Key Indicators Report.

Key Indicators Report

Survey Background, Implementation and Design
PRESENTER ALUWISIO MUKAVHI

Government of Zimbabwe
The 2015 Zimbabwe Demographic and Health Survey (2015 ZDHS) was implemented by the Zimbabwe National Statistics Agency from July through December The HIV testing component was implemented by the National Microbiology Reference Laboratory (NMRL). The funding for the ZDHS was provided by the Government of Zimbabwe, the United States Agency for International Development (USAID), the United Nations Population Fund (UNFPA), the United Nations Development Programme (UNDP), the United Nations Children’s Fund (UNICEF), the United Kingdom Department for International Development (UKaid), Irish Aid, the Royal Danish Embassy, the Australian Agency for International Development (AusAID), the European Union (EU), and the Swedish International Development Cooperation (Sida). ICF International provided technical assistance through The DHS Program, a USAID-funded project providing support and technical assistance in the implementation of population and health surveys in countries worldwide.

Objectives Fertility and child mortality levels Maternal mortality
The main objective of the 2015 ZDHS is to provide up-to-date information on: Fertility and child mortality levels Maternal mortality Fertility preferences Contraceptive use

Objectives Cont`d Utilization of maternal and child health services
Women’s and children’s nutrition status Knowledge, attitudes and behaviours relating to HIV/AIDS and other sexually transmitted diseases Domestic violence.

The Survey The 2015 ZDHS is the 6th Demographic and Health Survey conducted in Zimbabwe as part of The DHS Program. Designed to provide estimates for most indicators for the country as a whole, for urban and rural areas, and for each of Zimbabwe’s ten provinces.

Sample Design A two stage –stratified cluster sample design was used
First Stage: 400 EAs were selected using probability proportional to size sample method . The average EA size is about households, either for urban or rural areas. The EA size is an adequate size for being a primary sampling unit (PSU). 166 were in urban areas and 234 in rural areas

Sample Design Cont`d Second Stage:
A complete listing of households was carried out in each of the 400 selected EAs. A representative sample of 11,196 households was selected for the ZDHS. The households were selected using random systematic sampling

Sampling Frame Sampling Frame:
The 2012 Zimbabwe Population Census frame was used as the sampling frame for the 2015 ZDHS The frame excludes institutional EAs Among them 10,475 are in urban areas, and 18,890 are in rural areas.

Sample Eligibility Criteria
All women age and all men age were eligible to be interviewed. All females age 0-49 years and all males age 0-54 years were eligible for anaemia testing Also, a subsample of one eligible female in each household was randomly selected to be asked additional questions regarding domestic violence. With consent from the respondent, or parental or guardian consent in the case of a minor, blood samples were collected in each household for anaemia testing in the field and HIV testing in the laboratory for all females age 0-49 years and all males age 0-54 years who consented.

Survey Questionnaires
Household Questionnaire Woman’s Questionnaire Man’s Questionnaire Biomarker Questionnaire Questionnaires were translated into 2 main local languages: Shona and Ndebele

Questionnaires: Household Questionnaire
Lists usual members and visitors to identify eligible individuals Collects basic characteristics of each person in the household Determines the survival status of the parents of children under age 18 Identifies women and men eligible for individual interviews and anthropometry measurement, and haemoglobin and HIV testing

Questionnaires: Household Questionnaire
Identifies children age 0-14 years for HIV testing and children 6-59 months for anaemia testing and anthropometry measurement Collects household dwelling unit characteristics

Questionnaires: Woman’s Questionnaire
Background characteristics Birth history and childhood mortality Knowledge and use of family planning methods Fertility preferences Antenatal, delivery, and postnatal care Breastfeeding and infant feeding practices Vaccinations and childhood illnesses

Questionnaires: Woman’s Questionnaire (cont’d)
Marriage and sexual activity Women’s employment, husband’s employment, and gender roles Malaria prevention and treatment Awareness and behaviour regarding AIDS and (STIs) Adult mortality, including maternal mortality Domestic violence Tobacco and alcohol use Knowledge and prevention of cervical cancer

Questionnaires: Man’s Questionnaire
Background characteristics Knowledge and use of family planning methods Fertility preferences Marriage and sexual activity Men’s employment and gender roles Awareness and behaviour regarding AIDS and STIs Male circumcision Tobacco and alcohol use

Biomarkers Questionnaires
Anthropometry: Children 0-59 months, women age 15-49, and men age 15-54 Anaemia: Children 6-59 months, women age 15-49, and men age 15-54 HIV: Children age 0-14, women age 15-49, and men age 15-54

Survey Trainings Training of Trainers: Pretest: Main Survey Training:
3-day training in April 2015 with the 15-member ZDHS technical team and 3 ICF technical specialists who worked as trainers in the pretest and main survey training and then as fieldwork coordinators during data collection Pretest: 2-week training of 29 participants from late April to early May 2015 Main Survey Training: 3-week training of 120 participants in June 2015

Fieldwork and Data Processing
15 teams (consisting of 1 team supervisor, 7 interviewers, and 1 driver. ) 3 interviewers on each team were also biomarker technicians. Fieldwork conducted from July 6- December 20, 2015

Fieldwork and Data Processing
Computer assisted personal interviewing (CAPI) was used CSPro was used for data editing, weighting, cleaning, and tabulation. Data received from the supervisor’s tablets were registered and checked for any inconsistencies and outliers.

THANK YOU

Response Rate

Results of the Household and Individual Interviews
All Household Interviews Households selected 11,196 Households occupied 10,657 Households interviewed 10,534 Response rate 99% All Interviews with Women age 15-49 Eligible women 10,351 Women interviewed 9,955 Response rate 96% Interviews with Men age 15-54 Eligible men 9,132 Men interviewed 8,396 Response rate 92%

Educational Attainment of Respondents
Percent of women and men age 15-49 1% of women and less than 1% of men have never attended school. Most Zimbabweans reach the secondary level of schooling: 73 percent of women and 77 percent of men attended at least some secondary school/obtained secondary + education.

Age group of respondents

Marital Status of Respondents

Area of residence of Respondents
1% of women and less than 1% of men have never attended school. Most Zimbabweans reach the secondary level of schooling: 73 percent of women and 77 percent of men attended at least some secondary school/obtained secondary + education.

Wealth quintile of Respondents

Fertility Measured by the Total Fertility Rate (TFR)
TFR is the number of children a woman would have by the end of her childbearing years (15 – 49 yrs) if she were to pass through those years bearing children at the currently observed age-specific rates The TFR is at 4.0 Rural TFR is at 4.7 and urban TFR is at 3.0

Births per woman for the 3-year period before the survey
Fertility Trends Births per woman for the 3-year period before the survey At current fertility levels, a Zimbabwean woman will have an average of 4.0 children in her lifetime. Over a 27-year period, TFR decreased from 5.4 in 1988 to 4.0 in 2015.

Fertility Preferences of Married Women
Percent distribution of currently married women age by desire for children 41% of currently married women want no more children or are sterilised. 19% of women want another child soon (within 2 years) while 35% of women want another child 2 or more years later.

Family Planning Refers to a conscious effort by a couple to limit or space the number of children they want to have through the use of contraceptive methods Contraceptive methods are classified as modern or traditional methods The contraceptive prevalence rate (CPR) for any method is at 67% The CPR is the percentage of currently married women who report currently using a family planning method.

Current Use of Contraception
Percent of women age 15-49 The contraceptive prevalence rate (CPR) is defined as the percent of married women using a method of contraception. Currently, the CPR for Zimbabwe is 67% with 66% of married women using modern methods of contraception and 1% use any traditional method of contraception. Among married women, the pill, injectables, and implants are the most popular. 68% of sexually active unmarried women are using a method of contraception, 67% are using a modern method. Male condoms are the most popular method among sexually active unmarried women (27%).

Contraceptive Method Mix
The contraceptive method mix is heavily tilted towards the pill (41%); no significant differentials between the rural and urban However there has been a significant increase in the proportion of those using the implants (10% from 2.7% in 2010/11 ZDHS) Pill 41 in 2010 ZDHS

Current Use of Contraception by Province
Mashonaland East 70% Mashonaland Central 66% Mashonaland West 72% Harare 71% Matabeleland North 67% Manicaland 59% Midlands 67% Bulawayo 72% Provincially, the contraceptive prevalence rate is highest in Mashonaland West and Bulawayo (72% each) and lowest in Manicalaland (59%). Compare from previous DHS across the provinces Matabeleland South 60% Masvingo 61% Zimbabwe 67% Percent of currently married women age currently using any method of family planning

Trends in Use of Contraception
Percent of currently married women age 15-49 Use of any contraception has increased from 43% in 1988 to 67% in Modern method contraceptive use has increased from 36% in 1988 to 66% in 2015.

Unmet Need of Family Planning
Unmet need for contraception refers to fecund women who are married or in union and are not using any method of contraception but who wish to postpone the next birth (spacing) or who wish to stop childbearing altogether (limiting) The unmet need is at 10.4%; 9.4% for urban an 10.9% for rural Unmet need is highest in Mat South (16.2%) and lowest in Mash West (6.5%)

Demand for Family Planning
Percent of currently married women age 15-49 Overall, 10% of currently married women have an unmet need for family planning. 67% of women have a met need for family planning or are using a contraceptive method. If all currently married women who say they want to space or limit their children were to use a family planning method, the CPR would increase to 77%, or total demand. Of the total demand for family planning methods, 87% is met by using any method and 85% is met by using modern methods.

END THANK YOU!!!

Infant and Child Mortality
. BY Langton Chikeya

Childhood Mortality Under Five Mortality is 69 deaths per 1,000 live births Infant Mortality rate is 50 deaths per 1,000 live births. Neonatal mortality is 29 deaths per 1,000 live births

Trends in Childhood Mortality
Deaths per 1,000 live births for the 5-year period before the survey The current level of infant mortality is 50 deaths per 1,000 live births. The level of under-5 mortality is 69 deaths per 1,000 live births. At these current mortality levels, 1 in every 15 children in Zimbabwe dies before their 5th birthday. Childhood mortality has decreased since 1999, when infant mortality was 65 deaths per 1,000 live births and under-5 mortality was 102 deaths per 1,000 live births.

MATERNAL MORTALITY

Maternal Mortality Maternal mortality- death of a woman while pregnant or within 42 days of termination of pregnancy, irrespective of the duration and site of the pregnancy, from any cause related to or aggravated by the pregnancy or its management but not from accidental or incidental causes. (WHO,2012).

651 The maternal mortality ratio in Zimbabwe is 651 per live births. The 95% confidence interval surrounding the estimate is

Delivery Care Access to proper medical attention and hygienic conditions during delivery can reduce the risk of complications and infections that may lead to death or serious illness for the mother, the baby or both

Delivery Care 78 percent of women reported that their last live birth was delivered by a health professional 72 percent were delivered in health facilities

Assistance during Delivery by Province
Mashonaland East 74% Mashonaland Central 69% Mashonaland West 67% Harare 91% Matabeleland North 84% Manicaland 70% Midlands 81% Bulawayo 95% Provincially, delivery assistance by a skilled provider is highest in Bulawayo (95%) followed by Harare (91%) and lowest in Mashonaland West and Mashonaland Central (67% each). Matabeleland South 88% Masvingo 80% Zimbabwe 78% Percent of live births in the 5-year period before the survey delivered by a skilled provider (doctor, nurse, or nurse-midwife)

Delivery in a Health Facility by Province
Mashonaland East 71% Mashonaland Central 68% Mashonaland West 63% Harare 79% Matabeleland North 81% Manicaland 67% Midlands 76% Bulawayo 84% Provincially, delivery in a health facility is highest in Bulawayo (84%) and lowest in Mashonaland West (63%). Matabeleland South 82% Masvingo 70% Zimbabwe 72% Percent of live births in the 5-year period before the survey delivered in a health facility

Trends in Maternal Health
Percent of live births in the 5-year period before the survey While maternal health indicators declined between 1999 and , there are some improvements since ANC by a skilled provider remains the same at 93% since Skilled assistance during delivery has increased from 72% in 1999 to 78% in Facility-based deliveries have decreased slightly from 73% in 1999 to 72% in 2015. *Skilled provider includes doctor, nurse, or nurse-midwife.

END. THANK YOU!!!

Childhood Vaccinations
By G Chaora

Outline Vaccinations Childhood illness Nutritional Status
Breastfeeding Anaemia

Childhood Vaccinations
Percent of children age months vaccinated 90% of children received the BCG vaccination and 82% are vaccinated against measles. Coverage of the 1st dose of the Pentavalent and polio vaccines is relatively high (90% and 89%, respectively); however, 83% received the 3rd dose of Pentavalent and 78% received the 3rd dose of polio. Overall, 73% of children age months have received all basic vaccinations. 10% of children did not receive any vaccination at all. Pentavalent Polio Pneumococcal

Vaccination Coverage by Province
Mashonaland East 80% Mashonaland Central 78% Mashonaland West 75% Harare 76% Matabeleland North 87% Manicaland 71% Midlands 67% * Bulawayo 69% Provincially, the percentage of children who have received all basic vaccinations is highest in Matabeleland North (87%) and lowest in Masvingo (60%). * BCG, measles, and three doses each of pentavalent and polio vaccine excluding polio vaccine given at birth. Matabeleland South 80% Masvingo 60% Zimbabwe 73% Percent of children age months with all basic vaccinations*

Childhood Illnesses Among children under 5 with symptoms of acute respiratory infection (ARI), fever, or diarrhoea, percent whom advice or treatment was sought from a health facility or provider Among children under 5 with symptoms of ARI, 51% sought treatment or advice from a health facility or provider. Among children under 5 with fever, 45% sought advice or treatment from a health facility or provider. Among children under 5 with diarrhoea, 39% sought treatment of advice from a health facility or provider.

Nutritional Status of Children
Percent of children under 5 36 4 The nutritional status of young children is a comprehensive index that reflects the level and pace of household, community, and national development. Malnutrition is a direct result of insufficient food intake or repeated infectious diseases or a combination of both. It can result in increased risk to illness and death and can also result in a lower level of cognitive development. Children who are stunted are considered too short for their age. 36% of children are stunted. Children who are wasted are too thin for their height. 4% of children are wasted. Children who are underweight are too thin for their age. 10% of children are underweight. 10 *Based on the 2006 WHO Child Growth Standards

Stunting by Province Zimbabwe 27% Mashonaland East Mashonaland Central
25% Mashonaland Central 29% Mashonaland West 28% Harare 23% Matabeleland North 23% Manicaland 30% Midlands 28% * Bulawayo 19% Provincially, the percent of children who are stunted is highest in Matabeleland South (31%) and lowest in Bulawayo (19%). Matabeleland South 31% Masvingo 27% Zimbabwe 27% Percent of children under 5 who are stunted, or too short for age

Trends in Nutritional Status of Children
Percent of children under 5 Overall, nutritional status of children has slightly improved since 1999 with declines in stunting, wasting, and underweight. *Based on the 2006 WHO Child Growth Standards

Breastfeeding Status Under 6 Months
Percent distribution of youngest children under 6 months who are living with their mother by breastfeeding status Supplementing breast milk with other liquids or foods starts at an early age in Zimbabwe. 48% of children under 6 months were exclusively breastfed. Contrary to the recommendation of exclusive breastfeeding, 22% of children under 6 months were given plain water, other milk, or other non-milk liquids while 28% were fed complementary foods in addition to breast milk. 2% of children are not breastfed.

Anemia Prevalence in Children
Anaemia is a condition that is marked by low levels of haemoglobin. It can be caused by malaria, nutritional deficiencies, chronic infections etc. It is a concern because it can impair cognitive development, stunt growth and increase morbidity from infections diseases.

Anemia Prevalence in Children (cont…)
Haemoglobin testing was carried out among children 6-59 months. Children with haemoglobin levels below g/dL were defined as anaemic. Overall 37% suffered from some degree of anaemia.

Anaemia Prevalence (cont…)
It is prevalent in children under 24 months. It was highest in Harare(42%) and lowest in Masvingo (29%). 22% were mildly anaemic, 15% moderately anaemic and less than 1% severely anaemic

ITN Ownership by Province
Mashonaland East 53% Mashonaland Central 49% Mashonaland West 67% Harare 17% Matabeleland North 71% Manicaland 57% Midlands 47% * Bulawayo 30% In Zimbabwe, an ITN is defined as either 1) a factory-treated net that doesn’t require additional treatment, or 2) a net that has been soaked with insecticide within the past 6 months. ITN ownership is highest in Matabeleland North (71%) and lowest in Harare (17%). Matabeleland South 40% Masvingo 55% Zimbabwe 48% Percent of households with at least one insecticide-treated net (ITN)

Ownership of and Access to ITNs
Percent of household population Percent of households While 48% of households own at least one ITN, only 26% of households have enough ITNs to cover each household member, assuming one ITN is used by two people. Among the household population, 33% have access to an ITN—could sleep under an ITN if each ITN in the household were used by up to 2 people. In Zimbabwe, an ITN is defined as either 1) factory-treated net that doesn’t require additional treatment, or 2) a net that has been soaked with insecticide within the past 6 months. *Assuming one ITN covers 2 people

Use of ITNs Percent who slept under an ITN the night before the survey among all households Percent who slept under an ITN the night before the survey among households with at least one ITN In Zimbabwe, an ITN is defined as either 1) factory-treated net that doesn’t require additional treatment, or 2) a net that has been soaked with insecticide within the past 6 months. Only 9% of children under 5 and 6% of pregnant women slept under an ITN the night before the survey—the groups most at risk from malaria. Owning a net does not automatically mean families use it. 18% of children under 5 and 13% of pregnant women in households with an ITN slept under an ITN the night before the survey.

Fever in Children In the 2 weeks before the survey, 14% of children under 5 had a fever. 50% were taken to a health facility or provider for advice or treatment. 13% had blood taken from a finger or heel for testing. <1% took ACT. 14% of children had fever within the 2 weeks before the survey. Of these children, 50% were taken to a health facility, provider, or pharmacy for treatment or advice. 13% had their blood taken from finger or heel for testing. Less than 1% were given ACT.

Knowledge of HIV Prevention Methods
Percent of women and men age who know that HIV can be prevented by: Men generally have higher knowledge of HIV prevention methods than women. 84% of women and 88% men know that the risk of getting HIV can be reduced by using a condom. 92% of women and 94% of men know that HIV can be prevented by limiting sex to one faithful, uninfected partner. Overall, 79% of women and 85% of men know that HIV can be prevented by both methods.

Comprehensive Knowledge of HIV among Youth by Residence
Percent of women and men age with comprehensive knowledge* of HIV Comprehensive knowledge is an indicator that measures how much young people know about transmission and prevention of HIV. Comprehensive knowledge includes knowing that condoms and monogamy prevent HIV transmission, that a healthy looking person can have HIV infection, and rejects the two most common local misconceptions about HIV transmission. This slide shows that young men are somewhat more informed than young women; and urban women and men are more informed than their rural counterparts. *Comprehensive knowledge means knowing that the risk of getting HIV can be reduced by using condoms and limiting sex to one uninfected partner, knowing that a healthy looking person can have HIV, and rejecting the two most common local misconceptions about HIV prevention and transmission.

Multiple Sexual Partners
Among women and men age who had 2+ sexual partners in past 12 months, percent who: Among women and men age who have ever had sexual intercourse: Percent of women and men age who had: Men are more likely than women to report having multiple partners in the past 12 months. 14% men have had 2 or more partners compared to only 1% of women. Among both men and women with multiple partners in the past year, half of women and 37% of men say they used a condom at last intercourse. Men report having more lifetime sexual partners than women, more than 3 times as many partners (1.8 for women versus 6.1 for men).

Percent of women and men age 15-49
HIV Testing Percent of women and men age 15-49 80% of women nationwide and 62% of men have been tested at some time and received the results. In the 12 months before the survey, nearly half of women and 36% of men have been tested and received the results.

Recent HIV Testing by Province: Women
Mashonaland East 46% Mashonaland Central 55% Mashonaland West 47% Harare 46% Matabeleland North 51% Manicaland 45% Midlands 54% * Bulawayo 48% Recent HIV testing among women is highest in Mashonaland Central at 55% and lowest in Manicaland at 45% each. Matabeleland South 52% Masvingo 50% Zimbabwe 49% Percent of women age who were tested for HIV in the past 12 months and received their results

Recent HIV Testing by Province: Men
Mashonaland East 37% Mashonaland Central 40% Mashonaland West 40% Harare 37% Matabeleland North 32% Manicaland 29% Midlands 38% * Bulawayo 34% Recent HIV testing among men is highest in Mashonaland Central, Mashonaland West, and Matabeleland South at 40% each and lowest in Manicaland at 29%. Matabeleland South 40% Masvingo 32% Zimbabwe 36% Percent of men age who were tested for HIV in the past 12 months and received their results

Male Circumcision 14% of men age 15-49 have been circumcised
In urban areas (18%) and rural areas (12%) 15-19 age group more likely to get circumcised than any other age group (23%) Circumcision is practiced in some areas in Zimbabwe. In recent years, male circumcision has been associated with a lower risk of HIV transmission (WHO and UNAIDS, 2007). Only 14% of Zimbabwean men have been circumcised.

Knowledge and Prevention of Cervical Cancer
Percent of women age who have ever heard of cervical cancer, have had a cervical screening (Pap test) ever or in the last 12 months and the last 3 years Cervical cancer is one of the leading causes of deaths among women. Cervical cancer screening via the Papanicolau (Pap) test or the Visual Inspection with Acetic Acid and Camera (VIAC) are effective for detecting early abnormal or cancer cells in the cervix and uterus. Nationally, 79% of women report that they have heard of cervical cancer. However, only 13% of women have ever had a cervical exam. Among those who report having a cervical exam, 90% report having the exam in the last 3 years and 66% had their cervical exam within the last 12 months.

Experience of Domestic Violence
Percent of ever-married women age who have ever experienced physical or sexual violence committed by their spouse/partner 31% of ever-married women have ever experienced physical violence. In this context, physical violence means any type of physical violence, whether it is experienced at home or in another location, such as the workplace or school. 13% of ever-married women have ever experienced sexual violence. 35% of ever-married women have ever experienced physical or sexual violence.

Key Findings Women have an average of 4.0 children.
The contraceptive prevalence rate of any contraceptive method among married women is 67%. Infant mortality rate is 50 deaths per 1,000 live births and under-5 mortality rate is 69 deaths per 1,000 live births. 72% of births were delivered in a health facility. 73% of children received have all basic vaccinations. 27% of children under 5 are stunted (too short for age). 37% of Zimbabwean household population has access to an ITN. 49% of women and 36% of men were tested for HIV in past 12 months and received the results of the test. 14% of men report having been circumcised. 13% of women have ever been screened for cervical cancer. 35% of women have experienced physical or sexual violence. The maternal mortality ratio is 651 deaths per 1,000 woman-years of exposure.

END. THANK YOU!!!

Next Steps

ZDHS 2015 Gaunt Chart 2015 2016 Activity J A S O N D F M Main Training Data Collection Data Editing Preliminary Report Writing HIV Testing in Laboratory Production of Tables Final report writing workshop Analysis, writing HIV prevalence chap Review & formatting of final Report Printing of Final Report National Seminar

Dissemination of Final Results
Final results (main report) will be disseminated from Sep/Oct – Dec in all the 10 provinces through seminars

Preparations for Secondary Analysis
Themes will be user/demand driven Raw data (recoded) will be available from October 2015 Consultants (subject matter specialists and statisticians) will be recruited A secondary data analysis workshop will be held to orient analysts on the 2015 ZDHS data set, statistical analysis software and launch of the in- depth report writing process Process is likely to spill into 2017.

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