1. 2003-2004 Madagascar Demographic and Health Survey DDSS/INSTAT, ORC Macro Key Preliminary Findings 2003-2004 Madagascar DHS

2. 2003-2004 Madagascar Demographic and Health Survey DDSS/INSTAT, ORC Macro Introduction The 2003-2004 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 2003-2004 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).

3. 2003-2004 Madagascar Demographic and Health Survey DDSS/INSTAT, ORC Macro 2003-2004 MDHS Sample Nationally representative survey of >8,400 households: –Close to 8,000 women age 15-49 –Close to 2,700 men age 15-59 Biological testing (“biomarkers”) was implemented for a sub-sample of the population for tetanus, measles, syphilis and anemia

4. 2003-2004 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

5. 2003-2004 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

6. 2003-2004 Madagascar Demographic and Health Survey DDSS/INSTAT, ORC Macro KEY FINDINGS 2003-2004 Madagascar Demographic and Health Survey Photo courtesy of Freedom From Hunger

7. 2003-2004 Madagascar Demographic and Health Survey DDSS/INSTAT, ORC Macro FERTILITY Photo courtesy of Freedom From Hunger

8. 2003-2004 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 2003-2004 which is for 3 years

9. 2003-2004 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

10. 2003-2004 Madagascar Demographic and Health Survey DDSS/INSTAT, ORC Macro Total Fertility Rate: A Cross-national Comparison *Based on preliminary findings

11. 2003-2004 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 15-19 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?

12. 2003-2004 Madagascar Demographic and Health Survey DDSS/INSTAT, ORC Macro Years Trends in Fertility Determinants

13. 2003-2004 Madagascar Demographic and Health Survey DDSS/INSTAT, ORC Macro FAMILY PLANNING Photo courtesy of Photoshare

14. 2003-2004 Madagascar Demographic and Health Survey DDSS/INSTAT, ORC Macro Percent Trends in Use of Modern Methods

15. 2003-2004 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 15-49 use a modern method of contraception. Modern use varies from 11% in Mahajanga to 27% in Antananarivo. How does modern use vary by province?

16. 2003-2004 Madagascar Demographic and Health Survey DDSS/INSTAT, ORC Macro Use of Modern Contraception: A Cross-national Comparison *Based on preliminary findings

17. 2003-2004 Madagascar Demographic and Health Survey DDSS/INSTAT, ORC Macro FERTILITY PREFERENCES Photo courtesy of Freedom From Hunger

18. 2003-2004 Madagascar Demographic and Health Survey DDSS/INSTAT, ORC Macro 3.5 – 3.9 4.0 – 4.9 5.0 – 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?

19. 2003-2004 Madagascar Demographic and Health Survey DDSS/INSTAT, ORC Macro MATERNITY CARE Photo courtesy of Freedom From Hunger

20. 2003-2004 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%

21. 2003-2004 Madagascar Demographic and Health Survey DDSS/INSTAT, ORC Macro Medical Assistance at Delivery: A Cross-national Comparison *Based on preliminary findings

22. 2003-2004 Madagascar Demographic and Health Survey DDSS/INSTAT, ORC Macro CHILD HEALTH AND NUTRITION Photo courtesy of Freedom From Hunger

23. 2003-2004 Madagascar Demographic and Health Survey DDSS/INSTAT, ORC Macro Trends in Initial Breastfeeding (within 1 hour after birth) Percent

24. 2003-2004 Madagascar Demographic and Health Survey DDSS/INSTAT, ORC Macro Trends in Exclusive Breastfeeding (children under 6 months) Percent

25. 2003-2004 Madagascar Demographic and Health Survey DDSS/INSTAT, ORC Macro Percent *For children age 12-23 months, at any time before the survey Trends in Vaccination Coverage

26. 2003-2004 Madagascar Demographic and Health Survey DDSS/INSTAT, ORC Macro Full Immunization: A Cross-national Comparison *Based on preliminary findings

27. 2003-2004 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 1997.  Of all children with ARI and/or fever, 44% were taken to a health facility/provider. Prevalence and Treatment for Diarrhoea, ARI and Fever

28. 2003-2004 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 1997. How does vitamin A supplementation vary by province? 70 – 74% 75 – 79% 80 – 84% ANTSI MA A/RIVO TOA FI TOL 76%