Demographic and Health Survey 2009

The survey was conducted by the Bureau of Statistics (BOS) and the Ministry of Health (MOH) of Guyana. ICF Macro of Calverton, Maryland, provided technical assistance to the project through its contract with the U.S. Agency for International Development (USAID). Funding to cover technical assistance by ICF Macro and local costs was provided in its entirety by the USAID Mission in Georgetown, Guyana.

The primary objective of the 2009 GDHS was to collect information on characteristics of the households and their members, including exposure to malaria and tuberculosis; infant and child mortality; fertility and family planning; pregnancy and postnatal care; childhood immunization, health, and nutrition; marriage and sexual activity; and HIV/AIDS indicators.

Other objectives of the 2009 GDHS included (1) supporting the dissemination and utilization of the results in planning, managing, and improving family planning and health services in the country and (2) enhancing the survey capabilities of the institutions involved to facilitate surveys of this type in the future.

The 2009 GDHS sampled 5,632 households and completed interviews with 4,996 women age 15-49 and 3,522 men age 15-49. Three questionnaires were used for the 2009 GDHS: the Household Questionnaire, the Women's Questionnaire, and the Men's Questionnaire. The content of these questionnaires was based on the model questionnaires developed by the MEASURE DHS program of ICF Macro.

The primary objective of the 2009 GDHS was to collect information on the following topics:

• Characteristics of households and household members
• Fertility and reproductive preferences, infant and child mortality, and family planning
• Health-related matters, such as breastfeeding, antenatal care, children's immunizations, and childhood diseases
• Marriage, sexual activity, and awareness and behavior regarding HIV and other sexually transmitted infections (STIs)
• The nutritional status of mothers and children, including anthropometry measurements and anemia testing Other complementary objectives of the 2009 GDHS were:
• To support dissemination and utilization of the results in planning, managing, and improving family planning and health services in the country
• To enhance the survey capabilities of the institutions involved to facilitate their use of surveys of this type in the future

MAIN RESULTS

FERTILITY

Fertility Levels and Differentials
If fertility were to remain constant in Guyana, women would bear, on average, 2.8 children by the end of their reproductive lifespan. The total fertility rate (TFR) is close to replacement level in urban areas (2.1 children per woman), and higher in the rural areas (3.0 children per woman). The TFR in the Interior area (6.0 children) is more than twice as high as the TFR in the Coastal area (2.4 children per woman) and is three times the fertility in the Georgetown (urban) area (2.0 children). The TFRs for women in the Interior area are significantly higher for all age groups.

Fertility Preferences
Fifty-six percent of currently married women reported that they don't want to have a/another child, and five percent are already sterilized. The figures for men are 51 and 1 percent, respectively. The desire to stop childbearing increases rapidly as the number of children increases. Among respondents with one child, around one in five wants no more children. Among those with three children, about eight in ten women and seven in ten men want no more children.

FAMILY PLANNING

Use of Contraception
Forty-three percent of women who are currently married or in union are currently using a contraceptive method, mainly a modern method (40 percent). The methods most commonly used by currently married women are the male condom (13 percent), the pill (9 percent), and the IUD (7 percent). Female sterilization and injectables are each used by 5 percent of women. The 2009 GDHS prevalence rate of 43 percent represents an increase of 8 percentage points since the 2005 GAIS (35 percent). Most of the increase was in condom use, injectables, and female sterilization.

Unmet Need for Family Planning
Twenty-nine percent of currently married women have an unmet need for family planning, mostly for limiting births (19 percent) compared with spacing (10 percent). Because 43 percent of married women are currently using a contraceptive method (met need), the total demand for family planning is estimated at 71 percent of married women (22 percent for spacing, 49 percent for limiting). As a result, only 60 percent of the total demand for family planning is met.

MATERNAL HEALTH

Antenatal Care
Among women who had a birth in the five years preceding the survey, 92 percent received antenatal care (ANC) from a skilled health provider for their most recent birth (51 percent from a nurse/midwife and 35 percent from a doctor). Older mothers (35-49 years) are less likely to receive antenatal care by a skilled health provider than younger mothers. Eighty-six percent of women with no education received ANC from a skilled health provider compared with 95 percent of women with more than secondary education.

Delivery Care
Overall, 92 percent of births in the five years preceding the survey were assisted by a skilled birth provider, mainly by a nurse or midwife (56 percent), followed by a doctor (31 percent). Births to mothers under age 35 and lower order births are more likely to have assistance at delivery by a skilled provider than births to older mothers and higher order births. By residence, births in Urban areas are more likely than those in Rural areas, and births in the Coastal area are more likely than births in the Interior area, to be assisted by a skilled health provider. The percentage of births assisted by a skilled provider ranges from a low of 57 percent in Region 9 to a high of 98 percent in Region 4. Births to mothers who have more education and births in the higher wealth quintiles are more likely to be assisted by a skilled provider than other births. Almost all births to mothers with more than secondary education (98 percent) are assisted by a skilled provider compared with 71 percent of births to mothers with no education.

Caesarean section
One in eight births (13 percent) in the five years preceding the survey was delivered by caesarean section. The prevalence of C-section delivery increases steadily with mother's age and decreases with birth order. Regions 1, 6, 7, and 9 have the lowest levels of deliveries by C-section (2-5 percent) and Region 3 has the highest level (23 percent). The percentage of births delivered by C-section increases with a mother's education and generally increases with her wealth.

CHILD HEALTH

Infant and Child Mortality
Childhood mortality rates in Guyana are relatively low. For every 1,000 live births, 38 children die during the first year of life (infant mortality), and 40 children die during the first five years (under-age 5 mortality). Almost two-thirds of deaths in the first five years (25 deaths per 1,000 live births) take place during the neonatal period (the first month of life). The mortality rate after the first year of life up to age 5 (child mortality) is also very low at 3 deaths per 1,000 live births. The 2009 GDHS mortality data do not show any clear trends over time. However, mortality data have to be interpreted with caution because sampling errors associated with mortality estimates are large.

Vaccination Coverage
Overall, 63 percent of Guyanese children age 18-29 months are fully immunized, and only 5 percent of the children received no vaccinations at all. Looking at coverage for specific vaccines, 94 percent of children received the BCG vaccination, 92 percent received the first dose of pentavalent vaccine, and 78 percent received the first polio dose (Polio 1). Coverage for the pentavalent and polio vaccinations declines with subsequent doses; 85 percent of children received the recommended three doses of pentavalent vaccine, and 70 percent received three doses of polio. These figures reflect dropout rates of 8 percent for the pentavalent vaccine and 11 percent for polio; the dropout rate represents the proportion of children who received the first dose of a vaccine but who did not get the third dose. Eighty-two percent of children are vaccinated against measles, and 79 percent of children have been vaccinated against yellow fever.

Illnesses and Treatment

Acute Respiratory Infections (ARI)
Five percent of children under age 5 had symptoms of acute respiratory infection (ARI) in the two weeks preceding the survey. Among children with symptoms of ARI, advice or treatment was sought from a health facility or provider for 65 percent, and antibiotics were prescribed as treatment for 18 percent (data not shown).

Fever
Fever was found to be moderately frequent in children under age 5 in Guyana (20 percent), ranging from 17 percent in children under 6 months to about 26 percent in children 12-17 months.. Most of the children under age 5 with fever (59 percent) were taken to a health facility or a health provider for their most recent episode of fever. Overall, about one in five children with fever (21 percent) received antibiotics, and 6 percent received antimalarial drugs.

Diarrhea
Overall, about 10 percent of children were reported to have diarrhea in the two weeks immediately before the survey, with just 1 percent reporting bloody diarrhea. Overall, about six in ten children under age 5 with diarrhea (59 percent) were taken to a health facility or health provider for advice or treatment. Male children (55 percent) are less likely than female children (63 percent) to be taken for treatment or advice to a health facility or provider. Additionally, children living in the Coastal area are much less likely to be taken for treatment or advice (50 percent) than children in the Interior area (79 percent).

NUTRITION OF CHILDREN

Height and Weight
Almost one in five children (18 percent) under age 5 is short for age or stunted, and one in twenty (5 percent) is severely stunted. As expected, stunting, which reflects chronic malnutrition, rises with age during the first year. Stunting is lower among children whose mothers have more than secondary education (16 percent). Children in Rural areas are almost twice as likely to be stunted as children in Urban areas (20 and 11 percent, respectively). The highest levels of stunting are found among children in the Interior area (35 percent).

Anemia
Overall, about four in ten (39 percent) children age 6-59 months have some level of anemia, in­cluding 23 percent of children who are mildly anemic, 15 percent who are moderately anemic, and less than 1 percent with severe anemia. Prevalence of any anemia is highest for children 9-11 months (74 percent) and lowest for those 36-59 months (25 to 28 percent). More than half of children in Region 1 are anemic (51 percent) compared with three in ten (30 percent) in Region 8. The percentage of children with anemia is lowest among children of mothers with secondary or higher education (38-40 percent) and among children of mothers in the highest wealth quintile (32 percent).

Malaria
Eighty-nine percent of households own a mosquito net, whether treated or untreated, and 66 percent of households own more than one net. Rural households are more likely to own at least one net than urban households (90 percent versus 85 percent). About nine in ten households (89 percent) in the malaria-endemic regions (Regions 1, 7, 8, and 9) have at least one mosquito net.

HIV/AIDS

Knowledge of HIV Prevention Methods
Knowledge of AIDS is almost universal in Guyana-97 percent of women and men have heard of AIDS. There are minor variations in knowledge of AIDS by age, marital status, or residence. The only exception is the level of knowledge in the Interior area, which is the lowest for both women (89 percent) and men (95 percent).

Beliefs about AIDS
About nine in ten Guyanese adults know that a healthy-looking person can have the AIDS virus (87 percent of women and men) or that AIDS cannot be transmitted by supernatural means (87 percent of women and 88 percent of men). About three-quarters of women (73 percent) and two-thirds of men (65 percent) are aware that the AIDS virus cannot be transmitted through mosquito bites. Furthermore, 84 percent of women and 79 percent of men know that the AIDS virus cannot be contracted by sharing food with a person who has AIDS. These findings show that the two most common local misconceptions are that the HIV virus can be transmitted (1) by mosquito bites and (2) by sharing food with someone with AIDS.

Mother-to-Child Transmission
About eight in ten women (79 percent) and seven in ten men (67 percent) know that HIV can be transmitted by breastfeeding. Sixty-eight percent of women and 54 percent of men are aware that the risk of mother-to-child transmission (MTCT) can be reduced by the mother taking drugs during pregnancy.

Attitudes toward Negotiating Safer Sex
Almost nine in ten respondents (89 percent of women and 88 percent of men) feel that a wife is justified in refusing to have sexual intercourse with her husband if she knows that he has a sexually transmitted disease. Ninety-six percent of women and men agree that a woman is justified in either refusing sexual intercourse with her husband or in asking him to use a condom if she knows that he has an STI.

Attitudes toward Educating Children on Condom Use
Overall, more than eight in ten women (81 percent) and men (86 percent) age 18-49 agree that children age 12-14 should be taught to use condoms to avoid AIDS. Older respondents age 40-49 are slightly less likely than younger respondents to support education of children age 12-14 about condom use to prevent AIDS. Women and men living in the Coastal area (82 and 86 percent, respectively) are more likely than women and men living in the Interior area (73 and 82 percent, respectively) to agree about education on condom use of children age 12-14.

Higher-risk Sex
A larger proportion of men (10 percent) than women (1 percent) reported having had more than one sexual partner in the 12 months preceding the survey. Additionally, a higher percentage of men (30 percent) than women (17 percent) reported having had sex with a person who was neither their spouse nor their cohabiting partner (higher-risk sex) in the year before the survey.

HIV/AIDS-Related Knowledge and Sexual Behavior among Young Adults
About half of respondents age 15-24 (54 percent of women and 47 percent of men) have a comprehensive knowledge of AIDS (i.e., they know that people can reduce their chances of getting the AIDS virus by having sex with only one uninfected, faithful partner and by using condoms consistently; know that a healthy-looking person can have the AIDS virus; and know that HIV cannot be transmitted by mosquito bites or by supernatural means).