Demographic and. Health Survey. Key Findings Albania Demograpfic and Health Survey

Transcription

1 Demographic and Health Survey Albania Demograpfic and Health Survey 1 Key Findings

2 The Albania Demographic and Health Survey ( ADHS) was implemented by the Institute of Statistics (INSTAT) and the Institute of Public Health (IPH) from September 2008 to April ICF Macro, an ICF International Company, provided technical assistance to the project through funding from UNICEF and the MEASURE DHS programme, a USAID-funded project providing support and technical assistance in the implementation of population and health surveys in countries worldwide. Funding for the ADHS was provided by USAID, Swiss Agency for Cooperation and Development (SCD), UNICEF, UNFPA, and World Health Organization (WHO). The opinions expressed in this report are those of the authors and do not necessarily reflect the views of USAID, SCD, UNICEF, UNFPA, and WHO. Additional information about the ADHS may be obtained from either: The Institute of Public Health Elizana Petrela, Coordinator ADHS, Street address: Aleksander Moisiu # 80, Tirana, Albania. Telephone: +355 (4) , Fax: +355 (4) , elapetrela@ishp.gov.al or The National Institute of Statistics, Lantona Sado, Coordinator ADHS Street address: Blvd Gergj Fishta #3, Tirana, Albania. Telephone: +355 (4) , Fax: +355 (4) , lsado@instat.gov.al Information about the DHS programme may be obtained from the MEASURE DHS Project, ICF Macro, Beltsville Drive, Suite 300, Calverton, MD 20705, USA; Telephone: , Fax: , reports@macrointernational.com, Internet: Albania Demograpfic and Health Survey

3 ALBANIA Demographic and Health Survey (ADHS ) Key findings report The Albania Demographic and Health Survey (ADHS) is a nationally representative survey of 7,584 women and 3,013 men age Survey fieldwork was conducted during the period of October 2008 to April The ADHS was conducted by the Institute of Statis tics and the Institute of Public Health of the Republic of Albania. ICF Macro provided technical support for the survey. The U.S. Agency for International Development (USAID), Swiss Agency for Cooperation and Development, United Nations Photo credits:jutta Benzenberg/UNICEF Albania 2009 Children s Fund (UNICEF), United Nations Population Fund (UNFPA), the World Health Organization (WHO), and the Spanish Agency for International Development Cooperation (AECID) provided funding for the survey. BACKGROUND CHARACTERISTICS OF THE POPULATION Household composition In Albania, almost 65 percent of population is in the group ages while children under age 15 make up 23 percent of the population. Elderly people age 65 and older make up 12 percent of the population. More than half of the population (52 percent) is female. Households are made up of, on average, 3.8 persons. Overall, 84 percent of households are headed by males. More than four in five (86 percent) children under age 18 live with both parents Albania Demograpfic and Health Survey 3

4 Housing Characteristics More than nine in ten households in Albania (94 percent) use an improved source for drinking water, including bottled water safe for drinking, with urban households (97 percent) being somewhat more likely than rural households (92 percent). Ninetytwo percent of households in Albania use improved sanitation facilities About three in ten households in Albania (29 percent) have a car or truck, about one in five (21 percent) have a bicycle, and one in ten own a motorcycle or scooter. More than half of the Albanian households (52 percent) own agricultural land; the large majority is belonging to rural homes (89 percent). FERTILITY Fertility Level The overall national total fertility rate (TFR) has substantially declined in Albania from 3.3 children per women in to 2.6 in to current level of 1.6 children for woman in Photo credits: Institute of Public Health Albania Albania Demograpfic and Health Survey

5 The national trend is dominated by the rural figures. The TFR for rural areas (1.8 births) is higher than that for urban areas (1.3 births). Compared with recent fertility estimates from Demographic and Health Surveys conducted in other countries in the region, fertility is higher in Albania than in Ukraine: 1.2 births per woman in 2007 (UCSR, SSC, and Macro International, 2008) but lower than in Azerbaijan: 2.0 births per woman in 2006 (SSC, MOH, and Macro International, 2008), Moldova: 1.7 births per woman in 2005 (NCPM and ORC Macro, 2006), and Armenia: 1.7 births per woman in 2005 (NSS, MOH, and ORC Macro, 2006). 1.6 Total Fertility Rate Births per woman Total Urban Rural Age Pattern of Fertility Age-specific fertility rates are useful in understanding the age pattern of fertility. According to the ADHS, age-specific fertility rates peak in age group (126 births per 1,000 women), regardless of residence, and with a differential between urban and rural areas 113 and 138 births per 1,000 women, respectively and decline to about half their peak in age group Age-specific fertility rates for the three years period preceding the survey, by urban-rural residence, Albania Births for w omen rgtegpv cig"itqwr Wtdcp Twtcn Vqvcn Albania Demograpfic and Health Survey 5

6 Age at first Birth Findings indicate that childbearing begins relatively late in Albania; three fourths of women age years have never given birth. On the other hand, only 12 percent of women age have never given birth. Only 3 percent of teenagers had begun childbearing, including 2 percent who are already mothers FAMILY PLANNING Contraceptive Use Currently, about two-third of currently women (69 percent) are presently using some method of contraception. Traditional methods are much commonly used than modern methods: about six in ten (59 percent) married women use traditional methods, while about one in ten (11 percent) use modern methods. The male condom is the most widely used modern method (4 percent) followed by female sterilization (3 percent) and the pill (2 percent). Withdrawal is the most popular traditional method. It is used by virtually all users of traditional methods (58 percent). Current Use of Family Planning Percent of morried women age using family planning Any method Any modern method Male condom Fermale sterilization Pill Other modern Withdrawal Trends in current use: Use of traditional methods has dropped considerably, from 67 percent among married women age in 2002 to 59 percent in the ADHS while the use of modern methods has increased from 8 percent to 11 percent. The decline in use of traditional methods has been partially offset by slight increases in the use of modern methods such as condoms (from 3 to 4 percent among married women age 15-44), the pill, IUD, and LAM Albania Demograpfic and Health Survey

7 The different age group of women interviewed in the ADHS, years in ADHS versus years in RH 2002 likely results in a slightly lower contraceptive prevalence because proportionally fewer women age use contraception, especially modern methods. Comparison of use of contraception RHS 2002 and AHDS RHS 2002 currently married women age using modern methods in % ADHS currently married women age using modern methods in % RHS 2002 currently married women age traditional in % ADHS currently married women age traditional in % Compared with other countries in the region, use of any contraceptive method by married women age is higher in Albania (69 percent) than in Serbia: 41 percent (SORS and SMMRI, 2007), Montenegro: 39 percent (MONSTAT and SMMRI, 2006), and The Former Yugoslav Republic of Macedonia: 14 percent (SSO, 2007). For modern contraceptive methods, the comparison shows a different picture. Thus, use of modern methods among married women 11 percent is lower in Albania than in Serbia: 19 percent (SORS and SMMRI, 2007) and Montenegro: 17 percent (MONSTAT and SMMRI, 2006). Only The Former Yugoslav Republic of Macedonia: 10 percent (SSO, 2007) has a lower level of use of modern methods than Albania. Unmet Need for Family Planning Overall, 13 percent of currently married women in Albania have an unmet need for family planning, 3 percent for spacing births and 9 percent for limiting births. Unmet need for family planning is highest among the youngest women; those age (17 to 18 percent), and tends to decrease with age. However, while unmet need for spacing declines with age, unmet need for limiting generally increases Albania Demograpfic and Health Survey 7

8 with age up to age 44, after which it declines. A higher proportion of women in rural areas than in urban areas have an unmet need for family planning (15 percent compared with 10 percent). Unmet needs (timing and spacing) for family planing by age group, married women years of age Rgtegpv"wpogv" pggfu Total For spacing For limiting 37/3;" 42/46" 47/4;" 52/56" 57/5;" 62/66" 67/6;" Cig"itqwr Age at First Birth and Teenage Pregnancy and Motherhood The ADHS findings indicate that childbearing begins relatively late in Albania; three-fourths of women age years have never given birth. The median age at first birth among women age who gave birth is 23 years. There is little variation by age groups (median years). Only 3 percent of teenagers had begun childbearing, including 2 percent who are already mothers. The proportion of young women who have begun childbearing increases rapidly with age, from almost none among women age 15, to 12 percent among women age 19. Teenagers in the Mountain region are most likely to start childbearing, while those in Urban Tirana are the least likely (4 percent compared with less than 1 percent, respectively). Fertility Trends Fertility has fallen substantially in the past 20 years among all age groups. The decline is particularly evident among women in the young age groups. For example, age-specific fertility among women age declined from 50 births per 1,000 women in the period years before the survey to 20 births per 1,000 women in the period 0-4 years before the survey, a 60 percent decrease Albania Demograpfic and Health Survey

9 INFANT AND CHILD MORTALITY Levels and Differentials Under-five mortality have decreased over the period has decreased in Albania from an under-five mortality rate of 39 per 1,000 births to 22 per 1,000 births. Currently, 22 children per 1,000 births die before reaching their fifth birthday. The infant mortality rate is 18 deaths per 1,000 births indicating that most early childhood deaths take place in the first year of life. Almost two thirds of infant deaths take place in the first month of life. Rgt"3.222""nkxg"dktvju Trends in Infant Mortality Rates, Albania, Year INSTAT MoH MICS 2000 RHS 2002 MICS 2005 DHS Under-five mortality rates are higher in Albania compared to other countries in the Balkan region (Bosnia Herzegovina 17, Bulgaria 16, Croatia 8, Greece 5, Montenegro 13, FYROM 19, and Serbia 13). Under five mortality in rural areas is twice as high as in urban areas (28 per 1,000 births compared to 13 per 1,000 births). Infants and children under 5 years in the Mountain region had the highest mortality rate (42 per 1,000 births). Trends in childhood mortality Data from the ADHS indicate that there has been a decline in childhood mortality over the five years preceding the survey. For example, infant mortality has declined from 26 deaths per 1,000 live births for the period to 18 for the period There has been a similar decline in under-five mortality from 32 to 22 deaths per 1,000 births Albania Demograpfic and Health Survey 9

10 MATERNAL HEALTH Antenatal Care According to ADHS, the percentage of women receiving antenatal care in the first trimester has increased substantially since 2002, from 59 percent (2002 RHS) to 78 percent in ADHS. Photo credits: Institute of Public Health Albania Sixty seven percent of women had the recommended number of ANC visits (4 or more) during pregnancy. This percentage is substantially lower in rural areas than in urban areas (57 percent compared with 82 percent). Women are recommended to take iron supplements during pregnancy to prevent anaemia. Only about one-third (34 percent) of pregnant women receive iron supplements. About half (48 percent) of pregnant women were informed about the signs of pregnancy complications. Delivery and postnatal care Ninety seven percent of deliveries took place in a health facility. 88 percent of all women with a birth in the past five years received a post-natal check up. CHILD HEALTH Vaccination coverage According to the ADHS, 95 percent of children age months are fully vaccinated. Regarding coverage for specific vaccines, at least 97 Photo credits:robert Few/UNICEF Albania 2008 percent of children have received the BCG vaccine, all three doses of DPT, Polio and Hepatitis B, and measles vaccine. There is a slight decline in DPT vaccination from 100 percent for the first dose to 98 percent for the third dose. Vaccination cards or child health books were seen by the interviewer of only about 68 percent, but immunization records at the health facilities were seen for almost 96 percent of children indicating that a strong immunization programme is in place in Albania Albania Demograpfic and Health Survey

11 95 Immunisation Coverage Percent of children age months fully vaccinated Total Urban Rural Childhood illnesses In the two weeks before the survey, 5 percent of children under five had symptoms of acute respiratory infection (ARI) and the same percentage was observed for diarrhoea episodes. Among children with ARI seven in ten were taken to a health facility or provider for advice or treatment. However, female children (61 percent), children in rural areas (70 percent) and those in mountain region (30) are less likely than other children to be taken to a health facility or health provider. Six in ten children with diarrhoea in the past two weeks, were taken for treatment, more than two thirds (68 percent) received ORT, and three fourths (75 percent) received ORT or increased fluids. NUTRITIONAL STATUS OF WOMEN AND CHILDREN Breastfeeding and complementary feeding In Albania, 96 percent of children are ever breastfeed and 39 percent of children 0-6 months are exclusively breastfeed. More than half of children 6-8 months (55 percent) received complementary food in addition to Photo credits: Institute of Public Health Albania breast milk. Children receive breast milk for an average of 15 months and are exclusively breastfeed for an average of 2 months. Overall 25 percent of breastfed children 6-23 months are fed according to all recommended Infant and young child feeding (IYCF) practices compared to 11 percent of non-breastfed children Albania Demograpfic and Health Survey 11

12 Children s nutritional status The nutritional status of children has improved over the last 5 years. However, 19 percent of children under age five are stunted. Stunting is present even among children under six months of age. Stunting indicates chronic malnutrition. Stunting is more common in the Mountain region (28 percent) than in Urban Tirana, Coastal and Central regions; Photo credits:robert Few/UNICEF Albania 2008 Children in the lowest wealth quintile are two times more likely to be stunted (27 percent) than those in highest quintiles (13 percent). Wasting (too thin for height) which is a sign of acute malnutrition is 9 percent. Five percent of children under age five were underweight for their age. Twenty two percent of children under five were overweight. Nutrition status of children under five, Albania 2000, 2005, and Based on NCHS/WHO reference for 2000 and 2005 and WHO standard for Rgtegpv :/2; 44 3; ; 9 : 7 Stunted Wasted Underweight Women s nutritional status The ADHS collected information on height and weight of women. Only 3 percent of women are considered too thin (BMI less than 18.5). However, 30 percent are overweight and 10 percent are obese. Anaemia and iodine deficiency Micronutrients are essential vitamins and minerals required for good health. ADHS indicates that 88 percent of children ages 6-35 months are consuming foods rich in vitamin A on a daily basis; 84 percent of children consume iron-rich foods. Photo credits:jutta Benzenberg/UNICEF Albania Albania Demograpfic and Health Survey

13 Photo credits:jutta Benzenberg/UNICEF Albania 2009 Seventeen percent of children 6-59 months in Albania have some level of anaemia. Anaemia is considerably higher in rural areas than in urban areas, for children of women with no education and for the lowest wealth quintile. Nineteen percent of women whose haemoglobin level was tested were found to be anaemic. Among the households that had their salt tested, slightly more than three quarters (76 percent) of the households were using salt that was adequately iodized. ADULT HEALTH Photo credits:robert Few/UNICEF Albania 20 Eighty-one percent of women compared with 89 percent of men report their current health status as very good or good, while 17 percent of women and 9 percent of men report their health status as fair. Two percent of women and 1 percent of men report their health status as poor or very poor. Smoking is relatively rare among women (4 percent), but quite common among men (43 percent). One-third of women (32 percent) and two-thirds of men (65 percent) have ever drunk alcohol and most Albania Demograpfic and Health Survey 13

14 of these women and men have drunk alcohol in the past 12 months 30 percent of all women and 63 percent of all men. On average, women consume 1.2 drinks per day when they drink alcohol. One in five women (20 percent) and 28 percent of men in Albania are classified as hypertensive. Forty percent of women and 45 percent of men age are suffering from hypertension, indicating that hypertension is a serious health problem among older age groups in Albania. Seventy-nine percent of women and 90 percent of men with high blood pressure are unaware that they are hypertensive. Access to health care Almost nine in ten women (87 percent) and four in five men (80 percent) report at least one problem in accessing health care. Utilization and quality of health services Public sector facilities are used by more than nine in ten women and men, with just 7 percent of women and 6 percent of men using private health facilities. Among the public sector facilities, 44 percent of women and 54 percent of men visited public hospitals, and about three in ten (30 percent of women and 29 percent of men) visited public health centres. The data suggest that there is an association between the gender and the reporting of the thoroughness and carefulness of the examination and treatment received at the health facility. Only one in five men estimate the thoroughness and carefulness of the examination and treatment received at the health facility as very good, compared with one in three women. MIGRATION The ADHS results show that more than half of Albanian households (52 percent) have at least one former member (member in 1990 or later) who has migrated within or outside Albania. One in five households (21 percent) have at least one former member who has moved within the country, while around two in five (42 percent) have at least one former member who has left the country or emigrated. Households in rural areas are more likely to have had at least one former member who has migrated within or outside Albania compared with urban areas (22 percent versus 20 percent for internal migration; 46 percent versus 38 percent for international migration). Migrant Population Data show that 9 percent of the Albanian population has migrated within Albania, 11 percent of females and 7 percent of males. If the survey results are applied to the whole population of Albania, an estimated 289,000 Albanians have migrated internally Albania Demograpfic and Health Survey

15 An estimated 657,000 Albanians have migrated outside of Albania and the estimated total number of Albanians, including emigrants, is 3.9 million. The large majority of emigrants fall in the age groups (49 percent have emigrated) and (45 percent have emigrated). WOMEN S EMPOWERMENT Use of earnings More than eight in ten (83 percent) of married women who receive cash earnings decide jointly with their husband or partner how to use the money, 8 percent decide mainly themselves, and for 9 percent of women, it is the husband who mainly decides how the woman s earnings are used. Household decision-making Two in three women (66 percent) say they make decisions about their health care jointly with their husband or partner and 61 percent participate jointly in decisions about major household purchases. Married men feel strongly (86 percent) that the wife and husband should have equal say in the decision how many children to have. Attitudes toward wife beating Women s attitudes toward the acceptance of wife beating (husband is justified in beating his wife) ranges from 4 percent (wife burns the food) to 22 percent (wife neglects the children), and 30 percent of women agree with at least one of the specified reasons justifying a husband beating his wife. Women age are less likely than older women to agree that a husband is justified in beating his wife. About one in four men agree that a husband has the right to beat his wife if she goes out without telling him or if she neglects the children (24 percent and 23 percent, respectively) and 18 percent think wife beating is justified if the wife argues with her husband. Attitudes toward refusing sexual relations Overall, 63 percent of women agree that a woman is justified in refusing to have sexual intercourse with her husband if she knows he has an STD, or he is having sexual intercourse with another woman or if she is not in the mood or is tired. Men are less likely than women to agree with all three of the specified reasons for a wife to withhold sexual intercourse from her husband (49 percent compared with 63 percent) Albania Demograpfic and Health Survey 15

16 HIV-RELATED KNOWLEDGE, ATTITUDES, AND BEHAVIOUR Knowledge of HIV/AIDS The knowledge of AIDS although not universal is high in Albania, with 93 percent of women and 94 percent of men reporting that they have heard of AIDS. Knowledge of HIV Prevention Methods Percent who know that the risk of getting HIV can be reduced by: 85 women men using condoms limiting sex to one partner who is not HIV positive abstaining from sex Using condoms (74 percent), limiting sexual intercourse to one partner who is HIV negative and has no other partners (78 percent), and abstaining from sex (72 percent) were each recognized by about three-fourths of all women as ways to reduce the risk of getting HIV. About seven in ten women (67 percent) mentioned both using condoms and limiting sex to one HIV-negative partner who has no other partners as ways to prevent transmission of HIV. Men are more likely than women to know of ways to avoid HIV. The most frequently cited way to prevent transmission of HIV was use of condoms (83 percent). The two other methods of HIV/AIDS prevention limiting sex to one partner who is HIV negative and has no other partners, and abstaining from sexual intercourse were mentioned by 81 and 76 percent of men, respectively. Knowledge of Ways to Reduce AIDS Transmission Measuring the level of knowledge about HIV/AIDS transmission and prevention, the ADHS results indicate that comprehensive knowledge of AIDS in Albania is low: less than three in ten women (28 percent) and just one in five men (20 percent) in Albania have comprehensive knowledge of HIV/ AIDS transmission and prevention. Women are more likely than men to know of the risk of mother-to-child transmission of HIV through breastfeeding (75 and 51 percent, respectively). About one in three women (31 percent) and one in four men (27 percent) know that the risk of motherto-child transmission of HIV can be reduced by the mother taking special drugs during pregnancy Albania Demograpfic and Health Survey

17 Percent Knowledge of prevention of mother to child transmission of HIV Percent who know the risk of mother-to-child transmission of HIV through breastfeeding Women Men Percent who know that the risk of mother-to-child transmission of HIV can be reduced by the mother taking special drugs during pregnancy Attitudes towards Negotiating Safer Sex Seventy-seven percent of women and 73 percent of men believe that a woman is justified in refusing to have sexual intercourse with her husband if she knows he has an STI, and 82 percent of women and 86 percent of men agreed that a woman is justified in asking her husband to use a condom if he has an STI. Overall, 88 percent of women and 89 percent of men believe that a woman may either refuse to have sexual intercourse with her husband or ask him to wear a condom if she knows he has an STI. Adult Support of Education about Condom Use to Prevent AIDS Sixty-one per cent of women and 57 percent of men agree that children age should be taught about condom use to avoid AIDS. Testing for HIV Men are more likely than women to know where to get an HIV test (40 percent compared with 26 percent). The findings from the ADHS indicate that only 1 percent of young people in Albania have been tested in the past year and received the results. However, young women and men in urban areas and those with higher education are more likely to have been tested in the past year and received the results. Age at First Sexual Intercourse About 1 percent of young women and men age had sexual intercourse before age 15. This proportion rises quickly and by age 18, 15 percent of young women age and 23 percent of young men age had experienced sexual intercourse Albania Demograpfic and Health Survey 17

18 Fertility Total fertility rate Ideal number of children: women / men Median age at first sexual intercourse: women / men age Median age at first marriage: women age / men age Median age at first birth: women age Women age who have begun childbearing (%) Childhood mortality (deaths per 1,000 live births) 1 Infant mortality (per 1,000 live births) Under-five mortality (per 1,000 live births) Family Planning Knows any modern method (married women, age 15-49) (%) Currently using a method (married women, age 15-49) (%) Currently using a modern method (married women, age 15-49) (%) Total unmet need for family planning (married women 15-49) (%) Maternal health Women who delivered a live birth in the 5 years preceding the survey who received antenatal care from a health professional (%) Births in the 5 years preceding the survey for which the mother has: Delivered in a health facility (%) Delivered with the assistance of a health professional (%) Women having the recommended number of ANC visits (4+) (%) Child health Children age months who have received all the EPI vaccines (BCG, 3 doses of DPT, 3 doses of Polio, and MMR) (%) Children under five with symptoms of ARI in the two weeks preceding the survey (%) Children under five with symptoms of diarrhoea in the two weeks preceding the survey (%) Children with symptoms of fever who sought advice or treatment from a health facility or provider (%) Nutrition Children age 6-59 months who are anaemic (%) Women age who are anaemic (%) Children under 5 who are stunted (too short for age) (%) Children under 5 who are wasted (too thin for height) (%) Children under 5 who are underweight (%) Children under 5 who are overweight (%) Women age who are overweight or obese (BMI >25.0) (%) Adult Health Women / Men who have at least one problem accessing health care (%) Women who ever heard of a Pap smear (%) Men who smoke cigarettes (%) Women who ever heard of a mammogram (%) Women/men with hypertension (%) Woman Empowerment Women who earn about the same compared with husband (%) Percentage of cases when Wife and husband jointly decide how the wife s cash earnings are used (%) All women age who agreed that a husband is justified in hitting or beating if she neglects the children (%) HIV/AIDS Women/men who know that people can reduce the risk of getting the AIDS virus by using condoms every time they have sexual intercourse (%) Men who had sexual intercourse in the past 12 months with a non-marital, non-cohabiting partner (%) Women/men who have comprehensive knowledge about HIV/AIDS transmission and prevention (%)

19 Total Rural Urban Coastal Central Mountain Urban Tirana / / / / / / /2.4 21/22 21/23 21/22 21/23 21/22 21/24 21/22 22/26 21/26 23/28 22/27 22/26 22/26 24/ /80 93/84 79/77 87/70 92/86 93/85 65/ /28 24/31 16/24 22/37 23/27 24/30 5/ /83 64/78 86/90 75/81 70/82 63/73 91/ /20 19/12 40/30 30/20 23/15 17/12 49/41

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