.2 Polygyny . 70 4.3 Age at First Marriage . 71 4.4 Age at First Sexual Intercourse . 72 4.5 Recent Sexual Activity . 72 5 FERTILITY . 83 5.1 Current Fertility . 83 5.2 Children Ever Born and Living . 84 5.3 Birth Intervals . 85 5.4 Insusceptibility to Pregnancy . 86 5.5 Menopause . 87 5.6 Age at First Birth . 87 5.7 Teenage Childbearing . 88 5.8 Sexual and Reproductive Behaviors before Age 15 . 88 6 FERTILITY PREFERENCES . 101 6.1 Desire for Another Child . 101 6.2 Ideal Family Size . 102 6.3 Fertility Planning Status . 103 6.4 Wanted Fertility Rates . 104 7 FAMILY PLANNING . 113 7.1 Contraceptive Knowledge and Use . 114 7.2 Source of Modern Contraceptive Methods . 116 7.3 Informed Choice . 116 7.4 Discontinuation of Contraceptives . 117 7.5 Demand for Family Planning . 118 7.5.1 Decision Making about Family Planning . 119 7.5.2 Future Use of Contraception . 119 7.5.3 Exposure to Family Planning Messages in the Media . 119 7.6 Contact of Nonusers with Family Planning Providers . 119 8 INFANT AND CHILD MORTALITY . 137 8.1 Infant and Child Mortality . 138 8.2 Biodemographic Risk Factors . 139 8.3 Perinatal Mortality . 139 8.4 High-Risk Fertility Behavior . 140 9 MATERNAL HEALTH CARE . 145 9.1 Prenatal Care Coverage and Content . 146 9.1.1 Skilled Providers . 146 9.1.2 Timing and Number of Prenatal Care Visits . 146 9.1.3 Reasons for Lack of Prenatal Care . 146 9.2 Components of Prenatal Care Visits . 147 9.3 Protection against Neonatal Tetanus . 147 Contents • v 9.4 Delivery Services . 148 9.4.1 Institutional Deliveries . 148 9.4.2 Skilled Assistance during Delivery . 149 9.4.3 Skin-to-skin Contact Immediately after Birth . 150 9.4.4 Delivery by Cesarean . 150 9.5 Postnatal Care . 151 9.5.1 Postnatal Health Check for Mothers . 151 9.5.2 Postnatal Health Check for Newborns . 151 9.5.3 Cord Cutting . 152 9.5.4 Cord Care . 152 9.6 Problems in Accessing Health Care . 153 10 CHILD HEALTH . 173 10.1 Birth Weight . 173 10.2 Vaccination of Children . 174 10.3 Symptoms of Acute Respiratory Infection . 177 10.4 Fever . 177 10.5 Diarrheal Disease . 178 10.5.1 Prevalence of Diarrhea and Treatment-seeking Behavior . 178 10.5.2 Feeding Practices . 178 10.5.3 Oral Rehydration Therapy and Other Treatments . 179 10.5.4 Knowledge of ORS Packets . 180 10.6 Treatment of Childhood Illness . 180 10.7 Disposal of Children’s Stools . 180 11 NUTRITION OF CHILDREN AND WOMEN . 197 11.1 Nutritional Status of Children . 197 11.1.1 Anthropometry Training and Data Collection . 199 11.1.2 Levels of Child Malnutrition . 199 11.2 Infant and Young Child Feeding Practices . 201 11.2.1 Early Initiation of Breastfeeding . 201 11.2.2 Exclusive Breastfeeding . 201 11.2.3 Bottle Feeding . 203 11.2.4 Introduction of Complementary Foods . 203 11.2.5 Minimum Dietary Diversity, Minimum Meal Frequency, and Minimum Acceptable Diet . 203 11.3 Anemia Prevalence in Children . 205 11.4 Presence of Iodized Salt in Households . 206 11.5 Micronutrient Intake and Supplementation among Children . 206 11.6 Women’s Nutritional Status . 208 11.7 Anemia Prevalence in Women . 209 11.8 Micronutrient Supplementation and Deworming during Pregnancy . 210 12 MALARIA . 229 12.1 Ownership of Insecticide-treated Nets . 229 12.2 Household Access and Use of ITNs . 231 12.3 Use of ITNs by Children and Pregnant Women . 233 12.4 Malaria in Pregnancy . 233 12.5 Case Management of Malaria in Children . 234 12.6 Prevalence of Low Hemoglobin in Children . 236 vi • Contents 13 HIV/AIDS-RELATED KNOWLEDGE, ATTITUDES, AND BEHAVIOR . 253 13.1 HIV Knowledge, Transmission, and Prevention Methods . 254 13.2 Knowledge about Mother-to-Child Transmission . 255 13.3 Discriminatory Attitudes towards People Living with HIV . 255 13.4 Multiple Sexual Partners . 256 13.5 Paid Sex . 257 13.6 Coverage of HIV Testing Services . 258 13.6.1 Awareness of HIV Testing Services and Experience with HIV Testing . 258 13.6.2 HIV Testing of Pregnant Women . 259 13.6.3 HIV Self-testing . 260 13.7 Self-reporting of Sexually Transmitted Infections . 260 13.8 HIV/AIDS-related Knowledge and Behavior among Young People . 261 13.8.1 Knowledge . 261 13.8.2 First Sex . 261 13.8.3 Premarital Sex . 262 13.8.4 Multiple Sexual Partners . 262 13.8.5 Coverage of HIV Testing Services . 262 14 ADULT AND MATERNAL MORTALITY . 281 14.1 Data . 281 14.2 Direct Estimates of Adult Mortality . 282 14.3 Trends in Adult Mortality . 283 14.4 Direct Estimates of Maternal Mortality . 283 14.5 Trends in Pregnancy-Related Mortality . 284 15 WOMEN’S EMPOWERMENT . 289 15.1 Married Women’s and Men’s Employment . 290 15.2 Control over Women’s Earnings . 291 15.3 Control over Men’s Earnings . 291 15.4 Women’s and Men’s Ownership of Assets . 292 15.5 Possession of Title or Deed for a House or Land . 293 15.6 Ownership and Use of Bank Accounts and Mobile Phones . 293 15.7 Women’s Participation in Decision Making . 294 15.8 Attitudes toward Wife Beating . 295 15.9 Negotiating Sexual Relations . 296 15.10 Female Genital Cutting . 297 15.10.1 Knowledge of and Membership in Sande Secret Society . 297 15.10.2 Knowledge and Prevalence of Female Genital Cutting . 297 15.10.3 Opinions about the Continuation of the Practice of FGC . 298 16 DOMESTIC VIOLENCE . 327 16.1 Measurement of Violence . 328 16.2 Women’s Experience of Physical Violence . 329 16.2.1 Prevalence of Physical Violence . 329 16.2.2 Perpetrators of Physical Violence . 329 16.3 Experience of Sexual Violence . 330 16.3.1 Prevalence of Sexual Violence . 330 16.3.2 Perpetrators of Sexual Violence . 330 16.4 Experience of Different Forms of Violence . 330 Contents • vii 16.5 Marital Control by Husband . 331 16.6 Forms of Spousal Violence . 331 16.6.1 Prevalence of Spousal Violence . 332 16.6.2 Onset of Spousal Violence . 334 16.7 Injuries to Women due to Spousal Violence . 334 16.8 Violence Initiated by Women against Husbands . 335 16.9 Help Seeking among Women Who Have Experienced Violence . 335 16.9.1 Sources for Help . 336 16.9.2 Usefulness and Impact of Help Sought . 336 17 CHILD DISCIPLINE AND CHILD LABOR . 357 17.1 Child Discipline . 358 17.2 Child Labor . 359 17.2.1 Child Labor Outside the Home . 359 17.2.2 Child Labor Inside the Home . 360 17.2.3 Child Labor Hazardous Work . 361 17.2.4 Overall Child Labor . 362 REFERENCES. 369 APPENDIX A SAMPLE DESIGN . 373 A.1 Introduction . 373 A.2 Sample Frame . 373 A.3 Sample Design and Implementation . 375 A.4 Sample Probabilities and Sampling Weights . 378 APPENDIX B ESTIMATES OF SAMPLING ERRORS . 381 APPENDIX C DATA QUALITY TABLES . 403 APPENDIX D LDHS CONTRIBUTORS . 411 APPENDIX E QUESTIONNAIRES . 415 Tables and Figures • ix TABLES AND FIGURES 1 INTRODUCTION AND SURVEY METHODOLOGY . 1 Table 1.1 Results of the household and individual interviews . 10 2 HOUSING CHARACTERISTICS AND HOUSEHOLD POPULATION . 11 Table 2.1.1 Household drinking water . 20 Table 2.1.2 Drinking water according to region and wealth . 21 Table 2.1.3 Treatment of household drinking water . 22 Table 2.2 Availability of water . 22 Table 2.3.1 Household sanitation facilities . 23 Table 2.3.2 Sanitation facility type according to region and wealth . 24 Table 2.4 Household characteristics . 25 Table 2.5 Household possessions . 26 Table 2.6 Wealth quintiles . 27 Table 2.7 Handwashing . 28 Table 2.8 Household population by age, sex, and residence . 29 Table 2.9 Household composition . 30 Table 2.10 Children’s living arrangements and orphanhood . 31 Table 2.11 Birth registration of children under age 5 . 32 Table 2.12.1 Educational attainment of the female household population . 33 Table 2.12.2 Educational attainment of the male household population . 34 Table 2.13 School attendance ratios . 35 Figure 2.1 Household drinking water by residence . 12 Figure 2.2 Household toilet facilities by residence . 13 Figure 2.3 Household wealth by residence. 14 Figure 2.4 Population pyramid . 15 Figure 2.5 Birth registration by county . 17 Figure 2.6 Secondary school attendance by household wealth . 19 3 CHARACTERISTICS OF RESPONDENTS . 37 Table 3.1 Background characteristics of respondents . 45 Table 3.2.1 Educational attainment: Women . 46 Table 3.2.2 Educational attainment: Men . 47 Table 3.3.1 Literacy: Women . 48 Table 3.3.2 Literacy: Men . 49 Table 3.4.1 Exposure to mass media: Women . 50 Table 3.4.2 Exposure to mass media: Men . 51 Table 3.5.1 Internet usage: Women . 52 Table 3.5.2 Internet usage: Men . 53 Table 3.6.1 Employment status: Women . 54 Table 3.6.2 Employment status: Men . 55 Table 3.7.1 Occupation: Women . 56 Table 3.7.2 Occupation: Men . 57 x • Tables and Figures Table 3.8 Type of employment: Women . 58 Table 3.9.1 Health insurance coverage: Women . 59 Table 3.9.2 Health insurance coverage: Men . 60 Table 3.10.1 Tobacco smoking: Women . 61 Table 3.10.2 Tobacco smoking: Men . 62 Table 3.11 Smokeless tobacco use and any tobacco use . 63 Table 3.12.1 Knowledge concerning tuberculosis: Women . 64 Table 3.12.2 Knowledge concerning tuberculosis: Men . 65 Table 3.13.1 Possession of identity documents: Women . 66 Table 3.13.2 Possession of identity documents: Men . 67 Figure 3.1 Education of survey respondents . 38 Figure 3.2 Education by county . 39 Figure 3.3 Exposure to mass media . 40 Figure 3.4 Employment status by wealth . 41 Figure 3.5 Occupation . 42 4 MARRIAGE AND SEXUAL ACTIVITY . 69 Table 4.1 Current marital status . 74 Table 4.2.1 Number of women’s co-wives . 75 Table 4.2.2 Number of men’s wives . 76 Table 4.3 Age at first marriage . 77 Table 4.4 Median age at first marriage by background characteristics . 78 Table 4.5 Age at first sexual intercourse . 79 Table 4.6 Median age at first sexual intercourse according to background characteristics . 80 Table 4.7.1 Recent sexual activity: Women . 81 Table 4.7.2 Recent sexual activity: Men . 82 Figure 4.1 Marital status . 70 Figure 4.2 Polygyny by county . 71 5 FERTILITY . 83 Table 5.1 Current fertility . 90 Table 5.2 Fertility by background characteristics . 91 Table 5.3.1 Trends in age-specific fertility rates . 92 Table 5.3.2 Trends in age-specific and total fertility rates . 92 Table 5.4 Children ever born and living . 93 Table 5.5 Birth intervals . 94 Table 5.6 Postpartum amenorrhea, abstinence, and insusceptibility . 95 Table 5.7 Median duration of amenorrhea, postpartum abstinence, and postpartum insusceptibility . 96 Table 5.8 Menopause . 97 Table 5.9 Age at first birth . 97 Table 5.10 Median age at first birth . 98 Table 5.11 Teenage pregnancy and motherhood . 99 Table 5.12 Sexual and reproductive health behaviors before age 15 . 100 Tables and Figures • xi Figure 5.1 Trends in fertility by residence . 84 Figure 5.2 Fertility by county . 84 Figure 5.3 Birth intervals . 85 Figure 5.4 Median age at first birth by residence . 87 Figure 5.5 Teenage pregnancy and motherhood by residence . 88 6 FERTILITY PREFERENCES . 101 Table 6.1 Fertility preferences according to number of living children . 106 Table 6.2.1 Desire to limit childbearing: Women . 107 Table 6.2.2 Desire to limit childbearing: Men . 108 Table 6.3 Ideal number of children according to number of living children . 109 Table 6.4 Mean ideal number of children according to background characteristics . 110 Table 6.5 Fertility planning status . 111 Table 6.6 Wanted fertility rates . 112 Figure 6.1 Desire to limit childbearing by number of living children . 102 Figure 6.2 Ideal family size . 103 Figure 6.3 Ideal family size by number of living children . 103 Figure 6.4 Trends in wanted and actual fertility . 104 7 FAMILY PLANNING . 113 Table 7.1 Knowledge of contraceptive methods . 121 Table 7.2 Knowledge of contraceptive methods according to background characteristics . 122 Table 7.3 Current use of contraception according to age . 123 Table 7.4 Current use of contraception according to background characteristics . 124 Table 7.5 Knowledge of fertile period . 125 Table 7.6 Knowledge of fertile period by age . 125 Table 7.7 Source of modern contraceptive methods . 126 Table 7.8 Use of social marketing brand pills . 127 Table 7.9 Informed choice . 128 Table 7.10 Twelve-month contraceptive discontinuation rates . 128 Table 7.11 Reasons for discontinuation . 129 Table 7.12.1 Need and demand for family planning among currently married women . 130 Table 7.12.2 Need and demand for family planning for all women and for sexually active unmarried women . 131 Table 7.13 Decision making about family planning . 133 Table 7.14 Future use of contraception . 134 Table 7.15 Exposure to family planning messages . 135 Table 7.16 Contact of nonusers with family planning providers . 136 Figure 7.1 Contraceptive use . 114 Figure 7.2 Trends in contraceptive use . 115 Figure 7.3 Use of modern methods by education . 115 Figure 7.4 Modern contraceptive use by county . 115 Figure 7.5 Source of modern contraceptive methods . 116 Figure 7.6 Contraceptive discontinuation rates . 117 Figure 7.7 Unmet need for family planning by education . 119 xii • Tables and Figures 8 INFANT AND CHILD MORTALITY . 137 Table 8.1 Early childhood mortality rates . 141 Table 8.2 Five-year early childhood mortality rates according to background characteristics . 141 Table 8.3 Ten-year early childhood mortality rates according to additional characteristics . 142 Table 8.4 Perinatal mortality . 143 Table 8.5 High-risk fertility behavior . 144 Figure 8.1 Trends in early childhood mortality rates . 138 Figure 8.2 Under-5 mortality by region . 139 9 MATERNAL HEALTH CARE . 145 Table 9.1 Prenatal care . 155 Table 9.2 Number of prenatal care visits and timing of first visit. 156 Table 9.3 Reasons for not attending recommended number of prenatal care visits . 157 Table 9.4 Components of prenatal care . 158 Table 9.5 Tetanus toxoid injections . 159 Table 9.6 Place of delivery . 160 Table 9.7 Assistance during delivery and skin-to-skin contact of newborn. 161 Table 9.8 Cesarean section . 162 Table 9.9 Duration of stay in health facility after birth . 163 Table 9.10 Timing of first postnatal check for the mother . 164 Table 9.11 Type of provider of first postnatal check for the mother . 165 Table 9.12 Timing of first postnatal check for the newborn . 166 Table 9.13 Type of provider for the first postnatal check for the newborn . 167 Table 9.14 Content of postnatal care for newborns . 168 Table 9.15 Cord cutting . 169 Table 9.16 Cord care . 170 Table 9.17 Problems in accessing health care . 171 Figure 9.1 Trends in prenatal care coverage . 146 Figure 9.2 Components of prenatal care . 147 Figure 9.3 Trends in place of birth . 148 Figure 9.4 Health facility births by education . 148 Figure 9.5 Health facility births by county . 149 Figure 9.6 Assistance during delivery . 149 10 CHILD HEALTH . 173 Table 10.1 Child’s size and weight at birth. 182 Table 10.2 Vaccinations by source of information . 183 Table 10.3 Possession and observation of vaccination cards, according to background characteristics . 184 Table 10.4 Vaccinations by background characteristics . 185 Table 10.5 Prevalence and treatment of symptoms of ARI . 187 Table 10.6 Source of advice or treatment for children with symptoms of ARI . 188 Table 10.7 Prevalence and treatment of fever . 189 Table 10.8 Prevalence and treatment of diarrhea . 190 Table 10.9 Feeding practices during diarrhea . 191 Table 10.10 Oral rehydration therapy, zinc, and other treatments for diarrhea . 192 Tables and Figures • xiii Table 10.11 Source of advice or treatment for children with diarrhea . 193 Table 10.12 Knowledge of ORS packets . 194 Table 10.13 Disposal of children’s stools . 195 Figure 10.1 Childhood vaccinations . 175 Figure 10.2 Trends in childhood vaccinations . 176 Figure 10.3 Vaccination coverage by county . 177 Figure 10.4 Feeding practices during diarrhea . 179 Figure 10.5 Treatment of diarrhea . 179 Figure 10.6 Prevalence and treatment of childhood illness . 180 11 NUTRITION OF CHILDREN AND WOMEN . 197 Table 11.1 Nutritional status of children . 212 Table 11.2 Initial breastfeeding . 214 Table 11.3 Breastfeeding status by age . 215 Table 11.4 Infant and young child feeding (IYCF) indicators on breastfeeding status . 215 Table 11.5 Median duration of breastfeeding . 216 Table 11.6 Foods and liquids consumed by children in the day or night preceding the interview . 217 Table 11.7 Minimum acceptable diet . 218 Table 11.8 Prevalence of anemia in children . 220 Table 11.9 Presence of iodized salt in household . 221 Table 11.10 Micronutrient intake among children . 222 Table 11.11 Therapeutic and supplemental foods . 223 Table 11.12 Nutritional status of women . 225 Table 11.13 Prevalence of anemia in women . 226 Table 11.14 Micronutrient intake among mothers . 227 Figure 11.1 Trends in nutritional status of children . 199 Figure 11.2 Stunting in children by county . 200 Figure 11.3 Stunting in children by wealth quintile . 200 Figure 11.4 Breastfeeding practices by age . 202 Figure 11.5 IYCF indicators on minimum acceptable diet . 204 Figure 11.6 Trends in childhood anemia . 206 Figure 11.7 Anemia in children by county . 206 Figure 11.8 Nutritional status of women . 209 12 MALARIA . 229 Table 12.1 Household possession of mosquito nets . 238 Table 12.2 Source of mosquito nets . 239 Table 12.3 Access to an insecticide-treated net (ITN) . 240 Table 12.4 Access to an ITN according to background characteristics . 241 Table 12.5 Use of mosquito nets by persons in the household . 242 Table 12.6 Use of existing ITNs . 243 Table 12.7 Use of mosquito nets by children . 244 Table 12.8 Use of mosquito nets by pregnant women . 245 Table 12.9 Use of intermittent preventive treatment (IPTp) by women during pregnancy . 246 Table 12.10 Prevalence, diagnosis, and prompt treatment of children with fever . 247 Table 12.11 Source of advice or treatment for children with fever . 248 xiv • Tables and Figures Table 12.12 Type of antimalarial drugs used . 249 Table 12.13 Coverage of testing for anemia in children . 250 Table 12.14 Hemoglobin <8.0 g/dl in children . 251 Figure 12.1 Household ownership of ITNs . 230 Figure 12.2 Trends in household ownership of ITNs . 230 Figure 12.3 ITN ownership by county . 230 Figure 12.4 Source of ITNs . 231 Figure 12.5 Access to and use of ITNs . 232 Figure 12.6 ITN access by county . 232 Figure 12.7 ITN use . 233 Figure 12.8 Trends in IPTp use by pregnant women . 234 Figure 12.9 Trends in ACT use by children with fever . 236 13 HIV/AIDS-RELATED KNOWLEDGE, ATTITUDES, AND BEHAVIOR . 253 Table 13.1 Knowledge of HIV prevention methods . 264 Table 13.2 Comprehensive knowledge about HIV . 265 Table 13.3 Knowledge of prevention of mother-to-child transmission of HIV . 266 Table 13.4 Discriminatory attitudes towards people living with HIV . 267 Table 13.5.1 Multiple sexual partners and higher-risk sexual intercourse in the past 12 months: Women . 268 Table 13.5.2 Multiple sexual partners and higher-risk sexual intercourse in the past 12 months: Men . 269 Table 13.6 Payment for sexual intercourse and condom use at last paid sexual intercourse . 270 Table 13.7.1 Coverage of prior HIV testing: Women . 271 Table 13.7.2 Coverage of prior HIV testing: Men . 272 Table 13.8 Pregnant women counseled and tested for HIV . 273 Table 13.9 Knowledge and coverage of self-testing for HIV . 274 Table 13.10 Self-reported prevalence of sexually transmitted infections (STIs) and STI symptoms . 275 Table 13.11 Women and men seeking treatment for STIs . 276 Table 13.12 Comprehensive knowledge about HIV among young people . 276 Table 13.13 Age at first sexual intercourse among young people . 277 Table 13.14 Premarital sexual intercourse among young people . 277 Table 13.15.1 Multiple sexual partners and higher-risk sexual intercourse in the past 12 months among young people: Women . 278 Table 13.15.2 Multiple sexual partners and higher-risk sexual intercourse in the past 12 months among young people: Men . 279 Table 13.16 Recent HIV tests among young people . 280 Figure 13.1 Trends in knowledge of mother-to-child transmission (MTCT) . 255 Figure 13.2 Discriminatory attitudes towards people living with HIV by education . 256 Figure 13.3 Sex and condom use with high-risk partners . 256 Figure 13.4 HIV testing . 258 Figure 13.5 Trends in recent HIV testing . 258 Figure 13.6 Recent HIV testing among women by county . 259 Figure 13.7 Recent HIV testing among men by county . 259 Figure 13.8 Trends in comprehensive HIV knowledge among youth . 261 Tables and Figures • xv 14 ADULT AND MATERNAL MORTALITY . 281 Table 14.1 Adult mortality rates . 286 Table 14.2 Adult mortality probabilities . 286 Table 14.3 Maternal mortality . 286 Table 14.4 Maternal mortality ratio . 287 Table 14.5 Pregnancy-related mortality trends . 287 Figure 14.1 Adult mortality rates by age . 282 Figure 14.2 Trends in the pregnancy-related mortality ratio (PRMR) with confidence intervals . 285 15 WOMEN’S EMPOWERMENT . 289 Table 15.1 Employment and cash earnings of currently married women and men . 301 Table 15.2.1 Control over women’s cash earnings and relative magnitude of women’s cash earnings . 302 Table 15.2.2 Control over men’s cash earnings . 303 Table 15.3 Women’s control over their own earnings and over those of their husbands . 304 Table 15.4.1 Ownership of assets: Women . 305 Table 15.4.2 Ownership of assets: Men . 306 Table 15.5.1 Ownership of title or deed for house: Women . 307 Table 15.5.2 Ownership of title or deed for house: Men . 308 Table 15.6.1 Ownership of title or deed for land: Women . 309 Table 15.6.2 Ownership of title or deed for land: Men . 310 Table 15.7.1 Ownership and use of bank accounts and mobile phones: Women . 311 Table 15.7.2 Ownership and use of bank accounts and mobile phones: Men . 312 Table 15.8 Participation in decision making . 313 Table 15.9.1 Women’s participation in decision making according to background characteristics . 314 Table 15.9.2 Men’s participation in decision making according to background characteristics . 315 Table 15.10.1 Attitude toward wife beating: Women . 316 Table 15.10.2 Attitude toward wife beating: Men . 317 Table 15.11 Attitudes toward negotiating safer sexual relations with husband . 318 Table 15.12 Ability to negotiate sexual relations with husband . 319 Table 15.13 Indicators of women’s empowerment . 320 Table 15.14 Current use of contraception by women’s empowerment . 320 Table 15.15 Ideal number of children and unmet need for family planning by women’s empowerment . 321 Table 15.16 Reproductive health care by women’s empowerment . 321 Table 15.17 Early childhood mortality rates by indicators of women’s empowerment . 322 Table 15.18 Knowledge of and membership in Sande or bush societies . 323 Table 15.19 Knowledge and prevalence of female circumcision . 324 Table 15.20 Age at circumcision . 325 Table 15.21 Opinions of women about whether the practice of circumcision should continue . 326 Figure 15.1 Employment by age . 290 Figure 15.2 Control over women’s earnings . 291 Figure 15.3 Ownership of assets . 292 Figure 15.4 Women’s participation in decision making. 294 Figure 15.5 Attitudes towards wife beating . 295 xvi • Tables and Figures Figure 15.6 Female circumcision by age . 298 Figure 15.7 Female circumcision by county . 298 16 DOMESTIC VIOLENCE . 327 Table 16.1 Experience of physical violence . 338 Table 16.2 Experience of violence during pregnancy . 339 Table 16.3 Persons committing physical violence . 340 Table 16.4 Experience of sexual violence. 341 Table 16.5 Age at first experience of sexual violence . 342 Table 16.6 Persons committing sexual violence . 342 Table 16.7 Experience of different forms of violence . 343 Table 16.8 Marital control exercised by husbands . 344 Table 16.9 Forms of spousal violence . 345 Table 16.10 Spousal violence by background characteristics . 346 Table 16.11 Spousal violence by husband’s characteristics and empowerment indicators . 347 Table 16.12 Violence by any husband/partner in the last 12 months. 348 Table 16.13 Experience of spousal violence by duration of marriage . 349 Table 16.14 Injuries to women due to spousal violence . 349 Table 16.15 Violence by women against their husband by women’s background characteristics . 350 Table 16.16 Violence by women against their husband by husband’s characteristics and empowerment indicators . 352 Table 16.17 Help seeking to stop violence . 353 Table 16.18 Sources for help to stop the violence . 354 Table 16.19 Usefulness and impact of help sought . 355 Figure 16.1 Women’s experience of violence by marital status . 329 Figure 16.2 Forms of spousal violence . 332 Figure 16.3 Spousal violence by county . 333 Figure 16.4 Spousal violence by husband’s alcohol consumption . 334 Figure 16.5 Help seeking by type of violence experienced . 336 17 CHILD DISCIPLINE AND CHILD LABOR . 357 Table 17.1 Child discipline . 363 Table 17.2 Attitudes toward physical punishment . 364 Table 17.3 Children’s involvement in economic activities . 365 Table 17.4 Children’s involvement in household chores . 366 Table 17.5 Hazardous work . 367 Table 17.6 Child labor . 368 Figure 17.1 Child discipline by age group . 359 Figure 17.2 Child labor . 362 Figure 17.3 Child labor by wealth . 362 Tables and Figures • xvii APPENDIX A SAMPLE DESIGN . 373 Table A.1 Households . 374 Table A.2 Enumeration areas and households . 374 Table A.3 Sample allocation of EAs and households . 375 Table A.4 Sample allocation of completed interviews with women and men . 376 Table A.5 Sample implementation: Women . 377 Table A.6 Sample implementation: Men . 378 APPENDIX B ESTIMATES OF SAMPLING ERRORS . 381 Table B.1 List of selected variables for sampling errors, Liberia DHS 2019-20. 383 Table B.2 Sampling errors: Total sample, Liberia DHS 2019-20 . 385 Table B.3 Sampling errors: Urban sample, Liberia DHS 2019-20 . 387 Table B.4 Sampling errors: Rural sample, Liberia DHS 2019-20 . 389 Table B.5 Sampling errors: North Western sample, Liberia DHS 2019-20 . 391 Table B.6 Sampling errors: South Central sample, Liberia DHS 2019-20 . 393 Table B.7 Sampling errors: South Eastern A sample, Liberia DHS 2019-20 . 395 Table B.8 Sampling errors: South Eastern B sample, Liberia DHS 2019-20 . 397 Table B.9 Sampling errors: North Central sample, Liberia DHS 2019-20 . 399 Table B.10 Sampling errors for adult and maternal mortality rates, Liberia DHS 2019-20 . 401 APPENDIX C DATA QUALITY TABLES . 403 Table C.1 Household age distribution . 403 Table C.2.1 Age distribution of eligible and interviewed women . 404 Table C.2.2 Age distribution of eligible and interviewed men . 404 Table C.3 Completeness of reporting . 405 Table C.4 Births by calendar years . 405 Table C.5 Reporting of age at death in days . 406 Table C.6 Reporting of age at death in months . 406 Table C.7 Standardization exercise results from anthropometry training . 408 Table C.8 Height and weight data completeness and quality for children . 409 Table C.9 Height measurements from random subsample of measured children . 411 Foreword • xix FOREWORD he 2019-20 Liberia Demographic and Health Survey (LDHS) was authorized by the Ministry of Health (MOH) and implemented by the Liberia Institute of Statistics and Geo-Information Services (LISGIS). The study is the fifth in a series of Demographic and Health Surveys conducted in Liberia. Previous surveys were conducted in 1986, 1999/2000, 2007, and 2013. The LDHS provides an opportunity to inform policy and provide data for planning, implementation, and monitoring and evaluation of national health programs. It is designed to provide up-to-date information on health indicators including fertility levels, sexual activity, fertility preferences, awareness and use of family planning methods, breastfeeding practices, nutritional status of children, early childhood and maternal mortality, maternal and child health, and awareness and behaviors regarding HIV/AIDS and other sexually transmitted infections. The study also incorporated measurements of HIV, hepatitis B, and hepatitis C prevalence along with seroprevalence of Ebola virus disease antibodies, the results of which will be included in future addendums. In addition to presenting national estimates, the report provides estimates of key indicators for both rural and urban areas, the country’s 15 counties, and the capital, Monrovia. LISGIS wishes to express its appreciation to those involved in the implementation of the 2019-20 LDHS through financial and technical support and the preparation of this report. Particular thanks go to the following: ▪ The U.S. Agency for International Development (USAID) in Liberia, for providing the funding for organizing and conducting the 2019-20 Liberia DHS ▪ The United Nations Population Fund (UNFPA) Liberia Country Office, the United States Centers for Disease Control and Prevention (CDC), the United Nations Children’s Fund (UNICEF), the Embassy of Ireland (Irish Aid), UN Women, the World Health Organization (WHO), and the Global Alliance for Vaccine and Immunization (GAVI), for providing additional funds ▪ The Liberia Institute of Biomedical Research (LIBR) and the National AIDS Control Program (NACP), for providing technical support in the implementation of biomarker collection ▪ The MOH, for providing technical input during the questionnaire review process and guidance throughout the conduct of the survey ▪ The National Malaria Control Program (NMCP), Family Health Division, and other health programs, for their invaluable technical expertise ▪ The LDHS Steering Committee, for its commitment and dedication to the survey’s successful implementation ▪ ICF, for providing technical support, training of fieldwork staff, consultations, recommendations, and analyses of the data collected We offer our sincere appreciation to the honorable Minister of Health, Dr. Wilhemina Jallah, for her commitment to the success of the survey and the Assistant Minister for Vital and Health Statistics at the Ministry of Health, Chea Sanford Wesseh, for serving as chairman of the Survey Steering Committee. T xx • Foreword The survey would not have been possible without the good work and dedication of the project staff at various levels. We wish to express our appreciation to Mr. Germue Gbawoquiye, coordinator of the LDHS, as well as the field supervisors, interviewers, biomarker technicians, and drivers for their active participation in and contribution to this work. Above all, we appreciate the assistance of all of the survey respondents nationwide who have made the 2019-20 LDHS a success. Prof. Francis F. Wreh DIRECTOR-GENERAL Liberia Institute of Statistics and Geo-Information Services (LISGIS) Acronyms and Abbreviations • xxi ACRONYMS AND ABBREVIATIONS ACT Artemisinin-based combination therapy AIDS Acquired immunodeficiency syndrome AL Artemether/lumefantrine ARI Acute respiratory infection ART Antiretroviral therapy ASAQ Artesunate/amodiaquine BCG Bacille Calmette-Guérin BMI Body mass index CAPI Computer-assisted personal interviewing CDC Centers for Disease Control and Prevention CI Confidence interval CPR Contraceptive prevalence rate CSPro Census and Survey Processing DBS Dried blood spot DHS Demographic and Health Survey DPT Diphtheria, pertussis, and tetanus vaccine EAs Enumeration areas EVD Ebola virus disease FGC Female genital cutting FGM Female genital mutilation GAR Gross attendance ratio GAVI Global Alliance for Vaccine and Immunization GFR Gross fertility rate GPI Gender parity index HepB Hepatitis B HepC Hepatitis C Hib Haemophilus influenzae type B HIV Human immunodeficiency syndrome ICF ICF (originally, Inner City Fund) ID Identification document IFSS Internet File Streaming System IPTp Intermittent preventive treatment during pregnancy IPV Inactivated polio vaccine IRB Institutional review board IT Information technology xxii • Acronyms and Abbreviations ITN Insecticide-treated net IUD Intrauterine device IYCF Infant and young child feeding LAM Lactational amenorrhea LDHS Liberia Demographic and Health Survey LISGIS Liberia Institute of Statistics and Geo-Information Services LLINs Long-lasting insecticidal nets LMIS Liberia Malaria Indicator Survey MAM Moderate acute malnutrition MICS Multiple Indicator Cluster Survey MMR Maternal mortality ratio MOH Ministry of Health MTCT Mother-to-child transmission NAR Net attendance ratio NHSP National Health Strategic Plan NN Neonatal mortality NPHC National Population and Housing Census NRL Liberia National Reference Laboratory OPV Oral polio vaccine ORS Oral rehydration salts ORT Oral rehydration therapy PNN Postneonatal mortality PRMR Pregnancy-related mortality ratio RDT Rapid diagnostic testing RHF Government-recommended homemade fluids RMNCAH Reproductive, maternal, newborn, child, and adolescent health SAM Severe acute malnutrition SD Standard deviation SDGs Sustainable Development Goals SDM Standard days method SE Standard error SP Sulfadoxine-pyrimethamine STIs Sexually transmitted infections TB Tuberculosis TFR Total fertility rate Acronyms and Abbreviations • xxiii UL-PIRE University of Liberia Pacific Institute for Research and Evaluation UNDP United Nations Development Programme UNFPA United Nations Population Fund UNICEF United Nations Children’s Fund USAID United States Agency for International Development VAD Vitamin A deficiency VIP Ventilated improved pit latrine WHO World Health Organization Reading and Understanding Tables from the 2019-20 LDHS • xxv READING AND UNDERSTANDING TABLES FROM THE 2019-20 LIBERIA DEMOGRAPHIC AND HEALTH SURVEY (LDHS) he 2019-20 Liberia DHS final report is based on approximately 200 tables of data. For quick reference, they are located at the end of each chapter and can be accessed through links in the pertinent text (electronic version). Additionally, this more reader-friendly version features about 90 figures that clearly highlight trends, subnational patterns, and background characteristics. Large colorful maps display breakdowns for regions and counties in Liberia. The text has been simplified to highlight key points in bullets and to clearly identify indicator definitions in boxes. While the text and figures featured in each chapter highlight some of the most important findings from the tables, not every finding can be discussed or displayed graphically. For this reason, LDHS data users should be comfortable reading and interpreting tables. The following pages provide an introduction to the organization of LDHS tables, the presentation of background characteristics, and a brief summary of sampling and understanding denominators. In addition, this section provides some exercises for users as they practice their new skills in interpreting LDHS tables. T xxvi • Reading and Understanding Tables from the 2019-20 LDHS Example 1: Exposure to Mass Media: Women A Question Asked of All Survey Respondents Table 3.4.1 Exposure to mass media: Women Percentage of women age 15-49 who are exposed to specific media on a weekly basis, according to background characteristics, Liberia DHS 2019-20 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 Accesses all three media at least once a week Accesses none of the three media at least once a week Number of women Age 15-19 1.9 14.6 20.1 0.4 72.0 1,657 20-24 2.1 18.7 26.8 0.5 65.2 1,506 25-29 1.5 20.6 30.8 0.7 62.0 1,375 30-34 2.5 17.0 25.9 1.6 66.8 1,112 35-39 1.7 18.4 30.2 1.0 65.5 1,020 40-44 1.7 12.3 30.4 1.4 66.3 769 45-49 3.6 11.3 23.4 3.0 71.8 626 Residence Urban 2.9 24.7 32.0 1.5 58.4 5,023 Greater Monrovia 3.8 33.7 36.5 2.3 50.7 2,866 Other urban 1.7 12.7 25.9 0.5 68.7 2,157 Rural 0.6 3.6 17.4 0.2 81.0 3,042 Region North Western 0.8 6.3 19.3 0.3 77.1 621 South Central 3.1 27.0 31.2 1.7 58.2 4,105 South Eastern A 1.8 11.3 24.7 0.6 71.2 458 South Eastern B 1.7 8.6 20.4 0.4 76.2 441 North Central 0.8 4.6 21.9 0.2 76.6 2,439 County Bomi 0.4 4.2 15.0 0.2 82.6 249 Bong 1.0 3.9 21.4 0.4 76.9 796 Gbarpolu 0.2 4.4 36.1 0.0 63.2 112 Grand Bassa 0.4 8.9 20.6 0.1 74.6 467 Grand Cape Mount 1.3 9.1 16.1 0.5 77.7 260 Grand Gedeh 0.8 9.0 27.4 0.3 68.6 172 Grand Kru 0.0 0.7 1.2 0.0 98.5 136 Lofa 0.7 3.3 14.3 0.0 84.0 658 Margibi 3.1 18.4 23.3 0.7 67.9 441 Maryland 2.2 16.3 33.9 0.5 59.7 215 Montserrado 3.4 30.8 33.8 2.0 54.4 3,197 Nimba 0.7 6.1 27.3 0.2 71.3 985 River Cess 0.2 1.5 12.2 0.0 87.4 104 River Gee 2.8 2.5 16.9 0.8 82.1 91 Sinoe 3.6 19.1 29.3 1.3 64.5 182 Education No education 0.0 6.5 18.6 0.0 78.6 2,474 Elementary 0.7 8.9 20.1 0.3 76.0 1,911 Junior high 2.3 15.9 23.5 0.6 69.1 1,445 Senior high 3.6 30.6 37.1 1.5 49.6 1,761 Higher 12.0 52.5 63.0 8.3 26.9 474 Wealth quintile Lowest 0.3 2.0 14.2 0.2 85.0 1,379 Second 0.7 2.6 19.8 0.0 79.0 1,431 Middle 1.8 7.5 23.0 0.7 73.7 1,517 Fourth 2.1 19.7 29.1 0.7 62.1 1,829 Highest 4.5 42.5 40.7 2.9 44.0 1,910 Total 2.1 16.7 26.5 1.0 66.9 8,065 Step 1: Read the title and subtitle, highlighted in orange in the table above. They tell you the topic and the specific population group being described. In this case, the table is about women age 15-49 and their exposure to different types of media. All eligible female respondents age 15-49 were asked these questions. Step 2: Scan the column headings—highlighted in green in Example 1. They describe how the information is categorized. In this table, the first three columns of data show different types of media that women access at 1 2 3 4 5 Reading and Understanding Tables from the 2019-20 LDHS • xxvii least once a week. The fourth column shows women who access all three types of media, while the fifth column shows women who do not access any of the three types of media on a weekly basis. The last column lists the number of women age 15-49 interviewed in the survey. Step 3: Scan the row headings—the first vertical column highlighted in blue in Example 1. These show the different ways the data are divided into categories based on population characteristics. In this case, the table presents women’s exposure to media by age, urban-rural residence, region, county, level of education, and wealth quintile. Most of the tables in the LDHS report will be divided into these same categories. Step 4: Look at the row at the bottom of the table highlighted in pink. These percentages represent the totals of all women age 15-49 and their weekly access to different types of media. In this case, 2.1%* of women age 15-49 read a newspaper at least once a week, 16.7% watch television at least weekly, and 26.5% listen to the radio on a weekly basis. Step 5: To find out what percentage of women with no education listen to the radio at least once a week, draw two imaginary lines, as shown on the table. This shows that 18.6% of women age 15-49 with no education listen to the radio at least once a week. By looking at patterns by background characteristics, we can see how exposure to mass media varies across Liberia. Mass media are often used to communicate health messages. Knowing how mass media exposure varies among different groups can help program planners and policymakers determine how to most effectively reach their target populations. *For the purpose of this document, data are presented exactly as they appear in the table, including decimal places. However, the text in the remainder of this report rounds data to the nearest whole percentage point. Practice: Use the table in Example 1 to answer the following questions: a) What percentage of women in Liberia do not access any of the three media at least once a week? b) Which age group of women is most likely to watch television at least once a week? c) Compare women in urban areas to women in rural areas—which group is more likely to listen to the radio on a weekly basis? d) What are the lowest and the highest percentages (range) of women who do not access any media at least once a week by county? e) Is there a clear pattern in exposure to radio at least once a week by wealth quintile? Answers: a) 66.9%. b) Women age 25-29: 20.6% of women in this age group watch television weekly. c) Women in urban areas: 32.0% of women in urban areas listen to the radio at least once a week, as compared with 17.4% of women in rural areas. d) The percentage of women with no exposure to any of these three media at least once a week ranges from a low of 54.4% in Montserrado to a high of 98.5% in Grand Kru. e) Yes. Weekly exposure to the radio increases as household wealth increases: 14.2% of women from the lowest wealth quintile listen to the radio at least once a week, compared with 40.7% of women from the highest wealth quintile. xxviii • Reading and Understanding Tables from the 2019-20 LDHS Example 2: Prevalence and Treatment of ARI A Question Asked of a Subgroup of Survey Respondents Table 10.5 Prevalence and treatment of symptoms of ARI Among children under age 5, percentage who had symptoms of acute respiratory infection (ARI) in the 2 weeks preceding the survey, and among children with symptoms of ARI in the 2 weeks preceding the survey, percentage for whom advice or treatment was sought, according to background characteristics, Liberia DHS 2019-20 Among children under age 5: Among children under age 5 with symptoms of ARI: Background characteristic Percentage with symptoms of ARI1 Number of children Percentage for whom advice or treatment was sought2 Percentage for whom advice or treatment was sought same or next day2 Number of children Age in months <6 5.2 569 (81.8) (28.6) 30 6-11 8.8 529 (64.9) (20.9) 46 12-23 5.7 937 78.3 36.4 53 24-35 4.0 873 (84.4) (39.0) 35 36-47 3.5 978 (85.5) (51.2) 35 48-59 1.7 980 (83.1) (14.4) 16 Sex Male 4.1 2,431 81.4 39.2 100 Female 4.7 2,434 75.8 27.8 115 Cooking fuel Electricity or gas (0.4) 61 * * 0 Kerosene * 5 * nc 0 Fire coal/charcoal 4.7 2,132 80.1 38.5 100 Wood/straw3 4.3 2,668 76.9 28.5 115 Residence Urban 3.8 2,615 76.3 35.0 101 Greater Monrovia 4.7 1,326 * * 63 Other urban 2.9 1,289 (87.7) (41.1) 38 Rural 5.1 2,251 80.3 31.5 115 Region North Western 3.7 419 (71.9) (37.6) 16 South Central 4.8 2,123 75.8 25.2 102 South Eastern A 4.7 302 (89.2) (48.1) 14 South Eastern B 6.9 268 82.9 47.1 18 North Central 3.7 1,755 80.3 37.0 66 County Bomi 1.4 143 * * 2 Bong 6.1 540 (83.6) (45.0) 33 Gbarpolu 8.8 86 * * 8 Grand Bassa 4.2 341 * * 14 Grand Cape Mount 3.2 190 * * 6 Grand Gedeh 5.3 111 * * 6 Grand Kru 7.3 96 * * 7 Lofa 4.3 375 * * 16 Margibi 1.9 256 * * 5 Maryland 5.5 123 * * 7 Montserrado 5.4 1,526 (72.2) (27.5) 82 Nimba 1.9 839 * * 16 River Cess 7.4 74 * * 5 River Gee 9.4 48 * * 5 Sinoe 2.5 117 * * 3 Mother’s education No education 4.2 1,723 70.6 27.8 73 Elementary 4.3 1,236 87.5 33.8 53 Junior high 3.5 852 (66.0) (21.6) 30 Senior high 4.9 866 (80.6) (36.2) 42 Higher 8.9 189 * * 17 Wealth quintile Lowest 5.3 1,169 70.7 23.1 62 Second 3.8 1,061 84.3 34.6 40 Middle 3.7 912 71.6 33.9 33 Fourth 4.3 913 (74.6) (33.7) 39 Highest 5.0 811 * * 40 Total 4.4 4,866 78.4 33.1 216 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. nc = No unweighted cases 1 Symptoms of ARI include short, rapid breathing that is chest-related and/or difficult breathing that is chest-related. 2 Includes advice or treatment from the following sources: public sector, private medical sector, shop, market, or black baggers/drug peddlers. Excludes advice or treatment from a traditional practitioner. 3 Includes grass, shrubs, and crop residues 1 2 3 4 a b Reading and Understanding Tables from the 2019-20 LDHS • xxix Step 1: Read the title and subtitle. In this case, the table is about two separate groups of children: all children under age 5 (a) and children under age 5 with symptoms of acute respiratory infection (ARI) in the 2 weeks before the survey (b). Step 2: Identify the two panels. First, identify the columns that refer to all children under age 5 (a), and then isolate the columns that refer only to children under age 5 with symptoms of ARI in the 2 weeks before the survey (b). Step 3: Look at the first panel. What percentage of children under age 5 had symptoms of ARI in the 2 weeks before the survey? It’s 4.4%. Now look at the second panel. How many children under age 5 are there who had symptoms of ARI in the 2 weeks before the survey? It’s 216 children, or 4.4% of the 4,866 children under age 5 (with rounding). The second panel is a subset of the first panel. Step 4: Only 4.4% of children under age 5 had symptoms of ARI in the 2 weeks before the survey. Once these children are further divided into the background characteristic categories, there may be too few cases for the percentages to be reliable. • What percentage of children under age 5 with symptoms of ARI in the 2 weeks before the survey in the North Western region had advice or treatment sought? It’s 71.9%. This percentage is in parentheses because there are between 25 and 49 children (unweighted) in this category. Readers should use this number with caution—it may not be reliable. (For more information on weighted and unweighted numbers, see Example 3.) • What percentage of children under age 5 with symptoms of ARI in the 2 weeks before the survey in Bomi county had advice or treatment sought? There is no number in this cell—only an asterisk. This is because there are fewer than 25 children. Results for this group are not reported. The subgroup is too small, and therefore the data are not reliable. Note: When parentheses or asterisks are used in a table, the explanation will be noted under the table. If there are no parentheses or asterisks in a table, you can proceed with confidence that enough cases were included in all categories that the data are reliable. xxx • Reading and Understanding Tables from the 2019-20 LDHS Example 3: Understanding Sampling Weights in LDHS Tables A sample is a group of people who have been selected for a survey. In the LDHS, the sample is designed to represent the national population age 15-49. In addition to national data, most countries want to collect and report data on smaller geographical or administrative areas. However, doing so requires a large enough sample size in each area. For the 2019-20 LDHS, the survey sample is representative at the national level, for urban and rural areas, for each of the 5 regions, and, for most indicators, for each of the 15 counties. To generate statistics that are representative of the country as a whole and the 15 counties, the number of women surveyed in each county should contribute to the size of the total (national) sample in proportion to size of the county. However, if some counties have small populations, then a sample allocated in proportion to each county’s population may not include sufficient women from each county for analysis. To solve this problem, counties with small populations are oversampled. For example, let’s say that you have enough money to interview 8,065 women and want to produce results that are representative of Liberia as a whole and its counties (as in Table 3.1). However, the total population of Liberia is not evenly distributed among the counties: some counties, such as Montserrado, are heavily populated while others, such as River Gee, are not. Thus, River Gee must be oversampled. A sampling statistician determines how many women should be interviewed in each county in order to get reliable statistics. The blue column (1) in the table at right shows the actual number of women interviewed in each county. The number of women interviewed by county ranges from 337 in Gbarpolu to 1,219 in Montserrado. The number of interviews is sufficient to get reliable results in each region and county. With this distribution of interviews, some counties are overrepresented and some counties are underrepresented. For example, the population in Montserrado is about 39.6% of the population in Liberia, while Gbarpolu’s population contributes only 1.4% of the population in Liberia. But as the blue column shows, the number of women interviewed in Montserrado accounts for only about 15.1% of the total sample of women interviewed (1,219/8,065) and the number of women interviewed in Gbarpolu accounts for about 4.2% of the total sample of women interviewed (337/8,065). This unweighted distribution of women does not accurately represent the population. In order to get statistics that are representative of Liberia, the distribution of the women in the sample needs to be weighted (or mathematically adjusted) such that it resembles the true distribution in the country. Women from a small county, like Gbarpolu, should contribute only a small amount to the national total. Women from a large county, like Montserrado, should contribute much more. Therefore, DHS statisticians mathematically calculate a “weight” that is used to adjust the number of women from each county so that each county’s contribution to the total is proportional to the actual population of the county. The numbers in the purple column (2) represent the “weighted” values. The weighted values can be smaller or larger than the unweighted values at the county level. The total national sample size of 8,065 women has not changed after weighting, but Table 3.1 Background characteristics of respondents Percent distribution of women and men age 15-49 by selected background characteristics, Liberia DHS 2019-20 Women Background characteristic Weighted percent Weighted number Unweighted number Region North Western 7.7 621 1,158 South Central 50.9 4,105 2,301 South Eastern A 5.7 458 1,195 South Eastern B 5.5 441 1,486 North Central 30.2 2,439 1,925 County Bomi 3.1 249 401 Bong 9.9 796 671 Gbarpolu 1.4 112 337 Grand Bassa 5.8 467 543 Grand Cape Mount 3.2 260 420 Grand Gedeh 2.1 172 384 Grand Kru 1.7 136 449 Lofa 8.2 658 581 Margibi 5.5 441 539 Maryland 2.7 215 574 Montserrado 39.6 3,197 1,219 Nimba 12.2 985 673 River Cess 1.3 104 365 River Gee 1.1 91 463 Sinoe 2.3 182 446 Total 15-49 100.0 8,065 8,065 1 2 3 Reading and Understanding Tables from the 2019-20 LDHS • xxxi the distribution of the women in the counties has been changed to represent their contribution to the total population size. How do statisticians weight each category? They take into account the probability that a woman was selected in the sample. If you were to compare the green column (3) to the actual population distribution of Liberia, you would see that women in each county are contributing to the total sample with the same weight that they contribute to the population of the country. The weighted number of women in the survey now accurately represents the proportion of women who live in Montserrado and the proportion of women who live in Gbarpolu. With sampling and weighting, it is possible to interview enough women to provide reliable statistics at national, regional, and, in most cases, county levels. In general, only the weighted numbers are shown in each of the LDHS tables, so don’t be surprised if these numbers seem low: they may actually represent a larger number of women interviewed. Sustainable Development Goals Indicators • xxxiii Sustainable Development Goals Indicators Liberia DHS 2019-20 Sex Total DHS table number Indicator Male Female 2. Zero hunger 2.2.1 Prevalence of stunting among children under 5 years of age 31.8 27.9 29.8 11.1 2.2.2 Prevalence of malnutrition among children under 5 years of age 8.2 7.4 7.8a na a) Prevalence of wasting among children under 5 years of age 3.6 3.2 3.4a 11.1 b) Prevalence of overweight among children under 5 years of age 4.5 4.2 4.4a 11.1 3. Good health and well-being 3.1.1 Maternal mortality ratio1 na na 742 14.04 3.1.2 Proportion of births attended by skilled health personnel na na 84.4 9. 7 3.2.1 Under-5 mortality rate2 96 91 93 8.2 3.2.2 Neonatal mortality rate2 45 30 37 8.2 3.7.1 Proportion of women of reproductive age (age 15-49 years) who have their need for family planning satisfied with modern methods na 47.8 na 7.13.2 3.7.2 Adolescent birth rates per 1,000 women a) Girls age 10-14 years3 na 4 na 5.1 b) Women age 15-19 years4 na 128 na 5.1 3.a.1 Age-standardized prevalence of current tobacco use among persons age 15 years and older5 7.3 1.0 4.2a 3.10.1, 3.10.2 3.b.1 Proportion of the target population covered by all vaccines included in their national program a) Coverage of DPT containing vaccine (3rd dose)6 70.5 68.0 69.2 10.4 c) Coverage of pneumococcal conjugate vaccine (last dose in schedule)7 70.9 66.2 68.5 10.4 5. Gender equality 5.2.1 Proportion of ever-partnered women and girls age 15 years and older subjected to physical, sexual or psychological violence by a current or former intimate partner in the previous 12 months8,9 na 45.6 na 16.12 a) Physical violence na 34.0 na 16.12 b) Sexual violence na 6.9 na 16.12 c) Psychological violence na 35.0 na 16.12 5.3.1 Proportion of women age 20-24 years who were married or in a union before age 15 and before age 18 a) before age 15 na 5.8 na 4.3 b) before age 18 na 24.9 na 4.3 5.3.2 Proportion of girls and women age 15-49 years who have undergone female genital mutilation/cutting na 38.2 na 15.19 5.6.1 Proportion of women age 15-49 years who make their own informed decisions regarding sexual relations, contraceptive use and reproductive health care10 na 58.8 na na 5.b.1 Proportion of individuals who own a mobile telephone11 60.6 46.7 53.7a 15.7.1, 15.7.2 Residence Total DHS table number Indicator Urban Rural 7. Affordable clean energy 7.1.1 Proportion of population with access to electricity 37.0 4.3 23.1 2.4 7.1.2 Proportion of population with primary reliance on clean fuels and technology12 1.5 0.3 1.0 2.4 Sex Total DHS table number Indicator Male Female 8. Decent work and economic growth 8.7.1 Proportion and number of children age 5-17 years engaged in child labor 29.3 34.3 31.7 17.6 8.10.2 Proportion of adults (15 years and older) with an account at a bank or other financial institution or with a mobile-money-service provider13 21.3 12.0 16.7a 15.7.1, 15.7.2 16. Peace, justice, and strong institutions 16.2.1 Percentage of children age 1-17 years who experienced any physical punishment and/or psychological aggression by caregivers in the past month14 85.2 85.1 85.2 17.1 16.9.1 Proportion of children under 5 years of age whose births have been registered with a civil authority 67.1 65.4 66.3 2.11 17. Partnerships for the goals 17.8.1 Proportion of individuals using the Internet15 36.4 22.0 29.2a 3.5.1, 3.5.2 na = Not applicable 1 Expressed in terms of maternal deaths per 100,000 live births in the 7-year period preceding the survey 2 Expressed in terms of deaths per 1,000 live births for the 5-year period preceding the survey 3 Equivalent to the age-specific fertility rate for girls age 10-14 for the 3-year period preceding the survey, expressed in terms of births per 1,000 girls age 10-14 4 Equivalent to the age-specific fertility rate for women age 15-19 for the 3-year period preceding the survey, expressed in terms of births per 1,000 women age 15-19 5 Data are not age-standardized and are available for women and men age 15-49 only. 6 The percentage of children age 12-23 months who received three doses of DPT containing vaccine 7 The percentage of children age 12-23 months who received three doses of pneumococcal conjugate vaccine 8 Data are available for women age 15-49 who have ever been in union only. 9 In the DHS, psychological violence is termed emotional violence. 10 Data are available for currently married women who are not pregnant only. 11 Data are available for women and men age 15-49 only. 12 Measured as the percentage of the population using clean fuel for cooking. 13 Data are available for women and men age 15-49 who have and use an account at bank or other financial institution; information on use of a mobile-money-service provider is not available 14 Data are available for children age 1-14 only. 15 Data are available for women and men age 15-49 who have used the internet in the past 12 months. a The total is calculated as the simple arithmetic mean of the percentages in the columns for males and females. xxxiv • Map of Liberia Introduction and Survey Methodology • 1 INTRODUCTION AND SURVEY METHODOLOGY 1 he 2019-20 Liberia Demographic and Health Survey (LDHS) is the fifth Demographic and Health Survey to be conducted in Liberia. It was implemented by the Liberia Institute of Statistics and Geo- Information Services (LISGIS) in partnership with the Ministry of Health (MOH). Data collection took place from October 16, 2019, to February 12, 2020. Funding was provided by the United States Agency for International Development (USAID). The United States Centers for Disease Control and Prevention (CDC), the United Nations Population Fund (UNFPA), the United Nations Children’s Fund (UNICEF), the Embassy of Ireland (Irish Aid), the United Nations Development Programme (UNDP), the World Health Organization (WHO), UN Women, and the Global Alliance for Vaccine and Immunization (GAVI) provided additional funds for the survey. ICF provided technical assistance through The DHS Program, a USAID-funded project providing support and technical assistance in the implementation of population and health surveys in countries worldwide. 1.1 SURVEY OBJECTIVES The primary objective of the 2019-20 LDHS is to provide up-to-date estimates of key demographic and health indicators necessary for program managers, policymakers, and implementers to monitor and evaluate the impact of existing policies and programs and to design new initiatives for health policies in Liberia. This survey is considered a key resource for the new sixth National Health Strategic Plan (NHSP) 2017-2021. Specifically, the main objectives of the survey are: ▪ To collect high-quality data on fertility levels and preferences; contraceptive use; maternal and child health; neonatal, infant, and child mortality levels; maternal mortality; and other health issues relevant to the achievement of the Sustainable Development Goals (SDGs) (e.g., gender, nutrition, awareness regarding HIV/AIDS) ▪ To provide information on availability of, access to, and use of mosquito nets as part of national malaria control programs ▪ To assess protection of children from violence and exploitation ▪ To provide information on other health issues, such as tobacco use, tuberculosis, and health insurance ▪ To obtain data on women’s empowerment, domestic violence, and female genital cutting ▪ To test household salt for the presence of iodine ▪ To obtain data on child feeding practices, including breastfeeding, and collect anthropometric measures to assess the nutritional status of children under age 5 and women age 15-49 ▪ To conduct anemia testing of women age 15-49 and children age 6-59 months ▪ To measure HIV prevalence levels among men age 15-59 and women age 15-49 ▪ To measure hepatitis B and C prevalence levels among men age 15-59 and women age 15-49 T 2 • Introduction and Survey Methodology ▪ To measure the seroprevalence of Ebola virus disease (EVD) antibodies among men age 15-59 and women age 15-49 and collect data on risk factors related to Ebola It should be noted that although the 2019-20 LDHS is considered the fifth Demographic and Health Survey to be conducted in Liberia, the results of the 1999-2000 LDHS, the second survey conducted in the country, are withheld from the trends in this report because that survey was undertaken outside the purview of The DHS Program and with no external technical assistance. Additionally, a subset of the indicators included in the 2019-20 LDHS overlap with indicators produced as part of the 2016, 2011, and 2009 Liberia Malaria Indicator Surveys (LMIS). 1.2 SAMPLE DESIGN The sampling frame used for the 2019-20 LDHS is based on the 2008 National Population and Housing Census (NPHC), conducted by the LISGIS. Liberia is divided into 15 counties grouped to form five geographical regions, with each region consisting of three counties. Each county is divided into districts and each district into clans. In the 2008 NPHC, each clan was subdivided into enumeration areas (EAs). An enumeration area is a geographical area assigned to an enumerator for the purpose of conducting a census count; according to the Liberian census frame, each EA consists of an average of 100 households. The 2019-20 LDHS followed a stratified two-stage cluster design. The first stage involved selecting sample points (clusters) consisting of EAs. EAs were drawn with a probability proportional to their size within each sampling stratum. A total of 325 clusters were selected. The second stage involved systematic sampling of households. A household listing operation was undertaken in all of the selected clusters. During the listing, an average of 129 households were found in each cluster, from which a fixed number of 30 households were selected with an equal probability systematic selection process; the total sample size was 9,745 households. Results from this sample will be representative at the national, urban (Greater Monrovia and all other urban areas), and rural levels, including each of the five regions. The survey will also produce separate representative results for most key indicators of the 15 counties. All women age 15-49 and men age 15-59 who were either permanent residents of the selected households or visitors who stayed in the households the night before the survey were eligible to be interviewed. However, male interviews were conducted only in a subsample consisting of half of the households in each cluster. Biomarker collection also occurred only in this subsample. In these households, all adult women age 18-49 and men age 18-59, as well as young women and men age 15-17 who either were emancipated minors or received parental or guardian consent, were eligible for HIV testing. HIV testing was conducted in two ways: rapid diagnostic testing (RDT) and dried blood spot preparation (DBS). RDT immediately provided respondents with their HIV status, while DBS samples were sent for laboratory testing to produce a national HIV prevalence estimate. Hemoglobin testing for anemia was performed in each household among eligible women age 18-49 and young emancipated women age 15-17 who consented to being tested. With consent from parents or guardians, children age 6-59 months and young non-emancipated women age 15-17 were also tested for anemia in each household. In addition, height and weight measurements were collected from women age 15-49 and children age 0-59 months in all households selected for biomarker collection. All women age 18-49, men age 18-59, and young women and men age 15-17 who either were emancipated or received parental or guardian consent were also eligible for hepatitis B and C and EVD antibody testing by a CDC follow-up survey team. The follow-up team collected venous blood samples from eligible respondents who consented to hepatitis B and C and/or EVD antibody testing. Introduction and Survey Methodology • 3 Finally, one eligible woman from each household in the subsample of households participating in the male interviews and biomarker collection was randomly selected to be asked additional questions about domestic violence. 1.3 QUESTIONNAIRES Seven questionnaires were used for the 2019-20 LDHS: the Household Questionnaire, the Woman’s Questionnaire, the Man’s Questionnaire, the Biomarker Questionnaire Part A, the Biomarker Questionnaire Part B, the Biomarker Revisit Questionnaire, and the Fieldworker Questionnaire. These questionnaires, based on The DHS Program’s standard questionnaires, were adapted to reflect the population and health issues relevant to Liberia. Suggestions were solicited from various stakeholders representing government ministries and agencies, nongovernmental organizations, and international donors. After all questionnaires were finalized in English, they were translated into a form of simple English commonly understood in Liberia. The Household Questionnaire listed all members of and visitors to the selected households. Basic demographic information was collected on each person listed, including age, sex, marital status, education, and relationship to the head of the household. For children under age 18, survival status of parents was determined. Information on child labor and discipline was collected for one randomly selected child age 1-17 in the household. Data on age and sex of household members were used to identify women and men eligible for individual interviews. The Household Questionnaire also collected information on characteristics of the household’s dwelling unit, such as source of water; type of toilet facilities; materials used for flooring, external walls, and roofing; ownership of various household goods; and access to and use of mosquito nets. In addition, household salt was tested for iodine content. The Woman’s Questionnaire was used to collect information from all eligible women age 15-49. These women were asked questions on the following topics: ▪ Background characteristics (including age, education, and media exposure) ▪ Reproduction and child mortality ▪ Contraception ▪ Prenatal, delivery, and postnatal care ▪ Vaccinations and childhood illnesses ▪ Maternal and child health and nutrition ▪ Marriage and sexual activity ▪ Fertility preferences ▪ Women’s work and husbands’ background characteristics ▪ Knowledge, awareness, and behavior regarding HIV/AIDS and other sexually transmitted infections (STIs) ▪ Knowledge, attitudes, and behavior related to other health issues (e.g., injections, smoking, tuberculosis, childhood illnesses, and pregnancy and childbirth) ▪ Female genital cutting/mutilation ▪ Experiences during the Ebola outbreak in Liberia ▪ Adult and maternal mortality ▪ Domestic violence The Man’s Questionnaire was used to collect information from all eligible men age 15-59 in half of the selected households. These men were asked questions on the following topics: ▪ Background characteristics ▪ Reproduction 4 • Introduction and Survey Methodology ▪ Contraception ▪ Marriage and sexual activity ▪ Fertility preferences ▪ Employment and gender roles ▪ HIV/AIDS ▪ Experiences during the Ebola outbreak in Liberia ▪ Other health issues (e.g., injections, smoking, tuberculosis, and health insurance) The 2019-20 LDHS biomarker collection, which occurred in the same subsample as the male interviews, involved a two-part field operation. As a result, biomarkers were collected using two questionnaires: Part A and Part B. Part A was the traditional DHS Biomarker Questionnaire, in which respondent characteristics, consent, and results from anthropometry, anemia, and RDT HIV testing were recorded. This questionnaire was administered exclusively by DHS biomarker technicians in conjunction with DHS interviews. DHS biomarker technicians then used Part B to administer the consent to the follow-up visit by Team B. If the respondent agreed to a follow-up visit, Part B was used by the CDC follow-up field team, which consisted of phlebotomists, counselors, and supervisors, to administer the consent for the venous blood testing before proceeding with the collection. As part of DHS anthropometry data quality assurance procedures, the 2019-20 LDHS included random and flagged measurement revisits. Random revisits were used to assess the biomarker technicians’ precision, while flagged revisits were used to identify suspicious initial measurements and improve data quality. The results of these remeasurements were recorded in the separate Biomarker Revisit Questionnaire. The Household, Woman’s, and Man’s Questionnaires were programmed into tablet computers to facilitate computer-assisted personal interviewing (CAPI) for data collection purposes. The Biomarker Questionnaire Part A and the Biomarker Revisit Questionnaire were completed on paper during data collection and then entered into the CAPI system in the field before the data collection teams completed each cluster. In contrast, the Biomarker Questionnaire Part B was completed exclusively on paper. The Fieldworker Questionnaire, which collected data on fieldworkers’ general background characteristics, served as a tool for conducting analyses of data quality. Fieldworkers filled out the two-page self-administered questionnaire after the main training and before they entered the field. No personal identifiers were attached to the Liberia DHS fieldworkers’ data file. The protocols for survey methodology, biomarker measurements, and all instruments used were approved by institutional review boards (IRBs) at ICF and the University of Liberia Pacific Institute for Research and Evaluation (UL-PIRE) in Liberia. Both IRBs approved protocols before the commencement of data collection activities. 1.4 ANTHROPOMETRY, ANEMIA, HIV, HEPATITIS, AND EVD TESTING The 2019-20 LDHS incorporated the following biomarkers: anthropometry, hemoglobin, rapid and laboratory testing for HIV, and collection of venous blood samples for laboratory testing of hepatitis B and C and EVD antibodies. As noted, data on HIV were collected through two methods: RDT, which provided respondents with immediate results regarding their HIV status, and collection of DBS samples. The DBS samples, along with the venous blood samples collected by the follow-up CDC survey team, were sent for laboratory testing. The venous blood samples will be used to produce national hepatitis B and C prevalence estimates and to estimate the EVD survivor population in Liberia. The results of DBS, hepatitis B and C, and EVD testing were not Introduction and Survey Methodology • 5 available at the time of publication of this report and therefore have not been included. Once the testing is completed, the results will be published in separate annexes to this report. 1.4.1 Anthropometric Measurements In households selected for biomarker collection, height and weight measurements were recorded for children age 0-59 months and women age 15-49. Weight measurements were obtained using lightweight, electronic SECA 878 scales with a digital screen and a mother and child function. Height measurements were carried out with ShorrBoards® made by Weigh and Measure, LLC. Children younger than age 24 months were measured while lying down on the board, while standing height was measured for children age 2-5 and for women. As mentioned, the 2019-20 LDHS included a remeasurement process to ensure anthropometry data quality. To that end, during data collection, two children in each cluster and all children with anthropometry data outside of a pre-specified range were flagged for remeasurement. The remeasurement occurred on the day after the original measurement. Fieldworkers were blinded to the reason for the remeasurement. 1.4.2 Anemia Testing Blood specimens for anemia testing were collected from all children age 6-59 months and women age 15-49 for whom consent had been obtained. For non-emancipated young women age 15-17 who had never been married, the consent of a parent or guardian was sought first, followed by the minor’s assent. For children age 6-59 months, consent was provided by a parent or guardian. The consent statement explained the purpose of the test and how the test would be performed, informed the respondent that the results would be kept confidential, and requested permission for the test to be carried out. Blood samples were drawn from a drop of blood taken from a finger prick (or a heel prick for young children age 6-11 months or very thin children with small fingers) and collected in a microcuvette. Hemoglobin analysis was carried out on-site using a battery-operated portable HemoCue 201+ analyzer, which produces a result in less than 1 minute. Results were given verbally and in writing. Parents of children with a hemoglobin level below 7 g/dl were advised to take the child to a health facility for follow-up care. Likewise, nonpregnant women and pregnant women were referred for follow-up care if their hemoglobin levels were below 7 g/dl and 9 g/dl, respectively. Lancets and other supplies and equipment used during collection of samples were disposed of safely, usually by taking the materials to a nearby health facility that uses proper protocols for the disposal of biohazardous waste. 1.4.3 HIV Testing The survey featured two forms of HIV testing. RDT was performed according to a national HIV testing algorithm for respondents who wished to be informed of their status, while DBS specimens were collected and transported to a central lab for anonymized testing. HIV prevalence for the survey will be based on the laboratory test results. The national RDT algorithm in Liberia consists of a screening RDT (Determine® HIV 1/2) followed by confirmatory testing of all reactive samples with a second RDT (SD Bioline HIV 1/2 3.0). If a respondent tested positive on the screening test and negative on the confirmatory test, a third tie-breaker test was performed (Uni-Gold™ HIV). To test respondents via RDT, a blood sample was collected directly from a finger prick using a sample collection device supplied with the test kit. 6 • Introduction and Survey Methodology Dedicated nurse counselors who provided pre- and post-test counseling conducted HIV rapid testing. Pretest counseling included an explanation of HIV infection and transmission, the meaning of test results, risks associated with sexual behaviors, and how to prevent and treat HIV and other sexually transmitted infections. Post-test counseling messages were tailored to respondents’ HIV results and risk profiles. The testing and delivery of results at home were done after creating conditions that would guarantee the confidentiality of the respondents. All respondents with HIV-seropositive results were referred to the nearest health facility for further care and treatment. For HIV testing using DBS samples, at the time of collection of the blood sample, a unique and random barcoded identification number was assigned to each respondent who consented to testing. Sheets of peel-off labels with unique barcodes were pre-printed for use in the field. Matching barcode labels were affixed to the Biomarker Questionnaire, a fresh filter paper card, and a DBS transmittal sheet. Approximately every 2 weeks, or more frequently, all DBS samples and transmittal sheets were picked up from teams in the field by central office coordinators and transported to the Liberia National Reference Laboratory (NRL) for processing and registration. Each specimen was then assigned a unique serial laboratory number during the registration process at the lab before being stored in a freezer for preservation. The DBS laboratory testing is scheduled to be conducted at NRL; these results were not available at the time of publication of this report. When testing is completed, results will be published in an annex to this report. 1.5 PRETEST Fifteen participants (nine women and six men) took part in training to pretest the LDHS survey questionnaires over a 4-week period from June 17 to July 13, 2019. The pretest training utilized a blended approach to train participants concurrently on the paper questionnaires and on CAPI, an electronic data capture system programmed on tablet computers that the participants used to implement the survey. LISGIS personnel and staff from The DHS Program led the classroom portion of the training together in standard English and Liberian English from June 17 to July 8. In addition, specialists from the MOH, UNFPA, and UNICEF were invited to make short presentations on programs in Liberia that provide services in the areas of family planning, reproductive health, HIV/AIDS and other STIs, childhood immunization, and domestic violence. Speakers from the CDC were also invited to deliver a lecture on Ebola in Liberia. Six participants attended the LDHS biomarker training from July 1-8. The training utilized a variety of different learning tools such as formal lectures on the technical aspects of biomarker collection, descriptions of the target population and eligibility, videos to demonstrate the process of anthropometry and blood collection, and hands-on demonstrations. In addition to the above-mentioned training, biomarker technicians participated in an anthropometry standardization exercise, a health clinic visit, and 4 days of field practice. Staff from The DHS Program supported follow-up survey training for nine participants that ran concurrently with the LDHS biomarker technician training. On July 9, to improve team coordination, all LDHS pretest training participants (supervisors, interviewers, and biomarker technicians for both the standard and follow-up surveys) were divided into three teams that mirrored the team composition proposed for the actual fieldwork and simulated all components of the 2019-20 LDHS data collection in the LISGIS training hall. The team supervisors also simulated the interaction and handoff of survey materials to the follow-up team supervisors. Introduction and Survey Methodology • 7 From July 10-13, interviewers and biomarker technicians conducted practice fieldwork to solidify skills learned during pretest training and to provide a simulated fieldwork experience to test survey materials. The participants worked in the same three teams as in the simulation. The standard LDHS teams were composed of one male or female supervisor, three female interviewers, one male interviewer, and two biomarker technicians. The follow-up survey teams joined the fieldwork practice on days 3 and 4. The practice occurred in three communities (one urban and two rural) that were not far from the training venue. Each team visited one community, which served as a practice mini-cluster of 15 households. To complete the fieldwork, each interviewer had to complete at least one household interview per day. While the interviewers recorded responses on tablet computers using CAPI, the Biomarker Questionnaires were first filled out on paper and later entered into the CAPI system by the interviewers. Most interviews were conducted in Liberian English. Over the course of field practice, 40 households and 57 individual women and men were interviewed. At the end of each day, both during and after the pretest fieldwork, debriefing sessions were held and questionnaires were modified based on lessons drawn from the exercise. 1.6 TRAINING OF FIELD STAFF Ninety-five people (37 men and 58 women) attended the training on the questionnaire content, which consisted of lectures, demonstrations, and practice interviews. Thirty-eight LDHS biomarker technicians (11 male and 27 female) attended a parallel training course on conducting biomarker tests. A follow-up survey training course was also held in parallel. The main fieldwork training, conducted from September 2-28, 2019, was led by eight LISGIS coordinators with assistance from six training assistants selected from the pretest exercise. The training was backstopped by staff from The DHS Program. The interviewer training was conducted in standard English, with portions in Liberian English, and sessions discussed concepts, procedures, and methodologies related to conducting the survey. As in the pretest training, the main fieldwork training utilized a blended approach to train participants on the paper questionnaires and CAPI concurrently. Again, senior subject specialists from the MOH, UNFPA, and UNICEF were invited to make short presentations on programs in Liberia that provide services in the areas of family planning and reproductive health, HIV/AIDS and other STIs, childhood immunization, and domestic violence, and representatives from the CDC delivered a lecture on Ebola in Liberia. The training included presentations, lectures, hands-on exercises, mock interviews, roleplays, group work, and quizzes. In-class exercises included probing for age, checking age consistencies, copying information from vaccination cards, completing the reproductive calendar, and practicing interviews. All participants also received training on how to test household salt for iodine. Data processing staff from The DHS Program and information technology (IT) personnel from LISGIS led all sessions on CAPI. Participants learned about features of the data collection system, different scenarios and technical issues typically encountered during fieldwork, and ways to resolve issues. The biomarker portion of the main fieldwork training ran from September 9-28. This training was led by staff from The DHS Program with assistance from LISGIS coordinators and training assistants. Staff members from the Liberia National AIDS Control Program supported the HIV portion of the training. Biomarker training included classroom instruction that focused on anthropometry measurements, anemia and HIV testing, appropriate procedures for obtaining informed consent, recording of biomarker information in the Biomarker Questionnaire, reporting test results back to respondents with referrals as needed, and pre- and post-test counseling for HIV. The facilitators used learning tools similar to those used during the pretest, including two anthropometry standardization exercises, a health clinic visit, and 4 days of field practice. 8 • Introduction and Survey Methodology The training of follow-up survey staff was held in concurrence with the biomarker training and was led by the CDC and WHO, with occasional assistance from The DHS Program. On the last 2 days of the classroom portion of the training, supervisors, interviewers, and biomarker technicians were divided into 19 fieldwork teams. The teams then simulated all components of the 2019-20 LDHS data collection on September 20 and 21. The team supervisors also simulated the handoff of materials to the follow-up team supervisors. A joint classroom session of the biomarker technicians with the interviewers was also organized. All participants were given an overview of biomarker collection in the 2019-20 LDHS. This described eligibility for biomarker collection, use of the Household and Biomarker Questionnaires to record data, appropriate procedures for obtaining informed consent, supply packing and transportation logistics, and how to facilitate intra-team coordination and cooperation. A 1-day training session for supervisors was held to cover topics including preparation for the practice fieldwork, team and workflow management, monitoring of data collection and biomarker procedures, and conducting quality control checks on the survey questionnaires. The CDC presented background on the follow- up team objectives and work and provided guidance on how the two teams should communicate and cooperate. Throughout the training, participants were evaluated through in-class exercises, quizzes, and observations made during field practice. At the end of the training, teams were formed by selecting supervisors, interviewers, and biomarker technicians. From September 24-28, interviewers and biomarker technicians conducted practice fieldwork to solidify skills learned during the training and to provide a simulated fieldwork experience to test survey materials. The practice occurred in five communities in Margibi County, two of which were urban and three of which were rural. The five communities were divided into 19 mini-clusters of 10 households each. Each team was assigned a mini-cluster. To complete the fieldwork, each interviewer had to complete at least one household per day. All of the interviewers/supervisors had the opportunity to practice household and individual interviews, while the biomarker technicians practiced testing and measuring eligible household members. On average, each interviewer interviewed 2.5 households, female interviewers completed 4.4 interviews with women, and male interviewers completed 6.5 interviews with men. Feedback was provided during the exercise and debriefs. All teams successfully closed their clusters and sent the data to the central office. The follow-up teams also visited the same five communities after practicing the survey questionnaire handoff. As part of the practice fieldwork, the follow-up teams administered consent for collection of venous blood from consenting eligible respondents. On September 28, the teams came together for a final debriefing session to provide feedback about the questionnaires, the CAPI system, interviewer/biomarker technician interchanges, language issues, field procedures, and any other issues encountered during the field exercise. The DHS Program and LISGIS addressed all issues and remaining questions before fieldwork launched. 1.7 FIELDWORK Data collection, which ran from October 16, 2019, to February 12, 2020, was carried out by 17 teams, with each team consisting of six members typically featuring the following composition: one supervisor, three female interviewers, one male interviewer, and two biomarker technicians. Introduction and Survey Methodology • 9 All 17 teams were scheduled to deploy to the field on October 2; after an unanticipated delay, fieldwork began on October 16. The nine follow-up survey teams began fieldwork 2 weeks later. To ensure that all aspects of the survey were still well understood among fieldworkers, a series of refresher training sessions were held on October 7, 13, and 14. Fieldwork monitoring was an integral part of the LDHS. Coordinators from LISGIS, monitoring assistants (previously training assistants) hired by LISGIS, and USAID Liberia senior staff visited teams regularly to review their work and monitor data quality. LISGIS organized coordinators and two biomarker monitoring assistants to visit teams, resolve any issues that arose in teams accessing clusters, monitor data and biomarker collection and quality, distribute supplies, and collect DBS cards from teams and drop them off at the NRL. Fieldwork monitoring assistants, on the other hand, moved from team to team in the field and closely monitored data collection and data quality, as well as supporting technological and technical aspects of fieldwork. LISGIS IT staff were deployed to teams on an as-needed basis to resolve complex CAPI-related issues, and two biomarker monitors observed biomarker collection over the course of the fieldwork. The DHS Program resident advisor monitored data collection and biomarker collection for the first half of data collection. Two additional fieldwork monitoring visits by staff from The DHS Program were made from December 11-21 and January 16-31. During field visits, monitors provided the teams they visited with critical feedback to improve their performance. All monitors used the LDHS field-check tables as well as data quality and fieldwork status reports, based on data from completed clusters, to illustrate problems specific to each team visited. 1.8 DATA PROCESSING Data processing for the 2019-20 LDHS began a few days after fieldwork started. As data collection was completed for each cluster, team supervisors transferred all electronic data files to the LISGIS central office in Monrovia via the Internet File Streaming System (IFSS), where they were stored on a password-protected computer. IFSS automatically encrypts the data and sends the data to a server, which in turn downloads the data to the data processing supervisor’s password-protected computer in the central office. These data files were registered and checked for inconsistencies, incompleteness, and outliers. Field supervisors were alerted of and resolved any errors any issues found. The LISGIS data processing operation also included secondary editing, which required resolution of computer- identified inconsistencies and coding of open-ended questions. The data were processed by the LISGIS data processing manager and two secondary editors who took part in the pretest and main fieldwork training; they were supervised remotely by staff from The DHS Program. Data editing was accomplished using Censuses and Survey Processing (CSPro) software. Biomarker paper questionnaires were compared with electronic data files to check for any inconsistencies in data entry. Daily generation of check reports in addition to weekly generation of field-check tables allowed for effective monitoring. Specific feedback was given to the teams to improve their performance. Secondary editing and data processing were initiated in October 2019 and completed in March 2020. 1.9 RESPONSE RATES Table 1.1 shows response rates for the 2019-20 LDHS. All 9,745 households in the selected housing units were eligible for the survey, and 9,207 of these households were occupied. Of the occupied households, 9,068 were successfully interviewed, yielding a response rate of 99%. Of the successful household interviews, 5,192 were completed in 2019 and 3,876 in 2020. 10 • Introduction and Survey Methodology In the interviewed households, 8,364 women age 15-49 were identified for individual interviews; 8,065 women were interviewed, yielding a response rate of 96%. A total of 4,527 men were eligible for individual interviews; 4,249 of these men were interviewed, producing a response rate of 94%. Table 1.1 Results of the household and individual interviews Number of households, number of interviews, and response rates, according to residence (unweighted), Liberia DHS 2019- 20 Residence Total Result Total Urban Greater Monrovia Other Urban Rural Household interviews Households selected 3,605 991 2,614 6,140 9,745 Households occupied 3,401 929 2,472 5,806 9,207 Households interviewed 3,321 887 2,434 5,747 9,068 Household response rate1 97.6 95.5 98.5 99.0 98.5 Interviews with women age 15-49 Number of eligible women 3,463 970 2,493 4,901 8,364 Number of eligible women interviewed 3,338 917 2,421 4,727 8,065 Eligible women response rate2 96.4 94.5 97.1 96.4 96.4 Household interviews in subsample Households selected 1,803 495 1,308 3,072 4,875 Households occupied 1,692 461 1,231 2,901 4,593 Households interviewed 1,650 436 1,214 2,868 4,518 Household response rate in subsample1 97.5 94.6 98.6 98.9 98.4 Interviews with men age 15-59 Number of eligible men 1,683 478 1,205 2,844 4,527 Number of eligible men interviewed 1,563 415 1,148 2,686 4,249 Eligible men response rate2 92.9 86.8 95.3 94.4 93.9 1 Households interviewed/households occupied 2 Respondents interviewed/eligible respondents Housing Characteristics and Household Population • 11 HOUSING CHARACTERISTICS AND HOUSEHOLD POPULATION 2 Key Findings ▪ Drinking water: 84% of households have access to an improved source of drinking water. ▪ Sanitation: 47% of households in Liberia use improved toilet facilities. ▪ Electricity: 24% of households have access to electricity (39% of urban households and 4% of rural households). ▪ Birth registration: 66% of children under age 5 have their births registered with the civil authorities. ▪ Education: 41% of females and 30% of males age 6 and older have no formal education. nformation on the socioeconomic characteristics of the household population in the 2019-20 LDHS provides a context to interpret demographic and health indicators and can furnish an approximate indication of the representativeness of the survey. In addition, this information sheds light on the living conditions of the population. This chapter presents information on sources of drinking water, sanitation, exposure to smoke inside the home, wealth, handwashing, household population and composition, educational attainment, school attendance, birth registration, and family living arrangements. 2.1 DRINKING WATER SOURCES AND TREATMENT Improved sources of drinking water Include piped water, public taps, standpipes, tube wells, boreholes, hand pumps, protected dug wells and springs, rainwater, water delivered via a tanker truck or a cart with a small tank, and bottled water. Sample: Households Universal access to clean water and sanitation is one of the 17 global goals that make up the 2030 Agenda for Sustainable Development. To achieve progress towards this goal, an integrated approach across various sectors is crucial. I http://www.undp.org/content/undp/en/home/mdgoverview/post-2015-development-agenda/ http://www.undp.org/content/undp/en/home/mdgoverview/post-2015-development-agenda/ 12 • Housing Characteristics and Household Population Table 2.1.1 includes a number of indicators regarding household and population access to improved drinking water. In Liberia, 84% of households have access to an improved water source (95% in urban areas and 69% in rural areas). The most common sources of drinking water in urban households are hand pumps, tube wells, or boreholes (48%); bottled water or mineral water in sachets (30%); and protected dug well (6%). Rural households obtain their drinking water mainly from hand pumps, tube wells, or boreholes (63%) and protected dug wells (2%). Figure 2.1 shows that 31% of rural households obtain their drinking water from an unimproved source, as compared with 5% of urban households. Across counties, access to an improved source of drinking water is lowest in River Cess (52%) and highest in Grand Gedeh and Montserrado (96% each). The percentage of households with an unimproved source of drinking water decreases with increasing wealth (Table 2.1.2). Trends: The percentage of households with an improved source of drinking water has increased over time, from 68% in 2007 to 84% in 2019-20. Basic drinking water service Drinking water from an improved source, provided either water is on the premises or round-trip collection time is 30 minutes or less. Sample: De jure population Limited drinking water service Drinking water from an improved source, and round-trip collection time is more than 30 minutes. Sample: De jure population In Liberia, 74% of the de jure population has basic drinking water service, and 10% has limited drinking service (Table 2.1.1). Access to basic drinking water service ranges from 50% in River Cess to 91% in Grand Gedeh and increases with increasing wealth (Table 2.1.2). Most Liberian households (73%) do not treat their water prior to drinking. A quarter of households (25%) use an appropriate treatment method (28% in urban areas and 21% in rural areas). Appropriate treatment methods include boiling, bleaching, PUR™, WaterGuard™, filtering, and solar disinfecting (Table 2.1.3). Table 2.2 presents information on the percentage of households using piped water or water from a tube well or borehole that reported availability of water in the last 2 weeks. Seventy-six percent of households in Liberia reported having water with no interruption of at least 1 day in the 2 weeks before the survey. Eighty-one percent of rural households had availability with no interruption of at least 1 day, as compared with 72% of Figure 2.1 Household drinking water by residence 3 5 13 5 1 54 48 63 5 7 4 16 5 31 Total Urban Rural Percent distribution of households by source of drinking water Unimproved source Protected well or spring Hand pump, tube well, or borehole Public tap/ standpipe Piped water into dwelling/yard/plot/ neighbor’s yard Housing Characteristics and Household Population • 13 urban households. Urban households were more likely than rural households to report not having water available for at least 1 day (27% and 18%, respectively). 2.2 SANITATION Improved toilet facility Includes flush/pour flush toilets that flush water and waste to a piped sewer system, septic tank, pit latrine, or unknown destination; ventilated improved pit (VIP) latrines; pit latrines with slabs; or composting toilets. Sample: Households Forty-seven percent of households in Liberia use improved toilet facilities (66% in urban areas and 21% in rural areas) (Figure 2.2). Flush or pour flush toilets that flush to a septic tank are the most common type of improved sanitation facility (Table 2.3.1). About 2 in 10 households (17%) use unimproved toilet facilities. Overall, 63% of rural households have no toilet facility, as compared with 16% of urban households. Trends: The percentage of households with access to improved sanitation increased from 28% in 2007 to 47% in 2019-20. Basic sanitation service Use of improved facilities that are not shared with other households. Sample: De jure population Limited sanitation service Use of improved facilities shared by two or more households. Sample: De jure population Seventy-two percent of households in Liberia have their toilet facility in their own dwelling, yard, or plot. One in five (20%) households have basic sanitation service (29% of urban households and 8% of rural households), while 27% have limited sanitation (Table 2.3.1). The percentage of the population with basic and limited sanitation service is highest in Montserrado (38% and 33%, respectively) and lowest in Grand Kru (3% and 6%, respectively) (Table 2.3.2). Access to basic sanitation service rises with increasing wealth. 2.3 EXPOSURE TO SMOKE INSIDE THE HOME Exposure to smoke inside the home, from either cooking with solid fuels or smoking tobacco, has potentially harmful health effects. In Liberia, 16% of households cook inside the home and 96% use solid fuel for cooking, with wood and fire coal/charcoal being predominant (49% and 47%, respectively). Only 1% of households use clean fuel for cooking. In 7% of households, someone smokes inside the house daily (Table 2.4). Figure 2.2 Household toilet facilities by residence 47 66 21 17 19 16 36 16 63 Total Urban Rural Percent distribution of households by type of toilet facilities No facility/ bush/field Unimproved facility Improved facility 14 • Housing Characteristics and Household Population Other Housing Characteristics The 2019-20 LDHS also collected data on access to electricity, flooring materials, and the number of rooms used for sleeping. Twenty-four percent of households in Liberia have access to electricity (39% of urban households and 4% of rural households). The flooring materials most commonly used are concrete or cement (49%) and earth, sand, or mud (41%). Flooring materials vary widely by residence, with 70% of rural households using earth, sand, or mud and 66% of urban households using concrete or cement (Table 2.4). 2.4 HOUSEHOLD WEALTH 2.4.1 Household Durable Goods Possession of durable consumer goods is an indicator of a household’s wealth. The survey collected information on household effects, ownership of means of transport, and ownership of agricultural land and farm animals (Table 2.5). Urban households generally are more likely to own various household effects; for example, 84% of urban households own a mobile phone, as compared with 50% of rural households. Rural households are more likely to own agricultural land (45%) and farm animals (53%) than urban households (20% and 24%, respectively). 2.4.2 Wealth Index Wealth index Households are given scores based on the number and kinds of consumer goods they own, ranging from a television to a bicycle or car, and housing characteristics such as source of drinking water, toilet facilities, and flooring materials. These scores are derived using principal component analysis. National wealth quintiles are compiled by assigning the household score to each usual (de jure) household member, ranking each person in the household population by her or his score, and then dividing the distribution into five equal categories, each comprising 20% of the population. Sample: Households Table 2.6 presents wealth quintiles according to urban- rural residence and region. The table also includes the Gini coefficient, a measure of disparity in wealth. The Gini coefficient ranges from 0-1, with 0 implying an equal distribution of wealth and 1 implying an unequal distribution. About two-thirds of the de jure population (65%) in urban areas are in the highest wealth quintile, in sharp contrast to 2% in rural areas. Seventy-five percent of households in rural areas are in the lowest or second lowest wealth quintile (39% and 36%, respectively) (Figure 2.3). Among the counties, Montserrado has the highest percentage of households in the highest wealth quintile (49%), while Gbarpolu, Grand Kru, and Lofa have the lowest (2% each). Figure 2.3 Household wealth by residence 13 39 17 36 42 19 63 4 65 2 Urban Rural Percent distribution of de jure population by wealth quintiles Wealthiest Fourth Middle Second Poorest Housing Characteristics and Household Population • 15 2.5 HANDWASHING Interviewers asked to see the place used for handwashing in each household. Overall, interviewers observed such a place for 20% of the de jure population. Among the de jure population for whom the place for handwashing was observed, 29% had water available and 23% had soap (Table 2.7). 2.6 HOUSEHOLD POPULATION AND COMPOSITION Household A person or group of related or unrelated persons who live together in the same dwelling unit(s), who acknowledge one adult male or female as the head of the household, who share the same housekeeping arrangements, and who are considered a single unit. De facto population All persons who stayed in the selected households the night before the interview (whether usual residents or visitors). De jure population All persons who are usual residents of the selected households, whether or not they stayed in the household the night before the interview. How data are calculated All tables are based on the de facto population unless otherwise specified. Household composition and population data provide information on the socioeconomic characteristics of the households and respondents surveyed in terms of age, sex, and place of residence. A total of 40,202 individuals stayed overnight in the 9,068 interviewed households; 19,618 of these individuals were male and 20,584 were female. Forty-five percent of household members are age 0-14 and 51% are age 15-64; only 4% of household members are age 65 and above (Table 2.8). The population pyramid in Figure 2.4 shows the de facto household population by 5-year age groups and sex. The broad base of the pyramid shows that a large proportion of Liberia’s population is relatively young. Table 2.9 shows that women head about one in every three households (34%). The average household size is 4.6 persons. Thirty-six percent of Liberian households are caring for foster and/or orphaned children. Figure 2.4 Population pyramid 10 6 2 2 6 10 <5 5-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65-69 70-74 75-79 80+ Age Percent distribution of the household population Male Female 2610 16 • Housing Characteristics and Household Population 2.7 CHILDREN’S LIVING ARRANGEMENTS AND PARENTAL SURVIVAL Orphan A child with one or both parents who are dead. Sample: Children under age 18 Twenty-seven percent of children under age 18 do not live with a biological parent, while 9% are orphans (i.e., one or both parents are dead). Among children less than age 2, 5% were not living with their parents at the time of the interview, and 2% had lost one or both parents. The percentage of children who are orphans rises with age, from 4% among those age 2-4 to 17% among those age 15-17. By county, the percentage of children who are orphans is highest in Bomi (14%) and lowest in Sinoe (4%) (Table 2.10). Trends: The percentage of children under age 18 living with both parents has decreased over time, from 47% in 2007 to 41% in 2019-20. 2.8 BIRTH REGISTRATION Birth registration, the documentation of the facts of each birth into an official logbook kept at the registrar’s office, is fundamental to providing children with a legal identity. Not only does it help to uphold their access to fundamental rights, including education and health care, but it also protects them from abuse, such as child marriage or child labor. Registered birth Child has a birth certificate or child does not have a birth certificate, but his/her birth is registered with the civil authorities. Sample: De jure children under age 5 Housing Characteristics and Household Population • 17 Table 2.11 presents information on birth registration of children under age 5. Sixty-six percent of children under age 5 have their births registered with the civil authorities. About one in three (30%) of these children have birth certificates. Children in urban areas are more likely than rural children to have their births registered (69% versus 63%). Figure 2.5 shows large variations by county in the percentage of children whose births are registered with the civil authorities. Lofa (85%) has the highest percentage of registered births, while River Gee (33%) has the lowest. Trends: The proportion of de jure children whose births are registered has increased substantially from 4% in 2007 to 66% in 2019- 20. 2.9 EDUCATION 2.9.1 Educational Attainment Median educational attainment Half of the population has completed less than the median number of years of schooling, and half of the population has completed more than the median number of years of schooling. Sample: De facto household population age 6 and older Many Liberians have either no formal education or only some elementary education (Tables 2.12.1 and 2.12.2). Forty-one percent of females and 30% of males age 6 and older have never had any formal education. Twenty-nine percent of females and 27% of males have not completed elementary schooling. Three percent of females and males have completed elementary school. Only 5% of women and 8% of men have completed senior high school. Women have completed a median of 1 year of school, while men have completed a median of 3.5 years. Trends: The percentage of males age 6 and older with no education declined from 39% in 2007 to 30% in 2019-20. Among females, the percentage decreased from 56% to 41%. Patterns by background characteristics ▪ Urban residents are more educated than rural residents. Thirty-one percent of females age 6 and older in urban areas have no education, as compared with 57% in rural areas. Among males, the corresponding percentages are 21% and 41% (Tables 2.12.1 and 2.12.2). ▪ The median number of years of education is highest in Montserrado (4.6 years among women and 6.4 among men). Figure 2.5 Birth registration by county Percentage of de jure children under age 5 whose births are registered with the civil authorities 18 • Housing Characteristics and Household Population ▪ Twelve percent of women in the highest wealth quintile have attained a higher education, while 18% have no education. On the contrary, 65% of women in the lowest quintile have no education and less than 1% have attained a higher education. 2.9.2 School Attendance Net attendance ratio (NAR) Percentage of the school-age population that attends primary or secondary school. Sample: Children age 6-11 for primary school NAR and children age 12-17 for secondary school NAR Gross attendance ratio (GAR) The total number of children attending primary school divided by the official primary school-age population and the total number of children attending secondary school divided by the official secondary school-age population. Sample: Children age 6-11 for primary school GAR and children age 12-17 for secondary school GAR In Liberia, the primary school net attendance ratio (NAR) for the population age 6-11 is 43% (41% for girls and 45% for boys). The high school NAR drops to 26% (25% for boys and 26% for girls) (Table 2.13). The gross attendance ratio (GAR) is also presented in Table 2.13. A GAR value of more than 100% means that a significant number of students fall outside the official age range for that level of education. Overall, in Liberia, the GAR is 91% at the primary level, and there is no difference based on gender (91% for both boys and girls). The GAR drops to 52% at the secondary level; however, there is still little difference between boys and girls (52% and 51%, respectively). Gender parity index (GPI) The ratio of female to male students attending primary school and the ratio of female to male students attending secondary school. The index reflects the magnitude of the gender gap. Sample: Primary school students and secondary school students A GPI of 1 indicates parity or equality between male and female school participation ratios. A GPI of less than 1 indicates a higher proportion of males than females attending the specified level of schooling, while a GPI greater than 1 indicates that more females attend the specific level of schooling. In Liberia, the GPI based on the GAR is 0.99 at both the primary school and secondary school levels. Housing Characteristics and Household Population • 19 Patterns by background characteristics ▪ By county, the primary school net attendance ratio (NAR) ranges from 26% in River Cess to 57% in Montserrado. ▪ The variation in secondary school NARs by residence is large, with a difference of 22 percentage points between urban (34%) and rural (12%) areas. ▪ Forty-five percent of girls in the highest wealth quintile attend secondary school, as compared with 6% of those in the lowest wealth quintile. Boys follow a similar pattern, with 49% in the highest quintile and 5% in the lowest quintile attending secondary school (Figure 2.6). LIST OF TABLES For more information on household population and housing characteristics, see the following tables: ▪ Table 2.1.1 Household drinking water ▪ Table 2.1.2 Drinking water according to region and wealth ▪ Table 2.1.3 Treatment of household drinking water ▪ Table 2.2 Availability of water ▪ Table 2.3.1 Household sanitation facilities ▪ Table 2.3.2 Sanitation facility type according to region and wealth ▪ Table 2.4 Household characteristics ▪ Table 2.5 Household possessions ▪ Table 2.6 Wealth quintiles ▪ Table 2.7 Handwashing ▪ Table 2.8 Household population by age, sex, and residence ▪ Table 2.9 Household composition ▪ Table 2.10 Children’s living arrangements and orphanhood ▪ Table 2.11 Birth registration of children under age 5 ▪ Table 2.12.1 Educational attainment of the female household population ▪ Table 2.12.2 Educational attainment of the male household population ▪ Table 2.13 School attendance ratios Figure 2.6 Secondary school attendance by household wealth 6 9 18 35 45 5 10 16 37 49 Lowest Second Middle Fourth Highest Net attendance ratio for secondary school among children age 12-17 Girls Boys WealthiestPoorest 20 • Housing Characteristics and Household Population Table 2.1.1 Household drinking water Percent distribution of households and de jure population by source of drinking water and by time to obtain drinking water, percentage of households and de jure population with basic drinking water service, and percentage with limited drinking water service, according to residence, Liberia DHS 2019-20 Households Population Characteristic Urban Rural Total Urban Rural Total Source of drinking water Improved source 95.3 68.9 84.0 95.0 70.7 84.6 Piped into dwelling/yard/plot 0.9 0.3 0.7 1.4 0.4 1.0 Piped to neighbor 4.2 0.3 2.5 3.7 0.3 2.2 Public tap/standpipe 5.0 0.9 3.3 4.9 0.9 3.2 Tube well/borehole/hand pump 48.4 62.5 54.4 53.4 64.6 58.1 Protected dug well 6.0 2.4 4.5 6.5 2.3 4.7 Protected spring 0.5 1.3 0.8 0.6 1.3 0.9 Rainwater 0.1 0.3 0.2 0.1 0.2 0.2 Tanker truck/cart with small tank 0.7 0.1 0.4 0.7 0.1 0.4 Bottled water/mineral water in sachet 29.5 0.8 17.2 23.8 0.6 13.9 Unimproved source 4.7 31.1 16.0 5.0 29.3 15.4 Unprotected dug well 3.0 7.7 5.0 3.2 7.1 4.8 Unprotected spring 1.0 6.1 3.2 1.3 6.5 3.5 Surface water 0.7 17.3 7.8 0.5 15.8 7.0 Total 100.0 100.0 100.0 100.0 100.0 100.0 Time to obtain drinking water (round trip) Water on premises1 28.0 7.6 19.3 26.7 7.6 18.6 30 minutes or less 60.2 82.4 69.7 60.1 81.6 69.2 More than 30 minutes 10.3 8.7 9.6 11.4 9.6 10.6 Don’t know 1.4 1.3 1.4 1.8 1.1 1.5 Total 100.0 100.0 100.0 100.0 100.0 100.0 Percentage with basic drinking water service2 84.3 61.8 74.7 82.7 63.0 74.3 Percentage with limited drinking water service3 11.0 7.1 9.3 12.3 7.7 10.3 Number of households/population 5,195 3,873 9,068 23,855 17,651 41,506 1 Includes water piped to a neighbor and those reporting a round-trip collection time of zero minutes 2 Defined as drinking water from an improved source, provided either water is on the premises or round-trip collection time is 30 minutes or less. Includes safely managed drinking water, which is not shown separately. 3 Drinking water from an improved source, and round-trip collection time is more than 30 minutes or is unknown Housing Characteristics and Household Population • 21 Table 2.1.2 Drinking water according to region and wealth Percent distribution of de jure population by drinking water source, percentage of de jure population with basic drinking water service, and percentage with limited drinking water service, according to region, county, and wealth quintile, Liberia DHS 2019-20 Background characteristic Improved source of drinking water1 Unimproved source of drinking water2 Total Percentage with basic drinking water service3 Percentage with limited drinking water service4 Number of persons Region North Western 82.6 17.4 100.0 73.1 9.5 3,496 South Central 89.7 10.3 100.0 78.1 11.6 18,776 South Eastern A 73.1 26.9 100.0 69.9 3.2 2,597 South Eastern B 83.1 16.9 100.0 70.9 12.2 2,420 North Central 80.8 19.2 100.0 71.0 9.8 14,217 County Bomi 92.1 7.9 100.0 85.1 7.0 1,344 Bong 78.1 21.9 100.0 62.8 15.3 4,061 Gbarpolu 64.9 35.1 100.0 56.8 8.1 677 Grand Bassa 56.0 44.0 100.0 54.1 1.9 2,356 Grand Cape Mount 82.0 18.0 100.0 69.6 12.4 1,474 Grand Gedeh 96.0 4.0 100.0 90.9 5.1 923 Grand Kru 66.7 33.3 100.0 54.7 12.0 755 Lofa 79.0 21.0 100.0 70.2 8.8 3,538 Margibi 86.4 13.6 100.0 76.6 9.8 2,301 Maryland 90.5 9.5 100.0 78.0 12.5 1,160 Montserrado 95.9 4.1 100.0 82.3 13.6 14,119 Nimba 83.4 16.6 100.0 76.5 6.9 6,617 River Cess 52.1 47.9 100.0 50.3 1.7 648 River Gee 90.8 9.2 100.0 79.0 11.7 504 Sinoe 65.8 34.2 100.0 63.2 2.5 1,026 Wealth quintile Lowest 54.1 45.9 100.0 48.6 5.5 8,285 Second 82.5 17.5 100.0 75.0 7.5 8,305 Middle 91.5 8.5 100.0 79.9 11.7 8,307 Fourth 96.9 3.1 100.0 80.7 16.3 8,298 Highest 98.0 2.0 100.0 87.2 10.8 8,311 Total 84.6 15.4 100.0 74.3 10.3 41,506 1 See Table 2.1.1 for definition of an improved source. 2 See Table 2.1.1 for definition of an unimproved source. 3 Defined as drinking water from an improved source, provided either water is on the premises or round-trip collection time is 30 minutes or less. Includes safely managed drinking water, which is not shown separately. 4 Drinking water from an improved source, and round-trip collection time is more than 30 minutes or is unknown 22 • Housing Characteristics and Household Population Table 2.1.3 Treatment of household drinking water Percentage of households and de jure population using various methods to treat drinking water, and percentage using an appropriate treatment method, according to residence, Liberia DHS 2019-20 Households Population Water treatment method Urban Rural Total Urban Rural Total Boil 0.5 0.3 0.4 0.4 0.3 0.4 Bleach/chlorine added 22.3 15.4 19.3 22.6 15.2 19.5 PURTM 0.0 0.0 0.0 0.0 0.0 0.0 WaterGuardTM 6.1 2.9 4.8 6.9 2.9 5.2 Strain through a cloth 0.1 0.3 0.2 0.1 0.3 0.2 Ceramic, sand, or other filter 1.0 3.0 1.9 1.3 3.0 2.0 Solar disinfection 0.1 0.1 0.1 0.0 0.1 0.1 Let stand and settle 0.9 2.2 1.5 1.0 2.1 1.5 Other 0.0 0.2 0.1 0.0 0.2 0.1 No treatment 70.4 76.4 72.9 69.3 76.5 72.4 Don’t know 0.0 0.2 0.1 0.0 0.2 0.1 Percentage using an appropriate treatment method1 28.0 20.8 24.9 29.0 20.7 25.4 Number of households/population 5,195 3,873 9,068 23,855 17,651 41,506 Note: Respondents may report multiple treatment methods, so the sum of treatment may exceed 100%. 1 Appropriate water treatment methods are boiling, bleaching, PURTM, WaterGuardTM, filtering, and solar disinfecting. Table 2.2 Availability of water Percent distribution of households and de jure population using piped water or water from a tube well or borehole by availability of water in the last 2 weeks, according to residence, Liberia DHS 2019-20 Households Population Availability of water in last 2 weeks Urban Rural Total Urban Rural Total Not available for at least 1 day 27.3 18.3 23.7 25.3 19.4 22.9 Available with no interruption of at least 1 day 72.1 81.3 75.9 74.2 80.3 76.6 Don’t know 0.6 0.3 0.5 0.6 0.3 0.5 Total 100.0 100.0 100.0 100.0 100.0 100.0 Number of households/population using piped water or water from a tube well1 3,617 2,491 6,108 17,309 11,725 29,035 1 Includes households/population reporting piped water or water from a tube well or borehole as their main source of drinking water and households/population reporting bottled water or mineral water from sachets as their main source of drinking water if their main source of water for cooking and handwashing is piped water or water from a tube well or borehole Housing Characteristics and Household Population • 23 Table 2.3.1 Household sanitation facilities Percent distribution of households and de jure population by type of toilet/latrine facilities, percent distribution of households and de jure population with a toilet/latrine facility by location of the facility, percentage of households and de jure population with basic sanitation service, and percentage with limited sanitation service, according to residence, Liberia DHS 2019-20 Households Population Type and location of toilet/latrine facility Urban Rural Total Urban Rural Total Improved sanitation facility 65.5 21.1 46.5 66.6 22.0 47.6 Flush/pour flush to piped sewer system 1.7 0.2 1.1 1.4 0.2 0.9 Flush/pour flush to septic tank 43.0 5.7 27.1 43.5 6.3 27.7 Flush/pour flush to pit latrine 9.5 4.1 7.2 10.3 4.6 7.9 Flush/pour flush, don’t know where 0.2 0.1 0.1 0.2 0.1 0.2 Ventilated improved pit (VIP) latrine 3.0 1.6 2.4 2.9 1.5 2.3 Pit latrine with slab 7.8 8.7 8.2 8.1 8.6 8.3 Composting toilet 0.3 0.7 0.4 0.3 0.6 0.4 Unimproved sanitation facility 18.8 15.5 17.4 17.8 17.4 17.6 Flush/pour flush not to sewer/septic tank/pit latrine 1.7 0.6 1.2 1.5 0.6 1.1 Pit latrine without slab/open pit 9.3 12.9 10.9 9.4 14.3 11.5 Bucket 0.6 0.1 0.4 0.6 0.2 0.4 Hanging toilet/hanging latrine 7.0 1.8 4.8 6.0 2.1 4.3 Other 0.3 0.1 0.2 0.2 0.1 0.2 Open defecation (no facility/bush/field) 15.7 63.4 36.1 15.7 60.7 34.8 Total 100.0 100.0 100.0 100.0 100.0 100.0 Number of households/population 5,195 3,873 9,068 23,855 17,651 41,506 Location of toilet facility In own dwelling 34.4 9.9 28.5 36.6 9.4 29.7 In own yard/plot 42.7 46.6 43.7 42.6 49.8 44.5 Elsewhere 22.8 43.4 27.9 20.7 40.7 25.9 Total 100.0 100.0 100.0 100.0 100.0 100.0 Number of households/population with a toilet/latrine facility 4,380 1,418 5,797 20,121 6,939 27,061 Percentage with basic sanitation service1 28.9 7.5 19.8 35.0 8.7 23.8 Percentage with limited sanitation service2 36.6 13.5 26.7 31.6 13.3 23.8 Number of households/population 5,195 3,873 9,068 23,855 17,651 41,506 1 Defined as use of improved facilities that are not shared with other households. Includes safely managed sanitation service, which is not shown separately. 2 Defined as use of improved facilities shared by 2 or more households 24 • Housing Characteristics and Household Population Table 2.3.2 Sanitation facility type according to region and wealth Percent distribution of de jure population by type of sanitation, percentage of de jure population with basic sanitation service, and percentage with limited sanitation service, according to region, county, and wealth quintile, Liberia DHS 2019-20 Type of sanitation Total Percentage with basic sanitation service3 Percentage with limited sanitation service4 Number of persons Background characteristic Improved sanitation facility1 Unimproved sanitation facility2 Open defecation Region North Western 26.7 11.5 61.8 100.0 9.3 17.4 3,496 South Central 64.7 14.3 21.0 100.0 35.2 29.5 18,776 South Eastern A 31.0 18.1 50.9 100.0 15.9 15.1 2,597 South Eastern B 26.3 40.7 33.0 100.0 9.8 16.6 2,420 North Central 36.8 19.4 43.8 100.0 16.1 20.6 14,217 County Bomi 23.9 12.0 64.1 100.0 12.0 11.9 1,344 Bong 36.9 13.6 49.5 100.0 19.0 17.9 4,061 Gbarpolu 19.4 10.4 70.2 100.0 6.0 13.4 677 Grand Bassa 34.9 11.8 53.2 100.0 17.1 17.8 2,356 Grand Cape Mount 32.6 11.5 55.9 100.0 8.3 24.3 1,474 Grand Gedeh 45.7 20.6 33.7 100.0 18.9 26.8 923 Grand Kru 8.0 35.6 56.4 100.0 2.5 5.5 755 Lofa 27.2 23.5 49.3 100.0 10.3 16.9 3,538 Margibi 52.6 12.4 35.0 100.0 34.9 17.7 2,301 Maryland 35.7 39.9 24.3 100.0 12.1 23.7 1,160 Montserrado 71.7 15.0 13.3 100.0 38.3 33.4 14,119 Nimba 41.8 20.8 37.4 100.0 17.5 24.3 6,617 River Cess 22.6 21.7 55.7 100.0 13.4 9.2 648 River Gee 32.2 50.2 17.7 100.0 15.3 16.9 504 Sinoe 23.0 13.7 63.3 100.0 14.8 8.2 1,026 Wealth quintile Lowest 8.7 12.8 78.4 100.0 1.9 6.9 8,285 Second 23.8 22.1 54.1 100.0 6.5 17.3 8,305 Middle 46.3 25.3 28.4 100.0 17.5 28.8 8,307 Fourth 69.9 19.2 10.9 100.0 28.8 41.1 8,298 Highest 89.2 8.5 2.3 100.0 64.2 24.9 8,311 Total 47.6 17.6 34.8 100.0 23.8 23.8 41,506 1 See Table 2.3.1 for definition of an improved facility. 2 See Table 2.3.1 for definition of an unimproved facility. 3 Defined as use of improved facilities that are not shared with other households. Includes safely managed sanitation service, which is not shown separately. 4 Defined as use of improved facilities shared by 2 or more households Housing Characteristics and Household Population • 25 Table 2.4 Household characteristics Percent distribution of households and de jure population by housing characteristics, percentage using solid fuel for cooking, percentage using clean fuel for cooking, and percent distribution by frequency of smoking in the home, according to residence, Liberia DHS 2019-20 Households Population Housing characteristic Urban Rural Total Urban Rural Total Electricity Yes 38.7 4.1 23.9 37.0 4.3 23.1 No 61.3 95.9 76.1 63.0 95.7 76.9 Total 100.0 100.0 100.0 100.0 100.0 100.0 Flooring material Earth/sand/mud 19.1 69.7 40.7 19.8 67.2 40.0 Dung 0.8 1.6 1.1 1.0 1.8 1.3 Wood planks 0.0 0.1 0.1 0.0 0.1 0.0 Palm/bamboo 0.0 0.0 0.0 0.0 0.0 0.0 Parquet or polished wood 0.0 0.0 0.0 0.0 0.0 0.0 Floormat/linoleum/vinyl 5.1 0.8 3.2 3.5 0.6 2.3 Ceramic tiles/terrazzo 9.3 1.2 5.9 11.1 1.3 6.9 Concrete/cement 65.7 26.6 49.0 64.5 29.0 49.4 Carpet 0.1 0.0 0.1 0.1 0.0 0.1 Total 100.0 100.0 100.0 100.0 100.0 100.0 Rooms used for sleeping One 41.6 28.9 36.2 28.6 18.7 24.4 Two 19.3 28.1 23.1 21.4 28.1 24.2 Three or more 39.1 43.0 40.8 50.1 53.2 51.4 Total 100.0 100.0 100.0 100.0 100.0 100.0 Place for cooking In the house 23.4 7.1 16.4 23.5 6.7 16.3 In a separate building 17.6 52.0 32.3 19.9 53.5 34.2 On a porch 33.9 11.6 24.4 33.8 10.4 23.8 Outdoors 21.3 28.0 24.2 21.6 29.0 24.7 No food cooked in household 3.7 1.0 2.5 1.2 0.2 0.8 Other 0.2 0.3 0.2 0.1 0.2 0.2 Total 100.0 100.0 100.0 100.0 100.0 100.0 Cooking fuel Electricity 1.0 0.0 0.6 0.8 0.1 0.5 Gas cylinder 0.8 0.3 0.5 0.7 0.2 0.5 Kerosene stove 0.4 0.0 0.3 0.4 0.0 0.2 Fire coal/charcoal 73.6 11.9 47.2 73.5 10.9 46.9 Wood 20.5 86.8 48.8 23.5 88.5 51.1 Straw/shrubs/grass 0.0 0.0 0.0 0.0 0.0 0.0 No food cooked in household 3.7 1.0 2.5 1.2 0.2 0.8 Total 100.0 100.0 100.0 100.0 100.0 100.0 Percentage using solid fuel for cooking1 94.1 98.7 96.1 96.9 99.5 98.0 Percentage using clean fuel for cooking2 1.8 0.3 1.2 1.5 0.3 1.0 Frequency of smoking in the home Daily 4.1 10.6 6.9 4.0 9.9 6.5 Weekly 2.3 4.3 3.2 2.1 3.9 2.9 Monthly 0.5 0.4 0.5 0.4 0.3 0.4 Less than once a month 0.8 0.5 0.6 0.7 0.4 0.6 Never 92.3 84.2 88.9 92.8 85.4 89.7 Total 100.0 100.0 100.0 100.0 100.0 100.0 Number of households/ population 5,195 3,873 9,068 23,855 17,651 41,506 1 Includes fire coal/charcoal, wood, and straw/shrubs/grass 2 Includes electricity and gas cylinder 26 • Housing Characteristics and Household Population Table 2.5 Household possessions Percentage of households possessing various household effects, means of transportation, agricultural land, and livestock/farm animals, by residence, Liberia DHS 2019-20 Residence Total Possession Urban Rural Household effects Generator 9.8 4.3 7.5 Solar panel 3.4 6.9 4.9 Radio 54.3 39.5 48.0 Television 32.5 3.3 20.0 Mobile phone 84.4 50.0 69.7 Non-mobile phone 1.7 0.9 1.4 Computer 10.9 0.8 6.6 Refrigerator (ice box) 15.3 1.7 9.5 Table 86.0 69.6 79.0 Chairs 83.7 64.5 75.5 Cupboard 40.4 7.8 26.5 Mattress 94.3 75.8 86.4 Sewing machine 2.4 1.3 2.0 Watch 42.9 23.4 34.6 Means of transport Bicycle 4.3 1.0 2.9 Motorcycle/tricycle 9.7 7.9 9.0 Car/truck 6.9 0.5 4.1 Boat/canoe 0.6 1.6 1.0 Ownership of agricultural land 19.8 44.9 30.5 Ownership of farm animals1 23.7 53.2 36.3 Number of households 5,195 3,873 9,068 1 Cows/bulls, pigs, goats, sheep, or chickens/ducks/guinea fowl Housing Characteristics and Household Population • 27 Table 2.6 Wealth quintiles Percent distribution of the de jure population by wealth quintiles, and the Gini coefficient, according to residence, region, and county, Liberia DHS 2019-20 Residence/ region/county Wealth quintile Total Number of persons Gini coefficient Lowest Second Middle Fourth Highest Residence Urban 12.5 17.2 42.4 62.6 65.3 100.0 23,855 0.13 Greater Monrovia 0.0 0.4 9.9 36.3 53.4 100.0 12,483 0.10 Other urban 12.4 16.8 32.6 26.2 11.9 100.0 11,372 0.16 Rural 38.9 35.9 19.1 4.4 1.7 100.0 17,651 0.29 Region North Western 29.9 30.8 26.6 9.8 2.9 100.0 3,496 0.23 South Central 7.7 6.8 14.1 31.9 39.5 100.0 18,776 0.18 South Eastern A 35.7 30.2 20.5 7.9 5.7 100.0 2,597 0.30 South Eastern B 29.5 30.0 24.7 11.1 4.7 100.0 2,420 0.37 North Central 29.2 31.2 25.3 10.5 3.8 100.0 14,217 0.14 County Bomi 24.5 33.9 27.9 10.0 3.8 100.0 1,344 0.33 Bong 35.5 19.4 18.7 19.0 7.5 100.0 4,061 0.27 Gbarpolu 47.3 35.2 12.6 3.3 1.5 100.0 677 0.35 Grand Bassa 36.5 19.5 15.0 17.7 11.3 100.0 2,356 0.34 Grand Cape Mount 27.0 25.9 31.9 12.6 2.7 100.0 1,474 0.17 Grand Gedeh 26.8 30.0 26.3 9.2 7.7 100.0 923 0.26 Grand Kru 46.3 30.6 17.2 3.8 2.1 100.0 755 0.33 Lofa 27.9 36.2 28.3 5.6 2.0 100.0 3,538 0.13 Margibi 14.2 16.8 27.0 30.3 11.7 100.0 2,301 0.21 Maryland 20.8 29.1 27.0 17.3 5.8 100.0 1,160 0.31 Montserrado 1.8 3.1 11.9 34.5 48.7 100.0 14,119 0.04 Nimba 26.0 35.9 27.7 7.9 2.5 100.0 6,617 0.19 River Cess 53.7 28.6 11.1 3.9 2.7 100.0 648 0.38 River Gee 24.5 30.9 30.4 8.0 6.1 100.0 504 0.33 Sinoe 32.4 31.4 21.1 9.2 5.9 100.0 1,026 0.36 Total 20.0 20.0 20.0 20.0 20.0 100.0 41,506 0.21 28 • Housing Characteristics and Household Population Table 2.7 Handwashing Percentage of the de jure population for whom the place most often used for washing hands was observed, by whether the location was fixed or mobile; total percentage of the de jure population for whom the place for handwashing was observed; among the de jure population for whom the place for handwashing was observed, percentage with water available, percentage with soap available, and percentage with a cleansing agent other than soap available; percentage of the de jure population with a basic handwashing facility; and percentage with a limited handwashing facility, according to background characteristics, Liberia DHS 2019-20 Percentage of de jure population for whom place for washing hands was observed: Number of persons Place for handwashing observed and: Number of persons for whom place for hand- washing was observed Percentage of the de jure population with a basic hand- washing facility3 Percentage of the de jure population with a limited hand- washing facility4 Number of persons for whom a place for hand- washing was observed or with no place for hand- washing in the dwelling, yard, or plot Background characteristic Place for hand- washing was a fixed place Place for hand- washing was mobile Total Water available Soap available1 Cleansing agent other than soap available2 Residence Urban 5.3 21.2 26.5 23,855 32.0 24.4 0.7 6,318 5.7 28.5 18,481 Greater Monrovia 7.9 30.5 38.4 12,483 36.8 27.0 0.8 4,793 8.5 36.2 10,731 Other urban 2.5 10.9 13.4 11,372 16.9 16.5 0.2 1,525 1.8 17.9 7,750 Rural 2.8 9.4 12.2 17,651 20.4 16.8 1.8 2,158 1.1 15.9 12,714 Region North Western 5.8 11.5 17.3 3,496 28.5 12.5 2.2 605 2.9 22.2 2,414 South Central 6.2 26.2 32.3 18,776 31.3 26.2 0.7 6,070 6.5 33.7 15,091 South Eastern A 2.5 16.3 18.8 2,597 11.7 3.4 1.0 487 0.9 27.0 1,747 South Eastern B 1.4 10.8 12.2 2,420 22.5 5.6 0.4 295 0.6 13.7 2,073 North Central 2.2 5.0 7.2 14,217 25.8 20.5 2.1 1,018 1.1 9.2 9,870 County Bomi 1.5 4.7 6.2 1,344 32.5 24.2 0.0 83 2.5 7.7 822 Bong 2.6 4.1 6.7 4,061 28.3 43.4 7.9 272 1.3 9.5 2,535 Gbarpolu 10.3 18.7 29.0 677 32.0 7.2 0.0 196 3.1 39.9 457 Grand Bassa 2.3 3.0 5.3 2,356 34.6 19.8 0.0 125 1.0 7.8 1,428 Grand Cape Mount 7.6 14.4 22.1 1,474 25.4 12.8 4.0 325 3.1 25.5 1,135 Grand Gedeh 3.0 9.5 12.5 923 36.7 3.2 3.2 116 0.7 20.3 552 Grand Kru 0.2 15.1 15.3 755 25.8 1.8 0.0 116 0.3 15.7 725 Lofa 3.6 10.7 14.2 3,538 23.3 8.9 0.0 504 1.1 17.2 2,754 Margibi 3.1 32.1 35.3 2,301 7.4 4.6 0.3 812 2.4 50.0 1,548 Maryland 1.3 11.8 13.1 1,160 14.5 3.0 0.5 152 0.5 14.6 1,011 Montserrado 7.3 29.1 36.4 14,119 35.0 29.7 0.7 5,133 7.7 34.6 12,115 Nimba 1.2 2.5 3.7 6,617 28.5 18.9 0.0 242 1.0 4.3 4,581 River Cess 4.1 10.7 14.8 648 8.8 5.6 1.1 96 1.0 17.0 532 River Gee 3.2 2.3 5.5 504 53.0 35.8 1.9 28 1.4 6.8 337 Sinoe 1.0 25.9 26.8 1,026 2.1 2.8 0.0 276 0.9 40.7 662 Wealth quintile Lowest 1.7 8.7 10.4 8,285 12.8 8.3 1.3 862 0.6 14.1 5,889 Second 2.0 8.0 9.9 8,305 15.1 12.4 2.2 823 0.9 13.2 5,844 Middle 3.1 13.5 16.6 8,307 24.9 12.2 1.0 1,378 1.3 21.6 6,032 Fourth 3.2 23.4 26.6 8,298 26.9 17.1 0.4 2,208 3.0 31.8 6,344 Highest 11.3 27.3 38.6 8,311 40.1 37.0 0.9 3,204 11.8 33.4 7,085 Total 4.3 16.2 20.4 41,506 29.0 22.5 0.9 8,476 3.8 23.3 31,195 1 Soap includes soap or detergent in bar, liquid, powder, or paste form. 2 Cleansing agents other than soap include locally available materials such as ash, mud, or sand. 3 The availability of a handwashing facility on premises with soap and water 4 The availability of a handwashing facility on premises without soap and/or water Housing Characteristics and Household Population • 29 Table 2.8 Household population by age, sex, and residence Percent distribution of the de facto household population by various age groups and percentage of the de facto household population age 10-19, according to sex and residence, Liberia DHS 2019-20 Urban Rural Male Female Total Age Male Female Total Male Female Total <5 14.1 13.1 13.6 16.0 16.2 16.1 15.0 14.4 14.7 5-9 14.4 13.9 14.1 17.6 15.3 16.4 15.8 14.4 15.1 10-14 14.8 16.6 15.7 14.9 13.0 14.0 14.9 15.1 15.0 15-19 11.2 9.8 10.5 9.0 7.7 8.3 10.2 8.9 9.5 20-24 8.5 9.4 9.0 5.6 6.6 6.1 7.3 8.2 7.7 25-29 7.2 8.6 7.9 5.5 5.9 5.7 6.5 7.5 7.0 30-34 6.2 6.6 6.4 4.8 5.4 5.1 5.6 6.1 5.8 35-39 6.3 5.6 5.9 5.5 5.8 5.6 5.9 5.7 5.8 40-44 4.3 3.8 4.0 5.0 4.4 4.7 4.6 4.0 4.3 45-49 3.3 2.4 2.9 4.2 3.9 4.1 3.7 3.1 3.4 50-54 2.8 3.1 3.0 3.0 5.3 4.2 2.9 4.0 3.5 55-59 1.4 2.2 1.9 2.5 2.6 2.5 1.9 2.4 2.1 60-64 2.2 1.9 2.0 2.4 2.3 2.3 2.2 2.0 2.1 65-69 1.5 0.8 1.1 1.4 1.9 1.6 1.4 1.3 1.3 70-74 0.7 0.9 0.8 1.0 1.4 1.2 0.8 1.1 1.0 75-79 0.5 0.7 0.6 0.9 1.0 0.9 0.7 0.8 0.7 80+ 0.6 0.7 0.6 0.8 1.4 1.1 0.7 1.0 0.8 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Dependency age groups 0-14 43.4 43.5 43.4 48.5 44.5 46.5 45.6 43.9 44.8 15-64 53.4 53.4 53.4 47.4 49.8 48.6 50.8 51.9 51.4 65+ 3.2 3.1 3.1 4.1 5.6 4.9 3.6 4.2 3.9 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Child and adult populations 0-17 50.5 48.8 49.7 54.4 49.3 51.9 52.2 49.0 50.6 18+ 49.5 51.2 50.3 45.6 50.7 48.1 47.8 51.0 49.4 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Adolescents 10-19 26.1 26.3 26.2 23.9 20.7 22.3 25.1 24.0 24.5 Number of persons 11,015 12,075 23,089 8,603 8,510 17,113 19,618 20,584 40,202 30 • Housing Characteristics and Household Population Table 2.9 Household composition Percent distribution of households by sex of head of household and by household size, mean size of households, and percentage of households with children under age 18 who are orphans or not living with a biological parent, according to residence, Liberia DHS 2019-20 Residence Total Characteristic Urban Rural Household headship Male 64.0 69.5 66.3 Female 36.0 30.5 33.7 Total 100.0 100.0 100.0 Number of usual members 1 12.6 11.2 12.0 2 12.5 11.6 12.1 3 13.8 14.9 14.2 4 15.0 15.9 15.3 5 13.7 15.0 14.3 6 11.3 11.6 11.4 7 7.9 7.7 7.8 8 5.5 4.7 5.1 9+ 7.8 7.3 7.5 Total 100.0 100.0 100.0 Mean size of households 4.6 4.6 4.6 Percentage of households with children under age 18 who are orphans or not living with a biological parent Double orphans 2.0 1.3 1.7 Single orphans1 12.4 11.4 12.0 Children not living with a biological parent2 34.7 28.3 32.0 Orphans and/or children not living with a biological parent 38.2 32.3 35.7 Number of households 5,195 3,873 9,068 Note: Table is based on de jure household members, i.e., usual residents. 1 Includes children with one dead parent and an unknown survival status of the other parent 2 Children not living with a biological parent are those under age 18 living in households with neither their mother nor their father present. Housing Characteristics and Household Population • 31 Table 2.10 Children’s living arrangements and orphanhood Percent distribution of de jure children under age 18 by living arrangements and survival status of parents, percentage of children not living with a biological parent, and percentage of children with one or both parents dead, according to background characteristics, Liberia DHS 2019-20 Living with both parents Living with mother but not with father Living with father but not with mother Not living with either parent Total Percent- age not living with a bio- logical parent Percent- age with one or both parents dead1 Number of children Background characteristic Father alive Father dead Mother alive Mother dead Both alive Only mother alive Only father alive Both dead Missing informa- tion on father/ mother Age 0-4 51.8 27.9 1.9 4.2 0.1 12.5 0.7 0.4 0.4 0.1 100.0 14.0 3.5 6,017 <2 56.6 35.4 1.5 1.5 0.1 4.2 0.3 0.3 0.1 0.1 100.0 4.8 2.3 2,302 2-4 48.8 23.2 2.1 5.9 0.1 17.6 1.0 0.5 0.6 0.2 100.0 19.6 4.2 3,715 5-9 42.1 17.5 2.9 8.3 0.6 24.0 1.6 1.5 1.0 0.5 100.0 28.2 7.8 6,197 10-14 33.9 16.0 4.9 10.2 1.0 27.1 3.3 1.8 1.5 0.3 100.0 33.7 12.6 6,128 15-17 28.5 15.6 6.6 8.4 1.2 30.1 3.9 3.1 2.3 0.3 100.0 39.4 17.1 2,404 Sex Male 42.3 19.1 3.4 8.2 0.8 21.3 2.1 1.5 1.0 0.4 100.0 25.9 8.8 10,465 Female 39.5 20.6 3.9 7.2 0.5 23.2 2.2 1.4 1.3 0.3 100.0 28.1 9.3 10,281 Residence Urban 36.0 21.2 3.7 8.2 0.5 24.8 2.3 1.5 1.5 0.4 100.0 30.0 9.5 11,708 Greater Monrovia 32.6 22.3 5.0 8.8 0.6 23.9 2.6 1.5 2.4 0.3 100.0 30.4 12.0 5,748 Other urban 39.2 20.1 2.4 7.7 0.5 25.6 2.0 1.5 0.5 0.5 100.0 29.6 7.1 5,960 Rural 47.3 18.1 3.5 7.0 0.7 19.0 1.9 1.5 0.8 0.2 100.0 23.1 8.4 9,038 Region North Western 43.3 16.6 4.8 5.8 0.6 22.1 2.5 2.5 1.3 0.5 100.0 28.5 11.7 1,803 South Central 35.3 21.8 4.2 9.0 0.7 22.8 2.5 1.6 1.8 0.3 100.0 28.6 10.8 8,886 South Eastern A 43.7 20.2 2.1 7.4 0.8 22.9 1.2 0.9 0.5 0.4 100.0 25.5 5.4 1,313 South Eastern B 46.1 17.5 3.6 6.4 1.2 21.0 1.3 1.5 1.0 0.5 100.0 24.7 8.7 1,257 North Central 45.6 18.6 2.9 6.8 0.4 21.8 1.8 1.2 0.5 0.3 100.0 25.4 7.0 7,487 County Bomi 44.0 17.2 5.8 5.4 0.4 19.4 3.0 3.0 1.5 0.3 100.0 26.9 13.8 693 Bong 41.3 22.4 3.4 6.3 0.4 22.9 1.4 1.3 0.4 0.1 100.0 26.1 7.0 2,033 Gbarpolu 45.4 16.2 3.3 6.1 1.0 23.0 1.4 1.6 0.7 1.2 100.0 26.8 8.0 337 Grand Bassa 46.1 19.3 2.9 8.8 0.8 19.2 1.9 0.9 0.2 0.1 100.0 22.1 6.7 1,183 Grand Cape Mount 41.7 16.3 4.4 6.1 0.6 24.2 2.6 2.5 1.3 0.4 100.0 30.6 11.4 773 Grand Gedeh 46.6 20.8 2.8 5.9 1.0 20.5 0.4 0.7 0.6 0.7 100.0 22.2 5.5 456 Grand Kru 46.1 19.6 4.2 5.1 1.2 20.1 1.7 1.0 0.6 0.4 100.0 23.4 8.7 411 Lofa 40.5 19.9 4.0 7.2 0.5 22.7 3.3 0.7 1.0 0.0 100.0 27.8 9.7 1,837 Margibi 38.6 19.9 3.2 10.1 1.1 20.6 2.7 2.7 0.6 0.4 100.0 26.6 10.3 1,140 Maryland 46.0 17.4 3.3 7.1 1.4 19.9 1.2 1.6 1.6 0.6 100.0 24.2 9.1 595 Montserrado 32.8 22.6 4.7 8.9 0.6 23.8 2.6 1.5 2.2 0.3 100.0 30.2 11.7 6,563 Nimba 50.7 15.7 2.0 6.8 0.4 20.7 1.2 1.4 0.4 0.6 100.0 23.7 5.7 3,617 River Cess 44.7 17.4 2.4 7.4 0.9 22.6 2.5 1.0 0.8 0.3 100.0 26.9 7.6 339 River Gee 46.2 14.4 3.2 6.7 1.1 25.0 1.0 2.0 0.3 0.1 100.0 28.2 7.7 251 Sinoe 40.6 21.5 1.2 8.7 0.5 25.2 1.1 0.9 0.2 0.0 100.0 27.5 3.9 518 Wealth quintile Lowest 50.6 18.6 3.3 5.8 0.4 17.3 1.7 1.2 0.7 0.2 100.0 21.0 7.4 4,196 Second 48.4 18.2 3.6 6.6 0.9 18.6 1.4 1.4 0.7 0.3 100.0 22.1 7.9 4,258 Middle 35.4 20.1 4.4 7.4 0.5 26.1 2.6 2.2 0.7 0.5 100.0 31.7 10.8 4,372 Fourth 35.2 23.3 4.5 7.7 0.7 23.2 1.8 1.2 2.1 0.2 100.0 28.4 10.4 4,050 Highest 34.3 19.1 2.1 11.2 0.7 26.2 3.1 1.2 1.6 0.4 100.0 32.1 8.7 3,869 Total <15 42.5 20.4 3.2 7.6 0.6 21.2 1.9 1.3 1.0 0.3 100.0 25.4 8.0 18,342 Total <18 40.9 19.8 3.6 7.7 0.6 22.3 2.1 1.5 1.2 0.3 100.0 27.0 9.1 20,746 Note: Table is based on de jure members, i.e., usual residents. 1 Includes children with father dead, mother dead, both dead, and one parent dead but missing information on survival status of the other parent 32 • Housing Characteristics and Household Population Table 2.11 Birth registration of children under age 5 Percentage of de jure children under age 5 whose births are registered with the civil authorities, according to background characteristics, Liberia DHS 2019-20 Percentage of children whose births are registered and who: Number of children Background characteristic Had a birth certificate Did not have a birth certificate Total percentage of children whose births are registered Age <2 27.9 39.4 67.3 2,302 2-4 31.7 33.9 65.6 3,715 Sex Male 30.4 36.7 67.1 3,018 Female 30.1 35.3 65.4 3,000 Residence Urban 32.0 37.2 69.3 3,218 Greater Monrovia 32.8 39.9 72.7 1,568 Other urban 31.3 34.7 66.0 1,650 Rural 28.2 34.5 62.8 2,799 Region North Western 36.3 35.1 71.4 508 South Central 31.2 35.3 66.5 2,481 South Eastern A 24.5 35.7 60.3 368 South Eastern B 24.6 40.1 64.7 338 North Central 29.7 36.3 66.0 2,322 County Bomi 35.4 37.9 73.3 176 Bong 25.7 12.0 37.7 633 Gbarpolu 29.5 41.4 70.9 102 Grand Bassa 28.5 28.4 56.9 372 Grand Cape Mount 40.1 30.2 70.3 230 Grand Gedeh 21.3 55.5 76.9 132 Grand Kru 15.9 56.3 72.2 115 Lofa 59.7 25.1 84.9 511 Margibi 27.6 37.9 65.5 306 Maryland 33.1 38.8 71.9 160 Montserrado 32.4 36.3 68.7 1,803 Nimba 18.8 54.3 73.1 1,179 River Cess 23.2 44.8 68.0 96 River Gee 18.9 13.8 32.8 63 Sinoe 28.5 10.7 39.2 139 Wealth quintile Lowest 23.0 38.6 61.5 1,444 Second 28.3 34.9 63.3 1,364 Middle 32.6 33.1 65.7 1,156 Fourth 33.3 35.4 68.8 1,060 Highest 37.6 37.6 75.2 994 Total 30.3 36.0 66.3 6,017 Housing Characteristics and Household Population • 33 Table 2.12.1 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 years completed, according to background characteristics, Liberia DHS 2019-20 Background characteristic No education Some elementary Completed elementary1 Some junior high Completed junior high2 Some senior high Completed senior high3 Higher Don’t know/ missing Total Number of women Median years completed Age 6-9 72.2 27.4 0.1 0.0 0.1 0.0 0.1 0.0 0.0 100.0 2,411 0.0 10-14 22.8 67.5 2.1 0.2 6.7 0.0 0.6 0.0 0.0 100.0 3,108 1.3 15-19 8.8 37.1 5.9 3.8 28.3 3.0 12.5 0.6 0.0 100.0 1,830 5.2 20-24 15.6 18.4 4.1 4.8 17.5 15.4 18.2 5.5 0.6 100.0 1,689 6.3 25-29 23.0 16.5 3.7 3.7 13.1 20.8 10.2 8.7 0.4 100.0 1,543 6.2 30-34 35.1 13.9 2.3 2.6 11.1 16.9 7.3 10.6 0.3 100.0 1,260 5.1 35-39 47.2 19.4 3.7 2.4 6.8 10.5 2.5 6.8 0.6 100.0 1,169 0.8 40-44 52.9 17.1 2.2 1.9 7.9 9.7 2.3 5.3 0.8 100.0 831 0.0 45-49 60.4 16.4 2.9 0.2 5.9 5.4 3.5 4.5 0.7 100.0 629 0.0 50-54 70.8 9.9 2.0 1.7 6.4 5.1 1.3 3.0 0.0 100.0 833 0.0 55-59 71.3 9.5 1.4 1.8 3.6 6.5 2.4 3.1 0.6 100.0 488 0.0 60-64 77.0 8.2 1.5 2.3 2.0 3.9 0.9 3.8 0.4 100.0 420 0.0 65+ 89.8 5.2 1.1 0.0 0.8 0.6 0.4 1.6 0.4 100.0 855 0.0 Residence Urban 30.9 28.7 2.7 2.7 11.4 10.3 7.5 5.5 0.3 100.0 10,203 2.7 Greater Monrovia 24.4 26.0 2.6 3.9 11.5 14.9 8.6 8.0 0.2 100.0 5,504 4.9 Other urban 38.5 31.8 2.8 1.4 11.4 5.1 6.2 2.6 0.3 100.0 4,699 1.4 Rural 57.1 28.2 2.6 0.7 6.8 1.8 2.1 0.4 0.3 100.0 6,863 0.0 Region North Western 54.5 27.0 4.4 0.6 7.4 2.3 2.6 0.8 0.4 100.0 1,397 0.0 South Central 31.4 27.3 2.3 2.9 11.2 11.3 7.4 6.0 0.3 100.0 8,130 3.3 South Eastern A 49.4 32.9 2.7 0.9 8.0 2.1 3.2 0.7 0.2 100.0 1,011 0.0 South Eastern B 42.3 36.5 2.6 1.1 9.0 3.4 3.7 1.2 0.2 100.0 948 0.6 North Central 51.1 28.4 2.7 1.1 8.1 3.2 3.6 1.4 0.3 100.0 5,580 0.0 County Bomi 47.9 29.5 5.1 0.4 7.6 2.9 4.5 1.5 0.6 100.0 565 0.0 Bong 52.7 26.4 3.6 1.7 5.9 3.6 3.5 2.5 0.2 100.0 1,705 0.0 Gbarpolu 61.8 27.4 4.1 0.8 3.5 1.3 0.6 0.4 0.2 100.0 265 0.0 Grand Bassa 53.8 29.4 1.6 0.8 8.3 1.5 2.7 1.4 0.5 100.0 964 0.0 Grand Cape Mount 57.7 24.4 3.8 0.9 9.1 2.0 1.6 0.4 0.2 100.0 568 0.0 Grand Gedeh 42.5 35.2 3.7 0.9 9.0 3.3 3.9 1.2 0.3 100.0 362 0.3 Grand Kru 43.1 41.1 2.5 0.8 8.1 1.9 1.7 0.2 0.6 100.0 289 0.3 Lofa 60.3 24.4 1.6 0.8 6.8 2.7 2.7 0.5 0.2 100.0 1,480 0.0 Margibi 44.4 30.5 1.9 0.7 9.6 5.0 5.8 1.8 0.2 100.0 980 0.4 Maryland 40.9 35.0 1.6 1.0 9.3 4.7 5.2 2.1 0.1 100.0 460 0.7 Montserrado 25.9 26.4 2.4 3.6 11.9 13.8 8.4 7.3 0.2 100.0 6,186 4.6 Nimba 44.4 32.4 2.8 0.8 10.5 3.3 4.2 1.1 0.5 100.0 2,395 0.2 River Cess 59.3 30.0 2.3 0.7 5.4 1.0 0.8 0.3 0.2 100.0 248 0.0 River Gee 44.3 33.4 5.2 1.7 9.7 2.3 3.1 0.3 0.0 100.0 198 0.7 Sinoe 49.6 32.7 2.0 1.0 8.6 1.7 4.0 0.6 0.0 100.0 400 0.0 Wealth quintile Lowest 64.9 26.0 2.1 0.5 4.6 0.6 0.9 0.1 0.4 100.0 3,143 0.0 Second 55.7 29.3 2.3 0.8 8.1 1.5 2.0 0.1 0.2 100.0 3,186 0.0 Middle 43.6 31.2 3.1 1.3 10.3 4.4 5.2 0.7 0.3 100.0 3,378 0.5 Fourth 30.2 29.1 2.6 3.9 13.1 9.1 8.8 3.2 0.1 100.0 3,678 3.2 Highest 18.4 26.8 3.0 2.6 10.9 17.1 8.5 12.1 0.4 100.0 3,681 5.7 Total 41.4 28.5 2.6 1.9 9.6 6.9 5.3 3.5 0.3 100.0 17,066 1.0 1 Completed grade 6 at the elementary level 2 Completed grade 9 at the junior high level 3 Completed grade 12 at the senior high level 34 • Housing Characteristics and Household Population Table 2.12.2 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 years completed, according to background characteristics, Liberia DHS 2019-20 Background characteristic No education Some elementary Completed elementary1 Some junior high Completed junior high2 Some senior high Completed senior high3 Higher Don’t know/ missing Total Number of men Median years completed Age 6-9 75.6 24.1 0.0 0.0 0.1 0.0 0.0 0.0 0.1 100.0 2,449 0.0 10-14 28.5 63.3 1.8 0.3 5.3 0.1 0.3 0.2 0.1 100.0 2,917 0.9 15-19 9.8 41.8 4.5 2.5 26.6 2.0 12.1 0.6 0.2 100.0 2,009 4.8 20-24 8.8 15.4 3.4 4.0 17.3 18.7 24.1 8.0 0.3 100.0 1,424 7.1 25-29 13.3 10.9 2.6 2.7 14.7 28.1 15.5 11.3 0.8 100.0 1,266 7.4 30-34 13.5 12.0 1.6 2.3 9.8 28.1 13.6 17.4 1.5 100.0 1,090 7.9 35-39 19.0 12.4 3.8 1.7 12.7 23.6 10.9 15.2 0.7 100.0 1,167 7.2 40-44 25.4 13.1 4.6 2.5 9.4 22.0 7.7 13.2 2.1 100.0 902 6.4 45-49 29.8 13.3 2.7 2.1 12.3 15.3 8.3 13.9 2.3 100.0 723 6.0 50-54 22.2 12.8 2.8 5.6 9.3 21.0 8.3 17.0 0.9 100.0 562 7.3 55-59 31.8 13.2 3.1 2.1 9.0 18.6 8.8 11.8 1.6 100.0 373 5.8 60-64 38.2 10.4 2.9 2.8 7.0 17.3 6.1 14.8 0.5 100.0 440 5.2 65+ 48.1 15.3 2.1 1.3 5.4 12.3 3.9 10.1 1.6 100.0 707 0.2 Residence Urban 20.9 26.0 2.3 2.1 11.3 15.7 10.0 11.1 0.5 100.0 9,121 4.4 Greater Monrovia 15.4 20.9 2.6 2.7 11.3 20.2 11.7 14.9 0.3 100.0 4,813 6.7 Other urban 27.1 31.8 2.0 1.3 11.4 10.7 8.2 6.8 0.8 100.0 4,308 3.3 Rural 41.0 29.3 2.8 1.5 9.7 6.8 6.0 1.8 0.9 100.0 6,909 0.9 Region North Western 42.1 28.1 3.0 1.9 8.9 7.2 5.1 2.8 1.0 100.0 1,386 0.9 South Central 20.8 24.0 2.3 2.3 11.2 17.0 10.2 11.8 0.5 100.0 7,268 5.7 South Eastern A 29.9 31.9 3.3 1.9 13.2 7.9 7.4 3.1 1.5 100.0 1,087 2.9 South Eastern B 27.9 32.7 4.5 2.1 12.6 8.8 6.6 4.2 0.6 100.0 979 3.1 North Central 38.5 30.1 2.2 1.1 9.5 7.5 7.1 3.2 0.7 100.0 5,311 1.3 County Bomi 34.7 29.0 3.8 2.1 9.4 9.7 5.7 4.8 0.8 100.0 540 2.0 Bong 40.6 28.1 4.1 1.7 7.9 7.5 5.0 4.2 0.9 100.0 1,533 1.0 Gbarpolu 45.0 29.1 3.3 2.2 7.9 6.1 3.8 1.2 1.4 100.0 262 0.3 Grand Bassa 39.2 30.8 1.4 1.6 10.8 6.3 5.9 3.6 0.5 100.0 919 0.8 Grand Cape Mount 47.5 26.9 2.1 1.6 8.9 5.4 5.1 1.7 0.9 100.0 584 0.1 Grand Gedeh 25.4 33.4 4.2 2.1 12.7 8.5 7.9 4.4 1.4 100.0 367 3.7 Grand Kru 26.1 36.1 2.7 1.7 14.0 9.2 5.4 3.6 1.2 100.0 301 2.9 Lofa 43.3 28.4 1.8 1.3 7.7 8.0 6.7 2.2 0.5 100.0 1,345 0.4 Margibi 26.9 31.1 2.3 1.8 11.7 13.0 6.5 6.2 0.4 100.0 884 3.3 Maryland 28.7 31.1 5.2 1.8 12.0 8.0 7.4 5.7 0.3 100.0 468 3.1 Montserrado 16.8 21.7 2.4 2.5 11.2 19.4 11.5 14.0 0.5 100.0 5,465 6.4 Nimba 34.6 32.4 1.3 0.6 11.4 7.3 8.6 3.2 0.6 100.0 2,433 1.9 River Cess 39.2 30.7 4.3 2.0 12.0 5.4 4.3 1.7 0.5 100.0 274 1.6 River Gee 28.9 31.6 5.5 3.1 11.8 10.2 6.7 1.7 0.5 100.0 209 3.2 Sinoe 27.9 31.5 1.9 1.6 14.3 8.9 9.0 2.9 2.1 100.0 447 3.0 Wealth quintile Lowest 48.6 29.2 2.6 1.6 8.5 3.9 4.4 0.5 0.8 100.0 3,152 0.0 Second 38.7 30.1 2.8 1.6 10.9 6.9 6.8 1.4 0.9 100.0 3,203 1.4 Middle 29.9 33.3 2.8 1.5 10.0 9.8 8.9 3.1 0.7 100.0 3,247 2.7 Fourth 19.4 24.9 2.3 2.3 13.1 18.1 11.1 8.1 0.7 100.0 3,153 5.7 Highest 11.8 19.9 2.1 2.2 10.8 20.6 10.2 22.1 0.3 100.0 3,275 7.4 Total 29.6 27.4 2.5 1.8 10.6 11.9 8.3 7.1 0.7 100.0 16,030 3.5 1 Completed grade 6 at the elementary level 2 Completed grade 9 at the junior high level 3 Completed grade 12 at the senior high level Housing Characteristics and Household Population • 35 Table 2.13 School attendance ratios Net attendance ratios (NAR) and gross attendance ratios (GAR) for the de facto household population by sex and level of schooling, and the gender parity index (GPI), according to background characteristics, Liberia DHS 2019-20 Net attendance ratio 1 Gross attendance ratio2 Background characteristic Male Female Total Gender parity index3 Male Female Total Gender parity index3 PRIMARY SCHOOL Residence Urban 51.7 52.9 52.3 1.02 103.7 100.2 101.8 0.97 Greater Monrovia 57.9 58.8 58.4 1.02 107.4 104.0 105.4 0.97 Other urban 46.9 46.9 46.9 1.00 100.9 96.4 98.6 0.95 Rural 30.0 34.5 32.1 1.15 77.9 77.0 77.5 0.99 Region North Western 36.3 40.7 38.3 1.12 82.8 95.0 88.3 1.15 South Central 49.7 53.2 51.6 1.07 99.5 99.4 99.5 1.00 South Eastern A 35.8 36.2 36.0 1.01 100.1 80.9 90.9 0.81 South Eastern B 46.2 48.9 47.5 1.06 105.9 101.2 103.6 0.96 North Central 34.4 37.2 35.7 1.08 81.5 78.1 79.9 0.96 County Bomi 43.0 48.8 45.7 1.14 99.6 125.1 111.4 1.26 Bong 36.3 39.1 37.6 1.08 83.5 87.7 85.4 1.05 Gbarpolu 22.2 31.7 26.6 1.43 54.3 61.7 57.8 1.13 Grand Bassa 25.5 32.6 28.9 1.28 80.3 76.9 78.7 0.96 Grand Cape Mount 37.2 37.8 37.5 1.02 81.7 84.3 82.8 1.03 Grand Gedeh 43.6 46.9 45.3 1.08 114.3 85.3 99.4 0.75 Grand Kru 46.2 49.6 47.9 1.07 112.2 104.5 108.5 0.93 Lofa 34.3 35.7 35.0 1.04 77.8 75.9 76.9 0.98 Margibi 45.6 45.2 45.4 0.99 86.8 101.6 94.2 1.17 Maryland 47.5 51.0 49.3 1.07 99.7 94.0 96.8 0.94 Montserrado 56.2 57.8 57.1 1.03 106.9 102.6 104.5 0.96 Nimba 33.4 37.0 35.1 1.11 82.2 74.1 78.4 0.90 River Cess 26.0 25.2 25.6 0.97 80.8 68.7 75.3 0.85 River Gee 43.2 41.1 42.3 0.95 110.5 117.5 113.6 1.06 Sinoe 36.5 33.3 35.0 0.91 102.5 85.0 94.3 0.83 Wealth quintile Lowest 23.1 26.1 24.5 1.13 65.1 59.0 62.4 0.91 Second 31.8 34.5 33.0 1.09 79.6 78.5 79.1 0.99 Middle 44.7 43.0 43.9 0.96 96.2 93.0 94.7 0.97 Fourth 55.5 57.1 56.4 1.03 112.1 109.3 110.5 0.98 Highest 62.0 62.4 62.3 1.01 118.0 108.2 112.3 0.92 Total 41.2 45.3 43.3 1.10 91.2 90.7 90.9 0.99 Continued… 36 • Housing Characteristics and Household Population Table 2.13—Continued Net attendance ratio 1 Gross attendance ratio2 Background characteristic Male Female Total Gender parity index3 Male Female Total Gender parity index3 SECONDARY SCHOOL Residence Urban 34.4 33.5 33.9 0.97 67.3 66.1 66.7 0.98 Greater Monrovia 47.0 40.1 43.3 0.85 82.9 72.2 77.2 0.87 Other urban 21.3 25.4 23.3 1.19 51.2 58.5 54.8 1.14 Rural 10.8 13.0 11.8 1.20 28.9 24.9 27.0 0.86 Region North Western 15.1 18.7 16.9 1.24 34.1 36.1 35.1 1.06 South Central 38.5 34.6 36.5 0.90 71.2 65.0 68.0 0.91 South Eastern A 12.8 13.2 12.9 1.03 36.6 29.0 33.3 0.79 South Eastern B 16.8 16.2 16.5 0.97 44.4 40.3 42.4 0.91 North Central 12.3 17.9 14.9 1.45 33.6 38.3 35.8 1.14 County Bomi 19.0 23.1 21.2 1.22 38.4 41.9 40.3 1.09 Bong 16.7 20.1 18.4 1.21 41.7 46.7 44.1 1.12 Gbarpolu 6.0 8.7 7.4 1.46 23.0 16.7 19.8 0.73 Grand Bassa 17.3 15.6 16.6 0.90 35.6 36.5 36.0 1.03 Grand Cape Mount 14.5 16.8 15.6 1.16 33.9 36.2 34.9 1.07 Grand Gedeh 15.9 13.6 14.9 0.86 37.0 31.0 34.4 0.84 Grand Kru 12.8 9.1 11.1 0.70 30.1 25.0 27.7 0.83 Lofa 8.6 13.6 10.9 1.58 27.5 31.7 29.5 1.15 Margibi 24.4 16.2 20.1 0.66 56.5 46.7 51.4 0.83 Maryland 19.8 19.7 19.7 1.00 56.5 53.6 55.1 0.95 Montserrado 44.4 39.7 41.9 0.89 79.8 71.2 75.2 0.89 Nimba 11.5 18.8 14.7 1.64 31.8 35.8 33.6 1.12 River Cess 11.4 9.1 10.4 0.80 31.9 24.5 28.8 0.77 River Gee 16.8 19.4 18.1 1.15 42.5 35.6 39.2 0.84 Sinoe 11.1 15.0 12.8 1.36 39.2 29.8 35.1 0.76 Wealth quintile Lowest 5.3 6.3 5.7 1.19 20.4 15.4 18.3 0.76 Second 10.3 8.8 9.6 0.85 31.1 28.7 30.0 0.92 Middle 16.4 17.5 16.9 1.07 41.4 37.6 39.6 0.91 Fourth 36.5 35.3 35.9 0.97 72.9 71.6 72.2 0.98 Highest 48.7 45.4 46.9 0.93 82.3 75.5 78.7 0.92 Total 24.9 26.2 25.5 1.05 51.8 51.4 51.6 0.99 1 The NAR for primary school is the percentage of the primary school-age (6-11 years) population that is attending primary school. The NAR for secondary school is the percentage of the secondary school-age (12-17 years) population that is attending secondary school. By definition, the NAR cannot exceed 100.0. 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 100.0. 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. Characteristics of Respondents • 37 CHARACTERISTICS OF RESPONDENTS 3 Key Findings ▪ Education: 16% of women and 27% of men age 15-49 have completed senior high or a higher level of education. ▪ Literacy: 52% of women and 75% of men age 15-49 are literate. ▪ Exposure to mass media: Only 1% of women and 4% of men have access to three specified types of mass media (newspaper, television, and radio) on a weekly basis. ▪ Employment: 61% of women and 81% of men are currently employed. ▪ Health insurance: Health insurance coverage is low, with only 4% of women and 7% of men age 15-49 having any type of health insurance. ▪ Knowledge of tuberculosis: Knowledge of tuberculosis is high; 91% of women and 92% of men age 15-49 have heard of tuberculosis. his chapter presents information on the demographic and socioeconomic characteristics of the survey respondents such as age, religion, marital status, residence, region, education, and wealth status. The chapter also explores access to media and the internet, health insurance coverage, use of tobacco, employment status, occupation, and earnings. This information is useful for understanding the factors that affect use of reproductive health services, contraceptive use, and other health behaviors. 3.1 BASIC CHARACTERISTICS OF SURVEY RESPONDENTS The 2019-20 LDHS interviewed 8,065 women age 15-49 and 4,249 men age 15-59. Table 3.1 shows the percent distribution of women and men age 15-49 by background characteristics. More than half of Liberian women and men are under age 30 (56% of women and 55% of men). Eighty-four percent of women and 83% of men are Christian. Fourteen percent of Liberian women and men are Muslim, and 1% practice no religion. Nearly 4 in 10 women (39%) and more than 4 in 10 men (44%) have never been married. Twenty-six percent of women and 22% of men are currently married, while 27% of women and 28% of men are living with someone as if married. Female respondents are more likely than male respondents to be divorced or separated (7% versus 6%) or widowed (2% versus 1%). T 38 • Characteristics of Respondents More than half of women and men live in urban areas (62% and 61%, respectively). South Central is the most populous region in Liberia. By county, the largest percentage of Liberians live in Montserrado (40%), while the smallest percentages live in Gbarpolu, River Cess, and River Gee (1% each). 3.2 EDUCATION AND LITERACY Literacy Respondents who had attended higher than senior high school were assumed to be literate. All other respondents, shown a typed sentence to read aloud, were considered literate if they could read all or part of the sentence. Sample: Women and men age 15-49 Tables 3.2.1 and 3.2.2 show that men have greater educational attainment than women; the median number of years of schooling completed among men is 6.6, as compared with 4.8 among women. In addition, 31% of women have no formal education, compared with 13% of men. A tenth of women (10%) and one-sixth (16%) of men age 15-49 have completed senior high school. Advanced education is relatively uncommon; only 6% of women and 11% of men have completed education beyond the senior high school level (Figure 3.1). Overall, 16% of women and 27% of men age 15-49 have completed senior high or a higher level of education. About half of Liberian women (52%) and three quarters of Liberian men (75%) are literate (Tables 3.3.1 and 3.3.2). Trends: The percentage of women age 15-49 with no education has decreased since 2007, from 42% to 31%. Over the same period, the median number of years of schooling completed has increased from 1.7 to 4.8 years. Among men age 15-49, the percentage with no education has decreased from 18% to 13%, while the median number of years of education completed has increased from 5.8 to 6.6 years. Patterns by background characteristics ▪ Twenty-one percent of urban women have no education, as compared with 47% of rural women. Overall, 9% of urban women have completed education beyond senior high school, compared with 1% of rural women (Table 3.2.1). Figure 3.1 Education of survey respondents 31 13 20 20 3 3 3 3 15 17 12 18 10 16 6 11 Women Men Percent distribution of women and men age 15-49 by highest level of schooling attended or completed Higher Completed senior high Some senior high Completed junior high Some junior high Elementary complete Some elementary No education Characteristics of Respondents • 39 ▪ Montserrado County has the largest percentage of women and men (26% and 40%, respectively) with a completed senior high or higher level of education. River Cess and Gbarpolu have the lowest percentage of women (2% each) who have completed senior high or higher, while River Cess has the lowest percentage of men who have reached this level of education (9%) (Figure 3.2, Table 3.2.1, and Table 3.2.2). ▪ Educational attainment increases with increasing household wealth. A third of women (33%) and almost half of men (47%) in the highest wealth quintile have completed senior high or a higher level of education. In the lowest quintile, only 2% of women and 10% of men have completed senior high school or higher. ▪ Literacy among women decreases with age, from 72% among those age 15-19 to 22% among those age 45-49 (Table 3.3.1). ▪ Urban Liberians are more likely than their rural counterparts to be literate. Sixty-three percent of urban women and 84% of urban men are literate, as compared with 34% of rural women and 61% of rural men (Tables 3.3.1 and 3.3.2). 3.3 MASS MEDIA EXPOSURE Exposure to mass media Respondents were asked how often they read a newspaper, listened to the radio, or watched television. Those who responded at least once a week are considered regularly exposed to that form of media. Sample: Women and men age 15-49 Access to information is essential in increasing people’s knowledge and awareness of important issues. Data on women’s and men’s exposure to mass media are especially crucial in the development of health education programs and the dissemination of information, particularly on family planning, nutrition, HIV/AIDS, and other essential topics. Figure 3.2 Education by county Percentage of women age 15-49 with a completed senior high education or higher 40 • Characteristics of Respondents Tables 3.4.1 and 3.4.2 show the percentages of women and men who are exposed to specific types of media, by background characteristics. The level of exposure to mass media is generally low in Liberia. Radio is the dominant medium of information for both women and men: 27% of women and 42% of men listen to the radio. Men are more likely (4%) than women (1%) to access all three forms of media (newspaper, television, and radio) on a weekly basis. Sixty-seven percent of women and 52% of men do not access any of the three media on a weekly basis (Figure 3.3). The internet is also a critical tool through which people access and share information. Internet use includes accessing web pages, email, and social media. Among all women and men age 15-49, 22% and 36% have used the internet in the last 12 months, respectively. Of those who have accessed the internet in the past 12 months, more women (49%) than men (43%) use the internet almost daily (Tables 3.5.1 and 3.5.2). Trends: Exposure to mass media has decreased over time. The percentage of women age 15-49 with no weekly access to mass media increased from 45% in 2007 to 67% in 2019-20. Among men, the percentage increased from 23% to 52%. Patterns by background characteristics ▪ Urban women and men (2% and 7%, respectively) are more likely than their rural counterparts (less than 1% and 1%, respectively) to have accessed all three forms of mass media in the last week (Tables 3.4.1 and 3.4.2). ▪ The percentage of women who do not access any of the three media on a weekly basis decreases with increasing education, from 79% among those with no education to 27% among those with a higher education. The corresponding percentages among men are 78% and 12%. ▪ The South Central region has the highest percentages of women (41%) and men (65%) who have ever used the internet (Tables 3.5.1 and 3.5.2). ▪ By county, Montserrado has the highest percentages of women and men who have used the internet in the past 12 months (41% and 64%, respectively). Internet use is lowest in Gbarpolu and Lofa among women (4% each) and in Gbarpolu, Nimba, and River Cess among men (10% each). ▪ Liberians in the highest wealth quintile (55% of women and 77% of men) are more likely to have used the internet during the past 12 months than those in the lowest wealth quintile (2% of women and 4% of men). 3.4 EMPLOYMENT Currently employed Respondents who were employed in the 7 days before the survey. Sample: Women and men age 15-49 Figure 3.3 Exposure to mass media 2 17 27 1 67 11 18 42 4 52 Reads news- paper Watches television Listens to radio All three media None of these media Percentage of women and men age 15-49 who are exposed to media on a weekly basis Women Men Characteristics of Respondents • 41 Men (81%) are more likely than women (61%) to be currently employed (Tables 3.6.1 and 3.6.2). Three percent of women and 4% of men were not currently employed but had worked in the past 12 months. Trends: The percentage of women who are currently employed has fluctuated over time, decreasing from 59% in 2007 to 55% in 2013 before increasing to 61% in 2019-20. Among men, the percentage currently employed decreased from 78% in 2007 to 72% in 2013 and subsequently increased to 81% in 2019-20. Patterns by background characteristics ▪ Employment increases with age, from 33% among women age 15-19 to 83% among those age 45-49 and from 54% among men age 15-19 to 97% among those age 45-49. ▪ Women and men who are married or living together with a partner (73% and 95%, respectively) are more likely than those who have never been married (42% and 63%, respectively) to be employed. ▪ Current employment is higher among rural Liberians than urban Liberians (67% versus 57% among women and 88% versus 76% among men). ▪ The percentage of women who are currently employed is highest in Gbarpolu (82%) and lowest in Grand Cape Mount (48%). Conversely, the percentage of men who are employed is highest in Nimba (97%) and lowest in Maryland (66%). ▪ Women (76%) and men (96%) with no education are more likely than their counterparts to be employed. ▪ Employment is lowest among women (50%) and men (71%) in the highest wealth quintile (Figure 3.4). 3.5 OCCUPATION Occupation Categorized as professional/technical/managerial, clerical, sales and services, skilled manual, unskilled manual, domestic service, agriculture, and other. Sample: Women and men age 15-49 who were currently employed or had worked in the 12 months before the survey Figure 3.4 Employment status by wealth 73 69 62 56 50 92 89 82 73 71 Lowest Second Middle Fourth Highest Percentage of women and men age 15-49 who are currently employed Women Men WealthiestPoorest 42 • Characteristics of Respondents Among women who are currently employed or worked in the 12 months before the survey, one in two work in sales (52%) and nearly two in five (38%) work in agriculture. Forty-one percent of men work in agriculture, and 23% are engaged in skilled manual labor (Table 3.7.1, Table 3.7.2, and Figure 3.5). Thirty-two percent of employed women in Liberia are not paid for the work they do. Women engaged in agricultural work (57%) are more likely than women performing nonagricultural work (17%) not to be paid for their work. Seventy-eight percent of women who worked in the past year are self-employed (Table 3.8). Trends: The percentage of women working in agriculture decreased from 55% in 2007 to 38% in 2019- 20. Among men, the percentage decreased from 53% to 41% over the same period. Patterns by background characteristics ▪ Urban women (68%) are twice as likely as rural women (30%) to work in sales and services, while urban men (32%) are three times more likely than their rural counterparts (10%) to perform skilled manual labor. Rural women (66%) and rural men (69%) are more likely than urban women (18%) and men (21%) to be engaged in the agricultural sector (Tables 3.7.1 and 3.7.2). ▪ Women and men with no education (56% and 66%, respectively) are more likely than those with education beyond senior high school (2% and 4%, respectively) to work in the agricultural sector. ▪ The percentages of men and women employed in professional/technical/managerial and clerical occupations rise with increasing wealth. 3.6 HEALTH INSURANCE COVERAGE Only 4% of women and 7% of men age 15-49 have health insurance. Among those with insurance, most women and men (3% and 5%, respectively) have employer-based insurance (Tables 3.9.1 and 3.9.2). Trends: Since 2013, the percentage of uninsured Liberians has remained the same (96% among women and 93% among men). 3.7 TOBACCO USE One percent of women age 15-49 smoke any kind of tobacco (Table 3.10.1), as compared with 7% of men (Table 3.10.2). Four percent of men smoke daily, and 4% are occasional smokers. Three out of five men (61%) who are daily smokers reported that they smoke on average less than five cigarettes per day (data not shown). Three percent of men use smokeless tobacco (Table 3.11). Trends: The percentage of men age 15-49 who smoke any type of tobacco declined from 15% in 2007 to 7% in 2019-20. Figure 3.5 Occupation 5 1 52 1 1 1 38 11 1 17 23 4 2 41 Professional/ technical/ managerial Clerical Sales and services Skilled manual Unskilled manual Domestic service Agriculture Percentage of women and men age 15-49 employed in the 12 months before the survey by occupation Women Men Characteristics of Respondents • 43 Patterns by background characteristics ▪ The percentage of men who smoke any type of tobacco increases from 2% among those age 15-19 to 16% among those age 45-49. ▪ By county, cigarette smoking ranges from 3% in Margibi and Maryland to 15% in Grand Cape Mount. ▪ Tobacco use varies by education, from a high of 16% among men with no education to a low of 4% among men who have attained a higher education. 3.8 KNOWLEDGE OF TUBERCULOSIS Ninety-one percent of women and 92% of men age 15-49 have heard of tuberculosis (TB). Among those have heard of TB, 61% of women and 58% of men report hemoptysis as a common symptom of TB, 48% of women and 62% of men report coughing for more than 2 weeks, and 18% of women and 27% of men report chest pain. Additionally, 79% of women and 80% of men believe that TB can be cured, and 86% of women and 88% of men would not keep it a secret if a family member was diagnosed with TB (Tables 3.12.1 and 3.12.2). 3.9 POSSESSION OF IDENTITY DOCUMENTS Three out of four women and men (75% each) age 15-49 possess a form of identification document (ID). A voter card is the most common form of ID among both women and men (93% and 90%, respectively). Only 11% of women and 16% of men possess a national ID. Twenty-one percent of women and 32% of men have a birth certificate. The proportion of women and men with a birth certificate increases with increasing wealth. Among women the percentage increases from 6% among those in the lowest wealth quintile to 43% among those in the highest wealth quintile. Among men, possession of a birth certificate increases from 13% in the lowest wealth quintile to 54% in the highest quintile (Tables 3.13.1 and 3.13.2). LIST OF TABLES For more information on the characteristics of survey respondents, see the following tables: ▪ Table 3.1 Background characteristics of respondents ▪ Table 3.2.1 Educational attainment: Women ▪ Table 3.2.2 Educational attainment: Men ▪ Table 3.3.1 Literacy: Women ▪ Table 3.3.2 Literacy: Men ▪ Table 3.4.1 Exposure to mass media: Women ▪ Table 3.4.2 Exposure to mass media: Men ▪ Table 3.5.1 Internet usage: Women ▪ Table 3.5.2 Internet usage: Men ▪ Table 3.6.1 Employment status: Women ▪ Table 3.6.2 Employment status: Men ▪ Table 3.7.1 Occupation: Women ▪ Table 3.7.2 Occupation: Men ▪ Table 3.8 Type of employment: Women ▪ Table 3.9.1 Health insurance coverage: Women ▪ Table 3.9.2 Health insurance coverage: Men ▪ Table 3.10.1 Tobacco smoking: Women ▪ Table 3.10.2 Tobacco smoking: Men 44 • Characteristics of Respondents ▪ Table 3.11 Smokeless tobacco use and any tobacco use ▪ Table 3.12.1 Knowledge concerning tuberculosis: Women ▪ Table 3.12.2 Knowledge concerning tuberculosis: Men ▪ Table 3.13.1 Possession of identity documents: Women ▪ Table 3.13.2 Possession of identity documents: Men Characteristics of Respondents • 45 Table 3.1 Background characteristics of respondents Percent distribution of women and men age 15-49 by selected background characteristics, Liberia DHS 2019-20 Women Men Background characteristic Weighted percent Weighted number Unweighted number Weighted percent Weighted number Unweighted number Age 15-19 20.5 1,657 1,716 22.9 876 885 20-24 18.7 1,506 1,408 17.2 658 596 25-29 17.0 1,375 1,202 14.6 558 459 30-34 13.8 1,112 1,052 12.9 494 482 35-39 12.6 1,020 1,103 12.8 487 488 40-44 9.5 769 857 10.9 418 456 45-49 7.8 626 727 8.6 330 394 Religion Christian 84.0 6,776 6,878 83.1 3,175 3,114 Muslim 14.3 1,153 1,046 13.8 527 484 Traditional religion 0.4 31 42 2.0 75 108 No religion 1.2 100 98 1.1 41 50 Other 0.1 4 1 0.1 2 4 Marital status Never married 38.8 3,129 2,621 44.1 1,684 1,537 Married 25.6 2,067 2,315 21.7 831 934 Living together 26.6 2,149 2,339 28.1 1,075 1,090 Divorced/separated 7.2 584 645 5.5 211 184 Widowed 1.7 137 145 0.5 20 15 Residence Urban 62.3 5,023 3,338 60.5 2,313 1,434 Greater Monrovia 35.5 2,866 917 35.8 1,368 385 Other urban 26.7 2,157 2,421 24.7 944 1,049 Rural 37.7 3,042 4,727 39.5 1,508 2,326 Region North Western 7.7 621 1,158 7.9 301 508 South Central 50.9 4,105 2,301 50.6 1,932 1,016 South Eastern A 5.7 458 1,195 6.7 254 665 South Eastern B 5.5 441 1,486 5.9 226 741 North Central 30.2 2,439 1,925 29.0 1,107 830 County Bomi 3.1 249 401 3.1 118 161 Bong 9.9 796 671 8.5 324 257 Gbarpolu 1.4 112 337 1.4 53 160 Grand Bassa 5.8 467 543 5.2 197 233 Grand Cape Mount 3.2 260 420 3.4 130 187 Grand Gedeh 2.1 172 384 2.4 92 210 Grand Kru 1.7 136 449 1.7 67 213 Lofa 8.2 658 581 7.5 287 240 Margibi 5.5 441 539 5.5 209 260 Maryland 2.7 215 574 2.9 110 281 Montserrado 39.6 3,197 1,219 39.9 1,525 523 Nimba 12.2 985 673 13.0 496 333 River Cess 1.3 104 365 1.4 52 192 River Gee 1.1 91 463 1.3 50 247 Sinoe 2.3 182 446 2.9 110 263 Education No education 30.7 2,474 2,985 13.0 498 613 Elementary 23.7 1,911 2,389 23.0 877 1,114 Junior high 17.9 1,445 1,329 19.3 738 800 Senior high 21.8 1,761 1,117 34.1 1,303 986 Higher 5.9 474 245 10.6 405 247 Wealth quintile Lowest 17.1 1,379 2,104 17.2 657 970 Second 17.7 1,431 2,029 17.3 663 965 Middle 18.8 1,517 1,723 19.4 743 816 Fourth 22.7 1,829 1,242 21.9 838 537 Highest 23.7 1,910 967 24.1 920 472 Total 15-49 100.0 8,065 8,065 100.0 3,821 3,760 50-59 na na na na 428 489 Total 15-59 na na na na 4,249 4,249 Note: Education categories refer to the highest level of education attended, whether or not that level was completed. na = Not applicable 46 • Characteristics of Respondents Table 3.2.1 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, Liberia DHS 2019-20 Highest level of schooling Total Median years completed Number of women Background characteristic No education Some elementary Completed elementary1 Some junior high Completed junior high2 Some senior high Completed senior high3 Higher Age 15-24 12.5 27.3 4.2 4.2 24.1 8.4 15.8 3.5 100.0 5.7 3,163 15-19 10.4 34.8 5.3 4.2 29.3 2.9 12.2 0.8 100.0 5.3 1,657 20-24 14.8 18.9 3.0 4.1 18.4 14.5 19.8 6.6 100.0 6.4 1,506 25-29 24.5 15.4 3.1 2.8 13.0 21.7 10.3 9.3 100.0 6.1 1,375 30-34 34.7 14.2 2.7 1.7 11.2 18.0 7.4 10.1 100.0 5.2 1,112 35-39 51.1 18.3 3.8 2.6 5.0 9.2 4.0 6.0 100.0 0.0 1,020 40-44 57.2 13.8 2.3 1.9 8.0 9.0 2.8 4.9 100.0 0.0 769 45-49 63.1 17.9 2.3 0.2 5.5 5.2 2.0 3.7 100.0 0.0 626 Residence Urban 21.0 15.2 3.2 3.9 16.7 17.5 13.4 9.1 100.0 6.3 5,023 Greater Monrovia 17.2 9.7 2.4 4.8 14.5 23.7 15.0 12.6 100.0 7.3 2,866 Other urban 26.1 22.6 4.2 2.7 19.6 9.2 11.3 4.3 100.0 5.1 2,157 Rural 46.6 28.6 3.8 1.1 12.3 2.7 4.1 0.6 100.0 0.7 3,042 Region North Western 48.9 20.0 5.8 1.1 14.4 4.1 4.5 1.1 100.0 0.0 621 South Central 22.2 14.8 2.4 3.8 15.3 18.5 13.3 9.6 100.0 6.4 4,105 South Eastern A 37.1 34.0 3.2 1.9 13.8 3.6 5.0 1.3 100.0 2.5 458 South Eastern B 37.7 27.8 4.3 1.7 14.3 5.8 6.3 2.0 100.0 2.9 441 North Central 37.9 25.6 4.3 2.1 15.1 5.5 7.1 2.4 100.0 3.1 2,439 County Bomi 43.2 18.7 7.2 0.8 14.8 5.1 7.9 2.3 100.0 2.7 249 Bong 40.8 24.3 5.2 3.4 9.5 5.5 6.6 4.7 100.0 2.3 796 Gbarpolu 50.6 29.5 6.4 2.1 7.4 2.1 1.1 0.8 100.0 0.0 112 Grand Bassa 41.6 27.9 3.6 1.2 15.2 2.1 6.4 2.0 100.0 1.4 467 Grand Cape Mount 53.6 17.1 4.2 1.0 17.0 4.1 2.8 0.2 100.0 0.0 260 Grand Gedeh 33.2 32.8 4.3 2.4 13.8 6.0 5.4 2.0 100.0 3.5 172 Grand Kru 41.4 33.0 4.5 1.4 13.6 3.5 2.5 0.1 100.0 2.2 136 Lofa 49.8 21.4 2.6 1.4 13.8 4.7 5.5 0.7 100.0 0.0 658 Margibi 31.6 26.2 1.9 1.0 16.6 9.8 10.1 2.9 100.0 3.5 441 Maryland 36.9 23.6 2.5 1.4 13.5 8.4 9.7 4.0 100.0 3.4 215 Montserrado 18.1 11.3 2.4 4.6 15.2 22.1 14.8 11.6 100.0 7.1 3,197 Nimba 27.6 29.5 4.7 1.5 20.5 6.0 8.6 1.7 100.0 4.4 985 River Cess 44.9 36.1 3.5 1.3 10.7 1.6 1.2 0.6 100.0 1.1 104 River Gee 34.0 30.0 8.5 2.6 17.5 3.1 4.0 0.3 100.0 3.3 91 Sinoe 36.3 34.0 2.0 1.7 15.5 2.6 6.8 1.1 100.0 2.4 182 Wealth quintile Lowest 54.3 29.1 4.0 1.2 8.6 1.0 1.6 0.2 100.0 0.0 1,379 Second 43.5 30.7 3.5 0.9 14.7 2.5 4.2 0.1 100.0 1.8 1,431 Middle 32.6 24.3 4.3 2.1 18.1 7.5 9.7 1.3 100.0 4.2 1,517 Fourth 20.9 13.5 3.0 5.6 20.1 15.4 16.6 4.9 100.0 6.3 1,829 Highest 11.9 9.5 2.6 3.5 12.6 27.1 14.0 18.9 100.0 7.9 1,910 Total 30.7 20.3 3.4 2.9 15.0 11.9 9.9 5.9 100.0 4.8 8,065 1 Completed grade 6 at the elementary level 2 Completed grade 9 at the junior high level 3 Completed grade 12 at the senior high level Characteristics of Respondents • 47 Table 3.2.2 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, Liberia DHS 2019-20 Highest level of schooling Total Median years completed Number of men Background characteristic No education Some elementary Completed elementary1 Some junior high Completed junior high2 Some senior high Completed senior high3 Higher Age 15-24 6.8 29.2 3.6 3.4 23.2 10.6 19.8 3.2 100.0 6.1 1,533 15-19 7.2 43.3 3.9 4.0 25.6 0.9 14.7 0.6 100.0 5.0 876 20-24 6.4 10.5 3.2 2.8 20.1 23.7 26.6 6.8 100.0 7.3 658 25-29 12.6 11.0 2.4 2.6 13.7 26.4 17.7 13.7 100.0 7.4 558 30-34 10.4 12.8 1.8 1.9 10.8 27.4 16.9 18.0 100.0 7.8 494 35-39 18.6 15.8 3.5 1.9 11.9 19.1 12.4 16.8 100.0 6.9 487 40-44 19.1 18.0 2.4 2.0 10.7 21.8 12.1 14.0 100.0 6.7 418 45-49 30.5 12.8 1.9 1.5 15.0 14.6 8.7 15.0 100.0 6.0 330 Residence Urban 7.4 15.1 1.3 2.7 15.3 22.5 20.0 15.7 100.0 7.4 2,313 Greater Monrovia 5.3 11.1 0.6 2.7 12.3 27.1 21.4 19.5 100.0 7.9 1,368 Other urban 10.4 20.9 2.2 2.8 19.7 15.9 18.0 10.1 100.0 6.9 944 Rural 21.7 27.7 5.4 2.4 18.8 10.4 10.8 2.8 100.0 5.1 1,508 Region North Western 26.3 20.8 6.4 2.9 18.0 11.3 9.8 4.5 100.0 5.3 301 South Central 8.0 14.7 1.1 2.3 13.7 23.5 19.9 16.9 100.0 7.5 1,932 South Eastern A 12.9 30.7 4.9 3.1 20.9 11.3 11.6 4.6 100.0 5.5 254 South Eastern B 14.7 27.1 6.7 3.1 20.1 11.2 11.8 5.2 100.0 5.6 226 North Central 17.9 25.4 3.9 2.9 20.0 12.1 14.0 3.7 100.0 5.6 1,107 County Bomi 20.5 17.5 4.8 2.6 21.5 14.6 11.1 7.5 100.0 6.3 118 Bong 19.4 26.5 6.6 4.9 15.7 9.6 12.3 5.0 100.0 5.5 324 Gbarpolu 21.1 28.4 5.2 3.2 20.7 8.4 9.0 4.0 100.0 5.0 53 Grand Bassa 20.7 32.2 1.3 2.0 15.9 8.3 13.8 5.8 100.0 4.6 197 Grand Cape Mount 33.7 20.6 8.3 3.0 13.8 9.5 9.1 1.9 100.0 4.5 130 Grand Gedeh 13.9 27.1 3.7 2.1 20.5 12.8 13.5 6.4 100.0 6.0 92 Grand Kru 12.7 30.1 3.3 2.4 26.9 10.5 9.2 4.8 100.0 5.4 67 Lofa 24.5 23.5 3.1 3.2 15.9 15.7 11.7 2.5 100.0 5.3 287 Margibi 13.4 20.9 2.8 1.3 17.1 15.4 14.7 14.4 100.0 6.7 209 Maryland 16.8 25.6 8.4 2.7 16.1 9.0 14.0 7.4 100.0 5.5 110 Montserrado 5.6 11.5 0.8 2.4 12.9 26.6 21.4 18.7 100.0 7.8 1,525 Nimba 13.1 25.8 2.6 1.4 25.3 11.8 16.5 3.5 100.0 5.8 496 River Cess 10.6 37.3 7.8 3.9 23.4 7.4 6.6 2.8 100.0 5.2 52 River Gee 12.6 26.6 7.8 5.0 19.8 16.9 10.5 0.8 100.0 6.1 50 Sinoe 13.1 30.5 4.5 3.7 19.9 11.9 12.4 4.0 100.0 5.4 110 Wealth quintile Lowest 29.5 28.5 5.8 2.2 18.0 6.1 9.2 0.7 100.0 3.9 657 Second 18.3 29.0 4.7 2.7 21.7 10.5 10.7 2.2 100.0 5.2 663 Middle 13.0 24.7 3.9 2.3 16.2 15.4 19.4 5.0 100.0 6.1 743 Fourth 8.1 13.8 0.9 2.7 17.5 24.5 21.2 11.3 100.0 7.2 838 Highest 1.9 9.5 0.5 2.9 11.8 26.9 18.9 27.6 100.0 8.2 920 Total 15-49 13.0 20.1 2.9 2.6 16.7 17.7 16.4 10.6 100.0 6.6 3,821 50-59 24.0 16.6 2.7 3.6 10.7 17.7 11.4 13.4 100.0 6.3 428 Total 15-59 14.1 19.7 2.9 2.7 16.1 17.7 15.9 10.9 100.0 6.6 4,249 1 Completed grade 6 at the elementary level 2 Completed grade 9 at the junior high level 3 Completed grade 12 at the senior high level 48 • Characteristics of Respondents Table 3.3.1 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, Liberia DHS 2019-20 Higher than senior high school No schooling, elementary, junior high, or senior high school Total Percentage literate1 Number of women Background characteristic Can read a whole sentence Can read part of a sentence Cannot read at all No card with required language Blind/ visually impaired Age 15-24 3.5 41.6 24.0 30.7 0.1 0.1 100.0 69.1 3,163 15-19 0.8 44.5 26.6 27.9 0.1 0.1 100.0 71.9 1,657 20-24 6.6 38.3 21.1 33.8 0.2 0.0 100.0 66.0 1,506 25-29 9.3 33.1 15.9 41.7 0.0 0.1 100.0 58.2 1,375 30-34 10.1 22.7 14.7 52.0 0.5 0.0 100.0 47.5 1,112 35-39 6.0 13.5 13.4 66.9 0.2 0.0 100.0 32.9 1,020 40-44 4.9 12.4 9.7 72.9 0.0 0.0 100.0 27.1 769 45-49 3.7 8.7 9.3 78.2 0.0 0.0 100.0 21.7 626 Residence Urban 9.1 36.6 17.5 36.6 0.2 0.0 100.0 63.2 5,023 Greater Monrovia 12.6 40.2 15.9 31.1 0.1 0.1 100.0 68.7 2,866 Other urban 4.3 31.9 19.6 43.8 0.3 0.0 100.0 55.8 2,157 Rural 0.6 15.4 17.5 66.4 0.1 0.0 100.0 33.5 3,042 Region North Western 1.1 21.7 19.8 57.2 0.0 0.1 100.0 42.7 621 South Central 9.6 36.1 16.6 37.6 0.1 0.1 100.0 62.3 4,105 South Eastern A 1.3 23.6 15.1 59.8 0.1 0.0 100.0 40.1 458 South Eastern B 2.0 24.1 22.1 51.7 0.0 0.1 100.0 48.2 441 North Central 2.4 19.7 17.9 59.6 0.3 0.0 100.0 40.0 2,439 County Bomi 2.3 31.6 14.0 52.0 0.0 0.0 100.0 48.0 249 Bong 4.7 20.5 20.2 54.6 0.0 0.0 100.0 45.4 796 Gbarpolu 0.8 9.6 18.7 70.7 0.0 0.1 100.0 29.1 112 Grand Bassa 2.0 18.9 15.3 63.8 0.0 0.0 100.0 36.2 467 Grand Cape Mount 0.2 17.5 25.8 56.4 0.0 0.1 100.0 43.5 260 Grand Gedeh 2.0 23.8 18.9 55.1 0.3 0.0 100.0 44.6 172 Grand Kru 0.1 13.4 19.2 66.9 0.0 0.3 100.0 32.8 136 Lofa 0.7 13.6 15.3 70.3 0.1 0.0 100.0 29.6 658 Margibi 2.9 29.1 17.9 50.1 0.0 0.0 100.0 49.9 441 Maryland 4.0 29.4 23.6 43.0 0.0 0.0 100.0 57.0 215 Montserrado 11.6 39.5 16.7 32.0 0.1 0.1 100.0 67.8 3,197 Nimba 1.7 23.1 17.9 56.6 0.8 0.0 100.0 42.7 985 River Cess 0.6 25.9 14.1 59.5 0.0 0.0 100.0 40.5 104 River Gee 0.3 27.2 22.8 49.7 0.0 0.0 100.0 50.3 91 Sinoe 1.1 22.2 12.2 64.5 0.0 0.0 100.0 35.5 182 Wealth quintile Lowest 0.2 9.3 14.2 75.7 0.5 0.0 100.0 23.7 1,379 Second 0.1 14.2 17.8 67.9 0.0 0.0 100.0 32.1 1,431 Middle 1.3 27.7 21.7 49.4 0.0 0.0 100.0 50.6 1,517 Fourth 4.9 38.2 20.5 36.2 0.1 0.0 100.0 63.7 1,829 Highest 18.9 45.0 13.4 22.4 0.2 0.1 100.0 77.3 1,910 Total 5.9 28.6 17.5 47.8 0.1 0.0 100.0 52.0 8,065 1 Refers to women who attended schooling higher than senior high school and women who can read a whole sentence or part of a sentence Characteristics of Respondents • 49 Table 3.3.2 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, Liberia DHS 2019-20 Higher than senior high school No schooling, elementary, junior high, or senior high school Total Percentage literate1 Number of men Background characteristic Can read a whole sentence Can read part of a sentence Cannot read at all No card with required language Blind/ visually impaired Age 15-24 3.2 56.7 20.4 19.2 0.3 0.1 100.0 80.3 1,533 15-19 0.6 53.6 23.5 22.2 0.0 0.2 100.0 77.6 876 20-24 6.8 60.7 16.4 15.3 0.8 0.0 100.0 83.9 658 25-29 13.7 45.0 14.3 27.0 0.0 0.0 100.0 73.0 558 30-34 18.0 43.5 18.4 19.8 0.0 0.4 100.0 79.9 494 35-39 16.8 36.3 18.7 28.2 0.0 0.0 100.0 71.8 487 40-44 14.0 38.6 16.7 29.7 0.1 1.0 100.0 69.2 418 45-49 15.0 29.5 14.3 41.1 0.0 0.0 100.0 58.9 330 Residence Urban 15.7 53.3 15.0 15.4 0.2 0.3 100.0 84.0 2,313 Greater Monrovia 19.5 55.4 13.4 10.9 0.4 0.6 100.0 88.2 1,368 Other urban 10.1 50.3 17.5 22.1 0.0 0.0 100.0 77.9 944 Rural 2.8 35.7 22.8 38.7 0.0 0.0 100.0 61.3 1,508 Region North Western 4.5 38.2 18.0 39.3 0.0 0.0 100.0 60.7 301 South Central 16.9 53.0 14.0 15.4 0.3 0.4 100.0 83.9 1,932 South Eastern A 4.6 38.9 21.8 34.6 0.0 0.0 100.0 65.4 254 South Eastern B 5.2 46.1 18.1 30.4 0.1 0.0 100.0 69.4 226 North Central 3.7 38.8 24.4 33.2 0.0 0.0 100.0 66.8 1,107 County Bomi 7.5 46.7 11.5 34.3 0.0 0.0 100.0 65.7 118 Bong 5.0 41.6 20.5 32.8 0.0 0.0 100.0 67.2 324 Gbarpolu 4.0 29.5 30.7 35.8 0.0 0.0 100.0 64.2 53 Grand Bassa 5.8 40.5 14.2 39.6 0.0 0.0 100.0 60.4 197 Grand Cape Mount 1.9 34.1 18.7 45.2 0.0 0.0 100.0 54.8 130 Grand Gedeh 6.4 27.1 31.0 35.6 0.0 0.0 100.0 64.4 92 Grand Kru 4.8 38.6 29.9 26.2 0.5 0.0 100.0 73.3 67 Lofa 2.5 31.0 26.1 40.5 0.0 0.0 100.0 59.5 287 Margibi 14.4 48.3 13.8 23.5 0.0 0.0 100.0 76.5 209 Maryland 7.4 51.6 8.2 32.9 0.0 0.0 100.0 67.1 110 Montserrado 18.7 55.2 14.1 11.2 0.3 0.5 100.0 88.0 1,525 Nimba 3.5 41.4 25.8 29.3 0.0 0.0 100.0 70.7 496 River Cess 2.8 47.7 19.6 29.8 0.0 0.0 100.0 70.2 52 River Gee 0.8 44.1 24.4 30.7 0.0 0.0 100.0 69.3 50 Sinoe 4.0 44.7 15.1 36.1 0.0 0.0 100.0 63.9 110 Wealth quintile Lowest 0.7 29.3 21.0 49.0 0.1 0.0 100.0 50.9 657 Second 2.2 34.3 25.5 38.0 0.0 0.0 100.0 62.0 663 Middle 5.0 45.6 21.6 27.8 0.0 0.0 100.0 72.2 743 Fourth 11.3 59.3 15.0 12.9 0.6 0.9 100.0 85.5 838 Highest 27.6 56.0 10.8 5.7 0.0 0.0 100.0 94.3 920 Total 15-49 10.6 46.3 18.1 24.6 0.1 0.2 100.0 75.0 3,821 50-59 13.4 33.4 20.8 32.4 0.0 0.0 100.0 67.6 428 Total 15-59 10.9 45.0 18.4 25.4 0.1 0.2 100.0 74.3 4,249 1 Refers to men who attended schooling higher than senior high school and men who can read a whole sentence or part of a sentence 50 • Characteristics of Respondents Table 3.4.1 Exposure to mass media: Women Percentage of women age 15-49 who are exposed to specific media on a weekly basis, according to background characteristics, Liberia DHS 2019-20 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 Accesses all three media at least once a week Accesses none of the three media at least once a week Number of women Age 15-19 1.9 14.6 20.1 0.4 72.0 1,657 20-24 2.1 18.7 26.8 0.5 65.2 1,506 25-29 1.5 20.6 30.8 0.7 62.0 1,375 30-34 2.5 17.0 25.9 1.6 66.8 1,112 35-39 1.7 18.4 30.2 1.0 65.5 1,020 40-44 1.7 12.3 30.4 1.4 66.3 769 45-49 3.6 11.3 23.4 3.0 71.8 626 Residence Urban 2.9 24.7 32.0 1.5 58.4 5,023 Greater Monrovia 3.8 33.7 36.5 2.3 50.7 2,866 Other urban 1.7 12.7 25.9 0.5 68.7 2,157 Rural 0.6 3.6 17.4 0.2 81.0 3,042 Region North Western 0.8 6.3 19.3 0.3 77.1 621 South Central 3.1 27.0 31.2 1.7 58.2 4,105 South Eastern A 1.8 11.3 24.7 0.6 71.2 458 South Eastern B 1.7 8.6 20.4 0.4 76.2 441 North Central 0.8 4.6 21.9 0.2 76.6 2,439 County Bomi 0.4 4.2 15.0 0.2 82.6 249 Bong 1.0 3.9 21.4 0.4 76.9 796 Gbarpolu 0.2 4.4 36.1 0.0 63.2 112 Grand Bassa 0.4 8.9 20.6 0.1 74.6 467 Grand Cape Mount 1.3 9.1 16.1 0.5 77.7 260 Grand Gedeh 0.8 9.0 27.4 0.3 68.6 172 Grand Kru 0.0 0.7 1.2 0.0 98.5 136 Lofa 0.7 3.3 14.3 0.0 84.0 658 Margibi 3.1 18.4 23.3 0.7 67.9 441 Maryland 2.2 16.3 33.9 0.5 59.7 215 Montserrado 3.4 30.8 33.8 2.0 54.4 3,197 Nimba 0.7 6.1 27.3 0.2 71.3 985 River Cess 0.2 1.5 12.2 0.0 87.4 104 River Gee 2.8 2.5 16.9 0.8 82.1 91 Sinoe 3.6 19.1 29.3 1.3 64.5 182 Education No education 0.0 6.5 18.6 0.0 78.6 2,474 Elementary 0.7 8.9 20.1 0.3 76.0 1,911 Junior high 2.3 15.9 23.5 0.6 69.1 1,445 Senior high 3.6 30.6 37.1 1.5 49.6 1,761 Higher 12.0 52.5 63.0 8.3 26.9 474 Wealth quintile Lowest 0.3 2.0 14.2 0.2 85.0 1,379 Second 0.7 2.6 19.8 0.0 79.0 1,431 Middle 1.8 7.5 23.0 0.7 73.7 1,517 Fourth 2.1 19.7 29.1 0.7 62.1 1,829 Highest 4.5 42.5 40.7 2.9 44.0 1,910 Total 2.1 16.7 26.5 1.0 66.9 8,065 Characteristics of Respondents • 51 Table 3.4.2 Exposure to mass media: Men Percentage of men age 15-49 who are exposed to specific media on a weekly basis, according to background characteristics, Liberia DHS 2019-20 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 Accesses all three media at least once a week Accesses none of the three media at least once a week Number of men Age 15-19 4.0 19.0 28.9 1.1 62.3 876 20-24 10.4 17.0 43.5 2.9 48.0 658 25-29 14.9 18.4 43.0 5.0 47.2 558 30-34 18.6 16.1 45.9 8.6 50.2 494 35-39 12.2 17.9 46.0 5.7 48.6 487 40-44 12.4 16.2 51.0 5.1 44.0 418 45-49 11.5 16.1 42.9 5.9 53.0 330 Residence Urban 16.1 25.4 48.2 6.9 42.0 2,313 Greater Monrovia 20.0 34.0 55.5 10.1 33.0 1,368 Other urban 10.5 12.8 37.6 2.2 55.0 944 Rural 3.7 5.4 31.2 0.5 66.1 1,508 Region North Western 2.5 9.0 38.4 0.0 56.9 301 South Central 18.3 27.9 52.5 8.4 37.8 1,932 South Eastern A 3.1 10.1 37.2 0.8 59.6 254 South Eastern B 6.3 12.4 20.4 0.6 68.6 226 North Central 4.0 4.4 28.4 0.2 68.6 1,107 County Bomi 1.7 12.6 48.1 0.0 46.3 118 Bong 1.0 3.2 25.8 0.0 72.9 324 Gbarpolu 1.8 9.0 46.1 0.0 50.8 53 Grand Bassa 19.8 10.2 51.9 3.9 45.6 197 Grand Cape Mount 3.5 5.7 26.6 0.0 68.9 130 Grand Gedeh 2.4 15.4 48.9 1.6 48.9 92 Grand Kru 1.1 4.5 13.4 0.0 82.8 67 Lofa 4.0 6.2 30.3 0.0 65.4 287 Margibi 11.9 14.8 48.6 3.8 44.3 209 Maryland 11.0 19.9 25.2 0.9 56.4 110 Montserrado 19.0 32.0 53.1 9.6 35.9 1,525 Nimba 6.0 4.0 29.1 0.4 67.6 496 River Cess 0.9 2.5 20.6 0.5 79.4 52 River Gee 3.0 6.5 19.1 0.6 76.5 50 Sinoe 4.7 9.3 35.2 0.3 59.2 110 Education No education 0.0 5.1 20.8 0.0 77.7 498 Elementary 0.9 7.7 25.9 0.2 69.4 877 Junior high 4.6 20.0 34.4 1.1 55.8 738 Senior high 18.4 21.2 54.0 7.4 39.3 1,303 Higher 35.8 37.6 73.3 15.1 12.1 405 Wealth quintile Lowest 1.9 2.4 23.2 0.1 75.6 657 Second 4.0 5.5 30.8 0.7 66.6 663 Middle 8.3 9.0 34.8 1.1 58.9 743 Fourth 14.0 22.3 47.6 6.0 43.0 838 Highest 22.7 39.5 62.1 11.2 25.2 920 Total 15-49 11.2 17.5 41.5 4.4 51.5 3,821 50-59 8.4 11.0 50.3 3.8 48.8 428 Total 15-59 10.9 16.8 42.4 4.3 51.2 4,249 52 • Characteristics of Respondents Table 3.5.1 Internet usage: Women Percentage of women age 15-49 who have ever used the internet and percentage who have used the internet in the past 12 months, and among women who have used the internet in the past 12 months, percent distribution by frequency of internet use in the past month, according to background characteristics, Liberia DHS 2019-20 Ever used the internet Used the internet in the past 12 months Number of women Among women who have used the internet in the past 12 months, percentage who, in the past month, used the internet: Background characteristic Almost every day At least once a week Less than once a week Not at all Total Number Age 15-19 19.9 16.8 1,657 34.2 28.2 32.8 4.9 100.0 279 20-24 36.7 30.9 1,506 50.9 26.5 18.3 4.3 100.0 466 25-29 35.2 28.4 1,375 54.0 29.9 14.3 1.8 100.0 391 30-34 32.6 27.2 1,112 55.2 25.6 16.0 3.2 100.0 302 35-39 20.8 17.9 1,020 50.3 29.8 18.7 1.2 100.0 183 40-44 15.0 13.2 769 33.6 43.3 18.0 5.0 100.0 101 45-49 10.1 8.5 626 (52.1) (32.2) (15.4) (0.4) 100.0 53 Residence Urban 38.3 32.9 5,023 49.9 28.2 18.8 3.1 100.0 1,652 Greater Monrovia 50.4 44.1 2,866 53.7 26.7 16.8 2.8 100.0 1,263 Other urban 22.1 18.1 2,157 37.7 32.9 25.3 4.0 100.0 389 Rural 6.5 4.0 3,042 31.8 37.6 25.4 5.2 100.0 123 Region North Western 11.4 8.0 621 31.2 35.8 21.8 11.2 100.0 50 South Central 40.6 35.1 4,105 52.0 27.9 17.4 2.7 100.0 1,441 South Eastern A 16.8 12.3 458 37.4 37.0 19.2 6.4 100.0 56 South Eastern B 15.8 12.1 441 40.6 37.8 20.2 1.5 100.0 53 North Central 9.7 7.2 2,439 32.5 29.3 33.2 4.9 100.0 175 County Bomi 14.1 10.5 249 29.4 47.7 18.3 4.6 100.0 26 Bong 13.2 11.7 796 39.2 37.4 21.4 2.1 100.0 93 Gbarpolu 6.1 4.3 112 * * * * 100.0 5 Grand Bassa 13.7 11.3 467 32.5 37.0 30.5 0.0 100.0 53 Grand Cape Mount 11.1 7.2 260 (35.7) (21.3) (23.4) (19.6) 100.0 19 Grand Gedeh 23.1 16.1 172 49.1 30.1 11.1 9.7 100.0 28 Grand Kru 7.5 5.5 136 (17.3) (33.0) (45.5) (4.3) 100.0 7 Lofa 6.9 3.8 658 * * * * 100.0 25 Margibi 19.1 18.0 441 39.0 42.4 16.7 1.9 100.0 79 Maryland 23.3 18.1 215 48.4 37.9 13.1 0.6 100.0 39 Montserrado 47.5 40.9 3,197 53.6 26.6 17.0 2.9 100.0 1,309 Nimba 8.7 5.7 985 (33.3) (8.9) (46.2) (11.7) 100.0 56 River Cess 7.3 4.5 104 * * * * 100.0 5 River Gee 10.3 7.9 91 (22.5) (42.0) (32.2) (3.2) 100.0 7 Sinoe 16.2 13.1 182 25.0 42.6 30.1 2.2 100.0 24 Education No education 4.6 3.2 2,474 27.3 35.3 37.4 0.0 100.0 79 Elementary 7.0 4.8 1,911 27.4 23.9 47.7 1.0 100.0 91 Junior high 23.0 18.1 1,445 27.2 39.5 27.7 5.6 100.0 262 Senior high 62.3 52.3 1,761 48.2 30.7 17.0 4.2 100.0 922 Higher 93.9 88.7 474 71.9 18.0 9.4 0.7 100.0 421 Wealth quintile Lowest 2.7 1.7 1,379 (21.5) (23.2) (46.9) (8.4) 100.0 24 Second 4.5 2.1 1,431 21.3 47.0 26.7 4.9 100.0 31 Middle 14.0 10.4 1,517 24.6 39.2 33.1 3.2 100.0 157 Fourth 34.6 27.8 1,829 37.8 34.7 23.7 3.8 100.0 508 Highest 61.5 55.2 1,910 58.9 24.1 14.2 2.8 100.0 1,055 Total 26.3 22.0 8,065 48.7 28.8 19.3 3.2 100.0 1,775 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. Characteristics of Respondents • 53 Table 3.5.2 Internet usage: Men Percentage of men age 15-49 who have ever used the internet and percentage who have used the internet in the past 12 months, and among men who have used the internet in the past 12 months, percent distribution by frequency of internet use in the past month, according to background characteristics, Liberia DHS 2019-20 Ever used the internet Used the internet in the past 12 months Number of women Among men who have used the internet in the past 12 months, percentage who, in the past month, used the internet: Background characteristic Almost every day At least once a week Less than once a week Not at all Total Number Age 15-19 33.9 28.4 876 27.4 38.4 23.7 10.6 100.0 248 20-24 61.2 49.0 658 39.3 34.5 17.6 8.5 100.0 322 25-29 51.0 41.5 558 54.4 29.0 8.5 8.1 100.0 232 30-34 50.8 43.9 494 43.2 31.2 15.0 10.6 100.0 217 35-39 38.3 34.1 487 41.1 22.6 24.5 11.9 100.0 166 40-44 31.9 27.7 418 56.8 13.4 26.0 3.9 100.0 116 45-49 28.7 27.2 330 55.0 30.1 14.4 0.6 100.0 90 Residence Urban 60.5 53.1 2,313 45.8 30.3 16.2 7.7 100.0 1,228 Greater Monrovia 73.7 65.8 1,368 45.1 30.8 15.5 8.6 100.0 901 Other urban 41.5 34.6 944 47.6 29.1 18.2 5.1 100.0 327 Rural 16.6 10.8 1,508 22.0 30.0 31.9 16.1 100.0 163 Region North Western 16.4 11.8 301 32.4 27.6 25.6 14.4 100.0 36 South Central 65.1 57.2 1,932 44.1 30.1 17.3 8.5 100.0 1,104 South Eastern A 28.9 21.2 254 36.7 33.0 23.9 6.3 100.0 54 South Eastern B 27.3 21.2 226 42.3 33.8 17.2 6.8 100.0 48 North Central 18.7 13.4 1,107 39.9 30.2 20.2 9.7 100.0 149 County Bomi 13.6 13.1 118 * * * * 100.0 15 Bong 20.5 19.3 324 (40.6) (37.0) (22.4) (0.0) 100.0 63 Gbarpolu 14.9 9.8 53 * * * * 100.0 5 Grand Bassa 28.6 23.7 197 67.1 20.9 7.1 5.0 100.0 47 Grand Cape Mount 19.6 11.5 130 (9.4) (48.7) (14.2) (27.7) 100.0 15 Grand Gedeh 25.3 19.4 92 (51.7) (29.4) (18.9) (0.0) 100.0 18 Grand Kru 18.1 14.9 67 (31.5) (34.1) (27.1) (7.3) 100.0 10 Lofa 18.2 13.3 287 (23.2) (34.2) (26.8) (15.8) 100.0 38 Margibi 51.6 42.2 209 29.5 37.1 19.4 14.0 100.0 88 Maryland 34.9 27.3 110 51.7 34.3 7.0 7.0 100.0 30 Montserrado 71.7 63.5 1,525 44.3 29.9 17.6 8.2 100.0 969 Nimba 17.9 9.7 496 (52.5) (18.1) (12.1) (17.4) 100.0 48 River Cess 19.8 10.1 52 (7.8) (29.1) (54.4) (8.7) 100.0 5 River Gee 22.9 16.3 50 (20.4) (31.7) (42.8) (5.1) 100.0 8 Sinoe 36.3 28.0 110 33.0 35.8 21.6 9.6 100.0 31 Education No education 9.7 6.7 498 (15.6) (54.0) (29.4) (0.9) 100.0 33 Elementary 10.8 7.1 877 16.7 38.3 33.4 11.6 100.0 62 Junior high 38.7 29.4 738 21.3 41.9 24.7 12.1 100.0 217 Senior high 65.5 55.8 1,303 39.6 31.6 18.4 10.4 100.0 728 Higher 91.0 86.6 405 70.8 16.7 9.4 3.1 100.0 351 Wealth quintile Lowest 8.3 4.4 657 (18.4) (35.9) (22.0) (23.7) 100.0 29 Second 15.6 7.9 663 17.5 31.5 32.5 18.5 100.0 52 Middle 31.1 23.3 743 22.9 37.5 28.7 10.9 100.0 173 Fourth 60.0 50.8 838 29.1 33.9 25.0 12.1 100.0 425 Highest 82.4 77.3 920 59.1 26.1 10.1 4.7 100.0 711 Total 15-49 43.2 36.4 3,821 43.0 30.3 18.1 8.6 100.0 1,391 50-59 20.5 16.4 428 34.6 35.4 27.8 2.3 100.0 70 Total 15-59 40.9 34.4 4,249 42.6 30.5 18.5 8.3 100.0 1,461 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. 54 • Characteristics of Respondents Table 3.6.1 Employment status: Women Percent distribution of women age 15-49 by employment status, according to background characteristics, Liberia DHS 2019-20 Employed in the 12 months preceding the survey Not employed in the 12 months preceding the survey Total Number of women Background characteristic Currently employed1 Not currently employed Age 15-19 32.7 2.4 64.9 100.0 1,657 20-24 48.7 2.8 48.5 100.0 1,506 25-29 63.8 4.6 31.6 100.0 1,375 30-34 74.0 4.3 21.7 100.0 1,112 35-39 77.3 3.9 18.8 100.0 1,020 40-44 81.1 3.7 15.2 100.0 769 45-49 83.0 2.7 14.3 100.0 626 Marital status Never married 42.1 3.0 54.9 100.0 3,129 Married or living together 72.7 3.2 24.0 100.0 4,216 Divorced/separated/ widowed 72.4 6.8 20.8 100.0 721 Number of living children 0 34.4 2.0 63.6 100.0 1,916 1-2 60.9 3.7 35.3 100.0 3,023 3-4 75.5 4.6 19.8 100.0 1,832 5+ 79.0 3.1 17.9 100.0 1,294 Residence Urban 57.1 3.2 39.7 100.0 5,023 Greater Monrovia 53.1 3.7 43.2 100.0 2,866 Other urban 62.4 2.5 35.0 100.0 2,157 Rural 67.0 3.9 29.1 100.0 3,042 Region North Western 63.2 3.4 33.4 100.0 621 South Central 54.4 3.9 41.6 100.0 4,105 South Eastern A 73.6 2.0 24.4 100.0 458 South Eastern B 54.1 4.0 41.9 100.0 441 North Central 69.8 2.8 27.4 100.0 2,439 County Bomi 70.7 2.1 27.2 100.0 249 Bong 68.4 4.3 27.3 100.0 796 Gbarpolu 82.0 7.5 10.5 100.0 112 Grand Bassa 63.6 2.6 33.8 100.0 467 Grand Cape Mount 47.9 3.0 49.1 100.0 260 Grand Gedeh 78.2 1.2 20.6 100.0 172 Grand Kru 52.7 1.6 45.7 100.0 136 Lofa 71.7 2.9 25.3 100.0 658 Margibi 63.9 3.5 32.6 100.0 441 Maryland 51.2 6.1 42.7 100.0 215 Montserrado 51.8 4.2 44.0 100.0 3,197 Nimba 69.7 1.5 28.9 100.0 985 River Cess 71.2 1.7 27.1 100.0 104 River Gee 63.2 2.3 34.5 100.0 91 Sinoe 70.7 2.9 26.5 100.0 182 Education No education 75.5 3.3 21.2 100.0 2,474 Elementary 61.4 3.8 34.8 100.0 1,911 Junior high 47.5 3.7 48.9 100.0 1,445 Senior high 52.0 3.0 44.9 100.0 1,761 Higher 55.5 3.5 41.1 100.0 474 Wealth quintile Lowest 72.7 4.1 23.3 100.0 1,379 Second 69.2 3.4 27.5 100.0 1,431 Middle 62.1 2.0 35.9 100.0 1,517 Fourth 56.0 5.0 38.9 100.0 1,829 Highest 49.6 2.7 47.7 100.0 1,910 Total 60.8 3.4 35.7 100.0 8,065 1 “Currently employed” is defined as having done work in the past 7 days. Includes persons who did not work in the past 7 days but who are regularly employed and were absent from work for leave, illness, vacation, or any other such reason. Characteristics of Respondents • 55 Table 3.6.2 Employment status: Men Percent distribution of men age 15-49 by employment status, according to background characteristics, Liberia DHS 2019-20 Employed in the 12 months preceding the survey Not employed in the 12 months preceding the survey Total Number of men Background characteristic Currently employed1 Not currently employed Age 15-19 53.7 5.8 40.5 100.0 876 20-24 73.8 5.6 20.7 100.0 658 25-29 88.7 3.5 7.8 100.0 558 30-34 93.9 0.9 5.3 100.0 494 35-39 92.5 5.8 1.7 100.0 487 40-44 93.4 1.1 5.5 100.0 418 45-49 97.4 1.0 1.5 100.0 330 Marital status Never married 62.6 6.1 31.2 100.0 1,684 Married or living together 94.8 2.1 3.1 100.0 1,906 Divorced/separated/ widowed 93.4 1.6 5.0 100.0 231 Number of living children 0 62.2 6.1 31.7 100.0 1,616 1-2 91.4 2.3 6.4 100.0 937 3-4 96.1 2.2 1.7 100.0 673 5+ 95.6 2.2 2.2 100.0 594 Residence Urban 75.9 4.4 19.7 100.0 2,313 Greater Monrovia 71.6 5.5 22.8 100.0 1,368 Other urban 82.2 2.7 15.1 100.0 944 Rural 87.6 3.0 9.4 100.0 1,508 Region North Western 81.0 5.6 13.4 100.0 301 South Central 74.2 5.0 20.8 100.0 1,932 South Eastern A 89.9 2.6 7.5 100.0 254 South Eastern B 74.1 3.5 22.4 100.0 226 North Central 90.6 1.8 7.6 100.0 1,107 County Bomi 75.7 5.9 18.4 100.0 118 Bong 78.6 4.3 17.1 100.0 324 Gbarpolu 95.9 1.7 2.3 100.0 53 Grand Bassa 94.3 3.8 1.9 100.0 197 Grand Cape Mount 79.8 6.8 13.4 100.0 130 Grand Gedeh 90.7 0.7 8.6 100.0 92 Grand Kru 84.6 4.9 10.5 100.0 67 Lofa 92.6 0.0 7.4 100.0 287 Margibi 77.1 3.9 19.0 100.0 209 Maryland 66.0 2.6 31.4 100.0 110 Montserrado 71.2 5.3 23.5 100.0 1,525 Nimba 97.4 1.1 1.5 100.0 496 River Cess 81.0 6.0 13.0 100.0 52 River Gee 77.9 3.6 18.5 100.0 50 Sinoe 93.4 2.5 4.1 100.0 110 Education No education 96.0 1.5 2.6 100.0 498 Elementary 78.9 3.6 17.4 100.0 877 Junior high 76.9 3.3 19.8 100.0 738 Senior high 77.6 4.8 17.6 100.0 1,303 Higher 81.1 5.1 13.8 100.0 405 Wealth quintile Lowest 92.1 1.9 6.0 100.0 657 Second 89.1 3.4 7.4 100.0 663 Middle 82.4 2.8 14.7 100.0 743 Fourth 73.4 5.9 20.7 100.0 838 Highest 71.0 4.5 24.5 100.0 920 Total 15-49 80.5 3.8 15.6 100.0 3,821 50-59 91.1 1.6 7.2 100.0 428 Total 15-59 81.6 3.6 14.8 100.0 4,249 1 “Currently employed” is defined as having done work in the past 7 days. Includes persons who did not work in the past 7 days but who are regularly employed and were absent from work for leave, illness, vacation, or any other such reason. 56 • Characteristics of Respondents Table 3.7.1 Occupation: Wom

View the publication