Fayoum Villages Health Survey 2005 Baseline
El-Zanaty& Associates
CHL Programs
Tulane University
Fayoum Villages Health Survey 2005 Baseline
Fatma El- Zanaty Dina Armanious Noha El- Ghazaly Dominique Meekers
TABLE OF CONTENTS ACKNOWLEDGMENTS …………………………………………….………………………I EXECUTIVE SUMMARY ................................................................................................... II 1
INTRODUCTION.......................................................................................................1 1.1 1.2 1.3 1.4
2
SOCIOECONOMIC CHARACTERISTICS OF HOUSEHOLDS AND RESPONDENTS..........6 2.1 2.2 2.3 2.4
3
Immunization of Children ...................................................................................36 Prevalence and Treatment of Diarrhea .................................................................37 Prevalence and Treatment of Acute Respiratory Infections .................................. 37 Breast Feeding and Supplementation ...................................................................38 Vitamin A Supplementation among Children.......................................................39
KNOWLEDGE, ATTITUDES, PERCEPTIONS AND PRACTICES OF HIV/AIDS, HEPATITIS C AND SAFE INJECTIONS ................................................................... 40 6.1 6.2 6.3
7
Care During Pregnancy .......................................................................................29 Delivery Care...................................................................................................... 31 Postpartum Care.................................................................................................. 32 Attitudes toward Maternal Health ........................................................................ 34
CHILD HEALTH ....................................................................................................36 5.1 5.2 5.3 5.4 5.5
6
Age at First Marriage ..........................................................................................13 Fertility Levels .................................................................................................... 13 Fertility Preference..............................................................................................14 Knowledge and Attitudes toward Family Planning .............................................. 17 Ever Use of Family Planning...............................................................................21 Current Use of Family Planning .......................................................................... 22 Discontinuation Rates..........................................................................................26 Intention to Use Contraception in the Future........................................................27
MATERNAL HEALTH ............................................................................................29 4.1 4.2 4.3 4.4
5
Household Composition ........................................................................................6 Education of the Household Population .................................................................6 Household Environment ........................................................................................8 General Characteristics of Respondents ............................................................... 10
FERTILITY AND FAMILY PLANNING......................................................................13 3.1 3.2 3.3 3.4 3.5 3.6 3.7 3.8
4
Background...........................................................................................................1 Organization and Objectives of the 2005 Fayoum Villages Health Survey (MVHS)....................................................................................................1 Implementation of the 2005 Fayoum Villages Health Survey ........................2 Coverage of the Survey .........................................................................................5
Knowledge and Perceptions related to HIV/AIDS................................................ 40 Knowledge and Perceptions related to Hepatitis C ...............................................42 Knowledge, Attitudes and Practices related to Safe Injections and Blood Borne Diseases .........................................................................................44
HEALTHY LIFESTYLES AND PASSIVE SMOKING....................................................47 7.1
Hand Washing Practices ......................................................................................47
7.2 7.3 7.4
8
LEADERSHIP, HEALTH INFORMATION AND SUPPORT FOR HEALTH IMPROVEMENT........................................................................................54 8.1 8.2 8.3 8.4 8.5 8.6 8.7 8.8
9
Knowledge of Female Circumcision .................................................................... 62 Prevalence of Female Circumcision and Intention to Circumcise Daughters.........62 Support for Female Circumcision ........................................................................ 62 Perceptions about Female Circumcision ..............................................................63
EXPOSURE TO INFORMATION, EDUCATION, AND COMMUNICATION CAMPAIGNS ............................................................................65 10.1 10.2 10.3 10.4 10.5 10.6 10.7 10.8
11
Perceptions about Leadership Characteristics.......................................................54 Perceptions about Actual Community Leaders.....................................................55 Access to Health Information ............................................................................ 56 Attitudes related to Maternal and Child Health ....................................................58 Attitudes related to Maternal Health .................................................................... 59 Willingness to Participate in Family Health Improvement Activities....................59 Perceptions about Families’ Ability to Avoid or Solve Health Problems .............. 60 Perceptions about Community Health Problems ..................................................61
FEMALE CIRCUMCISION.......................................................................................62 9.1 9.2 9.3 9.4
10
Performing Usual Activities ................................................................................ 48 Knowledge, Attitudes, Practices and Perceptions related to Smoking...................48 Attitudes toward Passive Smoking.......................................................................51
Communication about Family Planning .............................................................. 65 Communication about Birth Spacing ...................................................................68 Communication about Pre- and Postnatal Care ....................................................69 Communication about Passive Smoking ..............................................................71 Communication about HIV/AIDS........................................................................ 73 Communication about Safe Injections.................................................................. 74 Communication about Female Circumcision........................................................75 Health Campaigns in Egypt .................................................................................75
CHL BEHAVIOR CHANGES COMMUNICATION ACTIVITIES ..................................77 11.1 11.2 11.3 11.4 11.5 11.6
Exposure to CHL Campaign Messages on TV .....................................................77 Exposure to CHL Campaign Messages through Printed Media ............................79 Exposure to CHL Campaign Messages through Interpersonal Channels .....82 Exposure to CHL Campaign Messages through Visits .........................................82 Exposure to CHL Campaign Messages through “Mabrouk” book ........................83 Recall of Specific CHL Campaign Spots and Slogans .........................................83
APPENDIX A DETAILED TABLES....................................................................................88 Chapter 3 ...........................................................................................................88 Chapter 4 ......................................................................................................... 117 Chapter 5 ......................................................................................................... 131 Chapter 6 ......................................................................................................... 136 Chapter 7 ......................................................................................................... 155 Chapter 8 ......................................................................................................... 174 Chapter 9 ......................................................................................................... 199 Chapter 10 ....................................................................................................... 207
Chapter 11 ....................................................................................................... 236
APPENDIX B QUESTIONNAIRES ...................................................................................260 Household Questionnaire ................................................................................. 260 Women’s Questionnaire ................................................................................... 271 Husband’s Questionnaire.................................................................................. 337 Youth’s Questionnaire...................................................................................... 381
APPENDIX C SURVEY STAFF........................................................................................416 Technical and Administrative Staff .................................................................. 416 Field Staff ........................................................................................................ 417
ACKNOWLEDGEMENTS The 2005 Fayoum Villages Health Survey (FVHS 2005) was conducted in three villages of the Fayoum governorate under the auspices of the Ministry of Health and Population (MOHP). The survey was funded by the United States Agency for International Development (USAID), as part of the external evaluation of the impact of the Health Communication Partnership (HCP). Tulane University’s Department for International Health and Development (Tulane/IHD), School of Public Health and Tropical Medicine, has been selected as the external evaluator for the HCP program. The external evaluation of the HCP partnership will comprise in-depth evaluations of a selected number of HCP programs, including the Communication for Healthy Living (CHL) program in Egypt. The goal of research and monitoring efforts is to assess the reach and impact of the CHL program activities on the family members’ values, attitudes, intentions, and health competency; to encourage life-stage appropriate health behaviors; and to increase demand for and utilization of health information and services. The 2005 FVHS was designed to provide estimates for key indicators such as contraceptive use, immunization levels, coverage of antenatal and delivery care, maternal and child health nutrition, infectious diseases, and other aspects of healthy life. The survey results are intended to assist the technical staff at the CHL project to design new communication strategies and activities for improving the health status of Egyptians. The results will also serve as a baseline to measure the impact of the CHL project. Two additional waves of the FVHS are scheduled to be conducted at 18-month intervals to monitor and evaluate the reach and impact of the CHL project activities. This survey could not have been implemented without the administrative and technical support of the Health Communication Partnership. We particularly wish to thank Mr. Ron Hess, Chief of Party HCP, for his contribution and support. We would also like to thank Dr. Tawhida Khalil, Senior Health Communication Advisor to the CHL program. We are deeply grateful to Tulane university experts who contributed to the successful completion of this project, especially Dr. Dominique Meekers, professor in the Department of International Health and Development, Tulane University, and Associate Director for Summative Evaluation of the Health Communication Partnership, whose active support and insight throughout the survey was important for the success of the survey. Special thanks are also due to Dr. Douglas Storey, Associate Director for Program Research & Communication Sciences of the Health Communication Partnership for technical assistance in the design of the study. This survey could not have been conducted in such a timely fashion without the combined efforts of the senior, office and field staff in the FVHS team. I would like to express my appreciation for the dedication and skill with which they performed their tasks. Finally, I would like to express my appreciation to all respondents who participated in the survey; without their participation this project would have been impossible.
i
EXECUTIVE SUMMARY For many years, various programs have been implemented in Egypt to improve the health status of all Egyptians. Among those programs, the Communication for Healthy Living Program (CHL) is implemented as part of the Health Communication Partnership (HCP), which is funded by the United States Agency for International Development (USAID). The communication for healthy living (CHL) program contributes to the Egyptian government's efforts to reduce population growth, promote infection prevention practices, reduce maternal and child mortality, as well as promote healthy lifestyles and advance health sector reform. The 2005 Fayoum Villages Health Survey (FVHS) was conducted in three villages at Fayoum governorate as a baseline to assess the reach and impact of the CHL program activities on the family members, provide estimates for key indicators that will assist the technical staff at the CHL project to design new communication strategies and activities for improving the health status of Egyptians. These villages are; Al Tawfikia, Tersa and Kasr Rashwan The study included interviews with 945 ever married women (15-49 years), 792 husbands, and 890 never married youth (15-24 years).
Fertility Preference and Unmet Need Age at first marriage. One of the factors that have had a considerable impact in influencing the continuous decline in fertility levels in Egypt is the steady increase in age at which women marry. The median age at first marriage among women age 25-29 in the surveyed villages is currently 18.5, which is around two and a half years greater than the median age at first marriage prevailing among women age 45-49. Ideal number of children. The respondents in the different groups were asked about the ideal number of children they would like to have, in general married respondents want on average more children (3.5 and 3.0 children for husbands and women respectively) than never married youth do (2.9 and 2.4 children for male and female youth respectively). Premarital and newly wed examination. There was a wide difference between the respondent's knowledge about premarital examination and newly wed examination. Overall, knowledge about premarital examination ranged from 69 % among women to 78% among never married female youth, while knowledge about newly wed examination ranged from 2% among women to 13 % among never married female youth. Furthermore, almost none of the women and husbands have had premarital or newly wed examination, whereas a relatively encouraging percentage of never married female youth (28 %) and never married male youth (37%) intend to have premarital examination. Moreover, only about 2% of never married youth intend to have newly wed examination. Need for family planning. Nineteen percent of all currently interviewed married women are considered to have an immediate need for family planning, 6 % of those married women represent a desire to space the next birth and the remaining 13 % represent a desire to limit births. Furthermore, 54% of currently married women have a met need for family planning, where 40 % of those women are limiters while the remainders (14%) are spacers, additionally the total demand for family planning was slightly more than 74%, and slightly less than 74% of this total demand was completely satisfied.
Family Planning Knowledge of family planning. Data of the FVHS 2005 show that the knowledge about the contraception methods (pill, IUD and injectables) is universal among all groups of respondents. It should be taken into consideration that almost 1% or less of the respondents had ever heard about emergency contraception.
ii
Approval of family planning use. Almost 96% and more of all respondents in the surveyed villages approve of a couple’s using family planning. However a fewer percentage of respondents indicated that it is appropriate for a couple to use family planning after the birth of their first child, as was indicated by almost 93% of women and never married female youth, and 91 % of husbands and 85% of never married male youth. Still, use before first pregnancy is not acceptable among all respondents, where 13% or less of women, husbands and never married male youth and 18% of never-married female youth mentioned that it was appropriate for a couple to use family planning before the first pregnancy. Knowledge of fertile period. Knowledge of the women's fertile period is quite deficient among all the respondents, where only 34% of all interviewed women, 30% of husbands, 16% of never married female youth, and 13% of never married male youth knew the fertile period. In addition, 42% of women and 30% of husbands who know the fertile period mentioned that it is half way between two periods, while fewer percentages were observed among youth. Ever and current use of family planning. Eighty-one percent of women in the surveyed villages have ever used a method of family planning; the modern methods were used much more often than the traditional methods (77% compared to 24%). Furthermore, the most commonly used modern method was the injectables (52%), closely followed by the IUD (48%) and the Pill (46 %). Currently, the use of modern methods outweighs by far the use of traditional methods. Furthermore, almost one quarter (24%) of currently married women are using injectables, followed by the IUD (18%) and then pills (6%) as the most commonly used method of contraception. Source of family planning methods. Overall, the public sector was the most common source for the IUD (71%) and the injectables (94%); whereas the private sector was the most common source for the pill (82%). Moreover, when husbands and never married youth were asked about the source from which they could get a family planning method, the rural health unit was mentioned as the most common source of family planning methods. Discontinuation rates. Overall, 61% of users discontinue using a method within 12 months of starting use. The percentage of discontinuation among pill users is 77% and this percentage decreased to 65% among injectable users and to 48% among IUD users. Generally, the most commonly mentioned reason for the discontinuation of contraceptive methods was side effects and health concerns. Future use of family planning. Almost all female and male youth reported that they have the intention to use contraception in the future. While the intention to use among women and husbands are much less (72% and 68% respectively). Being subfecund was the most commonly mentioned reason for nonuse of family planning by both women and husbands (33%) followed by menopausal or hysterectomy reason.
Maternal Health Coverage of care during pregnancy. Overall, 57% of mothers in the five years preceding the survey received antenatal care mainly from a doctor and at a private sector (35%). Only 42% of mothers received regular antenatal care and the median timing for the first antenatal care check was at the third month of pregnancy. Knowledge and intention to do antenatal care. Ninety-three percent of husbands and 95% of never married female youth in all surveyed villages had ever heard about antenatal care, while 88% of never married male youth had heard about antenatal care. The appropriate median number of antenatal care visits was 9 among husbands, 7.3 among never married female youth and 4.3 among never married male youth. Moreover, 93% of female youth reported that they intend to go for antenatal care in the future, and 95% of male youth intend to let their wives go for antenatal care when they get married. Delivery care. The data show that 54% of mothers delivered at home, the Daya assisted 50% of women during delivery and the doctor assisted 47%. In addition, 94% of all deliveries were
iii
normal vaginal deliveries. When all respondents except women were asked about the appropriate place of delivery and the attendant who should assist in delivery, the data show that 81% of husbands and 91% of youth mentioned that women should give birth in a medical facility and 84% of husbands and almost 92% of youth indicated that the doctor should assist her during birth. Postpartum care for the mother. Only 19% of mothers received a postnatal checkup within 2 days after delivery, while 75% of women didn't receive any care. Furthermore, almost all postnatal checkups were conducted by a doctor, and the checkup was most likely to be conducted at clinic/private doctor. Postpartum care for the newborn. Overall, 12% of newborn received postnatal care within 2 days of birth, while 60% of the children did not receive any care. However, most of the children who received postnatal care had it conducted at the clinic/private doctor. Furthermore, the data shows that a blood sample was taken from 80% of last births. Advantages of postpartum care for mother and newborn. Around 90 % of all respondents indicated that checking the child's health was the most important advantage of having postnatal care for the newborn. Additionally, around 90 % of all groups of respondents mentioned that checking the mother's health was the most important advantage of having postnatal care for the mother.
Child Health Childhood vaccination coverage. Among children 12-23 months, the data revealed that 76% of all children are considered fully immunized against preventable childhood diseases. Prevalence and treatment of childhood illnesses. The findings indicated that 15% of the children in the surveyed villages had diarrhea during the two weeks prior to the survey, the children who had diarrhea mostly received medical care from any health provider (42%). Furthermore, the most commonly used medication is the rehydration therapy, which was ORT/increased fluids (48%). Seven percent of the children were found to be ill with cough and short rapid breathing during the two weeks prior to the survey, as was the case with children with diarrhea, 62% of the children with acute respiratory infection received medical care from any health provider and they were mostly treated with antibiotics (80%). Nutrition for children and supplementation. Ninety-seven percent of all interviewed women ever breastfed their babies. More than half of children (51%) started breastfeeding within one hour of birth, 59% started breastfeeding within one day of birth, while 71% of the children received prelacteal feeding. Additionally, 89% of all children under two months old were exclusively breastfed; however, this figure dropped to reach 63% for children between 2 and 3 months. With regard to Vitamin A supplementation among children, 78% of children aged 12-23 received a vitamin A capsule.
Knowledge and Modes of Transmission of HIV/AIDS, Hepatitis C and Safe Injection Knowledge and modes of transmission of HIV/AIDS. Overall, knowledge about HIV/AIDS is not universal, where 89 % of husbands, 87 % of never married male youth, 80 % of never married female youth and only 72 % of women had heard about AIDS. Almost all respondents who knew about AIDS indicated that the television was their source of knowledge. Illicit sexual relations was indicated by most of the respondents as the most common mode of transmission of AIDS, ranging from 38% among never married female youth to 72% among husbands. Knowledge and modes of transmission of Hepatitis C. Only 67% of never married female youth, 66% of husbands, 58% of women and 49% of never married male youth had ever heard about Hepatitis C. As was the case with AIDS, the television was also the most common source of knowledge about Hepatitis C. The most commonly mentioned mode of transmission of Hepatitis C among married respondents was the infected needles as was indicated by 56% of women and 64% of husbands. While the most commonly mentioned mode of transmission among youth was blood
iv
transfusion as was indicated by 80 % of never married male youth, 63% of never married female youth. Knowledge of blood borne diseases and safe injection practices. The respondents were asked to indicate whether or not they had heard about blood borne diseases that are transmitted through used needles. Overall, the data indicated that 52% of ever married women, 57% of husbands, 60% of unmarried female youth, and 46% of unmarried male youth had heard about blood borne diseases that can be transmitted through syringes. The respondents indicated that the three most common blood borne disease that can be transferred through used needles were HIV/AIDS followed by Hepatitis C and Tetanus. The most mentioned method to prevent the risk of infection from an infected person was not to share or reuse needles.
Community Leaders Knowledge of actual community leaders. Respondents from all groups were asked if there is someone that they considered to be a leader in their community. Data from the 2005 FVHS show that around one quarter of respondents believe their community has a leader, where 27% of women, 26% of husbands and never-married female youth, and 24% of never-married male youth mentioned the presence of an actual leader in their community.
Female Circumcision Levels and attitude. The data of the 2005 FVHS revealed that the practice of female circumcision is wide spread, where almost all women and never-married female youth indicated that they had been circumcised (99% and 98% of women and never married female youth respectively). Moreover slightly less than half women and husbands reported that at least one of their daughters had been circumcised. With regard to youth’s intention to have any future daughters circumcised, around three quarter of never-married female and male youth intend to circumcise their daughters in the future. Support for female circumcision. Overall, women and husbands were the groups that were most supportive to the continuation of female circumcision (86% and 80% respectively). There is a wide degree of consistency between the never married youth's intention to circumcise their daughters and their support for the continuation or discontinuation of the practice of female circumcision, as 73% and 74% of never married female youth and male youth respectively support the female circumcision practice.
Exposure to Health Messages Family planning and maternal health messages. Overall, between 59% (never married female youth) and 41% (husbands) indicated that they had heard or seen information about family planning during the six months preceding the survey. The percentage of respondents who had heard or seen information about family planning use after the birth of the first child is relatively low, where female respondents were the group that was most exposed to these messages (30% and 32% of women and unmarried female youth respectively). The percentages of exposure to such messages decreased to 20% among husbands and 25% among male youth. Regarding the optimal birth spacing messages, the data revealed that 29% or less of respondents had been exposed to optimal birth spacing messages with highest exposure among females (29%) and least exposure among husbands (16%). Regarding maternal health messages, data of 2005 FVHS revealed that 19% of ever married women and 15% of never married female youth report that they received such information. Level of exposure to such information is much lower among males, where 8% of husbands and 4% of never married male youth reported receiving information about safe pregnancy during the past six months. While exposure to postpartum/neonatal medical consultation messages was quite low as was indicated by only 19% of never married female youth, 14% of women and 5% of both husbands and never married male youth.
v
Passive smoking messages. The findings indicated that around 27% of all respondents except never married male youth (19%) had heard/seen messages about the health effects of second hand smoke. HIV/AIDS messages. There was some degree of discrepancy among respondents with regard to whether or not they had heard about HIV/AIDS, where the awareness regarding HIV/AIDS among females is less than among males, where 72% of women, 80% of never-married female youth, 89% of husbands and 87% of never-married male youth had ever heard about HIV/AIDS. Safe injection messages. Overall, 42% of both women and never married female youth, 28% of husbands, and 19% of never married male youth had heard/seen or received any information about how injections are given safely. Nearly all respondents who received information about safe injections reported that they were informed to only use a syringe in a sealed packet (94% or more), and around 50% were informed not to share syringes except for never-married male youth (35%). Female circumcision messages. Data of 2005 FVHS revealed that unmarried youth heard about female circumcision more than women and husbands. About two thirds of women and husbands (67% and 64% respectively) heard about FGM from the television during the last six months, while these percentages increase to around three quarters among never-married youth (75% among females and 73% among males). Source of information of health messages. The TV was the most common source of information for all health messages mentioned by all respondents.
Level of Comfortable Discussing Health Information Use of family planning and maternal health. Data of the 2005 FVHS shows that women and husbands would be comfortable talking with their spouse as well as service providers about the use of family planning methods, safe pregnancy and delivery, and keeping babies healthy. However, the data revealed that discussing postpartum and neonatal consultations and family planning among women and husbands was quite infrequent in the six months preceding the survey. Never married female youth would be most comfortable talking with their parents, while never married male youth would be most comfortable talking with their friends, neighbors or service providers. Regarding discussing the optimal birth spacing, the data shows that youth had discussed this mostly with their friends/neighbors, while married respondents had talked most with their spouse. Second hand smoking. With respect to comfort discussing dangers of second hand smoke, service provider is the most mentioned reference by all groups of respondents. In addition, the data shows that 19% or less of respondents talked about the effects of exposure to second hand smoke. HIV/AIDS prevention. Overall, one third or more of women and never married female youth (36% and 33% respectively) preferred not to discuss how HIV/AIDS could be prevented with anyone, however, more than half of both husbands and never married male youth would be comfortable talking with the service provider. In addition, the data revealed that there was lack of interpersonal communication about HIV/AIDS prevention among the respondents. Preventing unsafe injection. With regard to talking about preventing unsafe injections, the data revealed that the respondents in the different groups would be most comfortable talking with the service provider. Health campaigns in Egypt. Almost two third of female youth (63%) and 55% of ever married women remembered “Zeina and Zaki” campaign, compared to 36% and 50% of husbands and never married male youth respectively. Additionally, most never-married female youth remembered “Gold Star” health campaign (72%), while more than half of women (58%), 47% of never-married male youth and 39% of husbands remembered such campaign. Furthermore, more than three quarters of unmarried female youth (76 percent), 59% of women, 54% of male youth and 43% of husbands remembered "Isaal Istasher" health campaign.
vi
Exposure to CHL Communication Interventions through TV Exposure to TV Spot “Your Health is Your Wealth”. Data of 2005 FVHS indicated that the females watched the spot more than males, where 57% of female youth and 43% of women, while slightly less than one third of husbands and one quarter of male youth who report watching TV watched the spot. Most respondents who watch the spot reported that the spot affect their behaviors. Youth are more likely to mention that their behaviors were affected by the spot messages more than women and husbands. Exposure to TV Spot “Family’s Doctor”. Data of 2005 FVHS indicates that only few respondents saw TV spot “Family’s Doctor” during the last 12 month. Females reported that they saw the spot more than the males. One in five women and unmarried females, 14% of husbands and 10% of unmarried males mentioned that they saw the spot in the television during the past 12 months. The most frequent recalled messages among all groups of respondents are: “Family’s doctor is available in every health unit”, “Family’s doctor will be a private doctor for all family’s member” and “Family health clinics will include all kinds of examination”. Exposure to TV Spot “Isaal Istashir”. Data of survey indicated that females saw or heard the spot more than the males. Eighty-one percent of unmarried females, 64% of women, 57% of unmarried males and 52% of husbands have ever seen/heard the spot and the television is the main source for the spot followed by a poster in a pharmacy or in a clinic. In addition, the data revealed that the highest recall message among all respondents was that the spot advise people to consult a doctor/pharmacist about problems or inquiries. Additionally, around one third of all groups of respondents reported that they have ever gone to a pharmacy have “Isaal Istashir” sign. Exposure to TV Programs. Data of 2005 FVHS indicates that the exposure to the television programs during the 12 months preceding the survey was not as high as the television spots. The data shows that less than one quarter of all groups of respondents saw a television program during the last 12 months. The most frequent practice affected by the programs mentioned by married respondents was that they used family planning methods, while for unmarried youth, they mentioned that they intend to use family planning methods after marriage. The second most frequent practice changed by the programs is that the married respondents spaced between births, while youth intend to space between births.
Exposure to CHL Communication Interventions through Printed Media It has to be taken into consideration that due to the low educational level of respondents the level of exposure to printed media is remarkably much lower than broadcast media especially the television. Data of 2005 FVHS indicates that half of respondents or less read newspapers/magazines regularly or sometimes. Additionally, only a limited percentage of those who read newspapers/magazines read a subject about family health and family planning. Very low percentage (3% or less) reported that they ever saw “Mabrouk book”.
Exposure to CHL Communication Interventions through Posters/flyers/billboard Data of 2005 FVHS revealed that the percentages of females who saw the posters/flyers/billboards talking about family planning, family health…etc. during the 12 months preceding the survey are greater than the males, where the percentages ranges from 30% among unmarried females to 13% among unmarried males. However, the data shows that the females are less likely to learn something from these posters than males. The first ranked message learned by all groups of respondents was “the importance of family planning”.
vii
INTRODUCTION 1.1
1
Background
For many years, various programs have been implemented in Egypt to improve the health status of all Egyptians. Among those programs, the Communication for Healthy Living Program (CHL) is implemented as part of the Health Communication Partnership (HCP), which is funded by the United States Agency for International Development (USAID). The CHL program aims to: • Achieve broad scale behavioral change for health at the individual, family, and community levels in Egypt by July 2008. • Strengthen leadership around health issues. • Improve the capacity of Egyptian health systems and organizations to conduct sustainable and strategic health communication programs. To achieve those goals, the CHL program provides support across the following health areas: family planning and reproductive health, maternal and child health, infectious diseases control, healthy lifestyle, household preventive health, and health maintenance practices. This report presents the results of a health survey conducted in several villages in Fayoum, which is one of the target areas for the CHL project. The survey focuses on respondents’ knowledge and practices in areas related to family planning/reproductive health, healthy lifestyles, healthy mother/healthy child, and infectious diseases. The aim of the survey is to provide data that can be used to inform the design of the CHL program, and that can serve as a baseline for a planned external evaluation of the CHL program. Indicators derived from this survey will be compared with those from subsequent survey waves to assess the reach and impact of the program.
1.2 Organization and Objectives of the 2005 Fayoum Villages Health Survey (MVHS) The 2005 Fayoum Villages Health Survey (FVHS 2005) was conducted in three villages of the Fayoum governorate under the auspices of the Ministry of Health and Population (MOHP). The survey was funded by the United States Agency for International Development (USAID), as part of the external evaluation of the impact of the Health Communication Partnership (HCP). Tulane University’s Department for International Health and Development (Tulane/IHD), School of Public Health and Tropical Medicine, has been selected as the external evaluator for the HCP program. The external evaluation of the HCP partnership will comprise in-depth evaluations of a selected number of HCP programs, including the Communication for Healthy Living (CHL) program in Egypt. To enable a rigorous evaluation of the reach and impact of the CHL program, the research design selected was a three-round panel survey to be conducted in each of the intervention locations and in a control group. The 2005 FVHS is the first wave of that survey. El-Zanaty & Associates implemented the survey, with limited technical assistance from Tulane/IHD. The goal of research and monitoring efforts is to assess the reach and impact of the CHL program activities on the family members’ values, attitudes, intentions, and health competency; to encourage life-stage appropriate health behaviors; and to increase demand for and utilization of health information and services. The 2005 FVHS was designed to provide estimates for key indicators such as contraceptive use, immunization levels, coverage of antenatal and delivery care, maternal and child health nutrition, infectious diseases, and other aspects of healthy life. The
1
survey results are intended to assist the technical staff at the CHL project to design new communication strategies and activities for improving the health status of Egyptians. The results will also serve as a baseline to measure the impact of the CHL project. Two additional waves of the FVHS are scheduled to be conducted at 18-month intervals to monitor and evaluate the reach and impact of the CHL project activities.
1.3
Implementation of the 2005 Fayoum Villages Health Survey
The 2005 FVHS was executed in three stages. The first stage involved preparatory activities, including the sample design and household listing in the intervention villages. The preparatory stage was initiated in July 2005, and all of the activities were completed by August 2005. No pretest was conducted since the instruments were all tested in 2004 before conducting the Menya villages' survey. The second stage took place from July 2005 through August 2005, and involved training of field staff and interviewing of eligible households and individual respondents. The third stage involved all of the data processing activities necessary to produce a clean data file, including the data entry, verification of the data, editing, and coding, as well as consistency checking and tabulations. This stage started soon after the beginning of the fieldwork and lasted through midOctober 2005. The focus of the final stage of the survey was data analysis and report preparation. This phase began in Late October 2005 and took about 3 months. Sample design As previously mentioned, this baseline survey was implemented in the Fayoum governorate. The survey collected data from ever-married women in the age group 15-49 years, and from husbands and never-married male and female youth aged 15-24 years. To permit estimating of the main indicators at the village level, a sample size of approximately 330 households per village was recommended (i.e., a total of about 1000 households). A total sample of about 1,000 ever-married women, 900 husbands, and 900 youth were expected to be interviewed in the selected households. Sample selection The sample of the study was a multistage random sample consisting of the following stages (for each sample):
First Stage: The CHL selected three villages in Fayoum for their interventions, and it was agreed to take them all. The intervention villages included Al Tawfikia, Tersa, and Kasr Rashwan. No control villages included in Fayoum survey. Second Stage: The total population of each village was estimated and accordingly the number of households was estimated. Then the village was divided into parts; each part consisted of around 1000 households. Thus, Al- Tawfikia was divided into 10 part from each part one segment was selected, while Tersa was divided into 15 parts with 15 segment. Finally, Kasr Rashwan was divided into 19 parts and 19 segments were selected. El-Zanaty & Associates has long experience in preparing maps, using topographers, conducting quick counts, and performing household listings. Thus, El-Zanaty & Associates used separate teams to conduct the listing one week prior to data collection. . Third Stage: Using the household listing of each segment, a systematic random sample of the households was chosen from each segment. The number of households selected from each segment was calculated based the total number of households need to be selected (330 Households) divided by the number of segments per villages. The number of households selected per segment for villages was 33 in El-Tawfikia, 23 in Tersa, and 17 in Kasr Rashwan. For each segment, the sampling interval was calculated by dividing the number of households in the segment by the number of households to be selected form each segment. Eligibility: In the selected households, interviews were conducted with all eligible household members. Eligible household members included ever- married women aged 15-49 years, husbands of women in reproductive age, and never-married youth aged 15-24 years.
2
Questionnaire development The 2005 FVHS involved two types of questionnaire: a household questionnaire and an individual questionnaire. The individual questionnaire was developed in three different versions, for women, husbands, and never-married youth. The household and individual questionnaires were the same that were used in Menya Health Survey baseline. However, few questions were added in the Household questionnaire in addition to one section in the individual questionnaire on exposure to communication activities. All questionnaires were developed based mainly on EDHS questionnaires. Additional questions on a number of topics not covered in the DHS model questionnaires were also included in the 2004 MVHS questionnaires and 2005, Menya and Fayoum health surveys. These additional questions focus predominantly on exposure to health communication and on health behaviors. The household questionnaire consisted of two parts: a household schedule and a series of questions relating to the socioeconomic status of the household. The household schedule was used to list all usual household members and to identify those present in the household during the night before the interviewer's visit. For each of the individuals included in the schedule, information was collected on the relationship to the household head, age, sex, marital status (for those 15 years and older), educational attainment (for those 3 years and older), and current enrollment (for those 3-24 years). The second part of the household questionnaire obtained information on characteristics of the physical and social environment of the household (e.g., type of dwelling, availability of electricity, source of drinking water, household possessions, and type of salt the household uses for cooking). The individual questionnaires were administered to all ever-married women aged 15-49 who were usual residents, husbands of women in the reproductive age, and never-married male and female youth aged 15-24. The individual questionnaires mainly covered the same topics; however, there were some differences according to which version was administered. For example, questions about current use of contraception were not addressed to the youth. In general, individual questionnaires gathered information on the following topics: • Respondent's background • Reproduction • Contraceptive knowledge and use • Fertility preferences and attitudes about family planning • Pregnancy and breastfeeding • Immunization and child health • Knowledge of some infectious diseases • Healthy life style and passive smoking • Leadership information and support for health improvement • Female circumcision • Exposure to communication campaigns The individual questionnaire for ever-married woman included a monthly calendar, which was used to record a history of the respondent's fertility, contraceptive use (including the source from which the method was obtained and the reason for discontinuation for each segment of use), and marital status during each month (for nearly a 6-year period beginning in January 2000). Pretest The questionnaires for the 2005 FVHS were those that were used in 2004 MVHS. No pretest was carried out for this survey since the questionnaires were tested and finalized in 2004 during the preparation for Menya survey. English versions of the final Arabic language questionnaires are included in Appendix B.
3
Data collection activities
Staff recruitment. To recruit interviewers and field editors, a list of interviewers and field editors who had worked with the firm in the EDHS 2005 was prepared to identify those who were qualified to participate in the training. This action was taken to reduce the duration of training and to enhance the quality of the data. All candidates for the interviewer and field editor positions were university graduates and had intensive experience in DHS surveys. Another basic qualification was the willingness to work in any village covered in the survey.
Training materials. A variety of materials were developed for training personnel involved in the fieldwork. A lengthy interviewer's manual was prepared and given to all field staff. The manual presented general guidelines for conducting an interview as well as specific instructions for asking each of the questions in the 2005 FVHS questionnaires. Other training materials, including special manuals describing the duties of the team supervisor and the rules for field editing, were prepared. Supervisor and interviewer training. A special training program for supervisors was conducted during the training and prior to the main fieldwork training. This training focused specifically on the supervisor's duties. Interviewer training for the 2005 FVHS data collection began in August 2005. Four supervisors and 20 interviewers participated in the training program. The training program was held in Cairo for 3 weeks and included: • Lectures related to basic interviewing techniques and specific survey topics (e.g., fertility and family planning, maternal and child health, and female circumcision); • Sessions on how to fill out the questionnaire, using visual aids; • Opportunities for role playing and mock interviews; • Two days of field practice in areas not covered in the survey; • Two quizzes. Trainees who failed to show interest in the survey, who did not attend the training program on a regular basis, or who failed in the first three tests were terminated immediately. Each team was assigned to work in only one village. Each team consists of six members, one supervisor, one field editor and 4 interviewers. To supplement the experience gained from working in various surveys (especially DHS); a special training session focusing on field editing duties was held for the field editors and supervisors.
Fieldwork. Fieldwork for the 2005 FVHS began in 20th of August and was completed by midSeptember 2005. A total of 24 staff was responsible for the data collection. The field staff was divided into three teams; each team was composed of a supervisor, a field editor, and four interviewers. Each team worked in only one village. As soon as the main data collection was completed, a random sample of up to 5 % of the households was selected for re-interview as a quality control measure. Shorter versions of the 2005 FVHS questionnaires were prepared and used for the re-interviews. The visits to PSUs to conduct re-interviews also offered an opportunity to make callbacks to complete interviews with households or individuals who were not available at the time of the original visit. Special teams were organized to handle callbacks and re-interviews. During this phase of the survey, interviewers were not allowed to work in the village in which they had participated in the initial fieldwork. Callbacks and re-interviews began on September ?? and were completed by the end on September.
4
Data processing activities
Office editing. Staff from the central El-Zanaty & Associates office was responsible for collecting questionnaires from the teams on a regular basis. Office editors reviewed questionnaires for consistency and completeness, and a few questions (e.g., occupation) were coded in the office prior to data entry. To provide feedback for the field teams, the office editors were instructed to report any problems detected while editing the questionnaires; these problems were reviewed by the senior staff. If serious errors were found in one or more questionnaires from a certain village, the supervisor of the team working in the village was notified and advised of the steps to be taken to avoid these problems in the future. Machine entry and editing. The machine entry and editing phase began while the interviewing teams were still in the field. The data from the questionnaires were entered and edited on microcomputers using the Census and Survey Processing system (CSPro), which is a software package for entering, editing, tabulating, and disseminating data from censuses and surveys. Ten data entry personnel with 10 microcomputers processed the 2005 FVHS data. During the machine entry, 100% of each segment was reentered for verification. By working one shift 5 days per week, the data processing staff completed the entry and editing of data by Mid October 2005.
1.4
Coverage of the Survey
Table 1.1 summarizes the outcome of the fieldwork for the 2005 Fayoum Villages Health Survey, by village. The table shows that, during the main fieldwork and callback phases of the survey, out of 1,010 households selected for the 2005 FVHS, 973 households were successfully contacted, which represents a response rate of almost 100 %.
Table 1.1 Results of the household and individual interviews - CHLFAYOUM 2005. All villages
Village Al Tawfikia Interview Results Households sampled Households found Households Interviewed Household response rate Women sampled Women interviewed Women response rate Husbands sampled Husbands interviewed Husbands response rate Young men sampled Young men interviewed Young men response rate Young women sampled Young women interviewed Young women response rate Youth sampled Youth interviewed Youth response rate
331 320 320 100.0 314 311 99.0 299 294 98.3 209 206 98.6 89 89 100.0 298 295 99.0
Kasr Tersa Rashwan
Total
346 340 338 99.4 347 338 97.4 297 244 82.2 197 175 88.8 132 132 100.0 329 307 93.3
1,010 978 973 99.5 966 945 97.8 872 794 91.1 626 576 92.0 309 308 99.7 935 884 94.5
333 318 315 99.1 305 296 97.0 276 256 92.8 220 195 88.6 88 87 98.9 308 282 91.6
A total of 966 women were identified as eligible to be interviewed in the three villages. Questionnaires were completed for 945 of those women, which represents a response rate of almost 98 %. A total of 872 husbands were identified as eligible to be interviewed; out of those, 792 husbands were successfully interviewed, a response rate of 91%. About 890 youth were interviewed, a response rate of 95 %. The response rate of husbands and youth varied by village; the husbands’ response rate varied from a minimum of 82 % in Tersa up to 98 % in Al- Tawfikia. Also, the female youths’ response rate was higher than the male youths’ response rate in all villages.
5
SOCIOECONOMIC CHARACTERISTICS OF HOUSEHOLDS AND RESPONDENTS
2
This chapter provides a demographic and socioeconomic profile of the villages in the 2005 FVHS along with a descriptive assessment of the environment in which women, husbands, youth, and children live. This was accomplished by examining the general characteristics of the households in the sample. Information is presented on the age, sex, and education of the household population as well as on housing facilities and household possessions. Also, this chapter provides a profile of the respondents (ever-married women, husbands, and never- married youth 15-24) who were interviewed in the 2005 FVHS. Information is presented on a number of basic characteristics of the FVHS respondents, including age, residence, education, and work status. The 2005 FVHS households profile provided in this chapter will help in understanding the results presented in the following chapters. In addition, it can help in providing useful input for social and economic development planning.
2.1
Household Composition
Table 2.1 presents the distribution of households in the FVHS sample per village by sex of the head of the household and by the number of household members. The importance of these characteristics is that they are often associated with socioeconomic differences between households. For example, female-headed households are frequently poorer than male-headed households are. In addition, the size and composition of the household affects the allocation of financial and other resources among household members, which in turn influences the overall well-being of these individuals. Household size is also associated with crowdedness in the dwelling, which can lead to unfavorable health conditions. Table 2.1 shows the household composition based on de jure members (i.e., usual residents).
Table 2.1 Household Composition Percent distribution of households by sex of head of household and household size, by focal villages, FVHS 2005. Characteristics Household headship Male Female Total Number of usual members 1 2 3 4 5 6 7 8 9+ Total Mean size Number of households
Al Kasr Total Tawfikia Tersa Rashwan (weighted) 89.1 10.9 100.0
85.5 14.5 100.0
88.9 11.1 100.0
87.6 12.4 100.0
4.1 6.3 10.6 14.1 14.4 19.1 11.9 6.9 12.8 100.0 5.6 320
4.4 6.5 9.5 15.7 14.8 15.4 13.3 7.4 13.0 100.0 5.7 338
3.2 10.8 11.7 13.7 15.2 14.0 14.6 5.7 11.1 100.0 5.4 315
3.8 8.2 10.6 14.5 14.9 15.6 13.5 6.6 12.2 100.0 5.6 973
Among 12% of households, the household head is female. There is little variation in the proportion of female-headed households between the 3 village, where the females in Tersa headed 15% of households compared with around 11% in both Al Tawfikia and Kasr Rashwan. The average number of persons per household is 5.6, with almost no variation between villages. Slightly less than one in four households have 3 members or fewer, while more than 30% of the households have 7 or more members.
2.2
Education of the Household Population
The educational level of the household members is among the most important characteristics of the household because it is associated with many phenomena including reproductive behavior, use of contraception, and the health of children. Results from household interviews can be used to look at both educational attainment among household members and school attendance among children and young adults.
6
Educational attainment Data on the educational level of the household population (age 6 and over) is presented in Table 2.2. Primary education in Egypt starts at age 6 and continues for 6 years. A further 3-year period, known as the preparatory stage, is considered basic education and is compulsory. The secondary stage, which includes an additional 3 years of schooling, is not compulsory. The results in Table 2.2 confirm that there is a gap in educational attainment between males and females. Overall, 74% of males in the FVHS households have ever attended school compared with only 52% of females. The mean number of years of schooling for males is 6.1, which is 2.4 years higher than the mean level for females (3.7 years).
Table 2.2 Educational Level of the Household Population Percent distribution of the de facto male and female household population age 6 and over by the highest level of education attended and mean number of years of schooling by focal villages, FVHS 2005. Al Kasr Total Tawfikia Tersa Rashwan (weighted) MALE Education No education Primary incomplete Primary comp./ some sec. Secondary complete Higher Number Mean number of years schooling
14.0 16.5 26.2 30.6 12.7 798
28.3 20.6 24.9 21.0 5.3 796
30.9 19.3 29.1 15.7 5.0 783
26.4 19.2 26.9 20.8 6.7 2,372
8.2
5.8
5.4
6.1
FEMALE Education No education Primary incomplete Primary comp./ some sec. Secondary complete Higher
33.9 22.9 22.3 17.5 3.4
41.8 19.1 22.1 12.4 4.7
61.5 17.0 15.7 4.9 0.9
47.9 19.1 19.6 10.5 2.9
Number
716
816
676
2,206
Looking at the educational level by Mean number of years village, it is clear that Al Tawfikia 5.0 4.4 2.3 3.7 schooling stands in a better position than the other two villages, as only 14% of males and 34% of females had no education. In addition males in Al Tawfikia reported the highest percentage of university or higher education attendance (13%). The situation is reversed in Kasr Rashwan where 31% of males and 62% of females had no education, while only 5% of males and 1% of females having attended university or higher. An examination of the differentials in educational indicators between villages indicates substantial differences between villages in the educational attainment of both men and women. For example, the mean number of years of schooling for males is 8.2 years in Al Tawfikia compared with 5.4 years in Kasr Rashwan. Additionally, female education has substantial differences between villages. For example, the mean number of years of schooling is only 2.3 years in Kasr Rashwan compared with 5.0 years in Al Tawfikia. Also, the gap between males and females years of education is most in Al Tawfikia (3.2 years) and least in Tersa (1.4 years). Current school attendance The 2005 FVHS collected information on current school attendance for the population age 6-24 years. Table 2.3 presents the percentage of the population in this age range that was attending school at the time of the survey. The comparatively low age-specific attendance rate for children age 6 reflects the fact that some of these children had not had their 6th birthday at the time the school year started, and thus were not eligible to attend school. Overall, the majority of children of both sexes age 15 and under were attending school. However, the data show that school attendance rates are generally higher among boys. The gender gap in school attendance is clear among all age groups and increases somewhat with age to reach the peak in the age group 16-20. The data also show that school attendance among members aged 11-20 years in Al Tawfikia is much higher than in the other two villages. For example, 98% of males and 91% of females aged
7
11-15 years in Al Tawfikia were attending school at the time of the survey compared with 88% of males and 78% of females in Kasr Rashwan. Table 2.3 School Attendance Percentage of the de facto household population age 6-24 years who are currently attending school, by age group, and sex, by focal villages, FVHS 2005. Age Group
Al Kasr Total Tawfikia Tersa Rashwan (weighted) MALE
6-10 11-15 6-15 16-20 21-24
79.1 98.0 89.0 66.4 11.3
75.9 91.0 82.9 45.0 2.6
76.2 88.4 83.3 46.1 12.9
76.6 91.0 84.2 49.8 8.6
FEMALE 6-10 11-15 6-15 16-20 21-24
78.4 91.3 84.9 44.1 7.2
74.4 79.8 77.1 45.7 15.8
67.4 63.3 65.2 22.0 1.7
72.6 75.7 74.2 35.8 8.8
72.1 78.0 75.4 35.6 7.8
74.7 83.6 79.3 43.2 8.7
TOTAL 6-10 11-15 6-15 16-20 21-24
2.3
78.8 94.6 86.9 56.3 9.4
75.1 84.9 79.9 45.4 9.2
Household Environment
Housing characteristics Table 2.4 presents the distribution of households by selected housing characteristics, including the source of drinking water, type of sanitation facilities, type of flooring, and number of rooms in the dwelling. These are important determinants of the health status of household members, particularly children. They can also be used as indicators of the socioeconomic status of households. Almost all FVHS 2005 households live in dwellings with electricity, and around 9 in 10 households have access to piped water, mainly within their dwelling or yard. For most households, the source for their drinking water is within their dwelling or yard. Overall, 95% of households obtain drinking water in their dwelling or yard or within 15 minutes of the residence. More than 8 in 10 households in the FVHS 2005 have traditional toilets, mainly with bucket flush. Ten percent of households have no toilet facility with differences between villages. Around onefifth of the households in Kasr Rashwan have no toilet facility compared with only 1 percent of households in Al Tawfikia and 3 percent of households in Tersa. Additionally, the pit toilet is available only in Kasr Rashwan (one percent). Only 5% of households in Tersa have modern flush toilets. It is also worth mentioning that almost all households in Al Tawfikia and Tersa have a sanitation facility. With regard to flooring, more than half of FVHS households live in dwellings with cement floors and the other half of dwellings have mainly cement tiled floors or earth/sand floors. There are small differences in the flooring materials among the village’s dwellings. One in three households in Kasr Rashwan lives in a dwelling with earth/sand floors, compared with only one quarter of
8
households in Al Tawfikia and Tersa. On the other hand, the cement tiles are found more in Al Tawfikia and Tersa than in Kasr Rashwan (19%, 17% and 7% respectively). Table 2.4 Housing Characteristics Percent distribution of households by housing characteristics, by focal villages, FVHS 2005. Characteristic Electricity Yes No Total Source of drinking water Piped into residence/plot Public tap Open well Covered well Total Time to water source Water within 15 minutes Sanitation facility Modern flush toilet Traditional with tank flush Traditional with bucket flush Pit toilet No facility Total Flooring Earth, sand Parquet, polished wood Ceramic/marble tiles Cement tiles Cement Total Number of rooms 1-2 3-4 5+ Total Mean rooms per household Mean persons per room Number of households
Al Kasr EDHS 2005 Tawfikia Tersa Rashwan Rural Fayoum 98.1 1.9 100.0
98.5 1.5 100.0
98.1 1.6 100.0
88.1 11.9 0.0 88.1 100.0
94.7 5.3 0.0 94.7 100.0
87.9 11.4 0.6 87.9 100.0
95.6
96.7
93.0
3.1 2.5 93.1 0.0 1.3 100.0
5.0 4.1 87.9 0.0 3.0 100.0
2.2 0.0 75.2 1.3 21.3 100.0
24.4 0.3 0.9 18.8 55.3 100.0
25.1 0.0 2.7 17.2 54.1 100.0
34.3 0.0 2.2 7.0 56.5 100.0
5.3 62.8 31.9 100.0 4.1 1.4 320
8.9 59.5 31.7 100.0 4.1 1.5 338
11.4 49.5 39.0 100.0 4.1 1.5 315
The 2005 FVHS included a question on the number of rooms that a household had (excluding the bathrooms, kitchen, and hallways). Taken together with the information on the number of persons in the household, the results provide a measure of crowding. Table 2.4 shows that only 9% of households have 1 or 2 rooms, 56% have 3-4 rooms, and 35 % have 5 or more rooms. The mean rooms per household are 4.1, and there is an average of 1.5 persons per room. Household possessions Table 2.5 provides information on household ownership of durable goods and other possessions. With regard to durable goods, around 75% of FVHS households own a television (color or black and white), almost 7 in 10 households own a radio with a cassette recorder, and 85% own an electric fan. Seventy-five percent own a washing machine, more than two-thirds own a refrigerator and livestock/poultry, and 49% own a gas/electric cooking stove. Only one-third of the households have a telephone, and 6% have a mobile phone.
9
Differentials exist between villages. Households in Al Tawfikia are more likely to have the convenience of these items than households in the other two villages. For example, around 90% of households in Al Tawfikia own a television, electric fan or washing machine. Households in Kasr Rashwan are less likely to have the convenience of these items than the other two villages. Table 2.5 also includes information on household ownership of means of transportation. Overall, only 2% of households own a car, with the highest rate of ownership in Kasr Rashwan village (3%). Relatively few households have a motorcycle (2 %), and rates of ownership of bicycles vary from 14% in Al Tawfikia to only 5% in Kasr Rashwan. As expected, because interviewed households are in rural areas, land or farm ownership is high. About 35% of households in all villages own a farm or other land. Almost no differentials exist between villages.
2.4
Table 2.5 Household Possessions Percentage of households possessing various household effects, means of transportation, property, and farm animals, by focal villages, FVHS 2005. Possessions
Al Kasr Total Tawfikia Tersa Rashwan (weighted)
Household effects Radio Television Video Telephone Mobile Computer Electric Fan Water Heater Refrigerator Freezer Sewing machine Washing machine Gas/electric cooking stove Air condition Satellite
81.9 88.4 0.9 44.4 4.7 1.9 90.0 4.1 75.9 0.0 0.3 90.6 58.8 0.0 0.0
74.0 76.0 1.5 40.2 6.8 0.3 83.1 8.0 70.4 1.5 5.9 74.3 51.5 0.3 0.3
58.4 66.3 0.6 21.3 4.8 0.6 84.4 1.3 63.2 0.0 1.9 67.3 41.3 0.0 0.0
69.2 74.6 1.0 33.3 5.5 0.8 85.1 4.4 68.6 0.6 3.1 74.8 48.8 0.1 0.1
Means of transportation Bicycle Motorcycle/motor scooter Car/van/truck
14.1 0.9 1.6
7.1 4.1 1.8
5.1 1.0 2.5
7.7 2.2 2.0
Property Farm/Other land
34.4
35.2
34.0
34.5
Farm animals Livestock/poultry
61.9
62.1
67.9
64.5
None of the above
1.9
2.4
2.9
2.5
Number of households
320
338
315
973
General Characteristics of Respondents
Table 2.6 presents the distribution of eligible women, husbands, and female and male youth by various background characteristics including age, marital status, educational level, and work status per village. As noted in Chapter 1, for youth, only never-married youth aged 15-24 were eligible for the interview. Accordingly, in Table 2.6a marital status is not presented for youth. Among the ever-married women in the sample, 93% are currently married, 4% are widowed, and 3% are divorced or separated, with no significant differences between villages. Looking at the age distribution in Table 2.6, 49% of FVHS 2005 interviewed women are under age 30 and around one quarter are age 40 and over; there are fewer women in the 15-19 age group (10 %) than in the other cohorts. This was expected as many women aged 15-19 are not yet married, and hence not included in the sample of ever-married women. Husbands are older than their wives; only 22% of husbands are under age 30 years, while 35% are age 40 and over. As for youth, around two thirds of interviewed male youth are in the 15-19 age range and one third in the 20-24 range; female youth were younger, with 79% aged 15-19 and 21% aged 20-24.
10
There were limited differentials in youth age distribution between villages (Table 2.6a). Women’s education is still low in rural areas, where 57% of interviewed women have no education, and only 19% have secondary education or higher, with significant differences between villages. Interviewed women from Al Tawfikia are more educated than other women (33% completed secondary education or higher), while women from Kasr Rashwan are less educated than other women (6% only completed secondary education or higher). Husbands are much more educated than women. Slightly more than one third of husbands have no education, and one third have secondary or higher education. Like their wives, husbands from Al Tawfikia are more educated; where, 55% have secondary or higher education, compared with only 22% of husbands from Kasr Rashwan.
Table 2.6 Background Characteristics of Respondents Percent distribution of ever-married women and husbands by selected background characteristics, by focal villages, FVHS 2005. Method
Al Kasr Total Tawfikia Tersa Rashwan (weighted) Number WOMEN
Current marital status Married Widowed Divorced Separated Age 15-19 20-24 25-29 30-34 35-39 40-44 45-49 Education No education Primary incomplete Primary complete/ some secondary Secondary complete Higher Work status Working for cash Not working for cash Total
95.2 2.9 1.9 0.0
92.9 4.1 2.4 0.6
91.6 4.1 3.7 0.7
92.8 3.9 2.8 0.5
877 36 27 5
7.1 26.4 18.0 11.9 12.2 12.2 12.2
8.6 21.0 16.0 16.6 14.8 11.8 11.2
13.2 22.6 15.2 12.2 13.5 15.9 7.4
10.1 22.8 16.1 13.8 13.8 13.5 9.9
96 215 152 131 130 128 94
37.3 19.3
53.3 12.4
70.9 12.8
57.1 14.0
540 132
10.3 28.9 4.2
8.6 20.4 5.3
10.1 4.7 1.4
9.6 15.9 3.5
90 150 33
12.9 87.1 100.0
23.1 76.9 100.0
6.4 93.6 100.0
14.3 85.7 100.0
135 810 945
HUSBANDS Current marital status Married Age 15-19 20-24 25-29 30-34 35-39 40-44 45-49 50-54 55+ Education No education Primary incomplete Primary complete/ some secondary Secondary complete Higher Work status Working for cash Not working for cash Total
100.0
100.0
100.0
100.0
794
0.7
0.8
0.4
0.6
5
Female and male youth are 4.4 7.4 15.5 8.0 64 18.0 11.9 13.3 13.8 109 more educated than older 16.7 18.9 15.2 16.9 134 adults. However, around one 15.6 13.1 10.5 12.6 100 quarter of female youth still 15.3 14.3 9.4 12.5 100 have no education and 8% of 9.2 7.4 10.5 9.1 72 male youth have no education. 6.1 8.6 6.3 7.1 56 6.1 9.4 2.7 6.0 48 Differentials are clear between villages. For example, 43% of 13.6 38.1 43.8 35.1 279 female youth in Kasr Rashwan 13.9 20.1 19.1 18.4 146 have no education, compared to only 8% of female youth in 15.6 9.8 15.2 13.3 105 38.1 24.2 17.6 24.5 195 Al Tawfikia. Paid employment 18.7 7.8 4.3 8.7 69 is very low among females. Only 14% of ever-married 84.7 71.7 56.3 68.3 542 women and 8% of female 15.3 28.3 43.8 31.7 252 youth reported that they are 100.0 100.0 100.0 100.0 794 currently working for cash, with some differences between villages. Ever-married women and female youth in Tersa are more likely to have paid employment (23% and 13%, respectively). More than two thirds of husbands are working for cash, and slightly less than 60% of male youth are working for cash. Husbands in Al Tawfikia are more likely to work for cash (85%), while
11
those in Kasr Rashwan are less likely to do so (56%). However, among male youth paid labor is most common in Tersa (67%) and least common in Kasr Rashwan (52%). Table 2.6a Background Characteristics of Respondents Percent distribution of never-married female youth and never-married male youth by selected background characteristics, by focal villages, FVHS 2005. Al Kasr Total Tawfikia Tersa Rashwan (weighted) Number
Method
NEVER-MARRIED FEMALE YOUTH Current marital status Not Engaged Engaged Singed contract
73.0 21.3 5.6
83.3 15.9 0.8
81.6 17.2 1.1
81.0 17.3 1.7
253 54 5
Age 15-19 20-24
82.0 18.0
78.8 21.2
78.2 21.8
79.1 20.9
247 65
Education No education Primary incomplete Primary complete/ some secondary Secondary complete Higher
7.9 2.2
12.9 3.8
42.5 4.6
22.8 3.8
71 12
48.3 31.5 10.1
47.0 23.5 12.9
29.9 20.7 2.3
41.0 23.8 8.6
128 75 27
Work status Working for cash Not working for cash
2.2 97.8
12.9 87.1
4.6 95.4
8.1 91.9
25 288
Total
100.0
100.0
100.0
100.0
313
NEVER-MARRIED MALE YOUTH Current marital status Not Engaged Engaged Singed contract
94.2 5.8 0.0
95.4 4.6 0.0
94.9 4.1 0.5
94.9 4.6 0.2
542 26 1
Age 15-19 20-24
59.7 40.3
57.7 41.7
67.2 32.8
62.4 37.4
356 215
Education No education Primary incomplete Primary complete/ some secondary Secondary complete Higher
0.0 2.4
8.6 6.9
10.3 5.6
7.5 5.4
43 31
34.5 49.5 13.6
46.3 32.6 5.7
43.6 29.7 10.8
42.5 35.0 9.7
243 200 55
Work status Working for cash Not working for cash
58.3 41.7
66.9 33.1
51.8 48.2
58.3 41.7
333 238
Total
100.0
100.0
100.0
100.0
571
12
FERTILITY AND FAMILY PLANNING
3
One of the main objectives of the 2005 FVHS is to provide information on fertility levels and preferences, family planning usage, and intention to use family planning in the future. Such information is of particular interest in addressing the contraceptive needs of nonusers who are concerned about spacing between births or limiting their fertility. This chapter looks at a number of fertility and family planning indicators among women and husbands, including age at first marriage, fertility levels, fertility preference and need for family planning, ever and current use of family planning, reasons for discontinuation of contraceptive methods, approval of and attitudes toward family planning, source of method, and intentions to use contraception in the future. When sample size permits, these indicators are presented at the village level.
3.1
Age at First Marriage (Appendix A Table 3.1)
The duration of exposure to the risk of pregnancy is closely associated with the age at first marriage for women, and is considered an important proximate determinant of fertility. When women delay marriage, they shorten the period of exposure to pregnancy and thus ultimately reduce the number of children they will bear.
Fig 3.1 Median Age at First Marriage 18.9
18.5 16.9
15.9
15.6
15.7
Due to the sample size, age at first marriage is presented only for the total sample. The results 20-24 25-29 30-34 35-39 40-44 45-49 show that there has been a steady increase in the age at which women in Fayoum villages marry. Current age The median age at first marriage among women in the age group 20-24 is 18.5 years, 2 years older than that among women in the age group 30-34 (16.9 years), and around 3 years older than that among women in the age group 40-44 (15.6 years). The data also show that the proportion of women marrying at very young ages decreased significantly over the past decades. The percentage of women married by exact age 15 dropped from 38% among women in the age group 45-49 to only 7% among women in the age group 2024.
3.2
Fertility Levels (Appendix A Table 3.2)
Data on childbearing patterns were collected in the 2005 FVHS by asking each interviewed ever-married woman and husbands about the number of sons and daughters living with them, the number living elsewhere, and the number who have died. For women, the 2005 FVHS data show that fertility levels are high in Fayoum. The data show that the average number of ever-born children is 3.7. Women in Al Tawfikia reported the lowest fertility levels (3.5 children) compared with Tersa and Kasr Rashwan (3.8 for both).
Fig 3.2 Pe rce ntage Distribution of Wome n by Nu mber of Ch ildren Eve r Born 34.6
30.7
9.3
0
1-2
13.3
12
3
4
5+
Overall, more than one third of women (35 %) have 5 children or more, and 12% of women have 4 children. In addition, about one third have 1 or 2 children (31 %). Women in Kasr Rashwan are more likely to have more children ever born, where 39 % have 5 or more children.
13
3.3
Fertility Preference
Data on fertility preferences in a population are important, for both estimating the potential unmet need for family planning and for predicting future fertility behavior. Currently married women and husbands in the 2005 FVHS were asked about their intention to have another child in the future. In addition, all respondents were asked about the ideal number of children they would prefer. The responses to these questions are used to explore the level of wanted fertility in Fayoum villages and to gain insight about future fertility changes. Desire for more children (Appendix A Table 3.3) To obtain information about fertility preferences, non-sterilized currently married women and husbands were asked whether they would like to have a/another child or would prefer not to have any (more) children. Pregnant women were asked whether they would like to have a/another child or would prefer not to have any (more) children after the child they were expecting. Sixty percent of currently married women do not want any more children, with the highest percentage found in Tersa village (62%), and the lowest percentages found in Kasr Fig 3.3 Percen tage Wh o W an t An oth er Rashwan village (58%). The data show Ch ild, an d Wh o Wan t No More or No that slightly more than one third of all 60 57 currently married women want to have another child, with minor differentials 40 between villages. 35
Have another child Women
No more, none Husbands
The results further indicate that 40% of husbands want to have another child, while 57% want no more children. Comparison of the results for husbands and married women reveals important gender differences in fertility preference. Generally, in all villages husbands want to have another child more than women.
Ideal number of children (Appendix A Table 3.4) The fertility preferences are Fig 3.4 Ide al Nu mbe r of C hildre n (Mean) obviously influenced by the number 3.5 of children the women or husbands 3 2.9 already have. The 2005 FVHS 2.4 obtained a measure of fertility preferences that is less dependent on the current family size by asking about the ideal number of children. The question about ideal family size required the respondents to consider the number of children they would choose to have in their whole life Women Husbands Never-married Never-married female Youth male youth regardless of the number (if any) that they already had. However, the ideal number of children tends to be fairly closely associated with the actual number of children a respondent has. Respondents who want a large family tend to have more children than others. Respondents may also rationalize their ideal family size, so that as the actual number of children increases, their preferred family size increases as well. Data from the 2005 FVHS show that women want smaller families than husbands do. Among those respondents who gave a numeric response to the question about the ideal number of children, women wanted an average of 3.0 children, compared to 3.5 children for husbands. Almost one
14
third (32 %) of all ever-married women mentioned that they want 1 or 2 children, while 5 % want 5 or more children. Around one fifth of women did not mention a numeric preference. Women in Tersa reported the highest mean ideal number of children (3.1 children) compared to women in Al Tawfikia and Kasr Rashwan (2.9 children). One-quarter of women in Tersa village mentioned that they want 4 children or more, compared to only 15% of women in Kasr Rashwan village. Data about husbands’ fertility preferences show different pattern. Husbands in Tersa unlike their women reported the lowest mean ideal number of children (3.3), compared with 3.5 in Al Tawfikia and 3.7 in Kasr Rashwan. About one third of husbands want 4 children or more. The data show that never-married female youth want fewer children than male youth (on average 2.4 and 2.9 children, respectively). Female youth in Tersa reported slightly higher mean ideal number of children than Al Tawfikia and Kasr Rashwan (2.5 and 2.4, respectively). By contrast, male youth in Tersa reported the lowest ideal mean number of children (2.7 children). About two thirds of male youth in this village reported that they want 3 children or fewer. The data also show that male youth in Kasr Rashwan village have the highest mean ideal number of children. Very few youth mentioned a nonnumeric answer (almost 17%). Premarital and newlywed examination (Appendix A Table 3.5) The CHL program aims to raise awareness about the benefits of premarital and newlywed examinations. The individual questionnaires in the 2005 FVHS included questions about the respondents’ awareness of these two examinations. In addition, ever-married women and husbands who had heard about either examination were asked if they had ever had such a premarital or newlywed examination. Never-married male and female youth were asked about their intention to have these examinations in the future. More than two thirds of ever-married women (69 %) had heard about premarital examinations, and 11 % percent had heard about the newlywed examination. Women in Al Tawfikia village showed greater awareness of those examinations than women in the other two villages. However, only a very small percentage (less than 1%) of the women had ever had these examinations. The same pattern was observed among husbands. Husbands in Al Tawfikia village have the highest degree of awareness about the premarital examination (87 %), while those in Kasr Rashwan have the lowest awareness (62 %). Data from the 2005 FVHS show Table 3.1 Premarital and Newlywed Examination that the awareness about premarital and newlywed examinations is Never-married higher among never-married female Female Male youth than among never-married Women Husbands youth youth male youth. This is the case in all Know about premarital villages. Seventy-Eight percent of examination (%) 68.7 70.1 77.7 72.5 female youth had heard about Know about newly wed premarital examinations. The examination (%) 10.5 12.1 13.4 10.5 highest awareness was reported in Had (intend to have) Al Tawfikia (88 %) and the lowest premarital examination (%) 0.4 0.7 28.4 36.5 Kasr Rashwan (75 %). Thirteen Had (intend to have) newly percent of female youth had heard wed examination (%) 0.2 0.0 2.4 2.1 about newlywed examinations, with the highest awareness reported in Al Tawfikia village (19%) and the lowest in Kasr Rashwan (5 %). Only 11% of male youth knew about newlywed examinations. Although knowledge of premarital examinations is higher among female youth than among male youth, never-married males are more likely than females to intend having such an examination. More than one-third of male youth (37 %) intend to have a premarital examination, compared to
15
only 28% of female youth. Among male youth, those from Kasr Rashwan are most likely to intend to have a premarital examination in the future (47%), while those in Al Tawfikia are least likely to intend to have one (22 %). Among female youth, intentions to have a premarital examination are highest in Al Tawfikia (39%) and lowest in Tersa (24%). Very few female and male youth intend to have a newlywed examination (2 % each). Female youth in Kasr Rashwan are most likely to plan on having a newlywed examination (5 %), whereas female youth in Al Tawfikia don’t intend at all to have such examination. Among male youth, 5% of those living in Tersa intend to have a newlywed examination, compared to only 1% of males from Al Tawfikia. Need for family planning (Appendix A Table 3.6) One of the major concerns of family planning programs is to define the size of the potential demand for contraception and to identify women who are most in need of contraceptive services. Women with an unmet need for family planning include the following: •
Currently married women who are in need of family planning for spacing purposes. This group includes (1) pregnant women whose pregnancy is mistimed (i.e., who had preferred to postpone the pregnancy); (2) amenorrheic women whose last birth was mistimed; and (3) nonusers who are neither pregnant nor amenorrheic and who either want to delay the next birth at least 2 or more years, are unsure whether they want another child, or want another child but are unsure when to have the birth.
•
Currently married women who are in need of family planning for limiting purposes. This group includes (1) pregnant women whose pregnancy is unwanted; (2) amenorrheic women whose last child was unwanted; and (3) nonusers who are neither pregnant nor amenorrheic and who want no more children.
Menopausal and infecund women are excluded from the unmet need category, as are pregnant or amenorrheic women who became pregnant while using a contraceptive method. The latter group is considered to be in need of better contraception. Women with a met need for family planning include women who are currently using contraception. The total demand for family planning Table 3. 2 Need For Family Planning Services represents the sum of unmet need and met need. The total demand also includes pregnant and amenorrheic All women who became pregnant while using a family Categories villages planning method. The indicators of the total demand for family planning, the unmet need and the met need for family planning, were only calculated for the total sample, not at the village level, since the sample size of each village was not sufficiently large to allow for such analysis. The total unmet need for all the FVHS sample is 19 %, with 7 % of this need representing a need for child spacing and 13 % a need for limiting family size. The total met need for family planning is 54 %, comprising 40 % who are limiting their family size and 14 % who report a desire to delay the next birth. Data of the 2005 FVHS further show that the total demand for family planning is 74 % and that almost three quarters of this total demand for family planning is satisfied.
Unmet need for family planning For spacing (%) For limiting (%) Total (%) Met need for family planning (Currently using) For spacing (%) For limiting (%) Total (%) Contraceptive failure For spacing (%) For limiting (%) Total (%) Total demand for family planning For spacing (%) For limiting (%) Total (%) Percentage of demand satisfied Total
6.5 12.9 19.4
14.2 39.9 54.1 0.3 0.5 0.9 21.0 53.4 74.3 73.9 877
16
3.4
Knowledge and Attitudes toward Family Planning
Knowledge of family planning (Appendix A Table 3.7) Awareness of family planning methods is crucial in deciding whether to use a contraceptive method and which method to use. Family planning programs typically aim to raise the awareness about the importance of family planning, and employ a variety of channels to promote family planning, including mass media.
Table 3.3 Knowledge of Family Planning Methods Nevermarried Female Male Women Husbands youth youth Pill (%)
100
100
99
IUD (%)
100
100
99
100
100 The 2005 FVHS collected data on knowledge of eight modern methods (the pill, IUD, injectables, Injectables (%) 100 100 99 100 implant, diaphragm/effervescent tablets/cream/ gel, condoms, female sterilization, and male sterilization) and three traditional methods (periodic abstinence, withdrawal, and prolonged breastfeeding). In addition, provision was made in the questionnaire to record other methods that respondents mentioned spontaneously.
Data from the 2005 FVHS show that knowledge of modern family planning methods is universal among respondents. All respondents (except for never-married female youth) know about pills, IUD, and injectables. However, knowledge of Norplant/implant varies considerably, ranging from 97% among women to only 42 % among never-married male youth. Concerning the traditional methods, the data show that almost all ever-married women knew at least one of these methods, mainly prolonged breastfeeding, while only 64% of husbands knew any traditional method. Around half of female youth mentioned that they knew of prolonged breastfeeding as one of the family planning methods, but only 12% of never-married male youth did. Knowledge of family planning methods varies across villages. Respondents were also asked about their knowledge of emergency contraception. Respondents aware of emergency contraception were asked to explain how this method is used. Most respondents had not heard of or did not know about emergency contraception. Only 1% of evermarried women, husbands and never-married male youth had heard about this method, and only 0.5% of female youth had (not shown). Attitudes toward family planning (Appendix A Table 3.8) To measure attitudes about use of family planning and about the ideal time intervals between births, the 2005 FVHS respondents were asked about their level of agreement with a series of statements about these topics. The responses were presented on a scale of 1-5, ranging from strongly disagree to strongly agree. During the analysis stage, the responses were recoded into three categories: agree, disagree, and neutral. Attitudes toward birth spacing were assessed using respondents’ level of agreement with the statement, “Couples should space Fig 3.5 Pe rce ntage Wh o Agre e That births at least 2 years.” The majority Couple s S h ou ld Space Birth s 3-5 Ye ars of all respondents (around 96%) 91 89 90 89 agreed that couples should space their children at least 2 years. Those living in Tersa were slightly less likely to favor spacing (94% of women and never-married female youth and 89% of husbands and never-married male youth). Respondents were also asked about their level of agreement with the statement that couples should space
Women
Husbands
Never-married
Never-married
female youth
male youth
17
children 3 to 5 years. The 2005 FVHS shows that women and never-married female youth are more likely than husbands to agree that 3-5 years of spacing is needed. In addition, the data show that there are significant differences between villages. Almost all women (99%) in Al Tawfikia agreed that couples should space children 3-5 years, compared to 86 % among women in Tersa. The situation is almost the same among husbands, where husbands in Tersa are least likely to think that 3-5 years of spacing is needed (78%). Respondents’ attitude toward using a Fig 3.6 Percen tage W ho Agre e Th at After the contraceptive method was assessed Birth of a C hild, Couples should Be gin Usin g a FP by asking about their agreement with Meth od Be fore Resum ing Marital Re lations the statement that after having a 89 89 86 child, couples should begin using a 82 family planning method before resuming marital relations. Overall, about 89% of women and husbands agreed that couples should use family planning before resuming sexual relations compared with 86% of never-married male youth and Women Husbands Never-married Never-married 82% of never-married female youth. female youth male youth Respondents (except never-married female youth) in Al Tawfikia village are most likely to agree that couples should use family planning before resuming sexual relations after having a child, while respondents in Tersa are least likely to believe this is necessary. Respondents were also asked whether they agreed that proper spacing will cause the next child to be healthier and that delaying the birth of the next child will keep the mother healthier. The results show that nearly all respondents believed this to be true (around 90% for both statements). Respondents in Tersa village were least likely to think that child spacing is good for the health of the child and of the mother. Finally, respondents were asked whether they agreed that starting contraception immediately after the birth of a child will prevent accidentally becoming pregnant too soon. Data from the 2005 FVHS show that opinions about this vary considerably. Ninety-eight percent of women in Al Tawfikia agreed that starting contraception immediately after birth will prevent pregnancies that occur too soon, compared to only about two third of women in Tersa (68%). Nearly all husbands in Al Tawfikia (98%), compared with only 78% of husbands in Tersa have a favorable attitude toward use of contraception immediately after childbirth. Opinions about family planning use in the community (Appendix A Table 3.9) To obtain information on perceptions Fig 3.7 Perce ntage Agre e in g With Variou s about the extent of family planning O pin ion s abou t Use of Family Plan ning (Wome n) use in the community, respondents in 88.9 86.5 the 2005 FVHS sample were asked 73.7 whether most, some, very few, or none of the couples in the reproductive ages living in this area use family planning. In addition, 1.7 they were asked to assess the extent Most couples use Most couples use Most couples use Using FP is of family planning use in the FP after first child before first increasing community between the first and the pregnancy second child and before the first pregnancy. They were also asked if use of family planning in their community was increasing, decreasing, or staying about the same. Overall, the results show that 87% of women mentioned that most couples in their community are
18
using family planning and 89% believe that family planning use is increasing. However, there are variations between villages in the extent to which women share this perception. Ninety-seven percent of women in Al Tawfikia believe that most couples are using family planning in the community, compared to only 73% of women in Kasr Rashwan. Husbands’ opinions show a different pattern. Slightly more than three quarters of all husbands (76%) believe that most couples in their community are using family planning and 89% think that family planning use is increasing. Husbands in Al Tawfikia are most likely to believe most of the couples in their community are using family planning (90%), while husbands in Tersa are least likely to believe this is the case (66%), which reflects the same pattern like women. Youth’s opinions about the extent of Table 3.4 Percentage Agreeing With Various Opinions About family planning use among couples in the Level of Family Planning Use their community differ somewhat Never-married from the opinions of married adults. Female Male Almost three quarters of female youth Women Husbands youth youth believe that most couples in the area Most couples using FP 87 76 74 64 are using family planning, and 86% Most couples begin using percent believe family planning use is FP after first child 74 65 65 58 increasing. However, only 64% of Most couples begin using male youth think that most couples in 2 2 2 3 before first pregnancy the community are using family Number of couples using planning, although 87% do believe FP is increasing 89 89 86 87 that use of family planning is increasing. Differences across villages for female youth have the same pattern as for married women, and male youth have the same pattern as husbands. Almost three quarter of ever-married women and two thirds of husbands believe that most couples in the reproductive age living in their community begin using family planning after the first child. However, there is a significant difference in opinions across villages. For example, while almost all women in Al Tawfikia believe that most women in their community begin using family planning after the first child (96%), only 54% of women in Tersa believe this to be the case. The same variation across villages is observed for husbands. Two thirds of female youth (65%) and 58% of male youth think that most couples in their community begin using family planning after the first child. Again, youth in Tersa village are least likely to believe that most couples start using family planning after the birth of their first child (46% for both female and male youth). More than 70% of all respondents believe that none of the couples in their community begin using family planning before the first pregnancy, with limited differentials between villages. Approval of family planning use (Appendix A Tables 3.10-3.12) Having a positive attitude toward family planning is prerequisite for the adoption of family planning. Respondents were asked whether they themselves approve of a couple’s using family planning. Data from the 2005 FVHS show that almost all respondents (96% and more) approve of a couple’s using family planning. This percentage varies little across villages. Respondents who approve the use of family planning were asked questions about the appropriateness of a couple’s
Fig 3.8 Percen tage Wh o Approve of Family Plann ing Use afte r th e First Birth 92
91
93 85
Women
Husbands
Never-married Never-married female Youth
male youth
19
use of family planning after the first birth. They were also asked about appropriate reasons for deciding to use contraception after the birth of the first child. In addition, those respondents were asked about the appropriateness for a newly married couple to begin using contraception before they have their first child and about appropriate reasons for using family planning before the first child. The results show that more than women and female youth who approve the use of family planning, 93% consider it appropriate to use family planning after the first birth (92% and 93%, respectively). Ninety-one percent of husbands and 85% of male youth also believe this to be appropriate. Approval of contraceptive use after the first birth varies across villages. Among women in Al Tawfikia who approve using contraception, almost all consider it appropriate for a couple to use family planning after the first birth (97%). By comparison, only 86% of women in Tersa think this would be appropriate. For husbands, variations across villages are having the same pattern. Ninety-nine percent of husbands in Al Tawfikia believe it is appropriate for a couple to use contraception after the first birth, compared to 82% of husbands in Tersa. The pattern for female and male youth is similar. Almost all female youth in Al Tawfikia and Kasr Rashwan approve of using contraception after the first birth (97% for both), compared to 89% among female youth in Tersa. When asked about the reasons for using family planning after the first child, the most commonly reported answer is that the woman should rest for some time after the first birth. The second most common reply is that the first/next child will be healthier. Few respondents consider it Fig 3.9 Pe rcen tage Wh o Approve of appropriate to adopt family planning Family Plann in g Use be fore the First before the first birth. Among those 18 who approve of family planning, only around 13% of ever-married women 13 consider it appropriate for a newly 10 9 married couple to adopt contraception before the birth of their first child. However, this percentage increased to 18% among female youth and decreased for husbands and male Women Husbands Never-married Never-married youth (10% and 9%, respectively). For female Youth male youth married women and husbands these percentages vary across villages. Women and husbands from Kasr Rashwan are the least likely to approve family planning use before the first pregnancy (4% for both). However, for female and male youth, attitudes toward use of family planning before the first child also vary across villages. Surprising, one quarter of female youth in Tersa consider using contraception before the first child appropriate, compared to only 15% among male youth. Regarding the appropriate reasons that would be acceptable for a couple to begin using contraception before they have their first child, the results of the study show that the most commonly mentioned reason is financial circumstances. The second most mentioned reason was that the husband or the wife is still studying, or the husband’s being in debt. Knowledge of fertile period (Appendix A Table 3.13) Respondents in the 2005 FVHS were asked when during the ovulatory cycle a woman is most likely to become pregnant. This information may be useful in ensuring success in the use of coitusrelated methods such as the condom, vaginal methods, and withdrawal, and it is especially critical for the practice of periodic abstinence.
20
Respondents were asked whether there are certain days a woman is more likely to become pregnant if she has sexual intercourse, and if so, whether this time was just before the period begins, after the period ends, or half way between two periods. Data from the 2005 FVHS show that the knowledge about the fertile period is limited, with only 34% of all evermarried women knowing about the fertile period.
Fig 3.10 Pe rce ntage W ho Know the Fe rtile Pe riod 34 30
16 13
Women
Husbands
Never-married Never-married female Youth
male youth
However, knowledge of the fecund period varies slightly across villages. For women, knowledge of the Fecund period in Kasr Rashwan village is 39% compared to 29% in Tersa village. Of those women who are aware that there is a fecund period, only 42% mentioned that it is half way between two periods. Looking at husbands’ knowledge, the data show that 30% of husbands know the fertile period (46% among husbands in Tersa village). Of those husbands aware that there is a fecund period, 51% reported that this period is right after the period. Youth’s knowledge of the fecund period is much lower: Only 16%and 13% of female and male youth respectively know about the fertile period. Female youth in Kasr Rashwan village are most likely to know of the fecund period (20%), while male youth of Al Tawfikia are the most likely to know of the fecund period (22%).
3.5
Ever Use of Family Planning
The 2005 FVHS collected data about ever use of family planning methods, as well as about the number of children the woman had when she adopted family planning for the first time. Levels of ever use (Appendix A Table 3.14) The individual questionnaires of the 2005 FVHS for women and husbands included a series of questions on ever use of family planning methods. The data were obtained by asking respondents whether they had ever used any of the family planning methods that they reported to know. Overall, the results of the survey indicate that 81% of all women had ever used a method. Slightly more than three quarter of all women (77%) had tried a modern method, and 24% had ever used a traditional method. The most commonly used modern method is the injectables (52%), followed by IUD (48%) and the pills (46%). The most common Table 3.5 Percentage Who Ever Used traditional method was prolonged breastfeeding (23% of Various Family Planning Methods all women). Slight Variations were observed between Method % villages, with women in Tersa village using pills more than any other method (53%), while women in Al 81 Any method Tawfikia village mostly use IUD. 77 Any modern method The data also show that 82% of husbands have ever used a method, and that 81% have used a modern method. The most common modern method mentioned by husbands is the injectables (52%), followed by the IUD (50%) and the pills (44%). Differentials in use across villages are similar to those for women.
Pill IUD Injectables Norplant/Implant
Any traditional method Prolonged breastfeeding
46 48 52 4
24 23
First use of family planning (Appendix A Table 3.15) Ever-married women who reported that they had ever used family planning were asked about the number of children they had when they first used a method. These data are useful in identifying the stage in the family-building process when women begin using family planning and their motivation for adopting family planning.
21
The results indicate that almost none of all ever-married women started using family planning after marriage while they had no children. Less than half of women (45%) began use of family planning after they had their first child, with the percentage ranging from 41% in Kasr Rashwan to 59% in Al Tawfikia. Fourteen percent of ever-married women started using family planning after they had their second child and very fewer women (8%) started using some method after having three or more children.
Table 3.6 Percentage Distribution of Ever Married Women by Number of Children at First Use of Family Planning % Never used contraception 0 1 2 3 4+ Total
19 0 45 14 8 14 100.0
Differentials between villages indicate that women in Al Median 1.9 Tawfikia are more likely to start family planning at a lower parity than women in the other village. The median parity at which women begin using contraception in this village is 1.7 children, compared to 1.9 children for women in Tersa village and 2.0 children for women in Kasr Rashwan village.
3.6
Current Use of Family Planning
Information on family planning use is very important since it provides insight into one of the main determinants of fertility and serves as a key measure for assessing the success of the national family planning program. This survey asked currently married women of reproductive age and husbands about current use of family planning. In addition, it collected detailed information about the name and the location of the source from which they had most recently obtained their method. Levels of current use of family planning (Appendix A Table 3.16) Overall, the 2005 FVHS Fig 3.11 Pe rce ntage C urren tly Usin g Variou s results indicate that 54% of Family Plan ning Meth ods (Wome n) currently married women 54 51 are using contraception, with 51% using modern methods and 3% using traditional methods. The 24 most widely used methods 18 are injectables, IUD, and 6 pills. Almost one quarter 3 3 (24%) of currently married women are using Any Any modern Pill IUD InjecAny tradiProlonged injectables, followed by the method method tables tional breastfeeding method IUD (18%) and then pills (6%). Small proportions of women are using other modern methods, with 2% currently using Norplant/Implant, and 3% using prolonged breastfeeding. The level of contraceptive use differs across villages. Currently married women in Al Tawfikia village are more likely to be using a contraceptive method (66%) than currently married women from Tersa and Kasr Rashwan villages (50% and 52%, respectively). The injectable is the most frequently used method in all villages. Women in Al Tawfikia rely on pills more than women from any other village (10%). Use of traditional methods is highest among women in Al Tawfikia (4%). Husbands are slightly more likely than women to report current use of contraceptives. Around sixty percent of husbands (58%) mentioned that they or their wives are using a method, compared to 54% among women. Two –third of husbands in Al Tawfikia reported using contraception, compared to 53% in Tersa.
22
Source of family planning methods (Appendix A Tables 3.17-3.18) Detailed information about the source from Table 3.7 Percentage Distribution of Women by which users had obtained their method was Source of Family Planning Methods and by Type of Method collected in the 2005 FVHS. Current users of modern methods were asked for the name and Public Private location of the source from which they sector sector Other received their methods at the beginning of the Pill 18 82 100% current segment of use. Users relying on IUD 71 28 1 100% supply methods like the pill and injectables Injectables 94 3 3 100% were also asked about the source from which they had most recently obtained the method. The source for family planning methods varies markedly by method used. Overall, the data show that 82% of pill users obtained their method from a private sector source, mostly pharmacies. However, the results vary across villages. One third of women from Kasr Rashwan received their method from the public sector compared to only 7% of women from Al Tawfikia. Conversely, the majority of the current IUD users have the device inserted at a public source, mainly at the MOHP facilities. Again, differentials were observed among villages. Current users of the IUD in Tersa were least likely to rely on the public sector (56%), while those in Al Tawfikia were most likely to rely on the public sector (81%). The data show that 94% of all injectable users rely on the public sector, mainly rural health units. No significant differences were observed between villages. The individual questionnaires of the 2005 FVHS for the husbands and youth included a question asking whether the respondents know any source from which they can get a family planning method. If so, they were asked to report the name and the location of the source. The results indicate that the rural hospital is the most mentioned source for family planning methods in all villages (85% or more). However, almost 9% of male youth mentioned the pharmacy as the main source of family planning methods. In Tersa village, that is the case for 20% of male youth. Use of Pill, IUD, and Injectables The majority of the contraceptive users who were interviewed in the 2005 FVHS rely on pills, IUD, and injectables. The FVHS asked several questions about the adoption and use of those methods, including questions about the cost of the method, willingness to pay, and use of specific pill brands. Pill use (Appendix A Tables 3.19-3.21) Overall, 6% of all currently married women Fig 3.12 Percen tage Distribu tion of in the 2005 FVHS are pill users. Current Pill Use rs by Bran d of Pill Used users of the pill were asked about the brand Microvlar 2% Exluton 8% of pills they used, the cost of a pill cycle, and Gynera 6% Don't know the amount that they would be willing to pay 30% for a cycle. Information about the brands used by women was collected by asking pill users to show the packet of pills. If the packet was available, the interviewer recorded the name of the brand. If the Other 8% Microcept interviewer did not see the packet, she asked 47% the respondent to name the brand she was using. The results of 2005 FVHS show that a quarter of all pill users were not able to show the packet or identify the brand they were using. Overall, 47% of current users were using the Microcept brand, while 8% were using Exluton, 6% Gynera, and 2% Microvlar. Brand use varies by village. While 63% of pill users in Tersa village
23
use Microcept, only 30% of the pill users in Al Tawfikia are using this brand. Women from Al Tawfikia village only are using the Microvlar and Exluton. To obtain information on the cost of pills, Fig 3.13 Cost of Method for Pill Use rs current users were asked about the amount (Wom en ) they paid for the most recent packet of pills. DK; 6% Women report a median price of 100.5 51-75 piastres per pill cycle, while husbands report piaster; 41% 100.7 piastres. Forty three percent of the women mentioned that they paid more than More than 100 piastres, while 41% paid from 51-75 100 piaster; piasters. Women in Kasr Rashwan report 43% lower prices, with a median cost of 65.8 piasters., which is consistent with the fact 76-100 piaster; 10% that pill users from Kasr Rashwan obtain pills from a public sector more than the other 2 villages (33% obtain pills from public sector). Pill users were asked about their willingness to pay specific amounts for the pill cycle, with the aim of ascertaining whether they would be willing to pay a Amount willing to pay for higher price. The results show that husbands are one pill cycle % willing to pay more money than women. Reports from 75 piasters 98 both women and husbands show that almost all pill 1 pound 90 users are willing to pay one pound for a packet of pills. 2 pounds 78 5 pounds 50 Slightly more than three quarters of women (78%) and More than 5 pounds 42 89% of husbands are willing to pay two pounds for a 59 Number pill cycle. In addition, half of the women and two thirds of the husbands are willing to pay 5 pounds. Forty two percent of women and 53% husbands are willing to pay more than 5 pounds. However, willingness to pay varies by village. Pill users in Tersa village are less likely to report being willing to pay more than 5 pounds for a pill cycle. Table 3.8 Percentage of Women Willing to Pay Various Amounts for the Pill
IUD use (Appendix A Tables 3.22-3.23) IUD users were asked for information on the actual price they paid when they obtained the IUD, as well as about their willingness to pay various amounts for an IUD.
Fig 3.14 Percen tage Distribu tion of IUD Use rs by Cost of Me thod (Wome n ) More than 31 pounds; 13% 16-30
The 2005 FVHS looks at the information pounds; 9% provided by the current users about the 6-15 amount that they paid for the IUD services. pounds; 7% Virtually three quarter of IUD users paid to obtain the method; twenty four percent mentioned that they had obtained the method 3-5 pounds; free of charge. Among those paying to obtain 23% the IUD, quarter paid less than 3 pounds (26%). Another quarter paid 3 to 5 pounds (23%). Almost 22% paid 16 pounds or more for the IUD services.
Free; 24%
<3 pounds; 26%
Village-level data show that almost half of women in Al Tawfikia paid for the IUD services less than 3 pounds, compared to only 15% of women from Tersa. Additionally the median cost for women in Al Tawfikia was only 2.3 pounds compared to 5.3 pounds for women in Tersa. Data for husbands show a similar pattern.
24
To investigate whether the price of the IUD can be increased, all current IUD users were asked about their willingness to pay specific amounts, ranging from 5 pounds to more than 200 pounds. As expected, willingness to pay decreases as the price level increases. Almost all IUD users (97%) would be willing to pay 5 pounds, and 86% said that they are willing to pay 10 pounds. More than half (54%) are willing to pay 25 pounds, and only 30% are willing to pay 50 pounds. Only 4% of IUD users are willing to pay more than 200 pounds for an IUD.
Table 3.9 Percentage of Women Willing to Pay Various Amounts for IUD Insertion Amount willing to pay for IUD
%
5 pounds 10 pounds 25 pounds 50 pounds 100 pounds 150 pounds 200 pounds More than 200 pounds Total
97 86 54 30 11 7 6 4 159
The data show that there are slight differences between villages. In Tersa 38% of IUD users are willing to pay 50 pounds, compared to only 12% for users in Al Tawfikia. Although 21% of IUD users in Kasr Rashwan village are willing to pay 100 pounds for an IUD, only 3% of women in Al Tawfikia and 2% of women in Tersa are willing to pay the same amount. None of the IUD users in Al Tawfikia and Tersa are willing to pay more than 100 pounds. The pattern was different among husbands. None of the husbands from Kasr Rashwan are willing to pay more than 100 pounds. Injectable use (Appendix A Tables 3.24-3.25) Injectables are one of the main family planning methods used by Egyptian women. The 2005 FVHS data show that 24% of all current users are using injectables. As with the pills and the IUD, the FVHS obtained information on the actual cost of the method and on willingness to pay.
Fig 3.15 Cost of Meth od for Inje ctable Use rs (Wom en ) 5-6 pounds 1% 3-4 pounds;
Free; 3%
3%
Data from the FVHS show that 99% of the injectable users paid for the method. However, 92% paid less than 3 pounds. This <3 pounds; 92% was expected, considering that the MOHP fixed the cost of the injectables at 1 pound. The data also show that 94% of all injectable users received the injectable from a public source (Appendix A-Table 3.18). No significant differences were observed between villages, except for the fact that 6% percent of users in Kasr Rashwan village received the method for free. The data show that 35% of husbands did not know the actual cost of the injectable, which is a very high percentage. Table 3.9 Percentage of Women Willing to Pay Various Amounts for Injectables % Amount willing to pay for injectables 2 pounds 5 pounds 10 pounds 15 pounds 20 pounds More than 20 pounds Total
97 80 38 16 11 9 214
Injectable users were asked about their willingness to pay amounts ranging from 2 pounds to more than 20 pounds. Again, willingness to pay decreases as the price increases. Ninety seven percent of injectable users would be willing to pay 2 pounds for the method, 80% would be willing to pay 5 pounds, 38% would be willing to pay 10 pounds, and 9% would be willing to pay more than 20 pounds. Husbands report almost a similar pattern.
Willingness to pay for injectables is fairly constant across villages, with the exception that relatively some users in Kasr Rashwan are willing to pay high amounts. Additionally, while more than 90% of users in Al Tawfikia and Kasr Rashwan are willing to pay 5 pounds only 64% of users from Tersa are willing to pay the same amount.
25
Service assessment indicators (Appendix A Table 3.26) All current users were asked about the quality of services and the source from which they obtained their method. The 2005 FVHS shows that 15% of all pill users reported that the provider told them about other methods. Nine percent of pill users indicated that their provider described the side effects of the pill, but only 1% reported that the provider informed them what to do about such side effects.
Table 3.11 Percent of Women Who Received Information about Family Planning, by Type of Method Used Pill IUD Injectables Told about other methods 15 Told about side effects 9 Told what to do about 1 side effects
59 52
50 36
47
26
Because the IUD is inserted by medical providers, IUD users received more information than pill users. Overall, 59% of IUD users were told about other methods, 52% were told about side effects, and 47% were told how to address these side effects. Half of injectable users were told about other methods. Thirty-six percent were told about side effects and 26% were told what to do about these side effects.
3.7
Discontinuation Rates (Appendix A Table 3.27)
This section focuses on women not currently using family planning, and presents information on levels of family planning discontinuation, reasons for discontinuation, intention to use in the future, and the reasons for not planning to use contraception in the future. The information presented in this section is important in evaluating the prospects for family planning acceptance among women who are not currently using a family planning method. One of the important aspects for family planning programs is the rate at which users discontinue use of contraception and the reasons for such discontinuation. Reasons for discontinuation may vary but usually include factors such as contraceptive failure, dissatisfaction with the method, side effects and health concerns, and the lack of availability or the cost of the methods. High rates of discontinuation indicate that a family planning program should devote more attention to counseling and follow-up, which can reduce discontinuation rates by helping women to deal with obstacles to continued use. Discontinuation rates are calculated using data from the contraceptive calendar in the 2005 FVHS. All episodes of contraceptive use between January 2000 and the date of interview were recorded in the calendar, along with the main reason for any discontinuation of use during this period. To obtain the duration of the first episode of use recorded in the calendar, all women using a method in January 2000 were asked about the date they started that period of use. Accordingly, the discontinuation rates refer to all episodes of use during the time period covered by the calendar, not just those episodes that began during the calendar period. Life table techniques were used to calculate contraceptive discontinuation rates. The rates are 1year discontinuation rates that represent the proportion of users discontinuing within the first 12 months after beginning to use the method. The rates are calculated separately for the following methods: pills, IUD, injectables, and prolonged breastfeeding. Because so few women discontinue the use of a method in the first 12 months, data were calculated for the total sample only. In order to ensure a sufficient number of segments of use to allow calculation of the rates, the reasons for discontinuation were grouped into four specific categories: method failure (i.e., they became pregnant while using the method), desire for pregnancy, side effects/health concerns, and other reasons (including husband’s disapproval, need for a more effective method, marital dissolution, etc).
26
Overall, data from the 2005 FVHS indicate that 61% of users stopped using a method within 12 months of starting use. Two percent of users stopped using due to method failure, 5% because they wanted to become pregnant, 20% because of side effects or health concerns, and 34% for other reasons. Looking at specific contraceptive methods, pills had the highest 1-year discontinuation rate (77%), followed by injectables (65%), followed by the prolonged breastfeeding (58%), and IUD (48%).
Fig 3.16 C on trace ptive Discon tin uation Rate s by Method and Re asons for Stoppin g Use 52.4
35 28.7 23.2
7.4
20.8
4.9 0.9 Pill
22.8
23.5
7
2.7
4.8 0.8
0 IUD
0
Injectables
Prolonged breastfeeding
Method failure To become pregnant Side effects Other reasons The data from the 2005 FVHS show that more than one quarter of pill users (29%) reported side effects/health concerns as the main reason for discontinuation. Also, almost one quarter (23%) of injectable users stopped using the method during the first 12 months of use due to side effects and health concerns. Only 21% of IUD users stopped using for this reason. Less than 1% of IUD and none of injectable users stopped using the method because of method failure, compared to 7% of pill users and 5% of prolonged breastfeeding users.
3.8
Intention to Use Contraception in the Future
To obtain information about the potential demand for family planning services, all currently married women and husbands who were not using contraception at the time of the survey were asked about their interest in adopting family planning in the future. Female and male youth were also asked about their intention to use contraception in the future. In addition, respondents who mentioned that they are not likely to adopt contraception in the future were asked about the reasons why they do not plan on using a method. Future use of family planning (Appendix A Table 3.28) The data show that slightly fewer than three quarters of women (72%) mentioned that they are likely to use family planning in the future. Sixty eight percent of husbands mentioned that they are likely to use contraception in the future. Village-level data show that 54% of husbands in Tersa reported that they are likely to use a method in the future, compared to 77% among husbands in Kasr Rashwan. For women, intentions to use vary little by village. Almost all female and male youth reported that they have the intention to use contraception in the future. Reasons for nonuse (Appendix A Table 3.29) Understanding the reasons that people do not intend to use contraceptives can be helpful in identifying areas for potential interventions. Among women who do not plan to use a method, 57% gave various fertility-related reasons for not planning to adopt contraceptive use. Most of those women do not need contraception because they are subfecund (33%), menopausal or have had a hysterectomy (22%) or want more children (2%). One quarter of female nonusers cited method-related reasons, 9% mentioned health concerns, 16% mentioned fear of side effects, and 15% mentioned other reasons.
Table 3.12 Percentage Reporting Various Reasons for Not Using Family Planning in the Future Women Husbands Menopausal, hysterectomy Subfecund Wants more children Health concerns Fear of side effects Other
22 33 2 9 16 15
25 33 10 6 2 22
27
The reasons for not planning to use contraceptives vary across villages. For example, 31% of women in Al Tawfikia mentioned that they do not intend to use contraception because of health concerns, compared to only 7% among women on Kasr Rashwan, and none of the women in Tersa. Twenty nine percent of women in Kasr Rashwan mentioned that they fear the side effects, compared to 5% of the women in Al Tawfikia and 4% of the women in Tersa. The 2005 FVHS data show that most husbands reported that they are not planning to use contraception because their wives are subfecund (33%), menopausal or have had a hysterectomy (25%). Ten percent of husbands who do not intend to use contraception in the future mentioned that they want more children. However, while 14% of husbands in Kasr Rashwan village mentioned this latter reason, only 4% of husbands in Al Tawfikia village did. Around 17% of husbands in Al Tawfikia mentioned that they do not plan to use contraception in the future because of health concerns, compared to about 3% in Tersa and 5% in Kasr Rashwan. While 5% of husbands in Kasr Rashwan reported that they fear the side effects, none of husbands in the other two villages did. Only 11 youth mentioned that they do not intend to use in the future, mostly because they want more children (not shown).
28
MATERNAL HEALTH
4
During the past decade, maternal health has been one of the major focuses of the health program in Egypt. Adequate antenatal care by a medical provider is important in monitoring women’s health status during pregnancy and in avoiding maternal deaths. Appropriate medical care during pregnancy, at delivery and in the early postpartum period is also crucial in identifying children at greater risk of mortality. This chapter looks at the extent to which women are obtaining medical care during pregnancy, at the time of delivery and in the postpartum period. To obtain data on utilization of maternity care services, women were asked a series of questions relating to the types of health care services that they received during pregnancy, at delivery, and in postnatal period. This information was collected for each birth during the five year period before the survey. In addition, husbands and youth were asked a series of questions to assess their knowledge and attitudes toward maternity care. This chapter presents the results of these questions.
4.1
Care During Pregnancy
Women who were pregnant in the five years before the survey were asked about the antenatal care they received, including the number of visits, the source of care, timing of first and last antenatal care and tetanus toxoid injection. Husbands and never married female and male youth were asked questions about their knowledge about antenatal care, its importance, and the number of visits. Antenatal care coverage (Appendix A Table 4.1) The World Health Organization (WHO) recommends that a pregnant woman should have at least four antenatal care visits to ensure proper care. Tetanus toxoid injections are a crucial element of adequate pregnancy care and help prevent infant deaths due to neonatal tetanus. During the five years preceding the survey, 57% of mothers received care during pregnancy, mainly from a doctor. Levels of care vary between villages. Around six out of ten mothers from Tersa received care during pregnancy compared with five out of ten of mothers from Al-Tawfikia. Thirty-five percent of mothers received care from the private sector, 26% from the public sector, and 4% from both sectors. The remaining 43% either received care from a nonmedical provider, or received no care at all.
Fig 4.1 Pe rce ntage Distribu tion of Moth e rs by Sou rce of Anten atal Care
43
35 26
4 Public
Private Public and
Non-
private medical/no care Use of public and private sector antenatal care varies across villages. The public sector is the main source of antenatal care services for 31% of mothers from Kasr Rashwan, while around 23% of mothers from both Al-Tawfikia and Tersa received antenatal Fig 4.2 Me dian Num be r of ANC care from the public sector. The private sector is the main source of antenatal care services for mothers 7 7 from Tersa village (40%), while around 31% of 6 mothers from Al-Tawfikia and Kasr Rashwan received antenatal care from the private sector.
AL-Tawfikia
Tersa
Kasr Rashwan
While more than half of mothers received some care during pregnancy, only 42% received regular antenatal care with no significant differences among villages. Considering only those births for which their mothers received antenatal care, the data shows that the median number of antenatal visits was 6.7
29
visits. The median number of visits ranges from 6.3 in Tersa to 7.4 visits in Al-Tawfikia village. To prevent problems, it is recommended that women have their first antenatal checkup early in the pregnancy. Among those births for which antenatal care was reported, the first visit occurred before the sixth month of pregnancy in 92% of births. Half of mothers who received antenatal care reported having their first visit at the third month of pregnancy. The majority of mothers had their last visit during the ninth month of pregnancy. Care during pregnancy (Appendix A Table 4.2) The questionnaire asked mothers whether they had seen any health worker during the pregnancy for ANC or for a tetanus toxoid injection (TT). The data show that 52% of women received both ANC and TT injections, 32% received TT injections only, 6% received ANC only, and 11% did not receive either.
Fig 4.3 C are Du rin g Pere gn ancy No ANC/No
ANC only 6
TT 11
TT only 32
There are clear differences in levels of care between villages. Almost 53% of mothers from ANC and TT Tersa and Kasr Rashwan received both ANC 52 and TT injections compared with 46% from Al– Tawfikia. On the other hand, the percentage of mothers who only received a TT injection was higher in Al-Tawfikia (41%) than among mothers from Kasr Rashwan and Tersa (35% and 24% respectively). However, the highest percentage Fig 4.4 Pe rcen tage of Moth ers of mothers who did not receive any ANC or TT Re ce iving Care O th er th an ANC and TT injection was in Tersa (16%). 46 41
10
3 ANC only ANC and TT only
No
TT
ANC/No
injection
TT
Women were also asked whether they received any care other than ANC or TT injection during pregnancy. The data shows that almost 13% of mothers received other care during pregnancy (not shown). Of those receiving other care, 46% received both ANC and TT, 41% received TT only, 3% received ANC only, and 10% received neither.
Husbands and youths’ knowledge of antenatal care (Appendix A Tables 4.3) Almost most husbands have ever heard about antenatal care (93%), and a similar figure was observed among female youth (95%). However, only 88% of male youth have heard about antenatal care. The majority of respondents (husbands and youth) reported that antenatal care should be received from private provider (73% or more) and some of them reported that it should be received from public providers (43% among male youth, 39% among husbands and 28% among female youth).
Table 4.1 Husbands and Youths' Knowledge of Antenatal Care Never-married Female Male Husbands youth youth Ever heard about ANC Source for ANC Public sector Private sector Both
93
95
88
39 81 2
28 73 1
43 84 1
However, significant differences were observed by villages. For example; in Al-Tawfikia; 69% of husbands mentioned that antenatal care should be received from a public provider, compared with only 27% of husbands in Tersa village. Slightly more than 90% of husbands in Kasr Rashwan said it should be from a private provider compared to 72% of husbands from Tersa. The same pattern was observed among youth.
30
Husbands and youth were asked about the Fig 4.5 Appropriate Num be r of appropriate number of antenatal care visits An te n atal C are Visits (Median ) during pregnancy. Twenty-eight percent of 9 husbands admitted that they do not know, while 7 almost all the other husbands reported 4 or more 4 visits would be appropriate (62%). Almost a similar pattern was observed among female youth. Male youth were less knowledgeable about the appropriate number of visits, with Husbands Never-married Never-married more than one-third reporting that they don’t female youth male youth know the appropriate number of visits (39%). The median number of visits reported was 9 visits for husbands, 7.3 visits for female youth, and 4.3 visits for male youth. Most respondents reported that it is important for a woman to go for antenatal care (over 92%). Youth’s intention to conduct antenatal care was assessed by asking them a question: “Do you intend to (let your wife) go for antenatal care?” The results show that 93% of female youth reported that they intend to go for antenatal care in the future, and 95% of male youth intend to let their wives go for antenatal care when they get married.
4.2
Delivery Care
Another crucial element in reducing health risks for mothers and children is increasing the proportion of babies who are delivered in health facilities. Proper medical attention and hygienic conditions during delivery can reduce the risk of complications and infections that can cause death or serious illness for either the mother or the baby. This section discusses three topics related to delivery: place of delivery, type of assistance during delivery and type of delivery. Place of delivery and assistance during delivery (Appendix A Table 4.4) The woman’s questionnaire included questions about place of delivery, assistance during delivery, and whether the delivery was normal or caesarean for women who gave birth during the five years preceding the survey. The data show that 54% of mothers delivered at home, while 39% delivered at a private facility and only 8% delivered at a public facility. Minor differences exist between villages.
Fig. 4.6 Pe rce ntage Distribu tion of Moth ers by Place of De livery At home; 54
Public facility; 8
Private facility; 39
Due to the fact that 54% delivered at home, it was found that 50% of the deliveries were assisted by the Daya. Almost 54% of the deliveries in Tersa were conducted by the Daya compared to 48% of deliveries in Kasr Rashwan and Al-Tawfikia. On the other hand, about 47% of deliveries were assisted by a doctor with slight differences between villages. Fig 4.7 Pe rce ntage Distribu tion of Delive rie s, by Type of De live ry Assistan ce 50
47
2
1 Doctor Trained
Daya Relative
nurse/midwife
/other
0 No one
The 2005 FVHS also asked whether the delivery was a normal delivery or by caesarean section. The data show that 94% of all deliveries were normal vaginal deliveries, ranging from 92% among women in Tersa to 96% among women in Kasr Rashwan.
31
Husbands and youth’ knowledge of delivery (Appendix A Tables 4.5) Fig. 4.8 Pe rception of Hu sbands about the Appropriate Place of
At home; 4 According to her condition; 15
Medical place; 81
The individual questionnaires for husbands and youth included questions concerning their knowledge about the appropriate place of delivery and the person who should assist during delivery. The data show that 81% of husbands mentioned that women should give birth in a medical facility, while 15% mentioned that the appropriate place of delivery depends on the woman’s health condition. Husbands’ perceptions about the appropriate place of delivery vary by village. Eighty-five percent of
husbands in both Tersa and Kasr Rashwan mentioned that the delivery should be conducted at a medical facility compared to 67% of husbands in Al-Tawfikia village. Eight percent of husbands in Al-Tawfikia and 5% of husbands in Tersa mentioned that women should give birth at home compared to none of husbands in Kasr Rashwan. The FVHS data shows that 84% of husbands reported that a doctor should assist during the delivery, while 14% mentioned that it depends on the woman’s condition during the delivery. Almost 86% of husbands in both Tersa and Kasr Rashwan mentioned that the doctor should assist during delivery. This was expected since most of them mentioned that the delivery should take place at a health facility. In addition, 4% of husbands in AlTawfikia and Tersa recommend the Daya to assist during delivery, while none of husbands in Kasr Rashwan. More than 90% of youth mentioned that the delivery should be conducted at a medical facility. Around 92% of female and male youth mentioned that the doctor should assist women during delivery. However, 6% of youth mentioned that the type of recommended delivery assistance depends on the woman's condition.
Fig 4.9 Pe rce ntage of Hu sban ds Be lie vin g that a Doctor/Nu rse S hould Assistin g During De livery 87
86
74
Al-Tawfikia
Tersa
Kasr Rashwan
Table 4.2 Percentage favoring various places of delivery and percentage favoring various types of delivery assistance Never-married Place of delivery/assistance Female during delivery youth
Male youth
Place of delivery In a medical place At home According to her condition
91 2 7
91 1 7
Assistance during delivery Doctor Nurse Daya According to her condition
92 1 2 6
93 0 1 6
Delivery complications Women who gave birth during the five years preceding the survey were asked if they experienced complications during delivery, including severe bleeding, being in labor for more than 12 hours, fever, vaginal infection, and convulsions. This information was collected for each child born in the five years preceding the survey.
4.3
Postpartum Care
Care after the delivery is very important not only for the newborn but also for the mother. Proper care for the mother is particularly important when the birth is not assisted by a health provider. The MOHP recommends several visits for the mother after delivery. The first visit should occur within two days after delivery. Subsequent visits should occur after seven days, after two weeks, and after 40 days.
32
Care for the mother (Appendix A Table 4.7) It is assumed that mothers who deliver in a health facility (private or public) will have the first postnatal checkup within the first two days after delivery. As 54% of women delivered at home, it was found that 75% of mothers did not have any postpartum care. Only 19% of mothers received a postnatal checkup within 2 days of birth. Some differences were observed between villages. While 31% of mothers in Al-Tawfikia received postnatal care within the first two days, only 12% of mothers in Tersa did.
Fig 4.10 Pe rcen tage Distribution of Moth e rs by Timing of First Postn atal Ch ecku p Within 2 days 19
3-7 days 2 8-27 days 2
No care
4+ weeks
75
1
The data from the 2005 FVHS show that almost all postnatal checkups were conducted by a doctor, and were conducted at the office of a private doctor or at a clinic (20%), while 2% took place in a hospital. In addition, 2% took place at the woman’s home. Care for the child (Appendix A Table 4.8) The 2005 FVHS asked mothers whether their last child received any postnatal care following delivery and if so, what the source for this postnatal care was. This information was collected only for the last birth during the five year period before the survey. Overall, the data shows that 60% of these children did not receive any care after delivery. Twelve percent received postnatal care within two days of birth and another 12% within 3-7 days of birth. Looking at the differences between villages, almost 16% of children in Al-Tawfikia received postnatal care within two days of birth compared to 10% for Tersa village.
Fig 4.11 Timing of First Postnatal Che cku p for Ch ild Within 2 days 12 3-7 days 12 No care 60
8-27 days 7 4+ weeks 9
Among those children who received postnatal care, slightly less than three quarter (73%) of them received care at a private doctor’s office or clinic, 16% at a health unit and 6% at a hospital. Differences were observed between villages. The percentage of children receiving postnatal care at a physician’s office or clinic ranges from 66% for children in Tersa to 82% for children in AlTawfikia. For the last birth during the five year period before the survey, women were asked whether a blood sample was taken from the child’s heel. Overall, the data shows that a blood sample was taken from 80% of last births. In addition, minor differences were observed between villages; with 83% of last births in Kasr Rashwan received this test compared with almost 79% in both Al-Tawfikia and Tersa villages. Intention to have postnatal care (Appendix A Table 4.9) Husbands were asked about their intention to seek postnatal care for both the newborn and mother within one week of delivery. The likelihood of seeking care was recorded on a 5 point scale ranging from very unlikely to very likely. During the analysis stage, the responses were grouped into three groups; likely, unlikely and somewhat likely. The data show that more than three quarter of husbands (76%) indicated that they were likely to go for medical consultation for their newborn within one week of birth. However, differentials were observed between villages. Eighty-three percent of husbands in Kasr Rashwan were likely to obtain postnatal care for their newborn compared to only 66% of husbands in Tersa. The same pattern was observed for the intention to obtain postnatal care for the mother. Overall, 73% of husbands were likely to let their wives go for
33
medical consultation within one week of delivery. Husbands in Kasr Rashwan were most likely to let their wives go for postnatal care (80%), compared to 64% for husbands in Tersa village. Youth have more positive attitude towards postnatal care than the husbands do. Overall, 79% of female youth and 82% of male youth reported it is likely that they will obtain a medical consultation for their newborn within one week of birth. In addition, 77% of female youth mentioned that they were likely to go for postnatal care after delivery; 80% of male youth mentioned that they were likely to let their wives go for postnatal care. Some differences were observed between villages. Female youth in Al-Tawfikia were most likely to intend to obtain postnatal care for both mother and child, while male youth in Kasr Rashwan were more likely to intend to seek postnatal care.
4.4
Table 4.4 Intention to Have Postnatal Care for Mother and Child Never-married Female Male Intention to do postnatal care Husbands youth youth Intention to do postnatal care for the newborn Unlikely Somewhat likely Likely Don't know/missing Intention to do postnatal care for the wife Unlikely Somewhat likely Likely Don't know/missing
8 7 76 10
2 4 79 16
3 5 82 10
9 9 73 10
3 6 77 15
3 8 80 9
Attitudes toward Maternal Health
Respondents were asked to express their attitudes towards the postnatal care for mother and the newborn within the first week of delivery. The interviewer read two statements for the respondents. The responses were presented on a five point scale ranging from strongly disagree to strongly agree. During the analysis stage, the responses were grouped into three categories; agree, disagree and neutral. In addition, respondents were asked to list the advantages of having postnatal care for the mother and the child within the first week after delivery. Attitudes towards postnatal care for mother and child (Appendix A Table 4.10) The individual questionnaires include Fig 4.12 Pe rce nt agree ing th at a ne wborn mu st questions about the attitudes of all rece ive Postn atal C are within on e wee k of birth respondents toward the postnatal care 92 91 for the child and toward consulting a 90 provider about starting family planning after delivery. The data show that most respondents agree that 85 the newborn must receive a medical consultation within one week of birth (85% among women, 92% among husbands and around 90% among Women Husbands Never-married Never-married youth). However, there are female youth male youth remarkable differences between villages. Almost 98% of women from Al-Tawfikia village agreed that the newborn must be taken for postnatal care within one week of birth compared to 78% of women from Tersa village. Same trend was observed among female youth. Husbands and male youth in Kasr Rashwan are most likely to agree that a postnatal checkup for the newborn within the first week is necessary (96 and 93% respectively).
34
Around 90% of both husbands and youth and 83% of women agreed that a provider should be consulted within one week after the delivery to discuss starting the use of family planning.
Fig 4.13 Pe rce nt Agree ing a Provider Sh ould be C on sulte d Within O n e We e k of De live ry to Discu ss Family Plan nin g 91
90 88
However, marked differences in 83 attitudes toward the postnatal care for women were observed between villages. Most women and neverWomen Husbands Never-married Never-married married female youth from Alfemale youth male youth Tawfikia village are most likely to agree that it is necessary to consult a health provider within one week of delivery to start using contraception (98% for both women and female youth). Almost most husbands and never-married male youth from Kasr Rashwan agree that such a visit is needed to discuss family planning (95% and 93% respectively). Advantages of postnatal care (Appendix A Table 4.11) The individual questionnaires included questions about perceptions regarding the advantages of postnatal care for mother and the newborn. The data shows that the most often mentioned advantage is that it checks the child’s health. The second most mentioned advantage was early detection of any childhood diseases. Some differentials were observed between villages. For example, women in Kasr Rashwan are more likely to mention that postnatal care for child is important to check child’s health (99%) compared to women in Al-Tawfikia village (88%). Regarding the advantages of postnatal care for mothers, the data show that the most commonly mentioned advantage is that it checks the mother’s health. The second most important advantage mentioned by women, husbands and never-married female youth was that it provides an opportunity to have a family planning consultation. Clear differences were observed across villages. For example, while more than half of women (51 %) in Al-Tawfikia mentioned that one of the advantages of postnatal care is that it provides a family planning consultation, only 7% of women in Tersa mentioned that as an advantage.
Table 4.5 Advantages of Having Postnatal Consultation for Mother and the Newborn
Medical
Never-married Advantage of having postnatal care Advantage of having postnatal care for child Check child's health Check child's umbilicus Early detection of any child's disease Advantage of having postnatal care for mother Check mother's health Not to be pregnant/take family planning consultation Giver her tonics Early detection of any postpartum disease
Female Male Women Husbands youth youth
93 7
91 7
89 6
89 4
18
18
23
14
92
92
90
89
17 2
16 1
16 1
5 1
5
6
9
8
35
CHILD HEALTH
5
Increasing the proportion of children who are vaccinated against the major preventable diseases is a cornerstone of Egypt’s child survival programs. In addition, promoting treatment of diarrhea and acute respiratory infection is one of the important aspects of child’s health. Moreover, the CHL program aims at promoting the idea of “healthy family”, and consequently focuses on the health status of children under 6 years. To address this objective, the 2005 FVHS collected information on the level of immunization among young children (under 5 years). The chapter also considers information from the 2005 FVHS on the prevalence and treatment of diarrhea and acute respiratory infections, illnesses that are among the most common causes of childhood deaths in Egypt. Finally the chapter also looks at several important aspects such as breastfeeding and Vitamin A supplementation.
5.1
Immunization of Children (Appendix A Table 5.1)
Egypt’s Ministry of Health and Population has adopted World Health Organization guidelines for childhood immunizations that call for all children to receive several vaccinations during the first year of life. The recommended vaccinations include a BCG vaccination against tuberculosis, three doses of the DPT vaccine (DPT 1, DPT 2, and DPT 3) to prevent diphtheria pertussis and tetanus, three doses of polio vaccine (Polio 1, Polio 2, and Polio 3), and a measles vaccination. In addition to these standard immunizations, the Egyptian childhood immunization program recommends that children receive three doses of the hepatitis vaccine, poster doses for DPT and polio, and the MMR vaccine against measles, mumps and rubella.
Immunization levels In Egypt, immunization may be recorded on a child’s birth record (certificate) or on a special health card. In collecting data on immunization coverage in 2005 FVHS, mothers were asked to show the interviewer the birth record and/or health card for each child born since January 2000. When the mother was able to show the birth record and/or health card, the dates of vaccinations were copied from the documents to the questionnaire. If neither a birth record nor a health card was available, mothers were asked a series of questions to determine whether the child had ever received specific vaccines and, if so, the number of doses received. Collected information about child immunizations are presented for children 12-23 months. The age range was chosen in order to assess the current situation with respect to immunization coverage. The findings show that birth records and/or health cards were available and seen for 77% of those children. Results of the 2005 FVHS reveal that 95% of children 12-23 months have received BCG, and around 83% have received the recommended three doses of the DPT and polio vaccines (DPT 1-3 and polio 1-3). Eighty-one percent have received a measles vaccination. Overall, 76% of children are considered fully immunized against all preventable childhood diseases, i.e., they have received a BCG, the three DPT, the three polio, and measles immunizations.
Fig 5.1 Pe rce ntage of childre n 12-23 m on ths wh o are fully im mu nize d 76
Total
80
Rural Menya-
EIDHS 2003 Looking at the other vaccines, the coverage levels are relatively high for the hepatitis vaccine, with 74% of children reported as having received the third dose of hepatitis vaccine. The data displays low levels for the other vaccines. Only 3% of children had received the Polio 0 vaccine; 46% received Activated DPT; 52% received Polio 4 and Activated Polio and 44% received MMR.
36
Differentials in vaccination coverage Looking at the differences in the proportions considered fully immunized, there are minor differences in immunization coverage between boys and girls (74% and 79% respectively). Looking at mother‘s education, unexpectedly, the percentage of fully immunized children decreases as the mother’s education levels increases. Eighty percent of children whose mothers never attended school was fully immunized compared to 70% among children whose mothers completed secondary education or higher. In addition, 80% of children whose mothers are working for cash are fully immunized, compared to 76% of children whose mothers are not working for cash.
5.2
Prevalence and Treatment of Diarrhea (Appendix A Table 5.2)
In the 2005 FVHS, mothers of children under 5 years of age were asked whether any of their children under 5 years of age had diarrhea during the two-week period prior to the survey. If the child had diarrhea, the mother was asked about feeding practices during the diarrhea episode and the actions that were taken to treat the diarrhea. Overall, 15% of children were reported as having had diarrhea in the two week period prior to the survey. The age pattern shows the typical peak in diarrhea prevalence among children age 6-23 months. The 2005 FVHS results indicate that some effort was made to treat the diarrhea in most episodes in young children; mothers reported that nothing was done in 21% of the cases. With regards to specific actions taken when a child was ill with diarrhea, mothers sought advice or treatment from a health provider in 42% of the diarrhea episodes. Among those receiving medical advice, private health care providers were consulted more often than providers at public sector facilities (27% vs. 14%).
Fig 5.2 Percen tage of Moth e rs Se e king Advice or Tre atm en t for Diarrhe a for C hildre n Unde r 5 Ye ars 42 27 14
Any health
Public
Private
provider provider provider Around 35% of the ill children received oral dehydration therapy (either ORS packets or RHS at home) in order to prevent dehydration. In addition, for slightly less than half of the children (48%), the mothers reported that they received ORT and increased the amount of fluids given to them.
5.3
Prevalence and Treatment of Acute Respiratory Infections (Appendix A Table 5.3)
Along with diarrhea, the Acute Respiratory Infection (ARI), pneumonia is a common cause of death among infants and young children. The 2005 FVHS collected information on Fig 5.3 Prevale nce of ARI Am on g Ch ildre n Un de r 5 Years the prevalence and treatment of ARI and on the type of treatment of children with 14 ARI symptoms had received. Data of 2005 FVHS shows that 7% of children under five years of age suffered from cough with short, rapid breathing during the two week period prior to the survey. Differentials in the proportion of children with ARI by age of the child show that the highest rate of illness was among children 6-11 months (14%), followed by children 24-35 months (10%), children
10 7
6
5
5
Under 6
6-11
12-23
24-35
36-47
48-59
months
months
months
months
months
months
37
under 6 months (7%), children 36-47 months (6%), children 48-59 months and children 12-23 months (5% each). Among children ill with ARI symptoms, data shows that 62% were given medical treatment by a health provider. Those who were most likely to receive medical care included the boys, children of higher order and children whose mother had no education or primary incomplete. In addition, 80% of ill children received antibiotics to treat respiratory illness.
5.4
Breast Feeding and Supplementation
Initiation of breastfeeding (Appendix A Table 5.4)
Fig 5.4 Initiation Breastfe e din g Am on g Ch ildren Unde r Age 5
According to 2005 FVHS results, 97% of children aged 5 years and under at the time of the survey were reported as having been breastfed. Among the children who were ever breastfed, 51% of the children were put to the breast within an hour of delivery, and 59% of the children were breastfed within the first day. It is worth mentioning that only 71% of children received prelacteal feeding during the first 3 days after birth.
97
59
51
Ever breastfed start with in 1 start with in 1 hour
day
Introduction of complementary feeding (Appendix A Table 5.5) To obtain information on feeding patterns, mothers were asked about the breastfeeding status of all children under the age of five in the 24-hour period before the interview. They were also asked about what other liquids or solids, if any, that had been given during that 24 hour period. Exclusive breastfeeding is common but not universal among very young infants. For example, 89% of infants under two months of age received only breast milk. This percentage drops to 63% among children 2-3 months of age. Fig 5.5 Percen tage Distribu tion of Ch ildren by Bre astfee din g S tatu s, by Age (in Mon ths)
100 90 80 70 60 50 40 30 20 10 0 0
2
4
6
8
10
12
14
16
18
20
Not breastfeeding
Exclusively breastfed
Breastfed and water-based liquids/juices
Breastfed and complemetary foods/milk
22
24
26
28
30
32
34
Breastfed and plain water
38
Differentials in the duration and frequency of breastfeeding and bottle feeding (Appendix A Table 5.6)
Data from the 2005 FVHS was used to calculate the median duration of breastfeeding for children less than 3 years of age and prevalence of bottle-feeding among children less than 2 years old. Overall, the median duration of breastfeeding is 17 months. Children are exclusively breastfed or predominantly breastfed for 1.5 months and 5.5 months, respectively. Looking at differentials in the median Fig 5.6 Me dian Du ration of Bre astfe eding by breastfeeding duration, children born Mothe r's Le ve l of Edu cation 19 in public health facilities are breastfed 18 for a longer period (19 months) than 15 15 those born at private health facilities and at home (15 months and 17.7 months respectively). A different pattern is observed in looking at the relationship between assistance at delivery and breastfeeding durations. The median duration of breastfeeding No education Primary Primary secondery incomplete complete/some complete/higher for children whose mothers were secondery assisted at delivery by a medical provider was 16 months, compared to 17.3 months for children whose mothers received assistance at delivery from a Daya. Looking at other characteristics, the median duration of breastfeeding for female babies tends to be somewhat longer than for males (18.7 and 15.8 months respectively). Children whose mothers were not educated or have some primary education are breastfed for a longer period than children whose mothers have higher education. Overall, 11% of children less than 2 years old are bottle-fed. Bottle-feeding is more common among children who born in private health facilities and whose mothers were assisted at delivery by a medical provider. In addition, children whose mothers receive some education and working for cash are bottle-fed than among children whose mothers were not educated and not working for cash.
5.5
Vitamin A Supplementation among Children (Appendix A Table 5.7)
Beginning at the age of nine months (typically at the same time the child receives the measles vaccination, young children are given one Vitamin A capsule (100,000 international units). Two additional capsules are given to children at age 18 months, at the time when the activated polio dose is administered.
Fig 5.7 Pe rcen tage of C hildre n 1223 Months Wh o Re ce ive d Vitamin A 78 58
Data of 2005 FVHS examines the coverage of Total Rural Fayoum EDHS vitamin A supplementation among children aged 2005 12-23 months at the time of the survey. The rate of vitamin A supplementation is based on information reported by the mother that the child received a capsule. About 78% of children aged 12-23 months have received a vitamin A capsule. Children whose mothers completed secondary education or higher are less likely to receive vitamin A supplementation than those whose mothers are low educated.
39
KNOWLEDGE, ATTITUDES, PERCEPTIONS AND PRACTICES OF HIV/AIDS, HEPATITIS AND SAFE INJECTIONS 6 The 2005 FVHS questionnaire collected information on the levels of knowledge, perception, attitudes, and practices related to AIDS, Hepatitis C, and blood borne diseases. The survey included also questions relating on the awareness of safe injection practices. Program efforts are being directed at increasing the awareness about AIDS, Hepatitis and the importance of safe injections; thus these data will be valuable in strengthening these efforts by both assessing current knowledge and providing information on the channels through which people obtain such information.
6.1
Knowledge and Perceptions related to HIV/AIDS
A series of questions were asked to women, husbands and youth to assess the overall level of respondents’ knowledge of AIDS, the source from which information on AIDS had most recently been obtained, and knowledge of the avenues through which AIDS might be contracted. Tables 6.1 through 6.3 present these findings.
Fig 6.1 Eve r he ard abou t AIDS 89 80
87
72
Women
Husbands
Never married Never married female youth
male youth
Knowledge of HIV/AIDS (Appendix A Table 6.1) Although HIV prevalence has remained low in Egypt, it is important to provide information about HIV/AIDS to prevent a future epidemic. Accordingly, respondents were asked if they had ever heard about AIDS and if so, they were asked to mention the last source of knowledge. Data of 2005 FVHS shows that the awareness among females is less than among males. The data reveal that 72% of women had ever heard about AIDS, which was the lowest percentage among the different groups of respondents. Husbands’ knowledge about AIDS was the highest among all groups (89 %) followed Table 6.1 Knowledge of Modes of Transmission of HIV/AIDS (among respondents aware of AIDS) by never-married male youth (87 %). Never-married Differentials were observed among different villages, where respondents in Al-Tawfikia Female Male Women Husbands youth youth village are more aware of AIDS than those in other villages. Eighty-eight percent of Modes of transmission women in Al-Tawfikia ever heard about of HIV/AIDS Illicit sexual relations 60 72 38 63 AIDS compared to only 66% among women Blood transfusion 46 59 60 62 in Kasr Rashwan. Same trend was observed Infected needles 45 42 54 35 among never-married female youth. Ninety- Number 441 575 173 398 five or more of husbands and male youth from Al-Tawfikia ever heard about AIDS, while the lowest percentages were observed in Tersa village. Television was the most recent common source of knowledge by far. Around 90% of women and never-married male youth and 84% of husbands and never-married female youth who were aware of AIDS reported that the most recent source for their knowledge was the television. It is worth mentioning that friends/ neighbors are the most second recent source of knowledge for AIDS. There were no discrepancies among the villages with regard to the source of knowledge.
40
Modes of transmission of HIV/AIDS (Appendix A Table 6.2) It is important to point out that AIDS is transmitted through blood transfusions, from mother to fetus, and sexual contact. Respondents who had heard about AIDS were asked to name at least two ways by which AIDS can be transmitted. The data reveal that even among those aware of HIV/ADIS, a significant number of respondents lack sufficient knowledge about the modes of transmission, especially with regard to mother to fetus transmission. Illicit sexual relations was the most mentioned transmitted mode of HIV/AIDS among all respondents except for never-married female youth, where only 38% of female youth mentioned that mode of transmission. Slightly less than three quarters of husbands, 63% of male youth and 60% of women mentioned that HIV/AIDS can be transmitted through illicit sexual relations. Blood transfusion was mentioned as a mode of transmission by around 60% of all respondents except women, where 46% of women mentioned blood transfusion as one of the mode of transmission. Few respondents mentioned mother to fetus transmission (2% of women and husbands, 3% of never-married female and male youth). The data of 2005 FVHS shows that there are substantial differences in knowledge about the modes of HIV/AIDS transmission across villages. For example, 69% of women in Al-Tawfikia village mentioned illicit sexual relations and blood transfusion as the modes of transmission of HIV/AIDS, compared to only 49% and 33% of women in Kasr Rashwan village who mentioned illicit sexual relations and blood transfusion respectively. For never-married female youth, the data revealed that 86% in Al-Tawfikia village were more likely to mention the blood transfusion as one of the modes of transmission of AIDS compared to 49% in Tersa village. The data also disclose that a significant number of respondents in all groups are under the impression that casual physical contact is a mode of transmission. However, husbands and never-married male youth were least likely to mention casual physical contact as a mode of transmission (6% and 5% respectively). By contrast, a significant number of never-married female youth and women (31% and 27%) mentioned casual physical contact as a mode of transmission.
Fig. 6.2 HIV/AIDS can be Tran sm ite d through C asual Ph ysical Contact with an Infacted Prson 31 27
6
Women
Husbands
5
Never married Never married female youth
male youth
Perceptions related to HIV/AIDS (Appendix A Table 6.3) The respondents in all target groups were read a series of statements to assess their perceptions related to HIV/AIDS. The responses were presented on a scale of 1-5 (strongly disagree, disagree, neutral, agree, and strongly agree). During the analysis stage, the responses were recoded into three categories; agree, disagree and neutral. Almost all respondents agree that getting an HIV/AIDS infection is severe (around 97% of women and 96% female youth and almost all husbands and male youth). Perceptions about the severity of HIV/AIDS vary little across villages. Few respondents believe that it is possible that they could be infected with HIV/AIDS (13% of women, 11% of husbands, 12% of never-married female youth, and 10% of never-married male youth). However, significant differences were observed between villages, where respondents from Al-Tawfikia were less likely than respondents from other villages to believe they could be infected. For example, 24% of women from Tersa village agree that they could be infected with HIV/AIDS compared to 3% among women in Al-Tawfikia village. Same pattern was observed among all groups of respondents.
41
Most respondents are not aware that using condoms is an effective way to prevent HIV/AIDS infection, and a significant number believe using condoms is ineffective. For example, 59% of ever married women reported not knowing whether using condoms is effective and 9% state that it is ineffective. Among husbands, 38% do not know if condoms are effective and 28% believe they are ineffective. Among never married female youth, awareness of the effectiveness of condoms for HIV prevention is the lowest among all groups of respondents. Almost two thirds of unmarried females reported that they do not know if condoms are effective. Slightly less than half of nevermarried males (47%) mentioned that they do not know. The data show that at least 60% of respondents agreed that HIV/AIDS is a serious problem in Egypt. However, significant differences were observed between villages. More than two thirds of women in Al-Tawfikia agreed that HIV/AIDS is a serious problem in Egypt compared to 55% of women in Tersa village. Same pattern was observed among never-married female youth. Nevermarried male youth in Kasr Rashwan are more likely to agree that HIV/AIDS is a serious problem in Egypt than those in other villages. Minor differences were observed among husbands in different villages. Around half of all respondents agree with the statement “"The HIV/AIDS problem in Egypt will increase in the coming years" (54% of both husbands and never-married male youth, 49% of women and 48% of never-married female youth). Significant differences were observed between villages, where women and never-married female youth in Al-Tawfikia are more likely to agree that HIV/AIDS problem will increase in the coming year than those in the other villages. While husbands and never-married male youth in Kasr Rashwan are more likely to agree that the problem of HIV/AIDS is likely to increase than those in other villages. Most respondents are confident that they Fig 6.3 You r are confide n t that you can protect can protect themselves from HIV/AIDS yourself from HIV/AIDS In fection s 84 83 (84% of husbands, 83% of never-married 70 male youth, 70% of women, and 64% of 64 never-married female youth). Significant differences were observed among villages, where around 80% of women and never12 10 8 13 married female youth from Al-Tawfikia 6 6 6 4 and Kasr Rashwan agreed that they could Women Husbands Never married Never married protect themselves from HIV/AIDS female youth male youth compared to around half from Tersa Agree Disagree Don't know village. Husbands and never-married male youth from Kasr Rashwan are more likely to agree that they could protect themselves from HIV/AIDS than those in other villages do.
6.2
Knowledge and Perceptions related to Hepatitis C
A series of questions were asked to assess respondents’ knowledge of Hepatitis C, the source from which information on Hepatitis C had most recently been obtained, and their perceptions about Hepatitis C.
Knowledge of Hepatitis C (Appendix A Table 6.4) Data of 2005 FVHS revealed that awareness of husbands and never-married female youth about Hepatitis C are more than other groups of respondents. Almost two thirds of husbands and nevermarried female youth had ever heard about Hepatitis C, while 58% of women and 49% of nevermarried male youth had ever heard about Hepatitis C. These findings indicated that knowledge about Hepatitis C is significantly lower than knowledge about AIDS among all groups. Awareness of Hepatitis C was higher in Al-Tawfikia village than in any other village among all groups of respondents. Women and female youth in Tersa and husbands and male youth in Kasr Rashwan have the least knowledge about Hepatitis C.
42
Respondents, who had ever heard Fig 6.4 Eve r h eard about He patitis C about Hepatitis C, were asked about 67 66 their last source of information about 58 the disease. Television was the most 49 commonly mentioned source of information among all groups, and was cited by 69% of never-married female youth, 68% of never-married male youth, 65% of women and 56% of husbands. The second most Women Husbands Never-marreied Never-marreied commonly noted source of female youth male youth information was the “friends/neighbors”. Slightly less than one third of husbands, around 20% of women and never-married male youth and 13% of never-married female youth reported that they lastly heard about Hepatitis C from friends/neighbors.
Modes of transmission of Hepatitis C (Appendix A Table 6.5) Respondents who had heard about Hepatitis C were asked to name at least two ways by which Hepatitis C can be transmitted. As was the case with AIDS, the data reveal that even among those who had heard about Hepatitis C a significant number lack sufficient knowledge about the modes of transmission.
Table 6.2 Knowledge of Modes of Transmission of Hepatitis C Never-married Female Male Women Husbands youth youth Modes of transmission of Hepatitis C Blood transfusion Infected needles Other contact with contaminated blood
55
72
63
80
Among respondents aware of Hepatitis C, 56 64 56 65 the most commonly mentioned mode of 20 23 17 18 transmission was blood transfusion 224 306 97 161 followed by the infected needles. However, Number respondents in Al-Tawfikia were more likely to mention blood transfusion and infected needles as the modes of transmission of the disease than respondents in any other village A large percentage of respondents have Fig 6.5 He patitis C can be Tran sm itted throu gh the notion that Hepatitis C can be C asu al Ph ysical Contact with an Infe cte d Person transmitted through casual physical 24 contact with an infected person 21 especially for women and never-married female youth. Slightly less than one quarter of women and 21% of never11 11 married female youth mentioned that casual physical contact with an infected person is one of the modes of transmission of Hepatitis C, while 11% of both husbands and never-married Women Husbands Never-married Never-married male youth mentioned that mode of female youth male youth transmission is through casual physical contact with an infected person. Significant differences were observed among villages. Women and never-married female youth from Kasr Rashwan village were more likely to mention casual physical contact as one of the modes of transmission than females in any other village. Similarly, husbands and never-married male youth from Tersa were more likely to mention this mode than males from any other village.
43
Perceptions related to Hepatitis C (Appendix A Table 6.6) Respondents who had ever heard about Hepatitis C were read a series of statements to assess their perceptions related to the disease. The answers were coded on a three point scale (disagree, neutral and agree). Ninety percent or more of respondents agreed that Hepatitis C infection is severe. Almost all respondents in Al-Tawfikia village agreed about the severity of the disease. However, Women from Kasr Rashwan and husbands and never-married youth from Tersa are least likely to agree that getting Hepatitis C infection is severe. The majority of respondents feel that it is not possible to contract Hepatitis C, as indicated by the high disagreement with the statement "It is possible that you will contract Hepatitis C". Sixty-five percent of never-married male youth, 52% of husbands, and 47% of women and never-married female youth indicate that they do not think it is possible that they will contract Hepatitis C. Regarding the discrepancies between villages, the data shows that respondents from Al-Tawfikia village are most likely to believe that they cannot contract Hepatitis C except for never-married male youth. Never-married male youth from Tersa are most likely to believe they cannot contract the Hepatitis C (68%), while those in Kasr Rashwan are least likely to believe the canhont contract the disease (59%). Among respondents who had ever heard about Table 6.3 Use of disposable syringes is an effective Hepatitis C, most of respondents agreed that use way to prevent Hepatitis C infection of disposable syringes is an effective way to Never-married prevent Hepatitis C (88% of never-married male youth, 86% of husbands, 81% of women and 76% Female Male of never-married female youth). Clear differences Women Husbands youth youth were observed among villages, where around 95% Agree 81 86 76 88 of women and husbands from Al-Tawfikia village Disagree 2 3 4 3 reported that the disposable syringe is an effective Don’t Know 11 7 12 7 550 526 209 282 way to prevent the Hepatitis C infection compared Number to only 71% of women and 77% of husbands from Tersa village. Same trend was observed among never-married female youth. Regarding nevermarried male youth, the data shows that 91% of male youth from Kasr Rashwan village agreed about the effectiveness of the disposable syringe as an effective way to prevent Hepatitis C infection compared to 85% from those in Tersa village.
6.3
Knowledge, Attitudes and Practices related to Safe Injections and Blood Borne Diseases
The 2005 FVHS questionnaire asked respondents about their knowledge, attitudes and practices with regard to safe injections and the related blood borne diseases.
Knowledge of blood borne diseases and safe injections practices (Appendix A Table 6.7) Respondents were asked if they had ever heard about blood borne diseases that can be transmitted through used needles. The results show that 52% of ever married women, 57% of husbands, 60% of nevermarried female youth, and 46% of never-married male youth had heard about blood borne diseases that can be transmitted through syringes. In addition, respondents from Al-Tawfikia had higher awareness of blood born diseases than respondents in other villages, while respondents from Kasr Rashwan had the least awareness of these diseases.
Table 6.4 Percentage aware of blood borne diseases that can be transmitted through used needles Never-married Female Male Women Husbands youth youth HIV/AIDS Hepatitis C Tetanus
48 40 6
69 59 7
53 43 7
71 52 4
44
Respondents who were aware of blood borne diseases were asked to mention the ones they knew. HIV/AIDS was most often mentioned, followed by Hepatitis C and Tetanus. HIV/AIDS was mentioned by 71% of never-married male youth, 69% of husbands, 53% of never-married female youth, and 48% of women. Breakdown by village shows that HIV/AIDS was most often mentioned by all groups of respondents from Al-Tawfikia village. Hepatitis C was mentioned by more than half of husbands and never-married male youth (59% and 52% respectively), but less by women and never-married female youth (40% and 43% respectively). However, 80% of never-married female youth and 56% of women from Al-Tawfikia village mentioned Hepatitis C as one of the blood borne disease that could be transferred through needles. Tetanus was listed by 6% of women, 7% of both husbands and never-married female youth, and 4% of never-married male youth. Respondents were asked to mention the methods that prevent the risk of infection Table 6.5 Ways to prevent the risk of infection from infected needles from the infected needles. The most commonly mentioned method for preventing Never-married infection from infected needles was not Female Male sharing or reusing needles, which was Women Husbands youth youth indicated most by 87% of husbands, 86% of never-married female youth, 85% of women, Don’t share/reuse 85 87 86 78 and 78% of never-married male youth. The needles Purchase disposable second most often mentioned method among syringe for provider 7 15 8 29 husbands and male youth was purchasing disposable syringes for the provider to use, which was cited by 15% of husbands and 29 percent of never-married male youth. While the second most mentioned method among women and female youth was using oral medications instead of injections which were mentioned by 9% of women and 10% of never-married female youth. The percentage of respondents who did not know any method for preventing infection from infected needles was quite high, ranging from 5% among husbands to 10% among women.
Self-efficacy with respect to safe injection practices (Appendix A Table 6.8) Respondents were read several statements to assess their intentions with respect to safe injection practices. The responses were presented on a scale of 1-5 (very unlikely, unlikely, somewhat likely, likely, and very likely). During the analysis stage, the responses were recoded into three categories; likely, unlikely and somewhat likely. The first statement asked respondents how likely they would be to ask a medical service provider to use a disposable syringe; the second statement asked about the likelihood of asking the medical service provider to properly dispose the Fig 6.6 Lik elihood of Ask ing th e Me dical needles/syringes. Se rvice Provide r to Use A Disposable Syrin ge Almost all respondents reported being likely to ask the medical service provider to use a disposable syringe (96% of never-married female youth, 95% of ever married women, 94% of husbands and 92% of never-married male youth). Husbands and never-married male youth from Tersa village appear to be least likely to ask for a disposable syringe, and women from Al-Tawfikia and nevermarried female youth from Kasr Rashwan are least likely to ask the medical provider for a disposable syringe.
96
94
95
92
Likely Unlikely
1 Women
3 Husbands
1
2
Never-married Never-married female youth
male youth
45
Most of respondents reported being likely to ask the medical service provider to properly dispose the needles/syringes, with the percentages ranging from 82% among never-married male youth to 89% among husbands.
Practices related to safe injection (Appendix A Table 6.9) Quite a few respondents reported that they had ever asked the service provider to use a disposable syringe (10% of never-married female youth, 8% of husbands, 7% of women, and 6% of nevermarried male youth). However, few respondents mentioned that they bring their own syringes with them, with the percentage ranging from 2% among never-married male youth to 9% among women. Slightly more than half of women, two fifth Fig 6.7 Eve r Re used a S yringe of husbands and around one third of never17 married female and male youth mentioned that they had ever purchased or obtained syringes for use at home. The respondents who had ever purchased or obtained syringes for use at home were asked if they or any family member had ever reused a 4 3 3 syringe; a small number of respondents had ever reused a syringe except for women. Seventeen percent of women mentioned that Women Husbands Never married Never married female youth male youth they reuse the syringe by themselves or by any other member at home, while 4% of husbands, 3% of never-married female and male youth reported having reused a syringe at least once by themselves. Fig 6.8 Meth od of Disposal of Syrin ge 85
30
Women
26
Husbands
81
80
80
31
25
Never
Never
married
married male
female youth
youth
Destroy the needle so that it cannot be used again Throw it in the garbage
Respondents who had ever purchased or obtained syringes for use at home were asked about the method of disposal of syringes when they are no longer useful. Most respondents indicated that they throw the syringes in the garbage without destroying them. Nevertheless, there is a promising degree of awareness of the need to properly dispose used syringes, as 31% of never-married female youth, 30% of women, around 26% of husbands and 25% of never-married male youth reported destroying the needle so that it cannot be used again.
46
HEALTHY LIFESTYLES AND PASSIVE SMOKING
7
Promoting healthy lifestyles is one of the main objectives of the CHL program. The program aims to increase demand for health services and to stimulate the adoption of healthy behaviors and lifestyles. Keeping in mind this objective, the 2005 FVHS collected information about attitudes and practices related to healthy lifestyles. Additionally, the survey collected information about hand washing, smoking, and passive smoking.
7.1
Hand Washing Practices (Appendix A Table 7.1)
The questionnaire included Fig 7.1 Frequency of Washing Hands questions for respondents about 60 56 55 their hand washing habits. Overall, 12% of women wash their hands 144 44 3 times a day, 44% wash their 32 hands 4-6 times a day, and also 23 21 20 44% wash their hands 7 times or 18 1 2 12 more. A similar pattern was observed among husbands and female youth, and never-married W omen H usband s Nev er married Never married male youth; more than half of the female yo uth male you th three groups washed their hands 46 times a day. There are clear 1 -3 times 4 -6 times 7 times or mo re differences between villages. Women, husbands, never-married female youth, and never-married male youth from Al Tawfikia village were the most likely to wash their hands 7 times or more per day (62%, 41%, 53%, and 40% respectively). By contrast, women, husbands, never-married female youth, and never-married male youth from Kasr Rashwan village were the least likely to wash their hands 7 times or more per day (33%, 18%, 17%, and 11% respectively).However, respondents from Kasr Rashwan were the most likely to wash their hands 4-6 times a day. Respondents who reported Fig 7.2 Washing Han ds Practice s washing their hands were asked 98 93 92 94 94 93 90 89 89 90 86 84 when they tend to do so. Ninety 82 76 75 72 three percent of women and nevermarried female youth wash their hands when waking up in the morning compared to 86% of husbands and 84% of nevermarried male youth. The least practice of washing hands is before Women Husbands Never married Never married eating, with the lowest percentage female youth male youth among husbands (72%). Slight When waking up in the morning Before eating After eating After using the bathroom differences were found between villages, were women from Kasr Rashwan village, female youth and male youth from Al Tawfikia village, and husbands from Tersa village are the least likely to wash their hands before eating (65%, 70%, 61%, and 66% respectively). Around 95% of women and never-married female youth report washing their hands after using the bathroom compared to 89% of husbands and 90% of never-married male youth. Differences are exist between villages and among the four groups, where women and female youth from Al Tawfikia village and husbands and male youth from Tersa village were the least likely to wash their hands after using bathroom (88%, 94%, 82%, and 84% respectively). Al Respondents from Kasr Rashwan village were the most likely to do this practice.
47
7.2
Performing Usual Activities (Appendix A Table 7.2)
Respondents were asked about their ability to perform their usual Table 7.1 Percentage Having Difficulties Performing Usual Activities activities in order to assess their Never-married health status. Eighty four percent of women and 89% of husbands had no Female Male problems in performing their usual Women Husbands youth youth activities, compared to 96% of male youth and 95% of female youth. With Currently have no/some difficulty in the same pattern, 13% of women and /great performing usual activities 9% of husbands had some difficulty No difficulty 84 89 95 96 in performing their usual activities Some difficulty 13 9 5 4 Great difficulty 3 2 0 0 compared to 5% of female youth and 4% of male youth. Some differences were found between villages. Fifteen percent of husbands from Al Tawfikia village had some problems in performing their usual activities, compared with only 3% of husbands from Tersa village. As expected, due to the age difference, none of both never-married female and male youth reported having great problems performing their usual activities (except for female youth from Kasr Rashwan village) than ever-married women and husbands. Respondents were asked about the number of days that they were unable to perform their usual activities or work during the month preceding the survey. Data from the 2005 FVHS show that more than 20% of women, husbands and female youth reported that they were unable to do their usual work for 1-7 days (22%, 23%, and 21% respectively) compared to 18% of male youth. Limited differentials were observed between villages, where women, husbands and female youth from Al Tawfikia village were the least likely to report that they were not able to perform their usual work for 7 days or less, while male youth from the same village were the most likely reporting the same point. The data show also that more than two thirds of women and husbands mentioned that they were able to perform their usual activities every day during the month preceding the survey. This is also the case for 77% of female youth and 81% of male youth.
7.3
Knowledge, Attitudes, Practices, and Perceptions related to Smoking
Practices related to smoking (Appendix A Table 7.3) Respondents were asked about smoking and smoking practices. Appendix Table A7.3 Table 7.2 Percentage Who Smoke Cigarettes or represents these practices. Due to the fact that Water Pipes Al Kasr only 6 ever-married women and 5 neverTawfikia Tersa Rashwan married female youth reported smoking, results are shown for husbands and never-married male Husbands youth only. Smoking is common among males. Smoke cigarettes 87 77 81 Half of husbands and 16% percent of never- Water pipe “shisha” 16 27 19 married male youth report that they smoke Never-married male youth cigarettes or “measel” or any kind of smoke. 100 93 100 The most common type of smoking practice Smoke cigarettes Water pipe “shisha” 0 7 0 among husbands and never-married male youth is cigarette smoking (81% and 98%, respectively). The data also show that 22% of husbands and only 2% of never-married male youth report smoking a water pipe (“shisha”). However, smoking varies by village. Husbands and never-married male youth from Kasr Rashwan reported the lowest percentage of smoking (47% and 13%, respectively), while the highest percentages were found in Al Tawfikia (57% and 21%, respectively). All male youth from Kasr Rashwan and Al Tawfikia who are currently smoking smoke cigarettes while 7% of male youth from Tersa smoke water pipe (“shisha”). Husbands are more likely to smoke water pipe (“shisha”)
48
(16% or more). The mean number of cigarettes smoked per day was around 19 and 20 for husbands and never-married male youth respectively, with slight differences among male youth. The highest mean was 25 cigarettes for male youth in Tersa village, while the lowest mean was 18 cigarettes for male youth in Al Tawfikia village. Smoking rolled cigarettes is uncommon among husbands (Less than 1%) and not practiced at all by male youth. Additionally, only husbands from Al Tawfikia village smoke rolled cigarettes.
Fig 7.3 Me an Num be r of S mok ed Cigarette s 25 20 20
19
Husbands
18
17
Never-married male youth
Al Tawfikia
Tersa
Kasr Rashwan
Attitudes toward smoking (Appendix A Table 7.4) Respondents were read a set of Table 7.3 Attitudes Toward Smoking four statements about smoking Never-married in order to assess their attitudes Female Male toward smoking. Respondents’ Women Husbands youth youth agreement with the statement Smoking endangers the health of was presented on a scale of 1-5, smokers (Mean) 4.9 4.9 4.9 4.9 where 5 means strongly agree Smoking endangers the health of 4.8 4.7 4.8 4.8 and 1 strongly disagrees. For the people around smokers (Mean) purpose of the analysis, Smoking reduces a person's ability participate in sports (Agree) 90 91 92 93 responses were regrouped into to Creating a nonsmoking area in your three categories: agree, disagree, home is an effective way to reduce and neutral. The data show that the harmful effects of exposure to 90 90 88 91 there is almost a universal secondhand smoke (Agree) agreement that smoking endangers the health of both the smoker and the people around the smoker. Slight differences exist between the four target groups and between villages. Ninety percent or more of all respondents agreed that smoking reduces a person’s ability to participate in sports, with slight differences among villages. Lowest agreement was found among respondents in Tersa village (81% of women, 87% of husbands, 85% of female youth, and 86% of male youth). Around 90% of respondents agree that creating a nonsmoking area at home is an effective way to reduce the harmful effects of exposure to secondhand smoke, with the lowest percentage found among never-married female youth (88%). Again, lowest agreement was found among respondents in Tersa village (80% of women, 86% of husbands, 81% of female youth, and 86% of male youth). Knowledge of the health effects of exposure to secondhand smoke (Appendix A Table 7.5) Fig 7.4 He alth Effe ctsof Exposu re to S e condh an d S moke 75
70
73
67 53 45
44
43 35
29 22
16 9
8 Women
Husbands
9
Never married Never married female youth
Heart disease
Respiratory problems
6
male youth
High blood pressure
Cancer
Respondents were asked to name some of the health effects of exposure to secondhand smoke. The data show that the main health effects cited by the different groups are respiratory problems, followed by heart disease and cancer. Seventy percent of women, 75% of husbands, 67% of female youth, and 73% of male youth reported that exposure to secondhand smoke may cause respiratory problems. There are huge differences among villages. Ninety seven percent of
49
women from Al Tawfikia village reported that exposure to secondhand smoke may cause respiratory problems compared to only 53% of women youth from Tersa village. Same pattern was found among the other three groups. More than four in ten of all respondents mentioned that secondhand smoke may cause heart disease, with strike differences among villages. Seventy one percent of women from Al Tawfikia village reported that exposure to secondhand smoke may cause heart disease compared to only 20% of female youth from Kasr Rashwan village. Same pattern was found among the other three groups and with point that exposure to secondhand smoke may cause high blood pressure. On the other hand, the situation was reversed when respondents were asked whether exposure to secondhand smoke might cause cancer. Respondents from Al Tawfikia village reported the lowest percentages. Other problems were mentioned rarely by respondents. Perceptions related to the health effects of exposure to secondhand smoke (Appendix A Table 7.6) Respondents were asked about their Fig 7.5 Liklelih ood of He alth Effe cts Se con dh and perceptions regarding the likelihood that S moke r Will Ge t the secondhand smoker will get health 94 96 97 99 92 97 80 90 97 89 82 82 problems. More than 90% of all 85 83 7884 respondents believe that secondhand smoke may cause heart disease, with Kasr Rashwan village being reporting the lowest percentage among the four groups. There is almost a universal agreement among respondents that secondhand Women Husbands Never married Never married female youth male youth smokers are likely to have respiratory problems. Slight differences exist between Heart disease Respiratory problems High blood pressure Cancer villages. More than 80% of all respondents believe that secondhand smoke may cause cancer, with differences among villages and groups. Seventy nine percent of women and female youth from Tersa believe that secondhand smoke may cause cancer, compared to around 90% of husbands and male youth from Kasr Rashwan. Perceptions about people’s concern about the health effects of exposure to secondhand smoke (Appendix A Table 7.7) Respondents in the different groups were asked to indicate whether most, some, very few, or none of the people who are living in their area are concerned about the health 52 effects of exposure to secondhand smoke. 41 The most common response was that none 37 35 of the people are concerned about the health effects of exposure to secondhand smoke (53% of never-married male youth, 41% of husbands, 37% of never-married female youth, and 35% of women). Clear Women Husbands Never married Never married differences exist among women and neverfemale youth male youth married female youth in the three villages, were women and never-married female youth from Kasr Rashwan village are least likely to believe that none of the people are concerned about secondhand smoke (20% and 18respectively), while women and never-married female youth from Al Tawfikia are most likely to believe that none of the people are concerned about secondhand smoke (49% and 51% respectively). Also, husbands and never-married male youth in Al Tawfikia are most likely to believe that none of the people are concerned about secondhand smoke (42% and 58% respectively). Fig 7.6 Pe ople are C on ce rne d Abou t th e He alth Effects of Exposu re to S econdhan d Sm ok e
50
7.4
Attitudes toward Passive Smoking
Future attitudes toward passive smoking (Appendix A Table 7.8) Respondents were asked about the likelihood they would engage in various smoking-related behaviors. The responses were measured on a 5-point scale ranging from very unlikely to very likely. During the analysis stage, the responses were recoded into three categories: likely, unlikely, and somewhat likely. First, smokers were asked about the likelihood that they will stop smoking in their home or in the presence of children. Never-married female youth were the least likely to intend to stop smoking in their home or in the presence of children (25%), while on the other hand women were the most likely to intend to do so (57%). Differences exist among villages, were respondents from Al Tawfikia village were the least likely to intend to stop smoking in their home or in the presence of children (none of women and female youth and only 23% of husbands and 18% of male youth).
Fig 7.7 Lik lelihood of Fu tu re Attitudes Toward Passive 57 42 39 38
35
37 31
31
Women
25
Husbands
42 40
26
Never married Never married female youth
male youth
Stop smoking in home/inpresence of children Ask visitors not to smoke in home/in presence of children Create non-smoking area at home
Respondents were also asked about the likelihood that they will ask visitors not to smoke in their home or in the presence of children. Respondents in each group were less likely in reporting that they would ask visitors not to smoke in their home or in the presence of children (42% of nevermarried male youth, 39% of husbands, 31% of never-married female youth, and 35% of women). Women and never-married female youth from Kasr Rashwan village where the most likely to ask visitors not to smoke in their home or in the presence of children (43% and 34% respectively), while husbands and never-married male youth from Tersa village where most likely to ask visitors not to smoke in their home or in the presence of children (45% and 50% respectively). Those respondents who did not have a nonsmoking area in their home were asked about the likelihood that they would create at least one such area in their home. The most common answer from both husbands and never-married male youth was that it was likely that they would create at least one nonsmoking area in their home (38% and 40%, respectively). However, the most common answer from married women and never-married female youth was that it was unlikely that they would create such an area in their home (42% and 49%, respectively). In Tawfikia village women, husbands, and never-married female youth were the least likely to report that they are likely to create at least one nonsmoking area (16% for women, 24% for husbands, and 15% for never-married females), while never-married male youth from Kasr Rashwan village were the least likely to report that they are likely to create at least one nonsmoking area (29%).
51
Table 7.4 Mean number of future attitudes toward passive smoking Never-married Female Male Women Husbands youth youth Likelihood that you will Stop smoking in your home /in the presence of children Ask visitors not to smoke in your home/in the presence of children Create at least one “non smoking” area in your home
3.8
3.0
2.3
3.2
2.8
3.0
2.6
3.2
2.7
3.0
2.5
3.1
home/in the presence of children was in Tersa village (5.0 for female youth, and 3.7 for male youth).
The mean for the likelihood that respondents will stop smoking in their home/in the presence of children was higher among women (3.8) and lower among never-married female youth (2.3). Among husbands the mean for the three future attitudes was 3.0 for each. The highest mean for the likelihooh that respondents will stop smoking in your women, 3.8 for husbands, 3.0 for
Attitudes toward the created nonsmoking area (Appendix A Table 7.9) Around one third of all respondents reported having a nonsmoking area in their home (34% of never-married male youth, 33% of husbands, 31% of never-married female youth, and 29% of women). Women and never-married female youth from Kasr Rashwan village were least likely to indicate the presence of a nonsmoking area in their home (27% and 26% respectively), while on contrast male youth from Kasr Rashwan village were most likely to indicate the presence of a nonsmoking area in their home (49%).
Fig 7.8 Have a Nonsmoking Area in Respondent Home
34
33 31 29
Women
Husbands
Never-married Never-married female youth
male youth
The respondents who indicated that there was a nonsmoking area in their home were asked how various people reacted to the creation of this nonsmoking area. All husbands reported that their spouse were supportive compared to 93% of women. Children were supportive for 85% of women and 93% of husbands. Regarding other family members reaction, 71% of women, 83% of husbands, 75% of never-married female youth, and 90% of never-married male youth reported that they were supportive. According to all never-married female youth and never-married male youth the mother was supportive, while father was supportive for 85% of never-married female youth, and 98% of never-married male youth. Friends were more supportive for never-married male youth than never-married female (83% and 44% respectively). Attitudes toward creating a nonsmoking area in the future (Appendix A Table 7.10) Respondents who indicated that they did not have a nonsmoking area in their home were asked to predict how different people would react if they were to create such an area. The data indicate that although few homes have a nonsmoking area, most respondents expect their relatives to be supportive of the creation of a nonsmoking area.
Fig 7.9 Don 't Have a Nonsmoking Area in Re sponden t Hom e 71 69 68 66
Women
Husbands
Never-married
Never-married
female youth
male youth
52
While almost all husbands believed that their spouse would be supportive (98%), only 53% of women believed in so. Furthermore, 67% of women and 85% of husbands expected other family members to be supportive. Similarly, 38% and 56% of women and husbands expected friends to support them in this effort. Almost all never-married male youth believed that their mother would be supportive in creating a non smoking area at home (97%) compared to 85% of never-married female youth. Nevertheless, only 55% of neverTable 7.5 Percentage of Respondents Believing married male youth and 39% of never-married that Various Persons Would Support Creating a female youth believed their father would support Nonsmoking Area creating a non smoking area. Around half of nevermarried male youth and never-married female Women Husbands youth also believed that their friends would support Spouse’s reaction 53 98 such a zone. Children’s reaction 67 85 Other family members’ reaction Friends’ reaction Husband’s friends’ reaction
53 38 14
74 56 NA
53
LEADERSHIP, HEALTH INFORMATION, AND SUPPORT FOR HEALTH IMPROVEMENT
8
Since community leaders can play an important role in changing a community’s attitude and thus are able to influence behavior change, the 2005 FVHS questionnaire included questions about leadership characteristics that respondents value as well as questions about the perceived characteristics of actual leaders in the community. Additionally, the 2005 FVHS collected information about access to health information and perceptions about the role of individuals, families, providers, and communities in ensuring good health.
8.1
Perceptions about Leadership Characteristics (Appendix A Table 8.1)
The questionnaire included questions about specific leadership characteristics, and were asked to rate their importance. The respondents were read a series of statements about specific leadership characteristics, and were asked to rate their importance according to their perception. Responses were coded as not important, moderately important, and important. There was almost a universal agreement that it is important for the leader to be concerned about the welfare of others (98% of women, 99% of husbands, 97% of never-married female youth, and 98% of nevermarried male youth), with almost no differences between villages. There was also a wide agreement that it is important for the leader to be willing to share resources and benefits with others (97% of women, 99% of husbands, 97% of never-married female youth, and 98% of nevermarried male youth), with almost no differences between villages. Around 90% of respondents reported that it is important for the leader to understand local culture, with slight differences among villages. The lowest percentage was found in Tersa village (82% of women, 84% of husbands, 78% of never-married female youth, and 82% of nevermarried male youth) while the highest percentage was found in Al
Table 8.1 Percentage of knowledge about leadership characteristics Never-married Female Male Women Husbands youth youth A leader is concerned about the welfare of the others Leader willing to share resources and benefits with others Leader understand the local culture Leader well educated Leader can appeal to higher authorities for support and action Leader can identify and obtain resources from outside the community Leader understand local community needs
97.6
99.2
96.8
97.9
96.8
98.8
97.4
97.9
91.2 89.2
92.5 81.8
88.9 87.4
90.4 75.2
88.6
93.6
90.8
89.3
90.5
94.4
90.4
91.1
93.2
95.0
91.5
92.0
Table 8.2 Mean number of knowledge about leadership characteristics Never-married Female Male Women Husbands youth youth A leader is concerned about the welfare of the others Leader willing to share resources and benefits with others Leader understand the local culture Leader well educated Leader can appeal to higher authorities for support and action Leader can identify and obtain resources from outside the community Leader understand local community needs
4.8
4.8
4.9
4.8
4.8
4.7
4.7
4.7
4.7 4.6
4.7 4.4
4.7 4.6
4.6 4.2
4.7
4.6
4.6
4.5
4.7
4.7
4.6
4.6
4.7
4.7
4.6
4.6
54
Tawfikia village (99% of women, 99% of husbands, and all never-married female and male youth). The data also showed that respondents are somewhat less likely to agree that the leader’s education is important (89% of women, 82% of husbands, 87% of never-married female youth, and 75% of never-married male youth), with differences between villages. Al Tawfikia village also had the highest percentage (98% of women, 97% of husbands, all never-married female youth, and 97% of never-married male youth). Around 90% of respondents reported that it is important for the leader to appeal to higher authorities for support and action (89% of women, 94% of husbands, 91% of never-married female youth, and 89% of never-married male youth). Almost the same pattern was found for the importance for the leader to identify and obtain resources from outside the community (91% of women, 94% of husbands, 90% of never-married female youth, and 91% of never-married male youth). More than 90% of all respondents mentioned that it is important for the leader to understand the local community needs, with slight differences between villages; Generally, Tersa village had the lowest percentage.
8.2
Table 8.3 knowledge of actual community leaders characteristics Never-married Female Male Women Husbands youth youth A leader is concerned about the welfare of the others Leader willing to share resources and benefits with others Leader understand the local culture Leader well educated Leader can appeal to higher authorities for support and action Leader can identify and obtain resources from outside the community Leader understand local community needs
84
97
93
95
81
94
92
92
93 71
95 84
96 75
94 85
47
69
57
71
52
68
55
73
77
86
84
93
Perceptions about Actual Community Leaders (Appendix A Table 8.2)
Respondents from all groups were asked if there is someone that they consider to be a leader in their community. Data from the 2005 FVHS show that around one quarter of respondents believe their community has a leader (27% of women, 26% of husbands and never-married female youth, and 24% of never-married male youth), with differences between villages. Respondents from Tersa village were the most likely to report that they have a leader in their community (32% of women, 46% of husbands, 30% of never-married female youth, and 38% of never-married male youth). On the other hand, woman and never-married female youth from Al Tawfikia village and husbands and never-married male youth from Kasr Rashwan were the least likely to report that they have a leader in their community (15%, 21%,11%, and 10% respectively). Those respondents who reported having a community leader were asked about their level of agreement that this leader had the earlier-mentioned characteristics. Responses were recoded into three categories: agree, disagree, and neutral. More than 90% of respondents (except for women) agree that their leader is concerned about the welfare of others. All never-married female and male youth from Kasr Rashwan village agree that their leader is concerned about the welfare of others compared with 82%
Fig 8.1 Pre se nce of an Actu al Le ader in the C omm unity 27
26
26 24
Women
Husbands
Never married
Never married
female youth
male youth
55
of women and 96% of husbands from the same village. More than 80% of women and husbands and more than 90% of never-married female and male youth agree that their leader shared resources and benefits with others. All never-married male youth from Kasr Rashwan agreed with this issue, compared to only 79% of women from the same village. More than nine in ten of all the groups of respondents agree that their community leader understands the local culture (93% of women, 95% of husbands, 96% of never-married female youth, and 94% of never-married male youth). There were almost no differences in this perception among the villages. More than 70% of women and never-married female youth and around 84% of husbands and never-married male youth agreed that their leader is well educated, with clear differences between villages. Respondents from Kasr Rashwan village are the least likely to agree that their community leader is well educated (55% of women, 68% of husbands, 67% of never-married female youth, and 75% of never-married male youth). Never-married male youth and husbands are more likely than women and never-married female youth to agree that their community leader can appeal to higher authorities for support and action (71%, 69%, 47%, and 57% respectively). Women, husbands and never-married female youth from Kasr Rashwan reported the lowest percentage (22%, 46%, and 24% respectively), while nevermarried male youth from Al Tawfikia reported the lowest percentage (53%). Also, never-married male youth and husbands are more likely than women and never-married female youth to agree that their community leader can identify and obtain resources from outside the community (71%, 68%, 52%, and 55% respectively). Clear differences appear between villages and groups. While 77% of women from Al Tawfikia village agree with this issue, only 38% of Women from Kasr Rashwan agree with this issue. While only 43% of never-married female youth from Kasr Rashwan village agree that their community leader can identify and obtain resources from outside the community, 75% of never-married male youth from the same village agree with this issue. Higher percentages of respondents believe that their community leader understands the local community needs. The highest level of agreement was among the never-married male youth (93%), followed by husbands (86%).
8.3
Access to Health Information (Appendix A Table 8.3)
The questionnaires included questions Fig 8.2 Percen tage believing th ey have en ou gh related to access to health information. information abou t h ealth topics Respondents were asked whether they 63 62 have enough information about health 57 topics to protect their family’s health. 41 The data shows that 63% of women, 57% of husbands, 62% of nevermarried female youth, and only 41% of never-married male youth reported that they have enough information about health topics. Slight differences were Women Husbands Never married Never married observed between villages. Women and female youth male youth husbands from Al Tawfikia village and never-married female and male youth from Kasr Rashwan reported the highest agreement (65%, 67%, 70%, and 49% respectively).
56
All respondents were asked to mention how confident they could obtain information about various health topics. Responses were recoded into three 88 categories: not confident, neutral, and 81 80 78 confident. Slightly less than 90% of women, 81% of husbands, 78% of never-married female youth and 80% of never-married male youth are confident that they could obtain information about the use of family planning methods, with very slight differences Women Husbands Never married Never married female youth male youth among villages. Regarding the level of confidence to obtain information about keeping children healthy, the data shows that 87% of women, 81% of husbands, 82% of nevermarried female youth and 80% of never-married male youth mentioned that they confident to obtain information about keeping children healthy. Tersa village being reporting the lowest percentage among male respondents, while female respondents in Al-Tawfikia village reporting the lowest percentage. Fig 8.3 Percen tage con fiden t the y can obtain Information about Use of Fam ily Plan ning Me th ods
Concerning preventing unsafe Table 8.4 Percentage who are confident that they Can obtain injections, the data shows that less information about various health topics than three quarters of all respondents Never-married (72% of all groups of respondents except never-married male youth Female Male (71%)) feel confident that they could Women Husbands Youth Youth obtain information about preventing Keeping children healthy 87 81 82 80 unsafe injections. Differences exist Preventing unsafe injection 72 72 72 71 between villages. The highest level of Healthy diet for the whole confidence among female family 77 75 71 70 Dangers of smoking and respondents was found in Kasr how to stop smoking 68 76 62 72 Rashwan village (83% of women and 77% of never-married female youth), and male respondents in Al-Tawfikia village (81% of husbands and 79% of never-married male youth). Additionally, the data shows that the lowest level of confidence among all groups of respondents was found in Tersa village (59% of women, 65% of husbands, 66% of never-married female youth, and 62% of never-married male youth). More than 7 out of every 10 respondents feel confident that they are able to obtain information about a healthy diet for the whole family (77% of women, 75% of husbands, 71% of never-married female youth, and 70% of never-married male youth), with also the same pattern between villages as the previous topic. The highest level of confidence among female respondents found in Kasr Rashwan village, while found in Al-Tawfikia village regarding male respondents. Additionally, the data shows that the lowest level of confidence was found in Tersa village (68% of women, 71% of husbands, 64% of never-married female youth, and 61% of never-married male youth). Husbands and never-married male youth were confident that they could obtain information about the dangers of smoking and how to stop smoking more than women and female youth. The data shows that 76% of husbands and 72% of male youth, while only 68% of women and 62% of female youth felt that they could get such information. Again, the lowest level of confidence was observed in Tersa village (59% of women, 72% of husbands, 57% of never-married female youth, and 62% of never-married male youth). Like obtaining information about the dangers of smoking and how to stop smoking, husbands and never-married male youth were confident that they could obtain information about how HIV/AIDS could be prevented more than female respondents. The 2005 FVHS shows that 59% of husbands
57
and 63% of male youth felt they could get such information compared to only 44% of women, and 45% of nevermarried female youth. Differences exit between villages. The highest level of confidence among never-married male youth was found in Kasr Rashwan village (70%) and among husbands in Tersa village (62%). Women and never-married female youth from Al Tawfikia village reported the highest level of confidence (48% of women and 45% of never-married female youth).
Fig 8.4 Percen tage Con fiden t About Ability to O btain In formation abou t HIV/AIDS Preve ntion 59
Women
Women
75
Husbands
72
Husbands
Never married Never married female youth
Fig 8.5 Perce ntage Confide nt Abou t Ability to O btain Information about Safe Pre gn an cy an d De livery 82
63 45
44
67
Never married Never married female youth male youth
male youth
As expected, confidence regarding obtaining information about safe pregnancy and delivery is highest among married respondents (82% of women and 75% of husbands). Nevermarried female and male youth reported slightly lower levels of confidence (72% and 67% respectively). Again Tersa village reported the lowest levels of confidence (70% of women, 68% of husbands, 64% of never-married female youth, and 53% of never-married male youth), while Kasr Rashwan among female respondents and Al-Tawfikia among male respondents reported the
highest level of confidence.
8.4
Attitudes related to Maternal and Child Health (Appendix A Table 8.4)
The survey also asked question about who is responsible for ensuring a safe delivery for both the child and the mother. Specifically, respondents were asked about the level of responsibility of the mother, father, the whole family, health provider, and the whole community. Responses were coded as high responsibility, low responsibility, and not responsible at all. Almost all women, husbands and never-married male youth agree that it is the responsibility of the mother to ensure safe delivery for both mother and child health (99%) while it decreased to 95% among nevermarried female youth. Slight differences were observed between villages. Same pattern was observed among different groups regarding
Table 8.5 Responsibility of different groups for ensuring safe delivery Never-married Female Male Women Husbands Youth Youth Responsibility related to maternal and child health-the mother Responsibility related to maternal and child health-the father Responsibility related to maternal and child health-the whole family Responsibility related to maternal and child health-the health provider Responsibility related to maternal and child health-the whole community including the community leaders
99
99
95
99
95
97
96
99
87
84
86
84
94
94
91
93
61
63
62
53
58
the responsibility of the father, where 95% or more of all groups of respondents reported that it is the responsibility of the father to ensure safe delivery for maternal and child health, with some differences were observed between villages. More than 8 out of 10 of all groups of respondents believe that this is the responsibility of the whole family, with almost all respondents from Al Tawfikia village mentioning this issue. Almost 94% of women, husbands and never-married male youth, while 91% of female youth believe that it is the responsibility of the health provider to ensure safe delivery for maternal and child health. Regarding the responsibility of all community including the community leaders, the data shows that almost 62% of all groups of respondents except never-married male youth (53%) reporting the responsibility of the community to ensure safe delivery for maternal and child health.
8.5
Attitudes related to Maternal Health (Appendix A Table 8.5)
All respondents were asked about what they would do if a 6 months-pregnant woman in their family became ill. Multiple responses were permitted. Data from the FVHS 2005 show that 8 out of 10 respondents (except for nevermarried female youth) would consult a health service provider in such case. A higher percentage from Kasr Rashwan village is willing to do so (95% of women, 94% of husbands, 89% of never-married female youth, and 88% of never-married male youth). None of the respondents from Kasr Rashwan village is willing to talk with husband.
Fig 8.6 Be lie fs Abou t W hat S hould Be Don e If a 6-Mon th s- Pre gn an t W om an Become s Ill 81
81
80 71
14
13 3 0 1 Women
1
6
13 1 1
1
Husbands
Nothing; wait f or her to get better Talk with a relative Consult a health service provider
3 3 1
10 2
3
0 0
2
Never-married
Never-married male
female youth
youth
Talk with the husband Talk with a f riend Consult a pharmacist
An average of about 1 out of 10 respondents is willing to do nothing and wait for the woman to get better. Very small percentages are willing to consult a pharmacist (1% of women and husbands, 2% of never-married female and male youth). Additionally same pattern was found in talking with a friend or a relative.
8.6
Willingness to Participate in Family Health Improvement Activities (Appendix A Table 8.6)
The questionnaire included Fig 8.7 Pe rce n tage Willin g to Participate in questions that aimed at exploring Activities to Improve Family He alth in th e Village respondents’ willingness to 53 52 participate in activities to improve 41 40 family health in their village. Those willing to participate were asked about the roles they would be willing to perform in those activities. The FVHS data show that female youth, and male youth Women Husbands Never married Never married (53% and 52% respectively) would female youth male youth be willing to participate in such activities more than women and husbands (41% and 40% respectively). Respondents from Al Tawfikia village are less willing to participate in such activities (21% of women, 22% of husbands, 29% of never-married female youth, and 36% of never-married male youth). Women and never-married female youth from Tersa village and husbands and never-married male youth from Kasr Rashwan are more willing to participate in such activities (52%, 60%, 52%, and 63% respectively).
59
Those respondents who reported that they would be willing to participate in activities to Never-married improve family health in their Female Male community were asked which Women Husbands Youth Youth role they would be willing to Percentage willing to perform perform for each of those various roles in those activities activities. Multiple responses Attend meeting 100 99 100 100 were allowed. There is a Speak out in meetings 97 99 97 99 universal indication among all Help to assess community needs 92 94 90 95 respondents that they would be Help to plan activities 77 84 74 85 Help implement the activities 72 86 78 89 willing to attend meetings. Willing to be leader for activities 66 64 67 49 Almost all respondents would be Provide resources for activities 72 81 71 87 willing to speak out in meetings. Ninety percent or more would be willing to help to assess community needs. Limited differences were found among villages. Table 8.6 Willingness to Participate in Family Health Improvement Activities
Additionally, data showed that husbands and never-married male youth (84% and 85% respectively) would be more willing to help to plan activities than women and never-married female youth (77% and 74% respectively), with slight differences among villages. Respondents from Kasr Rashwan village would be more willing than other villages to plan activities (98% of women, 97% of husbands, 96% of never-married female youth, and 96% of never-married male youth). Same pattern was found regarding respondents’ willingness to implement the activities. Around two thirds of women, husbands, never-married female youth and half never-married male youth would be willing to be leader for activities. Additionally, husbands and never-married male (81% and 87%, respectively) youth are more willing to provide resources for activities than women and never-married female youth (72% and 71%, respectively)
8.7
Perceptions about Families’ Ability to Avoid or Solve Health Problems (Appendix A Table 8.7) Table 8.7 Attitude related to Family and Health Problems
Respondents were asked Never-married questions about their perceptions Female Male about their families’ ability to Women Husbands Youth Youth avoid or solve health problems. To that effect, respondents were Family health problems are too complex for the family to presented with a number of overcome by itself 82.1 85.7 83.6 84.4 scenarios and were asked to Family is able to protect the health indicate their level of agreement of its members 84.3 86.5 90.7 84.4 with the statement (disagree, Family has the resources it needs to protect the health of its members 74.3 71.9 77.0 69.2 neutral, agree). More than 8 out People in your family are aware of of 10 respondents agree that 73.4 80.2 64.9 the most important health problems 76.8 family health problems are too Families should talk together about complex to be handled by the how to achieve and maintain good family, with variations among health 81.5 86.5 80.6 84.2 It is better for families to prevent villages. Kasr Rashwan village health problems before they occur showed the highest percentages than to cure health problems after (95% of women, 94% of they happen 87.1 91.7 80.2 88.7 husbands, 89% of never-married female youth, and 88% of nevermarried male youth). Additionally, more than 8 out of 10 respondents agreed that their families are able to protect the health of their members. Al Tawfikia village showed the highest percentages (97% of women, 98% of husbands, 97% of never-married female youth, and 89% of never-married male youth).
60
Around 7 out of 10 respondents agreed that their families have the resources needed to protect the health of its members, with differences among groups and villages. While only two thirds of women form Kasr Rashwan agreed about this issue, more than 95% of women from Al Tawfikia agreed with the same issue. Slightly more than half of husbands and never-married male youth from Tersa village agreed with this issue. Same pattern was found when respondent were asked about whether the people in the family are aware of the most important health problems.
Fig 8.9 Perce ntage Be lie ving Th eir Village Has the Resource s It Nee ds to Solve Its Health Proble ms 46
Women
43
Husbands
41
52
Never married Never married female youth
male youth
More than 8 out of 10 respondents agreed that families should talk together about how to achieve and maintain good health, with differences between villages. Only two thirds of women from Tersa agreed with this issue compared to 92% of women from Al Tawfikia. High percentage of respondents agreed that it is better for families to prevent health problems before they occur than to cure health problems after they happen (87% of women, 92% of husbands, 80% of nevermarried female youth, and 89% of never-married male youth), and again Tersa village showed the lowest percentages. 8.8
Perceptions about Community Health Problems (Appendix A Table 8.8)
Respondents were asked about their Fig 8.10 Pe rce ntage Be lie vin g Village rs Are level of agreement with various Aware of th e Most Im portant He alth Problem s statements related to community 52 44 45 44 health problems. As before, the responses were recoded into three categories: agree, disagree, and neutral. Half or more of the respondents agreed that their village has the ability to solve the health problems that it faces (56% of women, 53% of husbands, 50% of neverWomen Husbands Never married Never married married female youth, and 59% of female youth male youth never-married male youth). However, fewer percentages mentioned that their village has the resources it needs to solve its health problems (46% of women, 43% of husbands, 41% of never-married female youth, and 52% of never-married male youth). Only one third of women from Kasr Rashwan believe that their village has sufficient resources to do so compared to two thirds of never-married male youth from the same village. Husabnds and never-married male youth believe more than women and never-married female youth that village factions make working together difficult (53%, 55%, 44%, and 49% respectively). Respondents from Kasr Rashwan village showed the highest percentages in believing in so. More than 4 out of 10 women, husbands and never-married female youth and around half of never-married male youth agreed that people in their community are aware of the most important health problems. Respondents from Tersa village showed the lowest percentages in believing in so.
61
FEMALE CIRCUMCISION
9
In Egypt, female circumcision is widely spread practice especially in rural areas. The 2005 FVHS questionnaire included several questions about knowledge, prevalence, attitudes, and practices related to female circumcision.
9.1
Knowledge of Female Circumcision (Appendix A Table 9.1)
Fig. 9.1 Kn owle dge of Fe male Circu mcision 100
Respondents of the different groups were asked about whether they heard about female circumcision or not to assess their knowledge about this issue. Data showed that there is a universal knowledge about female circumcision as 100% of all groups (98% of never-married male youth) indicated that they had heard about female circumcision.
9.2
100
100
98
Women
Husbands
Never married Never married female youth
Prevalence of Female Circumcision and Intention to Circumcise Daughters (Appendix A Table 9.2)
male youth
Fig 9.2 Pre valen ce of Female Circu mcision 99
Both women and never-married female youth were asked whether they had been circumcised or 98 not in order to obtain insight about the prevalence of female circumcision. Almost all women and never-married female youth indicated that they Women Never-married female had been circumcised. Only 94% of neveryouth married female youth from Kasr Rashwan village had been circumcised. Moreover, slightly less than half women and husbands reported that at least one of their daughters had been circumcised. Tersa was the village with the highest percentage of circumcised daughters (56% of women and 52% of Fig 9.3 You th Inte ntion to Circu mcise husbands). the ir Daugh te rs 76
73
Never married female Never married male youth
9.3
youth
With regard to youth’s intention to have any future daughters circumcised, around three quarter of never-married female and male youth intend to circumcise their daughters in the future. Only two thirds of never-married female youth from Kasr Rashwan intend to circumcise their daughters in the future compared to 82% of never-married female youth from Al Tawfikia.
Support for Female Circumcision (Appendix A Table 9.3)
Respondents in the different groups were asked whether the practice of female circumcision should be continued or discontinued in order to assess their attitudes about supporting continuation of female circumcision. Women and husbands were more likely than never-married female and male youth to indicate that the practice should be continued (86%, 80%, 73% and 74% respectively). Al Tawfikia was the village where respondents were most likely to indicate that this practice should continue (93% of women, 89% of husbands, 75% of never-married female and male youth).
62
Those respondents who indicated that Fig 9.4 S upport for female circumcision should be Fem ale Circu mcision continued were asked to list their 86 reasons for this belief (multiple reasons could be mentioned). The most common 80 reason indicated by women and nevermarried female youth was good tradition 74 73 (38% and 34% respectively), while the most common reason indicated by husbands and never-married male youth was that it is required by religion (38% for both). Around one third of husbands Women Husbands Never married Never married female youth male youth and never-married male youth indicated that female circumcision should be continued as it reduces lust compared to 20% of women and only 13% of never-married female youth. Cleanliness was mentioned by only 17% of never-married male youth compared to around one third of women and husbands. Significant differences were noticed Table 9.1 Reasons Female Circumcision Should Be Continued Never-married between villages. While 75% of women from Al Tawfikia mentioned that Female Male Women Husbands youth youth female circumcision is required by Reasons religion only 8% of women from Kasr Percentage of FC Rashwan mentioned the same reason. Supporters Who Cited: Good tradition
38
31
34
27
Respondents who indicated that female Required by religion 24 38 22 38 31 32 24 17 circumcision should be discontinued Cleanliness were also asked about the reasons for their beliefs. Multiple responses were permitted; accordingly, percentages do not add to 100%. The most common reason provided by both women and husbands was that it is against religion (46% and 32%, respectively), while the most Table 9.2 Reasons Female Circumcision Should Be common reason indicated by never-married discontinued female and male youth was is that it causes Never-married many medical complications (48% and 71%, respectively); All never-married male youth Female Male Reasons Women Husbands youth youth from Kasr Rashwan village mentioned this reason. Bad tradition was mentioned by Reasons slightly lower percentages of respondents Bad tradition 28 24 31 22 Against religion 46 32 46 41 (28% of women, 24% of husbands, 31% of Causes medical never-married female youth, and 22% of complications 36 30 48 71 never-married male youth).
9.4
Perceptions about Female Circumcision (Appendix A Table 9.4)
Interviewers read a series of statements about female circumcision and asked respondents to indicate whether they agreed or disagreed with them in order to assess respondents’ perceptions about female circumcision. When presented with the statement that circumcision is an important part of religious tradition, most respondents agreed (68% of women, 67% of husbands, 59% of never-married female youth, and 60% of never-married male youth).
Fig 9.5 Pe rce ption Toward Fem ale Circu mcision 68
80
73
75
67 59 53
47 32
29
60 52
52
26 26 20
Women
Husbands
Never married
Never married
female youth
male youth
63
However, respondents from Kasr Rashwan village reported lower percentages (54% of women, 55% of husbands, 48% of never-married female youth, and 44% of never-married male youth). When presented with the statement that a husband prefers his wife to be circumcised, a larger percentage of respondents agreed (except never-married female youth) (73% of women, 80% of husbands, and 75% of never-married male youth), with almost no differences between villages. While around half women, husbands, and never-married male youth agreed with the statement that circumcision prevents adultery, only 26% of never-married female youth agreed with the same statement. The results indicate that few respondents recognize the adverse consequences of female circumcision. Only 28% of never-married female youth agreed that circumcision may cause severe complications compared to only 19% of women, 15% of husbands and 9% of never-married male youth. Respondents were asked whether circumcision may cause a woman to have problems becoming pregnant. Only 11% of women, 7% of husbands, 14% of never-married female youth, and 10% of never-married male youth agreed that circumcision may cause difficulties in becoming pregnant. Tersa village showed the highest agreement (18% of women, 12% of husbands, 24% of nevermarried female youth, and 17% of never-married male youth). When asked whether female circumcision reduces sexual satisfaction for a couple, only 32% of women, 29% of husbands, 26% of never-married female youth, and 20% of never-married male youth believed this to be true. Again, Tersa village showed the highest agreement (60% of women, 49% of husbands, 42% of never-married female youth, and 31% of never-married male youth). Respondents were also asked whether childbirth is more difficult for a woman who has been circumcised. Few respondents agreed: 9% of women, 5% of husbands, 12% of never-married female youth, and 7% of never-married male youth. None of the never-married male-youth from Kasr Rashwan village agreed with this statement.
64
EXPOSURE TO INFORMATION, EDUCATION, AND COMMUNICATION CAMPAIGNS
10
Since the mid-1980s, a strong mass media public information and education program was conducted to be one of the main components of the Egyptian family planning program. After focusing initially on general “population awareness” messages, the education and communication effort has increasingly moved to providing more specific advice and information on family planning and family health in general. The 2005 FVHS obtained information on the proportion of who have been recently exposed to family health information and the channels through which they received the information. This information may be useful in guiding future information and education efforts in Egypt’s family health programs. This chapter first examines the levels of exposure to various spots and programs on television and printed media that talk about family health, family planning, smoking, safe injection, child health…etc. In addition, the learning messages from these spots and programs and the effectiveness of these spots/programs on respondents’ behaviors were also examined in this chapter. Next, the chapter examines the levels of recent exposure to various sources of mass media and interpersonal communications about family planning, birth spacing, pre- and post-natal care, healthy lifestyles (smoking cessation), HIV/AIDS, safe injection and female circumcision.
10.1
Communication about Family Planning (Appendix A Tables 10.1-10.5)
Family Planning Messages (Appendix A Table 10.1) Respondents were asked if they heard Fig 10.1 Exposu re to Fam ily Plann ing Me ssage s or seen information about family 59 55 planning during the six months 51 preceding the survey. The results show 41 that around half of respondents mentioned that they were exposed to family planning messages during the past six months. Overall, 55% of ever married women, 41%, 59% of nevermarried female youth and 51% of never-married male youth reported Women Husbands Never married Never married female youth male youth hearing or seeing information about family planning in the past six months. The data shows that the level of exposure varies across villages. The levels of exposure to family planning message in Al-Tawfikia village is the highest for all four target groups, while the levels of exposure in Kasr Rashwan village is the lowest among all groups of respondents except for women, where women in Tersa are least likely to expose to family planning messages. Among those recently exposed to family planning messages, television is by far the most important source of information. Billboards, posters and brochures are also important sources of family planning information, but have considerably less coverage than television. Among ever married women recently exposed to family planning messages, television is the dominant source of information (84%), followed by posters and billboards (31% and 30% respectively), and leaflets/brochures (14%). Among husbands who recently received information about family planning, the main sources of exposure are television (91%), billboards (25%), and posters (21%). Among never-married female youth, the most important sources of recent exposure to family planning are television (91%), posters (28%), billboards (26%), and brochures and community meetings (14%). Never married males also identify television and billboards as the main sources of information. However, different pattern was observed, where the radio became one of the main
65
sources of information for never married male youth, and only 8% of never married males report that they receive their information from posters and 5% from brochures. It is noteworthy that the sources of Table 10.1 Source of information about FP messages information about family planning messages vary substantially across Never-married villages. For example, the posters and the Female Male billboards are the second most important Women Husbands Youth Youth sources of information for all groups of Television 84 91 91 96 respondents in Kasr Rashwan village Radio 12 11 13 13 except for never married male youth. For Posters 31 21 28 8 women, 49% in Kasr Rashwan reported seeing a family planning message on Leaflets/Brochures 14 12 14 5 Billboards/Sign posters compared to only 11% among boards 30 25 26 14 women in Al-Tawfikia village. Similarly, around two thirds of never married female youth in Kasr Rashwan reported seeing posters about family planning during the last six months compared to only 5% of never-married female youth in Al-Tawfikia village. Regarding never-married male youth, the radio is the second most source of family planning information in Al-Tawfikia village (34%), while the billboards are the second source of information in Tersa village (27%). The television is the only major source of information about family planning for never-married male youth in Kasr Rashwan village. Messages about Family Planning after the First Birth (Appendix A Table 10.2) Fig 10.2 Exposure to Message s about Family Plann ing after the First Birth 32
30
25 20
Women
Husbands
Never married Never married
Information about exposure to messages about the use of family planning after the birth of the first child was investigated in the 2005 FVHS. The results show that slightly less than one third of ever-married women and never married female youth were recently exposed to such messages (30% and 32% respectively). Exposure among males is considerably lower, at 20% for husbands and 25% for never married male youth.
Breakdown by village shows that exposure to messages about family planning after the first birth was most frequent in Al-Tawfikia village for all four groups of respondents. Women and husbands in Kasr Rashwan village and never-married youth in Tersa village are least likely to expose to such messages. female youth
male youth
Among those who were recently exposed to messages about the use family planning after the birth of the first child, television is the main source of exposure. Over 95% of never-married male youth, 94% of husbands, 87% of unmarried females and 77% women reported that the television is their source of information for such messages. Medical provider was the second source of information for women (18%), while the television is the only major source of information for all other groups of respondents. Significant differences were observed between villages, where medical provider was mentioned by 25% of women in Tersa, while it was mentioned by only 4% in Al-Tawfikia village. Slightly less than one fifth of never-married female youth (17%) mentioned the medical provider in Tersa village and 14% of never-married male youth mentioned other relatives.
66
Level of Comfort Discussing Family Planning (Appendix A Table 10.3) In addition to mass media, interpersonal communications can be an important source of information about family planning. Respondents were asked if they feel comfortable talking about family planning with various persons. The results show that the large majority of respondents feel comfortable discussing family planning. Only 3% of ever-married women and 6% of husbands reported that they are not comfortable discussing family planning with anyone. Even among never married female youth, only 8% report not feeling comfortable discussing family planning. However, one in five never married male youth (19%) are not comfortable doing so. Data of 2005 FVHS presented that Table 10.2 Communication with Others about Use of women are more likely to discuss family Family Planning Methods planning methods with service provider Never-married (59%). Almost half of ever-married women feel comfortable discussing Female Male Women Husbands Youth Youth family planning with their husband (47%). Similarly, husbands feel Spouse 47 70 comfortable talking about family Parents/Parents in law 9 3 45 29 planning with their wives (70%) or with Other relatives 14 5 7 2 a service provider (45%), and little with Service Provider 59 45 38 53 others (6% or less). More than two fifth Friends/neighbors 18 6 21 12 of never married female youth (45%) No one 3 6 8 19 report feeling comfortable discussing family planning with their parents, and 38% feel comfortable doing so with service providers, and almost one in five mentioned friends or neighbors. The pattern for never married male youth is different. More than half of never-married male youth reported feeling comfortable discussing family planning with services providers (53%), with their parents (29%), and with their friends or neighbors (12%). The results indicated that levels of comfort discussing family planning with various people tend to vary considerably across villages. For example, 60% of ever-married women in Al-Tawfikia village report feeling comfortable discussing family planning with their husband, compared to only 42% of ever-married women in Kasr Rashwan village. Similarly, although more than three quarters (76%) of ever- married women report feeling comfortable discussing family planning with a service provider, this percentage decreases to 36% in Al-Tawfikia. Hence, lack of comfort is likely to hamper the reach effectiveness of interpersonal communication activities among some groups. Interpersonal Communication about Family Planning (Appendix A Table 10.4-10.5) The 2005 FVHS collected information about the frequency of discussion of family planning between couples during the six months before the survey. Among married women, 72% reported that they did Women Husbands not discuss family planning with their spouse in the Never 72 65 past six months, 19% discussed it once or twice, Once or twice 19 28 and only 5% discussed it more often. The results More often 5 7 for husbands are similar, where 65% of husbands never discussed family planning with their spouse during the last six months, 28% discussed such topic once or twice and 7% of husbands discussed such topic more often. Table 10.3 Discussion of Family Planning among Couples
Differentials exist between villages. Al-Tawfikia has high levels of spousal communication about family planning, with 32% of married women and 34% of husband reporting that they have discussed the subject with their spouse once or twice in the past six months. By contrast, only 14% of married women and 22% of husbands in Tersa reported discussing family planning with their spouse once or twice during that same period.
67
The level of contact with family planning workers was investigated in the survey. Among nonusers currently married women, 38% reported visiting a public health facility and 28% reported visiting a private health facility in the past six months. Less than two-thirds (62%) of nonusers married women had some contact with a family planning worker at a health facility. The results for husbands indicated that 18% and 11% of husbands report visiting a public health facility and a private health facility respectively. One quarter of husbands reported that they had some contact with a family planning worker at a health facility.
10.2
Communication about Birth Spacing (Appendix A Tables 10.6- 10.7)
Messages about Optimal Birth Spacing (Appendix A Table 10.6) Respondents were asked if they Fig 10.3 Exposure to O ptimal Birth received information about optimal S pacing Message s birth spacing during the six months 29 29 preceding the survey. The results indicate that 29% of ever married 19 women and never-married female youth 16 reported being exposed to such messages or information. By contrast, males are less likely to receive information on optimal birth spacing, where only 19% of never married male youth and 16% of husbands reported Women Husbands Never married Never married receiving such information. As with female youth male youth communication about family planning, the levels of exposure vary across villages. For example, the percentage of ever married women receiving information about optimal birth spacing varies from 25% in Kasr Rashwan to 37% in Al-Tawfikia. For husbands, it ranges from 12% in Kasr Rashwan to 21% in Tersa village. As expected, television is virtually the only source of information about optimal birth spacing for males (95% and 97% for husbands and never-married male youth respectively). While for females, the data shows that the television is the source of information for most of females followed by the medical provider, where 72% of women and 79% of female youth mentioned the television, 20% of women and 12% of never-married female youth mentioned the medical provider. Interpersonal Communication about Optimal Birth Spacing (Appendix A Table 10.7) FVHS 2005 collected information about Fig 10.4 In terpersonal C ommu n ication respondents who have discussed about O ptim al Birth S pacing optimal birth spacing in the six months 18 preceding the survey. The data shows that the interpersonal communication 11 10 about birth spacing is much less than that about family planning. Less than one fifth of ever married women (18%) 3 reported that they have recently discussed optimal birth spacing. The Women Husbands Never married Never married discussion among the other groups of female youth male youth respondents is much lower. Around one in ten of husbands and never married female youth mentioned that they discussed the optimal birth spacing with others. Discussion of optimal birth spacing among never married male youth is considerably low (3%). Among ever married women who recently discussed optimal birth spacing, 36% reported doing so with their husbands, 32% with friends or neighbors, and 21% with other relatives or other service
68
provider. Husbands who discussed the subject did so predominantly with their wives (83%) and friends/neighbors or other relatives (11%). Never married youth who discussed optimal birth spacing did so predominantly with friends/neighbors or other relatives.
10.3
Communication about Pre- and Postnatal Care (Appendix A Tables 10.810.12)
Messages about Pre- and Postnatal Care (Appendix A Tables 10.8-10.9) Respondents were asked if they received Fig 10.5 Exposure to Safe Pregn an cy Message s information about pregnancy precautions or 19 dangerous signs to be known by the pregnant woman to have a safe pregnancy during the 15 six months preceding the survey. Overall, 19% of ever married women and 15% of 8 never married female youth report that they received such information. Level of exposure 4 to such information is much lower among males, where 8% of husbands and 4% of never married male youth reported receiving Women Husbands Never married Never married information about safe pregnancy during the female youth male youth past six months. However, levels of exposure to safe pregnancy information vary greatly across villages. All groups of respondents in Al-Tawfikia village reported the highest levels of exposure, while respondents in Kasr Rashwan reported the lowest levels of exposure. Television and medical providers are the last 1 sources of information about safe pregnancy for all groups of respondents except for never-married male youth, where the television is the last source mentioned by most never-married male youth. More than half of women and three quarters of husbands who received information about safe pregnancy reported television as their last source of information. One third of women and 13% of husbands reported that they last received information about safe pregnancy from medical providers. To increase the level of postnatal care for both the mother and the child, the CHL Never-married communication activities have been recommending that Female Male mothers have postpartum and Women Husbands Youth Youth neonatal consultation within Exposure to postnatal/neonatal one week following the 14 5 19 5 consultation messages delivery2. At the time of the Source of information survey, exposure to these T.V. 56 75 67 87 messages was still fairly low. Medical provider 31 12 15 4 Only 14% of ever-married women and 19% of never married female youth reported receiving information about the postpartum/neonatal consultations. Among husbands and never married males, this was reported only by 5% of both groups. Table 10.4 Exposure to Postnatal/Neonatal Medical Consultation Messages
Once again, levels of exposure vary across villages. Ever married women in Tersa report level of exposure that is substantially above average (16%) compared to 11% among women in Kasr Rashwan. One quarter of never married female youth in Al-Tawfikia village report level of 1
Note that unlike the questions about exposure to communication activities about family planning, this question only asks about the last source of information about safe pregnancy (of those who exposed to such information in the past six months). 2 Cite a CHL document or website.
69
exposure to postpartum/neonatal consultations messages compared to 12% among never-married female youth in Kasr Rashwan. More than half of ever married women who were exposed to information about the recommended postpartum/neonatal consultations reported that they received their information from the television, while 31% reported that the source of their information is the medical providers. To some extent, they also obtain this information from friends and neighbors (12%). Same pattern was observed for the never-married female youth, where the television is the most frequent source of information followed by friends/neighbors and the medical providers. Most husbands exposed to postpartum/neonatal consultations information reported having this information from the television (75%), and 12% mentioned medical providers or their spouse as their source of information. Most never married male youth reported that the television was their source of information (87%). However, some never-married male youth report receiving their information from other relatives (14%). Level of Comfort Discussing Pre- and Postnatal Care (Appendix A Tables 10.10-10.11) Data of 2005 FVHS shows the percentage of respondents who report feeling comfortable talking about safe pregnancy and delivery. The results show that there is a high level of comfort discussing this topic among married respondents, but less so among the never married youth. Among married respondents, 96% and 93% of women and husbands respectively report feeling comfortable discussing safe pregnancy and delivery. While these percentages decrease to 89% and 82% among never married females and males respectively. All groups of respondents are most likely to feel comfortable discussing safe pregnancy and delivery with service providers. More than one quarter of evermarried women (28%) and half of husbands report their spouse as the one they feel comfortable discussing with him/her this topic. Regarding unmarried youth, the second reference reported by female and male youth is their parents (30% and 15% for female and male youth respectively). Brothers/sisters were mentioned by 16% of never-married female youth and 5% of never-married male youth. Differentials were observed among villages. For example, 53% of women in Al-Tawfikia village report feel comfortable discussing safe pregnancy and delivery with their husbands, compared to 22% among women in Kasr Rashwan village. Regarding the discussion about keeping babies healthy, overall, the percentage of respondents who feel comfortable discussing keeping babies healthy with someone is 95% or more for all groups except for never-married male youth, where only 86% of never-married male youth reported that they feel comfortable discussing this topic. Service provider is respondents except for husbands, where most
Table 10.5 Level of Comfort Discussing Safe Pregnancy and Delivery Never married Female Male Women Husbands Youth Youth Spouse
28
50
-
-
Parents/parents in law Service provider Friends/neighbors
10 62 14
3 55 6
30 43 19
15 58 9
Brothers/sisters No one
4
7
16 11
5 18
Table 10.6 Level of Comfort Discussing Keeping Babies Healthy Never married Female Male Women Husbands Youth Youth Spouse Parents/parents in law Other relatives Service providers Friends/neighbors Brothers/sisters No one
30 12 12 58 13 2
55 4 6 48 6 5
33 7 38 18 24 4
24 3 55 10 10 14
the most mentioned reference by all groups of husbands feel comfortable discussing this topic with
70
their wives. More than half women feel comfortable discussing keeping babies healthy with service provider, while 30% feel comfortable doing so with their husbands. Never married youth feel most comfortable discussing this subject with service provider, followed by their parents, brothers/sisters and friends/neighbors. Significant differences were observed among villages, where women in Kasr Rashwan are more likely to discuss keeping babies healthy with service providers, while women in Al-Tawfikia feel comfortable discussing this topic with their husbands. Interpersonal Communication about Postpartum/Neonatal Consultations (Appendix A Table 10.12) Fig 10.6 Interpe rsonal C om mun ication abou t Postpartum /Neonatal Consultation
12
The results of 2005 FVHS show that interpersonal communications about postpartum and neonatal medical consultations within the first week of delivery are very uncommon. Only 12% of ever-married women and 3% of husband had such discussions in the past six months.
3
The small number of women who did discuss these consultations did so predominantly with Women Husbands their friends/neighbors (34%), service providers other than the doctor (28%) and with their husbands (23%). Husbands who had such discussions did so mostly with their wives (73%), friends and neighbors (22%), and service providers other than the doctor (14%).
10.4
Communication about Passive Smoking (Appendix A Tables 10.13-10.15)
Health Messages about Passive Smoking (Appendix A Table 10.13) Exposure to the health messages related to passive smoking is relatively low. Overall, 29% of ever-married women, 27% for both husbands and never-married female youth and 19% of never-married male youth reported receiving information about passive smoking in the past six months.
Fig 10.7 Exposu re to Health Me ssages about Passive S mokin g 29
27
27 19
Breakdown by village, the data shows Women Husbands Never married Never married that the exposure to passive smoking female youth male youth messages varies dramatically across villages. For example, the percentage of ever-married women who reported receiving such messages in the past six months ranges from 18% in Kasr Rashwan to 58% in Al-Tawfikia. Similar differentials exist for all other groups of respondents. Respondents in Al-Tawfikia are more likely to receive messages about passive smoking than respondents from other villages. Those who reported receiving information about passive smoking in the past six months identified television as their main source of information followed by friends/neighbors and other relatives.
71
Level of Comfort Discussing Smoking (Appendix A Table 10.14) Most people feel comfortable talking about the dangers of smoking and how to stop smoking. Specifically, 87% of ever married women, 93% of husbands, 86% of never married female youth, and 92% of never married male youth feel comfortable discussing this subject with someone.
Table 10.7 Level of Comfort Discussing the Dangers of Smoking and Smoking Cessions Never married Female Male Women Husbands Youth Youth Spouse
37
25
-
-
Parents/parents in law
6
4
26
12
Service providers are the most Other relatives 10 8 6 5 mentioned reference by all groups of Service providers 42 48 36 56 respondents. More than half of neverFriends/neighbors 13 28 17 30 married male youth, 48% of husbands, Brothers/sisters 18 6 42% of women and 36% of neverNo one 13 7 14 9 married female youth reported that they are feel comfortable discussing dangers of smoking with service providers. Among married women, 37% reported feeling comfortable discussing smoking with their husbands. More than one in ten feel comfortable discussing this topic with friends and neighbors. Husbands reported that they feel comfortable discussing smoking with friends and neighbors (28%), and with their wives (25%). Never married female youth feel comfortable discussing this subject with their parents (26%), brothers/sisters (18%), and friends or neighbors (17%). Never married male youth are comfortable discussing smoking with their friends or neighbors (30%) and with their parents (12%). Differentials were observed among villages. Ever married women and never-married male youth in Kasr Rashwan, and husbands and nevermarried female youth in Tersa village are more likely to feel comfortable discussing about dangers of smoking with service providers than respondents in other villages. Interpersonal Communication about Passive Smoking (Appendix A Table 10.15) Fig 10.8 In te rpe rson al Comm un ication abou t S e cond Han d S mokin g 19 17
18 14
Women
Husbands
Never married Never married female youth
Although people tend to feel comfortable discussing the dangers of smoking and how to stop smoking, this does not necessarily imply that such discussion actually take place. For example, the results show that only 19% of ever-married women and 17% of husband reported that they discussed passive smoking in the six months preceding the survey. Among never married youth, this is the case for 18% of females and only 14% of males.
male youth
Women who discussed passive smoking did so predominantly with their husbands (55%), other relatives (28%), and friends or neighbors (21%). Husbands who discussed passive smoking did so mostly with friends and neighbors (56%), their wives (36%), and other relatives (14%). Never married youth did so mostly with friends and neighbors (45% and 70% for females and males respectively), their parents (42% and 18% for females and males respectively) and other relatives (23% and 18% for females and males respectively). Differences were observed among villages, where women and husbands in Al-Tawfikia village are most likely to talk with their spouse about the health effect of passive smoking than in other villages. In addition, most never-married male youth in Tersa village (86%) talked about passive smoking with
72
their friends or neighbors compared to 44% among never-married male youth in Al-Tawfikia village.
10.5
Communication about HIV/AIDS (Appendix A Tables 10.16-10.17)
Messages about HIV/AIDS As mentioned previously in chapter six, data of 2005 FVHS shows that the awareness regarding HIV/AIDS among females is less than among males, where 72% of women, 89% of husbands, 80% of never-married female youth and 87% of never-married male youth had ever heard about HIV/AIDS. In addition, television was the most common recent source of knowledge of HIV/AIDS by far. Level of Comfort Discussing HIV/AIDS Prevention (Appendix A Table 10.16) The results of 2005 FVHS indicated that many people do not feel comfortable discussing HIV/AIDS prevention especially females. More than one third of ever married women and 33% of never married female youth reported that they do not feel comfortable discussing this subject with anyone. Likewise, 20% of husbands and 17% of never married male youth do not feel comfortable discussing HIV/AIDS prevention. Among those who feel comfortable discussing HIV/AIDS prevention, service providers is the most mentioned reference by all groups of respondents, followed by the spouse for married women and husbands. Never married female youth feel comfortable discussing HIV/AIDS prevention with their parents (14%) and friends or neighbors (13%). Never married male youth feel comfortable discussing this topic with friends or neighbors (13%) and with parents (8%).
Table 10.8 Level of Comfort Discussing HIV/AIDS Prevention Never married Female Male Women Husbands Youth Youth Spouse
17
18
-
-
Parents/Parents in law Service Provider
4 38
1 53
14 31
8 59
Friends/neighbors No one
7 36
12 20
13 33
13 17
Interpersonal Communication about Risk of Contracting HIV/AIDS (Appendix A Table 10.17) Respondents were asked if they have discussed the risk of contracting HIV/AIDS during the six months preceding the survey (among 9 respondents who have heard of HIV/AIDS). The results of 2005 FVHS 6 6 show that although 64% or more of respondents feel comfortable 4 discussing HIV/AIDS prevention, the actual talking about risk of contracting HIV/AIDS is much less. The data shows that only 6% of women and husbands who are aware of HIV/AIDS Women Husbands Never married Never married have recently discussed the risk of female youth male youth contracting HIV/AIDS. Among those youth who know about HIV/AIDS, only 9% of never married female youth and 4% of never married male youth have discussed the risk of contracting the disease. Although the percentages of those who have discussed the risk of contracting HIV/AIDS vary across villages, the levels do not exceed 15%. Fig 10.9 Inte rperson al Comm un ication about risk of con tracting HIV/AIDS am on g those who He ard abou t HIV/AIDS
73
Ever-married women who discussed the risk of contracting HIV/AIDS did so mostly with their husbands (45%) and to a lesser extent with friends and neighbors (36%). Husbands who discussed the topic did so almost exclusively with friends and neighbors (78%) and to a much lesser extent with their spouse (17%). Never married youth who discussed the risk of contracting HIV/AIDS did so mostly with friends (40% for females and 86% for males).
10.6
Communication about Safe Injections (Appendix A Tables 10.18-10.19)
Health Messages about Safe Injections (Appendix A Table 10.18) Several communication programs Fig 10.10 Exposure to Safe inje ction s Messages provide information about safe injections, with the aim of reducing Hepatitis infections. Respondents were 42 42 asked if they received information about safe injections during the six 28 months preceding the survey. Overall, 19 exposure to such messages is low. Less than half of women and never married female youth (42%), 28% of husbands and only 19% of never married male Women Husbands Never married Never married youth have recently received female youth male youth information about safe infections. Breakdowns by village further show that levels of exposure to messages about safe injections are high in Al-Tawfikia village. Nearly all respondents who received information about safe injections reported that they were informed to only use a syringe in a sealed packet (95 % or more), and around 50% were informed not to share syringes except for never-married male youth (35%). Differences were observed between villages, where around 80% of women and husbands in Kasr Rashwan recalled that they do not share a syringe compared to less than one quarter in Tersa village. Among those who reported receiving information about safe injections in the past six months, the television is the most frequent last source mentioned by all respondents followed by the medical provider. Over 66% of all respondents reported last receiving this information from television, while the percentage who mentioned medical provider ranges from 7% among never-married male youth to 21% among women. Level of Comfort Discussing Prevention of Unsafe Injections (Appendix A Table 10.19) The results show that virtually all respondents feel comfortable discussing the prevention of unsafe injections (89% and over for each of the four target groups). Service provider is the most mentioned reference by all groups of respondents, where the percentage of respondents who reported service provider ranging from 43% among never-married female youth to 61% among never-married male youth. Following the service provider, evermarried women report appear to be most comfortable discussing the subject with their husbands (21%) and friends or neighbors (12%). Husbands are most comfortable broaching the subject with their spouse (28%) and friends or neighbors (11%). The results for never married female youth indicated that they
Table 10.9 Comfortable talking about preventing unsafe injection Never married Female Male Women Husbands Youth Youth Spouse Parents/parents in law Service Provider Friends/neighbors
21
28
-
-
7 58 12
3 58 11
21 43 20
15 61 13
Brothers/Sisters No one
7
8
15 9
7 11
74
are most comfortable discussing the topic of unsafe injections with their parents (21%), friends or neighbors (20%) and siblings (15%). Finally, never married male youth are most comfortable discussing this topic with parents (15%) and friends or neighbors (13%).
10.7
Communication about Female Circumcision
As indicated in the 2003 EIDHS surveys, the practice of female circumcision is nearly universal, with 97% of ever-married women reporting they have been circumcised. This was also the case in rural Fayoum. The results presented in Chapter 9 of this report confirm the high prevalence of female circumcision in the rural villages included in the 2005 Fayoum Village Health Survey. In recent years, several programs have aimed to reduce female circumcision. For example, there is a television spot called “No for FGM, I am an Egyptian Girl”. This spot cover different important topics which is mainly girls education, early marriage, and FGM. Health Messages about Female Circumcision (Appendix A Table 10.20) Respondents were asked if they heard about female circumcision from different mass media during the six 73 67 75 64 months preceding the survey. The results show that the majority of respondents heard information about female circumcision on the television. However, unmarried youth heard about female circumcision more than women and husbands. About two thirds of women and husbands (67% and 64% Women Husbands Never married Never married respectively) heard about FGM from female youth male youth the television during the last six months, while these percentages increase to around three quarters among never-married youth (75% among females and 73% among males). Significant differences were observed among villages, where respondents from AlTawfikia are more likely to hear about female circumcision from television than respondents in other villages. Radio is not important source of information about female circumcision, as was mentioned by less than 7% of respondents in each group. Similarly, magazines, local meetings, mosques, and churches are not important sources of information. Fig 10.11 Exposure to FGM Me ssage s from Tele vision
Respondents were asked whether they discussed female circumcision with relatives, friends, or neighbors during the last six months. Overall, 24% of ever married women, 10% of husbands, 20% of never married female youth, and 7% of never married male youth discussed the subject of female circumcision with their relatives/ friends/ neighbors. Differentials were observed between villages, where respondents from Al Tawfikia village are more likely to discuss female circumcision with relatives, friends, or neighbors than respondents from other villages.
10.8
Health Campaigns in Egypt (Appendix A Table 10.21)
The 2005 FVHS questionnaire includes question about the health campaign that were carried out during the past years in Egypt, where respondents were asked to mention whether they remembered “Zeina and Zaki”, “Gold Star”, “Isaal Istasher” and other health campaigns. These campaigns cover many important health topics as the antenatal care, family
Fig 10.12 Recalling “Issal Istashe r” C am paign 76 59
54 43
Women
Husbands
Never married Never married female youth
male youth
75
planning, birth spacing, FGM, early marriage…etc. The data shows that females remembered the health campaigns more than males. Regarding “Zeina and Zaki” health campaign, the data shows that almost two third of female youth (63%) and 55% of ever married women remembered “Zeina and Zaki” campaign, compared to 36% and 50% of husbands and never married male youth respectively. Substantial differences were observed among villages. Respondents from Al-Tawfikia village reported that they remembered such campaign more than any other village. Regarding “Gold Star” health campaign, the data shows that most never-married female youth remembered that campaign (72%), while more than half of women (58%), 47% of never-married male youth and 39% of husbands remembered such campaign. With respect to “Isaal Istasher” health campaign, data of 2005 FVHS Table 10.10 Recalling Some of the Health Campaigns in indicated that respondents remembered Egypt such campaign more than any other campaign. More than three quarters of Never married unmarried female youth (76 percent), Female Male 59% of women, 54% of male youth and Women Husbands Youth Youth 43% of husbands remembered that Zeina and Zaki 55 36 63 50 campaign. No significant differences were observed among villages regarding Gold Star 58 39 72 47 “Isaal Istasher” campaign.
76
CHL BEHAVIOR CHANGES COMMUNICATION ACTIVITIES
11
Communication plays a vital role in all health programs. In the mid-1970s, awareness and use of health information has increased dramatically, contributing to an overall improvement in the health of the population. The Communication for Healthy Living Project is the principal vehicle for affecting broad scale behavior change and building sustained capacity within the public, private and NGO sectors to design and successfully implement strategic communication programs. The first step in assessing the behavior changes due to different media interventions is to measure the levels of recalling the messages of the spots and the programs, the perceived benefits and to examine how these communication activities affect respondent’s behaviors. Accordingly, a series of questions were asked to different groups of respondents in order to explore these topics and the answers of these questions were presented in the following sections.
11.1
Exposure to CHL Campaign Messages on TV
Watching Television Habits (Appendix A Table 11.1) A series of questions were asked to assess media habits including questions about exposure to TV, the preferred channels and watching times. In the following, the data on exposure to TV will be discussed for women, husbands, and youth interviewed in the survey. The results of 2005 FVHS show that youths are more likely to watch TV Table 11.1 Television Habits than older respondents, where 90% Never married of youth reported that they watch TV regularly or sometimes Female Male compared to around 80% among Women Husbands Youth Youth women and husbands. Most of those 81 79 90 90 Watch TV who watch TV prefer channels one Preferred TV Channels and two. They also prefer Satellite Channel 1 91 90 94 85 channels; however, males prefer satellite channels more than females. Channel 2 78 74 85 76 Respondents in Al-Tawfikia village Channel 3 15 7 20 7 prefer to watch satellite channels Channel 7 22 13 25 13 more than any other village except Satellite Channel 22 32 21 41 for male youth, where more than half of male youth in Kasr Rashwan prefer to watch the satellite channels. Regarding TV watching times, all groups of respondents prefer to watch the TV in the evening (6 pm: 9 pm) or at night (after 9 pm).
77
11.1.1 Exposure to CHL Campaign Messages through TV Programs (Appendix A Table 11.2) One of the CHL activities is to have programs on television talking about some topics related to family planning after the first birth, family health, smoking, safe injection, child health…etc. Respondents were asked whether they saw Fig 11.1 Watch ing TV program s such television programs during the past 12 months and to mention the topics of these 21 programs, the learned messages from the 16 15 14 programs and how they believe these programs affected and/or changed their behaviors. Data of 2005 FVHS indicates that the exposure to the television programs during Women Husbands Never married Never married female youth male youth the 12 months preceding the survey was not high. The data shows that 21% of unmarried females, 16% of women, 15% of unmarried males and 14% of husbands saw a television program during the last 12 months talk about the previous mentioned health issues. Respondents in Tersa village are highly exposed to these programs than respondents in other villages. Respondents were asked to mention the topics of these programs. The most frequent topic mentioned by all groups of Table 11.2 Recalling topics of TV programs respondents was “Birth Spacing” which was mentioned by 8% of Never married unmarried female and male youth Female Male and 7% of women and husbands. Women Husbands Youth Youth The second most mentioned topic was “The Multiple Birth Problems”, Premarital Examination 3 3 4 4 which was mentioned by 6% of all Birth Spacing 7 7 8 8 respondents except women (4%). Multiple birth problems 4 6 6 6 “Premarital examination” and Danger of secondhand “Danger of secondhand smoking” smoking 3 4 5 7 were from the topics that mentioned by all groups of respondents. Antenatal care was one of the topics that mentioned by female respondents (3% of women and 4% of unmarried female youth). Differences were clear among villages regarding the recalling topics. For example, 6% of women in Al-Tawfikia village mentioned the “premarital examination” compared to less than one percent among women in Kasr Rashwan village. Respondents were asked if they Table 11.3 Messages learned from TV programs learned anything from the programs and what was they learned. The Never married results show that 88% of married respondents, 87% of unmarried Female Male Women Husbands Youth Youth males and 84% of unmarried females mentioned that they did not Knew FP methods 7 9 10 10 learn any thing from these programs Importance of Birth Spacing 4 5 7 5 or they did not watch the programs Importance of protecting at all. The most frequent learning nonsmokers from smokers 2 3 5 5 message mentioned by all Nothing/Did not watch the respondents is that they knew family program 88 88 84 87 planning methods, followed by the importance of birth spacing and the importance of protecting nonsmokers from smokers.
78
Additionally, respondents were asked to mention how these programs affect and change their behaviors. Data of 2005 FVHS shows Fig 11.2 Uesd (Inte nd to u se afte r marriage ) that 90% or more of married FP m ethods respondents (90% of women and 91% 9 of husbands), and 88% of unmarried 8 males and 86% of unmarried females 5 reported that these programs did not change or affect their behaviors or they 3 did not watch the programs. However, respondents who reported that the programs affect their behaviors Women Husbands Never married Never married mentioned the practices and the female youth male youth attitudes that changed by the programs. The most frequent practice affected by the TV programs mentioned by married respondents was that they used family planning methods (3% of women and 5% of husbands). Regarding unmarried youth, the most frequent attitude mentioned by female and male youth was that they intend to use family planning methods after marriage (8% among female youth and 9% among male youth). The second most frequent practice changed by the programs is that the married respondents spaced between births, while youth intend to space between births. 11.2
Exposure to CHL Campaign Messages through Print Media
Reading Habits of the Printed Media (Newspapers/Magazines) (Appendix A Table 11.3) Data of 2005 FVHS shows that the level of exposure to printed media is remarkably much lower than broadcast media especially the television. Data of the survey indicates that 41% of unmarried male youth, 33% of unmarried female youth, 30% of husbands and only 15% of women read newspapers/magazines regularly or sometimes. Differentials were observed among different villages. For example, less than one in ten women (9%) in Kasr Rashwan read newspapers/magazines compared to 23% among women in Tersa village. Same pattern was observed among unmarried female youth.
Fig 11.3 Readin g Ne wspape rs/magazine s
41 30
33
15
Women
Husbands
Never married Never married female youth
male youth
11.2.1 Exposure to CHL Campaign Messages through newspapers/magazines (Appendix A Table 11.3) The 2005 FVHS also collected information on the exposure of respondents to printed media. The level of exposure of respondents to print materials is important to identify those who are subject to exposure to family planning and family health messages through that media. Respondents who can read were asked if they read any newspapers and/or magazines, and among those who read newspapers/magazines, they were asked whether they read any subject during the 12 months preceding the survey about family health and family planning. Then a series of questions about the topics they read on the newspapers/magazines were adressed, what they learned from these topics and how these topics affect their behaviors.
79
Respondents were asked whether they read any subject about family planning after the first birth, family health, smoking, safe injection or child health 7 during the 12 months preceding the survey. The data shows that only a 4 limited percentage of respondents read 3 a subject about family health and family 2 planning. Seven percent of unmarried female youth, 4% of husbands, 3% of unmarried male youth and 2% of Women Husbands Never Never women read a subject about family married married health during the reference time. female male youth youth Female respondents in Al-Tawfikia are least likely to read such topics in newspapers/magazines, while male respondents in Kasr Rashwan village are least likely to read these topics. Fig 11.4 Reading programs about family health and Family Planning
Regarding the recalling messages from the newspapers/magazines, the most frequent message mentioned by all respondents are: birth spacing, multiple birth problems, family planning and danger of secondhand smoking. When respondents were asked about what they learned from these topics, they mentioned that they gained knowledge about family planning methods, the importance of birth spacing and the importance of protecting nonsmokers from smokers. (not shown in a table due to the few number of respondents).
11.2.2 Exposure to CHL Campaign Messages through Posters/flyers/billboard (Appendix A Table 11.4) All respondents were asked if they have seen any posters/flyers/billboards about family planning after the first birth, family health, Fig 11.5 Saw posters/ flyers/billboards smoking, safe injection or child health 30 abou t fam ily h ealth during the 12 months preceding the survey. Of those who saw the 24 posters/flyers/billboards they were asked about the posters/flyers/billboards messages, what did they learn from these 14 13 messages and the place where they saw these posters. Data of 2005 FVHS indicates that the percentages of females who saw the posters/flyers/billboards are greater than Women Husbands Never married Never married the males. The data shows that 30% of female youth male youth unmarried females and 24% of women mentioned that they saw such posters, while less than 15% of males (14% of husbands and 13% of unmarried males) reported that they saw posters/flyers/ billboards that talked about the previous mentioned topics. However, significant differences were observed among villages, where respondents from Tersa village are most likely to see such posters/flyers/billboards than respondents from other villages.
80
Respondents were asked about the topics of these posters. However posters/flyers/billboards have many messages, all groups of respondents agreed about some topics which are: “family planning is a health essential” that mentioned Table 11.4 Posters/flyers/billboards Messages by around 15% of female respondents and 8% of male Never married respondents. The second most Female Male frequent message mentioned by all Women Husbands Youth Youth respondents is the “antenatal care” that mentioned by 9% of women, Antenatal Care 9 5 8 3 8% of female youth, 5% of Family planning is a health husbands and 3% of male youth. 15 8 16 8 essential FP and RH services for all “Family planning and reproductive 7 3 5 2 Dangers of secondhand health services for all” and “dangers smoking 3 4 7 5 of secondhand smoking” are also messages recalled by some respondents. Significant differences were observed between villages. As for example, 10% of women in Tersa recalled “family planning and reproductive health services for all” message compared to less than one percent among women in Al-Tawfikia village. Additionally, respondents were asked to mention the learned messages from these posters/flyers/billboards. The data revealed that 79% of women, 73% of unmarried female youth and 87% of both husbands and unmarried male youth did not learn anything from these posters/flyers/ billboards or they did not see such posters. Respondents from Tersa village are most likely to learn something from these posters than those in other villages.
Table 11.5 Learned messages from Posters/flyers/billboards Never married Female Male Women Husbands Youth Youth Importance of FP
13
9
15
9
Importance of ANC Importance of protecting nonsmokers from smokers Nothing/Did not see Posters/flyers/billboards
6
4
6
2
3
3
6
4
79
87
73
87
Regarding the learning messages from such posters/flyers/billboards, the first ranked message learned by all groups of respondents was “The importance of family planning”. This message learned by 15% of unmarried female youth and 13% of women, while learned by 9% of both husbands and unmarried male youth. The second ranked message learned by married respondents is “The importance of ANC”, while the second ranked message learned by youth is “the importance of protecting nonsmokers from smokers”. Among those recently exposed to posters/flyers/billboards, the health unit is by far the most important source of posters among all groups of respondents, where it was mentioned by 21% of both women and unmarried female youth, while mentioned by 10% of husbands and 7% of male youth. Almost 6% of female and male youth and 5% of husbands mentioned that they saw these posters/flyers in the street, while 4% of husbands and 3% of male youth mentioned the pharmacy. Some differences were observed between villages. Women in Tersa village are most likely to see such posters in the health unit (28%) than women in other villages. Same trend was observed for husbands and unmarried males.
81
11.3
Exposure to CHL Campaign Messages through Interpersonal Channels (Seminars/ Community Meetings)
Meeting and seminars that conducted at the community level is considered one of the CHL interventions. The 2005 FVHS investigates to what extent respondents exposed to those activities, main topics of these meetings, the learned messages and the effect of these meetings and seminars on respondent’s behaviors. In the following a discussion of respondents exposed to such meetings is presented. Exposure to Seminars/Community Meetings (Appendix A Table 11.5) Respondents were asked whether they Fig 11.6 Atten ding se minars/m ee tings attended seminars or community meetings abou t family he alth about use of family planning after the first birth, family health, smoking, safe injection or child health during the 12 12 11 months preceding the survey. As confirmed in many surveys attending community meetings is still low. Data of 2005 FVHS shows that 12% of unmarried 3 females, 11% of women, 3% only of 1 husbands and 1% of unmarried males attended seminars or community meetings Women Husbands Never married Never married during the 12 months preceding the survey. female youth male youth Respondents in Al-Tawfikia village are more likely to attend such seminars and meetings than respondents do in other villages. Due to the few number of cases who attende seminars/meetings, data concerning recalling messages, messages learned are not presented here. All respondents whether attended seminars/community meetings or not were asked if they know anyone 32 attended seminars or meetings about use of family planning after the first 27 birth, family health, smoking, safe 19 injection or child health during the 12 14 months preceding the survey. Data of 2005 FVHS shows that females are more likely to know anyone who attended meetings during the last 12 months more than males. Almost one Women Husbands Never married Never married third of unmarried females and 27% of female youth male youth women knew people attended meetings, while 19% of husbands and 14% of unmarried male youth mentioned that they knew somebody attended meetings about family health. Respondents in Al-Tawfikia village are more likely to report knowing people attended seminars/meetings than respondents in other villages. Fig 11.7 Kn ow an yon e atte ndin g se minars/me etings about fam ily h e alth
11.4
Exposure to CHL Campaign Messages through Visits (Appendix A Table 11.5)
One of the CHL communication interventions is the home’ visits by any health worker or Raida Refia. Ever-married women were asked if there was any Raida Refia/ health worker visited them during the last 12 months and the subjects they talked about. The data shows that 23% of women mentioned that they were visited by a Raida Refia or a health worker. The level of home visits is very low in Kasr Rashwan (1%), compared to 48% among women in Al-Tawfikia village. Family planning is the most important subject that discussed by Raida Refia/health worker followed by the reproductive health then the antenatal care.
82
11.5
Exposure to CHL Campaign Messages through “Mabrouk” book (Appendix A Table 11.6)
The CHL produce a book called “Mabrouk”, which talks about family health and happiness, pregnancy period, safe delivery, birth and child caring and child vaccination. Fig 11.8 Exposure to "Mabrouk " book This book distributed to newly married couples. Accordingly, one of the questions that were asked to all 2.7 respondents was whether they saw 1.9 1.8 “Mabrouk” book and about the topics of 1.6 this book. Data of 2005 FVHS indicates that only 3% of women and less than 2% of all other groups of respondents saw “Mabrouk” book. This due to the Women Husbands Never Never married married male fact that the Baseline survey data female youth youth collection started just before the CHL intervention started in those villages.
11.6
Recall of Specific CHL Campaign Spots and Slogans
Many specific spots that talk about the health of all family members, family planning, smoking, child health…etc. were aired during the 12 months preceding the survey. This section assesses the exposure of respondent to these specific CHL campaing spots and slogans through prompted questions. Respondents were asked about specific campaign activities, such as the “Your Health is Your Wealth”, “Family doctor” and “Isaal Istashir” spots. They were then asked a series of questions including: spots messages, benefits, and effect of the spots on respondents’ behaviors. 11.6.1 Exposure to the “Your Health is Your Wealth” Spot
11.6.1.a Exposure to the “Your Health is Your Wealth” Spot through TV (Appendix A Table 11.7) “Your Health is Your Wealth” spot is one of the spots that aired in the television during the 12 months 51 preceding the survey, where this spot talks about the health care of all family 35 members, parent’s health affect child’s 25 23 health, antenatal care, birth spacing, breastfeeding, safe injection…etc. The data of 2005 FVHS indicated that the females watched the spot more than the males. More than half of female youth Women Husbands Never married Never married (51%) and 35% of women watched the female youth male youth spot. While one quarter of husbands and 23% of male youth watched the spot. Differences were observed among villages. For example, women in Al-Tawfikia village report watching the spot more than women do in Kasr Rashwan (55% vs. 23%). Fig 11.9 Watch in g "Your he alth is your we alth" TV spot
83
Regarding recall of the messages of Table 11.6 Recalling messages of “your health is your wealth” TV the “Your Health is Your Wealth” spot TV spot, the data revealed that the highest recall message among all Never married respondents was “Family health Female Male care” (28% of unmarried female Husbands Youth Youth Women youth, 17% of women and 11% of male respondents), followed by Parent’s health affect child’s 11 9 14 7 health “Family planning” (from low of 10% among husbands to high of Family Health Care 17 11 28 11 Antenatal Care 18% among female youth). 6 3 6 2 Family Planning “Parent’s health affects child’s 15 10 18 11 health” was mentioned by more than Birth Spacing 7 4 9 3 10% of female respondents (11% of women and 14% of female youth), while mentioned by less than 10% of male respondents (9% of husbands and 7% of male youth). “Birth spacing” was one of the messages that mentioned frequently by all respondents. Significant differences were observed among villages. Respondents were asked if they learned anything from the spot and if so, what they learned. The results indicated that 75% of women, 81% of husbands, 62% of female youth and 80% of male youth did not learn any thing from Table 11.7 Messages learned from “your health is your wealth” the spot or they did not see the spot. TV spot Differences were observed among Never married villages, where male respondents in Tersa and female respondents in AlFemale Male Tawfikia are more likely to learn Women Husbands Youth Youth from the spot than any other If parent’s health is good, villages. The most learned message child’s health will be good 9 8 14 7 mentioned by all respondents is Importance of family health “Importance of family health care” care 12 10 24 13 which was reported by almost one Importance of birth spacing from 3 to 5 years 8 5 11 4 quarter of female youth (24%), 13% Nothing / Did not see the spot 75 81 62 80 of male youth, 12% of women and 10% of husbands. The second most learned message is “If parent’s health is good, child’s health will be good” followed by the “Importance of birth spacing from 3 to 5 years”. The 2005 FVHS data shows that females Fig 11.10 Effect of "You r h e alth is you r wealth" are more likely to mention that their spot on Respon de nts' be havior behavior was affected by the spot messages more than males. Almost one 34 third of female youth (34%), 20% of women, 17% of male youth and 14% of 20 husbands mentioned that their behavior 17 14 was affected by the spot. With regard to married respondents (women and husbands), “cared by respondent’s health and spouse health”, “used family planning Women Husbands Never married Never married methods” and “spaced between births” female youth male youth were the most practices affected by spot messages more than any other messages. While youth mentioned that the spot affect their behavior as they intend to care by their health and their spouse’s health, they intend to space between births and intend to use family planning methods in the future. Large differences were observed between villages, for example, care by
84
respondent’s health and spouse’s health was reported by women and husbands from Al-Tawfikia and Tersa village more than respondents in Kasr Rashwan village. Also, male youth in AlTawfikia and Tersa village are more likely to mention that they intend to use family planning methods more than in Kasr Rashwan village. Respondents were asked whether they talked with someone about the spot, the data revealed that most respondents mentioned that they did not talk about the spot with anyone, where the percentage ranges from 94% among women to 99% among male youth. However, most respondents who talked about the spot talked with their friends/neighbors except for husbands, where they talked mostly with their wives.
11.6.1.b Exposure to the “Your Health is Your Wealth” Spot through Slogan (Appendix A Table 11.8) Fig 11.11 Eve r see n/h eard "You r h ealth is your we alth" S logan 58
40 33
Women
Husbands
29
Never married Never married female youth
male youth
One of the questions in the individual questionnaire that was asked to all respondents is whether they saw/heard “your health is your wealth” slogan during the 12 month preceding the survey and where did they see/hear the slogan. The data of 2005 FVHS show that never married female youth are more likely than other groups of respondents to have seen or heard the slogan “Your Health is your Wealth”. More than half of never married female youth (58%), 40% of women, 33% of husbands and 29% of unmarried male youth reported that they saw/heard this
slogan mostly through television. 11.6.2 Exposure to the “Family Doctor” Spot
11.6.2.a Exposure to the “Family Doctor” Spot through TV (Appendix A Table 11.9) “Family Doctor” spot is also one of the Fig 11.12 Watch in g "Fam ily doctor" TV spot spots that aired in the television during the 12 months preceding the survey. “Family 18 Doctor” spot informed people by the 16 availability of family doctor in every health unit and he will be a private doctor 11 for all family members to check for their 9 health, their will be a file for each family member for the disease history, family health clinics will include all kinds of examinations…etc. Data of 2005 FVHS indicates that only few respondents saw Women Husbands Never married Never married “Family Doctor” TV spot during the last female youth male youth 12 month. However, females reported that they saw the spot more than the males. Slightly less than one in five unmarried females (18%), 16% of women, 11% of husbands and 9% of unmarried male youth mentioned that they saw the spot in the television during the past 12 months. Significant differences were observed between villages, where respondents in Tersa are more likely to report that they saw the spot than respondents in other villages. Respondents were asked to recall the messages of the spot. Data of 2005 FVHS shows that the most frequent recalled messages among all groups of respondents are: “Family doctor is available
85
in every health unit”, “Family doctor will be a private doctor for all family member” and “Family health clinics will include all kinds of examination”. However, differentials were observed among different villages, as an example, women in Al-Tawfikia and Tersa village are more likely to recall the message “Family doctor is available in every health unit” than women in Kasr Rashwan. 11.6.3 Exposure to “Isaal Istashir” Spot
11.6.3.a Exposure to “Isaal Istashir” Spot through TV, posters…etc. (Appendix A Table 11.10) One of the spots that 2005 FVHS asked about is “Isaal Istashir” spot, where this spot could be seen at the television, in posters at a pharmacy or at a health unit or clinic, however, respondents were asked about this spot without any time reference. “Isaal Istashir” spot advise people to consult a doctor in any medical center or pharmacy that has the sign of “Isaal Istashir” about any problem, promote people to use family planning methods, give information about contraceptive pills for the breastfeeding women…etc. Accordingly, respondents were asked whether they ever seen/heard “Isaal Istashir” spot in any place. Data of 2005 FVHS indicated that unmarried females saw or heard the spot more than other Fig 11.13 S ee n/h eard "Isaal Istashir" spot respondents. Slightly less than three 73 quarters (73%) of unmarried female youth mentioned that they saw the spot 51 51 and the television is the main source for 41 the spot. Same pattern was observed among all groups of respondents, where 51% of both women and unmarried males, and 41% of husbands ever seen/heard the spot and the television is the main source for the spot followed Women Husbands Never married Never married by a poster in a pharmacy or in a clinic. female youth male youth Differentials were observed between villages, where respondents in Kasr Rashwan are least likely to see/hear “Isaal Istashir” spot. Slightly more than one quarter of husbands (26%) in Kasr Rashwan saw the spot compared to more than half of husbands (54%) in Al-Tawfikia village. Same pattern was observed between villages among unmarried male youth. Respondents were asked to recall “Isaal Istashir” spot messages, the Table 11.8 Recalling messages of “Isaal Istashir” spot data reveal that the most frequent Never married recalled message among all respondents was that the spot advise Female Male people to consult a Women Husbands Youth Youth doctor/pharmacist about problems or Advise people to consult a inquiries. Unmarried female youth doctor about problems 25 24 34 28 recalled this message more than Promotes use of FP methods 11 8 18 13 other respondents. Almost one third Consult medical center that of female youth recalled this has (Isaal Istashir) sign 6 7 10 14 Talk about FP methods message compared to around one 25 12 34 13 quarter of women and husbands and 28% of unmarried males. The second most recalled message was that the spot talks about family planning methods, where one quarter or more of women and unmarried females mentioned this message, while 12% of husbands and 13% unmarried male youth recalled this message. Other messages were reported by fewer percentages.
86
As the previous spots, respondents Table 11.9 Messages learned from “Isaal Istashir” spot were asked whether they learned anything from “Isaal Istashir” spot Never married and what was they learned. The data Female Male revealed that unmarried youth Women Husbands Youth Youth learned from the spot more than married respondents did. Around two Consult medical center that has (Isaal Istashir) sign 21 21 36 35 thirds of married respondents (64% Consult a doctor/pharmacist of women and 69% of husbands) about problems 13 11 18 16 reported that they learned nothing Knew FP methods 9 3 14 4 from the spot compared to 41% of Nothing /Did not see the spot 64 69 41 55 unmarried females and 55% of unmarried males. In addition, respondents in Kasr Rashwan are least likely to mention that they learned something from the spot if compared by other villages. Among those who mentioned that they learned something from the spot, the data shows that most of them reported that they should consult doctor/pharmacist or medical center that has “Isaal Istashir” sign. The second most learning message mentioned by all groups of respondents is that they should consult doctor/pharmacist about any problem/inquiry. The third most learning message is “Knew family planning methods”. Breakdown by villages, significant differences were observed between villages, for example, respondents in Al-Tawfikia village are more likely to mention that they should consult a doctor or medical center that has “Isaal Istashir’ sign more than respondents in other villages.
11.6.3.b Exposure to “Isaal Istashir” Sign through Pharmacies (Appendix A Table 11.10) Private sector initiative progam provide training for pharmacist on interpersonal communication in order to provide 26 advice to women when they come to 19 get family planning method. The 17 15 pharmacies in which pharmacist took training have a poster of “Isaal Istashir” sign at the pharmacy in order to be identified to people. Accordingly, respondents were asked whether they Women Husbands Never married Never married have ever gone to a pharmacy have female youth male youth “Isaal Istashir” sign. The data of 2005 FVHS revealed that almost one quarter or less of all groups of respondents reported that they have ever gone to a pharmacy have “Isaal Istashir” sign. However, differences were observed between villages, respondents in Tersa village are more likely to mention that they went to a pharmacy with “Isaal Istashir” sign more than respondents in other villages. Thirty five percent of women, 28% of husbands, 49% of unmarried female youth and 31% of unmarried males in Tersa village mentioned that they went to a pharmacy having this sign. Fig 11.14 Eve r gone to ph armacy h ave "Isaal Istash ir" sign
87
