Madagascar Demographic and Health Survey DDSS/INSTAT, ORC Macro Key Preliminary Findings Madagascar DHS

Madagascar Demographic and Health Survey DDSS/INSTAT, ORC Macro Introduction The Madagascar DHS (MDHS) is the 3 rd in a series (1992, 1997). The MDHS was conducted by the Direction de la Démographie et des Statistiques Sociales at INSTAT, in partnership with the Ministère de la Santé et du Planning Familial. ORC Macro provided technical support. The MDHS was funded by the World Bank, UNICEF, UNFPA and USAID/Madagascar. The MDHS provides estimates on key indicators, including fertility, MCH, STIs and AIDS awareness. New features include the implementation of 4 biomarkers (tetanus, measles, syphilis and anemia).

Madagascar Demographic and Health Survey DDSS/INSTAT, ORC Macro MDHS Sample Nationally representative survey of >8,400 households: –Close to 8,000 women age –Close to 2,700 men age Biological testing (“biomarkers”) was implemented for a sub-sample of the population for tetanus, measles, syphilis and anemia

Madagascar Demographic and Health Survey DDSS/INSTAT, ORC Macro  Training consisted of interviewing techniques, field procedures, questionnaire review, and mock interviews in classroom and field as well as an anthropometric measurement practice.  Fieldwork: 11/23/2003 to 03/28/2004.  11 teams went in the field, each comprised of 2 nurses (for 4 biomarkers). Training and Fieldwork

Madagascar Demographic and Health Survey DDSS/INSTAT, ORC Macro Households Selected Households Interviewed Response rate (%)9,295 8,420 98% Eligible Women Women Interviewed Response rate (%)8,337 7,949 95% Eligible Men Men Interviewed Response rate (%)2,685 2,432 91% Response Rates

Madagascar Demographic and Health Survey DDSS/INSTAT, ORC Macro KEY FINDINGS Madagascar Demographic and Health Survey Photo courtesy of Freedom From Hunger

Madagascar Demographic and Health Survey DDSS/INSTAT, ORC Macro FERTILITY Photo courtesy of Freedom From Hunger

Madagascar Demographic and Health Survey DDSS/INSTAT, ORC Macro Trends in Total Fertility Rates* *Per 1,000 women; refer to the 5-year period preceding the survey, except for which is for 3 years

Madagascar Demographic and Health Survey DDSS/INSTAT, ORC Macro 4,0 – 4,9 5,0 – 5,9 6,0 – 6,9 ANTSI MA A/RIVO TOA FI TOL 5.2 births National average: 5.2 births Varies from 4.2 births in Antananarivo to 6.3 births in Toliara. How does fertility* vary by province? *TFR for women age 15-49

Madagascar Demographic and Health Survey DDSS/INSTAT, ORC Macro Total Fertility Rate: A Cross-national Comparison *Based on preliminary findings

Madagascar Demographic and Health Survey DDSS/INSTAT, ORC Macro 15 – 19% 20 – 39% 40 – 59% ANTSI MA A/RIVO TOA FI TOL 34% Nationally, 34% of women age are either already mothers (28%) or pregnant with their 1 st child (6%) Varies from 19% in Antananarivo to 56% in Mahajanga. How does teenage pregnancy vary by province?

Madagascar Demographic and Health Survey DDSS/INSTAT, ORC Macro Years Trends in Fertility Determinants

Madagascar Demographic and Health Survey DDSS/INSTAT, ORC Macro FAMILY PLANNING Photo courtesy of Photoshare

Madagascar Demographic and Health Survey DDSS/INSTAT, ORC Macro Percent Trends in Use of Modern Methods

Madagascar Demographic and Health Survey DDSS/INSTAT, ORC Macro 10 – 14% 15 – 19% 20 – 29% ANTSI MA A/RIVO TOA FI TOL 18% Nationally, 18% of women age use a modern method of contraception. Modern use varies from 11% in Mahajanga to 27% in Antananarivo. How does modern use vary by province?

Madagascar Demographic and Health Survey DDSS/INSTAT, ORC Macro Use of Modern Contraception: A Cross-national Comparison *Based on preliminary findings

Madagascar Demographic and Health Survey DDSS/INSTAT, ORC Macro FERTILITY PREFERENCES Photo courtesy of Freedom From Hunger

Madagascar Demographic and Health Survey DDSS/INSTAT, ORC Macro 3.5 – – – 5.9 ANTSI MA A/RIVO TOA FI TOL 4.7 Nationally, women would like to have an average of 4.7 births. Desired fertility varies from 3.7 births in Antananarivo to 5.7 in Toliara. How does desired fertility vary by province?

Madagascar Demographic and Health Survey DDSS/INSTAT, ORC Macro MATERNITY CARE Photo courtesy of Freedom From Hunger

Madagascar Demographic and Health Survey DDSS/INSTAT, ORC Macro Medical assistance from a doctor or nurse/midwife at delivery varies from 38% in Toamasina and Toliara to 66% in Antananarivo. How does medical assistance at delivery vary by province? 35 – 39% 40 – 49% 50 – 69% ANTSI MA A/RIVO TOA FI TOL For the 5-year preceding the survey 51%

Madagascar Demographic and Health Survey DDSS/INSTAT, ORC Macro Medical Assistance at Delivery: A Cross-national Comparison *Based on preliminary findings

Madagascar Demographic and Health Survey DDSS/INSTAT, ORC Macro CHILD HEALTH AND NUTRITION Photo courtesy of Freedom From Hunger

Madagascar Demographic and Health Survey DDSS/INSTAT, ORC Macro Trends in Initial Breastfeeding (within 1 hour after birth) Percent

Madagascar Demographic and Health Survey DDSS/INSTAT, ORC Macro Trends in Exclusive Breastfeeding (children under 6 months) Percent

Madagascar Demographic and Health Survey DDSS/INSTAT, ORC Macro Percent *For children age months, at any time before the survey Trends in Vaccination Coverage

Madagascar Demographic and Health Survey DDSS/INSTAT, ORC Macro Full Immunization: A Cross-national Comparison *Based on preliminary findings

Madagascar Demographic and Health Survey DDSS/INSTAT, ORC Macro  Prevalence of diarrhea: reduced by half since 1997  Among those with diarrhoea, 42% received either ORS or especially a homemade solution (twice what was recorded in 1997).  Prevalence of children with ARI: reduced by more than half since 1997 (from 24% to 11%).  Prevalence of children with fever: from 32% to 27% since  Of all children with ARI and/or fever, 44% were taken to a health facility/provider. Prevalence and Treatment for Diarrhoea, ARI and Fever

Madagascar Demographic and Health Survey DDSS/INSTAT, ORC Macro Supplementation of Vitamin A varies from 70% in Mahajanga to 83% in Antananarivo. In comparison, 4% of women said their children had received a Vitamin A supplement in How does vitamin A supplementation vary by province? 70 – 74% 75 – 79% 80 – 84% ANTSI MA A/RIVO TOA FI TOL 76%