Zambia - Demographic and Health Survey - 2009

Publication date: 2009

Zambia Demographic and Health Survey 2007 Zam bia 2007 D em ographic and H ealth Survey Zambia Demographic and Health Survey 2007 Central Statistical Office Lusaka, Zambia Ministry of Health Lusaka, Zambia Tropical Diseases Research Centre Ndola, Zambia University of Zambia Lusaka, Zambia March 2009 The 2007 Zambia Demographic and Health Survey (2007 ZDHS) was implemented by the Central Statistical Office (CSO) in partnership with the Ministry of Health from April to October 2007. The Tropical Diseases Research Centre (TDRC) provided technical support and implementation of the syphilis and HIV testing. Macro International Inc. provided technical assistance as well as funding to the project through the MEASURE DHS programme, a USAID-funded project providing support and technical assistance in the implementation of population and health surveys in countries worldwide. Additional funding for the ZDHS was provided by the Ministry of Health, the Ministry of Finance and National Planning, the United States Agency for International Development (USAID), the Centers for Disease Control and Prevention (CDC), the Malaria Control and Evaluation Partnership in Africa (MACEPA), the European Union (EU), the World Bank through the Zambia National Response to HIV/AIDS (ZANARA) project, the United Nations Population Fund (UNFPA), the United Nations Development Program (UNDP), the Joint United Nations Programmes on HIV/AIDS (UNAIDS), the United Nations Children’s Fund (UNICEF), the Japan International Cooperation Agency (JICA), Swedish International Development Assistance (SIDA), United Kingdom Department for International Development (DFID), World Health Organisation (WHO) and Development Cooperation Ireland (DCI). The opinions expressed in this report are those of the authors and do not necessarily reflect the views of the Government of Zambia or the donor organizations. Additional information about the 2007 ZDHS may be obtained from the Central Statistical Office, P. O. Box 31908, Lusaka, Zambia, Telephone: (260-211) 251377/85; Fax: (260-211) 1253468; E-mail: Info@zamstats.gov.zm; http:www.zamstats gov.zm. Information about the DHS programme may be obtained from the MEASURE DHS Project, Macro International Inc., 11785 Beltsville Drive, Suite 300, Calverton, MD 20705, USA; Telephone: 301- 572-0200, Fax: 301-572-0999, E-mail: reports@macrointernational.com, Internet: http://www.measuredhs.com. Recommended citation: Central Statistical Office (CSO), Ministry of Health (MOH), Tropical Diseases Research Centre (TDRC), University of Zambia, and Macro International Inc. 2009. Zambia Demographic and Health Survey 2007. Calverton, Maryland, USA: CSO and Macro International Inc. Contents | iii CONTENTS Page TABLES AND FIGURES .xi PREFACE . xix SUMMARY OF FINDINGS . xxi MILLENNIUM DEVELOPMENT GOAL INDICATORS .xxvii MAP OF ZAMBIA .xxviii CHAPTER 1 INTRODUCTION Nchimunya Nkombo, Chanda Mulenga and Webster Kasongo 1.1 History, Geography, and Economy .1 1.1.1 History.1 1.1.2 Geography.1 1.1.3 Economy .1 1.2 Population .2 1.3 The Population Policy and National Population and Development Programme of Action .3 1.4 Health Priorities and Programmes .4 1.5 Strategic Framework to Combat the National HIV/AIDS Epidemic .5 1.6 Objectives and Organization of the Survey.6 1.6.1 Objectives .6 1.6.2 Organization.7 1.7 Sample Design .7 1.8 Questionnaires.8 1.9 Syphilis and HIV Testing.9 1.9.1 Syphilis Testing .9 1.9.2 HIV Testing.9 1.9.3 Quality Control.10 1.9.4 External quality control .10 1.10 Pretest Activities .11 1.10.1 Training of Field Staff .11 1.10.2 Fieldwork .11 1.11 Data Processing.11 1.12 Response Rates .12 CHAPTER 2 HOUSEHOLD POPULATION AND HOUSING CHARACTERISTICS Palver Sikanyiti 2.1 Population by Age and Sex.13 2.2 Household Composition .14 2.3 Education of the Household Population .15 2.3.1 Educational Attainment.16 2.3.2 School Attendance Rates .18 2.3.3 Grade Repetition and Dropout Rates .20 2.4 Household Environment.22 iv � Contents 2.4.1 Drinking Water.22 2.4.2 Household Sanitation Facilities .24 2.4.3 Housing Characteristics.25 2.5 Household Possessions.27 2.6 Wealth Index .29 2.7 Birth Registration.30 CHAPTER 3 CHARACTERISTICS OF RESPONDENTS Chipalo Kaliki and Arthur Kachemba 3.1 Characteristics of Survey Respondents.33 3.2 Educational Attainment .34 3.3 Literacy Assessment.36 3.4 Exposure to Mass Media .38 3.5 Employment Status .40 3.6 Occupation.43 3.7 Type of Employment.45 3.8 Health Insurance Coverage .47 3.9 Knowledge and Attitudes Regarding Tuberculosis .49 3.10 Tobacco Use.51 CHAPTER 4 FERTILITY LEVELS, TRENDS, AND DIFFERENTIALS Margaret Tembo-Mwanamwenge 4.1 Introduction.55 4.2 Current Fertility.55 4.3 Fertility Differentials .57 4.4 Fertility Trends .58 4.5 Children Ever Born and Living.60 4.6 Birth Intervals.61 4.7 Age at First Birth.62 4.8 Teenage Pregnancy and Motherhood.64 CHAPTER 5 FAMILY PLANNING Chola Nakazwe Daka and Brian Munkombwe 5.1 Knowledge of Contraceptive Methods.67 5.2 Ever Use of Contraception .70 5.3 Current Use of Contraceptive Methods .72 5.4 Differentials in Contraceptive Use by Background Characteristics.73 5.5 Trends in Contraceptive Use .74 5.6 Brands of Pills, Condoms, and Injectables Used.76 5.7 Knowledge of the Fertile Period .78 5.8 Number of Children at First Use of Contraception.79 5.9 Timing of Sterilization .80 5.10 Source of Contraception .80 5.11 Cost of Contraception .81 5.12 Informed Choice.82 5.13 Future Use of Contraception .83 5.14 Reasons for Not Intending to Use Contraception in the Future .84 5.15 Preferred Method for Future Use .84 Contents | v 5.16 Exposure to Family Planning Messages in the Media.85 5.17 Contact of Nonusers with Family Planning Providers .87 5.18 Husband/Partner’s Knowledge of Women’s Contraceptive Use .89 CHAPTER 6 OTHER PROXIMATE DETERMINANTS OF FERTILITY Nchimunya Nkombo and Brian Munkombwe 6.1 Current Marital Status .91 6.2 Polygyny .92 6.3 Age at First Marriage .93 6.4 Median Age at First Marriage.95 6.5 Age at First Sexual Intercourse.96 6.6 Recent Sexual Activity .99 6.7 Postpartum Amenorrhoea, Abstinence, and Insusceptibility. 101 6.8 Menopause. 102 CHAPTER 7 FERTILITY PREFERENCES Richard Banda 7.1 Desire for More Children . 103 7.2 Desire to Limit Childbearing by Background Characteristics . 104 7.3 Need for Family Planning Services. 106 7.4 Ideal Family Size . 110 7.5 Fertility Planning . 112 7.6 Wanted Fertility Rates . 113 CHAPTER 8 INFANT AND CHILD MORTALITY Christopher C. Mapoma 8.1 Background and Assessment of Data Quality. 115 8.2 Infant and Child Mortality Levels and Trends. 116 8.3 Socio-economic Differentials in Infant and Child Mortality . 117 8.4 Biodemographic Differentials in Early Childhood Mortality. 118 8.5 Perinatal Mortality. 119 8.6 High-Risk Fertility Behaviour . 120 8.7 Women’s Status and Early Childhood Mortality . 122 CHAPTER 9 MATERNAL HEALTH Linda Nyangu Chonya and Josephine Chewe-Banda 9.1 Antenatal Care . 123 9.2 Number of ANC Visits and Timing of First Visit. 125 9.3 Components of Antenatal Care . 126 9.4 Tetanus Toxoid Injections . 128 9.5 Place of Delivery. 129 9.6 Assistance during Delivery. 131 9.7 Delivery Characteristics . 132 9.8 Postnatal Care. 133 9.9 Problems in Accessing Health Care . 136 vi � Contents CHAPTER 10 CHILD HEALTH Penelope Kalesha and Nchimunya Nkombo 10.1 Child’s Size at Birth . 139 10.2 Vaccination Coverage . 141 10.2.1 Trends in Vaccination Coverage. 143 10.3 Acute Respiratory Infection . 144 10.4 Fever. 146 10.5 Prevalence of Diarrhoea. 148 10.6 Diarrhoea Treatment. 149 10.7 Feeding Practices . 151 10.8 Knowledge of ORS Packets . 152 10.9 Stool Disposal . 152 CHAPTER 11 NUTRITION OF CHILDREN AND ADULTS Lubinda Mukata 11.1 Nutritional Status of Children . 155 11.1.1 Measurement of Nutritional Status among Young Children . 155 11.1.2 Results of Data Collection . 156 11.1.3 Trends in Malnutrition . 159 11.2 Initiation of Breastfeeding. 160 11.3 Breastfeeding Status by Age. 161 11.4 Duration and Frequency of Breastfeeding . 163 11.5 Types of Complementary Foods . 164 11.6 Infant and Young Child Feeding (IYCF) Practices . 166 11.7 Micronutrient Intake among Children. 169 11.8 Nutritional Status of Women. 171 11.9 Foods Consumed by Mothers. 174 11.10 Micronutrient Intake among Mothers . 175 CHAPTER 12 MALARIA Pascalina Chanda and Richard Banda 12.1 Introduction. 177 12.2 Mosquito Nets . 177 12.2.1 Ownership of Mosquito Nets . 178 12.2.2 Use of Mosquito Nets by Children under Age Five. 179 12.2.3 Use of Mosquito Nets by Women Age 15-49, Including Pregnant Women . 181 12.3 Prophylactic Use of Antimalarial Drugs and Use of Intermittent Preventive Treatment in Pregnant Women. 183 12.4 Prevalence and Prompt Treatment of Fever in Children under Age Five . 184 12.5 Indoor Residual Spraying. 188 CHAPTER 13 HIV AND AIDS-RELATED KNOWLEDGE, ATTITUDES, AND BEHAVIOUR Jacob R.S. Malungo and Josephine Chewe-Banda 13.1 Introduction. 189 Contents | vii 13.2 HIVAIDS Knowledge, Transmission, and Prevention Methods . 189 13.2.1 Awareness of HIV and AIDS . 189 13.2.2 Knowledge of HIV Prevention. 190 13.2.3 Rejection of Misconceptions about HIV and AIDS . 192 13.3 Knowledge about Mother-to-Child Transmission . 194 13.4 Attitudes towards People Living with AIDS . 196 13.5 Attitudes towards Negotiating Safer Sexual Relations with Husbands . 198 13.6 Attitudes Towards Condom Education for Youth . 199 13.7 Higher-risk Sex. 200 13.8 Payment for Sex. 203 13.9 Coverage of HIV Testing Services . 204 13.10 Male Circumcision . 208 13.11 Self-reporting of Sexually Transmitted Infections . 208 13.12 Prevalence of Medical Injections . 209 13.13 Perceptions and Beliefs about Abstinence and Faithfulness. 211 13.14 HIV/AIDS-Related Knowledge and Behaviour among Youth . 212 13.14.1 Knowledge about HIV/AIDS and Sources for Condoms. 212 13.14.2 Age at First Sex . 214 13.14.3 Trends in Age at First Sexual Intercourse . 215 13.14.4 Condom Use at First Sex. 216 13.14.5 Premarital Sex . 217 13.14.6 Higher-Risk Sex. 218 13.14.7 Age-mixing in Sexual Relationships . 221 13.14.8 Drunkenness during Sexual Intercourse . 221 13.14.9 HIV Testing. 222 CHAPTER 14 PREVALENCE OF HIV AND SYPHILIS Margaret Tembo-Mwanamwenge and Webster Kasongo 14.1 Coverage Rates for HIV Testing . 225 14.2 HIV Prevalence . 228 14.2.1 HIV Prevalence by Age, Sex, and Residence . 228 14.2.2 Trends in HIV Prevalence . 229 14.2.3 HIV Prevalence by Socio-Economic Characteristics . 230 14.2.4 HIV Prevalence by Demographic Characteristics. 232 14.2.5 HIV Prevalence by Sexual Risk Behaviour . 233 14.3 HIV Prevalence among Youth. 235 14.3.1 HIV Prevalence by Sexual Behaviour among Youth. 236 14.4 HIV Prevalence by Other Characteristics . 237 14.4.1 HIV Prevalence and STIs. 237 14.4.2 HIV Prevalence by Previous Testing Behaviour. 238 14.4.3 HIV Prevalence by Male Circumcision . 239 14.4.4 HIV Prevalence among Cohabitating Partners . 240 14.4.5 HIV Prevalence among Women Who Recently Gave Birth . 241 14.5 Coverage for Syphilis Testing . 242 14.6 Syphilis Prevalence. 244 14.6.1 Syphilis Prevalence by Age, Sex, and Residence. 244 14.6.2 Syphilis Prevalence by Reproductive and Sexual Activity Characteristics . 246 14.6.3 Syphilis Prevalence by Condom Use, Sexual Behaviour, and STI Treatment. 247 viii � Contents CHAPTER 15 ADULT AND MATERNAL MORTALITY Margaret Tembo-Mwanamwenge 15.1 Data. 249 15.2 Direct Estimates of Adult Mortality . 250 15.3 Trends in Adult Mortality. 251 15.4 Direct Estimates of Maternal Mortality. 252 CHAPTER 16 WOMEN’S EMPOWERMENT AND HEALTH OUTCOMES Chola Nakazwe Daka, Mildred Sapeyo Tolosi, and Arthur Kachemba 16.1 Women’s and Men’s Employment . 255 16.1.1 Employment Status. 255 16.2 Women’s Control Over Their Own Earnings and Relative Magnitude of Women’s Earnings . 256 16.3 Woman’s Participation in Decision-making . 259 16.4 Attitudes towards Wife Beating . 263 16.5 Attitudes towards Refusing Sex with Husband . 266 16.6 Women’s Empowerment Indicators . 270 16.7 Current Use of Contraception by Woman’s Empowerment Status . 271 16.8 Ideal Family Size and Unmet Need by Women’s Status. 272 16.9 Women’s Status and Reproductive Health Care . 273 CHAPTER 17 DOMESTIC VIOLENCE Linda Nyangu Chonya and Mildred Sapeyo Tolosi 17.1 Women Experiencing Physical Violence . 275 17.2 Perpetrators of Physical Violence. 278 17.3 Experience of Sexual Violence . 278 17.4 Experience of Different Forms of Violence . 281 17.5 Violence during Pregnancy. 281 17.6 Marital Control by Husband or Partner. 283 17.7 Forms of Spousal Violence . 285 17.8 Violence by Spousal Characteristics and Women’s Indicators . 288 17.9 Frequency of Spousal Violence . 290 17.10 Onset of Spousal Violence . 291 17.11 Types of Injuries to Women Because of Spousal Violence . 292 17.12 Violence by Women against Their Spouse. 292 17.13 Help-Seeking Behaviour by Women Who Experience Violence . 295 CHAPTER 18 ORPHANS AND VULNERABLE CHILDREN Dorothy Simambo Kaemba 18.1 Orphaned and Vulnerable Children . 299 18.1.1 Children’s Living Arrangements and Orphanhood. 299 18.1.2 Orphaned and Vulnerable Children. 300 18.2 Social and Economic Situation of Orphaned and Vulnerable Children. 302 18.2.1 School Attendance. 302 18.2.2 Basic Material Needs . 303 18.2.3 Orphans Living with Siblings . 304 18.2.4 Nutritional Status . 305 Contents | ix 18.2.5 Sex before Age 15 . 306 18.3 Care and Support for OVCs. 307 18.3.1 Succession Planning. 307 18.3.2 External Support for Households with OVCs . 308 REFERENCES . 311 APPENDIX A SAMPLE IMPLEMENTATION. 315 APPENDIX B ESTIMATES OF SAMPLING ERRORS .321 APPENDIX C DATA QUALITY TABLES .337 APPENDIX D NUTRITIONAL STATUS OF CHILDREN: 2007 ZDHS DATA ACCORDING TO THE NCHS/CDC/WHO INTERNATIONAL REFERENCE POPULATION.343 APPENDIX E PERSONS INVOLVED IN THE 2007 ZAMBIA DEMOGRAPHIC AND HEALTH SURVEY.345 APPENDIX F QUESTIONNAIRES .351 Tables and Figures | xi TABLES AND FIGURES Page CHAPTER 1 INTRODUCTION Table 1.1 Demographic characteristics .2 Table 1.2 Results of the household and individual interviews.12 CHAPTER 2 HOUSEHOLD POPULATION AND HOUSING CHARACTERISTICS Table 2.1 Household population by age, sex, and residence.13 Table 2.2 Household composition.15 Table 2.3.1 Educational attainment of the female household population .16 Table 2.3.2 Educational attainment of the male household population .17 Table 2.4 School attendance ratios .19 Table 2.5 Grade repetition and dropout rates.21 Table 2.6 Household drinking water.23 Table 2.7 Knowledge and use of Clorin .24 Table 2.8 Household sanitation facilities.25 Table 2.9 Household characteristics .26 Table 2.10 Household possessions goods .28 Table 2.11 Wealth quintiles.30 Table 2.12 Birth registration of children under age five .31 Figure 2.1 Population Pyramid .14 Figure 2.2 Percent Distribution of Household Population with No Education by Sex .18 Figure 2.3 Net and Gross Attendance Ratios by Sex.20 Figure 2.4 Age-Specific Attendance Rates of the De Facto Population Age 5 to 24 by Sex.22 Figure 2.6 Trends in Percentage of Households Owning Specific Possessions, Zambia 1992-2007.29 CHAPTER 3 CHARACTERISTICS OF RESPONDENTS Table 3.1 Background characteristics of respondents .33 Table 3.2.1 Educational attainment: Women.35 Table 3.2.2 Educational attainment: Men .36 Table 3.3.1 Literacy: Women .37 Table 3.3.2 Literacy: Men .38 Table 3.4.1 Exposure to mass media: Women.39 Table 3.4.2 Exposure to mass media: Men .40 Table 3.5.1 Employment status: Women .41 Table 3.5.2 Employment status: Men.42 Table 3.6.1 Occupation: Women.44 Table 3.6.2 Occupation: Men .45 Table 3.7.1 Type of employment: Women.46 Table 3.7.2 Type of employment: Men .47 Table 3.8.1 Health insurance coverage: Women .48 Table 3.8.2 Health insurance coverage: Men.49 Table 3.9.1 Knowledge and attitudes concerning tuberculosis: Women.50 xii | Tables and Figures Table 3.9.2 Knowledge and attitudes concerning tuberculosis: Men .51 Table 3.10.1 Use of tobacco: Women.52 Table 3.10.2 Use of tobacco: Women.53 Table 3.10.3 Use of tobacco: Men .54 Figure 3.1 Men’s and Women’s Employment Status (Past 12 months).43 Figure 3.2 Type of Earnings among Women Employed in the Past 12 Months .46 CHAPTER 4 FERTILITY LEVELS, TRENDS, AND DIFFERENTIALS Table 4.1 Current fertility .56 Table 4.2 Fertility by background characteristics .57 Table 4.3 Trends in age-specific fertility rates.58 Table 4.4 Trends in age-specific and total fertility rates, various sources.59 Table 4.5 Children ever born and living.60 Table 4.6 Birth intervals.62 Table 4.7 Age at first birth .63 Table 4.8 Median age at first birth .63 Table 4.9 Teenage pregnancy and motherhood.64 Figure 4.1 Total Fertility Rates of Various Countries in Sub-Saharan Africa .56 Figure 4.2 Total Fertility Rate by Level of Education.58 Figure 4.3 Trends in Fertility, 1980-2007.59 Figure 4.4 Trends in Fertility Rates by Urban-Rural Residence .60 Figure 4.5 Percentage of Teenagers Who Have Begun Childbearing or Are Pregnant With Their First Child .65 CHAPTER 5 FAMILY PLANNING Table 5.1 Knowledge of contraceptive methods .68 Table 5.2 Knowledge of contraceptive methods by background characteristics .69 Table 5.3.1 Ever use of contraception: Women .70 Table 5.3.2 Ever use of contraception: Men .71 Table 5.4 Current use of contraception by age .73 Table 5.5 Current use of contraception by background characteristics .74 Table 5.6 Trends in the current use of family planning.75 Table 5.7 Use of social marketing brand pills and injectables .76 Table 5.8 Use of social marketing brand condoms: women .77 Table 5.9 Use of social marketing brand condoms: men.78 Table 5.10 Knowledge of fertile period.79 Table 5.11 Number of children at first use of contraception .80 Table 5.12 Timing of sterilization.80 Table 5.13 Source of modern contraception methods .81 Table 5.14 Cost of modern contraceptive methods.82 Table 5.15 Informed choice .83 Table 5.16 Future use of contraception .84 Table 5.17 Reason for not intending to use contraception in the future .84 Table 5.18 Preferred method of contraception for future use.85 Table 5.19 Exposure to family planning messages .86 Table 5.20 Exposure to specific radio and television programs.87 Table 5.21 Contact of nonusers with family planning providers .88 Table 5.22 Husband/partner's knowledge of women's use of contraception .89 Tables and Figures | xiii Figure 5.1 Trends in Contraceptive Use among Currently Married Women .75 CHAPTER 6 OTHER PROXIMATE DETERMINANTS OF FERTILITY Table 6.1 Current marital status .91 Table 6.2 Polygyny .93 Table 6.3 Age at first marriage .94 Table 6.4.1 Median age at first marriage: Women .95 Table 6.4.2 Median age at first marriage: Men.96 Table 6.5 Age at first sexual intercourse .97 Table 6.6.1 Median age at first intercourse: Women .98 Table 6.6.2 Median age at first intercourse: Men.98 Table 6.7.1 Recent sexual activity: Women .99 Table 6.7.2 Recent sexual activity: Men . 100 Table 6.8 Postpartum amenorrhoea, abstinence and insusceptibility. 101 Table 6.9 Median duration of amenorrhoea, postpartum abstinence and postpartum insusceptibility. 102 Table 6.10 Menopause. 102 CHAPTER 7 FERTILITY PREFERENCES Table 7.1 Fertility preferences by number of living children . 104 Table 7.2.1 Desire to limit childbearing: Women . 105 Table 7.2.2 Desire to limit childbearing: Men. 106 Table 7.3.1 Need and demand for family planning: Currently married women. 108 Table 7.3.2 Need and demand for family planning for all women and for women who are not currently married. 109 Table 7.4 Ideal number of children . 111 Table 7.5 Mean ideal number of children. 112 Table 7.6 Fertility planning status. 112 Table 7.7 Wanted fertility rates. 113 Figure 7.1 Percentage of Currently Married Women and Men Who Want No More Children, by Number of Living Children . 107 Figure 7.2 Unmet Need for Family Planning for Currently Married Women by Residence and Province. 107 CHAPTER 8 INFANT AND CHILD MORTALITY Table 8.1 Early childhood mortality rates . 116 Table 8.2 Trends in early childhood mortality rates. 117 Table 8.3 Early childhood mortality rates by socioeconomic characteristics. 117 Table 8.4 Early childhood mortality rates by demographic characteristics. 118 Table 8.5 Perinatal mortality. 120 Table 8.6 High-risk fertility behaviour . 121 Table 8.7 Early childhood mortality rates by women's status . 122 CHAPTER 9 MATERNAL HEALTH Table 9.1 Antenatal care. 124 Table 9.2 Number of antenatal care visits and timing of first visit . 125 Table 9.3 Components of antenatal care . 127 Table 9.4 Tetanus toxoid injections . 129 xiv | Tables and Figures Table 9.5 Place of delivery . 130 Table 9.6 Assistance during delivery . 132 Table 9.7 Delivery characteristics . 133 Table 9.8 Timing of first postnatal check-up . 134 Table 9.9 Type of provider of first postnatal check-up . 135 Table 9.10 Problems in accessing health care . 137 CHAPTER 10 CHILD HEALTH Table 10.1 Children's weight and size at birth. 140 Table 10.2 Vaccinations by source of information. 141 Table 10.3 Vaccinations by background characteristics . 142 Table 10.4 Vaccinations in first year of life. 143 Table 10.5 Prevalence and treatment of symptoms of ARI . 146 Table 10.6 Prevalence and treatment of fever. 147 Table 10.7 Availability at home of antimalarial drugs taken by children . 148 Table 10.8 Prevalence of diarrhoea . 149 Table 10.9 Diarrhoea treatment . 150 Table 10.10 Feeding practices during diarrhoea . 151 Table 10.11 Knowledge of ORS packets or pre-packaged liquids. 152 Table 10.12 Disposal of children's stools. 153 Figure 10.1 Trends in Vaccination Coverage Among Children Age 12-23 Months . 144 CHAPTER 11 NUTRITION OF CHILDREN AND ADULTS Table 11.1 Nutritional status of children . 158 Table 11.2 Initial breastfeeding. 161 Table 11.3 Breastfeeding status by age . 162 Table 11.4 Median duration and frequency of breastfeeding . 164 Table 11.5 Foods and liquids consumed by children in the day and night preceding the interview . 165 Table 11.6 Infant and young child feeding (IYCF) practices . 168 Table 11.7 Micronutrient intake among children . 170 Table 11.8 Nutritional status of women . 172 Table 11.9 Foods consumed by mothers in the day and night preceding the interview. 174 Table 11.10 Micronutrient intake among mothers . 176 Figure 11.1 Nutritional Status of Children by Age . 159 Figure 11.2 Trends in Nutritional Status of children under Five Years. 159 Figure 11.3 Infant Feeding Practices by Age. 163 Figure 11.4 Infant and Young Child Feeding (IYCF) Practices . 169 Figure 11.5 Trends in Nutritional Status among Women Age 15-49. 173 CHAPTER 12 MALARIA Table 12.1 Ownership of mosquito nets . 178 Table 12.2 Use of mosquito nets by children. 180 Table 12.3 Use of mosquito nets by pregnant women . 182 Table 12.4 Prophylactic use of antimalarial drugs and use of Intermittent Preventive Treatment (IPT) by women during pregnancy. 183 Table 12.5 Prevalence and prompt treatment of fever . 185 Tables and Figures | xv Table 12.6 Type and timing of antimalarial drugs. 187 Table 12.7 Availability at home of anti-malarial drugs taken by children with fever. 187 Table 12.8 Dwelling sprayed against mosquitoes in the past 12 months. 188 Figure 12.1 Trends in Ownership of Bednets by Type, Zambia 2001-2002 and 2007 . 179 Figure 12.2 Trends in Percentage of Children Under Five Who Slept Under a Bednet on the Night before the Survey by Type of Net, Zambia 2001-2002 and 2007. 181 Figure 12.3 Trends in Use of Bednets among Women Age 15-49 by Type of Bednet, Zambia 2001-2002 and 2007. 182 Figure 12.4 Trends in Percentage of Women Who Took Antimalarial Drugs as Preventive Treatment During Pregnancy, Zambia 2001-2002 and 2007. 184 Figure 12.5 Trends in Prevalence and Treatment of Fever in Children Under Five Who Had Fever in the Two Weeks Preceding the Survey, Zambia 2001-2002 and 2007. 186 CHAPTER 13 HIV AND AIDS-RELATED KNOWLEDGE, ATTITUDES, AND BEHAVIOUR Table 13.1 Knowledge of AIDS. 190 Table 13.2 Knowledge of HIV prevention methods. 191 Table 13.3.1 Comprehensive knowledge about HIV and AIDS: women . 193 Table 13.3.2 Comprehensive knowledge about HIV and AIDS: men . 194 Table 13.4 Knowledge of prevention of mother-to-child transmission of HIV. 195 Table 13.5.1 Accepting attitudes towards people living with HIV/AIDS: Women . 196 Table 13.5.2 Accepting attitudes towards those living with HIV/AIDS: Men . 197 Table 13.6 Attitudes towards negotiating safer sexual relations with husband. 199 Table 13.7 Adult support of education about condom use to prevent HIV infection . 200 Table 13.8.1 Multiple sexual partners and higher-risk sexual intercourse in the past 12 months: Men. 202 Table 13.8.2 Multiple sexual partners and higher-risk sexual intercourse in the past 12 months: Men. 202 Table 13.9 Payment for sexual intercourse and condom use at last paid sexual intercourse among men . 204 Table 13.10.1 Coverage of prior HIV testing: women . 205 Table 13.10.2 Coverage of prior HIV testing: men. 206 Table 13.11 Pregnant women counselled and tested for HIV. 207 Table 13.12 Male circumcision. 208 Table 13.13 Self-reported prevalence of sexually transmitted infections (STIs) and STIs symptoms . 209 Table 13.14 Prevalence of medical injections . 210 Table 13.15 Comprehensive knowledge about HIV/AIDS and of a source of condoms among youth . 213 Table 13.16 Age at first sexual intercourse among youth. 214 Table 13.17 Condom use at first sexual intercourse among youth. 216 Table 13.18 Premarital sexual intercourse and condom use during premarital sexual intercourse among youth. 217 Table 13.19.1 Higher-risk sexual intercourse among youth and condom use at last higher-risk intercourse in the past 12 months: women . 219 Table 13.19.2 Higher-risk sexual intercourse among youth and condom use at last higher-risk intercourse in the past 12 months: men . 220 xvi | Tables and Figures Table 13.20 Age-mixing in sexual relationships among women age 15-19 . 221 Table 13.21 Drunkenness during sexual intercourse among youth. 222 Table 13.22 Recent HIV tests among youth . 223 Figure 13.1 Source of Most Recent Medical Injection . 211 Figure 13.2 Perceptions and Beliefs about Abstinence and Faithfulness . 212 Figure 13.3 Trends in Age at First Sexual Intercourse . 215 CHAPTER 14 PREVALENCE OF HIV AND SYPHILIS Table 14.1 Coverage of HIV testing by residence and province. 226 Table 14.2 Coverage of HIV testing by selected background characteristics . 227 Table 14.3 HIV prevalence by age, sex, and urban-rural residence . 228 Table 14.4 Trends in HIV prevalence by age . 229 Table 14.5 HIV prevalence by socio-economic characteristics . 231 Table 14.6 HIV prevalence by demographic characteristics . 232 Table 14.7 HIV prevalence by sexual behaviour . 234 Table 14.8 HIV prevalence among young people by background characteristics . 235 Table 14.9 HIV prevalence among young people by sexual behaviour. 237 Table 14.10 HIV prevalence by other characteristics. 238 Table 14.11 Prior HIV testing by current HIV status . 239 Table 14.12 HIV prevalence by male circumcision status. 240 Table 14.13 HIV prevalence among cohabitating partners . 241 Table 14.14 HIV prevalence among women who recently gave birth. 242 Table 14.15 Coverage of syphilis testing by residence. 243 Table 14.16 Coverage of syphilis testing by province . 244 Table 14.17 Syphilis testing by age . 245 Table 14.18 Syphilis prevalence by background characteristic . 245 Table 14.19 Syphilis prevalence by age, sex, and urban-rural residence. 246 Table 14.20 Syphilis prevalence by reproductive and sexual activity characteristics . 247 Table 14.21 Syphilis prevention and STI treatment experience . 248 Figure 14.1 HIV Prevalence by Sex and Age . 229 Figure 14.2 HIV Prevalence by Sex and Age ZDHS 2001-2002 and 2007 . 230 CHAPTER 15 ADULT AND MATERNAL MORTALITY Table 15.1 Completeness of reporting on siblings . 250 Table 15.2 Adult mortality rates and trends . 251 Table 15.3 Trends in adult mortality rates. 252 Table 15.4 Direct estimates of maternal mortality . 253 Figure 15.1 Age-Specific Mortality Rates by Sex . 251 CHAPTER 16 WOMEN’S EMPOWERMENT AND HEALTH OUTCOMES Table 16.1 Employment and cash earnings of currently married women. 256 Table 16.2.1 Control over women's cash earnings and relative magnitude of women's earnings: Women. 257 Table 16.2.2 Control over men's cash earnings . 258 Table 16.3 Women's control over their own earnings and over those of their husband. 259 Table 16.4.1 Women’s participation in decision-making according to women. 260 Tables and Figures | xvii Table 16.4.2 Women’s participation in decision-making according to men. 260 Table 16.5.1 Women’s participation in decision-making by background characteristics . 261 Table 16.5.2 Men’s attitudes towards wives’ participation in decision-making . 262 Table 16.6.1 Attitudes towards wife beating: Women. 264 Table 16.6.2 Attitudes towards wife beating: Men . 265 Table 16.7.1 Attitudes towards refusing sexual intercourse with husband: Women. 267 Table 16.7.2 Attitude towards refusing sexual intercourse with husband: Men. 268 Table 16.7.3 Men's attitudes towards a husband's rights when his wife refuses to have sexual intercourse. 269 Table 16.8 Indicators of women’s empowerment . 270 Table 16.9 Current use of contraception by women's status. 271 Table 16.10 Women's empowerment and ideal number of children and unmet need for family planning . 272 Table 16.11 Reproductive health care by women's empowerment . 273 CHAPTER 17 DOMESTIC VIOLENCE Table 17.1 Experience of physical violence. 277 Table 17.2 Persons committing physical violence . 278 Table 17.3 Experience of sexual violence . 279 Table 17.4 Age at first experience of sexual violence . 280 Table 17.5 Persons committing sexual violence . 280 Table 17.6 Experience of different forms of violence . 281 Table 17.7 Violence during pregnancy . 282 Table 17.8 Degree of marital control exercised by husbands . 284 Table 17.9 Forms of spousal violence . 285 Table 17.10 Spousal violence by background characteristics. 287 Table 17.11 Spousal violence by husband's characteristics and empowerment indicators. 289 Table 17.12 Frequency of spousal violence among those who report violence. 290 Table 17.13 Onset of marital violence . 291 Table 17.14 Injuries to women due to spousal violence. 292 Table 17.15 Violence by women against their spouse. 293 Table 17.16 Help seeking to stop violence . 296 Table 17.17 Sources from where help was sought . 297 Figure 17.1 Forms of Spousal Violence . 286 CHAPTER 18 ORPHANS AND VULNERABLE CHILDREN Table 18.1 Children's living arrangements and orphanhood. 300 Table 18.2 Orphans and vulnerable children (OVC) . 301 Table 18.3 School attendance by survivorship of parents and by OVC status . 303 Table 18.4 Possession of basic material needs by orphans and vulnerable children. 304 Table 18.5 Orphans not living with siblings. 305 Table 18.6 Underweight orphans and vulnerable children. 306 Table 18.7 Sexual intercourse before age 15 of orphans and vulnerable children . 307 Table 18.8 Succession planning. 308 Table 18.9 External support for very sick persons. 309 Table 18.10 External support for orphans and vulnerable children. 310 xviii | Tables and Figures APPENDIX A SAMPLE IMPLEMENTATION Table A.1 Sample implementation: Women . 315 Table A.2 Sample implementation: Men. 316 Table A.3 Coverage of HIV testing by social and demographic characteristics: Women . 317 Table A.4 Coverage of HIV testing by social and demographic characteristics: Men. 318 Table A.5 Coverage of HIV testing by sexual behavior characteristics: Women . 319 Table A.6 Coverage of HIV testing by sexual behavior characteristics: Men. 320 APPENDIX B ESTIMATES OF SAMPLING ERRORS Table B.1 List of selected variables for sampling errors . 323 Table B.2 Sampling errors for national sample . 324 Table B.3 Sampling errors for urban sample. 325 Table B,4 Sampling errors for rural sample. 326 Table B.5 Sampling errors for Central sample. 327 Table B.6 Sampling errors for Copperbelt sample . 328 Table B.7 Sampling errors for Eastern sample. 329 Table B.8 Sampling errors for Luapula sample. 330 Table B.9 Sampling errors for Lusaka sample . 331 Table B.10 Sampling errors for Northern sample. 332 Table B.11 Sampling errors for North-Western sample. 333 Table B.12 Sampling errors for Southern sample. 334 Table B.13 Sampling errors for Western sample . 335 APPENDIX C DATA QUALITY TABLES Table C.1 Household age distribution . 337 Table C.2.1 Age distribution of eligible and interviewed women . 338 Table C.2.2 Age distribution of eligible and interviewed men. 338 Table C.3 Completeness of reporting . 339 Table C.4 Births by calendar years . 339 Table C.5 Reporting of age at death in days . 340 Table C.6 Reporting of age at death in months. 341 APPENDIX D NUTRITIONAL STATUS OF CHILDREN: 2007 ZDHS DATA ACCORDING TO THE NCHS/CDC/WHO INTERNATIONAL REFERENCE POPULATION Table D.1 Nutritional status of children . 343 Preface | xix PREFACE The 2007 Zambia Demographic and Health Survey (ZDHS) is a national sample survey designed to provide up-to-date information on background characteristics of the respondents, fertility levels, nuptiality, sexual activity, fertility preferences, awareness and use of family planning methods; breastfeeding practices; nutritional status of mothers and young children; early childhood mortality and maternal mortality; maternal and child health; and awareness, behaviour, and prevalence regarding HIV/AIDS and other sexually transmitted infections. The target groups were men age 15-59 and women age 15-49 in randomly selected households across Zambia. Information about children age 0-5 was also collected, including weight and height. The survey collected blood samples for syphilis and HIV testing in order to determine national prevalence rates. While significantly expanded, the 2007 ZDHS is a follow-up to the 1992, 1996, and 2001- 2002 ZDHS surveys and provides updated estimates of basic demographic and health indicators covered in the earlier surveys. The 2007 ZDHS is the second DHS that includes the collection of information on violence against women, and syphilis and HIV testing. In addition, data on malaria prevention and treatment were collected. The ZDHS was implemented by the Central Statistical Office (CSO) in partnership with the Ministry of Health, the Tropical Disease Research Centre (TDRC), and the Demography Division at the University of Zambia (UNZA) from April to October 2007. The TDRC provided technical support in the implementation of the syphilis and HIV testing. Macro International provided technical assistance as well as funding to the project through MEASURE DHS, a USAID-funded project providing support and technical assistance in the implementation of population and health surveys in countries worldwide. Funding for the ZDHS was provided by the Ministry of Health, the Ministry of Finance and National Planning, the United States Agency for International Development (USAID), the Centers for Disease Control and Prevention (CDC), the Malaria Control and Evaluation Partnership in Africa (MACEPA), the European Union (EU), the World Bank through the Zambia National Response to HIV/AIDS (ZANARA) project, the United Nations Population Fund (UNFPA), the United Nations Development Programme (UNDP), the Joint United Nations Programmes on HIV/AIDS (UNAIDS), the United Nations Children’s Fund (UNICEF), the Japan International Cooperation Agency (JICA), the Swedish International Development Assistance (SIDA), the United Kingdom Department for International Development (DFID), the World Health Organization (WHO), and Development Cooperation Ireland (DCI). Key people in the implementation of the 2007 ZDHS were Dr Simon Miti, Permanent Secretary, Ministry of Health; Mr Davies Chifwembe, Director Policy and Planning; Mr William Mayaka, Deputy Director, Social Statistics Central Statistical Office; Dr Christopher Simoonga, Deputy Director of Policy and Planning, Ministry of Health; Ms Nchimunya Nkombo, Survey Coordinator from Central Statistical Office; and Mr Chipalo Kaliki, Survey Coordinator from Ministry of Health. Also instrumental to the implementation of the survey were Ms Chanda Mulenga, TDRC; Ms Margaret Tembo-Mwanamwenge from Central Statistical Office; Jacob RS Malungo, UNZA; and Ms Adrienne Cox, Project Manager from Macro International. xx | Preface Special gratitude goes to the Field Monitors, Supervisors, Editors, Interviewers, Laboratory Technicians, Regional Statisticians, Provincial Directors of Health, and Drivers for their hard work. Gratitude also goes to the respondents for their patience and generosity in providing the required information and the blood samples. Without their cooperation, this survey would not have been a success. Ms Efreda Chulu Director – Central Statistical Office Summary of Findings | xxi SUMMARY OF FINDINGS The 2007 Zambia Demographic Health Sur- vey (ZDHS) is a nationally representative survey of 7,146 women age 15-49 and 6,500 men age 15-59. The 2007 ZDHS is the fourth comprehen- sive survey conducted in Zambia as part of the Demographic and Health Surveys (DHS) pro- gramme. The data are intended to furnish pro- gramme managers and policymakers with de- tailed information on levels and trends in fertil- ity; nuptiality; sexual activity; fertility prefer- ences; awareness and use of family planning methods; infants and young children feeding practices; nutritional status of mothers and young children; early childhood mortality and maternal mortality; maternal and child health; and aware- ness and behaviour regarding HIV/AIDS and other sexually transmitted infections. Addition- ally, the 2007 ZDHS collected information on malaria prevention and treatment, domestic vio- lence, and HIV and syphilis prevalence among women age 15-49 and men age 15-59. The 2007 ZDHS is the second survey in Zambia to provide population-based prevalence estimates for HIV. FERTILITY The survey results show fertility in Zambia has remained at a high level over the last 15 years from 6.5 births per woman in 1992 to 6.2 births in 2007. On average, rural women are hav- ing three children more than urban women (7.5 and 4.3 children, respectively). The low level of fertility among urban women is also reflected in the lower fertility among women in the urban provinces of Lusaka and Copperbelt, where women on average are having 4.1 and 4.8 chil- dren, respectively, compared with 6.2 or more children in other provinces. Fertility differentials by education and wealth are noticeable. Women who have no formal education and women in the lowest wealth quintile on average are having more than 8 children, while women with higher than a secondary education and women in the highest wealth quintile are having less than 4 children. Unplanned pregnancies are common in Zambia. Overall, 16 percent of births are un- wanted, while 26 percent are mistimed (wanted later). If all unwanted births were prevented, women would have an average of 5.2 children, compared with the actual average of 6.2 children. Marriage patterns are an important determi- nant of fertility levels in a population. The me- dian age at first marriage in Zambia among women age 25-49 is 18.2 years. Urban women marry one year later than rural women (19.1 and 17.8 years old, respectively). The median age at first marriage varies greatly by the woman’s edu- cational status. The median age at marriage for women age 25-49 with no education is 17.3 years compared with 24.4 years for women with more than secondary education. Men enter into first union at a much later age than women; the me- dian age at first marriage for men age 25-59 is 23.5 years. The average man and woman in Zambia ini- tiate sexual activity before marriage. Among the population age 25-49, the median age at first sexual intercourse is 17.9 years for men and 17.2 years for women. Teenage pregnancy is high in Zambia. About three in ten young women age 15-19 have begun childbearing, that is, they have given birth al- ready or are currently pregnant with their first child. The 2007 ZDHS shows that 14 percent of currently married women are married to men who are in a polygynous union. Older women, women who live in rural areas, women with less education, and women in the lowest wealth quin- tiles are more likely than other women to have co-wives. The prevalence of polygyny varies markedly across provinces, with Lusaka having the lowest level (4 percent), while Southern hav- ing the highest (25 percent). FAMILY PLANNING Overall, knowledge of family planning in Zambia has been nearly universal since 1996. In the 2007 ZDHS, 97 percent of all women and 99 percent of all men know about a contraceptive method. The pill, male condoms, and injectables are the most widely known methods. xxii � Summary of Findings Seventy-seven percent of currently married women have used a family planning method at least once in their lifetime. About four in ten of currently married women are using any contra- ceptive method, and about three in ten report us- ing a modern method. The most commonly used method among currently married women is the pill (11 percent), followed by injectables (9 per- cent) and the male condom (5 percent). The current use of contraception in Zambia has increased from a rate of 15 percent in 1992, 26 percent in 1996 and 34 percent in 2001-2002 to the rate of 41 percent in 2007. There has also been a corresponding increase in the use of mod- ern methods from 9 percent in 1992, 14 percent in 1996 and 23 percent in 2001-2002 to 33 per- cent in 2007. Government-sponsored facilities remain the chief providers of contraceptive methods in Zambia. The distribution of sources of modern method supplies for current users shows that the majority of users (68 percent) obtain their con- traceptives from the public sector. The participa- tion of the private medical sector in family plan- ning service delivery has decreased steadily dur- ing the last 15 years from 36 percent in 1992 to 17 percent in 2007. Ten percent of current users obtain their methods from retail outlets. Overall, 27 percent of currently married women have an unmet need for family plan- ning—17 percent for spacing, and 9 percent for limiting. Unmet need for family planning has remained the same since 1996. If all married women with an unmet need for family planning were to use a contraceptive method, the contra- ceptive prevalence rate for any method in Zam- bia would increase from 41 to 67 percent. CHILD HEALTH Data from the 2007 ZDHS indicate that the infant mortality rate is 70 deaths per 1,000 live births, while the under-five mortality rate is 119 per 1,000 live births for the five-year period im- mediately preceding the survey. The neonatal mortality rate is 34 per 1,000 births. Thus, almost two-thirds of childhood deaths occurred during infancy, with more than one-quarter taking place during the first month of life. Child mortality is consistently lower in urban areas than in rural areas; however, the differ- ences are not great. There is also variation in the mortality level across provinces. Infant mortality rate is highest in Luapula, Western and Northern provinces, while under-five mortality rate is highest in Northern and Luapula provinces. In Zambia, children are considered fully vac- cinated when they receive one dose of BCG vac- cine, three doses of DPT or the combination DPT-HepB-Hib vaccine, three doses of polio vaccine, and one dose of measles vaccine. Over- all, 68 percent of children 12-23 months have received all vaccinations at the time of the sur- vey. Ninety-two percent of children have re- ceived the BCG vaccination, and 85 percent have vaccinated against measles. The coverage of the first dose of DPT or DPT-HepB-Hib vaccine and polio is relatively high (92 and 94 percent, re- spectively). However, only 80 percent of chil- dren have received the third dose of DPT or DPT-HepB-Hib vaccine, and 77 percent have received the third dose of polio vaccine. A com- parison of the 2007 ZDHS results with those of the earlier surveys shows there has been a de- cline in the overall vaccination coverage in Zam- bia from 78 percent in 1996 to 70 percent in 2001-2002 to the current rate of 68 percent. Five percent of children under age five showed symptoms of acute respiratory infection (ARI) within the two weeks before the survey. Treatment from a health facility or provider was sought for about two-thirds of children (68 per- cent). About half of children (47 percent) re- ceived antibiotics. Eighteen percent of children under five were reported to have had fever, a major manifestation of malaria, within the two weeks prior to the sur- vey. Almost two-thirds of children (63 percent) were taken to a health facility or provider for treatment. About four in ten children with fever (38 percent) received antimalarial drugs and more than one-quarter (27 percent) received an- tibiotics. At the time of the survey, 16 percent of chil- dren under age five had diarrhoea at some time within the two weeks before the survey. Six in ten children with diarrhoea were taken to a health provider. The majority (74 percent) of children were treated with some type of oral rehydration therapy (ORT) or increased fluids: 60 percent were treated with solution prepared from an oral rehydration salt (ORS) packet; 10 percent were given recommended home fluids (RHF) prepared at home; and 34 percent were given increased fluids. Sixteen percent of children with diarrhoea did not receive any type of treatment at all. Summary of Findings | xxiii MATERNAL HEALTH In Zambia almost all women who had a live birth in the five years preceding the survey re- ceived antenatal care from a health professional (94 percent); 2 percent from a doctor, 5 percent from a clinical officer, and 87 percent from a trained nurse or midwife. Only 2 percent of mothers did not receive any antenatal care. Tetanus toxoid injections are given during pregnancy to prevent neonatal tetanus. Overall, eight in ten (81 percent) of women’s last births in Zambia were protected against neonatal tetanus. Less than half of births in the five years be- fore the survey were delivered in a health facility (48 percent). Forty-three percent of births oc- curred in public health facilities and 5 percent occurred in private health facilities. More than half (52 percent) of births occurred at home. Three percent of births were assisted by a doctor, 1 percent by and clinical officer, 42 percent by a trained nurse or midwife, and 23 percent by a traditional birth attendant. A quarter of births were assisted by a relative and 5 percent of births had no assistance at all. Three percent of births were delivered by a Caesarean section. Overall, 48 percent of mothers received a postnatal check-up for the most recent birth in the five years preceding the survey, with 39 per- cent having the check-up within the critical 48 hours after delivery. Results from the 2007 ZDHS show that the estimated maternal mortality ratio during the seven-year period prior to the survey is 591 ma- ternal deaths per 100,000 live births. Ninety-eight percent of Zambian children under age five were breastfed at some point in their life. The median breastfeeding duration in Zambia is long (20.3 months). On the other hand, the median duration for exclusive breastfeeding is only 3.1 months. A large majority of babies (61 percent) are exclusively breastfed throughout the first six months of life. More than nine in ten (93 percent) children age 6-9 months receive complementary foods, and more than half (55 percent) of children age 18-23 months have been weaned. Bottle feeding is not very common; only 3 percent of babies less than six months of age are fed with a bottle with a nipple, and the pro- portion bottle-fed peaks at 5 percent among chil- dren 4-5 months. Overall, 45 percent of children are stunted (short for their age) at the time of the survey, 5 percent are wasted (thin for their height), and 15 percent are underweight. The indices indicate that malnutrition increases with a child’s age, with prevalence peaking in the 18-23 months age range for the stunting and underweight indices, and declining as children approach their second birthday. Stunting affects more than six in ten children 18-23 months, and one-third of children in that age range are severely stunted. Eighteen percent of children 18-23 months are under- weight. The highest rate of wasting is found in the 9-11 month age group (12 percent). Overall, 71 percent of women have a body mass index (BMI) in the normal range. Nineteen percent of women are overweight or obese, with 5 percent classified as obese. At the other ex- treme, 10 percent are thin, while 3 percent are severely thin. MALARIA Sixty-four percent of all households inter- viewed during the survey had at least one mos- quito net, while 31 percent had more than one. Sixty-two percent of households had at least one net that had ever been treated with an insecticide. Half of households (53 percent) had at least one insecticide-treated net (ITN). There is an average of one ITN per household. Bednet usage is moderate among young chil- dren and pregnant women, groups which are par- ticularly vulnerable to malaria’s effect. Overall, a third of children under five slept under a mos- quito net the night before the survey. Thirty-three percent of children slept under an ever-treated net and 29 percent slept under an ITN. Among pregnant women, 39 percent slept under any mosquito net the night before the interview. Thirty-seven percent slept under an ever-treated net and 33 percent slept under an ITN. Sixteen percent of households reported that the interior walls of their dwelling had been sprayed within the last 12 months, principally as part of the Ministry of Health programme (61 percent). Fifteen percent of households were sprayed by local councils, 10 percent were sprayed by a household member, and 8 percent were sprayed by a mining company. BREASTFEEDING AND NUTRITION xxiv � Summary of Findings Among women who had their last birth in the two years before the survey, the majority (87 percent) took an antimalarial drug during their pregnancy. Eighty-seven percent of all pregnant women took at least one dose of SP/Fansidar., while 66 percent reported taking two or more doses of SP/Fansidar. Almost all of the women who took SP/Fansidar were given the drug dur- ing an antenatal care visit, and are thus consid- ered to have had preventive intermittent treat- ment (IPT). HIV/AIDS AND SYPHILIS Knowledge of HIV and AIDS is universal in Zambia. Almost all (99 percent) of women and men age 15-49 have heard of HIV or AIDS. However, only 36 percent of women and 39 per- cent of men have what can be considered com- prehensive knowledge about the modes of HIV transmission and prevention. Comprehensive knowledge means knowing that used of condoms and having just one uninfected, faithful partner can reduce the chance of getting HIV, knowing that a healthy-looking person can have HIV, and rejecting the two most common local misconcep- tions about HIV transmission or prevention, that HIV and AIDS can be transmitted through su- pernatural means or through mosquito bites. Eighty-five percent of women and 75 percent of men age 15-49 know that HIV can be trans- mitted through breastfeeding. Sixty-eight percent of women and 56 percent of men know that the risk of mother-to-child transmission (MTCT) can be reduced by a mother taking special drugs dur- ing pregnancy. Given that most HIV infections in Zambia are contracted through heterosexual contact, infor- mation on the level of higher-risk sex (i.e., sexual intercourse with a partner who is neither a spouse nor a cohabitating partner and/or sex with two or more partners in the past 12 months) is important for planning prevention programmes. The 2007 results indicate that 1 percent of women and 14 percent of men have had two or more partners during the 12 months preceding the survey, and 13 percent of women and 28 percent of men have had higher-risk sexual INTERCOURSE. Among the respondents who engaged in higher-risk sexual intercourse, only 37 percent of women and 50 percent of men reported that they used a condom at the last high-risk sexual intercourse. Among the adult population age 15-49, 39 percent of women and 22 percent of men have been tested for HIV at some point in time. Nine- teen percent of women and 12 of men received the results from their last HIV test that was taken within the last 12 months. Results from the HIV testing component in the 2007 ZDHS indicate that 14 percent of Zam- bian adults age 15-49 are HIV positive. Among women, the HIV rate is 16 percent compared to 12 percent among men. For adult women, the HIV prevalence peaks at 26 percent in the 30-34 age group, which is four times the rate among women 15-19 and around twice the rate observed among women age 45-49. Among men, the HIV prevalence increases from 4 percent in the 15-19 age group to 24 percent in the 40-44 years age range, and then decreases to 12 percent in the 55- 59 age group. HIV prevalence in urban areas is twice that of rural areas (20 percent versus 10 percent, respectively). The differentials by prov- ince range from the highest prevalence rate in Lusaka (21 percent) to the lowest prevalence in North-Western and Northern (7 percent for both). More than 2,000 cohabiting couples were tested for HIV in the 2007 ZDHS. Results indi- cate that among 81 percent of cohabiting cou- ples, both partners tested negative for HIV. Both partners were HIV positive among 8 percent of cohabiting couples. Overall, 11 percent of cohab- iting partners were discordant, that is, one partner was infected and the other was not. In 7 percent of couples, the male partner was infected and the woman was not, while in another 5 percent of couples, the woman was infected and the man was not. Results from the syphilis testing component in the 2007 ZDHS indicate that 4 percent of Zambia adults age 15-49 tested positive for syphilis. Among women, the syphilis rate was 4 percent compared with 5 percent among men. For women, syphilis prevalence peaks at 7 per- cent among those in the 30-34 age group, while for men it peaks at 10 percent among those in the 40-44 age group. There is no variation in syphilis rates by urban and rural residence. DOMESTIC VIOLENCE One eligible woman in each household was asked questions on domestic violence. In Zam- bia, domestic violence occurs across all socio- economic and cultural backgrounds. Almost half (47 percent) of all women have experienced physical violence since they were 15 and one- third of women experienced physical violence in Summary of Findings | xxv the 12 months preceding the survey. Among women who experienced violence since age 15, a total of 60 percent reported that their current husband or partner was the perpetrator and 17 percent reported that the perpetrator was a former husband or partner. Seven percent of all women who have experienced physical violence since 15 reported that the perpetrator was their sister or brother, while 6 percent reported the perpetrator was their father or step-father. Overall, one in five women reported that they have experienced sexual violence at some point in their lives. Thirty-five percent of women reported that their first experience with sexual intercourse occurred when they were age 19 or younger. The majority (64 percent) of women reported that their current or former husband, partner, or boyfriend committed the act of sexual violence. It is important to highlight that among women who were younger than 15 years old when their first experience of sexual violence occurred, 19 percent reported that the perpetra- tors were a relative, 6 percent reported that the person was a family friend, and 10 percent re- ported that the person was their own friend. Forty-six percent of Zambian women who ever experienced physical or sexual violence have ever sought help from any source. Only 6 percent of abused women who never sought help told someone about the violence, and 41 percent never sought help and never told anyone. ORPHANS AND VULNERABLE CHILDREN Four in ten Zambian children under age 18 in the households sampled for the 2007 ZDHS are not living with both parents. One in five children are not living with either parent. Fifteen percent of children under age 18 are orphaned, that is, one or both parents are dead. Earlier ZDHS surveys obtained information on orphanhood only for children under age 15. A comparison of the results from the 2001-2002 and 2007 surveys for this age group indicates that there has been a slight decrease in orphan- hood. The proportion of children orphaned has decreased from 15 to 13 percent between the two surveys. However, the proportion of children who are not living with either parent remains the same (17 percent). Overall, 6 percent of children under age 18 was considered as vulnerable, i.e., they live in a household in which at least one adult had been chronically ill during the year before the survey or they have at least a parent living in the house- hold or elsewhere who had suffered from a chronic illness. Overall, about one in five chil- dren (19 percent) under age 18 are considered orphans and/or vulnerable Millennium Development Goal Indicators | xxvii MILLENNIUM DEVELOPMENT GOAL INDICATORS Value Goal Indicator Female Male Total Eradicate extreme poverty and hunger 4-Prevalence of underweight children under five years of age1 12.6 16.7 14.6 Achieve universal primary education 6-Net attendance ratio in primary school2 80.1 80.0 80.0 7-Percentage of pupils starting grade 1 who reach grade 53 93.5 92.1 92.8 8-Literacy rate of 15-24 year-olds4 67.6 82.5 74.4 Promote gender equality and empower women 9-Ratio of girls to boys in primary, secondary and tertiary education na na 91.8 10-Ratio of literate women to men, 15-24 years old na na 81.9 11-Share of women in wage employment in the non-agricultural sector5 na na 43.8 Reduce child mortality Under-five mortality rate (per 1,000 live births) Infant mortality rate (per 1,000 live births) 15-Percentage of 1 year-old children immunized against measles 84.9 84.9 84.9 Improve maternal health 16-Maternal mortality ratio ( 0 - 6 year period before survey) na na 591.2 17-Percentage of births attended by skilled health personnel6 45.8 47.1 46.5 Combat HIV/AIDS, malaria and other diseases 19-Percentage of current users of contraception who are using condoms (any contraceptive method, currently married women and men age 15-49) 11.9 32.4 20.9 19A-Condom use at last high-risk sex7 38.0 47.6 44.0 19B-Percentage of population 15-24 years with comprehensive correct knowledge of HIV/AIDS8 34.0 36.9 34.9 19C-Contraceptive prevalence rate (any contraceptive method, currently married women and men age 15-49) 40.8 38.8 39.9 20-Ratio of school attendance of orphans to school attendance of non- orphans aged 10-14 years 97.2 89.8 93.4 22-Percentage of population in malaria-risk areas using effective malaria prevention and treatment measures na na 56.2 22A-Percentage of children under five sleeping under ITN 27.6 29.5 28.5 22B-Percentage of children under five with fever who are appropriately treated9 39.2 37.6 38.4 Urban Rural Total Ensure environmental sustainability 29-Percentage of population using solid fuels ( de jure population )10 58.7 98.2 84.1 30-Percentage of population with sustainable access to an improved water source ( de jure population )11 82.2 19.6 41.9 31-Percentage of population with access to improved sanitation (de jure population )12 43.7 12.9 23.9 na=Not applicable 1 Proportion of children age 0-59 months who are below -2 standard deviations (SD) from the median of the WHO child Growth Standards in weight- for-age 2 2007 ZDHS data are based on reported attendance, not enrolment. 3The cohort of people enrolled in grade 1 who are expected to reach grade 5. 4 Refers to respondents who attended secondary school or higher or who can read a whole sentence 5 Wage employment includes respondents who received wages in cash or in cash and kind. 6 Among births in the past 5 years 7 High-risk refers to sexual intercourse with a partner who neither was a spouse nor who lived with the respondent; time frame is 12 months preceding the survey. 8 A person is considered to have a comprehensive knowledge about HIV/AIDS when they say that use of condoms for every sexual intercourse and having just one uninfected and faithful partner can reduce the chance of getting HIV, that a healthy-looking person can have HIV, and when they reject the two most common misconceptions that HIV can be transmitted through mosquito bites and that a person can become infected with HIV by eating from the same plate as someone who has HIV. 9 Malaria treatment is measured as the percentage of children ages 0-59 months who were ill with a fever in the two weeks preceding the interview who received an antimalarial drug. 10 Includes coal/lignite, charcoal, wood/straw/shrubs, agricultural crops, and animal dung 11 Proportion whose main source of drinking water is a household connection (piped), public standpipe, borehole, protected dug well or spring, or rainwater collection. 12 Improved sanitation technologies are: flush toilet, ventilated improved pit latrine, traditional pit latrine with a slab, or composting toilet. xxviii | Map of Zambia Introduction | 1 INTRODUCTION 1 Nchimunya Nkombo, Chanda Mulenga and Webster Kasongo 1.1 HISTORY, GEOGRAPHY, AND ECONOMY 1.1.1 History Historical and archaeological evidence indicates that by the year 1500, much of modern Zambia was occupied by Bantu-speaking horticulturalists, ancestors of the present inhabitants. In the late nineteenth century, the British South Africa Company administered various parts of what was to become Northern Rhodesia. In 1924, the British Colonial Office assumed responsibility for adminis- tering the territory. In 1953, Northern Rhodesia (Zambia) and Southern Rhodesia (Zimbabwe) joined Nyasaland (Malawi) to form the Central African Federation of Rhodesia and Nyasaland, despite the opposition of Northern Rhodesia’s Africans. This Federation was dissolved in 1963. Soon after the Federation was dissolved, in October 1964, Zambia gained political independence and adopted a multiparty system of government. This system changed in 1972 when the country became a one-party state. Zambia adopted the current multiparty system of government again in 1991. 1.1.2 Geography Zambia is a land-locked sub-Saharan country sharing boundaries with the Democratic Republic of Congo (DRC) and Tanzania in the north; Malawi and Mozambique in the east; Zimbabwe and Botswana in the south; Namibia in the southwest and Angola in the west. Zambia covers a land area of 752,612 square kilometres, which is about 2.5 percent of Africa. Administratively, the country is divided into nine provinces and 72 districts. Of the nine provinces, two are predominantly urban, namely Lusaka and Copperbelt provinces. The remaining provinces—Central, Eastern, Northern, Luapula, North-Western, Western, and Southern—are predominantly rural provinces. Zambia lies between 8 and 18 degrees south latitude and between 20 and 35 degrees east longitude. It has a tropical climate and vegetation with three distinct seasons: the cool dry winter from May to August, a hot dry season during September and October, and a warm wet season from November to April. Zambia has a number of major rivers that are the main sources of water—the Zambezi, Kafue, Luangwa, and Luapula. The country also has major lakes such as Tanganyika, Mweru, Bangweulu, and the man-made Kariba. The northern part of the country receives the highest rainfall, with an annual average ranging from 1,100 mm to over 1,400 mm. The southern and eastern parts of the country have less rainfall, ranging from 600 mm to 1,100 mm annually, which often results in droughts. 1.1.3 Economy Zambia has a mixed economy consisting of a modern urban sector that, geographically, follows the rail line and a rural agricultural sector. For a long time, the modern sector was dominated by parastatal organizations, while private businesses dominated the construction and agriculture sector. Since 1991, the government has actively pursued policies that facilitated private sector growth, including decontrol of prices, trade liberalization, market-determined exchange and interest rates; financial sector liberalization; and more responsible fiscal and monetary policies. With the introduction of the liberalized market-oriented economy, most parastatals were privatized and some were liquidated. 2 | Introduction Copper mining continues to be the country’s main economic activity, accounting for 95 per- cent of export earnings and contributing 45 percent of government revenue during the decade following independence (1965-1975). In the mid-1970s, following a sharp decline in copper prices and a sharp increase in oil prices, the country’s economy deteriorated. Attempts were made to minimise dependency on copper exports by diversifying the economy through the creation of import substitution parastatals. This did not achieve the desired results. Zambia embarked on implementing vigorous Structural Adjustment Programmes (SAP) in the 1980s amidst a stagnating economy. The SAP failed to substantially alter the economy and led to in- creased levels of poverty for the majority of Zambians. According to the Living Conditions Moni- toring Survey 2006, 64 percent of Zambians were classified as poor. Poverty has remained more prevalent in rural areas than urban areas (80 and 34 percent, respectively) in 2006. Poverty in the Zambian context can be defined as lack of access to income, employment opportunities, entitlements for citizens to such things as freely determined consumption of goods and services, shelter, and other basic needs of life (MOFNP, 2002). In an effort to halt the economic recession, the Movement for Multiparty Democracy (MMD) Government has launched an Economic Recovery Programme (ERP) to turn around the protracted decline of the economy into sustained positive growth, leading to improvement in living standards and the quality of life (Republic of Zambia, 1992). The performance of the Zambian economy considerably improved during the period of the implementation of the Poverty Reduction Strategy Plan (PRSP) and Transitional National Develop- ment Plan (TNDP) from 2002 to 2005. Both strategies serve as frameworks for economic and social development. Real gross domestic product (GDP) growth averaged 4.7 percent per year, up from an annual average of 2.2 percent in the preceding four years. Growth actually exceeded the 4 percent target identified in the PRSP/TNDP. The improvements in performance represented a marked reversal of the economic stagnation experienced during the 1990s. These positive growth trends are largely due to several factors including favourable global economic conditions and the overall impact of economic reforms that started in the early 1990s. The rapid expansion of mining and construction primarily drove the growth during the period. The increase in global metal prices had a positive impact on Zambia’s mining industry and the macroeconomic environment in general. The mining industry, which faced difficulties during the 1998-2001 period, received a major boost as a consequence of the rise in prices since 2003. Locally, the renewed expansion of the mining sector was a result of recapitalization and new investments following the privatisation of the state-owned mines and the buoyant world commodity markets. The construction sector recorded rapid growth as a result of private construction activities, especially in residential housing in the main urban centres (MOFNP, 2006 FNDP). 1.2 POPULATION Table 1.1 presents selected demographic indi- cators from the 1980, 1990, and 2000 Zambia Census Reports. The 2000 national census reported a popu- lation of 9.9 million with a population growth rate of 2.4 percent per annum. The population increased from 5.7 million in 1980 to 7.8 million in 1990. During the 1990-2000 intercensal period, growth rates varied by province, ranging from 0.8 percent in Copperbelt to 3.4 percent in Lusaka. The population density in Zambia increased from 7.5 people per square kilometre in 1980 to 10.4 in 1990 and 13.1 in 2000. The average density by prov- Table 1.1 Demographic characteristics Selected demographic indicators, Zambia, 1980, 1990, and 2000 Census year Indicator 1980 1990 2000 Population (millions) 5.7 7.8 9.9 Density (pop/sq km) 7.5 10.4 13.1 Percent urban 39.9 38.0 35.0 Total fertility rate 7.2 6.7 6.0 Completed family size (women age 45-49) 6.6 7.1 6.9 Infant mortality rate 97 123 110 Life expectancy at birth Male 50.4 46.1 48.0 Female 52.5 47.6 52.0 Sources: Central Statistical Office, 1985a, 1985b, 1995b, 2002b, and 2003 Introduction | 3 ince in 2000 ranged from 64 people per square kilometre in Lusaka province to five people per square kilometre in North-Western province. In addition to being the most densely populated provinces, Lusaka and Copperbelt are also the most urbanized. The decline in the economy has gradually reduced the proportion of the population in urban areas. The proportion of the population living in urban areas has decreased steadily from 40 percent in 1980 to 38 percent in 1990 and to 35 percent in 2000. The proportion of the urban population varies by province from 81 percent in Copperbelt to 9 percent in Eastern province (CSO, 2002b). Total fertility rates estimated from the 1969 and 1980 censuses were 7.4 and 7.2 births per woman, respectively. The fertility rate declined to 6.7 births per woman in 1990, to 6.0 in 2000, and to 5.9 in 2002. Life expectancy at birth for males was 50 years in 1980 and was estimated to have declined to 46 years by 1990. In 2000, it increased to 48 years. Overall, life expectancy at birth ranged from 44 years in Western province to 56 years in North-Western province (CSO, 2002b). Zambian women live, on average, 4 years longer than men. The overall infant mortality rate declined from 141 deaths per 1,000 live births in the mid-1960s (based on the 1969 census) to 99 deaths in the late 1980s, after which it increased to 123 in 1990. According to the 2000 Census, infant mortality was estimated at 110 deaths per 1,000 live births. The ZDHS estimates show a decline in infant mortality from 95 deaths per 1,000 live births in 2001-2002 to 70 deaths in 2007. 1.3 THE POPULATION POLICY AND NATIONAL POPULATION AND DEVELOPMENT PROGRAMME OF ACTION The results of the 1980 Population and Housing Census emphasised the rapidity with which the population was expanding and the implied adverse effect on development and individual welfare. This led the government to reappraise the role of population in national development efforts. In 1984, the then National Commission for Development Planning (NCDP) was given a mandate to initiate a draft population policy that would aim at achieving a population growth rate consistent with the growth rate of the economy (NCDP, 1989). The National Population Policy was accepted in May 1989. Since then, the country’s population growth rate has remained high and continues to be a serious impediment to sustainable development. The demographic factors and other emerging issues such as rapid urbanization, gender concerns, brain drain, and HIV/AIDS started unfolding in the 1990s, thereby constituting major obstacles to ensuring improved quality of life for Zambia’s population. In an effort to address these issues, the process of revising the population policy started in December 1996, and was based on issues adopted by the 1994 Cairo International Conference on Population and Development. The new objectives of the policy took into account the concerns regarding HIV and AIDS, poverty, reproductive health, the environment, unemployment, gender issues, and a global perspective on population and development. The policy was finally revised in 2007 with a vision to improve the quality of life for the people through the achievement of improved population trends with socio- economic development. The main objectives of the policy are to: � Integrate population variables, reproductive health including family planning, gender, and HIV/AIDS into development planning and programme implementation processes, especially in education, health, and agriculture. � Reduce the incidence of morbidity and mortality, particularly maternal, infant and child mortality. � Reduce the high level of fertility, particularly adolescent fertility. � Improve sexual and reproductive health (including family planning) so as to encourage a manageable family size. � Improve and maintain the nation’s population database. 4 | Introduction � Achieve a more even distribution of the population between rural and urban areas and to regulate international migration. (MOFNP, 2007). 1.4 HEALTH PRIORITIES AND PROGRAMMES The high disease burden in Zambia is compounded by the high prevalence of HIV, high poverty levels, and the poor macroeconomic situation. The Government of the Republic of Zambia is committed to improving the quality of life for all Zambians, and this commitment is demonstrated through the government’s efforts to improve health care delivery by reforming the health sector. In 1991, the Government of the Republic of Zambia launched radical health policy reforms characterised by a move from a strongly centralized health system in which the central structures provided support and national guidance to the peripheral structures. An important component of health policy reform is the restructured Primary Health Care (PHC) programme. The government is committed to providing efficient and cost-effective quality basic health care services for common illnesses as close to the family as possible through the implementation of the Basic Health Care Package (BHCP) at all levels of health care. Currently, the following priority areas for health services have been identified for inclusion into the basic health care package: nutrition; environmental health; control and management of communicable diseases; malaria; tuberculosis; epidemic and disaster prevention, preparedness, and response; school health; and oral health. The elements of the BHCP are selected on the basis of an epidemiological analysis of diseases and conditions that cause the highest burden of morbidity and mortality. Population-based and health facility-based surveys are regularly and consistently conducted to guide policy and planning. The 1996 launch of the Health Information System and Financial Administration management marked a major milestone in the development of health sector performance monitoring under the health reforms. Performance appraisals are regularly executed by Provincial Health Offices, and the Integrated Diseases Surveillance Response is well developed for polio, measles, and tetanus. A Health Information Management System is in place to allow for collection of routine data for health indicators in the subject matters of childhood nutritional status; measles immunization coverage; care during delivery; malaria and TB incidence; and TB Directly-Observed Treatment, Short-Course (DOTS) coverage. Since the commencement of the health care reforms, the public health sector in Zambia has taken significant steps towards meeting the objectives of the reforms, particularly in improving access to health care, affordability of health services, and health systems strengthening. These health reforms established the government’s commitment to improve the population’s health and set the following targets to be achieved by the year 2000: � Reduce the percentage of underweight children (0-5 years) from 23 to 18 percent. � Bring under control 80 percent of tuberculosis cases. � Increase accessibility to and acceptability of family planning services and appropriate use of information in order to increase family planning use. � Improve the quality of, access to, and utilization of maternal and child health services in order to reduce maternal deaths and complications. � Reduce the incidence of STIs, HIV, and reproductive tract infections. � Reduce the incidence of induced abortions in order to reduce maternal complications and deaths. � Increase the percentage of the population having adequate sanitation from 66 to 75 per- cent in urban areas and from 37 to 57 percent in rural areas by 1996 (MOH, 1992) The targets were to be achieved through a basic health care services package to be provided at all levels of the health care system. A number of challenges were encountered in trying to meet the above objectives, therefore calling for a set of renewed strategies to counter the challenges. Introduction | 5 In 2005 the Ministry of Health embarked on the National Health Strategic Plan, aimed at reducing the disease burden and accelerating the attainment of the Millennium Development Goals and other national priorities. The plan presents a major departure from the past strategic plans. While it is recognized that all health care interventions are important and should continue to receive the necessary levels of support, prioritization of interventions is of critical importance as the resources and capabilities available are significantly constrained. In order to improve the health sector’s general performance and meet the Millennium Development Goals, the National Health Strategic Plan places emphasis on dealing with human resources crises; improving the state of the health care infrastructure; fostering multisectoral responses in key areas such as nutrition, HIV/AIDS, control of epidemics, health education; and increased access to basic environmental health facilities such as water, acceptable basic sanitation, electricity, and telecommunication. The plan has placed greater emphasis on establishing effective, strong, and sustainable partnerships among all key stakeholders involved in health service delivery in Zambia. The National Health Strategic Plan identifies priority areas grouped into four major categories—human resources, health service delivery interventions, clinical care and diagnostic services priority interventions, and priority integrated support systems. The objectives under these health priority areas are to: � Train, recruit, and retain appropriate and adequate staff at all levels. � Reduce the mortality rate among children under five. � Reduce the maternal mortality ratio. � Reduce the spread of HIV, TB, and STIs through effective interventions. � Reduce the incidence and mortality due to malaria. � Improve public health surveillance and control of epidemics. � Promote and implement appropriate interventions aimed at improving hygiene, access to basic sanitation, safe water, and safe food. � Ensure availability of essential drugs and medical supplies at all levels. � Ensure availability of appropriate infrastructure and equipment at all levels, including the availability of basic services such as water, electricity, and telecommunications at all health facilities. � Strengthen existing integrated operational systems, financing mechanisms, and gover- nance arrangements for effective policy implementation and delivery of health services. Zambia, like many sub-Saharan countries, has been adversely affected by the HIV/AIDS pandemic. In response to the high morbidity and mortality associated with HIV infection, the government introduced free antiretroviral drugs in two major public health care facilities in 2005. The distribution of highly effective antiretroviral therapy (ART) has since been scaled up to include almost all the districts in Zambia. A laboratory infrastructure for basic assessment and monitoring of HIV-positive patients has been set up in almost all provincial hospitals. Further, the Ministry of Health has expanded quality services for prevention of mother-to-child HIV transmission, Voluntary HIV counselling and testing (VCT), ART, and other treatment and care services. 1.5 STRATEGIC FRAMEWORK TO COMBAT THE NATIONAL HIV/AIDS EPIDEMIC The first AIDS case in Zambia was diagnosed in 1984. Upon the realization of the need for behavioural interventions, as well as care and support programmes, the Government of the Republic of Zambia, with the assistance from the WHO Global Programme on HIV/AIDS, established the National AIDS Prevention and Control Programme (NACP). Three national plans have been developed to respond to the HIV/AIDS epidemic. The first one was the Emergency Short-Term Plan developed in 1987 to ensure safe blood and blood product supplies. Second, the two Medium-Term Plans (MTP1 and MTP2) covered the years 1988-1992 and 1994-1998, respectively. The National HIV/AIDS Intervention Strategic Plan and the National Monitoring and Evaluation Plan were 6 | Introduction developed for 2002-2005. These comprehensive plans focused on national-level decisionmaking and coordination. To coordinate and support the development, monitoring, and evaluation of the multisectoral national response for the prevention and mitigation of HIV/AIDS, STIs, and TB, the National HIV/AIDS/STI/TB Council (NAC) was established by an act of Parliament in December 2002. The National HIV/AIDS Policy was published in 2005 to provide the directive and mandate for the national response. In 2006, the Government of the Republic of Zambia created a National HIV/AIDS/STI/TB Monitoring and Evaluation Plan for 2006-2010. The plan was developed to prevent, halt, and begin to reverse the spread of HIV and AIDS by 2010. The plan defines six themes, which describe priority action areas: 1) intensifying prevention; 2) expanding treatment, care, and support; 3) mitigating the socio-economic impact of HIV and AIDS; 4) strengthening decentralized response and mainstreaming HIV and AIDS; 5) improving the monitoring of the response; and 6) integrating advocacy and coordination of the multisectoral response. The Government of the Republic of Zambia has made monitoring and evaluation an in- creasingly key component of this programme design and management approach. To facilitate effective coordination, the NAC developed a National HIV/AIDS Monitoring and Evaluation System to allow the country to track its progress towards the goal and objectives as stated in the plan. 1.6 OBJECTIVES AND ORGANIZATION OF THE SURVEY 1.6.1 Objectives The Zambia Demographic and Health Survey (ZDHS) is a nationally representative sample survey of women and men of reproductive age. The main objective is to provide information on levels and trends in fertility, childhood mortality, use of family planning methods, and maternal and child health indicators including HIV/AIDS. This information is necessary for programme managers, policymakers, and implementers to monitor and evaluate the impact of existing programmes and to design new initiatives for health policies in Zambia. The primary objectives of the 2007 ZDHS project are: � To collect up-to-date information on fertility, infant and child mortality, and family planning. � To collect information on health-related matters such as breastfeeding, antenatal care, children’s immunisations, and childhood diseases. � To assess the nutritional status of mothers and children. � To support dissemination and utilization of the results in planning, managing, and improving family planning and health services in the country. � To enhance the survey capabilities of the institutions involved in order to facilitate the implementation of surveys of this type in future. � To document current epidemics of STIs and HIV/AIDS through use of specialized modules. For HIV/AIDS and syphilis in particular, the testing component of the 2007 Zambia DHS was undertaken to provide information to address the monitoring and evaluation needs of government and non-governmental organization programmes addressing HIV/AIDS and syphilis, and to provide programme managers and policy makers with the information that they need to effectively plan and implement future interventions. The overall objective of the survey was to collect high-quality and representative data on knowledge, attitudes, and behaviours regarding HIV/AIDS and other STIs, and on the prevalence of HIV and syphilis infection among women and men. Introduction | 7 1.6.2 Organization The 2007 ZDHS was implemented by the Central Statistical Office (CSO) in partnership with the Ministry of Health, Tropical Diseases Research Centre (TDRC), and the Demography Division at the University of Zambia (UNZA) from April to October 2007. The TDRC provided technical support in the implementation of the syphilis and HIV testing. Macro International provided technical assistance to the project through the USAID-funded MEASURE DHS programme. Funding for the ZDHS was provided by USAID, the Ministry of Health, the Ministry of Finance and National Planning, the Centres for Disease Control and Prevention (CDC), the U.S. President’s Emergency Plan for AIDS Relief (PEPFAR), the Malaria Control and Evaluation Partnership in Africa (MACEPA), the European Union (EU), the World Bank through the Zambia National Response to HIV/AIDS (ZANARA) project, the United Nations Population Fund (UNFPA), the United Nations Development Programme (UNDP), the Joint United Nations Programme on HIV/AIDS (UNAIDS), the United Nations Children’s Fund (UNICEF), the Japan International Cooperation Agency (JICA), Swedish International Development Assistance (SIDA), the United Kingdom Department for International Development (DFID), the World Health Organization (WHO), and Development Cooperation Ireland (DCI). While significantly expanded in content, the 2007 ZDHS is a follow-up to the 1992, 1996, and 2001-2002 ZDHS and provides updated estimates of basic demographic and health indicators covered in the earlier surveys. The 2007 ZDHS is the second DHS survey that includes information on violence against women and testing of individuals for syphilis and HIV. In addition, data on malaria prevention and treatment were also collected. 1.7 SAMPLE DESIGN The sample for the 2007 ZDHS was designed to provide estimates of population and health indicators at the national and provincial levels. The sample design allowed for specific indicators, such as contraceptive use, to be calculated for each of the nine provinces (Central, Copperbelt, Eastern, Lusaka, Luapula, Northern, North-Western, Southern, and Western). The sampling frame used for the 2007 ZDHS was adopted from the Census of Population and Housing of the Republic of Zambia (CPH) conducted in 2000, provided by the CSO. The frame consists of 16,757 standard enumeration areas (SEA) created for the CPH 2000. A SEA is a convenient geographical area with an average size of 130 households or 600 people. A SEA contains information about its location, the type of residence, the number of households and the number of males and females in the population. Each SEA has a cartographical map, which delimits the boundaries and shows the main landmarks of the SEA. A representative sample of 8,000 households was drawn for the 2007 ZDHS survey. The sample for ZDHS 2007 was a stratified sample selected in two stages from the CPH 2000 frame. Stratification was achieved by separating every province into urban and rural areas. Therefore, the nine provinces were stratified into 18 sampling strata. Samples were selected independently in every stratum by a two-stage selection. Implicit stratifications and proportional allocation was achieved at each of the lower geographical/administrative levels by sorting the sampling frame according to the geographical/administrative order and by using a probability proportional to size selection at the first- stage sampling. In the first stage, 320 SEAs were selected with probability proportional to the SEA size.1 The household listing operation was conducted in all selected SEAs, with the resulting lists of households serving as the sampling frame for the selection of households in the second stage. Selected SEAs with more than 300 households were segmented, with only one segment selected for the survey with probability proportional to the segment size. Household listing was conducted only in the selected 1 The final survey sample included 319 clusters instead of 320 clusters. During fieldwork, access was not granted for the field team to conduct data collection exercises in one cluster. 8 | Introduction segment. Therefore, a ZDHS 2007 cluster is either an SEA or a segment of an SEA. In the second- stage selection, an average number of 25 households were selected in every cluster, by equal probability systematic sampling. A complete listing of households and a mapping exercise was carried out for each cluster in August 2006. All private households were listed. The listing excluded people living in institutional households (army barracks, hospitals, police camps, boarding schools, etc.). CSO listing enumerators were trained to use Global Positioning System (GPS) receivers to record the geographic coordinates of the 2007 ZDHS sample clusters. All women age 15-49 and all men age 15-59 who were either permanent residents of the households in the 2007 ZDHS sample or visitors present in the household on the night before the survey were eligible to be interviewed. HIV testing was performed in each household among eligible women and men who consented to the test. In a sub-sample of one in every three households, syphilis testing was performed among eligible women and men who consented to the test. In addition, a sub- sample of one eligible woman in each household was randomly selected to be asked additional questions about domestic violence. 1.8 QUESTIONNAIRES Three questionnaires were used for the 2007 ZDHS. They are the Household Questionnaire, the Women’s Questionnaire, and the Men’s Questionnaire. These questionnaires were based on questionnaires developed for the MEASURE DHS programme and were adapted to reflect the population and health issues relevant to Zambia at a series of meetings with various stakeholders from government ministries and agencies, non-governmental organizations, and international donors. In addition to English, the questionnaires were translated into seven major local languages, Nyanja, Bemba, Kaonde, Lunda, Lozi, Tonga, and Luvale. The Household Questionnaire was used to list all the usual members and visitors of selected households. Some basic information was collected on the characteristics of each person listed, including age, sex, education, and relationship to the head of the household. For children under age 18, survival status of the parents was determined. If a child in the household had a parent who was sick for more than three consecutive months in the 12 months preceding the survey or had a parent who had died, additional questions related to support for orphans and vulnerable children were asked. Additionally, if an adult in the household was sick for three or more consecutive months in the 12 months preceding the survey or an adult in the household died, questions were asked related to support for sick people or people who had died. The Household Questionnaire was also used to identify women and men who were eligible for the individual interview. In addition, the Household Questionnaire collected information about the dwelling, such as the source of water; type of toilet facilities; materials used to construct the house; ownership of various durable goods; and ownership and use of mosquito nets. The Household Questionnaire was also used to record height and weight measurements for children age 5-59 months and women age 15-49 years. Additionally, the Household Questionnaire included questions on malaria prevention as well as the information on the consent of eligible household members for the HIV and syphilis testing. The Women’s Questionnaire was used to collect information from all women age 15-49. These women were asked questions on the following main topics: � Background characteristics (education, residential history, media exposure, etc.) � Birth history and childhood mortality � Knowledge and use of family planning methods � Fertility preferences � Antenatal and delivery care � Breastfeeding and infant feeding practices � Vaccinations and childhood illnesses � Marriage and sexual activity Introduction | 9 � Women’s work and husband’s background characteristics � Women’s and children’s nutritional status � Malaria prevention and treatment � Domestic violence � Awareness and behaviour regarding HIV and other STIs � Adult mortality including maternal mortality The Men’s Questionnaire was administered to all men age 15-59 in each household in the 2007 ZDHS sample. The Men’s Questionnaire collected much of the same information found in the Women’s Questionnaire, but was shorter because it did not contain a detailed reproductive history or questions on maternal and child health or nutrition. 1.9 SYPHILIS AND HIV TESTING In the 2007 ZDHS, dried blood spot (DBS) samples were collected for HIV testing from all voluntary, consenting, eligible women and men, in all selected survey households. In addition, in every third household selected for the survey, venous blood specimens were collected from all eligible women and men who voluntarily consented to having the syphilis test. The protocol for the blood specimen collection and testing for syphilis and HIV was reviewed and approved by the TDRC Ethical Review Committee, the Institutional Review Board of Macro International, and CDC Atlanta. 1.9.1 Syphilis Testing For the syphilis testing activities, a nurse/nurse counsellor and a laboratory technician were added to each of the 12 ZDHS field teams. The nurse/nurse counsellors and laboratory technicians were recruited through the Ministry of Health and had experience in venous blood collection and testing. According to the protocol, syphilis testing was conducted in the field by the laboratory technician, using a qualitative Rapid Plasma Reagin (RPR). If the respondent had also consented to HIV testing, all blood specimens were given a bar code label unique to the respondent, which was identical to the label fixed on the individual’s questionnaire and on the DBS filter paper used for collecting blood for HIV testing. Those individuals who were found to test positive for syphilis were offered treatment at home with one injection of benzathine penicillin, which is the standard treatment in Zambia. Alternative treatment was given to those allergic to penicillin and to pregnant women (erythromycin capsules for pregnant women and doxycycline capsules for men and non-pregnant women). An emergency kit (epinephrine) was provided to each nurse/nurse counsellor for penicillin- allergic cases. If the respondent tested positive for syphilis and did not want to be treated at home, a referral letter was given for free treatment at the nearest health facility. All RPR reactive sera samples were collected in cryo vials and labelled with appropriate bar code labels, frozen in liquid nitrogen tanks and transported to TDRC for syphilis confirmatory testing using Treponema Pallidum Haemaglutination Assay (TPHA). 1.9.2 HIV Testing The protocol for the blood specimen collection and analysis for the 2007 ZDHS was based on the anonymous linked protocol developed for MEASURE DHS. The protocol allows for the merging of the HIV results to the socio-demographic data collected in the individual questionnaires, provided that information that could potentially identify an individual is destroyed before the linking takes place. Eligible women and men who consented to HIV testing were asked to voluntarily provide five drops of blood from a finger prick for anonymous HIV testing. Interviewers explained the procedure, the confidentiality of the data, and the fact that the test results would not be made available to the respondent. They also explained the option of dried blood spot (DBS) storage for use in additional testing. If a respondent consented to the HIV testing, five blood spots from the finger prick were collected on a filter paper card, which a bar code label unique 10 | Introduction to the respondent was affixed. If the respondent did not consent to additional testing using their sample, the words “no further testing” were indicated on the filter paper card. Each household, whether individuals consented to HIV testing or not, was given an information brochure on HIV/ AIDS and a list of fixed sites providing voluntary counselling and testing (VCT) services grouped by province. Each DBS sample was given a bar code label, with a duplicate label attached to the Women’s or Men’s Questionnaire. A third copy of the same bar code was affixed to the Blood Sample Transmittal Form to track the blood samples from the field to the laboratory. DBS samples were dried overnight and packaged for storage the following morning. Samples were periodically collected in the field along with the completed questionnaires and transported to CSO in Lusaka to be logged in, checked, and then transported to the TDRC in Ndola. The processing of DBS samples for HIV testing at TDRC was handled by eight laboratory personnel. Each DBS sample was logged into the CSPro HIV Test Tracking System (CHTTS) database, given a laboratory number, and stored at -20�C until tested. Testing on all samples was conducted between February and April 2008, after all of the questionnaire data entry was completed, verified, cleaned, and all unique identifiers removed from the questionnaire file except the bar code number. All samples were tested on the first assay test, an ELISA, Vironostika� HIV Uni-Form II Plus O, Biomerieux. A negative result was considered negative. All positives were subjected to a second ELISA test by Enzygnost� Anti-HIV 1/2 Plus, Dade Behring. Positive samples on the second test were considered positive. If the first and second tests were discordant, the sample was retested with tests 1 and 2. If on repeat of tests 1 and 2, both were negative, the sample was rendered negative. If both were positive, the sample was rendered positive. If there was still a discrepancy in the results after repeating tests 1 and 2, a third confirmatory test, Western Blot 2.2, Abbott Labs, was administered. The final result was rendered positive if the Western Blot (WB) confirmed the result to be positive, and rendered negative if the WB confirmed it to be negative. If the results were still discordant, the sample was rendered indeterminate. 1.9.3 Quality Control To ensure quality and validity of test results, two forms of quality control were employed for the survey at TDRC laboratory. During testing, an internal quality control was established. Additionally, a selected number of the samples were sent to Global Clinical Viral Laboratory for external quality control. Procedures for internal quality control are outlined below. 1) Positive and negative serum controls supplied by the manufacturer with the test kits were included in each run. 2) Known HIV-negative, low-positive, and high-positive DBS samples obtained from CDC, Atlanta, USA were included in each run. 3) Known HIV negative, low-positive, and high-positive serum samples from the TDRC laboratory were also included in each run. 1.9.4 External quality control External quality control for the 2007 ZDHS HIV samples was conducted by Global Clinical Viral Laboratory (GCVL) in Durban, South Africa. Following the standard protocol in DHS for external quality control, TDRC sent 10 percent of all the HIV samples collected during the survey to the GCVL. The samples included both reactive (positive) samples and HIV non-reactive (negative) samples. The CHTTS programme randomly selected the 10 percent sub-sample, comprising approxi- mately 60 percent positives and 40 percent negatives, for retesting. The external quality control testing yielded a 99 percent agreement with the TDRC results. Introduction | 11 The HIV test results for the 2007 ZDHS were entered into a spreadsheet with the bar code as the unique identifier for the result. Data from the HIV results and linked demographic and health data are published in this 2007 report. 1.10 PRETEST ACTIVITIES The 2007 ZDHS was significantly expanded in content and included a different methodology for collecting HIV samples. A pretest was conducted to pilot the procedures involved and to pilot the ZDHS questionnaires. The training and fieldwork for the pretest took place from August 8 to September 4, 2006. Fourteen interviewers (seven females and seven males) were trained to administer the questionnaires, take anthropometric measurements, and collect blood samples for and HIV testing. In addition, three laboratory technicians and seven interviewers who were nurses were also trained to collect venous blood samples for syphilis testing. Representatives from the TDRC assisted in training participants to perform the finger prick for HIV sample collection, venous draws for syphilis sample collection, and proper handling and storage of the dried blood spots (DBS) and venous blood. The trainers/resource persons included professionals from UNZA, CSO, TDRC, the MOH, and Macro International. Guest lecturers were also invited from the Ministry of Health, the Centre for Infectious Disease Research in Zambia (CIDRZ), and the Johns Hopkins Program for International Education in Gynaecology and Obstetrics (JHPIEGO). The pretest fieldwork was conducted in two urban and three rural clusters, covering 151 households. Debriefing sessions were held with the pre-test field staff, and modifications to the questionnaires were made based on lessons drawn from the exercise. The pretest field staff was divided into 3 teams of at least eight field people. The female interviewers were nurses. The supervisors and editors were drawn from amongst the resource people. 1.10.1 Training of Field Staff CSO recruited and trained 122 people for the fieldwork to serve as supervisors, field editors, male and female interviewers, and reserve interviewers. Training of field staff for the main survey was conducted during February 2007. The training course consisted of instruction regarding interviewing techniques and field procedures, a detailed review of items on the questionnaires, instruction and practice in weighing and measuring children, mock interviews between participants in the classroom, and practice interviews with real respondents in areas outside the 2007 ZDHS sample clusters. Field practice in syphilis testing and HIV DBS specimen collection was also conducted. During this period, field editors and team supervisors were provided with additional training in methods of field editing, data quality control procedures, and fieldwork coordination. Twelve supervisors, 12 editors, 36 female interviewers, and 36 male interviewers were selected to make up 12 data collection teams for the 2007 ZDHS. 1.10.2 Fieldwork Twelve interviewing teams carried out data collection for the 2007 ZDHS. Each team consisted of one supervisor (team leader), one female field editor, one laboratory technician, three female interviewers, three male interviewers, and one driver. Seven senior staff members from CSO coordinated and supervised fieldwork activities. Three members of staff from UNZA assisted in the field supervision. In addition, three Macro staff members conducted field supervision. Data collection took place over a six-month period, from April 2007 to October 2007. 1.11 DATA PROCESSING All questionnaires for the ZDHS were returned to the CSO in Lusaka for data processing, which consisted of office editing, coding of open-ended questions, data entry, and editing computer- identified errors. The data were processed by a team of 11 data entry clerks, four data editors, four 12 | Introduction data entry supervisors, and one administrator to receive and check the blood samples received from the field. Data entry and editing were accomplished using the CSPro software. The process of office editing and data processing was initiated in May 2007 and the completed in November 2007. 1.12 RESPONSE RATES Table 1.2 shows response rates for the 2007 ZDHS. A total of 7,969 house- holds were selected for the sample, of which 7,326 were occupied. The shortfall was largely due to households that were away for an extended period of the time and structures that were found to be vacant at the time of the interview. Of the 7,326 existing households, 7,164 were success- fully interviewed, yielding a response rate of 98 percent. In the interviewed households, a total of 7,408 women were identified, of whom 7,146 were successfully interviewed, yielding a response rate of 97 percent. With regard to the male survey results, 7,146 eligible men identified, of whom 6,500 were successfully interviewed, yielding a 91 percent response rate. The response rates are slightly lower in the urban than rural sample for women, and more markedly for men (88 percent compared with 94 percent). The principal reason for non-response among eligible men was the failure to find individuals at home despite repeated visits to the household, followed by refusal to be interviewed. The substantially lower response rate for men reflects the more frequent and longer absence of men from the households. Table 1.2 Results of the household and individual interviews Number of households, number of interviews, and response rates, according to residence, Zambia 2007 Residence Result Urban Rural Total Household interviews Households selected 2,899 5,070 7,969 Households occupied 2,748 4,578 7,326 Households interviewed 2,694 4,470 7,164 Household response rate 98.0 97.6 97.8 Individual interviews: women Number of eligible women 3,320 4,088 7,408 Number of eligible women interviewed 3,178 3,968 7,146 Eligible woman response rate 95.7 97.1 96.5 Individual interviews: men Number of eligible men 3,225 3,921 7,146 Number of eligible men interviewed 2,831 3,669 6,500 Eligible man response rate 87.8 93.6 91.0 Household Population and Housing Characteristics | 13 HOUSEHOLD POPULATION AND HOUSING CHARACTERISTICS 2 Palver Sikanyiti The purpose of this chapter is to provide a summary of some demographic and socio- economic characteristics of the population in the households sampled in the 2007 ZDHS. For the purpose of the 2007 ZDHS, a household was defined as a person or a group of persons, related or unrelated, who live together and share common cooking and eating arrangements. The Household Questionnaire (see Appendix G) included a schedule for collecting basic demographic and socio- economic information (e.g., age, sex, educational attainment, and current school attendance) for all usual residents and visitors who slept in the household the night preceding the interview. This method of data collection allows the analysis of the results for either the de jure population (usual residents) or the de facto population (i.e., persons in the household at the time of the survey). The Household Questionnaire also obtained information on housing facilities, e.g., dwelling characteristics, source of water supply, and sanitation facilities) and household possessions. The information presented in this chapter is intended to facilitate interpretation of the key demographic, socio-economic, and health indices presented later in the report. It is also intended to assist in the assessment of the representativeness of the survey sample. 2.1 POPULATION BY AGE AND SEX Age and sex are important demographic variables and are the primary basis of demographic classification. They are also very important variables in the study of mortality, fertility, and nuptiality. The distribution of the de facto household population in the 2007 ZDHS is shown in Table 2.1 by five-year age groups, according to sex and residence. There are more women (17,551) than men (16, 314) in Zambia (52 and 48 percent, respectively). The sex ratio (proportion of men per 100 women) is 93. The ratio in rural areas is lower than that of urban areas (92 compared with 95). The data show that the household population has a greater number of younger people than older people. Fifty percent of the total population is under 15 years of age while 3 percent is 65 or older. The proportions decline as age increases; the lowest age group (0-4) has the largest proportion of the population (19 percent), while the highest age group (80+) has the smallest proportion with less than 1 percent. Table 2.1 Household population by age, sex, and residence Percent distribution of the de facto household population by five-year age groups, according to sex and residence, Zambia 2007 Urban Rural Total Age Male Female Total Male Female Total Male Female Total <5 15.8 13.6 14.7 20.8 20.5 20.6 18.9 18.0 18.5 5-9 13.2 13.9 13.5 17.4 17.4 17.4 15.9 16.1 16.0 10-14 15.0 15.4 15.2 16.4 13.7 15.0 15.9 14.3 15.1 15-19 11.9 12.5 12.2 8.0 7.5 7.7 9.4 9.2 9.3 20-24 9.4 10.2 9.8 6.1 7.3 6.7 7.3 8.3 7.8 25-29 8.1 9.5 8.8 6.0 7.1 6.6 6.8 8.0 7.4 30-34 7.6 6.9 7.2 6.0 5.8 5.9 6.6 6.2 6.4 35-39 5.5 4.4 4.9 4.7 4.4 4.5 5.0 4.4 4.7 40-44 3.5 3.7 3.6 3.0 3.1 3.1 3.2 3.3 3.3 45-49 2.6 3.0 2.8 2.7 2.6 2.6 2.6 2.7 2.7 50-54 2.4 2.4 2.4 1.8 2.5 2.2 2.0 2.5 2.3 55-59 1.5 1.8 1.7 1.3 2.3 1.8 1.4 2.1 1.8 60-64 1.7 0.9 1.3 1.5 1.8 1.7 1.6 1.5 1.5 65-69 0.6 0.7 0.7 1.3 1.6 1.5 1.1 1.3 1.2 70-74 0.6 0.6 0.6 1.0 1.2 1.1 0.9 1.0 0.9 75-79 0.3 0.3 0.3 1.1 0.8 1.0 0.8 0.6 0.7 80 + 0.2 0.3 0.2 0.8 0.5 0.7 0.6 0.5 0.5 Don't know/missing 0.1 0.0 0.0 0.0 0.0 0.0 0.0 0.0 0.0 Total 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 100.0 Number 5,935 6,217 12,152 10,378 11,334 21,712 16,314 17,551 33,864 14 | Household Population and Housing Characteristics Figure 2.1 illustrates the age structure of the household population in a population pyramid. Another feature of population pyramids is their strength in illustrating whether a population is “young” or “old.” The broad base of the pyramid indicates that Zambia’s population is young. This scenario is typical of countries with higher fertility rates. The pyramid also shows that there are slightly more females than males, as can be noticed from the slightly longer bars for females than those for males, especially in lower age groups. 2.2 HOUSEHOLD COMPOSITION Information on key aspects of the household composition, including the sex of the household head and the size of the household, is presented in Table 2.2. These characteristics are important because they are associated with the household welfare. Female-headed households are, for example, typically poorer than male-headed households. Economic resources are often more limited in larger households. Moreover, where the size of the household is large, crowding also can lead to health problems. Table 2.2 shows that about three-quarters (76 percent) of the households are male-headed while only about a quarter (24 percent) are female-headed. This is true for both rural and urban areas. However, the proportion of female-headed households is higher in rural areas (25 percent) than urban areas (22 percent). There has been a slight increase in the proportion of female-headed households from 23 percent in the 2001-2002 ZDHS to 24 percent in the 2007 ZDHS. In the 2007 ZDHS, the average household size is 4.9 persons, compared with 5.2 persons in the 2001-2002 ZDHS, 5.4 persons in the 1996 ZDHS, and 5.6 persons in the 1992 ZDHS. This shows a modest decline over the past 15 years. The table further shows that the average household size is similar in urban areas (5.0 persons) and in rural areas (4.8 persons). Also, the proportion of households with nine or more members is higher in urban areas (11 percent) than in rural areas (7 percent). Table 2.2 provides information on the proportion of foster children (children who live in households without either parent), double orphans (children with both parents dead), and single orphans (children with one parent dead in the household population). There are more foster children (31 percent) as opposed to double orphans (7 percent) and single orphans (17 percent). Urban areas have a higher proportion of foster children, double and single orphans, and foster/orphan children than rural areas. Figure 2.1 Population Pyramid 80+ 75-79 70-74 65-69 60-64 55-59 50-54 45-49 40-44 35-39 30-34 25-29 20-24 15-19 10-14 5-9 0-4 0246810 0 2 4 6 8 10 ZDHS 2007 Male Percent Female Age Household Population and Housing Characteristics | 15 Table 2.2 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 18, according to residence, Zambia 2007 Residence Characteristic Urban Rural Total Household headship Male 77.9 74.6 75.7 Female 22.1 25.4 24.3 Total 100.0 100.0 100.0 Number of usual members 0 0.0 0.0 0.0 1 6.8 8.2 7.7 2 11.1 9.7 10.2 3 13.6 14.0 13.9 4 14.9 15.6 15.4 5 15.3 16.2 15.9 6 12.0 13.7 13.1 7 9.2 9.1 9.1 8 6.4 6.0 6.2 9+ 10.7 7.4 8.5 Total 100.0 100.0 100.0 Mean size of households 5.0 4.8 4.9 Percentage of households with orphans1 and foster children2 under 18 Foster children 35.3 28.0 30.6 Double orphans 9.8 4.9 6.6 Single orphans 21.9 14.7 17.2 Foster and/or orphan children 43.4 32.4 36.3 Number of households 2,479 4,685 7,164 Note: Table is based on de jure household members, i.e., usual residents. 1 An orphan is a child under age 18 who has lost either one or both parents. 2 Foster children are those under age 18 living in households with neither their mother nor their father present. 2.3 EDUCATION OF THE HOUSEHOLD POPULATION Education is a key determinant of the lifestyle and societal status an individual enjoys. Studies have consistently shown that educational attainment has a strong effect on health behaviours and attitudes. Results from the 2007 ZDHS can be used to look at educational attainment among household members and school attendance, repetition, and drop-out rates among youth. For the purposes of the analysis presented below, the official age for entry into the primary level is six years old. Formal education in Zambia is based on a three-tier system: primary education consisting of 7 years, junior secondary school consisting of 2 years, and senior secondary school consisting of 3 years. Upon completion of secondary school, one may choose to further his or her education by either going to university for 4 to 7 years, depending on the field of study, and obtain a degree, or by attending a vocational or technical institute for a 2- to 3-year certificate/diploma course. 16 | Household Population and Housing Characteristics 2.3.1 Educational Attainment Tables 2.3.1 and 2.3.2 show data on educational attainment for female and male household members age six and older. Results from both tables indicate that, overall, more females than males have no education (20 percent contrasted to 14 percent, respectively). More than four in ten males (45 percent) and females (47 percent) have some primary education. The proportion of men completing the primary level of education is 13 percent, compared with 12 percent of women. Six percent of men have completed the secondary level of education, compared with 3 percent of women. There are urban-rural differences in educational attainment. Eleven percent of males in urban areas and 2 percent in rural areas have completed the secondary level, compared with 7 percent of females in urban areas and 1 percent in rural areas. Twenty-seven percent of females and 18 percent of males in rural areas have no education. In urban areas, 9 percent of females and 6 percent of males have no education. Results from past ZDHS surveys indicate that the proportion of children age 10-14 not attending school has decreased slightly over the past five years. In 1992, 11 percent of boys and girls age 10-14 had never attended school; in 1996, 13 percent of males and 12 percent of females in this age group had never attended school; and in 2001-2002, 14 percent of males and 15 percent of females age 10-14 had never attended school. However, the 2007 ZDHS has shown an improvement. Only 6 percent of both males and females age 10-14 had never attended school. Table 2.3.1 Educational attainment of the female household population Percent distribution of the de facto female household population age six and over by highest level of schooling attended or completed and median grade completed, according to background characteristics, Zambia 2007 Background characteristic No education Some primary Completed primary1 Some secondary Completed secondary2 More than secondary Don't know/ missing Total Number Median years completed Age 6-9 46.3 53.0 0.1 0.0 0.0 0.0 0.6 100.0 2,364 0.0 10-14 5.7 85.6 4.0 4.6 0.0 0.0 0.2 100.0 2,510 3.0 15-19 4.3 37.2 15.4 38.6 4.0 0.3 0.2 100.0 1,622 6.5 20-24 10.4 32.5 16.5 23.5 12.1 4.9 0.2 100.0 1,456 6.4 25-29 9.4 33.6 20.6 22.5 5.3 8.2 0.3 100.0 1,398 6.3 30-34 13.2 37.1 20.0 20.1 3.9 5.6 0.2 100.0 1,081 6.0 35-39 13.2 35.3 26.3 14.8 3.0 6.8 0.5 100.0 770 6.0 40-44 17.2 32.0 26.2 15.3 2.7 6.5 0.0 100.0 582 6.0 45-49 19.4 35.5 22.0 13.3 1.0 8.0 0.9 100.0 482 5.3 50-54 22.4 34.5 20.4 12.4 2.1 6.8 1.3 100.0 433 4.9 55-59 40.3 36.3 9.5 7.4 1.1 3.4 1.9 100.0 371 1.8 60-64 52.5 38.1 5.9 1.6 0.1 0.3 1.5 100.0 258 0.0 65+ 66.9 24.6 2.8 0.7 0.6 0.6 3.8 100.0 582 0.0 Residence Urban 9.2 37.8 13.5 25.0 6.6 7.4 0.6 100.0 5,225 6.2 Rural 26.7 52.1 11.6 7.7 0.8 0.5 0.6 100.0 8,688 2.4 Province Central 18.4 47.5 14.5 14.8 2.3 1.8 0.7 100.0 1,329 3.8 Copperbelt 9.9 41.4 14.3 22.3 5.2 6.5 0.4 100.0 2,313 5.8 Eastern 30.8 49.7 9.7 6.5 1.6 0.9 0.8 100.0 2,043 1.9 Luapula 24.9 53.8 10.3 8.9 1.3 0.8 0.1 100.0 1,085 2.8 Lusaka 10.5 39.6 12.3 22.8 5.8 8.4 0.5 100.0 2,008 5.9 Northern 24.3 52.9 11.4 8.6 1.8 0.4 0.7 100.0 1,963 2.8 North-Western 23.8 56.2 7.5 9.0 1.7 0.6 1.2 100.0 753 2.2 Southern 17.3 43.1 17.8 16.5 2.7 2.2 0.5 100.0 1,383 4.4 Western 31.3 44.5 10.3 10.7 1.7 1.2 0.4 100.0 1,035 2.1 Wealth quintile Lowest 29.4 55.8 9.8 4.1 0.3 0.1 0.6 100.0 2,608 1.7 Second 31.5 50.3 11.1 6.0 0.3 0.0 0.7 100.0 2,758 1.9 Middle 23.7 53.2 12.8 9.1 0.6 0.2 0.4 100.0 2,729 2.9 Fourth 12.3 44.6 16.1 21.7 3.5 1.3 0.6 100.0 2,765 5.1 Highest 5.9 31.9 11.8 27.9 9.5 12.6 0.5 100.0 3,052 6.9 Total 20.1 46.7 12.3 14.2 3.0 3.1 0.6 100.0 13,913 3.7 1 Completed 7th year at the primary level 2 Completed 12th year at the secondary level Household Population and Housing Characteristics | 17 At the provincial level, Eastern province has the highest proportion of the population with no education: 31 percent of females and 21 percent of males. Copperbelt has the smallest proportion of uneducated people (10 percent od females and 6 percent of males). Lusaka has the highest proportion who completed more than a secondary education for both females and males (8 percent for females and 12 percent for males). As expected, educational attainment is positively related to household wealth status. Females and males in the highest wealth quintiles are more likely to be educated than those in the lowest wealth quintiles. Table 2.3.2 Educational attainment of the male household population Percent distribution of the de facto male household population age six and over by highest level of schooling attended or completed and median grade completed, according to background characteristics, Zambia 2007 Background characteristic No education Some primary Completed primary1 Some secondary Completed secondary2 More than secondary Don't know/ missing Total Number Median years completed Age 6-9 47.4 52.1 0.0 0.0 0.0 0.0 0.5 100.0 2,123 0.0 10-14 6.4 87.6 3.5 2.5 0.0 0.0 0.1 100.0 2,596 2.8 15-19 1.9 39.0 14.4 40.9 3.3 0.4 0.2 100.0 1,531 6.5 20-24 4.1 25.5 16.6 32.7 16.1 4.9 0.2 100.0 1,186 7.4 25-29 5.6 22.0 20.8 26.2 16.5 8.4 0.4 100.0 1,103 7.1 30-34 6.0 23.6 21.5 28.0 9.7 10.9 0.2 100.0 1,071 6.9 35-39 5.5 26.2 21.1 26.3 9.2 11.3 0.4 100.0 817 6.8 40-44 6.9 24.3 23.3 23.9 10.0 11.3 0.3 100.0 520 6.8 45-49 7.4 20.8 29.4 23.5 6.1 12.2 0.6 100.0 431 6.7 50-54 5.4 18.2 25.1 30.5 3.8 16.0 0.9 100.0 331 7.3 55-59 8.8 25.6 17.7 25.2 2.9 19.6 0.2 100.0 230 6.9 60-64 18.1 41.1 14.2 14.4 3.7 7.9 0.6 100.0 259 4.4 65+ 27.5 45.5 13.1 8.3 1.2 2.9 1.5 100.0 555 3.1 Residence Urban 6.3 34.4 10.9 26.6 10.9 10.5 0.5 100.0 4,859 6.7 Rural 18.0 50.8 13.8 13.4 2.4 1.3 0.2 100.0 7,897 3.6 Province Central 12.1 47.0 15.0 17.2 5.5 2.9 0.3 100.0 1,252 4.7 Copperbelt 6.3 36.8 12.0 24.5 10.6 9.3 0.5 100.0 2,168 6.5 Eastern 21.2 51.7 11.5 11.1 3.0 1.1 0.3 100.0 1,883 3.0 Luapula 15.9 50.5 15.3 14.0 2.6 1.5 0.1 100.0 993 3.8 Lusaka 8.1 34.8 10.1 25.0 9.3 12.4 0.4 100.0 1,949 6.6 Northern 15.5 48.5 14.0 17.0 3.1 1.8 0.1 100.0 1,715 4.4 North-Western 16.5 50.7 8.7 18.0 3.6 1.8 0.6 100.0 671 3.7 Southern 12.2 45.6 16.8 18.2 4.1 2.7 0.3 100.0 1,351 4.9 Western 23.8 45.5 10.6 14.3 3.2 2.0 0.6 100.0 775 3.0 Wealth quintile Lowest 21.3 54.3 13.3 9.9 1.0 0.1 0.2 100.0 2,445 2.9 Second 21.3 51.5 13.4 12.1 1.2 0.2 0.3 100.0 2,343 3.0 Middle 14.4 50.9 15.4 15.6 2.9 0.6 0.3 100.0 2,490 4.1 Fourth 9.3 38.7 14.6 25.9 7.7 3.1 0.6 100.0 2,682 6.1 Highest 3.7 30.1 7.4 26.5 13.8 18.1 0.4 100.0 2,796 8.2 Total 13.6 44.5 12.7 18.4 5.6 4.8 0.4 100.0 12,756 4.8 1 Completed 7th year at the primary level 2 Completed 12th year at the secondary level Figure 2.2 illustrates that the proportion with no education is higher for females than for males in all age groups, apart from the younger age groups 6-9 and 10-14. 18 | Household Population and Housing Characteristics 2.3.2 School Attendance Rates Table 2.4 shows primary school and secondary school net and gross attendance ratios (NAR and GAR) for the school year that started in 2007 by household residence and zones. The NAR for primary school is the percentage of the primary-school-age (6-12 years) population that is attending primary school. The NAR for secondary school is the percentage of the secondary-school-age (13-17 years) population that is attending secondary school. By definition, the NAR cannot exceed 100 per- cent. The GAR for primary school is the total number of primary school students, of any age, expressed as a percentage of the official primary-school-age population. The GAR for secondary school is the total number of secondary school students, of any age, expressed as a percentage of the official secondary-school-age population. If there are significant numbers of overage and underage students at a given level of schooling, the GAR can exceed 100 percent. Youth are considered to be attending school currently if they attended formal academic school at any point during the given school year. The gender parity index (GPI) assesses sex-related differences in school attendance rates and is calculated by dividing the GAR for females by the GAR for males. A GPI less than 1 indicates a gender disparity in favour of males (i.e., a higher proportion of males than females attends that level of schooling). A GPI greater than 1 indicates a gender disparity in favour of females. A GPI of 1 indicates parity or equality between the rates of participation for males and females. Table 2.4 shows the NARs and GARs for the de facto household population by sex and level of schooling and the GPI, by background characteristics. Results show that the overall NAR for primary schools is 80 percent, while the GAR is 105 percent. Analysis by rural and urban residences reveals that the NAR is much higher in urban areas (87 percent) than in rural areas (76 percent). Similarly, the GAR is also higher in urban areas than in rural areas (110 and 102 percent, respectively). At the provincial level, the primary NAR and GAR is highest in the Copperbelt (88 and 113 percent, respectively). Western province has the lowest NAR and GAR with 71 and 93 percent, respectively. In terms of wealth quintile, the NAR is 90 percent for the highest quintile and 73 percent for the lowest quintile. The same trend applies to the GAR at the primary level (112 percent for the highest quintile and 100 percent for the lowest quintile, respectively). Figure 2.2 Percent Distribution of Household Population with No Education by Sex � � � � � � � � � � � � � � � � � � � � � � � � � � 6-9 10-14 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55-59 60-64 65+ Age 0 10 20 30 40 50 60 70 Percentage Female Male� � ZDHS 2007 Household Population and Housing Characteristics | 19 Table 2.4 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, Zambia 2007 Net attendance ratio1 Gross attendance ratio2 Background characteristic Male Female Total Gender Parity Index3 Male Female Total Gender Parity Index PRIMARY SCHOOL Residence Urban 87.7 86.5 87.1 0.99 110.8 108.8 109.8 0.98 Rural 76.1 76.7 76.4 1.01 105.8 98.3 102.0 0.93 Province Central 83.0 83.0 83.0 1.00 108.1 108.7 108.4 1.01 Copperbelt 89.3 86.6 87.9 0.97 114.7 111.9 113.3 0.98 Eastern 73.8 74.5 74.1 1.01 100.4 94.1 97.3 0.94 Luapula 74.0 69.4 71.8 0.94 98.3 89.4 94.1 0.91 Lusaka 85.2 84.8 85.0 0.99 107.8 105.9 106.8 0.98 Northern 74.6 77.1 76.0 1.03 109.8 97.3 103.1 0.89 North-Western 77.3 80.7 79.1 1.04 112.2 108.1 110.1 0.96 Southern 87.7 86.9 87.3 0.99 119.7 104.9 112.6 0.88 Western 67.9 73.2 70.6 1.08 90.9 94.9 93.0 1.04 Wealth quintile Lowest 71.5 74.2 72.9 1.04 101.7 97.5 99.6 0.96 Second 74.6 73.5 74.1 0.99 100.3 93.5 97.0 0.93 Middle 79.8 80.0 79.9 1.00 113.0 101.4 107.1 0.90 Fourth 84.8 85.0 84.9 1.00 110.9 107.0 109.0 0.96 Highest 91.2 88.3 89.7 0.97 112.8 110.6 111.7 0.98 Total 80.0 80.1 80.0 1.00 107.5 101.9 104.7 0.95 SECONDARY SCHOOL Residence Urban 57.8 52.6 55.0 0.91 86.0 70.0 77.4 0.81 Rural 24.2 20.5 22.4 0.85 40.9 24.2 32.7 0.59 Province Central 36.2 32.8 34.4 0.91 56.2 38.3 46.9 0.68 Copperbelt 55.3 53.1 54.1 0.96 81.0 70.5 75.3 0.87 Eastern 20.1 20.8 20.4 1.04 37.7 25.2 31.4 0.67 Luapula 30.2 19.4 24.8 0.64 48.5 28.7 38.6 0.59 Lusaka 52.7 45.6 48.9 0.86 74.8 58.2 66.0 0.78 Northern 29.2 22.8 26.2 0.78 50.4 32.9 42.2 0.65 North-Western 31.1 23.3 27.0 0.75 57.3 30.5 43.2 0.53 Southern 37.0 41.9 39.3 1.13 54.3 48.6 51.7 0.89 Western 28.7 26.4 27.3 0.92 56.4 32.8 42.6 0.58 Wealth quintile Lowest 14.2 5.4 9.8 0.38 28.7 7.2 18.0 0.25 Second 20.3 19.2 19.7 0.95 37.6 22.8 30.0 0.61 Middle 25.3 22.2 23.9 0.88 42.2 27.9 35.6 0.66 Fourth 43.6 40.7 42.1 0.93 68.6 51.6 59.5 0.75 Highest 69.0 63.1 65.9 0.91 98.1 82.8 89.9 0.84 Total 38.2 35.4 36.8 0.93 59.7 45.5 52.4 0.76 1 The NAR for primary school is the percentage of the primary-school-age (7-13 years) population that is attending primary school. The NAR for secondary school is the percentage of the secondary-school-age (14-18 years) population that is attending secondary school. By definition the NAR cannot exceed 100 percent. 2 The GAR for primary school is the total number of primary school students, expressed as a percentage of the official primary-school-age population. The GAR for secondary school is the total number of secondary school students, expressed as a percentage of the official secondary-school-age population. If there are significant numbers of overage and underage students at a given level of schooling, the GAR can exceed 100 percent. 3 The Gender Parity Index for primary school is the ratio of the primary school NAR(GAR) for females to the NAR(GAR) for males. The Gender Parity Index for secondary school is the ratio of the secondary school NAR(GAR) for females to the NAR(GAR) for males. The NAR at the secondary school level is 37 percent, while the GAR is 52 percent. This is an indication that fewer people attend secondary school than primary school. The rural and urban ratios follow the national pattern; however, the ratios are much higher in urban areas than in rural areas. 20 | Household Population and Housing Characteristics Copperbelt has the highest NAR (54 percent) while Eastern province has the lowest (20 per- cent). The same provinces have the highest and lowest GAR (75 percent for Copperbelt and 31 per- cent for Eastern). Like primary school ratios, the NAR and GAR are higher in the highest wealth quintile (66 and 90 percent, respectively) and lower in the lowest wealth quintile (10 and 18 percent, respectively). Figure 2.3 illustrates net and gross attendance ratios by sex. There are no marked differences in the NAR between males and females at the primary school level, but at the secondary school level slight differences can be observed. In terms of gross ratios, differences are noted between males and females, with males having higher ratios in both cases. 2.3.3 Grade Repetition and Dropout Rates Repetition rates and dropout rates shown in Table 2.5 describe the flow of pupils through the educational system in Zambia at the primary level. The repetition rates indicate the percentage of pupils who attended a particular grade during the school year that started in 2006 who again attended that same class during the following school year. The dropout rates show the percentage of pupils in a grade during the school year that started in 2006 who no longer attended school the following school year. Table 2.5 shows that, overall, repetition and dropping out of school in Zambia is highest at grade seven (5 percent). There are no differences in repetition rates between rural and urban areas at the seventh grade level. However, in terms of sex, the repetition rates are higher among males (7 per- cent) than among females (3 percent) at the same level. Provincial differentials indicate that repetition rates are generally higher in Copperbelt and Southern provinces and lower in Luapula, Eastern, and Western provinces for primary school grades 1-7. 80 38 108 60 80 35 102 46 80 37 105 53 Primary Secondary Primary Secondary 0 20 40 60 80 100 120 Percentage Male Female Total Figure 2.3 Net and Gross Attendance Ratios by Sex ZDHS 2007 80.0 80.0 NET ATTENDANCE RATIO GROSS ATTENDANCE RATIO Household Population and Housing Characteristics | 21 Table 2.5 Grade repetition and dropout rates Repetition and dropout rates for the de facto household population age 5-24 who attended primary school in the previous school year by school grade, according to background characteristics, Zambia 2007 School grade Background characteristic 1 2 3 4 5 6 7 REPETITION RATE1 Sex Male 3.1 4.3 2.4 2.0 1.8 1.7 6.9 Female 2.0 3.1 2.1 1.8 3.3 1.4 3.3 Residence Urban 1.0 3.1 3.1 1.6 3.4 1.4 5.3 Rural 3.2 3.9 1.8 2.2 2.0 1.8 5.3 Province Central 4.8 4.1 1.1 2.2 1.5 2.7 2.8 Copperbelt 0.5 6.1 1.8 1.9 6.0 1.8 10.9 Eastern 3.9 6.4 2.1 1.8 3.0 3.9 0.6 Luapula 0.0 1.1 0.0 0.0 0.0 0.0 0.8 Lusaka 2.0 0.4 5.0 1.2 1.5 1.2 2.8 Northern 3.4 2.7 2.2 5.8 3.6 0.0 6.3 North-Western 4.3 3.3 2.3 2.1 1.3 0.0 2.7 Southern 2.9 4.7 3.5 0.8 1.9 3.1 10.3 Western 0.0 0.0 1.2 0.0 0.0 0.0 1.0 Wealth quintile Lowest 6.2 2.5 1.7 3.1 0.0 2.1 7.9 Second 2.0 4.6 1.2 0.7 1.8 0.0 3.2 Middle 0.8 4.4 1.9 1.9 2.5 3.4 5.4 Fourth 1.8 3.3 2.0 2.4 4.0 0.2 6.8 Highest 1.1 3.6 4.3 1.6 3.6 2.0 4.4 Total 2.5 3.7 2.3 1.9 2.5 1.6 5.3 DROPOUT RATE2 Sex Male 1.5 1.7 1.8 2.9 1.2 2.7 9.8 Female 1.7 1.6 1.6 1.4 3.9 5.5 13.4 Residence Urban 1.4 2.0 1.8 1.3 1.4 3.8 11.0 Rural 1.7 1.6 1.7 2.7 3.2 4.2 11.8 Province Central 2.9 1.0 0.0 0.0 2.7 5.6 13.9 Copperbelt 3.3 1.4 2.6 1.4 0.6 4.4 7.3 Eastern 0.7 2.7 3.7 4.2 3.6 8.9 14.5 Luapula 1.8 2.6 1.0 2.3 1.5 0.0 13.6 Lusaka 1.1 3.3 2.7 3.0 2.7 4.5 16.6 Northern 1.7 0.0 0.9 1.7 3.0 2.1 6.1 North-Western 0.0 2.4 1.3 3.2 5.1 4.1 8.4 Southern 2.2 0.0 0.0 0.8 0.0 1.0 10.8 Western 0.0 2.8 1.2 1.7 6.9 4.5 11.6 Wealth quintile Lowest 1.7 1.6 1.9 4.8 3.8 8.0 17.9 Second 1.4 1.6 1.9 0.4 6.3 1.7 9.8 Middle 2.1 1.4 0.7 3.3 1.9 4.2 10.8 Fourth 2.2 2.6 4.3 1.9 1.5 5.9 16.8 Highest 0.7 1.2 0.0 0.6 0.0 1.5 7.0 Total 1.6 1.7 1.7 2.1 2.5 4.0 11.4 1 The repetition rate is the percentage of students in a given grade in the previous school year who are repeating that grade in the current school year. 2 The dropout rate is the percentage of students in a given grade in the previous school year who are not attending school. The patterns for dropout rates are similar to those of repetition rates. Dropout rates are highest in the seventh grade (1 percent) and lowest in the first grade (2 percent). Dropout rates at grade seven are higher among females (13 percent) than among males (10 percent). In terms of residence, dropout rates at grade seven are similar in rural (12 percent) and urban areas (11 percent). The table also shows that dropout rates at grade seven are highest among respondents in the lowest wealth quintile (18 percent) and lowest among respondents in the highest wealth quintile (7 percent). 22 | Household Population and Housing Characteristics Figure 2.4 shows the age-specific attendance rates for the male and female de facto population age 5 to 24. The figure shows that there are no marked differences in the attendance rates between males and females from age 5 to 14; however, after age 14 attendance rates for males are much higher than those for females at all ages. 2.4 HOUSEHOLD ENVIRONMENT The physical characteristics of a household dwelling are important determinants of socio- economic and health status. The 2007 ZDHS respondents were asked a number of questions about their household environment, including questions on the source of drinking water; type of sanitation facility; type of flooring, walls, and roof; and number of rooms in the dwelling. The results are presented both in terms of households and the de jure population. 2.4.1 Drinking Water Increasing access to improved drinking water is one of the Millennium Development Goals that Zambia and other nations worldwide have adopted (United Nations General Assembly, 2001). Table 2.6 includes a number of indicators that are useful in monitoring household access to improved drinking water (WHO and UNICEF, 2005). The source of drinking water is an indicator of whether it is suitable for drinking. Sources that are likely to provide water suitable for drinking are identified as improved sources in Table 2.6. They include a piped source within the dwelling or plot, public tap, tube well or borehole, and protected well or spring.1 Lack of ready access to water may limit the quantity of suitable drinking water that is available to a household, even if the water is obtained from an improved source. Water that must be fetched from a source that is not immediately accessible to the household may be contaminated during transport or storage. Another factor in considering the accessibility of water sources is that the burden of fetching water often falls disproportionately on female members of the household. Finally, home water treatment can be effective in improving the quality of household drinking water. 1 The categorization into improved and non-improved follows that proposed by the WHO/UNICEF Joint Monitoring Programme for Water Supply and Sanitation (WHO and UNICEF, 2004). Figure 2.4 Age-Specific Attendance Rates of the De Facto Population Age 5 to 24 by Sex � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � � 5 10 15 20 Age 0 20 40 60 80 100 Percent Male Female� � ZDHS 2007 Household Population and Housing Characteristics | 23 Table 2.6 Household drinking water Percent distribution of households and de jure population by characteristics of source of drinking water, and percentage using an appropriate method to treat drinking water, according to residence, Zambia 2007 Households Population Characteristic Urban Rural Total Urban Rural Total Source of drinking water Improved source 82.2 19.2 41.0 82.0 19.6 41.8 Piped water into dwelling/yard/plot 39.7 1.4 14.7 42.5 1.3 16.0 Public tap/standpipe 36.9 1.9 14.0 33.8 1.8 13.2 Protected dug well 5.6 15.9 12.3 5.7 16.4 12.6 Non-improved source 13.7 78.0 55.8 14.0 77.7 55.0 Unprotected dug well 12.6 46.8 35.0 13.1 46.9 34.9 Tanker truck/cart with small tank 0.0 0.0 0.0 0.0 0.0 0.0 Surface water 1.1 31.1 20.7 1.0 30.7 20.1 Bottled water, improved source for cooking/washing1 0.3 0.0 0.1 0.2 0.0 0.1 Other 3.8 2.8 3.2 3.8 2.8 3.1 Total 100.0 100.0 100.0 100.0 100.0 100.0 Percentage using any improved source of drinking water 82.5 19.2 41.1 82.2 19.6 41.9 Time to obtain drinking water (round trip) Water on premises 48.9 8.1 22.2 51.9 8.4 23.9 Less than 30 minutes 42.1 60.8 54.3 39.3 60.1 52.7 30 minutes or longer 8.4 30.0 22.5 8.3 30.5 22.6 Don't know/missing 0.6 1.2 1.0 0.5 1.0 0.8 Total 100.0 100.0 100.0 100.0 100.0 100.0 Person who usually collects drinking water Adult female 15+ 37.3 81.3 66.1 36.5 83.4 66.7 Adult male 15+ 9.0 6.3 7.2 6.0 3.3 4.3 Female child under age 15 3.3 2.9 3.0 3.8 3.5 3.6 Male child under age 15 1.3 1.1 1.1 1.5 1.1 1.2 Other 0.2 0.4 0.3 0.3 0.2 0.3 Water on premises 48.8 8.0 22.1 51.8 8.4 23.9 Missing 0.1 0.1 0.1 0.1 0.1 0.1 Total 100.0 100.0 100.0 100.0 100.0 100.0 Water treatment prior to drinking2 Boiled 26.5 9.3 15.2 28.5 9.4 16.2 Bleach/chlorine/Clorin 43.5 18.6 27.2 44.5 20.2 28.9 Strained through cloth 0.1 0.1 0.1 0.2 0.2 0.2 Ceramic, sand or other filter 0.1 0.0 0.1 0.0 0.0 0.0 Solar disinfection 0.0 0.1 0.1 0.0 0.1 0.0 Other 0.4 1.0 0.8 0.4 1.0 0.8 No treatment 44.9 75.9 65.1 42.7 74.6 63.2 Percentage using an appropriate treatment method 3 54.8 23.2 34.2 57.0 24.5 36.1 Method for storing water Closed container/jerry can 91.3 89.1 89.9 90.9 89.0 89.7 Open container/bucket 7.7 8.9 8.5 8.0 9.1 8.7 Other 1.0 1.7 1.5 1.1 1.6 1.4 Missing 0.1 0.2 0.2 0.1 0.2 0.2 Total 100.0 100.0 100.0 100.0 100.0 100.0 Number 2,479 4,685 7,164 12,457 22,523 34,980 1 Because the quality of bottled water is not known, households using bottled water for drinking are classified as using an improved or non-improved source according to their water source for cooking and washing. 2 Respondents may report multiple treatment methods so the sum of treatment may exceed 100 percent. 3 Appropriate water treatment methods include boiling, bleaching, straining, filtering, and solar disinfecting. The table shows that only 41 percent of the households have access to improved sources of water. Households in urban areas are more likely to have access to improved sources of water than those in rural areas (83 percent compared with 19 percent). More than half of the households (56 per- cent) draw their water from an unimproved source. Almost half of the households in urban areas (49 percent) have water on their premises, while about one in every ten households (8 percent) in rural areas have water on their premises. Overall, 23 percent of the households take 30 or more minutes to obtain water; 8 percent in urban areas compared with 30 percent in the rural areas. 24 | Household Population and Housing Characteristics It can also be observed that adult females collect drinking water more often than adult males (66 and 7 percent, respectively). Results also show that both male and female children below age 15 are involved in collecting drinking water. Most of the households (65 percent) do not treat their water, while only 34 percent use an appropriate method to treat their water. Bleach, chlorine or Clorin use and boiling are the most common methods used by households for water treatment (27 and 15 percent, respectively). Treating drinking water with Clorin, a locally produced solution of 0.5% sodium hypochlorite, is promoted throughout Zambia to make the water safer to drink. Table 2.7 shows that 91 percent of Zambians have heard of Clorin. The sources of where Clorin messages are heard differ by urban and rural residence. Forty percent of respondents living in urban areas have heard Clorin messages on the radio, compared with only 17 percent in rural areas. Respondents living in rural areas are informed of Clorin primarily at health facilities (38 per- cent). Overall, 13 percent of respondents use Clorin, of which 24 percent are in urban areas and 8 percent are in rural areas. 2.4.2 Household Sanitation Facilities Ensuring adequate sanitation facilities is another of the Millennium Development Goals that Zambia shares with other countries. A household is classified as having an improved toilet if the toilet is used only by members of one household (i.e., it is not shared) and if the facility used by the household separates the waste from human contact (WHO/UNICEF Joint Monitoring Programme for Water Supply and Sanitation, 2004). Table 2.8 shows that almost four in ten households in Zambia (39 percent) use pit latrines that are open or have no slab: 27 percent in urban areas and 45 percent in rural areas. Flush toilets are mainly found in urban areas and are used by 26 percent of households, compared with 1 percent in rural areas. Overall, 25 percent of households in Zambia have no toilet facilities. This problem is more common in rural areas (37 per- cent) than in urban areas (2 percent). Table 2.7 Knowledge and use of Clorin Percent distribution of households by knowledge of Clorin, source of information about Clorin, and current use of Clorin, according to residence, Zambia 2007 Residence Characteristic Urban Rural Total Ever heard about/saw Clorin Yes 97.8 86.6 90.5 No 2.2 13.3 9.5 Missing 0.0 0.0 0.0 Total 100.0 100.0 100.0 Source where heard/saw messages about Clorin1 Radio 40.0 17.2 25.1 Television 32.0 2.7 12.8 Shop 25.0 17.4 20.1 Leaflets/booklets 3.9 0.8 1.9 Poster 3.2 0.8 1.6 Community-based agent 34.2 32.0 32.7 Health facility 30.5 37.7 35.2 Other 9.1 8.1 8.4 Never heard or saw messages/no source mentioned/missing 2.2 13.4 9.5 Currently using Clorin Yes 23.6 7.7 13.2 No 74.0 89.9 84.4 Missing 2.4 2.4 2.4 Total 100.0 100.0 100.0 Number 2,479 4,685 7,164 1 Respondents may report multiple information sources so the sum of sources may exceed 100 percent. Household Population and Housing Characteristics | 25 Table 2.8 Household sanitation facilities Percent distribution of households and de jure population by type of toilet/latrine facilities, according to residence, Zambia 2007 Households Population Type of toilet/latrine facility Urban Rural Total Urban Rural Total Improved, not shared facility 36.9 11.4 20.2 43.7 12.9 23.9 Flush/pour flush to piped sewer system 19.2 0.2 6.8 22.6 0.3 8.2 Flush/pour flush to septic tank 6.5 0.4 2.5 7.5 0.5 3.0 Flush/pour flush to pit latrine 0.4 0.1 0.2 0.5 0.1 0.3 Ventilated improved pit (VIP) latrine 3.1 5.4 4.6 3.9 5.9 5.2 Pit latrine with slab 7.6 5.3 6.1 9.1 6.1 7.2 Composting toilet 0.1 0.0 0.0 0.1 0.0 0.0 Non-improved facility 63.2 88.6 79.8 56.2 87.1 76.1 Any facility shared with other households 32.8 5.8 15.1 27.8 5.5 13.4 Flush/pour flush not to sewer/septic tank/pit latrine 0.4 0.0 0.1 0.3 0.0 0.1 Pit latrine without slab/open pit 27.0 44.5 38.5 25.9 45.4 38.5 Hanging toilet/hanging latrine 0.0 0.1 0.1 0.0 0.1 0.0 No facility/bush/field 2.4 37.3 25.2 1.8 35.4 23.5 Other 0.5 0.8 0.7 0.3 0.7 0.5 Missing 0.1 0.1 0.1 0.1 0.0 0.1 Total 100.0 100.0 100.0 100.0 100.0 100.0 Number 2,479 4,685 7,164 12,457 22,523 34,980 2.4.3 Housing Characteristics Table 2.9 presents information on a number of household dwelling characteristics. These characteristics reflect the household’s socio-economic situation. They also may influence environ- mental conditions—for example, in the case of the use of biomass fuels, exposure to indoor pollu- tion—that have a direct bearing on household members’ health and welfare. The proportion of households with electricity in Zambia is 19 percent. There are more households with electricity in urban areas (48 percent) than in rural areas (3 percent). Figure 2.5 shows that there has been a slight improvement in electrification during the past 15 years. Overall, less than one in every five households has electricity. In urban areas, there has been a continuous improvement in electrification from 39 percent in 1992 to 48 percent in 2007. Earth/sand is the most common material used for floors, with six in every ten households having floors made of earth/sand. The percentages are higher in rural areas where more than eight in ten households (86 percent) have floors made out of earth/sand, compared with 16 percent in urban areas. Cement is the second most common flooring material (35 percent). Almost half of the households in Zambia (47 percent) live in housing units with only one bedroom, while less than one in five households (17 percent) live in housing units with three or more bedrooms. About four in ten households (41 percent) cook outdoors, while slightly over a quarter (27 percent) cook in their dwelling. The percentage of households that cook in their dwelling is much higher in urban areas (63 percent) than in rural areas (8 percent). Wood is the most common fuel used for cooking, reported by 60 percent of households. Wood is more commonly used in rural areas (88 percent) than in urban areas (8 percent). In urban areas, charcoal is more commonly used than in rural areas (53 and 10 percent, respectively). 26 | Household Population and Housing Characteristics Table 2.9 Household characteristics Percent distribution of households and de jure population by housing characteristics and percentage using solid fuel for cooking; and among those using solid fuels, percent distribution by type of fire/stove, according to residence, Zambia 2007 Households Population Housing characteristic Urban Rural Total Urban Rural Total Electricity Yes 47.8 3.0 18.5 52.1 3.3 20.7 No 52.2 97.0 81.5 47.9 96.7 79.3 Total 100.0 100.0 100.0 100.0 100.0 100.0 Flooring material Earth, sand 15.5 85.5 61.3 14.3 84.2 59.3 Dung 1.5 2.0 1.8 1.2 1.9 1.7 Palm/bamboo 0.0 0.0 0.0 0.0 0.0 0.0 Parquet or polished wood 0.3 0.0 0.1 0.4 0.0 0.1 Vinyl or asphalt strips 0.9 0.0 0.4 1.1 0.0 0.4 Ceramic tiles 2.6 0.1 1.0 2.9 0.1 1.1 Cement 78.0 12.4 35.1 79.1 13.7 37.0 Carpet 0.8 0.0 0.3 0.9 0.0 0.3 Other 0.2 0.0 0.1 0.2 0.0 0.1 Total 100.0 100.0 100.0 100.0 100.0 100.0 Main roof material No roof 0.1 0.6 0.4 0.0 0.6 0.4 Thatch/palm leaf 8.2 83.5 57.4 7.2 82.2 55.5 Rustic mat 0.0 0.0 0.0 0.0 0.0 0.0 Palm/bamboo 0.0 0.0 0.0 0.0 0.0 0.0 Metal/Iron Sheets 41.4 13.1 22.9 40.1 14.0 23.3 Wood 0.1 0.1 0.1 0.2 0.2 0.2 Calamine/cement fibre (asbestos) 46.7 2.4 17.7 49.0 2.6 19.1 Ceramic tiles/Harvey tiles 0.7 0.0 0.3 0.9 0.1 0.4 Cement 1.9 0.1 0.7 1.7 0.1 0.7 Roofing shingles 0.1 0.0 0.0 0.0 0.0 0.0 Mud tiles 0.2 0.0 0.1 0.3 0.0 0.1 Other 0.6 0.2 0.3 0.5 0.2 0.3 Total 100.0 100.0 100.0 100.0 100.0 100.0 Main wall material No walls 0.0 0.8 0.5 0.0 0.8 0.5 Cane/palm/trunks 0.2 2.5 1.7 0.2 2.3 1.5 Mud 7.4 33.7 24.6 6.7 33.3 23.8 Bamboo/pole with mud 0.6 9.8 6.7 0.5 8.5 5.7 Stone with mud 1.2 0.9 1.0 0.9 0.9 0.9 Plywood 0.1 0.0 0.0 0.1 0.0 0.1 Cardboard 0.0 0.0 0.0 0.0 0.0 0.0 Reused wood 0.0 0.0 0.0 0.0 0.1 0.0 Cement 22.8 2.2 9.3 24.5 2.3 10.2 Stone with lime/cement 9.9 0.5 3.8 10.0 0.6 4.0 Bricks 26.2 46.1 39.2 26.2 47.9 40.2 Cement blocks 30.8 2.4 12.2 30.2 2.6 12.4 Wood planks/shingles 0.0 0.0 0.0 0.0 0.0 0.0 Other 0.7 1.0 0.8 0.5 0.8 0.7 Missing 0.1 0.0 0.1 0.1 0.0 0.1 Total 100.0 100.0 100.0 100.0 100.0 100.0 Rooms used for sleeping One 34.3 54.0 47.2 22.3 45.3 37.1 Two 37.9 33.6 35.1 38.7 37.3 37.8 Three or more 26.9 11.6 16.9 38.0 16.6 24.2 Missing 0.9 0.7 0.8 0.9 0.8 0.8 Total 100.0 100.0 100.0 100.0 100.0 100.0 Continued… Household Population and Housing Characteristics | 27 Table 2.9—Continued Households Population Housing characteristic Urban Rural Total Urban Rural Total Place for cooking In the house 63.1 7.6 26.8 64.4 6.9 27.4 Has separate kitchen 39.9 5.7 17.5 45.4 5.4 19.6 No separate kitchen 21.5 1.8 8.6 17.3 1.4 7.0 Missing 1.8 0.2 0.8 1.8 0.2 0.8 In a separate building 5.0 45.7 31.6 5.7 48.0 32.9 Outdoors 31.7 45.7 40.9 29.6 44.0 38.9 Other 0.1 0.9 0.7 0.2 1.1 0.8 Missing 0.0 0.0 0.0 0.1 0.0 0.0 Total 163.1 107.6 126.8 164.4 106.9 127.4 Cooking fuel Electricity 38.5 1.8 14.5 41.2 1.8 15.8 LPG/natural gas/biogas 0.0 0.0 0.0 0.0 0.0 0.0 Kerosene 0.0 0.0 0.0 0.0 0.0 0.0 Coal/lignite 0.6 0.0 0.2 0.5 0.0 0.2 Charcoal 53.1 10.2 25.0 50.7 10.0 24.5 Wood 7.5 87.8 60.0 7.5 88.1 59.4 Straw/shrubs/grass 0.0 0.1 0.1 0.0 0.1 0.1 Agricultural crop 0.0 0.0 0.0 0.0 0.0 0.0 No food cooked in household 0.2 0.1 0.1 0.0 0.0 0.0 Total 100.0 100.0 100.0 100.0 100.0 100.0 Percentage using solid fuel for cooking 1 61.3 98.2 85.4 58.7 98.2 84.1 Number of households 2,479 4,685 7,164 12,457 22,523 34,980 Type of fire/stove among households using solid fuel Closed stove with chimney 0.1 0.0 0.0 0.1 0.0 0.0 Open fire/stove with chimney 0.2 0.2 0.2 0.2 0.2 0.2 Open fire/stove with hood 0.4 0.1 0.2 0.5 0.1 0.2 Open fire/stove without chimney or hood 98.7 99.2 99.1 98.5 99.1 99.0 Missing 0.6 0.4 0.4 0.6 0.5 0.5 Total 100.0 100.0 100.0 100.0 100.0 100.0 Number of households/population using solid fuel 1,518 4,599 6,117 7,311 22,119 29,430 LPG = Liquid petroleum gas 1 Includes coal/lignite, charcoal, wood/straw/shrubs/grass, agricultural crops, and animal dung The percentage of households using solid fuel is quite high (85 percent)—98 percent of household in rural areas and 61 percent of households in urban areas. Among the households that reported use of solid fuel for cooking, almost all (99 percent) were using an open fire/stove without a chimney or hood. 2.5 HOUSEHOLD POSSESSIONS The availability of durable consumer goods is a good indicator of a household’s socio- economic status. Moreover, particular goods have specific benefits. For instance, having access to a radio or a television exposes household members to innovative ideas; a refrigerator prolongs food storage; and a means of transport allows greater access to many services away from the local area. Table 2.10 shows the availability of selected consumer goods by residence; 58 percent of households own a radio, (71 percent in urban areas and 50 percent in rural areas) and 24 percent own a television (57 percent in urban areas and 7 percent in rural areas). A mobile telephone is owned by 28 percent of the households (62 percent in urban areas and 10 percent in rural areas). Thirteen percent of households own a refrigerator. Televisions, refrigerators, and telephones or cell phones are predominantly in urban areas, presumably because of the lack of electricity and/or financial resources in rural areas. 28 | Household Population and Housing Characteristics Table 2.10 Household possessions goods Percentage of households and de jure population possessing various household effects, and means of transportation, agricultural land and livestock/farm animals, by residence, Zambia 2007 Households Population Possession Urban Rural Total Urban Rural Total Household effects Radio 71.1 50.3 57.5 75.0 54.7 61.9 Television 56.7 7.3 24.4 63.9 8.8 28.4 Mobile telephone 61.7 10.2 28.0 67.9 12.0 31.9 Non-mobile telephone 5.9 0.2 2.1 6.4 0.2 2.4 Refrigerator 32.9 1.7 12.5 38.6 1.9 15.0 Bed 89.4 54.3 66.4 92.3 57.1 69.6 Chair 71.7 44.9 54.2 76.9 48.9 58.9 Table 80.1 43.0 55.8 85.0 47.4 60.8 Cupboard 61.5 15.3 31.3 67.2 17.6 35.3 Sofa 59.9 10.1 27.3 67.1 11.7 31.4 Clock 57.3 11.1 27.1 62.8 12.7 30.5 Fan 26.4 1.3 10.0 30.5 1.3 11.7 Sewing machine 12.9 4.6 7.5 15.8 5.4 9.1 Cassette player 46.2 18.3 27.9 50.3 21.1 31.5 Plough 2.5 13.7 9.8 2.9 16.2 11.5 Grain grinder 2.3 1.5 1.7 2.7 1.9 2.2 VCR/DVD 29.9 2.0 11.7 34.4 2.1 13.6 Tractor 0.5 0.3 0.4 0.5 0.3 0.4 Hammer mill 0.4 0.9 0.7 0.5 1.3 1.1 Watch 51.2 31.7 38.5 55.1 35.4 42.4 Means of transport Bicycle 27.1 47.8 40.6 31.5 54.1 46.0 Animal drawn cart 0.5 5.7 3.9 0.8 7.0 4.8 Motorcycle/scooter 0.4 0.4 0.4 0.5 0.4 0.5 Car/truck 6.5 0.6 2.7 7.9 0.8 3.3 Boat with a motor 0.2 0.1 0.1 0.2 0.1 0.1 Banana boat 0.3 3.8 2.6 0.3 4.2 2.8 Ownership of agricultural land 27.4 88.3 67.2 30.7 89.7 68.7 Ownership of farm animals1 19.7 72.3 54.1 23.5 77.9 58.5 Ownership of bank/savings account2 31.1 4.2 13.5 35.6 4.9 15.8 Number 2,479 4,685 7,164 12,457 22,523 34,980 1 Includes livestock and poultry 2 At least one household member has an account. Four in ten households (41 percent) own a bicycle (27 percent in urban areas and 48 percent in rural areas), while only 3 percent own a car and less than 1 percent own a motorcycle. Among the household possessions listed above, the bicycle and animal drawn cart are the only possessions that are more common in rural areas than in urban areas. Agricultural land is owned by 67 percent of households (88 percent in rural areas and 27 percent in urban areas, respectively), whereas farm animals are owned by 54 percent of households (72 percent in rural areas and 20 percent in urban areas). Figure 2.6 shows that household ownership of a television and bicycle has increased over time, while possession of a car/truck has remained at the same level from 1996 to 2007. There has been an increase in the ownership of a radio from 42 percent in 2002 to 58 percent in 2007. Household Population and Housing Characteristics | 29 2.6 WEALTH INDEX The wealth index is a background characteristic that is used throughout the report as a proxy for measuring the household’s long-term standard of living. It is based on data from the household’s ownership of consumer goods; dwelling characteristics; type of drinking water source; toilet facilities; and other characteristics that are related to a household’s socio-economic status. To construct the index, each of these assets was assigned a weight (factor score) generated through principal component analysis, and the resulting asset scores were standardized in relation to a standard normal distribution with a mean of zero and standard deviation of one (Gwatkin et al., 2000). Each household was then assigned a score for each asset, and the scores were summed for each household. Individuals were ranked according to the total score of the household in which they resided. The sample was then divided into quintiles from one (lowest) to five (highest). A single asset index was developed on the basis of data from the entire country sample and this index is used in all the tabulations presented. Table 2.11 shows the distribution of the de jure household population into five wealth levels (quintiles) based on the wealth index by residence and province. The distributions indicate the degree to which wealth is evenly (or unevenly) distributed geographically. The table shows that urban areas have higher proportions of people in the fourth and highest quintiles (40 and 53 percent, respectively) as opposed to rural areas (9 and 2 percent, respectively). On the other hand, rural areas have more people in the lowest and second quintiles (31 percent each) than urban areas, which have less than 1 percent for both categories combined. It also follows that the more urbanized provinces of Lusaka and Copperbelt have high proportions of people in the highest quintiles (58 and 48 percent, re- spectively) while predominantly rural provinces, apart from Luapula (9 percent), have higher proportions of people in the lowest quintiles. Among the rural provinces, Eastern and Western exhibit the highest proportions of people in the lowest quintile (45 percent for both). 39 8 7 19 1 4 44 17 7 25 1 3 42 19 10 30 0 3 58 24 13 41 0 3 Radio Television Refrigerator Bicycle Motorcycle Car/Truck Possessions 0 20 40 60 80 Percentage 1992 1996 2001-02 2007 Figure 2.6 Trends in Percentage of Households Owning Specific Possessions, Zambia 1992-2007 30 | Household Population and Housing Characteristics Table 2.11 Wealth quintiles Percent distribution of the de jure population by wealth quintiles, according to residence and province, Zambia 2007 Wealth quintile Residence/region Lowest Second Middle Fourth Highest Total Number of population Residence Urban 0.1 0.5 5.8 40.3 53.4 100.0 12,457 Rural 31.0 30.8 27.9 8.8 1.5 100.0 22,523 Province Central 17.6 24.1 27.9 21.5 8.9 100.0 3,450 Copperbelt 3.4 4.9 7.8 35.8 48.1 100.0 5,676 Eastern 44.8 23.8 15.8 12.5 3.0 100.0 5,216 Luapula 8.8 32.1 43.0 12.0 4.1 100.0 2,811 Lusaka 1.6 2.0 5.5 33.5 57.5 100.0 4,817 Northern 24.7 31.8 27.4 9.8 6.3 100.0 5,044 North-Western 21.7 37.3 28.2 9.9 2.8 100.0 2,023 Southern 21.9 14.8 29.0 22.0 12.3 100.0 3,610 Western 45.2 32.3 12.6 5.7 4.2 100.0 2,333 Total 20.0 20.0 20.0 20.0 20.0 100.0 34,980 2.7 BIRTH REGISTRATION Birth registration is the formal inscription of the facts of a birth into an official log kept at the registrar’s office. A birth certificate is issued at the time of registration or later as proof of the registration of the birth. Birth registration is basic to ensuring a child’s legal status and, thus, basic rights and services (UNICEF, 2006; United Nations General Assembly, 2002). Table 2.12 shows the percentage of children under five years of age whose births were officially registered and the percentage who had a birth certificate at the time of the survey. Not all children who are registered have a birth certificate because some certificates may have been lost or were never issued. However, all children with a certificate have been registered. The table shows that only 14 percent of children under the age of five have been registered. Only 5 percent of registered children under five have birth certificates. More births are registered in urban areas (28 percent) than in rural areas (9 percent). This could be attributed to the fact that most of the registration centres are in urban areas. At the provincial level, Lusaka has the highest proportion of registered births (35 percent) while Eastern and Luapula have the lowest (1 percent each). Children in wealthier households are more likely to be registered than those in poorer households; 31 percent are registered in household in the highest quintile com- pared with 5 percent in households in the lowest quintile. Household Population and Housing Characteristics | 31 Table 2.12 Birth registration of children under age five Percentage of de jure children under five years of age whose births are registered with the civil authorities, by background characteristics, Zambia 2007 Children whose births are registered Background characteristic Percentage who had birth certificate Percentage who did not have birth certificate Percentage registered Number of children Age <2 5.0 8.6 13.7 2,697 2-4 5.5 8.8 14.3 3,644 Sex Male 5.2 8.8 14.0 3,133 Female 5.4 8.7 14.0 3,208 Residence Urban 14.4 13.2 27.7 1,795 Rural 1.7 7.0 8.6 4,546 Province Central 1.8 15.8 17.6 643 Copperbelt 9.9 7.4 17.3 872 Eastern 0.4 0.6 1.0 997 Luapula 0.8 0.3 1.1 577 Lusaka 20.8 14.4 35.2 695 Northern 2.1 16.6 18.7 1,003 North-Western 1.2 14.2 15.4 428 Southern 5.6 7.0 12.6 679 Western 4.2 1.3 5.5 447 Wealth quintile Lowest 0.9 4.4 5.3 1,526 Second 0.8 7.8 8.6 1,425 Middle 2.4 9.9 12.3 1,360 Fourth 9.9 11.7 21.6 1,166 Highest 18.7 12.2 30.9 864 Total 5.3 8.7 14.0 6,341 Characteristics of Respondents | 33 CHARACTERISTICS OF RESPONDENTS 3 Chipalo Kaliki and Arthur Kachemba The objective of this chapter is to provide a demographic and socioeconomic profile of respondents in the 2007 ZDHS. Information on the basic characteristics of women and men interviewed in the survey is important for the interpretation of findings presented in the report. The chapter begins by describing basic background characteristics, including age, marital status, educational level, and residential characteristics. This is followed by more detailed information on education, literacy, and exposure to mass media. Next, data on the employment status and earnings of women and men, health insurance coverage, and knowledge and attitudes concerning tuberculosis are presented. Last, data on tobacco use are provided as a lifestyle measure. 3.1 CHARACTERISTICS OF SURVEY RESPONDENTS The percent distributions of women age 15-49 and of men age 15-59 interviewed in the 2007 ZDHS by key background characteristics, including age, marital status, urban-rural residence, place of residence, educational level, and household wealth quintile are presented in Table 3.1. For both sexes, a high proportion of the respondents are youth age 15-24 (41 percent of both women and men). The proportion in each age group tends to decrease with increasing age. Table 3.1 shows that most of the respondents are currently married (61 percent of women and 52 percent of men). About a quarter (26 percent) of female respondents have never been married compared with over two-fifths (43 percent) of male respondents. Table 3.1 also shows that female respondents are twice as likely as male respondents to be divorced or separated (8 and 4 percent, respectively). Table 3.1 Background characteristics of respondents Percent distribution of women and men age 15-49 by selected background characteristics, Zambia 2007 Women Men Background characteristic Weighted percent Weighted Unweighted Weighted percent Weighted Unweighted Age 15-19 22.0 1,574 1,598 23.6 1,416 1,412 20-24 19.2 1,370 1,405 17.8 1,066 1,065 25-29 19.1 1,363 1,374 16.3 977 987 30-34 14.8 1,056 1,042 15.9 954 940 35-39 10.5 747 732 12.0 717 733 40-44 7.9 561 533 7.9 475 472 45-49 6.6 475 462 6.5 390 396 Marital status Never married 26.0 1,856 1,941 42.6 2,553 2,542 Married 60.9 4,351 4,264 52.3 3,136 3,158 Living together 0.7 52 52 0.5 32 28 Divorced/separated 8.1 577 577 3.6 217 220 Widowed 4.4 311 312 1.0 57 57 Residence Urban 42.1 3,009 3,178 43.4 2,601 2,631 Rural 57.9 4,137 3,968 56.6 3,395 3,374 Continued… 34 | Characteristics of Respondents Table 3.1—Continued Women Men Background characteristic Weighted percent Weighted Unweighted Weighted percent Weighted Unweighted Province Central 9.2 659 672 9.3 559 550 Copperbelt 17.7 1,264 829 19.0 1,140 743 Eastern 13.6 971 940 13.3 795 783 Luapula 7.4 530 704 6.5 387 516 Lusaka 16.4 1,172 939 17.9 1,072 896 Northern 13.5 966 783 13.4 805 661 North-Western 5.1 365 685 5.0 303 583 Southern 10.2 727 822 10.4 621 726 Western 6.9 492 772 5.2 315 547 Education No education 10.4 744 741 4.5 267 263 Primary 54.4 3,891 3,805 46.3 2,775 2,759 Secondary 29.9 2,140 2,242 41.9 2,512 2,562 More than secondary 5.2 371 358 7.4 441 421 Wealth quintile Lowest 17.4 1,240 1,131 18.6 1,114 1,051 Second 18.0 1,283 1,245 14.5 869 870 Middle 17.9 1,280 1,409 18.3 1,097 1,214 Fourth 21.9 1,567 1,733 23.0 1,381 1,503 Highest 24.9 1,776 1,628 25.6 1,534 1,367 Religion Catholic 20.4 1,461 1,368 21.6 1,295 1,228 Protestant 77.8 5,558 5,652 75.1 4,501 4,586 Muslim 0.5 33 26 0.5 32 24 Other 1.2 87 90 2.6 154 158 Missing 0.1 9 10 0.2 12 9 Total 15-49 100.0 7,146 7,146 100.0 5,995 6,005 50-59 na na na 100.0 505 495 Total men 15-59 na na na 100.0 6,500 6,500 Note: Education categories refer to the highest level of education attended, whether or not that level was completed. na = Not applicable More than half of women and men interviewed live in rural areas (58 and 57 percent, respectively). The largest proportion of both female and male respondents are from the Copperbelt province (18 and 19 percent, respectively), with the smallest proportion residing in North-Western province (5 percent for both women and men). Table 3.1 further shows that 90 percent of women and 96 percent of men have some form of education at the primary, secondary, and higher than secondary levels. Fifty-four percent of women and 46 percent of men have attended primary school, while the proportion is reversed for secondary education where more men than women (42 and 30 percent, respectively) have attended secondary education. Table 3.1 also shows that the majority of women (78 percent) and men (75 percent) are Protestant, followed by Catholic (20 and 22 percent, respectively). A quarter of both female and male respondents live in households in the highest wealth quintile. 3.2 EDUCATIONAL ATTAINMENT Educational attainment is generally one of the key indicators for analysing women’s status. As stated in an International Labour Organisation (ILO) briefing kit, large educational differentials between men and women tend to sustain a perpetual gender inequality within the family and in society at large. Data on enrolment ratios suggest that educational attainment is largely conditioned by a society’s level of socioeconomic development and that larger gender gaps in schooling are observed in regions with lower overall educational levels (ILO, 1995). Characteristics of Respondents | 35 Overall, the level of education in Zambia is higher among men than women. Tables 3.2.1 and 3.2.2 provide an overview of the relationship between the respondents’ level of education and other background characteristics. The tables show that younger respondents, especially among women, are more likely to be educated and to reach higher levels of education than respondents of older age groups. The proportion of women without education ranges from 4 percent for women age 15-19 years to 20 percent for women age 45-49. In contrast, men with no education range from 1 percent for the age group 15-19 to 7 percent for age group 45-49. Tables 3.2.1 and 3.2.2 also show that when compared with women, higher proportions of men complete secondary school, particularly at age 20-24 and 25-29 (16 and 17 percent of men compared with 12 and 5 percent of women, respectively). High dropout rates among girls at the primary and secondary levels may explain some of the differences in educational attainment between women and men. The Government of Zambia has considered measures to enhance girls’ retention rates in school. One such measure allows girls who drop out of school due to pregnancy to return and continue their education after they have delivered. At the provincial level, rural provinces1 have the highest proportion of respondents with no schooling, with Western province leading for females (22 percent) and Eastern province leading for males (11 percent). Among provinces, the gender gap (the difference in percentage points between women and men) in the proportion reporting no schooling is 9 percentage points in Eastern province versus only 1 and 2 percentage points in Copperbelt and Lusaka, respectively. Table 3.2.1 Educational attainment: Women Percent distribution of women age 15-49 by highest level of schooling attended or completed, and median number of years completed, according to background characteristics, Zambia 2007 Highest level of schooling Background characteristic No education Some primary Completed primary1 Some secondary Completed secondary2 More than secondary Total Median years completed Number of women Age 15-24 6.5 34.2 14.9 33.7 8.0 2.7 100.0 6.6 2,944 15-19 4.0 34.2 14.3 42.3 4.7 0.5 100.0 6.7 1,574 20-24 9.4 34.1 15.5 23.9 11.9 5.2 100.0 6.4 1,370 25-29 9.6 34.6 19.5 22.8 5.3 8.4 100.0 6.3 1,363 30-34 12.9 38.3 21.4 18.5 3.8 5.1 100.0 5.9 1,056 35-39 12.7 38.7 24.5 13.7 2.9 7.4 100.0 5.8 747 40-44 17.3 33.3 25.2 15.9 2.1 6.2 100.0 5.9 561 45-49 19.5 36.5 22.5 13.4 0.9 7.2 100.0 5.3 475 Residence Urban 3.2 19.7 17.3 37.7 10.7 11.3 100.0 8.0 3,009 Rural 15.6 46.8 20.3 15.0 1.5 0.8 100.0 4.9 4,137 Province Central 7.7 35.7 21.7 27.5 4.2 3.3 100.0 6.3 659 Copperbelt 2.8 23.6 18.4 36.0 9.0 10.2 100.0 7.5 1,264 Eastern 19.5 46.7 17.7 11.7 3.0 1.4 100.0 4.3 971 Luapula 12.0 49.1 17.0 18.3 2.0 1.6 100.0 4.9 530 Lusaka 4.4 24.5 17.3 31.9 9.4 12.5 100.0 7.3 1,172 Northern 13.2 46.7 19.4 16.1 3.6 1.0 100.0 5.1 966 North-Western 15.4 48.2 14.5 17.3 3.3 1.3 100.0 4.8 365 Southern 8.3 26.2 25.7 31.4 4.5 3.9 100.0 6.6 727 Western 22.2 36.4 18.8 17.5 3.1 1.9 100.0 5.2 492 Wealth quintile Lowest 19.6 53.8 17.9 8.2 0.6 0.0 100.0 3.9 1,240 Second 19.0 48.3 20.1 11.9 0.7 0.1 100.0 4.4 1,283 Middle 12.0 45.3 22.4 18.7 1.3 0.3 100.0 5.4 1,280 Fourth 4.9 30.3 22.8 35.1 5.5 1.4 100.0 6.6 1,567 Highest 1.5 10.7 13.3 40.0 15.1 19.4 100.0 8.8 1,776 Total 10.4 35.4 19.0 24.5 5.4 5.2 100.0 6.2 7,146 1 Completed 7th grade at the primary level 2 Completed 12th grade at the secondary level 1 Rural provinces refers to all provinces of Zambia with the exception of Copperbelt and Lusaka. 36 | Characteristics of Respondents Higher wealth status is associated with higher level of educational attainment. Nine percent of women in the lowest wealth quintile have attended or completed secondary or higher education compared with 55 percent of women in the highest wealth quintile. Among men, 20 percent in the lowest wealth quintile have attended or completed secondary or higher education, compared with 60 percent in the highest quintile. Tables 3.2.1 and 3.2.2 also show the median number of years of schooling. Overall, the median number of years of schooling completed is 6.2 for women and 6.9 for men. Younger female and male respondents and those living in urban areas have more years of schooling. Respondents in Copperbelt and Lusaka provinces have more years of schooling than those in other provinces. Table 3.2.2 Educational attainment: Men Percent distribution of men age 15-49 by highest level of schooling attended or completed, and median number of years completed, according to background characteristics, Zambia 2007 Highest level of schooling Background characteristic No education Some primary Completed primary1 Some secondary Completed secondary2 More than secondary Total Median years completed Number of men Age 15-24 2.4 29.9 14.9 40.7 9.3 2.8 100.0 7.1 2,482 15-19 1.1 34.1 14.4 45.8 4.1 0.6 100.0 6.9 1,416 20-24 4.0 24.3 15.7 34.0 16.3 5.7 100.0 7.7 1,066 25-29 5.6 23.9 20.5 23.8 16.7 9.5 100.0 7.0 977 30-34 5.4 25.1 22.0 27.0 9.7 10.8 100.0 6.9 954 35-39 5.9 28.8 20.6 26.2 7.9 10.5 100.0 6.7 717 40-44 6.8 23.9 24.4 25.1 7.9 11.7 100.0 6.8 475 45-49 7.1 21.0 29.3 26.4 4.6 11.7 100.0 6.8 390 Residence Urban 1.5 12.2 14.6 40.4 16.9 14.4 100.0 8.7 2,601 Rural 6.8 38.2 23.0 25.4 4.7 1.9 100.0 6.2 3,395 Province Central 3.9 27.3 21.9 32.0 10.4 4.4 100.0 6.8 559 Copperbelt 2.0 13.2 15.9 39.8 16.1 12.9 100.0 8.6 1,140 Eastern 10.7 43.1 18.8 19.7 6.0 1.8 100.0 5.6 795 Luapula 2.6 37.9 23.6 28.1 5.0 2.8 100.0 6.4 387 Lusaka 2.5 16.1 15.1 36.0 13.7 16.6 100.0 8.4 1,072 Northern 4.8 33.1 23.6 29.0 7.0 2.5 100.0 6.5 805 North-Western 5.3 35.8 13.2 35.4 7.1 3.1 100.0 6.5 303 Southern 2.6 27.5 26.5 32.0 7.4 4.0 100.0 6.7 621 Western 9.6 33.3 18.5 28.4 6.5 3.6 100.0 6.4 315 Wealth quintile Lowest 9.3 46.9 23.5 18.3 2.0 0.0 100.0 5.4 1,114 Second 7.7 40.3 23.2 25.8 2.9 0.2 100.0 6.1 869 Middle 4.8 35.8 24.1 29.4 5.1 0.9 100.0 6.4 1,097 Fourth 2.6 18.0 22.2 40.9 12.4 3.9 100.0 7.8 1,381 Highest 0.6 6.7 8.1 39.0 21.2 24.5 100.0 10.4 1,534 Total 15-49 4.5 27.0 19.3 31.9 10.0 7.4 100.0 6.9 5,995 50-59 6.2 23.7 22.6 27.5 3.0 16.9 100.0 6.9 505 Total men 15-59 4.6 26.7 19.6 31.6 9.5 8.1 100.0 6.9 6,500 1 Completed 7th grade at the primary level 2 Completed 12th grade at the secondary level 3.3 LITERACY ASSESSMENT The ability to read is an important personal asset allowing women and men increased opportuni- ties in life. Knowing the distribution of the literate population can help programme managers—especially those concerned with health and family planning programmes—adopt approaches that are most likely to best reach women and men with their messages. In the 2007 ZDHS, literacy was assessed by a respondent’s ability to read all or part of a simple sentence in any of the seven major language groups of Zambia.2 The literacy test was administered only to respondents who had less than secondary education. 2 The major language groups are Bemba, Kaonde, Lozi, Lunda, Luvale, Nyanja, Tonga, and English. Characteristics of Respondents | 37 Tables 3.3.1 and 3.3.2 show the percent distribution of female and male respondents according to their level of schooling attended, level of literacy, and percent literate by background characteristics. As with educational achievement, literacy rates are higher among men than women. More than six in ten women (64 percent) compared with eight in ten men (82 percent) in Zambia are literate. There are no clear patterns of literacy by age. For women, however, literacy is highest (73 percent) among young women age 15-19; for men, literacy is highest among those age 15-19 and 40-44 (84 percent each). Table 3.3.1 Literacy: Women Percent distribution of women age 15-49 by level of schooling attended and level of literacy, and percentage literate, according to background characteristics, Zambia 2007 No schooling or primary school Background characteristic Secondary school or higher Can read a whole sentence Can read part of a sentence Cannot read at all No card with required language Blind/ visually impaired Missing Total Percentage literate1 Number Age 15-19 47.5 16.9 8.9 24.7 1.6 0.0 0.4 100.0 73.3 1,574 20-24 41.0 10.4 9.6 37.9 0.9 0.0 0.2 100.0 61.0 1,370 25-29 36.4 17.4 10.6 33.9 1.5 0.3 0.0 100.0 64.3 1,363 30-34 27.4 19.0 9.9 40.8 2.3 0.2 0.5 100.0 56.2 1,056 35-39 24.1 24.9 10.1 38.6 2.1 0.2 0.0 100.0 59.1 747 40-44 24.2 28.3 11.8 34.1 1.0 0.3 0.3 100.0 64.3 561 45-49 21.5 27.1 12.0 35.5 3.0 0.8 0.0 100.0 60.7 475 Residence Urban 59.7 13.0 8.7 16.4 1.8 0.2 0.2 100.0 81.3 3,009 Rural 17.3 22.5 11.1 47.3 1.5 0.2 0.2 100.0 50.8 4,137 Province Central 34.9 18.4 15.7 28.5 2.1 0.2 0.2 100.0 69.0 659 Copperbelt 55.2 18.2 7.0 18.0 1.3 0.1 0.2 100.0 80.3 1,264 Eastern 16.1 23.4 8.2 52.0 0.0 0.1 0.1 100.0 47.7 971 Luapula 21.9 19.9 16.0 41.9 0.2 0.2 0.0 100.0 57.8 530 Lusaka 53.8 8.9 11.3 22.7 2.6 0.3 0.4 100.0 74.1 1,172 Northern 20.8 20.7 10.8 45.7 1.5 0.2 0.3 100.0 52.3 966 North-Western 21.9 8.4 16.3 47.1 5.9 0.2 0.2 100.0 46.6 365 Southern 39.8 22.9 3.9 31.4 1.6 0.2 0.1 100.0 66.6 727 Western 22.6 27.1 7.6 40.5 1.7 0.0 0.4 100.0 57.4 492 Wealth quintile Lowest 8.7 21.7 9.9 58.0 1.6 0.1 0.1 100.0 40.3 1,240 Second 12.6 22.9 12.1 50.5 1.3 0.2 0.3 100.0 47.6 1,283 Middle 20.3 22.9 12.9 41.9 1.5 0.2 0.3 100.0 56.1 1,280 Fourth 42.1 19.0 10.3 26.4 2.0 0.2 0.0 100.0 71.4 1,567 Highest 74.5 9.4 6.4 7.4 1.7 0.2 0.4 100.0 90.3 1,776 Total 35.1 18.5 10.1 34.3 1.6 0.2 0.2 100.0 63.7 7,146 1 Refers to women who attended secondary school or higher and women who can read a whole sentence or part of a sentence. Women and men in urban areas have higher literacy rates (81 and 90 percent, respectively) than their rural counterparts (51 and 75 percent, respectively). Variations in literacy by province show that Copperbelt and Lusaka have the highest literacy rates for women (80 and 74 percent, respectively) and men (90 and 85 percent, respectively). It must be noted that literacy rates among men are reasonably high across all provinces, ranging from 71 percent in Eastern to 90 percent in Copperbelt. As with educational attainment, literacy is positively associated with household wealth status. 38 | Characteristics of Respondents Table 3.3.2 Literacy: Men Percent distribution of men age 15-49 by level of schooling attended and level of literacy, and percentage literate, according to background characteristics, Zambia 2007 No schooling or primary school Background characteristic Secondary school or higher Can read a whole sentence Can read part of a sentence Cannot read at all No card with required language Blind/ visually impaired Missing Total Percentage literate1 Number Age 15-19 50.4 21.5 11.6 15.2 1.0 0.0 0.3 100.0 83.5 1,416 20-24 56.0 15.7 9.4 18.2 0.7 0.0 0.0 100.0 81.0 1,066 25-29 50.0 17.8 11.2 19.2 1.3 0.0 0.4 100.0 79.1 977 30-34 47.5 20.5 12.5 18.0 1.5 0.0 0.0 100.0 80.5 954 35-39 44.7 23.2 12.0 18.8 1.2 0.0 0.1 100.0 79.9 717 40-44 44.8 28.8 10.7 14.4 1.2 0.0 0.0 100.0 84.4 475 45-49 42.7 32.3 8.1 13.9 3.0 0.0 0.0 100.0 83.1 390 Residence Urban 71.7 9.9 8.3 8.8 1.1 0.0 0.2 100.0 89.9 2,601 Rural 32.0 29.8 13.1 23.4 1.4 0.0 0.2 100.0 75.0 3,395 Province Central 46.9 19.5 16.3 15.2 1.9 0.0 0.2 100.0 82.7 559 Copperbelt 68.9 12.8 8.6 9.6 0.2 0.0 0.0 100.0 90.2 1,140 Eastern 27.4 27.3 16.5 28.6 0.0 0.0 0.2 100.0 71.2 795 Luapula 35.9 37.9 8.7 17.3 0.0 0.0 0.2 100.0 82.5 387 Lusaka 66.3 7.6 10.8 13.3 1.7 0.0 0.3 100.0 84.8 1,072 Northern 38.4 32.1 9.6 18.3 1.6 0.0 0.0 100.0 80.2 805 North-Western 45.7 11.7 15.1 18.2 9.2 0.0 0.1 100.0 72.5 303 Southern 43.4 28.0 8.7 19.6 0.1 0.0 0.2 100.0 80.1 621 Western 38.6 32.6 4.6 22.5 1.2 0.0 0.4 100.0 75.8 315 Wealth quintile Lowest 20.2 32.9 14.8 30.2 1.7 0.0 0.2 100.0 67.9 1,114 Second 28.8 33.5 11.9 23.9 1.7 0.0 0.1 100.0 74.2 869 Middle 35.4 28.9 12.9 21.3 1.4 0.0 0.1 100.0 77.2 1,097 Fourth 57.3 15.8 12.6 13.0 1.3 0.0 0.1 100.0 85.7 1,381 Highest 84.6 5.1 5.0 4.5 0.5 0.0 0.2 100.0 94.8 1,534 Total 15-49 49.3 21.2 11.0 17.1 1.3 0.0 0.2 100.0 81.5 5,995 50-59 47.5 28.3 11.1 11.2 1.0 0.9 0.1 100.0 86.8 505 Total men 15-59 49.1 21.7 11.0 16.6 1.2 0.1 0.2 100.0 81.9 6,500 1 Refers to men who attended secondary school or higher and men who can read a whole sentence or part of a sentence. 3.4 EXPOSURE TO MASS MEDIA Access to information is essential to increasing people’s knowledge and awareness of what is taking place around them, which may eventually affect their perceptions and behaviour. This information is important for use in planning programmes intended to spread information about health and family planning through various media messages. In the 2007 ZDHS, exposure to the media was assessed by asking how often a respondent reads the newspaper, watches television, or listens to the radio. Tables 3.4.1 and 3.4.2 show the percentage of women and men who were exposed to different types of media at least once a week by background characteristics. Tables 3.4.1 and 3.4.2 show distinct patterns of exposure to different forms of mass media. The majority of women and men listen to the radio at least once a week (59 percent of women and 74 percent of men, respectively). Thirty-one percent of women and 37 percent of men watch television at least once a week. It is apparent that print media are least utilised by both women and men when compared with other media. This is particularly true for women (22 percent read a newspaper at least once a week) compared with men (29 percent read a newspaper at least once a week). Only 12 percent of women and 18 percent Characteristics of Respondents | 39 of men have access to all three types of media at least once a week. One-third of women and one-fifth of men are not exposed to media of any type. It is important to note that there are pronounced differentials by sex and residence in exposure to different forms of mass media. Generally, urban residents are more likely to be exposed to any or all forms of mass media than rural residents. Education has a major impact on access to any of the specified media for women and men. Exposure to mass media increases steadily with an increase in educational attainment. A similar pattern is observed in the relationship between mass media exposure and wealth quintiles. Table 3.4.1 Exposure to mass media: Women Percentage of women age 15-49 who are exposed to specific media on a weekly basis, by background characteristics, Zambia 2007 Background characteristic Reads a newspaper at least once a week Watches television at least once a week Listens to radio at least once a week All three media at least once a week No media at least once a week Number Age 15-19 29.3 36.3 58.3 14.8 29.4 1,574 20-24 20.5 29.9 57.8 11.6 34.2 1,370 25-29 20.9 32.5 61.3 11.7 31.5 1,363 30-34 16.3 28.4 56.6 10.2 36.3 1,056 35-39 21.2 28.2 59.2 12.6 34.5 747 40-44 23.9 26.5 57.7 10.7 35.3 561 45-49 21.2 28.5 57.8 10.6 34.4 475 Residence Urban 34.7 60.8 71.0 25.2 16.6 3,009 Rural 13.3 9.4 49.5 2.5 45.1 4,137 Province Central 16.2 30.6 59.2 7.3 32.2 659 Copperbelt 26.6 55.8 73.6 20.0 16.5 1,264 Eastern 29.5 12.3 65.2 6.8 26.8 971 Luapula 4.5 10.0 43.9 2.5 53.7 530 Lusaka 36.4 64.8 69.1 28.1 17.1 1,172 Northern 4.6 11.4 42.5 3.0 55.1 966 North-Western 10.3 7.8 50.1 2.4 45.9 365 Southern 39.8 27.0 58.1 13.7 27.3 727 Western 8.6 9.6 35.2 3.2 61.4 492 Education No education 0.6 8.1 41.3 0.0 56.7 744 Primary 11.0 17.4 52.4 2.6 41.1 3,891 Secondary 40.0 53.6 71.0 23.7 15.7 2,140 More than secondary 82.0 91.0 85.5 68.9 1.8 371 Wealth quintile Lowest 9.3 1.7 39.9 0.2 55.8 1,240 Second 10.0 2.4 44.8 0.5 50.9 1,283 Middle 13.1 9.4 52.9 1.5 41.0 1,280 Fourth 20.3 33.4 64.2 8.1 26.3 1,567 Highest 48.6 85.9 80.6 39.8 4.7 1,776 Total 22.3 31.1 58.6 12.1 33.1 7,146 40 | Characteristics of Respondents Table 3.4.2 Exposure to mass media: Men Percentage of men age 15-49 who are exposed to specific media on a weekly basis, by background characteristics, Zambia 2007 Background characteristic Reads a newspaper at least once a week Watches television at least once a week Listens to radio at least once a week All three media at least once a week No media at least once a week Number Age 15-19 24.6 44.4 69.4 14.1 19.8 1,416 20-24 33.0 40.1 72.6 20.5 18.2 1,066 25-29 30.6 35.5 77.2 19.1 17.7 977 30-34 30.4 35.0 75.3 18.4 19.4 954 35-39 27.5 28.6 77.1 16.8 20.2 717 40-44 27.4 32.6 77.3 18.7 18.5 475 45-49 29.1 29.9 74.5 15.8 20.0 390 Residence Urban 47.1 66.5 80.3 34.6 9.0 2,601 Rural 14.9 14.3 69.3 4.5 26.8 3,395 Province Central 17.4 29.7 69.4 10.5 23.2 559 Copperbelt 36.3 59.2 78.2 25.8 12.5 1,140 Eastern 23.1 15.2 71.8 6.4 22.6 795 Luapula 15.2 20.8 81.3 8.8 17.8 387 Lusaka 51.0 68.7 80.3 38.7 8.7 1,072 Northern 17.5 15.2 67.3 6.7 28.3 805 North-Western 25.5 13.8 64.5 6.7 29.1 303 Southern 24.9 35.7 75.6 15.8 18.8 621 Western 18.2 15.9 66.2 8.7 30.5 315 Education No education 1.1 10.8 56.0 0.0 41.7 267 Primary 11.7 19.9 69.3 3.8 26.2 2,775 Secondary 41.5 49.8 78.4 26.0 12.0 2,512 More than secondary 81.4 86.5 89.7 66.6 1.2 441 Wealth quintile Lowest 12.8 4.0 59.1 0.8 36.4 1,114 Second 11.9 6.1 70.6 2.0 27.5 869 Middle 13.4 15.8 73.0 4.0 23.5 1,097 Fourth 32.0 42.9 76.8 17.0 15.3 1,381 Highest 58.3 88.1 85.2 48.7 2.0 1,534 Total 15-49 28.9 36.9 74.1 17.5 19.1 5,995 50-59 32.6 34.2 75.5 19.5 20.0 505 Total men 15-59 29.1 36.7 74.2 17.7 19.2 6,500 3.5 EMPLOYMENT STATUS Female and male respondents were asked whether they were employed at the time of the survey and if not, whether they had been employed in the 12 months preceding the survey. Accurate assessment of employment status can be difficult because some work, especially on family farms, family businesses, or in the informal sector, is often not perceived as employment and hence not reported as such. To avoid underestimating a respondent’s employment status, the 2007 ZDHS asked respondents several questions to probe for their employment status and to ensure complete coverage of employment in both the formal or informal sectors. Respondents were asked a number of questions to elicit their current employment status and continuity of employment in the past 12 months. Employed individuals are those who reported that they were currently working (i.e., had worked in the past 7 days) and those who had worked at any time during the 12 months preceding the survey. Tables 3.5.1 and 3.5.2 show the percent distribution of respondents according to current and recent employment status. Overall, less than half (47 percent) of women and about eight in ten men (76 percent) are currently employed. Seven percent of women were not employed at the time of the survey, while 46 percent did not work in the 12 months preceding the survey. Among men, 4 percent were not employed at the time of the survey and 20 percent had not worked in the 12 months preceding the survey. Characteristics of Respondents | 41 Table 3.5.1 Employment status: Women Percent distribution of women age 15-49 by employment status, according to background characteristics, Zambia 2007 Employed in the 12 months preceding the survey Background characteristic Currently employed1 Not currently employed Not employed in the 12 months preceding the survey Missing/ don't know Total Number of women Age 15-19 19.2 4.3 76.5 0.0 100.0 1,574 20-24 44.0 7.2 48.8 0.0 100.0 1,370 25-29 52.4 6.8 40.6 0.2 100.0 1,363 30-34 58.3 8.8 32.8 0.1 100.0 1,056 35-39 62.2 8.3 29.4 0.1 100.0 747 40-44 64.8 9.7 25.6 0.0 100.0 561 45-49 65.5 10.4 24.1 0.0 100.0 475 Marital status Never married 26.6 3.0 70.5 0.0 100.0 1,856 Married or living together 51.9 9.1 38.9 0.1 100.0 4,402 Divorced/separated/widowed 67.3 6.9 25.9 0.0 100.0 888 Number of living children 0 27.4 3.8 68.8 0.0 100.0 1,855 1-2 49.3 7.3 43.3 0.1 100.0 2,150 3-4 55.5 8.8 35.6 0.1 100.0 1,642 5+ 59.6 9.8 30.6 0.1 100.0 1,499 Residence Urban 45.2 3.1 51.6 0.1 100.0 3,009 Rural 48.7 10.2 41.1 0.1 100.0 4,137 Province Central 46.0 2.1 51.7 0.2 100.0 659 Copperbelt 49.9 5.7 44.2 0.1 100.0 1,264 Eastern 22.9 24.9 52.1 0.0 100.0 971 Luapula 33.0 1.7 65.4 0.0 100.0 530 Lusaka 42.6 1.7 55.7 0.0 100.0 1,172 Northern 53.5 8.2 38.3 0.0 100.0 966 North-Western 72.9 4.4 22.7 0.0 100.0 365 Southern 57.7 8.1 34.0 0.1 100.0 727 Western 69.3 1.3 29.2 0.2 100.0 492 Education No education 48.8 12.6 38.4 0.1 100.0 744 Primary 48.8 8.5 42.6 0.1 100.0 3,891 Secondary 38.8 3.9 57.2 0.1 100.0 2,140 More than secondary 75.7 2.4 21.9 0.0 100.0 371 Wealth quintile Lowest 48.4 14.6 36.9 0.1 100.0 1,240 Second 51.7 9.0 39.3 0.0 100.0 1,283 Middle 45.4 8.1 46.5 0.1 100.0 1,280 Fourth 46.8 4.7 48.4 0.1 100.0 1,567 Highest 44.8 2.4 52.7 0.1 100.0 1,776 Total 47.2 7.2 45.5 0.1 100.0 7,146 1 Currently employed is defined as having done work in the past seven days. The category includes persons who did not work in the past seven days but who are regularly employed and were absent from work for leave, illness, vacation, or any other such reason. Current employment levels increase with age among women, ranging from 19 percent for women age 15-19 to 66 percent for women age 45-49. The highest proportion of currently employed men is among men age 30-39 (95 percent). Women who are divorced, separated, or widowed are more likely to be currently employed (67 percent) than women who have never been married (27 percent) or those who are currently in union (52 percent), whereas men who are currently in union are more likely to be currently employed (95 percent) than men who have never been married (51 percent) or are divorced, separated, or widowed (87 percent). The data further indicate that the proportion of women and men who are employed increases with the number of living children. Women and men with no children are least likely to be employed. Diverting from the general pattern observed in most countries, variations by place of residence 42 | Characteristics of Respondents show that a higher percentage of women and men in rural areas (49 and 82 percent, respectively) are employed compared with their urban counterparts (45 and 69 percent, respectively). There are substantial provincial variations in women’s and men’s employment characteristics. Women in North-Western (73 percent), Western (69 percent), and Southern (58 percent) provinces are more likely than women in other provinces to have been currently employed in the past 12 months, while the same is true for men in Central (90 percent), Luapula (84 percent), Northern (83 percent), and North-Western (81 percent) provinces, who are more likely than men in other provinces to be currently employed. Table 3.5.2 Employment status: Men Percent distribution of men age 15-49 by employment status, according to background characteristics, Zambia 2007 Employed in the 12 months preceding the survey Background characteristic Currently employed1 Not currently employed Not employed in the 12 months preceding the survey Missing/ don't know Total Number of men Age 15-19 37.0 3.8 59.0 0.1 100.0 1,416 20-24 71.7 4.4 23.6 0.4 100.0 1,066 25-29 90.8 3.8 5.4 0.0 100.0 977 30-34 94.9 2.1 2.9 0.1 100.0 954 35-39 94.9 2.6 2.5 0.0 100.0 717 40-44 92.5 3.6 3.9 0.0 100.0 475 45-49 92.0 5.0 2.6 0.5 100.0 390 Marital status Never married 51.1 4.2 44.6 0.1 100.0 2,553 Married or living together 95.2 2.8 1.7 0.2 100.0 3,168 Divorced/separated/widowed 86.5 6.0 7.4 0.0 100.0 274 Number of living children 0 54.0 4.0 41.8 0.2 100.0 2,697 1-2 93.3 3.2 3.4 0.1 100.0 1,235 3-4 94.3 2.6 2.9 0.2 100.0 1,085 5+ 94.9 3.7 1.4 0.0 100.0 978 Residence Urban 68.9 2.9 28.0 0.3 100.0 2,601 Rural 81.6 4.1 14.3 0.1 100.0 3,395 Province Central 90.1 1.9 8.0 0.0 100.0 559 Copperbelt 69.8 2.3 27.6 0.2 100.0 1,140 Eastern 75.0 7.1 17.8 0.1 100.0 795 Luapula 83.8 1.9 14.1 0.2 100.0 387 Lusaka 69.1 3.2 27.3 0.4 100.0 1,072 Northern 83.0 1.6 15.5 0.0 100.0 805 North-Western 80.9 4.8 14.3 0.0 100.0 303 Southern 77.6 4.2 18.2 0.0 100.0 621 Western 65.0 8.2 26.8 0.0 100.0 315 Education No education 84.6 7.2 8.2 0.0 100.0 267 Primary 80.9 3.7 15.3 0.1 100.0 2,775 Secondary 67.8 2.9 29.1 0.2 100.0 2,512 More than secondary 87.4 3.8 8.5 0.4 100.0 441 Wealth quintile Lowest 84.1 5.3 10.7 0.0 100.0 1,114 Second 82.0 3.7 14.3 0.0 100.0 869 Middle 81.2 3.9 14.6 0.2 100.0 1,097 Fourth 76.4 2.5 20.9 0.2 100.0 1,381 Highest 62.9 2.9 34.0 0.2 100.0 1,534 Total 15-49 76.0 3.6 20.2 0.1 100.0 5,995 50-59 92.7 3.6 3.7 0.0 100.0 505 Total men 15-59 77.3 3.6 19.0 0.1 100.0 6,500 1 Currently employed is defined as having done work in the past seven days. The category Includes persons who did not work in the past seven days but who are regularly employed and were absent from work for leave, illness, vacation, or any other such reason. Characteristics of Respondents | 43 Women and men with more than secondary education are most likely to be currently employed (76 percent of women and 87 percent of men). Women and men with secondary education are least likely to be currently employed compared with their counterparts in other educational categories (39 percent for women and 68 percent for men). The proportion of men who are currently employed declines as wealth quintile increases. For women, current employment is highest for those in the second quintile but there is no discernable pattern in the relationship between current employment and wealth quintile. Figure 3.1 shows the percent distribution of women and men by employment status during the 12 months preceding the survey. Comparison between women and men shows that women in general were less likely to be employed in the past 12 months than men. 3.6 OCCUPATION Tables 3.6.1 and 3.6.2 show the occupations reported by women and men employed in the 12- month period before the survey. The majority of currently employed women (49 percent) and men (48 percent) worked in agriculture, followed by 37 percent of women and 21 percent of men who were working in sales and services occupations. 0 20 40 60 80 100 Percent Figure 3.1 Men’s and Women’s Employment Status (Past 12 months) ZDHS 2007 WOMEN MEN Currently employed 47% Not currently employed 7% Not employed in the 12 months preceding the survey 46% Currently employed 76% Not currently employed 4% Not employed in the 12 months preceding the survey 20% 44 | Characteristics of Respondents Table 3.6.1 Occupation: Women Percent distribution of women age 15-49 employed in the 12 months preceding the survey by occupation, according to background characteristics, Zambia 2007 Background characteristic Professional/ technical/ managerial Clerical Sales and services Skilled manual Unskilled manual Agriculture Missing Total Number of women Age 15-19 1.1 0.5 40.4 4.3 0.1 52.6 1.0 100.0 370 20-24 4.7 1.4 34.2 4.6 0.0 54.3 0.7 100.0 701 25-29 7.2 2.0 41.0 6.1 0.0 43.1 0.4 100.0 807 30-34 5.5 1.5 39.6 7.8 0.1 45.2 0.2 100.0 709 35-39 6.9 0.8 37.0 7.4 0.0 47.9 0.0 100.0 526 40-44 6.8 2.1 33.2 8.2 0.1 49.1 0.5 100.0 418 45-49 7.4 0.7 33.7 5.9 0.0 52.3 0.0 100.0 360 Marital status Never married 12.1 3.1 47.0 6.5 0.2 29.6 1.5 100.0 548 Married or living together 4.9 1.0 32.8 6.4 0.0 54.6 0.2 100.0 2,685 Divorced/separated/ widowed 4.1 1.7 48.3 6.0 0.0 39.6 0.3 100.0 658 Number of living children 0 11.4 2.2 44.2 5.9 0.0 35.2 1.2 100.0 579 1-2 6.9 1.8 41.7 5.3 0.0 44.0 0.3 100.0 1,217 3-4 4.9 1.5 34.5 6.7 0.1 52.1 0.3 100.0 1,055 5+ 2.3 0.4 31.6 7.6 0.1 57.9 0.2 100.0 1,040 Residence Urban 12.9 3.2 68.4 8.3 0.0 6.6 0.5 100.0 1,456 Rural 1.6 0.4 18.8 5.2 0.1 73.6 0.4 100.0 2,435 Province Central 5.4 1.5 45.0 6.5 0.0 41.7 0.0 100.0 317 Copperbelt 12.4 1.3 60.3 7.9 0.0 17.3 0.9 100.0 703 Eastern 2.7 0.8 18.5 5.2 0.1 72.5 0.3 100.0 465 Luapula 3.3 0.6 37.8 6.9 0.0 51.4 0.0 100.0 184 Lusaka 12.4 4.2 69.4 7.2 0.1 6.7 0.0 100.0 518 Northern 2.1 0.6 17.8 6.1 0.0 73.1 0.3 100.0 596 North-Western 0.8 0.2 13.2 5.5 0.0 80.0 0.3 100.0 282 Southern 3.6 1.6 31.7 5.2 0.2 56.9 0.8 100.0 478 Western 1.9 0.9 22.6 5.9 0.0 67.9 0.7 100.0 347 Education No education 0.2 0.4 20.9 3.0 0.0 75.3 0.3 100.0 457 Primary 0.3 0.2 33.9 6.5 0.1 58.7 0.2 100.0 2,230 Secondary 4.6 2.1 59.3 7.7 0.0 25.5 0.7 100.0 914 More than secondary 60.8 10.0 21.3 5.9 0.0 0.9 1.2 100.0 290 Wealth quintile Lowest 0.5 0.0 12.0 5.0 0.0 82.0 0.5 100.0 782 Second 0.2 0.1 14.1 4.8 0.0 80.7 0.1 100.0 779 Middle 1.2 0.4 27.8 6.1 0.2 63.6 0.7 100.0 684 Fourth 2.8 1.5 68.7 8.3 0.1 18.2 0.3 100.0 808 Highest 22.5 4.6 60.5 7.4 0.0 4.5 0.5 100.0 839 Total 5.8 1.4 37.4 6.4 0.1 48.6 0.4 100.0 3,891 Characteristics of Respondents | 45 Table 3.6.2 Occupation: Men Percent distribution of men age 15-49 employed in the 12 months preceding the survey by occupation, according to background characteristics, Zambia 2007 Background characteristic Professional/ technical/ managerial Clerical Sales and services Skilled manual Unskilled manual Agriculture Missing Total Number of men Age 15-19 0.4 0.9 16.6 11.1 0.8 50.7 19.6 100.0 578 20-24 3.6 0.2 24.2 19.1 0.7 45.8 6.4 100.0 811 25-29 6.2 1.0 25.3 20.1 0.7 44.5 2.2 100.0 924 30-34 7.4 0.7 22.0 21.1 0.7 46.6 1.4 100.0 926 35-39 8.8 1.3 20.4 20.6 0.8 47.7 0.6 100.0 699 40-44 9.6 0.9 14.7 22.1 0.1 51.6 1.1 100.0 457 45-49 6.7 1.9 12.3 20.2 0.4 57.9 0.5 100.0 378 Marital status Never married 4.4 1.0 24.5 18.1 0.8 39.4 11.8 100.0 1,413 Married or living together 7.0 0.9 18.2 19.0 0.5 53.2 1.2 100.0 3,106 Divorced/separated/ widowed 2.8 0.4 29.6 30.0 1.5 33.5 2.2 100.0 254 Number of living children 0 5.0 1.1 23.0 18.4 0.9 40.8 10.8 100.0 1,565 1-2 7.5 0.6 25.7 20.8 0.4 42.9 2.2 100.0 1,192 3-4 6.8 1.2 18.1 19.1 0.7 53.3 0.7 100.0 1,052 5+ 5.2 0.7 13.4 19.1 0.4 60.5 0.6 100.0 964 Residence Urban 11.3 1.9 39.2 32.3 1.2 9.6 4.4 100.0 1,866 Rural 2.6 0.3 8.7 11.0 0.3 72.8 4.3 100.0 2,907 Province Central 4.3 0.4 15.2 11.6 0.5 63.4 4.6 100.0 514 Copperbelt 9.7 1.6 29.7 32.7 0.9 21.1 4.3 100.0 822 Eastern 2.6 0.6 11.4 8.5 0.2 72.6 4.2 100.0 652 Luapula 3.3 0.5 8.3 27.5 0.9 59.2 0.4 100.0 331 Lusaka 11.3 1.9 39.8 29.8 1.2 13.3 2.7 100.0 774 Northern 3.8 0.2 11.3 9.5 0.4 66.8 8.0 100.0 681 North-Western 3.2 0.5 13.0 15.2 0.6 64.8 2.7 100.0 259 Southern 5.2 0.9 21.4 13.1 0.5 51.7 7.2 100.0 508 Western 4.7 0.7 14.4 19.3 0.0 59.7 1.2 100.0 230 Education No education 0.8 0.0 10.8 10.6 1.0 74.9 1.9 100.0 246 Primary 0.4 0.1 17.0 14.8 0.3 62.9 4.5 100.0 2,349 Secondary 4.7 1.5 27.3 25.6 1.1 35.1 4.8 100.0 1,776 More than secondary 48.1 3.8 18.7 23.2 0.4 2.5 3.4 100.0 402 Wealth quintile Lowest 0.2 0.0 2.7 3.6 0.1 90.8 2.6 100.0 995 Second 1.2 0.0 7.2 12.6 0.2 74.4 4.3 100.0 745 Middle 2.0 0.1 13.7 17.3 0.6 60.8 5.4 100.0 935 Fourth 5.8 1.1 39.1 30.1 0.9 17.9 5.0 100.0 1,089 Highest 19.4 3.0 34.7 29.9 1.2 7.4 4.5 100.0 1,009 Total 15-49 6.0 0.9 20.6 19.3 0.6 48.1 4.4 100.0 4,773 50-59 11.9 1.1 12.6 20.0 0.8 51.6 2.2 100.0 486 Total men 15-59 6.6 0.9 19.9 19.4 0.6 48.4 4.2 100.0 5,259 3.7 TYPE OF EMPLOYMENT Table 3.7.1 shows the percent distribution of women employed in the 12 months preceding the survey by type of earnings, type of employer, and continuity of employment, according to type of employment (agriculture or non-agriculture). Table 3.7.1 and Figure 3.2 show that 55 percent of all women employed in agricultural work are not paid for their work, while 83 percent of women in non- agricultural work are given their earnings in cash only. Seventy-nine percent of women employed in agricultural work and 64 percent of women in non-agricultural work are self-employed. Differentials by continuity of employment show that 71 percent of all women in agricultural work are seasonally employed, whereas 67 percent of women in non-agricultural work are employed all year. 46 | Characteristics of Respondents Table 3.7.1 Type of employment: Women Percent distribution of women age 15-49 employed in the 12 months preceding the survey by type of earnings, type of employer, and continuity of employment, according to type of employment (agricultural or non-agricultural), Zambia 2007 Employment characteristics Agricultural work Non- agricultural work Total Type of earnings Cash only 29.3 83.3 57.0 Cash and in-kind 12.5 7.0 9.6 In-kind only 2.9 1.9 2.3 Not paid 55.2 7.8 31.0 Missing 0.1 0.0 0.0 Total 100.0 100.0 100.0 Type of employer Employed by family member 15.6 6.0 10.8 Employed by nonfamily member 5.1 30.0 17.8 Self-employed 79.3 63.9 71.3 Missing 0.0 0.1 0.0 Total 100.0 100.0 100.0 Continuity of employment All year 25.1 67.1 46.7 Seasonal 71.1 14.2 41.9 Occasional 3.6 18.6 11.3 Missing 0.2 0.1 0.1 Total 100.0 100.0 100.0 Number of women employed during the past 12 months 1,890 1,985 3,891 Note: Total includes 16 women with information missing on type of employment who are not shown separately. 29 83 57 13 7 10 3 2 2 55 8 31 Agricultural work Non-agricultural work Total 0 20 40 60 80 100 Percent Cash only Cash and in-kind In-kind only Not paid Figure 3.2 Type of Earnings among Women Employed in the Past 12 Months ZDHS 2007 Characteristics of Respondents | 47 Table 3.7.2 shows the percent distribution of men employed in the 12 months preceding the survey by type of earnings, type of employer, continuity of employment, and whether employment is in the agricultural or non-agricultural sector. Overall, 58 percent of men were paid in cash only, 12 percent received cash and in-kind payment, and just 2 percent received in-kind payment only. Overall, 24 percent of men were not paid for their work. Among men working in the agricultural sector, 43 percent were not paid, 35 percent were paid in cash only, 19 percent received cash and in-kind payment, and 3 percent received in-kind payment only. In contrast, among men working in the non-agricultural sector, 86 percent received cash only, 6 percent received a combination of cash and in-kind payment, and less than 1 percent received in-kind payment only. Overall, 8 percent did not receive any payment for their work. Table 3.7.2 Type of employment: Men Percent distribution of men age 15-49 employed in the 12 months preceding the survey by type of earnings, type of employer, and continuity of employment, according to type of employment (agricultural or non-agricultural), Zambia 2007 Employment characteristics Agricultural work Non-agricultural work Missing Total Type of earnings Cash only 35.3 85.7 13.7 58.3 Cash and in-kind 18.9 6.2 0.0 12.0 In-kind only 3.2 0.6 0.7 1.8 Not paid 42.6 7.5 1.9 24.1 Missing 0.1 0.0 83.7 3.7 Total 15-49 100.0 100.0 100.0 100.0 Type of employer Employed by family member 17.5 6.1 2.6 11.4 Employed by nonfamily member 8.3 55.7 12.3 31.0 Self-employed 74.2 38.2 1.5 53.9 Missing 0.0 0.0 83.7 3.7 Total 15-49 100.0 100.0 100.0 100.0 Continuity of employment All year 44.4 73.8 8.9 56.8 Seasonal 52.2 17.5 5.4 33.6 Occasional 3.2 8.7 2.0 5.8 Missing 0.2 0.0 83.7 3.8 Total 100.0 100.0 100.0 100.0 Number of men age 15-49 employed during the past 12 months 2,295 2,269 209 4,773 Note: Total includes 38 men with information missing on type of employment who are not shown separately. 3.8 HEALTH INSURANCE COVERAGE Access to health care improves when individuals are covered by some form of health insurance. Tables 3.8.1 and 3.8.2 present information on the coverage of various health insurance plans among women and men in Zambia. The majority of Zambian women and men age 15-49 do not have access to health insurance (92 and 91 percent, respectively) . Among the 8 percent of women with health insurance, 5 percent have insurance through a low-cost prepayment scheme, and 2

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