Kenya. Demographic and Health Survey

Transcription

1 Kenya Demographic and Health Survey

2 KENYA DEMOGRAPHIC AND HEALTH SURVEY Kenya National Bureau of Statistics Nairobi, Kenya National AIDS Control Council Nairobi, Kenya National AIDS/STD Control Programme Nairobi, Kenya Ministry of Public Health and Sanitation Nairobi, Kenya Kenya Medical Research Institute Nairobi, Kenya National Coordinating Agency for Population and Development Nairobi, Kenya MEASURE DHS, ICF Macro Calverton, Maryland, U.S.A. U.S. Agency for International Development (USAID) Nairobi, Kenya United Nations Population Fund Nairobi, Kenya United Nations Children s Fund Nairobi, Kenya June 2010 KENYANS AND AMERICANS IN PARTNERSHIP TO FIGHT HIV/AIDS

3 This report summarises the findings of the Kenya Demographic and Health Survey (KDHS) carried out by the Kenya National Bureau of Statistics (KNBS) in partnership with the National AIDS Control Council (NACC), the National AIDS/STD Control Programme (NASCOP), the Ministry of Health and Sanitation, the Kenya Medical Research Institute (KEMRI), and the National Coordinating Agency for Population and Development (NCAPD). ICF Macro provided technical assistance for the survey through the USAID-funded MEASURE DHS programme, which is designed to assist developing countries to collect data on fertility, family planning, and maternal and child health. Funding for the KDHS was received from USAID/Kenya, the United Nations Population Fund (UNFPA), the United Nations Children s Fund (UNICEF), UNAIDS, and the World Bank. The opinions expressed in this report are those of the authors and do not necessarily reflect the views of the donor organisations. Additional information about the survey may be obtained from the Kenya National Bureau of Statistics (KNBS), P.O. Box 30266, Nairobi (Telephone: ; Fax: , director@cbs.go.ke). Additional information about the DHS programme may be obtained from MEASURE DHS, ICF Macro, Beltsville Drive, Suite 300, Calverton, MD 20705, U.S.A. (Telephone: ; Fax: ; reports@macrointernational.com). Recommended citation: Kenya National Bureau of Statistics (KNBS) and ICF Macro Kenya Demographic and Health Survey Calverton, Maryland: KNBS and ICF Macro.

4 CONTENTS TABLES AND FIGURES... ix FOREWORD... xvii ACKNOWLEDGMENTS... xix SUMMARY OF FINDINGS... xxi MAP OF KENYA... xxvi CHAPTER 1 INTRODUCTION 1.1 Geography, History, and the Economy Geography History Economy Population Population and Family Planning Policies and Programmes Health Priorities and Programmes Strategic Framework to Combat the HIV/AIDS Epidemic Objectives of the Survey Survey Organisation Sample Design Questionnaires HIV Testing Training Fieldwork Data Processing Response Rates CHAPTER 2 HOUSEHOLD POPULATION AND HOUSING CHARACTERISTICS 2.1 Population by Age and Sex Household Composition Education of the Household Population Educational Attainment School Attendance Rates Household Environment Drinking Water Household Sanitation Facilities Housing Characteristics Household Possessions Wealth Index Birth Registration Contents iii

5 CHAPTER 3 CHARACTERISTICS OF RESPONDENTS 3.1 Characteristics of Survey Respondents Educational Attainment by Background Characteristics Literacy Access to Mass Media Employment Occupation Earnings and Type of Employment Health Insurance Coverage Knowledge and Attitudes Concerning Tuberculosis Smoking CHAPTER 4 FERTILITY LEVELS, TRENDS, AND DIFFERENTIALS 4.1 Introduction Current Fertility Fertility Trends Children Ever Born and Children Surviving Birth Intervals Age at First Birth Teenage Fertility CHAPTER 5 FAMILY PLANNING 5.1 Knowledge of Contraceptive Methods Ever Use of Family Planning Methods Current Use of Contraceptive Methods Differentials in Contraceptive Use by Background Characteristics Number of Children at First Use of Contraception Knowledge of Fertile Period Timing of Sterilisation Source of Contraception Cost of Contraceptive Methods Informed Choice Contraceptive Discontinuation Future Use of Contraception Reasons for Not Intending to Use Exposure to Family Planning Messages Contact of Non-users with Family Planning Providers Husband/Partner s Knowledge of Women s Contraceptive Use CHAPTER 6 OTHER PROXIMATE DETERMINANTS OF FERTILITY 6.1 Current Marital Status Polygyny Age at First Marriage Age at First Sexual Intercourse Recent Sexual Activity Postpartum Amenorrhoea, Abstinence, and Insusceptibility Menopause iv Contents

6 CHAPTER 7 FERTILITY PREFERENCES 7.1 Desire for More Children Desire to Limit Childbearing by Background Characteristics Need for Family Planning Services Ideal Number of Children Mean Ideal Number of Children by Background Characteristics Fertility Planning Status Wanted Fertility Rates CHAPTER 8 INFANT AND CHILD MORTALITY 8.1 Levels and Trends in Infant and Child Mortality Data Quality Socioeconomic Differentials in Infant and Child Mortality Demographic Differentials in Infant and Child Mortality Perinatal Mortality High-risk Fertility Behaviour CHAPTER 9 MATERNAL HEALTH 9.1 Antenatal Care Antenatal Care Coverage Source of Antenatal Care Number and Timing of Antenatal Care Visits Components of Antenatal Care Tetanus Toxoid Injections Place of Delivery Assistance during Delivery Postnatal Care CHAPTER 10 CHILD HEALTH 10.1 Weight and Size at Birth Vaccination Coverage Acute Respiratory Infection Fever Diarrhoeal Disease Knowledge of ORS Packets Stool Disposal CHAPTER 11 NUTRITION OF WOMEN AND CHILDREN 11.1 Nutritional Status of Children Measurement of Nutritional Status among Young Children Results of Data Collection Levels of Malnutrition Initiation of Breastfeeding Breastfeeding Status by Age Contents v

7 11.4 Duration and Frequency of Breastfeeding Types of Complementary Foods Infant and Young Child Feeding Practices Micronutrient Intake among Children Nutritional Status of Women Micronutrient Intake among Mothers CHAPTER 12 MALARIA 12.1 Introduction Household Ownership of Mosquito Nets Use of Mosquito Nets Intermittent Preventive Treatment of Malaria in Pregnancy Malaria Case Management among Children CHAPTER 13 HIV/AIDS-RELATED KNOWLEDGE, ATTITUDES, AND BEHAVIOUR 13.1 Introduction HIV/AIDS Knowledge of Transmission and Prevention Methods Awareness of HIV/AIDS Knowledge of HIV Prevention Rejection of Misconceptions about HIV/AIDS Knowledge of Mother-to-Child Transmission of HIV Attitudes towards People Living with AIDS Attitudes Towards Condom Education for Youth Higher Risk Sex Multiple Partners and Condom Use Transactional Sex Coverage of HIV Counselling and Testing General HIV Testing HIV Counselling and Testing during Pregnancy Male Circumcision Self-Reporting of Sexually Transmitted Infections HIV/AIDS Knowledge and Sexual Behaviour among Youth HIV/AIDS-Related Knowledge among Young Adults Trends in Age at First Sex Condom Use at First Sex Abstinence and Premarital Sex Higher-Risk Sex and Condom Use among Young Adults Cross-generational Sexual Partners Drunkenness during Sex among Young Adults Voluntary HIV Counselling and Testing among Young Adults CHAPTER 14 HIV PREVALENCE AND ASSOCIATED FACTORS 14.1 Coverage of HIV Testing HIV Prevalence by Age Trends in HIV Prevalence vi Contents

8 14.4 HIV Prevalence by Socioeconomic Characteristics HIV Prevalence by Demographic Characteristics and Sexual Behaviour HIV Prevalence among Youth HIV Prevalence by Other Characteristics HIV Prevalence by Male Circumcision HIV Prevalence among Couples Distribution of the HIV Burden in Kenya CHAPTER 15 WOMEN S EMPOWERMENT AND DEMOGRAPHIC AND HEALTH OUTCOMES 15.1 Employment and Form of Earnings Controls over Earnings Control over Wife s Earnings Control over Husband s Earnings Women s Participation in Decision-making Attitudes towards Wife Beating Men s Attitudes towards Wife s Refusing Sex Women s Empowerment Indicators Current Use of Contraception by Women s Status Ideal Family Size and Unmet Need by Women s Status Women s Status and Reproductive Health Care CHAPTER 16 GENDER-BASED VIOLENCE 16.1 Introduction Data Collection Experience of Physical Violence Experience of Sexual Violence Marital Control Marital Violence Frequency of Spousal Violence Physical Consequences of Spousal Violence Violence Initiated by Women Against Husbands Response to Violence Female Genital Cutting CHAPTER 17 ADULT AND MATERNAL MORTALITY 17.1 Data Estimates of Adult Mortality Estimates of Maternal Mortality REFERENCES APPENDIX A SAMPLE IMPLEMENTATION APPENDIX B ESTIMATES OF SAMPLING ERRORS APPENDIX C DATA QUALITY APPENDIX D LIST OF KDHS PARTICIPANTS APPENDIX E QUESTIONNAIRES Contents vii

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10 TABLES AND FIGURES CHAPTER 1 INTRODUCTION Table 1.1 Basic demographic indicators... 3 Table 1.2 Results of the household and individual interviews CHAPTER 2 HOUSEHOLD POPULATION AND HOUSING CHARACTERISTICS Table 2.1 Household population by age, sex, and residence Table 2.2 Household composition Table Educational attainment of the female household population Table Educational attainment of the male household population Table 2.4 School attendance ratios Table 2.5 School attendance Table 2.6 Household drinking water Table 2.7 Household sanitation facilities Table 2.8 Household characteristics Table 2.9 Household durable goods Table 2.10 Wealth quintiles Table 2.11 Birth registration of children under age five Table 2.12 Reason for not registering birth Figure 2.1 Population Pyramid Figure 2.2 Age-specific Attendance Rates of the de-facto Population 5 to 24 Years CHAPTER 3 CHARACTERISTICS OF RESPONDENTS Table 3.1 Background characteristics of respondents Table Educational attainment: Women Table Educational attainment: Men Table Literacy: Women Table Literacy: Men Table Exposure to mass media: Women Table Exposure to mass media: Men Table Employment status: Women Table Employment status: Men Table Occupation: Women Table Occupation: Men Table 3.7 Type of employment among women Table Knowledge and attitude concerning tuberculosis: Women Table Knowledge and attitude concerning tuberculosis: Men Table 3.9 Use of tobacco: Men Figure 3.1 Access to Mass Media Figure 3.2 Women s Employment Status in the Past 12 Months Figure 3.3 Employment Characteristics among Working Women Figure 3.4 Health Insurance Coverage Tables and Figures ix

11 CHAPTER 4 FERTILITY LEVELS, TRENDS, AND DIFFERENTIALS Table 4.1 Current fertility Table 4.2 Fertility by background characteristics Table 4.3 Trends in age-specific fertility rates Table 4.4 Trends in fertility by background characteristics Table 4.5 Trends in age-specific fertility rates Table 4.6 Children ever born and living Table 4.7 Birth intervals Table 4.8 Age at first birth Table 4.9 Median age at first birth Table 4.10 Teenage pregnancy and motherhood Figure 4.1 Total Fertility Rates by Background Characteristics Figure 4.2 Trends in Total Fertility Rate, Kenya CHAPTER 5 FAMILY PLANNING Table 5.1 Knowledge of contraceptive methods Table 5.2 Trends in contraceptive knowledge Table 5.3 Ever use of contraception Table 5.4 Current use of contraception by age Table 5.5 Current use of contraception by background characteristics Table 5.6 Number of children at first use of contraception Table 5.7 Knowledge of fertile period Table 5.8 Timing of sterilisation Table 5.9 Source of modern contraception methods Table 5.10 Cost of modern contraceptive methods Table 5.11 Informed choice Table 5.12 First-year contraceptive discontinuation rates Table 5.13 Future use of contraception Table 5.14 Reason for not intending to use contraception in the future Table 5.15 Preferred method of contraception for future use Table 5.16 Exposure to family planning messages Table 5.17 Exposure to condom messages Table 5.18 Acceptability of condom messages Table 5.19 Contact of nonusers with family planning providers Table 5.20 Husband/partner s knowledge of women s use of contraception Table 5.21 Men s attitudes toward contraception Figure 5.1 Figure 5.2 Figure 5.3 Trends in Contraceptive Use, Kenya (percentage of currently married women using any method) Trends in Current Use of Specific Contraceptive Methods among Currently Married Women Age 15-49, Kenya Current Use of Any Contraceptive Method among Currently Married Women Age 15-49, by Background Characteristics x Tables and Figures

12 CHAPTER 6 OTHER PROXIMATE DETERMINANTS OF FERTILITY Table 6.1 Current marital status Table Number of women s co-wives Table Number of men s co-wives Table 6.3 Age at first marriage Table 6.4 Median age at first marriage Table 6.5 Age at first sexual intercourse Table 6.6 Median age at first intercourse Table Recent sexual activity: Women Table Recent sexual activity: Men Table 6.8 Postpartum amenorrhoea, abstinence and insusceptibility Table 6.9 Median duration of amenorrhoea, postpartum abstinence, and postpartum insusceptibility Table 6.10 Menopause Figure 6.1 CHAPTER 7 Percentage of Currently Married Women Whose Husbands Have At Least One Other Wife FERTILITY PREFERENCES Table 7.1 Fertility preferences by number of living children Table 7.2 Desire to limit childbearing Table 7.3 Need and demand for family planning among currently married women Table 7.4 Ideal number of children Table 7.5 Mean ideal number of children by background characteristics Table 7.6 Fertility planning status Table 7.7 Wanted fertility rates Figure 7.1 Fertility Preferences among Currently Married Women Age Figure 7.2 Planning Status of Births CHAPTER 8 INFANT AND CHILD MORTALITY Table 8.1 Early childhood mortality rates Table 8.2 Early childhood mortality rates by socioeconomic characteristics Table 8.3 Early childhood mortality rates by demographic characteristics Table 8.4 Perinatal mortality Table 8.5 High-risk fertility behaviour Figure 8.1 Trends in Infant and Under-Five Mortality 2003 KDHS and KDHS Figure 8.2 Under-Five Mortality by Background Characteristics CHAPTER 9 MATERNAL HEALTH Table 9.1 Antenatal care Table 9.2 Source of antenatal care Table 9.3 Number of antenatal care visits and timing of first visit Table 9.4 Components of antenatal care Table 9.5 Tetanus toxoid injections Table 9.6 Place of delivery Tables and Figures xi

13 Table 9.7 Reason for not delivering in a health facility Table 9.8 Assistance during delivery Table 9.9 Timing of first postnatal checkup Table 9.10 Type of provider of first postnatal checkup Figure 9.1 Trends in Receipt of Antenatal Care from a Skilled Medical Provider, Kenya Figure 9.2 Components of Antenatal Care Figure 9.3 Trends in Delivery Care CHAPTER 10 CHILD HEALTH Table 10.1 Child s weight and size at birth Table 10.2 Vaccinations by source of information Table 10.3 Vaccinations by background characteristics Table 10.4 Prevalence and treatment of symptoms of ARI Table 10.5 Prevalence and treatment of fever Table 10.6 Prevalence of diarrhoea Table 10.7 Diarrhoea treatment Table 10.8 Feeding practices during diarrhoea Table 10.9 Knowledge of ORS Table Disposal of children s stools Figure 10.1 Percentage of Children Age Months with Specific Vaccinations Figure 10.2 Trends in Childhood Vaccination Coverage CHAPTER 11 NUTRITION OF WOMEN AND CHILDREN Table 11.1 Nutritional status of children Table 11.2 Trends in nutritional status of children Table 11.3 Initial breastfeeding Table 11.4 Breastfeeding status by age Table 11.5 Median duration and frequency of breastfeeding Table 11.6 Foods and liquids consumed by children in the day or night preceding the interview Table 11.7 Infant and young child feeding (IYCF) practices Table 11.8 Micronutrient intake among children Table 11.9 Presence of iodized salt in household Table Nutritional status of women Table Micronutrient intake among mothers Figure 11.1 Nutritional Status of Children by Age Figure 11.2 Proportion of Underweight Children by Province, 2003 and Figure 11.3 Prelacteal Liquids Figure 11.4 Infant Feeding Practices by Age Figure 11.5 Infant and Young Child Feeding (IYCF) Practices xii Tables and Figures

14 CHAPTER 12 MALARIA Table 12.1 Ownership of mosquito nets Table 12.2 Use of mosquito nets by children Table 12.3 Use of mosquito nets by women Table 12.4 Prophylactic use of antimalarial drugs and use of intermittent preventive treatment (IPT) by women during pregnancy Table 12.5 Prevalence and prompt treatment of fever Table 12.6 Type and timing of antimalarial drugs Table 12.7 Availability at home of antimalarial drugs taken by children with fever Figure 12.1 Ownership of Mosquito Nets, Figure 12.2 Use of Mosquito Nets by Children under Five Figure 12.3 Use of Mosquito Nets by Women Age CHAPTER 13 HIV/AIDS-RELATED KNOWLEDGE, ATTITUDES, AND BEHAVIOUR Table 13.1 Knowledge of AIDS Table 13.2 Knowledge of HIV prevention methods Table Comprehensive knowledge about AIDS: Women Table Comprehensive knowledge about AIDS: Men Table 13.4 Knowledge of prevention of mother to child transmission of HIV Table Accepting attitudes toward those living with HIV/AIDS: Women Table Accepting attitudes toward those living with HIV/AIDS: Men Table 13.6 Adult support of education about condom use to prevent AIDS Table Multiple sexual partners and higher-risk sexual intercourse in the past Table months: Women Multiple sexual partners and higher-risk sexual intercourse in the past 12 months: Men Table 13.8 Payment for sexual intercourse: Men Table Coverage of prior HIV testing: Women Table Coverage of prior HIV testing: Men Table Pregnant women counselled and tested for HIV Table Male circumcision Table Self-reported prevalence of sexually-transmitted infections (STIs) and STIs symptoms Table Comprehensive knowledge about AIDS and of a source of condoms among youth Table Age at first sexual intercourse among youth Table Condom use at first sexual intercourse among youth Table Premarital sexual intercourse and condom use during premarital sexual intercourse among youth Table Higher-risk sexual intercourse among youth and condom use at last higher-risk intercourse in the past 12 months: Women Table Higher-risk sexual intercourse among youth and condom use at last higher-risk intercourse in the past 12 months: Men Table Age-mixing in sexual relationships among women age Table Drunkenness during sexual intercourse among youth Table Recent HIV tests among youth Tables and Figures xiii

15 Figure 13.1 Trends in Knowledge of HIV Prevention Methods: Women Figure 13.2 Trends in Knowledge of HIV Prevention Methods: Men Figure 13.3 Comprehensive Knowledge about AIDS Figure 13.4 Accepting Attitudes towards Those with HIV: Women Figure 13.5 Accepting Attitudes towards Those with HIV: Men Figure 13.6 Comprehensive Knowledge about AIDS and Source of Condoms among Youth Figure 13.7 Age at First Sexual Intercourse among Youth Figure 13.8 Abstinence, Being Faithful and Condom Use (ABC) among Young Women and Men CHAPTER 14 HIV PREVALENCE AND ASSOCIATED FACTORS Table 14.1 Coverage of HIV testing by residence and region Table 14.2 Coverage of HIV testing by selected background characteristics Table 14.3 HIV prevalence by age Table 14.4 Trends in HIV prevalence by age Table 14.5 HIV prevalence by socioeconomic characteristics Table 14.6 HIV prevalence by demographic characteristics Table 14.7 HIV prevalence by sexual behaviour Table 14.8 HIV prevalence among young people by background characteristics Table 14.9 HIV prevalence among young people by sexual behaviour Table HIV prevalence by other characteristics Table Prior HIV testing by current HIV status Table HIV prevalence by male circumcision Table HIV prevalence among couples Figure 14.1 Coverage of HIV Testing by Gender Figure 14.2 HIV Prevalence by Age Group and Sex Figure 14.3 Trends in HIV Prevalence among Women Figure 14.4 Trends in HIV Prevalence among Men Figure 14.5 HIV Prevalence by Gender and Province CHAPTER 15 WOMEN S EMPOWERMENT AND DEMOGRAPHIC AND HEALTH OUTCOMES Table 15.1 Employment and cash earnings of currently married women and men Table Control over women s cash earnings and relative magnitude of women s earnings: Women Table Control over men s cash earnings Table 15.3 Women s control over her own earnings and over those of her husband Table Women s participation in decision-making Table Women s participation in decision-making according to men Table Women s participation in decision-making by background characteristics Table Men s attitude toward wives participation in decision-making Table Attitude toward wife beating: Women Table Attitude toward wife beating: Men Table 15.7 Men s attitudes toward a husband s rights when his wife refuses to have sexual intercourse Table 15.8 Indicators of women s empowerment Table 15.9 Current use of contraception by women s status xiv Tables and Figures

16 Table Women s empowerment and ideal number of children and unmet need for family planning Table Reproductive health care by women s empowerment Figure 15.1 Number of Decisions in Which Women Participate CHAPTER 16 GENDER-BASED VIOLENCE Table 16.1 Experience of physical violence Table 16.2 Persons committing physical violence Table 16.3 Force at sexual initiation Table 16.4 Experience of sexual violence Table 16.5 Persons committing sexual violence Table 16.6 Experience of different forms of violence Table 16.7 Degree of marital control exercised by husbands Table 16.8 Forms of spousal violence Table 16.9 Spousal violence by background characteristics Table Spousal violence by husband s characteristics and empowerment indicators Table Frequency of spousal violence among those who report violence Table Injuries to women due to spousal violence Table Violence by women against their spouse Table Help seeking to stop violence Table Sources from where help was sought Table Knowledge and prevalence of female circumcision Table Age at circumcision Table Person performing circumcisions among women by residence Table Benefits of circumcision Table Attitudes about female circumcision Figure 16.1 Domestic Violence CHAPTER 17 ADULT AND MATERNAL MORTALITY Table 17.1 Data on siblings Table 17.2 Adult mortality rates Table 17.3 Maternal mortality Figure 17.1 Trends in Adult Mortality, Kenya and APPENDIX A SAMPLE IMPLEMENTATION Table A.1 Sample implementation: women Table A.2 Sample implementation: men Table A.3 Coverage of HIV testing among interviewed women by social and demographic characteristics Table A.4 Coverage of HIV testing among interviewed men by social and demographic characteristics Table A.5 Coverage of HIV testing among interviewed women by sexual behaviour characteristics Table A.6 Coverage of HIV testing among interviewed men by sexual behaviour characteristics Tables and Figures xv

17 APPENDIX B ESTIMATES OF SAMPLING ERRORS Table B.1 List of selected variables for sampling errors, Kenya Table B.2 Sampling Errors for Kenya Table B.3 Sampling Errors for Urban Table B.4 Sampling Errors for Rural Table B.5 Sampling Errors for Nairobi Table B.6 Sampling Errors for Central Province Table B.7 Sampling Errors for Coast Province Table B.8 Sampling Errors for Eastern Province Table B.9 Sampling Errors for Nyanza Province Table B.10 Sampling Errors for Rift Valley Province Table B.11 Sampling Errors for Western Province Table B.12 Sampling Errors for North Eastern Province APPENDIX C DATA QUALITY Table C.1 Household age distribution Table C.2.1 Age distribution of eligible and interviewed women Table C.2.2 Age distribution of eligible and interviewed men Table C.3 Completeness of reporting Table C.4 Births by calendar years Table C.5 Reporting of age at death in days Table C.6 Reporting of age at death in months Table C.7 Nutritional status of children xvi Tables and Figures

18 FOREWORD The primary objective of the KDHS, like its predecessors, is to provide up-to-date information for policymakers, planners, researchers, and programme managers. This information guides the planning, implementation, monitoring, and evaluation of population and health programmes in Kenya. Specifically, the survey collects data on the following: fertility levels, marriage, sexual activity, fertility preferences, awareness and use of family planning methods, breastfeeding practices, nutritional status of women and young children, childhood and maternal mortality, maternal and child health, malaria and use of mosquito nets, domestic violence, awareness and behaviour regarding HIV/AIDS and other sexually transmitted infections (STIs), and HIV prevalence among adults. The results of the current survey present evidence of a resumption of the fertility decline observed in the 1980s and the 1990s in Kenya. The total fertility rate (TFR) of 4.6 children per woman is the lowest rate ever recorded for Kenya. This decline in fertility could be attributed to an increase in the proportion of currently married women using contraception, which rose from 7 percent in 1978 to 46 percent in Survey results also indicate a resumption in the decline of childhood mortality. The underfive-mortality rate decreased to 74 deaths per 1,000 live births in , down from 115 deaths in 2003, while the infant mortality rate was 52 deaths per 1,000 live births, down from 77 deaths reported in The improvement in child survival is corroborated by increases in child vaccination coverage, in ownership and use of mosquito bednets, and in antenatal care coverage, all of which have been shown to reduce child mortality. Overall, 77 percent of children age months are fully vaccinated, and only three percent have not received any vaccines. Use of mosquito nets is considered to be one of the strongest strategies in the fight against malaria. The survey found that 61 percent of households own at least one mosquito net (treated or untreated), and 56 percent report owning at least one insecticide-treated net (ITN). Fifty-one percent of children under five years and 53 percent of pregnant women slept under a mosquito net the night prior to the interview. The results also indicate that 9 in 10 mothers visited a health professional at least once for antenatal care for the most recent birth in the five-year period preceding the survey. These trends and a plethora of other important findings imply that the deterioration in the quality of life among the Kenyan population seen in earlier surveys has been reversed. The Kenya National Bureau of Statistics (KNBS) wishes to acknowledge the contributions of the various agencies and institutions that culminated in the compilation of the Kenya Demographic and Health Survey (KDHS). The survey was conducted in close collaboration with the National Public Health Laboratory Services (NPHLS), the National Coordinating Agency for Population and Development (NCAPD), the Kenya Medical Research Institute (KEMRI), the National AIDS Control Council (NACC), ICF Macro, the United Nations Fund for Population Activities (UNFPA), the United Nations Children s Fund (UNICEF), and the United States Agency for International Development (USAID). These institutions provided technical, administrative, and logistical support to the process, for which we are exceedingly grateful. Special thanks go to staff of the Kenya National Bureau of Statistics, Ministry of Public Health and Sanitation, National AIDS Control Council (NACC), National Coordinating Agency for Population and Development (NCAPD), and Kenya Medical Research Institute (KEMRI) who coordinated the survey. Lastly, we acknowledge the financial support provided by USAID, UNFPA, the World Bank, and UNICEF. Foreword xvii

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20 SUMMARY OF FINDINGS The Kenya Demographic and Health Survey (KDHS) is a nationally representative sample survey of 8,444 women age 15 to 49 and 3,465 men age 15 to 54 selected from 400 sample points (clusters) throughout Kenya. It is designed to provide data to monitor the population and health situation in Kenya as a follow-up to the 1989, 1993, 1998, and 2003 KDHS surveys. The survey utilised a two-stage sample based on the 1999 Population and Housing Census and was designed to produce separate estimates for key indicators for each of the eight provinces in Kenya. Data collection took place over a three-month period, from 13 November 2008 to late February The survey obtained detailed information on fertility levels, marriage, sexual activity, fertility preferences, awareness and use of family planning methods, breastfeeding practices, nutritional status of women and young children, childhood and maternal mortality, maternal and child health, and awareness and behaviour regarding HIV/AIDS. The survey also included collection information on ownership and use of mosquito nets, domestic violence, and HIV testing of adults. The KDHS was implemented by the Kenya National Bureau of Statistics (KNBS) in collaboration with the Ministry of Public Health and Sanitation (including the National AIDS and STIs Control Programme-NASCOP), the Ministry of Medical Services, the Ministry of Gender, the Kenya Medical Research Institute (KEMRI), the National Coordinating Agency for Population Development (NCAPD), and the National AIDS Control Council (NACC). The National Public Health Laboratory Services assisted in recruitment and training of the health field workers, supported the voluntary counselling and testing of respondents, and implemented the HIV testing in the laboratory. Technical assistance was provided through the international MEASURE DHS programme at ICF Macro and NCAPD. Financial support for the survey was provided by the Government of Kenya and the U.S. Agency for International Development (USAID), the United Nations Population Fund (UNFPA), and the United Nations Children s Fund (UNICEF). FERTILITY Fertility Levels and Trends. One of the most important findings from the KDHS is that fertility rates which had stagnated in the late 1990s have declined somewhat. The total fertility rate of 4.6 children per woman for the three-year period preceding the survey ( ) is lower than the rate of 4.9 derived from the 2003 KDHS and the rate of 5.0 from the 1999 Population and Housing Census. Fertility Differentials. There are substantial differences in fertility levels throughout Kenya. The total fertility rate is considerably higher in the rural areas (5.2 children per woman) than in the urban areas (2.9 children per woman). Regional differences are also marked. Fertility is lowest in Nairobi province (2.8 children per woman) and highest in North Eastern province (5.9 children per woman). Fertility in Central province is also relatively low (3.4), compared with Western (5.6) and Nyanza (5.4) provinces. Education of women is strongly associated with low fertility. The total fertility rate (TFR) decreases dramatically from 6.7 for women with no education to 3.1 for women with at least some secondary education. Over time, fertility has actually increased among women with no education and has only declined among those with primary incomplete education. Unplanned Fertility. Despite a relatively high level of contraceptive use, the KDHS data indicate that unplanned pregnancies are common in Kenya. Overall, 17 percent of births in Kenya are unwanted, while 26 percent are mistimed (wanted later). Overall, the proportion of births considered unwanted has decreased slightly, compared with the 2003 KDHS, while the proportion mistimed has hardly changed at all. Summary of Findings xix

21 Fertility Preferences. There have been some changes in fertility preferences since The proportion of currently married women who want another child soon has declined slightly (from 16 to 14 percent), as has the proportion who want another child later in life (from 29 to 27 percent). The proportion of married women who either want no more children or who have been sterilised increased from 49 percent in 2003 to 54 percent in The mean ideal family size among currently married women has declined from 4.3 to 4.0. FAMILY PLANNING Knowledge of Contraception. Knowledge of family planning is nearly universal, with 95 percent of all women and 97 percent of men age 15 to 49 knowing at least one modern method of family planning. Among all women, the most widely known methods of family planning are male condoms, injectables, and pills, with about 89 percent of all women saying that they know these methods. Around 6 in 10 women have heard of female sterilisation, the IUD, implants, and the female condom. With regard to traditional methods, about two-thirds of women have heard of the rhythm method, and just under half know about withdrawal, while folk methods are the least likely to be mentioned. There has been little change in levels of knowledge of contraceptive methods among all women since The level of knowledge of female and male sterilisation and of the IUD has declined since 2003, while knowledge of implants and withdrawal has increased slightly. Use of Contraception. Slightly less than half of married women (46 percent) in Kenya are using a method of family planning. Most are using a modern method (39 percent of married women), but 6 percent use a traditional method. Injectables are by far the most commonly used contraceptive method; they are used by 22 percent of married women, while pills are used by 7 percent of women, and female sterilisation and periodic abstinence are each used by 5 percent of married women. Trends in Contraceptive Use. Contraceptive use has increased since 2003, from 39 to 46 percent of married women. Between 2003 and , use of modern methods increased from 32 to 39 percent of married women, while use of traditional methods over the same time period actually decreased from 8 to 6 percent of married women. The KDHS corroborates trends in method mix, namely, a continuing increase in use of injectables and decrease in use of the pill as was the case in earlier KDHS surveys. Differentials in Contraceptive Use. As expected, contraceptive use increases with level of education. Use of any method increases from 14 percent among married women with no education to 60 percent among women with at least some secondary education. Urban women (53 percent) are more likely to use contraception than rural women (43 percent). Source of Modern Methods. In Kenya, public (government) facilities provide contraceptives to more than half (57 percent) of modern method users, while 36 percent are supplied through private medical sources, and 6 percent are supplied through other sources. Contraception Discontinuation. Overall, more than one in three women (36 percent) discontinue use within 12 months of adopting a method. The 12-month discontinuation rates for injectables (29 percent) and periodic abstinence (33 percent) are lower than the rates for the pill (43 percent) and for the male condom (59 percent). Unmet Need for Family Planning. Onequarter of currently married women in Kenya have an unmet need for family planning, which remains unchanged since Unmet need is evenly split between women who want to wait two or more years before having their next child (spacers) and those who want no more children (limiters). MATERNAL HEALTH Antenatal Care. The KDHS data indicate that 92 percent of women in Kenya receive antenatal care from a medical professional, either from doctors (29 percent) or nurses or midwives (63 percent). The data indicate a slight increase since 2003 in medical antenatal care coverage, from 88 percent to 92 percent. Just over half of women (55 percent) received two or more tetanus toxoid injections dur- xx Summary of Findings

22 ing pregnancy for their most recent birth in the five years preceding the survey, slightly higher than the 52 percent level in Taking into account previous injections, almost three in four births are protected against tetanus. Delivery Care. Proper medical attention and hygienic conditions during delivery can reduce the risk of serious illness among mothers and their babies. The KDHS found that two out of five births (43 percent) are delivered in a health facility, while 56 percent are delivered at home. This represents a slight improvement in the proportion of births occurring at a health facility, from 40 percent in 2003 to 43 percent in Similarly, 44 percent of births in Kenya are delivered under the supervision of a health professional, mainly a nurse or midwife. Traditional birth attendants continue to play a vital role in delivery, assisting with 28 percent of births. Relatives and friends assist in 21 percent of births. The proportion of births assisted by medically trained personnel increased slightly since Only 6 percent of births are delivered by Caesarean section, a slight increase since Maternal Mortality. Data on the survival of respondents sisters were used to calculate a maternal mortality ratio for the 10-year period before the survey, which was estimated as 488 maternal deaths per 100,000 live births. This is statistically insignificantly different from the rate of 414 maternal deaths per 100,000 live births for the ten-year period prior to the 2003 KDHS Thus, it is impossible to say with confidence that maternal mortality has changed. CHILD HEALTH Childhood Mortality. Data from the KDHS show remarkable declines in child mortality levels compared with the 2003 survey. Comparing data for the five-year period before each survey, under-five mortality has declined from 115 to 74 deaths per 1,000 births, while infant mortality has dropped from 77 to 52 deaths per 1,000 live births. Childhood Vaccination Coverage. In the KDHS, mothers were able to show a health card with immunisation data for 70 percent of children age months. Accordingly, estimates of coverage are based on both data from health cards and mothers recall. The data show that 77 percent of children months are fully vaccinated against the major childhood illnesses. Only 3 percent of children months have not received any of the recommended immunisations. These results represent an improvement in immunisation coverage for children since 2003 when only 57 percent of children age months were fully immunised. Child Illness and Treatment. Among children under five years of age, 8 percent were reported to have had symptoms of acute respiratory illness in the two weeks preceding the survey, 24 percent had a fever in the two weeks preceding the survey, and 17 percent had diarrhoea. Around half of children with symptoms of acute respiratory illness, fever, or diarrhoea were taken to a health facility or provider for treatment. For example, 49 percent of children with diarrhoea were taken to a facility for treatment, while 78 percent were given either a solution prepared from oral rehydration salt (ORS) packets or increased fluids. NUTRITION Breastfeeding Practices. Breastfeeding is nearly universal in Kenya; 97 percent of children are breastfed. The median duration of breastfeeding is 21 months, similar to the duration documented in the 2003 KDHS. The KDHS data indicate that complementary feeding of children begins early. For example, among newborns less than two months of age, 24 percent are receiving complementary foods or liquids other than water. The median duration of exclusive breastfeeding is estimated at less than one month. Bottle-feeding is common in Kenya; 25 percent of children under 6 months are fed with bottles with teats. Nevertheless, use of infant formula milk is minimal; only a tiny fraction of children below six months receive commercially produced infant formula. Intake of Vitamin A. Ensuring that children between six months and 59 months receive enough vitamin A may be the single most effective child survival intervention, since deficiencies in this micronutrient can cause blindness and can increase the severity of infections such Summary of Findings xxi

23 as measles and diarrhoea. Overall, 77 percent of children age 6-35 months consumed vitamin A- rich foods in the day before the survey, and 30 percent of children age 6-59 months received a vitamin A supplement in the six months preceding the survey. Nutritional Status of Children. Survey data show that the nutritional status of children under five has improved only slightly in the past few years. At the national level, 35 percent of children under five are stunted (low height-forage), while 7 percent of children are wasted (low weight-for-height) and 16 percent are underweight (low weight-for-age). Nutritional Status of Women. The mean body mass index (BMI) for women age is 23, identical to what it was in MALARIA The country has witnessed an impressive rise in household ownership of insecticidetreated mosquito nets (ITNs). The KDHS shows that 56 percent of households have at least one ITN, up from 48 percent recorded in the 2007 Kenya Malaria Indicator Survey and 6 percent recorded in the 2003 KDHS. Just under half of children under five (47 percent) were reported to have slept under an ITN the night before the survey, compared with only five percent in The KDHS data show that 49 percent of pregnant women slept under an ITN the night before the survey, and 14 percent received intermittent preventive treatment with antimalarial medication during antenatal care visits. Among children with fever in the two weeks preceding the survey, 8 percent were given the recommended medicine, ACT, while 3 percent were given the second-line drug, sulfadoxinepyrimethamine or SP. Only about half of children receive these drugs within a day of the onset of the fever. HIV/AIDS Awareness of AIDS. Almost all Kenyan women and men (more than 99 percent) have heard of AIDS. More than 90 percent of women and men indicate that the chances of getting the AIDS virus can be reduced by limiting sex to one faithful partner. Similarly, 75 percent of women and 81 percent of men age know that using condoms can reduce the risk of contracting the HIV virus. As expected, the proportion of both women and men who know that abstaining from sex reduces the chances of getting the AIDS virus is high 88 percent among women and 90 percent among men. Almost 9 in 10 women and men (87 percent) know that HIV can be transmitted by breastfeeding, and 7 in 10 know that the risk of maternalto-child transmission can be reduced by the mother taking certain drugs during pregnancy. Ninety percent of women and 92 percent of men age are aware that a healthy-looking person can have the AIDS virus. Attitudes towards HIV-Infected People. Large majorities of Kenyan women and men (90 and 94 percent, respectively) express a willingness to care for a relative sick with AIDS in their own household, while far fewer (68 and 80 percent, respectively) say they would be willing to buy fresh vegetables from a vendor who has the AIDS virus. Survey results further indicate that 76 and 80 percent of women and men, respectively, believe that a female teacher who has the AIDS virus should be allowed to continue teaching in school. Finally, 54 percent of women and 69 percent of men say that if a member of their family got infected with the virus that causes AIDS, they would not necessarily want it to remain a secret. HIV-Related Behavioural Indicators. Comparison of data from the KDHS with similar data from the 2003 KDHS indicates that there has been a slight increase in the age at first sexual experience. The median age at first sex has increased from 17.8 to 18.2 among women age and 17.1 to 17.6 among men aged Since the most important mechanism of HIV transmission is sexual intercourse, it is important to know the extent of multiple sexual partners. The KDHS data show that only 1 percent of women and 9 percent of men report having had more than one sexual partner in the 12 months prior to the survey. HIV Prevalence. In the one-half of the households selected for the man s survey, all women and men who were interviewed were asked to voluntarily provide some drops of blood for HIV testing in the laboratory. Results indi- xxii Summary of Findings

24 cate that 6 percent of Kenyan adults age are infected with HIV, only slightly lower than the level of 7 percent measured in the 2003 KDHS and the 2007 Kenya AIDS Indicator Survey (KAIS). HIV prevalence is 8 percent among women age and 4 percent among men The peak prevalence among women is at age (14 percent), while prevalence among men is highest at age (10 percent). Patterns of HIV Prevalence. The HIV epidemic shows regional heterogeneity. Nyanza province has an overall prevalence of 14 percent, double the level of the next highest provinces Nairobi and Western, at 7 percent each. All other provinces have levels between 3 percent and 5 percent overall, except North Eastern province where the prevalence is about 1 percent. HIV prevalence is by far the highest among women who are widowed (43 percent). Both women and men who are divorced or separated also have relatively high HIV prevalence (17 and 10 percent, respectively). Survey findings indicate that there is a strong relationship between HIV prevalence and male circumcision; 13 percent of men who are uncircumcised are HIV infected compared with 3 percent of those who are circumcised. Among couples who are married or living together, 6 percent are discordant, with one partner infected and the other uninfected. get drunk often compared with those whose husbands do not drink. Attitudes Towards Marital Violence. To gauge the acceptability of domestic violence, women and men interviewed in the KDHS were asked whether they thought a husband would be justified in hitting or beating his wife in each of the following five situations: if she burns the food; if she argues with him; if she goes out without telling him; if she neglects the children; and if she refuses to have sexual relations with him. Results show that 53 percent of Kenyan women and 44 percent of men agree that at least one of these factors is sufficient justification for wife beating. Female Genital Cutting. Survey data show that there has been a gradual decline in the proportion of Kenyan women who are circumcised, from 38 percent in 1998 to 32 percent in 2003 and to 27 percent in GENDER-RELATED VIOLENCE Violence Since Age 15. In the KDHS, women were asked if they had experienced violence since age 15. The data show that 39 percent of women have experienced violence since they were 15 and one in four reported experiencing violence in the 12 months preceding the survey. The main perpetrators are husbands, and to a lesser extent, teachers, mothers, fathers, and brothers. Marital Violence. Thirty percent of evermarried women report having experienced emotional violence by husbands, 37 percent report physical violence, and 17 percent report sexual violence. Almost half (47 percent) of evermarried women report suffering emotional, physical, or sexual violence, while 10 percent have experienced all three forms of violence by their current or most recent husband. The factor most strongly related to marital violence is husband s alcohol use; violence is 2-3 times more prevalent among women who say their husbands Summary of Findings xxiii