Nepal - Demographic and Health Survey - 2017

Publication date: 2017

Nepal Demographic and Health Survey 2016 D em ographic and H ealth S urvey N epal 2016 NEPAL DEMOGRAPHIC AND HEALTH SURVEY 2016 Ministry of Health Ramshah Path, Kathmandu Nepal New ERA Kathmandu, Nepal The DHS Program ICF Rockville, Maryland, USA November 2017 New ERA Ministry of Health The 2016 Nepal Demographic and Health Survey (2016 NDHS) was implemented by New ERA under the aegis of the Ministry of Health of Nepal. Funding for the survey was provided by the United States Agency for International Development (USAID). 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 2016 NDHS may be obtained from the Ministry of Health, Ramshahpath, Kathmandu; Telephone: (+) 977-1-4262543/4262802; Internet: http://www.mohp.gov.np; and New ERA, Rudramati Marg, Kathmandu, P.O. Box 722, Kathmandu 44600, Nepal; Telephone: +977-1-4413603; Email: info@newera.com.np; Internet: http://www.newera.com.np. 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; E-mail: info@DHSprogram.com; Internet: www.DHSprogram.com. Cover photo: ©2017 Ashess Shakya/Photo Zenith Pokhara/98560 37870 Suggested citation: Ministry of Health, Nepal; New ERA; and ICF. 2017. Nepal Demographic and Health Survey 2016. Kathmandu, Nepal: Ministry of Health, Nepal. Contents • iii CONTENTS TABLES AND FIGURES . ix FOREWORD . xix ACKNOWLEDGEMENTS . xxi 2016 NEPAL DEMOGRAPHIC AND HEALTH SURVEY TECHNICAL ADVISORY COMMITTEE . xxiii 2016 NEPAL DEMOGRAPHIC AND HEALTH SURVEY TECHNICAL WORKING GROUP . xxiv CONTRIBUTORS TO THE REPORT . xxv ACRONYMS AND ABBREVIATIONS . xxvii READING AND UNDERSTANDING TABLES FROM THE 2016 NEPAL DEMOGRAPHIC AND HEALTH SURVEY (NDHS) . xxxi SUSTAINABLE DEVELOPMENT GOAL INDICATORS . xxxvii MAP OF NEPAL . xlii 1 INTRODUCTION AND SURVEY METHODOLOGY . 1 1.1 Survey Objectives .1 1.2 Sample Design .1 1.3 Questionnaires.3 1.4 Anthropometry, Hemoglobin Testing, and Blood Pressure Measurement .4 1.5 Pretest .5 1.6 Training of Field Staff .5 1.7 Fieldwork .6 1.8 Data Processing .7 1.9 Response Rates .7 2 HOUSING CHARACTERISTICS AND HOUSEHOLD POPULATION . 9 2.1 Drinking Water Sources and Treatment .9 2.2 Sanitation .10 2.3 Exposure to Smoke inside the Home and Other Household Characteristics .11 2.3.1 Exposure to Smoke Inside the Home .11 2.3.2 Other Housing Characteristics .11 2.3.3 Household Durable Goods .11 2.3.4 Access to Government Health Facilities .11 2.4 Household Wealth .11 2.5 Hand Washing .12 2.6 Household Population and Composition .13 2.7 Migration.14 2.8 Birth Registration .14 2.9 Children’s Living Arrangements and Parental Survival .15 2.10 Education .15 2.10.1 Educational Attainment .15 2.10.2 School Attendance .16 2.10.3 Other Measures of School Attendance .17 2.11 Possession of Mosquito Nets .17 2.12 Knowledge of Lymphatic Filariasis .17 2.13 Food Security .18 3 CHARACTERISTICS OF RESPONDENTS . 43 iv • Contents 3.1 Basic Characteristics of Survey Respondents .43 3.2 Spousal Separation .44 3.3 Education and Literacy .44 3.4 Mass Media Exposure and Internet Usage.45 3.5 Employment .46 3.6 Occupation .47 3.7 Tobacco Use.47 3.8 Knowledge and Attitudes Regarding Tuberculosis .48 4 MARRIAGE AND SEXUAL ACTIVITY . 75 4.1 Marital Status .75 4.2 Polygyny .76 4.3 Age at First Marriage .77 4.4 Age at First Sexual Intercourse .77 4.5 Recent Sexual Activity .78 5 FERTILITY . 89 5.1 Current Fertility .89 5.2 Children Ever Born and Living.91 5.3 Birth Intervals .91 5.4 Insusceptibility to Pregnancy .92 5.5 Age at First Birth .93 5.6 Teenage Childbearing and Sexual and Reproductive Behaviors before Age 15 .93 5.6.1 Teenage Childbearing .93 5.6.2 Sexual and Reproductive Behaviors before Age 15 .94 6 FERTILITY PREFERENCES . 103 6.1 Desire for Another Child .103 6.2 Ideal Family Size .104 6.3 Fertility Planning Status .105 6.4 Wanted Fertility Rates .106 7 FAMILY PLANNING . 115 7.1 Contraceptive Knowledge and Use .115 7.2 Source of Modern Contraceptive Methods .118 7.3 Informed Choice .118 7.4 Discontinuation of Contraceptives .119 7.5 Demand for Family Planning .119 7.6 Decision Making about Family Planning .121 7.7 Future Use of Contraception .121 7.8 Exposure to Family Planning Messages in the Media .121 7.9 Contact of Nonusers with Family Planning Providers .121 8 INFANT AND CHILD MORTALITY . 141 8.1 Infant and Child Mortality .142 8.2 Biodemographic and Sociodemographic Risk Factors .143 8.3 Perinatal Mortality .144 8.4 High-risk Fertility Behavior .145 9 MATERNAL AND NEWBORN HEALTH CARE. 151 9.1 Antenatal Care Coverage .152 9.1.1 Skilled Providers .152 Contents • v 9.1.2 Timing and Number of ANC Visits .152 9.2 Components of ANC Visits .153 9.3 Protection against Neonatal Tetanus .154 9.4 Delivery Services .154 9.4.1 Institutional Deliveries .154 9.4.2 Skilled Assistance during Delivery .155 9.4.3 Delivery by Cesarean .156 9.4.4 Care and Support during Delivery .157 9.5 Postnatal Care .158 9.5.1 Postnatal Health Check for Mothers .158 9.5.2 Postnatal Health Check for Newborns .159 9.5.3 Newborn Care Practices .160 9.6 Abortion .161 9.6.1 Knowledge that Abortion Is Legal .161 9.6.2 Pregnancy Outcomes .162 9.6.3 Abortion Status among Women .162 9.7 Problems in Accessing Health Care .163 10 CHILD HEALTH . 201 10.1 Birth Weight.201 10.2 Vaccination of Children .202 10.3 Symptoms of Acute Respiratory Infection .204 10.4 Fever .205 10.5 Diarrheal Disease .205 10.5.1 Prevalence of Diarrhea .205 10.5.2 Treatment or Advice Seeking during Diarrhea .206 10.5.3 Feeding Practices .207 10.5.4 Treatment of Diarrhea .208 10.6 Disposal of Children’s Stools .209 11 NUTRITION OF CHILDREN AND ADULTS . 223 11.1 Nutritional Status of Children .223 11.1.1 Measurement of Nutritional Status among Young Children .224 11.1.2 Data Collection .225 11.1.3 Levels of Child Malnutrition .225 11.2 Infant and Young Child Feeding Practices .226 11.2.1 Initiation of Breastfeeding .226 11.2.2 Exclusive Breastfeeding.227 11.2.3 Median Duration of Breastfeeding.227 11.2.4 Infant and Young Child Feeding (IYCF) Indicators and Breastfeeding Status.228 11.2.5 Complementary Feeding .228 11.2.6 Minimum Acceptable Diet .229 11.3 Anemia Prevalence in Children .230 11.4 Presence of Iodized Salt in Households .232 11.5 Micronutrient Intake and Supplementation among Children.232 11.6 Adult Nutritional Status .233 11.6.1 Nutritional Status of Women .233 11.6.2 Nutritional Status of Men.234 11.7 Anemia Prevalence in Women .235 11.8 Micronutrient Intake and Food Consumed among Mothers .236 vi • Contents 11.8.1 Micronutrient Intake among Mothers .236 11.8.2 Food Consumed by Mothers .237 11.9 Counseling on Maternal, Infant, and Young Child Nutrition .237 11.10 Growth Monitoring and Promotion and Counseling at the Monitoring and Promotion Session .238 12 ADULT AND MATERNAL MORTALITY . 259 12.1 Data .259 12.2 Direct Estimates of Adult Mortality .260 12.3 Direct Estimates of Maternal Mortality .261 12.4 Trends in Pregnancy-Related Mortality .262 13 HIV/AIDS-RELATED KNOWLEDGE, ATTITUDES, AND BEHAVIOR . 265 13.1 HIV/AIDS Knowledge, Transmission, and Prevention Methods .266 13.2 Knowledge about Mother-to-Child Transmission .267 13.3 Discriminatory Attitudes towards People Living with HIV .267 13.4 Multiple Sexual Partners .268 13.5 Paid Sex .268 13.6 Coverage of HIV Testing Services .269 13.6.1 Awareness of HIV Testing Services and Experience with HIV Testing.269 13.6.2 HIV Testing of Pregnant Women .270 13.7 Knowledge on Treatment for HIV .270 13.8 Self-reporting of Sexually Transmitted Infections .270 13.9 HIV/AIDS-Related Knowledge and Behavior among Young People .271 13.9.1 Knowledge .271 13.9.2 First Sex .271 13.9.3 Premarital Sex .272 13.9.4 Multiple Sexual Partners .272 13.9.5 Coverage of HIV Testing Services .273 14 BLOOD PRESSURE . 289 14.1 History of High Blood Pressure .289 14.2 Blood Pressure status .290 15 WOMEN’S EMPOWERMENT . 301 15.1 Married Women’s and Men’s Employment .301 15.2 Control over Women’s Earnings .302 15.2.1 Control over Men’s Earnings .303 15.3 Women’s Control over Their Own Earnings and over Those of Their Husbands .303 15.4 Women’s and Men’s Ownership of Assets .304 15.5 Ownership of Title or Deed for House and Land .304 15.6 Knowledge About the Household Property .305 15.7 Ownership and Use of Bank Accounts and Mobile Phones .305 15.8 Women’s Participation in Decision Making .306 15.9 Attitudes towards Wife Beating .307 15.10 Attitude towards Negotiating Safer Sexual Relations with Husband .307 15.11 Ability to Negotiate Sexual Relations with Husband .308 15.12 Women’s Empowerment Indicators .308 15.13 Current Use of Contraception by Women’s Empowerment .309 Contents • vii 15.14 Ideal Number of Children and Unmet Need for Family Planning by Women’s Empowerment .309 15.15 Reproductive Health Care by Women’s Empowerment .309 15.16 Early Childhood Mortality and Women’s Empowerment .309 16 DOMESTIC VIOLENCE . 337 16.1 Measurement of Violence .338 16.2 Women’s Experience of Physical Violence .339 16.2.1 Perpetrators of Physical Violence .340 16.3 Experience of Sexual Violence .340 16.3.1 Prevalence of Sexual Violence .340 16.3.2 Perpetrators of Sexual Violence.340 16.4 Experience of Different Forms of Violence.340 16.5 Marital Control by Husband .341 16.6 Forms of Spousal Violence .341 16.6.1 Prevalence of Spousal Violence.342 16.6.2 Onset of Spousal Violence .344 16.7 Injuries to Women due to Spousal Violence.344 16.8 Violence Initiated by Women against Husbands .345 16.9 Forms of Emotional Violence in the household .346 16.10 Help-Seeking among Women Who Have Experienced Violence .346 16.10.1 Sources for Help .347 17 CAUSE OF DEATH IN NEONATES . 365 17.1 The Verbal Autopsy Instrument.365 17.2 Data Collection Methods .366 17.3 Quality Assurance .366 17.4 Cause of Death Certification and coding .366 17.5 Characteristics of Neonatal Deaths and Stillbirths .367 17.6 Cause of Neonatal Deaths .368 17.7 Cause of Stillbirths .369 17.8 Health Services related to Neonatal Deaths and Stillbirths .369 REFERENCES. 375 APPENDIX A SAMPLE DESIGN . 379 A.1 Introduction .379 A.2 Sample Frame .379 A.3 Sample Design and Implementation .380 A.4 Sample Probabilities and Sampling Weights .383 APPENDIX B ESTIMATES OF SAMPLING ERRORS . 385 APPENDIX C DATA QUALITY TABLES . 399 APPENDIX D MORTALITY CLASSIFICATION AND WHO INTERNATIONAL CLASSIFICATION OF DISEASE (ICD) CODES . 405 APPENDIX E PERSONS INVOLVED IN THE 2016 NEPAL DEMOGRAPHIC AND HEALTH SURVEY . 407 APPENDIX F QUESTIONNAIRES . 411 Tables and Figures • ix TABLES AND FIGURES 1 INTRODUCTION AND SURVEY METHODOLOGY . 1 Table 1.1 Results of the household and individual interviews . 8 2 HOUSING CHARACTERISTICS AND HOUSEHOLD POPULATION . 9 Table 2.1 Household drinking water . 20 Table 2.2 Availability of water . 21 Table 2.3 Household sanitation facilities. 22 Table 2.4 Household characteristics . 23 Table 2.5 Household possessions . 24 Table 2.6 Distance to nearest government health facility . 25 Table 2.7 Wealth quintiles . 26 Table 2.8 Hand washing . 27 Table 2.9 Household population by age, sex, and residence . 28 Table 2.10 Household composition . 29 Table 2.11 Migration status . 30 Table 2.12.1 Duration and destination of migration: Women . 31 Table 2.12.2 Duration and destination of migration: Men . 32 Table 2.13 Birth registration of children under age 5 . 33 Table 2.14 Children's living arrangements and orphanhood . 34 Table 2.15.1 Educational attainment of the female household population . 35 Table 2.15.2 Educational attainment of the male household population . 36 Table 2.16 School attendance ratios . 37 Table 2.17 Possession of mosquito nets . 39 Table 2.18 Protection against mosquito bites . 40 Table 2.19 Knowledge of lymphatic filariasis . 41 Table 2.20 Household food security . 42 Figure 2.1 Household drinking water by residence . 10 Figure 2.2 Household toilet facilities by residence . 10 Figure 2.3 Household wealth by residence . 12 Figure 2.4 Population pyramid . 13 Figure 2.5 Out-migration by reasons . 14 Figure 2.6 Birth registration by province . 15 Figure 2.7 Secondary school net attendance ratio by province . 16 3 CHARACTERISTICS OF RESPONDENTS . 43 Table 3.1 Background characteristics of respondents . 50 Table 3.2 Spousal separation . 51 Table 3.3.1 Educational attainment: Women . 52 Table 3.3.2 Educational attainment: Men . 53 Table 3.4.1 Literacy: Women . 54 Table 3.4.2 Literacy: Men . 55 Table 3.5.1 Exposure to mass media: Women . 56 Table 3.5.2 Exposure to mass media: Men . 57 Table 3.6.1 Exposure to specific health programs on radio and television: Women . 58 Table 3.6.2 Exposure to specific health programs on radio and television: Men . 59 Table 3.7.1 Internet usage: Women . 60 Table 3.7.2 Internet usage: Men . 61 Table 3.8.1 Employment status: Women . 62 Table 3.8.2 Employment status: Men . 63 Table 3.9.1 Occupation: Women . 64 x • Tables and Figures Table 3.9.2 Occupation: Men . 65 Table 3.10.1 Type of employment: Women . 66 Table 3.10.2 Type of employment: Men . 66 Table 3.11.1 Tobacco smoking: Women . 67 Table 3.11.2 Tobacco smoking: Men . 68 Table 3.12 Average number of cigarettes smoked daily: Men . 69 Table 3.13 Smokeless tobacco use and any tobacco use . 70 Table 3.14.1 Knowledge concerning tuberculosis: Women . 71 Table 3.14.2 Knowledge concerning tuberculosis: Men . 72 Table 3.15 Preferred source of treatment for TB . 73 Figure 3.1 Education of survey respondents . 44 Figure 3.2 Secondary education by province . 45 Figure 3.3 Exposure to mass media . 45 Figure 3.4 Employment by education . 46 Figure 3.5 Occupation . 47 Figure 3.6 Use of tobacco among women and men . 48 4 MARRIAGE AND SEXUAL ACTIVITY . 75 Table 4.1 Current marital status . 80 Table 4.2.1 Number of women’s co-wives . 81 Table 4.2.2 Number of men’s wives . 82 Table 4.3 Age at first marriage . 83 Table 4.4 Median age at first marriage by background characteristics . 84 Table 4.5 Age at first sexual intercourse . 85 Table 4.6 Median age at first sexual intercourse by background characteristics . 86 Table 4.7.1 Recent sexual activity: Women . 87 Table 4.7.2 Recent sexual activity: Men . 88 Figure 4.1 Marital status . 76 Figure 4.2 Women’s median age at first marriage by education . 77 Figure 4.3 Median age at first sex and first marriage . 78 Figure 4.4 Trends in early sexual intercourse . 78 5 FERTILITY . 89 Table 5.1 Current fertility . 95 Table 5.2 Fertility by background characteristics . 95 Table 5.3 Trends in age-specific fertility rates . 96 Table 5.4 Children ever born and living . 96 Table 5.5 Birth intervals . 97 Table 5.6 Postpartum amenorrhea, abstinence, and insusceptibility . 98 Table 5.7 Median duration of postpartum amenorrhea, postpartum abstinence, and postpartum insusceptibility . 99 Table 5.8 Menopause . 99 Table 5.9 Age at first birth. 100 Table 5.10 Median age at first birth . 100 Table 5.11 Teenage pregnancy and motherhood . 101 Table 5.12 Sexual and reproductive health behaviors before age 15 . 101 Figure 5.1 Trends in fertility . 90 Figure 5.2 Trends in age-specific fertlity . 90 Figure 5.3 Fertility by province . 90 Figure 5.4 Fertility by mother's education . 90 Figure 5.5 Birth intervals . 91 Figure 5.6 Median age at first birth by mother's education. 93 Tables and Figures • xi Figure 5.7 Teenage childbearing by province . 94 Figure 5.8 Teenage childbearing by education . 94 6 FERTILITY PREFERENCES . 103 Table 6.1 Fertility preferences by number of living children . 108 Table 6.2.1 Desire to limit childbearing: Women . 109 Table 6.2.2 Desire to limit childbearing: Men . 110 Table 6.3 Ideal number of children by number of living children . 111 Table 6.4 Mean ideal number of children . 112 Table 6.5 Fertility planning status . 113 Table 6.6 Wanted fertility rates . 113 Figure 6.1 Trends in desire to limit childbearing by number of living children . 104 Figure 6.2 Desire to limit childbearing by number of living children . 104 Figure 6.3 Ideal family size . 105 Figure 6.4 Ideal family size by number of living children . 105 Figure 6.5 Fertility planning status . 106 Figure 6.6 Trends in wanted and actual fertility . 106 7 FAMILY PLANNING . 115 Table 7.1 Knowledge of contraceptive methods . 124 Table 7.2 Current use of contraception by age . 125 Table 7.3 Current use of contraception according to background characteristics . 126 Table 7.4 Knowledge of fertile period . 127 Table 7.5 Knowledge of fertile period by age . 127 Table 7.6 Timing of sterilization . 127 Table 7.7 Source of modern contraception methods . 128 Table 7.8 Use of social marketing brand pills and condoms . 129 Table 7.9 Informed choice . 130 Table 7.10 Twelve-month contraceptive discontinuation rates . 130 Table 7.11 Reasons for discontinuation. 131 Table 7.12.1 Need and demand for family planning among currently married women . 132 Table 7.12.2 Need and demand for family planning among all women . 133 Table 7.13 Decision making about family planning . 134 Table 7.14 Future use of contraception . 135 Table 7.15.1 Exposure to family planning messages: Women . 135 Table 7.15.2 Exposure to family planning messages: Men . 136 Table 7.16 Contact of nonusers with family planning providers . 137 Table 7.17 Information on family planning methods and counseling . 138 Table 7.18 Men's attitudes towards contraceptive use . 139 Figure 7.1 Contraceptive use . 116 Figure 7.2 Trends in contraceptive use . 117 Figure 7.3 Use of modern methods by province . 117 Figure 7.4 Use of modern methods by education . 117 Figure 7.5 Source of modern contraceptive methods . 118 Figure 7.6 Contraceptive discontinuation rates . 119 Figure 7.7 Demand for family planning. 120 Figure 7.8 Trends in total demand for family planning . 120 Figure 7.9 Unmet need for family planning by province . 120 8 INFANT AND CHILD MORTALITY . 141 Table 8.1 Early childhood mortality rates . 146 Table 8.2 Five-year early childhood mortality rates according to background characteristics . 146 xii • Tables and Figures Table 8.3 Ten-year early childhood mortality rates according to additional characteristics . 147 Table 8.4 Perinatal mortality . 148 Table 8.5 High-risk fertility behavior . 149 Figure 8.1 Trends in early childhood mortality rates . 142 Figure 8.2 Child mortality by previous birth interval . 143 Figure 8.3 Perinatal mortality by mother's education . 145 9 MATERNAL AND NEWBORN HEALTH CARE. 151 Table 9.1 Antenatal care . 165 Table 9.2 Number of antenatal care visits and timing of first visit. 166 Table 9.3 Antenatal care as recommended . 167 Table 9.4 Components of antenatal care. 168 Table 9.5 Counseling during antenatal care visits . 169 Table 9.6 Tetanus toxoid injections . 170 Table 9.7 Place of delivery . 171 Table 9.8 Reasons for not delivering in a health facility . 172 Table 9.9 Assistance during delivery. 173 Table 9.10 Cesarean section . 174 Table 9.11 Care during delivery . 175 Table 9.12 Support during delivery . 176 Table 9.13 Matri Surakshya Chakki . 177 Table 9.14 Birth preparedness . 178 Table 9.15 Time taken to reach health facility . 179 Table 9.16 Timing of first postnatal check for the mother . 180 Table 9.17 Type of provider of first postnatal check for the mother . 181 Table 9.18 Place of first postnatal checkup for the mother . 182 Table 9.19 Timing of first postnatal check for the newborn. 183 Table 9.20 Type of provider of first postnatal check for the newborn . 184 Table 9.21 Place of first postnatal checkup for the newborn . 185 Table 9.22 Content of postnatal care for newborns . 186 Table 9.23 Newborn care practices . 187 Table 9.24 Use of clean home delivery kits and other instruments to cut the umbilical cord . 188 Table 9.25 Umbilical cord care . 189 Table 9.26 Timing of application of Navi Malam (chlorhexidine) . 190 Table 9.27 Knowledge that abortion is legal in Nepal . 191 Table 9.28 Knowledge about places that provide safe abortions . 192 Table 9.29 Source of information on safe abortion . 193 Table 9.30 Pregnancy outcomes . 194 Table 9.31 Main reason for the most recent abortion in the past 5 years . 195 Table 9.32 Procedure adopted for abortion . 196 Table 9.33 Type of provider for abortion . 197 Table 9.34 Place where abortion took place . 198 Table 9.35 Problems in accessing health care . 199 Figure 9.1 Trends in antenatal care coverage. 152 Figure 9.2 Components of antenatal care. 153 Figure 9.3 Trends in place of birth . 155 Figure 9.4 Institutional deliveries by province . 155 Figure 9.5 Institutional deliveries by household wealth . 155 Figure 9.6 Delivery assistance . 156 Figure 9.7 Delivery assistance by education . 156 Figure 9.8 Postnatal care by place of delivery . 159 Tables and Figures • xiii 10 CHILD HEALTH . 201 Table 10.1 Child’s size and weight at birth . 210 Table 10.2 Vaccinations by source of information . 211 Table 10.3 Vaccinations by background characteristics . 212 Table 10.4 Possession and observation of vaccination cards, according to background characteristics . 213 Table 10.5 Prevalence of symptoms of ARI . 214 Table 10.6 Source of advice or treatment for children with symptoms of ARI . 215 Table 10.7 Prevalence and treatment of fever . 216 Table 10.8 Prevalence and treatment of diarrhea . 217 Table 10.9 Feeding practices during diarrhea . 218 Table 10.10 Oral rehydration therapy, zinc, and other treatments for diarrhea . 219 Table 10.11 Source of advice or treatment for children with diarrhea . 220 Table 10.12 Disposal of children’s stools. 221 Figure 10.1 Childhood vaccinations . 203 Figure 10.2 Trends in childhood vaccinations . 203 Figure 10.3 Vaccination coverage by province. 203 Figure 10.4 Vaccination coverage by mother’s education . 204 Figure 10.5 Diarrhea prevalence by age . 206 Figure 10.6 Treatment of diarrhea . 207 Figure 10.7 Feeding practices during diarrhea . 207 Figure 10.8 Prevalence and treatment of childhood illnesses . 208 11 NUTRITION OF CHILDREN AND ADULTS . 223 Table 11.1 Nutritional status of children . 239 Table 11.2 Initial breastfeeding . 241 Table 11.3 Breastfeeding status according to age . 242 Table 11.4 Median duration of breastfeeding . 243 Table 11.5 Foods and liquids consumed by children in the day or night preceding the interview . 244 Table 11.6 Infant and young child feeding (IYCF) practices . 245 Table 11.7 Prevalence of anemia in children . 247 Table 11.8 Presence of iodized salt in the household . 248 Table 11.9 Micronutrient intake and deworming among children . 249 Table 11.10.1 Nutritional status of women . 251 Table 11.10.2 Nutritional status of men . 252 Table 11.11 Prevalence of anemia in women . 253 Table 11.12 Micronutrient intake and deworming among mothers . 254 Table 11.13 Foods and liquids consumed by mothers in the day or night preceding the interview . 255 Table 11.14 Topics during counseling on maternal, infant, and young child nutrition . 256 Table 11.15 Growth monitoring and promotion . 257 Table 11.16 Counseling at the growth monitoring and promotion sessions . 258 Figure 11.1 Trends in nutritional status of children . 225 Figure 11.2 Stunting in children by province . 226 Figure 11.3 Stunting in children by household wealth . 226 Figure 11.4 Breastfeeding practices by age . 227 Figure 11.5 IYCF indicators on breastfeeding status . 228 Figure 11.6 IYCF indicators on Minimum Acceptable Diet . 230 Figure 11.7 Trends in childhood anemia . 231 Figure 11.8 Anemia prevalence in children by province . 232 Figure 11.9 Trends in women's nutritional status . 233 Figure 11.10 Nutritional status of women and men . 235 xiv • Tables and Figures Figure 11.11 Trends in anemia in women. 236 Figure 11.12 Trends in anemia by maternity status among women. 236 12 ADULT AND MATERNAL MORTALITY . 259 Table 12.1 Completeness of information on siblings . 263 Table 12.2 Adult mortality rates . 263 Table 12.3 Adult mortality probabilities . 264 Table 12.4 Maternal mortality . 264 Figure 12.1 Adult mortality rates by age . 260 Figure 12.2 Pregnancy-related mortality ratios with confidence intervals . 262 13 HIV/AIDS-RELATED KNOWLEDGE, ATTITUDES, AND BEHAVIOR . 265 Table 13.1 Knowledge of HIV or AIDS. 274 Table 13.2 Knowledge of HIV prevention methods . 275 Table 13.3 Comprehensive knowledge about HIV . 276 Table 13.4 Knowledge of prevention of mother-to-child transmission of HIV . 276 Table 13.5 Discriminatory attitudes towards people living with HIV . 277 Table 13.6 Multiple sexual partners and higher-risk sexual intercourse in the past 12 months among men . 278 Table 13.7 Payment for sexual intercourse and condom use at last paid sexual intercourse . 279 Table 13.8.1 Coverage of prior HIV testing: Women . 280 Table 13.8.2 Coverage of prior HIV testing: Men . 281 Table 13.9 Pregnant women counseled and tested for HIV . 282 Table 13.10 Knowledge on treatment for HIV . 283 Table 13.11 Self-reported prevalence of sexually transmitted infections (STIs) and STI symptoms . 284 Table 13.12 Women and men seeking treatment for STIs . 285 Table 13.13 Comprehensive knowledge about HIV among young people . 285 Table 13.14 Age at first sexual intercourse among young people . 286 Table 13.15 Premarital sexual intercourse among young people . 286 Table 13.16 Multiple sexual partners and higher-risk sexual behavior in the past 12 months among young men . 287 Table 13.17 Recent HIV tests among young people . 287 Figure 13.1 Knowledge of HIV prevention methods by province . 266 Figure 13.2 Knowledge of mother-to-child transmission (MTCT) of HIV . 267 Figure 13.3 Trends in knowledge of mother-to-child transmission (MTCT) of HIV . 267 Figure 13.4 Discriminatory attitudes towards people living with HIV by education . 268 Figure 13.5 HIV testing . 269 Figure 13.6 Trends in comprehensive HIV knowledge among youth . 271 14 BLOOD PRESSURE . 289 Table 14.1.1 History of high blood pressure and actions taken to lower blood pressure: Women . 293 Table 14.1.2 History of high blood pressure and actions taken to lower blood pressure: Men . 294 Table 14.2 Coverage of blood pressure measurement among women and men . 295 Table 14.3.1 Blood pressure status: Women . 296 Table 14.3.2 Blood pressure status: Men. 297 Table 14.4.1 Blood pressure status by health status measures: Women . 298 Table 14.4.2 Blood pressure status by health status measures: Men . 299 Figure 14.1 Hypertension prevalence by age . 290 Figure 14.2 Hypertension prevalence among women by province . 291 Tables and Figures • xv Figure 14.3 Hypertension by household wealth . 291 Figure 14.4 Hypertension by BMI . 291 15 WOMEN’S EMPOWERMENT . 301 Table 15.1 Employment and cash earnings of currently married women and men . 311 Table 15.2.1 Control over women’s cash earnings and relative magnitude of women’s cash earnings . 312 Table 15.2.2 Control over men’s cash earnings . 313 Table 15.3 Women’s control over their own earnings and over those of their husbands . 314 Table 15.4.1 Ownership of assets: Women . 315 Table 15.4.2 Ownership of assets: Men. 316 Table 15.5.1 Ownership of title or deed for house: Women . 317 Table 15.5.2 Ownership of title or deed for house: Men . 318 Table 15.6.1 Ownership of title or deed for land: Women . 319 Table 15.6.2 Ownership of title or deed for land: Men . 320 Table 15.7 Knowledge about the household property . 321 Table 15.8.1 Ownership and use of bank accounts and mobile phones: Women . 322 Table 15.8.2 Ownership and use of bank accounts and mobile phones: Men . 323 Table 15.9 Participation in decision making . 324 Table 15.10.1 Women’s participation in decision making by background characteristics . 325 Table 15.10.2 Men’s participation in decision making by background characteristics . 326 Table 15.11.1 Attitude toward wife beating: Women . 327 Table 15.11.2 Attitude toward wife beating: Men . 328 Table 15.12 Attitudes toward negotiating safer sexual relations with husband. 329 Table 15.13 Ability to negotiate sexual relations with husband . 330 Table 15.14 Indicators of women’s empowerment . 331 Table 15.15 Current use of contraception by women’s empowerment . 332 Table 15.16 Ideal number of children and unmet need for family planning by women’s empowerment . 333 Table 15.17 Reproductive health care by women’s empowerment . 334 Table 15.18 Early childhood mortality rates by women’s status . 335 Figure 15.1 Employment by age . 302 Figure 15.2 Control over women’s earnings . 303 Figure 15.3 Ownership of assets . 304 Figure 15.4 Women’s participation in decision making . 306 Figure 15.5 Attitudes toward wife beating. 307 16 DOMESTIC VIOLENCE . 337 Table 16.1 Experience of physical violence . 348 Table 16.2 Experience of violence during pregnancy . 349 Table 16.3 Persons committing physical violence. 350 Table 16.4 Experience of sexual violence . 351 Table 16.5 Age at first experience of sexual violence . 352 Table 16.6 Persons committing sexual violence . 352 Table 16.7 Experience of different forms of violence . 352 Table 16.8 Marital control exercised by husbands . 353 Table 16.9 Forms of spousal violence . 354 Table 16.10 Spousal violence by background characteristics . 355 Table 16.11 Spousal violence by husband’s characteristics and empowerment indicators . 356 Table 16.12 Violence by any husband in the last 12 months . 357 Table 16.13 Experience of spousal violence by duration of marriage . 358 Table 16.14 Injuries to women due to spousal violence . 358 xvi • Tables and Figures Table 16.15 Violence by women against their husband by women’s background characteristics . 359 Table 16.16 Violence by women against their husband by husband’s characteristics and empowerment indicators . 360 Table 16.17 Forms of emotional violence in the household . 361 Table 16.18 Help seeking to stop violence . 362 Table 16.19 Sources for help to stop the violence . 363 Figure 16.1 Women's experience of violence by marital status . 339 Figure 16.2 Types of spousal violence. 342 Figure 16.3 Spousal violence by province . 343 Figure 16.4 Spousal violence by husband's alcohol consumption . 344 Figure 16.5 Help seeking by type of violence experienced . 346 17 CAUSE OF DEATH IN NEONATES . 365 Table 17.1 Stillbirths and neonatal deaths by verbal autopsy . 371 Table 17.2 Causes of neonatal deaths . 371 Table 17.3 Cause of neonatal deaths by age at death and sex of the child . 372 Table 17.4 Causes of neonatal deaths by residence . 372 Table 17.5 Causes of stillbirths . 372 Table 17.6 Health service status for stillbirths and neonatal deaths . 373 Figure 17.1 Neonatal deaths by age . 367 Figure 17.2 Cause of neonatal deaths . 368 Figure 17.3 Causes of death by sex . 369 Figure 17.4 Causes of still births . 369 REFERENCES. 375 APPENDIX A SAMPLE DESIGN . 379 Table A.1 Distribution of residential households by provinces and type of residence . 380 Table A.2 Distribution of wards and their average size in number of households . 380 Table A.3 The 2016 NDHS sample allocation of clusters by provinces and type of residence . 381 Table A.4 The 2016 NDHS sample allocation of expected completed women and men interviews by province and type of residence . 381 Table A.5 Sample implementation: Women . 382 Table A.6 Sample implementation: Men . 383 APPENDIX B ESTIMATES OF SAMPLING ERRORS . 385 Table B.1 List of indicators for sampling errors, Nepal DHS 2016 . 387 Table B.2 Sampling errors: Total sample, Nepal DHS 2016 . 388 Table B.3 Sampling errors: Urban sample, Nepal DHS 2016 . 389 Table B.4 Sampling errors: Rural sample, Nepal DHS 2016 . 390 Table B.5 Sampling errors: Province 1 sample, Nepal DHS 2016 . 391 Table B.6 Sampling errors: Province 2 sample, Nepal DHS 2016 . 392 Table B.7 Sampling errors: Province 3 sample, Nepal DHS 2016 . 393 Table B.8 Sampling errors: Province 4 sample, Nepal DHS 2016 . 394 Table B.9 Sampling errors: Province 5 sample, Nepal DHS 2016 . 395 Table B.10 Sampling errors: Province 6 sample, Nepal DHS 2016 . 396 Table B.11 Sampling errors: Province 7 sample, Nepal DHS 2016 . 397 Table B.12 Sampling errors for adult and maternal mortality rates, Nepal DHS 2016 . 398 Tables and Figures • xvii APPENDIX C DATA QUALITY TABLES . 399 Table C.1 Household age distribution . 399 Table C.2.1 Age distribution of eligible and interviewed women. 400 Table C.2.2 Age distribution of eligible and interviewed men . 400 Table C.3 Completeness of reporting . 401 Table C.4 Births by calendar years . 401 Table C.5 Reporting of age at death in days . 402 Table C.6 Reporting of age at death in months . 403 Table C.7 Sibship size and sex ratio of siblings . 403 Table C.8 Pregnancy-related mortality trends . 404 Foreword • xix FOREWORD he 2016 Nepal Demographic and Health Survey (NDHS) is the fifth survey of its kind to be implemented in the country as part of the worldwide Demographic and Health Surveys (DHS) Program. It was implemented by New ERA under the aegis of the Ministry of Health (MOH) of the Government of Nepal with the objective of providing reliable, accurate, and up-to-date data for the country. We hope that the information in this report will assist policymakers and program managers in policy formulation and monitoring and designing programs and strategies for improving maternal, child health, and family planning services in Nepal. The 2016 NDHS also provides indicators relevant to the Nepal Health Sector Strategy (NHSS) – 2016-2021 and the Sustainable Development Goals (SDGs). This report presents the findings of the survey. The 2016 NDHS is a national sample survey that provides up-to-date information on fertility levels; marriage; fertility preferences; awareness and use of family planning methods; child feeding practices; nutrition; adult and childhood mortality; awareness and attitudes regarding HIV/AIDS; women’s empowerment; and domestic violence. The target groups were women and men age 15-49 residing in randomly selected households across the country. In addition to national estimates, the report provides estimates of key indicators for both urban and rural areas in Nepal and also for the seven provinces. The successful completion of the 2016 NDHS was made possible through contributions from a number of organizations and professionals. The MOH wishes to express its gratitude to the Government of Nepal for granting the opportunity to implement the fifth DHS in the country. We would like to acknowledge the financial assistance and support provided by the United States Agency for International Development in Nepal (USAID). The technical advice provided by the Technical Committee and the Steering Committee during different phases of the survey was critical for the success of the survey. Furthermore, the support and collaboration rendered by the national, provincial, and local administration; nongovernmental and international development organizations; and other major stakeholders is greatly acknowledged. We would like to thank ICF for the technical backstopping throughout the survey. The MOH appreciates the effort of Dr. Dipendra Raman Singh and team of the Public Health Administration Monitoring and Evaluation Division for their support during the different phases of the survey. Finally, we are grateful to the 2016 NDHS core team of New ERA for managing technical, administrative, and logistical aspects of the survey; the trainers for their support in training and monitoring of the field work; the field staff, for data collection; the data processing team; and, in particular, the survey respondents. Dr. Kiran Regmi Secretary Ministry of Health T Acknowledgements • xxi ACKNOWLEDGEMENTS he 2016 Nepal Demographic and Health Survey (NDHS) is the result of earnest effort put forth by different individuals and organizations. The survey was conducted under the aegis of the Ministry of Health (MOH) of the Government of Nepal. The United States Agency for International Development (USAID) provided financial support through its mission in Nepal, while technical assistance was provided by ICF. The survey was implemented by New ERA, a local research firm having wide experience in conducting such surveys in the past. We express our deep sense of appreciation to the technical experts in the various fields of population and health for their valuable input during the various phases of the survey, including the development of final questionnaires, training of field staff, and review of draft tables. The input provided by the members of the Technical Advisory Committee (TAC) and Technical Working Group (TWG) is highly appreciated. We would like to extend our sincere gratitude to Mr. Shanta Bahadur Shrestha, former Secretary of the MOH, and Dr. G. D. Thakur, former Chief of the Public Health Administration Monitoring and Evaluation Division (PHAMED), MOH, and Mr. Ram Chandra Khanal, former Senior Public Health Administrator for their guidance and support during the initial phase of the survey. We would also like to express our sincere gratitude to Dr. Kiran Regmi, Health Secretary, MOH, for her direction and guidance to complete the survey. We would like to thank Mr. Giri Raj Subedi, Senior Public Health Administrator, Mr. Jhabindra Pandey, Director of Statistics, Mr. Shiva Lal Sharma, Statistical Officer, and other staff of PHAMED, MOH, for their continuing efforts in successful implementation of the survey. We would like to extend our appreciation to the USAID mission in Nepal for funding the survey. We would particularly like to thank the former Director and Deputy Director of the Health Office, USAID Nepal, Ms. Shanda Steimer and Mr. Daniel Sinclair, and also the current Director, Ms. Carrie Rasmussen, Deputy Director, Mr. Daniel VerSchneider, Maternal Newborn and Child Health (MNCH) Team Leader, Ms. Monica Villanueva, MNCH Specialist, Ms. Sabita Tuladhar, for their continuous support to improve the quality of the survey. The technical support provided by ICF is highly appreciated and acknowledged. Our special thanks go to Ms. Anjushree Pradhan, Senior Technical Specialist, for her technical support throughout the survey. We would also like to thank Mr. Trevor Croft, Capacity Strengthening Technical Coordinator; Mr. Rajendra Lal Dangol, Data Processing Specialist; and other ICF staff for their valuable technical assistance and contribution. Similarly, special thanks go to the core staff of New ERA: Mr. Yogendra Prasai, Project Director; Ms. Pranita Thapa, Deputy Project Director; Mr. Ashoke Shrestha, Technical Advisor; Dr. Ramesh Kanta Adhikari, Senior Pediatrician; Dr. Jyoti Ratna Dhakwa, Pediatrician; Dr. Krishna Prasad Paudel, Pediatrician; Ms. Jyoti Manandhar, Dr. Surakschha Thapa, Ms. Sajani Manandhar, and Mr. Sachin Shrestha, Research Officers; Dr. Sanjay Paudel, Medical Officer; Mr. Harihar Nath Regmi, Senior Programmer; Ms. Sharmila Prasai Shrestha, Senior Data Processing Officer; Mr. Gehendra Man Pradhan and Mr. Sajid Shrestha, IT/data processing supervisors; Mr. Sanu Raja Shakya and Ms. Geeta Shrestha Amatya, word processing staff; quality control team members, and other field staff of New ERA for their valuable contributions towards the successful completion of the survey. We would also like to thank all the contributors to the report. The survey was made possible through the cooperation we received from the local level agencies, including the District Health Offices, Primary Health Care Centers, Health-Posts, District Development Committees, and Village Development Committees. The female community health volunteers require special mention here; their support has been highly appreciated. Finally, we extend our deepest gratitude to all the respondents for their time and patience during the interview. Mr. Jagat Bahadur Basnet Dr. Dipendra Raman Singh Executive Director Chief, PHAMED New ERA Ministry of Health T Technical Committee • xxiii 2016 NEPAL DEMOGRAPHIC AND HEALTH SURVEY TECHNICAL ADVISORY COMMITTEE Secretary, Ministry of Health, Chair person Director General, Department of Health Services Member Joint Secretary, National Planning Commission Member Director, Family Health Division Member Director, Child Health Division Member Chief, Curative Service Division Member Director, Epidemiology Disease Control Division Member Director, Logistic Management Division Member Chief, Policy Planning and International Cooperation Division Member Director, Management Division Member Director, National Health Education, Information and Communication Centre Member Director, National Health Training Center Member Director, National Tuberculosis Centre Member Director, National Centre for AIDS and STDs Control Member Director, Primary Health Care Revitalization Division Member Chief, Personal Administration Division Member Joint Secretary, Recourse Financial Mobilization Member Chairperson, Nepal Health Research Council Member Director General, Central Bureau of Statistics Member Chief, Family Planning Association Nepal Member Department Head, Central Department of Population Studies Member Chief, Institute of Medicine Member Representative, EDP Member Representative, USAID Member Representative, DFID Member Representative, WHO Member Representative, UNFPA Member Representative, ICF Member Representative, New ERA Member Chief, Public Health Administration Monitoring and Evaluation Division Member Secretary xxiv • Technical Committee 2016 NEPAL DEMOGRAPHIC AND HEALTH SURVEY TECHNICAL WORKING GROUP Dr. Dipendra Raman Singh, Public Health Administration Monitoring and Evaluation Division Chairperson Mr. Jhabindra Pandey, Public Health Administration Monitoring and Evaluation Division Member Mr. Arun Gautam, Public Health Administration Monitoring and Evaluation Division Member Dr. Sharad Kumar Sharma, Family Health Division Member Mr. Kapil Timalsena, Child Health Division Member Mr. Anil Thapa, National Tuberculosis Center Member Mr. Mukti Nath Khanal, Management Division Member Mr. Satya Acharya, Public Health Administration Monitoring and Evaluation Division Member Mr. Shiva Lal Sharma, Public Health Administration Monitoring and Evaluation Division Member Representative, National Centre for AIDS and STDs Control Member Representative, National Health Education, Information and Communication Centre Member Representative, National Health Training Center Member Mr. Keshab Prasad Adhikari, Central Department of Population Studies, T.U Member Dr. Meghnath Dhimal, Nepal Health Research Council Member Mr. Paban Ghimire, WHO Member Mr. Tirtha Man Tamang, UNFPA Member Mr. Daniel Sinclair, USAID Member Ms. Sabita Tuladhar, USAID Member Mr. Pradeep Paudel, NHSSP Member Dr. Suresh Mehata, IPAS Member Dr. Prakash Dev Pant, FHI 360 Member Mr. Ajit Pradhan, Senior Demographer Member Representative, New ERA Member Mr. Giriraj Subedi, Public Health Administration Monitoring and Evaluation Division Member Secretary Contributors to the Report • xxv CONTRIBUTORS TO THE REPORT Mr. Anil Thapa, National Tuberculosis Center Mr. Ashoke Shrestha, New ERA Mr. Badri Nath Jnawali, EDCD, Ministry of Health Dr. Bibek Kumar Lal, EDCD, DoHS Mr. Bishnu Prasad Dulal, Nepal Health Sector Support Programme Mr. Deepak Joshi, Save the Children Dr. Devendra Shrestha, Abt Associates Nepal Mr. Dilli Raman Adhikari, FHD, DoHS Ms. Femila Sapkota, Helen Keller International Mr. Giri Raj Subedi, Ministry of Health Dr. Guna Nidhi Sharma, EDCD, DoHS Dr. Hemanta Ojha, Management Division, Department of Health Services Ms. Indu Adhikary, FHI360 Dr. Ishwari Sharma Paudel, New ERA Mr. Jhabindra Pandey, Ministry of Health Dr. Jyoti Ratna Dhakhwa, New ERA Ms. Jyoti Manandhar, New ERA Mr. Kapil Timalsena, Child Health Division, Department of Health Services Dr. Krishna Kumar Aryal, Nepal Health Research Council Dr. Krishna Paudel, New ERA Mr. Madav Prasad Dhakal, Ministry of Health Mr. Mukti Nath Khanal, Management Division, Department of Health Services Dr. Neeta Shrestha, United Nations Population Fund Mr. Netra Bhatta, USAID Ms. Nira Joshi, New ERA Mr. Parshu Ram Shrestha, Child Health Division, Department of Health Services Mr. Pawan Ghimire, World Health Organization Mr. Pradeep Paudel, Nepal Health Sector Support Programme Dr. Prakash Dev Pant, Demographer Ms. Pranita Thapa, New ERA Mr. Raj Kumar Pokharel, Child Health Division, Department of Health Services Dr. Ramesh Kanta Adhikari, New ERA Mr. Sachin Shrestha, New ERA Ms. Sabita Tuladhar, USAID Mr. Sagar Dahal, PHCRD, Department of Health Services Dr. Sanjay Paudel, New ERA Mr. Shambhu Kafle, National Center for AIDS and STI Control, Department of Health Services Dr. Sharad Kumar Sharma, Family Health Division, Department of Health Services Dr. Suresh Mehata, IPAS Mr. Uttam Neupane, RTI Mr. Yogendra Prasai, New ERA xxvi • Contributors to the Report REVIEWERS Dr. Anjani Kumar Jha, Chairperson, Nepal Health Research Council Mr. Arun Gautam, Director (Statistics), Ministry of Health Mr. Badri Bahdur Khadga, Director, NHEICC, Department of Health Services Dr. Bhim Acharya, Director, EDCD, Department of Health Services Mr. Bhogendra Raj Dottel, Director, PHCRD, Department of Health Services Dr. Bhola Ram Shrestha, Chief, Curative Service Division, Ministry of Health Dr. Bikas Devkota, Director, Management Division, Department of Health Services Dr. Bikash Lamichhane, Director, Child Health Division, Department of Health Services Mr. Chuda Mani Bhandari, Deputy Director General, Department of Health Services Dr. Dipendra Raman Singh, Chief, PHAMED, Ministry of Health Dr. Kedar Narsingh K.C., Director, National Tuberculosis Center Mr. Mohammad Daud, Director, Leprosy Control Division Dr. Naresh Pratap K.C., Director, Family Health Division, Department of Health Services Mr. Sitaram Prasai, Senior GESI Advisor, Nepal Health Sector Support Program Dr. Tarun Paudel, Director, NCASC, Department of Health Services Acronyms and Abbreviations • xxvii ACRONYMS AND ABBREVIATIONS ACT artemisinin-based combination therapy AIDS acquired immunodeficiency syndrome ANM auxiliary nurse midwife ANC antenatal care ARI acute respiratory infection ART antiretroviral therapy ASFR age-specific fertility rate BCG Bacille-Calmette-Guerin vaccine against tuberculosis BMI body mass index BPP birth preparedness package CAPI computer-assisted personal interview CB-IMNCI community-based integrated management of neonatal and childhood illness CBR crude birth rate CBS Central Bureau of Statistics CHREPA Center for Research on Environment, Health and Population Activities CI confidence interval CPR contraceptive prevalence rate CRS contraceptive retail sales DBP diastolic blood pressure DHS Demographic and Health Survey DoHS Department of Health Services DPT diphtheria, pertussis, and tetanus vaccine EA enumeration area EPI Expanded Program on Immunization FANTA food and nutrition technical project FCHV female community health volunteer FHD family health division FP family planning GAR gross attendance ratio GBV gender-based violence GESI gender equity and social inclusion GFR general fertility rate GPI gender parity index HFIAS household food insecurity access scale HIV human immunodeficiency virus HTC HIV testing and counseling ICD international classification of diseases ICD-PM international classification of diseases-perinatal mortality IFSS internet file streaming system INSEC informal sector service center xxviii • Acronyms and Abbreviations IPV-IM inactivated polio vaccine-intramuscular ITN insecticide-treated net IU international unit IUD intrauterine device IYCF infant and young child feeding LAM lactational amenorrhea method LLIN long-lasting insecticide-treated net LPG liquid petroleum gas MAD minimum acceptable diet MIYCN maternal, infant, and young child nutrition MICS multiple indicator cluster survey MOHP Ministry of Health and Population MOH Ministry of Health MMDS mortality medical data system MMR maternal mortality ratio MR measles and rubella MTCT mother-to-child transmission NAR net attendance ratio NCD noncommunicable diseases NDHS Nepal Demographic and Health Survey NENAP Nepal every newborn action plan NFHS Nepal Family Health Survey NGO nongovernmental organization NHRC Nepal Health Research Council NHSS Nepal health sector strategy NIH National Institutes of Health NN neonatal mortality NPHC Nepal population and housing census OCMC one-stop crisis management centers OPV oral polio vaccine ORS oral rehydration salts ORT oral rehydration therapy PCV pneumococcal conjugate vaccine PHC primary health care PNN postneonatal mortality PPH postpartum hemorrhage PPS probability proportional to size PRMR pregnancy-related mortality ratio PSU primary sampling unit RHF recommended homemade fluids SBA skilled birth attendant SBP systolic blood pressure SD standard deviation SDGs sustainable development goals SDIP safe delivery incentive scheme SLC school-leaving certificate Acronyms and Abbreviations • xxix STI sexually transmitted infection TB tuberculosis TFR total fertility rate UNAIDS Joint United Nations Programme on HIV/AIDS UNICEF United Nations Children’s Fund USAID United States Agency for International Development VA verbal autopsy VAD vitamin A deficiency VIP ventilated improved pit WHO World Health Organization YSD years since death Reading and Understanding Tables from the 2016 NDHS • xxxi READING AND UNDERSTANDING TABLES FROM THE 2016 NEPAL DEMOGRAPHIC AND HEALTH SURVEY (NDHS) he new format of the 2016 NDHS final report is based on approximately 200 tables of data. They are located for quick reference through links in the text (electronic version) and at the end of each chapter. 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 provinces in Nepal. 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, NDHS data users should be comfortable reading and interpreting tables. The following pages provide an introduction to the organization of NDHS 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 NDHS tables. T xxxii • Reading and Understanding Tables from the 2016 NDHS Example 1: Exposure to Mass Media: Women A Question Asked of All Survey Respondents Table 3.5.1 Exposure to mass media: Women Percentage of women age 15-49 who are exposed to specific media on a weekly basis, by background characteristics, Nepal DHS 2016 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 9.7 52.7 34.0 3.6 30.7 2,598 20-24 8.5 52.2 31.4 2.4 33.4 2,251 25-29 11.1 51.3 26.3 4.2 36.7 2,135 30-34 9.3 52.5 25.1 2.6 36.8 1,806 35-39 7.4 46.9 22.9 3.0 43.1 1,572 40-44 6.8 45.8 23.3 2.7 44.6 1,388 45-49 5.6 45.8 24.9 3.3 43.9 1,113 Residence Urban 12.4 59.5 27.4 4.4 30.5 8,072 Rural 2.5 34.7 28.2 1.0 48.4 4,790 Ecological zone Mountain 3.1 27.8 41.7 1.6 44.5 775 Hill 12.0 52.0 32.4 3.9 32.1 5,556 Terai 6.5 51.5 22.1 2.7 40.7 6,531 Development region Eastern 8.2 53.9 29.7 3.2 34.5 2,900 Central 13.2 57.7 24.4 4.2 33.7 4,569 Western 7.9 58.8 27.7 3.6 30.4 2,597 Mid-western 2.6 27.1 29.8 1.0 52.9 1,650 Far-western 2.7 25.9 32.9 0.9 50.6 1,145 Province Province 1 9.8 53.2 32.1 3.5 32.6 2,173 Province 2 2.6 47.1 18.6 1.2 46.8 2,563 Province 3 20.5 67.1 29.4 6.5 23.2 2,732 Province 4 7.8 63.2 30.5 3.3 25.3 1,249 Province 5 5.8 47.3 26.0 2.7 40.6 2,274 Province 6 2.5 15.2 33.1 0.9 58.5 724 Province 7 2.7 25.9 32.9 0.9 50.6 1,145 Education No education 0.2 30.5 15.6 0.0 59.9 4,281 Primary 2.7 44.7 24.3 0.6 41.7 2,150 Some secondary 6.9 57.2 33.5 2.6 28.0 3,291 SLC and above 26.3 73.8 40.5 9.8 12.8 3,140 Wealth quintile Lowest 0.6 9.5 30.4 0.0 63.9 2,176 Second 1.8 32.3 32.8 0.6 48.0 2,525 Middle 2.8 48.0 24.3 1.4 42.8 2,595 Fourth 7.4 64.9 24.5 2.7 28.1 2,765 Highest 28.1 85.9 27.4 10.0 10.5 2,801 Total 8.7 50.3 27.7 3.2 37.2 12,862 Step 1: Read the title and subtitle. 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. 1 2 3 4 5 Reading and Understanding Tables from the 2016 NDHS • xxxiii 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 least once a week. The fourth column shows women who access all three media, while the fifth column shows women who do not access any of the three types of media at least once a week. The last column lists the number of women 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, ecological zone, development region, province, educational level, and wealth quintile. Most of the tables in the NDHS 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 access to different types of media. In this case, 8.7%* of women age 15-49 read a newspaper at least once a week, 50.3% watch television weekly, and 27.7% listen to the radio weekly. Step 5: To find out what percentage of women with SLC and above education access all three media weekly, draw two imaginary lines, as shown on the table. This shows that 9.8% of women age 15-49 with SLC and above education access all three types of media weekly. Step 6: By looking at patterns by background characteristics, we can see how exposure to mass media varies across Nepal. Mass media are often used to communicate health messages. Knowing how mass media exposure varies among different groups can help program planners and policy makers 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 Nepal do not access any of the three media at least once a week? b) What age group of women are most likely to listen to the radio weekly? c) Compare women in urban areas to women in rural areas – which group is more likely to read the newspaper weekly? d) What are the lowest and highest percentages (range) of women who do not access any of the three media at least once a week by province? e) Is there a clear pattern in exposure to television on a weekly basis by education level? f) Is there a clear pattern in exposure to newspapers on a weekly basis by wealth quintile? Answers: a) 37.2% b) Women age 15-19: 34.0% of women in this age group listen to radio weekly c) Women in urban areas, 12.4% read a newspaper weekly, compared to 2.5% of women in rural areas d) Women with no exposure to media ranges from a low of 23.2% in Province 3 to a high of 58.5% in Province 6. e) Exposure to television on a weekly basis increases as a women’s level of education increases; 30.5% of women with no education watch television weekly, compared to 73.8% of women with SLC and above education. f) Exposure to newspaper on a weekly basis increases as household wealth increases; 0.6% of women in the lowest wealth quintile read a newspaper on a weekly basis, compared to 28.1% of women in the highest wealth quintile. xxxiv • Reading and Understanding Tables from the 2016 NDHS Example 2: Prevalence and Treatment of Diarrhea A Question Asked of a Subgroup of Survey Respondents Table 10.8 Prevalence and treatment of diarrhea Percentage of children under age 5 who had diarrhea in the 2 weeks preceding the survey; among children with diarrhea in the 2 weeks preceding the survey, percentage for whom advice or treatment was sought, according to background characteristics, Nepal DHS 2016 Percentage with diarrhea Number of children Among children under age 5 with diarrhea: Background characteristic Percentage for whom advice or treatment was sought1 Number of children with diarrhea Age in months <6 6.0 445 (67.6) 27 6-11 15.2 499 52.0 76 12-23 9.9 1,034 77.2 102 24-35 6.5 919 81.8 60 36-47 6.2 968 48.9 60 48-59 4.5 1,021 (52.2) 46 Sex Male 7.7 2,563 71.9 197 Female 7.5 2,324 56.1 175 Source of drinking water2 Improved 7.6 4,648 64.2 354 Not improved 7.3 239 * 17 Toilet facility3 Improved 6.5 2,810 64.5 182 Unimproved sanitation 9.1 2,077 64.4 189 Shared facility4 8.0 923 73.6 74 Unimproved facility 10.1 81 * 8 Open defecation 10.0 1,072 62.5 107 Residence Urban 7.8 2,649 59.8 207 Rural 7.4 2,238 70.2 165 Ecological zone Mountain 5.2 342 * 18 Hill 6.4 1,857 44.9 120 Terai 8.7 2,688 74.0 234 Development region Eastern 6.3 1,105 70.1 69 Central 9.6 1,791 51.6 171 Western 5.3 897 (84.6) 48 Mid-western 8.4 673 78.6 57 Far-western 6.2 421 (65.9) 26 Province Province 1 7.2 794 65.7 57 Province 2 8.6 1,310 68.2 112 Province 3 9.0 792 (32.1) 71 Province 4 3.7 380 * 14 Province 5 8.2 869 82.4 71 Province 6 6.0 322 (83.3) 19 Province 7 6.2 421 (65.9) 26 Mother’s education No education 8.5 1,663 58.4 142 Primary 8.4 981 75.0 82 Some secondary 6.5 1,183 67.6 77 SLC and above 6.7 1,060 60.9 71 Wealth quintile Lowest 5.9 1,041 54.7 61 Second 8.0 1,028 61.0 82 Middle 8.4 1,087 75.2 91 Fourth 8.3 999 66.8 83 Highest 7.3 732 (59.0) 54 Total 7.6 4,887 64.4 371 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. 1 Includes advice or treatment from the following sources: government sector, non-government sector, private sector, pharmacy, and shop. Excludes advice or treatment from a traditional practitioner. 2 See Table 2.1 for definition of categories 3 See Table 2.3 for definition of categories 4 Facilities that would be considered improved if they were not shared by two or more households 1 2 4 a b 3 Reading and Understanding Tables from the 2016 NDHS • xxxv Step 1: Read the title and subtitle. In this case, the table is about two separate groups of children: all children under five (a) and children under five with diarrhea in the two weeks before the survey (b). Step 2: Identify the two panels. First, identify the columns that refer to all children under five (a), and then isolate the columns that refer only to those children under five with diarrhea in the two weeks before the survey (b). Step 3: Look at the first panel. What percentage of children under five had diarrhea in the two weeks before the survey? It’s 7.6%. Now look at the second panel. How many children under five are there who had diarrhea in the two weeks before the survey? It’s 371 children or 7.6% of the 4,887 children under five. The second panel is a subset of the first panel. Step 4: Only 7.6% of children under five had diarrhea in the two 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 five who had diarrhea in the two weeks before the survey from Province 7 had advice or treatment sought? It’s 65.9%. This percentage is in parentheses because there are between 25 and 49 unweighted cases 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 five who had diarrhea in the two weeks before the survey from Province 4 had advice or treatment sought? There is no number in this cell—only an asterisk. This is because fewer than 25 children under five who had diarrhea in the two weeks before the survey from Province 4 had advice or treatment sought. 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. xxxvi • Reading and Understanding Tables from the 2016 NDHS Example 3: Understanding Sampling Weights in NDHS Tables A sample is a group of people who have been selected for a survey. In the NDHS, 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 minimum sample size per area. For the 2016 NDHS, the survey sample is representative at the national and provincial levels, for ecological zones and development regions, and for urban and rural areas. To generate statistics that are representative of the country as a whole and the seven provinces, the number of women surveyed in each province should contribute to the size of the total (national) sample in proportion to size of the province. However, if some provinces have small populations, then a sample allocated in proportion to each province’s population may not include sufficient women from each province for analysis. To solve this problem, provinces with small populations are oversampled. For example, let’s say that you have enough money to interview 12,862 women and want to produce results that are representative of Nepal as a whole and its provinces (as in Table 3.1). However, the total population of Nepal is not evenly distributed among the provinces: some provinces, such as Province 3, are heavily populated while others, such as Province 6 are not. Thus, Province 6 must be oversampled. A sampling statistician determines how many women should be interviewed in each province in order to get reliable statistics. The blue column (1) in the table at the right shows the actual number of women interviewed in each province. Within the provinces, the number of women interviewed ranges from 1,589 in Province 4 to 2,097 in Province 2. The number of interviews is sufficient to get reliable results in each province. With this distribution of interviews, some provinces are overrepresented and some provinces are underrepresented. For example, the population in Province 3 is about 21% of the population in Nepal, while Province 6’s population contributes only 6% of the population in Nepal. But as the blue column shows, the number of women interviewed in Province 3 accounts for only about 13% of the total sample of women interviewed (1,660/12,862) and the number of women interviewed in Province 6 accounts for almost the same percentage of the total sample of women interviewed (14%, or 1,761 /12,862). This unweighted distribution of women does not accurately represent the population. In order to get statistics that are representative of Nepal, 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 province, like Province 6, should only contribute a small amount to the national total. Women from a large province, like Province 3, should contribute much more. Therefore, DHS statisticians mathematically calculate a “weight” which is used to adjust the number of women from each province so that each province’s contribution to the total is proportional to the actual population of the province. 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 provincial level. The total national sample size of 12,862 women has not changed after weighting, but the distribution of the women in the provinces 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 Nepal, you would see that women in each province 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 Table 3.1 Background characteristics of respondents Percent distribution of women age 15-49 by selected background characteristics, Nepal DHS 2016 Women Background characteristic Weighted percent Weighted number Unweighted number Province Province 1 16.9 2,173 1,837 Province 2 19.9 2,563 2,097 Province 3 21.2 2,732 1,660 Province 4 9.7 1,249 1,589 Province 5 17.7 2,274 2,072 Province 6 5.6 724 1,761 Province 7 8.9 1,145 1,846 Total 100.0 12,862 12,862 1 2 3 Reading and Understanding Tables from the 2016 NDHS • xxxvii now accurately represents the proportion of women who live in Province 3 and the proportion of women who live in Province 6. With sampling and weighting, it is possible to interview enough women to provide reliable statistics at national and provincial levels. In general, only the weighted numbers are shown in each of the NDHS tables, so don’t be surprised if these numbers seem low: they may actually represent a larger number of women interviewed. Sustainable Development Goal Indicators • xxxix SUSTAINABLE DEVELOPMENT GOAL INDICATORS Sustainable Development Goals Indicators Nepal DHS 2016 Sex Total DHS table number Indicator Male Female 2. Zero hunger 2.2.1 Prevalence of stunting among children under 5 years of age 36.0 35.7 35.8 11.1 2.2.2 Prevalence of malnutrition among children under 5 years of age 10.9 10.8 10.9 - a) Prevalence of wasting among children under 5 years of age 9.5 9.8 9.7 11.1 b) Prevalence of overweight among children under 5 years of age 1.4 1.0 1.2 11.1 3. Good health and well-being 3.1.1 Maternal mortality ratio1 na na 239 12.4 3.1.2 Proportion of births attended by skilled health personnel na na 58.0 9.9 3.2.1 Under-five mortality rate2 36 41 39 8.2 3.2.2 Neonatal mortality rate2 24 17 21 8.2 3.7.1 Proportion of women of reproductive age (aged 15-49 years) who have their need for family planning satisfied with modern methods na 56.3 na 7.12.2 3.7.2 Adolescent birth rates per 1,000 women a) Girls aged 10-14 years3 na 1 na 5.1 b) Women aged 15-19 years4 na 88 na 5.1 3.a.1 Age-standardized prevalence of current tobacco use among persons aged 15 years and older5 27.2 5.8 16.5a 3.11.1 and 3.11.2 3.b.1 Proportion of the target population covered by all vaccines included in their national programme6 43.2 41.8 42.6 10.3 5. Gender equality 5.2.1 Proportion of ever-partnered women and girls aged 15 years and older subjected to physical, sexual or psychological violence by a current or former intimate partner in the previous 12 months7,8 na 13.5 na 16.12 a) Physical violence na 10.0 na 16.12 b) Sexual violence na 4.0 na 16.12 c) Psychological violence na 7.7 na 16.12 5.3.1 Proportion of women aged 20-24 years who were married or in a union before age 15 and before age 18 a) before age 15 na 7.0 na 4.3 b) before age 18 na 39.5 na 4.3 5.6.1 Proportion of women aged 15-49 years who make their own informed decisions regarding sexual relations, contraceptive use and reproductive health care9 na 19.1 na 15.0 5.b.1 Proportion of individuals who own a mobile telephone10 89.3 72.6 81.0 a 15.8.1 and 15.8.2 Residence Total Urban Rural 6. Clean water and sanitation 6.1.1 Proportion of the population using safely managed drinking water services11 93.9 96.3 94.9 2.1 6.2.1 Proportion of population using safely managed sanitation services, including a handwashing facility with soap and water12 64.8 64.3 64.6 2.3 7. Affordable clean energy 7.1.1 Proportion of population with access to electricity 94.5 85.2 90.7 2.4 7.1.2 Proportion of population with primary reliance on clean fuels and technology13 43.8 10.0 30.2 2.4 Sex Total 8. Decent work and economic growth Male Female 8.7.2 Proportion of adults (15 years and older) with an account at a bank or other financial institution or with a mobile-money-service provider10 40.1 40.5 40.3 a 15.8.1 and 15.8.2 16. Peace, justice, and strong institutions 16.9.1 Proportion of children under 5 years of age whose births have been registered with a civil authority 57.1 55.2 56.2 2.11 17. Partnerships for the goals 17.8.1 Proportion of individuals using the Internet10,14 47.1 23.1 35.1a 3.7.1 and 3.7.2 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 Data are presented for children age 12-23 months receiving all vaccines included in their national program appropriate for their age: BCG, three doses of DPT- Hep B-Hib (Pentavalent), three doses of oral polio vaccine, three doses of pneumococcal vaccine, and one dose of Measles Rubella. 7 Data are available for women age 15-49 who have ever been in union only. 8 In the DHS, psychological violence is termed emotional violence. 9 Data are available for currently married women who are not pregnant only. xl • Sustainable Development Goal Indicators 10 Data are available for women and men age 15-49 only. 11 Measured as the percentage of population using an improved water source: the percentage of de jure population whose main source of drinking water is a household connection (piped), public tap or standpipe, tube well or borehole, protected dug well, protected spring, or rainwater collection. Households using bottled water for drinking are classified as using an improved or unimproved source according to their water source for cooking and handwashing. 12 Measured as the percentage of population using an improved sanitation facility: the percentage of de jure population whose household has a flush or pour flush toilet to a piped water system, septic tank or pit latrine; ventilated improved pit latrine; pit latrine with a slab; or composting toilet and does not share this facility with other households. 13 Measured as the percentage of the population using clean fuel for cooking 14 Refers to internet use is in the 12 months preceding the survey a The total is calculated as the simple arithmetic mean of the percentages in the columns for males and females. xlii • Map of Nepal Introduction and Survey Methodology • 1 INTRODUCTION AND SURVEY METHODOLOGY 1 he 2016 Nepal Demographic and Health Survey (NDHS) was implemented by New ERA under the aegis of the Ministry of Health (MOH). Data collection took place from June 19, 2016, to January 31, 2017. ICF provided technical assistance through The DHS Program, which is funded by the United States Agency for International Development (USAID) and offers financial support and technical assistance for population and health surveys in countries worldwide. 1.1 SURVEY OBJECTIVES The primary objective of the 2016 NDHS is to provide up-to-date estimates of basic demographic and health indicators. The NDHS provides a comprehensive overview of population, maternal, and child health issues in Nepal. Specifically, the 2016 NDHS: ▪ Collected data that allowed calculation of key demographic indicators, particularly fertility and under- 5 mortality rates, at the national level, for urban and rural areas, and for the country’s seven provinces ▪ Collected data that allowed for calculation of adult and maternal mortality rates at the national level ▪ Explored the direct and indirect factors that determine levels and trends of fertility and child mortality ▪ Measured levels of contraceptive knowledge and practice ▪ Collected data on key aspects of family health, including immunization coverage among children, prevalence and treatment of diarrhea and other diseases among children under age 5, maternity care indicators such as antenatal visits and assistance at delivery, and newborn care ▪ Obtained data on child feeding practices, including breastfeeding ▪ Collected anthropometric measures to assess the nutritional status of children under age 5 and women and men age 15-49 ▪ Conducted hemoglobin testing on eligible children age 6-59 months and women age 15-49 to provide information on the prevalence of anemia in these groups ▪ Collected data on knowledge and attitudes of women and men about sexually transmitted diseases and HIV/AIDS and evaluated potential exposure to the risk of HIV infection by exploring high-risk behaviors and condom use ▪ Measured blood pressure among women and men age 15 and above ▪ Obtained data on women’s experience of emotional, physical, and sexual violence The information collected through the 2016 NDHS is intended to assist policymakers and program managers in the Ministry of Health and other organizations in designing and evaluating programs and strategies for improving the health of the country’s population. The 2016 NDHS also provides data on indicators relevant to the Nepal Health Sector Strategy (NHSS) 2016-2021 and the Sustainable Development Goals (SDGs). 1.2 SAMPLE DESIGN The sampling frame used for the 2016 NDHS is an updated version of the frame from the 2011 National Population and Housing Census (NPHC), conducted by the Central Bureau of Statistics (CBS). The census frame is a complete list of all census wards created for the 2011 NPHC. Although the NPHC was conducted only 4 years ago, the frame had to be updated due to consecutive changes in urban/rural classifications at the ward level; new municipalities were declared and old municipalities were upgraded T 2 • Introduction and Survey Methodology by adding more wards. Originally, the 2011 NPHC included 58 municipalities; this number increased to 191 municipalities during 2014, and 26 more were declared in 2015, yielding a total of 217 municipalities. In addition, in March 2017, structural changes were made in the classifications of urban and rural locations officially known as “Nagarpalika” and “Gaonpalika.” The country now has 263 municipalities, and 59% of the total population lives in urban areas. The 2016 NDHS results are based on the updated urban-rural classification. Nepal consists of 75 districts distributed across the different ecological zones and development regions. After recent changes approved by Nepal’s Constituent Assembly in September 2015, administratively Nepal is divided into seven provinces (Province 1, Province 2, Province 3, Province 4, Province 5, Province 6, and Province 7). Each province is sub-divided into urban and rural areas. The demarcation of the provinces involves inclusion of selected districts within their boundaries. Although entire districts were selected for inclusion in most cases, two districts, Rukum and Nawalparasi, were split into two separate provinces. The districts are divided into urban and rural locations, which are in turn divided into wards. The sampling frame contains information about ward location, type of residence (urban or rural), estimated number of residential households, and estimated population. In rural areas, the wards are small in size (average of 104 households) and serve as the primary sampling units (PSUs). In urban areas, the wards are large, with average of 800 households per ward. The CBS has a frame of enumeration areas (EAs) for each ward in the original 58 municipalities. However, for the 159 municipalities declared in 2014 and 2015, each municipality is composed of old wards, which are small in size and can serve as EAs. The 2016 NDHS sample was stratified and selected in two stages in rural areas and three stages in urban areas. In rural areas, wards were selected as primary sampling units, and households were selected from the sample PSUs. In urban areas, wards were selected as PSUs, one EA was selected from each PSU, and then households were selected from the sample EAs. Each province was stratified into urban and rural areas, yielding 14 sampling strata. Samples of wards were selected independently in each stratum. Implicit stratification and proportional allocation were achieved at each of the lower administrative levels by sorting the sampling frame within each sampling stratum before sample selection, according to administrative units at different levels, and by using a probability proportional to size selection during the first stage of sampling. In the first stage, 383 wards were selected with probability proportional to ward size and with independent selection in each sampling stratum. The ward size is the number of residential households in the ward census used in the 2011 NPHC. Due to the large size of the urban wards, in a second stage of sample selection, one EA was randomly selected from each of the sample urban wards. A household listing operation was carried out in all of the selected sampling clusters (rural wards or urban EAs), and the resulting lists of households served as the sampling frame for the selection of households in the next stage. Some of the selected clusters were large. In order to minimize the task of household listing for the selected clusters with more than 200 households, each large cluster was segmented. Only one segment was selected for the survey with probability proportional to segment size. Household listing was conducted only in the selected segment. Thus, a 2016 NDHS cluster is a ward, an EA, or a segment of a ward or an EA. In the last stage of selection, a fixed number of 30 households per cluster were selected with an equal probability systematic selection from the newly created household listing. The survey interviewers were to conduct interviews only in the pre-selected households. In order to prevent bias, no replacements of or changes in the pre-selected households were allowed in the implementing stages. Because of the non- proportional sample allocation, the sample was not self-weighting. Weighting factors have been calculated, added to the data file, and applied so that results are representative at the national level as well as the regional and provincial levels. Introduction and Survey Methodology • 3 All women age 15-49 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. In half of the households (every second household) selected, all men age 15-49 who were either residents of the selected households or visitors who stayed in the households the night before the survey were eligible to be interviewed. The survey involved collection of biomarker information from respondents in a subsample of the households. 1.3 QUESTIONNAIRES Six questionnaires were administered in the 2016 NDHS: the Household Questionnaire, the Woman’s Questionnaire, the Man’s Questionnaire, the Biomarker Questionnaire, the Fieldworker Questionnaire, and the Verbal Autopsy Questionnaire (for neonatal deaths). The first five questionnaires, based on The DHS Program’s standard Demographic and Health Survey (DHS-7) questionnaires, were adapted to reflect the population and health issues relevant to Nepal. The Verbal Autopsy Questionnaire was based on the recent 2014 World Health Organization (WHO) verbal autopsy instruments (WHO 2015a). Input on the questionnaires was solicited from various stakeholders representing government ministries and agencies, nongovernmental organizations, and international donors. The survey protocol was reviewed and approved by the Nepal Health Research Council (NHRC) and the ICF Institutional Review Board. The 2016 NDHS required written consent from the household head to carry out the interviews and anemia testing. After all questionnaires were finalized in English, they were translated into Nepali, Maithili, and Bhojpuri. The Household, Woman’s, and Man’s Questionnaires were programmed into tablet computers to facilitate computer-assisted personal interviewing (CAPI) for data collection purposes, with the capability to choose any of the three languages for each questionnaire. The Biomarker Questionnaire was completed on paper during data collection and then entered into the CAPI system. The Fieldworker Questionnaire and the Verbal Autopsy Questionnaire were completed on paper. The Household Questionnaire was used to list all of the household members and visitors in selected households. Basic demographic information was collected on the characteristics of each person listed, including his or her age, sex, marital status, education, and relationship to the head of the household. For children under age 18, parents’ survival status was determined. The data on age and sex of household members obtained in the Household Questionnaire were used to identify women and men who were 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, and materials used for the floor of the dwelling unit, as well as ownership of various durable goods, migration, and food security. The Woman’s Questionnaire was used to collect information from all women age 15-49. These women were asked questions on the following topics: ▪ Background characteristics (including age, education, and media exposure) ▪ Pregnancy history and child mortality ▪ Knowledge, use, and source of family planning methods ▪ Fertility preferences (including desire for more children and ideal number of children) ▪ Antenatal, delivery, and postnatal care ▪ Breastfeeding and infant feeding practices ▪ Vaccinations and childhood illnesses ▪ Women’s work and husbands’ background characteristics ▪ Domestic violence 4 • Introduction and Survey Methodology ▪ Knowledge, awareness, and behavior regarding HIV/AIDS and other sexually transmitted infections (STIs) ▪ Adult mortality, including maternal mortality ▪ Knowledge, attitudes, and behavior related to other health issues (e.g., tuberculosis) The Man’s Questionnaire was administered to all men age 15-49 in the subsample of households selected for the male survey. The Man’s Questionnaire collected much of the same information elicited from the Woman’s Questionnaire but was shorter because it did not contain a detailed reproductive history or questions on maternal and child health. The Biomarker Questionnaire was used to record anthropometry measurements, hemoglobin testing, and blood pressure measurements. These questionnaires were administered only in the subsample selected for the men’s survey. All children age 0-59 months and women and men age 15 and above in these households were eligible for height and weight measurements. Similarly, children age 6-59 months and women age 15-49 were eligible for hemoglobin testing. Blood pressure was measured for all women and men age 15 and above in this subsample. The Fieldworker Questionnaire was used as a tool in conducting analyses of data quality. The Verbal Autopsy Questionnaire was administered in households where a neonatal death took place within the 5 years prior to the survey. Interviewers were instructed to interview mothers to the extent possible and also, in relevant cases, to interview other members of the household who were present when the baby died and could report on the event. The instrument included questions on the respondent’s account of the cause of death, vital registration and certification, general signs and symptoms associated with the illness, history of injury, and service utilization to assist in proper diagnosis of cause of death. The questionnaire was adapted from Verbal Autopsy Standards: The 2014 WHO Verbal Autopsy Instrument, which allows for determinations of cause of death based on International Classification of Diseases (10th revision; ICD-10) codes (WHO 2015a). The enumerators used tablet computers for data collection. The tablet computers were equipped with Bluetooth technology to enable remote electronic transfer of files, such as assignments from the team supervisor to the interviewers, individual questionnaires among survey team members, and completed questionnaires from interviewers to team supervisors. The CAPI data collection system employed in the 2016 NDHS was developed by The DHS Program with the mobile version of CSPro. The CSPro software was developed jointly by the U.S. Census Bureau, Serpro S.A., and The DHS Program. 1.4 ANTHROPOMETRY, HEMOGLOBIN TESTING, AND BLOOD PRESSURE MEASUREMENT In a subsample of the households selected for the male survey, the 2016 NDHS incorporated the following biomarkers: anthropometry, anemia testing, and blood pressure measurement. In contrast to the data collection procedure for the household and individual interviews, data related to biomarkers were initially recorded on the Biomarker Questionnaire and subsequently entered into interviewers’ tablet computers. Blood pressure: During the individual interview, three blood pressure measurements were taken from consenting women and men age 15 and above using UA-767F/FAC (A&D Medical) blood pressure monitors. Measurements were taken at intervals of 5 minutes or more. The average of the second and third measurements was used to classify the respondent with respect to hypertension, according to internationally recommended categories (WHO 1999; NIH 1997). The results, as well as information about the symptoms of high blood pressure and ways in which it can be prevented, were provided to the respondent via a blood pressure brochure. Anthropometry: Height and weight measurements were recorded for children age 0-59 months and women and men age 15-49. Height and weight were also measured for women and men age 50 and above to provide background information for blood pressure assessments. Introduction and Survey Methodology • 5 Hemoglobin testing: Blood specimens for hemoglobin testing were collected from women age 15-49 who voluntarily consented to be tested and from all children age 6-59 months for whom consent was obtained from their parents or the adults responsible for them. Blood samples were drawn from a drop of blood taken from a finger prick (or a heel prick in the case of children age 6-11 months) and collected in a microcuvette. Hemoglobin analysis was carried out on-site using a battery-operated portable HemoCue analyzer. Results were provided verbally and in writing. Parents or guardians of children with a hemoglobin level under 7 g/dl were instructed 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. All households in which anthropometry and/or hemoglobin testing was conducted were given a brochure explaining the causes and prevention of anemia. 1.5 PRETEST Twelve enumerators, five members of the core project team, and four data processing personnel from New ERA participated in the training to pretest the NDHS survey protocol over a 3-week period in February 2016. Most of the participants had previous experience carrying out NDHS surveys. The idea behind having the data processing staff participate in the pretest was to familiarize them with the CAPI system. The training was carried out by ICF staff focusing on the technical components of the survey, biomarkers, and CAPI system. Along with discussions on the technical aspects of the survey, the pretest training was designed to prepare the trainers for the main training. The training focused on key components such as age probing; interview techniques and procedures for completing the NDHS questionnaires; birth histories, family planning, and contraceptive calendars; completion of the vaccination section; standardization procedures for anthropometry; blood pressure measurement; and hemoglobin testing. The participants worked in groups using various training techniques, including interactive question-and-answer sessions, case studies, and role plays. Along with the enumerators, the trainers administered the questionnaires in the field, provided feedback on the content and language of the questionnaires, tested the CAPI software program, and learned the various training techniques. Adult learning principles were emphasized through hands-on training, and various in-class exercises were carried out. The fieldwork for the pretest was carried out in three locations focusing on Nepal’s three language groups (Nepali, Maithili, and Bhojpuri). These locations were Sarlahi district for Maithili, Kalaiya district for Bhojpuri, and Dhading district for Nepali. The reason for selecting Dhading was to gain an understanding of the issues in earthquake-affected areas. Each team carried out the pretest in an urban and a rural location, completing six clusters in total. Following the fieldwork, a debriefing session was held with the pretest field staff, and modifications to the questionnaires were made based on lessons drawn from the exercise. 1.6 TRAINING OF FIELD STAFF The main training for the 2016 NDHS started on May 15, 2016, in Kathmandu. The training included 2 weeks of orientation on use of paper questionnaires followed by 1 week of CAPI training. Selected participants were trained in the collection of biomarker information during the fourth week. Specialized training on conducting a verbal autopsy was carried out for the supervisors and selected enumerators. The participants for the main training included 101 trainees, selected through a strict vetting process. They took a written test and a computerized test and also completed a personal interview to qualify for participation in the main training. Attendees came from different parts of Nepal and represented major language groups within the country. Most of the candidates had previous fieldwork experience, and some had experience gained through previous rounds of the NDHS. Five members of the core project staff and three data processing personnel from New ERA also participated in the training as facilitators. The New ERA staff members were trained during the pretest 6 • Introduction and Survey Methodology training in preparation for the main training. They took the initiative in managing the training. ICF staff provided technical support during the training sessions. The participants were divided into two classrooms of about 50 participants each. The training sessions included discussions of concepts, procedures, and methodology related to conducting the DHS survey. Participants were guided through the questionnaires. In-class exercises were carried out, keeping in mind that involving participants in the training process would give them a better understanding of the training content. Various techniques were used to facilitate the training, including role playing on completing a household schedule, age probing in pairs, consistency checking for age and date of birth, correcting errors in the pregnancy history table, completing a contraceptive calendar with given cases, creating a vaccination card for an imaginary child, and filling in the questionnaires using cards prepared by colleagues. Resource personnel from the Ministry of Health and the Nepal Health Research Council attended the sessions to provide technical guidance. The training also included discussions on the CAPI system, demonstrations of the CAPI DHS menus, and practice in conducting interviews through the CAPI system. As noted, the 2016 NDHS collected data on three major types of biomarkers: anthropometry, hemoglobin/anemia, and blood pressure. Two female members and one male member of each team were trained to take height and weight measurements. The two female members were also trained in carrying out anemia testing and blood pressure measurements, and the single male member was trained in taking blood pressure measurements. Unlike the 2011 NDHS, the survey involved measuring the heights and weights of men. The supervisors of the teams were also trained in taking blood pressure measurements. The biomarker training included lecture sessions, hands-on demonstrations, and practical exercises. Children were brought to the training venue for the participants to practice taking their measurements and testing blood samples for hemoglobin (finger and heel pricks). A complete day was assigned to practice blood pressure measurement and hemoglobin testing. After intense training and practice sessions, an anthropometry standardization exercise was carried out in which the instructor and all measurers weighed and measured the same group of children twice to assess the accuracy and precision of the measurements. The results of the standardization exercise were entered into an Excel spreadsheet and presented to the participants. Accuracy and precision results were compared against the true values as well as the mean values of the measurers. Those who were out of range three or more times were invited to a separate session and trained further. Participants were evaluated through in-class exercises, quizzes, and observations made during field practice. Ultimately, 16 supervisors were identified based on their performance. Similarly, 64 participants were selected to serve as enumerators, while the rest were kept as reserves. Specialized training on conducting verbal autopsies on causes of neonatal deaths was carried out for one female interviewer and the supervisor of each team. The supervisors received additional training in performing supervisory activities with the CAPI system, data quality control procedures, fieldwork coordination, and management. The supervisors were trained on assigning households and receiving completed interviews from the interviewers, recognizing and dealing with error messages, receiving system updates and distributing updates to the interviewers, completing the Biomarker Questionnaires, resolving duplicated cases, closing clusters, and transferring interviews to the central office via the secure Internet File Streaming System (IFSS) developed by the DHS Program. Six quality controllers were identified from among the individuals who underwent training with the supervisors and received additional training on supporting the teams and monitoring fieldwork. 1.7 FIELDWORK The fieldwork for the 2016 NDHS was launched under close supervision on June 19, 2016, in the clusters in Kathmandu. Sixteen teams consisting of one supervisor, one male interviewer, and three female interviewers were spread across the different Kathmandu clusters. The teams were closely monitored by the trainers and quality controllers. After completion of the fieldwork in Kathmandu in the first week, Introduction and Survey Methodology • 7 teams were brought back to the central office for a review session in which they had an opportunity to clarify any questions they had. The teams were then dispatched to their respective districts. Data collection lasted until January 31, 2017. The fieldwork in some districts took longer than expected due to the monsoon season, during which flooding and landslides impacted the mobility of the field teams. Fieldwork monitoring was an integral part of the 2016 NDHS, and several rounds of monitoring were carried out by the NDHS core team, the quality controllers, and ICF staff. The technical team from the Ministry of Health and the Nepal Health Research Council also monitored the fieldwork. The monitors were provided with guidelines for overseeing the fieldwork. Weekly field check tables were generated from the completed interviews that were sent to the central office to monitor progress in the fieldwork, and regular feedback was sent out to the teams. It should be noted that a massive 7.8 magnitude earthquake hit the country in April 2015, leaving a huge impact on the life of Nepal’s general population. The earthquake mostly affected the 14 districts of the Central development region. At least 9,000 people lost their lives, about 22,000 were injured, and some 3.5 million were displaced and homeless. Although the 2016 NDHS took place a year after this massive destruction (June 19, 2016, to January 31, 2017), some of the survey indicators should be interpreted with caution. 1.8 DATA PROCESSING The processing of the 2016 NDHS data began simultaneously with the fieldwork. As soon as data collection was completed in each cluster, all electronic data files were transferred via the IFSS to the New ERA central office in Kathmandu. These data files were registered and checked for inconsistencies, incompleteness, and outliers. The field teams were alerted to any inconsistencies or errors. Secondary editing, carried out in the central office, involved resolving inconsistencies and coding the open-ended questions. The New ERA senior data processor coordinated the exercise at the central office. The NDHS core team members assisted with the secondary editing. The biomarker paper questionnaires were compared with the electronic data files to check for any inconsistencies in data entry. Data entry and editing were carried out using the CSPro software package. The concurrent processing of the data offered a distinct advantage in that it maximized the likelihood of the data being error-free and accurate. Timely generation of field check tables allowed for effective monitoring. The secondary editing of the data was completed in the second week of February 2017. The final cleaning of the data set was carried out by The DHS Program data processing specialist and was completed by the end of February 2017. 1.9 RESPONSE RATES Table 1.1 shows response rates for the 2016 NDHS. A total of 11,473 households were selected for the sample, of which 11,203 were occupied. Of the occupied households, 11,040 were successfully interviewed, yielding a response rate of 99%. In the interviewed households, 13,089 women age 15-49 were identified for individual interviews; interviews were completed with 12,862 women, yielding a response rate of 98%. In the subsample of households selected for the male survey, 4,235 men age 15-49 were identified and 4,063 were successfully interviewed, yielding a response rate of 96%. Response rates were lower in urban areas than in rural areas. The difference was slightly more prominent for men than for women, as men in urban areas were often away from their households for work. 8 • Introduction and Survey Methodology Table 1.1 Results of the household and individual interviews Number of households, number of interviews, and response rates, according to residence (unweighted), Nepal DHS 2016 Residence Total Result Urban Rural Household interviews Households selected 7,294 4,179 11,473 Households occupied 7,106 4,097 11,203 Households interviewed 6,978 4,062 11,040 Household response rate1 98.2 99.1 98.5 Interviews with women age 15-49 Number of eligible women 8,460 4,629 13,089 Number of eligible women interviewed 8,279 4,583 12,862 Eligible women response rate2 97.9 99.0 98.3 Interviews with men age 15-49 Number of eligible men 2,812 1,423 4,235 Number of eligible men interviewed 2,667 1,396 4,063 Eligible men response rate2 94.8 98.1 95.9 1 Households interviewed/households occupied 2 Respondents interviewed/eligible respondents Housing Characteristics and Household Population • 9 HOUSING CHARACTERISTICS AND HOUSEHOLD POPULATION 2 Key Findings ▪ Drinking water: Almost all households (95%) have access to an improved source of drinking water. ▪ Sanitation: Sixty-two percent of households have an improved toilet facility that is not shared with other households. ▪ Indoor smoke: Sixty-six percent of all households use solid fuel for cooking. Thirty-one percent of households are exposed daily to secondhand smoke. ▪ Access to a health facility: Almost half (49%) of households are within 30 minutes of a government health facility. ▪ Household population and composition: One-third (34%) of the population is under age 15.Thirty-one percent of households are headed by women. ▪ Birth registration: Fifty-six percent of children have had their births registered with the civil authorities. ▪ Food security: Forty-eight percent of households in Nepal are food secure and have access to food year round. nformation on the socioeconomic characteristics of the household population in the 2016 NDHS 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, hand washing, household population and composition, access to government health facilities, migration, birth registration, family living arrangements, educational attainment, school attendance, possession of mosquito nets, and food security. 2.1 DRINKING WATER SOURCES AND TREATMENT Improved sources of drinking water Include piped water, public taps, standpipes, tube wells, boreholes, protected dug wells and springs, and rainwater. Households that use bottled water for drinking are classified as using an improved source only if the water they use for cooking and hand washing comes from an improved source. Sample: Households Improved sources of water protect against outside contamination so that water is more likely to be safe to drink. In Nepal, almost all households (95%) have access to an improved source of drinking water (Table 2.1 and Figure 2.1). The most common source of drinking water in Nepal is a tube well or borehole (36%), I 10 • Housing Characteristics and Household Population followed by piped water (33%). Tube wells or boreholes are the most common source in rural areas (41%), while piped water is the most common source in urban areas (35%) (Table 2.1). Sixty-nine percent of households have drinking water on their premises, and only 5% of households spend more than 30 minutes to obtain water. Eighty- seven percent of households using piped water or water from a tube well or borehole reported that water was available without interruption in the past 2 weeks. Availability of water without interruption was slightly higher in rural (90%) than in urban (85%) areas (Table 2.2). Only 23% of households follow appropriate water treatment practices prior to drinking. Appropriate treatment practices are followed more often in urban areas (30%) than in rural areas (12%) (Table 2.1). Trends: Access to improved water sources has improved in the past 5 years. In 2016, 95% of households used an improved source of drinking water, as compared with 89% in 2011. There was also an overall improvement in use of appropriate water treatment practices, from 18% to 23%. 2.2 SANITATION Improved toilet facilities Include any non-shared toilet of the following types: flush/pour flush toilets to piped sewer systems, septic tanks, and pit latrines; ventilated improved pit (VIP) latrines; pit latrines with slabs; and composting toilets. Sample: Households Use of improved toilet facilities, which are non- shared facilities that prevent people from coming into contact with human waste, helps reduce the transmission of communicable diseases such as cholera and typhoid. Overall, 62% of households (63% in rural areas and 61% in urban areas) use improved toilet facilities (Figure 2.2). Fifteen percent of households have no toilet facility (21% in rural areas and 11% in urban areas) (Table 2.3). Trends: There have been substantial improvements in the use of improved sanitation facilities in the past 5 years. Households using improved facilities almost doubled from 38% in 2011 to 62% in 2016. Similarly, the percentage of households with no toilet facility decreased from 36% to 15%. Figure 2.1 Household drinking water by residence Figure 2.2 Household toilet facilities by residence 33 35 31 20 18 22 36 32 41 3 3 23 4 <1 5 6 4 Total Urban Rural Unimproved source Bottled water, improved source for cooking/ hand washing Protected well or spring Tube well or borehole Public tap/standpipe Piped water into dwelling/yard/plot/ neighbor's yard Percent distribution of households by source of drinking water 62 61 63 22 27 15 2 2 1 15 11 21 Total Urban Rural No facility/bush/field Unimproved facility Shared facility Improved facility Percent distribution of households by type of toilet facilities Housing Characteristics and Household Population • 11 2.3 EXPOSURE TO SMOKE INSIDE THE HOME AND OTHER HOUSEHOLD CHARACTERISTICS 2.3.1 Exposure to Smoke Inside the Home Exposure to smoke inside the home, either from cooking with solid fuels or smoking tobacco, has potentially harmful health effects. Cooking takes place inside the home in slightly more than two-thirds (68%) of households, while 26% of households have a separate building for cooking (Table 2.4). About two-thirds of households (66%) use solid fuel for cooking, and this practice is more common in rural households (88%) than urban households (52%). Wood is the most common type of solid fuel used for cooking, and it is used more often in rural (77%) than urban (48%) areas. Use of clean fuel (electricity and liquefied petroleum gas/natural gas/biogas) is more common in urban areas than in rural areas (48% and 12%, respectively). Thirty-one percent of households are exposed to tobacco smoke daily (34% in rural areas and 30% in urban areas) (Table 2.4). 2.3.2 Other Housing Characteristics The survey collected data on access to electricity, flooring materials, and the number of rooms used for sleeping. A vast majority (91%) of the households in Nepal (94% in urban areas and 85% in rural areas) have access to electricity. A variety of flooring materials (e.g., earth, sand, cement, dung, wood/planks, ceramic tiles) are used in Nepalese households. Earth and sand (53%) and cement (30%) are the most commonly used materials. Earth and sand are most commonly used in rural households (73%) (Table 2.4). 2.3.3 Household Durable Goods The survey also collected information on household effects, means of transportation, and ownership of agricultural land and farm animals (Table 2.5). Mobile phones, televisions, and radios are the most common information and communication devices in Nepal. Almost all households (93%) have at least one mobile phone. In addition to mobile phones, 7% of households also have non-mobile telephones (10% in urban area and 2% in rural areas). Although urban households are more likely than rural households to own a television (62% versus 35%), there is no urban-rural difference in possession of a radio (3 in 10 households in both urban and rural areas own a radio). Rural households are more likely to own agricultural land than urban households (87% versus 72%). Ownership of farm animals is much more common in rural households (87%) than in urban households (59%). 2.3.4 Access to Government Health Facilities Almost half of the households in Nepal (49%) are within 30 minutes of a government health facility, while 11% have to travel more than 1 hour. Nineteen percent of rural households, 25% of households in the mountain zone, 29% of households in Province 6, and 34% of households in the lowest wealth quintile have to travel more than an hour to reach the nearest government health facility (Table 2.6). 2.4 HOUSEHOLD WEALTH 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 12 • Housing Characteristics and Household Population five equal categories, each comprising 20% of the population. Sample: Households Table 2.7 presents data on wealth quintiles and the Gini coefficient according to residence, region, and province. The Gini coefficient indicates the level of concentration of wealth, with 0 representing an equal wealth distribution and 1 representing a totally unequal distribution. Nepal’s Gini coefficient is 0.31, indicating a fairly uneven distribution of wealth in the population. The wealthiest households are concentrated in urban areas (30%). More than half (51%) of the urban population belongs to the two highest wealth quintiles, whereas 53% of the rural population falls in the two lowest quintiles (Figure 2.3). A majority of the households in Province 6 fall in the lowest wealth quintile (69%), while the majority of households in Province 3 are concentrated in the highest quintile (42%) (Table 2.7). 2.5 HAND WASHING Hand washing is one of the most effective ways to prevent germs from spreading. A place for hand washing was observed in all of the surveyed households in the 2016 NDHS. Eighty-one percent of the households had a fixed place for hand washing, and 19% had a mobile hand washing place. Forty-seven percent of households used soap and water, while 20% did not have water, soap, or any other cleaning agents in place for hand washing (Table 2.8). Patterns by background characteristics ▪ Fifty-seven percent of urban households had soap and water available for washing hands, as compared with 31% of rural households. ▪ Thirty-nine percent of households in the mountain zone and 34% of households in Province 2 did not have water or any cleansing agents for hand washing. ▪ Thirty-nine percent of households in the lowest wealth quintile did not have water or any cleansing agents for hand washing. Figure 2.3 Household wealth by residence 13 31 19 2217 24 21 1830 5 Urban Rural Percent distribution of de jure population by wealth quintiles Wealthiest Fourth Middle Second Poorest Housing Characteristics and Household Population • 13 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. The de facto survey population (those who stayed overnight in the surveyed households) is 46,814; 54% of these individuals are male and 46% are female, yielding a sex ratio (number of males per 100 females) of 85. One-third (34%) of the population is under age 15. Children under age 5 and adolescents age 10-19 account for 11% and 23% of the population, respectively. About 7% of the population is age 65 and above, a group considered as a dependent population (Table 2.9 and Figure 2.4). Trends: The proportion of the population under age 15 has declined slightly, from 37% in 2011 to 34% in 2016. However, there has been no change in the proportion of children under age 5 (11%) in the past 5 years, although the fertility rate declined from 2.6 in 2011 to 2.3 in 2016. Overall, the population distribution remained constant between 2011 and 2016 (MOHP, New ERA, and ICF International 2012). The proportion of female-headed households has almost doubled in the past 15 years, from 16% in 2001 to 31% in 2016 (Table 2.10). This seems to be the result of recent migration (see section 2.7). The average household size is 4.2 persons, which is slightly less than in 2011 (4.4). Average household size is slightly larger in rural (4.4) than urban (4.1) areas. Twelve percent of households have foster and/or orphan children, with no differences between rural and urban areas (Table 2.10). 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 261210 14 • Housing Characteristics and Household Population 2.7 MIGRATION The 2016 NDHS collected information on household members who had migrated elsewhere in the 10 years prior to the survey. Information was collected by sex, age at migration, date of migration, reasons for migration, and destination. These data offer insights into period migration (mobility patterns of internal migrants 5 years before the survey in terms of where they were living then) and lifetime migration (permanent shifts in place of residence since more than 5 years prior to the survey). Forty-seven percent of households reported that at least one person had migrated from the household at some time in the 10 years preceding the survey (data not shown). A total of 8,836 persons migrated in the past 10 years, of whom 57% were men and 43% were women (Table 2.11). Seventy-one percent of women and 84% of men migrated in the last 5 years (Table 2.12.1 and Table 2.12.2). One in three men migrated in the past year. External migration is not common among women; 84% of women migrated within Nepal, while the majority of men (68%) migrated outside the country. The most common destinations for male migration were the Middle East (32%) and India (17%). About 7% of women migrated to the Middle East and to other countries. Patterns by background characteristics ▪ More than two-thirds of the household members migrated at age 24 or younger. Women are likely to migrate at a younger age than men: 44% of women migrated at age 15-19, while male migration mostly took place at age 20-24 (26%) (Table 2.11). ▪ Both male and female migrants are mainly from Province 1, Province 2, and Province 3, which together account for 61% of female migrants and 56% of male migrants (Table 2.11). ▪ More than three-fourths (78%) of men migrated mostly for work, and nearly two-thirds (64%) of women migrated due to marriage (Figure 2.5). ▪ Among those who migrated for work, 40% of men and 22% of women went to the Middle East (Table 2.12.1 and Table 2.12.2). 2.8 BIRTH REGISTRATION Registered birth Child has a birth certificate or child does not have a birth certificate, but his/her birth has been registered with the civil authorities. Sample: De jure children under age 5 Nepal has a legal and administrative structure stipulating official registration of births according to standard procedures. The practice of formally registering births is not widely adhered to in the country, even though the registration system was implemented about 36 years ago and is enforced through the Births, Deaths and Other Personal Events (Registration) Act of 1976 (Nepal Law Commission 2006). Table 2.13 presents data on de jure children under age 5 whose births are registered with the civil authorities by their background characteristics. Figure 2.5 Out-migration by reasons 10 11 64 14 1 78 14 1 6 1 Work Study Marriage Accompany family Other Percentage of women and men who migrated in the past 10 years Series1 Series2Women Men Housing Characteristics and Household Population • 15 Fifty-six percent of children under age 5 are registered with the civil authorities, and 52% have a birth certificate. Children age 2-4 are more likely to have had their births registered than children under age 2 (67% versus 40%). Patterns by background characteristics ▪ Children in the mountain zone are more likely to have their births registered (71%) than children in the hill (61%) and terai (51%) zones. ▪ Birth registration is less common among children in Province 2 (45%) than among children in Province 6 (65%) and Province 3 (64%) (Figure 2.6). Trends: There has been an improvement in birth registration over the past 5 years. Forty-two percent of births were registered in 2011, as compared with 56% in 2016. 2.9 CHILDREN’S LIVING ARRANGEMENTS AND PARENTAL SURVIVAL Orphan A child with one or both parents who are dead. Sample: Children under age 18 About 58% of de jure children under age 18 live with both of their parents; 7% are not living with their biological parents. Four percent of children under age 18 are orphans, with one or both parents dead (Table 2.14). Patterns by background characteristics ▪ Orphanhood is more prevalent among children age 15-17 (8%) than among those under age 2 (less than 1%). ▪ Orphaned children are mostly concentrated in the mountain zone (6%), Province 7 (6%), and households in the lowest wealth quintile (5%). Trends: There has been a slight decline in orphanhood in the past 5 years, from 5% in 2011 to 4% in 2016 (MOHP, New ERA, and ICF International 2012). 2.10 EDUCATION 2.10.1 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 Table 2.15.1 and Table 2.15.2 present educational attainment among women and men, respectively. Two in five women and one in five men in Nepal have no education. Thirty-five percent of women and 47% of men have a secondary education or higher. The median number of years of schooling is more than double among men than women (4.6 versus 2.1). Figure 2.6 Birth registration by province Percentage of de jure children under age 5 whose births are registered with the civil authorities 16 • Housing Characteristics and Household Population Patterns by background characteristics ▪ Rural women (47%) and men (26%) are more likely than urban women (35%) and men (17%) to have no education. ▪ By province, the percentages of women and men with more than a secondary education are lowest in Province 2 (3% and 8%, respectively) and highest in Province 3 (18% and 22%, respectively). ▪ Only 2% of women and 3% of men from the lowest wealth quintile have more than a secondary education, as compared with 25% of women and 34% of men from the highest wealth quintile (Table 2.15.1 and Table 2.15.2). Trends: The percentages of residents who have some secondary education or higher have increased over the past 5 years, from 29% to 35% among women and from 41% to 47% among men. Median number of years of schooling completed by women increased from 1.0 in 2011 to 2.1 in 2016. Among men, the median increased from 3.9 years to 4.6 years (MOHP, New ERA, and ICF International 2012). 2.10.2 School Attendance Net attendance ratio (NAR) Percentage of the school-age population that attends primary or secondary school. Sample: Children age 6-10 for primary school NAR and children age 11-15 for secondary school NAR Table 2.16 shows that the net attendance ratio (NAR) for primary school children (age 6-12) is 80%. However, the figure is much lower, at 67%, for secondary school children (age 11-15). The NAR for primary school is slightly higher among girls (81%) than among boys (79%), while the secondary school NAR is slightly higher among boys (68%) than girls (66%). Patterns by background characteristics ▪ Both the primary school NAR and the secondary school NAR are lower in rural areas. Seventy-seven percent of rural children and 83% of urban children have attended primary school. Similarly, 61% of rural children and 71% of urban children have attended secondary school. ▪ The primary school NAR is above 80% in each of the provinces other than Province 2 (68%). The secondary school NAR is also lowest in Province 2, at 45% (42% for girls and 49% for boys) (Figure 2.7). Figure 2.7 Secondary school net attendance ratio by province 66 70 42 77 82 64 73 75 68 75 49 77 81 64 74 71 Total Province 1 Province 2 Province 3 Province 4 Province 5 Province 6 Province 7 Girls Boys Net attendance ratio for secondary school among children age 11-15 Housing Characteristics and Household Population • 17 2.10.3 Other Measures of School Attendance 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 6-10 for primary school GAR and children age 11-15 for secondary school GAR Gender parity index (GPI) The ratio of female to male students attending primary school and the ratio of female to male children attending secondary school. The index reflects the magnitude of the gender gap. Sample: Primary and secondary school students Data on the gross attendance ratio (GAR) and the gender parity index (GPI) are presented in Table 2.16. A primary school GAR of more than 100% means that a significant number of primary school students are not of the official primary school age. In Nepal, the primary school GAR is 113% and the secondary school GAR is 88%. A gender parity index (GPI) of 1 indicates parity or equality between school participation ratios. A GPI lower than 1 indicates a gender disparity in favor of males, with a higher proportion of males than females attending that level of schooling. A GPI higher than 1 indicates a gender disparity in favor of females. The GPI for NAR is 1.02 at the primary school, indicating that more girls are attending school than boys; however, the GPI for NAR is 0.96 at the secondary school level, indicating that girls are dropping out (Table 2.16). 2.11 POSSESSION OF MOSQUITO NETS An important strategy in the control of malaria and kala-azar is prevention through indoor residual spraying and use of long-lasting insecticidal bednets (LLINs). In addition, other different methods, such as repellent cream and coils, have been used by households to protect themselves from mosquito bites. The 2016 NDHS collected information on household possession of mosquito nets. Three in four households (75%) have mosquito nets, and 56% of households possess two to three nets (Table 2.17). Patterns by background characteristics ▪ Urban households are much more likely than rural households to possess mosquito nets (80% versus 68%). ▪ More than 90% of households in the terai zone (95%), Province 2 (96%), and the middle wealth quintile (91%) possess mosquito nets. ▪ Among the various methods used to protect against mosquito bites, 91% of households use nets, 32% use coils, and 24% use mosquito repellent mats. One in five households indicate that proper sanitation is an important action to prevent mosquito bites (Table 2.18). 2.12 KNOWLEDGE OF LYMPHATIC FILARIASIS Data on knowledge regarding transmission of lymphatic filariasis were collected in the survey (Table 2.19). Only 28% of households have appropriate knowledge on transmission of lymphatic filariasis (i.e., that it is transmitted through mosquito bites). A majority of households (62%) do not know about the mode 18 • Housing Characteristics and Household Population of transmission of lymphatic filariasis. Levels of knowledge are slightly higher among households in the hill zone (30%) and households in the highest wealth quintile (44%). 2.13 FOOD SECURITY As a follow-up to the 2011 NDHS, a series of questions on household food security were included in the 2016 NDHS Household Questionnaire. In the current survey, all nine questions from the Household Food Insecurity Access Scale developed by USAID’s Food and Nutrition Technical (FANTA) project were included, as opposed to the seven questions used in 2011. Questionnaires focusing on household food insecurity (i.e., food insecurity for the household as a unit) were administered to the household heads. The questions, arranged in order of severity and frequency of occurrence, captured household perceptions of food vulnerability or stress and behavioral responses to food insecurity. Based on the responses, four food insecurity categories were created: food secure households, mildly food insecure households, moderately food insecure households, and severely food insecure households. Almost half of the households in Nepal are food secure (48%) and have access to food year round. Among food insecure households, 20% are mildly food insecure, 22% are moderately food insecure, and 10% are severely food insecure (Table 2.20). Patterns by background characteristics ▪ Urban households are more likely (54%) to be food secure than rural households (39%). ▪ A large proportion of households in Province 6 (42%) and the lowest wealth quintile (39%) fall in the moderately food insecure category. ▪ Similarly, the highest proportions of severely food insecure households are in the lowest wealth quintile (22%) and Province 6 (18%). Trends: Overall, food secure households have more or less remained constant (49% in 2011 versus 48% in 2016) over the past 5 years. The proportion of mildly food insecure households increased from 12% in 2011 to 20% in 2016, while the proportion of severely food insecure households decreased slightly from 16% to 10%. LIST OF TABLES For more information on household population and housing characteristics, see the following tables: ▪ Table 2.1 Household drinking water ▪ Table 2.2 Availability of water ▪ Table 2.3 Household sanitation facilities ▪ Table 2.4 Household characteristics ▪ Table 2.5 Household possessions ▪ Table 2.6 Distance to nearest government health facility ▪ Table 2.7 Wealth quintiles ▪ Table 2.8 Hand washing ▪ Table 2.9 Household population by age, sex, and residence ▪ Table 2.10 Household composition ▪ Table 2.11 Migration status ▪ Table 2.12.1 Duration and destination of migration: Women ▪ Table 2.12.2 Duration and destination of migration: Men ▪ Table 2.13 Birth registration of children under age 5 ▪ Table 2.14 Children's living arrangements and orphanhood ▪ Table 2.15.1 Educational attainment of the female household population ▪ Table 2.15.2 Educational attainment of the male household population Housing Characteristics and Household Population • 19 ▪ Table 2.16 School attendance ratios ▪ Table 2.17 Possession of mosquito nets ▪ Table 2.18 Protection against mosquito bites ▪ Table 2.19 Knowledge of lymphatic filariasis ▪ Table 2.20 Household food security 20 • Housing Characteristics and Household Population Table 2.1 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 using various methods to treat drinking water, and percentage using an appropriate treatment method, according to residence, Nepal DHS 2016 Households Population Characteristic Urban Rural Total Urban Rural Total Source of drinking water Improved source 93.7 96.1 94.6 93.9 96.3 94.9 Piped into dwelling/yard/plot 33.4 28.6 31.5 30.9 25.8 28.8 Piped to neighbor 1.7 2.1 1.8 1.5 1.7 1.6 Public tap/standpipe 18.3 22.3 19.9 18.0 21.0 19.2 Tube well or borehole 32.4 41.4 35.9 37.0 46.2 40.7 Protected dug well 1.7 0.5 1.3 1.7 0.4 1.2 Protected spring 1.7 1.2 1.5 1.5 1.1 1.3 Bottled water, improved source for cooking/hand washing1 4.4 0.1 2.8 3.4 0.1 2.1 Unimproved source 6.3 3.9 5.4 6.1 3.7 5.1 Unprotected dug well 1.4 0.5 1.0 1.5 0.4 1.0 Unprotected spring 0.6 1.5 1.0 0.6 1.5 1.0 Tanker truck/cart with small tank 0.8 0.0 0.5 0.6 0.0 0.4 Surface water 2.1 1.9 2.0 2.0 1.9 2.0 Bottled water, unimproved source for cooking/hand washing1 1.4 0.0 0.9 1.3 0.0 0.8 Total 100.0 100.0 100.0 100.0 100.0 100.0 Time to obtain drinking water (round trip) Water on premises2 70.6 66.3 68.9 71.3 67.2 69.7 Less than 30 minutes 24.4 28.5 26.0 23.7 27.9 25.4 30 minutes or longer 5.0 5.2 5.1 5.0 4.9 5.0 Total 100.0 100.0 100.0 100.0 100.0 100.0 Water treatment prior to drinking3 Boiled 14.8 9.3 12.7 13.1 8.1 11.1 Bleach/chlorine added 2.5 0.3 1.7 2.3 0.3 1.5 Strained through cloth 2.7 2.4 2.6 2.6 2.1 2.4 Ceramic, sand, or other filter 19.5 3.3 13.2 17.6 2.9 11.6 Solar disinfection 0.6 0.4 0.5 0.5 0.3 0.4 Let stand and settle 0.2 0.1 0.2 0.2 0.1 0.2 No treatment 68.2 86.1 75.1 71.4 87.9 78.0 Percentage using an appropriate treatment method4 29.9 12.1 23.1 26.8 10.5 20.2 Number 6,781 4,259 11,040 27,920 18,877 46,797 1 Because the quality of bottled water is not known, households using bottled water for drinking are classified as using an improved or unimproved source according to their water source for cooking and hand washing. 2 Includes water piped to a neighbor 3 Respondents may report multiple treatment methods, so the sum of treatment may exceed 100%. 4 Appropriate water treatment methods include boiling, bleaching, filtering, and solar disinfecting. Housing Characteristics and Household Population • 21 Table 2.2 Availability of water Among households and de jure population using piped water or water from a tube well or borehole, percentage lacking available water in the last 2 weeks, according to residence, Nepal DHS 2016 Households Population Availability of water in last 2 weeks Urban Rural Total Urban Rural Total Not available for at least 1 day 14.9 10.2 13.0 13.7 10.0 12.2 Available with no interruption of at least 1 day 84.9 89.8 86.9 86.1 89.9 87.7 Don't know/missing 0.2 0.1 0.2 0.1 0.1 0.1 Total 100.0 100.0 100.0 100.0 100.0 100.0 Number using piped water or water from a tube well1 6,067 4,021 10,087 25,182 17,881 43,063 1 Includes households reporting piped water or water from a tube well or borehole as their main source of drinking water and households reporting bottled water as their main source of drinking water if their main source of water for cooking and hand washing is piped water or water from a tube well or borehole 22 • Housing Characteristics and Household Population Table 2.3 Household sanitation facilities Percent distribution of households and de jure population by type of toilet/latrine facilities and percent distribution of households and de jure population with a toilet/latrine facility by location of the facility, according to residence, Nepal DHS 2016 Households Population Type and location of toilet/latrine facility Urban Rural Total Urban Rural Total Improved sanitation 61.1 62.9 61.7 64.8 64.3 64.6 Flush/pour flush to piped sewer system 7.0 0.2 4.4 6.9 0.2 4.2 Flush/pour flush to septic tank 39.7 40.3 39.9 42.5 40.5 41.7 Flush/pour flush to pit latrine 8.8 13.3 10.5 9.2 13.7 11.1 Ventilated improved pit (VIP) latrine 2.0 4.3 2.9 2.4 5.1 3.5 Pit latrine with slab 2.4 3.9 3.0 2.5 4.0 3.1 Composting toilet 1.1 0.8 1.0 1.2 0.8 1.0 Unimproved sanitation 38.9 37.1 38.3 35.2 35.7 35.4 Shared facility1 26.5 14.9 22.0 21.4 12.6 17.8 Flush/pour flush to piped sewer system 5.6 0.1 3.5 4.1 0.1 2.5 Flush/pour flush to septic tank 17.1 8.9 13.9 13.8 7.0 11.1 Flush/pour flush to pit latrine 2.5 3.7 3.0 2.2 3.3 2.7 Ventilated improved pit (VIP) latrine 0.4 1.2 0.7 0.4 1.1 0.7 Pit latrine with slab 0.4 0.5 0.4 0.4 0.5 0.4 Composting toilet 0.5 0.5 0.5 0.4 0.6 0.5 Unimproved facility 1.7 1.4 1.6 1.8 1.2 1.6 Flush/pour flush not to sewer/septic tank/pit latrine 0.7 0.3 0.5 0.7 0.2 0.5 Pit latrine without slab/open pit 0.9 1.1 1.0 1.0 1.0 1.0 Other 0.1 0.0 0.1 0.1 0.0 0.1 Open defecation (no facility/bush/field) 10.8 20.9 14.7 12.1 21.9 16.0 Total 100.0 100.0 100.0 100.0 100.0 100.0 Number of households/population 6,781 4,259 11,040 27,920 18,877 46,797 Location of toilet facility In own dwelling 33.0 5.8 23.3 30.9 5.6 21.4 In own yard/plot 61.8 83.5 69.6 64.3 83.9 71.7 Elsewhere 5.2 10.7 7.1 4.8 10.5 7.0 Total 100.0 100.0 100.0 100.0 100.0 100.0 Number of households/population with a toilet/latrine facility 6,049 3,370 9,419 24,546 14,744 39,290 1 Facilities that would be considered improved if they were not shared by two or more households Housing Characteristics and Household Population • 23 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, Nepal DHS 2016 Households Population Housing characteristic Urban Rural Total Urban Rural Total Electricity Yes 94.2 84.5 90.5 94.5 85.2 90.7 No 5.8 15.5 9.5 5.5 14.8 9.3 Total 100.0 100.0 100.0 100.0 100.0 100.0 Flooring material Earth, sand 40.7 72.9 53.1 43.5 73.7 55.7 Dung 5.7 8.7 6.8 6.0 9.1 7.3 Wood/planks 0.7 0.7 0.7 0.6 0.5 0.5 Parquet or polished wood 0.5 0.2 0.4 0.4 0.1 0.3 Vinyl or asphalt strips 1.1 0.0 0.7 0.8 0.0 0.5 Ceramic tiles 1.3 0.1 0.8 1.2 0.1 0.7 Cement 39.3 16.3 30.4 38.3 15.7 29.1 Carpet 10.6 1.0 6.9 9.1 0.7 5.7 Other 0.1 0.3 0.2 0.1 0.2 0.1 Total 100.0 100.0 100.0 100.0 100.0 100.0 Rooms used for sleeping One 31.8 31.2 31.6 23.1 23.3 23.2 Two 34.8 37.3 35.7 33.7 36.9 35.0 Three or more 33.4 31.5 32.7 43.3 39.8 41.9 Total 100.0 100.0 100.0 100.0 100.0 100.0 Place for cooking1 In the house 69.8 64.6 67.8 67.1 62.8 65.4 In a separate building 24.6 29.4 26.4 27.1 31.3 28.8 Outdoors 5.1 5.9 5.4 5.5 5.9 5.7 No food cooked in household 0.4 0.1 0.3 0.1 0.0 0.1 Total 100.0 100.0 100.0 100.0 100.0 100.0 Cooking fuel Electricity 1.2 0.6 1.0 1.1 0.6 0.9 LPG/natural gas/biogas 46.4 11.5 33.0 42.7 9.5 29.3 Wood 48.4 77.3 59.5 51.8 76.9 62.0 Straw/shrubs/grass 0.8 3.6 1.9 1.0 4.1 2.2 Animal dung 2.6 6.9 4.3 3.2 8.9 5.5 Other 0.1 0.0 0.1 0.1 0.0 0.1 No food cooked in household 0.4 0.1 0.3 0.1 0.0 0.1 Total 100.0 100.0 100.0 100.0 100.0 100.0 Percentage using solid fuel for cooking2 51.8 87.8 65.7 56.0 89.9 69.7 Percentage using clean fuel for cooking3 47.7 12.1 33.9 43.8 10.0 30.2 Frequency of smoking in the home Daily 29.8 33.8 31.3 32.9 36.2 34.3 Weekly 4.2 5.8 4.8 4.3 5.5 4.8 Monthly 2.5 2.6 2.5 2.6 2.3 2.5 Less than once a month 4.0 5.1 4.4 4.1 5.2 4.6 Never 59.5 52.7 56.9 56.1 50.8 53.9 Total 100.0 100.0 100.0 100.0 100.0 100.0 Number 6,781 4,259 11,040 27,920 18,877 46,797 LPG = Liquefied petroleum gas 1 As only 3 households used another place for cooking, these data are not shown separately. 2 Includes charcoal, wood, straw/shrubs/grass, agricultural crops, and animal dung 3 Includes electricity and LPG/natural gas/biogas 24 • 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, Nepal DHS 2016 Residence Possession Urban Rural Total Household effects Radio 28.8 30.0 29.3 Television 62.1 34.9 51.6 Mobile phone 94.3 90.5 92.8 Non-mobile telephone 10.4 1.9 7.1 Computer 18.0 4.3 12.7 Refrigerator 22.1 4.9 15.5 Table 65.0 44.5 57.1 Chair 61.9 47.4 56.3 Bed 95.8 92.3 94.5 Sofa 22.2 6.8 16.2 Cupboard 58.4 35.1 49.4 Clock 45.8 28.8 39.2 Fan 54.6 35.9 47.4 Invertor 15.7 3.6 11.0 Dhiki/janto 25.6 47.8 34.1 Means of transport Bicycle/rickshaw 38.7 35.0 37.3 Animal-drawn cart 2.5 3.7 3.0 Motorcycle/scooter 23.5 10.9 18.6 Car/truck 4.3 1.9 3.3 Three-wheel tempo 0.5 0.3 0.4 Ownership of agricultural land 71.5 87.0 77.5 Ownership of farm animals1 58.8 86.5 69.5 Number 6,781 4,259 11,040 1 Cows, bulls, buffalo, horses, donkeys, mules, goats, sheep, pigs, yaks, ducks, chickens, or other poultry Housing Characteristics and Household Population • 25 Table 2.6 Distance to nearest government health facility Percent distribution of households with distance to the nearest government health facility, according to background characteristics, Nepal DHS 2016 Background characteristic <30 minutes 30-60 minutes 60+ minutes Don't know Total Number of households Residence Urban 54.9 37.6 6.7 0.8 100.0 6,781 Rural 40.5 40.7 18.7 0.1 100.0 4,259 Ecological zone Mountain 34.5 39.9 25.3 0.2 100.0 781 Hill 39.4 42.1 17.4 1.1 100.0 5,134 Terai 61.5 35.3 3.1 0.0 100.0 5,125 Development region Eastern 53.8 36.0 10.1 0.1 100.0 2,590 Central 57.9 34.0 6.8 1.4 100.0 3,949 Western 52.1 37.6 10.3 0.0 100.0 2,245 Mid-western 24.9 52.0 23.0 0.1 100.0 1,339 Far-western 28.7 50.8 20.3 0.1 100.0 915 Province Province 1 50.5 36.6 12.9 0.1 100.0 2,004 Province 2 69.1 29.2 1.7 0.1 100.0 2,014 Province 3 50.6 37.9 9.4 2.1 100.0 2,521 Province 4 46.5 39.7 13.7 0.0 100.0 1,173 Province 5 45.3 43.4 11.2 0.1 100.0 1,793 Province 6 23.6 47.9 28.5 0.0 100.0 619 Province 7 28.7 50.8 20.3 0.1 100.0 915 Wealth quintile Lowest 19.6 45.9 34.3 0.2 100.0 2,234 Second 39.5 46.7 13.8 0.0 100.0 2,225 Middle 55.0 39.1 5.7 0.1 100.0 2,065 Fourth 60.7 35.9 2.3 1.2 100.0 2,240 Highest 71.9 26.5 0.4 1.2 100.0 2,276 Total 49.3 38.8 11.3 0.5 100.0 11,040 26 • Housing Characteristics and Household Population Table 2.7 Wealth quintiles Percent distribution of the de jure population by wealth quintiles, and the Gini coefficient, according to residence and region, Nepal DHS 2016 Wealth quintile Total Number of persons Gini coefficient Residence/region Lowest Second Middle Fourth Highest Residence Urban 12.5 18.6 17.4 21.4 30.1 100.0 27,920 0.28 Rural 31.1 22.1 23.8 17.9 5.0 100.0 18,877 0.28 Ecological zone Mountain 57.8 23.4 8.3 5.7 4.9 100.0 3,230 0.38 Hill 31.0 20.5 11.2 14.6 22.6 100.0 19,793 0.37 Terai 5.7 19.1 28.9 26.4 19.9 100.0 23,774 0.24 Development region Eastern 16.9 24.2 24.3 20.5 14.1 100.0 10,718 0.32 Central 10.9 16.8 21.0 22.9 28.3 100.0 16,697 0.28 Western 15.6 18.5 17.1 23.1 25.6 100.0 9,116 0.31 Mid-western 45.3 20.2 16.0 11.5 7.0 100.0 6,040 0.37 Far-western 37.1 24.5 17.1 12.5 8.7 100.0 4,226 0.33 Province Province 1 20.4 23.8 21.5 18.8 15.5 100.0 8,008 0.35 Province 2 3.9 22.4 36.5 26.0 11.1 100.0 10,076 0.22 Province 3 17.2 13.3 7.5 20.4 41.6 100.0 9,332 0.25 Province 4 22.0 21.1 16.2 20.3 20.4 100.0 4,320 0.37 Province 5 15.8 19.6 20.4 21.9 22.4 100.0 8,019 0.31 Province 6 69.1 15.3 7.0 6.0 2.6 100.0 2,817 0.42 Province 7 37.1 24.5 17.1 12.5 8.7 100.0 4,226 0.33 Total 20.0 20.0 20.0 20.0 20.0 100.0 46,797 0.31 Housing Characteristics and Household Population • 27 Table 2.8 Hand washing Percentage of households in which the place most often used for washing hands was observed by whether the location was fixed or mobile and total percentage of households in which the place for hand washing was observed, and among households in which the place for hand washing was observed, percent distribution by availability of water, soap, and other cleansing agents, according to background characteristics, Nepal 2016 Background characteristic Percentage of households in which place for washing hands was observed: Number of households Among households where place for hand washing was observed, percentage with: Number of households in which place for hand washing observed And place for hand washing was a fixed place And place for hand washing was mobile Total Soap and water1 Water and cleansing agent other than soap only2 Water only Soap but no water3 Cleansing agent other than soap only2 No water, no soap, no other cleansing agent Total Residence Urban 84.9 14.8 99.7 6,781 57.4 6.4 18.5 1.3 1.1 15.3 100.0 6,762 Rural 74.7 25.1 99.8 4,259 30.7 10.9 27.6 0.8 2.1 27.9 100.0 4,250 Ecological zone Mountain 70.4 29.0 99.3 781 28.9 6.8 22.2 0.7 2.8 38.6 100.0 776 Hill 83.9 15.9 99.8 5,134 51.2 9.2 19.0 1.2 2.2 17.1 100.0 5,122 Terai 79.6 20.2 99.8 5,125 45.7 7.2 25.1 1.0 0.5 20.4 100.0 5,113 Development region Eastern 81.1 18.6 99.7 2,590 46.7 7.4 26.7 1.0 0.6 17.6 100.0 2,582 Central 78.2 21.7 99.9 3,949 51.1 5.3 17.6 1.4 0.9 23.7 100.0 3,945 Western 90.2 9.6 99.8 2,245 49.4 8.8 27.5 0.8 1.6 11.9 100.0 2,241 Mid-western 72.3 27.2 99.5 1,339 32.2 13.6 19.9 1.2 4.8 28.3 100.0 1,333 Far-western 82.1 17.4 99.5 915 46.9 12.7 18.1 0.4 1.5 20.4 100.0 911 Province Province 1 82.3 17.3 99.6 2,004 47.8 6.4 27.8 1.1 0.7 16.2 100.0 1,996 Province 2 67.6 32.4 100.0 2,014 33.1 7.6 24.3 1.0 0.3 33.7 100.0 2,014 Province 3 86.5 13.4 99.8 2,521 63.5 4.7 13.5 1.6 1.2 15.4 100.0 2,517 Province 4 91.5 8.4 99.9 1,173 53.0 7.7 25.3 1.0 1.2 11.9 100.0 1,172 Province 5 83.1 16.5 99.5 1,793 42.3 10.2 27.5 0.5 1.6 17.8 100.0 1,784 Province 6 69.8 29.9 99.7 619 25.9 17.2 15.4 2.1 9.3 30.0 100.0 617 Province 7 82.1 17.4 99.5 915 46.9 12.7 18.1 0.4 1.5 20.4 100.0 911 Wealth quintile Lowest 65.4 34.2 99.6 2,234 16.7 14.8 24.0 0.6 4.8 39.0 100.0 2,224 Second 78.9 20.9 99.8 2,225 34.1 13.2 26.9 0.9 1.6 23.2 100.0 2,221 Middle 77.7 22.2 99.9 2,065 37.2 8.8 28.4 1.1 0.6 23.8 100.0 2,064 Fourth 86.2 13.6 99.7 2,240 59.8 3.6 22.6 1.3 0.4 12.4 100.0 2,234 Highest 96.0 3.7 99.7 2,276 86.1 0.5 9.1 1.5 0.0 2.9 100.0 2,269 Total 80.9 18.8 99.7 11,040 47.1 8.1 22.1 1.1 1.5 20.2 100.0 11,011 1 Soap includes soap or detergent in bar, liquid, powder, or paste form. This column includes households with soap and water only as well as those that had soap and water and another cleansing agent. 2 Cleansing agents other than soap include locally available materials such as ash, mud, or sand. 3 Includes households with soap only as well as those with soap and another cleansing agent 28 • Housing Characteristics and Household Population Table 2.9 Household population by age, sex, and residence Percent distribution of the de facto household population by 5-year age groups, according to sex and residence, Nepal DHS 2016 Urban Rural Age Male Female Total Male Female Total Male Female Total <5 11.0 8.3 9.6 14.0 10.6 12.1 12.2 9.2 10.6 5-9 10.9 9.6 10.2 13.7 11.1 12.3 12.0 10.2 11.1 10-14 13.2 10.5 11.8 14.1 12.5 13.2 13.6 11.3 12.3 15-19 10.5 10.8 10.7 9.0 9.7 9.4 9.9 10.4 10.2 20-24 7.6 9.8 8.8 5.4 8.8 7.3 6.8 9.4 8.2 25-29 6.1 8.8 7.6 4.5 7.6 6.2 5.5 8.3 7.0 30-34 6.0 7.8 6.9 5.0 6.5 5.8 5.6 7.2 6.5 35-39 5.7 6.9 6.3 4.7 5.9 5.4 5.3 6.5 5.9 40-44 5.4 5.9 5.7 4.3 4.9 4.6 5.0 5.4 5.2 45-49 4.8 4.5 4.7 4.5 4.0 4.2 4.7 4.3 4.5 50-54 4.8 4.7 4.7 4.5 4.9 4.7 4.7 4.8 4.7 55-59 3.8 3.5 3.6 4.5 3.6 4.0 4.0 3.5 3.8 60-64 3.1 3.1 3.1 3.3 3.5 3.4 3.2 3.3 3.2 65-69 2.6 2.0 2.3 3.0 2.8 2.9 2.8 2.3 2.5 70-74 2.1 2.0 2.1 3.1 2.1 2.5 2.5 2.0 2.2 75-79 0.9 0.8 0.8 1.1 0.7 0.9 1.0 0.8 0.9 80+ 1.2 1.1 1.2 1.3 0.9 1.1 1.2 1.0 1.1 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Dependency age groups 0-14 35.2 28.4 31.6 41.8 34.2 37.6 37.8 30.8 34.0 15-64 58.0 65.7 62.1 49.7 59.3 55.0 54.7 63.1 59.2 65+ 6.9 5.9 6.3 8.5 6.5 7.4 7.5 6.1 6.8 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 41.5 34.9 37.9 47.9 40.3 43.7 44.0 37.1 40.3 18+ 58.5 65.1 62.1 52.1 59.7 56.3 56.0 62.9 59.7 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Adolescents 10-19 23.7 21.3 22.4 23.1 22.2 22.6 23.5 21.7 22.5 Number of persons 12,975 15,044 28,019 8,513 10,282 18,795 21,487 25,326 46,814 Housing Characteristics and Household Population • 29 Table 2.10 Household composition Percent distribution of households by sex of head of household and by household size, mean size of household, and percentage of households with orphans and foster children under age 18, according to residence, Nepal DHS 2016 Residence Characteristic Urban Rural Total Household headship Male 68.3 69.3 68.7 Female 31.7 30.7 31.3 Total 100.0 100.0 100.0 Number of usual members 1 6.8 5.9 6.4 2 14.9 14.9 14.9 3 21.0 16.0 19.1 4 21.6 19.2 20.7 5 15.2 17.0 15.9 6 9.3 11.7 10.2 7 5.5 6.5 5.9 8 2.4 3.8 3.0 9+ 3.2 4.9 3.9 Total 100.0 100.0 100.0 Mean size of households 4.1 4.4 4.2 Percentage of households with orphans and foster children under age 18 Double orphans 0.1 0.1 0.1 Single orphans1 3.7 4.3 4.0 Foster children2 9.1 8.8 9.0 Foster and/or orphan children 11.5 11.6 11.5 Number of households 6,781 4,259 11,040 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 Foster children are those under age 18 living in households with neither their mother nor their father present, and the mother and/or the father are alive. 30 • Housing Characteristics and Household Population Table 2.11 Migration status Percentage distribution of women and men who migrated in the 10 years before the survey by selected background characteristics, Nepal DHS 2016 Background characteristic Women Men Total Age at migration <15 11.2 9.8 10.4 15-19 43.8 20.6 30.4 20-24 29.2 25.7 27.1 25-29 9.4 17.2 13.9 30-34 3.1 12.2 8.3 35-39 1.6 7.1 4.8 40-44 0.5 3.9 2.4 45-49 0.3 1.8 1.2 50+ 1.0 1.7 1.4 Total 100.0 100.0 100.0 Reason for migration Work 9.6 78.3 49.1 Study 10.9 14.2 12.8 Marriage 64.1 0.7 27.7 Accompany family 14.4 5.9 9.5 Security 0.2 0.2 0.2 Other 0.6 0.6 0.6 Don't know 0.2 0.1 0.1 Total 100.0 100.0 100.0 Residence Urban 54.0 53.5 53.7 Rural 46.0 46.5 46.3 Total 100.0 100.0 100.0 Ecological zone Mountain 8.1 7.7 7.8 Hill 47.0 45.5 46.2 Terai 44.9 46.8 46.0 Total 100.0 100.0 100.0 Development region Eastern 27.2 26.0 26.5 Central 33.4 30.4 31.7 Western 21.6 22.2 21.9 Mid-western 9.1 12.3 10.9 Far-western 8.7 9.2 9.0 Total 100.0 100.0 100.0 Province Province 1 20.4 19.0 19.6 Province 2 20.2 20.4 20.3 Province 3 20.0 17.0 18.3 Province 4 11.7 12.5 12.2 Province 5 14.8 16.8 15.9 Province 6 4.3 5.1 4.8 Province 7 8.7 9.2 9.0 Total 100.0 100.0 100.0 Wealth quintile Lowest 20.6 21.1 20.9 Second 25.4 22.5 23.7 Middle 20.6 22.7 21.8 Fourth 17.3 18.8 18.2 Highest 16.1 14.9 15.4 Total 100.0 100.0 100.0 Number 3,756 5,080 8,836 Housing Characteristics and Household Population • 31 Table 2.12.1 Duration and destination of migration: Women Percentage of female migrants by years since migration and percent distribution of female migrants by destination, according to background characteristics, Nepal DHS 2016 Time since migration Destination Background characteristic <1 year <5 years1 5+ years Within Nepal India Middle East Other countries Don't know Total Number of migrants Age at migration <15 19.6 71.5 28.5 88.0 10.4 0.4 1.1 0.2 100.0 421 15-19 15.1 67.8 32.2 86.6 11.3 1.0 1.1 0.1 100.0 1,646 20-24 21.2 70.4 29.6 86.0 5.9 2.3 5.7 0.1 100.0 1,095 25-29 24.0 76.8 23.2 73.8 6.8 5.4 14.0 0.0 100.0 351 30-34 29.1 83.3 16.7 62.0 9.9 10.7 12.0 5.4 100.0 116 35-39 23.7 72.5 27.5 63.9 12.1 9.7 13.2 1.1 100.0 61 40-44 * * * * * * * * * 18 45-49 * * * * * * * * * 11 50+ (51.3) (84.8) (15.2) (51.5) (15.1) (0.0) (33.4) (0.0) 100.0 37 Reason for migration Work 29.8 86.5 13.5 52.3 6.5 21.8 19.4 0.0 100.0 362 Study 29.0 80.5 19.5 82.5 5.1 0.0 12.4 0.0 100.0 408 Marriage 13.6 64.4 35.6 90.2 9.1 0.1 0.6 0.1 100.0 2,408 Accompany family 28.2 80.5 19.5 77.5 15.0 0.7 6.5 0.3 100.0 540 Security * * * * * * * * * 7 Other (46.9) (82.4) (17.6) (69.4) (10.0) (0.0) (16.4) (4.1) 100.0 24 Don't know * * * * * * * * * 7 Residence Urban 17.6 68.8 31.2 80.3 9.3 3.1 6.8 0.4 100.0 2,029 Rural 21.0 72.9 27.1 87.4 9.2 1.3 2.0 0.1 100.0 1,727 Ecological zone Mountain 27.0 83.3 16.7 90.6 4.5 3.3 1.6 0.0 100.0 304 Hill 20.0 71.0 29.0 86.8 4.4 2.3 6.2 0.4 100.0 1,765 Terai 16.9 68.1 31.9 78.9 15.3 2.1 3.5 0.2 100.0 1,687 Development region Eastern 19.5 69.6 30.4 85.6 7.5 2.6 4.1 0.1 100.0 1,021 Central 17.0 68.8 31.2 81.3 9.1 2.8 6.3 0.5 100.0 1,255 Western 17.3 68.6 31.4 84.2 8.2 2.4 5.2 0.0 100.0 812 Mid-western 27.1 80.0 20.0 87.4 8.8 1.2 1.9 0.8 100.0 341 Far-western 22.9 77.0 23.0 80.3 19.0 0.0 0.7 0.0 100.0 326 Province Province 1 21.3 70.7 29.3 84.4 6.8 3.5 5.1 0.1 100.0 765 Province 2 12.5 66.4 33.6 83.0 16.3 0.2 0.6 0.0 100.0 760 Province 3 20.6 70.3 29.7 82.3 1.9 4.6 10.3 0.8 100.0 752 Province 4 19.2 71.9 28.1 88.1 2.2 1.8 8.0 0.0 100.0 439 Province 5 17.9 69.2 30.8 82.0 12.6 2.7 2.2 0.5 100.0 554 Province 6 30.7 81.8 18.2 87.8 10.6 0.5 1.1 0.0 100.0 160 Province 7 22.9 77.0 23.0 80.3 19.0 0.0 0.7 0.0 100.0 326 Wealth quintile Lowest 25.0 77.6 22.4 90.3 6.7 2.0 0.9 0.2 100.0 774 Second 19.6 72.0 28.0 88.1 8.3 1.7 1.8 0.0 100.0 954 Middle 15.3 65.8 34.2 84.9 11.8 1.2 2.0 0.1 100.0 775 Fourth 16.1 68.1 31.9 80.6 10.5 3.6 4.3 1.1 100.0 650 Highest 19.2 68.8 31.2 69.3 9.6 3.6 17.5 0.0 100.0 604 Total 19.2 70.7 29.3 83.6 9.3 2.3 4.6 0.3 100.0 3,756 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. 1 Includes those who migrated since less than a year prior to the survey 32 • Housing Characteristics and Household Population Table 2.12.2 Duration and destination of migration: Men Percentage of male migrants by years since migration and percent distribution of male migrants by destination, according to background characteristics, Nepal DHS 2016 Time since migration Destination Background characteristic <1 year <5 years1 5+ years Within Nepal India Middle East Other countries Don't know Total Number of migrants Age at migration <15 26.9 75.6 24.4 87.1 12.0 0.0 0.6 0.3 100.0 500 15-19 31.2 82.8 17.2 44.2 26.2 14.5 15.0 0.0 100.0 1,045 20-24 31.3 86.0 14.0 23.6 14.5 34.8 27.0 0.0 100.0 1,303 25-29 30.3 83.6 16.4 21.2 10.8 41.9 26.1 0.0 100.0 874 30-34 36.6 86.2 13.8 15.2 13.6 49.0 22.2 0.0 100.0 621 35-39 39.6 89.7 10.3 17.0 14.1 50.8 18.2 0.0 100.0 362 40-44 35.1 91.4 8.6 14.0 18.9 53.5 13.6 0.0 100.0 199 45-49 37.3 81.6 18.4 22.2 26.9 37.4 13.4 0.0 100.0 91 50+ 50.8 87.7 12.3 32.5 34.0 15.1 16.3 2.1 100.0 84 Reason for migration Work 34.2 86.4 13.6 18.9 18.7 40.4 22.1 0.0 100.0 3,977 Study 27.6 78.5 21.5 75.9 8.9 1.0 14.3 0.0 100.0 723 Marriage (9.3) (62.6) (37.4) (91.2) (8.8) (0.0) (0.0) (0.0) 100.0 36 Accompany family 26.2 76.9 23.1 85.3 10.0 0.3 4.4 0.0 100.0 300 Security * * * * * * * * * 10 Other (31.6) (65.7) (34.3) (77.4) (7.8) (0.0) (10.2) (4.6) 100.0 31 Don't know * * * * * * * * * 3 Residence Urban 30.0 83.0 17.0 28.8 16.2 33.9 21.1 0.1 100.0 2,719 Rural 35.3 86.0 14.0 35.6 17.1 29.3 18.0 0.1 100.0 2,361 Ecological zone Mountain 33.7 84.5 15.5 61.4 17.3 9.1 12.0 0.2 100.0 389 Hill 30.9 82.8 17.2 34.8 17.8 26.4 21.0 0.0 100.0 2,314 Terai 33.8 85.9 14.1 24.3 15.3 40.7 19.6 0.1 100.0 2,377 Development region Eastern 31.3 85.1 14.9 29.4 8.6 40.9 21.0 0.1 100.0 1,322 Central 30.0 83.0 17.0 38.2 7.2 32.0 22.5 0.0 100.0 1,542 Western 31.5 83.7 16.3 24.3 15.6 37.2 22.9 0.1 100.0 1,127 Mid-western 41.9 88.5 11.5 28.5 36.8 20.8 13.9 0.1 100.0 623 Far-western 33.9 83.1 16.9 41.1 46.0 6.4 6.3 0.1 100.0 465 Province Province 1 31.7 85.5 14.5 30.6 8.6 39.3 21.4 0.1 100.0 966 Province 2 32.9 85.1 14.9 26.6 9.9 45.4 18.1 0.0 100.0 1,035 Province 3 26.7 80.8 19.2 47.3 4.6 21.4 26.7 0.0 100.0 863 Province 4 27.1 82.9 17.1 27.7 8.9 38.8 24.6 0.1 100.0 637 Province 5 35.5 85.0 15.0 23.0 26.7 32.6 17.7 0.0 100.0 853 Province 6 54.1 92.9 7.1 30.5 46.3 9.2 13.9 0.2 100.0 260 Province 7 33.9 83.1 16.9 41.1 46.0 6.4 6.3 0.1 100.0 465 Wealth quintile Lowest 36.0 88.1 11.9 35.1 31.3 18.8 14.8 0.1 100.0 1,070 Second 31.4 85.0 15.0 38.7 16.8 26.6 17.9 0.1 100.0 1,143 Middle 35.0 85.0 15.0 27.7 14.0 39.2 19.1 0.0 100.0 1,153 Fourth 29.8 81.3 18.7 29.0 9.2 43.6 18.1 0.1 100.0 956 Highest 28.9 81.0 19.0 27.5 9.1 31.6 31.7 0.1 100.0 758 Total 32.5 84.4 15.6 31.9 16.6 31.8 19.6 0.1 100.0 5,080 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. 1 Includes those who migrated since less than a year prior to the survey Housing Characteristics and Household Population • 33 Table 2.13 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, Nepal DHS 2016 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 37.0 3.3 40.3 1,931 2-4 62.2 4.6 66.8 2,909 Sex Male 52.6 4.5 57.1 2,580 Female 51.7 3.5 55.2 2,260 Residence Urban 51.1 3.8 54.8 2,619 Rural 53.4 4.4 57.8 2,222 Ecological zone Mountain 66.4 5.0 71.4 353 Hill 56.3 4.4 60.8 1,859 Terai 47.3 3.6 50.9 2,628 Development region Eastern 53.1 4.1 57.2 1,091 Central 49.6 3.5 53.1 1,768 Western 54.2 2.4 56.6 887 Mid-western 57.5 5.8 63.4 666 Far-western 47.5 6.9 54.4 428 Province Province 1 58.4 3.0 61.4 776 Province 2 42.1 2.9 45.0 1,286 Province 3 58.0 5.7 63.7 798 Province 4 60.1 0.8 60.8 385 Province 5 52.7 4.2 56.8 840 Province 6 58.1 6.8 64.9 328 Province 7 47.5 6.9 54.4 428 Wealth quintile Lowest 52.4 5.6 58.1 1,050 Second 56.1 2.6 58.7 1,000 Middle 50.1 4.4 54.5 1,073 Fourth 52.0 3.3 55.2 953 Highest 49.7 4.3 54.1 765 Total 52.2 4.0 56.2 4,840 34 • Housing Characteristics and Household Population Table 2.14 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, Nepal DHS 2016 Background characteristic 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 biolog- ical parent Percent age with one or both parents dead1 Number of children Father alive Father dead Mother alive Mother dead Both alive Only father alive Only mother alive Both dead Missing infor- mation on father/ mother Age 0-4 56.7 40.8 0.5 0.2 0.2 1.4 0.1 0.0 0.0 0.0 100.0 1.5 0.8 4,840 <2 59.1 40.2 0.2 0.0 0.1 0.2 0.2 0.0 0.0 0.0 100.0 0.4 0.5 1,931 2-4 55.1 41.2 0.7 0.4 0.2 2.2 0.1 0.0 0.0 0.1 100.0 2.3 1.0 2,909 5-9 56.2 34.8 1.2 1.2 0.8 4.9 0.5 0.2 0.0 0.2 100.0 5.6 2.8 5,165 10-14 59.5 26.6 2.5 1.9 1.4 6.6 0.7 0.5 0.1 0.2 100.0 7.9 5.2 5,760 15-17 58.2 18.4 4.0 2.2 1.6 13.4 0.7 1.0 0.3 0.2 100.0 15.4 7.5 2,906 Sex Male 57.7 32.3 1.8 1.6 0.8 4.8 0.4 0.4 0.1 0.2 100.0 5.7 3.4 9,395 Female 57.6 30.2 1.9 1.1 1.1 6.9 0.6 0.4 0.1 0.1 100.0 7.9 4.1 9,276 Residence Urban 57.4 30.4 1.9 1.6 1.0 6.6 0.5 0.4 0.1 0.2 100.0 7.6 3.9 10,477 Rural 58.0 32.4 1.8 1.0 0.9 4.9 0.5 0.3 0.1 0.1 100.0 5.8 3.6 8,195 Ecological zone Mountain 64.8 20.5 2.5 1.9 2.0 6.8 0.4 1.0 0.2 0.0 100.0 8.3 6.1 1,399 Hill 56.3 31.6 2.3 1.3 0.7 6.6 0.6 0.4 0.1 0.1 100.0 7.7 4.1 7,334 Terai 57.7 32.6 1.4 1.3 1.0 5.1 0.4 0.2 0.1 0.2 100.0 5.9 3.1 9,938 Development region Eastern 59.0 29.9 1.2 1.0 1.0 6.5 0.6 0.4 0.1 0.2 100.0 7.7 3.3 4,133 Central 59.3 29.2 1.7 1.6 0.9 6.3 0.5 0.3 0.1 0.1 100.0 7.2 3.5 6,438 Western 53.9 36.0 1.7 1.4 1.0 5.1 0.3 0.3 0.1 0.2 100.0 5.8 3.3 3,478 Mid-western 57.3 31.8 2.4 1.2 0.6 5.2 0.7 0.6 0.0 0.1 100.0 6.5 4.3 2,715 Far-western 56.2 31.7 3.4 1.3 1.6 5.0 0.1 0.4 0.1 0.2 100.0 5.6 5.5 1,907 Province Province 1 59.9 26.9 1.2 1.3 1.3 7.7 0.8 0.5 0.1 0.2 100.0 9.1 3.9 3,031 Province 2 57.6 35.4 1.0 0.6 0.6 4.2 0.4 0.1 0.1 0.0 100.0 4.7 2.2 4,562 Province 3 61.0 23.1 2.5 2.6 1.0 8.4 0.7 0.5 0.1 0.2 100.0 9.7 4.8 2,978 Province 4 49.4 38.9 1.7 1.4 0.9 6.5 0.4 0.3 0.3 0.3 100.0 7.5 3.6 1,538 Province 5 56.6 34.1 1.8 1.3 0.9 4.3 0.5 0.4 0.0 0.1 100.0 5.2 3.6 3,307 Province 6 59.5 29.0 2.9 1.1 0.5 5.9 0.5 0.4 0.0 0.0 100.0 7.0 4.4 1,348 Province 7 56.2 31.7 3.4 1.3 1.6 5.0 0.1 0.4 0.1 0.2 100.0 5.6 5.5 1,907 Wealth quintile Lowest 60.7 28.1 2.8 1.1 1.4 5.0 0.4 0.3 0.1 0.1 100.0 5.8 5.0 4,346 Second 56.5 33.5 1.8 1.0 0.9 5.3 0.5 0.3 0.1 0.1 100.0 6.3 3.6 3,860 Middle 54.0 36.3 1.2 1.1 0.9 5.0 0.8 0.4 0.0 0.2 100.0 6.3 3.4 3,913 Fourth 53.4 34.0 2.2 1.7 0.6 7.3 0.4 0.4 0.0 0.1 100.0 8.1 3.6 3,613 Highest 64.9 23.1 1.0 1.9 0.9 7.1 0.3 0.5 0.1 0.2 100.0 8.0 2.7 2,939 Total <15 57.6 33.7 1.5 1.2 0.8 4.5 0.5 0.3 0.0 0.1 100.0 5.2 3.0 15,766 Total <18 57.7 31.3 1.9 1.3 0.9 5.8 0.5 0.4 0.1 0.1 100.0 6.8 3.7 18,671 Note: Table is based on de jure household 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 Housing Characteristics and Household Population • 35 Table 2.15.1 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, Nepal DHS 2016 Background characteristic No education Some primary Completed primary1 Some secondary Completed secondary2 More than secondary Total Number Median years completed Age 6-9 23.9 74.9 0.9 0.3 0.0 0.0 100.0 2,090 0.5 10-14 3.7 41.3 16.5 38.1 0.4 0.1 100.0 2,858 4.3 15-19 5.8 7.2 5.7 48.6 18.2 14.5 100.0 2,625 8.1 20-24 14.0 9.2 6.7 30.1 11.7 28.3 100.0 2,375 8.3 25-29 27.1 11.7 7.5 20.3 9.1 24.2 100.0 2,108 6.1 30-34 37.4 15.1 7.7 19.9 7.6 12.3 100.0 1,832 3.5 35-39 53.5 12.3 5.7 16.4 5.7 6.4 100.0 1,637 0.0 40-44 61.9 10.8 4.7 12.8 4.7 4.9 100.0 1,380 0.0 45-49 73.0 10.2 2.6 6.9 3.4 4.0 100.0 1,088 0.0 50-54 83.6 7.6 1.7 4.4 1.9 0.8 100.0 1,205 0.0 55-59 89.8 4.0 2.0 2.6 0.5 1.1 100.0 899 0.0 60-64 91.2 4.6 0.7 1.1 0.9 1.4 100.0 828 0.0 65+ 95.8 2.4 0.4 0.9 0.1 0.4 100.0 1,556 0.0 Residence Urban 35.2 18.1 5.8 21.3 7.4 12.2 100.0 13,517 3.3 Rural 46.6 21.2 6.1 18.1 3.7 4.3 100.0 8,965 0.3 Ecological zone Mountain 44.3 20.1 5.6 19.3 3.7 7.0 100.0 1,462 0.8 Hill 34.8 18.0 6.0 22.3 7.0 11.9 100.0 9,628 3.4 Terai 43.3 20.3 5.9 18.2 5.3 7.0 100.0 11,392 1.1 Development region Eastern 39.5 18.9 6.2 20.7 7.0 7.7 100.0 5,142 2.2 Central 42.1 18.6 5.5 17.0 5.6 11.3 100.0 7,856 1.5 Western 35.1 19.4 6.2 22.9 6.4 10.0 100.0 4,507 3.1 Mid-western 39.1 21.8 6.4 21.9 5.0 5.9 100.0 2,901 1.9 Far-western 42.5 19.5 5.7 21.2 4.5 6.6 100.0 2,076 1.4 Province Province 1 35.7 18.3 6.8 22.8 7.4 9.0 100.0 3,839 3.2 Province 2 52.9 21.3 5.4 13.4 3.7 3.3 100.0 4,723 0.0 Province 3 33.0 16.4 5.3 20.0 7.7 17.7 100.0 4,435 4.1 Province 4 34.5 16.3 6.6 24.7 6.8 11.1 100.0 2,173 3.8 Province 5 36.7 22.1 6.3 21.6 5.7 7.6 100.0 3,924 2.5 Province 6 40.2 21.4 5.8 21.4 4.7 6.4 100.0 1,311 1.5 Province 7 42.5 19.5 5.7 21.2 4.5 6.6 100.0 2,076 1.4 Wealth quintile Lowest 47.8 23.9 6.3 17.6 2.3 2.2 100.0 4,432 0.0 Second 45.5 19.8 6.0 19.6 4.0 5.0 100.0 4,571 0.6 Middle 45.3 21.4 5.8 18.6 4.6 4.3 100.0 4,513 0.5 Fourth 37.8 17.4 6.4 21.6 7.6 9.2 100.0 4,511 2.9 Highest 22.1 14.0 5.2 22.7 11.2 24.8 100.0 4,455 7.1 Total 39.7 19.3 5.9 20.0 5.9 9.1 100.0 22,482 2.1 1 Completed grade 5 at the primary level 2 Completed grade 10 at the secondary level 36 • Housing Characteristics and Household Population Table 2.15.2 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, Nepal DHS 2016 Background characteristic No education Some primary Completed primary1 Some secondary Completed secondary2 More than secondary Don't know Total Number Median years completed Age 6-9 28.2 71.0 0.7 0.1 0.0 0.0 0.0 100.0 2,071 0.3 10-14 3.8 41.8 17.0 37.3 0.2 0.0 0.0 100.0 2,916 4.3 15-19 1.7 6.2 5.8 52.3 18.8 15.2 0.0 100.0 2,134 8.2 20-24 4.2 9.4 5.9 28.8 15.5 36.2 0.0 100.0 1,451 9.1 25-29 7.4 10.8 6.0 27.6 13.4 34.6 0.3 100.0 1,174 8.8 30-34 11.3 14.3 8.7 30.5 12.2 22.8 0.2 100.0 1,196 7.6 35-39 14.2 17.4 7.6 30.6 12.9 16.7 0.5 100.0 1,145 7.1 40-44 20.9 14.3 8.8 25.6 12.7 17.3 0.4 100.0 1,070 6.4 45-49 23.5 18.3 7.3 24.1 10.6 15.8 0.4 100.0 1,015 5.2 50-54 32.7 20.9 5.6 18.7 9.6 12.1 0.4 100.0 1,010 3.2 55-59 42.6 19.4 8.5 15.1 6.4 7.9 0.0 100.0 869 1.7 60-64 49.2 19.9 7.4 11.0 6.2 6.2 0.2 100.0 691 0.0 65+ 68.1 13.6 4.8 7.0 2.5 3.8 0.2 100.0 1,612 0.0 Residence Urban 16.9 22.4 7.5 26.4 10.0 16.6 0.2 100.0 11,264 5.6 Rural 26.3 28.3 7.9 24.2 6.2 6.9 0.1 100.0 7,091 3.3 Ecological zone Mountain 21.9 28.0 8.6 24.0 7.1 10.2 0.1 100.0 1,188 4.0 Hill 16.0 23.8 7.6 27.3 9.1 15.9 0.3 100.0 7,914 5.4 Terai 24.3 25.0 7.6 24.2 8.2 10.6 0.1 100.0 9,254 4.1 Development region Eastern 21.4 23.3 7.5 27.2 9.2 11.4 0.1 100.0 4,230 4.7 Central 21.9 23.0 7.1 22.2 9.3 16.2 0.3 100.0 6,767 4.7 Western 18.0 24.6 8.0 27.9 9.1 12.4 0.1 100.0 3,559 4.9 Mid-western 20.5 30.1 9.0 27.0 5.4 7.9 0.1 100.0 2,258 3.9 Far-western 18.4 28.1 8.1 28.2 6.6 10.6 0.1 100.0 1,541 4.4 Province Province 1 19.2 23.2 8.0 28.6 9.1 11.8 0.1 100.0 3,222 5.0 Province 2 30.6 25.0 6.8 21.4 7.7 8.3 0.1 100.0 3,851 2.9 Province 3 15.0 21.2 7.0 23.1 10.9 22.4 0.5 100.0 3,924 6.4 Province 4 17.2 23.0 8.2 28.5 9.4 13.5 0.1 100.0 1,667 5.3 Province 5 19.9 27.7 8.3 27.5 7.2 9.4 0.1 100.0 3,108 4.3 Province 6 19.2 29.8 8.8 26.3 6.2 9.6 0.0 100.0 1,041 4.1 Province 7 18.4 28.1 8.1 28.2 6.6 10.6 0.1 100.0 1,541 4.4 Wealth quintile Lowest 28.5 35.3 8.6 21.6 3.1 2.8 0.0 100.0 3,492 2.2 Second 26.3 28.6 8.4 25.6 5.8 5.3 0.0 100.0 3,546 3.3 Middle 26.5 25.0 8.7 26.2 7.2 6.4 0.1 100.0 3,596 3.8 Fourth 16.4 21.5 8.1 29.3 11.6 13.0 0.2 100.0 3,720 5.7 Highest 7.1 14.7 4.9 24.8 14.0 34.0 0.5 100.0 4,001 8.8 Total 20.6 24.7 7.7 25.5 8.5 12.9 0.2 100.0 18,355 4.6 1 Completed grade 5 at the primary level 2 Completed grade 10 at the secondary level Housing Characteristics and Household Population • 37 Table 2.16 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, Nepal DHS 2016 Net attendance ratio1 Gross attendance ratio2 Background characteristic Male Female Total Gender parity index3 Male Female Total Gender parity index3 PRIMARY SCHOOL Residence Urban 82.3 83.3 82.8 1.01 112.8 113.7 113.3 1.01 Rural 75.9 78.3 77.1 1.03 111.1 114.4 112.7 1.03 Ecological zone Mountain 84.6 86.4 85.5 1.02 115.8 124.7 120.0 1.08 Hill 84.6 87.0 85.8 1.03 114.8 118.0 116.4 1.03 Terai 75.0 76.2 75.6 1.02 109.6 110.0 109.8 1.00 Development region Eastern 80.3 82.3 81.3 1.02 108.5 117.6 112.8 1.08 Central 73.4 74.3 73.8 1.01 105.1 107.6 106.3 1.02 Western 81.4 84.4 82.9 1.04 116.8 116.8 116.8 1.00 Mid-western 86.4 86.7 86.5 1.00 120.7 121.8 121.3 1.01 Far-western 83.4 84.8 84.1 1.02 121.2 111.0 115.7 0.92 Province Province 1 82.2 82.2 82.2 1.00 109.1 113.5 111.2 1.04 Province 2 66.8 68.4 67.6 1.02 100.9 106.4 103.6 1.05 Province 3 85.6 88.4 87.0 1.03 113.2 118.1 115.5 1.04 Province 4 84.2 86.6 85.4 1.03 111.7 110.3 111.0 0.99 Province 5 82.9 84.1 83.5 1.01 124.1 121.1 122.6 0.98 Province 6 84.9 87.8 86.3 1.03 113.0 123.3 118.0 1.09 Province 7 83.4 84.8 84.1 1.02 121.2 111.0 115.7 0.92 Wealth quintile Lowest 86.3 83.9 85.0 0.97 122.8 122.2 122.5 1.00 Second 75.5 78.4 76.9 1.04 103.8 108.4 106.1 1.04 Middle 73.6 76.8 75.2 1.04 108.0 113.1 110.5 1.05 Fourth 76.6 81.4 79.0 1.06 111.5 115.7 113.6 1.04 Highest 85.4 85.5 85.4 1.00 112.4 107.1 109.7 0.95 Total 79.4 81.0 80.2 1.02 112.0 114.0 113.0 1.02 SECONDARY SCHOOL Residence Urban 71.5 71.0 71.3 0.99 92.1 92.4 92.2 1.00 Rural 62.6 58.5 60.5 0.93 84.3 78.9 81.5 0.94 Ecological zone Mountain 72.0 71.3 71.7 0.99 91.3 94.8 93.1 1.04 Hill 77.9 77.7 77.8 1.00 103.3 101.0 102.2 0.98 Terai 59.2 54.8 57.0 0.93 76.8 73.4 75.1 0.96 Development region Eastern 71.8 65.5 68.6 0.91 93.9 88.3 91.0 0.94 Central 61.6 57.6 59.6 0.93 81.6 72.5 76.9 0.89 Western 71.9 72.0 71.9 1.00 92.4 91.3 91.9 0.99 Mid-western 68.7 69.4 69.0 1.01 89.3 96.6 93.1 1.08 Far-western 71.0 75.4 73.1 1.06 94.3 106.5 100.2 1.13 Province Province 1 75.3 70.3 72.8 0.93 94.7 95.8 95.2 1.01 Province 2 48.6 41.7 44.9 0.86 66.6 55.6 60.8 0.83 Province 3 77.0 77.4 77.2 1.01 103.1 93.7 98.3 0.91 Province 4 80.9 81.8 81.3 1.01 106.7 107.1 106.9 1.00 Province 5 64.4 64.4 64.4 1.00 80.4 84.1 82.2 1.05 Province 6 73.8 73.3 73.5 0.99 100.2 100.5 100.3 1.00 Province 7 71.0 75.4 73.1 1.06 94.3 106.5 100.2 1.13 (Continued…) 38 • Housing Characteristics and Household Population Table 2.16—Continued Net attendance ratio1 Gross attendance ratio2 Background characteristic Male Female Total Gender Parity Index3 Male Female Total Gender Parity Index3 Wealth quintile Lowest 66.9 64.3 65.6 0.96 85.2 88.7 87.0 1.04 Second 66.2 64.0 65.1 0.97 87.4 87.9 87.7 1.01 Middle 62.1 56.6 59.3 0.91 81.4 75.5 78.4 0.93 Fourth 66.9 67.3 67.1 1.01 93.2 84.7 88.9 0.91 Highest 78.8 79.0 78.9 1.00 99.4 97.4 98.4 0.98 Total 67.9 65.5 66.7 0.96 89.0 86.5 87.7 0.97 1 The NAR for primary school is the percentage of the primary school-age (6-10 years) population that is attending primary school. The NAR for secondary school is the percentage of the secondary school-age (11-15 years) population that is attending secondary school. By definition, the NAR cannot exceed 100%. 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%. 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. Housing Characteristics and Household Population • 39 Table 2.17 Possession of mosquito nets Percentage of households with mosquito nets, and among households with mosquito nets, percent distribution by number of nets in the household, according to background characteristics, Nepal DHS 2016 Background characteristic Percentage of households with nets Number of households Number of nets in household Number of households with nets 1 2-3 4+ Total Residence Urban 79.8 6,781 20.1 55.8 24.1 100.0 5,411 Rural 67.6 4,259 23.1 55.9 21.0 100.0 2,879 Ecological zone Mountain 34.0 781 37.4 51.5 11.1 100.0 265 Hill 61.4 5,134 26.7 55.0 18.3 100.0 3,155 Terai 95.0 5,125 16.6 56.6 26.7 100.0 4,870 Development region Eastern 80.2 2,590 17.7 54.2 28.0 100.0 2,078 Central 78.0 3,949 24.6 57.1 18.3 100.0 3,079 Western 79.6 2,245 18.5 55.3 26.2 100.0 1,788 Mid-western 61.0 1,339 22.5 56.0 21.5 100.0 816 Far-western 57.8 915 20.9 56.7 22.3 100.0 529 Province Province 1 75.0 2,004 17.7 52.7 29.6 100.0 1,504 Province 2 96.3 2,014 20.6 58.1 21.3 100.0 1,940 Province 3 67.9 2,521 26.8 56.4 16.8 100.0 1,713 Province 4 72.3 1,173 21.8 54.0 24.2 100.0 848 Province 5 83.2 1,793 16.4 56.7 26.9 100.0 1,492 Province 6 42.7 619 32.3 53.5 14.2 100.0 264 Province 7 57.8 915 20.9 56.7 22.3 100.0 529 Wealth quintile Lowest 39.3 2,234 39.5 54.0 6.5 100.0 878 Second 78.5 2,225 25.8 59.0 15.2 100.0 1,747 Middle 91.0 2,065 16.7 60.4 22.9 100.0 1,880 Fourth 86.8 2,240 17.6 54.5 27.9 100.0 1,944 Highest 80.9 2,276 16.2 50.6 33.3 100.0 1,842 Total 75.1 11,040 21.1 55.9 23.0 100.0 8,290 40 • Housing Characteristics and Household Population Table 2.18 Protection against mosquito bites Percentage of households using different methods to protect themselves from mosquito bites, according to background characteristics, Nepal DHS 2016 Background characteristic Nets Repel- lent cream Coils Good- night mat/ liquid Take injection Electric bat Insecti- cide spray Fan Proper sanita- tion Use smoke Other Don't know Number of house- holds Residence Urban 91.0 2.8 34.1 30.9 0.3 3.9 7.1 9.9 21.7 5.7 3.0 1.6 6,781 Rural 90.7 1.4 28.8 13.5 0.3 3.6 6.0 9.2 19.9 7.6 1.6 4.6 4,259 Ecological zone Mountain 75.5 1.9 21.9 10.8 0.5 0.2 4.3 2.5 18.5 6.0 2.1 12.3 781 Hill 86.1 2.4 27.2 29.6 0.3 1.6 4.4 4.5 21.8 2.9 2.6 3.9 5,134 Terai 98.0 2.2 38.5 20.8 0.3 6.5 9.3 15.8 20.5 10.1 2.4 0.2 5,125 Development region Eastern 95.3 1.9 32.4 15.9 0.3 3.7 9.3 11.3 24.1 10.0 2.1 1.3 2,590 Central 90.6 2.6 37.2 31.5 0.5 5.4 5.8 10.7 17.8 6.2 2.1 1.0 3,949 Western 94.6 2.7 35.8 31.0 0.2 3.4 5.6 6.6 22.2 2.4 2.9 1.3 2,245 Mid-western 84.9 1.5 21.7 13.5 0.1 1.4 6.3 7.4 22.5 4.6 3.9 8.1 1,339 Far-western 79.5 1.8 14.9 14.9 0.3 1.7 6.3 10.7 20.6 10.1 2.0 9.7 915 Province Province 1 94.1 2.2 27.5 15.9 0.3 2.5 9.1 8.3 26.7 5.5 2.1 1.7 2,004 Province 2 98.7 0.7 48.0 14.1 0.4 9.9 9.1 20.2 15.7 16.3 1.5 0.0 2,014 Province 3 86.1 3.7 31.3 41.8 0.5 2.4 4.1 5.7 19.0 2.7 2.6 1.6 2,521 Province 4 91.7 2.7 30.1 31.8 0.2 1.5 3.8 6.0 19.9 1.7 1.7 1.9 1,173 Province 5 96.0 2.7 35.5 25.3 0.2 4.1 7.9 9.2 24.2 3.3 4.4 1.5 1,793 Province 6 75.1 0.3 17.1 8.1 0.1 0.4 3.6 1.9 21.4 5.8 2.9 14.2 619 Province 7 79.5 1.8 14.9 14.9 0.3 1.7 6.3 10.7 20.6 10.1 2.0 9.7 915 Wealth quintile Lowest 80.1 1.0 15.3 6.1 0.3 0.3 3.0 2.2 16.7 6.5 2.0 11.2 2,234 Second 94.9 0.7 28.6 10.3 0.1 2.1 5.5 6.7 20.5 8.2 1.8 1.4 2,225 Middle 97.1 1.2 37.5 16.3 0.2 4.2 6.7 13.3 19.0 9.8 1.1 0.6 2,065 Fourth 93.8 2.9 43.6 32.7 0.3 5.4 7.8 13.6 22.3 6.5 1.6 0.2 2,240 Highest 89.1 5.4 35.7 54.2 0.5 6.9 10.2 12.5 26.1 1.6 5.7 0.1 2,276 Total 90.9 2.3 32.1 24.2 0.3 3.8 6.7 9.6 21.0 6.5 2.5 2.7 11,040 Housing Characteristics and Household Population • 41 Table 2.19 Knowledge of lymphatic filariasis Percentage of households with members having knowledge on transmission of lymphatic filariasis, according to background characteristics, Nepal DHS 2016 Background characteristic Through mosquito bite From contami- nated food Other Don't know Unaware Number of households Residence Urban 30.3 1.7 1.6 60.5 7.4 6,781 Rural 24.0 1.4 1.2 64.9 9.3 4,259 Ecological zone Mountain 19.3 0.9 1.0 53.9 25.3 781 Hill 30.4 1.7 1.6 61.0 6.7 5,134 Terai 26.7 1.6 1.3 64.6 7.0 5,125 Development region Eastern 27.3 1.7 1.0 63.4 7.8 2,590 Central 30.7 1.7 2.1 56.6 10.4 3,949 Western 29.5 1.8 0.9 64.8 4.1 2,245 Mid-western 23.5 0.9 1.1 64.0 11.1 1,339 Far-western 19.8 1.0 1.1 73.6 4.9 915 Province Province 1 28.1 1.6 1.1 61.5 9.0 2,004 Province 2 25.5 0.9 0.9 62.5 10.6 2,014 Province 3 33.4 2.5 2.8 55.0 8.6 2,521 Province 4 33.1 1.9 0.4 61.7 3.6 1,173 Province 5 24.9 1.5 1.6 68.5 4.9 1,793 Province 6 23.1 0.6 0.5 58.0 18.1 619 Province 7 19.8 1.0 1.1 73.6 4.9 915 Wealth quintile Lowest 15.5 0.9 0.8 68.6 14.6 2,234 Second 23.9 1.0 0.8 66.3 8.6 2,225 Middle 25.9 1.4 1.1 65.4 7.3 2,065 Fourth 29.8 1.8 1.4 61.3 6.8 2,240 Highest 43.9 2.8 3.0 49.8 3.5 2,276 Total 27.9 1.6 1.4 62.2 8.1 11,040 Note: Respondents may report multiple answers, so the sum may exceed 100%. 42 • Housing Characteristics and Household Population Table 2.20 Household food security Percent distribution of households by level of food insecurity, according to background characteristics, Nepal DHS 2016 Background characteristic Food secure Mildly food insecure Moderately food insecure Severely food insecure Total Number of households Residence Urban 54.0 17.3 19.9 8.8 100.0 6,781 Rural 38.8 23.5 26.0 11.7 100.0 4,259 Ecological zone Mountain 38.4 18.8 28.9 13.8 100.0 781 Hill 46.8 18.8 24.4 10.0 100.0 5,134 Terai 51.0 20.7 19.1 9.2 100.0 5,125 Development region Eastern 50.8 21.9 18.0 9.2 100.0 2,590 Central 50.5 19.9 20.2 9.5 100.0 3,949 Western 57.6 18.0 18.4 6.0 100.0 2,245 Mid-western 27.7 18.6 36.8 16.9 100.0 1,339 Far-western 37.7 18.0 31.2 13.0 100.0 915 Province Province 1 52.6 20.3 18.0 9.2 100.0 2,004 Province 2 43.1 26.4 19.8 10.7 100.0 2,014 Province 3 55.0 16.4 20.0 8.5 100.0 2,521 Province 4 56.0 16.9 21.1 6.0 100.0 1,173 Province 5 48.4 19.2 22.2 10.2 100.0 1,793 Province 6 22.5 17.8 42.2 17.5 100.0 619 Province 7 37.7 18.0 31.2 13.0 100.0 915 Wealth quintile Lowest 18.1 20.8 38.9 22.2 100.0 2,234 Second 36.7 23.5 28.0 11.7 100.0 2,225 Middle 45.5 25.8 21.4 7.3 100.0 2,065 Fourth 61.2 19.3 14.3 5.2 100.0 2,240 Highest 78.5 9.5 8.9 3.1 100.0 2,276 Total 48.2 19.7 22.2 9.9 100.0 11,040 Characteristics of Respondents • 43 CHARACTERISTICS OF RESPONDENTS 3 Key Findings ▪ Age: More than half of the women and men interviewed are below age 30. ▪ Marital status: Seventy-seven percent of women and 66% of men are currently married, while 21% of women and 33% of men have never been married. ▪ Spousal separation: Thirty-four percent of currently married women report that their husband lives away from home. Among these women, almost half (49%) indicate that their husbands have been living away for 12 months or more. ▪ Education: Women are less likely than men to have some secondary or higher education (50% and 71%, respectively). ▪ Exposure to media: Television is the most commonly accessed form of media among both women (50%) and men (51%). Twenty-three percent of women and 47% of men have used the Internet in the past 12 months. ▪ Employment: Fifty-seven percent of women and 78% of men are currently employed. ▪ Occupation: Agriculture is the main occupation among both women (70%) and men (33%). Twenty-nine percent of women and 47% of men who are involved in agriculture receive payment in cash or in-kind. ▪ Tobacco use: Cigarette smoking and use of any type of tobacco are comparatively higher among men than among women (27% versus 6% each). his chapter presents information on demographic and socioeconomic characteristics of the survey respondents such as age, education, place of residence, marital status, employment, and wealth status. This information is useful in understanding the factors that affect use of reproductive health services, contraceptive use, and other health behaviors. 3.1 BASIC CHARACTERISTICS OF SURVEY RESPONDENTS The 2016 NDHS interviewed 12,862 women and 4,063 men age 15-49. More than half of the women and men are below age 30 (Table 3.1). A vast majority of respondents (86% of women and 85% of men) are Hindu, followed by Buddhist (5% of women and 6% of men) and Muslim (5% each of women and men). Thirty-two percent of women and 29% of men are Bhramin/Chhetri, 31% of women and 33% of men are Janajati, and 12% each of women and men are Dalit (Table 3.1). A majority of women (77%) and men (66%) are currently married, while 21% of women and 33% of men have never been married. Three percent of women and 1% of men are divorced, separated, or widowed. Around 6 in 10 women (63%) and men (65%) live in urban areas. T 44 • Characteristics of Respondents 3.2 SPOUSAL SEPARATION Thirty-four percent of currently married women reported that their husband lives away from home. Among these women, almost half (49%) indicated that their husbands have been living away for 12 or more months (Table 3.2). Trends: Migration has remained high in the country; one-third of women still indicate that their spouse lives away from home, similar to what was reported in the 2011 NDHS (34% and 32%, respectively). Spousal separation lasting 1 or more years has increased substantially, from 35% to 49%. Patterns by background characteristics ▪ Spousal separation peaks among women age 20-24 (45%) and decreases thereafter with increasing age (Table 3.2). Spousal separation for more than 12 months is higher among women age 30 and above. ▪ Thirty-seven percent of women with no children report that their husband lives away from home. Among them, 31% say their husband is away for 12 or more months. Similarly, 39% of women with one or two children report that their husband lives away, with 51% of these women saying that he is away for 12 or more months. ▪ Spousal separation is slightly higher in rural areas than in urban areas (37% versus 32%). ▪ Two in five women in Province 4 report that their husband lives away, a higher figure than in any of the other provinces. ▪ Among women whose spouse lives away from home, those in Province 6 (28%) are less likely than those in other provinces (45%-55%) to indicate that he is away for 12 or more months. 3.3 EDUCATION AND LITERACY Literacy Respondents who had attended higher than secondary school were assumed to be literate. All other respondents were given a sentence to read, and they were considered to be literate if they could read all or part of the sentence. Sample: Women and men age 15-49 Men are more likely than women to have some secondary or higher education (71% and 50%, respectively) (Figure 3.1, Tables 3.3.1 and 3.3.2). One-third of women and 10% of men have no education. Eighty-nine percent of men are literate, as compared with 69% of women (Tables 3.4.1 and 3.4.2). Trends: The median number of years of schooling among respondents age 15-49 has increased slightly since the 2011 NDHS, from 3.5 to 5.0 among women and from 7.4 to 8.0 among men. Patterns by background characteristics ▪ Urban women and men (57% and 76%, respectively) are more likely to have completed at least some secondary education than their rural counterparts (39% and 62%, respectively) (Tables 3.3.1 and 3.3.2). Figure 3.1 Education of survey respondents 33 10 11 13 6 7 26 34 10 15 15 22 Women Men Percent distribution of women and men age 15-49 by highest level of schooling attended or completed More than secondary Completed secondary Some secondary Primary complete Primary incomplete No education Characteristics of Respondents • 45 ▪ By province, women in Province 2 are least likely to have completed at least some secondary education (29%) (Table 3.3.1 and Figure 3.2). ▪ The proportions of women and men with no education are highest among those in the lowest wealth quintile (Tables 3.3.1 and 3.3.2). ▪ Women from Province 2 (39%) and those in the lowest wealth quintile (59%) are less likely than other women to be literate (Table 3.4.1). Similarly, men in Province 2 (78%) are comparatively less literate than men in other provinces (Table 3.4.2). 3.4 MASS MEDIA EXPOSURE AND INTERNET USAGE 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 to be regularly exposed to that form of media. Sample: Women and men age 15-49 Television is the most commonly accessed form of media among both women (50%) and men (51%). Men are more likely than women to be exposed to the other two forms of media: 22% of men and 9% of women read a newspaper, while 36% of men and 28% of women listen to the radio (Figure 3.3, Tables 3.5.1 and 3.5.2). Thirty-seven percent of women and 31% of men have no access to any of the three media. Among both women and men, Navimalam TV/radio karyakram is reported as the most frequently heard and seen program (45% and 46%, respectively), followed by Pariwarniyojan smart banchha jeevan TV/radio karyakram (37% and 42%) and Sathi sanga manka kura radio karyakram (22% and 25%) (Tables 3.6.1 and 3.6.2). Internet usage The Internet is a global network through which information is shared. Internet use includes accessing web pages, email, and social media. Sample: Women and men age 15-49 Overall, 23% of women and 47% of men age 15-49 reported having used the Internet in the past 12 months. Among those who had used the Internet in the past 12 months, more than half of women and men tended to use it on a daily basis during the past month (56% and 54%, respectively) (Tables 3.7.1 and 3.7.2). Figure 3.2 Secondary education by province Percentage of women age 15-49 with secondary education complete or higher Figure 3.3 Exposure to mass media 9 50 28 3 37 22 51 36 9 31 Reads newspaper 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 46 • Characteristics of Respondents Trends: There has been a decreasing trend in exposure to mass media over the past 5 years. Seven percent of women and 20% of men were exposed to the three mass media at least once a week in 2011, as compared with 3% and 9%, respectively, in 2016. Patterns by background characteristics ▪ Rural women are more likely than their urban counterparts (48% versus 31%) to have no access to the three media (newspaper, television, and radio). The pattern is similar among men (43% versus 25%) (Tables 3.5.1 and 3.5.2). ▪ Exposure to mass media increases with increasing educational attainment and wealth (Tables 3.5.1 and Table 3.5.2). ▪ Women and men in Province 2 are less likely than those in other provinces to be exposed to specific health programs on radio and television. For instance, with the exception of Navimalam TV/Radio karyakram (15% of women and 31% of men) and Pariwarniyojan smart banchha jeevan TV/radio karyakram (14% of women and 42% of men), less than 6% of women and less than 16% of men in Province 2 are exposed to these programs (Tables 3.6.1 and 3.6.2). ▪ Internet use is least common among women and men age 40-49, those living in Provinces 6 and Province 7, those who are not educated, and those in the lowest wealth quintile (Tables 3.7.1 and 3.7.2). ▪ Internet use in the past 12 months is relatively higher in urban areas (30% of women and 54% of men) than in rural areas (11% of women and 35% of men). 3.5 EMPLOYMENT Currently employed Respondents who were employed in the 7 days before the survey. Sample: Women and men age 15-49 More women than men were unemployed in the past 12 months (33% versus 14%). Fifty-seven percent of women and 78% of men reported current employment (Tables 3.8.1 and 3.8.2). Fifty-three percent of women and 73% of men who have a School Leaving Certificate (SLC) or above are currently employed, while 63% of women and 89% of men who have no education are employed (Figure 3.4). Trends: Current employment among both women and men has remained somewhat stagnant in the past 5 years. Sixty percent of women were currently employed in 2011, as compared with 57% in 2016. Among men, current employment was 78% in both 2011 and 2016. Patterns by background characteristics ▪ Younger women and men (age 15-19) are less likely to be employed (40% and 47%, respectively) than older women and men (Tables 3.8.1 and 3.8.2). ▪ Province 2 has fewer currently employed women (39%) than other provinces (Table 3.8.1). ▪ Women and men in the highest wealth quintile (44% and 74%, respectively) are less likely to be employed than their other counterparts in the other wealth quintiles (Tables 3.8.1 and 3.8.2). Figure 3.4 Employment by education 63 60 52 53 89 92 72 73 No education Primary Some secondary SLC and above Percentage of women and men age 15-49 who are currently employed Women Men Characteristics of Respondents • 47 3.6 OCCUPATION Occupation Categorized as professional/technical/managerial, clerical, sales and services, skilled manual, unskilled manual, agriculture, and other Sample: Women and men age 15-49 who were currently employed or had worked in the 12 months before the survey Women are far more likely to be employed in agriculture than men (70% versus 33%) (Figure 3.5, Tables 3.9.1 and 3.9.2). Trends: Involvement in agricultural work has decreased among both women and men over the past 5 years, from 75% and 35% in 2011 to 70% and 33% in 2016, respectively. In contrast, involvement in professional/technical/managerial work has increased, from 4% to 6% among women and from 8% to 10% among men. Patterns by background characteristics ▪ Women are less likely than men to be employed in professional/technical/managerial occupations (6% versus 10%), as well as clerical services (2% versus 6%), sales and services (13% versus 23%), skilled manual labor (6% versus 15%), and unskilled manual labor (3% versus 13%) (Figure 3.5, Tables 3.9.1 and 3.9.2). ▪ Women who were employed in agriculture in the past 12 months were less likely than men to receive any payment for their work (29% versus 47%) (Tables 3.10.1 and 3.10.2). 3.7 TOBACCO USE Men are more likely than women to use tobacco. Twenty-seven percent of men use any type of tobacco, as compared with 6% of women. Among those who smoke various tobacco products, cigarettes are most common (27% of men and 6% of women) (Tables 3.11.1 and 3.11.2). While almost 73% of men are nonsmokers, 17% smoke on a daily basis and 11% smoke occasionally. Trends: Use of cigarettes has decreased slightly during the past 5 years, from 9% to 6% among women and from 30% to 27% among men. Patterns by background characteristics ▪ Among women, the prevalence of smoking rises consistently with age, from less than 1% among those age 15-49 to 19% among those age 45-49 (Table 3.11.1). ▪ Province 6 has more women smokers (13%) than other provinces; use of any type of tobacco is also highest in that province (15%). ▪ Cigarette smoking declines with education attainment: 13% of women and 38% of men with no education smoke cigarettes, as compared with only 1% of women and 19% of men with an SLC or higher (Tables 3.11.1 and 3.11.2). Figure 3.5 Occupation 6 2 13 6 3 70 10 6 23 15 13 33 Professional/ technical/ managerial Clerical Sales and services Skilled manual Unskilled manual Agriculture Percentage of women and men age 15-49 employed in the 12 months before the survey by occupation Women Men 48 • Characteristics of Respondents ▪ Cigarette smoking declines with increasing wealth: only 2% of women and 21% of men in the highest wealth quintile smoke cigarettes, compared with 13% of women and 34% of men in the lowest quintile. ▪ Among those who smoke cigarettes daily, 49% of women (data not shown) and 45% of men smoke less than five cigarettes a day (Table 3.12). ▪ Use of any type of smokeless tobacco is much higher among men (40%) than among women (3%) (Figure 3.6 and Table 3.13). 3.8 KNOWLEDGE AND ATTITUDES REGARDING TUBERCULOSIS Ninety-six percent of women and 98% of men age 15-49 have heard of tuberculosis (TB). Among those who report having heard of TB, 16% of women and 21% of men know that chest pain is a common symptom of TB, 56% of women and 67% of men know that TB is spread through the air by coughing or sneezing, and 90% of women and 87% of men would not keep it a secret if a family member was diagnosed with TB (Tables 3.14.1 and 3.14.2). Patterns by background characteristics ▪ Women in rural areas (53%) are less likely than women in urban areas (57%) to correctly report that TB is spread through the air by coughing or sneezing (Table 3.14.1). ▪ The percentage of women who correctly report that TB is spread through the air by coughing or sneezing increases with increasing education, from 48% among those with no education to 69% among those with an SLC or higher. Similarly, 64% of men with no education have correct knowledge regarding the spread of TB, as compared with 75% of men with an SLC or higher. ▪ The percentage of women and men who correctly report that TB is spread through the air by coughing or sneezing increases remarkably with increasing wealth; 45% of women and 48% of men in the lowest wealth quintile have correct knowledge regarding the spread of TB, compared with 68% of women and 71% of men in the highest quintile. ▪ The government sector is most often reported as the preferred source of treatment for TB (85% of women and 92% of men), followed by the private medical sector (27% of women and 17% of men) (Table 3.15). The most preferred government sector source of treatment for TB is a government hospital or clinic (74% of women and 80% of men). Figure 3.6 Use of tobacco among women and men 6 1 3 27 5 40 Cigarettes Pipe, sulpha, chilam,water pipes Any type of smokeless tobacco Percentage of women and men age 15-49 who use tobacco products Women Men Characteristics of Respondents • 49 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 Spousal separation ▪ Table 3.3.1 Educational attainment: Women ▪ Table 3.3.2 Educational attainment: Men ▪ Table 3.4.1 Literacy: Women ▪ Table 3.4.2 Literacy: Men ▪ Table 3.5.1 Exposure to mass media: Women ▪ Table 3.5.2 Exposure to mass media: Men ▪ Table 3.6.1 Exposure to specific health programs on radio and television: Women ▪ Table 3.6.2 Exposure to specific health programs on radio and television: Men ▪ Table 3.7.1 Internet usage: Women ▪ Table 3.7.2 Internet usage: Men ▪ Table 3.8.1 Employment status: Women ▪ Table 3.8.2 Employment status: Men ▪ Table 3.9.1 Occupation: Women ▪ Table 3.9.2 Occupation: Men ▪ Table 3.10.1 Type of employment: Women ▪ Table 3.10.2 Type of employment: Men ▪ Table 3.11.1 Tobacco smoking: Women ▪ Table 3.11.2 Tobacco smoking: Men ▪ Table 3.12 Average number of cigarettes smoked daily: Men ▪ Table 3.13 Smokeless tobacco use and any tobacco use ▪ Table 3.14.1 Knowledge concerning tuberculosis: Women ▪ Table 3.14.2 Knowledge concerning tuberculosis: Men ▪ Table 3.15 Preferred source of treatment for TB 50 • Characteristics of Respondents Table 3.1 Background characteristics of respondents Percent distribution of women and men age 15-49 by selected background characteristics, Nepal DHS 2016 Women Men Background characteristic Weighted percent Weighted number Unweighted number Weighted percent Weighted number Unweighted number Age 15-19 20.2 2,598 2,622 22.9 931 964 20-24 17.5 2,251 2,306 16.0 649 633 25-29 16.6 2,135 2,094 12.9 525 522 30-34 14.0 1,806 1,789 13.2 535 532 35-39 12.2 1,572 1,584 13.4 544 516 40-44 10.8 1,388 1,336 11.4 463 473 45-49 8.6 1,113 1,131 10.2 415 423 Religion Hindu 85.8 11,040 11,198 85.4 3,470 3,522 Buddhist 5.1 652 582 6.1 249 200 Muslim 5.0 644 580 4.9 198 186 Kirat 1.4 177 152 1.2 49 45 Christian 2.7 346 347 2.2 88 101 Other 0.0 3 3 0.2 9 9 Ethnic group Hill Brahmin 11.8 1,512 1,488 11.8 479 460 Hill Chhetri 18.2 2,343 2,861 16.4 665 849 Terai Brahmin/Chhetri 1.7 217 202 1.1 47 51 Other Terai caste 14.8 1,908 1,502 15.7 637 514 Hill Dalit 8.1 1,042 1,265 7.3 297 348 Terai Dalit 4.3 554 422 4.5 182 145 Newar 5.0 639 450 5.1 207 160 Hill Janajati 20.9 2,694 2,609 22.8 924 833 Terai Janajati 9.8 1,266 1,439 10.2 415 502 Muslim 5.0 643 582 4.9 198 186 Other 0.3 43 42 0.3 12 15 Marital status Never married 20.8 2,669 2,626 33.4 1,355 1,341 Married 76.8 9,875 9,904 65.8 2,675 2,691 Divorced/separated 0.8 105 98 0.5 18 15 Widowed 1.7 213 234 0.3 14 16 Residence Urban 62.8 8,072 8,279 65.2 2,647 2,667 Rural 37.2 4,790 4,583 34.8 1,416 1,396 Ecological zone Mountain 6.0 775 931 6.2 252 312 Hill 43.2 5,556 5,739 44.1 1,791 1,770 Terai 50.8 6,531 6,192 49.7 2,019 1,981 Development region Eastern 22.5 2,900 2,432 21.9 892 787 Central 35.5 4,569 3,162 39.5 1,604 1,088 Western 20.2 2,597 2,756 19.3 785 861 Mid-western 12.8 1,650 2,666 11.2 453 773 Far-western 8.9 1,145 1,846 8.1 330 554 Province Province 1 16.9 2,173 1,837 17.0 691 610 Province 2 19.9 2,563 2,097 19.6 795 682 Province 3 21.2 2,732 1,660 24.8 1,009 583 Province 4 9.7 1,249 1,589 9.3 376 501 Province 5 17.7 2,274 2,072 16.2 658 619 Province 6 5.6 724 1,761 5.0 203 514 Province 7 8.9 1,145 1,846 8.1 330 554 Education No education 33.3 4,281 4,346 9.6 391 401 Primary 16.7 2,150 2,081 19.4 789 790 Some secondary 25.6 3,291 3,410 34.1 1,386 1,449 SLC and above 24.4 3,140 3,025 36.8 1,497 1,423 Wealth quintile Lowest 16.9 2,176 2,723 15.3 623 778 Second 19.6 2,525 2,710 17.4 706 789 Middle 20.2 2,595 2,600 18.7 758 797 Fourth 21.5 2,765 2,537 24.2 982 896 Highest 21.8 2,801 2,292 24.5 994 803 Total 100.0 12,862 12,862 100.0 4,063 4,063 Note: Education categories refer to the highest level of education attended, whether or not that level was completed. Characteristics of Respondents • 51 Table 3.2 Spousal separation Percentage distribution of currently married women age 15-49 whose husbands live away from home, and among those whose husbands live away, percent distribution by duration away from home, according to selected background characteristics, Nepal DHS 2016 Husband is away Number of women Duration away from home Number of women Background characteristic <7 months 7-11 months 12+ months Total Age 15-19 40.6 704 58.2 14.3 27.5 100.0 286 20-24 44.9 1,684 40.8 13.3 45.9 100.0 755 25-29 42.9 1,957 38.1 12.2 49.6 100.0 839 30-34 37.2 1,726 36.7 9.5 53.8 100.0 642 35-39 28.8 1,510 34.3 7.8 57.9 100.0 436 40-44 19.7 1,283 34.2 10.2 55.6 100.0 253 45-49 14.1 1,011 39.5 9.0 51.6 100.0 143 Number of living children 0 36.8 1,025 55.6 13.3 31.0 100.0 377 1-2 39.2 5,044 37.1 11.7 51.3 100.0 1,978 3-4 27.6 2,965 36.0 10.2 53.8 100.0 817 5+ 21.6 840 46.8 7.4 45.8 100.0 181 Residence Urban 31.8 6,031 38.2 10.5 51.2 100.0 1,919 Rural 37.3 3,844 41.0 12.3 46.8 100.0 1,434 Ecological zone Mountain 31.3 576 40.3 11.9 47.8 100.0 180 Hill 32.7 4,150 37.3 12.7 50.0 100.0 1,359 Terai 35.2 5,148 40.9 10.2 48.9 100.0 1,814 Development region Eastern 34.4 2,256 32.9 11.5 55.6 100.0 775 Central 30.8 3,486 41.7 9.3 49.1 100.0 1,075 Western 39.0 1,988 37.4 14.3 48.3 100.0 774 Mid-western 32.4 1,298 51.4 11.4 37.3 100.0 420 Far-western 36.5 846 36.5 10.0 53.5 100.0 309 Province Province 1 32.5 1,655 36.9 11.8 51.3 100.0 537 Province 2 38.7 2,168 40.2 9.4 50.5 100.0 839 Province 3 24.7 1,920 35.3 9.9 54.7 100.0 473 Province 4 41.8 950 32.2 15.8 52.0 100.0 397 Province 5 34.2 1,749 43.0 12.0 45.0 100.0 599 Province 6 33.8 586 60.7 11.8 27.5 100.0 198 Province 7 36.5 846 36.5 10.0 53.5 100.0 309 Education No education 30.1 3,984 37.1 9.9 53.1 100.0 1,200 Primary 36.2 1,853 39.4 10.1 50.5 100.0 670 Some secondary 38.3 2,177 39.7 12.9 47.5 100.0 833 SLC and above 34.9 1,861 43.4 13.1 43.6 100.0 650 Wealth quintile Lowest 34.4 1,687 39.1 11.7 49.3 100.0 580 Second 36.5 1,946 43.1 9.6 47.3 100.0 711 Middle 39.5 2,088 38.3 12.1 49.6 100.0 825 Fourth 35.5 2,107 36.9 10.5 52.6 100.0 749 Highest 23.9 2,047 40.1 13.0 46.8 100.0 490 Total 34.0 9,875 39.4 11.3 49.3 100.0 3,353 52 • Characteristics of Respondents Table 3.3.1 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, Nepal DHS 2016 Highest level of schooling Total Median years completed Number of women Background characteristic No education Some primary Completed primary1 Some secondary Completed secondary2 More than secondary Age 15-24 10.0 8.7 5.7 40.3 15.3 20.1 100.0 8.2 4,849 15-19 6.1 8.1 5.2 48.9 18.7 12.9 100.0 8.1 2,598 20-24 14.4 9.3 6.2 30.3 11.4 28.4 100.0 8.3 2,251 25-29 27.9 11.8 6.7 21.0 8.6 24.1 100.0 6.1 2,135 30-34 37.5 15.2 6.9 21.7 6.7 12.0 100.0 3.5 1,806 35-39 53.8 14.8 4.5 16.0 4.9 6.0 100.0 0.0 1,572 40-44 62.3 11.0 4.1 12.4 4.9 5.2 100.0 0.0 1,388 45-49 73.3 10.7 2.8 6.6 2.8 3.8 100.0 0.0 1,113 Residence Urban 27.8 10.1 5.3 26.5 11.2 19.1 100.0 6.7 8,072 Rural 42.6 13.2 5.7 24.1 6.8 7.7 100.0 2.7 4,790 Ecological zone Mountain 40.5 9.6 5.5 24.5 7.5 12.4 100.0 4.0 775 Hill 25.3 11.2 5.6 27.9 10.8 19.1 100.0 6.8 5,556 Terai 39.2 11.5 5.3 23.7 8.7 11.6 100.0 3.8 6,531 Development region Eastern 32.1 11.1 5.5 26.9 11.7 12.7 100.0 5.4 2,900 Central 35.7 11.9 5.1 21.1 8.4 17.8 100.0 4.5 4,569 Western 24.0 12.7 6.3 30.1 10.2 16.8 100.0 6.4 2,597 Mid-western 38.1 10.1 5.8 27.3 8.5 10.2 100.0 4.3 1,650 Far-western 40.9 7.7 4.6 27.1 8.4 11.3 100.0 4.3 1,145 Province Province 1 25.6 11.5 6.3 29.6 12.4 14.6 100.0 6.5 2,173 Province 2 53.3 13.0 4.3 17.2 6.4 5.8 100.0 0.0 2,563 Province 3 23.4 10.2 5.3 24.3 10.7 26.2 100.0 7.6 2,732 Province 4 19.4 11.7 7.2 32.7 10.7 18.3 100.0 7.0 1,249 Province 5 31.0 12.8 6.0 28.0 9.3 12.9 100.0 5.1 2,274 Province 6 41.9 8.3 4.4 25.8 8.2 11.5 100.0 3.9 724 Province 7 40.9 7.7 4.6 27.1 8.4 11.3 100.0 4.3 1,145 Wealth quintile Lowest 46.9 13.8 5.9 24.3 4.8 4.3 100.0 1.1 2,176 Second 40.8 12.0 5.3 26.1 6.9 8.9 100.0 3.3 2,525 Middle 41.2 13.6 6.1 24.5 7.3 7.3 100.0 2.9 2,595 Fourth 29.9 11.2 5.8 27.0 11.9 14.2 100.0 6.1 2,765 Highest 12.0 6.5 4.3 25.8 15.2 36.2 100.0 9.1 2,801 Total 33.3 11.3 5.5 25.6 9.5 14.9 100.0 5.0 12,862 1 Completed grade 5 at the primary level 2 Completed grade 10 at the secondary level Characteristics of Respondents • 53 Table 3.3.2 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, Nepal DHS 2016 Highest level of schooling Total Median years completed Number of men Background characteristic No education Some primary Completed primary1 Some secondary Completed secondary2 More than secondary Age 15-24 2.8 6.6 5.6 43.1 17.2 24.6 100.0 8.5 1,580 15-19 1.7 6.0 4.6 54.3 17.5 15.9 100.0 8.2 931 20-24 4.5 7.6 7.1 27.1 16.8 37.0 100.0 9.2 649 25-29 6.0 13.7 6.2 26.6 13.2 34.3 100.0 8.7 525 30-34 11.1 13.1 7.8 33.0 14.4 20.5 100.0 7.6 535 35-39 14.1 19.7 8.0 31.0 13.3 13.8 100.0 6.5 544 40-44 19.5 15.4 9.3 25.6 14.4 15.8 100.0 6.4 463 45-49 21.3 20.9 6.4 24.2 11.1 16.2 100.0 5.3 415 Residence Urban 7.4 11.0 5.9 33.3 16.4 26.1 100.0 8.4 2,647 Rural 13.9 15.7 8.6 35.6 12.0 14.3 100.0 6.9 1,416 Ecological zone Mountain 10.5 13.0 9.2 31.7 14.4 21.1 100.0 8.0 252 Hill 4.4 11.3 6.2 35.5 15.7 27.0 100.0 8.5 1,791 Terai 14.1 13.7 7.1 33.2 14.2 17.7 100.0 7.2 2,019 Development region Eastern 8.7 11.3 7.4 37.3 16.2 19.2 100.0 8.0 892 Central 10.2 13.4 5.2 29.0 16.8 25.4 100.0 8.2 1,604 Western 8.7 10.1 8.2 39.6 12.1 21.3 100.0 7.9 785 Mid-western 11.9 16.2 9.6 33.3 12.4 16.6 100.0 7.2 453 Far-western 8.4 13.2 6.2 38.3 12.0 21.9 100.0 7.7 330 Province Province 1 8.0 11.2 7.9 37.2 16.3 19.3 100.0 7.9 691 Province 2 16.6 14.0 6.2 33.4 15.1 14.6 100.0 7.0 795 Province 3 5.3 12.6 4.4 27.2 17.9 32.6 100.0 9.0 1,009 Province 4 6.3 8.5 7.6 39.0 13.3 25.3 100.0 8.2 376 Province 5 11.8 14.4 9.8 37.2 11.0 15.7 100.0 7.1 658 Province 6 10.3 12.6 7.2 34.6 13.7 21.6 100.0 8.1 203 Province 7 8.4 13.2 6.2 38.3 12.0 21.9 100.0 7.7 330 Wealth quintile Lowest 19.0 22.4 9.3 34.8 7.1 7.4 100.0 4.9 623 Second 16.0 17.3 7.8 38.1 10.7 10.2 100.0 6.3 706 Middle 12.1 14.6 8.9 38.0 13.5 13.0 100.0 6.9 758 Fourth 5.9 10.6 6.2 38.3 18.0 21.0 100.0 8.3 982 Highest 1.0 3.6 3.6 23.8 20.6 47.4 100.0 9.9 994 Total 9.6 12.6 6.8 34.1 14.9 22.0 100.0 8.0 4,063 1 Completed grade 5 at the primary level 2 Completed grade 10 at the secondary level 54 • Characteristics of Respondents Table 3.4.1 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, Nepal DHS 2016 No schooling, primary or secondary school Total Percentage literate1 Number of women Background characteristic SLC and above 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 35.4 42.7 6.4 15.2 0.1 0.1 100.0 84.5 4,849 15-19 31.6 49.1 6.4 12.6 0.2 0.1 100.0 87.1 2,598 20-24 39.8 35.3 6.5 18.2 0.1 0.0 100.0 81.6 2,251 25-29 32.7 33.5 6.1 27.7 0.1 0.0 100.0 72.2 2,135 30-34 18.7 39.5 10.7 31.0 0.0 0.0 100.0 69.0 1,806 35-39 10.9 33.2 11.9 44.0 0.1 0.0 100.0 56.0 1,572 40-44 10.1 25.8 12.1 51.7 0.0 0.3 100.0 48.1 1,388 45-49 6.7 20.8 13.6 58.9 0.0 0.0 100.0 41.1 1,113 Residence Urban 30

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